Quarterly Report MindanaoHealth Project

Program Year 6 Quarter 1

(October 1 – December 31, 2017)

Submitted: February 9, 2018

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

On the cover:

Top left: USAID-supported Goldenstate Maternity Clinic (in City) Owner Ms. Sarah Jane Manilay (left) lets USAID Mission Director Lawrence Hardy II gently hold a healthy newborn baby from one of the clinic’s postpartum mother-patients. Mission Director Hardy visited General Santos City and met with various partners provided by USAID with technical assistance for decades. (MCossid/Jhpiego) Bottom left: Provincial Health Officer Dr. Fahra A. Tan-Omar wins the attention and gains the appreciation of the audience of the Parallel Session on Showcasing Good Practices in Family Planning Service Delivery and Demand Generation in as she emphatically shares the good practices of Sulu in delivering family planning and maternal and neonatal services to women, men and their families through the CATCH and CHANGE Program –

Caring for All Tausug in the Community thro ugh Health; and Community Health Assembly through Networking and Gender and Empowerment. (MCossid/Jhpiego) Top right: Members of the Upi Youth Peer Educators Association pose after conducting a Usapang Barkadahan session in a village in Upi, . (MCossid/Jhpiego) Bottom right: Merca Lagutod, a Matigsalug woman living in geographically isolated district in is carrying her child and is all smiles as she tells her story of persevering to avail of maternal, newborn and child, and family planning from nearby village health facilitiy despite challenges in access like distance and transportation. (AGonzales/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 , , 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 ...... 4 Progress Against Planned Performance ...... 5 A. Increase in the number of FP current users (CU) ...... 5 B. MH Contribution to FHSIS Reports on LARC/PM Acceptors ...... 6 C. Increasing Private Sector Contribution to LARC/PM Services ...... 8 D. Increase in Couple Years of Protection (CYP) ...... 9 E. Sustaining Low Stock-out Rates on FP Commodities ...... 10 F. Continued provision of FP Services in USG-assisted SDPs, both public and private ...... 10 G. Provincial and City LGUs and City LGUs Institutionalizing Data Quality Check (DQC) ...... 11 H. Increasing number of CHWs providing FP information, services, and, referrals ...... 11 I. Women giving birth who received uterotonic in the 3rd stage of labor ...... 11 J. Increasing PPFP/PPIUD trained service providers certified by DOH ...... 11 K. Profiled WRA with FP Unmet Need ...... 11 L. Progress in Conflict Affected Areas: ...... 12 Outreach Activities in Conflict-Affected Areas (CAAs) ...... 13 CSOs’ Advocacy on AY Program in CAA Provinces ...... 13 Program Management ...... 14 A. Monitoring, Evaluation and Research ...... 14 B. Project Communications ...... 16 Implementation Issues/Challenges and Mitigation Measures ...... 18 ANNEX A ...... 20 Narrative of Key Achievements in Priority LGUs ...... 20 1. Increasing the Supply of FP/MNCHN/AYRH Services ...... 20 2. Increasing the Demand for MNCHN/FP Services ...... 32 3. Removing Policy and Systems Barriers to Service Delivery ...... 35 ANNEX B ...... 47 Financial Expenditure and Cost Share ...... 47 ANNEX C ...... 49 Environmental Compliance and Informed Choice & Voluntarism Monitoring ...... 49 ANNEX D ...... 59 Success Stories and Evolving Initiatives ...... 59

List of Abbreviations

ABC Association of Captains ADNPH 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 BTL Bilateral Tubal Ligation CA Cooperating Agencies CAA Conflict Affected Area CCT Conditional Cash Transfer CDI Cities Development Initiative CDO de Oro CDOHO Health Office 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 CHW Community Health Worker CMNC Caring for Mothers and Newborns in the Community COE Center of Excellence CSO Civil Society Organization CYP Couple-Years of Protection DMO Development Management Officer DQC Data Quality Check EBF Exclusive Breastfeeding EO Executive Order EOP End of Project FHSIS Field Health Services Information System FPOP Family Planning Organization of the HFEP Health Facility Enhancement Program HSP Health Service Provider ICV Informed Choice and Voluntarism IEC Information, Education, and Communication ILHZ Inter-Local Health Zone IPHO Integrated Provincial Health Office IUD Intrauterine Device

LAM Lactational Amenorrhea Method LAPM Long Acting and Permanent Method LARC Long Acting Reversible Contraception LGUs Local Government Units LHB Local Health Board LIPH Local Investment Plan for Health LMT Lactation Management Training M&E Monitoring and Evaluation MCP Maternity Care Package MH MindanaoHealth MHO Municipal Health Office MLLA Mini Laparotomy using Local Anesthesia MNCHN/FP Maternal, Newborn, and Child Health and Nutrition/Family Planning MOA Memorandum of Agreement MSH Specialist Hospital MSI Marie Stopes International NCP Newborn Care Package NDP Nurse Deployment Program NHTS National Household Targeting System NGO Non-Government Organization NSV No Scalpel Vasectomy OSCE Objective Structured Competency Evaluation PHA Public Health Associate PHILHEALTH Philippine Health Insurance Corporation PHIC Philippine Health Insurance Corporation PHO Provincial Health Office PHN Public Health Nurse PMP Performance Monitoring Plan POPCOM Commission on Population PPFP Postpartum Family Planning PPIUD Postpartum Intrauterine Device PSI Progestin Subdermal Implant RPRH Responsible Parenthood and Reproductive Health RIT Regional Implementation Team SDN Service Delivery Network SDP Service Delivery Point South , Cotabato, , and Gen. Santos TCL Target Client List TRO Temporary Restraining Order TWG Technical Working Group WRA Women of Reproductive Age ZFF Zuellig Family Foundation

Executive Summary

The MindanaoHealth (MH) Project, initially a five-year (2013–2018) initiative funded by the United States Agency for International Development (USAID), is implemented by Jhpiego in partnership with RTI International. The Project’s goal is to improve family health by dramatically increasing the quality and uptake of integrated maternal, newborn, and child health and nutrition/family planning (MNCHN/FP) services, resulting in improved child health and nutrition, reduced maternal and infant deaths, and decreased unmet need for FP services— especially among the population belonging to lowest wealth quintiles, in conflict-affected areas and those affected by the humanitarian crises in Mindanao. MH collaborates with the Department of Health (DOH) to scale up high-impact services, that includes adopting client-centered approaches by providers for Mindanao, the southernmost of the three island groups in the Philippines. Aside from working directly with six DOH-regional health offices (RHOs), it has forged strong partnerships with Local Government Units of 19 provinces, two (2) cities, and 368 municipalities to help the government achieve its commitment to reduce maternal and under-five deaths and to reduce unmet need for modern family planning. In the aftermath of the unfortunate Marawi Siege, the Project has been offered a 10-month extension until December 2018 to be able to continue to work in areas with low income/poor populations with high unmet need, and high teenage pregnancies with high neonatal deaths. During the extension period, MH shall continue to address health system gaps in three major components – supply, demand, and policy/financing. Each component focuses on five major stakeholders with different roles to play in translating MH technical assistance and their own to expand the reach of quality services, namely: the DOH-ROs, PHOs, providers/managers both public and private, CSOs/NGOs, and clients/beneficiaries. MH shall adopt a tailored and focused technical assistance given the gains achieved in the last five years and the absorptive capacity of partners. The Project has accordingly prioritized 12 LGUs where unmet need for family planning and teenage pregnancy rates are high, and areas where the health system/service provision is affected by humanitarian crises and conflicts. Building from its past five (5)-year gains, MH shall strive to ensure that at least one functional SDN with FP and AYRH program/services in priority LGUs and functional facilities with FP/AY services in non-priority LGU, including conflict affected areas. In Marawi and its corridors in particular, MH shall assist in providing immediate response to health emergencies as well as restoring/strengthening essential family planning and maternal and child health services. MindanaoHealth made key achievements during the 1st quarter of this extension from October 1 to December 31, 2017: • Increased CYP. Q4PY5 posted a CYP accomplishment which was 12 percent higher than the previous quarter of 112, 881 and represented 23 percent of the current year’s target of 562,837. The cumulative CYP to date stands at 1,321,430 equivalent to about 75 percent of the EOP target. • Reached an additional 4,958 LARC/PM acceptors through outreach and fixed facility family planning services; this represents a contribution of roughly 21% of all LAPM cases reported in the FHSIS for Q4PY5; • The project’s Q1PY6 technical support resulted to providing LARC/PM services to 11,012 acceptors, much higher than the 4,958 project contribution to Q4PY5. This 122% increment from Q4PY5 MH contribution, with improving health system capacity would help accelerate the reduction on WRA with FP Unmet Need.

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• Increased family planning (FP) current users (CU) from all regions except Zamboanga Peninsula. ARMM showed twenty-three percent (23%) increase from the period of the previous year as its performance already included reports from ; and Northern Mindanao posted the highest increase at twenty-six percent (26%) over the previous quarter’s number of FP current users. • Thirty-four percent (34%) of FP outreaches services (51 out of 151 FP outreaches) supported were in Conflict Affected Areas (CAAs) reaching 1,410 LARC/PM acceptors. In addition, 79 outreaches/REACH were supported reaching 2,262 women, men with varied medical services, 552 pregnant women with ante-antal care and information on breastfeeding and FP, and 50 newborns with antigens. • Based on partial available reports from 16 project sites, profiled thirty four percent (34%) equivalent to 379,895 out of estimated 1,105,306 WRA with FP Unmet Need in project sites and 32% (121,973) were provided services. CARAGA reported the highest FP services to profiled WRA with unmet need at 95% (49,072 out of 51,865), followed by Zamboanga Peninsula at 92% (27,650 out of 30,110 profiled WRA with FP Unmet Need). • Eight (8) LARC-PSI and 12 PPIUD trainees that were supportively supervised were certified by DOH during the quarter. To date, of the 1,134 trained health service providers that were supportively supervised, 690 are now DOH-certified services providers (60 on FPCBT1, 99 FPCBT2, 125 for LARC/PSI, 344 on PPIUD, and 62 for BTL Also of the 96 trainer supportively supervised, 82 are certified trainers brokendown as follows; 56 on PPIUD, 24 on BTL/MLLA and 9 for LARC/PSI. • Strengthening the systems, structures and integration mechanisms in the 60 SDPs providing adolescent and youth reproductive health (AYRH) services were the focus during the quarter. Parallel to this, the supported Campus-based AYRH services dubbed as “Youth Optimizing Lifes’ Opportunities (YOLO)”, an initiative that supports, complements and reinforces academic instructions in schools was launched after capacitating guidance counselors in 24 schools from 13 districts of Agusan del Norte, and development of the YOLO program manual. A total of 5,208 learners were assessed using rapid HEEADSS tool in 24 schools; 1,177 were further assessed in-depth and 338 students at risks from 8 schools were followed up and counseled, including referral of 1 VAWC to DSWD and 2 cases (miscarriage and STI) to nearest hospital; and a 2018 budget was included by DepED Agusan del Norte to support this initiative. • The project support to Marawi and its corridors continued after the siege to help restore essential health services and help conduct outreach services. Initial results are: i) supported capacity building cum outreach activity resulted to 88 informed clients accessed LARC/PSI services, 9 LARC/PSI-trained HSP supportively supervised, and additional 9 HSPs trained on LARC/PSI; ii) series of consultations with LGUs and partners resulted to 20 identified priority facilities/areas to help restore the delivery of essential health services, initiated procurement of requested supplies such as dignity kits, maternity packs, aquatabs and water tanks; and iii) outreach services generated 11 BTL acceptors, 2 IUD and 290 LARC/PSI in ; 3 IDPs in Iligan accessed SDI services; and 3,071 IDPs in Marawi were reached with various health services. • Maintained the low number of SDPs with stock-outs of FP commodities. Stock out rates for pills, DMPA, and IUD were at 4% or less since Q1PY5. MH-provided TA plus the strong collaboration with the Population Commission (PopCom) field teams helped tracked and resolved incidences of stock-out in every facility. Overall, MindanaoHealth’s performance in Q1PY6 showed that most indicator values were either on track, or within range of this quarter’s expectations. The topline indicator - Current Users (CU)

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posted a positive increment of seven (7) percent over the previous year’s level. The CYP performance for the quarter likewise registered 23 percent of the target for the year. Accomplishments for CAA indicators generally showed improvements as well from the previous quarter with more outreach activities conducted and clients reached. Several key challenges confronted project implementation, the most notable of which includes: the disruption of operations in ARMM areas despite post-Marawi Siege for varied reasons; slow implementation of DOH Circular for hospitals as reporting units; the inability of the existing health management information system to generate sex disaggregated data; slow expansion of outreach servcies to GIDAs due to mobility challenges, not to mention security related issues; the uptake in demand generation activities; and the accelerated strengthening of service delivery networks (SDNs). At the project management level, large performance variances across regions and provinces/cities need to be managed while putting in place the needed mechanisms to sustain gains. MH will amplify corresponding measures in the remaining months of the extension period with specific strategies consistent with the Health Agenda of the new administration to address these challenges and put forward as well the sustainability plan of the Project as it nears re- scheduled closeout. The total financial support to bring these gains of the project implementation in Q1PY6 is $1,008,671.36. The total cumulative expenses as of end of the quarter in review is $22,541,946.44 from an approved budget of $30,440,000.00.

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Introduction

This report covers the period from October 1 to December 31, 2017 or Quarter 1 of Program Year 6, the extension period. During the quarter in review, MH remained focus on the following technical priorities: Accelerate strategies to reach PY6 and End-of-Project targets for CYP:  Focus on reducing unmet need for family planning (FP) in priority LGUs, including conflict-affected areas (CAAs), by intensifying long-acting and permanent methods (LAPM) outreach activities;  Reduce teenage pregnancies by scaling up evidenced-based best practices that will include promising high impact interventions on adolescent reproductive health;  Strengthen the capacity of the local health systems in consolidating results and institutionalizing effective strategies to reduce unmet need for modern family planning, and maternal and child;  Develop innovative approaches in the provision of quality adolescent reproductive health and gender-friendly health services;  Assist in providing immediate response to health emergencies in Marawi City and its corridors as well as restoring/strengthening essential family planning and maternal and child health services;  Expand the inter-regional pool of certified trainers and increasing frequency of supportive supervision visits to trained yet uncertified PPFP/PPIUD and BTL providers; and  Facilitate the inclusion of and collection of FP/MNCHN-related reports from previously non-reporting SDPs, specifically hospitals (public and private) and private clinics. Engage the private sector to ensure that a wide contraception method mix is available to clients. With the Temporary Restraining Order (TRO) on implants now lifted, MH is strengthening private sector collaboration, including the integration of FP and AY programs in hospital operations and strengthening linkages between the public and private health facilities for referrals in the service delivery network (SDN), logistics, and health data reporting. Fast-track recognition and sustain support in engaging facilities integrate FP and AYRH programs in hospitals and develop Clinical Practice Sites on PPFP. Thirteen (13) facilities in 12 priority SDN sites continue to receive technical assistance to be able to complete the integration of the FP and AYRH programs in hospitals. Meanwhile, 45 public and private health facilities have so far been identified and certified by the Department of Health (DOH) as Clinical Practice Sites (CPS) inclusive of six (6) hospitals serving as FP Training Provider. Eighteen (18) other RHUs and birthing centers, mostly in the (7) and Zamboanga Peninsula (5) shall be developed as coaching and mentoring sites. Strengthen demand generation activities for LAPM through the conduct of target-focused USAPAN sessions to provide potential FP clients with comprehensible information on a wide range of FP services and to address cultural barriers, myths, and misconceptions on FP services. Sustain support to the established Center for Teens in 13 health facilities and 32 adolescent-youth (AY)-friendly RHUs and build their capacities to provide DOH-compliant AYRH services. Sustain support to the 21 SDN sites, inclusive of the 12 SDN sites whose functionalities are being accelerated, via continuing technical assistance to the DOH-ROs and PHOs.

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By indicator, the following table summarizes MindanaoHealth’s accomplishments for the quarter in review. As applicable, the table likewise includes cumulative accomplishment results of the Project as of the current quarter. This Q1PY6 report, excluding the introductory part, comprises five (5) sections: a) the “Project- wide Progress Against Planned Performance” section which summarizes the achievements in this reporting period against the “MUST” indicators; b) “Regional Analysis of Current FP Users and Couple Years of Protection (CYP)” which provides further analyses of progress against the Project’s two foremost indicators; c) “Program Management” which summarizes progress in Monitoring, Evaluation and Research, Communications, Training and Information Management System Development and Installation, Project Communications and Knowledge/Information Management; d) “Implementation Issues and Challenges”; and e) Annexes.

Progress Against Planned Performance This section summarizes project progress on the eight (8) PY6 “MUST” indicators in the Performance Monitoring Plan (PMP), including current users (CUs) and four (4) indicators for Conflict Affected Areas (CAAs). The sub-headings of the “MUST” indicators in the PMP summarize the progress in the reporting period. Indicators that report Field Health Service Information System (FHSIS) data, such as CU, CYP and use of Uteretonics, present progress for Q4PY5, while indicators using project databases present progress for Q1PY6.

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Table 1. Summary of Accomplishments Against Performance Targets as of Q1PY6

PY 6 % Accom‐ Cumulative Accomplishment (i.e., TARGET Q1PY6 Accomplishments by Region Annual IND. plishmen running total as applicable) Indicator Baseline Accom‐ REF. t vs. PY6 ZAMBO NORTH SOCCKS‐ plishmen As of end As % of PY6 EOP DAVAO CARAGA ARMM TOTAL Target PY1 to PY5 ‐PEN MIN KARGEN t to Date of Q1PY6 eop (o) = i+j+ (s) = (p + t = (a) (b) (c) (d) (e) (i) (j) (k) (l) (m) (n) (p) (q)= (p/d) (r) k+l+m+n) r) [(s/e) 1,522,420 1,522,420 94% 1,468,220 1,522,420 94% Current User of Modern 260,990 309206 294,901 344,818 131,569 180,936 FP 1 1,070,486 1,615,042 1,615,042 FP Method Q1PY6 reported figures are from Oct‐Dec. 2017 FHSIS reports as per M&E TWG agreement of one quarter back reporting. 126,642 126,642 23% 1,194,788 1,321,430 75% Couple Years Protection 24,496 31,915 20,805 26,816 16,836 5,774 HL.7 (CYP) in USG‐ supported 228,438 562,837 1,757,625 .1.1 Q1PY6 reported figures are from Oct‐Dec. 2017 FHSIS reports as per M&E TWG sites (LAPM only) agreement of one quarter back reporting. Average stock‐out rate of contraceptive

commodities at family planning SDPs Pills 2% 2% 0% 3% 6% 0% 0% 0% 2% 2% 1% 2%

Numerator 15 15 0 4 9 0 0 0 13 13 87% 10 13 87% Denominator 737 737 133 125 154 111 59 155 737 737 737 737 DMPA 1% 0% 0% 0% 3% 0% 0% 0% 1% 1% 1% 1%

Numerator 7 0 0 0 5 0 0 0 5 5 71% 10 5 71% HL.7 Denominator 737 737 133 125 154 111 59 155 737 737 737 737 .1.2 IUD 24% 0% 0% 0% 0% 2% 0% 0% 0% 0% 0% 1% 0% Numerator 302 0 0 0 0 3 0 0 0 3 3 #DIV/0! 5 3 #DIV/0! Denominator 1,270 737 737 133 125 154 111 59 155 737 737 737 737 SDM Beads 3% 3% 32% 0% 0% 0% 0% 0% 6% 6% 10% 6%

Numerator 22 22 42 0 0 0 0 0 42 42 191% 74 42 191% Denominator 737 737 133 125 154 111 59 155 737 737 737 737 Condom 1% 1% 0% 0% 2% 0% 0% 0% 0% 0% 1% 0%

Numerator 7 7 0 0 3 0 0 0 3 3 43% 5 3 43% Denominator 737 737 133 125 154 111 59 155 737 737 737 737 Stock‐outs on SDM beads (42 SDPs) reported in , Pills (9 SDPs in Davao City, 4 SDPs in ), DMPA (4 SDPs in Davao City, 1 SDP in Compostela

Valley), IUD (1 SDP IN Davao City, 2 in Compostela Valley), Condom (3 SDP in Davao City).

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PY 6 % Accom‐ Cumulative Accomplishment (i.e., TARGET Q1PY6 Accomplishments by Region Annual IND. plishmen running total as applicable) Indicator Baseline Accom‐ REF. t vs. PY6 ZAMBO NORTH SOCCKS‐ plishmen As of end As % of PY6 EOP DAVAO CARAGA ARMM TOTAL Target PY1 to PY5 ‐PEN MIN KARGEN t to Date of Q1PY6 eop The continuing delivery of commodities from DOH Central, availability of buffer stock at regional offices, and the effective coordination and reporting mechanisms at the local level with the Regional Implementation Team (RIT) at the helm played a key role in this accomplishment. PopCom has likewise been tasked to track and monitor FP commodities while the DOH‐ROs perform continuing inventory management through their Pharmacists deployed in the provinces. Inability of DOH deliver to IUD during the quarter contributed to IUD stock‐outs.

Percent of USG‐ assisted service delivery points 25% 97% 97% 97% 102% 101% 110% 102% 81% 97% 97% 97% 97% 100% (SDPs) providing FP counseling and services 100% Numerator 198 715 715 129 127 155 122 60 125 718 718 718 718 FP 4 Denominator 777 737 737 133 125 154 111 59 155 737 737 737 737 No additional SDPs counted in for Q1PY6. Latest report from Lanao del Sur show all reported SDPs particularly RHUs and hospitals are providing FP services. Only BHS

Sugod and BHS Ambolong are not yet open. These however are not part of the target SDPs. CHO Marawi City with skeletal force is now in operation together with 8 BHS. Number of USG‐ assisted 78 78 0 10 15 16 4 15 60 60 77% 8% 60 77% SDPs providing FP/RH While there is additional RHU providing AYRH services (Buenavista, Agusan del Norte), services for adolescents Remedios T. Romualdez RHU in same province is temporarily not functional because and youth of on‐going renovation, thus no change in total number. Additional 19 SDPs were supported and now with AJA‐trianed staff. Sustained support will continue to mamke these functional. Figures are cumulative Percent of LGUs conducting data quality 73% 85% 85% 69% 37% 0% 0% 0% 19% 27% 27% 76% 27% 27% checks (DQC) annually 31% Numerator 268 313 313 49 26 0 0 0 23 98 98 280 98 Denominator 365 368 368 71 71 38 43 26 119 368 368 368 368 DQC activity is now LGU‐led. Other LGUs will conduct DQC in Q2PY6 Number of USG‐ assisted 0 0 0 22 0 41 63 63 1% 2,035 2,1,09 38% CHWs providing FP information, referrals 2,330 3535 5555 Additional CHWs reported as providing FP information, referrals and/or services came

and/or services during from Sultan Kudarat and Lanao del Sur the year Number of women giving 131 228 228 255 192 1018 2052 2,052 41% 4448 6500 99% birth who received 108,005 5000 6560 uterotonic in the 3rd Figures are new clients seen during the period. Only ARMM has included Uteretonics use in its reporting system. stage of labor

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PY 6 % Accom‐ Cumulative Accomplishment (i.e., TARGET Q1PY6 Accomplishments by Region Annual IND. plishmen running total as applicable) Indicator Baseline Accom‐ REF. t vs. PY6 ZAMBO NORTH SOCCKS‐ plishmen As of end As % of PY6 EOP DAVAO CARAGA ARMM TOTAL Target PY1 to PY5 ‐PEN MIN KARGEN t to Date of Q1PY6 eop

CAA INDICATORS 13 18 NA* 0 NA* 35 66 66 44% 670 736 90% 336 150 820 CAA Number of health Concentration of health outreach is in Lanao del Norte, , and Sulu 1 outreach conducted Cumu‐

lative Number of civil society 0 23 23 9 NA* NA* 5 NA* 9 23 23 100% 23 23 100% organizations (CSOs) CAA trained to effectively 2 engage with local No additional CSOs during the period. Figures are cumulative from PY5 governments 0 200 373 144 NA* NA* 15 NA* 14 173 173 87% 173 173 46% CAA Number of youth trained Cumu‐ 3 as peer educators No additional peer educators trained during the period. Figures are cumulative. lative Number of clients 53,448 6000 69737 307 392 NA* 0 NA 1563 2262 2262 38% 63737 65,999 95% CAA reached during health Cumu‐ 4 Concentration of health outreach is in Lanao del Norte, Basilan, and Sulu outreach activities lative New Indicators NI1 Number of SDPs with functional health service provision. TBD NI2 Percentage of PPFP/PPIUD trained providers that have been certified by the Department of Health in USG assisted sites 36% 80% 80% 0% 4% 0% 0% 0% 0% 0% 0% 0% 36% 37% 37% Numerator 344 754 754 0 7 1 0 0 0 8 8 344 352 Denominator 955 942 942 183 194 182 276 59 61 955 955 955 955 Cumu‐ Cumu‐ Figures are from the Baseline. Reported figures do not include certified MH trained

lative0 lative providers from (4) NI3 No. of women of reproductive age that 428,037 New have been profiled and (June 470,840 470,840 30,110 18,688 222,359 8,386 51,865 48,487 379,865 379,865 171% 807,902 171% Indicator identified as having 2017) unmet need for FP As there are developments in the targeting of unmet need profiling, from NHTS populations in mid‐2016 to all WRA by the 2nd quarter of 2017 that included the introduction of standardized reporting forms, DOHROs are in the process of rolling out and reporting forms and harmonizing their data with previous datasets as well as the required indicators to be reported. Current reports still need refinement to address 3

PY 6 % Accom‐ Cumulative Accomplishment (i.e., TARGET Q1PY6 Accomplishments by Region Annual IND. plishmen running total as applicable) Indicator Baseline Accom‐ REF. t vs. PY6 ZAMBO NORTH SOCCKS‐ plishmen As of end As % of PY6 EOP DAVAO CARAGA ARMM TOTAL Target PY1 to PY5 ‐PEN MIN KARGEN t to Date of Q1PY6 eop data quality issues. Some of the reports may be cumulative. Consequently, there may be adjustments to this report in the next period

NI4 Percent of women of reproductive age that have been profiled and identified as having 26% 85% 85% 92% 54% 7% 19% 95% 35% 32% 32% 31% 32% unmet need who have been provided with FP services. Numerator (provided FP services) 112,431 400,214 400,214 27,650 10,070 16,633 1,612 49,072 16,936 121,973 121,973 121,973 New Denominator 428,037 Indicator (no identified with (June 470,840 470,840 30,110 18,688 222,359 8,386 51,865 48,487 379,865 379,865 379,865 unmet need) 2017) 31% Denominator derived from target WRA with unmet need identified. Data represents partial reports form 16 project sites. Other project sites reports were just submitted and for inclusion in Q2PY6 report.

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The next section is an analysis of topline indicators reflected in Table 1.

A. Increase in the number of FP current users (CU) As of the end of Q4PY5, the number of current FP users posted an increment of 54,200 over the previous quarter (Q3 PY5) level representing an increase of about 3%. Biggest contributor is PPIUD/IUD at 48%, followed by LARC/PSI with 29% and BTL at 23%. Despite the increase in the coverage on NSV by 15% in Q4PY5, higher than BTL (9%) and PPIUD/IUD (12%), it only contributed 0.4% to total FHSIS reported LARC/PM. The end of the quarter’s current user report of 1,522,420 is 42% higher than the 2012 baseline figure of 1,070,486 as shown in Figure 1. Furthermore, the former is equivalent to 94% of the end-of-project (EOP) target of 1,615,042 current users of FP.

Figure 1: Summary of Accomplishments and Trends in Current Users (Q4PY2 – Q4PY5)

By region, all showed increases from the last quarter of the previous year (Q4PY4) with the highest growth seen in CARAGA at 34%. The current report of ARMM showed a 23% increase from the previous quarter as reports from Lanao del Sur where the reporting system was earlier disrupted by the Marawi siege has already been completely restored. Trends on FP current users by region are shown in Figure 2.

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Figure 2: Current User Trends by Region (Q4 PY2-Q4PY5)

B. MH Contribution to FHSIS Reports on LARC/PM Acceptors Data as of Q4PY5 in Figure 3 shows that the combined action of MH, DOH and LGUs has led to a general improvement in key indicators over time. For the same period a total of 24,044 acceptors (5551-BTL, 101-NSV, 11,496-IUD/PPIUD, and 6,896-LARC-PSI) was reported in the FHSIS of project sites as either new acceptors or shifters to more permanent methods. LARC-PSI continues to increase significantly reaching the highest figure since its introduction. MH supported providers both public and private contributed 21% (4,958) of the total reported LARC/PM acceptors in Q4PY5, an 8 percentage point lower than Q4PY4 project contribution of 28.8%, and 49% reduction from Q3PY5 contribution of 45.5%. The reduction in the number of supported outreach services due to competing LGU/DOHRO activities, and the project’s mode of initiating its close-out plan of activities during this period may have contributed to reduced project’s contribution. Of the project’s contribution in Q4PY5, fixed FP services contributed seventy percent (70%) or 3,491 LARC/PM acceptors. Further review of available data revealed that 2,448 LARC/PM acceptors or 70% of acceptors from fixed services were generated from the seventeen (17)1 out of hospitals with and being targeted on FP/AY Programs. It was also noted that the 17 hospitals reached 1,887 acceptors on short acting reversible contraceptives (SARC). The 17 hospitals is roughly 7 percent of all the public hospitals in USG-assisted sites. Strengthening and expanding the integration of FP/AP programs in hospitals, with improved reporting system, will significantly increase LARC/PM service coverage. Furthermore, analysis of Q3PY5 and Q4PY5 data (Fig 3) revealed that the overall performance of Mindanao-wide health system is picking up with a 13% increment on FHSIS data on LARC/PM, despite the 49% reduction in project’s contribution from

1 Maguindanao Provincial Hospital, Southern Philippines Medical Center, Cotabato Provincial Hospital, Provincial Hospital, Agusan del Norte Provincial Hospital, Zamboanga Sibuagy Provincial Hospital, Margosatubig Regional Hospital, Basilan General Hospital, DO Plaza Memorial Hospital, Provincial Medical Center, Davao Provincial Hospital,Compostela Provincial Hospital, Brokenshire Memorial Hospital, Bukidnon Provincial Hospital,Sultan Kudarat Provincial Hospital, Gregori T. Lutch Memorial Hospital, and Northern Mindanao Medical Center.

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45.54% to 20.62% during this period. Improved capacity of the health system with established FP/AY Programs in hospitals will accelerate reduction of WRA with FP Unmet Need and reduction of 2nd or succeeding pregnancies among teen moms. The project’s effort to help accelerate its support in the extension period showed a significant increase in the project’s contribution to Mindanao-wide Q4Y5/Q1PY6 FHSIS data. The Q1PY6 figure is noticeably higher than the previous quarter period and the highest to date, particularly for outreach (Fig 4). A total of 10,079 LARC/PM acceptors were reached in Q1PY6 (Fig 4), a 103% increase from Q4PY5 MH contribution of 4,958 against 24,044 LARC/PM acceptors as reported in Q4PY5/Q3Y5 FHSIS data (Fig 4). Given the significant clients reached from MH supported fixed facilities and outreach services in Q1PY6 (Fig 4), it can be deduced that Q4Y5 FHSIS data on LARC/PM will significantly increase, if the system-wide momentum observed in Q4PY5 is sustained by the health sector with the public sector able now to provide LARC/PSI after the lifting of the TRO by Supreme Court, more hospitals with established FP/AY Programs and with itinerant teams for FP services, and LGUs conducting more outreach services, in partnership with the private sectors.

Figure 3: MH Contribution to Reported LARC/PM Acceptors, Q1PY3-Q4PY5

Figure 4, showed that in Q1PY6, LARC/PM clients from outreach comprised 68% with 6,823 served, a figure that has been increasing in the last four quarters, except in Q4PY5. LARC-PSI contributed the most to outreach services accounting for 95% (6,467) of all clients served. This is mainly attributable to private providers that responded to the high demand on LARC/PSI among counseled WRA with unmet need and could not be addressed by public providers who were then covered by the Supreme Court TRO on implants. On the other hand, client served by fixed facility providers trained by MH show increasing trends as well. It contributes to 32% of total LARC/PM clients served while PPIUD/IUD accounts for 39%, BTL contributing 35%, and LARC/PSI 24%. Partial available Q1PY6 data from the 17 hospitals with or targeted on FP/AY Programs showed 1341 LARC/PM acceptors, and 2,426 SARC acceptors. Increasing the frequency of FP fixed services and outreach services, improved profiling of WRA with FP unmet need, and better collection of reports from fixed facilities especially from private providers contributed to increase LARC/PM coverage in Q1PY6.

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Figure 4: Total Clients Served from Fixed and Outreach Activities Supported by MH, Q1PY3-Q1PY6

C. Increasing Private Sector Contribution to LARC/PM Services HPDP (2013) estimates that the contribution of private facilities to CPR for modern FP methods in Mindanao USG sites can reach as high as 52.3% showing the a significant role of the sector to program outcomes. Administrative data from FHIS however do not fully capture this contribution reflecting mostly public-sector performance. In most cities for example, where private sector providers gravitate, program outcomes are low (eg. Zamboanga City, Cagayan de Oro City) as large segments of WRA population source their FP methods from private facilities. For the period, MH-supported private sector providers (fixed and outreach) served 5,554 or 55% of the total 10,079 LARC/PM acceptors generated in Q1PY6. This comes mostly from private provider led outreach activities that account for more than 75% (5,129) of clients. Private sector contribution is mostly LARC-PSI (4,989), which is 69% of the total 7,261 LARC/PSI acceptors reached during the period for both public and private. Private sector participation is also becoming more evident in non-service provision activities such as training and clinical practice sites, service delivery network, and DQC quality assurance. For fixed facilities, public sector providers remain the top provider for LARC/PM services contributing 2,831 LARC/PM acceptors or 87% of total 3,256 acceptors reached through fixed services. Barely 13% or 425 LARC/PM acceptors were generated from the private sector fixed services. The close collaboration of the project, LGU and private sectors providers during outreach, and the high demand for LARC/PSI are factors to high private sector contribution. The lack of harmonized reporting system between private and public sector, and the weak capacity of the public sector to generate private sector reports are factors to seemingly low private sector contribution to fixed LARC/PM acceptors. To date, it is only in General Santos City, Iligan City were private sector reports are included in FHSIS data. The project is intensifying its efforts in major cities, with high private sector providers to replicate these emerging good practices either independently or through our SDN initiatives. By method, LARC/PSI acceptors is highest at 7,261 or 72% of 10,079 LARC/PM acceptors in Q1PY6, with BTL and PPFP/PPIUD coming second at 13% each, followed insignificantly with 2% IUD.

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D. Increase in Couple Years of Protection (CYP) The couple years of protection (CYP) figure for the period ending Q4PY5 of 126,642 rose by about 12% over the previous quarter’s figure of 112,881, slightly higher by 2% with Q4PY4 data but lower than the Q2PY5 figure where it peaked at 148,917. The Project achieved 23% of the total target for the year of 562,837. As of the end of the quarter in review, the Project’s cumulative CYP stands at 1,321,430 or roughly 75% of the EOP target of 1,757,625. The reported CYP figures in Figure 5 cover only LAPM/LARC methods (i.e., BTL, NSV, IUD, and Implants).

Figure 5: Couple-Years of Protection (Number by Region, PY5)

The significant increase in LARC/PSI acceptors, partial generation of data from 10 targeted hospitals, and improving health system to accelerate the delivery FP/LARC/PM services in response to Executive Order #12 are factors to 12% increment observed during the quarter. With the gradual integration of the private and hospital contribution, not to mention the lifting of the TRO, the project, and implementing partners are confident in reaching deliverables. Figure 6 below shows the CYP Figure 6: Couple Years of Protection (CYP) by Region, Q1PY4-Q4PY5 accomplishments by region. All regions achieved at least 25% of their respective annual targets, i.e., Zamboanga Peninsula (25%), SOCCSKARGEN (26%), Northern Mindanao (26%), CARAGA (25%) and ARMM (33%), except Davao Region with only 14%. While project-wide figures show generally increasing trends for CYP, there are variations in performance across regions. ARMM, despite the effects of the on-

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going conflict in Marawi, Lanao Del Sur surprisingly managed to show improvements in the last quarter period. Zamboanga Peninsula and SOCCSKSARGN also showed similar trends while Davao and CARAGA showed slight declines. Reduction in CARAGA can be attributed to reduced PPIUD/BTL acceptors in targeted hospitals, a trend observed on the same period in PY4, while the continued reduction in Davao Region is the inability of the LGU to generate complete report from all private sector and hospitals in Davao City, an area that the project has been supporting but with slow uptake from the CHO.

Figure 7: CYP Trends by Region

E. Sustaining Low Stock-out Rates on FP Commodities The over-all stock-out rate on FP commodities in USG-assisted and monitored SDPs was maintained during the reporting quarter as shown by following data: a) Pills at 2%; b) DMPA at 1%; c) IUD at 0%; and d) Condoms at 0%. SDM beads, however, were not available in 42 SDPs as reported in Zamboanga del Sur. For Pills, nine (9) SDPs in Davao City and four (4) SDPs in Bukidnon reported stock-outs. DMPA was not available in four (4) SDPs in Davao City and one (1) SDP in Compostela Valley. One (1) SDP in Davao City and two (2) SDPs in Compostela Valley had stock-outs of IUD, due to inadequate delivery of IUD supplies from DOH and non- procurement of FP supplies by LGU. The poor logistic monitoring and reporting of the Davao City Health Office resulted to maldistribution of supplies resulting to over-stocking and understocking among district health offices, a priority area for continued technical assistance by the project. Stock-outs were acted upon by asking supplies from nearby province/municipalities (e.g. Lanao del Norte for Bukidnon). After introducing the RHUs/CHOs to the supply management and recording system (SMRS) and the simplified FP commodity inventory and order tool developed by DOH and PopCom, MH’s TA for health facilities to be able maintain low stock-out rates has been focused on providing regular coaching to PHNs and RHMs during facility visits on inventory tracking, recoding and reporting of consumption reports to FP provincial coordinator and FP logistics hotline, linking the public health facilities to PHO and DOH-RO in the event of near stock-out and stock out incidence for immediate stock replenishment, promoting inter-LGU coordination that allows the PHOs and DOH-ROs to redistribute commodities from facilities with reported over supply (either due to low service provision or over projection) to facilities with near stock-out or stock-out incidence. F. Continued provision of FP Services in USG-assisted SDPs, both public and private The major focus for Q1PY6 period has been the enhancement of FP/AY programs in hospital settings covering a total of 13 service delivery points, mostly public facilities. In addition, during field visits and consultation meetings with partners, appropriate technical assistance were

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provided to help sustain the provision of FP services in the supported 718 SDPs (both public and private) in USG-assisted sites, including the 83 SDPs in non-USG-sited that were supported in previous years through DOHROs. Sustained technical assistance to LGU-led activities during the quarter contributed to the functionality of these supported facilities. With project’s support to date, a total of 718 SDPs are now providing FP Services in USG-assisted sites, an additional 479 to 239 baseline in 2013. Field visits in Marawi after the siege showed that 8 barangay health stations and the city health office are fully functional with new FP supplies. The BHS in the about 24 barangays at ground zero are totally damaged and non-functional. G. Provincial and City LGUs and City LGUs Institutionalizing Data Quality Check (DQC) The conduct of DQC is now a LGU-led with minimal support from the project. During the quarter covered, a total of 98 LGUs or 31 percent of the 368 project sites conducted DQC activities. Regular DQC has contributed to improved recording and reporting system such as using official prescribed forms and tools vis-à-vis logbooks/notebooks, better and common understanding on key indicators resulting to quality and complete data. The DQC’d data were used during the program implementation reviews and 2018 LIPH planning workshops of LGUs. H. Increasing number of CHWs providing FP information, services, and, referrals An additional sixty-three (63) community health workers from Lanao del Sur (Wao-41) and Sultan Kudarat (22) were provided training/orientation or issued CHT toolkits developed by the project. In the case of CHWs in Lanao del Sur, their participation was part of the demand generation for the PTE activity of the LGU. For the period, previously reported CHWs from all project sites including those mobilized for the quarter were able to reach 6,99O men, women and youth and provided with FP information and 4,469 were referred for FP methods. I. Women giving birth who received uterotonic in the 3rd stage of labor A total of 2,052 women who delivered a child has received uteretonic in the 3rd stage of labor. ARMM accounted for 1,018 or roughly half of all the cases. The place of delivery of these pregnancies are facilities with an MH trained provider on EINC, BEmONC or CMNC in the case of ARMM, PhilHealth accredited and with standard protocols for service provision. J. Increasing PPFP/PPIUD trained service providers certified by DOH In Q1 PY 6, twelve (12) PPFP/PPIUD providers from Misamis Occidental (4) – a non-USG site but MH trained, (7) and (1) received their certifications from their respective DOH regional offices. There were however no new supportive supervision activities conducted during the period. As of Q1PY6, a total of 584 or 61% of 995 PPIUD trained health service privders are supportively supervised and 344 of them are already DOH-certified. K. Profiled WRA with FP Unmet Need During the reporting period, status reports on the on-going profiling activities to identify and provide FP services were gathered from 16 project sites2. The reports show that at least 12% of the estimated number of WRA were profiled during the period with over 379,895 WRA with unmet need identified or roughly 34% of the estimated 1,105,306 women who either want to space or

2 Davao city, Compostela Valley,Davao Oriental,, Misamis Oriental, Lanao del Norte, Bukidnon, Cagayan de Oro, Sultan Kudarat, Zamboanga del Sur, City,Basilan, Sulu, Lanao del Sur, Agusan del Norte, and

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limit their pregnancy but are not currently using a modern FP method. Among these women identified with unmet need, 121,973 or 32% have been provided FP services during the period. Davao Region profiled more than estimated WRA with unmet need but lowest in service provision at only 7%, because of FHAs’ focus on profiling with weak linkage to service provision, an area being addressed onwards. It should be noted that the current estimates were derived from the 2010 Population Census. Project supported activities to set up reporting systems in the middle of last year particularly in Zamboanga Peninsula, SOCCKSKARGEN, and Iligan City show from 30%-40% of those profiled have already been given FP services (current users) in health facilities implying overall FP service coverage may be higher than 32% as this is only for the Q1PY6 period. In general, regions are still in the process of reconciling datasets from previous year initiatives that focused on the NHTS population, rolling out the FHA reporting forms, and adjusting their previous recording systems (eg. Davao City and CARAGA). Inadequacy of resources to mobilize support from community health workers particularly in ARMM have been noted during consultation meetings. With support from MH, partnerships have been improved between DOH-POPCOM, DSWD in Zamboanga Peninsula, Northern Mindanao, Davao and SOCCSKSARGEN particularly on data sharing and service provision. For the period, MH responded with requests for technical assistance (establishment of recording and reporting system and targeting) in the provinces of Tawi-Tawi and Basilan. Table 2: Status of Profiling, Unmet Need Identification, and FP Service Provision

DEMOGRAPHICS ACCOMPLISHMENTS PERFORMANCE % Provided FP No. % of Unmet Est. No. of No. Services REGION Est. No. of No. Identified Need among WRA with provided among those WRA Profiled* with Unmet those Unmet Need FP Services with Unmet Need Profiled Need (1) (2) (3) (4) (5) (6) (7)=(5)/(4) (8)=(6)/(5)

DAVAO 1,034,719 216,872 335,804 222,359 16,633 66% 7%

NORTHMIN 1,038,825 209,310 57,565 18,688 10,070 32% 54% SOCCSKSARGEN 1,073,852 206,180 47,371 8,386 1,612 18% 19% ZAMBOPEN 924,718 180,405 30504 30110 27,650 99% 92% ARMM 1,022,627 220,362 69,609 48,487 16,936 70% 35% CARAGA 344,252 72,177 108,843 51,865 49,072 48% 95% TOTAL 5,438,993 1,105,306 620,363 349,915 94,831 58% 32% *No reports collected from Tawi-Tawi, Maguindanao, , North Cotabato, South Cotabato, Zamboanga City, , , and General Santos City L. Progress in Conflict Affected Areas: In addition to 12 priority LGUs for PY6, support to Marawi and its corridors (Lanao del Sur, Lanao del Norte, Iligan City) is given equal technical support with the establishment of Iligan-based regional office with 3 technical staff, an admin/finance officer and a driver, aimed at supporting partner LGUs to increase reach of health/FP/AY/MNH/psychosocial services to affected IDPs and host communities through outreach services, and help them restore their capacity to deliver essential health services. Establishment of Iligan-based office facilitated the coordination with LGU and other humanitarian partners, with the following initial results: i) supported capacity building cum outreach resulted to 88 informed clients accessed LARC/PSI services, 8 LARC/PSI-

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trained HSP supportively supervised and now for certification, and additional 9 HSPs trained on LARC/PSI; ii) series of consultations with LGUs and partners resulted to 20 identified priority facilities/areas to help restore the delivery of essential health services, initiated procurement of requested supplies such as dignity kits, maternity packs, aqua tabs and water tanks; and iii) outreach services generated 11 BTL acceptors, 2 IUD and 290 LARC/PSI in Lanao del Norte; 3 IDPs in Iligan accessed SDI services; and 3,071 IDPs in Marawi were reached with various health services. Outreach Activities in Conflict-Affected Areas (CAAs) For the period, a total of 66 outreach activities were organized in CAAs reaching a total of 2,262 men, women, and children for family planning, pre-natal services, provision of breastfeeding information, and immunization. FP outreach totaling 51 resulted in 1,410 FP acceptors of LARC/PM. The thirteen (13) REACH activities on the other hand were able to provide 552 pregnant women with information on exclusive breastfeeding and 50 newborns and children provided with antigens. Outreach activities for FP were mostly conducted in Basilan, Zamboanga City, Lanao del Norte, and Maguindanao while REACH activities were concentrated in Basilan and Sulu. CSOs’ Advocacy on AY Program in CAA Provinces There were no new CSOs engaged by MH as of the quarter in review. The current number still stands at 23 CSOs in the assisted CAA provinces that already represents 100 percent of the EOP target. These are spread in ARMM (9), Zamboanga Peninsula (9) and CARAGA (5). In ARMM, these CSOs are continuously engaged by MindanaoHealth on advocacy for health governance and capacitated on improving demand generations for AYRH concerns.3 All of these local partners were capacitated on Teen Facilitation to assist their respective RHUs in the demand generation activities for AYRH and link them to AY service provisions. Specifically, the local CSO partners’ work cover advocacy, ASRH information, risks assessment, referral, and progress tracking for the health and development of OSYs and young parents, through outreach and public-private multi- sectoral partnership. Advocacy work of five (5) of these local CSOs already led to the issuances of Executive Orders by LCEs of City of Basilan, , Tawi Tawi, Bubong, Lanao del Sur and Maguindanao’s and UPI municipalities. These issuances contains provisions of establishing an AY Friendly facilities as well as strengthening the demand generations for quality services that will address the needs of adolescents and youths in their communities. Specifically for Marawi City and its corridors, the project initiated the procurement of potential CSOs to help LGUs of Marawi City, Lanao del Sur and Lanao del Norte provide FP/AY/MNH Services to IDPs. Two potential CSOs were shortlisted and invited to submit their proposals. The project targets to forge the partnership with the selected CSO early on Q2PY6.

3 These are Tarbilang Foundation in Bongao, Tawi Tawi, Sulu Provincial Women's Council and Kalimayahan Foundation (Jolo, Sulu), Isabela Foundation for Basilan, Bubong OSY Council (Bubong, Lanao del Sur) and Al Mujadillah Development Foundation (Marawi City), and for Maguindanao - UNYPHIL (Buluan), Upi Youth For Governance Program (Upi) and Bangsamoro Women and Children (Datu Piang).

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Program Management

A. Monitoring, Evaluation and Research During the quarter under review, Monitoring, Evaluation and Research (MER) activities focused on providing support for the implementation of the Zero Unmet Need policy of the DOH, support for the development and roll-out of the Training Information Management System, and enhancements to the project monitoring system. Updates on Indicators During the quarter, MH prepared a revision of its PY6 Workplan and submitted the same to USAID. For its key performance measures, 14 indicators were proposed consisting of 8 USG indicators, 2 custom indicators, and 4 new indicators that measure contributions to unmet need profiling and FP service provision and restoration of health services in Marawi-City. The following table outlines these performance indicators, the baselines used, status to date for carry- over indicators, as well as targets for the year. BASELINE Y5 PERFORMANCE INDICATOR 2012 (UNLESS ACHIEVEMENT AS Y6 TARGET (INDICATOR #) OTHERWISE OF JUNE NOTED) 2017 1. Couple-Years of Protection from LAPM 114,280 543,090 (June 2017) 562,837 1,776,085 (cumulative) 2. Stock out rate of contraceptive commodities at family Pills: 1% Pills: 3% Pills: 2% planning (FP) service delivery points (SDPs) DMPA: 0% IUD: 1% DMPA: 1% IUD: 0% DMPA: 0% IUD: Condoms: 1% SDM Condoms: 1% 0% Condoms: Bead: SDM Bead: 4% (June 1% 11% (2015) 2017) SDM Bead: 3% 3. Percentage of FP SDPs providing FP counseling and 25% (198/777) 97% (712/737) 97% (712/737) services to couples, men, women, youth and adolescents of both sexes meeting minimum standards (FP 4) 4. Number of MH- supported community health workers 0 2030 3535 (additional) (CHWs) providing FP information, referrals, and/or services 5. No. of MH- supported SDPs providing FP/RH services to 60 78 adolescents and youth meeting minimum requirements (cumulative, 18 additional SDPs) 6. Number of Universal Health Coverage (UHC) areas New indicator in 5 5 supported by MH 2016 7. MH support to Strengthen Human Resources for Health New indicator in 2 2 (HRH) 2016 8. Percentage of LGUs conducting data quality checks (DQC) 73% (268/365) 74% (269/365) 85% (310/365) 9. Percentage of audience who recall hearing or seeing a 49% TBD specific MH- supported FP/RH messages (from FY 2017 New indicator in Change report) 2017 10. Number of women giving birth who received uterotonics in 108,005 1560 5,000 the third stage of labor (or immediately after birth) in select June 2017 – GIDA/CAA MH-supported facilities selected sites Areas 11. Number of SDPs in Marawi City and its corridors with TBD TBD TBD functional health service provision. 12. Percentage of PPFP/PPIUD trained providers that have 0 New Indicator 80% been certified by the Department of Health in USG assisted (only includes those 37% (754/942) sites trained by MH) 354/955 13. No. of women of reproductive age that have been profiled TBD New Indicator 10% increment and identified as having unmet need for FP from PY5 WRA with Unmet Need profiled

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BASELINE Y5 PERFORMANCE INDICATOR 2012 (UNLESS ACHIEVEMENT AS Y6 TARGET (INDICATOR #) OTHERWISE OF JUNE NOTED) 2017 14. Percent of women of reproductive age that have been TBD New Indicator 80% of identified profiled and identified as having unmet need who have been women with provided with FP services. unmet need

Baseline data was also collected for the two indicators on identification and service provision for those identified with unmet need. Initial reports show significant data reporting issues, no standard reporting forms were used although the FHA report that was issued in mid-2017 is slowly being introduced among LGUs in other regions (ARMM, SOCCSKARGEN, and CARAGA). In Davao for example, new NDPs that replaced previous hires were retrained, the reporting system enhanced adopting the FHA reporting system, and rollout at the community level conducted in the last quarter of 2017. For the indicator on “Percentage of audience who recall hearing or seeing a specific MH- supported FP/RH messages” available data collected by the CHANGE project was adopted as the project baseline. Enhancements to the project program management systems The FP Capacity Composite Index Tool that was developed and used by the project in assessing gains made by the project on FP/AY Services helped in prioritizing USG-project sites. It measures the status of 13 key results areas that can widen access to FP/AY services, increase demand, and help establish an enabling environment for sustainability. The used of tool guided the project in prioritizing 12 USG-sites with high unmet need and teenage pregnancies, covering about 62% of GIDAS of USG-sites and has contributed an average of 77% CYP for the past three years. The tool will be used to monitor progress on these 13 key indicators during the extension period. As a result of the project restructuring at the field and central level, the addition of new indicators, and the clustering of sites by priority area that need monitoring and evaluation dis-aggregations, the existing reporting system was enhanced. The project database was migrated from ACCESS to an Excel base system updated through OneDrive. More in-depth data collection forms were also prepared for special project concerns such as FP/AY Integration in Hospitals and Service Delivery Network. Guidelines were developed discussing the roles of personnel, reporting schedules and procedures for updating records. TIMS Development and Installation During the period, the focus of MH for TIMS was the development of the additional modules as agreed upon with the Zamboanga Peninsula consultation workshop, namely:  Adoption of the DOH standards for facility codes;  Inclusion of a PPIUD checklist that can be accomplished online;  An alert system reminding program manager of trained providers with pending supportive supervision visit; and  Categorization of training course aligned with HHRDB Health Service Management for Service Delivery component under their Competency-Based Learning and Development Initiative.

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User installation and mentoring visits were planned for January 2018 in Zamboanga. Latest reports show a total of 298 entries for FP and AY trainings conducted in 2016 and 2017 that were not in the database turned over by MH was reported for Zamboanga Peninsula. Also, the IT unit of the region has taken charge in enrolling and conducting follow-through orientations for new users. A total of 11 DOH RO-level users have been provided access to the system and staff assigned to update the regional database. B. Project Communications Dr. Roston G. Garces, Municipal Health Officer of Pangantucan in Bukidnon, Following the documentation of identified good takes part in opening the 2nd National Family Planning Conference as one practices in the last quarter of PY5, MH had the of the Speakers during the first Plenary Session talking about improving access to family planning in a rural area with particular attention given to opportunity to present some of these during the indigenous peoples. (MCossid/Jhpiego) 2nd National Family Planning Conference held in City in November 2017. More than a thousand participants, such as national and local government leaders, development partners, youth and civil society advocates and practitioners, attended this event.

Nineteen (19) good practices were presented in various plenary and parallel sessions of the conference. The presentations generally drew interests from the audience. In particular, Agusan del Norte-Department of Education’s YOLO (Youth Optimizing Life Opportunities) Program caught the interest of the Municipal Speakers of the Satellite Session sponsored by USAID’s MindanaoHealth Health Officer of , to put Project dubbed “Formidable Mindanao: Telling Stories. Sharing our up the same program. The presentation on J.R. Treasures” prepare for their turn to present their respective stories and Borja General Hospital’s Family Planning jewels, as part of the 2nd National Family Planning Conference. (Left to Right) Agusan del Sur Provincial Family Planning Coordinator Gina Karen Program also elicited attention as it revealed Canonoy,; RN South Cotabato Provincial Hospital Computer Programmer that a little over a year after its launch in June Jomae Rona M. Socuya; Davao Regional Medical Center Adolescent and 2016, the hospital has already collected more Youth Wellness Clinic Focal Person Dr. Leslie M. Capuno; J.R. Borja General Hospital OB‐Gyne Department Head Dr. Llova M. De Guia; and Davao City than ₱4M in PhilHealth reimbursements. Third District Health Officer and District 3 Service Delivery Network Chair Dr. In the coming months, MH would have the Ely Buenaventura. (MCossid/Jhpiego) chance to share the 19 good practices presented and the other documented project initiatives with health partners and stakeholders in the field once the Dissemination Fora for other remaining regions are mounted.

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These USAID-supported good practices, among others, were also featured in the USAID Philippines Highlights in November 2017. A couple more MH stories were published by USAID in their Office of Health Weekly Bulletin: Upi, Maguindanao’s “Peer Educators Helping Prevent Teen Pregnancy” (published on 13 October 2017); and Sulu’s “CATCH and CHANGE (Caring for All Tausugs in the Community through Health and Community Health Assembly through Networking and Gender Empowerment)” published on 8 December 2017 and also on USAID Philippines’ Facebook Page. The latter describes the PLGU’s comprehensive outreach strategy to improve access to health services of residents especially in geographically isolated and disadvantaged island municipalities who are most in need of health services.

Sulu Provincial Health Education and Promotion Officer Edmiraldo Wee (center in blue) walks around a community in the island municipality of Hadji Panglima Tahil in Sulu. He holds a portable sound system, delivering health messages and encouraging people to participate in the CATCH and CHANGE outreach activities. (Photo by Sulu Integrated Provincial Health Office)

In November 2017, USAID Mission Director Lawrence Hardy II visited General Santos City. One of his trip stops was the USAID-supported private facility – Goldenstate Maternity Clinic. Director Hardy met with the Clinic Owner and the USAID-trained Clinic Manager and learned how the facility is currently thriving and helping boost the health outcomes of General Santos City, particularly on facility-based deliveries, prenatal care and family planning. This visit was highlighted and published on the USAID Philippines Facebook page and on USAID’s Storify account. These social media sites that feature MindanaoHealth articles, among others, continue to generate viewership/readership that expand the reach of our stories and information on what the Project has been doing and has achieved. USAID Philippines has more than 21, 000 Facebook followers. The Project’s following, on the other hand, is growing, now at 936. It continues to maximize social media sites such as Facebook to communicate its stories and successes.

Aside from the social media sites and USAID’s Health Bulletins, MH was able to produce the Project Magazine for Year 4 which is being distributed all over USG-assisted sites in Mindanao, specifically to partners/stakeholders in LGUs, private sector, Jhpiego and USAID Philippines.

A. Knowledge/Information Management While continuously using Dropbox account to store important files/resources readily accessible to the Project Team when needed, the Project has also uploaded some important files, in final versions, to USAID’s Development Experience Clearinghouse (DEC). These files include mostly project Quarterly and Annual Reports submitted to USAID, project materials and technical products like Operational Guides for Service Delivery Network and Centers for Teens, Annual Magazines and other promotional materials/program communication products approved by USAID. DEC is USAID’s online repository of technical and program documents available for viewing and electronic download. Files uploaded here should be in their final and approved formats.

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Jhpiego is also coordinating with the Knowledge Management and IT Specialists of the Project soliciting ideas and recommendations to improve the usability of my.Jhpiego (Jhpiego’s central knowledge sharing place/page). This is part of the move to redesign my.Jhpiego to make more user-friendly; thus, encouraging more staff to work with it to store knowledge products and other resources. USAID Mission Director Lawrence Hardy arrives at the privately‐ owned Goldenstate Maternity Clinic in General Santos City and is met by Clinic Owner Ms. Sarah Jane Manilay (2nd from left), with Clinic Manager and USAID‐trained Midwife Maidy Galleto (extreme right, face partly hidden), USAID’s MindanaoHealth Project Chief of Party Dr. Dolores C. Castillo (extreme left). Also in photo is the Alternate Agreement Officer’s Representative for MindanaoHealth Project Consuelo L. Añonuevo (2nd from left). (MCossid/Jhpiego)

Implementation Issues/Challenges and Mitigation Measures The issues/challenges that continue to confront MindanaoHealth this quarter and mitigation measures implemented and/or planned are enumerated as follows. Issues/Challenges Mitigation Measures Improving the supply of MNCHN/FP services The extended implementation Planned: Having differing views/interpretations of the various DOH of Martial Law in the whole of issuances and memos by different partners/stakeholders, Mindanao MindanaoHealth needs to continue the involvement of regional and local colleagues who know the situation well in the execution of plans such as conduct of trainings, integration of FP/AY in hospitals, transforming RHUs into AY-friendly facilities, supportive supervision, etc.

Conduct of Rapid Health Assessment of Marawi City and its corridors, and deployment of STTAs to pave the way for better availability of supply of FP/RH/AY services. Adequacy, equitable Planned: Continue conduct of FPCBT1 in ARMM with prioritization distribution and reach of among facilities with no providers (preferably, regular, hospital-based or service delivery points (SDPs) birthing facilities—both public and private). for FP especially in ARMM Difficulty in scheduling and Planned: Continue the engagement of STTAs to oversee PPIUD implementing TA activities supervise in Clinical Practice or Coaching/Mentoring sites (CP/CMS) and due to numerous execute another batch of TOT on LARC/PSI removal for Zamboanga, simultaneous DOH-initiated Northern Mindanao and ARMM-BASULTA areas. Further, re-hire activities that conflict and/or STTA/Trainer on BTL/MLLA. compete for time and manpower at the PHO and Continue engagement of DOH and LGUs on FPCBT1, FPCBT2 and other RHU-CHO levels especially on FP supportive supervisions. supportive supervision and dissemination forum. High CYP requirements as Planned: Continue engagements of CSO partners in areas still performance targets challenged with access and support the engagements of fixed providers in the conduct of LARC/PM services while ensuring the distribution and availability of FP commodities.

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Issues/Challenges Mitigation Measures

Increasing the demand for MNCHN/FP services Meeting Unmet Need Planned: Intensify the harmonization FP unmet need databases among agencies tasked to implement EO 12 and harmonize demand generation initiatives. Perceived poor knowledge and Implemented: Completed survey of RHMs in 7 SDN sites which skills of RHMs to address confirmed the wide disparity in terms of knowledge and counseling skills client’s fears of side effects and of RHMs with and without training on FPCBT1, among senior and newly- misconceptions on modern hired RHMs and across regions. family planning. Planned: Intensify the distribution of job aids (FAQs, MEC Wheel) to address frequently asked questions on mFP, including method-specific fears and misconceptions.

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ANNEX A

Narrative of Key Achievements in Priority LGUs

This annex highlights the progress made on key milestones in priority LGUs. Moreover, it also discusses measures by strategy to move the Project forward.

1. Increasing the Supply of FP/MNCHN/AYRH Services a. Assisting the DOHROs and LGUs in mobilizing FP outreach services providers A total of 151 outreach activities in different regions were undertaken during the current quarter bringing the cumulative total of outreach activities conducted to 1,147. Outreach services have of late been focused on geographically isolated and disadvantaged areas (GIDAs). By region, Zamboanga Peninsula posted a share of 34 percent of the total number outreaches followed next by Northern Mindanao and Davao at an almost even percentage share of 18 percent each. At the province level, half the total number of outreach activities was concluded in Zamboanga del Sur, Lanao del Norte, Agusan del Norte, Compostela Valley and Maguindanao as the aggregate number of outreach activities in these five (5) reached 78. The current quarter’s yield reached 6,823 LAPM acceptors with the total LARC-PSI acceptors of 6, 467, and LARC-PSI acceptors from Zamboanga Peninsula accounts for the 36% of this total, since 95% of its outreach yields is LARC/PSI. It should be noted that the Supreme Court TRO on Implanon was lifted in November 2017 and this event could have pushed upwards the acceptability of this FP method among FP clients. BTL acceptors just made up a mere 3.2 percent of the total LAPM acceptor with most these BTL acceptors mostly coming from the provinces of Cotabato and Bukidnon. These outreaches were made possible by the partnership with several NGOs/CSOs such as PSPI, MSI, UNYPHIL, ARCHESS and FPOP mostly serving as co-service providers of the host LGUs and DOH-ROs. Post outreach meetings were conducted to ensure that the key gaps identified were responded to like improving the tracking and navigation of the identified WRA with unmet needs by the community volunteers to improve the yield. As has always been the case, other services provided during outreach activities included counseling, immunization, vitamin supplementation, medical consultations, etc. Table 1: Number of FP Outreaches Conducted and LAPM/LARC-PSI Acceptors by Region in Q1PY6

Total No. of Acceptors Served during Outreach Activities Province/ Region Outreach PPFP/ LARC- City BTL NSV IUD TOTAL in Q1Y6 PPIUD PSI Basilan 8 0 0 0 0 198 198 Lanao del Sur 0 0 0 0 0 88 88 Marawi City 0 0 0 0 0 0 0 ARMM Maguindanao 10 0 0 0 0 175 175 Sulu 1 0 0 0 104 200 304 Tawi-Tawi 0 0 0 0 0 0 0 Isabela City 1 0 0 0 0 40 40 Zamboanga City 13 32 0 0 0 275 307 Zamboanga Zamboanga del 8 9 0 0 0 388 397 Peninsula Norte Zamboanga del 23 0 0 0 0 1,008 1,008 Sur

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Total No. of Acceptors Served during Outreach Activities Province/ Region Outreach PPFP/ LARC- City BTL NSV IUD TOTAL in Q1Y6 PPIUD PSI Zamboanga 6 0 0 0 0 632 632 Sibugay Bukidnon 7 55 0 10 2 331 398 Cagayan de Oro 1 0 0 0 0 230 230 Northern City Mindanao Lanao del Norte 18 11 0 0 2 290 303 Misamis Oriental 2 17 0 0 1 98 116 Compostela Valley 16 0 0 0 9 589 598 Davao City 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Davao Davao del Sur 2 0 0 0 0 108 108 Davao Occidental 0 0 0 0 0 0 0 Davao Oriental 7 0 0 0 0 373 373 Cotabato 8 64 0 2 8 203 277 Cotabato City 0 0 0 0 0 0 0 SOCCSK General Santos 0 0 0 0 0 0 0 SARGEN City South Cotabato 0 0 0 0 0 0 0 Sultan Kudarat 1 5 0 0 0 56 61 Agusan del Norte 11 25 0 0 0 349 374 CARAGA Agusan del Sur 8 0 0 0 0 836 836 TOTAL (USG-Sites) 151 218 0 12 126 6,467 6,823 b. Continuing support to both public and private health facilities to provide fixed and outreach LARC/PM+ services

Support in building the capacities of service providers in public and private hospitals as well as private and non-hospital or birthing facilities outside highly urbanized areas has been a continuing effort of the Project to bring LARC/PM/FP services nearer or more accessible to the communities and potential FP clients. MH support varies from actual training on specific skills to the provision of anatomical models, supportive supervision sessions with actual clients, and mentoring and coaching. As a result, 10,079 clients availed of LARC/PM services in both public and private facilities during the quarter in review with the private health facilities accounting for 55 percent of the total. LARC/PM services provided to clients by the private sector during outreach made up 92 percent of output. By type of FP method provided by the private sector, whether in fixed facilities or through outreach, LARC-PSI easily stood out the most preferred FP method as 90 percent of its clients opted for this method followed next by PPIUD (at 5%) and then BTL (at 4%). With the SC TRO on implants was in effect during much of the second semester of 2017, LGUs encouraged FP clients seeking implants to patronize private health facilities. The regional and provincial distributions of LAPM acceptors served in Q1PY6 in fixed facilities, both public and private, are shown in the table below. Almost 31 percent (1,014 acceptors) of LAPM acceptors came from Northern Mindanao’s provinces of Misamis Oriental, Bukidnon and Lanao del Norte while 24 percent (791 acceptors) are from Zamboanga Peninsula, notably Zamboanga del Sur’s ZDSMC, the DOH-retained Margosatubig Hospital and its birthing facilities.

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Table 2: Number of LAPM Acceptors Served in Public and Private Health Facilities by Type of FP Method as of Q1PY6

Number of LAPM Acceptors Served FP Services Provided by the Private and Public Sectors As of PY2 to Jul-Sept Cumulative Total as Oct-Dec 2017 June 2017 2017 of Dec. 2017 Private sector-provided 7,752 337 5,554 13,643 LAPM/LARC Services Fixed: 6,570 190 425 7,185 BTL 641 12 71 724 IUD 1,437 29 25 1,491 LARC-PSI 2,480 145 57 2,682 PPFP/PPIUD 2,012 4 272 2,288 Outreach: 1,182 147 5,129 6,458 BTL 438 5 178 621 IUD 7 - 19 26 LARC-PSI 737 142 4932 5811 Public sector-provided 68,652 4,621 77,798 LAPM/LARC services 4,525 Total Public-Private 76,404 4,958 10,079 91,441 Private sector contribution (%) 10% 7% 55% 15%

Northern Mindanao’s performance continue to benefit from the efforts of DOH-RO X to increase the network of public/private sector providers on quality FP services through the training on FPCBT2 for interval IUDs that the DOH-RO co-sponsored with CMSU/IMAP-DOH-CDO CHO- MH for 15 trained private and public providers from 13 SDPs. Capacity building for HSPs and the availability of more fixed facilities providing LAPM+ services explain why the region continue to have a significant number of clients availing of LARC/PM methods. While CARAGA region contributed 14 percent during the quarter, this figure is significant as it comes only from the two (2) provinces of Agusan del Norte and Agusan del Sur. Both provinces of Agusan Norte and Agusan Sur have capabilities to provide continuously fixed-facility PPIUD services in their hospitals, birthing facilities and RHUs. Specifically, seven (7) facilities in the former and 6 in the latter. Only Agusan Del Norte Provincial Hospital is continuously providing a broader range of FP services like BTL and PPIUD. The 7 facilities from Agusan Norte are the following: Medical Center, Agusan Del Norte Provincial Hospital (ADNPH) and District Hospital, plus the four (4) birthing centers/facilities of Kitcharao RHU, San Vicente Birthing, Mama Care Birthing Center and Rainbee Birthing Center in Butuan City. Similarly, in Agusan del Sur, the six (6) facilities are: the Trento Rural Health Unit, the D.O. Plaza Memorial Hospital (DOPMH), Bunawan District Hospital, Bayugan City Health Office, Talacogon RHU and San Luis RHU. In ARMM, which posted only seven (7) percent share of the number of LAPM acceptors during the same reporting period, Maguindanao’s outputs on BTL-MLLA came from the three (3) hospitals, namely: Maguindanao Provincial Hospital, Buluan District Hospital and Datu Blah Sinsuat District Hospital.

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Table 3: Number of LAPM Acceptors Served in Fixed Public and Private Health Facilities by Region and by Type of FP Method in Q1PY6 Number of LAPM Acceptors Served in Fixed Facilities Region Province/City PPFP/ LARC- BTL NSV IUD TOTAL PPIUD PSI Basilan 0 0 16 0 6 22 Lanao del Sur 0 0 0 0 0 0 Marawi City 0 0 0 0 0 0 ARMM Maguindanao 32 0 0 0 0 32 Sulu 23 0 7 0 137 167 Tawi-Tawi 15 0 0 0 0 15 Isabela City 19 0 0 0 0 19 Zamboanga City 0 0 0 0 0 0 Zamboanga Peninsula Zamboanga del Norte 0 0 160 0 0 160 Zamboanga del Sur 56 0 486 25 45 612 Zamboanga Sibugay 0 0 0 0 0 0 Bukidnon 317 0 50 2 0 369 Northern Cagayan de Oro City 0 0 0 0 0 0 Mindanao Lanao del Norte 120 0 67 25 44 256 Misamis Oriental 46 0 0 0 343 389 Compostela Valley 0 0 0 0 77 77 Davao City 0 0 0 0 0 0 Davao del Norte 0 Davao Davao del Sur 0 0 0 0 106 106 Davao Occidental 0 0 0 0 0 0 Davao Oriental 86 0 22 4 0 112 Cotabato 0 0 0 0 0 0 Cotabato City 0 0 0 0 0 0 SOCCSK SARGEN General Santos City 0 0 83 0 0 83 South Cotabato 105 0 241 9 0 355 Sultan Kudarat 14 0 0 0 0 14 Agusan del Norte 149 0 71 7 36 263 CARAGA Agusan del Sur 148 0 57 0 0 205 GRAND TOTAL 1,130 0 1,260 72 794 3,256 c. Integrating FP and AYRH Programs in hospitals in SDNs For PY6, MH shall continue to scale-up the integration of FP program in hospital in 13 hospitals currently receiving assistance within the 12 SDNs in consonance with 2014 DOH Memorandum on the Establishment of FP Programs in Hospitals. Pursuant to DOH AO No. 2013-0013 implementing the National Policy and Strategic Framework on Adolescent Health and Development, however, MH has also moved to assist these same hospitals in integrating AYRH program in their respective operations. While they are making progress on FP program integration, these 13 priority hospitals are now being closely followed-up and formally assisted in developing their Operational Guides (Op Guides), implementation plans and enabling orders for an integrated FP and AYRH services. On AYRH program integration in particular, six (6) hospitals

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have undergone formal orientation with specialists while three (3) others have undertaken partial orientation processes on AYRH integration. Five (5) hospitals (i.e., MPH, SPMC, BMH, SCPH and ADSPH) already have AYRH Coordinators formally named and designated while five (5) others (i.e., SPMC, BMH, SCPH, SKPH and ADSPH) have already established Center for Teens. The table below tracks the progress that these 13 hospitals have made on FP and AYRH programs integration as of the end of Q1PY6. Table 4: Status of FP and AYRH Integration in Hospitals as of December 2017

Region/ Name of STATUS OF FP/AY INTEGRATION Name of Oriented on Disaggreg Mgt. FP/ RH AYRH Hospital Opera- Demand Regular W/ Center W/ Priority Hospitals* SDN FP/ AYRH ate data Com Coor- Coor- Order tional Gen.: 1- FP FP for Ongoing Integration records/ mi- dintor dinator /EO Guide or on-1/ Clinic Coun- Teens Capacity Hours seling Bldg. ttee Policy Group reports** Space ARMM: Iranun Yes Yes Yes Yes Yes Yes To be Yes Yes Yes None Inter- 1. Maguindanao Cluster enhanced mittent Provincial Hospital (PH) Zambo Peninsula: Cluster 1 No Yes (not Yes Yes None Yes None Yes ND Yes None Yes 2. Margosatubig Region – MCH) Hospital Margusat ubig HZ 3. Zamboanaga Sibugay Liloy area No Yes None Yes None None None ND ND Yes None Yes PH, (for Liloy) HZ Northern Min: CDO, Yes ND None Yes ND Yes ISO ND Yes Yes None Inter- 4. Northern Mindanao MIsamis review mittent Medical Center Oriental 5. Bukidnon Prov Hosp- South Yes Yes None Yes None None None Yes (no ND Yes None Yes Maramag ILHZ bedside) Davao Region: Congessio Yes None Yes Yes Yes Yes Yes Yes Yes Yes- Yes Yes 6. Southern Phil. nal rviw Medical Center District 3 7. Com Valley PH – CoMMMo No None In Ob ND None None None Yes ND Well None Inter- Montevista NN mittet 8. Brokenshire Congessio Partial None Yes ND Yes Yes- Yes- FP ND Yes Yes Yes Yes Memorial Hospital nal review review District 3 9. Davao del Sur PH DiMaBaM Partial ND ND Yes ND ND For ND ND ND None Inter- aSS review mittent SOCCSKSARGEN: PALMA-B No None None Yes-no None None None ND ND ND None Inter- 10. North Cotabato PH fx mittent 11. South Cotabato PH Province- Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Inter- wide mittent 12. Sultan Kudarat PH BITES Yes ND Yes Yes ND Yes Yes Yes Yes Yes Yes Inter- mittent CARAGA: DOP HZ Partial Yes ND Yes Yes Yes- None Yes ND Yes Yes Inter- 13. Agusan Sur PH Review mittent *Previously, the 13 priority hospitals where FP integration was being pushed included ZCMC, BGH, JRBorja, GTLluch, DRMC, CRH and CRMC. They have been replaced by MRH, ZSPH, BPH, BMH, CVPH, NCPH and ADSPH where integration of both FP and AYRH has been deemed to be more critical, as these hospitals are located in priority USG-assisted sites. **Data disaggregation required is in terms of age group and type of FP service/method provided to clients. Available reports on the number of clients served with FP services by 17 hospitals including the above-listed reporting hospitals for Q1PY6 (Oct. – Dec. 2017) and for the 12-month period of 2017 are summarized table 5. In this quarter, the number of clients served with FP (i.e., short-acting and long-acting methods) services by reporting hospitals reached 3,767, with Margosatubig Regional Hospital NMMC contributing thirty-seven percent (37%) of the total number of FP clients.

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Table 5: Number of FP Clients Served by Hospitals with/targeted on FP/AY Hospitals in the SDNs, as of Q1PY6 (All FP Methods)

LIST OF HOSPITALS WITH Service 2017 FP-AY INTEGRATED Delivery 2015 2016 Jan- Apr- Jul-Sept Oct-Dec Total PROGRAM Network Mar Jun Name of Hospital 7007 7440 3596 3280 4335 3767 15229 Maguindanao Provincial Hospital Iranun Cluster 42 184 124 51 43 26 244 (MPH) Southern Philippines Medical District3 SDN 0 413 49 41 91 41 222 Center (SPMC) Cotabato Provincial Hospital PALMA-B 0 260 65 56 71 33 225

South Cotabato Provincial Province-wide 319 584 555 809 831 411 2606 Hospital (SCPH) Agusan Del Norte Provincial BueNasCar SDN 1941 2347 1306 1097 1927 616 4946 Hospital (ADNPH) Zamboanga Sibugay Provincial Liloy Area HZ 31 36 26 21 30 22 99 Hospital Margosatubig Regional Hospital Cluster1 HZ 2958 849 129 121 185 1417 1852 Basilan General Hospital (BGH) Basilan HZ 0 69 33 29 38 18 118 Democrito O. Plaza Memorial DOPlaza HZ 318 447 275 225 242 182 924 Hospital (DOPMH) Davao Oriental Provincial Medical Province-wide 166 323 174 157 174 150 655 Center (DOPMC) Davao Del Sur Provincial Hospital DiMaBaMaSS 15 78 49 47 38 21 155 Composela Valley Provincial Hospital – Montevista CoMMMoNN 0 150 0 0 0 157 157 (CVPH-M) Brokenshire Memorial Hospital Davao City-Wide 46 251 53 23 0 0 327 Bukidnon Provincial Hospital – South LHZ 30 47 104 99 119 126 448 Maramag (BPH-M) Sultan Kudarat Provincial Hospital BITES 290 265 50 130 132 94 406 (SKPH) Gregorio T. Lluch Memorial Iligan City-Wide 246 388 218 162 168 209 757 Hospital (GTLMH) Northern Mindanao Medical ClaJaViTa SDN 605 749 386 212 246 244 1088 Center (NMMC) * shaded cells are from MH database

BY FP METHOD 7007 7440 3596 3280 4335 3767 15229 LAPM/LARC 4771 4816 2303 2235 2448 1341 8578 BTL 1555 2673 1023 977 991 581 3572 NSV 0 1 0 0 0 2 2 PPFP/PPIUD 705 1578 916 949 1159 676 3700 IUD (Int) 2382 267 30 39 35 54 158 LARC-PSI #REF! 92 532 270 263 28 1146 COMMODITY BASED- 2236 2624 1293 1045 1887 2426 6651 METHODS DMPA 337 387 276 277 232 376 1161 PILLS 38 213 776 474 1351 1115 3716 CONDOM 178 91 205 244 244 341 1034 NFP 1683 1933 36 50 60 594 740

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d. Sustaining support to capacitate SDPs providing FP/MNCHN services in SDN and non-SDN sites through supportive supervision, coaching and mentoring

d.1. Continuing Capacitation of Service Delivery Points (SDPs) providing FP Counseling and Services As the number of service delivery points providing FP Counseling and Services has now reached 718 or 100 percent of MH’s EOP target, the Project continued to capacitate these SDPs by ensuring that facilities in USG-assisted sites have at least one provider trained on FP-CBT Level 1 capable of conducting regular FP counseling to clients, and allocating provisions for the conduct of FPCBT Level 1 (inclusive of commodity tracking) training to capacitate untrained FP providers including those in hospitals. In particular, newly-hired Family Health Associates (FHA) have been trained by DOH-ROs with the assistance of MH in Q1PY6. d.2. Support to the conduct of Supportive Supervision/PTE to trained HSPs and trainers The Project supports building the confidence of non-performing trained HSPs by supporting DOH-led supportive supervision/post-training evaluation activities and facilitating their certifications by the DOH. As of this reporting period, the numbers of trained trainers in FPCBT1, LARC-PSI, PPIUD and BTL-MLLA and trainers in LARC-PSI, PPIUD and BTL- MLLA who underwent supportive supervision were maintained at 160 and 96, respectively. Of the latter group, 82 or the same number of them during the previous reporting period has been certified. Only nine (9) each of trained HSPs and trained HSPs who were supportively supervised, all on LARC-PSI and all from ARMM (i.e., Wao, Rahmain, Bubong, Kapai and Madamba and from IPHO/Marawi City in Lanao del Sur) were added to the pool of 5,664 HSPs trained and 1,125 HSPs trained and supportively supervised reported as of the previous quarter. The number of certified trained HSPs remained at 690 comprising just 12 percent of the total number of trained HSPs or 61 percent of the total number of trained HSPs with PTE as shown in the table below. Table 6: Status of Supportive Supervision Activities as of Q1PY6 (USG-assisted Sites) FP Trainer Health Service Provider % HSPs % HSPs Methods Certifie Certified Trained Support- Certified Trained Support- Certified d/ HSPs / Trained ively ively Trained HSPs Super- Super- with SS vised vised (SS) (SS) 2% 83% FPCBT1 10 0 0 3,008 72 60

FPCBT2 0 0 0 702 122 99 14% 81% LARC-PSI 24 8 2 697 271 125 18% 46%

PPIUD 83 64 56 955 584 344 36% 59%

BTL-MLLA 43 24 24 125 89 62 50% 70% NSV 0 0 0 19 4 0 Total 160 96 82 5,673 1,134 690 12% 61%

By type of FP method, all the trained trainers with PTE and already certified are specializing in the provision of LARC-PSI, PPIUD and BTL-MLLA. On the otherhand, FPCBT1-trained HSPs constituted 53 percent of the total number of trained HSPs. The rest of the HSPs (47%) underwent training on the long-acting FP methods with those trained in PPIUD making up 36 percent followed by FPCBT2 and LARC-PSI at 26 percent each. From the same table above, the report on those trained HSPs who underwent supportive supervision slightly increased to

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1,134 with 51 percent of them provided PTE on PPIUD with 59 percent of them eventually being certified. The distribution by FP method of current pool of 690 certified HSPs stands as follows: PPIUD (50%); LARC-PSI (18%); FPCBT2 (14%); BTL-MLLA (9%); and FPCBT1 (9%). d.3. Development of Clinical Practice Sites (CPS) for postpartum family planning The capacity building interventions of the Project remain focused both on building the technical capabilities of trainers and non-performing trained providers (HSPs), as well as reviewing the capacities of health facilities in providing clients and developing clinical practice and/or mentoring sites for post-partum family planning (PPFP). Developing clinical practice sites for post-partum family planning (PPFP) by MH and its partners was intensified through validation visits to complete the certification of six (6) facilities that are almost evenly distributed in five (5)-assisted regions excluding ARMM as both PPFP Training Providers and Clinical Practice Sites (CPS). In the table below, 39 facilities have gone through the certification process of DOH to be certified exclusively as Clinical Practice Sites. Eighteen (18) other RHUs and birthing facilities secured recognizitions/ certifications as Coaching and Mentoring Sites for PPFP/PPIUD. To date, a few of these CMPS sites are not fully able to provide at least 2 PPFP clients during the 24-hour duty despite being proximate to the trained providers. Fifteen facilities (11 from priority areas and 4 in non- priority areas) of the 18 sites are up for review for MH and partners to identify which sites will be fully supported in the succeeding quarters with trainers and skills laboratories. Meanwhile, MH commenced during the quarter with the recruitment of four (4) DOH- recognized master trainers for long acting reversible contraceptives and permanent methods (LARC/PM) of contraception. These trainers will assist potential local trainers conduct the supportive supervision/post training evaluation of trained HSPs and facilitate their certifications by the DOH starting in Q2PY6. Table 7: PPFP/PPIUD Training Providers and Clinical Practice Sites PPFP Training Region/ Areas Providers and Coaching and Clinical Practice Sites alone Covered Clinical Mentoring Sites Practice Sites Zamboanga 1 – ZCMC 6 - Margosatubig RH, ZDSPH, 5 - Rotary Birthing Penisula ZSPH, Dr. Jose Memorial Center of Upper Hospital, Leon Postigo RHU and Calarian, Ipil RHU, Tukuran RHU Imelda RHU, RHU and Sindangan DH Northern 1 – NMMC 10 – JRBGH,CHO, Bulua HC, 0 Mindanao GTLMH, Kapatagan PH, Maramag RHU, Pangantukan RHU, Tagoloan RHU, Happy Midwife Clinic of Jasaan and MOPH Davao Region 2 – SPMC and 4 - Bansalan RHU, DDSPH, 7 - Sta. Maria BC, DRMC Brokenshire Memorial Hospital Magsaysay BC, Berato (BMH) and Mercy Birthing Center BC, DOPH, Lupon (MBC). RHU, Maco RHU and RHU SOCCSKARGEN 1 – CRMC 9 - SKPH, SCPH and Dr. Royeca 4 - Isulan-RHU, , CHO, Bagumbayan RHU, RHU, Sto. Esperanza RHU, Dr. Amado Diaz Nino RHU and MPH, Mlang District Hospital and -RHU CHO. CARAGA 1 - CRH 8* - Agusan del Norte Provincial 2 - WFMC-Doongan Hospital (ADNPH), Cabadbaran and WFMC-Bayugan DH, Agusan del Sur PH (DOPMH), CRH-Surgao City, Bayugan City HO,

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PPFP Training Region/ Areas Providers and Coaching and Clinical Practice Sites alone Covered Clinical Mentoring Sites Practice Sites Adela Serra Ty and Bislig CHO) and one (1) from , the Caraga Regional Hospital ARMM None 2 – BGH and Limook BHS 0 Total 6 39* 18 Note: *DOH-CARAGA certified 8 CPS but 2 of these (Adela Serra Ty and Bislig CHO) are non-USG sites. e. Expanding AYRH services Service provision for family planning and maternal health among adolescents-youths is anchored on DOH AO 2008-0029 or the “Implementing Health Reforms for Rapid Reduction of Maternal and Neonatal Mortality.” This policy and its manual of operations states that adolescent group is one of priority population groups most at risk for birth complications. The MNCHN core package of services consists of interventions at each life stage: pre-pregnancy, pregnancy, delivery, post- partum, newborn and childcare. e.1 Hospital-Based Center for Teens In PY6, the Project adapted an integrated FP-AY approach to scale-up provision of technical assistance to hospitals. This is to ensure that AY clients altogether with WRAs consulting in the different clinical departments are all captured in the hospitals’ FP service cascade, beginning with profiling/risks assessment, counseling, and access to FP/RH services, which are provided either on-site and/or by referral. MH targeted 12 hospitals, i.e., 10 public and one (1) private, currently serving as the end-referral facilities of their respective SDNs. Two (2) hospitals, ADNPH and DOPH, which were supported in PY5, will be provided with continuing technical assistance. To properly track progress, the Project assisted the targeted hospitals take stock of their institutional capacities in terms of program management, FP-AY service capacities, resources and support system which are deemed critical in carrying out conscious and efficient provision of quality FP/RH services for both WRA and AY clients with built-in demand generation through FP-AY service cascade. The following table summarizes the findings. Table 8: Status of Target Hospitals for FP/AY Program Implementation

Base Program Management Service Capacities FP Demand Gen Rcrdng‐Rprt Phil‐ ‐line Servce Health 2017 FP AY Core HSPs AJA‐ Cas‐ Profilin Counsel Moth FP Hosp Cert. Name of Hospital FPRH Coor Coor Team provdn traind cade g/risks ling ers’Cla Form Srvc to ‐ ‐ g dffrnt HSPs Guide asses ss 1 e AYs dinat dinat FP Stats or or 1. Maguindanao PH 18 Yes none none Yes none Yes none Yes Yes Yes Yes Yes (Iranun SDN) 2. Basilan GenHosp 23 Yes Yes Yes Yes none Yes none Yes none Yes Yes Yes 3. Margosatubig DH 622 Yes none Yes Yes none none none Yes Yes Yes Yes Yes ( Cluster District2 SDN) 4. ZamboSibugay PH Yes Yes Yes Yes Yes Yes (ZDN Liloy SDN) 5. BPH‐Maramag Not Yes none none Yes none none none Yes Yes Yes Yes Yes (South ILHZ SDN) disag 6. JRBorja Hospital Yes 7. GTLlutch Hosp 27 none none none Yes none none none Yes none Yes none Yes (SANLAKASS SDN) 8. NMMC Not Yes Yes Yes Yes none Yes none none none Yes Yes Yes (ClaJaVita) disag 9. ComVal PH Not none none none Yes none none none Yes none none none none (COMMON SDN) disag 10. DavaoDS PH 39 none Yes none Yes Yes none none none Yes none none BTL (DIMABAMAS) only

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Base Program Management Service Capacities FP Demand Gen Rcrdng‐Rprt Phil‐ ‐line Servce Health 2017 FP AY Core HSPs AJA‐ Cas‐ Profilin Counsel Moth FP Hosp Cert. Name of Hospital FPRH Coor Coor Team provdn traind cade g/risks ling ers’Cla Form Srvc to ‐ ‐ g dffrnt HSPs Guide asses ss 1 e AYs dinat dinat FP Stats or or 11. San Pedro Hosp Yes 12. Cotabato PH Not none none none Yes none none none none none Yes none Yes (M3K2C2 SDN) disag 13. AgusanDN PH 217 Yes Yes Yes Yes Yes none HEEADS Yes Yes Yes Yes Yes (BueNasCar SDN) 14. DOPlaza Hosp 306 Yes Yes none Yes Yes none HEEADS none Yes Yes Yes Yes

Based on the joint report, it can be concluded that majority of hospitals have strong capacities to provide a wide- range of FP services (i.e., BTL, PPFP/PPIUD, LARC-PSI, interval IUD). Except for CVPH and DDSPH, their health service providers are PhilHealth-certified. Meanwhile, the report also showed weak program management, notably weak mix of passive demand generation activities which come in the form of group or bedside one-on-one counseling. While three (3) of the hospitals studied, namely: MPH, BGH and NMMC, have FP in hospital guidelines, majority of them have no clear policy on FP/RH-AY service cascade guidelines that are understood and observed by all personnel from different clinical departments. Further, it can be also noted that, except for ADNPH and DOPMH, the capacities of hospitals to provide risks assessment and counseling to adolescent-youth clients based on DOH standards remain wanting. On recording and reporting, the report supports that nine (9) of the 12 hospitals (with data) comply with use of FP Form 1 as basic facility level recording form for FP acceptors. However, except for MSDH, ADNPH, DOPMH, the disaggregation of data that show FP access of adolescents-youths, is also a challenge that need to be addressed in order to properly track progress, relevance (or the lack thereof) of project initiatives on AYRH in hospitals. For these reasons, the individual hospital’s potential as hub for effective creation of demand and on-site provision of wide-ranging modern FP methods to respond to the unmet needs of AYs and WRAs have yet to be fully realized. With the above findings, the Project began to assist three (3) hospitals in Northern Mindanao, namely: i) Bukidnon Provincial Hospital-Maramag; ii) Justiniano R. Borja Hospital in CDO, and iii) Gregorio T Llutch Memorial Hospital in Lanao del Norte, tighten their integrated FP-AY service programs. The Project assisted them organize their Core Teams of providers and draft their FP Service Cascade Guidelines that capture all WRA and AY clients consulting in different departments (OB, Pedia, IM, etc) and units (OPD, ER, Ward) of the respective hospitals. In addition, the Project assisted these hospitals develop an integrated profiling/risks assessment questionnaire “OB-Gyne Gender and RH History” to be incorporated as part of OB history during medical history taking among WRA and AY clients. An innovative doable approach that would strengthen the creation of demand among WRA and AY clients, those detected with unmet need/SRH risks will be provided with information, informed-counseling, and when ready, service provision through the FP/RH Service Cascade procedures of the hospitals. It was agreed during a workshop that the hospitals will start using the profiling questionnaire once available. The three (3) hospitals requested MH to assist them in drafting a hospital policy or executive order, detailing the FP-AY service cascade guidelines, financing, recording-reporting, management structures, for signature by their Hospital Chiefs (JRBorja and GTLlutch) and Governor (Bukidnon Provincial Hospitals). This hospital policy/EO will help them push the institutionalization of an integrated FP-AY service program in their respective hospitals. Follow through assistance will focus on recording & reporting and disaggregation of data and capacity building on adolescent-youth health. e.2 AY-Friendly Ready RHUs

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Community-tier SDPs serve as the first catchment and sometimes the only accessible facilities especially in far-flung areas. MH assists RHUs to expand the access of young people to youth- friendly health facilities with profiling/risks assessment to attract and sustain their interests in seeking FP/RH counseling and services in RHUs. In PY6, the Project continued to assist 32 RHUs to meet the minimum criteria of at least a designated private room for profiling/risks assessment, availability of HSPs trained on adolescent health, capability to perform risks assessment, availability of separate daily recording for AY clients. These RHUs are mostly community-level members of respective SDNs, or the most accessible facilities for consultation. In Q1PY6, the Project assisted the RHUs conduct an inventory of their capacities to provide youth-friendly service based on the minimum standards. The results are tabulated below. Table 9: Status of RHUs’ Development Efforts to Become AY-Friendly Facilities as of Q1PY6. Base‐ line Minimum Criteria Recording RHU AYFP Name of 2017 Name of RHU Service LGU/Region FPRH to Private AJA‐ HEEADS Service Guide AYs Counseling trained Risks/ Records Room HSP Profiling Logbook Zambo 1) Lapuyan None None None None None DS (R9) 2) V. Sagun none None None None None 3) Margosatubig None None None None Zamboanga City 4) Ayala Health Yes Yes None None (R9) Center and Lying‐in 5) Labuan Yes Yes None None 6) Calarian Yes Yes None None 7) Baliwasan Yes Yes None None 8) Canelar Yes Yes None None 9) Tetuan Yes Yes None None 10) Sta. Catalina Yes Yes None None 11) Talon‐Talon Yes Yes None None None 12) Tumaga Yes Yes None None 13) Mercedes Yes Yes None None 14) Manicahan Yes Yes None None 15) Sangali Main Yes Yes None None Health Center 16) Curuan Yes Yes None None 17) Vitali Health Yes Yes None None Center and Lying in 18) Guiwan Yes Yes None None 19) StaMaria MainHC Yes Yes None None Lanao DS (ARMM) 20) Bubong Yes Yes Yes Yes Yes Tawi Tawi (ARMM) 21) Bongao Yes Yes None None None Sulu (ARMM) 22) Patikul Yes Yes None None None 23) Luuk Yes Yes None None None 24) Pangutaran Yes Yes None None None 25) Talipao Yes Yes None None None 26) Parang Yes Yes None None None 27) Indanan Yes Yes None None None 28) Panamao Yes Yes None None None 29) Jolo Yes Yes None None None Basilan (ARMM) 30) Maluso Yes Yes None None None 31) Lamitan Yes Yes None None None Agusan del Norte 32) Buenavista RHU None None None None None (CARAGA)

Except for Buenavista RHU in CARAGA, field reports reveal that majority of the RHUs assessed have designated private rooms for AY interview, counseling and medical consultation, and trained providers on DOH-adolescent health. Cramped for space, usually it is the physician’s office or the

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counseling room that serve as room designated for AY. This may not be the most ideal because it takes a little more time to interview an AY client to draw out the relevant information necessary to address the RH concerns of a young client. The reports also show, except for Bubong RHU in Lanao del Sur, the absence risks assessment among AY clients despite the presence of trained HSP/s. This can be attributed to the longer time required to perform risks assessment which covers risks at home, bullying–abuse, school or employment performance, peer-related activities, substance use, sexuality and sexual health, and mental health. The comprehensiveness of the process usually overwhelms the interviewing HSP. Absence of multi sectoral /multi- disciplinary referral points limits the capacity to help adolescents-youths. The systematic disaggregation of data beginning at the daily recording level is also a concern. RHUs use only one daily service records logbook for all patients coming in for consultation thus making the disaggregation of data showing FP/RH services accessed by AY clients more time consuming. Meanwhile, the absence of AY-FP service cascade guideline, which can boost the implementation of youth-friendly services, is common among the targeted RHUs. On the whole, four (4) RHUs, namely: RHUs of Lapuyan, V. Sagun, Margosatubig in Zamboanga del Sur which are experiencing rapid increases in teenage pregnancy, and Buenavista RHU in CARAGA where the YOLO (Youth Optimizing Life Opportunities) program, an SRH program of DepED Division of Agusan del Norte is being implemented, need the full package of technical assistance to facilitate their transformations into youth-friendly RHUs. Majority of the RHUs need an innovative approach to simplify and shorten the process of SRH risks assessment/profiling among AY clients to the increase demand for FP/RH among this e.3 #SoMe4AYRH As part of SoMe4AYRH (social media for AYRH advocacy) initiative of the Project, engagement meetings and platform analysis were conducted on the existing social media pages of the target areas – the Youth Optimizing Learning Opportunities (YOLO) program of DepEd Agusan del Norte and of Agusan del Norte Provincial Hospital AY Clinic. The result of the assessment showed low engagement and reach of the identified pages. Moreover, no posting strategy was used and posting frequency was very minimal resulting in the low number of interactions with its audience. These results were analyzed and became the basis for the design of the training-workshop to be conducted in Q2PY6 to capacitate these institutions to leverage the use of social media in providing directed and focused AYRH messages to its followers. e.4 Comprehensive Sexuality Education in Schools During the quarter, the Project designed a package of technical assistance to support two DepEd divisions in Mindanao, namely: DepEd Divisions of Agusan del Norte, and Zamboanga del Sur, to strengthen the capacities of their respective teaching staffs on Comprehensive Sexuality Education (CSE). Earlier, MH assisted the DepED Division of Agusan del Norte strengthen its learner support services, i.e., the guidance counselling and health and nutrition programs by creating and implementing its YOLO (Youth Optimizing Life Opportunities) program. YOLO serves as the platform for institutionalizing HEEADSS risks assessment during physical examination performed by nurses under its Health and Nutrition program. The CSE integrated in the schools’ curricula is designed to complement the YOLO program. Utilizing the project’s STTA mechanism, MindanaoHealth started its processes of engaging an STTA to facilitate the delivery of this technical assistance initiative to the two (2) DepEd Divisions. This STTA seeks to strengthen comprehensive sexuality education in schools under their jurisdiction, in consonance with the RPRH Act of 2012, and based on K to 12 health competency requirements. Expected deliverables are enhanced CSE teaching methodologies for Grades 7-11 using BCC principles, teaching staff and DepEd personnel at regional and division offices

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capacitated on enhanced CSE curriculum and technical reports that capture processes and initial results, including emerging good practices, challenges, and lessons learned. e.5 AYRH in Marawi Starting in May 2017, the Marawi siege affected almost 98 percent of its population as it displaced 359,680 persons (data source: DSWD-DROIC as August 30, 2017). Majority of displaced persons from Marawi sought refuge from relatives, while others are found cramped in the 42 evacuation centers set up by the government and its partners located in Iligan City, municipalities of Balo-i, Pantar, and Pantao-Ragat in Lanao del Norte of RegionX, and Saguiaran in Lanao del Sur in ARMM. While close to a third (more than 87,000) of the population had returned to their respective barangays, the siege itself and the resulting ruins and congestion in camps make the adolescents-youth vulnerable to threats of abuse, prostitution, unplanned pregnancy, sexually transmitted infections, trafficking, and recruitment by rebel or extremist groups. During the quarter, the Project designed a package of assistance not only to carry-out an SRH peer education and outreach in Marawi City and its corridors that promotes inclusion, participation, resilience among adolescents-youths, but also to provide access to psychosocial and SRH guidance, counseling and services through outreach. Utilizing the Project’s sub-award mechanism, MH commenced its processes of engaging a local CSO to facilitate the delivery of this technical assistance initiative in Marawi and its corridors and reach-out to adolescents-youth ages 10-24 y/o affected by the siege. Among others, the STTA’s expected outputs include the establishment of linkages among different sectors for referral to help young mothers/parents, adolescents-youths gain access to health, and livelihood skills development opportunities, and mainstreaming of safety and preventive measures, safe spaces, and A-Y health and welfare committees for adolescents-youths in evacuation sites with LGU existing systems. 2. Increasing the Demand for MNCHN/FP Services a. Improving FP services uptake from profiling activities and health events To support the Philippine Health Agenda especially on reaching Zero Unmet Need for family planning, MH in the previous quarters facilitated initiatives to analyze unmet need data at the regional and provincial levels, provided tools for profiling and mentored partners on using data for demand generation and service delivery. MH advocated for harmonizing data sets used by government sector partners, recognizing that various agencies tasked to achieving the goals of Zero Unmet Need – DOH, POPCOM and DILG – are using varied data sets while essentially targeting the same population: the CCT/NHTS beneficiaries. This quarter, MH focused on facilitating efforts to improve collaboration between its partners, not only in harmonizing data but also in improving demand generation for FP among the target populations of the Zero Unmet Need goal. The following table summarizes the the demand generation activities that include the conduct of USAPAN sessions, Buntis Events and REACH in ARMM as well as the results of these in terms of women reached and FP acceptors generated.

Table 10: Demand Generation Activities, As of Q1PY6 Demand Generation PY5 PY6Q1 TOTAL Reach of Project supported demand generation activities No. of WRA 33,512 6662 40,174 No. of AY (15-24) 11,253 1803 13,056

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Demand Generation PY5 PY6Q1 TOTAL No. of Men 2,944 78 3,022 Provided EBF Info 30,528 6654 37,182 Provided Antigens 1,246 50 1,296 Provided Vit. A 0 0 0 No. of acceptors generated 10,197 4616 14,813 No. of referrals 311 610 921 No. of Usapan & Health Events Sessions 222 14 236 No. of Usapan & Health Events Participants 40,426 6860 47,286 % Conversion Rate 30% 69% 37% No. of USAPAN facilitators 1,113 0 1,113 No. of USAPAN Sessions Conducted 939 366 1,305 USAPAN - KONTENTO NA/PWEDE PA 715 327 1,042 USAPAN - BUNTIS 150 33 183 USAPAN - MAGINOO 2 6 8 USAPAN - BARKADAHAN 72 0 72 No. of USAPAN Participants 24,042 6,216 30,258 USAPAN - KONTENTO NA/PWEDE PA 16,476 5737 22,213 USAPAN - BUNTIS 5,141 422 5,563 USAPAN - MAGINOO 30 57 87 USAPAN - BARKADAHAN 2,395 0 2,395 No. of Health Events Conducted 238 14 252 AYRH EVENT 11 0 11 BUNTIS EVENT 14 0 14 FP FORUM 0 0 0 REACH 213 14 227 No. of Health Events Participants 15,527 644 16,171 AYRH EVENT 259 0 259 BUNTIS EVENT 142 0 142 FP FORUM 0 0 0 REACH 15,126 644 15,770 b. Increasing the effectiveness of community volunteers to identify and motivate WRA with unmet need during profiling activities For this quarter, only 63 community health workers (CHWs) from two regions were added to the 2,035 CHWs that MH had already oriented on the use of tools and job aids and who had been able to provide FP information to 8,324 men and women of reproductive age and had referred 6,890 probable clients for FP, along with providing other services to 1,275 more as of the end of PY5. Reporting for this indicator requires two (2) criteria: (i) receiving USAID assistance coupled with (ii) “active” status or evidence of participation in referrals/provision of information on FP. To meet the second criterion, LGUAs of MH need to proof of referrals/FP services including information giving using completed referral forms or logbooks showing CHW is still active and providing services.

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c. Improved counseling skills of MWs on addressing fears of side effect, and myths and misconceptions on FP - Survey of Cohort Midwives Involving a total of 246 rural health midwives (RHMs) from 29 municipalities and one (1) city covering six (6) provinces in Mindanao, MH completed the “Descriptive Survey of Rural Health Midwives’ Knowledge and Experience on Modern Family Planning Counseling and Addressing Fears, Rumors, Myths and Misconceptions” during the quarter in review. This survey was undertaken to support DOH’s goal in promoting Maternal and Newborn Health through a comprehensive Family Planning program by improving provider-client interaction on Family Planning, specifically in addressing fears of side effect, rumors, myths and misconceptions. Results show that education, years of service and religion play significantly in the knowledge, confidence and practice of family planning counseling among RHMs in Mindanao. Knowledge of modern FP methods and confidence to counsel clients are generally high, but varies per specific method. Training on FPCBT1 is a necessary activity that the DOH wisely invested in but follow- through capability building such as supportive supervision and frequent on-the-job mentoring and coaching are as important as well. This survey concludes that RHMs need all the help that they can get in order to continue providing the high standard and quality of counseling and care expected from them. Midwives need to be provided with regular evidence-based and accurate information about modern family planning. Continued in-service capacity building and training are ideal. However, job aids and means to provide updates on contraceptive technology either electronically or in print, are just as effective in ensuring that the provider’s knowledge are up to par and up to date and thus enriches their counseling practice better. It wraps up with a finding that certification of FP providers is a concern that needs immediate attention in order to improve service provision for modern FP methods, especially the long-acting or permanent contraception methods. Policy issues on certification of RHMs on surgical or longer acting methods such as IUD needs review as well. The other half of the certification issue is facilitating the conduct of Post Training Evaluation (PTE) or supportive supervision activities to complete providers’ training and capacity building. Further to that, the survey ends with a plea that program managers must help service providers address men’s needs and concerns for modern family planning as well as that of the women. This is to foster an environment wherein both sexes can equally seek FP services, and to encourage men to discuss FP concerns with their wives. d. Engaging MRLs to address gender and cultural barriers to FP use in ARMM The Regional Darul-Ifta of ARMM, with technical assistance from MH, has developed a sermon guide or khutba that will help imams when they lead Islamic worship services at the masjid. The guide was pre-tested last quarter and submitted for USAID review and approval. Currently, MH has secured the commitment of the Bureau of Madaris Education to sponsor the khutba as co- author with the Regional Darul-Ifta. While waiting for USAID approval, MH proposed to explore other means of engaging the Muslim Religious Leaders (MRLs) in shaping and promoting positive behaviors on health, promoting peace, and in mainstreaming moderate views on family planning in the context of birth spacing and protecting women’s health among their respective constituents. This is critical in the aftermath of the recent crisis that befell the communities of Marawi City and Lanao Del Sur and continued rumblings of unrest in various parts of Maguindanao. Towards that end, MH has put into motion the deployment of a STTA to engage MRLs in promoting male involvement and partnership on MNCHN/FP. Specifically, through the STTA, the DOH-ARMM will be assisted in orienting local imam/a’immah on maternal, newborn and child health and nutrition and family planning in the Islamic context through the Khutba on FP/MNCHN/RP; RHUs will also be assisted in promoting male involvement on FP/MNHCN/RP

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during community education sessions by mobilizing the MRLs; a core team of MRLs will be organized as resource persons during community mobilization sessions (community health events, Usapan sessions, FDS sessions) and as on-air spokespersons on programs supported by DOH-ARMM (REACH++, Usapan sessions). e. Women provided information on the benefits of EBF For this quarter, 34 “USAPANG Buntis” events were held. More than 6,600 pregnant women received information and educated on the benefits of exclusive breast-feeding (EBF) and safe motherhood. 3. Removing Policy and Systems Barriers to Service Delivery a. Accelerating the functionality of established SDNs For PY6, the Project has to further accelerate the establishment of SDNs across USG sites in Mindanao and strengthen those that are already organized. Being the strategic focus of the DOH in institutionalizing the Universal Health Coverage (UHC), these networks need to be sustainably financed, accountable, integrated and people-centered. MH has so far established 21 SDN sites in 13 provinces and three (3) cities involving 79 LGUs with established TWGs and referral pathways for MNCHN/FP and AY services. These cluster areas comprise 341 GIDA barangays, 473,388 NHTS families, and approximately 70,525 women of reproductive age (WRA) with unmet need for contraception. The roll out was supported by the endorsement of the SDN Operational Guide developed by MH in 2015 through the five (5) DOH Regional Directors and the Secretary of DOH-ARMM with corresponding fund support. Prior to this roll out, six (6) regional teams were trained as trainers on the use of SDN operational guide. As of this quarter, there are three (3) functional SDNs as shown in the table below, i.e., BITES in Sultan Kudarat, IliganCity in Lanao del Norte, and DOP SDN in Agusan del Sur. Sanlakass SDN, being proximate to Marawi and affected by the siege, slid from being functional to operational. From the established SDNs, good practices emerged on public and private partnership (PPP) such as the unified reporting system in Iligan City, the enlistment in the SDN of six (6) private hospitals in BITES SDN, Sultan Kudarat, the community-based transportation and communication support for referral in DOP SDN, Agusan del Sur, and the PPP on health in Davao City District 3 to better serve the health needs of the IP community. Service Delivery Sites Regions Service Delivery Network # of LGUs Organized Operational Functional 1. Northern Mindanao 12 0 3 1 (Iligan City) 2. ARMM 4 1 0 0 3. Davao 24 2 3 0 4. SOCCSKSARGEN 10 1 2 1 (BITES) 5. Zambo Pen 13 3 1 0 6. CARAGA 14 0 2 1 (DOP SDN) Total 79 LGUs 7 SDNs 11 SDNs 3 SDNs

Moving forward, the Project will prioritize establishment of functional SDNs in the 12 provinces by tracking performance on FP service coverage and program elements, scorecard, and SDNs’ contribution to higher-level results. Deployment of four (4) STTAs in Bukidnon, Davao del Sur, Maguindanao and North Cotabato for this task, whose contracts/recruitments are in process, proceeds in Q2PY6. Each STTA’s expected outputs include, among others, SDN mapping and analysis, directory, implementation plan, M&E referral system and referral guide.

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In this reporting quarter, MH partnered with DOH-RO-IX and PHOs of Zamboanga Sibugay and Zamboanga del Norte in rolling out SDN establishment in four (4) LGU clusters of Liloy ILHZ in Zamboanga del Norte and three (3) other ILHZs of OLTAMA, Ipil, and Alicia in Zamboanga Sibugay. Liloy ILHZ constituents are accessing health services in Zamboanga Sibugay Provincial Hospital. This needs to be formalized through cross-border referral arrangements. The initial SDN rollout in these two (2) provinces resulted in, among others, the creation of the SDN structures, formulation of the SDN implementation plan, and drafting of the referral guideline. On building and enhancing PPP initiative, there are to date nine (9) SDN PPPs that were forged while five (5) others are ongoing. BueNasCar SDN is still in the process of formalizing its PPP agreement with identified private sector partners while groundworks for the development of SPAs with stakeholders are continuing in Zamboanga del Sur (Districts 1 and 2) and Iranun SDN in Maguindanao so that the formulation of referral guidelines and the integration of hospitals with FP/AY services within the network could start in earnest. Currently, there are three (3) approved referral guidelines and six (6) are works-in-progress including the reconfiguration of Zamboanga del Sur’s SDN referral manual due to the new grouping of LGUs from ILHZ to district clustering. Further, Sultan Kudarat and South Cotabato benefited from the assistance provided by MH to produce the second draft of the manual for presentation to member hospitals and private facilities. On logistics management, in collaboration with PDOHO Zamboanga del Sur, MH facilitated the use of the simplified FP commodity inventory tool by FP Coordinators, FHAs, and PHNs and RHMs of the 15 RHUs of SDN District 2. The PDOHO FHA team leader meanwhile was tasked to monitor stock outs and the regular submission of reports to FP logistics hotline. The RHUs agreed to submit inventory and consumption reports every 5th day of the following month of the quarter to the provincial FP coordinator and the FP logistics hotline.

Table 11: Status of Development of 12 Priority SDNs as of Q1PY6. No. of SDPs w/ Health Information PHIC System SDN Referral SDN Accreditation and DQC LMS Stage of Priority SDN PPP Guideline Management LGU w/ Policy Develop s Reimbursement ment Policy Use FP 1. Liloy ILHZ, SDN TWG created commodity 7/7 W/ policy and Zamboanga del SDN Plan drafted W/O Drafted W/O inventory, Organized accredited Norte W/O M&E System recording & reporting system SDN Provl Mgt Use FP 2. District 2, Comm 13/15; Guipos & commodity Zamboanga del SDN TWG Draft SPA Drafted Dinas LGUs W/O W/ inventory, Organized Sur SDN plan policy recording & W/ M&E System reporting system Use FP commodity 3. South ILHZ, 10/10 W/ policy & To be To be organized W/O W/O W/ inventory, Bukidnon accredited organized recording & reporting system Use FP SDN TWG MoA with 3/4 W/ policy; commodity 4. ClaJaViTa, Operation SDN Plan Private W/O Jasaan no W/ inventory, Misamis Oriental al W/O M&E System Hospital accreditation recording & reporting system MoA with DMSF and Use FP SDN TWG Brokenshire; 3/5 DHCs commodity 5. 3rd District, Davao Operation SDN Plan PPP with W/O accredited; W/O W/O inventory, City al W/O M&E System German policy recording & Doctors reporting system Hospital

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SDN TWG 6. DMaBaMaS, 5/5 accredited, and Use SIMS or Operation SDN Plan W/O W/O W/O Davao del Sur W/ policy CDLMIS al W/O M&E System Use FP SDN TWG PPP with 6 commodity 7. CoMMMoNN, 6/6 accredited, and Operation SDN Plan private W/O W/ inventory, Compostela Valley W/ policy al W/O M&E System hospitals recording & reporting system Use SMRS and simplified FP SDN TWG PPP with 6 8. BITES, Sultan 5/5 accredited, and commodity SDN Plan private W/ W/ Functional Kudarat W/ policy inventory. Hired W/ M&E System hospitals own Pharmacist to manage LMS 8/11 with SDN TWG functional LMS 9. South Cotabato 13/18 accredited; Operation SDN Plan W/O Drafted W/ (except Lake Province-wide 16/18 W/ policy al W/ M&E System Sebu, Sto. Nino & ) Use FP 5/7 accredited and commodity 10. PALMA+PB, Mgt Board with policy; Alama & Operation W/O W/O W/ inventory, North Cotabato SDN TWG Aleosan not al recording & accredited reporting system Use FP SDN TWG SPA and MoA commodity 11. DOP SDN, Agusan All 3 accredited, and SDN Plan with transport Approved W/ inventory, Functional del Sur W/ policy W/ M&E System group recording & reporting system SDN TWG 12. Iranun SDN, All 6 accredited, and SDN Plan Draft SPA Drafted W/ Use SMRS Organized Maguindanao W/ policy W/O M&E System

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b. Improving quality of data and use of health information After successfully facilitating the institutionalization of DQC in 15 provinces and 28 individual LGUs in Region 12 (which in PY5 translated to 105% performance or 321 out of 305 targeted LGUs conducting DQC activity regularly) through the issuance of either Executive Orders (EOs) by the LCEs or Office Orders by the P/CHOs, MH this current program year seeks to sustain this initiative by enabling the four (4) remaining provinces and three (3) cities without DQC policy and 47 LGUs (mostly in Lanao del Sur) not presently conducting DQC regularly to also formally adopt the practice. During the first quarter, no new DQC policy issuance was reported. However, 31 or 10% of the 308 targeted LGUs re-started the conduct of DQC activity as shown in the table below. It is expected, therefore, that the DQC activity will pick up in the second quarter in time for the preparation of LGUs’ local investment plans for health. Accomplishment for the Core Activity Status to Date Quarter (Q1PY6)  Northern Mindanao: All 3 provinces of MisOr, LDN and Bukidnon and the two cities of Iligan and Cagayan de Oro have issued DQC policy;  Davao Region: Only Compostela Valley with EO on DQC;  SOCCSKSARGEN: Sultan Kudarat thru PHO Office Order and 28 LGUs issued EOs (Cotabato City, North Cotabato – 18, SC- 9/11);  Caraga: The two provinces of Agusan del Sur province and DQC Institutionalization  No additional DQC policy Agusan del Norte issued DQC policy; through policy issuance, issuance was reported in team mobilization and fund  ARMM: Regional government’s memorandum order backed the first quarter. allocation by province-wide office orders of the 5 provinces; and  Zamboanga Peninsula: Only Zamboanga del Sur has the DQC policy. Summary: 15 provinces and 28 individual LGUs in R12 issued policy on DQC institutionalization. Four (4) PLGUs and 3 CLGUs remain without such policy (Zamboanga del Norte, Zamboanga Sibugay, Davao Oriental, Davao del Sur, Zamboanga City, Koronadal City, and Davao City).

 Zamboanga Peninsula:  ZamboPen: 4/70 (6%) LGUs conducted DQC for the quarter; Zamboanga del Norte (3 RHU/CHO conducted  Northern Mindanao: No report for the quarter; DQC) and Zamboanga  Davao Region: No Report for the quarter; City; LGUs regularly conducting  SOCCSKSARGEN: No report for the quarter; DQC  CARAGA: All LGUs of Agusan del Sur conducted  CARAGA: 14/26 (54%) LGUs of the 2 provinces conducted DQC for the quarter; and DQC; and  ARMM: All 12 RHUs and  ARMM: 13 (11%) out of 119 LGUs (13 LGUs in Basilan. Isabela City in Basilan conducted DQC in the  Summary: 31 (10%) out of 310 target LGUs for PY6 conducted first quarter. DQC activity in the first quarter c. Improved financing through PhilHealth MNCHN/FP packages As of the first quarter, the number of facilities that obtained MCP/NCP accreditation reached 304 from 301 in the previous quarter while the number of LGUs utilizing PhilHealth reimbursements as per PHIC guidelines remains at 327, which is already way above the EOP target of 308 LGUs. The renewal of PHIC accreditation periodically commences in the month of January. It is therefore likely that the covered LGUs/SDPs had the first quarter spent on preparing the

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accreditation documents and other requirements. Currently, there are 41 LGUs remaining without PHIC reimbursements policy, and out of the 64 non-accredited facilities 33 or 52% of them have their applications for accreditation ongoing. In this reporting quarter, three (3) RHUs in the Davao region (i.e., Hagonoy, Governor Generoso, and Laak) achieved MCP/NCP accreditation. On PhilHealth accreditation, there are 380 LAPM accredited providers across USG sites in Mindanao, of which 94 are BTL/MLLA providers, 281 (50%) PPFP/PPIUD accredited providers out of 558 DOH certified providers, and 5 NSV accredited out of 6 certified providers. These PhilHealth accredited LAPM providers are filing claims for PhilHealth reimbursements for FP services rendered. On BTL/MLLA, the three (3) provinces (Zamboanga del Sur, South Cotabato and Agusan del Norte) and four (4) cities (Zamboanga City, CDO, Davao City, and Cotabato City- CRMC) have the most number of available BTL/MLLA PHIC accredited providers. There are only five (5) PHIC-accredited NSV providers across USG sites, of which three (3) are in Davao City CHO, one (1) each in Zamboanga del Sur Medical Center and Maguindanao Provincial Hospital. One non-accredited NSV but DOH certified provider is in Agusan del Norte Provincial Hospital. In Basilan, the Basilan General Hospital (BGH) now have started submitting BTL reimbursement claims from clients who underwent the procedure while Limook BHS is receiving reimbursements from PPIUD services. The table below shows the updated status of USG-assisted facilities and providers in terms of FP and MCP accreditation and LGUs’ status with respect to PHIC reimbursement policy. Table 12: Status of FP/MCP Accreditation and Reimbursement Policy FP PHIC Accredited MCP LAPM Providers Reimb Area Accredited Remarks BTL- PPFP/P NSV Policy Facility MLLA PIUD Zamboa 5 facilities non-accredited; 47 (51%) 66 (93%) out 67 (94%) nga 2 with ongoing applications; 18 over 93 1 of 71 / 71 Peninsu 4 LGUs without policy; certified RHUs/CHOs LGUs la 67 SDPs with EMRs Sirawai and Baliguian; No MHO and no policy. Zamboan 11 out of 23 accredited 4 RHUs of Kalawit, Sibuco, ga del 3 15 None 25 out of 27 RHUs Sirawai and Baliguian are not Norte certified accredited. EMR: 23 use iClinicSys Dumalinao and achieved 25 (20 25 (24 accreditation. public, 5 27 accredited Zamboan 1 MLLA; M/CLGU private) 1 out of 28 ga del Sur 6 BTL s) out of LGUs without policy: out of 40 RHUs/City 28 LGUs Guipos,Dinas, & Josefina. certified

EMR: All 28 RHUs use WAH. 5 with 2 RHU Kabasalan and Pathfinder Zamboan certified General Hospital are adjacent to 15 accredited ga 2 trainers None 16 each other, thus the MHO is not out of 16 RHUs Sibugay out of 27 interested in accreditation. certified EMR: All 16 RHUs use WAH. 6 (ZCMC) 6 ZCMC out of 11; All 16 district Zamboan EMR: All 16 MHCs use OB remainin None health centers 1 ga City iClinicSys doctors g 5 from are accredited CHO

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FP PHIC Accredited MCP LAPM Providers Reimb Area Accredited Remarks BTL- PPFP/P NSV Policy Facility MLLA PIUD 86 21 non-accredited, Norther 50 (52%) 50 (70%) out 8 with on-going n (70%) 12 out of None of 71 applications; Mindan /71 165 RHUs/CHOs 21 LGUs without policy; ao LGUs certified 24 SDPs with EMRs 4 (MOPH Initao, 14 RHUs/CHO Manticao, 22 out of Misamis are accredited 12 non-accredited RHU facilities Gingoog 43 None 14 Oriental out of 26 EMR: 14 RHUs & certified health centers Talisayan ) Only is not 4 accredited, non-functional 17 out of 21 accredited Bukidnon (hospital None 21 birthing facility. RHU Baungon 27 trained out of 22 RHUs HSPs) has no policy. EMR: 7 RHUs 14 (4 hospitals; 8 RHUs with ongoing HFEP 2 Lanao del 10 RHU 14 accredited building construction or (LDNPH None 14 Norte providers out of 22 RHUs renovation & KPH) ) out of EMR: 2 (Linamon & ) 28 Cagayan 2 (NMMC 33 out of 48 accredited 6 BHS with ongoing de Oro & JR None 1 67 out of 54 BHS accreditation. EMR: 1 iClinicSys City Borja) 7 non- accredited; 7 (54%) 31 (82%) out 30 Davao 5 with ongoing applications; 19 over 13 3 of 38 (79%)/ Region 8 LGUs without policy; certified RHUs/CHO 38 LGUs 14 SDPs with EMRs Hagonoy achieved accreditation 2 out of 7 while Kiblawan and Matanao 2 BTL (Bansalan Davao del 11 accredited with ongoing accreditation. JAS (hospitals & None 10 Sur out of 15 RHUs and Don Marcelino RHUs are ) Magsaysa undergoing construction y) EMR: 1 Malita RHU-iClinicSys Gov.Generoso RHU achieved accreditation and Cateel RHU is 2 BTL the only non-accredited facility. Davao (DOPMC 10 accredited 1 (Lupon) None 9 Gov. Generoso and Cateel have Oriental & DOPH- out of 11 RHUs pending approval of sharing Lupon scheme EMR: 10 RHUs iClinicSys Laak RHU already received BEmONC certification; 1 Monkayo was issued LTO and Composte 4 BTL (4 9 accredited Nabuntur None 11 awaiting accreditation while la Valley hospitals) out of 11 RHUs an Maragusan is still complying with BEmONC requirements. EMR: 2 (Maco & Nabunturan); Only 3 are accredited out of 17: 4 BTL (Tibungco, Toril, and Bunawan). (SPMC) Policy is pending upon IRR Davao 3/17 district 7 MLLA 3 out of 4 3 CHO formulation on MNCHN City health centers (private ordinance. hospitals) Baguio and Agdao DHCs have ongoing application.

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FP PHIC Accredited MCP LAPM Providers Reimb Area Accredited Remarks BTL- PPFP/P NSV Policy Facility MLLA PIUD EMR: 1 (iClinicSys)

SOCCSK 123 7 non-accredited; 36 (84%) out 39 - (57%) 6 with ongoing applications; 21 None of 43 (91%)/ SARGE over 215 4 LGUs without policy; RHUs/CHO 43 LGUs N certified 43 SDNs with EMRs GenSan City has 26 barangays General clustered into 12 RHUs and 7 29 out of 7/12 RHUs Santos 3 out of 3 None 1 RHUs have attached birthing 29 accredited City clinics EMR: iClinicSys 17 out of 1 out of 7 The CHO has 37 BHS in 37 10 out of Cotabato 17 (CRMC (Poblacion Barangays, and grouped into 7 10 None 1 City 15, CHO, Mother Clusters (CRMC) Blue Star) Birthing Clinic) EMR: iClinicSys 10/11 10 MLLA 10 accredited Koronadal City CHO is not South and 5 (SCPH) None RHUs/CHO; 10 accredited Cotabato BTL out of 33 and SCPH and EMR: 11 installed iClinicSys DJPRH 5 non-accredited: Alamada, 13 accredited Aleosan, Antipas, Kabacan and out of 18 Cotabato 11 out of Matalam; with ongoing 5 out of 5 None RHUs/CHO; 16 Province 57 application DADFPH in EMR: iClinicSys installed in 18 RHUs 11 accredited RHU with MCP 56 (22 out of 12 application and complying with Sultan from RHUs/CHO; 3 out 3 None 11 infra requirements Kudarat SKPH) Kapingkong EMR: iClinicSys installed in 12 out of 79 BHS in RHUs Lambayong 13 (27%) 22 3 non-accredited; CARAG 23 (88%) out out of (85%) 3 with ongoing applications; A 10 None of 26 48 /26 4 LGUs without policy; Region RHUs/CHO certified LGUs 24 SDPs with EMR Tubay RHUs on-process accreditation and undergoing 1 renovation; Magallanes RHU 8 out of ADNP 6 MHO resigned thus advised to Agusan 31 (5 H but 10 accredited (ADNPH 11 re-accredit and is now awaiting del Norte public, 3 not out of 12 RHUs & BMC) release of LTO. private) accredit Las Nieves LHB endorsed the ed PHIC reimbursement policy EMR: 10/12 with iClinicSys 5 out of 17 Bunawan and Loreto RHUs (4 undergoing renovation thru 4 BTL private, 1 Agusan 12 accredited HFEP. LGUs with no policy: San (OB public- None 11 del Sur out of 14 RHUs Francisco (for SB deliberation), Gyne) Trento Bunawan & Loreto Infirmary EMR: all 14 with iClinicSys )

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FP PHIC Accredited MCP LAPM Providers Reimb Area Accredited Remarks BTL- PPFP/P NSV Policy Facility MLLA PIUD 21 non-accredited; 5 (21%) 98 (82%) out Region- 9 with on-going ARMM 14 None out of 24 of 119 wide applications; 107 SDPs with EMRs BGH submitted claims for BTL and Limook BHS for PPIUD 5 accredited reimbursement. 3 out of 3 out of 12 RHUs Region- 2 out of 9 7 RHUs need appointment Basilan (BGH & None (Maluso, Tipo- wide (Lamitan) letters to contract out Physicians LDH) Tipo, Lamitan, Policy or renew MOA with private Isabela) OBGyne. EMR: 7/12 iClinicSys 11 accredited Turtle Island RHU failed to out of 12 Region- comply with PHIC facility Tawi- 1 0 out of RHUs, 5 None wide specification due to absence of Tawi DHSMH 12 hospitals (2 Policy Doctor districts & 3 EMR: all 12 with iClinicSys municipal) 3 6 not accredited: Tapul, Lugus, 13 out of 19 Region- (Parang, Pandami, HP Tahil, K. Caluang, Sulu 2 out of 4 None accredited wide Talipao, and Tongkil facilities Policy SPH) EMR: all 19 with iClinicSys 35 accredited out of 40 4 out of 5 RHUs and 4 5 RHUs of Binidayan, (Wao, district Region- Pagayawan, Tuburan, Tugaya & Lanao del Tampara None None hospitals of wide Lumbaca Unayan are not Sur n, Malabang, Policy accredited Marawi) Balindong, EMR: 35 RHUs with iClinicSys Wao and Tamparan 34 out of 36 Region- 2 RHUs R. Buayan & DBS with Maguinda RHUs are 4 out of 5 None 1 MPH wide ongoingaccreditation nao accredited; 5 Policy EMR: 34 RHUs BHS 64 RHUs/CHOs Non- 281 327 accredited; 94 (50%) 304 (83%) (89%) 33 with ongoing 5 out TOTAL BTL/ML out of out of 368 out of application; of 6 LA 558 RHUs/CHOs 368 41 LGUs without PHIC certified LGUs Reimbursement Policy; 279 (76%) with EMRs d. Linking SDPs to the commodity distribution and tracking network (towards a “pull” system) For PY6, the Project will further strengthen the coordination mechanism with DOH-RO and PopCom including inter-facility coordination to address FP commodity stock-outs efficiently, link them to the commodity tracking network and operationalize the simplified FP commodity monitoring and reporting tool developed by DOH national. In this reporting period, almost all 19 USG supported provinces are using either the SMRS/SIMS, CDLMIS or the simplified FP commodity monitoring tool except for a few RHUs in South Cotabato (3), Sultan Kudarat (5), North Cotabato (5), Zamboanga Sibugay, and Cotabato City which do not have any FP commodity recording and reporting system. In terms of FP commodity

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status, 14 provinces and four (4) cities reported no stock-out of FP supplies in the last three months while two RHUs in Zamboanga del Sur reported oversupply of commodities. In response, the PDOHO and MH coordinated the transfer of FP commodities to RHUs Tabina and Midsalip. However, the two (2) provinces of Compostela Valley and Bukidnon reported stock-outs of POP in eight (8) and two (2) RHUs, respectively while Zamboanga del Norte reported stock-out of SDM beads in all 27 RHUs/CHO except RHU Salug and RHU Talusan in Zamboanga Sibugay on DMPA. The stock-out was immediately addressed through the coordination of the Project with PHO, PopCom, and DOH-RO to replenish the stocks. In Compostela Valley, the RHUs of Maragusan, Compostela, and Nabunturan augmented the POP supplies of the eight (8) RHUs through inter-facility coordination with support from the two (2) DOH-deployed Pharmacists and PopCom. Four (4) RHUs of Davao Oriental alerted the PHO of near stock-out of POP. Table 13: Status of LMS and FP Commodities per Province/City as of December 2017

LGU FP Commodity Status LMS Status Remarks Zamboanga Peninsula: No stock out of any FP  All 27 LGUs W/ FP commodity PHO was informed and 1. Zamboanga del commodity except SDM inventory, recording & awaiting response to Norte beads. Only RHU Salug reporting system. address the issue. has available SDM beads  Simplified FP commodity No reported stock-out of inventory tool was introduced PDOHO coordinated the commodities in 27 by MH and PDOHO with FHA transfer of FP commodities 2. Zamboanga del RHUs. Large inventories TL collating the data and to RHU Tabina and Sur of FP commodities coordinating redistribution of Midsalip from Labangan reported by Labangan FP commodities when and Lakewood. and Lakewood RHUs. overstock occurs.  All 16 LGUs W/ FP commodity No stockout reported 3. Zamboanga inventory, recording & Stock out in RHU Talusan except in RHU Talusan Sibugay reporting system but needs was addressed by the PHO. on DMPA follow through. Zero stock-out was validated by the ZC CHO.  W/ FP commodity inventory, FP Coordinator in all 16 4. Zamboanga forecasting, storage, No issues/concerns RHUs and 2 public City distribution & recording & reported hospitals (ZCMC and reporting. Cristino Paragas Mem. Hosp.)  Uses the FP commodity and inventory tracking tool and FP No reported stock-out of No issues/concerns 5. Isabela City coordinator submits commodities in all BHS reported consumption reports via FB and FP logistics hotline Northern Mindanao:  Uses the simplified logistics management inventory tool with forecasting, recording & 6. Cagayan de No stock-out in all SDPs. reporting to FP logistics hotline No issues/concerns Oro and online reporting every 3rd reported week of the succeeding month of the quarter to DOH-CO and FP logistics hotline  Uses simplified FP inventory & No stockout reported for order form. CHO FP the quarter, including the coordinator is in charge of No issues/concerns 7. Iligan City 6 private hospitals and 3 consolidating quarterly FP reported private birthing clinics inventory for submission to DOH-RO and Central every 3rd

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LGU FP Commodity Status LMS Status Remarks week of the succeeding month of each quarter  Uses simplified FP inventory & The PHO, DOH-RO, and order form introduced by DOH PopCom facilitated the and Popcom and submits replenishment of POP Two (2) RHUs of Talakag consumption reports to DOH stocks to the 2 RHUs. 8. Bukidnon and Libona reported and FP logistics hotline every stockouts on POP 3rd of the succeeding month of Private facilities were also each quarter to the DOH CO provided with FP and FP logistics hotline commodities.  Uses simplified FP inventory & order form introduced by DOH 9. Misamis No stock out reported for No issues/concerns and submits consumption Oriental the quarter reported reports to DOH and FP logistics hotline PopCom  All 22 RHUs are now using the simplified logistic inventory tool and reports on inventory FHAs were also oriented on 10. Lanao del No stock out reported for and consumption are quarterly the FP inventory and Norte the quarter submitted to DOH-RO, reporting tool. PopCom and FP logistics hotline Davao Region  Simplified inventory, recording and reporting tool managed by No stock out reported for No issues/concerns 11. Davao City the FP Coordinator. The DOH- the quarter reported RO Pharmacist and PopCom collect the reports.  All LGUs are using either SIMS or CDLMIS and regularly submitting report to FP FHAs regularly monitor FP No stock out reported for logistics hotline and DOH- 12. Davao del Sur inventory status of each the quarter Central with support from RHU every month. DOH-RO XI assigned Pharmacist per SDN/ILHZ area Since most of the SDM beads are distributed to all barangays, suggest that No stock out reported for there should be supplies on  Uses the simplified FP the quarter, however, 4 SDM beads at RHU level; Commodity and Inventory RHUs of Boston, Cateel, Coordinate with the new Form for recording and 13. Davao Oriental Caraga and Governor supervising pharmacist reporting to DOH Central, FP Generoso alerted the (DOH hired assigned in Logistics Hotline, PDOHO and PHO of near stock out of PDOHO); and Popcom on a quarterly basis POP Public hospitals and Manansala WFMC (private birthing clinic) also have FP commodities  Uses the simplified FP The RHUs of Maragusan, Commodity and Inventory Compostela, and Nabunturan augmented the Stock out of POP was Form for recording and POP supplies of 8 RHUs reported in the 8 RHUs reporting to DOH Central, FP with stockout. 14. Compostela of Laak, Mabini, Maco, Logistics Hotline, PDOHO The 2 DOH deployed Valley Mawab, Monkayo, and Popcom. Reports on a pharmacists regularly Montevista, New monthly basis. monitor the allocated and Pantukan medicines and supplies in all LGUs, including the FP commodities

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LGU FP Commodity Status LMS Status Remarks SOCCSKSARGEN No issues/concerns 15. Cotabato City No stockout was reported  No system is in place reported  13/18 LGUs W/ functional LMS 5 RHUs of Aleosan, with inventory, forecasting, Antipas, Banisilan, No stock out was Kabacan, and Matalam 16. North Cotabato warehousing, recording and reported for the quarter reporting of consumption need to adopt the simplified reports FP inventory and monitoring tool  8/11 with functional LMS No stock-outs in all 11 No issues/concerns 17. South Cotabato (except Lake Sebu, Sto. Nino & RHUs reported Koronadal)  7/12 W/ functional LMS with inventory management, Introduce the simplified No stock-outs in 12 forecasting, storage, utilization SMRS to RHUs without the RHUs and two hospitals reports, procurement plan, & system (, 18. Sultan Kudarat (SKPH and Lambayong reporting of consumption Lambayong, , District Hospital) reports. BITES SDN hired Palimbang, Pres. ) Pharmacist to manage their LMS. CARAGA  Implements the simplified FP Commodity and Inventory monitoring tool of DOH and 19. Agusan del No stock-out reported for No issues/concerns Popcom Norte the quarter reported  PopCom established Regional FP Hotline and online monitoring / FB  Uses the simplified FP commodity and inventory monitoring tool. No stockout reported for No issues/concerns 20. Agusan del Sur  PHO conducts quarterly stock the quarter out monitoring and facilitates reported re-distribution of FP commodities for those with overstock ARMM  Uses the FP commodity and No stock-outs of FP inventory tracking tool and FP commodities for the last coordinator submits 3 months in all 21 SDPs consumption reports via FB No issues/ concerns 21. Basilan including public and FP logistics hotline reported hospitals (BGH, LDH,  FP Coordinator coordinates SDH, ISAH) with RHUs with overstock/ near expiry and facilitates redistribution  All 36 uses SMRS with regular No stock-outs in 36 reporting of consumption RHUs for the last 3 No issues/concerns 22. Maguindanao reports to DOH and Popcom months. reported  All RHUs have stock rooms; PHO manages a Supply Room No stock-outs in 40  Uses stock cards (Stock Issue Facilitated coordination RHUs. 2 barangays of Card and Dispense to User 23. Lanao del Sur with Marawi CHO to Marawi City with Record to track FP commodity restock pills stockout on Pills inventory  Uses the simplified FP No stock-outs of FP commodity inventory and No issues/concerns 24. Sulu commodities in all public monitoring tool. FP focal reported facilities including the person conducts quarterly

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LGU FP Commodity Status LMS Status Remarks Sulu Provincial Hospital meeting to monitor FP (SPH) inventory  Quarterly submits report to DOH Central and FP logistics hotline  Uses the simplified FP No stock-outs of FP commodity inventory and commodities in all 13 monitoring tool. FP focal No issues/concerns 25. Tawi-Tawi RHUs includng the person conducts quarterly reported public hospitals and meeting to monitor FP island RHUs inventory

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ANNEX C

Environmental Compliance and Informed Choice & Voluntarism Monitoring

Our Environmental Compliance

As part and parcel of infection prevention control measures, MindanaoHealth/ Jhpiego ensures that proper hand washing techniques are observed by providers prior to long acting reversible contraception or permanent method (LARC/PM) service provision for FP, that proper collection and disposal of the sharp objects that were used for modern family planning services should not inflict more harm to others. As such, the blades for removal and the cartridges used in inserting LARC/PSI, the needles of syringes for local anesthetics, the supplies for ligation, the unused IUDs or other FP services with sharps during fixed and outreach services are separated from the other materials or hospital wastes and have been disposed properly. Thus, colleagues and partners have reported serious compliance to this requirement for quality services.

While not regularly reported, assisted hospitals have been reminded on maintaining a placental pit to dispose birthing or biological wastes right after deliveries and segregate these from the other hazardous wastes. This requirement has been observed or noted to be present in Zamboanga Peninsula region in its 3 hospitals and 3 RHU facilities and the priority sites of Zamboanga del Sur for Margosatubig Regional Hospital, Zamboanga del Sur Medical Center (ZDSMC) and the Lapuyan Main RHU; and in the sites of Zamboanga Sibugay, the ZS Provincial Hospital (ZSPH), the Olotanga RHU and the Main RHU of Ipil.

Monitoring and validation visits were also conducted in the facility sites of Davao Region, the priority site of Davao City such as the Southern Philippines Medical Center (SPMC); and in the propority sites of SOCCSKSARGEN region, the province of South Cotabato for the South Cotabato Provincial Hospital (SCPH), in North Cotabato, the Dr. Amado Diaz Foundation Hospital and in Mlang RHU Birthing Facility. This observation also holds true in Sultan Kudarat for the S. Kudarat Provincial Hospital. These are few facilities that were visited, which included the birthing facilities of Mlang of North Cotabato.

As such, the above-mentioned facilities have been enjoying the accreditation for claims and reimbursements as required by PhilHealth.

For the succeeding period and regular monitoring, MindanaoHealth/Jhpiego staff shall ensure closer monitoring to comply with these requirements. The monitoring tool on FP/AYRH program integration shall be updated or enhanced to provide regular (quarterly) information of these requirements.

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Informed Choice and Voluntarism (ICV) Protocol Compliance Monitoring

This report covers the informed choice and voluntarism (ICV) compliance performance as of Q1PY6 and for USAID Fiscal Year 2017. The activities ranged from the conduct of doing an observation, re-orientation, sharing of information, education and communication (IEC) materials and ICV Wall Charts, discussion on ICV protocols and actual monitoring.

MindanaoHealth/Jhpiego has been generally successful in ensuring the observation of the ICV protocol by partners like Marie Stopes, FPOP and other private partners prior to and during the provision of FP information, counseling and service provision to clients. Thus, MindanaoHealth/Jhpiego staff and personnel do the spot checking of compliance during outreach events and in fixed service provision within the hospitals. Further, the series of dialogues, meetings and agreements with health supervisors and officials also made mention on the need to observe and monitor compliance to this protocol.

Results of MindanaoHealth’s Technical Assistance on ICV

For Part A for the consolidation of all TAs, re-orientation and other activities on ICV

During field visits in 2 regions namely Zamboanga Peninsula amd SOCCSKSARGEN, ICV wall charts are strategically posted in the facilities. The DOH-Regional Office for Zamboanga Peninsula are religiously monitoing compliance on ICV protocol.

In SOCCSKSARGEN Region, ICV re-orientation and discussion visits were done in the Provincial Health Office (PHO) of North Cotabato, the Cotabato Provincial Hospital (CPH), Surallah –RHU Birthing Clinic and Matavia-Tomines Ob-GYne and Lying –in Clinic (private facility) and extended to South Cotabato Provincial Hospital (SCPH) and the participants to the inter-agency meeting during a December Health Summit in General Santos City,

The reviews or monitoring visits also took place in Kidapawan City Health Office, Cotabato Provincial Hospital, Surallah RHU Lying- in Clinic, the Mlang RHU and Birthing CLinic. All these four (4) facilities and 9 providers who were visited were ICV compliant.

For this quarter, a total of five (5) orientation meetings on ICV happened in SOCCSKSAREGN for 61 doctor, nurse or midwife-providers (16 male and 45 female) who were re-oriented on the ICV protocol when doing FP service provisions and provided with FP IEC and ICV materials.

Part B is the listing of names of providers and actual clients interviewed or monitored on the ICV protocol compliance.

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ICV Monitoring Results in North Cotabato, South Cotabato & General Santos City Part A: Technical Assistance, Inputs and Other Activities

Number of Date Location Specific Activity/ Conducted by Participants Specific Audience Remarks/Results/ Topic or Content Whom M F Outputs Dec. 4, 2017 PHO and Partners Meeting on Dr. Eva Rabaya, 1 7 PHO and C/MHOs FP Courtesy call to PHO; endorsement and December Cotabato LAPM-LARC Mr. Ely Nebrija, Coordinators, and MH of FP wall charts to IPHO; provision 13-14, 2017 Provincial outreach Najie Gatchalian, LGUA of a copy of the list of CCTs/NHTS Hospital, Amas RN; Mary Jean from DSWDO to PHO and Kidapawan, Mendoza,RN, downloading of the list per LGU to Cotabato Juanita Santos, cross-tabulate vs. CCT households RN, Maida profiled. Scheduling of LAPM-LARC Francisco, RN, R. outreach in GIDA barangays; client Antenor, MD demand generation will be based on the current HH profiling; December 13, CPH, North Hospital assessment CPH& MH: Dr. 0 4 COH; FP Coordinator, They were re-oriented on the 2017 Cotabato on FP/AY services Lilian Roldan; OR/DR Head Nurse importance of observance of ICV in Ms. Rhodora their FP services Andoy, Ms. Liela Solis, R. Antenor, MD December 6, Surallah RHU Partners Meeting; RHU- Honey O 4 Head-Lying-in clinic; The 2 lying in clinics – public and 2017 Birthing Clinic & Clinic assessment on Dumalaog, Annie Midwife; private were practicing EINC/ Matavia-Tomines the use of Basuel, RM Clinic Owner -Private AMSTL to prevent PPH. Both clinics OB-GYNE and Dr. Jenina. M. are FP trained providers including uterotonics during Lying in Clinic Tomines; PPIUD services. Both are MCP the third stage of R. Antenor, MD accredited, however, they were not labor-AMSTL yet FP accredited with PhilHealth. FP wall charts were posted publicly. Few IEC materials were noted; FP FORM 1 were used with each FP client . Provided inputs on ICV standards and compliance. December 5, South Cotabato Partners Meeting; Dr. Allah Baby 0 5 PHO1, PESU staff, Courtesy Call to PHO; FHSIS data 2017 provincial Hospital assessment Vingno, Cecille SCPH FP Coordinator & not collected due to inavailability of Hospital on FP/AY services Lorenzo, Lillien IT Specialist- I-HOMIS the coordinator; Data gathering on Gonio, JoeMae FP/AY services in the hospital. manager; MH LGUA Songcuya, R. Emphasized importance of Antenor, MD compliance to ICV in their services provision to FP and AY clients.

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Number of Date Location Specific Activity/ Conducted by Participants Specific Audience Remarks/Results/ Topic or Content Whom M F Outputs December 5, General Santos Health Summit DOHRO, LGU 15 30 DOHRO12, CHO GSC, FP Coordinator of the Region 2017 City General Santos DePEd, CSWDO, provided re-orientation on RPRH City and Partners Popcom 12, CSO/NGO Law mentioning ICV compliance. partners Guidance Counselor, School Nurses, HSPs Total Number of Orientation/Training Activities conducted: 05 Total Number of Participants Trained or Oriented: 61 Males: 16 Females: 45

Part B. Summary Matrix of Service Providers/Facilities Monitored and Family Planning Clients Interviewed

Steps Taken/ Name/ No. of FP Results/ Findings Date Name of Location of Recommendations Designation of Clients Monitored by (please be as detailed as Monitored Facilities facilities (please provide as much Service Providers Interviewed possible) detail as possible) December 13, Kidapawan Kidapawan City Juanita G. Santos, 0 Rhodora T. Discussed strategies to reduce -Designated FP room with 2017 Antenor, MD unmet needs- increase freq of City Health RN visual and auditory privacy; outreaches; FP discharge- all Office; Alma Bragas,RM FP wallchart is visible; FP women delivering in birthing Birthing Clinic Gina Subaldo, RM IEC materials were publicly clinic will undergo FP posted in consultation area counselling prior to and FP provision area; Use discharge. Other FAQs of FP form 1 is observed. regarding the LARC PSI No ICV violation noted December 13, Cotabato Amas, Rhodora Andoy, RN 0 Rhodora T. FP counselling room is Provided inputs on ICV 2017 provincial Kidapawan City Leila Solis, RN Antenor, MD shared with breastfeeding principles for refresher HospitalWell counselling room; FP wall Family Mid chart is visibly posted inside the room; few IEC materials Clinic noted; designate FP coordinator claimed she was trained long time ago in Basic Comprehensive FP training in the 1990’s. No ICV violation is observed

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Steps Taken/ Name/ No. of FP Results/ Findings Date Name of Location of Recommendations Designation of Clients Monitored by (please be as detailed as Monitored Facilities facilities (please provide as much Service Providers Interviewed possible) detail as possible) December 6, Surallah RHU Surallah, South Honey Dumalaog, 0 Rhodora T. Designated FP room with 2017 Cotabato Antenor, MD Provided feedback on good Lying in Clinic RM visual and auditory privacy; points of the lying in on ICV Annie Basuel, RM FP wallchart is visible posted compliance. in the waiting area of the clinic; Use of FP form 1 is observed. No ICV violation noted December 14, Mlang RHU Mlang, Maida Francisco, RN 0 R. Antenor Desi Has a separate FP 2017 Cotabato Provided feedback on good and Birthing Remia Palmes, RM room with visual and points on ICV compliance. Clinic auditory privacy; FP wallchart is posted outside the FP room and immediately visible upon entry; FP IEC materials were publicly posted in consultation area and FP provision area; Use of FP form 1 is observed. No ICV violation noted Total number of Facilities Monitored: 4 Number of facilities noted to be compliant to policies: 4 Total number of Service Providers Monitored: 9 Number of facilities with possible vulnerabilities: none Total number of FP clients interviewed: 0 Number of facilities with possible violations: none

ICV Monitoring Results in Misamis Oriental and Cagayan de Oro City

Date Submitted: Jan. 11, 2018 Project: MindanaoHealth Report for the Month of: October – December 2017

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Instructions: This form will be accomplished and submitted to designated project staff on a monthly basis. This should record ALL activities related to compliance to FP and Abortion-Related Policies, such as, but not limited to, orientation sessions on Informed Choice Voluntarism, compliance monitoring tools, systems or activities.

Part A: Technical Assistance, Inputs and Other Activities Number of Participants Date Location Specific Activity/ Conducted By Specific Audience Remarks/Results/ Whom Topic or Content M F Outputs

Oct. 16, 2017 MOPH LAPM+ Outreach with MSI DOH (NDPs) 13 LAPM+ clients* LGU/DOH partners ensured that Alubijid clients were provided RHUs (MWs) comprehensible info on the broad range of FP methods (natural & modern) by LGU partners during pre-counseling; no coercion was done to any of the clients who went to the LAPM venue;

Oct. 17, 2017 Jasaan Mun. LAPM+ Outreach with MSI -do- 69 LAPM+ clients* -do- Hospital

Oct. 20, 2017 MOPH LAPM+ Outreach with MSI -do- 80 LAPM+ clients* -do- Manticao

Oct. 12, 2017 ABC Hall, FP Orientation for Gingoog City MH LGUA 9 70 NDPs, RHMs, FHA, LGUA discussed ICV Compliance & Gingoog City PHN, PopCom Staff Monitoring as one of the topics during the FP Special Orientation (on Unmet Need) upon the invitation of CHO Gingoog

Dec. 1, 2017 DOH ACT Coordination meeting with FHAs on MH LGUA 3 22 Participants, especially the FHAs Bldg., LAPM+ were reminded to observe the basic 3 PHO staff, 21 FHA, 1 Carmen, ICV principles and the FP policy (Social Preparation) DOH CDOC requirements; compliance to these was reiterated

Dec. 5, 2017 RHU LARC Outreach RHU (MWs, 76 LARC clients* Clients were pre-counselled on the Talisayan PHN, MHO) (removal/reinsertion) broad range of FP methods available so they can decide on the FP method of their choice

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Number of Participants Date Location Specific Activity/ Conducted By Specific Audience Remarks/Results/ Whom Topic or Content M F Outputs

Dec. 11, 2017 MOPH LAPM+ Outreach with MSI LAPM clients 78 LAPM clients* -do- Balingasag

Dec. 12, 2017 MOPH LAPM+ Outreach with MSI LAPM clients 87 LAPM clients* -do- Gingoog *LAPM/LARC clients includes those who were not successfully provided services but were pre-counselled prior to LAPM/LARC actual skeds. Total Number of Orientation/Training Activities conducted: 8 Total Number of Participants Trained or Oriented: 507 Males: 12 Females: 495

Part B. Summary Matrix of Service Providers/Facilities Monitored and Family Planning Clients Interviewed

Date Name of Location Name/Designation No. of FP Monitored Results/Findings Steps Taken/ Monitored Facilities of facilities of Service Providers Clients by Recommendati (be as detailed as possible pls) Interviewed ons (please provide as much detail as possible)

10/12/17 MOPH Gingoog Berta Galupo 2 MH In the FP clinic of the hospital, The ICV Gingoog City, clients have the opportunity to principles and Misamis MW, FP Coordinator- choose voluntarily whether or not to the FP policy Designate 12/12/17 Oriental Charo Echalico use FP and if they decide to use FP, requirements they are free to choose any specific were discussed FP method; There are no with the service target/quota setting; nor coercion of providers and clients for a particular method. compliance to these Clients for pills, condoms, DMPA requirements was are referred to the CHO or to the reiterated BHS nearest them. NFP is also discussed to clients. BTL and PSI clients are advised on the next MSI

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Date Name of Location Name/Designation No. of FP Monitored Results/Findings Steps Taken/ Monitored Facilities of facilities of Service Providers Clients by Recommendati (be as detailed as possible pls) Interviewed ons (please provide as much detail as possible) outreach schedule visibly posted at the FP clinic. Clients have access to information (wall charts, flip charts) on a wide variety of FP choices, including the benefits and risks of all FP methods, with special focus on the method of their choice. Facility is found to be ICV compliant.

10/12/17 CHO Gingoog Charo Echalico 0 MH The CHO provides broad range of Gingoog City, Mis. FP services- like pill and condom Oriental PHN & FP Coordinator- dispensing, IUD, DMPA, and do Designate counseling on NFP (LAM). Clients for BTL and PSI are referred to MSI during outreach at MOPH Gingoog. No FP targets for HSPs are set , targets are only for planning purposes. No incentives or rewards for service providers nor for FP clients are provided. Flipchart and brochures are available in English and Tagalog and can be taken home by clients. FP wall chart is posted at the health center. Informed consent is explained to the VSS clients prior to LAPM procedures or during the recording processes.

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Date Name of Location Name/Designation No. of FP Monitored Results/Findings Steps Taken/ Monitored Facilities of facilities of Service Providers Clients by Recommendati (be as detailed as possible pls) Interviewed ons (please provide as much detail as possible)

10/25/17 RHU Lagonglong, Norma Gadrinab MH The RHU provides broad range of Lagonglong Misamis FP services- like pill and condom Oriental MW dispensing, IUD, DMPA, and do counseling on NFP (LAM). Clients for BTL and PSI are referred to MSI during outreach at MOPH Balingasag. No FP targets for HSPs are set , targets are only for planning purposes. No incentives or rewards for service providers nor for FP clients are provided. Flipchart and brochures are available in English and Tagalog and can be taken home by clients. FP wall chart is posted at the health center. Informed consent is explained to the VSS clients during LAPM procedures. Facility is found to be ICV compliant.

10/25/17 MOPH Balingasag, 0 MH LGUA Clients have the opportunity to Balingsag Misamis choose voluntarily whether or not to Oriental use FP and if they decide to use FP, they are free to choose any specific FP method; There are no target/quota setting; nor coercion of clients for a particular method. Clients for pills, condoms, DMPA are however referred to RHU Balingasag or to the BHS nearest them. NFP is also discussed to

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Date Name of Location Name/Designation No. of FP Monitored Results/Findings Steps Taken/ Monitored Facilities of facilities of Service Providers Clients by Recommendati (be as detailed as possible pls) Interviewed ons (please provide as much detail as possible) clients during counseling. BTL or PSI clients are advised on the next outreach schedule. Facility is found to be ICV compliant.

Total number of Facilities Monitored: __4___ Number of facilities noted to be compliant to policies: __3 Total number of Service Providers Monitored: ___4_ Number of facilities with possible vulnerabilities: 0_____ Total number of FP clients interviewed: 2______Number of facilities with possible violations: 0____

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ANNEX D

Success Stories and Evolving Initiatives

1. Peer Educators Group in Upi - Making a Dent in Educating Teens to Prevent More Teenage Pregnancies Teenage pregnancy in the Municipality of Upi in Maguindanao, one of the Mindanao provinces identified as vulnerable to violent extremism, has been a continuing challenge as frequently presented during Provincial Program Implementation Reviews. Upi Municipal Health Officer Dr. Carmelo B. Esberto shared, “When we assist deliveries here, we noticed that there really are a number of clients under 19 years old giving birth. Our Provincial Health Officer Dr. Tahir B. Sulaik has always pointed out that Upi has one of the highest teenage deliveries.” Dr. Esberto added that there have been efforts in the past to conduct lectures for teens but have not really had a dent on the reduction of the number of pregnant teens. In 2014, for instance, 217 teenage pregnancy cases were reported, then increasing to 315 cases in 2015. Upi has a young population vulnerable to such risky behaviors. Out of 53,583 people (2015 Philippine Census), an estimated 60 percent belong to the age group 24 years old and below. To respond to the challenge of limited access to correct reproductive health, including family planning (FP) and maternal and child health (MCH) information and guidance for its adolescents and youths, the Municipal Health Office of Upi partnered with USAID through its MindanaoHealth Project with Jhpiego. This partnership harnesses the critical role of peers as influencers and partners in reaching more young people, both in school and out of school, primarily with information on reproductive health, and the pregnant young women and teen moms on maternal and child health and family planning; hence, the series of Peer Education Training. Across Mindanao, MindanaoHealth was able to train 692 leaders/students and guidance counselors in secondary schools, civil society organizations, and health service providers as peer educators; 95 of them from Maguindanao, including 30 from Upi. A significant outcome of this training was the formation of the Upi Youth Peer Educators Association that bolsters the roll-out of peer education activities, particularly the Usapang Barkadahan, which is an interactive discussion sessions for young people (loosely translated as discussion among friends) in schools and in barangays. The organization already conducted sessions in all the nine national high schools of Upi reaching some 600 students. The group is now focusing on the conduct of information and education campaign at the community level and has already covered six out of the 23 barangays (villages) reaching 240 adolescents and youths even in far-flung areas. Dr. Esberto reported, “With this intervention, we noted a significant reduction of our teenage pregnancy cases, from 315 cases in 2015 to 171 cases in 2016. While in the first quarter of 2017, we reported 30 cases.” The Upi Youth Peer Educators Association also conducts Usapang Teen Moms that is focused on maternal and newborn care, and family planning accompanied by nurses and midwives to provide outright the needed services. Participants needing further treatment and management are referred to the USAID-supported Adolescent and Youth Reproductive Health (AYRH) Clinic of Upi Rural Health Unit (RHU) for psychosocial risk assessment and counseling. Meanwhile, gender-based violence victims are referred to the Social Welfare and Development Office of the municipality. “We are proud that the Usapang Barkadahan sessions have significantly contributed to the drop in the number of teenage pregnancy cases. We are proud and happy that the local government unit and the RHU do acknowledge our efforts to reach more adolescents and youth especially in

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far-flung barangays to provide the needed health information and services,” said James Tamayo, a USAID-trained senior member of the Upi Youth Peer Educators Association.

James Tamayo, a senior member of the Upi Youth Peer Educators Association facilitates an Usapang Teen Moms session in a village in Upi, Maguindanao. (MCossid/Jhpiego)

2. Province Improves Health Outcomes through Expanded Outreach Home to over 800,000 people, the island province of Sulu in the Autonomous Region in Muslim Mindanao comprises more than 19 municipalities and 410 villages, many of which are geographically isolated and disadvantaged. Sulu’s isolation is compounded by armed conflicts and sporadic terroristic activities, further challenging the ability to deliver quality health services. Not surprisingly, the indigenous Tausug people of Sulu have some of the lowest indicators in family planning and maternal, newborn and child health. To improve access to health services for the residents of Sulu, the Provincial Health Office developed a comprehensive outreach strategy which involves health workers, civic society organizations and local government units at the provincial, municipal and village levels. The “CATCH and CHANGE” strategy or “Caring for All Tausugs in the Community through Health and Community Health Assembly through Networking and Gender Empowerment”, prioritizes the communities that are most in need of health services. In these priority communities, women and children receive key health messages delivered through storytelling in the Tausug dialect that are based on local customs and daily life. They also receive onsite health services, including family planning and maternal and child health. Sulu Provincial Health Officer, Dr. Tan-Omar explained, “We have to catch the people with unmet health needs to change their situation towards something better. People do not usually come to the health facilities; and not all health facilities are accessible. We are bound to serve our people and serve them fully.” CATCH and CHANGE activities are now implemented in all 19 municipalities of Sulu. Over 100 health providers offer family planning counseling and services, maternal, child and newborn health care, and adolescent-sensitive services. USAID, through MindanaoHealth trained many of the health providers who are participating in the strategy. To date, the initiative has reached more than 14,000 clients throughout the province. From 2013 to 2016, home-based deliveries decreased from 92 to 76 percent, contraceptive prevalence increased from 18 to 35 percent, while fully immunized children increased from 28 to 44 percent. While still below national standards, these indicators show that utilization of health services is slowly improving. Over time, it is hoped that health outcomes will further improve through the

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sustained commitment of health personnel and collaboration and support from USAID and other local partners.

Sulu Provincial Health Education and Promotion Officer Edmiraldo Wee (center in blue) walks around a community in the island municipality of Hadji Panglima Tahil in Sulu. He holds a portable sound system, delivering health messages and encouraging people to participate in the CATCH and CHANGE outreach activities. (Photo by Sulu Integrated Provincial Health Office)

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