Department of Health Program Directions and Priorities Towards MDGs 4 and 5


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Dr. Irma Asuncion
NCDPC, Department of Health

Published in: Health & Medicine
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Department of Health Program Directions and Priorities Towards MDGs 4 and 5

  1. 1. DOH Program Directions andPriorities Towards MDG 4 and 5
  2. 2. Outline of thePresentation Current efforts Status of MDG 4 and MDG 5 Policy and program directions on public healthprograms using the Maternal Newborn, Child Healthand Nutrition strategy Challenges and plan of action
  3. 3. What have been done. . .
  4. 4. Established Emergency Obstetricand Newborn Care in select facilities identified 1784 facilities 1443 RHUs (476 BHSs) 341 hospitals 1232 (69%) are staffed by a trained team of healthprofessionals identified 252 facilities to provide ComprehensiveEmergency Obstetric and Newborn Care, mostlyRegional Hospitals and Medical Centers, includingprovincial hospitals
  5. 5. Integrated Service Package for Women, Mothersand Newborns•Integration of FP with other MNCHN serviceseg. FP- ANC/ EPI integrationPostpartum IUD insertion• Facility based deliveries
  6. 6. Developed a system for training healthprovidersDJFMHUniversity HospitalTraining Unit AdministrativeUnitTRAINING INSTITUTIONSRH WOMENNBSERVICE PROVIDERSCLIENTSNCDPC HHRDBEstablished 29Training CentersTrained 1445 of2444(59%)Health Teamson BEmONCSkills
  7. 7. Developed a system for monitoringand evaluation
  8. 8. Developed a system for maternal deathreporting and reviewReportingSystemReviewSystemCommunity: C/WHTFacility: BEmONC andCEmONC TeamsPHO: PRT SecretariatPROVINCIAL REVIEWTEAMPHO: PRT SecretariatAssuring Data Quality to Improve the System*MNDRS
  9. 9. • Maternal and Neonatal Death ReportingSystem (with IMS-DOH)• submission of data thru the use of SMS technology• The system aims to address immediate reporting ofmaternal and neonatal death.• Initial sites : Centers for Health Developmento Metro Manilao CALABARZONo MIMAROPA (Marinduque, Oriental and Occidental Mindoro
  10. 10. Adolescent Health•Training of Trainers on comprehensive management on adolescent health(13regions started rolling out, regions need trainings);•Leaders for health and health advocates training for out of school youth (streetchildren of Metro Manila (86) and indigenous people (Mangyans, 100) and(Dumagat,100)) (total px -286);•Peer educators training for in-school adolescents (NCR 300px)•Program implementation review integrating catch up immunization program foradolescents (using MMR and Td) nationwide; Joint Memorandum Circularsigning(DOH, DepEd and NYC) on CSE and Adolescent immunization program•National Adolescent Immunization Program (August. 2013)•Drafting Guidelines for Adolescent Health Package with Philhealth and otherpartners.•National Awareness Campaign on Preventing Teen Pregnancy
  11. 11. Expanded Program onImmunization / Vaccines2,011,194 fully immunized children(given complete doses ofBCG+OPV+DPT+Hepa+Measles)Rotavirus vaccination for diarrheafor 700,000 poor childrenPneumonia vaccines for 700,000poor childrenInfluenza and Pneumococcalvaccines for 1.1 million SeniorCitizensWhat has DOH accomplished?
  12. 12. Family Health17 CHDs; 33 DOH Hospitals, 81 provinces and41 independent cities accessed grants forMNCHN activities worth PHP167 millionProcured P400M worth of FP commodities37 Hospitals provided with Voluntary SurgicalContraception funding worth PHP37 millionPHP 11,836,000 was used to procure FP Kits(BTL, NVS) for FP trainingVit A supplement provided to 1,186,356 infants;9,450,553 children; and 2,616,000 postpartumwomenProvided iron to 586,811 low birthweight infantsand 2,655 childrenProvided micronutrient powder to182,951 infants and 365,902 childrenTrained providers on FP CBT 1, FP CBT 2 etc.What has DOH accomplished? 2
  13. 13. Family Health50% of hospitals providing maternity andchild health services are certified MBFHI60% of municipalities/cities have at leastone functional IYCF support group (4,010BF/IYCF support groups at themunicipal/city/barangay level);50% of workplaces have lactation unitsand/or implementing nursing/lactationbreaks55% (71/129) cities, 17% mun.(263/1522), 28% provinces (23/80)passed local ordinance/resolutions thatadopts IYCF recommendations(23/80)provincial governmentsWhat has DOH accomplished? 2
  14. 14. Community Health Teams(CHTs)44,009 CHTs (164,456members) trained and deployed2,999,707 NHTS householdsnationwide visitedWhat has DOH accomplished? 3
  15. 15. Specific Policies Issued in Supportof FP/MNCHN• AO 2008-0036 (MNCHN AO)• AO 2009-0025 (ENC Protocol)• DM 2011-0117 (MNCHN MOP)• AO 2012 – 009 (FP AO)• AO2013-0013 (Adolescent Health Policy)• RPRH Law and IRR - under SQAO by SC• Various PHIC circulars on accreditation and FP/MNCHNbenefit packages• AO No. 2010-0010 – Micronutrient Supplementation Guidelines;AO No. 2007-0045 – Zinc Guideline; DM No. 2011-0303 –Micronutrient Powder
  16. 16. What do we want to achieve?• Reduce unmet need for modern FP affecting 6M women, of which2M are poor• Reduce unmet need for FBD affecting 850,000 women of which722,000 are poor• Reduce unmet need for full immunization affecting 367,000 childrenof which 21, 232 are poor• Reduce unmet need for Vit A supplementation affecting 981,000children of which 394,353 are poor• Ensure that newborns are given EINC• Upgrade health facilities to improve quality of care for at least 5.2MNHTS poor families• Sustain the deployment of at least 50,000 CHTs to serve poorfamilies• Train all midwives etc
  17. 17. Where are we. . .
  18. 18. Antenatal Care Coverage hardly increased inthe past five years78% of pregnant women have at least 4ANC visits.2015TARGET:85%
  19. 19. Skilled attendance and facility based birthsincreased , but why is MMR still increasing?11 percentage pointsincrease in FacilityDelivery2015TARGET:85%
  20. 20. Facility Delivery and Skilled Health ProfessionalAssistance at Birthas of end 2012, PHO Reports
  21. 21. Facility Based Deliveries
  22. 22. Skilled Health Professional Assistanceat Birth
  23. 23. Frequency of Postnatal Care Received by Mothers within firstweek of deliveryFHS 2011: NSO, DOH, USAID84% of women received postnatal careduring first week after delivery.2015 TARGET: 85%
  24. 24. INFANT AND UNDER-FIVE MORTALITY(2003 – 2011)FHS 2011: NSO, DOH, USAIDMDG Targetsfor 2015(26.7 and 19)areACHIEVABLE
  25. 25. FIC, 2012, CHD data
  27. 27. Contraceptive use rates have barelychanged in the past decade
  28. 28. Unmet need for modern FP continues topersist
  29. 29. Family Planning Method FPS 2006 FHS 2011Any Method 50.6 48.9Any Modern Method 35.9 36.9Pill 16.6 19.8Female Sterilization 10.4 8.6IUD 4.1 3.1Injectables 2.8 3.4Male condom 1.6 1.2Other Modern 0.3 0.8Any traditional 14.8 12OCPs are most preferred method; LAPM use declined
  30. 30. CHALLENGES. . .
  31. 31. As of Dec 2012Less than a third of RHUs are MCPaccredited
  32. 32. SUSTAINABLE FINANCING CALLS FOR:1. Rationale investments to cause thePHILHEALTH ACCREDITATION offacilities2. Revenue retention – share for healthworkers, CHTs3. Allow user fee collection from non-poorclients.
  33. 33. Make Safe Blood Available• Implement fully the National VoluntaryBlood Program.• Establish a Safe Blood Supply Network inevery city and province.• Make blood easily, readily accessible
  34. 34. Referral Network Set up an Efficient Referral Network within ILHZsand Province with the following in place:› Emergency Transport on stand-by in every facility thatprovide BEmONC 24/7.• Can be for free or fee– Properly maintained government owned ambulance– Privately owned vehicles : MOA with public transport groupsfor conveyance of referred cases› Efficient Communication System to allow the referringdoctor to make endorsements to the referral hospital› National Referral Manual of Operations
  35. 35. Ensure health teams competence• Encourage LGUs to allow their staff toundergo training on basic emergencyobstetrics and newborn care .• post training evaluation
  36. 36. Conduct Maternal Death Reviews• Strengthen and support Provincial andCity Review Teams.• Conduct MDR at least once per 3months– Assist LGUs identify systemic gaps– Assist LGUs address these gaps
  37. 37. And. . .
  38. 38. Connect the CHTs. . .• Data•Supervision• Monitoring• Members
  39. 39. Extent of CHT deployment varies widelyacross areasI IIIIIIVSource: CHDs as of August 2012
  40. 40. Access to safe deliveries in RHUs isuneven across areasI IIIII IVSource: HPDP Survey of Selected Government Health Facilities as ofAugust 2012
  41. 41. Access to surgical services in district and sub-provincialhospitals is inadequateI IIIII IVSource: HPDP Survey of Selected Government Health Facilities as of
  42. 42. Other Challenges• Logistics management capacity that needs to bestrengthened• Inadequate number of trained providers onFP/MNCHN• Delay in CHT deployment; limited effect on healthcare use• Limited functionality of service delivery networks;mechanisms to formally engage private sectorproviders need to be established
  43. 43. Proposed Approach to Scaling upFP/MNCHN under KP• Focus on poor households, starting with CCT/4Ps• Tap Family Development Sessions (FDS) as entry point toreach families• Utilize Parent Leaders (PLs) and other volunteers to engagefamilies• Conduct needs assessment and planning by making use ofavailable survey data and local information• Estimate and match demand with supply of services,including partnering with private sector• Introduce innovations (health vouchers, outreach)to facilitateuse of services by families• Engage local technical assistance partners (i.e. NGOs) tohelp the LGUs and CHD execute the scale up strategy
  44. 44. Proposed collaboration with partners• Updating of clinical standards and protocols• Capacity building of health providers on IPCC, FP CBT 1 and2• Capacity building for midwives, nurses etc , includingmechanism for certification• Strengthening logistics and supply-chain management• Enhancement of CHT functions and support to deployment• Improving monitoring and evaluation of programs includingcompliance of facilities to EINC implementation• Development of policies and guidelines includingmanagement of prematurity and prevention of prematuritycomplications• Conduct of implementation research
  45. 45. Thank you. . .