2 2

of of

and and

large large

li'om li'om

arc arc

on on

thc thc

Fl' Fl' way way

now now

slLltable slLltable

( (

__ __

are are

if if . .

and and

have have

that that

lIn: lIn:

Fcwer Fcwer

firewood, firewood,

of of

Olle Olle

marginal marginal

forest forest

the the

to to

chddn:n chddn:n

t.:lllidren t.:lllidren

dangl'r dangl'r

prcssure prcssure

census/ census/

i.'i i.'i

______

often often

tloods tloods

, ,

ror ror

of of

wrcckll1g wrcckll1g

who who

support support

lands lands

into into

L(;~~s L(;~~s challenges challenges

disastL'rs, disastL'rs,

SUppOl"tll1g SUppOl"tll1g

the the

FP FP

not not

13CL' 13CL'

address address

lands, lands,

lands lands

and and

logistics, logistics,

111 111

h:wcr h:wcr

young young

to to

huy huy

m. m.

Phillppmes Phillppmes

The The

devt devt

arc arc

rL'~u1t, rL'~u1t,

of of kveled kveled

People People

to to

protecting protecting

and and

lands lands

should should

the the

sc!;ments sc!;ments

development development

povcrty. povcrty.

acculllulatloll acculllulatloll

and and

in in

"grieullural "grieullural

work work

in in

marglllallands. marglllallands.

de. de.

marginal marginal

~)f ~)f

many many

overtlow overtlow

populated, populated,

marginal marginal

resulting resulting

harder harder

1l0l)L\S 1l0l)L\S

or or

thc-s...: thc-s...:

forests forests

people. people.

large large

III III

silLs silLs

numher numher

encroachment encroachment

lead lead

found found

gcncratioll."!i. gcncratioll."!i.

(lile (lile

uut uut

services services

vers vers

lands lands

on on

into into

hOll~';\[lg, hOll~';\[lg,

limited limited

to to

livc livc

partners partners

cut, cut,

cities cities

the the

alld alld

cxplolt cxplolt

Itll'l'dul'atuHl. Itll'l'dul'atuHl.

much much

RI RI

poor poor

(Ollll:, (Ollll:,

and and or or

to to

address address

livlIlg livlIlg

sparsely sparsely

Iloodmg, Iloodmg,

to to

hy hy

info, info,

are are

~ ~

margl!lallands margl!lallands _I,~IOVl' _I,~IOVl'

and and

or or

future future

( 1 1 (

living living

l~ads l~ads

are are

also also

arable arable

other other

protected protected

rainS rainS

III III

still still

FP FP

place place

must must

production production

-

the the

and and

and and

IK'Opk IK'Opk

Trces Trces

;Jrl' ;Jrl'

cover cover

.. ..

and and

Ih'illg Ih'illg

arc arc

towns, towns,

llcrrltl llcrrltl

of of

pressure pressure

i.lfli:ctcd i.lfli:ctcd

agriculture, agriculture,

Pc-opk Pc-opk

Whl'n Whl'n

liVing liVing

families families other other

fCltJilty/llla!lY fCltJilty/llla!lY

encroachment encroachment

help help

problems problems

earthquakes, earthquakes,

support support

forest forest

no no

lands lands

health, health,

LG~:s LG~:s

much much

curn.'Ilt curn.'Ilt

ages. ages.

t(Xl'sts, t(Xl'sts,

uncmployed, uncmployed,

resources resources

largt: largt:

families families

grl'atcl" grl'atcl"

forwanl-Iooking forwanl-Iooking IHgh IHgh

barrios, barrios,

pcople pcople

mOllntalI1S mOllntalI1S

and and

Devt Devt

agricultural agricultural

for for

111 111

have have Of Of

The The

other other

ling ling

and and

be be

nutrition, nutrition,

Ilcgatively Ilcgatively

exports, exports,

famllics famllics

for for

should should

sick, sick,

large, large,

logistics. logistics.

fix fix

h;l\'c h;l\'c

yo yo

agriculture. agriculture.

IS IS

agncuiturailHoduCI10l1 agncuiturailHoduCI10l1

and and

erosions, erosions,

rall1\\'ater~ rall1\\'ater~

t(Hlli t(Hlli

is is

farms, farms,

popUlation popUlation

removing removing

--

and and

t!',hl'lp t!',hl'lp

etc,). etc,).

and and

onen onen

or or

a a

!esult !esult

to to

j"or j"or

must must

the the

and and

While While

It.l!" It.l!"

used used

J, J,

funds funds

lIlany lIlany

hold hold olkn olkn

forcsts. forcsts.

III III

arc arc

old). old).

smaller smaller

--

assets assets

w.~~ w.~~

trees, trees, due due

rc~ourcc,1oI rc~ourcc,1oI government government

population population

lip lip

to to

lands lands

mountains mountains

partners partners

or or

coulJ coulJ

has has

health health

lowland lowland

prevent prevent

fam1ing fam1ing

land land being being

areas areas

forestlands forestlands

OUl' OUl'

leaders leaders

sll!lahk sll!lahk

motlcy motlcy

years years study). study).

free free

like like

trees trees scrvices scrvices

if if

trees trees

is is

settlements settlements

i2 i2 area area

other other

manpower, manpower,

(like (like

Scarce Scarce

help help

growing growing

household household

population population

(. (.

FI' FI'

Rural Rural

!";.1l111\JC~ !";.1l111\JC~

may may

!l\orc !l\orc

morc morc

chtldrcl1 chtldrcl1 marginal marginal

Ianushdes Ianushdes !()f !()f

Many Many

in~_~ in~_~

mountain.s, mountain.s,

to to

Local Local

mountain mountain

{ {

through through

other other

!;ew !;ew

lands lands

hOllses, hOllses,

UPLB UPLB

a a

Even Even

already already

• •

-----

poverty poverty

youth youth

family family

ratio, ratio,

poverty poverty

youth youth

migration migration

and and

and and

dependency dependency Large Large

pOjlulation/high pOjlulation/high

size, size,

Population/large Population/large

as as

to to

so so

or or

are are

-

at at

arc arc

IivlIlg IivlIlg

hl' hl'

t~\I11i1y t~\I11i1y

n<:w n<:w

living living

arc arc

lands lands

civIl civIl

can can

that that

good good

1 1 might might

10/03 10/03

mighl mighl

i()rcsts." i()rcsts."

rnountallls rnountallls

local local

is is

will will

Issue Issue

Population Population

other other

rural rural

of of

large large

.- groups groups

pcoph: pcoph:

tht'y tht'y

to to

the the

an an

"It "It a a

areas areas

_ _ -~------+---

of of

Ihey Ihey

leaders, leaders,

"There "There

tbs, tbs,

People People

unoccupied unoccupied

develop develop

y y

_. _.

these these

.. .. in in

there there

margina margina

_ _

limTI." limTI."

U U

as as

not not

______L(;Us, L(;Us,

leaders leaders

you you

more more

or or

H'lwl H'lwl

on on

so so

have have

say: say: in in

PopulatJons PopulatJons

move move settlements." settlements."

and and

alL alL

is is

unused. unused.

still still

man man

Whal Whal

say: say:

1 1

influentials, influentials,

ooeiety ooeiety LG LG

f-----

the the

. .

VerSiOn VerSiOn

and and

with with

----

-- (e.g. (e.g.

and and

Youth Youth

( (

near near

Regions Regions

3. 3.

Bicol, Bicol,

Mindanao) Mindanao)

forests forests

mountain mountain

zones zones

provinces provinces

or or

2. 2.

TSAl'-t'P TSAl'-t'P

1------/'Y /'Y

\11 \11

of of

!'Ish !'Ish

in in

to to

WIth WIth

sea sea

out out

('nastal ('nastal

( (

low low

arc arc

of of

and and

rapidly rapidly

have have

Farn1 Farn1

In In

(assist (assist

tide tide

nUI11bl'r nUI11bl'r

as as

sea. sea.

deep deep

l:utting l:utting

~ ~

i:l') i:l')

dL'L"\llllng dL'L"\llllng

younger younger

which which

to to s s

red red

poorest. poorest.

populatIOn populatIOn the the

only only

oLltmigratL' oLltmigratL'

work work

and and

chances chances

would would

OIl OIl

hatchlllg hatchlllg

of of

~row ~row

support support

out out

to to

to to

the the

the the

send send

ruraL ruraL

have have

i,.:

work work

contributing contributing

not not

{ish {ish

of of

to to

or or

can can

etc. etc.

hC;,llth. hC;,llth.

most most

ch~Ull ch~Ull

shdllish. shdllish.

._~_'hddrl'~,~~)P ._~_'hddrl'~,~~)P

(llata (llata

better better

do do

and and

can can

rlllthl'l" rlllthl'l"

flI1d flI1d

people people

U!/(/j(lI1li1y U!/(/j(lI1li1y

school school

fnll, fnll,

among among

anti anti

Children Children

back back

they they

food food

(a (a

inputs inputs

low. low.

}.:(} }.:(}

cities, cities,

have have

arc arc

dCStJ"(lYS dCStJ"(lYS

da da

ph.:king ph.:king

walc] walc]

to to

segments segments

healthy. healthy.

kavc kavc

he he

to to

etc. etc.

youth youth

young young

poor. poor.

{~\rm {~\rm

to to

money money

Families Families

become become

!.:.:!11_~~l!.£~~1. !.:.:!11_~~l!.£~~1.

number number

would would

The The

.. ..

large large

t.:ducation t.:ducation

for for

boats boats

aITel'llIl)!, aITel'llIl)!, to to

push push

opportunities opportunities

illcome illcome

coastal coastal

mostly mostly

~ ~

little little

Ill'c\vOOU Ill'c\vOOU

the the

children children

trained. trained.

and and

rL'lll~llnS rL'lll~llnS

go go

etc. etc.

food, food,

swimmers), swimmers),

ol-lishermen ol-lishermen

funds funds

arcas arcas

and and

l"01111l111l'S l"01111l111l'S

Ilshlllg Ilshlllg poverty. poverty.

flSh_ flSh_

ailed ailed

remIt remIt

elllotionally, elllotionally,

have have

for for

Their Their

Children Children

1999)_ 1999)_

or or

of of

for for

L'VL'lllllally L'VL'lllllally

to to

rural rural

Youth Youth

family family

dirt dirt

fertility fertility

ca]_~_~~)~!y ca]_~_~~)~!y

jilrmlruru/ jilrmlruru/

.. ..

limited limited

employment employment healthy, healthy,

in in

educated. educated.

(Jut (Jut

etc. etc. 's 's

lamllies lamllies

coastal coastal

hard. hard.

I'lid I'lid

hOLlSll1g hOLlSll1g

~IIH.I ~IIH.I

nllIro-umi nllIro-umi

Pernia Pernia

high high

hegging}. hegging}. II1I!,rants II1I!,rants

Rural Rural

dn:ill1l's dn:ill1l's

and and

fur fur

have have resources resources

as as

.ralll~ .ralll~

and and

fish fish

SIlt SIlt

huy huy

assisted assisted

-7 -7

• •

being being

whL're whL're

financially. financially.

and and

to to

income income

to to

have have

ovcrlished. ovcrlished.

t t

trained, trained,

families families

he he

of of

and and

Rural Rural

1 1

t t

..l. ..l.

catch catch Halis(Jc(Jll Halis(Jc(Jll

cannot cannot

society. society.

Low Low

[() [()

~ ~

peddling. peddling.

have have

emotionally, emotionally,

schoo1. schoo1. often often

shellfISh shellfISh

npportu111ties~ npportu111ties~

!-"Ish !-"Ish

move move

(Orbeta (Orbeta

support support

of of

PollutIon, PollutIon,

grounds. grounds.

mangroves mangroves

to to

should should

continue continue

pDpulalJons pDpulalJons

Ill'Coflle Ill'Coflle

(sometimes (sometimes

income income

cong~slcd, cong~slcd,

chances chances

.~W_l_!~_C(~]_ly.; .~W_l_!~_C(~]_ly.;

jobs jobs

also also

of of

areas areas

educated, educated,

can can

15-24. 15-24.

better better

helps helps

'alers 'alers

needed needed

.. ..

allectmg allectmg

11s11lng. 11s11lng.

catch), catch),

i'IShLTllll"n i'IShLTllll"n

v v

rl'cdlll~ rl'cdlll~

I,nss I,nss

li'lhll1g li'lhll1g

mangrO\'L', mangrO\'L',

hshcrmcn hshcrmcn

limited limited

c...... ~~~~ c...... ~~~~ Fl' Fl'

Coastal Coastal they they

{ {

t~m1iliL's t~m1iliL's

(RL:(er (RL:(er

children children

paylI1g paylI1g

as as

already already

seck seck

ages ages

Rural Rural

members members

_hetter _hetter

financially, financially, being being

Families Families

._ ._

in in

in in

~----

______

ulder. ulder.

large large

large large

they they

and and

~ ~

few few

a a

years, years,

are are

_. _.

a a

get get

\n \n

family" family"

.. ..

say: say:

say: say:

few few

good good

older, older,

______

the the

just just

populatIons populatIons

-' -'

population population

a a

means means

poverty poverty

family" family"

______

" "

people people

are are

get get

mighl mighl

might might

children children

belp belp

______

Just Just

this this

__ __

the the

of of

land/fishing land/fishing

"" ""

youth youth

as as

populations populations

youth youth

labunn labunn

In In

areas areas

thev thev

areas areas

can can

they they

help help

children children

______

. .

PopulatIOn, PopulatIOn,

coastal coastal

resnurces resnurces

they they

years, years,

youth youth

number number

rural rural

What What because because

"Large "Large

rural rural

Large Large

as as

can can

good. good. What What

"Large "Large

"_ "_

_+::-_,-

civil civil

______

,, ,,

6103 6103

______

groups groups

611 611

LGUs, LGUs,

~ ~

kaders. kaders.

of of

leaders leaders

--.,.--c---

______

as as

society society

int1ucntials. int1ucntials.

LGLI LGLI

local local

Youth, Youth,

Version Version

youth youth

and and

" "

( (

Rural Rural

------f--c---

rcginl1s rcginl1s

areas areas

4. 4.

rs:--Coastal rs:--Coastal TSAP-FP TSAP-FP f TSAP-FP Version as of6116/03

school to work. Poor IClmily health, nutrition and education.

,J.. Coastal populations remain poor Or become even poorer. Loeallcaders need to be It)rward looking and lead in the p\'Otcction of coastal zones. FP is one way to help prevent population encroachment into marginal marshlands and coastal ZOIlt,;S. LGU and nOllgovt partllers should work together to support/provide Fl' r _ .. _ . . .. _.__ ._ .~~~-I--,.--~~~~~___ .~_._ JnJ~o,se.rvices and logis.tics at the c.".mmullit~level. ... __ ~~~~~~~-I 6. Areas ncar LGU leaders, Expanding population • Land use around Metro IS last ehangmg as the metropolIS grows Metro-Manila influentials, civil and limited lalld rapidly. Lands sUItable Itlr agriculture arc converted to lIlc\ustnal and

(Bulacall, society groups "Population is growing I~lst rc.-;iuL'ntialuscs. ('ombination or kss agricultural lands, hnVCfl'd farm

Region IV) because of migration. We inputs (luW/pOOf fertilizer O[ p~Stlcldl'lISC due to lack of funds) and do not h:J.Vcany fertility mefiiclL'llt agriculture practices ~ low harvests, for Ontncstlc problem." consumptIOn, \'L"-Y' little cxportl:d, might even need to Import (e.g. rice)

• Poor mlgr~.mtswho cannot Ix:' absorbed or live 1!1 MdroMantla. ItH..:luding relocated syuattcrs live 1!1 enclaves oi'POVl.'rty In the periphery. Leaders should stress that I:P is a way in which the poor can havc better chances

_.. __ . __ (.!f_mnvll1~(~!~~Lr~)Yc.0Y . . -.------+---- ..-~.-. -...--' I'oor couples ill The poor who Ii vo 111 the penphcry oj' the metropolis prOVIde labor I'or outlying areas of industru.:s/tactones in the suhurbs and sen"ice workers for the rich 111 the metropolis, ill exclusive villages in the suburbs. resettlemcnt sites FP is a coping mcch.lnislll that ,,"illallow tht' poor to muve out of

___ .._____ ...._ .._ .__ . _ l~~Y~r!v~.____ . __... __ ._.. __ __ _.... _ .._ 7. Urball poor Urban poor \,,(j Es. urhan poor leaders l lrban areas kem With the urban pour who ltve 111 slum and s4uat1L'r shanties

ill metro ~treas couplcs in unoccupied lands, under hridges. along river hanks

mechanism. an intt'rVl'ntioll. th~ltwill allow tht.' poor tu IIlI)Ve out of

-" - -~ ----- ~--.-

4 ~ 'i"'" AED THE SOCIAL ACCEPTANCE PROJECT Strengthening the Social Acceptance of Family Planning in the ~ TSAP-FP 'n.t:'

NAME: Components ! Inclusive Oates of Trip: Advocacy and Social Reed Ramlow Mobilization June 2 10 12. 2003 I Health Service L ______-'--. ! ~="__Provision __~ ______~ ______

TRIP REPORT

Trip Objectives

Mr. Reed Ramlow, Futures Group's senior technical coordinator for the TSAP-FP project tra\ekd to \!arllia from May 31 to June 12,2003. The primary purpose orthis trip was to assist the TS ..... P-FP medical team in moving forward and completing major elements of the health prmider component workplan for the second third quarter 2003 and beyond.

Mr. Ramlow's trip objectives were as follows:

I. To participate in a meeting of the Evidence-Based Reproductive \!edicine :\etwork (EBR\!-:\etl on June 2. 2. To assist the EBlUvl-Net in producing the following EBR1\1 material outputs. with the assistance of a copywriter and advertising agency.

-,_.- 3. To discuss EBR.\.1 orientation and interacti\'e workshops for health pro\'idcrs and for phannaceutical company management and detailers. 4. To follow-up opportunities to incorporate EBR;\! into POGS and DOH contracepti\e and family planning service deliYery guidelines. 5. To follow-up opportunities to incorporate EB1\1 into medical school curricula. 6. To follow-up the progress of the baseline survey on health providers knowledge. attitudes. beliefs and practices (KABP). 7. To follow-up the progress of the profiling of health facilities/clinics in convergent sites.

Persons and Organizations Met/Places Visited

USAID/OPHN Ephraim Despabiladeras, TSAP-FP CTO Nilda Perez, Technical Advisor Neil Hollander, Private Sector Tec1mical Advisor

Department of Health Dr. Mila Fernandez, Undersecretary _.Dr. Honorata Catibog, Director, Family Planning Services

,if( I - Commercial Market Strategies (eMS) Project Grace Migallos, Country Representative Delila I. Lojo, Medical Groups Advisor risanto Frianeza, Business Groups Advisor

AEO TSAP-FP Team Mark Miebach, Vice-President, Contracts/Grant 1-.lanagement

Research Firms ISIS Research: Odette Navarro, Country Manager, and team AC Nielsen: Ma. Beatriz Gobencion, Client Sen'ice Director, and team NFO Trends, Ophelia Ramirez, Associate Research Director, and team UP College of Public Health, Dr. R. Ong, Chairperson, Department ofl!ealth and Promotion. and team

National Institutes of Health (NIH) Dr. Jaime Galvez Tan, NIH Executive Director and Vice Chancellor for Research, l"niwrsit\· of the Philippines

Philippine Obstetrical and Gynecological Society (POGS) Dr. Lyra Chua, President

FriendlyCare Dr. Alberto Romualdez, Jr., CEO

Philippine League of Gonrnment Midwives Inc, (PLGMI) -'ecille Banca Santos, President

Findings

Mr. Ramlow completed his Scope of Work during his TOY in the Philippines.

EBRl\I-Net Meeting

There was a two-thirds membership quomm at the EBRM-Net meeting at the Traders Hotel in '.Ianila on June 2. Attendees were as follows:

I. Mario R. Festin, 1\10 - EBRNI-Net leader/coordinator. graduate of \IS Clinical Epidemiology, Obstetrician Gynecologist at the PGH, former Executive Director of the National Institutes of Health and Vice-Chancellor of Research at the College of Medicine, Uni\'ersity of the Philippines (UP), '.Ianila 2. Blanca F, de Guia, MO - graduate of MS Clinical Epidemiology, Obstetrician G~llecologist at the Philippine General Hospital (PGH) , reproductive endocrinology specialist 3, Bernadette 0, Cruz, MO - graduate of MS Epidemiology, Obstetrician G:-llecologist at PGH, trophoblastic disease specialist 4. Ditas Oecena, MO - graduate of Masters in Public Health, Obstetrician G~llecologist at the University of Santo Tomas Hospital 5, Joseline Ferrolino, MO - Obstetrician Gynecologist at De La Salle L:ni\'ersity Hospital. active contributor to the Clinical Practice Guidelines and Consensus of the PS\IFM 6. Jose Marcos, MO - Obstetrician Gynecologist at the Cagayan Valley "'Iedical Center. Tuguegarao City 7. Ma, Virginia S, Abalos, 1\10 - Obstetrician Gynecologist at Chong Hua Hospital in Cebu City, with - training in OB-GYNE infections in Japan Ohstetrician G\llecologist at 8. Lora G. Tansengco, MD - graduate student ofMS Clinical Epidemiology, PGH, with training in Perinatology and OB Gyne Ultrasound 9. Elmer Chua, 1\10 - Obstetrician Gynecologist in Davao City PGI-1. reproductive cndocrinollogv and 10. Enrico Gil C. Oblepias, MD - Obstetrician GYl1ecologist at the family planning specialist

Team (Dr. Ric Gonzales and Reed Ramlow) Dr. Mario Festin, the EBRM-Net leader, and the TSAP-FP Medical learned" for the initial set ofCriticall\· co-facilitated the meeting. The EBRM-Net members reviewed "lessons a second set of C.-\ Ts. Proposed topics Appraised Topics (CATs) that they developed. and agreed to de\clop members were in\itcd to submit their own win be circulated and assigned to the EBRM-Net members although proposed topics. The following issues were also discussed:

and the Philippines Obstetrical and • Institutional linkages to the National Institutes of Health (NIH) Gynecological Society (POGS) • Permanent access to medical journal articles for critical re\·iews • EBIUv! orientations and interactive workshops for other health providers

EBRM Materials CATs are as follows: Thirteen CATs are ready for design and production. The approwd Tubal Ligation 1. Interval Tubal Sterilization has No Effect on Sexual Interest and Pleasure. 2. Tubal Ligation Reduces the Risk of Abnonnal Menstrual Bleeding. When Csing Bipolar Salpingectomy 3. The Risk of Ectopic Pregnancy after Tubal Sterilization is Lowest _ and Methods Other Than Bipolar Coagulation.

Vasectomy 4. Vasectomy Docs Not Affect Sexual and Marital Satisfaction Among ~Iarried ~len.

Natural Family Planning 5% with Perfect L-se and 12°0 with 5. The Probability of Pregnancy Using the Standard Days Method is Typical Use.

IUDs (IUDs) are Due to Pre­ 6. The Primary Mechanisms of Action of Various Intra-Uterine Devices Fertilization Effects.

DMPA Cancer. 7. Women Who Use DMPA Are Not At Increased Risk of Cervical

Oral Contraceptive Pills Risk of Breast Canccr. 8. Use of Oral Contraceptive Pills Does Not Lead to an Increased That Follow Previous Use of Oral 9. There is No Increased Risk of Down's S)udrome in Pregnancies Contraceptives. Increased Risk ofStrokc. 10. Women with Migraine Who Use Oral Contraceptives Have an the Risk of Cervical Cancer in II. Short-Term Oral Contraceptive Use « 5 Years) Does Not Increase Tenn Use (> 5 years) Does Increase the Risk. _ Women with Human Papillomavirus Infection, but Long Offers an Owrall Decreased Risk of 12. The Condom Remains as the Only Contraceptive l'.lcthod That or D,,\PA is Associated with a Acquiring a Sexually Transmitted Disease (STD). The Use ofOCPs Decrease in the Risk of Some STDs. for ""ulliparous Women Compared 13. OC Pills and Short-term IUD Use Offer Quicker Return to Fertility to Long-Tenn IUD Use.

including: An action plan has been developed for the production of other EBRc\\materials. • Quarterly newsletter • EBM user guide • Evidence-based guidelines for contraceptive methods

EBRM Orientation and Interactive Workshops will schedule. de\'elop and organize at least The TSAP-FP Medical Team, Dr. Mario Festin and the EBRl\\-Net quarter ~003 among the following groups: five EBRM orientation and interactive workshop sessions in the third 1. OB/GYNs, in conjunction with POGS \'lidwi\es Inc. (PLG\'\I) 2. Midwives, in conjunction with the Philippine League of Go\'ernment in conjunction with the Commercial 3. Pharmaceutical company and DKT management and detailers. Market Strategies (CMS) project with the Philippine 4. Occupational physicians and nurses (in the Industrial Zones). in conjunction Health '-.'urses .-\ssociation of the College of Occupational Medicine (PCOM) and the Occupational Philippines (OHNAP) of Municipal Health Officers of the 5. Municipal health officers, in conjunction with the Association Philippines (AMBOP) (in conjunction with provincial 6. Local government unit (LGU) physicians, midwi\'es and nurses health officers) officers (in conjunction with the DOH 7. Department of Health (DOH) hospital providers and regional training officer and OB:G)l1 chairnlan) visit of Dr. Fred Tudiver. scheduled for (Note: Some of these workshops will be conducted during the return to schedule as many workshops as possible September 29 to October 10,2003, but the operative mode will be in the third quarter 2003.)

Family Planning Sen-ice Delivery Guidelines Mila Fernandez and Family Plalming Services The TSAP-FP Medical Team met with DOH Undersecretary Dr. Planning Clinical Standards 1\lanual. which Director Dr. Honorata Catibog to discuss the updating of the Family was agreed that TS.-\P-FP will organize and will incorporate evidence-based contraception guidelines. It manage a task force to complete this task. Dr. L)Ta Chua to discHss linkages between In addition, the TSAP-FP Medical Team met with POGS president technical assistance for the development POGS and the EBRM-Net on a number of fronts, including providing with the Philippine Board for of evidence-based guidelines for contraception. working in collaboration )bstetrics and Gynecology. '-'f-" EBM in Medical School Curricula to incorporate EB~! EBR-\! into medical The TSAP-FP Medical Team and the EBRM-Net will initiate efforts of Family Planning at Southwestern 'chool curricula. This effort will begin by contacting the Department with EBRT\I-Net member Dr. Virginia _.niversity's College of Medicine in Ccbu. possibly in conjunction Abalos, who is based in Cebu.

Health Providers !(APB Study KAPB stud\·. Two firnls haH' been Four research finns presented their proposals for the health providers decision and award by June 17. s,:lected for final negotiation. The TSAP-FP Team anticipates a final

Profiling oflndustrial Zone Health Clinics l\ledical Team needs to travel to the The indnstrial zone health clinic profiling is ongoing. The TSAP-FP expected to be completed in July 2003. Pampanga industrial zone to complete the profiling. The profiling is

- Issues/Recommendations strategy document, which will be Issues and recommendations are contained in the health provider component lbmitted separately.

-Next Steps

Health Provider Component Work Plan 3rd Quarter 2003 Timingj Activity --'-_-----1 EB"I-F"P'---c_--c--~~_--c---c ______Criticalll' Appraised Topics (CATs) ! Sept 1 I) Produce second set of CATs. EBM-FP Materials July I) CATs Spiral Notebook .\f('{hods a) Title: El"idence-Based ,\fedieille: Key Fill(hngs 011 Cumracer(J\'c b) Copies: 50.000 c) Content Para(/igmfor .\fedietll Practict? i) Description ofEBM titled: fl'idence-Based ,\ledicille. A Sew use Ii) Description of need for EBRL\t to expand modem family planning l'se of Fam!Z\' P!ll1P!lng (1) Title: Evidence-Based Afedicine j-'Z the Plll"hpl'incs. Expantiirlg (2) Problem:need statement rate arrxmg the hlghest lD ..\5Ia. (a) Philippines has unacceptably high population gro\\1h ratt?, fertihty etc. contracerti\"C5 (b) Side efTect fears and health concerns are barriers to use of modem methods (c) Philippines EBR1.1-Net formed to e\'aluate safety of contraceptive ,\fethod5 (3) Sunmlary of CATs titled: Critically Appraised Toplcs on Gmtraceptil"t! method (4) CATs (13 total): Should be grouped and tabbed by contraceptiw (a) Tubal Ligation (3) (b) Vasectomy (I) (c) Natural Family Planning (I) (d) IUDs (I) (e) DMPA (I) (I) Oral contraceptives (6) Bibliography & Resources (5) Aug 2) Evidence-Based Medicine User Guides should be developed for ditTerent clas.ses of EB\t­ a) Evidence-Based ;\fedicine A/ode Easy: Different user guides pharmaceutical detailers FP orientation participants, including doctors. nurses, midwives and r~~~~~=7~~~~~~~~~~==~==~~~==~~~~~~------~----­ EBM-FP Orientalioll and [nteraeti,'e Workshops and EBRM-Net members schedule. develop and In collaboration with the TSAP-FP Medical Team, Dr. Fred Tudiver sessions among the follo\'\ing groups. organize at least five EBRi\1 orientation and interactive workshop of the lIealth Sector: Presentations and July I) NIH Science and Technology Week: EBM as a Social Responsibility Reactions Aug and detailers, in conjunction with the CommercIal .\1arket Strategies I 2) Pharmaceutical company and DKT management (eMS) project Inc. (PLG~II) Aug in conjunction with the Philippine League of Govemment :-lidwi"es 3) :-.\idwives, Sept I 4) OBiGYNs, in conjunction with POGS teaching skills and systematic reviews workshop I 5) EBR.\1-Net Oct of Deans and Principals of Colleges ofl\'ursing II, 6) ~urses, in conjunction with the Association in conjunction with the Philippine College of TBD 7) Occupational physicians and nurses (in the Industrial Zones). Association of the Phihppmes (Ofi'\AP) Occupational Medicine (PCOM) and the Occupational Health :-;urses Officers of the Philippines TBD 8) Municipal health officers, in conjunction with the AssociatIOn of MUllIclpalllealth (AMHOP) TBD (,in conjunction with pro\-incial health officers) " J) Local government LUllt (LGU) phYSicians, midwives and llLUses (in conjunctIOn With the DOH training officer TIm '""rIO) Department of Health (DOH) hospital providers and regional officers i and OB(Gyn chairman) Timing CtiYity July Social Jfarketilrg o[EBM-FP II Media Relations fomut and 5uQn--;.it for team to package CA Is in reader-friendly R \\'ork with TSAP~FP communications an ad\-enorial series (ould a) tIle material. tabloids. (If publications do not accept publication in leading dailies and be considered.) .-\ug 2) Newsletter Series "/ ) Senes 011 F

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