QUARTERLY REPORT Reporting Period 01 January 2014 – 31 March 2014 VisayasHealth

Submitted to

United States Agency for International Development

by

VisayasHealth

New York, NY, USA &Cebu, Philippines

under

Agreement No. AID-492-A-13-00007

30 April 2014

Table of Contents

List of Abbreviations ...... 3

I. Background ...... 5 II. The Project and Objectives ...... 8 III. Accomplishments ...... 9 IV. Reasons for Variances in the Performance ...... 11 V. Major Implementation Issues ...... 14 VI. Milestone, Key Tasks and Activities ...... 15 VII. Financial Reports ...... 19 VIII. Success Stories / Highlights ...... 19 IX. Communication and Outreach ...... 24

ANNEXES : Annex A. List of Products Developed in the Quarter ...... 25 Annex B. ICV Compliance ...... 29 Annex C. Environmental Examination Compliance Report ...... 32 Annex D. PPP Report ...... 33 Annex E. Cities Development Initiative Report ...... 34 Annex F. Gender ...... 37 Annex G. Proceedings on the Clinical Case Conference on PP IUCD ...... 38

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 2 List of Abbreviations

AJA Adolescent Job Aid ALAGA Alamin at Gamitin, PhilHealth Benefits (translation: know/understand and use) ANC Ante-Natal Care AOP Annual Operations Plan(ning) ASec Assistant Secretary ASRH Adolescent Sexual & Reproductive Health AYRH Adolescent and Youth Reproductive Health BEmONC Basic and Emergency Obstetrics and Neonatal Care BTL Bilateral Tubal Ligation C4C Communication for Change CA Cooperating Agency (ies) CHO City Health Office CHT Community Health Team CPO City Population Office CPR Contraceptive Prevalence Rate DHC District Health Center DOH Department of Health DSWD Department of Social Welfare and Development EDC /D Expected Date of Confinement / Delivery EINC Essential Intra-partum and Newborn Care EMMP Environmental Monitoring and Mitigation Plan EVRMC Eastern Visayas Regional Medical Center EXECOM Executive Committee FBD Facility-Based Deliveries FHS Field Health Survey FP Family Planning FPCBT Family Planning Competency-Based Training GCGMH Governor Celestino Gallares Memorial Hospital GIDA Geographically Isolated and Depressed Area HR Human Resources HSP Health Service Provider JHPIEGO John Hopkins Program for International Education on Gynecology & Obstetrics ICM International Care Ministries ICV Informed Choice and Voluntarism IEC Information, Education, and Communication IMAP Integrated Midwives Association of the Philippines Inter-CA Inter -Cooperating Agencies (of USAID) IPC Inter-Personal Communication IUD Intra-uterine Device JICA Japan International Cooperating Agency KP Kalusugang Pangkalahatan (Universal Healthcare) LAPM Long-Acting and Permanent Method LGU Local Government Unit LMT Lactation Management Training LTO License to Operate MDG Millennium Development Goal MCH Maternal and Child Health MCHIP Integrated Maternal and Child Health Program MCP Maternity Care Package MCPR Modern Contraceptive Prevalence Rate

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 3 MHO Municipal Health Officer MLLA Mini Laparotomy with Local Anesthesia MNCHN Maternal, Newborn (or Neonatal), and Child, Health and Nutrition NCP Newborn Care Package NGO Non-Government Organization NHIP National Health Insurance Policy NO Nitrous Oxide NOSIRS National Online Stocks Inventory Recording System NSO National Statistics Office OH Office of Health ODH Ormoc District Hospital PC Provincial Coordinator PHN Public Health Nurse PHO Provincial Health Office PPFP Post-Partum Family Planning PPIUD/ PP IUCD Post-Partum Intra-Uterine Device/Post-Partum Intra-Uterine Contraceptive Device PhilHealth Philippine Health Insurance PMP Performance Monitoring Plan (PMP) PRIMEX Pacific Rim Innovation & Management Exponents, Inc. PRISM2 Private Sector Mobilization for Family Health project – Phase 2 PYP Program for Young Parents Q1/2/3/4 Quarter 1 / Quarter 2 / Quarter 3 / Quarter 4 RH Reproductive Health RHM Rural Health Midwife RHU Rural Health Unit RO Regional Office SDP Service Delivery Point NSD Service Delivery Network SEC Securities and Exchange Commission SEED Supply-Enabling Environment-Demand SMS Short Messaging System SOTA State Of The Art StS Stiftung Solarenergie – Solar Energy Foundation STTA Short-Term Technical Assistant TA Technical Assistance TOF Training of Facilitators TOT Training of Trainers TWG Technical Working Group UNFPA United Nations Population Fund UP PGH University of the Philippines Philippine General Hospital USAID United States Agency for International Development USG United States Government VH VisayasHealth VOC Visayas Operations Cluster VSMMC Vicente Sotto Memorial Medical Center VSC Voluntary Surgical Contraception VSS Voluntary Surgical Sterilization WFP Work and Financial Plan WV Western Visayas WVMC Western Visayas Medical Center

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 4 I. Background

A. National Context. With a vibrant and growing economy, a political commitment at the highest level to meet its Millennium Development Goals (MDGs), a progressive Responsible Parenthood and Reproductive Health Law passed in 2012 by the Philippine Congress, a Department of Health (DOH) administrative order to reduce unmet need for Family Planning, and a social health insurance program that proactively supports access to public health services, the Philippines is poised to achieve important health and social gains. In addition, a large demographic cohort of young people and high access to technology—including almost universal cell phone usage—provide unprecedented opportunities to transform the social norms and health systems in support of improved Reproductive Health (RH) and Maternal and Child Health (MCH). On the other hand, the Philippines’ highly decentralized health system poses various service delivery and management challenges, making it critical to focus on strengthening the capacity and engagement of provincial and municipal leaders and health offices. The project will capitalize on high-level support from no less than the President of the Philippines to make sure that interested men and women are able to access MNCHN/FP services.

B. Situation in Visayas Region. The Visayas island grouping is home to more than 18 million Filipinos and is divided into 3 administrative regions (VI, VII, and VIII). Poverty incidence varies widely among the provinces, from 22% of households in Negros Occidental to around 46% of households in North and West Samar, yet the absolute numbers of poor households are almost equal, with a projected 261,000 in Region VI and 288,000 in Region VIII. Likewise, Maternal, Neonatal, Child Health and Nutrition and Family Planning statistics are extremely variable between and within provinces in Visayas. Region VIII generally has the worst indicators for Facility-based Deliveries (FBDs) (46%), immunization (76%), and unmet need for FP (30%). With respect to Child Health (CH), nutrition rates are similar among all three regions, and Vitamin A coverage (83–86%) is higher than the national average. However, around 40% of children under age five are stunted. Immediate initiation of breastfeeding among newborns is highly variable—only 34% in Canlaon City in Region VII and 75% in Southern Leyte in Region VIII. ASRH is significantly overlooked. In Central Visayas, a growing number of 15 to 19-year-olds are giving birth having increased from 6.9% in 2006 to 10% in 2011.

C. Health System Priorities. The Philippines has a relatively new vision of mobilizing Community Health Teams (CHTs), comprised of community health workers and parent leaders, and managed by a midwife to encourage health-seeking behavior and help clients particularly the poorest of the poor, navigate the health system. In the Visayas area, LGUs are at vastly different stages of activating CHTs. While some provinces, such as Southern Leyte, have completed CHT training (1,159 trained from all 18 municipalities), other provinces, such as Samar, have only just begun mobilizing CHTs (only four out of 24 municipalities). PhilHealth is on the move to achieve 100% enrollment, promote facility/provider accreditation (registration), and assist clients and the health system to maximize utilization of benefits.

Despite their extensive and dynamic workforce, PhilHealth is challenged to fulfill their mandate in Visayas at the very local level. For example, only 4 out of 27 RHUs are accredited with the maternity care package (MCP) in the province of Negros Oriental. Private-sector provision of health services plays a significant role in health service provision (51%): With the advent of PhilHealth, private birthing homes are burgeoning. The Integrated Midwives Association of the Philippines-owned private clinic network has 11 birthing homes in Bohol, and in Region VIII, 38 Mother Bless private lying-in facilities provide private-sector alternatives for FBD. In the public sector, the DOH is working to increase trained health providers in rural and remote areas with two-year postings through such programs as Doctors to the Barrios and RNHeals. With several island communities and geographically isolated and depressed areas (GIDAs), Visayas has benefited from these temporary infusions of health personnel, but in many cases, LGUs do not budget adequately to transition these staff into permanent placements.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 5 D. Accomplishments of the Previous Quarters

1. Year 1 Quarter 1 (19 February – 31 March 2013)

Initial mobilization was done which covered the hiring of key staff for the Cebu City, VisayasHealth Office and negotiation with the DOH for a temporary office space while on the lookout for a final office space. As the staff was settling in and the sub-award agreement was being completed, the pre-awards sub-agreement was issued with PRIMEX amounting to US$35,000. Along with this, a third party administration vendor - KMC Solutions was contracted to handle staff payroll. Even as these developed, work planning for the project year was conducted on March 18-22, 2013 which was followed by a series of engagements with the DOH Regional Office and the Visayas Operations Cluster.

2. Year 1 Quarter 2 (1 April – 30 June 2013) 2.1 Project Management. Rapid mobilization of the project was pursued with the selection and recruitment of 90% of the staff and procurement of office equipment which include the laptops, desktop computers, fax machines and printers. The setting up of the permanent office space was finally started and completed with the engagement of a local contractor after the lease agreement with the Department of Health Regional Office 7 was signed. The 1st Visayas Inter-CA (Cooperating Agencies) coordination meeting was also organized to encourage better and more effective collaboration among the USAID CAs. The workshop was participated by representatives of the seven USAID CAs and the respective Agreements Officer Representatives (AOR) from the Office of Health (OH). A harmonized Visayas-wide Implementation Plan for the period June to September 2013 was developed as well as defining the coordination mechanisms that the Inter-CAs will observe with DOH regional and LGU partners.

2.2 Project Components 2.2.1 Increasing Demand by Training Providers on the Usapan Series which is the main demand generation mechanism adopted by VisayasHealth. These are specific Usapan sessions designed for pregnant mothers, those who want more children or who wish no longer to have children and for men who want to be involved in family planning. These were conducted in facilities with high volume of deliveries.

2.2.2 Improving Supply by conducting the first batch of the PPIUD Training on June 24-26, 2013 in collaboration with Vicente Sotto Memorial Medical Center (VSMMC) and the Maternal and Child Health Integrated Project (MCHIP) of JHPIEGO. A total of 19 service providers coming from hospitals/birthing clinics with high volume deliveries in the VisayasHealth project areas were trained. In terms of training, 46 health providers were trained on Family Planning Competency-Based Training (FPCBT) level 1; 27 were trained on FPCBT level 2; 97 trained on Long Acting Permanent Methods, such as BTL and NSV; 20 were trained on Supportive Supervision. In the implementation of family planning, it is imperative that clients should be informed on all methods of FP and is free to choose what methods they would like, hence a total of 110 health providers were trained on Informed Choice and Voluntarism (ICV).

3. Year 1 Quarter 3 (July 1 to September 30, 2013) 3.1 Project Management: During the period of 01 July to 30 September 2013, VisayasHealth was able to complete the hiring of technical staff and procure all the necessary equipment. The project was able to secure a permanent office space within the DOH-RO 7 compound. VH was also able to complete and finalize the Year 2 project work plan.

3.2 Project Components 3.2.1 Increasing Demand. Under this component, VisayasHealth trained 270 Health Service Providers (HSPs) to facilitate the Usapan sessions. These providers conducted Usapan alone or in tandem with another trained provider. As of end of September 2013, these providers were able to conduct 189 Sessions and reached 2,890 clients (See Table 6). Another 185 clients were also reached during Usapan training conducted by VisayasHealth staff.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 6

Background/Accomplishments of the Previous Quarters, continued

Part of its efforts to integrate FP to existing maternal and child health services, VisayasHealth introduced an application of the Usapan series to post-partum clients. This intervention was introduced to hospitals and birthing centers for clients who have just delivered and prior to their discharge. VisayasHealth trained health care providers to organize Usapan sessions in the maternity wards. Data from three hospitals showed sharp increase in the number of post-partum FP clients after this intervention was introduced. 3.2.2 Improving Supply.VisayasHealth, in coordination with the ROs in Regions 6, 7 and 8, other cooperating agencies PRISM 2, MCHIP, 8 LGUs and NGOs (Integrated Midwife Association of the Philippines, Siliman University Medical Center) identified and facilitated the training of service providers and Trainers on LA/PMs (especially Post-partum IUD, BTL and NSV) and EINC. It prioritized training of providers in high volume facilities and areas with high unmet needs as identified in previous studies. In 24-27 June 2013 and 27-31August 2013, VisayasHealth organized two training courses for Post-partum IUD insertion. The training was conducted at the Vicente Sotto Memorial Medical Center (VSMMC) in Cebu City. A total of 35 health professionals (Table 8) were able to statisfactorily complete the training requirements and became certified PPIUD providers. The training course included a 3-day didactic discussion and 2-day practicum where participants practiced on a model and insertion of IUDs to actual clients. These participants came from regional /DOH-retained hospitals (5), provincial hospitals (6), district hospitals (5) and one private hospital. 670 clients were able to access PPIUD services During the period July-September 2013, 670 post-partum women were able to access PPIUD services. The women were given counseling prior to the provision of PPIUD services. Interviews of these clients showed that many of them were very happy about the opportunity to avail of a FP method right after their delivery and/or prior to their discharge from the maternity wards. 4. Year 2 Quarter 1 (October 1- December 31, 2013) 4.1 Response to Earthquake and Typhoon Disasters 4.1.1 Bohol Earthquake.On October15, 2013 a powerful earthquake registering 7.5 magnitude in the Richter scale hit the province of Bohol causing massive damage to thousands of houses and tens of thousands of residents rendered homeless and had to be relocated to evacuation centers. VisayasHealth organized a team to conduct an assessment of the health facilities in the Province of Bohol. There were 3 district hospitals, 5 main health centers and 30 Barangay Health Stations (BHSs) that were heavily damaged. In response to a request from the Philippines Department of Social Welfare and Development (DSWD), VH procured hygiene kits for the affected families. The kits contained water pails, soap, shampoo, toothbrush, laundry soap, sanitary napkins and other items needed for the maintenance of proper personal hygiene. These items were turned over to the DSWD in Tagbilaran City by Ms. Gloria Steele, the Mission Director of USAID Philippines in a formal public ceremony attended by Gov. Edgardo Chatto and provincial officials of Bohol.province . In addition to the hygiene kits, the project also provided emergency lights and other emergency supplies to the affected health facilities particularly to the health centers in the municipalities of Carmen, Catigbian and Sagbayan. The assistance was much appreciated by the health center staff. 4.1.2 Typhoon.On November 8, 2013, a super-typhoon with maximum winds of 200 km per hour ravaged the provinces of Samar, Leyte, Cebu and Iloilo. The typhoon caused significant damage to health facilities and other infrastructure and affected millions of people living in the affected areas. Rapid Assessment was conducted by VisayasHealth teams in the Province of Leyte, Northern Cebu towns and South Iloilo municipalities. VisayasHealth responded to this disaster through the following activities: provision of nutrition kits to families; provision of tents to serve as temporary health centers; provided logistical andtechnical support to the OCV during the immediate relief and emergency responseperiod.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 7

Background/Response…, continued

VH facilitated the deployment of solar powered refrigerators for the DOH 8 to prevent damage to vaccines as a result of the absence of electricity. Finally, VH partnered with other donors and agencies in the repair and rehabilitation of affected health centers and village health stations. 4.2 Completion of the Baseline Survey of eight project sites.The baseline survey for VH was conducted in the provinces of Iloilo, Negros Occidental, Bohol, Negros Oriental, Leyte, South Leyte, Samar and North Samar in October 2013. The survey generated important information on the status of demand generation, supply and policies and systems in the Visayas. The results were presented during one of the DOH-OCV meetings and during meetings of the CHD and the provincial health offices. The results are summarized below and were used to adjust and recalibrate the project's quarterly and annual targets.

II. The Project and Objectives

The VisayasHealth project will work towards achieving the following goals and objectives: reducing maternal and child mortality, reducing unmet need for family planning, increasing CPR, increasing skilled birth attendance, increasing newborns given neonatal care, reducing the number of teenage pregnancies, and increasing exclusive breastfeeding rates.

To achieve these goals and objectives, VisayasHealth will implement the following components: scaling-up of supply and demand for MNCHN-FP services, removing policy and systems barriers and developing capacity of ROs to manage and coordinate MNCHN-FP program and activities. Below is the VisayasHealth results framework.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 8 III. Accomplishments

FY 2014 Accomplishment Baseline value End of Target Cumulative Indicator (reference Project for Performance Remarks Q1 Q2 Q3 Q4 year) Target 2014 to Date

FP 1Number of Modern FP current users in 664,771 (2011) 932,176 723,704 424,774 75,064* NA Incomplete reports. Data USG-assisted sites come from 27% of RHUs only FP 3 Percent of USG-assisted service delivery 70% 20% 51% 70% 70% *Baseline and targets to be re- facilities experiencing stock-outs (2013) processed based on M&E TWG agreement - stock outs will be disaggregated by commodity FP 4 Percent of service delivery points (SDPs) 44% (2013) 85% 54% 44% 27%* *incomplete reports providing FP counseling and services to couples, men and women youth and adolescents FP 8 No. of youth (15-24 years old) provided 7,906 (2012) 19,673 9,847 738 2,610 5,551 Cumulative performance with FP counseling and/or services in USG includes Year 1 (2,203) supported sites FP 9 No. of men provided with FP counseling 184 (2013) 2 33 219 Cumulative performance and/or services in USG-supported sites Usapan session 417* includes Year 1 (184) *One-on-One Traditional Counseling FP 10 Percent of service delivery points 0% 60% 30% 0 0 Training on implant to start providing sub-dermal implants (new) next quarter (April-June2014) FP 11 Percent of service delivery points 4% 50% 17% 6% 12% 12% providing post-partum services (cumulative) N: 12 N:191 N: 47 D: 383 D: 383 D: 383 Number of clients provided PPIUD service 370 630 1,673 Cumulative performance includes Year 1 (673) FP 12 Percent of service delivery points 50% 65% 52% 50% 56% 56% providing VSS services N:58 N:75 N:60 D: 115 D: 115 D: 115 Number of ambulatory VSS missions 7 9 21 Cumulative performance includes Year 1 (5) Number of clients provided BTL service 240 353 689 Cumulative performance includes Year 1 (96) FP 13 Number of health providers trained on FP/RH with USG funds per type of training (cumulative) Physicians trained on PPIUD 0 94 65 14 4 18

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 9 FY 2014 Accomplishment Baseline value End of Target Cumulative Indicator (reference Project for Performance Remarks Q1 Q2 Q3 Q4 year) Target 2014 to Date RHMs trained on PPIUD 0 127 59 13 12 25 Nurses trained on PPIUD 0 0 0 3 5 8 PPFP-PPIUD trainers 0 (2012) 10 12 0 12 Physicians trained on BTL-MLLA 30 (2013)* 38 13 0 7 7 FP 17 Number of pregnant women provided 106,691 197,608 145,687 921 3,154 50,387 Cumulative performance with with FP information or counseling (cumulative) (2012) baseline indirect accomplishment (FHSIS TCL, 42,406) survey* FP 18 Number of post-partum women provided 75,110 160,799 101,271 440 340 33,050 Cumulative performance with with FP counseling/services (cumulative) (2012) baseline indirect accomplishment (FHSIS TCL) survey)* MCH 1Number of deliveries with skilled birth 224,130 301,306 241,671 54,691 13,737* *Only 30% of facilities attendants in USG assisted programs submitted reports on deliveries MCH 3 Number of women reached with 52 29,381 25,380 4,314 4,185* 8,499 *incomplete reports individual or small group level education on the (2013) Usapan benefits of exclusive breastfeeding session MCH 4Number of adolescents and youth 304 304 provided with youth-friendly MNCHN/FP counseling and referral services in USG-assisted service delivery points MCH 8 Number of health providers trained on MCH with USG funds RHMs trained on EINC 225 (2013) 625 247 0 0

RHMs trained on BEMONC 247 (2013) 686 212 0 0

hospital nurses (permanent items) trained in 87 (2013) 110 110 145 0 Lactational Management Training MCH 9 Number of LGUs with at least 149 189 162 0 0 CHT/community support group providing breastfeeding information, and referral to lactating mothers MCH19 Number of quality supervisory visits on 0 104 14 0 0 MNCHN/FP ~quarterly estimates were derived from annual reports of SBAs from 6 provinces; only 2 provinces have quarterly reports

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 10 IV. Reasons for Variances in the Performance A. Demand Generation A.1 Increase in the number of men and women provided with FP information and counseling services as compared to the previous quarter.Compared to the previous quarter, the VH project was able to show a sharp increase in the number of clients who were given family planning information and counseling, from 1,363 pregnant and post-partum women and men in Quarter 1 to 3,316 in Quarter 2. The following are the reasons for the increase: A.1.1.ENGAGEMENT OF MORE health providers and facilities IN THE CONDUCT OF USAPAN SESSIONS.During the reporting period, VH was able to capacitate 128 facilities in conducting Usapan sessions. The increase is particularly evident in the province of Cebu which accounted for 77 of the 128 facilities implementing the project's main demand generation intervention. The table below shows the number of facilities conducting Usapan sessions for the current and previous quarters.

TABLE 1: Number of Facilities Conducting Usapan Session Area Y2Q1 Y2Q2 Visayas 5 128 Iloilo 1 3 Negros Occidental 0 1 Bohol 0 6 Cebu 1 77 Leyte 1 8 South Leyte 1 10 Samar 1 6 North Samar 0 17

A.1.2. INTRODUCTION OF TOOLS TO TRACK PREGNANCIES AND DELIVERIES. In order to promote the utilization of birthing centers the VisayasHealth project introduced a tool to track pregnant women and facilitate the provision of ante-natal care and safe delivery in an accredited birthing facility. The Facility-Based Delivery Package (FBDP) involves the active participation of CHTs in identifying pregnant women in the community and encouraging them to access ante-natal care and safe delivery services in birthing centers. The package also includes the provision of incentives to the CHTs and the clients who avail of this service. The incentives are taken out from the funds generated through PHIC reimbursements to accredited health care facilities. Below is a table showing the number of facilities implementing the pregnancy tracking tool and Delivery Tracking Board:

TABLE 2: Number of Facilities with trained personnel on FBDP Area Visayas 42 Iloilo 0 Negros Occidental 0 Bohol 0 Cebu 27 Leyte 2 South Leyte 8 Samar 4 North Samar 1

A.1.3. INTRODUCTION OF EVENTS INVOLVING THE PARTICIPATION OF PREGNANT WOMEN. Another intervention introduced by the VisayasHealth project during this reporting period is the conduct of a meeting of all pregnant women in the community. The meeting is designed to provide important information to the pregnant women about their current pregnancy and help them make decisions about their

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 11

Reasons for Variances in the Performance/A.1.3, continued fertility intentions after delivery. Below is the number of health facilities that conducted meetings involving pregnant women and their partners.

TABLE 3: Number of Facilities Conducting "Buntis Congress" Area Visayas 8 North Samar 2 Samar 2 Negros Occidental 2 Bohol 2

A.2. Level of demand generation activities is still way below the project's performance targets. Despite the project's improvement in performance in demand, the level of performance is still way below the figures targeted for this quarter. The reasons for this performance are:

A.2.1. Underreporting of data from "routine" demand generation activities of local service providers. The data presented in this quarterly report is mainly taken from the results of project-initiated activities such as the conduct of Usapan sessions and meetings of pregnant women. These activities are but a fraction of the regular demand generation activities performed by the service providers such as individual counseling sessions during routine antenatal care and postpartum visits. The difficulty lies in the stringent reporting requirement of having client signatures as a means of verification for the service being rendered. The routine counseling services during prenatal and postpartum visits do not have the required signature of clients served. To address this issue the project will propose to have a list of clients served and have them certified by service providers. A.2.2. Limited availability of data from public hospitals. The absence of a reporting system for public hospitals to report public health activities such as the numbers of clients given FP counseling is another factor that is responsible for the underreporting of demand generation activities. There are at least 35 publicly owned hospitals in the Visayas that have large volumes of clients who come for prenatal and postnatal visits but are not captured in the existing reporting system of the DOH. To address this problem, the project will introduce a system that will enable hospitals to record and report its performance with respect to demand generation. A.2.3. Absence of performance data from the private sector. A major source of service provision for MNCHN/FP services is the private sector. The VH project does not have the capacity to access this information. B. Improving Supply B.1. Reasons for increase in supply-related performance compared to the previous quarter. The data generated for this reporting period showed further increases especially in the provision of postpartum FP services and in the number of clients who decided to avail of surgical sterilization services. These increases are due to the following: B.1.1. INCREASE IN THE NUMBER OF PPIUD PROVIDERS.VH conducted two training courses on PPFP/PPIUD and increased the number of PPIUD providers to 51. The additional providers accounted for 650 clients who decided to avail of the method. The training courses were conducted by provincial-based trainers in the provinces of Bohol and Iloilo. B.1.2.Increase in the number of trained VSS providers.VH was able to provide an opportunity for trained VSS-MLLA providers to enhance their clinical skills by organizing outreach services. A total of 7 providers were involved and were able to perform the procedure under the guidance of trainers engaged by the project.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 12 Reasons for Variances in the Performance, continued

B.1.3. TRAINING ON CONTRACEPTIVE TECHNOLOGY FOR VH STAFF.On February 17 to 21, 2014, VisayasHealth staff underwent training on contraceptive technology. The training course was facilitated by Dr. Levent Cagatay and Dr. Jared Nyanchoka of EngenderHealth’s Global Clinical Support Team and was designed to update the staff on contraceptive technology and family planning. The course was attended by all the staff and temporary hires who are directly or indirectly involved in the clinical training of service providers. The course focused on the provision of sub-dermal implants and IUD services which are two of the methods that VH project intends to roll-out over the next 5-6 months. B.1.4. Conduct of a CLINICAL CASE FOR POST-PARTUM FP and PPIUD.On March 3, 2014, the VisayasHealth project organized a clinical case conference for providers trained on post-partum family planning. The conference was designed to provide a venue to share clinical information and experiences by trained PPFP/PPIUD providers. A total of 80 PPFP/PPIUD trainers and providers attended the conference. Case presentations on important clinical issues such as common complications and difficult cases encountered and training issues such as trainee selection and trainee follow-up were discussed. The clinical case conference helped build the skills of providers on how to manage commonly encountered clinical issues. A copy of the conference proceedings may be appreciated at Annex G. A special feature is also dedicated under the section Success Stories/Highlights. B.1.5 CONDUCT OF THE FAMILY PLANNING STATE OF THE ART TECHNICAL CONFERENCE.On 27March 2014, the VisayasHealth project, in collaboration with Maternal and Child health Integrated Project, organized a technical conference on the state of the art of contraceptive technology. The conference was designed to present and discuss current practices regarding the provision of family planning services. The conference focused on hormonal contraceptives and options for clients interested in post-partum family planning. Many participants expressed interest to be trained in PPFP and in the recently introduced sub-dermal implant method. B.2. Reasons for low level of performance compared to targets for the quarter. B.2.1. ABSENCE OF DATA/INFORMATION FROM THE PRIVATE SECTOR AND THE COMMUNITY.The data generated by the project is taken mainly from the public sector and does not capture information from private sector sources. The private sector accounts for 53.8% of the total family planning usersbased on the NDHS. B.2.2. LIMITED INFORMATION COMING FROM PUBLIC HOSPITALS.Within the public sector, public hospitals do not routinely report MNCHN/FP data. The project has introduced a system to collect information especially on post-partum FP from selected hospitals where there are trained PPFP providers but this is only a small fraction of the total number of public hospitals in the Visayas.

C. Increase in the number of birthing centers that applied for a license to operate as an MCP accredited facility. In order to facilitate the accreditation of birthing centers in Region 7, the Department of Health RO7 introduce an initiative that would provide temporary licenses to operate while awaiting the completion of the required standards based on assessments conducted by the licensing office of the DOH. In support to this initiative the VisayasHealth project conducted meetings among healthcare providers and provided technical assistance in the submission of applications for the temporary license to operate and other supporting documents required. Table 4 summarizes the number of birthing centers (35) that the VisayasHealth project assisted that actually submitted their applications to the DOH. As a result of this initiative, the project is anticipating a sharp increase in the number of MCP accredited facilities in the next quarter.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 13

Reasons for Variances in the Performance, continued

Table 4: No. of RHUs who have applied for MCP Accreditation as of Q2Y2 Area

Bohol 6 Cebu Province 6 Cebu City 15 Lapulapu City 0 Mandaue City 0 Total 35

D. Increase in the Number of Young Women Provided with FP Information and Counseling Services  INTRODUCTION OF PROGRAM FOR YOUNG PARENTS. On March 4, 2014, the VisayasHealth project launched the program for young parents established in the Vicente Sotto Memorial Medical Center. The PYP is intended to provide special attention to the needs of young and pregnant adolescents. The PYP will also facilitate the provision of family planning services to these young women to prevent the next unwanted pregnancy. The launching was high-lighted by the presence of USAID deputy mission director, MR. Reed Aischliman who delivered the message during the opening program. During the launching, the participants and guests were able to witness the health education session attended by a group of teenage pregnant women as part of the PYP. A special feature provides a brief description of the event under Success Stories/Highlights.

V. Major Implementation Issues

Areas of Planned Actions if Implementation Issues Actions Taken Concern Not Resolved 1. Management  Many health facilities Implemented the supplemental plan -Identify other options Concerns damaged by the disasters that VisayasHealth formulated with non-government especially in Leyte, Northern which include: organizations to fast- Cebu and Bohol still not - hiring of 2 additional short term track rehabilitation of rehabilitated preventing the technical personnel to assist the health facilities and the project from carrying out provincial coordinator (PC) of Leyte provision of equipment. the planned technical in providing technical assistance to -Train health providers assistance activities in the the local government units of the affected health affected areas. - coordination with other non- facilities on the government organizations in the technology of providing rehabilitation of some health reproductive health facilities and in the provision of services during equipment and solar lights to humanitarian crisis facilities without electricity situations. - designation of a point person, Ms. Alicia de Guzman from among the Cebu-based specialists to supervise and assist VH staff in Leyte

 Many health facilities in the -VisayasHealth offered through the Explore other options Visayas experience stock- DOH-OCV to help the DOH in the for the DOH to fast- outs because of the failure distribution of contraceptive track the delivery of of the DOH to deliver supplies. DOH has yet to reply to contraceptive supplies. the offer of assistance.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 14 Areas of Planned Actions if Implementation Issues Actions Taken Concern Not Resolved contraceptive supplies -The project is also working with the provincial health offices to deliver stocks that are still available at the provincial warehouses and advocated for local procurement of contraceptives.

 Difficulty of the project in VH in collaboration with the DOH VH will explore obtaining service delivery regional offices introduced a system conducting cluster information from private to capture postpartum FP data in surveys or sentinel sector providers and from hospitals with trained PPFP reporting sites to government hospitals providers address this problem 2. Security Not Applicable Not Applicable Not Applicable Concerns 3. Others - Facility-based deliveries in the Assisted the Department of Health Obtain copies of the list PhilHealth Visayas have increased but (DOH) licensing team to fast-track of deficiencies for each MCP MCP accreditation esp. in the applications for license to facility and assist these Accreditatio Regions 6 and 7 remain low operate(LTO) which by 2015 is facilities in complying n making this a missed needed for PhilHealth accreditation the deficiencies. opportunity for the facility to be reimbursed by PhilHealth.

VI. Milestones, Key Tasks, and Activities A. Highlights of the Activities in the Quarter 1. Completion of the Baseline Survey of VisayasHealth assisted sites including Cebu province, Cebu City, Mandaue City and Lapulapu City. The baseline survey for the other VisayasHealth-assisted provinces (Bohol, Iloilo, Negros Occidental, Leyte, South Leyte, Samar and West Samar) was carried out in October 2013. For the province of Cebu and the tri-cities of Cebu, Mandaue and Lapulapu, the survey was completed in January to February, 2014. The main objective of the survey was to provide a description of the status and trends of maternal and child health in VH-assisted areas. A total of 112 hospitals and 339 health centers were covered. Some results of the survey show that:  Only 4 in 10 pregnant women seeking ANC are provided FP counseling  Only 5 in 10 postpartum women provided with FP counseling and services  Only 4 out of 10 Service Delivery Points (SDPs) able to provide FP counseling, services and/or referral to clients in USG-assisted sites  50% of hospitals are able to provide VSS services  Only 27% of hospitals provide BTL-MLLA services  High level of stock-outs in SDPs  6 of 10 midwives/nurses trained on FP-CBT1 including basic counseling  3-4 of 10 RHMs/PHNs trained on interval IUD  Four out of 10 hospital midwife/nurse trained on LMT  More policies in LGUs supportive of SBA/FBD compared to FP  Almost all assisted facilities in Region 8 are PhilHealth certified for MCP-NCP; much to catch up in Region 7

2. Clinical Case Conference on PPFP/PPIUD. VisayasHealth organized a clinical conference on PPFP/PPIUD on March 3, 2013. The clinical case conference was designed to present and discuss clinical issues encountered by trained providers in the provision of PPFP services. Case presentations were made and

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 15

Milestones, Key Tasks, and Activities/Highlights/CCC, continued discussed by providers and technical resource persons during the conference. A total of 160 participants composed mostly of PPFP trained providers, trainers and interested participants were in attendance.

The objectives of the clinical case conference were:  To present and discuss clinical issues based on the experience of trained health providers on PPIUD  To recommend measures to improve the quality and effectiveness of PPIUD  To discuss ways of promoting PPIUD as an FP method  To discuss ways to sustain PPIUD services  To discuss issues related to the training of PPIUD service providers 3. Launching of the "Program for Young Parents". VisayasHealth is adapting the Teen Moms program of the University of the Philippines Philippine General Hospital (UP PGH) in its Program for Young Parents (PYP). This intervention will help reduce births among young women in the Visayas. The venue of the program launch was the Vicente Sotto Memorial Medical Center (VSMMC), a DOH-owned teaching training health facility based in Cebu City. The program was officially launched on March 4 with the participation of Ms. Pam Barnes, president and CEO of EngenderHealth, Mr. Reed Aeschliman, Deputy Mission Director, USAID, ASEC Paulyn Jean Rosell-Ubial, Assistant Secretary of Health, Visayas Operations Cluster as special guests. 4. Clinical Foundational Training This training was conducted with the main objective of orienting VisayasHealth program staff to EngenderHealth’s approaches, tools, resources and policies for improving the quality of technical assistance provided for clinical services supported by VisayasHealth. This was facilitated by Dr. Levent Cagatay and Dr. Jared Nyanchoka of EngenderHealth's global Clinical Support Team. Other objectives of the training are:  Explain EngenderHealth’s SEED programming model  Orient participants to EngenderHealth’s and US Government’s policy requirements  Orient participants to Ensuring Clinical Quality framework and its components  Introduce EngenderHealth’s programs and technical library  Provide an update on contraceptive technology  Standardize skills for provision of long-acting reversible contraceptives (IUD including PPIUD and implants)  Identify action points and next steps in the implementation of VisayasHealth work plan

At the training, the participants were able to practice IUD insertion IUD using the Zoe model and implants using the arm model. The training course enabled the VH staff to be more confident in dealing with questions relative to the provision of family planning services. 5. Partnerships with non-government organizations. During the 2nd quarter of year 2 for USAID/VisayasHealth-EngenderHealth, partnerships were forged primarily to form part of the disaster assistance program for the typhoon-hit project areas, except for UNFPA which allotted support for the introduction of the sub-dermal contraceptive implants. Below are some of the details of these organizations and their support. See also summary table on the next page or in Annex D on PPP.  Americares, a U.S.-based NGO, focused on disaster response and provided funding assistance to typhoon stricken areas in the Provinces of Leyte and Northern Cebu. The partnership between EngenderHealth and AmeriCares resulted in the rehabilitation of selected damaged health facilities in Leyte (7 health facilities) and Northern Cebu towns (15 BHSs). The group also donated supplies and medicines.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 16 Milestones, Key Tasks, and Activities/Highlights/Partnerships…, continued

 We Care Solar allotted Solar Suitcases that would power up small but very necessary appliances for birthing centers such as solar-powered lights, mobile phones, and the fetal Doppler among others. Only 2 (two) were sent this quarter but the group has committed to ship more in the coming months.  StiftungSolarenergie-Solar Energy Foundation donated solar powered lights with solar panels to light up health/birthing centers especially at night.  UNFPA has given 20,000 implants to support the project’s upcoming launch of the sub- dermal contraceptive implants.

Activity/ Private partner/s Cost share Budget Component AmeriCares Supplies and Medicines Php16,286,224 Breakdown: Leyte: Php7,522,311 North Cebu: Php8,763,913 We Care Solar Two Solar Suitcases Php150,000.00 Disaster Breakdown: Response P75,000.00/suitcase X 2 Stiftung Solarenergie Solar Powered Lights: Approx. Php 104,000.00 Solar Energy M100 – 13 units Foundation M300 XL – 18 units Home 200 – 2 units

Supply for UNFPA 20,000 pcs Implants Php6,000,000 Training and Service Delivery

6. Ms. Pamela Barnes' Meeting with Partners.The president and CEO of EngenderHealth, Ms. Pam Barnes, paid the VisayasHealth staff a visit on March 2-7, 2014. Highlights of her visit include:  participation in the clinical case conference and the launching of the Program for Young Parents  meeting with top officials of USAID, DOH, PRIMEX, UNFPA, AmeriCares, International Care Ministries (ICM) and Solar Energy Foundation and other Cooperating Agencies for Visayas  site visit to Bohol to one of our training centers, Gov. Celestino Gallores Memorial Regional Hospital, and to birthing centers badly affected by the earthquake  meeting with VisayasHealth staff 7. 2014 DOH OCV Executive Committee Meeting. The first Executive Committee Meeting of the DOH Operations Cluster for the Visayas for 2014 was facilitated by VisayasHealth on February 5-6, 2014 in Panglao, Bohol. The event was attended by Chiefs of DOH-retained hospitals and the Regional Directors and Assistant Regional Directors and technical staff of the 3 DOH Regional Field Offices 6,7, and 8 and representatives of the Visayas Inter-CAs. Highlights of the meeting include the updates on DOH issuances, the General Appropriations for 2014 and a presentation of the results of the baseline survey conducted by VH in 8 provinces covered by the project.

B. Planned Major Activities in the Next Quarter: 1. Program Management:  Hiring of Human Resource Manager, STTAs for program implementation in Iloilo, Negros Occidental and West Samar

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 17 Milestones, Key Tasks, and Activities/Planned Major Activities…, continued

 Expand Net Training for EngenderHealth Staff  TOF on Gender Awareness and Programming  Work planning Workshop for Year 3  Training of Sexual and Reproductive Health in Humanitarian Conditions 2. Demand Generation:  "Buntis Party" in selected municipalities  Capability building of Breastfeeding Counselors  Conduct of Usapan sessions and pregnancy tracking sessions in selected areas for health service providers, CHTs and nurses assigned in the Nurses Deployment Program of the Department of Health 3. Increasing Supply:  TOT for trained health service providers on PPIUD  Training of health service providers on PPIUD in identified training centers  Training on the use of Sub-dermal Implants  Orientation on PYP (Program for Young Parents) to EVRMC and WVMC staff  Provision of ambulatory surgical services (BTL) by 2 ambulatory teams to selected sites 4. Policies and Systems:  Facilitate the issuances of DOH License To Operate (LTO) which will be a requirement for all birthing facilities by August 2015; the issued LTO will automatically be issued an MCP accreditation by PhilHealth in Region 7; the same initiative is being encouraged to be implemented also in Region 6;  Enhance logistics management systems of regional and provincial health offices through the NOSIRS (National On-line Stock Inventory Reporting System) or other available logistics management system adopted by the provincial/LGUs;  Development and finalization of an advocacy tool that can be used to provide estimated data on PHIC reimbursement given the estimated number of births in a given period of time; the MCP Benefit showing 3 scenarios that can be utilized by the health facilities and at the same time provide a scheme for CHT incentive. 5. Gender  Conduct of the Training of Facilitators (TOF) on Gender for VH Gender Team, USAID/Visayas Inter-CAs and regional/local partners on May 5-9, 2014;  Conduct of Gender Orientation for PYP Management Team of Vicente Sotto Memorial Medical Center, Cebu City on May 2, 2014 and for Corazon LocsinMontelibano Memorial Regional Hospital in Bacolod City, Negros Occidental on May 12, 2014;  Development and finalization of an advocacy tool used in the identification of a Gender- Friendly Health Facility.

C. New Opportunities for Program Expansion  Conduct of Program Implementation Reviews by interlocal health zones in Leyte and Samar  Partnership with government and non-government organizations  Hiring of additional provincial coordinators for Negros Occidental, Iloilo and Samar

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 18 VII. Financial Reports Itemized Project Expenditures (USD) Expenditure This Quarter Cumulative Total Cumulative % of Amount at LOP Expenses Month Month Month Expenses Cost Items End of This of Previous Mar Based on Jan Feb This Quarter Quarters 2014 the LOP 2014 2014 Quarter Labor + Fringe Benefits 222,184 53,549 62,242 111,389 227,180 102.25

Travel and 317,985 32,715 53,596 63,502 149,813 47.11 Transportation Project Activities Sub-grantees/ sub- 55,000 33,191 19,450 20,292 72,933 132.61 contractors Other Direct Costs 164,523 22,797 53,272 26,108 102,177 62.11 Indirect Costs 201,990 90,451 76,674 167,125 82.74 TOTAL 961,682 232,703 265,234 221,291 719,228

Provincial/City Expenditures Costs of Activities Per Province Logistics Others (please Total Province/City (equipment, TA Training specify) Expenditure supplies, Disaster Relief materials) Ilo-ilo 7,178 10,117 17,295 Negros Occ 3,897 116 4,013 Negros Or Bohol 6,204 4,992 11,196 Leyte 4,189 1,225. 5,414 Southern 2,672 1,410 4,082 Leyte Northern 3,451 3,222 6,673 Samar Western 1,622 2,426 4,048 Samar Cebu 3,818 31,793 35,611 TOTAL 33,031 55,301 88,332

NOTE: The amount for Travel & Transportation includes the Project activities

VIII. Success Stories / Highlights 1. First Clinical Case Conference on PP IUCD held In order to share experiences in the application of the newly introduced Post-partum Intra-Uterine Contraceptive Device (PP IUCD), 66 trained service providers from the provinces of Iloilo, Negros Occidental, Bohol, Cebu, Leyte, Southern Leyte, Samar, and Northern Samar gathered with 14 trainers among the total of 207 other participants at the Cebu Marriott Hotel on March 3, 2014. It was the first case conference held after the series of provider trainings in the said provinces from June 2013 to February 2014. These trainings and the conduct of the conference are part of the technical assistance to the regional and provincial government health agencies by the USAID-supported VisayasHealth project of EngenderHealth in partnership with MCHIP.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 19 Success Stories/Highlights...PP IUCD CCC , continued

The conference provided a venue for the discussion of issues and concerns related to PPIUCD including: management and side effects and complications; generating demand; improving the quality of service provision; and identifying and addressing issues related to training and sustainability.

Participants dubbed this new contraceptive technology as the “almost perfect method” due to the fact that it is much easier to perform though requires a lot of practice. This Participants from Central Visayas had the most number at was among the highlights gleaned at the gathering along the Case Conference for PPIUD from among the total of 207 with the importance of early counseling for clients, follow participants composed of doctors, nurses, midwives, program managers, FP/MNCH Coordinators, LGU Executives; Regional up initiatives for both client and trained providers, more and Provincial Health Officers. The event was also graced by discriminate selection of trainees, standardized recording & Assistant Regional Director Lakshmi Legaspi of the Regional reporting systems, and defined hospital policies in the Health Office Central Visayas; Ms. Reynalda Perez, AOR of performance of procedures (e.g. doctors’ orders, the option USAID OH; Dr. Yolanda Oliveros, Development Projects Specialist, also of USAID OH; Ms. Pamela Barnes, President on manual procedure of insertion, and parental consent for and CEO of EngenderHealth; Dr. Jose Rodriguez, minor clients). VisayasHealth COP; Dr. Susana Madarieta, VisayasHealth DCOP; as well as representatives of different cooperating agencies implementing health projects. (Photo by USAID/ VisayasHealth-EngenderHealth)

2. Program for Young Parents Launched at VSMMC

In response to the alarming increase in pregnancies among teenagers, Central Visayas Regional Hospital Vicente Sotto Memorial Medical Center (VSMMC) launched on March 4, 2014 the Program for Young Parents (PYP) and inaugurated its new Center for Young Parents. The Center is operated by an inter-departmental team of health service providers under the PYP

The United States Agency for International Development The ceremonial ribbon cutting to officially open the Young Parents' Center at VSMMC was graced by (USAID) extends its support to the hospital’s PYP through the (from left) VSMMC Chief of Clinics Dr. Roque VisayasHealth project in the form of technical assistance in Antonio Paradela, Assistant Health Secretary Dr. organizing and setting up of the program; ensuring the Paulyn Jean Rosell-Ubial, EngenderHealth availability of an adolescent-friendly area where the young President and Chief Executive Officer Pamela Barnes, and USAID Deputy Mission Director Mr. parents can receive information and counseling; and in Reed Aeschliman. strengthening the capacity of health service providers in the (Photo by Basal/USAID/VisayasHealth-EngenderHealth) management of adolescent cases.

The VSMMC PYP reaches out to pregnant adolescents, their partners, and eventually their newborns in safeguarding the health of mothers and their babies. This comes in cognizance of the fact that an adolescent’s young body has not reached adequate maturity for the stresses of pregnancy and childbirth.The program seeks to encourage young parents to complete the four pre-natal consultations: once during the first three months of pregnancy, another between the 4th and 6thmonths of pregnancy, and twice between the 7th month until the time of delivery. The PYP also steers young parents to deliver their babies in accredited facilities under the care of trained professionals, encourages them to exclusively breastfeed their newborns for at least six months, and counsels young parents on modern family planning practices to help them space their children three to five years apart.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 20 Success Stories/Highlights...PYP, continued

The Center for Young Parents feature group counseling for the teen mothers (Left) on the wide range of family planning options while waiting for their turn for their pre-natal counseling by a VSMMC health provider. At right, a child plays by herself at the designated Play Area at the Young Parents Center while her mother attends the group counseling. (Photo by Basal & Alfafara/USAID/VisayasHealth-EngenderHealth)

Recent data from the National Statistics Office (NSO) reveal an alarming 70% increase in teen pregnancies in 2010 from the recorded number in 2000. Nationwide, about 12% of all live births in 2010 happened among mothers 18 years old and below. Further, data shows that teen mothers tend to have closely spaced succeeding pregnancies. In 2013, one out of ten babies born in VSMMC were delivered by mothers younger than 18 years old. It is with such data which spurred the regional hospital to set up the PYP.

3. Buntis Celebrations: A Breakthrough in Better Healthcare for pregnant women  Bobon, Northern Samar

In the coastal town of Bobon, Northern Samar, the Provincial Health Office (PHO) saw the need to address the growing need for quality maternal, child and newborn health and nutrition (MNCHN) of the town’s 20,956 constituents (2010 National Statistics Office data) from its 18 barangays. On top of the growing population rate, the PHO was particularly concerned over the health of women’s health during pregnancy, childbirth, and the post-partum period. It was also concerned that maternal and child deaths related to pregnancy and childbirth complications attributed to delays in seeking medical care; in identifying appropriate facility, and; in the receiving of appropriate and adequate care at the facility by the mothers.

Usapan sessions and PhilHealth enrollment highlights Bobon Buntis Congress.

Below for L-R: A DOH nurse facilitates the session with the Bobon Municipal Health Officer observing; male involvement was also encouraged with separate counseling sessions for the men who accompanied their spouses; Philhealth staff were available to enroll the pregnant women. (Photos by Tenedero/USAID/VisayasHealth-EngenderHealth)

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 21 Success Stories/Highlights...Bobon Buntis Congress, continued

On March 10-11, 2014, the Northern Samar PHO, USAID/VisayasHealth Project, the Rural Health Unit (RHU) staff, and PhilHealth conducted Bobon’s very first “Buntis Congress”, or a gathering of pregnant women in Bobon. Among the highlights was the project-initiated Usapan sessions (conversational group counselling) which gathered groups of 10-15 pregnant women and engaged them in a dialog on a range of family planning. The sessions were facilitated by the nurses and midwives of the RHU. Out of the175 total of attendees, 90% indicated interestin a family planning method after they deliver their babies. Bobon’s Mayor Celespara gave his inspirational message. Asked to why he supported the event and allowed the release of Php1,000,000.00 for PhilHealth enrollment, Mayor Celespora reasoned health improvement as the priority of his administration.

“There is a lack of funds and I saw the income potential from Philhealth. If the mothers would really avail of the health services at the health center, we would attain our goals for health, and the local government unit will earn at the same time. This way, we are hitting two birds in one stone. There will be additional funds to improve the health services and we could shoulder the cost for additional manpower,” added Mayor Celespara Bobon Mayor Rene Celespara delivers an inspirational speech at his town’s first Buntis Congress. (Photo by Tenedero/USAID/VisayasHealth-EngenderHealth)  Motiong, Samar

Motiong is a fourth class municipality in Samar. It has 30 barangays, only 10 of which are connected by a road network;; the rest are classified by the Philippines' Department of Health (DOH) as geographically isolated and disadvantaged areas (GIDA). Due in large part to the isolation, the Local Government Unit (LGU) has had to be very innovative in addressing the challenges of maternal and child health and nutrition.

According to the Municipal Health Officer (MHO), Dr. Perlie P. Langi, in 2009, only six percent of deliveries were facility-based. Most mothers preferred to deliver their babies at home, attended by palteras or traditional, unskilled birth attendants. First, travel to the birthing facility takes a long time and incurs expense. Second, mothers have a personal relationship with the paltera since they live within their neighborhood. In addition to delivering the baby, the paltera takes on household chores -- like doing the laundry and preparing food -- while the mother recovers from child birth.

Left, The first participants to register for the event received a special gift -- baskets of fruit -- a reminder to eat healthy during their pregnancy; At right, Fathers listen intently to the facilitator's explanation during the Usapang Maginoo -- one of three Usapan sessions that capped the Buntis Congress. Many participants signified their intention to adopt family planning after delivery.

Photos show the “Buntis Bank” project in progress at the Buntis Congress. This is another initiative of the LGU. Pregnant women are encouraged to put aside whatever amount that they can to help defray unexpected expenses during their delivery. The coin banks are kept at the Rural Health Unit. Anyone who wants to make a contribution can do so. The LGU matches the savings of the mothers in kind. For example, if a mother is able to save up Php 1,000.00, the LGU gifts her with a maternity package containing basic items for her delivery and confinement. Photos by De Guzman/USAID/VisayasHealth-EngenderHealth

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 22

Success Stories/Highlights, continued The Sangguniang Bayan (local legislative council) passed an ordinance encouraging facility-based deliveries last (year). Through this ordinance, the paltera is given a cash incentive (150 PhP) for bringing the pregnant mother to deliver in the birthing facility. Mothers from distant areas can choose to stay in a designated area to await delivery. The LGU supports their basic needs for a place to stay and food before and during their confinement. Today, 51 percent of mothers opt for facility-based delivery. The LGU is also implementing a local family welfare program called 4K. Couples enroll in and attend educational sessions. Couples receive incentives -- like assistance on backyard gardening; sponsorship/scholarship for one of the children; home improvements; etc. -- if they are able to complete 12 sessions.

The LGU hosts a Buntis Congress where pregnant mothers are feted every year. There are educational sessions and other activities. Each mother goes home with a gift bag containing essential items for the baby like a bonnet, booties, mittens, and diaper. Last March 31, a total of 120 pregnant women attended the Congress.

4. Light at the end of the storm

The aftermath of the super typhoon Yolanda rendered many areas in the Visayas homeless, bereft of basic survival needs. Government offices and health facilities designed to assist communities were not spared and at a loss on how to help their respective constituents rise and rebuild their lives. Among the greatest losses were the availability of electricity essential to power up basic appliances, and communication devices. Save for the incandescent glows of candles, oil lamps, bonfires and occasional beams of flashlights, nights are pitch black in the islands of Bantayan in Cebu, and in the municipalities of Medellin, Bogo, and Daan Bantayan in Northern Cebu among other places. The need is more felt for relief operatives, students who needed to study at home, and at Barangay Health Stations during medical care emergencies and delivery of babies especially at night.

The USAID/VisayasHealth project, implemented by EngenderHealth sought out local organizations to help the people in these areas as well as in Leyte, Samar, and Iloilo. Through the Stiftung Solarengergie – Solar Energy Foundation Philippines (StS), a group engaged in mobilizing joint relief efforts with on-the- ground rescue in the disaster hit areas by providing access to light, energy, and communications with solar panels and solar suitcases, VH partnered with Philippine Inter-Inter-Island Sailing Foundation (PhInSaF) to distribute the solar power system in the islands. The solar panels and solar suitcases can power up LED light units of several The ceremonial turnover of solar-powered lights to variations, fetal doppler (maternity/birthing centers), and VisayasHealth-EngenderHealth and to its beneficiaries formed part of the operation co-sponsored by Stiftung Solarenergie recharge mobile phones. and PHINSAF, dubbed “Sail for Light”. The program included a demonstration (top right photos) of the use and care of the On March 15, 2014, the first ceremonial turnover of various models of the donated solar-powered lights. solar-powered lights (with panels) took place in Daan (Photo by Alfafara/USAID/VisayasHealth-EngenderHealth) Bantayan. StS and VisayasHealth-EngenderHealth turned over the units to the Muncipal Health Officers of Medellin, Bogo, and Daan Bantayan and their staff.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 23 Success Stories/Highlights, continued

The second turnover was held in Bantayan Island on March 18, 2014 for the RHUs of Bantayan, Sta. Fe, and Madridejos. The shipment of the solar suitcases is still underway and these two will be turned over upon their arrival.

Today, even as electricity is still unstable or yet to be restored in those Cebu areas, constituents can heave a sigh of relief. With solar-powered lights illuminating the birthing centers, work for birth attendants is more safe and efficient even after dark – whether it’s to deliver babies or to give care after delivery.

IX. Communication and Outreach

1. Facility-Based Delivery Package VisayasHealth has taken the pregnancy tracking strategy initiated by the Japanese International Cooperating Agency (JICA) in Region 8 and adapted and expanded it into a Facility-Based Delivery Package.

Under this strategy, Community Health Team (CHT) members identify pregnant women in their respective catchment areas and immediately record the information about the individual mother in a Pregnancy Tracking Form. (See Annex A Figure 1). The pregnancy is reported to the Rural Health Unit (RHU) and the assistance of the Rural Health Midwife (RHM) or Public Health Nurse (PHN) is requested for the computation of the expected date of confinement/delivery (EDC/D) as well as the dates when the pregnant mother should come for prenatal consultations. The CHT member is expected to remind the mothers of their checkup dates during domiciliary visits. The information is posted on a Pregnancy Tracking Board that is posted prominently in the RHU, so that the RHU staff knows who to expect for checkup and when. (See Annex A Figure 2.) Should a mother fail to come for her checkup, the CHT is immediately alerted so she can follow up the mother. The EDC/D is also posted on a Delivery Tracking Board in the birthing center so that the staff is similarly updated about impending deliveries. (See Annex A Figure 3.)

Through the Facility-Based Delivery Package, CHT members will also know who among the mothers in her area are interested in accepting a family planning method. The CHT member can, thus, initiate the conduct of an Usapan small group discussion and counseling session with the PHN or RHM as facilitator.

2. Usapan for Expectant Mothers

VisayasHealth adapted Usapan from Private Sector Mobilization for Family Health Project (PRISM2), another USAID-supported health project. Usapan has been proven effective in helping clients make family planning decisions. These decisions are reinforced through individual counseling, leading to the eventual adoption of a family planning method. Participants in Usapan small group discussion and counseling sessions are purposively selected so that each group is homogenous, such as, pregnant women; women who want to space pregnancies or stop bearing children; and men. VisayasHealth has simplified the Usapan process so that it takes a much shorter time to conduct (30 minutes instead of two hours). The Action Card (See Annex A Figures 4a, 4b, 4c, 5, 6) has been enhanced with the use of colored photographs to make it more attractive as well as enhance comprehension, particularly when it comes to family planning options. It now also features a detachable portion where mothers/fathers can signify their concurrence to receive messages on their mobile phones. The Pahinumdom or reminders via SMS are intended to further reinforce messages to submit to ANC on the specified dates, as well as other messages to promote healthy pregnancy and delivery, including: facility-based delivery; modern contraceptive methods; exclusive breastfeeding; process and requirements for availing of PhilHealth benefits; pregnant mothers and infant immunization schedule; etc.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 24 Annex A

List of Products Developed in Year 2 Q2 1. Facility-Based Delivery Package

Figure 1: The Pregnancy Tracking Form

Figure 2: The Pregnancy Tracking Board. Each box contains spaces for NAME, ADDRESS, and STATUS.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 25 Figure 3: The Delivery Tracking Board. Similar to the Pregnancy Tracking Board, each box contains spaces for NAME, ADDRESS, and STATUS.

2. Usapan for Expectant Mothers

Figure 4a: The Usapan Action Card -Front. Below is the Cebuano version of the action cards. Tagalog, Waray for Leyte, Waray for Northern Samar, and Ilonggo versions are also available.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 26

Figure 4b: The Usapan Action Card –Back / Flip side.

Figure 4c: The SMS Reminder Consent Form allows Usapan attendees to choose whether they wish to receive text messages aimed to encourage them to complete their four prenatal visits; to deliver their baby in health facilities; choose/accept a family planning method, and; exclusively breastfeed their babies.

Figure 5: The Pahinumdom SMS-based Automated Reminders. The table below is a sample of the log of the system. Monitoring and recording is done weekly . WOMEN PREGNANT WOMEN MEN Message sent Isama ang asawa tuwing Magpa-prenatal kaagad sa oras this week magpapa-konsulta sa na tumigil ang pagreregla center/clinic. hanggang ika-3 buwan ng pagbubuntis Translated into Bisaya, Ilonggo Translated into Bisaya, Ilonggo and Waray and Waray

Number + This Total Number + This Total Number + This Total in Data Week in Data Week in Data Week Base Base Base

Region 6 Iloilo 21 34 55 16 0 16 0 0 0

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 27 Figure 4: The Usapan Attendance Sheet. Other than the mere record of attendees, the document also summarizes the outcome of the session such as the number of women who chose a particular method.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 28 Annex B ICV Compliance Report (Semi-annual: Q2/Q4)

Part A: Technical Assistance, Inputs and Other Activities Compliance to ICV guidelines were observed during these training and PPIUD post training follow-up visits/activities Number of Date Location Specific Activity/ Conducted Participants Specific Remarks/Results/ Topic or Content By Whom Audience Outputs M F 2/4- GCGMMC, PPIUD training of 2 VH + 4 1 9 Doctor, Nurses LGU Personnel at 7/14 Tagbilaran, Providers Bohol and Midwives RHUs with Birthing Bohol Trainers Clinic; 10 clients provided PPIUD 2/11- Iloilo PPIUD training of 2 VH + 2 1 10 Doctor, Nurses LGU Personnel at 14/14 Provincial Providers Iloilo and Midwives RHUs with Birthing Hospital. Trainers Clinic; 11 clients Pototan, Iloilo provided PPIU 2/17- Summit Circle VH Clinical Start- 2 EH + 3VH 12 24 Doctor, Nurses 21/14 Suites, Cebu up Workshop trainers and Midwives. City 2/24- IPH and VSC Refresher 2VH Trainer 1 3 Doctors Only 1 recommended 26/14 Balasan Practicum for for certification for District Certification MLLA Hospital 3/4/14 Marriott’s Clinical case VH 44 163 Doctor, Nurses Well attended Hotel Conference on and Midwives, Case studies showed PPIUD Program how to manage Managers, difficulties, issues FP/MNCHN related to PPIUD Coordinators, training, service LGU Executives, provision Regional, Provincial Health Officer 3/11- Manuel B. PPIUD Post- 2 VH staff 0 2 District Health Both Staff 13/14 Veloso District Training Follow- Nurse at recommended to be Hospital, up MBVMH and given Certificate of Palompon, Midwife at ODH proficiency Leyte one doctor not Ormoc interviewed nor District observed Hospital Ormoc Leyte 3/25/14 Ormoc VSC Refresher 1 VH +Prism 0 3 2 service provider Joint activity with District Practicum for 2 + 1 Trainer PRISM2 Hospital Certification

Total 59 214

Total Number of Orientation/Training Activities conducted: __8__ Total Number of Participants Trained or Oriented: _273_ Males: _59__ Females: _214_

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 29

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

Results/Finding Steps Taken/ Name/Desi No. of FP s Recommenda- Date Name of Location gnation of Clients Monitored tions (please Monitor Facilities of facilities Service Interview by (please be as provide as ed Providers ed detailed as much detail as possible) possible)

2/4-7/14 GCGMMC, Tagbilaran, Drs. Alex 2 Dr. Cherry PPIUD clients are additional wall Bohol Navales II Pangilinan counselled during charts and flip and Ruby ANC and after charts for OPD Robles delivery thru and DR Usapan and individual counseling

2/11- Iloilo Provincial Pototan, Drs. Elizabeth 3 Dr. Gerry BTL Clients initial procurement of 14/14 Hospital. Iloilo Dator and Cruz, Cherry screening done by more IEC Lorna Canong Pangilinan RHU personnel materials and and group provision of counseling done more wall charts by Dr. Cherry Pangilinan

2/24- Balasan District Balasan, Dr. Esteban Dr. Cherry BTL Clients are recommended 26/14 Hospital Iloilo Magalona Pangilinan counseled by training of RHU staff prior hospital staff on to referral to the Usapan and hospital Counseling

3/11- Manuel B. Palompon, Ms. Juliet none Dr. Gerry IEC Materials requested the 13/14 Veloso District Leyte Lachica Cruz, Cherry available but the VH PC to Hospital, Pangilinan all chat needs replace the ICV replacement wall Charts

3/12/14 Ormoc District Ormoc Ms Luz none Dr. Gerry No IEC materials Requested VH Hospital Leyte Manatad Cruz, Cherry available, No ICV PC to provide Pangilinan Wall Chart, Uses ICV wallcharts PPIUD Manual to venue when discussing FP methods with cli

Total number of Facilities Monitored: 5 Number of facilities noted to be compliant to policies: 5 Total number of Service Providers Monitored: 6 Number of facilities with possible vulnerabilities: 0 Total number of FP clients interviewed: 5 Number of facilities with possible violations: 0

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 30 Part C. General Recommendations and Next Steps

Good points determined during this monitoring:  Clients are given information on FP methods based on their reproductive intensions during Usapan sessions (group counseling) and specific method counseling after screening using the WHO medical eligibility criteria

Points to improve on and recommendations/next steps:  needs more IEC materials and replacement of flip charts and ICV wall charts

Prepared by: __Gerardito F. Cruz____ Date: _4-07-14______

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 31 Annex C

Environmental Examination Compliance Report

Trainings: A total of 21 service providers were trained on PPIUD in Bohol and Iloilo Training Centers. The standard protocol on Infection Prevention and Hospital/General Waste Management of the Department of Health are already integrated in the training curriculum in adherence to the national policy on environmental mitigation in reducing the risk of infection associated to PPIUD insertion.

Baseline survey: Placental pit is the most important indicator in the hospitals and birthing centers. Its presence follows medical waste and other infectious waste are segregated and thrown in the vault. In Cebu province and its three cities, almost 100% of the hospitals (23 out of 24) have placental pit or septic vault compared to the 30% of the birthing units (30 out of 93). Further, this is one of the requirements for the MCP accreditation.

Monitoring: A total of 16 health facilities (RHU/CHO/Birthing Clinics and hospitals) of Negros Occidental and Southern Leyte provinces were monitored utilizing the EMMP monitoring checklist. Generally, infection prevention was observed but 5 of the facilities don't have an autoclave for high level disinfection. As to proper waste disposal, half don't have separate disposal for pathologic or infectious waste because they have no placental of septic tank.

Table 2. Results of EMMP Monitoring AREA Type of facility Infection Prevention Waste Disposal Hospital RHU/ CHO Measures Birthing Clinic NEGROS 0 8  hand washing  Needle and sharps OCCIDENTAL  Gloving in Bins/container SOUTHERN 3 5  Decontamination  50% NO Septic LEYTE  Cleaning tank for placenta,  50% NO autoclave for blood, Fallopian high level disinfection tubes  segregation not in place to most RHUs specifically on infectious or pathologic waste

TOTAL 3 13

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 32 Annex D

Public-Private Partners Report

Activity/ Public/Private Cost share Leverage Component partner/s Public Private AmeriCares Supplies and Medicines Php16,286,224 Leyte: Php7,522,311 North Cebu: Php8,763,913 Disaster We Care Solar P75,000.00/suitcase x 2 Php150,000.00 Response Stiftung Solar Lights: Approx. Solarenergie Solar M100 – 13 units Php 104,000.00 Energy M300 XL – 18 units Home 200 – 2 units Foundation Approx. Php 104,000.00 Supply for UNFPA 20,000 pcs Implants Php6,000,000 Training and = Php6,000,000 Service Delivery

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 33 Annex E Cities Development Initiative ILOILO CITY

The involvement of VisayasHealth in the Cities Development Initiative (CDI) program for Iloilo City started in the 4th quarter of 2013 and has started to bloom this quarter of January to March 2014. Informal courtesy and coordination meetings were done with the CHO and CPO for MNCHN/FP TA activities. This was seeded with the orientation on the MNCHN/FP program jointly conducted by DOH-RO VI and VisayasHealth where the VH technical assistance project was introduced. Initial plans were laid out for the activities on increasing demand, improving supply of services and enhancing systems for MNCHN/FP program implementation in the city. Entry point on Adolescent and Youth program initiatives were discussed and set. This was worked out closely with the Regional DOH-RO VI TWG on MNCHN/FP for the capacity building of service providers on AYRH-AJA training. This was realized on March 13-15, 2014 where 15 CHO service providers of 3 doctors and 12 nurses were trained. Three of them were further trained as trainers for the AJA training of service providers.

During the quarter, VH gave inputs for Iloilo City CDI plan in line with the need to strengthen health services for human capital development. Hereunder are the details of the 2014-2016 plan for TA on CDI project focusing on MNCHN/FP based on the TA portfolio of VisayasHealth.

VH Additional Inputs for Iloilo City CDI plan (as of January 2014) Counterparts (regional, Development Follow-On USAID City Actions provincial and other city Constraints Activities public and private agencies) Session 2: Strengthening Health Services for Human Capital Development 8/9 District Health CHO Iloilo City to provide VisayasHealth will Western Visayas Medical Centers in the city list of priority District Health coordinate with CHD WV Center as a training hospital of Iloilo do not Centers who needs to send for the inclusion of Iloilo will conduct the BEMONC have BEMONC BEMONC teams for training City priority DHCs in the Training with the support of (Basic Emergency BEMONC training; CHD WV; Maternal, VH to assist the CHO in CHD to provide for the Obstetrical and priority setting based on board and lodging of the Neonatal Care) DOH assessment criteria; BEMONC teams to be trained teams trained VH to support the LGU Iloilo City to pay for registration of BEMONC the registration of the teams to be trained when the participants LGU cannot provide due to unavailability of funds Service Providers CHO to update the inventory VH to assist the CHO in the CHD to provide in 9 DHCs have of trained HSPs and identify inventory of HSPs trained MNCHN/FP funds for the inadequate capacity priority service providers and in identifying priority training of HSPs on FPCBT1 in the provision of from all DHCs to be trained service providers to be and 2 and other FP trainings modern Family based on selection criteria set trained VH to upgrade the Iloilo Provincial Hospital as Planning services basic FP competencies of the PPIUD training particularly on HSPs thru the Contraceptive institution for Western LAPM/PPFP/ technology Updates, PCBT1 Visayas accommodate the PPIUD and 2 VH to conduct/ training of Iloilo City HSPs facilitate the training of Iloilo City LGU to allocate service providers on counterpart funds LAPM/PPFP/ PPIUD Health service CHO and CPO to identify VH to assist CHO and CPO CHO to provide counterpart provider RHMs in RHMs and Population in identifying RHMs for support for the training and 9 DHCs have Officers for training on USAPAN training implementation on

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 34 Counterparts (regional, Development Follow-On USAID City Actions provincial and other city Constraints Activities public and private agencies) inadequate skills on USAPAN conversation series VH in coordination with USAPAN CHD to support demand generation CHO/CPO to jointly CHD WV to conduct the the conduct and for MNCHN/FP spearhead the implementation USAPAN training for implementation of the services of USAPAN sessions in all RHMs and VH in USAPAN training and DHCs and birthing clinics partnership with CHW WV pregnancy tracking and among clients referred by the will orient CHO and CPO provide MNCHN/funds CHTs from the communities core staff/District Medical CHO/CPO to identify Officers/PHNs on the service providers to be gender responsive USAPAN oriented on pregnancy Pambabae and USAPAN tracking CHO/CPO to panlalake demand initiate and sustain the generation approach VH to pregnancy tracking as part of train CHO HSPs on their service protocol pregnancy tracking tool CHTs have CHO and CPO to identify VH to assist the CHO in the CHD and CHO to provide inadequate skills to CHT partners for IPC IPC training for CHTs counterpart funds for IPC communicate training CHO and CPO to VH to assist the CHO/CPO training of CHTs MNCHN/FP key conduct training of CHT in the conduct the messages and to partners on IPC for orientation on pregnancy generate and MNCHN/FP CHO and CPO tracking navigate women to identify CHT partners for with unmet needs pregnancy tracking to the health orientation facilities in the SDNs DHCs not yet CHO will follow up and VH to assist the CHO in the CHD to assist CHO in the PhilHealth- pursue MCP PhilHealth MCP facility assessment and pursuit of human resource accredited accreditation assessment and follow-up with PHIC for and facility requirements for accreditation for selected city compliance of requirements MCP accreditation CHD to district health centers and obtain MCP provide MNCHN funds to accreditation for support the requirements selected/priority DHCs- birthing centers Health service CHO to identify participants VH to assist in the training CHD WV to coordinate with facilities and HSPs to attend training on the of HSPs on gender sensitive DOH on the provision of have inadequate AYRH and use of Adolescent and responsive AYRH/AJA AJA manuals and AYRH services for AYRH Job-Aid Manual for the modules CHD to provide to address the Service Providers MNCHN funds for the Increasing cases of CHO to spearhead the trainings CHD to assist teenage pregnancy implementation of the use of CHO in the conduct of AJA and AYRH monitoring trainings tools in all district health facilities Set up Youth-Friendly Health Provide technical assistance CHD to support CHO in Facilities/Teen Moms' Clinics in the setting up Assist the this initiative CHD to CHO and DHCs in provide the technical strengthening the service direction and policy for the delivery network of services local establishment and on AYRH for pregnant implementation teen-agers

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 35 Counterparts (regional, Development Follow-On USAID City Actions provincial and other city Constraints Activities public and private agencies) CHO to build on public VH to engage public private CHD to assist CHO in this private partnership for the partners among birthing initiative with a regional AYRH/Teen Moms program homes as providers for mandate supporting the teen Iloilo City to facilitate the youth-friendly services moms clinic initiative improvement and including FP information operationalization of the and counseling VH to assist local policy on AYRH Iloilo City LGU in the friendly to include the Teen improvement of the local Moms program in the entire policy supporting city MNCHN/ FP and AYRH to include the Teen Moms programs MNCHN/FP CHO to include all of the VH to provide technical CHD to provide directions initiatives have above activities in the assistance to CHO in the on the AOP preparation inadequate funding AOP/WFP with allocation of plan formulation and CHD to equate funding support from the counterpart funds finalization support for all MNCHN/FP LGU CHO/CPO to source out activities funding support from NGOs and other development partners

This was further worked out with the USAID Philippines OH initiated Inter-CA meeting hosted by VH on January 27, 2014 in Iloilo City that harmonized inter-CA efforts to provide TA on MNCHN/FP. This was followed up by the training of service providers on AYRH AJA training in March. The orientation on the Program for Young Parents Teen Moms project conducted by DOH-RO VI with the TA from VisayasHealth on March 18, 2014 further strengthened the intentions of the CHO and city multi-stakeholders to work-up on the CHO project on the Friday Clinic for Adolescents/Youth. The attendance of three CHO representatives to the FP-SOTA last march 27, 2014 also addressed the CHO need for updates on FP methods and service provision.

As a highly urbanized city, the LGU has a very high powered political make-up that affects service delivery provision and system. There is a need to maximize strong links among the public private partnership and in- house politics to mobilize the entire workforce of the CHO for the project.

As such, TA plans for the next quarter April to June 2014 focus on assisting the city to have improved and harmonized multi-stakeholders' communed efforts for the MNCHN/FP program, improving demand generation for the services through training of service providers on the conduct USAPAN sessions cum Pregnancy Tracking System, capacitating selected service providers on FPCBT1 and Supportive Supervision.

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 36 Annex F

Gender

Integration of Gender has been paramount in the efforts that USAID/VisayasHealth Project has exerted in its scope of work as one of its technical approaches and guiding principles. As the initial step of its gender sensitive approach at a minimal level during the first quarter of Year 2, the project staff and selected regional partners were given a 3-day orientation/training on Gender Awareness, Gender Analysis and Gender Transformative Programming with the technical assistance provided by the EngenderHealth Head Office’ Gender Technical Advisor.

The VisayasHealth Gender Action Plan was also finalized and one of the identified action steps is the Training of Facilitators (TOF) on Gender which was planned for this quarter. However, due to several activities at the national, regional and LGU levels, this was re-scheduled to the 3rd quarter of Year 2. Preparations and arrangements are on-going for this TOF that will be conducted on May 5-9, 2014.

The organization of the VH Gender Team also gave way to efforts on integrating Gender in the planning workshop of the VSMMC- Program of Young Parents (PYP) in the hospital setting and in the development of the new Usapan Action Card used by the project for demand generation activities. VH also initiated in the latter part of this quarter, the development of a tool that will be used in defining a gender-friendly health facility that will be advocated by the project Visayaswide.

Submitted by:

Merlyn Rodriguez Gender Focal Person

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 37 Annex G Proceedings of the Clinical Case Conference on PP IUCD

8:00 - 9:00 AM Opening of Mini-Exhibit by VisayasHealth and other participating USAID partner projects - CHANGE; PRISM, MCHIP, IMPACT Registration & Assembly

9:00 - 9:40 AM Introductions, Welcome Spiels, and Acknowledgment of Delegates/Guests by Kaye Alfafara - Knowledge Management Officer, VisayasHealth Opening Prayer by Ms. Celia Fuentebaja - Provincial FP Coordinator, Negros Occidental National Anthem Welcome Message by Dr. Jose Rodriguez - Chief of Party, VisayasHealth 9:40 - 10:00 AM Inspirational Messages  Dr. Lakshmi Legaspi - Asst. Regional Director, DOH-RH 7 (On behalf of DOH Central Asst. Secretary Dr. Paulyn Jean Rosel-Ubial)  Ms. Reynalda Perez - Agreements Office Representative, OH-USAID Philippines  Ms. Pamela Barnes - President & Chief Executive Officer, EngenderHealth Inc. 10:00 - 11:15 AM Session I: BEST PRACTICES a. The Value of Early Counseling on Postpartum IUD Insertion (SOYMPH) - Dr. Iris Monsanto - Southern Leyte b. USAPAN: A Breakthrough Strategy in PPIUD Insertion - Dr. Janeatte A. Sobrevega -Mina RHU, Iloilo Province c. Strengthening Hospital FP Program & Tapping Facilitators for Demand Generation - Dr. Realino Molina -EVRMC, Tacloban City d. Recording System on FP Services at GCGMH - Dr. Alex Navales - GCGMC, Tagbilaran City, Bohol e. A System To Follow-Up PPIUD Clients at Carmen Municipal Health Office - Dr. Josephine Jabonillo - Carmen MHO, Bohol f. DISCUSSANT'S SYNTHESIS / REACTION: Ms. Alicia Lourdes M. De Guzman BCC Specialist, VisayasHealth g. OPEN FORUM / Q & A Facilitated by Dr. Gerardito F. Cruz - MNCHN/FP Specialist VisayasHealth 11:15 AM - 12:30 PM Session II: EXPERIENCES IN THE CONDUCT OF PPIUD TRAINING a. Practice Makes Perfect: Training on PPIUD Insertion Applied - Dr. Janeatte A. Sobrevega -Mina RHU, Iloilo Province b. Lessons Learned from PPIUD Training - Dr. Gerardito F. Cruz - MNCHN/FP Specialist VisayasHealth c. DISCUSSANT'S SYNTHESIS / REACTION: Dr. Bernabe Marinduque Senior Technical Adviser, MCHIP d. OPEN FORUM / Q & A Facilitated by Ms. Lucina Tapere Capacity Building Specialist, VisayasHealth 12:30 - 1:30 PM LUNCH

1:30 - 3:00 PM Session III: CLINICAL ISSUES a. A Case of Missing IUD - Dr. Hannah C. Jabasa Iloilo Provincial Hospital, Pototan, Iloilo b. A Case Report on PPIUD Expulsion - Dr. Marilyn Villalino Samar Provincial Hospital c. Manual Insertion of IUD Immediate Postpartum - Dr. Maria Elena B. Patalinghug Medical Officer III, SAMCH, Cebu City d. PPIUD Insertion under 10 “u” Oxytocin Intramuscular Injection - Dr. Melodia Nerida, Catubig District Hospital, Catubig, Northern Samar

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 38 e. The Dilemma on Hospital Requirement for Doctor’s Orders Prior to PPIUD Insertion f. Minors Requiring Parental Consent Prior to PPIUD - Dr. Alex Navales - GCGMC, Tagbilaran City, Bohol g. DISCUSSANT'S SYNTHESIS / REACTION: Dr. Cherry Pangilinan Master Trainer/Consultant, VisayasHealth h. OPEN FORUM / Q & A Facilitated by Ms. Alicia Lourdes M. De Guzman BCC Specialist, VisayasHealth

3:00 - 3:45 PM FINANCING OPPORTUNITIES IN THE PROVISION OF FP SERVICES a. MCH and PhilHealth Reimbursement - Dr. Ann Aguinsatan, Municipal Health Officer Javier, Leyte b. PRO VIII Updates as of Feb 7, 2014 - Mr. Walter R. Bacareza Regional Vice-President PhilHealth Regional Office c. OPEN FORUM / Q & A

3:45 - 4:00 PM AWARDING OF CERTIFICATES OF APPRECIATION (Presenters & Discussants)

4:00 - 4:15 PM SYNTHESIS & CLOSING REMARKS by Dr. Susana K. Madarieta Deputy Chief of Party, VisayasHealth

VisayasHealth Quarterly Report ● January 1, 2014 – March 31, 2014 39