The MindanaoHealth Project A Partnership to Deliver Quality Health Services

Results from Years Two and Three

MindanaoHealth_Magazine.indd 1 20/02/2016 2:18 PM MNCHN/FP PROGRAM PERFORMANCE

14% increase in Couple Years Protection (long acting or 8,700 children received antigens permanent FP methods) from FY 2014 to FY 2015; total for the two year period is over 520,000 years of protection 7,400 children provided with vitamin A 37% increase in acceptors of LAPM methods out of over during community health events 96,000 total clients for two years 4,900 pregnant women provided 70,000 women received information on exclusive antenatal care services and iron breastfeeding, out of which 26,000 were pregnant women supplementation during REACH++ provided with antenatal care activities MINDANAOHEALTH ACHIEVEMENTS/CONTRIBUTIONS Family Planning

33% contribution to LAPM acceptors equivalent to over 31,000 clients served through outreach and Results at a Glance fixed facilities with a project-trained provider 123% expansion (from 209 to 466) in the number of health 2,000 health providers trained in long- centers and hospitals with capacity to provide counseling and acting, permanent, and reversible family family planning services planning methods Maternal and Child Health

1,200 health service providers trained 22% or 1,069 out of the 4,697 on newborn care midwives capacitated to provide newborn care Reaching the Most Underserved

8% of the 441,103 women of reproductive age (NHTS/CCT) 1,800 clients from outreach in conflict-affected areas (CAAs) reached in various health activities in CAAs provided with events and outreach services family planning methods

23,500 women and children in conflict-affected areas received immunization, nutrition, maternal care and family planning services Strengthening the Health Systems 18 service delivery networks (SDN) established across 53 local government units and engaged with SDN maps, indicating development of referral pathways for family planning and maternal, neonatal and child health and nutrition services

8 public-private partnerships initiated to provide 42 local government units, with around 1,300 family planning and maternal, neonatal and child trained health workers, conducting data quality checks health and nutrition services Adolescent-Youth Reproductive Health

5 Centers for Teens Programs in 5 hospitals in Mindanao established to cater to the RH/FP needs of young mothers, and male and female adolescents-youths

15% (55 of 365) of municipalities/cities with 123 youth leaders trained as peer educators equipped 397 health service providers and guidance with knowledge and practical skills in conducting peer counselors trained on the use of Adolescent Job education or informal group conversation sessions for Aid (AJA) as guide to dealing with adolescent young people about adolescent reproductive health, clients behaviours and risks

MindanaoHealth_Magazine.indd 2 20/02/2016 2:18 PM Inside

2 Message from the Chief of Party 5 From Islands to Highlands 8 Engaging Media as Partners on Safe Motherhood 10 Getting Needed Skills into the Hands of Mindanao Providers 12 Family Planning: Protecting My Family, Protecting My Future 14 Engaging Private Practitioners to Expand Family Planning Services in Davao City 16 Centers of Excellence: Raising the Bar for Service Delivery in Mindanao and Its Conflict-Affected Sites 19 Empowering Youth for Reproductive Health 21 Usapan - Let’s Talk! 23 Putting the Needs of Mothers and Newborns First 25 New Skills for Nurses and Midwives Help Newborns Thrive 27 Ensuring Quality Vaccines for Immunization through USAID-Donated Solar-Powered Refrigerators 29 The Electronic Masterlisting and Tracking Tool (EMTT) 32 Taking Better Care of her Family: The Story of Nur- Ana 34 Mobile Mentoring: Supportive Supervision through Mobile Technology 35 Getting the Numbers Right! 36 Strengthening Health Systems—the SDN Way!

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MindanaoHealth_Magazine.indd 1 20/02/2016 2:18 PM During the Paanakan (Birthing) Dialogue in Talipao, , traditional birth attendants try to demonstrate facility-based deliveries with help from skilled birth attendants. (Talipao Rural Health Unit)

Message from the Dear Colleagues, I am pleased to share with you the USAID Chief of Party MindanaoHealth Project magazine, which highlights the results and the progress made over the past two years (2014 and 2015) in delivering high quality reproductive, maternal and newborn health services to women, men, families, adolescents and teenage mothers in Southeastern , especially

Dolores C. Castillo, MD, MPH, CESO III those in geographically isolated and disadvantaged Chief of Party, MindanaoHealth Project Country Director, Jhpiego Philippines communities.

From islands to highlands, including conflict-affected areas, the MindanaoHealth Project, implemented by Jhpiego with partner Research Triangle Institute, has worked alongside dedicated colleagues and health providers from the Philippines Department of Health (DOH), local government units (LGUs), and private and non-profit partner organizations to increase the number of pregnant women delivering with the assistance of a skilled-birth attendant (SBA) in facilities, provide family planning services to clients with unmet needs, and deliver other maternal, neonatal, child health care services.. Despite peace and order challenges, especially in far-flung areas in ARMM, the project continued to support the delivery of needed health services, in strong partnership with LGUs, health providers and with the Armed Forces of the Philippines.

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MindanaoHealth_Magazine.indd 2 20/02/2016 2:18 PM Another project success in its second and third year is the limited mobility of COE-based trainers particularly the unique collaboration between the MindanaoHealth in the conduct of supportive supervision and follow-up project and Talipao Municipality of Sulu Province in mentoring in designated practice sites. implementing the Paanakan Initiative. This initiative resulted in traditional birth attendants, locally called In an effort to improve demand for MNCHN and FP pandays, now accompanying women to rural health units, services, the MindanaoHealth project, working closely increasing SBA deliveries from just two to 60 (Field Health with LGUs, supported over 200 community outreach Service Information System, Talipao Rural Health Unit) in and health interactive (Usapan) sessions reaching about 2014. 70,000 women, couples and youth. These efforts contributed to reaching about 31,000 clients in 211 In the area of improving knowledge, skills and confidence municipalities/cities with family planning services. This also of frontline health workers toward delivery of maternal reflects a 33 percent contribution of the project to the and newborn health, and family planning services, more than 50,000 total women and men who accepted the MindanaoHealth Project, in partnership with the long-term contraception in the past two years alone (Field Department of Health-Regional Health Offices, built Health Service Information System). the capacity of more than 8,000 midwives, nurses, peer educators and community providers, over the past two Moreover, the rising trend of teenage pregnancies in years. To date, they have been providing maternal and Mindanao, particularly in the regions of Zamboanga neonatal health care, and Family Planning services to Peninsula, Davao and Caraga, made it imperative to women and men of reproductive age. Furthermore the conduct reproductive health-related activities for young project coordinated with the Centers of Excellence for people. MindanaoHealth in collaboration with the regional MNCHN and FP training and service provision namely offices of the Department of Education Regional Offices Medical Center, Southern Philippines and the Commission on Population provided over 28,000 Medical Center, Davao Regional and Medical Center, adolescents with youth-friendly, reproductive health Cotabato Regional and Medical Center, and Northern information through health events and interactive health Mindanao Medical Center, to form a pool of competent discussion sessions. and certified trainers available to continue training, supervising, mentoring and coaching health service Towards the end of 2015, the project supported the providers even beyond the project life, in addition to establishment of Programs for Teens in five private providing direct services. Also with this partnership with and public hospitals in Davao City, General Santos City COEs, public and private clinical practice sites for maternal and South Cotabato Province that are now providing and child health care and family planning were established adolescent-friendly health information and services to in- for health service providers could further hone their school and out-of-school youth. This is 150 percent higher acquired skills from training; and for certification and from the project’s annual target of two hospitals. Philippine Health Insurance (PhilHealth) accreditation. The project and the COEs also capacitated health service The project is also working together with partners to providers at the rural health units as trainers with capacity help reduce or totally take away the burden of out-of- to conduct supportive supervision; thereby addressing pocket expenses/costs of giving birth at facilities. For the past two years, Mindanaohealth supported the conduct of health facilities assessment and advocated to LGUs to address gaps identified from assessment results to comply with PhilHealth accreditation requirements. The project also supported needed training of health providers, also as requirement for Philippine Health Insurance Corporation’s (PHIC) Maternity Care Package (MCP) and Newborn Care Package (NCP) accreditation. As a result of these, pregnant women, who are PhilHealth The MindanaoHealth Project family during their Annual Workplanning members or dependents, and especially beneficiaries of Workshop. (Jhpiego) the government’s Conditional Cash Transfer/National

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MindanaoHealth_Magazine.indd 3 20/02/2016 2:18 PM Household Targeting System (CCT/NHTS), are now Datu Blah Sinsuat committed to improve health services assured to give birth at health facilities with the help within their cluster. As a result, the Municipality of South of skilled birth attendants, without paying from their Upi, for one, is implementing the electronic masterlisting pockets. To date, the project has supported 326 and tracking tool (EMTT) to track pregnant women and facilities for their Maternity Care Package accreditation, clients with unmet needs for family planning. On the representing 54 percent of the overall 599 MCP/ other hand, the Local Chief Executive of the Municipality NCP accredited facilities or 67 percent of 888 public of Upi requested support to expand EMMT in his own and private potential health facilities for MCP/NCP locality. In Zamboanga City, the project jointly worked accreditation. with ENGAGE, civil society organizations, and the city government for adolescent-youth health development Moving forward, MindanaoHealth is building the initiatives to help address health issues of the young foundation for sustainability of our interventions so that people including reproductive health. gains are maintained even after project life by engaging local government leaders and supporting policies These are just some of our significant achievements, through our many forms of partnership with other and we couldn’t have gotten to this stage without our USAID projects like Zuellig Family Foundation (ZFF)- teamwork -- along with other USAID Cooperating Health Leadership Governance Project (HLGP) and Agencies, and the support and guidance of USAID. For Enhancing Governance Accountability and Engagement this, thank you very much. (ENGAGE). The project tightens its collaboration with ZFF-HLGP, along with DOH-ROs, Commission on Let us join hands and continue to work together to bring Population (PopCom), and LGUs, in moving forward gains high quality services to the doorsteps of women, men, that support the creation of an enabling environment children and their families in our commitment to end (policy and systems) for FP/MNCHN/RH services, such preventable deaths. as establishment of a service delivery network (SDN), a Supply Management and Reporting System, data quality Mabuhay! check, use of dashboards, and formulation of an LGU ordinance on PhilHealth reimbursement utilization, among others.

Meanwhile, the project’s partnership with the ENGAGE Project supported interventions that brought in Local Chief Executives (LCEs) toward planning and health management of their respective LGUs like in Dolores C. Castillo, MD, MPH, CESO III wherein the LCEs of the Tri-People Cluster Chief of Party, MindanaoHealth Project for Peace and Development namely Upi, South Upi and Country Director, Jhpiego Philippines

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MindanaoHealth_Magazine.indd 4 20/02/2016 2:18 PM Health providers in ARMM paddle through rivers just to reach island villages and bring needed health services. From Islands to Highlands Bringing Essential Maternal, Child Health and Family Planning Services to the Doorsteps of Conflict-Affected and Disadvantaged Communities in Mindanao indanaoHealth Project to increase their visibility, and as issues have impeded delivery of health is working with the the Secretary of DOH-ARMM said, services in these areas, notably in the Department of Health “making people in conflict areas far-flung island provinces. According M(DOH) in the Autonomous Region know that they are at the core of the to the 2013 Philippines DOH National in Muslim Mindanao (ARMM) government’s health agenda.” Demographic and Health Survey, over through the Reaching Every ARMM 60% of women of reproductive age Community for Health (REACH++) While there has been progress in (15–49) in the ARMM regions cite initiative to bring an integrated increasing access to facility-based distance to a health facility as one of the package of maternal, newborn and services—particularly maternal, main reasons for the poor utilization child health and family planning neonatal, child health and nutrition of health services. The situation is services to the doorsteps of women (MNCHN) and family planning (FP) made worse by poor methods of and their families. REACH++ is part services—challenges remain. Frequent transportation in the island provinces, of the ARMM Regional Government reports of bombings, kidnappings, inadequate number of health providers and the DOH-ARMM’s objective armed conflicts and other security and high poverty levels.

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MindanaoHealth_Magazine.indd 5 20/02/2016 2:18 PM These health outreach activities contribute greatly to Mohammad Ajul’s health program accomplishments.”

Building on the“ REACH++ network FP services to more than 23,000 clients “Besides the services, the REACH++ and its previous successes, the in difficult-to-reach areas. outreach activities are sometimes MindanaoHealth Project has been the only opportunity families in these working with the midwives in every “These health outreach activities communities have to meet with health community in ARMM to equip over contribute greatly to the municipality personnel,” she added. 600 midwives with essential skills to of Mohammad Ajul in Basilan’s care for mothers and newborns in the health program’s accomplishments. Adopting the previous ARMM region’s community. In the project’s second and Bringing a package of interventions Reaching Every strategy, third years, these project-supported to geographically isolated and MindanaoHealth is committed to midwives were deployed in 207 disadvantaged villages, or barangays, supporting REACH++ outreach REACH++ activities, covering 103 was satisfying teamwork,” said activities in an effort to bring essential barangays (villages) and 47 municipalities Soraida Jaiyari, a Rural Health Midwife MNCHN/FP services closer to to provide outreach services that in the Municipality of Mohammad Ajul geographically isolated and conflict- included immunization, micronutrient in Basilan. affected communities in the region. supplementation as well as MNCHN/

Health service provider immunizes a baby A pregnant women receives a dose of tetanus A mother registers herself and her children to during one of the REACH++ activities in toxoid vaccine during the outreach activity in access health services during the outreach Tawi-Tawi. (Photo by M. Abdulwahid, Jhpiego.) , Sulu. (Photo by N. Julkarnain, Jhpiego.) conducted in an evacuation center in Maguindanao. (Photo by S. Alih, Jhpiego.) 23,000 participated in health education about 1,800 individuals were MNCHN/FP activities provided with modern FP methods REACH++ 4,900 during REACH++ pregnant women were provided CONDUCTED activities only 207 with antenatal care services and iron supplementation during REACH++ activities

of women of reproductive age 8,700 7,400 16% in conflict-affected areas reached children were children were given vitamin with MNCHN/FP information and immunized A supplementation services through health events

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MindanaoHealth_Magazine.indd 6 20/02/2016 2:18 PM ARMM Provinces and Municipalities REACH-ed!

Akbar Linungan Languyan Adnin Manggusu Basbas Proper Paguengan BasLikud Semut Kualabaro Al-Barka Danapah Parang Pantay Kuhon Lennuh Tumbagaan Kailih Sibutu Tandu Banak Tawi-Tawi Magcawa Simunul Mongkay (cont.) Candiis South Ubian Bintawlan Langil Bubuan Pintasan Nusa-Nusa Sibago Putat Sulutan Matangal Tandubas Himbah Parian-Baunoh Naungan Suba-an (Pangasaan) Basilan Tandubato Tairan Ampatuan Dicalongan Calang Canas Kamasi Tamuk Digal Tabuan Lasa Lanawan Maslabeng Tipo-Tipo Banah Buldon Dinganen Tuburan Calut Datu Blah T. Sinsuat Matuber Bohetambis Nalkan Duga-a Penansaran Lahi-Lahi Lower Mahawid Datu Saudi Ampatuan Dapiawan Sinangkapan Madia Tumahubong Datu Odin Sinsuat Kusiong Amaloy Penditen Kamamburingan Datu Unsay Bulayan Bangas Kabingig Indanan Adjid Panangeti Bato-Bato Maguindanao Guindulungan Kalumamis Timbangan Mamasapano Tukanalipao Asturias Parang Bongo Island San Ray Mundo (Litayen) Lantong Rajah Buayan Pidsandawan Lahi Sampao Manubul Zapakan () Sulu Parang Buton Kuloy Bangkal Lapok Umangay Nabundas Laminusa Shariff Saydona Mus- Duguengen Tulling tapha Nabundas Talipao Bandang Sultan Sa Barongis Barurao Mauboh Talayan Katibpuan Tuyang Poblacion Alu Bunah Upi Nuro Lumah Dapdap Pualas Talambo (Poblacion) Lapid-Lapid Tagoloan Tagoloan Poblacion Mandulan Lanao del Tawi-Tawi Masantong Sur Lumba-Bayabao Maribo (Poblacion) Pagatpat City Cayadonan Tarawakan Bubonga Punod

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MindanaoHealth_Magazine.indd 7 20/02/2016 2:18 PM Isabela City North RHU Nurse Supervisor Bernardita Hontucan (second from right) takes the lead in providing safe motherhood messages through radio broadcasts with support from media partner DXNO 97.5 Radyo Komunidad de Isabela City. (Resurreccion/Jhpiego) Engaging Basilan Media as Partners on Safe Motherhood

he MindanaoHealth Project areas to spread the message and partnered with Isabela City Rural is working with central and advocate communities get involved Health Unit (RHU) and the only regional governments, the in the national campaign to bring radio station in Basilan, the DXNO Tprivate sector and community to reproductive, maternal, neonatal, 97.5 Radio Komunidad de Isabela generate awareness among women child, nutrition and family planning City. Working with DXNO 97.5 and their partners about the services close to the people. was a rewarding experience as the importance of safe motherhood and partnership made it possible to air newborn health. The goal of this This communication effort is safe motherhood messages approved communication campaign is to dispel especially crucial in island provinces by the Department of Health in the misconceptions about family planning, of the Autonomous Region in Muslim dialect. The airing was while advocating for strengthened Mindanao (ARMM), where transistor accomplished with assistance from health service delivery systems and radio is the preferred and widely the Isabela City RHU as it is the providing access to quality maternal available medium of communication community’s referral health facility. and newborn services. To meet this given the geography and the civil goal, the project has partnered with unrest. Tapping into this opportunity, “The airing of safe motherhood local media in the implementation the MindanaoHealth Project recently messages on DXNO 97.5 Radio

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MindanaoHealth_Magazine.indd 8 20/02/2016 2:18 PM I feel happy when I hear from pregnant women coming to the facility for prenatal visits that they heard our ad and messages on the radio. And that the “ information they received influenced them to come to the clinic to seek safe pregnancy and motherhood services.”

Komunidad is a big boost to our “Inakup, Arekup” campaign that airs advocacy efforts in the region. We messages on DXNO 97.5 about five are reaching communities with times a day. These messages reach messages that are addressing poor over 100,000 women and men in health-seeking behaviors, especially Isabela City and the nearby villages of for pregnant women, encouraging City, and the municipalities of them to deliver at health facilities and Lantawan and Maluso. avail of postpartum services that they can benefit from,” said Bernardita “I feel happy when I hear from Hontucan, Nurse Supervisor at the pregnant women coming to the Bernardita Hontucan, North Isabela City RHU. “Through facility for prenatal visits that they Nurse Supervisor these radio sessions, we are reaching heard our ad and messages on the Isabela City North RHU a wide range of listeners in the most radio, and that the information they remote barangays (villages) in the received influenced them to come City.” to the clinic to seek safe pregnancy and motherhood services,” added Since the collaboration started, two Hontucan. safe motherhood radio programs have been aired in Chavacano. For family planning, MindanaoHealth and Isabela City have launched the

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MindanaoHealth_Magazine.indd 9 20/02/2016 2:18 PM Dr. Bonita Montes, a project-trained physician of M’lang District Hospital in North Cotabato inserts a subdermal implant to a client. (Jhpiego) Getting Needed Skills into the Hands of Mindanao Providers How the MindanaoHealth Project Empowers Health Providers to Address their Clients’ Family Planning Needs or Dr. Bonita Montes, a resident one of MindanaoHealth Project’s acting and reversible contraception physician of M’lang District competency-based family planning and permanent methods to more Hospital in Cotabato Province in trainings in 2014, that changed. than 200 women. She also serves FMindanao, the skills she obtained from as supervisor in the M’lang Rural the MindanaoHealth Project have “I am now more capable and Health Unit to other family planning been very valuable. Before this, she confident to serve and…want to health service providers who were wasn’t able to competently perform continue helping women, especially the trained but have not practiced their bilateral tubal ligation—a surgical young ones, delivering at this facility skills. She is mentoring and coaching procedure performed on consenting who clearly need guidance in healthy more of them and helping to women—or insert intrauterine timing of pregnancy, birth spacing, boost their confidence in providing contraceptive devices for long-acting and responsible parenthood,” said Dr. services. contraception. After she attended Montes who has helped provide long-

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MindanaoHealth_Magazine.indd 10 20/02/2016 2:18 PM I am now sharing my experience with my relatives and friends, and they are also interested to undergo “counseling and learn more about [family planning].”

Even Dr. Montes’ clients are adopting in the Autonomous Region in Muslim her spirit of sharing. Merie June Mindanao (ARMM) and the local Postpartum Lustre, a mother of two who went government units, MindanaoHealth Intrauterine with her husband, said, “One good has equipped providers like Contraceptive thing is that Dr. Montes checks on me Drs. Montes and Montañer and Devices—Now and asks about my condition every approximately 1,500 others with PhilHealth now and then. I am doing great and competencies to perform bilateral covered! have not seen any side effects. I am tubal ligation by minilaparotomy— an As a member of the now sharing my experience with my abdominal surgery of the fallopian Department of Health relatives and friends and they are also tubes that is done under local National Implementation interested to undergo counseling and anaesthesia to insert intrauterine Team-Technical Working learn more about [family planning].” contraceptive devices, especially Group, MindanaoHealth during postpartum. The training actively lobbied for the In the city of Cotabato, another also includes how to remove the expansion of PhilHealth’s family provider trained by MindanaoHealth, intrauterine contraceptive device. planning benefits, resulting in Dr. Edvir Jane Montañer, is equipped the inclusion of postpartum and ready to dispel common cultural These health providers have also intrauterine contraceptive family planning misconceptions and participated in over 500 family devices (PPIUCD) into myths in her area. “Because of culture planning outreach events conducted Philhealth coverage/benefits and religion, many people in this in partnership with Marie Stopes as a separate case rate. The Philippine Department of area are reluctant to accept family International and the Jerome Health is also reviewing for planning,” she said. “MindanaoHealth Foundation, reaching more than approval the USAID-supported has given me the opportunity…[to] do 13,000 women, couples and youths PPIUCD Manual. The project the best that I can to ensure the health with family planning information and is also currently advocating for of families, especially of women and safe contraceptions of their choice. reimbursements of bilateral children.” tubal ligation/minilaparotomy under local anesthesia and In collaboration with the regional no-scalpel vasectomy in offices of the Philippines Department nonhospital settings. of Health, the Department of Health

Trained Health Service Providers in Year 2 and 3

FPCBT2 Interval IUD 791 536 671 141

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MindanaoHealth_Magazine.indd 11 20/02/2016 2:18 PM Family planning acceptor Joan Ramonal, shown here with her youngest son, is now confident that she would be able to take care of her family without the worries of unplanned pregnancy. (Cossid/Jhpiego) Family Planning: Protecting My Family, Protecting My Future

oan Ramonal had always dreamed family was no longer manageable. Budiongan provided. Joan wanted of getting a college degree. But Joan had no choice but to stay home to be sure that Implanon was the Jwhen she was 19 years old, she and attend to the needs of her young right choice for her. “I answered the became pregnant for the first time children, relying on Jason’s meager questions truthfully even if I felt a and had to put these dreams on hold pay as a part-time laborer. The couple little uneasy and embarrassed,” said because she and Jason, her partner of realized they would need to plan their the 23-year-old mother. almost six years, were not prepared family to avoid more pregnancies. financially for a baby. Fortunately for Joan, at that time In February 2015, when a barangay the MindanaoHealth Project was Joan had to give up her job as a (village) health worker made a conducting supportive supervision house helper so that she could care regular visit to Joan’s community, of trained health service providers for her child. Still, at first, life seemed Joan went with other women to at Northern Mindanao Medical bearable because Joan’s mother learn about family planning and the Center, and she received her was able to provide food for Joan methods available. Eager for more Implanon insertion the next and her family. The couple shrugged information about the long-acting day for free. “I did not have any off the idea of using contraception, subdermal implant called Implanon, apprehensions or fear about the rationalizing that having another child Joan went immediately for counseling procedure and about the side was God’s will. Then, at the age of 21, at the health center where she effects. I just wanted to protect another baby came, and barely a year listened intently and absorbed all myself and my family.” later, their third child. Their growing the information that Nurse Jara

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MindanaoHealth_Magazine.indd 12 20/02/2016 2:18 PM I am very happy with subdermal implant. “ I got it for free, and it fits my needs.”

Today, when she works part time Almost 10 months after her doing laundry, Joan brings her children Implanon insertion, Joan remains along. She cannot imagine how satisfied about her family planning much harder this work would be if experience. Through support from she were pregnant once again with MindanaoHealth, she received a long- her children in tow. In fact, Joan has acting but reversible method, and her become a successful family planning biggest fear of getting pregnant again advocate. She encouraged her sister, is gone. “I am no longer anxious. I who has two children, to go to the don’t have to think about anything, health center for family planning just my children, caring for them and information. Months later, Joan’s planning to have a better life and a sister received a subdermal implant better future for them,” she said with insertion and is currently enjoying pride. the benefits of being protected from unwanted pregnancy.

Joan Ramonal with her family

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MindanaoHealth_Magazine.indd 13 20/02/2016 2:18 PM Private practicing midwife Genevieve N. Berato (extreme right in black) facilitates and assists in the return-demonstration for PPIUD insertion during the PPIUD Training she conducted as one of the trainers. (Berato/Jhpiego) Engaging Private Practitioners to Expand Family Planning Services in Davao City

avao City exhibits a more whom are private practicing midwives facilities,” she recalled. Apparently, this strengthened engagement and around 13% (around 120) are understanding was shared by many with both private and public from Davao City. other private practitioners. Facilities Dhealth service providers in delivering providing short-term methods such as family planning/reproductive health Genevieve Berato is one of these injectables are few and far between; if services in the Davao Region, if not private midwives from downtown clients need a family planning method, in the whole of Mindanao. These Davao City. She never imagined she they are referred to public facilities. services range from capacity-building would be providing long-term family However, with the high unmet need to supportive supervision. Around planning services at her Well Family for family planning services in Davao 890 health service providers have Clinic in the Agdao barangay (village). City and other areas in the Mindanao been trained on family planning with region, providers in both private and support from the MindanaoHealth “I thought this was reserved only public facilities had to be engaged. Project: more than 50 percent of for providers working with public

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MindanaoHealth_Magazine.indd 14 20/02/2016 2:18 PM To increase access to family planning service delivery outlets, MindanaoHealth Project is reaching out to private practitioners like Berato One midwife thanked me and told me that she and equipping them with competency- based training to provide high-quality considers me as her mentor. This has challenged me. postpartum intrauterine device (PPIUD) services for women who give I want to see more private midwives be like me.” birth at their facilities. Prior to 2012, postpartum family planning services “ were not available in Mindanao and only provided at the Jose Fabella the region. Berato became both—a Memorial Hospital, a Department provider and trainer. of Health hospital in Manila. As identified by the Maternal and Child Immediately after the Health Integrated Program (MCHIP), MindanaoHealth PPIUD skills a former project of the United States training, Berato started offering Agency for International Development family planning services at her Well (USAID), also implemented by Jhpiego, Family Midwife Clinic, a private postpartum family planning is a service birthing facility she operates under Genevieve Berato, Private gap that needs to be filled. supervision from the Kinasang-an Midwife in Davao City Foundation, Inc. (KSFI), a nonprofit In 2013, USAID, through MCHIP, organization in Davao that supports “I am proud to be one of the first implemented postpartum family small business start-ups working in private practicing midwives to be planning in nine sites all over the its community. engaged by the MindanaoHealth Philippines and invited Berato to Project, and as a trainer too,” Berato attend the PPIUD training. At first, she “When I administered my first shared. She has taken part in in more could not believe it; she was hesitant PPIUD insertion, I was nervous,” than 10 PPIUD training sessions, and because she had no knowledge of Berato recalled. “But with time, is “happy to have helped over 100 PPIUD and she was not confident. I became more confident.” From midwives strengthen their PPIUD But the call to serve overpowered this modest beginning, Berato has insertion skills.” her worries. Motivated by the need successfully inserted 189 PPIUDs to make a difference, she gave it a try. as part of the 425 deliveries she “When it comes to participating in Berato was further humbled to find attended since her training in 2013. training such as on family planning, I that other cadres—nurses, doctors— have no reservations because I know from the public sector were taking Berato attributes her new confidence that I am also learning new things,” she part in the PPIUD training. and success to the “constant beamed. practice and supportive supervision Taking off from MCHIP’s activities, from MindanaoHealth trainers and “One midwife thanked me and told me the MindanaoHealth Project designed mentors.” PPIUD insertions are “now that she considers me as her mentor. a more comprehensive postpartum easy and fast,” said a satisfied Berato. This has challenged me. I want to see family planning program, a key As a result, she has made family more private midwives be like me.” element of which is introducing and planning counseling a routine service enhancing private and public health for all clients who come to deliver at Berato is no longer shy but full of service providers’ skills in PPIUD the Well Family Midwife Clinic. “As gratitude: “I thank MindanaoHealth insertions. The MindanaoHealth soon as they [mothers who have just Project for their trust in my capabilities. Project is working on increasing the given birth] voluntarily choose to I am carrying along this trust and number of PPIUD trainers who can have a PPIUD insertion, I provide it applying the learning that I have impart skills to their colleagues across to them.” acquired”.

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MindanaoHealth_Magazine.indd 15 20/02/2016 2:18 PM Trained trainers and providers on postpartum family planning/postpartum intrauterine device (PPFP/PPIUD) now ready to expand the delivery of PPIUD service throughout the Zamboanga Peninsula Region and neighboring island provinces of ARMM. (Saplan/Jhpiego) Centers of Excellence: Raising the Bar for Service Delivery in Mindanao and Its Conflict-Affected Sites n integral part of (Zamboanga City Medical Center), located in Cagayan de Oro City. MindanaoHealth’s strategy Davao Region (Southern Philippines NMMC joined the roster of COEs is to engage the Centers of Medical Center, Davao Regional after meeting related requirements AExcellence (COE) in Mindanao. The Hospital) and the SOCCSKSARGEN and criteria, particularly for training COEs were originally established region (Cotabato Regional and Medical and service delivery. by the Maternal and Child Health Center). (, Cotabato Integrated Project (MCHIP), funded Province, Sultan Kudarat, Sarangani MindanaoHealth considers these COEs by the United States Agency for and General Santos City are known to be a key part of its service delivery International Development (USAID), collectively as the SOCCSKSARGEN component. The project-trained to deliver postpartum intrauterine region.) In 2014, MindanaoHealth service providers and trainers in these device (PPIUD) services. With assisted the Philippines Department institutions have strengthened the USAID’s support, the Philippines of Health in setting up postpartum COEs by building the capacity of health Department of Health established family planning services in Northern service providers and revitalizing or COEs in Zamboanga Peninsula Mindanao Medical Center (NMMC), establishing maternal, neonatal and child

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MindanaoHealth_Magazine.indd 16 20/02/2016 2:18 PM Transferring knowledge and skills on PPFP/PPIUD to health service providers who can easily perform the procedure, given proper technique in their areas of “ assignment, gives me a sense of fulfilment knowing that more mothers are saved from maternal death not just in Region IX but also to neighboring ARMM provinces of Basilan, Sulu and Tawi-Tawi as well.”

~ Dr. Suzette Montuno, Obstetrician/Gynecologist, Department Head, Zamboanga City Medical Centerr

health, nutrition and family planning of Basilan, Sulu and Tawi-Tawi. From (MNCHN/FP) programs in hospitals. December 2013 to September 2014, These programs include not only ZCMC trained eight trainers and training on postpartum family planning 131 health service providers from (PPFP)/PPIUD insertion and removal Zamboanga Peninsula. ZCMC also but also on interval intrauterine device built the capacity of 16 hospitals and insertion and removal, progestin- trained 18 health service providers only subdermal implant, bilateral from Basilan, Sulu and Tawi-Tawi. tubal ligation by minilaparotomy under local anaesthesia (BTL-MLLA) With the MindanaoHealth Project’s and no-scalpel vasectomy as well as support, ZCMC has reached 748 basic and comprehensive emergency clients as of September 2014. Aside obstetrics and newborn care, lactation from fixed PPFP/PPIUD services management and kangaroo mother rendered at the hospital, ZCMC’s care training. providers conducted long-acting and permanent family planning method With assistance from MindanaoHealth, outreach activities such as the one in COEs were trained to conduct Zamboanga del Norte in May 2014 competency-based skills training on that benefited 94 clients, 62 of whom MNCHN/FP service provision. COEs were provided with BTL-MLLA. Trained trainers supervise trainees in eventually established training teams demonstrating acquired skills on Family composed of competent service One of the providers trained by Planning and Maternal and Newborn Care. (Saplan/Jhpiego) providers who had clinical training skills ZCMC is midwife Yolanda Tangon and who were trained as trainers by from Tukuran, Zamboanga del MindanaoHealth. Sur. Motivated by the competency she acquired from the training, One of the more successful COEs is Yolanda stated, “I am committed to the Zamboanga City Medical Center earnestly performing my duties in (ZCMC). As a COE for PPFP/PPIUD, my community, giving more focus to ZCMC has established itself as a women from distant villages.” training hub for Zamboanga Peninsula and the Autonomous Region in Yolanda integrated family planning Muslim Mindanao (ARMM) provinces services, including PPFP/PPIUD,

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MindanaoHealth_Magazine.indd 17 20/02/2016 2:18 PM I was really assigned in one of the farthest barangays (villages) of Tukuran but after the training, courtesy of Zamboanga City Medical Center, I was “ transferred to the main health center at the town proper because of the increasing demand for PPFP/PPIUD services. With the skills and knowledge that I acquired from the training, I was able to provide PPFP/PPIUD services to 78 happy and satisfied clients.”

~ Yolanda Tangon, PPFP/PPIUD Trained Trainer and Health Service Provider from Tukuran, Zamboanga del Sur

in the care of pregnant women in mouth, there have been an increasing old mother of four who says she now her community. She provided clear number of women wanting her feels relieved that she is free of worries messages on the health and financial services. about becoming accidentally pregnant benefits of longer birth spacing, again. “The procedure,” she says, “was and this increased the demand for Two of Tangon’s clients have spoken painless and I felt no discomfort. It is her services. She made an effort to about their experience as PPIUD very difficult to raise many children, so dispel myths and misconceptions acceptors. The first is a 15-year-old we really have to plan our family well.” about family planning in every chance single mother of two who says she is she got. Because of the positive not ready to get pregnant again and These two cases illustrate how experiences of those she had decided to receive PPIUD. It was ZCMC has developed itself as a COE, provided PPIUD and the clarity of her mother who signed the consent resulting in having a positive effect her messages that found their way form to enable her to undergo the on a number of clients. “ZCMC’s to the community through word of procedure. The second is a 20-year- PPFP/PPIUD service provision can be replicated and sustained at the community level in low resource settings...where the impact can be felt with fewer mothers dying from complications of pregnancy and more children growing up with proper guidance and care from their mothers,” said Dr. Nimfa Torrizo, DOH Zamboanga Peninsula Director.

Recognizing its excellence in PPFP/ PPIUD service provision and capacity- building for conflict-affected sites in Mindanao, USAID’s MCHIP tapped the ZCMC to accept the National Economic and Development A trained provider and participant of the Objective Structured Clinical Evaluation (OSCE) undergo Authority’s Good Practice Award on skills examination on Essential Intrapartum and Newborn Care (EINC) supervised by trained trainers of behalf of the project. Zamboanga City Medical Center. (Saplan/Jhpiego)

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MindanaoHealth_Magazine.indd 18 20/02/2016 2:18 PM High school students participating in a Youth Forum in General Santos City express their opinion through a workshop encouraging them to voice their recommendations to address problems facing adolescents and youth such as teenage pregnancy. (Cossid/Jhpiego) Empowering Youth for Reproductive Health Young People Exchange Ideas in Youth Forum

ella Taniola never Today, Taniola is a midwife-in-training. about early pregnancy during an expected to be a mother She is willingly sharing her experience adolescent and youth health forum at the age of 21. She was with students and young adults, sponsored by the MindanaoHealth unpreparedW and clueless about how giving them advice to be careful and Project, in cooperation with the: local best to stay healthy for herself and to delay pregnancy, through family government of General Santos City; her baby. planning, until they are physically and Family Planning Organization of the emotionally prepared to be parents. Philippines; and regional agencies of Taniola’s case is not unique. Of the the Department of Education and 1.2 billion adolescents in the world “Is anyone ever ready to have a Commission on Population in South today, 88% live in low- and middle- baby, especially if it is unplanned? If it Cotabato, which is in Cotabato income countries where access comes very early, like in the situation City, Cotabato Province, Sultan to reproductive and sexual health I was in, you just have to face it Kudarat, Sarangani and General education is difficult. and learn your lesson.” This is how Santos City—known collectively as Taniola expressed her sentiments SOCCSKSARGEN.

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MindanaoHealth_Magazine.indd 19 20/02/2016 2:18 PM Taniola, now 26, knows only too well have no source of sexual education “It was really temptations and that young people often engage in and often seek the advice of peers curiosity that drew young people risky behaviors because of problems or friends, who may themselves lack toward doing risky actions and at home. When she was 20, her knowledge on reproductive health. indulging in early sexual activities,” parents separated and had new said 16-year-old Russel Maravilla, families of their own. Taniola then Students attending the adolescent one of the 250 participants in the decided to leave school and start health forum came from adolescent and youth forum. working. She sought comfort from SOCCSKSARGEN, where one in her friends and her closest confidante every four youths, ages 15 to 24, This activity for young people, who would later become the father had engaged in premarital sex. dubbed Young People’s Marketplace of her child. The majority of the youth (91%) of Ideas Forum, concluded with had unprotected sex during their students signing a commitment Throughout her pregnancy, she had first premarital sexual experience, wall signifying their involvement in no peer counselors nor did she know according to the Young Adult Fertility addressing health issues of concern of a place where she could receive and Sexuality Study of 2013. These to them. Shirlyn Bañas-Nograles, basic reproductive health information. practices put young women at risk of Vice Mayor of General Santos City, She did not seek help from her complications associated with early also committed to passing legislation mother. Her experience is not unlike and unplanned pregnancies. to address needs identified by that of most young people in the participating adolescents and youths. region: 56% of youth in the Philippines

The Young Adult Fertility and Sexuality Study of 2013 revealed a high prevalence of sexual activity—and unprotected sexual activity at that—among adolescents and youth in the SOCCSKSARGEN region. This region has the highest prevalence of unprotected sexual activity in Mindanao at 91%. These data tie in with the relatively high teenage pregnancy rate of 13.7% in SOCCSKSARGEN, which is one of the highest in Mindanao. Youth forums are significant activities that provide opportunities for these young people to express their ideas and recommendations on how to create effective adolescent and youth reproductive health programs.

MindanaoHealth Project conducts these forums for high school students and out-of-school youths to provide age-appropriate information on reproductive health. Youth forums, however, are not the only interventions of the project for adolescents and youth. Currently, the project implements Training on Adolescent Job Aids (AJA) to build the capacity of health service providers in catering to young people with maternal, newborn, child health and nutrition and family planning needs. As of its third year, 397 health service providers and guidance counselors were trained on AJA through 13 training sessions. The project also provides training on peer education and Usapan Barkadahan (teenage discussions). As of September 2015, there were four training sessions on AYRH peer education, which reached 123 youth and guidance counselor. The counselors were supported in Agusan del Norte, Cotabato City, Zamboanga del Norte and Zamboanga City as part of a technical assistance package to strengthen campus-based peer education and guidance.

MindanaoHealth was also instrumental in establishing Center for Teens Program that cater to the reproductive health and family planning needs of young mothers and male and female adolescents and youths in five hospitals in Mindanao: Brokenshire Integrated Memorial Hospital and Southern Philippines Medical Center in the Davao Region; and General Santos City Hospital, South Cotabato Provincial Hospital and Cotabato City Regional Medical Center in SOCCSKSARGEN. As part of these centers’ capacity-building, the project trained 103 physicians, nurses and midwives from different clinical departments, including obstetrics and gynecology, pediatrics, internal medicine, surgery and ancillary departments (family planning, sexually transmitted infections and violence against women and children) on the AJA Manual and early detection of risks among these young clients. MindanaoHealth also assisted in the development of Center for Teens’ Operational Guide, an internal policy approved by hospital leadership, which set standard procedures for handling adolescent and youth clients as well as for establishing management structures, job aids and tools, and recording and reporting mechanisms.

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MindanaoHealth_Magazine.indd 20 20/02/2016 2:18 PM Usapan Let’s Talk Family Planning, Maternal and Child Health! o help women and couples participants to consider how life goals • Usapang Buntis for pregnant make informed decisions might be influenced by the decision to women—women who want about their reproductive space or limit births through the use information on safe motherhood Thealth or family planning method, the of a modern family planning method. and need help deciding about MindanaoHealth Project organizes Through MindanaoHealth Project’s postpartum family planning Usapan (health discussions), a efforts, more than 37,000 clients facilitated conversation with up to have been reached by 3,076 Usapan When organizing Usapan sessions, 15 people. These group sessions last sessions. Of these clients, there have counselors ensure that family planning about two hours and are held in the been 3,080 acceptors of voluntary commodities will be available on site community or at a health facility. family planning. so that when Usapan participants voluntarily decide to use a particular Usapan sessions educate participants These group sessions target clients method, they will undergo one-on-one about male and female reproductive identified with unmet need for family counseling about the chosen method physiology, modern family planning planning. The clients include those and immediately have access to family methods and how they work and the contemplating a contraceptive method planning commodities. Referrals are value of couples sharing responsibility or couples who have decided to delay also arranged for clients who will for communicating about family choose long-acting or permanent family having another child. These are the planning. Rather than overloading planning methods, such as bilateral tubal Usapan sessions: couples with multiple, complex details, ligation. • Usapang Pwede Pa for spacers— Usapan provides the right amount couples who may want another of information for adults to process In Mindanao, Usapan sessions are child in the future in one sitting. Through Usapan’s indeed helping women and families • Usapang Kuntento Na for structured learning exercises, each make informed and voluntary family limiters—couples who may not participant reviews her or his life and planning choices and access safe want to have another child future goals. The exercises enable motherhood services.. • Usapang Bagong Maginoo for men

health service providers from 479 service of the 333 local government units, delivery point trained on Usapan (264 local government units) have 1,117 79% trained facilitators on Usapan

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MindanaoHealth_Magazine.indd 21 20/02/2016 2:18 PM I got married at a young age and had my first child when I was 19, whom I delivered at home with the help of a traditional birth attendant. Being a wife and a young mother, I really did not know what to do. Now I am pregnant again but having attended Usapang “Buntis session, I am now more informed about the benefits of delivering at the rural health facility under the care of the public health midwife. That’s what I will do this time.

I have also learned that I should have at least four antenatal care clinic visits, so the mid- wife can monitor the progress of my pregnancy and check if both my baby and I are healthy. The session on gender relations and rights in the family was new and revealing to me. Now I know a few things on how to manage stress in such a way it doesn’t affect my pregnancy and my relationship.”

~Niccam Siose-Ramo, Young Pregnant Woman from Barangay Sta. Clara, Lamitan City, Basilan.

Niccam Sios-Ramo was true to her promise. She delivered her second baby at the health facility, Bascom Hospital in Basilan and accepted postpartum family planning.

It is not typical for Muslim women to be accompanied by their husbands when seeking counseling about family planning or safe motherhood services. However, in our Usapang Bagong Maginoo sessions, where men also participate, I noted a great interest from men and that they wanted to learn more about family planning. In this particular session, of the 15 “ who were there, four immediately agreed to start using condoms as their method of choice. The other 11 men returned home energized, promising to discuss family planning with their wives, schedule appointments with counselors and bring their wives.”

~Estrella M. Undon, Rural Health Midwife of Barangay Bulalo Health Station

The Usapan counseling sessions have been very effective in increasing the utilization of family planning and maternal, newborn and child health services in my area. As a midwife, the changes I have seen when I use “Usapan have brought me a sense of fulfilment.” ~Elsa Balces-Pescadera, Usapan, Public Health Midwife in Sapa-Sapa, Tawi-Tawi District

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MindanaoHealth_Magazine.indd 22 20/02/2016 2:18 PM Trained midwives of Sulu attend to a newborn baby according to standard protocols while ensuring that equipment and their handling are sterile. (Talipao RHU) Putting the Needs of Mothers and Newborns First A Unique Partnership between Traditional and Skilled Birth Attendants is Increasing Facility-Based Deliveries in Autonomous Region in Muslim Mindanao n the past two years, only two and newborn. This is more or less the related to pregnancy and birth are not women delivered babies in the same in other areas of ARMM where acceptable. Recognizing the problem, Rural Health Unit in Talipao, which only 12% of pregnant women deliver the Talipao Municipality decided to act. Iis a municipality in Sulu and a conflict- with the assistance of a skilled birth prone area in the Autonomous attendant. With support from MindanaoHealth, Region in Muslim Mindanao (ARMM). the Sulu Integrated Provincial Health Typically, women in this region turn Unfortunately, this practice comes Office, through the Talipao Municipal to traditional birth attendants (called with a cost to women and families Health Office (MHO), partnered apo pandays in the local language) to in Talipao, with its 52 barangays pandays (traditional birth attendants help them deliver and perform rituals (villages). Even though maternal [TBAs]) with skilled birth attendants and religious practices for the mother mortality has remained low, deaths in rural health units. The goal of this

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MindanaoHealth_Magazine.indd 23 20/02/2016 2:18 PM pairing was to increase the number of pregnant women delivering The Paanakan Initiative with assistance from a skilled birth attendant. Since August 2014, the MindanaoHealth Project has been supporting ARMM through seven Paanakan (Birthing) Initiatives implemented in Basilan (Akbar and Lamitan City), Sulu (Talipao and Maimbung), Tawi-Tawi (Bongao) and To establish trust and understanding Maguindanao (South Upi). The activity aims to foster strong partnership within the community, MindanaoHealth and close collaboration between traditional birth attendants (TBAs) and and MHO organized a Traditional Birth skilled birth attendants to eliminate maternal and infant deaths. This initiative Attendants (Panday) Dialogue where does so specifically by improving referral practices and strengthening the skilled birth attendants demonstrated partnership between TBAs and skilled birth attendants as they are both the active management of third significant in the service delivery network. In Muslim communities, deliveries stage of labor and essential newborn are usually performed by TBAs at home. When bringing the TBAs and care. Skilled birth attendants also skilled birth attendants together, there emerges a need to clarify roles and showed how facility-based deliveries responsibilities during deliveries. The MindanaoHealth Project has provided are performed. TBAs received an technical assistance to enhance the Paanakan Initiative’s design and create opportunity to learn and realize the presentations that emphasize the roles and responsibilities of TBAs and importance of giving birth in a facility, skilled birth attendants. The project also provided technical updates on Active Management of the Third Stage of Labor, an intervention that can where a skilled provider can intervene prevent postpartum hemorrhage, and on Essential Newborn Care, an in case of complications with the intervention that can save the lives of the newborn lives. mother or the newborn. The Panday Dialogue was also conducted in other To date, 386 TBAs have been engaged as referral agents of pregnant women— provinces of ARMM where TBAs are bringing the women to facilities rather than doing the deliveries themselves. Out working as referral agents and helping of the 351 pregnant women referred by TBAs, 247 have delivered in facilities. to bring pregnant mothers to facilities for deliveries. The program gives TBAs PHP 500 500 (USD 10) for each pregnant “When the midwives showed us how (USD 10) for every pregnant woman woman who chooses to deliver at the they attend deliveries at the facilities, they refer or bring to a health facility Talipao Rural Health Unit, and a pack I realized that indeed, we should be for delivery. Moreover, the Talipao of groceries to the traditional birth very concerned about the safety of the Municipality made adjustments to attendant and the mother. mother and newborn, and this should allow the TBAs to accompany women not be treated negligibly,” said Halilan to the health facility and perform This initiative has brought immediate H. Majid, one of 31 TBAs participating traditional rituals and prayers as results. Over 60 pregnant women in the program. long as these do not affect infection (a 30-fold increase in just a year prevention procedures. based on Talipao Rural Health Unit’s “The goal of the project is to open Field Health Service Information doors and build partnerships, “We are no longer telling the patients System data), escorted by TBAs, cooperation and coordination with who come to us that they will not have delivered at the Talipao Rural the TBAs in order to ensure facility- receive good care at the health center Health Unit since the partnership based deliveries to reduce the risk of because the truth is, they will. But then between TBAs and skilled birth maternal and neonatal deaths,” said again, it is good to learn that we are attendants began in 2014, and Talipao Talipao Municipal Health Officer Dr. allowed to be with our patients inside Municipality is keen to sustain the Sharifa Madzda. the facility. Our patients often do not momentum. “Other provinces, cities want us to leave them,” said Halilan, a and municipalities are penalizing TBAs. To allay concerns of TBAs who traditional birth attendant. But for us in Talipao, we consider them feared that they would lose their jobs The Facility-Based Delivery Incentive as partners/part of the team,” added and source of income, the Talipao Program’s offerings do not end with Dr. Samain Municipality proposed a Facility- TBAs. Talipao Mayor Sitti Raya Tulawie . based Delivery Incentive Program. has committed an additional PHP

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MindanaoHealth_Magazine.indd 24 20/02/2016 2:18 PM EINC-trained nurse Reymund Lumantas checks on one-month old Jessa Mae who was not breathing when was born prematurely at the Nabunturan Rural Health Unit Birthing Facility and was revived through newborn resuscitation. (Photo by M. Cossid, Jhpiego.) New Skills for Nurses and Midwives Help Newborns Thrive

essa Mae wasn’t breathing. She participated in a training course in an Ambu bag—a common handheld was born prematurely one evening essential intrapartum and newborn device used to help patients breath. Jat the Nabunturan Rural Health care (EINC) organized by the Unit in Compostela Valley Province, MindanaoHealth Project. The training Jessa Mae’s chest began to rise and and the local health officer advised was conducted in collaboration with fall. her parents to prepare for the worst. the local nonprofit organization, Jessa Mae’s heart rate was low, and Kalusugan ng Mag-ina (Health of And then, she cried. although the birth attendant had Mother and Child), Inc., in partnership placed the baby against her mother’s with the Department of Health’s Lumantas was thrilled. “It is very chest for skin-to-skin contact— regional offices. fulfilling to revive a baby,” he said. “I routine post birth care to ensure a saved a baby’s life.” baby stays warm in the first hours of Lumantas quickly set to work, life—there was no response. preparing a space and equipment to Lumantas is among more than resuscitate the baby. He set her gently 1,000 health care providers who Nurse Reymund Lumantas on her back on a flat surface and have improved their newborn care stepped in to help. He had recently began pumping air into her lungs with skills through the MindanaoHealth

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MindanaoHealth_Magazine.indd 25 20/02/2016 2:18 PM Because I underwent the essential intrapartum and newborn care training, I am confident that I am doing the right thing, and I am going to save the lives “ of more babies.”

Project. The new skills gained by minute”—a window of time during and practicum, which are included in Lumantas underscore the importance which health workers must act to the EINC training, are vital.” of strengthening the capacity of save a newborn’s life. nurses and midwives worldwide and Lumantas has benefited personally increasing their numbers to meet Lumantas himself was apprehensive and professionally. “I wanted to the health needs of women and their going into the essential intrapartum be confident when I went back to families. and newborn care training. He was the facility, so I would know how participating with a wide range of to deal with emergency cases,” he “Because I underwent the EINC health care providers, many of whom said. “Now, I am confident that I training, I am confident that I am had more experience than he did. can handle emergency cases during doing the right thing, and I am going But he knew that the skills he would delivery. I was trained on basic to save the lives of more babies,” learn there would complement and emergency obstetric and newborn Lumantas says. refresh his previous training in basic care, and [my knowledge and skills emergency obstetric and newborn were] refreshed through essential Before the training, “depressed” care, so he persisted in listening, intrapartum and newborn care. Plus, newborns like Jessa Mae—newborn learning and gaining valuable hands-on I was able to successfully handle real babies who are not breathing or experience during practice sessions cases and revive two sick babies.” crying at birth—usually have poor and simulations. muscle tone and heart rates below “Now, I see Jessa Mae and, although 100 beats/minute had little chances Dr. Daniel Rubillos, Nabunturan she was delivered prematurely, she is of surviving. Health Officer, pledged to send all healthy. We were not expecting she health workers in the birthing facility would live. It is very fulfilling,” he said. LLumantas and fellow health to update their skills in this valuable workers lacked the confidence and maternal and newborn care program. knowledge to perform newborn “I believe that a training of excellent resuscitation. They didn’t understand quality requires practice more than the importance of the “golden theories,” he said. “Demonstration

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MindanaoHealth_Magazine.indd 26 20/02/2016 2:18 PM A health service provider of Balindong Rural Health Unit immunizes a baby using vaccines with guaranteed potency because cold storage is also assured through the USAID-donated vaccine refrigerator. (Balindong RHU/USAID/Jhpiego) Ensuring Quality Vaccines for Immunization through USAID- Donated Solar-Powered Refrigerators

r. Aida Abaton, Municipal She could only bring the vaccines When Dr. Abaton learned that Health Officer of Balindong they needed for that day. Because their facility would be one of the in , used to the number of vaccines she collected recipients of a solar-powered Dtravel two hours daily, from Balindong was based on estimates, the RHU vaccine refrigerator from the United to Marawi City, to get to the Lanao sometimes ran out and was unable to States Agency for International del Sur Integrated Provincial Health provide immunization services to the Development (USAID), she was Office (IPHO) just to collect the children and pregnant women who extremely relieved and grateful. allocated vaccines for Balindong Rural came for services. Finally, her RHU would have easily Health Unit’s (RHU) immunization available vaccines for its immunization services. Each time, she would return The IPHO was also faced with a big program, with their quality and to the RHU short of the needed challenge in storing vaccines due to potency guaranteed. vaccines simply because they had no the frequent and long power outages refrigerators in which to store the that damaged medicines and vaccines. Recognizing vaccine storage concerns, vaccines at the required temperature. USAID donated a total of 57 solar-

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MindanaoHealth_Magazine.indd 27 20/02/2016 2:19 PM “We are able to save time as well as money because we proceed with our “ immunization program smoothly, without having to travel back and forth to IPHO to get vaccines. We have them within our reach.”

~Dr. Aida Abaton, Municipal Health Officer—Balindong Rural Health Unit, Lanao del Sur.

powered and 42 ice-lined vaccine supplies,” said Dr. Abanton. “We have in Muslim Mindanao (ARMM) as the refrigerators to the conflict-affected them within our reach.” 2014 Anti-Measles and Anti-Polio sites of Lanao del Sur Maguindanao, Campaign’s top performer1 with Basilan, Sulu, Tawi-Tawi, Marawi Previous to having vaccine Lanao del Sur and Maguindanao City, Isabela City, Cotabato City refrigerators, Balindong’s fully provinces being the Number 1 and Zamboanga City. USAID also immunized child (FIC) coverage and Number 9 top performers, donated to other areas devastated was registered at 199. The donated respectively.2 The Department by typhoon Pablo, namely Davao equipment has helped them increase of Health also recognized Davao Oriental and Compostela Valley. their FIC coverage to 564 as of June Oriental and Compostela Valley 2014. Province as among the regions with These vaccine refrigerators are the highest number of children essential in ensuring the potency of Dr. Abaton also said that the solar- vaccinated for MMR. vaccines for an effective Expanded powered and ice-lined refrigerators Program on Immunization, especially donated to nine facilities in Lanao MindanaoHealth has been supporting because the province frequently del Sur contributed greatly to the outreach activities at the village level experiences long-term power lapses province’s coverage of Measles, in ARMM where immunization is one that potentially damage medicines and Mumps and Rubella (MMR) of the services provided. vaccines. “We are now able to save immunization campaigns. time as well as money (and) smoothly roll out the immunization program The Philippines Department of 1 http://www.armm-info.com/2014/10/doh-armm- tops-the-ligtas-sa-tigdas-at-polio-campaign.html without having to travel back and Health declared the Department of 2 Department of Health’s official page: https:// forth to the province to get new Health in the Autonomous Region www.facebook.com/OfficialDOHgov?pnref=story

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MindanaoHealth_Magazine.indd 28 20/02/2016 2:19 PM Valencia City Health Officer Dr. Marlyn V. Agbayani checks on her pregnant patient during one of the city’s health events. (Base/Jhpiego) The Electronic Masterlisting and Tracking Tool (EMTT) A Simple but Powerful Innovation that Is Helping Providers and Decision-Makers in Mindanao to Reach More Women with the Family Planning Care They Need alusugan Pangkalahatan, the health workers to meet the family and appropriate health services to Philippines government’s flagship planning needs of women and their clientele. health campaign for Universal families. KHealth Care, is President Benigno Then came the challenge. If a client Aquino’s call to action to bring health Working with health providers visited the RHU, or if the health and nutrition services closer to the at Rural Health Units (RHUs), provider wanted to verify that a people, particularly mothers and community health workers went woman initially identified with an children in poor and underserved door-to-door in the barangays unmet family planning need had communities. (villages), profiling and documenting later received services, the provider thousands of individualized paper had to search through thousands of In response to the call, the Philippines Health Use Plans (HUPs) that were HUPs records that usually gathered Department of Health (DOH) submitted to the RHUs. Health dust in storage areas. This was time engaged hundreds of community facilities used HUPs to deliver needed consuming and often ended with

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MindanaoHealth_Magazine.indd 29 20/02/2016 2:19 PM missed opportunities for women to FP Methods Provided to Profiled and Tracked receive timely services. Clients of Valencia CHO through EMTT Dr. Marlyn V. Agbayani, Valencia City Health Officer, asked, “After two 2% years of profiling and assessing unmet CONDOM needs…have we provided services to 4% 1% DMPA those we found with [family planning] LARC-PSI unmet needs?” He was challenging his colleagues in one of the regional meetings held to assess the progress 1% NSV 15% in rolling out the DOH’s HUPs NATURAL FAMILY tracking tool. PLANNING

What was needed was an information system to help family planning providers and decision makers use the data for planning and delivering services in response to the woman’s needs. Valencia City has led efforts in implementing a simple, yet effective, solution to the challenge of tracking the kind of services provided to women.

With support from MindanaoHealth Project, the Philippines DOH used the HUPs system to develop a 51% simple electronic masterlisting and IUD tracking tool (EMTT) that uses the 51% PILLS 15% MS Excel database program. Over BTL-MLLA 500 community heath teams (CHTs) were given EMTT questionnaires and deployed to 31 barangays in Valencia, collecting information on current, probable and undecided family planning users. These pieces of information gathered and stored in the electronic database are only accessed by health service providers and assigned CHT member trained on Interpersonal Communication and Counseling, thereby observing the value of and ensuring confidentiality.

The beauty of the innovation is revealed when the information is keyed into the EMTT database. Apart Dr. Marlyn V. Agbayani, Valencia City Health Officer, champions EMTT in Bukidnon. (Base/ from the usual clutter of data fields Jhpiego)

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MindanaoHealth_Magazine.indd 30 20/02/2016 2:19 PM We look at EMTT as an essential system to help us track men and women with unmet need for family planning and consequently provide them with “ needed services. The issuance of the DOH ARMM Memorandum was made to facilitate the improvement and eventual replication of the system after assessment and refinements are done as needed.”

such as province, municipality, name, 15 people—and the type of family and age, among others, the EMTT planning commodities needed by dashboard immediately generates their clients. Clients undergo one- figures and colorful charts plotting on-one counseling before voluntarily numbers of clients with the type of accepting a family planning method. family planning method they received or will potentially use. Using data Following Mindanao DOH’s Regional collected by the CHTs in 31 barangays Health Cluster success with EMTT and plotting the data in the EMTT, in helping Valencia to scale up the Valencia City Health Office has family planning services, other been able to provide 1,769 women regions, including SOCCSKSARGEN with a family planning method of their (includes Cotabato City, Cotabato choice (as new acceptors), something Province, Sultan Kudarat, Sarangani Dr. Khadil Jojo Sinolinding, Jr., DOH ARMM Secretary that could not be easily attained with and General Santos City) and the the former paper-based system. Autonomous Region in Muslim Mindanao (ARMM), have also replication of the system after At RHUs, information generated adopted the innovation. assessment and refinements are from the EMTT helps providers and done as needed,” said Dr. Khadil Jojo CHTs to plan outreach services. “We look at EMTT as an essential Sinolinding, Jr., Secretary, ARMM Teams have information at their system to help us track men and DOH. fingertips on individuals, groups and women with unmet needs for the community they will meet. This family planning and consequently Mindanao and ARMM have since helps providers and CHTs prepare provide them with needed services. developed policy guidelines to help tailored counseling sessions known The issuance of the DOH-ARMM health facilities incorporate the family as Usapan (health discussion)—a Memorandum was made to facilitate planning EMTT into their service facilitated conversation with up to the improvement and eventual delivery systems.

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MindanaoHealth_Magazine.indd 31 20/02/2016 2:19 PM Nur-Ana Sakilan of Ipil, Zamboanga Sibugay is now happy that she can attend to the needs of her children after voluntary availing of free PPIUD insertion following Usapan (group interactive health discussion) session and one-on-one counseling. (Jhpiego) Taking Better Care of her Family: The Story of Nur-Ana

ur-ana Sakilan and her Given the family size, it is not enough. Philippines Department of Health and husband, Abdul Ahod “[Our] children have become too regional municipalities’ departments Sakilan, live along the Sanito many and it has become difficult of health, MindanaoHealth is using an Nriverbank, a flood-prone area in providing for their needs,” Nur-ana innovative, multipronged approach Bangkerohan village in the municipality said. to identify women with unmet of Ipil in Zamboanga Sibugay. They family planning needs, offer them have seven children. Nur-ana was 44 While she and her husband have appropriate services and track their years when she became pregnant with heard about family planning, they needs over time. their seventh child, Nurjikran, now a have always believed contraceptives 5-month-old baby boy. It wasn’t easy. “I are haram (prohibited) by Islamic With the help of community health am not young anymore so when I was teaching. As devout practitioners of workers supported by the program, pregnant with my youngest child, I really their faith, they never attempted any MindanaoHealth and the Zamboanga had a hard time,” Nur-ana shared. contraception. Torn between their Sibugay municipality have profiled religion and a desire to limit family 10,710 families and entered them Even before this latest child, the size, they didn’t know what to do. into the municipality’s electronic family was struggling to make ends masterlisting tracking tool (EMTT). meet. They depend on every little But through MindanaoHealth Project, Of these families, 4,983 women, catch Nur-Ana’s husband, who is Nur-ana and her husband received including Nur-ana, have been a fisherman, can make. They also the family planning information, identified as having unmet needs for receive cash grants from a Philippines counseling and health services they family planning. During Nur-ana’s program for the poor—Pantawid needed to make the right decision pregnancy, community health workers Pamilyang Pilipino Program (4Ps). for their family. Working with the visited her home on numerous

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MindanaoHealth_Magazine.indd 32 20/02/2016 2:19 PM I can now attend to the needs of my children and cook nutritious meals for my family. I am also thinking of helping “ my husband sell fish.”

occasions to check the progress of husband decided to limit the size her pregnancy, eventually making sure of their family for the good of their she delivered at the health facility. As children and Nur-ana’s health. a devout Muslim, Nur-ana carefully After voluntary one-on-one weighed her family planning options counseling, Nur-ana, with her as her pregnancy progressed. husband in agreement, consented to have a postpartum intrauterine Eventually, through the help of device inserted after giving birth. She community health workers, she is among the 535 women provided took an initial step and agreed with needed family planning services to participate in Usapang Buntis, in Ipil, Zamboanga Sibugay. Nur-Ana and her husband Abdul Ahod interactive health discussion Sakilan catch and sell fish for a living. sessions for pregnant women where “I am happy,” says Nur-ana, reflecting (Jhpiego) information on postpartum family on her family’s decision for a long- planning was given. acting contraception method.

The session helped Nur-ana “I can now attend to the needs of my understand that family planning is children, cook nutritious meals for my permissible in Islam for health or family. I am also thinking of helping my economic reasons. Reflecting on her husband sell fish.” family situation, Nur-ana and her

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MindanaoHealth_Magazine.indd 33 20/02/2016 2:19 PM A trained PPIUD provider tries the SMS/text messaging as a form of post-training supportive supervision. (Albaracin/Jhpiego) Mobile Mentoring: Supportive Supervision through Mobile Technology he MindanaoHealth Project providers trained on PPIUD services MOBILE MENTORING is piloting a voice and text- were enrolled. They currently receive INTERVENTIONS based mobile mentoring targeted reminders and quiz-type T(mMentoring) program to messages every day. mMentoring Text Messages complement trainings and expand the mentees can also access real-time Reminder reach and effectiveness of supportive support from their assigned mentors Interactive supervision for health workers skilled through voice calls. Quizes in providing postpartum intrauterine Data Reporting device (PPIUD) contraception. To assess the value of mMentoring, this cohort will be compared with another By connecting the mentor and the group of health providers who are not Voice Call mentee through text messaging and receiving text messages or voice calls. Real-time voice voice call interventions, mMentoring At the end of the pilot, an evaluation call mentoring reinforces knowledge, improves will be performed to assess the performance and provides post- effectiveness of the initiative and how it training support. can be scaled up.

During the initial phase of the Mobile mentoring poster program, online software was presented at the National customized to handle and manage Science and Technology Week 2014 at SMX the release of scheduled messages. Convention Center, Pasay A total of 130 messages were City on July 26, 2014. developed on various PPIUD topics.

In the second and third phases of the program, a total of 89 health service

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MindanaoHealth_Magazine.indd 34 20/02/2016 2:19 PM Getting the Numbers Right! Accurate and High-Quality Data for Appropriate Program Planning indanaoHealth Project is in Agusan del Sur,” said Nanette S. in prioritizing delivery of health services committed to ensuring Cabanos, Provincial Health Office to our target population,” Espera said. that facility-level data are Technical Division Chief. While “Most importantly, regular DQCs Mmanaged appropriately and recorded the province has just recently will eventually lessen our time doing correctly. This also means that data implemented DQCs, its trained report consolidation because we have collected, reported and stored are health workers are already leading organized the data ahead [of time]. accurate and reliable for planning quarterly (eventually, semiannual) This means we will have more time and decision-making. As technical DQCs at the rural health facilities. for other equally important tasks,” she assistance, the project supports “Towards institutionalization, we will added. capacity-building on data quality be doing more regular monitoring checks (DQCs), resulting in over at the facility level to ensure that Facility health workers like Espera 1,000 health workers trained and DQC is really conducted,” Cabanos believe that regular DQCs make for 228 local government units (LGUs) remarked. equitable distribution of resources, conducting DQCs. such as budget, supplies, manpower Flordelis M. Espera, Public Health and infrastructure, with the goal of Agusan del Sur is among the LGUs Nurse in the Talacogon Rural Health improving the delivery of high-quality assisted by the MindanaoHealth Unit, appreciated the value of doing health services when they are needed Project toward institutionalizing DQCs. “We know that doing DQCs and to where they are needed. DQCs in 14 facilities across the will result in generating reliable province. “Our public health nurses information and data of program are our data quality champions here indicators that will serve as our bases

Talacogon Rural Health Unit Nurse Flordelis M. Espera supervises a health worker and checks the quality and accurateness of data. (Talacogon RHU)

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MindanaoHealth_Magazine.indd 35 20/02/2016 2:19 PM Participants to the Service Delivery Network (SDN) Workshop map existing facilities to be included in Davao City SDN. (Jhpiego) Strengthening Health Systems— the SDN Way!

he service delivery network Department of Health’s High Impact partnership where both private has been the convergence hub Five along with infant care, maternal and public health service delivery for all our technical assistance, health, child care and HIV/AIDS. The points are part of the SDN and Tparticularly on maternal, neonatal, establishment of an SDN, including have established health referral child health and nutrition and family strengthened communication and systems. In the second quarter of planning,” remarked Dr. Dolores C. transportation systems, supports 2015, Davao Region launched a Castillo, MindanaoHealth Project Chief delivery of services at all levels of care multisectoral coalition, called Davao’s of Party. within a network of public and private Coalition of Health Advocates for health care facilities and providers. It Mothers’ and Infants’ Protection and It is strategic that the service delivery also emphasizes improving the quality Safety. This coalition emphasizes network (SDN) is aptly captured of the referral network such that the close collaboration among the in the Maternal, Neonatal, Child health facilities within are functional Department of Health in the Davao Health and Nutrition (MNCHN) and have the capacity to provide a Region, MindanaoHealth Project, Policy and Manual of Operations wide range of quality MNCHN and other partner agencies and local and mandated by the Reproductive family planning (FP) services. government units (LGUs)—all of Health and Responsible Parenthood whom are working together to scale Act of 2012 to increase access and Recognizing that local health systems up the functional SDNs for MNCHN/ utilization of services by Conditional or networks in project sites take FP services. Cash Transfer/National Health many forms, MindanaoHealth works Targeting System beneficiaries—the with existing systems or links. In the With the current increasing trend poorest of the poor. Significantly, this case of Davao Region, the project of maternal and infant deaths in the is one of the priority areas of the relies on the strong public-private region, Davao Region’s advocacy is

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MindanaoHealth_Magazine.indd 36 20/02/2016 2:19 PM Walang nanay at sanggol ang mamamatay dahil sa panganganak (or, no mother should die giving life especially when the causes of these deaths “ are mostly preventable).” anchored on the maxim, “Walang of MNCHN/FP services were done. nanay at sanggol ang mamamatay The guide is also being used to train dahil sa panganganak” (no mother partners and provide detailed steps should die giving life especially when for the establishment of SDNs, taking the causes of these deaths are into consideration the 10 elements of most preventable). “While giving an SDN. birth is one of the most wonderful experiences in life, it is also very In other project sites where risky,” said Dr. Abdullah B. Dumama, MindanaoHealth plays a key role in Jr., Department of Health Director in establishing or strengthening SDNs, the Davao Region, emphasizing the existing Interlocal Health Zones and urgency of creating a coalition that clusters of LGUs were taken as entry would work on the aforementioned points. To date, six SDN management maxim. structures in all Department of Health Regional offices of Mindanao The MindanaoHealth Project and 53 LGUs have been established developed the SDN Operational where 60 members were trained SDN Workshop for Compostela Valley Guide, influenced by the existing as trainers on the use of the same Province functional SDN of San Isidro, SDN Operational Guide. Also, 18 Kapalong, Asuncion and Talaingod SDNs across 53 LGUs are engaged, (SIKAT) in Davao del Norte. This including the development of SDN became a guiding document in the maps to indicate referral pathways series of workshops conducted by for MNCHN/FP and the initiation of Team D CHAMPS where initial eight public-private partnerships for mapping of clusters of municipalities MNCHN/FP services. regarding provision and utilization

The establishment of Service Delivery Networks (SDN) is primarily focused on the High Impact Five (HI5) priority areas identified by the Department of Health per region such as the provinces of Davao del Sur and Davao City, Agusan del Sur, Zamboanga del Sur, Lanao del Norte, North Cotabato, and Maguindanao. The DOH-Regional Offices’ and MindanaoHealth’s entry point of intervention revolves around getting the ILHZs transition into SDN, strengthening the public-private partnership on FP/MNCHN service delivery, capacitating the health service providers, establishing cross-sector and cross-border referral mechanism, optimizing PhilHealth reimbursements, connecting the GIDA and indigenous peoples (IP) population to the local health system, and integrating hospitals with FP programs in the network.

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MindanaoHealth_Magazine.indd 37 20/02/2016 2:19 PM The publication was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the resposibility of the MindanaoHealth Project and do not necessarily reflect views of USAID or the United States Government. 38 | MindanaoHealth Project: A Partnership to Deliver High Quality Health Services

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