EXCERPT FROM THE MINUTES OF THE REGULAR SESSION OF THE SANGGUNIANG BAYAN OF MAGALLANES, SORSOGON HELD AT THE SB SESSION HALL ON FEBRUARY 7, 2011

Present: Hon. VM Augusto Manuel M. Ragragio Presiding OfficerHon. Ferdinand A. Abraham SB MemberHon. Antonio A. Maraña SB MemberHon. Wenceslao A. Borlon SB MemberHon. Edmundo M. Labalan Jr. SB MemberHon. Romeo L. Buban SB MemberHon. Camilo C. Buelo SB MemberHon. Edgar B. Apuya SB MemberHon.Melchor G. Carrascal SB MemberHon. Charita R. Bon Ex-OfficioMember/

ABC President Hon. Jack Jerick M. Erestain Ex-OfficioMember/

SK Fed. President

Absent: NONE============================================================

MUNICIPAL ORDINANCE NO.02-2011

AN ORDINANCE REGULATING THE PRACTICES OF TRAINED BIRTH ATTENDANTS AND HEALTH WORKERS INVOLVED ON SAFE MOTHERHOOD/ MATERNAL AND CHILD HEALTH PROGRAM IN THE MUNICIPALITY OF MAGALLANES

____________________________________________________________Introduced by: Honorable Councilor Camilo C. Buelo

____________________________________________________________

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BE IT ORDAINED BY THE SANGGUNIANG BAYAN OF MAGALLANES, SORSOGON THAT:

WHEREAS, the Local Government Code of 1991 provided for the transfer of health services and facilities, powers and responsibilities from the Department of Health to Local Government Units (province, municipalities and cities) which are mandated to ensure effective delivery of health services to the people especially of women and children;

WHEREAS, the Provincial Government of Sorsogon passed an Ordinance regulating the practices of Trained Birth Assistants and all Health Workers on safe motherhood/maternal and child health program in the province citing the following data:

1. A High rate of maternal death (1.53/ 1,000 live births as of December 2007);

2. A High rate of infant death (7.86/1,000 live births as of December 2007);

3. A High rate of stillbirth (2.75/1,000 live births as of December 2007);

4. A High home-deliveries (58% of Total deliveries as of December 2007), which is attributed as one major cause of incessant problems jeopardizing maternal deliveries and immediate Post-natal infant safety, wellbeing and continuous health care;

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WHEREAS, the Municipality of Magallanes has a similar situation, thereby the need for the establishment of a trained, dedicated and well organized Women’s Health Team (WHT) in every barangay throughout the municipality. These WHTs will have the primary responsibility of monitoring as much as possible through house visitations of expectant mother and at the opportune time take them to government lie-in hospitals or clinics. They shall undertake Birth Attendance, if necessary; and perform services, functions and duties according to the Safe Motherhood/ Maternal and Child Health Care program of the government, including the recording and documentation for data bank purposes for future reference. Furthermore, they shall undertake information dissemination and education drives on the above mentioned health concerns;

WHEREAS, in the province of Sorsogon including the Municipality of Magallanes, traditional birth attendants or so-called Hilots play a substantial role in birth attendance, the subsequent and delicate post-natal maternal and child-care especially in far flung barangays thus putting at risk pregnant mothers and their newborn babies.

WHEREAS, under the Joint WHO/UNPF-UNICEF 1999 Statement, registered doctors, nurses and midwives are the ones only considered as skilled birth attendants hence the need to regulate attendance to pregnancy, birth and post natal care with the purpose of protecting and safely caring for the mother and child;

WHEREAS, to ensure the efficient, effective and continual performance of Women’s Health Team’s, which is planned to be institutionalized even beyond their project life, it is necessary to provide some form of incentive to its members. This incentive will come from both the SAFE MOTHERHOOD/MATERNAL AND CHILD HEALTH PROGRAM OF THE PROVINCE OF SORSOGON of which the Second Women’s Health & Safe Motherhood Project is attached, as well as allocations coming from local counterpart funds of the Municipality of Magallanes;

NOW, THEREFORE, upon the motion of the Honorable Camilo C. Buelo, Chair of the Committee on Health, Population and Social Services, be it RESOLVED, to enact, as it is hereby DONE:

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SECTION 1. TITLE.- This Ordinance shall be known as the Municipal Birth Attendance and Safe Motherhood and Child Health Care Ordinance of 2011.

SECTION 2. COVERAGE – This Ordinance and its provisions shall govern the functions, services and practices on birth attendance and post-natal care and the conduct of all registered and non-registered Trained Birth Attendants, either active or non-active, whether in the government health service or private individuals.

SECTION 3. DECLARATION OF POLICY. The provision of this Ordinance is in line with the Memorandum of Agreement by and between the Province of Sorsogon and the Department of Health (DOH). It hereby fully adopts the policy to undertake a paradigm shift in maternal care from “risk approach” to “emergency maternal obstetrics care” or the EMOC approach that is fully interpreted as ‘’an approach that considers all pregnant women to be at risk of complications during pregnancy”. The EMOC approach requires pregnant women to deliver at facilities assisted only by skilled birth attendants. Henceforth, it will also be the policy of the Municipality to recognize the Joint WHO/ UNPF-UNICEF 1999 statement that registered doctors, nurses and midwives are the only ones who are considered as skilled birth attendants (SBA). Furthermore it shall also be the policy of the Municipality of Magallanes that Home Deliveries facilitated by Traditional Birth Attendants (TBA) or Hilots or any health personnel not described above are prohibited unless the succeeding provisions define some exceptions.

SECTION 4. OPERATIVE PRINCIPLES/PURPOSES. This Ordinance is hereby enacted for the following purposes:

a) To establish a well-trained; well-coordinated and institutionalized Women’s Health Team (WHT) in every barangay throughout the municipality that shall monitor and keep track of expectant mothers in their locality;

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b) At the opportune time, to properly convey said expectant mothers to government-run lying-in hospitals, or clinics and ensuring that all mothers and their newborns have skilled care and guidance during pregnancy, childbirth and the immediate postnatal period; and

c) To ensure the efficient, effective and continual performance of WHTs, which shall be institutionalized even beyond their project life, it shall be necessary to provide its members with some form of incentive coming from the Second Women’s Health Safe Motherhood Program, under which this safe Motherhood/ Maternal and Child Health project of the Province of Sorsogon is attached as well as incentives coming from local counterpart funds.

SECTION 5. DEFINITION OF TERMS. Terms for purposes of this Ordinance are defined below. Definition of other terms not included may be defined based on their universally accepted definitions or through common usage or scientific understanding.

1. SKILLED BIRTH ATTENDANTS (SBAs) are the following : Registered Doctors; Registered Nurses; and Registered Midwives.

2. WOMEN’S HEALTH TEAM (WHT): The Women’s Health Team are organized and established in every Barangay. The team is composed of the following:

a. Rural Health Midwife- is the Team Leader of all WHTs organized in her/his catchment areas.

b. Barangay Health Worker or BHW(s)c. Traditional Birth Attendant or TBA(s)

The organization of Women’s Health Team (WHT) guarantees an effective community level support system in the implementation of the Women’s Health and Safe Motherhood (WHSM) intervention program. The Municipal Health Officer acts as supervisor of all WHT’s within the RHU catchment area and shall be on call to give advice and attend to cases which are beyond the capacity of the WHT to handle.

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FUNCTIONS OF WOMEN’S HEALTH TEAM (WHT)

To assist in accomplishing the birth plan; To refer women to appropriate facilities for WHSM services; and To report maternal complication.

3. ORDINARY CITIZEN: Any person or resident in the community who has knowledge or witnesses an alleged violation of this Ordinance. The Women’s Health Team as the frontline entity for effective intervention in such cases will cause the mother together with other members of their family to decide to give birth only in appropriate health facilities as defined in this Ordinance.

4. BIRTHING FACILITY- the appropriate facility where deliveries are performed.

5. ACCREDITED BIRTH FACILITIES- the following are considered accredited birthing facilities:

5.1 BASIC EMERGENCY OBSTERIC AND NEWBORN CARE (BEmONC)

a. Rural Health Unit (RHU)b. Lying-In Clinic Accredited by DOHc. District Hospitald. Birthing Home Accredited by DOHe. Private Hospital Accredited by DOHf. Magallanes Medicare Hospital situated in Brgy. Aguada

Norte

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5.2 COMPREHENSIVE EMERGENCY OBSTETRIC AND NEWBORN CARE (CEmONC)

a. Irosin District Hospitalb. Dr. Fernando B. Duran, Sr. Memorial Hospital

(Sorsogon Provincial Hospital)c. DOH Accredited Secondary/ Tertiary Hospitals

SECTION 5. ACRONYMS. – As used in this Ordinance, the following acronyms shall mean, to wit:

5.1 BEMOC - Basic Emergency Maternal Obstetric Care5.2 BHW - Barangay Health Worker5.3 CHO - City Health Office5.4 LIC - Lying-In Center5.5 MHO - Municipal Health Office5.6 PHO - Provincial Health Office5.7 RHU - Rural Health Unit5.8 SBA - Skilled Birth Attendant5.9 TBA - Traditional Birth Attendant, or Hilot in local

parlane5.10 UNICEF -United Nation International Children Emerge Emergency Fund5.11 UNPF - United Nation’s Population Fund5.12 WHO - World Health Organization5.13 WHT - Women’s Health Team

SECTION 6.- PERSONS QUALIFIED TO BE BIRTH ATTENDANTS

The practice and function of Birth Attendance should be limited only to the following, who shall be deemed as the only technically competent persons to perform, except under extraordinary circumstances, the practice and function of Birth Attendance, viz:

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6.1. Skilled Birth Attendants (SBA) who are the following 1}. Registered Doctors, 2}. Registered Nurses and 3}. Registered Midwives;

6.2. Barangay WHT, with the government’s RHU Midwife, assigned in the barangay concerned as SBA and Team Leader, and BHWs and TBAs, as members to assist

the SBA in providing services to maternal and newborn needs;

SECTION 7. – PROHIBITION ON MOTHERS TO HAVE HOME BIRTH DELIVERIES OR IN PLACES NOT DESIGNATED AS BIRTHING FACILITIES AND FOR TRADITIONAL BIRTH ATTENDANTS (TBA) TO PERFORM CHILDBIRTH DELIVERIES WITHOUT THE IMMEDIATE AND DIRECT SUPERVISION OF A SKILLED BIRTH ATTENDANT (SBA) OR RHU MIDWIFE

It shall be prohibited for pregnant mothers to deliberately give birth at home or in places not designated as a birthing facility.

Traditional Birth Attendants (TBAs) are prohibited from the practice of Birth Attendance or from performing deliveries of an expectant mother, except when providing assistance under the immediate and direct supervision of a SBA as provided for in Section 6 of this Ordinance.

SECTION 8. REGISTRATION AND ACCREDITION OF TRADITIONAL BIRTH ATTENDANTS (TBAs),

OTHERWISE KNOWN AS “HILOTS”.

8.1 TBAs, to be qualified as members of Barangay WHT shall register with and be accredited by the Municipal Health Office. This will ensure that he/she has jurisdiction within the barangay;

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8.2 A TBA shall file an Application for Registration / Accreditation before the Barangay Women’s Health Team, which shall initially evaluate the competence of a TBA to assist in Birth Attendance and be member of WHT.

8.3 Registration/ Accreditation Forms shall be prepared and issued by the MunicipalHealth Office. Said Accreditation Form shall be duly signed by the following: a]Team Leader of the Barangay Women’s Health Team as ENDORSING OFFICER, b.] Municipal Health Officer as RECOMMENDING OFFICER, and c.] Municipal Mayor as APPROVING OFFICER.

8.4 Approved Registration/Accreditation Form shall be issued to the TBA concernedafter payment of FIFTY PESOS [P50.00] to the Municipal Treasurer’s Office as Documentation/administrative fee.

8.5 The Municipal Health Officer shall thoroughly review, verify and determine the technical competence and capability of the applicant TBA, before recommending approval and issuance of a Certificate of Registration and Accreditation by the Local Government Unit of Magallanes.

8.6 REGISTRATION and ACCREDITATION of the concerned TBAs shall be renewed every Two [2] years.

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SECTION 9. FUNCTIONS, DUTIES AND RESPONSIBILITIES OF A BARANGAY WOMEN’S HEALTH TEAM (WHT).

9.1 In writing, identify, record, monitor or keep track of expectant mothers in the barangay. Render health counseling before, during and after maternal delivery; and conduct or facilitate transport of expectant mothers to government hospitals or Maternal clinics or BEMOC Center within the municipality or province;

9.2 Support and assist SBAs in the performance of Birth Attendance, keep a written record so it may be a part of the WHT’s monthly report to the Municipal Health Office;

9.3 Perform individualized or group counseling, as the case may be, and conduct information dissemination campaigns and serve as advocates of safe motherhood/maternal and child health care in the barangay. Advocacy may be as follows:

9.3.1 Encourage pregnant women to enroll for essential pre-natal andpost-natal care and to obtain care from a skilled attendant duringchildbirth;

9.3.2 Help women and families to follow-up on self-care advice and other recommendations from the skilled birth attendants such as nutrition,early diagnosis and treatment, dietary supplementation, immunization, scheduled appointments, plans for births and emergencies, etc.;

9.4 Encourage the involvement of the male partner in the care of the woman and their newborn;

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9.5 Disseminate health information throughout the community and to particularfamilies directly concerned with imminent childbirth;

9.6 Give care support during and after delivery, either as birth attendant or birth companion;

9.7 Report to and / or inform the Municipal Health Office, through the Barangay Rural Health Station about pregnant women in the community so that the SBA can make direct contact with them;

9.8 Serve as link between the families, communities and local authorities and the reproductive health services;

9.9 Encourage community involvement in the development/ maintenance of the continuity of care for nursing mothers and their infants;

SECTION 10. ADMINISTRATIVE RESPONSIBILITIES:

10.1 The Municipal Health Office, under the supervision of the Municipal Health Officer shall be responsible for the implementation of the provisions of this Ordinance. Furthermore, they shall coordinate with the Magallanes Medicare Hospital administration and staff as the need arises.

10.2 Establish and operate BEMOC Center, where there is no existinggovernment hospital, to be manned by routinely scheduled SBAs and WHTs to minister to the needs of expectant mothers before, during and after maternal delivery.

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SECTION 11. INCENTIVES FOR MEMBERS OF BARANGAY WOMEN HEALTH ITEMS:

11.1 As provided for in Provincial Ordinance 05 – 2008 as amended, The Provincial Health Office, shall provide a monthly cash incentive to Barangay Women’s Health Teams, out of funds from the SECOND WOMEN’S HEALTH AND SAFE MOTHERHOOD/MATERNAL AND CHILD HEALTH PROGRAM. It may also be taken from any available health allocation as determined and fixed by subsequent and appropriate provincial ordinance.

11.2 The Municipality of Magallanes shall provide a counterpart cash incentive to members of the Barangay Women’s Health Team, as shall be fixed by a duly approved appropriation ordinance.

SECTION 12. COMPOSITION, DUTIES AND RESPONSIBILITIES OF THE MUNICIPAL MATERNAL INVESTIGATING TEAM (MMIT).

The Municipal Maternal Investigating Team or MMIT shall investigate reported cases of home birth deliveries and will coordinate with the proper enforcement agency, which in this Ordinance is the Local PNP station. Any citizen or resident who has witnessed or has actual knowledge of home birth deliveries may report the said case to the MMIT.

1. The MMIT shall be composed of the following members:

a. Sangguniang Bayan Chairperson of the Committee on Health and Social Services;

b. Municipal Health Officer and Head Nurse of the Municipal Health Office;

c. A representative from the Municipal Social Welfare and Development Office (MSWDO);

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d. A representative from the local Philippine National Police (PNP) station

2. The MMIT shall perform the following duties and responsibilities:

a. To monitor the proper compliance to the provisions of this Ordinance and apply the

appropriate penalties as described in Section 13.

b. To investigate and recommend proper action based on the result of its

investigation.

c. To conduct individual and group counseling to offenders and survivors as a result of violation (s) as defined under Section 13 of this Ordinance.

d. To submit findings to proper authority for further action.

3. Flow and Process of Investigation for Home Birth Deliveries:

a. Any report from a citizen regarding an alleged violation of this Ordinance.

b. The Municipal Health Office shall report such case to the MMIT for investigation.

c. The MMIT shall convene and conduct an investigation on the case.

d. A written Investigation Report shall be prepared and submitted to the PNP for further action.

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4. Procedure for Filing the Case:

a. The MMIT files the recommendation/ investigation report to the PNP.

b. The PNP is duty bound to file the case to proper Courts.

SECTION 13. PENALTY CLAUSE: The following shall be the penalties for willful violation of the provisions in Sections 7 and 8. They are presented according to the number of offence and degree.

A. FIRST OFFENSE:

1. A fine of P1, 000.00 for the mother who practices home birth delivery.

2. A fine of P1, 000.00 for the parents, husband, legal guardian or caregiver who have given consent to the pregnant woman to practice home birth delivery.

3. The following are the fines/ penalties for Trained Birth Attendants (TBA) and Skilled Birth Attendants (SBA):

3.1 Without Complications - a fine of P1,000.00 for TBA and/ or SBA

3.2 With Complications – a fine of P1,5000.00

3.3. Maternal and/or Neonatal Death- a fine of P2,500.00 and imprisonment, as provided under the Revised Penal Code.

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B. SECOND OFFENSE:

1. A fine of P1,500.00 for the mother who practices home delivery.

2. A fine of P1,500.00 for the parents, husband, legal guardian, caregiver who have given consent to the pregnant woman to practice home-delivery.

3. The following are the fines/ penalties for Trained Birth Attendants (TBA) and Skilled Birth Attendants (SB):

3.1 Without Complications - a fine of P1,500.00 for TBA and/or SBA

3.2 With Complications – a fine of P2,000.00

3.3 Maternal and/or Neonatal Death-a fine of P2,500.00 and imprisonment, as provided under the Revised Penal Code.

C. THIRD OFFENCE:

1. A fine of P2, 000.00 for the mother who practices home delivery.

2. A fine of P2,000.00 for the parents, husband, legal guardian or caregiver who have given consent to the pregnant woman to practice home-delivery.

3. The following are the fines/ penalties for Trained Birth Attendants(TBA) and Skilled Birth Attendants(SBA):

3.1 Without Complications - a fine of P2, 000.00 for TBA and/ or SBA

3.2 With complications - a fine of P2,500.00

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3.3 Maternal and Neonatal Death- a fine of P2,500.00 and imprisonment, as provided under the Revised Penal Code.

SECTION 14. SEPARABILITY CLAUSE.- If for any reason any section or provision of this Ordinance is held unconstitutional or invalid, no other section or provision hereof shall be affected.

SECTION 15. REPEALING CLAUSE.- Any ordinance, rules and regulations or parts thereof whichare inconsistent or in conflict with any of the provisions of this Ordinance are hereby repealed or modified accordingly.

SECTION 16. EFFECTIVITY.- The Ordinance shall take effect upon the approval of the Sangguniang Panlalawigan of Sorsogon and upon the completion of its mandatory publication in a newspaper of general circulation in the Province of Sorsogon, whichever occurs later.

ENACTED AND APPROVED this 7th day of February 2011 at Magallanes, Sorsogon. X===========================================================

I hereby certify to the correctness of the foregoing Municipal Ordinance which was duly adopted by the Sangguniang Bayan in its Regular Session conducted on February 7, 2011.

ZHANNETA O. ARAMBULO Secretary to the Sanggunian Bayan

ATTESTED AND CERTIFIEDTO BE DULY ADOPTED:

AUGUSTO MANUEL M. RAGRAGIO Municipal Vice-Mayor/Presiding Officer

APPROVED:

DR. ROQUE L. CARRANZA Municipal Mayor

Date Signed: __________

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