MALABON CITY

About the City Our Approach

USAID’s LuzonHealth Project provides technical assistance to the City of Malabon in improving demand for and supply of services, and in strengthening local health policies and systems toward increasing utilization of family planning and maternal, neonatal, child health and nutrition (FP/MNCHN) services.

Increasing demand for FP/MNCHN services involves tailored outreach activities and health events, efforts to integrate FP and MNCHN services and support to barangay (village) health workers (BHWs) in strategically identifying individuals who need health services and enhancing their interpersonal communication skills. Improving supply consists of capacity-building interventions to ensure that all health facilities become FP/MNCHN service delivery points with trained health workers and adequate health supplies. Health service providers (HSPs) in health centers and Local Government Unit (LGU)-owned hospitals have been trained to effectively respond with greater sensitivity to the needs of adolescent clients. Greater attention has also been given to enhancing the role of hospitals in FP/MNCHN service delivery.

Systems and policy interventions are geared toward strengthening systems and processes key to the provision of quality services, such as conduct of data quality check (DQC) to ensure the reliability of data generated from the Field Health Service Information System and utilization of such data and information in planning for appropriate interventions; improving competencies of HSPs through completion of the training continuum, and instituting a system for tracking FP and MCH clients to minimize dropouts. Tying up all these efforts is the Project’s support to the City’s Service Delivery Network (SDN) which is propelled by a referral mechanism that ensures clients receive appropriate and

Malabon City Map. Screen grab from Google Maps. Our Impact

Quick Facts Contraceptive prevalence rate increased from 40 percent in 2015 to 68 percent as of July 2018. Total Population (2017) 366,000 Proportion of deliveries attended by a skilled birth attendant Married Women of Reproductive Age 58,000 increased from 95 percent in 2015 to 96 percent in 2017.

No. of Villages (Barangays) 21 Proportion of deliveries in health facilities increased from 92 percent in 2015 to 93 percent in 2017. No. of Public Birthing Facilities 1 Snapshots No. of Health Centers 21

No. of Hospitals 2 DOH-Retained 1 District/LGU-Owned 1

No. of Public Health Service Providers 57 Doctors 39 Nurses 49 Midwives 25

Infant Mortality Rate, per 1,000 live Left: A woman receives immediate family planning service after attending an Usapan session in 6.6 births (2015) Barangay Longos. Right: Representatives from health facilities and officials from the City Government, headed by Mayor , sign the Service Providers’ Agreement for Poverty Incidence, in percent (2015) 8.1 the implementation of the City’s Service Delivery Network (MSevilla/RTI International). Our Key Interventions and Activities Spotlight: Enhanced Reaching Every Purok Strategy in Malabon City Increasing Demand

 Integrate FP in provision of maternal and child health services. As of August 2018, all 21 health centers (HCs) have at least one HSP trained in Family Planning - Basic Course (FPCBT 1) who integrate FP- related messages during maternal and child health service provision.

 Organize Usapan sessions. Since 2014, nine Usapan sessions, which are facility-based or outreach group discussions on FP and safe motherhood that end with counseling and service provision, have been conducted for 75 participants. In 2016, the Usapan was integrated with the “Reaching Every Purok” strategy and with other health events, e.g. celebration of Women’s Month, Safe Motherhood Month, Men’s Health Month and FP Month. In 2017 up until the present, Usapan has been conducted once a month in every barangay through team approach of midwives within the cluster.

Strengthening Supply

a village health worker, profiles a household in Barangay  Support training of HSPs in various skills. As of September 2018, two HSPs have been trained in Bilateral Tubal Ligation by Baritan, Malabon City (NGonzales/RTI International). Minilaparotomy under Local Anesthesia (BTL-MLLA), one each from the LGU-owned hospital and DOH-retained hospital; six in Basic Urban areas often demonstrate improving reproductive health Emergency Obstetric and Newborn Care (BEmONC); 35 in FPCBT 1; five in Post-partum IUD (PPIUD) Insertion (2 from the LGU-owned outcomes as more women participate in the economy and are hospital and 3 from the DOH-retained hospital); four in Lactation empowered to make informed reproductive health choices. Management; 39 in Adolescent Job Aid; 62 in DQC, eight in Supportive However, looking only at the average numbers eclipses the Supervision; and two in eCourse on Basic FP for Physicians. health conditions of the urban poor who still have high rates of unintended pregnancies, high fertility, and poor maternal  Ensure FP commodities are available and delivered on time by operationalizing a system for recording and tracking the flow of and child health.

commodities. None of the 27 monitored health facilities reported Malabon City shows how inclusive interventions and strategies commodity stock-outs in any of the three major FP commodities (pills, IUD, DMPA) between July to September 2018. can transform urban health challenges into opportunities. The City has seen an increase in the proportion of reproductive- Improving Systems and Policy aged women using a family planning method from 27 percent in 2014 to 68 percent as of July 2018. It seeks to sustain this  Strengthen systems and processes key to the provision of quality improvement and further satisfy all unmet need through the services, particularly health information systems, All 21 HCs and one integrated Reaching Every Purok (REP) and enhanced Usapan LGU-owned hospital are regularly conducting monthly DQC. Results of strategy. the DQC are used to improve service delivery and identify HSPs needing supportive supervision. Under this integrated strategy, the City’s community health  Build the capacity of health facilities as FP service delivery points teams composed of village health workers go to every purok (SDPs). As a result of interventions such as training in basic FP skills to profile each household, give FP/MNCHN information and and improving logistics management, there are now 28 FP SDPs in the identify target clients with unmet need using a community City (21 HCs, 1 LGU-owned birthing facility, 1 LGU-owned hospital, 1 household form. They then organize enhanced Usapan DOH-retained hospital and 4 private birthing homes). sessions with service delivery in each purok, with priority given  Build competencies of HSPs by improving the training system, to areas with high unmet need. which encompasses training needs assessment, conduct of training, supportive supervision, and post-training evaluation (PTE) and USAID’s LuzonHealth Project helped the City train volunteer Diagnostic Workshops. The Project supports the conduct of PTEs and workers in integrating FP and MNCHN services and in Diagnostic Workshops to assess and improve the skills of HSPs. Six logistics management for efficient and effective implementation HSPs trained in BEmONC, two in BTL-MLLA and five in PPIUD have of the program. Relevant information and educational undergone PTE, while 21 HSPs trained in FPCBT I and 7 HSPs trained materials are distributed and used in these outreach activities. in Interval IUD have been assessed through a Diagnostic Workshop. “I hope this strategy is sustained until all unmet need is  Support the establishment of an SDN, a network of health facilities propelled by a referral mechanism that ensures clients receive satisfied,” says a health volunteer in Baritan appropriate and timely care at the appropriate facility. The City’s SDN, village. She says the REP already shows some success in composed of 35 facilities, posted 733 outgoing FP referrals from April Baritan with the increase in the number of women using a to August 2017. family planning method. In 2015, there were only 467 current users but, as of July 2018, this figure has increased to 603.

Contact Information:

Project Development Specialist, USAID Chief of Party, LuzonHealth, RTI International