QUARTERLY REPORT Reporting Period 01 January 2015 – 31 March 2015 Visayashealth

QUARTERLY REPORT Reporting Period 01 January 2015 – 31 March 2015 VisayasHealth

Submitted to

United States Agency for International Development

VisayasHealth

New York, NY, USA &Cebu, Philippines

under

Agreement No. AID-492-A-13-00007

30 April 2015

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 1 Table of Contents

List of Abbreviations ...... 3

I. Introduction ...... 5 II. The Project and Objectives ...... 12 III. Accomplishments ...... 13 IV. Summary of Major Accomplishments and Reasons for Variances in the Performance ...... 23 V. Major Implementation Issues / Challenges ...... 26 VI. Milestone, Key Tasks and Activities ...... 27 VII. Financial Reports ...... 37 VIII. Success Stories / Highlights ...... 38 IX. Communication and Outreach ...... 41

ANNEXES : Annex A. List of Products Developed in the Quarter ...... 45 Annex B. ICV Compliance ...... 48 Annex C. Environmental Examination Compliance Report ...... 52 Annex D. Gender ...... 54 Annex E. Cities Development Initiative Report ...... 55

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 2 List of Abbreviations

AFHS Adolescent-friendly health services AIDS Acquired Immune Deficiency Syndrome AJA Adolescent Job Aid ANC Ante-Natal Care AOR Agreements Officer Representative ARD Assistant Regional Director ASRH Adolescent Sexual & Reproductive Health AYRH Adolescent and Youth Reproductive Health BEmONC Basic Emergency Obstetric and Newborn Care BHS Barangay Health Station BHW Barangay Health Worker BTL Bilateral Tubal Ligation BTL-MLLA Bilateral Tubal Ligation – Mini Laparotomy with Local Anesthesia CA Cooperating Agency (ies) CCT Conditional Cash Transfer CBT Competency-Based Training CDI Cities Development Initiative CHANGE Communication for Health Advancement through Networking and Governance Enhancement CHO City Health Office CHT Community Health Team CPH Cebu Provincial Health CPR Contraceptive Prevalence Rate DHC District Health Centers DMO Development Management Officer DOH Department of Health DOHRO Department of Health – Regional Office DQC Data Quality Check DSWD Department of Social Welfare and Development EH EngenderHealth EINC Essential Intra-partum and Newborn Care EMMP Environmental Monitoring and Mitigation Plan EOP End of Project EVRMC Eastern Visayas Regional Medical Center FBD Facility-Based Deliveries FHSIS Field Health Service and Information Survey FP Family planning FPCBT Family Planning Competency-Based Training FS Female Sterilization FY Fiscal Year GCGMH Governor Celestino Gallares Memorial Hospital HIB High Impact Breakthrough HIV Human Immunodeficiency Virus HPDP Health Policy and Development Program HSP Health service provider HUP Health use plan ICV Informed Choice and Voluntarism ILHZ Inter-Local Health Zone

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 3 IPO Iloilo Provincial Hospital Inter-CA Inter -Cooperating Agencies (of USAID) IUD Intra-Uterine Device JHPIEGO John Hopkins Program for International Education on Gynecology & Obstetrics LAPM Long-Acting and Permanent Method LARC Long-Acting and Reversible Contraceptive LCE Local Chief Executive LGBT Lesbians, Gays, Bisexuals, and Transgenders LGU Local Government Unit MDG Millennium Development Goal MCH Maternal and Child Health MCHIP Integrated Maternal and Child Health Program MCP Maternity Care Package MHO Municipal Health Officer MISP Minimum Initial Service Package MLGP Municipal Local Governance Program MMR Maternal Mortality Rate MNCHN Maternal, Newborn (or Neonatal), and Child, Health and Nutrition MOA Memorandum of Agreement NBS Newborn Screening NCP Newborn Care Package NDHS National Demographic and Health Survey NGO Non-Government Organization NHTS National Household Targeting System for Poverty Reduction NSV Non-Scalpel Vasectomy NVD Normal Vaginal Delivery OB Obstetrics / Obstetrician OH Office of Health PHIC Philippine Health Insurance Corporation PHO Provincial Health Office POPCOM Population Commission PhilHealth Philippine Health Insurance Corp. (also referred to as PHIC) PPFP Post-partum family planning PPIUD Post-partum intra-uterine device PPM Private Practice Midwife PPP Public-Private Partnership PRIMEX Pacific Rim Innovation & Management Exponents, Inc. PRISM2 Private Sector Mobilization for Family Health project – Phase 2 PSI Progestin-containing Sub-dermal Contraceptive Implant PYP Program for Young Parents RA Republic Act RD Regional Director RH Reproductive Health RHU Rural Health Unit RIT Regional Implementation Team RO Regional Office RTA Regional Technical Adviser SAMCH St. Anthony Mother and Child Hospital SBA Skilled Birth Attendance SC Steering Committee SDI Subdermal Implant SDN Service Delivery Network

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 4 SDP Service Delivery Point SEED Supply, Enabling Environment, Demand TM SIFI Sugar Industries Foundation Incorporated SMRS Supply Management and Recording System sms Short Messaging System TA Technical Assistance TBD To be determined TCH Tacloban City Hospital TCHO Tacloban City Health Office TESDA Technical Education and Skills Development Authority TOT Training of Trainers TSEk (Breastfeeding campaign) Tama (right) Sapat (just enough), Eksklusibo (exclusive) TWG Technical Working Group UFMR Under-five Mortality Rate UNFPA United Nations Fund for Population Activities UP-PGH University of the Philippines – Philippine General Hospital USAID United States Agency for International Development USD US Dollar USG United States Government VH VisayasHealth Project VOC Visayas Operations Cluster VSMMC Vicente Sotto Memorial Medical Center VSC Voluntary Surgical Contraception VSS Voluntary Surgical Sterilization WHO World Health Organization WVMC Western Visayas Medical Center Y2 / Y3 Year 2 / Year 3 YAFSS Young Adults Fertility and Sexual Survey ZFF Zuellig Family Foundation

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 5 I. INTRODUCTION

A. Background The United States Agency for International Development (USAID) is providing assistance to the Philippines in the form of an integrated regional maternal, neonatal, child health, nutrition (MNCHN), and Family Planning (FP) project in the Visayas. EngenderHealth (EH) and its partners will apply their complementary individual and collective institutional expertise to implement VisayasHealth. The project will scale up proven and effective practices in the following provinces: Iloilo and Negros Occidental in Western Visayas; Bohol and Cebu in Central Visayas; Leyte, Southern Leyte, Samar and Northern Samar in Eastern Visayas. VisayasHealth seeks to improve the health of families in the Visayas region through strategic interventions on increasing demand and enhancing the supply of MNCHN and FP services as well as strengthening the capacity of Department of Health Regional Offices (DOHROs) as stewards for the implementation of FP/RH programs. The project will expand access to high quality integrated MNCHN/FP services to help reduce unmet need for family planning, especially among the poor and women below age 18; improve access to quality maternal and newborn care; and increase exclusive breastfeeding among infants from birth up to six months old. Philippines’ health statistics and in the Visayas in particular, show high unmet needs for quality MNCHN and FP services, especially among the vulnerable poor and geographically isolated families who comprise nearly one third of the total households. VisayasHealth hopes to contribute to efforts towards achieving the Millennium Development Goals (MDG) 4 and 5 on reducing under-five and maternal mortality. Poor MNCHN/FP outcomes are attributed to the following:  Inadequate behavior change focused interventions  Inadequate supply of accessible and quality services in health facilities  Policy and systems barriers to service delivery

Table 1: Project Sites Region Province Western Visayas Iloilo and Negros Occidental Central Visayas Cebu and Bohol Eastern Visayas Leyte, Southern Leyte, Samar and Northern Samar

Partnering with public health and local government officials, and with private sector and civil society groups, VisayasHealth will work in 8 provinces and 259 municipalities/cities to accelerate progress towards achieving MDGs. The main focus will be increasing demand and improving supply of MNCHN/FP services and prioritizing targeted geographic areas as well as creating an enabling environment to yield maximum results. VisayasHealth will work to address provider bias and myths and misconceptions on FP; promote post- partum and other long-acting and permanent FP methods; mobilize community networks for health promotion, adopting proven high impact interventions as appropriate. The following key interventions will be implemented in partnership and close collaboration with the DOHROs: Increase demand for MNCHN/FP services  Strengthen the skills of CHTs and facility based providers to promote MNCHN/FP services.  Apply modern communication technology to reach clients  Reduce financial barriers to MNCHN/FP services Increase supply of quality MNCHN/FP services  Enhance CHT skills to offer a basic integrated MNCHN/FP package to the community  Provide regular quality integrated MNCHN/FP ambulatory services in areas of need

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 6  Improve quality and range of integrated MNCHN/FP services at selected static public and private sites Remove local policy and health systems barriers  Facilitate promulgation of supportive local policy  Improve training and facilitative supervision systems  Improve data management and utilization in LGUs  Strengthen logistics management systems

B. Summary of Accomplishments of the previous quarters

1. Year 1 Quarter 1 (19 February – 31 March 2013) Initial mobilization was completed, which covered the hiring of key staff for the Cebu City-based EngenderHealth-VisayasHealth (VH)project office, as well as negotiation with the DOH for a temporary office space while securing permanent office space. A pre-award sub-agreement was issued to PRIMEX, amounting to US$35,000. Additionally, a third party administration vendor—KMC Solutions—was contracted to manage staff payroll. As these activities were underway, the work planning process for the project’s first year was conducted on March 18-22, 2013 and was followed by a series of engagements with the DOH Regional Office (DOH-RO) and the Visayas Operations Cluster (VOC).

2. Year 1 Quarter 2 (1 April – 30 June 2013) a. Project Management. Rapid mobilization of the project was undertaken with the selection and recruitment of 90% of the staff and procurement of office equipment, including laptops, desktop computers, fax machines, and printers. Establishing the permanent office space was undertaken through a local contractor once the lease agreement with the DOHRO 7 was signed. The first Visayas inter- Cooperating Agency (Inter-CA) coordination meeting was organized to encourage better and more effective collaboration among USAID CAs. The workshop was attended by representatives all seven USAID CAs and their respective Agreement Officer Representatives (AOR) from the Office of Health (OH). A harmonized, Visayas-wide project implementation plan for the period June to September 2013 was developed and a coordination mechanism defined for the Inter-CAs to observe with DOH-ROs and LGU partners. b. Project Components i. Increase demand for MNCHN/FP by training providers on the Usapan series, the primary demand-generation mechanism adopted by VH (VH). Usapan sessions are designed specifically for pregnant mothers, both those who want more children and those who wish no longer to have children, and for men who want to be involved in FP. Usapan trainings were conducted in facilities with a high volume of deliveries. ii. Improve supply by conducting an initial batch of postpartum intra-uterine device (PPIUD) trainings on June 24-26, 2013 in collaboration with the Vicente Sotto Memorial Medical Center (VSMMC) and the Maternal and Child Health Integrated Project (MCHIP) of JHPIEGO. A total of 19 service providers were trained in PPIUD service provision from hospitals/birthing clinics in the VH project area with a high volume of deliveries. A total of 46 health providers were trained on FP competency-based training (FPCBT) level 1; 27 were trained on FPCBT level 2; 97 were trained on long-acting and permanent methods (LAPMs), such as female sterilization(FS) and no-scalpel vasectomy (NSV); and 20 were trained in supportive supervision. A total of 110 providers were trained on informed choice and voluntarism (ICV) to ensure that client’s rights are respected, protected, and fulfilled and that they have access to the contraceptive method best suited to their reproductive intentions and desires.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 7 3. Year 1 Quarter 3 (July 1 to September 30, 2013) a. Project Management: During the period of 01 July to 30 September 2013, VH completed the hiring of all project technical staff and procured all the equipment necessary for project implementation. The project was able to secure a permanent office space within the DOH-RO 7 compound. VH also finalized its Year 2 project work plan. b. Project Components i. Increasing Demand.Under this component, VH project trained 270 health service providers (HSPs) to facilitate the Usapan sessions. These providers conducted Usapan alone or in tandem with another trained provider. As of end of September 2013, these providers were able to conduct 189 Sessions and reached 2,890 clients (See Table 6). Another 185 clients were also reached during Usapan training conducted by VH staff. As part of VH’s efforts to integrate FP into existing MCH services, the project introduced the Usapan series to post-partum clients. This intervention was introduced in hospitals and birthing centers to clients prior to discharge after delivery. VH trained health care providers to organize Usapan sessions in maternity wards. Data from three hospitals showed a significant increase by 50 % (See Table 10) in the number of postpartum FP (PPFP) clients after this intervention was introduced. ii. Improving Supply.In coordination with the ROs in Regions 6, 7, and 8, USAID CAs (including PRISM 2, MCHIP, 8 LGUs, and NGOs [Integrated Midwife Association of the Philippines, Siliman University Medical Center], VH identified and facilitated the training of service providers and trainers on LAPMs of FP (especially the PPIUD, female sterilization, and NSV) and essential intra- partum and newborn care (EINC). Prioity was given to the trainingof providers fromfacilities with a high volume of deliveries and areas with high unmet need for FP, as identified in previous studies. On 24-27 June 2013 and 27-31August 2013, VH organized two training courses for PPIUD insertion at the VSMMC in Cebu City. A total of 35 health professionals completed the training requirements and became certified PPIUD providers. The training course included a 3-day didactic discussion and 2-day practicum where participants practiced insertion of an IUD on models, as well as actual clients. Trainees came from regional/DOH-retained hospitals (5), provincial hospitals (6), district hospitals (5), and one private hospital. iii. PPIUD service provided to 670 clients. Between July and September 2013, 670 post-partum women were provided PPIUD services and became users of the method. These women were provided counseling prior to the provision of PPIUD services. Based on client exit interviews and informal dialogues, clients expressed satisfaction with the opportunity to initiate use of an FP method at the time of delivery, prior to being discharged from the maternity ward.

4. Year 2 Quarter 1 (October 1– December 31, 2013) a. Response to Earthquake and Typhoon Disasters i. Bohol Earthquake.On October15, 2013 a powerful earthquake registering 7.5 magnitude hit the province of Bohol causing massive damage to thousands of homes; tens of thousands of residents were rendered homeless and had to be relocated to evacuation centers. As assessment conducted by VHof health facilities in Bohol found that 3 district hospitals, 5 main health centers, and 30 Barangay Health Stations (BHSs) were heavily damaged. At the request of the Philippines Department of Social Welfare and Development (DSWD), VH procured hygiene kits for the affected families, which contained water pails, soap, shampoo, toothbrushes, laundry soap, sanitary napkins, and other items needed for maintaining proper personal hygiene. These items were turned over to the DSWD in Tagbilaran City by Ms. Gloria Steele, Mission Director of USAID/Philippines in a formal public ceremony attended by Gov. Edgardo Chatto and provincial officials from Bohol Province. In addition, the project provided emergency lights and other emergency supplies to the affected health facilities, particularly the health centers in the municipalities of Carmen, Catigbian, and Sagbayan.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 8 ii. Typhoon. On November 8, 2013, a super-typhoon with maximum winds of 200 km per hour ravaged the provinces of Samar, Leyte, Cebu, and Iloilo. The typhoon caused significant damage to health facilities and other infrastructure and affected millions of people living in these areas. A rapid assessment was conducted by VH teams in the provinces of Leyte, Northern Cebu, and South Iloilo municipalities which determined the priority health facilities. The project responded to this disaster through the following activities: the provision of nutrition kits; the provision of tents to serve as temporary health centers; the provision of logistical and technical support to the VOC during the immediate relief and emergency response period. VH facilitated the deployment of six solar-powered refrigerators for the DOH 8 to prevent damage to vaccines as a result of the absence of electricity. Finally, VH partnered with other donors and agencies to repair and rehabilitate affected health centers and village health stations. b. Completion of baseline survey in eight provinces. The baseline survey for VH was conducted in the provinces of Iloilo, Negros Occidental, Bohol, Negros Oriental, Leyte, South Leyte, Samar, and North Samar in October 2013. The survey generated important information on the status of demand generation, supply-related issues, and policies and health systems in the Visayas region. Baseline survey results were presented during a DOH-VOC meeting and during meetings of the DOHRO and provincial health offices. The results are summarized below and were used to adjust the project's quarterly and annual targets.

5. Year 2 Quarter 2 (January 1 – March 31, 2014) a. Increase in the number of trained PPFP/PPIUD providers. Utilizing the newly established PPFP/PPIUD training centers in the provinces of Iloilo and Bohol, VH conducted two training courses that increased the number of trained PPFP/PPIUD providers to 51 in the Visayas region. b. Increase in the number of trained voluntary surgical sterilization (VSS) providers. VH assisted 7 female sterilization providers in the provinces of Leyte, Bohol, Negros Occidental, and Iloilo in the completion of their training requirements. The training was completed under the guidance of the project's clinical consultant who is an accredited trainer of the DOH. c. Introduction of the Program for Young Parents (PYP) in Vicente Sotto Memorial Medical Centre (VSMMC). With the assistance of a VH consultant from the Philippine General Hospital, VSMMC launched the PYP on March 4, 2014. The PYP intervention is designed to reduce teenage pregnancies by helping currently pregnant teenagers postpone or delay their next pregnancy. The Deputy Mission Director of USAID was the guest of honor during the launch. d. Introduction of events-based demand generation and service delivery activities. VH staff assisted local health providers in organizing events for pregnant women and their partners to improve attendance in antenatal care (ANC) clinics and increase the number of FBDs. These events and celebrations were well attended and serve as a template for improving demand generation and service delivery activities. e. VisayasHealth Technical Start-up Workshop.This was conducted last February 17-21, 2014 with the support of EngenderHealth Clinical Support Staff. All VisayasHealth regional and field staff participated in the workshop. Topics included The SEED Programming Model, EngenderHealth and the US government legislative policy requirement, the clinical quality framework, contraceptive technology update, skills on the provision of PPIUD and Sub-dermal Implants.

6. Year 2 Quarter 3 (01 April – 30June 2014) a. Successful Introduction of Sub-dermal Implants in the Visayas Region. During the period April 1-June 30, a total of 1,688 clients became users of progestin-containing sub-dermal contraceptive implants (PSIs). This contraceptive method was introduced successfully in 6 of the 8 provinces covered by the VH project.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 9 The following are the reasons for the successful introduction and the rapid increase in the utilization of PSIs:  Many providers were trained in a short period of time.  Intensification of demand generation activities  Enough caseloads during training  Adequacy of supplies.  Facilities covering large populations b. Increase in the Number of Pregnant Women Given FP Information. The project also registered a significant increase in the number of pregnant women given FP information. This increase was most prominent in the provinces of Cebu, North Samar, and Leyte. The reasons for the increase in the number of pregnant women given FP information are explained below:  Cumulative increase in the number of CHT trained on Pregnancy Tracking Chart  Increase in the number of “Buntis” events organized by VH staff.  Better documentation of group and individual education. c. Increase in the Number of Men Given FP Information. The project also noted a sharp increase in the number of men who were given FP information from 33 in the previous quarter to 647 during this reporting period. This increase was evident throughout all provinces except in Leyte. The reasons for this increase in the number of men given FP information are explained below:  Encouraging couples to come during demand-generation activities and events  Training on gender awareness and sensitivity

7. Year 2 Quarter 4 (01 July – 30 September 2014) a. Increase in the Number of Adolescents Provided with FP Information. In the 4th quarter of Year 2, VH strengthened service provision to adolescents and youth by supporting the training of health staff on dealing with adolescents, particularly in facilities with high volumes of deliveries engaged for the Program for Young Parents (PYP). The main demand generation vehicle was still the Usapan session, this time adapted to the youthful audience. A total of 34,218 adolescents and youth attended Usapan sessions during the reporting period. Each Usapan session is designed for 10 to 15 participants and lasts 30-45 minutes. Cebu province and the tri-cities of Cebu, Mandaue, and Lapu-Lapu contributed to 30% of this accomplishment. Project staff set conservative targets for reaching out to adolescents due to provisions of the Reproductive Health Law requiring parental consent for young clients. Nevertheless, VH experience shows that adolescents/youth are accessing FP information and services from health facilities in spite of these restrictive provisions. b. Increase in Number of Women Provided with Information on Exclusive Breastfeeding.In compliance with the DOH mandate to encourage the practice of exclusive breastfeeding for the first six (6) months, VisayasHealth integrated messages on breastfeeding in Usapan sessions. A total of 60,918 women were reached and provided information on the benefits of exclusive breastfeeding. c. Increase in the Number of Community Health Team (CHT) Members Trained on Pregnancy Tracking. In YR2, a total of 3,723 (or 51% of CHTs) were trained on the Pregnancy Tracking System. Southern Leyte was able to train three times its planned target by working closely with the Provincial Health Office (PHO) and DOH. The province initially trained selected RHU staff as trainers in July 2013. VH provided the inputs on the Pregnancy Tracking System and the use of relevant tools (including the Pregnancy Tracking Form, Pregnancy Tracking Board, and Delivery Tracking Board). The RHU staff trained 996 CHTs in their respective LGUs. d. Introduction of sms Reminders to Reinforce Health Messages. Participants in Usapan sessions receive an Usapan Action Card which serves as a discussion aid and take home motivational material. It has a detachable portion where pregnant mothers can signify their concurrence to receive messages on

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 10 their mobile phones. The messages are intended to reinforce reminders to submit to ANC on the specified dates, as well as other messages to promote healthy pregnancy and delivery, including: facility- based delivery; modern contraceptive methods; exclusive breastfeeding; process and requirements for availing of Philippine Health Insurance (PhilHealth) benefits; pregnant mothers and infant immunization schedule; etc. VisayasHealth has built a data base of 16,148 mobile telephone numbers from participants in Usapan sessions in the different project areas. VisayasHealth will be undertaking operations research to determine the extent to which the application of sms technology contributes to improving health-seeking behavior and outcomes before scaling up the use of sms. VisayasHealth achieved considerable gains in Year 2, exceeding its targets for providing counseling to pregnant women (103%); reaching out to adolescents and youth (322%); reaching out to men (304%); and providing information and counseling on exclusive breastfeeding (240%). Greater efforts are needed to reach out to postpartum women with only 82% of target achieved. As well, there is need to reach out to more CHTs since only 51% have been trained on the PTS.

8. Year 3 Quarter 1 (01 October – 31 December 2014) a. Assessment of VH training courses on PSI: With technical support from a consultant, VH conducted an assessment of the PSI training courses which showed the following findings and observations: i. VH needs to systematize the conduct of post-training evaluation and follow-up ii. Infection control during the training should be given more emphasis iii. Future courses should ensure that clients who do not meet the eligibility criteria are offered other methods iv. Inclusion of Public Health Nurses and Rural Health Midwives as part of the team to be trained. v. Inclusion of client generation as part of the training package b. Conduct of Consultation Meeting with Highly Urbanized Cities. The team organized a meeting of health managers from the highly urbanized cities and discussed the challenges and opportunities in improving health services especially for the urban poor. c. Training of VH staff and partners on the Minimum Initial Service Package (MISP). VH engaged the services of The Women's Refugee Commission to train the staff and selected partners on the MISP. The training was designed to enable the project to better respond to humanitarian emergencies given that the Visayas region is prone to natural disasters.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 11 II. THE PROJECT AND OBJECTIVES The VisayasHealth project is working towards achieving the following goals and objectives throughout its project life: reducing maternal and child mortality, reducing unmet need for family planning, increasing CPR, increasing skilled birth attendance, increasing newborns given neonatal care, reducing the number of teenage pregnancies, and increasing exclusive breastfeeding rates.

To achieve these goals and objectives, VisayasHealth will implement the following components: scaling-up of supply and demand for MNCHN-FP services, removing policy and systems barriers and developing capacityof ROs to manage and coordinate MNCHN/FP programs and activities. Below is the VisayasHealth results framework.

VisayasHealth Results Framework for FP/MNCHN

Goal: Family Health Improved (Unmet Need for FP Reduced, MMR Reduced, UFMR Reduced)

Purpose: Utilization of FP Services Increased

Modern CPR (archived) Percent of deliveries with skilled birth attendants in USG-assisted sites (archived)

Unmet need for FP (archived) Percent of deliveries in health facilities (archived) Percent of NHTS-PR beneficiaries including CCT availing of MCP and NCP packages (A)

Couple Years Protection (CYP) in USG-assistedSub programs-purpose (Q)2: Strengthening the Supply of Sub-purpose 1: Generating Demand Sub-purpose 3: Health Policies and Systems for MNCHN FP Services Integrated MNCHN FP Services on FP and MCH improved Output1. Individuals' health Output1. Availability of health services Output1. Policy barriers to service knowledge and awareness increased provision and financing resolved increased - Percent of service delivery points providing FP - Percent of budget in DOH regional offices counseling and services to couples, men and No. of women reached with education utilized for FP/MCH (new, A) women in USG-assisted sites (Q) on the benefits of breastfeeding (Q) Output 2.Financing of No. of pregnant women seeking ANC - Percent of USG-assisted SDPs providing FP/RH provision/consumption of services provided with FP information (Q) services for adolescents and youth (Q) No. of post-partum women provided - Percent of service delivery sites providing made more sustainable with FP information (Q) post-partum IUD services (Q) - Percent of LGUs utilizing PhilHealth No. of men provided with FP - Percent of SDPs providing VSS services (BTL or reimbursement per guidelines (new, A) NSV) (Q) information (Q) No. of adolescents and youth - Percent of SDPs providing sub-dermal Output3. FP Commodity Secured, implants (Q) available and accessible in both public provided with youth-friendly MNCHN/FP information (Q) and private facilities Output2. Quality of health services - Percent of USG-assisted SDPs that Output2. Communities improved experience stock outs in the last three months mobilized to support healthy - Number of health providers trained on FP/RH of any of the methods expected to be behaviors with USG funds per type of training (LAPM, provided by the facility (Q) FPCBT 1&2) -No. of CHTs trained in Pregnancy Output4. Critical health systems Tracking System and basic Family - Number of health providers trained on MCH underpinning LGU services Planning referral (Q) with USG funds (BEMONC and EINC) - Number of people receiving FP Trainers' strengthened training with USG support - Percent of LGUs conducting data quality Legend: - Number of training institutions for Family checks (DQC) annually (new, A) Red: USAID/W(PPR) indicators (5) Planning - Number of trained PHNs on Applied Blue: archived indicators (5) Output3. Implementation of exclusive Supportive Supervision (Q) Black Calibri font: USAID inter-CA custom breastfeeding strengthened - Number of quality supervisory visits indicators - Percent of children exclusively breastfed for the first Purple Calibri font: VH internal indicators six months (archived) - Number of LGUs with at least CHT / community support group providing breastfeeding information and referral to lactating mothers (A)

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 12 III. ACCOMPLISHMENTS (Highlights of previous quarters)

Demand Generation All demand generation-related indicators for the reporting quarter were less compared to the previous quarter. This is because of the widely variable submissions for the 3rd month of the reporting quarter (6%- 94%, median of 55%). For trend analysis, the first two months of the previous quarter as well as the first two months of the current quarter will be used. There were 4,690 Usapan sessions conducted during the quarter by trained Usapan facilitators, or an average of 426 per province (4,962 sessions during the previous quarter; average ~ 451). When only the first two months of both quarters are compared, on average, there were more sessions per province (341) during the reporting quarter compared to 331 during the previous quarter. Usapan sessions in Cebu City, Lapu-Lapu City, Mandaue City and South Leyte increased across the two periods. This is reflected as significant increases in reach for specific audiences/clients in these LGUs as shown later.

Table 2. Number of Usapan Sessions per province, Year 3 Q1 and Q2

Y3 Area Q1 Oct - Nov Q2 Jan - Feb Visayas 4962 3640 4690 3747 Iloilo 1025 734 723 494 Negros Occidental 201 123 119 101 Bohol 321 256 235 230 Cebu 615 500 525 411 Cebu City 924 583 1421 1256 Lapu-Lapu City 338 222 473 313 Mandaue City 222 148 270 196 Leyte 570 447 359 349 South Leyte 207 126 344 255 Samar 235 232 17 17 North Samar 304 269 204 125

A total of 36,496 women were provided education on breastfeeding during Usapan sessions for the quarter. Four provinces / cities namely Cebu, Lapu-Lapu City, Mandaue City and South Leyte reached more women during the quarter and provided them with education on breastfeeding. This was confirmed on trend analysis where the increase ranged from 4% to 91% (average of 60%) compared to the previous quarter for these provinces/cities. By end of the quarter, VisayasHealth's cumulative performance is at 80% of its Year 3 target and 47% of its end of project target.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 13

Table 3. Number of women reached with education on breastfeeding (VH)

Baseline FY 2015 Accomplishment Cumulative value Oct- Indicator Jan-Feb Target for Accomp. EOP Target (reference Q1 Nov Q2 2015 2015 Year3 year) 2014

Visayas 0 48,041 35,820 36,496 28,449 109,898 87,932 185,728

Iloilo 9,086 7,504 4,032 3,368 17,053 13,118 28,820 Negros Occidental 4,967 3,112 1,409 1,257 8,289 6,376 14,008

Bohol 3,331 2,779 2,139 2,027 7,111 5,470 12,018

Cebu 4,394 3,485 4,593 3,654 11,683 8,987 19,744

Cebu city 5,877 4,024 4,945 3,575 14,069 10,822 23,776 Lapu-Lapu City 3,055 2,099 4,894 3,387 10,334 7,949 17,464 Mandaue City 2,710 1,515 4,193 2,893 8,974 6,903 15,166

Leyte 6,946 5,196 3,851 3,711 14,036 10,797 23,721

South Leyte 2,270 1,449 3,543 2,671 7,557 5,813 12,771

Samar 1,504 1,471 387 387 2,458 1,891 4,155

North Samar 3,901 3,186 2,510 1,519 8,334 6,411 14,085

A total of 19,688 pregnant women seeking antenatal care (ANC) were provided with FP information during the quarter. Four of 11 provinces/cities (36%) showed apparent increases in their performance for this indicator. Trend analysis: Negros Occidental, Lapu-Lapu City, and Mandaue City showed consistent increase for this indicator on analysis of their Oct-Nov 2014 and Jan-Feb 2015 performance.

Table 4. No. of pregnant women seeking ANC and provided with FP information (VH) Indicator Baseline FY 2015 Accomplishment Target for FY 2014 Cumulative value 2015 Accomp. Accomp. (reference Oct-Nov Jan-Feb (including Q1 Q2 year) 2014 2015 baseline) Visayas 132,116 26,861 21,013 19,688 14,356 248,218 66,746 245,411 Iloilo 40,708 8,544 7,090 2,793 2,197 51,183 9,173 61,218 Negros Occidental 9,920 543 360 540 418 43,967 3,531 14,534 Bohol 13,133 1,543 1,212 1,244 1,193 18,978 851 16,771 Cebu 6,513 2,308 1,872 2,665 1,586 38,987 11,571 23,057 Cebu City 15,226 3,475 2,661 3,225 2,258 21,266 20,302 42,228 Lapu-Lapu City 2,001 1,885 1,387 3,087 2,041 4,962 3,600 10,573 Mandaue City 1,685 1,903 1,134 2,589 1,751 5,671 4,747 10,924

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 14

A total of 7,088 postpartum women were provided with FP information either during Usapan sessions and postnatal visits during the quarter. Trend analysis: Increases for this indicator were noted from Negros Occidental, Lapu-Lapu City, Mandaue City and South Leyte.

Table 5. No. of postpartum women provided with FP information (VH) Province Baseline FY 2015 Accomplishment Target FY 2014 Cumulative value Q1 Oct-Nov Q2 Jan-Feb for 2015 Accomp. Accomp. (reference 2014 2015 (including year) baseline) Visayas 98,301 11,120 7,386 7,088 5,057 184,169 9,429 125,938 Iloilo 27,082 3,360 2,208 575 553 30,710 3,144 34,161 Negros Occidental 10,330 533 214 339 332 37,686 426 11,628 Bohol 11,440 979 737 532 520 16,266 606 13,557 Cebu 8,306 1,099 876 583 433 33,947 1,411 11,399 Cebu City 12,132 1,298 861 1,002 688 11,226 639 15,071 Lapu-Lapu City 493 989 484 1,312 1,001 4,542 526 3,320 Mandaue City 2,260 798 484 1,543 1,102 4,294 677 5,278 Leyte 9,245 1,229 863 539 500 23,187 704 11,717 South Leyte 4,905 248 128 369 288 7,634 158 5,680 Samar 7,959 164 164 0 0 9,505 355 8,478 North Samar 4,149 423 367 294 193 5,173 783 5,649

A total of 15,062 adolescents and youth women were provided with FP information during Usapan sessions during the quarter. Trend analysis: Increases for this indicator were noted from Negros Occidental, Lapu-Lapu City, Mandaue City and South Leyte.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 15

Table 6. Number of adolescents and youth provided with MNCHN/FP information (VH) Province Baseline FY 2015 Accomplishment Target FY 2014 Cumulative value Q1 Oct-Nov Q2* Jan-Feb for 2015 Accomp. Accomp. (reference 2014 2015 (including year) baseline) Negros Occ 1,162 727 542 637 341 6,200 426 2,952 Bohol 1,357 1,184 961 1,041 704 2,676 771 4,353 Cebu 313 2,025 1,698 2,047 1,431 6,022 4,319 8,704 Cebu City 380 1,855 1,448 2,370 1,431 4,507 3,087 7,692 Lapu-Lapu City 0 1,270 857 1,991 1,334 560 993 4,254 Mandaue City 0 1,159 674 1,682 1,050 1,325 1,900 4741 Leyte 311 2,306 1,800 1,202 717 3,815 704 4,523 South Leyte 1,195 736 482 1,244 838 851 983 4,215 Samar 187 563 552 169 83 1,256 1,617 2,536 North Samar 690 1,608 1,245 1,212 945 1,564 5,476 8,986

For this quarter 1,092 men were reached with FP information, bringing the cumulative accomplishment of the project at 6,226 or 55% of its Year 3 target. Iloilo province conducted a series of FP information giving activities for men during the quarter and this is shown in the table above. More of these activities need to be carried out by the project as it re-introduces No-Scalpel Vasectomy as another FP option for couples.

Table 7. Number of men provided with FP information (VH) Province Baseline value FY 2015 Target FY 2014 Cumulative EOP (reference year) Accomplishment for 2015 Accomplishment Accomplishment Target (including Q1 Q2 baseline) Visayas 184 2,670 1,092 11,220 2,279 6,226 11,220 Iloilo 27 487 669 1,590 127 1,310 1,590 Negros Occidental 36 889 39 1,020 135 1,099 1,020 Bohol 15 443 204 1,470 242 904 1,470 Cebu 57 209 55 2,225 125 446 2,225 Cebu City 0 136 39 736 28 203 736 Lapu Lapu City 0 11 5 298 1 17 298 Mandaue City 0 54 7 281 0 61 281 Leyte 26 43 0 1,470 24 93 1,470 South Leyte 5 66 40 630 24 135 630 Samar 10 33 0 780 106 149 780 North Samar 9 299 34 720 1,467 1,809 720

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 16

Strengthening Supply for FP and MCH

For January to March 2015, most of the trainings carried out by partners were for Family Planning Competency Based Training 1 (FP-CBT1) and FPCBT2 (interval IUD) (Table 8). For trainings directly provided by VisayasHealth and its trained trainers, several batches of Progesterone-only Subdermal Implants were carried out.

Table 8. FP-CBT Trainings carried out by partners Oct-Dec 2014 Jan-Mar 2015 Province FPCBT1 FPCBT2 PPIUD PSI FPCBT1 FPCBT2 PPIUD PSI Visayas 30 25 0 36 60 32 0 28 Iloilo 0 0 0 12 15 0 0 9 Negros Occidental 30 25 0 0 0 32 0 0 Bohol 0 0 0 0 0 0 0 0 Cebu 0 TBD TBD 24 45 TBD TBD 0 Leyte 0 0 0 0 0 0 0 9 South Leyte 0 0 0 0 0 0 0 0 Samar 0 0 0 0 0 0 0 10 N. Samar 0 0 0 0 0 0 0

As a result of these trainings, the percent of SDPs providing FP counseling and services increased from 41% to 52%.

Table 9. Percent of service delivery points (SDPs) providing FP counseling and services to couples, men, and women (inter-CA)

Total No. of Total No. of Y3Q1 Y3Q2 Province Facilities % Facilities % Accomplishment Accomplishment (denominator) (denominator) Visayas 215 477 41% 248 477 52% Iloilo 29 68 43% 34 68 50% Negros Occidental 34 47 60% 21 47 45% Bohol 26 63 41% 31 63 49% Cebu 27 80 34% 44 80 55% Cebu City 36 40 90% 39 40 98% Lapu- Lapu City 10 10 100% 10 10 100% Mandaue City 11 14 79% 11 14 79% Leyte 22 69 33% 24 69 35% South Leyte 4 25 14% 14 25 56% Samar 2 30 6% 7 30 23% North Samar 19 31 58% 22 31 71%

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 17

For increasing access to specific Long Acting and Permanent Method (LAPM) services, the project's accomplishments are on the rise, specifically for PSI (Table 10), and for PPIUD (Table 12); access to BTL services (Table14) , including ambulatory missions and in-house service provision is stable.

From January to March 2015, 39 more SDPs were added to facilities able to provide PSI services. These came from Iloilo, Leyte and Samar provinces. SDPs providing PSI services are 40% by end of this quarter (Table 10). A total of 4,558 clients have been provided PSI services for the quarter, lower than the previous quarter (5,805). Cumulative accomplishment is almost 18,000 with a monthly caseload of 1,400. The number of removals reported thus far is 97 or a removal rate of 0.5. The most common reason for removal is heavy bleeding.

Table 10. Percent of SDPs providing PSI services (VH) Baseline FY 2015 Accomplishment FY 2015 value Q1 Q2 Target Province (reference N D* % N D % year) Visayas 0 223 503 38% 262 503 50% 61% Iloilo 0 28 68 41% 37 68 54% 62% Negros 0 16 47 34% 16 47 34% 45% Occidental Bohol 0 18 63 29% 18 63 29% 33% Cebu 0 35 62 56% 35 62 56% 65% Tri-Cities 0 83 108 77% 83 108 77% 81% Leyte 0 17 69 30% 28 69 41% 48% South Leyte 0 7 25 28% 15 25 60% 80% Samar 0 1 30 3% 16 30 53% 70% North Samar 0 14 31 45% 14 31 45% 61% *target denominator adjusted based on performance by end of FY 2014

Table 11. No. of PSI New Acceptors Y3Q1 and Y3Q2

Y2 Year 3 Accomplishments Cumulative Province Accomplishments Accomplishment Q1 Q2 Visayas 8,100 5,805 4,558 18,463 Iloilo 821 796 824 2,441 Negros Occidental 636 1232 685 2,553 Bohol 798 567 442 1,807 Cebu 965 900 675 2,540 Tri-Cities 1431 1046 635 3,112 Leyte 1215 498 662 2,375 South Leyte 560 318 247 1,125 Samar 350 120 184 654 North Samar 1,179 266 175 1,620

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 18

For PPIUD, the number of SDPs able to provide PPIUD increased from 68 to 92, with most of the additional SDPs coming from the tri-cities; new providers were also trained in Leyte, South Leyte and Northern Samar. For the next quarter, Iloilo, Negros Occidental and Bohol need to be prioritized for training to increase the SDPs able to provide PPIUD services to improve access to this service.

Table 12. Percent of service delivery sites providing post-partum IUD services (VH)

Total Y3Q1 Y3Q2 No. of Baseline Hospitals Target Area % (2013) & N D* % N D* % for 2015 Birthing Facilities Visayas 11 383 3% 68 382 18% 95 382 25% 32% Iloilo 1 53 2% 3 53 6% 3 53 6% 42% Negros 1 42 2% 3 42 7% 3 42 7% 26% Occidental Bohol 1 55 2% 15 55 27% 15 55 27% 33% Cebu 0 61 0% 7 61 11% 11 61 18% 33% Tri-Cities 1 57 2% 8 56 14% 26 56 46% 40% Leyte 4 48 8% 14 48 29% 16 48 33% 35% South Leyte 1 23 4% 6 23 26% 7 23 30% 22% Samar 2 21 10% 6 21 29% 6 21 29% 24% North Samar 1 23 4% 6 23 26% 8 23 35% 30% *target denominator adjusted based on performance by end of FY 2014

A total of 512 clients were provided PPIUD services for the reporting quarter bringing the total clients served by VH-trained providers to 4,052. However, this quarter's performance is lower than the previous quarter (698). By province, increases were noted only for Negros Occidental, Leyte, and North Samar from the previous quarter (Table 13).

Table 13. Number of clients provided PPIUD services by province and quarterr Area Y1 and Y2 Y3 Accomplishments Cumulative Accomplishments Q1 Q2 Performance VisayasHealth 2,842 698 512 4,052 Iloilo 250 63 12 325 Negros Occidental 286 89 105 480 Bohol 623 145 41 809 Cebu 216 97 30 343 Tri-Cities 522 149 133 804 Leyte 491 62 105 658 South Leyte 326 43 30 399 Samar 76 26 12 114 North Samar 52 24 44 120

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 19

As a result, a study was carried out to understand the varying performance of trained providers and inform the PPIUD training program. Preliminary analysis showed four factors with significant association with performance: Trained providers who came from facilities with deliveries of more than 20 (high) were 2.5 times more likely to perform (95%CI 0.92 - 7.1, p < 0.03); those who reported they were confident to provide the service after the training were more 2.6 times more likely to perform (95%CI 1.09-6.4, p < 0.01); those who perceive that the number of insertions during training were adequate were 1.8 times more likely to perform (95%CI 1.1 - 3.2, p = 0.01). Providers who perceived they were adequately trained were 4.6 times more likely to perform (95%CI 1.6 - 13.4, p < .01). The final results of the study will be shared in the next quarterly report. The proportion of hospitals providing VSS services increased from 43% in the previous quarter to 46% for the reporting quarter. The increase was due to new hospitals provided ambulatory BTL service in Iloilo, Cebu and Leyte.

Table 14. Percent of SDPs providing VSS services (BTL or NSV) Q5 Q6 Baseline D % N D Area % N % (2013) (total # of (total # hospitals) of hospitals) Visayas 41 36% 55 115 48% 58 114 51% Iloilo 10 63% 11 16 69% 12 16 75% Negros Occidental 4 21% 5 19 26% 5 19 26% Bohol 4 27% 4 15 27% 4 15 27% Cebu 5 28% 13 18 72% 15 18 83% Tri-Cities 6 75% 6 8 75% 5^ 7^ 71% Leyte 6 35% 7 17 41% 8 17 47% South Leyte 1 14% 3 7 43% 3 7 43% Samar 2 33% 2 6 33% 2 6 33% North Samar 3 33% 4 9 44% 4 9 44% ^One hospital in Cebu City (Cebu City Medical Center) has been damaged by the earthquake and has only been providing basic health services.

However, the number of BTL clients was lower during the reporting quarter relative to the previous. There were lesser ambulatory missions carried out from January to March 2015.

BTL clients per province, Oct –Dec 2014 (n=1,680) BTL clients per province, Jan-Mar 2015 (n= 598)

500 500

400 400

300 300 Number 200 Number 200

100 100

0 0 Neg Tri- N Neg Tri- N Iloilo Bohol Cebu Leyte S Leyte Samar Iloilo Bohol Cebu Leyte S Leyte Samar Occ cities Samar Occ cities Samar in-house 125 165 44 18 253 14 23 0 0 in-house 33 140 21 83 148 0 12 0 1 ambulatory 102 119 47 397 153 40 58 122 ambulatory 58 0 14 41 47 0 0 0

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 20

Systems

Stock out rate for Pills decreased from 36% from the previous quarter, to 13% for the reporting quarter. Deliveries sent out by the Department of Health central office during the last quarter of calendar year 2014 arrived early January to mid-February 2015. The highest level of stock out rate is seen in the tri-cities since deliveries to these LGUs were under-estimated, i.e., Cebu City, Lapu-Lapu City and Mandaue City were treated as one RHU.

Table 15. Stock out rate for Pills by province Oct - Dec 2014 Jan - Mar 2015 N D % N D % Province No. of Facilities No. of Facilities w/ Reports w/ Reports Iloilo 10 57 18% 5 52 10% Negros Occidental 11 35 31% 3 31 10% Bohol 5 42 12% 2 44 5% Cebu 33 71 46% 10 73 14% Cebu City 12 37 32.43% 21 38 55.26% Lapu-Lapu City 2 10 20.00% 2 10 20.00% Mandaue City 8 13 61.54% 1 12 8.33% Leyte 10 43 23% 5 49 10% South Leyte 4 25 16% 1 22 5% Samar 19 22 86% 0 20 0% North Samar 14 26 54% 2 26 8% Visayas 36% 11%

Stock out rate for injectables likewise decreased from 33% in the previous quarter to 16% in the reporting quarter. As in the case of pills, the highest stock out rate was noted in the tri-cities.

Table 16. Stock out rate for Injectables by province Oct - Dec Jan - Mar N D % N D % Province No. of Facilities No. of Facilities w/ Reports w/ Reports Iloilo 11 57 19.30% 8 52 15.38% Negros Occidental 11 34 32.35% 4 31 12.90% Bohol 7 42 16.67% 2 44 4.55% Cebu 37 71 52.11% 10 73 13.70% Cebu City 16 37 43.24% 17 38 44.74% Lapu-Lapu City 2 10 20.00% 3 10 30.00% Mandaue City 5 13 38.46% 1 12 8.33% Leyte 11 43 25.58% 3 49 6.12% South Leyte 4 25 16.00% 1 22 4.55% Samar 11 22 50.00% 1 20 5.00% North Samar 12 26 46.15% 9 26 34.62% Visayas 32.72% 16.35%

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 21

Stock out rate for IUD improved from 37% from the previous quarter to 18% for the reporting quarter. The tri-cities experienced the highest stock out rates.

Table 17. Stock out rate for IUD by province Oct - Dec 2014 Jan - Mar 2015 Province N D % N D % No. of Facilities No. of Facilities w/ Reports w/ Reports

Iloilo 4 42 10% 10 39 26%

Negros Occidental 11 31 35% 6 25 24%

Bohol 7 29 24% 2 24 8%

Cebu 14 20 70% 5 20 25%

Tri-Cities 13 39 33% 16 41 39%

Leyte 4 25 16% 0 39 0%

South Leyte 3 25 12% 3 25 12%

Samar 7 10 70% 0 9 0%

North Samar 14 21 67% 7 22 32%

Visayas 37% 18%

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 22

IV. SUMMARY OF MAJOR ACCOMPLISHMENTS AND REASONS FOR VARIANCES IN THE

1. Increase in the number of acceptors of sub-dermal implants During the quarter, the project was able to document a total of 4031 new acceptors of PSI bringing the total of PSI acceptors in the Visayas to 18,463 (Table 18). Based on these numbers and estimating the increase in CPR using the 2013 NDHS results the Reality Check tool shows that by end of 2017, Visayas will have a CPR of 44.96 (Table 19).

Table18. Number of PSI New Acceptors as of March 2015 Year 3 Accomplishments Cummulative Province as of December Jan - Mar Accomplishment 2014 2015 Visayas 13,698 4,529 18,463 Iloilo 1617 824 2,441 Negros Occidental 1868 685 2,553 Bohol 1365 442 1,807 Cebu 1865 675 2,540 Tri-Cities 2477 635 3,112 Leyte 1713 662 2,375 South Leyte 878 247 1,125 Samar 470 184 654 North Samar 1445 175 1,620 Facilitator 207 29 236

Table 19. Estimated Contraceptive Prevalence Rate 2014 - 2017 Goal 2014 2015 2016 2017 Visayas CPR (Increased 37.11 39.73 42.34 44.96 by .5 Annually) *This is based on the assumption to continue past rate of CPR increase/decrease 2008 and 2013 with the increase in Implanon®, IUD and male /female sterilization. a. Addition of 26 providers trained during the quarter. During this reporting period, VH trained 26 providers in the provinces of Iloilo, Leyte and Samar bringing the total of trained providers to 185. b. Utilizing regular training sessions to introduce the technique of inserting Implanon® NXT to providers who were trained on the classical implants In order to save time and training resources, the training team of VH in collaboration with DOH regional and provincial trainers utilized the NXT training courses for new providers to also enhance the skills of those who have been trained using the classical implants. This "2 in 1" training activity proved to be efficient mainly because the number of clients is sufficient to meet the needs of the trainees during the practicum.

c. Adoption of a team approach in the conduct of the training courses and inclusion of demand generation as a topic during the training course. Based on recommendations from an assessment made by a project consultant on the PSI training course, VH utilized the training courses to adopt a team approach in the conduct of the training courses for PSI. The inclusion of Public Health Nurses and Rural Health Midwives in the training

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 23

really helped in ensuring that the Municipal Health Officers get the necessary support especially in the area of demand generation and counseling of interested clients. d. Conduct of events-based service delivery activities. The field staff of VH assisted providers in organizing events designed to attract more interested clients to avail of FP services. These events also called health fairs and family planning days provided an opportunity for interested clients to obtain more information about FP methods and get counseling services prior to receiving the FP method of choice. 2. Doubling in the number of facilities providing a wide range of choices (more than 2 modern FP methods) to clients including accessto at least one LARC During the period an additional 189 facilities are providing more than 2 FP methods with at least one LARC (interval IUD, PPIUD or PSI) bringing the total for the Visayas to 374. Comparing the numbers to that of the baseline (Table 20), the project has already doubled the number of facilities offering a wide range of methods to interested clients. This is very significant because according to the literature, one of the most effective ways of increasing CPR is by introducing new methods and offering more choices to clients. The increase is mainly due to the sustained effort of VH to establish capacity in the RHUs to provide PPIUD and PSI services. Table 20. Facilities providing more than 2 FP Method: Baseline vs Y3Q2 Facilities Providing more than 2 Facilities Providing more than 2 FP Area FP Methods [Baseline] Methods [Y3Q2] N D % N D % Visayas 185 478 39% 374 478 78% Iloilo 37 68 54% 57 68 84% Negros Occidental 21 47 45% 42 47 89% Bohol 20 64 31% 43 64 67% Cebu 16 80 20% 43 80 54% Tri-Cities 17 64 27% 59 64 92% Leyte 36 69 52% 60 69 87% South Leyte 17 25 68% 24 25 96% Samar 12 30 40% 21 30 70% North Samar 9 31 29% 25 31 81%

3. Reduction in the number of facilities with stock-outs During this period, the number of contraceptive stock-outs has been reduced. The reasons for the reduction in the number of facilities that experienced a stock-out during the quarter are the following: a. Deliveries of contraceptives made by the DOH during the last quarter of 2014 and first quarter of 2015. The DOH through a contractor delivered directly to the health facilities stocks of pills, DMPA and IUD. Unfortunately, hospitals were not included in the allocation hence the facilities that were reported as having no stocks are mostly hospitals. Some RHU facilities also reported a stock-out in January, 2015 since these facilities received their allocations only in February or March 2015. b. Deliveries of contraceptives to facilities using stocks from the Provincial Health Offices. The VH staff facilitated the delivery of contraceptives from the PHOs to facilities that were running out of stocks including district and provincial hospitals. The stocks from the PHO were limited but they helped in beefing up the supplies in the health facilities.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 24

4. Increase in the number of MCP Accredited Facilities The number of PHIC accredited birthing centers in the 8 USG-assisted provinces in the Visayas now totals 235 which is 62% of the total number of RHUs/District Health Centers. Compared to the data during the baseline this represents a 22 percentage points increase. This is significant as MCP accreditation is an important step to making MNCHN/FP services sustainable in the long term. The increase can be attributed to: a. Assistance by the project in facilitating the conduct of facility assessments by the DOH licensing team. The project staff also helped the health facilities in producing some of the documents required for licensing. b. Initiatives of some DOH-ROs such as DOH 7 to fast-track the accreditation of birthing centers. c. Continued support from PHIC to motivate local officials and providers to have their facilities accredited. The PHIC region 8 office has been very consistent in its support to the accreditation of birthing centers.

Table 21. Number of MCP Accredited Facilities: Baseline vs Y3Q2 MCP Accredited Facilities MCP Accredited Facilities [Y3Q2] Area [Baseline] N D* % N D* % Visayas 159 382 42% 235 382 62% Iloilo 30 53 57% 37 53 70% Negros Occidental 18 32 56% 21 32 66% Bohol 28 53 53% 28 53 53% Cebu 11 62 18% 21 62 34% Tri-Cities 3 56 5% 9 56 16% Leyte 26 55 47% 51 55 93% South Leyte 17 21 81% 18 21 86% Samar 13 26 50% 26 26 100% North Samar 13 24 54% 24 24 100% *Total Number of RHUs/DHCs

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 25

V. MAJOR IMPLEMENTATION ISSUES/CHALLENGES

Table 22. Areas of Concern, Issues, Actions Done, and Plans for Unresolved Actions Planned Actions if Not Areas of Concern Implementation Issues Actions Taken Resolved 1. Management  Irregular DOH Requested DOHROs to include Facilitate the schedule of Concerns MNCHN/FP Regional VH as regular member of the RIT regular meetings Implementation Team to which they agreed. meeting Promptly submitted application Personally follow up with  DOH slow certification for certification as training center RD/ARD the issuance of process (VH as training the certificate center) DOH and PHIC has agreed to forego the space requirement but  PPMs Training BEMONC not for equipment and training Facilitate the conduct of requirements for requirements. BEMONC training for accreditation midwives Advised Health Service Providers to give the accurate information  Negative media on implants and to be vigilant for Reinforced/strengthened pronouncement of an anti- any untoward events. health education and reproductive health medical counseling activities in the practitioner Continuously advocate to PHIC field.

the inclusion of implants in PHIC  Non-inclusion as yet of reimbursement. To be resolved at the implant in PHIC national level reimbursement

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 26

VI. MILESTONES, KEY TASKS, AND ACTIVITIES

A. Activity Highlights from FY3 Q2

1. Public-Private Partnership (PPP) Activities For this quarter, PPP was beefed up with the engagement of the private practicing midwives (PPM). VisayasHealth has taken up the cudgels of involving the PPMs and other private organizations in MNCHN/FP implementation which was initiated by another USAID project. The following PPP-related activities were conducted:  Consultation-meetings with Private Practicing Midwives (PPMs)/owners and managers of private midwife-led birthing homes to determine the status of their operations and participation in the public-private SDN for MNCHN in the following areas: a. Cebu – January 23, 2015 b. Bohol – January 31, 2015 c. Iloilo – February 24, 2015 d. Leyte – March 11, 2015 e. Negros Occidental – March 24, 2015  Facilitation of dialogues between PPMs and local health offices/DOH ROs to discuss issues and concerns regarding operations of private birthing homes and their participation in the SDN and mapping-out of an indicative action plan to improve public-private partnerships  Identification of training needs of PPMs/private birthing homes in relation to meeting DOH licensing requirements, expansion of FP/MNCHN services, and improving participation in the SDN; identification of priority PPMs for training in PPIUD based on existing and projected client volumes, strategic location of facilities, and other considerations.  Review of FP/MNCHN service reporting policies under FHSIS and actual PPM practices, orientation on project reporting and initial report/data collection.  Initiated discussions with the Sugar Industries Foundation, Inc. (SIFI) for a possible technical cooperation in developing a financing scheme to support community-based volunteer FP/MNCHN promotions work in selected sugar farm communities in Negros Occidental.

VH engaged a total of 146 PPMs affiliated with 109 private birthing homes in Bohol, the province and tri- cities of Cebu, Iloilo, Leyte, and Negros Occidental through consultation-meetings. Of the 109 birthing homes, 22 or 20% have successfully secured DOH licenses to operate while 90 or 82% are accredited by PhilHealth for the MCP package.

Table 23. Private Midwife-led Birthing Homes engaged, by Area, by Licensure and Accreditation Status. Area No. Engaged DOH Licensed % PHIC MCP Accredited % Bohol 9 0 0 9 100 Cebu 45 20 44 40 89 Iloilo 12 1 8 7 58 Leyte 29 1 3 23 79

Most of the 22 DOH licensed birthing homes have secured their licenses to operate from DOH on a conditional basis: that the midwives complete the BEmONC for midwives training course by August of this year. Below is a table showing the training needs of the PPMs. 199 midwives have expressed their need for the BEmONC training in order to completely fulfill DOH licensing requirements as shown in Table 3.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 27

However, the DOH ROs in regions 6, 7, and 8 have admitted that the training requirements of the private midwives have not been factored into agency plans and that the capacity of designated DOH-retained training hospitals to accommodate these numbers have yet to be ascertained. Meanwhile, private midwives have expressed their concerns about the high cost of training (quoted at P10,000.00 to P12,000.00 by certain DOH-retained training hospitals) and the limited time left in which to satisfy this requirement under DOH’s licensing rules. Local midwife associations in the areas covered by VH are taking a major role in providing guidance to PPMs in securing their DOH licenses and PhilHealth accreditation including facilitating the processing of applications.

Table 24. Training Needs of Engaged PPMs TYPE OF TRAINING REQUIRED PPMs FP-CBT1 FP-CBT2 BEmONC Newborn Basic Life LMT PPIUD Area Engaged Screening Support Bohol 42 0 6 35 27 42 38 19 Cebu 91 26 47 91 27 0 91 31 Iloilo 33 10 15 12 0 0 0 16 Leyte 45 15 28 38 0 0 0 36 Negros Occ. 23 7 10 23 0 0 0 13 TOTAL 234 58 106 199 54 42 129 115

Note that BEmONC and Lactation Management Training (LMT) training have been specified by a great majority of the private midwives as these are requirements for DOH licensing of their birthing homes. Note also the high numbers specifying PPIUD in the hope of introducing an additional service at their birthing homes. The interest in PPIUD is in part, fueled by the expectation that this procedure will soon be recognized by PhilHealth under its case payment for IUD. It is thus recommended that training requirements of PPMs may be addressed by:  Facilitating discussions with DOH RO, DOH-retained training hospitals and LGUs on the subject and explore opportunities for accommodating (including financing) the PPMs in planned training on the subject areas  Explore with DOH, possibility of contracting private training institution to conduct BEmONC for midwives course  Explore co-financing schemes between DOH, LGU, PPMs, donor-assisted projects  Explore study or training loan scheme with midwife associations

2. Program for Young Parents (PYP) The VisayasHealth Project's primary intervention for adolescents is the PYP, a hospital-based intervention adapted from the Teen Moms Program of the University of the Philippines -Philippine General Hospital (UP-PGH). In addition to the five (5) existing and functional PYP Centers namely: Vicente Sotto Memorial Medical Center, Abuyog District Hospital, Iloilo Provincial Hospital, Eastern Visayas Regional Medical Center, and Don Emilio Del Valle Memorial Hospital, three more hospitals launched PYP centers this quarter. These hospitals include the following:  Governor Celestino Gallares Memorial Hospital (GCGMH) in Tagbilaran City - Jan. 30, 2015  Cebu Provincial Hospital (CPH) in Danao City - Feb. 13, 2015  Saint Anthony Mother and Child Hospital (SAMCH) in Cebu City - March 13, 2015 The launching events in these hospitals were attended by Provincial Local Officials, Provincial Health Officials, VH staff and the concerned hospital staff. As in the previously installed PYP centers in other hospitals, the recently launched PYP Centers have a designated space for counseling and health education

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 28 classes and a space for prenatal examination and consultation. A dedicated day for antenatal consultations for mothers below 19 years old was designated. The following activities are expected to be implemented in these PYP centers:  Enrol target clients who submit for antenatal consultations, deliveries, post-natal care and essential intra-partal and newborn care (EINC) in the PYP  Engage husbands and partners who accompany their wives/girlfriends when they avail of obstetric and pediatric services  Emphasize joint responsibility and gender sensitivity during provision of services  Reach out to other significant adults (mother, mother-in-law, guardian, care giver) by involving them during health classes and group counseling  Apply interactive educational sessions to reach out to teen mothers, their partners, and significant adults  Involve the Breastfeeding Support Group/s in each of the facilities to promote exclusive breastfeeding.

3. Launching of the Adolescent and Youth Reproductive Health (AYRH) Clinic of Mina Rural Health Unit On Feb. 20, 2015, the AYRH clinic of Mina RHU was launched graced by the ff. local officials: the Representative of the Third District of Iloilo Arthur R. Defensor, Jr. , the Regional Director of the Technical Education and Skills Development Authority (TESDA) Toni June A. Tamayo, Mina Mayor Rey Grabato, Executive Officer and Former Mayor Lydia Grabato, Vice Mayor Bernardino Chichirita, Members of the Sangguniang Bayan, Provincial FP/MNCHN Coordinator Beth Banez, Chief of Iloilo Provincial Hospital Dr. Prem Parcon, Chief of the Philippine National Police, the President of the Community Health Workers Federation, Pupils, Faculty and Staff of the Mina National High School. The AYRH clinic was established:  To consolidate efforts of various government and civic institutions to address concerns of adolescents in Mina, particularly as these impact on their reproductive health  To establish the reputation of the Mina RHU as an adolescent and youth friendly health facility  To encourage adolescents and youth to access reproductive health information and services at the Adolescent and Youth Reproductive Health Clinic of the Mina RHU  To strengthen the referral system between the Iloilo Provincial Hospital in Pototan and the municipalities comprising the Inter-Local Health Zone (ILHZ), particularly of pregnant and post- partum teens

Mina RHU provides pre-natal checkup, laboratory examinations, immunization, and vitamin supplementation for all pregnant clients, but pregnant teens and other high risk cases are referred to the Iloilo Provincial Hospital (IPH) for the last two (2) pre-natal consultations and delivery. After delivery, clients are referred back to the RHU for post-natal follow up and well-baby checkup and immunization. By strengthening linkages between the municipalities that are part of the inter-local health zone and the main referral hospital, Mina RHU hopes to ensure safe deliveries and the health of mothers and their babies. By convening a municipal youth development council, Mina RHU hopes to consolidate efforts to prevent early sexual activity, unintended pregnancies, and the spread of sexually transmitted infections. Specifically, the council will spearhead activities for broader dissemination of AYRH information to in-school and out-of-school youth of Mina. One of these is the youth camp planned for the summer break.

4. Establishment of the Tacloban City Service Delivery Network (SDN) On November 8, 2013, typhoon Haiyan (Yolanda) damaged many health facilities of Tacloban City, which resulted in the disruption of health service delivery. The damages sustained required the restoration as well as

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 29 improvement of the delivery of health services in Tacloban City. This required the construction and rehabilitation of health facilities as well as re-establishment of the SDN. The SDN is a network of health providers that deliver health care services in an integrated and coordinated manner in order to address the health needs of a priority population. An initial meeting to formally create the Tacloban City SDN Steering Committee (SC) and Technical Working Group (TWG) was conducted last Jan 21, 2015 at the Tacloban City Mayor's board room. This was attended by Tacloban City officials headed by the city administrator, DOHRO 8 officials headed by the Regional Director, USAID officials headed by the Deputy Head for Office for Health, PhilHealth 8 Officials headed by the Assistant Vice president, Health Policy and Development Program (HPDP) staff and VH staff. The Tacloban City Health officer and the Chief of the Tacloban City Hospital (TCH) also participated in the meeting. Issues and concerns on the delivery of health service and the reimbursement of PhilHealth benefits were the main focus of discussion. After the meeting, a rapid appraisal of the health facilities in the SDN was conducted by HPDP. In Tacloban City, the SDN will focus on MNCHN/FP and will include public and private health providers who are available and accessible to the priority population comprising of poor households. The core network of facilities of the SDN includes the Tacloban City Health Office (TCHO) and 7 District Health Centers (DHC). In addition, private clinics and hospitals will also be included in the network. The newly-rehabilitated TCH will be designated as the main hospital referral center of the Tacloban City SDN. On the other hand, the DHCs and the other private clinics and hospitals will provide primary services including normal deliveries and refer complicated cases to TCH and other suitable facilities. The second meeting was conducted Feb. 25, 2015 attended by the same group of people during the initial meeting. The members of the SC and the TWG were finalized and the tasks of each member were clarified. It was discussed that the designation of TCH as main referral center will require critical improvements in the clinical and hospital management capacities of the facility. Some of these improvements include hiring of surgeon and anesthesiologist, developing guidelines for pricing of services, private practice by specialists, sharing of hospital revenues, and setting up the system for hospital finance and accounting as well as billing, collection, and filling of claims. Implementing these improvements will require investments from the City Government in order to hire additional personnel, pay for consultancy services, acquisition and maintenance of necessary equipment. Likewise, the operation of DHCs as primary providers and referring facilities also need to be improved. For this, the City Government needs to invest in the deployment of CHTs, upgrading of facilities and equipment, hiring of additional personnel, and procurement of necessary commodities. One of the recommendations was for the City Government to develop a business plan. The business plan will provide strategy or direction in allocating scarce resources in the most efficient and effective way possible. The plan will also provide a roadmap on how the TCH and the DHCs can be organized, managed, and financed to ensure efficient operations and long- term sustainability of the SDN.

5. US Ambassador's visit (Feb. 5, 2015) U.S. Ambassador Philip S. Goldberg together with Gloria D. Steele, Mission Director, USAID/Philippines, and Ms. Reynalda Perez, Project Management Specialist, USAID/Philippines visited Governor Celestino Gallares Memorial Hospital (GCGMH) in Tagbilaran City to observe implementation of USAID-assisted health interventions at the hospital. GCGMH is a tertiary level government hospital under the direct supervision of DOH. It has an intensive care unit, operating room, and capability to provide surgery, internal medicine, pediatrics, and obstetrics and gynecology services. The hospital is the only teaching and training hospital in the island of Bohol. GCGMH is a certified family planning provider, including tubal ligations. It sustained minimal damage during the October 2013 earthquake and services were not disrupted.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 30

USAID assistance to GCGMH includes:  Capacity Building on Long-Acting Reversible Contraceptives - USAID, through the VisayasHealth project trained GCGMH staff on the provision of family planning services, including, tubal ligation, post-partum Intra-Uterine Device (IUD) and Sub-dermal Implants. From June 2013 to December 2014, GCGMH served 445 family planning clients. The facility now offers an expanded range of family planning methods to women thereby increasing family planning acceptor rates and improving the health of women and families. USAID also facilitates distribution of contraceptive supplies to ensure their availability in the health facility, as the supply chain is frequently disrupted and there are frequent commodity stock outs at the local level.  Program for Young Parents Center - The Program for Young Parents (PYP) seeks to ensure that pregnant teens receive appropriate health information and services. Teen mothers are at heightened risks for pregnancy and child birth complications because of their under developed bodies. Additionally, their children are at greater risk of being underweight at birth. USAID’s VisayasHealth Project’s health facility assessment indicates that approximately 10 percent of deliveries are among women below 18 years old. USAID through the VisayasHealth project provides:(1) training assistance to staff on communicating with adolescent clients; (2) guidance to develop hospital protocol for young parents; (3) orientation for all hospital staff on the protocol and provision of adolescent-friendly services; and (4) refurbishing of designated areas to achieve a more adolescent-friendly atmosphere.  Usapan Sessions - Prospective family planning clients are reached through the conduct of Usapan (guided conversations) sessions where the client is educated on all family planning options and guided to make an appropriate family planning decision, based on their own circumstances and preferences. USAID trained 52 GCGMH staff members on facilitating Usapan sessions. To date, they have conducted 27 Usapan sessions and reached 565 clients. Although the visit was only for 20 min., the Ambassador and the other guests were bombarded with information by the Chief of Hospital and other concerned hospital staff on USAID's assistance to the hospital particularly for MNCHN/FP services. Simultaneously, the guests visited the OB ward and the PYP Center of the hospital.

6. DOHRO 6 and DOHRO 7 Financial Grants to POPCOM for AYRH VisayasHealth provided technical assistance to PopCom Regional Offices to access grants from the respective DOHROs. Meetings were conducted by VH to the respective PopCom Regional Offices which were more than willing with great enthusiasm to access funds for its AYRH activities. DOHRO 6 and PopCom 6 signed a Memorandum of Agreement (MOA) allocating Php3M from its 2014 Supplemental budget for 1 year of implementation, management and mobilization of young people programs in Region 6. PopCom whose mandate is for demand generation, will implement activities and projects that will increase the access of young people to information and education on sexuality and reproductive health using DOH-approved modules and materials. Its activities include the dissemination of Young Adults Fertility and Sexuality Survey 4 (YAFSS 4) results for Western Visayas at the provincial level; training of young people as facilitators of the U4U Teen Trail; training of teachers on the use of POPDEV exemplars for integration of population and reproductive health concepts in high school 8 key learning areas; and mobilization of health service providers during USAPAN FP sessions among NHTS/CCT beneficiaries. In Central Visayas, DOHRO 7 allocated Php1.8M to PopCom 7 implementing AYRH activities for 1 year. To facilitate the signing of the MOA, PopCom 7 submitted to DOHRO 7 a list of AYRH training activities that will be financially supported by DOHRO7. 7. PSI Team Training Approach The DOH standard guidelines on training for the provision of PSI allowed only Physicians to be trained and to provide the service. VisayasHealth has successfully conducted several PSI courses in the 8 project sites

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 31 since April 2014. However, during the conduct of trainings and post training monitoring and evaluation, the need to train the nurses/Midwives was identified, to assist the doctors in the screening, counseling and provision of post insertion instructions. More importantly, there was a need for them to keep track on the inventory and prompt and accurate reporting of related issues and concerns e.g. stock outs/ reporting of clients with adverse effects. Thus, starting December 2014 VH adapted the team approach (Doctors and Nurses or Midwives) training for PSI which was welcomed by the participants.

8. Accreditation of VH as a Training Center Pursuant to Sections 6.02 and 6.04 of the implementing rules and regulations of the Responsible Parenthood and Reproductive Health (RPRH) Act of 2012 (RA 10354), the DOH shall develop guidelines to ensure the training of the SDN skilled health professionals to meet the required clinical competencies. In the process, it may certify specific institutions, whether form the government or from the private sector, to deliver training services. To comply with the RPRH law, the DOH issued Administrative Order NO. 2014 - 0041 "Guidelines on the Recognition of Family Planning Training Providers of the DOH" for the DOH to facilitate a process for recognizing potential trainers for modern FP methods. The training processes for the following courses are in place: FP CBT 2 BTL-MLLA, FPCBT2 NSV, FPCBT2 IUD, FP CBT2 for Subdermal Implants and FPCBT 1. Work is still to be done for new program methods including FP CBT2 PPIUD, FP CBT2 FP Backup Course for Physicians, and the Training of Trainers for these courses. The objectives of this order are as follows:  Increase the number of available service delivery points that can provide quality FP services.  Install a process for DOH to build up a next generation cadre of trainers.  Ensure that this process allows DOH to maintain an acceptable level of quality of its FP training providers. After the administrative order was signed and issued out sometime Nov., 2014 , VH submitted to DOHROs 6, 7 and 8, application of EH for certificate of recognition as training center of DOH for modern FP methods. DOHRO 8 has already signed and issued the certification. With the certification as training center, we can now recommend trained HSPs to DOH for post training evaluation (PTE) and issuance of certificates of completion.

9. Efforts to reduce stock-outs Since the start of the project, one of the major concerns in FP program implementation is the frequent FP commodity stock-outs experienced by health facilities. VH initially provided assistance to the DOH in addressing this concern by facilitating the distribution of commodities to the local health units by the provincial health office through the provision of transportation services. DOH then developed a new distribution system by hiring a new forwarder to deliver the commodities directly to the local health units without passing through the regional and provincial health offices. So for this quarter, the commodities were delivered directly to the local health units reducing stock outs in these facilities. However, the hospitals were not included in the allocation list for FP commodities. VH met with the Visayas DOHROs top officials to discuss this matter and to recommend that the VH provincial coordinators in coordination with the DOH Development Management Officers visit the local health units to check on the status of the FP commodities. If there is overstocking of commodities, then overstocked commodities should be redistributed to other facilities especially the hospitals. Some facilities may have been allocated commodities not appropriate to their facility in the absence of a trained health service provider. In these cases, the commodities should be redistributed to a facility with a trained health service provider who can appropriately dispense the commodities. The DOHROs gave the go signal for VH to assist in the redistribution of these commodities.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 32

10. Resupply of Implants from PSRP The continuous supply of the progestin sub-dermal implant is critical in the training of service providers and meeting the needs of the increasing number of clients. In the first year of the VH project implementation before the start of the training activities for PSI, VH was provided with 20,000 units of implants by UNFPA through the Philippine Society for Responsible Parenthood (PSRP). These were distributed to the health service providers who were trained in PSI in the eight provincial project sites. For this quarter, the supplies dwindled to a very critical level that limited our capacity to support the training needs and service delivery activities by trained providers in their clinics and during health events. While the DOH has already purchased 700,000 units of Subdermal Implant, it could not be distributed yet as the new supply has to undergo quality testing by batch by the Food and Drug Administration (FDA) as required by Law. VH requested for additional supply from PSRP. Fortunately, UNFPA has given PSRP additional 200,000 units of Implanon® NXT and endorsed our request to PSRP. 15,000 units of implants were delivered to us.

11. Conduct of PPIUD study "Factors Associated with Good Performance of PPIUD Trained Providers in the Visayas, Philippines" PPIUD insertion is the first family planning technology introduced by VisayasHealth during its first project year in 2013. From June 2013 to October 2014, VisayasHealth trained a total of 79 providers on PPIUD insertion in five (5) batches. Over 18 months, the 79 trained providers reported a total of 3,489 PPIUD insertions, or an average of 2.5 per month per provider. This is a dismal performance given the resources that go into each training course and participant. To understand factors related to the widely variable outputs of its trained providers VisayasHealth conducted a follow-up study of its PPIUD trainees in February 2015. A total of 58 PPIUD trained health providers were interviewed: 23 doctors, 11 nurses and 24 midwives. Based on the reported PPIUD insertions per month, 29 respondents (51%) are performers while 28 (49%) have less than 2 monthly insertions or were unable to make any insertion at all. Preliminary analysis showed four factors with significant association with performance:  Trained providers who came from facilities with deliveries of more than 20 per month were 2.5 times more likely to perform.  Those who reported they were confident to provide the service after the training were 2.6 times more likely to perform.  Those who perceive that the number of insertions during training were adequate were 1.8 times more likely to perform.  Providers who perceived they were adequately trained were 4.6 times more likely to perform. Future training courses should ensure that trainees are recruited from facilities with adequate number of deliveries; this is to ensure that trainees have enough opportunities for insertions on actual cases post- training. The number of required insertions should be informed by the actual competence of each trainee. Each trainee should be required to continue PPIUD insertions during practicum until he/she is assessed as competent by the trainer. To allow this, fewer providers should be trained in each batch. The importance of post training follow up, although not significant as of this time, cannot be overemphasized. Follow-up visits and regular monitoring of the trainers has been constantly mentioned as one of the post-training support that would have been beneficial to PPIUD performance.

12. Collaboration with the MLGP (Municipal Local Governance Program) of the Zuellig Family Foundation ZFF is presently implementing the MLGP in the provinces of Samar and Iloilo. The MLGP is designed to mobilize support from local chief executives for the MNCHN/FP program. One of the activities organized by ZFF is an orientation program for the mayors and municipal health officers in the participating provinces. VH shared its experiences and lessons learned in enhancing supply especially in expanding the family

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 33 planning choices to interested clients. In addition, VH also shared its demand generation strategy based on its experiences in the conduct of group education sessions (Usapan). Finally, VH shared some practical tips in ensuring compliance to the principles of Informed Choice and Voluntarism (ICV).

13. Training on Applied Supportive Supervision The Province of Southern Leyte spearheaded by the Provincial Health Office and the DOH/DMO conducted its 3rd batch of Applied Supportive Supervision covering the InterLocal Health Zones of Pacific and Panaon. This was conducted on January 27-29, 2015 at Kissbon Cove, Saint Bernard, Southern Leyte. A total of 13 PHNs of the member LGUs participated in the training. It is expected that the data that will be presented during the local program reviews of the member LGUs in the Panaon and Pacific ILHZs as part of the Applied Supportive Supervision will be the cleaned data after the TOT on Data Quality Check for selected MNCHN/FP indicators based on the 2012 FHSIS was conducted by DOHRO8 in coordination with VisayasHealth.

14. Training of Trainers (TOT) on Data Quality Check on selected MNCHN/FP Indicators based on the 2012 FHSIS The Department of Health Regional Office 8 (DOHRO8) with technical assistance from VisayasHealth conducted 3 batches of TOT on Data Quality Check on selected MNCHN/FP - based on the 2012 FHSIS for all provinces in the region. The 1st batch was conducted on March 11-12, 2015 at Ritz Tower, Tacloban City and was attended by the Leyte Provinces and its cities of Ormoc and Tacloban. Batch 2 was conducted on March 17-18, 2015 at the Asia Stars Hotel, Tacloban City for the Provinces of Southern Leyte, Eastern Samar and Biliran. Batch 3 was conducted on March 19-20, 2015 at Asia Stars Hotel, Tacloban City for the Provinces of Western and Northern Samar. All these batches were attended by respective PHO technical staff and the assigned DOH/DMOs of the province. Action plans were developed per provinces that specify the schedules and venues of the roll-outs. As agreed, the actual data quality checks will be conducted within 1 month after the training. At the provincial/municipal levels, VH will provide technical assistance and ensure a quality data check. As one of the activities in the re-establishment of Tacloban City Service Delivery Network (SDN), training on DQC was conducted for Tacloban City Health Office which is composed of five District Health Centers (DHCs) manned by a doctor, nurses and midwives. The training on March 4-6, 2015 at Hotel Lorenza, Tacloban City was attended by 25 participants from the CHO and 5 DHCs. Agreements for the next steps include the masterlisting of the FP current users by the BHWs since the records were destroyed during super typhoon Yolanda.

15. Training on SMS and Google Sheet Tools To address the gaps in the logistics management system within the Department of Health and the LGUs, and ultimately to minimize the prevalence of stock-outs in service delivery points (SDPs), the USAID-funded Health Policy and Development Project (HPDP) implemented by UP-Econ Foundation proposed the use of the SMS and Google Sheet tools. The SMS tool will provide real time reporting of stockouts while the Google Sheet tool will monitor the current status of stocks and will automatically flag if status is lower than the buffer stocks. Two VH technical staff attended the orientation/training on March 26, 2015 at the LuzonHealth office, Tycoon Bldg., Ortigas Center, Manila. This intervention is expected to be an interim solution to the logistics problem while a more permanent system is being developed. It was agreed that collection of the data will start immediately. VisayasHealth conducted a preliminary orientation on the system to the field staff (PCs and RTAs) last March 25, 2015 via GoToMeeting web session. HPDP is also scheduled to conduct a web meeting for the final version of the SMS and Google Sheet tools this coming April 21, 2015. All field staff are expected to attend the said orientation.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 34

B. Planned Major Activities In The Next Quarter

1. RPRH Champions Recognition Day on May 7, 2015 In the Visayas, the VH project is fortunate to partner with a number of providers who have not only demonstrated high levels of performance in their localities but have also gone out of their way to help and motivate other providers as well. These local champions are an important resource for a program that does not have a lot of manpower at the national and regional levels. The local champions can be mobilized to carry out a number of activities including but not limited to:  Serve as mentors to other providers  Assist in generating clients during clinical training courses  Provide venues for technical exchange among health providers  Serve as technical resources during contraceptive updates  Introduce innovative approaches to program implementation  Participate in other knowledge management activities In recognition of the value of local champions, VH is organizing a recognition day that would introduce these local champions to the DOH and other relevant government agencies. The recognition day is also an opportunity for the national government agencies to mobilize these champions for the program. The objectives of this recognition day are:  To recognize the RP-RH champions and discuss how the RP-RH Champions can be mobilized to support the family planning program  To share the champions' experiences/stories that feature how they were able to overcome problem/challenges that they faced  To recognize these good practices/success stories for other interested health service providers to apply similar interventions in their respective areas.

2. Local Chief Executives (LCE) Forum VH will convene the local chief executives of Leyte in June to provide a venue for the LCEs to discuss and share experiences on PHIC reimbursements and incentive schemes. The participants will be the officers and members of the Mayors league in Leyte.

3. Visit of Ms. Pamela Barnes - May 4-8, 2015 Ms. Pam Barnes, CEO of EngenderHealth, will be visiting the Philippines particularly Manila, Cebu and Iloilo. In Iloilo, she will be meeting the Midwives' association and visit the adolescent projects in Mina Rural Health Unit and Iloilo Provincial Hospital. In Cebu, she will attend the RPRH Champions Recognition Day and meet with VH staff and other DOH and USAID key officials. In Manila, she will be meeting with the Secretary of Health and USAID officials.

4. Hiring of Business Plan Consultant One of the recommendations was for the City Government to develop a business plan. The business plan will provide strategy or direction in allocating scarce resources in the most efficient and effective way possible. The plan will also provide a roadmap on how the TCH and the DHCs can be organized, managed, and financed to ensure efficient operations and long- term sustainability of the SDN. VH will hire a Business Plan Consultant to facilitate the conduct of strategic planning workshop for Tacloban City Health staff both from the City Health Office and the Tacloban City Hospital and to facilitate the formulation of the Business plan for the Tacloban City SDN.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 35

5. NSV training - April 14-15, 2015 This will be the first of a series of VH initiated NSV training and this will be conducted in Don Emilio Del Valle Memorial Hospital, Ubay, Bohol. Five participants from the some municipalities of Bohol are expected to be trained by 3 local trainors and 1 VH trainor.

6. Visit of Sanjida Hassan Dr. Sanjida Hasan, Clinical Adviser for EngenderHealth Clinical Support Team will visit Cebu on the second week of June. The purpose of the visit is to provide technical assistance for the PPIUD training for service providers in Iloilo Provincial Hospital. She will also provide technical assistance in the conduct of post training monitoring and evaluation.

7. Issuance of certificates of recognition of EH as training center of DOH for modern FP methods and issuance of certificates of completion/proficiency to trained HSPs. DOHRO 8 has already issued to EH the certificate of recognition as training center of DOH for modern FP methods. For the next quarter, VH will follow up the issuance of this certificate from the DOHROs 6 and 7. Once the certificates of recognition are issued, VH will fast track the certification of completion/proficiency of trained FP providers. An orientation of FP providers on processes for accreditation and claims reimbursement by PhilHealth will then be conducted.

8. SMS pilot study in Naga During the Usapan session, each participant receives an Usapan Action Card which serves as a discussion aid and take home motivational material. It has a detachable portion where pregnant mothers can signify their concurrence to receive messages on their mobile phones. The messages are intended to reinforce reminders to submit to ANC on the specified dates, as well as other messages to promote healthy pregnancy and delivery, including: facility-based delivery; exclusive breastfeeding ; process and requirements for availing of Philippine Health Insurance (PhilHealth) benefits; pregnant mothers and infant immunization schedule; and modern contraceptive methods. VisayasHealth employs multiple, mutually reinforcing approaches to communicate and reiterate messages to clients: interpersonal, group and individual counseling, information materials as well as SMS. Since this is the first time that SMS technology is being used to encourage compliance with health practices, this study seeks to determine whether and to what extent SMS contributes to ANC, FBD, SBA, PPFP, and EBF.

9. Data Quality Check DQC will be conducted on selected MNCHN/FP indicators based on the 2012 FHSIS for the provinces of Cebu, Iloilo and Negros Occidental between May - June 2015.

10. Supply Management and Recording System VH will assist DOH in conducting the SMRS Training of Trainors for Regions 6, 7 and 8 in June, 2015.

C. New Opportunities For Program Expansion

• High Impact Breakthrough Process The newly appointed Secretary of Health recently announced the program thrusts of her administration and this includes the High Impact Breakthrough (HIB) Process. The HIB focuses on five major concerns namely: Maternal Health, Infant Health, Under Five Health, HIV/AIDS and Service Delivery Network (SDN). The DOHROs were instructed to come up with model plans for the five concerns and shouls be able to come up with results after 15 months, before the end of the present administration.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 36

VII. Financial Reports

SUMMARY OF FINANCIAL REPORTS Fiscal Year 3, Quarter 2 (1 January – 31 March 2015)

Table 25. Itemized Project Expenditures (USD) Expenditure This Quarter Cumulative Total Cumulative % of Amount at LOP Expenses Expenses Cost Items Month Month Month End of This of Previous Based on Oct 2014 Nov 2014 Dec 2014 This Quarter Quarters the LOP Quarter Labor + Fringe Benefits 452,326 172,338 43,889 59,619 57,676 333,522 73.73% Travel and Transportation 664,334 322,534 33,462 13,821 96,466 466,283 70.19% Project Activities Sub-grantees/ sub-contractors 164,370 85,132 19,779 39,521 144,432 87.87% Other Direct Costs 232,542 64,741 28,489 30,736 38,006 161,972 69.65% Indirect Costs 415,508 157,541 53,428 53,026 90,187 354,182 85.24% TOTAL 1,929,080 802,286 159,268 176,981 321,856 1,460,391 75.70% NOTE: The amount for Travel & Transportation includes the Project activities

Table 26. Provincial/City Expenditures Costs of Activities Per Province Logistics Others (please Total Province/City (equipment, TA Training specify) Expenditure supplies, Disaster Relief materials) Ilo-ilo 7,012 5,879 12,891 Negros Occ 2,310 2,809 5,119 Bohol 4,051 14,819 18,870 Leyte 5,552 10,286 15,838 Southern Leyte 3,345 5,113 8,458 Northern Samar 1,143 4,421 5,564 Western Samar 3,867 2,891 6,758 Cebu ( Province & 9,398 27,282 36,680 Tri-Cities) TOTAL 36,678 73,500 110,178

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 37

VIII. Success Stories / Highlights

• Building doctors’ post-training confidence through extensive practice. The lack of confidence has been the common concern among the doctors right after completing the training course in PSI insertion. The doctor trainees of Negros Occidental were no exception. In this, VH project team organized a series of PSI ambulatory service provision events in cooperation with the Negros Occidental Provincial Health Office. The team, composed of 6 of the 21 project-trained doctors was given the opportunity to harness their skills in cities that have yet to have PSI-trained providers such as Sipalay and Silay cities. Through these events, the doctors claimed increased confidence in providing the service. The team’s effort contributed to the total of 1,682 insertions that were recorded from July 2014 to January 2015. This effective strategy has also been duplicated in Iloilo Province for the VH-trained doctors there as well.

Dr. Marc Leong of from Teresita L. Jalanadoni Provincial Hospital (left), Dr. Raul Fama of Talisay City (middle), and Dr. Edmundo Janeo of E.B. Magalona all profess that their confidence level in providing progestin only subdermal contraceptive implant. The three doctors cut a 26% performance out of the total of 1,682 insertions made by all 21 doctor trainees in the province. (LTitular/EngenderHealth)

 Initiatives for mothers at a regional hospital in Bohol get thumbs up from US Ambassador. The Gov. Celestino Gallares Memorial Hospital (GCGMH), the largest hospital in Bohol Province recently received its latest nods of approval from no less than US Ambassador to the Philippines Phillip Goldberg. At his visit to Bohol last February, Mr. Goldberg witnessed an Usapan (conversations) counseling session for postpartum mothers at the Obstetrics Room and then toured GCGMH'S Program for Young Parents (PYP) Center. Head of Obstetrics Dr. Delia Maluenda explained that the PYP and the conduct of Usapan were made possible with USAID assistance through the VisayasHealth Project. GCGMH staff received additional training for the provision of maternal, newborn and child health and nutrition/family planning (MNCHN/FP) services. GCGMH attends to at least 40 mothers daily -- 10% of these, aged 19 years old and below. The efforts to reach out to adolescents received two thumbs up from the visiting envoy.

US Ambassador Phillip Goldberg witnessed a nurse facilitating an Usapan session for post-partum clients at the GCGMH OB Ward (left and middle photos). Extreme right photo shows the ambassador listen to GCGMH Head of Obstetrics Dr. Delia Maluenda (foreground, right) talk about USAID assistance on building the capacity of GCGMH for the provision of FP services through the VisayasHealth Project. (Photos by JLicardo/EngenderHealth)

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 38

 DOH RO6 awards 3M grant to POPCOM to implement adolescent & youth reproductive health program. In response to the alarming increase in teenage pregnancy, the Department of Health of Region 6 (DOH RO6) decided to engage the services of the Commission on Population Office (POPCOM 6) for the management and implementation of adolescent and youth reproductive health programs in the region. In the Memorandum Of Agreement signed on December 29, 2014, the Php 3,000,000 grant will be utilized to fund activities and projects that are designed to increase access to youth- oriented, reproductive health, information and services. These activities * include U4U Teen Trail and the conduct of Family Development DOH Region 6, represented by Regional Sessions wherein, group education sessions using the Usapan Director Marlyn Convocar signs the (Conversations) series will be conducted. USAID-funded VisayasHealth Memorandum of Agreement with POPCOM VI Director Alfred Marshall Project paved the way for this award by triggering discussions on ways affirms the appropriation of funding to of fast tracking utilization of DOH regional funds. support youth health programs in Western Visayas. *U4U is an inter-active awareness raising activity facilitated by trained youth peer (MJDichosa/EngenderHealth) facilitators among young people to provide them with information on health and responsible sexuality. The module covers such areas in youth development such as body image and self-concept/awareness, confidence, sexuality and romantic relationships.

 A pregnant moms’ health fair with a wellness twist. Midway through the Women’s Month Celebration, the municipal and health offices of Liloan, Cebu organized with the VisayasHealth Project (VH) and the Department of Health VII, a health fair for pregnant women. A total of 243 pregnant mothers aged 14-40 years old gathered on March 19, 2015 to hear messages on safe pregnancy, exclusive breastfeeding for newborns up to 6 months, and healthy spacing between pregnancies. The half day event was also highlighted by free makeover and massage services as well as free blood sugar and blood pressure checks offered by nurses, community health volunteers, and a town council member. Liloan Mayor Duke Frasco and his wife Atty. Christine Garcia-Frasco in their separate messages emphasized that health and wellness are intertwined in the administration’s thrust towards women’s health and hailed the event as a milestone that paved the way for healthier moms and babies and commended USAID through its funded project – VH, for being responsible for inspiring his administration to give more importance to women’s health.

Unique to the health fair for pregnant women in Liloan is the inclusion of wellness services as hair trim & styling, hand & foot massage, and makeup by nurses, community health volunteers, and a town council member Edna Cala (3rd photo from left). Blood sugar and blood pressure checks were also offered at the event (extreme right). (CAlfafara/EngenderHealth)

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 39

 271 men participate in male-oriented RH/FP forum in Iloilo. Male involvement is a critical element of the Reproductive Health/ Family Planning program that oftentimes gets little attention from program managers and providers. Recognizing the importance of male participation and involvement, the municipality of San Joaquin, Iloilo organized such a forum with the support of USAID through the VisayasHealth Project. The meeting was specifically designed to actively engage men in meaningful discussions about reproductive health rights and services. A total of 271 men aged 20-50 years old came and actively participated in the discussions about their fertility intentions and ways of achieving their desired family size. One appreciative participant claimed that the activity enlightened him about the different options available for couples interested to regulate their fertility and expressed the wish that the health care providers in San Joaquin will continue to involve men in the provision of reproductive and maternal and child health services.

At the plenary session, Iloilo 1st District Congressman Richard Garin encouraged men to take a more active role in their spouse’s reproductive health and in family planning saying, “it is for (your) better life”. He also emphasized his own slogan that communicated advocacy towards responsible parenthood as part of responsible governance.

(Photos by MJ. Dichosa and M.Rodriguez /EngenderHealth)

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 40

X. Communication and Outreach

This section presents communication activities and products intended primarily to communicate to the USAID Projects’ internal publics, e.g., USAID/Philippines, USAID/Washington) and external publics e.g., stakeholders and target project beneficiaries; what USAID is doing to contribute to attaining health development goals. (Copies/snapshots of the communication products may be attached as an Annex).  Usapan Sessions VisayasHealth adapted the Usapan session initiated by the PRISM 2 project. The Usapan session is a guided small group discussion participated in by homogenous groups, for example, women with similar family planning intention, pregnant women, and men. A key feature of the Usapan is the immediate provision of family planning services and/or supplies to clients who signify their desire to use contraceptives.

To date, 2,845 health service providers have been trained to facilitate Usapan and 162,586 clients have been reached.

Table 27. Clients Reached Through Usapan Sessions

No. of Usapan Sessions Total No. of Clients Total No. of Area Conducted Reached Providers Trained as of March 2015 as of March 2015

Visayas 2,845 16,561 162,586 Iloilo 263 2,579 22,591 Negros Occidental 471 572 9,162 Bohol 700 805 9,092 Cebu 614 2,537 21,197 Tri-Cities 138 4,866 38,190 Leyte 223 1,478 18,656 South Leyte 201 738 8,548 Samar 99 916 8,336 North Samar 136 2,070 26,814

 sms Reminders Participants in Usapan sessions receive Action Cards that serve as discussion guide and take home material. The Usapan Action Card has a detachable portion where pregnant mothers can signify their concurrence to receive messages on their mobile phones. The messages are intended to reinforce reminders to submit to ANC on the specified dates, as well as other messages to promote healthy pregnancy and delivery, including: facility-based delivery; modern contraceptive methods; exclusive breastfeeding; process and requirements for availing of PhilHealth benefits; pregnant mothers and infant immunization schedule; etc. Implementation of this intervention was suspended in April 2014 to give time for operations research to determine its effectiveness in bringing about the desired health behaviors among clients. VisayasHealth has finalized the research protocol for the study which will be conducted beginning the third quarter of this implementation year. In this connection, the project will resume sending out sms reminders.  Buntis Celebration Another way of reaching out to pregnant women is through health events, especially the Buntis Celebration. Pregnant women are feted in a baby shower with the special objective of imparting important health messages to pregnant women in a fun, non-threatening environment through games. For example, the

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 41 importance of keeping documents like the PhilHealth Card and Mother-Baby Book is emphasized in a game of Bring Me; messages on maternal and child health and nutrition is conveyed through Make the Right Choice; and participants learn about the different family planning methods through Family Planning Feud. Fathers also get into the fun and learn ways to support their wives/partners through a relay game Getting Ready for the Big Day. And to encourage exclusive breastfeeding for the first six (6) months, Breastfeeding TSEk is played. For this quarter, 12 health events were conducted that reached 2,095 clients. Table 28. Health Events No. of Health No. of Clients Area Events Reached Jan - Mar Jan - Mar Visayas 12 2,068 Iloilo 2 187 Negros Occidental 0 0 Bohol 2 756 Cebu 2 279 Cebu City 2 181 Lapu-Lapu City 0 0 Mandaue City 1 178 Leyte 0 0 South Leyte 1 172 Samar 2 315 North Samar 0 0

 Reaching Out to Adolescents The VisayasHealth Project's primary intervention for adolescents is the Program for Young Parents (PYP). The PYP is a hospital-based intervention patterned after the Teen Moms Program of the University of the Philippines -Philippine General Hospital (UP-PGH). The PYP seeks to:

 Promote joint responsibility and gender sensitivity  Provide holistic care to young mothers and their babies (pre and post natal, including immunization)  Promote facility-based deliveries (PhilHealth MCP)  Prevent rapid repeat pregnancy/healthy timing and spacing of births (long acting reversible contraceptives)  Promote exclusive breastfeeding for at least six (6) months The PYP Centers: • Provide a dedicated day for antenatal consultations for mothers below 19 years old • Designate a space for counseling and health education classes following the national standards set by DOH on the provision of Adolescent-Friendly Health Services • Enroll target clients who submit for antenatal consultations, deliveries, post-natal care and essential intra- partal and newborn care (EINC) in the PYP • Engage husbands and partners who accompany their wives/girlfriends when they avail of obstetric and pediatric services • Emphasize joint responsibility and gender sensitivity during provision of services

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 42

• Reach out to other significant adults (mother, mother-in-law, guardian, care giver) by involving them during health classes and group counseling • Apply interactive educational sessions to reach out to teen mothers, their partners, and significant adults • Involve the Breastfeeding Support Group/s in each of the facilities to promote exclusive breastfeeding The VisayasHealth Project developed a pre-engagement checklist to help field staff determine the readiness of a facility to be engaged for the PYP. The PYP is designed for facilities with high volumes of deliveries, particularly among women less than 19 years old. It is important that key stakeholders in the hospital management recognize the need for an intervention to address the concerns of young, pregnant mothers, their partners, and significant adults. Once the facility signifies their desire to set up a PYP in their facility, the VisayasHealth Project conducts and orientation on the intervention and provides technical assistance to help the facility identify a core PYP Team. Thereafter, the VisayasHealth Project conducts Dealing with Adolescent Clients training for the members of the PYP Team. This training adheres closely to the DOH- approved Adolescent Job Aid (AJA). In addition, sessions on gender sensitivity and values clarification have been incorporated.. Emphasis is given to compliance with the DOH Standards for Adolescent-Friendly Health Services or AFHS. Thereafter, facilities are guided through the process of developing their respective protocols for the provision of AFHS. Once finalized and approved by hospital management, all hospital staff are oriented on the protocol to ensure that all hospital personnel are aware of the protocol and are primed to provide adolescent-friendly health services. Further, facilities are assisted in transforming the spaces they identify for the PYP into more adolescent-friendly spaces in compliance with the DOH AFHS Standards. For this quarter, Dealing with Adolescent Clients was conducted for the province of Cebu and the Cebu Provincial Health as well as the Tri-Cities of Cebu, Mandaue, and LapuLapu. This brings the total number of hospital staff trained on Dealing with Adolescent Clients to 137.

Table 29. Dealing with Adolescent Clients (AJA) Training Province of Cebu 21 to 22 January 2015 Summit Circle Hotel, Cebu City Bantayan District Hospital 5 Cebu Provincial Hospital - Bogo City 3 Cebu Provincial Hospital - Carcar City 5 Cebu Provincial Hospital - Danao City Cebu Provincial Health Office 3 Sub-Total 21 Tri-Cities 11 to 12 February 2015 Summit Circle Hotel, Cebu City Saint Anthony Mother and Child Hospital 4 Cebu City Eversley Childs Sanitarium and General Hospital 10 Mandaue City Lapu-lapu City Hospital 7 Sub-Total 21 TOTAL 42

This quarter, three (3) PYP Centers were launched: Governor Celestino Gallares Memorial Hospital (DOH retained) in Tagbilaran City, Bohol on 30 January; Cebu Provincial Hospital - Danao City on 13 February; and Saint Anthony Mother and Child Hospital in Cebu City on 23 February 2015. In addition, the Rural Health Unit (RHU) of the municipality of Mina, Province of Iloilo formally opened its Adolescent and Youth Reproductive Health Center on 20 February 2015. RHU Mina is the main referring facility to the PYP Center in Iloilo Provincial Hospital in Pototan, Iloilo. During his visit to the GCGMH PYP Center on 30 January

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 43

2015, United States Ambassador to the Philippine Philip S. Goldberg expressed his appreciation for the efforts being exerted to reach out to adolescent clients. There are currently eight (8) PYP Centers. In addition to the above mentioned are Vicente Sotto Memorial Medical Center, Abuyog District Hospital, Iloilo Provincial Hospital, Eastern Visayas Regional Medical Center, Don Emilio Del Valle Memorial Hospital, PYP has been received with much interest and enthusiasm, particularly in areas that are experiencing many teen pregnancies. Meanwhile, the VisayasHealth Project is undertaking operations research to gather empirical evidence on the effectiveness of the intervention.

VisayasHealth is also supporting efforts of LGU partners to provide information and services to adolescents, such as, the conduct of sexuality education classes for 441 students of the Silvino Lubos Vocational High School. Since January 2015, the MHO of this geographically isolated and disadvantaged area in Northern Samar has recorded 33 pregnancies among girls 19 years old and younger, with the youngest 14 years old. There are also increasing cases of sexually transmitted infections. In Ubay, Bohol, the MHO has expanded the reach of the PYP Center to the community by partnering with eight (8) schools through Giya, Amoma, Sagop, Agak or GASA. As well, the project is partnering with the Tacloban City Population Office in the training of youth and peer educators in the community.

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 44

XI. ANNEXES Annex A

List of Products Developed in the Quarter

PRINT  Usapan Action Card for Men  Usapan Action Card for Women  Flyers (6 kinds)  (CHANGE)  Flip Chart (CHANGE)  GATHER Job Aid  (DOH)  MEC Wheel (WHO)  ICV Wall Chart  (USAID)  Usapan Attendance Sheet  Pregnancy Tracking Form  PYP Enrolment Cards (Facility)  PYP Enrolment Cards (Clients)  Project Brief

BELOW THE LINE COLLATERALS

 Eco-bag  Pregnancy Tracking Board  Delivery Tracking Board  Information Standees (4 types) (HealthPro)  Signage  Folder

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Table 30. General Description of Materials to be Produced / Published Communication Type of Material Ref Specifications Quantity Purpose Cost Channels No. PRINT Usapan Action Card for VH-1 Bookpaper 13,500 copies Discussion guide 1.00 PhP/copy Men 120 gsm, 13" x 8.5" Take home material PhP 13,500.00 Usapan Action Card for VH-2 Bookpaper 477,500 copies Discussion guide 1.00 PhP/copy Women 120 gsm, 13" x 8.5" Take home material 477,500.00 Flyers (6 kinds) VH-31-36 Bookpaper 6 types Take home 1.50 PhP/copy (CHANGE) 120 gsm 100 copies/type information material 540,000.00 11" x 8" 600 RHUs/DHCs /hospitals 360,000 copies Flip Chart (CHANGE) VH-5 C2S 120 lbs 240 Job aid 650.00 PhP/copy 14" x 9" RHUs/DHCs/hospitals 156,000.00 Metal Ring Binder 240 copies GATHER Job Aid VH-6 C2S 120 lbs 500/region Job aid 20.00 PhP/copy (DOH) Spread - 24" x 8.5" 3 regions 30,000.00 Folded - 8" x 8.5" 1,500 copies MEC Wheel VH-7 C2S 120 lbs 500/region Job aid 52.00 PhP/copy (WHO) Spread - 19.5" x 7.5" 3 regions 78,000.00 Folded - 7.5" x 7.5" 1,500 copies Die cut Metal eyelet ICV Wall Chart VH-8 Tarpaulin 600 Compliance with 78.00 PhP/copy (USAID) 24" x 37" RHUs/DHCs/hospitals ICV Guidelines 46,800.00 600 copies Attendance Sheet VH-9 Bookpaper 491,000 clients Record attendance in 1.00 PhP/copy 120 gsm 10 clients/page Usapan sessions 98,000.00 13" x 8.5" 2 copies @ 98,000 copies Pregnancy Tracking VH-10 Bookpaper 650 CHWs Track compliance 1.00 PhP/form Form 120 gsm 10/kit with ANC 6,500.00 13" x 8.5" 6500 forms PYP Enrolment Cards VH-15 C2S 120 lbs 22 PYP Centers Facility record 3.00 PhP/card (Facility) 8.5" x 5.5" 500 cards/PYP Center 33,000.00 11,000 cards PYP Enrolment Cards VH-16 C2S 120 lbs 22 PYP Centers Reminder for clients 3.00 PhP/card

VisayasHealth Quarterly Report ● January 1, 2015 – March 31, 2015 46

Communication Type of Material Ref Specifications Quantity Purpose Cost Channels No. (Clients) Spread - 6" x 3" 500 cards/PYP Center 33,000.00 Folded - 2" x 3" 11,000 cards Project Brief VH-18 C2S 120 lbs 500 pieces/site Advocacy material 5.00 PhP/copy 8.5" x 11" 11 project sites 27,500.00 Full color 5,500 briefs Eco-bag VH-4 Fabric 250 pax/Family Health Contain flyers given 35.00/bag 14" x 15.5" x 4" Fair away during Family 1,155,000.00 12 Family Health Fairs Health Fairs and 11 Sites Buntis Celebrations 33,000 bags Pregnancy Tracking VH-11 Tarpaulin 259 municipalities Track compliance 78.00 PhP/board Board 38" x 28" 5 BHS/municipality with ANC 101,010.00 1,295 boards Delivery Tracking VH-12 Tarpaulin 600 Track compliance 78.00 PhP/board Board 38" x 28" RHUs/DHCs/hospitals with FBD 46,800.00 Information Standees VH-13 Tarpaulin 22 PYP Centers Compliance with 1,400.00PhP/set (4 types) 33" x 72" 11 sites DOH AFHS 246,400.00 (HealthPro) Roll-up Frame 2 sets/site Standards 4 types 44 sets Signage VH-14 Sticker on sintra 22 PYP Centers Compliance with 1,290.00 PhP/set board DOH AFHS 28,380.00 As needed Standards Folder VH-17 Foldcote 500 pieces/site Advocacy material 15.00 PhP/folder Spread - 11 project sites 82,500.00 19" x 11.5" 5,500 folders Folded - 9.5" x 11.5" x .5" Die cut & scored TOTAL: PhP 3,200,090.00

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Annex B

ICV Compliance Semi-Annual Report (October 2014 – March 2015)

This records all activities related to compliance to FP and Abortion-Related Policies, such as, but not limited to, orientation sessions on Informed Choice, Voluntarism, and compliance monitoring tools, systems or activities.

Table 31: Technical Assistance, Inputs and Other Activities Number of

No. Date Location Specific Activity/ Participants Specific Remarks/Results/ Conducted By Whom Topic or Content M F Audience Outputs 10/13- 1 Cebu City Clinical Skills Training for PSI EH/VH 2 6 Doctors ICV Compliant 14/14 10/16- 2 Cebu Clinical Skills Training for PSI EH/VH 5 5 Doctors 17/14 10/23- 3 Cebu Clinical Skills Training for PSI EH/VH 1 6 Doctors 24/14 Clinical Case Conference & 11-20-21- 4 Cebu Skills Enhancement on EH/VH 14 29 Doctors 14 Implanon NXT Clinical case Conference & 11/10- 5 Tacloban City Skills Enhancement on EH/VH 7 13 Doctors 11/14 Implanon NXT Clinical case Conference & 11-27-28- 6 N. Samar Skills Enhancement on EH/VH 4 5 Doctors 14 Implanon NXT Clinical case Conference & 11-17-18- 7 Bacolod City Skills Enhancement on EH/VH 7 17 Doctors 14 Implanon NXT Doctor-2 10/7- 8 Tacloban PPIUD Training EH/VH/EVRMC 0 12 Nurse -1 10/14 Midwives-9 40 93

Total Number of Orientation/Training Activities conducted: 8 Total Number of Participants Trained or Oriented: 133 Males: 40 Females: 93

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Table 32. Summary Matrix of Service Providers/Facilities Monitored and Family Planning Clients Interviewed Steps Taken/ Results/Findings Recommendations Date Name/Designation FP Clients (please be as Name of Facilities Location of Facilities Monitored by (please provide as Monitored of Service Providers Interviewed detailed as much detail as possible) possible) 1. Moises Padilla Moises Padila, Negros No ICV Violations 10/09/14 Andrea Estacion- RN 0 Lucille Titular RHU Occidental Noted Rosalie O. Bancaya, Christine Bangilan No ICV Violations 10/17/14 2. Murcia MHO Murcia, N. Occidental 0 PHN (C. Bangilan) Noted 3. Cadiz City Health Cadiz City, Negros Ana Rosal-FP No ICV Violations 10/02/14 0 C. Bangilan Office Occidental Coordinator Noted 4. Escalante City Escalante. Negros No ICV Violations 10/09/14 1 C. Bangilan Health Office Occidental Noted 5. Pres. Carlos P. Pres. Carlos P. Garcia, Mr. Ogie Abad-PHN No ICV Violations 01/22/15 0 Minjel Naparete Garcia MHO Bohol Noted Further investigation showed the sister The sister allegedly only suggested that Ma. Rifrani T. Abella- 03/05/15 6. Dumanjug RHU Dumanjug, Cebu 1 Jaminnie Uy chose the method-BTL she had a BTL but RHM for her the client after the counselling decided to have the BTL Recommended to revive FP services & 7. Hilongos District Ms. Delia Lora, Chief Hermart Severino Only BTL during CS for DOH to include 11/2014 Hilongos, Leyte 0 Hospital Nurse (H. Severino) available Hospital for staff trng and supply of contraceptives Request Wall Chart 11/2014 8. Bato RHU Bato, Leyte Evangelina Salar, 0 H. Severino No FP wall chart and other IEC/BCC materials Recommended Ellen Grace Mantua, inclusion in list of 9. Baybay City 0nly Injectables and 11/2014 Baybay City, Leyte In-Charge FP 0 H. Severino facilities for Health Office PSI available Commodities contraceptive allocation No ICV Violation 11/2014 10. Hilongos I RHU Hilongos, Leyte Rizzalyn R. Paulo, NDP 0 H. Severino Noted 11/2014 11. Leyte RHU Leytre, Leyte Jean Cabi-ao, RHM 0 H. Severino No ICV Violation

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Steps Taken/ Results/Findings Recommendations Date Name/Designation FP Clients (please be as Name of Facilities Location of Facilities Monitored by (please provide as Monitored of Service Providers Interviewed detailed as much detail as possible) possible) Noted Bernadette B. Dulfo, H. Severino No ICV Violation 11/2014 12. Calubian RHU Calubian, Leyte 0 RHM Noted H. Severino No ICV Violation 11/2014 13. Mahaplag RHU Mahaplag, Leyte Dalisay Rufila, PHN 0 Noted Ernesto Olimberio, Clemence Tenedero No ICV Violation 10/02/14 14. Catubig RHU Catubig, N. Samar 0 PHN (C. Tenedero) Noted Norma E. balugo, C. Tenedero No ICV Violation 10/02/14 15. Bubolosan BHS Laoang, N. Samar 0 RHM Noted Bgy. Sto Nino, Laoang, C. Tenedero No ICV Violation 10/02/14 16. Sto. Nino BHS Felix Trinco, RHM 0 N. Samar Noted Bgy. Lucban, Bubon, N. C. Tenedero No ICV Violation 10/03/14 17. Bubon RHU Natividad Lao, RHM 0 Samar Noted C. Tenedero No ICV Violation 10/03/14 18. Pambujan RHU Pambujan, N. Samar Eva E. Bacarra 0 Noted Catherine D. C. Tenedero No ICV Violation 10/03/14 19. Catarman RHU Catarman, N. Samar 0 Maninocay, PHN Noted 20. Silvino Lobos C. Tenedero No ICV Violation 10/04/14 Silvino Lobos, N. Samar Altagracia S. Aleson 0 RHU Noted Further investigation Possible ICV showed amount is Vulnerability noted, 21. Cebu Provincial commensurate to 10/22/14 Danao City, Cebu FP Coordinator 0 Lurica June Gambe Cash amounting to P Hospital 2000 given to each lost income during NSV client by LGU operation and recovery- 4-5 days Pulupandan, Neg. No ICV Violation 3/19/15 22. Pulupandan RHU Merlyn Abellar 0 Lucille Titular Occidental Noted 23. La Castellana No ICV Violation 3/23/15 La Castellana, Neg. Occ Maricris Paterata, Client 1 Lucille Titular RHU Noted No ICV Violation 3/17/15 24. Alegria RHU Alegria, Cebu Genera Lerio, PHN 1 Antonia Lucero Noted Malabuyoc, Ma. Elena F. Paler, No ICV Violation 3/17/15 25. Malabuyoc RHU 0 Antonia Lucero Cebu PHN Noted TOTAL: 25 4

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Total number of Facilities Monitored: 25 Number of facilities noted to be compliant to policies: 25 Total number of Service Providers Monitored: 25 Number of facilities with possible vulnerabilities: 4 Total number of FP clients interviewed: 4 Number of facilities with possible violations: 0

Possible Vulnerabilities

1. Limited choices of available contraceptives, those listed in the above table were traced to lack of available supply of other contraceptives or lack of trained staff to provide the other methods especially in hospitals where no FP supplies are allocated by the DOH that limits choices in some faculties. 2. Visit to Cebu Provincial Hospital in Danao City for possible engagement/use for mobile VSV services reveals a possible vulnerability. Cash incentive of P2000 per client -given per NSV Clients by NSVI after the procedure. Further investigation showed the amount is considered as commensurate to transportation expenses during the operation and lost income during operation and recovery- 4-5 days

General Recommendations and Next Steps:

Good points determined during this monitoring: 5. Increasing number of facilities with PSI services in addition to pills, injectables and IUD 6. Addition of PPIUD and PSI services improve choices and reduce vulnerabilities of offering only one or two methods

Points to improve on and recommendations/next steps: 1. Improve DOH Allocation of Contraceptive commodities to RHUs and hospitals based on consumption and contraceptive deliveries to facility level 2. Update Training needs assessment at facility level and training of more providers based on the TNA 3. Need for new IEC/BCC materials for modern methods at facility level

Recommendations: 1. Revival of FP services in Hospitals and Inclusion of hospitals in allocation of contraceptive supplies from the DOH 2. Training Needs assessment/training of field staff on CBT FP training Level 1 &2, PPIUD, PSI, MLLA and NSV 3. Fielding mobile or itinerant services for IUD, PSI and MLLA in areas where trained service providers are not available to improve access to these methods 4. Involvement of NDPs (with proper training) in demand generation and counseling in areas lacking FP service providers

Prepared by: GERARDITO F. CRUZ, MD Date: April 8, 2015

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Annex C

Environmental Examination Compliance Semi Annual Report (October 2014 - March 2015)

A total of 181 service providers (169 for PSI and 12 for PPIUD) were trained. There was only one batch conducted for PPIUD and 11 batches for Progestin Containing Subdermal Implant (PSI) with one Training of Trainers. This was conducted by the newly trained doctors from the project areas.

Table 33. Environmental Examination Compliance Report Training Modules for Service Participants Duration of Training Agency/ Institution with whom Providers/TRAINERS &Est Time for IP/ HWM was vetted IP/ HWM 1. Training of Trainers  Resident  Infection  DOH, PHO (1 batch) Physicians/ OB Prevention/HWM  Provinces of Iloilo, Negros 2. Training of Service consultants in =1.5 to 2 hours Occidental, Cebu, Bohol, Leyte, Providers on PSI – hospitals South Leyte, West and North 11 batches  MHOs Samar

3. PPIUD Training  team of MHO,  Infection  Bogo City Health Office, Cebu (1 batch) PHN and RHM prevention/ HWM  Leyte, South Leyte, West and = 1.5 to 2 hours North Samar

Standard procedures and protocol on Infection Prevention and Waste Management were strictly followed and emphasized both during didactics and practicum. This is in adherence to the DOH’ national policy on environmental mitigation in order to reduce the risk of infection associated to implant insertion as well as the IUD. Implementation of these guidelines was always highlighted in every batch of the training.

As to EMMP monitoring, the table below shows a total of 72 health facilities (RHU/CHO/Birthing Clinics and hospitals) from the provinces of Iloilo, Negros Occidental, Cebu, South Leyte, West and North Samar were monitored utilizing the EMMP monitoring checklist.

Table 34. Results of EMMP Monitoring Type of facility Hospital RHU/ FP/MCH Services Infection Prevention AREA Waste Disposal CHO offered Measures Birthing Clinic ILOILO 4 20 FP Counseling, ANC,  hand washing  no waste EPI, NBS,  Gloving segregation for 1  Scrub suite facility  Decontamination  no placental pit  Cleaning for 6 HF NEGROS 2 7 FP Counselling, ANC,  handwashing  2 HF with no OCCIDENTAL EPI, Normal deliveries  cleaning placental pit  decontamination  scrub suit  gloving CEBU 1 9 FP Counseling, ANC,  hand washing  no segregation EPI, NBS, Normal  Gloving for the 3 health deliveries,  Scrub suite centers  Decontamination  no placental pit in

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Type of facility Hospital RHU/ FP/MCH Services Infection Prevention AREA Waste Disposal CHO offered Measures Birthing Clinic  Cleaning 3HF  High level disinfection in the hospital S. LEYTE 0 15 FP Counselling, ANC,  handwashing  no waste EPI, Normal deliveries  cleaning segregation to 7  decontamination HF  no placental pit to 3 birthing LEYTE 1 3 FP Counselling, ANC,  handwashing  no waste EPI, Normal deliveries  cleaning segregation  decontamination WEST SAMAR 0 10 FP Counseling, ANC,  hand washing  mostly not EPI, NBS, Normal  Gloving practicing the deliveries,  Scrub suite proper waste

 Decontamination segregation  Cleaning N. SAMAR 3 10 FP counseling, ANC,  hand washing  no segregation of EPI, NBS, NVD  Gloving waste  Scrub suite  no placental pit to  Decontamination few TOTAL 11 74

Most of the garbage and other waste from these facilities were collected by the garbage trucks from their local LGU hence segregation was not properly practiced and the placental pits were not fully utilized.

Recommendation: 1. Re-orientation on general waste management is to be conducted to all staff of the health facilities. 2. Reactivate the waste management committee of each facility, if any.

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Annex D

Gender

VisayasHealth, as a standard policy and practice of EngenderHealth, has organized its VH Gender Team with the addition of the Human Resource Manager as a member. While the EH Headquarters Gender Team are finalizing the EH Standards and Practices (S & Ps), the VH-Human Resource will ensure that key organizational policies, systems and practices, including but not limited to, budgeting, recruitment and HR practices, training and management, and decision making are gender sensitive (identifying factors that impact men and women differently) and advance women’s rights and equality.

VH Gender Team provided technical assistance to an ASRH Youth Leadership Camp organized by Save the Children for boys and girls coming from their priority 7 municipalities (Kananga, Matag-ob, Villaba, Merida, Isabel, Capoocan, Palompon) and 1 City of Ormoc. The 4-day youth camp will provide the youths ages 13- 17 years the information about Save the Children and its Child safeguarding policy, knowledge and skills about ASRH and basic psychosocial support in emergencies, enhance knowledge and skills on basic facilitation of adolescent-friendly sexual and reproductive health education sessions. Its main output is the organization of ASRH core group who will become peer facilitators. This was conducted on February 17-20, 2015 at Visayas State University (VISCA), Baybay, Leyte. VisayasHealth introduced gender concepts, presented the latest data on AYRH situationer and discuss the family planning program. A total of 40 participants participated and from among them, the ASRH core group will be selected and organized. It is expected that this ASRH core group will become the peer facilitator in their respective LGU and will facilitate the AYRH activities that will be conducted in their own areas.

On March 30, 2015, VH Gender Team members attended the training/orientation at the OH-USAID, Manila by Jay Guillian of USAID-Washington Office of Senior LGBT Coordinator. The orientation focused on the newly signed US foreign policy and priority which is the promotion and inclusion of LGBT persons both in workplace and as beneficiaries of projects’ programming. Related to this, VH will need to conduct one of its activities in the VH Gender Action Plan which is a consultative meeting with LGBT organizations, women’s groups, youth and other stakeholders to discuss in-depth gender issues.

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Annex E

Highly Urbanized Cities Report: Cities Development Initiative

1. City Development Initiatives (CDI) in Tagbilaran City

The 1st meeting of the CDI-Task Working Group for Health was conducted on March 5, 2015 at the Soledad Suites, Tagbilaran City. Chaired by the City Health Officer, 12 CHO technical staff, 4 city department representatives, DOH/DMO and 2 VisayasHealth staff attended the meeting. A review of the 7 development challenges and its proposed actions identified by the group during its first workshop in December 2014 was done. This was followed by updates on the proposed actions and the next steps. Among the agreements of the TWG are: a) the next TWG meeting is on May 7, 2015 and a regular meeting every 2 months hereon; b) the City Information Officer will bring a draft copy of the CDI MOU in the next scheduled meeting; and c) conduct of Family Health Day on June 26, 2015 at the Island City Mall as part of the mall’s anniversary celebration and as a prelude to the City’s Charter Day Celebration. The tasks and responsibilities of the TWG members were identified and agreed for the proposed Family Health Day. This quarter, as part of the CDI activities, Data Quality Check training for selected MNCHN indicators based on 2012 FHSIS was conducted on March 15-17, 2015 at the Reina Havens, Tagbilaran City. This was spearheaded by VisayasHealth in coordination with the DOHRO 7 technical staff. A total of 34 participants (13 PHNs, 17 RHMs and 3 PHOs and 1 DMO) attended the training. The group agreed that the final cleaned data will be submitted by end of May 2015.

2. City Development Initiatives in Iloilo City This quarter for the demand generation activities, the 6 District Health Centers (DHC) of Iloilo CHO were already covered and trained for the Usapan and Pregnancy Tracking System. Usapan sessions have been conducted among target clients and pregnancy tracking boards installed in the different BHSs. A total of additional 90 BHWs/CHT partners are implementing the PTS using the forms provided. During the culmination of the Women’s Month Celebration, the CPO and CHO have been conducting Usapan sessions for all non-pregnant women at Sta. Monica. On the supply side, the 2 trained PSI doctors from Jaro 1 and Molo DHCs are continually providing PSI insertions services in the city. While the AYHP Friday Teen Clinics of the 9 DHCs are providing services after their AJA Training last year. Birthing clinics of Arevalo DHC and Calumpang, Molo BHS are providing continuous facility-based delivery of services. CDI TWG meetings were also conducted chaired by the City Mayor on January 19, 2015 and March 23, 2015. Status reports of the TA initiatives were presented by each TA provider in the city and VH was also recognized for the close coordination and support to these initiatives.

3. City Development Initiatives in Tacloban City The City of Tacloban was the most devastated during the super typhoon Yolanda thus disrupting its health services. A rapid assessment was done which showed the need to build new structures and do major repairs to these health facilities, re-configure the availability of health services, and very crucial is the re-establishment of the Service Delivery Network of the City particularly to address the need of RH services of clients, especially the NHTS poor families. Visayashealth and HPDP provided technical assistance to help re-establish the SDN ensuring that the Tacloban City Hospital as the core referral hospital of the SDN will be capable in sustaining the service provision over the long term. Among the identified steps to be done will be to identify priority population; map available health care providers; designate priority population to facilities; monitor utilization and provision of health services.

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This quarter, the city government issued Executive Order on the Creation of Steering Committee, as the policymaking body, headed by the City Administrator and the creation of Technical Working Group, as the implementing body of the SDN activities. Major activities include: profiling of NHTS families and development of health use plan (HUP) utilizing the CHTs; DOHRO 8 will be responsible in the production of profiling and HUP forms and the CHT allowance budget for 2015; PhilHealth as the lead agency in conducting facility assessment and to provide the list of NHTS families; and VisayasHealth as the secretariat of the SDN Steering Committee. Other activities as planned will be pursued in the next quarter including the hiring of a consultant to develop the business plan of the SDN.

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