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Manual on Family Planning Client Referral System for the Public Sector

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Manual on Family Planning Client Referral System for the Public Sector Health Governance Resource Center MANUAL ON THE FAMILY PLANNING CLIENT REFERRAL SYSTEM FOR THE PUBLIC SECTOR May 2006 This publication was made possible through the support provided by the United States Agency for International Development (USAID) under the terms of contract No. 492-C-00-03-00024-00. The opinions expressed herein are those of the author(s)' and do not necessarily reflect the views of USAID. TABLE OF CONTENTS Page Acknowledgements 1 List of Abbreviations 2 INTRODUCTION 3 I. Purpose of the FP Client Referral System 4 II. Scope of the FP Client Referral System 5 III. Elements of a Functional FP Client Referral System 6 IV. Organizing the Public Sector FP Client Referral System 7 V. Referral Procedures A. Referrals for FP Contraceptives & Pills 9 B. Referrals for BTL and NSV 13 C. Referrals for Consultation and Technical Evaluation 17 VI. Recording and Reporting 22 A. Referrror B. Receiving Provider VII. Monitoring and Evaluation 24 Annexes 25 A. Levels of Public Health Care and Service Capability for Family Planning B. Criteria for Selection of Private Providers C. Synopsis of Department of Health Administrative Order 158 D. Memorandum of Understanding E. Addendum Contract of services F. Referral slip for dispensing commodities G. Informed consent form for surgical sterilization H. Referral form for consultation/technical intervention I. Reporting tables for referror J. Reporting tables for receiving providers ACKNOWLEDGEMENTS The development and production of this manual was made possible through the support and invaluable inputs of the following resource persons for which deep gratitude is extended by the authors: • The Provincial Population Office of Pangasinan under the stewardship of Ms. Luz Muego and her staff, Ms. Loida Episcope, Ms. Vicky Banez for their help in improving the systems content of this manual so that they may be as relevant and as useful for the users of this manual in the province of Pangasinan. The same is also acknowledged for the selection of the municipalities/cities for the pilot implementation of this referral system • The Municipalities/Cities of Mangaldan, Binalonan and Urdaneta under the stewardship of Dr. Ophelia Rivera, Dr. Larry Patawaran and Dr. Bernard Macaraeg implementation of this referral system even if it meant adding to the already voluminous tasks and activities in their respective offices. • Dr. Babes Perez, Ms. Lynn Almario, Ms. Risa Yapchiongco, Mr. Fidel Bautista, Mr. Delbert Marquez of the PRISM Project and their consultants Dr. Melchor Lucas, Jr. and Ariel Canaveral, likewise under the funding assistance of USAID for the collaboration in the design and development of this referral system and manual especially in the clinical procedures presented herein. • Ms. RoseAnn Gaffud (Field Coordinator, LEAD for Health Pangasinan) and Mr. Ed Joel Carlos , Ms. Ailene Nitor and Mr. Daniel Culili (PLCPD - LEAD for Health Pangasinan Partner) for providing the logistical arrangements in the conduct of coordination meetings with the pilot areas. • Mr. Verne Quiazon and Ms. Ida Cayetano for the relentless faith and support to the authors of this manual that it may come to fruition and final completion for the benefit of use in the various LGUs who may adopt the referral system for family planning services from the public to the private sector towards achieving the market development goals ultimately leading to the attainment of Contraceptive Self-Reliance in the country. Once again, our heartfelt gratitude and acknowledgement for all the assistance. 1 LIST OF ABBREVIATIONS AO Administrative Order BHS Barangay Health Station BHW Barangay Health Worker BTL Bilateral Tubal Ligation CBDO Community-Based Drug Outlet CBMIS Community-Based Monitoring and Information System CII Contraceptive Independence Initiative CSR Contraceptive Self-Reliance DOH Department of Health FP Family Planning HC Health Center IUD Intra-Uterine Device LGU Local Government Unit LHS Local Health System (Sector) MHO Municipal Health Office MWRA Married Women of Reproductive Age NGO Non-Government Organization NSV Non-Scalpel Vasectomy PhilHealth Philippine Health Insurance Corporation PhP Philippine Peso PHO Provincial Health Office POPCOM Population Commission RHU Rural Health Unit SES Socio Economic Status STD Sexually Transmitted Disease USAID United States Agency for International Development USD US Dollar 2 INTRODUCTION For the last 30 years, the country’s Family Planning Program has relied primarily on foreign donations for the supply of contraceptives. Specifically, the United States Agency for International Development (USAID) has been providing 80% of the country’s contraceptive supply – pills, condoms, IUDs and injectables, amounting to around USD 3 million yearly. In 1999, the national government of the Philippines produced a draft of the Contraceptive Independence Initiative (CII) to launch the country’s bid to be more self-reliant in securing its own contraceptive supply. This was spearheaded by the Department of Health followed through by a multi-sectoral task force convened by the POPCOM that led to the issuance by the DOH of a National Family Planning Program Policy in September 2001. Overall, this policy states that the Philippine Government will now assume greater responsibility for the Family Planning (FP) program of the Philippines. In response to this development, USAID initiated the program for the phase-down of its contraceptive assistance to the Philippine government. The continuing support of USAID shall now be focused on the country’s poorest and the neediest coming from the socio- economic brackets D1 (earning roughly PhP 5,209 to PhP 7,291 per month) and E (PhP 5,208 and below per month). After several meetings with key stakeholders in this industry, USAID officially announced its phase-down plan to the public in September 2002. Phasedown of pills began in 2004, and will be completely phased out by 2007. Injectables shall begin in 2005 and will be completely phased-out by 2008. IUD’s is planned for a later date because of the lack of availability of other brands and sources in the country. Since then, preparations have been underway to ensure that family planning services will continue to be given to both current and future potential users. Many initiatives have been undertaken in the national government level towards the direction of contraceptive self reliance. However, in the local government level, the LGU’s capacity to completely cover the current as well as future demands may be constrained by its limited funds. While this might be the case, several studies already show that many contraceptive users are actually willing to pay for their supplies, that is, of 4.6 million women who use contraceptives, 1/3 or 3.22 million come from middle and high income classes who can afford and are willing to pay for their supplies. As such, one of the approaches being explored is the setting up of a client referral network whose aim is to direct public sector clients to the appropriate provider in the private sector and also higher level public sector providers. Once the referral networks is in place, the public and private FP providers shall have covered both the non-paying and paying clients respectively and contribute to the elimination of “unmet needs” for family planning. 3 PURPOSE OF THE FP CLIENT REFERRAL SYSTEM The health care delivery system typically involves different geographic units, departments, and levels—including central, regional, and community. Thinking about the way work is organized helps managers and providers throughout the system to see their organization as a collection of interdependent resources (including infrastructure, supplies, and referral sites) and processes (such as client scheduling and information management) that change and evolve in response to both clients’ and staff needs. In the public health sector, there are different levels of health care providers. The most basic unit is the barangay health station followed by the rural health unit, municipal health hospital, district hospital and provincial health hospital. Each of these has a different service capability for family planning services (Attachment A). For cases beyond its capability level, the health care provider sends its patient to another provider as a referral. The health provider from whom the patient/client is being transferred is called the referring provider or referror while the health provider to whom the patient/client is being transferred is called the receiving provider. This manual is written to guide the health care providers in setting up a Family Planning Referral System that will standardize the referral procedures among participating FP service providers and/or commodity dispensers to help ensure a safe and efficient transfer of services in the network As necessary, the municipality may also improve the systems or procedures contained herein so that it may respond to other conditions existing in the locality. 4 SCOPE OF THE FP REFERRAL SYSTEM The local health landscape consists of the private sector and the public health sector. To date, the bulk of family planning services are still availed of from the public sector. With the phase-down of donated contraceptives, the private sector will now have a more active involvement in the effort to address the challenges of the national family planning program. One of the ways this can be done is through organizing a referral network. Broadly speaking, the referral network can be established along the following types: 1. Referrals from Public Sector Facilities/Providers to other Public Sector Facilities/Providers 2. Referrals from Public Sector Facilities/Providers to Private Sector Facilities/Providers 3. Referrals from Private Sector Facilities/Providers to Public Sector Facilities/Providers 4. Referrals from Private Sector Facilities/Providers to other Private Sector Facilities/Providers This manual will focus on the second referral type (i.e. from Public to Private) although much of the procedures may be applicable to any of the other three sectors. In addition, within each sector, there are different geographic levels of health service delivery such as: 1.
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