Live as if you were to die tomorrow. Learn as if you were to live forever. Mahatma Gandhi
Idea Transcript
Technical Assistance to the Health Sector Policy Support Programme ESTABLISHING THE WOMEN’S HEALTH AND SAFE MOTHERHOOD FACILITY NETWORK IN FOURmula ONE for Health Program Provinces A Report Submitted by: Bienvenido P. Alano Jr., PhD Consultant October 2007 Technical Assistance to the Health Sector Policy Programme in the Philippines An EU funded programme managed by the EC Delegation and the DoH 2 TABLE OF CONTENTS Executive Summary Acknowledgements Report Objective and Design Rationale The DOH Strategy in Reducing Maternal Deaths in the F1 Context The Facility Mapping Exercise The Facility Maps of F1 LGUs Ifugao Ilocos Norte Nueva Vizcaya Pangasinan Oriental Mindoro Romblon Capiz Negros Oriental Biliran Eastern Samar Southern Leyte Misamis Occidental North Cotabato Agusan del Sur Lessons Learned Next Steps References 3 8 9 11 14 18 20 21 28 34 40 45 53 61 67 75 80 92 97 101 107 117 119 120 3 EXECUTIVE SUMMARY This paper reports on the results of an effort to identify in each of the provinces covered by the FOURmula ONE for Health Program (F1), the network of health facilities that could cost-effectively provide an integrated package of women’s health and safe motherhood services. This mapping activity represents the initial step in implementing the DOH strategy for addressing the persistently high rate of maternal death in the country. Implementation experience in the F1 provinces is envisioned to guide the rollout effort towards nationwide coverage. An international consensus on the best way to address high maternal mortality rates in developing countries underlies the DOH strategy. It involves a basic paradigm shift in managing pregnancy and child birth. For the past twenty or so years, the strategy of choice emphasized the importance of antenatal care in predicting pregnancy risks and the training of traditional birth attendants to make pregnancy and childbirth at the grassroots level safer. However, recent studies revealed the ineffectiveness of this strategy in reducing maternal mortality in poor countries. The current consensus is that a strategy of encouraging mothers to give birth in adequately-equipped primary level facilities so that they could be attended by a team of skilled providers would be a more effective approach to addressing high mortality rates. The strategy of the Department of Health (DOH) hews to such an approach. It seeks to establish in every province a network of health facilities that could cost-effectively provide basic emergency obstetric care (BEmOC) during childbirth and comprehensive emergency obstetric care (CEmOC) for high-risk and complicated cases. To help ensure that each pregnancy has a favorable outcome and to avoid missed opportunities, the above services are integrated with other interventions that are deemed critical to the mother’s reproductive health, e.g., family planning and STI and HIV/AIDS prevention. This integrated package of service is envisioned to be delivered by highly trained teams of skilled health providers in strategically-located health facilities. To ensure that the facility network is tailored to specific needs of the province and adequately addresses local health concerns, important stakeholders are encouraged to conduct a facility mapping exercise. The exercise therefore usually involves the provincial health officer, the provincial health staff,