QUARTERLY REPORT - United States Agency for International ...

VisayasHealth Quarterly Report ● October 1, 2014 – December 31, 2014 1

QUARTERLY REPORT

Reporting Period

01 October 2014 – 30 December 2014

VisayasHealth

Submitted to

United States Agency for International Development

by

VisayasHealth

New York, NY, USA &Cebu, Philippines

under

Agreement No. AID-492-A-13-00007

31 January 2015


Table of Contents

List of Abbreviations ................................................................................................................. 3

I. Background ................................................................................................................................................... 5

II. The Project and Objectives ...................................................................................................................... 11

III. Accomplishments ...................................................................................................................................... 12

IV. Reasons for Variances in the Performance ........................................................................................... 22

V. Major Implementation Issues .................................................................................................................. 24

VI. Milestone, Key Tasks and Activities ...................................................................................................... 25

VII. Financial Reports ....................................................................................................................................... 35

VIII. Success Stories / Highlights ..................................................................................................................... 36

IX. Communication and Outreach ................................................................................................................ 39

ANNEXES :

Annex A. Gender .................................................................................................................................................. 41


List of Abbreviations

AJA Adolescent Job Aid ANC Ante-Natal Care BHW Barangay Health Worker BTL Bilateral Tubal Ligation CA Cooperating Agency (ies) CCT Conditional Cash Transfer CBT Competency-Based Training CDI Cities Development Initiative CHO City Health Office CHT Community Health Team CMSU Community MNCHN Scale Up CPO City Population Office CPR Contraceptive Prevalence Rate DOH Department of Health DOHRO Department of Health – Regional Office DQC Data Quality Check DSWD Department of Social Welfare and Development EINC Essential Intra-partum and Newborn Care EVRMC Eastern Visayas Regional Medical Center FBD Facility-Based Deliveries FHSIS Field Health Service and Information Survey FP Family Planning FPCBT Family Planning Competency-Based Training GCGMH Governor Celestino Gallares Memorial Hospital HSP Health Service Provider ICV Informed Choice and Voluntarism IEC Information, Education, and Communication Inter-CA Inter -Cooperating Agencies (of USAID) IUD Intra-Uterine Device JHPIEGO John Hopkins Program for International Education on Gynecology & Obstetrics KP Kalusugang Pangkalahatan (Universal Healthcare) LAPM Long-Acting and Permanent Method LGU Local Government Unit MDG Millennium Development Goal MCH Maternal and Child Health MCHIP Integrated Maternal and Child Health Program MCP Maternity Care Package MHO Municipal Health Officer MMR Maternal Mortality Rate MNCHN Maternal, Newborn (or Neonatal), and Child, Health and Nutrition NCP Newborn Care Package NGO Non-Government Organization NSV Non-Scalpel Vasectomy PC Provincial Coordinator PHN Public Health Nurse PHO Provincial Health Office POPCOM Population Commission PhilHealth Philippine Health Insurance Corp. (also referred to as PHIC)

PRIMEX Pacific Rim Innovation & Management Exponents, Inc. PRISM2 Private Sector Mobilization for Family Health project – Phase 2


PSI Progestin-containing Sub-dermal Contraceptive Implant PTP Pregnancy Tracking Package PYP Program for Young Parents RH Reproductive Health RHM Rural Health Midwife RHU Rural Health Unit RO Regional Office SDN Service Delivery Network SDP Service Delivery Point SEED Supply, Enabling Environment, Demand TM MS Short Messaging System STTA Short-term technical assistant/ce TA Technical Assistance TOT Training of Trainers USAID United States Agency for International Development USG United States Government VH VisayasHealth Project VOC Visayas Operations Cluster VSMMC Vicente Sotto Memorial Medical Center VSC Voluntary Surgical Contraception VSS Voluntary Surgical Sterilization WVMC Western Visayas Medical Center


I. INTRODUCTION

A. Background

The United States Agency for International Development (USAID) is providing assistance to the Philippines in the form of an integrated regional maternal, neonatal, child health, nutrition (MNCHN), and Family Planning (FP) project in the Visayas. EngenderHealth (EH) and its partners will apply their complementary individual and collective institutional expertise to implement VisayasHealth. The project will scale up proven and effective practices in the following provinces: Iloilo and Negros Occidental in Western Visayas; Bohol and Cebu in Central Visayas; Leyte, Southern Leyte, Samar and Northern Samar in Eastern Visayas.

VisayasHealth seeks to improve the health of families in the Visayas region through strategic interventions on increasing demand and enhancing the supply of MNCHN and FP services as well as strengthening the capacity of Department of Health Regional Offices (DOHROs) as stewards for the implementation of FP/RH programs. The project will expand access to high quality integrated MNCHN/FP services to help reduce unmet need for family planning, especially among the poor and women below age 18; improve access to quality maternal and newborn care; and increase exclusive breastfeeding among infants from birth up to six months old.

Philippines’ health statistics and in the Visayas in particular, show high unmet needs for quality MNCHN and FP services, especially among the vulnerable poor and geographically isolated families who comprise nearly one third of the total households. VisayasHealth hopes to contribute to efforts towards achieving the Millennium Development Goals (MDG) 4 and 5 on reducing under-five and maternal mortality.

Poor MNCHN/FP outcomes are attributed to the following:

Inadequate behavior change focused interventions

Inadequate supply of accessible and quality services in health facilities

Policy and systems barriers to service delivery

Table1: Project Sites

Region Province

Western Visayas Iloilo and Negros Occidental

Central Visayas Cebu and Bohol

Eastern Visayas Leyte, Southern Leyte, Samar and Northern Samar

Partnering with public health and local government officials, and with private sector and civil society groups, VisayasHealth will work in 8 provinces and 259 municipalities/cities to accelerate progress towards achieving MDGs. The main focus will be increasing demand and improving supply of MNCHN/FP services and prioritizing targeted geographic areas as well as creating an enabling environment to yield maximum results. VisayasHealth will work to address provider bias and myths and misconceptions on FP; promote post-partum and other long-acting and permanent FP methods; mobilize community networks for health promotion, adopting proven high impact interventions as appropriate. The following key interventions will be implemented in partnership and close collaboration with the DOHROs:

Increase demand for MNCHN/FP services

Strengthen the skills of CHTs and facility based providers to promote MNCHN/FP services.

Apply modern communication technology to reach clients

Reduce financial barriers to MNCHN/FP services

Increase supply of quality MNCHN/FP services

Enhance CHT skills to offer a basic integrated MNCHN/FP package to the community

Provide regular quality integrated MNCHN/FP ambulatory services in areas of need


Improve quality and range of integrated MNCHN/FP services at selected static public and private sites

Remove local policy and health systems barriers

Facilitate promulgation of supportive local policy

Improve training and facilitative supervision systems

Improve data management and utilization in LGUs

Strengthen logistics management systems

B. Summary of Accomplishments of the previous quarters

1. Year 1 Quarter 1 (19 February – 31 March 2013)

Initial mobilization was completed, which covered the hiring of key staff for the Cebu City-based EngenderHealth-VisayasHealth (VH)project office, as well as negotiation with the DOH for a temporary office space while securing permanent office space. A pre-award sub-agreement was issued to PRIMEX, amounting to US$35,000. Additionally, a third party administration vendor—KMC Solutions—was contracted to manage staff payroll. As these activities were underway, the work planning process for the project’s first year was conducted on March 18-22, 2013 and was followed by a series of engagements with the DOH Regional Office (DOH-RO) and the Visayas Operations Cluster (VOC).

2. Year 1 Quarter 2 (1 April – 30 June 2013)

a. Project Management. Rapid mobilization of the project was undertaken with the selection and recruitment of 90% of the staff and procurement of office equipment, including laptops, desktop computers, fax machines, and printers. Establishing the permanent office space was undertaken through a local contractor once the lease agreement with the DOHRO 7 was signed. The first Visayas inter-Cooperating Agency (Inter-CA) coordination meeting was organized to encourage better and more effective collaboration among USAID CAs. The workshop was attended by representatives all seven USAID CAs and their respective Agreement Officer Representatives (AOR) from the Office of Health (OH). A harmonized, Visayas-wide project implementation plan for the period June to September 2013 was developed and a coordination mechanism defined for the Inter-CAs to observe with DOH-ROs and LGU partners.

b. Project Components

i. Increase demand for MNCHN/FP by training providers on the Usapan series, the primary demand-generation mechanism adopted by VH (VH). Usapan sessions are designed specifically for pregnant mothers, both those who want more children and those who wish no longer to have children, and for men who want to be involved in FP. Usapan trainings were conducted in facilities with a high volume of deliveries.

ii. Improve supply by conducting an initial batch of postpartum intra-uterine device (PPIUD) trainings on June 24-26, 2013 in collaboration with the Vicente Sotto Memorial Medical Center (VSMMC) and the Maternal and Child Health Integrated Project (MCHIP) of JHPIEGO. A total of 19 service providers were trained in PPIUD service provision from hospitals/birthing clinics in the VH project area with a high volume of deliveries.

A total of 46 health providers were trained on FP competency-based training (FPCBT) level 1; 27 were trained on FPCBT level 2; 97 were trained on long-acting and permanent methods (LAPMs), such as female sterilization(FS) and no-scalpel vasectomy (NSV); and 20 were trained in supportive supervision. A total of 110 providers were trained on informed choice and voluntarism (ICV) to ensure that client’s rights are respected, protected, and fulfilled and that they have access to the contraceptive method best suited to their reproductive intentions and desires.


3. Year 1 Quarter 3 (July 1 to September 30, 2013)

a. Project Management: During the period of 01 July to 30 September 2013, VH completed the hiring of all project technical staff and procured all the equipment necessary for project implementation. The project was able to secure a permanent office space within the DOH-RO 7 compound. VH also finalized its Year 2 project work plan.

b. Project Components

i. Increasing Demand.Under this component, VH project trained 270 health service providers (HSPs) to facilitate the Usapan sessions. These providers conducted Usapan alone or in tandem with another trained provider. As of end of September 2013, these providers were able to conduct189 Sessions and reached 2,890 clients (See Table 6). Another 185 clients were also reached during Usapan training conducted by VH staff.

As part of VH’s efforts to integrate FP into existing MCH services, the project introduced the Usapan series to post-partum clients. This intervention was introduced in hospitals and birthing centers to clients prior to discharge after delivery. VH trained health care providers to organize Usapan sessions in maternity wards. Data from three hospitals showed a significant increase by 50 % (See Table 10) in the number of postpartum FP (PPFP) clients after this intervention was introduced.

ii. Improving Supply.In coordination with the ROs in Regions 6, 7, and 8, USAID CAs (including PRISM 2, MCHIP, 8 LGUs, and NGOs [Integrated Midwife Association of the Philippines, Siliman University Medical Center], VH identified and facilitated the training of service providers and trainers on LAPMs of FP (especially the PPIUD, female sterilization, and NSV) and essential intra-partum and newborn care (EINC). Prioity was given to the trainingof providers fromfacilities with a high volume of deliveries and areas with high unmet need for FP, as identified in previous studies.

On 24-27 June 2013 and 27-31August 2013, VH organized two training courses for PPIUD insertion at the VSMMC in Cebu City. A total of 35 health professionals completed the training requirements and became certified PPIUD providers. The training course included a 3-day didactic discussion and 2-day practicum where participants practiced insertion of an IUD on models, as well as actual clients. Trainees came from regional/DOH-retained hospitals (5), provincial hospitals (6), district hospitals (5), and one private hospital.

iii. PPIUD service provided to 670 clients. Between July and September 2013, 670 post-partum women were provided PPIUD services and became users of the method. These women were provided counseling prior to the provision of PPIUD services. Based on client exit interviews and informal dialogues, clients expressed satisfaction with the opportunity to initiate use of an FP method at the time of delivery, prior to being discharged from the maternity ward.

4. Year 2 Quarter 1 (October 1– December 31, 2013)

a. Response to Earthquake and Typhoon Disasters

i. Bohol Earthquake.On October15, 2013 a powerful earthquake registering 7.5 magnitude hit the province of Bohol causing massive damage to thousands of homes; tens of thousands of residents were rendered homeless and had to be relocated to evacuation centers. As assessment conducted by VHof health facilities in Bohol found that 3 district hospitals, 5 main health centers, and 30 Barangay Health Stations (BHSs) were heavily damaged. At the request of the Philippines Department of Social Welfare and Development (DSWD), VH procured hygiene kits for the affected families, which contained water pails, soap, shampoo, toothbrushes, laundry soap, sanitary napkins, and other items needed for maintaining proper personal hygiene. These items were turned over to the DSWD in Tagbilaran City by Ms. Gloria Steele, Mission Director of USAID/Philippines in a formal public ceremony attended by Gov. Edgardo Chatto and provincial officials from Bohol Province. In addition, the project provided emergency lights and other emergency supplies to the affected health facilities, particularly the health centers in the municipalities of Carmen, Catigbian, and Sagbayan.


ii. Typhoon. On November 8, 2013, a super-typhoon with maximum winds of 200 km per hour ravaged the provinces of Samar, Leyte, Cebu, and Iloilo. The typhoon caused significant damage to health facilities and other infrastructure and affected millions of people living in these areas. A rapid assessment was conducted by VH teams in the provinces of Leyte, Northern Cebu, and South Iloilo municipalities which determined the priority health facilities. The project responded to this disaster through the following activities: the provision of nutrition kits; the provision of tents to serve as temporary health centers; the provision of logistical and technical support to the VOC during the immediate relief and emergency response period.

VH facilitated the deployment of six solar-powered refrigerators for the DOH 8 to prevent damage to vaccines as a result of the absence of electricity. Finally, VH partnered with other donors and agencies to repair and rehabilitate affected health centers and village health stations.

b. Completion of baseline survey in eight provinces. The baseline survey for VH was conducted in the provinces of Iloilo, Negros Occidental, Bohol, Negros Oriental, Leyte, South Leyte, Samar, and North Samar in October 2013. The survey generated important information on the status of demand generation, supply-related issues, and policies and health systems in the Visayas region. Baseline survey results were presented during a DOH-VOC meeting and during meetings of the DOHRO and provincial health offices. The results are summarized below and were used to adjust the project's quarterly and annual targets.

5. Year 2 Quarter 2 (January 1 – March 31, 2014)

a. Increase in the number of trained PPFP/PPIUD providers. Utilizing the newly established PPFP/PPIUD training centers in the provinces of Iloilo and Bohol, VH conducted two training courses that increased the number of trained PPFP/PPIUD providers to 51 in the Visayas region.

b. Increase in the number of trained voluntary surgical sterilization (VSS) providers. VH assisted 7 female sterilization providers in the provinces of Leyte, Bohol, Negros Occidental, and Iloilo in the completion of their training requirements. The training was completed under the guidance of the project's clinical consultant who is an accredited trainer of the DOH.

c. Introduction of the Program for Young Parents (PYP) in Vicente Sotto Memorial Medical Centre (VSMMC). With the assistance of a VH consultant from the Philippine General Hospital, VSMMC launched the PYP on March 4, 2014. The PYP intervention is designed to reduce teenage pregnancies by helping currently pregnant teenagers postpone or delay their next pregnancy. The Deputy Mission Director of USAID was the guest of honor during the launch.

d. Introduction of events-based demand generation and service delivery activities. VH staff assisted local health providers in organizing events for pregnant women and their partners to improve attendance in antenatal care (ANC) clinics and increase the number of FBDs. These events and celebrations were well attended and serve as a template for improving demand generation and service delivery activities.

e. VisayasHealth Technical Start-up Workshop.This was conducted last February 17-21, 2014 with the support of EngenderHealth Clinical Support Staff. All VisayasHealth regional and field staff participated in the workshop. Topics included The SEED Programming Model, EngenderHealth and the US government legislative policy requirement, the clinical quality framework, contraceptive technology update, skills on the provision of PPIUD and Sub-dermal Implants.

6. Year 2 Quarter 3 (01 April – 30June 2014)

a. Successful Introduction of Sub-dermal Implants in the Visayas Region. During the period April 1-June 30, a total of 1,688 clients became users of progestin-containing sub-dermal contraceptive implants (PSIs). This contraceptive method was introduced successfully in 6 of the 8 provinces covered by the VH project.


The following are the reasons for the successful introduction and the rapid increase in the utilization of SDIs:

Many providers were trained in a short period of time.

Intensification of demand generation activities

Enough caseloads during training

Adequacy of supplies.

Facilities covering large populations

b. Increase in the Number of Pregnant Women Given FP Information. The project also registered a significant increase in the number of pregnant women given FP information. This increase was most prominent in the provinces of Cebu, North Samar, and Leyte.

The reasons for the increase in the number of pregnant women given FP information are explained below:

Cumulative increase in the number of CHT trained on Pregnancy Tracking Chart

Increase in the number of “Buntis” events organized by VH staff.

Better documentation of group and individual education.

c. Increase in the Number of Men Given FP Information. The project also noted a sharp increase in the number of men who were given FP information from 33 in the previous quarter to 647 during this reporting period. This increase was evident throughout all provinces except in Leyte.

The reasons for this increase in the number of men given FP information are explained below:

Encouraging couples to come during demand-generation activities and events

Training on gender awareness and sensitivity

7. Year 2 Quarter 4 (01 July – 30 September 2014)

a. Increase in the Number of Adolescents Provided with FP Information. In the 4th quarter of Year 2, VH strengthened service provision to adolescents and youth by supporting the training of health staff on dealing with adolescents, particularly in facilities with high volumes of deliveries engaged for the Program for Young Parents (PYP). The main demand generation vehicle was still the Usapan session, this time adapted to the youthful audience. A total of 34,218 adolescents and youth attended Usapan sessions during the reporting period. Each Usapan session is designed for 10 to 15 participants and lasts 30-45 minutes. Cebu province and the tri-cities of Cebu, Mandaue, and Lapu-Lapu contributed to 30% of this accomplishment. Project staff set conservative targets for reaching out to adolescents due to provisions of the Reproductive Health Law requiring parental consent for young clients. Nevertheless, VH experience shows that adolescents/youth are accessing FP information and services from health facilities in spite of these restrictive provisions.

b. Increase in Number of Women Provided with Information on Exclusive Breastfeeding.In compliance with the DOH mandate to encourage the practice of exclusive breastfeeding for the first six (6) months, VisayasHealth integrated messages on breastfeeding in Usapan sessions. A total of 60,918 women were reached and provided information on the benefits of exclusive breastfeeding.

c. Increase in the Number of Community Health Team (CHT) Members Trained on Pregnancy Tracking. In YR2, a total of 3,723 (or 51% of CHTs) were trained on the Pregnancy Tracking System. Southern Leyte was able to train three times its planned target by working closely with the Provincial Health Office (PHO) and DOH. The province initially trained selected RHU staff as trainers in July 2013. VH provided the inputs on the Pregnancy Tracking System and the use of relevant tools (including the Pregnancy Tracking Form, Pregnancy Tracking Board, and Delivery Tracking Board). The RHU staff trained996 CHTs in their respective LGUs.


d. Introduction of SMS Reminders to Reinforce Health Messages. Participants in Usapan sessions receive anUsapan Action Card which serves as a discussion aid and take home motivational material. It has a detachable portion where pregnant mothers can signify their concurrence to receive messages on their mobile phones. The messages are intended to reinforce reminders to submit to ANC on the specified dates, as well as other messages to promote healthy pregnancy and delivery, including: facility-based delivery; modern contraceptive methods; exclusive breastfeeding; process and requirements for availing of Philippine Health Insurance (PhilHealth) benefits; pregnant mothers and infant immunization schedule; etc. VisayasHealth has built a data base of 16,148 mobile telephone numbers from participants in Usapan sessions in the different project areas. VisayasHealth will be undertaking operations research to determine the extent to which the application of SMS technology contributes to improving health-seeking behavior and outcomes before scaling up the use of SMS.

VisayasHealth achieved considerable gains in YR2, exceeding its targets for providing counseling to pregnant women (103%); reaching out to adolescents and youth (322%); reaching out to men (304%); and providing information and counseling on exclusive breastfeeding (240%). Greater efforts are needed to reach out to postpartum women with only 82% of target achieved. As well, there is need to reach out to more CHTs since only 51% have been trained on the PTS.


Purpose: Utilization of FP Services Increased

II. THE PROJECT AND OBJECTIVES

The VisayasHealth project is working towards achieving the following goals and objectives throughout its project life: reducing maternal and child mortality, reducing unmet need for family planning, increasing CPR, increasing skilled birth attendance, increasing newborns given neonatal care, reducing the number of teenage pregnancies, and increasing exclusive breastfeeding rates. To achieve these goals and objectives, VisayasHealth will implement the following components: scaling-up of supply and demand for MNCHN-FP services, removing policy and systems barriers and developing capacityof ROs to manage and coordinate MNCHN/FP programs and activities. Below is the VisayasHealth results framework.

VisayasHealth Results Framework for FP/MNCHN

Goal: Family Health Improved (Unmet Need for FP Reduced, MMR Reduced, UFMR Reduced)

Percent of deliveries with skilled birth attendants in USG-assisted sites (archived) Percent of deliveries in health facilities (archived)

Percent of NHTS-PR beneficiaries including CCT availing of MCP and NCP packages (A)

Modern CPR (archived)

Unmet need for FP (archived)

Couple Years Protection (CYP) in USG-assisted programs (Q) Sub-purpose 3: Health Policies and Systems

on FP and MCH improved

Sub-purpose 2: Strengthening the Supply of Integrated MNCHN FP Services

Sub-purpose 1: Generating Demand for MNCHN FP Services

Output1. Policy barriers to service

provision and financing resolved - Percent of budget in DOH regional offices

utilized for FP/MCH (new, A)

Output 2.Financing of

provision/consumption of services

made more sustainable

- Percent of LGUs utilizing PhilHealth

reimbursement per guidelines (new, A)

Output3. FP Commodity Secured, available and accessible in both public and private facilities - Percent of USG-assisted SDPs that experience stock outs in the last three months of any of the methods expected to be provided by the facility (Q)

Output4. Critical health systems underpinning LGU services strengthened

- Percent of LGUs conducting data quality

checks (DQC) annually (new, A)

- Number of trained PHNs on Applied

Supportive Supervision (Q)

- Number of quality supervisory visits

Output1. Availability of health services increased - Percent of service delivery points providing FP counseling and services to couples, men and women in USG-assisted sites (Q) - Percent of USG-assisted SDPs providing FP/RH services for adolescents and youth (Q) - Percent of service delivery sites providing

post-partum IUD services (Q) - Percent of SDPs providing VSS services (BTL or

NSV) (Q) - Percent of SDPs providing sub-dermal

implants (Q)

Output2. Quality of health services improved - Number of health providers trained on FP/RH

with USG funds per type of training (LAPM, FPCBT 1&2)

- Number of health providers trained on MCH with USG funds (BEMONC and EINC)

- Number of people receiving FP Trainers' training with USG support

- Number of training institutions for Family Planning

Output3. Implementation of exclusive breastfeeding strengthened - Percent of children exclusively breastfed for the first

six months (archived)

- Number of LGUs with at least CHT / community support group providing breastfeeding information and referral to lactating mothers (A)

Output1. Individuals' health knowledge and awareness increased No. of women reached with education on the benefits of breastfeeding (Q)

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

No. of post-partum women provided with FP information (Q)

No. of men provided with FP information (Q)

No. of adolescents and youth provided with youth-friendly MNCHN/FP information (Q)

Output2. Communities mobilized to support healthy behaviors -No. of CHTs trained in Pregnancy

Tracking System and basic Family Planning referral (Q)

Legend:

Red: USAID/W(PPR) indicators (5)

Blue: archived indicators (5)

Black Calibri font: USAID inter-CA custom

indicators

Purple Calibri font: VH internal indicators


III. ACCOMPLISHMENTS

As a result of the USAID Program Portfolio Review last October 2014, USAID Office of Health made changes in the indicators to be reported to Washington starting year 3 (Fiscal Year 2015). VisayasHealth is currently revising its Monitoring and Evaluation Plan based on these changes, on the comments from the M&E Plan review of the USAID Program Office and on the year 2 accomplishments. Under the tables below, notes are made per indicator for year 3 and end of project targets which are still under review. Further, the tri-cities will be reported on separately starting year 3. The indicator names are marked as follows: PPR (reportable to USAID Washington), inter-CA (common indicators among service delivery projects) and VH (internal indicator for the project).

Demand Generation

Targets for this indicator for 2015 and end of project (2017) are under review as FY2014 accomplishments (60,918) exceeded initial end of project target (25,380).

Year 2 Q4 vs. Year 3 Q1. The number of women reached with education on the benefits of breastfeeding from October to December 2014 increased by 16% compared to the period July to September 2014. Significant increases were noted from the provinces of Bohol, Negros Occidental, Leyte, Cebu, tri-cities and South Leyte (38% to 250%) from Year 2 Q4 to Year 3 Q1 while the numbers decreased for Iloilo, Samar and North Samar.

Year 3 Q1. Iloilo had the most number of women reached with education on breastfeeding followed by tri-cities, Leyte and Negros Occidental.

Table 2. No. of women provided education on exclusive breastfeeding (PPR)

Indicator Baseline value

(reference year) End of Project

Target Target for

2015

FY 2014 Accomplishment

FY 2015 Accomplishment Remarks

Q4 Q1

Visayas 0 To be adjusted based on Y3

accomplishments

To be adjusted based on Y3

accomplishments 36,454 42,207

Iloilo 13,083 9,249

Negros Occidental

1,961 5,682

Bohol 1,229 4,242

Cebu 1,588* 3,937

Tri-Cities

5,388* 9,180 *Q4 accomplishments include late reports

Leyte 2,234 7,082

South Leyte 1,306 1,801

Samar 2,172 1,734

North Samar 7,493 4,300


Year 2 Q4 vs. Year 3 Q1. The number of pregnant women seeking antenatal care and provided FP information increased by 33% compared to the previous quarter. Six provinces posted increases ranging from 5% (South Leyte) to 500% in Bohol; the latter was due to more Usapan trained facilitators in the province and renewed efforts to reach out to these clients following recovery from the 2013 earthquake.

Year 3 Q1.Iloilo, tri-cities and Bohol reported the most number of pregnant women provided FP information during their ANC visit.

Table 3. No. of pregnant women seeking ANC and provided with FP information (VH)

Indicator Baseline value

(reference year)

End of Project Target

Target for 2015



Q4 Q1

Visayas 132,116 To be adjusted

based on Y3 accomplishments

248,218 18,911 25,109

Iloilo 40,708 51,183 4,545 7,885

Negros Occidental

9,920 43,967 1,888 408

Bohol 13,133 18,978 587 3,691

Cebu 6,513 38,987 1,124 1,587

Tri-Cities 18,912 31,899 4,235 5,485

*Q4 accomplishments including late reports

Leyte 22,335 27,052 1,339 2,917

South Leyte 6,823 9,160 857 896

Samar 4,290 11,089 1,481 523

North Samar 9,482 15,903 2,855 1,717

Table 4. No. of postpartum women provided with FP information (VH)

Province Baseline value

(reference year)


Target for 2015



Q4 Q1

Visayas 98,301 To be adjusted based on Y3

accomplishments

184,169

5,367 10,282

Iloilo 27,082 54,472 30,710 2,009 3,258

Negros Occidental

10,330 20,777 37,686 399 824

Bohol 11,440 23,010 16,266 424 1,195

Cebu 8,306 46,645^ 33,947 659 702 ^targets include Tri-Cities

Tri-Cities 14,885 20,062 858* 2,495 *Q4 accomplishments including late reports

Leyte 9,245 18,595 23,187 134 1,040

South Leyte 4,905 9,866 7,634 7 181

Samar 7,959 16,008 9,505 353 164

North Samar 4,149 8,345 5,173 524 423


For Year 2, VisayasHealth was able to meet 82% of its goal for postpartum women reached with FP information. Targets for Year 3 and end of project will remain the same.

Year 2 Q4 vs. Year 3 Q1. The total number of postpartum women provided FP information for the reporting quarter almost doubled compared to the previous quarter. The increase was mainly in the provinces of Leyte, South Leyte, tri-cities, Bohol and Negros Occidental.

Year 3 Q1.Iloilo, tri-cities, Bohol and Leyte reported the most number of postpartum women provided FP information.

For Year 3 onwards, VisayasHealth will adjust its target based on the Year 2 experience with Usapan where men attended the sessions with their spouses/partners and were provided FP information.

Year 2 Q4 vs. Year 3 Q1. The number of men reached with FP information for the reporting quarter was slightly higher than the previous quarter; on a per province basis however, significant increases were noted in five provinces (Iloilo, Bohol, Cebu, Leyte and South Leyte).

Year 3 Q1.Iloilo, Bohol, tri-cities and North Samar had the most number of men reached with FP information although the numbers were lesser when compared with previous' quarters performance for the tri-cities and North Samar.

Table 5. Number of men provided with FP information (VH)

Province Baseline value

(reference year) End of Project

Target Target for

2015



Remarks

Q4 Q1


accomplishments 11,220 1,812 1,900

Iloilo 27 1,590 68 483

Negros Occidental

36 1,020 104 109

Bohol 15 1,470 12 426

Cebu 57 2,225 79 134

Tri-Cities 0

1,315 345 303


Leyte 26 1,470 1 47

South Leyte 5 630 9 66

Samar 10 780 95 33

North Samar 9 720 1,099 299


Table 6. Number of adolescents and youth provided with MNCHN/FP information (VH)

For Year 3 onwards, VisayasHealth will adjust its target based on the Year 2 experience with Usapan sessions in facilities where Program for Young People (PYP) have been installed/are being installed, as well as in non-PYP facilities. It is apparent that there are more adolescent/youth who are seeking services whether in specialized settings (PYP) or non-specialized settings (34,606).

Year 2 Q4 vs. Year 3 Q1. The number of adolescents/youth reached with FP/MNCH information increased by 30% during the reporting quarter relative to the previous. Across the provinces, increases were noted in six provinces, with the highest increases in Leyte and Bohol. Family Health Fairs reaching out to these types of clients were organized for these provinces during the reporting quarter.

Year 3 Q1. Iloilo, tri-cities and Leyte reached the most number of adolescents/youth with FP/MNCHN information.

Strengthening Supply for FP and MCH

Table 7. Percent of service delivery points (SDPs) providing FP counseling and services to couples, men, and women (inter-CA)

Province Q4Y2

Accomplishments

Total No. of Facilities

(denominator)

% Q1Y3

Accomplishments

Total No. of Facilities

(denominator) %

Visayas 138 489 28% 213 489 44%

Iloilo 23 69 33% 29 69 42%

Negros Occidental 17 53 32% 32 53 60%

Bohol 27 64 42% 26 64 41%

Cebu 9 80 11% 27 80 34%

Tri-Cities 11 64 17% 52 64 81%

Leyte 10 66 15% 22 66 33%

South Leyte 6 28 21% 4 28 14%

Samar 15 32 47% 2 32 6%

North Samar 20 33 61% 19 33 58%

Province

Baseline value

(reference year)


Target for 2015



Remarks

Q4 Q1

Visayas 7,906 To be adjusted based on Y2

accomplishments


accomplishments 12,028 15,647

Iloilo 2,311 2,287 3,839

Negros Occidental 1,162 683 556

Bohol 1,357 502 1,402

Cebu 313 1,029 1,463

Tri-Cities 380 2,503* 3,379


Leyte 311 780 2,316

South Leyte 1,195 316 650

Samar 187 1,197 552

North Samar 690 2,731 1,490


Year 2 Q4 vs. Year 3 Q1.The proportion of SDPs able to provide FP counseling (trained counselor and documented counseling visits) and services to couples, men and women (at least two methods and referral mechanism for methods not present in the facility) increased from 28% (July to Sept 2014) to 44% (Oct to Dec 2014). Most of the increases came from the tri-cities, Negros Occidental and Leyte where additional providers were trained on FP-CBT1 including counseling. In the provinces of South Leyte and Samar, the percent of SDPs able to counsel and provide services decreased based on the absence of reports on documented counseling visits which is treated as no counseling visits for the reporting quarter.

Year 3 Q1.The tri-cities, Negros Occidental, and North Samar had more than 50% of their SDPs able to provide the broad range of services (counseling and at least two FP methods). On the other hand, Samar only had 6% of its SDPs able to meet indicator criteria based on submitted reports.

Of the 489 facilities covered by VisayasHealth, only 15 (3%) have trained staff on Adolescent Job Aid and have space to provide services for adolescent/youth clients. These are already part of the effort in establishing PYP in selected facilities. For Year 3, the proportion is expected to increase given initial project efforts in facilities of Cebu, Leyte, and South Leyte. These will be reflected in the accomplishments for the next quarter.

Table 9. Percent of service delivery sites providing post-partum IUD services (VH)

Area Baseline

(2013) %

Target for

2015

Y2Q4 Y3Q1 Remarks

N D* % N D* %

Visayas 11 3% 32% 46 383 12.0% 68 383 18% Iloilo 1 2% 42% 3 53 5.7% 3 53 6% Negros Occidental

1 2% 26% 3 42 7.1% 3 42 7% Bohol 1 2% 33% 5 55 9.1% 15 55 27%

Cebu 0 0% 33%^ 7 61 11.5% 7 61 11% ^Including Targets for Tri-cities

Tri-Cities 1 2% 8 57 14.0% 8 57 14% Leyte 4 8% 35% 9 48 18.8% 14 48 29% South Leyte 1 4% 22% 2 23 8.7% 6 23 26% Samar 2 10% 24% 5 21 23.8% 6 21 29% North Samar 1 4% 30% 4 23 17.4% 6 23 26%

*Denominator is the total number of hospitals and birthing facilities

Table 8. Percent of service delivery points (SDPs) providing FP counseling and services to

adolescents/youth (inter-CA, new) Province Numerator* Denominator %

Visayas 3.07

Iloilo 6 69 8.70

Negros Occidental 2 53 3.77

Bohol 2 64 3.13

Cebu 0 80 0

Tri-Cities 2 64 3.13

Leyte 3 66 4.54

South Leyte 0 28 0

Samar 0 32 0

North Samar 0 33 0


Year 2 Q4 vs. Year 3 Q1.The proportion of SDPs able to provide PPIUD services increased from 12% during the previous quarter to 18% for the reporting quarter. This was due to additional providers trained from the provinces of Bohol, Leyte, Samar and North Samar during the reporting quarter. A good post training follow up will ensure that these providers gain confidence in PPIUD insertion in order to be able to continuously provide the service.

Year 3 Q1.The provinces in region 8 (Leyte, Samar, South Leyte, North Samar) and Bohol are almost approaching 30% level of facilities with trained providers while those in region 6 need to train more providers to establish a good enough level of facilities able to provide PPIUD service.

Table 10. No. of PPIUD Acceptors Y2Q4 and Y3Q1

Province No. of New PPIUD

Clients for Y2Q4 No. of New PPIUD

Clients for Y3Q1

Cumulative Number of PPIUD Acceptors

(as of end of Dec., 2014)

Visayas 502 647 3,489

Iloilo 94 63 313

Negros Occidental 40 89 375

Bohol 141 145 768

Cebu 60 79 295

Tri-Cities 14 141 663

Leyte 78 47 538

South Leyte 57 39 365

Samar 11 20 96

North Samar 7 24 76

The table above compares cumulative totals per province and shows that on average, the client load for PPIUD increased by 26% across the facilities assisted by VH from the previous quarter (minimum of 12% in South Leyte, maximum of 46% in North Samar).

Table 11. Percent of SDPs providing sub-dermal implants (VH)

Province

Baseline value

(reference year)


Target for 2015


Q4


Q1 Remarks

N D % N D %


accomplishments


accomplishments 125 296 42.23% 145 296 50.68%

Iloilo 0 15 37 41% 26 37 70.30%

Negros Occidental 0

16 23 70% 16 23 70.00%

Bohol 0 18 40 45% 18 40 45.00%

Cebu 0 18 61 38% 28 61 45.90%

Tri-Cities 0 14 57 32% 18 57 31.58%

Leyte 0 17 31 55% 17 31 54.84%

South Leyte 0 7 18 39% 7 18 38.81%

Samar 0 6 15 40% 1 15 40%

North Samar 0 14 14 100% 14 14 100%

Targets for this indicator are being reviewed given the very positive response of both providers and clients to this FP method during its first year of introduction such that original goals set for Year 2 as well as end of project targets have been met at the end of Year 2.


Year 2 Q4 vs. Year 3 Q1.The proportion of SDPs able to provide sub-dermal implants services increased from 42% to 51% this quarter. Across provinces, this was seen in Iloilo, Cebu and tri-cities due to additional batch of providers trained on sub-dermal implant insertion.

Year 3 Q1.Based on the number of facilities originally planned by the project to provide the service, North Samar, Leyte and Iloilo have achieved good coverage for the service. However, these figures also need to be viewed vis a viz the consistent service provision by trained providers. In the chart below, significant increases in client load between two reporting quarters are noted for the provinces of Iloilo, Negros Occidental, Cebu and Tri-cities. There were additional training providers trained from these provinces during the quarter which accounts for the increase; in Samar, Leyte, and North Samar however, no additional providers were trained and the figures reflect constant caseload by trained providers.

Table 12. No. of PSI New Acceptors Y2Q4 and Y3Q1

Province Number of New PSI

Clients for Y2Q4 Number of New PSI

Clients for Y3Q1*

Cummulative Number of PSI Acceptors

(as of end of Dec., 2014)

Visayas 5,153 3,136 11,057

Iloilo 821 500 1,321

Negros Occidental 586 521 1,107

Bohol 587 388 1,184

Cebu 691 433 1,563

Tri-Cities 887 767 2,190

Leyte 651 190 1,325

South Leyte 286 165 703

Samar 98 2 315

North Samar 546 170 1,349

*Incomplete December reports

The table above compares accomplishments between the fourth quarter of Year 2 and first quarter of Year 3 per province. It shows that on average, trained providers per province have a case load of about 572 for Y2Q4 while Y3Q1. Although still with incomplete December reports from the field, it is already about 60% of the average loads of the previous quarter. Among the provinces, the Tri-cities of Cebu City, Mandaue and Lapu-Lapu City had the highest number of new acceptors both in the 1st quarter of year 3 and the previous quarter. These are followed by Iloilo and Negros Occidental. However, in the province of Samar, there has been no progress in the number of PSI acceptors. In this there is a need to closely look at factors affecting this performance.

Table 13. Percent of SDPs providing VSS services (BTL or NSV) (VH)

Area Baseline

(2013) %

Y2Q4 Y3Q1

SDPs providing

VSS services

Total No. of

Hospitals %

SDPs providing

VSS services

Total No. of

Hospitals %

Visayas 41 36% 46 115 40% 50 115 43%

Iloilo 10 63% 11 16 69% 11 16 69%

Negros Occidental 4 21% 5 19 26% 5 19 26%

Bohol 4 27% 4 15 27% 4 15 27%

Cebu 9 50% 9 18 50% 12 18 67%

Tri-Cities 2 25% 2 8 25% 2 8 25%

Leyte 6 35% 7 17 41% 7 17 41%

South Leyte 1 14% 3 7 43% 3 7 43%

Samar 2 33% 2 6 33% 2 6 33%

North Samar 3 33% 3 9 33% 4 9 44%


Year 2 Q4 vs. Year 3 Q1.The percent of facilities providing VSS services increased from 40% in the previous quarter to 43.5% for the reporting quarter. This was brought about by additional VSS service site in North Samar. For the rest of Year 3, expansion to more service sites need to happen to make VSS more available.

Year 3 Q1.The provinces of Iloilo, Cebu and North Samar have the most proportion of hospitals able to provide VSS (in-house/ambulatory). As in the first two indicators related to LAPM, this indicator should be viewed in the light of actual caseloads generated over time. The table below shows that movements were only seen in the provinces of Cebu, Samar and North Samar during the reporting quarter compared to the previous. Factors for this sluggish performance need to be looked into.

Health Policies and Systems on FP and MCH improved

Starting Year 3, three new indicators need to be reported on the inter-CA level on an annual basis. This includes the following:

Percent of budget in DOH regional offices utilized for FP/MCH

Percent of LGUs utilizing PhilHealth reimbursement per guidelines

Percent of LGUs conducted data quality checks (DQC) annually

For this reporting, VisayasHealth will report on the stock out levels for pills, injectables and IUD. Data has been processed using the total number of assisted facilities. This departs from the agreement at the inter-CA TWG where the level of stock outs is computed using the number of facilities with reports as denominator. For comparability across VH-assisted sites, the denominator has been used and is consistent across the baseline, Year1 Q4 and Year2 Q1.

Table 14. Percent of USG-assisted SDPs that experienced stock-outs in the last three months for Pills

(inter CA)

Province Baseline % Y2Q4 Y3Q1

N D % D %

Visayas 132 27% 283 489 58% 302 489 62%

Iloilo 24 35% 25 69 36% 26 69 38%


Bohol 15 23% 42 64 66% 31 64 48%

Cebu Province 24 17% 44 80 55% 68 80 85%

Tri-Cities 36 64 56% 47 64 73%

Leyte 22 33% 42 66 64% 41 66 62%

South Leyte 12 43% 14 28 50% 11 28 39%

Samar 8 25% 21 32 66% 20 32 63%

North Samar 10 30% 13 33 39% 23 33 70%

NOTE:

Year 2 Q4 vs. Year 3 Q1.The overall trend for stock out for pills is on the rise for VH-assisted provinces. By the end of December 2014, 62% are stocked out for pills. By province, stock out level increased in Cebu province, tri-cities and North Samar. Based on expected deliveries of commodities from the DOH-central office, VH field staff have confirmed that Cebu province and tri-cities received deliveries from DOH-central office; however, the amount of deliveries was less than the amount allocated for the province and tri-cities. For Northern Samar, no deliveries came despite repeated request for pills made through the regional DOH offices.


Year 3 Q1. Cebu province, tri-cities and Northern Samar report the highest stock outs for pills. While trends in Negros Occidental, Bohol, Leyte, South Leyte and Samar show lowering of stock-outs for pills.

Table 15. Percent of USG-assisted SDPs that experience stock-outs in the last three months for

Injectables(inter CA)


N D % D %

Visayas 177 36% 292 489 60% 318 489 65%

Iloilo 29 42% 29 69 42% 26 69 38%


Bohol 23 36% 43 64 67% 37 64 58%

Cebu Province 26 18% 49 80 61% 73 80 91%

Tri-Cities 35 64 55% 50 64 78%

Leyte 31 47% 43 66 65% 40 66 61%

South Leyte 14 50% 14 28 50% 11 28 39%

Samar 11 34% 21 32 66% 21 32 66%

North Samar 17 52% 13 33 39% 22 33 67%

Year 2 Q4 vs. Year 3 Q1.The overall trend for stock out for injectables is on the rise for VH-assisted provinces. By the end of December 2014, 65% are stocked out for injectables. Like pills, stock out levels increased in Cebu province, tri-cities and North Samar.

Year 3 Q1. Cebu province, tri-cities and Northern Samar report the highest stock outs for injectables. However, trends in Iloilo, Negros Occidental, Bohol, Leyte, and South Leyte show lowering of stock-outs for injectables.

Table 16. Percent of USG-assisted SDPs that experience stock-outs in the last three months for IUD (for facilities with trained providers on FP-CBT2 IUD) (inter CA)


N D % D %

Visayas 26 14% 113 185 61% 108 185 58%

Iloilo 4 11% 15 37 41% 14 37 38%


Bohol 1 5% 14 20 70% 9 20 45%

Cebu Province 7 21% 11 16 69% 14 16 88%

Tri-Cities 7 17 41% 15 17 88%

Leyte 6 17% 20 36 56% 24 36 67%

South Leyte 5 29% 8 17 47% 4 17 24%

Samar 0 0% 12 12 100% 8 12 67%

North Samar 0 0% 5 9 56% 5 9 56%

Year 2 Q4 vs. Year 3 Q1.The overall stock out level for IUD is lower for the quarter compared to the previous. However, this level is much higher than the baseline stock level for IUD (14%). The same trend is observed on a per province level (Iloilo, Negros Occidental, Bohol, South Leyte, Samar). The provinces of


Cebu and Leyte, as well as the tri-cities report higher stock out levels for this quarter compared to the previous.

The stock outs in VH-assisted facilities can be explained in part by the commodity distribution patterns from the DOH during the past quarter. The table below shows the DOH 6-month allocation per province per type of commodity. In three of eight provinces (38%), there were no deliveries of commodities. In the province/cities where there were deliveries, three (pills, injectables, IUD) of four ((pills, injectables, IUD and implants) expected commodities were provided.

For pills, the amount of deliveries relative to the allocation was only 23% (median); for injectables 18% (median) and 26% for IUD (median). A better understanding of the basis for the allocation will inform how these deliveries were determined (see Table).

Table 17. 2014 DOH Six-month FP commodities allocation and volume received by province

(VisayasHealth sites only)

Pills DMPA IUD Implants

Province

Amount allocated

for 6 months

2014

Amount received

as of January

2015

Amount allocated

for 6 months

2014

Amount received

as of January

2015

Amount allocated

for 6 months

2014

Amount received

as of January

2015

Amount allocated

for 6 months

2014

Amount received

as of January

2015

Iloilo 204,722 0 43,361 0 5,017 0 5,350 0

Negros Occidental

231,225 0 48,975 0 5,667 0 6,043 0

Bohol 125,904 969* 26,667 200* 3,086 36* 3,739 0

Cebu (includes tri-cities)

272,248 63,546 57,663 12,303 6,672 2,082 8,085 0

Leyte 220,021 56,865 46,602 13,125 5,392 2,223 6,634 0

South Leyte 38,535 13,409 8,162 3,055 944 531 1,162 0

Northern Samar

98,498 0 20,862 0 2,414 0 2,970 0

Samar 122,706 1,983** 25,990 425** 3,007 73** 3,700 0

* Tagbilaran City data only ** five municipalities confirmed to have received FP commodities; figures from Jiabong municipality only


IV. REASONS FOR VARIANCES IN THE PERFORMANCE

Compared to the previous quarter, VisayasHealth showed increases during this reporting period in the following demand generation indicators:

1. Number of women provided education on exclusive breastfeeding 2. Number of pregnant women seeking ANC and provided FP information 3. Number of postpartum women provided FP information

The reasons for the increase are the following:

1. Successful engagement of the NDP nurses in demand generation activities

The provincial coordinators particularly in the provinces of North Samar and Iloilo, and in the cities of Iloilo, Cebu, Mandaue and Lapulapu were able to mobilize the NDP nurses of the DOH in generating demand for MNCHN/FP services. The NDP nurses were trained in conducting Usapan sessions and took responsibility for organizing the group education sessions in the health facilities.

2. Taking advantage of the promotional activities under the Health for All Road-shows of the DOH

As part of its Health for All initiative, the DOH organized a series of promotional activities all over the country including the Visayas. These promotional events consisted of giving lectures, video presentations and organizing service delivery activities such as provision of FP information and services.

The regional and provincial coordinators of VH utilized these promotional events to generate demand for MNCHN/FP services by mobilizing the CHTs to identify and refer clients to selected health facilities.

3. Locally organized Buntis Congresses, family health fairs and related events

A number of cities and municipalities organized health events featuring services for pregnant women and those with unmet need for FP. During these health events, Usapan sessions were conducted in addition to lectures and educational games.

4. Increase in the number of health volunteers and providers trained under VH' demand generation package

The province of Iloilo and the cities of Cebu, Mandaue and Lapu-lapu were able to train more volunteers and providers in pregnancy tracking and in the conduct of Usapan sessions.

In addition to the increase in performance in demand generation, VH was also able to show improvements in the supply of MNCHN/FP based on the following indicators:

1. Percent of service delivery points providing FP services 2. Percent of service delivery points providing FP counseling and services to adolescents/youth 3. Percent of service delivery sites providing PPIUD services 4. Percent of service delivery sites providing sub-dermal implants 5. Percent of service delivery points providing VSS services

The reasons for the supply-side improvements are the following:

1. Collaboration with the CMSU Project in the training of midwives

VH collaborated with the CMSU Project in the training of midwives on FP and BEMONC/EINC specifically in the provinces of Leyte, Negros Occidental and Iloilo. The project tapped the services of the Integrated Midwives Association (IMAP) to do the training as IMAP is an accredited training provider by the DOH. In addition to the clinical skills upgrading, CMSU also trained the midwives on coaching and mentoring techniques.


2. Introduction of Adolescent Job Aid training

The project facilitated the conduct of training courses on Adolescent Job Aid (AJA) in the provinces of Iloilo, Bohol, Leyte and Negros Occidental and in the cities of Cebu, Mandaue and Lapu-lapu. The training course is designed to provide health care providers with the necessary skills in providing counseling services to adolescents and youth.

3. Scaling Up of clinical training courses

During this reporting period, the project continued to train more providers in PPIUD, implants and VSS especially in the provinces of Iloilo, Leyte, Cebu and in the highly urbanized areas of Cebu, Mandaue and Lapu-lapu. The scaling up process was facilitated by the establishment of training centers that tapped local trainers based in the provinces, cities and municipalities.

Another major accomplishment of the VH project during this reporting period is the significant increase in the number of clients who decided to accept family planning services especially implants. The reasons for the increase are the following:

1. Scaling Up of the clinical training courses

The introduction of the NXT implants and the enthusiastic reception from the trained providers with this version of the sub-dermal implants contributed to the increase in the number of implant acceptors. The NXT is much easier to administer compared to the classical implant and much more convenient for both the client and provider.

2. Expansion of demand generation activities

The increase in demand generation activities in the field also contributed to the increase in the number of FP acceptors. The conduct of Usapan sessions and one-on-one counseling in the health facilities helped generate more FP clients to accept services. The conduct of roadshows, health fairs and other promotional events also generated a lot of interest for both clients and providers.


V. MAJOR IMPLEMENTATION ISSUES/CHALLENGES

Table 18. Areas of Concern, Issues, Actions Done, and Plans for Unresolved Actions

Areas of Concern Implementation Issues Actions Taken Planned Actions if Not

Resolved

1. Management Concerns

Per report from our provincial coordinators, most LGUs have not received the FP commodities that were allocated to them by DOH - Central Office Training and Post training evaluation not fully implemented because of inadequate trained and accredited human resource. Low utilization of DOH budget for RH activities

Reported this to DOH-CO and HPDP to make follow up with the forwarder. Submitted to DOH-ROs application for accreditation as a training institution per newly approved DOH training accreditation guidelines. Met with the regional directors of the DOH-ROs to discuss strategies of increasing budget utilization e.g. outsourcing of services, performance based grants to LGUs and provision of grants to attached agencies like PopCom and National nutrition Council

Persistent coordination with the Materials Management Division of DOH and the forwarder to ensure distribution of commodities based on the allocation list. PCs to follow up with the DOH-ROs application for accreditation of VH as a training institution. Secure the services of a consultant to further discuss this with DOH-ROs and initiate its implementation.

2. Security Concerns

Not Applicable Not Applicable Not Applicable

3. Others: 3.1 Typhoons 3.2. Major Reorganization in top management of DOH

The operations of some health facilities were affected by two strong typhoons that recently visited the Philippines, typhoon Ruby affecting Leyte and Samar and typhoon Senyang affecting Southern Cebu The Secretary of Health resigned from his post. Fortunately, he did so after signing some important DOH issuances on reproductive health. The acting Secretary of Health is pushing for the implementation of thre RPRH Law. However, the Visayas Operations Cluster has been dissolved.

A rapid assessment of health facilities in affected areas was done. A few facilities had to temporarily stop operations because of flooding. VH facilitated the provision of tents by the DOH-RO8 to a municipality in Samar. VH to coordinate directly to the DOH-ROs instead of passing through the VOC.

The respective LGUs are taking care of the damages to health facilities brought about by the typhoons. Coordinate with DOH-CO esp. Office for Technical Services where the Family Health Cluster is lodged.


VI. MILESTONES, KEY TASKS, AND ACTIVITIES

A. Activity Highlights from FY3 Q1

1. Introduction of Implanon NXT

The adoption of a “National Training System” and the new Guidelines for PSI service delivery during the fourth quarter of year 2 requires: [i] the use of DOH approved Clinical Skills Training Curriculum for PSI, and; [ii] the use of the Implanon NXT instead of the Implanon Classic used during the earlier training activities for service providers.

A rapid review of the performance of the trained service providers showed the person who actually performs the counselling or inserts the PSI may vary from facility to facility. This depends on the local/national clinical and programmatic policies and availability of trained healthcare providers and FP commodities. Thus, VisayasHealth conducted a series of Clinical Case Conference and Skills Enhancement on Insertion and removal of Implanon NXT. This served as a forum for sharing programmatic and clinical experiences in the integration of PSI services in their facilities. The events provided opportunities for learning and practicing the range of FP services; counselling and clinical skills not only on insertion and removal of the PSI Implanon NX; but also emphasized infection prevention, recordkeeping, follow-up of clients, as well as managing adverse effects and complication. Even if a learner will not carry out a specific task at the workplace, s/he needs to be familiar with what it involves in order to help ensure transfer of new skills to the workplace and high-quality service delivery.

A total of 109 service providers were trained and 668 PSI clients were given services for Implanon NXT. Table 17 below shows the performance during the Clinical Case Conference in Leyte (Tacloban City), Negros Occidental (Bacolod City), Cebu and Northern Samar.

Table19. Service Providers trained and clients given NXT

Date Area Region Province No. of Service Providers Trained

No. of Clients Inserted with NXT

November 10-11,

2015

Region 8 –for Tacloban City,

Leyte and S. Leyte 20 66

November 17-18,

2014

Region 6- for Bacolod City,

Negros Occidental, Iloilo City

and Iloilo Province

28 226

November 20-21,

2014

Region 7- Province of Cebu and

Bohol and the Tri-cities of Cebu,

Mandaue and Lapu-Lapu

52 330

November 27-28,

2014

Region 8- Northern Samar and

Samar 9 46

TOTAL: 109 668

2. Results of Assessment of Training on Sub-Dermal Implant

VH engaged the services of a consultant from the EH global clinical support team to assess the ongoing training of providers on PSI. Below are following are the key findings and recommendations:

a. Strengthening training capacity in implants. The following were done towards this end: [i] Reviewed the training package for implants: The global Learning Resource Package provided the general framework for the training content. This is the DOH Two days Clinical Skills Training for Service Providers (Doctors) on Subdermal Implant Insertion and Removal.; [ii] Explored the content, scope and outcome of implants clinical training conducted so far, through interviews with trainers and trainees; [iii] Reviewed trainee follow up approaches and findings: prior to the STTA VH haven’t been able to conduct


a clinical post-training follow up visit of trained PSI providers. VH has been coordinating with PCs to learn what is happening in the field and managing each situation on a case by case basis; [iv] Adapt trainee follow-up tools for implants: EH trainee follow up tools were meant for phone follow up interview and facility visit. Three sites were visited and service provision was observed in one facility. VH MNCHN/FP Specialist Dr. Gerry Cruz was introduced to the tools and he led the follow up in some facilities. VH Training Consultant Dr. Cherry Pangilinan is yet to conduct a follow up; [v] Model, observe and coach as needed EngenderHealth clinical staff (namely Dr. Cruz, Dr. Pangilinan and other staff to be identified) in conducting a trainee follow up visit: as in item d) above; [vi] Observe implants trainees as they provide implants and coach accordingly: discussed below; [vii] Provide clinical updates on implants: done. Issues were discussed as they arose and clarification made.

b. Supported and attended clinical case conferences on implants. Four (4) Two (2)-days clinical case conference and skills standardization on NXT were held in Tacloban, 10th and 11th November; Bacolod 17th-18th November; Cebu, 20th – 21st November and 27th-28th November in Northern Samar. The four events drew in a huge number of participants of 96 PSI providers and trainers. Exposure to clients was also good. In Tacloban, there were 20 providers who served 62 clients while in Bacolod 29 doctors attended to 216 clients. The highest turnout was witnessed in Cebu of 46 doctors serving 275 clients. Northern Samar has the ideal number of 9 service providers and 46 clients.

c. No opportunity arose to provide technical assistance in applied supportive supervision.The following curriculum were requested for review: [i] Training/orientation for the applied supportive supervision and compare it to EngenderHealth’s generic Facilitative Supervision training curriculum; [ii] Explore with project technical staff the implementation of AppSS activity and address identified gaps if any.

d. On Female sterilization iii. Explored current and planned activities for supporting female sterilization services with a

focus on training and its outcomes: Currently Ambulatory Surgical Services are being done that provides opportunity for enhancing skills of service providers previously trained on MLLA by DOH and PRISM 2 project. Six (6) doctors were however given 1 day refresher orientation and skills enhancement; and some are now providing MLLA. The project will in the coming month be charting the activities to be done in this area next year. A request for the DOH Standard training curriculum will be shared with EH to have a look and advise if there is need for update. Otherwise, EH has finalized a training curriculum on MLLA which should be due for circulation.

iv. Discussed any necessary changes/support on the planned activities

e. Perception of choice. There was initial concern that VH had prepared to only give implants but this was allayed knowing that the mothers had actually been pre-screened, counseled and had opted for PSI and hence the availability of a single method during the activity. However, since not all mothers who turned up for PSI received the implants due to various reasons, in future there will have to be methods available with us to give to such mothers to avoid deferred mothers getting unwanted pregnancies.

f. Utility of CCC as a follow up approach. The clinical case conference was by any standard very successful in NXT skills standardization. However, it was ineffective as a post training follow up approach. As participants are faced with unique challenges in their work places, an effective post training approach requires a more personalized approach through either phone contact or preferably visits in respective work stations to assess services as they are delivered and customized solutions offered. While this can be facilitated by our field staff, it is still recommended that trainers are able to conduct these follow up as they are better placed to appreciate gaps.


g. Effectiveness of our trainings.Based on observations, trainings have actually delivered going by the status of PSI service initiation and the trainings our trainers have conducted. All doctors reported having actually inserted PSI at varying degrees in their facilities. Their clinical judgment in the management of side effect was also very good. The trainers talked to also reported having conducted training of providers. However, caution must be considered that training activities are still incomplete. Just like no demonstration is complete without a return demonstration, no training is complete without a post training followup.

h. Gaps/Areas of improvement noted in our PSI training.

Infection prevention

i. Running water was not always available in all training sites. Trainees only relied on alcohol hand rub through and through. Alcohol hand rub is not effective in removing the dead debris of microorganisms and therefore hand washing with soap and running water is recommended once in a while after a certain number of clients. This was corrected in Northern Samar

ii. Hand Hygiene. Providers were observed not to be performing correct hand hygiene using recommended preparations such as commercially available preparations or local preparation. This was corrected in the following activities in Bacolod, Cebu and Northern Samar

iii. Draping. In our PSI training, use of drapes was not part of the training. This was highlighted and incorporated in the skills standardization for NXT.

iv. Procedure tables. In most instances, appropriate procedure tables were lacking. Procedures were done on beds or tables covered with bed sheets. This did not provide opportunity for cleaning the procedure surface after each client as recommended. It is recommended that plastic sheets are used under such circumstances. This was done in last leg of the CCC and Skills Enhancement in Northern Samar.

v. Lack of mayo trays. This necessitated a pool set up of sterile supplies. Although this was corrected in subsequent activities, optimum standard of setting individual tray per client in all sites was still unattained except in Northern Samar.

vi. Waste segregation. There was no appropriate color-coded waste bins for the different categories of waste generated during the procedure. However, the sharps bins were present in all training sites.

vii. Removal equipment: Providers were provided with one removal set comprising of 2 curved mosquito forceps. One curved and 1 straight mosquito forceps is recommended. In addition, drapes are also recommended. As time goes by, sites should be encouraged to have at least 5 sets for removal.

viii. Trainee follow up: There is a need to do this so as to complete training activities. This should be viewed as a continuation of the training process and therefore separate from DOH certification of proficiency PTE monitoring.

ix. Trainers Trainee follow: Trainers have not conducted trainee follow up of their trainees. They need to do this to complete their training as trainers as well.

x. Data quality management. It was observed in one of the facilities visited that the number of PSI inserted is not captured in the TCL register although they are being reported. There is a need to find out the situation in other areas and provide necessary support. Entry into the TCL is done monthly. If possible, it is better done as services are provided to lessen errors in the entry.

xi. Lack of other methods readily available in training sites for clients deferred. Ensuring choice demands that all methods are available in VH-organized/conducted events so as to minimize on missed opportunities.


i. Challenges

i. Lack of placebos for NXT skills standardization. This affected return demonstration ii. High number of participants for NXT skills standardization coupled with few trainers iii. High number of clients turnout although appropriate for the high number of participants

shifting focus to service delivery mode. iv. Logistical challenges: client turnout outstripping supplies in some situation v. The duration for the activity: two days too short.

j. Successes

i. Successfully completed skills standardization in NXT for 97 PSI providers and trainers ii. Standardized demonstration and coaching skills for a number of trainers iii. Visited a few facilities and conducted a trainee follow up introducing Dr. Cruz to EH trainee

follow up approach

k. Programmatic issues

i. Training. By its very nature, the design of VH PSI service delivery approach requires 3 key personnel: the doctor, assistant nurse and counselor. It is critical that the training focuses on these key personnel for quality PSI service provision.

Currently the focus is on training doctors who in VH’s set up are specialists in providing skills. Other support services necessary for quality PSI provision is normally provided by nurses. There is therefore need to train nurses as well on how to assist the doctors by ensuring aseptic set up, proper processing of equipment, correct supplies for PSI and correct record keeping.

Counseling is a critical step in PSI provision. However, by design of the current service delivery system, doctors are rarely involved in counselling. Their role is limited to validating the information the client has been given. This necessitates training of counsellors on CTU and PSI focused counseling.

The current training modality is cadre/role specific. This will require 3 streams of training event to ensure an adequately trained team competent enough to provide quality PSI satisfactorily. Perhaps a team approach can be a solution to this in future trainings?

Task shifting.There is a need to advocate through relevant organs using existing global evidence or conducting OR for PSI to be performed by other cadres as well.

Other training approaches. Currently the training approach is reliant on centralized design. This was seen as insufficient to produce a critical mass of service providers to address the existing/emerging need for PSI both in the short and long run. There is therefore a need to begin advocating for adoption/recognition of other modalities of training approaches such as structured or unstructured OJT to augment the current centralized training approach. EH is in the process of developing an OJT curriculum. Should TA be required, the consulted offered willingness to participate in this.

ii. Clinical standard and guidelines. An updated clinical standards manual is not yet in circulation. A review of the draft indicates that the manual is silent on many salient areas for quality PSI provision. The language captured in the manual is more inclined towards the two rode implant in most part instead of the single rod implant. A second look on this section is therefore suggested before the final draft is printed for circulation. Among these areas are:

Initiation of Implanon in mother on the menses.

Use of Implanon on obese mothers.

Minimum quality standard for PSI service provision


iii. Post-Training follow-up. Post training follow up is a critical component of our clinical training programming. It’s not feasible to do this with our current clinical capacity of the project. There is therefore need to consider additional capacity of clinical advisors to help in conducting trainee follow up. If support is needed in conducting trainee follow up, CST is available to offer any necessary support.

iv. Clinical advisors. Need for additional clinical capacity to assist with setting up clinical quality systems in the facility, continuous quality monitoring of the services we support through the DOH

v. Infection prevention. Use of drapes is recommended in PSI provision. Encourage use of procedure tables covered with “plastic sheets” to facilitate cleaning after each clients. IPC job aids on hand hygiene, 0.5% chlorine solution preparation to be provided in the facilities.

vi. Data. PSI clients not captured in the current TLC.

vii. Enabling environment. PSI is a new service. Needs to support existing system to accommodate the service. A 5-phase integration approach is a useful tool in introducing new services.

viii. Demand generation activities. The program implementation seems to have run way ahead of demand generation activities. This is good and bad at the same time. Good because we are getting mothers seeking services out of satisfied client based on the satisfied clients pleasant experiences. Bad because the proponents are laying a long term strategy to offend the program in a big way by exploiting our weakest link yet-the demand generation.

Finally, it is recommended that all the three key elements of the SEED™ programming approach is balanced so as not to skew the program so much as to leave it amenable to attack from the unattended component

3. Consultation Meeting with Highly Urbanized Cities in the Visayas - Nov. 12, 2014

One of the major concerns discussed during the Visayas Regional Convergence Workshop conducted last August 28 - 29, 2014 was the need for a concerted effort among health stakeholders to address the gaps identified based on the results of the 2013 National Health and Demographic Survey (NHDS). The NHDS have shown most key indicators related to MNCHN/FP have hardly changed for the past ten years especially for the poorest of the poor. The Total Fertility Rate (TFR) is declining in all wealth quintiles except for the lowest quintile. Modern Contraceptive Prevalence Rate (CPR) is lowest in the lowest wealth quintile. Facility Based Deliveries (FBD) and deliveries attended by skilled birth attendants are also lowest in the lowest wealth quintile.

The highly urbanized cities (HUC) play a major role in this effort because of the large urban poor population. To address this problem, a consultation meeting was conceptualized involving eight (8) highly urbanized cities in the Visayas namely: Cebu City, Mandaue City, Lapulapu City, Tagbilaran City, Iloilo City, Bacolod City, Tacloban City and Ormoc city. Participants were the City Health Officers, City Planning Development Officers, City MNCHN/FP coordinators. Discussions were led by VH and Assistant Secretary Paulyn Ubial of VOC, DOH.

The City Health Officers presented the status of MNCHN/FP implementation in their respective cities to a panel of reactors and the other participants. At the end of the meeting, all participants committed to support the improvement of MNCHN/FP implementation in urban areas.

The following were some of the important issues/concerns that came out during the consultative meeting:

a. Difficulty in obtaining health data and information from poor households

The city health officers of the 8 cities narrated their difficulties in collecting health data from the urban poor. According to them, the existing FHSIS does not allow for disaggregation of the health data by income. While the health status of urban areas appear to be better compared to the non-urban population, the absence of health information from the urban poor raises important questions about possible differentials in health status that exist in the urban areas.


In response to this need, the VH project will engage the services of a consultant to assist the urban health managers in obtaining health data and information from urban poor households and use the information to improve the delivery of health services.

b. Difficulty in getting urban birthing centers accredited by PHIC

A common problem among highly urbanized cities is in having their centers accredited by PHIC. Most urban health centers are multi-purpose facilities and are not primarily designed for health service delivery hence many of them are unable to meet the requirements of the DOH. While some cities received assistance from the DOH in improving the health facilities through the Health Facility Enhancement Program of the DOH, some of the health centers that were rehabilitated still could not meet the MCP licensing requirements.

The VisayasHealth project will coordinate with the DOH and PHIC in assisting the urban health staff address some of the licensing and accreditation issues

c. Engaging the private sector

A comparable advantage of the highly urbanized cities is the presence of many private sector providers that serve clients who are able to pay for services. The private sector providers help decongest the public health centers and enable the public health providers to focus their attention to the poor and those who cannot afford to pay for private sector services. However, the city health officers claim that they encounter some difficulty in coordinating their efforts with the private providers in their respective areas. While the PRISM2 project had initiated coordination meetings, there is a need to continue working with the private sector to ensure to better harness their contribution to the delivery of health services.

4. KP roadshow

For this quarter, VH participated and assisted the DOH-ROs in the conduct of 4 KP roadshows:

Oct. 27, 2014 - SanJoaquin, Iloilo

Nov. 11, 2014 - Tabogon, Cebu

Nov. 12, 2014 - Tuburan, Cebu

Nov. 14, 2014 - Anda, Bohol

The Department of Health (DOH) recently launched the DOH on Wheels: Kalusugan Pangkalahatan or KP Roadshow. KP is the Aquino administration’s universal health care agenda, which seeks to improve health outcomes like maternal and child health at the least possible cost. This event, conducted in different regions of the country, consisted of activities meant to showcase the wide range of health services available for women, children, and even men – essentially, all members of the family. Special service packages for adolescents and the elderly were likewise highlighted.

The Kalusugang Pangkalahatan Roadshow also aims to promote the programs and services available at the health facilities in order to increase utilization and coverage. Moreover, addressing the target health goals of the Millennium Development Goals namely: No.4 - Reduce child Mortality, No.5 - Improve Maternal Health and No.6 – Combat HIV/AIDS, Malaria and other infections disease by bringing these health services closer to the people especially in far flung communities.

5. Orientation of Tagbilaran City to the CDI program of USAID- 21 November 2014 Tagbilaran City, Bohol.

Tagbilaran City was chosen to be part of the USAID City Development Initiative (CDI) for its potential to have an enabling environment for growth. This was affirmed by the National Competitiveness Council when they ranked Tagbilaran City as No.1 in Government Efficiency in the whole of Central Visayas.

The workshop entailed a needs assessment workshop participated by city government heads, representatives from the academe, civil society organizations, Provincial Health Office, PhilHealth-Head, Tagbilaran CHO, DSWD National and Local Team Leader, Department of Health- Bohol Province, and non-government organizations – Bohol Integrated Devt. Foundation (BIDEF), Integrated Midwives Association of the


Philippines (IMAP), EngenderHealth- VisayasHealth), and the Tagbilaran City Mayor. The workshop was envisaged to identify crucial needs and development challenges of the city, its existing programs and projects of development partners and national agencies.

The needs assessment workshop was structured to effectively identify and assess the development challenges that Tagbilaran City has in the following areas of growth: [i] Enabling Environment for Investments (Infrastructure, Transport, and Cost of Doing Business); [ii] Development of the City’s Production Sectors; [iii] Issues on Energy, Environment, Climate Change, and;[iv] Issues on Health.

6. Minimum Initial Service Package for Reproductive Health in Crisis Situations - Dec. 8 - 12, 2015

Since the project started in March, 2013, the Visayas has been devastated by multiple catastrophic events. In October 2013, Bohol experienced the impact of a 7.2 magnitude earthquake. It was the deadliest earthquake to hit the Philippines in 23 years. This disaster was then immediately followed by Typhoon Haiyan (locally known as Yolanda) in November 2013. Regions VI, VII and VIII were among the most impacted by the storm and recovery efforts are still underway. The Philippines is frequently visited by tropical storms. Each year nearly 20 Typhoons enter the Philippine area of responsibility and between six and nine make landfall, many times with devastating force. The Philippines is also prone to earthquakes, Tsunamis and volcanic eruptions.

Successful and sustainable reproductive health programming in the Philippines will require a focus on resilience, preparedness, health systems strengthening, and when a disaster occurs—response and recovery. The Women’s Refugee Commission (WRC) proposed to work with EngenderHealth/Philippines to build its capacity in these areas. The WRC will work closely with EngenderHealth to build capacity in the Minimum Initial Service Package (MISP) for Reproductive Health and to provide follow-up technical support and guidance.

The overarching goal of the 5 day MISP training is to increase knowledge of the MISP and coordination skills among VH staff with responsibility for collaborative planning and managing SRH programs during crisis situations. At the end of the training, participants underwent online distance learning through the MISP distance learning module and had to pass the examination before certificates of completion were given. All of the participants were awarded certificates of completion.a plan to conduct data quality check activities in the 8 provincial sites.

7. Reaching Out to Adolescents. The VisayasHealth Project's primary intervention for adolescents is

the Program for Young Parents (PYP). The PYP is a hospital-based intervention patterned after the Teen

Moms Program of the University of the Philippines -Philippine General Hospital (UP-PGH). The PYP seeks

to:

• Promote joint responsibility and gender sensitivity

• Provide holistic care to young mothers and their babies (pre and post natal, including immunization)

• Promote facility-based deliveries (PhilHealth MCP)

• Prevent rapid repeat pregnancy/healthy timing and spacing of births (long acting reversible contraceptives)

• Promote exclusive breastfeeding for at least six (6) months

The PYP Centers:

• Provide a dedicated day for antenatal consultations for mothers below 19 years old

• Designate a space for counseling and health education classes following the national standards set by DOH on the provision of Adolescent-Friendly Health Services

• Enrol target clients who submit for antenatal consultations, deliveries, post-natal care and essential intra-partal and newborn care (EINC) in the PYP


• Engage husbands and partners who accompany their wives/girlfriends when they avail of obstetric and pediatric services

• Emphasize joint responsibility and gender sensitivity during provision of services

• Reach out to other significant adults (mother, mother-in-law, guardian, care giver) by involving them during health classes and group counseling

• Apply interactive educational sessions to reach out to teen mothers, their partners, and significant adults

• Involve the Breastfeeding Support Group/s in each of the facilities to promote exclusive breastfeeding

The VisayasHealth Project has developed a pre-engagement checklist to help field staff determine the readiness of a facility to be engaged for the PYP. The PYP is designed for facilities with high volumes of deliveries, particularly among women less than 19 years old. It is important that key stakeholders in the hospital management recognize the need for an intervention to address the concerns of young, pregnant mothers, their partners, and significant adults. Once the facility signifies their desire to set up a PYP in their facility, the VisayasHealth Project conducts and orientation on the intervention and provides technical assistance to help the facility identify a core PYP Team. Thereafter, the VisayasHealth Project conducts Dealing with Adolescent Clients training for the members of the PYP Team. This training adheres closely to the DOH-approved Adolescent Job Aid (AJA). In addition, sessions on gender sensitivity and values clarification have been incorporated.. Emphasis is given to compliance with the DOH Standards for Adolescent-Friendly Health Services or AFHS. Thereafter, facilities are guided through the process of developing their respective protocols for the provision of AFHS. Once finalized and approved by hospital management, all hospital staff are oriented on the protocol to ensure that all hospital personnel are aware of the protocol and are primed to provide adolescent-friendly health services. Further, facilities are assisted in transforming the spaces they identify for the PYP into more adolescent-friendly spaces in compliance with the DOH AFHS Standards.

For this quarter, Dealing with Adolescent Clients was conducted for four (4) facilities of Negros Occidental (21 participants) and four (4) facilities of Iloilo, including the Rural Health Unit (RHU) of the municipality of Mina which serves as the main referring facility to the PYP Center in the Iloilo Provincial Hospital (IPH) in Pototan, Iloilo (29 participants). This brings the total number of hospital staff trained on Dealing with Adolescent Clients to 95. (23 staff from Vicente Sotto Memorial Medical Center, Iloilo Provincial Hospital, Iloilo Provincial Health Office, and DOH RO 7 were trained in August 2014; while 22 staff from Abuyog District Hospital, Ormoc District Hospital, Governor Celestino Gallares Memorial Hospital, Don Emilio Del Valle Memorial Hospital, Cebu Provincial Health Office were trained in September 2014.)

Table 20: Dealing with Adolescent Clients (AJA) Training

Province of Negros Occidental

27 to 28 October 2014

Nature's Village, Talisay City

Lorenzo D Zayco District HospitalKabankalan City 8

Cadiz District Hospital 6

Corazon LocsinMontelibano Memorial Regional HospitalBacolod City 5

Provincial Health OfficeNegros Occidental 2

Sub-Total 21

Province of Iloilo

24 to 25 November 2014

Diversion 21 Hotel, Iloilo City

Ramon Tabiana Memorial District HospitalMunicipality of Cabatuan 7

Jesus M Colmenares District HospitalMunicipality of Balasan 7

Western Visayas Sanitarium and General HospitalMunicipality of Santa Barbara 6


Table 20: Dealing with Adolescent Clients (AJA) Training

Rural Health Unit of Mina 4

Iloilo Provincial Health Office 1

DOH RO 6 3

HMO 1

Sub-Total 29

TOTAL 50

This quarter, the PYP Center in Don Emilio Del Valle Memorial Hospital (DOH retained)Ubay, Bohol was launched on 18 October 2014. The PYP Center launch in Governor Celestino Gallares Memorial Hospital (DOH retained) in Tagbilaran City, Bohol had to be moved from 05 December 2014 moved to 30 January 2015 due to Typhoon Ruby.

There are currently five (5) PYP Centers: Vicente Sotto Memorial Medical Center, Abuyog District Hospital, Iloilo Provincial Hospital, Eastern Visayas Regional Medical Center, and Don Emilio Del Valle Memorial Hospital. PYP has been received with much interest and enthusiasm, particularly in areas that are experiencing many teen pregnancies. Meanwhile, the VisayasHealth Project is undertaking operations research to gather empirical evidence on the effectiveness of the intervention.

B. Planned Major Activities In The Next Quarter:

1. Capacity Building of DOH-ROs:

Provision of technical assistance to DOH-ROs in outsourcing, provision of grants to DOH attached agencies and Performance Based Grants to LGUs

Assistance to the cities in establishing the CDI 2. Activities for Big Push provinces:

Consultation with Provincial Health Officials regarding the plan for 2015

preparation of training calendar

Conduct of joint semi-annual program reviews of the three big push provinces 3. Activities for PPP

Consultation/Coordination with private midwives in big push provinces and tri cities

Training of PPMs on PPIUD, FPCBT 1 and 2.

Facilitate integration into existing SDNs

4. Program Management:

Attendance of COP/DCOP and finance team to Program Managers' meeting in Cote D'Ivoire, West Africa

regular quarterly general staff meetings

5. Demand Generation:

Participation in Family Health Days/KP roadshows conducted by LGUs and DOH.

Continuation of training of CHTs and other health service providers on Pregnancy Tracking System.

Localization of National campaigns.

6. Increasing Supply:

Application of accreditation as training institution in the three Visayas regions

TOT for trained health service providers on PPIUD/PSI


Installation of PYP (Program for Young Parents) in Gov. Celestino Gallares Memorial Hospital, Kabangkalan District Hospital

Initiation of NSV training in Bohol

7. Policies and Systems:

Dissemination of IRR of RPRH Law.

Approval of DOH Issuances and guidelines on training accreditation.

Development of TOT manual for PSI

Assistance to LGUs on proper utilization of PhilHealth reimbursements.

C. New Opportunities For Program Expansion

Change in DOH top management, the new acting Secretary of Health has created a committee to address RH concerns.

The Visayas DOH-ROs have created assessment teams to review VH application for accreditation as a training institution

Establishment of SDN in Tacloban City spearheaded by the city government, assisted by Philhealth, HPDP, DOH, development partners and the private sector.

Proposed establishment of the Cities Development Initiative (CDI) in Tagbilaran City and Tacloban City.

PhilHealth Issuance on the automatic enrollment of all pregnant women so they can avail of PhilHealth benefits


VII. Financial Reports

SUMMARY OF FINANCIAL REPORTS Fiscal Year 3, Quarter 1 (1 October – 31 December 2014)

Table 20. Itemized Project Expenditures (USD)

Cost Items

Total LOP This

Quarter

Cumulative Expenses

of Previous Quarters

Expenditure This Quarter Cumulative Amount at

End of This

Quarter

% of Expenses Based on the LOP

Month Oct 2014

Month Nov 2014

Month Dec 2014

Labor + Fringe Benefits

221,163

73,159.32 96,310.01 64,738.60 234,207.93 105.90

Travel and Transportation

332,167

64,823.08 86,731.52 70,521.96 222,076.56 66.86

Project Activities

Sub-grantees/ sub-contractors

82,185 39,919.47 19,428.49

19,490.56 78,838.52 95.93

Other Direct Costs

116,271 58,245.06 45,958.54 38,060.18 142,263.78 122.36

Indirect Costs 207,754 96,416.04 112,760.08 79,462.38 288,638.50 137.93

TOTAL 959,540 332,562.97 361,188.64 272,273.68 966,025.29 100.68

NOTE: The amount for Travel & Transportation includes the Project activities

Table 21. Provincial/City Expenditures

Province/City

Costs of Activities Per Province

Total Expenditure TA Training

Logistics (equipment,

supplies, materials)

Others (please specify)

Disaster Relief

Ilo-ilo 6,270.15 6,541.75 12,811.90

Negros Occ 1,518.19 3,233.11 4,751.30

Negros Or

Bohol 7,165.96 5,850.09 13,016.05

Leyte 8,380.83 20,390.83 28,774.66

Southern Leyte 1,141.30 13,637.59 14,778.89

Northern Samar 1,538.64 6,514.09 8,052.73

Western Samar 1,670.53 2,828.01 4,498.54

Cebu 6,791.84 18,431.02 25,222.86

TOTAL 34,477.44 77,426.49 111,903.93


VIII. Success Stories / Highlights

USAID-assisted private midwife clinic network sees further rapid expansion

Cebu City, PHILIPPINES - In just six months from June 2014, the USAID-assisted network of private

practicing midwives (PPMs) in Cebu added 15 new Philippine Health Insurance (PhilHealth)-accredited

birthing homes to its network. This brings the total number of PPM-led clinics to 57, and accounts for

70% of all PhilHealth-accredited facilities in Cebu at the end of 2014. With the combined average

volume of almost 2,000 clients a month, these birthing homes have become ideal launching points for

new and expanded information, products, and services related to maternal, newborn, and child health and

nutrition/family planning (MNCHN/FP). The rapid growth in numbers is traced to the continuing high

demand for quality FP/MNCHN services especially among low-income women/families recently enrolled

into PhilHealth. Cebu local health managers and providers welcome this development for its contribution

to service coverage expansion under a public-private service delivery network setting.

At a recent meeting, USAID-assisted PPMs revealed the rapid

expansion of their clinic network to a total of 57 in just 6 months

from June to December 2014 to respond to the growing demand for

MNCHN/FP information, products, and services especially among

low-income women/families enrolled into PhilHealth.

(Photo by EngenderHealth-VisayasHealth)

The USAID-assisted PPM clinics contribute 4-14% to the total

MNCHN/FP output based on the 2014 Field Health Service

Information System report submissions by the private birthing

clinics.

(Photo by EngenderHealth-VisayasHealth)

City Mayor leads urban leaders in pledging better health services for urban poor

CEBU CITY - In response to the widening disparity of the health status between the poor and non-poor

families and individuals, Cebu City Mayor Michael Rama called for the prioritization of basic health

services for the poor. This was his message when he led leaders and health officers of highly urbanized

cities in the Visayas to pledge a preferential bias for the poor at a recent USAID-organized forum through

the VisayasHealth Project. The gathering engaged the 35 participants to share experiences, difficulties

and successes in providing services to the estimated 140,400 urban poor families1. Among the common

problems cited is the inability to collect data and health information from poor and disadvantaged

households and individuals. Led by Mayor Rama, the group pledged to pursue the following agreed

1 Estimates from the 2010 Census of Population and Housing particularly for the Cities of Cebu, Mandaue, and Lapu-Lapu of

Central Visayas; Ormoc & Tacloban Cities of Eastern Visayas, and; Bacolod City of Western Visayas.


agenda for action: prioritize NHTS/CCT families in the delivery of MNCHN/FP services; mobilize

community volunteers in identifying unmet need for MNCHN/FP among the urban poor households and

individual clients; organize special days for providing MNCHN/FP services to these priority families;

document successful interventions, and; participate in similar forums / meetings to share their experiences

and lessons learned.

PHOTOS: LEFT: Cebu City Mayor Mike Rama urges urban health managers to

prioritize health services for the urban poor. (Photo by J. Licardo

/EngenderHealth-VisayasHealth)

RIGHT: City Officers and urban officials signify their commitment to

improve urban basic health service to NHTS/CCT families.

(Photo by C. Alfafara/EngenderHealth-VisayasHealth)

Quality standards of subdermal implant provision emphasized in Western Visayas

BACOLOD CITY - Fear of side effects is the most common reason why women are afraid to use a family

planning (FP) method2. To facilitate improvement of service delivery and uphold procedure standards, USAID,

through the VisayasHealth Project implemented by EngenderHealth, held a clinical case conference and skills

enhancement on the Progestin-only Subdermal Implant (PSI) with 32 trained doctors in Iloilo and Negros

Occidental. Reported side-effects and complications of this relatively new FP technology and their corresponding

management were thoroughly discussed. This included comprehensive client counseling, correct execution of

procedure standards, and infection prevention. Improved quality of service delivery of the PSI is seen to benefit

approximately 369,9773 women with unmet FP need from among the estimated 1,343,763 women of reproductive

age in the two provinces4.

PHOTOS:

LEFT: The clinical case conference and skills enhancement on PSI greatly emphasized the provision of in-depth counseling to

clients before, during and after insertion.

MIDDLE: A health staff provides group counseling to waiting clients prior to receiving PSI insertion on the expected side effects

and initial management. Fear of experienced side effects has been known to be one of the reasons for implant removals

and for others who hear about it, their refusal to use any FP method.

RIGHT:One of the trained doctors shows the client the implant applicator (ImplanonTM NXT) and the implant rod inside it.

Doing this is part of the important steps in PSI service provision

(Photos by C. Alfafara/EngenderHealth)

2 2013 NDHS pegs 25.7% among women of reproductive age (15-49 yrs.old) with fears of side effects as reason for not intending

to use contraception.

3 Estimates based on NDHS 2013 data

4 Estimate from the 2010 Census of Population and Household on Negros Occidental and Iloilo Provinces


Hospital midwife integrates Usapan session in pre-natal checks

ORMOC CITY- . Luz Manatad’s job title at the bustling Ormoc Distric Hospital (ODH) is “Nursing Aide”. Being a midwife by profession, the hospital acknowledged her skills by designating her at the hospital’s Family Health Clinic. Although she does not handle/assist deliveries of babies, she handles pre-natal and post-natal checks. One of her expressed regrets is how she had felt inadequate in providing pre and post-partum family planning information and service provision to the hospital clients, partly because of the large influx of deliveries at the hospital, which adds to the challenge to the meager number of hospital staff. When Luz underwent the Usapan training organized by USAID through the VisayasHealth Project of EngenderHealth, she said her training in Usapan as an ideal solution to comprehensively present the various FP methods for the mothers to choose without taking so much time. Usapan for her has the perfect formula that enables mothers to be more comfortable discussing FP because of its relaxed but systematic format. Further, she believed it has complemented the training she received on post-partum intra-uterine device insertion (PPIUD) as an additional FP option for her clients.

ODH is the referral hospital of the municipalities of Albuera, Kannangga, Merida, and Matag-ob in Leyte Province and has approximate deliveries of more or less 400 babies a month. However, today,

Luz says she is no longer as intimidated as before she underwent the Usapan training.

Ormoc District Hospital midwife Luz Manatad provides prenatal examination and interview on a client.

(Photo by H.Severino/EngenderHealth-VisayasHealth)

After a thorough examination, Luz proceeds to do an Usapan (conversation) with her client and later encouraged the client’s husband to be involved in the session.

(Photo by H.Severino/EngenderHealth-VisayasHealth)


IX. Communication and Outreach

Pregnancy Tracking System

VisayasHealth employs multiple, mutually reinforcing media to reach out to its intended clients. This is done through an integrated Pregnancy Tracking System adapted from a system initiated and proven effective in Eastern Visayas with the support of the Japanese International Cooperating Agency (JICA). Under this strategy, the community health workers (CHW) identify pregnant women in their respective catchment areas and immediately record the pregnancy in a Pregnancy Tracking Form. The pregnancy is reported to the Rural Health Unit (RHU). With the assistance of the Rural Health Midwife (RHM) or the Public Health Nurse (PHN), the expected date of confinement/delivery (EDC/D) as well as the dates when the pregnant mother should come for prenatal consultations are computed. The CHW is expected to remind the mothers of their check up dates during home visits. The information is posted on a Pregnancy Tracking Board that is posted prominently in the RHU, so that the RHU staff knows who to expect for check up and when. Should a mother fail to come for her check up, the CHW is immediately alerted so she can follow up the mother. The EDC/D is also posted on a Delivery Tracking Board in the birthing center so that the staff is similarly updated about deliveries.

Through the Pregnancy Tracking System, CHW will also know who among the mothers in her area are interested in accepting a family planning method. The CHW can, thus, initiate the conduct of anUsapan small group discussion and counseling session with the PHN or RHM as facilitator.

Usapan Sessions

VisayasHealth adapted the Usapan session initiated by the PRISM 2 project. The Usapan session is a guided small group discussion participated in by homogenous groups, for example, women with similar family planning intention, pregnant women, and men. A key feature of the Usapan is the immediate provision of family planning services and/or supplies to clients who signify their desire to use contraceptives.

Table23: Clients Reached Through Usapan Sessions

USG Sites Usapan Sessions Clients Reached

Region 6

Iloilo 1,205 8,108

Negros Occidental 253 3,059

Region 7

Bohol 345 4,242

Cebu 480 3,937

3-Cities 1,288 9,180

Region 8

Leyte 476 7,082

Southern Leyte 175 1,761

Western Samar 232 1,734

Northern Samar 173 4,300

TOTAL 4,627 43,403

According to reports, most participants in Usapan sessions are able to decide on a family planning method, with the most common choices being pills, implants, lactational amenorrhea method, and fertility based methods.


sms Reminders

Participants in Usapan sessions receive Action Cards that serve as discussion guide and take home material. The Usapan Action Card has a detachable portion where pregnant mothers can signify their concurrence to receive messages on their mobile phones. The messages are intended to reinforce reminders to submit to ANC on the specified dates, as well as other messages to promote healthy pregnancy and delivery, including: facility-based delivery; modern contraceptive methods; exclusive breastfeeding; process and requirements for availing of PhilHealth benefits; pregnant mothers and infant immunization schedule; etc.

Table 24: Clients in sms Data Base

USG Sites Clients in sms Data

Base

Region 6

Iloilo 1,677 Negros Occidental 1,134 Region 7

Bohol 98 Cebu 3,803 3-Cities 2,668 Region 8

Leyte 1,566 Southern Leyte 135 Western Samar 756 Northern Samar 4,311 TOTAL 1,566

Buntis Celebration

Another way of reaching out to pregnant women is through the Buntis Celebration. Pregnant women are feted in a baby shower with the special objective of imparting important health messages to pregnant women in a fun, non-threatening environment through games. For example, the importance of keeping documents like the PhilHealth Card and Mother-Baby Book is emphasized in a game of Bring Me; messages on maternal and child health and nutrition is conveyed through Make the Right Choice; and participants learn about the different family planning methods through Family Planning Feud. Fathers also get into the fun and learn ways to support their wives/partners through a relay game Getting Ready for the Big Day. And to encourage exclusive breastfeeding for the first six (6) months, Breastfeeding TSEk is played.

Table 25:Buntis Celebrations

USG Sites Buntis Celebrations Held

Pregnant Women Reached

Region 6

Iloilo 1 40

Negros Occidental 0 0

Region 7

Bohol 0 0

Cebu 1 247

3-Cities 0 0

Region 8

Leyte 1 202

Southern Leyte 2 302

Western Samar 0 0

Northern Samar 1 252

TOTAL 6 1,043


Annex A

GENDER

For this 1st quarter of Year 3, the VH Regional Gender Team have started to integrate gender reflective sessions during the Orientation for Nurses under the DOH Nurses’ Deployment Program (NDP). VH sees the need for this gender reflective sessions particularly since these nurses are newly hired by DOH and are directly providing technical assistance to the LGUs and oversee the Community Health Teams in demand generation activities. This quarter, the nurses oriented under the NDPs in Southern Leyte on October 27-28, 2014 totaled to 130 participants. The VH Regional Gender Team was given the opportunity to conduct gender reflective sessions during the Inter-CA Gender Messaging Workshop at AIM, Manila organized by CHANGE, a USAID Cooperating Agency. 18 representatives from the different CAs participated in this workshop with enthusiasm. The gender reflective sessions were conducted in preparation for the workshop where we crafted messages for 15-24 males and females in union and not in union. The workshop outputs also included the identification of touch points for these messages. This quarter, gender reflective sessions were also integrated in the Training on Dealing with Adolescent Clients for Health Service Providers using the Adolescent Job-Aid (AJA) modules of the DOH. There were 2 batches conducted in Talisay City, Negros Occidental on October 27-28, 2014 with 20 participants coming from 3 health facilities (Kabankalan District Hospital, Cadiz City Hospital, and Corazon LocsinMontelibano Memorial Regional Hospital) and in Iloilo City on November 24-25, 2014 with 21 participants coming from 3 health facilities (Balasa, Cabatuan and Mina Rural Health Units).

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