ANNEX C_Presentation on Maternal Health focusing on NCR/Pasig City
1. MDG 4 and 5
Facilitating a Reliable Outcome
Presented during the Local Roundtable Discussion for the
Formulation of the Philippine MDG Acceleration Plan for
Maternal Health, Astoria Plaza, Ortigas Center,
Pasig City, 21st June, 2012
2. Current Approach to Reduction of
Maternal Mortality
“Every Pregnancy Is at Risk”
“Every Pregnancy should end at
the health facility with assistance
by skilled health professional”
2
3. Most Effective Intervention to
Prevent Maternal Deaths
Skilled attendant at
childbirth is the
most effective
intervention
WHO 1999.
5. Vital Indicators
(2010 vs. 2011)
• Total Population – 2.3% increase from
11.552 M in 2010 to 11.819 M in 2011
• CBR – 11% decrease from 20.1 to 17.9
• CDR – 7% decrease from 5.6 to 5.2
• IMR – 8% increase from 17.3 to 18.7
• UFMR – 12% increase from 23.3 to 17.3
• MMR – 24% increase from 58 to 72
6. Trend in Infant and Under-five Mortality Rates NCR, 2005-
2011, FHSIS
18. Contributory to high MMR/IMR
1. MM as central referral region
( facilities cater to outside MM)
1. Referred pregnant women mostly
pathological/complicated cases
2. MWs because of unbundled
PhilHealth payment refer late or do
not refer at all
3. No or late registration of live births
4. Wrong recoding or entry (e.g. NBM
also counted in UFM
22. • Acumen and competency for research
• Recognition and credits for training
• Sustaining irreversible reforms on trainings;
research; and, data/information generation
23. Tactical Plans
1. micro management/individual
care (service)
2. Reliable data (information
technology)
“ PLAN AND PREPARE”
24. Regional Center for Monitoring
Maternal and Child Health
or
Regional Center for Public Health
Leadership and Governance
25. Why UMak …
• More facilitating than hindering factors
Political and Institutional Leadership
Prestige and credibility
Health is a priority in Makati
Geographically at the center of MetroManila
Distance from CHD-MM
Facilities and human resource complement
26. The Center …
General Specific
• Research • Disaggregate addresses
and other delivery/deaths
• ICT variables
• Daily or weekly reporting
• Evaluation/Assessment • Maternal/Infant Death
Review/PathoConference
• Cause of Death
• Trainings
• Others
27. Application: Pregnant Women in …
CCT NHTS Others
PL with CHT CHT with DOHRep and CL CHO with
CL with DOHRep CHO with RNHeals/MWs DOHRep &
CHO with RNHeals/MWs RNHeals/MWs
Health Center Lying-in
(For ICT monitoring and research) (For provision of health service)
University of Makati Higher referral level (service)
(as Maternal and Child Health
Monitoring Center)
28. KP Nurses LGUs/CHOs Hospitals
• Data Collection
•Verification
Research,
ICT Surveillance Program Statistics and
Managers Action
•Analysis
•Segregation
•Report Generation
Data Gathering and Report Generation
29. Six (6) Buntis Connections
(Health Plan)
• Health facility and referral network
• Health Professional/s up to referral
facility/ies
• Source of blood if needed
• Transportation
• Communication
• Pre- and Post- natal visits
30. Other Variables/Indicators
• Prenatal and Postnatal Visits ( with TT and
Supplements)
• Prenatal and Postnatal Complications
• Teenage Pregnancies
• Breastfeeding/Nutrition
• EPI
• FP (commodities and 3-yr gap)
31. Immediate Actions from CHDMM
• Makati Health Board Presentation done
• MOA with UMak
• Conference/Summit of Civil Society Groups, Non-
Government Organizations and People’s
Organizations to:
- present CHDMM Plans and Programs/Roadmap
- gather info on the participants’ organizations to
make into compendium
- agreements on individual organizations’
partnership activities with DOH indentifying
specific areas and activities/services to be carried
out
• With ZFF/?Umak meet all NCR Mayors
32. Expectations from LCEs
• Take the lead to consolidate efforts as a team
(CHT, CL, PL, RNHeals, PHMWs, CHO)
• Support to CHTs (financial for transportation
and meals; in-kind for forms, bags umbrellas,
etc.
• Assign ICT person-in-charge
• ICT maintenance and support
• E-link to UMak and maintenance
• Declare all pregnancies as an “emergency case”
33. Expectations from Umak …
• Office space
• Human resource complement
• Other facilities that can be provided
• Coordination and conduct of trainings
• Generation of data and information
• Conduct of research
• Maintenance
Editor's Notes
The total population of NCR is projected to increase by 2.3% from 2010-2011. The CBR and CDR have decreased by 11% and 7% respectively based on FHSIS reports from LGUs; IMR has increased by 8%; UFMR by 12% and MMR by 24% comparing the 2010 to the 2011 figures.
This graph shows the multi-year trend of IMR and UFMR from 2005-2011 in NCR. There is an increase in both UFMR and IMR from 2010 to 2011
There is really an increase of maternal mortality ratio for the past 4 years and the there will be a great possibility of not reaching the MDG targets by 2015 if the rate of increase persists and nothing is being done at the Regional or LGU level to avert further increase in maternal deaths. The National target for the country on MMR by 2015 is 52 and for the NCR, it is 11. In 2011, the MMR in NCR is below the National Target of 77/100,000 LBs while it is above the Regional target of 16/100,000 LBs.
This graph shows the distribution of maternal deaths in the NCR per LGU in 2011 in terms of absolute number of deaths and the standardized rates which is the MMR. In terms of absolute number of deaths, Quezon City has the highest number (46 deaths) followed by Manila (20 deaths) Pasig (15 deaths) Marikina (12) and Muntinlupa (11). However, in terms of MMR, Pateros is the highest with the MMR of 248/100,000 LBs followed by Muntinlupa (191), Pasig (184), Marikina (136), Valenzuela (111), Quezon City (110) and Makati (106). The lowest MMR were reported in the cities of Caloocan (10), San Juan (31) and Navotas (32).
In the NCR, most cases of maternal deaths in 2011 are due to any form of hemorrhage (42% of cases); followed by hypertensive disorders of pregnancy to including pre-eclampsia (31%); medical complications aggravated by pregnancy (11%); infection (11%) and embolic complications (5%) which is hard to prevent or predict but can be treated if promptly referred.
This is a graph shows the proportion of deliveries by place per LGU in 2011. Manila, San Juan and Mandaluyong have the highest proportion of deliveries taking place in health facilities while Las Pinas, Pateros, Taguig, Paranaque, Malabon, Navotas and Valenzuela have the highest proportion of deliveries occurring at home.
This table shows the selected delivery rates by place and assistant, which illustrates that home deliveries and TBA-assisted deliveries are declining over the years while health facility deliveries are increasing.
. In the NCR in 2011, 86% (182, 271) of deliveries occurred in health facilities while 29, 246 deliveries (14%) occurred at home.
This graph shows the deliveries by attendants in NCR in 2011. Most of the deliveries (57%) or 120, 852 deliveries were assisted by physicians; 36% by midwives; 7% by TBAs; and only 0.4% assisted by nurses.
The use of FP methods for birth spacing and limiting is one of the effective strategies to prevent maternal deaths due to very short birth intervals and very large number of children. Contraceptive prevalence rate reflects the current user rate of the modern FP methods among women of reproductive age (15-49 y.o.) and their husbands/partners. In the NCR, the CPR has increased for the past 5 years from 23% in 2007 to 33% in 2011. But there is a need to further increase this figure to 65% by 2015 and to integrate figures from the private sector in the reports.
This graph shows the ranking per LGU in terms of CPR in 2011. Valenzuela, Quezon City and Muntinlupa are the top 3 LGUs for CPR while Manila, Taguig, Paranaque, Pasig and Makati are the lowest 5 LGUs.
