Quarterly Report Mindanaohealth Project

Quarterly Report MindanaoHealth Project

Program Year 4 Quarter 3 (March 1 – June 30, 2016)

Submitted: July 30, 2016

Submitted by: Dolores C. Castillo, MD, MPH, CESO III Chief of Party MindanaoHealth Project E‐‐‐mail: [email protected] Mobile phone: 0917795430

On the cover:

Top left: Trained Bagumbayan Rural Health Unit (RHU) midwives administer the Unang Yakap (First Embrace) to a mother and her newborn baby in the RHU’s PhilHealth-accredited birthing facility assisted by USAID’s MindanaoHealth Project. (Photos by: Jhpiego)

Bottom left: USAID-trained Usapan (interactive health conversation) Facilitator conducts Usapang Buntis (pregnant women) to participants from Maguindanao as part of the province’s outreach activity spearheaded by the Maguindanao Integrated Provincial Health Office. (SAlih/Jhpiego)

Top right: AJA-trained personnel and Adolescent Health and Youth Development Coordinator Sheila Amata-Dy (left) talks to a teen client inside the Health Promotions and Counseling Office in the RHU and conducts a psychosocial risk assessment to determine his risky behaviors and health services needed. (Cossid/Jhpiego)

Bottom right: An NDP nurse from the village of Tipo-Tipo in Basilan (center) reviews the Target Clients List from Tipo-Tipo health station to check on the quality of data entries and to examine its correctness and consistency, with support from USAID-trained personnel of Basilan PHO. (RResurreccion/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.

Contents List of Abbreviations ...... 1 Executive Summary ...... 1 Introduction ...... 3 Progress Against Performance Indicators ...... 4 Analysis of CYP and Current FP Users, Overall and by Region ...... 12 Narrative of Key Achievements and Recommended Measures by Strategy ...... 16 Strategy 1: Strengthening MNCHN/FP/RH service delivery...... 16 Strategy 2: Increasing the Demand for MNCHN/FP Services...... 20 Strategy 3: Removal of policy and systems barriers to service delivery and its utilization ...... 26 Strategy 4: Strengthening the Capabilities of DOH Regional Offices and Provincial Health Offices in Program Development, Management and Oversight ...... 29 Program Management ...... 32 Challenges and Solutions ...... 35 Success Stories and Evolving Initiatives ...... 38 Financial Expenditure and Cost Share ...... 43

Annexes Annex A: List of Certified Trained Health Service Providers and Trainers by FP/LAPM/LARC in Q3PY4 .... 45 Annex B: List of Trainings and Participants in Q3 PY4 ...... 48 Annex C: Distribution List of IEC Materials ...... 81 Annex D: Safety and Security ...... 85

List of Abbreviations ABC Association of Barangay Captains ADNPH Agusan del Norte Provincial Hospital ADPCN Association of Deans of Philippine Colleges of Nursing AJA Adolescent Job Aids AMTSL Active Management of the Third Stage of Labor ANC Antenatal Care AOP Annual Operational Plan APSOM Association of Philippine Schools of Midwifery ARMM Autonomous Region of Muslim Mindanao AY Adolescent and Youth AYRH Adolescent and Youth Reproductive Health BCS + Balanced Counseling Strategy Plus BEmONC Basic Emergency and Obstetric Newborn Care BH Birthing Homes BHS Barangay Health Station BHW Barangay Health Worker BMC Butuan Medical Center BTL Bilateral Tubal Ligation CA Cooperating Agencies CAA Conflict Affected Areas CCT Conditional Cash Transfer CDI Cities Development Initiative CDO Cagayan de Oro CDOHO Cagayan de Oro Health Office CECAP Cervical Cancer Prevention Program CEmONC Comprehensive Emergency Obstetric and Newborn Care CHANGE Communication for Health Advancement through Networking and Governance Enhancement CHO City Health Office CHT Community Health Team CHT‐IS Community Health Team–Information System CMNC Caring for Mothers and Newborns in the Community COE Center of Excellence EBF Exclusive Breastfeeding IEC Information, Education, and Communication ILHZ Inter‐Local Health Zone IPHO Integrated Provincial Health Office LAM Lactational Amenorrhea Method LAPM Long Acting and Permanent Method LARC Long Acting Reversible Contraception LGUs Local Government Units LIPH Local Investment Plan for Health

LMT Lactation Management Training M&E Monitoring and Evaluation MCP Maternity Care Package MH MindanaoHealth MLLA Mini Laparotomy using Local Anesthesia MNCHN/FP Maternal, Newborn, and Child Health and Nutrition/Family Planning MOA Memorandum of Agreement MSH Marawi Specialist Hospital MSI Marie Stopes International NCP Newborn Care Package NDP Nurse Deployment Program NHT National Household Targeting System NSV No Scalpel Vasectomy OSCE Objective Structured Competency Evaluation PHO Provincial Health Office PHN Public Health Nurse PMP Performance Monitoring Plan POPCOM Commission on Population PPFP Postpartum Family Planning PPIUD Postpartum Intrauterine Device TCL Target Client List

Executive Summary

The five-year (2013–2018) MindanaoHealth (MH) Project, a United States Agency for International Development (USAID)-funded project, is primed by Jhpiego in partnership with RTI International. The project’s goal is to improve family health by dramatically increasing the quality and uptake of integrated maternal, newborn, and child health and nutrition/family planning (MNCHN/FP) services at the household level, in communities, and at public and private health facilities, thereby resulting in improved child health and nutrition, reduced maternal and infant deaths, and decreased unmet need for FP services—especially among Mindanao’s lowest wealth quintiles and in conflict-affected areas. The project actively works and collaborates with the Department of Health (DOH)-led scale-up of high-impact services and client-centered information for Mindanao, the southernmost of the three island groups in the Philippines. MH works directly with five DOH-regional health offices (RHOs) of Zamboanga Peninsula, Northern Mindanao, Davao Region, SOCCSKSARGEN, and CARAGA as well as the DOH for the Autonomous Region of Muslim Mindanao (ARMM). The MH partnership involves local government units (LGUs) (provincial/municipal/city/barangays) in 19 provinces, two cities, and 366 municipalities and component cities. Building on the commitment of the DOH, MH made key achievements during the quarter from April 1 to June 30,, 2016: • Accomplished a promising increase in couple years of protection (CYP) from previous quarters especially on fixed provision of PPIUD and the re-introduction of LARC/PSI (both fixed and outreach) through the private sector; however, these FP interventions need to be accelerated to reach the Program Year (PY) 4 target. • Increased family planning (FP) current users (CU) from the previous quarter, with the exception of a few provinces and cities in Zamboanga Peninsula, Davao Region and ARMM. • Grew the network of service delivery points (SDPs) providing FP/reproductive health (RH) services from 535 as of the end of PY3 to 622, representing 96% of the PY4 target. • Achieved a slight increase in the number of women provided information on exclusive breastfeeding (EBF). • Scaled up the implementation of data quality checks (DQCs) in 61 LGUs of Zamboanga Peninsula, Northern Mindanao, Davao and SOCCKSARGEN Regions during the quarter bringing the total to139 LGUs, equivalent to 52% of the PY4 target. • Expanded the number of SDPs providing adolescent and youth reproductive health (AYRH) services. The number of hospitals and RHUs with established Center for Teens increased from 1 as of the end of PY3 to 25 as of the end of this reporting period. For the same period, Adolescent Job Aides (AJA) training expanded in 4 provinces (Zamboanga del Norte, Zamboanga del Sur, Lanao del Norte and Misamis Oriental, with 122 doctors, nurses and midwives attending. • Reduced the number of SDPs with stock-outs on FP commodities from nine (9) SDPs in Q1PY4 to four (4) SDPs in Q3PY4 as the strong collaboration with the Population Commission (PopCom) field teams helped tracked and resolved incidences of stock-out in every facility.

• Directly-assisted 49 LGUs, which earlier participated in the Health Leadership and Governance Program of the Zuellig Family Foundation (ZFF), developed their respective PhilHealth reimbursement policies. Overall, Mindanao Health Q3PY4 data analysis shows that the majority of program indicators are on track for meeting PY4 targets, with some exceptions. This quarterly report itemizes data by the five regions and ARMM to localize findings. Overall, the largest contributors to current FP users includes: SOCCK-SARGEN, Davao, Northern Mindanao and Zamboanga, with Davao and N. Mindanao contributing substantially to the regional CYP target. FP stock outs were again limited this quarter but reported mostly in SOCCSKARGEN (5), Zamboanga Peninsula (5), and CHO CDO (9). With the exception of Northern Mindanao, most regions are near or have exceeded targets on (SDPs) providing FP counseling and services. Throughout the region, work is needed to expand ARYH services. LGUs in Davao and SOCCK-SARGEN will need to increase PhilHealth reimbursements per guidelines. While Davao reports the largest percent of LGUs conducting DQCs and the number of LGUs conducting DQC doubled from 71 to 139 during the quarter in review as project sites became increasingly involved in the roll-out of this activity, all regions fell short of Q3 targets. For ARMM specifically, MH identified and trained more CSOs this quarter to effectively engage with local governments but other indicators for this region feel short of their targets with Ramadan observations. There were several key challenges affecting implementation, most notably: the limited number of LAPM outreach activities conducted in conflict affected areas (CAAs); the inability to deploy trainers to do supportive supervision as security threats not only in ARMM but also in some provinces in other regions like SOCCSKSARGEN, CARAGA, Northern Mindanao, and Zamboanga Peninsula continued to persist, and the moderate scale-up of DQCs. MH will amplify corresponding measures in the remaining quarter of PY4 with specific strategies consistent with the Health Agenda of the new administration to address these challenges.

Introduction

This report covers the period from April 1 to June 30, 2016 of project implementation. During the current quarter, MH focused on the following technical priorities: Accelerate strategies to reach PY4 targets for CYP:  Expand long acting and permanent methods (LAPM) outreach activities, particularly in geographically isolated and disadvantaged areas (GIDA);  Conduct supportive supervision (i.e., post-training follow up) to health providers who have received postpartum family planning (PPFP)/postpartum intrauterine device (PPIUD) and bilateral tubal ligation (BTL) training to ensure application of newly acquired skills and to receive certification as providers from DOH RO. Prioritization of supportive supervision is in response to the challenge that many training recipients (as high as 50% in some provinces) do not practice skills post-training, due to lack of confidence or inadequate demand for services;  Facilitate inclusion of and collect reports among previously non-reporting SDPs, specifically hospitals (public and private) and private clinics;  Expand DQCs to hospitals and the private sector; and  Advocate for the increase in the hospital schedules on LAPM/LARC services, while expanding SDPs providing LAPM/LARC services. Engage the private sector to ensure that a wide contraception method mix is available to clients. Following the Temporary Restraining Order (TRO) on implants, MH is strengthening private sector collaboration, including strengthening linkages between the public and private health facilities for referrals in the service delivery network (SDN), logistics, reporting and DQCs. Strengthen demand generation activities for LAPM and link with outreach and fixed facility services to provide comprehensible information on wide range of FP services and to address cultural barriers, myths, and misconceptions on FP services. Garner further buy-in from DOH retained hospital officials and regional representatives on the AYRH program and build the capacity of hospitals to provide high-quality AYRH services. Sustain support to the establishment of six MH-supported SDNs, while continuing technical assistance to DOH-ROs and PHOs to the other 18 DOH-supported SDNs.

This report is organized as follows: a) the “Progress against Performance Indicators” section summarizes achievements in this reporting period against the “MUST” indicators; b) “Analysis of CYP and FP Users, Overall and by Region”, which provides further analysis of progress against the project’s two foremost indicators; c) the “Narrative of Key Achievements and Recommended Measures by Strategy” describes accomplishments by the three project strategies and objectives against the workplan and proposed measures for the next quarter to move MH forward; d) “Program Management” summarizes progress in Monitoring, Evaluation and Research, Communications, Human Resources, Administrative and Financial Management; e) “Challenges and Solutions”; and f) Annexes.

Progress Against Performance Indicators

This section summarizes progress towards the seven (7) of the eight (8) PY4 “MUST” indicators in the Performance Monitoring Plan (PMP), including current users and fourindicators for Conflict Affected Areas (CAAs). The indicator on utilization of DOH regional budgets is an annual indicator and this will be reported at the end of PY4. The sub-headings of the “MUST” indicators summarize the progress in the reporting period. Indicators that report Field Health Service Information System (FHSIS) data, such as CYP, CU, and EBF present progress for Q2PY4 while indicators using project databases present progress for Q3PY4. 1. Continuous increase in CYP during the last three (3) quarters but acceleration to reach PY4 target is still needed CYP increased in both Q1 PY4 Figure 1: Mindanao Health CYP, Q4 PY2-Q1 PY4 and Q2PY4 over the previous two quarters such that the cumulative accomplishment to date reached 53% of the annual target (see Figure 1). 98,444 The increasing trend in CYP is 82,077 84,181 due to the increasing number 71,220 of acceptors of BTL and IUD 67,085 68,437 (interval and postpartum) 55,431 resulting from more outreach and report collection from private providers in Davao and Northern Mindanao Total Couple Years Protection regions. In the last three quarters, acceptors of LARC- Q4 PY2 Q1 PY3 Q2 PY3 Q3 PY3 Q4 PY3 Q1 PY4 Q2 PY4 PSI dramatically decreased compared to PY3 as the Temporary Restraining Order (TRO) on “procuring, selling, distributing, dispensing or administering, advertising or promoting Implanon and Implanon NXT” took effect.

In Q1 and Q2 of the current program year, MH contributed 18% (2,970) to the total 16,439 LAPM acceptors, a rate lower than the 40% PY3 average. This resulted from the decline in fixed facility services that also outweighed the increase in the number of outreach services provided. To address the latter, MH is increasing supportive supervision activities to help increase providers’ confidence and support demand creation for services. However, challenges in achieving a higher coverage of supportive supervision remain. For instance, despite MH support, roughly half 434of the total 789 (55%) providers trained in PPIUD have been visited for supportive supervision (including enhanced objective structured clinical examination) to date. The low coverage was due to inadequacy of master trainers within the health system in Mindanao to conduct supportive supervision, dependency on availability of external consultants, the availability of whom is influenced by security threats in Mindanao, and insufficient implementation of an organized supportive supervision schedule brought about in some instances by unplanned activities in the localities. Despite these challenges, MH has mobilized PPIUD trainers in some provinces to mentor and coach trained health service providers, which resulted in 130 providers mentored/supportively supervised in Q3PY4 alone. MH will continue to address these challenges in the upcoming quarter, including supporting the DOH ROs to integrate supportive supervision activities into

4 current post-training evaluation activities, and to build capacity of pool of trainers as well as developing existing junior and mid-level trainers as master trainers. In Northern Mindanao, for instance, a two-month capacity-building activity focused on providing supportive supervision to providers for all methods has been scheduled. 2. Increased in overall number of FP current users from previous quarter, (with the exception of Davao and CARAGA regions) In this reporting period, current FP users declined by about 3% in comparison to the previous quarter. The overall trend from PY2 to date reflects an increase in number of current users. Progress against the Q2 target was 79.5%. All regions had increases in current FP users in the last four quarters, with the exception of Davao, where DQC activities resulted in a reduction of approximately 33,000 users. The reduction in Davao was largely attributable to DQC activities where midwives used loose sheets, as opposed to the standardized target client list (TCL), for recording clients. It is expected that the figure will rebound when Davao finishes migrating data into the standardized forms. The most common reason for a large variation in FP CUs before and after DQC is that lactational amenorrhea method (LAM) acceptors are not re-classified as drop-outs after six months. Approximately 30-60% of new acceptors are LAM; therefore, removing LAM acceptors after six months will affect total FP current users. While Davao region’s number of current FP users declined, there were increases in BTL and IUD/PPIUD cases reported in the cities of Cagayan de Oro and Davao, as a result of the facilities cleaning data and including previously unreported cases in year-end reports. MH is also expanding its partnership with the private clinics and hospitals, in close collaboration with LGUs, to expand clients’ access to contraceptive methods, and thus, would include their FP/MNCHN accomplishments in FHSIS, the main source of this indicator. 3. Added 56 new facilities to the network of SDPs providing FP/RH services bringing the total to 622 SDPs resulting in 81% coverage of the PY4 target From 566 SDPs during the previous quarter, the network of SDPs with trained provider on FP competency-based training (CBT)-1 and thus capable of providing FP/RH services grew by 10% during the quarter as 56 SDPs were added thus bringing the total to 622 SDPs, or equivalent to

Figure 2: Current User Trends by Region (Q4 PY2-Q2 PY4)

350,000

300,000

250,000

200,000

150,000

100,000

50,000

0 Q4Y2 Q1Y3 Q2Y3 Q3Y3 Q4Y3 Q1Y4 Q2Y4

ARMM ZAMBOPEN SOCCSKARGEN DAVAO NORTHMIN CARAGA

81% of the PY4 target of 649 out of 764 SDPs. The recently added SDPs are mostly from the Davao and SOCCSKSARGEN regions, and 52 or 93% of these facilities are privately-owned. The influencing factors for this positive growth include: a) the complete buy-in and cost-sharing between MH and DOH-ROs of Davao and SOCCSKSARGEN; and b) the introduction of the more acceptable four-day staggered FBCBT1/balanced counseling strategy plus (BCS+) training module/design for medical doctors in lieu of the five-day FPCBT1 course. The call of the new administration for a serious review of approaches to limiting family size and addressing teen-age pregnancies will likely further spur this growth and enable MH to reach its PY4 target. 4. Accomplished a slight increase in the number of women provided information on EBF

Data for this indicator is drawn from facility and community-activities where information on EBF is provided: a) at the facility level, the number of women delivering in a health facility is used as a proxy indicator; and b) at the community level, health events, such as Buntis Party/Congress and USAPAN sessions are reported. Overall, MH remains on track to meet the PY4 target, as the cumulative accomplishment for the last two quarters (Q4 PY3 to Q3 PY4) is equivalent to 86%% (144,345 out of the 315,384) of the total PY4 target. There are report challenges with this indicator, particularly in Zamboanga Peninsula and Northern Mindanao, where only annual reports on health facility delivery are available. 5. Scaled up DQCs to an additional 68 LGUs, resulting in 39% coverage of the PY4 target The number of LGUs conducting DQC doubled from 71 to 139 during the quarter in review as project sites became increasingly involved in the roll-out of this activity. The number represents LGUs conducting MH-supported DQC activities as well as those initiated by the LGUs themselves. A total of 632 doctors, nurses and midwives were involved during the quarter.

Implementation of DQC continues to be a substantial challenge for MH. The project is confronted with: 1) non-universal commitment and action by LGUs to conduct DQC at all SDPs down to village level; 2) issues with data quality, resulting from the growing scale of the DQC implementation; and 3) the current DQC methodology, which does not include hospitals and private sector facilities. MH is addressing these challenges by: 1) advocating with municipalities on the benefits of DQC, including mainstreaming the activity so that DQCs are conducted at least each quarter and cover most facilities under each municipality/city 2); supporting LGUs and facilities to better understand the DQC methodology via on-site coaching through MH LGU Advisors (LGUAs); 3) building capacity and tapping into the Development Management Officers (DMOs) or the DOH Representatives to act as resources in DQCs; 4) engaging current non- reporting hospitals and private sector facilities to participate in DQCs; and 5) continue collaborating with the Zuellig Family Foundation (ZFF) to become another sustained proponent of DQC.

6. Expanded SDPs providing AYRH services from 19 to 24 With an additional five (5) adolescent and youth (AY) centers established during the current quarter, the project now has a total of 24 functional hospital-, RHU-, and NGO-based-teen centers.1 Three (3) of the five (5) additional AY Teen Centers are in CARAGA (Bunawan District Hospital in Agusan del Sur, Remedios T. Romuldez RHU in Agusan del Norte, and San

1 A teen center is considered functional if it meets the following criteria: a) it has a private counseling room; b) it has a trained provider in adolescent job aids (AJA); c) it uses the HEEADSS forms for the early detection of risky behaviors, such as engaging in early sex, cigarette smoking, substance abuse or experience of physical or sexual abuse, and bullying; and d) it has available service record/logbook.

Francisco RU in Agusan del Sur). While there are 877 health workers trained on AJA in about 150 LGUs, the buy-in of the LGUs to establish youth-friendly services is a gradual process, thus, only 25 were established. Consequently, these 25 SDPs are now the main focus of MH technical support for sustainability purposes. MH has developed a prototype Operational Guide and executive order/policy for the LGU to adapt within the local setting/context.

7. Reduced stock-outs on FP commodities at 4% While the total number of SDPs with stock-outs increased during the quarter to 34 from nine (9) in the previous period, overall stock-out rate remains low at 4%. Stock-outs have been reported mostly in SOCCSKARGEN (5), Zamboanga Peninsula (5), and CHO CDO (9). Stock-outs in these areas did not even linger as these were verified by MH LGU Advisors, immediately followed-up and resolved by the DOH ROs. FP Logistics Hotline is continuously gathering reports of stock- out, overstocks and consumption of FP Commodities by RHUs/MHOs/CHOs in Mindanao. The strengthened implementation of demand generation and tracking of commodities by PopCom at the ground have played a role in this accomplishment. MH supported the LGU by informing the PHO and Population Offices regarding the menu of options to sustained reduction or avoidance of commodity stock-out occurrence.

8. Attained 73% (266/366) of LGUs utilizing PhilHealth reimbursements per guidelines An additional two LGUs in North Cotabato passed an ordinance adopting Philhealth reimbursement guidelines resulting in a total of 266, or 73% of the PY4 target. All the midwives interviewed in 57 facilities in Northern Mindanao expressed satisfaction on the share received from the Philhealth capitation fund. Close follow up and advocacy to the ZFF MLGP LGU graduates were helpful.

9. Limited implementation of LAPM outreach activities conducted in conflict affected areas During the reporting period, the DOH ARMM issued Memorandum Order 2016 s 10004884 which imposed aaoratorium restricting activities other than supporting the Tetanus Elimination campaign from January to March 2016. As a result, outreach activities to provide LAPM and REACH (++) initiatives were constrained, coupled with the onset of the campaign period for national and local elections, and heightened security issues within ARMM. Only two LAPM outreach services or a cumulative total of 15 out of the more than 200 planned for the quarter were conducted in Maguindanao and Sulu, reaching only 17 BTL and 7 LARC/PSI by the private sector. This is in addition to six outreach services conducted in Basilan and Maguindanao during Q1PY4, reaching eight BTL and 150 LARC/PSI. UNYPHIL and Arches remain as key private partners. Since limited outreach activities deprive basic MNCHN/FP services to GIDAs and CAAs in ARMM, MH will continue to address this challenge in the upcoming quarter.

Table 1. Progress against performance indicators, as of Q3 PY4

Cumulative FY 2015 TARGET Q3Y4 Accomplishments by Region IND. Accomplish‐ Indicator Baseline Perfor‐ REF. ment as % of mance NORTH SOCCK‐ ZAMBOANGA Q3Y4 Target 2016 Q3Y4 ARMM CARAGA DAVAO MIN SARGEN

FP 1 Current Users of 1,070,486 1,244,594 1,369,053 1,334,892 157,215 94,037 267,592 245,044 326,684 244,320 79% Modern FP Reported figure is Q2Y4 data as per M&E TWG Agreements.

FP 2 Couple Years 228,438 279,334 472,767 236,384 4,231 11,362 26,399 25,226 14,013 18,233 78% Protection in USG supported Reported figure is Q2Y4 data. Reported figures include reports from private sector programs (CYP) providers/facilities.

BTL acceptors are at their highest levels, due to the collection of reports from partner hospitals and private providers that have not been included in the FHSIS reports (particularly in Davao City, Cotabato City, and Cagayan de Oro City). In Misamis Oriental and Zamboanga del Norte, part of the data cleaning process resulted in the inclusion during the quarter of previously missed LAPM cases.

PPIUD/IUD acceptors remain a significant proportion of the aggregate FP acceptors.

LARC‐PSI acceptors, which accounted for a third of the total number of acceptors in the previous quarters, continued to decline due to the TRO. However, increasing private sector involvement is slowly reversing the trend among PSI acceptors as shown by the figures for SOCCSKARGEN, Davao and Zamboanga Peninsula.

Overall, there is also a significantly lower number of BTL and PPIUD acceptors. The project contribution of LAPM supported activities also decreased from an average of 39% in PY3 to 18% in the quarter. FP 3 Percent of USG‐ 24% 42% 4% 4% 0% 0% 0% 1% 5% 1% 111% assisted SDPs that experience a stock‐out at any time during the defined reporting period of any contraceptive method that the SDP is expected to provide Numerator 302 532 31 31 0 0 0 1 5 1 Cumulative FY 2015 TARGET Q3Y4 Accomplishments by Region IND. Accomplish‐ Indicator Baseline Perfor‐ REF. ment as % of mance NORTH SOCCK‐ ZAMBOANGA Q3Y4 Target 2016 Q3Y4 ARMM CARAGA DAVAO MIN SARGEN

Denominator 1,270 1,270 764 764 155 55 154 156 111 133

Stock‐outs have been reported mostly in SOCCSKARGEN (5), Zamboanga (5), and CHO CDO

(9 BHS). FP 4 Percent of USG‐ 25% 64% 85% 80% 75% 78% 96% 58% 105% 80% 93% assisted service delivery points (SDPs) providing FP counseling and services Numerator 198 494 649 610 117 43 148 90 117 107 Denominator 777 777 764 764 155 55 154 156 111 133 Additional 56 public and private SDPs from SOCCSKARGEN and DAVAO region thus bringing the total to 622 SDPs, or equivalent to 81% of the PY4 target of 649 out of the total 764 SDPs. The influencing factors for this positive growth include: a) the complete buy‐in and cost‐sharing between MH and DOH‐ROs of Davao and SOCCSKSARGEN; and b) the introduction of the more acceptable four‐day staggered FBCBT1/balanced counseling strategy plus (BCS+) training module/design for medical doctors in lieu of the five‐day FPCBT1 course. The call of the new administration for a serious review of approaches to limiting family size and addressing teen‐age pregnancies will likely further spur this growth and enable MH to reach its PY4 target. MCH 3 Number of women 280,851 315,384 157,692 11,249 5,648 16,255 10,763 11,722 5877 86% reached with education on exclusive breastfeeding There are incomplete reports from Zamboanga Peninsula particularly Zamboanga del Norte, Zamboanga del Sur, and Zamboanga Sibugay due to annual reporting of natality data. NEW Percent of USG‐ 0% 15% 11% 22% assisted SDPs providing FP/RH 0% 13% 2% 7% 4% 0% services for adolescents and youth Numerator 1 115 87 0 7 3 11 4 0 Denominator 836 764 764 155 55 154 156 111 133 An additional 6 SDPs during the period. Figure is cumulative.

NEW Percent of budget 74% 74% 80% Annual Annual Annual Annual Annual Annual in DOH regional indicator indicator indicator indicator indicator indicator offices utilized for FP/MCH For reporting at the end of the year.

NEW Percent of LGUs 56% utilizing PhilHealth 54% 54% 72% 68% 99% 81% 39% 68% 47% 86% reimbursements per guidelines Numerator 198 198 263 247 116 21 15 48 20 61 Denominator 366 366 366 366 117 26 38 71 43 71

No additional LGUs with policy and utilizing PhilHealth reimbursements per guidelines. Q1Y4 figure is baseline.

MH however directly‐assisted 49 LGUs, which earlier participated in the Health Leadership and Governance Program of the Zuellig Family Foundation (ZFF), developed their PhilHealth reimbursement policy. These, however, are on‐going activities. For the remaining quarter of PY4, another 52 LGUs are targeted to be provided assistance in partnership with the ZFF and the DOH Reps. NEW Percent of LGUs 52% conducting data 73% 73% 79% 78% 9% 21 74% 56% 5% 54% quality checks (DQC) annually Numerator 268 268 290 285 10 26 28 40 2 38 Denominator 365 365 365 365 117 26 38 71 43 71

The number of LGUs conducting DQC doubled from 71 to 139 during the quarter in review as project sites became increasingly involved in the roll‐out of this activity. The number represents LGUs conducting MH‐supported DQC activities as well as those initiated by the LGUs themselves. A total of 632 doctors, nurses and midwives were involved during the quarter.

PPR Indicators

CAA1 Number of health 336 134 410 308 12 5 7% outreach conducted Observance of Ramadan limited outreach activities. Figure is additional outreach conducted during the period.

CAA2 Number of civil 0 1 8 6 5 83% society organizations (CSOs) trained to Maguindanao – effectively engage (3) Youth Governance of Upi, Couple’s for Christ and UNYPHIL capacitated and engaged with local on PEER to PEER governments Sulu ‐Paanakan Initiative in Talipao (52 TBAs) Patikul (127 TBAs). CAA3 Number of youth 0 37 150 113 47 0% trained as peer educators Figure is for Maguindanao only

CAA4 Number of clients 53,448 11,035 38,500 28,875 121 83 56 0% reached during health outreach Observance of Ramadan limited outreach activities activities

Analysis of CYP and Current FP Users, Overall and by Region

This section provides further analysis of the project’s top-line indicators: current FP users; and CYP. Data as of Q3PY4 in Figure 2 suggests that the combined action of MH, DOH, and LGUs have led to a general improvement in both key indicators over time. For Q1PY4 to Q2PY4, there were a total of 30,438 acceptors of LAPM and LARC broken down as follows by type of FP method used: BTL (8,800); NSV (268); PPIUD/IUD (18,343) and LARC/PSI (3027). These translate to a CYP of 182,625 and an accomplishment rate of 39% of the PY4 target of 472,767. On a quarterly basis, the Q2PY4 report of 16,439 LAPM/LARC acceptors which translates to a CYP of 98,444 is 21% higher than the CYPs posted in Q1PY4. These achievements, notwithstanding, MH needs to accelerate its efforts towards ensuring the availability to and accessibility by intended clients of accepted contraception methods.

Figure 3: Total LAPM Acceptors (FHSIS) and MH Figure 4: CYP Contribution by Region Contribution

18,000 16,450 16,567 100% 100,000 15,301 16,000 14,001 13,999 14,000 12,378 80% 75,000 12,000 60% 10,000 8,611 50,000 8,000 5,913 6,135 40% 6,000 25,000 4,000 2,808 2,970 1,857 20% 2,000 0 ‐ 0% Q3Y3 Q4Y3 Q1Y4 Q2Y4 Q1 PY3 Q2 PY3 Q3 PY3 Q4 PY3 Q1 PY4 Q2PY4 ARMM REGION IX: ZAMBO PEN Region XII: SOCCSKSARGEN Region XI: Davao Region MH Supported LGU (FHSIS) % MH Contribution Region X: Northern Mindanao Region XIII: CARAGA Region

Figure 6 summarizes FP clients served from among trained fixed providers and outreach activities directly assisted MH and DOH. Due to the TRO on PSI and reduced outreach services, the number of LARC-PSI clients significantly dropped from 13,958 in PY3 to just 1,605 as of Q3PY4. However, LARC-PSI clients tripled in number during the current quarter compared to the previous quarter of PY4. These changing patterns could be attributed to the innovative approaches on public-private partnerships and joint activities to strengthen capacities of fixed providers and trainers adopted by partners, as well as the provision of LAPM and LARC through post-partum (PPIUD) and interval IUDs.

The overall performance of Figure 5: Total Clients Served from Fixed and Outreach Activities the health sector on Supported by MH LARC/PM especially in Muslim communities was affected and limited by the peace and order situation, the elections in May 2016 and followed by the observance of Ramadan. In the Autonomous Region of Muslim Mindanao (ARMM) in particular, CYP performance dropped during the quarter under review as reports from its three (3) provinces remained unaccounted for. Even then, the region has the highest number or highest proportion of non-practicing PPIUD provider-trainees. This trend is slowly being reversed in Basilan, Maguindanao and parts of Sulu. Capacity building for trainers and providers on LARC/PM has been intensified especially BTL, PPIUD both for public and private partners and LARC/PSI with the private sector. Meanwhile, private sector partnership with Marie Stopes (MSI), ARCHES and other individual private providers has been intensified for client generation, joint planning, referral and service provision. Still in Maguindanao, the need by PPIUD health service providers for supportive supervision remains evident. Regional performance in Zamboanga Peninsula was boosted through multi-agency partnership among DOH, POPCOM, LGUs and private sector in the provision of fixed and outreach LARC/PM services, purposive identification of clients with unmet need, and referral of informed clients to capable trained service providers and health facilities. The creation of 4 BTL-MLLA teams (2 from ZCMC, 1 from CHO and 1 from private sector) in Zamboanga City has contributed to reaching about 156 cleint with BTL services, a joint undertaking of Zamboanga City Medical Center, OCSWD, MSI, and City Health Office. Similarly, outreach services on LARC/PM in Zamboanga del Sur, Zamboanga Sibugay, Zamboanga del Norte and Isabela City were intensified with project’s support, in partnership with DOHRO, MSI, and Friendly Care, in addition to existing fixed services in supported hospitals in these three provinces. The total number of FP acceptors serviced by fixed government facilities with MH assistance in Northern Mindanao Region in Q3PY4 reached 1,363 corresponding to a CYP of 9,612. During the same quarter, the private sector brought in a total of 687 acceptors with an equivalent CYP of 3,125. By type of FP method, 288 acceptors opted for IUD/PPIUD while 106 acceptors chose BTL. The PSPI-MSI accepted 101 clients for BTL. PSI-recipients serviced by the private sector reached 292 clients. Taken together, the region achieved 80% of the annual target for both number of acceptors and equivalent CYP and this could be attributed to: 1. The availability of five (5) master trainers on PPIUD and an additional nine (9) trainers at the LGU level, complemented by the presence of several potential practicum/preceptor sites; 2. The recognition by the DOHRO leadership of the emerging “good practice” models through MH efforts, as well as the need to move them forward in an

organized/systematic manner. An example is the contribution of the private sector and hospitals to increasing CU/CYP; 3. The outreach activities undertaken by MSI in GDH- Valencia and GDH- CDO and LGUs MCP facilities upon request of the LGUs despite the prohibition imposed by the Governor of Bukidnon on MSI from conducting outreach activities in provincial hospitals; and 4. The active involvement of non-government organizations (NGOs) like the MSI and FPOP as PSI providers despite the TRO on PSI/SDI. In Davao Region in addition to existing fixed facilities both public and private providing LAPM services, 16 LARC/PM outreach activities were supported, in partnership with MSI, and LGUs. In Davao city alone, about 534 clients that were reached by 4 private facilities namely MSI, Friendly Care, Davao Doctors and Brokenshire, including SPMC, government-managed facility. These accomplishments are already recorded in appropriate District Health Offices of Davao City, with support from the project. Implementation of FP/MNCHN services in the region is challenged by; (a) the low frequency of LAPM/LARC services; and (b) the under-reporting/non- collection of reports from private clinics/birthing facilities and hospitals. Furthermore, while there are improvements in the conduct of USAPAN sessions, more need to be done to ensure that no current users are participating in USAPAN sessions but rather advocate to non-users, private sectors are knowledgeable and engaged in USAPAN Sessions, and the gap between service provision and USAPAN Session are narrowed down. Figure 6: Couple Years Protection (By Region, Accomplishment Q3 PY3-Q1 PY4)

SOCCSKSARGEN Region remains the highest CYP contributor. For the quarter a total of 17 LAPM outreach services were supported, in addition to 5 fixed BTL hospital facilities. In addition, practicum phase of training and supportive supervision activities were optimized to provide services, by conducting demand generation activities prior to these activities, in close collaboration with the LGUs and private partners. In Caraga region, the increase in accomplishments can be attributed to the improved coordination among DOH-RO, MSI and PHO officials and staff, with the project’s continued support; massive build-up of capable providers through FPCBT2 trainings of health providers with indetification of eight (8) prospective trainers among the trained health service providers; and inclusion of the accomplishment of private sector providers in Butuan City. Comparing the six regional units (Figure 6), Northern Mindanao shows sustained CYP increases in the last four quarters although tapering off in the last quarter. Davao and CARAGA, on the other hand, show high variability in the reported cases across four (4) quarters, while ARMM

14 has even gone down. Davao Region is apparently the highest CYP contributor to the project. For ARMM, despite considerable training in PPIUD, it has the most number or proportion of non- practicing PPIUD providers. It is reported, for example, that of the 48 MH-trained providers in Basilan and Sulu only seven (7) are practicing. Likewise, in Maguindanao, all 22 PPIUD health service providers need supportive supervision to further reinforce their confidence. BTL coverage started to decline in Q3PY3 but slowly increased in Q4PY3 marked with dramatic increases for Davao and SOCCSKSARGEN regions in Q1PY4 compared to the slow but steady increase in Northern Mindanao Region (Figure 5). Most of BTL-trained providers that are functional and trainers are located in these 3 regions, in addition to MSI support to outreach services. No outreach services were conducted due to lack of support to FP programs by the chief executive of one LGU in the CARAGA region. This, plus the fact that only two capable facilities available in the region, could have contributed to the erratic trend in the Region. It is expected that with a pool of newly trained health service providers in ARMM available, coverage will increase in the succeeding quarters. Figure 7: BTL Acceptors (By Region, Accomplishment Q3 PY3-Q1 PY4)

Voluntary PPIUD/IUD acceptors started to increase in all regions in Q1PY4 except Northern Mindanao after some backlash in Q4PY3 (Fig 6). Despite 793 trained on PPIUD and 670 on Interval IUD, the yield is not much, for reasons that there are significant numbers trained that do not practice their skills after training for lack of confidence and inadequate supportive supervision; and quality of demand generation initiatives needs more strengthening to improve yields.

Figure 8: PPIUD/IUD Acceptors (By Region, Accomplishment Q3 PY3-Q1 PY4)

Narrative of Key Achievements and Recommended Measures by Strategy

This section highlights progress made on key milestones by project component and/or strategy and also recommended measures by strategy to move MH forward.

Strategy 1: Strengthening MNCHN/FP/RH service delivery

Strategy 1 Key Achievements:

 Increasing number of LARC/PM outreach services in partnership with the private sectors, DOHRO, POPCOM and LGUs.  Increrase frequency in the provision of fixed FP services.  Conduct of supportive supervision and training activities optimized to provide LARC/PM services to counseled clients.  Adequate certified trainers with capacity to support DOHRO on supportive supervison/post-training evaluation.

1.1 Establishment of an integrated FP/AY program in 13 targeted hospitals Strengthening FP programs in hospitals is slowly picking up with varied level of development upon the completion of the readiness assessment in all thirteen (13) hospitals revealing the inadequacy to lack of demand generation and behavorial change communication initiatives within the hospitals; building capacities of hospital core teams on FPCBT1/BCS+, issuance of hospitalorder on FP Programs, and the conduct of nine (9) workshops to initially draft operational guide. Given the limited information from the readiness assessment and the challenges faced during the initial drafting of the operational guide, the initial assessments will be revisited with a follow- through more in-depth Table 1 Hospitals selected for implementation of integrated FP/AY program analysis that will guide No. Province Hospital hospital core teams in coming 1 Basilan 1. Basilan General Hospital up with a plan of action and 2 Maguindanao 2. IPHO-Maguindanao Hospital finalization of their 3 Zamboanga City 3. Zamboanga City Medical Center 4 Zamboanga del Sur 4. Zamboanga del Sur Provincial Hospital Operational Guide responsive 5 Cagayan de Oro City 5. Northern Mindanao Medical Center (NMMC) to their hospital settings and 6 CDO City 6. JR Borja Medical Center (JRBMC) context. The project, with 7 Misamis Oriental 7. Misamis Oriental Provincial Hospital (MOPH- Gingoog City support and guidance from 8 Davao City 7. Davao Regional Medical Center (DRMC) FP/RH Global Director and 9 8. Southern Philippines Medical Center (SPMC), MindanaoHealth/Jphiego 10 9. Brokenshire Memorial Hospital management, will continue to 11 Cotabato City 10. Cotabato Regional Medical Center (CRMC) tighten its strategic support in 12 South Cotabato 11. South Cotabato Provincial Hospital 13 Sultan Kudarat 12. Sultan Kudarat Provincial Hospital the coming quarter to establish 14 Surigao City 13. DOH-Caraga Regional Hospital a robust FP programs in these 15 LDN GTLLUCH Memorial Hospital hospitals. 16 Davao del Sur DDS Provincial Hospital

1.2 Continue support to the provision of LARC/PM+ services of choice

Intensify LAPM through need-based outreach services Only 42 MH-supported outreaches were conducted during the quarter reaching a total of 932 FP clients, in partnership with the Centers of Excellence, MSI, Jerome Foundation and teams from the provincial hospitals. Field reports reveal that the provinces of Zamboanga del Sur, Misamis Oriental, Sultan Kudarat and Davao del Sur were the top 4 performers on LARC/PM events this quarter. Other provinces had less than one event. Limited outreach resulted from lingering effects of the issuance of DOH ARMM Memorandum Order 2016 s 10004884-which imposed a moratorium on the campaign for Tetanus Elimination during the pre-election period, the post-election changes in various local administrations, and the increasing security- related incidences which affected personnel movement. Moving forward, MH shall focus on: a) continuing partnerships (e.g. MSI, etc.) to plan and diligently implement LARC/PM+ outreach services, in partnership with LGUs ; b) engaging the private sector/birthing homes to expand FP/LARC/PM services and to share reports/data; c) tapping community volunteers and Nurse Deployment Program (NDPs) in tracking FP unmet needs; d) using couple/individual counseling sessions to address fears, myths/misconception; e) giving assurances on local support system, companion of choice and securing consent (and assent from minors); and f) strengthening collaboration with POPCOM and DSWD on demand generation activities.

Institutionalize regular/fixed services To ensure sustainability of LARC/PM+ services in Mindanao, aside from increasing the number of health facilities providing wide range of FP services, MH continues to advocate for the institutionalization of regular schedules for LAPM/LARC services in COEs, lower level hospital facilities and birthing homes in established SDNs. For the latter two types of facilities, the integration of regular schedule of services in a continuum care of services enables them to comply with DOH licensing requirement and PhilHealth accreditation. Moving forward, MH shall focus on: a) establishing and finalizing the operational guide on integrated FP/AY program for the 13 targeted hospitals; b) sustaining advocacy to increase and standardize the provision of fixed services (i.e., from weekly to twice weekly, etc.); c) conducting advocacy and supporting the expansion of FP services to other strategic health facilities; d) sharing information on “readiness” to clients, volunteers, and local partners; e) ensuring compliance to ICV, not only encouraging written consent; f) referring clients with companion of choice to attend schedules of fixed providers; g) facilitating supportive supervision of trained health service providers; and h) continuing technical support to establishment of FP/AY programs in 13 hospitals also in close collaboration with ZFF as they have some MNCHN initiatives already in some of these hospitals. 1.3 Increase SDPs and training institutions with capacity on FP/MNCHN services

Ensure quality of care, continuous assurance and sustainability through capacity building MH engaged 14 master trainers, of which 97% 13) are master trainers on PPIUD; six mid-level trainers and 50% are BTL trainers; and four junior trainers , 75% as trainers on BTL to: a) provide guidance on observing clinical standards; b) identify and gradually develop potential trainers from the providers pool; c) supervise candidate-trainers; d) develop tools/ job-aides or learning resource packages; e) transfer technologies through training of health service providers; and f) periodically review quality performance using standards checklists.

Build capacity of additional trainers, and health service providers on LARC/LAPM Services

Through MH support, an additional 78 service providers were trained on LAPM/LARC, consisting of: 19 on FPCBT2; 15 on PPIUD; and 45 on BTL/MLLA. As a result, 660 health service providers have the knowledge and skills to provide interval IUD services; 793 health service providers on PPIUD; and 186 with capacity to do BTL/MLLA. Supportive supervision is also gaining traction. During the quarter, service providers were supervised and A trained health provider from Brokenshire Memorial DOH-certified: 36 on interval IUD; 203 on Hospital in Davao City prepares a patient for subdermal PPIUD; and six on BTL/MLLA. Twelve (12) implant insertion following voluntary one‐on‐one BTL trainers in Q1 PY4 conducted roll-out counseling. (EPleños/Jhpiego) trainings, while being supervised by master and mid-level trainers, and reached 45 health service providers. The trainers were recommended for DOH certification; four received certificates and the others are waiting. Based on lessons learned to date, a “how to” guide for conducting supportive supervision has been drafted and will be finalized in consultation with regional partners.

Expand SDPs providing FP counseling and services and essential intrapartum and newborn care (EINC) services MH supported the training of 59 service providers on FPCBT1, resulting in a total of 2,519. More importantly, continued MH advocacy encouraged the five DOH regional offices to provide higher cost-shares for FPCBT1 training to expand SDPs providing counseling and short-acting FP services. In collaboration with DOH-ROs, MH trained an additional 59 health service providers on EINC, resulting in a total of 1,058 EINC-trained partners. Supportive supervision resulted in 23 EINC-trained health service providers recommended for DOH certification.

1.4 Inroduction of Misoprostol as Alternative to Oxytocin in selected GIDAs of Sulu

This initiative is challenge with the inability to bring into the country misoprostol drug, since it is not a registered drug in-country. ring Two letter requests to import misoprostol, within the context of ARMM Reproductive Health Care Act of 2012, were forwarded to FDA by DOH- ARMM with support from the project, after informal discussion with some FDA staff, but no official response yet. as they are still consulting their legal unit. Parallel to this effort, another track is being explored in coordination with DKT, , a company that has expressed interest to register the drug in-country.While follow-ups were being done to import the drug, , the project continued to support other technical aspect which resulted to an updated RACI template that clearly delineate roles and responsibilities of HQ, Country Office and DOH-ARMM, drafted Ghannt Chart, reviewed study protocol and training materials on Miso used by other countries, and finalized Scope of Work of a consultant to help translate simple tools in three dialect, commonly used in the province of Sulu.

1.5 Expand AYRH services

Hospital-based Center for Teens Led by the DOH-RO11 and the Davao Regional Medical Center, the project supported the

18 hospital formally launched its Adolescent & Youth Wellness Clinic. As of this quarter, a total of 15 hospitals were engaged, capacitated, and equipped towards enhancing RH/ FP-MCH services for young people through the Center for Teens program. Conscious and proactive efforts to reach-out to adolescent and youth clients resulted in a total of 1,036 AYs (Brok-238; Royeca-111; SCPH-276; CRMC-42; ADNPH-216; DOPMC-21; DRMC- 132) being counseled using the HEEADSS risks assessment. One hundred youths (SCPC-16; ADNPH-81; DOPMC-3) were provided with FP services and products, while 429 accessed perinatal care (SCPH-126; CRMC-33; ADNPH-135; DOPMC-3; DRMC-132).

AY-friendly Ready RHUs A total of 76 RHUs (R10-11; R11-10; R12-4; R13-2; ARMM-48) were capacitated and in varying degrees of implementation towards transforming their facilities to be youth-friendly.2 Being the most common first-contact SDPs for young mothers seeking ANC, and considered referring agents to tertiary level facilities, MindanaoHealth assists RHUs in LGUs where hospital-based Centers for Teens are also located, or accessible to a hospital like in ARMM wherein there is no CEmONC facility. During the quarter, the TA provided by the project to the LGU of Davao City in conducting the workshop on the development of the operational guide for RHUs resulted in the preparation of the draft Guide for integrating services responsive to the needs of young people. The Guide will be used in 8 pilot RHUs of the City and will be used as template for assisting other RHUs.

Campus-based AYRH To date, a total of 41 educational institutions have been engaged, and provided varying support towards: a) institutionalizing HEEADSS risks assessment as part of their routine student profiling and daily operations; and b) building the capacities of peer facilitators to facilitate ASRH peer education sessions. During the quarter, the project supported two (2) batches of youth peer education training on ASRH (UsapangBarkadahan) for peer facilitators of 16 engaged schools, i.e., 8 schools from Davao del Sur and 8 schools from North Upi, Maguindanao. The latter was a joint initiative of IPHO, LGU of North Upi, and MindanoHealth to assist Upi strengthen its youth program in 6 national high schools.

Expand access to FP/RH counselling and services in hospital setting In addition to what has been stated in 1.1, 124 adolescents and youths were provided with various FP-RH services through HEEADS psychosocial risks assessment and counseling in General Santos City Hospital -Center for Teens. Of the 124: two of the 89 young mothers accessed PPIUD services after parental consent was secured; 10 accessed STI/HIV counseling and services; 20 were referred to Women & Children Protection Unit (WCPU); and five availed of medical services. 20 Expand access to FP/RH counseling and services in community- level health facilities (RHUs-BHSs, private midwife clinics, NGO clinics)

2 An RHU is considered AY-friendly ready if it had met the following minimum criteria: a) it has a private counseling room; b) trained provider/s in adolescent job aids (AJA); c) performs HEEADSS risks assessment as basic facility-level demand generation mechanism that early detects risky behaviors, such as engaging in early sex, cigarette smoking, substance abuse or experience of physical or sexual abuse, and bullying; and d) availability of service record/logbook. 19

(Left photo) Participants of the Usapang Barkadahan session during the 12th Youth Mnth celebration in Cagayan de Oro City engage in conversations with fellow youths about relationships and reproductive health. (Right photo) One of the participants of the Usapang Barkadahan found to be engaged in risky behavior undergoes one‐on‐one counseling with a trained health provider from Cagayan de Oro City Health Office. (Photo: City Government of Cagayan de Oro)

Teen Hotline

The use of Information Communications Technology (ICT) on adolescent/youth health care is being piloted. The Brokenshire Hospital’s Teen Hotline started its operation in October 2015 as part of the hospital’s Program for Teens to reach out to teens that are uncomfortable visiting facilities for consultation. As of February 2016, a total of 55 clients consulted the hotline through voice calls, while 72 clients consulted through text messaging, and some called/tested for follow- up or for other concerns. Questions raised by teens include body changes, fertility awareness, breastfeeding, abuses, FP options and what to do during emergency cases, such as deliveries. To address implementation issues identified along the way, such as missed and undocumented calls, MH provided assistance in updating the Teen Hotline phone to capture and record calls, as well as to provide alert to assigned resident when a call is missed and provide a notice to the caller to expect a return call very soon. Moving forward and based on lessons learned from this initiative, MindanaoHealth will help develop a Teen Hotline guide to provide support to the residents on answering hotline calls and on documentation protocol. The Teen Hotline will be replicated in four (4) more selected medical centers in Mindanao: Southern Philippines Medical Center; Zamboanga City Medical Center; Cotabato Regional Medical Center; and Northern Mindanao Medical Center.

Strategy 2: Increasing the Demand for MNCHN/FP Services

Strategy 2 key achievements:

. Intensified the convergence between demand generation and service delivery to increase FP acceptance through in social preparation and client generation for LARC/PM services (outreach or fixed facility service delivery); . Eighty (80) FP providers from the private sector and 43 from public sector trained on providing client-centered counseling on family planning and safe motherhood in one-on- one consultation or in a group setting; . Various types of IEC materials produced and disseminated throughout project sites to

promote increased use of modern FP methods, addressing fear of side effects and correcting rumors and misconceptions on FP, promote safer motherhood and exclusive breastfeeding; and . Expanded reach to more than 5,000 women pregnant and postpartum women on information on exclusive breastfeeding through health events, information materials and group education.

2.1 Strengthen conduct of Usapan Sessions and link to fixed and ambulatory LARC/LAPM services

The conduct of MH supported USAPAN sessions directly linked to both fixed and ambulatory LAPM service provision continue to generate positive results as these sessions reached another 412 FP acceptors during the quarter, which is 14% of the total 2953 participants of health events supported by MH.

In Davao Region for example, the conduct of Table 2: Summary of Health Events Participants and USAPAN weeks prior to scheduled LAPM Results contributed to an average of 33 clients per outreach event. In SOCKSARGEN, active client Results generation yielded positive results as far as TA ACTIVITY for achieving CYP targets are concerned. Cotabato Q3, PY4 and Sultan Kudarat provinces remain on track. In Kidapawan City, out of the 55 clients No. of Health Events 386 mobilized for a BTL-MLLA outreach, 37 women Total Participants 7,956 opted for BTL, while 18 women who were not Total Acceptors 443 qualified for BTL services were provided with other FP services (i.e., 1 IUD, 14 OCPs and 1 New Acceptors 438 condom). In Pigcawayan, of the 17 who went to Other Acceptors 5 the RHU, eight (8) received BTL services, three (3) opted for IUD while the six (6) chose DMPA. % of Acceptors to USAPAN Kuntento Na/ 29.24% In Pikit, nine (9) women were provided with Puwede Pa/Maginoo session participants BTL services. Sultan Kudarat had three outreach Women provided with information on EBF 5,218 activities in Isulan, Lambayong and Tacurong from Health events and Usapang Buntis City. In the case of Cotabato City, it conducts Usapan sessions to identify clients choosing Adolescents and youth reached 3,530 LAPM/LARC services. Clients opting for LAPM are referred immediately to CRMC while those electing for LARC and short acting methods are immediately serviced by the CHO Staff.

2.2 Strengthen partnerships for demand generation and FP service provision Advocacy with private providers to strengthen partnership on demand generation and service provision activities is also yielding the desired results in terms of generating more clients for LARC/PM. To sustain this initiative, MH has provided technical support to private sector partners in building their capacity on client-centered FP counseling, proper recording and reporting, and inclusion of FP data in the FHSIS, and FP/AY program establishment. In the ARMM, in the province of Basilan, MH partnered with MSI and a Menzi Cooperative Clinic to conduct FP outreach in Maluso and Lantawan Municipalities and the cities of Lamitan and Isabela which resulted in 110 women availing of LARC-PSI. In Maguindanao, MH partnered with UNYPHIL for FP outreach in the municipalities of Sultan sa Barongis, Sultan Kudarat, Datu Montawal and gained 18 new acceptors for PSI. Usapan sessions also in partnership with

UNYPHIL yielded 35 new acceptors for PSI. Partnership with two private facilities in Lanao Del Sur (Mindalano Hospital and an NGO facility Al-Mujadillah Development Foundation- ARCHES) bore 9 BTL acceptors and 55 PSI clients. Eighteen (18)more SI clients were also served in Sulu in partnership with the ARCHES Foundation. In Tawi Tawi, MH partnership with Tarbilang Foundation-ARCHES yielded 27 PSI acceptors. In Isabela City, MH mobilized six (6) health service providers to conduct Usapan sessions in 8 barangays as part of the social preparation for a BTL activity scheduled on May 30-31, 2016. A total of 139 participants were counseled on family planning. Turnout was very low however; only eight (8) women opted to undergo BTL procedure and while one decided to use IUD. Still in the ARMM, fixed facility client generation yielded 86 BTL clients in Sulu (SPH and Parang District Hospitals) and nine BTL clients in Amai Pakpak Medical Center. Fixed facility service provision for LAPM services remains a challenge in Tawi-Tawi in the absence of private facilities providing LAPM BTL/NSV services. Two MH-trained BTL teams from the public sector are non-performing. While accomplishments are noteworthy, rooms for improvement are still observed. During the conduct of Usapan sessions for outreach for example, it has been observed that the gap between the conduct of Usapan sessions as social preparation and the date of actual service provision for LAPM is too long that some of the participants lose interest or the HSPs lose track of the clients who expressed interest. Some HSPs, especially those who were recently trained on Usapan, conduct Usapan sessions primarily as compliance to achieve set number of sessions, not on addressing unmet needs such that not all of the participants in the Usapan sessions have unmet FP needs. Some are already current FP users. To increase the frequency and improve quality of client generation for LAPM fixed and outreach services, MH needs to: a) improve collaboration with Provincial Population Officers through Regional PopCom offices in the identification and referral of probable clients and providing RHUs/BHS with the list of CCT/NHTS with FP unmet needs so that they can in turn be mobilized to participate in the Usapan/Family Development Sessions (FDS) and thereafter access FP services; b) improve the quality of pre-screening during the client generation phase to reduce non-qualification of some probable clients; c) conduct couples counselling instead of one-on-one counselling for BTL clients; and d) expand collaboration with the private FP providers in client generation for LARC/PM. On this last item, FPOP has indicated an openness to a counterpart mechanism where MH will cost-share on the logistics needed to mobilize Usapan clients, while FPOP will provide facilitators and FP supplies not available in the catchment facility or in case of long-acting or permanent methods, even offer their clinics as referral facilities. The improvement in yield varies according to approaches per area. For instance, while yield is increasing there is a need to further understand the other 80% USAPAN participants, who are with FP unmet needs, but decided not to access FP services for varied reasons. These reasons include the need to still seek consent from husbands/partners; fear of side effects; and not being ready, among others. MH and key partners will continue the discussion on this in the next quarter to address these challenges.

2.3 Enhancing the capability of HSPs in conducting IPC/C to address misconception and fear of side effects

Training of private and public hospital based MDs and FP providers on FPCBT1 with BCS+ Three training activities for private FP providers on FP Competency-based Training Level 1 integrated with Balanced Counseling Strategy Plus module were conducted this quarter.

To support initiatives to institutionalize FP Programs in private and public hospitals in Zamboanga Peninsula, training on FPCBT with BCS+ was conducted June 2016 in Pagadian City. Twenty-five 25 participants, representing 24 SDPs, underwent clinical training on LARC with a private sector trainer. During clinical practicum, the trainees successfully counseled 29 clients using the BCS+ approach and were then provided with LARC-PSI. In SOCKSARGEN, 29 private providers took part in an FPCBT1 with BCS+ training in Gen. Santos City. A day was allotted for a clinical training on LARC by a private sector partner. The providers came from 24 private SDPs in SOCKSARGEN. Similarly in Davao Region, private providers (doctors and nurses) attended an FP CBT1 with BCS+ training, One day was allotted for the discussion of LARC and practicum for the provision of the LARC with application of the BCS+ strategy at the Friendly Care Clinic. Among the participants were 26 private nurses and doctors from 21 private facilities. The trainees were able to provide LARC-PSI to 36 clients during practicum.

Enhance the capability of HSPs (RHMs) in client-centered counseling at primary level of health care to address common myths and misconceptions An MH initiative to improve provider’s knowledge, skill and behavior to properly address and manage fear of side effects, and correct rumors and misconceptions on FP methods among women and men of reproductive age is the “Cohort 300”. The Concept note is being finalized, while the processes of engaging additional technical consultants are in the pipeline.

Usapan IPCC Training DOH-RO X initiated the conduct of an Usapan IPCC Training of Trainers (TOT) for health service providers in the region. With MH technical and logistical support, 19 FP providers (11 nurses; 8 midwives) from various provinces of the region were trained. As a pre-requisite for completion, participants were required to form a team of two members with each team conducting 10 Usapan sessions in the presence of the other as supportive supervisor or mentor for one another. This arrangement has been included in their respective action plans for implementing the roll-out of Usapan at the community level. Twenty (20) other HSPs attended a similar training course in Davao del Norte supported by MH. This raises to 93 the total number of trainers for Usapan throughout Mindanao.

Monitor and provide supportive supervision during the conduct of village-level Usapan sessions In Basilan, a total of 450 participants attended 32 various Usapan sessions conducted in Lamitan City (14) and Municipalities of Albarka (4), Lantawan (3), Maluso (4), Hadji Muhtammad (3), Tuburan (1), and Akbar (3). MH mobilized five (5) HSPs trained on USAPAN to facilitate the sessions and provide information on Family Planning, Safe Motherhood, and importance of breastfeeding. Spearheaded by MH, these sessions were undertaken as part of the ROSE (Reaching-Out Serving Everyone) CARAVAN, a year round activity that is being conducted once each quarter to bring public services including health to the people of Lamitan City. Usapan sessions are regularly included in the ROSE Caravan to highlight FP and safe motherhood information and services for pregnant women and other WRAs.

2.4 Orientation of Community Health Workers on the CHW Toolkit In Zamboanga City, 480 CHTs in three (3) batches participated in the “Orientation/Update on CHT and High Five for CHT Navigators” conducted in May 2016 by the CHO in partnership with MH. Eight (8) MH-trained Badjaos from the Masepla Transitory Site attended this activity and

23 are accordingly being groomed as community mobilizers in future FP activities in the Transitory Sites. In Isabela City, Basilan 45 Community Health Workers/Volunteers engaged in client generation for FP/ MNCHN were oriented on FP and safe motherhood concepts and how to navigate probable clients towards seeking care in the facilities. They were also oriented on how to use the Gabay sa Kaalamang Pangkalusugan: Home Visit Tool Kit, a job aid designed to improve the interpersonal communication skills of CHW/Vs to motivate women and men to seek health care in the facility. 2.5 Enhancing pre-service education on IPCC for FP/MNCH Partnership with regional chapters of the Association of Deans of Philippine Colleges of Nursing (ADPCN) and Association of Philippine Schools of Midwifery (APSOM) is also being pursued in Region XI. This collaboration will explore options for improving the affiliation protocol between nursing schools and colleges with their affiliate facilities and communities.

2.6 Male Involvement in MNCHN/FP To improve male involvement in FP/MNCH, 15 sessions of Usapang Bagong Maginoo with an aggregate attendance of 184 men were conducted in various MH sites to inform them about the role of men in promoting family planning and safe motherhood.

Usapan Facilitators conduct group education and counseling among men (Usapang Bagong Maginoo) in Barangay Kauswagan, Cagayan De Oro City.

In the ARMM, MH is in the process of hiring a technical consultant to write a collection of khutba or sermon guides for pilot testing by local imams in Maguindana and Cotabato City. The guides will cover topics such as the national fatwa on FP/RH, exclusive breastfeeding and model family in Islam, male involvement, healthy timing and spacing of births, safe motherhood, and appropriate marrying age in Islam.

2.7 Promoting Exclusive Breastfeeding among women through IEC, health events and radio For this quarter, MH supported the DOH-initiated health events including Usapang Buntis and other community health events. Some 5,218 women attended and informed about exclusive breastfeeding. Information materials on breastfeeding such as 4,000 copies of EBF posters and 40,000 copies of Mother and Baby Books were distributed throughout the project sites.

In Zamboanga Peninsula last June 2016, MH together with CHO midwives were invited by the Junior Chamber International (JCI) Zamboanga to give an orientation to 16 pregnant mothers on Maternal Health with the theme "Kalusugan ni Nanay, Buhay ni Baby Nakasalalay". Aside from discussing topics on exclusive breastfeeding, the attendees were also counselled on FP with the theme "Si el Plano Tupaw, Familia Asigurao". During the Buntis congress in Zamboanga Del Norte, 119 pregnant mothers were informed on the benefits of exclusive breastfeeding through Usapan sessions and open forums. In Northern Mindanao, 81 pregnant women attended Usapan Buntis sessions in Kibawe, Bukidnon and Jasaan, Misamis Oriental. In Davao Region, 2,313 women were oriented on EBF. During the Ligtas Buntis in Digos City, 86 antepartum mothers were provided with prenatal, dental services, laboratory examinations and AP consultations. In the City of Mati, Compostela Valley, NDPs were required by their supervising PHN to conduct Usapan sessions at least once a month in every barangay. Reports were submitted quarterly. Some municipalities in ComVal were conducting Usapan Buntis during EPI or mothers’ classes. MH also provided TA in the conduct of Usapan sessions among RHUs not doing Usapan. In the ARMM, REACH++ is an outreach mechanism to bring a comprehensive package of FP/MNCHN services and information in geographically isolated and disadvantaged areas. Twenty-two (22) REACH++ events were conducted this quarter in Maguindanao, Basilan and Lanao Del Sur where 463 women from five (5) municipalities of Talayan, Barira, Datu Salibo, Ampatuan and South Upi; 179 pregnant women from RHU Hadji Muhtammad, Maluso, Akbar, Tuburan and Lamitan City; and 37 pregnant women were educated on EBF. More women were also reached during the AMANAT Kasambuhan on Air radio program in Sulu.

Health outreach in the Municipality of Albarka, a geographically isolated and disadvantaged area (GIDA) in the province of Basilan

A challenge for increasing demand for FP/MNCHN services is the underreporting of potential clients. For instance, EBF counseling during routine prenatal consultation at the field level is not recorded in the TCLs and are therefore not reported. Additionally, not all participants in Buntis caravans are recorded and reported. MH recommends providing guidance to LGUs/DOH conducting the Buntis Caravan or health events to record antepartum women who attended the session on EBF in the TCL. Lastly, while the distribution of IEC materials on EBF has been completed at the provincial level, there is a need to ensure that these are distributed down to the RHU and BHS levels.

Strategy 3: Removal of policy and systems barriers to service delivery and its utilization

Strategy 3 key achievements:

For the current period, the project achieved the following:

. A further reduction from nine (9) SDPs that experienced stock-out in Q2PY4 to four (4) SDPs in the current quarter. This situation did not even persist for long as the reported stock-outs were immediately monitored and addressed; . Directly and successfully supported 49 additional SDPs acquire Philhealth MCP/NCP accreditation. The applications for MCP/NCP accreditation of another seven (7) MH- directly assisted SDPs are in various stages of processing; . Extended continuing assistance to DOH-ROs in Mindanao to sustain the roll-out of SDNs, paving the way for instance for DOH-RO SOCCSKSARGEN to lead the SDN roll- out in South Cotabato while at the same time enabling its 12 MLGUs/CLGUs to integrate their local investment plans for health (LIPH) in their respective local development plans; and . Obtained a commitment from Misamis Oriental via a provincial resolution to support the public and private sector partnership for health information system.

3.1 Monitor SDPs for FP commodity stock-outs

To sustain the low stock-out turn out among SDPs in the last two quarters,, MH continued to provide onsite coaching and monitoring of commodity inventory levels by its LGUAs to health staff through facility visits coupled with online FP commodity monitoring system which allows users to provide real time feedback to alert and validate facilities with stock-out or over supply. This reporting period showed a decline in the number of SDPs with stock-outs from 9 in Q1PY4 to 4 SDPs. These occurred in Banisilan and Kidapawan City in Cotabato Province, Polomolok, South Cotabato and Cagayan de Oro City. The stock-out, however, was immediately addressed by the FHO-DOH with the help of online FP commodity monitoring. On the contrary, there was an increase in the number of SDPs reporting oversupply of either pills, COC, or condom which prompted nine (9) health facilities (Tandubas, Tawi-Tawi; Tantangan, South Cotabato; Talusan, Zamboanga Sibugay; Sirawai, Zamboanga del Norte; Maragusan, Compostela Valley; Guipos, Zamboanga del Sur; Tarragona, Davao Oriental; Pikit, North Cotabato; and Claveria, Misamis Oriental) to request the FHO to cancel or stop delivery of FP commodities. In the current “push” system of the national DOH logistics management, incidence of under and/or oversupply of commodities in the facilities cannot be eliminated when the allocation list is based on the estimated requirements of NHTS WRA population and a recommended method mix is being applied to all areas regardless of their classification and socio-demographic profile. In response to the reported stock-out and overstocking incidence in Agusan del Norte and Agusan del Sur, CARAGA region in the previous quarter, the DOH-RO issued a memorandum order enjoining all PHOs and LGUs to conduct regular inventory of FP commodities and monthly stock-out monitoring and submit the result and consumption reports to the PHO and FHO. The PHOs issued the same policy to the RHUs which resulted in zero stock-out and over supply this quarter. Also, the DOH-RO committed to provide FP commodities to hospitals and

26 private clinics to ensure that every facility has the necessary supply mix. The same effort is also being done with private health facilities in Misamis Oriental as members of SDN. On the other hand, with MH technical support, the provinces of Basilan and Zamboanga del Norte, 35 RHUs and one CHO adapted SMRS as their system of tracking and projecting inventory of FP commodity. The participants committed to reproduce the forms and more importantly assigned a staff to charge of the system. To further strengthen the logistics management system in the LGUs, the project shall fast track the implementation of the following measures: 1) Capacitate 332 private providers in FPCBT1 and purposively link them with DOH-ROs and LGUs as sources of FP commodities by developing an enabling instrument that allows LGU to provide FP commodities to the private sector is the public-private partnership agreement in the SDN or a MOA with clear reporting agreement; 2) Intensify demand generation in areas with overstock and available FP providers; 3) Customize SMRS and build on the existing LMS of the LGUs; and 4) Support the FP and TB Commodity Monitoring through the FB platform at the LGU level to achieve real time FP commodity inventory status in terms of:  Adopting of RHU Inventory and Order Form through orientation training;  Promoting the use of FB reporting of stock outs among end-users at the SDPs; and;  Recommending the creation of a group chat in the FB page for all FP regional and provincial coordinators to address non-or-late submission of consumption reports from all SDPs.

3.2 Support for maternity care package (MCP)/newborn care package (NCP) accreditation and drafting of policy on use of PhilHealth reimbursements

MH continues to assist LGUs formulate MCP/NCP PhilHealth accreditation. To date, out of 366 LGUs, 86% (317) have existing PhilHealth reimbursement policy of which 49 LGUs were so far directly assisted by MH. For the remaining quarter of PY4, the project will work with 52 LGUs in close collaboration with ZFF-MLGP project to fast track their PHIC reimbursement policy amidst certain compelling issues that impede accreditation and policy formulation such as: (a) compliance with DOH Safe Birthing Facility Licensing Standard in the on-going construction of 13 health facilities through HFEP in Misamis Oriental (6), Lanao del Norte (1), Agusan del Norte (1); Davao del Sur (3), Davao Oriental (2); (b) absence of facility in Nunungan, Lanao del Norte; (c) unstable peace and order situation in Tagoloan, Pantar Ragat, and Pantar, Lanao del Norte; and (c) indifference of five LGUs in Misamis Oriental (Initao, Manticao, Balingasag, Talisayan and Jasaan) to put up and accredit MCP facilities due to the presence of nearby MCP/NCP accredited public hospitals. On MH support to MCP/NCP accreditation, applications from seven (7) SDPs (Baungon, Sta. Maria, Malalag, Sarangani, Kitcharao, Lake Sebu, and Governor Generoso) are being processed. To date, the number of SDPs accredited by PhilHealth remains at 362 or 57% of total 635 SDPs. On FP reimbursement, four (4) public facilities in Lanao del Norte (Lala RHU for PPIUD and GTLMH, Kapatagan Provincial Hospital and LDN Provincial Hospital for BTL) and a private birthing facility in San Francisco, Agusan del Sur are now receiving PHIC reimbursements for PPIUD and BTL services.

Table 3: LGUs with MCP/NCP Reimbursement Policy Baseline Cumulative # of LGUs Assisted LGUs on PHIC Region/Provinces as of 2015 with MCP/NCP Reimbursement Policy for Reimbursement Policy Q3P4 and Q4P4 Zamboanga Peninsula (68/71) Total: 3 LGUs Zamboanga del Norte 24/27 24/27 Bacungan, Dapitan City, Tampilisan (3 LGUs) Zamboanga del Sur 28/28 28/28 0 Zamboanga Sibugay 16/16 16/16 0 Northern Mindanao (49/70) Total: 23 LGUs Misamis Oriental 11/25 14/25 Balingasag, Balingoan, Binuangan, Gitagum, Initao, Jasaan, Lagonglong, Libertad, Manticao, Naawan, Talisayan (11 LGUs) Lanao del Norte 10/23 14/23 Magsaysay, Maigo, Matungao, Nunungan, Pantao Ragat, Pantar, Poona Piagapo, Sapad, SND, Tagoloan, and Tangcal (11 LGUs) Bukidnon 18/22 21/22 Baungon (1 LGU) Davao Region (23/37) Total: 15 LGUs Davao del Sur (incl. 7/16 9/16 Davao City, Don Marcelino, Davao City) Hagonoy, Kiblawan, Malalag, Santa Maria, Sarangani (7 LGUs) Davao Oriental 3/11 6/11 Baganga, Caraga, Cateel, Lupon, Manay, (5 LGUs) Compostela Valley 7/11 8/11 Laak, Maragusan, Mawab (3 LGUs) SOCCSKSARGEN (37/43) Total: 6 LGUs South Cotabato (incl. 5/12 10/12 Koronadal City and Lake Sebu (2 GenSan) LGUs) North Cotabato (incl. 9/19 16/19 Pigkawayan, Tulunan, Cotabato Cotabato) City (3 LGUs) Sultan Kudarat 6/12 11/12 Palimbang (1 LGU) Caraga Region (21/26) Total: 5 LGUs Agusan del Norte 3/12 10/12 Kitcharao and Tubay (2 LGUs) Agusan del Sur 2/14 11/14 Bunawan, Loreto, and Veruela (3 LGUs) ARMM 119 Use of MCP/NCP Reimbursement is covered by guidelines issued by DOH-ARMM Total 268/366 317/366 52 LGUs

3.3 Establishing SDN in Mindanao through partnership with DOH and LGUs. Continuing DOH-ROs support to SDN rollout in Mindanao, DOH-RO SOCCSKSARGEN led the SDN provincial rollout in South Cotabato participated in by 10 municipalities and the cities of General Santos and Koronadal. In addition, MH also supported the five (5) ILHZs of South Cotabato province operationalize their SDNs by assisting the 12 LGUs integrate their local investment plans for health (LIPH) in their respective municipal development plans and

28 investment programs. DOH-RO 10, with technical support from MH, conducted a public and private consultative workshop meeting participated in by 78 health stakeholders from public and private birthing clinics and hospitals, 22 RHUs, CHO and PHO in Misamis Oriental. This resulted in the issuance of a resolution signifying their commitment to support the public and private sector partnership for health information system and created the Public-Private FHSIS Coordination Group tasked to oversee the implementation of a unified recording and reporting system through the FHSIS.

3.4 Support LGUs to conduct DQCs During this quarter, the project intensified its support to onsite DQC activities by orienting and training an additional 636 health staff from nine (9) provinces in the conduct DQC and FHSIS down to the barangay level. To date, a total of 2,409 HSPs in 308 LGUs have been capacitated on DQC. There is an increase of 38% or 97 LGUs from 253 in the previous quarter to 350 LGUs who are now conducting DQC activities. Despite the increased number of LGUs with DQC capacity, its roll out remains constrained by the following: a) non-availability of LGU and DOH- RO cost share to conduct onsite DQC, b) lack of updated worksheets and TCL forms, c) competing schedules, and d) lack of staff to manage the activities. Thus far, the DQC activities revealed some glaring problems such as: a) difficulty of midwives in doing data cleaning on FP; b) incorrect definition and therefore varying interpretations of CU: c) reporting of deliveries outside of catchment areas / municipalities; d) over-aged clients were not dropped from the list; e) counting of ANC based on visit and not following the prescribed definition of 4ANC. In the next quarter, the project needs to intensify DQC rollout activities focusing on the ten (10) provinces of Lanao del Sur, Maguindanao, Sulu, Lanao del Norte, Misamis Oriental, North Cotabato, South Cotabato, and Sultan Kudarat, and Isabela City, while working closely with DOH-RO and PHO to put into action the agreement of having PDOHO and PHO point persons per municipality to roll-out DQC on site.

3.5 Sustain partnership with Zuellig Foundation and ENGAGE project MH partnership with USAID-ENGAGE project in the Tri-People Cluster LGUs for Peace and Development of Upi, South Upi, and Datu Blah Sinsuat with respect to the implementation of its health strategic plan led to the issuance of facility based delivery ordinance in Upi, Maguindanao and the construction of a maternity waiting home in Barangay Rempes of the same municipality funded by ENGAGE through its CSO grant. The barangay leadership is aiming for BHS MCP/NCP accreditation given that the BHS is a catchment area of four barangays (Kiga, Kinitaan, Kaba-Kaba and Renedi) mostly inhabited by Tedurays of more than 1,000 households. Partnership with ZFF continues in Zamboanga del Norte and Basilan Provinces in the conduct of DQC activities where the latter is tasked to secure policy support from the local health managers and local chief executives to issue either a memorandum or executive order creating a DQC team to oversee and coach PHNs and RHMs perform regular data cleaning, validation, and reporting.

Strategy 4: Strengthening the Capabilities of DOH Regional Offices and Provincial Health Offices in Program Development, Management and Oversight

Key Achievements:

A total of 4 trainers on BTL/MLLA and 79 FP service providers, (13 FPCBT2 and 68 PPFP/PPIUD) were certified by DOH-ROs after they were supportively supervised by the

29 project (Annex A). This is addition to the 46 health service providers that were certified in Q1PY4. During the period, DOH ROs continued to participate in different capacity building activities including training on FP courses, data quality roll-out, SDN workshops, and supportive supervision visits. In ARMM, for example, DOH together with MindanaoHealth, capacitated 7 new teams of LAPM providers (Maguindanao = 3, Lanao del Sur = 3 with 1 private hospital of Marawi City), which enabled public hospital facilities to perform standardized mini laparotomy using local anesthesia (MLLA) for BTL procedure. Supportive supervision activities have been planned in DOH ARMM, Northern Mindanao, CARAGA, and Davao in succeeding periods.

4.1 Improving capacity of LGUs on Local Investment Plan for Health Development For this quarter, MH closely worked with DOH-ROs Northern Mindanao and SOCCSKSARGEN to assist LGUs in their respective regions to craft their 3-year Investment Plan for Health including Annual Operational Plan for 2016. MH’s technical assistance focused on the provision of local health managers a framework and strategies on horizontal integration of Local Program (AIP). This is one critical step in ensuring that health plans are mainstreamed in the LGU planning and budget process. The technical assistance enabled the provinces to finalize and submit their 3-year PIPH and 2016 AOP to the 2 DOH-ROs for final review and endorsement to DOH Central.

4.2 Strengthening DOH-ROs Capability in TA provision on Informed Choice and Voluntarism In Zamboanga Peninsula, the DOH and POPCOM regional offices recently conducted an ICV Training for its DOH provincial health teams of Zamboanga Del Sur, Del Norte and Sibugay, (6) six POPCOM Provincial Officers and five (5) DMOs were trained on the conduct ICV training roll out for Zamboanga City, Isabela, Zamboanga Sibugay, Zamboanga Sur and Zamboanga del Norte. The training became a venue to discuss the roles and update the names of ICV committee members, together with the validation and monitoring team as some of them have already resigned. The ICV committee will be lodged at the Regional Implementation team (RIT) and is expecting reports from the monitoring team so that this can be discussed and resolved at the regional level during the RIT meeting. During the ICV monitoring in Zamboanga city, there were several issues that were noted and this is true across all the provinces in Zamboanga, a) employment of user fees; b) donation clauses for services provided; c) Parental/Guardians consent for Adolescent FP acceptor; and d) diminishing supply of IEC material; and e) dissemination of Muslim Fatwa for our brothers and sisters in Islam.

4.3 Advocacy to DOHROs for Systems Strengthening DOH ROs and Last May 2016, during the Regional Technical Working Committee on Adolescent and Youth Health Development of Northern Mindanao MH presented the status of the establishment of AY friendly facilities in the USG provinces/cities. Among the resolutions resulting from the discussions include: i) to address the lack of an operational guide, they will await the DOH issuance of an MOP for AY friendly facilities which will become the basis for the preparation of an operational guide and ii) that the committee will submit a resoultion to the SDC of the RDC requesting to enjoin the municipal mayors to pass an ordinance establishing their RHU as AY friendly-“ A RESOLUTION ENDORSING TO THE SOCIAL DEVELOPMENT COMMITTEE, REGIONAL DEVELOPMENT COUNCIL FOR ENDORSEMENT TO THE REGIONAL DEVELOPMENT COUNCIL, REGION X, FOR THE LATTER TO PASS A RESOLUTION ENCOURAGING ALL GOVERNMENT UNITS TO TRANSFORM EXISTING HEALTH AND WELLNESS FACILITIES INTO ADOLESCENT-FRIENDLY FACILITIES AND

IN FUTURE CONSTRUCTIONS, TO INCORPORATE ADOLESCENT-FRIENDLY COMPONENTS THEREOF”

Coordination and feedback meetings with RD/ARD of DOHRO XI resulted in the agreement to engage trainers to fast track certification of HSP as well as to coach and mentor non-performing trained HSPs; engaging BPVs of POPCOM to conduct house to house tracking (greater yield) than USAPAN sessions; and the active engagement of DMOs on DQC to sustain the practice of DQC. STTA on DQC will be outsourced by MH who will be working closely with the DMOs of Mis Or (25) and LDN (22) to cover 47 LGUs. As for the installation of the TIMS, the regional statistician was identified to be trained by MH to manage the system. With regards orientation and advocacy to newly elected officials, the DOHRO team has already a plan to do the orientation at LGU level in July. DOH RO and MH will coordinate with the DILG Regional Office for the scheduling.

In Davavo, discussions with the DOH RO XI RHIS coordinator on the discrepancies found in the Davao City reports were communicated to the City Health Office for action.

Program Management

Monitoring, Evaluation and Research

During the quarter under review, Monitoring, Evaluation and Research (MER) activities focused on the conduct of regional performance reviews, development of data series to support decision- making, conduct of data quality checks both internal and in support of MH’s Component 2. The latter being designed as an assistance to review and correct recording and reporting, and assess the implementation of the Electronic Masterlisting and Tracking Tool (EMTT) at the facility level.

EMTT Documentation Workshop Two (2) EMTT documentation workshops were undertaken: in Zamboanga City from June 22- 23 for RHU West Lamitan City (Basilan), Isabela City (Basilan), Jolo (Sulu), and Sibutu (Tawi- Tawi); and in South Cotabato for the municipalities of Maguindanao (South Upi), Sultan Kudarat (Maguindanao), and Esperanza (Sultan Kudarat). From the EMTT, the number of women profiled and identified as having unmet FP need is generally high compared to the estimated number of CCT/NHTS WRAs across the different sites the discrepancy was observed to have arisen from the way field data was collected during the past two administrations at the DOH. The previous approach involved deploying community health teams (CHTs) mostly made up BHWs tasked to profile, navigate and follow-up probable users of service facilities. The CHTs were later replaced by hired community health advocates when a new Secretary of Health was appointed in 2014. The health advocates basically had the same functions but made use of data generated from the TCL and later inputted into the EMTT. For instance, ANC data extracted from the TCL covered those women profiled in the NDHS whose ages range from at least 30 years to early 40s and with at least 3 children as those who prefer permanent FP methods. The use of the TCL data apparently eliminated certain biases in the way women with unmet need or not currently using FP methods are identified.

Regional Program Reviews Also during the current quarter, regional implementation reviews were conducted in the Northern Mindanao and CARAGA regions aimed at comparing progress versus the regional targets for each of the performance indicators. The results of these reviews became the basis for identifying catch-up activities and preparing the required action plans.

Private Sector Involvement in FP Private sector involvement in FP activities through public-private partnership became more pronounced in recent months. The MH partnership with private health facilities resulted in the training of 482 private HSPs from 329 facilities across Mindanao. Also, to help build a core group of trainers on FP (PPIUD, SDI BTL+ and one-on-one FP counseling), 30 out of these 482 potential trainers underwent further training and are now capable of training additional health service providers from both public and private health facilities. To date and, as USAID support continues through the MindanaoHealth Project, an additional 104 private service delivery points (SDPs) now provide PPIUD services representing a 79% increase from a baseline of 12 SDPs. The number of SDPs providing interval IUD services and BTL grew as well by 54% from 65 to 100 SDP and by 5% from 58 to 61 SDPs, respectively. Also, private sector providers such as Marie Stopes International, Jerome Foundation, FriendlyCare, Family Planning Organization of the Philippines and the Philippine Obstetrical and Gynecological Society have been actively

32 engaged in 311 FP outreach activities in 21 areas reaching around 6,000 clients. These outreach activities contributed 33% to the total LAPM/LARC acceptors in Mindanao. Following voluntary one-on-one counseling, the contribution of private partners at fixed facilities and during outreach activities is highest for insertion IUD 56% or 412 out of the 730 clients served, and for BTL at 52% or 4,088 out of 7,884 clients served.

Tracking LARC-PSI clients in Preparation for Removal As of the end of the current quarter, MindanaoHealth has supported the insertion of more than 19,000 LARC-PSIs from both public and private sector providers in fixed facility and outreach settings. The figure above summarizes the distribution of LARC-PSI clients according to the number of years they have been in place. Based on the 3 year effectiveness of LARC-PSI, the tracker shows that by November 2016, about 292 clients, mostly from Davao Region, will need removal services from their nearest provider and this will balloon to 1547 by May 2017. Not providing this service means giving the LARC-PSI clients a false sense of protection from unwanted pregnancy and a potential missed opportunity to provide continuing services – i.e., higher dropout rates.

Given the time needed to Figure 9: Total LARC-PSU Clients by Non. of Years from Date of prepare those that Insertion MindanaoHealth has already trained, there is a need to undertake follow- through capability building activities for providers and assist them in planning how to reach the clients especially those provided through outreach services. Using the project’s own client registries that include the names of the clients, SDP-fixed facility providers and the SDP-providing outreach, the project needs to draw in the participation of the DOH ROs and PHOs in mapping out an action plan that could address this concern. MindanaoHealth can initiate the preparation of protocols or guidelines for this purpose.

Support for the Conduct of Data Quality Checks For this reporting period, various DQC workshops in the provinces of Marawi, Zamboanga City, Zamboanga del Sur, and Sultan Kudarat were supported by the M&E Team of the project. These were DQC roll-out activities where previously trained nurses and midwives are mentored to conduct follow-through data cleaning among midwives. Data quality checks on MindanaoHealth’s core indicators were also conducted in selected municipalities/cities in the provinces of Compostela Valley, Davao Oriental, and Basilan.

Development of Training Information Management System During the period, MindanaoHealth conducted initial consultative meetings with Northern Mindanao in setting up a Training Information Management System that will facilitate the tracking of capability building activities on FP from training, supportive supervision, certification, and PhilHealth accreditation. Among the issues raised during the consultation meeting were: i) the presence of many trained providers that have not undergone supportive

33 supervision, ii) the high number of trained providers not practicing, and iii) the low number of DOH RO certified providers. MindanaoHealth proposed the conduct of regional consultation meetings to thresh out organizational arrangements that will systematize the conduct of supportive supervision activities including: i) the deputization of MindanaoHealth-trained trainers, ii) the legitimization of high volume providers as preceptor sites; iii) outsourcing the conduct of supportive supervision and post-training evaluation activities to “public and private individuals and training institutions” pursuant to DOH AO 2014-00041. From the consultative meeting with Northern Mindanao, there was good reception for the installation of a Training Management System. The regional statistician was designated as the point person and schedules were set up to conduct data quality checks. Also, the region decided to undertake, with MindanaoHealth’s support, the conduct of a two-month long activity to complete all supportive supervision of FPCBT1, FPCBT2, BTL-MLLA, PPIUD, and LARC-PSI trainees who have not been visited to date.

Project Communications

During this reporting period, USAID Philippines continued to pick up stories and milestones of MindanaoHealth Project’s implementation, and accordingly published the following for the USAID Weekly Highlights: a) Local Government-led Youth Friendly Program in Maramag, Bukidnon (Week of 25 April 2016 and which reached close to 2,000 Facebook users when posted on the USAID MindanaoHealth Facebook Page); b) Paanakan Initiative of ARMM wherein traditional birth attendants are helping increase facility-based deliveries (Week of 08 May 2016 in celebration of the Safe Motherhood Week also shared on USAID Philippines Facebook page); c) USAID’s support to accreditation of Government service delivery points (Week of 23 May 2016); d) Data quality checks conducted at village-level health facilities of Basilan (Week of 20 June 2016 and shared on USAID Philippines Facebook); and e) Private sector providers’ contribution to bolster provision of Family Planning services (Week of 27 June 2016). Clearly, the use of social media also contributes in terms of communicating how USAID’s technical assistance reaches and benefits its partners and beneficiaries in the communities. Jhpiego, through its Facebook page, also featured a photo and caption from the MindanaoHealth project that conveyed a message on how Respectful Maternity Care observed by Pangantukan Rural Health Unit in Bukidnon when dealing with clients from indigenous tribes upheld rituals and practices prescribed by their culture. The post earned 305 likes and 21 shares. USAID Philippines’ Program Resources Management called for an Outreach Session for its Implementing Partners including the MindanaoHealth Project. The meeting dealt mostly on updates in terms of branding and marking wherein USAID emphasized how branding is important and should be everyone’s responsibility. The USAID also released guidelines and pointers on the use of Social Media in various project communications campaign to make messages clearer in terms of putting up, running and using social media in communicating with partners and stakeholders about the project’s progress, accomplishments and success stories. The agency also shared the various ways that Implementing Partners could tell stories through the use of Pictograms, Frontlines, Transforming Lives, Impact Blog, Impact Newsletter, Medium, Exposure and Content Hub.

Challenges and Solutions

Table 4: Challenges faced by MindanaoHealth this quarter and solutions (implemented and/or planned) Challenge Solution

IMPROVING THE SUPPLY OF MNCHN/FP SERVICES Increasing supportive supervision Implemented: During the regional consultations held in May and visits and certification of providers July in Northern Mindanao , Soccksargen and Davao, the following – Re-energizing supportive agreements were reached: supervision and certification of providers 1. Develop a system to track distribution of MNCHN/FP trainees, status of practice and certification status . This will be used to prepared supportive supervision plans with priority to those not currently practicing 2. Fast-track issuance of certifications. There are pending MH endorsements in the regions of Davao and SOCCSKARGEN. 3. Engagement of provincial public and private trainors for PTE as per AO 2014-00041 to address lack of personnel to to supportive supervision Planned:

1. For BTL, Dr. Floresca will be engaged to undertake supportive supervision for BTL trainees in SOCCSKARGEN and ARMM. For PPIUD, schedules for the conduct of SS will be firmed up with COEs and Trainors. 2. A training information management system will be introduced initially in SOCCSKARGEN and DAVAO to help the DOH RO track and conduct more systematic and regular SS visits. At the DOH RO level, MH will work to integrate supportive supervision activities into current post-training evaluation activities. Increasing the frequency of Implemented: Agreements with MSI on a tentative schedule of outreach activities outreach activities have been disseminated to LGU Advisors in the previous period. While many have been conducted as planned a similar number have also been re-scheduled or did not push through.

Planned: Discussions with key partners particularly MSI, Jerome Foundation, FriendlyCare, etc. to firm up schedules of outreach. On the ground, LGU Advisors will improve support for social preparation activities through assistance in linking information from POPCOM, EMTT, and USAPAN sessions to LAPM activities; improving the screening of clients through the use of standard eligibility criteria checklists .

Increasing the number of private Implemented: Action plans and reporting mechanisms at the facilities that are reporting or are project level to include reports from the private sector have been

Challenge Solution included in the FHIS reports thoroughly discussed with ATTLs and LGU Advisors during the regional program reviews. This has been agreed upon as a key strategy to increase CYP. In Davao City, Misamis Oriental, Lanao del Norte and Cagayan de Oro where this has happened, remarkable increases have been observed.

Planned: The current DQC methodology has been improved to include a process whereby reports from hospitals, private clinics are reconciled with midwives service records. In SOCCKSARGEN, this will be mainstreamed by working with DOH ROs. Project will also document contributions of private sector to be used as advocacy to other LGUs.

FDA approval on Misoprostol for Implemented: Redraft protocol of public health program local implementation in Sulu. intervention to actual research.

Planned: Continue the recommended and prescribed regulatory processes of FDA on drug importation.

Tapping private sector Implemented: 11 Health Facilities and 15 HSPs have been oriented on FPCBT1 and BCS+. LGU Advisors have already identified the specific private providers and hospitals that will be targeted for technical assistance.

Planned: Additional FPCBT1 trainings have been identified in the next quarter. TA will include assisting the providers in linking with the public sector for logistics. Additional TA will be provided in the areas of reporting and recording and orientation on ICV. Continuing advocacy to PHOs for the collection of private sector service data.

INCREASING THE DEMAND FOR MNCHN/FP SERVICES

Increasing the yield of demand Implemented: Efficiency of demand generation activities are generation activities [only 18% of closely monitored. LGU Advisors have already been given guidance Health Event participants have on how to increase yield. been provided services or have Planned: Field personnel have been directed to coordinate with been referred. While this is higher POPCOM field officers to make use of the RH Online databases of than the PY3 figure, it still needs a CCT/4P with unmet needs and bring this information at the facility lot of improvement. level for the conduct of USAPAN sessions. Other models with better efficiency have been disseminated during the regional PIRs (eg. using TCLs as the source for identifying women with unmet need including those from EMTT). Specific areas with workable EMTT in Basilan, Sulu, Maguindanao, and Bukidnon will be visited to enhance the use of EMTT information. In addition, the IEC for ARMM will be enhanced to include more culturally sensitive messages. Talking points for Ulamas have also been identified as a possible TA for ARMM with specific focus on delivering FP oriented

Challenge Solution

messages in the Fatwah.

REMOVING POLICY/FINANCING/ AND SYSTEMS BARRIERS TO ACCESS

Mainstreaming of DQC Activities Implemented: Capacity building of nurses, midwives, and even DMOs at the DOH RO have been completed in most project sites/regions. 20% of LGUs are already conducting roll-out activities with or without project support.

Planned: DQC activities will be accelerated in provinces/cities that have not conducted DQC to date. In Zamboanga Pen, MH personnel will work closely with HLGP to put DQC into the agenda of the LGUs participating in the program. MH will document DQC results from other provinces/cities that have conducted province-wide DQC and use it as an advocacy tool to gain more support in other areas.

Success Stories and Evolving Initiatives

Iligan City exemplifies Public-Private Partnership within city-wide Service Delivery Network

Efforts to improve the family planning, and maternal, neonatal, child health and nutrition (FP - MNCHN) outcomes do not lie solely on the public sector albeit for a long time, it has been at the fore. Key players of the health sector in Iligan City know this very well. Above all, the local government recognizes the importance of the private sector health providers’ contribution to the whole spectrum of health service delivery. The USAID’s Private Sector Mobilization Project took the initial steps in providing technical support to the formation and establishment of the city-wide Service Delivery Network (SDN) with particular emphasis on private sector representation. MindanaoHealth Project, with Jhpiego at the helm, followed next and successfully moved the initiative forward until the city government issued Executive Order No. 149 s. 2013 mandating and designating the SDN to improve the provision of FP and MNCHN services in Iligan City. This embodies a Public-Private Partnership (PPP) agreement that binds the players and stakeholders within the SDN. Anchored on the SDN, the recording and reporting of FP and MNCHN service coverage of both public and private health facilities is given particular focus. What better way to demonstrate this than by reflecting and integrating the health service performance and coverage of private health providers into the local health information system using the Field Health Service Information System (FHSIS) --- a public health information system operating throughout the Philippines. This is a notch higher from the main goal of mobilizing the private sector providers serve communities in hard-to-reach areas. Moreover, the partnership forged among all public and private provider-members of the SDN provides an impetus for creating a unified reporting system with quality-checked data from public and private health providers reflected with FHSIS-trained data encoders taking the lead. Currently, the Iligan CHO health information system reflects reports from one government hospital – Gregorio T. Lluch Memorial Hospital, and all the six (6) private sector partner- members of the SDN particularly, St. Mary’s Maternity and Children Hospital, Adventist

Private and public health sector members of the Iligan City Service Delivery Network gather for their regular consultative meeting to discuss activities and initiatives that will strengthen service delivery in the city. (NAlfad/Jhpiego)

Medical Center- Iligan, Iligan Medical Center Hospital, Dr. Uy Hospital, Dan’s Fatima Birthing Clinic and Grospe Polyclinic (formerly Tubod Maternity Clinic). Recently, another private health facility, the E and R Hospital voluntarily joined the SDN and now submits reports to the CHO. Currently, the Iligan CHO health information system reflects reports from one government hospital – Gregorio T. Lluch Memorial Hospital, and all the six (6) private sector partner- members of the SDN particularly, St. Mary’s Maternity and Children Hospital, Adventist Medical Center- Iligan, Iligan Medical Center Hospital, Dr. Uy Hospital, Dan’s Fatima Birthing Clinic and Grospe Polyclinic (formerly Tubod Maternity Clinic). Recently, another private health facility, the E and R Hospital voluntarily joined the SDN and now submits reports to the CHO. With the SDN in place, the sharing of resources among the public and private health providers, an effective two-way referral system and submission of services reports also came about. For instance, Iligan CHO provided BCG and Hepa B vaccines to private facilities, with the latter committing to make available to the CHO not only the immunization reports but also facility-based deliveries and family planning. These are accordingly recorded in the FHSIS. Janet Llanzana, a Neonatal Intensive Care Unit Nurse of the Adventist Medical Center and one of the private sector provider-members of the SDN have this to share: “We appreciate being part of the Iligan City Health System. We care ecstatic learning that upon analysis of the FHSIS data such as on FP and MNCHN indicators i.e. ANC, FBD, FP, we were recognized for our contribution to the significant improvement in the City Health indicators”.

Leadership is partnership! From 2013’s 61%, Agusan del Sur’s Contraceptive Prevalence Rate increased to 67% two years after. The province also consistently recorded the highest number of family planning acceptors from 2013 to 2015, reaching almost 69,000 acceptors compared to the other four CARAGA provinces which ranged only from 8,000 to 18,000. These accomplishments, in and of themselves, are feats worth noting. What is more commendable, however, is the fact that these achievements of the province came in the midst of the strong and known opposition to family planning (FP) of Agusan del Sur Provincial Health Officer Dr. Joel Esparagoza the Local Chief Executive. This (standing) discusses plans of action of the province to improve remains as an extreme challenge for MNCHN and FP service provision such as through the Provincial Health Office whose strengthening of hospital-based MNCHN and FP services. primary obligation is to address the (ALachica/Jhpiego) needs of clients in his constituency for

39 family planning services. Accepting the challenge and with USAID technical support, the PHO facilitated the deployment of trained health providers at the municipal or Rural Health Unit level become the center of the action for delivery of FP services. Village health workers and midwives conduct education and group counseling sessions such as through Usapan to provide information to potential FP clients. Despite the Provincial LGU’s campaign against Family Planning (dubbed as “Moral Recovery Program”), PHO Dr. Joel Esparagoza ensures that health service providers are skilled and readily available to serve clients with medical needs, including family planning. Not to be construed as open defiance of the Local Chief Executive, Dr. Esparagoza believes that the difficult situation he faces should not hinder him from serving clients in need, and therefore save lives. This is also a demonstration of good leadership. In any health initiatives, stakeholders’ participation is as important as having a competent, skilled and strong-willed leader at the forefront. Dr. Esparagoza along with the PHO Technical Division Chief Nanette Cabanos and FP Coordinator Gina Canonoy and the health providers in the RHUs demonstrated this. Most importantly, they fostered a credible partnership among themselves, an essential ingredient of leadership and governance. While the RHUs are mobilized to serve clients with FP unmet needs, Dr. Esparagoza fervently spearheads the strengthening of fixed hospital-based family planning services as alternative service delivery points where people could access FP services. He is now working towards the provision of a new and bigger FP room at the newly-constructed hospital building of D.O. Plaza Memorial Hospital which is seen to be functional towards the end of the year. This same leadership and governance within the PHO motivate all health workers to perform, especially that there is constant monitoring of service provision, data quality checking, family planning commodities inventory and the required coaching or mentoring by the PHO’s FP Coordinator, Ms. Canonoy who is a seasoned trainer. “Apart from our efforts in the province, our partnership with the MindanaoHealth Project is truly a big encouragement for us to excel and really provide for the health needs of our clients in the province,” Ms. Canonoy said.

Basilan Province increases coverage of community-level facilities conducting Data Quality Checks

The 2013 Baseline Assessment by USAID’s MindanaoHealth Project revealed that Basilan Province, conducted regular Data Quality Checks (DQC) on maternal, neonatal, child health and nutrition (MNCHN), and family planning (FP) per Department of Health guidelines. The means to verify and validate the conduct of said processes, and results however were not available then. Moreover, Basilan Provincial Health Office (PHO) had not identified personnel or team to visit and assist health service providers in the conduct of DQC activities at the facility level. As such, DQC initiatives were not fully institutionalized in the province. Recognizing the importance of good data management for program planning, budgeting, and policy development, putting DQC in place at the facility levels became one of the priorities of the local government. With USAID’s MindanaoHealth Project’s full support to

40 institutionalize the conduct of DQC at the facility level, a total of 33 health personnel from the province underwent training on DQC. The group consisted of ten (10) personnel from the Basilan Provincial Health Office, eight (8) from Lamitan City Health Office, and 15 nurse supervisors from the 11 municipal health offices. This trained core group now facilitates and oversees the conduct of more systematic and continuing DQC activities down to the village- level facilities aimed at institutionalizing the process. Just after the training, this group conducted DQCs in 20 village-level facilities (12 facilities in Basilan Province, and 8 facilities in Lamitan City).

An NDP nurse from the village of Tipo-Tipo in Basilan (center) reviews the Target Clients

List from Tipo-Tipo health station to check on the quality of data entries and to examine its correctness and consistency, with support from USAID-trained personnel of Basilan PHO. (RResurreccion/Jhpiego)

Continued on-site DQC mentoring and coaching activities by this trained group, with USAID support, yielded more than 100 midwives and Nurse Deployment Program (NDP) nurses at village levels, and nurse supervisors from Rural Health Units who gained working knowledge and skills on DQC. As a result, regular data quality check using worksheets and tools developed and introduced by USAID are now being conducted. To date, a total of 159 facilities (121 from the 11 municipalities of Basilan Province and 38 in Lamitan City) or 76% of the 210 health facilities have been covered. The province aims to cover all facilities within the year to ensure that validated data are available. "The beauty of DQC is not only in its purpose of ensuring data consistency and accuracy but also in its being instrumental as a tool for lobbying and advocacy to Local Chief Executives," said Moh Sarip Pangamdas, a nurse supervisor from Tuburan Municipality. He went on to share that after a DQC which he conducted, the province’s indicator on antenatal care decreased. Still, they proceeded to present this to their LCE along with their other accomplishments backed by validated data. This prompted them to strategize and provide monetary incentives (₱200) to encourage pregnant women to visit a facility on the first 84 days or during the first trimester of their pregnancies to prevent any pregnancy complications. Across the 21 USAID-assisted sites in Mindanao, 1,400 health workers are trained on DQC resulting in about 220 local government units (LGUs) conducting DQCs, of which 5 percent is from Basilan, a conflict-affected area.

USAID expands clinical practice sites for postpartum family planning

Often, the non-performance of trained health providers on postpartum family planning arises from the lack of self-confidence and dearth of trained persons who could do the needed supervision. Post-training evaluation and supportive supervision, which used to be lodged at the Medical Centers and done by trained master trainers have been instrumental in ensuring the correct application of knowledge and skills on postpartum FP acquired during training. To reach out to more trained providers and ensure that their application of knowledge and skills are correct, USAID supports the Department of Health and the Local Government Units in Mindanao build clinical practice sites or preceptor sites with high volume of clients wherein select and certified trainers can supportively supervise trained providers practice what they have learned. SOCCSKSARGEN is the first among the Mindanao regions which had DOH identify and recognize eight (8) Rural Health Units (Bagumbayan RHU Birthing Clinic, Kalamansig RHU Birthing Clinic, Lambayong RHU Birthing Clinic and Isulan MHO Birthing Clinic in Sultan Kudarat; Tacurong City Birthing Clinic and Sto. Niño Birthing Clinic in South Cotabato; and Mlang District Hospital, and Mlang RHU Birthing Clinic in Cotabato Province) as actively functioning preceptor sites with mentors available to guide midwives and other providers in facilities trained especially on PPIUD. Proper mentoring and coaching these trained providers enabled them to strengthen their capacities and develop confidence to perform PPIUD insertion more advantageously because these facilities have high volume of clients. To date, out of the 185 health service providers in SOCCSKSARGEN trained on PPIUD 104 underwent supportive supervision and of which 39 passed and were already certified by the Department of Health. Lester Defensor, a nurse from Bagumbayan Rural Health Unit Birthing Clinic in Sultan Kudarat, is the identified mentor in said facility who was responsible for more than 200 PPIUD insertions in the clinic. “I am happy not only because I was able to serve the family planning needs of our clients in Bagumbayan but also because I am able to help strengthen the capacities of other health service providers like me so they will be more equipped and confident to provide the PPIUD service.” Bagumbayan RHU is the first facility in SOCCSKSARGEN qualified to receive PhilHealth reimbursement from PPIUD services rendered.

A trained provider in Sultan Kudarat performs PPIUD insertion through a training model as a trainer observes and provides supportive supervision. (SNebres/Jhpiego)

Financial Expenditure and Cost Share Jhpiego Corporation PRIME: Jhpiego Corporation Award Name: Integrated MNCHN/FP in Mindanao (MindanaoHealth) Award No.: CA‐AID‐492‐A‐13‐00005 Period of Expenditure: 1 April 2016 to 30 June 2016

Itemized Project Expenditures All figures are in US$ Cumulative Expenditure in this quarter Cumulative Obligated Expenses of % of Expenses Cost Expenditure as amount Previous Annuals to 31 Based on Items of ending March'16 Apr‐16 May‐16 Jun‐16 Obligated June'16 Amount

Personnel including Fringe 7,222,155.11 5,541,270.97 199,977.91 144,385.97 62,987.73 5,948,622.5 8 Travel and Transportation 2,896,771.47 2,686,861.47 110,796.29 53,335.14 83,885.74 2,934,878.6 1 Equipment and Supplies 1,165,045.90 888,552.25 29,114.94 39,965.70 (5,997.38) 951,635.5 8 Sub‐grantees/ sub‐contractors 1,265,692.79 1,186,177.53 27,991.79 51,558.47 58,776.23 1,324,504.0 1 2 0 Other Direct Costs 2,974,380.43 1,987,115.56 58,550.78 46,652.55 48,939.90 2,141,258.7 7 Indirect Costs 2,935,199.39 2,467,477.15 88,125.91 69,028.19 50,344.77 2,674,976.0 9 TOTAL 18,459,245.09 14,757,454.93 514,557.62 404,926.02 298,936.99 15,975,875.5 8

Cost Share Summary as of: 30 June'16 All figures are in US$ Cost Share Requirement (5% of total expenditure) 798,794 Total Cost Share Contributed 1,032,651 Remaining Cost Share Requirement / Over (Under) 233,857 Total % of Cost Share Contributed 129%

Mindanao Working Group Site Expenditure (In‐country only) (All figures are in US$) Cost of Activities per Provinces

Activities Training Logistics Technical_Assis Others Grand Total t ance ARMM 9,685 6,725 5,827 15,891 38,128 Maguindanao 1,193 1,783 2,569 3,985 9,530 Sulu 2,197 2,282 286 4,441 9,206 Tawi‐Tawi 2,717 760 1,038 2,455 6,971 Basilan/Isabela 1,130 878 1,050 2,873 5,932 Lanao del Sur 2,411 870 884 2,136 6,301 Marawi City 36 152 188 IX Zamboanga_Peninsula 908 2,253 4,085 3,510 10,756 Zamboanga City 908 2,253 4,085 3,510 10,756 XII SOCCSKSARGEN 648 443 105 4,562 5,758 Cotabato City 648 443 105 4,562 5,758 Grand Total 11,242 9,421 10,017 23,963 54,642

Provincial/City Expenditures (without allocation) (All figures are in US$) Costs of activities Per Province Technical Region/Provinces Training Logistics Others Grand Total Assistance ARMM 19,384 11,882 11,180 40,717 83,163 Maguindanao 1,193 1,783 2,569 3,985 9,530 Cross‐Cutting 9,699 5,157 5,353 24,827 45,036 Sulu 2,197 2,282 286 4,441 9,206 Lanao del Sur 2,411 870 884 2,136 6,301 Basilan/Isabela 1,130 878 1,050 2,873 5,932 Tawi‐Tawi 2,717 760 1,038 2,455 6,971 Marawi City 36 152 188 Central Office Expenses 18,063 47,184 24,548 176,473 266,268 Cross‐Cutting 18,063 47,184 24,548 176,473 266,268 IX: Zamboanga Peninsula 13,681 12,754 11,647 38,851 76,933 Zambonaga del Norte 663 1,463 499 4,339 6,964 Cross‐Cutting 6,952 6,806 251 22,341 36,351 Zamboanga City 908 2,253 4,085 3,510 10,756 Zamboanga Sibugay 1,639 1,281 3,435 3,907 10,262 Zamboanga del Sur 3,519 950 3,376 4,755 12,600 X: Northern Mindanao 33,473 10,724 8,992 35,552 88,741 Cross‐Cutting 21,147 8,647 6,871 21,733 58,398 Misamis Oriental 5,838 586 665 3,109 10,198 Lanao del Norte 1,935 352 32 3,955 6,274 Bukidnon 4,553 1,090 1,424 3,939 11,006 Cagayan De Oro City 50 2,815 2,866 XI: Davao Region 34,172 2,980 11,979 30,245 79,376 Davao City Cross‐ 5,600 744 3,784 2,464 12,592 Cutting 22,424 1,407 2,238 16,157 42,225 Compostela Valley 2,302 252 1,707 2,954 7,215 Davao Del Sur 3,846 578 2,481 5,838 12,743 Davao Oriental 1,769 2,833 4,602 XII: SOCCSKSARGEN 17,603 11,400 10,646 39,084 78,732 Sultan Kudrat 1,545 658 365 4,271 6,838 Cotabato City 648 443 105 4,562 5,758 Cross‐Cutting 7,059 8,816 7,373 20,924 44,171 North Cotabato 4,168 738 1,465 3,888 10,260 South Cotabato 4,182 745 1,338 5,440 11,705 XIII: CARAGA 9,317 9,122 4,122 19,961 42,522 Cross‐Cutting 7,638 7,701 2,150 15,930 33,418 Agusan del Sur 1,218 827 1,578 2,580 6,202 Agusan del Norte 462 594 394 1,452 2,902 Grand Total 145,693 106,046 83,112 380,884 715,735

Annex A: List of Certified Trained Health Service Providers and Trainers by FP/LAPM/LARC in Q3PY4 Name Designation Place of Assignment Status

BTL MLLA (Trainers)

1. Dr. Gay Emerald B. Oribello MS I OB-GYN SPMC Issued April Consultant 2. Dr. Mary Jean L. Bergonia OB-GYN Consultant SPMC Issued April 3. Dr. Cherry Jay C. Tabora OB-GYN Consultant SPMC Issued April 4. Dr. Gina Bacol OB-GYN Consultant CARAGA Region Issued April FPCBT2 (Providers)

1. Sherly N. Mahusay Midwife II RHU Bansalan Issued April 2. Ruth Sherwin G. Balawag RHM RHU Malita Issued April 3. Joanne J. Laranjo RHM Davao del Sur, Digos City Issued April 4. Gloria P. Golimlim Midwife Davao del Sur, Padada Issued April 5. Ana P Marie Sayun RHM Davao del Sur, Bansalan Issued April 6. Sherry Ann Orcajada Midwife RHU Malalag Issued April 7. Jean Mizy J. Gipulan Midwife RHU Malalag Issued April 8. Thelma M. Tubat Nurse RHU Sta. Maria Issued April 9. Wilma P. Ordaneza Midwife III RHU Kiblawan Issued April 10. Dolores B. Lopez MHO RHU Padada Issued April 11. Artemio E. Senoy Midwife Kiblawan, Davao del Sur Issued April 12. Cicilia C. Cabillon Midwife Digos City, Davao del Sur Issued April 13. Precious A. Tajoda Midwife Sulop, Davao del Sur Issued April PPFP/PPIUD

Northern Mindanao 1. Orimaco, Caroline V. MD Medical Center DOH Certified Northern Mindanao 2. Pingol, Ciara Chloe MD Medical Center DOH Certified Northern Mindanao 3. Labis, Flora B. RN Medical Center DOH Certified Northern Mindanao 4. Gallago, Eileen RM Medical Center DOH Certified Northern Mindanao 5. Usman, Cecile J. RM Medical Center DOH Certified Northern Mindanao 6. Judith Montero MD Medical Center DOH Certified Northern Mindanao 7. Espra, Ma Louiela MD Medical Center DOH Certified Northern Mindanao 8. Estavilla, Flora Medical Center DOH Certified 9. Brioso, Maria Leotina Northern Mindanao Amparo MD Medical Center DOH Certified Northern Mindanao 10. Brioso, Ronald Mr. Medical Center DOH Certified Northern Mindanao 11. Tamano, Heidi Mr. Medical Center DOH Certified Northern Mindanao 12. Cuenco, Karil Mr. Medical Center DOH Certified 13. Lacdawin, Dante Mr. Northern Mindanao DOH Certified

Name Designation Place of Assignment Status

Medical Center Northern Mindanao 14. Sharon Jane Galagnara MD Medical Center DOH Certified Northern Mindanao 15. Anadel Tordos RM Medical Center DOH Certified Northern Mindanao 16. Dequeros, Grace A. RM Medical Center DOH Certified Bukidnon Provincial 17. De Asis, Marichu L. RN Medical Center DOH Certified Bukidnon Provincial 18. Gamo, Mary Grace C. RM Medical Center DOH Certified 19. Mangadang, Marianita RN Camiguin General Hospital DOH Certified 20. Magangcong, Asnairah MD Camiguin General Hospital DOH Certified 21. Dumalayan, Cristita A. MD MOPH – Oroquita City DOH Certified 22. Cutab, Pauline Tchaiya MD Camiguin General Hospital DOH Certified Gregorio T. Lluch Memorial 23. Reponte, Teresa MD Hospital (Gtlmh) DOH Certified 24. Nepomoceno, Manuela C. CHO – Iligan City DOH Certified 25. Ramos, Mercy M. RM CHO – Iligan City DOH Certified 26. Elona, Rebecca U. RM CHO – Iligan City DOH Certified 27. Ungab, Helen RM CHO – Iligan City DOH Certified 28. Viloria, Myrtle M. RM CHO – Cagayan de Oro City DOH Certified 29. Abrogar, Virgie RM CHO – Cagayan de Oro City DOH Certified 30. Cabacungan, Clarina C. RM CHO – Cagayan de Oro City DOH Certified 31. Mercurio, Gene RM CHO – Cagayan de Oro City DOH Certified 32. Miso, Vivian Ms. RM CHO – Cagayan de Oro City DOH Certified 33. Escalante, Esterlita T. RM CHO – Cagayan de Oro City DOH Certified 34. Lapinig, Edeliza B. Ms. CHO – Ozamis City DOH Certified RHU – Kauswagan, Lanao 35. Recoplacion, Epifania A. RM del Norte DOH Certified RHU – Kapatagan, Lanao 36. Babanto, Maribeth RM del Norte DOH Certified RHU - Lala, Lanao del 37. Clerigo, Lorena R. RM Norte DOH Certified RHU - Opol, Misamis 38. Dablio, Leonila B. RM Oriental DOH Certified RHU - Opol, Misamis 39. Anora, Marivic E. RM Oriental DOH Certified RHU - Opol, Misamis 40. Raiz, Merlyn M. RM Oriental DOH Certified RHU – Claveria,– Misamis 41. Dela Cruz, Ziegred D. RM Oriental DOH Certified RHU – Claveria,– Misamis 42. Nagangdang, Rosela RM Oriental DOH Certified RHU – Claveria,– Misamis 43. Escoro, Blanca Joy RM Oriental DOH Certified RHU – Claveria,– Misamis 44. Pines, Juliet M. RM Oriental DOH Certified RHU – Claveria,– Misamis 45. Blanco, Elda Ms. Oriental DOH Certified RHU – Initao, Misamis 46. Waga, Lydia A RM Oriental DOH Certified 47. Bade, Luzminda RM RHU - Jasaan, Misamis DOH Certified

Name Designation Place of Assignment Status

Oriental Happy Family Midwife 48. Justo, Diesybel RM Clinic DOH Certified RHU – Lagonglong, 49. Fabro, Daisy J RM Misamis Oriental DOH Certified RHU – Alubijid, Misamis 50. Buray, Julieta T. RM Oriental DOH Certified RHU – Tagoloan, Misamis 51. Gabatan, Othelia RM Oriental DOH Certified RHU – Tagoloan, Misamis 52. Emata, Dorie E. MS RM Oriental DOH Certified RHU – Tagoloan, Misamis 53. Llido, Maria Gina RM Oriental DOH Certified RHU – Tagoloan, Misamis 54. Lim, Ana Rica RM Oriental DOH Certified RHU – Tagoloan, Misamis 55. Solis, Shirley RM Oriental DOH Certified RHU – Tagoloan, Misamis 56. Vale, Jennifer T. RM Oriental DOH Certified RHU – Tagoloan, Misamis 57. Bueno, Marites RM Oriental DOH Certified RHU – Tagoloan, Misamis 58. Quilang, Anna Grethel RN Oriental DOH Certified RHU – Kadingilan, 59. Requino, Rogersita RM Bukidnon DOH Certified RHU – Maramag, 60. Revilla, Evangeline C. MD Bukidnon DOH Certified RHU – Maramag, 61. Yosores, Magdalena D. RM Bukidnon DOH Certified RHU – Pangantucan, 62. Jolampong, Julieta B. RM Bukidnon DOH Certified RHU – Pangantucan, 63. Ponce, Merlita C. RM Bukidnon DOH Certified 64. Mahayag, Blandina D. RM RHU – Quezon, Bukidnon DOH Certified 65. Marines, Lilibeth E. RN RHU - Catarman DOH Certified 66. Timene, Maria Fe E. RN RHU - Catarman DOH Certified 67. Prenio, Jerlyn R. RM RHU - Clarin DOH Certified 68. Dapitan, Marivic G. RM RHU - Clarin DOH Certified

Annex B: List of Trainings and Participants in Q3 PY4 Health Health Facility/ Training Trainee’s Trainee’s First Facility/Provinc Municipality or City Course Facility/Region Last Name Name Profession e AJA North Min-danao AbejoJanetMidwifeLanao del Norte Iligan City

TRAINING (Region X) Abrero Vivian Midwife

Alimoren Lucy Midwife Ambrose Ri Midwife

Angara Cleo Jean Nurse

Aquino Maricris Others Ardiente Rowena Midwife

Balasio Mitzie Midwife Banachita Wilbur Nurse Barinque Marnie Midwife

Beldad Sorina Midwife Cañada Lani Midwife Cañeda Joa Others

Nelia Nurse Canoy Ofelia Midwife

Casas Fe Midwife

Colis Ivy Others Dando Agnes Midwife

Ege Swen Nurse

Elona Rebecca Midwife Fenis Marites Midwife

Gallemit Vicenta Midwife Gallera Catherine Others

Kaning Cherlie Midwife

Labra Lilibeth Midwife Liguton Rosemarie Midwife Lomondaya Luz Midwife

Maghanoy Julia Midwife Mohamad Diamond Midwife

Orellaneda Joann Midwife

Ostia Viena Mae Midwife Pagaling Judy Midwife

Patay Elvira Midwife

Ramos Mercy Midwife Pacita Midwife

Reces Clarence Midwife Rivera Marissa Midwife Sanguenza Genevieve Midwife

Saritado Medelisa Midwife Silva Karl Michael Nurse Sumugat Rhona Nurse

Tacbubo Chona Midwife Uncab Helen Midwife

Valencia Judelen Others

Villacorta Amy Midwife Villar Merlinda Midwife

Violanda Marilou Midwife Yap Flora Midwife Agbu Nena Others Misamis Tagoloan Baclay Verlyn Others Oriental

Bangco Judemenda Nurse

Bueno Marites Midwife Casino Resma Midwife Castillejos Nena Others

Castro Lailaine Others Emano Concepcion Midwife

Escalera Evelyn Others

Gabatan Othelia Midwife Juguilon Nimfa Nurse

Magdaraog Arlene Midwife

Marinas Julie Others Nambatac Candy Others

Obsioma Mirasol Lynne Others Pongcol Pedrita Others Rosal Eva Others

Torreco Lolita Others Valdehueza Geollegue Aida Others Velez Delia Midwife Virtudazo Diza Others Yabo Chariza Nurse Zamaro Agnes Nurse

Zambo Peninsula Canete Imelda Nurse Isabela City Isabela City (Region IX) Saure Joan Nurse Zamboanga City Zamboanga City Lao Kengchay Others

Alvarez Fe Midwife Ramillano Mary Grace Nurse

Taburada Adelwisa Midwife

Marquez Erlinda Midwife Urian Corazon Nurse Guevarra Florina Midwife

Obias Roselle Lee Nurse Alvarez Maricris Others

Dinalagan Lowelia Nurse

Mustafa Jesselyn Midwife

Alavar Jocelyn Nurse

Bello Lulu Midwife

Beebe Kapril Midwife

Corrales Cecilia Midwife

Ailani Gina Nurse Luna Ma. Fe Midwife

Tubilla Rosibel Midwife

Halapto Juvaina Midwife

Lubaton Vivian Nurse

Limen Merylie Midwife

Sumicad Ma. Roselyn Nurse

Almario Pilar Nurse

Apolinario Olaida Midwife

Asuncion Gemma Midwife

Bue Josefina Nurse

Garingo Ma. Iris Portia Nurse Lim Maria Christine Nurse

Mendoza Ma. Rosalie Nurse

Resurreccion Elsa Nurse

Fernandez Evelyn Nurse

Mariano Rosa maria Midwife Nono Milabelle Midwife Gumbahali ABIGAIL Midwife

Lachica Pilar Midwife Peralta Jessibel Midwife

Arcillas Daisy Nurse

Medina Eloisa Nurse Cortes Doreta Nurse

Lorena Sylvia Nurse

Balan Nancy Nurse Sinsuan Kristoffer Doctor Dipolog City

Kyamko Reynald Others Zamboanga del Partosa Ma. Gloria Others Norte Bagor Heidi Others Pamaran Marivic Others

Ramirez Nolan Others Cuenca Jancho Others Labason Sindangan Magalta Michael Others

BCS Davao Region Compostela Maco TRAINING (Region XI) Bersano Leah Nurse Valley

Retardo Novee jean Nurse

Rimando Rodolfo Doctor Corpuz Ria joy Others Mawab

Jampayas Marie michele Doctor Porcadilla Grace Nurse Nabun-turan

De los Santos Violeta Nurse

Galenzoga Donabel Nurse Alvarez Gina Doctor Gadingan Cora Nurse

Toledanes Kristyl Kay Nurse Enardecido Liezl Nurse Davao City Davao City

Ladesma Karlynn Nurse

Digal Ma. Fe Nurse Padora Roena Nurse

Buendia Kathleen Nurse

Dela Cruz Gene Ann Doctor Morandante Zyra Nurse

Dimatulac Cynthia Nurse

Flores Josephine Nurse Salinas Betty Nurse

Taninas Sharmaine Ila Nurse Jetter Doctor Embolturio Lea Nurse

Torregosa Cherryl Doctor Davao del Sur Dato Maureen Nurse

Monarca Armie Doctor

Enerio Rezzel Nurse

Abudante Yeshry Krsh Nurse

Dahiroc Myrish Nurse Davao Fanlo Ma. Dulce Doctor Occidental SOCCSKSARGEN Dela Cruz Carlo Jason Nurse Cotabato (Region XII) Bada Hazel Mae Nurse

Mamades Asmyra Nurse

Santos Franny james Nurse Bernadas Rosalinda Midwife Baa Angela Nurse

Calayla Lina Nurse Abonado Mary sharon Nurse

Sebastian Caridel Nurse

Esmeralda Agnes Midwife Pagaduan Phoebe joy Midwife Libungan Mendoza Edenrose Midwife

Sonsona Magdalena Midwife Cagas Lilibeth Midwife Makilala

Garibay Jesiree Lee Nurse Midsayap Dojinog Elsa Others Morada Marlou Midwife Cotabato City Porras Myra Lynn Nurse M'lang

Facunla Valerie Nurse Tulunan

General Santos Malaga Maryjecel Midwife City Cotabato City Lu Michelle Nurse Digusen Asriya Midwife

Sambo Shirley Midwife

Bansalan Mahusay Florida Midwife Digos City Mercado Veronica Leilani Doctor

Panes Emerlita Nurse South Cotabato

Peñales Christopher Others Angin Lovely Nurse

Nayal Abigail Nurse Koronadal City Malalag Aguilar Rhela Nurse Malita Faderan Ana Celpha Others Kabacan Tamaño Mary Grace S. Doctor Kidapawan City Dela china Noren joy Midwife

Suderio Yvonne Grace Nurse

Salada Ivan Leo Nurse Polomolok

Aseneta Carlyn Joy Others Fontanos Miguelita Midwife Santo Nino Crespo Jessyl Grace Nurse Molina Ma. Jessyeen Nurse Surallah

Cocjin Rayzhel Nurse

Armecin Faye Joy Nurse Gedorio Susie Midwife

Basco Elisha Nurse T'boli Corridor Roselyn Nurse

Quimpan Esther Mae Nurse Tupi

Cabasalan Saralyn Midwife

Gevieso Norben Doctor Espe-ranza Kalaw Arman Nurse Sultan Kudarat Isulan BEMONC TRAINING Manabilang Evelyn Nurse Riola Nenita Nurse

Fuyonan Jennily Midwife

Sudio Shiena Rose Nurse President Quirino Cuello Ma. Nezeth Nurse Dalumpines Ronette Joy Nurse

Barroquillo Yvonne Doctor Tacurong City

Quiambao Gemalyn Nurse

Gerios Kirstine Ivane Nurse

Northern Areno Sarah Kay Midwife Mindanao Lacdo-o Arshiel Midwife (Region X) Arceo Jacqueline Nurse

Catibog Susana Midwife Don Carlos Norh Susan Beth Midwife Bukidnon Abunda Diamond Midwife Impasug-ong Bayo Joy Ruth Midwife Macapayag Reme Midwife Manolo Fortich Mendoza Editha Midwife Balong Flora Midwife Sumilao Adrias Grace Midwife Cagayan de Oro City Cagayan de Oro City Melchor Melita Midwife Cabales Jovy Midwife Sultan Naga Lanao del Norte Dimaporo Sesmondo Amelita Midwife Dapitan Asil Midwife Misamis Occidental Clarin Panugaling Lovely Midwife Albinda Leticia Midwife Misamis Gingoog City Ascuncion Jennifer Midwife Oriental

Bravo Aileen Doctor Basilan Lamitan City (ARMM Sulaik Bidasari Doctor Shariff Aguak Maguindanao Alcala Ruby Feron Doctor South Upi Petilo Ester Doctor BTL-MLLA General Santos TOT Mercado Veronica Leilani Doctor City General Santos City

Braña, JR. Conrado Doctor SOCCSKSARGEN Koronadal City (Region XII) Tamaño Mary Grace S. Doctor South Cotabato

Quinton Mila Doctor Norala

Tuburan ANA MARIE Doctor Surallah Dedel Ma Rona Yen Doctor Sultan Kudarat Isulan

Nakan Sittie Sandra Doctor

BTL-MLLA ARMM Esmael Agnes isec Nurse Maguindanao Datu Piang TRAINING Usman Amirel Doctor

Davao Region Mundoc Judelhen Nurse

(Region XI) Davao City Davao City Sandig Sammy Doctor

Alcala Ruby Feron Doctor

Nantes Roselle Nurse

Zamboanga Aranan Myra Doctor Peninsula Lubaton Vivian Nurse (Region IX) Ramillano Mary Grace Nurse

Saure Joan Nurse Sahijuan Maryam Doctor Davao City Davao City

Annil Catherine Nurse Araneta Jennifer Doctor

Hermosa Susana Nurse

Natividad Glenda Doctor Miranda Christopher Nurse Cabonce Shellah Mae Midwife Agusan del DQC Caraga (Region Norte TRAINING XIII) Lagare RUBILYN Midwife Buenavista

Palang-at Daisy Nurse

Perez Micah Midwife

Sanchez Merry Cris Midwife

Semblamte Rhys Nurse

Aloyon Rachel Nurse Baldivinio Crystal jade Nurse

Bamba, jr. Eduardo Nurse Barliso Rechell Nurse Bucong Kharin Kay KeaneNurse Butuan City Collado Arnold Nurse Cheryl Ann Nurse Diones Ameliza Nurse

Maglupay Apple Jane Nurse Mallonga Lorelei Abigail Nurse

Maloloyon Glaiza Nurse

Maniago Georiss Mae Nurse Montero Irehn Others

Rafols Christine Nurse

Arroyo Kronryl Herbert Others Nancy Saray Others

Pagaran Mariedeth Nurse Senaca Haydee Others

Ansing Cherry Nurse Cabadbaran City Libres Evelyn Nurse Romillano Bria ross Nurse Apat Harold Nurse Carmen Canatoy Leonelyn Others Badiang Andre Lou Nurse

Cebrian Jean Nurse

Duncano Dante Christian Nurse Jabonga

Fuerte Ian Nurse

Gomez Corazon Theresa Nurse

Goopio April joy Midwife

Herrera Maria Luisa Nurse

Posadas Francis Nelson Others Alijo Jessa Midwife Angchanigco Imee Nurse Kitcharao Casinillo Leonil Others Ciudad Kritchel Nurse

Montilla Danlor Nurse

Paeste Mitzie Rose Midwife Abejar Melanie

Cambray Isyl Midwife Las Nieves Clarin Jess Nurse Colina Nino Janderick Nurse

Nonan Glenna Rose Midwife Yu Maria Ida Nurse Galinea Divine Grace Midwife Magallanes Gula Alexis Marie Nurse

Mateo Brenda Midwife

Padin Maria Noemie Midwife Payot Hannah joy Nurse Mar Love Joy Nurse Nasipit

Sona Joan Midwife RTR Budlat Mayshel Acesna Nurse

Castanos Rhea Midwife Santiago

Mapula Jacqueline Midwife

Pandeling Noueem mae Nurse Sobremonte Varry Others Gallegos Stacy Jade Nurse Tubay Gomez Merrie Nurse Lanao del Norte North Mindanao Canello Maria Lita Midwife (Region X) Exchaure Phebe Midwife Bacolod

Gedoaz Milma Nurse Jamamil Dinah Midwife

Abdullah Nadjerah Midwife Baloi Amer Norhanie Midwife

Arobero Nadjira Midwife Baroy

Mangompia Jobaira Midwife Pasandalan Monaifa Nurse

Maghamil Lilia Midwife

Magpantay Mayline Midwife Iligan City

Rafanan Rogaciana Nurse

Abejo Janet Midwife

Abrero Vivian Midwife

Alivio Ed Kristian Midwife

Ambrose Riza Midwife Balasio Mitzie Midwife Beldad Sorina Midwife

Cañada Lani Midwife Canoy Ofelia Midwife

Casas Fe Midwife

Dando Agnes Midwife Elona Rebecca Midwife

Fenis Marites Midwife

Kaning Cherlie Midwife Lagra Lilibeth Midwife

Lomondaya Luz Midwife Maghanoy Julia Midwife Milo Fritualo Midwife

Nato Hedjara Midwife Ong Elnora Midwife Orellaneda Joann Midwife

Ortogan Prescila Midwife

Padilla Virgincita Midwe

Pagaling Judy Midwife

Patay Elvira Midwife Ramos Mercy Midwife Pacita Midwife

Rivera Marissa Midwife Sanguenza Genevieve Midwife

Saritado Medelisa Midwife

Tacbubo Chona Midwife

Tiin Angelita Nurse

Timbon Anna Liza Midwife Uncab Helen Midwife Villacorta Amy Midwife

Villar Merlinda Midwife Violanda Marilou Midwife

Yap Flora Midwife

Atay Atay Nurse Kapa-tagan Cabajar Celestina Midwife

Fernan Jan Angeles Nurse

Branzuela Ives Nurse Lagat Maria May Midwife Kaus-wagan

Recopelacion Felmore Nurse Usman Johanna jane Midwife Cainglet Maelrubby Nurse Kolam-bugan Cariño Menchie Midwife

Empasis Olivia Midwife Vergerie Cleofe Nurse

Opay Josephine Nurse Mag-saysay

Oyog Jeanny Nurse

Sandra Midwife

Bantiles Victoria Nurse Dansal Sahara Nurse Maigo

Osing Glaiza Midwife

Virginia Midwife Sarip Raga Nurse

Ariraya Raisa Midwife Munai

Mangompia Shirley Nurse

Darimbang Nor-ain Midwife Pantao Ragat Monsanto Ma. Emily Nurse Guina Noraisa Midwife Pantar EINC Omar Cairia Nurse TRAINING Dalidig Saripa Midwife Poona Piagapo Demecillo Joycie Nurse

Tejada Elsie Jane Midwife

Dagondon Gladys Nurse Salvador

Mamamilao Annabelle Midwife

Abdulbasit Normina Midwife Sapad Anhao Yolanda Nurse

Sultan Naga Aranzado Elisea Nurse Dimaporo Calimpon Juvy Midwife

Gayomali Nibelita Midwife

Ventures Christine Mae Nurse Tagoloan Cal Roselyn Midwife

Lacanglacang Eva Nurse Tubod

Maghinay Genevieve Midwife FPCBT1 Rom Fore Nurse TRAINING Apdian Ma. Xenia Nurse Misamis Alubijid Cagalawan Joni Amor Nurse Oriental Balingasag

Ratilla Shellah Lyn Nurse

Zulita Glendalita Midwife Balingoan

Agudong Mary Ann Nurse Binu-angan

Martinez Luz Doctor

Del rosario Jocelyn Nurse Cagayan de Oro City

Gomez Marites Others

Lacbain Mary Jean Nurse Emano Patricia Nurse Claveria Guevara Ederlyn Midwife

Ebajay Diana Rose Nurse El Salvador City Echalico Charo Nurse Gingoog City

Baculio Rosa Midwife Gitagum Sarile Zarlyn Nurse Cabigquez Alma Midwife Initao

Bade Luzminda Midwife Jasaan

Ellezo Brenda Maribeth Midwife Kinoguitan Gadrinab NORMA Midwife Lagonglong

Mapir Feoril Midwife Laguindingan Acain Desahyril Nurse Libertad Gabe Maybelle Nurse Lugait

Babaylan Terecia Mie Nurse Magsaysay

Aninon Elvie Others Manticao Quimanhan Daisy Midwife

Culla Iris Nurse Medina

Catipay Vicky Nurse Naawan

Macabinlar Nena Midwife

Caballero Myra Nurse Opol Sumaylo Tessie Midwife Sugbongcogon

Bade Rhodora Nurse Tagoloan Anitan Leizl Nurse Talisayan RO Cagayan de Oro City Abamonga Sulpicio Doctor

Armada Estela Nurse

Arnado Jucel Nurse Bacoy Anita Nurse Balansag Inocencia Nurse

Cebedo Tessie Nurse Evangelista Esther Nurse

Manguis Marifi Nurse

Mofar Esther Nurse Pala Alana Nurse

Panulaya Richard Nurse

Vanguardia Jose Lee Nurse

Davao Region Velasco Analiza Midwife (Region XI) Adtoon Judith Midwife Apolinares Genesa Nurse Davao City

Quibal Arlene Midwife Saligumba Anabel Midwife Davao City

Arquintillo Lorie Anne Others

Hinubes Wilfreda Midwife

Cago Emma Nurse

Milano Myra Pacita Midwife

Cabarles Mirasol Midwife

Tenorio Ofelia Midwife

Ancajas Myrna Midwife Davao del Sur Bansalan Abrenica Anecita Midwife Magsaysay

Daffon Rosalinda Midwife Felamin Jennifer Midwife

Tampus SherylMidwife

Narvaez Amihan Midwife Malalag Talagtag Mary Jane Midwife Padada Gavilan Rowena Midwife Santa Cruz

Medronial Aida Midwife Agusan del Norte Butuan City Romero Isabelita Midwife Saavellon Ligaya Midwife Balan Lilibeth Midwife Caraga (Region Esperanza XIII) Maglague Mirasol Midwife Agusan del Sur

Miro Ester Midwife

Plaza Christine Midwife Talacogon Ortiz Ervie Midwife Dinagat Islands Dinagat

Escuyos Lynn Nurse

Oracoy Prossie Midwife Bonono Belen Midwife Dinagat Islands Dinagat

Cabras Chrisnalyn Nurse

Gordo Mary Grace Midwife Surigao del Sur Tandag City Clar Anita Midwife

Del valle Mirasol Midwife Romero Jerelim Midwife Davao Region Colardo Girly Midwife Compostela Compostela (Region XI) Valley Bersano LEAH Nurse

Miraflor Edith Nurse Maco Retardo Novee Jean Nurse

Rimando Rodolfo Doctor Sosas Mary Jo Nurse

Robles Jennisa Midwife

Corpuz Ria Joy Others Mawab Jampayas Marie Michele Doctor

Cabreros Karen Iris Midwife

Cruda Josel Ann Midwife Calantoc Roger Nurse Montevista

Porcadilla Grace Nurse Nabunturan Gonzaga Ruchile Kristie Nurse Rasonabe Desiree Nurse

Gamayo Garchita Midwife Pantukan Villamero Perla Midwife Lucamora Leanrose Midwife

De los Santos Violeta Nurse Davao City Davao City

Galenzoga Donabel Nurse Bacong Jean Whelm Midwife Dela merced Racquel Midwife

Anloague Mayflor Midwife

Oniot Rosebelyn Midwife

Sangarios Sharnine Midwife

Alvarez Gina Doctor

Gadingan Cora Nurse

Toledanes Kristyl Kay Nurse

Nano Josie Midwife

Burdeos Layah Midwife

Digal Ma. Fe Nurse

Padora Roena Nurse Balani Cirila Midwife

Dayodon Michel Midwife

Buendia Kathleen Nurse Cadalo Pheby Midwife Dela Cruz Gene Ann Doctor

Morandante Zyra Nurse Dimatulac Cynthia Nurse

Flores Josephine Nurse

Delicano Rayna Lynn Midwife Oliveros Loida Midwife

Morantes Tiffany Midwife

Salinas Betty Nurse Taninas Sharmaine Ila Nurse

Cuizon Noemi Midwife Villano Harold John Nurse Asuncion Davao del Norte Aninon Jose Ronilo Others Braulio E. Dujali

Gaviola Angealyn Doctor Carmen Jetter Doctor

Corpuz Apple Grace Nurse

Magalasin Rullaybee Midwife Kapalong

Talde Amalia Nurse New Corella

Duran Gemma Midwife Santo Tomas Pastoril Jenny Midwife

Biteng Llewellyn Nurse Tagum City Rosos Marichu Midwife Ducducan January Doctor

Mercado Alyne Nurse Agustin Makita Nurse

Fronteras Jason Nurse

Inggatan Leonora Midwife Talaingod Salusad Josephine Midwife Sarmiento Jeramie Midwife

Embolturio Lea Nurse Davao del Sur Torregosa Cherryl Doctor

Dato Maureen Nurse Digos City

Monarca Armie Doctor

Enerio Rezzel Nurse

Abudante Yeshry Krsh Nurse

Dahiroc Myrish Nurse Davao Fanlo Ma. Dulce Doctor Occidental Malita Northern Davao Mindanao (R10) Aguirre Rowena Midwife Occidental Malita SOCCSKSARGEN Dela Cruz Carlo Jason Nurse Cotabato Kabacan

(Region XII) Bada Hazel Mae Nurse

Mamades Asmyra Nurse Kidapawan City

Santos Franny James Nurse

Bernadas Rosalinda Midwife

Abonado Mary Sharon Nurse

Sebastian Caridel Nurse

Esmeralda Agnes Midwife

Pagaduan Phoebe Joy Midwife Libungan Mendoza Edenrose Midwife

Sonsona Magdalena Midwife

Cagas Lilibeth Midwife Makilala Garibay Jesiree Lee Nurse Midsayap

Dojinog Elsa Others

Morada Marlou Midwife Porras Myra Lynn Nurse M'lang Malaga Maryjecel Midwife Tulunan

Lu Michelle Nurse Cotabato City Cotabato City

Digusen Asriya Midwife

Sambo Shirley Midwife

Mahusay Florida Midwife General Santos Mercado Veronica Leilani Doctor City General Santos City

Panes Emerlita Nurse

Peñales Christopher Others Angin Lovely Nurse

Nayal ABIGAIL Nurse Aguilar Rhela Nurse KORONADAL CITY South Cotabato Faderan Ana Celpha Others

Tamaño Mary Grace S. Doctor Dela china Noren joy Midwife Norala Suderio Yvonne Grace Nurse

Salada Ivan Leo Nurse Polomolok

Aseneta Carlyn Joy Others

Fontanos Miguelita Midwife

Crespo Jessyl Grace Nurse

Molina Ma. Jessyeen Nurse Santo Nino

Cocjin Rayzhel Nurse Surallah

Armecin Faye Joy Nurse

Gedorio Susie Midwife

Basco Elisha Nurse T'boli

Corridor Roselyn Nurse

Quimpan Esther Mae Nurse Tupi Cabasalan Saralyn Midwife Gevieso Norben Doctor Esperanza Kalaw Arman Nurse Manabilang Evelyn Nurse Isulan

Riola Nenita Nurse Sultan Kudarat Fuyonan Jennily Midwife Sudio Shiena Rose Nurse President Quirino

Cuello Ma. Nezeth Nurse

Dalumpines Ronette Joy Nurse Barroquillo Yvonne Doctor Tacurong City

Quiambao Gemalyn Nurse Gerios Kirstine Ivane Nurse

Areno Sarah Kay Midwife

Lacdo-o Arshiel Midwife Arceo Jacqueline Nurse

Zamboanga Martinez Leo Vanjun Nurse Zamboanga City Zamboanga City Peninsula Bael Juliet Midwife (Region IX) Balladares Veronica Midwife

Balucan Gerlin Midwife Dapitan City Castor Teresita Midwife

Descallar Glenda Midwife

Dizon Dolores Midwife Sagario Rafaela Midwife

Saldon Marilou Midwife Tendero Neriza Midwife Del Norte

Bayawa Concesa Midwife

Bongkawil Almira Midwife Cadano FELINEL Midwife Dipolog City

Simborio Esmeralda Midwife

Ang Ralph vincent Nurse Bulahan Wilma Others

Carabin Jocelyn kim Nurse Sacal Rosemarie Midwife Penaso Algen Midwife Gutalac Flores Rizalita Midwife Lacay Editha Midwife Labason Faelden Judie Nurse

Centino Shalee Nurse Manukan

Ortega Marilyn Midwife

Corsero Lucia Midwife Pres. Manuel A. Ronday Marilou Nurse Roxas

Rosalem Goldie Midwife Salug Tablac Carolina Midwife Tampilisan FPCBT2 Davao Region Calunsag Jocelyn Midwife TRAINING (Region XI) Bioco Mary jane Midwife

Compostela Dela Cruz Aileen Nurse Valley Montecillo Kristine Midwife

Carongay Gemma Midwife Davao City Lingatong Rosabella Midwife Doria Perlita Midwife Davao del Norte Braulio E. Dujali Paraguya Jonalyn Midwife Pastoril Jenny Midwife Santo Tomas

Ducducan January Doctor Tagum City

Doromal Indira Christine Nurse Davao Occidental Malita Labis LEAH Midwife

Bete Merian Midwife Cateel GOVERNOR Davao Oriental Gutual Gemma Midwife GENEROSO

Gandaruza Dina Midwife Lupon

Lodripas Elaine Jane Midwife San Isidro

Dagoc Arlene Midwife Bacolod Danlag Patricia Midwife

Guibone Rebecca Midwife Lanao del Norte Baloi Northern Mangompia Jobaira Midwife Mindanao Dimpas Rovelyn Midwife Baroy (Region X) Ruiles Alicia Midwife

Maguindanao Snooky Midwife Matungao Mangotara Jessica Midwife Tangcal Mapandi Saalica Midwife Mauyag Faisa Midwife

Roselim Marizee Midwife Balingasag

Tion Bernalyn Midwife El Salvador City Rollorata Verlyn Midwife Libertad

Casiño Alma Midwife Opol Ebarat Nadine Midwife Sayan Coreen Midwife

Sebastian Crystal Gail Nurse Tagoloan

PPFP/PPIUD ARMM Pael Felis Anne Nurse Lanao del Sur Tamparan

TRAINING NONE Bitoy Giovanni Nurse (blank) (blank)

Lano Rutchell Midwife Dangcagn Sanico Aida Midwife Bukidnon DonCarls

Umpay Lilian Midwife Manolo Fortich Northern Mindanao Macote Marilyn Nurse Valencia City (Region X) Bonbon Evenia Midwife

Celeste Efren Doctor

Datoon Marissa Midwife Cagayan de Oro City Cagayan de Oro City Gamus Warlina Nurse

Miso Vivian Midwife

Villarte Jane Nurse

Viloria Myrtle Others

Pingol Ciara Chloe Doctor Urbiztondo Judith Midwife

Usman Cecil Midwife

Taleon Ma. Josephine Doctor Babia Juvelyn Midwife Camiguin Mambajao Grado Aileen Nurse

Yuson Janice Doctor

Maglinao Mimi Doctor Iligan City

Zosa Meraluna Midwife Lanao del Norte Mendoza Nilda Doctor Kapatagan

Recopelacion Epifania Midwife Kauswagan

Ibrahim Norisa Midwife Sapad Lacanglacang Eva Nurse Tubod

Libetario Jane Midwife Calamba Misamis Narona Merlyn Midwife Occidental Clarin

Gomez Flrepen Midwife Ozamis City Ponday Mary Jane Midwife

Fabro Daisy Midwife Misamis Lagonglong Oriental Salvaria Remedios Midwife SALAY

Ayco Valentina Midwife Kidapawan City SOCCSKSARGEN (Region XII) Bernadas Rosalinda Midwife

Mendoza Edenrose Midwife Cotabato Libungan

Cagas Lilibeth Midwife Makilala

Garibay Jesiree Lee Nurse Midsayap

Herrera Nenita Midwife

Villa Norina Midwife PIGKAWAYAN Calimayan Avelina Midwife Tulunan

Ibrahim Samia Midwife COTABATO CITY

Bridente Celestial joy Nurse Cotabato City

Candao Junairah Nurse

Tan Kim Jane Nurse

Sarangani Balanag Umve Midwife Kiamba

Mosqueda Marichu Midwife

KORONADAL CITY Abkilan Raquel Others South Cotabato

Pacificar Ronna Midwife

Braña, JR. Conrado Doctor

Tamaño Mary Grace S. Doctor

Maypa Benny Nurse Norala

Caspe Shirley Nurse Sultan Kudarat Bagumbayan Espador Maribeth Midwife

Mamalo Liza jane Midwife

Perales Shirley Midwife Puyong Marivic Midwife Diado Maximina Midwife Columbio Ramos Nilda Midwife Almendral Magdalena Midwife

Barcelona Ma. Lina Midwife

Biadora Lanyfe Doctor Isulan

Garcia Judith Midwife

Padilla Almafor Midwife

Tuquero Aracelie Midwife

Bagaforo Myra Nurse

Molato Michelle Midwife Juanico Grace Midwife Kalamansig Talle Lorelie Midwife

Guiamadel Bambay Midwife Juan Marilyn Midwife Lambayong Lucas Bella Midwife

Miran Megans Grace Midwife Romero Ofelia Midwife

Tanangonan Janrie Doctor Lebak

Garcia Corazon Midwife Lutayan Mangudadatu Leah Nurse

Pangarintao Wiljun Doctor Librado Rosalina Nurse PALIMBANG Tadena Jocelyn Doctor President Quirino Guioguio Patrick Franz Midwife Tacurong City

Nismal EmelynMidwife

Orcullo Blessy Midwife Torre Mary grace Midwife Dela Cruz IRENE Nurse

Quiambao Gemalyn Nurse Arceo Jacqueline Nurse

USAPAN Davao Region Castro Jowena Grace Others Davao del Sur TRAINING (Region XI) Bansalan Gragasin Glory Others

Toraja Ma. Joyce Diane Others Bontia Edgar Others

Cabrillos Angelita Others Lumanog Josefina Others Macumbo Percilito Others

Mercado Elvira Others Digos City Orida Leoniza Others Penas Olelmie Others

Raut Raul Others Rebuyon Jeremias Others

Reyes Carlos Jr Others

Tac-an Victoria Others Filepe Christopher Others

Sanoy Daissy Jane Others

Zozobrado Rosa Others Marikit Margie Others

Blanco Britany Faith Others Del rosario Eric Others

Gallarde Marissa Others Magsaysay Labio Kenneth Vane Others Cabigas Christy Ann Others Malalag Hernan Carole Joy Others

Jumalin Adelaida Others Puno Lita Others Matanao Arquia Jonathan Others

Betarmos Ariane Faye Others Cordero Victoria Others Santa Cruz Dumagan Boobert Others

Pascua France Yuri Others Espacio Icy Others Sulop Perang Miraflor Others Emperador Pia Salome Others Malita Decipolo Aleah Lyca Others Davao Occidental Tesaluna Erlinda Others Santa Maria Dizon Mykka Therese Others Aldanese Rosula Others

Lanticse Lelibeth Others Mata Jovita Others Northern Pacalod Benedicta Midwife Don Carlos Mindanao Salapang Jovelyn Midwife Bukidnon (Region X) Berdin Ivy Mae Midwife Kibawe Sacote Pearl Joy Midwife Abella Marites Midwife Lantapan Canoa Marissa Midwife Alonzo Chona Midwife Malay-balay City

Manuel Germelou Midwife

Rodriguez Jeanette Nurse Cagayan de Oro City Cagayan de Oro City Yu Meg Irene Nurse

Odchigue Conrado Nurse Camiguin Mambajao

Babia JuvelynMidwife

Juyod Roquesa Nurse

Camins Ariane Doctor Lanao del Norte Tubod Lim Annie Nurse Cobrilla Ma. Rebecca Midwife Misamis Occidental Ozamis City Sumaly Geranima Midwife

Annex C: Distribution List of IEC Materials

Material Target Audience Purpose/Content Target areas/ Status distribution (title, type, print specs, versions)

Gabay sa Kaalamang Community Health The Toolkit is a job aid to • Lamitan City, Basilan Ready for distribution Pangkalusugan: Workers/Volunteers improve the interpersonal Home Visit Tool Kit engaged in client communication skills of • Isabela City, Basilan • 350 copies in reserve (Guide to Information on generation for FP, CHW/Vs to motivate for Cohort 300 sites Health) MNCHN women and men to seek • Davao City health care in the facility • Full color deskchart • CHT Navigators on FP, MCH and TB. • Tacurong City, Sultan Kudarat • 2,000 copies • BHWs • Zamboanga City • PPWs • Valencia City, Bukidnon • BSPOs • Malaybalay, Bukidnon

• Lanao Del Norte

Breastfeeding Tsek Breast feeding • Breastfeeding TSEK; • Project-wide • 4,000 distributed women; women in Guidelines on exclusive • EBF Poster the immediate breastfeeding • 4,822 Public and Private • 822 remaining in the postpartum Health Facilities printers for Davao • 2’ x 3 Full color poster • To be displayed in EBF Region room or area where mother’s classes are usually held; high traffic areas within the facility

Say and Save: Life For use of Health Stand-by material in the 1. CAAs • Distributed Saving Tips after a Service Providers RHUs/BHSs for use in Disaster evacuation centers/ a. Basilan – 250 cps temporary shelters in times • 8 ½” x 11”; Full Color of man-made or natural b. Sulu – 250 cps disasters or emergencies • English and Tagalog in c. Maguindanao – 250 cps back-to-back printing d. Cotabato – 250 cps • 6,450 copies e. Lanao Del Sur – 250 cps

f. Zamboanga City – 250 cps

2. Disaster-prone areas

a. Compostela Valley – 250 cps

b. Davao del Norte – 250 cps

Material Target Audience Purpose/Content Target areas/ Status distribution (title, type, print specs, versions)

c. Cagayan De Oro City – 250 cps

3. Regional Offices

a. Zamboanga Peninsula – 1,200 cps

b. Northern Mindanao – 750 cps

c. CARAGA- 500 cps

d. Davao Region – 500 copies

e. SOCSKSARGEN – 1,000 cps

f. ARMM –250 cps

Nanay and Baby Book Pregnant and 1. To convince pregnant • Project-wide • Distributed postpartum women; women to go for a check- • Booklet size; • Full mothers with up within the first three Color children not more months of pregnancy. than one year old • 40,000 copies 2. To convince pregnant women to ensure safe pregnancy via:

a. A minimum of 4ANC visits

b. Having a birth plan

3. To motivate mothers to safeguard their and their infant’s health via:

a. Exclusive breastfeeding

b. Postnatal check-up

c. Health timing and spacing of births using FP

FP Fan Pregnant and Take-away material during • Project-wide • Distributed postpartum women; FP consultation, Usapan • Oval shaped; Full men and women of sessions, community Color; Foldcote 30 reproductive age with health events, or during unmet need on FP EPI days at health centers • Tagalog due to fear of side effects • 6,000 copies

Material Target Audience Purpose/Content Target areas/ Status distribution (title, type, print specs, versions)

FP Placemat Public and private Job aid for HSPs to help in • Project-wide • Distributed health service counseling MWRAs with • 17” x 11”; Full Color; providers unmet need on FP due to • Public and Private Health Foldcote 30 fear of side effects Facilities

• 8,700 copies

FP methods Men and women of • LARCs (IUD and PSI) • Project-wide • Distributed brochures reproductive age who have need for • PMs (NSV and BTL) • Public and Private Health • 3,000 Brown Brochure, LARC/PMs; Facilities two folds (FP myths and addressing fear of • FP myths and misconceptions), 3 panel side effects; misconceptions correcting myths and • 3,000 Orange Brochure misconceptions on LARCs (IUDs, PSIs); one fold

• 3,000 Green Brochure (NSV, BTL); one fold

MCH Poster Women planning to Highlights the importance • Selected distribution • Distributed be pregnant, of having the 1st pre-natal during a training activity in • 18” x 24” Full color pregnant moms, check-up in the first 3 Gen. Santos City poster pregnant moms who months of pregnancy. This are delivering soon, material is to be displayed • 50 copies Class DE, aged 18-40 at public health facilities. years old

FP/EPI integration Mothers bringing Contains key messages: • Initially distributed in • Distributed tarp posters their child for Northern Mindanao (NorthMin) vaccination at health • For pregnant women, (Visayan version); • 18” x 24” Full color centers proper schedule of tarpaulin poster prenatal visits • For wider distribution

• Visayan and Tagalog • For women not using any versions MFP methods or still using traditional methods to • 469 copies schedule modern FP consultation

• For women currently using MFP, to schedule resupply and reminder for return check-up

FP Methods Chart Health facilities • Modern FP Methods, • Project-wide • Distributed (ICV wallchart) clients including NFP methods; Methods Effectiveness • 4,822 Public and Private • 23” x 37”; Full Color; Chart Health Facilities Tarpaulin • To be displayed indoors, in the FP room or area

Material Target Audience Purpose/Content Target areas/ Status distribution (title, type, print specs, versions)

where FP counseling is usually held

FP/MCH Fliptarps Health facilities Updated FP/MCH flipchart • For targeted distribution in • To be distributed clients for use during health LGUs with HSP strained on during the planned • 452 copies •Tarpaulin classes or Usapan sessions, IPCC but has no deskchart Usapan training 2'X3' flipchart with angle client consultation on or FP flipchart yet activity next quarter bar and rivets (15 pages) FP/MCH • In Caraga, to be distributed during the planned Usapan training activity next quarter

Usapan Facilitators HSPs trained as Learning resource package • Technical assistance to • Distributed Module Usapan Facilitators for training HSPs to Davao Oriental PHO conduct group education • 25 copies and counseling using the Usapan approach

Annex D: Safety and Security

A total of 51 security threats were experienced in the last 2 quarters (January to June 2016) of project operations in Mindanao provinces of North Cotabato, South Cotabato, Maguindanao, Lanao Del Sur, Zamboanga del Norte, Zamboanga City and Cotabato City (Table __). These threats ranged from the detonation of IEDs, NPA attacks, ambush operations by the NPA and BIFF to the kidnapping of Malaysian nationals. Whenever security threats are present, the security focal person communicates with field staff and provides guidance for security travel. The security threat mitigation and management was once put to test last April 2016. As the adjacent travel agency adjacent the sub-office was stormed by unknown gunmen and killed the owner of the agency. Our team leader immediately called up the Security Focal Person where prompt advice was given. The Davao Office then immediately notified the authorities and the area was cordoned-off. Staff communication lines were kept open to keep staff abreast with updates up until final clearance was given. After 3 days, a security debriefing was made and to address the security issues in the sub-office.

Table ____ Security Threats/Risks in the Regions/Provinces and Cities of Mindanao from January to June 2016.

Region/Province/Cities Nature of Security Impact to project Threats/Risk activities Zamboanga Peninsula Zamboanga City Feb 7- Ambush Bongao Sulu Happened on Sunday no Mayor Jasper Que impact to operations. March 1 – Saudi nationals Staff advised to avoid areas shot as they were leaving close to the university unless Western Mindanao cleared by authorities. University March 17 – Mayoralty Staff were advised to avoid candidate of Pangutaran, areas close to Barangay Sulu shot and killed. Tetuan June 29 – IED explosions Our staff was conducting ICV along Maria Clara Lobregat training in the city, the Focal highway. Person was also in the area and we re-scheduled our practicum to avoid travel to the outskirts of the city. June 21 – ASG bandit Close watch for possible nabbed skirmishes in the city.

Region/Province/Cities Nature of Security Impact to project Threats/Risk activities Zamboanga del Norte April 12 -NPA Rebels Advised staff to be very Disarmed 4 Policemen in cautious when traveling to Roxas, Zamboanga del Norte Zamboanga Sibugay and Zamboanga del Norte as communist insurgents were continuously conducting harassment activities. Northern Mindanao Misamis Oriental March 1 – red Alert for NPA Advisory to limit travel attacks outside the area April 3 – NPA road blocks in Travel withheld to and from Talisayan CDO Bukidnon March 1 – red Alert for NPA Advisory to limit travel attacks outside the area April 6 – NPA clash in Staff advised to be extremely Malaybalay cautious when traveling to the Northern Mindanao provinces as military offensives were going on in these areas. Davao Davao del Sur March 17 – arrest of NPA Advised staff to forego non- vice commander in Bgy Buri, travel to Matanao Matanao

Compostela Valley March 1 – red Alert for NPA Advisory to limit travel attacks outside the area April 19 – Security Travel to Advised staff of clearance for Bgy Ngan, Compostela travel, with SMS updates Municpality June 29 – NPA leader Eddie Advised staff to be vigilant Genelsa arrested in when traveling to the Pantukan province of Compostela Valley due to dangers of harassment by communist insurgents and other armed lawless groups.

SOCCSKSARGEN South Cotabato March 1 – red Alert for NPA Advisory to limit travel

Region/Province/Cities Nature of Security Impact to project Threats/Risk activities attacks outside the area.

North Cotabato Feb 25 – Folied bombing Advised staff to limit travel Midsayap, North Cotabato, to outskirts of North Cotabato.

Feb 23 – Foiled ambush Advised staff on travel to attack in San Fernando Central Mindanao, and Bukidnon public places.

March 1 – red Alert for NPA Advisory to limit travel attacks outside the area.

Cotabato City Feb 10- BIFF clash, and Advised staff to limit travel capture of its Vice Chair for to Cotabato City and no Internal Affairs travel to Cotabato from Davao region.

Sultan Kudarat March 1 – bombing plot Travel safety advisory was issued from 7am to 4 pm only.

CARAGA Feb 16 – NPA attacks in Travel advisory on NPA Surigao. attacks issued. Staff advised to avoid non-essential travel to Surigao. No impact on project operations.

Agusan del Sur March 28 – NPA Staff advised to avoid non- checkpoints essential travel to the area.

ARMM April 1 – ASG kidnapping of Staff required clearance from 3 Malaysians off Sabah the Security Focal person for travel to the Sulu Archipelago. Only travel between 7:00am to 4:00pm was allowed.

Maguindanao Feb 7 - BIFF Clash with AFP With the highway between Datu Piang, Saudi and

Region/Province/Cities Nature of Security Impact to project Threats/Risk activities Butalo closed, team advised to forego non-essential travel from Maguindanao to Cotabato and vice-versa.

March 3 – Clashes between No travel to Datu Salibo, no BIFF and AFP in Datu Salibo impact to project activities. Feb 12 – IED explosion Maguindanao Capitol issued interim provincial capitol advisory of precaution for grounds in Poblacion Buluan travel within Maguindanao, no impact to project operations.

Lanao Del Sur Feb 20 – rebels attack in No operations in Lanao Butig during that day; advised staff to limit movements within provincial capitol only.

Basilan March 27 – Abu sayaff camp MindanaoHealth staff seized in Al-Barka advised to take extra precaution when traveling to Isabela, Basilan. Travel to Isabela City requires travel security clearance from the Security Focal Person.

April 15 – IED explosion in Travel to Basilan, Sulu and Lamitan Tawi-Tawi requires approval from the Security Focal Person.

March 28 – IED explosion in MindanaoHealth staff Lamitan City school building advised to take extra precaution when traveling to Isabela, Basilan. Travel to Lamitan City requires travel security clearance from the Security Focal Person.

Sulu April 5 – Head teacher killed Staff advised to be extremely

Region/Province/Cities Nature of Security Impact to project Threats/Risk activities in PATA, Sulu cautious when traveling to the island provinces of Sulu Archipelago with military offensives going on in these areas.

June 21 – ASG and Staff advised to be extra government troops clashed vigilant when traveling due in Patikul Sulu to threats of harassment by other armed lawless groups. Travel to the provinces of Basilan, Sulu and Tawi-Tawi requires clearance from the Security Focal Person.

Tawi-tawi March 28 – Abduction 10 Indonesian Nationals by ASG

Our safety and security pre-election preparation such as the Safety and Security Orientation for Drivers provided last April 25 to 26, 2016 was conducted to re-tool our team on security risk mitigation. It was a 2-day course developed through RSM and our Safety and Security Focal Person which was attended by 4 (four) project drivers. One (1) driver wasn’t able to attend due to illness. The in-house didactic sessions covered Safe Driving, Road Hazards, External vehicle and Engine Checks, Cockpit Drill, Speed, Braking and Distancing, Passing and Crossroads and Safe Cornering. Likewise, pointers in case of vehicle breakdown, accidents and emergencies, to -do in case of aggressive driving, Security Threats needed to forecast, Driver’s safety skills and the code of conduct, were issued and signed by the participants to seal off their commitment as the new safety and security stewards of the project.

To better prepare and mitigate effective response mechanism to Security and Safety threats , MindanaoHealth provided six (6) satellite phones to its project sub-offices last June 7, 2016. Likewise, all eight (8) administrative staff and eight (8) finance staff were oriented on the use of satellite phone through the implementation of the Jhpiego Philippines satellite phone policy using utilization tools. Security Guidelines were revised to include an updated communication plan which provides a strengthened communication protocol providing options to communicate to project staff in the sub-offices of Cotabato City, Zamboanga City, Cagayan De Oro City and Butuan City through the use of satellite phones. The table below shows the satellite phone numbers and corresponding geo-locations.

Table ___. Satellite phone numbers and geo-location.

Geo-location Satellite Number Zamboanga 8816-2344-9894 CDO 8816-2347-6997 Butuan 8816-2244-5782 Cotabato 8816-2347-8723 Davao 8816-2341-6455 Davao 8988-2345-9021

Fleet Management System, likewise, was prioritized this quarter. This was installed in all five (5) project vehicles. To manage the system, we sent our team for capability building last May 5, 2016 at the Globe Tower in BGC, Metro Manila to further determine consumption expenses and utilization analysis.