Updates from the Field BEST

No. 5 Series of 2002 PRACTICESLNo. 1 series ofhttp://www.msh.org.ph 2001GU PER- COLLABORATION BETWEEN LOCAL GOVERNMENT UNITS AND NGOs FOR BILATERAL TUBAL LIGATION IN NORTH Background Figure 1 North Cotabato, one of three provinces Proportions of Married Women of Reproductive Age The City Health Office undertook prepa- located in Central Mindanao, has 11munici- with Unmet Needs for Family Planning* ratory activities before the arrival of the palities (of 17) and 1 city enrolled in the % of MWRA outreach team. (village) Health Department of Health’s Matching Grant 60 Workers (BHWs) were dispatched to mo- 42.9% Program (MGP). Of these 12, 3, namely, 40 37.2% 36.3% Baseline tivate high-priority clients to undergo BTL. 27.4% 29.2% City, M’lang, and Makilala, have 21.5% Potential clients were identified based on the 20 Mar-02 linkages with nongovernmental organizations Family Profiles generated from the CBMIS (NGOs) for the provision of female steriliza- 0 survey. The CHO had previously trained its Kidapawan M'lang Makilala tion services, which are otherwise available March 2001 Nov. 2001 Dec. 2001 190 BHWs in family planning counseling to Baseline only at the provincial hospital. N=4,825 N=3,460 N=3,974 Mar-02 N=5,033 N=3,460 N=4,064 ensure that they impart correct information and messages about family planning methods. Kidapawan City was the first MGP enrollee *CBMIS results for selected barangays The BHWs were given information kits in the province. It was enrolled in 1999, and flip charts for use in their motivation along with 11 other local government units a nonprofit NGO that provides high-quality activities. Both initiatives were funded out of (LGUs) nationwide. It received an initial basic health care and family planning services the city’s MGP grant. grant of PhP500,000 (US$10,000) for the to low-income and lower-middle-income Fili- implementation of innovative service delivery pino families. On September 7, 2001, the CHO briefed the interventions and establishment of a com- M’lang and Makilala collaborated with prospective clients on the BTL procedure. munity-based monitoring and information Jerome Foundation, a -based NGO, On the 23rd of the same month, an FCFI team system (CBMIS). Meanwhile, M’lang and to further increase the number of bilateral composed of four doctors went to Kidapawan Makilala were among the 2001 MGP tubal ligation (BTL) acceptors in their areas. to provide the service. The procedure was enrollees that received a grant of PhP250,000 Jerome Foundation, which was founded by performed at the provincial hospital. Of the (US$5,000) each. philanthropists Frank and Helen Jerome, started 18 prospective clients, 5 were disqualified for failure to meet all the screening criteria. As MGP sites, the three LGUs have been out helping people afflicted with polio and challenged to expand their service coverage those with cleft lip and palate but eventually The clients were ferried to the hospital either through innovative interventions and effective expanded its services to include BTL. by a vehicle provided by the barangays or by and efficient resource mobilization. Among Collaborating with Friendly Care an ambulance provided by the CHO. The the strategies adopted by these LGUs is close Foundation: The Experience of medicines and supplies used and the meals collaboration with NGOs, which helps them Kidapawan City provided to the outreach team and clients were expand their reach and improve program paid for from the matching grant. The city Realizing the urgency of responding to its performance, particularly in the area of funded the PhP200 cost per client out of its clients’ unmet family planning needs by family planning. It is worth noting that promoting the use of permanent methods, the regular budget. while the numbers and the corresponding City Health Office joined forces with FCFI to proportions of women of reproductive age make BTL services available to women in (MWRA) with unmet needs in the three LGUs Kidapawan City. In July 2001, representatives are generally on the decline, the numbers of from FCFI discussed with the City Health those with unmet needs remain relatively high Office the possibility of FCFI deploying a (Figure 1). team to Kidapawan City to perform BTL on To improve its family planning perfor- prospective clients. Based on their agreement, mance, particularly for female sterilization, FCFI would require at least 20 clients to Kidapawan City linked up with Friendly organize an outreach service. The city pays Care Foundation, Inc. (FCFI). The FCFI is FCFI PhP200.00 (US$4) per client served.

MATCHING GRANT PROGRAM Department of Health The CHO intends to invite FCFI again for • Not pregnant In this regard, the Provincial Health Office of another outreach activity within the year. • Using any FP method North Cotabato has taken the initiative to Meanwhile, it is in the process of identifying • No other medical problems, e.g., ensure that the required skills and services and motivating qualified women to accept the hypertension are available locally. It is now working towards method. Priority clients (married women not sponsoring the training of the Municipal Health using any method or with at least 5 children Officers on male and female sterilization and considered indigent), however, are imme- procedures in reputable institutions. diately referred to the provincial hospital. The This is in line with the vision of M’lang’s MHO cost of BTL, which ranges from PhP400 to of having all MHOs in the province trained in 700 (US$8-14), is shouldered by the LGU BTL and no-scalpel vasectomy, to form a team using the MGP grant. that would go around the different municipali- Collaborating with the Jerome ties to perform those procedures on interested Foundation: The Experiences clients. When that day comes, they will no of M’lang and Makilala longer have to depend on outside help to M’lang’s collaboration with the Jerome address the unmet family planning needs of Foundation for bilateral tubal ligation started their constituents, especially for permanent in 2000. The Jerome Foundation branched out methods. to provide BTL services at the request of As part of M’lang’s efforts to adequately M’lang’s Municipal Health Officer (MHO). The Jerome Foundation’s outreach team has respond to the family planning needs of its The MHO, Dr. Roy Firma, saw it as a perfect performed BTL in M’lang on two occasions: people, it is also strengthening its interdistrict opportunity to piggyback Operation Tali onto one in August 2000 and another in July 2001, IUD referral system. Under this system, the the Foundation’s outreach program since the where a total of 37 and 35 clients were served, Sentrong Sigla-certified Barangay Health same surgeons could very well perform BTL. respectively. Two more outreach visits have Stations (BHSs) are used as referral centers Jerome Foundation was amenable to the idea been lined up for July and December of this for IUD insertion for a cluster of barangays provided there were at least 10 cheiloplasty year. As of the end of May, some 19 prospec- (district). Midwives trained in IUD insertion clients during each outreach. There was no tive clients had been identified for the July and who are considered as among the best minimum requirement set for BTL clients. In schedule. Hospital, a private hospital, are deployed in these BHSs once a week to some cases, the Foundation will deploy its served as the venue in 2000 and 2001, while provide the service. team solely for BTL but there should be at procedures will be done from now on at the least 20 clients to make the outreach activity M’lang District Hospital. In addition, the MHO now requires health cost effective. All outreach visits are sched- personnel to record information on family plan- Makilala, another municipality in North uled on weekends, since the members of ning method used in the Individual Treatment Cotabato, has also recently established a part- the team have their own respective private Record upon consultation. This is one way of nership with the Jerome Foundation, upon the practices. The doctors receive an honorarium monitoring family planning practice among recommendation of the MHO of M’lang. The of PhP400 (US$8) per ligated client from the couples and a perfect opportunity to counsel first round of ligation was conducted in April Foundation. and encourage nonacceptors to use any of the 2002. However, only 4 of the 10 prospective more effective methods. This also enables the clients showed up and were ligated. Based on Resource Requirements MHO to identify and recruit prospective BTL information gathered by the health staff, those On the Part of Jerome Foundation clients. • Cost of supplies (PhP1,200/client paid to who failed to come were discouraged by the hospital) church from undergoing the procedure. Meanwhile, Makilala is considering the • Honorarium of surgical team possibility of working again with Population As in the case of Kidapawan and M’lang, the Services Pilipinas Inc.’s Marie Stopes Clinic On the Part of the LGU local government took care of transporting the • Cost of postoperative medicines (in 2000 in Davao City to provide BTL services to its clients after the operation, using the municipal & 2001, from the regular budget; in 2002, people, with the provincial hospital as the from MGP) ambulance. It also provided free postoperative venue. In the first collaboration between • Transportation, meals, and accommodation medicines. The Public Health Nurse carried out Makilala and PSPI, in 1997, 26 women were of surgical team: 3 surgeons & 1 the presurgical counseling. Makilala plans to anesthesiologist (courtesy of either the ligated. hospital or the mayor) ask the Jerome Foundation for another outreach sometime during the third quarter of the year. It First-level recruitment of clients is done by This publication was made possible through support had identified at least 20 prospective clients as provided by the U. S. Agency for International the BHWs. Those recruited by the BHWs are of the end of May 2002. Development, under the terms of Contract No. 492- referred to the midwife for individual counsel- 0480-C-00-5093-00. The opinions expressed herein are those of the author(s) and do not necessarily reflect the ing and then to the Municipal Health Officer Future Initiatives views of the U.S Agency for International Development. for screening and, if necessary, for further While partnership with the NGOs is an impor- Please address all inquiries to: counseling. The screening requirements are: Management Sciences for Health tant dimension of the LGUs’ efforts to increase Unit TN No.4, 10/F Times Plaza Building • No postoperative abdominal scar service coverage, the LGUs also realize that they U.N. Ave cor Taft Ave, Ermita, Manila, Tel. Nos: (632) 525-7145/52/56 Fax No.: (632) 525-6086 • Not more than 10% overweight cannot depend forever on external assistance. E-mail: [email protected]