VisayasHealth EngenderHealth, Inc.

VisayasHealth

EngenderHealth, Inc.

QUARTERLY REPORT/PROGRESS REPORT

January 1, 2017 – March 31, 2017 / Year 5 Quarter 2

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 2017

VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |2

This document is produced for review by the United States Agency for International Development (USAID). The VisayasHealth Project is managed by the EngenderHealth with headquarters in 440 Ninth Avenue, New York City, NY 10001.The contents are the responsibility of EngenderHealth and do not necessarily reflect the views of USAID or the United States Government


TABLE OF CONTENTS

Acronyms and Abbreviations ................................................................................................................................ 4

I. EXECUTIVE SUMMARY ................................................................................................................................ 7

II. PROGRAM ACTIVITIES AND ACCOMPLISHMENTS ............................................................................. 9

A. Progress/Accomplishments against Project Indicators as of Year 5, Quarter 2 (Y5 Q2) .......................................... 9

B. Demand Generation Accomplishments: ........................................................................................................................... 13

C. Supply Strengthening Accomplishments ........................................................................................................................... 15

D. Policies and Systems Enhancement Accomplishments .................................................................................................. 19

III. CROSS-CUTTING ACTIVITIES................................................................................................................. 21

A. Adolescent and Youth Reproductive Health (AYRH).................................................................................................... 21

B. Monitoring and Evaluation (M&E) .................................................................................................................................... 23

C. Knowledge Management Report ........................................................................................................................................ 24

D. Informed Choice and Voluntarism (ICV) Compliance Report. .................................................................................... 27

E. Environmental Monitoring and Mitigation Plan (EMMP) Compliance Semi-Annual Report ................................ 27

F. Cities Development Initiative (CDI) Reports ................................................................................................................... 28

IV. PROGRAM MANAGEMENT ..................................................................................................................... 29

A. General Staff Meeting at the Regional levels .................................................................................................................... 29

B. Attendance to National Events ........................................................................................................................................... 30

C. Facility Turnovers .................................................................................................................................................................. 31

D. Coordinative Meetings .......................................................................................................................................................... 32

E. Staffing Updates ..................................................................................................................................................................... 33

F. Financial Reports ................................................................................................................................................................... 33

V. OPPORTUNITIES & CHALLENGES ........................................................................................................ 34

A. DOH Advisory Clarifies Application of the Temporary Restraining Order (TRO) on Implanon® ..................... 34

B. Executive Order No. 12 ....................................................................................................................................................... 35

C. DOH Administrative Order No. 2017 – 0005 ................................................................................................................. 35

D. Alternative Learning System ................................................................................................................................................ 35

VI. PLANNED ACTIVITIES FOR NEXT QUARTER ................................................................................... 35

ANNEXES ......................................................................................................................................................... 37

ANNEX I: UNRS Best Practices Abstracts ................................................................................................................................ 37

ANNEX II: Training Components ............................................................................................................................................... 42

ANNEX III: Training Course Enrollment .................................................................................................................................. 43

ANNEX IV: Process Flow for the Modified FP CBT Level 2 PPIUD/Interval IUD Courses ........................................ 43

ANNEX V: Introduction of Interactive Voice Response (IVR) and SMS to the new FP Training Approach for FP CBT 2 ....................................................................................................................................................................................... 45

ANNEX VI: Informed Choice and Voluntarism Compliance ................................................................................................. 52

ANNEX VII: Stories from the Field ............................................................................................................................................. 59


Acronyms and Abbreviations

ANC Ante-Natal Care

ASRH Adolescent Sexual and Reproductive Health

AYRH Adolescent and Youth Reproductive Health

BHS Barangay Health Station

BTL Bilateral Tubal Ligation

BTL-MLLA Bilateral Tubal Ligation – Minilaparotomy under Local Anesthesia

CDI Cities Development Initiative

CHO City Health Office

CPH Cebu Provincial Hospital*

CPH-CC Cebu Provincial Hospital –Carcar City

CPO City Population Office (Officer)

CS Caesarian Section

CYP Couple Year Protection

DepEd Department of Education

DHC District Health Center

DMPA Depot Medroxy Progesterone Acetate (injectable contraceptive)

DOH Department of Health

DQC Data Quality Check

DSWD Department of Social Welfare and Development

EBF Exclusive Breastfeeding

EH EngenderHealth

EO Executive Order

EOP End of Project

FBD Facility-based delivery

FHSIS Field Health Service Information System

FP CBT 1/2 Family Planning Competency-Based Training Level 1/Level 2

FP Family Planning

FPBP Family Planning Benefit Package*

FPOP Family Planning Organization of the Philippines

GIS Geographical Information System

HKI Helen Keller International

HPDP Health Policy Development Program

HSP Health Service Provider


ICM International Care Ministries

ICV Informed Choice and Voluntarism

IEC Information, Education, and Communication

IIUD Interval Intrauterine Device

ILCI IMAP Lying-In Clinic, Inc.

ILHZ Inter-local Health Zone

IMAP Integrated Midwives Association of the Philippines

IUD Intrauterine Device

KRA Key Results Area

LAPM Long-Acting Permanent Method

LARC Long-Acting Reversible Contraceptive

LARC Long-Acting Reversible Contraceptive

LGU Local Government Unit

M/LGU Municipal/Local Government Unit

MCH Maternal and Child Health

MCP Maternity Care Package

MD Medical Doctors

MFP Modern Family Planning*

MNCHN Maternal, Newborn, and Child Health and Nutrition

MW Midwife

NDHS National Demographic and Health Survey

NGO Non-Governmental Organization

NSV No-Scalpel Vasectomy

NSVD Normal Spontaneous Vaginal Delivery*

P2P Peer-to-Peer

PHIC/PhilHealth Philippine Health Insurance Corporation

PHO Provincial Health Office/r

POPCOM Commission on Population

PPFP Postpartum Family Planning

PPIUD Postpartum Intra-Uterine Device

PPM Private Practicing Midwife

PPP Public-Private Partnership

PPR Program Portfolio Review

PRIMEX Pacific Rim Innovation and Management Exponents, Inc.

PSA Philippine Statistics Authority


PSI Progestin Subdermal Implant

PTME Post-Training Monitoring and Evaluation

PYP Program for Young Parents

QGIS Quantum Geographical Information System

REDI Rapport Building, Exploration, Decision making, Implementing decision

RHU Rural Health Unit

RN Registered Nurses

RO Regional Office

RPRH Responsible Parenthood and Reproductive Health

SDM Standard Days Method

SDN Service Delivery Network

SDP Service Delivery Points

SMS Short Messaging System (Text Messaging)

SPH Samar Provincial Hospital*

SS Supportive Supervision

SU Satisfied user

TAP Technical Assistance Package

TB DOTS Tuberculosis Directly Observed Treatment Short Course

TESDA Technical Education and Skills Development Authority

TOT Training of Trainers

TRO Temporary Restraining Order

TUV-SUD Technischer Überwachungsverein-South

UHC Universal Health Care

UNFPA United Nations Population Fund

UNRS Unmet Need Reduction Strategy

USAID United States Agency for International Development

USG United States Government

W/PPR Washington /Program Portfolio Review

WMR World Medical Relief*

WRA Women of Reproductive Age

Y5 Q2 Project Year 5, Quarter 2


I. EXECUTIVE SUMMARY

The VisayasHealth Project is a USAID-assisted project implemented by EngenderHealth Inc. aimed at

improving maternal and child health (MCH) and family planning (FP) services in eight provinces in the

Visayas region of the Philippines. The project provides technical assistance (TA) to the Philippines

Department of Health (DOH) and Local Government Units (LGUs) to strengthen supply, increase demand

for services, strengthen the health system, and advocate for policies supportive of the national Maternal,

Newborn, and Child Health and Nutrition (MNCHN)/FP program.

During the quarter the project was able to accomplish the following:

1. Continue to generate high levels of Couple Year Protection (CYP)

During the quarter the project was able to generate a total of 111,472 CYP. This brings the total

number of CYPs to 788,193 which, is already 91% of the end of project benchmark. At this rate of

increase, the end of project (EOP) target is going to be achieved during the next quarter.

The reason for the sustained increase in the number CYPs is the successful scaling up of

VisayasHealth's unmet need reduction strategy. During the quarter, the number of facilities

implementing the Unmet Need Reduction Strategy (UNRS) has reached 147, with a total number of

298 family planning days conducted, and 5,294 men and women able to access family planning

services. The UNRS entails the mobilization of satisfied users in generating demand for family

planning services. Based on the experience of facilities that were successful in attracting family

planning clients to access FP services, the satisfied users provided the most credible defense against

rumors, myths and misconceptions against the FP methods. Another important feature of the UNRS is

the conduct of FP days where interested clients come to the health facility for FP counseling and

services.

The success of the implementation of the VisayasHealth UNRS can be attributed to the following

factors: [i] increase in the number of providers trained on LAPM; [ii] highly motivated workers who

went out of their ways to visit geographically isolated areas; [iii] facilities are well-stocked with

contraceptive supplies; [iv] partnership with private sector providers especially in areas where the

public health facilities do not have a trained provider; [v] support from provincial and regional

partners; and [vi] active community engagement and participation.

2. Successful introduction of a cost-effective training approach

In response to the clamor for a training methodology that minimizes not only the cost of the training

but also reduce the amount of time that health care providers are taken away from their work stations,

the VisayasHealth project developed and field-tested a training approach featuring the use of self-

instructional materials. This new training approach utilizes the same training curriculum for the training

of health care providers on interval IUD and PPIUD. However, instead of a classroom based didactic

phase, the new training approach introduced a self-instructional module wherein trainees can just read

and perform the necessary exercises in the workplace. After completing the module, the trainees take a

mid-course evaluation to qualify for the practicum phase which takes place in a field-training area or

preceptor site which is located near the trainee’s area of assignment. During the practicum phase the

trainee practices first on a model before performing the procedure under the guidance of an accredited

preceptor.


The project conducted a rapid assessment of this new training approach and found that the providers

who were trained under this training methodology performed just as competently as those trained

using the traditional classroom-based training approach. A comparison of the cost showed that the

new training approach could save as much as 40% of the cost of doing the training. In addition, the

health providers spend less time away from their areas of assignment during training.

To further enhance the effectiveness of the new training methodology, the project plans to apply the

interactive voice response (IVR) technology to follow-up the progress of the trainees during the self-

instructional phase. The IVR will facilitate the link between the trainee and the preceptor. In

addition, VH is also developing training videos that will complement the reading sessions in the

training module. The videos will be installed in the smartphones of providers during the orientation

to the training course.

3. Training of trainers for Bilateral Tubal Ligation – Minilaparotomy under Local Anesthesia

(BTL-MLLA)

In response to the need for more BTL-MLLA trainers and providers, VisayasHealth conducted a

training of trainers (TOT) course in Cebu City. There were six candidate trainers who participated in

the training course coming from the provincial and district hospitals in the three regions of the

Visayas. If all the trainees are able to successfully complete the course requirements there will now be

14 of BTL-MLLA trainers in the Visayas and an estimated 51 number of providers. This training

course will translate into better access for LAPM services in the Visayas.

4. Documentation of best practices in the implementation of UNRS

During the quarter, a number of promising and best practices emerged that VH was able to

document. These best practices include: [i] A successful partnership between an island municipality

and a NGO for the provision of FP services; [ii] A local chief executive who invested local funds to

fund family planning days and as a result was able to fully recover the investments from the social

health insurance program; [iii] A health facility that was able to generate enough acceptors and

satisfied users that active demand generation is no longer necessary. In this facility, clients are coming

to the facility on their own to demand for FP services; [iv] A provincial health officer (PHO) who is

bringing back public health services especially FP into the provincially-owned and operated hospital

facilities; [v] a privately-owned birthing facility in an urban center that successfully adopted the

UNRS.

These best practices will be shared, presented and discussed during the planned technical conferences

next quarter. The technical conferences will serve as a venue for technical exchange among the

implementing partners and create better ways of reducing unmet need in the Visayas. A list of the

best practices is attached as Annex I.


II. PROGRAM ACTIVITIES AND ACCOMPLISHMENTS

A. Progress/Accomplishments against Project Indicators as of Year 5, Quarter 2 (Y5 Q2)

Table 1, shows that the VisayasHealth project is on track to meet most of its indicator benchmarks by the end

of Year 5.

The CYP performance of the project shows a total of 111,472 CYPs generated by the project bringing the

cumulative total to 788,295 CYPs. The project is now 80,035 short of the end of project benchmark of

868,330 CYPs. At this rate of increase, VH will achieve its EOP target in the next quarter. The reason for the

continued high level of performance of the project in generating CYP is the scaling up of the project’s unmet

need reduction for FP initiative. This initiative is anchored on mobilizing satisfied users to generate demand

for FP services especially for long acting and permanent methods. The UNRS also utilizes the conduct of

family planning days to attract men and women who prefer to visit the health center in the company of

friends and relatives. A total of 153 rural health units and health centers successfully implemented the UNRS.

The indicators for supply enhancement such as SDPs providing PPIUD, BTL and NSV are also being met by

the project as the training activities gathered momentum with the introduction of a cost-effective and trainee-

friendly training approach utilizing self-instructional materials and distance learning techniques. The project

also got another boost in building capacity for LAPM with the conduct of a TOT for BTL-MLLA. Six

candidate-trainers participated in the TOT course and are expected to complete the course requirements in

the next quarter.The project continued to make progress with the demand generation indicators especially

women reached with FP information during antenatal care and postpartum care services. Local providers

continued to utilize Usapan and group education sessions to provide family planning information to pregnant

and postpartum women.

Commodity stockouts during the quarter continued to be at low levels. However, the project continued to

monitor the stocks of IUD as the number of IUD users increased as a result of the UNRS. The availability of

stocks of condoms and Standard Days Method (SDM) beads were lower than the other FP commodities as

these were not included in the DOH’s regular supply to the health facilities.

The project also started to collect baseline data for the new Program Portfolio Review (PPR) indicators. The

data collected showed that the project will likely meet the end of project benchmarks for these indicators.

Table 1. Status of selected FP/MNCHN indicators

Indicator

Un

it o

f

Measu

re

Base

lin

e

YE

AR

2

YE

AR

3

YE

AR

4

Y5Q2 Cumulative

Total EOP Benchmark

% Accomp Y5

Target Accomp*

As of March 2017

Utilization of FP Services Increased

CYP in USG-assisted programs (USAID/W/PPR)

251,123 340,199 298,910 350,840 662,278 111,472 788,295 868,330

Short-term methods 205,337 239,837 167,669 253788

Long-acting methods 45,786 100,362 131,241 350,840 408,490 111,472 788,295 868,330

91%

Subdermal implants No. 0 17,112 39,330

7,958 0 9,545 72,198 463,697

Postpartum IUD No. 2,958 10,732 13,299

22,499 107,065 3,183 44,478 25,536

Interval IUD No. 14,628 25,438 21,252

268,773 57,859 89,424 543,789 137,965

Bilateral tubal ligation No. 27,450 45,100 57,200

44,660 229,460 9,300 120,210 199,906

No-scalpel vasectomy No. 750 1,980 160

6,950 14,106 20 7,620 41,225

Supply Enhancement

Percent of service delivery sites (SDPs) providing FP counseling and services to women, men, and couples(USAID/W/PPR) %

48% 37% 89% 88% 94% 90% 90% 94%

90%

Numerator 235 175 420 488 522 500 500 522

Denominator 489 474 474 554 554 554 554 554

Percent of SDPs providing post-partum IUD services

%

3% 12% 45% 51% 60% 54% 54% 60%

54% Numerator 12 46 151 222 262 237 237 262

Denominator 383 383 337 437 437 437 437 437

Percent of SDPs providing BTL services

%

36% 40% 55% 83% 85% 86% 86% 85%

86% Numerator 41 46 63 67 69 70 70 69

Denominator 115 115 114 81 81 81 81 81


Indicator

Un

it o

f

Measu

re

Base

lin

e

YE

AR

2

YE

AR

3

YE

AR

4

Y5Q2 Cumulative

Total EOP Benchmark

% Accomp Y5

Target Accomp*

As of March 2017

Percent of SDPs providing Non-Scalpel Vasectomy

% 0% 0.70% 6% 10% 6% 6% 10%

6% Numerator 3 25 46 25 25 46

Denominator 454 454 454 454 454 454

Demand Generation

No. of pregnant women seeking ANC and provided with FP information (cum)

No. 132,116 (2012)

173,437 277,014 361,866 325,782 387,956 387,956 421,866 92%

No. of postpartum women provided with FP information (cum)

No. 98,301 (2012)

107,730 145,350 172,907 283,737 183,070 183,070 283,737 65%

No. of adolescent and youth provided with MNCHN/FP information

No. 7,906 34,606 76,792 62,769 119,147 5,856 190,838 258,635 74%

No. of men provided with FP information

No. 185 2,464 9,208 5,725 13,576 161 18,447 37,949 49%

Health Policies and Systems on FP and MCH improved

Percent of USG-assisted SDPs that experience a stock-out at any time during the defined reporting period of any contraceptive method that the SDP is expected to provide

Pills % 27% 9% 6% 2% 1% 2% 2% 1% 2%

DMPA (injectable) % 36% 12% 7% 2% 2% 2% 2% 2% 2%

IUD % 14% 5% 4% 2% 0.4% 1% 1% 0.4% 1%

Condom 5% 5% 5% 5% 5%

SDM 80% 33% 33% 80% 33%

Implants 0% 0% 0% 0% 0%

% of LGUs doing Data Quality Check at least once a year

% 51% 51% 73% 100% 82% 82% 100% 82%


Indicator

Un

it o

f

Measu

re

Base

lin

e

YE

AR

2

YE

AR

3

YE

AR

4

Y5Q2 Cumulative

Total EOP Benchmark

% Accomp Y5

Target Accomp*

As of March 2017

New PPR Indicators

Number of women giving birth who received Oxytocin in the third stage of labor (or immediately after birth)

No. 15,148 TBD 3,247 18,395 TBD 18,395

Number of community health workers providing FP information, referrals and/or services during the year

No. 1,103 3,000 2,692 4,632 For

adjustment

Number of Universal Health Coverage (UHC) areas supported by USG investment

a. Strengthening essential package of health services

No. 278 287 279 279 287 97%

b. Assuring quality of health services

No. 112 174 112 112 174 64%

c. Financial Risk Protection

No. 110 174 110 110 174 63%

Presence of Mission support to strengthen Human Resources for Health

a. Upgrading skills mix No. 175 202 182 182 202 90%

b. Integrating community health cadre into the formal health system

No. 58 131 129 129 For

adjustment 98%

B. Demand Generation Accomplishments:

1. Unmet Need Reduction Strategy (UNRS)

As of end of March 2017, a total of 6, 066 clients have been served during FP days (n=359)

conducted in selected VisayasHealth areas. Bohol has conducted the most number of FP days (66),

followed by Cebu (52) and Iloilo and Negros Occidental (45).

Figure 1. Family Planning Days Conducted per Province

Almost half (47%, 136 out of 289) of project assisted cities/municipalities have implemented at least

one FP day, and this is expected to expand to more areas during the next quarter.

Figure 2. Project areas conducting at least one FP Day

45

45

52

66

23

48

32

21

27

0 10 20 30 40 50 60 70

Negros Occidental

Iloilo

Cebu

Bohol

Tri-cities

Leyte

S Leyte

W Samar

N Samar

Number of FP days conducted to date


During these FP days, 17 clients were provided with FP methods on average. However in big

provinces like Cebu, Bohol and Negros Occidental, as much as 100 clients were served with FP

services in a single FP day.

By region, Central Visayas (Region 7) served the most number of clients (2,274), followed by Eastern

Visayas (Region 8). Most (82%) women opt for Long Acting Reversible Contraception (LARC),

16% for short term methods and 6% for Long Acting Permanent Method (LAPM) (Table 2).

Table 2. Number of clients served by province and by FP methods as of March 31, 2017

Region Province BTL IUD PSI DMPA Pills Condom Total Clients

Served

6 Iloilo 0 435 12 42 45 5 539

Negros Occidental 5 862 67 54 132 11 1,131

7

Cebu 32 743 10 42 47 53 927

Bohol 20 936 33 18 64 73 1,144

Tri-cities 0 137 31 18 15 2 203

8

Leyte 60 355 171 111 46 3 736

South Leyte 1 491 19 6 24 19 560

West Samar 6 84 145 21 31 31 318

North Samar 29 124 302 27 26 0 508

VisayasHealth provinces

TOTAL 153 4,167 790 339 430 197 6,066

The VisayasHealth Project lined up Regional Technical Conferences for the UNRS in the next

quarter starting with Region 7 on April 6, 2017. The conference will showcase the best practices of

selected areas and organizations that have been employing UNRS (See also under section III.C.6, VI. C

and Annex I).

BTL 2%

IUD 69%

PSI 13%

DMPA 6%

Pills 7%

Condoms 3%

Figure 3. Distribution by FP method, FP days, Oct 2016 to March 2017


C. Supply Strengthening Accomplishments

EngenderHealth Philippines, as an accredited training institution in Regions 6, 7, and 8, conducts FP CBT

Courses Level 2 for health service providers on PPIUD/Interval IUD Insertion and Removal; Bilateral Tubal

Ligation under Local Anesthesia (BTL-MLLA) with or without sedation; No Scalpel Vasectomy) and

Subdermal Implants (Implanon® NXT). For this quarter, it conducted the following courses in areas

covered by VisayasHealth:

1. Self-Instructional Learning Approach for LAPM/LARC Training

The traditional approach to training Philippine FP service providers is both lengthy and costly. It

requires trainees to leave their posts to participate in the didactic and practicum phases of training

usually held at urban centers. This often puts rural-based providers at a disadvantage and, by

extension, their intended clients.

In order to address the issues of time, provider absence from their posts, cost and the resulting

inequity in service delivery, USAID through the VisayasHealth Project with implementing partner

EngenderHealth introduced an alternative learning approach for the FP CBT Level 2-

PPIUD/Interval IUD courses. Self-instructional materials substitutes for the 4-5 days’ classroom-

held didactics and mobilizing local trainers for the practicum, instead of tapping centrally based ones.

However, it requires a learner to allot at least one to two hours daily to study the modules

without leaving their facilities over a period of at least 2 weeks; attend a 1-day Orientation on the

course and 2 days in the practicum or preceptor sites. The details of the training components, course

enrollment, and the process flow for the modified FP CBT Level 2 PPIUD/Interval IUD courses are

thoroughly discussed in Annexes II, III, and IV respectively.

Bohol and South Leyte provinces piloted the implementation of the alternative approach. The rapid

assessment and course evaluation using focus group discussions and key informant interviews with

stakeholders were conducted. On the bases of assessment results, enhancements were developed.

These include the use of interactive voice response (IVR) and text messaging systems to strengthen

trainee and trainer interaction. The subsequent training activities used the improved version.

The Rapid assessment and Course Evaluation of the pilot implementation in two sites involving 14

local trainers and 20 trainees showed that training costs were 40% lower than the traditional

approach. Local government officials liked the new approach as workers stayed on-site while

learning. Post training monitoring and evaluation results showed trainees completed the required

number of insertions for certification much earlier than they completed the trainees under the

traditional approach. The learners achieved Competency and Confidence earlier in Alternative

Learning Approach (3-6 weeks) compared to the traditional approach (3-6 months).

The rapid assessment also showed the following findings and recommendations:

a. The need to strengthen the process of screening the qualification of the prospective learner based on the screening criteria and getting the support of the learners supervisor in giving them the needed break to enable them to do the self-paced study

b. To enhance the module by making it user friendly – larger fonts, more photo’s or videos to aid visualization of the techniques of infection prevention and the steps in IUD specific counselling and Insertion.


c. To make the trainers/preceptors more visible and available to the learners, especially if they have questions related to the self-paced study.

d. To enhance the self-paced study, group interaction/study should be encourage involving the other learners or experienced providers within the facility or their supervisors in some activities

e. To improve the follow-up and reminders to the learners during the self-pace study and their interaction with trainers/preceptors and organizer using interactive voice and text response system.

To further, enhance the modules and the methodologies the above recommendations are used in the

alternative learning strategy.

The interactive voice and text response system assured trainees of ready access to their trainers when

they had difficulties. The trainers and trainees greatly appreciated the reminders sent to them using

the system.

Nascent area-based training systems saw increased focus on demand generation, training of providers

on- site and mobilization of local trainers that brought services closer to clients especially those in

rural and geographically isolated areas.

The implementation of the adaptation of the Self-Instructional Modules in the FP CBT Level 2

PPIUD and Interval IUD insertion from September 2016 to March 31, 2017 yielded the following

results-Completed 9 batches of PPIUD and 5 batches of Interval IUD training activities; 100 service

providers (25 MD, 13 Nurses and 62 Midwives) enrolled for the PPIUD course. Of this number 85

completed the course or a completion rate of 85% (56% for Doctors, 92% for Nurses and 95% for

Midwives). Sixty-seven (67) service providers enrolled to the Interval IUD course and 61 completed

the course for a completion rate of 91%. Sixty-two local preceptors were involved in both training

courses.

The following table shows the number of training activities conducted using the alternative training

approach, the numbers of trainees who attended the orientation and those who completed the

training and the local trainers/preceptor involved.

Table 3. Number of PPIUD and Interval IUD Providers Trained using the Self-instructional Alternative Learning Approach and No. of Local Trainers/Preceptors Involved

Date of P2P Orientation

VENUE No. of Learners

Date of Culmination

Venue No. who completed the Course

No. of Preceptors /Trainers

MD RN MW MD RN MW

09/09/16-PPIUD

Chocolate Hills Complex, Carmen Bohol

4 2 5 10/26/16 Soledad Hotel,

Tagbilaran City

0

1 4 5

09/28/16 PPIUD

Villa Romana, Maasin S. Leyte

0 4 8 11/04/16 Villa Romana, Maasin S.

Leyte

0 4 8 2

11/15/16 PPIUD

Diversion 21 Hotel, Iloilo

4 4 6 01/27/17 Diversion 21 4 4 6 6

11/16/16 PPIUD

Business Inn Hotel, Bacolod City

2 0 9 01/05/17 El Fisher Hotel, Bacolod

City

2 0 9 6

12/09/16 PPIUD

Gov. Celestino Gallares

7 0 2 02/17/17 Gov. Celestino

7 0 0 1


Date of P2P Orientation

VENUE No. of Learners

Date of Culmination

Venue No. who completed the Course

No. of Preceptors /Trainers

MD RN MW MD RN MW

Memorial Hospital

Gallares Memorial Hospital

2/13/17 PPIUD

Hotel Lorenza, Tacloban City

4 2 5 4/18/17 Hotel Lorenza Tacloban City

1 2 5 4

Feb. 20, 2017 PPIUD

P2P PPIUD Iloilo

1 0 5 4/18/17 Small Ville Hotel Iloilo

City

0 0 6 6

03/8/17 PPIUD

Soledad Hotel, Tagbilaran

3 0 12 4/11/17 Kew Hotel Tagbilaran City, Bohol

0 0 11 5

03/10/17 PPUD

Chocolate Hills Complex Carmen, Bohol


0 1 10 5

9 Subtotal 25 13 62 Subtotal 14 12 59 40

Completion rate 56% 92% 95%

11/29/16 Interval IUD

Villa Romana, Maasin Leyte

0 2 14 02/24/17 Villa Romana, Maasin Leyte

0 2 14 2

Feb 21, 2017 IIUD

P2P IIUD Iloilo 0 2 12 4/18/17 Small Ville

Hotel Iloilo City

0 0 12 6

2/28/17 IIUD

XYZ Hotel Tacloban

2 2 10 4/18/17 Hotel Lorenza Tacloban City

1 1 12 5

3/1/17 IIUD

Lex Hotel Cebu City

0 0 12 3-27-30/17 Summit Circle0

0 0 9 3

03/7/17 IIUD

Soledad Hotel, Tagbilaran, Bohol


0 0 10 6

5 Subtotal 3 6 58 Subtotal 1 3 57 22


Total 28 19 120 Total 15 15 116 62


2. FP CBT level 2 Bilateral Tubal Ligation – Minilap under Local Anesthesia (BTL-MLLA) EngenderHealth/VisayasHealth prioritized the training of service providers from DOH Regional, Level 1 Retained and Provincial Hospitals on BTL-MLLA as well as PPIUD. This effort contributed to the increase on available options, access for quality, affordable and safe FP methods categorized as Long Acting and permanent methods (LAPM).

a. Training of Trainers in Hospitals on FP CBT L2 -BTL-MLLA. Bilateral Tubal Ligation

under spinal and general anesthesia is the most common procedure for permanent FP method

done in the Visayas. This procedure exposes the clients to the risk associated with the above

anesthesia regimen. For women weighing below 60-kilogram body weight, the recommended

procedure is Bilateral Tubal Ligation thru Mini laparotomy under Local Anesthesia (BTL-MLLA)

with or without sedation. The lack of training and available local trainers on this procedure

contributed to the proliferation of the above practice. Review of the residency training on OB-

Gyne reveals that most resident-physicians are trained on tubal ligation under spinal anesthesia.


EngenderHealth/VisayasHealth approached this situation in two ways. The first approach was to

train new service providers as well as retraining those Doctors using spinal anesthesia on BTL-

MLLA. The second is to conduct a training of trainers on BTL-MLLA. For the last three years,

training on BTL-MLLA by a master trainer from Manila, now local trainers have been capacitated

to do the training.

The Training of trainers is a 7-day course consisting of a 2-day didactic/practice sessions and the

actual conduct of the 4-5 days FP CBT Level 2 Training on Minilap under local anesthesia.

The 2-days didactic session prepares the participants in conducting the training of service

providers. [i] Adult Learning Principles; [ii] use of different techniques/modalities in training; [iii]

the rights of the Clients; [iv] FP Counselling and elements of Informed Consent; [v] review of

infection prevention measures; [vi] standard technique of BTL-MLLA; [vii] Prevention and

management of complication; [viii] preparing for the training- training plan; [ix] organizing and

conducting a training on BTL-MLLA.

Trained in March 2017 were six local trainers in Hospitals who conducted 2 batches of FP CBT

Level 2 in Region 6 &7. This brings the number of local trainers on BTL-MLLA to 14. During

the quarter in review, VisayasHealth conducted trainers’ training on BTL to in 2 DOH-retained

hospitals – Gov. Celestino Gallares Memorial Regional Hospital in Bohol and Western Visayas

Sanitarium in Iloilo; and 2 provincial hospitals, namely: Iloilo Provincial Hospital and Cebu

Provincial Hospital-Danao City.

Presented in Table 4 are the number of trainers trained and number of service providers trained

Table 4. Number of Trainers and Service Providers Trained

DATE VENUE TYPE OF TRAINING NO. OF PARTICIPANTS

March 15-16, 2017 Lex Hotel, Cebu City TOT for BTL-MLLA Region-6 = 2 Region-7 = 4

March 22-24, 2017 Lex Hotel, Cebu City FP CBT 2 BTL-MLLA for service providers

Region-7 = 3 MDs 2 Assistants

March 21-24, 2017 Diversion Hotel, Iloilo City

FP CBT2 BTL-MLLA for service providers

Region-6 =4 MDs = 4 assistant

b. FP CBT Level 1. The EngenderHealth/VisayasHealth project continued conducting FP CBT Level

1 and FP CBT Level 2 Interval IUD courses when the participants using the alternative learning

strategy failed to push through with the self-instructional modules.

Table 5. Number of trainings using the traditional approach

DATE VENUE TYPE OF TRAINING NO. OF PARTICIPANTS

01/23/17 Soledad Hotel, Tagbilaran, Bohol FP CBT Level 1 MW 19

03/20-24/17 N. Samar FP CBT L 1 RHM-24 PHN=2

03/27-30 Summit Circle FP CBT L2 IIUD RHMs- 9

L1-2; L2-1 54


c. Preceptor’s assessment conducted during this period. An assessment of potential Preceptors

and their facilities were done in February 2017. To strengthen the training capacity at the local level.

Leyte- 3 midwives; Samar 2 nurses and 1 midwife; North Samar –3 midwives; S. Leyte—2 midwives..

D. Policies and Systems Enhancement Accomplishments

1. Support to Hospital-Based Family Planning Programs

During the period in review, VisayasHealth sustained its work with assisted-hospitals to ensure the

continuous availability of family planning services in these higher-level facilities. Apart from making

sure that post-partum FP and services to young parents are available through hospital-based

Program for Young Parents (PYPs), the project also looked into the hospital’s role as referral points

for surgical FP procedures and complications arising from family planning procedures done in

lower-level facilities. The concept of a Service Delivery Network (SDN) for family planning was

supported by providing guidance in the conduct of coordination meetings and dialogues held at

Inter-Local Health Zones (ILHZs) which are chaired by district and provincial hospital chiefs. At

these meetings, the matter of referrals, financing, and assorted technical and management issues are

high on the agenda.

a. Hospital Systems Improvement through Study visit. A sound hospital management system is

key to sustainable improvements in hospital services on FP, MCH, and related drivers of hospital

growth. For this reason, VisayasHealth invested resources to improve quality management

systems of two strategic LGU hospitals through a study visit by the hospital management teams

of the Cebu Provincial Hospital-Carcar City (CPH-CC) and Samar Provincial Hospital (SPH) to

the Justice Jose Abad Santos General Hospital (JJASGH) of the Manila City Government in

January 2017.

The JJASGH has been chosen as the study site due to its successful efforts in improving its

hospital management systems which has led to its certification by TUV-SUD as an ISO-9001-

certified hospital in 2016. Apart from this, the JJASGH also has a strong FP-MCH program,

extensive experience in tapping PhilHealth financing, and network building and resource

mobilization – all of these being relevant to the CPH-CC and SPH’s hospital improvement

efforts.

The study visit afforded the management teams of CPH and SPH important insights and tips in

LGU hospital improvement. A session with the Ambassador of Health of the World Medical

Relief (WMR) was also done during the visit to provide the participants with information on

opportunities for securing medical equipment donations including those related to the provision

of hospital-based FP and diagnostic services such as OR and digital imaging equipment.

b. Capacity Building for FP. After providing basic family planning training on IUD, implants,

BTL, and NSV for providers in targeted hospitals during the previous quarters, the project moved

towards capacitating hospitals into becoming centers for training in family planning in their

respective catchment areas or SDNs. As detailed under section II.C.2.a., the project conducted

trainers’ training on BTL in two DOH-retained hospitals and two provincial hospitals. This

strategic move was designed to ensure the sustainability of area-based training initiatives beyond

project life.


c. Strategic Planning. VisayasHealth conducted a strategic planning workshop for CPH-CC and

SPH during the second quarter in order to put development plans for FP in a proper perspective

and to ensure the harmonization of all existing hospital improvement plans, making sure that

these align to a clear vision for making FP and MCH services more readily available not only in

these hospitals but also to the rest of their catchment areas. A strong desire to attain ISO

certification and the improvement of FP programs features that strongly stood out in the plans.

d. ISO certification. As part of its work in improving hospital quality management systems that

covers FP, the project facilitated the linkage of CPH-CC and SPH with the ISO audit provider,

TUV-SUD and its affiliated organizations. As a result of the initial engagement by the subject

hospitals of the said audit group, hospital protocols for FP and SDN activities have already been

reviewed, updated, and formatted in accordance with ISO standards.

2. District Health System in Cebu

In its attempt to regain its leadership and influence over the provincial public health system, the

Cebu PHO has put forward its idea of resurrecting the old district health system where provincial

and district hospitals play an important role in primary care and public health. The Local

Government Code of 1991 weakened the PHO’s role in primary prevention and public health as its

attention was focused almost entirely on curative care in the devolved hospitals. Over time, the

PHO’s role in public health programs further eroded and trivialized as the responsibility of

managing the provincial and district hospitals was fraught with many challenges and problems.

To realize the vision of a revitalized health district system, VisayasHealth has assured the Cebu

PHO of technical support in developing appropriate frameworks, organizational structures,

operational plans, as well as the required pieces of legislation and policies to establish the new

approach.

The technical assistance partnership is pursued amidst the DOH’s listing of Cebu province as

among the 17 areas in the country with the highest population and concentration of poor families

with unmet needs for family planning. The health department’s latest estimate puts the number of

women of reproductive age among the poorest families in Cebu at 483,107, with 141,548 or 30% of

them having unmet needs for family planning. Moreover, applying 2013 National Demographic and

Health Survey (NDHS) estimates over the number of poor Women of Reproductive Age (WRA),

those with unmet needs for limiting family size among them would translate to 57,006.

With the strengthening of the core hospitals in Cebu province well on its way, the province is

rebuilding its relationship with the Rural Health Units (RHUs) and cities and municipalities to

reassert its role in primary prevention. The FP program is paving the way in demonstrating how the

district hospitals’ role complements the functions and services provided by the referring RHUs and

health centers.

In line with this effort, VisayasHealth also supported the PHO in tightening the referral loop to

make the service delivery network robust and fully functional. This model asserts the overall

technical leadership of the PHO in the province and applies not only to the FP program but also to

the rest of the other public health programs making the service delivery system more relevant, more

efficient and more effective and inevitably lead to greater impact.


III. CROSS-CUTTING ACTIVITIES

A. Adolescent and Youth Reproductive Health (AYRH)

The Program for Young Parents (PYP) is VisayasHealth’s main programmatic response to the rise in teen

pregnancy in the Visayas.

The latest PYP center was formally launched in Anahawan District Hospital, Anahawan, Southern Leyte on

20 January 2017, bringing the number of PYP centers to 24: six in Region 6; 12 in Region 7; and six in Region

8.

Enrollment in the PYP during this quarter continues to increase, growing from 117 pregnant teens (and their

male partners) in 2014 to 2,988 in 2015 and to 5,992 Table 4). In terms of deliveries, women 19 years and

below in PYP centers averaged about 14%, higher than the national average of 10%. This may actually reflect

an improvement in the referral of pregnant teenagers to PYP facilities. More young mothers are opting to

adopt long-acting reversible contraceptives (LARCs) (771 choosing IUD/PPIUD), 228 oral contraceptive

pills, 159 injectable contraceptives, 58 condoms, 810 Lactation Amenorrhea Method (LAM), and two fertility-

based methods.

Table 6. Maternal and Child Health (MCH) and FP Accomplishments, PYP Facilities, FY2014-2016

Program for Young Parents 2014 2015 2016

*Jan-Dec Oct-Dec

2016

Attendance in ANC

Total Number of Clients w Completed ANC 1807 16800 14144 3756

Women <19 years old w Completed ANC 69 2186 2870 879

Facility-based Deliveries

Total Number of Deliveries 3955 23327 36553 8310

Deliveries to Women <19 years old 525 3331 5605 1316

Total Number of NSVD 3196 18567 30453 6901

NSVD to Women <19 years old 458 2961 4957 1157

Total Number of CS Deliveries 673 4023 5843 1163

CS to Women <19 years old 59 286 413 102

Enrollment in PYP 177 2988 5992 1131

Use of Family Planning

Number of Family Planning Acceptors <19 years old (Please specify method)

· NSV 0 0 0 0

· BTL/ PP BTL 0 0 0 0

· IUD/ PP IUD 16 140 771 252

· Sub-dermal Implant 18 49 0 0

· Oral Contraceptive Pills 10 30 228 64

· Injectable/ DMPA 4 38 159 36

· Condoms 0 4 58 20

· LAM 230 611 810 142

· Fertility Based Methods 0 0 2 0


Program for Young Parents 2014 2015 2016

*Jan-Dec Oct-Dec

2016

Breastfeeding

Total Number of Mothers Initiated on Breastfeeding 114 3111 5612 1217

The PYP supplements prenatal services (e.g., weight and blood pressure monitoring, laboratory tests) with

education of young mothers, their male partners, and significant adults in their lives (e.g., parents,

grandparents). Topics discussed during educational sessions include gender sensitization; recognition of

danger signs and symptoms; birth planning (including compliance with Philippine Health Insurance

(PhilHealth) requirements for the coverage of the young mother and her infant); decision-making; healthy

timing and spacing of births through the use of long-acting contraceptives upon delivery; and exclusive

breastfeeding for at least six months after giving birth. Clients are presented with a certificate upon

completion of the educational sessions.

VisayasHealth has likewise assisted the PYP Centers in identifying and training PYP “graduates” to share

their experiences with their peers and motivate them to use contraceptives to postpone subsequent

pregnancies until they are ready.

As an incentive for completing the educational sessions, VisayasHealth has initiated linkages with the

Department of Education (DepEd), Department of Social Welfare and Development (DSWD), and the

Technical Education and Skills Development Authority (TESDA) to extend preferential access to their

programs and services to PYP clients who complete the educational sessions. This measure will help young

parents pursue their education and livelihood opportunities for their personal growth and the well-being of

their family. This will also help them postpone the next pregnancy.

For this quarter, two (2) PYP centers held “graduation” ceremonies. Iloilo Provincial Hospital (IPH) in

Pototan, Iloilo graduated 30 PYP clients on 10 February 2017 while Eastern Visayas Regional Medical Center

(EVRMC) in Tacloban City graduated 22 PYP clients on 31 March 2017.

VisayasHealth will continue to provide technical assistance (TA) to engaged facilities to help them sustain the

PYP beyond the project life. The project continues to place emphasis on compliance with the DOH

Adolescent Friendly Health Services standards; the strengthening of connections with the interlocal health

zone (ILHZ) where PYP centers are located, including private practice midwives (PPMs); as well as

reinforcing working relations with development partners (i.e., the Department of Education, Department of

Social Welfare and Development, Technical Education and Skills Development Authority, Department of

Labor and Employment, and Department of Agriculture) where PYP clients can access services to further

their education and bolster livelihood opportunities. PYP clients are guided in accessing PhilHealth benefits

for ANC, delivery care, newborn screening, infant immunization, and FP services. It is hoped that PhilHealth

reimbursements will help sustain PYPs in the coming years.

A number of hospitals expressed interest in setting up PYP in their respective facilities. To help them

understand what the PYP entails, Samar Provincial Hospital in Catbalogan City, Western Samar, Western

Visayas Medical Center in Iloilo City, and Tacloban City Hospital were oriented on the PYP.

Thereafter, Dealing with Adolescent Clients training was conducted for 16 Cebu Province-supported

hospitals from 20 to 24 February 2017 and for Tacloban City Hospital, Samar Provincial Hospital, and

Abucay Health Center from 26 to 30 March 2017. These recent batches have the advantage being able to

observe the actual conduct of educational sessions as well as the day-to-day operation of the PYP, the first


one in Cebu Provincial Hospital – Danao City and the latter in Abuyog District Hospital. Samar Provincial

Hospital and Tacloban City Hospital are set to launch their PYP Centers in the next quarter.

B. Monitoring and Evaluation (M&E)

1. Updates of Studies

VisayasHealth engaged two research organizations during the quarter to commence data collection for two

evaluation studies:

a. The Field Epidemiology Training Program Alumni Foundation Inc. (FETPAFI) started

work on data collection last January, 2017 for the study on “Improving Health Behaviors among Pregnant

Women in Cebu City, Cebu, Philippines: An Analytic Study Evaluating the Usefulness of the Usapan Sessions

and SMS Pahinumdom Intervention”. A study manual was developed prior to data collection. A total

of 100 clients each for standard care, Usapan and Usapan +SMS needed to be interviewed for the

study.

As of March 28, 2017, a total of 212 clients met the inclusion criteria1 per protocol, provided

consent and have been interviewed from the study sites as shown in the table below.

Table 7. Number of Clients Interviewed

Mabolo Health Center

(n=106)

Compostela Health Center (n=106)

Standard Care Usapan Usapan+SMS Standard Care Usapan

23 19 15 104 2

M&E/Research backstop for VisayasHealth, Dr. Mahabub Anwar was consulted for options for

meeting the sample size given the yield from initial interviews. VisayasHealth was given the go signal

to interview clients from Barrio Luz, another health area in Cebu City and within the contiguous site

as Mabolo Health Center. Barrio Luz also conducts Usapan sessions. For clients exposed to SMS,

advice was provided to use the SMS database as sampling frame.

b. The Asia Pacific Management and Research Group, Inc. (APMARGIN) was engaged last

February 23, 2017 to assist VisayasHealth in the data collection and analysis of the study on the PYP.

The inception meeting was held to further advise the development of the study manual in order to

commence data collection. APMARGIN staffs were introduced to the three projects sites, namely

Cebu Provincial Hospital-Danao, Iloilo Provincial Hospital and Eastern Visayas Memorial Medical

Center during the week of March 13 to 16, 2017. Training of data collectors were carried out during

the last week of March using a draft study manual.

2. Updates on Data Quality Check (DQC)

1 All post-partum women who were registered in Mabolo Health Center and the Rural Health Unit of Compostela from the period of January to December 2016 will be included. A Postpartum Woman is a female who delivered a baby within 6 weeks, is a resident of Cebu City (exposed groups) and Compostela (control group), between 18-49 years of age and who received any intrapartum services from these facilities prior to delivery. She should have initiated either her 1st or 2nd ANC visit starting November 2015 to allow for maximum exposure to VH interventions including SMS messages, collaterals and Usapan.


For this reporting period, VisayasHealth provided technical assistance to Bacolod City Health Office in the

conduct of Data Quality Check to institutionalize systems for improvement on their FP/MNCHN

recording and reporting systems. In Iloilo City, VisayasHealth also provided technical assistance to the

conduct of Regional DQC Training of Trainers and Applied Supportive Supervision Training funded by

DOH-RO 6 last February 20-24, 2017. This was participated by FP, MNCHN and Field Health Service

Information System (FHSIS) coordinators from VisayasHealth assisted and non-VisayasHealth assisted

provinces.

Table 8. Status of of DQC in project areas

Province

No. of LGUs

Total Oriented to DQC

RHU level DQC

completed

% completed

Leyte 43 43 42 98%

So Leyte 21 21 21 100%

W Samar 24 24 14 58%

N Samar 24 24 17 71%

Bohol 48 48 41 85%

Cebu 53 58 15 71%

Neg Occ 32 32 24 75%

Iloilo 44 44 40 91%

C. Knowledge Management Report

1. Documentation of best practices in the implementation of UNRS

As part of the project’s knowledge management strategy the project was able to identify and

document a number of promising initiatives and best practices (See also Annex I).

a. The unmet need reduction strategy tipping point: transitioning from family planning

events to routine service provision. This best practice documented the journey of one

municipality from the initial efforts to organize family planning days to the point where the flow

of FP information in the community has reached a level whereby special events are no longer

necessary. Clients are now coming on a regular basis to the clinics to demand for family planning

services

b. Responding to the unmet needs in geographically isolated communities through

partnership with a project sector. This best practice highlights the efforts of an island

municipality that partnered with a private sector provider to provide much-needed FP services to

its constituents. The local health managers decided to invite a group of willing private family

planning sector providers to complement the locally initiated demand generation activities

involving satisfied FP users. The resulting successful partnership serves as a model

c. Adopting UNRS in a privately owned birthing facility. This best practice captures the

experience of a privately owned birthing facility that decided to adopt the project’s unmet need

reduction initiative. The results showed that UNRS can be easily and successfully implemented in

the private sector.


d. Positioning district hospitals as hubs for family planning services. This best practice from

the province of Cebu chronicles the efforts of the provincial health office to strengthen the

complementary role of district hospitals in providing family planning services. The district

hospitals in Cebu provide family planning methods that are not available in the public health

centers. The hospital facilities even organize family planning days to serve the needs of clients

within their catchment areas.

e. Investing in family planning services: meeting clients’ needs in a sustainable way. This

best practice documents the experience of a local chief executive who discovered that investing in

family planning services is not only important because it improves the health of his constituents

but also generate additional and much-needed revenue for his municipality. The proceeds from

the family planning benefit packages of PHIC not only augment the income of the municipality

but also serve to motivate the health providers.

2. Technical Assistance Products (TAPs).

During this reporting quarter, the TAPs were revisited yet again. After thorough discussions, the

project has further streamlined the number of TAPs from sixteen (16) to six (6). Most of the

interventions that were previously documented separately have been integrated into these six TAPs

(Table 9).

Table 9. Technical Assistance Products’ Summary of Contents

TECHNICAL ASSISTANCE PRODUCT INCLUSIONS

I. TRAINING SYSTEMS

Establishment of Field Training Areas and Preceptor Sites

Self-Instruction Training Manual

PTME / DOH Certification & PHIC Accreditation / NHIP Localization

Applied Supportive Supervision

II. UNMET NEED REDUCTION STRATEGY (UNRS)

Usapan

Mobilization of Satisfied Users

Organizing FP Day(s)

Ensuring Zero Stockouts of FP Supply

FP In Hospitals

VH Project Tools for Enhancing the Quality of Client-Provider Interactions During FP Service Delivery (IEC Materials)

III. PUBLIC PRIVATE PARTNERSHIPS FOR BETTER MNCHN/FP COVERAGE

Public Private Partnerships For Better MNCHN/FP Coverage

IV. THE PROGRAM FOR YOUNG PARENTS (PYP)

Gender

V. TECHNOLOGY-BASED INTERVENTION

Applying Interactive Voice Response (IVR) and sms to:

Eenforce the Self-Instructional Learning Approach for LAPM/LARC Training

As a vehicle to reinforce Usapan messages to clients such as FP, reminders to complete ANC visits, danger signs to watch during pregnancy, and exclusive breastfeeding among others


TECHNICAL ASSISTANCE PRODUCT INCLUSIONS

VI. MCH PACKAGE

Breastfeeding Community Support Group

Integration of FP to Maternity Care

Pregnancy & Delivery Tracking System

3. Packaging of Training Manuals

As the Self-Instructional Learning Approach for LAPM/LARC Training was introduced during this

quarter, VisayasHealth sought to enhance the training materials. Although the content remained the

same, the project began steps to improve the packaging / presentation of the material. Among the

first steps was having separate materials for Trainers/Preceptors and another for the

Learners/Trainees. This was followed by style editing which was done initially by assigned

VisayasHealth staff. These materials were sent to the EngenderHealth headquarters for further

review of contents and further style editing. The next step is to apply actual photos in lieu of the

graphic illustrations that are currently being used. VisayasHealth is soon to coordinate further with

EH headquarters for the final packaging and finishing of these documents along with other

Knowledge Products.

4. Production of Instructional Videos

Still with the end in mind to enhance the new training approach introduced by the project, the

project has introduced the use of instructional videos for the LARC/LAPM procedures. These

videos would be shown and made available to trainees to enhance or reinforce the content of their

training manuals. Such videos are the ones that have already been approved for use such as those on

Progestin Subdermal Implant contraceptives (PSI) (EngenderHealth), PPIUD (EngenderHealth), and

NSV (C-Men and UNFPA). However, there are certain procedures that the project saw that need to

be also emphasized through video production, particularly those for Interval IUD Insertion. These

include: [i] Pre and Post-Procedure Counseling; [ii] Pelvic Examination; [iii] Speculum Examination;

[iv] Sounding The Uterus; [v] Loading the IUD; [vi] Step-by-Step Guide to IUD Insertion Using the

No-Touch Technique; and [viii] Infection Prevention. The video and photo shoots were done during

the last week of March. These will be post-processed and applied to video editing through the month

of April and targeted to be completed by the end of the same month.

5. Developing Interactive Voice Response (IVR) Scripts for the New Training Approach

VisayasHealth employed an application that would support the Self-Instructional Learning Approach for

LAPM/LARC Training. Pre-recorded voice and sms messages are pushed to trainees to diligently

read their training materials and complete the required number of cases to increase their proficiency

level. Other than the trainees, the technology also entails voice and sms messages sent to preceptors

or trainers to remind them to do trainee follow up visits. Annex IV details the concept and mechanics

of the use of this technology.

6. Organizing of Regional and National Technical Conferences for VisayasHealth

Interventions

As part of the Legacy Plan, technical conferences are in the pipeline for the project’s interventions.

Preparations are underway for the series of Regional Technical Conferences for UNRS starting with

Region 7 (See also VI. C). A national technical conference is also planned for the Self-Instructional

Learning Approach for LAPM/LARC Training sometime in the third quarter of the project year but a

definite date has yet to be set for this.


D. Informed Choice and Voluntarism (ICV) Compliance Report.

VisayasHealth project staff conducted routine monitoring on ICV Compliance on partner LGU

clinics visited during the first and second quarter of Year 5 (October 2016-March 2017), during

Training and FP Days activities. The project monitored fourteen (14) batches of FP CBT Level 2

PPIUD and Interval IUD courses using the Self-Instructional Modules for the didactic and

mobilizing Local trainers/preceptors during the practicum monitored; One (1) batch FP CBT Level

1; one batch FP CBT level 2 IIUD; one batch TOT for BTL MLLA and 2 batches of FP CBT Level

2 BTL-MLLA during the first two quarters of Year 5 (See ICV Compliance report in Annex VI, Part A

and B). FP Counselling, Infection Control and quality of care in the modules and during mentoring

and coaching during practicum were emphasized.

VH looked into anecdotal reports of possible ICV vulnerabilities during the Unmet Need Reduction

Strategy/FP Day activities with the following findings and conclusions

1. Provision of transportation reimbursement for clients and Volunteers.

This is not considered as violation of ICV as these are provided to clients whether or not they are

provided the method they requested if they come from barangays or areas far or not easily

accessible

2. The unmet need reduction strategy identify clients who wants to practice family planning.

Service facilities for short-term methods like pill, DMPA and Condom are referred to their health

centers. The clients are provided the method not available in their area like Interval IUD

insertion, PSI; and NSV; BTL clients are referred to hospital offering the service or directly during

FP Days through the FP Service Providers mobilized during FP Days.

E. Environmental Monitoring and Mitigation Plan (EMMP) Compliance Semi-Annual Report

(October 2016 - March 2017)

1. Trainings

As the project is on its last year, a new initiative has evolved—the Peer to Peer Experiential CBT.

With the initial assessment, this new initiative) in the project comprised the bulk of the training

activities. A total of 113 service providers were trained in the 11 batches conducted by the project,

which included FP CBT 1 and BTL aside from the new initiative. The standard protocol on Infection

Prevention and Hospital/General Waste Management of the Department of Health is part given

importance as it is integrated in the course curriculum as required in the national policy on

environmental mitigation in reducing the risk of infection associated with the insertion or the

procedure.

Table 10. Training Courses/Orientation Conducted

Items Number

Number of training courses conducted that included a session on Infection Prevention

and Waste Disposal:

FP CBT 1 1

BTL 1

Orientation Peer-Peer Experiential CBT on IUD/ PP-IUD 9


2. Monitoring

There are 30% of the government health units and 40% of hospitals are still to be covered in the

project areas; but more to be visited in the private birthing facilities. Many trainees received post

training monitoring and evaluation. Some of the facilities need constant reminder on the practice of

proper waste disposal and infection control.

Table 11. Facilities Monitored/Supervised

Items No

Number of Facilities monitored/supervised (RHU and Hospitals) 307

Number of Facilities that were monitored/supervised during the PTME 64

Number of PPIUD/Interval, NSV, BTL-MLLA trained staff who received post-

training monitoring and evaluation

127

By end of the project, at least 90% of the government facilities (both RHU and hospitals) is targeted

to be monitored. A more aggressive monitoring visit to the private birthing clinics be done,

particularly those being utilized as preceptor sites of the training.

A continuous reminder to the facilities on the practice of proper waste disposal and infection

Control in every chance especially during Family Planning Days where clients are plenty.

F. Cities Development Initiative (CDI) Reports

1. Iloilo City

During the reporting period (January to March 2017) saw a continuing pattern of improving

MNCHN/FP initiatives focused on health programs and services, particularly improving maternal

and child health though Family Planning among the urban poor women and their families. Public-

private partnership (PPP) in the health service delivery network was observed to be blooming with

concerted influence on FP program and services that yielded more new acceptors and continuing

users for modern FP methods, particularly on LAPM. CDI -Health initiatives continued to generate

empowered satisfied users for FP long acting methods. The nine District Health Centers (DHCs)

provided regular MNCHN/FP services including the Friday Teen Clinics during which, trained

service providers utilized Adolescent Job Aids (AJAs) to address all their needs. Three birthing

facilities of Arevalo, Calumpang Molo and Lapaz Maternity Clinic continually provided services for

maternal care.

The City Health Office (CHO) also coagulated efforts with all line partners. With the assistance of

DOH Region 6 and VisayasHealth, it also conducted activities to continually improve FP supply of

services on FP, and demand generation to help realize unmet need reduction as well as policies and

systems. A total of 24 BTL clients from Iloilo City were served during BTL training practicum and

post-training monitoring and evaluation (PTME) of trained doctors during the period. With the

support and technical assistance of the VisayasHealth project’s UNRS, orientation and coaching of

satisfied users (SUs) of FP were given. Three FP Days were initially facilitated in March at Arevalo

District Health Center, CFC PPM clinic, IDC College Clinic participated by multi-sectoral service

providers (SP). This churned 10 IIUD insertions and 11 PSI insertions among 30 mothers. Satisfied

users on IIUD were utilized to generate demand while long acting service providers from Jaro 1 and


Bo Obrero as well as CFC, IDC clinics and FPOP jointly helped out. Also, all 30 service providers

trained on FP CBT 1 from 9 DHCs in the previous quarter were noted to have continually done FP

counseling and service provision for different methods among clients based on ICV compliance.

A/Y friendly clinic services are provided on Fridays for walk-in adolescents and youth needing

counseling and services that include the teen moms who come for pre-natal consultation.

The 9 DHC service delivery network with multi-sectoral engagement for FP and AYRH is

progressively working to achieve the intended reduction of unmet needs. To further improve DQC

implementation and supportive supervision (SS) monitoring, CDI Iloilo City sent 5 CHO and CPO

team members who attended the TOT on DQC and SS on Feb 20-24, 2017 conducted by DOH6

and VisayasHealth. With that, the DQC and validation of data were also on-going per quarter for

systems improvement on FP/MNCHN recording and reporting in the DOH FHSIS. Also, to

promote ICV compliance particularly to WRAs aged 15-49 years old, all CHO and CPO staff utilized

the ICV wall charts and IEC materials on FP. In partnership with DOH RO6, VisayasHealth also

provided technical assistance to the CHO, CPO and the 9 DHCs, FPOP and different private

practicing midwife (PPM) clinics in the carrying out of MNCHN/FP programs execution.

2. Tagbilaran City, Bohol

The VisayasHealth project’s technical assistance to the local government of Tagbilaran City

continued throughout the reporting quarter. This was particularly in ensuring sustainability of the

local FP program implementation through the FP service providers’ availment of PhilHealth FP

package reimbursements. On February 2, 2017 VisayasHealth assisted PhilHealth and DOH in

conducting an orientation for trained FP service providers on the documentary requirements for

accreditation as well as on filing for FP benefit package claims. Part of strengthening the Service

Delivery Network (SDN) of Tagbilaran City, the new P2P / self-learning training approach for

FPCBT Level 2 PPIUD was introduced by the VisayasHealth project. Thirty (30) participants joined

the training under this approach. All the trainees were able to successfully complete the training

modules and were able to perform three IUD insertions during the practicum phase of the training.

At the PYP of DOH-retained Gov. Celestino Gallares Memorial Hospital (GCGMH), 27 teen

mothers participated in the first graduation rites accompanied by some partners and parents on

February 3, 2017. These graduates have completed their ANC visits, delivered in the facility,

practiced exclusive breastfeeding and used a FP method before they went home.

IV. PROGRAM MANAGEMENT

A. General Staff Meeting at the Regional levels

VisayasHealth project management, with some technical staff proceeded to the three regions to meet with the

field staff in the respective regions. The one-day meeting for Regions 6 and 7 were conducted in the first

week of January, 2017 while the meeting with the Region 8 team was done on the second week of January.

The main agenda of the meetings was to discuss the progress of the implementation of the unmet need

reduction strategy (UNRS) in the different provinces of the regions. Each project provincial coordinator (PC)

presented the status of UNRS implementation in engaged areas. After their presentations, the PCs were

requested to submit his/her plan on expanding UNRS using the Geographic Information System (GIS)


Mapping Technology. Issues and concerns on the new training approach, PYP and other administrative and

programmatic matters were also discussed.

B. Attendance to National Events

Selected VH staff attended the following national events:

1. AYRH Compendium Writeshop

The VisayasHealth Project participated in the back-to-back compendium writing workshops on FP in

Hospitals and AYRH in Baguio City from 11 to 13 January 2017. The workshops were convened by

the USAID and organized by HPDP to document promising interventions and help interested

parties replicate these interventions.

VH's primary intervention for AYRH is the Program for Young Parents. It is a facility-based and

seeks to encourage women 19 years old or younger and their partners/significant adults to: [i]

complete four prenatal consultations; [ii] deliver in the health facility; [iii] breastfeed exclusively for at

least six months; and [iv] use contraception upon delivery to prevent another pregnancy until ready.

In addition to the usual pre-natal services (like blood pressure and weight monitoring, physical

examination, laboratory examinations), young parents are encouraged to complete educational

sessions, after which they are endorsed to development partners (Technical Education & Skills

Development Authority, Department of Education, Department of Social Welfare & Development,

etc.) so that they can access opportunities for further education and/or livelihood. It is hoped that

such opportunities will help improve the lot of young parents as well as prevent rapid repeat

pregnancy.

The PYP is cited for its holistic approach, addressing the biomedical needs of young mothers and

their infants, as well as their psychosocial development needs.

Moreover, VH is instituting measures to help engaged facilities sustain the PYP beyond the project

life through building their technical capability and financial capacity through PhilHealth.

2. Third Responsible Parenthood and Reproductive Health (RPRH) Annual Report Workshop.

VisayasHealth was asked to participate in the third annual report writing workshop on the progress

of the implementation of the RPRH Law held in Tagaytay City from March 13 to 17, 2017. The

RPRH Law National Implementation Team convened the writeshop with participants from the

DOH Central and Regional Offices, POPCOM, representatives from NGOs, development partners

and funding organizations like the United Nations Population Fund (UNFPA) and USAID,

specifically the regional projects (Luzon, Visayas, and MindanaoHealth) and the Health Policy

Development Program (HPDP).

The 3rd RPRH Annual Implementation Report focuses on five (5) Key Results Areas:

KRA 1 – MNCHN

KRA 2 – FP

KRA 3 – ASRH

KRA 4 – STIs, HIV & AIDS

KRA 5 – Gender-Based Violence


The Regional Projects shared data and narrative write-ups on accomplishments to date and in

particular, the first quarter of Year 5 for KRAs 1, 2, and 3. The Regional Projects also allowed use of

success stories and photos to enrich the RP RH Implementation Report.

3. FP in Hospitals Compendium Writeshop

The writeshop for the FP in Hospitals Compendium was done in early January, 2017 as a back-to-

back activity with the AYRH Writeshop. This compendium will provide an account of all related

efforts and technical assistance provided by the three regional projects in installing FP services in

selected hospitals in various project sites in the country. For the Visayas, focus was made on Cebu as

the site for the implementation of HPDP demonstration study. The study focused on providing

assistance to selected hospitals in operationalizing the guidelines in the establishment of providing FP

services in these hospital and helping them with recommendations and solutions to a number of

operational challenges. The experience in providing assistance to participating hospitals are

organized in this document including the preparatory activities and efforts to improve or establish

systems in FP service delivery in a hospital setting e.g. recording and reporting, logistics management,

information system, financing, and monitoring and evaluation of service delivery.

The Compendium was packaged by HPDP consultant and is still being reviewed by the participants

of the writeshop and the three regional projects before finalization. The primary audience for this will

be the DOH and LGUs and other partners who are directly responsible for implementing programs

in their respective areas.

C. Facility Turnovers

Turnover of the Dagami RHU with Birthing Facility and TB DOTS Center and the Carigara

Hospital Ward and TB DOTS Center

The newly constructed RHU with Birthing Center and TB DOTS Center in Dagami was turned over

to the LGU of Dagami, Leyte by USAID on March 22, 2017. This was graced by distinguished

dignitaries in the person of no less than the chief of the Office of Health, Ms. Karen Klimowski and

the Mayor of Dagami. The birthing facility will serve the population of Dagami and its neighboring

municipalities.

On the same day, the Carigara Hospital Ward and TB DOTS Center was also turned over to the Leyte

Provincial Government through the Provincial Administrator and the Carigara Chief of Hospital by

USAID. The turnover was done by Ms. Karen Klimowski. This will serve the catchment areas of

Carigara District Hospital.


D. Coordinative Meetings

1. DOH 7 Regional Director and DOH 7 FP/MNCHN staff

Executive Order no. 12 mandated the DOH to come up with guidelines to achieve zero unmet need

by 2020. As such, on the second week of March, 2017, the FP/MNCHN staff of DOH Region 7

approached VisayasHealth requesting for assistance in the formulation and implementation of their

work and financial plan for the roll out of the UNRS initiated by VisayasHealth. A meeting with the

Regional Director of DOH 7 was set up on March 28 with the objective or requesting DOH to

increase the budget for this activity and to discuss preparations for the UNRS Regional technical

Conference for Region 7 on the first week of April. The meeting ended with the regional director

committing to allocate more funds for the UNRS roll out activities and to participate as host and

reactor to the upcoming UNRS Regional Technical Conference.

2. International Care Ministries (ICM)

On March 10, 2017, VH Management met with the President of ICM, Philippines to discuss areas of

collaboration in the provision of FP services in ICM supported areas in Iloilo City and Bacolod City.

The meeting resulted to the commitment of VisayasHealth to include the ICM communities in

demand generation activities for FP so that the appropriate FP services can be provided to potential

clients. VisayasHealth will provide schedules of FP days to ICM staff.

As an offshoot of this meeting, on March 13, 2017, VisayasHealth oriented the FP staff of ICM,

Iloilo on UNRS and on how to coach satisfied users. This is for ICM to do its own demand

generation activities. The same was done for ICM, Negros Occidental on March 15.

3. Provincial Health Office, Cebu

VisayasHealth met with the provincial health officer of Cebu Province on March 7, 2017 to discuss

strategies on how the provincial health office can develop or enhance their hospitals in the provision

provision of preventive and public health services on top of the curative services. The Cebu

Provincial Health Officer presented his plan of revitalizing the district health system in the province

with the four designated provincial hospitals in Danao, Carcar, Bogo and Balamban as core hospitals

for catchment municipalities. Family Planning will be used as the entry point in establishing the

District System. VisayasHealth will provide assistance and continued support in enhancing the

capacity of these hospitals in providing FP services.

Left: Ribbon-Cutting and

turnover rites for the Dagami

RHU

Right: Unveiling of the TB

DOTS and Birthing Centers


E. Staffing Updates

As of March 31, 2017, headcount for VisayasHealth staff totals Forty-One (41) full time staff. On top of

this number, the project has five (5) staff from sub-awardees, PRIMEX and HKI, and seven (7)

consultants. The table below shows the headcount breakdown:

Table 12. Current Staffing Details

Regular Probationary Short Term Staff

TOTAL

MANAGEMENT

COP & DCOP 2 2

TECHNICAL STAFF

Field Staffs (Provincial Coordinators)

Region 6 4 4

Region 7 7 7

Region 8 6 6

Training Staffs (Nurses/Specialists)

6 6

M& E 4 4

BCC 1 1

Policy and Advocacy 1 1

SUPPORT STAFF

HR 1 1

ADMIN 2 2

FINANCE & Grants & Procurement

7 7

TOTAL 43 0 0 41

Seconded Staff (PRIMEX & HK)

5

Consultants 7

TOTAL 12

There have been two (2) turn overs for the Regular Full Time staffs for Q2 of Year 5. The average

turnover rate is 4%.

F. Financial Reports

Table 13. Itemized project expenditures (USD)

Cost Items Total LOP

Cumulative Expenses of

Previous Quarters

Expenditure 2nd Quarter (Fiscal Year 2016 - 2017)

Cumulative Amount at

End of This Quarter

% of Expenses Based on the LOP

January 2017

February 2017

March 2017

Labor + Fringe Benefits

3,164,745.83 213,436.95 63,149.43 63,175.75 72,435.04 412,197.17 13%

Travel and Transportation

2,581,018.36 140,804.16 56,021.36 46,023.11 89,606.42 332,455.05 13%


Cost Items Total LOP

Cumulative Expenses of

Previous Quarters

Expenditure 2nd Quarter (Fiscal Year 2016 - 2017)

Cumulative Amount at

End of This Quarter

% of Expenses Based on the LOP

January 2017

February 2017

March 2017

Sub-grantees/ sub-contractors

1,411,139.50 71,793.64 56,350.52 50,191.77 25,083.77 203,419.70 14%

Other Direct Costs

1,765,792.04 45,709.34 17,347.74 40,567.00 31,206.14 134,830.22 7%

Indirect Costs 3,862,181.40 186,209.65 63,846.64 67,702.76 80,636.72 398,395.77 10%

TOTAL 12,784,877.13 657,953.74 256,715.69 267,660.39 298,968.09 1,481,297.91 57%

Bal Per Monthly Expenses Generated Data 256,715.69

267,660.39

298,968.09

Difference

-

-

-

V. OPPORTUNITIES & CHALLENGES

A. DOH Advisory Clarifies Application of the Temporary Restraining Order (TRO) on

Implanon®

The Undersecretary of Health for the office of technical services signed this DOH advisory on February

1, 2017 clarifying the issue of the TRO on Implanon. The advisory clarified that “the TRO applies only

to the DOH-procured Implanon and Implanon NXT supplies. Other government agencies, DOH-

ARMM, local government units (LGUs), private sector and civil society organizations (CSOs) are

independent and autonomous, hence, are not covered by the TRO. They can only be considered as

agents, representatives, or other persons acting in behalf of the DOH if the Implanon and Implanon

NXT being used are from the DOH. Therefore, they are encouraged to utilize ALL their family planning

contraceptive methods, including their own lmplanon and lmplanon NXT supplies and those donated by

the development partners.”

In addition the advisory clarified that although the TRO does not explicitly restrain training for PSI

insertion, the said training conducted by DOH will require insertion of Implanon or Implanon NXT.

However, qualified PSI training providers may continue to conduct training to the LGUs, CSOs, and

private health care providers as long as they do not use DOH-procured Implanon and Implanon NXT

for the said training. Further, PhilHealth can continue accrediting health service providers who have

successfully completed the said training since accreditation is not covered by the TRO.

The TRO however remains a challenge to the program. The Supreme Court expanded the coverage of

the TRO to include the suspension on the new registration and renewal by the Food and Drug

Administration of the Certificate of Product of all contraceptives commodities so that by 2020 condoms,

abstinence and surgery could be the FP options available in the country. With the registration of new and

existing contraceptives “temporarily suspended in the Philippines, pharmacies, hospitals and health

centers are running out of everything from implants to pills and IUDs.


B. Executive Order No. 12

The executive order signed by the President of the Philippines on January 9, 2017 focuses on attaining

zero unmet need for modern family planning through the strict implementation of the Responsible

Parenthood and Reproductive Health Law and providing funds thereof. This is one of the 10 point socio

economic agenda of the present administration. The Department of Health in coordination with

development partners and other concerned agencies is mandated to craft the policies and guidelines for

the implementation of this executive order.

C. DOH Administrative Order No. 2017 – 0005

This administrative order issued by the Department of Health signed by the Secretary of Health on

march 30, 2017 include guidelines in achieving desired family size through accelerated and sustained

reduction in Unmet Need for modern family planning methods. The objective of this order is to provide

guidelines to the health sector and other stakeholders in the implementation of the strategies necessary to

accelerate and sustain reduction in unmet need for MFP and eventually attain the desired family size

especially among the poor and marginalized.

The administrative order includes the roles and responbsibilities of the different stakeholders like DOH

and its regional offices, Commission on Population, Food and Drug Administration, PhilHealth, other

government agencies, local government units, private partners, civil society organizations, faith based

organizations and development partners. However, this order remains good in paper when contraceptive

commodities are running out of stocks because of the Supreme Court TRO.

D. Alternative Learning System

The adaptation and use of Alternative Learning/Training Systems developed by EngenderHealth/

VisayasHealth provided a boost in increasing the number and quality of available of service providers for

long acting reversible such as PPIUD/Interval IUD and permanent methods. However, some trainees

still prefer having their trainer actually stand with them as they go through the theoretical part of the

training (manual contents). Also, some feel comfortable having their questions or concerns addressed as

they arise during the conventional classroom discussions, especially in their dialect. Further, many of the

trainees, especially those coming from the hospitals and birthing clinics are actually unable to find time

and energy to read diligently and religiously their training modules after a day's work at their stations. The

number of deliveries negates the break that supervisors could give them and paper works they need to do

after the delivery.

There is a need to continue consultations to resolve these issues, while continuing the enhancement of

the modules to improve the interest and comprehension of the learners-improve visuals, videos;

individual and group interaction with other learners and the preceptor while reading or doing assigned

activities.

VI. PLANNED ACTIVITIES FOR NEXT QUARTER

A. National Technical Conference on the Alternative Training Strategies


This activity will present the experiences of EngenderHealth and partner LGUs on the use of mix modalities

in FP CBT Level 2 PPIUD/Interval IUD Training courses:

1. Enhanced self-Instructional modules using larger fonts, more photos/videos

2. Mobilization of local trainers/preceptors in the conduct of the practicum, supportive supervision and

Post-Training monitoring and Evaluation;

3. Use of interactive voice and SMS system in the follow up of learners during the self-paced learning

and implementation of post-training action plan implementation, supportive supervision prior to the

conduct of the PTME

B. Introduction of the REDI Counseling Frame Work for Family- Client Oriented FP

Counseling

1. Orientation of VH Staff, selected FP Coordinators from the Regional and provincial and City

partners on the REDI Counseling Frame Work for Family- Client Oriented FP Counseling

2. Integration of REDI Counseling Frame Work for Family- Client Oriented FP Counseling in the FP

CBT Level 1 and 2 Courses Conduct of more FP CBT Courses

C. Regional Technical Conference for Unmet Need Reduction Strategy

A series of regional conferences will feature best practices in the field using the UNRS (See Annex I) will

be held for representatives from the DOH national and regional offices, representatives from Provincial

Health Offices, representatives from the LGU, and the private health sector (e.g. IMAP). The first leg

will be with Region 7 on April 6 where guests from USAID, UNFPA, and EngenderHealth New York

have been invited to be among the panel of reactors. This is set to be followed by Regions 8 and 6 that

will be scheduled within the months of May and June respectively.

The technical conferences will serve as a venue for technical exchange among the implementing partners

and create better ways of reducing unmet need in the Visayas.


ANNEXES

ANNEX I: UNRS BEST PRACTICES ABSTRACTS

1. The Unmet Need Reduction Strategy Tipping Point: Transitioning from Family Planning Events

to Routine Family Planning Service Provision

Presenter: Jose Mineleo Guibao, Administrator, Calape Mother and Child Hospital

The municipality of Calape, Bohol (2015 Population: 30,863, PSA) adopted USAID/VisayasHealth’s Unmet

Need Reduction Strategy (UNRS) in November 2016 against a backdrop of high unmet needs for family

planning (FP) in its catchment area, particularly for limiting family size, and a lack of proficiency among

health staff in providing long-acting FP methods.

Using GIS technology, mapping of health facility

functionality in providing FP services was

generated. Calape was one of 16 municipalities that

need strengthening of provider skills in Long

Acting method provision and demand generation.

The municipality saw the new strategy as a fitting

intervention to address the twin challenges of

improving provider skills and creating demand for

long-acting FP methods.

From November 2016 to February 2017, its RHU

conducted 13 FP days where providers received

coaching and skills updating support from

VisayasHealth-engaged trainers; IUD and implant

services were provided to women referred by

satisfied IUD and implant users mobilized earlier.

Today, FP days are a weekly fare at the RHU and some BHSs have also begun the practice to make the

services more readily available to those in need. All 33 barangays now have satisfied users who help provide

accurate information on long-acting methods to relatives, friends, neighbors, and associates who they know

want to limit family size but are not yet into FP. Their numbers are continuously expanding as new acceptors

also express interest and willingness to reach out to other women in need of such methods. As of end of

February 2017, these volunteer information providers have referred and caused the servicing of 415 women

who have become as happy and satisfied as they are after receiving their FP methods of choice.

Calape’s experience shows how the UNRS has beefed-up an LGU’s capacity to address unmet FP needs and

how satisfied users are willing to help their lot in taking care of their reproductive health by providing

behavior-changing information on FP. It further shows that by making FP services available on a regular

basis, the positive change in community behavior towards FP is perpetuated.


2. Responding to the Unmet Needs in Geographically Isolated Communities through Partnership

with the Private Sector: The Carlos P. Garcia Experience

Presenter: Corazon L. Paras, President & CEO, IMAP Lying-In Clinic, Inc.

This case presentation highlights the use of public-

private partnership in implementing the Unmet Need

Reduction Strategy (UNRS) in the island-municipality

of Carlos P. Garcia in Bohol province. Faced by a

high unmet need for limiting FP methods, a

disproportionate number of island-based providers of

family planning (FP) services, and lack of access to

alternative health facilities, the health team of this

municipality thought it wise to work with itinerant

private midwives from mainland Bohol. This approach

was seen to help make long-acting methods,

particularly IUD and implants, available in the island-

community, while building the capacity of local

providers.

In support of this direction, USAID/VisayasHealth linked the LGU with ILCI or the IMAP Lying-In Clinic,

Inc., an association of midwives who own a network of private birthing and FP clinics all over Bohol under

the trade name ILCI. ILCI previously received assistance from USAID and the DOH in capacity-building for

providers and trainers in FP as well as in clinic establishment and management. Today, all its 18 clinics are

accredited with PhilHealth and provide services under the Maternity Care Package and Family Planning

Benefit Package. It is a DOH-accredited training institution for FP.

Upon the LGU’s request, ILCI dispatched a team of three midwives to the island during a FP day held on

March 8, 2017. Bringing with them the necessary instruments and supplies, they provided support to the

island’s health team by exposing them to new techniques in IUD insertion and coaching them as services

were rendered. At the end of the day, a total of 60 women were served, 31 for IUD and 29 for implants.

Those seeking short-acting methods were also served, while those who preferred BTL were advised on

preparations for the procedure and the schedule of services at facilities in the mainland.

Encouraged by the successful island campaign, the LGU and ILCI agreed to do additional rounds. In order

to generate funds to sustain the joint effort, both parties have agreed to work together as a team in filing

claims with PhilHealth under the Family Planning Benefit Package (FPBP). Funds to be generated from

FPBP case payments will be pooled and distributed over allowable costs including provider compensation.

The LGU and ILCI’s work in Pres. Carlos P. Garcia, Bohol has demonstrated that partnership between the

public and private sector can be a viable option in addressing unmet family planning needs in a geographically

isolated area.


3. Adapting Community-based approach in Demand Generation for Family Planning in A Private

Clinic: The Glory Reborn Experience

Presenter: Hillary Overton, Founder, Glory Reborn

Glory Reborn is a non-profit organization which operates a birthing and family planning clinic in Cebu City

(2015 Population: 923,000, PSA). Since its establishment in 2003, it has seen over 3,500 deliveries and

numerous women needing family planning services.

The need to effectively respond to family planning (FP) needs especially among poor women in the city

prompted the organization to partner with USAID’s VisayasHealth Project in improving the capacity of its

clinic staff in providing post-partum family planning (PPFP) methods, particularly implants and IUD. By the

end of 2016, a total of 15 Glory Reborn health staff have been trained on basic FP as well as on interval and

post-partum IUD and implants. Five of the trained providers have been certified by the Department of

Health.

Realizing the need to further uncover, reach-out to and serve other women in the community with FP needs,

the organization received additional technical assistance from VisayasHealth, this time, on the Unmet Need

Reduction Strategy (UNRS). At the heart of this new strategy are satisfied users of IUD and implants who are

willing to spend time and effort in talking to relatives, friends, neighbors, and community associates on ways

of meeting their needs for limiting family size and refer them to the Glory Reborn clinic during FP days.

Glory Reborn clinic hosted the first UNRS-family planning day last April 1. A total of 48 women with FP

needs came. Of these, 16 had implants and 19 had intrauterine device insertions; two opted for condoms.

Glory Reborn believes that PhilHealth’s FP benefit package is key to sustaining and expanding quality FP

services especially to the poor. With near-universal coverage of families under the national health insurance

program, even the poorest of the poor are able to access quality FP services from public and even private

clinics like Glory Reborn. Indeed, private sector participation in meeting family planning needs can be

sustainable.


4. Positioning District Hospitals as Hubs for Family Planning Services: A Blueprint for Bringing

Back Public Health to the Agenda of the Provincial Health Office

Presenter: Dr. Rene C. Catan, Provincial Health Officer of Cebu

Hospitals play a key role in ensuring quality of care in family planning (FP). As facilities providing higher

levels of care, provincial and district hospitals can serve as referral facilities for surgical FP procedures in their

catchment areas or Service Delivery Networks (SDNs). They complement the range of FP methods available

at lower-level facilities, ensuring the broad range of FP services for women and men. Hospitals also serve as

referral facility for complications arising from FP procedures done by lower level facilities, as well as strategic

repositories of health information and training resources. All these functions, performed under a district

health system approach, will greatly enhance access to and use of FP services.

To realize the vision of a revitalized health district system, the PHO partnered with USAID’s VisayasHealth

Project for technical support. It took a dual track to developing its health facilities: BHSs and RHUs with the

capacity to do all clinical FP methods for both short and long-acting methods, while the district and

provincial hospitals focus on surgical FP procedures, FP complications, and provision of FP training and

technical oversight over component municipalities.

To date, a total of 64 providers of FP in 35 component municipalities and 22 providers and trainers in 11

district and provincial hospitals have been trained. Links among facilities in defined SDNs are strengthened

through the regular conduct of FP days spearheaded by RHUs.

The introduction of the Unmet Need reduction Strategy (UNRS) in November 2016 allowed the province to

improve the FP caseload of both lower and higher-level facilities. From November 2016 to February 2017,

the PHO spearheaded implementation of the UNRS in 17 municipal LGUs which mobilized a total of 270

satisfied users who referred 595 clients that received services during 67 family planning days. Hospitals have

seen increased referrals for surgical FP from lower level facilities. From November 2016 to February 2017, a

total of 14 BTL clients were served at Cebu’s district and provincial hospitals; seven out of every 10 clients

referred for hospital-based FP are PhilHealth members. Claims under PhilHealth’s FP benefit package have

been increasing across all provincial hospitals since 2015. With UNRS implementation, this trend is expected

to rise even further.

Encouraged by the positive results of UNRS implementation in an initial set of M/LGUs and district

hospitals as well as its potential to help the province achieve zero-unmet need (EO No.12), the PHO recently

decided to scale-up UNRS implementation to cover all component-LGUs of the province and district

hospitals. Its support includes: (1) establishment of district-level structures for FP training and program

supervision based at district and provincial hospitals; (2) strengthen RHU and district hospital referral of

surgical FP cases to provincial and selected district hospitals; (3) strengthen data collection, management and

use with the application of QGIS in site prioritization/selection, progress monitoring, evaluation, and

decision-making; and (4) promote shared UNRS financing arrangements between the province and

component LGUs and encourage the use of PhilHealth funds for this purpose.

The FP program provided the demonstration platform for the district hospitals’ role in overall FP service

provision and helped make the FP SDN robust and fully functional. This model that asserts the overall

technical leadership of the PHO can be applied to the other public health programs and makes the service

delivery system more relevant, efficient and effective and inevitably lead to greater impact.


5. Mobilizing Family Planning funds from PhilHealth: Meeting Clients’ Needs in A Sustainable

Way

Presenter: Hon. Mariano Martinez, Municipal Mayor, San Remigio, Cebu

Improving and sustaining local family planning (FP) programs is a challenge for many local government units

(LGU). Even as the responsibility for health services delivery has been devolved to local governments under

the 1991 Local Government Code, the Department of Health (DOH) and provincial governments continue

to provide supplemental resources to municipal governments for use in the different public health programs.

However, under this arrangement, resources are still not enough, especially when municipal governments

embark on improvement initiatives to meet increasing needs.

In 2016, when the municipality of San Remigio

decided to adopt USAID/EngenderHealth’s Unmet

Need Reduction Strategy (UNRS), one of the

concerns raised by the LGU after seeing positive

results from initial implementation was how this

initiative might be sustained after

USAID/EngenderHealth withdraws its assistance. As

a pilot site of the UNRS, the municipality received

orientation for service providers and volunteers on the

UNRS, technical tools including GIS map-making

software, IEC materials and job aids, support for

preparation meetings and transportation, and coaching services for providers during family planning day from

USAID.

Recalling earlier assistance from VisayasHealth in improving LGU ANC rates through an incentive scheme

using PhilHealth funds, the LGU thought of using PhilHealth funds once again to sustain the UNRS. Back in

2015, VisayasHealth assisted the LGU in developing an incentive scheme to improve compliance by pregnant

mothers of required ante-natal care visits. The incentive scheme which used PhilHealth earnings was coupled

with active enrolment of pregnant women under PhilHealth’s “Women-About-To-Give-Birth” policy. The

scheme continues to this day and has been chiefly responsible for increased ANC, FBD, and even EBF rates

at the LGU, not to mention, earnings from MCP.

With VisayasHealth’s guidance, the LGU has developed a business plan on how UNRS might be sustained

using PhilHealth earnings. An investment of Php 4,250 covers for orientation of providers and satisfied

users, tools, manuals reproduction, IEC materials /job aids, meeting costs, transportation costs of volunteers,

and coaching services of trainers. The gross revenue is Php 10,000 assuming an average of 7 IUD clients

served per FP day, 5 of whom are PhilHealth members at P2,000.00 case payment for IUD.

The Local Health Board has recently passed a resolution adopting the use of the UNRS in its FP program

implementation, providing start-up funding therefor, and allowing the use of PhilHealth revenues for

purposes of sustaining and expanding its implementation. In addition to tapping PhilHealth, the LGU also

intends to use POPCOM funds to partly cover the costs of transportation of satisfied users as they visit and

talk to prospective clients.

San Remigio’s experience in UNRS implementation shows that effective demand-generation coupled by

efficient use of PhilHealth financing can spell the difference in FP service sustainability.


ANNEX II: Training Components

ORIENTATION PHASE 1-day orientation to the course, the process flow from Learners

Selection, the Learner’s Study Guide and Reference Manual, and Learner’s Workbook. This phase is

a run through on the process flow - modular instructions, exercises, assessment of learning and

skills, service integration, post-training monitoring and evaluation, DOH certification and

PhilHealth Accreditation.

SELF-PACED STUDY- done by the Learners, studying each of the ten modules for PPIUD and

five for IntervalIUD one by one, doing the assigned activities, exercises and case-studies and taking

the Modular exam before proceeding to the next module. After completing the last module, the

Learner inform the organizer for his/her readiness to go into the Practicum

PRACTICUM- after completing the ten modules, the learner reports to the organizer/training

institution, who will arrange for their stay in the Preceptor/or trainer in the preceptor facilities.

There, they will take the Midcourse Knowledge Assessment. After passing the Assessment, the

preceptor will conduct the demonstration and return demonstration, coach and mentor the Learner

on the proper technique of counselling, screening and insertion of PPIUD/Interval IUD in

anatomical models-the ZOE or the Mama U. The Learners are graded and required to do the

standard procedures on their own to at least three (3) actual clients, for issuance of the Certificate of

Training by the Training Agency. This will allow them to integrate PPIUD as one of the family

planning method when they go back in their facility

POST TRAINING MONITORING AND EVALUATION (PTME) AND DOH

CERTIFICATION- the Learner is required to do at least 10 standard PPIUD insertions on their

own in their facility within two months after the training. Monitoring of the learner on their

progress, on PPIUD/Interval IUD insertions done during this period assesses, would tell whether

they are meeting the required insertions or are they having problems. The supervisors, trainers or

preceptors also do Supportive supervision to address the problems and guide through the Learners

until the requirements are completed. The Post Training Monitoring and Evaluation visits is a tool

for assessing the quality of PPIUD/Interval IUD insertion and integration of the service in their

facilities. It determines their qualification for endorsement to the Department of Health Regional

Office by the training institution for issuance of the Certificate of Competency as PPIUD/Interval

IUD Service provider signed by the DOH Regional Director.

PHILHEALTH ACCREDITATION – once the DOH Regional Office issued the Certificate of

Competency, the provider may now apply for accreditation as Health Service Provider with

PhilHealth. Once accredited as Health Service provider, the provider can now claim case payments

for PPIUD/Interval IUD insertion done in at least Maternal Care Package accredited Birthing

facilities or level 1 hospital (for PPIUD) and Primary Care Benefit Package accredited facilities for

Interval IUD.


ANNEX III: Training Course Enrollment

A service Provider may enroll to the course by filling out an enrollment form endorsed by their supervisor,

the hospital Chief, and Ob-Gyne Department of their facility and sending this form to the nearest Regional

or Provincial Coordinator of the VisayasHealth, their names are at the back of this briefer. The trainees or

learners are assessed based on the following criteria:

A registered Health Professional-Physician, Nurse or Midwife with valid ID from the

Professional Regulation Commission (PRC).

A staff of a hospital or MCP accredited Birthing Home, licensed by the Department of Health,

handling deliveries No religious objection to provision of FP Contraceptives specially IUD

insertions.

Endorsed by the supervisor/LCE to attend the course and agree to provide time for the self-

paced study while in the clinic or hospital by signing the enrollment form

ANNEX IV: Process Flow for the Modified FP CBT Level 2 PPIUD/Interval IUD Courses

Pre-Training- the program/facility managers conducts:

training needs assessment –determine type of training a provider needed

facility assessment – a self-assessment done to determine if the facility is qualified for the service to be

provided

decision-making process or consultation to enroll a qualified provider for training course

Figure 4. process flow for the modified FP CBT Level 2 PPIUD/Interval IUD Courses

In-Training Processes

Process Orientation conducted by DOH accredited Training Institution

Training Need Assessment

Facility Assessment

Enrollmrnt

PRACTICUM

o MENTORING

o COACHING o AT

PRECEPTOR SITES

DEMAND GEN

o COMMUNITY AND CLINIC-IDENTIFY UNMET NEEDS

o DISCUSS ISSUES ON IUD WITH SATISFIED USERS


Self-paced Learning – knowledge acquisition of learners in their facility

Practicum-skills acquisition with mentoring, coaching of learners by trainers/preceptors at

preceptor sites

Demand generation in the community and clinic-identify unmet needs and mobilizing satisfied

users to discuss issues on IUD with potential clients

Figure 5. In-Training Flow

Post Training Process

a. Integration of IUD/PPIUD Services in facility. Announcing availability of and Provision of

IUD/PPIUD services, Demand generation, Monitoring and supportive supervision

b. Post Training Monitoring & Evaluation (PTME)- a process leading to DOH Certification

of training of the provider, PhilHealth –involves accreditation of the provider and the facility to

provide IUD/PPIUD and claim for case reimbursement. for services rendered.

c. Sustainability Planning. Income retention; Income utilization; Income sharing

Figure 6. Flow of Post-Training

NOTES: In the Process-

The Program Manager or Facility Manager and the Learner jointly decide if the Learner will enroll to the course.

The Training Institution/Trainer/Preceptor assess whether the learner is qualified to attend the course; have completed the course; conducts the Post training Monitoring and evaluation and recommend issuance of certificate of training to the DOH Regional Office.

The course starts with the Orientation of the Learners and ends with the issuance of the Certificate of Training signed by the DOH Regional Director

The Certified Provider applies for accreditation as Health service provider for the particular FP service

PRACTICUM

• MENTORING

• COACHING • AT

PRECEPTOR SITES

DEMAND GEN

• COMMUNITY AND CLINIC-IDENTIFY UNMET NEEDS

• DISCUSS ISSUES ON IUD WITH SATISFIED USERS DEMAND GEN

• COMMUNITY AND CLINIC-IDENTIFY UNMET NEEDS

• DISCUSS ISSUES ON IUD WITH SATISFIED USERS

• Self-paced knowledge Acquisition at learner’s facility

PRACTICUM

• Mentoring • Coaching • At preceptor sites

DEMAND GEN

• Community and clinic-identify unmet needs

• Discuss issues on IUD with satisfied users

ANNEX V: Introduction of Interactive Voice Response (IVR) and SMS to the new FP Training

Approach for FP CBT 2

BACKGROUND

On September 2016, VH developed a training curriculum for the training of family planning providers on

PIUD and interval IUD. From October-February 2017 a total of 16 interval IUD and 32 PPIUD providers

were trained using this new training methodology.

Evaluation of the new approach by the trainees revealed that they liked the new approach as it minimizes

time away from their areas of assignment. However, they expressed lack of time to focus on their reading

assignments. They also expressed difficulty because of the absence of interaction with somebody who can

discuss with them some concerns that arise from reading their learning modules and workbooks.

In order to address the above concerns, VisayasHealth introduced an intervention that uses applications of

SMS or voice mail technology to encourage the trainees to complete their reading assignments and exercises.

It was also seen to help spur trainees to comply with the number of insertions prior to the conduct of the

PTME. Meanwhile, this innovation was also designed to remind the trainers to visit and interact with the

trainees during the self-instructional phase.

OBJECTIVES

General: To improve the implementation of the VH project’s new training methodology for PPIUD and

interval IUD providers using applications of SMS and voice technology

Specific: During the conduct of FP training courses for PPIUD and interval IUD

METHODOLOGY

Messages are sent to trainees to encourage them to complete the requirements during the self-reading

phase

Messages are sent to trainers to encourage them to visit the trainees during the self-reading phase

Messages are sent to the trainees encouraging him/her to continue meeting the required number of

insertions or achieving the necessary competency for the conduct of the PTME

CONTACT FLOW

The Figures 7, 8, & 9 show the general flow of the IVR engagements.


Figure 7

Figure 8


Figure 9

IVR SCRIPT DRAFTS:

A. SMS Alert for the SUPERVISORS

These message alerts are intended to the supervisors of the trainees and preceptors as identified

during the training orientation. The involvement of the supervisors in the whole training procedure is vital in

the smooth execution of the training process and will create a supportive environment during the entire

training duration. Supervisors will be informed on the important training milestones of their trainees or

preceptors through a SMS alert which will be sent to them a day after the orientation commences. This will

be followed by the subsequent SMS alert upon the completion of the trainees or preceptors of the necessary

phases.

Table 13. SMS scripts

Messages to the Trainee’s Supervisors Messages to the Preceptor’s Supervisors

Self-instructional Phase

Message 1: Good day [SUPERVISOR NAME]! This is your training coordinator. I would like to inform you that your staff [FIRST NAME] [LAST NAME] is already done with the orientation and will now be reading the modules and exercises. Thank you for your continued support to your trainee. Have a great day!

Message 1: Good day [SUPERVISOR NAME]! This is your training coordinator. I would like to inform you that your staff [FIRST NAME & LAST NAME of Preceptor] will now be visited by his/her trainees anytime soon for the administration of the mid-course evaluation followed by the practicum. Thank you for your continued support to your preceptor! Have a great day! Message 2: Good day [SUPERVISOR NAME]! I

would like to inform you that your trainee [FIRST NAME] [LAST NAME] has just completed reading the modules and workbook, and is now ready to take


the mid-course evaluation. I would like to appreciate the support you continually provide to your trainee. Meanwhile, [FIRST NAME] will visit his/her preceptor for the evaluation followed by the completion of cases for the practicum anytime soon. Thank you and have a great day!

After the Practicum

Message 1: Good day [SUPERVISOR NAME]! I would like to inform you that your trainee [FIRST NAME] [LAST NAME] has already completed the practicum. [FIRST NAME] will now be going back to your facility in order to complete the case requirements prior to the Post Training Monitoring and Evaluation. Great job for the continued support you extend to your trainee! Thank you and Have a great day!

Message 1: Good day [SUPERVISOR NAME]! I would like to inform you that your preceptor [FIRST NAME] [LAST NAME] has already completed the conduct of practicum to the trainees. Your preceptor will now be contacted by the trainees for the conduct of Post Training Monitoring and Evaluation anytime soon. Thank you for your continued support! Have a great day!

After the PTME Before the PTME

Message 1: Hello [SUPERVISOR NAME]! Great Job! Your trainee [FIRST NAME] [LAST NAME] has just completed the PTME! We will now be issuing a certification for your trainee. Meanwhile, [FIRST NAME] is now also ready to apply for PHIC accreditation. Congratulations for a job well done! Have a great day!

Message 1: Good day [SUPERVISOR NAME]! I would like to inform you that your preceptor [FIRST NAME] [LAST NAME] will be visiting the trainees for the conduct of the Post Training Monitoring and Evaluation to check for the trainees’ skills in doing the procedure. Likewise, your preceptor will endorse trainees that would qualify to be certified as a trained provider. Thank you so much for your kind support to your preceptor! Have a great day!

B. IVR & SMS Alert to TRAINEES

These messages are designed to encourage the trainees who are in the self-instructional phase to

complete their reading assignments and the accompanying exercises. These messages are also intended for

trainees who will undergo the Post Training Monitoring and Evaluation (PTME). 3 days after the training

orientation, a Voice call will be sent to the trainees to check for their progress on their reading assignments

and in completing the exercises. The voice call messages will be repeated every two days until the participants

complete the modules and the workbook. Meanwhile, on the 5th day after the orientation commences, the

trainees will again receive a voice call confirming if they already visited their preceptors. Finally, just before the

PTME, a voice call message will be received by the trainees to check their readiness for the Post Training

Monitoring and Evaluation. After the call, a separate SMS alert will also be sent to the trainees to inform them

of their preceptors’ contact numbers.

Table 14. Voice Mail Scripts

Voice Mail Message SMS Alert to trainee

Self-instructional Phase: Messages to check their reading progress

INTRO: Hi there! This is your training coordinator. If

you want this call to be in English, PRESS 1; For Tagalog,

PRESS 2; For local Dialect (depending on the area),

PRESS 3; To repeat this recording, PRESS 4.

ENGLISH-QUESTION 1: Thank You! Now, I would

like to know how you’re progressing. Are you done


reading ALL the modules? If YES, press 1. If NO, press 2.

To repeat this recording, press 3.

Q1 Key press 1: GREAT JOB! You may now proceed in

taking the mid-course evaluation. I will be sending your

preceptor’s number for you to contact in a short while.

Congratulations!

Hi [FIRST NAME] and congratulations again! You may

contact your preceptor [NAME OF TRAINER] for your

mid-course evaluation anytime at [TRAINER MOBILE

NUMBER]. Thank you and have a great day!

Q1 Key press 2-QUESTION 2: I would like to

encourage you to proceed with your readings. Do you

have any questions, clarifications or problems regarding

your readings so far? If YES, press 1. If NO, press 2. To

repeat this recording, press 3.

Q2 KEY PRESS 1: That’s OK! I will just refer you to

your preceptor. In a short while, I will send you the

contact number of your preceptor for you to address your

questions and concerns anytime. Thank you!

Hi, [FIRST NAME]! You may contact your preceptor

[NAME OF PRECEPTOR] anytime at [TRAINER

MOBILE NUMBER] for your questions / clarifications /

or CONCERNS on your training. Thank you and have a

great day!

Q2 KEY PRESS 2: Thanks for taking the time for this

call! You may now continue with your readings. I will call

you again to follow up, after two days. You may also

contact your preceptor directly any time. I will send you

the contact number of your preceptor in a short while.

Thank you!

Should you encounter any problems or have any questions

from your readings, please feel free to contact your

preceptor [NAME OF PRECEPTOR] anytime at

[NUMBER OF PRECEPTOR]. Thank you very much

and enjoy your day!

Self-instructional Phase: Messages to confirm if they visited their preceptor





ENGLISH-QUESTION 1: Thank You! Now, I would

like to know how you are doing. Have you already visited

your preceptor? If YES, press 1. If NO, press 2. To

repeat this recording, press 3.

Q1 Key press 1: GREAT JOB! Now that you have visited

your preceptor, you may continue in completing your

reading assignments. Should you have any questions or

problems encountered with your readings you may contact

your preceptor anytime. I will be sending your preceptor’s

number for you to contact in a short while. Thank you

and have a great day!

Hi, [FIRST NAME]! Should you encounter any problems

or have any questions from your readings, please feel free

to contact your preceptor [NAME OF PRECEPTOR]

anytime at [NUMBER OF PRECEPTOR]. Thank you

very much and enjoy your day!

Q1 Key press 2: Thank you! I would like to encourage

you to visit your preceptor for you to discuss any

questions/ problems you may have encountered on your

readings and in completing the exercises. This is also a

good time to interact and learn from your preceptor. In a

short while, I will send you the contact number of your

preceptor for you to schedule your visit. Thank you!

Hi, [FIRST NAME]! You may contact your preceptor

[NAME OF PRECEPTOR] anytime at [TRAINER

MOBILE NUMBER] for your scheduled visit and for any

questions / clarifications / or CONCERNS on your

training. Thank you and have a great day!


Before the PTME





ENGLISH-QUESTION 1: Thank you! Now, I would

like to know how you’re doing with your training so far.

Have you completed the number of IUD insertions

required for you to become a certified provider? If YES,

press 1. If NO, press 2. To repeat this recording, press 3.

Q1 KEY PRESS 1: Congratulations! You are now ready

to undergo the post-training and monitoring evaluation.

Please contact your preceptor through the number which I

will send to you shortly. Thank you!

Thank you [FIRST NAME]! You may now contact your

preceptor [NAME OF PRECEPTOR] anytime for your

post-training monitoring and evaluation at [MOBILE

NUMBER OF PRECEPTOR]. Have a great day!

Q1 KEY PRESS 1-QUESTION 2: Do you feel

confident that you’re ready for the Post-training

monitoring and evaluation? If YES, press 1. If NO, press

2. To repeat the question, press 3.

Q2 KEY PRESS 1: Congratulations! You are now ready

to undergo the post-training and monitoring evaluation.

Please contact your preceptor through the number which I

will send to you shortly. Thank you!

Thank you [FIRST NAME]! You may now contact your

preceptor [NAME OF PRECEPTOR] anytime for your

post-training monitoring and evaluation at [MOBILE

NUMBER OF PRECEPTOR]. Have a great day!

Q2 KEY PRESS 2-QUESTION 3: I would like to

encourage you to continue with meeting your required

number of insertions, OR until you feel ready and

confident for the post-training monitoring and evaluation.

Do you have any questions, clarifications and or problems

in practicing your skills? If YES, press 1. If NO, press 2.

To repeat this recording, press 3.

Q3 KEY PRESS 1: Thank you! It is always best to

express your questions, concerns, and or talk about the

problems you may have encountered in practicing your

skills. For these to be addressed, I will refer you to your

preceptor. I will send you the contact number of your

preceptor in a short while for you to call or text your

concerns or questions.

Good day [NAME OF PRECEPTOR]! Your trainee

[FIRST NAME] [LAST NAME] has concerns and

questions regarding the application of the newly acquired

skills. You may expect a message or call form your trainee

anytime soon. Thank you and have a lovely day.

Q3 KEY PRESS 2: Thank you for taking my call today!

You may now proceed in completing the required number

of insertions or until you feel ready and confident for the

post-training monitoring and evaluation. We will call you

again to follow up after 1 week. You may also contact

your preceptor directly through the contact number I will

be sending you in a short while.

Thank you [FIRST NAME] for taking our call today! You

may contact your preceptor [NAME OF PRECEPTOR]

anytime for questions, clarifications and or problems

encountered in practicing your skills at [PRECEPTOR’S

CONTACT NUMBER). Have a great day!


C. IVR & SMS Alert to PRECEPTORS

The Preceptors will also receive a voice call message to remind him/her to visit and check the

trainees before the conduct of the Post Training Monitoring and Evaluation (PTME). A separate

SMS alert will also be sent to the preceptors informing them of the progress of the trainees or if there

are questions that have surfaced during the entire training process. These messages for the preceptors

are important to keep them informed on the progress of their trainees and prompt them to respond

to the needs or problems encountered.

Table 15. VM and SMS scripts

Voice Mail Message SMS Alert to Preceptor

Self-instructional Phase

If the trainee have completed the self-instructional phase: Good day, [TRAINER], your trainee [FIRST NAME] [LAST NAME] has just completed reading the modules and workbook, and is ready to take the mid-course evaluation. You may expect a message or call from the trainee anytime soon. Thank you and have a great day!

If the trainee has questions/ problems during self-instructional phase: Good day, [TRAINER], your trainee [FIRST NAME] [LAST NAME] has concerns / questions regarding the self-instructional modules. You may expect a message or call from the trainee anytime soon. Thank you!

Before PTME Before PTME

INTRO: Hi there! This is your training coordinator. If you want this call to be in English, PRESS 1; For Tagalog, PRESS 2; For local Dialect (depending on the area), PRESS 3; To repeat this recording, PRESS 4.

If the trainee has completed the required number of insertions or is ready for PTME: Good day [NAME OF PRECEPTOR]! Your Trainee [FIRST NAME][LAST NAME] has just completed the required number of insertions and is ready for the PTME. You may expect a message or call from the trainee anytime soon. Thank you.

ENGLISH-QUESTION 1: Hello there! This is your training coordinator. Before anything else, I would like to congratulate you for the great job you’ve done as preceptor. Now, I would like to know if you have already followed up and visited your trainees for the conduct of the Post Training Monitoring and Evaluation (PTME). If YES, press 1; If NO, press 2, To repeat this recording, press 3

If the trainee has questions/ problems in the application of newly acquired skills: Good day [NAME OF PRECEPTOR]! Your trainee [FIRST NAME] [LAST NAME] has concerns and questions regarding the application of the newly acquired skills. You may expect a message or call form your trainee anytime soon. Thank you and have a lovely day.

Q1 KEY PRESS 1: Thank you for helping and encouraging your trainee to complete the training course! Now that you are done with the conduct of the PTME, I would like to congratulate you for a job well done! Thank you for taking this call. Have a great day!

Q1 KEY PRESS 2: Thank you! I would like to encourage you to follow-up and visit your trainees to check for any questions/ problems that they may have encountered on the application of the new skills they acquired. Thank you and have a lovely day.

ANNEX VI: Informed Choice and Voluntarism Compliance

(Semi-annual: Q2/Q4)

This records ALL activities related to compliance to FP and Abortion-Related Policies, such as, but not limited to, orientation sessions on Informed

Choice, Voluntarism, and compliance monitoring tools, systems or activities.

Table 16. Part A: Technical Assistance, Inputs and Other Activities

Date

Location

Specific Activity/

Topic or Content

Conducted By Whom

Number of Participants

Specific Audience

Remarks/Results/

Outputs M F

September 9, 2016 Chocolate Hills Complex, Carmen Bohol

Orientation on Peer to Peer Experiential Competency Based Training on PPIUD

EH/VH 2 9 Doctors – 4

Midwife – 5

Nurse – 2

Counseling discussed in the Manual and mentoring in the practicum.

33 clients provided IUD

September 28, 2016



EH/VH 0 12 Midwife – 8

Nurse – 4



October 26, 2016 Soledad Suites, Bohol

Culminating Activity on Peer to Peer Experiential Competency Based Training on PPIUD


Midwife – 4

Nurse – 1



November 4, 2016 Villa Romana, Maasin Leyte



Nurse – 4



November 15, 2016

Diversion 21 Hotel, Iloilo



Midwife – 6

Nurse - 4



November 15-19, 2016

Diversion 21 Hotel, Iloilo/ Iloilo Provincial Hospital/ Western Visayas Sanitarium

Bilateral Tubal Ligation Training


Midwife – 1

Nurse - 3



6 5 60 65

November

16, 2016

Business Inn, Bacolod Negros

Orientation on Peer to Peer Experiential Competency


Midwife – 9



Date

Location

Specific Activity/

Topic or Content

Conducted By Whom


Specific Audience

Remarks/Results/

Outputs M F

Occidental Based Training on PPIUD 33 clients provided IUD

November

29, 2016


Orientation on Peer to Peer Experiential Competency Based Training on Interval IUD


Midwife – 14

Nurse - 2



December 9, 2016 Gov. Celestino Gallares Memorial Hospital


EH/VH 0 7 Doctor - 7 Counseling discussed in the Manual and mentoring in the practicum.


January 5, 2017 El Fisher Hotel, Bacolod Negros Occidental



Midwife – 9



January 23-27, 2017

Soledad Suites, Bohol

FBCBT 1 EH/VH 0 19 Midwife - 19 Counseling discussed in the Manual and mentoring in the practicum.

January 27, 2017 Diversion Hotel, Iloilo



Midwife – 6

Nurse - 4

Counseling discussed in the Manual and mentoring in the practicum 33 clients provided IUD

February 13, 2017 Hotel Lorenza Tacloban



Midwife – 5

Nurse - 2

Counseling discussed in the Manual and mentoring in the practicum. 33 clients provided IUD

February 17, 2017 Gov. Celestino Gallares Memorial Hospital


EH/VH 0 7 Doctor - 7 Counseling discussed in the Manual and mentoring in the practicum. 33 clients provided IUD

8 5 91 96

February 24, 2017


Culminating Activity on Peer to Peer Experiential Competency Based Training on Interval IUD


Midwife – 14

Nurse - 2


Date

Location

Specific Activity/

Topic or Content

Conducted By Whom


Specific Audience

Remarks/Results/

Outputs M F

February 28, 2017 XYZ Hotel Tacloban



Midwife – 10

Nurse - 2

March 1, 2017 Lex Hotel Cebu Orientation on Peer to Peer Experiential Competency Based Training on Interval IUD


March 7, 2017 Soledad Hotel, Tagbilaran, Bohol


EH/VH 0 12 Midwife-11

Dr-1

Total=12

March 8, 2017 Soledad Hotel, Tagbilaran

P2P Orientation IIUD EH/VH 0 15 midwife- 12

dr-3

Total=15

March 10, 2017 Chocolate Hills Complex, Carmen, Bohol

P2P PPIUD Orientation EH/VH 0 11 Midwife-11

March 15-16, 2017 Lex Hotel, Cebu City

TOT for BTL-MLLA EH/VH 0 8 MDs-8 FP Counselling discusses in the didactic and practicum sessions

March 21-24, 2017 Summit Circle Cebu City

CBT FP Level 2 BTL-MLLA HSP Cebu

EH/VH 0 5 MD-3

RN-2

total=5

FP Counselling discusses in the didactic and practicum sessions

March 20-24, 2017 Diversion 21 Hotel, Iloilo City

CBT FP Level 2 BTL-MLLA HSP Iloilo

EH/VH 0 8 MDs 4

RN- 4


March 20-24, 2017 Pink Hotel, Catarman, N. Samar

CBT FP Level 1, North Samar EH/VH 2 24 RN- 2

MW-24


10 2 126

March 27-30, 2017 Summit Circle Hotel, Cebu City

FP CBT IIUD Cebu Culmination

EH/VH 0 9 9 midwives


Date

Location

Specific Activity/

Topic or Content

Conducted By Whom


Specific Audience

Remarks/Results/

Outputs M F

1

12

25

Total Number of Orientation/Training Activities conducted: __25____ Total Number of Participants Trained or Oriented: __277_ Males: __12_____ Females: __265_ Table 17. Part B. Summary Matrix of Service Providers/Facilities Monitored and Family Planning Clients Interviewed

Date Monitored

Name of Facilities

Location of facilities

Name/Designation of Service

Providers

No. of FP Clients

Interviewed Monitored by

Results/Findings

Steps Taken/

Recommenda-tions

9/23/16 Getafe Rural Health Unit

Getafe, Bohol

Risabel Bancale, Midwife

0 Dr. Elaine Teleron, Regional Technical

Adviser

The primary health unit provides only counselling on BTL but the Informed Consent form is further explained and signed in the referral hospital.

The said primary facility has no copy of the Informed Consent form.

9/22/16

2

Sierra Bullones Rural Health

Unit

Sierra Bullones, Bohol

Gerlie Jaso, Midwife

1

Dr. Elaine Teleron, Regional Technical

Adviser

The primary health unit provides only counselling on BTL but the Informed Consent form is further explained and signed in the referral hospital.

The said primary facility has no copy of the Informed Consent form.


Date Monitored

Name of Facilities



Providers

No. of FP Clients


Results/Findings

Steps Taken/

Recommenda-tions

11/16/16

Mabini Rural Health Unit

Mabini, Bohol 2 Jeffrey Licardo,

Provincial Coordinator

There is no violation on Informed Consent and Voluntarism (ICV)

3/1/17 BHS

Guibawian Guimbawian,

Pinamungahan

Monica Tuguib

Midwife 1

Lurica Gambe



3/3/17 Carreta Health

Center Carreta, Cebu

City

Esmeralda Coming,

Midwife

2

Carlo Dale Pacana, MCTA

Jaminnie Andrea Uy,



3/3/17 Samboan RHU Samboan, Cebu Basiledes Repunte,

Midwife 0

Dr. Elaine Teleron, Regional Technical

Adviser


3/3/17 Alegria RHU Alegria, Cebu 1 Dr. Elaine Teleron, Regional Technical

Adviser


3/3/17

6

Mambaling Health Center

Mambaling, Cebu

Felisa Habasa, Midwife

1

Jaminnie Andrea Uy,



3/9/17 Candijay RHU Birthing Center

Candijay, Bohol Juanita Iballa,

Midwife 3

Annie H. Lucero,


Although the facility does not provide sterilization services like BTL/Vasectomy, the RHU do counselling on this services but does not tackle about Informed Consent.


Date Monitored

Name of Facilities



Providers

No. of FP Clients


Results/Findings

Steps Taken/

Recommenda-tions

3/8/17 Ajuy RHU Ajuy, Iloilo Susie Canoso,

Midwife 0

Cielo M. Alcuino, MCTA


3/8/17 Banate RHU Banate, Iloilo Amalia Felicidario,

Midwife 0

Isabella Esguerra,

MCTA


3/9/17 Passi CHO Passi City, Iloilo Gladys Bernales,

Nurse 0



3/9/17 FPOP Iloilo

Chapter Iloilo City Razel Cabrera 0


There is no violation on Informed Consent and

Voluntarism (ICV)

3/9/17

6 Mina RHU Mina, Iloilo

Lorne Leano, Midwife

0 Isabella Esguerra,

MCTA


Voluntarism (ICV)

3/16/17 Sambag 2

Health Center Cebu City Vercel Belvestre 1

Antonia Lucero, Provincial

Coordinator


Voluntarism (ICV)

1

Number of Facilities monitored - 15

Number of Provider Interviewed- 15

Number of Client’s Interviewed- 10

Number of Vulnerabilities noted- 0

ANNEX VII: Stories from the Field

1. STORIES RELATED TO THE FIRST IPH PYP GRADUATION

USAID-supported young parent program links clients to education and employment

opportunities

POTOTAN, ILOILO PROVINCE

Adolescent mothers enrolled in the Program for Young Parents (PYP) of the Iloilo Provincial Hospital (IPH)

will now have opportunities to pursue careers after giving birth. This was the good news that the 22 young

mothers, aged 18-20 years old, received along with the Certificates of Completion from IPH PYP during its

first graduation rites on February 10, 2017. A PYP client is considered a “graduate” if she submitted for four

(4) ante-natal consultations, attended the four (4) educational sessions, delivered in the facility, and used a

family planning method to delay the next pregnancy.

Beyond these services, IPH Chief Dr. Prem Parcon explained, “Our next step is to help these young mothers and/or

their partners find the resources to support their family.” He went on to announce that the Department of Education

(DepEd), Technical Education and Skills Development Authority (TESDA), Department of Labor and

Employment (DOLE), and Department of Social Welfare and Development (DSWD) have gladly agreed to

partner with the PYP by offering opportunities for the teen moms and/or their partners to continue their

education, pursue skills training, and find employment. USAID, through its VisayasHealth project, facilitated

linkages with these agencies with the IPH PYP team, together with the Department of Health Region 6 office

and the Provincial Government of Iloilo.

Left photo shows some of the 22 Graduates of the Program for Young Parents of Iloilo Provincial Hospital together with PYP Focal Person, Ms. Wilma Ponta-oy (foreground). Right photo shows them with IPH staff and PYP Team.

(Photos by CAlfafara/EngenderHealth)

DEMAND GEN

o COMMUNITY AND CLINIC-IDENTIFY UNMET NEEDS

o DISCUSS ISSUES ON IUD WITH SATISFIED USERS

“Teen pregnancy is not just a medical issue. Beyond caring for

the young mothers and their babies, we are now linking them

to other agencies that can help them face the many challenges

of parenthood.”

DR. PREM PARCON Chief of Hospital Iloilo Provincial Hospital

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Teen Mom found hope for her future with USAID’s AYRH program

Jonah Lloyd Intong was only 17 and on her first year in

Agricultural Engineering when she became pregnant. Being the

second child and only daughter of 3 children, it was difficult for

her to deal with the disappointment of her family upon learning

about her pregnancy. Her partner’s family was more accepting

of her situation and her own family slowly came to terms with it

as well. They encouraged her to seek maternity care at the Iloilo

Provincial Hospital (IPH), which eventually led to her

enrollment in the Program for Young Parents (PYP), a USAID

initiative adopted by IPH.

Now 19 years old and a mother of a one-year old baby girl, she

recently received a Certificate of Completion from IPH PYP,

along with 21 other young moms. She and her fellow teen

moms received recognition at IPH as graduates of PYP for

completing prenatal, delivery, and postpartum services and

completing especially designed education sessions on

Recognition of Danger Signs of Pregnancy; Gender; Exclusive

Breastfeeding; Family Planning / Responsible Parenthood to

postpone subsequent pregnancies, and Life Skills to help them

deal with challenges they are likely to encounter as they

transition to adulthood.

Asked about her best experiences with PYP, Jonah replied it

was the education sessions that had great impact on her. She

learned how to take care of her baby and how to be a good

parent. She appreciated the opportunity to share life stories with

other young mothers, gaining inspiration from them and

spurring them to rise with hope and not despair.

Jonah’s resolve to complete her education was strengthened along with her emotional strength as she had to

take a different course due to financial constraints. She is now on her second year of Bachelor of Elementary

Education and optimistic that things will work out, saying “I think I will enjoy teaching children in the future.”

Should other young women find themselves in the same position, Jonah says they should work doubly hard

to pursue their dreams for their own and their children’s sake. She is grateful for the care of the IPH PYP and

the help of development partners.

USAID Young parents program inspires young mother to help fellow teen parents

Distraught and apprehensive of her family’s reaction to her situation, Joy Pelenia was only able to disclose

her pregnancy on the second month. While upset with the turn of events, her family supported Joy and

encouraged her to seek medical care at the IPH

“The Program for Young Parents

helped me find strength to get up

and move forward with my life for

myself and for my baby. I am

thankful for the opportunity given

to me to pursue my dreams. ”

~ JONAH LLOYD INTONG, 19 IPH PYP Graduate

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“Being a PYP Peer Educator

is my way of thanking the

kind health service providers

of the IPH PYP. I feel

fulfilled when I see my fellow

teen moms with hope in their

eyes after I share my story”.

~ JOY PELENIA, 20 IPH PYP Graduate & Peer Educator

Joy had dreamt of being a cruise ship attendant and was on her

second year. The early, unexpected pregnancy posed a

seemingly insurmountable obstacle to attaining her dream.

Fortunately, the PYP helped Joy “find strength to get up and move

forward with my life for myself and for my baby”. Through the PYP’s

recently forged partnership with the Technical Education and

Skills Development Authority (TESDA), Joy is confident that

she can still pursue the bright future she dreamed of through a

career in health care.

Joy Pelenia is now 20 years old and the mother of an 11-

month old baby boy. She has become one of the active peer

educators of Iloilo Provincial Hospital (IPH) Program for

Young Parents (PYP). She helps the IPH staff with routine

tasks like having clients sign attendance and making

nameplates. Most important, she shares her life experience

with other teen parents during the weekly PYP day at the

facility. She is grateful for the solicitous care she received from

IPH PYP staff which she credits for the change in her outlook

from a sad, young pregnant girl to the hopeful individual she is

now. Joy finds fulfillment in sharing her life story with other

young parents. The PYP facilitates the formation of natural

support groups, especially among the young women who find

comfort and draw strength from each other.

2. STORIES RELATED TO THE FACILITY TURNOVERS

Looking Forward To Better Service Provision

for Dagami Clients with New USAID-Built RHU and

TB-DOTS Facility

DAGAMI, LEYTE

There is never a dull day at the Rural Health Unit (RHU) of

Dagami, Leyte. Ms. Letecia Flores, a 64-year old Public

Health Nurse (PHN) and 57- year old midwife Ms. Myrna

Cabidog, have seen a lot in the last 37 years of service at the

RHU. As population of the municipality grew over the

years, the number of clients at the RHU has also increased.

Prenatal days are scheduled every first and last Wednesday

of the month. On these days, about 15-25 pregnant mothers

composing of first time mothers, teen mothers, and those

who’ve had other children gather for their prenatal consultations. Immunization days happen every second

and third Wednesday where about 50-65 babies are attended to. However, on some days, the RHU gets

Dagami RHU’S Ms. Letecia Flores, PHN (left) and Midwife Ms. Myrna Cabidog (right) have been serving the RHU for 37 years and 36 years respectively and look forward to more good things at the newly completed RHU.

(Photo by HSeverino/EngenderHealth)

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crowded and the RHU staff are barely able to attend to all the clients who come to the client for varying

health issues including Tuberculosis treatment and family planning (FP) services.

Prior to the onslaught of Typhoon Yolanda in 2013, Dagami RHU assisted an average of 10-15 births a

month. The following year, the RHU recorded 20 deliveries a month. According to Ms. Cabidog, “in spite of

dilapidated walls; rundown delivery and recovery rooms; small and humid waiting areas; and examination rooms, the RHU staff

tirelessly received clients even from other municipalities.” It was only when private birthing clinics started

mushrooming in neighboring towns in 2015 that the RHU‘s monthly average of deliveries reportedly went

down to 1-7 deliveries. Still, the problem of congestion and discomfort remained.

A typical day at the current Dagami RHU is a crowded scene at registration and waiting rooms even in the early hours of the morning. The crowd expands during dedicated days like EPI, Prenatal, and FP days. (Photos by CAlfafara/EngenderHealth)

Ms. Flores meanwhile relates clients’ expressed wish for the RHU saying, “Mothers who are here for prenatal say

they want a more conducive and comfortable space to deliver their baby. As you can see our place is exactly the opposite on what

they want for their baby. Sometimes during heavy rains, clients had to be moved to more elevated areas of the RHU as the water

comes in and starts flooding the facility.”

Asked about their thoughts on the building of a new RHU and Tuberculosis –Directly Observed Treatment

Short-course (TB-DOTS) facility by USAID, Midwife Cabidog said, “Finally, our clients would be comfortable when

they go for consultations or to deliver their babies. As among the USAID-trained providers on FP, I and other trained staff of

the RHU will be more inspired to give FP services in a more comfortable facility. I’m grateful for all the (USAID) support we

received. All the FP training and supplies, IEC materials, orientations and seminars you had provided for Dagami have been

very useful and now with the beautiful new facility you built for us, this is truly a big help especially for third class municipalities

like ours. We hope that we could sustain the momentum of change””

Operations at the current RHU meet physical challenges as the staff take in clients in humid and dilapidated facilities, flood-prone floors, peeling paint, and lack of storage places for files and supplies. Leftmost photo shows boxes and supplies stacked on top of the other on benches to avoid flood waters destroying these during heavy rains. Middle and rightmost photos show the maternity ward and hallways in disrepair. (Photos by HSeverino/EngenderHealth)


“Thank you for all the help. I am

thankful that there are Family

Planning services here in Carigara. It

is really a big help to us mothers, to

our family. It is why I am always

willing to share my experience to my

fellow mothers about the benefits of

Family Planning are, especially to

those teen age mothers. These young

moms should be given full attention on

this information.” ~Sarah Faye Esmero

The new Dagami Rural Health Unit and TB-DOTS facility is part of the U.S. government’s over Php 6.3 billion ($143-million) assistance to Eastern Visayas, which was severely hit by the Typhoon Haiyan (Yolanda) in 2013. The new Dagami RHU is nearing completion and will then be turned over to the Dagami LGU to serve its 35,147 population (Source: 2015 Census of Population, Philippine Statistics Authority) from its 65 barangays and those from nearby towns. (Photos by HSeverino & CAlfafara/EngenderHealth)

Nurse Flores on the other hand also expressed her gratitude saying, “Absurd to say, but we are also thanking

Typhoon Haiyan, because of that catastrophe we are receiving this blessing now. We will truly cherish this. We will surely be able

to provide better quality service to our people as what you gave to Dagami. With the new building, rooms and equipment, there is

no reason for us not to excel in health. Aside from the mothers and their babies, TB patients will find greater hope for cure with

effective TB diagnostics and treatment with the new facility. Thank you (USAID) from our hearts ‘damo nga salamat’ (Thank

you very much)!”

Mother Gives Back to RHU Out Of Gratitude to

Care Received

Sarah Faye Esmero is a 33 y.o. housewife and mother of a

baby boy aged 2 years and 3 months. She has been a recipient

of prenatal, birthing, and FP services of the Carigara Rural

Health Unit (RHU), under the care of USAID-trained service

providers. Sarah Faye expressed great satisfaction with the care

she has received because it has also impacted the life of her

family.

The thorough care Sarah Faye got through information and

service provision on maternal and newborn care and family

planning has enabled her family to attain utmost health and

well-being. She claims her baby is healthy because the health

providers always emphasized the importance of completing

antenatal visits and exclusive breastfeeding through the

information (Usapan) and counseling sessions she attended. She

also learned how important proper birth spacing is to her

reproductive health. After accepting family planning (FP), she

also found its impact in her family’s quality of life. She explains,

“Financially we can be stable. Now, I can follow up the

growing years of my child not worrying. It is also a big

help, financially and emotionally “. She added that she and

her husband are able to spend more quality time together

without fear of getting pregnant too soon.

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Joy Abuyabor, a midwife from Leyte, and other USAID-trained midwives are helping more parents across the Philippines access quality health care.

(Photo by CAlfafara/ EngenderHealth)

Today, out of her appreciation for the services she received, she is giving back to the RHU as one of the

fifteen (15) FP satisfied users who share their experiences with their FP method of choice to other clients at

the RHU during the FP Days that are now regularly held at the Carigara RHU. Through Sarah Faye, several

mothers are now also sharing that same improved quality of life and are considering being FP champions like

her.

She looks forward to even better service provision quality when the new Carigara District Hospital Expansion

Maternity Ward and TB DOTS Center built by USAID is turned over to the local government of Carigara.

“Now that we will soon benefit from you (USAID) an additional building in our Hospital that I

believe will continue the good services currently done here in the RHU or better.”.

3. OTHER

BRINGING SAFER DELIVERIES TO MOTHERS AND NEWBORNS IN THE PHILIPPINES

One midwife’s relentless determination to give families a healthy start

(See also https://www.usaid.gov/results-data/success-stories/bringing-safer-deliveries-to-mothers-and-

newborns-in-the-philippines)

“We mentor one another, which helps us give the right

information and the right services to our clients.”

February 2017—Joy Abuyabor is a midwife from

Leyte, in the central region of the Philippines called

Visayas. Since 2008, she has been operating her family

health care and maternity clinic so more babies can be

delivered safely and parents can seek family planning

options.

Abuyabor’s work reflects the national government’s

objectives to reduce maternal and infant deaths and

meet family planning needs. In 2015 alone, about

2,700 Filipino mothers lost their lives to preventable

causes related to pregnancy and childbirth, and almost

30,000 newborns lost their lives before reaching 1

month old.

To help the Philippine Government address this, USAID, in partnership with EngenderHealth, launched the

VisayasHealth Project in 2013.

Project staff train health workers on patient-centered counseling so parents can make informed decisions

about family planning. The project also supports public-private midwives networks, where experienced

midwives mentor other members on skills like caring for pregnant women or inserting and removing

intrauterine devices.

https://www.usaid.gov/results-data/success-stories/bringing-safer-deliveries-to-mothers-and-newborns-in-the-philippines

https://www.usaid.gov/results-data/success-stories/bringing-safer-deliveries-to-mothers-and-newborns-in-the-philippines


Top Left photo shows the clinic devastated after Typhoon Yolanda

hit in 2013. Undaunted, Joy Abuyabor continued to provide services

to the women of Tacloban City and Palo, Leyte even under difficult

circumstances (right photos). With much perseverance and support

from partners, she was able to rebuild her clinic. Lower left photo

shows the clinic after the completion of the reconstruction.

(EngenderHealth)

Through these networks, the providers coordinate services to better serve clients. For example, a woman may

learn about family planning methods in a private clinic, but can be referred to a nearby public clinic for free

products and services.

In 2013, Abuyabor joined one of these networks. That same year, on Nov. 8, Typhoon Haiyan made landfall

in the Philippines. It was one of the most powerful storms on record and Abuyabor had just delivered a baby

in her clinic.

Storm surges battered the building while seawater washed away equipment, medical supplies and records.

Abuyabor took her staff, the new mother and the baby to the roof for safety. When the water subsided, she

salvaged supplies to care for survivors. She resumed services in just weeks and even delivered babies. Over

time, she fully restored her clinic.

“I never lost hope,” says Abuyabor smiling.

Today, she provides antenatal care to about 400 women and delivers around 25 babies per month. She

counsels parents seeking options for family planning, and gives them the method best suited to their needs.

The network convenes regularly to improve members’ skills and collaboration. Abuyabor is a mentor now

and hosts workshops. “This network has enhanced my skills and knowledge,” she says. “We mentor one

another, which helps us give the right information and services to our clients.”

USAID has trained and provided technical

support on maternal care and family

planning to more than 11,000 community

health workers nationwide. By educating

parents and providing quality services,

these health workers have contributed to

the Philippine Government’s achievement

in 2015 of assisting more than 77 percent

of deliveries with a skilled birth attendant.

And in 2016 alone, almost 90 percent of

service delivery sites supported by the U.S.

Government also provided family planning

services.

These measures allow more Filipinos to

access quality health care and raise healthy,

stable families.

VisayasHealth EngenderHealth, Inc.

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