Mindanaohealth Project Program Year 6 Accomplishment Report (October 2017- September 2018)

Home , Cabadbaran, Caraga, Godod, Labangan, Lapuyan, Marawi

MindanaoHealth Project Program Year 6 Accomplishment Report (October 2017- September 2018)

Vol. 01: PY6 Accomplishment Report

Submitted: November 15, 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: USAID’s MindanaoHealth Project with Jhpiego represented by Chief of Party Dr. Dolores C. Castilo (center) launches the USAID-supported Social Media for Adolescent-Youth Reproductive Health (SoMe4AYRH) campaigns starting in the region of Caraga, to increase points of contact with young people through platforms familiar to them, which is the social media, for them to be provided with accurate, appropriate and needed health information and services. Also present during the launch were (from left to right) Department of Education-Agusan del Norte Division Superintendent Arsenio T. Cornites Jr., CESO V; Commission on Population Caraga Director Alexander A. Makinano, CESE; and Department of Health Caraga OIC-Assistant Regional Director Dr. Gerna Manatad. (MCossid/Jhpiego)

Bottom left: In conflict-affected areas such as in Lanao del Sur, health providers are continually providing health services including family planning especially to women with unmet need who could not easily access services from health facilities. (RTindugan/Jhpiego)

Top right: A trained health provider from Zamboanga del Sur explains family planning to a postpartum mother teaching her to protect herself from unplanned immediate pregnancy. (Photo by: Jhpiego)

Bottom right: A teacher-participant undergoes teaching demonstration of Health and Sexuality Education using lesson plans they developed during a USAID-supported training. (FMorales/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 (to be updated once finalized) ...... 5 1. Activity Overview/ Executive Summary ...... 9 1.2 Program Description/Introduction ...... 9 1.3 Description of Key Achievements: ...... 10 1.4 Key Challenges ...... 11 2. Key Achievements and Challenges ...... 12 2.1 Key Achievements for the year ...... 12 2.2 Standard Indicators Update ...... 17 Indicator FP 1: No. of Modern FP Current Users in USG-Assisted Areas ...... 17 Indicator FP 2: Couple Years Protection (CYP)* in USG-Assisted Areas ...... 23 Indicator FP 3: Average Stock- Out Rate of Contraceptive Commodities at Family Planning Service Delivery Points (SDPs) ...... 25 Indicator FP 4: Percent of USG-assisted SDPs Providing FP Counseling and Services to Couples, Men, Women, Youth and Adolescents of Both Sexes ...... 29 Indicator FP 5: Number of USG-assisted community health workers (CHWs) providing family planning (FP) information, referrals, and/or services during the year . 31 Indicator N 1: Percent of LGUs conducting data quality checks (DQC) ...... 39 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 ...... 38 Indicator NI 1: No. of Women of Reproductive Age that Have Been Profiled and Identified as Having Unmet Need for FP ...... 42 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. 43 Indicator NI 3: Percentage of PPFP/PPIUD Trained Providers that Have Been Certified by the Department of Health in USG Assisted Sites ...... 45

Indicator NI 4: Number of Newborns Not Breathing at Birth who were Resuscitated in USG-Supported Programs ...... 47 Indicator NI 5: Number of SDPs in Marawi City with Functional Health Service Provision. .. 48 Indicator NI 6: Percent of Audience recall of hearing and/or seeing MH-supported FP/RH Key Messages...... 51 Indicator CAA1: Number of Health Outreach Conducted ...... 52 Indicator CAA2: Number of Civil Society Organizations Trained to Effectively Engage with Local Governments ...... 53 Indicator CAA3: Number of youth trained as peer educators ...... 54 Indicator CAA4: Number of clients reached during health outreach activities ...... 55 3. Cross-Cutting Issues ...... 55 3.1 Updates on Gender ...... 55 3.2 Update on Sustainability and Self-Reliance ...... 57 3.3 Update on Environmental Compliance and Climate Risk Mitigation ...... 58 3.4 Update on Family Planning Compliance (no ARMM report) ...... 61 4. Collaboration, Learning and Adapting ...... 62 5. Management, Administrative and Financial Issues ...... 64 6. High-Level Planned Activities for October-December, 2018 ...... 64 6.1 High level turn-over of supply support to Marawi and its Corridors in December 2018 ..... 64 6.2 Regional Dissemination/Turn For-over Activities: October–November 2018 ...... 64

List of Acronyms

AND Agusan del Norte ADNPH Agusan del Norte Provincial Hospital ADS Agusan del Sur AJA Adolescent Job Aids ANC Antenatal Care APMC Amai Pakpak Medical Center ARMM Autonomous Region of Muslim Mindanao AY Adolescent and Youth AYRH Adolescent and Youth Reproductive Health BaSulTa Basilan, Sulu, and Tawitawi BEmONC Basic Emergency and Obstetric Newborn Care BHW Barangay Health Worker BTL Bilateral Tubal Ligation CAA Conflict Affected Area CDI Cities Development Initiative CDOC Cagayan de Oro City CEmONC Comprehensive Emergency Obstetric and Newborn Care CHO City Health Office CHT Community Health Team CHW Community Health Worker CIP Costed Implementation Plan CPR Contraceptive Prevalence Rate COE Center of Excellence CRMC Cotabato Regional Medical Center CSO Civil Society Organization CSR Cotraceptive Self Reliance CU Current Users CYP Couple-Years of Protection

DOH-CO Department of Health- Central Office DOH-RO Department of Health- Regional Office DQC Data Quality Check DRMC Davao Regional Medical Center EO Executive Order EOP End of Project FBD Facilty Based Delivery FHA Family Health Associate FHSIS Field Health Services Information System FP/AY Family Planning/Adolescent Youth FPOP Family Planning Organization of the Philippines GIDA Geographically Isolated and Disadvantaged Area GTLMH Gregorio T. Lluch Memorial Hospital (LGU hospital in Iligan City) HEEADSS Home environment, Education and employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, and Safety 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 LAPM Long Acting and Permanent Method LARC Long Acting Reversible Contraceptive LARC-PM Long Acting Reversible Contraceptive-Permanent Method LCE Local Chief Executive LDS Lanao del Sur LDN Lanao del Norte LGUs Local Government Units

LIPH Local Investment Plan for Health

LTO License to Operate M&E Monitoring and Evaluation MCP Maternity Care Package MCP/NCP Maternal Care Package/Newborn Care Package mFP Modern Family Planning MH MindanaoHealth MHO Municipal Health Office MIT Municipal (RPRH) Implementation Team MLLA Mini Laparotomy using Local Anesthesia MNCHN/FP Maternal, Newborn, and Child Health and Nutrition/Family Planning MOA Memorandum of Agreement NCP Newborn Care Package NDP Nurse Deployment Program NFP Natural Family Planning NGO Non-Government Organization NMMC Northern Mindanao Medical Center NSV No Scalpel Vasectomy PDOHO Provincial DOH (Department of Health) Office PHIC Philippine Health Insurance Corporation PhilHealth Philippine Health Insurance Corporation PHN Public Health Nurse PHO Provincial Health Office PIT Provincial (RPRH) Implementation Team POPCOM Commission on Population PPFP Postpartum Family Planning PPIUD Postpartum Intrauterine Device PPP Public Private Partnership PSI Progestin Subdermal Implant PY Project Year R & R Reporting and Recording

RHU Rural Health Unit

RIT Regional Implementation Team RPRH Responsible Parenthood and Reproductive Health SARC Short Acting Reversible Contraceptive 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 TA Technical Assistance TCL Target Client List TRO Temporary Restraining Order USG United States Government WRA Women of Reproductive Age ZCMC Zamboanga City Medical Center (DOH hospital)

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

Project Year 6 Annual Report: October, Reporting Period: 2017 – September, 2018

1.2 Program Description/Introduction

The MindanaoHealth (MH) project, a five-year (2013–2018) initiative funded by the United States Agency for International Development (USAID), is implemented by Jhpiego in partnership with RTI International. The Project’s first 5 year goal is anchored to USAID/Philippines Health Strategy goal “Family Health Improved”, with three objectives namely: (i) supply of an integrated maternal, neonatal, and child health and nutrition, and family planning (MNCHN/FP) services improved, including the availability and quality of public sector services and selective expansion of the private sector as primary care supplier; (ii) demand for primary care services strengthened by encouraging adoption of appropriate health behaviors within families; and (iii) policy and systems barriers removed to improve supply and demand for services, ultimately contributing to improved child health and nutrition, reduce maternal and infant deaths, and decrease unmet need for FP services, especially among the population belonging to the lowest wealth quintiles, and in conflict-affected areas 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 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 the later part of PY5, MindanaoHealth was granted a 10-month cost extension from March 2018 - December 2018 to continue to work in areas with low income/poor populations with high-unmet need for FP, high teenage pregnancies and high neonatal deaths by scaling-up evidence-based best practices that include promising high impact interventions on adolescent reproductive health. Specifically, MH will help: bolster the capacity of the local health systems in consolidating results and institutionalizing effective strategies to reduce unmet need for modern family planning teenage pregnancies, and maternal and child mortality; develop innovative approaches in the provision of quality adolescent reproductive health and gender-friendly health services; and assist in providing immediate response to health emergencies in Marawi City and its corridors as well as restoring/strengthening essential family planning and maternal and child health services. MH’s core interventions and activities are fully in synchronization with the 2017-2022 USAID/Philippines’ Health Project overall goal of “Improved Health for Underserved Filipinos”.

1.3 Description of Key Achievements:

The technical assistance on integrated maternal, neonatal, and child health and nutrition and family planning (MNCHN/FP) in USG-sites in Mindanao started in 2013, in close collaboration with the five (5) Regional Health Offices of DOH and DOH-ARMM and with the LGUs of 19 provinces, 2 highly urbanized cities, and 368 municipalities/component cities. This partnership resulted to: a) increased and sustained number of MCP/NCP accredited facilities in USG-sites from 168 in 2012 to 301; b) 819% increase in the number of SDPs providing FP counseling and services from 81 in 2012 to 744 in September 2018, 90 of which are providng AY-friendly services (19 supported hospitals implementing integrated FP/AY Programs, with itinerant teams and 71 AY-friendly primary health facilities) reaching 64,869 adolescent/youths with varied FP/RH services; d) 21 Service Delivery Networks on MNCHN/FP/AY Services established with initial promising results showing significant contribution of SDNs to CU and CYP - the average CYP generated from the 11 SDN sites was 44% of the total provincial CYPs; e) the conduct at least annual data quality checks in all facilities are institutionalized with available pool of capable DQC-trained HSPs, further supported by the issuances of resolutions/policies supportive to DQC by the Local Chief Executives/Health Leaderships in ARMM, 15 provinces and 28 municipalities,; f) capacitated pool of certified trainers: 25 for BTL, 72 for PPIUD and 6 for LARC/PSI, and no longer dependent from Manila-based trainers; g) strengthened oversight functions of DOHROs and functionality of RIT/PIT/MIT, though at varying degrees ; h) significant increase in CU from 1,070,486 in 2012 to 1,689,513 in 2018 ( source: FHSIS) with an additional users of 619,027; and i) increasing trend in Couple-Years of Protection (CYP) through out the project life.

These results contributed to the overall improvement on FP/MNCHN indicators from 2013 to 2017 as revealed in National Demographic Health Surveys (NDHS) as follows:

National Demographic Health Surveys Results on Selected FP/MNCHN Indicators by Region in Mindanao, 2013 and 2017 CPR, any FP Unmet ANC FBD Region method Need 2013 2017 2013 2017 2013 2017 2013 2017 PH National 34.6 54.3 12.5 16.7 42.5 86.5 61.1 77.7 Zambo Pen 47.3 49.5 21.9 24.0 35.8 88.9 43.4 72.3 Northern Mindanao 50.7 53.5 20.2 17.8 42.9 92.0 52.6 76.0 Davao Region 53.8 62.2 17.5 13.5 33.1 91.9 62.9 74.1 SOCCSKSARGEN 57.5 58.9 15.6 17.5 33.2 74.1 48.5 63.5 CARAGA 54.2 54.8 13.7 17.8 45.9 90.4 55.5 77.2 ARMM 23.9 26.3 27.6 17.8 9.0 47.8 12.3 28.4

Performance indicators like CPR – all methods, 4ANC, and FBD have increased in all the regions in Mindanao while the proportion of WRA with unmet need for FP has decreased in Northern Mindanao, Davao Region, and ARMM. ARMM showed highest gains in terms of 4ANC and FBD at 431% and 131% rate of increase respectively, as well as in the reduction of FP Unmet Need at 36%. The increase in FBD in Mindanao regions, except for Davao Region, is higher than the average rate of increase in the country. Furthermore, the reduction in FP Unmet Need in Northern Mindanao, Davao Region, and ARMM ranging from 12 to 36 percent is higher than the national average reduction of 4.6%. The increase in CPR of any method in regions Zamboanga Peninsula, SOCCSKSARGEN, and CARAGA is minimal, therefore emphasis and stronger advocacy on the scaling up of emerging proven good practices like SDN in GIDAs, FP/AY integration in the hospital and Toktok Planado among others during the Regional Dissemination Forum will help expand the reach on FP/MNCHN/AY in these regions considering that there is also an increase in their FP unmet needs per 2017 NDHS results.

1.4 Key Challenges

In addition to operational challenges due to inadequate transportation systems limiting mobility, and the geographic nature of the areas, not to mention security challenges in Mindanao, the following key challenges have affected the delivery of quality integrated FP/MNCHN/AY Services; (1) difficulty of LGUs and private clinics in maintaining the physical structure of their MCP/NCP PhilHealth accredited facilities, 2) dwindling FP commodity in the USG-supported sites, aggravated by FP commodity distribution through push strategy, and (3) poor compliance of some level 3 DOH hospitals to DOH Memo classifying them as reporting units and requiring them to submit report to DOH-ROs, among others, due to inadequate regional oversight to narrow-down gaps between policy/technical guidelines and actual operationalization of these policies at implementing levels, in general.

In January 1, 2018, PhilHealth required all maternity care package providers/birthing homes applying for initial, or re-accreditation to submit DOH License to Operate (LTO). This resulted to a reduction of the number of public and private health facilities who were unable to renew their MCP/NCP-PhilHealth accreditation due to their failure to comply with DOH-licensing requirements. This issue was brought to the attention of the RPRH-National Implementation Team, but there is no concrete action to date from the DOH’s Bureau of Health Facilities and Services, not to mention the varied interpretation of guidelines at regional/provincial offices of PhilHealth/DOH.

To date, FP commodities from the Central Office are distributed to various service delivery points through push strategy with little or no analysis of inventory and consumption reports being submitted by DOH-ROs and LGUs through the FP Logistics Hotline. Inventory reports from different SDPs showing critical stock level of IUD and PSI coupled with increasing demand for PSI, and with the non-procurement of FP commodities by DOH this year, FP- commodities stock-out rates observed on the ground may continue to increase not only for SARC but also for LARC, especially for PSI. To help SDPs with critical stock level, the project technical support focuses in strengthening existing mechanisms geared towards institutionalization of FP commodity recording and reporting system through the FP commodity tracking network (logistics hotline and social media) as initial step to shift DOH FP commodity/logistic support from push to pull strategy, while coordinating at regional and local level for DOH pharmacist and FHAs to regularly monitor health commodities, including FP, as input to immediate reallocation and redistribution of commodities through inter-LGU and facility coordination, and advocating at DOHRO and/or LGUs to procure FP commodities.

Despite DOH-led national orientation of core hospital team on FP recording and reporting and follow-through technical assistance by the Project, in close collaboration with regional health offices, the take-off among hospitals is very slow for varying reasons such as: difficulty to institutionalize due to too much dependence to designated focal person who also performs other tasks and lack of additional HRH to support the FP Program; fast turnover of trained staff; and transfer of trained staff to perform other tasks in other department, among others. Lastly, while the Project‘s and DOH-ROs’ initiatives of downloading policies/technical guidelines on FP/MNCHN/AY to LGU partners for their localization is working in some regions with appreciation from the LGUs, other DOHROs in Mindanao need to strengthen their technical oversight.

2. Key Achievements and Challenges

2.1 Key Achievements for the year

During the extension period, MH has continued to address health system gaps in three (3) major components – supply, demand, and policy/financing, while supporting the provision of

FP/MNCHN and other services to post Marawi siege IDPs and host communities. Each

13 component focuses on five (5) major stakeholders with different roles to play in translating MH technical assistance (TA) and 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 Project’s key achievements during PY6 –from October 2017 to September 2018, are as follows:

 Surpassed EOP Target on FP Current Users. The number of current users (CU) as per FHSIS report in April –June 2018 is 1,698,137 that is 58.63% higher than the 2012 baseline figure of 1,070,486 and equivalent to 105% of the EOP target of 1,615,402. Both 12 priority sites and the 5 provinces/HUCs that are already performing well with minimal technical assistance from the project accomplished their EOP targets at 104% and 123% respectively. These contributed 83% to overall system-wide CU. There is an observed increasing trend in the number of CU with a dip in Q2PY5, then back to a rising trend in the last 5 quarters at an average rate of 3.1% per quarter.

The percentage share of MH Project to FHSIS’s total number of FP acceptors in the previous 4 quarters has increased from 20.6% in Q4PY5 to 76% in Q3PY6. The improved capacity of the public sector with itinerant teams from hospitals, partnership with private sector/CSO in FP/MNCHN service providers, and the increasing LGU-initiated outreach services supported by the Project resulted to the increase in MH contribution.

 Exceeded PY6-CYP Target. The cumulative CYP-accomplishment for the past four (4) quarters is 571,468 or 101.5% of PY6 annual target of 562,837. The Project’s support resulted to: a) an increased number of HSPs trained on BTL-MLLA, PPFP/PPIUD, PSI, FPCBT2 who are strategically located in USG-sites; b) increased number of hospitals (19 as of Q4PY6) implementing FP/AY Programs integrated with hospital services; c) expanded reach through outreach FP services by public hospitals, FP-itinerant teams from IPHO and RHUs, and NGOs, and e) increased number of RHUs/CHOs/private birthing facilities with PhilHealth MCP-accreditation with reimbursement for performance of IUD and PSI procedures contributed to the sustained increase in the number of LARC-PM (especially PSI) and other acceptors.

 Significant increase in SDPs providing FP Services. As of PY6, a total of 744 SDPs are providing FP counseling and services, an 819% increase from 81 SDPs in 2012. Sixty-nine

percent (69%) of these SDPs are in rural areas, and seventeen percent (17%) are private facilities. The observed increased in the contribution of fixed FP LARC/PM services of 50.4% to total LARC/PM clients in Q3PY6 will continue to increase with the increasing frequency of providing FP fixed services across these functioning facilities. This is a shift from the observed pattern in Q1PY6 where 67.5% were reached through outreach. This does not discount though, the contribution of outreach services to expand services in GIDAs, as well as in conflict affected areas – for example Lanao del Sur was able to surpass its CU target by conducting at least two outreach services every month in the last two quarters.

The sustainability of SDPs providing FP services, despite personnel movement among other challenges, can be maintained with a) the presence of established pool of certified trainers on a wide range of FP methods, b) 5 centers of excellence on PPIUD strategically located in Mindanao, and c) 19 hospitals now implementing FP/AY services integration with hospital services and certified as clinical practice and mentoring sites. This pool of resources supports the continuous capacity building initiatives in Mindanao, not to mention the PhilHealth benefits that can also support their financial viability to provide quality care/services.

 Improving Efficiency of Service Delivery through SDN Initiative

o In the USG-assisted 21 SDNs, there are 128 public facilities that were linked to four apex hospitals (CRMC, SPMC, DRMC, and NMMC), 18 public hospitals with FP and AY programs, and 14 private hospitals that provide LAPM and CEmONC services. There were 1,013 health services providers both from public and private sectors that were trained and provided services for implants, IUDs, PPFP/PPIUD, and BTL/MLLA with 17,600 clients served (PSI-8,665 and LAPM- 8,935). Based on the initial analysis done by the project on SDN’s potential contribution to CYP involving 11 SDN sites, the average CYP generated by the SDN in a province is at 44%. Furthermore, available provincial data showed that functional SDNs namely BITES in Sultan Kudarat, DO Plaza Cooperative Zone in Agusan del Sur), and three (3) operational SDNs namely South Bukidnon, SANLAKASS in Lanao del Sur, and Liloy SDN in Zamboanga del Norte have a bigger share in the province’s CYP relative to their share in the province’s population. o The public, private and community partnership modality was a key strategy to addressing health system gaps in the network in the area of capacity building support, human resource complementation, fund augmentation, and commodity security. The partnership also formalized the cross-border and cross-sector referral service delivery provision among SDN members including the gradual institutionalization of a unified reporting system where the private facilities and providers are required to submit regular health service delivery reports.

o Lastly, financing mechanism of SDN is largely hinged on optimizing PhilHealth reimbursements to be plowed back to health services through policy support and the creation of a common trust fund to support SDN operations and cover hospital costs of referred PhilHealth beneficiaries. To date, there are 333 of the 368 LGUs with policy on the

use of PhilHealth reimbursement, a 97% increase from 169 LGUs in 2012, project-wide. Within SDN, there are 35 LGUs that cost-share operations in seven SDNs; 107 of the 124 LGUs have policy on the use of PhilHealth reimbursements; and a total of 178 (105 public birthing facilities, 31 public hospitals, and 42 private birthing clinics) or 77% out of 231 (158 public birthing facilities, 31 public hospitals, and 42 private birthing clinics) SDPs are MCP/NCP accredited and implementing NBB.

 Surpassed the EOP-target for number of PhilHealth accredited facilities The project exceeds its EOP target of 277 MCP/NCP PhilHealth accredited facilities with 301 health facilities in USG-sites with additional 95 facilities accredited for the first time and 206 facilities maintaing their MCP/NCP PhilHealth accreditation to date, despite the stiff DOH requirement for LTO issuance that resulted to substantial reduction in PhilHealth accredited SDPs in Misamis Oriental to 5 from 13, and in Cagayan de Oro to 15 from 48. In the case of CDO, meeting the LTO requirements for all the 48 was challenging that they opted to work for the MCP/NCP accreditation of 15 strategically situated facilities to ensure better management and provision of quality services accessible to its constituents citywide.

 Increased number of AY-friendly hospitals, RHUs/CHOs and schools MH’s sustained TA on AY resulted to increase number of hospitals with integrated FP/AY Programs within hospital services from 8 in PY5 to 19 hospitals PY6 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. Also, the number of RHUs/CHOs and schools that have been declared AYRH- friendly facilities increase from 47 (35 RHU/CHOs/12 schools) in PY5 to 111 (71 RHUs/CHOs and 40 schools) in PY6.

 Continued support to Marawi and its environs resulted to a four point two percent (4.2%) increment in CU for Lanao del Sur (647) and in Marawi City (930) thereby surpassing their EOP CU target. The conduct of at least two outreaches per month in PY6 enables the province to exceed its target despite the fact that only 46 out of its 53 facilities are providing FP services. In addition, the project accessed technical expertise of SURGE team, a technical provider to MCWD-LUA-DILG Salintubig Initiative, in the installation of 3 water tanks in health facilties (BHS of Ambolong and Tuca in Marawi and Nunungan RHU of LDN). The installation of the remaining 7 water tanks is ongoing with completion date end of October. Furthermore, provision of maternal and neonatal services resulted to reaching additional 7,722 pregnant women, and 5,881 postpartum women provided services including the provision of dignity kits and maternity kits respectively during the quarter. Also, psychosocial services were provided to 124 women and 105 adults during outreach services, in partnership with Duyog Marawi. The 24 trained MRLs are now using Khutba materials (Maranao dialect) as reference during sermons and other relevant community meetings/assemblies to encourage male to

support their partners/wives or/and access FP services. Lastly, MH closely worked with B –

LEADERS Project in the assessment of the 4 targeted health facilities and installation of solar powers. Three of the four recipient facilities will also be provided with solar refrigerators upon arrival in country early December.

 Capacities of USG-assisted LGUs on FP/AY Services shifted from low/Level 1 to Medium/High Level. The FP capacity index aims to measure 13 key result areas that can widen access to FP/AY services, increase demand, and establish an enabling environment for sustainability, while looking at the demographic and geographic profiles. A weighted scoring or threshold is 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 with 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 to arrive at a maximum composite FP capacity index of 100. With the indices serving as proxies for LGUs’ performance levels, they are now grouped into three (3) classes: High/Level 3 (76 to 100); Medium/Level 2 (51 to 75); and Low/Level 1 (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.

There is a significant improvement in the capacity of USG-assisted LGUs in Q4PY6 FP Capacity Index as compared to the Q4PY5 results. The six USG-sites namely Zamboanga City, Davao Oriental, Lanao del Sur, Tawi-Tawi, Sulu, and Zamboanga del Norte located in Level 1 (red zone) in 2017 moved to Level 2 (yellow zone), with Zamboanga del Norte nearer to Level 3 (green zone). Ten (10) out of the 18 USG-sites in Level 2 moved to Level 3 in Q4PY6, while the progress made in the other remaining seven (7) USG fall short of reaching the green zone and no movement for Davao City. With the observed high score on policy and financing mechanisms - supportive to institutionalizing reforms, building up these gains through sustained advocacy and leveraging resources, and focused technical support from oversight bodies and other development partners will result to strong capable local health system able to provide quality FP/AY services along the continuum of care across levels of health care. (Fig. 1 & 2 under 7.6 of Volume 2)

The increase in FP Capacity Index from Q4PY5 to Q4PY6 ranges from 4% to 69% with Lanao del Sur posting the highest percentage increase. The accelerated support to Lanao del Sur post Marawi Siege resulted to profiling 27,916 WRA with unmet need and provision of FP services to 2,351 with support from 39 FHAs trained by the project; conduct of at least two outreach services per month, in partnership with civil society organizations, with demand generation as integral component; certification of 3 BTL/MLLA providers and 10 supportively supervised LARC/PSI trained HSPs recommended for certification; and training of additional 30 CHWs.

The overall increase in the FP Composite Index in all USG-sites, except Davao City are due to: 136% increase in the number of AY friendly facilities from 55 in PY5 to 130 in PY6 (from 8 to 19 hospitals; from 35 to 71 RHUs and from 12 to 40 schools) with varying functionalities; 25% increase in the number of LGUs that conducted DQC from 280 in PY5 to 349 in PY6; increasing

number of FP trained HSPs supportively supervised and certified; and sustained support to 21 SDNs across USG-sites resulting to 4 functional, 10 operational and 7 organized SDNs. While there is increase in total FPCI scores per USG-sites, the slight decrease in the reduction in the number of MCP/NCP accredited SDPs, reduction in the number of validated SDPs providing FP counseling and services from 757 in PY5 to 744 in PY6, and the increasing number of facilities with stock-outs has affected the movement of FPCI scores in some LGUs such as Zamboanga del Sur, Misamis Oriental, and Cagayan de Oro.

The technical support in Davao City during the year resulted to: i) increase in the number of hospitals with FP/AY Programs from 1 (SPMC) to 3 SPMC, Brokenshire and San Pedro Hospital), ii) DOH-certification of 2 out of 7 supportively supervised PPIUD trained HSPs, iii) increase outreach services in the later part of the year, and iv) sustained support to District 2 SDN. Analysis of CUs and CYP accomplishment of the city for the year though, showed that city exceeded its CU targets but fall short with its CYP for the following reasons: San Pedro Hospital, being a Catholic-managed facility, provides only NFP methods; TA to Brokenshire was only in the later part of PY6, reduction of SDPs providing FP counseling and services from 75 to 66 with the closure of 9 private facilities in Q2PY6; reduction in the number of AY-friendly RHU facilities from 12 to 9, and stock-outs in 10 facilities. In summary, MindanaoHealth Project has achieved its deliverables/commitment as reflected in the performance reached per standard indicators below.

2.2 Standard Indicators Update

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

Table 1.0 Distribution of Number of Current Users in USG/MH-Assisted Sites by Priority Clusters, PY5-PY6 Accomplish Accomplishment, Project Areas Baseline ment, PY5 PY6a Clustered by level of 2012 Target, Priority Actual % PY6 (A) Priority Areas: (1) 12 priority 704,076 1,065,334 1,100,761 1,148,358 104 Sites (2) CAA Sites: (a) BaSulTa, 147,063 180,564 174,758 97 Zambo City 267,936 Cotabato City (b) Marawi & 103,029 118,590 107,044 90 Its Environs (B) 5 Non-Priority 98,474 152,795 215,487 267,977 124 Sites Project-wide 1,070,486 1,468,220 1,615,402 1,698,137 105

Analysis of Accomplishment

The number of mFP-current users (CU) increased by 3.3% from 1,643,924 in the previous quarter compared with PY6-target, this achievement is already 105%. The project-wide PY6-target was already surpassed in the previous quarter [Figure 1].

Figure 1 illustrates an increasing trend in the number of current users in the last 4 quarters at an average rate of 3.1% per quarter (ranges from 1.6% to 4.3) with highest rate of increase observed in Q2PY6. Only Davao del Sur, Zamboanga del Norte, North Cotabato, and Cagayan de Oro City showed a sustained increase in their number of current users in the four (4) previous quarters [Table 01 in Vol. 2].

Figure 1: Summary of Accomplishments and Trends in Current Users (Q4PY2 – Q3PY6)

Compared to their accomplishment in the previous quarter, most of the provinces/HUC posted an increase in the number of current users including Lanao del Sur. The highest rate of increase at 14.3% was observed in Bukidnon – from 113,043 to 129,194. This exemplary accomplishment is due to the following factors: a) Creation of the Provincial FP Itinerant Team that uses the SDN approach in providing LARC+ services especially in GIDAs and in areas where there are no or very few trained HSPs on LARC+ services, b) Creation of the PIT/MIT/CIT – clarifies the roles of each agency involved in the implementation of RPRH at the local level thereby increasing support to FP Outreach Services - both technical and financial, c) institutionalization of recording and reporting system with periodic DQC that ensures recording of all WRA provided with FP services as per FP Form 1 in the Target Client List which is the source document/record for the monthly FHSIS FP report, d) Functional logistics reporting, recording, management and data utilization that prevents stock out of FP commodities coupled with the strong inter-municipal and inter-regional coordination especially on FP commodity sharing, e) quarterly incremental increase in the number of MH-assisted CHWs who were able to help reach 56,306 WRA with unmet need, providing FP information and referred 40,454 or 72% for FP services.

During the quarter, the increment in the number of CU in Lanao del Sur is 647 and that of Marawi City is 930 – a 4.2% increase for the entireo province. Like many of the provinces/HUC, Lanao del Sur has also surpassed its PY6-target for CU in the previous quarter. The conduct of at least two outreach services per month in Lanao del Sur in PY6 enables the province to surpass its EOP target for CU and CYP, despite only 46 out of 53 targeted SDPs are providing FP counseling and services.

Compared to the accomplishment in PY5, there is an increase in the number of current users by 15.1% (Table 1.0). Also, current users has increase by 619,027 as of end of project life, giving a total current users of 1,698,137 as compared to the 2012 FHSIS-figure of 1,070,486, equivalent to a rate of increase of 57.8%.

The priority areas-cluster, which is composed of 12 LGUs, and the non-priority areas-cluster consisting of 5 LGUs exceeded their PY6-target and contributed 67% and 16% respectively to the over-all total current users [Table 01 in Vol. 2].

Table 1.1. Distribution of Current Users by Type of mFP methods, in USG/MH-Assisted Areas, Q3PY6 LAPM LARC SARC (pills, NFP Project Areas (NSV/BTL) (PPUID,IUD,PSI) DMPA, condom) Total # % # % # % # % # % A. Priority Areas: (1) 12 Priority 102,240 9% 193,642 17% 735,878 64% 116,598 10% 1,148,358 67 Sites (2) CAA : (a) BaSulTa, 9,593 9% 17,467 17% 122,982 64% 24,716 10% 174,758 10.5 Zambo City, Cotabato City (b) Lanao del 3,979 9% 11,216 17% 72,486 64% 19,363 10% 107,044 6.5 Sur & Norte B. 5 Non-Priority 26,879 9% 53,584 17% 151,638 64% 35,876 10% 267,977 16 Sites Project-wide 142,691 8% 275,909 17% 1,082,984 64% 196,553 12% 1,698,137 100

As to the distribution of current users, as in the previous quarters SARCs (pills, DMPA-injection, and condom) are still the most popular in all project areas accounting for 63.9% of total CUs [Table 1.1 above]. Among the project areas, the mFP-users in Conflict Affected Areas are comparatively more dependent on SARC especially Sulu (79.2%), Tawi-tawi (75.2%), Lanao del Norte (73.5%) and Cotabato City (71.0%) [Table 02 in Vol. 2]. For every 4 NFP-users, 3 are LAM- users. Given this situation, health workers should continue to be guided and monitored, to ensure LAM users are counselled properly to shift to more effective and long acting FP methods of their choice on time.

There is a small shift in the distribution of CUs in Q3PY6 compared to that in Q2PY6 – there is a decline by 0.7% (n=1,363) in NFP-users and a rise by 6.2% (n=16,129) in LARC-users with the increasing popularity of PSI. PSI-users increased by 14.3% - from 64,426 in Q2PY6 to 73,627 in Q3PY6 [Table 02 in Vol. 2]. Of the total number of current users in Q3PY6, 24.5% (n=413,353)

are LARC-PM users. This is 3.8% higher than the LARC-PM users (n=398,080) in Q2PY6. About one-third of total CUs in Gen. Santos City (35.3%), Cagayan de Oro City (32.4%) and Misamis Oriental (31.4%) are LARC-PM-users [Table 02 in Vol. 2]. The dis-aggregation of potential clients into limiters and spacers with targeted focused counseling is a contributory factor to high LARC/PM users in these three USG-sites, including close follow-up of referred clients to ensure that they accessed desired methods of their choice.

Figure 2 reflects an increasing trend in the number of LARC/PM new and other acceptors, and a sustained increase from 21,528 in Q3PY5 to 36,857 in Q3PY6. Except for NSV, a sustained increase in the number of new and other acceptors of BTL, IUD/PPIUD and PSI has been observed since Q1PY6. The biggest rate of increase is noted in the number of PSI-acceptors with average rate of increase of 41.7% from Q4PY5, with the highest rate observed in Q2PY6 (75.9%). The increasing popularity of PSI is due to a) its relatively better acceptability among clients (“less invasive compared to IUD”), b) relative ease in performing the procedure especially in an outreach setting, c) increasing number of HSPs trained on LARC-PSI supportively supervised and receiving DOH certification which is a requirement for PhilHealth accreditation, d) higher PhilHealth reimbursement (P3,000 for PSI vs P2,500 for IUD), and e) more outreach services in barangays by IPHO/RHU-based itinerant team offering SARC/NFP and LARC-PSI services. As such, further analysis on the proportion of user of a particular LARC-PM method in the past 4 quarters shows that the proportion of PSI new and other acceptors is increasing – from 28.7% in Q4PY5 to 49.9% in Q3PY6 while the proportions of BTL and PPIUD/IUD new & other acceptors relative to the total are declining – from 20.4% in Q4PY5 to 15.6% in Q3PY6, and from 43.0% in Q4PY5 to 33.8% in Q3PY6 respectively.

Figure 2: LARC-PM New and Other Acceptors by Method and Quarter, Q4PY2-Q3PY6

Source: DOH FHSIS

Figure 3 reveals that contribution of FP fixed sites continues to increase from 62.5% in Q2PY6 to 64.4% in Q3PY6 LARC/PM new and other acceptors relative to the total, a shift from the observed pattern in Q1PY6 where 67.5% were served in outreach services. The improved capacity and increased in frequency of FP fixed services in MH-supported public health facilities and the close down of one NGO providing more frequent LARC/PM services through outreach are factors in the shift, not to mention that the majority of FP outreach services are conducted by LGUs (itinerant team from the IPHOs and RHUs) that offer only SARC/NFP and LARC-PSI.

In Q3PY6, the contribution of private sector partners remained small (n=1,892 or 6.7%) relative to the total number of LARC-PM clients served in Q2PY6, slightly lower when compared to its contribution in Q1PY6 (n=1,275 or 8.7% of the total), - a 23% reduction 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 and non-renewal of MCP/NCP PhilHealth accreditation of 41 public health facilities in Misamis Oriental and Cagayan de Oro City.

Figure 3: LARC-PM Clients Served in Fixed Sites and Outreach Activities Supported by MH (Q1PY3-Q3PY6)

Figure 4 shows that there is a significant increase in MH’s contribution to FHSIS’s total number of LARC-PM new and other acceptors in the previous 4 quarters – from 20.6% in Q4PY5 to 76% in Q3PY6.

The improved capacity of the public sector with itinerant teams of hospitals and the accelerated LGU-initiated outreach services with sustained support from the Project resulted to increased MH contribution.

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

MH sustained technical assistance to SDPs resulting to reaching additional 20,188 LARC/PM acceptors in Q4PY6 as reflected in table 1.2 below:

Table 1.2. Distribution of LARC/PM Contribution of MindanaoHealth by Project Areas, Q4PY6

Total Type of Service Providers LARC/PM Project Areas Acceptors Public Sector Private Sector # % Fixed Outreach Fixed Outreach

A. Priority Areas: (1) 12 Priority 11,739 58 Sites (2) CAA : (a) BaSulTa, 2,575 13 Zambo City, Cotabato City (b) Lanao del 1,023 5 Sur & Norte B. 5 Non-Priority 4,851 24 Sites Project-wide 20,188 100 8,558 11,369 261 0

LARC/PM contribution from MH for Q4PY6 is lower by 27.7% from Q3PY6 contribution of 27,918. More than half (58%) were generated from 12 priority LGUs, and 98.7% (n=19,927) delivered by the public sector through outreach services (57.1%) and fixed services (42.9%). The contribution of the private sector is negligible at only 1.3% (n=261). Sixty-nine percent (69%) of total CU are PSI users, followed by PPFP/IUD at 22%, BTL at 8.55 and only 0.5% NSV (97). This Q4PY6 MH contribution to CU is equivalent to 73,363 Couple-Years Protection.

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

Table 2.0 Couple Years Protection (CYP)* by USG-MH Assisted Sites as of Q3PY6 Cumulative Accomplishment Accomplishment, Project Areas Baseline Q3PY6 Q4PY5-Q3PY6 Target PY6 Actual % Actual % (A) Priority Areas: 169,518 386,851 103,774 26.8 360,618 93.2 (1) 12 Priority Sites (2) CAA Sites: (a) BaSulTa, Zambo 56,660 22,532 39.8 61,792 109.1 City, Cotabato City 25,543 (b) Marawi & Environs (Lanao Sur 14,821 4,633 31.3 17,874 120.6 & Lanao Norte) (B) 5 Non-Priority Sites 33,378 104,505 32,489 31.1 131,180 125.5 Project-wide 228,438 562,837 163,427 29.0 571,468 101.5 * - from LARC-PM methods only

Analysis of Accomplishment

The cumulative CYP-accomplishment for the past four (4) quarters is 571,468 or 101.5% of PY6 annual target of 562,837. The 12 priority LGUs contributed 63% to the CYP-accomplishment during the quarter while the five non-priority LGUs contributed 23% and 14% was generated from conflict-affected areas.

Figure 5 demonstrates that there is an increasing trend in CYP. Project-wide, the CYP in Q3PY6 rose by 5.4% compared to 154,999 CYP in Q2PY6.

Among MH-assisted LGUs, only Misamis Oriental, Compostela Valley, Davao Oriental, Sulu and Isabela City, Zamboanga del Norte posted a sustained increase in CYP in the past 4 quarters [Figure 1 and Table 3 in vol 2].This means that the sustained increase in CU specifically in Bukidnon and Zamboanga del Norte as mentioned earlier also reflects a shift to LARC/PM FP methods resulting to sustained increase in CYP [Table 02 in Vol. 2].

Figure 5: Couple-Years of Protection by Project Quarter, Q1PY3-Q3PY6

Analysis of Accomplishments:

The sustained increase in the number of LARC-PM new and other acceptors especially PSI is due to the following factors: a) increased number of HSPs trained and supportively supervised on BTL-MLLA, PPFP/PPIUD, PSI, FPCBT2 that expand service coverage – 109 HSPs in 91 SDPs for BTL-MLLA, 661 HSPs in 514 SDPs for PPFP/PPIUD, 358 HSPs in 458 SDPs for PSI, and 153 HSPs in 263 SDPs for FPCBT2, b) increased number of hospitals (19 as of EO Q4PY6) implementing FP/AY integration within hospital services, c) increased number of SDPs providing FP counseling and services from 81 in 2012 to 744 in Q4PY6, of which 90 are also providing AYRH-friendly health servcies, d) intensified outreach services by public hospitals, FP-itinerant teams from IPHO and RHUs, and NGOs, especially in GIDAs and conflict affected areas, e) increased number of RHUs/CHOs with PhilHealth MCP/NCP-accreditation that provides reimbursement for performance of IUD and PSI procedures, and f) improved referral system of WRAs preferring to use LARC-PM and more effective collaboration between and among SDPs within functional and performing SDNs.

Table 06 in Volume 2 of this report shows the comparison between the SDNs’ share of their province’s population and their share in their province’s CYP. Functional SDNs (BITES in Sultan Kudarat, DO Plaza Cooperative Zone in Agusan del Sur) and four (4) operational SDNs (South Bukidnon, SANLAKASS in Lanao del Norte, CoMMoNN in Compostela Valley, and DiMaBaMas in Davao del Sur) tend to have a bigger share in their province’s CYP relative to their share in their province’s population.

Further review of these 6 SDNs revealed three common elements namely strong leadership from the provincial health office and Provincial Office of DOH, and cost-sharing for SDN operation among member LGUs, conduct of joint outreach within SDN are factors to improved SDN contribution to overall provincial CU and CYP. The provincial health office leadership resulted to building networks with referral hospitals, both public and private, in North Cotabato and Davao

City as component of DiMaBaMas SDN has addressed provincial weak point due to

25 indifferent/passive engagement of Davao del Sur Provincial Hospital leadership as referral facilities. This cross-border partnership due to strong PHO leadership has resulted to 47.6% (11,300) contribution of DiMaBaMas SDN to Davao del Sur total CYP of 23.718.

While role of primary health care facilities as the gatekeepers within SDNs is an area that requires strengthening to most of the supported SDNs, it is the strength of South Bukidnon SDN. The strong leadership of all the municipal health officers of 10 municipalities within the SDN resulted to closer coordination sharing of resources thereby about 38% to total provincial CYP, and most importantly is the formation of critical mass of influencers resulting to approval of public-private partnership, establishment of FP/AY integration and AY-friendly facilities, and has work with the provincial leadership and chairperson of Committee on Health of the Provincial Board craft a provincial ordinance on SDN now on its 3rd reading.

SANLAKASS SDN was temporary affected initially with the unfortunate lost of the leadership and was downgraded from functional to operational category, but gradually pick up early this year under the leadership of USAID-trained BTL certified trainer. Despite the Marawi siege, through this new leadership, SANLAKASS contributed 58.9% (6,155) in its province CYP of 10,441. The facilitating factors in its exemplary performance in CYP are: a) FP itinerant team from Kapatagan Provincial Hospital that regularly conducts outreach services especially in GIDA- municipalities of Salvador, Sapad and Nunungan, b) DOH-certified LARC-PM providers – 1 for BTL (who is also a certified trainer), 5 for PPIUD, and 7 for PSI, and c) Provision of funds for the conduct of FP outreach services from the provincial and municipal LGUs.

While accomplishment project-wide surpassed PY6- and EOP-targets for CYP, highly urbanized cities lagged behind their EOP target: Davao City (only 66% of EOP-target), Zamboanga City (only 71% of EOP-target), Cagayan de Oro City (only 88% of EOP-target) and Gen. Santos City (only 65% of EOP-target). FHSIS data captures mostly public sector performance. In highly urbanized cities where private SDPs concentrate, WRAs who wants to avoid queuing tend to go to private facilities for FP services. The challenge has always been on how to sustain the integration of private SDPs accomplishment into the FHSIS of the LGU. Scaling-up of the project gains on integrating private accomplishment into the FHSIS report through SDN initiative is very slow due to varied operational challenges, and the lack of clear national guidelines to strengthen health information management system through public/private partnership, given the increasing number of privately-owned/managed facilities providing FP/MNCHN/AY services.

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, in Q4PY6 Status for the Quarter, Q4PY6 Baseline Acceptable Actual Project Areas 2016 Level, Type Num Den* % 2018 Pills – Pills – 2% Pills 17 457 3.7 A. Priority Areas: 1% DMPA 9 457 2.0 (1) 12 Priority Sites DMPA – Condom 5 457 1.1

Table 3.0 Stock-Out Rate of FP Commodities in USG/MH-Assisted SDPs, in Q4PY6 Status for the Quarter, Q4PY6 Baseline Acceptable Actual Project Areas 2016 Level, Type Num Den* % 2018 DMPA – 1% Beads 68 457 14.9 0 IUD 4 457 0.9 (2) CAA Areas: IUD – 0% Pills 9 96 9.4 (a) BaSulTa, Zambo IUD – DMPA 3 96 3.1 City, Cotabato City 1% Condom – Beads 1 96 1.0 (b) Marawi & 1% Environs (Lanao Sur Condom Beads 39 90 43.3 & Lanao Norte) – 1% Beads – 3% Pills 8 94 8.5 B. 5 Non-Priority Sites Beads – Beads 15 94 16.0 11% Pills 34 737 4.6 DMPA 12 737 1.6 Project-Wide Condom 5 737 0.7 IUD 4 737 0.5 Beads 125 737 17.0 * No. of SDPs in the priority clusters

Analysis of Accomplishment

The number of USG-MH-assisted SDPs that reported stock out of one or more FP commodities increased during the quarter by 44.4% from 99 in Q3PY6 to 143 in Q4PY6. Project-wide, the highest stock-out rate was of SDM beads at 17.0% followed by pills at 4.6%, then DMPA at 1.6%, condom at 0.7% and IUD at 0.5%. Except for condom, and IUD, stock out rate of pills, DMPA and SDM beads is above the acceptable level.

About 42.1% of current user in Q3PY6 are pill-users. Proportion of pill-users has always been more than 40% of total mFP users. So, a stock-out of pills in an area will affect majority of mFP- current users. Instead of switching to COC, pill users continue to use POP even if they are no longer lactating for the simple reason that they are used to it. This has been the pattern of use for many years and yet the FP commodities procurement plan failed to take this into consideration. In effect there is a relative “oversupply” of COC and a shortage of POP.

Stock-out of pills (POP) during the quarter was observed in Tawitawi (n=9), Davao City (n=8 SDPs), and Zamboanga Sibugay (n=8).

Stock out of DMPA was observed in Davao City (n=8) and in Tawitawi (n=3). In Tawitawi, pill and DMPA users make up 73% (n=19,046) of mFP current users in the province. A stock-out of these two SARCs in nine SDPs can cause a significant negative effect on the number of mFP current users in Q4 of 2018 and in 2019 if stock-out is not addressed.

Stock-out of SDM beads has been observed since Q2. The number of SDPs reporting stock-out of SDM beads has been increasing. Provinces reporting stock-out in SDM beads are Lanao del Sur (n=39 since Q3PY6, 17 SDPs since Q2PY6), Zamboanga del Sur (n=26 SDPs since Q3), Zamboanga del Norte (n=25, 12 SDPs since Q3), Zamboanga Sibugay (n=15 since Q3), Davao City (n=10), Tawi-tawi (n=10), and Compostela Valley (n=7 SDPs). DOH Regional Offices do not maintain a buffer stock of SDM beads. DOH – Central Office reportedly procures only 2,000 pieces of SDM beads annually. Project-wide, the proportion of NFP-SDM users is only about 1%, and in some provinces/HUC it is even less than 1% like in Zamboanga del Sur (0.2%), Compostela Valley (0.4%), Lanao del Sur (0.6%) and Zamboanga Sibugay (n = 0.9%).

Thus, a stock-out of SDM beads may not significantly alter the number of CUs, however, inavailability of the preferred choice of some patients may discourage them to seek consultation on time. Though SDM beads can be produced by the RHU (like in RHU-Salug of Zamboanga del Norte) from locally available materials, the production is just intended for their own use. The Archdiocese of CDO also produce SDM beads and being sold for a minimal fee. The project staff informed their LGUs of this opportunity; however, the long and tedious procurement process in the government discourages LGU partners to initiate the process.

Some SDPs are already reporting critical inventory level of PSI and IUD. Due to more than adequate supply of FP commodities in the previous years, DOH-Regional offices and many LGUs stopped procuring supplemental stock of pills and DMPA.

Not a single SDP in the regions of Caraga, Northern Mindanao and SOCCSKSARGEN reported stock-out. DOH-RO-Caraga hired pharmacists with assigned municipalities to monitor FP and other medical supplies of the RHUs. PopCom–Northern Mindanao assigned one person who will monitor the FP commodity for the entire region. This person conducts phone interviews and field visits and collates inventory reports collected by the FHAs. In SOCCSKSARGEN, DOH-RO XII purchased POP and augmented the supplies of the provinces.

Analysis of the last five years’ technical assistance to 737 SDPs to avert stock-out of FP commodities from 2014 to 2018 revealed that the most common commodities that ran out of stock are SDM beads at 14%, Pills at 6%, and Condom at 5%. Reported stock-out of pills and condoms often occurred in the areas of Davao City, and Tawi-Tawi while stock-out of SDM beads is pronounced in the provinces of Zamboanga del Sur, Zamboanga del Norte, and Lanao del Sur including Marawi City. Stock-out of SDM beads was tracked only in the last two years of the project (Table 3.1)

Table 3.1 Status of FP Commodity Stock-out by Year

The first two years of the project was focused on strengthening capacities on logistics management system both at the facility level and PHO/DOH-RO by promoting the wider use of supply management and reporting system (SMRS), setting up inter-LGU coordination mechanism to enable PHOs and DOH-ROs monitor stock-outs, overstocking and reallocation of commodities, inventory of commodities, delivery of commodities to health facilities, projection and procurement/ request for replenishment based on actual demand. The SMRS later on was simplified with the help of Popcom and DOH-ROs for easy use of facility staff. Also, within this period, it was evident that the stock-out rates were at its highest, averaging 15% across four commodities.

The trend, however, changed in the beginning of third year and fourth year when the stock-out rate stood at less than one percent among 898 facilities surveyed by the project. This was the period when DOH procurement of commodities was intensified by contracting a third party for warehousing and direct distribution of commodities to SDPs, use of social media network for FP commodity tracking and setting up of FP Logistics Hotline for real time reporting and action on reported stock-out, and roll out of simplified commodity inventory tool to aid LGUs track expendable supplies in health facilities. Further, the strengthened implementation of demand generation and tracking of commodities by Popcom on the ground and DOH-ROs’ Pharmacists deployed in the provinces performing inventory management played a key role in this accomplishment. MindanaoHealth, on the other hand, facilitated the setting up of mechanisms at the facility and provincial levels through mentoring and coaching resulting to 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. To date, there are 324 (88%) RHUs/CHOs use commodity tracking tools such as SMRS and simplified logistics management tool which strengthened the recording and reporting of consumption reports; b) Effective inter-LGU and facility coordination and reporting mechanisms for immediate reallocation and redistribution of commodities in the event of over/under supply, near stock- out, and stock-out including expiring supplies; c) Tracking of delivery of commodities by PHOs from DOH Central down to the facility;

d) PHO, Popcom and DOH-RO coordination ensuring availability of buffer stocks at the regional offices. This coordination essentially makes up for an alert mechanism at the provincial and regional DOH to quickly identify SDPs with inventories breaching the buffer stock and enables to respond appropriately by linking them with regional and DOH Central FP logistics hotline; and the elevation of this agenda in the RIT/PIT meetings was helpful. e) Regular monitoring of DOH supervising pharmacist and support of FHAs at the municipal/city level; and f) Continuing advocacy to LGUs for the procurement of commodities to augment DOH supply.

The fifth and sixth year of project implementation, however, showed an increasing stock-out rate beginning in the last quarter of fifth year and breaching the 3% acceptable stock-out rate in year 6 mainly due to break in the supply chain at the central down to the facility level resulting to unstable commodity security. The following are the cited reasons, among others: a) a truly demand-driven logistics management system is still wanting; b) changes in the DOH structure, which caused inadequacy of staffing and lack of full capacities to manage and implement the whole national FP logistics management system; c) a number of SDPs submit consumption reports but these are not used by DOH to achieve accurate projection and allocation list; d) 83 (23%) LGUs in Mindanao have CSR policy but only 30 LGUs are procuring commodities; not a single LGU in ARMM procures FP commodities.

Deviation Narrative

All the RHUs and the government hospitals have been trained on the use of the quarterly inventory and commodity order form- the Logistics Management System for FP Commodity Inventory for quick monitoring, inventory and response for impending commodity stock outs. In most regions over-all monitoring is the responsibility of the FHA at the Provincial DOH Office (PDOHO) who directs augmentation of FP commodity nearing stock out in a particular SDP, or transfer FP commodity from over stocked SDPs to those in need. However, stock-out cannot be avoided if the delivery of FP commodities from DOH CO is not on time, and LGUs do not procure FP commodities to augment supply. To avert stock-out DOH-Central FP Logistics Management should assess the performance of the 3rd Party Logistics (3PL) in the delivery and distribution of commodities to health facilities and the national supply chain and logistics management system to identify prevailing bottlenecks to cut down the more than three months re-stocking of commodities at the facility level. It is also high time to revive the CSR strategy in the LGUs to mitigate the impending impact on the huge DOH-budget cut for FP commodities.

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 Q4PY6 Accomplishment Cumulative Accomplishment Baseline for the Quarter, Q4PY6 Project Areas 2013 Target, Target, Actual % Actual % PY6 EOP (A) Priority Areas: 49/457 444 449 101 444 449 101 (1) 12 priority Sites (2) CAA Sites: (a) BaSulTa, Zambo 93 98 105 93 98 105 City, Cotabato City 26/186 (b) Marawi & Environs (Lanao Sur 87 82 94 87 82 94 & Lanao Norte) (B) 5 Non-Priority 6/94 91 115 126 91 115 126 Sites Project-wide 81/737 715 744 104 715 744 104 * - denominator changed to exclude barangay health stations and private clinics that closed Target in PY6 is 97% of 737 = 715

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.

In Q3PY6, 12 SDPs were reported closed due to failure to comply with the LTO-requirements of DOH, or transfer of trained staff to the hospitals (9 in Davao City, 2 in Misamis Oriental and 1 in Cagayan de Oro City), but twelve (12) private birthing facilities managed by members of the Unified Private Midwives Association of General Santos City were added as FP-SDPs. In Q4PY6, there is no addition or reduction in the number of functional SDPs. However, the reported number of functional SDPs in Q4PY6 increased to 744. The 28 private SDPs have been functional since PY5 but were not reported because they were not submitting reports to the RHU/CHO.

The 744 functional SDPs as of Q4PY6 is equivalent to 133% of the EOP-target of 715, and 101% of the initially assisted SDPs of 737. One core technical support provided by the Project is capacity building of health service providers and ensuring that they are DOH certified, therefore it is not a surprise to increase the number of functional SDPs providing FP counseling and services by 819% from 81 in 2012 to 744 in PY6.

Table 4.1 Distribution of SDPs by Ownership/Control, Location (Rural/Urban) and Type of Facility, as of Q4PY6 Ownership Location Type of Facility Project Areas Public Private Rural Urban Hospital RHU/CHO Clinic (A) Priority Areas: 304 145 306 143 124 234 91 (1) 12 priority USG

Sites (2) CAA Sites: (a) BaSulTa, Zambo 85 15 62 36 30 62 6 City, Cotabato City (b) Marawi & Environs (Lanao Sur 74 8 73 9 16 62 4 & Lanao Norte) (B) 5 Non-Priority 70 45 72 43 28 55 32 Areas Project-wide 531 213 513 231 198 413 133

It is noteworthy that 69% (n=513) of the functional SDPs are located in rural areas, and 71% (n= 531) are public or government-owned. Of the 744 functional SDPs, 56% are RHUs/CHOs, 27% are hospitals and the remaining 17% are private clinics.

Deviation Narrative:

The Project has been conducting training and supportive supervision since 2013 involving HSPs in both the public and private sectors. As of EO PY5, 884 HSPs have been trained on PPFP/PPIUD, 794 on LARC-PSI, 722 on FPCBT2 and 234 on BTL-MLLA. DOH-ROs have also been conducting training on FPCBT1 and FPCBT2 in collaboration with MH. Thus, there are more SDPs that are capable of providing at least two or more FP methods.

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 USG-Assisted Community Health Workers (CHWs) Providing Family Planning (FP) Information, Referrals, and/or Services by Priority Cluster, Q4PY6 Baseline Actual, Q4PY6 Target, Project Areas % 2013 F M Total PY6 (A) Priority Areas: (1) 12 priority USG 420 3,165 17 3,182 2,027 157 Sites (2) CAA Sites: (a) BaSulTa, Zambo 576 11 587 824 71 City, Cotabato City 28 (b) Marawi & Environs (Lanao Sur 356 3 359 252 142 & Lanao Norte) (B) 5 Non-Priority 1,032 594 3 597 584 102

Sites Project-Wide 1,480 4,691 34 4,725 3,687* 128 * In PIRS, target is 3,358. In the allocation of target to LGUs, rouding up of numbers resulted to a total of 3,687.

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 appropriate FP/MCH information/ basic messages. CHWs also invite, follow up, and escort WRAs identified with unmet need to Usapan sessions and/or FP outreach services.

Project-wide, the total number of CHWs who were providing information and referring WRA with unmet need to appropriate SDPs during the quarter is 4,725, which is 128% of the annual target. All the 4,182 MH-assisted CHWs who were active in Q3PY6 continued their tasks of listing WRAs with unmet need, giving FP information and referring them to HSPs for further counseling and FP services in Q4PY6 in addition to the 543 new CHWs engaged during the quarter who were given technical assistance and provided with CHT Toolkits. These new ones were coming from the following provinces: Bukidnon (105), South Cotabato (55), Davao Oriental (50), Lanao del Norte (44), Misamis Oriental (41), Zamboanga del Sur (20), Zamboanga Sibugay (13), Zamboanga del Norte (99), Davao City (105) and Tawi-tawi (11), About 99% (4,594) of the active CHWs in Q4PY6 are female and 1% (32) are male.

Fewer MH-assisted CHWs are active in the implementation of Presidential EO No. 2017-12 in Davao City (38% of target), Sulu (8%), Tawi-Tawi (51%), Cotabato City (11%), Zamboanga City (48%), Cagayan de Oro City and General Santos City (20%).

Deviation Narrative

There are 11 USG-sites where the number of active MH-assisted CHWs is more than 100% of the target like Bukidnon (692%), Davao Oriental (236%), Basilan (202%), Lanao del Norte (167%), Agusan del Sur (162%), Agusan del Norte (113%) , and Zamboanga del Sur (106%) where the number of WRA profiled and identified with unmet need tend to be comparatively much higher [Table 08 in Vol. 2 ]. The willingness of the population volunteer workers to be trained and do the job in Bukidnon, the strong support of the LGU leadership, involvement of the community in the rest of the areas, and the regular monitoring and coaching by the HSPs were among the facilitating factors cited.

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

Table 6.0 Distribution of USG-MH-Assisted AYRH-Friendly Facilities by Priority Cluster, as of Q4PY6

Target vs Accomplishment Cummulative Priority Cluster Base PY5 PY6 Accomplishment

EOP EOP line Hospb a RHU School Total Target 2012 (c) Hospital RHU School Hosp RHUs Sch. Target Accomp Target Accomp Target Accomp (A) Priority Areas: 5 26 7 7 3 4 6 6 12 30 6 48 (1) Non-CAA Sites (2) CAA Sites: 78 SDPs (a) BaSulTa, 1 2 27 28 1 30 31 ZamboCity; Cotabato City (b) Marawi & Environs 3 1 1 1 1 1 4 4 (Lanao Sur & Lanao Norte) (B) Non-Priority 2 4 12 3 3 1 3 22 5 7 34 46 Areas Project-Wide 78 0 8 35 12 11 11 32 36 6 28 19 71 40 130 (a) SDPs include either hospitals, NGO clinics, RHUs, educationa institutions, at least 1 in USG-asssisted LGUs (b) This number includes Davao Regional Medical Center located in Davao Province, a non-MH project area but serves as the end-referral hospital of Compostela Valley. This number also includes San Pedro Hospital a private hospital with TeenHub launched in PY6Q4 that offers information, counseling and referral, and services for Natural Family Planning methods only. (c ) Schools are included in the denominator because PIRS definition include a wide array of AY SDPs such as hospitals, NGO clinics, RHUs, educational instituitions providing either information, counseling , services and or referral

Analysis of Accomplishment

The Project had surpassed its overall EOP target of 78 SDPs by accomplishing 130 or 167%. The synergy of MH, DOH-ROs, LGUs and other agencies has led to expansion of AYRH in different settings, including 19 hospitals, 71 rural health units, 40 educational institutions, which has resulted to 64,869 varied FP-RH services including SRH information, risks screening, counseling and access to varied FP-SRH services, including mFP methods.

In Upi, Maguindanao, decreasing trend in teenage pregnancy was noted - from 315 in 2015 to 171 cases in 2016, and 91 in 2017. The LGU attributed this to the combined actions of MH- asssisted RHU Teen Center youth-friendly service and peer education program through its Upi Youth Governance Program. This trend is also noted in New Bataan, Compostela Valley with 18.9% teenage pregnancy rate among aged 10-19 years in 2015, and significantly reduced to 15.6% in 2016, which according to the MHO is highly attributed to the strengthened SRH campaign activities and youth-friendly service at AYRH clinic in the RHU facility. Supporting the institutionalization of Youth Development Club in school, as one of the regular clubs, helps in the continuity of the youth engagement once the youth leaders graduate and leave the area for other opportunities. AYRH-Friendly Hospitals

MH assisted hospitals in drafting respective operational guidelines in addition to training of core teams of AYRH-providers. Partial reports from 17/19 hospitals revealed that an estimated 30,654 clients accessed wide-ranging FP-RH services covering perinatal care (pre-natal care, delivery, post-natal care), FP services, management of STIs and VAWC, psycho-social risk assessment using HEEADSS were accessed by adolescents-youth in PY6 (refer to Table 6.1).

Table 6.1 FPRH Services Provided to AYs in AY-Friendly Hospitals, PY6

FP to AY FPRH Services 2018 Jul – Sep 2018 Service HEEA Peri Name of Hospital Delivery FP to AY FP DSS Jan – Apr- Jul- 2017 nata Network Mar Sep Meth risks Jun l (Q2) (Q4) ods Guid (Q3) Care ance

1) ZDS-Margosatubig Regional ZDS District 1 622 641 725 115 28 87 Hospital 2) Dr. Justiniano R. Borja ClaJaViTa 1,058 1,761 2,109 1,175 279 896 Hospital 3) Maguindanao Provincial IranunClustr 195 141 281 Hospital 4) Bukidnon Provl Hospital- South LHZ 30 727 1,642 Maramag 5) Davao Oriental Prov’l 38 563 722 MedicalCenter 6) Compostela Valley Provl CoMMMoNN 481 543 533 93 56 384 Hospital –Montevista 7) Sultan Kudarat Provincial BITES 4,498 2,077 2,065 Hospital 8) Butuan Medical Center 1,020 9) San Pedro Hospital New in Q4 10) Bunawan District Hospital 7 97 61 11) Gregorio T. Llutch Hospital Iligan 173 32 12) Agusan Del Norte Provl BueNasCar SDN 217 360 1,000 Hospital 13) Southern Philippines Medical DC District3 302 411 826 Center SDN 14) Brokenshire Memorial Davao City- 106 310 Hospital Wide 15) Davao Regional Medical CoMMMoNN Not updted Center 16) Dr J. P. Royeca Hospital 102 471 1,112 627 112 515 17) South Cotabato Provincial South Cotabato 1,363 1,124 2,016 1,570 332 1,238 Hospital 18) Cotabato Regional Medical Notupdted 2,350 Center 19) Democrito O. Plaza Provincial DOPlaza HZ 306 266 227 Hospital TOTAL 9,017 9152 17,009 4,020

The increasing trend in the number of AYs seeking SRH services in hospitals indicates that, on the supply side, hospitals are prepared and equipped to handle the unique FP-SRH needs of young people; and on the demand side, AYs are opening up to seek and access needed services in facilities. But there is still a need to effectively link demand generation to FP service provision to narrow the gap between AYs provided with FP services compared with the number of AYs seeking perinatal care in hospitals. First noted in PY6Q3, this trend persisted in Q4PY6, as observed in two hospitals, namely JR Borja Hospital and CVPH-Montevista, with 279 and 93 AYs respectively provided with FP services as against 896 and 384 teen mothers respectively who gave birth in the said hospitals.

AYRH-Friendly RHUs/CHOs

Equipped with core team of FP and AJA–trained providers, client-provider interaction guidelines, local policy, and job aid tools, available partial reports from 55 of 71 MH-assisted RHUs showed at least 20,116 FP-RH services accessed by adolescent-youth clients in PY6 (refer to Table 6.2). Sixty-four percent or 12,910 received counseling, 17.5% or a total of 3,532 female and male youths accessed varied mFP methods, while 18.2% (3,674) were referred to other facilities for further management, including delivery.

Table 6.2 FPRH Services Provided to AYs in AY-Friendly RHUs/CHOs, PY6 Project Areasa Counseled Referred FP Service M F M F M F (A) Priority Areas: 1,361 5,290 57 1,826 62 1,948 (1) Non-CAA Sites (2) CAA Sites: (a) BaSulTa, Zambo 1,791 3,785 1 1,108 297 1,102 City, Cotabato City (b) Marawi & Environs 52 287 20 390 0 13 (Lanao Sur & Lanao Norte) (B) Non-Priority Areas 13 331 8 264 13 97 Project-Wide 3,217 9,693 86 3,588 372 3,160 (a) In the total 71 RHUs assisted, ten are not included in the list but noteworthy to be mentioned. In non-CAA sites, seven (7) RHUs in Zamboanga Del Norte, a non-target LGU, was provided with TA, which resulted in the endorsement, by the PHO for DOH- RO9 assessment for certification as AY friendly facilities: 1) Salug RHU, 2) Katipunan RHU, 3) Dapitan CHO, 4) Dipolog CHO, 5) Godod RHU. 6) Manukan RHU, and 7) Polanco RHU and Lying-in. In non-priority sites, 3 RHUs of Olutangga, Talusan, and Mabuhay belonging to 4th--5th class municipalities in Zamboanga Sibugay received training of health providers on DOH-AJA protocol and now working towards meeting minimum criteria for youth-friendly facility.

MindanaoHealth provided technical assistance to Lamitan City Health Office in transforming its two RHUs as youth-friendly facilities and in establishing its banner program dubbed as “Kasangyangan sin Kamakanakan” (Youth Development focusing Adolescent Reproductive Health). This initiative was selected and presented during the Module 4 focusing on Delivering Result, Creating Public Value and Governance Fair, as one of the finalists in the Galing Pook Award, a respected award giving body in the Philippines that searches and recognizes innovative practices of local government units.

AYRH-Friendly Schools

Backed-up with core teams of trained school providers composed of guidance counsellor designates and health & nutrition nurses, guidelines, and SRH messaging, the DepEd-Division of Agusan del Norte has expanded YOLO (Youth Optimizing Life Opportunities) to 34 schools in PY6 from 12 initial schools in PY5. YOLO had reached a total of 6,015 learners with SRH information thru Province Wide Campaign on STI-HIV/AIDS, Teenage Pregnancy and Lifestyle Diseases Prevention; and reached 35% or 6,856 of the total 19,621 population enrolled in 34

covered schools with psychosocial risks assessment and guidance using the Rapid HEADDSS (refer to Table 6.3). PY6 cummulative data showed that bullying topped among the risks detected at (25%); followed by involvement in romantic relationships at 20% putting young people at risk of early exposure to physical intimacy, which may lead to teen pregnancy. Problems at home are notably high with 16% of youths had thoughts of running away from home, and a sizeable 12% experiencing domestic violence. Ten percent of youths have ideation of committing suicide, while 15.6% comprised issues on substance use and abuse (smoking, alcoholic drinking, drug use). Twenty-one percent were followed up for counseling, and 42 were referred for various conditions, including 7 referrals due to pregnancy. ADN DepEd, with R13- POPCOM and DOH-CHD13 started its work in forging patnerships with different health and non-health stakeholder groups to strengthen its referral network through integrated service delivery network or ISDN for adolescents-youth.

Table 6.3 Distribution of Learners Assessed Using HEEADSS by Psycho-social Risks Detected, Dep-Ed Division of Agusan del Norte, PY6 Numb Risks Identified* er of AY Home Hom Suici Envir Alcoh Drug Sm Sexu Assess Ref Thoug e dal onm ol expo oki ality Reporting ed erre ht of Violen thoug ent - drink sure ng Period with d runnin ce hts Bullyi ing Rapid g ng HEEA away DSS June 2017- 5,670 21 1,604 1,216 1,000 2,547 702 616 324 1,960 Mar2018** Apr to 99 20 11 12 12 4 4 4 11 Jun18 July to 1,087 1 386 249 296 589 135 114 53 512 August Total 6856 42 2,001 1,477 1,296 3148 841 734 381 2483 (0.3%) (16%) (12%) (10.4%) (25%) (6.7%) (5.9%) (3%) (20%) * - Some learners have more than one psycho-social risks (12,403) **- Data source from Annual Implementation Reprot of DepEd-Division of Agusan del Norte YOLO program, June 2017- March 2018

In Zamboanga Del Sur, MH extended similar TAs to six schools, i.e. 3 senior high schools of Margosatubig, Lapuyan and V. Sagun and three J.H Cerilles Colleges-all within District 2 SDN with Margosatubig Regional Hospital-Center for Teens as apical referral SDP. Available data showed 32 AY clients referred to outside facilities.

#SoMe4AYRH (Social Media for AYRH)

According to 2013 YAFS4 survey, Facebook remains the most used social media by more than three-quarters (80.3%) of youths using the Internet for social networking. The Project’s technical assistance to six partner agencies/institutions1 implementing programs on Adolescent-Youth Health with significant result:

1 Six partner institutions implementing programs on Adolescent-Youth Health

. Fourteen individuals from targeted 6 partner agencies/institutions trained and equipped in crafting SRH messages and in administering 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. . Four of six assisted agencies/institutions’ social media platforms, 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, and Brokenshire Hospital “Program 4 Teens” were formally launched. . MH document #SOME4AYRH: A Guide in Using Social Media & Social Networking Sites for AYRH Advocacy was presented as one among the different technical products presented during the joint WHO, KOICA or the Korea International Cooperation Agency, and MindanaoHealth Region 11 dissemination forum.

From the available data as of the end 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 who had 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 Target ADN-DepEd TeenTalk QUALIFIERS (After 3 Division ADNPH PopCom XIII Davao months) YOLO Page A new page More focused messages More AY- Focus on was created on teenage pregnancy, focused STI- dedicated motherhood and family through their HIV and Page Use for the planning options #CaragaTeens the campaign Campaign millennials

The number 300% (of the 4,291 256 Cannot be 3,492 (367%) of people number of (429.1%) (492%) measured who had any followers in groups Reached posts from page Page enter their screen. Engagement

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

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

In general, the challenge for administrators of respective FB accounts is the maintainance of at least one SRH message per day. In the previous quarter, almost all achieved half, except for POPCOM XIII who was able to achieve close to the target of one to keep FP pages interesting, dynamic, informative thus will be able to gain and sustain the number of followers. Follow- through mentoring and coaching are needed to keep administrators updated with the emerging trends in the use of social media, which is a very dynamic virtual milieu.

Analysis of Accomplishment

The increasing trend in the number of AYs seeking SRH and medical consults in hospitals and RHUs, combined with active case finding through risks assessment, other demand generation activities/programmes and youth-friendly services with defined service flow and procedures provide opportunities for scaling up interventions to reduce teen pregnancy. However, there still a need to effectively link demand generation to FP service provision to narrow the gap between AYs provided with FP services compared with the number of AYs seeking perinatal care in hospitals. There still a need for RHUs to forge partnership with schools, alternative and vocational schools, and informal industries within its catchment to maximize the availability of youth-friendly services in RHUs. AYRH program in schools can be effectively implemented within the campus by harnessing schools’ existing learner support non-curricular programs, and building the capacities of school service providers to provide information, perform risks screening, counsel, refer and make shools as part of the SDN.

Indicator HL.6.2.1: Number of Women Giving Birth who Received Uterotonics in the Third Stage of Labor through USG- Supported Program Table 7.0 Distribution of Women Giving Birth who Received Uterotonic Postpartum by Priority Cluster, Q1-Q4 PY6 Accomplishment Target, Project Areas Actual, Actual,Q1- PY6 % Q4PY6 Q4PY6 (A) Priority Areas: 4,837 4,002 14,059 291 (1) 12 USG priority sites (2) CAA Sites: (a) BaSulTa, Zambo City, 2,489 1,196 4,636 186 Cotabato City

(b) Marawi & Environs (Lanao 1,739 2,417 11,021 634 Sur & Lanao Norte) (B) 5 Non-Priority Sites 934 308 2,750 294 Project-Wide 10,000 7,923 32,466 325

Analysis of Accomplishment

To track this indicator, sentinel birthing facilities (both public and private) in every USG-MH- assisted province/HUC were selected based on the following criteria: a) presence of an MH- trained BeMONC/EINC/CMNC provider, b) with PhilHealth accreditation for MCP/NCP, c) with written guidelines on the use of oxytocin, and d) with available oxytocin.

In Q4PY6, 7,923 parturient received uterotonic during the third stage of labor. As of the end of PY6, a total of 32,466 women who gave birth were given uterotonic. This represents 325% of the prescribed PY6-target of 10,000.

The administration of oxytocin during the third stage of labor to prevent post-partum hemorrhage is part of the standard of care for women giving birth even in home deliveries. Project-wide, despite lack of reports from some sentinel facilities that are mostly public and private birthing facilities, accomplishment has surpassed the targeted number of women given uterotonic, which may imply universal implementation of AMTSL in Mindanao, not only in ARMM.

Deviation Narrative

The very high accomplishment is primarily due to under-targeting, given the fact that provision of oxytocin during the third stage of labor is already a standard of care for women giving birth, not to mention that BEmONC (includes administration of a uterotonic as standard care in the management of the third stage of labor) trained personnel are both requirements for DOH licensing and Philhealth MCP/NCP Accreditation for birthing facilities. The potency of the oxytocin maybe compromised, though, given the difficulty in maintaining the cold chain in GIDAs. Storage temperature of oxytocin should then be regularly monitored.

Indicator N 1: RHUs/CHOs Conducting Data Quality Checks (DQC)

Table 08. Distribution of USG-MH-Assisted Provinces/HUC that Conducted DQC in PY6 by Priority Cluster Baseline Accomplishment, PY5 Accomplishment, PY6 Project Areas 2015 Targeta Q1-Q4 % Targetb Q1-Q4 % (A) Priority Areas: 184/219 153/184 83 186/219 200/186 108 (1) 12 USG Sites (2) CAA Sites: (a) BaSulTa, Zambo 38/45 26/38 68 38/45 45/38 118 City, Cotabato City (b) Marawi & Environs (Lanao 53/63 61/53 115 54/63 63/54 117 Sur & Lanao

Norte) (B) 5 Non-Priority Sites 34/41 40/34 118 35/41 41/35 117 Project-Wide 268/ 368 309/368 280/309 91 313/368 349/313 112 a – Target is 84% of RHUs/CHOs b – Target is 85% of RHUs/CHOs Standard : RHU/CHO conducts DQC at least once a year

Analysis of Accomplishment

Improving the health information system is a critical management tool for policymakers and health managers from regional DOH and LGUs. As such, DQC is highlighted in the DOH’s Manual of Operations (MOP) for MNCHN (2nd Edition, March 27, 2011). This is to ensure the validity and reliability of data generated through the FHSIS for an enabling evidence-based LGU planning and decision-making. Throughout the years, MindanaoHealth supported the strengthening of DOH and LGUs health information systems through the institutionalization of Data Quality Check (DQC) for family planning and selected MNCHN indicators in support to MNCHN strategy to reduce maternal and infant mortality.

During this reporting quarter, seventy-seven (77) RHU/CHOs conducted DQC activities in addition to the two hundred seventy-two (272) in the previous three quarters resulting to a cumulative total of three hundred forty-nine (349) LGUs or 112% of 313 PY6-target, and 95% of the total number of RHUs/CHOs assisted by USG-MH. The number of LGUs implementing the DQC process as part of FHSIS data management increased by 25% from 280 in PY5 to 349 in PY6. Compared to the baseline (2012) of 268, the number of RHU/CHOs conducting DQCs increased by 30%.

The focus on the second and third year of the project was laying down the capacity of the public health sector and staff on DQC through training of trainers and training of users on DQC guide, and follow-on coaching and mentoring. To fast track DQC, a total of 3,669 LGU DQC trained health staff across 19 provinces and two cities were involved in the DQC rollout. The conduct of DQC is now an LGU-led regular activity with minimal support from the Project, and RHUs/CHOs personnel professed that regular conduct of DQCs has proved helpful in the transition to electronic medical record (EMR) system which is a PhilHealth requirement for their facility accreditation and in improving their FP accomplishment/CPR because the transfer of acceptors with Form 1 to the TCL for FP is assured. FP-TCL is the source document for the reporting of CUs, the numerator in the computation of CPR.

In the course of implementing DQC, the main sources of variances identified on the data validation process for both family planning current users and other MNCHN indicators were computational errors and erroneous applications of technical definitions of indicators. Computational errors lead to discrepancies, especially for those indicators that are usually recorded and reported as disaggregated figures but are eventually summed up. Along with these errors, transcriptional errors were also noted as a contributory source of variance. As far as errors go, these are not substantial given that these could be remedied through a greater degree of diligence in the accomplishment of the forms and employing additional data validation procedures. The RHMs and PHNs are aware and understood these measures to improve data quality.

In the last five years, seven provinces and its component municipalities and cities (Compostela Valley, North Cotabato, Agusan del Sur, Agusan del Norte, Lanao del Norte, Maguindanao, and Basilan including Isabela City), consistently implemented DQC activities at least twice a year or more, although the indicator only requires once a year. Two of these provinces, Compostela Valley and Agusan del Sur, demonstrated good practices on the use of validated data in better health programming and budgeting results while Iligan City showcased the importance of unified reporting system for public and private facilities in the SDN. The Project deliberately assisted all provinces in the development of their local investment plans for health (LIPH) and program implementation review (PIR) using only “DQCed” health information. The generation of “DQCed” data allowed the local health managers and LCEs to develop context- and site-specific health programs directly targeting the underserved population. In PY6, the Project seeks to sustain the institutionalization of DQC in 15 provinces and 28 individual municipal-LGUs with DQC policy2, and the advocacy and capability building in the four (4) remaining provinces without DQC policy3, and Zamboanga City. The Secretary of Health of ARMM issued policy guidelines directing all local health units to conduct DQC of FHSIS statistical data prior to submission to the PHO. All PHOs in ARMM issued an iteration of these policy guidelines. Lastly, Davao City Health Office shall “validate the data or report received from the District Health Centers and local sources, both public and private facilities” as included in the Ordinance Establishing Systems and Mechanisms for the Implementation of MNCHN Strategy in Davao City (Article VI Section 5.3) passed in 2016 by the Sangguniang Panlungsod of Davao City.

The presence of a DQC-trained public health nurse at the RHU/CHO and a functional technical team at the provincial level tasked to monitor, validate and analyse FHSIS-data and provide technical support and updates to the RHU/CHO DQC team are crucial in the sustainability of the RHU/CHO-based DQC activities. The administrative issuances institutionalizing the DQC process and the inclusion of DQC budget in the LIPH and AOP also help to ensure the success of the initiative in the succeeding years as demonstrated by the LGUs regularly conducting DQC activities since 2015.

Deviation Narrative

Davao City is the only highly urbanized city/province that has not conducted DQC for the past two years despite the available policy and constant advocacy to conduct the DQC by DOH-RO X and the Project. The DQC exercise in 2016 resulted to a drop in the city’s CPR by almost half with the removal of FP –CUs in TCL with no accomplished FP Form 1. While all the district health offices are now using FP Form 1 after the DQC, the CHO leadership failed to operationalize their City

2 With DQC policy in the form of EO by the LCE or Office Order by the P/CHO: Zamboanga Peninsula: Zamboanga del Sur, Zamboanga City Northern Mindanao: Misamis Oriental, Lanao del Norte, Bukidnon; Iligan City and Cagayan de Oro City Davao Region: Compostela Valley SOCCSKSARGEN: Sultan Kudarat and 28 LGUs (Cotabato City, North Cotabato – 18/18, South Cotabato- 9/11) Caraga: Agusan del Sur and Agusan del Norte ARMM: DOH-ARMM Memorandum backed by province-wide office order from the 5 IPHOs 3 Zamboanga del Norte, Zamboanga Sibugay, Davao del Sur/Davao Occidental , Davao Oriental

Ordinance on data validation by building up their DQC processes to address weaknesses in their recording/reporting system.

While there is an increasing number of LGUs conducting DQC through the years, it is crucial, that in addition to policy issuance on DQC, an in-house DQC champion and an in-place facility mechanism to orient/mentor incoming new personnel will reduce unnecessary gaps due to fast turn-over and resignation of DQC-trained health service providers, including the frequent changes in the LGU health leadership. These are the most common reasons that have affected the continuity of DQC- activities in many local health units.

Challenges

While the Project has provided significant technical assistance to all partners, the timeliness of reports, and completeness and quality of data are major challenges that have affected not only the quality and submission of substantive reports, but also advocacy works on the ground. MH addressed these challenges by: a) imparting to the LCEs and local health managers the benefits of DQC in LGU planning, implementation, monitoring and evaluation processes; b) capacitating the RHMs, FHAs, NDPs and PHNs on DQC and mainstreaming the activity so that DQCs are conducted at least every quarter and cover most facilities under each municipality/city; c) supporting LGUs and facilities to better understand the DQC methodology via on-site coaching through MH LGU Advisors (LGUAs); d) engaging currently non-reporting hospitals and private sector facilities to participate in DQCs; and e) collaboration with the Zuellig Family Foundation (ZFF) which became an active proponent of DQC.

Indicator NI 1: No. of Women of Reproductive Age Who 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 Q4PY6 WRA with Unmet Accomplishme Cumulative Accomplishment Project Areas Need for FP* nt for Q4PY6 Target, EOP Actual % (A) Priority Areas: (1) 12 USG priority 464,639 450,317 464,639 720,262 155 Sites (2) CAA Sites: (a) BaSulTa, 112,663 12,094 112,663 18,761 17 Zambo City, Cotabato City (b) Marawi & Environs (Lanao 75,109 10.944 75,109 39,281 53 Sur & Lanao Norte) (B) 5 Non-Priority Areas 116,074 30,278 116,074 40,605 34 Project-Wide Total 768,485 503,633 768,485 818,909 107 * - 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 has already surpassed the estimated number of WRA with unmet need.

Based on PIRS, the EOP-target is only 470,840. Using this target, the Project accomplishment is already 174% of this target. As of Q4PY6, the number of WRA profiled and identified with unmet need for FP is 107% of the estimated number of WRA with unmet need for FP as per Costed Implementation Plan target specified in the DOH memo dated November 16, 2017.

Deviation Narrative

Although projectwide, the number of WRA profiled and identified with unmet need is 107% of the estimated number of WRAs with unmet need, it is low in Conflict Affected Areas (CAA) – because of the following reasons: a) 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, b) the inadequate mobility and capacity to reach island and mountainous barangays in ARMM and other CAAs not to mention the security risks, c) the comparatively lower number of CHWs who were mobilized to do profiling, and d) lack of report from Zamboanga City and incomplete report from Isabela City.

In the 12 Priority USG sites, the cumulative accomplishment is 155% of the estimated number of WRA with unmet need. The focused house-to-house profiling in Compostela Valley and the Tuktok Planado Pamilya initiatives in Agusan del Sur resulted to the identification of WRAs with unmet need, the total number of which is much higher than the estimated.

Indicator NI 2: Percent of Women of Reproductive Age Who have been Profiled and Identified as Having Unmet Need and Have Been Provided with FP Services

Table 10.0 WRA with FP Unmet Need Provided with FP Services as of Q4PY6 Accomplishment Cumulative Accomplishment Project Areas for the Quarter Target* Actual % (A) Priority Areas: 59,924 720,262 225,657 31

(1) 12 priority Sites (2) CAA Sites: (a) BaSulTa, Zambo 7,433 18,761 18,616 99 City, Cotabato City (b) Marawi & Environs (Lanao Sur & Lanao 5,389 39,281 17,892 46 Norte) (B) 5 Non-Priority Areas 7,822 40,605 25,899 63 Project-Wide Total 80,568 818,909 288,064 35 * - Target based on the accrued accomplishment of NI 1 – WRAs profiled and identified with unmet need for FP

Analysis of Accomplishment

While there is 5.4 percentage point increase from Q3PY6 accomplishment, only 35% of the number of WRAs profiled and identified with unmet were provided with appropriate FP service, especially so that there is 16 percentage point increase in the number of profiled WRA with FP unmet need from 91% in Q3PY6 to 107% in Q4PY6.

Deviation Narrative

The low accomplishment vis-à-vis the number of profiled WRA with unmet need is due primarily to a) poor recording of WRAs identified with unmet need and provided with FP services given the above-the-target performance of the LGUs’ in CU and CYP, Take for example Davao City, the monthly unmet need tracking sheet provided by the project is not updated on time based on the service logbook, hence, seemingly low coverage from the unmet need list though provided already with appropriate services; b) time lag between identification of WRA with unmet need to service provision – profiled WRAs identified with unmet need were not followed up to attend Usapan sessions or FP outreach services or to access the FP services.

Indicator NI 3: Percentage of PPFP/PPIUD Trained Providers Who Have Been Certified by the Department of Health

Analysis of Accomplishment.

During the quarter, only eight additional HSPs were supportively supervised and only 2 were certified by DOH. Project-wide 661 (74.8%) of the 884 PPIUD- trained HSPs underwent supportive supervision as of the end of Q4PY6, of which 62.0% of those supportively supervised or only 46.4% of total PPIUD trained are DOH-certified. All the 884 HSPs trained on PPFP/PPIUD are working in 514 SDPs.

The highest proportion of PPIUD-trained HSPs who had supportive supervison is observed in SOCCSKSARGEN (92.7%), followed by Caraga (90.7%), Zamboanga Peninsula (76.8%), Davao Region (67.1%), Northern Mindanao (65.3%) and ARMM (61.8%).

The provinces where more than 85% of PPIUD-trained HSPs completed post-training evaluation/supportive supervision are Cotabato (100%), South Cotabato (87.9%), and Sultan Kudarat (93.9%) in SOCCSKSARGEN; Zamboanga del Sur (90.3%) in Zamboanga Peninsula; Misamis Oriental (97.9%) in Northern Mindanao; Davao del Sur (100%), and Compostela Valley (84.6%) in Davao Region, and Basilan (90.0%) in ARMM. The common facilitating factor in this achievement is the support of the provincial/city chapter of the Integrated Midwives Association

Table 11. PPIUD-Trained Health Service Providers by Status (Completed Supportive Supervision or Certified by DOH) as of Q4PY6

SupSup/ Baseline SDP Project Areas Traineda Recommended for % 2012 Coverageb Certification (A) Priority Areas: 55 534 447 83.7 349 (1) 12 priority (2) CAA Sites: (a) BaSulTa, 24 102 60 58.8 46 Zambo City, Cotabato City (b) Marawi & 2 47 19 40.4 33 Its Environs (B) 5 Non-Priority 7 201 135 67.2 86 Sites Project-Wide 88 884 661 74.8 514 a – In Q4PY6, those who are no longer with the health service were removed from the total number HSPs who attended MH-assisted/supported training. This number is lower than that reported earlier. b–No. of SDPs where PPIUD-trained HSPs are assigned

46 of the Philippines (IMAP) that is instrumental in contacting and mentoring HSPs for post-training evaluation (PTE) and active engagement of PDOHO.

Status of PPIUD-trained HSPs certified by DOH varies across regions for different reasons. The commitment of Regional FP Program Coordinaotr of SOCCSKSARGEN, in close collaboration with PDOHO and the Project resulted to supportively supervising 165 or 92.7% of the 178 trained HSPs and certifying 132 or 80.0% of those supportively supervised, with Cotabato (100%) and South Cotabato (84.8%) exceeding 80% of targeted proportion of HSPs-trained who are certified by DOH. While only 76.8% of PPIUD-trained HSP in Zamboanga Peninsula were supportively supervised, 97.6% (41/42) of supportively supervised trained-HSPs of Zamboanga del Sur are already certified, because of the strong leadership at the PHO level ably accessing technical from the PDOHO, and MindanaoHealth Project.

On the other hand, despite the availability of capable facilities and master trainers in Davao Region, it ranks 6th among the regions with only 33 (34.4%) out of 96 (67.1%) supportively supervised from the total 143 PPIUD-trained were certified. In Davao City, of the active 44 PPIUD-trained HSPs (39 private and 5 public), only two of the seven (5 public and 2 private) who were supportively supervised are certified. In ARMM, the low number of HSPs certified (21/55 trained) is primarily due to the inability of trained service providers to complete the 10 successfully completed PPIUD-cases-requirement to undergo post-training evaluation, for reasons that, in general PPIUD/IUD method is not culturally acceptable, as it requires exposure of private parts. While a little more than 65.3% of PPIUD trained HSPs in Northern Mindanao underwent post-training evaluation, but only about half (49.2%) of those supportively supervised are certified.

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

Deviation Narrative

The certification process varies among DOH-ROs especially on the documentary requirements. For example, an FP Regional Program Manager requires the submission of pre- and post-test results even if the post-training evaluation was conducted months or even years before the application for certification. The processing time also varies. DOH-SOCCSKSARGEN is facilitative while the others require frequent follow throughs.

The lack of dedicated trainers/mentors to conduct post-training evaluation and on-site mentoring/coaching of trained service providers even at the regional level is another key factor in low certification rate. 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 the database to capture new trainees and to continuously clean the training data base to weed out trainees who have already resigned/retired from the service, transferred to another

47 unit/department, or who are conscientious objectors. For example, in Agusan del Sur and Agusan del Norte, of the 59 MH-assisted PPIUD trained HSPs, 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, due to the low demand for PPIUD among Muslim WRAs because IUD is not culturally acceptable to them. In other provinces/HUCs with low supportive supervision coverage (e.g., Davao City, Cagayan de Oro City) most trainees are based in Barangay Health Stations with only once or twice in a week duty in their DHO/RHU-based birthing facility thus are not able to comply with the required minimum of 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.

Indicator NI 4: Number of Newborns Not Breathing at Birth who were Resuscitated in USG-Supported Programs Cumulative Accomplishment Project Areas Actual, Q4 Target, Actual,Q1-Q4 % PY6 (A) Priority Areas: (1) 12 priority 127/ 3,514 386/8,988 Sites (2) CAA Sites: (a) BaSulTa, NAa NA Zambo City, Cotabato City (b) Marawi & Environs (Lanao 9/1,282 31/2,121 Sur & Lanao Norte) (B) 5 Non-Priority 114/ 1,371 399/5,418 Sites Project-Wide 250/6,167 70 818/16,947(5%) 1,168 a – NA means Not Applicable; no sentinel hospital was selected

Analysis of Accomplishment

For this indicator, reports are being collected from ten (10) sentinel hospitals – 6 in the Priority Areas cluster, 1 in the Priority CAA (b) cluster, and 3 in the Non-Priority Areas cluster. Based on submitted reports, as of Q4PY6, 818 (4.8%) out of 16,947 live births in the sentinel hospitals had difficulty of breathing and were resuscitated. Compared to given EOP target of 70,

818 is 1,168% of the given target. Obviously, the very high accomplishment is due to severe undertargeting (Target was set by USAID and agreed by TWG).

Deviation Narrative

The very high accomplishment here is due to the very low target of 70 per year as agreed during one of the USAID-led inter CA M&E TWG meetings, and it is not due to indiscriminate newborn resuscitation practices. The reported proportion of resuscitated newborns is 4.8%, which is within the acceptable standard range of 5-10%, according to global studies. This means that sentinel hospital sites are complying to medical criteria/indications to newborn resuscitation.

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

Provision.

Accomplishment Cumulative Accomplishment, Baseline Indicator for the Quarter, Q4PY6 2018 2017 Target Actual % Target Actual % Marawi & Its 0 21 21 100 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 as of September, 2018 Provision of The conduct of outreach servces was accelerated in Q4PY6 with engagement of two immediate CSOs namely Duyog Marawi and Balay Mindanaw. A total of 55 outreach with medical/RH services USAPAN services were supported by the project giving total of 89 outreach services including for the year reaching about half of GIDAs in Marawi and its environs including psychosocial services transitory sites, tent cities located in LDS, LDN/Iligan and Marawi City.

Intervent Q4PY6 Q1-Q3PY6 Total ions LDN/Iliga LDS/Marawi LDN/Iligan n LDS/Marawi ANC 551 1,308 1859 PPV visits 396 1,041 1437 FP 65 (51 594 (145 650 (203 1,110 FP acceptors Services LARC & LARC, 449 LARC/PSI) 14 SARC SARC) Medical 94 (19 976 medical 3,108 of which 4,178 of which 313 consultat AY consultation 313 are AY are AY reached with

ions, etc clients s, 240 Vit A accessed medical FP and BF message

and 548 consultation and and medical immunized informed on FP consultations; 349 and BF messages; with Vit A, and 633 85 children children immunized immunized; 109 provided with Vitamin A, Others 6 Psychosocial services 10,000 aquatabs 10,000 aquatabs conducted reaching 124 in response to provided & 124 adult women and 105 typhoon Vinta, adult and 105 children. children reached with psychosocial Trained 24 HSP, 21 services. teachers/guidance counselors and 5 CSO representaitves as adult Support to Peer Educators in LDS/Marawi

Conducted 3 USAPANG Barkadahan reaching 59 adolescent ages 13-17 (21 male and 38 female); 48 provided psychosocial assessment and 24 were further referred for counseling (common risks identified were domestic abuse, bullying in schools and suicidal thoughts

Provision of fixed FP For Q4PY6, additional 326 FP acceptors were reached at GTLluchMHosp giving a total services - GTLMH, of 445 FP clients reached during the last 2 quarters of PY6 (87 BTL, 280 LARC and 78 Iligan City and APMC, SARC). FP fixed services was likewise provided at APMC reaching 99 clients during the quarter (90 BTL and 9 SARC) in Q4PY6. Marawi City

In summary, technical assistance resulting to reaching 1,535 FP acceptors through outreach and fixed FP services during the year in 21 targeted priority areas in Marawi and its environs.

Ensuring safe During the quarter, additional 10,000 each of dignity kits and maternity kits were motherhood and procured in supoprt to strengthening safemotherhood services. This is in addition to nd newborn care the 3,000 kits procured during the 2 quarter of PY6.

(provision of Additional 7,722 pregnant women were provided with dignity/women’s kits during maternity and dignity antenatal care service provision during the quarter, giving a total of 8,458 pregnant kits) women reached to date. Similarly, additional 5,881 postpartum women were provided with maternity kits during follow-up consultations at the facility or during outreach services, giving a total of 6,610 postpartum women with PPV2 provided with maternity kits, as detailed below.

Maternity USG-sites Dignity kit Comments kits Lanao del 8226 6378 38 sites were reached with Sur/Marawi safe mother hood services and kit distribution. Lanao del 232 232 Covered (2) Balo-I, Pantar Norte Total 8,458 6,610 Target list per facility already completed and validated; safe motherhood services with kit distribution on-going, in close collaboration with PHO, Offcie of LDS Governor staff, Bangasamoro Youth Leaders, Duyog Marawi, Balay Mindanao, and staff of targeted facilities.

The engagement of two Marawi/Iligan-based CSOs namely Duyog Marawi and Balay Mindanaw as well as participation of Bangsamoro Youth Leaders and Medical Officer of Office of Governor of LDS has accelerated this technical assistance. Safemotherhood services including the provisions of the dignity/women and maternity kit to qualified pregnant (seeking ANC in the first trimester including all pregnant teens), and postpartum women, respectively is on-going and will be completed by end of October. II. Help restore/strengthen 1. Trained 2 HSPs of Amai Pakpak Medical Center and 3 HSPs in GTMLluch provision of essential Hospital in Iligan City on Hospital Recording and Reporting, with follow-up RH/health services onsite coaching and mentoring of FP Recording and reporting 2. Trained during the quarter 30 CHWs in Marawi City on Interpersonal Communication (IPC) to improve their knowledge and skills in providing FP information and initial counseling and were able to refer 212 potential clients from their reprohealth mobile session.

3. Printed Khutba Materials into Maranao dialects (Male Involvement on FP, Maternal Neonatal and Child Health and Breastfeeding), and were provided to the 24 MRLs that were oriented by the project. Said material is now being used as reference during sermons. 4. Installed water tank in three sites (Olo-Ambolong BHS, Sugod BHS and Tuca BHS) in Marawi City, and in Nunungan RHU in LDN, and are now functional; completed fabrication of steel platforms for 7 water tanks and delivered to the sites. Installation of the remaining 7 started in Bangco BHS, and the completion target date for all the 7 water tanks is 31st of October. This is in close coordination with SURGE as they provide technical assistance in the Marawi City- LWUA-DILG Salintubig Program. 5. Working closely with B-LEADERS, the project assisted in the assessment of the targeted health facilities for the installation of solar power energy. Three of the four recipient facilities are part of the 15 targeted health facilities for solar refrigerators by first week of December: Marawi – CHO, Bangco BHS, Ambolong BHS, Basak Malutlut, Tuca BHS; Lanao del Sur – Saguiaran RHU, Malundo RHU, Ditsaan Ramain RHU,Bubong RHU,Buadipuso Buntong RHU, Piagapo RHU, Marantao RHU; Lanao del Norte- Balo-I RHU, Munai RHU, Nunungan RHU. 6. To help keep the potency of the vaccines, (1) Generator set will be provided to the CHO Marawi and PHO, and the other (1) to Saguiaran RHU upon further validation (ICRC has provided genset to Saguiran per latest information) or to other facility per consultation with CHO/PHO.

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, Q1-Q3PY6 Q4PY6 As of Project Areas Target Accomplish % Health WRA CHWs’ Q4PY6 ment FBD Others Total Events Profiled Clients (A) Priority Areas: 1,229,779 976,319 7,199 46,832 450,317 3,083 55,004 562,435 1,538,754 125 (1) 12 priority Sites (2) CAA Sites: (a) BaSulTa, 284,355 153,607 1,054 8,796 12,094 587 483,925 506,456 660,063 233 Zambo City, Cotabato City

b) Marawi & Environs (Lanao 206,169 77,258 1,022 3,457 10,533 359 2,648 18,019 95,277 46 Sur & Lanao Norte) (B) 5 Non-Priority 279,697 91,250 1,234 5,443 30,278 597 279,081 316,633 407,883 145

Areas (C) Project-wide contribution 156,876 156,876 156,876 (allocated as IEC Materials etc.) Project-wide 2,000,000 1,298,434 10,509 64,528 503,222 4,626 977,534 1,560,419 2,858,853 143

As guided, the project is utilizing the following outputs to constitutes 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, (6) estimated size of audience of radio stations in Bukidnon, Basilan, and Isabela City that are plugging MNCHN-FP messages, (7) estimated number of recipients of IEC materials produced and distributed by MH, and (8) from FP reached of SOME4AYRH Initiatives.

In Q4PY6, the estimated size of the audience reached by MH-initiated/assisted dissemination activities of FP/RH key messages is 1,560,419, which is about 78% of the target. As of EO PY6, the estimated size of this audience is 2,858,853, or 143% of the PY6-target of 2,000,000.

Conflict Affected Areas Indicators

Indicator CAA1: Number of Health Outreach Conducted

Accomplishment Target, Project Areas Baseline As of As of EOP Q4PY6 % Q3PY6 EOP Conflict Affected 336 315 147 420 567 180 Areas (a)

Analysis of Accomplishment

Conduct of outreach services in Conflict Affected Areas exceeded its EOP target of 315. Outreach is the only means to reach IDPs in transitory sites in Marawi such as Sarimanok tent city, new temporary settlement in Guimba, existing evacuations sites in Balo-I and Pantar, and island sitios and GIDAs with no health facility or health service providers. The conduct of outreach services contributed significantly in reaching EOP targets on CU and CYP in conflict affected areas, example Lanao del Sur was able to surpassed its EOP targets on CU and CYP through the conduct of outreach services, in partnership with Civil Society Organizations such as ARCHES, Duyog Marawi and AMDF.

Deviation Narrative

While the project exceeded its end-of-project target, expanding reach to GIDA barangays in island barangays/sitios is slow given the operational challenges in CAAs, especially those controlled by armed groups and the non-availability of facilities/space for FP outreach services in GIDAs. As such, for the quarter, in addition to outreaches conducted in transitory sites, nine GIDA barangays reaching 41 clients were supported, thereby expanding reach to 44 GIDAs since Q3PY6. Most of the outreach activities were conducted at the poblacion but catered to clients from GIDAs. 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 in their regular health activities, in addition to a clustered outreach activities in partnership with the military.

Administrative issuances institutionalizing outreach services from DOH-ARMM that are iterated by the IPHO of Sulu, Lanao del Sur and Maguindanao especially after the Marawi siege are primarily responsible for the increase in the number of outreach activities in CAAs.

Indicator CAA2: Number of Civil Society Organizations Trained to Effectively Engage with Local Governments Accomplishment Target, Project Areas Baseline As of As of EOP Q4PY6 % Q3PY6 EOP Conflict Affected 0 23 0 23 23 100 Areas (a)

Analysis of Accomplishment

This indicator refers to the number of USG supported non-government associations or people’s organizations operating within conflict affected areas that have 1) trained members, 2) have undertaken advocacy activities and 3) have resulted in any of the following MNCHN/FP related initiatives by LGUs, namely: a) conduct of outreach, health promotion activities, b) issuance of a policy or ordinance, c) provision of financial or non-financial support, and d) engagement of public or private sector partners.

The 23 CSO assisted/tapped by MH to engage with the LGUs broken down as follows; nine (9) from Zamboanga Peninsula, five (5) are in SOCCSKSARGEN and nine (9) are in ARMM, additional two namely Duyog Marawi and Balay Mindanaw were tapped for Marawi and Lanao del Sur. The engagement of CSO is primarily in demand generation and service provision, and in some degree on advocacy to local chief executives. Of the twenty three (23) USG-MH-assisted CSOs, nine (9) 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

54 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. Engagement of the other CSOs on governance is minimal for varied reasons such as erratic functionality of local health boards, and poor relationship between local leaders with the existing CSO/NGOs.

Indicator CAA3: Number of youth trained as peer educators

Accomplishment Target, Project Areas Baseline As of As of EOP Q4PY6 % Q3PY6 EOP Conflict Affected 0 373 191 270 461 124 Areas (a)

Analysis of Accomplishment

This indicator refers to the number of youth peer educators capacitated by MH in conflict affected areas through USG supported training on various MNCH/FP topics including health management and leadership courses such as LGU scorecard, Service Delivery Networks, Localizing MDGs 4 & 5, and Adolescent and Youth Reproductive Health.

An additional 191 peer educators were trained during the quarter resulting to a cumulative total of 461, which is 124% of the EOP-target. While there were some dropout among trained peer educators, as some moved out from the area for greener pastures, it is noteworthy to note that all the 122 supported peer educators and support adults in Basilan are active. Together, they supported the conduct of USAPAN Barkadahan in 3 schools reaching 254 high school students with information of sexuality and reproductive health and assisted in risk assessment using Rapid HEEEADS tool to 96 student with guidance from DepEd, Population Office, CHO-Isabela City, and City Youth Development Council

All 68 peer educators in Upi, Maguindanao are likewise active reaching 1,067 students through Usapang Barkadahan sessions in 8 high schools in Upi and 15 out of 23 barangays; Usapang Teen Moms sessions in 10 out of 23 barangays reaching 170 teen moms, and has referred 18 in pre-arranged marriage for FP/MNCHN counseling to RHU. The functionality of peer educators in Upi, Maguindanao is sustained since they are organized and link with institution’s or government’s AY-development program supported by an Executive Order or Ordinance. The established Upi Youth Governance Program, with annual budget from the LGU since 2014 provide opportunity to youth to engage in leadership and local governance, participate in annual investment planning and oversee and manage community teen center, in close partnership with schools, RHUs and social welfare office. While there are no scientific analysis, the creation of Upi Youth Governance manned by core 15 A/Y and active peer educators supported by the project has contributed to the reduction of teenage pregnancy 217 in 2014 to 91 in 2017.

In addition to engagement of peer educators during outreach activities, three Usapan Barkadahan was conducted in Lanao del Sur/Marawi City. A total of 59 adolescent ages 13-17 were reached (21 male and 38 female). Of the 59, 48 were provided psychosocial assessment of which 24 were further counseled and referred for further management/counseling. Common risks identified during the assessment were domestic abuse, bullying in schools and suicidal thoughts. It is critical for the peer educators with their adult support group to follow-up these adolescent-at-risk to ensure that appropriate services/support as provided.

Indicator CAA4: Number of clients reached during health outreach activities

Accomplishment Baseline Target, Project Areas As of As of 2012* EOP Q4PY6 % Q3PY6 EOP Conflict Affected 33,774 69,737 2612 69,0914 71,196 102 Areas (a) * - from SHIELD final report

Analysis of Accomplishment

This indicator measures the extent of coverage of clients receiving information/services during outreach activities in conflict-affected areas that exhibit high levels of unmet need, poor maternal and child health outcomes.

The number of FP clients reached during health outreach activities in Q4PY6 is 2,261 (NSV-5; IUD-596; LARC/PSI-1,660). The total number of clients served as of EO Q4PY6 is 71,196, which is 102% of the EOP-target and represents a 30.8% compared to the baseline.

Deviation Narrative

The cumulative number of clients served surpassed the target due to the increased number of outreach activities conducted. The engagement of capable members of Civil Society Organizations namely Duyog Marawi and Balay Mindanao has accelerated the conduct of conduct outreach and psychosocial services in Lanao del Sur and Marawi City.

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, very few health facilities are submitting sex/age-disaggregated

information on services provided, and there was no significant change from Q3PY6 status, as reflected in the table below.

On the other hand, of the 744 supported service delivery points providing FP counseling and services, 513 or 69% are in rural areas and 31% (231) in urban areas. Of those in the rural areas, 60% (306) are in priority 12 LGUs, 27% (135) are in conflict affected areas and only 4% (72) in the five non-priority areas. (Table 4.1).

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 4 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 All the clients assessed sessions (HEEADSS) using HEEADSS in the 106 AYRH friendly facilities (partial reports) out of the total 130 facilities are sex disaggregated. 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 All ICV during capacity building training/orientation, peer educators training and some FP courses during the year were all sex disaggregated. Identify the gender of participants All 6 regions All the 332 health during ICV monitoring facilities visited have sex dis-aggregated data for HSP and clients observed. Provision of AYRH-friendly services All regions Selected AY- facilities: Sulu, Maguindanao, Zamboanga City, Zambo

Gender Planned Target Accomplished concern Sur, Agusan del Sur, Agusan del Norte, ComVal, davao del Sur, Davao Oriental, Davao City. Bukidnon, Lanao del Norte, Cotabato City, South Cotabato, General Santos City

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 inputs (e.g., SOCCSKSARGEN, CARAGA, technical assistance Northern Mindanao) Use of visualized data/infographics Number of RITs regularly using data for to update health leaders/LCE to updates/call for actions. (Regional ensure sustainability of efforts/gains Implementation Teams (RITs) of Davao, Conduct of Regional Dissemination SOCCSKSARGEN and Caraga regions) Forums on FP/MNCHN/AY # of regional dissemination forum conducted with clear commitments from partners Policy formulation Development of Operational Guide Number of Health Facilties with on FP/AY; Policy/issuances Operational Guide on FP and AYRH supportive to DQC, PhilHealth integration (e.g., 8 hospitals, SDN Reimbursement Referral Guides,) # of LGUs with policy issuances supportive to DQC institutionalization (15 provinces and 28 municipalities with policies that mobilize DQC team and allocating funds for DQC; ARMM wide policy issued on DQC which was iterated by all PHOs # of LGUs with policy adopting PhilHealth Guidelines on Reimbursement (333 LGUs) Capacity building Jointly identify providers for Number of trained providers supportive supervision, follow up on supportively supervised and certification and accreditation recommended for certification (Projectwide, out of the 913 PPIUD trained HSPs, 664 were supportively

supervised of which 408 are already DOH-certified and majority are PhilHealth accredited) 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/ Number of functional Mentoring Sites Mentoring/Clinical Practice sites (PPIUD= 18)

Center of Excellence on PPIUD To date, there are 5 recognized Center of Excellence on PPIUD namely DRMC, SPMC, ZCMC, CRMC and NMMC) Approval/production Approval from USAID already All the 9 generic and 3 specific USAID of technical sought and actions finalized approved technical products packaged, products for wide Reproduction of all approved reproduced ready for turn-over to dissemination technical products ; production of partners during regional dissemination omnibus AVP forums, in addition to the recenctly concluded regional forum for Northern Development and launching Mindanao and the National WHO/USAID/Jhpiego Toolbox on Dissemination Activity: omnibus AVP FP/MNCHN on FP/MNCHN/AY produced initially presented to Dereck and Kiel during the workshop conducted in Davao City

WHO/USAID/Jhpiego Toolbox Developed and Launched Establishment of Sustain technical assistance guided Proportion of functional SDN; SDN on by the SDN Operational Guide that Proportion of SDN’s contribution to MNCHN/FP/AY captures the 8 basic steps to SDN province-wide CU and CYP. establishment

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. • Waste segregation into infectious and non-infectious waste; • Sharps are collected in a puncture and leak-free boxes

# Health Region Facilities Compliance Rate Visited • 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; • 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

# Health Region Facilities Compliance Rate Visited 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. 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

# Health Region Facilities Compliance Rate Visited plastic or can containers) and containers are not emptied • Use .5% chorine Solution

Total 120

3.4 Update on Family Planning Compliance

As of September, all the facilities visited conformed to the principle of Informed Choice and Voluntarism where clients were provided with appropriate FP information on the different FP methods including the risks, benefits and possible side effects. The clients were guided in their decision-making through the information provided and through the physical assessment using the FP form 1 and the Medical Eligibility Criteria Wheel. Prior to any FP service provision, the clients were ensured if they understood the information provided and are encouraged to ask questions regarding the different FP methods. Consent forms were also obtained prior to any FP service provision.

In Zamboanga Peninsula, a total of 27 facilities were monitored and were found to be ICV complaint based on the observation results and interview of 100 clients and 32 health service providers. Furthermore 13 training/ICV orientation reaching 968 health service providers (654 females; 368 males) with FP skills and ICV principles, policies and guidelines. This is in addition to the 242 heath service providers oriented and 25 health facilities monitored where 44 health service privders were observed and 78 clients interviewed in Q3PY6.

For Northern Mindanao, there were five training/ICV orientation conducted where 200 health services (174 female and 26 males) were re-oriented on ICV policies and principles during the quarter. In addition, 27 facilities were monitored, where 31 health service providers were interviewed and observed while providing FP services, in addition to 100 clients interviewed. All visited health facilities and health service providers are complying to ICV guidelines and principles thereby rights and choices of clients were respected.

For the last two quarters of PY6, a total 318 health service providers, including 16 CMSU midwives that undergone training on various FP methods/skills were re-oriented on ICV; and all the 57 facilities monitored and 104 health service providers were observed are ICV compliant, as per observation and results of interview to 23 clients.

For Davao Region, as of September 2018, a total of 72 SDPs where 72 health service providers were observed/interviewed and 144 FP clients were interviewed. All these monitored facilities were found to be compliant to ICV guidelines and policies. Also 63 ICV orientation were conducted as integral component of training, outreach services reaching 2,878 service providers (32 males and 2,846 females. Of the thirteen (13) outreach activities conducted and monitored, 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. Some good points observed during monitoring are: a) some clients were hesitant at first but later cooperate when they are assured of confidentiality, b) husbands of clients were supportive and open to interview, c) HSPs are accommodating and very open about their situaiotn and concerns.

For SOCCSKSARGEN, ICV principles, policies and guidance were re-enforced as integral component of eight (8) supported LARC/PM activities by orienting 29 health service providers (5 males and 24 females) and additional seven (7) health facilities were monitored and found to be compliant based on observation results and interview of 19 health service providers and 10 clients.

For the last two quarters of PY6, 187 health service providers (60 males and 127 females) were re-oriented/oriented on ICV including 80 BHWs (2 males/78 females), and a total of 27 facilities were monitored reaching 77 service providers and 44 clients.

For CARAGA Region, as of Q4PY6, a total of 29 ICV orientation activities where 1,532 female health service providers were oriented/re-oriented and now equipped with working knowledge and skills on ICV; and a total of 90 health facilities were monitored where 127 health service providers were observed and interviewed, including 143 clients. There were no observed ICV violations and ICV FP wallcharts are available in all facilities visited. All service providers had deepened their understanding on the importance of ICV and use of GATHER approach during FP counseling. 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.

4. Collaboration, Learning and Adapting

The MindanaoHealth Project’s years of implementation also brewed partnerships that yielded promising results and outcomes that contributed in the improved FP/MNCH status in Mindanao. Along provision of technical support, emerging good practices FP/MNH/AY have evolved, documented, shared, adapted by implementing partners, for example the Campus-based AYRH Services dubbed as “Youth Optimizing Life Opportunities- YOLO” that was initiated in 12 schools in Agusan del Norte, in partnership with Provincial DepEd Division has expanded to additional 22 schools within the province under the leadership of the Provincial DepEd Superintendent, with minimal support from the project. Sharing of this initiative among provincial DepEd leadership resulted to expansion to another six schools within District 2 SDN of Zamboanga del Sur and orientation of core team from DepEd Division of Zamboanga Sibugay, among others. To date, we have documented 17 promising good practices that are now being advocated by the project and DOHRO during regionwide activities.

Furthermore, various USAID-approved technical products/tools on FP/MNCHN/AY were developed, reproduced and now being handed over, during regional dissemination and closeout activities, to regional and sub-regional health partners, both public and private, to augment available guides and references in the delivery of quality FP/MNCHN/AY health care and services.

 Service Delivery Network (SDN) Guide  Operational Guides for Hospital-based Programs or Centers for Teens  PPIUD Manual: Facilitators’ Guide  PPIUD Manual: Handbook for Health Service Providers  Frequently Asked Questions (FAQs) on Modern Family Planning Methods  Social Media Guide for AYRH *#SoMe4AYRH)  Teen Hotline: Operational Considerations, Protocols and Procedures  Khutba or Sermon Guide for Muslim Religious Leaders on family planning, reproductive health and maternal and child health topics  Community Health Workers (CHW) Toolkit  Rapid HEEADSS Guide

It was noteworthy to witness how regional close-out and turn-over activity in Northern Mindanao were used as avenue to learn how FP/AY champions are born. Health partners from the hospital, RHU, and provincial health office honestly shared their very own rough journey from passive implementer with degree of resistance to becoming FP/AY champions, through established sustained professional relationship/partnership where evolving gains are measured, appreciated and shared, operational challenges are resolved jointly through consultations and learning from others’ successes; and the hospitals’ recognition on their critical role within the health care system and not to work independently. The activity was also an avenue to showcase emerging good practices to non-USG sites, including the provision of these technical products to all health service providers/managers from the public and private sector.

In addition, there are specific technical guides developed, such as: i) Referral Guides for Agusan del Norte’s BueNasCar (Buenavista, Nasipit, Carmen) SDN and Agusan del Sur’s DOP (D.O. Plaza) SDN; and ii) Manual of Operations of Department of Education-Agusan del Norte Division’s YOLO (Youth Optimizing Life Opportunities) Program.

MindanaoHealth Project’s collaboration with World Health Organization’s Sub-national Initiative - Accelerating Convergence Efforts through Systems Strengthening for Maternal and Newborn Health (AcCESS for MNH, Maternal and Newborn Health) Project resulted to the development of a user-friendly toolbox on Maternal and Neonatal Health and Family Planning that consolidated relevant technical guidelines and technologies advanced and guided the implementation of the 2 projects. The toolbox was launched last Sept 6 and distributed to partners in Davao Region, aimed at sharing providing enabling tools in the area of maternal and newborn health that they can adapt to local settings.

MindanaoHealth presented its SDN implementation experience in Mindanao through the Learning Clinic during the National Dissemination Forum conducted by USAID. The session was participated in by staff from DOH Central, DOH Regional Directors, Provincial and Municipal/City Health Officers, Program Managers/Coordinators, Chiefs of Hospital, USAID implementing partners, and USAID staff. The sharing and learning session elicited varying degree of appreciation and understanding of SDN mainly due to the non-prescriptive approach to setting up SDNs. In Luzon, as described by the Chief of Hospital of Batangas Medical Center (BMC), the operation of SDN revolves around the influence of BMC as its apex facility in the referral

64 mechanism, which is a positive development as it addresses one of SDN’s challenges--the propensity of higher-level hospitals to operate autonomously out of SDN’s larger goals and objectives. It is widely recognized the critical role that hospitals play in the health care system and to look at them as an integrated part of the broader health delivery system such as SDN. MindanaoHealth experience, in contrast, is holistic in its approach by putting emphasis on strong governance and leadership as the driving force to crystallize support around robust financing mechanism, dynamic public-private and community partnership, cross border and cross sector referral arrangements, capacity building, moving plans and policies into action, among others, towards providing equitable, comprehensive, integrated and continuous quality health services to a defined population.

5. Management, Administrative and Financial Issues

There are no critical management, administrative and financial issues during the reporting quarter.

Recently, to ensure smooth and timely implementation of the closeout plan per schedules, the management sought approval from USAID for HQ support to provide oversight to admin and finance unit while the Finance and Admin Director is on emergency leave. This leave of absence was not anticipated. HQ support started early October and still ongoing while this annual report is being developed.

6. High-Level Planned Activities for October-December, 2018

6.1 High level turnover of supply support to Marawi and its Corridors in December 2018

To support targeted facilities in Marawi and its environs restore provision essential FP/MNCHN/AY services after the siege, the project supported the installation of 3 water tanks and the on-going installation of the seven water tanks in Marawi City; offshore procurement of 15 solar, provision of two generator sets to selected facilities and on-going provision of safemotherhood including provision of dignity kits to pregnant women visiting health facilities or attending outreach services for antenatal care during their 1st trimester, and maternity kits to postpartum women with 2 postpartum visits. The planned ceremonial turn-over of these supplies and equipment to key leaders of government by the Mission Director and other USAID dignitaries, will help in our advocacy efforts to ensure recipient LGUs’ counterpart in the maintenance of equipment thus optimizing their usage, as well as transition to incoming new project on FP/MNCHN/AY for ARMM. It is tentatively being scheduled in December 10/11.

6.2 Regional Dissemination/Turnover Activities: October –November 2018

Part of the project’s sustainability plan is the conduct of regional/provincial dissemination and turnover activities. This one- to two-day activity will serve as avenue for local and regional leaders to appreciate partnership gains through AVP, share emerging good practices on FP/MNCHN/AYRH and to generate their commitments for sustainability from regional and LGU partners, including the turn-over technical tools/products developed jointly during the project

65 life, aimed at providing partners additional tools on FP/MNH/AY Programs in their efforts to institutionalize/scale-up these interventions/initiatives with clear commitment from their leaders.

Regional dissemination was already conducted for NorthernMindanao last Oct 12, 2018. Schedules for the remaining five regions are as follows:

a) November 13-14 = CARAGA Region in Butuan City

b) November 15-16 = Zamboanga Peninsula in Zamboanga City

c) November 20-21 Davao Region in Davao City

d) November 22-23 = SOCCSKSARGEN in General Santos City

e) November 27 = ARMM in Davao City

MindanaoHealth Project Program Year 6 Accomplishment Report (October 2017- September 2018)

Vol. 02: Annexes

Submitted: November 15, 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 right: A trained health provider from Zamboanga del Sur explains family planning to a postpartum mother teaching her to protect herself from unplanned immediate pregnancy. (Photo by: Jhpiego)

Bottom right: A teacher-participant undergoes teaching demonstration of Health and Sexuality Education using lesson plans they developed during a USAID-supported training. (FMorales/Jhpiego)

iii

Table of Conten ts

TABLE OF CONTENTS

List of Acronyms ...... v 7.1 MindnaoHealth Project Performance Indicator Tracking Table (PITT), end of October 2018 ...... 1 7.2 Project Financial Information ...... 5 7.3 Potential Success Stories, Pictures, etc...... 6 Summary of Story Idea - 1 ...... 6 7.4 Summary of Accomplishments per Province/Highly Urbanized City ...... 7 Table 01. Number of Modern Family Planning Current Users by USG-Assisted LGUs, by Project Year, and Quarter in PY6 ...... 7 Table 02. Modern Family Planning Current Users by Method and by USG-Assisted LGUs as of Q3PY6...... 8 Table 03. Couple Years Protection for Long Acting Reversible Contraceptives and Permanent Methods (LARC-PM) by USG-Assisted LGUs, by Quarter in PY6 and as of Q3PY6 ...... 9 Table 04. Distribution of LARC-PM New and Other Acceptors by USG-Assisted LGU and Type of Service Provision (Fixed Site or Outreach), Q4PY6...... 10 Table 05. LARC-PM New and Other Acceptors by USG-Assisted LGU and Type of Service Delivery Points (Public or Private), Q1-Q4PY6 ...... 11 Table 06. SDNs’ Share of their Province’s Population vs SDN’s Share of their Province’s PY6-CYP ...... 12 Table 07. Functional Service Delivery Points Providing FP Counseling and Services by USG-Assisted LGU as of Q4PY6 ...... 13 Table 08. USG-Assisted Community Health Workers (CHWs) Providing Family Planning Information, Referrals, and/or Services by USG-Assisted LGU, Q4PY6 ...... 14 Table 09. USG-Assisted LGUs with FP Commodity Stock-Out by FP Commodity, in Q3PY6 and Q4PY6 ...... 15 Table 10. List of AY-Friendly Hospitals, as of Q4PY6 ...... 16 Table 11. List of AY-Friendly Rural Health Units/City Health Offices by USG-Assisted LGU, as of Q4PY6 ...... 17

Table 12. USG-Assisted LGUs Conducting Data Quality Checks (DQC)by Quarter of PY6 ..... 19

Table 13. Women of Reproductive Age Profiled and Identified with Unmet Need for FP, and Those Provided with FP Services by USG-Assisted LGU, as of Q4PY6 ...... 20 Table 14. Health Service Providers Trained on MNCHN/FP by USG-Assisted LGU and their Status as to Supportive Supervision and DOH-Certification as of Q4PY6 ...... 21 Table 15. Magnitude of Audience who Recall Hearing or Seeing a Specific MH-Supported FP/RH Messages by USG-Assisted LGU and Quarter in PY6 ...... 22 7.5 Cities Development Initiative ...... 23 CAGAYAN DE ORO CITY ...... 25 ZAMBOANGA CITY ...... 29 GENERAL SANTOS CITY ...... 39 7.6 Family Planning Composite Index Summary ...... 44 7.7 Component Specialist Report & Updates for Q3PY6 ...... 54 Health Policy & Systems Development Report ...... 54 Adolecent-Youth Reproductive Health Component Report ...... 70 MNCHN/FP Service Delivery Component Report Report ...... 80

List of Acronyms

ADN Agusan del Norte ADNPH Agusan del Norte Provincial Hospital ADS Agusan del Sur AJA Adolescent Job Aids ANC Antenatal Care APMC Amai Pakpak Medical Center ARMM Autonomous Region of Muslim Mindanao AY Adolescent and Youth AYRH Adolescent and Youth Reproductive Health BaSulTa Basilan, Sulu, and Tawitawi BEmONC Basic Emergency and Obstetric Newborn Care BHW Barangay Health Worker BTL Bilateral Tubal Ligation CAA Conflict Affected Area CDI Cities Development Initiative CDOC Cagayan de Oro City CEmONC Comprehensive Emergency Obstetric and Newborn Care CHO City Health Office CHT Community Health Team CHW Community Health Worker CIP Costed Implementation Plan CPR Contraceptive Prevalence Rate COE Center of Excellence CRMC Cotabato Regional Medical Center CSO Civil Society Organization CSR Cotraceptive Self Reliance CU Current Users CYP Couple-Years of Protection

vii

LIPH Local Investment Plan for Health LTO License to Operate M&E Monitoring and Evaluation MCP Maternity Care Package MCP/NCP Maternal Care Package/Newborn Care Package MFP Modern Family Planning MH MindanaoHealth MHO Municipal Health Office MIT Municipal (RPRH) Implementation Team MLLA Mini Laparotomy using Local Anesthesia MNCHN/FP Maternal, Newborn, and Child Health and Nutrition/Family Planning MOA Memorandum of Agreement NCP Newborn Care Package NDP Nurse Deployment Program NFP Natural Family Planning NGO Non-Government Organization NMMC Northern Mindanao Medical Center NSV No Scalpel Vasectomy PDOHO Provincial DOH (Department of Health) Office PHIC Philippine Health Insurance Corporation PhilHealth Philippine Health Insurance Corporation PHN Public Health Nurse PHO Provincial Health Office PIT Provincial (RPRH) Implementation Team POPCOM Commission on Population PPFP Postpartum Family Planning PPIUD Postpartum Intrauterine Device PPP Public Private Partnership PSI Progestin Subdermal Implant PY Project Year

viii

R & R Reporting and Recording RHU Rural Health Unit RIT Regional Implementation Team RPRH Responsible Parenthood and Reproductive Health SARC Short Acting Reversible Contraceptive 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 TA Technical Assistance TCL Target Client List TRO Temporary Restraining Order USG United States Government WRA Women of Reproductive Age ZCMC Zamboanga City Medical Center (DOH hospital)

7.1 MindnaoHealth Project Performance Indicator Tracking Table (PITT), end of October 2018 FISCAL YEAR 6 TARGET END OF PROJECT TARGET BASELINE VALUE (October 2017-September QUARTERLY PY 6 2018 ACCOMPLISHMENT (Provide Numerator and CUMULATIVE PERFORMANCE (Provide Numerator and Denominator 2018) Denominator for indicators in TO DATE Indicator for indicators in Percent) Q1 Q2 Q3 QUARTER 4 (July 2018 - Q4 Indicator Percent) TARGET QUARTER 3 (April 2018 - June 2018) REMARKS Code September 2018) Baseline N D % Source and N D % N D % N D % N D % N D % Date FP 1 No. of modern FP current users in 1,070,486 N/A N/A 1,615,042 N/A N/A 1,615,042 N/A N/A 1,689,513 N/A N/A 1,698,137 1,698,137 105 USG assisted sites BTL N/A N/A N/A N/A N/A N/A 139,179 N/A N/A 139,179 N/A N/A VASECTOMY N/A N/A N/A N/A N/A N/A 3,512 N/A N/A 3,512 N/A N/A PILLS N/A N/A N/A N/A N/A N/A 710,977 N/A N/A 710,977 N/A N/A IUD N/A N/A N/A N/A N/A N/A 197,035 N/A N/A 197,035 N/A N/A INJECTALBES N/A N/A FHSIS 2012 N/A N/A N/A N/A 298,310 N/A N/A 298,310 N/A N/A NFP-CM N/A N/A N/A N/A N/A N/A 8,769 N/A N/A 8,769 N/A N/A NFP-BBT N/A N/A N/A N/A N/A N/A 808 N/A N/A 808 N/A N/A NFP-STM N/A N/A N/A N/A N/A N/A 11,226 N/A N/A 11,226 N/A N/A NFP-SDM N/A N/A N/A N/A N/A N/A 17,060 N/A N/A 17,060 N/A N/A NFP-LAM N/A N/A N/A N/A N/A N/A 158,690 N/A N/A 158,690 N/A N/A CONDOM N/A N/A N/A N/A N/A N/A 70,320 N/A N/A 73,697 N/A N/A Implants N/A N/A N/A N/A N/A N/A 73,627 N/A N/A 78,874 N/A N/A FP 2 Couple Years Protection (CYP) No. of 228,438 N/A N/A 1,743,825 N/A N/A 562,837 N/A N/A 163,422 N/A N/A 571,463 562,837 102 Acceptors/Units FHSIS 2012 for Commodities BTL 10,890 N/A N/A N/A N/A N/A N/A 57,440 N/A N/A N/A N/A NSV 538 N/A N/A N/A N/A N/A N/A 2,720 N/A N/A N/A N/A PPIUD/IUD 24,817 N/A N/A N/A N/A N/A N/A 57,302 N/A N/A N/A N/A SDI - N/A N/A N/A N/A N/A N/A 45,960 N/A N/A N/A N/A Pills (cycles) No. IMS N/A N/A No. IMS N/A N/A N/A N/A Removed Removed Removed Injectables (3 report N/A N/A report N/A N/A N/A N/A from CYP from CYP from CYP months) Target Target Target Injectables (1 N/A N/A N/A N/A N/A N/A month) Condom N/A N/A N/A N/A N/A N/A FP 3 Percent of USG 303 898 34% Facility Revised to average stock-out Reporting is average stockout by Reporting is average stockout by Reporting is average stockout assisted SDPs that Survey 2013 rate method. method. by method. experience stock- outs Pills 11 764 1% Facility 15 737 2% 15 737 2% 41 737 6% 34 737 5% 22 737 3% DMPA 2 764 0% Survey 2016 7 737 1% 7 737 1% - 737 0% 12 737 2% 4 737 1% IUD 7 764 1% 0 737 0 - 737 0% - 737 0% 4 737 1% 2 737 0% SDM Beads 85 764 11% 22 737 3% 22 737 3% 93 737 13% 125 737 17% 69 737 9% Condom 7 764 1% 7 737 1% 7 737 1% 9 737 1% 5 737 1% 4 737 1%

FP 4 Percent of service Facility Previously delivery points Survey 2013 unreported providing FP : counseling and Davao City services to 1 couples, men, Cotabato women, youth North 1 and adolescents 1,27 Maguindan 284 22% 715 737 97% 715 737 97% 716 715 101% 744 715 104% 744 715 104% of both sexes in 0 ao 1 USG-sites (Cum) Zamboang a City 6 Lanao del Sur 15 Zamboang a Sibugay 4 Total 28 FP 5 Number of *Target set additional USG- in PIRS is assisted 3,535 but community health when workers providing distributed FP information to priority CHT Reports and completed 3,886 N/A N/A 3,687* N/A N/A 3,687* N/A N/A 4,182 N/A N/A 4,725 3,687 128 4,725 3,687 128 clusters, 2013 referral during sub-totals the year add up to 3,687 due to rounding of numbers. Male 194 N/A N/A 106 N/A N/A 177 N/A N/A 25 34 N/A N/A 34 N/A N/A Female 3,692 N/A N/A 5,209 N/A N/A 3,358 N/A N/A 4,157 4,691 N/A N/A 4,691 N/A N/A FP 20 Number of USG- N/A N/A Hospitals assisted NGO 19 facilities, Midwife 35 RHUs 71 clinics, Cumulative 39 Schools 40 Educational as of Q3PY6 Cumulative Total 130 institutions Facility = as of Q4PY6 0 N/A N/A 78 N/A N/A 78 N/A N/A 78 167% 130 78 167% providing FP/RH Survey 2013 91 = services for (PY5=56 + 130 adolescents Q3PY6=35) (91 + 39) and/or youth of both sexes (Cumulative) HL.6.2. Number of 1 women giving Y5 = 5,082 birth who PY5 Annual 108,005 N/A N/A FHSIS 2016 11,884 N/A N/A 10,000 10,036 N/A N/A 7,923 N/A N/A 32,466 10,000 325% received Report = uterotonic in the 4,448 3rd stage of labor NI 4 Number of 5% of 290 from newborns not births PY6Q2 was 5,660 6,167 16,947 breathing at birth TBD N/A N/A TBD 70 N/A N/A 70 278 5% 250 4% 818 1,168 not births births births who were of reported in resuscitated target

PY6Q2 Report N1. Percent of LGUs 73% 2015 Facility 85% 85% 32.9% 77 313 24.6% 349 313 112% Custo conducting DQC Assessment m 268 368 313 368 313 368 103 313 Indicat or HEALTH SYSTEM STRENGTHENING HL-1 Number of 5 N/A N/A PY 2015 5 N/A N/A 5 5 5 5 Universal Health Project Coverage (UHC) Reports areas supported by USG investment HL-2 Presence of the Yes N/A N/A PY 2015 Yes N/A N/A 2 2 2 2 Mission support Project to Strengthen Reports Human Resources for Health (HRH) CAA

CAA1 Number of health 336 N/A N/A SHIELD 315 N/A N/A 50 N/A N/A 71 142 N/A N/A 562 N/A N/A outreach Report for conducted Y6 CAA2 Number of civil 0 N/A N/A Project 23 N/A N/A 23 N/A N/A 23 23 N/A N/A 23 N/A N/A No socciety Records additional organizations CSOs trained to engaged effectively engate with local governments (Cumulative) CAA3 Number of youth 0 N/A N/A Project 373 N/A N/A 200 N/A N/A 97 191 N/A N/A 461 N/A N/A trained as peer Records educators CAA4 Number of clients 33,774 N/A N/A SHIELD 69,737 N/A N/A 6,000 N/A N/A 1,826 2261 N/A N/A 71,352 N/A N/A reached during Report for health outreach Y6 activities NEW INDICATORS (for PY 6)

NI 1 No. of women of Instead of reproductive age using the that have been target set profiled and in PIRS, identified as DOH RO target was having unmet 428,037 reports as of 470,840 470,840 199,105 503,633 818,909 est. no. of need for FP June 2017 WRAs with unmet need specified in CIP.

NI 2 Percent of Instead of women of using the reproductive age targeted that have been no. of profiled and WRAs DOH RO identified as 428, identified 112,431 26% reports as of 400,214 470,840 85% 400,214 470,840 85% 81,736 199,105 41% 80,568 503,633 16% 306,622 818,909 35% having unmet 037 with unmet June 2017 need who have need, the been provided denominat with FP services. or used is the actual number. NI 3 Percentage of As of As of As of As of Q4PY6: Inventory PPFP/PPIUD Q3PY6: Q3PY6: Q4PY6: of trained trained providers HSPs that have been 967 42% of HSPs 46% of HSPs showed Baseline is certified by the 406 trained trained 410 trained that of the 344 955 36% PY5 end 774 967 80% 754 942 80% 410 884 46% Department of 656 62% of HSPs 62% of HSPs 967 year figures Health in USG supsup who had who had trained, 83 assisted sites supsup supsup left the health service. NI 5 SDPs in Marawi - 21 21 21 21 21 9 SDPs in City and Corridors Marawi with Functional City; Health Services 12 SDPs in Corridors (Lanao del Sur and Lanao del Norte) NI 6 Percentage of 2,000,000 2,000,000 100% 2,000,000 2,000,000 100% 784,011 2,000,000 39% 1,560,419 2,000,000 78% 2,858,853 2,000,000 143% Figures in audience who PY6Q2 recall hearing or were seeing a specific previously MH- supported unreported FP/RH messages

7.3 Potential Success Stories, Pictures, etc.

Summary of Story Idea - 1

The story to be presented may be considered a remarkable feat for family planning programs implemented in Muslim areas. The story will feature a male Maguindanaoan who went through the no scalpel vasectomy procedure following thorough one-on-one education and counseling about family planning and his chosen method.

Sentences of Supporting Information

In the recent past, family planning has been considered a taboo for Muslim communities. Moreso, misconceptions were rampant and incorrect information circulated such as on no scalpel vasectomy. A lot of Muslim men and women used to believe that the procedure would involve castration, which is strongly opposed by Islamic teaching. As a result, it is a rare case or close to non-existent occurrence that men would consider or undergo vasectomy. Women have always been the acceptors of modern family planning method.

It is therefore a positive news that slowly the project is seeing acceptors of NSV in Maguindanao. The story will feature a male Maguindanaoan who went through the no scalpel vasectomy procedure learning as well about what he has undergone until the procedure including following thorough one-on-one counseling and education about family planning and his chosen method. It is Learning his points of view in the midst of a still considerably unpopular family planning method

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

 Identified satisfied male NSV acceptor from Maguindanao  NSV provider and USAID-trained midwife or a health provider involved in counseling said NSV acceptor  Wife of NSV acceptor

Description of anticipated photos/graphics that will accompany main article

Profile shot of identified satisfied male NSV acceptor as the person-in-focus NSV acceptor together with his wife and children NSV acceptor with the health provider who counseled him, in a health facility NSV acceptor perhaps talking to a group of men in an information or health session

7.4 Summary of Accomplishments per Province/Highly Urbanized City Table 01. Number of Modern Family Planning Current Users by USG-Assisted LGUs, by Project Year, and Quarter in PY6 FP - Current Users PROVINCE/CITY Baseline Y6 Target/ PY1 PY2 PY3 PY4 PY5 PY6Q1 PY6Q2 PY6Q3 PY6Q4 (2012, MH Survey) EOP Target 2013 Annual FHSIS PRIORITY AREAS Davao City 74,629 129,633 119,816 136,705 121,132 81,179 111,236 117,117 128,836 132,894 135,125 Cotabato 54,272 127,970 106,699 110,004 104,450 118,272 122,045 115,474 115,809 122,708 127,218 Bukidnon 53,417 121,098 72,408 93,496 104,464 100,499 94,877 109,202 108,992 113,043 129,194 Maguindanao 107,574 74,475 100,342 49,246 55,151 59,153 65,109 66,646 66,287 70,338 67,657 South Cotabato 42,793 83,064 73,121 108,834 127,208 115,620 116,253 123,727 127,897 84,368 84,132 Davao del Sur 32,046 61,184 68,973 74,715 72,923 76,320 81,700 54,514 81,123 85,174 90,488 Zamboanga del Sur 123,295 88,492 56,443 70,726 82,449 74,684 75,587 79,440 77,709 81,760 82,421 Misamis Oriental 39,784 97,010 61,096 66,713 77,557 82,044 86,393 87,215 87,433 91,484 90,694 Sultan Kudarat 31,786 86,922 56,189 46,084 65,661 75,331 78,589 78,007 76,792 80,843 82,993 Compostela Valley 31,860 82,390 59,222 62,265 66,552 70,917 72,470 73,870 71,620 75,898 79,378 Agusan del Sur 30,600 70,527 57,948 51,749 52,007 52,224 70,194 74,344 71,225 75,028 76,884 Zamboanga del Norte 82,020 77,996 47,747 62,313 73,416 84,568 90,877 95,553 96,443 100,494 102,174 Sub-Total for Non-CAA Priority Areas 704,076 1,100,761 880,004 932,850 1,002,970 990,811 1,065,334 1,075,109 1,110,166 1,114,032 1,148,358 Basilan 18,341 19,161 9,252 10,455 9,672 9,364 11,208 19,161 3,605 13,434 14,119 Isabela City 5,989 5,915 8,700 3,008 3,129 3,369 4,177 5,915 63,417 5,778 6,001 Sulu 36,651 40,887 16,058 25,177 27,203 30,993 35,131 40,887 37,296 41,376 42,723 Tawi-Tawi 32,513 25,926 19,291 16,003 13,856 19,709 21,582 25,926 21,193 25,244 26,037 Zamboanga City 68,059 62,805 30,918 30,687 41,091 47,977 54,410 62,805 55,411 59,462 60,815 Cotabato City 3,679 25,871 9,689 12,875 17,980 20,660 20,553 25,871 19,226 23,277 25,063 Sub-Total for CAA (a): BaSulTa + 3 CAA Cities165,232 (Zamboanga, Cotabato,180,564 Isabela) 93,908 98,205 112,931 132,072 147,063 180,564 200,148 168,571 174,758 Marawi City 72,056 37,781 32,564 29,084 32,807 40,361 32,633 33,153 33,841 1,519 2,449 Lanao Del Sur 36,373 37,020 Lanao Del Norte 30,648 80,809 49,306 37,966 49,584 63,801 70,396 71,316 37,684 41,735 46,569 Iligan City 21,904 21,006 Sub-Total for CAA (b): Marawi & its Corridors102,704 118,590 81,870 67,050 82,391 104,162 103,029 104,469 71,525 101,531 107,044

NON-PRIORITY AREAS Zamboanga Sibugay s 38,063 18,956 22,713 22,378 37,870 42,735 44,969 44,950 49,001 48,007 Cagayan de Oro City 7,093 30,809 12,682 12,530 13,912 15,463 34,445 36,145 43,872 47,923 48,692 Davao Oriental 18,555 37,428 29,807 31,256 34,002 33,191 26,883 44,197 41,991 46,042 46,769 General Santos City 14,308 53,947 13,843 Lodged with South Cotabato 47,580 50,932 Agusan del Norte 29,885 55,240 43,984 29,886 45,162 45,861 48,731 66,967 65,193 69,244 73,577 Sub-Total for Non-Priority Areas 98,474 215,487 119,272 96,385 115,454 132,385 152,795 192,278 196,006 259,790 267,977

Over All TOTAL 1,070,486 1,615,402 1,175,054 1,194,490 1,313,746 1,359,430 1,468,220 1,552,420 1,577,845 1,643,924 1,698,137

Table 02. Modern Family Planning Current Users by Method and by USG-Assisted LGUs as of Q3PY6 FP - Current Users Family Planning Method Specific PROVINCE/CITY Baseline PY6 Target/ PY6Q4 BTL NSV PILLS IUD DMPA NFP-CM NFP-BBT NFP-STM NFP-SDM NFP-LAM CONDOM IMPLANTS (2012, MH Survey) EOP Target Accomplishment PRIORITY AREAS Davao City 74,629 129,633 135,125 11,547 1,086 55,956 13,592 20,482 399 237 61 234 14,911 7,225 9,395 Cotabato 54,272 127,970 127,218 11,215 185 56,750 14,878 24,227 743 0 6 116 9,599 3,638 5,861 Bukidnon 53,417 121,098 129,194 10,725 325 60,698 19,650 12,920 1,493 40 549 3,653 9,683 4,484 4,974 Maguindanao 107,574 74,475 67,657 1,409 23 21,822 2,784 22,666 1 4 0 182 15,629 2,094 1,043 South Cotabato 42,793 83,064 84,132 10,691 508 36,916 7,832 15,061 86 0 0 549 6,596 3,515 2,378 Davao del Sur 32,046 61,184 90,488 9,921 161 40,399 12,037 15,419 268 113 9 290 2,398 5,389 4,084 Zamboanga del Sur 123,295 88,492 82,421 4,115 38 37,232 11,547 10,594 45 0 8 154 7,729 3,636 7,323 Misamis Oriental 39,784 97,010 90,694 7,663 163 34,020 18,651 9,849 2,020 91 78 3,104 9,943 3,115 1,997 Sultan Kudarat 31,786 86,922 82,993 9,693 206 35,440 8,125 16,721 117 1 0 219 5,196 2,773 4,502 Compostela Valley 31,860 82,390 79,378 8,931 231 42,237 8,882 9,732 796 83 0 288 864 3,406 3,928 Agusan del Sur 30,600 70,527 76,884 7,051 112 34,736 12,630 8,895 1,038 4 17 1,311 5,183 2,703 3,204 Zamboanga del Norte 82,020 77,996 102,174 6,231 10 49,852 11,651 15,022 2 218 0 1,718 8,522 6,254 2,694 Sub-Total for Non-CAA Priority Areas 704,076 1,100,761 1,148,358 99,192 3,048 506,058 142,259 181,588 7,008 791 728 11,818 96,253 48,232 51,383 Basilan 18,341 19,161 14,119 590 0 5,138 864 3,584 10 4 12 47 2,190 522 1,158 Isabela City 5,989 5,915 6,001 709 2 2,040 159 1,438 0 0 0 28 884 252 489 Sulu 36,651 40,887 42,723 1,123 0 13,897 528 19,218 7 5 4 12 5,424 720 1,785 Tawi-Tawi 32,513 25,926 26,037 578 3 9,542 46 9,504 0 0 0 112 4,687 539 1,026 Zamboanga City 68,059 62,805 60,815 4,102 15 25,171 5,576 12,961 0 0 0 0 10,043 650 2,297 Cotabato City 3,679 25,871 25,063 2,471 0 8,799 2,316 6,506 59 0 0 99 1,089 2,501 1,223 Sub-Total for CAA (a): BaSulTa + 3 CAA Cities165,232 (Zamboanga, Cotabato,180,564 Isabela) 174,758 9,573 20 64,587 9,489 53,211 76 9 16 298 24,317 5,184 7,978 Marawi City 72,056 37,781 2,449 88 0 665 15 313 0 0 893 30 0 394 51 Lanao Del Sur 37,020 1,261 13 12,114 1,111 8,781 13 0 9,487 212 1 3,551 476 Lanao Del Norte 30,648 80,809 46,569 999 15 21,925 4,429 9,272 175 0 5 342 5,829 3,014 564 Iligan City 21,006 1,575 28 7,026 2,978 3,874 36 0 0 458 1,882 1,557 1,592 Sub-Total for CAA (b): Marawi & its Corridors102,704 118,590 107,044 3,923 56 41,730 8,533 22,240 224 0 10,385 1,042 7,712 8,516 2,683

NON-PRIORITY AREAS Zamboanga Sibugay s 38,063 48,007 1,789 41 17,563 5,911 8,782 33 0 5 426 5,414 2,189 5,854 Cagayan de Oro City 7,093 30,809 48,692 3,474 6 15,087 9,591 6,824 12 0 13 1,234 6,448 3,310 2,693 Davao Oriental 18,555 37,428 46,769 5,468 190 22,213 4,254 4,058 1,289 5 67 2,049 3,785 1,519 1,872 General Santos City 14,308 53,947 50,932 9,165 93 14,174 5,074 11,074 17 0 0 100 5,678 1,924 3,633 Agusan del Norte 29,885 55,240 73,577 6,595 58 29,565 11,924 10,533 110 3 12 93 9,083 2,823 2,778 Sub-Total for Non-Priority Areas 98,474 215,487 267,977 26,491 388 98,602 36,754 41,271 1,461 8 97 3,902 30,408 11,765 16,830

Over All TOTAL 1,070,486 1,615,402 1,698,137 139,179 3,512 710,977 197,035 298,310 8,769 808 11,226 17,060 158,690 73,697 78,874

Table 03. Couple Years Protection for Long Acting Reversible Contraceptives and Permanent Methods (LARC-PM) by USG- Assisted LGUs, by Quarter in PY6 and as of Q3PY6

Baseline Couple Years Protection EOP PY6 PROVINCE/CITY (2012, MH EOP Target Y6 Target Q1 CYP Q2 CYP Q3 CYP Q4 CYP Q4 Acceptors Q4 BTL Q4 NSV Q4 IUD Q4 PSI Accomplishment Accomplishment Survey) Accomplishment Accomplishment Accomplishment Accomplishment Total Acceptors Acceptors Acceptors Acceptors PRIORITY AREAS Davao City 13,638 304,170 200,745 98,174 45,737 9,260 2,852 22,038 11,587 2,395 406 174 595 1,220 Cotabato 7,315 105,447 123,507 34,034 29,002 7,299 4,726 8,708 8,269 2,237 227 5 446 1,559 Bukidnon 10,321 141,514 180,969 45,675 51,496 14,526 15,126 9,986 11,859 2,769 365 14 997 1,393 Maguindanao 2,996 28,098 37,163 9,069 10,917 2,777 1,770 3,525 2,844 712 115 0 96 501 South Cotabato 3,261 44,699 97,386 14,427 18,539 4,846 3,727 6,196 3,769 830 143 9 264 414 Davao del Sur 26,975 96,136 96,736 31,029 23,718 4,717 4,769 7,970 6,263 1,381 225 4 518 636 Zamboanga del Sur 12,853 37,585 132,995 12,131 51,187 11,843 8,361 7,237 23,747 5,523 536 1 2,815 2,171 Misamis Oriental 15,572 91,876 100,631 29,654 32,461 6,944 7,534 8,461 9,522 1,501 600 20 533 348 Sultan Kudarat 16,079 58,570 102,206 18,904 21,481 3,236 4,886 7,358 6,002 1,506 198 5 340 963 Compostela Valley 23,111 43,915 72,393 14,174 21,425 3,328 3,605 6,788 7,705 1,637 370 5 381 881 Agusan del Sur 20,022 144,150 145,607 46,526 32,298 9,448 9,467 8,249 5,134 1,152 167 14 427 544 Zamboanga del Norte 17,374 102,410 109,196 33,054 22,357 4,472 4,659 6,154 7,073 1,938 194 9 336 1,399 Sub-Total for Non-CAA Priority Areas 169,518 1,198,572 1,399,534 386,851 360,618 82,695 71,481 102,669 103,774 23,581 3,546 260 7,748 12,029 Basilan 936 8,396 18,784 2,710 9,104 1,757 5,624 989 734 204 20 0 35 149 Isabela City 356 12,582 7,806 4,061 1,223 204 220 314 485 84 19 0 63 2 Sulu 644 10,441 15,241 3,370 5,505 506 1,292 1,720 1,987 399 126 0 21 252 Tawi-Tawi 4,811 3,622 6,867 1,169 2,096 194 247 427 1,228 449 13 0 4 432 Zamboanga City 8,456 89,912 64,276 29,020 25,446 4,904 4,676 6,658 9,208 1,634 412 0 968 254 Cotabato City 4,320 50,595 57,250 16,330 18,418 5,601 1,726 2,201 8,891 1,823 337 0 860 626 Sub-Total for CAA (a): BaSulTa + 3 CAA Cities19,522 (Zamboanga,175,548 Cotabato, Isabela)170,226 56,660 61,792 13,166 13,784 12,309 22,532 4,593 927 0 1,951 1,715 Marawi City 415 415 249 10 87 69 14 4 0 2 8 2,616 4,400 1,420 Lanao Del Sur 1,832 1,832 290 161 481 899 210 40 0 35 135 Lanao Del Norte 10,441 10,441 2,541 1,044 241 27 1 110 103 3,405 41,520 13,401 2,309 4,548 Iligan City 5,186 5,186 2,565 2,621 519 104 0 259 156 Sub-Total for CAA (b): Marawi & its Corridors6,021 45,920 63,098 14,821 17,874 2,848 4,719 5,674 4,633 984 175 1 406 402

NON-PRIORITY AREAS Zamboanga Sibugay 6,815 59,069 63,049 19,065 32,366 3,073 10,770 9,390 9,132 2,547 253 0 413 1,881 Cagayan de Oro City 888 105,403 92,410 34,020 31,793 8,137 9,340 6,858 7,459 1,435 301 3 758 373 Davao Oriental 8,274 30,310 50,401 9,783 14,467 3,500 3,597 3,664 3,705 952 134 6 131 681 General Santos City 4,399 61,079 39,593 19,714 21,677 5,834 5,384 4,516 5,942 1,310 166 2 670 472 Agusan del Norte 13,002 67,924 83,227 21,923 30,877 7,388 7,319 9,920 6,251 1,455 242 0 380 833 Sub-Total for Non-Priority Areas 33,378 323,785 328,680 104,505 131,180 27,933 36,411 34,347 32,489 7,699 1,096 11 2,352 4,240

Over All TOTAL 228,438 1,743,825 1,961,538 562,837 571,463 126,642 126,395 154,999 163,427 36,857 5,744 272 12,457 18,386

Table 04. Distribution of LARC-PM New and Other Acceptors by USG-Assisted LGU and Type of Service Provision (Fixed Site or Outreach), Q4PY6 PY6Q4 (JULY-SEPTEMBER 2018) LAPM - MH CONTRIBUTION Total Acceptors FIXED FACILITY OUTREACH PROVINCE/CITY CYP Accomplishment Total Acceptors BTL Acceptors NSV Acceptors IUD Acceptors PSI Acceptors BTL Acceptors NSV Acceptors IUD Acceptors PSI Acceptors Total Acceptors BTL Acceptors NSV Acceptors IUD Acceptors PSI Acceptors Total Acceptors No. of Outreach

PRIORITY AREAS Davao City 403 131 10 - - 121 - - - - - 10 - - 121 131 10 Cotabato 1,200 439 - - 49 390 ------49 390 439 10 Bukidnon 8,118 1,960 404 8 61 1,487 404 8 61 156 629 - - - 1,331 1,331 19 Maguindanao 4,855 1,285 40 6 618 621 40 1 618 - 659 - 5 - 621 626 68 South Cotabato 4,090 864 236 - 76 552 129 - 74 80 283 107 - 2 472 581 10 Davao del Sur 1,964 411 70 - 196 145 70 - 196 145 411 ------Zamboanga del Sur 6,451 1,710 - - 1,036 674 - - 1,036 - 1,036 - - - 674 674 16 Misamis Oriental 1,875 684 22 - - 662 - - - - - 22 - - 662 684 16 Sultan Kudarat 570 228 - - - 228 ------228 228 6 Compostela Valley 4,203 1,624 - - 68 1,556 - - 62 925 987 - - 6 631 637 23 Agusan del Sur 1,652 654 - - 8 646 - - 8 48 56 - - - 598 598 10 Zamboanga del Norte 5,009 1,749 35 - 178 1,536 35 - 178 1,254 1,467 - - - 282 282 18 Sub-Total for Non-CAA Priority Areas 40,389 11,739 817 14 2,290 8,618 678 9 2,233 2,608 5,528 139 5 57 6,010 6,211 206 Basilan 555 205 - - 20 185 - - 20 131 151 - - - 54 54 9 Isabela City 672 204 21 - 2 181 21 - 2 123 146 - - - 58 58 2 Sulu 1,073 375 13 - 18 344 13 - 18 271 302 - - - 73 73 5 Tawi-Tawi 870 348 - - - 348 - - - 226 226 - - - 122 122 19 Zamboanga City 4,102 968 147 - 276 545 147 - 276 155 578 - - - 390 390 13 Cotabato City 2,197 475 66 - 245 164 66 - 245 127 438 - - - 37 37 4 Sub-Total for CAA (a): BaSulTa + 3 CAA Cities (Zamboanga, 9,468 Cotabato, 2,575 Isabela) 247 - 561 1,767 247 - 561 1,033 1,841 - - - 734 734 52 Lanao del Sur 373 149 - - - 149 ------149 149 28 Marawi City ------Lanao del Norte 4,299 874 152 - 464 258 152 - 464 102 718 - - - 156 156 8 Iligan City ------Sub-Total for CAA (b): Marawi & its Corridors 4,672 1,023 152 - 464 407 152 - 464 102 718 - - - 305 305 36

NON-PRIORITY AREAS Zamboanga Sibugay 1,993 797 - - - 797 ------797 797 10 Cagayan de Oro City 6,679 1,361 195 - 864 302 195 - 864 - 1,059 - - - 302 302 18 Davao Oriental 2,323 728 66 - 4 658 66 - 1 149 216 - - 3 509 512 10 General Santos City 3,595 794 148 - 238 408 142 - 216 59 417 6 - 22 349 377 2 Agusan del Norte 4,244 1,171 62 83 109 917 62 - 109 231 402 - 83 - 686 769 17 Sub-Total for Non-Priority Areas 18,834 4,851 471 83 1,215 3,082 465 - 1,190 439 2,094 6 83 25 2,643 2,757 57

Over All TOTAL 73,363 20,188 1,687 97 4,530 13,874 1,542 9 4,448 4,182 10,181 145 88 82 9,692 10,007 351 11

Table 05. LARC-PM New and Other Acceptors by USG-Assisted LGU and Type of Service Delivery Points (Public or Private), Q1-Q4PY6 Number of Acceptors Couple Years Protection Cumulative Total Cumumative Row Labels January- April-June July-Sept January- April-June July-Sept Oct-Dec 2017 as og September Oct-Dec 2017 Totam as of March 2018 2018 2018 March 2018 2018 2018 2018 September 2018 Private Sector LAPM/LARC Services 5,612 1,275 1,892 261 9,040 16,832 4,332 3,201 1,016 25,381 FIXED 481 881 594 261 2,217 2,628 3,347 2,068 1,016 9,059 BTL 99 - - 99 990 - - - 990 IUD 25 370 322 1 718 115 1,702 1,481 5 3,303 LARC-PSI 57 336 187 88 668 143 840 468 220 1,670 PPFP/PPIUD 300 175 26 172 673 1,380 805 120 791 3,096 NSV 59 59 - OUTREACH 5,131 394 1,298 - 6,823 14,205 985 1,133 - 16,322 BTL 178 - - 178 1,780 - - - 1,780 IUD 20 - - 20 92 - - - 92 LARC-PSI 4,933 394 453 5,780 12,333 985 1,133 - 14,450 NSV 845 845 - - Public Sector 4,575 13,436 26,026 19,927 63,964 22,103 54,694 107,315 71,597 255,709 FIXED 2,833 7,063 17,384 8,558 35,838 17,203 38,489 84,413 39,055 179,159 BTL 1,059 1,751 3,428 1,542 7,780 10,590 17,510 34,280 15,420 77,800 IUD 49 411 1,340 600 2,400 225 1,891 6,164 2,760 11,040 LARC-PSI 737 1,646 6,196 4,094 12,673 1,843 4,115 15,490 10,235 31,683 PPFP/PPIUD 988 3,255 6,191 2,313 12,747 4,545 14,973 28,479 10,640 58,636 NSV 229 9 238 - OUTREACH 1,742 6,373 8,642 11,369 35,796 4,901 16,205 22,902 32,542 76,550 BTL 40 3 164 145 352 400 30 1,640 1,450 3,520 IUD 117 119 32 1,444 1,712 538 547 147 6,642 7,875 LARC-PSI 1,585 6,251 8,201 9,692 25,729 3,963 15,628 20,503 24,230 64,323 NSV 245 88 8,003 613 220 833 TOTAL PUBLIC AND PRIVATE 10,187 14,711 27,918 20,188 73,004 38,935 59,026 110,516 72,613 281,090

Table 06. SDNs’ Share of their Province’s Population vs SDN’s Share of their Province’s PY6-CYP Supported Service Delivery No. of C/MLGU With PPP No. Hosp w FP No. of AYRH Population of SDN's Share CYP of SDN's Share Province/HUC Status of SDN Network or DHO Agreement Integration RHU/Clinic in Province Population % Province, PY6 CYP, PY6 % PRIORITY AREAS Davao City District 3, DAV SDN Organized 5 YES, 1 YES, 2 1,748,123 474,145 27.1% 45,737 10,969 24.0% Cotabato Arakan Valley Complex SDN Organized 3 YES, 1 1,475,670 120,555 8.2% 29,002 No Data 0.0% Cotabato PALMA-PB SDN Operational 7 1,475,670 567,845 38.5% 29,002 No Data 0.0% Bukidnon South Bukidnon SDN Operational 10 YES YES, 1 YES, 2 1,486,060 544,604 36.6% 51,496 19,915 38.7% Maguindanao Iranun SDN Cluster Organized 6 YES YES, 1 1,328,933 184,098 13.9% 10,917 No Data 0.0% South Cotabato South Cotabato Provincial SDN Operational 11 YES, 1 YES, 3 969,724 969,724 100.0% 18,539 18,539 100.0% Davao del Sur DiMaBaMaS SDN Operational 5 YES YES, 2 630,672 414,538 65.7% 23,718 11,300 47.6% Davao Occidental SaMaDomJAS SDN Organized 4 315,754 291,717 92.4% 23,718 5,547 23.4% Zamboanga del Sur District 1 ZDS DSN Operational 12 YES, 1 YES, 3 1,040,989 382,745 36.8% 51,187 17,756 34.7% Zamboanga del Sur District 2 ZDS SDN Functional 15 YES, 1 1,040,989 209,086 20.1% 51,187 8,235 16.1% Misamis Oriental ClaJaViTa SDN Organized 4 YES YES, 1 YES, 1 934,160 213,321 22.8% 32,461 5,301 16.3% Sultan Kudarat BITES SDN Functional 5 YES YES, 1 851,714 368,100 43.2% 21,481 13,447 62.6% Compostela Valley CoMMMoNN SDN Operational 6 YES YES, 2 YES, 1 765,576 392,098 51.2% 21,425 11,000 51.3% Agusan del Sur Bayugan Cooperative Zone Operational 3 YES, 1 727,231 188,240 25.9% 32,298 7,796 24.1% Agusan del Sur DO Plaza Cooperative Zone Functional 3 YES, 1 YES, 2 727,231 203,545 28.0% 32,298 12,473 38.6% Zamboanga del Norte Liloy SDN Cluster Operational 7 YES YES, 2 1,043,201 213,127 20.4% 22,357 6,061 27.1% Sub-Total for Non-CAA Priority Areas 106 7 - - 16,561,697 6,273,605 37.9% 496,823 148,339 29.9%

Sub-Total for CAA (a): BaSulTa + 3 CAA Cities (Zamboanga, Cotabato, Isabela) ------0.0% - - 0.0% Lanao del Norte Iligan City-wide SDN Functional 1 YES, 1 354,459 354,459 100.0% 5,186 5,186 100.0% Lanao del Norte SANLAKASS SDN Operational 6 YES, 1 YES, 1 718,894 258,392 35.9% 10,441 6,155 58.9% Sub-Total for CAA (b): Marawi & its Corridors 7 - - - 1,073,353 612,851 57.1% 15,627 11,341 72.6%

NON-PRIORITY AREAS Zamboanga Sibugay Alicia SDN Organized 7 662,565 239,362 36.1% 32,366 8,243 25.5% Agusan del Norte BueNasCar SDN Operational 3 YES, 1 YES, 1 367,720 124,293 33.8% 30,877 3,869 12.5% Agusan del Norte Cabadbaran SDN Organized 5 367,720 149,824 40.7% 30,877 3,901 12.6% Sub-Total for Non-Priority Areas 15 - - - 1,398,005 513,479 36.7% 94,120 16,013 17.0%

Over All TOTAL 128 7 - - 19,033,055 7,399,935 38.9% 606,570 175,693 29.0%

Table 07. Functional Service Delivery Points Providing FP Counseling and Services by USG-Assisted LGU as of Q4PY6 Identified MUNICIPAL CLASSIFICATION Type of Facility Kind of Facility REGION Providing Additionality ACCOMPLISHME FUNCTIONAL AS TARGET Y6 CLOSED PROVINCE/CITY @Baseline by MH NT END OF PY5 END OF PY6 End of Q2 PY6 URBAN RURAL TOTAL HOSPITALS RHU/CHO CLINICS TOTAL PUBLIC PRIVATE TOTAL PRIORITY AREAS Davao City 75 25 50 75 9 66 66 - 66 11 17 38 66 22 44 66 Cotabato 38 - 38 38 - 38 - 38 38 14 18 6 38 25 13 38 Bukidnon 34 - 35 35 - 35 13 22 35 10 21 4 35 29 6 35 Maguindanao 44 2 39 41 - 41 2 39 41 4 35 2 41 39 2 41 South Cotabato 30 - 31 31 - 31 11 20 31 15 11 5 31 15 16 31 Davao del Sur 41 2 39 41 - 41 12 29 41 9 15 17 41 20 21 41 Zamboanga del Sur 40 - 43 43 - 43 10 33 43 12 28 3 43 33 10 43 Misamis Oriental 41 4 39 43 2 41 2 39 41 11 25 5 41 34 7 41 Sultan Kudarat 28 - 26 26 - 26 14 12 26 12 12 2 26 14 12 26 Compostela Valley 21 - 23 23 - 23 8 15 23 7 11 5 23 15 8 23 Agusan del Sur 29 3 24 27 - 27 2 25 27 9 14 4 27 21 6 27 Zamboanga del Norte 36 1 36 37 - 37 3 34 37 10 27 - 37 37 - 37 Sub-Total for Non-CAA Priority 457 Areas 37 423 460 11 449 143 306 449 124 234 91 449 304 145 449 Basilan 14 1 14 15 - 15 - 15 15 2 12 1 15 14 1 15 Isabela City 6 3 3 6 - 6 - 6 6 3 2 1 6 3 3 6 Sulu 27 - 27 27 - 27 2 25 27 8 19 - 27 27 - 27 Tawi-Tawi 17 - 16 16 - 16 - 16 16 5 11 - 16 16 - 16 Zamboanga City 27 - 28 28 - 28 28 - 28 11 17 - 28 21 7 28 Cotabato City 5 - 6 6 - 6 6 - 6 1 1 4 6 2 4 6 Sub-Total for CAA (a): BaSulTa + 96 3 CAA Cities (Zamboanga, 4 Cotabato, 94 Isabela) 98 - 98 36 62 98 30 62 6 98 83 15 98 Lanao del Sur 53 15 32 47 1 46 1 45 46 6 40 - 46 45 1 46 Lanao del Norte 37 7 29 36 - 36 8 28 36 10 22 4 36 29 7 36 Sub-Total for CAA (b): Marawi & 90 its Corridors 22 61 83 1 82 9 73 82 16 62 4 82 74 8 82

NON-PRIORITY AREAS Zamboanga Sibugay 24 - 25 25 - 25 - 25 25 9 16 - 25 17 8 25 Cagayan de Oro City 13 3 10 13 1 12 12 - 12 4 1 7 12 3 9 12 Davao Oriental 17 - 17 17 - 17 3 14 17 5 11 1 17 15 2 17 General Santos City 10 - 28 28 - 28 28 - 28 2 13 13 28 14 14 28 Agusan del Norte 30 3 30 33 - 33 - 33 33 8 14 11 33 21 12 33 Sub-Total for Non-Priority Areas 94 6 110 116 1 115 43 72 115 28 55 32 115 70 45 115

Over All TOTAL 737 69 688 757 13 744 231 513 744 198 413 133 744 531 213 744

Table 08. USG-Assisted Community Health Workers (CHWs) Providing Family Planning Information, Referrals, and/or Services by USG-Assisted LGU, Q4PY6 Accomplishments on CHW Activities CHWs Profiling WRA Referring those with Unmet Needs Clinets Provided PROVINCE/CITY Target PY6Q1 PY6Q2 PY6Q3 Client Referred % with FP Male Female TOTAL for FP Service Accomplishment Information PRIORITY AREAS Davao City 278 - - 1 104 105 37.8 - - Cotabato 220 78 117 117 117 117 53.2 290 93 Bukidnon 248 66 194 1,611 1,716 1,716 691.9 14,709 14,709 Maguindanao 126 23 23 76 6 70 76 60.3 4,687 4,402 South Cotabato 145 237 242 39 2 92 94 64.8 140 16 Davao del Sur 161 155 155 155 155 155 96.3 648 610 Zamboanga del Sur 160 5 5 150 1 169 170 106.3 1,239 776 Misamis Oriental 156 104 104 104 145 145 92.9 199 104 Sultan Kudarat 128 120 120 120 2 118 120 93.8 139 46 Compostela Valley 130 129 129 129 129 129 99.2 335 288 Agusan del Sur 115 83 170 186 3 183 186 161.7 18,611 2,081 Zamboanga del Norte 160 17 17 70 2 167 169 105.6 507 507 Sub-Total for Non-CAA Priority Areas 2,027 1,017 1,276 2,757 17 3,165 3,182 157.0 41,504 23,632 Basilan 126 205 250 255 3 252 255 202.4 1,094 78 Isabela City 160 31 150 167 167 167 104.4 795 721 Sulu 126 34 34 10 10 10 7.9 90 90 Tawi-Tawi 126 52 53 53 6 58 64 50.8 344 84 Zamboanga City 160 96 96 77 77 77 48.1 511 481 Cotabato City 126 81 81 14 2 12 14 11.1 241 99 Sub-Total for CAA (a): BaSulTa + 3 CAA Cities (Zamboanga, 824 Cotabato, Isabela) 499 664 576 11 576 587 71.2 3,075 1,553 Lanao del Sur 126 63 159 148 148 148 117.5 343 338 Lanao del Norte 126 111 167 167 3 208 211 167.5 2,305 507 Sub-Total for CAA (b): Marawi & its Corridors 252 174 326 315 3 356 359 142.5 2,648 845

NON-PRIORITY AREAS Zamboanga Sibugay 160 8 172 172 185 185 115.6 959 747 Cagayan de Oro City 106 21 21 21 21 21 19.8 55 55 Davao Oriental 106 200 200 200 3 247 250 235.8 4,956 13,121 General Santos City 106 - 21 21 21 21 19.8 33 22 Agusan del Norte 106 134 134 120 120 120 113.2 3,078 479 Sub-Total for Non-Priority Areas 584 363 534 534 3 594 597 102.2 9,081 14,424

Over All TOTAL 3,687 2,053 2,800 4,182 34 4,691 4,725 128.2 56,308 40,454

Table 09. USG-Assisted LGUs with FP Commodity Stock-Out by FP Commodity, in Q3PY6 and Q4PY6 TARGET Q3PY6 Commodities with Stockouts during Q4PY6 PROVINCE/CITY Facility SDM Facility N D IUD DMPA Pills Condom Stockout Beads Stockout PRIORITY AREAS Davao City 2 75 - 1 8 9 2 10 10 Cotabato 1 38 ------Bukidnon 1 34 - - - 4 - - 4 Maguindanao 1 44 ------South Cotabato 1 30 ------Davao del Sur 1 41 - 1 - 3 - - 4 Zamboanga del Sur 1 40 25 1 1 1 2 26 26 Misamis Oriental 1 41 - 1 - - 1 - 1 Sultan Kudarat 1 28 ------Compostela Valley 1 21 - - - - - 7 7 Agusan del Sur 1 29 ------Zamboanga del Norte 1 36 12 - - - - 25 25 Sub-Total for Non-CAA Priority Areas 14 457 37 4 9 17 5 68 77 Basilan 0 14 - - - - - 1 1 Isabela City 1 27 ------Sulu 1 17 ------Tawi-Tawi 1 27 - - 3 9 - - 9 Zamboanga City 0 6 ------Cotabato City 0 5 ------Sub-Total for CAA (a): BaSulTa + 3 CAA Cities 3 (Zamboanga, 96 Cotabato, - Isabela) - 3 9 - 1 10 Lanao Del Sur 2 53 40 - - - - 39 39 Lanao Del Norte 1 37 ------Sub-Total for CAA (b): Marawi & its Corridors 3 90 40 - - - - 39 39

NON-PRIORITY AREAS Zamboanga Sibugay 1 24 15 - - 8 - 15 15 Cagayan de Oro City 0 13 ------Davao Oriental 1 17 7 - - - - 2 2 General Santos City 0 10 ------Agusan del Norte 1 30 ------Sub-Total for Non-Priority Areas 3 94 22 - - 8 - 17 17

Over All TOTAL 22 737 99 4 12 34 5 125 143

Table 10. List of AY-Friendly Hospitals, as of Q4PY6 AYRH Clients PY6 (Cummulative) AYRH Status Counselled Referred FP Service Province/HUC Municipality/City Name of Service Delivery Point (Hospital) SDN Sentinel Area Male Female Male Female Male Female PRIORITY AREAS Davao City Davao City Souther Philippines Medical Center (SPMC) District 3, DAV SDN - 1,618 - 66 - - Davao City Davao City San Pedro Hospital (SPH) NONE - 310 - - - - Davao City Davao City Brokenshire Memorial Hospital NONE ------Cotabato Kidapawan City Cotabato Provincial Hospital (NCPH) Arakan Valley Complex SDN - 2,350 - - - - Bukidnon Maramag Bukinon Provincial Hospital - Maramag (BPH - Maramag) South Bukidnon SDN - 2,369 - - - - Maguindanao Shariff Aguak Maguindanao Provincial Hospital (MPH) Iranun SDN Cluster - 422 - - - 195 South Cotabato Koronadal City South Cotabato Provincial Hospital (SCPH) SoCot Provincial SDN - 4,710 - - - 334 Davao del Sur Digos City Davao del Sur Provincial Hospital (DDSPH) DMaBaMaS SDN ------Davao Occidental Malita Malita District Hospital (MDH) SaMaDoMJAS SDN ------Zamboanga del Sur Margosatubig Margosatubig Regional Hospital (MRH) District 1, ZamboSur SDN 511 970 - 1 12 16 Zamboanga del Sur Pagadian City Zamboanga del Sur Medical Center (ZDSMC) Districts 1 & 2, ZamboSur SDN - - - 1 - 7 Sultan Kudarat Isulan Sultan Kudarat Provincial Hospital (SKPH) BITES SDN - 4,142 - - - - Compostela Valley Montevista Compostela Valley Provincial Hospital - Montevista (CVPH - Motevista) CoMMMoNN SDN - 1,557 - - - - Agusan del Sur Bunawan Bunawan District Hospital (BDH) NONE 23 227 5 76 3 80 Agusan del Sur Prosperidad Democrito O. Plaza Memorial Hospital (DOPMH) DO Plaza Cooperative Zone 66 427 42 159 39 86 Zamboanga del Norte Pagadian City Zamboanga del Sur Medical Center (ZDSMC) Liloy SDN Cluster ------Sub-Total for Non-CAA Priority Areas 600 19,102 47 303 54 718 Basilan Isabela City Basilan General Hospital (BGH) NONE ------Sulu Jolo Sulu Provincial Hospital (SuluPH) NONE 496 1,342 - - 29 473 Cotabato City Cotabato City Cotabato Regional Medical Center (CRMC) NONE ------Sub-Total for CAA (a): BaSulTa + 3 CAA Cities (Zamboanga, Cotabato, Isabela) 496 1,342 - - 29 473 Lanao del Norte Iligan City Gregorio T, Lluch Memorial Hospital (GTLMH) SANLAKASS SDN ------Sub-Total for CAA (b): Marawi & its Corridors ------

NON-PRIORITY AREAS Zamboanga Sibugay Ipil Zamboanga Sibugay Provincial Hospital (ZSibPH) NONE ------Cagayan de Oro City Cagayan de Oro City Northern Mindanao Medical Center (NMMC) ClaJaViTa SDN ------Cagayan de Oro City Cagayan de Oro City JR Borja General Hospital (JRBGH) ClaJaViTa SDN 470 4,575 - 743 - 531 Davao Oriental Mati City Davao Oriental Provincial Medical Center (DOPMC) NONE - 1,285 - - - - General Santos City General Santos City Dr. JP Royeca Hospital (DJPRH) NONE - 2,210 - 125 - 112 Agusan del Norte Butuan City Agusan del Norte Provincial Hospital (ADNPH) BueNasCar SDN 246 1,114 121 581 109 264 Agusan del Norte Butuan City Butuan Medical Center (BMC) NONE 38 982 34 301 46 167 Sub-Total for Non-Priority Areas 754 10,166 155 1,750 155 1,074

NON-TARGETED AREAS Misamis Occidental Ozamis City Mayor Hilarion A. Ramiro Sr. Regional and Teaching And Training Hospital (MHARTTMC) District 1, ZamboSur SDN ------Davao del Norte Tagum City Davao Regional Medical Center (DRMC) CoMMMoNN SDN ------Surigao del Norte Surigao City Caraga Regional Hospital (CRH) Bayugan SDN ------Sub-Total for Non-Target Areas ------

Over All TOTAL 1,850 30,610 202 2,053 238 2,265 17

Table 11. List of AY-Friendly Rural Health Units/City Health Offices by USG-Assisted LGU, as of Q4PY6 AYRH Clients PY6 (Cummulative) Counselled Referred FP Service Province/HUC Municipality/City Service Delivery Point Service Delivery Network Male Female Male Female Male Female PRIORITY AREAS Davao City Buhangin CHO - Buhangin Health Center NONE ------Davao City Calinan CHO - Calinan District District 3, DAV SDN ------Davao City District A CHO - District A T. Claudio NONE 44 162 - - - 102 Davao City District C CHO - District C Mini-Forest NONE 24 871 - 602 - 194 Davao City District D CHO - District D Jacinto NONE - 31 - 31 - - Davao City Sasa CHO - Sasa Health Center NONE 126 316 - 26 - 9 Davao City Talomo Central CHO - Talomo Central NONE ------Davao City District C CHO - Bgy 21-C NONE ------Davao City Toril CHO - Toril District Health Center District 3, DAV SDN - 25 - - - 169 Cotabato Kidapawan City FPOP - Kidapawan City NONE ------Cotabato Mlang RHU - Mlang NONE ------Cotabato President Roxas RHU - Pres. Roxas NONE - 18 - 5 - - Bukidnon Maramag RHU - Maramag, Bukidnon South Bukidnon SDN - 867 - 319 - 548 Bukidnon Pangantucan RHU - Pangantucan, Bukidnon South Bukidnon SDN - 207 - 59 - 148 Bukidnon San Fernando RHU - San Fernando, Bukidnon NONE - 577 - 252 - 323 Maguindanao Upi Upi RHU NONE 1 104 - 36 - 55 Maguindanao Buluan Buluan RHU NONE ------Maguindanao Datu Datu RHU NONE ------South Cotabato Polomolok RHU - Polomolok NONE ------South Cotabato Surallah RHU - Surallah Lying-In Clinic SoCot Provincial SDN ------South Cotabato T'boli RHU - T'boli Lying-In Clinic SoCot Provincial SDN - 209 - - - - South Cotabato Tupi RHU - Tupi Lying-In Clinic SoCot Provincial SDN 53 145 - - - - Davao del Sur Bansalan RHU - Bansalan DMaBaMaS SDN - 4 - 1 - - Davao del Sur Santa Cruz RHU - Sta. Cruz DMaBaMaS SDN - 140 - 17 - 82 Zamboanga del Sur Lapuyan RHU - Lapuyan District 1 SDN 3 2 3 - - - Zamboanga del Sur Vincenzo Sagun RHU - V. Sagun District 1 SDN 3 5 3 1 - - Zamboanga del Sur Margosatubig RHU - Margosatubig District 1 SDN 5 8 - - 2 2 Zamboanga del Sur Olutanga RHU - Olutanga NONE ------Zamboanga del Sur Talusan RHU - Talusan NONE ------Zamboanga del Sur Mabuhay RHU - Mabuhay NONE ------Zamboanga del Sur Labangan RHU - Labangan NONE ------Misamis Oriental Jasaan RHU - Jasaan, Misamis Oriental ClaJaViTa SDN 501 486 - 62 - - Misamis Oriental Tagolan RHU - Tagoloan, Misamis Oriental NONE ------Misamis Oriental Gingoog City CHO - Gingoog City NONE ------Compostela Valley New Bataan RHU - New Bataan CoMMMoNN SDN 228 399 - 138 3 1 Agusan del Sur Rosario RHU - Rosario, Agusan Del Sur DO Plaza Cooperative 157 237 45 91 41 105 Zone Agusan del Sur San Francisco RHU - San Francisco, Agusan Del Sur DO Plaza Cooperative 216 477 6 186 16 210 Zone Zamboanga del Norte Polanco RHU - Polanco Health Center And Lying - In NONE ------Zamboanga del Norte Dapitan City CHO - Dapitan City NONE ------Zamboanga del Norte Manukan RHU - Manukan Health Center And Lying - In NONE ------Zamboanga del Norte Katipunan RHU - Katipunan Health Center And Lying - In NONE ------Zamboanga del Norte Salug RHU - Salug Health Center And Lying - In Liloy SDN Cluster ------Zamboanga del Norte Godod RHU - Godod Health Center And Lying - In Liloy SDN Cluster ------Sub-Total for Non-CAA Priority Areas 1,361 5,290 57 1,826 62 1,948 18

AYRH Clients PY6 (Cummulative) Counselled Referred FP Service Province/HUC Municipality/City Service Delivery Point Service Delivery Network Male Female Male Female Male Female PRIORITY AREAS Sub-Total for Non-CAA Priority Areas 1,361 5,290 57 1,826 62 1,948 Basilan Maluso Maluso RHU NONE 54 100 - 40 - - Basilan Lamitan City Lamitan-East RHU NONE - 122 - 88 - - Basilan Lamitan City Lamitan-West RHU NONE ------Sulu Patikul Patikul RHU NONE - 5 - 31 - - Sulu Luuk Luuk RHU NONE 150 244 - 54 - - Sulu Pangutaran Pangutaran RHU NONE 27 48 - 13 - - Sulu Talipao Talipao RHU NONE - 47 - 84 - - Sulu Parang Parang RHU NONE 349 648 - 44 - 1 Sulu Indanan Indanan RHU NONE 507 757 1 38 112 748 Sulu Panamao Panamao RHU NONE 68 114 - - - - Sulu Jolo Jolo RHU NONE ------Tawi-Tawi Bongao Bongao RHU NONE - 354 - 233 - - Zamboanga City Zamboanga City DHO - Ayala Main Health Center And Lying-In NONE 75 157 - 34 26 80 Zamboanga City Zamboanga City DHO - Baliwasan Main Health Center And Lying-In NONE 16 168 - 32 10 15 Zamboanga City Zamboanga City DHO - Calarian Main Health Center And Lying-In NONE 31 43 - 41 8 9 Zamboanga City Zamboanga City DHO - Canelar Main Health Center And Lying-In NONE 39 34 - 35 19 10 Zamboanga City Zamboanga City DHO - Curuan Main Health Center And Lying-In NONE 85 98 - 24 45 58 Zamboanga City Zamboanga City DHO - Guiwan Main Health Center And Lying-In NONE 29 33 - 42 - - Zamboanga City Zamboanga City DHO - Labuan Main Health Center And Lying-In NONE 15 25 - 15 12 22 Zamboanga City Zamboanga City DHO- Manicahan Main Health Center And Lying-In NONE 5 10 - 44 - 2 Zamboanga City Zamboanga City DHO - Mercedes Main Health Center And Lying-In NONE 46 47 - 36 33 33 Zamboanga City Zamboanga City DHO - Sangali Main Health Center And Lying-In NONE 38 221 - 24 - 3 Zamboanga City Zamboanga City DHO - Sta Catalina Main Health Center And Lying-In NONE 15 15 - 19 - - Zamboanga City Zamboanga City DHO - Sta Maria Main Health Center And Lying-In NONE 40 79 - 17 8 34 Zamboanga City Zamboanga City DHO - Talon-Talon Main Health Center And Lying-In NONE 86 141 - 18 - - Zamboanga City Zamboanga City DHO - Tetuan Main Health Center And Lying-In NONE 18 18 - 10 13 13 Zamboanga City Zamboanga City DHO - Tumaga Main Health Center And Lying - In NONE 65 139 - 30 8 8 Zamboanga City Zamboanga City DHO - Vitali Main Health Center And Lying-In NONE 33 71 - 45 3 43 Zamboanga City Zamboanga City Doña Isabel Climaco NONE ------Zamboanga City Zamboanga City Rotary Lying In NONE ------Cotabato City Cotabato City Bhs - Bagua Mother NONE ------Cotabato City Cotabato City Bhs - Poblacion Mother, Cotabato City NONE - 47 - 17 - 23 Cotabato City Cotabato City Bhs - Rosary Heights Mother NONE ------Cotabato City Cotabato City Bhs - Tamontaka Mother NONE ------Sub-Total for CAA (a): BaSulTa + 3 CAA Cities (Zamboanga, Cotabato, Isabela) 1,791 3,785 1 1,108 297 1,102 Lanao del Sur Bubong Bubong RHU NONE ------Lanao del Norte Baroy RHU - Baroy, Lanao Del Norte NONE 1 115 12 94 - 12 Lanao del Norte Kapatagan RHU - Kapatagan, Lanao Del Norte SANLAKASS SDN 51 113 8 250 - - Lanao del Norte Kolambugan RHU - Kolambugan, Lanao Del Norte NONE - 59 - 46 - 1 Sub-Total for CAA (b): Marawi & its Corridors 52 287 20 390 - 13

NON-PRIORITY AREAS Zamboanga Sibugay Ipil RHU - Ipil Main Health Center And Lying - In NONE - 65 - 105 - 13 Zamboanga Sibugay Buug RHU - Buug Main Health Center And Lying - In NONE - 93 - 56 - - Cagayan de Oro City Cagayan de Oro City Bhs - Pontud Health Center NONE ------General Santos City General Santos City RHU - Bula Community Lying-In Center, Gsc NONE ------General Santos City General Santos City RHU - Calumpang, Gsc NONE ------General Santos City General Santos City CHO - Fatima NONE ------Agusan del Norte Remedios T. Romualdez RHU - Remedios T. Romualdez NONE 13 173 8 103 13 84 Agusan del Norte Buenavista RHU - Buenavista BueNasCar SDN ------Sub-Total for Non-Priority Areas 13 331 8 264 13 97

Over All TOTAL 3,217 9,693 86 3,588 372 3,160 19

Table 12. USG-Assisted LGUs Conducting Data Quality Checks (DQC)by Quarter of PY6

Target Baseline (2012) Accomplishment PY5 Accomplishment PY6 PROVINCE/CITY Oct - Dec Jan - Mar Apr - Jun Jul - Sep N D PY1 % PY5 % PY6 % 2017 2018 2018 2018 PRIORITY AREAS Davao City 1 1 1 100.0% 0 s/f 0 0 0 0 0 s/f Cotabato 15 18 0 s/f 11 73.3% 11 0 0 4 15 100.0% Bukidnon 19 22 0 s/f 22 115.8% 22 0 0 0 22 115.8% Maguindanao 31 36 0 s/f 17 54.8% 17 0 0 19 36 116.1% South Cotabato 9 11 0 s/f 0 s/f 0 0 0 5 5 55.6% Davao del Sur 13 15 8 s/f 0 s/f 0 0 6 0 6 46.2% Zamboanga del Sur 23 27 0 s/f 27 117.4% 27 0 0 0 27 117.4% Misamis Oriental 21 25 0 s/f 25 119.0% 24 1 0 0 25 119.0% Sultan Kudarat 10 12 0 s/f 0 s/f 0 0 0 12 12 120.0% Compostela Valley 9 11 0 s/f 11 122.2% 10 1 0 0 11 122.2% Agusan del Sur 12 14 4 s/f 13 108.3% 0 0 14 0 14 116.7% Zamboanga del Norte 23 27 0 s/f 27 117.4% 0 0 19 8 27 117.4% Sub-Total for Non-CAA Priority Areas 186 219 13 0.5% 153 82.3% 111 2 39 48 200 107.5% Basilan 10 12 0 s/f 12 120.0% 0 0 12 0 12 120.0% Isabela City 1 1 1 s/f 1 100.0% 1 0 0 0 1 100.0% Sulu 16 19 0 s/f 0 s/f 0 0 0 19 19 118.8% Tawi-Tawi 9 11 0 s/f 11 122.2% 0 0 10 1 11 122.2% Zamboanga City 1 1 0 s/f 1 100.0% 0 0 0 1 1 100.0% Cotabato City 1 1 0 s/f 1 100.0% 0 0 0 1 1 100.0% Sub-Total for CAA (a): BaSulTa + 3 CAA Cities 38 (Zamboanga, 45 Cotabato, 1 s/f Isabela) 26 68.4% 1 - 22 22 45 118.4% Lanao Del Sur 0 39 39 0 0 0 39 34 40 s/f 114.7% 114.7% Marawi City 0 0 0 0 0 1 1 Lanao Del Norte 0 21 0 0 17 5 22 20 23 s/f 105.0% 110.0% Iligan City 1 1 0 0 1 0 1 Sub-Total for CAA (b): Marawi & its Corridors 54 63 1 s/f 61 113.0% 39 - 18 6 63 116.7%

NON-PRIORITY AREAS Zamboanga Sibugay 14 16 0 s/f 16 114.3% 0 0 16 0 16 114.3% Cagayan de Oro City 1 1 0 s/f 1 100.0% 0 0 1 0 1 100.0% Davao Oriental 9 11 0 s/f 11 122.2% 2 2 7 0 11 122.2% General Santos City 1 1 0 s/f 1 100.0% 0 0 0 1 1 100.0% Agusan del Norte 10 12 1 10.0% 11 110.0% 12 0 0 0 12 120.0% Sub-Total for Non-Priority Areas 35 41 1 2.9% 40 114.3% 14 2 24 1 41 117.1%

Over All TOTAL 313 368 16 0.6% 280 89.5% 165 4 103 77 349 111.2% s/f : Still for conduct o the DQC Activity in their respective provinces/ cities % : Accomplishment / Numerator 20

Table 13. Women of Reproductive Age Profiled and Identified with Unmet Need for FP, and Those Provided with FP Services by USG-Assisted LGU, as of Q4PY6 CIP Potential Q4PY6 Accomplishment Cummulative End of Q4PY6 PROVINCE/CITY Target, 2017 WRA Profiled UMFP Served WRA Profiled UMFP Served PRIORITY AREAS Davao City 60,097 174 324 44,018 41,958 Cotabato 50,777 50,907 8,266 50,907 8,266 Bukidnon 52,082 8,595 5,724 12,517 40,442 Maguindanao 43,203 7,184 11,720 218,365 28,306 South Cotabato 33,684 - - - - Davao del Sur 34,922 110,867 13,303 110,867 32,047 Zamboanga del Sur 37,194 - - 7,360 14,255 Misamis Oriental 32,698 3,371 2,214 3,371 3,497 Sultan Kudarat 29,886 - - - - Compostela Valley 27,090 172,077 6,522 172,077 30,370 Agusan del Sur 25,785 87,535 4,607 87,535 19,272 Zamboanga del Norte 37,221 9,607 7,244 13,245 7,244 Sub-Total for Non-CAA Priority Areas 464,639 450,317 59,924 720,262 225,657 Basilan 12,755 8,077 1,626 10,652 3,568 Isabela City 4,151 241 - 253 12 Sulu 30,351 1,657 2,588 2,474 5,088 Tawi-Tawi 14,379 1,987 3,219 3,983 5,934 Zamboanga City 31,716 - - - - Cotabato City 11,020 132 - 1,399 4,014 Sub-Total for CAA (a): BaSulTa + 3 CAA Cities (Zamboanga, 104,371 Cotabato, 12,094 Isabela) 7,433 18,761 18,616 Lanao Del Sur 45,899 411 546 27,916 2,351 Lanao Del Norte 37,501 10,533 4,843 11,365 15,541 Sub-Total for CAA (b): Marawi & its Corridors 83,400 10,944 5,389 39,281 17,892

NON-PRIORITY AREAS Zamboanga Sibugay 23,300 959 959 - Cagayan de Oro City 24,876 1,123 3,022 1,123 3,146 Davao Oriental 20,571 207 508 10,534 10,460 General Santos City 21,877 1,489 1,489 1,489 2,384 Agusan del Norte 25,451 26,500 2,803 26,500 9,909 Sub-Total for Non-Priority Areas 116,074 30,278 7,822 40,605 25,899

Over All TOTAL 768,484 503,633 80,568 818,909 288,064 21

Table 14. Health Service Providers Trained on MNCHN/FP by USG-Assisted LGU and their Status as to Supportive Supervision and DOH-Certification as of Q4PY6

BTL-MLLA LARC-PSI PPFP/PPIUD FPCBT2 CMNC/EINC LMT Province Certifie Supported Certifie Supported Certifie Supported Certifie Supported Certifie Supported Certifie Supported Baseline Trained Supsup Baseline Trained Supsup Baseline Trained Supsup Baseline Trained Supsup Baseline Trained Supsup Baseline Trained Supsup d LGU Sites d SDPs d SDPs d SDPs d SDPs d SDPs PRIORITY AREAS Davao City ------58 29 8 36 7 44 7 2 51 4 23 1 - 19 - 19 - - 15 - 4 - - 4 Cotabato - 6 4 4 3 - 45 6 1 33 3 57 57 57 31 - 19 10 - 16 1 54 36 31 33 1 10 4 - 7 Bukidnon - 18 14 14 7 - 36 13 - 24 1 31 21 10 19 1 65 10 10 20 2 189 11 - 24 2 17 11 - 16 Maguindanao - 17 3 1 8 - 26 1 - 17 7 25 16 - 18 ------113 - - 38 4 - - - 4 South Cotabato - 19 15 10 10 - 46 13 1 34 3 33 29 28 25 3 26 - - 12 - 44 37 30 15 3 11 4 - 9 Davao del Sur - 11 2 - 4 - 29 17 6 24 2 61 61 29 32 3 54 30 11 21 - 76 3 - 20 - - - - - Zamboanga del Sur - 6 1 1 3 - 64 15 15 38 2 46 42 41 31 5 13 - - 10 - - - - - 6 41 - - 39 Misamis Oriental - 3 1 1 2 - 13 12 12 7 - 48 47 16 29 5 140 76 63 31 4 109 23 11 28 4 21 10 - 13 Sultan Kudarat - 7 6 3 4 - 41 17 10 27 7 98 92 62 19 ------66 66 45 21 4 11 11 - 10 Compostela Valley - 1 - - 1 - 20 20 15 16 3 13 11 1 18 4 8 - - 5 5 30 - - 13 2 8 - - 4 Agusan del Sur - 8 - - 3 - 46 37 25 16 1 32 27 17 17 26 91 4 4 16 - 49 32 27 24 55 31 8 - 14 Zamboanga del Norte - 13 6 - 6 - 72 42 39 19 19 46 37 22 59 10 47 - - 32 - - - - - 4 34 - - Sub-Total for Non-Priority - Areas 109 52 34 51 - 496 222 132 291 55 534 447 285 349 61 486 131 88 182 12 749 208 144 231 85 188 48 - 120 Basilan ------22 8 8 10 5 10 9 5 5 ------41 - - 12 - 2 - - 2 Isabela City - 2 2 1 1 - 5 2 2 3 4 6 3 - 4 ------Sulu - 6 6 6 3 - 17 8 8 16 2 17 6 2 5 ------70 - - 21 - 8 - - 8 Tawi-Tawi - 5 - - 2 - 34 16 6 8 - 5 - - 6 ------27 - - 7 6 - - - 5 Zamboanga City - 11 4 4 7 - 34 15 12 22 13 41 23 19 23 4 5 - - 5 - - - - - 8 20 - - 17 Cotabato City - 15 10 10 2 - 8 3 2 5 - 23 19 14 3 - 28 - - 2 - 5 - - 3 - - - - - Sub-Total for CAA (a): BaSulTa - + 3 39 CAA Cities 22 (Zamboanga, 21 Cotabato, 15 - Isabela) 120 52 38 64 24 102 60 40 46 4 33 - - 7 - 143 - - 43 14 30 - - 32 Lanao del Sur - 22 3 3 6 - 31 10 - 18 - 14 2 - 10 - 17 - - 12 - 84 - - 36 - 7 - - 6 Lanao del Norte - 15 7 6 5 - 21 18 15 19 2 33 17 9 23 1 66 11 7 37 - - - - - 2 34 8 - 26 Sub-Total for CAA (b): Marawi - & its 37 Corridors 10 9 11 - 52 28 15 37 2 47 19 9 33 1 83 11 7 49 - 84 - - 36 2 41 8 - 32

NON-PRIORITY AREAS Zamboanga Sibugay - 13 8 2 3 - 2 - - 23 - 25 21 10 18 - 1 - - 1 - - - - - 1 25 - - 23 Cagayan de Oro City - 14 8 8 2 - 47 12 4 4 - 84 43 28 10 3 62 5 4 7 1 25 1 1 5 - 48 6 - 10 Davao Oriental - 2 - - 1 - 15 6 1 12 3 25 17 1 14 2 9 - - 6 2 34 - - 10 - 5 - - 3 General Santos City - 7 5 1 4 - 24 7 5 12 4 40 32 31 29 ------5 3 1 1 - 5 3 - 3 Agusan del Norte - 13 4 - 4 - 38 31 10 15 - 27 22 6 15 3 48 6 15 11 9 55 34 33 21 10 31 24 - 15 Sub-Total for Non-Priority - Areas 49 25 11 14 - 126 56 20 66 7 201 135 76 86 8 120 11 19 25 12 119 38 35 37 11 114 33 - 54

Over All TOTAL - 234 109 75 91 - 794 358 205 458 88 884 661 410 514 74 722 153 114 263 24 1,095 246 179 347 112 373 89 - 238

Table 15. Magnitude of Audience who Recall Hearing or Seeing a Specific MH-Supported FP/RH Messages by USG-Assisted LGU and Quarter in PY6 PY6Q4 Accomplishment Usapan & Facility Based Number of CHWs CHWs (Clients Others (Radio, PROVINCE/CITY Target PY6Q1 PY6Q2 PY6Q3 Health Events Delivery WRA Profiled (accrued) Provided with IEC Materials, Total Audience PY6 TOTAL FP Information) Capacity Recall Building, etc.) PRIORITY AREAS - Davao City 163,082 9,179 9,566 53,247 151 174 105 - 430 72,422 Cotabato 137,791 28,208 4,573 4,606 882 4,897 50,907 117 290 57,093 94,480 Bukidnon 141,334 53,907 - 4,658 1,261 13,844 8,595 1,716 14,709 13,500 53,625 112,190 Maguindanao 117,237 541 83,012 216,248 1,658 1,444 7,184 76 4,687 15,049 314,850 South Cotabato 91,407 4,408 4,872 4,389 333 4,389 - 94 140 4,956 18,625 Davao del Sur 63,175 - 2,365 100,989 185 1,786 110,867 155 648 113,641 216,995 Zamboanga del Sur 100,933 31,764 11,219 11,787 1,233 3,012 - 170 1,239 5,654 60,424 Misamis Oriental 88,733 15,119 273 2,090 1,370 7,316 3,371 145 199 12,401 29,883 Sultan Kudarat 81,101 2,486 - 2,762 126 2,924 - 120 139 3,309 8,557 Compostela Valley 73,513 4,040 4,559 175,945 3,179 172,077 129 335 175,720 360,264 Agusan del Sur 69,972 998 5,146 93,024 87,535 186 18,611 106,332 205,500 Zamboanga del Norte 101,005 18,489 3,396 8,454 4,041 9,607 70 507 14,225 44,564 Sub-Total for Non-CAA Priority Areas 1,229,280 169,139 128,981 678,199 7,199 46,832 450,317 3,083 41,504 13,500 562,435 1,538,754 Basilan 34,612 24,183 15,637 3,301 356 566 8,077 255 1,094 365,456 375,804 418,925 Isabela City 82,363 686 204 444 161 388 241 167 795 115,394 117,146 118,480 Sulu 39,019 42,887 10,125 1,913 1,321 1,657 10 90 3,078 58,003 Tawi-Tawi 86,065 - 17,745 3,646 414 1,683 1,987 64 344 4,492 25,883 Zamboanga City 11,264 4,821 5,036 5,559 123 4,838 - 77 511 5,549 20,965 Cotabato City 29,904 8,334 5,688 3,398 132 14 241 387 17,807 Sub-Total for CAA (a): BaSulTa + 3 CAA Cities 283,227 (Zamboanga, 80,911 Cotabato, Isabela) 54,435 18,261 1,054 8,796 12,094 587 3,075 480,850 506,456 660,063 Marawi City 84,252 - - 203 148 343 491 694 Lanao Del Sur 20,152 3,826 6,884 32,759 Lanao Del Norte 67,549 19,100 7,998 2,596 1,022 2,242 10,533 211 2,305 16,313 46,007 Iligan City 34,216 1,331 1,435 1,126 Sub-Total for CAA (b): Marawi & its Corridors 206,169 24,257 16,317 36,684 1,022 3,457 10,533 359 2,648 - 18,019 95,277

NON-PRIORITY AREAS Zamboanga Sibugay 63,229 - 50 2,951 2,786 959 185 959 270,000 274,889 277,890 Cagayan de Oro City 67,505 19,753 - 4,432 277 1,123 21 55 1,476 25,661 Davao Oriental 55,821 2,671 2,681 13,116 593 207 250 4,956 6,006 24,474 General Santos City 59,365 13,629 1,599 - 2,657 1,489 21 33 4,200 19,428 Agusan del Norte 35,403 - - 30,368 364 26,500 120 3,078 30,062 60,430 Sub-Total for Non-Priority Areas 281,323 36,053 4,330 50,867 1,234 5,443 30,278 597 9,081 270,000 316,633 407,883

Project-Wide Contribution (Accrued, PY6) 156,876 313,752 313,752

Over All TOTAL 2,000,000 310,360 204,063 784,011 10,509 64,528 503,222 4,626 56,308 764,350 1,560,419 2,858,853

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. 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 INITIATIVES CAGAYAN DE ORO CITY For the period July - September 2018

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

Session 2: Strengthening Health Services for Human Capital Development

A. Quality of Care: Birthing Home Standards Capabilities of some facilities are not in full compliance with the standards 1. Training

1.1 Conducted 1.1 CHO CDOC DOHRO – For this quarter DOH ROX in partnership with CHO CDOC certified Training on PSI trainers for PSI provided funds trainers on PSI were able to train 31 HSPs in Region 10. Below is the for HSPs in conducted PSI for the needed breakdown of those HSPs trained. Region 10 training for HSPs capacity Province/Area of including Amai in Region 10 building (PSI) Doctor Nurse Midwife Assignment Pakpak Hospital including HSPs among HSPs in Misamis Oriental 1 2 of Marawi City from Amai Region 10. Misamis Occidental 4 NMMC - CDOC 1 3 26

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities Pakpak in Marawi St Ignatius Birthing 1 Clinic - CDOC City CHO trainers Camiguin 1 conducted the Lanao del Norte 1 training Bukidnon 1 4 JR Borja Hospital - 2

CDOC NMMC and CHO CDOC 3 3 Agusan Health CHO Iligan City 1 GT Lluch – Iligan City 1 Center provided Amai pakpak hospital 1 1 the venue – Marawi City Total 10 6 15

during the practicum day.

B. Reduction of Teenage Pregnancy . 1. Creation of Creation of Adolescent Assisted the creation DOHRO – Currently the hospital is under renovation, while looking for a Adolescent Friendly Facility at JR of Teen Center in JR trained 2 HSPs space/room, adolescents requiring reproductive health services are Friendly Borja Hospital Borja Hospital – MH from JR Borja being referred to the Women’s’ Reproductive Health Clinic of the Facility with trained the OB GYNE Hospital on hospital which is fully functional immediate and Pedia Head of JR Healthy Young service Borja Hospital in Ones. With Below is the output of the hospital from April-June 2018 provisions Davao last December DOH, USAID- Month No of AY Counseled with No of AY Provided with FP Services HEADDSS who gave 2017. MH trained the birth HSPs in AJA

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities Provision of 10-14 15-19 20-24 14- 20- PPIUD Pills DMPA Condom PSI YO YO YO 19 24 HEADDSS rapid YO YO assessment form once the clinic is M F M F M F operational. July 5 173 206 80 Aug 4 215 224 118 3

Sept 3 170 196 81 1 1

Mis Or Province – 14 Opol - 10 El Salvador - 2 Tagoloan - 2

Bukidnon Province – 9 Talakag - 2 Kalilangan - 1 Baungon - 6 C. FP-MCH Commodities

1. Service 1.1 Conduct regular Follow up the DOHRO – The various health centers in CDOC continue to implement the DOH Delivery inventory of FP Monthly Inventory of provision of FP prescribed Inventory and Order Form of commodities. The NDP commodities so FP commodities thru Commodities to assigned in the city conducts the actual inventory while the FHA can re-allocate NDP/FHA and FP CHO summarized the output per health facility and submit the same to DOH.

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities to BHS nearing Coordinator monthly Condom – DOH ROX were informed by the Provincial and City FP coordinator that stock-outs commodity reports. 15,000 IUD stocks were slowly dwindling and restocking of the said commodity Pills – 100,000 should be one of the prioritize to prevent stock outs. DMPA – 15,000 PSI – 300 pcs

CITY DEVELOPMENT INITIATIVE ZAMBOANGA CITY For the period July - September 2018

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

Session 2: Strengthening Health Services for Human Capital Development

A. Quality of Care: Birthing Home Standards

Capabilities of some facilities are not in full compliance with the standards

1.1 Supportive 1.1 1.1 1.1 1.1 Supervision (SS)  ZC CHO wants all its 16 medical  MH worked with  DOH Regional  Fast-track DOH certification by end for second batch officers assigned in the RHUs, DOH-IX and CHO Office IX’s FP of October or 1st week of of medical including the city-run Cristino for the Post Training coordinator will be November officers from the Paragas Memorial hospital, be Evaluation/SS of present to process RHUs, city equipped with certified FP these medical the certification of  To monitor then their Philhealth hospital, and medical officers on LARC PSI. officers. The those found accreditation by November DOH-retained September original competent in hospitals on  Presently, of the 16 RHUs, only date is now moved subdermal implant LARC PSI method seven (7) have certified FP to 3rd week October. insertion and medical officers since Feb. 2018 MH Master Trainer removal after the with project support. for DOH

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities Certification will be supportive present. supervision

 MH identified 9 MOs from the RHUs, 1 from CPMH, 1 from Labuan Public Hospital, 2 from Mindanao Central Sanitarium, and additional 2 from Zamboanga City Medical Center

1.2 Certification of 1.2 Review of data showed: 1.2 LARC PSI 14 nurses and 7 midwives from 1.2 1.2  MH started collecting all the providers trained the 16 RHUS of ZC were trained  All were already  DOH RO IX FP required cases from the nurses and last June 2018  These nurses and midwives recommended by coordinator midwives and handing them over are completing their MH Master Trainer awaiting the to DOH RO IX’s FP coordinator number of cases required for DOH submission of by DOH RO IX FP Certification cases from the  MH to check for the signed coordinator Mr. Gilbert nurses and certificates by 2nd week of October Natividad for their  MH conducted midwives; ready to 2018 certification series of LARC endorse the

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities PSI outreaches in certificates to DOH  CHO to submit to PhilHealth for the different RHUs RO IX RD for accreditation after certificates are around Zamboanga signature received from DOH RO IX City.

 A Total of eleven (11) outreach activities were conducted from July to September 2018

1.3 Certification of 1.3 1.3 1.3 1.3 PPIUD providers CHO established a regular  MH to follow-up with DOH RO IX for updating of database on the certification of all HSPs MNCHN/FP capability profile of recommended by MH master trainer service providers.  MH to visit Mr. Gilbert Natividad by Review of data showed: 2nd week of October 2018 (after the a) a) Oct.1-5 FPCBT1 training of the sardine a) Zamboanga City Medical  MH worked with  DOH RO IX FP canneries’ nurses) Center has 8 HSPs: DOH-IX and coordinator have 3 MDs, 3 RNs, and 2 RMs CHO for the SS already reviewed  Neighboring LGUs of Zamboanga City who are actively providing of these HSPs each HSPs’ benefit from support provided by PPIUD services (were submitted number

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities supportively supervised and  All were already of cases Zamboanga City and ZCMC – Center of already recommended for recommended (requirement for Excellence on LAPM+. certification by MH master by MH Master certification) trainer) Trainer for DOH  Increasing number of facilities with Certification capacity to provide quality FP/MNCHN services means ZC constituents and b) Labuan Public Hospital b) MH has b) DOH RO IX FP residents of LGUs outside the city, (LPH) has 1 PPIUD-trained collected the coordinator working at various companies located midwife who is actively PPIUD cases and have reviewed in the city can likewise access FP and performing submitted to the midwife’s other medical services. MH has DOH RO IX FP submitted supported some sardines companies coordinator for number of on FP demand generation evaluation cases (as requirement for  Zamboanga City Medical Center, a certification); DOH Regional Hospital is the apex certificate referral facility for the whole region IX endorsed to DOH RD  ZCMC is a training and clinical practice already site for the region as well as for BASULTA provinces of ARMM. c) Mindanao Central c) MH has c) Sanitarium Gen. Hosp. collected her  DOH RO IX  DOH RO IX’s Family Health Cluster (MCS) still has 1 PPIUD PPIUD cases and included her in Head, Dr. Sherryl Sarmiento, will trained nurse for submitted to the Oct. 1-5, discuss and plan out with her FP- certification. She needs to DOH RO IX FP MNCHN Program Coordinators for the

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities complete her FPCBT1 coordinator for 2018 FPCBT1 conduct of SS/PTE to identified HSPs training. evaluation training by using the Training Information Management System (TIMS) which was  DOH IX has developed by MH already certified 2  TIMS installation (with Regional Memo PPIUD service Order from DOH RO IX’s RD issued last providers from Feb. 2018) - have listing of all trained MCS (1 MD, 1 HSPs on AJA, PPIUD/PPFP etc. They RM) share the data to the different provinces so the provinces can identify HSPs due for re-training or SS/PTE.

2. PhilHealth 2. Sustain the compliance of 2. MH conducts facility 2. DOH RO IX sustain 2. All 16 RHUs are re-accredited with Accreditation accreditation in all visits and do oversight functions PhilHealth for the year 2018 RHUs / birthing facilities quarterly technical to LGU facilities to assistance ensure provision of documentation quality services and report updated to national polices and guidance for adaptation B. Reduction of Teenage Pregnancy

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities 1. Creation of 1. All 16 RHUs in ZC have 1. 1. 1. Adolescent Friendly ADEPT/HYO/AJA - trained  TA supported CHO DOH RO IX has already  Similar to FP Initiatives, these Facilities with staff using individual in completing certified the 16 RHUs established Level 1 AY friendly facilities immediate service logbook for AY services and certification as Level 1 AY friendly within the city can serve as model to provisions with designated room for requirements of 16 facilities last July 16, nearby LGUs, given the initial results AY RHUs as Level 1 2018; provision of IEC derived from these 16 RHUs of ZC. category AY-friendly materials, gang chairs, facilities, including steel cabinets, AY  All AY facilities caters to all clients; the development of logbooks. refers STI/HIV clients (some are AY Policy, now for migrants/undocumented OFWs coming endorsement to the from the backdoor) to the Office of the City Reproductive Health Wellness Center Mayor for approval (RHWC) situated at the CHO and issuance of an compound Executive Order on AY  There is a need to follow-up for the Issuance of the EO from the Office of  MH-trained AJA the City Mayor. This will further tighten providers in all the the legal framework of AY program of 16 certified AY the city. friendly RHUs (level 1 category)  DOH RO IX Adolescent Health and Development Program coordinator Ms.  Monitoring of the Mae Orabe will endorse to DOH central AY friendly RHUs; office for the RHUs certification as

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities identify and assign Level 3 once Mayor Beng Climaco signs pregnant AY to the AY policy. health centers near their residences  The Office of the Sangguniang Panlungsod are on the act of passing  TA on the provision the Zamboanga Youth Code after the of AY signage to the July 31, 2018 enactment of Ordinance 16 RHUs No. 485 “An Ordinance Creating the Youth Development Council of the City  TA on the of Zamboanga and for other related development of the purposes”. YDC ordinance passed by ZC councilor BG Guingona

2. Demand Generation 2.1 2.1 2.1 2.1 needs strengthening  Re-activation of  TA on mapping of  POPCOM IX has  ISDN members convened last August the Information and Service services available by set-up Teen 23-24, 2018 for updates on respective Delivery Network for members of the Corners in agencies’ adolescent-youth programs Adolescents (ISDN-A) with ISDN and referral barangay halls of the LGU as the lead agency system these 4 pilot  Planned out the next steps to sustain barangays (Putik, AY services; in the finalization of Lumayang, reviewing and recommending amendments to the ordinance; started

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities Lumbangan, and identifying roles, task and functions of Tetuan) the members; and distribution of directory among member agencies for referral of AY concerns

2.2 2.2 2.2 2.2  Conduct of USAPAN  Mentored MH-  Information Drive  Advocate to CHO/DOHRO to support Barkadahan and USAPAN trained 19 by DOH RO IX and training off USAPAN facilitator to Batang Ina Batang Ama (BIBA) facilitators from the POPCOM IX in the replace retired or those trained HSPs sessions by POPCOM CHO and the different barangays that were re-assigned to other office or Population Office of Z.C. departments on the conduct of USAPAN Sessions

 Provided USAPAN Action Cards, FP Fans, and FP Flip chart

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

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities form and refer AY found with risks through the ISDN

2.3 2.3 2.3 2.3  Training for a new batch of  MH supported the  Zamboanga CHO  Population Office, DOH RO 9, CHO, PEER Educators training of new identified youth Department of Education, agrees with batch of PEER and adult-support MindanaoHealth Project in using the educators last July groups to be HEEADSSS assessment tool as best in 30-August 2, 2018 trained identifying risky behaviors among the AY group; with appropriate referral and interventions to be given

 Three different provinces: Sulu, Basilan, and Zamboanga were the participants, composed of SK and youth leaders. Of the 61 trained, 19 were from ZC; C. FP-MCH Commodities

1. Service  CHO conducts monthly  TA on the use of  DOH RO IX NO stock-out reported in the 16 RHUs and Delivery inventory (re-allocating BHSs forecasting tool supplies the CHO’s DOH-retained hospitals in Z.C. nearing stock outs), forecasting RHUs regularly and distribution of  Providing alert to with FP commodities, CHO regarding commodities storage/stockroom (to include

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities stock card), recording and status of stock levels  DOH-retained reporting of FP commodities hospitals ensures that FP commodities are available in the FP clinic/units in hospitals

2. Health 2. 2. 2. 2. Information  Provide mentoring and  Provides IEC DOH RO IX conducts Need to provide IPC training for all CHWs needs monitoring of materials to CHWs Interpersonal of the LGU; strengthening CHTs/BHWs regarding (FP fans, CHW Communication (IPC) MNCHN and FP toolkits, Nanay orientations to new CHO sees this to be efficient as selected messaging/information sharing booklets) CHWs as others have BHWs are taken in also as BPVs by the and also as a way to determine already retired from Population Office; CHO’s position is for all and ensure availability of FP service CHWs to be trained on IPC so they will be commodities motivated to perform at par with the BPVs.

CITY DEVELOPMENT INITIATIVES GENERAL SANTOS CITY For the period July - September 2018

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities Session 1: Strengthening Health Services for Human Capital Development A. Quality of Care: fixed and outreach services Capability Joint planning to conduct TA on the planned DOHRO-training Supportive Supervision on FPCBT2/PPIUD and PSI – building for Harmonized Supportive conduct of SS Trainings funds for FPCBT2. conducted last August 10-11, 2018 with practicum at DJPRH; service Supervision of the trained for Public & Private Cost share with funded by MH with cost sharing by DJPRH and DOH; CSOs delivery Doctors, Nurses and Midwives, HSPs (PPIUD PSI) – FPOP -provision of lend facilitative support to the activity, namely FPOP and both public and private sector forceps, manuals, commodities for the UPMGSC. on PPFP/PPIUD and PSI models (PSI- Rita Arm); practicum; CHO invited participation of collaboration with Participants from other provinces include: 1 from Sultan Private Facilities, CSOs, NGOs Coordinate with other CSOs (FPOP) for Kudarat; 3 from Cotabato Province and 3 from South in GenSan and other provinces provinces for their identifying trained Cotabato for sharing inputs trained HSPs to trainers anfd participate in the SS facilitators for the FP Follow-up of trained HSPs practices will be through the CHO Collaboration with CSOs, trainings and UPMGSC NGOs as skilled service Follow up with CHO providers for the conduct of and UPMGSC on the CSOs such as FPOP, LAPM planning is spearheaded by the CHO - FP outreach outreaches current practice of the UPMGSC- acts as services in the barangays and in the hospital, and assisted by trained HSPs facilitators, trainers MH and the 2 CSOs FPOP and UPMGSC. Demand generation FP/AY services in the hospital Discuss/ facilitate with and/or service is tasked to the CHO with assistance from City POPCOM. –established in DJPRH; DOHRO qualifications providers in the FPOP is helping helping the CLGU in the demand provision of quality for certification of HSPs conduct of trainings generation activities in the workplaces. FP/MNCHN services to the and outreaches;

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities populace of General Santos TA on FP/AY program helped out in The core referral hospital, DJPRH, caters to all clients from City and the neighboring in Hospitals; identification of GSC and the neighboring provinces. provinces of Sarangani and participants; South Cotabato Support actual conduct DOHRO- support FP Reports from DJPRH of outreach services in funds Capability building on FPCBT1 the villages & LAPM+ Month GSC SoCot Sarangani DDS Sultan and FPCBT2 in General Santos services in the core (Jose kudarat City which was spearheaded referral hospital Abad by the FPOP with participation (DJPRH) Santos) of both public and private July 2018 35 1 PSI; 5 PPIUD; facilities in and out of GenSan IUD; 1 BTL 6 BTL; City. 21 BTL, Developed LAPM planning - 10 schedules of regular PSI, outreaches in the barangays of 25 GSC Pills, 2 DMPA August 54 2 IUD 9 PPIUD; 018 IUD; 1PSI 3 BTL; 17 1PSI BTL;

67PSI;

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities 57 Pills; 14 DMPA September ND 2018 yet

Health Refer patients for LAPM-LARC TA on Usapan Series in DOHRO- provision Information services to DJPRH the workplaces (Group of IEC materials on Conduct Usapan Sessions Counseling); in MCH; (Pwede Pa, Buntis, Maginoo partnership with FPOP and Barkadahan) to various and UPMGSC Conduct of health health centers, schools and mission caravans OSYs in the city. Provided flip charts, inclusive of ICV wall Chart to 12 MNCHN/FP services, Media communications- Radio Main Health Centers; health classes; and TV regular health Private Lying in provide LPM services news/advisory for 1 hour 3x a week TA on Usapan sessions facilitators Provide IEC materials for MCH

B. Increased Rate of Teenage Pregnancy Health Functional center for Teens in TA on demand DOHRO-Orientation Recording and reporting in DJPRH is being improved Information a public hospital – generation activities on the Healthy covering the FP/AY Program. Reporting Forms were provided (Usapan sessions ,

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities Regular conduct of usapan bench conference) Young Once and followed by mentoring and coaching to the program sessions and counselling at the implementation by program coordinators for implementation. spacious RH Clinic where FP partners in fixed Provision of IEC and AY rooms are housed facilities & workplaces materials The Reports will be channeled to the trained IT staff for (with visual and auditory Fertility-awareness incorporation in the HOMIS. privacy) TA on the i- HOMIS classes by PPMs, recording and academes Current status: IT clerk provided in FP/RH unit with a reporting Information Drive in computer unit provided for the use of the program the different schools C. Lack of FP-MCH Commodities Service Sharing of FP commodities Linkage to PPP DOHRO- procured The various health centers in GSC continue to implement the Delivery with public and private TA on the outreach FP commodities for SMRS for the commodities. NDPs conduct the actual partners- Sarangani, So.Cot services in the NHTS families (new inventory while the FHA summarizes the output and submit province & GenSantos City: barangays users) the same to DOH ROX11. LGUs, UPMGSC and FPOP for DOHRO - adopt the service provision TA to support LAPM commodities Strengthened linkages between and among public and service provision in forecasting tool private health facilities is beneficial in addressing stock outs. DJPRH PPMs, clinics, serve as service delivery points for access to LARC-PM services Health Utilize CHTs/BHW on health TA on FP IEC materials Orientation for BHWs on the FP IEC materials for correct Information information provision –orientation information and messaging to be done during BHWs during BHW quarter meetings (done quarterly in the city for the giving of meeting

Development Follow-On USAID City Actions Counterparts Status/Remarks/Recommendations Constraints Activities honoraria). The CHO maximizes the time by providing TA on the “FP updates/guides to BHWs. discharge” & demand generation in the Provision of IEC materials including FP wall charts, flip charts hospital in the newly appointed RH Room in DJPRH

7.6 Family Planning Composite Index Summary FP Composite Index: Measuring Capacity of USG-Assisted Sites in Mindanao on FP/MNH/AY Services

Introduction

In the later part of PY5, MindanaoHealth has been offered a 10-month extension from March 2018 - December 2018 to continue to work in areas with low income/poor populations with high-unmet need and high teenage pregnancies with high neonatal deaths by scaling-up evidence-based best practices that will include promising high impact interventions on adolescent reproductive health. Specifically MindanaoHealth will help; (i) bolster the capacity of the local health systems in consolidating results and institutionalizing effective strategies to reduce unmet need for modern family planning, teenage pregnancies, and maternal and child; (ii) develop innovative approaches in the provision of quality adolescent reproductive health and gender-friendly health services; and assist in providing immediate response to health emergencies in Marawi City and its corridors, in the aftermath of the unfortunate Marawi siege, as well as help restore/strengthen essential family planning and maternal and child health services. MH’s core interventions and activities during this extension period are fully in sync with the 2017-2022 USAID/Philippines’ Health Project overall goal of “Improved Health for Underserved Filipinos”.

Prioritization of USG-Supported Sites

With only a year to accomplish the objectives of the extension, a 3-day comprehensive program implementation review (PIR) to take stock of the progress 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 was conducted. As an initial step, analysis of relevant available data by LGU on FP/MNH/AY services resulted to identification of 12 priority 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 (Table1).

Table 1: USG-Assisted Sites in Mindanao by Category Group, October 2017-December 2018

Estimated Estimated Teenage WRA with FP USG-Assisted LGUs Comments Pregnancy Unmet Need (Sept. 2017) (Sept. 2017) Priority USG-Assisted LGUs 1 Davao City 11,833 90,334  About 62% of 2 Cotabato 10,101 71,507 Geographically 45

Estimated Estimated Teenage WRA with FP USG-Assisted LGUs Comments Pregnancy Unmet Need (Sept. 2017) (Sept. 2017) 3 Bukidnon 8,547 80,699 Isolated and 4 Maguindanao 4,682 71,529 Depressed areas are 5 South Cotabato 10,867 47,138 Located in the 12 6 Davao del Sur 6,876 52,493 priority LGUs. Zamboanga del  Average 7 Sur 5,381 52,958 contribution of the 8 Misamis Oriental 5,184 50,619 12 priority sites to 9 Sultan Kudarat 6208 41,542 CYP is about 72% Compostela  12 priority sites are 10 Valley 5,454 42,186 top in terms of # of WRA with unmet 11 Agusan deL Sur 6035 37,279 need and teenage Zamboanga del pregnancy 12 Norte 4,933 52,147 Conflict Affected Areas (CAAs) 1 Basilan 1,486 26,714 2 Sulu 4,099 49,499 3 Tawi-Tawi 1,763 23,121 5 Zamboanga City 4,428 43,583 6 Cotabato City 2,804 15,396 Lanao del Sur (+ 7 Marawi City) 5,030 49,499 Lanao del Norte 8 (+ Iligan City) 6,302 39,483 Non-priority USG- Assisted LGUs Zamboanga 1 Sibugay 3,246 31,717 Cagayan de Oro 2 City 3,944 38,509 3 Davao Oriental 3,921 31,860 General Santos 4 City 6,208 30,596 5 Agusan del Norte 5716 34,898

Family Planning 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 FP/RH services and helps establish an enabling environment for sustainability.

Furthermore, variations are also evident in project coverage of key project technical assistance, and responsiveness of implementation partners. As such, MH shall therefore adopt a tailored and focused technical assistance given the gains achieved in the last five years and the absorptive capacity of partners.

Given the above context and to enable the Project to strategically prioritize and identify specific technical support to each province, MH conducted an assessment using a capacity index (Table 2) that measures the status of 13 key result areas that can widen access to FP/AY services, increase demand, and establish an enabling environment for sustainability, while looking at the demographic and geographic profiles.

As designed, the tool developed estimates a 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 of each LGU’s accomplishments on building their capacity to create demand and deliver an integrated FP/MNCHN services within an enabling supportive policy environment, during a fixed period, a raw score of from one (1) to three (3), with three (3) as the highest, is assigned to each subcomponent/element thence 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 performance levels, the LGUs are 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 to indicate their current or “moving forward” capacities to address unmet need for family planning.

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 6.67

MH Components and Sub-components Assigned Weights (%) conducting supportive supervision 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

FP Composite Capacity Index Baseline (Q4PY5)

From its inception, the project’s overarching goal is to improve family health by dramatically increasing the quality and uptake of integrated maternal, newborn, and child health and nutrition/family planning (MNCHN/FP) services at the household level, in communities, and at public and private facilities, thereby reducing maternal and infant deaths, and decreasing the unmet need for FP services—especially among Mindanao’s lowest wealth quintiles and in conflict- affected areas by scaling-up evidence-based best practices and promising high impact interventions on FP/MNCHN reproductive health; bolstering the capacity of the local health systems in consolidating results and institutionalizing effective strategies within an enabling policy environment; and developing innovative approaches in providing quality adolescent youth reproductive health (AYRH) and gender-friendly health services. As of September 2017, table 2 and Figure 1 below summarize how the USG-assisted LGUs responded to the TA in terms of their current capacities to accomplish the objectives of USAID’s MindanaoHealth Project.

Table 2. Estimated FP Capacity Indices of USG-Assisted LGUs as of September 2017.

Composite FP Component FP Capacity Index, Capacity Index, as of September 2017 as 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

Composite FP Component FP Capacity Index, Capacity Index, as of September 2017 as of September REGION/PROVINCE 2017 SD DG P/F AYRH CAA Tawi-Tawi 49.78 20.20 10.0 14.02 5.56 REGION IX: ZAMBO PEN CAA Zamboanga City 46.96 26.24 12.24 8.15 0.95 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 58.91 24.45 15.56 5.56 13.34 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 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 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.

In terms of capacity of LGUs to provide wide range of FP services, Zamboanga del Sur and Maguindanao are leading on service delivery, and are the highest contributor to LARC/PM in their respective regions in PY5 both for fixed and outreach services. Zamboanga del Sur contributed

4,236 or 45% of total 9413 USG-sites LARC/PM accomplishment in the region while Maguindanao contributed 566 or 34% ARMM wide project’s accomplishment of 1,686 on LARC/PM (PY5 Annual Report).

Overall, FP composite index scores of CAAs, except Maguindanao, are on the low to medium ranging from 32% to 59%, with varied capacity on service provision and demand generation on FP and AY services. Institutionalizing policy and financial reforms is also lowest in 3 CAAs namely Zamboanga City, Cotabato City and Basilan primarily due to the absence of SDN initiatives.

Six of the 24 USG-assisted sites have FP Composite Index score of 50% or less, three are in ARMM namely Sulu, Lanao del Sur and Tawi-Tawi, and the other three (3) are Zamboanga City, Zamboanga del Norte and Davao Oriental. The common denominator for the low score is the inadequacy of capable health service providers and facilities providing AY-friendly services. In addition, specifically for Lanao del Sur, the humanitarian responses during and immediately after the Marawi siege has affected the delivery of quality services and demand generation for FP/MNCHN services, while Davao Oriental and Tawi Tawi’s efforts on demand creation is an area that requires further technical support.

After a year, another assessment of the LGUs capacity to deliver FP/AY services to well-informed and counseled clients within an enabling policy environment was conducted with the following results as reflected in table 3 and Figure 2. Table 4 is a summary of the FP Capacity Index for Q4PY5 and Q4PY6.

Table 3. Estimated FP Capacity Indices of USG-Assisted LGUs as of September 2018 (Q4PY6)

Composite FP Component FP Capacity Index, Capacity as of September, 2018 REGION/PROVINCE Index, as of SD DG P/F AYRH September, 2018 CAA Basilan 60.4 29.1 15.6 10.4 5.3 CAA Lanao del Sur 55.3 19.3 16.7 16.2 3.1 P Maguindanao 88.5 36.3 20.0 18.3 13.9 CAA Sulu 55.8 18.2 15.6 11.5 10.5 CAA Tawi-Tawi 55.6 19.3 20.0 11.7 4.6 REGION IX: ZAMBO PEN CAA Zamboanga City 63.9 31.7 20.0 7.6 4.6 P Zamboanga del 69.8 26.5 20.0 17.5 5.9 Norte P Zamboanga del Sur 85.3 31.4 20.0 19.5 14.4 NP Zamboanga Sibugay 66.8 23.9 17.8 16.3 8.9 Region X: Northern Mindanao P Bukidnon 81.4 31.6 16.8 20 13.0 NP Cagayan de Oro City 82.2 30.7 20.0 18.2 13.3

Composite FP Component FP Capacity Index, Capacity as of September, 2018 REGION/PROVINCE Index, as of SD DG P/F AYRH September, 2018 CAA Lanao del Norte 64.5 23.4 16.7 18.4 6.1 P Misamis Oriental 76.5 27.1 20.0 20 9.4 Region XI: Davao Region P Compostela Valley 75.0 20.8 20.0 16.3 17.9 P Davao City 62.35 26.9 11.1 12.2 12.1 P Davao del Sur 88.5 29.8 20.0 20. 18.7 NP Davao Oriental 56.4 22.2 13.3 19.5 1.4 Region XII: SOCCSKSARGEN P North Cotabato 85.0 31.5 20.0 18.2 15.3 CAA Cotabato City 63.54 31.04 17.78 4.72 10 NP General Santos City 83.2 32.3 15.6 18.8 16.6 P South Cotabato 85.0 31.5 20.0 18.2 15.3 P Sultan Kudarat 72.9 30.1 20.0 20 2.8 Region XIII: CARAGA Region NP Agusan del Norte 77.2 26.2 17.8 18.5 14.8 P Agusan del Sur 76.0 31.0 15.6 17.7 11.8

Table 4 : Summary of FP Composite Index by Cluster of USG-Assisted Sites, Mindanao, Q4PY5 and Q4PY6 Component Composite FP FP Capacity Capacity Index, Index, as of As of September September, Percentage Cluster of Project Areas 2017 2018 increase Clust er 12 Priority LGUs 1 Davao City 62.35 62.35 0% 2 South Cotabato 62.25 85 37% 3 Maguindanao 64.20 88.5 38% 4 Sultan Kudarat 59.90 72.9 22% 5 Compostela Valley 60.09 75 25% 6 Agusan del Sur 61.05 76 24% 7 Zamboanga del Norte 44.60 69.8 57% 8 Zamboanga del Sur 62.19 85.3 37% 9 Bukidnon 61.71 81.4 32% 10. North Cotabato 55.46 85 53% 11 Davao del Sur 54.63 88.5 62% 12 Misamis Oriental 70.02 76.5 9%

Component Composite FP FP Capacity Capacity Index, Index, as of As of September September, Percentage Cluster of Project Areas 2017 2018 increase Cluster: Conflict Affected Areas 1 Lanao del Sur 32.65 55.3 69% 2 Lanao del Norte 51.70 64.5 25% 3 Basilan 50.51 60.4 20% 4 Sulu 43.95 55.8 27% 5 Tawi Tawi 49.78 55.6 12% 4% 6 Zamboanga City 46.96 63.9 7 Cotabato City 58.91 63.54 8% Cluster: 5 non-priority USG-sites 1 Agusan del Norte 61.62 77.2 25% 2 Davao Oriental 46.29 56.4 22% 3 General Santos City 63.29 83.2 31% 4 Cagayan de Oro 76.85 82.2 7% 5 Zamboanga Sibugay 61.81 66.8 8%

Except for Davao City, the increase in FP Capacity Index from Q4PY5 to Q4PY6 ranges from 4% to 69% with Lanao del Sur posting the highest percentage increase. The accelerated support to Lanao del Sur post Marawi Siege resulted to capacitating 39 FHAs that help profiled 27,916 WRA with unmet need and provision of services to 2,351; conduct of at least two outreach services per month, in partnership with civil society organizations, with demand generation as integral component; certification of 3 BTL/MLLA providers and 10 supportively supervised LARC/PSI trained HSPs recommended for certification; and training of additional 30 CHWs.

The overall increase in the FP Composite Index in USG-sites are due to: 136% increase in the number of AY friendly facilities from 55 in PY5 to 130 in PY6 (8 to 19 hospitals; 35 to 71 RHUs and 12 to 40 schools) with varying functionalities; 25% increase in the number of LGUs that conducted DQC from 280 in PY5 to 349 in PY6; increasing number of FP trained HSPs supportively supervised and certified; and sustained support to 21 SDNs across USG-sites resulting to 4 functional, 10 operational and 7 organized SDNs. While there is increase in total FPCI scores per USG-sites, the slight decrease in the reduction in the number of MCP/NCP accredited SDPs, reduction in the number of validated SDPs providing FP counseling and services from 757 in PY5 to 744 in PY6, and the increasing number of facilities with stock-outs has affected increase in some LGUs such as Zamboanga del Sur, Misamis Oriental, and Cagayan de Oro.

On the other hand, the no progress observed in Davao City is that any progress made during the year, such as increase in the number of hospitals with FP/AY Programs from 1 to 3, DOH- certification of 2 out of 7 supportively supervised PPIUD trained HSPs, the increase outreach services in the later part of the year, and sustained support to District 2 SDN are just enough to

52 counter balance the reduction of SDPs providing FP counseling and services from 75 to 66 with the closure of 9 private facilities in Q2PY6; no DQC conducted; reduction in the number of AY- friendly RHU facilities from 12 to 9 and stock-outs in 10 facilities.

Figures 1 and 2 showed graphically the improved capacity of local health systems of USG-assisted sites in Mindanao to deliver family planning and AYRH services within an enabling supportive policy environment. With only Cagayan de Oro in the green area in Q4PY5, it increases to 11 USG- sites in Q4PY6.

In Q4PY5, only Cagayan de Oro landed in the green zone with a score of about 77%. Through LGU’s initiatives, with technical assistance from the project and DOHRO, the city established its Reproductive/Women’s Health Center and FP Programs at JR Borja Hospital, had its 45 health facilities accredited on MCP/NCP, with enabling policy on FP/MNCHN services, and host to NMMC, the Center of Excellence for PPFP for Northern Mindanao. The other nearby provinces within and outside Northern Mindanao have accessed these facilities as venue to train/supportively supervised their health service providers as well as referral to their clients requiring further management. The increase from Q4PY5 to Q4PY6 though was minimal at only 7% because of the reduction in the number of MCP/NCP accredited facilities from 48 to 15.

The six USG-sites namely Zamboanga City, Davao Oriental, Lanao del Sur, Tawi-Tawi, Sulu, and Zamboanga del Norte located in the red zone in 2017 moved to yellow zone, with Zamboanga del Norte nearer to the green zone followed by Zamboanga City, and the other four (Sulu, Tawi Tawi, Lanao del Sur and Davao Oriental trailing behind. Ten (10) of the out of the 18 USG-sites in the yellow zone moved to green zone in Q4PY6, while the progress made in the other remaining seven (7) USG fall short of reaching the green zone and no movement for Davao City. With the observed high score on policy and financing mechanisms - supportive to institutionalizing reforms, building up these gains through sustained advocacy and leveraging resources, and focused technical support from oversight bodies and other development partners will result to strong capable local health system able to provide quality FP/AY services along the continuum of care across levels of health care.

Figure 1: FP Composite Index by USG-sites, September, 2017 (Q4PY5)

Figure 2: FP Composite Index by USG sites, September 2018 (Q4PY6)

Interventions

7.7 Component Specialist Report & Updates for Q3PY6

Health Policy & Systems Development Report

A. Service Delivery Network Accomplishment Cumulative Indicator Baseline For the Quarter Accomplishment to Date Target Actual % Target Actual % Sustained support to 0 14 11 79% 21 21 100% Strengthen SDN 2013 Functionality: a) Functional 0 2 3 2 4 b) Operational 0 9 6 9 10 c) Organized 0 3 2 10 7

Analysis of Accomplishment

In the 21 SDN areas supported by the project in the last three years, four SDNs achieved full functionality, 10 SDNs functional and seven SDNs at the organized stage (refer to Table: SDN Functionality) involving 158 rural and urban health centers; 31 public hospitals, and 47 private hospitals with referral guidelines. District 2 SDN of Zamboanga del Sur moved to functional status per evaluation of SDN TWG with respect to attaining functional referral mechanism with public and private facilities and providers, financing mechanism, formulation of SDN-related policies chief of which is the SDN provincial ordinance, among others. The 21 SDNs involve 124 LGUs located in 15 provinces and two cities of Davao and Iligan. The project also worked with ZFF-HLGP supported LGUs in 10 SDN sites covering eight provinces in which three of the four functional SDNs are found.

In collaboration with the regional Department of Health (DOH) and stakeholders across the health system, the MH project developed the SDN Operational Guide to assist provinces and cities with systematically establishing an SDN. The 8-step process in this guide serves as the foundation upon which MindanaoHealth provided technical assistance. The project’s key interventions to establishing functional SDN revolved mainly around setting up structures; formulating SDN related policies through high level advocacy meetings; strengthening public-private and community partnership; making referral mechanisms functional; instituting financing mechanisms; continuing capacity building support and monitoring, evaluation, learning and adapting processes for sustainability and scale up. See graph below.

In the last quarter of PY6, the following are the key achievements on SDN.

 SDN Provincial Ordinances were formulated and submitted to the legislative branch in the province of Bukidnon and Zamboanga del Sur. In the latter, funds to support the operation of SDN was committed by the DOH regional office and the Governor’s office.  Completion of referral guidelines in Iranun SDN in Maguindanao, District 1 and District 2 SDNs of Zamboanga del Sur, and South Bukidnon SDN while Arakan Valley, Liloy SDN, and Bayugan SDN guidelines are still in draft versions. The SDN TWG will pursue completion of the guidelines.  The referral guidelines of the functional and operational SDNs were communicated and disseminated to stakeholders including community partners.  PPPs were completed and approved in Zamboanga del Sur and South Bukidnon while Iranun SDN and Liloy SDN are still legworking on the commitment and full participation of private partners.  Maguindanao started the province-wide establishment of SDN by working on the other four clusters with MH support. The provincial SDN management committee has committed to continue and fund the SDN strengthening activities in the province.

Emerging Results:

1. Increased accessibility to long-acting and permanent methods

In 21 SDNs, there are 128 public facilities that were linked to four apex facilities (CRMC, SPMC, DRMC, and NMMC), 18 public hospitals with FP and AY programs, and 14 private hospitals that provide LAPM and CEmONC services. There were 1,013 health services providers both from public and private sectors that were trained and provided services for implants, IUDs, PPFP, and BTL/MLLA with 17,600 clients served (PSI-8,665 and LAPM- 8,935).

Based on the initial analysis done by the project on SDN’s potential contribution to CYP involving 11 SDN sites, the average CYP generated by the SDN in a province is at 44%.

2. Cost-effectively addressed health system gaps via public-private and community partnerships

The public, private and community partnership modality was a key strategy to addressing health system gaps in the network in the area of capacity building support, human resource complementation, fund augmentation, and commodity security. The partnership also formalized the cross-border and cross-sector referral service delivery provision among SDN members including the institutionalization of a unified reporting system where the private facilities and providers are required to submit regular health service delivery reports.

3. Financing mechanism

The financing mechanism of SDN is largely hinged on optimizing PhilHealth reimbursements to be plowed back to health services through policy support and the creation of a common trust fund to support SDN operation and cover hospital costs of referred patients. To date, there are 35 LGUs that cost-share operations in seven SDNs, 101 (81%) out of 124 SDPs are accredited maternal and newborn care facilities, 107 LGUs with policy on the use of PhilHealth reimbursements, and the implementation of the No Balance Billing policy in 158 rural and urban health centers, 31 public hospitals, and 42 private birthing clinics.

Findings:

 SDN is designed to address fragmentation of health system brought about by the devolution, which in itself is the same barrier to SDN implementation;  The DOH and other national agencies need to adopt progressive and supportive policies and guidelines for health and other social services assistance to clients for better access to basic services;  The Provincial Health Offices (PHOs) play a critical role in all phases of SDN establishment, and DOH sub-national agency deliver technical oversight and policy direction;  Public, Private, and Community Partnership is critical to SDN sustainability and scale-up;  Functional SDNs require highly skilled management teams in terms of systems analysis, design, program guidance & integration of services;  Hospitals cannot continue to operate as an autonomous entity, but rather align their goals and objectives to the larger health system;  An accountable, responsive, and resilient local health system requires policies and health legislations that support various SDN elements

SDN Collaborating, Learning and Adopting Experience

The sharing and learning session elicited varying degree of appreciation and understanding of SDN mainly due to the non-prescriptive approach to setting up SDNs. In Luzon, as described by the Chief of Hospital of Batangas Medical Center (BMC), the operation of SDN revolves around the influence of BMC as its apex facility in the referral mechanism, which is a positive development as it addresses one of SDN’s challenges--the propensity of higher level hospitals to operate autonomously out of SDN’s larger goals and objectives. It is widely recognized the critical role that hospitals play in the health care system and to look at them as an integrated part of the broader health delivery system such as SDN. MindanaoHealth experience, in contrast, is holistic in its approach by putting emphasis on strong governance and leadership as the driving force to crystallize support around robust financing mechanism, dynamic public-private and community partnership, cross border and cross sector referral arrangements, capacity building, moving plans and policies into action, among others, towards providing equitable, comprehensive, integrated and continuous quality health services to a defined population.

Unfinished Agenda

To sustain existing SDNs, stakeholders must continue to focus on strengthening SDN implementation management structures and overall coordination. Continued mobilization and engagement of private sector (health and non-health) through public-private and community partnerships are critical to creating effective networks in rural and urbanized areas. Private sector involvement in the SDN management structure augments the expertise and resource requirements of the network

PhilHealth Reimbursement System

To further defragment the Philippines health system, the national government has strongly considered shifting the PhilHealth reimbursement policy from facility-based to network-based. This change would allow LGUs to coordinate and redirect their trust funds toward the needs of the SDN rather than operating independently. Key stakeholders must continue to advocate for a network-based policy.

National No Balance Billing (NBB) Policy

The NBB Policy is intended to protect clients from high out-of-pocket expenses, which can also be an effective demand generation strategy. Facilities reported that the PhilHealth reimbursement was insufficient and left patients to carry the financial burden. However, MH discovered that many service providers were either not submitting claims or overestimating the cost of service. For example, providers would procure more medical products for a procedure than actually used. There is an ongoing need to review medical costs and the PhilHealth Reimbursement System with facilities in order to intensify the implementation of the NBB policy for the poorest of the poor.

National SDN Operational Guidelines

While MH collaboratively designed and implemented SDN Operational Guidelines for Mindanao with regional DOH, Central DOH still lack an official policy to standardize SDN creation across the continuum of care. The central DOH can leverage experiences and lessons learned from MindanaoHealth to design national SDN Operational Guidelines that regions can adopt.

ARMM

Even with political buy-in, the island provinces of ARMM face the most challenges with SDN establishment because they are underdeveloped, unstable, and geographically too far for referrals. Local governments, therefore, are generally biased toward tangible infrastructure projects rather than investments in FP/MNCHN/AY services and providers. Development partners and DOH ARMM may continue to establish an SDN that:

 Strengthens the capacity of primary care facilities and midwives to administer FP/MNCHN/AY services that are generally provided in higher level facilities.  Establishes innovative funding mechanisms or public-private partnerships for transportation  Improves outdated communications systems (e.g., satellite phones)  Effectively engages multiple sectors (e.g., counter-terrorism)

Status of SDN Functionality

Service Delivery Network # of Region LGUs Organized Operational Functional

*ZDS District 1 (12) *ZDS District 2 Zambo Peninsula (4) 41 *ZS Alicia (7 *ZDN Liloy (7) (15)

Northern Mindanao So. Bukidnon (10) 21 *MisOr: ClaJaViTa (4) Iligan City (4) Sanlakass (6)

DC District 3 DDS-DiMaBaMaS (5) Davao Region (4) 16 DOcc SaMaDomJAS (4) ComVal-CoMMMoNN (6)

*South Cot (11) SOCCSKSARGEN (4) 26 NC Arakan Valley (3) *SK BITES (5) NC PALMA-PB (7)

*ADN BueNasCar (3) Caraga Region (4) 14 *ADN Cabadbaran (5) *ADS DOP (3) *ADS Bayugan (3)

ARMM (1) 6 Iranun SDN (6)

124 Total 7 SDNs 10 SDNs 4 SDNs LGUs * ZFF supported provinces

B. PHIC Accreditation 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 6 2% 277 301 109% Denominator 368 368 368 368

Analysis of Accomplishment

For more than five years of technical assistance in supporting RHUs and CHOs achieved MCP and NCP accreditation including the formulation and approval of PhilHealth reimbursement policy, the project was able to consistently perform beyond performance target. The technical assistance package of the project in optimizing PhilHealth reimbursement follows the training, supportive supervision, DOH certification, PhilHealth tagging/ accreditation, and PhilHealth claims and

60 reimbursement continuum. Corresponding to health service providers PHIC tagging, the project also supported PHIC accreditation of facilities through pre-assessment process, advocacy to LCEs to address identified gaps, and formulation of LGU policy on the use of PHIC reimbursement per its guidelines.

Accreditation performance reached its peak in 2016 at 89% from the baseline of 19% due to intensive capacity building support required for accreditation and LGUs’ passage of PHIC reimbursement policy. This performance, however, gradually declines to 82% as of the last quarter of PY6. The reason for the decrease in the number of accredited facilities is mainly due to non- compliance of facilities to the DOH physical facility standards requiring facilities to provide adequate areas in order to safely, effectively, and efficiently provide health services to patients apart from absence of rural doctors and inability to continue partnership with private OB Gyne. Cagayan de Oro City LGU, in particular, deliberately reduced the BHS accredited facilities from 48 to 16 facilities as a management decision to meet quality standards in these strategically located facilities.

In the last five years, six provinces (Bukidnon, Lanao del Sur, two provinces of Zamboanga Peninsula- ZDS and ZDN, including Zamboanga City) demonstrated above 90% facility accreditation performance while Misamis Oriental and General Santos City are below 50% and the two cities of Cotabato and Davao are barely at 10%. The poor accreditation performance in the two cities are attributed to non-compliance with building specifications and capacity building requirements. These, among other issues, can be meaningfully addressed by bringing DOH and LGU executives to collectively put their action and resources altogether.

In the fourth quarter of PY6, six more facilities achieved MCP/NCP accreditation from Lanao del Sur (3), Misamis Oriental (2), and Agusan del Norte (1), the cumulative number of accredited facilities (RHUs/CHOs) to date reached 301 or 109% based on PY6 target of 75% (n-277) of which 178 (59%) facilities are in priority provinces, 87 (29%) in CAAs, and 36 (12%) in non-priority areas. On LGUs utilizing PHIC reimbursements as per PHIC guidelines, the number remains at 333 out of 368 LGUs where 195 LGUs are in the priority areas, 100 LGUs in CAAs, and 38 LGUs in non-CAAs.

MCP/NCP Annual Performance Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Priority Areas Accom % Accom % Accom % Accom % Accom % Accom % Davao City 1 5% 2 11% 2 11% 2 11% 2 11% 3 16% Cotabato 8 44% 9 50% 16 89% 16 89% 13 72% 12 67% Bukidnon 17 77% 18 82% 21 95% 21 95% 21 95% 21 95% Maguindanao 14 39% 36 100% 36 100% 36 100% 34 94% 34 94% South Cotabato 6 50% 6 50% 10 83% 10 83% 10 83% 9 75% Davao del Sur 5 33% 7 47% 9 60% 11 73% 15 100% 10 67% Zamboanga del Sur 27 100% 27 100% 27 100% 27 100% 25 93% 27 100% Misamis Oriental 10 38% 11 42% 14 54% 15 58% 14 54% 6 23% Sultan Kudarat 6 50% 6 50% 7 58% 11 92% 11 92% 11 92% Compostela Valley 7 64% 7 64% 8 73% 10 91% 8 73% 10 91% Agusan del Sur 2 14% 2 14% 11 79% 11 79% 12 86% 12 86% Zambo del Norte 23 85% 24 89% 24 89% 25 93% 25 93% 25 93% Total 126 155 185 195 190 180

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 CAA Accom % Accom % Accom % Accom % Accom % Accom % Basilan/Isabela 2 17% 11 92% 11 92% 11 92% 5 42% 9 75% Sulu 5 26% 19 100% 19 100% 19 100% 13 68% 15 79% Tawi-Tawi 3 27% 11 100% 11 100% 11 100% 11 100% 11 100% Zamboanga City 10 63% 16 100% 16 100% 16 100% 16 100% 16 100% Cotabato City 0 0% 0 0% 1 14% 1 14% 1 14% 1 14% LDS/Marawi 36 90% 40 100% 40 100% 40 100% 35 88% 35 88% LDN/Iligan City 10 43% 11 48% 14 61% 14 61% 11 48% 14 61% Total 66 108 112 112 92 101

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Non-CAA Accom % Accom % Accom % Accom % Accom % Accom % Zamboanga Sibugay 16 100% 16 100% 16 100% 16 100% 15 94% 16 100% Cagayan de Oro City 2 4% 6 11% 43 80% 48 89% 48 89% 15 28% GenSan City 1 8% 1 8% 1 8% 7 58% 7 58% 7 58% Davao Oriental 3 27% 3 27% 6 55% 7 64% 9 82% 6 55% Agusan del Norte 2 17% 3 25% 10 83% 10 83% 11 92% 11 92% Total 24 29 76 88 90 55

Summary of Annual Accomplisthment Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Non-CAA Accom % Accom % Accom % Accom % Accom % Accom % Annual Accomp 206 56% 272 74% 316 86% 327 89% 304 83% 301 82% Annual Target 19% 21% 68% 72% 75% 75%

C. Data Quality Check amongst Local Government Units

Improving the health information system is a critical management tool for policymakers and health managers from regional DOH and LGUs. Ensuring the validity and reliability of data generated through the FHSIS is critical in enabling evidence-based LGU planning and decision- making. Throughout the years, MindanaoHealth supported strengthening of DOH and LGUs health information systems through the institutionalization of Data Quality Check (DQC) for family planning and selected MNCHN indicators in support of the MNCHN strategy to reduce maternal and infant mortality.

Efforts to institutionalize DQC was demonstrated in 15 provinces and 28 individual municipal LGUs through policy issuances by mobilizing the DQC team with fund allocation for DQC related activities resulting in minimal support from the project and DOH regional offices. The Secretary of Health of ARMM issued a policy guidelines directing all local health units to conduct DQC of FHSIS statistical data prior to submission to the PHO. All PHOs in ARMM issued an iteration of this policy guidelines. Lastly, Davao City Health Office shall “validate the data or report received from the District Health Centers and local sources, both public and private facilities” as included in the Ordinance Establishing Systems and Mechanisms for the Implementation of MNCHN Strategy in Davao City (Article VI Section 5.3) passed in 2016 by the Sangguniang Panlungsod of Davao City. The presence of functional technical team at the provincial level tasked to monitor, validate and analyze, and provide technical support and updates to the RHU/CHO DQC teams is key to regularizing on-site DQC activities.

The implementation of DQC allowed the partner regional DOH offices to generate valid and reliable MNCHN and FP data including private sector contribution for 19 provinces covering 356 LGUs, a 114% accomplishment rate over the PY6 target of 313 LGUs or 97% of the 368 USG- assisted LGUs. The second and third year of project implementation intensified strengthening the DQC capacities of project staff and LGU staff through training of trainers and training of users on DQC guide. The project commissioned short-term technical assistance to fast track DQC implementation. A total of 3,669 LGU DQC trained health staff across 19 provinces and two cities were involved in the DQC rollout. This further explained the high number of LGUs conducting DQC activities beginning in Year 4 to Year 6 with accomplishment rate ranging from 94% to 114%. (See table below).

While there is an increasing number of LGUs conducting DQC through the years, it is important, that in addition to a policy issuances on DQC, an in-house DQC champion and an in-place facility mechanism to orient/mentor incoming new personnel will reduce unnecessary gaps due to fast turn-over and resignation of DQC-trained health service providers, including the frequent changes in the LGU health leadership, the two most common reasons that have affected the continuity of DQC- activities in many local health units.

In the course of implementing DQC, the main sources of variances identified on the data validation process for both family planning current users and other MNCHN indicators were computational

errors and erroneous applications of technical definitions of indicators. Computational errors lead to discrepancies, especially for those indicators which are usually recorded and reported as disaggregated figures but are eventually summed up. Along with these errors, transcriptional errors were also noted as a contributory source of variance. As far as errors go, these are not substantial given that these could be remedied through a greater degree of diligence in the accomplishment of the forms and employing additional data validation procedures. The RHMs and PHNs are aware and understood these measures to improve data quality.

Data Quality Checks Annual Performance Baseline Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Target Priority Areas # LGUs % Accom % Accom % Accom % Accom % Accom % Accom % %LGUs Total LGUs Davao City 1 100% 1 100% 1 100% 1 100% 1 100% 0 0% 0 0% 1 1 Cotabato 0 0% 0 0% 5 33% 11 73% 15 100% 11 73% 18 120% 15 18 Bukidnon 0 0% 0 0% 0 0% 1 5% 21 111% 22 116% 22 116% 19 22 Maguindanao 0 0% 0 0% 5 16% 25 81% 28 90% 17 55% 36 116% 31 36 South Cotabato 0 0% 0 0% 11 122% 0 0% 11 122% 0 0% 9 100% 9 11 Davao del Sur 8 53% 12 92% 13 100% 13 100% 11 85% 0 0% 6 46% 13 15 Zamboanga del Sur 0 0% 0 0% 0 0% 0 0% 25 109% 27 117% 27 117% 23 27 Misamis Oriental 0 0% 0 0% 0 0% 1 5% 23 110% 25 119% 25 119% 21 25 Sultan Kudarat 0 0% 0 0% 8 80% 0 0% 7 70% 1 10% 12 120% 10 12 Compostela Valley 0 0% 0 0% 11 122% 11 122% 11 122% 11 122% 11 122% 9 11 Agusan del Sur 4 29% 0 0% 12 100% 0 0% 14 117% 13 108% 14 117% 12 14 Zambo del Norte 0 0% 0 0% 0 0% 0 0% 22 96% 27 117% 27 117% 23 27 Sub-Total 13 6% 13 7% 66 35% 63 34% 189 102% 154 83% 207 111% 186 219

Baseline Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Target CAAs # LGUs % Accom % Accom % Accom % Accom % Accom % Accom % %LGUs Total LGUs Basilan/Isabela 1 8% 0 0% 6 55% 1 9% 13 118% 13 118% 13 118% 11 13 Sulu 0 0% 0 0% 0 0% 6 38% 15 94% 1 6% 19 119% 16 19 Tawi-Tawi 0 0% 0 0% 0 0% 8 89% 1 11% 11 122% 11 122% 9 11 Zambo City 0 0% 0 0% 0 0% 1 100% 1 100% 1 100% 1 100% 1 1 Cotabato City 0 0% 0 0% 1 100% 1 100% 1 100% 1 100% 1 100% 1 1 LDS/Marawi City 0 0% 0 0% 0 0% 40 118% 25 74% 39 115% 40 118% 34 40 LDN/ Iligan City 1 4% 16 80% 23 115% 0 0% 15 75% 22 110% 23 115% 20 23 Sub-Total for CAA 2 2% 16 17% 30 33% 57 62% 71 77% 88 96% 108 117% 92 108

Baseline Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Target Non-CAA # LGUs % Accom % Accom % Accom % Accom % Accom % Accom % %LGUs Total LGUs Zamboanga Sibugay 0 0% 0 0% 0 0% 0 0% 11 79% 16 114% 16 114% 14 16 CDO City 0 0% 0 0% 0 0% 0 0% 1 100% 1 100% 1 100% 1 1 Davao Oriental 0 0% 0 0% 0 0% 0 0% 9 100% 11 122% 11 122% 9 11 General Santos City 0 0% 0 0% 0 0% 1 100% 1 100% 1 100% 1 100% 1 1 Agusan del Norte 1 8% 1 10% 0 0% 12 120% 12 120% 11 110% 12 120% 10 12 Sub-Total Non-PA 1 2% 1 3% 0 0% 13 37% 34 97% 40 114% 41 117% 35 41 Total 16 4% 30 10% 96 31% 133 42% 294 94% 282 90% 356 114% 313 368

Distribution of USG-MH-Assisted Provinces/HUC that Conducted DQC in PY6 by Priority Cluster Baseline Accomplishment, PY5 Accomplishment, PY6 Project Areas 2015 Targeta Q1-Q4 % Targetb Q1-Q4 % (A) Priority Areas: 184/219 153/184 83 186/219 200/186 108 (1) 12 USG Sites (2) CAA Sites: (a) BaSulTa, Zambo 38/45 26/38 68 38/45 45/38 118 City, Cotabato City (b) Marawi & Environs (Lanao Sur 53/63 61/53 115 54/63 63/54 117 & Lanao Norte) (B) Non-Priority Areas 34/41 40/34 118 35/41 41/35 117 Project-Wide Total 268/ 368 309/368 280/309 91 313/368 349c/313 112 Standard : RHU/CHO conducts DQC at least once a year a – Target is 84% of RHUs/CHOs b – Target is 85% of RHUs/CHOs c – Seven (7) RHUs were verbally reported as having conducted DQC during the quarter but no MOVs were submitted

During this reporting quarter, eigthy-four (84) RHU/CHOs conducted DQC activities in addition to the two hundred seventy-two (272) in the previous three quarters resulting to a cumulative total of three hundred fifty-six (356) LGUs or 114% of 313 PY6-target, and 97% of the total number of RHUs/CHOs assisted by USG-MH. The number of LGUs implementing the DQC process as part of FHSIS data management increased by 26% from 282 in PY5 to 356 in PY6. Compared to the baseline (2012) of 268, the number of RHU/CHOs conducting DQCs increased by 33%. The presence of a DQC-trained public health nurse at the RHU/CHO and a functional technical team at the provincial level tasked to monitor, validate and analyse FHSIS-data and provide technical support and updates to the RHU/CHO DQC team are crucial in the sustainability of the RHU/CHO-based DQC activities. The administrative issuances institutionalizing the DQC process and the inclusion of DQC budget in the LIPH and AOP also help to ensure the success of the initiative in the succeeding years as demonstrated by the LGUs regularly conducting DQC activities since 2015.

Compostela Valley is the only province where all 11 RHUs conducted DQC regularly since PY2. Provinces where not all component-LGUs have conducted DQC at least once during PY6 consist of Cotabato (only15/28), South Cotabato1 (only 5/11, and Davao del Sur & Occidental (only 6/15). The last DQC-activity ever conducted by Davao City Health Office was in PY4.

The while the two provinces are conducting DQc in the last 4 years, processing of the administrative issuance institutionalizing the regular conduct of DQC in the RHUs/CHO in Zamboanga del Norte and Zamboanga City stalled. Unfortunately, there was reshuffling of the PHO Staff in 2016. The PHO was transferred to the provincial hospital and returned to his post only in late September 2018.

1 According to the LGUAs of South Cotabato and Davao del Sur and Occidental, all RHUs/CHO in these provices had conducted DQC this year but they have yet to submit the MOVs for the conduct of this activity in the remaining RHUs/CHO in South Cotabato and 9 RHUs in Davao del Sur and Occidental.

Deviation Narrative

Davao City is the only highly urbanized city/province that has not conducted DQC for the past past two years despite the available policy and constant advocacy to conduct the DQC by DOH- RO X and the Project. Instead of appreciating the value of DQC and challenged to do better after the DQC conducted in PY4/2016, service providers refused to attend DQC activities, despite the utilization of FP Form 1, the major gap found during the DQC in PY4/2016. The lack of FP Form 1 of CU clients captured in the TCL-FP-CU resulted to a drop in the city’s CPR by almost half in 2016. This is a sign that they failed to build up their DQC processes to address weaknesses in their recording/reporting system observed during the past DQCs, in addition to using FP Form 1.

Challenges

While the project has provided significant technical assistance to all partners, the timeliness of reports, and completeness and quality of data are major challenges that have affected not only the quality and submission of substantive reports, but also advocacy works on the ground. MH addressed these challenges by: (i) imparting to LCEs and local health managers the benefits of DQC in LGU planning, implementation, monitoring and evaluation processes; (ii) capacitating the RHMs, FHAs and PHNs on DQC and mainstreaming the activity so that DQCs are conducted at least every quarter and cover most facilities under each municipality/city; (iii) supporting LGUs and facilities to better understand the DQC methodology via on-site coaching through MH LGU Advisors (LGUAs); (iv) engaging current non-reporting hospitals and private sector facilities to participate in DQCs; and (v) collaboration with the Zuellig Family Foundation (ZFF) which became an active proponent of DQC.

D. Family Planning Commodity Monitoring

Annual Stockout Report Average Commodities Baseline 2014 2015 2016 2017 2018 Stockout Rate N D % N D % N D % N D % N D % N D % Pills 220 974 23% 169 764 22% 8 764 1% 0 764 0% 10 737 1% 34 737 5% 6% DMPA 245 964 25% 89 764 12% 0 764 0% 1 764 0% 10 737 1% 12 737 2% 3% IUD 115 981 12% 21 764 3% 0 764 0% 1 764 0% 5 737 1% 4 737 1% 1% SDM Beads 88 764 12% 74 737 10% 125 737 17% 14% Condom 317 1023 31% 171 764 22% 3 764 0% 0 764 0% 5 737 1% 5 737 1% 5% Annual Stockout 24% 15% 0.4% 0.1% 3% 5% Rate

Analysis of Accomplishment

In the last five years of providing technical assistance to 737 SDPs avert stock-out of FP commodities from 2014 to 2018, the most common commodities that ran out of stock are SDM beads at 14%, Pills at 6%, and Condom at 5% though SDM beads was tracked only in the last two years of the project. The average stock - out rates of these commodities are above the

66 acceptable level of 3%. Reported stock-out of pills and condoms often occurred in the areas of Davao City, Bukidnon, and Tawi-Tawi while stock-out of SDM beads is pronounced in the provinces of Zamboanga del Sur, Zamboanga del Norte, and Lanao del Sur including Marawi City.

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. To date, there are 324 (88%) RHUs/CHOs use commodity tracking tools such as SMRS and simplified logistics management tool which strengthened the recording and reporting of consumption reports; b) effective inter-LGU and facility coordination and reporting mechanisms for immediate reallocation and redistribution of commodities in the event of over/under supply, near stock-out, and stock-out including expiring supplies; c) tracking of delivery of commodities by PHOs from DOH Central down to the facility; d) PHO, Popcom and DOH-RO coordination ensuring availability of buffer stocks at the regional offices. This coordination essentially makes up for an alert mechanism at the provincial and regional DOH to quickly identify SDPs with inventories breaching the buffer stock and enables to respond appropriately by linking them with regional and DOH Central FP logistics hotline; e) regular monitoring of DOH supervising pharmacist and support of FHAs at the municipal/city level; f) continuing advocacy to LGUs procurement of commodities to augment DOH supply

Table 3.0 Stock-Out Rate of FP Commodities in USG/MH-Assisted SDPs, in Q4PY6 Status for the Quarter, Q4PY6 Project Areas Baseline Acceptable Actual Level, 2018 Type Num Den* % Pills 13 457 2.8 DMPA 9 457 2.0 A. Priority Areas: Condom 5 457 1.1 (1) Non-CAA Areas Beads 68 457 14.9 Pills – 1% Pills – 2% IUD 4 457 0.9

(2) CAA Areas: Pills 9 96 9.4 DMPA – 0 (a) BaSulTa, Zambo DMPA – 1% DMPA 3 96 3.1

City, Cotabato City Beads 1 96 IUD – 1% IUD – 0% (b) Marawi &

Environs (Lanao Sur Condom Beads 39 90 1.0 Condom – & Lanao Norte) – 1% 1% Pills 8 94 8.5 B. Non-Priority Areas Beads – Beads 17 94 18.1 Beads – 3% 11% Pills 30 737 4.1 DMPA 12 737 1.6 Project-Wide Condom 5 737 0.7 IUD 4 737 0.5 Beads 125 737 17.0 * No. of SDPs in the priority clusters

The number of USG-MH-assisted SDPs that reported stock out of one or more FP commodities increased during the quarter by 40.4% from 99 in Q3PY6 to 139 in Q4PY6. Project-wide, the highest stock-out rate was of SDM beads at 17.0% followed by pills at 4.1%, then DMPA at 1.6%, condom at 0.7% and IUD at 0.5%. Except for condom, stock out rate for pills, DMPA, IUD and SDM beads is above the acceptable level.

About 42.1% of current user in Q3PY6 are pill-users. Proportion of pill-users has always been more than 40% of total mFP users. So, a stock-out on pills in an area will affect majority of mFP-users. Instead of switching to COC, pill users continue to use POP even if they are no longer lactating for the simple reason that they are used to it. This has been the pattern of use for many years and yet the FP commodities procurement plan failed to take this into consideration. In effect there is a relative “oversupply” of COC and a shortage of POP.

Stock-out of pills (POP) during the quarter was observed in Zamboanga del Sur (n = 26 SDPs since Q3), Zamboanga Sibugay (n = 8 SDPs since Q3), Davao City (n = 7 SDPs), Tawitawi (n = 9), and Davao del Sur (n = 3).

Stock out of DMPA was observed in Davao City (n = 4) and in Tawitawi (n = 3). In Tawitawi, pill and DMPA users make up 73% of mFP current users in the province. A stock of these two SARCs in 9 SDPs can cause a significant negative effect on the number of mFP current users in Q3 and Q4 of 2018.

Stock-out of SDM beads has been observed since Q2. The number of SDPs reporting stock-out of SDM beads has been increasing. Provinces reporting stock-out in SDM beads are Lanao del Sur (n = 39 since Q3PY6, 17 SDPs since Q2PY6), Zamboanga del Sur (n = 26 SDPs since Q3), Zamboanga del Norte (n = 25, 12 SDPs since Q3), Zamboanga Sibugay (n = 26 since Q3), Compostela Valley (n = 7 SDPs), Davao Oriental (n = 6) and Davao City (n = 2). DOH Regional Offices do not maintain a buffer stock of SDM beads. DOH – Central Office reportedly procures only 2,000 pieces of SDM beads annually. Project-wide the proportion of NFP-SDM users is only about 1%, and in some provinces/HUC it is even less than 1% like in Zamboanga del Sur (0.2%), Compostela Valley (0.4%), Lanao del Sur (0.6%) and Zamboanga Sibugay (n = 0.9%).

Deviation Narrative

Recommendations:

 HRH to seriously address capacities of DOH central staff to effectively and efficiently manage the national supply chain and logistics management system

 Review the current supply chain to immediately address the more than three months restocking/replenishment of commodities at the facility level. When a stock-out is reported to the Central office, the system ensures a 14 to 26-day turn-around but this is not happening.  Advocate with LGUs to assign a dedicated supply officer in the facility to manage commodities  Revive the CSR strategy in the LGUs to mitigate the impending impact on huge budget cut in FP commodities.  Regular procurement of commodities by regional DOH to ensure buffer stock  Assess performance of the 3rd Party Logistics (3PL) in the delivery and distribution of commodities to health facilities

Adolescent-Youth Reproductive Health Component Report

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

Table 6.0 Distribution of USG-MH-Assisted AYRH-Friendly Facilities by Priority Cluster, as of Q4PY6

Cummulative Accomplishment Target vs Accomplishment PY5 Hospb EOP Base PY6 RHU School Priority Cluster EOP Total (c) Target a line Hospital RHU School 2012 Hosp RHUs Sch. Target Accomp Target Accomp Target Accomp (A) Priority Areas: 5 26 7 7 3 4 6 6 12 30 6 48 (1) Non-CAA Sites (2) CAA Sites: 78 (a) BaSulTa, SDPs 1 2 27 28 1 30 31 ZamboCity; Cotabato City (b) Marawi & Environs (Lanao 3 1 1 1 1 1 4 4 Sur & Lanao Norte)

(B) Non-Priority Areas 2 4 12 3 3 1 3 22 5 7 34 46 Project-Wide 21 0 8 35 12 11 11 32 36 6 28 19 71 40 130 (a) SDPs include either hospitals, NGO clinics, RHUs, educationa institution LGUs (b) This number includes Davao Regional Medical Center located in Davao Province, a non-MH project area but serves as the end-referral hospital of Compostela Valley. This number also includes San Pedro Hospital a private hospital with TeenHub launched in PY6Q4 and offers only information, counselling and referral, and service for Natural Family Planning methods. (c ) Schools are included in the denominator because PIRS definition include a wide array of AY SDPs such as hospitals, NGO clinics, RHUs, educational instituitions providing either information, counseling , services and or referral

Analysis of Accomplishment

The project had surpassed its overall EOP target of 78 SDPs by accomplishing 166% or 130 facilities providing FP/RH services to adolescents-youth. The synergy of MH, DOH-ROs, LGUs and other agencies has led to expansion of AYRH in different settings, including i.e. 19 hospitals, 71 rural health units, 40 educational institutions, which has resulted to 64,869 varied FP-RH services including SRH information, risks screening, counseling and access to varied FP-SRH services, including mFP methods, and equipping youths with greater ability to manage their sexuality and fertility.

In Upi in Maguindanao, decreasing trend in teen pregnancy from 315 in 2015 to 171 cases in 2016, and 91 in 2017 has been attributed to the combined actions of MH-asssisted RHU Teen Center youth-friendly service and peer education program through its Upi Youth Governance Program. This trend is also noted in New Bataan in Compostela Valley with 18.9% teenage pregnancy rate among 10-19 y/o in 2015, and significantly reduced to 15.6% in 2016, which according to the MHO is highly attributed to the strengthened SRH campaign activities and youth-friendly service at AYRH clinic in the RHU facility.

AYRH-Friendly Hospitals

Of the 11 hospitals targeted for PY6, eight has already integrated AY services into FP service programs achieved in quarter 3, and in Quarter4, three hospitals namely: San Pedro Hospital’s TeenHub, and Compostela Vallley Provincial Hospital – Montevista’s Reproductive Health and Teen Clinic were formally launched to bolster their FP-RH services to young people, while Butuan Medical Center refined its FP-AY operations. With a baseline of 8 hospitals already assisted in PY5, and additional 11 achieved in PY6, the project had achieved 100% of the project’s overall target in transforming 19 hospitals into active providers of integrated FP and AYRH information, products and services.

MH assisted hospitals in drafting respective operational guidelines in addition to training of core teams of AYRH-providers. Partial reports from 17/19 hospitals revealed that an estimated 30,181 wide-ranging FP-RH services covering perinatal care (pre-natal care, delivery, post-natal care), FP services and products, management of STIs and VAWC were accessed by adolescents-youth in PY6 (refer to Table 6.1).

Table 6.1 FPRH Services Provided to AYs in AY-Friendly Hospitals, PY6 FP-RH Services (July –September 2018) 2018 FP/RH to AYs FP HEEA Name of Hospital Service Delivery 2017 Meth DSS Perinat V S Network ods risks al Care A FP to AY Jan- Apr- Jul- TI Guid W Baseline March Jun Sept an C (q2) (q3) (q4)

1) ZDZ-Margosatubig Regnl Hospital Cluster1 HZ 622 641 725 115 28 87 2) Dr. Justiniano R.Borja Hosptal 1,058 1,761 2,109 1,175 279 896 3) Maguindanao Provincial Hospital IranunClustr 195 141 281 4) Bukidnon PH-Maramag South LHZ 30 727 1,642 5) DavaoOriental 38 563 722 Prov’lMedicalCenter 6) Compostela Valley PH-Montevista CoMMMoNN 481 543 533 93 56 384 7) Sultan Kudarat Provincial Hospital BITES 4,498 2,077 2,065 8) Butuan Medical Center 1,020 9) San Pedro Hospital New in q4 10) Bunawan District Hospital 7 97 61 11) Gregorio T. Llutch Hospital 173 32 12) Agusan Del Norte Provl Hospital BueNasCar SDN 217 360 1,000 13) Southern Philippines Medical District3 SDN 302 411 826 Center 14) Brokenshire Memorial Hospital Davao City- 106 310 Wide 15) Davao Regional Medical Center Not

updted 16) Dr J.P Royeca Hospital 102 471 1,112 627 112 515 17) South Cotabato Provincial 1,363 1,124 2,016 1,570 332 1,238 Hospital

18) Cotabato Regional Medical Center Notupdte 2,350 d 19) Democrito O. Plaza Hospital DOPlaza HZ 306 266 227 TOTAL 844 1896 17,00 1280 9,017 9152 4020 (21% (47% 9 (32%) ) )

Drawn from observations in quarter 3, hospitals’ steady adoption of a holistic HEEADSS screening as a tool to identifying FP-RH risks contributed 35% in the dramatic increase in the services provided to AY clients. Available data from 5 hospitals, this trend persisted in Q4 with HEEADSS screening and guidance comprising 47% of FP-RH services provided to AY clients. However, notably there still a need to tighten demand generation mechanisms to narrow the gap between AYs provided with FP services which is 21% compared with the number of AYs seeking perinatal care in hospitals comprising 32% of total FP-RH services.

Sustained engagement with 19 hospitals remained focused on training of specialty physicians, nurses, and midwives in OB-Gyne, Pedia, FamMed assigned in different hospital units (OPD, ER, Wards, etc), improving FP-AY client demand generation and service delivery flow and protocols thru issuances of internal policy guidelines; and provision for use of job aid tools. All 19 hospitals underwent orientation, stock-taking, and action planning on FP and AYRH integration, followed- on with needs-based TA leading to the following milestones: 11 facilities have hospital orders in place; 8 hospitals, including i) ZDS-Margosatubig Regional Hospital; ii) J.R.Borja Hospital; iii) BukidnonPH-Maramag; iv) Gregorio TLlutch Hospital; v) Davao Oriental Medical Center-Mati; vi) ZamboSibugaybPH; vii) Compostela Valley PH-Montevista; and viii) SanPedroHospital trained on use HEEADSS risks assessment with job aids; Margosatubig Regional Hospital, 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” (Adolescent-Youth Unit for Development and Advancement) to further boost its services for AYs, awaiting completion of hospital renovation.

At present, AY clients are attended in its Women Reproductive Health (WRHC) Clinic; Sultan Kudarat Provincial Hospital firmed up its AY policy to be integrated with its policy of FP service delivery; Similar assistance extended to Dr. Jose Rizal Memorial Hospital in Zamboanga del Norte with FP-AY integration operational procedures; Hospitals including Bunawan District Hospital, D.O.Plaza Memorial Hospital, Agusan del Norte Provincial Hospital, and Davao Regional Medical

Center are already DOH certified as youth-friendly facilities; FP coordinators and IT personnel of all 19 hospitals were jointly trained on FP recording and reporting for hospitals using DOH standard recording-reporting tool; San Pedro Hospital’s TeenHub, Brokenshire Hospital’ strengthened FP-AY program, and Compostela Vallley Provincial Hospital – Montevista’s Reproductive Health and Teen Clinic formally launched during the quarter.

AYRH-Friendly RHUs/CHOs

FP-RH Services Services Provided to AY PY6 (Cummulative) Counselled Referred FP Service Region Province/City Service Delivery Point Male Female Male Female Male Female - PRIORITY AREAS R11 Davao City 1. CHO - Buhangin Health Center ------R11 Davao City 2. CHO - Calinan District ------R11 Davao City 3. CHO - District A T. Claudio 44 162 - - - 102 R11 Davao City 4. CHO - District C Mini-Forest 24 871 - 602 - 194 R11 Davao City 5. CHO - District D Jacinto - 31 - 31 - - R11 Davao City 6. CHO - Sasa Health Center 126 316 - 26 - 9 R11 Davao City 7. CHO - Talomo Central ------R11 Davao City 8. CHO - Bgy 21-C ------R11 Davao City 9. CHO - Toril District Health Center - 25 - - - 169 R12 Cotabato 10. RHU - Pres. Roxas - 18 - 5 - - R10 Bukidnon 11. RHU - Maramag, Bukidnon - 867 - 319 - 548 R10 Bukidnon 12. RHU - Pangantucan, Bukidnon - 207 - 59 - 148 R10 Bukidnon 13. RHU - San Fernando, Bukidnon - 577 - 252 - 323 ARMM Maguindanao 14. Upi RHU 1 104 - 36 - 55 ARMM Maguindanao 15. Buluan RHU ------ARMM Maguindanao 16. DatuPiang RHU ------R12 South 17. RHU - Polomolok ------Cotabato R12 South 18. RHU - Surallah Lying-In Clinic ------Cotabato

FP-RH Services Services Provided to AY PY6 (Cummulative) Counselled Referred FP Service Region Province/City Service Delivery Point Male Female Male Female Male Female R12 South 19. RHU - T'boli Lying-In Clinic - 209 - - - - Cotabato R12 South 20. RHU - Tupi Lying-In Clinic 53 145 - - - - Cotabato R11 Davao del Sur 21. RHU - Bansalan - 4 - 1 - - R11 Davao del Sur 22. RHU - Sta. Cruz - 140 - 17 - 82 R11 Compostela 23. RHU - New Bataan 228 399 - 138 3 1 Valley R09 Zamboanga 24. RHU - Lapuyan 3 2 3 - - - del Sur R09 Zamboanga 25. RHU - V. Sagun 3 5 3 1 - - del Sur R09 Zamboanga 26. RHU - Margosatubig 5 8 - - 2 2 del Sur R10 Misamis 27. RHU - Jasaan, Misamis Oriental 501 486 - 62 - - Oriental R10 Misamis 28. RHU - Tagoloan, Misamis Oriental ------Oriental R13 Agusan del 29. RHU - Rosario, Agusan Del Sur 157 237 45 91 41 105 Sur R13 Agusan del 30. RHU - San Francisco, Agusan Del Sur 216 477 6 186 16 210 Sur - Sub-Total for Non-CAA Priority Areas 1,361 5,290 57 1,826 62 1,948 ARMM Basilan 31. Maluso RHU 54 100 - 40 - - ARMM Basilan 32. Lamitan-East RHU - 122 - 88 - - ARMM Basilan 33. Lamitan-West RHU ------ARMM Sulu 34. Patikul RHU - 5 - 31 - - ARMM Sulu 35. Luuk RHU 150 244 - 54 - - ARMM Sulu 36. Pangutaran RHU 27 48 - 13 - - ARMM Sulu 37. Talipao RHU - 47 - 84 - - ARMM Sulu 38. Parang RHU 349 648 - 44 - 1 ARMM Sulu 39. Indanan RHU 507 757 1 38 112 748 ARMM Sulu 40. Panamao RHU 68 114 - - - - ARMM Sulu 41. Jolo RHU ------ARMM Tawi-Tawi 42. Bongao RHU - 354 - 233 - - R09 Zamboanga 43. DHO - Ayala Main Health Center And 75 157 - 34 26 80 City Lying-In R09 Zamboanga 44. DHO - Baliwasan Main Health Center 16 168 - 32 10 15 City And Lying-In R09 Zamboanga 45. DHO - Calarian Main Health Center And 31 43 - 41 8 9 City Lying-In R09 Zamboanga 46. DHO - Canelar Main Health Center And 39 34 - 35 19 10 City Lying-In R09 Zamboanga 47. DHO - Curuan Main Health Center And 85 98 - 24 45 58 City Lying-In R09 Zamboanga 48. DHO - Guiwan Main Health Center And 29 33 - 42 - - City Lying-In R09 Zamboanga 49. DHO - Labuan Main Health Center And 15 25 - 15 12 22 City Lying-In

FP-RH Services Services Provided to AY PY6 (Cummulative) Counselled Referred FP Service Region Province/City Service Delivery Point Male Female Male Female Male Female R09 Zamboanga 50. DHO- Manicahan Main Health Center 5 10 - 44 - 2 City And Lying-In R09 Zamboanga 51. DHO - Mercedes Main Health Center 46 47 - 36 33 33 City And Lying-In R09 Zamboanga 52. DHO - Sangali Main Health Center And 38 221 - 24 - 3 City Lying-In R09 Zamboanga 53. DHO - Sta Catalina Main Health Center 15 15 - 19 - - City And Lying-In R09 Zamboanga 54. DHO - Doña Isabel Climaco Sta Maria 40 79 - 17 8 34 City Main Health Center And Lying-In R09 Zamboanga 55. DHO - Talon-Talon Main Health Center 86 141 - 18 - - City And Lying-In R09 Zamboanga 56. DHO - Tetuan Main Health Center And 18 18 - 10 13 13 City Lying-In R09 Zamboanga 57. DHO - Tumaga Main Health Center And 65 139 - 30 8 8 City Lying - In R09 Zamboanga 58. DHO - Vitali Main Health Center And 33 71 - 45 3 43 City Lying-In R12 Cotabato City 59. Bhs - Poblacion Mother, Cotabato City - 47 - 17 - 23 R12 Cotabato City 60. Bhs - Rosary Heights Mother ------Sub-Total for CAA (a): BaSulTa + 3 CAA Cities 1,791 3,785 1 1,108 297 1,102 (Zamboanga, Cotabato, Isabela) ARMM Lanao del Sur 61. Bubong RHU ------R10 Lanao del 62. RHU - Baroy, Lanao Del Norte 1 115 12 94 - 12 Norte R10 Lanao del 63. RHU - Kapatagan, Lanao Del Norte 51 113 8 250 - - Norte R10 Lanao del 64. RHU - Kolambugan, Lanao Del Norte - 59 - 46 - 1 Norte - Sub-Total for CAA (b): Marawi & its Corridors 52 287 20 390 - 13 - NON-PRIORITY AREAS R09 Zamboanga 65. RHU - Ipil Main Health Center And Lying - 65 - 105 - 13 Sibugay - In R09 Zamboanga 66. RHU - Buug Main Health Center And - 93 - 56 - - Sibugay Lying - In R12 General 67. RHU - Bula Community Lying-In Center, ------Santos City Gsc R12 General 68. RHU - Calumpang, Gsc ------Santos City R12 General 69. CHO -Fatima ------Santos City R13 Agusan del 70. RHU - Remedios T. Romualdez 13 173 8 103 13 84 Norte R13 Agusan del 71. RHU - Buenavista ------Norte - Sub-Total for Non-Priority Areas 13 331 8 264 13 97 - - Over All 3,217 9,693 86 3,588 372 3,160

TOTAL

Largely accessible to AYs, MH’ sustained engagement with 71 RHUs focused on assisting them meet the minimum youth-friendly facility criteria of having trained providers on DOH- Adolescent Job Aid protocol, use of HEEADSS risks screening, development of client-provider interaction guidelines, and use of job aids such as HEEADSS forms, daily recording logbook, signage, which resulted in the following milestones:

– 34 assisted RHUs merited DOH certification as Level 1 Youth-friendly facilities, including: 16 RHUs of Zamboanga City; 9 DHOs of Davao City, NewBataan RHU in Compotela Valley, 2 RHUs in Agusan del Sur-namely: San Francisco RHU, and Rosario RHU; 3 RHUs in Maguindanao, including Upi, Buluan and Datu Piang; 2 RHUs of Lamitan City, namely: RHU Lamitan-East. and Lamitan-West RHU; RHU President Roxas in NorthCotabato. – TA to LGU of Lamitan City and City Health Office on youth-friendly RHUs, the LGU was selected and presented during the quarter as among finalists in Galing Pook award, a respected award giving body in the Philippines that searches and recognizes innovative practices of local government units. LGUs with outstanding initiatives are carefully selected and winners are recognized in a very prestigious awarding ceremony. – 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 6/27 RHUs as AY friendly facilities, including: Salug RHU, Katipunan RHU, Dapitan CHO, Dipolog CHO, Godod RHU and Manukan RHU, and Polanco RHU and Lying-in. – Zamboanga Sibugay, aside from Ipil and Buug, MH with PHO also assisted 3 RHUs of Olutangga, Talusan, and Mabuhay, belonging to 4th-5th class municipalities in Zamboanga Sibugay received training of health providers on DOH-AJA protocol and now working towards meeting minimum criteria for youth-friendly facility.

AYRH-Friendly Schools

Backed-up with core teams of trained school providers composed of guidance designates and health&nutrition nurses, guidelines, and SRH messaging, the DepEd-Division of Agusan del Norte has expanded YOLO (Youth Optimizing Life Opportunities) to 34 schools in PY6 from 12 initial schools in PY5. YOLO had reached a total of 6,015 learners with SRH information thru Province Wide Campaign on STI-HIV/AIDS, Teenage Pregnancy and Lifestyle Diseases Prevention; and reached 35% or 6,856 of the total 19,621 population enrolled in 34 covered schools with psychosocial risks assessment and guidance using the Rapid HEADDSS (refer to Table 6.3). PY6 cummulative data showed that bullying topped among the risks detected at (25%); followed by involvement in romantic relationaships at 20% putting young people at risk of early exposure to physical intimacy which may lead to teen pregnancy. Problems at home are notably high with 16% of youths had thoughts of running away from home, and a sizeable 12% experiencing domestic violence. Ten percent of youths have ideation of committing suicide, while 15.6% comprised issues on substance use and abuse (smoking, alcoholic drinking, drug use). Twenty- one percent were followed up for counseling, and 42 were referred for various conditions, including 7 referrals due to pregnancy. ADN DepEd, with R13-POPCOM and DOH-CHD13

started its work in forging patnerships with different health and non-health stakeholder groups to strengthen its referral network through integrated service delivery network or ISDN for adolescents-youth.

Table 6.3 Distribution of Learners Assessed Using HEEADSS by Psycho-social Risks Detected, Dep-Ed Division of Agusan del Norte, PY6 Risks Identified* Number of

AY Home Home Suicidal Environme Alcohol Drug Smoking Sexuality Reporting Assessed Thought Violence thoughts nt -Bullying drinking exposure Period with Rapid of Referred HEEADSS running away June 2017- 5,670 21 1,604 1,216 1,000 2,547 702 616 324 1,960 Mar2018** Apr to Jun18 99 20 11 12 12 4 4 4 11 July to 1,087 1 386 249 296 589 135 114 53 512 August Total 6856 42 2,001 1,477 1,296 3148 841 734 381 2483 (0.3%) (16%) (12%) (10.4%) (25%) (6.7%) (5.9%) (3%) (20%) * - Some learners have more than one psycho-social risks (12,403) **- Data source from Annual Implementation Report of DepEd-Division of Agusan del Norte YOLO program, June 2017- March 2018

In Zamboanga Del Sur, MH extended similar TAs to six schools, i.e. 3 senior high schools of Margosatubig, Lapuyan and V. Sagun and 3 J.H Cerilles Colleges-all within District 2 SDN with Margosatubig Regional Hospital-Center for Teens as apical referral SDP. Available data showed 32 AY clients referred to outside facilities.

#SoMe4AYRH (Social Media for AYRH) According to 2013 YAFS4 survey, Facebook remains the most used social media by more than three-quarters (80.3%) of youths using the Internet for social networking. The Project’s technical assistance to six partner agencies/institutions2 implementing programs on Adolescent-Youth Health with significant result:

2 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

. Four of six assisted agencies/institutions’ social media platforms, 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, and Brokenshire Hospital “Program 4 Teens” were formally launched. . MH document #SOME4AYRH: A Guide in Using Social Media & Social Networking Sites for AYRH Advocacy was presented as one among the different technical products presented during the joint WHO, KOICA or the Korea International Cooperation Agency, and MindanaoHealth Region 11 dissemination forum.

June 28-July 22 (after the launch) – Organic Data QUALIFIERS Target ADN-DepEd ADNPH PopCom XIII TeenTalk (After 3 Division Davao months) YOLO Page Page Use A new page More focused messages on More AY- Focus on was created teenage pregnancy, focused through STI- dedicated for motherhood and family their HIV and the the campaign planning options #CaragaTeens Millennials Campaign Reached The number of 300% (of 4,291 (429.1%) 256 (492%) Cannot be 3,492 (367%) people who had the measured any posts from number of in groups page Page enter followers their screen. Engagement Post The number of 80% of the 621 (806.4%) 59 (113%) Cannot be 589 (61.9%) Engagements times people have total measured engaged with the number of in groups posts through likes, followers comments and shares and more. Post/Day Number of posts 1 0.5 0.4 0.4 0.8 per day

Deviation Narrative

MNCHN/FP Service Delivery Component Report

Background:

In 2013, USAID issued Cooperative Agreement No. AID-492-A-13-00005 with an overall strategy of “Family Health Improved” and has awarded Jhpiego to provide support in maternal, neonatal, child health nutrition and family planning (MNCHN/FP) based on the familiarity of the health situation and application of the “already proven best practices” that result in better MCH outcomes with the main objective of supply services being improved, including the availability and quality of the public sector services and selective expansion of the private sector as primary care supplier. This will be done through an integrated approach of developing and increasing competent service providers on MNCHN/FP. These approaches need to be anchored within the context of poverty reduction, devolution of health services, reforms on social health insurance, public-private provision of services and sector-wide development approaches.

In the initial years, there was a realization to address the unmet need for FRP/MNCHN in Mindanao with its low utilization and the contraceptive prevalence rate (CPR) for the country remaining low at 36.9% (FHS 2011), four antenatal care visits at 78.1 %, birth deliveries by SBAs at 72.2 while only 55.2 % were delivered in health facilities. The supply side of FP was met with a long standing neglect for LAPM and NFP services, unstable supply of FP commodities, missed opportunities and lack of FP services for adolescents. While on MNCHN, there was inadequate trained providers and slow functionality of a service delivery network (SDN) in Mindanao.

While awaiting the final national demographic health survey (NDHS) 2013 results, a TNS survey through Jean Grey Project was commissioned to provide information on the access to public health and services, determine health determinants and provide basis for yearly track on FP, MCH, TB and its variations together with a baseline study on the service delivery points (SDPs) that have been in existence for both the private and public sectors.

While facing a lot of challenges on security concerns in Mindanao, especially in conflict-affected areas (CAAs) and the areas in ARMM, MindanaoHealth and its partners developed stronger affiliations and ties with regional and local implementers in pursuing the need for services in the villages, pockets of areas or the geographically isolated and disadvantaged areas (GIDAs) in Mindanao. In May 2017, Martial Law was declared in Mindanao to respond to the community- based organizing work, ground working and establishment of an Islamic State in Marawi City and its corridors.

After five (5) years of project implementation, the performances on FP indicators showed that contraceptive use has slightly decreased for the country from 55.1 to 54.3 percent, the modern CPR for the country slightly increased from 38.0 to 40.0 percent but with significant leap in all Mindanao regions. The comparative data on FP showed that all Mindanao regions have an increasing CPR from the baseline (2013) to NDHS 2017. The increased CPRs for any methods (from 2013 to 2017) showed highest performance in Davao Region at 62.2 (from 53.8), followed by SOCCSKSARGEN at 58.9 (from 57.5), Caraga (from 54.2 to 54.8), Northern Mindanao (from 50.7 to 53.5) and in the Autonomous Region of Muslim Mindanao (ARMM) at 26.3 (from 23.9) percent.

For Mindanao, the MCH indicators have been improving in a period of 5 years from 2013 to 2017 with the collective efforts of the Department of Health (DOH) and the local government units (LGUs) to meet the millennium development goal (MDG) 2015 targets on at least 4 antenatal care (ANC) visits. This ANC visits was noted to be highest in Northern Mindanao at 92.4 and ARMM got 47.4 while the country’s average was at 86.5. Then, the deliveries attended by skilled birth attendants (SBAs) with the highest recorded at 82.0 in 2017 (from 67.7) for Davao Region and ARMM at 33.6 from 20.4 percent in 2013 (national average at 84.4 from 72.8 in 2013). The facility- based deliveries also showed the highest improvements in Caraga region at 77.2 (from 55.5 in 2013) and ARMM at 28.4 from 12.3 in 2013 (national at 77.7 in 2017 from 61.1 in 2013). Finally, the percentage of women with a postnatal check during first 2 days after birth (postpartum services) showed highest in Davao at 90.6 from 73.0 in 2013 and in ARMM at 63.6 percent from 20.4 in 2013 (national at 86.1 in 2017 from 72.0 in 2013).

Despite these efforts and results, however, the challenges remain. While the unmet need for modern FP being reduced in the ARMM, four (4) other regions (i.e., Northern Mindanao at 27.8, Zamboanga Peninsula at 24.6, SOCCSKSARGEN at 17.5 and Caraga Region at 17.5) have an increasing unmet need for modern FP than the national average of 16.7. Furthermore, the adolescent and youth situation has shown a percentage of 15-19 year old who started childbearing at an early age have tremendously increased in at least the three (3) regions of Davao at 17.9, Northern Mindanao at 14.7 and SOCCSKARGEN at 14.5 as compared to the national average of 8.6.

Apart from this project directly attributing to increases in CPR, the mandated tracking of couple of years protection (CYP) also helped the project focus its limited resources on investing on the modern FP methods that would yield more CYP equivalent while providing more options to potential clients with government and private sector partners that respect the informed choice and voluntarism (ICV) principles.

For the extension year, the USG-assisted areas have been divided to 12 priority areas of Davao City, Zamboanga del Sur, Zamboanga del Norte, Bukidnon, Maguindanao, Misamis Oriental, Davao del Sur, Compostela Valley, North Cotabato, South Cotabato, Sultan Kudarat and Agusan del Sur; the conflict-affected areas (CAAs) with Marawi City; and the non-priority areas of Cagayan de Oro City, General Santos City, Zamboanga Sibugay, Davao Oriental and Agusan del Norte.

At the start of the project, MindanaoHealth started with the performances of its regions based on a logical framework (Log frame). Along the way, the implementation of the framework was affected by the changes of its targets and additional indicators in February 15, 2015 that were asked by and agreed by the project representatives with the major donor. Thus, meetings, agreements and adjustments were made along the process using the performance indicator reference sheets (PIRS) that defined or described the key output and outcome indicators, unit of measures, plans for data collection, data quality issues and its baseline and expected targets or deliverables and changes to the indicator during the remaining project cycles. The PIRS underwent several revisions.

The PIRS defined 33 indicators distributed as 15 indicators for family planning (FP), 11 for maternal and child health (MCH) and 7 more specifics deliverables for the conflict-affected areas (CAAs). Critical to supply side strengthening were the number of current users (FP1), the Couple of Years Protection or CYP (FP2), percent of service delivery points (SDPs) providing FP counseling and services to couples, men, women, youth and adolescents of both sexes in USG sites (FP4), percent of SDPs providing sub-dermal implants (FP10), percent of SDPs providing postpartum IUD services (FP11), percent of SDPs providing voluntary surgical sterilization (VSS) services (FP12), number of health providers trained on FP/RH with USG finds per type of training (FP13), number of postpartum women provided with FP counseling and services. (FP18).

And for the MCH program, the number of deliveries with a skilled birth attendant in USG programs (MCH1), percent of trained health providers correctly practicing essential intra-partum newborn care (EINC) protocol (MCH2) and the number of women reached with individual or small group education of exclusive breastfeeding (MCH3). In terms of conflict-affected areas, the indicators on number of health outreach conducted (CAA1) and the number of clients reached during health outreach activities (CAA4).

In the last year of project implementation, two (2) more indicators were added: Number of women giving birth who received uterotonics in the third stage of labor (HL 6.2.1) and the number of newborns not breathing at birth who were resuscitated in USG-supported program (N14). Accomplishments by LGU per indicators are already captured under 7.4 (Summary of Accomplishments per Province/Highly Urbanized City).

IV-1.Building Capacities to Do Outreach Services

Rationale:

Guided by the subcomponent of improving capacity of health care providers in FP counseling and service provision, the DOH, LGU partners and MindanaoHealth embarked on in-service training for midwives on basic FP and capacitating service providers (public and private) on interval and postpartum family planning. Expanding services to deploy itinerant teams were already emphasized in the initial years of engagements and integrated approaches during prenatal, postpartum and well –child visits became an evolving pattern in Mindanao.

Men, adolescents and youth were tapped for their involvement and the private sector participation through referral systems have to be restored. There has been a need to strengthen communication, joint scheduling, transportation and follow-up arrangements through DOH and/or LGU taking leadership roles in a service delivery networks (SDNs).

Addressing the unmet need for limiting already paused a challenge for Davao region, SOCCSKSARGEN and the rest of the regions in Mindanao. Thus, a more creative and logical approaches have been advocated to DOH, LGU and other critical partners.

Building capacities to do outreach services through the years:

Starting in June 2013, a team of providers was met, expectations were leveled off and partnerships organized by the DOH-Regional Office and Local Government Unit (LGU) partners and MindanaoHealth to respond to the aftermath of typhoon Pablo that hit Davao Oriental. More than 60 clients underwent final screening and more than 40 clients successfully underwent BTL/MLLA in Cateel District Hospital. With the approval of then Asec. Romulo Busuego, another schedule and set of clients underwent BTL/ MLLA in the RHU-Baganga. This initial gain on addressing unmet need for modern FP paved the way to subsequent engagements of the private sector partners to push through the plans of addressing unmet need on limiting for the rest of Davao Region, in SOCCSKSARGEN, Caraga and Northern Mindanao who have been underserved and residing in geographically isolated and disadvantaged areas (GIDAs).

Initially, the public sector partners have difficulties arranging services that have to be rendered outside the comforts of their assigned facilities. This reluctance became a huge challenge for health partners in Mindanao. Until the 3rd year of the project, Mindanao partners depended much on outreach services to gain accomplishments on meeting the unmet need especially on limiting. These were mostly performed and complemented by the private sector providers.

With the realization that these private practices could not be sustained, Mindanao partners invested much on capacitating the public sector providers who could initially provide fixed services, especially on BTL/MLLA, the PPFP through IUDs and LARC/PSI. These public sector partners have been highly expected to also extend or perform outreach or form itinerant team from their fixed services. More trainees [FP 13 and MCH 8] were capacitated, being realized and being led by DOH and LGU partners for FCBT 1 (counseling and short-acting methods), FCBT 2 and subsequently with MindanaoHealth’s assistance for the LARC/PSI, and the BTL through MLLA.

The same summarized report also showed that MindanaoHealth assisted clients and contributed to the FHSIS consolidated report from a very low 15% in Q4PY3 to as high as 57% in Q3PY4 and just recently at 42% in the second (2nd) quarter alone of year 6.

In year 3 (Oct. 2014 to Sept. 2015), MindanaoHealth and its partners contributed to the defined roles and total gains/ contributions of the private sector in conducting outreach services. At this time, it has been observed that the largest contributors to current users (CU) on family planning (FP) include SOCCKSARGEN, Northern Mindanao, Davao and Zamboanga Peninsula. It was also noted that Northern Mindanao and Davao regions have contributed the most to the region’s Couple Years of Protection (CYP) accomplishments. In PY3, the number of clients served as shown in Table 1.3 already reached the cumulative total of LAPM+ clients through project-assisted activities with an outreach contribution that reached a total of 8,301 clients corresponding to a combined CYP equivalent of 55,198 or 44.6% of the PY4 target.

The surge was later affected with the reduction of activities related to the TRO on LARC/PSI for the public sector that reduced performance in year 4. With the strong cooperation of the private sector, the outreach performances regained its year 3 marks and even surpassed this in year 5

84 with 11,026 clients served during outreach. In the first half of the last year, the outreach activities already listed 13,642 clients.

Monitoring the outreach and fixed services

Although needing more time to sustain the introduction in the last few months of project implementation, MindanaoHealth introduced a Data Entry/Editing system for Outreach Services in each province, municipality and service delivery points (SDPs), and show breakdown of clients provided FP services by method. For Fixed Services, a provider code was also assigned to simplify tracking of individual trainee’s performance, identify those needing clients for referral to clinical practice/mentoring sites.

IV-2. Building Capacities on Fixed Services:

Establishing FP Program in 18 Hospitals

Rationale:

Initially, around 4 DOH-retained hospitals (ZCMC, SPMC, DRMC, CRMC) were assisted through MCHIP Project as Centers of Excellence on PPFP. These were carried over by MindanaoHealth Project with Jhpiego expanding to one more DOH-retained hospital (NMMC). The initial years proved that these hospitals could go beyond building their capacities on service provision but strengthening their faculties since most of these were Obstetrics-Gynecology Residency Training Programs. In areas that were short of DOH-retained assistance, the LGUs of South Cotabato took the leadership on PPFP/PPIUD. This eventually blossomed to include other LGU-managed hospitals that led to a total of 13 hospitals that were eventually assisted in year 4. In the last year, MindanaoHealth/Jhpiego expanded its TA to another 5 hospitals giving a total of 18 hospitals. In addition to building their capacity on wide range of FP services, demand generation within an enabling policy environment, all were re-oriented on DOH-required recording and reporting systems in hospitals.

The MindanaoHealth’s assistance with Jhpiego and MCHIP on core TA packages particularly on PPIUD and LARC/ PSI resulted to significant expansions in service delivery points (SDPs) and provision of new and broader modern FP options.

The need to invest on PPFP in birthing facilities

Ideally, all birthing facilities (hospitals, infirmaries and birthing clinics) should be able to identify, counsel and capture those who just delivered to be modern FP acceptors before their departure from these facilities. The 2001 studies have shown that Ross and Winfrey have documented that in this country around 95 % of women who just delivered would not want to be pregnant within 2 years while as much as 70 % are not using any modern FP methods.

The series of performances on fixed services showed an increasing but stable trend from a total of these methods in year 3 at 14,382 clients to as high as 20,166 in year 5 and a partial (half-year)

85 report of 11,256 in year 6. It has to be noted that fixed and hospital-based contributions could augment performances in meeting the CYP requirements.

The evolution of FP/MCH and AYRH integration in hospitals

Capacity building activities on bilateral tubal ligation through mini-laparotomy (BTL/MLLA) and postpartum intrauterine devices (PPIUD) other than short acting methods have been initiated and ongoing. Good performing, enthusiastic and potential providers were later on invited to become trainers. These started to bear fruits in the pioneering hospitals, while most of these facilities were oriented on the provisions of integrating FP in hospitals per DOH Memorandum 0312. Subsequently, the hospitals capacitated their own staff, while issuance of the hospital order was partially affected with the finalization of Operational Guides.

MindanaoHealth assisted partners by hiring consultants for short-term engagements (STTAs) in service provision and capacitating activities. However, the journey to produce operational guide was stalled in pioneering hospitals such as the Northern Mindanao Medical Center (NMMC) that need reconciliation with the International Standard Organizations (ISO) requirements. Most of the difficulties centered on not allowing partners to share their accomplishment reports, not to share the demand generation activities in the hospitals and taking all the initiatives as their own in this facility.

In the second year, the supply side indicators for maternal and child health (MCH) programs show a general above par performance with its agreed training targets on maternal, child health care (MCH) that were mostly achieved. The related capacity building, a similar positive trend can also be noted for training related indicators [MCH 8]. New training activities particularly essential intra- partum newborn care (EINC) with Kalusugang Mag-ina Fondation, the basic emergency obstetrics and newborn care (BEMONC) with DOH and LGUs and lactation management training (LMT) were included. Interventions aimed at increasing facilities with Mother Baby-Friendly Initiatives [MCH 10] have not taken off as planned, still facing a lot of challenges, as the DOH-ROs are yet to agree and initiate the process of re-certification at the national level.

Eventually, DOH decided to pursue BEmONC rather than invest much on EINC in subsequent years.

On Hospital Recording and Reporting Systems

Evolution of DOH-prescribed recording and reporting system in hospitals

While several attempts were made in improving the recording and reporting system of hospitals through the DOH Memorandum 0312, it was only in November 2017 that the FP and AYRH integration started to take shape in Mindanao when DOH-retained hospitals were convened in Luzon and a Northern Mindanao orientation was requested by DOH and done for more than twenty (20) hospitals in the region. At the start, MindanaoHealth already used a monitoring tool to capture hospital data and reporting system that disaggregated age groups among modern FP clients being served and the number of deliveries in a monthly or quarterly basis (i.e., 10-14, 15- 19, 20-24 and 25-49 years of age). The monitoring assessment tool helped out partners fill up

86 their accomplishments, determine how much rooms for improvement were needed in integrating FP and AYRH implementation in hospitals.

The Collaborative, Learning and Adapting (CLA) processes:

LuzonHealth/RTI international invited the key staff of MindanaoHealth on the processes that they went through with their regional and local partners. The CLA process proved to be very useful in Mindanao. Thus, MindanaoHealth attendees decided to push for the orientation in three (3) batches with a follow-up per facility and/or in clusters. The plan was initiated in Manila but was shelved when members of the senior management did not agree as one to the methodologies that should be adapted for Mindanao-based hospitals. Despite this major stumbling block, the specialists, ATTLs and LGUAs proceeded to conduct the orientation and appraise their own LGU advisers to do the same to partners (i.e., coach and mentor in filling up the FP Form 1, the M1 and A1 forms) that shall be submitted centrally for recording purposes.

In May 2018, around 18 hospitals benefited from the orientation process on using the DOH- approved recording and reporting system of hospitals that are matched with the Field Health Service Information System (FHSIS). There is therefore a need to DOH-retained hospitals to take the lead in recording and reporting their performance electronically.

IV-1.c.2a. Recording/Reporting for 2017 Performance:

Based on the 2017 data as shown in Table 1.4A, three (3) hospitals (i.e., Zamboanga Sibugay Peninsula Hospital, Margosatubig Regional Hospital and Agusan del Sur Provincial Hospital (ADSPH) reported an increased number of clients who were served with postpartum family planning (PPFP). Thus, MindanaoHealth recommends a review of the entries in these hospitals since there are possibilities that postpartum women and those who received the procedures on interval basis were mixed.

The performance on PPFP ranged from high performance of Agusan del Norte PH (at 95 percent), followed by Cotabato Regional Medical Center (CRMC) at 79 percent, then JR Borja Memorial Medical Center (JRBMMC) at 60 percent and followed by South Cotabato Provincial Hospital (SCPH) at 48 percent and George Royeca Memorial Hospital (GRMH) of Gen. Santos City also at 48 percent. All these hospitals need to be studied how they were able to perform high in addressing the unmet need among postpartum women.

On the lower end, the Compostela Valley Provincial Hospital in Monte vista (CVPH-M) at 5 percent and the Zamboanga del Norte Medical Center (ZDNMC), a late entry at 9 percent, also need to double their efforts in capacitating their staff in providing other modern FP methods especially those that could easily address PPFP. The Davao del Sur Provincial Hospital (DDSPH) at 11 percent, the North Cotabato Provincial Hospital (NCPH) also at 11 percent and the Davao Oriental Provincial Hospital in Mati City at 12 percent need to review the capacity of their staff in providing integrated and postpartum FP services.

BPH Maramag has just started the integration of FP services in the hospital with 16 percent performance in 2017 data. Although LAPM services are provided regularly by the HSPs trained by the project in partnership with DOH particularly on BTL MLLA and PPIUD, there was no system established yet prior to the project’s assistance or TA on FP-MCH-AY integration in the hospital last December 2017. BPH Maramag was identified as the end referral facility among the 10 LGUs of Southern Bukidnon’s SDN.

Table 1.4A. Selected Mindanao Hospitals with FP Integration and Data Disagregation for 2017 (Source: MH One Drive) 2017 No. PROVINCIAL HOSPITALS Total FP Total Unmet Number Percent Number Percent Total Number TOTAL Percent of acceptors Deliveries need for of PPIUD share of of PP- share of PPIUD+BTL of POP PPFP reduction PPFP (95% Clients PPIUD BTL BTL Clients clients of unmet of 70%) Clients need for 1 Zamboanga Sibugay PH 2 66 2 24 1 49 196 74% 70 26% 2 66 0 266 PPFP179% 2 Margosatubig Regional Hospi 1 ,260 1 ,518 1 ,009 557 44% 20 2% 5 77 713 1,290 128% 3 Zamboanga del Sur Medical Center 1 ,078 3 ,868 2 ,572 750 70% 256 24% 1,006 0 1,006 39% 4 Zamboanga del NORTE MC 3 25 3 ,977 2 ,645 0 0% 127 39% 1 27 113 240 9% 5 Bukidnon PH-Maramag 4 58 4 ,269 2 ,839 37 8% 411 90% 4 48 0 448 16% 6 Northern Mindanao Medical Center 1 ,663 6 ,816 4 ,533 975 59% 316 19% 1,291 1,291 28% 7 JR Borja Medical Center 2 ,382 6 ,779 4 ,508 2,054 86% 613 26% 2,667 28 2,695 60% 8 Gregorio T. Lluch Medical Center 3 46 4 ,894 3 ,255 58 17% 288 83% 3 46 187 533 16% 9 Southern Philippines Medical Center 1 ,093 1 6,991 11,299 475 43% 174 16% 6 49 185 834 7% 10 Davao Regional Medical Center 1 ,477 65 4% 39 3% 1 04 903 1,007 #DIV/0! 11 Compostela Valley PH-Montevista 7 67 4 ,254 2 ,829 0 0% 57 7% 5 7 90 147 5% 12 Davao del Sur PH-Digos 1 55 2 ,091 1 ,391 73 47% 82 53% 1 55 0 155 11% 13 Davao Oriental-Mati City 3 19 3 ,717 2 ,472 0 0% 263 82% 2 63 28 291 12% 14 North Cotabato PH 2 25 3 ,099 2 ,061 18 8% 207 92% 2 25 0 225 11% 15 SOUTH COTABATO PH 2 ,999 3 ,439 2 ,287 854 28% 238 8% 1,092 1,092 48% 16 Sultan Kudarat PH 3 75 2 ,220 1 ,476 194 52% 141 38% 3 35 335 23% 17 Jorge Royeca Memorial Hospital-GS City 9 98 3 ,099 2 ,061 486 49% 512 51% 9 98 0 998 48% 18 Cotabato Regional Medical Center 4 ,290 6 ,356 4 ,227 2127 50% 859 20% 2,986 354 3,340 79% 19 Agusan del Sur PH 1 ,429 6 65 4 42 173 12% 435 30% 6 08 0 608 137% 20 Agusan del Norte PH 3 ,339 2 ,467 1 ,641 897 27% 664 20% 1,561 0 1,561 95% 21 Maguindanao Provincial Hospital 2 92 - 6 2% 0% 6 6 #DIV/0!

IV-1.c.2b. On Developing the Hospital Reporting Systems in 2018

The hospital performance should be computed from those who desire not to be pregnant but are not using any modern FP method (Ross 2001) should be computed against the actual performance on postpartum family planning (PPFP). It has to be noted that the World Health Organization’s Medical Eligibility Criteria (WHO-MEC) already recommended in 2015 that not only ligation and IUD, the intra-uterine system, progestin only implant and the progestin only pills (POP) could be given and tracked within 48 hours after delivery. In table 1.4B, the computation per hospitals that initiated this process could be shown.

On the quarter of January to March of 2018 As continuing processes for the first quarter of 2018, the recording and reporting of performances should continue to be tracked and compared. As shown in Table 1.4B, two of the twelve (12) hospitals (i.e., Maguindanao Provincial Hospital and the Margosatubig Regional Hospital), need to be reviewed again for its possible report of including interval procedures and clients. In these 2 hospitals, the number of deliveries has been noted to be less compared to the actual performances on modern FP.

Having made available and shared their data, this report showed that the performances in 12 hospitals ranged from a high achievement of 86 percent in GT Lluch Memorial Hospital (GTLMH) in Iligan City, followed by JR BOrja Memorial Medical Center (DJRBMH) in Cagayan de Oro and South Cotabato Provincial Hospital (SCPH) at 61 percent to low performances at 12 percent

reduction of unmet need in Bukidnon Provincial Hospital (BPH) in Maramag, followed with 22% in Dr. Jorge Royeca Memorial Hospital (DJRMH) of Gen. Santos City.

Table 1.4B. Percent reduction of unmet need in hospitals with deliveries through PPFP, Qtr 1 of 2018 January to March Quarter of 2018 NO Priority Number Number Total Number TOTAL FP Deliveries Estimated Percent . Hospitals of PPIUD of BTL PPIUD of POP Q2 Unmet reduction of for 2018 Clients Clients and BTL clients Need for umet need (Q2) (Q2) Clients PPFP 1 MRH 153 14 167 189 356 436 290 123% 2 ZDSMC 153 53 206 18 224 771 513 44% 3 BPH-M 1 85 86 0 86 1052 700 12% 4 SCPH 155 55 210 0 210 515 342 61% 5 DRMC 147 152 299 257 556 0 - #DIV/0! 6 ADSPH 47 96 143 23 166 923 614 27% 7 MPH-SA 15 45 60 19 79 91 61 131% 8 ZDSMC 123 0 123 0 123 771 513 24% 9 DJRBMH 409 0 409 0 409 894 595 69% 10 GTLMH 51 54 105 19 124 218 145 86% 11 DJRMH 47 86 133 0 133 894 595 22% 12 ADNPH 33 64 97 0 97 639 425 23%

In Bukidnon Provincial Hospital (BPH) of Maramag, the result of the workshop, the hospital will start implementing the use of the HFP client card, client record and hospital M1 form. Although BPH Maramag was just been recently trained on FP hospital recording and reporting, the hospital has been already practicing the use of the standard DOH’s target client list (TCL) since September 2016 and is regularly reporting to the RHU of Maramag.

In the quarter of April-June of 2018 Finally, the series of monitoring and updating led to only few six (6) hospitals reporting their data of accomplishments on the third quarter of 2018. In Table 1.4D, the data show an improved performance of Margosatubig Regional Hospital at 97 percent, followed by Zamboanga del Sur Medical Center (ZDSMC) at 80 percent and GT Lluch Memorial Medical Center (GTLMMC) of Iligan City at 52 percent. This final report only shows that if those who have been oriented and pursued, better results could be obtained.

This report captures that the lowest facility only reported 16 percent of accomplishments on family planning in Agusan del Sur Provincial Hospital (ADSPH) despite the overflowing report of accomplishments in 2017. Such low performance in addressing unmet need for postpartum FP has been reflected in Agusan del Norte Provincial Hospital (ADNPH) at 34 percent and the Maguindanao Provincial Hospital (MPH) at 30 percent in Shariff Aguak.

Table 1.4D. Percent reduction of unmet need in hospitals with deliveries through PPFP, Qtr 2 of 2018 NO April to June Quarter of 2018 . Priority Number Number Total Number TOTAL FP Deliveries Estimated Percent Hospitals of PPIUD of BTL PPIUD of POP Q2 Unmet reduction of for 2018 Clients Clients and BTL clients Need for umet need (Q2) (Q2) Clients PPFP 1 MRH 208 9 217 72 289 448 297.92 97% 2 ZDSMC 376 48 424 0 424 801 532.665 80% 3 ADSPH 5 89 94 3 97 893 593.845 16% 4 MPH-SA 11 20 31 18 49 243 161.595 30% 5 GTLMH 76 58 134 110 244 699 464.835 52% 6 ADNPH 23 19 42 101 143 639 424.935 34%

IV-1.c.3. In Terms of Demand Generation: All hospitals, just like the Agusan del Norte Provincial Hospital (ADNPH) and the JR Borja Memorial Hospital (JRBMH), the FP coordinators and other hospital staff, need to conduct daily ward classes (watchers’ classes) and FP classes at the OPD. Likewise, one-on-one information giving and counseling should be given to those probable FP acceptors prior to discharge. In like manner, all women of reproductive age (WRAs) need to undergo the FP class where job aids and other IEC materials have to be shared. Further, the signages should be also available posted in conspicuous areas for the clients to read and refer.

BPH-Maramag has not released yet a standing policy on FP demand generation. However, as a result of the FP- MCH- AY integration last June 2017, the hospital was able to develop a client flow chart wherein WRAs are screened using the self-assessment tool coming from the different point of entries such as the ER, OPD, DR and wards. These WRAs are then identified if they have FP needs were provided with one-on-one or group counseling by the FP coordinator and services after they have consented and fully understood the mechanism, risks, benefits and side effects of the method they chose to accept.

IV-1.c.4. Building Sustainability through Health Care Financing: In 2017, BPH Maramag was able to provide delivery services to women. Among those who delivered, 15.8 % have accepted Family Planning of which 37 have opted to space pregnancy and accepted PPIUD as their method of choice while 411 have decided to limit their family size and accepted BTL as their family planning method.

The 15.78% performance on family planning in BPH-Maramag is very low vis-à-vis the 67% probable acceptors; the disparity can be attributed to a variety of reasons. Firstly, there is only 1 provider trained on FPCBT 1, FPCBT 2, PPIUD and LARC PSI who single-handedly offered the FP services from client education to provision of the method. Second, the facility has very limited choices of FP methods. The hospital focused on providing LARC/PM services of which the remaining 51% or more may have opted to use the short acting methods. Thirdly, the facility has no established system of triage/ screening, referral and reporting. Hence, clients were not identified nor screened for FP acceptance. The facility mainly caters the walk-ins and those post-

90 partum women who have underwent operative deliveries as such, the C-section to ride on the BTL or Intra CS PPIUD acceptance.

Due to the identified varied reasons for a very low FP acceptance among those women who delivered at BPH Maramag, the facility missed providing FP services of about 89.74% and 8.08% on BTL and PPIUD, respectively. This can be computed or translated to a total of PHP 8,968,428.89 income loss due to the lack of a functional system on family planning in the hospital. Should the hospital able to integrate the functionality of Family Planning services among the other services, a total of PHP 8,582,128.69 could have been added in hospital income from BTL services alone and an additional PHP 386,300.20 could have been an added from PPIUD services, both procedures require very minimal amount of expenditures.

Also, in the quarter 3 of year 6, MindanaoHealth supported in scaling up the integration of FP and AYRH programs in 16 hospitals within SDN, in consonance with the 2014 DOH Memorandum 0312 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.

In May 2018, around 18 hospitals underwent an orientation on the required DOH-recording and reporting with an FHSIS format. However, most of the hospitals need to be followed up and coached in their respective areas of assignment to fill up the M1 and A1 and submit these forms regularly and on time.

The postpartum family planning (PPFP) should be reviewed from the provision of natural FP, exclusive breastfeeding to provision of progestin-only pills (POP), injectable, longer-acting reversible contraceptive methods on progestin-only implants (LARC/PSI), postpartum IUDs and the voluntary surgical sterilization techniques.

Learnings:  Hospitals do not want to be at the bottom of their performances to hospitals with similar condition or bed capacity  Regular monitoring and updating of data could help improve their practices.

Recommendations:  Given the past experiences, develop a criteria for choosing or selecting FP/AYRH Integration in hospitals.  All birthing centers should be able to develop capacities on PPFP and capture all clients prior to discharge. Support systems should be introduced (i.e., not only the conduct of orientation, training/capacity building, recording and reporting through FHSIS, use of data in planning and using the data for demonstrating results of accomplishments.

 Hospital staff should be alerted to present their accomplishments with other hospital staff to promote “healthy competition”. The information and data could further be compared to results on contributions to the costed investment plans (CIPs) and the missed opportunities for PhilHealth reimbursements.  The data on their accomplishments should be shared to them, the chiefs of hospital and solutions be sought for their improvements. The data should be validated and the quality improved through Data Quality Checking (DQC)  Specifics to hospital facilities in JR Borja Medical Center (JRBMMC), the staff should ensure that signages are in place—show direction to RH/Women’s Clinic or even, a Teen Center. At the OPD, JRBMMC need to make sure that FP promotion/information-sharing is ongoing, to be continued in the wards (near the nurse stations) and also address the need to share FP information among the watchers (huge area) in 2nd floor. In Northern Mindanao Medical Center (NMMC), there is a need to review the reporting system that defines multi-para from nulliparas to attune to the DOH-required disaggregation by age groups from below 14, 15- 19, 20-24 and 25 to 49 years old.  As a training facility, NMMC should not stop conducting trainings but build their capacities to develop quality trainers, not only on PPIUD, but on BTL, even NSV, LARC/PSI and interval IUDs. Further, these FP technologies with clinical practices should also form part of the curriculum of their residency training and other affiliates program.  All DOH-retained facilities of CRMC, NMMC, including Davao Regional Medical Center (DRMC) and Margosatubig Regional Hospital (MRH) need to ensure the completeness of their data and information on regular basis. On the other hand, the Southern Philippines Medical Center (SPMC) at 7 percent have to address the high number of women who deliver in this facility with additional and well-trained human resources to cope with demands on PPFP.  DOH-retained facilities have been expected to take leadership roles in satisfying the provisions of Executive Order No. 12 and the RPRH Law with no restrictions nor limitations.  Hospital recording and reporting system needs reforms in hospitals. While slowly introducing this FHSIS in hospitals, dedicated staff with clear plantilla positions should be readily identified and prepared. Those who have been identified should undergo orientation, training and rigorous follow-up until it becomes mechanical to the regular staff. DOH-retained hospitals to take the lead in recording and reporting their performance electronically.  In terms of the number of women giving birth who received uterotoncs in the third stage of labor would require a countdown on the consumption report on uterotonics dispensed. The facilities that were included in monitoring are those that received BEmONC/EINC/CMNC trainings, PhilHealth accreditation with MCP/NCP and those with written guidelines on the use of oxytocin. The target was 10,000. For the ARMM alone were the basic AMTSL has been introduced as a matter of policy, MindanaoHealth would need to report accomplishments among 11,560 women given with uterotonics.

V. Roles and Total Gains/Contributions of the Private Sector

Rationale In Mindanao, there was not much service providers dedicated to address the unmet need for limiting in difficult or isolated areas or GIDAs. With the limitations at the start of the project implementation and not being able to engage local technical assistance programs (LTAPs) with their own budget and set of deliverables, MindanaoHealth, DOH and LGU partners explored the engagements of the private sector, civil society organizations (CSOs) and non-government organizations (NGOs) as partners, short term consultants, among others.

In 2015, the public sector was struck and their operations halted with the issuance of the temporary restraining order (TRO) from the Supreme Court, the LARC/PSI took a deep turn and only recently, took a rebound from recent assurances (November 2017) that this has been lifted when the Food and Drug Administration (FDA) already issued a memorandum that certain FP methods, commodities and supplies were not “abortifacient”.

Meanwhile, the private sector groups, the academe, the CSOs and NGOs have been resilient with existing government and court rules and could be also tapped in quality assurances, in conducting trainings, supportive supervision and developing referral networks through SDN.

Building relationships and service delivery networks (SDNs) through the years MindanaoHealth has been engaging the private sector through the Marie Stopes International; other health service providers like the Jerome Foundation and the FP Consortium also pitched in in providing ambulatory services Mindanao-wide for BTL/MLLAs and LARC. Meanwhile, the LARC/PSI services benefited from the additional mobilization of FriendlyCare Foundation, Family Planning Organization of the Philippines (FPOP), UNYPHIL Midwives group, the AlJa Mudilah Foundation and other civil society organizations (CSOs).

In the second year, the project prepared the environment for private sector engagements through unpopular initiatives with the turnover of private sector mobilization (PRISM2) on Reproductive Health to MindanaoHealth in Quarter 3, expanded the cognizant of private sector’s participation in providing FP services at 47.8% and providing commodities 68.1%. Mindanao-wide performances were also adversely affected when in June 2015, the Temporary Restraining Order (TRO) for the LARC/PSI was issued by the Supreme Court and has been implemented on DOH that influenced the public sector. The presence of the private sector, CSOs and NGOs served as buffer for Mindanao to continue its FP services to those with unmet need for modern FP.

On the other hand, the Autonomous Region of Muslim Mindanao (ARMM) works on reaching every community in ARMM (REACH), which was previously reaching every barangay (REB ++),

93 as a vehicle to conduct outreach and expanded the availability of modern FP services especially to GIDAs in the ARMM. ARMM worked closely with Tagbilang Foundation, the Alja Mudilah Foundation, the Marie Stopes and Likhaan.

With the temporary nature of such arrangements, the private sector groups, the CSOs and the NGOs improved its engagement with the public sector, pursued relationships as partners on a more regular basis and participated in strengthening referral services in service delivery networks (SDN) on FP and MCH in selected sites of Mindanao.

Learnings:  The private sector showed a faster rate and wider coverage of implementation than the public sector.  The government’s and donor’s accounting rules and regulations put a limitation in the use of project funds by the private sector  As a result, project implementation was affected by the priorities of private sector providers and the high rates of consultants who can train, do the supportive supervision and recommend for certification on FP/MNCHN courses (i.e., PPPIUD, PSI and voluntary surgical sterilization or VSS and the EINC and the LMT).

Recommendations:  Tap the private sector at the start of any project.  Remove the constraints, obstacles with well-defined terms of engagements in engaging the private sector.  Develop local, regional and public sector counterparts to be trainers at par with what the private sector could provide.

VI. Capacity Building (Public/Private) on FP and MNCHN

Rationale At the project start up, tubal ligation through mini-laparotomy with local anesthesia (BTL/MLLA), no scalpel vasectomies (NSV) and interval intra-uterine devices (IUDs) were made available selectively and in a limited way in Mindanao, no providers on postpartum family planning through intra-uterine devices (PPFP/PPIUD) and the long acting reversible contraceptives through progestin sub-dermal implants (LARC/PSI) have been working to provide broader range of modern FP services. There were no regional and local trainers on PPFP/PPIUD and LARC/PSI and would need to rely on trainers from Manila to get these technologies offered, transferred and running in Mindanao. On MCH, on the other hand, no regional or local EINC trainers could be found in Mindanao. This includes Lactation Management Training (LMT).

Thus, there was a real need to slowly build capacities of regional, facility-based and local providers to offer wider range of modern FP services. Further, potential trainers need to be identified, preferably assigned in strategic locations and sustain capacity building in the near future.

MindanaoHealth, DOH and its LGU partners made use of the DOH-approved and existing manuals to identify, select and train health care providers for tubal ligation (BTL/MLLA), no scalpel vasectomy (NSV), FPCBT2 (interval IUDs) and FPCBT1 while manuals for facilitators and providers for PPFP through PPIUD and the progestin sub-dermal implant (PSI) were also developed by MindanaoHealth with DOH leadership in organizing the Manila-based technical working groups (TWGs). Meanwhile, the training of trainers (TOTs) was introduced using the self-administered and supervised modified computer-assisted learning (MODCAL) approaches.

In the initial years, the project also embarked on capacitating frontline service providers on essential intra-partum newborn care (EINC) and the community-based maternal-newborn care (CMNC) initiatives that encompass the active management of the third stage of labor (AMTSL) and newborn resuscitation while promoting exclusive breastfeeding (EBF) practices. This approach was also strengthened through referral practices in SDNs.

Training Providers and Trainers On family planning (FP) services: In the first seven-month period (up to Sept. 2013) of project start-up, MindanaoHealth initially trained seven (7) providers on BTL with MLLA from Compostela Valley that led to 61 clients initially served in this province. In order to build the capacity for high quality health services, MindanaoHealth in the second year of the project, further assessed and assisted in building the competency of health professionals, sponsored the conduct of trainings, provided training kits for recently-trained providers so that they can immediately apply the skills they learned, conducted supportive supervision after trainings, reviewed the status of health infrastructures, provided logistical support for health management and their operations, and reviewed the sharing of available resources that can be mobilized for maintenance and operating expenses.

MindanaoHealth's efforts to scale- up integrated MNCHN/FP services resulted in the training of 3,017 health service providers on MCH and FP, including long-acting and permanent method (LAPM) and other modern FP Methods with the inclusion of essential intrapartum and newborn care (EINC), for ARMM, the community managed newborn care (CMNC) and the lactation management training (LMT). Table 1.5A below shows a matrix of those 2,717 providers who were trained, classified as belonging to priority sites, conflict-affected areas and the non-priority sites.

Table 1.5A.Capacity Building of Health Service Providers in Priority, CAAs and Non- Priority Areas, as of Q3PY6 Went for Supportive Total Percent Feb to Total who Number Supervision accomplished Sept went for Category of HSPs CAAs Non- on 2013 Priority Supportive trained and priority Supportive (Baseline) areas Supervision Marawi areas Supervision BTL-MLLA 0 234 52 32 25 109 46.5% providers* PPIUD 88/119 967 452 69 135 656 67.8% Providers FPCBT2 (I- 43 722 131 11 11 153 21.2% IUD)** LARC/PSI 0 794 222 80 56 358 45.1% Note: *Need to review and identify only doctors who have been trained and would need supervision. **DOH and LGU partners continued identifying and training FPCBT2 (interval IUDs) but not much supportive supervision and public sector partners did efforts on certification.

While BTL, NSV and interval IUD clients being served may not be directly attributed to the presence of MindanaoHealth; the data on PPIUD and LARC/PSI should be treated otherwise. MindanaoHealth and maternal and child health integrated program (MCHIP), both Jhpiego- assisted, introduced the PPFP through PPIUD in Mindanao. This was followed with the initial and subsequent introduction of progestin sub-dermal implants (PSI).

Initially, around 119 providers were trained on PPIUD (doctors and midwives) that led to 1,438 clients being served. In 2013, The MindanaoHealth and MCHIP combined its resources to do the initial training of ten (10) trainers who represented at least four (4) DOH-retained facilities that made the pioneering work on PPIUD and later became the DOH-recognized Centers of Excellence (COEs) on PPFP/PPIUD in Mindanao.

The modified computer-assisted learning (MODCAL) together with the Objective Structured Competency Evaluation (OSCE) were introduced, including the manuals from Jhpiego that were used in conducting the training of trainers (TOTs) during MCHIP and MindanaoHealth implementation. Also, the inclusion and training of Northern Mindanao Medical Center (NMMC) participants eventually led to an additional COE being developed by MIndanaoHealth. This initiative was also recognized by DOH-Northern Mindanao.

While only 80.0 % of those who were trained on PPIUD need to be accomplished or delivered for supportive supervision, the project already reached 67.8 % as of this latest report in 2018. This target could be fully satisfied if efforts have been or will be concentrated on providing supportive supervision to PPIUD. Cleaning the list of PPIUD trained service providers to weed

96 out inactive, transferred/promoted, and those retired resulted to 884 total active PPIUD trained providers of which 661 were supportively supervised and recommended for DOH certification.

For validated th234 BTL/MLLA trained service providers, 109 were supportively supervised and 75 were certified catering to 91 SDPs.

As a continuing quest on LARC/PSI when the TRO was “recently lifted”, reports showed that of the 794 trained, 358 were supportively supervised and 205 are already DOH certified. All the 794 LARC/PSI trained HSPs are spread across 458 SDPs in Mindanao, of which more than half of trained HSPs and SDPs are in 12 priority LGUs.

Further, 54 service providers were trained on FPCBT1. The importance of this course could not be underestimated since most FPCBT level 2 courses would depend if the providers have undertaken FPCBT1 courses on counseling, ICV protocol and offering of broad options for modern family planning methods.

In the 4th year, MindanaoHealth further assisted partners in updating the knowledge and skills of service providers on MNCHN/FP (i.e., 475 on FPCBT1, 73 on FPCBT2, 94 on LARC-PSI, 136 on PPIUD, 101 on BTL, and 495 additional providers on adolescent and youth (AY)). In the 6th year, significant strides were made in capacity building when DOH and LGU partners started pouring their resources to capacitate their own staff on modern FP to meet the expectations of the Executive Order No. 12. and went beyond FPCBT1 and FPCBT2.

VI.2. Recording Training Accomplishments

Before there was no clear encoding of individual participants for training activities, the project introduced Worksheet Trainees Registry that requires to first register new training/supportive supervision and until the certification activity. All training events as indicated in the training code have been categorized into standard categories and to determine first whether the trainee and facility have been registered for new trainees and/or for new facilities.

The importance of quality assurance, certifying those who passed and recommending those who passed for PhilHealth accreditation are vital information that could sustain the services on the ground. MindanaoHealth also assisted in facilitating not only the certification but also the PhilHealth accreditation of service providers on modern FP.

Table 1.5B. Number of participants who underwent supportive supervision on LARC/PSI (PY6Q2 Report Category of Baseline Trained Supportive Percent participants supervision (T/SS) accomplished LARC/PSI providers* 0 794 358 45% FPCBT2 providers** 74 722 153 21.2% PPIUD providers 88 967 656 67.8% BTL/MLLA providers 0 234 109 46.6% Note: *Affected by the issuance of the TRO by the Supreme Court (lifted only in Nov. 2017). **Mostly DOH and LGU-initiated trainings

The project supported building the confidence of non-performing but trained HSPs through the DOH and/or LGU-led supportive supervision/post-training evaluation (PTE) activities, following up and facilitating their certification by the DOH.

In the annual report of year 5, the PPIUD trainees who were supportively supervised reached 60.5 % (or 584 of the 967 trainees). Project-wide and as of the end of PY6Q2 report in Table 1.5B, the proportion of trainees who underwent supportive supervision has been noted at 67.8 % - still below the target of 80% among those who completed the training on PPFP/PPIUD. DOH and LGU partners conducted the rest of the trainings while the LARC/PSI was put on hold for 2 years with the issuance of the temporary restraining order (TRO) of the Supreme Court.

The health service providers (HSPs) assigned in Conflict Affected Areas (CAA) and the ARMM have difficulty in complying with the required ten (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 (CAAs), the proportion of PPIUD-trained HSPs who underwent supportive supervision is only 46%.

On maternal and child health (MCH) services

Initially as a continuation of the SHIELD project, MindanaoHealth trained 12 trainers on CMNC that boasted the momentum on the active management for the third stage of labour (AMTSL) and essential newborn care (ENC) in ARMM. Around 146 MECA midwives underwent training on CMNC.

In partnership with the Kalusugang Mag-ina Foundation (KMI), the MindanaoHealth started facilitating/offering courses on essential intra-partum newborn care (EINC), a three-day course that offered various methods of preventing post-partum hemorrhage (PPH), slightly addressing

98 severe pre-eclampsia and eclampsia cases and handling the newborns who suffer from difficulties in breathing or not breathing at birth.

While, MNCHN indicators on skilled birth attended (SBA) deliveries improved in Mindanao regions, the Region 12 (SOCCSKSARGEN) NDHS results, as an example, showed an improvement from 55.7 to 65.9 (2013 to 2017) and in the ARMM from 20.4 to 33.6 percent. This could also be readily observed in facility-based deliveries (FBD) where in Region 12, this increased almost 2 folds from 48.5 to 63.5 in 2017 and in the ARMM, from 12.4 to 28.4 percent. This is partly brought about by the outstanding policy on AMTSL in ARMM and the CMNC training for Midwives in Every Community Program.

Further, MindanaoHealth also tied up with Integrated Midwives Association of the Philippines (IMAP) for a CMSU project for midwives to train more midwives (members of IMAP) on essential intra-partum and newborn care (EINC) with KMI team of consultants in Davao del Sur, Misamis Oriental and Cagayan de Oro and to certain extent, the midwives from Zamboanga del Sur.

Learnings:  There is a need for the training (residency) facilities to continuously train their staff and neighboring providers since the attrition rates are high for modern FP providers. Further, institutions with residency training courses have been noticed that their cadres move faster or graduates and be out of touch early than the others.  Limitation in the use of project funds to conduct trainings became more pronounced in the last two (2) years of project implementation. Early on, there should be a clear policy when funded trainings should stop and for the DOH, LGU and other partners to fund the needs for expansion.  The weakest link has been on demand generation-- one of the major challenges in project implementation is the capacity building for community volunteers and workers to identify, refer and navigate clients to midwives or health professionals near the villages and communities and prepare for their referral services.

Recommendations:  Conduct of trainings should be able to develop a package of ---the conduct of trainings, then coaching, mentoring or supportive supervision and this should be closely monitored with the providers who were submitted to be certified and be PhilHealth accredited.  For sustainability purposes, health care providers should be monitored, their performances assessed and their relationships observed. Those who will be trained as trainers should come from the active list of members.  The status on Philhealth accreditation should always be updated, their corresponding share or benefits that could be received from their host institutions be monitored and the level of satisfaction in terms of acceptability be determined.

 Linking status and monitoring data with demand generation (working with BHWs and other community volunteers).

VI.3. Developing Trainers on Different FP/MCH Courses

Rationale While initially ignored by major partners per DOH AO 2014-0041, the partners realized the importance of linking arms together to meet the basic requirements of recognition and conduct of trainings since MindanaoHealth project is about to close shop. While an initial deadline in January 2017 was mentioned to recognize training providers on FP, this DOH AO has been the subject of recent efforts to strengthen the capacities of providers and their facilities to be training providers for family planning.

Prior to recommendation for DOH certification, the providers are being assessed in terms of the number of clients performed on PPIUD and the LARC/PSI. Further, five (5) areas are being evaluated with actual clients, namely: client assessment, client counseling, infection prevention, PSI insertion or removal and post-procedure instructions. Those with more clients, outstanding performances and being recognized with inherent qualities of trainers have been identified, recommended to DOH and LGUs to be part of the training team if a training of trainers (TOTs) are being foreseen in the future.

Starting with identifying potentials to implement the adult learning principles and the use of the self-administered modified computerized advance learning (MODCAL), potential trainers have been invited on the different FP and MCH courses. It has to be realized that the quality on capacity building rely so much on the outstanding performances of among those who were trained, underwent supportive supervision (SS), certification and PhilHealth accreditation (on FP: PPFP/PPIUD and LARC/PSI and MCH: EINC or CMNC).

Developing trainers and clinical practice sites: The training of trainers (TOTs) of 133 PPIUD trainers led to the development of coaching and mentoring sites and later, evolving to clinical practice and mentoring sites (CPMS) that were recognized by DOH. With the trainers, training providers/institutions were slowly being recognized by DOH (AO 2014-0041) as their training providers even in ARMM. Around 128 public health nurses and managers were introduced to the topic on supportive supervision (SS) to a select few doctors, nurses and program managers in Mindanao.

As reported initially, partners were only guided not only by baseline assessment results but also by a modified version of performance standard checklists to know if their facility fits well as a clinical practice or coaching and mentoring site. MindanaoHealth and its partners intensified

100 the validation visits to complete the certification of six (6) facilities as both Training Providers and Clinical Practice Sites (CPS) for PPFP, more on PPIUD.

Re-intensification of trainers On FP: This 2018, despite the calls of prioritizing PPFP/PPIUD supportive supervision, the heavy concentrations for supervision (SS) were still made and responded to high demand to compensate for the 2-year loss on LARC/PSI. The initial list showed that the number of trainers for LARC/PSI were 6 in Maguindanao, 3 in Cagayan de Oro and 3 Caraga trainers were identified in Butuan City were identified as trainers or potential trainers to be invited in future conduct of training of trainers (TOT).

On MNCHN: The MindanaoHealth trained 12 trainers on CMNC that boasted the momentum on the active management for the third stage of labor (AMTSL) and essential newborn care (ENC) in the ARMM. An additional 38 trainers were also served, recognized with KMI Foundation and certified as trainers in Mindanao. Meanwhile, around 146 MECA midwives underwent training on CMNC.

VI.4 Developing the Clinical Practice and Mentoring Sites (CPMS) for PPFP

Rationale The scouting, selection and identification of trainers need to be linked with the strategic location and distribution of the health facilities that should be developed as clinical practice and mentoring sites (CPMS). With the persistent complaints of chief executives for more time to be of local service by their providers, coaching and supportive supervision need to be closer where the providers are regularly assigned, to go “on duty” and closely linked their actual performances with demand generation from their own communities (i.e., working with BHWs and other community volunteers) and developing trainers on different courses.

Assessing the qualities and developing the Clinical Practice and Mentoring Sites (CPMS) should be anchored on their abilities to have a full time trainer on PPFP, specifically the PPIUD, a high volume providers with more than 2 babies being delivered on daily basis and the support structures are in place with training/ IEC and sample materials and the training management’s readiness to absorb this additional tasks.

Thus, all facilities that were either classified as clinical practice sites or coaching and mentoring sites need to be re-evaluated using the performance standard checklists (PSC) developed, pilot- tested and reviewed with DOH-SOCCSKSARGEN, DOH-Zamboanga Peninsula and the DOH- ARMM.

101

The evolution of clinical practice and mentoring sites: In the 4th year of the project, the number of CPMS went beyond the target of more than 50 facilities. However, upon careful review and evaluation, not all these facilities could be recommended as Clinical Practice and Mentoring Site (CPMS). It has to be noted that the CPMS requires the number of deliveries of at least 2 per day shift—this could give enough cases for those who would go on duty or exposure to have at least one (1) case to do the following-up counseling and actual insertion while being coached or mentored while on duty. The CPMS should be able to benefit from the presence of a trainer or a coach on PPFP, preferably PPIUD.

In year 5, around 55 health facilities in Table 1.6 have been identified to support the Training Providers and were categorized by DOH as either Clinical Practice Sites (37) or Coaching and Mentoring Sites (18) as follows:

Table 1.6. Number of health facilities categorized as Clinical Practice Sites or Coaching and Mentoring Sites Region/Areas Covered Clinical Practice Coaching and Sites Mentoring Sites Zamboanga Peninsula 6 5 Northern Mindanao 10 0 Davao Region 4 7 SOCCSKSARGEN 9 4 Caraga 6 2 ARMM 2 0 Total 37 18

In year 6, the realization has been, not all these 55 health facilities have the trainers and enough clinical cases to support the trainee when they go “on duty” for coaching, mentoring and supportive supervision. Thus, MindanaoHealth and the DOH-Regional and LGU Partners in SOCCSKSARGEN, Zamboanga Peninsula and parts of Davao Region to further review, ensure quality assurance, develop and finalize a performance checklist to re-evaluate the capacities of the health facilities on PPFP/PPIUD. The trainer should be ready to accept to be a trainer of the other modern FP methods especially on LARC through PSI.

The CPMSs are good institutions to develop a network of trainers on modern FP. As an institution, the team members could form a group or faculty and have themselves registered once the conduct of supportive supervision or training becomes manageable according to standards.

102

What learnings on developing clinical practice and mentoring sites (CMPS)  Even with minimal interventions, the strengthening of CPMS could push through if the DOH- Regional Offices are involved (e.g., DOH-ARMM for Lamitan City in Basilan).  The use of the evaluation tool on CPMS has been useful in the regions of Zamboanga Peninsula, SOCCSKSARGEN, ARMM and parts of Davao and Caraga regions.  Not all providers have been updated on the WHO-MEC 2015.  Postpartum IUDs are highly effective in facilities with high volume deliveries (e.g., more than 2 deliveries per day).  Proper selection of participants should be re-emphasized, train only those who have the clients for PPFP/PPIUD or those who deliver babies and could counsel and administer the PPFP.

Recommendations for the CPMS:

 Link the process of selecting health service providers to the possibility of building a cadre of trainers or faculty members of these FP technologies;  There should be proper selection of participants to the training. Trainers and those who would plan, recommend the participants to training—to make sure that proper selection of participants has been diligently observed to select those who have actual cases prior to actual training, coaching and supportive supervision.  The evaluation tool for CPMS needs to be introduced to other DOH-Regional Offices for final comments and possible acceptance. There is a need to create or subsume this tool to a technical working group (TWG) on modern FP, particularly those working on PPFP for its possible improvement and acceptance by the present leadership of DOH.  In the meantime, those birthing facilities with potential trainers should be tapped and be part of the pool of faculty members—do coaching and mentoring or be part of the larger pool of faculty members in the city, province or region, who can form a consortium or an institution on PPFP, beginning with PPIUD.  There is a need to invest and train high rates of consultants who can train, do the supportive supervision and recommend for certification on FP/MNCHN courses (PPPIUD, PSI and VSS and the EINC).  Need to disseminate the WHO-MEC 2015 to all service providers, including the trainers to help in spreading these broader criteria to providers, trainers and other institutions.  On demand generation—The demand generation should be more systematic—individuals and group

103

VI.5. Kangaroo Mother Care (KMC) Initiatives

Rationale Mindanao Health/Jhpiego and the Davao Regional Medical Center (DRMC) of Tagum City with then Assistant Secretary of Health for Mindanao, the Kangaroo Mother Care (KMC) initiatives were started. With technologies adopted from a meeting co-sponsored by Jhpiego, few staff got their initiation and started operating this initiative in DRMC.

While the KMC initiatives could easily be integrated in EINC and BEmONC approaches, the caring for small babies became the alternative ways in helping out premature, malnourished or under-nourished babies who would still need care and support not only among hospital or facility-based staff but also from the communities once these babies are being discharged from the facilities.

Where are we? The DRMC renovated its complex to house this KMC initiative with the Pediatrics Department with a few hospital-based staff from other facilities learning its mechanics and the challenges in actual operations.

In the 3rd year of implementation, the Department of Health (DOH) of Davao Region and the World Health Organization (WHO) started to showcase these DRMC initiatives. Meanwhile, other DOH-retained hospitals in year 6 (e.g., Cotabato Regional Medical Center), Maguindanao Provincial Hospital (MPH) and even LGU-managed facilities started their share and implemented these initiatives.

Upon closer look or review visits, the MPH-Sharif Aguak initiatives met challenges in its operations, sustaining this initiative. With so much demand for time and services, no special arrangements yet were made to sustain such life-saving intervention in this facility.

What Learnings on KMC: This initiative could really save the lives of premature babies who would need the warmth of the mother through skin-to-skin contact and the continuous breastfeeding practices to gain the desired weight and proper status on nutritional requirements. In some instances, the fathers got engaged in providing warmth to small babies.

This initiative should be linked and integrated to the efforts of ensuring that babies who were not breathing at birth or born with difficulty of breathing, should be revived or be resuscitated.

104

Recommendations for KMC:

1. Continue this initiative in other regions and linked this KMC initiatives to saving newborn lives with the multi-sectoral involvement of hospital-based experts, birthing facility staff and institutions that care for the lives of newborns. 2. Simplify the protocol or “how tos” so this could be adapted to lower level hospitals or birthing facilities that could also capture premature babies or resuscitate babies who have been delivered with difficulty breathing.

VII. What are the Remaining Challenges in FP/MCH Implementation?

In order to sustain project interventions and innovations, there should be DOH and LGU ownership and anchored on PhilHealth accreditation, claims and reimbursements. In all our interventions, the DOH-Regional and Field Offices, those assisting the local government units (LGUs), the provincial/ city and municipal health officies should be part of the whole scheme in project conceptualization, implementation, reviews and enhancement. Their approval, active participation and ownership should serve as a key towards sustainability.

With the lessons and practices ongoing, how do we now scale up and sustain these initial gains in addressing the unmet need for spacing and limiting?  The outreach services--remain on reaching those with unmet need for limiting and residing in remote areas or GIDAs  The Fixed services are the keys to sustainability—the expansion on PPFP should go beyond the confines in hospitals. Birthing facilities, clinics and related facilities should appear to be more attractive to clients, especially among the younger generation  FP Integration in hospitals--The FP integration has shown significant contributions to the reduction of unmet need among postpartum women. This should also be demonstrated in birthing facilities/centers

In terms of capacity building—training needs assessment (TNA) becomes the first step  We should always target well the number of (clinical) providers who would need training and supportive supervision based on the possible demand for these services. We nee to prepare our providers on the need to do more processes than just simply training (e.g., supportive supervision, certification, PhilHealth accreditation and monitoring of performances)  We should ensure that those who have been trained could also gain certification  Those who have been certified, should also acquire accreditation from PhilHealth  Those who have been accredited and receiving reimbursements from PhilHealth are generally satisfied of the sharing scheme

105

In terms of health care financing:  We should develop a scheme or mechanisms that monitors about PhilHealth accreditation, reviewing the processes and its actual utilization

Demand generation:  Tapping community volunteers in identifying and addressing the increasing unmet need;  Tapping other hospital and birthing facility volunteers to also identify and refer the unmet need for postpartum FP prior to discharge;  Addressing the adolescent and youth health: how can we drastically prevent the increases among 10-19 years of age who started childbearing.  We can learn lessons from Caraga Region that drastically showed a decline on teen-age pregnancies with the mobilization of all sectors, including the schools both public and private.

VIII. Major Lessons Learned

The summary of learnings that have been captured here may not be complete. At least, here are the key points or highlights that we need to reflect on:

 There is always a need for constant follow-up and coordination with concerned DOH, the LGU and the private sector partners.  Not all public health providers are ready to provide the needed services especially for those residing in remote, hard-to-reach or geographically isolated and disadvantaged areas (GIDAs).  We need to tap the private sector at once to show and demonstrate results while we rebuild the capacity of the public sector. Therefore, a service delivery network (SDN) approach could help better off or formalize this engagement.  It is therefore a challenge to make all means possible by either doing massive outreach with government partners or bringing those with unmet need to the nearest health facility with the ongoing limitations of a major private sector partner to do bilateral tubal ligations (BTL). We cannot dictate on them what to or not to do. We need agreements and contractual documents to do this (e.g., the private sector partner shelved off its operations this year, has disbanded and could no longer serve those with clear demand for BTL as compared to the first 3 exciting years of the project).  If agreed, there could be a much faster rate and broader reach in lower level LGUs of implementation than the public sector. Adjustments need to be made on Limitation in the use of project funds.  High rates of private consultants, who can train, do the supportive supervision and recommend for certification on FP/MNCHN courses (PPPIUD, PSI and VSS and the EINC). Proper selection of participants should be re-emphasized, train only those who have the clients or those who deliver babies and could counsel and administer the PPFP.

106

 Hospitals do not want to be at the bottom of their performances to hospitals with similar conditions or bed capacity. The regular monitoring, updating of and presenting data could help improve their practices.  There is a need for the training (on residency, nursing or midwifery schools) facilities to modify, enhance their curriculum and develop their own management team to continuously train since the attrition rates are high for modern FP providers. Further, institutions with residency training cadre move faster than the others.  Postpartum IUDs are highly effective in facilities with high volume deliveries (e.g., more than 2 deliveries per day). This is not the only method on PPFP, there are more modern FP methods based on the WHO-MEC 2015 recommendations. Not all providers have been updated on the WHO-MEC 2015.  Limitation in the use of project funds to conduct trainings became more pronounced in the last 2 years of project implementation. Early on, there should be a clear policy when funded trainings should stop and for the DOH, LGU and other partners to fund the needs for expansion.  Even with minimal interventions, the strengthening of CPMS could push through if the DOH- Regional Offices are involved (e.g., DOH-ARMM for Lamitan City in Basilan). More likely, these are more sustained.  The use of the evaluation tool on CPMS has been useful in the regions of Zamboanga Peninsula, SOCCSKSARGEN, ARMM and parts of Caraga. This would need further review and presentation to a technical working group (TWG) for possible adoption by the national government/agency.

IX. Emerging Good Practices

There are ongoing practices on FP and MCH that need to be replicated and this has been documented elsewhere and will soon be presented in a dissemination forum for this purpose.

To name a few, the JR Borja Memorial Hospital (JRBMH) in Cagayan de Oro City, Agusan del Norte Provincial Hospital in Butuan City and the Cotabato Regional Medical Center (CRMC) of Cotabato City are more likely candidates that need to be reviewed, properly documented and presented for integrating FP and AYRH in hospital services. Meanwhile, the South Cotabato Provincial Hospital (SCPH) could stand ground for its integration of electronically master-listed clients in hospital management information system (HOMIS)

In terms of demand generation in which the supply-side has been involved, the house-to-house approaches of Agusan del Sur could stand out while reaching the far or remote areas or in GIDAs could be seen in Pangantucan, Bukidnon, the Kalamansig approaches in Sultan Kudarat and still undocumented but emerging approaches in Compostela Valley.

107

In terms of multi-sectoral involvement and widening of resources, the tripartite approaches and agreements demonstrated in Zamboanga del Sur and the BITES (Bagumnbayan, Isulan, Experanza, Tacurong City and Sen. Ninoy Aquino) experiences could stand its way. X. Recommendations for the Future:

Capacity building:

 Study, use and share the World Health Organization (WHO)’s guidelines on MEC, maximize the MEC Wheel for providers, selected practices and recommendations (SPR) for contraceptive use, the manuals and providers handbook on PPFP. Need to disseminate the WHO-MEC 2015 to all service providers, including the trainers to help in spreading these broader criteria to providers, trainers and other institutions.  There should be proper selection of participants to the training. Trainers and those who would plan, recommend the participants to training—to make sure that proper selection of participants has been diligently observed to select those who have actual cases prior to actual training, coaching and supportive supervision. Link the process of selecting health service providers to the possibility of building a cadre of trainers or faculty members of these FP technologies;  Conduct of trainings should be able to package the conduct of coaching, mentoring or supportive supervision and this should be closely monitored with those providers who should be certified and be PhilHealth accredited.  There is a need to invest and train potential providers, trainers or consultants who can train, do the supportive supervision and recommend for certification on FP/MNCHN courses (PPPIUD, PSI and VSS and the EINC). In the meantime, for those birthing facilities with potential trainers should be tapped and be part of the pool of faculty members—do coaching and mentoring or be part of the larger pool of faculty members who can form a consortium or an institution on PPFP, beginning with PPIUD.

On demand generation:

 The demand generation should be more systematic—individuals and group and looks at cultural and gender sensitivities, both in preparation for outreach and/or fixed services.  Community volunteers and workers should be aware that their work or contributions do not end with identification of clients with unmet need but towards service provision, monitoring and reporting adverse events or determining the level of satisfaction.

Service provision in a service delivery network (SDN):

 Tap the private sector at the start of any project. Remove the constraints, obstacles with a well defined terms of engagements in engaging the private sector

108

 All birthing centers should be able to develop capacities on PPFP and capture all clients prior to discharge  In the meantime, the interval intra-uterine devices (I-IUDs) could be strengthened together with the wildly acceptable LARC/PSI services that have been regaining its popularity, all over Mindanao, after the TRO has been lifted.

Hospital integration and enhancement of birthing facilities

 Hospital staff should be alerted to present their accomplishments with other hospital staff to promote “healthy competition”. The data on their accomplishments should be shared to them, the chiefs of hospital and solutions be sought for their improvements.  Hospital recording and reporting system needs reforms in hospitals. While slowly introducing this FHSIS in hospitals, dedicated staff with clear plantilla positions should be readily identified and prepared. Those who have been identified should undergo orientation, training and rigorous follow-up until it becomes mechanical to the regular staff.  In terms of the number of women giving birth who received uterotoncs in the third stage of labor would require a countdown on the consumption report on uterotonics dispensed. The facilities that were included in monitoring are those that received BEmONC/EINC/CMNC trainings, PhilHealth accreditation with MCP/NCP and those with written guidelines on the use of oxytocin. For the number of newborns who have difficulty or not breathing at birth but were resuscitated should be mandatorily reported.

Monitoring and evaluation:  Start always with a baseline in introducing concepts, innovations and ideas to further improve the present approaches and situations and compare results through time. Follow-up the other 4 percent of facilities that did not submit reports to the FHSIS.  The evaluation tool for practice and mentoring sites (CPMS) need to be introduced to other DOH-Regional Offices for final comments and possible acceptance. There is a need to create or subsume this tool to a technical working group (TWG) on modern FP, particularly those working on PPFP for its possible improvement and acceptance by the present leadership of DOH.  For sustainability purposes, health care providers should be monitored, their status updated on Philhealth accreditation, their corresponding share or benefits that could be received from their host institutions be monitored and the level of satisfaction in terms of acceptability be determined.

XI. What Tools to be Endorsed ?

While working and using the existing and approved tools, manuals and IEC materials of government, MindanaoHealth and partners were also able to develop a few sets of tools for sharing.

109

1. Disaggregated on LARC/PSI. --Need to also share the YouTube on the difficult removal procedures on PSI. 2. With partners, MindanaoHealth was able to secure the approval of USAID and the Department of Health (DOH) on 2 manuals:  Facilitators Guide on PPFP; and  Health Service Providers Handbook. 3. Furthermore, we need to follow-up on the conduct of PPIUD Supervision Made Easy. 4. We also need to follow-up on the evaluation tool for CPMS (i.e, already used in upgrading the Limook from a CMS to CPMS) 5. BTL Manual (c/o PRISM or Dr. Francis Floresca), FPCBT and other FP tools.  There are 5 tools for the BTL/MLLA and for the NSV.  In addition to FPCBT1 and FPCBT2 (interval IUD tools) 6. Further the development and the process on FP integration in Hospitals  Start with the Triage Form of segregating those with unmet need for FP and AYRH services 7. The monitoring tool (disaggregating tools for FP integration with AYRH in hospitals, the OB History Form that will be used during OPD sessions; 8. The FP Composite Index as scoring tools for the LGUs; and lastly, 9. The previously approved tools/ materials from WHO and Jhpiego such as, but not limited to, the WHO-MEC, the MEC Wheel, Balance Counseling Strategy Plus (BCS+), etc.