Institution Building: Community-Based Reproductive Health (CBRH) Project

Network of Asia-Pacific Schools and Institutes of Public Administration and Governance (NAPSIPAG) Annual Conference 2005 Beijing, PRC, 5-7 December 2005 Theme: The Role of Public Administration in Building a Harmonious Society Workshop on Health Care for the Poor in Asia Institution Building: Community-Based Reproductive Health (CBRH) Project Dr. Estelita V. Tucay Director, RET-Training / ILGA Program Nueva Vizcaya State University Bayombong, Nueva Vizcaya Philippines 3700

ABSTRACT The Nueva Vizcaya Institute for Local Government Administration (NV-ILGA) and the United Nations Population Fund (UNFPA) Reproductive Health Project of Nueva Vizcaya entered into an agreement by signing a Memorandum of Agreement (MOA) in May 13, 2002 for the implementation of Institution Building: Community-Based Reproductive Health Project (CBRHP). Reproductive Health (RH) is a state of complete physical, mental and social well-being and not merely the absence of disease in all matters relating to the reproductive system and to its function and processes (UNFPA, 2000). The RH ten (10) elements are: 1) family planning, 2) maternal and child care and nutrition, 3) adolescent RH, 4) education and counseling on sexual health, 5) violence against women, 6) men s RH and involvement, 7) infertility, 8) prevention of abortion & management of complication, 9) breast & reproductive tract cancers, and 10) reproductive tract infections (RTIs) / sexually transmitted diseases (STDs) / HIVs / AIDS. The CBRH project was implemented to contribute to the attainment of the provincial goal, which was to improve the quality of life of the people of Nueva Vizcaya through better reproductive health. It sought to contribute to the purpose of increased utilization of: a) integrated and quality reproductive health services for women, men and adolescents; and b) gender-sensitive RH information, knowledge and counseling services to bring about behavioral changes regarding healthy reproductive and sexual practices. The CBRH Project was piloted in fifty-four (54) barangays (communities) covered by nine (9) municipalities in the province of Nueva Vizcaya. The project had three target outputs with notable accomplishment in collaboration of undertakings to all stakeholders; as follows: 1) technical capacity of service providers at all levels of the health service delivery system, including NGOs, enhanced for the provision of RH services; 2) improved knowledge and awareness among men, women and adolescents on RH issues and concerns; and 3) institutional capacity (in government and NGO sectors) in planning, implementation, management and monitoring of RH program at municipal and barangay levels enhanced. RATIONALE: Nueva Vizcaya is one of the five (5) component provinces of Region 02 (Cagayan Valley) located in the north central part of the Luzon island. It is bounded in the north by the provinces of Ifugao and Isabela, on the east and southeast by the provinces of Quirino and Aurora, on the south by Nueva Ecija and the west by the provinces of Benguet and Pangasinan. In the area of Reproductive Health (RH), Nueva Vizcaya had been a pilot area of the 4 th Country Program of the UNFPA concentrated in six (6) out of the 15 municipalities which included Bayombong, Solano, Bagabag, Bambang, Villaverde and Dupax del Sur. However, with the Country Programme Evaluation conducted in July 1999, it is recommended that expansion of the RH Program to the whole province with the entire range of RH direct support services had been offered. The bottom line of the impact of the Reproductive Health Project in Nueva Vizcaya is yet to be felt at the community level. Hence, in 2002 expansion of the pilot project included nine (9) municipalities: Alfonso Castañeda, Ambaguio, Aritao, Diadi, Dupax del Norte, Kasibu, Kayapa, Quezon and Sta Fe. Considering the topographic setting of the nine (9) municipalities, there was quite difficulties in the implementation. However, with the Participatory Local Governance of which the province is acclaimed of, on-going drive in strengthening the existing Barangay Development Councils in the province served as the entry point of the Community-Based Reproductive Health Project (CBRHP). Similarly, General Assembly (GA) in the barangay mandated to meet at least once a year and the Community-Based Initiatives (CBIs) were also maximized by the project as entry points for Reproductive Health IEC/Advocacy 2

REVIEW OF LITERATURE The Fourth Cycle Project of the Country Programme Development is called strengthening the Management and Field Implementation of Family Planning and Reproductive Health. This was implemented through the collaborative efforts of the Local Government Units (LGUs) and the Department of Health (DOH) with the financial and technical assistance of the United Nations Population Fund (UNFPA). Its long-term objective was to increase the number of couples and individuals practicing responsible sexuality and parenthood in order to contribute to the improvement of the health of women and children and to the reduction of total fertility. During its inception stage, the project managers presented seven short-term outputs in a Logical Framework Matrix. These outputs served as their basis for identifying the project activities because of the premise that achievement of these outputs was the stepladder for achievement of the programs long-term objectives. These outputs were: Development of essential reproductive health services- namely family planning, maternal and newborn care, RTI & STD, AIDS services and sexuality education. Expansion and improvement of Reproductive Health services Human resource development of all service e providers including NGO s Health education and promotion campaign on reproductive health Strengthening of managerial competencies in government and NGOs sector providing RH services Development of an adolescent reproductive health projects expansion to the different communities of counseling and referral services on reproductive health Increased LGU support for RH program In the integrated approach to Reproductive Health, the health worker assumes many roles. Doctors, like all members of the health team are expected to provide information, education, communication and motivation (IECM) activities for reproductive health. (RH Survey 2000) Reproductive Health will be consistent with national programs to improve the health of the Filipinos in general, by promoting personal responsibility, disseminating information and emphasizing freedom of choice in accessing to programs, services and information. It recognizes that the goals of reproductive health cannot be achieved independent of national goals and objective rights will be promoted to empower individuals and communities to actively participate in achieving reproductive health goals and objectives (Modules for Rural Health Physicians 2002). OBJECTIVES OF THE PROJECT The project sought to contribute to the attainment of the three (3) outputs identified in the provincial RH project, namely: 1. Technical capacity of service providers at all levels of the health service delivery system, including NGOs, enhanced for the provision of RH services; 2. Improved knowledge and awareness among men, women and adolescents on RH issues and concerns; 3. Institutional capacity (in government and NGO sectors) in planning, implementation, management and monitoring of RH program at municipal and barangay levels enhanced. In attaining the target project outputs, the CBRH Project covered 54 barangays in 9 municipalities. The 54 barangays were mobilized in taking action in addressing RH concerns; 9 Municipal Health Boards (MHBs) or Municipal Development Councils (MDCs), 9 Municipal Health Offices (MHOs), 9 Municipal 3

Planning and Development Offices, 9 Municipal Social Welfare and Development Offices, 9 Municipal Population Offices, 9 Municipal Federations of BHWs 54 Barangay Development Councils (BDCs)/Committees on Health and Nutrition, 54 Barangay Health Stations were mobilized for RH activities. Integration of RH Program in the 9 Municipal Development Plans and 54 Barangay Development Plans and annual allocation provided for RH in 9 municipalities and 54 barangays. METHODOLOGY The project aimed to contribute to the Nueva Vizcaya Reproductive Health Project s overall goal and purpose. It complemented on-going interventions and moved towards the institutionalization of the gains of the programme by building on existing systems and social structure like the Municipal Health Boards, the Local Development Councils and its Health and Nutrition Committees. Hands-on Institution Building as the major strategy attempted to integrate Reproductive Health Advocacy concerns in the regular or mandated functions of Local Special Bodies in planning, implementation, monitoring and evaluation. On the other hand, there is adequate knowledge and skills of these special bodies, hence the intervention work for the strengthening of the systems and procedures towards institutionalization. Pre-operations Activities: NV-ILGA Organizational Structure Provincial Executive Board PPMU Management Committee Project Management Unit UNFPA Project Coordinator Technical Support Group Project Coordinator Project Coordinator Administrative Support Group Federation of BHWs MHOs MHBs MDCs Liga ng Mga Brgy MPOs MSD WOs BDC Committee on Health and Nutrition Barangay Health Station Community 4

DISCUSSION OF RESULTS Prior to the formal start of project implementation, signing of project agreement through MOA was done between UNFPA Provincial Project Management Unit of Nueva Vizcaya, and Nueva Vizcaya Institute for Local Government Administration Provincial Executive Board (PEB) and Management Committee (MANCOM) then followed by establishing Project Management Unit and required project hired staff. RH project orientation was conducted and development of project operation plan and procedures including coordination and networking with partner agencies, the Provincial and Municipal Health Offices. A. Operations: Hands-on Institution Building 1. Municipal Development Plans (MDP) Involvement of partner agencies and concerned stakeholders in every aspect of the project major activities were very significant to ensure in depth adoption of the project system and methodologies. Facilitated institutionalization of the project activities, consultation meeting on the identification of target barangays were implemented in every municipality which were attended by the members of the Management Committee (MANCOM); Federation of BHWs Presidents, Municipal Health Boards/Municipal Development Councils, Liga ng mga Barangay/ABC Presidents, Municipal Planning Officers, Municipal Social Work and Development Officers and Municipal Councilors Chairmen on Committee on Health. The RH Municipal Core Group identified six (6) barangays in each of the 9 municipalities on a pilot basis through their formulated criteria as CBRH Project Areas. As a result, fifty-four-(54) barangays were identified as shown in table 1. Table 1. List of municipalities and barangays (communities) as pilot areas Municipalities Pilot Barangays 1.Alfonso Castaneda Abuyo Lipuga Cawayan Lublub Galintuja Pelaway 2.Ambaguio Ammoweg Labang Camandag Poblacion Dulli Tiblac 3.Aritao Bone North Darapidap Bone South Poblacion Comon Sta Clara 4.Diadi Arwas Duruarog Butao Lurad Escoting San Pablo 5.Dupax del Norte Belance Ineangan Binuangan Lamo Bitnong Malasin 6.Kasibu Binogawan Kongkong Catarawan Malabing Cordon Muta 7.Kayapa Acacia Cabanglasan Baan Kayapa Proper West Besong Pangawan 8.Quezon Baresbes Darubba Calaocan Maddiangat Caliat Nalubbunan 9.Sta Fe Bacneng Baracbac 5

Balete Baliling Tactac Villa Flores To ensure all-out support, integration and implementation of Barangay Plans relative to the CBRH Project series of Municipal Development Council Meeting-Workshop was conducted separately in all the nine (9) municipalities namely: Alfonso Castaneda, Ambaguio, Aritao, Diadi, Dupax del Norte, Kasibu, Kayapa, Quezon and Sta Fe. These series of workshops conducted were facilitated by NV-ILGA Project Staff and the Municipal Development Planning Coordinator (MPDC), Municipal Health Officer (MHO), Municipal Local Government Operation Officer (MLGOO), Municipal Social Welfare Development Officer (MSWDO), Presidient of the Municipal BHW Federation and the ABC President. The conduct of these series off activity were actively participated in by the respective Sangguniang Bayan Chairmen on Committee for Health, Punong Barangay (Barangay Captains), Barangay Kagawad on Health, Barangay Health Workers, Barangay Nutrition Scholars, Day Care Workers and Rural Midwives. It is in these meeting workshops wherein all barangays covered by the respective municipalities were asked to present their Barangay Development Plan (BDP) with focus on Reproductive Health for the integration into the Municipal Master Development Plan. In this scheme, funds for Reproductive Health activities in the pilot barangays were ensured for allocation. These activities were conducted every after six (6) months which started on September 2002 up to March 2004. Provision of annual budget allocation for Reproductive Health in nine (9) municipalities and in the target barangays started in year 2003 until year 2004. Municipal Development Councils were also encouraged to sustain the allocation of fund for RH activities as well as in the barangay level. 2. Barangay Development Plan (BDP) Barangay Orientation Meetings and Action Planning were conducted to the target eighteen (18) barangays in every quarter. Of the nine (9) municipalities, six (6) met the target schedules of Barangay Development Planning namely Ambaguio, Diadi, Dupax del Norte, Quezon, Kasibu and Kayapa. Three (3) municipalities did not meet the target number and schedule of Barangay Development Planning. (Alfonso Castaneda, Sta Fe and Aritao) due to inaccessibility of places caused by typhoons, unavailability of other concerned partner agencies and the process of BDP methodology was not much acceptable for the BDCs. Through the joint facilitation of NV-ILGA Community Organizers, Municipal Planning and Development Coordinators, Municipal Budget Officers, Municipal Health Officers, Rural Health Midwives and Municipal Councilors in-charge on Health Committees, all the fifty (50) pilot barangays were facilitated in undertaking the Barangay Development Planning Workshops (BDPWs) with a maximum of four (4) meetings and a minimum of two (2) days. These barangays were mobilized taking action in addressing the RH concerns in the barangay. A total of one hundred thirty (130) Barangay Development Planning Workshops were facilitated in fifty (50) pilot barangays. All these meeting-workshops facilitated were achieved in closed coordination and collaboration with the Local Government Units (LGUs) at the provincial, municipal and barangay levels. The Barangay Development Plans covered components in General Services Sector, Economic Sector and Social Sector of which all of the prioritized projects and activities identified based on the Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis under each sector were included in the prepared Barangay Development Plans. It is stated in the mandated functions of the Expanded Barangay Development Council that one of their functions is to prepare Barangay Development Plan (BDP) based on needs. The workshops on the Barangay Development Planning have been attended by the Expanded Barangay Development Council members included the following: Barangay Development Council, Barangay Lupon, Chief of Barangay 6

Tanod, Barangay Secretary, Barangay Treasurer, SK Chairman and Secretary, Purok or Sitio Presidents, Rural Health Midwives, Barangay Health Workers, Barangay Nutrition Scholars, Day Care Workers, Principal/Teacher In-Charge, Chairman / President of Farmers Organizations, Cooperatives, People s Organizations, Tribal Chieftain, other Government Workers assigned in the project area. With the participants from the different sectors in the barangay, integration of the Reproductive Health Program in all the Barangay Development Plans formulated were ensured including the allocation of fund to the prioritized RH project or activity taken from the Internal Revenue Allotment (IRA) of the Barangay. With the participative approach in the conduct of the series of Barangay Development Planning, it is observed that there is improvement in the knowledge and awareness level on RH issues and concerns among the men, women and adolescent participants as indicated by their active participation through monitoring and evaluation and the planning workshops especially on health in general as given emphasis during the workshops. Considering the project sustainability, potential facilitators and documenters of respective pilot barangays were also identified and were given tasks to facilitate and document during the conduct of Barangay Meeting-Workshops. With the continued conduct of BDP activity, 80% of the pilot barangays have capable and trainable facilitators and documentors. In terms of planning, implementation, monitoring, evaluation and management, it is also noted that 85% of the facilitated barangays are capable of doing their tasks with minimal supervision and technical assistance from outside human resources. Monitoring and evaluation of the implementation of Barangay Action Plans was also conducted by NV- ILGA in cooperation with the Municipal Health Offices and Municipal Planning Development Offices Coordinators and or staff through Regular Expanded Barangay Development Council Meeting in the respective barangays with the use of Monitoring and Evaluation forms, actual visit in the project area and interview with the implementors. Table 2. List of barangays with development plans Name of Municipality Name of Barangay No. of BDPs conducted Inclusive Dates of BDP Workshops 1.Alfonso Castaňeda Abuyo 3 January 8-9, 2003 August 28-29, 2003 April 15-16, 2004 Cawayan 3 March 14-15, 2003 October 20-21, 2003 May 28-29, 2004 Galintuja 3 December 9-10, 2002 May 15-16, 2003 November 18-19, 2004 Lipuga 3 March 10-12, 2003 October 14-15, 2003 May 24-25, 2004 Lublub 3 December 11-12, 2002 August 5-6, 2003 December 18-19, 2003 Pelaway 3 March 12-13, 2003 October 16-17, 2003 May 26-27, 2004 2. Ambaguio Labang 3 October 15-16, 2002 March 27-28, 2003 September 17-18, 2003 7

Poblacion 3 October 17-18, 2002 July 2-3, 2003 December 3-4, 2003 Tiblac 3 November 4-5, 2002 February 7-8, 2003 June 30-July 1, 2003 Ammoweg 3 May 15-16, 2003 December 12-13, 2003 March 18-19, 2004 Camandag 2 October 28-29, 2003 March 9-10, 2004 Dulli 2 October 28-29, 2003 April 5-6, 2004 3. Aritao Bone North 2 October 4-5, 2002 September 4-5, 2003 Bone South 3 October 10-11, 2002 July 3-4, 2003 April 29-30, 2004 Comon 2 November 12-13, 2002 June 16-17, 2003 Darapidap 3 November 17-18, 2002 May 29-30, 2003 May 4-5, 2004 Poblacion 2 October 3-4, 2002 May 29-30, 2003 Sta Clara 3 November 28-29, 2002 May 19-20, 2003 April 27-28, 2004 4. Diadi Arwas 2 November 28-29, 2002 November 20-21, 2003 Escoting 3 October 15-16, 2002 September 10-11, 2003 November 26-27, 2003 Duruarog 2 July 10-11, 2003 October 20-21, 2003 Butao 4 July 15-16, 2003 September 21-22, 26, 2003 November 17-28, 2003 March 29-30, 2004 Lurad 3 June 10-11, 2003 December 18-19, 2003 April 17-18, 2004 San Pablo 3 July 17-18, 2003 November 24-25, 2003 April 12-13, 2004 5.Dupax del Norte Belance 3 October 29-30, 2002 June 18-19, 2003 March 24-25, 2004 Binuangan 3 October 22-23, 2002 May 22-23, 2003 May 22-23, 2004 Bitnong 3 November 21-22, 2002 October 16-17, 2003 8

March 26-27, 2004 Ineangan 3 April 22-23, 2003 December 4-5, 2003 March 15-16, 2004 Lamo 3 April 22-23, 2003 August 16-17, 2003 March 19-20, 2004 Malasin 3 March 9-10, 2003 July 13-14, 2004 March 17-18, 2004 6. Kasibu Kongkong 2 November 6, 2002 December 9-10, 2003 Malabing 2 June 16-17, 2003 December 9-10, 2003 Muta 2 October 8-9, 2002 July 29-30, 2003 Binogawan 3 April 14-15, 2003 August 5-6, 2003 May 20-21, 2004 Catarawan 2 May 19-20, 2003 May 6-7, 2004 Cordon 3 May 21-22, 2003 November 13-14, 2003 May 15-16, 2004 7. Kayapa Acacia 2 June 10-11, 2003 November 4-5, 2003 Baan 3 May 22-23, 2003 September 22-23, 2003 April 2-3, 2004 Besong 3 December 27-28, 2002 May 13-14, 2003 September 18-19, 2003 Cabanglasan 3 May 6-7, 2003 October 9-10, 2003 March 29-30, 2004 Kayapa Proper West 3 November 21-22, 2002 July 8-9, 2003 November 18-19, 2003 Pangawan 3 November 25-26, 2002 June 20-21, 2003 November 20-21, 2003 8. Quezon Baresbes 1 October 13-14, 2003 Caliat 2 September 5-6, 2002 July 24-25, 2003 Maddiangat 2 September 5-6, 2002 October 15-16, 2003 Calaocan 3 May 19-20, 2003 November 4-5, 2003 April 28-29, 2004 Darubba 3 June 3-4, 2003 November 10-11, 2003 March 15-16, 2004 Nalubbunan 2 November 6-7, 2003 9

May 13-14, 2004 9. Sta Fe Bacneng 0 (Not Conducted) Balete 0 (Not Conducted) Baliling 1 February 17-18, 2004 Baracbac 0 (Not Conducted) Villa Flores 0 (Not Conducted) Tactac 1 March 23-24, 2004 3. Barangay Health Services Reproductive Program was integrated in all the Barangay Development Plans of the fifty (50) pilot barangays of the Community-Based Reproductive Health Project. Barangay Health Services were always given emphasis during the conduct of Barangay Assessment and Development Planning especially on the integration of any of the ten-(10) elements of Reproductive Health. With the facilitated Barangay Development Planning Workshops, it is commonly observe that the participants had given priority mostly on the Maternal and Child Health, Expanded Program on Immunization, Family Planning, Male Reproductive Health, Adolescent Reproductive Health, and Nutrition Program. For the implementation of the prioritized Reproductive Health Elements which were not included in the regular program of the Department of Health, Provincial Health Office and Municipal Health Office as well as for the purchase of identified and prioritized equipment and materials to have better provision of barangay health services, the Expanded Barangay Development Council had allocated fund amounting with an average of Two Thousand Pesos (P2,000.00) up to Ten Thousand Pesos (P10,000.00) annually, aside from the integration of the RH elements Regular conduct of Household Teaching Class (HTC) in all the pilot barangays were noted as one of their means of doing Information, Education and Communication (IEC). This activity was facilitated by the respective Rural Health Midwives, Barangay Health Workers and Barangay Nutrition Scholars. The Barangay Health Workers were also trained on Reproductive Health for them to provide more quality Reproductive Health services to the barangay constituents. Through the trainings conducted, the technical capacity of service providers at all levels of the health service delivery system was enhanced for the provision of Reproductive Health services. Knowledge and awareness level among men, women and adolescents on reproductive health issues and concerns including the Barangay Health Workers and Barangay Nutrition Scholars were enhanced through the conducted trainings, barangay orientations and series barangay assessment and development planning/budgeting workshops. Improvement of existing Barangay Health Stations/Centers and construction of new Barangay Health Stations/Centers were also noted in most of the barangays except for those which constructed their health stations on a catchment s basis of which one (1) Health Center/Station is servicing 3 to 5 barangays. ANALYSIS A. Evaluation: Attainment of the Project The Reproductive Health project had contributed to the protection of mothers from danger during delivery, control of population, and improvement of provision of Reproductive Health services by the health service providers such as Barangay Health Workers, Barangay Nutrition Scholar, and Rural Health Midwife. It also increased advocates for gender-sensitive issues and Reproductive Health issues and information. The covered barangays had committed to annually allocate fund for the Reproductive Health services with an average amount of P2,000 to P10,000 for the acquisition/purchase of identified and prioritized equipment/facilities needed and activities. 10

Capability of Expanded Barangay Development Council Members in planning. monitoring and evaluation is increased. Births assisted by trained Rural Health Unit personnel and Volunteers is also increased. Women with obstetric complications were treated in referral to hospitals. Increase number of pregnant women treated for prenatal and postnatal check-up especially in the rural barangays. It also contributed to the technical capacity of health services providers at all levels, improved provision of reproductive health services and increase awareness among men, women and adolescents on Reproductive Health issues and concerns B. Benefits Delivered to Target Group During the project duration, financial and technical assistance were provided to all the pilot areas of the Community-Based Reproductive Health Project. An amount of P4,000.00 was provided for every conduct of Barangay Development Workshop in each Barangay. Technical assistance specifically facilitation and documentation was provided as well as lobbying for the regular funding of Reproductive Health activities and concerns to the Barangay and Municipal level was also extended. Reproductive Health activities, which were not being prioritized before the entry of the CBRH Project, became one of the priorities of the MLGU and BLGU during development planning activities. Opportunities in trainings/seminars were also one of the benefits gained by all the Barangay Health Workers and Barangay Nutrition Scholars. Through the training, it helps the primary health service providers improved their capacity in providing the health services needed in their respective barangays. C. Levels of Groups in Planning, Implementation and Evaluation Skills During the last year of the project, all the pilot barangays are now about 80% capable of facilitating and conducting planning, implementation, monitoring and evaluation with the use of the introduced process workshop flow and the previous Barangay Development Plan. While 15% still need maximum supervision and technical support from outsiders/agencies. CONCLUSIONS Generally, the project goals and objectives were achieved which contributed in the development of the communities at various levels. Successful implementation of project activities has enhanced to the commitment and capability of the Expanded Barangay Development Councils (EBDCs) in planning, implementation, monitoring and evaluation of the community project and activities. Despite of the very limited life of the project which fast tracked the implementation of activities, various learnings and experiences from the pre-project operation to post project implementation were documented for guidance and replication of similar projects in the future. The communities initiative and sincere commitment to continue and maintain the project activities especially the regular allocation of fund for RH activities despite of their limitations especially financial resources should be recognized and take as an opportunity by the Municipal and Barangay Local Government Units and Municipal Health Office towards sustainability of the project. These agencies should uphold and affirm their commitment towards the realization of the project goals even without or minimal external assistance. RECOMMENDATIONS 11

The following are based from the experiences gained from the implementation of the project that can be replicated by other similar and future projects. Project Preparation The stages of implementation should be clearly specified from preparatory phase to its last stage which is monitoring and evaluation All stakeholders especially the Barangay should be involved in the planning process Clear and implementable sustainability activity and mechanisms should be integrated Implementation Continuous capacitating of Expanded Barangay Development Councils (e.g. provision of trainings and seminars) Strengthening of finances in the barangay (livelihood generation, financial management) Develop functional linkage of programs and resources and networking strategies Community Organizing Community Organizing should lead to increased efficiency in resource utilization, more equal distribution of benefits and increased awareness that by joint/collaborative efforts considerable changes can be achieved. This includes education and conscientization. The barangays should be assisted to realize the nature of problems they face and their own strengths. Municipal Level Provision of technical trainings to the BLGU Integration of the barangay plan to the municipal development plan Provincial Level Institutionalization of the project to the over-all environment program of the provincial government Provision of technical and financial assistance to the BLGU A collaborative approach is effective to encourage the stakeholders to participate (active and proper coordination, multi-agency planning and assessment activities, regular updating among stakeholders and other related activities) Education, Information and Communication activities, community organizing is an effective tool for a participatory implementation of project activities. The conduct of regular Project Status and Analysis Report should be maintained and developed; not only the financial aspect should be documented but also the processes undertaken, this will clearly show the progress and problems of project implementation (planned targets versus actual accomplishment) A combination of top-down approach and community based up to the project management balances the implementation performance at all level Organization and Management The operational structure should clearly state the specific roles and responsibilities of the project management and the respective project management officers and LGU detailed staff. The project management as the project administrator; and the Project Manager should lead in all aspects of the project operation, sufficient number of administrative staff will also contribute to efficient administration. Facilitative and practical leadership on project management and supervision allows the project to be flexible and conscious on the expected output of the project activities. Giving the project 12

management certain level of autonomy on decision making but considering the policies and guidelines brings forth initiative and new strategies on how to implement the project activities. Monitoring and Evaluation A simplified and use of friendly monitoring and evaluation scheme (all sectors should be in place before the project phase out with considerations to the qualitative and quantitative output on major activities and components Regular conduct of meetings to have an update on the progress of implementation (collaborative approach-all stakeholders involved) Creation of an internal monitoring unit or committee of the project aside from the UNFPA and NV- ILGA monitoring and evaluation units. PROBLEMS ENCOUNTERED AND RECOMMENDATIONS A. Project Weaknesses Management staff involved in the project was part timers and holding managerial positions in their respective agencies or office assignment, which limit them from doing their tasks effectively and efficiently. Originally, the project had adopted the government accounting system in terms of project staff salary, per diem, and others that concerns the project implementation. Modification was done because of difficulties experienced in the purchasing of supplies and materials needed for the conduct of Barangay Development Planning. Electronic bidding of supplies and materials, which was being used by the institution, hampered the fast processing of purchasing financial assistance to the barangays covered by the project. B. Project Strengths Technically, the project has enough source of trained and experienced pool of trainers to tap in facilitating the conduct of the project activities. It has supportive Municipal Local Government Unit partners except for one (1) municipality in the implementation of the project activities. Barangay Planning includes addressing of identified and prioritized issues in the Social, Economic and General Services Sectors. Application of learnings on Reproductive Health by concerned people in the project areas were now observable Technical know-how and skills of the respective Expanded Barangay Development Council Members in planning, implementation, monitoring and evaluation were developed and enhanced. Pilot barangays without Barangay Health Station/Center were motivated to construct their own. Barangay Monitoring and Evaluation Team were organized to most of the pilot barangays Barangay networking/linkaging skills were developed and improved. Supportive Provincial Executive and most Municipal Local Government Unit partners Receptive Barangay Local Government Units Presence of active, stable and supportive project partners such as Department of Interior and Local Government (DILG) and Nueva Vizcaya State University (NVSU) Respective barangays have established their network with other government line agencies and other funding agencies. The project has the capacity to advocate the Reproductive Health concerns. Existing practice of participatory governance in the province has facilitated the project implementation. C. Replicable Strategies 13

The Hands-on Institution Building as the project major strategy was proven to be effective and efficient as manifested by the project achievements during its implementation. D. Plan/Provisions for Follow-Up Action The Information Education and Communication (IEC) is very important in the concern of dissemination of information to make people in the barangays aware of the project activities as well as the all the other matters concerning the barangays. It is an activity that should be integrated in all project activities and not as a separate activity from the others. Since it is proven to be effective when integrated in all activities, future health projects to be implemented should consider inclusion of regular newsletter, flyers, leaflets, video shows, photo exhibits, project articles and other effective IEC activities to facilitate dissemination of project information. To have a good quality of photo documentation of the project activities as well as to lessen wastage, training on photography for all the project staff that would be involved in documentation should be included. The need to advocate for the formal institutionalization of the process in the province is still needed. BIBLIOGRAPHY Cascade-Department of Agriculture European Union Institute for Local Government Administration. Comprehensive Barangay Development Planning Manual, 2000 Department of Health United Nations Population Fund. Reproductive Health Survey 2000 (5 th Country Programme of Assistance to the Philippines 2000 2004), 2000. DOH UNFPA. Project Development and Evaluation Workshop, Baguio City, July 30 August 2, 2001. Institute for Local Government Administration. Community Based Reproductive Health Project, Annual Report 2002, 2003. LGU Aritao, Nueva Vizcaya. The Integration of Reproductive Health into the Municipal Comprehensive Development Plan/Master Plan, 2003 Nueva Vizcaya State Institute of Technology (NVSU) DOH UNFPA. Quality of Care Assessment Survey of the Reproductive Health Programme in Nueva Vizcaya, 2002. NVSIT (NVSU) PLGU PHO. Situation and Response Assessment on STD/HIV/AIDS in the Province of Nueva Vizcaya, 2001. University of the Philippines, Manila College of Public Health and the National Institute for Health, Reproductive Health Module For Doctors/Nurses, 1999 United Nations Population Fund (UNFPA). Nueva Vizcaya Population/RH Advocacy Project (PHI/05/03/P05), 2000. Aus-Aid Project. Women s Health Training Project, Modules for Rural Health Physicians. Identifying Information: 14

Project Title: Project Coordinator: Institution Building: Community Based Reproductive Health Project Dr. Estelita V. Tucay Implementing Agency: Lead Agency: Cooperating Agency: Funding Agency: Duration: Nueva Vizcaya State University (NVSU) Nueva Vizcaya Institute of Local Government Administration (NV-ILGA) Department of Health Provincial and Municipal Health Offices / Rural Health Unit; Local Government Units (Provincial, Municipal, Barangay) United Nations Population Assistance (UNFPA) 5 th Country Programme Assistance to the Philippines Date started: June 1, 2002 Date Ended: July 31, 2004 ACKNOWLEDGEMENT The author wishes to acknowledge the NV-ILGA PEB, MANCOM PMU, CBRH Project Management, Field and Administrative Staff; UNFPA National, Regional, Provincial PPMU, and Project Coordinator; LGU Key Staff at the Provincial, Municipal and Barangay Levels; all stakeholders in the health sector, and NVSU Management and RET Staff for their all-out moral support, financial, technical and material assistance in the conduct of the project. 15