Mindanaohealth Project Program Year 6 – Quarter 3 Accomplishment Report (April 2018-June 2018)

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MindanaoHealth Project Program Year 6 – Quarter 3 Accomplishment Report (April 2018-June 2018)

Vol. 01: Quarterly Progress Report

Submitted: August 3, 2018

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

On the cover:

Top left: Another pregnant woman who went to the Saguiran Rural Health Unit and completed her fourth antenatal care check-up receives her dignity package and maternity kit/bag from USAID, handed over by Department of Health-ARMM’s Universal Health Care Doctor-on-Duty Dr. Baima Macadato (2nd from left). (NJulkarnain/Jhpiego)

Bottom left: USAID-trained Family Planning Nurse Ruby Navales (left) talks about Family Planning to postpartum mothers. (Jhpiego)

Top right: USAID-trained Family Health Associate Ailleene Jhoy Verbo uses the material/toolkit that the MindanaoHealth Project provided to FHAs to aid them in delivering correct messages and in answering questions on Family Planning from her listeners. (Photo by: Jerald Jay De Leon, Siay Rural Health Unit, Zamboanga Sibugay)

Bottom right: A teen mother and now advocate of the adolescent and youth reproductive health, Shanille Blase (extreme right) expresses her gratitude to USAID Mission Director to the Philippines Lawrence Hardy II (extreme left) for USAID’s support to the Brokenshire Hospital’s Program for Teens, which provided her free antenatal, birthing and postpartum care. Also in photo: Dr. Dolores C. Castillo (second from left), MindanaoHealth Project Chief of Party. (Photos: MCossid/Jhpiego)

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

Table of Contents

Table of Contents Table of Contents ...... 3 List of Acronyms ...... 5 1. Activity Overview/ Executive Summary ...... 9 1.2 Program Description/Introduction ...... 9 1.3 Description of Key Achievements for the Quarter ...... 10 1.4 Key Challenges ...... 11 2. Key Achievements and Challenges ...... 11 2.1 Key Achievements for the quarter ...... 11 2.2 Standard Indicators Update ...... 14 Indicator FP 1: No. of Modern FP Current Users in USG-Assisted Areas ...... 14 Indicator FP 2: Couple Years Protection (CYP)* in USG-Assisted Areas ...... 20 Indicator FP 3: Average Stock- Out Rate of Contraceptive Commodities at Family Planning Service Delivery Points (SDPs) ...... 24 Indicator FP 4: Percent of USG-assisted SDPs Providing FP Counseling and Services to Couples, Men, Women, Youth and Adolescents of Both Sexes ...... 27 Indicator FP 5: Number of USG-assisted community health workers (CHWs) providing family planning (FP) information, referrals, and/or services during the year ...... 28 Indicator N 1: Percent of LGUs conducting data quality checks (DQC) ...... 30 Indicator N 4: Number of USG-assisted SDPs Providing FP-RH Services for Adolescents and Youth ...... 32 Indicator HL.6.2.1: Number of Women Giving Birth who Received Uterotonics in the Third Stage of Labor through USG- supported program...... 35 Indicator NI 1: No. of Women of Reproductive Age that Have Been Profiled and Identified as Having Unmet Need for FP...... 36 Indicator NI 2: Percent of women of reproductive age that have been profiled and identified as having unmet need who have been provided with FP services...... 37 Indicator NI 3: Percentage of PPFP/PPIUD Trained Providers that Have Been Certified by the Department of Health in USG Assisted Sites ...... 38

Indicator NI 4: Number of Newborns Not Breathing at Birth who were Resuscitated in USG- Supported Programs ...... 40 Indicator NI 5: Number of SDPs in Marawi City with Functional Health Service Provision. .. 41 Indicator NI 6: Percent of Audience recall of hearing and/or seeing MH supported FP/RH Key Messages ...... 44 Indicator CAA1: Number of Health Outreach Conducted ...... 45 Indicator CAA2: Number of Civil Society OrganizationsTrained to Effectively Engage with Local Governments ...... 47 Indicator CAA3: Number of youth trained as peer educators ...... 47 Indicator CAA4: Number of clients reached during health outreach activities ...... 48 2.3 Key Challenges and how they are being addressed ...... 49 3. Cross-Cutting Issues ...... 51 3.1 Updates on Gender ...... 51 3.2 Update on Sustainability and Self-Reliance ...... 52 3.3 Update on Environmental Compliance and Climate Risk Mitigation ...... 52 3.4 Update on Family Planning Compliance ...... 55 4. Collaboration, Learning and Adapting ...... 57 5. Management, Administrative and Financial Issues ...... 61 6. High-Level Planned Activities for Next Quarter Including Upcoming Events ...... 61 6.1 High level turn-over of supply support to Marawi and its Corridors in August ...... 61 6.2 Regional Dissemination/Turn For-over Activitties: October –November, 2018 ...... 61 6.3 Launching of the WHO/USAID/Jphiego Toolbox on FP/MNCHN – September 6, 2018 ...... 61

List of Acronyms

ADN Agusan del Norte ADNPH Agusan del Norte Provincial Hospital ADS Agusan del Sur AJA Adolescent Job Aids ANC Antenatal Care AOP Annual Operational Plan APSOM Association of Philippine Schools of Midwifery ARMM Autonomous Region of Muslim Mindanao AY Adolescent and Youth AYRH Adolescent and Youth Reproductive Health BCS + Balanced Counseling Strategy Plus BEmONC Basic Emergency and Obstetric Newborn Care BH Birthing Homes BHS Barangay Health Station BHW Barangay Health Worker BTL Bilateral Tubal Ligation CA Cooperating Agencies CAA Conflict Affected Area CDI Cities Development Initiative CDO Cagayan de Oro CEmONC Comprehensive Emergency Obstetric and Newborn Care CHANGE Communication for Health Advancement through Networking and Governance Enhancement CHO City Health Office CHT Community Health Team CHW Community Health Worker CIP Cost Implementation Plan 6

COE Center of Excellence CRMC Cotabato Regional Medical Center CSO Civil Society Organization CYP Couple-Years of Protection DH District Hospital DOH-CO Department of Health- Central Office DOH-RO Department of Health- Regional Office DQC Data Quality Check EBF Exclusive Breastfeeding EO Executive Order EOP End of Project FHA Family Health Associate FHSIS Field Health Services Information System FPOP Family Planning Organization of the Philippines GIDA Geographically Isolated and Disadvantaged Area HFEP Health Facility Enhancement Program HSP Health Service Provider HUC Highly Urbanized City ICV Informed Choice and Voluntarism IEC Information, Education, and Communication ILHZ Inter-Local Health Zone IPHO Integrated Provincial Health Office IUD Intrauterine Device LAM Lactational Amenorrhea Method LAPM Long Acting and Permanent Method LGUs Local Government Units LHB Local Health Board LIPH Local Investment Plan for Health LMT Lactation Management Training M&E Monitoring and Evaluation

MC Medical Center MCP Maternity Care Package MFP Modern Family Planning MH MindanaoHealth MHO Municipal Health Office MLLA Mini Laparotomy using Local Anesthesia MNCHN/FP Maternal, Newborn, and Child Health and Nutrition/Family Planning MOA Memorandum of Agreement MSH Marawi Specialist Hospital MSI Marie Stopes International NCP Newborn Care Package NDP Nurse Deployment Program NFP Natural Family Planning NGO Non-Government Organization NMMC Northern Mindanao Medical Center NHTS National Household Targeting System NSV No Scalpel Vasectomy OFIM Office of Field Implementation Management PH Provincial Hospital PHA Public Health Associate PHIC Philippine Health Insurance Corporation PHILHEALTH Philippine Health Insurance Corporation PHN Public Health Nurse PHO Provincial Health Office PMP Performance Monitoring Plan POPCOM Commission on Population PPFP Postpartum Family Planning PPIUD Postpartum Intrauterine Device PSI Progestin Subdermal Implant R & R Reporting and Recording

RH Regional Hospital RHU Rural Health Unit RIT Regional Implementation Team RPRH Responsible Parenthood and Reproductive Health SDN Service Delivery Network SDP Service Delivery Point SOCCSKSARGEN South Cotabato, Cotabato, Sultan Kudarat, Sarangani and General Santos City SPMC Southern Philippines Medical Center SupSup Supportive Supervision TCL Target Client List TRO Temporary Restraining Order WRA Women of Reproductive Age

1. Activity Overview/ Executive Summary

Activity Name: MindanaoHealth Project

Activity Start Date and End Date: Feb. 18, 2013 to Dec. 31, 2018

Jhpiego in partnership with RTI Implementing Partner: International

Cooperative Agreement Contract/Agreement Number: AID-492-A-13-00005

Research Triangle Institute Name of Subcontractors/Sub- awardees: (RTI International)

Southern Philippines:21 USG Sites: 19 Geographic Coverage provinces and 2 Highly Urbanized Cities

Reporting Period: PY6 Quarter 3: April – June 2018

1.2 Program Description/Introduction

The MindanaoHealth (MH) project, a five-year (2013–2018) initiative, with additional 10- month extension, funded by the United States Agency for International Development (USAID), is implemented by Jhpiego in partnership with RTI International. The Project’s goal is to improve family health by dramatically increasing the quality and uptake of integrated maternal, newborn, and child health and nutrition/family planning (MNCHN/FP) services, resulting in improved child health and nutrition, reduced maternal and infant deaths, and decreased unmet need for FP services—especially among the population belonging to lowest wealth quintiles, in conflict- affected areas, and those affected by humanitarian crises in Mindanao.

MH collaborates with the Department of Health (DOH) to scale up high-impact services that include adopting client-centered approaches by providers for Mindanao, the southernmost

of the three island groups in the Philippines. In addition to working directly with five (5) DOH- regional health offices (ROs) and DOH-ARMM, it has forged strong partnerships with Local Government Units (LGUs) of 19 provinces, 2 HUCs, and 368 municipalities to help the government achieve its commitment to reduce maternal and under-five deaths and to reduce unmet need for modern family planning (MFP). In the aftermath of the unfortunate Marawi Siege in 2017, the Project was granted a 10-month extension from February to December 2018 to continue to work in Marawi and its Corridors and other low-income areas with poor populations, with high unmet need, high rates of teenage pregnancy and high neonatal deaths.

1.3 Description of Key Achievements for the Quarter

The MindanaoHealth Project’s performance in the third quarter of its extension period (Project Year 6), showed that most indicator values remain either on track, or within range of this quarter’s target. The FP Current Users (CU), which is one of the project’s crucial FP indicators, posted a positive increment of about 4% from 1,577,845 in October to December 2017 to 1,643,924 in Janaury to March 2018, equivalent to 101.8% of EOP target of 1,615,042. Progressively, the CYP also increased, bringing the accomplishment rate to 72.5% (408,336) out of the PY6 target of 562,837. Noteworthy is the increasing uptake and actual conduct of counseling to adolescents and youth using HEEADSS as a tool in supported schools and health facilities to identify their psychosocial risks including FP-RH needs and consequent referral as needed. As of Q3PY6 a total of 13,386 adolescent/youths were assessed using HEEADSS, of which 3,801 accessed FP methods of their choice, and 31 students out of 3,524 assessed were referred.

The sustained MindanaoHealth technical assistance to 21 Service Delivery Networks (SDN), now in collaboration with ZFF-HLGP project, will result in strengthening the leadership and governance mechanism of the SDN, with initial gains by the introduction of resilience roadmap and its corresponding indicators into the SDN Framework to enable SDN to manage and respond quickly to natural and manmade disasters. To date there are three functional SDNs, ten operational, and eight organized. Also, in this quarter, MH support in scaling up the integration of FP and AYRH programs in 16 hospitals within SDN, in consonance with the 2014 DOH Memorandum on the Establishment of FP Programs in Hospitals and pursuant to DOH AO No. 2013-0013 implementing the National Policy and Strategic Framework on Adolescent Health and Development, is showing initial gains. Analysis of available data in 10 SDNs showed that 5 SDNs namely BITES in Sultan Kudarat, District 2 in Zamboanga del Sur, DiMaBaMaS in Davao del Sur, SANLAKASS in Lanao del Norte and CoMMMoNN Compostela Valley contributed more than half to total provincial CYP. Also, the DOP SDN comprised with only 3 out of 14 total municipalities of Agusan del Sur contributed 29% to provincewide CYP.

1.4 Key Challenges

Key challenges include (1) the maintenance of MCP/NCP PhilHealth accredited facilities, (2) FP commodity distribution in the USG supported sites, and (3) Slow compliance of some DOH hospitals as FP reporting unit per DOH Memo.

Starting January 1, 2018, PhilHealth required all maternity care package providers/ birthing homes applying for initial, continuous, and re-accreditation to submit DOH License to Operate (LTO). The PHIC advisory and DOH stiff requirements for LTO issuance resulted to a number of facilities unable to comply with accreditation requirements.

Regarding the FP commodity distribution from DOH- Central Office to various service delivery points (SDPs), it was observed that DOH-CO’s FP Logistics Hotline are not adequately using the inventory and consumption reports that they receive from SDPs, PHOs, and DOH-ROs . Thus, it perpetuates the same problem of overstocking and stock out incidence including delay in the delivery of commodities.

Despite DOH-led national orientation of core hospital team on FP recording and reporting and follow-on technical assistance by the project, in close collaboration with regional health offices, the take-off is very slow for varying reasons among hospitals.

2. Key Achievements and Challenges

2.1 Key Achievements for the quarter

During the extension period, MH has continued to address health system gaps in three (3) major components – supply, demand, and policy/financing. Each component focuses on five (5) major stakeholders with different roles to play in translating MH technical assistance (TA) and their own to expand the reach of quality services, namely: the DOH-ROs, Provincial Health Offices (PHOs), providers/managers both public and private, Civil Society Organizations (CSOs) and Non- Governmental Organizations (NGOs), and clients/beneficiaries. MH has adopted a tailored technical assistance (TA) leveraging the gains achieved in the last five years and the absorptive capacity of partners. The Project has accordingly prioritized 12 LGUs where unmet need for family planning and teenage pregnancy rates are high and most of the GIDAs are located, and 6 Conflict Affected Areas, including Marawi and its environs where humanitarian crises and conflicts have adversely impinged on the health system/service provision.

MindanaoHealth made key achievements during the third quarter of this extension from April 1 to June 30, 2018 as follows:

• Increased FP Current Users. The no. of current users (CU) as per FHSIS report in January – March 2018 is 1,643,924 which is 53.6% higher than the 2012 baseline figure of 1,070,486 and equivalent to 101.7% of the EOP target of 1,615,404. Both 12 priority sites and the 5 provinces/HUCs that are already performing well with minimal technical assistance from the project thus considered as PY6 non-priority areas accomplished their EOP target, with priority sites contributing 67.8% to total CU, and the 5 non-priority that posted the highest accomplishment of 160.9% against their EOP target contributed 15.8% to total CU.

 Increased CYP. Q2PY6 CYP of 154,999 is equivalent to an increment of 22.6% over the Q1PY6 of 126,395 and represented 27.5% of the current year’s target of 562,837. As of Q2PY6, the system was able to accomplish 408,336 or 72.5% of PY6 annual CYP target of 562,837. South Cotabato, Davao Oriental and Agusan del Norte have already surpassed their PY6-targets for CYP.

The percentage share of MH to CYP is 38% (59,026/154,999), of which 29% (17,190) are from supported outreach activities and 71% from fixed services; about 93% are from partnership with the public sector, with 7% coming from the private sector.

 SDN Initiative Yielding Promising Results: The project’s efforts on systems building since PY2 through SDN is showing promising results based on partial available data. Five SDN namely BITES, Sultan Kudarat; District 2, Zamboanga del Sur; DiMaBaMaS, Davao del Sur; SANLAKASS, Lanao del Norte; and CoMMMoNN, Compostela Valley contributed more than 50% to province wide CYP. Furthermore, DOP SDN composed of only 3 out of 14 municipalities of Agusan del Sur contributed to 29% of provincewide CYP. The high performance of these SDNs can be attributed to, but not limited to the following:

a) Leadership of the PHO in providing management and technical support and the PDOHO’s technical guidance and oversight;

b) SDN Champions in the legislative and executive branches to pass and execute SDN related policies and plans;

c) Active engagement of private hospitals and non-health sector (community-based organizations, transport and communication groups, cooperative) through PPP modality;

d) Sustained PHIC accreditation and PHIC reimbursements are plowed back to health services;

e) Full implementation of the No Balance Billing policy in all SDN facilities including private hospitals. NBB is a potent demand generation strategy;

f) Revival of LGU’s CSR strategy to mitigate the impending shortage of commodities;

g) Pooling of funds to provide for transportation cost, medicines, supplies and to cover hospital cost in the event of excess billing;

h) In place M&E system to track SDN contribution to health outcomes, service coverage, and referral services

 The project exceeds its EOP target of 277 MCP/NCP Accredited facilities with reimbursement policies per PhilHealth Guidelines with 295 PhilHealth MCP/NCP accredited facilities in USG-sites to date, despite the stiff DOH requirement for LTO issuances that resulted to substantial reduction on PhilHealth accreditation in Misamis Oriental from 13 in PY5 to only 5 in PY6.

• MH scaled-up TA on AY through the integration AY services in FP Programs in hospitals from 8 to 18 hospitals in consonance with the 2014 DOH Memorandum on the Establishment of FP Programs in Hospitals and pursuant to DOH AO No. 2013-0013 implementing the National Policy and Strategic Framework on Adolescent Health and Development. Partial data from the 14 supported hospitals showed that the number of FP/MNH/RH services increased by 51% from 7,965 in Q2PY6 to 16,466 during the quarter.

• The Project supports building the confidence of non-performing trained HSPs by supporting DOH-led supportive supervision/post-training evaluation (PTE) activities and facilitating their certification by the DOH. Project-wide and as of the end of PY6Q3, the proportion of trainees who underwent supportive supervision is only 68% - still below the target of 80% of those who completed the training. HSPs in Conflict Affected Areas (CAA) have difficulty in complying with the required 10 cases provided with PPIUD, before they can go for supportive supervision. There is a low demand for PPIUD among Muslim WRAs because IUD is not culturally acceptable to them. So, in Conflict Affected Areas, the proportion of PPIUD-trained HSPs who underwent supportive supervision is only 46%.

• Assisted in restoring the provision of essential health services in 9 targeted facilities in Marawi City through continuous mentoring and coaching of staff previously trained by the project, provision of tools and IEC materials on FP/MNH services; supporting conduct of REACH services and profiling of WRA with FP unmet need. In addition, other 12 facilities in nearby municipalities of Lanao del Sur and Lanao del Norte were likewise supported thereby strengthening the provision of essential health services to women, men and children.

• There are significant improvement in the capacity of USG-assisted sites as reflected in the Q3PY6 FP Composite Index results. From LGUs (Cagayan de Oro and Misamis Oriental) in the high/category 3 level in Q4PY5, it has increased to 13 LGUs in Q3PY6 (Bukidnon, Maguindanao, Cagayan de Oro, Zamboanga del Sur, Misamis Oriental, South Cotabato,

Sultan Kudarat, Compostela Valley, Agusan del Sur, Davao del Sur, General Santos City,

Agusan del Norte, and Cotabato City). This mean that USG-assisted sites in category 3 have established an enabling environment supportive to FP/AY service delivery. The FP Composite Index Tool, developed by the project, looks at demographic and geographic profiles as well as assess achievements made by the LGUs from a mix of TA interventions. As designed by the project, the FP capacity index estimates for each LGU through a weighted scoring or threshold applied first to the four (4) key components of the Project, i.e., service delivery (40%), demand generation (20%), policy and financing (20%), and AYRH (20%), and then down to their respective sub-components/elements. From the assessment of each LGU’s accomplishments during a fixed period, a raw score of from one (1) to three (3), with three (3) as the highest, is assigned to each sub-component/element then multiplied by the corresponding weight. All weighted component scores are then aggregated to arrive at a maximum composite FP capacity index of 100. With the indices serving as proxies for LGUs’ immediate past performance levels, the LGUs are grouped into three (3) categories: High (76 to 100); Medium (51 to 75); and Low (50 and below). In a chart, the LGUs’ computed indices are plotted against the respective LGUs’ number of women with unmet need to indicate their current or “moving forward” capacities to address unmet need for family planning.

Overall, MindanaoHealth’s performance in PY6Q3 showed that most indicator values remain either on track, or within the range of this quarter’s target.

2.2 Standard Indicators Update

Indicator FP 1: No. of Modern FP Current Users in USG-Assisted Areas

Table 1.0 Current Users in USG-Assisted Areas, Jan - Mar 2018 Accomplishment Reporting Units No. of for the Quarter, Q2PY6a (FHSIS) Project Areas Baseline LGUs With Target Actual % No. % Reportsd (1) Priority Areas: 12 704,076 1,100,761 1,114,032 101.2 199 190 95.5

(2) CAA Sites: (a) BaSulTa, Zambo 5 180,565 168,571 93.3 97 97 100.0 City, Cotabato City 267,936 (b) Marawi & Environs (Lanao Sur 2 118,590 101,531 85.6 62 59 95.6 & Lanao Norte) (B) Non-Priority 5 98,474 215,447 259,790 120.6 43 41 95.3 Areas Project-Wide Total 1,070,486 1,615,402 1,643,924 101.8 401 387 96.5

a - For data from DOH-FHSIS, reported data is from previous quarter, Jan-Mar 2018 b - EOP Target for CU was adjusted after the Marawi siege (refer to PIRS) c - These are RHUs, CHOs or District Health Offices. Whether the RHU/CHO/DHO FHSIS Reports are complete (include reports from all barangay health stations) cannot be determined. d - No. of health facilities that submitted Jan-Mar 2018 FHSIS report e – In all indicators, Davao Occidental is fused with Davao del Sur f - In some indicators, the performance of Iligan City and Marawi City are fused with Lanao del Norte and Lanao del Sur respectively

Analysis of Accomplishment

Compared with the EOP target of 1,615,404, this accomplishment is already 101.6% of the target with SOCCSKSARGEN and Davao Region contributing 22% and 21% respectively, followed by Northern Mindanao at 19% and Zamboanga Peninsula at 18%. In terms of accomplishment, 3 regions namely Zamboanga del Sur, Davao Region and CARAGA have already reached/exceeded EOP target. In terms of provinces, eleven (11) USG-assisted sites have already reached their CU EOP target namely Davao City, South Cotabato, Davao del Sur, Agusan del Sur, Zamboanga del Norte, Sulu, Zamboanga City, Zamboanga Sibugay, Cagayan de Oro, Davao Oriental, and Agusan del Norte.

The 12 priority areas exceeded their targets and contributed 67.8% to total current users, while the 5 LGUs PY6 non-priority areas, also exceeding their targets contributed 16% to overall total. Further analysis of the data showed an increment of 66,079 in Q2PY6, which is 19% higher than Q1PY6 increment of 55,425, resulting to a 4.0% increase in the number of modern FP methods (MFP) users from 1,577,845 in Q1PY6 to 1,643,924 in Q2PY6 (Table 1/ Fig 1). Of the 66,079 increment, 34,734 or 52.5% are LARC/PM methods, which is 29% higher than Q1PY6 LARC/PM users of 26,825 (Figure 3).

Total CU could have been higher if 14 reporting units have submitted their Jan-Mar 2018 FHSIS reports (5 are from Davao City, 2 from Bukidnon, 2 from Davao Occidental, 3 from Lanao del Norte, and 2 from Davao Oriental) after constant follow-up. The combined contribution of these 14 reporting units to the total number of CUs reported in Oct-Dec 2017 is 4% (67,449/1,577,845). While constant follow-up and coordination with concerned LGU health partners and DOHRO levels has improved the reporting rate, the above facilities failed because weak accountability and leadership at facility levels, and the resignation of the public health nurses in 2 RHUs in Bukidnon during the reporting period.

This report does not also include the FP-service performance of the 5 USG/MH-assisted DOH-hospitals. Despite DOH issuances directing all DOH-hospitals as FP reporting units, five has not been submitting reports to DOHRO. With the re-orientation of hospital staff on recording and reporting system by the project early this year, they started using M1 forms in May with some partial reports being generated to date which will be captured in Q4PY6/Annual report.

Figure 1 also shows a sustained increase of the FP Current Users at an average rate of increase of 3- 4% per quarter from Q4PY4, except in Q2PY5 where there was a reduction by 1% due to no report from Lanao del Sur because of the on-going Marawi conflict. Lanao del Sur has been contributing about 40,000 CU in previous years.

Figure 1: Summary of Accomplishments and Trends in Current Users (Q4PY2 – Q2PY6)

As to FP methods, SARC (pills, DMPA-injection, and NFP) is the most popular mFP in all project areas accounting to 75.8% of CU (Table 1.1). NFP users (197,916) accounts for 16% of SARC or 12% of current users, and among the NFP-users, 8 out of 10 are LAM-users. The reporting of LAM-users has always been problematic; thus, the project is sustaining its technical support to ensure partners track LAM- users and counsel them to shift to more effective FP methods of their choice on timely manner. The desire for big family size and influence of their partners/family members have contributed to the preference of women with FP unmet need in ARMM to space than limit their pregnancy, with 91% FP acceptors opting for SARC or 171,258 out of 188,284 CUs, and the observed increasing number of LARC/PSI acceptors with the lifting of TRO on Implanon/-NXT, and the relatively very low progress on LAPM users.

Table 1.1. Distribution of Current Users by Type of mFP methods, in USG-Assisted Areas, Jan- March, 2018 LARC SARC (pills, DMPA, Project LAPM (NSV/BTL) Totals (PPUID,IUD,PSI) condom, NFP Areas # % # % # % # % Priority 102,415 72 182,298 71 829,319 67 1,114,032 67.8 Area CAAs 12,781 9 25,428 10 231,893 18 270,102 16.4 Non- 26,093 18.5 49,065 19 184,632 15 259,790 15.8 priority Total 141,289 8.6 256,791 15.6 1,245,844 75.8 1,643,924 100

Figure 2 below shows the trends on FP current users by region, with increasing trend from Q1PY6 to Q2PY6 in all regions. The highest growth seen in Zamboanga Region is due to the inclusion of Zamboanga Sibugay’s two quarter reports after the project supported DQC in the later part of Q1PY6. The new provincial health officer opted not to submit non-DQC’d Q1PY6 report, thus his request for

the project to help the province re-activate DQC processes after the 2016 DQC. The implementation of DQC after 2016 was due to frequent changes in leaderships and resignation/retirement of DQC trained staff. With this commitment of the new leadership, it is expected that DQC will be sustained to ensure quality data for programming, advocacy and accountability. Figure 2: Current User Trends by Region (Q4PY2 – Q2Y6)

Figure 3 reflects an increasing trend in LARC/PM acceptors from Q4PY5 with significant increase on PSI at 76% from 9,915 in Q1PY6 to 17,444 in Q2PY6. The increasing capacity of the public sector given the lifting of the TRO on Implanon, and PSI methods as culturally acceptable among Muslim women are contributory factors. Figure 3: LARC-PM Number of Acceptors by Quarter System-wide as of Q2PY6

The project’s contribution to overall systems’ CU continuous to increase with an 8% increase from 39% contribution in Q1PY6 to 42% in Q2PY6. Of the 14,711 MH contribution, 59% (8,627) are LARC/PSI users; 29% (4330) PPIUD/IUD users; and 12% (1,754) underwent BTL services.

Figure 4: MH Contribution to Reported LARC/PM Acceptors (Q1PY3-Q3PY6)

Figure 5 below revealed that fixed activities contributed 54% LARC/PM users, a shift from Q1PY6 where 68% were generated from outreach. The discontinuation of one NGO providing LARC/PM services through outreach services is a factor to the shift, not to mention the improved capacity and increased in frequency of FP services in supported health facilities. Also, for Q2PY6, the private sector partners contributed only 8% or 1,275 out of 14,711 LARC/PM users, a 340% reduction from their Q1PY6 contribution of 5,612 due to the discontinuation of one NGO providing LARC/PM services and closure of 12 private birthing facilities who were not able to comply with the stringent DOH LTO requirements. The improved capacity of the public sector with itinerant teams of hospitals and the increasing LGU-initiated outreach services supported by the project resulted to increased MH contribution. Figure 5: Total Clients Served from Fixed and Outreach Activities Supported by MH (Q1PY3-Q2PY6)

Contributory Factors The aforementioned accomplishment is the combined results of the increase in the number of HSPs trained and supportively supervised to provide FP-services, increase in the number of outreach services conducted, high conversion rate of the Usapan sessions, the number of public/private facilities capacitated to provide FP-services, and the number of functional and operational SDNs, especially those with expanding Public-Private Partnership (PPP). SDNs (like BITES in Sultan Kudarat, DO Plaza SDN in Agusan del Sur) with expanding PPPs tend to have a higher contribution to their provinces’ CU (for details refer to Specialist’s Report on Health Policy and Systems Development Component: Sustaining Support to Strengthen Service Delivery Network (SDN) in Vol. 2 of Q3PY6 Report).

Table 1.2 No. of HSPs Trained* in USG-Assisted Areas, as of PY6Q2 PPFP/ BTL-MLLA LARC - PSI FPCBT2 Project Sites PPIUD B T SS B T SS B T SS B T SS Priority Sites 0 109 52 55 617 452 0 496 222 61 486 131 Conflict Affected 0 76 32 26 149 69 0 172 80 5 116 11 Areas Non-Priority Sites 0 49 25 7 201 135 0 126 56 8 120 11 Project-wide 0 234 109 88 967 656 0 794 358 74 722 153 * – number of trained HSPs who are still performing B = Baseline T = Trained SS = SupSup

By the sheer number of HSPs who have completed training, and had supportive supervision, the net result is that there are more service delivery points who can provide a broad range of FP services and thus enhancing access to these services (for details, refer to table 09 in Vol 2 of Q3PY6 Report). Project-wide, there was an increase in the number of outreach services conducted during the quarter. Although in Zamboanga City, and Zamboanga Sibugay that had measles outbreak, the 23 planned outreach activities in January – March 2018 were cancelled due to DOH-RO’s call for moratorium of all other activities by public health personnel for them to focus on the mass immunization campaign. Planned outreach services in Cagayan de Oro City and Misamis Oriental were greatly reduced due to failure of DOH-RO X to release the fund support for the outreach activities of Northern Mindanao Medical Center (NMMC).

Plan for the Next Quarter 1. Plan in detail the conduct of more FP outreach clinics to closely link demand generation and service provision: 1.1 Engage STTAs to provide FP outreach clinics targeting WRAs from GIDA barangays with unmet need for limiting. 1.2 Increase the number of FP outreach clinics to be conducted and hold these in or in locations nearest to GIDA barangays. 1.3 Improve conversion rate during the Usapan sessions by identifying WRA with unmet need for FP and tailor fit FP services to be provided to their need. 2. Continue coordination with leaders and program managers of DOHRO, PHOs and SDN TWGs on rolling-out of good practices on data recording and reporting (Ex. Improving FP/RH reporting in

Iligan SDN thru PPP, LCE Issuance on reporting in General Santos City as requirement to LTO re/issuances, etc.).

Indicator FP 2: Couple Years Protection (CYP)* in USG-Assisted Areas

Table 2.0 Couple Years Protection (CYP)*, USG-Assisted Sites, Mindanao, as of Q2PY6 Accomplishment Cumulative for the Quarter Accomplishment, PY6 Project Areas Baseline Actual Actual (as of Target PY6 % % (Q2PY6) Q2PY6) (A) Priority Areas: 169,518 386,851 102,669 26.5 256,845 66.4 (1) Non-CAA Sites (2) CAA Sites: (a) BaSulTa, Zambo City, 56,660 12,309 21.7 39,260 69.3 Cotabato City 25,543 (b) Marawi & Environs (Lanao Sur & Lanao 14,821 5,674 38.3 13,241 89.3 Norte) (B) Non-Priority Areas 33,378 104,505 34,347 32.9 98,691 94.4 Project-Wide Total 228,438 562,837 154,999 27.5 408,037 72.5 *LARC/PM only

Analysis of Accomplishment

There is an increasing trend in CYP. Project-wide, the Q2PY6 CYP of 154,999 is higher by 22.6% compared to 126,395 CYP in Q1PY6. The 12 priority LGUs contributed sixty-six (66%) of the CYP increment, followed by PY6 5 non-priority LGUs at 22%. The cumulative CYP-accomplishment for the first three quarters of PY6 is about 72.5% of PY6 annual target of 562,837.

Figure 6: Couple-Years of Protection by Project Quarter , Q1PY3-Q2PY6

Of the 11 LGUs that reached their EOP CU target, only South Cotabato, Davao Oriental and Agusan del Norte have already surpassed their PY6-targets for CYP, which maybe attributed to the following;

Accomplishment Province Comments Q1PY6 Q2PY6 South 3,727 6,196 66% increase is due to increase in the numbers of LGUs Cotabato conducting outreach activities resulting to PSI-CYP from 590 to 1,625.5; increase in clients availing of LAPM services in South Cotabato Provincial Hospital with BTL-CYP outcome of 2,650 from 1,270, and complete FP service reports from the hospitals Davao 3,500 10,761 The increased number of HSPs providers trained on FP Oriental (16=LARC/PSI; PPIUD=26 and BTL=1) resulted to sustained provision of FP in fixed facilities, augmented by outreach services. Agusan del 4,000 9,467 Increased LARC outreach activities of LGUs, and fixed site services Norte by both public and private SDPs, and inclusion of FP service reports from the hospitals and private birthing facilities contributed to the 137% increase. Furthermore, in Northern Mindanao, the WRAs with unmet need for limiting have been referred to fixed facilities with trained staff on BTL/MLLA in 4 provincial hospitals of Bukidnon, the Northern Mindanao Medical Center (NMMC) and JR Borja Hospital in Cagayan de Oro (CDO) City. All other provincial hospitals of Misamis Oriental (Misamis Oriental Provincial Hospital-Balingasag, MOPH- Talisayan, MOPH-Gingoog, MOPH-Alubijid, and MOPH-Manticao) have HSPs trained on PPIUD and PSI and are providing services to WRA with unmet need for FP who are seeking services in their hospitals. Furthermore, those who opt for LARC-PSI have been referred to the capacitated RHUs. Project-wide, there were 113 outreach services conducted in Q2PY6, though slightly lower in Q1PY6, the average no. of clients per outreach services was 36, slightly higher than that of the previous quarter which was only 34. Well-functioning SDNs are expanding their PPPs. These SDNs tend to have a bigger contribution to the number of CUs and CYP of the province/HUC. For example, in Sultan Kudarat, the BITES-SDN caters to approximately 45% of the province’s population but contributed 58% (7,107) to the province’s CYP-accomplishment in the last two reporting quarters (12,244). This SDN actively engages 8 private SDPs/hospitals. All RHUs in the SDN are providing PPFP/PPIUD and PSI with combined total of 40 PPFP/PPIUD-, 3 BTL- and 6 PSI-PhilHealth accredited providers. All health facilities are also MCP/NCP accredited by PhilHealth. DOP SDN in Agusan del Sur is comprised of three municipalities. It has a combined population of 228,087 equivalent to 32% of the province population. The CYP contribution of DOP SDN to the province’s CYP (15,568) in the last two quarters is 29% of which 56% came from Prosperidad municipality where the DOP Provincial Hospital and private hospitals are located (for more details, refer to Specialist’s Report on Health Policy and Systems Development Component: Sustaining Support to Strengthen Service Delivery Network (SDN) in Vol. 2 of Q3PY6 Report). Figure 6 reflects the CYP accomplishment by region. All, except ARMM, reached at least 50% of their

PY6 targets, highest in Northern Mindanao 81%. While Zamboanga Peninsula and Northern

Mindanao lead in CYP accomplishment to date, CYP quarterly trends showed a reduction in Q2PY6 lower than their Q4PY5 level due to reduction in the conduct of outreach by NMMC itinerant teams for varied reasons and the closure of an NGO providing BTL/MLLA in these 2 regions. All targeted hospitals are capable of providing BTL and in some degree NSV services, thus with the project’s continuous advocacy to LGUs on transport support to potential WRA with unmet need on limiting will scale-up to ensure these WRA access the services of their choice. It is also noted that while Davao Region exceeded CU target at 109% (340,008 vis 310632 target), only 50% of CYP target was reached as of Q2PY6 for reasons that most of Davao Regions CU are SARC acceptors. Figure 6: Couple-Years Protection (CYP) Accomplishment by Region as of Q2PY6

Figure 7. CYP Trends by Region up to March 2018

Based on available reports from the 27 LGU and private hospitals within these LGUs, and NMMC showed only 1% percentage total CU during the quarter. The biggest share came from the hospitals in Non-Priority Areas – JR Borja Hospital in CDO City and Dr. Jorge P. Royeca Hospital in General

Santos City (GSC). Although the contribution of these hospitals to the systems-wide CU is very small, its contribution to the CYP is fairly large, at 14% (22,003/154,999). Table 2.2 Contribution of Hospitals to CU & CYP . Project Areas BTL PPIUD IUD PSI CU/CYP Total

253 264 5 245 767 Priority Sites 2,530.0 1,214.4 23.0 612.5 4379.9 170 385 36 425 1,016 CAA 1,700.0 1,771.0 165.6 1,062.5 4,699.1 536 1,594 7 80 2217 Non-Priority 5,360.0 7,332.4 32.2 200.0 12,924.6

All (CU) 959 2,243 48 750 4,000 All (CYP) 9,590.0 10,317.8 220.8 1,875.0 22,003.6

Deviation Narrative Challenges: 1) The private service provider for LARC/LAPM that conducted relatively more frequent outreach FP- services stopped its operations starting Q2PY6. There was a 92% drop in the number of acceptors during outreach services by private service providers from 5,133 in Q1PY6 to 394; this is equivalent to a drop in CYP from 14,206.6 to 985. In Q2PY6, LARC-services by private SDPs were limited to PSI. (refer to Table 10 in Vol. 2 of the Q3PY6 Report) 2) DOH-hospitals have also reduced the frequency of its outreach activities. 3) In Davao Region, it is DOH-RO’s policy for BTL to be performed under spinal anesthesia. The hindering factors here are: a) the procedure requires an anesthesiologist, and b) patients from GIDAs are reluctant to have themselves admitted to the hospital for 1-2 days because nobody will attend to their younger children and the livestock. Opportunities: In Zamboanga del Sur, Compostela Valley and Bukidnon, the Provincial Health Office in partnership with DOH-ROs organized FP outreach teams comprised of HSPs trained on LARC services. These teams visit RHUs and barangay health stations (BHSs) to provide LARC services focused on GIDAs with high number of WRAs with unmet need. WRAs with unmet need for limiting who chose to have BTL are referred to hospitals with HSPs trained on BTL.

Plan for the Next Quarter 1) Engage the services of STTAs to conduct LARC/LAPM outreach clinics in areas with high unmet needs and in GIDAs to close the gap between the number of WRAs profiled and identified with unmet need and the number of WRAs profiled and identified with unmet need who received FP services 2) Advocate to the DOH-Regional Offices to resume their fund and logistics support for quarterly, monthly or more frequent outreach services of the NMMC, SPMC, CRMC and other medical centers' outreach teams.

Indicator FP 3: Average Stock- Out Rate of Contraceptive Commodities at Family Planning Service Delivery Points (SDPs)

Table 3.0 Stock-Out Rate of FP Commodities in USG/MH-Assisted SDPs Status for the Quarter, Q3PY6 Project Areas Baseline Acceptable Actual Level, 2018 Type Num Den* % Pills 20 457 4.3 (A) Priority Areas: Condom 8 457 1.7 (1) Non-CAA Areas Pills – 1% Beads 38 457 8.3 Pills – 2% (2) CAA Areas: No (a) BaSulTa, Zambo DMPA – 0 0 96 0.0 DMPA – 1% Stockout City, Cotabato City

(b) Marawi & IUD – 1% IUD – 0% Environs (Lanao Sur Beads 40 90 44.4

& Lanao Norte) Condom – Condom – 1% Pills 21 94 22.3 1% (B) Non-Priority Areas Condom 1 94 1.0

Beads – Beads 15 94 16.0 Beads – 3% 11% Pills 41 737 5.6 Project-Wide Total Condom 9 737 1.2 Beads 93 737 12.6 * No. of SDPs in the group of project sites

Analysis of Accomplishment

Ninety-nine (99) SDPs reported stock-out during the quarter at rates above the acceptable level for an FP commodity. Project-wide, the stock-out rate for pills was 5.6, for condom – 1.2% and for SDM beads – 12.6%. In the previous quarter only 17 SDPs in Marawi City and Lanao del Sur ran out of SDM beads. During this quarter, 76 more SDPs reported stock out of SDM beads - Lanao del Sur including Marawi City ({17 + 23}/53 SDPs), Zamboanga del Norte (12/36), Zamboanga del Sur (26/40), and Zamboanga Sibugay (15/24). DOH-ARMM reportedly has not maintained stock of SDM beads in the last 3 years due to low demand with only 0.28% reported NFP-SDM users in ARMM. DOH-Zamboanga Peninsula has no buffer stock of SDM beads, and there were no additional SDM supplies downloaded by DOH. To address stock-out of SDM-beads, starting 2016 RHU-Salug in Zamboanga del Norte has been making its own SDM beads out of plastic beads and other indigenous materials for distribution to NFP-SDM-users within its municipality only. Stock-out of POP was observed in Zamboanga del Sur (20/40 SDPs), Zamboanga Sibugay (15/24), and Davao Oriental (6/17); stock-out of condom in Zamboanga del Sur (8/40), and in Davao Oriental (1/17).

PDOHO-Zamboanga del Sur through the FHAs redistributed 5 boxes of POP from Margosatubig

Regional Hospital with the instruction to prioritize clients who cannot afford to buy. Proportion of pill-users as reported in FHSIS’s January-March 2018 report in affected provinces is 46.6% in Zamboanga del Sur, 38.2% in Zamboanga Sibugay, and 47.1% in Davao Oriental. If restocking of pills does not occur soon this will affect the number of continuing users (CU) and the CPR of these provinces. A decline in the number of pill users in Zamboanga del Sur and Davao Oriental has been observed since the last quarter. Five boxes of condom from RHU-Ipil were also redistributed to RHUs with stock-out. Strengthened linkages between and among public and private health facilities is beneficial in addressing stock outs. In SOCCSKSARGEN, the Unified Private Midwives Association of Gen. Santos City in coordination with DOH-RO was provided with 7 boxes of PSI last June 2018 for distribution to its members who were trained on PSI. MH facilitated the provision of PSI commodity to Goldenstate Maternity Clinic while FPOP- Gen. Santos City provided 1 box of PSI to RHU Tantangan (of South Cotabato Province) for their outreach activities. Sarangani Province (not an MH project site) shared 3 big boxes of POP and COC to Dr. J.P. Royeca Hospital in Gen. Santos City. There is no stock-out incidence in Northern Mindanao. There is an agreement between and among the RHU/CHOs, PHOs and the DOH-RO that once FP commodities of LGUs are near their critical level they can request the DOH-RO FP Coordinator for supplies. If the commodities are available from the DOH-RO’s buffer stock, these are delivered immediately. If not, the FP Regional coordinator would then access supplies from other provinces who have over supply based on the submitted stock inventory report. Regarding the availability of SDM beads, the Archdiocese of Cagayan De Oro City makes SDM beads and can supply the LGUs in Northern Mindanao at minimal cost. MH’s technical assistance to avert expiration or stock-out of FP commodities included: (i) inventory tracking, recording and reporting of consumption reports to FP provincial coordinator and FP logistics hotline, (ii) linking the public health facilities to PHO and DOH-RO in the event of near stock-out and stock out incidence for immediate stock replenishment, and (iii) promoting inter-LGU and inter-facility coordination that allows the PHOs, DOH-ROs and MH-LGUAs to redistribute commodities from facilities with reported over-supply (either due to low demand/service provision or over projection) to facilities with near stock-out or stock-out incidence. For example in Cagayan de Oro City, no health stations experienced stock-out. Based on the FP commodity inventory report from the FHA there were health stations where FP commodity level was nearing the buffer stock level of 25%. The PHO of Misamis Oriental with DOH-RO X distributed supplies to the City Health Office of Cagayan de Oro to prevent stock-out. The proportions of IUD- and PSI-users relative to the total are increasing. The number of PSI-users increased by 42% from 45,517 in Q4PY5 to 64,426 in Q3PY6. Given this observation, there is a need to leverage LGU resources for LARC/PSI, recognizing that DOH is not procuring FP commodity this year, to avert stock-out of PSIs.

Deviation Narrative

MH provided technical assistance to the 737 USG-assisted SDPs in institutionalizing the Logistics Management System for FP Commodity Inventory. The following mechanisms to prevent FP commodity stock-out are in place: i) FP commodity recording and reporting system, ii) periodic monitoring by DOH-ROs’ supervising pharmacists and Family Health Associates (FHAs) at the

municipal/city level, iii) inter-LGU/facility coordination to redistribute FP commodities through DOH- RO field workers, MH’s LGUAs and local health personnel, and iv) availability of buffer stock at DOH- ROs. But despite these mechanisms, occurrence of stock-out was not averted due to the following: a) DOH-ROs are no longer procuring FP commodities to augment their buffer stock; b) although some LGUs have maintained their CSR-budget, they are not procuring FP commodities; c) all public SDPs are dependent on the centrally-procured FP commodities but there is a delay in the restocking by DOH-Central. For cost-efficiency through bulk-delivery, DOH-Central reportedly pool FP commodities up to a desired volume before distribution to a particular area, and the hotline inventory reports is not analyzed to guide the quantity of FP commodities to be delivered. Stock-out of FP commodities undermines clients’ confidence in the entire FP services delivery system. There are very few SDM users – proportion of SDM users relative to the total MFP-users project-wide as reported in FHSIS’s January-March 2018 is only 1%. For the past 3 years, SDM beads was noted to be a very slow moving FP commodity in ARMM. While 91% FP acceptors opting for SARC or 171,258 out of 188,284 CU as of Q2PY6, only 0.28% are NFP-SDM users in ARMM, thus DOH-ARMM does not maintain a buffer stock of this commodity. Proportion of pill-users as reported in FHSIS’s January-March 2018 in affected provinces is 46.8% in Zamboanga del Sur, 40.3% in Zamboanga Sibugay, and 47.1% in Davao Oriental. If restocking of pills does not occur soon this will affect the number of continuing users (CU) and the CPR of these provinces. A decline in the number of pill users in Zamboanga del Sur and Davao Oriental has been observed since the last quarter. The stock-out of condom was caused by expiration of the commodity due to low demand in Davao Oriental the inability to report near expiry commodities in the hotline resulted to non-movement of the commodity to areas in need of the commodity.

Plan for the Next Quarter 1) Advocate to DOH-RO Management to purchase and/or increase buffer stock of FP commodities that frequently run out of stock, and to the LGUs to include POP in their procurement plan. 2) Assist LGUs with history of POP-stock-out to compute annual need for POP by using pill-use historical data and procure POP to prevent stock-out given that the highest number of MFP-users are on pills. 3) Advocate with LCEs and local health managers to revive the CSR policy to mitigate the impending shortage of commodities 4) Assist USG/MH-assisted SDPs to forecast and compute annual need for PSI to avert stock-out on PSI, given the increasing popularity of this method. 5) Coach the remaining 5 provinces (South Cotabato, North Cotabato, Davao Oriental, Sulu, Lanao del Sur and the 2 cities (Marawi & Cotabato) to adopt LMS & link with FP logistics hotline These activities will affect CU and CYP. When stock-out of FP commodities especially the popular ones is not immediately corrected this will adversely affect the demand for MFP-services and eventually the CU and CYP.

Indicator FP 4: Percent of USG-assisted SDPs Providing FP Counseling and Services to Couples, Men, Women, Youth and Adolescents of Both Sexes

Table 4.0 SDPs providing FP Counseling and Services as of Q3PY6 Accomplishment Cumulative Accomplishment Baseline for the Quarter, Q3PY6 Project Areas 2013 Target, Target, Actual % Actual % PY6 EOP (A) Priority Areas: 49/457 444 446 100.5 444 446 100.5 (1) Non-CAA Sites (2) CAA Sites: (a) BaSulTa, Zambo 93 71 76.3 93 71 76.3 City, Cotabato City 26/186 (b) Marawi & Environs (Lanao Sur 87 88 101.2 87 88 101.2 & Lanao Norte) (B) Non-Priority Areas 6/94 91 111 121.9 91 111 121.9 Project-Wide Total 81/737 715 716 100.1 715 716 100.1 * - denominator changed to exclude barangay health stations and private clinics that closed Target in PY6 is 97% of 737.

Analysis of Accomplishment

This indicator provides a measure of the ability of the local health system to maintain and sustain FP counseling and services and ensure continuity of options among service delivery points. This indicator is a key supply side input towards increase utilization of FP services.

The number of functional SDPs as of the Q4PY5 was 716. While there was 12 SDPs that were reported closed during the quarter due to failure to comply with the LTO-requirements of DOH, and the transfer of trained staff to the hospitals (9 in Davao City, 2 in Misamis Oriental and 1 in Cagayan de Oro City), there twelve (12) additional private birthing facilities, managed by Unified Private Midwives Association of General Santos City, supported by the project is now providing FP counseling and services thereby sustaining 716 SDPs providing FP services.

It is noteworthy that 68.5% or 491 out of 716 SDPs are located in rural areas, with remaining 225 (31.5%) in urban areas. Further, while there is only 31 out of 53 SDPs in Lanao del Sur providing FP counseling and services, the conduct of 8 outreach services during the quarter contributed to reaching 96% of its EOP CU target.

Deviation Narrative:

The inability to comply with the DOH LTO requirement and transfer of trained service providers to hospital resulted to the closure of 12 SDPs that were providing FP counseling and services, thus

despite additional capable 12 SDPs during the quarter, the total number of SDPs providing FP counseling and services is same as in previous quarters at 716 (110.1% of EOP target of 715).

Plan for the Next Quarter

1. Coordinate with DOH-ARMM and PHO to sustain their technical oversight functions to ensure sustainability of functional SDPs, and to assist identified potential SDPs as clinical/practicum sites on PPFP.

2. Working with regional offices and LGU health teams in identifying non-functional supported SDPs and help address gaps/causes of non-functionality.

Indicator FP 5: Number of USG-assisted community health workers (CHWs) providing family planning (FP) information, referrals, and/or services during the year

Table 5.0 No. of USG/MH-Assisted CHWs Providing Family Planning (FP) Information, Referrals, and/or Services during the year

Accomplishment for the Quarter, Q3PY6 Baseline Project Areas Actual PY5 Target, PY6 % M F Total (A) Priority Areas: 420 2,027 12 2,745 2,757 136.0 (1) Non-CAA Sites (2) CAA Sites: (a) BaSulTa, Zambo 824 11 94 576 69.9 City, Cotabato City (b) Marawi & 28 Environs (Lanao Sur 252 2 313 315 125.0 & Lanao Norte) (B) Non-Priority Areas 1,032 584 0 534 534 91.4 Project-Wide Total 1,480 3,687* 25 4,157 4,182 113.4 *In PIRS, target for PY-2018 is 3,535. In distributing the target to the different provinces/HUCs, the resulting total increased to 3,687 due to rounding up of numbers.

Analysis of Accomplishment Inadequate information, misconceptions, and fear of side effects of practicing MFP method are among the common barriers behind the non-use of FP services. CHWs are capacitated to use the CHW Toolkit for FP so that in the process of profiling WRAs to identify those with unmet need for FP, they can provide FP information and initial counseling. CHWs also invite and escort WRAs identified with unmet need to Usapan sessions and/or FP outreach services.

Project-wide, the average number of CHWs who were providing information and referring WRA with unmet need to appropriate SDPs during the quarter is 4,182. All the 2,800 CHWs who were active in Q2PY6 continued their tasks of listing WRAs with unmet need, giving FP information and referring them to HSPs for further counseling and FP services in Q3PY6. Additional 1,382 CHWs from the following provinces were given technical assistance and engaged in Q3PY6 – Bukidnon (691), Misamis Oriental (104), Agusan del Sur (73), Basilan (155), Sulu (10), Isabela City (85), Zamboanga City (77), Lanao del Sur (98), Zamboanga Sibugay (68), and Cagayan de Oro City (21). About 99% (4,147) of the active CHWs in Q3PY6 are female and 1% (25) are male.

In Bukidnon. Agusan del Sur, Basilan and Davao Oriental where the number of active CHWs is almost twice to 8x the target (in the case of Bukidnon), the number of WRA profiled and identified with unmet need is comparatively much higher (for details, refer to Table 07 in Vol. 2 of Q3PY6 Report). For example in Bukidnon, the 1,611 CHWs (target = 248) provided FP information to 4,833 WRA with unmet need and all of them were referred for FP services. Also in Bukidnon, provision of technical assistance to active volunteer population workers had been maximized. In Davao Oriental, 4,673 WRAs with unmet need were given FP information and 76% of them were referred for FP services. The Project continues to capacitate CHWs. During this quarter, the RHU of President Roxas (Cotabato Province) with assistance from MH trained 40 BHWs on the use of the FP job aids, and were provided with Flip Charts and IEC materials after the training. Another 40 BHWs from Arakan (Cotabato Province) were re-oriented and provided with job aids and IEC materials. In both orientation, ICV principles were integrated. They were instructed to report their referrals monthly to the RHUs, and their accomplishment will monitored and reported in the next quarter.

Deviation Narrative Given the project-wide accomplishment of 113.4 %, generally, there is no problem in mobilizing CHWs to help address unmet need for FP. Exception to this are Sulu, Tawi-Tawi, Zamboanga City, Cotabato City. General Santos City, and Cagayan de Oro.

Plan for the Next Quarter 1) Continue mentoring CHWs to improve the quality of FP information and initial counseling. 2) Work with LGU health teams in capacitating/orienting additional CHWs in selected CAAs. 3) Engage City/Municipal Government Operations Officers who have more influence on local chief executives in improving the engagement of CHWs.

Indicator N 1: Percent of LGUs conducting data quality checks (DQC)

Table 6.0 Percent of LGU conducting DQC as of Q3PY6 Accomplishment Cumulative Accomplishment, for Q3PY6 for PY6 Project Areas Baseline Target, Target, Actual Actual % % PY6 PY6 Q1-Q3 (A) Priority Areas: 157/186 39 24.8 157 152 96.8 (1) Non-CAA Sites (2) CAA Sites: (a) BaSulTa, Zambo 68/81 22 32.4 68 23 33.8 City, Cotabato City (b) Marawi & Environs (Lanao Sur 54/63 18 33.3 54 57 105.5 & Lanao Norte) (B) Non-Priority Areas 34/41 24 70.6 34 40 117.6 Project-Wide Total 268/ 368 313/ 368 103 32.9 313 272 86.9 Standard : RHU/CHO conducts DQC at least once a year Target = 85% of RHU/CHOs (313/368)

Analysis of Accomplishment.

DQC has been institutionalized in 15 provinces through policy issuance (either through an Executive Order or PHO memorandum), DQC team mobilization, and fund allocation for DQC related activities. For this quarter, the DQC policy of Zamboanga del Norte and Zamboanga City policy is in the process of being reviewed prior to approval by the LCE. One hundred three (103) RHU/CHOs conducted DQC activities in addition to 169 in the previous two quarters resulting to a cumulative total of 272 LGUs or 86.9% of 313 PY6 target. All LGUs in the provinces of Agusan del Sur, Zamboanga Sibugay, and Davao Occidental; 18 RHU/CHOs of Lanao del Norte, 7 RHUs of Davao Oriental, 10 RHUs of Tawi-Tawi, 12 RHUs of Basilan and Cagayan de Oro City Health Office conducted DQC during this quarter. At the current rate of DQC activities, the Project is still within its target except in Conflict Affected Areas.

In Zamboanga Sibugay, the last DQC conducted in the province was in 2016 due to changing health leadership and fast turn-over/movement of LGU health service providers and resignation of DQC- trained staff. During the September 2017 provincial PIR, the PHO, during FHSIS report analysis, observed that the numbers reported for the FP-MNCHN critical indicators (CU, ANC, FBD, SBA) were questionably high. The PHO then requested MH to conduct an orientation on DQC to the HSPs that included the newly hired HSPs. During the practicum, it was observed that misunderstanding on the definition of new acceptors (NA) for FP and how to remove drop outs from the Target Client List (TCL) were common. The post-DQC results revealed a difference between the initially reported and the

updated data on FP, 4 ANC, exclusive breastfeeding, deliveries attended by SBAs and facility-based deliveries. In addition, dates of prenatal visit were reflected in the wrong trimester column, and the reported numbers on the M1 forms did not match with the data entries in the TCL. This incident indicates the need to periodically orient existing and newly hired RHU staff on DQC.

The following factors significantly contributed to improved data quality;  DQC activities are conducted at the barangay/municipal level on a monthly basis and validated by PHNs prior to submission to DOH-RO in the case of Agusan del Sur and Agusan del Norte  “Drop everything” policy during the scheduled DQC activity.  Committed municipal/city and provincial DQC teams  Conduct of quarterly DQC activity at the provincial level to validate DQC results from RHUs

Local health managers see the value of DQC’d data in their PIR and LIPH formulation, advocacy efforts, and decision-making process.

Deviation Narrative. Generally, the project is within the target of achieving DQC objectives. Sulu, Zamboanga City and Cotabato City have scheduled DQC in the next quarter. However, there are areas where DQC remains a challenge especially when LGU leaders and personnel are not so receptive to conduct DQC as in the case of Davao City, despite constant advocacy to conduct the DQC by DOHRO and project, for fear of a repeat of what had happened during the first DQC when FP-CUs with no FP Form 1 were remove from the TCL. A sign that they did not build up their DQC processes to address weaknesses in their recording/reporting system observed during the past DQC. The project can do so much with partners that are non-responsive or ningas-kogon in their actions. The fast turn-over and resignation of DQC-trained health service providers, including the frequent changes in the provincial health leadership in Zamboanga Sibugay has also affected the continuity of DQC processes.

Plan for the Next Quarter. 1) Advocate to LCEs and local health managers of the remaining four provinces (ZS, ZDN, DO, DDS) and cities of Zamboanga Peninsula and Davao City to institutionalize DQC by facilitating the issuance of policy/guidelines, creation of DQC teams, and the allocation of budget for DQC related activities 2) Continue to provide coaching/mentoring support to PHN/RHMs for LGUs not conducting DQC regularly 3) Continue the conduct of random DQC activities for LGUs regularly doing DQC for quality assurance

Indicator N 4: Number of USG-assisted SDPs Providing FP-RH Services for Adolescents and Youth

Table 6.0 No. of AYRH-Friendly Facilities in USG/MH-Assisted Project Areas Accomplishment for Type of Baseline Target Cumulative Accomplishment PY6Q3 Facility PY5 PY6 Accomp % Target Accomp % Hospitals 8 10 8 80 18 16 88 RHUs 35 30 21 70 65 56 86 Schools 13 6 6 100 19 19 100

Analysis of Accomplishment Of the 10 targeted hospitals, 8 has already integrated AY services into FP Programs while the other two are on varying stage of development with technical support from MH. Also support to campus- based AYRH services scaled up to additional 6 resulting to 19 schools supported by the project. From the initial 12 schools supported by the project in Agusan del Norte, the province’ DepEd Division rolled out the Youth Optimizing Life Opportunities “YOLO” program to its 46 secondary schools through series of program orientation on teenage pregnancy, HIV/AIDS, drug use and risk assessment. Lastly with additional 21 RHU supported, a total of 56 RHUs are now providing AY friendly services. AYRH Friendly Hospitals As of PY6Q3, partial data from 14 of 18 hospitals targeted by the project showed that the number of FP-MCH/RH services accessed by AYs has dramatically increased from 7,965 provided in Q2PY6 to 16,466 FP-RH provided during the quarter, posting an increment of fifty-one percent (51%). Notably, the largest proportion of AY-clients in the 14 hospitals accessed perinatal care (ANC, delivery, PPC) at 38.3% (6,310), while 14% (2,338) visited FP Clinic. Among those who were provided FP services, 29% (679) had PPIUD, 28% (665) had Pills, 18% (414) had PSI, 11% (267) used DMPA injection and the rest opted to use condom and NFP. Significant number of STI- (225 at 1%) and VAWC-cases (68 at 0.5%) were managed during the quarter. It can also be noted that the conduct of counseling using HEEADSS as a tool to identify AYs with psychosocial risks including FP-RH needs gained steady response from the hospitals with a total of 5,771 AY assessed, counseled and referred as needed. AYRH Friendly RHU In its extension year, the project focused its technical assistance to 30 RHUs1 towards meeting the

1 PY6 Target RHUs for AY-friendly facilities

Priority Areas: 1. Zamboanga del Sur: ZDS-ClusterDistrict2 SDN (Lapuyan, V. Sagun, Margosatubig,) Conflict Affected Areas: 2. Zamboanga City (Ayala Health Center and lying, Labuan, Calarian, Baliwasan, Dona Isabel C. Climaco, Canelar, Tetuan, Sta. Catalina, Talon-Talon, Tumaga, Mercedes, Manicahan, Sangali Main Health Center, Curuan, Vitali Health Center and Lying in, Guiwan, Rotary Lying in Clinic); 3. Lanao del Sur (Bubong);

minimum criteria of AYRH-friendly facility such as having AJA-trained HSPs, use of risks assessment, designated room for privacy-confidentiality. Twenty-six of the targeted 30 RHUs were carried over to PY6 for TA completion, while 4 new RHUs were added, resulting to additional 21 during the quarter giving a total of 56 AY-friendly facilities, leaving 9 supported RHUs on stages of complying to DOH criteria on AY-friendly facility certification. As of Q3PY6, the number of FP-RH services accessed by AYs in 50 of 68 assisted-RHUs with report posted an estimated increment of 33% (6,854) compared to the data on FP-RH services (4,526) availed in previous quarter. Based on joint field partial reports, 21.5% (1473) of services availed were on various FP methods, while access to other RH services covering ANC, delivery, STI and VAWC comprised 20.2% (1389) of total posted availed services. Notably, the number of counseling using HEEADSS is increasingly being utilized at 58.2% (3992) of total provided. The project’s continuing technical assistance to the 68 RHUs, which began in PY4-PY5, and carried over to PY6 focused on 30 RHUs towards youth-friendly facilities meeting minimum requirements, including: HSPs trained on AJA-risks assessment, use of HEEADSS, designated room with privacy, and guidelines. AYRH Friendly Schools Begun in PY5, MH’s TA in schools focused on building the capacities of personnel in Learner Support Services that include guidance counselors, and district and Health & Nutrition-nurses; AJA-risk assessment counseling and referral; and enhancing the capacities of teaching staff under the Curriculum Implementation Division towards integrating Comprehensive Sexuality Education in MAPEH, TLE, Values, Science, and Araling Panlipunan subjects based on K 1-12 competencies curriculum. In PY6, the MH expanded its work in schools and targeted an additional six schools, i.e., 3 national high schools under the DepEd Division of Zamboanga del Sur, and 3 JH Cerilles Colleges also located in V. Sagun municipality. These schools were selected due to their high incidence of teen pregnancy, and their location within the catchment area of ZDS Cluster District 2 SDN, thus facilitating the students’ access to FP-RH services through the referral network. This initiative is in addition to the 12 schools under the DepEd Division of Agusan del Norte assisted in PY5 to implement AYSRH in schools named YOLO (an acronym for Youth Optimizing Life Opportunities) through the ARH program under the Learner Support Services. Agusan del Norte Schools Division, DepEd started rolling-out the YOLO Program to its 46 secondary schools. From Q1PY6 to Q2PY6, a total of 3,524 learners were assessed with alcoholic drinking and drug use as the highest among risks detected at 25% and 22% respectively, followed by home concerns (19%), experience bullying (17%), smoking (12%) and sexual health concern at 5%. Immediate and follow through guidance were done, with eleven (11) referred to service facilities for further management. With the long school break in Q3PY6, only 99 students were reached and 20 undergone full counseling, one teen pregnant referred to RHU for ANC and 19 referred to PNP due to safety risk associated concern (involvement in gangs).

4. Tawi-Tawi (Bongao); 5. Sulu (Patikul, Luuk, Pangutaran, Talipao, Parang, Indanan, Panamao, Jolo); 6. Basilan (Maluso, Lamitan) Non‐priority areas Agusan del Norte : BueNasCar SDN (Buenavista RHU)

Deviation Narrative AYRH Friendly Hospitals Internal coordination and referral for FP-RH between OPD FP-AYRH OPD with the hospital wards, and demand generation remain wanting, and this contribute to the big variation between number of women who delivered and those provided with FP services. Coordinated and proper recording and reporting with appropriate data disaggregation is still a challenge in all hospitals. Multi sectoral referral mechanism within the SDN including schools and other sectors especially of AYs in crises has yet to be fully in place. AYRH Friendly RHU AYRH services were disrupted due to on-going renovation in 3 RHUs in South Cotabato and due to the transfer of the AJA-trained person in RHU. AYRH Friendly Schools Multi sectoral referral network is still being discussed in both school divisions in Zamboanga del Sur and in Agusan del Norte. This is direly needed due to the varied psychosocial concerns of AY in need of help and ensure continuity of care. Not all members of the teaching staff in schools under these two divisions have the capacity to integrate Skills-based Health and Sexuality Education.

Plan for the Next Quarter AYRH Friendly Hospitals Continue technical support initiated in Q3 to: a) Assist Margosatubig Regional Hospital; JR Borja Hospital; Davao Oriental Medical Center-Mati; Compostela Valley PH-Montevista; San Pedro Hospital, Dr. Jose Rizal Memorial Hospital , Sultan Kudarat Provincial Hospital in finalizing FP-AY service guides; b) Follow-through mentoring of trained IT and FP personnel across hospitals on FP-RH recording and reporting with data disaggregation for timely analysis and utilization of information, with special attention to Brokenshire Hosp and Compostela Valley Provincial Hospital-Montevista who have adopted a systematic FP recording and reporting. AYRH Friendly RHU 1) Monitor and mentor DOH-ROs of Davao Region, and ARMM; AYRH-friendly DHO/RHUs, particularly DHOs - District A Jacinto and Buhangin in Davao City, and Datu Piang in Maguindanao; Bubong, in Lanao del Sur, Bongao in Tawi-Tawi, Maluso and Lamitan in Basilan, ; and Margosatubig, Lapuyan, and V. Sagun in Zamboanga del Sur on the proper use of AY Reporting and Recording forms and the use of DOH prescribed quarterly recording & reporting forms for FP-AY 2) Assist RHU-Sta. Cruz in forging partnerships with CSOs, industries, schools, barangays to promote and maximize utilization of services in RHU’s Teen Center 3) Strengthen the linkages with AJA- trained DepEd personnel for co-implementation of AYRH Services including rapid HEEADSSS assessment to identify high-risk-senior high school, -high school and - college students for immediate counseling, referral and management in Margosatubig, Lapuyan, and V. Sagun under the Cluster District 2 SDN, and RHUs under the OLTAMA SDN which include RHUs of Olutanga, Talusan, and Mabuhay in Zamboanga del Sur.

AYRH Friendly Schools 1) Assist in firming up referral pathways between the assisted schools in Zamboanga del Sur and

Zamboanga Sibugay with USG-assisted SDPs for further management of AYs with health risks. 2) Assist ADN-PHO and DOH-RO Caraga in strengthening the multi-sectoral referral mechanisms for AY services and engaging the DepEd Division and its schools as partners. 3) Support the 2 DepEd Divisions in Zamboanga del Sur and Agusan del Norte in building the capacities of select teaching staff in 7 schools (2 in ZDS and 4 in AND) in integrating comprehensive sexuality education in school curricula.

Indicator HL.6.2.1: Number of Women Giving Birth who Received Uterotonics in the Third Stage of Labor through USG- supported program

Table 8.0 Number of Women given with Uterotonics as of Q3PY6 Accomplishment Cumulative Accomplishment, for the Quarter, Q PY6 2018 Project Areas 3 Target, Target, Actual % Actual % PY6 PY6 (A) Priority Areas: 4,837 3,396 70 4,837 10,531 218 (1) Non-CAA Sites (2) CAA Sites: (a) BaSulTa, Zambo 2,489 2,099 84 2,489 4,963 199 City, Cotabato City (b) Marawi & Environs (Lanao Sur 1,739 4,095 235 1,739 4,095 235 & Lanao Norte) (B) Non-Priority Areas 934 446 48 934 1,668 179 Project-Wide Total 10,000 10,036 100 10,000 21,257 213

Analysis of Accomplishment The administration of oxytocin during the third stage of labor is part of the standard of care for women giving birth even in home deliveries. Project-wide, despite lack of reports from some sentinel sites, accomplishment have surpassed the targeted number of women given uterotonic, which may imply universal implementation of AMTSL in Mindanao, not only in ARMM.

Deviation Narrative Surpassing target for the year despite non-submission of reports from some sentinel SDPs is primarily due to under-targeting, especially that oxytocin is routinely given to women during the third stage of labor to prevent postpartum hemorrhage, including in home deliveries attended by SBA in ARMM. The potency of the oxytocin maybe be compromised, though, given the poor cold chain system in some ARMM areas, thus need to be monitored and address accordingly.

Plan for the Next Quarter 1. Review and adjust PY6 to reasonable level.

2. Continue coaching, mentoring and random monitoring of birthing facilities to ensure that the practice of AMTSL is widely sustained, that stock-out of AMSTL is prevented and that oxytocin shall always be stored at a temperature of 4◦ C to preserve potency.

Indicator NI 1: No. of Women of Reproductive Age that Have Been Profiled and Identified as Having Unmet Need for FP

Table 9.0 WRA profiled and identified with Unmet Need in FP as of Q3PY6 WRA with Unmet Accomplishme Cumulative Accomplishment Project Areas Need for FP* nt for PY6Q3 Target, EOP Actual % (A) Priority Areas: 464,639 176,161 464,639 628,129 135 (1) Non-CAA Sites (2) CAA Sites: (a) BaSulTa, 112,663 4,628 112,663 6,667 6 Zambo City, Cotabato City (b) Marawi & Environs (Lanao 75,109 1,984 75,109 28,337 38 Sur & Lanao Norte) (B) Non-Priority Areas 116,074 16,332 116,074 36,827 32 Project-Wide Total 768,485 199,105 768,485 699,960 91 * - Target based on the Costed Implementation Plan as per DOH Memo issued on November 16, 2017 In PIRS, EOP-target is only 470,840

Analysis of Accomplishment. This indicator measures the coverage of one of the demand generation activities that includes profiling of WRAs and identifying those with unmet need for FP. LGU health teams and/or DOH- deployed FHAs, with support from community health workers conduct house-to-house campaigns to actively reach WRA, identify those with unmet need, provide information services and refer them to trained health workers or health facilities. In some areas, teams with capacity to provide FP services, brings with them FP commodities and provide the services to clients after one-on-one counseling on- site.

Project-wide, the number of WRAs profiled and identified with unmet need for FP is already 91% of the estimated number of WRA with unmet need, but low in CAAs areas for the following reasons: profiling in Marawi and its environs started only after training of newly hired 40 FHAs for Lanao del Sur and Marawi with project support in the later part of Q2PY6, and the inadequate mobility and capacity to reach island and mountainous barangays in ARMM and other CAAs not to mention security risks.

Profiled WRA with unmet will now facilitate targeted/focused demand generation for FP counseling

and services; improved segmentation of potential clients targeted for USAPAN Pwede Pa or Kontento Na, thereby increasing conversion rate of USAPAN Sessions.

Deviation Narrative Project areas in the Conflict Affected Areas have identified only about 44% of the estimated WRAs with unmet need for FP. This is due to late deployment of FHAs in ARMM, limited number of CHWs who are actively profiling women with unmet need and referring them for FP services, and the unstable peace and order situation which limits CHW mobilization and causes internal displacement of residents. Complete reporting of this indicator is a huge challenge. FHAs are primarily responsible for maintaining this list. In some areas, FHAs report directly to their respective DOH-RO and do not share the report with their respective RHU/CHO. There are no reports for two to three quarters of PY6 on this indicator in 8 provinces/HUCs – 4 in Priority Non-CAA, 2 in Priority CAA (a) and 2 in Non-Priority Areas.

Plan for the Next Quarter Very crucial in increasing the profiling and identification of WRAs with unmet need is the mobilization of CHWs and other frontline workers. To enhance and sustain year round mobilization of CHWs and other frontline workers, we need to continue engaging DILG’s Municipal/City Government Operations Officers and local chief executives to implement the DILG Memorandum Circular in fast tracking the implementation of RPRH law.

Indicator NI 2: Percent of women of reproductive age that have been profiled and identified as having unmet need who have been provided with FP services.

Table 10.0 Percent of WRA with Unmet Need for FP Provided with FP Services Accomplishment Cumulative Accomplishment Project Areas for the Quarter Target* Actual % (A) Priority Areas: 68,034 628,129 165,733 26.4 (1) Non-CAA Sites (2) CAA Sites: (a) BaSulTa, Zambo 1,660 6,667 11,183 167.7 City, Cotabato City (b) Marawi & Environs (Lanao Sur & Lanao 1,106 28,337 12,503 44.1 Norte) (B) Non-Priority Areas 10,936 36,827 18,077 49.1 Project-Wide Total 81,736 699,960 207,496 29.6 * - Target based on the accrued accomplishment of NI 1 – WRAs profiled and identified with unmet need for FP-only Actual is Q3PY6 accomplishment

Analysis of Accomplishment

While about 91% of WRA with unmet need are profiled , only 29.6% were provided FP services to date.

There is an observed increase in the number of profiled WRA with unmet need provided with FP services, from 22,342 or 16% out of 137,952 profiled in Q2PY6 to 41% or 81,732 out of 199,105 profiled in Q3PY6. The increase in the number of profiled WRA with unmet need provided with FP services, though, is much lower than the additional number of profiled WRA with unmet need during the quarter, thereby the increasing accrued profiled WRA with unmet need. The service provision could not catch-up with the identification of WRA with FP unmet need.

Deviation Narrative Factors to the wide gap between the number of profiled WRA with unmet need and those provided FP services are complex requiring multi-sectoral and multi-level understanding of the issues in order to address the following varied systemic operational challenges; 1. While FHAs are DOH deployed to support LGUs on FP such as profiling among other things, POPCOM who is responsible for demand generation - conducts profiling – and more often than not are not link to service provision/late linkage with service providers. 2. The late realization of one region on the impact of focusing first on profiling than linking outright with service provision; coupled with analyzing profiling results at DOHRO level first before downloading to LGUs 4. The concentration of available FP services in urban areas, with minimal capacity in GIDAs can also be a factor to the inability of the system to narrow down gaps between profiling results and service provision ; 5. Outreach services conducted are still not enough especially in hard to reach areas;

Plan for the Next Quarter 1) Discuss and elevate this issue at RIT/PIT level. 2) Help DOHRO/LGU analyze profiling results and service coverage to identify areas to prioritize outreach services, in partnership with private/CSO providers., with built in USAPAN Sessions 3) Advocate to partners to increase frequency of fixed service provision and activate their itinerant teams.

Indicator NI 3: Percentage of PPFP/PPIUD Trained Providers that Have Been Certified by the Department of Health in USG Assisted Sites

SupSup Certified Project Areas Trained No. % No. % (A) Priority Areas: 617 452 73 282 62 (1) Non-CAA Sites (2) CAA Sites: (a) BaSulTa, Zambo City, 102 50 49 40 80 Cotabato City (b) Marawi & Environs 47 19 40 9 47 (Lanao Sur & Lanao Norte) (B) Non-Priority Areas 201 135 67 75 50 Project-Wide Total 967 656 68 406 62

Analysis of Accomplishment. Project-wide and as of the end of Q3PY6, the proportion of trainees who underwent supportive supervision is low at 68%, of which 62% of those supportively supervised or only 42% of total PPIUD trained are DOH-certified Status of certified trained PPIUD varies across region, with SOCCSKSARGEN region having the highest accomplishment in terms of number of PPIUD trained service providers and certification with a total of 276 PPIUD trained staff, and 233 or 84% were supportively supervised resulting to certification of 191 or 82% supportively supervised trained staff.

CARAGA, while had the lowest number of trained service providers at 59, forty nine (49) or 83% were supportively supervised but only 23 or 47% were certified for varied reasons (11 left and 7 opted not to pursue providing the services). The availability of region-based master trainers and engagement of external trainers through the project, with strong support from DOHRO are key factors to these high accomplishment.

On the other hand, despite the availability of capable facilities and master trainers in Davao Region, it ranks 5th with only 30 (30%) out of 97 (53%) supportively supervised from total 182 PPIUD trained were certified, with no certified among the 65 trained provider in Davao City. In ARMM, the seemingly low certification is primarily due to the inability of trained service providers to complete 10 cases requirement to undergo post-training evaluation, for reasons that, in general PPIUD/IUD methods is not culturally acceptable as it requires exposure of private parts. While more than half of PPIUD trained in Zamboanga Peninsula and Northern Mindanao underwent post-training evaluation, not all were certified.

Accelerating the post-training evaluation and certification processes are anchored to the willingness of the trainee to complete required cases and to undergo supervision, as well as the dedication of DOHRO to work with available master trainers, and with the project, to jointly move forward the post- training evaluation activities, and ensure provision of timely DOHRO certification, while implementing follow-on mentoring to other trainees to build their confidence.

Deviation Narrative. The lack of dedicated trainers/mentors to conduct post-training evaluation and on-site mentoring/coaching of trained service providers even at regional level is the key factor to low certification. Furthermore, current accomplishment captured to date may or may not reflect the actual status due to the lack of monitoring system/mechanism that regularly update database to capture new trainees and to continuously clean training data base to weed out trainees who have already resigned/retired from the service, transferred to another unit/department, or who are closely conscientious objectors. For example, in Agusan del Sur and Agusan del Norte, of the 59 MH-assisted PPIUD trained HSP, 11 have already left the service and 7 are not able to comply with the requirement and opted not to practice PPIUD anymore. HSPs in predominantly Muslim-provinces like Tawi-Tawi, Sulu, Isabela City, Zamboanga City , Lanao del Sur and Lanao del Norte have difficulty in complying with the required 10 cases provided with

PPIUD before they can go for supportive supervision, because of the low demand for PPIUD among

Muslim WRAs because IUD is not culturally acceptable to them. Other province/HUCs with low supportive supervision coverage (ex. Davao City, Compostela Valley and Cagayan de Oro City) is due to the fact that most trainees are based in Barangay Health Stations with only once in a week or in 2 weeks duty in their DHO/RHU-based birthing facility thus are not able to comply with the required at least 10 PPIUD cases. The Project has developed 53 clinical practice sites – 13 in Zamboanga Peninsula, 8 in Northern Mindanao, 10 in Davao Region, 13 in SOCCSKSARGEN, 8 in Caraga Region and 1 in ARMM located in Maguindanao. But trainees do not make use of many of them. Either their local chief executives (LCEs) do not allow them to travel outside of their service area, and/or they prefer to go to the big hospitals located in the city or capital town.

Plan for the Next Quarter 1) Update the training database including the SDP where the HSP is working to determine the distribution of SDPs that can provide both SARCs and LARCs to facilitate FP services mapping 2) List HSPs assigned in hospitals or in birthing facilities who are still interested to perform PPIUD but are not confident to do it, and submit the list to the DOH-CHD FP Coordinator for scheduling of re- training or PTE. 3) Advocate to the DOH-ROs to fast track the DOH certification so that the HSPs can apply for PhilHealth tagging/accreditation.

Indicator NI 4: Number of Newborns Not Breathing at Birth who were Resuscitated in USG-Supported Programs

Cumulative Accomplishment, Status for the Quarter, PY6Q3 Project Areas 2018 Status as of EOPY6Q3 Target Actual % Target Actual % Priority Sites 144 314 Conflict Affected Area 22 22 Non-Priority Sites 112 228 Project-Wide Total 70 278 397.1 70 564 805.7

Analysis of Accomplishment For this particular indicator, reports are being collected from ten (10) sentinel hospitals. A total of 278 newborns were resuscitated during the quarter giving a cumulative total of 562 as of Q3PY6 which is 805% of EOP target of 70. A total of 278 or 4.9% of the 5,660 livebirths were resuscitated during the quarter in the monitored 10 hospital,

Deviation Narrative The proportion of newborn resuscitated in 10 sentinel sites are within acceptable standard range of 5- 10%, according to studies. The very high accomplishment is due to low target.

Plan for the Next Quarter

Fully implement reporting form developed by the project that includes gender of the newborn

resuscitated and reason for resuscitation. Reconsider increasing PY6 target.

Indicator NI 5: Number of SDPs in Marawi City with Functional Health Service Provision.

Accomplishment Cumulative Accomplishment, Baseline Indicator for the Quarter, Q3PY6 2018 2017 Target Actual % Target Actual % Marawi & Its 0 21 21 100 Corridors

Analysis of Accomplishment All the 9 targeted health facilities in Marawi are now providing essential FP/MNCHN services. Likewise, the provision of FP/MNCHN services were further strengthened in other nearby 12 facilities in Lanao del Sur (7) and Lanao del Norte (5).

Table below summarizes the type and coverage of services provided: Core Interventions Accomplishment (April-June 2018) I. Immediate RH/medical a) Conducted 10 outreach/REACH* Services with USAPAN Sessions health services through: 1. 2 in Marawi : a) conduct of o Reached 134 WRA, of which 62 are AY (15-24), 22 men and Outreach/REACH Services children. with USAPAN Sessions in o 85 children provided with antigen; 109 provided with LDS/Marawi City Vitamin A, o Of the 45 potential clients reached through USAPAN, 29 accessed FP methods of their choice giving a conversion rate of 64.4% 2. 8 in Lanao del Sur with the following results: o 1206 WRA served with FP info, counselling, and services; of which 232 are AY (15-24 y.o.) o 249 New Acceptors (SARC and LARC-PSI) of which 115 are LARC/PSI acceptors, were generated from 603 participants of 31 supported USAPAN, with a conversion rate of 41.29%.

b) Conduct of USAPAN b) LDN/Iligan – 19 USAPAN Conducted reaching 236 USAPAN linked with service provision participants with FP info and Counselling and 199 participants accessed FP methods of their choice, with a conversion rate of 84%

c) Provision of fixed FP c) In addition, GTLluch, Iligan City reached 119 FP clients (29 BTL, services, GTMLH, Iligan City 21 PPFP/PPIUD, 8 IUD, and 61 LARC-PSI).

In summary, a total of 596 FP acceptors were reached during the quarter.

d) Ensuring safe motherhood d) A total of 736 pregnant women with 4ANC visits and 729 and newborn care postpartum women with PPV2 were provided with dignity/woman’s kit and maternity kits respectively broken down as follows:

Maternity USG-sites Dignity kit Comments kits Lanao del 504 497 Reached (7) Sur Buadiposo Buntog, Piagapo, Saguiran, Ramain, Bubong, Marantao, Mulondo Lanao del 232 232 Covered (2) Balo-I, Norte Pantar Total 736 729 Validation of Marawi CHO list is on-going for July distribution

The team focuses on the social preparation at barangay level to ensure there is full understanding on the criteria and rational of kit provision, thus the distribution rate is low. Distribution will be accelerated in the next coming months, in partnership with local health teams, and CSOs.

II. Help restore/strengthen 1. FP unmet Need Profiling: provision of essential o Trained 39 FHAs of Lanao Del Sur and 1 FHA of Marawi RH/health services City on FPCBT1 o Initiated profiling WRA with FP unmet needs and providing FP counseling and services. . Marawi – Profiled Women with FP Unmet Need: 127; Provided with FP info & Counseling: 127; . LDS - Women with FP Unmet Need Profiled: 1661; Provided with FP info & Counseling: 1518; Provided with FP services: 329 o LDN/Iligan - Women with FP Unmet Need Profiled: 1,024; Provided with FP info & Counseling: 1,024; Provided with FP services: 368 2. Trained 2 HSPs of Amai Pakpak Medical Center and 3 HSPs in GTMLH Hospital in Iligan City on Hospital Recording and Reporting , with follow-up onsite coaching and mentoring of FP Recording and reporting 3. Translated Khutba Materials on Maranao dialects (Male Involvement), printed and for distribution to 22 MRLs that were oriented to be used during sermons. 4. Procured 10 water tanks for 9 health facilities in Marawi and Nunungan RHU in LDN. Coordination with local officials done and installation will proceed in the coming months.

Deviation Narrative: The provision of essential health services is challenged by observance of Ramadhan during the quarter, imposition of curfew hour due to martial law implementation, wide catchment areas per facility, most service providers are non-residence of their areas of responsibility, and the limited mobility of staff to conduct field/home visits. Lastly, efforts spent to outsource CSOs on the early part of the quarter went in vain, due to inability of potential partner to renew its SEC Registration, after series of technical consultations with its core team.

The poor recording and reporting system on maternal, neonatal health care services, and non- optimization of other supported activities resulted to the delay in identifying/validating qualified recipients among pregnant and post-partum women and distribution of dignity and maternity kits. Furthermore, installation of water tanks to these 9 facilities are likewise derailed due to varied operational and coordination challenges. On the positive note, the TA (FPCBT1 training of FHA with follow-on on-site coaching mentoring of HSPs) resulted to improved profiling of WRA with unmet need in Q2PY6 thereby improving USAPAN Pwede Pa participants targeting ultimately increasing conversion rate in Q3PY6 to 67% from only 7.3 in Q2PY6.

Plan for the Next Quarter: With reinforced team; 1. Accelerate conduct of outreach services giving more focus to GIDAS and tent city/temporary shelter areas by expanding partnership with CSOs. 2. Coordinate with LGU and other partners to fast track the installation of 9 water tanks, 2 generator sets, including 15 solar refrigerators upon their arrival in-country. 3. Procure additional maternity and dignity kits to address gaps, while fast tracking distribution of remaining kits in Marawi City. 4. Support the conduct psychosocial services and USAPAN Sessions 5. Sustain on-site coaching on profiling and R & R System strengthening 6. Support conduct of DQC.

Indicator NI 6: Percent of Audience recall of hearing and/or seeing MH supported FP/RH Key Messages

Table 14.0 Percent of Audience Recall on MH FP/RH Key Messages Audience Reach for Recall of FP/RH Key Messages, Q3PY6 USAPAN Q1-Q2PY6 and Health Peer Project Areas Target Facility # WRA As of Q3PY6 Accom. Events CHWs Educat Total Based Profiled Participant ors s (A) Priority Areas: 1,229,779 337,272 9,033 41,037 628,129 2,757 38 680,956 1,018,228

(2) CAA Sites: (a) BaSulTa, 284,355 174,598 1,259 10,344 6,667 315 59 18,682 193,725 Zambo City, Cotabato City (b) Marawi & Environs (Lanao 206,169 79,726 1,589 6,749 28,337 576 - 37,251 116,725 Sur & Lanao Norte) (B) Non-Priority 279,697 79,535 2,576 11,464 36,827 534 - 51,401 130,936 Areas All 2,000,000 671,129 14,457 69,594 699,960 4,182 97 788,290 1,459,419

Analysis of Accomplishment. The project accomplished 788,290 or 39% audience reached for recall of FPR/RH key messages for the period Q3PY6. While this indicator was not reported in Q1 and Q2, review of records showed that there are about 671,129 audience who recalled of hearing and seeing USG-supported messages on FP/RH, resulting to an audience recall of 1,459,419 or 73% of the PY6 target of 2 million as of Q3PY6. The project agreed to utilize the following accomplishment as the reporting constitutes of this indicator: (1) Usapan & Health Events Participants, (2) Facility-Based Deliveries as reported in the FHSIS (3) Number of WRA Profiled during the identification of Unmet Need as mandated by EO12 of 2017, (4) number of WRA reached by CHW during profiling and motivational visits, and (5) number of adolescent/youth reached during USAPAN Barkadahan/peer educators training. Table 04 in Annexes shows the distribution of targets and accomplishments per priority and non-priority areas

Deviation Narrative The accomplishment to date is 2 percent points lower from 75% target for the quarter due to the non-inclusion of demand generation data in targeted hospitals and the estimated reach of radio plugs from ARMM and Zamboanga Sibugay.

Plan for the Next Quarter

1. Reproduction of FP fans for inclusion into maternity and dignity kits for Marawi and its environs. 2. Inclusion of package of IEC materials during dissemination activities at regional and provincial levels. 3. Collect data from hospital demand generation activities and estimate reach of radio plugs.

Conflict Affected Areas Indicators:

Indicator CAA1: Number of Health Outreach Conducted

Baseline Accomplishment Cumulative Accomplishment, Indicator 2013 for the Quarter, Q3PY6 2018 (SHIELD) Target Actual % Target Actual % Conflict Affected 336 50 173 346% 315 420 133% Areas

Analysis of Accomplishment Below details the breakdown of outreach/REACH activities during this reporting quarter, completed for PY6 and completed to date by CAAs. Accomplishment Total PY6 outreach CAAs Comments Q1& As of supported Q3 Q2 Q3PY6 to date Basilan 18 7 25 57 36% (76) of 210 barangays are GIDAs; 8 or only 14% of 57 supported outreaches to date were conducted in following 8 GIDAs barangays during the 1st 3 quarters of PY6: Bohebalong, Tipo-tipo; Sinulatan Tuburan; Lantawan Proper; Linungan, Akbar; Tambuling Buton Tabuan Lasa; Kinkutan al Barka; Danapah Albarkah; Tausan Hadji Muhtammad Sulu 8 0 8 24 29% (119) of 411 barangays are GIDAs, with an outreach supported in Laminusa, Siasi, or only 0.4 % total outreach supported. Tawi- 11 3 14 28 48% (97) of 204 barangays are GIDAs, supported Tawi outreach in barangay Ungus-ungus, Sibuto Lanao 6 8 14 31 16% (183) out of 1164 barangays are GIDAs; due to del Sur security challenges, clients from the 20 GIDA barangays (11% of total GIDAs) were transported to 14 outreaches services conducted in nearby non-GIDAs. Marawi 3 0 3 7 Two or 29% of 7 supported outreaches were conducted City in 2 GIDA barangays of the city. Namely Papanday, Pugaan and one was conducted in Sarimanok Tent City Maguind 10 38 48 80 45% (124) out of 275 barangays are GIDAs. 3 or roughly anao 4% of 80 supported outreaches were able to provide

services GIDA barangays namely Libutan, Mamasapano, Datu Paglas, Bulod, Sultan sa Barongis Darmpua Total 56 56 112 227 First 3 quarters of PY6 contributed 49% of total ARMM 227 outreaches supported in CAAs to date. Cotabat 4 0 4 7 15 (24%) of 33 barangays are GIDAs o City Zamboa 9 13 22 92 6 (6%) out of its 97 barangays are GIDAs nga City Isabela 2 2 4 31 8 (18%) of 45 barangays are GIDAs City Lanao 31 0 31 63 63 (12%) of 506 are GIDAs del Norte/Ili gan City Grand 102 71 173 420 To date, the project exceeded its EOP target of 315 total (346 (133% Outreaches, and PY6 target of 50 outreaches % pf of PY6 target) targe t While there are 691 GIDAS or 24% of total 2,945 barangays in CAAs, available PY6 records shows only 35 (20%) of 173 outreaches supported were conducted in GIDA barangays or has provided services to GIDA clients specifically in Basilan (8); Sulu (1); Tawi-Tawi (1); Maguindanao (3) and Marawi City (2), and Lanao del Sur where clients from 20 GIDAs were transported to the outreach site and provided FP services.

Deviation Narrative While the project exceeded its end-of-project target, the reach to GIDA barangays is low at only 20%, including GIDA barangays where potential clients were transported by the barangay officials and/or by the project to the población for FP services. Local initiatives such as People’s Day in ARMM, Rose Caravan in Basilan supported with LGU Ordinance, and Catch and Change of Sulu have already integrated outreach and other demand generation activities such as USAPAN. Furthermore, issuances of PHO Orders in Sulu, LDS and Maguindanao is gradually institutionalizing outreach services, and clustered outreach are conducted in partnership with military. The non-availability of facilities/space for FP services in GIDAs, security risks (some islands are controlled by armed groups), lack to inadequate mobility of teams, poor weather conditions and the observance of curfew hour to health personnel in ARMM due to martial law implementation are factors to low GIDA coverage and concentration of outreaches in poblacions.

Plan for the Next Quarter 1. Conduct outreach in nearby facilities targeting identified WRA with unmet need from 4 GIDA barangays of Zamboanga City 2. Accelerate conduct of outreach services in GIDA barangays of CAAs targeted LGUs; (6 in Sulu; 5 in Basilan; 10 in Tawi-Tawi and Cotabato City and 13 for LDS/Marawi City)

Indicator CAA2: Number of Civil Society Organizations Trained to Effectively Engage with Local Governments

Base Accomplishment Cumulative Accomplishment, Indicator line for the Quarter, Q3PY6 2018 2013 Target Actual % Target Actual % # of CSOs trained to effectively engage with 0 9 23 23 100 Local Governance No additional target for 2017 and 2018 but sustain support to existing NGOs/PO

Analysis of Accomplishment. All the 9 supported CSOs in ARMM namely Tarbilang Foundation (Tawi-Tawi), Sulu Provincial Women’s Council and Kalimayahan Foundation (Sulu), Isabela Foundation (Basilan), Bubong OSY Council (LDS), Al Mujadillah Development Foundation (Marawi City), UNYPHIL (Maguindanao), Upi Youth Governance (Upi, Maguindanao), Bangsamoro Women and Children (Maguindanao) are members of the Local Health Board and have contributed to the approval and issuances of Executive Orders on AYRH services by Local Chief Executives of Lamitan City in Basilan, Tawi-Tawi, Bubong in LDS, Buluan and Upi in Maguindanao. The Sulu and Basilan based NGOs are actively engaged in the Catch and Change and Rose Caravans of the LGUs specifically in the conduct of USAPAN teen moms and barkadahan and FP/MNCHN outreach services. Of the 9 original CSO partners in Zamboanga City, only one is actively engaged in FP/AY-related activities.

Deviation Narrative. The engagement of CSO is primarily in demand generation and service provision. Engagement on governance is minimal for varied reasons such as erratic functionality of local health boards, poor relationship between local leaders with CSO/NGOs, and the limited available local CSO/NGOs are tapped by various development partners.

Plan for the Next Quarter 1. Sustain collaboration with existing CSOs partners in demand generation activities and participation to LGU/PHO-led FP/RH initiatives

Indicator CAA3: Number of youth trained as peer educators

Accomplishment Cumulative Accomplishment, Baseline Indicator for the Quarter, Q3PY6 2018 2013 Target Actual % Target Actual % # of youth Not part of trained as peer MH 200 97 48.5 373 270 74 educator assessment

Analysis of Accomplishment.

Additional 97 peer educators (59 OSY in Isabela City and 38 in Upi, Maguindanao) were trained in

Q3PY6, giving a total of 270 or 74% of EOP 373 target accomplishment to date. These trained peer educators conducted a total of 87 USAPAN Barkadahan reaching 3,223 participants. Efforts to know key results/services provided to AYs reached during USAPAN Barkadahan is facing difficulty due to inadequacy of records and follow-up support to trained peer educators. While supporting adolescent/youth as peer educators are not sustainable, this support was in line with USAID Development Objective 2 (Peace and Stability in Conflict Affected Areas IR2.2.) aimed at providing alternative to adolescents/youths in CAAs. It is noteworthy to mention though the trained peer educators in Upi, Maguindanao are organized as Upi Youth Group and are fully integrated into LGU Program of the Local Chief Executive.

Deviation Narrative: The mobility of adolescents/youth trained as peer educator for greener pasture and career development affects sustainability. There is high probability of sustained functionalities of peer educators if they are organized and link with a program/institutions/organization as observed in Upi, Maguindanao.

Plan for the Next Quarter. 1. Follow-up status of trained peer educators, optimize active peer educators on USAPAN Barkadahan, in tandem with inactive trained peer educators to refresh their knowledge and skills.

Indicator CAA4: Number of clients reached during health outreach activities

Base Accomplishment Cumulative Indicator line for the Quarter, Q3PY6 Accomplishment, 2018 2017 PY6 Target Actual % EOP Target Actual % Number of clients reached during health 53,448 6,000 1,826 30.4% 69,737 69,091 99% outreach activities

Analysis of Accomplishment Accomplished thirty percent (30.4%) of 6,000 PY6 target contributing to 99% EOP accomplishment. ARMM provinces contributed 1693 (93%) of 1826 clients reached during the quarter, with remaining 7% (133 clients) from Zamboanga city and Isabela City, as there was no supported outreach in Lanao del Norte/Iligan City and Cotabato City. Further review of data showed that only 529 or 29% of 1826 clients reached are from GIDAs. Various services on FP and MNH are provided during outreach services.

Deviation Narrative: The low reach to GIDAs WRAs is primarily due to security reasons, impositions of curfew hours, and inadequate mobility and space in some GIDAs for outreach.

Plan for the Next Quarter 1. Improve profiling in Zamboanga City, Basilan, Sulu, Tawi-Tawi and Marawi City and its environs by disaggregating/identifying WRA with unmet need in GIDAs and to be prioritized for outreach.

2. Expand reached to GIDAs potential clients by transporting them to nearby outreach sites by leveraging transport support from the LGUs, with project’s support as last option. 3. Expand partnership by engaging additional CSOs and private providers to accelerate outreach with built-in focused USAPAN Sessions.

2.3 Key Challenges and how they are being addressed

Outcome/ Output/ Next Steps/ Responsible Challenge Proposed Solution(s) Timeline Indicators Action Items Party Affected Inability of some Number of Elevate the issue to Share MCP/NCP August, AOR, MCP/NCP MCP/NCP NIT appropriate accredited status to 2018 COP, Accredited facilities (# of action. AOR DCOP, Facilities & other MCP/NCP Health facilities (Public & accredited Elevated issue Systems & Private) to facilities already with AOR, Policy renew/apply Specialist MCP/NCP AOR to work with accreditation due NIT Secretariat for to full enforcement agenda inclusion of DOH-LTO requirements DOH and PHIC to primary structural revisit policies, its requirements; and implication/impact revised PhilHealth to access and quality requirements as to services required number and category of accredited health workers FP Commodity Stock-out Include to NIT and Continue providing August- AOR, Hotline Data not Rates, CU and DOH-CO agenda TA to LGUs/SDN to onwards COP, optimized by CYP analyze and use DCOP, DOH-CO to DOH-CO to analyze logistic consumption Health improve Logistic data from the field data among others Systems & Management and to rationalize to forecast FP Policy support to LGUs/ support to LGU commodity Specialist gradually shifting requirement, with

Outcome/ Output/ Next Steps/ Responsible Challenge Proposed Solution(s) Timeline Indicators Action Items Party Affected implementing from push to pull built-in logistic partners strategy monitoring tool. CSE Lessons AYRH Discuss initiative Link with organizer August - AYRH Guides anchored indicators during NIT meeting; of the national onwards Specialist, to Dep-Ed Memo Leverage support workshop for AOR, and Standards from Dep-Ed participation— COP/DCOP developed by the Regional Office/RIT, follow-up advocacy project in SDC, at national level collaboration with Attend National partners including workshop on CSE Support presentation Dep-Ed Regional (UNFPA/DepEd of the Lessons Office, used in Guides at NIT/RIT project sites not vetted to Dep-Ed Central Office Low compliance of CU and CYP Utilized RIT/PIT to Provide updates August FP/MNCHN hospitals as FP discuss the issue, during RIT/PIT onwards Specialists, reporting unit as including sustain TA meetings; Working ATTLs, per DOH Memo on R & R System as with DOHROs -utilize COP/DCOP Circular resulting integral component GPPIs on R & R and to non- of project’s TA on RIT/PIT actions appreciation of SDN and FP/AY points to leverage total FP coverage Program in Hospital hospital per area. management support

3. Cross-Cutting Issues

3.1 Updates on Gender

MindanaoHealth in earlier part of the project developed reporting/monitoring tools, in close collaboration with subnational partners, aimed at generating sex and age-disaggregated data for action. While these tools can generate sex/age disaggregated data at activity report level on demand and service provision, they are not yet fully institutionalized into the health information management system, and the latest FHSIS version has not yet been fully rolled-out at field level. As such, only age-disaggregated information on services provided to adolescents/youth in 15 supported hospitals and 27 supported AY-friendly facilities was generated and none for the other indicators. In addition, below table capture status on the availability of disaggregated data.

On the other hand, of the 712 supported service delivery points providing FP counseling and services, 487 or 68% are in rural areas, 62% (304) are in priority 12 LGUs, and 32% (.225) are in urban areas. Furthermore, 155 (22%) of supported 712 SDPs are in Conflict Affected Areas, 74% (115) of which are in rural areas (Table 08, Annex).

Gender Planned Target Accomplished concern Disaggregation Demand generation: of data Report on reach as to the number of All 6 regions Zambo Pen, North (according to participants on demand generation Mindanao, Davao region gender) activities Clients served through Usapan All 6 regions 2 regions (Zambo Pen, Sessions: Northern Mindanao, Davao and Maginoo sessions (Male) SOCCKSARGEN) reported Barkadahan sessions (Male or All 6 regions 2 regions (North Min, Female) Davao) reported Clients served through counseling Al 6 regions sessions (HEEADSS) Newborn resuscitation: Report on live births, newborns born All 6 regions Disaggregated in Zambo with difficulty of breathing and Pen. No disaggregation revived/ resuscictated (male or yet (North Min, Davao) female) Identify gender of participants All 6 regions during capacity building Identify the gender of participants All 6 regions during ICV monitoring

3.2 Update on Sustainability and Self-Reliance

This section discusses the activity’s accomplishments vis-à-vis agreed sustainability/self- reliance indicators.

Strategy Activity Indicators Advocacy Regional plans to embed Number of regional offices with MH MindanaoHealth’s efforts on technical inputs (e.g., SOCCSKSARGEN) assistance Use of data to update health leaders Number of RITs regularly using data for for possible support updates/call for actions. (Reginal Implementation Teams (RITs) of Davao, SOCCSKSARGEN and Caraga regions) Policy Development of Operational Guide Number of Health Facilties with formulation Operational Guide on FP and AYRH integration (e.g., 8 hospitals, SDN Referral Guides, ) Capacity Jointly identify providers for Number of trained providers supportively building supportive supervision, follow up on supervised and recommended for certification and accreditation certification (In PPIUD, around 656 trainees from 967 were supportively supervised. Around 406 providers are certified but need to be followed on PhilHealth accreditation.) Training of trainers (TOTs) on FP Availability of Pool of Trainers Courses: BTL= 25 trainers  BTL PPIUD= 72 trainers  PPIUD LARC/PSI= 4 trainers (still ongoing)  LARC/PSI Develop Clinical Practice / Mentoring Number of functional Mentoring/Clinical Sites Practice sites (PPIUD= 18) Reproduction Finalize manuals for PPIUD Facilitators Number of copies reproduced and of materials and Providers distributed.

3.3 Update on Environmental Compliance and Climate Risk Mitigation

All the 120 health facilities visited during the quarter are environmental compliant.

# Health Region Facilities Compliance Rate Visited Zambo Peninsula 39 All facilities are following the DOH guidelines on disposal of medical

wastes and sharps.

# Health Region Facilities Compliance Rate Visited • Waste segregation into infectious and non-infectious waste; • Sharps are collected in a puncture and leak-free boxes • Segregated waste in Color coded waste bags are stored in secured places (at the back of the health facility) prior to transport for disposal • Availability and use of latex gloves, plastic boots and PPE and facility for washing hands for all persons handling waste. • With SANITARY LANDFILL located away from population and properly managed • General waste (non-medical) are picked up by the garbage trucks and brought to a sanitary landfill. • Other waste especially sharps are placed in a septic vault which is already a requirement for the RHUs while the other types are buried at a designated site. • Not allowed to do burning of wastes Dr. Jose Rizal Memorial Hospital have placenta disposal pit and septic tank for sharps, with back -up power supply; Protective Equipment for staff, and contaminated waste are incinerated in area not accessible to staff and the non-combustible ash are disposed in a landfill. Margosatubig Regional Hospital has a facility that freezes all the general waste, and this is grated afterwards to very tiny pieces and then buried in their own landfill and septic vault that adheres to the ISO standards. All general waste of Zamboanga Del Sur Medical Center and Zamboanga Sibugay Provincial Hospital are picked up by garbage trucks and thrown to a sanitary landfill. All sharps and instruments are deposited in a septic vault. While other hazardous materials are buried at a designated area by the hospital.

Northern 5 • Dustbins are available, color coded and facilities practice waste Mindanao segregation • IPC practices are observed during handling of waste to avoid injuries and contamination; use of utility latex gloves and rubber boots; • Medical waste is transported to the interim storage area or for disposal in closed containers: • Sharps in puncture-resistant containers (heavy card box, hard plastic or can containers) and containers are not emptied • The interim storage area is not accessible to general staff, patients/clients and visitors;

# Health Region Facilities Compliance Rate Visited • Disposal - For the wastes that are biodegradable and non- biodegradable it will be picked-up by the LGU garbage vehicle and disposed in their respective off-site sanitary landfills. For the infectious and other hazardous wastes, all the facilities have septic tanks.

Davao Region 35 Thirty-five (35) SDPS were monitored for the quarter that were found to be generally compliant with the Environmental policy and follows the standard health care waste management protocol. Infection prevention measures like using handwashing and decontamination were done, waste segregation and disposing of sharps. Twenty-seven (27) SDPs, 12 RHUs and 15 private birthing facilities have placental pit in compliance to DOH requirements for birthing facility.

SOCCSKSARGEN 9 Nine RHU/MCP accredited facilities in 2 provinces of Region 12 were monitored on healthcare waste management and disposal of sharps with the following results; • There are sufficient dustbins outside of the facility (in the grounds) for general waste. The RHU has several labeled color-coded garbage bins found in every corner of the facility; • Housekeeping personnel wear personal protective equipment when handling medical waste: • With Placental Pit at the back of RHU • Medical waste is transported to the interim storage area or for disposal in closed containers: Located at the farthest wall of the RHU facility near the rear entrance of the RHU • Sharps in puncture-resistant containers (heavy card box, hard plastic or can containers). • The interim storage area is not accessible to general staff, patients/clients and visitors • These health care facilities practice the standard precautions for all patient care to prevent infection like proper hand washing, use of PPE, disinfection, etc.

CARAGA 26 26 RHUS were monitored, 12 in Agusan del Norte and 14 in Agusan del Sur. All the facilities visited found generally compliant with the Environmental policy and follows the standard health care waste management protocol. Infection prevention measures like using handwashing and decontamination were done, waste segregation and disposing of sharps. Twenty-two (22) RHUs have placental pit as in compliance to DOH requirements for birthing facility.

# Health Region Facilities Compliance Rate Visited ARMM 6 Dustbins are available, color coded and facilities practice waste segregation • IPC practices are observed during handling of waste to avoid injuries and contamination; use of utility latex gloves and rubber boots; • Sharps in puncture-resistant containers (heavy card box, hard plastic or can containers) and containers are not emptied • Use .5% chorine Solution

Total 120

3.4 Update on Family Planning Compliance

Overall summary, service delivery sites offer broad range of contraceptives, save for Long Acting Permanent Method which has been referred accordingly to hospitals. Around 578 Health Service Providers were re/oriented on ICV and now with improved working knowledge on ICV and visited 110 service delivery points where 197 trained health service providers were observed during counseling and 176 FP clients were interviewed. In all these facilities, service providers were not assigned a quota on any FP method, no incentives/financial rewards for service providers and clients for availing FP methods were given, and most importantly clients were provided with comprehensive information that help them decide on what FP methods is best for them. Eighty (80) CHWs were oriented on ICV principles with its integration into the training on FP job-aides in SOCCSKSARGEN. Lastly, the conduct of ICV in CARAGA is fully supported with Regional Policy and now adopted by 14 municipalities of Agusan del Sur.

No sharp increase in family planning methods were observed as well. No inconsistency (supply vs. utilization report) was noted, and no evidence of coercion could be found in the FP Programs in Mindanao. All clients made their decisions voluntarily in choosing their method of choice.

Zamboanga Peninsula, in close coordination with FP Coordinators and the PDOHO with assistance from MindanaoHealth, health providers are continuously being monitored for compliance to Informed Choice and Voluntarism (ICV) principles. To ensure a sustained working knowledge and application of ICV policies and principles, ICV re/orientation is fully integrated into relevant activities at LGU level. During the quarter, 143 HSP providers of Zambo Norte and Zambo Sibugay were oriented with DQC and ICV compliance; working knowledge on ICV by 24 trained health providers were reinforced during the conduct of supportive supervision in Zamboanga City; newly hired 32 staff of Zamboanga City were oriented on ICV during their training on GAD and USAPAN Pangkabataan; and DOH supported training on PPIUD and PSI integrated ICV and has reached 43 staff in Zambo del Sur. All the twenty five facilities visited are ICV compliant based on team’s observation of 44 health service providers providing counseling anchored to ICV principles and policies, and from the interview results of 78 clients during the visit. .

For Northern Mindanao, seven DOH-RO X and LGU-funded 7 trainings, on various FP methods/skills, with technical support from the project, has integrated ICV principles and policies reaching 118 health service providers, including 16 CMSU midwives. Also, for the quarter, thirty (30) facilities were visited and 73 health service providers were observed while providing counselling to clients, including 23 clients that were provided with family planning services post counselling. All counseling services are ICV compliant.

For Davao Region, a total of 24 SDPs were monitored and found to be compliant to ICV guidelines and policies; thirteen (13) outreach activities were conducted and monitored where all the 756 clients were clearly informed, offered wide range of FP options, assessed based on eligibility criteria and provided one-on-one counselling using the GATHER approach prior to provision of FP methods of their choice; 24 health service providers were interviewed and 29 service providers has deepened their knowledge on the importance of ICV compliance and consent of partners especially on providing LARC/PM services.

For SOCCSKSARGEN, ICV principles, policies and guidance were re-enforced as integral component of three (3) supported activities, namely training on recording and reporting to 22 hospitals (public/private) participated by 59 hospital staff (32 females and 27 males); orientation of 77 service providers (28 males and 29 females); and orientation of 80 CHWs on FP Job Aids (78 females and 2 males), collectively improving the working knowledge of 136 service providers and 80 CHWs on ICV compliance. Furthermore, 17 service delivery points were monitored by LGU and project team, where 45 service providers were observed/interviewed and 24 clients interviewed, and all were found to be ICV compliant. Lastly, before the conduct of USAPAN Pwede Pa targeting 18 participants from Dumangas, Tboli, ICV principles was explained targeting providers and USAPAN facilitators.

For CARAGA Region, fourteen SDPs were found to be compliant with ICV policies during outreach activities and facility visits; 29 service providers deepened their understanding on the importance of ICV and use of GATHER approach during FP counseling. There were a total of 12 activities with ICV orientation as regular component of the session/activity, and during LARC/PM outreaches, ICV principles were applied where clients were informed on wide range of options giving them to decide freely, while being guided by health service providers based on medical eligibility criteria results. As a results, 719 acceptors were informed on wide range of FP services, counseled individually and provided the FP methods of their choice. To date the Regional Policy on ICV are now adopted by 14 municipalities of Agusan del Sur giving a policy framework to all service providers in these municipalities to adhere and institutionalize ICV policies in their daily works.

In the ARMM, for the quarter 11 facilities were visited and 11 health service providers were observed during counselling. During the visit a total of 51 clients were observed as they were counselled of which 30 were given their desired method on modern family planning.

4. Collaboration, Learning and Adapting

The MindanaoHealth Project continue to optimize supported activities and initiatives to promote collaboration and stakeholder engagement, learning, and adaptive management., in addition to optimizing participation to RIT, other DOHRO/LGU led consultation, fora and planning workshops to advocate for scaling up/adaptation to local context documented emerging good practices for greater impact.

The team continue to deepen understanding on CLA through inter-regional project cross- pollination of gains. MH team led by the Chief of Party collaborated with LuzonHealth and learned success on FP Program in Hospital recording and reporting system, a DOH approved system national adoption, and on method to understand missed opportunities on PPFP in hospital settings. This added knowledge helped improve project’s TA and advocacy work on FP/AY Programs in Hospitals in 18 hospitals, under the leadership of Chief of Hospital and FP/AY program management team. After about a year from DOH memorandum designating hospital as FP Reporting Unit, the uptake is low, requiring follow on mentoring and coaching while bringing evolving gains among supported hospitals during the process.

Close collaboration with DOHRO and PHO is sustained in the project provision of TA to 21 SDN and with ZFF-HLGP project specifically to strengthen the leadership and governance mechanisms of the SDNs. TA gains are cross pollinated across the 21 SDN resulting evolving varied results.

The SDN management structure and M&E system is continuously being strengthened by the SDN TWG members reviewing their implementation plans, with TA from DOHRO and MH, resulting to:

1. Improvement in blood services availability and accessibility in five SDNs of ZDS (District 2), SK (BITES and province-wide), SoCot (province-wide, South Bukidnon and ZDN (Liloy SDN) by achieving the 1% population target for blood donors. Sultan Kudarat moved for the creation of the Provincial Blood Council;

2. Zamboanga del Sur created and mobilized two FP Outreach Teams to serve the District 1 and District 2 SDNs of the province through a PDOHO Memorandum Order #15-2018 in response to EO#12. Since its creation in February 2018, the teams were able to serve 1,153 clients for LARC-PSI, IUD, and BTL as of June 2018. The clients were from 13 GIDA municipalities;

3. The Sangguniang Panlalawigan (SP) Chair Committee on Health of the six provinces moved to institutionalize SDN through the issuance of ordinance, provincial resolution adopting the SDN referral guidelines, and executive order creating the SDN technical management committee. The project in consultation with TWG members developed the SDN related policies;

4. The two LGUs of Guipos and Dinas in Zamboanga del Sur approved its reimbursement policy per PHIC guideline and at the same time the 2 RHUs achieved MCP/NCP accreditation.

5. In terms of financing mechanism, pooling of funds are in place in BITES, Sultan Kudarat; CoMMMoNN SDN, ClaJaViTa SDN, South Bukidnon, Iranun SDN, DiMaBaMaS ILHZ, and Liloy SDN. SDN member pooling of funds is currently considered for establishment in BueNasCar SDN in Agusan del Norte and ZDS through SP Member Adlaon tabled the issue for discussion with the provincial health board.

Secondly, collaboration and coordination support to 9 SDNs aimed at enhancing Public and Private Partnership for FP/AY services yielded following evolving results;

1. Drafted and further enhanced the PPP agreements in ZDS District 1 and 2 SDNs with 5 private hospitals (PCMC, Aisah Medical, Cabahug Memorial Hospital, SVMC and Jamellarin), Iranun SDN, Liloy ILHZ, and South Bukidnon.

2. SK BITES expanded its partnership with the private hospitals from 4 to 8 with the aim to increase access and availability of health services, tap private sector resources (expertise, equipment, corporate social responsibility, etc.), harmonize governance and integrate local health system, among others.

3. DOP SDN of Agusan del Sur forged an agreement with women’s group and ADDSECCCO, a registered cooperative, to provide monetary support to indigent pregnant mothers during delivery and gasoline allowance to partner community-based transport group to transport pregnant mothers to the nearest SDN birthing facility.

Thirdly, project’s SDN TA on enhancing and documenting the SDN Referral System has;

1. Formalized the cross-border arrangements between;

a) ZDSMC and Margosatubig Regional hospitals with Zamboanga Sibugay by incorporating their referral protocols in the existing referral mechanisms and guideline of Zamboanga Sibugay ILHZ/SDNs;

b) ZDS with MHARS General Hospital in Ozamiz City and Kapatagan Provincial Hospital in Lanao del Sur as core referral facilities for LAPM and MNCHN services;

2. Enhanced referral guidelines of Iranun SDN, District 1 and District 2 SDNs of ZDS, Liloy SDN of ZDN, Bayugan SDN of Agusan Norte, South Bukidnon SDN, and Zamboanga Sibugay (3 ILHZs) through consultations with public and private sectors. To date, four SDNs (DOP SDN, BueNasCar, SK, and SoCot) have approved referral guidelines. In BITES SDN, the monitoring of referral services is tracked through the billing reports apart from the referral registry.

3. Evaluated and further enhanced the SDN referral forms and registry logbooks after a three-month field test in Zamboanga del Sur. One key findings was that RHMs did not fill out the referral forms properly, thus an orientation was conducted.

Lastly, while it may require more scientific method to determine correlation between SDN and CU/CYP, the project crudely analyzed the contribution of 10 SDNs to CYP vis-a-viz provincial CYP performance. Of the 10 SDNs, four SDNs (BITES in Sultan Kudarat, DiMaBaMaS in Davao del Sur, CoMMMoNN in Compostela Valley, SANLAKASS in Lanao del Norte, and District 2 in Zamboanga del Sur) yielded more than 50% of the total provincial CYP (refer to Annexes). DOP SDN performance of 29% CYP contribution is relatively high given that it is only comprised of three municipalities where Prosperidad LGU alone is generating 56% of new and other acceptors for LAPM/LARC methods in Agusan del Sur province.

The high performance of these SDNs is attributable, but not limited, to the following sustaining factors:

1. Leadership of PHO in providing management and technical support and PDOHO’s technical guidance and oversight;

2. SDN Champions in the legislative and executive branches to pass and execute SDN related policies and plans;

3. Active engagement of private hospitals and non-health sector (community-based organizations, transport and communication groups, cooperative) through PPP modality;

4. Sustained PHIC accreditation and PHIC reimbursements are plowed back to health services;

5. Full implementation of the No Balance Billing policy in all SDN facilities including private hospitals. NBB is a potent demand generation strategy;

6. Revival of LGU’s CSR strategy to mitigate the impending shortage of commodities;

7. Pooling of funds to provide for transportation cost, medicines, supplies and to cover hospital cost in the event of excess billing;

8. In place M&E system to track SDN contribution to health outcomes, service coverage, and referral services

Lessons Learned

1. PHO plays a critical role in all phases of SDN establishment to provide management and technical support while PDOHO/DOH-ROs leadership to delivery technical oversight and policy direction is imperative;

2. Putting SDN in the regular agenda of LHB, RICT, RIT, and other coordinating mechanisms generate collective support for and sustain the SDN initiatives at all levels;

3. Given the absence of operational guide from DOH central, direct engagement with DOH- RO/ PDOHO and PHO is the way forward;

4. Successful PPP embodies the strength of cooperation and the principle of shared governance and recognizes that governments and private entities each have certain advantages relative to one another in performing specific tasks;

5. Engagement of barangay leadership to mobilize community-based organizations (communication and transportation services), facilitate issuance of documents for PHIC and other medical programs, bloodletting services, etc.

SDN Challenges

1. Absence of clear technical guidance from DOH central resulting to intermittent and ambivalent DOH-RO technical support

2. SDN technical management committee entails high level technical expertise

3. LGUs inability to respond quickly to DOH LTO stiff requirements

4. Public hospitals operate as an autonomous entity detached from SDN’s VMG

5. Delay in the release of PhilHealth reimbursements caused interruption in the provision of LAPM services in hospitals

6. Underserved Areas: PHIC coverage for PPFP is only 15% in GIDAs and only 9% in CAAs including Marawi City and its corridors

7. Absence of CEmONC and apex hospital in some areas as end referral facility

8. Weak enforcement of health related policies (e.g. FBD, NBB policy)

Plan for the next Quarter

1. Coach SDN TWGs in communicating and disseminating the referral guidelines, protocols, tools and registry down to the barangay level including non-health sectors involved in the referral mechanism;

2. Completion and approval of referral guidelines in Iranun SDN, District 1 and District 2 SDNs of ZDS, Liloy SDN of ZDN, Bayugan SDN of Agusan Norte, and South Bukidnon SDN;

3. Completion and approval of PPPs in ZDS District 2 SDN, Iranun SDN, Liloy ILHZ, and South Bukidnon;

4. Follow through and provide coaching support to the four facilities of Antipas, NoCot; Lake Sebu and Koronadal City in South Cotabato; Jasaan, MisOr for MCP re-accreditation and formulation of reimbursement policy including Davao City. Out of 76 LGUs in the 12 priority SDNs, 72 (95%) RHUs/CHOs are accredited and with reimbursement policy;

5. Institutionalize DQC in Zamboanga del Norte, Davao del Sur, and Davao City

5. Management, Administrative and Financial Issues There are no critical management, administrative and financial issues during the quarter.

6. High-Level Planned Activities for Next Quarter Including Upcoming Events

6.1 High level turn-over of supply support to Marawi and its Corridors in August To support targeted facilities in Marawi and its environs restore provision essential FP/MNCHN/AY services after the siege, the project will support installation of 10 water tanks, 15 solar refs (being procured offshore), provision of 2 generator sets to selected facilities and provision of dignity kits to pregnant women visiting health facilities for antenatal care during their 1st trimester and maternity kits to postpartum women with 2 postpartum visits. This planned turn- over of these supplies to key leaders of government by the Mission Director will help in our advocacy efforts to ensure maintenance of supplies provided by partner LGUs thus optimizing their usage. It is tentatively being scheduled in August.

6.2 Regional Dissemination/Turn For-over Activities: October –November 2018 Part of the project’s sustainability plan is the conduct of regional dissemination/turn-over activities with regional and local leaders, and technical leaders both from the public, private sectors, and CSOs. This 2-day activity will serve as avenue for local and regional leaders to share emerging good practices on FP/MNCHN/AYRH and to generate their commitments, discuss gains including turn-over technical tools/products developed jointly during the project life as guide to identify proven interventions, identify opportunities and support regional and local technical partners develop their plan of action to institutionalize/scale-up these interventions/initiatives with clear commitment from their leaders.

There will be 6 regional dissemination/turn-over activities from October to November with participation from USAID-OH and national partners from DOH, POPCOM, DepEd and DILG. Actual date and venue will be shared after consultation with RIT/PIT members.

6.3 Launching of the WHO/USAID/Jhpiego Toolbox on FP/MNCHN – September 6, 2018 The project work closely with WHO team under their “Accelerating Convergence Efforts through Systems Strengthening for Maternal and Newborn Health Project “in Davao Region the past years. One of their end deliverables is the development of a Toolbox that captures tools/technical products used during the project life for turn-over to LGUs and DOHRO-XI as references, in response to Asec. Dumama’s request. Recognizing that MH has also developed tools and guides, WHO Regional team advocated for the inclusion of project’s tools and guides for wider dissemination. As a result, USAID approved tools/guide on SDN, AYRH and FP Services will be included in this toolbox.

Lay-outing and packaging is being done through consultation and tentative turn- over/dissemination of the tool in Davao Region is September 6. Said activity will be graced by WHO Country Representative, and USAID-OH team.

MindanaoHealth Project Program Year 6 – Quarter 3 Accomplishment Report

(April 2018-June 2018)

Vol. 02: Section 7. Annexes

Submitted: July 31, 2018

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

On the cover:

Bottom left: USAID-trained Family Planning Nurse Ruby Navales (left) talks about Family Planning to postpartum mothers. (Jhpiego)

iii

Table of Contents

Table of Contents Table of Contents ...... iii List of Acornyms ...... v 7. Annexes ...... 1 7.1 MindnaoHealth Project Performance Indicator Tracking Table (PITT), end of June 2018 ...... 1 7.2 Project Financial Information ...... 5 7.3 Potential Success Stories, Pictures, etc...... 6 Summary of Story Idea - 1 ...... 6 Summary of Story Idea - 2 ...... 7 7.4 Summary of Accomplishments per Province ...... 9 Table 01. Modern Family Planning Current Users by Methods per LGU ...... 9 Table 02. Couple Years Protection for Long Acting Reversible Methods and Permanent Contraceptives (LARC-PM) as of Q2PY6 ...... 10 Table 03. Status of DQC Implementation by LGUs, PY6Q1-Q3 ...... 11 Table 04. Percentage of audience who recall hearing or seeing a specific MH- supported FP/RH messages for Q3 ...... 12 Table 05. Number of women giving birth who received uterotonics in the third stage of labor (or immediately after birth) and Number of newborns not breathing at birth who were resuscitated in USG-supported programs ...... 13 Table 06. Number of Service Delivery Ploints with stock-out rate by FP Commodity, Q3PY6 ...... 14 Table 07. Number of USG-assisted community health workers (CHWs) providing family planning (FP) information, referrals, and/or services during the year ...... 15 Table 08. Number of Service Delivery Points providing FP Counseling and Services as of Q3PY6 ...... 16 Table 09. Status of Capacity Building Support on FP/MNCHN as of end of June 2018 ...... 17 Table 10. Public-Private FP Contribution to CYP ...... 18 7.5 Cities Development Initiative ...... 19 ZAMBOANGA CITY ...... 20

CAGAYAN DE ORO CITY ...... 24

GENERAL SANTOS CITY ...... 27 7.6 Family Planning Composite Index Summary ...... 31 7.7 Component Specialist Report & Updates for Q3PY6 ...... 42 Health Policy & Systems Development Report ...... 42 Adolecent-Youth Reproductive Health Component Report ...... 60 MNCHN/FP Service Delivery Component Report Report ...... 78

List of Acornyms

FPOP Family Planning Organization of the Philippines

GIDA Geographically Isolated and Disadvantaged Area HFEP Health Facility Enhancement Program HSP Health Service Provider HUC Highly Urbanized City ICV Informed Choice and Voluntarism IEC Information, Education, and Communication ILHZ Inter-Local Health Zone IPHO Integrated Provincial Health Office IUD Intrauterine Device LAM Lactational Amenorrhea Method LAPM Long Acting and Permanent Method LGUs Local Government Units LHB Local Health Board LIPH Local Investment Plan for Health LMT Lactation Management Training MC Medical Center M&E Monitoring and Evaluation MCP Maternity Care Package MFP Modern Family Planning MH MindanaoHealth MHO Municipal Health Office MLLA Mini Laparotomy using Local Anesthesia MNCHN/FP Maternal, Newborn, and Child Health and Nutrition/Family Planning MOA Memorandum of Agreement MSH Marawi Specialist Hospital MSI Marie Stopes International NCP Newborn Care Package NDP Nurse Deployment Program NFP Natural Family Planning NHTS National Household Targeting System NGO Non-Government Organization NMMC Northern Mindanao Medical Center NSV No Scalpel Vasectomy OFIM Office of Field Implementation Management PH Provincial Hospital PHA Public Health Associate PHILHEALTH Philippine Health Insurance Corporation PHIC Philippine Health Insurance Corporation PHO Provincial Health Office PHN Public Health Nurse PMP Performance Monitoring Plan POPCOM Commission on Population PPFP Postpartum Family Planning PPIUD Postpartum Intrauterine Device PSI Progestin Subdermal Implant

vii

RH Regional Hospital RHU Rural Health Unit RIT Regional Implementation Team RPRH Responsible Parenthood and Reproductive Health SDN Service Delivery Network SDP Service Delivery Point SOCCSKSARGEN South Cotabato, Cotabato, Sultan Kudarat, Sarangani and General Santos City SPMC Southern Philippines Medical Center TCL Target Client List TRO Temporary Restraining Order WRA Women of Reproductive Age

7. Annexes 7.1 MindnaoHealth Project Performance Indicator Tracking Table (PITT), end of June 2018

FISCAL YEAR 6 TARGET QUARTERLY PY 6 2018 (October 2017-September ACCOMPLISHMENT 2018) END OF PROJECT TARGET BASELINE VALUE (Provide Numerator and CUMULATIVE PERFORMANCE (Provide Numerator and Denominator Denominator for indicators TO DATE for indicators in Percent) QUARTER 3 (April 2018 - in Percent) TARGET June 2018) Indicator Indicator REMARKS Code

Baseline N D % Source and N D % N D % N D % N D % Date

FP 1 No. of modern FP current 1,070,486 N/A N/A FHSIS 2012 1,615,042 N/A N/A 1,615,042 N/A N/A 1,643,924 N/A N/A users in USG assisted sites BTL N/A N/A N/A N/A N/A N/A 137,462 N/A N/A VASECTOMY N/A N/A N/A N/A N/A N/A 3,827 N/A N/A PILLS N/A N/A N/A N/A N/A N/A 689,687 N/A N/A IUD N/A N/A N/A N/A N/A N/A 192,365 N/A N/A INJECTALBES N/A N/A N/A N/A N/A N/A 289,603 N/A N/A NFP-CM N/A N/A N/A N/A N/A N/A 10,319 N/A N/A NFP-BBT N/A N/A N/A N/A N/A N/A 603 N/A N/A NFP-STM N/A N/A N/A N/A N/A N/A 915 N/A N/A NFP-SDM N/A N/A N/A N/A N/A N/A 16,375 N/A N/A NFP-LAM N/A N/A N/A N/A N/A N/A 169,704 N/A N/A CONDOM N/A N/A N/A N/A N/A N/A 68,638 N/A N/A Implants N/A N/A N/A N/A N/A N/A 64,426 N/A N/A FP 2 Couple Years Protection 253,550 N/A N/A FHSIS 2012 1,743,825 N/A N/A 562,837 N/A N/A 281,394 N/A N/A (CYP)

No. of Acceptors/Units for Commodities BTL 10,890 N/A N/A N/A N/A N/A N/A N/A N/A NSV 538 N/A N/A N/A N/A N/A N/A N/A N/A PPIUD/IUD 24,817 N/A N/A N/A N/A N/A N/A N/A N/A SDI - N/A N/A N/A N/A N/A N/A N/A N/A

Baseline N D % Source and N D % N D % N D % N D % Date

Pills (cycles) No. IMS N/A N/A No. IMS N/A N/A N/A N/A Removed Removed Injectables (3 months) report N/A N/A report N/A N/A N/A N/A from CYP from CYP Injectables (1 month) N/A N/A N/A N/A N/A N/A Target Target Condom N/A N/A N/A N/A N/A N/A FP 3 Percent of USG assisted 303 898 34% Facility Revised to Average stock-out Reporting is average stockout Reporting is average stockout SDPs that experience Survey 2013 rate by method. by method. stock-outs Pills 11 764 1% Facility 15 737 2% 15 737 2% 41 737 6% 737 - DMPA 2 764 0 Survey 2016 7 737 1% 7 737 1% - 737 0% 737 - IUD 7 764 1% 737 0% - 737 0% - 737 0% 737 - SDM Beads 85 764 11% 22 737 3% 22 737 3% 93 737 13% 737 - Condom 7 764 1% 7 737 1% 7 737 1% 9 737 1% 737 - FP 4 Percent of service delivery 284 1,270 22% Facility 715 737 97% 715 737 97% 712 715 100% 712 715 1 points providing FP Survey 2013 counseling and services to couples, men, women, youth and adolescents of both sexes in USG-sites (Cum) FP 5 Number of additional USG- 3,886 N/A N/A CHT Reports 5,315 N/A N/A 3,535 N/A N/A 4,182 N/A N/A 4,182 N/A N/A assisted community health 2013 workers providing FP information and completed referral during the year. (Cum) Male 78 N/A N/A 106 N/A N/A N/A N/A 25 25 N/A N/A Female 3,808 N/A N/A 5,209 N/A N/A N/A N/A 4,157 4,157 N/A N/A FP 20 Number of USG-assisted - N/A N/A Facility 78 N/A N/A 78 N/A N/A 91 N/A N/A 91 N/A N/A = 16 hospitals NGO facilities, Midwife Survey 2013 + 56 RHUs clinics, Educational + 19 schools institutions providing FP/RH services for adolescents and/or youth of both sexes (Cumulative)

Baseline N D % Source and N D % N D % N D % N D % Date

HL.6.2.1 Number of women giving 108,005 N/A N/A FHSIS 2016 11,884 N/A N/A 10,000 7,459 N/A N/A 20,883 N/A N/A Y5 = 5,082 birth who received uterotonic in the 3rd stage of labor NI 4 Number of newborns not 70 N/A N/A 70 70 N/A N/A 70 278 N/A N/A 564 N/A N/A 286 from PY6Q2 breathing at birth who was not reported were resuscitated during PY6Q2 N1. Percent of LGUs 268 368 1 2015 Facility 313 368 1 313 368 1 102 313 0 272 313 1 Custom conducting DQC Assessment Indicator HEALTH SYSTEM STRENGTHENING HL-1 Number of Universal 5 N/A N/A PY 2015 5 N/A N/A 5 5 5 Health Coverage (UHC) Project areas supported by USG Reports investment HL-2 Presence of the Mission Yes N/A N/A PY 2015 Yes N/A N/A 2 2 2 support to Strengthen Project Human Resources for Reports Health (HRH) CAA CAA1 Number of health outreach 336 N/A N/A SHIELD 315 N/A N/A 50 N/A N/A 71 200 N/A N/A conducted Report for Y6 CAA2 Number of civil socciety - N/A N/A Project 23 N/A N/A 23 N/A N/A 23 23 N/A N/A organizations trained to Records effectively engate with local governments (Cumulative) CAA3 Number of youth trained - N/A N/A Project N/A N/A 200 N/A N/A 97 270 N/A N/A as peer educators Records CAA4 Number of clients reached 33,774 N/A N/A SHIELD 53,380 N/A N/A 6,000 N/A N/A 1,826 5,354 N/A N/A during health outreach Report for activities Y6

Baseline N D % Source and N D % N D % N D % N D % Date

OtTHER NEW INDICATORS (for PY 6) NI 1 No. of women of 428,037 DOH RO 470,840 470,840 199,105 716,922 reproductive age that have reports as of been profiled and June 2017 identified as having unmet need for FP NI 2 Percent of women of 112,431 428,037 0 DOH RO 400,214 470,840 1 400,214 470,840 1 81,736 199,105 0 226,054 716,922 0 reproductive age that have reports as of been profiled and June 2017 identified as having unmet need who have been provided with FP services. NI 3 Percentage of PPFP/PPIUD 344 955 0 Baseline is 774 967 1 774 774 1 406 774 1 406 774 1 656 have under trained providers that have PY5 end year SupSup been certified by the figures. Department of Health in USG assisted sites NI 5 SDPs in Marawi City and - 21 21 21 21 9 SDPs in Marawi Corridors with Functional City; Health Services 12 SDPs in Corridors (Lanao del Sur and Lanao del Norte) NI 6 Percentage of audience 2,000,000 2,000,000 1 2,000,000 2,000,000 1 788,290 2,000,000 0 1,459,419 2,000,000 1 Figures in PY6Q2 who recall hearing or and PY^q2 were seeing a specific MH- previouslu supported FP/RH messages unreported

7.3 Potential Success Stories, Pictures, etc.

Summary of Story Idea - 1

The story highlights the important role of a transport group within a service delivery network (SDN) particularly in transporting pregnant women, who are about to give birth, to the nearest hospital or birthing clinic within the network to avoid complications and take out these vulnerable women from danger.

Sentences of Supporting Information

One of the elements that should be put in place for a service delivery network to be considered functional is the presence of a transportation system either through a group or individual engaged as support primarily for timely transport of pregnant women, mothers, newborn and children to nearest birthing or health facilities. In the case of D.O. Plaza SDN in Agusan del Sur (Rosario, San Francisco and Prosperidad) wherein majority of the villages (barangay) are hard-to-reach, isolated, depressed and mostly with no existing health stations and permanent midwives assigned, the San Francisco Motors Operators and Drivers Federation in Agusan del Sur has been actively involved. The federation eases the burden brought by limited transportation, difficult road conditions and often unsafe peace and order situation that hinder health personnel from regularly visiting remote areas for the provision of basic preventive health services, and that also hold people back from going to the facilities to access services. Prior to 2014, the municipalities of Rosario, San Francisco and Prosperidad had slow improvements in facility-based deliveries and skilled birth attendants, with continued preference for traditional birth attendants-assisted delivery, especially in remote and geographically disadvantaged areas. The story shows how active participation of the transport group in the SDN contributes to the increase in the three municipalities’ facility-based deliveries and skilled birth attendance, as well as in the reduction of its infant and maternal deaths.

Details of who will be interviewed (names/titles or general description •• for example, three beneficiaries in the impacted town)  Mr. George Enguito - President of San Francisco Motors Operators and Drivers Federation in Agusan del Sur who has brought a lot of pregnant women to birthing facilities, ensuring their safety driver of a motorized tricycle and  Genevie Gomez and Marina Din-awan, mothers who were brought by Mr. Enguito to the birthing facilities within the SDN and safely delivered just in time

Description of anticipated photos/graphics that will accompany main article

Profile shot of Mr. Enguito on-board his motorized tricycle

Mr. Enguito interacting with women and kids he once helped and transported to a birthing facility/hospital for the safe deliveries of their children deliver safely Mr. Enguito and the women’s kids inside the motorized tricycle

Extra photos: The women and their children that Mr. Enguito helped Mr. Enguito and one of the women with her child inside the motorized tricycle

Summary of Story Idea - 2

The story will feature a postpartum multi-gravid mother from Marawi City or Lanao del Sur who persistently went to a health facility for needed maternal and newborn care, and family planning services and received these services, including dignity kits and maternity packs from USAID, despite lingering distresses and rebuilding efforts in areas affected by the Marawi siege in 2017.

Sentences of Supporting Information

Pregnant women are among the most vulnerable groups affected by the Marawi siege in 2017; specifically affecting their access to maternal care and reproductive health services because most of the health facilities in Marawi City and Lanao del Sur municipalities near ground zero were devastated and forced to close-down. USAID supported various health outreach activities in these areas in support to the continuous delivery of needed health services that affected health facilities could not temporarily provide. Women, men and children flocked to these activities including pregnant women to avail of the health care they need; proving that despite atrocities, health care and health service provision would not stop.

Details of who will be interviewed (names/titles or general description •• for example, three beneficiaries in the impacted town)

 A postpartum multi-gravid mother from Marawi City or Lanao del Sur (alone or with her husband) who will share her story for determinedly accessing maternal care especially during her pregnancy despite the chaos brought by the Marawi City siege  USAID-trained health provider who constantly assisted and attended to the health needs of woman (subject of the story)

Description of anticipated photos/graphics that will accompany main article

Profile photo of the postpartum multi-gravid mother from Marawi City or Lanao del Sur either in their house or in the health facility or community

Postpartum multi-gravid mother from Marawi City or Lanao del Sur carrying her baby and with other children around Postpartum multi-gravid mother from Marawi City or Lanao del Sur carrying her baby and with the rest of her family The postpartum multi-gravid mother from Marawi City or Lanao del Sur having a conversation (counseling) with a health provider – could be in a community outreach or in a facility

7.4 Summary of Accomplishments per Province

Table 01. Modern Family Planning Current Users by Methods by USG-Assisted LGUs as of Q2PY6 FP - Current Users Family Planning Method Specific PROVINCE/CITY Target Accomplishment BTL NSV PILLS IUD DMPA NFP-CM NFP-BBT NFP-STM NFP-SDM NFP-LAM CONDOM IMPLANTS

PRIORITY AREAS Davao City 129,633 132,894 11,460 1,076 55,219 13,290 20,063 639 249 66 629 14,251 7,116 8,836 Cotabato 127,970 122,708 11,279 193 55,241 14,450 23,311 825 12 - 133 9,356 3,196 4,712 Bukidnon 121,098 113,043 9,634 284 53,138 16,970 11,716 1,471 30 536 3,476 8,547 3,718 3,523 Maguindanao 74,475 70,338 3,488 23 22,250 2,901 23,167 2 - - 103 14,767 2,145 1,492 South Cotabato 83,064 84,368 10,675 884 35,469 7,653 14,884 101 - - 762 7,732 3,859 2,349 Davao del Sur 61,184 85,174 10,567 144 39,854 11,323 14,377 269 112 5 248 2,254 2,449 3,572 Zamboanga del Sur 88,492 81,760 3,609 34 38,136 12,482 10,440 45 - - 346 6,896 4,046 5,726 Misamis Oriental 97,010 91,484 7,201 203 33,037 19,042 9,941 2,329 92 101 3,357 11,368 3,055 1,758 Sultan Kudarat 86,922 80,843 9,637 205 34,978 8,015 16,316 130 1 - 259 5,288 2,439 3,575 Compostela Valley 82,390 75,898 8,369 233 41,159 8,723 9,645 792 69 - 261 947 2,711 2,989 Agusan del Sur 70,527 75,028 6,995 85 33,876 12,604 8,429 977 - 9 1,294 5,481 2,468 2,810 Zamboanga del Norte 77,996 100,494 6,126 11 49,142 11,826 15,023 305 2 - 1,602 8,927 5,853 1,677 1,100,761 1,114,032 99,040 3,375 491,499 139,279 177,312 7,885 567 717 12,470 95,814 43,055 43,019 Basilan 19,161 13,434 571 - 4,925 843 3,377 13 4 102 38 2,022 511 1,028 Isabela City 40,887 5,778 691 2 1,983 151 1,404 - - - 16 869 248 414 Sulu 25,926 41,376 1,046 - 13,511 510 18,684 7 5 4 12 5,574 591 1,432 Tawi-Tawi 62,805 25,244 566 3 9,307 43 9,150 95 - - 104 4,814 517 645 Zamboanga City 5,915 59,462 3,897 16 24,818 5,000 12,382 - - - - 10,351 580 2,418 Cotabato City 25,871 23,277 2,230 - 8,400 1,684 6,091 75 - - 107 1,193 2,982 515 Sub-Total for CAA (a): BaSulTa + CAA Cities (Zamboanga, 180,564 Cotabato, 168,571 Isabela) 9,001 21 62,944 8,231 51,088 190 9 106 277 24,823 5,429 6,452 Marawi City 37,781 1,519 55 - 453 9 210 - - - 29 466 287 10 Lanao Del Sur 36,373 1,134 14 12,056 1,102 8,175 30 - 3 247 10,152 3,349 111 Lanao Del Norte 80,809 41,735 943 15 19,354 4,401 8,269 166 - 8 204 5,368 2,443 564 Iligan City 21,904 1,568 30 7,338 2,923 3,974 29 - - 479 2,322 1,616 1,625 Sub-Total for CAA (b): Marawi & its Corridors 118,590 101,531 3,700 59 39,201 8,435 20,628 225 - 11 959 18,308 7,695 2,310

NON-PRIORITY AREAS Zamboanga Sibugay 38,063 49,001 1,667 43 18,704 6,342 9,199 56 4 10 443 5,841 2,934 3,758 Cagayan de Oro City 30,809 47,923 3,405 7 14,901 9,926 6,798 11 16 7 230 6,567 3,642 2,413 Davao Oriental 37,428 46,042 5,154 164 21,697 4,023 4,456 1,833 4 52 1,740 4,003 1,493 1,423 General Santos City 53,947 47,580 9,011 97 12,787 4,670 10,179 14 - - 10 5,677 1,882 3,253 Agusan del Norte 55,240 69,244 6,484 61 27,954 11,459 9,943 105 3 12 246 8,671 2,508 1,798 Sub-Total for Non-Priority Areas 215,487 259,790 25,721 372 96,043 36,420 40,575 2,019 27 81 2,669 30,759 12,459 12,645

Over All TOTAL 1,615,402 1,643,924 137,462 3,827 689,687 192,365 289,603 10,319 603 915 16,375 169,704 68,638 64,426

Table 02. Couple Years Protection for Long Acting Reversible Contraceptives and Permanent Methods (LARC-PM) by USG-assisted LGUs, Q2PY6 Accomplsihment and as Q2PY6 Couple Years Protection CYP as of Q2PY6 CYP BTL NSV IUD PSI Total CYP as PROVINCE/CITY Target Q1PY6 Accomplish Acceptor Accepto Accept Acceptor Acceptor of Q2PY6 ment s Total rs ors s s PRIORITY AREAS Davao City 98,174 12,112 22,038 5,045 776 203 992 3,074 34,150 Cotabato 34,034 12,025 8,708 2,194 308 3 424 1,459 20,733 Bukidnon 45,675 29,652 9,986 1,922 407 48 842 625 39,638 Maguindanao 9,069 4,548 3,525 789 149 - 207 433 8,072 South Cotabato 14,427 8,573 6,196 1,326 262 9 404 651 14,769 Davao del Sur 31,029 9,485 7,970 1,754 259 2 775 718 17,455 Zamboanga del Sur 12,131 20,203 7,237 1,940 124 1 690 1,125 27,440 Misamis Oriental 29,654 14,478 8,461 1,674 310 7 904 453 22,939 Sultan Kudarat 18,904 8,121 7,358 1,418 383 7 423 605 15,480 Compostela Valley 14,174 6,933 6,788 1,558 224 13 531 790 13,720 Agusan del Sur 46,526 18,915 8,249 1,690 365 1 609 715 27,164 Zamboanga del Norte 33,054 9,130 6,154 1,237 248 - 572 417 15,284 Sub-Total for Non-CAA Priority 386,851 Areas 154,176 102,669 22,547 3,815 294 7,373 11,065 256,845 Basilan 2,710 7,381 989 291 17 - 64 210 8,370 Isabela City 4,061 424 314 73 17 - 2 54 738 Sulu 3,370 1,798 1,720 539 34 - 56 449 3,519 Tawi-Tawi 1,169 440 427 143 9 - 1 133 868 Zamboanga City 29,020 9,580 6,658 1,201 302 - 662 237 16,238 Cotabato City 16,330 7,327 2,201 369 127 - 155 87 9,527 Sub-Total for CAA (a): BaSulTa 56,660 + 3 CAA 26,951Cities (Zamboanga, 12,309 Cotabato, 2,616 Isabela) 506 - 940 1,170 39,260 Marawi City 1,420 259 87 16 4 - 8 4 346 Lanao Del Sur 452 481 119 22 - 9 88 933 Lanao Del Norte 13,401 6,856 2,541 577 44 - 366 167 9,397 Iligan City 2,565 563 114 - 144 305 2,565 Sub-Total for CAA (b): Marawi 14,821 & its Corridors 7,567 5,674 1,275 184 - 527 564 13,241

NON-PRIORITY AREAS Zamboanga Sibugay 19,065 13,843 9,390 3,137 79 1 451 2,606 23,233 Cagayan de Oro City 34,020 17,476 6,858 1,383 210 4 855 314 24,334 Davao Oriental 9,783 7,098 3,664 732 190 1 191 350 10,761 General Santos City 19,714 11,219 4,516 1,024 168 1 328 527 15,735 Agusan del Norte 21,923 14,707 9,920 2,020 445 1 726 848 24,627 Sub-Total for Non-Priority Areas104,505 64,343 34,347 8,296 1,092 8 2,551 4,645 98,691

Over All TOTAL 562,837 253,037 154,999 34,734 5,597 302 11,391 17,444 408,037

Table 03. Status of DQC Implementation by LGUs, Q1-Q3PY6 Target Accomplishment Total LGUs PROVINCE/CITY Apr - Jun Jan - Mar Oct - Dec conducted DQC N D 2018 2018 2017 as of Q3PY6 PRIORITY AREAS Davao City 1 1 0 0 0 0 Cotabato 15 18 0 0 11 11 Bukidnon 19 22 0 0 22 22 Maguindanao 31 36 0 0 17 17 South Cotabato 9 11 0 0 0 0 Davao del Sur 13 15 6 0 0 6 Zamboanga del Sur 23 27 0 0 27 27 Misamis Oriental 21 25 0 1 24 25 Sultan Kudarat 10 12 0 0 0 0 Compostela Valley 9 11 0 1 10 11 Agusan del Sur 12 14 14 0 0 14 Zamboanga del Norte 23 27 19 0 0 19 Sub-Total for Non-CAA Priority Areas 186 219 39 2 111 152 Basilan 10 12 12 0 0 12 Isabela City 1 1 0 0 1 1 Sulu 16 19 0 0 0 0 Tawi-Tawi 9 11 10 0 0 10 Zamboanga City 1 1 0 0 0 0 Cotabato City 1 1 0 0 0 0 Sub-Total for CAA (a): BaSulTa + 3 CAA Cities 38 (Zamboanga,45 22 Cotabato, - Isabela) 1 23 Lanao Del Sur 0 0 0 0 34 40 Marawi City 0 0 39 39 Lanao Del Norte 17 0 0 17 20 23 Iligan City 1 0 0 1 Sub-Total for CAA (b): Marawi & its Corridors 54 63 18 - 39 57

NON-PRIORITY AREAS Zamboanga Sibugay 14 16 16 0 0 16 Cagayan de Oro City 1 1 1 0 0 1 Davao Oriental 9 11 7 2 2 11 General Santos City 1 1 0 0 0 0 Agusan del Norte 10 12 0 0 12 12 Sub-Total for Non-Priority Areas 35 41 24 2 14 40

Over All TOTAL 313 368 103 4 165 272 s/f : still for conduct o the DQC Activity in their respective provinces/ cities

Table 04. Number of audience who recall hearing or seeing a specific MH- supported FP/RH messages for Q3 Q3 PY6 Accomplishment Total Number of Total Audience PROVINCE/CITY Target Usapan & CHWs Facility Based WRA Profiled & Audience Recall as of Health Events (accrued) motivated Recall Q3PY6 PRIORITY AREAS Davao City 163,082 3,798 5,605 43,844 - 53,247 71,992 Cotabato 137,791 - 4,606 - 117 4,723 37,504 Bukidnon 141,334 736 - 3,922 1,611 6,269 60,176 Maguindanao 117,237 - 5,067 211,181 76 216,324 299,877 South Cotabato 91,407 - 4,389 - 39 4,428 13,708 Davao del Sur 63,175 - 2,417 98,572 155 101,144 103,509 Zamboanga del Sur 100,933 1,818 2,609 7,360 150 11,937 54,920 Misamis Oriental 88,733 - 2,090 - 104 2,194 17,586 Sultan Kudarat 81,101 - 2,762 - 120 2,882 5,368 Compostela Valley 73,513 942 2,926 172,077 129 176,074 184,673 Agusan del Sur 69,972 942 4,547 87,535 186 93,210 99,354 Zamboanga del Norte 101,005 797 4,019 3,638 70 8,524 30,409 Sub-Total for Non-CAA Priority Areas 1,229,280 9,033 41,037 628,129 2,757 680,956 1,018,228 Basilan 34,612 221 505 2,575 255 3,556 43,376 Isabela City 82,363 53 391 - 10 454 1,344 Sulu 39,019 - 1,084 829 53 1,966 54,978 Tawi-Tawi 86,065 179 1,471 1,996 77 3,723 21,468 Zamboanga City 11,264 797 4,762 - 167 5,726 15,583 Cotabato City 29,904 - 2,131 1,267 14 3,412 17,434 Sub-Total for CAA (a): BaSulTa + 3 CAA Cities 283,227 (Zamboanga, 1,250 Cotabato, 10,344 Isabela) 6,667 576 18,837 193,532 Marawi City 84,252 156 47 148 351 351 Lanao Del Sur 20,152 1,206 4,048 27,505 32,759 43,469 Lanao Del Norte 67,549 236 1,528 832 167 2,763 29,861 Iligan City 34,216 1,126 - 1,126 3,892 Sub-Total for CAA (b): Marawi & its Corridors 206,169 1,598 6,749 28,337 315 36,999 116,725 - NON-PRIORITY AREAS - Zamboanga Sibugay 63,229 797 2,154 - 172 3,123 3,173 Cagayan de Oro City 67,505 96 4,336 - 21 4,453 24,206 Davao Oriental 55,821 574 2,215 10,327 200 13,316 18,668 General Santos City 59,365 - - - 21 21 15,249 Agusan del Norte 35,403 1,109 2,759 26,500 120 30,488 30,488 Sub-Total for Non-Priority Areas 281,323 2,576 11,464 36,827 534 51,401 130,936 - Over All TOTAL 2,000,000 14,457 69,594 699,960 4,182 788,290 1,459,419

Table 05. Number of women giving birth who received uterotonics in the third stage of labor (or immediately after birth) and Number of newborns not breathing at birth who were resuscitated in USG-supported sites, Q3PY6 New Born Resucitation Uterotonic Use PROVINCE/CITY Livebirths Newborn Resucitated NB Revied Post Resucitation Facility Target Male Female Total Male Female Total Male Female Total PRIORITY AREAS Davao City 469 22 No Sentinal Hospital Cotabato 395 0 No Sentinal Hospital Bukidnon 421 56 No Sentinal Hospital Maguindanao 1,453 2,653 MPH/Province 105 218 323 10 13 23 7 11 18 South Cotabato 267 318 SCPH 99 95 194 0 1 1 0 0 Davao del Sur 279 31 No Sentinal Hospital Zamboanga del Sur 308 64 ZSurPH 801 17 15 Misamis Oriental 263 17 No Sentinal Hospital Sultan Kudarat 241 0 SKPH 535 0 14 14 0 14 14 Compostela Valley 222 62 CVPH - Montevista 776 47 46 Agusan del Sur 212 113 DOPMH 893 23 19 42 22 18 40 Zamboanga del Norte 308 60 No Sentinal Hospital Sub-Total for Non-CAA Priority Areas 4,837 3,396 6 Sentinel Hosp 204 313 3,522 33 47 144 29 43 133 Basilan 443 186 No Sentinal Hospital Sulu 1,101 1,570 No Sentinal Hospital Tawi-Tawi 566 162 No Sentinal Hospital Zamboanga City 260 102 No Sentinal Hospital Isabela City 32 79 No Sentinal Hospital Cotabato City 87 0 No Sentinal Hospital Sub-Total for CAA (a): BaSulTa + 3 CAA Cities2,489 (Zamboanga, 2,099Cotabato, Isabela) 0 0 0 0 0 0 0 0 0 Lanao del Sur 1,437 4,095 No Sentinal Hospital Lanao del Norte 302 0 GTLMH 839 22 15 Sub-Total for CAA (b): Marawi & its Corridors1,739 4,095 1 Sentinel Hosp 0 0 839 0 0 22 0 0 15

NON-PRIORITY AREAS Zamboanga Sibugay 189 83 ZSibPH 741 3 3 6 2 3 5 Cagayan de Oro City 196 59 JRBGH - 46 41 Davao Oriental 167 29 No Sentinal Hospital General Santos City 173 0 No Sentinal Hospital Agusan del Norte 209 275 ADNPH 558 39 21 60 37 0 58 Sub-Total for Non-Priority Areas 934 446 3 Sentinel Hosp 0 0 1,299 42 24 112 39 3 104

Over All TOTAL 10,000 10,036 10 Sentinel Hosp 204 313 5,660 75 71 278 68 46 252

Table 06. Number of SDPs with stock-out by FP commodities, Q3PY6 TARGET Number of SDPs with Stock-outs by FP commodity PROVINCE/CITY Total SDPs N D IUD DMPA Pills Condom SDM Beads PRIORITY AREAS Davao City 2 75 ------Cotabato 1 38 ------Bukidnon 1 34 ------Maguindanao 1 44 ------South Cotabato 1 30 ------Davao del Sur 1 41 ------Zamboanga del Sur 1 40 - - 20 8 26 26 Misamis Oriental 1 41 ------Sultan Kudarat 1 28 ------Compostela Valley 1 21 ------Agusan del Sur 1 29 ------Zamboanga del Norte 1 36 - - - - 12 12 Sub-Total for Non-CAA Priority Areas 14 457 - - 20 8 38 38 Basilan 0 14 ------Sulu 1 27 ------Tawi-Tawi 1 17 ------Zamboanga City 1 27 ------Isabela City 0 6 ------Cotabato City 0 5 ------Sub-Total for CAA (a): BaSulTa + 3 CAA Cities (Zamboanga, 3 96 Cotabato, - Isabela) - - - - Lanao del Sur 2 53 - - - - 40 40 Lanao del Norte 1 37 ------Sub-Total for CAA (b): Marawi & its Corridors 3 90 - - - - 40 40

NON-PRIORITY AREAS Zamboanga Sibugay 1 24 - - 15 - 14 15 Cagayan de Oro City 0 13 ------Davao Oriental 1 17 - - 6 1 1 6 General Santos City 0 10 ------Agusan del Norte 1 30 ------Sub-Total for Non-Priority Areas 3 94 - - 21 1 15 21

Over All TOTAL 22 737 - - 41 9 93 99

Table 07. Number of USG-assisted community health workers (CHWs) providing family planning (FP) information, referrals, and/or services during the year

Accomplishments Total number of CHWs supported, disaggregated by sex Clients Provided PROVINCE/CITY Target Client Referred % with FP Male Female TOTAL for FP Service Accomplishment Information

PRIORITY AREAS Davao City 278 - - - - Cotabato 220 117 117 53.2 10 10 Bukidnon 248 1,611 1,611 649.6 4,833 4,833 Maguindanao 126 6 70 76 60.3 1,070 1,070 South Cotabato 145 39 39 26.9 16 16 Davao del Sur 161 155 155 96.3 - - Zamboanga del Sur 160 1 149 150 93.8 709 482 Misamis Oriental 156 104 104 66.7 365 455 Sultan Kudarat 128 2 118 120 93.8 10 10 Compostela Valley 130 129 129 99.2 297 251 Agusan del Sur 115 3 183 186 161.7 17,912 1,535 Zamboanga del Norte 160 70 70 43.8 210 210 Sub-Total for Non-CAA Priority Areas 2,027 12 2,745 2,757 136.0 25,432 8,872 Basilan 126 3 252 255 202.4 951 8 Sulu 126 10 10 7.9 90 90 Tawi-Tawi 126 6 47 53 42.1 - - Zamboanga City 160 77 77 48.1 511 481 Isabela City 160 167 167 104.4 232 485 Cotabato City 126 2 12 14 11.1 241 99 Sub-Total for CAA (a): BaSulTa + 3 CAA Cities (Zamboanga, 824 Cotabato, 11 Isabela) 565 576 69.9 2,025 1,163 Lanao del Sur 126 148 148 117.5 343 319 Lanao del Norte 126 2 165 167 132.5 533 265 Sub-Total for CAA (b): Marawi & its Corridors 252 2 313 315 125.0 876 584

NON-PRIORITY AREAS Zamboanga Sibugay 160 172 172 107.5 593 484 Cagayan de Oro City 106 21 21 19.8 48 48 Davao Oriental 106 200 200 188.7 4,673 3,684 General Santos City 106 21 21 19.8 - - Agusan del Norte 106 120 120 113.2 5,877 514 Sub-Total for Non-Priority Areas 584 - 534 534 91.4 11,191 4,730

Over All TOTAL 3,687 25 4,157 4,182 113.4 39,524 15,349

Table 08. Number of Service Delivery Point Providing FP Counseling and Services as of Q3PY6

Table 09. Status of Capacity Building Support on FP/MNCHN as of end of June 2018 BTL-MLLA LARC-PSI PPFP/PPIUD FPCBT2 CMNC/EINC PROVINCE/CITY Trained SupSup Certified Trained SupSup Certified Trained SupSup Certified Trained SupSup Certified Trained SupSup Certified PRIORITY AREAS Davao City - - - 58 29 8 65 4 - 23 1 - 19 - - Cotabato 6 4 4 45 6 1 63 61 57 19 10 - 54 36 31 Bukidnon 18 14 14 36 13 - 31 21 10 65 10 10 189 11 - Maguindanao 17 3 1 26 1 - 25 16 - - - - 113 - - South Cotabato 19 15 10 46 13 1 40 29 28 26 - - 44 37 30 Davao del Sur 11 2 - 29 17 6 65 65 29 54 30 11 76 3 - Zamboanga del Sur 6 1 1 64 15 15 65 42 41 13 - - - - - Misamis Oriental 3 1 1 13 12 12 48 47 16 140 76 63 109 23 11 Sultan Kudarat 7 6 3 41 17 10 110 92 61 - - - 66 66 45 Compostela Valley 1 - - 20 20 15 27 11 1 8 - - 30 - - Agusan del Sur 8 - - 46 37 25 32 27 17 91 4 4 49 32 27 Zamboanga del Norte 13 6 - 72 42 39 46 37 22 47 - - - - - Sub-Total for Non-CAA Priority Areas 109 52 34 496 222 132 617 452 282 486 131 88 749 208 144 Basilan - - - 22 8 8 10 9 5 - - - 41 - - Isabela City 2 2 1 5 2 2 6 3 ------Sulu 6 6 6 17 8 8 17 6 2 - - - 70 - - Tawi-Tawi 5 - - 34 16 6 5 - - - - - 27 - - Zamboanga City 11 4 4 34 15 12 41 13 19 5 - - - - - Cotabato City 15 10 10 8 3 2 23 19 14 28 - - 5 - - Sub-Total for CAA (a): BaSulTa + 3 CAA Cities 39 (Zamboanga, 22 Cotabato, 21 Isabela) 120 52 38 102 50 40 33 - - 143 - - Lanao del Sur 22 3 3 31 10 - 14 2 - 17 - - 84 - - Marawi City ------Lanao Del Norte 15 7 6 21 18 15 33 17 9 66 11 7 - - - Iligan City ------Sub-Total for CAA (b): Marawi & its Corridors 37 10 9 52 28 15 47 19 9 83 11 7 84 - -

NON-PRIORITY AREAS Zamboanga Sibugay 13 8 2 2 - - 25 21 10 1 - - - - - Cagayan de Oro City 14 8 8 47 12 4 84 43 28 62 5 4 25 1 1 Davao Oriental 2 - - 15 6 1 25 17 - 9 - - 34 - - General Santos City 7 5 1 24 7 5 40 32 31 - - - 5 3 1 Agusan del Norte 13 4 - 38 31 10 27 22 6 48 6 15 55 34 33 Sub-Total for Non-Priority Areas 49 25 11 126 56 20 201 135 75 120 11 19 119 38 35

Over All TOTAL 234 109 75 794 358 205 967 656 406 722 153 114 1,095 246 179

Table 10. Number of MH Contribution on LARC/PM Acceptors by Public-Private Sector Contribution, Q1PY6 to Q3PY6

Number of Acceptors Couple Years Protection Row Labels January- April-June Cumulative Total January-March Cumulative Total Oct-Dec 2017 Oct-Dec 2017 April-June 2018 March 2018 2018 as of June 2016 2018 as of June 2016 Private Sector LAPM/LARC Services 5,612 1,275 1,173 8,060 16,832 4,332 3,663 24,827 FIXED 481 881 458 1,820 2,628 3,347 1,876 7,850 BTL 99 - - 99 990 - - 990 IUD 25 370 322 717 115 1,702 1,481 3,298 LARC-PSI 57 336 110 503 143 840 275 1,258 PPFP/PPIUD 300 175 26 501 1,380 805 120 2,305 OUTREACH 5,131 394 715 6,240 14,205 985 1,788 16,977 BTL 178 - - 178 1,780 - - 1,780 IUD 20 - - 20 92 - - 92 LARC-PSI 4,933 394 715 6,042 12,333 985 1,788 15,105 Public Sector 4,575 13,436 10,678 28,689 22,103 54,694 42,375 119,172 FIXED 2,833 7,063 6,551 16,447 17,203 38,489 31,252 86,943 BTL 1,059 1,751 1,358 4,168 10,590 17,510 13,580 41,680 IUD 49 411 223 683 225 1,891 1,026 3,142 LARC-PSI 737 1,646 2,960 5,343 1,843 4,115 7,400 13,358 PPFP/PPIUD 988 3,255 2,010 6,253 4,545 14,973 9,246 28,764 OUTREACH 1,742 6,373 4,127 12,242 4,901 16,205 11,123 32,229 BTL 40 3 101 144 400 30 1,010 1,440 IUD 117 119 23 259 538 547 106 1,191 LARC-PSI 1,585 6,251 4,003 11,839 3,963 15,628 10,008 29,598 TOTAL PUBLIC AND PRIVATE 10,187 14,711 11,851 36,749 38,935 59,026 46,038 143,999

7.5 Cities Development Initiative

CITIES DEVELOPMENT INITIATIVE- PROMOTING CITIES AS ENGINES OF GROWTH

USAID is working to strengthen the economic competitiveness and resilience of second-tier cities outside Metro Manila, Cebu and Davao through the CITY DEVELOPMENT INITIATIVE (CDI). CDI seeks to advance the development of second-tier cities as engines of growth that is inclusive, environmentally sustainable and resilient. Depending on the most urgent needs of the city, USAID will provide a range of technical assistance, drawing from resources in economic growth, health energy, environment, governance, and education to assist the cities achieve inclusive and resilient growth.

Partner cities were selected based on the following criteria:  An enabling environment for growth  Credible City government committed to good governance  Committed local partners  Engaged private sector High likelihood of producing impact

In Mindanao, three cities were selected as CDI partner cities – Cagayan De Oro, Zamboanga City, with inclusion of General Santos City for PY6. As of this quarter, the highlight of the health CDI Initiatives are:  Cagayan de Oro: Quality Improvement System: Two recognized Clinical Practice Sites namely Northern Mindanao Medical Center (NMMC), one of the 5 Centers of Excellence on PPFP in Mindanao, and the JR Borja General Hospital, with on-going FP/AY Integration initiatives continue to support supportive supervision on PPFP/PPIUD. This regionwide support is anchored to a previous agreement among 5 provinces, 9 cities and these 2 hospitals during one of the RIT meetings. All LGUs within the region agreed to support trained health service providers in their area to attend supportive supervision activities either at NMMC or JR Borja, a requirement for DOH certification and PhilHealth accreditation  Establishment of FP services in the Workplace for Zamboanga City - REPRODUCTIVITY TO PRODUCTIVITY: Enhancing Worker’s Productivity through Reproductive Health and Rights. There are 59 establishments (sardines factories) employing 200 workers each. Of this, 44 companies have Family Welfare Committee (FWC). Workers of these establishments comes from the different municipalities of Zamboanga Peninsula and other provinces. The 3 year partnership with United Nations Population Fund (UNFPA) with Employers Confederation of the Philippines (ECOP) Under the Business Action for Family Planning Access (BAFP) provide a

comprehensive program for private sector companies to directly participate in family planning (FP) through improved access to FP information, services and commodities. The DOH-CHD-IX, Zamboanga City Health Office, PopCom IX, DOLE IX and USAID-MH forged partnership with the existing UN/US Aid Foundations on the implementation/provision of Modern Family Planning. The first five companies that started provision of FP services to their employees including their families. The 5 companies are: 1. Permex Producer and Exporter Corporation 2. Universal Canning Incorporated 3. NY Marine Resource and Ice Plant Inc. 4. Southwest Asia Canning Corporation 5. Big Fish Food Corporation

Below is the status of the CDI on health in these three cities to date.

CITY DEVELOPMENT INITIATIVE ZAMBOANGA CITY For the period April-June 2018

Development Constraints City Actions Follow-On USAID Activities Counterparts Status/Remarks/Recommendations

Session 1: Enhancing Investments and Human Capital for Economic Growth Session 2: Strengthening Health Services for Human Capital Development

A. Quality of Care: Capability building for service delivery

1. Supportive (1.1) (1.1.1) (1.1.1) (1.1.1) Supervision (SS) for  ZC CHO sees the  MH facilitated the  DOH RO IX to  Signed Certificates of Completion by previously trained need to have all conduction of facilitate the DOH RO IX’s RD Monicimpo to be HSPs on LARC the 16 RHUs SS/PTE with the certification of out by July 2018 methods (PSI and provided with DOH RO IX for these HSPs who had PPIUD) certified LARC SDI these HSPs (14 undergone  For immediate submission to HSPs nurses, 7 thorough Post PhilHealth for accreditation (Nurses/midwives) Training Evaluation

Development Constraints City Actions Follow-On USAID Activities Counterparts Status/Remarks/Recommendations who are dedicated midwives) last under DOH- to perform this June 21-22, 2018 accredited master MFP method trainer, Dr.  MH coordinated Marinduque  Only 7/16 RHUs with these newly Bernabe have MDs SS HSPs for the previously trained conduct of FP on SDI (last 2015); outreach services they were only in their respective certified last Feb. areas for the 2018 months of July- August 2018

(1.1.2) DOH RO IX’s Family (1.1.2) Awaiting Dr. Rebollos and her (1.1.2) MH established a Health Cluster Head, Dr. Program Coordinators’ Action Plans regular updating of Sherryl Rebollos, will database on discuss and plan out MNCHN/FP capability with her MNCHN profile of service Program Coordinators providers using the for the conduct of Training Information SS/PTE to identified Management System HSPs (TIMS); with a signed Memo Order from DOH RO IX’s RD Monicimpo (1.2) Zamboanga City (1.2) DOH RO IX to fast track the (1.2) Signed Certificates of Completion by Medical Center (1.2) MH assisted the 8 HSPs certification of these HSPs DOH RO IX’s RD Monicimpo to be has 8 HSPs (3 to out by July 2018 MDs, 3 RNs, and 2 undergo SS/PTE under RMs) who are Dr. actively Marinduque Bernabe performing PPIUD and insertions but are ZCMC’s Dr. Ruvelinda not yet certified Grace Uy

(1.3) DOH RO IX to facilitate the

Development Constraints City Actions Follow-On USAID Activities Counterparts Status/Remarks/Recommendations (1.3) Labuan Public (1.3) MH assisted this lone HSP certification of this HSP (1.3) Awaiting DOH RO IX’s FP Hospital (LPH) has to undergo supportive Coordinator Mr. Gilbert Natividad’s 1 RM for PPIUD SS supervision towards DOH evaluation for the her certification RO IX certification (1.4)DOH RO IX already has (1.4) (1.4) Mindanao Central (1.4) MH assisted the 3 HSPs to certified 2/3 HSPs  Certificates were already awarded to Sanitarium Gen. undergo supportive the 2 HSPs (1 MD and 1 RM) last Hosp. (MCS) has 3 supervision towards DOH May 2018 HSPs (1 MD, 1 RN, RO IX certification and 1 RM) for  1 HSP (RN) has to undergo further PPIUD SS evaluation for her certification

2. Adolescent/Youth (2.1) (2.1) (AY) friendly RHUs (2.1) (2.1)  DOH RO IX provides  All 16 RHUs has passed the All 16 RHUs in Z.C.  TA on the certification facility enhancement certification by DOH RO IX for the are manned by AJA process of all the RHUs as support (provision of IEC Level 1 category as AY-friendly trained staff; with Level 1 category AY- materials, gang chairs, facilities designated corner friendly facilities steel cabinets, AY for logbooks)  Awaiting the City Mayor’s AY; separate  TA on the development of acceptance of the AY Policy logbook an AY Policy with City  DOH RO IX to ready AJA endorsed by the City Health Officer for AY Health Officer, Dr. Dulce manual and AHDP Policy Dagalea-Miravite; for endorsement to the City Mayor for acceptance and signing of an E.O. 3. PhilHealth (3.1) All 16 RHUs are re-accredited with Accreditation (3.1) Sustain the (3.1) Assisting partners in Phil Health for the year 2018 compliance of referral of clients to accreditation in all accredited facilities RHUs/birthing facilities B. Reduction of Teenage Pregnancy

Demand Generation needs (1.1) Re-activation of the (1.1) TA on the (1.1) ISDN members to (1.1) Fully functional ISDN to start by 2nd strengthening Information and mapping of convene on 3rd week half of the year 2018

Development Constraints City Actions Follow-On USAID Activities Counterparts Status/Remarks/Recommendations Service Delivery services available July 2018 for updates on Network (ISDN) with by members of respective agencies’ the LGU as the lead the ISDN and youth programs agency Referral System (1.2) POPCOM IX has initially set-up the establishment of Teen Corners inside the barangay halls of the these 4 barangays (Putik, Lumayang, Lumbangan, and Tetuan) (2.1) Conduct of USAPAN (2.1.1) (2.1) (2.1) A need to train another batch of Barkadahan and  TA on the conduct of  Information Drive by USAPAN facilitators as some have USAPAN Batang Ina USAPAN by MH- DOH RO IX and either retired or had changed to Batang Ama (BIBA) trained facilitators POPCOM IX in the other office departments sessions by POPCOM both from the CHO different barangays of and he Population Z.C. Office  Department of  USAPAN Action Cards, Education conducts FP Fans, and FP Flip Fertility-awareness charts provided to the classes facilitators

 TA on the conduct training of USAPAN to CHO personnel including risk assessment using the HEADDSS form

(3.1) AY friendly RHUs with (3.1) MH-trained AJA AJA / ADEPT / HYO providers present at all trained providers the 16 certified Level 1 AY friendly RHUs (3.2) Monitoring of the AY

Development Constraints City Actions Follow-On USAID Activities Counterparts Status/Remarks/Recommendations friendly RHUs C. Lack of FP-MCH Commodities

Service Delivery CHO conducts monthly  TA on the use of  DOH RO IX supplies the  NO stock-out reported for Z.C. inventory (re-allocating BHSs forecasting tool CHO regularly with FP nearing stockouts), forecasting commodities  Request for SDM Beads at the RHUs and distribution of  Providing alert to CHO for demonstration purposes commodities, regarding status of stock  DOH RO IX and DOH storage/stockroom (to include levels of FP commodities Retained Hospitals stock card), recording and ensures that FP reporting commodities are available in the FP clinic/Units in hospitals Health Information Provide mentoring and Provides IEC materials to CHWs DOH RO IX conducts Need to provide IPC training for all needs strengthening monitoring of CHTs/BHWs (FP fans, CHW toolkits, Nanay Interpersonal CHWs of the LGU; CHO sees this to regarding MNCHN and FP booklets) Communication be efficient as selected BHWs are messaging/information sharing (IPC) orientations to new taken in also as BPVs by the and also as a way to determine CHWs as others have Population Office; CHO’s position is and ensure availability of FP already for all CHWs to be trained in IPC so commodities retired from service they will be motivated to perform at par with the BPVs

CITY DEVELOPMENT INITIATIVES CAGAYAN DE ORO CITY For the period April-June 2018

Development City Actions Follow-On USAID Activities Counterparts Status/Remarks/Recommendations Constraints

Session 2: Strengthening Health Services for Human Capital Development

A. Quality of Care: Capabilities of some facilities are not in full

Development City Actions Follow-On USAID Activities Counterparts Status/Remarks/Recommendations Constraints compliance with the standards

1.1 Recognized trainers for 1.1 Organize Trainings for Private DOHRO – conduct of training on Private Midwives in CDOC, Mis Or and Bukidnon 1. Training PPIUD, FP CBT Level 1 and HSPs on various FP Skills (PSI PPIUD, EINC, FP CBT Level 1 and 2, trained on PSI insertion in partnership with Level 2 from Cagayan de for private midwives) for IPC training for BHWs/CHT CMSU-IMAP last April 12-13, 2018 at VIP Hotel. 4 Oro conduct harmonized private clinics in CDO and Navigators (public and private from Bukidnon, 6 from Mis Or and 7 from CDOC. training for both public Misamis Oriental to provide facilities and private midwives. broad-range of FP services in 1.2 Conduct FPCBT1 and the clinic. Two (2) HSPs from Mis Or underwent PPIUD FPCBT2, PPIUD trainings supportive supervision at JR Borja last May 24-25, for both public and 1.2 Regular updating of database 2018. They were recommended for DOH private midwives on MNCHN/FP capability profile of Certifications. Outputs were submitted to DOH especially among the service providers ROX for Certification. IMAP members. Through the mentor-mentee Private and Public Midwives Four (4) Private Midwives underwent PPIUD approach done by CMSU- trained on PPIUD were provided supportive supervision at JR Borja Hospital last IMAP the identified with assistance on supportive June 25-27, 2018. They were recommended for mentor midwives provides supervision towards DOH DOH ROX Certification. coaching and mentoring certification of providers. They are to other midwives to directed to have a one-day duty at FP CBT Level 2 training to various HSPs in Region private facilities in JR Borja Hospital to complete their 10 (Mis Or -5, CDOC –2 Bukidnon -10). Training Misamis Oriental. cases needed for DOH RO conducted by CHO CDOC Trainers. 1.3 POPCOM 10 together Certification. with CHO CDOC provided 1.3 Conduct various FP Skills DOHRO and PopCom- Conduct of As of June 2018 there were 317 BHWs actively orientation to BHW in training for HSPs assigned in GIDA orientation among CHTs/CHWs referring FP clients. identifying FP unmet need and facilitate supportive (125) to provide FP/MNCHN and linking them to SDP supervision leading to DOH messages and navigate identified for service provision. certification. clients/potential FP clients to the 1.1 Mentoring the CHO team on health facilities. 3.1 Due to, the DOH LTO strengthening the role of requirements CHO reduced the CHTs/CHWs in the provision number of MCPs in the City form of MCH/FP messages to 45 to 15, the 15 MCP passed the potential clients in their areas DOH LTO requirements and will thru the use of various IEC DOHRO- dissemination of IRR on MCP facilities in CDOC reduced to 15 from 48 due Liscensing of Birthing Facilities to the DOH LTO requirements. These 15 Health

Development City Actions Follow-On USAID Activities Counterparts Status/Remarks/Recommendations Constraints served as referral birthing facilities materials provided (FP Fan Centers will be the referral MCP for those health to all barangays in the city. and Flip Charts) centers that did not pass the MCP requirements. As it is, those clients who are ‘exclusions’ are 2.2 The City Hospital (JR Borja referred to JR Borja Hospital. 2. PhilHealth Hospital) is the main Accreditation referral hospital for those clients identified by the health center personnel as “high risk”.

B. Reduction of Teenage Pregnancy . Demand Generation JR Borja will open an Adolescent Friendly Facility, Needs Conduct of USAPAN G Barkadahan Conduct training on AJA including DepEd- Fertility-awareness classes this will be headed by Dr Alagadan- Head Pedia strengthening Conduct of fertility awareness risk assessment using the Dept. Series of orientation to the hospital staffs classes/AYRH classes HEADDSS form were done by Dr de Guia and Dr Alagadan. An AY Nurse was identified to manage the clinic. As of DOHRO and DepEd -Training of now the hospital is looking for a room for the said Assisted the creation of Teen faculty and guidance counselors clinic since the hospital is under renovation they Center in JR Borja Hospital on FP information provision and find it challenging where to put the clinic. GBV

DOH ROX conducted Healthy Young Ones Orientation to HSPs in CDO including HSPs from JR Borja Hospital C. Lack of FP-MCH Commodities 1. Service 1.1 Procure FP commodities TA on the use of forecasting tool DOHRO– Provision /procure FP The various health centers in CDOC continue to Delivery for current users commodities for NHTS families implement the SMRS for the commodities. NDP (new acceptors) conducts the actual inventory while the FHA 1.2 Conduct regular inventory Providing alert to CHO re status of assigned in CDOC summarized the output and of FP commodities so can stocklevels of FP commodities DOHRO- adopted the submit the same to DOH ROX. re-allocate to BHS commodities forecasting tool nearing stockouts Private MCP clinics were linked to developed by HealthGov 1.3 Distribution of FP pharmaceutical partners for their commodities to BHS FP commodities.

Development City Actions Follow-On USAID Activities Counterparts Status/Remarks/Recommendations Constraints DOHRO provides FP commodities 1.4 Provide mentoring and Monitored the BHWs trained on to NMMC (DOH-Retained monitoring of CHTs/BHWs their outputs for actual clients Hospital) and JR Borj Hospital reFP/MNCHN Messaging referred and provided with FP ensuring that FP commodities are /information sharing and services through the assistance of available in the FP clinic in also as a way to FHA. hospitals determine and ensure availability of FP commodities

CITY DEVELOPMENT INITIATIVES GENERAL SANTOS CITY For the period April-June 2018

Development City Actions Follow-On USAID Counterparts Status/Remarks/Recommendations Constraints Activities Session 1: Strengthening Health Services for Human Capital Development A. Quality of Care: fixed and outreach services Capability General Santos CHO conducted Provided list of qualified DOHRO-provided training On FPCBT1 training, FPOP and UPMGSC were the main partners for building for harmonized joint planning with trainers/mentors at DJPRH funds for 30 participants of identifying private lying-ins, hospitals, academes and some big private quality service CSOs and NGOs to conduct and FPOP on PPIUD; FPCBT1; 28 FPCBT2 companies for invitation to the training, spread all over the region, such delivery FPCBT1 and FPCBT2 (including invited as participants (manuals, as: Gen Tuna, AMCOOP, RD Group of Companies, Dole-Philippines- PPIUD) Training for Midwives and trainers/facilitators in the venue and food) venue Kidapawan City , Sultan Kudarat State University, Brokenshire College, Nurses among public and private training provision of commodities Stamford College. lying ins, hospitals and academe) Facilitated use of the for the practicum; Utilized On FPCBT2/PPIUD –conducted last April, 2018 with 28 participants; out with region-wide participation anatomical models during qualified trainers and of which were 3 LGU participants from RHU Makilala, Aleosan and training. facilitators for the training; Tulunan. MH followed-up start of practice of the LGU trained HSPs for Provision of placental Collaborattion with CSOs proficiency with provision of forceps to aid in service provision and forceps for PPIUD trained (FPOP & UPMGSC) for referral to previously trained HSPs for mentoring. participants (20 pcs only) inviting private to start their practice facilities/HSPs to Supportive supervision/Post training Evaluation of the trained HSPs on participate in the training. FPCBT1 and FPCBT2 will be funded by DOHRO for certification of HSPs. The CHO invited CSOs (UPMGSC), MH participation: inputted DOHRO provided funds for NGOs (FPOP, MH) and Private on the inclusion of PPP on the conduct of Next workshops for the enhancement of the referral manual were Facilities in General Santos City the draft referral manual TWG/stakeholder postponed due to MR SIA activities.

Development City Actions Follow-On USAID Counterparts Status/Remarks/Recommendations Constraints Activities (R. Diagan Coop Hospital, and on SDN ( provide template workshop for the lying-ins , and including of Iligan City PPP) having finalization of referral Sarangani PHO for the similar applicability to GSC manual stakeholders workshop on the FPOP, UPMGSC- acted as referral manual of the SDN facilitators, trainers and/or service providers in the conduct of trainings and In General Santos City; the HSPs certified & accredited were from FPOP, outreaches; helped out in UPMGSC and DJPRH; Those from the CHO (7 RHU physicians) were not Provided support to identification of yet certified and accredited. FP outreach services done in 10 barangays partners for the conduct of participants; of General Santos City were collaborated with FPOP with their staff as Collaboration with CSOs, NGOs as outreach; arranged primary service providers. This quarter, only one outreach in Mabuhay skilled service providers for the schedules with private was conducted. Other barangays postponed their outreach during the conduct of LARC-PSI outreaches, service providers and the election and the MR SIA activities. namely: skilled HSPs from FPOP, LGU staff for HSPs UPMGSC. availability and readiness of For DJPRH, the newly hired hospital management staff (chief nurse, chief The FPOP also served clients from the community clients; of clinics) were invited for the orientation of FP/AY program in hospitals neighboring Sarangani province; and the mandates/policies for making them advocates and further UPMGSC also conducted 1 MH provided TA on the strengthening the FP/AY services in DJPRH. outreach activity in Tupi. South workshop on FP/AY DJPRH in PY6Q1 had served the following clients on FP, many from Cotabato program in Hospitals and DOHRO participated with General Santos City but extended to clients coming from nearby Orientation in Recording the hospitals in the region provinces areas of So. Cotabato, Sarangani, Sultan Kudarat and Davao Strengthening of the FP/AY and Reporting in Hospitals; and facilitated the roll out del Sur (Jose Abad Santos): program established in DJPRH. Provided initial supplies in workshop to the other The Program coordinator, IT staff recording and reporting in hospital facilities in the Month GSC SoCot Sarangani DDS Sultan participated in the FP/AY services hospital. region, public and private. (Jose kudarat in Hospitals workshop and Participation of public and Abad orientation on the Recording and private hospitals in the Santos) Reporting of FP accomplishments region during the roll-out January, 34 IUD; 2 BTL 7 PPIUD; 1 BTL in hospitals and served as workshop, cost-shared by 2018 30 BTL, 1 2 –I-IUD; facilitators during the roll-out DOHRO 12 and MH. In PSI, 27 15 BTL; workshop for the other hospital GSC, private hospitals such Pills, 1 Pills facilities in the region. as, R.O Diagan 1 DMPA Cooperative Hospital and February 28 IUD; 0 4 PPIUD; 2 BTL SOCCSKSARGEN County 2018 27 BTL; 6 BTL; Hospital and the 5 PSI; 1PSI Mindanao Mission 16 Pills;

Development City Actions Follow-On USAID Counterparts Status/Remarks/Recommendations Constraints Activities Hospital participated in the 3 DMPA rollout workshop in FP/AY March, 37 IUD; 2 BTL 6 PPIUD; 1 BTL 2018 30 BTL; 2 I-IUD 9 PSI; 15 BTL; 27 pills; 1 pills 1 DMPA

Note: April-June Data to be extracted next reporting time

The R.O Diagan Cooperative Hospital had also served as referral hospital for LAPM clients coming from Sarangani province, and the nearby municipalities of South Cotabato such as Polomolok and Tboli as shared during the convergence meeting told by PPO. In Cotabato province, there were 3 private hospitals such as; Midway Hospital in Makilala, KMSCH in Kidapawan City, AMSCH in Antipas and 4 public hospitals like Aleosan District Hospital, Alamada Community Hospital, DADFPH and Arakan District Hospital who participated in the FP/AY workshop. Health CLGU supported Media Provided flip charts, FP IEC DOHRO- provision of IEC CLGU had adopted the CSE (Comprehensive Sexual Education) manual Information communications- Radio and TV materials, ICV wall Chart to materials on MCH; produced by FPOP and in coordination with DepEd had trained the regular health news/advisory for 1 12 RHUs, DJPRH, and 3 public school teachers in the city. hour 3x a week Private Lying ins Conduct of health mission (Brokenshire, FPOP, caravans inclusive of Core Referral hospital of clients Goldenstate Maternity MNCHN/FP services, for LAPM-LARC services to DJPRH Clinic) health classes; provide – widely communicated in the city LPM services

Policy and Local EO 12 Policy on Unmet Provided references for the The City passed a localized EO 12 version. It was drafted by the CHO Regulations Needs approved by the LCE, and EO 12 local policy- copy of with partners in March 2018; finalization was done at FPOP office with tracking its implementation EO 12 and DOH AO CHO and FP Coordinator, FPOP Manager, UPMGSC president and MH staff- approved last week of June.

B. Increased Rate of Teenage Pregnancy Health Regular conduct of IEC MH-trained TOF on Usapan DOHRO-Orientation on The workshop on FP/AY Program in the hospitals had tackled the Information /counselling at the RH Clinic of – 3 HSPs the Healthy Young Once integration of the AY and FP services; recording and reporting of AY is DJPRH prior to consultation; program

Development City Actions Follow-On USAID Counterparts Status/Remarks/Recommendations Constraints Activities FP and AY rooms are housed FP flipcharts for Usapan Provision of IEC materials given special attention as a dedicated logbook is assigned to AY together in RH Clinic Building; series services. accessible as it is in the first Academes building of the hospital complex - AJA trained HSPs- Information Drive in the FPOP had produced the CSE manual adopted by the DEpED in General with visual and auditory privacy) designated Focal Person different schools Santos City; they had trained the public school teachers; thus integrated for AY Center for Teens in in some of the subjects DJPRH- committed and proficient

Service Delivery Functional center for Teens in a DOHRO- HRH- FHA Note: Copy of the monthly inventory report for submission next public hospital –DJPRH TA to support LAPM monitors and reports reporting FP and AY rooms are housed service provision in DJPRH commodity inventory together in RH Clinic Building; and outreach monthly; reports to accessible as it is in the first DOHRO cc MHO/CHO Strengthened linkages between and among public and private health building of the hospital complex - facilities is beneficial in addressing stock outs. –UPMGSC through with visual and auditory privacy); PPMs, clinics, serve as coordination with DOHRO was provided with 7 boxes of PSI last June FP Counselling/service provision service delivery points for 2018 for distribution to trained PPMs; MH provided PSI commodity to prior to discharge access to LARC-PM Goldenstate Maternity Clinic. FPOP Gensan also provided 1 box of PSI to services RHU Tantangan, South Cotabato for their outreach. Sarangani province Sharing of commodities between shared POP/COC to DJPRH (3 big boxes – equivalent number of cycles and among private and public TBD) facilities

7.6 Family Planning Composite Index Summary

Introduction In the aftermath of the unfortunate Marawi Siege, the USAID-funded MindanaoHealth Project was extended over a 10-month period from March 2018 - December 2018 to be able to continue its work in areas with low income/poor populations with high unmet need for family planning (FP), and high teenage pregnancies with high neonatal deaths. With less than a year to accomplish the objectives of the extension, MH first undertook a 3-day comprehensive program implementation review (PIR) to take stock of the progresses thus far made, and firm up strategic core interventions in the areas of supply, demand and policy/financing required for October 2017 to December 2018. Given the narrow window for operations, MH had to cut back its presence in some USG-assisted Local Government Units (LGUs) while at the same time scaling up involvements in others. As an initial step and as shown below, the Project prioritized 12 LGUs and eight (8) Conflict Affected Areas (CAAs), where unmet need for family planning and teenage pregnancies are remarkably high and areas where the health system/service provision remains affected by humanitarian crises and conflicts, as prime beneficiaries of the Project during the extension period. Five (5) others were rated as non-priority USG-assisted LGUs.

Table 1. USG-Assisted LGUs’ Estimated Teenage Pregnancies, WRA with FP Unmet Need and CYP as of September 2017 (Q4PY5). Couple-Years of Estimated Estimated WRA Protection (CYP) Teenage with FP Unmet USG-Assisted LGUs (Sept. 2017) Pregnancy (Sept. Need (Sept. Annual % to 2017) 2017) Average Total Priority USG-Assisted LGUs 1 Davao City 11,833 90,334 46,811 12% 2 Cotabato 10,101 71,507 26,949 7% 3 Bukidnon 8,547 80,699 34,341 9% 4 Maguindanao 4,682 71,529 6,726 2% 5 South Cotabato 10,867 47,138 23,118 6% 6 Davao del Sur 6,876 52,493 31,477 8% 7 Zamboanga del Sur 5,381 52,958 20,994 5% 8 Misamis Oriental 5,184 50,619 19,542 5% 9 Sultan Kudarat 6208 41,542 18,514 5% 10 Compostela Valley 5,454 42,186 13,983 4% 11 Agusan deL Sur 6035 37,279 28,484 7%

Couple-Years of Estimated Estimated WRA Protection (CYP) Teenage with FP Unmet USG-Assisted LGUs (Sept. 2017) Pregnancy (Sept. Need (Sept. Annual % to 2017) 2017) Average Total 12 Zamboanga del Norte 4,933 52,147 26,509 7% Conflict Affected Areas (CAAs) 1 Basilan 1,486 26,714 2,439 1% 2 Sulu 4,099 49,499 3,211 1% 3 Tawi-Tawi 1,763 23,121 1,316 0% 5 Zamboanga City 4,428 43,583 10,740 3% 6 Cotabato City 2,804 15,396 10,804 3% Lanao del Sur (+ Marawi 7 City) 5,030 49,499 2,175 1% Lanao del Norte (+ Iligan 8 City) 6,302 39,483 10,272 3% Non-priority USG-Assisted LGUs 1 Zamboanga Sibugay 3,246 31,717 8,738 2% 2 Cagayan de Oro City 3,944 38,509 16,793 4% 3 Davao Oriental 3,921 31,860 9,273 2% 4 General Santos City 6,208 30,596 0 0% 5 Agusan del Norte 5716 34,898 12,264 3%

Family Planning (FP) Capacity Index Quickly identifying the LGUs/CAAs where MH interventions were deemed most urgent mandated the Project to develop a tool that provides a firm basis for continuing the technical assistance (TA) to them during the extension period. By looking at demographic and geographic profiles as well as for assessing achievements made by these LGUs from a mix of TA interventions provided as of September 2017 (Q4PY5), the tool allows the assessment of recipient-LGUs’ gains on family planning/reproductive health (FP/RH) services and helps establish an enabling environment for sustainability. As designed, the tool developed estimates a composite FP capacity index for each area or LGU through a weighted scoring or threshold applied first to the four (4) key components of the Project, i.e., service delivery (40%), demand generation (20%), policy and financing (20%), and AYRH (20%), and then down to their respective sub-components/elements. From the assessment or qualification of each LGU’s accomplishments during a certain fixed period, a raw score of from one (1) to three (3), with three (3) as the highest, is assigned to each sub-component/element

33 thence multiplied by the corresponding weight. All weighted component scores are then aggregated to arrive at a composite FP capacity index the maximum of which is 100. With the indices serving as proxies for LGUs’ immediate past performance levels, the LGUs are arbitrarily grouped into three (3) classes: High (76 to 100); Medium (51 to 75); and Low (50 and below). In a chart, the LGUs’ computed indices are plotted against the respective LGUs’ number of women with unmet need for family planning to indicate their current or “moving forward” capacities to address unmet need for family planning. Such becomes more evident when current results are reckoned against certain baselines.

Table 2. Estimating Weighted FP Capacity Index of Each LGU

MH Components and Sub-components Assigned Weights (%)

I. Service Delivery 40.00 40.00 A. Certification and coverage of LAPM providers 6.67 B. Presence of basic FP/RH service 6.67 C. Implementation of FP services for hospitals 6.67 D. Private sector participation in FP/RH 6.67 E. Conduct of outreach activities 6.67 F. Availability of network of certified trained providers conducting supportive supervision 6.67 II. Demand Generation 20.00 20.00 A. Conduct of USAPAN sessions 6.67 B. Efficiency of USAPAN 6.67 C. Implementation of unmet need identification and service provision 6.67 III. Policy and Financing 20.00 20.00 A. Accreditation and use of PHILHEALTH reimbursements 6.67 B. Health information systems development and quality 6.67 C. Functionality of SDN 6.67 IV. Adolescent Youth/Reproductive Health (AYRH) 20.00 20.00 A. Functionality of AY-friendly facilities 6.67 B. RHU-based Center for Teens 6.67 C. School-based program for AY 6.67 TOTAL 100.00 100.00

FY/AY Capacity Index as of September 2017 (Q4PY5, baseline) From its inception, the Project’s TA to the LGUs focused on: (i) reducing unmet need for FP by increasing the use of modern FP methods; (ii) reducing teenage pregnancies by scaling-up

evidence-based best practices and promising high impact interventions on adolescent reproductive health; (iii) bolstering the capacity of the local health systems in consolidating results and institutionalizing effective strategies to reduce unmet need for modern FP and improve maternal and child health (MCH); and (iv) developing innovative approaches in providing quality adolescent youth reproductive health (AYRH) and gender-friendly health services. As of September 2017, the table and chart below summarize how the USG-assisted LGUs responded to the TA in terms of their current capacities to accomplish the objectives of the TA.

Table 3. Estimated FP Capacity Indices of USG-Assisted LGUs as of September 2017 (Q4PY5). Composite FP Component FP Capacity Index, Capacity Index, as as of September 2017 of September REGION/PROVINCE 2017 SD DG P/F AYRH ARMM CAA Basilan 50.51 25.80 13.33 5.93 5.45 CAA Lanao del Sur 32.65 12.67 4.44 13.80 1.75 P Maguindanao 64.20 32.18 13.33 11.51 7.17 CAA Sulu 43.95 18.22 11.11 13.19 1.43 CAA Tawi-Tawi 49.78 20.20 10.0 14.02 5.56 REGION IX: ZAMBO PEN CAA Zamboanga City 56.22 26.24 11.11 11.44 7.43 P Zamboanga del Norte 44.60 19.55 13.33 11.71 0.00 P Zamboanga del Sur 62.19 32.93 13.33 15.77 0.16 NP Zamboanga Sibugay 61.81 28.69 15.56 17.56 0.00 Region X: Northern Mindanao P Bukidnon 61.71 26.16 15.56 13.91 5.47 NP Cagayan de Oro City 76.85 33.77 15.56 16.96 10.56 CAA Lanao del Norte 51.70 14.02 15.56 16.26 5.86 P Misamis Oriental 70.02 27.27 13.33 20.02 9.41 Region XI: Davao Region P Compostela Valley 60.09 29.27 11.11 13.05 6.67 P Davao City 62.35 26.98 11.11 12.22 12.04 P Davao del Sur 54.63 24.8 11.11 12.27 6.46 NP Davao Oriental 46.29 23.56 8.89 13.84 0.00 Region XII: SOCCSKSARGEN P North Cotabato 55.46 28.65 12.22 14.28 1.59 CAA Cotabato City 63.54 24.45 15.56 9.48 14.05 NP General Santos City 63.29 27.42 15.56 10.81 9.5 P South Cotabato 62.25 26.3 13.33 12.07 10.54 P Sultan Kudarat 59.90 24.85 20.00 15.00 0.05 Region XIII: CARAGA Region

Composite FP Component FP Capacity Index, Capacity Index, as as of September 2017 of September REGION/PROVINCE 2017 SD DG P/F AYRH NP Agusan del Norte 61.62 23.65 13.33 12.96 11.67 P Agusan del Sur 61.05 21.86 13.33 15.74 10.12 Note: CAA = Conflict Affected Area; P = Priority; and NP = Non-priority.

All 12 LGUs that have been categorized as priority areas for MH intervention based on their high numbers of teenage pregnancies and women of reproductive age (WRA) with unmet need have composite FP indices indicative of their medium-level capacities to provide FP services, generate FP demand, institutionalize policy and financing reforms and provide AYRH services. Misamis Oriental led all other LGUs as it markedly excelled in institutionalizing policy and financing reforms. More than half of its RHUs were already MCP-accredited and had in place PhilHealth reimbursement policies as of September 2017. All RHUs in the province were conducting regular demand generation activities like Mother's Classes and the various variants of USAPAN sessions. All its RHUs were likewise manned by FPCBT-1 and FPCBT-2 trained health service providers (HSPs). Zamboanga del Norte and Maguindanao were the LGUs that were in almost the same situation as Misamis Oriental except that both LGUs lagged behind the latter in implementing the policy and financing reform component of the Project.

Figure 1. Estimated FP Capacity Indices of USG-Assisted LGUs as of September 2017 (Q4PY5).

In this same priority group also are five (4) of the CAA-LGUs likewise targeted for continuing support, i.e., Cotabato City, Zamboanga City, Iligan City, Lanao del Norte and Basilan. CAA-LGUs which posted the lowest composite indices were Tawi-tawi and Lanao del Sur (including Marawi) following their insignificant contributions to AYRH services delivery in the ARMM region. These could be ascribed to the limited number of USAPAN Teen Moms sessions or community outreaches conducted, absence of RHU-based AY-friendly facilities, absence of financial schemes that AYs could access, no operational guidelines from the MHOs for providing AYRH services and no school- based program for AYs.

FP/AY Capacity Index as of March 2018 (Q2PY6)

As of March 2018, the table and chart below summarizes how the USG-assisted LGUs performed six (6) months after their baseline capacities were determined to accomplish the objectives of the TA. The table below also notes the changes in the LGUs’ indices from the baseline. Of the 12 priority LGUs, four (4) LGUs (i.e., Zamboanga del Sur, Bukidnon, South Cotabato and North Cotabato) posted remarkable improvements in their performances during the last six months that accordingly boosted their FP capacity indices. On the other hand, Zamboanga del Norte’s, Misamis Oriental’s and Davao City’s composite capacity indices for the quarter ending March 2018 practically remained unchanged.

Table 4. Estimated FP Capacity Indices of USG-Assisted LGUs as of March 2018 (Q2PY6).

Composite Component FP Capacity Index, Inc./Dec. FP Capacity as of March 2018 from Index, as of Baseline REGION/PROVINCE March 2018 SD DG P/F AYRH ARMM CAA Basilan 58.41 27.98 15.56 9.63 5.24 Inc. CAA Lanao del Sur 55.31 19.34 16.67 16.19 3.19 Inc. P Maguindanao 70.87 34.01 16.39 14.41 6.06 Inc. CAA Sulu 59.11 21.53 15.56 11.52 10.50 Inc. CAA Tawi-Tawi 53.44 21.03 15.56 11.30 5.56 Inc. REGION IX: ZAMBO PEN CAA Zamboanga City 59.08 29.45 15.56 9.63 4.44 Inc.

Composite Component FP Capacity Index, Inc./Dec. FP Capacity as of March 2018 from Index, as of Baseline REGION/PROVINCE March 2018 SD DG P/F AYRH P Zamboanga del Inc. 45.56 20.51 13.33 11.71 0.00 Norte P Zamboanga del Sur 84.20 31.42 20.00 18.39 14.40 Inc. Zamboanga Dec. 59.86 22.34 17.78 10.99 8.76 NP Sibugay Region X: Northern

Mindanao P Bukidnon 74.84 31.12 13.33 18.57 11.81 Inc. Cagayan de Oro Inc. 80.32 31.60 17.78 17.63 13.32 NP City CAA Lanao del Norte 55.31 19.64 16.36 14.43 4.88 Inc. P Misamis Oriental 70.68 22.80 17.78 20.69 9.41 Inc. Region XI: Davao Region P Compostela Valley 67.58 20.45 17.78 14.45 14.90 Inc. P Davao City 62.35 26.98 11.11 12.22 12.04 Same P Davao del Sur 63.07 23.89 12.22 12.42 14.53 Inc. NP Davao Oriental 52.52 23.83 13.33 12.96 2.39 Inc. Region XII:

SOCCSKSARGEN P North Cotabato 66.55 30.14 13.33 14.28 8.80 Inc. CAA Cotabato City 74.71 32.03 15.56 12.01 15.51 Inc. NP General Santos City 72.08 30.69 13.33 18.31 9.74 Inc. P South Cotabato 74.81 32.84 13.33 18.39 10.25 Inc. P Sultan Kudarat 75.68 28.01 20.00 22.21 5.46 Inc. Region XIII: CARAGA

Region NP Agusan del Norte 64.01 23.21 13.33 13.51 13.96 Inc. P Agusan del Sur 68.67 27.53 15.56 15.96 9.63 Inc. Note #1: CAA = Conflict Affected Area; P = Priority; and NP = Non-priority. Note #2: Sultan Kudarat registered one of the highest postive increments in its composite FP capacity index but this is substantively unexplained.

Figure 2. Estimated FP Capacity Indices of USG-Assisted LGUs as of March 2018 (Q2PY6).

Zamboanga del Sur’s surge in its composite FP capacity index could be attributed to vastly improved initiatives on AYRH during the last two quarters. Both its apex hospitals, Margosatubig Regional Hospital (MRH) and Zamboanga del Sur Medical Center (ZDSMC), have AJA trained providers and use the HEEADSS form. FP education and MCH counselling are provided in their OPD, FP Clinic and DR. All targeted RHUs in the province are using HEEADSSS and Rapid HEEADSSS Forms for psychosocial risk assessments and the DOH-provided AY Logbook.

Bukidnon made significant accomplishments in the areas of instituting policy/financing reforms and AYRH. On policy/financing, eight (8) provincial hospitals or service delivery points (SDPs) in the province have existing PHIC policies on reimbursement for all reimbursable services on FP/MCH and are currently using EMR. In its four (4) provincial hospitals (i.e., BPH Kibawe, BPH Manolo Fortich, BPH Maramag and BPMC), four (4) out of the 6 (67%) trained HSPs on BTL/ MLLA are PHIC accredited and are now utilizing the PHIC reimbursement fund in sustaining the FP program in their hospitals particularly in the provision of LARC/PM services. Their PHIC-accredited PPFP/PPIUD providers are covering 86% of the total GID areas (17 municipalities and 2 cities).

All of Bukidnon’s 22 RHUs/LGUs, with policies on Philhealth reimbursement already in place, were not only re-accredited with PhilHealth but were also accredited providers of neo-natal care package (NCP) and MCP (except CHO Malaybalay due to the unavailability of a space for birthing). As mandated by the DOH and PHIC, all of them each have a logistics management system (LMS) that allows them to submit regular accomplishment and inventory reports to the Provincial Health Office (PHO).

On initiatives relating to AYRH, BPH Maramag’s hospital-based teen center policy and operational guidelines remain a work in progress. At the RHU level, all the three (3) RHUs (i.e., Pangantucan, San Fernando and Maramag) targeted to become AY-friendly facilities have 66 trained providers on the use of AJA Tools, and are regularly using the HEEADSS Form in assessing AY client. Moreover, they are now conducting community and school outreaches like “Usapang Barkadahan” and providing FP/MCH information, counseling and services that are integrated with the other health programs of the LGUs especially during the ANC and immunization schedules. The three (3) AY-friendly RHUs have likewise established a referral system among schools and hospitals.

South Cotabato’s improved FP capacity index stemmed primarily from its enhanced FP services delivery. The province’s nine (9) of 11 RHUs, four (4), i.e., SCPH, NDH, UVCH and PMH) of six (6) public hospitals and two (2) private birthing clinics are providing PPIUD services. The same four (4) public hospitals are manned by certified BTL providers. Also, accredited POGS providers operate in six (6) public hospitals of which five (5) are providing FP services. Four (4) of five (5) LGUs classified as GIDAs have certified providers on PPFP/PPIUD while all 32 BHS situated in GIDA barangays each have at least one (1) FPCBT1 trained service provider.

Another significant source of growth was the policy/financing reforms initiated by South Cotabato. It has already an approved policy on the use of PhilHealth reimbursement. Nine (9) of its 11 RHUs are MCP-accredited facilities. The PHO has an existing memorandum stipulating the regular conduct of data quality check (DQC). Except for RHU Koronadal, all others have complied with the requirements of a functional LMS, primarily the warehousing/storage structures. For EMR, all 11 RHUs have been installed with ICLINICSYS.

Enhanced AYRH initiatives in North Cotabato, especially at the community level, fuelled the large increment in the province’s FP capacity index at the end of Q2PY6. While no RHU was specifically targeted, MH was able to provide TA to five (5) RHUs in the province, i.e., Kidapawan, Kabacan, Pigcawayan, Pres. Roxas and Mlang. The TA covered AJA training for RHU personnel, improving the recording and reporting tools on AYRH and drafting of local policy on AYRH. With these inputs, the RHUs of President Roxas and Mlang continued to enhance their AY development plan implementation. Both RHUs have designated rooms to maintain privacy during physical examinations (PE) and interviews with adolescent-youth clients; use the prescribed HEEADSS form as basic recording tool for psychosocial risk assessments; have internal policy guidelines for frontline health providers approved by their respective MHOs; have separate daily service records logbook for AY; have local policies in the form of executive order or municipal ordinance supportive of AY programs; have active demand generation mix via HIV-AIDS fora, health summits, Fun Runs cum AYRH lectures with schools and out-of-school youths (OSY); have regular FP/MCH education and counseling during perinatal consultation (ANC, delivery and PNC) targeting young mothers/parents; and employ master listing of pregnant adolescent-youths.

All composite FP capacity indices of target CAA-LGUs grew from their baseline estimates with Lanao del Sur and Cotabato City posting the most significant increments. Lanao del Sur, in particular, drew substantial improvements in its FP services delivery and demand generation. The Marawi City Health Office (CHO) has in its employ three (3) HSPs who have undergone supportive supervision on PPFP/PPIUD and are currently deployed in the GIDAs of Marawi, and also one (1) certified trainer on LARC/PSI. In addition, the province has four (4) BTL/MLLA providers, one (1) coming from a private SDP and three (3) employed by Amai Pakpak Medical Center (APMC). All 16 SDPs of the province and a private SDP have trained health service providers on FPCBT2 while only four (4) of them have FPCBT1-trained HSPs. Accordingly, APMC and Lanao del Sur’ three (3) district hospitals have been able to provide FP services as guided by their respective hospital policies/orders on FP, operational guide for FP services and designated FP focal persons. Six (6) hospitals currently use the standard recording and reporting systems.

On demand generation, more Family Health Associates (FHAs) whose trainings/orientations on unmet needs for FP were supported by MH were deployed during the last semester to conduct USAPAN sessions that reached 16 barangays of Marawi and five (5) MLGUs of Lanao del Sur. These FHAs have been complemented by two (2) FP Coordinators and two (2) HEPOs who conducted USAPANs during LARC/PSI outreach and REACH++ activities. Other than conducting USAPAN sessions, the FHAs have been tasked to profile WRA with FP unmet needs and provide FP counseling and services.

Cotabato City’s growth in its FP capacity index could be attributed principally to improved FP services delivery. Outreach activities dovetailed the Caravan and LARC Outreaches of the Marawi CHO where an additional five (5) SDPs with trained PSI providers participated. Service providers who already underwent supportive supervision and certified on PSI LARC have also been into PSI services provision at the Basilan General Hospital (BGH), in addition to PPIUD. At the Cotabato Regional Medical Center (CRMC), MLLA-BTL and PPIUD are offered 24/7.

7.7 Component Specialist Report & Updates for Q3PY6

Health Policy & Systems Development Report

Percent of LGUs conducting data quality checks (DQC)

Accomplishment Cumulative

Indicator Baseline For the Quarter Accomplishment to Date

Target Actual % Target Actual %

Percent of LGUs conducting data 73% 85% 85% quality checks (DQC)

Numerator 268 313 103 33% 313 273 87%

Denominator 368 368 368 368 368

Disaggregate by priority/CAA

Analysis of Accomplishment. Describe activities/factors that significantly contributed to the achievement/non-achievement of the target. Quantify results, where appropriate.

DQC has been institutionalized in 15 provinces through policy issuance (either through an Executive Order of the LCE or PHO memorandum), DQC team mobilization, and fund allocation for DQC related activities resulting to minimal funding support from the Project. For the reporting quarter, Zamboanga del Norte and Zamboanga City’s DQC policy are in the process of approval by the LCE. During the quarter covered, 103 LGUs conducted DQC activities from 174 in the previous quarter bringing a cumulative total of 273 LGUs or 87 percent of the 313 target LGUs for PY6. All LGUs in the provinces of Agusan del Sur, Zamboanga Sibugay, and Davao Occidental, 18 LGUs of Lanao del Norte, 7 LGUs of Davao Oriental, 10 LGUs of Tawi-Tawi, 12 LGUs of Basilan and Cagayan de Oro City conducted DQC in the reporting quarter. At the current rate of DQC activities, the project is still within its target to achieve the remaining 40 LGUs that are yet to conduct DQC in the next quarter.

The following factors significantly contributed to the achievement of DQC targets:

 DQC activities are conducted at the barangay/municipal level on a monthly basis and validated by PHNs prior to submission to PHO and DOHRO in the case of Agusan del Sur and Agusan del Norte  “Drop everything” policy during the scheduled DQC activity. Strong municipal/city and provincial DQC teams

 Conduct of quarterly DQC activity at the provincial level to validate DQC results from RHUs

Common findings in the recent DQC activities particularly in Zamboanga Sibugay revealed misunderstanding on the definition of new acceptors (NA) for FP and how to remove drop outs from the TCL being unfamiliar of the criteria that govern each FP method in terms of dropout. Further, DQC results indicates a difference between reported and updated data on FP, 4ANC, EB, SBA and FBD. Dates of prenatal visit reflected in the wrong trimester column and most common errors are that of reported number at M1 forms cannot be verified and reflected on the TCL including incomplete data and information reflected on the TCL forms.

Deviation Narrative. Highlight challenges and opportunities that resulted in under or over performance.

Generally, the project is within the target of achieving DQC objectives, however, there are areas where DQC remains a challenge such as in the case of Davao City where staff are not receptive to adapt the DQC processes.

Plan for the Next Quarter. Indicate key activities planned to be undertaken in the next quarter. Include catch-up activities planned, if targets are not being met, as well as planned adjustments in strategy/approaches, if any.

 Advocacy to LCEs and local health managers of the remaining four provinces (ZS, ZDN, DO, DDS) and cities of Zamboanga and Davao to institutionalize DQC by facilitating issuance of policy, creation of DQC teams, and budget allocation  Continue provide coaching/mentoring support to PHN/RHMs for LGUs not conducting DQC regularly (ZS, SDN, Sulu, DO)  Continue conduct random DQC activities for LGUs regularly doing DQC  Modify existing policy to cover all reporting units including hospitals, where necessary

Accomplishment for the Quarter Core Activity Status to Date (Q2PY6)

15 Provinces issued policy on DQC institutionalization; and 29 individual DQC LGUs in R12. The remaining 4 Institutionalization  Zamboanga City and ZDN DQC Provinces and 2 Cities without policy through policy policy is in the process of (Zamboanga del Norte, Zamboanga issuance, team approval by the LCE/PHO Sibugay, Davao Oriental, Davao del mobilization and Sur, Zamboanga City, and Davao fund allocation City)

 Zamboanga Peninsula: 16 LGUs  ZamboPen: 63 (89%) out of 71 of Zambo Sibugay, 19 Zambo LGUs conducted DQC (ZDS-27, Norte ZDN-19; Zs-16, Isabela City

 Northern Mindanao: 66 (93%) out of 71 LGUs (Bukidnon-22, CDO,  NorMin: CDO City (conducted per MisOr-25, LDN-18) district); 18 out of 23 LGUs of LDN  Davao Region: 28 (74%) out of 38  Davao Region: 7 LGUs of Davao LGUs; (ComVal-11, DavOr-11; Oriental; 1 LGU of Davao Occ, 5 DavOcc-6 LGUs DDS LGUs regularly  SOCCSKSARGEN: 11 (24%) out of conducting DQC  SOCCSKSARGEN: No Activity 46 LGUs NoCot-11) conducted

 Caraga: All 26 (100%) LGUs of the  Caraga: 14 LGUs of Agusan del 2 provinces Sur  ARMM: 78 (67%) out of 118 LGUs  ARMM: 10/11 LGUs of Tawi-Tawi, (Mag-17, Basilan-12, Tawi-Tawi- 12 LGUs of Basilan 10, LDS-39);

Summary: 103 LGUs conducted  Summary: 273 (87%) out of 313 DQC in the third quarter. target LGUs for PY6 conducted DQC activity for the last three quarters

FP3: Average stock out rate of contraceptive commodities at family planning SDPs

Accomplishment Cumulative Indicator Baseline For the Quarter Accomplishment to Date Target Actual % Target Actual % FP3: Average stock out rate of contraceptive commodities at family planning SDPs Pills 11 22 22 41 6% 41 6% (1.5%) (3%) (3%) DMPA 2 22 22 0 0% 0 0% (0.3%) (3%) (3%) IUD 7 22 22 0 0% 0 0% (1%) (3%) (3%) SDM Beads 88 22 22 93 13% 93 13% (12%) (3%) (3%) Condom 7 22 22 9 1% 9 1% (1%) (3%) (3%)

Analysis of Accomplishment. Describe activities/factors that significantly contributed to the achievement/non-achievement of the target. Quantify results, where appropriate.

MH support to 737 SDPs project-wide is to assist LGUs (local health managers, FP coordinators) maintain a stock-out rate of 3% for all five contraceptive commodities. In this reporting period, stock-out rate reached 4% from 2% in the previous quarter, higher than the set standard due to facility stock outs of SDM beads at 13%, Pills at 6%, and condom at 1%. Stock out of SDM beads was reported in 93 SDPs in Lanao del Sur (39 SDPs), Marawi City (1 SDP), Zamboanga del Sur (26 SDPs), Zamboanga del Norte (12 SDPs), and RHU Lupon in Davao Oriental while six SDPs in Davao Oriental reported stock out of Pills. Further, the three provinces of Zamboanga Peninsula also reported stock out of pills and condoms. Despite increase in stock out rate in this quarter, the mechanisms to avert facility stock outs are in place such as the following:

a) institutionalization of FP commodity recording and reporting system through the FP commodity tracking network (logistics hotline and social media) in 14 provinces and 4 cities in which nine are in priority LGUs, six in Marawi corridors and CAAs and three non-priority LGUs. b) effective coordination and reporting mechanisms at the local level for immediate reallocation and redistribution of commodities through inter-LGU and facility coordination in the event of over/under supply, near stock-out, and stock-out; include expiring supplies c) continuing delivery of commodities from DOH Central but currently in peril due to substantial budget cut enacted by Congress for 2019 procurement; d) availability of buffer stocks at the DOH regional offices; e) regular monitoring of DOH supervising pharmacist and support of FHAs at the municipal/city level; f) LGU procurement of commodities to augment DOH supply

Lanao del Sur and Marawi City SDPs experienced stock-out of SDM beads for the last two reporting quarters due to unavailability of supply in DOH-ARMM because the latter observed for the last three years that SDM beads are slow moving commodity generally in all SDPs in the region.

In Zamboanga Peninsula, the project in collaboration with PDOHO and PHO, redistributed eight boxes of POP from Margosatubig Regional Hospital and 5 boxes of condoms from RHU Ipil to RHUs with reported stock outs. As for the SDM beads, there are no reports of women wanting the method though it is still being included in all counselling / usapan sessions. DOH- RO IX is beefing up its buffer stock to proactively address impending shortage of supply.

In Davao Oriental, condom supplies expired in six SDPs thus the reported stock out. The project will discuss with IPHO and PDOHO to address issues on expiring commodities.

Deviation Narrative.

The stock out occurrence of SDM beads in 93 cited SDPs is due to almost zero demand for this commodity, thus replenishment of supply was not pursued by the concerned SDPs.

 Continue provide coaching support to remaining five provinces (SoCot, NoCot, DO, Sulu, Lanao del Sur) and two cities of Marawi and Cotabato to adapt the logistics management system and regularly submit consumption reports through DOH-RO, Popcom and FP logistics hotline  Further strengthen coordination and reporting mechanism down to the BHS level by encouraging PHNs to train RHMs on the use of FP commodity inventory tool  LGUAs in coordination with DOH supervising pharmacist and FHAs to continue regular conduct of stock monitoring in the RHUs and hospitals providing FP services  Conduct facility inventory of commodities in select SDPs to monitor near expiry commodities then redistribute to SDPs with high demand and near stock out inventory.  Advocate with LCEs and local health managers to revive the CSR policy to mitigate the impending shortage of commodities

MCP and GIDA Coverage PhilHealth PPFP Accredited Providers GIDA Coverage of PhilHealth Reimbursement LGUs MCP/NCP Accredited Facility PHIC Accredited Policy Provider Priority LGUs 6 GIDAs with PPIUD 25 out of 27 RHUs; 2 RHUs of certified providers but Sirawai and Baliguian not only 4 have PhilHealth Zamboanga del accredited 25 out of 27 LGUs with policy accreditation. These are: Norte Leon Postigo, Dapitan, EMR: 25 use iClinicSys Kalawit, Labason out of 12 GIDA municipalities All 27 RHUs accredited; Midsalip 9 out of 15 GIDA All 27 LGUs with policy, with the RHU achieved accreditation municipalities have PPFP Zamboanga del Sur addition of Guipos, Dinas, & EMR: All 27 RHUs use either accredited providers; 1 Josefina WAH or iClinicSys NSV provider 3 PPIUD HSPs assigned 5 out of 25 RHUs, substantial in GIDA underwent reduction from 14 facilities to 5 supportive supervision Misamis Oriental due to non-compliance to 14 out of 25 LGUs with policy at JR Borja Hospital and facility standard awaiting for DOH ROX EMR: 14 RHUs use iClinicSys Certification; 6 GIDA municipalities The 4 facilities (BPH Kibawe, BPH Manolo 21 out of 22 RHUs; only Fortich, BPH Manolo The 22 LGUs and 8 government Malaybalay CHO is not Fortich and BPMC) with hospitals have an existing PHIC accredited due to the presence accredited PHIC Bukidnon policy on reimbursement for all of BPMC nearby provider on PPFP/PPIUD reimbursible services on EMR: All 22 RHUs and 8 are covering 86% of the FP/MCH hospitals use iClinicSys total GID areas (17 municipalities and 2 cities) 10 out of 15 RHUs; RHU - Sta. Maria, RHU - Matanao and RHU - Hagonoy are still complying No PHIC PPFP/PPIUD with the documents for the LTO. accredited provider as Davao del Sur 10 out of 15 LGUs RHU - JAS and RHU-Sulop are of this reporting period still under construction in 8 GIDA municipalities

EMR: All 15 RHU-iClinicSys 2 PHIC accredited 10 out of 11 RHUs; RHUs Laak 11 out of 11 LGUs, however, provider assigned in Compostela Valley and Monkayo achieved Mawab LGU deferred the GIDA in 9 GIDA accreditation this quarter. On- reimbursement policy municipalities

GIDA Coverage of PhilHealth Reimbursement LGUs MCP/NCP Accredited Facility PHIC Accredited Policy Provider going accreditation for implementation due to some Maragusan political issues

EMR: iClinicSys for 11 RHUs 3 out of 17 health districts; only 3 are accredited out of 17: Policy is pending upon IRR No PHIC accredited (Tibungco, Toril, and Bunawan). Davao City formulation on MNCHN PPFP provider assigned Baguio and Agdao DHCs have ordinance in GIDA barangays ongoing application EMR: iClinicSys 9 out of 11 RHUs; 2 SDPs: Lake No PHIC accredited Sebu & Koronadal City CHO are PPFP provider assigned South Cotabato All 11 LGUs have policy not accredited in GIDA barangays in 5 EMR: 11 installed iClinicSys GIDA municipalities 12 out of 18; Kabacan and Midsayap newly accredited in 3 municipalities with the quarter. 5 non-accredited: GIDAs have a PhilHealth Alamada, Aleosan, Antipas, accredited PPIUD Cotabato Province Arakan, and Matalam; with 16 out of 18 LGUs have policy provider (Kidapawan ongoing application City, Midsayap, and Libungan) out of 17 EMR: iClinicSys installed in 18 municipalities RHUs/CHO 11 out of 12 RHUs; Palimbang RHU with MCP application and All 10 municipalities complying with infra with GIDA barangays Sultan Kudarat All 11 LGUs with policy requirements have PHIC accredited EMR: iClinicSys installed in 11 PPFP providers RHUs 3 municipalities with 27% of GIDAs have 12 out of 14 RHUs/CHO; Loreto PhilHealth accredited in the process of complying LTO 12 out of 14 with policy. LGUs PPFP/PPIUD provider. requirements while Bunawan without policy: Bunawan & (Trento, Talacogon and Agusan del Sur MHO needs BEmONC training Loreto. San Francisco approved Bayugan are Philheath being newly appointed its policy acrredited and the

services available at the EMR: 12/14 with iClinicSys BHS level). 7 GIDA municipalities 34 out of 36 RHUs; 2 RHUs R. South Upi municipality, Maguindanao Buayan & DBS with ongoing Region-wide policy a GIDA have a PHIC accreditation accredited on PPIUD

GIDA Coverage of PhilHealth Reimbursement LGUs MCP/NCP Accredited Facility PHIC Accredited Policy Provider provider in 26 GIDA EMR: 34 RHUs with iClinicSys municipalities 36 PHIC accredited 177 RHUs/CHOs out of 219 195 LGUs with PHIC PPFP/PPIUD providers Summary: Priority with MCP/NCP accreditation Reimbursement Policy in 129 GIDA municipalities Marawi &

Corridors & CAAs 4/6 GIDA Brgys are under Manicahan All 16 district health centers are District; 1 PPIUD Zamboanga City accredited With reimbursement policy certified provider in the EMR: iClinicSys district is Phil Health accredited as provider 1 out of 7 BHS accredited Cotabato City (Poblacion) With reimbursement policy No GIDA EMR: iClinicSys 6/9 or 67% DOH Certified Providers on PPIUD are Philhealth 9 out of 13 accredited Accredited ( Lamitan = Basilan/ Isabela EMR: 9 RHUs/CHO with Region-wide policy Limook BHS, Malinis iClinicSys BHS , CHO Birthing Facility and Sengal BHS , MalusoRHU, Tipo-Tipo ) Two GIDA assigned HSP All 11 RHUs accredited are not PHIC accredited, Tawi-Tawi Region-wide policy EMR: iClinicSys in 11 RHUs yet in 9 GIDA municipalities No GIDA assigned HSP 15 out of 19 accredited Sulu Region-wide policy is PHIC accredited in 17 EMR: iClinicSys GIDA municipalities 11 accredited HSPs cover GIDAs while HSPs of Tangcal, Sapad, and 12 out of 23 RHUs accredited Magsaysay application Lanao del Norte/ with EMR system; RHU Maigo 15 LGUs with reimbursement are for evaluation Iligan City achieved accreditation this policy In Iligan City, PHIC quarter accredited providers of Tipanoy and Tibanga

health centers and

GIDA Coverage of PhilHealth Reimbursement LGUs MCP/NCP Accredited Facility PHIC Accredited Policy Provider GTLMH cover GIDA barangays out of 14 GIDA municipalities 26 out of 40 municipalities are GIDA with 186 classified GIDA Lanao del Sur/ 35 out of 40 RHUs accredited barangays but only Region-wide policy Marawi City EMR: iClinicSys Marawi City with 6 GIDA barangays have PHIC accredited providers based at APMC 22 PHIC accredited 84 out of 1o8 RHUs/CHOs 100 LGUs with reimbursement PPFP/PPIUD providers Summary with EMR system policy in 81 GIDA municipalities Non-Priority One HSP trained on PPFP is assigned in a Cagayan de Oro 15/48 accredited out of 54 BHS With reimbursement policy GIDA Barangay City EMR: iClinicSys (Pagalungan, Cuachon Rene Von) Only 4/10 GIDA All 16 RHUs accredited Municipalities have Zamboanga EMR: 16 RHUs use iClinicSys or All 16 LGUs with policy Philhealth accredited Sibugay WAH provider on PPFP/PPIUD

2 certified PPIUD providers from Lupon 6 accredited out of 11 RHUs and Banaybanay are Davao Oriental EMR: 6 RHUs use iClinicSys or 9 out of 11 LGUs with policy also catering clients WAH from GIDA barangays; 11 GIDA municipalities

7 out of 12 BHS accredited With PHIC reimbursement General Santos City No GIDA EMR: iClinicSys policy 1 HSP accredited out of the 9 GIDA but are assigned only at the 10 out of 12 RHUs Agusan del Norte 11 LGUs with policy Poblacion Birthing EMR: 10 RHUs with iClinicSys facility. However, coverage of services

included clients from

GIDA Coverage of PhilHealth Reimbursement LGUs MCP/NCP Accredited Facility PHIC Accredited Policy Provider GIDA. Of the 55 PPIUD clients at the facility, (Kitcharao RHU) 10 clients or 18% came from GIDA. 8 PHIC accredited 34 out of 41 RHUs/CHOs with 38 LGUs with reimbursement PPFP/PPIUD providers Summary EMR system policy in 33 GIDA municipalities 66 PHIC accredited 295 MCP/NCP Accredited PPFP/PPIUD providers Total Facilities out of 368 333 LGUs in 243 GIDA RHUs/CHOs municipalities

Number of LGUs with MCP/NCP Accredited Facilities with Reimbursement Policy per PHIC Guidelines

Accomplishment Cumulative

Indicator Baseline For the Quarter Accomplishment to Date

Target Actual % Target Actual %

Number of LGUs with MCP/NCP Accredited Facilities 46% 75% 75% with Reimbursement Policy per PHIC Guidelines

Numerator 169 277 11 4% 277 295 106%

Denominator 368 368 368 368

Disaggregate by priority/CAA

Analysis of Accomplishment. Describe activities/factors that significantly contributed to the achievement/non-achievement of the target. Quantify results, where appropriate.

In the previous quarter, the cumulative number of facilities that achieved accreditation / re- accreditation for MCP/NCP was at 290 (79%) out of 368 end of project (EOP) target facilities. The mandatory submission of DOH License to Operate (LTO) beginning January 1, 2018 for all maternity care package providers / birthing homes applying for initial, continuous, and re- accreditation and the mandatory requirement of an electronic medical record (EMR) system for PCB providers per PhilHealth Advisory 2017-0070 impact on the capability of facilities to comply with accreditation requirements. In this reporting quarter, 11 additional facilities achieved MCP/NCP accreditation, however, substantial reduction in the MCP accredited facilities was reported in Misamis Oriental from 13 facilities down to 5 and in Cagayan de Oro City from 48 BHS to 15. The main reason for non-renewal of accreditation was failure to comply with DOH physical facility standards requiring facilities to provide adequate areas in order to safely, effectively, and efficiently provide health services to patients, among others. Currently, these facilities are undergoing renovation to comply with DOH LTO requirements. Despite DOH’s stiff requirement for LTO issuance, the cumulative number of MCP/NCP accredited facilities to date reached 295 or 106% based on the PY6 target of 75%, of which 177 (60%) facilities are in priority provinces, 84 (28%) in CAAs, and 34 (12%) in non-priority areas (see attached matrix). The current accreditation performance is at 80% of the EOP target. On LGUs utilizing PhilHealth reimbursements as per PHIC guidelines, four additional priority LGUs of Zamboanga del Sur (3) and Agusan del Sur (1) passed the PHIC reimbursement policy during the quarter bringing the cumulative number to 333 LGUs, of which 195 LGUs (59%) are in the priority areas, 100 LGUs (30%) in CAAs, and 38 LGUs (11%) in non-priority areas.

In terms of GIDA coverage of PHIC accredited provider for PPFP/PPIUD services, there are only 66 (27%) accredited providers out of the total 243 identified GIDA municipalities project-wide or a ratio of one PPFP/PPIUD accredited provider for every four GIDA municipalities. The GIDA coverage of PHIC accredited providers in the 12 priority provinces providing PPFP/PPIUD services is only 15% (36 HSPs), in which 4 provinces (MisOr, DDS, SoCot, and Maguindanao except South Upi RHU) and 1 city (Davao) do not have PHIC accredited PPFP provider while Sultan Kudarat in contrast have in all10 GIDA municipalities. In the conflict affected areas including Marawi City and its corridors, the PPFP Philhealth coverage is only 9% being currently served by 22 accredited providers in 81 GIDA municipalities. In Lanao del Sur province, in particular, out of 26 identified GIDAs only Amai Pakpak Medical Center in Marawi City have accredited PPFP providers. In non-priority areas, only 3% or eight PHIC accredited providers are providing PPFP services. This is understandably so because the focus of the project in capacity building support for PPFP/PPIUD is focused in hospitals and high volume MCP accredited facilities.

Deviation Narrative. Highlight challenges and opportunities that resulted in under or over performance.

While project performance is above the projected target of 85% of LGUs with MCP/NCP accreditation and reimbursement policy, there is a need to increase GIDA coverage of

PhilHealth accredited providers for PPFP/PPIUD services especially in MCP accredited facilities

located in GIDAs. The TA on Clinical Practice and Mentoring Sites (CPMS) was intended to address this issue which currently has 41 DOH certified CPMS sites.

 Fast track the formulation and approval of LGU reimbursement policy per PHIC guideline in seven LGUs of Palembang in Sultan Kudarat, Davao City, Maragusan in Compostela Valley, Sta. Maria and Sulop in Davao del Sur, and Jose Abad Santos in Davao Occidental  Review the accreditation documents and requirements of eight RHUs in Misamis Oriental and Maragusan RHU in Compostel Valley to facilitate MCP re-accreditation of facilities

Sustaining Support to Strengthen Service Delivery Network (SDN)

Accomplishment Cumulative

Indicator Baseline For the Quarter Accomplishment to Date

Target Actual % Target Actual %

Sustain support to 0 Strengthen SDN 14 10 71% 21 21 100% 2013

Disaggregate by priority/CAA

Analysis of Accomplishment. Describe activities/factors that significantly contributed to the achievement/non-achievement of the target. Quantify results, where appropriate.

The project sustained the provision of TA support to 12 targeted SDNs in priority LGUs and the other 9 SDNs in CAAs and non-priority areas through the DOH-ROs and PHOs. The project is also collaborating closely with ZFF-HLGP project to strengthen the leadership and governance mechanisms of the SDNs. Currently, resilience roadmap and its corresponding indicators are introduced in the SDN framework to enable SDNs to manage and respond quickly to natural and manmade disasters. In terms of SDN functionality in the 12 identified priority areas, 2 SDNs are classified as functional, 6 operational, and 4 organized, however, only 10 SDN sites were actively engaged in this quarter. SDN TA support did not move in ClaJaViTa, Davao City, CoMMMoNN, and Sanlakass.

In this reporting quarter, the following are the significant achievements based on key TA support of the project to SDNs:

1) Strengthening the SDN management structure and M&E system

Review of the SDN implementation plans and updating of SDN elements for the quarter by the SDN TWG members showed the following results:

a) Improvement in blood services availability and accessibility in five SDNs of ZDS (District 2), SK (BITES and province-wide), SoCot (province-wide, South Bukidnon and ZDN (Liloy SDN) by achieving the 1% population target for blood donors. Sultan Kudarat moved for the creation of the Provincial Blood Council; b) Zamboanga del Sur created and mobilized two FP Outreach Teams to serve the District 1 and District 2 SDNs of the province through a PDOHO Memorandum Order #15- 2018 in response to EO#12. Since its creation in February 2018, the teams were able to serve 1,153 clients for LARC-PSI, IUD, and BTL as of June 2018. The clients were from 13 GIDA municipalities; c) The Sangguniang Panlalawigan (SP) Chair Committee on Health of the six provinces moved to institutionalize SDN through the issuance of ordinance, provincial resolution adopting the SDN referral guidelines, and executive order creating the SDN technical management committee. The project in consultation with TWG members developed the SDN related policies; d) The two LGUs of Guipos and Dinas in Zamboanga del Sur approved its reimbursement policy per PHIC guideline and at the same time the 2 RHUs achieved MCP/NCP accreditation. e) DQC is regularly conducted in all 76 LGUs in 12 SDN priority sites. f) In terms of financing mechanism, pooling of funds are in place in BITES, Sultan Kudarat; CoMMMoNN SDN, ClaJaViTa SDN, South Bukidnon, Iranun SDN, DiMaBaMaS ILHZ, and Liloy SDN. SDN member pooling of funds is currently considered for establishment in BueNasCar SDN in Agusan del Norte and ZDS through SP Member Adlaon tabled the issue for discussion with the provincial health board.

2) Building and enhancing the Public and Private Partnership for FP/MNCHN/AY services a) Drafted and further enhanced the PPP agreements in ZDS District 1 and 2 SDNs with 5 private hospitals (PCMC, Aisah Medical, Cabahug Memorial Hospital, SVMC and Jamellarin), Iranun SDN, Liloy ILHZ, and South Bukidnon. b) SK BITES expanded its partnership with the private hospitals from 4 to 8 with the aim to increase access and availability of health services, tap private sector resources (expertise, equipment, corporate social responsibility, etc.), harmonize governance and integrate local health system, among others. c) DOP SDN of Agusan del Sur forged an agreement with women’s group and ADDSECCCO, a registered cooperative, to provide monetary support to indigent pregnant mothers during delivery and gasoline allowance to partner community-based

transport group to transport pregnant mothers to the nearest SDN birthing facility. d) To date, there are 9 PPPs in the SDNs supported by the project

3) Enhancing and documenting the SDN Referral System a) ZDSMC and Margosatubig Regional hospitals formalized the cross-border referral arrangements with Zamboanga Sibugay by incorporating their referral protocols in the existing referral mechanisms and guideline of Zamboanga Sibugay ILHZ/SDNs; b) ZDS through the PHO and PDOHO formalized the cross-border referral arrangements with MHARS General Hospital in Ozamiz City and Kapatagan Provincial Hospital in Lanao del Sur as core referral facilities for LAPM and MNCHN services; c) Further enhanced through public and private sector consultations the referral guidelines of Iranun SDN, District 1 and District 2 SDNs of ZDS, Liloy SDN of ZDN, Bayugan SDN of Agusan Norte, South Bukidnon SDN, and Zamboanga Sibugay (3 ILHZs). To date, four SDNs (DOP SDN, BueNasCar, SK, and SoCot) have approved referral guidelines out of 10 targeted SDNs for PY6. In BITES SDN, the monitoring of referral services is tracked through the billing reports apart from the referral registry. d) Evaluated and further enhanced the SDN referral forms and registry logbooks after a three-month field test in Zamboanga del Sur. It was observed that RHMs did not fill out the referral forms properly, thus an orientation was conducted.

During the reporting quarter, the project analyzed the contribution of 10 SDNs to CYP vis-a- viz provincial CYP performance. Of the 10 SDNs, four SDNs (BITES in Sultan Kudarat, DiMaBaMaS in Davao del Sur, CoMMMoNN in Compostela Valley, Sanlakass in Lanao del Norte, and District 2 in Zamboanga del Sur) yielded more than 50% of the total provincial CYP (refer to attached matrix). DOP SDN performance of 29% CYP contribution is relatively high given that it is only comprised of three municipalities where Prosperidad LGU alone is generating 56% of new and other acceptors for LAPM/LARC methods in Agusan del Sur province.

The high performance of these SDNs is attributable, but not limited, to the following sustaining factors: a) Leadership of PHO in providing management and technical support and PDOHO’s technical guidance and oversight; b) SDN Champions in the legislative and executive branches to pass and execute SDN related policies and plans; c) Active engagement of private hospitals and non-health sector (community-based organizations, transport and communication groups, cooperative) through PPP modality; d) Sustained PHIC accreditation and PHIC reimbursements are plowed back to health services; e) Full implementation of the No Balance Billing policy in all SDN facilities including private hospitals. NBB is a potent demand generation strategy; f) Revival of LGU’s CSR strategy to mitigate the impending shortage of commodities;

g) Pooling of funds to provide for transportation cost, medicines, supplies and to cover hospital cost in the event of excess billing; h) In place M&E system to track SDN contribution to health outcomes, service coverage, and referral services

Lessons Learned: a) PHO plays a critical role in all phases of SDN establishment to provide management and technical support while PDOHO/DOH-ROs leadership to delivery technical oversight and policy direction is imperative; b) Putting SDN in the regular agenda of LHB, RICT, RIT, and other coordinating mechanism generate collective support for and sustain the SDN initiatives at all levels; c) Given the absence of operational guide from DOH central, direct engagement with DOH- RO/ PDOHO and PHO is the way forward; d) Successful PPP embodies the strength of cooperation and the principle of shared governance and recognizes that governments and private entities each have certain advantages relative to one another in performing specific tasks; e) Engagement of barangay leadership to mobilize community-based organizations (communication and transportation services), facilitate issuance of documents for PHIC and other medical programs, blood letting services, etc.

SDN Challenges a) Absence of clear technical guidance from DOH central resulting to intermittent and ambivalent DOH-RO technical support b) SDN technical management committee entails high level technical expertise c) LGUs inability to respond quickly to DOH LTO stiff requirements d) Public hospitals operate as an autonomous entity detached from SDN’s VMG e) Delay in the release of PhilHealth reimbursements caused interruption in the provision of LAPM services in hospitals f) Underserved Areas: PHIC coverage for PPFP is only 15% in GIDAs and only 9% in CAAs including Marawi City and its corridors g) Absence of CEmONC and apex hospital in some areas as end referral facility h) Weak enforcement of health related policies (e.g. FBD, NBB policy)

Deviation Narrative. Highlight challenges and opportunities that resulted in under or over performance.

The TA support to three priority SDNs in Davao region involving the sites of District 3, Davao City; DiMaBaMaS, Davao del Sur, and CoMMMoNN, Compostela Valley stalled primarily because the SDN Team of DOH-RO XI waited for DOH Central to issue an operational guideline based on the redefined SDN framework. The guideline, however, did not materialize due to staff reshuffling at the central office, thus the latest RTD on SDN put to task the office of Asec Dumama to mobilize the SDN team of the DOH regional offices to spearhead the rollout of SDN establishment in Mindanao and use/enhance existing guidelines in

collaboration with development partners. Given the remaining timeframe, MH and the OIC Regional Director of DOH-XI agreed to assist DiMaBaMaS ILHZ transition to SDN in three areas: (1) formulation of the required SDN policies, (2) analysis of the results of facility and hospital assessment, and (3) strengthening of the SDN management structure at the provincial level.

Support to ClaJaViTa SDN was delayed mainly due to the following reasons: (a) The SDN TWG Chair resigned from her post and no one took over for quite some time, (b) DOH-RO IX SDN pointperson kept on postponing the agreed activities due to other competing schedules, and (c) MH LGUA assigned in MisOr resigned due to health reason until the post was filled in the second quarter.

 Coach SDN TWGs in communicating and disseminating the referral guidelines, protocols, tools and registry down to the barangay level including non-health sectors involved in the referral mechanism;  Completion and approval of referral guidelines in Iranun SDN, District 1 and District 2 SDNs of ZDS, Liloy SDN of ZDN, Bayugan SDN of Agusan Norte, and South Bukidnon SDN;  Completion and approval of PPPs in ZDS District 2 SDN, Iranun SDN, Liloy ILHZ, and South Bukidnon;  Follow through and provide coaching support to the four facilities of Antipas, NoCot; Lake Sebu and Koronadal City in South Cotabato; Jasaan, MisOr for MCP re- accreditation and formulation of reimbursement policy including Davao City. Out of 76 LGUs in the 12 priority SDNs, 72 (95%) RHUs/CHOs are accredited and with reimbursement policy;  Institutionalize DQC in Zamboanga del Norte, Davao del Sur, and Davao City

SDN Contribution to CYP Province-wide CYP SDN CYP % Contribution Total Total SDN Sites of SDN to Q1 Q2 Province Q1 Q2 SDN Province- CYP CYP wide CYP

South Bukidnon 5,126 4,874 4,661 9,535 38% 9,986 25,112 BITES, Sultan 4,886 2,821 4,286 7,107 58% Kudarat 7,358 12,244

Province-wide CYP SDN CYP % Contribution Total Total SDN Sites of SDN to Q1 Q2 Province Q1 Q2 SDN Province- CYP CYP wide CYP

Liloy SDN, ZDN 4,659 1,074 1,746 2,820 26% 6,154 10,813

District 2, ZDS 8,010 3,930 3,999 7,929 52% 7,183 15,193

DOP SDN, ADS 7,319 1,621 2,832 4,453 29% 8,249 15,568 BueNasCar, 9,467 616 867 1,483 8% Agusan Norte 9,920 19,387 DiMaBaMaS, 4,769 2,307 5,204 7,511 59% DDS 7,970 12,739 Iranun SDN, 1,770 771 753 1,524 29% Maguindanao 3,525 5,295 SANLAKASS, 4,548 2,636 1,307 3,943 56% LDN 2,541 7,089 CoMMMoNN, 3,605 2,136 3,116 5,252 57% ComVal 5,623 9,228

In South Bukidnon SDN, the LARC/PM services is more than 50% of province-wide reach largely contributed by BPH Maramag, BPH Kibawe, RHU Kitaotao, RHU Maramag, RHU Kalilangan, and RHU Pangantucan which accommodate clients coming from Wao and Bumbaran, Lanao del Sur; Marilog District in Davao City; and Arakan Valley (Carmen & Pres. Roxas) in North Cotabato. The SDN caters to 38.55% of the total population of Bukidnon with 134,258 population living in GIDAs. The CPR performance of the SDN is increasing from 61% to 71% in 2017, higher than the province’s 68% and national target of 65%.

Liloy SDN in Zamboanga del Norte is composed of 7 LGUs whose core referral hospitals are Zamboanga Sibugay Provincial Hospital, Zamboanga del Sur Medical Center and Margosatubig Regional Hospital. The CYP contribution of Liloy is 26% of the province-wide reach, while its CPR performance is at 71% and 81% compared to non-SDN’s CPR of 65% and 71% for the year 2016 and 2017, respectively. In terms of FP service availability, LARC/PM services are available in all RHUs and none for AY counselling. The combined LARC/PM clients served in the quarter within the SDN is 319, of which 44% are PPIUD clients. The PHIC accredited PPFP/PPIUD providers are in Liloy, Kalawit and Labason while LARC-PSI accredited providers are in Liloy, Tampilisan, and Gutalac RHUs who are now receiving reimbursements from PHIC.

District 2 SDN in Zamboanga del Sur is comprised of 15 municipalities largely belonging to 4th and 5th class municipalities. Around 41% of the total population of Zamboanga del Sur is being served by District 2 SDN. There are 103 GIDA barangays with a population of 95,507 or 27% of the total District 2 SDN population. In terms of FP performance in the last two quarters, the CYP contribution of District 2 SDN is 52% of the province -wide reach with large contribution from the facilities of Margosatubig where MRH is located, Dinas, Dumalinao, Bayog, Kumalarang, and

Lapuyan. On CPR performance, District 2 SDN registered a 61% CPR in 2017, which is higher compared to province-wide and non-SDN CPRs at 59% and 53%, respectively. The CPR performance of the three comparative areas, however, is still below the 65% national target. In terms of FP service availability, all facilities in 15 municipalities are providing PPFP/IUD (except San Miguel RHU), LARC/PSI, FP and AY counseling services including usapan sessions. All facilities are MCP/NCP accredited and the LGUs implement the PHIC reimbursement policy.

In Sultan Kudarat, the BITES ILHZ is composed of four municipalities and one city and caters around 45% of the province’s total population of 868,777. The CYP contribution of BITES is at 58% (7,107) out of the total province-wide CYP of 12,244 in the last two reporting quarters where Tacurong City (35%) and Isulan (24%) made the biggest contribution largely BTL for the former and PPIUD for the latter. BITES is also consistent in its CPR performance registering substantial increase for the last two years from 56% to 80% in 2017, higher than the province performance of 77%. Both BITES and the province CPRs are above the national standard of 65%. On FP service availability, all RHUs are providing PPFP/PPIUD, LARC/PSI, and FP counseling services with combined 40 PPFP/PPIUD accredited providers, 3 BTL accredited providers, and 6 LARC-PSI accredited providers. Only SKPH is providing AY counseling services and usapan session and bench conference are conducted regularly in all facilities. LARC/PM clients served during the quarter reached 233, where 61% are PSI clients followed by BTL/MLLA (19%) and PPIUD (18%). All facilities are MCP/NCP accredited with LGU PhilHealth reimbursement policy.

DOP SDN is comprised of three municipalities of San Francisco, Rosario and Prosperidad in Agusan del Sur. It has a combined population of 228,087 equivalents to 32% of the province population. The CYP contribution of DOP SDN is 29% out of the total 15,568 CYP generated by the province in the last two quarters, of which 56% came from Prosperidad municipality where the DOP Provincial Hospital and private hospitals are located. Its CPR dipped by 4% from 80% in 2016 to 76% in 2017, but still higher than the national standard. All facilities of DOP SDN are MCP/NCP accredited with reimbursement policy, 8 BTL providers, 2 NSV, 8 PPIUD certified providers, and 6 PSI certified providers. These providers were able to provide LARC/PM services to 949 clients or 48% of the total (1,987) clients served by the province as of the quarter who are mostly PSI and BTL/MLLA.

The DiMaBaMaS ILHZ caters to around 68% of the total population of Davao del Sur with an estimated WRA of 30,701 and estimated FP unmet need of 63,832. In terms of FP performance, the CYP contribution of DiMaBaMaS is almost 60% of the total CYP generated by the province for the last two quarters of which RHUs Bansalan and Magsaysay contributed the most at 38% and 26%, respectively. Digos City CYP contribution is at 19% only because the DDSPH discontinued the provision of mFP services due to delayed PhilHealth reimbursement. The CPR performance of DiMaBaMaS is almost equal to the CPR performance of the province at 66% and 73% from 2016 to 2017, respectively. Of the five LGUs, Digos, Bansalan and Sta Cruz have certified PPFP/PPIUD and LARC PSI providers in which 6,572 and 698 PPFP and LARC-PSI clients were served in 2017 while 538 LARC/PM clients served in the last two quarters of 2018. All SDN facilities are MCP/NCP accredited except RHU Matanao which is still complying with DOH LTO requirement.

Adolecent-Youth Reproductive Health Component Report

EXPANDING AYRH SERVICES

In its extension year, MindanaoHealth continued its multi-sector approach to contribute in achieving the following Extension Project Objectives: Reduction in teenage pregnancies by scaling-up evidence-based best practices and promising high impact interventions on adolescent reproductive health; and develop and study/investigate innovative approaches in the provision of quality adolescent reproductive health and gender-friendly health services. Teenage pregnancy in Mindanao is one among highest in the country particularly in regions CARAGA (17.3%), Davao Region (16.7%), and ZamboangaPeninsula (16.3%) compared to 13.6% national figure according to 2013YAFS4 survey; and it is estimated that there are 135,048 teenage pregnancies in 26 project assisted LGUs targeted in PY6. Likewise, AYRH is also seeks to achieve project level indicators: N4. Number of USG-assisted SDPs providing FP/RH services for adolescents and Youth; CAA3: number of youths trained as peer educators.

BASELINE Target ACCOMPLISHMENT FOR THE CUMULATIVE INDICATOR PY5 PY6 QUARTER ACCOMPLISHMENT TARGET ACCOMP % TARGET ACCOM % P N4. Number of USG-  8 hospitals 10 hosp. 8 hospitals 8 100 % 18 16 88 % assisted SDPs providing FP/RH services for  35 RHU 30 RHUs 22 RHUs 21 95% 65 56 86% adolescents and Youth  13 Schools 6 Schools 6NHS&college 6 100 % 19 19 100% s  0SoMe4AYR 6 SRH FB 6 SRH FB 4 67% 6 4 67% H pages pages

Analysis of Accomplishment. e.1 FP-AY Integration in Hospitals In PY6, the Project expanded its work with hospitals, targeting 10 for FP-AY integration in addition to 8 hospital assisted in PY4-PY5 with established hospital-based Centers for Teens. Parallel with project’s continuing assistance to the total 18 hospitals, significant progress was noted in terms of AY access to FP-RH services. As of end of Q3PY6, partial data from 14 of 18 total hospitals targeted by the project (see Table 8) showed that the number of FP-MCH/RH services accessed by AYs has dramatically increased from 7,965 provided in Q2PY6 compared to 16, 466 FP-RH provided during the quarter, posting an increment of fifty-one percent (51%). Notably, access to perinatal care (ANC, delivery, PNC) comprised the most availed services at 38.3% (6,310), while access to different FP methods made a cut at 14% (2,338). Significant number of STI (225 at 1%) and VAWC (68 at 0.5%) cases were received during the quarter. It can also be noted that conduct of counseling using HEEADSS as a tool to identifying AYs with psychosocial risks including FP-RH needs gained steady response from the hospitals with a total of 5,771 provided, -comprising 35% of services. Among FP services, PPIUD (679 at 29%), Pills (665 at at 28%) and subdermal implant (414 at 18%) were notably the preferred choices among young clients, followed by DMPA at 11% (267); condom, NFP, and BTL made up a collective small percent (13%). Project’s assistance to eight hospitals targeted for the quarter on internal guidelines development with job aids and orientation-training on risks assessment and reporting-recording resulted in different levels of development in assisted hospitals:  all 8 hospitals, including i) Margosatubig Regional Hospital; ii) J.R. Borja Hospital; iii) BukidnonPH-Maramag; iv) Grgorio TLlutch Hospital; v) Davao Oriental Medical Center-Mati; vi) ZamboSibugaybPH; vii) Compostela Valley PH-Montevista; and viii) SanPedroHospital, were trained on use HEEADSS risks assessment with job aids;  Margosatubig Regional Hospital, which is the core referral of the District 2 SDN (Lapuyan, V. Sagun, Margosatubig) has made its Center for Teens operational supervised and coordinated by a designated nurse and began its active provision of FP/RH services to AYs;  J.R Borja Hospital had initiated its internal work, headed by department chiefs of OB-Gyne and Pediatrics, on operationalization of the approved hospital order with designated nurse, in the establishment of teen center in the hospital called “AYUDA” (which means help but also an acronym) to further boost its services for AYs.  SanPedro Hospital, a private hospital in Davao City, has already established its TeenHub with dedicated Pediatric Consultant and nurses and support systems for operations, coordination and referral among clinical departments, and is set to be formally launched next quarter.  Similar assistance extended to Dr. Jose Rizal Memorial Hospital in Zamboanga del Norte which resulted in development of draft FP- AY integration operational procedures.  Sultan Kudarat Provincial Hospital initiated firming-up its AY policy to be integrated with its policy of FP service delivery.

 Hospitals including Bunawan District Hospital, D.O.Plaza Memorial Hospital, Agusan del Norte Provincial Hospital, Butuan Medical Center and Davao Regional Hospital are already DOH certified as youth-friendly facilities.  CVPH Montevista gradually started to operationalize their RH and Teen Center with risks assessment in OPD and admitted clients. Draft program protocol is still for finalization  FP coordinators and IT personnel of 17 (of eighteen) hospitals were jointly trained on FP recording and reporting for hospitals using DOH standard recording-reporting tool. This TA was initiated after baseline assessment showed that, although 16 hospitals (except for BrokenshireHosp and ComValPH-Montevista) already use the DOH FP form1 in FP recording, the disaggregation of FP-RH data and consolidation remained as challenge, resulting in difficulty in analysis and use of data. In Davao City, weak data consolidation and reporting encountered at Brokenshire

Meanwhile, based on joint field reports, much work remains to be done in terms of generating demand. It can be noted that across hospitals, there is a need to close the big gap between the numbers of AYs provided with FP services at 14% compared with the number of AYs seeking perinatal care in hospitals comprising 38% of total FP-RH services availed. Implementers must take this as a glaring window to address missed opportunities and promote delaying repeat pregnancies among young parents. HEEADDS risks assessment should also be taken as active tool to identifying AYs at risk of STI and getting pregnant. Table 1: Status of FP-RH Services Accessed by AYs in Target Hospitals for FP/AY Program Implementation FP/ RH Care ( Apr-Jun) FP Methods (14%) 2017 2018 FP/RH PILLS DMP LARC OTHE to AYs Jan- Apr- PPI RS HEE ANC Deliver PN S VA 1.HOSPITAL ZDS- 622FP 641 725 99 13 A7 -46PSI 0 55 65 213 21 7 7 Marc Jun ADS C T WC 2. MargoRJRBorjaS 1058 1761 2109 294UD 0 1 1 (Spec0 1027 /448786 3 Base- h S I 3. HHosptalAgusan 217 360 1000 7 14 2 44 1 ify) 306 184 113/75 11 6 32 DN PH line (BTL); 8 3 8

4. SPMC 302 411 826 25 21 1 61 430 359 71 28 8

5. Maguin 195 141 281 10 8 3 33 (LAM1(NF 0 12 107 100 0 0 6. dPHBPH- 30 727 1642 6 0 6 0 3(BTLP 42 381 592/243/10 597 1 19 7. MaramaDOPMC 38 563 722 2 0 0 20 73 3 ) 0 298 37296/73 272 0 0 8. g-GTLlutchMati 173 32 tbd cndm(BTL) 6 9. Brokens 106 10. hireDRMC Not 310 11. DJPRoye update102 471 1112 0 82 18 37 3con 515 425 3 12. caHSCotPH 1363d 1124 2016 107 286 100 53 1BTL;dm 732 200 268 26 25 3cnd 3 m;3s

13. SultanK 4498 2077 2065 86 206 89 79 98NF 436 302 375 30 1 2 udPH P; 14. CRMC Not 2350 23 34 28 4 1175 298 374 361 59 15. DOPMH updted306 266 227 20 1 2 13 273cn 156 13 2 21 16. Butuan 1020 0 0 10 23 cond5cond;1BT 907 45 13 17. SPedroH MC omdomL 0 18. Bunawa 7 97 61 61 nDisHTOTAL 4542 7965 1646 679 665 267 414 313 5771 1869 2183 22 22 68

6 58 5

Deviation Narrative. The increasing trends in the number of FP-RH services accessed by AYs in hospitals provides some level of indication that young people are opening up to seek varied FP-RH services in youth-friendly tertiary facility setting. This provides the opportunity for hospitals to further intensify internal and external demand generation mechanisms to close the gap between the numbers of AYs provided with FP services (14% in Q3PY6) compared with the number of AYs seeking perinatal care in hospitals, which comprised 38% of total FP-RH availed services. HEEADSS risks assessment needs to be maximized as a tool to identifying AYs at risk of getting pregnancy and STIs, leading to counseling.

In CARAGA, full integration of AY risks assessment and counselling to different departments of 4 assisted hospitals, including ButuanMC, BunawanDisH, DOPMC, ADNPH still wanting. Internal coordination and referral for FP-RH between OPD FP-AYRH with hospital wards remain wanting, which contribute in the big gap between provided with FP and number who gave birth. Coordinated and proper recording and reporting with data disaggregation still a challenge across hospitals. Multi sectoral referral mechanism that include schools and other sectors, as members of the network not yet fully in place that still needs to be strengthened, especially in BueNasCar SDN. Plan for the Next Quarter.  Intensify follow-through mentoring and coaching on active use of profiling / risks assessment to identifying potential FP clients among AY; follow-through mentoring on FP education and counseling among young mothers who deliver in hospitals to close the gap between the number of AYs provided with FP and number of AY clients delivered in hospitals across all hospitals.

 Continue support initiated in Q3 to following: – Assist Margosatubig Regional Hospital; J.R. Borja Hospital; Davao Oriental Medical Center-Mati; Compostela Valley PH- Montevista; SanPedroHospital, Dr. Jose Rizal Memorial Hospital, Sultan Kudarat Provincial Hospital in finalizing FP-AY service

guides. – Follow-through mentoring of trained IT and FP personnel across hospitals on FP-RH recording and reporting with data disaggregation for timely analysis and utilization of information, with special attention to BrokenshireHosp and ComValPH- Montevista who have adopted a systematic FP recording and reporting.

BASELINE Target ACCOMPLISHMENT FOR THE CUMULATIVE INDICATOR PY5 PY6 QUARTER ACCOMPLISHMENT TARGET ACCOMP % TARGET ACCOM % P N4. Number of USG-  8 hospitals 10 hosp. 8 hospitals 8 100 % 18 16 88 % assisted SDPs providing FP/RH services for  35 RHU 30 RHUs 22 RHUs 21 95% 65 56 86% adolescents and Youth  13 Schools 6 Schools 6NHS&college 6 100 % 19 19 100% s  0 6 SRH FB 6 SRH FB 4 67% 6 4 67% SoMe4AYRH pages pages

Analysis of Accomplishment. e.2 AY-Friendly Ready RHUs In its extension year, the project focused its technical assistance to 30 RHUs1 towards meeting minimum criteria of having AJA-trained HSPs, use of risks assessment, designated room for privacy-confidentiality. Twenty-six of 30 targeted RHUs were carried over to PY6 for TA

1 PY6 Target RHUs for AY-friendly facilities Priority Areas: 1. Zamboanga del Sur: ZDS-ClusterDistrict2 SDN (Lapuyan, V. Sagun, Margosatubig,) Conflict Affected Areas: 2. Zamboanga City ((Ayala Health Center and lying, Labuan, Calarian, Baliwasan, Dona Isabel C. Climaco, Canelar, Tetuan, Sta. Catalina, Talon-Talon, Tumaga, Mercedes, Manicahan, Sangali Main Health Center, Curuan, Vitali Health Center and Lying in, Guiwan, Rotary Lying in Clinic); 3. Lanao del Sur (Bubong); 4. Tawi-Tawi (Bongao); 5. Sulu (Patikul, Luuk, Pangutaran, Talipao, Parang, Indanan, Panamao, Jolo); 6. Basilan (Maluso, Lamitan)

65 completion, while 4 new RHUs were added, i.e., 3 Zamboanga del Sur (Lapuyan, V. Sagun, Margosatubig under ZDS-ClusterDistrict2 SDN), and Buenavista in Agusan del Norte being part of Buenascar SDN. As of culmination of Q3PY6, the number of FP-RH services accessed by AYs in 50 of 68 assisted-RHUs with report posted an estimated increment of 33% (6,854) compared to the data on FP-RH services (4,526) availed in previous quarter (see Table 9). Based on joint field partial reports, 21.5% (1473) of services availed were on various FP methods, while access to other RH services covering ANC, delivery, STI and VAWC comprised 20.2% (1389) of total posted availed services. Notably, the number of counseling using HEEADSS is increasingly being utilized at 58.2% (3992) of total provided. The project’s continuing technical assistance to the 68 RHUs, which began in PY4-PY5, and carried over to PY6 focused on 33 RHUs towards youth-friendly facilities meeting minimum requirements, including: HSPs trained on AJA- risks assessment, use of HEEADSS, designated room with privacy, and guidelines.

During the quarter, project’s varied TA, ranging from development of local policy, training, and internal guidelines with job aids to 22 targeted RHUs for the quarter, merited DOH certification of 21 RHUs as Level 1 Youth-friendly Facilities, which include: 16 RHUs of Zamboanga City; NewBataan RHU in Compotela Valley, and 2 RHUs in Agusan del Sur-namely: San Francisco RHU, and Rosario RHU; RHU President Roxas in NorthCotabato. In Basilan, Lamitan City Health Office worked, with project’s TA, on development of executive order with guidelines on youth-friendly services in CHO-RHUs for entry in Galing Pook award. The New Bataan RHU in COMVAL is actively functioning being as AY Friendly facility. For the present quarter, they have provided services to 259 AY clients, of which 68 were provided with FP services and 4 were referred having other serious health-related problems. They are currently processing for Level 3 DOH certification since they have in placed policies and protocols supported by the project. Positive developments also occurred in non-target LGUs for PY6: Zamboanga Del Norte, with assistance from MH, the PHO had endorsed and awaiting DOH-RO9 assessment of 7/27 RHUs as AY friendly facilities, including: Salug RHU, Katipunan RHU, Dapitan CHO, Dipolog CHO, Labason RHU, Godod RHU and Manukan RHU. Table 9: Status of FP-RH Services Accessed by AYs in Target RHUs’ for AY-Friendly Facilities as of Q3PY6. 2018 2017 FP/RH to AYs FP/ RH Care ( Apr-Jun) Region/ Name of FP Jan-Mar Apr-Jun FP HEEADSS Other Provinces RHUs Base Counsel RH

Non‐priority areas Agusan del Norte : BueNasCar SDN (Buenavista RHU)

RMM

1) Upi 17 42 18 24

Mguindan 2) Buluan 57 44 0 0 44 ao 3) DatuPiang tbd 63 23 27 13

Lanao del 4) Bubong tbd tbd Sur

Tawi-Tawi 5) Bongao 208 54 40 14

Sulu 6) Patikul 21 15 12 3

7) Luuk Tbd 73 54 19

8) Pangutaran Tbd 88 13 75

9) Talipao 37 47 47 0

10) Parang 517 525 9 516

11) Indanan 586 572 17 555

12) Panamao 139 43 0 43

13) Jolo Tbd 927 80 802 45

Basilan 14) Maluso tbd Tbd

15) Lamitan 27 134 13 80 41 (E/W)

TOTAL 1609 2627 326 2134 167

Zamboanga Peninsula (R9)

16) Ayala 266 HC&Lyg-in

17) Labuan 55

18) Calarian 115

19) Baliwasan 216 659 (april) 91 55 513 20) Canelar 108

21) Tetuan 46

22) Sta. Catalina 49

23) Talon-Talon 245

24) Tumaga 234

25) Mercedes 129

26) Manicahan 59

27) Sangali 283 MnHC

28) Curuan 207

29) Vitali 149 HC&Ly-in

30) Guiwan 104

31) StaMaria 136 MnHC

Zamboan 32) Lapuyan 8 330 148 182 ga del Sur 33) V. Sagun 12

34) Margosatubi 4 g

35) Olutanga tbd tbd

36) Talusan tbd tbd

37) Mabuhay tbd tbd

Zambo 38) Ipil tbd tbd

Sibugay 39) Buug tbd 151 39 91 21

TOTAL 2425 1140 278 328 534

Northern Mondanao (R10)

Lanao del 40) Kolambugan 14 29 10 19 Norte 41) Baroy 24 79 38 41

42) kapatagan 282 99 40 59

Mis.Orient 43) Tagoloan al

44) Jasaan 155 235 39 136 60 TeenCntr

Bukidnon 45) Pangantuka 10 20 10 10 n

46) Maramag 81 110 55 55

47) San 66 172 62 110 Fernando

TOTAL 632 744 254 430 60

DAVAO REGION (R11)

Davao 48) District 23 C 371 524 97 99 328 City

49) Sasa 435 42 3 39

50) Toril 221 155 66

51) Tomas 90 116 95 21 Claudio

52) District D 38 59 21 19 19 (Jacinto)

53) TalomoCent tbd tbd ral

54) Buhangin tbd tbd

55) Calinan tbd tbd

56) Barangay tbd tbd 21-C

Davao del 57) Bansalan tbd 5 1 4 Sur 58) Sta Cruz tbd 157 17 140

Comp.Vall 59) New Bataan tbd 327 68 259 ey

TOTAL 934 1451 457 647 347

SOCCSKSARGEN (R12)

South 60) Polomolok tbd tbd

Cotabato 61) Surallah tbd tbd

62) Tboli 68 70 23 47

63) Tupi tbd tbd

GenSan 64) Bula tbd tbd City (64- 66) 65) Calumpang tbd tbd 66) Fatima tbd tbd

CotCity 67) Calumpang tbd tbd (67-70 68) Fatima tbd tbd

69) Rosary tbd tbd Hights

70) Poblacion tbd tbd Mother

71) Tamontaka tbd tbd

72) Bagua tbd tbd

TOTAL 68 70 23 47

CARAGA (R13)

AgusanNo 73) Buenavista 286 15 173 98 rte

Agusan 74) Rosario 267 73 121 73 del Sur 75) San 269 47 112 110 Francisco

TOTAL 822 135 406 281

GRAND TOTAL 4526 6854 1473 3992 1389 (20.2%) (21.5%) (58.2%)

Deviation Narrative. Meantime, a number of assisted LGUs encountered some challenges that affected youth-friendly implementation. In Davao City, weak data consolidation and reporting encountered in assisted District Health Offices -Dist A Jacinto and Buhangin, needing follow through mentoring on FP recording and reporting. In South Cotabato, previously –assisted RHUs, including - Tupi, Tboli, and Polomolok are not operational due to on-going renovations. Surallah RHU is likewise not functional due to absence of an AY focal person.

It was observed in Davao del Sur RHUs Bansalan, and Sta. Cruz, few AY clients go to the center in-spite of presence of Teen Centers with trained providers. As explained, there is a need to market the presence of the center to the communities. Follow though mentoring with AJA-trained health providers in RHUs of Margosatubig, Lapuyan, and V. Sagun under the Cluster District2 SDN, and RHUs under the OLTAMA SDN which include RHUs of Olutanga, Talusan, and Mabuhay in Zamboanga del Sur; and RHUs of Ipil and Buug in Zamboanga

Sibugay including the enhancement of AY service cascade flow to bolster FP-RH provision.

Plan for the Next Quarter. o Monitor, mentor and coach with DOH-ROs 11, and ARMM, AY friendly health RHUs, particularly DHOs- Dist A Jacinto and Buhangin in DavaoCity, and in DatuPiang in Maguindanao, Bubong, in LanaoSur, Bongao in Tawi-Tawi, Maluso and Lamitan in Basilan, Margosatubig, Lapuyan, and V. Sagun in ZamboSur on proper use of AY Reporting and Recording form and use the DOH prescribed quarterly reporting form FP-AY recording and reporting o Assist Davao del Sur RHUs Bansalan and Sta. Cruz especially in forging partnerships with CSOs, industries, schools, baranggays to promote and maximize utilization of services in RHU Teen Center o In Margosatubig, Lapuyan, and V. Sagun under the Cluster District2 SDN, and RHUs under the OLTAMA SDN which include RHUs of Olutanga, Talusan, and Mabuhay in Zamboanga del Sur, strengthen the linkages with AJA- trained DepEd personnel for co- implementation of AYRH including rapid HEEADSSS assessment to identify high-risks in senior high school, high school and college students for immediate counselling, referral and management.

BASELINE Target ACCOMPLISHMENT FOR THE CUMULATIVE INDICATOR PY5 PY6 QUARTER ACCOMPLISHMENT TARGET ACCOMP % TARGET ACCOM % P N4. Number of USG-  8 hospitals 10 hosp. 8 hospitals 8 100 % 18 16 88 % assisted SDPs providing FP/RH services for  35 RHU 30 RHUs 22 RHUs 21 95% 65 56 86% adolescents and Youth  12 Schools 6 Schools 6NHS&colleg 6 100 % 18 100% es  0 6 SRH FB 6 SRH FB 4 67% 6 4 67% SoMe4AYRH pages pages

Analysis of Accomplishment. e.3 Campus-based AYRH Begun in PY5, project’s TA in schools focused on building the capacities of personnel in Learner Support Services that include guidance counselors and district and H&N nurses, AJA-risks assessment-counseling-and referral, and enhance the capacities of teaching staff under the Curriculum Implementation Division towards integrating Comprehensive Sexuality Education in MAPEH, TLE, Values, Science, Araling Panlipunan subjects based on K 1-12 competencies curriculum In project’s extension year, the project expanded its work in schools and targeted six schools, i.e., 3 national high schools under the DepEd Division of Zamboanga del Sur, including: Toribio NHS in Margosatubig, Lapuyan NHS, and V. Sagun NHS; and 3 JH Cerilles Colleges also located in V. Sagun municipality. These schools were selected due to high teen pregnancy, and these schools are located within the catchment of ZDS Cluster District 2 SDN, which facilitate access to FP/RH services through referral network. This initiative is in addition to the 23 schools2 under the DepEd Division of Agusan del Norte assisted in PY5 to implement AYSRH in schools, they named YOLO (an acronym for Youth Optimizing Life Opportunities) through the ARH program under Learner Support Services. In Zamboanga del Sur, as a result Project’s support in training of guidance counselors and youth formation officers on AJA-risks assessment3 held during the quarter, the three targeted high schools and the three JH Cerilles Colleges have already referred 32 AY clients to health facilities, and AJA trained DepEd GCs and School Nurses have started applying risks assessment using the of rapids HEEADDSS tool of their students. These schools are supported with a line of referral points including Margosatubig Regional Hospital and Zamboanga del Sur Medical Center, which are likewise equipped and adequately providing counselling and FP MNCHN services to AYs. Four MH- supported RHUs – Lapuyan, Margosatubig, V. Sagun and Labangan RHUs are allocated. Reports of these 4 SDPs showed that they have counselled 11 males and 171 females with 2 males and 146 females provided with FP services and 3 males referred to higher level for further psychiatric assessment. From the initial targeted 12 schools in Agusan del Norte, the province’ DepEd Division has started rolling -out YOLO implementation to its 46 secondary National High Schools through series of program orientation with health/SRH forums on Teenage Pregnancy, STI/HIV-AIDS, DrugUse and risks assessment. From Q1PY6 to end of Q2PY6, ADN DepEd Division had cumulatively reached-out to a total of 3,524 learners. Based on submitted report, it can be noted that alcoholic drinking and drug use comprised highest among risks detected at 25% and 24% respectively; followed by home concerns (19%) , experience of bullying (16%) and smoking (12%). Sexual health concerns made a cut at 4%. Immediate and follow-through guidance were conducted, of which a total of thirty-one were referred to service facilities for further

2 Agusan del Norte DepEd Division National High Schools implementing Youth Optimizing Life Opportunities, a learner support services under ARH 1) Kitcharao NHS; 2) Jabonga NHS; 3) Abilan NHS; 4) Agay NHS; 5) Bangonay NHS; 6) Buenavista NHS; 7) Cahayagan NHS; 8) Carmen NHS; 9) Carmen SHS; 10) Casiklan NHS; 11) Cuyago NHS; 12) Dona Rosario NHS; 13) Durian NHS; 14) FS. Omayana NHS; 15) Jaliobong NHS; 16) Lingayao NHS; 17) Magallanes NHS; 18) Magdagooc NHS; 19) Manapa NHS; 20) San Vicente NHS; 21) Tinigbasan NHS; 22) Tubay NHS; 23) Lawan-lawan NHS 3 HEEADSS risks assessment is an approach and a tool towards identifying AYs at risk (on home, education, peer-related activities, drugs, sexuality/sexual health, mental health), leading to provision of guidance, counseling, referral to facilitate access to services.

74 management. Meanwhile, due to the 2-month long school break (April-May), the number of reached students during the quarter is much lower (99) compared to that of 2 previous quarters. Nonetheless it did not deter the schools to help its learners in need: Twenty have undergone full counseling - 1 teen pregnant referred to RHU for ANC; and 19 were referred to PNP due to safety risk associated with their involvement in gangs.

Table 10: Number of AYs reached with Guidance through YOLO of DepdEd Division of Agusan del Norte Number of Referre Psychosocial Risks AY Assessed d Home - Home - School – Alcohol Drugs Smoking Sexuality with Rapid Truancy Violence Bullying/ HEEADSS gang Oct to Dec 17 1874 3 315 366 593 188 155 102 155 Jan to Mar18 1650 8 - - - 702 616 324 7 Apr to Jun18 99 20 11 12 12 4 4 4 11 Total 3,524 31 326 378 605 894 775 430 173

Jointly launched in June, MindanaoHealth likewise assisted Agusan del Norte DepEd Division along with Agusan del Norte Provincial Hospital-Center for Teens in implementing and managing its social media platforms, “YOLO” and AGAKAY“facebook accounts respectively. Designed to be interactive and participatory, these platform aims to reach significant number of young people with correct health and SRH information, as well as available services and programs in schools, youth-friendly health facilities, and communities. Deviation Narrative. Multi-sectoral collaboration, partnership and support is needed to assist DepEd in integrating ASRH implementation in schools. Due to extent and varied psychosocial concerns, multi sectoral referral network should be in place to ensure continuity and continuum of care for AYs needing help. This stiil needs to be firmed up in both assisted Divisions in Zamboanga del Sur and Agusan del Norte, particularly referral points for non-health issues. To institutionalize the provision of correct and meaningful SRH information, there is a need to assist DepEd in building the capacities of respective teaching staff in integrating Skills-based Health and Sexuality Education, which will be the next TA effort of the project for the next quarter.

Plan for the Next Quarter.  In Zamboanga del Sur and Zamboanga Sibugay, the project will assist in firming up referral pathways between the assisted six schools (Toribio NHS in Margosatubig, Lapuyan NHS, and V. Sagun NHS; and 3 JH Cerilles Colleges) and schools in ZamboSibugay, with MH

supported SDPs for further counselling and management of AYs with health risks.  In Agusan del Norte, work an assist ADN-PHO and DOH-RO13 in strengthening the multi-sectoral referral mechanisms for AY services and engaging DepEd Division and its school as partners.  Support the 2 DepEd Divisions in building the capacities of select teaching staff in seven schools, i.e., 3 in Zamboanga del Sur, and 4 in Agusan del Norte, in integrating comprehensive sexuality education in school curricula.

BASELINE Target ACCOMPLISHMENT FOR THE CUMULATIVE ACCOMPLISHMENT QUARTER INDICATOR PY5 PY6 TARGET ACCOMP % TARGET ACCOM % P

N4. Number of USG-  8 hospitals 10 hosp. 8 hospitals 8 100 % 18 16 88 % assisted SDPs providing FP/RH services for  35 RHU 30 RHUs 22 RHUs 21 95% 65 56 86% adolescents and Youth

 12 Schools 6 Schools 6NHS&colleg 6 100 % 18 100% es

 0 6 SRH FB 6 SRH FB 4 67% 6 4 67% SoMe4AYRH pages pages

Analysis of Accomplishment e.4 #SoMe4AYRH (Social Media for AYRH)

According to 2013YAFS4 survey, Facebook remains the most used social media by more than three-quarters (80.3%) of youths using the Internet for social networking. Project’s technical assistance to six partner agencies / institutions4 implementing programs on Adolescent- Youth Health with significant result:

. Fourteen individuals from targeted 6 partner agencies / institution trained and equipped in crafting SRH messages and in administrating social media account, particularly the Facebook platform. . Six partner agencies / institutions, including: Department of Education Division of Agusan del Norte (YOLO Program), Agusan del Norte Provincial Hospital – Center for Teens, Department of Health Caraga Region, Commission on Population - Caraga, Population Division of Davao City Health Office and the Brokenshire Hospital Program for Teens were able to create respective Facebook accounts with SRH messages. . Three of six assisted agencies / institutions, namely: “YOLO” facebook account of Agusan del Norte DepEd Division; “AGAKAY” of Agusan del Norte Provincial Hospital-Center for Teens; “Teen Talk Davao” of Davao CHO-Population Office were formally launched.

As of Q3PY6, a total of 8,039 individuals were reached by SRH messages, measured by the number of people who had any posts from page, Page enter and seen the messages on their screens; and at least 1,269 engaged as reflected in the number of times people have engaged with the posts through likes, comments and share, shown in the table below.

June 28-July 22 (after the launch) – Organic Data QUALIFIERS Target ADN-DepEd ADNPH (After 3 Division PopCom XIII TeenTalk months) YOLO Page Davao Page Use A new page More focused messages on More AY- Focus on STI- was created teenage pregnancy, focused dedicated for motherhood and family through their HIV and the the campaign planning options #CaragaTeens mellennials Campaign

4 Six partner institutions implementing programs on Adolescent-Youth Health i) Department of Education Division of Agusan del Norte (YOLO Program); ii) Agusan del Norte Provincial Hospital – Center for Teens; iii) Department of Health Caraga Region, iv) Commission on Population – Caraga; v) Population Division of Davao City Health Office; vi) and the Brokenshire Hospital Program for Teens

Reach Page Group

Likes/Followe Number of new 1,000 77 (7.7%) 52 (5.2%) 10% Increase 13% Increase in rs followers minus the the followers number of unfollows (currently at 951) Reached The number of 300% (of 4,291 256 (492%) Cannot be 3,492 (367%) people who had any the number (429.1%) measured in posts from page of groups Page enter their followers screen. Engagement

Post The number of times 80% of the 621 (806.4%) 59 (113%) Cannot be 589 (61.9%) Engagements people have total measured in engaged with the number of groups posts through likes, followers comments and shares and more. Post/Day Number of posts per 1 0.5 0.4 0.4 0.8 day

Deviation Narrative.

In general, administrators of respective FB accounts should be able to maintain the number of posts of at least one SRH message per day. As of Q3PY6, almost all achieved half, except for POPCOM XIII who was able to achieve close to target of one to keep FP pages interesting, dynamic, informative thus will be able to gain and sustain Number followers.

Plan for the Next Quarter.  Integrate the promotion of respective FB pages’ accounts in all SRH activities –youth forums, Usapans, consultations, etc.  Monitor results, continue mentoring on SRH messaging and managing FP page accounts of partners.

MNCHN/FP Service Delivery Component Report Report

FP1: Current Users

By priority Areas: As compared to the baseline, all project areas have substantially provided FP method in quarter 3 to new acceptors, adjusted to drop-outs and other acceptors as current users for the second and third quarters. Thus, the overall performance of USG-assisted sites in Mindanao led to 101.6 percent or 1,643,924 current users as compared to the target of 1,615,404.

The FHSIS data for the past 2 quarters showed that Mindanao regions got increasingly high in achieving the annual target for current users (CU) except for a slightly lower results than the targets noted in Northern Mindanao, SOCCKSARGEN and ARMM regions.

In Caraga region, the total current users for Q3 has reached 144,272 which is higher than PY6 cumulative target of 125,766 or 115%. This is also higher by 0.11% compared to Q2 CU.

The project has been supporting both fixed facility and outreach services to offer broad range of Family Planning services. Lately, the outreach services have been affected with the cease in operations of major private sector partners who brought services, even minilaparotomy, to the local level.

Overall, the significant contributions on the current users were derived from the reports of Davao, Zamboanga Peninsula and Caraga regions.

For the Priority Areas:

Figure 1.1. Current Users (CUs) in Priority Areas, Baseline, Target and Q3 Results

140,000

120,000

100,000

80,000

60,000

40,000

20,000

- Davao Maguind South Davao Zambo Misams Sultan Compost Agusan Zambo Cotabato Bukidnon City anao Cotabato Sur/Occ Sur Orientl Kudart ela Valley del Sur Norte BASELINE 74,629 54,272 53,417 107,574 42,793 32,046 123,295 39,784 31,786 31,860 30,600 82,020 Q3 (Jan-Mar 2018) 132,894 122,708 113,043 70,338 84,368 85,174 79,453 91,484 80,843 75,898 75,028 100,494 Target 129,633 127,970 121,098 74,475 83,064 61,184 88,492 97,010 86,922 82,390 70,527 77,996 Percent 103% 96% 93% 94% 102% 139% 90% 94% 93% 92% 106% 129%

For the Conflict-Affected Areas (CAAs)

Figure 1.2. CUs in Conflict-Affected Areas, Baseline, Target and Q3 Results

90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 - Zamboanga Lanao del Lanao del Basilan Isabela City Sulu Tawi-tawi Cotabato City City Sur/Marawi Norte/Iligan BASELINE 18,341 36,651 32,513 68,059 3,679 5,989 72,056 30,648 Q3 (Jan-Mar 2018) 13,434 5,778 41,376 25,244 58,702 23,277 37,892 63,639 Target 19,161 5,915 40,887 25,926 62,805 25,871 37,781 80,809 Percent 70% 98% 101% 97% 93% 90% 100% 79%

Analysis of Accomplishment. In figure 1.1, the graph shows us that most, if not all, of the 12 LGUs as priority areas already met the annual targets for curent users (CUs), notably in Davao del Sur, Zamboanga del Norte, Agusan del Sur, Davao City and South Cotabato. While depending highly on fixed facilties, minimal outreach services for LARC/PM especially BTL were conducted in Mindanao during the Jan-Mar 2018 period since there is no more private provider(s) after it closed shop to address the unmet need for limiting. In 6 of 12 priority provinces with long term investments, Zamboanga del Sur, South Cotabato, Maguindanao, Compostela Valley, Bukidnon and Misamis Oriental have shown the extra-ordinary efforts on LARC/PM services that went beyond expectations in hitting CYP requirements in 3 quarters for the year. Meanwhle, the WRAs with unmet need for limiting have been referred to fixed facilities trained on BTL by MLLA in four (4) Provincial Hospitals of Bukidnon, the NMMC and JRBorja for CDO. All other provincial hospitals of Misamis Oriental (MOPH- Balingasag, Talisayan, Gingoog, Alubijid, and Manticao) have HSPs trained on PPIUD and PSI and are providing services to WRA with unmet need seeking services in their hospitals. Further, those who opt for LARC-PSI have been referred to the strengthened RHUs. Figure 1.2 shows that in conflict-affected areas, Sulu and Lanao del Sur/Marawi City already met its annual CU targets.

Deviation Narrative. The over-performance of Davao del Sur/ Occidental, Zamboanga del Norte, Agusan del Sur and in the conflict-affected areas of Sulu and Lanao del Sur/ Marawi City on Family planning could be observed and have been seen as widely accepted in these areas. In Misamis Oriental, the NMMC also was not able to conduct outreach services because the subsidy for outreach was not released by DOH CHD X with its Q2 (Jan-Mar) accomplishments covered in fixed facilities. For Zamboanga del Sur, ComVal and Bukidnon, in partnership with DOH-CHD, the Provincial Health Offices were able to establish FP outreach teams comprised of trained HSPs on FP services,

started visiting the RHUs and BHSs with list of WRA with unmet need to conduct LARC/PM+ services focused on GIDAs and other areas with high number of WRA with unmet need. This strategy if done regularly will be able to reach communities that are hard-to-reach or low access to FP services (equity).

Plan for the Next Quarter. For areas achieving beloe 95 % of expected CUs, regular conduct of outreach services to reach community residents living in hard-to-reach or low access areas (GIDAs) to FP services in ZAmbo Sur, Comval, Bukidnon and Sultan Kudarat in prioirty areas and in the conlfict-affected areas of Basilan, Lanao del Norte/Iloigan City, Cotabato City and Zamboanga City.

For the Non-Priority Areas:

Figure 1.3. CUs in Non-priority Areas, from Baseline vs. Targets and Q3 Results

80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 - ZAmboanga Agusan del Cagayan de Oro Davao Oriental Gen. Santos City Sibugay Norte/Bxu BASELINE 28,633 7,093 18,555 14,308 29,885 Q3 (Jan-Mar 2018) 49,090 47,923 46,042 47,580 69,244 Target 38,063 30,809 37,428 53,947 55,240 Percent 129% 156% 123% 88% 125%

Analysis of Accomplishment. In the 5 Non-priority Areas, most of the 4 LGUs have also surpassed their targets especially in Cagayan de Oro, Zamboanga Sibugay, Agusan del Norte and Davao Oriental. Agusan Norte has the highest number of accomplishments while General Santos City, at 88 percent, is coming in second.

Deviation Narrative. The over-performance in Cagayan de Oro, Zamboanga Sibugay and Agusan del Norte were achieved with the assistance of JR Borja Hospital, NMMC, ZSPH, ADNPH and BMC and the private facilities that started reporting accomplishments on FP centrally.

Plan for the Next Quarter. For areas achieving beloe 95 % of expected CUs, regular conduct of outreach services to reach community residents living in hard-to-reach or low access areas (GIDAs) to FP services in non-prioirty areas of General Santos City. Continue the collection of data from the hospitals, publicly and privately-owned private birthing centers on contributions to postpartum family planning.

FP2: Couple of Years Protection (CYP)

Indicator Baseline Accomplishment Cumulative As of Q2PY6 Accomplishment FP2: Couple of Years Target Actual % Target Actual % 228,438 Protection 52,837 394,301 72.6 1,743.825

Although accomplishments for current users (CU) for the 3 quarters were high, these do not necessarily translate to high CYP. Mindanao regions got almost 50 % accomplishment for the annual CYP requirement in the last 3 quarters and remained on track to achieve the requirements for succeding quarters. Among the regions, ARMM and SOCCSKSARGEN got high percentage performances on CYP followed by Northern Mindanao and Caraga regions. Southern Mindanao (Davao) region got the lowest performance on CYP despite Caraga and Davao regions achieving high in current users (CUs). As observed the regional and local areas in Zamboang del Sur, South Cotabato, Basilan, Davao Oriental and Agusan del Norte showed that long, persistent and consistent investments on developing LARC/PM services have higher returns/performances for CYP. With the TRO lifted, ARMM has been reintroducing LARC/PSI to most of its women as a more acceptable alternative to short-acting methods. The reintroduction successfully added to the minimal CYP requirements expected from ARMM.

In priority areas:

Figure 2.1. Couple of Years Protection (CYP) in Priority Areas, by quarters vs. targets (percent)

120,000

100,000

80,000

60,000

40,000

20,000

- Davao Maguinda South Davao del Zambo Misams Sultan Composte Agusan Zambo Cotabato Bukidnon City nao Cotabato Sur Sur Orientl Kudrat la Valley del Sur Norte BASELINE 13,638 7,315 10,321 2,996 3,261 26,975 12,853 15,572 16,079 23,111 20,022 17,374 Q1 9,260 7,299 14,526 4,186 4,846 4,717 11,843 6,944 3,236 3,328 6,060 4,472 Q1+Q2 11,958 12,025 29,652 6,397 22,739 9,486 20,204 14,475 8,122 6,933 13,379 9,131 Q1+Q2+Q3 33,997 20,733 39,638 9,922 28,935 17,456 28,159 22,936 15,480 13,721 21,628 15,285 Adjusted Target 98,174 34,034 45,675 9,069 14,427 31,029 12,131 29,654 18,904 14,174 34,401 33,064 Percent Results 35% 61% 87% 109% 201% 56% 232% 77% 82% 97% 63% 46%

In the absence of an NGO that does BTL thru MLLA in addressing unmet need for limiting, the hospitals in priority areas should be reviewed and their capacities enhanced. As observed, they have already contributed to an increasing CYP in Zamboanga del Sur, South Cotabato, Maguindanao, In conflict-affected areas (CAAs). Zamboanga del Sur has the DOH-retained facility of Margosatubig Regional Hospital (MRH), the Zamboanga del Sur Medical Center and other public and private facilities that contribute to postpartum FP.

In the Conflict-affected Areas and Non-Priority Areas (TNPAs)

Figure 2.2. CYPs in Conflict-affected Areas, by Quarters vs. Targets (Percent)

30,000 25,000 20,000 15,000 10,000 5,000 - Lanao del Lanao del Basilan Isabela City Sulu Tawi-tawi Zamboanga City Cotabato City Sur/Marawi Norte/Iligan BASELINE 936 644 4,811 8,456 4,320 356 2,616 3,405 Q1 1,757 204 506 194 4,904 5,601 539 2,309 Q1+Q2 2,561 424 1,798 441 9,580 7,842 710 6,808 Q1+Q2+Q3 3,550 738 3,518 868 16,238 10,043 1,278 11,914 Y6 CYP Targets 2,710 4,061 3,370 1,169 29,020 16,330 1,420 13,401 Percent 131% 18% 104% 74% 56% 62% 90% 89%

CYPs in non-priority areas:

Figure 2.3. CYP in Non-Priority Areas, by quarters vs. targets (percent) 35,000 30,000 25,000 20,000 15,000 10,000 5,000 - Zambo Sibugay Cagayan de Oro Davao Oriental Gen. Santos City Agusan del Norte BASELINE 6,815 888 8,274 4,399 13,002 Q1 2,787 8,137 3,519 5,834 4,000 Q1+Q2 2,787 17,477 7,116 11,733 13,626 Q1+Q2+Q3 6,957 24,335 10,780 16,249 23,546 Adjusted Target 19,065 34,020 9,783 19,714 14,446 Percent Results 36% 72% 110% 82% 163%

Analysis of Accomplishment. While depending highly on fixed facilties, minimal outreach services for LARC/PM especially BTL were conducted in Mindanao during the Jan-Mar 2018 period since there is no more private provider(s) after it closed shop. In 6 of 12 priority provinces with long term investments, Zamboanga del Sur, South Cotabato, Maguindanao, Compostela Valley, Bukidnon and Misamis Oriental went beyond expectations in hitting CYP requirements in 3 quarters for the year by mobilizing its own set of providers in addressing the unmet need. For Zamboanga del Sur, ComVal and Bukidnon, in partnership with DOH-CHD, the Provincial Health Offices were able to establish FP outreach teams comprised of trained HSPs on FP services, started visiting communities, the RHUs and BHSs with list of WRA with unmet need to conduct LARC/PM+ services focused on GIDAs and other areas with high number of WRA with unmet need. This strategy if done regularly will be able to reach communities that are hard-to- reach or low access to FP services (equity). Meanwhle, the WRAs with unmet need for limiting have been referred to fixed facilities trained on BTL by MLLA in four(4) Provincial Hospitals of Bukidnon, the NMMC and JRBorja for CDO. All other provincial hospitals of Misamis Oriental (MOPH- Balingasag, Talisayan, Gingoog, Alubijid, and Manticao) have HSPs trained on PPIUD and PSI and are providing services to WRA with unmet need seeking services in their hospitals. Further, those who opt for LARC-PSI have been referred to the strengthened RHUs. Although Bukidnon and Davao City already achieved more than 39,638 and 33,997 of its combined CYP for 3 quarters, respectively, these will only represent 87% of the CYP requirement for Bukidnon and 35 percent of it’s the annual CYP for Davao City.

Deviation Narrative. In Norhtern Mindanao for Misamis Oriental, the NMMC also was not able to conduct outreach services because the subsidy for outreach was not released by DOH CHD X for the Jan-Mar 2018 period of accomplishments. The minimal percentage accomplishment in Davao (Southern Mindanao) region could be attributed to minimal responses to demand for FP services to address unmet need for limiting. As already observed, the BTL through minilaparotomy (MLLA) has not been widely accepted by the providers (provider bias) in the region. Spinal Anesthesia has been promoted but availability of providers could not respond well in the region for the number of women seeking better alternatives for their unmet need for limiting. Starting in Davao City, the policy on BTL also inflluenced the health leaders in the provinces of Compostela Valley and Davao del Sur despite the ongoing reliancefor MLLA in Tagum, Davao del Norte. While gaining wide acceptance from providers and clients, the LARC/PSI services could only contribute minimally with its equivalent of 2.5 and could not fully satisfy the requirements to address the unmet need for limiting.

Plan for the Next Quarter. Strengthen with DOH and LGUs the regular conduct of outreach services to reach out those with unmet need for limiting among community residents living in hard-to-reach or low access areas (GIDAs) and in non-prioirty areas of General Santos City. Continue the collection of data from the hospitals, publicly and privately-owned private birthing centers on contributions to postpartum family planning that would include BTL, IUD, PSI and other short-acting methods. Specifically, the areas needing more intensification on meeting the unmet need for limiting are in the priority areas of Davao City, Zamboanga del Norte, North Cotabato and even, Agusan del Sur; in the CAAs of Isabela and Zamboanga cities; and in the non-priority area of Zamboanga Sibugay. While regular but infrequent services were done by the medical centers in the past (e.g., NMMC, SPMC and DRMC and CRMC), there is a need to encourage fixed facility providers to respond to the demands for FP services that would address unmet need for limiting in smaller areas or GIDAs of the region. In a more strategic note, all regions notably Davao Region need to seriously find ways / alternatives to MLLA and the loss of private sector providers specifically in responding to unmet need for limiting.

FP4: Service Delivery Points (SDPs) Accomplishment Cumulative Indicator Baseline For the Quarter Accomplishment Number of SDPs provding Target Actual % Target Actual % FP information, counseling 68 737 737 700 and modern FP methods

Analysis of Accomplishment. While not much additional facilities were identified for staff to be trained as FPCBT1 providers (counselors), the health facilities in two regions (ie., CAraga in Agusan del Sur/Norte and SOCCSKASARGEN) already surpassed the requirements for FPCBT1. These FPCBT1 providers have been required to make sure that the provision of information, FP counseling, direct and referral of FP services are strictly observed and followed through.

Table 4 above shows that the target for the whole of Mindanao has been achieved at 95 % with 700 of the health facilities having complete set of providers who underwent training on FPCBT1, been provinding information and/ or referral for FP services. These results of functionality could be readily obsereved in areas with private providers in General Santos City, Cotabato City, Zamboanga del Sur, Compostela Valley, Basilan and Bukidnon, South Cotabato and even in Zamboanga del Norte. More efforts are expected and need to be provided to restore basic services in Lanao del Sur/ Marawi City and also in Davao City.

Deviation Narrative. In some areas, the hospital or private sector providers have been tapped.

Plan for the Next Quarter. Continue seeking providers to be trained on FPCBT1 especially in Davao City, Lanao del Sur/Marawi City. This should ensure that the hospital and private sector providers are included.

FP5: CHWs provided with technical assistacnce Indicator Baseline Accomplishment Cumulative For the Quarter Accomplishment Number of CHWs Target Actual % Target Actual % provided with technical assistance 3,687 4182 113.4 3687 4182 113

On CHWs per region:

The CHWs in priority areas:

Analysis of Accomplishment. Describe activities/factors that significantly contributed to the achievement/non-achievement of the target. Quantify results, where appropriate. The number of CHWs who have been technically assisted by the project exceeded its annual target especially in Norhtern Mindanao and Caraga regions. However, the mobilization of CHWs remained low for the last 2 quartes in SOCCSKARGEN and Davao regions. Southern (DAvao) Mindanao provided TAs to 484 CHWs and in SOCCSKARGEN to 306 CHWs who provided profiling, information and referral of women with unmet need for modern FP services. While 7 of 12 priority areas of Bukidnon, Agusan del Sur, Compostela Valley, Davao del Sur, Sultan Kudarat, Maguindanao, Misamis Oriental and Cotabato have exceeded their annual targets for CHWs who provided family planning (FP) information, referrals and/or services in quarter 3. These LGUs tapped a network of service providers beyond RHUs and fixed hospital facilities for LARC/PM with the inclusion of additional method of contraception after the TRO was lifted (PSI). However, Davao City, Zamboanga del Sur and Zamboanga del Norte would need to update their entries on CHWs.

Deviation Narrative. The WRAs with unmet need for limiting should be reviewed by the trained health service providers, re-counseled and referred to appropriate providers by subsequently arranging the necessary preparations for procedures. Davao City was not followed up since no LGUA was assigned on the said quarter. Around 18 CHWs from DAvao Oriental resigned / retired from government services.

Plan for the Next Quarter. Since addressing unmet need for limiting remains difficult to pursue in GIDAs, arrangements could be done in fixed facilities with trained on BTL by MLLA such as the

four (4) Provincial Hospitals in Bukidnon and the NMMC. Those who opt for LARC-PSI are referred to the RHUs. In Davao region, there is a need for further follow-up, coach and mentor CHWs on their tasks and expectations.

B-1: Number of women of reproductive age (WRA) who have been profiled, identified with unmet need and provided with FP services

Indicator Baseline Accomplishment Cumulative For the Quarter Accomplishment Number of WRA Target Actual % Target Actual % profiled and 843,886 200,00 23% 843,88 820,054 97% identified with 1 6 unmet need

The first stage: number of women profiled and identified with unmet need The indicator has been analyzed in two stages: The first stage requires the determination of unmet need from those women who have been profiled.

The second stage: number of women with unmet need provided with FP services

Analysis of Accomplishment. In the first stage: The number of women who have been profiled and identified by CHWs and other health volunteers with unmet need have been achived at 97 % from the target of estimated WRA with unmet need. Mindanao regions have successfully achieved 97% of the required women of reproductive age (WRA) to be profiled and subsequently identified with unmet need in 3 quarters of profiling. While the number of WRAs who have been profiled remained erratic from quarter 1, the women who were identified with unmet need for FP have been decreasing in the 3rd quarter from 60 to 19 percent but as earlier stated, these women/men already reached 97% of the required Costed Implementation Plan (CIP). In the conflict-affected areas (CAAs), the performances of most provinces/cities, while required to report a smaller number of clients in addressing unmet need, have been observed to be high in Sulu, Cotabato City and Iligan City. As observed with smaller numbers, high support from the IPHO could be noted in Sulu and Basilan. In the second stage, those women who were identified with unmet need and have been provided with FP services achieved 25 percent of the Costed Implementation Plan (CIP) requirements for Mindanao. Except in Zamboanga Peninsula and Northern MIndanao regions, almost all the 4 regions of Davao and Caraga showed an increasing trend in identifying women with unmet need who were provided with modern FP services.

From an overall slow start, the provision of FP services to those identified with unmet need has been increasing. The increasing performance could be attributed to the active participation and partnerships of different agencies (DOH, POPCOM, LGUs, the public and private sectors) in reducing the unmet need for modern FP. While addressing unmet need, a mechanism should be put in place to monitor the level of satisfaction among FP users. There has been a growing concern that those who expressed unmet need for limiting were able to receive only the modern FP for spacing due to unavailability of the providers.

Deviation Narrative. In Davao City, the additional deviation (increase) has been observed this quarter when most of the private facilities started submitting FHSIS reports to the city government and DOH. No data were received for Cotabato, South Cotabato, Misamis Oriental and Sultan Kudarat that affected the overall achievement on those being identified with FP unmet need and subsequently, those receiving modern FP based on unmet need. Ideally, those women/men who have been identified with unmet need for limiting be provided with a permanent method of modern FP or even IUD that could cover for `12 years to emphasize no barriers for limiting. However, the overall performance of providing FP only showed a respectabe percentage increase during the last 2 quarters. In few areas, the decline in the number of outreach services may be attributed to the unavailability of the trained HSPs due to outbreaks.

Plan for the Next Quarter. Continue monitoring the LGU performance of this indicator to reach the ideal set-up of almost all of those who were profiled and identified with unmet need for modern FP also received the modern FP services without delay. Continue mobiization of CHWs, volunteers, partners and monitor the regional and local performance of this indicator to reach the ideal set-up/situation of reducing the CIP. In Northern Mindanao, there is a plan to assist the DOH RO/POPCOM and PHOs, the LGUs to revisit their data on unmet need then do tabletop the analysis and mapping of estimated number of FP unmet needs per barangay. With PopCom, LGUs and volunteers shall continue the door-to-door canvassing of WRAs in prioritized areas per barangay with an immediate provision of modern FP service to WRA with FP unmet needs. The package of services must include education, counselling and the provision of contraceptive methods. Advocacy to LGUs to conduct twice a month "Usapan Series" activities with a one or 2 weeks before schedule of any outreach activities. Thus, the LGU health staff in Norhtern Mindanao to regularly coordinate and collaborate with the MSWD-MLs for the conduct of monthly "Family Development Sessions on FP" per barangay. Continue seeking women/ men for unmet need and complete data for Cotabato, South Cotabato, Misamis Oriental, Sultan Kudarat and even in Zamboanga del Norte on those receiving modern FP based on unmet need.

HL2.1: Women provided with Uterotonics

Indicator Baseline Accomplishment Cumulative For the Quarter Accomplishment Number of women Target Actual % Target Actual % given with uterotonics in AMTSL or during delivery 10,000 7,517 75% 10,000 12,30 123% 3

The use of uterotinics in Mindanao

Figure 5.1.A. Number of Women Given Uterotonics in AMTSL or Delivery in Quarters vs.Targets

12,000 10,000 8,000 6,000 4,000 2,000 - Zamboanga Northern ARMM Davao SOCCSKSARGEN Caraga Peninsula MIndanao Q1 1,018 186 228 228 255 192 Q2 4,913 389 272 183 298 244 Q3 6,089 309 132 144 455 388 Q2+Q3 11,002 698 404 327 753 632 2018 Target 5,000 1,815 1,953 1,879 1,921 695 Percent Achieved 220% 38% 21% 17% 39% 91%

Analysis of Accomplishment. Overall, the required number of 10,000 women who have been monitored and reported to be receiving oxytocin (uterotonics) right after the delivery of the baby (AMTSL) or after the dleivery of the placenta has been achieved in cumulatively in Mindanao at 123% and at 138 percent for the 2 quarters.

With its standing policy on AMTSL, the ARMM alone already significantly contributed to more than 11,000 women reported as receiving uterotonics. Caraga, Zamboanga Peninsula and SOCCSKSARGEN regions also achieved more than its assigned target if quarter 1 accomplishments are included in the analysis.

Deviation Narrative. While national staff and experts have been deliberating the evidences and limitations of existing laws, the courses and skills of midwives, a standard protocol in ARMM on the mandatory use of oxytocin in the AMTSL during deliveries has been signed and approved by

the DOH-ARMM Secretary of Health. Despite its limitation in the Midwivery Law, this protocol was also observed and attempted to be used in Caraga and SOSSCKSARGEN regions.

Plan for the Next Quarter. Continue monitoring of health facilties at random to ensure that AMTSL is widely practiced and no stock-outs could be observed in the essential drug (uterotonics) to prevent postpartum hemorraghes during deliveries.

B-1: Newborns resuscitated

Indicator Baseline Accomplishment Cumulative For the Quarter Accomplishment Number of newbors Target Actual % Target Actual % not breathing at None 70 278 397 70 278 397 birth who were resuscitated

Figure 5.2A Number of Newborns Resuscitated per Region in Quarters vs. Target

250

200

150

100 Axis Title Axis

0 ARMM ZAMBO PEN NORTH MIN SOUTH MIN SOCCSKSARGEN CARAGA ACCOMP Q3 23 23 68 47 15 102 Q2+Q3 26 41 109 94 24 237 TARGET 14 10 11 15 12 8

Analysis of Accomplishment.While 70 has been targeted for Mindanao, Figure 5.2A shows high accomplishments of newborns who were reported to have difficulty of breathing during delivery, underwent resuscitation and were successfully resuscitated to 210 in the last quarter. The highest report came from Caraga, followed by Davao region and Northern Mindanao accomplishments for the quarters.

Deviation Narrative. The indicator was introduced this year. No previous measures or accomplishments were noted. There is a need to review the understainding of the definition of this indicator and validate the numbers reported, including the underlying causes of the difficulty of breathing and its relation to the other indicator on uterotonics.

Plan for the Next Quarter. There has been an agreement not only to diasggregate by gender by include the underlying causes of diffiiculty of breathing (e.g., number of premature newborns, difficult labor with asphyxia, etc.). Continue the monitoring of health facilties in the succeeding months to ensure that newborns are appropriately monitored and once with difficulty breathing are immediately resuscitated. Review the understanding of the definition of this indicator and validate the numbers reported.

Indicator 8: NI3 Number of PPIUD trainees who underwent supportive supervision and have been certified by DOH

Indicator Baseline Accomplishment Cumulative For the Quarter Accomplishment Number of trained Target Actual % Target Actual % PPIUD providers wo underwent supportive supervision Supportive 773 656 84% supervision Underwent 773 406 52% certification

Analysis of Accomplishment. Overall, Table 8.1. shows that Mindanao regions achieved 656 of the 967 (68%) of the PPIUD-trained health service providers who underwent supportive supervision and 406 (42%) of whom have been certified. These providers represent 84% and 52% of the targeted number of PPIUD providers who were supportively supervised and subsequently certified, respectively.

With its excellent partnership of LGUs with the DOH-Regional Offices, the SOCCSKSARGEN and Caraga regions reported high accomplishments in conducting supportive supervision and subsequent certification from DOH. The rest of the regions like Davao and ARMM need to double their efforts in meeting its targets especially on DOH certification.

Deviation Narrative. There are ongoing efforts to validate the number of health service providers who have been trained as to their current status (i.e., still active in clinical practice, not retired or transferred to another assignment (non-clinical), etc.). This validation process will ensure that the targeted numbers could represent the actual providers who would be needing supportive supervision. Further, the latest M and E TWG agreements emphasized the need to report those who underwent the process of submission for certification. Further, MindanaoHealth will pursue efforts in documenting those accepted by PhilHealth for accreditation.

Plan for the Next Quarter. Continue the ongoing supportive supervision of PPIUD providers especially in Davao and the ARMM region. With cleaned or validated list, Davao and ARMM regional staff should work with the DOH and LGU authorities to schedule each provider to undergo respective duties in respective faciltiies (clinical practice and mentoring sites), generate more clients and tap the trainers for the conduct of supportive supervision. All other providers should ensure that not only supportive supervision has been done but a certification process should be also monitored until the provider is “tagged” or accredited by PhilHealth.

2.3 Key Challenges and how they are being addressed

Outcome/ Output/ Next Steps/ Responsible Challenge Proposed Solution(s) Timeline Indicators Action Items Party Affected Weak CYP Mobilize private sector providers Follow-up with August ATTLs, LGUAs performanc and tap/offer existing providers major to in Davao City, e on CYP in in medical centers for more stakeholdders Septemb Zamboanga key LGUs outreach; (DOH, er 2018 del Norte, Identify WRA with unmet need POPCOM, Agusan del for limiting, schedule for FP LGUs and Sur, Davao del services in big/medical centers hospital chiefs) Sur and Zamboanga Sibugay

Outcome/ Output/ Next Steps/ Responsible Challenge Proposed Solution(s) Timeline Indicators Action Items Party Affected Low CYP Clean the list of providers, Follow-up with August ATTLs, LGUAs Certitifcatio follow-up schedules with CPMS stakeholders, to in Davao City, n and or training centers for clean list HSPs, Septemb Maguindanao, PhilHealth supportive supervision, closer facilitate er 2018 ComVal, Davao accreditatio follow-up and submission of supervision, Oriental and n of PPIUD DOH requirements for follow-up ARMM areas. providers certification and PhilHealth certification “tagging” or accreditation and accreditation