Phase 2 Project Completion Report. Joint Programme on Maternal and Neonatal Health

Transcription

1 Phase 2 Project Completion Report Joint Programme on Maternal and Neonatal Health United Nations I January 2017

2 Contents I. INTRODUCTION... 7 II. PROGRAMME SUMMARY... 8 III. EXPENDITURES AND INPUTS IV. APPROACH AND STRATEGIES ADOPTED V. KEY OUTCOMES VI. EXPECTED LONG-TERM BENEFITS AND SUSTAINABILITY VII. OVERALL ASSESSMENT VIII. LESSONS LEARNED AND RECOMMENDATIONS IX. HANDOVER AND EXIT ARRANGEMENTS References Annex A. JPMNH Phase 2 Sites Annex B. JPMNH Phase 2 Results Framework Annex C. JPMNH Phase 2 Monitoring and Evaluation Framework

3 Acronyms 4Ps Pantawid Pamilyang Pilipino Program AA Administrative Agent ADEPT Adolescent Health Education and Practical Training AIDS Acquired Immunodeficiency Syndrome AJA Adolescent Job Aid ANC Antenatal Care AO Administrative Order ASRH Adolescent Sexual and Reproductive Health AUD Australian Dollar AusAID Australian Aid Agency AWP Annual Work Plan BCC Behavior Change Communication BEmONC Basic Emergency Obstetric and Newborn Care BHS Barangay Health Station BHW Barangay Health Worker BIHC Bureau of International Health Cooperation BiRTS Birth Registration Tracking System BTL Bilateral Tubal Ligation C4D Communication for Development CAPF Comprehensive Aid Policy Framework CCT Conditional Cash Transfer CEmONC Comprehensive Emergency Obstetric and Newborn Care CHO City Health Office CHT Community Health Team CIP Costed Implementation Plan CLGP City Leadership and Governance Program CS Caesarian Section DBM Department of Budget and Management DFAT Department of Foreign Affairs and Trade DMO Development Management Officer DOF Department of Finance DOH Department of Health DRRM Disaster Risk Reduction and Management DSWD Department of Social Welfare and Development EINC Essential Intrapartum and Newborn Care EmONC Emergency Obstetric and Newborn Care FDA Food and Drug Administration FDS Family Development Session FHSIS Field Health Services Information System FP Family Planning FPAS Family Planning Action Sessions FPCBT Family Planning Competency-Based Training GBV Gender-Based Violence GIDA Geographically Isolated and Disadvantaged Area GIS Geographic Information System HCP Health Care Personnel HHH Howard Hubbard Hospital HI-5 High Impact 5 HIS Health Information System 2

4 HIV HLGP ILHZ IMR IP IPR IRR IUD IYCF JMC JPMNH KMITS LAPM LCE LCR LGU LMT LQAS M&E MBFHI MCH MCP MDG MDR MEC MHO MInTS MISP MLGP MMR MNCHN MNDRS MNH MOA MOU MPTF NCD NCP NCR NEDA NGO NHTS-PR NIT NMR NOSIRS NSV NTHC OCD PCW PDP PDQ Human Immunodeficiency Virus Health Leadership and Governance Program Inter-Local Heath Zone Infant Mortality Rate Intrapartum Independent Progress Review Implementing Rules and Regulations Intrauterine Device Infant and Young Child Feeding Joint Memorandum Circular Joint Programme on Maternal and Neonatal Health Knowledge Management and Information Technology Service Long-Acting and Permanent Methods Local Chief Executive Local Civil Registrar Local Government Unit Lactation Management Training Lot Quality Assurance Sampling Monitoring and Evaluation Mother-Baby Friendly Hospital Initiative Maternal and Child Health Maternity Care Package Millennium Development Goal Maternal Death Review Medical Eligibility Criteria Municipal Health Office Mag-ina Telereferral System Minimum Initial Service Package Municipal Leadership and Governance Program Maternal Mortality Ratio Maternal, Newborn and Child Health and Nutrition Maternal and Neonatal Death Reporting and Surveillance Maternal and Newborn Health Memorandum of Agreement Memorandum of Understanding Multi-Partner Trust Fund Non-Communicable Disease Newborn Care Package National Capital Region National Economic Development Authority Non-Government Organization National Household Targeting System for Poverty Reduction National Implementation Team Neonatal Mortality Rate National Online Stock Inventory and Reporting System Non-scalpel Vasectomy National Telehealth Center Office of Civil Defense Philippine Commission on Women Philippine Development Plan Partner Defined Quality 3

5 PHIC/PhilHealth Philippine Health Insurance Corporation PHO Provincial Health Office PhP Philippine Peso PLGP Provincial Leadership and Governance Program PLW Pregnant and Lactating Women POPCOM Commission on Population PP Postpartum PPP Public-Private Partnership PIR Programme Implementation Review PRT Provincial Review Team PSC Project Steering Committee PSI Progestin Subdermal Implants PSRP Philippine Society for Responsible Parenthood PTE Post-Training Evaluation QC Quezon City rchits Real-Time Community Health Information Tracking System RH Reproductive Health RHU Rural Health Unit RO Regional Office RPRH Responsible Parenthood and Reproductive Health RUTF Ready-to-Use Therapeutic Food SAA Standard Administrative Agreement SAM Severe Acute Malnutrition SC Supreme Court SDN Service Delivery Network SHP Skilled Health Personnel SMART Specific, Measurable, Attainable, Realistic, Time-bound SPHERE School, Peer, Health, Engagement, Research, Employment SRH Sexual and Reproductive Health TA Technical Assistance TRO Temporary Restraining Order TSEKAP Tamang Serbisyo sa Kalusugan ng Pamilya TWG Technical Working Group U4U You-for-you U5MR Under-five Mortality Rate UN United Nations UNCO United Nations Coordinator's Office UNDAF United Nations Development Assistance Framework UNDP United Nations Development Program UNFPA United Nations Population Fund UNICEF United Nations Children's Fund UP University of the Philippines WATGB Women about to give birth WHO World Health Organization WRA Women of Reproductive Age ZFF Zuellig Family Foundation 4

6 Executive Summary In 2009, the Philippines Department of Health (DOH), with the support of the Australian government through Australian Aid Agency (AusAID), agreed to a joint programme with three United Nations (UN) agencies: the United Nations Population Fund (UNFPA), United Nations Children s Fund (UNICEF), and World Health Organization (WHO), to launch the Joint Programme on Maternal and Neonatal Health (JPMNH) to accelerate the country s efforts to achieve Millennium Development Goal (MDG) 4 to reduce child mortality, and MDG 5 to improve maternal health. The JPMNH focused specifically on reduction of newborn and maternal mortality, in support of the country s Maternal, Newborn and Child Health and Nutrition (MNCHN) strategy, as embodied in DOH Administrative Order The JPMNH objectives were to (1) improve access of quality maternal and newborn health services through a continuum of care approach, and (2) increase utilization of core reproductive health, maternal, and newborn services. At the end of Phase 1, improvements in MNCHN service coverage in project sites had been achieved. These were most notably seen through increases in facility based deliveries, postpartum visits, breastfeeding initiation, and proportion of PhilHealth accredited health facilities. Phase 1 initiatives also put mechanisms in place that empowered communities in project sites to address unintended pregnancies, avoid newborn deaths, and address important social determinants of health. At the end of its implementation, JPMNH achieved an overall decrease in maternal and neonatal mortality in its project sites. The absolute number of maternal deaths decreased by 11% and the maternal mortality ratio decreased by 9%. For newborns, the absolute number of deaths decreased by 8% and the neonatal mortality rate went down by 7%. This impact was achieved through improvements in health systems and services to which JPMNH interventions contributed. Facility-based deliveries increased by 8 percentage points and skilled birth attendance increased by 2 percentage points. All sites had functional Basic Emergency Obstetric and Newborn Care facilities whereas only two sites had these at baseline. These facilities also institutionalized the practice of Essential Intrapartum and Newborn Care and the delivery of client-centered and culturally sensitive care. Rates of postpartum counselling for availing FP services improved by 38 percentage points, and 7,442 women from disadvantaged households were able to use modern FP methods for the first time. Overall use of modern contraceptives improved by 19 percentage points. Improvements in these multiple aspects in delivering quality maternal and newborn care worked synergistically to achieve JPMNH impact. The second phase of JPMNH began in July of 2014 and sought to build on the gains of Phase 1. Addressing the findings of the AusAID-commissioned Independent Progress Review, Phase 2 was designed to maximize the synergy of the UN agencies organizational strengths by focusing thematically and geographically. Thematic focus centered on improving quality, access, and utilization of intrapartum (IP), postpartum (PP), and family planning (FP) services in JPMNH sites, a departure from Phase 1 that encompassed a wider spectrum of the life-cycle continuum of care, from pre-pregnancy to post-natal care. Geographical focus was agreed upon through the selection of sites where the three UN agencies worked at different levels to achieve vertical collaboration. In determining project sites, JPMNH aimed to align itself with the government s Conditional Cash Transfer (CCT) Program, and selected areas with high densities of CCT families. Phase 2 sites included the selected municipalities in Region XII namely, Aleosan, Arakan, Midsayap, and President Roxas in North Cotabato; Kalamansig and Lebak in Sultan Kudarat; Malungon in Sarangani; and in the National Capital Region District 2, Quezon City. UNICEF worked at the municipal level, UNFPA at the provincial level, and WHO with the 5

7 DOH Regional Office. The approach remained aligned with the MNCHN strategy to increase access to care through the development of functional service delivery networks (SDN). Phase 1 also highlighted the value of developing an integrated monitoring and evaluation plan which would be carried out jointly by the involved agencies. The outcome envisioned for JPMNH was the improvement of quality, access and utilization of IP, PP, and FP services in JPMNH areas by improving the functionality of SDNs. Specific intended sub-outcomes included (1) Improved quality of facility based IP and PP care; (2) Increased demand for IP, PP and FP services; (3) Improved availability of good quality FP services; and (4) Strengthened JPMNH area health systems in support of IP and PP. Key interventions developed in consultation with stakeholders were built around these sub-outcomes. JPMNH also worked with a 5 th sub-outcome which sought to document and institutionalize a joint working approach to programme management and implementation among National and Local Government and development partners. Health systems were improved on several fronts. All JPMNH sites were successful in establishing functional SDNs. Implementation of MNCHN-related activities improved by 7 percentage points. Sites engaging the private sector to support maternal and newborn health initiatives increased by 13 percentage points. PhilHealth accreditation and utilization improved markedly, with maternal care, newborn care, and FP benefits availed increasing by 302%, 642%, and 827%, respectively. Vital registration improved with the use of e-reporting mechanisms for maternal and neonatal deaths in all but one JPMNH site (versus e-reporting in three sites in 2013). Central to the gains made in Phase 2 of JPMNH were its joint operations and focus on improving project site SDNs. JPMNH benefitted from the active engagement with the Australian Department of Foreign Affairs and Trade (DFAT), providing technical and operational support as well as programme oversight through its membership in the JPMNH Project Steering Committee. UN agencies were tasked to take the lead in addressing issues in their respective fields, thus taking advantage of technical expertise and operational experience. Coordinated engagement of all levels, from local to national, that would impact on the public health systems of project sites made it possible not only to implement interventions, but to develop policies and mechanisms that would sustain improvements as well. In engaging individuals on the ground and the health systems in which they operate, JPMNH sought to reach every member of each project site s community and institutionalize improvements to which it contributed. At the end of Phase 2, DOH and Local Government Units were committed to continuing the efforts initiated through partnership with JPMNH. Recommendations at the programme s end include sustained investments in the following areas: (1) health systems-strengthening approach from the local levels through the engagement of the support of local government units and an important mix of stakeholders that goes beyond the health care sector to national levels through strong leadership on key policies and standards, (2) enabling the environment to create and institutionalize functional SDNs, (3) strengthening leadership and governance in health, (4) capacity building of health personnel in the context of an overall health human resource plan, (5) generating demand for health services, (6) removing barriers to access sexual and reproductive health services, with emphasis on improved data, and reaching the adolescent groups, (7) institutionalizing the use of electronic health information systems and the data generated from such for health decision-making, and (8) coordinating joint operations in health. 6

8 I. INTRODUCTION In September of the year 2000, the Philippines became one of the 189 Member Nations that were signatories to the United Nations (UN) Millennium Declaration. Among the Millennium Development Goals (MDG) committed to by these countries were the reduction of child and maternal mortality (MDG 4 and 5, respectively). Country goals for the year 2015 were the following: reduce under-five mortality rate (U5MR) to 27 for every 1,000 live births; reduce infant mortality rate (IMR) to 19 for every 1,000 live births; and reduce maternal mortality rate (MMR) to 52 for every 100,000 live births. Prior to the initiation of the Joint Programme on Maternal and Neonatal Health (JPMNH), maternal mortality in the Philippines was still at 162 deaths for every 100,000 live births and was assessed to be off track in meeting the MDG commitment. Under-five mortality was at 34 deaths for every 1,000 live births and was on track to meet the target of 26 for every 1,000 live births by These mortalities, however, were disproportionately found in the neonatal age group. Deaths in infants aged 28 days or younger (neonatal mortality rate of 16 in 1,000 live births) were found to compose nearly half of all deaths under the age of 5 years and needed to be addressed. It was in response to these circumstances that the first phase of the JPMNH began (United Nations, March 2015). In 2009, the Philippines Department of Health (DOH), with the support of the Australian government through the Australian Aid Agency (AusAID), agreed to a joint programme with three United Nations agencies: the United Nations Population Fund (UNFPA), United Nations Children s Fund (UNICEF), and World Health Organization (WHO) to launch JPMNH to accelerate the country s efforts to achieve MDG 4 to reduce child mortality, and MDG 5 to improve maternal health. The JPMNH focused specifically on reduction of newborn and maternal mortality, in support of the country s Maternal, Newborn and Child Health and Nutrition (MNCHN) strategy, as embodied in DOH Administrative Order (AO) The JPMNH objectives were to 1) improve access of women and newborns to quality health services and care through a continuum of care approach from pre-pregnancy, antenatal, intrapartum, post-partum and neonatal care, and 2) increase utilization of core reproductive health, maternal, and newborn services in geographically isolated and disadvantaged areas (GIDA), including the urban poor. The first phase of JPMNH ran until June 2014 and achieved improvements in MNCHN service coverage its project sites. These were most notably seen through increases in facility based deliveries, postpartum visits, breastfeeding initiation, and proportion of PhilHealth accredited health facilities. Phase 1 initiatives also put mechanisms in place that empowered communities in project sites to address unintended pregnancies, avoid newborn deaths, and address important social determinants of health (United Nations, March 2015). The second phase of JPMNH began in July of 2014 and sought to build on the gains of Phase 1. Addressing the findings of the AusAID-commissioned Independent Progress Review, Phase 2 was designed to maximize the synergy of the UN agencies organizational strengths by focusing thematically and geographically. Thematic focus centered on improving quality, access, and utilization of intrapartum (IP), postpartum (PP), and family planning (FP) services in JPMNH sites, a departure from Phase 1 that encompassed a wider spectrum of the life-cycle continuum of care, from pre-pregnancy to post-natal care. Geographical focus was agreed upon through the selection of sites where the three UN agencies worked at different levels to achieve vertical collaboration. The IP, PP, and FP services at selected JPMNH sites would be administered 7

9 through service delivery networks (SDN) which would serve as models for the provision on maternal and newborn health (MNH) services. II. PROGRAMME SUMMARY A. Basic Programme Information JPMNH was originally designed in two phases, the first being transitions phase that would run from 2009 to 2011, and the second, a full implementation phase that would run from 2011 to Due to implementation delays from unforeseen security risks, the succession of natural disasters and armed conflicts in 2013 culminating in Super Typhoon Haiyan that effectively put on hold regular development programs to pave the way for full-scale humanitarian response, events such as national and local elections, as well as some administrative bottlenecks, JPMNH Phase 1 extended into June of 2014, and Phase 2 subsequently commenced from July 2014 to June Handover and institutionalization of JPMNH strategies and interventions in partner sites were carried out at the end of this implementation phase. A timeframe for administrative closeout was set from July to December of Table 1 below describes the documented agreements for the creation and implementation of JPMNH. Table 1. Agreements entered into by DFAT and the UN Document Date Issued Remarks June 2009 JPMNH Project Document Binding document that covers project operations from June 2009 to December st Standard Administrative Agent (SAA) Agreement JPMNH Phase 2 Project Document 4 July 2012 Agreement (i.e. DFAT Agreement # 63406) that covers the new funding modality (i.e. from parallel to pooled funding), with the UNCO as the designated Administrative Agent. The contract pertains to the 2012 Annual Work Plan (AWP) funding worth AUD 8.5 million 4 June 2013 Binding document that covers project operations from July 2013 to December nd SAA Agreement 7 June 2013 Agreement stipulates the duration of the following fund tranches: 2012 AWP (from 28 February 2012 to 28 February 2014) Phase 2 (1 July 2013 to 31 December 2015) 3 rd SAA Agreement 28 February 2014 Agreement restates the duration of the following fund tranches: 2012 AWP (from 28 February 2012 to 30 June 2014) Phase 2 (from 1 July 2013 to 30 June 2016) The Agreement includes the PSC-approved Catch Up Plan, which addresses the 4-month extension of the 2012 AWP, and the approved work plan for Phase 2 as supplemental documents. 8

10 B. JPMNH Partner Sites In an effort to complement the government s Conditional Cash Transfer (CCT) Programme and poverty alleviation priorities, the following contexts served as the criteria for JPMNH site selection: urban poor setting with a high density of CCT beneficiaries, rural settings with geographically isolated and disadvantaged areas, and highland and coastal municipalities. The following were thus engaged as JPMNH Phase 2 partner sites (see Annex A for area maps): Municipalities of Aleosan, Arakan, Midsayap, and President Roxas in North Cotabato Province (77,605 CCT households) Municipalities of Kalamansig and Lebak in Sultan Kudarat Province (40,475 CCT households) Municipality of Malungon in Sarangani Province (30,000 CCT households) Quezon City District II in the National Capital Region (9,555 CCT households) The respective Provincial Governments and DOH Regional Offices (ROs) of these sites were also engaged as JPMNH partners. UNICEF worked at the municipal level, UNFPA at the provincial level, and WHO with the DOH ROs. The approach remained aligned with the MNCHN strategy to increase access to care through the development of functional SDNs. C. Programme Goal, Objectives, and Expected Outcomes The overarching goal of JPMNH Phase 2 was to continue support to the Philippine Government in meeting its MDG 4 and 5 commitments to improve maternal and child health. It further aimed to align with the country s CCT Programme by targeting sites with high densities of CCT beneficiaries. The focus given on improving the quality and accessibility of care in these sites intended to take advantage of CCT interventions that encouraged beneficiaries to seek out health services in health facilities. In developing the respective SDNs in these areas, non-cct households were also envisioned to benefit from the improvement of health services. The programme s desired impact was to reduce maternal and neonatal deaths in JPMNH sites. The outcome envisioned for JPMNH was the improvement of quality, access and utilization of IP, PP, and FP services in JPMNH areas by improving the functionality of SDNs, in line with the Maternal, Newborn, Child Health and Nutrition (MNCHN) strategy of the DOH. More specifically, JPMNH endeavored to achieve the following sub-outcomes: 1. Improved quality of facility based IP and PP care 2. Increased demand for IP, PP and FP services 3. Improved availability of good quality FP services 4. Strengthened JPMNH area health systems in support of IP and PP 5. Institutionalized joint working approach to programme management and implementation D. Governance and Management Arrangements 1. Governance 1.1 Project Steering Committee (PSC) JPMNH operated under the coordination and governance of the Project Steering Committee which was led by the DOH and co-chaired by UNFPA, UNICEF, or WHO, on an annual 9

11 rotational basis. These UN agencies were represented by their respective country representatives. PSC members included representatives from the United Nations Resident Coordinator s Office, the Australian Department of Foreign Affairs and Trade (DFAT), the National Economic Development Authority (NEDA), the Department of Budget and Management (DBM), Department of Finance (DOF), and civil society through Woman Health Philippines. The PSC was formally convened biannually. The PSC s role was to provide overall policy and strategic direction to the programme, review and approve JPMNH work plans and budgets, convene semi-annual programme reviews, address policy and programmatic constraints, and direct the tasks of the technical working group. 1.2 Technical Working Group (TWG) The JPMNH TWG was composed of technical specialists from DOH, UNFPA, UNICEF, and WHO. The TWG held monthly meetings and addressed technical and operational issues. Among its tasks were to 1) ensure that JPMNH was managed for results, including knowledge management, and reporting, 2) hold technical coordination meetings with government partners, 3) conduct joint planning and monitoring activities to project sites, 4) develop relevant guidelines and tools, and 5) ensure knowledge sharing and coordination among stakeholders. The TWG kept the PSC abreast of progress and arising concerns. The UN Coordinator s Office (UNCO) administered JPMNH on behalf of the three implementing UN agencies and assumed the role of focal agency for coordination between and among UN agencies, government partners, and DFAT. 1.3 DFAT Role and Support An Independent Progress Review (IPR) was commissioned by AusAID in 2012 to assess progress made during the transition phase. The IPR s recommendations for implementation in the next phase guided the formulation of Phase 2 making it more geographically aligned to priority areas of the Philippine Government, technically focused on interventions that have the potential to address immediate bottlenecks in utilization and service quality, robust in terms of its monitoring and evaluation (M&E) framework and plan, and demonstrating a joint working approach that harmonizes the comparative advantage of each of the three UN agencies, among others. In the course of Phase 2 implementation, the Australian Department of Foreign Affairs and Trade (DFAT) provided technical and operational support as well as programme oversight through its membership in the JPMNH PSC. In particular, DFAT: participated in the Phase 2 Roll Out and M&E Validation Workshop for local government units (LGUs) and provided initial suggestions to simplify and reduce the number of result indicators to be regularly tracked by partner LGUs; fielded its Regional Health Specialist to provide M&E-related technical assistance and advice to the JPMNH TWG which led to the finalization and approval of a streamlined results framework (e.g. adoption of 13 headline/high-level indicators, inclusion of indicators of quality in addition to quantitative measures, aggregation of programme targets and accomplishments to reflect overall impact); the Regional Health Specialist s Mission likewise shared advice on the following programmatic issues: 1) the need to support policy formulation on efficient use of 10

12 resources (e.g. devolving service delivery to and capacity building of midwives, basic resources allocations [access, financial, physical], leveraging the private sector s role and contribution); 2) role of communication for development (C4D) in getting the message across to policy-makers and in changing behaviors on effective care reaching women for delivery, referral systems, etc.; and 3) encouraging the conduct of research on financial flows around MNCHN services, including expenditure tracking in terms of financial allocations and actual budget releases; regularly participated in and provided balanced and constructive feedback on programme performance during Joint Monitoring Visits to JPMNH sites, Programme Implementation Reviews (PIRs), regular catch-up meetings between the JPMNH Secretariat and the DFAT Senior Programme Officer to facilitate collaboration/communication/responsiveness of the Programme, during submissions of JPMNH Annual Reports to DFAT, and during the formulation of Partner Performance Assessments as part of Australia s Investment Quality Reporting system; approved a close-out work plan for July 2016 to January 2017 that ensured dedicated capacity for preparing the Project Completion Report and for carrying out all administrative and financial closure procedures. 2. Fund Administration JPMNH fund administration utilized a pass-through funding mechanism under which the implementing UN agencies channeled programme funds through an Administrative Agent (AA). The Multi-Partner Trust Fund (MPTF) Office of the United Nations Development Programme (UNDP) assumed the role of AA for JPMNH. The MPTF was responsible for conducting a Memorandum of Understanding (MOU) with participating UN organizations and Standard Administrative Arrangements (SAA) with the donor, DFAT. It was also responsible for the receipt, administration, and management of contributions from donors; disbursement of funds to the implementing agencies; and consolidation of financial reports produced by JPMNH and provision of these reports to the Steering Committee for onward submission to DFAT. III. EXPENDITURES AND INPUTS The following tables show the planned and actual expenditures of JPMNH Phase 2, with disaggregation into expenditure categories per agency. Table 2. Comparison of Approved/Planned and Actual Expenditures for Phase 2, by Agency, July 2014 to December 2016 UN Agency Approved/Planned Actual Expenditure Expenditure (USD) (USD) UNFPA 3,707, ,707, UNICEF 1,484, ,484, WHO 1,180, ,187, UNDP 848, , TOTAL 7,222, ,010,

13 Table 3. Expenditure for Phase 2, by Agency and Expenditure Item July 2014 to December 2016 Expenditure Item Expenditure (USD) UNFPA UNICEF WHO UNDP Total Staff and other Personnel Costs 144, , , , , Supplies, Commodities, Materials 417, , , , , Equipment, Vehicles, Furniture, including 5, , , , Depreciation Contractual services 1,188, , , , ,075, Transfers and Grants - 538, , General Operating Costs 1,679, , , , ,833, Programme Costs Total 3,434, ,484, ,112, , ,661, Indirect Support Costs Total 273, , , Total 3,707, ,484, ,187, , ,010, IV. APPROACH AND STRATEGIES ADOPTED JPMNH designed its interventions to align with the DOH MNCHN AO strategy to achieve MDGs 4 and 5 through SDNs. JPMNH focused support to existing country systems so as not to create a parallel or redundant health delivery system. Interventions were tailored to respond to regional, provincial, and city or municipal contexts and issues. The three UN agencies of the JPMNH worked extensively with counterparts at the national and local levels, but as part of the geographical focusing of phase 2, initiatives were led at the regional level by WHO, at the provincial level by UNFPA, and at the municipal and city district level by UNICEF. JPMNH developed a results framework and monitoring and evaluation framework (Annexes B and C, respectively) to track progress along its programmed outcomes. Baseline and endline values for indicators in the results framework are summarized in the Outcomes section of this report (Tables 4 to 7, 10, and 13). Support given by JPMNH to partner sites included: 1. Technical assistance in the form of capacity development for evidence-based practices, and knowledge generation, documentation, and dissemination geared towards policy advocacy 2. Limited procurement of essential lifesaving medicines to ensure safe deliveries and neonatal survival, family planning commodities to meet increased demand and to leverage greater commitment by LGUs to ensuring sustainable provision thereof, and equipment to ensure priority facilities can provide Basic Emergency Obstetric and Newborn Care (BEmONC) and Comprehensive Emergency Obstetric and Newborn Care (CEmONC) and qualify for PhilHealth accreditation 3. Contracting of institutional providers to render technical and implementation support Phase 2 was the full implementation stage of JPMNH and sought to build on the gains and lessons learned from Phase 1. 12

14 Outcome 1: Improved quality of facility based IP and PP care To improve the quality of intrapartum and postpartum care, JPMNH activities were programmed to support the development and strengthening of functional BEmONC and CEmONC facilities, institutionalization of Essential Intrapartum and Newborn Care (EINC) in public health facilities, and development and implementation of client-centered and culturallycentered intrapartum services, as shown below. Output 1.1 and 1.2: Functioning Basic Emergency Obstetric and Newborn Care (BEmONC) and Comprehensive Emergency Obstetric and Newborn Care (CEmONC) facilities 1. JPMNH commissioned studies that assessed the accessibility of EmONC services to households in partner sites and the functionality of BEmONC facilities. These were able to identify varying issues that needed to be addressed, such as differing levels of capabilities of BEmONC facilities in performing signal functions; compliance with the implementation of IP, PP, and newborn care practices among trained public providers; and lack of resources for transportation in order to reach EmONC facilities, among others. The geographic mapping study was also able to identify specific areas with low accessibility coverage. From this, JPMNH was able to advise the DOH and Local Government Units where to focus efforts in establishing fully functional EmONC facilities and produce a policy paper shared with DOH and development partners. 2. JPMNH provided essential supplies, drugs, equipment, manuals, and communication for development materials to EmONC facilities and barangay health stations (BHS)/birthing clinics. Also included was ensuring proper nutrition for mothers and children through provision of breastfeeding orientation and training materials, manuals, height boards, weighing scales, and ready-to-use therapeutic food (RUTF) used in the treatment of severe acute malnutrition (SAM). 3. To ensure a sustainable roster of BEmONC-trained midwives, JPMNH supported the development and production of the DOH Harmonized BEmONC Modules for Midwives. The modules were designed as the training and reference materials for midwives and their facilitators administering the BEmONC trainings. The midwives may be trained as part of the BEmONC team composed of a physician, nurse and midwife or at a different training schedule from the rest of the team. The modules are now being utilized by all of the 31 DOH-accredited BEmONC training centers in their BEmONC midwives training. 4. JPMNH contributed to the capacity building of health care personnel (HCP) through training for Lactation Management, Adolescent Health Care and Management, Mother- Baby Friendly Hospital Initiative, BEmONC, Prevention of Non-Communicable Diseases and Promoting Healthy Lifestyle for Adolescents and Pregnant Lactating Women, Community Management of Acute Malnutrition, Therapeutic Management of Severe Acute Malnutrition, Prevention of Mother-to-Child Transmission of HIV/AIDS, Post-Training Supportive Supervision and Mentoring, Strengthening of supervisory capacities of health managers, MNCHN skills update for midwives, Community Health Team (CHT) roles on pregnancy tracking, PhilHealth Orientation for community health teams/barangay health workers, Care for the Small Baby, Service Excellence Training for Health Workers, Maternal Death Surveillance and Review, and Maternal and Neonatal Death Review Community Follow-through. 13

15 5. JPMNH supported efforts towards the development of CEmONC-capable facilities which included human resource augmentation for Caesarian Section and logistical support; engagement of CEmONC technical assistance providers and CS teams (obstetrician-gynecologist, anesthesiologist, pediatrician); the development of CEmONC Scorecards; hiring of medical technologists; and operationalization of blood banks in North Cotabato, Sultan Kudarat and Sarangani. Output 1.3: EINC institutionalized in JPMNH SDN sites 1. JPMNH commissioned formative and assessment studies to guide its assistance programme 1. Areas of focus included identification of provider-related and health system barriers in the provision of quality maternal and newborn care; assessments of intrapartum-postpartum related trainings; assessment of the implementation of midwifery and nursing pre-service curricular integration of EINC; and assessments of the status of supportive supervision 2. LGU partners were given assistance through training of health service providers on enhanced intrapartum, postpartum and newborn care practices, including training on relevant PhilHealth policies, and service excellence. Capacity-building of partner DOH Regional Offices/LGUs for post-training supportive supervision, monitoring and mentoring was also done. In addition, JPMNH supported the DOH in monitoring the implementation of MNCHN-EINC, Infant and Young Child Feeding (IYCF) and Mother-Baby Friendly Hospital Initiative (MBFHI) and Milk Code Compliance in JPMNH areas. The programme also promoted expanded EINC through development of social marketing templates in partnership with DOH Health Promotion and Communications Service Office. 3. JPMNH supported the development of the following key policies for ensuring quality maternal and neonatal care: a. Integrated Policies and Guidelines on the Essential Maternal and Newborn Care and Mother-Baby Friendly Health Facility Initiative b. National Policy on the Quality of Care for Small Babies to Fast Track Neonatal Mortality Reduction: Addressing Prematurity and Low Birth Weight 4. EINC was scaled up with integration in the pre-service curricula of nursing and midwifery schools nationwide, building on the work of integration in the curriculum of medical schools in the earlier years of Phase Implementation was scaled up to include private hospitals and private birthing clinics especially in the National Capital Region (Quezon City and Taguig), and in Region XII 1 BEmONC Functionality: Baseline Assessment of Facilities in Selected UNFPA Sites; Mapping of Facilities where Teens are giving birth; Assessment of Essential Intrapartum and Newborn Care (EINC) in Nursing and Midwifery Curricula; Assessment of Intrapartum-Postpartum (MNCHN) Related Capacity Development Activities and Trainings in Region 12; Determinants of Access to Reproductive Health, Maternal, Neonatal and Child Health Care (RHMNCH) Services; Geographic Accessibility to Emergency Obstetric and Neonatal Care (EMONC): Region XII (Soccsksargen); Formative Evalation of the Integration of EINC into the Medical Curriculum 14

16 (Cotabato City and General Santos City), resulting in horizontal referral mechanisms between and among the public and private health facilities. 6. JPMNH supported DOH s efforts in developing the following modules for institutionalizing mechanisms that will ensure quality in services for maternal and newborn health: a. Manual of Operations for Quality Improvement for Maternal and Newborn Health Services b. Integrated Maternal and Newborn Health Care Training for Mentoring, Coaching and Supportive Supervision 7. JPMNH supported the procurement and distribution of oxytocin, magnesium sulfate, dexamethasone, neonatal resuscitation kits, BEmONC manuals, EINC pocket guides, Mama-neonatalie models for EINC trainings, medical eligibility criteria (MEC) wheels, and delivery kits/sets to aid institutionalization of the EINC package for neonatal and maternal health care. JPMNH also purchased equipment as assistance for selected birthing homes to achieve PhilHealth accreditation for the Maternity Care Package (MCP)/Newborn Care Package (NCP). Output 1.4: Culture-sensitive and women-centered IP care 1. Enhancement of SDN quality was targeted through the implementation of the Partner Defined Quality (PDQ). JPMNH assisted in the implementation of the PDQ methodology in an effort to improve the quality and accessibility of services, and to involve communities in defining, implementing and monitoring the quality improvement process. JPMNH reviewed and finalized the PDQ module for maternal health services and held PDQ feedback meetings and technical exchange conferences in partner sites. 2. Training of trainers for regional and provincial PDQ facilitators was conducted. This was to strategically capacitate the Regional and Provincial level officials to further support the sustainability of the program. Outcome 2: Demand generated for IP and PP services JPMNH support included assistance to community health teams (CHTs) and other MNCHN support groups to capacitate them to address Maternal and Newborn Health (MNH) issues of pregnant mothers, women of reproductive age, including adolescents with particular focus on the poorest two quintiles in the Philippines who have been identified through the National Household Targeting System for Poverty Reduction (NHTS-PR), as well as the application of behavior change communication (BCC) or C4D strategies to influence health-seeking behavior. Output 2.1: Community Health Teams (CHT)/Community MNCHN support groups are functional in JPMNH areas to address Maternal and Child Health (MCH) issues of Q1 and Q2 poor and adolescents 1. Support was given for scaling-up demand generation for modern FP methods among NHTS families, capacity building of CHTs for their role in FP service demand generation and delivery. 15

17 2. Two major documents to support interventions addressing adolescent health, adolescent sexual behaviors, teenage pregnancy, and access of adolescents to health services were developed: a. Adolescent Health and Development Programme Manual of Operations Created for adolescent health and development programme officers, focal persons, and clinic managers in government, private, and non-government organization (NGO) facilities to guide them in the design of adolescent health and development program b. Supplemental Modules to the Adolescent Job Aid (AJA) Created in order to help service providers and their facilities become more responsive and conducive in providing appropriate and necessary adolescent health services, and in order to facilitate the efficient use of the Adolescent Job Aid Manual in training adolescent health providers 3. JPMNH supported CHTs, LGUs, and inter-local health zones (ILHZ) in utilizing the Family Development Sessions (FDS) as a communication channel to provide information on maternal and neonatal health, and family planning. Special focus was given to NHTS poor families, consisting of CCT recipients and non-cct recipients. Existing modules were streamlined by harmonizing the FDS guidelines of DOH, the Department of Social Welfare and Development (DSWD) and the Commission on Population (POPCOM). 4. JPMNH developed a data collection tool to track contraceptive prevalence rate among women of reproductive age through the use of Lot Quality Assurance Sampling (LQAS). The use of the tool would be valuable in the rapid assessment and triangulation of administrative data reports on contraceptive prevalence rate. Output 2.2: Communication for Development/Behaviour Change Communication (C4D/BCC) in IP, PP and FP services implemented 1. JPMNH initiated the conduct of Family Planning Action Sessions (FPAS) in its three partner provinces. The goal of these FPAS was to link couples, who were provided with FP information and couples who were identified to have unmet FP needs through FDS, to FP counselling and service delivery. Couples with unmet need for family planning were properly counseled on the full range of modern family planning methods available, and thereafter linked to immediate service provision. This was supported by Operational Research that documented workable mechanisms for addressing unmet needs for modern Family Planning by immediately linking FDS participants with unmet need to actual service delivery. 2. To influence maternal and newborn health-seeking behavior, JPMNH provided C4D support to its LGU partners. JPMNH commissioned a Communication Research Analysis for maternal and newborn health-seeking behavior which yielded data on commonly utilized communication channels, community awareness of MNH practices, roles assumed by all male and female family members in pregnancy, and knowledge regarding PhilHealth benefits. The findings were subsequently utilized in a joint planning workshop to develop effective communication strategies, materials, and implementation 16

18 plans for MNH service utilization and FP information and education to address unique issues such as those related to cultural practices and religious beliefs. As an output of the workshops, municipal/city district communication plans were developed, and technical assistance was further provided for the development of prototypes. These communication interventions consisted of maternal and neonatal flipchart for health workers, radio dramas, theater arts, short digital films, poster, fan and whiteboard animation. 3. JPMNH conducted adolescent sexual and reproductive health (ASRH) communication and education campaigns for the youth using social media through the conduct of You for You (U4U) events. U4U is a youth hub initiative aimed to deliver critical information to Filipino teens to prevent teen pregnancy and reduce the prevalence of sexually transmitted infections. U4U utilized multiple platforms in its delivery, including an online portal ( social media (Facebook, YouTube, and Twitter), interactive voice response system through dedicated mobile phone numbers, and community teen trail events. Co-developed with POPCOM, it was consequently scaled up using their own budget, and was likewise included as part of the DOH Kalusugan Pangkalahatan (Health for All) Roadshows. Having reached as much as 5 million Filipino teenagers as of the third quarter of 2016, its success has been properly acknowledged by being awarded the Grand Anvil Award and Quill Awards in The Local Government of Quezon City (QC) customized adolescent interventions as their Teen Walk to Health, to be conducted in the different barangays in their six districts citywide. Quezon City subsequently designed its own Gabayan ang Batang Ina ( Guide the teen mother ) comprehensive programme to improve timely access to care of pregnant teens. Outcome 3: Improved availability of quality FP services JPMNH supported the training of health service providers through the engagement of regional training centers on FP; scaled-up its assistance to deliver information on prevention of teen pregnancies and sexually-transmitted diseases through the Philippine POPCOM s Youth Hub initiative, U4U, with the involvement of LGUs; and pilot-tested the SPHERE (School, Peer, Health, Engagement, Research, Employment) model as a way for LGUs to reach young people with both adolescent sexual and reproductive health (ASRH) information and services. To address gender issues in accessing FP services, an operations research is being conducted to study avenues for male involvement in FP discussions and joint decision-making among couples for FP. JPMNH also provided assistance on FP logistics management to the DOH Central Office through the pilot-testing of a bar-coding system, as an alternative to the National Online Stock and Inventory Reporting System (NOSIRS). Lastly, to support and sustain sub-dermal implants as a modern FP method, JPMNH provided assistance to DOH in drafting the national policy on inclusion of subdermal implants as one of the modern methods recognized by the National Family Planning Programme and the PhilHealth circular on Subdermal Contraceptive Implant Package. 17

19 Output 3.1: Comprehensive FP methods (long term and short term) are available for women and men (including adolescents) 1. JPMNH provided services to women with intra-uterine device (IUD) and bilateral tubal ligation (BTL), and to men with non-scalpel vasectomy (NSV). Health service providers were trained on IUD, BTL and NSV through LGU partners, NGOs, hospitals and itinerant FP missions. 2. Popularization and scale up of the sub-dermal implant contraception was supported by JPMNH through provision of commodities, training of health care providers, provision of technical advice to DOH, and conduct of research that provided evidence in support of the formulation of a national policy on sub-dermal implant. As much as 200,000 acceptors of the subdermal implant were served as of December 2016, providing Filipino women another viable long acting method for family planning that remains effective for 3 years per unit. 3. JPMNH supported the strengthening of Regional DOH Training institutions in Region XII and the National Capital Region (NCR) as a mechanism for sustainability and institutionalization of FP training programs. This yielded a memorandum of understanding (MOU) with two regional training centers for FP support. Output 3.2: FP policies applied in JPMNH areas 1. JPMNH supported DOH in drafting Administrative Order (AO) on the national policy on inclusion of subdermal implants as one of the modern methods recognized by the National Family Planning Program, as well as PhilHealth Circular on PhilHealth Subdermal Contraceptive Implant Package. The PhilHealth benefit package serves as a sustaining mechanism by which the provision of subdermal implants would continue even after the end of JPMNH. Output 3.3: Health workers competent in using ASRH job aide 1. In 2015, as per the agreement of the PSC chaired by then DOH Assistant Secretary Paulyn Jean Rosell-Ubial, teenage pregnancy was included as an indicator in view of the high rates of teen pregnancy at the national level and in JPMNH sites. 2. JPMNH assisted in the capacity building of health workers in the use of the ASRH job aide. LGUs were also supported in the design and implementation of integrated ASRH programs according to the SPHERE framework. JPMNH developed a monitoring and evaluation tool for partner sites, which was aligned with the SPHERE framework. 3. Major research outputs on young parenthood/teenage pregnancy were also supported through JPMNH to contribute to the knowledge and evidence base on this increasingly important societal issue. These include the following: Teen Births Facility Research, Study on the Socio-Economic Impact of Teenage Pregnancy, Study on the Social Determinants of Teenage Pregnancy 18

20 4. JPMNH initiated the Teens Writing for Teens Project and supported its workshops, production and printing, and book launch. 5. Under the JPMNH, supplementary training modules for AJA were developed and pilot tested. The modules focused on deeper understanding of adolescents, and developing friendlier attitudes and a more welcoming workplace environment for providing services for adolescents. Output 3.4: Functional FP logistics management system in place 1. JPMNH provided support to FP logistics management through training in the use of SPECTRUM software, a computer-based projection and modeling system which facilitates analysis and planning for health programme resource requirements. 2. DOH put the National Online Stock Inventory and Reporting System (NOSIRS) on hold for improvements in In response to this, JPMNH piloted an alternative FP logistics system called Track and Trace, a barcoding system that could be operated through mobile devices, such as smartphones and tablets. This pilot implementation generated data that were translated into operational research and presented to DOH. This subsequently led to the formation of the DOH Technical Working Group for the adoption of the Track and Trace system. Output 3.5: Gender issues affecting access to services addressed 1. JPMNH engaged the Philippine Society of Responsible Parenthood (PSRP) to conduct operational research, which included a baseline of male involvement in FP. PSRP also carried out a study of demand generation activities that would encourage husbands to attend FDS, and couples to make joint decisions regarding FP. Outcome 4: Strengthened JPMNH area health systems in support of IP, PP and FP Output 4.1: Maternal Death Review (MDR) strengthened and instituted 1. JPMNH provided technical and monitoring assistance in support of improving the frequency and quality of Maternal Death Reviews (MDR) conducted at the provincial and city level. Emphasis was given towards enhancing formulation of, dissemination of, and compliance with recommendations, as well as monitoring LGU efforts and progress in complying with these. Capacity building was also provided for Development Management Officers (DMOs), which centered on their roles and responsibilities in the MDR. 2. In the JPMNH municipalities in Region XII and District 2 Quezon City, training involving community health teams, volunteer health workers, and frontline health workers was given, which focused on what the LGU and the community can do after learning about their LGU maternal and newborn deaths. The goal was to engage the community and foster accountability, responsibility, and commitment from local officials and other stakeholders. The Maternal Death Review Follow-through training was also 19

21 meant to highlight the roles of the community health workers in ensuring regular followup of pregnant women in their areas. Output 4.2: Increased capacity of LGUs and the DOH Regional Offices (ROs) in Public-Private Partnership (PPP) management for IP/PP and FP 1. In collaboration with the respective DOH ROs, Provincial Health Offices (PHO), and Municipal Health Offices (MHO)/City Health Office (CHO) of partner sites, JPMNH assisted in private sector engagement towards the delivery of quality IP, PP, FP, and newborn care services. 2. WHO information products on MNCHN were disseminated to government and nongovernment partners. Three national government agencies, 10 local government units, and 15 non-government partners (CSOs, private facilities, development agencies) received brochures on Maternity Care Package (MCP) advocacy materials, breastfeeding social marketing materials, complete sets of ICD 10 books, ICD 10 for Maternal and Pregnancy Related Deaths, CPG on Intrapartum and Immediate Postpartum, EINC brochures, pamphlets, newsletters, advocacy and social marketing materials, and selfinstructional modules 3. To explore the engagement of the private sector for the delivery of quality intrapartum, postpartum and newborn care services, JPMNH brokered the initial meeting between Region XII public hospitals and birthing facilities and the privately-owned Howard Hubbard Hospital (HHH), located in Polomolok South Cotabato in July At this meeting, an agreement was reached that HHH will be part of the SDN for MNH services within the JPMNH areas of Region XII. Further visits to the HHH were made and referral schemes were discussed from August to December In Quezon City, a consultative meeting with all the end-referral hospitals, including some private hospitals and private lying-in clinics, was conducted to discuss referral agreements and arrangements. Output 4.3: Increased capacity of LGUs/local chief executives (LCE) on local health governance for IP, PP and FP 1. At the provincial and municipal/city district levels, JPMNH assisted LGUs and LCEs in increasing their capacity for local health governance for IP/PP/FP elements of MNCHN. Focus was given to the operationalization of the SDN, and institutionalization of the use of the MNCHN monitoring tool. Supervisory capacities of health managers were enhanced through the Health Leadership and Governance Programme (HLGP). HLGP was designed to address inequities in the local health system by empowering local leaders, including governors, mayors, and local health officials, through leadership and governance training, coaching, and practicum. The programme showed positive results amongst enrolled local health leaders with the improvements in indicators on maternal mortality, infant mortality, facility-based deliveries, skilled birth attendance and contraceptive prevalence rate. 2. JPMNH provided technical support to the DOH, through the Responsible Parenthood and Reproductive Health National Implementation Team (RPRH NIT) in the 20

22 establishment of a costed implementation plan (CIP) for FP. The CIP provided the multi-year action plan for achieving the FP goals of the country, including the technical strategy and the associated costs to meet the goals. Output 4.4: Increased capacity of DOH ROs in providing Technical Assistance (TA) to LGUs on IP/PP elements of MNCHN 1. At the regional level, JPMNH continued to support DOH RO XII and DOH-NCR in increasing their capacity to provide technical assistance to LGUs on IP/PP elements of MNCHN. 2. Coordination meetings with focal persons at the DOH Central Office, NCR and Region XII DOH ROs, QC Health Department and the seven (7) municipal sites in Region XII were regularly done. These involved discussions regarding planned capacity building activities, monitoring, evaluation, coaching and supervision, as well as provision of technical assistance as needed. 3. A Geographic Information System (GIS) study on access to EmONC facilities was conducted to improve understanding of how EmONC facilities add up to form an SDN. The study also looked into appropriate designs and support for referral mechanisms between health facilities. 4. Technical assistance was provided to the City Government of Quezon City to strengthen its implementation of MNCHN guidelines through the development, public dissemination, finalization, and publication of implementing rules and regulations (IRRs) for relevant City Ordinances. Utilization of a monitoring tool for quality MNCHN services was assessed in the project sites. Guidelines were set through the assistance of the regional offices, including the enhancement of the maternal and referral form. A portfolio that contains MNCHN SDN Guidelines, particularly on the flow of the referral system which also features the Mag-ina Telereferral System (MInTS), was made and distributed to stakeholders. 5. At the municipal and city levels, JPMNH LGU experiences to localize the SDN were captured by process documentation for transmission to policy makers at the DOH and PhilHealth. All eight JPMNH LGUs have organized SDNs with varying degrees of maturity. Lessons learned in strengthening local SDNs include provision of leadership and governance training, installation of electronic health information systems and utilization of data for governance, mobilization of the barangays, capturing the process to connect the dots that comprise the SDN, and establishing accountability and sustainability systems through guidelines and tools for maternal and child health. 6. JPMNH engaged multiple levels of government through its membership and technical assistance to the SDN TWG of the Bureau of Local Health Systems Development of the DOH on the national level, the Regional Interagency Coordinating Team at the regional level, and the Quezon City Maternal and Neonatal Council on a city level. 21

23 Output 4.5: PhilHealth accreditation of facilities achieved 1. JPMNH provided technical assistance, equipment, and commodities in support of increasing the number of public lying-in facilities that are accredited under the PhilHealth MCP in partner sites. 2. JPMNH provided technical assistance for the issuance of PhilHealth Circular No entitled, Social health insurance coverage and benefits for women about to give birth, which defines policies and procedures that will give financial risk protection to women who are about to give birth. JPMMH further worked with partner sites to ensure its implementation. 3. PhilHealth-DOH-LGU dialogues were conducted in the provinces of North Cotabato, Sultan Kudarat and Sarangani, which aimed to orient LGUs on the accreditation requirements for the PhilHealth MCP. These dialogues also incorporated awareness raising seminars on PhilHealth circulars regarding MCP, Newborn Care Package (NCP), expanded primary care benefits (Tamang Serbisyo sa Kalusugan ng Pamilya - Tsekap), health insurance coverage, and benefits for women about to give birth (WATGB). 4. PhilHealth Orientations were done for community health workers in each project site to enable them to effectively disseminate information and to recruit others to do the same. The project s capacity building assistance came in the form of a one-day orientation on Maternity Care Package and Newborn Care Package for barangay health workers (BHWs). This activity aimed to bridge prevailing capacity and information gaps among BHWs who are tasked to inform regarding and advocate for public health programs such as PhilHealth membership, whether on a private capacity or sponsorship of the LGUs or as NHTS recipient. Output 4.6: Minimum Initial Service Package (MISP)-RH integrated into local Disaster Risk Reduction & Management (DRRM) plans 1. UN agencies, as part of the DOH RH-MCH Technical Working Group, assisted in the drafting of the National Policy on the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health (SRH) in Health Emergencies, Natural and Man-made Disasters. DOH AO on the implementation of the MISP was developed with programmatic support from UNFPA. This served as a national policy guideline towards ensuring that SRH concerns are properly addressed in emergency situations. 2. JPMNH supported capacity building for the conduct of MISP Level 1 trainings aimed to capacitate service providers on SRH and gender-based violence (GBV) prevention. MISP Level 2 trainings designed to integrate MISP in local DRMM plans were also conducted. 3. The development of local capacity on MISP was complemented by a national pool comprised of 50 MISP trainers, training manuals (Localized MISP Manual for LGUs, Manual for Standard RH Services in emergencies, ASRH in Emergencies Module, enhanced DSWD youth module incorporating AJA and ASRH in Emergencies). To further sustain and institutionalize MISP initiatives, JPMNH supported the drafting of a Joint Memorandum Circular (JMC) among DOH, DILG, Office of Civil Defense (OCD) and DSWD on the integration of the MISP (and aspects of ASRH) in the National DRRM Plan and local DRRM plans. 22

24 Output 4.7: Vital registration strengthened 1. The Maternal and Neonatal Death Reporting and Surveillance (MNDRS) was institutionalized by the DOH Knowledge Management and Information Technology Service (KMITS) with JPMNH support. Online real time maternal and newborn death reports are made available on the DOH website. 2. JPMNH engaged the University of the Philippines-National Telehealth Center (UP- NTHC) to strengthen the vital registration and health reporting systems of partner sites. Capacity building was supported through training for and implementation of the use of electronic health information systems. Maternal and neonatal death registration was improved. Reporting of these to the local civil registrar (LCR) was strengthened by linking health facility data to the LCR through the real-time Community Health Information Tracking System (rchits). 3. JPMNH supported the development of the Birth Registration Tracking System (BiRTS), a programme piloted in QC District 2. This was also developed by UP-NTHC. Birthing facilities in District 2 already send updated data on deliveries using this system, thus incurring no delay. The LGU also mandates this in all its other public birthing facilities. In Region XII municipalities, training on BiRTS and initial coordination were done with their respective LCRs. 4. JPMNH provided technical and funding support to the development and finalization of IRRs for Quezon City Ordinances that would ensure the timeliness and quality of data submitted to the CHO and LCR, which is also entered into the MNDRS of DOH. Output 4.8 HIS Operational in Health Facilities in LGUs 1. JPMNH supported the implementation of and training for the use of the rchits in partner sites. 2. To ensure that initiatives in improving the health information systems (HIS) will be sustained and operational in health facilities in LGUs, JPMNH initiated the institutionalization of sustainability mechanisms and linkage of rchits to the LGU Dashboard. In Quezon City, the CHITS Technical Working Group (TWG) led by the City Health Officer and composed of health and civil registry staff was organized. The Mag-Ina Telereferral System (MInTS) was developed. This was used for sending online referrals from the public lying-in clinic to the hospital MInTS Dashboard. Every referral triggers a visual, sound, and SMS notification upon receipt of the participating LGUoperated end referral hospitals, Quezon City General Hospital and the DOH-retained Quirino Memorial Medical Center. The MInTS project was also presented to the City Local Health Board meeting. Guidelines on the telereferral system were developed by the multi-stakeholder TWG. 3. With the realization of the huge difference ehealth had made in health services and its great potential to be implemented on a wider scale, JPMNH LGUs were self-organized into a community of practice on ehealth, particularly on maternal and child health. This Community of Practice aims to provide the LGUs and other stakeholders in health 23

25 with a functional network where they can share their ideas, experiences, resources, and aspirations towards improved care for the Filipino mother and child, and at the same time get updates to strengthen their technical capabilities in using ICT for health to ensure continuity of practice of ehealth beyond the lifespan of the JPMNH, with the support coming from the LGUs themselves. Outcome 5: Institutionalized joint working approach to programme management and implementation 1. A joint working approach characterized the management and implementation of JPMNH Phase 2, as evidenced by the jointly formulated JPMNH work plan for , a single programme results framework, one monitoring and evaluation plan, one National Programme Steering Committee that reviews, oversees and provides direction to the programme, and one Technical Working Group that ensures coordination and alignment of interventions and monitoring efforts. 2. JPMNH arrangements facilitated the exchange of information among the three UN agencies. This structure also simplified coordination with key partners, namely the DOH and the Australian Government, since they need only communicate with one representative or body, usually in the form of the JPMNH TWG. This further resulted in a unified direction, a common message, and a complementation of each of the UN agencies specialization and focus towards integrated implementation. 3. The DOH-Bureau of International Health Cooperation (BIHC) recognized the good practice of JPMNH in harmonizing development partner support to the health sector through effective collaboration and inter-linkages in and among development partners. V. KEY OUTCOMES A. Impact indicators JPMNH sites overall experienced a decrease in absolute number of maternal deaths, from 19 to 17 (an 11% decrease), and in MMR 2, from 55 to 50 (a 9% decrease). The absolute number of maternal deaths in the urban JPMNH (Quezon City District II) site decreased from 10 to 6, or by 40%, from 2013 to The rate of decrease was higher compared to the respective decreases of 10% (from 3,000 to 2,700 deaths) and 25% (from 195 to 146 deaths), at the national and NCR levels. There was an increase of two maternal deaths (from 9 to 11) from 2013 to 2015 among all the rural JPMNH sites. There was also an increase in maternal deaths in Region XII as a whole (from 62 to 64 deaths). It should be noted, however, that any conduct of a systematic investigation of maternal deaths in specific areas, as was done in JPMNH, is expected to provide a more complete picture of maternal mortality compared to vital records alone. This inevitably leads to an increase in the cases of maternal deaths detected (World Health Organization, 2004). 2 JPMNH tracked the absolute number of maternal deaths in project sites through Phase 2 and computed for MMRs as part of its M&E plan. Both absolute numbers and MMRs are presented in this section, but with a caveat for the understanding that the validity of the resultant MMRs may be limited because of the relatively small JPMNH population and the consequently small denominators used in computing for these values. 24

26 Table 4. Impact indicator: Reduced maternal mortality in JPMNH sites Maternal Deaths (absolute number) JPMNH Sites Overall a Region XII b NCR b National 3,000 c 2,700 d Sources: a JPMNH Baseline and Endline Studies; b 2013 and 2015 Annual Reports of the Field Health Services Information System (FHSIS); c Trends in Maternal Mortality : Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division; d Trends in Maternal Mortality : Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division Computed in terms of MMR, the MMR decreased from 55 to 50, or a decline of 9% over all the JPMNH sites. At the NCR level, maternal deaths decreased from 195 to 146, a decline of 25%; while MMR decreased from 76 to 60, a decline of 20%. The MMR remained unchanged at 71 in Region XII. In comparison, the reported MMR decreased from 120 to 114 maternal deaths per 100,000 live births, a decline of 5% at the national level. In the Endline Study, a t-test was performed to compare MMR among JPMNH sites in 2013 and 2015, and there was no significant difference between the means of the MMR and of maternal deaths in 2013 and those of The t-test also revealed no significant difference between the means of live births in 2013 and Based on the Endline Study, the following factors contributed to the continued occurrence of maternal deaths: Key informants cited delays in identifying complications (particularly in home deliveries with hilot or traditional birth attendants) and delays in bringing mothers to the hospital for immediate medical treatment. Families were also reluctant to bring birthing mothers or mothers who are to give birth, to the hospital due to the high cost of hospitalization. When patients are eventually brought to the hospital, it is often too late to help them; In Kalamansig and Lebak where MMRs were particularly high, cultural practices among indigenous people who prefer to deliver with the assistance of a traditional birth attendant resulted to complications for the mother and the baby, according to BHWs and midwives interviewed. Their isolated geographical location causes delays in reaching a health facility and since these mothers have not undergone regular prenatal check-ups, there can be additional delay in providing appropriate treatment for birth complications; and On the other hand, other key informants of the Endline Study attribute the decline in MMR in some sites to: improved pregnancy tracking, regular prenatal care provided in the Rural Health Units (RHUs) and BHS, and the encouragement of facility-based births and skilled birth attendance through local legislation 3 ; EINC in health facilities provided by skilled health personnel who were trained to perform BEmONC functions, postnatal care for mothers; 3 LGU support of health initiatives through local legislation is valuable in achieving health goals. LGUs vary in the development and implementation of local ordinances, however, and the JPMNH supports ordinances that encourage and incentivize good practices, and discourages punitive or discriminatory legislation that may violate human rights. 25

27 the existence of a functional SDN that allows mothers with complicated pregnancies to be referred to public hospitals; and provision of transport to mothers who are about to deliver which helps increase their access to quality IP and PP care. The situation on maternal deaths is mirrored and validated in the decrease in the absolute number of neonatal deaths (by 8%) and in neonatal mortality rate [NMR] (by 7%) in JPMNH sites overall. The rates of decline are at par with the national level where neonatal deaths and NMR decreased by 9% and 7%, respectively. The decrease was generally experienced in the urban JPMNH site (15% for both neonatal deaths and NMR) while an increase was shown in the rural JPMNH municipalities (35% and 44% for neonatal deaths and NMR, respectively). Four out of the seven rural JPMNH sites saw a decrease in deaths while three had increased neonatal deaths. However, the t-test performed on NMR among JPMNH sites showed no significant difference between the 2013 and 2015 figures. Similarly, the differences in neonatal deaths and live births between 2013 and 2015 were not found to be statistically significant. According to key informants interviewed, the common causes of neonatal deaths are birth asphyxia and birth trauma; prematurity; congenital anomalies; sepsis and other infectious conditions that were not diagnosed earlier by skilled health personnel and which happened mostly when mothers delivered at home assisted by a local hilot. Table 5. Impact indicator: Reduced neonatal mortality in JPMNH sites Neonatal Deaths Neonatal Mortality Rate (absolute number) JPMNH Sites Overall a JPMNH Sites Rural a JPMNH Sites Urban a Region XII Data not available* Data not available* NCR Data not available* Data not available* National 33,000 b 30,000 c 14 b 13 c * Data not reported in the 2013 and 2015 FHSIS Annual Reports Sources: a JPMNH Baseline and Endline Studies; b Trends in Maternal Mortality : Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division; c Trends in Maternal Mortality : Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Conversely, the general decline in NMR was attributed by the health personnel interviewed to interventions such as quality prenatal care and antenatal care (ANC), delivery at health facilities attended by skilled health personnel, and protection against neonatal tetanus. B. Outcome 1: Improved quality of facility-based IP and PP care For Outcome 1, the following result indicators (summarized in Table 6) registered improvements: a. Facility-based deliveries in JPMNH sites (overall) improved by 7.29%, with rural sites increasing at a much faster rate of 20.9% compared to the urban site at 0.92%. Rural sites also performed much better than the 8.3% increase shown by the entire Region XII and the 10.85% increase at the national level; and 26

28 b. Skilled birth attendance showed a modest increase of 1.81% with rural sites registering a 9.42% improvement compared to a 1.68% decline in the urban site. Region XII as a whole improved by 6.68% compared to NCR s decline by 0.92% while the national level increased by 4.05%. c. Post-partum mothers who initiated breastfeeding within an hour after giving birth in JPMNH areas increased by 25.82% from 2013 to This overall performance was better than the 5.98% increase in Region XII as a whole, the 5.53% decline experienced by NCR, and the 0.7% increase at the national level. Meanwhile, the cesarean section rate declined by 1% in JPMNH sites from 2013 to The C-section rate of 2.28% for 2015 continues to indicate low coverage. In a systematic review by Miller et al (2016), which included recommendations accepted by WHO, C-section rates of less than 9% were associated with increased maternal and perinatal mortality and morbidity. This remains an alarming finding that in the JPMNH sites, there are women who need this surgical intervention who may not be receiving it. Challenges in gathering data on C-section rates were encountered as many of these deliveries were done at referral hospitals outside of the project sites. This being the case, some project sites did not record these deliveries under their reports as the births technically occurred outside their LGUs. These circumstances led to underreported C-section rates in JPMNH sites. Even taking this into account, however, the C-section rates in project sites are still far from ideal. On functioning BEmONC and CEmONC facilities. A marked increase (by 75%) in the number of BEmONC-capable public health facilities (i.e. performing all eight signal functions) in JPMNH sites from 2013 to 2015 was seen by the Endline Study. Except for Arakan and Aleosan which have one BEmONC-capable public facility each, the rest of the JPMNH sites (five rural municipalities and one urban district) had two BEmONC-capable facilities in The Endline Study partly attributes this to the many health professionals who have undergone BEmONC-trainings funded by JPMNH and other partners, as well as by government. However, not all of these public facilities capable of BEmONC signal functions are PhilHealth MCP-accredited. The BEmONC Modules for Midwives were turned over to the Department of Health in July These manuals are now being utilized by all of the 31 DOH-accredited BEmONC training centers in their BEmONC midwives training. The first batch of printed modules was distributed to 1,565 participants and 100 trainers. Forty-five Rural Health Midwives were trained and certified as BEmONC capable after the post training mentoring in the provinces of North Cotabato, Sultan Kudarat and Sarangani. DOH also printed copies of these Harmonized BEmONC modules for midwives through their own funds. In cases involving complicated deliveries and newborn emergencies, all JPMNH sites now have referral hospitals that are capable of performing all CEmONC signal functions, whereas these hospitals were not capable of providing C-section services prior to JPMNH intervention. Through direct JPMNH support (e.g. human resource augmentation for C-section and logistical supply, engagement of technical assistance providers and C-section teams, operationalization of blood banks, etc.), 100 C-sections had been performed in the first three quarters of 2016 by Lambayong District Hospital in Sultan Kudarat, Dr. Cornelio C. Martinez Memorial Provincial Hospital in Sarangani, and Dr. Amado Diaz Provincial Hospital in North Cotabato, according to programme M&E reports as of September 2016 (Family Planning Consortium, 2016). 27

29 Table 6. Outcome 1: Improved quality of facility-based IP and PP care Indicator JPMNH Sites a Regional National b 2015 c Overall 75.16% b 86.01% c 81.35% (+10.85) Percentage of facility-based deliveries Percentage of live births attended by skilled health personnel Percentage of women who had a CS in government facilities in catchment areas Rural 59.76% Urban 94.34% Overall: 84.03% Rural: 65.68% Urban: 92.21% Overall 88.64% (+7.29) Rural 80.66% (+20.9) Urban 95.26% (+0.92) Overall 85.84% (+1.81) Rural 75.10% (+9.42) Urban 90.53% (-1.68) 3.2% 2.28% (-0.92) Region XII 71.41% NCR 90.21% Region XII 76.62% NCR 94.42% Region XII 5.7% Region XII 79.71% (+8.3) NCR 92.10% (+1.89) Region XII 83.30% (+6.68) NCR 93.50% (-0.92) No data available 84.5% b 88.55% c (+4.05) 9.3% d No data available Percentage of municipality/city LGUs with at least 1 public health facility that is BEmONCfunctional Percentage of provincial and city LGUs with CEmONC-functional hospitals Percentage of mothers giving birth in a public health facility practicing skin-to-skin contact Percentage of postpartum women who initiated breastfeeding within 1 hour after giving birth NCR 10.4% Output 1.1: Functioning BEmONC facilities 25% 100% (+75) Output 1.2: Functioning CEmONC facilities 100% 100% Output 1.3: EINC institutionalized in JPMNH SDN 71.9% Data not collected 71.90% e 97.72% (+25.82) Region XII 60.34% Region XII 66.32% (+5.98) *62.39% b *63.09% b (+0.7) Percentage of public health facilities that meet partner-defined quality standards (client-centered and culturally sensitive) NCR 77.55% NCR 72.02% (-5.53) Output 1.4: Client-centered, culturally sensitive IP care PDQ 100% standards not yet available in 2013 * Data retrieved is of women who started breastfeeding, regardless of time of initiation; Data to be collected in an endline survey to be commissioned by DOH Sources: a Baseline and Endline Studies; b 2013 FHSIS; c 2015 FHSIS; d 2013 National Demographic and Health Survey (NDHS); e Baseline Study sample survey 28

30 On institutionalization of EINC in JPMNH SDN sites JPMNH supported the DOH-Family Health Office in developing evidence-based policy and guidelines on prematurity and low birth weight, clinical practice guidelines on select causes of neonatal morbidity and mortality, and in updating/revising the DOH Administrative Order on Adopting Policies on Essential Newborn Care to become Adopting Policies and Guidelines on Essential Intrapartum and Essential Newborn Care. Formative research completed identified provider-related and health system barriers in the provision of quality maternal and newborn care. Barriers to facility delivery which were identified included having more than four children, living in a GIDA and membership in the government s CCT program, Pantawid Pampamilyang Pilipino Programme (4Ps). Transportation costs, out-ofpocket expenditures and limited income were also cited. An assessment of intrapartum-postpartum related trainings was completed, focusing on the public health sector in JPMNH areas in Region XII, and noted the following challenges to intrapartum and post-partum training implementation: (1) less or no administrative support; (2) no equipment and facilities; (3) some doctors do not adhere to the standards secondary to preference to the status quo, and secondary gains related to the performance of alternative intervention; and (4) MNCHN programs were treated as individual programs and not linked nor integrated with health systems strengthening. An assessment on the status of supportive supervision was completed, including the drafting of tools on supportive supervision, monitoring and mentoring. DOH assumed responsibility for the pretesting, pilot testing and finalization of these tools after the JPMNH project closeout in June A training assessment of the implementation of midwifery and nursing pre-service curricular integration of EINC was likewise supported. The assessment aimed to determine the degree of implementation of EINC practices in the various nursing and midwifery schools and recommend steps to improve the implementation of the EINC strategy. Training assistance to LGUs and DOH ROs included: Further training on Harmonized BEmONC of 50 health service providers of designated but not yet functioning BEmONC facilities in Region XII JPMNH sites. DMOs of DOH RO, and LGU and retained hospital staff were capacitated on supportive supervision and M&E on Harmonized BEmONC for midwives (37 graduates), Care for the Small Baby (6 programme managers), Maternal Death Surveillance and Review (21 graduates). On the adherence of health facilities to the implementation of MNCHN-EINC, IYCF and MBFHI Initiative and Milk Code Compliance, a monitoring team from JPMNH TWG, Family Health Office-DOH and Regional Family Cluster staff conducted the implementation monitoring in September Findings supported that several hospitals in Region 12 and QC are MBFHI accredited however not all of these hospitals are implementing the initiative nor complying to the Milk Code and IYCF policies. To further support MBFHI, JPMNH provided capacity building, including the provision of training supplies and breast models on lactation management where a total of 105 health service providers from various birthing facilities and hospitals of the JPMNH sites graduated. 29

31 On culture-sensitive and client-centered intrapartum care Problems identified through the PDQ process and the results realized after interventions were drawn up and implemented with the involvement/participation of community members themselves. One such example is the following: Problem: Poor provider-client and client-provider attitude; Result after intervention: Fifty-four percent of 26 clients who gave feedback were satisfied; supportive supervision was integrated in health center meetings; health staff were more open to feedback and comments; community members were more open to health workers; feedback tool was integrated in the health center process of those covered by the technical assistance C. Outcome 2: Increased demand for IP, PP, and FP services For Outcome 2 (summarized in Table 9), improvements were seen in terms of the following indicators: Infants exclusively breastfed increased by 6.36% in JPMNH sites from 2013 to 2015 compared to decreases experienced at the regional (-25.77% for Region XII and % for NCR) and national (-26.07%) levels; Post-partum women provided FP counselling increased by 37.97%; and Unmet need for FP was addressed among NHTS poor households with 7,442 new acceptors served with various modern FP methods. FPAS conducted effectively linked demand generation to service delivery, contributing to a reduction in unmet need among women of reproductive age belonging to the NHTS poor, as shown below: Province Table 7. Summary of FP acceptors in JPMNH city and provinces No. of FDS No. of No. No. of New Conducted WRAs Counselled FP Acceptors Pop n of NHTS Women % Acceptors vs. NHTS Women Reached Quezon City 258 5,086 5,081 4,183 (Dist. II) Sarangani 19, ,550 1,890 1,058 5% Sultan 17, ,520 1,945 1,469 9% Kudarat North 8, , % Cotabato TOTAL ,804 9,872 7,442 Table 8. Summary of FP methods accepted in JPMNH city and provinces Province Modern FP Methods Accepted Implant LAM Condom Pills DMPA IUD SDM BTL NFP Quezon City (Dist. II) , Sarangani Sultan Kudarat North Cotabato TOTAL ,240 3,628 1,

32 In addition, increases in province-wide contraceptive prevalence rates were observed in the three rural JPMNH provinces: North Cotabato from 68.4% in 2014 to 72.8% in 2015 (Provincial FHSIS) Sultan Kudarat from 60% in 2014 to 68% in 2015 (Provincial FHSIS) Sarangani from 52% in 2014 to 58% in 2015 (Provincial FHSIS) Indicator Percentage of women with unmet need for family planning Table 9. Outcome 2: Increased demand for IP, PP, and FP services JPMNH Sites Regional National % a Not collected Region No data 17.5% b No data XII available available 15.6% b NCR 14% b Output 2.1: CHT/Community MNCHN support groups are functional in JPMNH P2 to address MNCHN issues of Q1 and Q2 poor and adolescents Percentage of No accomplishment Overall c women years reported yet (Project to 7,442 new acceptors old in NHTS HHs reach out to NHTS from NHTS who are new women yet to be households covered acceptors of launched at that time) modern FP methods Rural c 7% (3,259 new acceptors out of 45,767 NHTS women covered in 13 municipalities from 3 JPMNH provinces) Percentage of mothers who delivered whose birth plans were implemented Percentage of infants 6 months exclusively breastfed Urban c 4,183 new acceptors from NHTS households in 5 barangays in QC District II 84.1% a Not collected Output 2.2: C4D/BCC in IP, PP, and FP interventions implemented 71.49% c 77.85% d Region Region (+6.36) XII XII 90.61% e 64.84% e (-25.77) 85.48% e 59.41% e (-26.07) Percentage of postpartum women provided FP counselling 59.8% b 97.77% d (+37.97) NCR 74.82% e NCR 46.71% e (-28.11) Data to be collected in an endline survey to be commissioned by DOH Sources: a Baseline Study sample survey; b 2013 NDHS; c JPMNH M&E reports; d Endline Study; e 2013 and 2015 FHSIS 31

33 D. Outcome 3: Improved availability of good quality FP services For Outcome 3, the indicator on contraceptive prevalence rate registered an overall increase of percentage points for JPMNH sites, with rural project sites improving at a faster rate of 14.27% than the 7.98% increase at the urban programme site. These are compared to the 14.03% and 2.24% increases in Region XII and NCR, respectively, and the 5.52% improvement seen at the national level (all based on the 2013 and 2015 FHSIS data). The percentage of LAM users likewise improved by 11% in all JPMNH sites. Table 10. Outcome 3: Improved availability of good quality FP services Indicator JPMNH Sites Regional National Overall Region XII 39.53% c 45.05% d 64.72% a 57.01% c (+5.52) Contraceptive prevalence rate for modern methods Percentage of municipalities/ city providing all modern FP methods through an SDN Rural 63.62% a Urban 80% a Overall 83.90% b (+19.18) Rural 77.89% b (+14.27) Urban 87.98% b (+7.98) NCR 42.04% c Region XII 71.04% d (+14.03) NCR 44.28% d (+2.24) Output 3.1: Comprehensive FP methods (long-term and short-term) available 100% e 100% b Percentage of LAM users 3.0% f Overall 14.06% b Percentage increase in the annual LGU budgetary allocation for FP* Percentage of municipalities/ city with at least one ASRH service delivery point (+11.06%) Rural 12.82% b Region XII 14.48% c NCR 16.49% c Urban 15.17% b Output 3.2: FP policies applied in JPMNH P2 areas ~PHP 14,832,000 e Region XII 13.40% d (-1.08) NCR 15.19% d (-1.3) ~PHP 630,000 b (-96%) Output 3.3: Health workers competent and using ASRH job aide 0% e 100% b Adolescent birth rate 40.4% f 11.94% b, No data available No data available Output 3.4: Functional FP logistics management system in place Percentage of RHU/CHO with 100% e 100% b no stock outs on FP commodities Percentage of husbands who have knowledge and positive attitudes towards FP Output 3.5: Gender issues affecting access to service are addressed 81.9% f Not collected 15.87% c 13.08% d (-2.79) 10.1% g No data available Data to be collected in an endline survey to be commissioned by DOH; * Based on LGUs where absolute figures were provided; Reported as percentage of adolescent deliveries among all deliveries, with missing data from Lebak Sources: a JPMNH M&E Reports; b Endline Study; c 2013 FHSIS; d 2015 FHSIS; e Baseline Study; f Baseline Study sample survey; g 2013 NDHS, reported as percentage of adolescents who have begun child bearing 32

34 The Endline Study cited the following factors as contributing to the improvement in CPR: widespread mass media campaign on reproductive health, particularly on the use of FP methods, conducted by skilled health personnel (SHPs); FP counseling given to post-partum women; FP commodities are readily available for free in health facilities (no stock out policy). According to SHPs interviewed, they had no stock-outs on pills and IUD, but were unable to procure progestin sub-dermal implants (PSIs) due to the Supreme Court s temporary restraining order. On adolescent births, the Endline Study interviews with health workers revealed that these cases are prevalent among indigenous tribes that arrange early marriages, and in isolated and poor rural areas where adolescents have little access to schooling, as well as access to information and knowledge on reproductive health. In urban centers, interviews revealed that the early exposure of adolescents to unprotected sexual relationships causes early and unplanned pregnancies. The field teams were unable to determine the adolescent birth rate as the administrative data from LGUs could not provide the total number of years old in 2015 in each JPMNH site; these were not collected separately, or data was not disaggregated. They only had records of the adolescent deliveries and total deliveries of women of reproductive age (WRA) in On availability of comprehensive FP methods to women and men As a direct result of Family Planning Competency-Based Training (FPCBT) and LAPM capacitybuilding in 2015: One hundred and three (103) health service providers were trained on IUD insertion, of whom 99 were given post-training evaluation (PTE) certification. Twelve (12) FPCBT capacity-building and LAPM missions were conducted in North Cotabato yielding 25 trained health service providers all of whom were given PTE certification and 2,254 WRA served with quality LAPM In Sultan Kudarat, 7 BTL and implant missions were conducted which provided quality LAPM to 2,745 WRA Eleven (11) LAPM missions were conducted in Sarangani, yielding 60 trained health service providers, half of whom were given PTE certification and 2,631 WRA provided quality LAPM JPMNH supported the pilot-testing of a population-based survey using the Lot Quality Assurance Sampling (LQAS) methodology. The objective was (1) to provide a quick tool for community health programme managers, (2) to assist field supervisors and service providers in validating contraceptive prevalence in a catchment area, and (3) to determine which specific part of the catchment area (which is further subdivided into supervision areas) is in need of greater focus. LQAS was initially used as an industrial quality control tool but has since been adapted for use in the health sector to assess coverage of health programmes, quality of performance of health workers, and prevalence of diseases (Valadez, 2001). Part of the pilot-testing was the conduct of population-based surveys using a working document to determine contraceptive coverage in the JPMNH sites. The results yielded the following: 33

35 Table 11. Contraceptive Prevalence Rate Estimates (with 95% confidence intervals) in JPMNH City and Provinces Site Family Health National Demographic Lot Quality Assurance Survey 2011 Health Survey 2013 Sampling (LQAS) Quezon City District II 40.2%* ( %) 40.1%* ( %) 37.9% ( %) Sarangani 39.3%* ( %) 44.2%* ( %) 51% (46-56%) Sultan Kudarat 45.4% ( %) 44.2%* ( %) 51.6% ( %) North Cotabato 39.84% ( %) 44.2%* ( %) 34.7% ( %) *Regional-level data; Provincial-level data On health workers competent in using ASRH job aid. As of September 2016, U4U s reach has reached the five million mark, broken down as follows: Table 12. U4U reach by platform U4U Platform Reach YouTube video channel views 4,104,256 Facebook followers 521,794 Served tweets 171,154 Ask U4U mobile text alerts 129,027 Teen Trail events 57,426 U4U website visitors 23,782 TOTAL 5,007,439 As part of the strategy to popularize U4U, the implementing partner, Center for Health Solutions and Innovations, entered the U4U Teen Trail in the Anvil Awards, a prestigious competition of communication programs, in November On February 26, 2016, U4U received the top prize in the 51st Anvil Awards, recognized by the Public Relations Society of the Philippines. U4U bagged the Grand Anvil award for the best communication programme implemented on a sustained basis. U4U received a Silver Anvil for the use of social media and a Gold Anvil for its implementation on a sustained basis. The Gold Anvil recognition automatically positioned U4U to compete with 27 other Gold Anvil winners for the most coveted, Grand Anvil award. U4U also won a Special Award for PR Excellence on Social Good, given to communication programs that have resulted in measurable changes in stakeholders knowledge, attitudes and practices. E. Outcome 4: Strengthened JPMNH area health systems in support of IP and PP According to the Endline Study, in 2015 all JPMNH areas had established a service delivery network in each municipality with a clear referral system from the BHS to RHU and to BEmONC/CEmONC facilities. MNCHN Coordinators were designated at the provincial and municipal levels. All JPMNH sites are working to formalize their referral system through memoranda of agreement (MOAs) with their CEmONC-capable facilities. Key informants admitted, however, that they still lack doctors, nurses and midwives to serve the total population, and that the two-way referral system has yet to be put in place. 34

36 Not all JPMNH sites provide a transportation system from the community level, especially remote ones. Midsayap and Aleosan have vehicles in the RHU provided by the LGU to transport mothers from the BHS to the birthing home. The vehicles issued to the barangays by the LGU in JPMNH sites (some barangays do not have vehicles) are usually made available for mothers who are about to give birth. All sites, however, have vehicles available 24/7 to transport patients from birthing homes in municipalities/rhus to end referral hospitals. Table 13. Outcome 4: JP area health systems strengthened in support of IP and PP Outcome Achieved Outcome Indicator JPMNH Sites Outcome 4: JP area health systems strengthened Percentage of functional SDN in in support of IP and PP JPMNH sites 0% a 100% b Output 4.1: Maternal Death Reviews strengthened Percentage of MDR and instituted recommendations implemented 75% a 73.91% b Output 4.2: Increased capacity of LGUs and DOH ROs in Public-Private Partnership management for IP, PP, and FP Percentage of JPMNH sites with formal private sector partnership arrangements 25% a 37.5% c Outcome 4.3: Increase capacity oflgus/lces on local health governance for IP/PP elements of MNCHN Output 4.4: Increased capacity of DOH ROs in providing technical assistance to LGUs on IP/PP elements on MNCHN Output 4.5: PhilHealth accreditation of facilities achieved Output 4.6: Minimum Initial Service Package for Reproductive Health (MISP-RH) integrated into local Disaster Risk Reduction and Management (DRRM) plans Output 4.7: Vital registration strengthened Percentage of planned MNCHNrelated activities in the Annual Operational Plan implemented Percentage of JP SDN visited quarterly by regional MNCHN teams Percentage of public lying-in facilities that are MCP accredited (including newborn care package) 87.5% a 94.87% b 81.3% a 43.75% b 87.5% a 75% b PhilHealth Utilization MCP benefits availed d 916 3,680 Total amount claimed (PhP) for MCP d 5,997,190 29,811,900 NCP benefits availed d 712 5,286 Total amount claimed (PhP) for NCP d 1,075,479 8,079,700 FP benefits availed d Total amount claimed (PhP) for FP d 109, ,000 Percentage of LGUs with MISP-RH integrated in approved local DRRM plans 0% a 100% b Percentage of JPMNH sites with functional e-reporting of maternal and neonatal deaths Percentage of JP municipalities/city 37.5% a 87.5% b Output 4.8: Health Information System (HIS) 100% operational in health facilities in LGUS with functional HIS a 100% b Sources: a Baseline Study; b Endline Study; c Operationalization of the Service Delivery Network for the Delivery of Quality MNCHN Services in Selected LGUs in Region XII and District II Quezon City; d PhilHealth data The most common communication system modalities used for referrals are mobile phone calls and SMS (texting). Some barangay officials are also provided hand-held radios in areas where there are no mobile phone signals. Table 14 presents an overview of how all eight JPMNH municipal/district sites are faring according to criteria defined by JPMNH for purposes of the Baseline and Endline Studies and where specific gaps lie (highlighted in yellow). While all JPMNH sites have established SDNs, these have different degrees of maturity and still need continued support and sustained investment from all stakeholders led by the local chief 35

37 executive to ensure adequate provision of health human resources and equipment, responsive mechanisms of health service delivery, and use of information and accountability systems. Table Profile of JPMNH Sites vis-à-vis SDN Functionality Criteria No. of JPMNH Sites Complying SDN Functionality Criteria Complied Partially Complied Not Complied 1. Leadership and Governance a. Availability of local ordinances and/or any document on SDN 3/8 5/8 0/8 (i.e., signing into ILHZ or SDN, MOAs for PPPs) b. Mapping of SDN; ILHZ 8/8 0/8 0/8 2. Health Financing (at municipal level) a. PhilHealth indicators: utilization rate (MCP, NCP); % of 8/8 0/8 0/8 births PhilHealth reimbursed, enrolment rate, sponsored patients b. Annual Health (MNCHN specific) budget as proportion of 8/8 0/8 0/8 IRA (actual no. per LGU), personnel (plantilla posts), MOOEs (job order posts), Capital Outlay c. No balance billing (from PhilHealth) 8/8 0/8 0/8 3. Health Human Resource [quantity + quality] a. Ratio of MD, RN, RM to population 3/8 4/8 1/8 b. Team trained (RHU, municipal) on BEMONC 8/8 0/8 0/8 c. BEMONC has one midwife/nurse, physician on call 8/8 0/8 0/8 d. Monthly availability-bemonc Team 8/8 0/8 0/8 e. One staff per RHU trained on at least FP Competency Based Training level 2 8/8 0/8 0/8 4. Access to Medicine and Technology a. No FP stock-outs 8/8 0/8 0/8 b. Maternal- Availability of oxytocin, magnesium sulphate, 8/8 0/8 0/8 steroids for premature labor c. Newborn - Availability of newborn resuscitation equipment, injectable antibiotics 2/8 0/8 6/8 5. Health Information System a. Conduct and documentation of maternal and neonatal death 8/8 0/8 0/8 reviews b. Knowledge/Awareness of what is happening within network 8/8 0/8 0/8 c. Use of LHIS and e-reporting 8/8 0/8 0/8 6. Health Service Delivery a. Two-way referral system [ BEmONC-CEmONC ] 0/8 3/8 5/8 b. Forms 8/8 0/8 0/8 c. Arrangements 8/8 0/8 0/8 d. Transportation system 3/8 5/8 0/8 e. Communication system 8/8 0/8 0/8 Sources: JPMNH Endline Study and JPMNH MNCHN SDN Process Documentation On strengthening and institutionalization of MDRs Initial gains in 2014 on strengthening and institutionalizing MDRs, in terms of the quarterly conduct of Maternal Death Review (MDR) and the appreciation of MDR teams of its importance and the emphasis on its formulation and dissemination and compliance with recommendations continued in In 2015, two MDRs were conducted in North Cotabato, with 70 percent of recommendations addressed; in Sultan Kudarat, one MDR was conducted, with 70 percent of recommendations addressed; and two MDRs were conducted in Sarangani, with 65 percent of recommendations addressed. Quezon City District 2 has also had MDRs, with 50 percent of recommendations in 2015 addressed. 36

38 On increasing capacity of LGUs/LCEs on local health governance for IP/PP elements of MNCHN The HLGP created impact through empowering local chief executives and local health leaders who are able to improve institutional arrangements and craft responsive policies and programs particularly for the poor. The enrolled local officials graduated from the curriculum in 2015, but the partnership continues to monitor progress in the provinces and municipalities covered by the intervention. Sixty (or 85% - 6 provinces and 54 municipalities) out of 71 target provinces and municipalities (9 provinces and 62 municipalities) of the HLGP demonstrated improved health roadmaps as of The Governor of Sarangani, Provincial Health Officers (PHOs) of Sultan Kudarat and Sarangani, and 21 provincial board members and department heads participated in and graduated from Provincial Leadership and Governance Programme (PLGP) sessions in Several colloquia for Municipal Leadership and Governance Programme (MLGP) were attended by mayors and municipal health officers (MHOs) in Sultan Kudarat, Sarangani (except for Malungon), and North Cotabato (except for Arakan). Quezon City completed the City Leadership and Governance Programme (CLGP) in All partner sites actively participated in these courses. While officials from Malungon and Arakan were unable to complete their training, technicalities and special circumstances were what prevented them from doing so, rather than a lack of interest. Support to LGUs and LCEs to set up functioning SDNs was also given. In broad strokes, the following were accomplished in the operationalization of the SDN, through the engagement with the Center for Innovations, Change and Productivity in 2015: (1) mapping of existing health facilities providing MNCHN core package of services including identification of partners and public and private service providers through the use of a Rapid Quality Assessment and Mapping tool. A total of 300 health facilities in Region XII and QC were assessed; (2) SDN strategic planning workshops with implementers and stakeholders were conducted in Quezon City, on June 1-2, 2015 and on July 27 to 29, 2015, in Region XII; (3) SDN Management Teams were formed with signed local issuances or Executive Orders, paving the way for institutionalization; and (4) engagement of barangay (village) level involvement, with the creation of barangay management teams and inter-barangay clusters and documentation of various models of agreements on referral and transport of pregnant women and mothers about to deliver. Meanwhile, JPMNH s technical support to the DOH, through the RPRH National Implementation Team (NIT), in formulating the multi-year costed implementation plan (CIP) for FP resulted in: a more realistic, clearly defined, and evidence-based targeting and programming for the DOH s thrust to achieve zero unmet need for FP whereby the focus is on WRAs from the 1 st to 3 rd wealth quintiles; the main strategies to reach this population are through intensified FP outreach missions and post-partum FP service provision, and the enablers for these strategies to be efficiently and effectively implemented include investments in improving the supportive environment, leadership and management and social marketing, as shown in the Figure 1 below; DOH s adoption of the CIP became the basis for the Department to revise the 2017 FP budget request it submitted to the Philippine Congress, with the amount significantly increasing from an initial PHP 165 million to around PHP 1.2 billion (Rappler, 2016). 37

39 Figure 1. Framework for the Multi-Year Costed Implementation Plan (CIP) for FP On achieving PhilHealth accreditation of facilities According to PhilHealth data, the benefits availed for MCP, NCP and even FP jumped by 302%, 642% and 827%, respectively, in JPMNH sites from 2013 to The increased utilization was accompanied by an attendant increase in benefit amounts claimed from PhilHealth (see Table 14). MCP claims amounts increased from about PhP 6 million to PhP 30 million (a 400% increase). NCP claims amounts increased from about PhP 1 million to Php 8 million (a 700% increase). FP claims amounts increased from about PhP 100 thousand to PhP 800 thousand (a 700% increase). These marked increases are likely attributable to improved availability and quality of services being provided at health facilities, the increased number of PhilHealth accredited facilities, and increased awareness and utilization of these packages. Based on the Endline Study, of the eight JPMNH sites, only Arakan had no MCP accredited public birthing facility in In 2015, Aleosan and Arakan had no MCP accredited public birthing facility. Aleosan District Hospital was found lacking in some MCP requirements by PhilHealth so their accreditation was suspended in At the time of data collection, Aleosan District Hospital was still complying with the MCP accreditation requirements while Arakan had started the MCP accreditation application process. The rest of the JPMNH municipalities had one MCP-accredited facility while District II in Quezon City already had two accredited facilities in 2013 and On integrating MISP-RH into local DRRM plans. In 2015, 90 members and service providers of the Provincial/Municipal Disaster Risk Reduction and Management Offices in North Cotabato, Sarangani, Sultan Kudarat had been trained on MISP Level 1 and basic knowledge and skills in providing SRH-related services during emergencies. In addition, 11 provincial and municipal local government units in North Cotabato (4) and Sarangani (7) had integrated MISP in their 2016 Annual Investment Plans for Health as a result of the MISP Level 2 Training provided. 38

40 F. Outcome 5: Institutionalized joint working approach to programme management and implementation Joint planning and implementation of JPMNH encouraged and facilitated professional and official linkages between National and Local government, the DOH, the UN, and the Australian Government. This made data sharing and coordination of efforts feasible and efficient. While JPMNH has officially closed, the DOH is currently drafting a document that would formalize and allow the same mechanism of joint operations between stakeholders to continue. JPMNH has also created a website that documents programme efforts since Phase 1, and makes electronic copies of generated knowledge products freely available. G. Unexpected Outcomes According to the Endline Study, JMPNH s unique and innovative trainings that promote service excellence proved valuable and insightful for the participating health workers. The comprehensive programme resulted in health workers in project sites reporting that they were able to appreciate the notion of looking at patients as customers, appreciating needs and demands; thus shifting their orientation of providing better service, as opposed to the past, where they looked at many patients as mere beneficiaries. This resulted in a client-friendly approach that was adopted in many health facilities in JPMNH sites, and where they noted that patients noticed better interactions with health workers. According to many respondents, this service-oriented approach resulted in a marked increase in the number of patients availing of MNCHN services during the past year, which many health workers found more challenging to cope with. This was also compounded by their claims that in the past year, the numerous training conducted under JPMNH caused a shortage in health service providers in the facilities since many of the staff had to attend training. Staff left behind found it difficult to cope with the increasing number of clients visiting the facility. Local ordinances prohibiting and even penalizing home births had also been observed in project sites. While these policies aimed to contribute to the increases in facility-based deliveries and reduction in maternal deaths, their actual effectiveness in adopting a punitive approach to encourage women to deliver in facilities has yet to be established. The JPMNH stands by the rights based approach to programming, and does not support any local policy that violates human rights. For some LGUs, the use of rchits improved the collection of real-time and accurate data, which in some instances led to the better reporting of vital events and therefore increased maternal mortality and neonatal death rates. This was a positive development in terms of improving surveillance and reporting efforts as issues of underreporting were being addressed. It did prove to be a cause for concern for the LGUs involved, however, as it exposed shortcomings in maternal and newborn care, and in previous data collection and reporting. 39

41 VI. EXPECTED LONG-TERM BENEFITS AND SUSTAINABILITY A. Expected Long-term Benefits The second phase of JPMNH was a concerted effort among UNFPA, UNICEF, WHO, and DFAT to support the Philippine government in attaining its targets for MDG 4 and 5 to reduce child and maternal deaths. JPMNH aimed to create impacts in reduction of maternal and newborn deaths through functional SDNs in its eight selected project sites and their corresponding provinces and regions. Programme focus was on improving quality, access, and utilization of intrapartum (IP), postpartum (PP), and family planning (FP) services. LGUs of the project sites were engaged in a consultative process in setting goals that would strengthen local health systems and complement the national government s conditional cash transfer (CCT) program. JPMNH strategies and interventions were designed to support project sites to achieve the following sub-outcomes that are expected, based on evidence, to contribute to the reduction of maternal and newborn deaths: (1) improved quality of facility based IP and PP care, (2) generation of increased demand for IP, PP, and FP services, (3) improved availability of quality FP services, and (4) strengthened health systems of JPMNH areas in support of IP, PP, and FP. In addition, the novel experience of joint programming led to the inclusion of a fifth suboutcome on (5) institutionalizing a joint working approach to programme management and implementation. Moving forward, the following benefits brought about by working towards these outcomes can be expected to continue in programme areas by the LGUs themselves as a result of the JPMNH. 1. Improved maternal health The Philippines has not met its MDG 5 target of reducing MMR to 52 per 100,000 livebirths. While there had been improvements, the MMR still remains high at 114 per 100,000 live births (World Health Organization, 2015), with the highest incidence of maternal deaths occurring during birth or within the first 24 hours after birth. This underscores the importance of skilled health personnel attending to deliveries, ideally in health facilities. JPMNH instituted measures to increase demand for IP and PP services in project sites. C4D interventions and materials based on communication research were utilized to improve health seeking behavior. Among NHTS poor families, demand generation was incorporated in the Family Development Sessions for CCT beneficiaries and other community health promotion activities. Well-planned, and wanted pregnancies and births led to better outcomes for both mothers and their children. An analysis conducted by the Johns Hopkins University showed that as much as 55% of maternal deaths in the Philippines could be averted by contraceptive use (Ahmed, Li, Liu, & Tsui, July 2012). This highlights the value of access to FP services. Community health workers at JPMNH sites were trained for demand generation for FP services. Besides adult women, JPMNH interventions also sought to engage adolescents and the partners of women of child-bearing age in order to raise awareness and change attitudes and behaviors towards family planning and reproductive health. JPMNH also worked to improve mechanisms for linking demand generation and service delivery for FP. In Quezon City, pregnant adolescents were targeted to seek early consultation through innovative communication interventions that were adopted by the city health office. 40

42 To adequately respond to an increased utilization of these services, JPMNH also addressed the supply side of quality services by facilities and their health personnel. Medical supplies and equipment provided to health facilities will sustain the upgrading of these to cater to safe birth and newborn care. Guided by policies and guidelines developed, and by global and national standards, health service providers were capacitated to provide more efficient, scientifically proven strategies and techniques of taking care of, and managing mothers, newborns and adolescents. Training and post-training evaluation, supervision and coaching of health service providers increased their ability and confidence to provide care and services for safer pregnancy, birthing practice, postnatal care and better assessment of clients, including their pre-pregnancy states. These changes are expected to contribute to increased confidence in the capability and quality of IP, PP, and FP services provided by public health facilities, and encourage greater utilization by families within their catchment areas. These will lead to planned births that are safely delivered by well-trained skilled birth attendants at well-equipped health facilities. Health personnel have been capacitated in the recognition, management, and appropriate and timely referral of pregnancies and deliveries with complications, reducing possible consequences of inappropriate management and late referrals. 2. Improved newborn outcomes National data show that while under-five mortality (28 per 1,000 live births) (United Nations Inter-agency Group for Child Mortality Estimation, 2015) has been markedly reduced in the Philippines, neonatal mortality (14 per 1,000 live births) (United Nations Inter-agency Group for Child Mortality Estimation, 2015) has not exhibited a proportional decline and now contributes about half of all under-five mortalities in the country. As with maternal deaths, the highest incidence of neonatal deaths occurs within the first 24 hours of life. The JPMNH aimed to decrease neonatal deaths through complementary mechanisms employed in addressing maternal mortality, such as capacitation of health facilities and health service providers, and advocating for skilled birth attendance and facility based delivery. Institution of Essential Intrapartum and Newborn Care (EINC) in health facilities in JPMNH sites also ensures a higher standard of evidence-based care for neonates and will impact not just on mortality rates, but also on other dimensions of health such as early and sustained breastfeeding that will in turn lead to improved nutritional status and well-being as newborns grow into their infancy and childhood years. Maintaining the quality of services offered at health facilities is crucial in sustaining demand for and adequate provision of health care. JPMNH support that ensures sustainability in this respect includes procurement and distribution of delivery sets, neonatal resuscitation kits, BEmONC manuals, EINC pocket guides, and MEC wheels. Health service providers have been capacitated on breastfeeding support and promotion through Lactation Management Training (LMT) and Mother Baby Friendly Hospital Initiative (MBFHI), among others. Health service providers are expected to keep their skills and knowledge updated through coaching, mentoring, and supportive supervision. These inputs are positioned to contribute to ensuring new health care staff to be provided with the appropriate training. To ensure this happens, DMOs and provincial health office staff were capacitated to manage and provide training beyond JPMNH life. Training on monitoring and evaluation, participatory localization of monitoring tools, incorporation of MNCHN initiatives in local health boards, and issuance of local ordinances and policies 41

43 institutionalizing the health system strengthening efforts done are seen as the mechanisms for sustaining changes. 3. Reaching adolescents An important population to reach is the adolescent age group. In the Philippines, 14.4% of all women aged years had already been pregnant at least once, which was a two-fold increase from just a decade prior (Research and Development Foundation, Inc., 2016). Besides an increasing percentage of adolescents becoming pregnant, special attention for adolescents is warranted due to vulnerabilities to poorer access to health care and FP services, and poorer outcomes for teenage pregnancies. Strategies employed by JPMNH to reach out to adolescents and improve access to adolescents regarding sexual and reproductive health information include peer education sessions, the Teens Writing for Teens Program, and an integrated community teen-trail, web and mobile phonebased youth communication platforms under the U4U program. These interventions take advantage of the younger generation s comfort with discussion of issues among peers, and with the use of more current modes of communication. Responsive, quality care for adolescents will see more consistent delivery through roll out of trainings on Competency-based Training on Adolescent Health Care and Management, Adolescent Health Education and Practical Training (ADEPT) e-learning course, and ASRH service delivery, as well as through compliance of health facilities with standards on adolescent friendly service delivery points. 4. Improved local health systems The current paradigm on improving health in a country with a devolved health system is through the development of local systems that deliver services which ensure good outcomes. Stakeholders in a health system are many and situated/positioned at varying levels. JPMNH sought to address multiple levels of the health system in improving service delivery in its project sites. Health leadership and governance were enhanced in JPMNH sites through the Health Leadership and Governance Programme (HLGP) that empowers local leaders to drive reforms that would improve local health systems and achieve better health outcomes. The programme has been implemented at different levels through the Provincial Leadership and Governance Programme (PLGP), the City Leadership and Governance Programme (CLGP) and the Municipal Leadership and Governance Programme (MLGP). Local chief executives and health teams who were capacitated under these programs are more proactive in working towards the prioritization and improvement of health outcomes in their respective localities. Coaching sessions on health management continue in areas covering but not limited to: Health Care Financing, Regulation, Governance, Human Resource, and Health Information Systems. In selected JPMNH site, the more proactive local chief executives have cascaded the methodology to the barangay level. Mechanisms have been placed in JPMNH sites to ensure continuous monitoring and evaluation of responsiveness and capability in delivering health services. These include the institutionalization of maternal death reviews (MDR) and the utilization of electronic health 42

44 information systems. DOH s Development Management Officers (DMO), and members of the Provincial Review Team (PRT) realize and better understand their roles and responsibilities in the MDR. Municipal Health Office (MHO) staffs have a greater appreciation of the method, strategy and principles behind the review versus the dissemination forum, and the importance of developing recommendations and intervention plans post-mdr. Through electronic health information systems, LGUs are able to strengthen vital registration through linkage of electronic reports to the local civil registry. SDNs are being improved to make health services more readily available and accessible for every family in JPMNH sites. These improvements come in the form of fully capable BEmONC and CEmONC facilities, guidelines and arrangements for coordinating referrals between facilities in a functional SDN, and functional health clustering of LGUs seeking to complement each other s health resources. Within LGUs, the chief executive and municipal/city health officer created referral networks for MNCHN at the barangay level, with attendant communication and transport networks, and inter-barangay governance structures which were institutionalized through Executive Orders and the creation of a Municipal Technical Working Committee and Interbarangay Health Cluster. In case of Quezon City, barangays in the District 2 SDN formulated their barangay ordinances in support of this. With the assistance and facilitation of JPMNH, programme sites are able to engage not only the public sector but also the private sector and civil society organizations in its efforts to provide more comprehensive services. Once fully developed, a functional SDN should be able to adequately provide IP, PP, and FP services for all its constituents. This will feed into the desired JPMNH outcomes of provision of timely quality services. Sexual and Reproductive Health have a special context in humanitarian situations. With the breakdown of health systems and social structures, pregnant women, lactating mothers, women of reproductive age, and adolescent boys and girls are faced with particular vulnerabilities that put them at higher risk for gender based violence and the consequences of poor access to SRH services. Through the JPMNH, LGUs were trained on the global standards for the Minimum Initial Service Package (MISP) for SRH in emergencies, making them more equipped to provide quality SRH services even in humanitarian emergencies. In order to sustain these mechanisms, LGUs have been capacitated to have MISP integrated in their Local Disaster Response and Management Plans. On a national level, JPMNH has provided technical assistance in crafting comprehensive and responsive policies for improved IP, PP, and FP services. These include policies on the Minimum Initial Service Package for Reproductive Health, Integrated Policies for Essential Maternal and Newborn Care and Mother-Baby Friendly Health Facility Initiative, and Quality Care for Low Birth Weight and Preterm Babies. JPMNH also participated in key national health policy technical working groups such as the National Implementation Team of the RPRH Law, the Technical Working Group on the Every Newborn Action Plan, and the Technical Working Group on Service Delivery Networks under the Bureau of Local Health Systems Development. Three policy papers on reaching every mother and newborn, on improving the quality of care for mothers and newborns, and on adolescents and facility-based deliveries, were submitted to the Department of Health and adopted by the UN agencies under its UN Development Assistance Framework as an output of the JPMNH. JPMNH demonstrated a working model of a joint programme co-chaired by the DOH. Serendipitously, the programme was chaired at the time by Assistant Secretary Dr. Paulyn Jean Rossell-Ubial, who was appointed as Secretary of Health of the current administration in June 2016, just as the JPMNH ended. The Secretary of Health is familiar with the strategies applied, 43

45 gains achieved, and lessons learned through JPMNH. This recognition of value of the work JPMNH has done can be a vehicle towards ensuring the sustainability of JPMNH interventions through incorporation into national policy and standards. B. Risks to Achieving Benefits, and Ensuring Sustainability The following risks to envisioned benefits have been identified and must be managed and appropriately addressed to ensure sustainability of JPMNH gains: 1. Maintaining quality care in service delivery networks A functional SDN is what ensures access of all families in a given locality to quality IP, PP, and FP services. A possible risk post-jpmnh is the failure to improve on, or the deterioration of gains in establishing SDNs capable of providing quality services. Quality of care may suffer if health service providers fall back or stick to their obsolete, inappropriate practices in caring for and managing mothers and children. Facilities and equipment can become outdated and worn down if appropriate investments are not made for their maintenance. Human resource problems could arise from the reassignment, retirement, or resignation of health service providers before they are able to cascade knowledge and capacities they have gained through JPMNH. Agreements among stakeholders may no longer be enforced if commitments are not honored or renewed. To prevent these from occurring, JPMNH sites must continue to make necessary investments in health, including maximizing the resources that can be availed from PhilHealth. Regions must have fully capacitated training institutions and sustain mechanisms for Mentoring, Coaching, and Supportive Supervision, and Post Training Evaluation. Project sites should enter into agreements between LGUs and regional offices to sustain the changes put in place by JMPNH initiatives. JPMNH sites should explore the expansion of SDNs to cater not only to MNCHN, but to other health services as well. Mechanisms to stimulate the creation and financing of service delivery networks should be explored. Monitoring and evaluation also play roles in sustaining efforts in maintaining quality services in SDNs. Changes put in place by JPMNH initiatives should be actively reassessed and fine-tuned by all stakeholders so that they continue to be responsive to the needs of the project sites. Ideally, LGU, Provincial, and Regional offices should take this on, with some support from development partners if needed. Many JPMNH indicators are already incorporated into regular monitoring systems (e.g. maternal and newborn deaths, facility-based delivery, FP services, etc.), but other crucial data have yet to be included (e.g. adolescent pregnancies and deliveries, etc.). In order to provide quality services in SDNs, quality data must also be readily available in and utilized by communities. 2. Political support The political will and support of local chief executives in JPMNH sites have contributed much to their achievements. Much was invested in their capacitation and in their involvement in each step from planning interventions to implementation, and monitoring and evaluation. A change in leadership entails a risk of losing political support and losing the gains made through these investments. Support for JPMNH initiatives must be institutionalized programmatically at 44

46 various levels, with the concomitant accountability mechanisms in order to ensure continued implementation of its established programs that will transcend the term of a local chief executive. 3. Temporary Restraining Order on subdermal implants In a Supreme Court (SC) resolution dated June 17, 2015, a temporary restraining order (TRO) was issued against the procurement, sale, distribution, dispensing, administration, advertisement, and promotion of progestin subdermal implants (PSI) by the Department of Health. In the same resolution, the Food and Drug Administration (FDA) was also prohibited from granting approval to all applications for reproductive products and supplies. While the TRO only currently affects services for PSIs, it will have an impact on services for all modern artificial family planning methods as the needed commodities will eventually need renewal of applications if the TRO will remain in effect. Proactive measures must be taken at the national level to address the current and potential repercussions of this TRO. 4. Large scale humanitarian emergencies Crises on a large scale such as natural calamities and armed conflict have the potential to overwhelm the capacity of LGUs to respond to them. The Department of Health, with technical assistance from JPMNH, developed the policy on MISP-RH to ensure basic RH services in the event of such occurrences. JPMNH sites and other LGUs must take measures to adopt and incorporate the outlined strategies in their local disaster management plans to ensure continued provision of services. VII. OVERALL ASSESSMENT A. Relevance The second phase of JPMNH sought to support country efforts in reducing maternal and neonatal deaths to meet MDG commitments. At the commencement of the programme, the Philippines was still unable to meet the desired reduction of maternal deaths, and neonatal deaths comprised about half the proportion of under-five mortalities. The programme aimed to improve access to and quality of IP, PP, and FP services, and also to increase demand for these services. Although CCT families were specifically targeted, strategies and interventions addressed the SDNs where these families were found. The benefits gained through JPMNH were thus expected and intended to extend to non-cct families found within the same health systems. JPMNH was designed to align with the thrusts of the Philippine Development Plan (PDP) for Policies for health outlined in the PDP focused on protection from the financial burdens of health care, improvement of access to quality health care, and attaining health-related MDGs. Specific tools identified in delivering these included health financing, service delivery structures, capable health human resources, development of health standards and regulations, good governance in health, and modern health information systems. 45

47 The JPMNH was also aligned to the UN Development Assistance Framework (UNDAF) Outcome Area 1 of achieving universal access to quality social services, with focus on attaining MDGs. JPMNH also sought to deliver as one by integrating the resources of three UN agencies in support of a common goal. Programme objectives were aligned with the Australia-Philippines Development Cooperation Programme for , which aimed to strengthen basic services for the poor through improved local government delivery of these services. JPMNH took into account DFAT s Comprehensive Aid Policy Framework (CAPF) which, at the time of JPMNH s inception, had goals to provide equitable access to basic health care for all, with specific focus on reducing maternal and child mortality. Through its interventions, JPMNH contributed to DFAT s crosscutting policy objectives to impact on gender, child protection, and disaster reduction. Envisioned direct and indirect programme outcomes were hence as follows: 1. Reduction of maternal and neonatal mortality; 2. Improved governance of health services at both local and national levels; 3. Improved delivery of essential health services; and 4. Poverty reduction by improving the economic prospects of children through increased rates of survival and reduced morbidity The second phase of JPMNH was further designed to build on evidence and experience gained from the prior phase. Phase 2 carried lessons learned in increasing access to health services, strengthening family planning, addressing health system constraints, and organizational management arrangements when working among a group of donors and partners. B. Appropriateness of Objective and Design If gains from the first phase of JPMNH were to be maximized, investments and support had to be continued in Phase 2. To ensure maximized impact of investment, JPMNH fine-tuned its strategies to take into account geographic and technical focus of the involved agencies, and to clarify exit strategy and sustainability mechanisms. The programme worked within existing country systems and took into account the devolved nature of health governance in the Philippines. National leadership was taken on by DOH so as to promote ownership and ensure policy relevance. JPMNH also engaged LGUs in a participative and consultative process in setting final programme targets. Targets were thus developed based on evaluability assessments, situational analyses, lessons learned from the previous phase of JPMNH, and strategic planning workshops with all stakeholders. This process ensured that defined targets were SMART (Specific, Measurable, Attainable, Realistic, Timebound) and that stakeholders were committed to achieving these. The programme was aligned specifically with the DOH s Maternal, Newborn, and Child Health and Nutrition (MNCHN) strategy, which emphasizes the delivery of core-packages of interventions for specific life stages through health service providers in a SDN. Targets complemented CCT programme efforts by increasing the quality of IP, PP, and FP services, as well as CCT interventions that bring families to service providers. JPMNH work plans were then drafted and budgeted based on consultation with DOH and LGU partners. These were developed on a yearly basis in order to be sensitive to arising needs, and to generate results specific to programme goals. 46

48 Convergence areas that enabled all three agencies to work together were selected as project sites. These included 4 th and 5 th class municipalities with either a high proportion or absolute number of CCT beneficiaries, or which had geographically isolated and disadvantaged areas (GIDA). These sites were also found within identified vulnerable provinces which had skilled birth attendance coverages of less than 50%. Community stakeholders and beneficiaries all contributed to the development, initiation, and implementation of solutions. This inculcated the recognition of their responsibilities in claiming their rights to health and challenging health providers to give quality services. JPMNH, at the inception of Phase 2, developed a risk register that outlined risks by each outcome with strategies to mitigate their possible effects. This enabled the programme to address arising risks adequately. C. Implementation Issues 1. Contextual Issues 1.1 Establishing baseline data The programme had planned to conduct a baseline study that would determine the state of maternal and neonatal health status and health services in the selected partner sites. Data generated would feed into the process of establishing targets and developing appropriate interventions to address priority issues. The firm contracted for this study, however, encountered several obstacles. The baseline study team found that the number of health facilities to be surveyed to cover the SDNs was more extensive than anticipated. The sampling frame for the survey, contrary to expectations, was not readily available in LGUs and RHUs. Field Health Service Information Systems (FHSIS) forms were meant to be the primary source of administrative data. The baseline study team, however, came to realize that not all LGUs used the same FHSIS forms nor followed the same standards in accomplishing these. The same was found to be true of the target client lists which were meant to keep track of patients seen at health facilities. These prompted consultation meetings with the involved PHOs and DOH FHSIS coordinator. All these taken together created significant delays for the completion of the baseline study. Targets and strategies were thus based on the best available data at the beginning of Phase 2. These consisted of data gathered from Phase 1 and previously conducted studies and activities, as well as data made available by project sites to JPMNH. The monitoring visits and annual programme reports served as assessment points for appropriateness of strategies and need for adjustments. 1.2 Changes in DOH Leadership Early in 2015, a new Secretary of Health was officially appointed. This inevitably led to changes in middle management leadership. DOH prioritization of the service delivery network approach was retained although variances in the operationalization were noted in later issuances. Specific focus was given to the implementation of the High Impact (Hi-5) Breakthrough Program. These created challenges in implementation, and a need to orient and engage new health officials regarding the objectives and initiatives of JPMNH. 47

49 1.3 Temporary Restraining Order on Subdermal Implants Since the passage of the RPRH Law, continued vigilance has been the rule, given continued opposition from anti-rh groups and numerous petitions for temporary restraining orders (TRO) for various aspects of implementation. As a result of JPMNH investments in the use of subdermal implants, the DOH used its own funds to purchase about 1.37 million units amounting to PHP 685,000,000 in 2014 and In a two-page resolution dated June 17, 2015, however, the Supreme Court issued a temporary restraining order prohibiting the DOH from "procuring, selling, distributing, dispensing or administering, advertising and promoting the hormonal contraceptive 'Implanon' and 'Implanon NXT.'" It also prohibited the FDA from "granting any and all pending application for reproductive products and supplies, including contraceptive drugs and devices," extending effects to FP commodities beyond subdermal implants. This TRO also hindered the full implementation of PhilHealth Circular on benefit package for long-acting and permanent methods (LAPM), particularly the use of sub-dermal implants. Likewise, the PHP 1 billion budget cut by the senate for the DOH's procurement of contraceptives posed a major issue and challenge. 1.4 Peace and Order Similar with the first phase of JPMNH, peace and order remained to be an issue in certain project sites. Arising safety and security concerns hampered project activities. This was among the anticipated risks, however, and implementation of programme activities were carried out as soon as safety and security conditions allowed. 2. Governance and Management Arrangements 2.1 Procurement Process With a JPMNH project officer in each UN agency, there was greater focus and dedication for JPMNH project implementation. Compared to the initial arrangements in Phase 1, the joint administration of Phase 2 through the UNCO was better coordinated and more efficient. Delays in procurement processes were still encountered, however, and this contributed to the delays in commencement of the JPMNH baseline and endline studies. 3. Stakeholder Participation 3.1 Local Health Boards Not all local health boards were fully functional or meeting on a regular basis. Development Management Officers (DMO) from DOH Regional Offices were engaged to provide technical assistance to LGUs in establishing and maintaining the functionality of local health boards. 48

50 4. Technical assistance and approach to capacity development 4.1 rchits Connectivity The Real-time Community Health Information Tracking System (rchits) was utilized as the main health information and tracking system in JPMNH sites. Integrating rchits, however, required investments in equipment and connectivity that were beyond the scope of project efforts. Efforts were made to lobby with LGUs to allocate budgets for initial investments in equipment, as well as upkeep for cellphone load, maintenance of hardware, and change of computers every three years. Interoperability with the other DOH health information systems remains to be a future goal that requires national leadership. In the meantime, JPMNH input was crucial in the DOH-led discussions on interoperability standards. D. Monitoring and Evaluation Overall, the M&E system of the programme generated useful data to support effective implementation of the different components and activities. More significantly, the M&E system for JPMNH Phase 2 was able to surmount the M&E challenges experienced in Phase 1 by: Crafting a unified M&E plan, results framework, and indicator matrix agreed upon by the three UN agencies; Setting aside specific resources (7% of the total Programme budget) for activities included in the unified M&E plan; Engaging an M&E specialist dedicated to JPMNH which contributed to consolidating and harmonizing what could otherwise be inconsistent and incoherent reporting among the three UN implementing agencies; Being specific about and properly defining and measuring indicators for outputs the programme is expected to deliver, the outcomes it is supposed to achieve, and the impact it is expected to contribute to; Ensuring that all components of JPMNH are included in the monitoring framework, particularly in the way output indicators were developed to reflect results expected from the actual range of inputs and investments that the programme is making; and Setting, in a consultative and participatory manner together with regional and local government partners, targets and milestones for overall programme monitoring which were subsequently reflected/fleshed out in individual agency annual work plans. The M&E system is robust given its mix of quantitative and qualitative monitoring indicators that address both service availability/coverage and quality of service provision. For instance, using good practices from international and local experiences as basis, functionality criteria and indicators were defined by JPMNH to determine whether a service delivery network, an adolescent sexual and reproductive health service delivery point, or a disaster risk reduction and management plan that incorporates the minimum initial service package for RH are actually functioning or being implemented as envisioned. With these functionality indicators, JPMNH moved beyond merely counting how many of these SDNs and service delivery points have been established or organized in the sites. Through the regular PIRs convened to bring together the regional and local government partners, the Department of Health (DOH) National Office and the three UN agencies, participated by DFAT, monitoring data generated by the system were presented, validated, and 49

51 analyzed to resolve policy and implementation bottlenecks. The PIR enabled agreements to be made on remaining activities and reprogramming of resources to maximize fund utilization. Joint Monitoring Missions composed of high-level and technical staff from the National DOH, the three UN agencies, and DFAT were also regularly conducted. Findings and recommendations from these Joint Monitoring Missions were clearly documented in comprehensive aide memoires and were discussed as main agenda in the PIRs and the Programme Steering Committee meetings. E. Gender The development of the JPMNH programme objectives was integrally focused on the health of mothers and newborns. Gender and culture perspectives were constantly considered in all project interventions and activities. The JPMNH design also sought to respond to issues on adolescent reproductive health needs. In recognition of the shared responsibilities of both women and men in ensuring reproductive, maternal, and neonatal health, male involvement was included throughout programme implementation and assessment. In the course of implementation of JPMNH, a Gender Mainstreaming Workshop was conducted for all of its implementing partners to ensure that planned activities benefit from a gender lens and become more responsive to gender issues. Each of the implementing agencies utilized the Harmonized Gender and Development Guidelines being used by the Philippine Commission on Women (PCW) and the National Economic and Development Authority (NEDA), to assess their current work plans and work on improving them to become more gender responsive. Communication research on community behaviors related to maternal and newborn health identified key issues faced by men and women in accessing reproductive, maternal, and neonatal services. Male partners were found to mainly provide monetary support and help in doing chores while female relatives contributed advice regarding practices in pregnancy and child care. JPMNH developed strategic and context-specific communication interventions to expand their reach to include these support groups (husbands, in-laws, mothers of pregnant women). JPMNH also sought to strengthen national and local government capacity to deliver RH information and services to communities. In support of this, the programme engaged in advocacy and policy dialogue for budget allocation for FP interventions and commodities. As a result, a broad array of modern contraceptive methods has been made available nationally and at JPMNH sites (United Nations Philippines, May 2016). Another goal of JPMNH was to build the capacities of service providers in delivering consistent SRH services to men and women even during disasters. Programme efforts led to the development of the DOH AO on MISP-RH and its integration into the Annual Investment Plans and Disaster Risk Reduction and Management plans of JPMNH sites. JPMNH also supported the development and use of a Manual for Standard RH Services in Emergencies (e.g. How to conduct RH medical missions, Core Messages for RH and GBV in Emergencies) in MISP trainings to aid in the capacitation of local health workers. 50

52 VIII. LESSONS LEARNED AND RECOMMENDATIONS A. Improving Health Systems There is an important mix of stakeholders that goes beyond the health sector that needs to be sufficiently engaged in order to effect change in local health systems. Government must be able to collaborate and coordinate among city/municipal, provincial, regional, and national levels, as well as with the private sector, civil society, and development partners in order to avoid duplication of interventions, and to create harmonized approaches to improving access to quality health care. The JPMNH modeling of the SDN surfaced the need for harmonized regulatory, monitoring, and supportive supervision mechanisms. It also demonstrated, however, that when local political will is harnessed to prioritize health issues, MCH goals can be achieved. Local health system elements need to be strengthened both at the ground level through local chief executives, but also at the national level through strong/firm leadership on key policies and standards on components such as health human resource and health information systems. JPMNH was strategically placed, being able to transmit experiences in local SDN building to the national policy-making level. Continuation of this advantage is facilitated by the relationships built through the JPMNH governance structure where DOH co-chaired the PSC and UN agencies worked closely with LGUs. Development and dissemination of key knowledge management products and process documentation are vital to bringing the lessons learned from JPMNH to the current administration. Continued advocacy for active legal agenda remains. These include the temporary restraining order on subdermal implants, and the RPRH Law provision requiring parental consent of adolescents to access contraception, among others. At the provincial level, there is a recognized need for improvement in the conduct of maternal death reviews. Cited areas for improvement include regularity of conduct, coordination of scheduled reviews, distinction and separate conduct of the death review and dissemination forum, documentation of proceedings and recommendations, and dissemination and monitoring of implementation of post-review recommendations, as well as the impact of the review on maternal health as a whole. B. Improving Service Delivery Networks Referrals from lower level to higher level facilities in JPMNH sites have improved. Much work has been done in determining partnerships, procedures, and protocols between LGUs and referral hospitals. Stronger partnerships within barangay councils that provide communications and transportation for patients to health facilities have also contributed to the improvement. An important aspect that needs further attention, however, is the feedback mechanism between health facilities. Many referral facilities still do not communicate the new health information and dispositions of referred patients back to the referring facilities. Also crucial in sustaining and improving SDNs is ensuring that these SDNs have functional CEmONC-capable referral hospitals. LGUs have a critical role in making investments to upgrade and maintain provincial and district level hospitals that are able to adequately provide CEmONC services. DOH should also support such efforts by augmenting LGU funds. 51

53 It is important to recognize that SDNs will not always be contained within geo-political boundaries such as municipalities, provinces, or regions. They may even extend between provinces and regions if health services are more appropriately delivered through closer facilities in a neighboring province or region. Strategies must be developed to realize adequate provisions and arrangements for such cases. The oversight and governance of SDNs need to be clarified, especially when these arrangements cross geo-political boundaries. The incentive to create the SDNs and the financial support to run them also need to be looked into. DOH and LGUs need to work together to expand the SDNs beyond those of MNCH. Expanding coverage to other health issues will increase an SDN s utility, relevance, and resources in its local context. C. Leadership in Health Engagement and active participation of local leaders are essential. The HLGP provided LGU leaders and officials a much better awareness and understanding of maternal, child, adolescent and reproductive health issues and needs. Well informed, highly aware leadership generates investments and plays an indispensable role in the improvement and sustainability of MNCHN services in JPMNH sites. Institutionalization of training like HLGP would contribute much to sustaining LGU support for MNCHN endeavors. JPMNH took advantage of the agreement signed between the DOH and the Zuellig Family Foundation (ZFF) to capacitate the regional levels in HLGP to sustain the coaching of project site mayors. This will be entrusted to the DOH ROs through mentoring and oversight of LGUs by the DMOs. In relation to this, DMOs will also need to be fully engaged and capacitated as they are also tasked to monitor and supervise technical programs in addition to health governance. D. Capacity Building Developing the competencies of health care providers is a crucial building block in providing quality IP, PP and FP services. Well trained HCPs are more competent, confident, proactive, and responsive in performing their duties. In addition to improving competencies, HCPs in JPMNH sites also cited the value of training on service quality and excellence. These led to better customer service, better awareness of how HCPs related to their patients, and ultimately, to greater demand and utilization of health services. For all the benefits provided by training, however, there are still short-comings. HCPs have noted that with the volume of trainings that have to be attended, they sometimes found themselves with less time to actually provide services to their patients. Communities also sought better capacitation of barangay health workers (BHW) who are situated closest to the clients of the public health system. Training programs that will address this need for capacity building of BHWs should be developed. To build on the capacitation of HCPs and sustain gains made in making quality care accessible, continuous education and provision of logistical support in terms of equipment and commodities must be considered. SDN enhancements such as provision of equipment for upgrading of primary health facilities, improvement of the quality of services at the secondary and tertiary levels (e.g. EINC), PhilHealth accreditation of health facilities, and establishment of 52

54 community volunteer groups or CHTs should be sustained. HCP career development and motivation must also be supported. E. Generating Demand Community participation must be fully engaged and enjoined by health care institutions in order to generate and sustain demand for IP, PP, and FP services. Client-centered and culturallysensitive health facilities and health care providers will contribute greatly to increasing demand for these health services. Strategies to improve health seeking behavior, especially among the indigenous people and the poor, need to be supported and scaled up. Social marketing, promotion and advocacy initiatives need to be strengthened further, if mistaken perceptions and beliefs of people on reproductive, maternal, and newborn health are to be changed. F. Sexual and Reproductive Health Issues Collection and analysis of reliable, accurate and timely data on adolescent birth rates remain to be issues since WRA and MCH data are not disaggregated into separate adolescent and adult groups, but are lumped in as a year old group. An immediate way forward is to sustain the advocacy with the DOH to integrate the monitoring and reporting of adolescent births in the regular FHSIS forms that LGUs fill up and submit to DOH. The same issue and recommendation for the indicator on adolescent births hold true for and are applicable to the indicator on how much each LGU allocates for its family planning programs and its procurement of family planning commodities/supplies. According to the Endline Study, while the LGUs allot a budget for health including FP, this usually covers several items and does not specify for purchase of FP commodities only. SHPs interviewed pointed out that their FP commodities were mostly procured by DOH and additional support provided by the provincial/city government. The LGUs will only purchase FP commodities as the need arises such that they cannot exactly determine their specific budget for FP commodities. G. Health Information Systems The utilization of rchits at JPMNH sites has contributed to improvements in data collection and reporting. Much investment is required, however, in ensuring connectivity, and sustaining availability of adequately functional hardware and software for its continued implementation. There is also an issue of transmitting data to provincial and regional offices. In the experience of some sites, higher offices are unable to receive electronic reports due to technical, administrative, or other issues. This results in having to translate already encoded data into formats that the higher offices accept (e.g. written reports), diminishing or even negating efficiency benefits that rchits can provide. At the local level, data that are accurate, timely, and consistently collected and reported create an evidence base that can be used to make better decisions and plans for health. Local leaders and health workers need to appreciate and develop skills on health information literacy in order to maximize the benefits of establishing a health information system. Provincial and regional offices must also conduct regular monitoring and evaluation of health programs and provide feedback 53

55 so health workers can further improve their performance and appreciate how data is used for policy formulation and decision-making. National standards must be developed for electronic health systems and their interoperability. These standards will feed into the creation of an interoperability layer within the reporting system which will facilitate accurate and timely reporting of health data regardless of the platform being utilized by different LGUs. H. Joint Operations The joint approach of JPMNH facilitated the exchange of information and synergized the organizational strengths of the three UN agencies and simplified coordination with key partners, in particular the DOH and the Australian government. The advantages of the joint approach extended to aspects of programme implementation. Lower level LGUs on the ground were supported and capacitated by UNICEF. These LGUs benefited from the oversight and monitoring of provincial and regional offices, which in turn were supported and capacitated by UNFPA and WHO, respectively. This joint coordination led to trust, collegiality, and a willingness for collaboration among all stakeholders. The UN agencies in partnership with DOH must continue monitoring and documenting continued implementation and sustenance of JPMNH initiatives. The PSC arrangement for JPMNH should be maintained as the high level coordinating and policy development unit for all UN and DOH collaborations, and for other development partners in the sector, too. IX. HANDOVER AND EXIT ARRANGEMENTS A. Turnover to JPMNH Sites Turnover ceremonies and sustainability fora for JPMNH sites were conducted in Davao City on June 16, 2016, and in Quezon City on June 23, All stakeholders and development and implementing partners were represented. JPMNH milestones were revisited and knowledge products generated through JPMNH were presented and turned over to the Department of Health and the respective regions, provinces, cities, and municipalities of the JPMNH sites. Tables on the subsequent pages indicate the personnel involved with JPMNH, as well as programme interventions that are expected to be continued and sustained, and those responsible for their continuation. 54

56 Table 15: People Involved in the Programme UN Agencies Name of Person Type of Employee Role Time Engaged Contact Details Jose Roi Avena UNFPA M&E Adviser 2013 to December 2016 Klaus Beck UNFPA Country Representative January 2014 to December 2016 Dyezebel Dado UNFPA Area Programme Officer for SK, Sarangani and North 2015 to December 2016 Cotabato Ugochi Daniels UNFPA Country Representative November 2014 to August 2014 Rena Dona UNFPA Assistant Representative 2013 to December 2016 Ahmad Hairon UNFPA Driver for SK, Sarangani and North Cotabato 2013 to December 2016 Arnan Kasan UNFPA Area Programme Officer for SK and Sarangani 2013 to 2014 Ivy Lecitona UNFPA Programme Assistant 2013 to December 2016 Mary Ann Obidos UNFPA Admin and Finance Assistant for SK, Sarangani and 2013 to December 2016 North Cotabato Joseph Michael Singh UNFPA National Programme Officer - RH 2013 to December 2016 jsingh@unfpa.org Angelito Umali UNFPA Maternal Health Adviser 2013 to December 2016 umali@unfpa.org Ronnel Villas UNFPA Humanitarian Coordinator, Tacloban 2013 to 2014 villas@unfpa.org Maridith Afuang UNICEF Health Specialist March 2014 to December 2016 mafuang@unicef.org maridithafuang@yahoo.com Abdul Alim UNICEF Deputy Representative 2013 to 2014 aabdul@unicef.org Mario Balibago UNICEF Adolescent Health November 2015 to December Rosalia Bataclan UNICEF Health & Nutrition Specialist January 2015 to December 2016 rbataclan@unicef.org Mariella Castillo UNICEF Health Specialist 2013 to December 2016 mscastillo@unicef.org Tomoo Hozumi UNICEF Country Representative April 2012 to January 2014 thozumi@unicef.org Rossan Lovendino UNICEF Administrative Assistant 2013 to December 2016 rmlovendino@unicef.org Carla Orozco UNICEF Health Specialist 2013 to December 2016 corozco@unicef.org Kathleen Solis UNICEF Communication for Development Specialist 2013 to December 2016 ksolis@unicef.org Lotta Sylwander UNICEF Country Representative April 2014 to December 2016 lsylwander@unicef.org Emmie Valdehuesa UNICEF Adolescent Health January 2015 to September

57 Name of Person Type of Employee Role Time Engaged Contact Details Willibald Zeck UNICEF Section Chief, Health & Nutrition 2013 to December Jocelyn Alcoreza UN-JPMNH Project Assistant for Policy Development May 2016 to July 2016 Kiarah Louise Florendo UN-JPMNH Programme Coordinator for Closeout October 2016 to March 2017 Odilyn Lazaro UN-JPMNH M&E Specialist October 2015 to June 2016 Arvi Miguel UN-JPMNH Programme Coordinator 2013 to June 2014 Mark Benjamin Quiazon UN-JPMNH Consultant for Project Closeout and Documentation July 2016 to December 2016 Nino Rocamora UN-JPMNH Programme Coordinator July 2014 to September 2016 Carmina Sarmiento UN-JPMNH M&E Specialist 2013 to October 2015 Ola Almgren UNRC Resident Coordinator June 2015 to December 2016 Luisa Carvalho UNRC Resident Coordinator 2012 to Terrence Jones UNRC Resident Coordinator a.i to 2015 Garibaldi Enriquez WHO Technical Coordinator for RUP 2013 to 2014 Lenny Fernanez WHO Programme Assistant for JPMNH 2010 to 2015 John Julliard Go WHO Technical Officer for RUP 2013 to 2014 Julie Lyn Hall WHO Country Representative 2013 to 2014 Johanna Hinnolan WHO SSA for JPMNH June 2015 to December 2015 Jacqueline F. Kitong WHO Technical Officer for MCN October 2012 to June 2016 Benjamin Lane WHO Team Leader - Health Systems Recovery 2013 to January 2017 laneb@who.int Lucille Nievera WHO Technical Officer for Health Systems 2013 to 2014 Nieveral@wpro.who.int Soe Nyunt-U WHO Country Representative September 2009 to December nyuntus@who.int 2012 Michelle Ortega WHO WHO-JPMNH Field Coordinator for Region XII June 2015 to June 2016 michelle050885ortega@gmail.com Riah Romero WHO Programme Assistant for JPMNH June 2015 to June 2016 romeror@who.int Howard Sobel WHO Country Representative 2009 to 2011 sobelh@who.int Florence Tienzo WHO Programme Management Officer 2013 to 2014 tienzof@wpro.who.int Technical Officer Gundo Aurel Weiler WHO Country Representative March 2016 to December 2016 weilerg@who.int 56

58 Table 16: People Involved in the Programme Government Counterparts: Department of Health Name of Person Type of Employee Role Time Engaged Contact Details Ma. Soledad Antonio Central Office Division Chief, Bureau of International Health Cooperation Irma Asuncion Central Office Director IV, National Center for Disease Prevention & Control 2013 to , local , local 1700, 1701, 1705, to , local 1729/1730, 1338 Mar Wynn Bello Central Office Supervising Health Programme Officer, Bureau of International Health Cooperation Maylene Beltran Central Office Director IV, Bureau of International Health 2013 to June , local 1301, 1338 Cooperation Anthony Calibo Central Office Child Health Coordinator 2013 to June Honorata Catibog Central Office Director III, Family Health Office, National Center for Disease Prevention & Control Diego Danila Central Office MS III/ Health Programme Officer, Family Health Office, National Center for Disease Prevention & Control Joyce Ducusin Central Office OIC-Director Family Health Office, National Center for Disease Prevention & Control Fatima Emban Central Office JPMNH Regional Focal Point; training officer and monitor Cynthia Fernandez-Tan Central Office Chief training officer, monitor and supervisor for Basic Emergency Obstetric and Neonatal Care (BEmONC) Janette Loreto Garin Central Office Acting Secretary of Health 2013 to July , local 1726, 1730, 1728, to June , local 1730 January 2015 to June 2016 June 2014 to June 2016 June 2014 to June , local 1105 JPMNH Project Steering Committee Chair, Undersecretary of Health; Women, Children and Family Health Cluster, DOH Teresita Guzman Central Office Chief Health Programme Officer, Bureau of Local Health Development Junice Melgar Central Office OIC-Director, Family Health Office, National Center for Disease Prevention & Control to , local 1308, 1309 January 2016 to June

59 Name of Person Type of Employee Role Time Engaged Contact Details Jonathan Monis Central Office Senior Health Programme Officer, Bureau of International Health Cooperation Dax Nofuente Central Office SDN Point person, Bureau of Local Health Systems Development 2013 to June local 1339 January 2015 to Dec to December Rosalie Paje Central Office MO VII/ Chief, Family Health Office, Disease Prevention & Control Bureau , local 1729 Zenaida Recidoro Central Office Safe Motherhood Coordinator, Family Health Office, 2013 to June 2016 Disease Prevention and Control Bureau Kenneth Remollo Central Office Administrative Assistant 2013 to June Paulyn Jean Rosell- Central Office Assistant Secretary of Health 2013 to June , local 1105 Ubial Linda Uy Central Office Technical Officer Office of Asec. Busuego 2013 to local 1130, 1131 Minerva Vinluan Central Office Adolescent Health Coordinator 2013 to June Wency Blas NCR RO DMO IV, Quezon City June 2015 to December Reinhard Dalumpines NCR RO Head, Family Health Cluster 2013 to June Jaya Ebuen NCR RO DMO IV January 2016 to June Eduardo Janairo NCR RO Director IV July 2014 to December 2015 Armand Lee NCR RO DMO V January 2015 to December 2015 medlee1us@gmail.com Ariel Valencia NCR RO Director IV January 2015 to June 2016 aievalencia@yahoo.com Teogenes Baluma Regional Office XII Director IV 2013 to November 2015 tfbaluma@yahoo.com Fatima Emban Regional Office XII Family Health Cluster/MNCHN Coordinator 2013 to June 2016 fatts.emban@yahoo.com.ph Rona B. Gelvoleo Regional Office XII DMO Pres Roxas, Arakan January 2015 to June 2016 rona_gelvoleo73@yahoo.com Marelyn Q. Gonzales Regional Office XII DMO Midsayap January 2015 to June 2016 elyngonzales@yahoo.com 58

60 Name of Person Type of Employee Role Time Engaged Contact Details Francisco Mateo Regional Office XII Director III; OIC- Director IV 2013 to June 2016 Overall overseer of the JPMNH in Region XII January 2015 to June 2016 Nelson L. Mendoza Regional Office XII DMO Aleosan January 2015 to June Agnes Panton Regional Office XII Family Health Cluster/ASRH Coordinator June 205 to June 2016 Bernadette Patrona Regional Office XII January 2015 to June Joy Tiu Regional Office XII FP Coordinator/MNCHN Coordinator January 2016 to June Helen B. de Peralta Regional Office XII Cotabato Regional Medical Center January 2015 June 2016 Yambao Rosalina Yparraguirre Regional Office XII National Immunization Programme (NIP) January 2015 to June Coordinator Angeles de Leon DOH Director - Quirino Memorial Medical Center 2013 to January Ma. Lourdes S. Imperial DOH Chief training officer, monitor and supervisor for June 2014 to June 2016 pinkysi2@gmail.com Essential Intraprtum and Newborn Care (EINC) Dr. Jose Fabella Memorial Hospital Zoraida Macao- DOH OB-Gyne Consultant East Avenue Medical Center January 2015 to June Fernandez Evelyn Victoria E. DOH Director Quirino Memorial Medical Center 2013 to January Reside Bella Vitangcol DOH Training Officer 2013 to January 2015 bpvitangcolmd@yahoo.com

61 Table 17: People Involved in the Programme Government Counterparts: Provincial Governments Name of Person Type of Employee Role Time Engaged Contact Details Marie Jane Apusaga North Cotabato Medical Officer - Cotabato Provincial Hospital July 2015 to July Najie Gatchalian North Cotabato HIS North Cotabato, Provincial Health Office January 2015 to June Ely M. Nebrija North Cotabato MNCHN Coordinator, Provincial Health Office July 2014 to June 2016 elleneb11@gmail.com Eva Rabaya North Cotabato OIC-Provincial Health Officer November 2014 to June 2016 evarabayamd@yahoo.com Lilian A. Roldan North Cotabato Chief of Hospital, Cotabato Provincial Hospital January 2015 to June Emmylou Talino- Mendoza North Cotabato Governor 2013 to June Arvin Alejandro Sarangani Provincial Health Officer March 2014 to June 2016 rvin_09@ymail.com Razel Bautista Sarangani MNCHN Coordinator 2013 to June 2016 brazerael@yahoo.com Allen Geofrey Espanola Sarangani Medical Officer Malungon Hospital 2013 to June Lily L. Derecho Sultan Kudarat MNCHN Coordinator, Provincial Health Office 2013 to June 2016 lilyderecho@gmail.com Margaret Ducusin Sultan Kudarat FHSIS Coordinator 2013 to June 2016 skpho12@yahoo.com Fax: Henry Lastimoso Sultan Kudarat OIC-Provincial Health Officer March 2014 to November 2014 dochen_1983@yahoo.com 60

62 Table 18: People Involved in the Programme Government Counterparts: Municipal and City Governments Name of Person Type of Employee Role Time Engaged Contact Details Ofelia Boado Aleosan Municipal Health Officer 2013 to June Vincent Sorupia Aleosan Mayor 2013 to June 2016 Karen Canario Arakan Municipal Health Officer 2013 to June Mary Jean Mendoza Arakan Public Health Nurse 2013 to June Rene Rubino Arakan Mayor 2013 to June 2016 Marinel Animas-Lim General Santos City Chief of Hospital - General Santos City District January 2015 to June Hospital Rolan Gonzales General Santos City Administrative Officer - General Santos City District January 2015 to June Hospital Marife Aruta Kalamansig Municipal Health Officer 2013 to June 2016 mcaruta_doc99@yahoo.com James Dapitan Kalamansig HIS point person 2013 to June 2016 rhukalamansig@yahoo.com Rolando Garcia Kalamansig Mayor 2013 to June (064) Thelma L. Macailing Kalamansig Public Health Nurse 2013 to June Dionesio Besana Lebak Mayor 2013 to June 2016 Jeffrey Ojas Lebak MNCHN Coordinator 2013 to June 2016 jeffoyas@yahoo.com Janrie Tanangonan Lebak Municipal Health Officer 2013 to June 2016 Janlp2000.jt@gmail.com Ma. Theresa Malungon Mayor Constantino Renato Constantino Malungon Mayor 2013 to June 2016 ricric_saranillo@yahoo.com Reynalda Ferrer Malungon Family Planning Coordinator 2013 to June Rafaida Hernandez Malungon Municipal Health Officer 2013 to June 2016 rafaidagh@gmail.com Ivy Palabrica Malungon MNCHN Coordinator 2013 to June 2016 Ivykatherine.palabrica@yahoo.com Romeo D. Arana Midsayap Mayor 2013 to June 2016 lgumidsayap@yahoo.com 61

63 Name of Person Type of Employee Role Time Engaged Contact Details Rosario Pader Midsayap Chief of Hospital - Amado Diaz District Hospital January 2016 to June Amymone Rayray Midsayap Municipal Health Officer 2013 to June 2016 amymone.rayray@yahoo.com Romeo Tuanquin Midsayap HIS Coordinator/Nurse Deployment Program 2013 to June 2016 errt03@gmail.com rhumidsayap@yahoo.com Dominic Laus Pres. Roxas Municipal Health Officer 2013 to June 2016 domzmd@yahoo.com Eufemia Mahimpit Pres. Roxas MNCHN Coordinator 2013 to June 2016 presroxascot@yahoo.com Jaime Mahimpit Pres. Roxas Mayor 2013 to June 2016 rhupresroxas@yahoo.com presroxascot@yahoo.com Ramona Abarquez Quezon City MNCHN Coordinator January 2015 to June 2016 abarquez_ramona@yahoo.com Edgardo Aldana Quezon City Director - Novaliches District Hospital January 2015 to June Esperanza Anita Arias Quezon City FP Coordinator 2013 to June 2016 esperanzaanita@yahoo.com Josephine Banaag- Sabando Quezon City Director - Quezon City General Hospital January 2015 to June 2016 jtgbanaag@yahoo.com Herbert Bautista Quezon City Mayor 2013 to June Juliana Bulac Quezon City Dist. 2 Midwife Supervisor 2013 to June 2016 bulacjulie@yahoo.com Co-manages JPMNH activities, especially EINC in June 2014 to June 2016 District 2 HC-QC Angela Cuadra Quezon City District 2 Nurse Supervisor 2013 to June 2016 angie_curada@yahoo.com.ph Leticia de Guzman Quezon City Adolescent Coordinator 2013 to June 2016 mldguzman@gmail.com Verdades Linga Quezon City City Health Officer III Overall Monitor for JPMNH in QC Laarni Malapit Quezon City District 2 Health Officer Provides day to day management of JPMNH activities at the District 2 QC Health Center June 2015 to June to June 2016 July 2014 to June 2016 vlinga@yahoo.com Malapit_laarni@yahoo.com

64 Name of Person Type of Employee Role Time Engaged Contact Details Mensie Medalla Quezon City Midwife Supervisor 2013 to June Susan Vinluan Quezon City District 2 Health Officer June 2014 to December 2014 mariasusanvinluan@yahoo.com Administrative Officer January 2015 to June

65 Table 19: People Involved in the Programme Implementing Partners Name of Person Type of Employee Role Time Engaged Contact Details Carlos Tiangco ACM Graphics Printer, BEmONC April to July 2015 Elizabeth Roxas Glenda Vargas Ma. Theresa Padilla Association of Deans of Philippine Colleges of Nursing (ADPCN) Association of Deans of Philippine Colleges of Nursing (ADPCN) Association of Philippine Schools of Midwifery (APSOM) April 2016 to June Telefax: President 2013 to June 2015 Project point person 2013 to June President; EINC/IMCI/KMC Integration in the midwifery curriculum Scale up of EINC and IMCI thru integration in the curriculum in the schools of midwifery Med Ramos Beetlebugs Media Lay out artist, Harmonized modules on BEmONC for Midwives; C4D whiteboard animation, poster/fan Amor Curaming Center for Innovations, Change & Productivity (CICP) Carmina Canila Elizabeth Dumaran Jowena Manalac Center for Innovations, Change & Productivity (CICP) Center for Innovations, Change & Productivity (CICP) Center for Innovations, Change & Productivity 2013 to June 2016 June 2014 to June to June Project Lead December 2014 to June Project Consultant December 2014 to October Project Consultant December 2014 to June Project Coordinator December 2014 to June

66 Name of Person Type of Employee Role Time Engaged Contact Details (CICP) Ethelyn Nieto Center for Project Consultant December 2014 to June Innovations, Change & Productivity (CICP) Glen Roy Paraso Center for Innovations, Change Project Consultant December 2014 to October & Productivity (CICP) Bea Quilingan Center for Innovations, Change Admin staff 2015 to June & Productivity (CICP) Patricia Gomez Integrated Midwives Scale up of EINC and BEmONC for Midwives thru June 2014 to June 2016 Association of the Philippines (IMAP) continuous training and monitoring and supervision of midwives and their birthing facilities Johanna Manimbo McCANN Account Director September 2015 to June , local 6368 Socorro De Leon NGO Chief training officer, monitor and supervisor for January 2015 to June 2016 Mendoza Teresita Cadiz Private Practitioner Obstetric- Gynecologist Private Practitioner Pediatrician Kangaroo Mother Care (KMC) Independent Consultant, BEmONC Modules for Midwives Pinky Imperial Independent Consultant, BEmONC Modules for Midwives Aleah Aliporo-Eugenio Red Ants Media Creative Director / Producer; Digital films, Munting Maria Alfred Reyes Red Ants Media Creative Director / Producer; Digital films, Munting Maria Ma. Theresa de la Pena Social Development Research Center, De la Salle University Portia Grace Marcelo UP-National Telehealth Center 2013 to June 2016 tetchiecadiz@gmail.com to June 2016 Pinkysi2@gmail.com April 2016 to June 2016 aleah@redantsmediainc.com April 2016 to June 2016 alfred.reyes@gmail.com Team Lead; Project point person August 2014 to June 2015 sdrc@dlsu.edu.ph Director 2013 to June 2016 portiamarcelo@telehealth.ph 65

67 Name of Person Type of Employee Role Time Engaged Contact Details (UP-NTHC) Arturo Ongkeko UP-National Telehealth Center (UP-NTHC) Project associate 2013 to June (02) Henri Joshua Igna UP-NTHC Staff June 2014 to December Khae Valdez VJ7 Printing Pinter, rchits Manuals April 2016 to June Nenette Capaning Xavier Science Foundation Administrative assistant June 2015 to June Ma. Theresa Rivera Xavier Science Foundation Team Lead June 2015 to June Alvin Cloyd Dakis Zuellig Family Foundation (ZFF) Coordinator for Region XII 2013 to June Geoffrey Gabriel Garcia Zuellig Family Foundation (ZFF) Coordinator for Region XII June 2015 to June Humphrey Gorriceta Zuellig Family Coordinator for QC 2013 to April 2016 Ellen Licup-Medina Foundation (ZFF) Zuellig Family Foundation (ZFF) Project Lead Coordinator 2013 to June

68 Table 20: Documents Produced by the Program Name of Document Type of Document Document Owner Date Document Produced Location/s of Document Adolescents and Facility-based Deliveries Position Paper UN-JPMNH March 2016 UN-JPMNH and DOH Assessment of Essential Intrapartum and Newborn Care (EINC) in Nursing and Midwifery Curricula Study UNICEF October 2016 UNICEF Assessment of Intrapartum-Postpartum (MNCHN) Related Capacity DOH, Regional Offices; WHO-PHL Survey analysis FHO-DOH 2015 Development Activities and Trainings in Region XII Library BEmONC functionality Assessment Report UNFPA and CHSI June 2014 UNFPA and CHSI Communication for Development Analysis of Maternal and Neonatal Health in Selected GIDAs in Mindanao and Quezon City Study UNICEF October 2016 UNICEF Comprehensive Set of Capacity Development Modules on Standards on Mentoring, Coaching and Supportive Supervision for Maternal and training/report Newborn Health Services in Health Facilities and Birthing Centers FHO-DOH June 2016 FHO-DOH, WHO-Phl Library Consolidated Annual Report on Activities Implemented under the Joint Programme Strategy to Improve Maternal and Neonatal Health in the Philippines Report of the Administrative Agent for the Period 1 January 31 December 2013 Consolidated Annual Report on Activities under the Joint Programme on Maternal and Neonatal Health Report of the Administrative Agent for the Period 1 January 31 December 2014 Consolidated Annual Report on Activities under the Joint Programme on Maternal and Neonatal Health Report of the Administrative Agent for the Period 1 January 31 December 2015 Demand Generation among National Household Targeting System (NHTS) Poor Families thru Family Development Sessions (FDS) in Sarangani, Sultan Kudarat, North Cotabato and District II of Quezon City Determinants of Access to RH, Maternal, Neonatal and Child Health Care (RHMNCH) Services Development of National Policy on the Quality of Care for Small Babies to Fast Track Neonatal Mortality Reduction: Addressing Prematurity and Low Birth Weight Dugtong-Kalinga Advocacy Booklet, brochures and DVDs Report Report Report UN-JPMNH and DFAT UN-JPMNH and DFAT UN-JPMNH and DFAT May 2014 UN-JPMNH and DFAT 2015 UN-JPMNH and DFAT 2016 UN-JPMNH and DFAT Report UNFPA and PSRP June 2016 UNFPA and PSRP Survey analysis DOH 2015 DOH, Regional Offices; WHO-PHL Library Draft Policy DOH August 2016 UN-JPMNH and DOH Advocacy material for policy HPCS-DOH, LGUs (JPMNH Sites) March 2013 DOH, LGUs of Marikina, Quezon City, Las Pinas, Navotas, Caloocan, Metro-manila area; WHO-PHL Library 67

69 Name of Document Economic Evaluation of EINC Protocol in a Facility Setting in the Philippines Essential Intrapartum and Newborn Care (EINC): Raising the Quality of Care for Mothers and Newborns Essential Intrapartum and Newborn Care-self instruction module (EINC-SIM) Type of Document Document Owner Report DOH 2014 Date Document Produced Location/s of Document DOH, Regional Offices; WHO-PHL Library Policy Brief UN-JPMNH March 2016 UN-JPMNH and DOH Standards, policies, guidelines DOH November 2012, Revised 2014 FHO-DOH; DOH-ROs, LGUs all over the Philippines, Academe, other Developmental Partners, NGOs, Health service providers; WHO-Mongolia,China,Vauato, Cambodia, PNG, Lao PDR, Vietnam, WPRO DOH, Regional Offices; WHO-PHL Formative Evaluation of EINC Integration in Medical Curriculum Survey report DOH, Medical 2014 Schools Library GIS Study: Geographic Accessibility to Emergency Obstetric and KMITS and FHO- DOH, Regional Offices; WHO-PHL Report 2014 Neonatal Care (EmONC) Region XII (Soccsksargen) DOH Library Guidelines and Manual of Operations on Quality Improvement for Maternal and Newborn Health Services in Health Facilities and Guidelines/report FHO-DOH May 2016 FHO-DOH, WHO-Phl Library Birthing Centers Implementing Rules and Regulations for 4 Quezon City MNCHrelated Ordinances, a Compilation City WHO and Quezon Policy Improving Access and Availability of Life-Saving Commodities for DOH, Regional Offices; WHO-PHL Survey analysis DOH 2013 Women and Children Library Integrated Policies on Essential Maternal and Newborn Care and the Mother - Baby - Friendly Hospital Initiative Draft Policy DOH August 2016 UN-JPMNH and DOH Manual on Maternal and Neonatal Death Reporting System (ereporting) MOP KMITS-DOH 2014 DOH, ROs, LGUs MNCHN Service Delivery Network Portfolio for Quezon City Report UNICEF October 2016 UNICEF MNCHN Service Delivery Network Process Documentation in JPMNH areas Report UNICEF October 2016 UNICEF Operational Research on Track and Trace Report UNFPA and PSRP June 2016 UNFPA and PSRP rchits Manuals: 1. Manual on Data Use for Decision-making for rchits End Users 2. Manual on Data Use for Decision-making for rchits End Users Facilitator's Guide 3. rchits Manual of Operations 4. LGU Dashboard User Manual Manuals UP National Telehealth Center and UN-JPMNH August 2016 UP National Telehealth Center, LGUs, and UN-JPMNH 68

70 Name of Document Type of Document Document Owner Date Document Produced Location/s of Document 5. rchits Infrastructure Maintenance Manual 6. Mag-ina Telereferral System (MInTS), Birth Registration Tracking System (BiRTS), Linking rchits to Local Civil Registry (LCR) 7. Birth and Death Registration Tracking System, Linking rchits to Local Civil Registry (LCR) Reaching Every Mother and Every Newborn Policy Brief UN-JPMNH March 2016 UN-JPMNH and DOH Research on Socio-economic impact of parental consent Report UNFPA and CHSI June 2016 UNFPA and CHSI Scale-Up Demand Generation on Reproductive Health among the NHTS Poor Families thru the Family Development Sessions to Cover the Densely Populated Areas in Quezon City District II, Report UNFPA and PSRP June 2016 UNFPA and PSRP Sarangani Province, North Cotabato and Sultan Kudarat SWS Survey on parental consent Survey UNFPA and CHSI June 2016 UNFPA and CHSI Teen Births Facility Research Report UNFPA and CHSI June 2016 UNFPA and CHSI Teens Writing For Teens Story Books Story Books UNFPA and Save the Children June 2016 Young Adult Fertility and Sexuality Study Survey UNFPA and DRDF May 2016 UNFPA and DRDF Beneficiary schools in QC, Sultan Kudarat and Sarangani 69

71 Table 21: Contractual Obligations/Terms and Status Name of Contract Contract Number Contractual Obligations/Terms Roland Acompanado APW - Conduct of Barangay Stakeholders Summit and Workshop on Performance Accountability System for Safe Motherhood in LGUs Maridith de Leaon Afuang Individual Consultancy Assists in the implementation of the UNICEF JPMNH workplan that will be implemented in the CPC 7 areas including contributing to reporting requirements of UNCO and/or AusAID and/or other donors. Status at the end of the Activity Completed Completed Maridith de Leon Afuang PAS-IC IC - Facilitator/ Documenter Completed Bienvenido Alano, Jr Study on Improving Access and Availability of Life-Saving Commodities for Women and Children. Completed Jocelyn dela Cruz Alcoreza PAS-IC IC-Project Assistant for Policy Development Completed Alliance for Improving Health Institutional Consultancy - (Evidence-based Planning for MNCHN (EBAP) Completed Outcomes, Inc. Alliance for Improving Health PAS-CC Development of National Policy on the Quality of Care of Small Babies: Addressing Prematurity and Completed Outcomes, Inc. Low Birth Weight Alliance for Improving Health PAS-CC Updating and/or Revision of AO Adopting policies and guidelines on Essential Newborn Completed Outcomes, Inc. Care to become adopting policies and guidelines on EINC AMC Advertising K004 Fabrication of U4U panel booths Completed AMC Advertising K Teen Spot Table Completed AMC Advertising K Teen Spot Table for U4U Completed AMC Advertising K U4U interactive exhibit panels Completed Asuncion Anden Consultancy Service for the conduct of Training on Medical Certification of the Cause of Death Completed Asia Pacific Management & Dtd Mar 3, 2016 Fixed Price Service Agreement - Conduct a population based survey using Lot Quality Assurance Completed Research Group, Inc. (AP Margin) Sampling (LQAS) Methodology to determine contraceptive coverage in JPMNH areas Asia Pacific Management & Dtd April 14, 2016 Memorandum of Agreement - Mobilization support for service provision of Progestin Only Completed Research Group, Inc. (AP Margin) Subdermal Implant Jose Roi Avena PAS-IC IC- MEAL Specialist Contractor Completed B.Y.P. Trading and Consultancy APW for the Conduct of Training-of-Trainers (TOT) Workshop on the Antimicrobial Stewardship Completed Services (AMS) Advocacy Package to Hospital Managers, 23 February -27 March Peter Banys Provision of technical advice and support to standardize and harmonize the policies in response to the Completed current drug situation in the Philippines, including MNH /RH Drugs. Bayview Park Institutional Consultancy - Conference Facilities, Meals and Equipment- ADEPT E-learning Completed Ceremonial Turn Over and Orientation Beetle Bugs Communication Inc Institutional Consultancy - Production of IEC materials for Adolescent maternal and Neonatal health Completed Raoul Bermejo III Individual Consultancy - Health System and Data Analysis Completed Bless-Tetada Kangaroo Mother Small Scale Funding Agreement - To provide training materials for the conduct of the Care for the Completed 70

72 Care Foundation Small Baby Trainor s and Implementor s course, for two batches. Boundary Spanners Institutional Consultancy - Event Management Services for the SDN Sustainability Forum for JPMNH Completed Building Inter Tribal Dtd April 9, 2016 Memorandum of Agreement - Mobilization support for service provision of Progestin Only Completed Ecodevelopment Inc. (BITE) Subdermal Implant Butter Solutions Dev. Co. Dtd Oct 14, 2015 Fixed Price Fixed Term Contract - Development of Mobile Application and Inventory Management Completed software for track and trace logistics management system Butter Solutions Dev. Co. Dtd April 11, 2016 Fixed Price Service Agreement - Enhancement of mobile app on Track and Trace Logistics system to Completed enable computation of commodity average monthly utilizations, prescribed commodity stocking levels and months on hand data Mario Cabrera Individual Consultancy - Copy-editing and proofing of documentations Completed Teresita Cadiz-Brion Development of a Comprehensive Set of capacity Development modules on Mentoring, Coaching and Completed Supportive Supervision for Maternal and Newborn Health Services in Health Facilities and Birthing Centers Teresita Cadiz Individual Consultancy - Assessment on the integration of Essential Intrapartum & Newbon Care Completed (EINC) in the Nursing and Midwifery Curricula Career Movers International For the conduct of survey on the Assessment of MNCHN- related Capacity Building Activities such as Completed Connections, Inc. (CMICI) but not Limited to EINC, BEmONC Career Movers International TA on the capcity building on Essential Intrapartum and Neonatal Care (EINC) trainings conducted Completed Connections, Inc. (CMICI) in collaboration with the Department of Health. CICP. Learn Business Management Institutional Consultancy - MNCHN Services QC and Region XII Completed Consultancy Co. CICP. Learn Business Management Institutional Consultancy - Operationalization of the Service Delivery Network for the delivery of Completed Consultancy Co. quality MNCHN Services in selected LGUs in Region XII and Quezon City Continuation of PO No CICP. Learn Business Management Consultancy Co Institutional Consultancy - Process documentation of the Operationalization of the Service Delivery Network in JPMNH Phase 2 Areas Completed Coms 360 K Social Media support engagement Completed Cotabato Regional & Medical Completed Center Training Division CRMC was contracted several times from January 2015 to May 2016 for the conduct of, monitoring and post training evaluation and supervision for Basic Emergency Obstretic and Newborn Care Training for Midwives (BeMONC) of JPMNH Sites in Region XII, at the Cotabato Regional and Medical Center CPRM Consultants, Inc. PAS-CC Endline Study for the JPMNH Phase 2 Completed Rosarita Villarama Dalisay (APW) Technical Support for the Implementation of Planned Activities in Quezon City, under the Completed Joint Programme on Maternal and Neonatal Health (JPMNH) Phase 2 De La Salle University- Social Development Research Center Institutional Consultancy - Communication analysis on maternal and neonatal health with emphasis on the role of community health teams in facilitating the adoption of positive behaviors in the context of Completed conflict and rapid urbanization in selected LGUs in Mindanao and Quezon City Dependable Printing Press Reprinting production of EINC Training Manuals and Facilitators Manual Completed Dependable Printing Press Layout and printing of Maternal and Neonatal Death Reporting System (MNDRS) Manual of Completed 71

73 Operations and Brochures for JPMNH pilot sites Abdel Jamal Disangcopan Technical and Administrative Assistance to the Implementation of JPMNH Project in QC (Development and Public Dissemination of the Implementing Rules and Regulations of 6 Local MNCHN-related Ordinances in Quezon City Dr. Jose Fabella Memorial Hospital Provision of training facilities and services for the several batches of Quezon City's Health Department Basic Emergency Obstetrics and Newborn Care Skills Training for Midwives and Lactation Management Training Completed Completed Drake Services, Inc. Institutional Consultancy - freight costs Completed Ebener, Steve Nicolas Assistance to the WHO Country Office for GIS mapping, especially on travel times to and from EmONC Facilities in Region XII. The incumbent will collate and analyse data related to EmONC and create a set of recommendations for action. Completed Eres Books Publishing, Inc Printing of AJA Trainer s Manual and AJA Participants Aid Completed Family Planning and Integrated Dtd April 19, 2016 Memorandum of Agreement - Mobilization support for service provision of Progestin Only Completed Health Services, Inc. (FPIHS) Subdermal Implant Field Epidemiology Training Programme Alumni Foundation Inc (FETPAFI) Dtd July 7, 2015 Fixed Price Service Agreement - Demand Generation among National Household Targeting System (NHTS) Poor Families thru Family Development Sessions (FDS) in JPMNH areas Completed Kiarah Louise Florendo PAS-IC IC- Project Coordinator for Administrative Closeout Completed Alexander Gregoria II Individual Consultancy Completed Manuel Alexander Haasis Individual Consultancy - Health System and Data Analysis Completed Alejandro Herrin Principal Investigator, Economic Component Completed Johanna Khristia Balanag Hinolan (APW) Implementation of Planned Activities in Region XII, under Joint Programme on Maternal and Neonatal Health (JPMNH) Phase 2: Project partners, stakeholders and clientele of maternal and newborn care at the JPMNH 2 sites in Region XII Integrated Midwives Association in the Philippines Integrated Midwives of the Philippines International Development Leadership and Learning Corporation (IDLLC) The APW aims to be able to smoothly and effectively conduct EINC training simultaneously to be able to catch-up on the training needs in the country, particularly in Quezon City. Programme Cooperation Agreement - Skills Training Programme Integrating Newborn Care, Nutrition and IMCI for Midwifery Curriculum Dtd April 19, 2016 Memorandum of Agreement - Mobilization support for service provision of Progestin Only Subdermal Implant Completed Completed Completed Completed Key Printing Press Design, layout and printing of training kits (bag and notebook) for the National Health Officers Completed Congress on Adolescent Health and Development Programme for JPMNH Sites Maria Odilyn Lazaro PAS-IC IC - Facilitator/ Documentor for JPMNH PIR Completed Maria Odilyn Lazaro PAS-IC IC - Monitoring and Evaluation Specialist Completed Melchor Lucas, Jr Development of National Guidelines and Manual of Operations on Quality Improvement for Completed Maternal and Newborn Health (MNH) services in Health Facilities and Birthing Ctrs. Mag-Rent A Car Transport service for JPMNH Team in Region XII for various activities from November 2015 to May Completed 72

74 Jonel Mapalad K U4U shirts Completed Jonel Mapalad K006 U4U statement shirts Completed Master Print K007 U4U collaterals Completed Master s Stewards Information PAS-InC JPMNH Web Portal Completed Technology (MSIT) Solutions, Inc. McCann Worldgroup Philippines Institutional Consultancy - Development of Communication Strategy to Improve the Health Seeking Completed Inc. Behavior of Pregnant Adolescent in Quezon City C4D JPMNH Socorro de Leon Mendoza Agreement on Performance of Work (APW) for the Training of Trainers of Preventing Newborn Completed Deaths from Prematurity/Low birth weight through the care for small baby course Municipal Health Office, MOA-Workplan - Strengthening Communication Intervention for the Pregnant Adolescent in Completed Kalamansig Kalamansig (SCIPAK) Ethelyn Nieto APW IPC skills training on FP methods and post -training monitoring on number of WRAs reached Completed and acceptors referred (period covered 2013 Q3-Q4) Northbelle Properties, Inc Institutional Consultancy - Conference Facilities, Meals and Equipment- National Symposium on Completed ehealth OBP Printing, Inc. Reproduction of Facilitators and Participants Manual on FPCBT I (2013 Q3) Completed On Media Creative Solutions K003 Interactive video and online application Completed Oracle Hotel Institutional Consultancy - Conference Facilities, Meals and Equipment- Service Delivery Network Completed (SDN) Planning for District 5, Quezon City Orient Integrated Development PAS CC Baseline Study for the JPMNH Phase 2 Completed Conslutants, Inc. Kathleen Palasi Individual Consultancy - Various Photo Coverage and Documentation Completed Philippine Legislators Committee Institutional Consultancy - "A Promise Renewed" Campaign to address preventable causes of child Completed on Population & Development Foundation, Inc. and maternal death Emanuelle Protasio PAS-IC IC - Resource Person Completed Provincial Government of Dtd Oct 1, 2015 Programme Grant Agreement - Capacity Building for C-Section services for CEMONC facility with Completed Cotabato easy access to safe blood supplies Provincial Government of Dtd Oct 14, 2015 Programme Grant Agreement - Capacity Building for C-Section services for CEMONC facility with Completed Sarangani easy access to safe blood supplies Provincial Government of Sultan Dtd Oct 14, 2015 Programme Grant Agreement - Capacity Building for C-Section services for CEMONC facility with Completed Kudarat easy access to safe blood supplies Mark Benjamin Quiazon PAS-IC IC - Consultant for Project Closeout and Documentation Completed Rainers Contract Research Services, APW on the 2016 Survey on MNH Drug Availability in Public Health Facilities. Completed Inc. Corazon Raymundo Principal Investigator, Social Component Completed 73

75 Red Ants Media Institutional Consultancy - Production of Digital Short Films and Radio Dramas on Teenage Completed Pregnancy Research Institute for Mindanao Implementation of the study on: Determinants of Access to Reproductive Health, Maternal, Neonatal Completed Culture (RIMCU), Inc. and Child Health Care (RHMNCH) Services in Region XII Madelline Valencia Romero Development and Packaging of the multi-media campaign for the Responsible Parenthood and Completed Reproductive Health (RPRH) Act of Anzaira Roxas Individual Consultancy - DOH-UNICEF Support for ADAP Implementation Completed Anna Ruaro, MD & Co. APW Conduct Training on PSI insertions for private sector providers under civil society Completed organizations (2015 Q Q2) Rural Health Unit- Pres. Roxas, MOA-Workplan - C4D activities for Barangay Lama-lama and Datu Inda Completed North Cotabato Stephanie Anne Macapanpan Sison PAS-CC Development of MNCHN Policy Briefs Completed Stephanie Anne Macapanpan Sison Conceptualize and develop the Manual of Operations for the Adolescent Health and Development Completed Programme of the Department of Health Social Weather Station Special National Survey of Teenagers and Parents Completed Tanghalang Pilipino Foundation Programme Cooperation Agreement - Development of a Forum Theatre Production on Adolescent Completed Inc. Maternal and Neonatal Health Tebtebba Foundation Inc. Programme Cooperation Agreement - Respecting Diversity, Promoting Equity; Mainstreaming the Completed rights of Indigenous Children in the Indigenous People s Agenda and National Indigenous People s Human Rights Situationer Teddy de Luna Transport Services Van rental relative to the conduct of various JPMNH activities from 2014 to 2015 Completed Jose Miguel Tejido K Graphic Designer and Lay-out Artist Completed Jovanni Rodriguez Templonuevo This PR is being raised for Dr Templonuevo, who will implement part of the country-wide JPMNH Completed program. This programme will include BeMONC, LMT and Adolescent Aid Training. Think Sumo K009 Off-line U4U website application Completed Angelito Umali PAS-IC IC- Moderator/ Emcee for JPMNH Closeout Completed University of the Philippines Memorandum of Agreement - (rchits- Pahse 3: rchits for local health governance towards Completed National Telehealth Center improved maternal and child health in selected GIDAs) Ma. Estrelita Villanueva Uy Agreement on Performance of Work (APW) for the Monitoring and Roll out of Preventing Newborn Completed Deaths from Prematurity/Low birth weight through the care for small baby course Katherine Reyes Villegas Increasing Budgets to Sustain Skilled Service Providers of Adolescent Reproductive Health Services in Completed the Philippines: Applying the Accountability Loop Budget Advocacy (ALBA) Framework Pura Angela Wee Individual Consultancy - (Health system strengthening and disabilities, DOH, PhilHealth, and other partners working in health system strengthening) Completed 74

76 Women's Health Care Foundation, Dtd April 19, 2016 Memorandum of Agreement - Mobilization support for service provision of Progestin Only Completed Inc. (WHCF) Subdermal Implant Xavier Science Foundation, Inc Institutional Consultancy - Joint Programme on Maternal Neonatal Health - C4D Completed Zuellig Family Foundation Programme Cooperation Agreement - Health Leadership and Governance in UNICEF Priority areas. Completed 75

77 Table 22: Continuation of Components of the Program Which component is being continued? Who is taking this forward? Contact details BBCPH SD2N District 2, QC MNCHN SDN Quezon City Health Department(QCHD) City and Barangay in District 2 LGUs 1. Dr. Verdades Linga, City Health Officer Mobile: verdades.linga@yahoo.com Expansion to District 5 QC SDN Mag-ina Telereferral System, QC Quezon City Health Department City and Barangays in District 5 LGUs QCHD Quezon City General Hospital (QCGH) Quirino Memorial Medical Center (QMMC), with possible expansion to East Avenue Medical Center, Novaliches District Hospital UP-NTHC *Region XII municipalities expressed interest in installing MINTS 2. Dr. Laarni Malapit District 2 health officer Mobile: malapit_laarni@yahoo.com 1. Dr. Verdades Linga, City Health Officer Mobile: verdades.linga@yahoo.com 2. Dr. Plata District 5 Health Officer Mobile: Dr. Verdades Linga, City Health Officer Mobile: verdades.linga@yahoo.com 2. Dr. Josephine B. Sabando Director, QCGH jtgbanaag@yahoo.com 3. QMMC Director Interbarangay Health Cluster (IBHC) Pilot 7 Municipal LGUs/Project sites Respective Mayors & MHOs Municipal/City/Provincial Health Leadership and Governance Program DOH Regional Offices- NCR & Region XII 7 Municipal LGUs QC North Cotabato, Sultan Kudarat, Sarangani DOH Regional Offices NCR & Region XII DOH-Regional Office Dir. Francisco Mateo fmateo_ph@yahoo.com DOH-NCR 76

78 rchits EINC Integration in the nursing/midwifery curricula 7 Municipal LGUs QC UP-NTHC Midwifery schools faculty members trained by APSOM Nursing schools faculty members trained by ADPCN Dir. Ariel Valencia aievalencia@yahoo.com Please refer to the Directory - Persons involved 1.Ma. Theresa Padilla Mobile: mhetpadilla@yahoo.com Communication for Development (C4D), particularly for QC, Kalamansig, Pres. Roxas, Lebak Maternal and Neonatal Death Reporting and Surveillance (MNDRS) Maternal Death Review Capacity Building, Supervision and Intervention Monitoring and Evaluation in Region XII LGUs in project sites Jane V. Agar-Floro DOH-KMITS (Training Division) RHOs: Region XII, NCR Ms Leah Grace Lonting (Regional MDR Focal Point) DMOs/PDOHOs Dr. Barbara Libatique, Dr. Manansala, Dr. Duldoco, Dr. Rubelita Aggalut, Ms. Rona Gelvoleo, Mr. Jessie Cercado, Ms. Myla Mapait, Dr. Marilou Barbara Libatique, Ms. Saada Salik, Mr. Godwin Gallo, Ms. Lorelei Resmundo, Mr. Nelson Mendez, Eng. Elmer Supremo 2. Ms. Glenda Vargas Mobile: adpcn01_inc@yahoo.com.ph Please refer to Persons involved agar_floro@hotmail.com leahlonting@yahoo.com Capacity Building on EINC FHO-DOH acalibomd@yahoo.com Capacity Building on Lactation Management, Supportive supervision and monitoring of the Mother-baby Friendly Hospital Initiative-Region 12 Ms. Jessen T. Masukat: Regional Nutrition Officer doh12nutrition@gmail.com Capacity Building and monitoring of the Care for Small Baby (EINC and KMC) Focus on Adolescent Health (Reaching the Urban Adolescent Population) Quality Improvement, regular monitoring and supportive supervision on EINC and Care for the Small Baby (EINC and Kangaroo Mother Care) Region XII: Ms Agnes Panton- Newborn Care Focal Designate QC Dr Ramona Abarquez Region XII: Ms Agnes Panton- Adolescent Health Care Focal Point QC Dr Ramona Abarquez DOH, Regions XII and NCR and other regions (Regions 1, 2, CAR, 3, 7, 11) Other Components being sustained at RO XII 1. Breastfeeding and nutrition - Jessen T. Masukat, RND Maternal Death Review - Lea Grace C. Yonting, RM Care for the Small Baby - Mary Agnes Panton, RN agnespanton87@gmail.com abarquez_ramona@yahoo,com agnespanton87@gmail.com DOH acalibomd@yahoo.com Region XII agnespanton87@gmail.com ORG Compound, Gutierrez Ave., RH VII, Cotabato City Philippines. 77

79 Support to CEMONC 4. MNDRS- Mr Renante Natano 5. EINC - Mary Agnes Panton 6. KMC - Mary Agnes Panton 7. Adolescent Health - Mary Agnes Panton 8. Maternal Health - Lea Grace Yonting 9. Newborn Health - Mary Agnes Panton Provincial Health Office of North Cotabato Provincial Health Office of Sultan Kudarat Provincial Health Office of Saranggani doh_chd12@yahoo.com Trunkline: (064) RD Office: (064) ; (064) Website: Dr. Eva Rabaya PHO North Cotabato Dr. Henry Lastimoso PHO Sultan Kudarat Dr. Arvin Alejandro PHO Saranggani Track and Trace Department of Health Family Health Office Dr. Joyce Ducusin Department of Health Family Health Office Implant Service Delivery Philippine Society for Responsible Parenthood in coordination with the RPRH Law National Implementation Team Dr. Esmeraldo Ilem President, PSRP HLGP Zuellig Family Foundation Department of Health Mr. Ramon Dirige Vice-President, ZFF CIP Department of Health through the RPRH Law National Implementation Team Dr. Joyce Ducusin Department of Health Family Health Office U4U Commission on Population Dr. Juan Antonio Perez Executive Director, PopCom 78

80 References Ahmed, S., Li, Q., Liu, L., & Tsui, A. (July 2012). Maternal deaths averted by contraceptive use: An analysis of 172 countries. Lancet, Family Planning Consortium. (2016). 3rd Q 2016 Quarterly Monitoring Tool. Miller, S. e. (2016). Beyond too little, too late and too much, too soon: A pathway towards evidencebased, respectful maternity care worldwide. The Lancet, 388 (10056), Rappler. (2016, September 14). DOH wants P1.2-B reproductive health budget in Manila, Philippines. Research and Development Foundation, Inc. (2016). The 2013 Young Adult Fertility and Sexuality Study in the Philippines. Quezon City: Demographic Research and Development Foundation, Inc. and Universiy of the Philippines Population Institute. UNICEF. (2016). Maternal, Newborn and Child Health and Nutrition Service Delivery Network (MNCHN SDN) Process Documentation. UNICEF. (2016). Operationalization of the Service Delivery Network for the Delivery of Quality MNCHN Services in Selected LGUs in Region XII and District II Quezon City. United Nations. (2016). Baseline study for the joint programme for maternal and neonatal health (JPMNH) Phase 2. United Nations. (2016). Endline study for the joint programme for maternal and neonatal health (JPMNH) Phase 2. United Nations Inter-agency Group for Child Mortality Estimation. (2015). Levels & Trends in Child Mortality Report New York: United Nations Children's Fund. United Nations. (March 2015). JPMNH Phase 1 Project Completion Report. United Nations Philippines. (May 2016). Consolidated UN ODA Gender Responsiveness Assessment. Valadez, J. J. (2001). A Trainers Guide for Baseline Surveys and Regular Monitoring: Using LQAS for Assessing Field Programs in Community Health in Developing Countries. Washington DC: NGO Networks for Health. World Health Organization. (2004). Beyond the numbers: Reviewing maternal deaths and complications to make pregnancy safer. Geneva: World Health Organization. World Health Organization. (2015). Trends in Maternal Mortality: 1990 to Geneva: World Health Organization. 79

81 Annex A. JPMNH Phase 2 Sites Urban Site Quezon City District 2 Sultan Kudarat Sarangani North Cotabato Lebak Malungon Aleosan Kalamansig Arakan Midsayap President Roxas 80