visayashealth engenderhealth, inc
TRANSCRIPT
VisayasHealth
EngenderHealth, Inc.
QUARTERLY REPORT/PROGRESS REPORT
January 1, 2017 – March 31, 2017 / Year 5 Quarter 2
Submitted to
United States Agency for International Development
by
VisayasHealth
New York, NY, USA & Cebu, Philippines
under
Agreement No. AID-492-A-13-00007
30 April 2017
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |2
This document is produced for review by the United States Agency for International Development (USAID). The VisayasHealth Project is managed by the EngenderHealth with headquarters in 440 Ninth Avenue, New York City, NY 10001.The contents are the responsibility of EngenderHealth and do not necessarily reflect the views of USAID or the United States Government
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |3
TABLE OF CONTENTS
Acronyms and Abbreviations ................................................................................................................................ 4
I. EXECUTIVE SUMMARY ................................................................................................................................ 7
II. PROGRAM ACTIVITIES AND ACCOMPLISHMENTS ............................................................................. 9
A. Progress/Accomplishments against Project Indicators as of Year 5, Quarter 2 (Y5 Q2) .......................................... 9
B. Demand Generation Accomplishments: ........................................................................................................................... 13
C. Supply Strengthening Accomplishments ........................................................................................................................... 15
D. Policies and Systems Enhancement Accomplishments .................................................................................................. 19
III. CROSS-CUTTING ACTIVITIES................................................................................................................. 21
A. Adolescent and Youth Reproductive Health (AYRH).................................................................................................... 21
B. Monitoring and Evaluation (M&E) .................................................................................................................................... 23
C. Knowledge Management Report ........................................................................................................................................ 24
D. Informed Choice and Voluntarism (ICV) Compliance Report. .................................................................................... 27
E. Environmental Monitoring and Mitigation Plan (EMMP) Compliance Semi-Annual Report ................................ 27
F. Cities Development Initiative (CDI) Reports ................................................................................................................... 28
IV. PROGRAM MANAGEMENT ..................................................................................................................... 29
A. General Staff Meeting at the Regional levels .................................................................................................................... 29
B. Attendance to National Events ........................................................................................................................................... 30
C. Facility Turnovers .................................................................................................................................................................. 31
D. Coordinative Meetings .......................................................................................................................................................... 32
E. Staffing Updates ..................................................................................................................................................................... 33
F. Financial Reports ................................................................................................................................................................... 33
V. OPPORTUNITIES & CHALLENGES ........................................................................................................ 34
A. DOH Advisory Clarifies Application of the Temporary Restraining Order (TRO) on Implanon® ..................... 34
B. Executive Order No. 12 ....................................................................................................................................................... 35
C. DOH Administrative Order No. 2017 – 0005 ................................................................................................................. 35
D. Alternative Learning System ................................................................................................................................................ 35
VI. PLANNED ACTIVITIES FOR NEXT QUARTER ................................................................................... 35
ANNEXES ......................................................................................................................................................... 37
ANNEX I: UNRS Best Practices Abstracts ................................................................................................................................ 37
ANNEX II: Training Components ............................................................................................................................................... 42
ANNEX III: Training Course Enrollment .................................................................................................................................. 43
ANNEX IV: Process Flow for the Modified FP CBT Level 2 PPIUD/Interval IUD Courses ........................................ 43
ANNEX V: Introduction of Interactive Voice Response (IVR) and SMS to the new FP Training Approach for FP CBT 2 ....................................................................................................................................................................................... 45
ANNEX VI: Informed Choice and Voluntarism Compliance ................................................................................................. 52
ANNEX VII: Stories from the Field ............................................................................................................................................. 59
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |4
Acronyms and Abbreviations
ANC Ante-Natal Care
ASRH Adolescent Sexual and Reproductive Health
AYRH Adolescent and Youth Reproductive Health
BHS Barangay Health Station
BTL Bilateral Tubal Ligation
BTL-MLLA Bilateral Tubal Ligation – Minilaparotomy under Local Anesthesia
CDI Cities Development Initiative
CHO City Health Office
CPH Cebu Provincial Hospital*
CPH-CC Cebu Provincial Hospital –Carcar City
CPO City Population Office (Officer)
CS Caesarian Section
CYP Couple Year Protection
DepEd Department of Education
DHC District Health Center
DMPA Depot Medroxy Progesterone Acetate (injectable contraceptive)
DOH Department of Health
DQC Data Quality Check
DSWD Department of Social Welfare and Development
EBF Exclusive Breastfeeding
EH EngenderHealth
EO Executive Order
EOP End of Project
FBD Facility-based delivery
FHSIS Field Health Service Information System
FP CBT 1/2 Family Planning Competency-Based Training Level 1/Level 2
FP Family Planning
FPBP Family Planning Benefit Package*
FPOP Family Planning Organization of the Philippines
GIS Geographical Information System
HKI Helen Keller International
HPDP Health Policy Development Program
HSP Health Service Provider
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |5
ICM International Care Ministries
ICV Informed Choice and Voluntarism
IEC Information, Education, and Communication
IIUD Interval Intrauterine Device
ILCI IMAP Lying-In Clinic, Inc.
ILHZ Inter-local Health Zone
IMAP Integrated Midwives Association of the Philippines
IUD Intrauterine Device
KRA Key Results Area
LAPM Long-Acting Permanent Method
LARC Long-Acting Reversible Contraceptive
LARC Long-Acting Reversible Contraceptive
LGU Local Government Unit
M/LGU Municipal/Local Government Unit
MCH Maternal and Child Health
MCP Maternity Care Package
MD Medical Doctors
MFP Modern Family Planning*
MNCHN Maternal, Newborn, and Child Health and Nutrition
MW Midwife
NDHS National Demographic and Health Survey
NGO Non-Governmental Organization
NSV No-Scalpel Vasectomy
NSVD Normal Spontaneous Vaginal Delivery*
P2P Peer-to-Peer
PHIC/PhilHealth Philippine Health Insurance Corporation
PHO Provincial Health Office/r
POPCOM Commission on Population
PPFP Postpartum Family Planning
PPIUD Postpartum Intra-Uterine Device
PPM Private Practicing Midwife
PPP Public-Private Partnership
PPR Program Portfolio Review
PRIMEX Pacific Rim Innovation and Management Exponents, Inc.
PSA Philippine Statistics Authority
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |6
PSI Progestin Subdermal Implant
PTME Post-Training Monitoring and Evaluation
PYP Program for Young Parents
QGIS Quantum Geographical Information System
REDI Rapport Building, Exploration, Decision making, Implementing decision
RHU Rural Health Unit
RN Registered Nurses
RO Regional Office
RPRH Responsible Parenthood and Reproductive Health
SDM Standard Days Method
SDN Service Delivery Network
SDP Service Delivery Points
SMS Short Messaging System (Text Messaging)
SPH Samar Provincial Hospital*
SS Supportive Supervision
SU Satisfied user
TAP Technical Assistance Package
TB DOTS Tuberculosis Directly Observed Treatment Short Course
TESDA Technical Education and Skills Development Authority
TOT Training of Trainers
TRO Temporary Restraining Order
TUV-SUD Technischer Überwachungsverein-South
UHC Universal Health Care
UNFPA United Nations Population Fund
UNRS Unmet Need Reduction Strategy
USAID United States Agency for International Development
USG United States Government
W/PPR Washington /Program Portfolio Review
WMR World Medical Relief*
WRA Women of Reproductive Age
Y5 Q2 Project Year 5, Quarter 2
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |7
I. EXECUTIVE SUMMARY
The VisayasHealth Project is a USAID-assisted project implemented by EngenderHealth Inc. aimed at
improving maternal and child health (MCH) and family planning (FP) services in eight provinces in the
Visayas region of the Philippines. The project provides technical assistance (TA) to the Philippines
Department of Health (DOH) and Local Government Units (LGUs) to strengthen supply, increase demand
for services, strengthen the health system, and advocate for policies supportive of the national Maternal,
Newborn, and Child Health and Nutrition (MNCHN)/FP program.
During the quarter the project was able to accomplish the following:
1. Continue to generate high levels of Couple Year Protection (CYP)
During the quarter the project was able to generate a total of 111,472 CYP. This brings the total
number of CYPs to 788,193 which, is already 91% of the end of project benchmark. At this rate of
increase, the end of project (EOP) target is going to be achieved during the next quarter.
The reason for the sustained increase in the number CYPs is the successful scaling up of
VisayasHealth's unmet need reduction strategy. During the quarter, the number of facilities
implementing the Unmet Need Reduction Strategy (UNRS) has reached 147, with a total number of
298 family planning days conducted, and 5,294 men and women able to access family planning
services. The UNRS entails the mobilization of satisfied users in generating demand for family
planning services. Based on the experience of facilities that were successful in attracting family
planning clients to access FP services, the satisfied users provided the most credible defense against
rumors, myths and misconceptions against the FP methods. Another important feature of the UNRS is
the conduct of FP days where interested clients come to the health facility for FP counseling and
services.
The success of the implementation of the VisayasHealth UNRS can be attributed to the following
factors: [i] increase in the number of providers trained on LAPM; [ii] highly motivated workers who
went out of their ways to visit geographically isolated areas; [iii] facilities are well-stocked with
contraceptive supplies; [iv] partnership with private sector providers especially in areas where the
public health facilities do not have a trained provider; [v] support from provincial and regional
partners; and [vi] active community engagement and participation.
2. Successful introduction of a cost-effective training approach
In response to the clamor for a training methodology that minimizes not only the cost of the training
but also reduce the amount of time that health care providers are taken away from their work stations,
the VisayasHealth project developed and field-tested a training approach featuring the use of self-
instructional materials. This new training approach utilizes the same training curriculum for the training
of health care providers on interval IUD and PPIUD. However, instead of a classroom based didactic
phase, the new training approach introduced a self-instructional module wherein trainees can just read
and perform the necessary exercises in the workplace. After completing the module, the trainees take a
mid-course evaluation to qualify for the practicum phase which takes place in a field-training area or
preceptor site which is located near the trainee’s area of assignment. During the practicum phase the
trainee practices first on a model before performing the procedure under the guidance of an accredited
preceptor.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |8
The project conducted a rapid assessment of this new training approach and found that the providers
who were trained under this training methodology performed just as competently as those trained
using the traditional classroom-based training approach. A comparison of the cost showed that the
new training approach could save as much as 40% of the cost of doing the training. In addition, the
health providers spend less time away from their areas of assignment during training.
To further enhance the effectiveness of the new training methodology, the project plans to apply the
interactive voice response (IVR) technology to follow-up the progress of the trainees during the self-
instructional phase. The IVR will facilitate the link between the trainee and the preceptor. In
addition, VH is also developing training videos that will complement the reading sessions in the
training module. The videos will be installed in the smartphones of providers during the orientation
to the training course.
3. Training of trainers for Bilateral Tubal Ligation – Minilaparotomy under Local Anesthesia
(BTL-MLLA)
In response to the need for more BTL-MLLA trainers and providers, VisayasHealth conducted a
training of trainers (TOT) course in Cebu City. There were six candidate trainers who participated in
the training course coming from the provincial and district hospitals in the three regions of the
Visayas. If all the trainees are able to successfully complete the course requirements there will now be
14 of BTL-MLLA trainers in the Visayas and an estimated 51 number of providers. This training
course will translate into better access for LAPM services in the Visayas.
4. Documentation of best practices in the implementation of UNRS
During the quarter, a number of promising and best practices emerged that VH was able to
document. These best practices include: [i] A successful partnership between an island municipality
and a NGO for the provision of FP services; [ii] A local chief executive who invested local funds to
fund family planning days and as a result was able to fully recover the investments from the social
health insurance program; [iii] A health facility that was able to generate enough acceptors and
satisfied users that active demand generation is no longer necessary. In this facility, clients are coming
to the facility on their own to demand for FP services; [iv] A provincial health officer (PHO) who is
bringing back public health services especially FP into the provincially-owned and operated hospital
facilities; [v] a privately-owned birthing facility in an urban center that successfully adopted the
UNRS.
These best practices will be shared, presented and discussed during the planned technical conferences
next quarter. The technical conferences will serve as a venue for technical exchange among the
implementing partners and create better ways of reducing unmet need in the Visayas. A list of the
best practices is attached as Annex I.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |9
II. PROGRAM ACTIVITIES AND ACCOMPLISHMENTS
A. Progress/Accomplishments against Project Indicators as of Year 5, Quarter 2 (Y5 Q2)
Table 1, shows that the VisayasHealth project is on track to meet most of its indicator benchmarks by the end
of Year 5.
The CYP performance of the project shows a total of 111,472 CYPs generated by the project bringing the
cumulative total to 788,295 CYPs. The project is now 80,035 short of the end of project benchmark of
868,330 CYPs. At this rate of increase, VH will achieve its EOP target in the next quarter. The reason for the
continued high level of performance of the project in generating CYP is the scaling up of the project’s unmet
need reduction for FP initiative. This initiative is anchored on mobilizing satisfied users to generate demand
for FP services especially for long acting and permanent methods. The UNRS also utilizes the conduct of
family planning days to attract men and women who prefer to visit the health center in the company of
friends and relatives. A total of 153 rural health units and health centers successfully implemented the UNRS.
The indicators for supply enhancement such as SDPs providing PPIUD, BTL and NSV are also being met by
the project as the training activities gathered momentum with the introduction of a cost-effective and trainee-
friendly training approach utilizing self-instructional materials and distance learning techniques. The project
also got another boost in building capacity for LAPM with the conduct of a TOT for BTL-MLLA. Six
candidate-trainers participated in the TOT course and are expected to complete the course requirements in
the next quarter.The project continued to make progress with the demand generation indicators especially
women reached with FP information during antenatal care and postpartum care services. Local providers
continued to utilize Usapan and group education sessions to provide family planning information to pregnant
and postpartum women.
Commodity stockouts during the quarter continued to be at low levels. However, the project continued to
monitor the stocks of IUD as the number of IUD users increased as a result of the UNRS. The availability of
stocks of condoms and Standard Days Method (SDM) beads were lower than the other FP commodities as
these were not included in the DOH’s regular supply to the health facilities.
The project also started to collect baseline data for the new Program Portfolio Review (PPR) indicators. The
data collected showed that the project will likely meet the end of project benchmarks for these indicators.
Table 1. Status of selected FP/MNCHN indicators
Indicator
Un
it o
f
Measu
re
Base
lin
e
YE
AR
2
YE
AR
3
YE
AR
4
Y5Q2 Cumulative
Total EOP Benchmark
% Accomp Y5
Target Accomp*
As of March 2017
Utilization of FP Services Increased
CYP in USG-assisted programs (USAID/W/PPR)
251,123 340,199 298,910 350,840 662,278 111,472 788,295 868,330
Short-term methods 205,337 239,837 167,669 253788
Long-acting methods 45,786 100,362 131,241 350,840 408,490 111,472 788,295 868,330
91%
Subdermal implants No. 0 17,112 39,330
7,958 0 9,545 72,198 463,697
Postpartum IUD No. 2,958 10,732 13,299
22,499 107,065 3,183 44,478 25,536
Interval IUD No. 14,628 25,438 21,252
268,773 57,859 89,424 543,789 137,965
Bilateral tubal ligation No. 27,450 45,100 57,200
44,660 229,460 9,300 120,210 199,906
No-scalpel vasectomy No. 750 1,980 160
6,950 14,106 20 7,620 41,225
Supply Enhancement
Percent of service delivery sites (SDPs) providing FP counseling and services to women, men, and couples(USAID/W/PPR) %
48% 37% 89% 88% 94% 90% 90% 94%
90%
Numerator 235 175 420 488 522 500 500 522
Denominator 489 474 474 554 554 554 554 554
Percent of SDPs providing post-partum IUD services
%
3% 12% 45% 51% 60% 54% 54% 60%
54% Numerator 12 46 151 222 262 237 237 262
Denominator 383 383 337 437 437 437 437 437
Percent of SDPs providing BTL services
%
36% 40% 55% 83% 85% 86% 86% 85%
86% Numerator 41 46 63 67 69 70 70 69
Denominator 115 115 114 81 81 81 81 81
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |11
Indicator
Un
it o
f
Measu
re
Base
lin
e
YE
AR
2
YE
AR
3
YE
AR
4
Y5Q2 Cumulative
Total EOP Benchmark
% Accomp Y5
Target Accomp*
As of March 2017
Percent of SDPs providing Non-Scalpel Vasectomy
% 0% 0.70% 6% 10% 6% 6% 10%
6% Numerator 3 25 46 25 25 46
Denominator 454 454 454 454 454 454
Demand Generation
No. of pregnant women seeking ANC and provided with FP information (cum)
No. 132,116 (2012)
173,437 277,014 361,866 325,782 387,956 387,956 421,866 92%
No. of postpartum women provided with FP information (cum)
No. 98,301 (2012)
107,730 145,350 172,907 283,737 183,070 183,070 283,737 65%
No. of adolescent and youth provided with MNCHN/FP information
No. 7,906 34,606 76,792 62,769 119,147 5,856 190,838 258,635 74%
No. of men provided with FP information
No. 185 2,464 9,208 5,725 13,576 161 18,447 37,949 49%
Health Policies and Systems on FP and MCH improved
Percent of USG-assisted SDPs that experience a stock-out at any time during the defined reporting period of any contraceptive method that the SDP is expected to provide
Pills % 27% 9% 6% 2% 1% 2% 2% 1% 2%
DMPA (injectable) % 36% 12% 7% 2% 2% 2% 2% 2% 2%
IUD % 14% 5% 4% 2% 0.4% 1% 1% 0.4% 1%
Condom 5% 5% 5% 5% 5%
SDM 80% 33% 33% 80% 33%
Implants 0% 0% 0% 0% 0%
% of LGUs doing Data Quality Check at least once a year
% 51% 51% 73% 100% 82% 82% 100% 82%
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |12
Indicator
Un
it o
f
Measu
re
Base
lin
e
YE
AR
2
YE
AR
3
YE
AR
4
Y5Q2 Cumulative
Total EOP Benchmark
% Accomp Y5
Target Accomp*
As of March 2017
New PPR Indicators
Number of women giving birth who received Oxytocin in the third stage of labor (or immediately after birth)
No. 15,148 TBD 3,247 18,395 TBD 18,395
Number of community health workers providing FP information, referrals and/or services during the year
No. 1,103 3,000 2,692 4,632 For
adjustment
Number of Universal Health Coverage (UHC) areas supported by USG investment
a. Strengthening essential package of health services
No. 278 287 279 279 287 97%
b. Assuring quality of health services
No. 112 174 112 112 174 64%
c. Financial Risk Protection
No. 110 174 110 110 174 63%
Presence of Mission support to strengthen Human Resources for Health
a. Upgrading skills mix No. 175 202 182 182 202 90%
b. Integrating community health cadre into the formal health system
No. 58 131 129 129 For
adjustment 98%
B. Demand Generation Accomplishments:
1. Unmet Need Reduction Strategy (UNRS)
As of end of March 2017, a total of 6, 066 clients have been served during FP days (n=359)
conducted in selected VisayasHealth areas. Bohol has conducted the most number of FP days (66),
followed by Cebu (52) and Iloilo and Negros Occidental (45).
Figure 1. Family Planning Days Conducted per Province
Almost half (47%, 136 out of 289) of project assisted cities/municipalities have implemented at least
one FP day, and this is expected to expand to more areas during the next quarter.
Figure 2. Project areas conducting at least one FP Day
45
45
52
66
23
48
32
21
27
0 10 20 30 40 50 60 70
Negros Occidental
Iloilo
Cebu
Bohol
Tri-cities
Leyte
S Leyte
W Samar
N Samar
Number of FP days conducted to date
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |14
During these FP days, 17 clients were provided with FP methods on average. However in big
provinces like Cebu, Bohol and Negros Occidental, as much as 100 clients were served with FP
services in a single FP day.
By region, Central Visayas (Region 7) served the most number of clients (2,274), followed by Eastern
Visayas (Region 8). Most (82%) women opt for Long Acting Reversible Contraception (LARC),
16% for short term methods and 6% for Long Acting Permanent Method (LAPM) (Table 2).
Table 2. Number of clients served by province and by FP methods as of March 31, 2017
Region Province BTL IUD PSI DMPA Pills Condom Total Clients
Served
6 Iloilo 0 435 12 42 45 5 539
Negros Occidental 5 862 67 54 132 11 1,131
7
Cebu 32 743 10 42 47 53 927
Bohol 20 936 33 18 64 73 1,144
Tri-cities 0 137 31 18 15 2 203
8
Leyte 60 355 171 111 46 3 736
South Leyte 1 491 19 6 24 19 560
West Samar 6 84 145 21 31 31 318
North Samar 29 124 302 27 26 0 508
VisayasHealth provinces
TOTAL 153 4,167 790 339 430 197 6,066
The VisayasHealth Project lined up Regional Technical Conferences for the UNRS in the next
quarter starting with Region 7 on April 6, 2017. The conference will showcase the best practices of
selected areas and organizations that have been employing UNRS (See also under section III.C.6, VI. C
and Annex I).
BTL 2%
IUD 69%
PSI 13%
DMPA 6%
Pills 7%
Condoms 3%
Figure 3. Distribution by FP method, FP days, Oct 2016 to March 2017
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |15
C. Supply Strengthening Accomplishments
EngenderHealth Philippines, as an accredited training institution in Regions 6, 7, and 8, conducts FP CBT
Courses Level 2 for health service providers on PPIUD/Interval IUD Insertion and Removal; Bilateral Tubal
Ligation under Local Anesthesia (BTL-MLLA) with or without sedation; No Scalpel Vasectomy) and
Subdermal Implants (Implanon® NXT). For this quarter, it conducted the following courses in areas
covered by VisayasHealth:
1. Self-Instructional Learning Approach for LAPM/LARC Training
The traditional approach to training Philippine FP service providers is both lengthy and costly. It
requires trainees to leave their posts to participate in the didactic and practicum phases of training
usually held at urban centers. This often puts rural-based providers at a disadvantage and, by
extension, their intended clients.
In order to address the issues of time, provider absence from their posts, cost and the resulting
inequity in service delivery, USAID through the VisayasHealth Project with implementing partner
EngenderHealth introduced an alternative learning approach for the FP CBT Level 2-
PPIUD/Interval IUD courses. Self-instructional materials substitutes for the 4-5 days’ classroom-
held didactics and mobilizing local trainers for the practicum, instead of tapping centrally based ones.
However, it requires a learner to allot at least one to two hours daily to study the modules
without leaving their facilities over a period of at least 2 weeks; attend a 1-day Orientation on the
course and 2 days in the practicum or preceptor sites. The details of the training components, course
enrollment, and the process flow for the modified FP CBT Level 2 PPIUD/Interval IUD courses are
thoroughly discussed in Annexes II, III, and IV respectively.
Bohol and South Leyte provinces piloted the implementation of the alternative approach. The rapid
assessment and course evaluation using focus group discussions and key informant interviews with
stakeholders were conducted. On the bases of assessment results, enhancements were developed.
These include the use of interactive voice response (IVR) and text messaging systems to strengthen
trainee and trainer interaction. The subsequent training activities used the improved version.
The Rapid assessment and Course Evaluation of the pilot implementation in two sites involving 14
local trainers and 20 trainees showed that training costs were 40% lower than the traditional
approach. Local government officials liked the new approach as workers stayed on-site while
learning. Post training monitoring and evaluation results showed trainees completed the required
number of insertions for certification much earlier than they completed the trainees under the
traditional approach. The learners achieved Competency and Confidence earlier in Alternative
Learning Approach (3-6 weeks) compared to the traditional approach (3-6 months).
The rapid assessment also showed the following findings and recommendations:
a. The need to strengthen the process of screening the qualification of the prospective learner based on the screening criteria and getting the support of the learners supervisor in giving them the needed break to enable them to do the self-paced study
b. To enhance the module by making it user friendly – larger fonts, more photo’s or videos to aid visualization of the techniques of infection prevention and the steps in IUD specific counselling and Insertion.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |16
c. To make the trainers/preceptors more visible and available to the learners, especially if they have questions related to the self-paced study.
d. To enhance the self-paced study, group interaction/study should be encourage involving the other learners or experienced providers within the facility or their supervisors in some activities
e. To improve the follow-up and reminders to the learners during the self-pace study and their interaction with trainers/preceptors and organizer using interactive voice and text response system.
To further, enhance the modules and the methodologies the above recommendations are used in the
alternative learning strategy.
The interactive voice and text response system assured trainees of ready access to their trainers when
they had difficulties. The trainers and trainees greatly appreciated the reminders sent to them using
the system.
Nascent area-based training systems saw increased focus on demand generation, training of providers
on- site and mobilization of local trainers that brought services closer to clients especially those in
rural and geographically isolated areas.
The implementation of the adaptation of the Self-Instructional Modules in the FP CBT Level 2
PPIUD and Interval IUD insertion from September 2016 to March 31, 2017 yielded the following
results-Completed 9 batches of PPIUD and 5 batches of Interval IUD training activities; 100 service
providers (25 MD, 13 Nurses and 62 Midwives) enrolled for the PPIUD course. Of this number 85
completed the course or a completion rate of 85% (56% for Doctors, 92% for Nurses and 95% for
Midwives). Sixty-seven (67) service providers enrolled to the Interval IUD course and 61 completed
the course for a completion rate of 91%. Sixty-two local preceptors were involved in both training
courses.
The following table shows the number of training activities conducted using the alternative training
approach, the numbers of trainees who attended the orientation and those who completed the
training and the local trainers/preceptor involved.
Table 3. Number of PPIUD and Interval IUD Providers Trained using the Self-instructional Alternative Learning Approach and No. of Local Trainers/Preceptors Involved
Date of P2P Orientation
VENUE No. of Learners
Date of Culmination
Venue No. who completed the Course
No. of Preceptors /Trainers
MD RN MW MD RN MW
09/09/16-PPIUD
Chocolate Hills Complex, Carmen Bohol
4 2 5 10/26/16 Soledad Hotel,
Tagbilaran City
0
1 4 5
09/28/16 PPIUD
Villa Romana, Maasin S. Leyte
0 4 8 11/04/16 Villa Romana, Maasin S.
Leyte
0 4 8 2
11/15/16 PPIUD
Diversion 21 Hotel, Iloilo
4 4 6 01/27/17 Diversion 21 4 4 6 6
11/16/16 PPIUD
Business Inn Hotel, Bacolod City
2 0 9 01/05/17 El Fisher Hotel, Bacolod
City
2 0 9 6
12/09/16 PPIUD
Gov. Celestino Gallares
7 0 2 02/17/17 Gov. Celestino
7 0 0 1
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |17
Date of P2P Orientation
VENUE No. of Learners
Date of Culmination
Venue No. who completed the Course
No. of Preceptors /Trainers
MD RN MW MD RN MW
Memorial Hospital
Gallares Memorial Hospital
2/13/17 PPIUD
Hotel Lorenza, Tacloban City
4 2 5 4/18/17 Hotel Lorenza Tacloban City
1 2 5 4
Feb. 20, 2017 PPIUD
P2P PPIUD Iloilo
1 0 5 4/18/17 Small Ville Hotel Iloilo
City
0 0 6 6
03/8/17 PPIUD
Soledad Hotel, Tagbilaran
3 0 12 4/11/17 Kew Hotel Tagbilaran City, Bohol
0 0 11 5
03/10/17 PPUD
Chocolate Hills Complex Carmen, Bohol
0 1 10 4/11/17 Kew Hotel Tagbilaran City, Bohol
0 1 10 5
9 Subtotal 25 13 62 Subtotal 14 12 59 40
Completion rate 56% 92% 95%
11/29/16 Interval IUD
Villa Romana, Maasin Leyte
0 2 14 02/24/17 Villa Romana, Maasin Leyte
0 2 14 2
Feb 21, 2017 IIUD
P2P IIUD Iloilo 0 2 12 4/18/17 Small Ville
Hotel Iloilo City
0 0 12 6
2/28/17 IIUD
XYZ Hotel Tacloban
2 2 10 4/18/17 Hotel Lorenza Tacloban City
1 1 12 5
3/1/17 IIUD
Lex Hotel Cebu City
0 0 12 3-27-30/17 Summit Circle0
0 0 9 3
03/7/17 IIUD
Soledad Hotel, Tagbilaran, Bohol
1 0 10 4/11/17 Kew Hotel Tagbilaran City, Bohol
0 0 10 6
5 Subtotal 3 6 58 Subtotal 1 3 57 22
Completion rate 33% 50% 98%
Total 28 19 120 Total 15 15 116 62
Completion rate 53% 79% 97%
2. FP CBT level 2 Bilateral Tubal Ligation – Minilap under Local Anesthesia (BTL-MLLA) EngenderHealth/VisayasHealth prioritized the training of service providers from DOH Regional, Level 1 Retained and Provincial Hospitals on BTL-MLLA as well as PPIUD. This effort contributed to the increase on available options, access for quality, affordable and safe FP methods categorized as Long Acting and permanent methods (LAPM).
a. Training of Trainers in Hospitals on FP CBT L2 -BTL-MLLA. Bilateral Tubal Ligation
under spinal and general anesthesia is the most common procedure for permanent FP method
done in the Visayas. This procedure exposes the clients to the risk associated with the above
anesthesia regimen. For women weighing below 60-kilogram body weight, the recommended
procedure is Bilateral Tubal Ligation thru Mini laparotomy under Local Anesthesia (BTL-MLLA)
with or without sedation. The lack of training and available local trainers on this procedure
contributed to the proliferation of the above practice. Review of the residency training on OB-
Gyne reveals that most resident-physicians are trained on tubal ligation under spinal anesthesia.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |18
EngenderHealth/VisayasHealth approached this situation in two ways. The first approach was to
train new service providers as well as retraining those Doctors using spinal anesthesia on BTL-
MLLA. The second is to conduct a training of trainers on BTL-MLLA. For the last three years,
training on BTL-MLLA by a master trainer from Manila, now local trainers have been capacitated
to do the training.
The Training of trainers is a 7-day course consisting of a 2-day didactic/practice sessions and the
actual conduct of the 4-5 days FP CBT Level 2 Training on Minilap under local anesthesia.
The 2-days didactic session prepares the participants in conducting the training of service
providers. [i] Adult Learning Principles; [ii] use of different techniques/modalities in training; [iii]
the rights of the Clients; [iv] FP Counselling and elements of Informed Consent; [v] review of
infection prevention measures; [vi] standard technique of BTL-MLLA; [vii] Prevention and
management of complication; [viii] preparing for the training- training plan; [ix] organizing and
conducting a training on BTL-MLLA.
Trained in March 2017 were six local trainers in Hospitals who conducted 2 batches of FP CBT
Level 2 in Region 6 &7. This brings the number of local trainers on BTL-MLLA to 14. During
the quarter in review, VisayasHealth conducted trainers’ training on BTL to in 2 DOH-retained
hospitals – Gov. Celestino Gallares Memorial Regional Hospital in Bohol and Western Visayas
Sanitarium in Iloilo; and 2 provincial hospitals, namely: Iloilo Provincial Hospital and Cebu
Provincial Hospital-Danao City.
Presented in Table 4 are the number of trainers trained and number of service providers trained
Table 4. Number of Trainers and Service Providers Trained
DATE VENUE TYPE OF TRAINING NO. OF PARTICIPANTS
March 15-16, 2017 Lex Hotel, Cebu City TOT for BTL-MLLA Region-6 = 2 Region-7 = 4
March 22-24, 2017 Lex Hotel, Cebu City FP CBT 2 BTL-MLLA for service providers
Region-7 = 3 MDs 2 Assistants
March 21-24, 2017 Diversion Hotel, Iloilo City
FP CBT2 BTL-MLLA for service providers
Region-6 =4 MDs = 4 assistant
b. FP CBT Level 1. The EngenderHealth/VisayasHealth project continued conducting FP CBT Level
1 and FP CBT Level 2 Interval IUD courses when the participants using the alternative learning
strategy failed to push through with the self-instructional modules.
Table 5. Number of trainings using the traditional approach
DATE VENUE TYPE OF TRAINING NO. OF PARTICIPANTS
01/23/17 Soledad Hotel, Tagbilaran, Bohol FP CBT Level 1 MW 19
03/20-24/17 N. Samar FP CBT L 1 RHM-24 PHN=2
03/27-30 Summit Circle FP CBT L2 IIUD RHMs- 9
L1-2; L2-1 54
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |19
c. Preceptor’s assessment conducted during this period. An assessment of potential Preceptors
and their facilities were done in February 2017. To strengthen the training capacity at the local level.
Leyte- 3 midwives; Samar 2 nurses and 1 midwife; North Samar –3 midwives; S. Leyte—2 midwives..
D. Policies and Systems Enhancement Accomplishments
1. Support to Hospital-Based Family Planning Programs
During the period in review, VisayasHealth sustained its work with assisted-hospitals to ensure the
continuous availability of family planning services in these higher-level facilities. Apart from making
sure that post-partum FP and services to young parents are available through hospital-based
Program for Young Parents (PYPs), the project also looked into the hospital’s role as referral points
for surgical FP procedures and complications arising from family planning procedures done in
lower-level facilities. The concept of a Service Delivery Network (SDN) for family planning was
supported by providing guidance in the conduct of coordination meetings and dialogues held at
Inter-Local Health Zones (ILHZs) which are chaired by district and provincial hospital chiefs. At
these meetings, the matter of referrals, financing, and assorted technical and management issues are
high on the agenda.
a. Hospital Systems Improvement through Study visit. A sound hospital management system is
key to sustainable improvements in hospital services on FP, MCH, and related drivers of hospital
growth. For this reason, VisayasHealth invested resources to improve quality management
systems of two strategic LGU hospitals through a study visit by the hospital management teams
of the Cebu Provincial Hospital-Carcar City (CPH-CC) and Samar Provincial Hospital (SPH) to
the Justice Jose Abad Santos General Hospital (JJASGH) of the Manila City Government in
January 2017.
The JJASGH has been chosen as the study site due to its successful efforts in improving its
hospital management systems which has led to its certification by TUV-SUD as an ISO-9001-
certified hospital in 2016. Apart from this, the JJASGH also has a strong FP-MCH program,
extensive experience in tapping PhilHealth financing, and network building and resource
mobilization – all of these being relevant to the CPH-CC and SPH’s hospital improvement
efforts.
The study visit afforded the management teams of CPH and SPH important insights and tips in
LGU hospital improvement. A session with the Ambassador of Health of the World Medical
Relief (WMR) was also done during the visit to provide the participants with information on
opportunities for securing medical equipment donations including those related to the provision
of hospital-based FP and diagnostic services such as OR and digital imaging equipment.
b. Capacity Building for FP. After providing basic family planning training on IUD, implants,
BTL, and NSV for providers in targeted hospitals during the previous quarters, the project moved
towards capacitating hospitals into becoming centers for training in family planning in their
respective catchment areas or SDNs. As detailed under section II.C.2.a., the project conducted
trainers’ training on BTL in two DOH-retained hospitals and two provincial hospitals. This
strategic move was designed to ensure the sustainability of area-based training initiatives beyond
project life.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |20
c. Strategic Planning. VisayasHealth conducted a strategic planning workshop for CPH-CC and
SPH during the second quarter in order to put development plans for FP in a proper perspective
and to ensure the harmonization of all existing hospital improvement plans, making sure that
these align to a clear vision for making FP and MCH services more readily available not only in
these hospitals but also to the rest of their catchment areas. A strong desire to attain ISO
certification and the improvement of FP programs features that strongly stood out in the plans.
d. ISO certification. As part of its work in improving hospital quality management systems that
covers FP, the project facilitated the linkage of CPH-CC and SPH with the ISO audit provider,
TUV-SUD and its affiliated organizations. As a result of the initial engagement by the subject
hospitals of the said audit group, hospital protocols for FP and SDN activities have already been
reviewed, updated, and formatted in accordance with ISO standards.
2. District Health System in Cebu
In its attempt to regain its leadership and influence over the provincial public health system, the
Cebu PHO has put forward its idea of resurrecting the old district health system where provincial
and district hospitals play an important role in primary care and public health. The Local
Government Code of 1991 weakened the PHO’s role in primary prevention and public health as its
attention was focused almost entirely on curative care in the devolved hospitals. Over time, the
PHO’s role in public health programs further eroded and trivialized as the responsibility of
managing the provincial and district hospitals was fraught with many challenges and problems.
To realize the vision of a revitalized health district system, VisayasHealth has assured the Cebu
PHO of technical support in developing appropriate frameworks, organizational structures,
operational plans, as well as the required pieces of legislation and policies to establish the new
approach.
The technical assistance partnership is pursued amidst the DOH’s listing of Cebu province as
among the 17 areas in the country with the highest population and concentration of poor families
with unmet needs for family planning. The health department’s latest estimate puts the number of
women of reproductive age among the poorest families in Cebu at 483,107, with 141,548 or 30% of
them having unmet needs for family planning. Moreover, applying 2013 National Demographic and
Health Survey (NDHS) estimates over the number of poor Women of Reproductive Age (WRA),
those with unmet needs for limiting family size among them would translate to 57,006.
With the strengthening of the core hospitals in Cebu province well on its way, the province is
rebuilding its relationship with the Rural Health Units (RHUs) and cities and municipalities to
reassert its role in primary prevention. The FP program is paving the way in demonstrating how the
district hospitals’ role complements the functions and services provided by the referring RHUs and
health centers.
In line with this effort, VisayasHealth also supported the PHO in tightening the referral loop to
make the service delivery network robust and fully functional. This model asserts the overall
technical leadership of the PHO in the province and applies not only to the FP program but also to
the rest of the other public health programs making the service delivery system more relevant, more
efficient and more effective and inevitably lead to greater impact.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |21
III. CROSS-CUTTING ACTIVITIES
A. Adolescent and Youth Reproductive Health (AYRH)
The Program for Young Parents (PYP) is VisayasHealth’s main programmatic response to the rise in teen
pregnancy in the Visayas.
The latest PYP center was formally launched in Anahawan District Hospital, Anahawan, Southern Leyte on
20 January 2017, bringing the number of PYP centers to 24: six in Region 6; 12 in Region 7; and six in Region
8.
Enrollment in the PYP during this quarter continues to increase, growing from 117 pregnant teens (and their
male partners) in 2014 to 2,988 in 2015 and to 5,992 Table 4). In terms of deliveries, women 19 years and
below in PYP centers averaged about 14%, higher than the national average of 10%. This may actually reflect
an improvement in the referral of pregnant teenagers to PYP facilities. More young mothers are opting to
adopt long-acting reversible contraceptives (LARCs) (771 choosing IUD/PPIUD), 228 oral contraceptive
pills, 159 injectable contraceptives, 58 condoms, 810 Lactation Amenorrhea Method (LAM), and two fertility-
based methods.
Table 6. Maternal and Child Health (MCH) and FP Accomplishments, PYP Facilities, FY2014-2016
Program for Young Parents 2014 2015 2016
*Jan-Dec Oct-Dec
2016
Attendance in ANC
Total Number of Clients w Completed ANC 1807 16800 14144 3756
Women <19 years old w Completed ANC 69 2186 2870 879
Facility-based Deliveries
Total Number of Deliveries 3955 23327 36553 8310
Deliveries to Women <19 years old 525 3331 5605 1316
Total Number of NSVD 3196 18567 30453 6901
NSVD to Women <19 years old 458 2961 4957 1157
Total Number of CS Deliveries 673 4023 5843 1163
CS to Women <19 years old 59 286 413 102
Enrollment in PYP 177 2988 5992 1131
Use of Family Planning
Number of Family Planning Acceptors <19 years old (Please specify method)
· NSV 0 0 0 0
· BTL/ PP BTL 0 0 0 0
· IUD/ PP IUD 16 140 771 252
· Sub-dermal Implant 18 49 0 0
· Oral Contraceptive Pills 10 30 228 64
· Injectable/ DMPA 4 38 159 36
· Condoms 0 4 58 20
· LAM 230 611 810 142
· Fertility Based Methods 0 0 2 0
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |22
Program for Young Parents 2014 2015 2016
*Jan-Dec Oct-Dec
2016
Breastfeeding
Total Number of Mothers Initiated on Breastfeeding 114 3111 5612 1217
The PYP supplements prenatal services (e.g., weight and blood pressure monitoring, laboratory tests) with
education of young mothers, their male partners, and significant adults in their lives (e.g., parents,
grandparents). Topics discussed during educational sessions include gender sensitization; recognition of
danger signs and symptoms; birth planning (including compliance with Philippine Health Insurance
(PhilHealth) requirements for the coverage of the young mother and her infant); decision-making; healthy
timing and spacing of births through the use of long-acting contraceptives upon delivery; and exclusive
breastfeeding for at least six months after giving birth. Clients are presented with a certificate upon
completion of the educational sessions.
VisayasHealth has likewise assisted the PYP Centers in identifying and training PYP “graduates” to share
their experiences with their peers and motivate them to use contraceptives to postpone subsequent
pregnancies until they are ready.
As an incentive for completing the educational sessions, VisayasHealth has initiated linkages with the
Department of Education (DepEd), Department of Social Welfare and Development (DSWD), and the
Technical Education and Skills Development Authority (TESDA) to extend preferential access to their
programs and services to PYP clients who complete the educational sessions. This measure will help young
parents pursue their education and livelihood opportunities for their personal growth and the well-being of
their family. This will also help them postpone the next pregnancy.
For this quarter, two (2) PYP centers held “graduation” ceremonies. Iloilo Provincial Hospital (IPH) in
Pototan, Iloilo graduated 30 PYP clients on 10 February 2017 while Eastern Visayas Regional Medical Center
(EVRMC) in Tacloban City graduated 22 PYP clients on 31 March 2017.
VisayasHealth will continue to provide technical assistance (TA) to engaged facilities to help them sustain the
PYP beyond the project life. The project continues to place emphasis on compliance with the DOH
Adolescent Friendly Health Services standards; the strengthening of connections with the interlocal health
zone (ILHZ) where PYP centers are located, including private practice midwives (PPMs); as well as
reinforcing working relations with development partners (i.e., the Department of Education, Department of
Social Welfare and Development, Technical Education and Skills Development Authority, Department of
Labor and Employment, and Department of Agriculture) where PYP clients can access services to further
their education and bolster livelihood opportunities. PYP clients are guided in accessing PhilHealth benefits
for ANC, delivery care, newborn screening, infant immunization, and FP services. It is hoped that PhilHealth
reimbursements will help sustain PYPs in the coming years.
A number of hospitals expressed interest in setting up PYP in their respective facilities. To help them
understand what the PYP entails, Samar Provincial Hospital in Catbalogan City, Western Samar, Western
Visayas Medical Center in Iloilo City, and Tacloban City Hospital were oriented on the PYP.
Thereafter, Dealing with Adolescent Clients training was conducted for 16 Cebu Province-supported
hospitals from 20 to 24 February 2017 and for Tacloban City Hospital, Samar Provincial Hospital, and
Abucay Health Center from 26 to 30 March 2017. These recent batches have the advantage being able to
observe the actual conduct of educational sessions as well as the day-to-day operation of the PYP, the first
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |23
one in Cebu Provincial Hospital – Danao City and the latter in Abuyog District Hospital. Samar Provincial
Hospital and Tacloban City Hospital are set to launch their PYP Centers in the next quarter.
B. Monitoring and Evaluation (M&E)
1. Updates of Studies
VisayasHealth engaged two research organizations during the quarter to commence data collection for two
evaluation studies:
a. The Field Epidemiology Training Program Alumni Foundation Inc. (FETPAFI) started
work on data collection last January, 2017 for the study on “Improving Health Behaviors among Pregnant
Women in Cebu City, Cebu, Philippines: An Analytic Study Evaluating the Usefulness of the Usapan Sessions
and SMS Pahinumdom Intervention”. A study manual was developed prior to data collection. A total
of 100 clients each for standard care, Usapan and Usapan +SMS needed to be interviewed for the
study.
As of March 28, 2017, a total of 212 clients met the inclusion criteria1 per protocol, provided
consent and have been interviewed from the study sites as shown in the table below.
Table 7. Number of Clients Interviewed
Mabolo Health Center
(n=106)
Compostela Health Center (n=106)
Standard Care Usapan Usapan+SMS Standard Care Usapan
23 19 15 104 2
M&E/Research backstop for VisayasHealth, Dr. Mahabub Anwar was consulted for options for
meeting the sample size given the yield from initial interviews. VisayasHealth was given the go signal
to interview clients from Barrio Luz, another health area in Cebu City and within the contiguous site
as Mabolo Health Center. Barrio Luz also conducts Usapan sessions. For clients exposed to SMS,
advice was provided to use the SMS database as sampling frame.
b. The Asia Pacific Management and Research Group, Inc. (APMARGIN) was engaged last
February 23, 2017 to assist VisayasHealth in the data collection and analysis of the study on the PYP.
The inception meeting was held to further advise the development of the study manual in order to
commence data collection. APMARGIN staffs were introduced to the three projects sites, namely
Cebu Provincial Hospital-Danao, Iloilo Provincial Hospital and Eastern Visayas Memorial Medical
Center during the week of March 13 to 16, 2017. Training of data collectors were carried out during
the last week of March using a draft study manual.
2. Updates on Data Quality Check (DQC)
1 All post-partum women who were registered in Mabolo Health Center and the Rural Health Unit of Compostela from the period of January to December 2016 will be included. A Postpartum Woman is a female who delivered a baby within 6 weeks, is a resident of Cebu City (exposed groups) and Compostela (control group), between 18-49 years of age and who received any intrapartum services from these facilities prior to delivery. She should have initiated either her 1st or 2nd ANC visit starting November 2015 to allow for maximum exposure to VH interventions including SMS messages, collaterals and Usapan.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |24
For this reporting period, VisayasHealth provided technical assistance to Bacolod City Health Office in the
conduct of Data Quality Check to institutionalize systems for improvement on their FP/MNCHN
recording and reporting systems. In Iloilo City, VisayasHealth also provided technical assistance to the
conduct of Regional DQC Training of Trainers and Applied Supportive Supervision Training funded by
DOH-RO 6 last February 20-24, 2017. This was participated by FP, MNCHN and Field Health Service
Information System (FHSIS) coordinators from VisayasHealth assisted and non-VisayasHealth assisted
provinces.
Table 8. Status of of DQC in project areas
Province
No. of LGUs
Total Oriented to DQC
RHU level DQC
completed
% completed
Leyte 43 43 42 98%
So Leyte 21 21 21 100%
W Samar 24 24 14 58%
N Samar 24 24 17 71%
Bohol 48 48 41 85%
Cebu 53 58 15 71%
Neg Occ 32 32 24 75%
Iloilo 44 44 40 91%
C. Knowledge Management Report
1. Documentation of best practices in the implementation of UNRS
As part of the project’s knowledge management strategy the project was able to identify and
document a number of promising initiatives and best practices (See also Annex I).
a. The unmet need reduction strategy tipping point: transitioning from family planning
events to routine service provision. This best practice documented the journey of one
municipality from the initial efforts to organize family planning days to the point where the flow
of FP information in the community has reached a level whereby special events are no longer
necessary. Clients are now coming on a regular basis to the clinics to demand for family planning
services
b. Responding to the unmet needs in geographically isolated communities through
partnership with a project sector. This best practice highlights the efforts of an island
municipality that partnered with a private sector provider to provide much-needed FP services to
its constituents. The local health managers decided to invite a group of willing private family
planning sector providers to complement the locally initiated demand generation activities
involving satisfied FP users. The resulting successful partnership serves as a model
c. Adopting UNRS in a privately owned birthing facility. This best practice captures the
experience of a privately owned birthing facility that decided to adopt the project’s unmet need
reduction initiative. The results showed that UNRS can be easily and successfully implemented in
the private sector.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |25
d. Positioning district hospitals as hubs for family planning services. This best practice from
the province of Cebu chronicles the efforts of the provincial health office to strengthen the
complementary role of district hospitals in providing family planning services. The district
hospitals in Cebu provide family planning methods that are not available in the public health
centers. The hospital facilities even organize family planning days to serve the needs of clients
within their catchment areas.
e. Investing in family planning services: meeting clients’ needs in a sustainable way. This
best practice documents the experience of a local chief executive who discovered that investing in
family planning services is not only important because it improves the health of his constituents
but also generate additional and much-needed revenue for his municipality. The proceeds from
the family planning benefit packages of PHIC not only augment the income of the municipality
but also serve to motivate the health providers.
2. Technical Assistance Products (TAPs).
During this reporting quarter, the TAPs were revisited yet again. After thorough discussions, the
project has further streamlined the number of TAPs from sixteen (16) to six (6). Most of the
interventions that were previously documented separately have been integrated into these six TAPs
(Table 9).
Table 9. Technical Assistance Products’ Summary of Contents
TECHNICAL ASSISTANCE PRODUCT INCLUSIONS
I. TRAINING SYSTEMS
Establishment of Field Training Areas and Preceptor Sites
Self-Instruction Training Manual
PTME / DOH Certification & PHIC Accreditation / NHIP Localization
Applied Supportive Supervision
II. UNMET NEED REDUCTION STRATEGY (UNRS)
Usapan
Mobilization of Satisfied Users
Organizing FP Day(s)
Ensuring Zero Stockouts of FP Supply
FP In Hospitals
VH Project Tools for Enhancing the Quality of Client-Provider Interactions During FP Service Delivery (IEC Materials)
III. PUBLIC PRIVATE PARTNERSHIPS FOR BETTER MNCHN/FP COVERAGE
Public Private Partnerships For Better MNCHN/FP Coverage
IV. THE PROGRAM FOR YOUNG PARENTS (PYP)
Gender
V. TECHNOLOGY-BASED INTERVENTION
Applying Interactive Voice Response (IVR) and sms to:
Eenforce the Self-Instructional Learning Approach for LAPM/LARC Training
As a vehicle to reinforce Usapan messages to clients such as FP, reminders to complete ANC visits, danger signs to watch during pregnancy, and exclusive breastfeeding among others
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |26
TECHNICAL ASSISTANCE PRODUCT INCLUSIONS
VI. MCH PACKAGE
Breastfeeding Community Support Group
Integration of FP to Maternity Care
Pregnancy & Delivery Tracking System
3. Packaging of Training Manuals
As the Self-Instructional Learning Approach for LAPM/LARC Training was introduced during this
quarter, VisayasHealth sought to enhance the training materials. Although the content remained the
same, the project began steps to improve the packaging / presentation of the material. Among the
first steps was having separate materials for Trainers/Preceptors and another for the
Learners/Trainees. This was followed by style editing which was done initially by assigned
VisayasHealth staff. These materials were sent to the EngenderHealth headquarters for further
review of contents and further style editing. The next step is to apply actual photos in lieu of the
graphic illustrations that are currently being used. VisayasHealth is soon to coordinate further with
EH headquarters for the final packaging and finishing of these documents along with other
Knowledge Products.
4. Production of Instructional Videos
Still with the end in mind to enhance the new training approach introduced by the project, the
project has introduced the use of instructional videos for the LARC/LAPM procedures. These
videos would be shown and made available to trainees to enhance or reinforce the content of their
training manuals. Such videos are the ones that have already been approved for use such as those on
Progestin Subdermal Implant contraceptives (PSI) (EngenderHealth), PPIUD (EngenderHealth), and
NSV (C-Men and UNFPA). However, there are certain procedures that the project saw that need to
be also emphasized through video production, particularly those for Interval IUD Insertion. These
include: [i] Pre and Post-Procedure Counseling; [ii] Pelvic Examination; [iii] Speculum Examination;
[iv] Sounding The Uterus; [v] Loading the IUD; [vi] Step-by-Step Guide to IUD Insertion Using the
No-Touch Technique; and [viii] Infection Prevention. The video and photo shoots were done during
the last week of March. These will be post-processed and applied to video editing through the month
of April and targeted to be completed by the end of the same month.
5. Developing Interactive Voice Response (IVR) Scripts for the New Training Approach
VisayasHealth employed an application that would support the Self-Instructional Learning Approach for
LAPM/LARC Training. Pre-recorded voice and sms messages are pushed to trainees to diligently
read their training materials and complete the required number of cases to increase their proficiency
level. Other than the trainees, the technology also entails voice and sms messages sent to preceptors
or trainers to remind them to do trainee follow up visits. Annex IV details the concept and mechanics
of the use of this technology.
6. Organizing of Regional and National Technical Conferences for VisayasHealth
Interventions
As part of the Legacy Plan, technical conferences are in the pipeline for the project’s interventions.
Preparations are underway for the series of Regional Technical Conferences for UNRS starting with
Region 7 (See also VI. C). A national technical conference is also planned for the Self-Instructional
Learning Approach for LAPM/LARC Training sometime in the third quarter of the project year but a
definite date has yet to be set for this.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |27
D. Informed Choice and Voluntarism (ICV) Compliance Report.
VisayasHealth project staff conducted routine monitoring on ICV Compliance on partner LGU
clinics visited during the first and second quarter of Year 5 (October 2016-March 2017), during
Training and FP Days activities. The project monitored fourteen (14) batches of FP CBT Level 2
PPIUD and Interval IUD courses using the Self-Instructional Modules for the didactic and
mobilizing Local trainers/preceptors during the practicum monitored; One (1) batch FP CBT Level
1; one batch FP CBT level 2 IIUD; one batch TOT for BTL MLLA and 2 batches of FP CBT Level
2 BTL-MLLA during the first two quarters of Year 5 (See ICV Compliance report in Annex VI, Part A
and B). FP Counselling, Infection Control and quality of care in the modules and during mentoring
and coaching during practicum were emphasized.
VH looked into anecdotal reports of possible ICV vulnerabilities during the Unmet Need Reduction
Strategy/FP Day activities with the following findings and conclusions
1. Provision of transportation reimbursement for clients and Volunteers.
This is not considered as violation of ICV as these are provided to clients whether or not they are
provided the method they requested if they come from barangays or areas far or not easily
accessible
2. The unmet need reduction strategy identify clients who wants to practice family planning.
Service facilities for short-term methods like pill, DMPA and Condom are referred to their health
centers. The clients are provided the method not available in their area like Interval IUD
insertion, PSI; and NSV; BTL clients are referred to hospital offering the service or directly during
FP Days through the FP Service Providers mobilized during FP Days.
E. Environmental Monitoring and Mitigation Plan (EMMP) Compliance Semi-Annual Report
(October 2016 - March 2017)
1. Trainings
As the project is on its last year, a new initiative has evolved—the Peer to Peer Experiential CBT.
With the initial assessment, this new initiative) in the project comprised the bulk of the training
activities. A total of 113 service providers were trained in the 11 batches conducted by the project,
which included FP CBT 1 and BTL aside from the new initiative. The standard protocol on Infection
Prevention and Hospital/General Waste Management of the Department of Health is part given
importance as it is integrated in the course curriculum as required in the national policy on
environmental mitigation in reducing the risk of infection associated with the insertion or the
procedure.
Table 10. Training Courses/Orientation Conducted
Items Number
Number of training courses conducted that included a session on Infection Prevention
and Waste Disposal:
FP CBT 1 1
BTL 1
Orientation Peer-Peer Experiential CBT on IUD/ PP-IUD 9
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |28
2. Monitoring
There are 30% of the government health units and 40% of hospitals are still to be covered in the
project areas; but more to be visited in the private birthing facilities. Many trainees received post
training monitoring and evaluation. Some of the facilities need constant reminder on the practice of
proper waste disposal and infection control.
Table 11. Facilities Monitored/Supervised
Items No
Number of Facilities monitored/supervised (RHU and Hospitals) 307
Number of Facilities that were monitored/supervised during the PTME 64
Number of PPIUD/Interval, NSV, BTL-MLLA trained staff who received post-
training monitoring and evaluation
127
By end of the project, at least 90% of the government facilities (both RHU and hospitals) is targeted
to be monitored. A more aggressive monitoring visit to the private birthing clinics be done,
particularly those being utilized as preceptor sites of the training.
A continuous reminder to the facilities on the practice of proper waste disposal and infection
Control in every chance especially during Family Planning Days where clients are plenty.
F. Cities Development Initiative (CDI) Reports
1. Iloilo City
During the reporting period (January to March 2017) saw a continuing pattern of improving
MNCHN/FP initiatives focused on health programs and services, particularly improving maternal
and child health though Family Planning among the urban poor women and their families. Public-
private partnership (PPP) in the health service delivery network was observed to be blooming with
concerted influence on FP program and services that yielded more new acceptors and continuing
users for modern FP methods, particularly on LAPM. CDI -Health initiatives continued to generate
empowered satisfied users for FP long acting methods. The nine District Health Centers (DHCs)
provided regular MNCHN/FP services including the Friday Teen Clinics during which, trained
service providers utilized Adolescent Job Aids (AJAs) to address all their needs. Three birthing
facilities of Arevalo, Calumpang Molo and Lapaz Maternity Clinic continually provided services for
maternal care.
The City Health Office (CHO) also coagulated efforts with all line partners. With the assistance of
DOH Region 6 and VisayasHealth, it also conducted activities to continually improve FP supply of
services on FP, and demand generation to help realize unmet need reduction as well as policies and
systems. A total of 24 BTL clients from Iloilo City were served during BTL training practicum and
post-training monitoring and evaluation (PTME) of trained doctors during the period. With the
support and technical assistance of the VisayasHealth project’s UNRS, orientation and coaching of
satisfied users (SUs) of FP were given. Three FP Days were initially facilitated in March at Arevalo
District Health Center, CFC PPM clinic, IDC College Clinic participated by multi-sectoral service
providers (SP). This churned 10 IIUD insertions and 11 PSI insertions among 30 mothers. Satisfied
users on IIUD were utilized to generate demand while long acting service providers from Jaro 1 and
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |29
Bo Obrero as well as CFC, IDC clinics and FPOP jointly helped out. Also, all 30 service providers
trained on FP CBT 1 from 9 DHCs in the previous quarter were noted to have continually done FP
counseling and service provision for different methods among clients based on ICV compliance.
A/Y friendly clinic services are provided on Fridays for walk-in adolescents and youth needing
counseling and services that include the teen moms who come for pre-natal consultation.
The 9 DHC service delivery network with multi-sectoral engagement for FP and AYRH is
progressively working to achieve the intended reduction of unmet needs. To further improve DQC
implementation and supportive supervision (SS) monitoring, CDI Iloilo City sent 5 CHO and CPO
team members who attended the TOT on DQC and SS on Feb 20-24, 2017 conducted by DOH6
and VisayasHealth. With that, the DQC and validation of data were also on-going per quarter for
systems improvement on FP/MNCHN recording and reporting in the DOH FHSIS. Also, to
promote ICV compliance particularly to WRAs aged 15-49 years old, all CHO and CPO staff utilized
the ICV wall charts and IEC materials on FP. In partnership with DOH RO6, VisayasHealth also
provided technical assistance to the CHO, CPO and the 9 DHCs, FPOP and different private
practicing midwife (PPM) clinics in the carrying out of MNCHN/FP programs execution.
2. Tagbilaran City, Bohol
The VisayasHealth project’s technical assistance to the local government of Tagbilaran City
continued throughout the reporting quarter. This was particularly in ensuring sustainability of the
local FP program implementation through the FP service providers’ availment of PhilHealth FP
package reimbursements. On February 2, 2017 VisayasHealth assisted PhilHealth and DOH in
conducting an orientation for trained FP service providers on the documentary requirements for
accreditation as well as on filing for FP benefit package claims. Part of strengthening the Service
Delivery Network (SDN) of Tagbilaran City, the new P2P / self-learning training approach for
FPCBT Level 2 PPIUD was introduced by the VisayasHealth project. Thirty (30) participants joined
the training under this approach. All the trainees were able to successfully complete the training
modules and were able to perform three IUD insertions during the practicum phase of the training.
At the PYP of DOH-retained Gov. Celestino Gallares Memorial Hospital (GCGMH), 27 teen
mothers participated in the first graduation rites accompanied by some partners and parents on
February 3, 2017. These graduates have completed their ANC visits, delivered in the facility,
practiced exclusive breastfeeding and used a FP method before they went home.
IV. PROGRAM MANAGEMENT
A. General Staff Meeting at the Regional levels
VisayasHealth project management, with some technical staff proceeded to the three regions to meet with the
field staff in the respective regions. The one-day meeting for Regions 6 and 7 were conducted in the first
week of January, 2017 while the meeting with the Region 8 team was done on the second week of January.
The main agenda of the meetings was to discuss the progress of the implementation of the unmet need
reduction strategy (UNRS) in the different provinces of the regions. Each project provincial coordinator (PC)
presented the status of UNRS implementation in engaged areas. After their presentations, the PCs were
requested to submit his/her plan on expanding UNRS using the Geographic Information System (GIS)
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |30
Mapping Technology. Issues and concerns on the new training approach, PYP and other administrative and
programmatic matters were also discussed.
B. Attendance to National Events
Selected VH staff attended the following national events:
1. AYRH Compendium Writeshop
The VisayasHealth Project participated in the back-to-back compendium writing workshops on FP in
Hospitals and AYRH in Baguio City from 11 to 13 January 2017. The workshops were convened by
the USAID and organized by HPDP to document promising interventions and help interested
parties replicate these interventions.
VH's primary intervention for AYRH is the Program for Young Parents. It is a facility-based and
seeks to encourage women 19 years old or younger and their partners/significant adults to: [i]
complete four prenatal consultations; [ii] deliver in the health facility; [iii] breastfeed exclusively for at
least six months; and [iv] use contraception upon delivery to prevent another pregnancy until ready.
In addition to the usual pre-natal services (like blood pressure and weight monitoring, physical
examination, laboratory examinations), young parents are encouraged to complete educational
sessions, after which they are endorsed to development partners (Technical Education & Skills
Development Authority, Department of Education, Department of Social Welfare & Development,
etc.) so that they can access opportunities for further education and/or livelihood. It is hoped that
such opportunities will help improve the lot of young parents as well as prevent rapid repeat
pregnancy.
The PYP is cited for its holistic approach, addressing the biomedical needs of young mothers and
their infants, as well as their psychosocial development needs.
Moreover, VH is instituting measures to help engaged facilities sustain the PYP beyond the project
life through building their technical capability and financial capacity through PhilHealth.
2. Third Responsible Parenthood and Reproductive Health (RPRH) Annual Report Workshop.
VisayasHealth was asked to participate in the third annual report writing workshop on the progress
of the implementation of the RPRH Law held in Tagaytay City from March 13 to 17, 2017. The
RPRH Law National Implementation Team convened the writeshop with participants from the
DOH Central and Regional Offices, POPCOM, representatives from NGOs, development partners
and funding organizations like the United Nations Population Fund (UNFPA) and USAID,
specifically the regional projects (Luzon, Visayas, and MindanaoHealth) and the Health Policy
Development Program (HPDP).
The 3rd RPRH Annual Implementation Report focuses on five (5) Key Results Areas:
KRA 1 – MNCHN
KRA 2 – FP
KRA 3 – ASRH
KRA 4 – STIs, HIV & AIDS
KRA 5 – Gender-Based Violence
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |31
The Regional Projects shared data and narrative write-ups on accomplishments to date and in
particular, the first quarter of Year 5 for KRAs 1, 2, and 3. The Regional Projects also allowed use of
success stories and photos to enrich the RP RH Implementation Report.
3. FP in Hospitals Compendium Writeshop
The writeshop for the FP in Hospitals Compendium was done in early January, 2017 as a back-to-
back activity with the AYRH Writeshop. This compendium will provide an account of all related
efforts and technical assistance provided by the three regional projects in installing FP services in
selected hospitals in various project sites in the country. For the Visayas, focus was made on Cebu as
the site for the implementation of HPDP demonstration study. The study focused on providing
assistance to selected hospitals in operationalizing the guidelines in the establishment of providing FP
services in these hospital and helping them with recommendations and solutions to a number of
operational challenges. The experience in providing assistance to participating hospitals are
organized in this document including the preparatory activities and efforts to improve or establish
systems in FP service delivery in a hospital setting e.g. recording and reporting, logistics management,
information system, financing, and monitoring and evaluation of service delivery.
The Compendium was packaged by HPDP consultant and is still being reviewed by the participants
of the writeshop and the three regional projects before finalization. The primary audience for this will
be the DOH and LGUs and other partners who are directly responsible for implementing programs
in their respective areas.
C. Facility Turnovers
Turnover of the Dagami RHU with Birthing Facility and TB DOTS Center and the Carigara
Hospital Ward and TB DOTS Center
The newly constructed RHU with Birthing Center and TB DOTS Center in Dagami was turned over
to the LGU of Dagami, Leyte by USAID on March 22, 2017. This was graced by distinguished
dignitaries in the person of no less than the chief of the Office of Health, Ms. Karen Klimowski and
the Mayor of Dagami. The birthing facility will serve the population of Dagami and its neighboring
municipalities.
On the same day, the Carigara Hospital Ward and TB DOTS Center was also turned over to the Leyte
Provincial Government through the Provincial Administrator and the Carigara Chief of Hospital by
USAID. The turnover was done by Ms. Karen Klimowski. This will serve the catchment areas of
Carigara District Hospital.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |32
D. Coordinative Meetings
1. DOH 7 Regional Director and DOH 7 FP/MNCHN staff
Executive Order no. 12 mandated the DOH to come up with guidelines to achieve zero unmet need
by 2020. As such, on the second week of March, 2017, the FP/MNCHN staff of DOH Region 7
approached VisayasHealth requesting for assistance in the formulation and implementation of their
work and financial plan for the roll out of the UNRS initiated by VisayasHealth. A meeting with the
Regional Director of DOH 7 was set up on March 28 with the objective or requesting DOH to
increase the budget for this activity and to discuss preparations for the UNRS Regional technical
Conference for Region 7 on the first week of April. The meeting ended with the regional director
committing to allocate more funds for the UNRS roll out activities and to participate as host and
reactor to the upcoming UNRS Regional Technical Conference.
2. International Care Ministries (ICM)
On March 10, 2017, VH Management met with the President of ICM, Philippines to discuss areas of
collaboration in the provision of FP services in ICM supported areas in Iloilo City and Bacolod City.
The meeting resulted to the commitment of VisayasHealth to include the ICM communities in
demand generation activities for FP so that the appropriate FP services can be provided to potential
clients. VisayasHealth will provide schedules of FP days to ICM staff.
As an offshoot of this meeting, on March 13, 2017, VisayasHealth oriented the FP staff of ICM,
Iloilo on UNRS and on how to coach satisfied users. This is for ICM to do its own demand
generation activities. The same was done for ICM, Negros Occidental on March 15.
3. Provincial Health Office, Cebu
VisayasHealth met with the provincial health officer of Cebu Province on March 7, 2017 to discuss
strategies on how the provincial health office can develop or enhance their hospitals in the provision
provision of preventive and public health services on top of the curative services. The Cebu
Provincial Health Officer presented his plan of revitalizing the district health system in the province
with the four designated provincial hospitals in Danao, Carcar, Bogo and Balamban as core hospitals
for catchment municipalities. Family Planning will be used as the entry point in establishing the
District System. VisayasHealth will provide assistance and continued support in enhancing the
capacity of these hospitals in providing FP services.
Left: Ribbon-Cutting and
turnover rites for the Dagami
RHU
Right: Unveiling of the TB
DOTS and Birthing Centers
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |33
E. Staffing Updates
As of March 31, 2017, headcount for VisayasHealth staff totals Forty-One (41) full time staff. On top of
this number, the project has five (5) staff from sub-awardees, PRIMEX and HKI, and seven (7)
consultants. The table below shows the headcount breakdown:
Table 12. Current Staffing Details
Regular Probationary Short Term Staff
TOTAL
MANAGEMENT
COP & DCOP 2 2
TECHNICAL STAFF
Field Staffs (Provincial Coordinators)
Region 6 4 4
Region 7 7 7
Region 8 6 6
Training Staffs (Nurses/Specialists)
6 6
M& E 4 4
BCC 1 1
Policy and Advocacy 1 1
SUPPORT STAFF
HR 1 1
ADMIN 2 2
FINANCE & Grants & Procurement
7 7
TOTAL 43 0 0 41
Seconded Staff (PRIMEX & HK)
5
Consultants 7
TOTAL 12
There have been two (2) turn overs for the Regular Full Time staffs for Q2 of Year 5. The average
turnover rate is 4%.
F. Financial Reports
Table 13. Itemized project expenditures (USD)
Cost Items Total LOP
Cumulative Expenses of
Previous Quarters
Expenditure 2nd Quarter (Fiscal Year 2016 - 2017)
Cumulative Amount at
End of This Quarter
% of Expenses Based on the LOP
January 2017
February 2017
March 2017
Labor + Fringe Benefits
3,164,745.83 213,436.95 63,149.43 63,175.75 72,435.04 412,197.17 13%
Travel and Transportation
2,581,018.36 140,804.16 56,021.36 46,023.11 89,606.42 332,455.05 13%
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |34
Cost Items Total LOP
Cumulative Expenses of
Previous Quarters
Expenditure 2nd Quarter (Fiscal Year 2016 - 2017)
Cumulative Amount at
End of This Quarter
% of Expenses Based on the LOP
January 2017
February 2017
March 2017
Sub-grantees/ sub-contractors
1,411,139.50 71,793.64 56,350.52 50,191.77 25,083.77 203,419.70 14%
Other Direct Costs
1,765,792.04 45,709.34 17,347.74 40,567.00 31,206.14 134,830.22 7%
Indirect Costs 3,862,181.40 186,209.65 63,846.64 67,702.76 80,636.72 398,395.77 10%
TOTAL 12,784,877.13 657,953.74 256,715.69 267,660.39 298,968.09 1,481,297.91 57%
Bal Per Monthly Expenses Generated Data 256,715.69
267,660.39
298,968.09
Difference
-
-
-
V. OPPORTUNITIES & CHALLENGES
A. DOH Advisory Clarifies Application of the Temporary Restraining Order (TRO) on
Implanon®
The Undersecretary of Health for the office of technical services signed this DOH advisory on February
1, 2017 clarifying the issue of the TRO on Implanon. The advisory clarified that “the TRO applies only
to the DOH-procured Implanon and Implanon NXT supplies. Other government agencies, DOH-
ARMM, local government units (LGUs), private sector and civil society organizations (CSOs) are
independent and autonomous, hence, are not covered by the TRO. They can only be considered as
agents, representatives, or other persons acting in behalf of the DOH if the Implanon and Implanon
NXT being used are from the DOH. Therefore, they are encouraged to utilize ALL their family planning
contraceptive methods, including their own lmplanon and lmplanon NXT supplies and those donated by
the development partners.”
In addition the advisory clarified that although the TRO does not explicitly restrain training for PSI
insertion, the said training conducted by DOH will require insertion of Implanon or Implanon NXT.
However, qualified PSI training providers may continue to conduct training to the LGUs, CSOs, and
private health care providers as long as they do not use DOH-procured Implanon and Implanon NXT
for the said training. Further, PhilHealth can continue accrediting health service providers who have
successfully completed the said training since accreditation is not covered by the TRO.
The TRO however remains a challenge to the program. The Supreme Court expanded the coverage of
the TRO to include the suspension on the new registration and renewal by the Food and Drug
Administration of the Certificate of Product of all contraceptives commodities so that by 2020 condoms,
abstinence and surgery could be the FP options available in the country. With the registration of new and
existing contraceptives “temporarily suspended in the Philippines, pharmacies, hospitals and health
centers are running out of everything from implants to pills and IUDs.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |35
B. Executive Order No. 12
The executive order signed by the President of the Philippines on January 9, 2017 focuses on attaining
zero unmet need for modern family planning through the strict implementation of the Responsible
Parenthood and Reproductive Health Law and providing funds thereof. This is one of the 10 point socio
economic agenda of the present administration. The Department of Health in coordination with
development partners and other concerned agencies is mandated to craft the policies and guidelines for
the implementation of this executive order.
C. DOH Administrative Order No. 2017 – 0005
This administrative order issued by the Department of Health signed by the Secretary of Health on
march 30, 2017 include guidelines in achieving desired family size through accelerated and sustained
reduction in Unmet Need for modern family planning methods. The objective of this order is to provide
guidelines to the health sector and other stakeholders in the implementation of the strategies necessary to
accelerate and sustain reduction in unmet need for MFP and eventually attain the desired family size
especially among the poor and marginalized.
The administrative order includes the roles and responbsibilities of the different stakeholders like DOH
and its regional offices, Commission on Population, Food and Drug Administration, PhilHealth, other
government agencies, local government units, private partners, civil society organizations, faith based
organizations and development partners. However, this order remains good in paper when contraceptive
commodities are running out of stocks because of the Supreme Court TRO.
D. Alternative Learning System
The adaptation and use of Alternative Learning/Training Systems developed by EngenderHealth/
VisayasHealth provided a boost in increasing the number and quality of available of service providers for
long acting reversible such as PPIUD/Interval IUD and permanent methods. However, some trainees
still prefer having their trainer actually stand with them as they go through the theoretical part of the
training (manual contents). Also, some feel comfortable having their questions or concerns addressed as
they arise during the conventional classroom discussions, especially in their dialect. Further, many of the
trainees, especially those coming from the hospitals and birthing clinics are actually unable to find time
and energy to read diligently and religiously their training modules after a day's work at their stations. The
number of deliveries negates the break that supervisors could give them and paper works they need to do
after the delivery.
There is a need to continue consultations to resolve these issues, while continuing the enhancement of
the modules to improve the interest and comprehension of the learners-improve visuals, videos;
individual and group interaction with other learners and the preceptor while reading or doing assigned
activities.
VI. PLANNED ACTIVITIES FOR NEXT QUARTER
A. National Technical Conference on the Alternative Training Strategies
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |36
This activity will present the experiences of EngenderHealth and partner LGUs on the use of mix modalities
in FP CBT Level 2 PPIUD/Interval IUD Training courses:
1. Enhanced self-Instructional modules using larger fonts, more photos/videos
2. Mobilization of local trainers/preceptors in the conduct of the practicum, supportive supervision and
Post-Training monitoring and Evaluation;
3. Use of interactive voice and SMS system in the follow up of learners during the self-paced learning
and implementation of post-training action plan implementation, supportive supervision prior to the
conduct of the PTME
B. Introduction of the REDI Counseling Frame Work for Family- Client Oriented FP
Counseling
1. Orientation of VH Staff, selected FP Coordinators from the Regional and provincial and City
partners on the REDI Counseling Frame Work for Family- Client Oriented FP Counseling
2. Integration of REDI Counseling Frame Work for Family- Client Oriented FP Counseling in the FP
CBT Level 1 and 2 Courses Conduct of more FP CBT Courses
C. Regional Technical Conference for Unmet Need Reduction Strategy
A series of regional conferences will feature best practices in the field using the UNRS (See Annex I) will
be held for representatives from the DOH national and regional offices, representatives from Provincial
Health Offices, representatives from the LGU, and the private health sector (e.g. IMAP). The first leg
will be with Region 7 on April 6 where guests from USAID, UNFPA, and EngenderHealth New York
have been invited to be among the panel of reactors. This is set to be followed by Regions 8 and 6 that
will be scheduled within the months of May and June respectively.
The technical conferences will serve as a venue for technical exchange among the implementing partners
and create better ways of reducing unmet need in the Visayas.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |37
ANNEXES
ANNEX I: UNRS BEST PRACTICES ABSTRACTS
1. The Unmet Need Reduction Strategy Tipping Point: Transitioning from Family Planning Events
to Routine Family Planning Service Provision
Presenter: Jose Mineleo Guibao, Administrator, Calape Mother and Child Hospital
The municipality of Calape, Bohol (2015 Population: 30,863, PSA) adopted USAID/VisayasHealth’s Unmet
Need Reduction Strategy (UNRS) in November 2016 against a backdrop of high unmet needs for family
planning (FP) in its catchment area, particularly for limiting family size, and a lack of proficiency among
health staff in providing long-acting FP methods.
Using GIS technology, mapping of health facility
functionality in providing FP services was
generated. Calape was one of 16 municipalities that
need strengthening of provider skills in Long
Acting method provision and demand generation.
The municipality saw the new strategy as a fitting
intervention to address the twin challenges of
improving provider skills and creating demand for
long-acting FP methods.
From November 2016 to February 2017, its RHU
conducted 13 FP days where providers received
coaching and skills updating support from
VisayasHealth-engaged trainers; IUD and implant
services were provided to women referred by
satisfied IUD and implant users mobilized earlier.
Today, FP days are a weekly fare at the RHU and some BHSs have also begun the practice to make the
services more readily available to those in need. All 33 barangays now have satisfied users who help provide
accurate information on long-acting methods to relatives, friends, neighbors, and associates who they know
want to limit family size but are not yet into FP. Their numbers are continuously expanding as new acceptors
also express interest and willingness to reach out to other women in need of such methods. As of end of
February 2017, these volunteer information providers have referred and caused the servicing of 415 women
who have become as happy and satisfied as they are after receiving their FP methods of choice.
Calape’s experience shows how the UNRS has beefed-up an LGU’s capacity to address unmet FP needs and
how satisfied users are willing to help their lot in taking care of their reproductive health by providing
behavior-changing information on FP. It further shows that by making FP services available on a regular
basis, the positive change in community behavior towards FP is perpetuated.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |38
2. Responding to the Unmet Needs in Geographically Isolated Communities through Partnership
with the Private Sector: The Carlos P. Garcia Experience
Presenter: Corazon L. Paras, President & CEO, IMAP Lying-In Clinic, Inc.
This case presentation highlights the use of public-
private partnership in implementing the Unmet Need
Reduction Strategy (UNRS) in the island-municipality
of Carlos P. Garcia in Bohol province. Faced by a
high unmet need for limiting FP methods, a
disproportionate number of island-based providers of
family planning (FP) services, and lack of access to
alternative health facilities, the health team of this
municipality thought it wise to work with itinerant
private midwives from mainland Bohol. This approach
was seen to help make long-acting methods,
particularly IUD and implants, available in the island-
community, while building the capacity of local
providers.
In support of this direction, USAID/VisayasHealth linked the LGU with ILCI or the IMAP Lying-In Clinic,
Inc., an association of midwives who own a network of private birthing and FP clinics all over Bohol under
the trade name ILCI. ILCI previously received assistance from USAID and the DOH in capacity-building for
providers and trainers in FP as well as in clinic establishment and management. Today, all its 18 clinics are
accredited with PhilHealth and provide services under the Maternity Care Package and Family Planning
Benefit Package. It is a DOH-accredited training institution for FP.
Upon the LGU’s request, ILCI dispatched a team of three midwives to the island during a FP day held on
March 8, 2017. Bringing with them the necessary instruments and supplies, they provided support to the
island’s health team by exposing them to new techniques in IUD insertion and coaching them as services
were rendered. At the end of the day, a total of 60 women were served, 31 for IUD and 29 for implants.
Those seeking short-acting methods were also served, while those who preferred BTL were advised on
preparations for the procedure and the schedule of services at facilities in the mainland.
Encouraged by the successful island campaign, the LGU and ILCI agreed to do additional rounds. In order
to generate funds to sustain the joint effort, both parties have agreed to work together as a team in filing
claims with PhilHealth under the Family Planning Benefit Package (FPBP). Funds to be generated from
FPBP case payments will be pooled and distributed over allowable costs including provider compensation.
The LGU and ILCI’s work in Pres. Carlos P. Garcia, Bohol has demonstrated that partnership between the
public and private sector can be a viable option in addressing unmet family planning needs in a geographically
isolated area.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |39
3. Adapting Community-based approach in Demand Generation for Family Planning in A Private
Clinic: The Glory Reborn Experience
Presenter: Hillary Overton, Founder, Glory Reborn
Glory Reborn is a non-profit organization which operates a birthing and family planning clinic in Cebu City
(2015 Population: 923,000, PSA). Since its establishment in 2003, it has seen over 3,500 deliveries and
numerous women needing family planning services.
The need to effectively respond to family planning (FP) needs especially among poor women in the city
prompted the organization to partner with USAID’s VisayasHealth Project in improving the capacity of its
clinic staff in providing post-partum family planning (PPFP) methods, particularly implants and IUD. By the
end of 2016, a total of 15 Glory Reborn health staff have been trained on basic FP as well as on interval and
post-partum IUD and implants. Five of the trained providers have been certified by the Department of
Health.
Realizing the need to further uncover, reach-out to and serve other women in the community with FP needs,
the organization received additional technical assistance from VisayasHealth, this time, on the Unmet Need
Reduction Strategy (UNRS). At the heart of this new strategy are satisfied users of IUD and implants who are
willing to spend time and effort in talking to relatives, friends, neighbors, and community associates on ways
of meeting their needs for limiting family size and refer them to the Glory Reborn clinic during FP days.
Glory Reborn clinic hosted the first UNRS-family planning day last April 1. A total of 48 women with FP
needs came. Of these, 16 had implants and 19 had intrauterine device insertions; two opted for condoms.
Glory Reborn believes that PhilHealth’s FP benefit package is key to sustaining and expanding quality FP
services especially to the poor. With near-universal coverage of families under the national health insurance
program, even the poorest of the poor are able to access quality FP services from public and even private
clinics like Glory Reborn. Indeed, private sector participation in meeting family planning needs can be
sustainable.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |40
4. Positioning District Hospitals as Hubs for Family Planning Services: A Blueprint for Bringing
Back Public Health to the Agenda of the Provincial Health Office
Presenter: Dr. Rene C. Catan, Provincial Health Officer of Cebu
Hospitals play a key role in ensuring quality of care in family planning (FP). As facilities providing higher
levels of care, provincial and district hospitals can serve as referral facilities for surgical FP procedures in their
catchment areas or Service Delivery Networks (SDNs). They complement the range of FP methods available
at lower-level facilities, ensuring the broad range of FP services for women and men. Hospitals also serve as
referral facility for complications arising from FP procedures done by lower level facilities, as well as strategic
repositories of health information and training resources. All these functions, performed under a district
health system approach, will greatly enhance access to and use of FP services.
To realize the vision of a revitalized health district system, the PHO partnered with USAID’s VisayasHealth
Project for technical support. It took a dual track to developing its health facilities: BHSs and RHUs with the
capacity to do all clinical FP methods for both short and long-acting methods, while the district and
provincial hospitals focus on surgical FP procedures, FP complications, and provision of FP training and
technical oversight over component municipalities.
To date, a total of 64 providers of FP in 35 component municipalities and 22 providers and trainers in 11
district and provincial hospitals have been trained. Links among facilities in defined SDNs are strengthened
through the regular conduct of FP days spearheaded by RHUs.
The introduction of the Unmet Need reduction Strategy (UNRS) in November 2016 allowed the province to
improve the FP caseload of both lower and higher-level facilities. From November 2016 to February 2017,
the PHO spearheaded implementation of the UNRS in 17 municipal LGUs which mobilized a total of 270
satisfied users who referred 595 clients that received services during 67 family planning days. Hospitals have
seen increased referrals for surgical FP from lower level facilities. From November 2016 to February 2017, a
total of 14 BTL clients were served at Cebu’s district and provincial hospitals; seven out of every 10 clients
referred for hospital-based FP are PhilHealth members. Claims under PhilHealth’s FP benefit package have
been increasing across all provincial hospitals since 2015. With UNRS implementation, this trend is expected
to rise even further.
Encouraged by the positive results of UNRS implementation in an initial set of M/LGUs and district
hospitals as well as its potential to help the province achieve zero-unmet need (EO No.12), the PHO recently
decided to scale-up UNRS implementation to cover all component-LGUs of the province and district
hospitals. Its support includes: (1) establishment of district-level structures for FP training and program
supervision based at district and provincial hospitals; (2) strengthen RHU and district hospital referral of
surgical FP cases to provincial and selected district hospitals; (3) strengthen data collection, management and
use with the application of QGIS in site prioritization/selection, progress monitoring, evaluation, and
decision-making; and (4) promote shared UNRS financing arrangements between the province and
component LGUs and encourage the use of PhilHealth funds for this purpose.
The FP program provided the demonstration platform for the district hospitals’ role in overall FP service
provision and helped make the FP SDN robust and fully functional. This model that asserts the overall
technical leadership of the PHO can be applied to the other public health programs and makes the service
delivery system more relevant, efficient and effective and inevitably lead to greater impact.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |41
5. Mobilizing Family Planning funds from PhilHealth: Meeting Clients’ Needs in A Sustainable
Way
Presenter: Hon. Mariano Martinez, Municipal Mayor, San Remigio, Cebu
Improving and sustaining local family planning (FP) programs is a challenge for many local government units
(LGU). Even as the responsibility for health services delivery has been devolved to local governments under
the 1991 Local Government Code, the Department of Health (DOH) and provincial governments continue
to provide supplemental resources to municipal governments for use in the different public health programs.
However, under this arrangement, resources are still not enough, especially when municipal governments
embark on improvement initiatives to meet increasing needs.
In 2016, when the municipality of San Remigio
decided to adopt USAID/EngenderHealth’s Unmet
Need Reduction Strategy (UNRS), one of the
concerns raised by the LGU after seeing positive
results from initial implementation was how this
initiative might be sustained after
USAID/EngenderHealth withdraws its assistance. As
a pilot site of the UNRS, the municipality received
orientation for service providers and volunteers on the
UNRS, technical tools including GIS map-making
software, IEC materials and job aids, support for
preparation meetings and transportation, and coaching services for providers during family planning day from
USAID.
Recalling earlier assistance from VisayasHealth in improving LGU ANC rates through an incentive scheme
using PhilHealth funds, the LGU thought of using PhilHealth funds once again to sustain the UNRS. Back in
2015, VisayasHealth assisted the LGU in developing an incentive scheme to improve compliance by pregnant
mothers of required ante-natal care visits. The incentive scheme which used PhilHealth earnings was coupled
with active enrolment of pregnant women under PhilHealth’s “Women-About-To-Give-Birth” policy. The
scheme continues to this day and has been chiefly responsible for increased ANC, FBD, and even EBF rates
at the LGU, not to mention, earnings from MCP.
With VisayasHealth’s guidance, the LGU has developed a business plan on how UNRS might be sustained
using PhilHealth earnings. An investment of Php 4,250 covers for orientation of providers and satisfied
users, tools, manuals reproduction, IEC materials /job aids, meeting costs, transportation costs of volunteers,
and coaching services of trainers. The gross revenue is Php 10,000 assuming an average of 7 IUD clients
served per FP day, 5 of whom are PhilHealth members at P2,000.00 case payment for IUD.
The Local Health Board has recently passed a resolution adopting the use of the UNRS in its FP program
implementation, providing start-up funding therefor, and allowing the use of PhilHealth revenues for
purposes of sustaining and expanding its implementation. In addition to tapping PhilHealth, the LGU also
intends to use POPCOM funds to partly cover the costs of transportation of satisfied users as they visit and
talk to prospective clients.
San Remigio’s experience in UNRS implementation shows that effective demand-generation coupled by
efficient use of PhilHealth financing can spell the difference in FP service sustainability.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |42
ANNEX II: Training Components
ORIENTATION PHASE 1-day orientation to the course, the process flow from Learners
Selection, the Learner’s Study Guide and Reference Manual, and Learner’s Workbook. This phase is
a run through on the process flow - modular instructions, exercises, assessment of learning and
skills, service integration, post-training monitoring and evaluation, DOH certification and
PhilHealth Accreditation.
SELF-PACED STUDY- done by the Learners, studying each of the ten modules for PPIUD and
five for IntervalIUD one by one, doing the assigned activities, exercises and case-studies and taking
the Modular exam before proceeding to the next module. After completing the last module, the
Learner inform the organizer for his/her readiness to go into the Practicum
PRACTICUM- after completing the ten modules, the learner reports to the organizer/training
institution, who will arrange for their stay in the Preceptor/or trainer in the preceptor facilities.
There, they will take the Midcourse Knowledge Assessment. After passing the Assessment, the
preceptor will conduct the demonstration and return demonstration, coach and mentor the Learner
on the proper technique of counselling, screening and insertion of PPIUD/Interval IUD in
anatomical models-the ZOE or the Mama U. The Learners are graded and required to do the
standard procedures on their own to at least three (3) actual clients, for issuance of the Certificate of
Training by the Training Agency. This will allow them to integrate PPIUD as one of the family
planning method when they go back in their facility
POST TRAINING MONITORING AND EVALUATION (PTME) AND DOH
CERTIFICATION- the Learner is required to do at least 10 standard PPIUD insertions on their
own in their facility within two months after the training. Monitoring of the learner on their
progress, on PPIUD/Interval IUD insertions done during this period assesses, would tell whether
they are meeting the required insertions or are they having problems. The supervisors, trainers or
preceptors also do Supportive supervision to address the problems and guide through the Learners
until the requirements are completed. The Post Training Monitoring and Evaluation visits is a tool
for assessing the quality of PPIUD/Interval IUD insertion and integration of the service in their
facilities. It determines their qualification for endorsement to the Department of Health Regional
Office by the training institution for issuance of the Certificate of Competency as PPIUD/Interval
IUD Service provider signed by the DOH Regional Director.
PHILHEALTH ACCREDITATION – once the DOH Regional Office issued the Certificate of
Competency, the provider may now apply for accreditation as Health Service Provider with
PhilHealth. Once accredited as Health Service provider, the provider can now claim case payments
for PPIUD/Interval IUD insertion done in at least Maternal Care Package accredited Birthing
facilities or level 1 hospital (for PPIUD) and Primary Care Benefit Package accredited facilities for
Interval IUD.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |43
ANNEX III: Training Course Enrollment
A service Provider may enroll to the course by filling out an enrollment form endorsed by their supervisor,
the hospital Chief, and Ob-Gyne Department of their facility and sending this form to the nearest Regional
or Provincial Coordinator of the VisayasHealth, their names are at the back of this briefer. The trainees or
learners are assessed based on the following criteria:
A registered Health Professional-Physician, Nurse or Midwife with valid ID from the
Professional Regulation Commission (PRC).
A staff of a hospital or MCP accredited Birthing Home, licensed by the Department of Health,
handling deliveries No religious objection to provision of FP Contraceptives specially IUD
insertions.
Endorsed by the supervisor/LCE to attend the course and agree to provide time for the self-
paced study while in the clinic or hospital by signing the enrollment form
ANNEX IV: Process Flow for the Modified FP CBT Level 2 PPIUD/Interval IUD Courses
Pre-Training- the program/facility managers conducts:
training needs assessment –determine type of training a provider needed
facility assessment – a self-assessment done to determine if the facility is qualified for the service to be
provided
decision-making process or consultation to enroll a qualified provider for training course
Figure 4. process flow for the modified FP CBT Level 2 PPIUD/Interval IUD Courses
In-Training Processes
Process Orientation conducted by DOH accredited Training Institution
Training Need Assessment
Facility Assessment
Enrollmrnt
PRACTICUM
o MENTORING
o COACHING o AT
PRECEPTOR SITES
DEMAND GEN
o COMMUNITY AND CLINIC-IDENTIFY UNMET NEEDS
o DISCUSS ISSUES ON IUD WITH SATISFIED USERS
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Self-paced Learning – knowledge acquisition of learners in their facility
Practicum-skills acquisition with mentoring, coaching of learners by trainers/preceptors at
preceptor sites
Demand generation in the community and clinic-identify unmet needs and mobilizing satisfied
users to discuss issues on IUD with potential clients
Figure 5. In-Training Flow
Post Training Process
a. Integration of IUD/PPIUD Services in facility. Announcing availability of and Provision of
IUD/PPIUD services, Demand generation, Monitoring and supportive supervision
b. Post Training Monitoring & Evaluation (PTME)- a process leading to DOH Certification
of training of the provider, PhilHealth –involves accreditation of the provider and the facility to
provide IUD/PPIUD and claim for case reimbursement. for services rendered.
c. Sustainability Planning. Income retention; Income utilization; Income sharing
Figure 6. Flow of Post-Training
NOTES: In the Process-
The Program Manager or Facility Manager and the Learner jointly decide if the Learner will enroll to the course.
The Training Institution/Trainer/Preceptor assess whether the learner is qualified to attend the course; have completed the course; conducts the Post training Monitoring and evaluation and recommend issuance of certificate of training to the DOH Regional Office.
The course starts with the Orientation of the Learners and ends with the issuance of the Certificate of Training signed by the DOH Regional Director
The Certified Provider applies for accreditation as Health service provider for the particular FP service
PRACTICUM
• MENTORING
• COACHING • AT
PRECEPTOR SITES
DEMAND GEN
• COMMUNITY AND CLINIC-IDENTIFY UNMET NEEDS
• DISCUSS ISSUES ON IUD WITH SATISFIED USERS DEMAND GEN
• COMMUNITY AND CLINIC-IDENTIFY UNMET NEEDS
• DISCUSS ISSUES ON IUD WITH SATISFIED USERS
• Self-paced knowledge Acquisition at learner’s facility
PRACTICUM
• Mentoring • Coaching • At preceptor sites
DEMAND GEN
• Community and clinic-identify unmet needs
• Discuss issues on IUD with satisfied users
ANNEX V: Introduction of Interactive Voice Response (IVR) and SMS to the new FP Training
Approach for FP CBT 2
BACKGROUND
On September 2016, VH developed a training curriculum for the training of family planning providers on
PIUD and interval IUD. From October-February 2017 a total of 16 interval IUD and 32 PPIUD providers
were trained using this new training methodology.
Evaluation of the new approach by the trainees revealed that they liked the new approach as it minimizes
time away from their areas of assignment. However, they expressed lack of time to focus on their reading
assignments. They also expressed difficulty because of the absence of interaction with somebody who can
discuss with them some concerns that arise from reading their learning modules and workbooks.
In order to address the above concerns, VisayasHealth introduced an intervention that uses applications of
SMS or voice mail technology to encourage the trainees to complete their reading assignments and exercises.
It was also seen to help spur trainees to comply with the number of insertions prior to the conduct of the
PTME. Meanwhile, this innovation was also designed to remind the trainers to visit and interact with the
trainees during the self-instructional phase.
OBJECTIVES
General: To improve the implementation of the VH project’s new training methodology for PPIUD and
interval IUD providers using applications of SMS and voice technology
Specific: During the conduct of FP training courses for PPIUD and interval IUD
METHODOLOGY
Messages are sent to trainees to encourage them to complete the requirements during the self-reading
phase
Messages are sent to trainers to encourage them to visit the trainees during the self-reading phase
Messages are sent to the trainees encouraging him/her to continue meeting the required number of
insertions or achieving the necessary competency for the conduct of the PTME
CONTACT FLOW
The Figures 7, 8, & 9 show the general flow of the IVR engagements.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |46
Figure 7
Figure 8
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |47
Figure 9
IVR SCRIPT DRAFTS:
A. SMS Alert for the SUPERVISORS
These message alerts are intended to the supervisors of the trainees and preceptors as identified
during the training orientation. The involvement of the supervisors in the whole training procedure is vital in
the smooth execution of the training process and will create a supportive environment during the entire
training duration. Supervisors will be informed on the important training milestones of their trainees or
preceptors through a SMS alert which will be sent to them a day after the orientation commences. This will
be followed by the subsequent SMS alert upon the completion of the trainees or preceptors of the necessary
phases.
Table 13. SMS scripts
Messages to the Trainee’s Supervisors Messages to the Preceptor’s Supervisors
Self-instructional Phase
Message 1: Good day [SUPERVISOR NAME]! This is your training coordinator. I would like to inform you that your staff [FIRST NAME] [LAST NAME] is already done with the orientation and will now be reading the modules and exercises. Thank you for your continued support to your trainee. Have a great day!
Message 1: Good day [SUPERVISOR NAME]! This is your training coordinator. I would like to inform you that your staff [FIRST NAME & LAST NAME of Preceptor] will now be visited by his/her trainees anytime soon for the administration of the mid-course evaluation followed by the practicum. Thank you for your continued support to your preceptor! Have a great day! Message 2: Good day [SUPERVISOR NAME]! I
would like to inform you that your trainee [FIRST NAME] [LAST NAME] has just completed reading the modules and workbook, and is now ready to take
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |48
the mid-course evaluation. I would like to appreciate the support you continually provide to your trainee. Meanwhile, [FIRST NAME] will visit his/her preceptor for the evaluation followed by the completion of cases for the practicum anytime soon. Thank you and have a great day!
After the Practicum
Message 1: Good day [SUPERVISOR NAME]! I would like to inform you that your trainee [FIRST NAME] [LAST NAME] has already completed the practicum. [FIRST NAME] will now be going back to your facility in order to complete the case requirements prior to the Post Training Monitoring and Evaluation. Great job for the continued support you extend to your trainee! Thank you and Have a great day!
Message 1: Good day [SUPERVISOR NAME]! I would like to inform you that your preceptor [FIRST NAME] [LAST NAME] has already completed the conduct of practicum to the trainees. Your preceptor will now be contacted by the trainees for the conduct of Post Training Monitoring and Evaluation anytime soon. Thank you for your continued support! Have a great day!
After the PTME Before the PTME
Message 1: Hello [SUPERVISOR NAME]! Great Job! Your trainee [FIRST NAME] [LAST NAME] has just completed the PTME! We will now be issuing a certification for your trainee. Meanwhile, [FIRST NAME] is now also ready to apply for PHIC accreditation. Congratulations for a job well done! Have a great day!
Message 1: Good day [SUPERVISOR NAME]! I would like to inform you that your preceptor [FIRST NAME] [LAST NAME] will be visiting the trainees for the conduct of the Post Training Monitoring and Evaluation to check for the trainees’ skills in doing the procedure. Likewise, your preceptor will endorse trainees that would qualify to be certified as a trained provider. Thank you so much for your kind support to your preceptor! Have a great day!
B. IVR & SMS Alert to TRAINEES
These messages are designed to encourage the trainees who are in the self-instructional phase to
complete their reading assignments and the accompanying exercises. These messages are also intended for
trainees who will undergo the Post Training Monitoring and Evaluation (PTME). 3 days after the training
orientation, a Voice call will be sent to the trainees to check for their progress on their reading assignments
and in completing the exercises. The voice call messages will be repeated every two days until the participants
complete the modules and the workbook. Meanwhile, on the 5th day after the orientation commences, the
trainees will again receive a voice call confirming if they already visited their preceptors. Finally, just before the
PTME, a voice call message will be received by the trainees to check their readiness for the Post Training
Monitoring and Evaluation. After the call, a separate SMS alert will also be sent to the trainees to inform them
of their preceptors’ contact numbers.
Table 14. Voice Mail Scripts
Voice Mail Message SMS Alert to trainee
Self-instructional Phase: Messages to check their reading progress
INTRO: Hi there! This is your training coordinator. If
you want this call to be in English, PRESS 1; For Tagalog,
PRESS 2; For local Dialect (depending on the area),
PRESS 3; To repeat this recording, PRESS 4.
ENGLISH-QUESTION 1: Thank You! Now, I would
like to know how you’re progressing. Are you done
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |49
reading ALL the modules? If YES, press 1. If NO, press 2.
To repeat this recording, press 3.
Q1 Key press 1: GREAT JOB! You may now proceed in
taking the mid-course evaluation. I will be sending your
preceptor’s number for you to contact in a short while.
Congratulations!
Hi [FIRST NAME] and congratulations again! You may
contact your preceptor [NAME OF TRAINER] for your
mid-course evaluation anytime at [TRAINER MOBILE
NUMBER]. Thank you and have a great day!
Q1 Key press 2-QUESTION 2: I would like to
encourage you to proceed with your readings. Do you
have any questions, clarifications or problems regarding
your readings so far? If YES, press 1. If NO, press 2. To
repeat this recording, press 3.
Q2 KEY PRESS 1: That’s OK! I will just refer you to
your preceptor. In a short while, I will send you the
contact number of your preceptor for you to address your
questions and concerns anytime. Thank you!
Hi, [FIRST NAME]! You may contact your preceptor
[NAME OF PRECEPTOR] anytime at [TRAINER
MOBILE NUMBER] for your questions / clarifications /
or CONCERNS on your training. Thank you and have a
great day!
Q2 KEY PRESS 2: Thanks for taking the time for this
call! You may now continue with your readings. I will call
you again to follow up, after two days. You may also
contact your preceptor directly any time. I will send you
the contact number of your preceptor in a short while.
Thank you!
Should you encounter any problems or have any questions
from your readings, please feel free to contact your
preceptor [NAME OF PRECEPTOR] anytime at
[NUMBER OF PRECEPTOR]. Thank you very much
and enjoy your day!
Self-instructional Phase: Messages to confirm if they visited their preceptor
INTRO: Hi there! This is your training coordinator. If
you want this call to be in English, PRESS 1; For Tagalog,
PRESS 2; For local Dialect (depending on the area),
PRESS 3; To repeat this recording, PRESS 4.
ENGLISH-QUESTION 1: Thank You! Now, I would
like to know how you are doing. Have you already visited
your preceptor? If YES, press 1. If NO, press 2. To
repeat this recording, press 3.
Q1 Key press 1: GREAT JOB! Now that you have visited
your preceptor, you may continue in completing your
reading assignments. Should you have any questions or
problems encountered with your readings you may contact
your preceptor anytime. I will be sending your preceptor’s
number for you to contact in a short while. Thank you
and have a great day!
Hi, [FIRST NAME]! Should you encounter any problems
or have any questions from your readings, please feel free
to contact your preceptor [NAME OF PRECEPTOR]
anytime at [NUMBER OF PRECEPTOR]. Thank you
very much and enjoy your day!
Q1 Key press 2: Thank you! I would like to encourage
you to visit your preceptor for you to discuss any
questions/ problems you may have encountered on your
readings and in completing the exercises. This is also a
good time to interact and learn from your preceptor. In a
short while, I will send you the contact number of your
preceptor for you to schedule your visit. Thank you!
Hi, [FIRST NAME]! You may contact your preceptor
[NAME OF PRECEPTOR] anytime at [TRAINER
MOBILE NUMBER] for your scheduled visit and for any
questions / clarifications / or CONCERNS on your
training. Thank you and have a great day!
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |50
Before the PTME
INTRO: Hi there! This is your training coordinator. If
you want this call to be in English, PRESS 1; For Tagalog,
PRESS 2; For local Dialect (depending on the area),
PRESS 3; To repeat this recording, PRESS 4.
ENGLISH-QUESTION 1: Thank you! Now, I would
like to know how you’re doing with your training so far.
Have you completed the number of IUD insertions
required for you to become a certified provider? If YES,
press 1. If NO, press 2. To repeat this recording, press 3.
Q1 KEY PRESS 1: Congratulations! You are now ready
to undergo the post-training and monitoring evaluation.
Please contact your preceptor through the number which I
will send to you shortly. Thank you!
Thank you [FIRST NAME]! You may now contact your
preceptor [NAME OF PRECEPTOR] anytime for your
post-training monitoring and evaluation at [MOBILE
NUMBER OF PRECEPTOR]. Have a great day!
Q1 KEY PRESS 1-QUESTION 2: Do you feel
confident that you’re ready for the Post-training
monitoring and evaluation? If YES, press 1. If NO, press
2. To repeat the question, press 3.
Q2 KEY PRESS 1: Congratulations! You are now ready
to undergo the post-training and monitoring evaluation.
Please contact your preceptor through the number which I
will send to you shortly. Thank you!
Thank you [FIRST NAME]! You may now contact your
preceptor [NAME OF PRECEPTOR] anytime for your
post-training monitoring and evaluation at [MOBILE
NUMBER OF PRECEPTOR]. Have a great day!
Q2 KEY PRESS 2-QUESTION 3: I would like to
encourage you to continue with meeting your required
number of insertions, OR until you feel ready and
confident for the post-training monitoring and evaluation.
Do you have any questions, clarifications and or problems
in practicing your skills? If YES, press 1. If NO, press 2.
To repeat this recording, press 3.
Q3 KEY PRESS 1: Thank you! It is always best to
express your questions, concerns, and or talk about the
problems you may have encountered in practicing your
skills. For these to be addressed, I will refer you to your
preceptor. I will send you the contact number of your
preceptor in a short while for you to call or text your
concerns or questions.
Good day [NAME OF PRECEPTOR]! Your trainee
[FIRST NAME] [LAST NAME] has concerns and
questions regarding the application of the newly acquired
skills. You may expect a message or call form your trainee
anytime soon. Thank you and have a lovely day.
Q3 KEY PRESS 2: Thank you for taking my call today!
You may now proceed in completing the required number
of insertions or until you feel ready and confident for the
post-training monitoring and evaluation. We will call you
again to follow up after 1 week. You may also contact
your preceptor directly through the contact number I will
be sending you in a short while.
Thank you [FIRST NAME] for taking our call today! You
may contact your preceptor [NAME OF PRECEPTOR]
anytime for questions, clarifications and or problems
encountered in practicing your skills at [PRECEPTOR’S
CONTACT NUMBER). Have a great day!
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C. IVR & SMS Alert to PRECEPTORS
The Preceptors will also receive a voice call message to remind him/her to visit and check the
trainees before the conduct of the Post Training Monitoring and Evaluation (PTME). A separate
SMS alert will also be sent to the preceptors informing them of the progress of the trainees or if there
are questions that have surfaced during the entire training process. These messages for the preceptors
are important to keep them informed on the progress of their trainees and prompt them to respond
to the needs or problems encountered.
Table 15. VM and SMS scripts
Voice Mail Message SMS Alert to Preceptor
Self-instructional Phase
If the trainee have completed the self-instructional phase: Good day, [TRAINER], your trainee [FIRST NAME] [LAST NAME] has just completed reading the modules and workbook, and is ready to take the mid-course evaluation. You may expect a message or call from the trainee anytime soon. Thank you and have a great day!
If the trainee has questions/ problems during self-instructional phase: Good day, [TRAINER], your trainee [FIRST NAME] [LAST NAME] has concerns / questions regarding the self-instructional modules. You may expect a message or call from the trainee anytime soon. Thank you!
Before PTME Before PTME
INTRO: Hi there! This is your training coordinator. If you want this call to be in English, PRESS 1; For Tagalog, PRESS 2; For local Dialect (depending on the area), PRESS 3; To repeat this recording, PRESS 4.
If the trainee has completed the required number of insertions or is ready for PTME: Good day [NAME OF PRECEPTOR]! Your Trainee [FIRST NAME][LAST NAME] has just completed the required number of insertions and is ready for the PTME. You may expect a message or call from the trainee anytime soon. Thank you.
ENGLISH-QUESTION 1: Hello there! This is your training coordinator. Before anything else, I would like to congratulate you for the great job you’ve done as preceptor. Now, I would like to know if you have already followed up and visited your trainees for the conduct of the Post Training Monitoring and Evaluation (PTME). If YES, press 1; If NO, press 2, To repeat this recording, press 3
If the trainee has questions/ problems in the application of newly acquired skills: Good day [NAME OF PRECEPTOR]! Your trainee [FIRST NAME] [LAST NAME] has concerns and questions regarding the application of the newly acquired skills. You may expect a message or call form your trainee anytime soon. Thank you and have a lovely day.
Q1 KEY PRESS 1: Thank you for helping and encouraging your trainee to complete the training course! Now that you are done with the conduct of the PTME, I would like to congratulate you for a job well done! Thank you for taking this call. Have a great day!
Q1 KEY PRESS 2: Thank you! I would like to encourage you to follow-up and visit your trainees to check for any questions/ problems that they may have encountered on the application of the new skills they acquired. Thank you and have a lovely day.
ANNEX VI: Informed Choice and Voluntarism Compliance
(Semi-annual: Q2/Q4)
This records ALL activities related to compliance to FP and Abortion-Related Policies, such as, but not limited to, orientation sessions on Informed
Choice, Voluntarism, and compliance monitoring tools, systems or activities.
Table 16. Part A: Technical Assistance, Inputs and Other Activities
Date
Location
Specific Activity/
Topic or Content
Conducted By Whom
Number of Participants
Specific Audience
Remarks/Results/
Outputs M F
September 9, 2016 Chocolate Hills Complex, Carmen Bohol
Orientation on Peer to Peer Experiential Competency Based Training on PPIUD
EH/VH 2 9 Doctors – 4
Midwife – 5
Nurse – 2
Counseling discussed in the Manual and mentoring in the practicum.
33 clients provided IUD
September 28, 2016
Villa Romana, Maasin Leyte
Orientation on Peer to Peer Experiential Competency Based Training on PPIUD
EH/VH 0 12 Midwife – 8
Nurse – 4
33 clients provided IUD
Counseling discussed in the Manual and mentoring in the practicum.
October 26, 2016 Soledad Suites, Bohol
Culminating Activity on Peer to Peer Experiential Competency Based Training on PPIUD
EH/VH 2 6 Doctors – 3
Midwife – 4
Nurse – 1
Counseling discussed in the Manual and mentoring in the practicum.
33 clients provided IUD
November 4, 2016 Villa Romana, Maasin Leyte
Culminating Activity on Peer to Peer Experiential Competency Based Training on PPIUD
EH/VH 0 12 Midwife – 8
Nurse – 4
Counseling discussed in the Manual and mentoring in the practicum.
33 clients provided IUD
November 15, 2016
Diversion 21 Hotel, Iloilo
Orientation on Peer to Peer Experiential Competency Based Training on PPIUD
EH/VH 1 13 Doctors – 4
Midwife – 6
Nurse - 4
Counseling discussed in the Manual and mentoring in the practicum.
33 clients provided IUD
November 15-19, 2016
Diversion 21 Hotel, Iloilo/ Iloilo Provincial Hospital/ Western Visayas Sanitarium
Bilateral Tubal Ligation Training
EH/VH 0 8 Doctors – 4
Midwife – 1
Nurse - 3
Counseling discussed in the Manual and mentoring in the practicum.
33 clients provided IUD
6 5 60 65
November
16, 2016
Business Inn, Bacolod Negros
Orientation on Peer to Peer Experiential Competency
EH/VH 1 10 Doctors – 2
Midwife – 9
Counseling discussed in the Manual and mentoring in the practicum.
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Date
Location
Specific Activity/
Topic or Content
Conducted By Whom
Number of Participants
Specific Audience
Remarks/Results/
Outputs M F
Occidental Based Training on PPIUD 33 clients provided IUD
November
29, 2016
Villa Romana, Maasin Leyte
Orientation on Peer to Peer Experiential Competency Based Training on Interval IUD
EH/VH 0 16 Doctors – 0
Midwife – 14
Nurse - 2
Counseling discussed in the Manual and mentoring in the practicum.
33 clients provided IUD
December 9, 2016 Gov. Celestino Gallares Memorial Hospital
Orientation on Peer to Peer Experiential Competency Based Training on PPIUD
EH/VH 0 7 Doctor - 7 Counseling discussed in the Manual and mentoring in the practicum.
33 clients provided IUD
January 5, 2017 El Fisher Hotel, Bacolod Negros Occidental
Culminating Activity on Peer to Peer Experiential Competency Based Training on PPIUD
EH/VH 1 10 Doctors – 2
Midwife – 9
Counseling discussed in the Manual and mentoring in the practicum.
33 clients provided IUD
January 23-27, 2017
Soledad Suites, Bohol
FBCBT 1 EH/VH 0 19 Midwife - 19 Counseling discussed in the Manual and mentoring in the practicum.
January 27, 2017 Diversion Hotel, Iloilo
Culminating Activity on Peer to Peer Experiential Competency Based Training on PPIUD
EH/VH 1 13 Doctors – 4
Midwife – 6
Nurse - 4
Counseling discussed in the Manual and mentoring in the practicum 33 clients provided IUD
February 13, 2017 Hotel Lorenza Tacloban
Orientation on Peer to Peer Experiential Competency Based Training on PPIUD
EH/VH 2 9 Doctors – 4
Midwife – 5
Nurse - 2
Counseling discussed in the Manual and mentoring in the practicum. 33 clients provided IUD
February 17, 2017 Gov. Celestino Gallares Memorial Hospital
Culminating Activity on Peer to Peer Experiential Competency Based Training on PPIUD
EH/VH 0 7 Doctor - 7 Counseling discussed in the Manual and mentoring in the practicum. 33 clients provided IUD
8 5 91 96
February 24, 2017
Villa Romana, Maasin Leyte
Culminating Activity on Peer to Peer Experiential Competency Based Training on Interval IUD
EH/VH 0 16 Doctors – 0
Midwife – 14
Nurse - 2
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |54
Date
Location
Specific Activity/
Topic or Content
Conducted By Whom
Number of Participants
Specific Audience
Remarks/Results/
Outputs M F
February 28, 2017 XYZ Hotel Tacloban
Orientation on Peer to Peer Experiential Competency Based Training on Interval IUD
EH/VH 0 14 Doctors – 2
Midwife – 10
Nurse - 2
March 1, 2017 Lex Hotel Cebu Orientation on Peer to Peer Experiential Competency Based Training on Interval IUD
EH/VH 0 13 Midwife – 13
March 7, 2017 Soledad Hotel, Tagbilaran, Bohol
Orientation on Peer to Peer Experiential Competency Based Training on Interval IUD
EH/VH 0 12 Midwife-11
Dr-1
Total=12
March 8, 2017 Soledad Hotel, Tagbilaran
P2P Orientation IIUD EH/VH 0 15 midwife- 12
dr-3
Total=15
March 10, 2017 Chocolate Hills Complex, Carmen, Bohol
P2P PPIUD Orientation EH/VH 0 11 Midwife-11
March 15-16, 2017 Lex Hotel, Cebu City
TOT for BTL-MLLA EH/VH 0 8 MDs-8 FP Counselling discusses in the didactic and practicum sessions
March 21-24, 2017 Summit Circle Cebu City
CBT FP Level 2 BTL-MLLA HSP Cebu
EH/VH 0 5 MD-3
RN-2
total=5
FP Counselling discusses in the didactic and practicum sessions
March 20-24, 2017 Diversion 21 Hotel, Iloilo City
CBT FP Level 2 BTL-MLLA HSP Iloilo
EH/VH 0 8 MDs 4
RN- 4
FP Counselling discusses in the didactic and practicum sessions
March 20-24, 2017 Pink Hotel, Catarman, N. Samar
CBT FP Level 1, North Samar EH/VH 2 24 RN- 2
MW-24
FP Counselling discusses in the didactic and practicum sessions
10 2 126
March 27-30, 2017 Summit Circle Hotel, Cebu City
FP CBT IIUD Cebu Culmination
EH/VH 0 9 9 midwives
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |55
Date
Location
Specific Activity/
Topic or Content
Conducted By Whom
Number of Participants
Specific Audience
Remarks/Results/
Outputs M F
1
12
25
Total Number of Orientation/Training Activities conducted: __25____ Total Number of Participants Trained or Oriented: __277_ Males: __12_____ Females: __265_ Table 17. Part B. Summary Matrix of Service Providers/Facilities Monitored and Family Planning Clients Interviewed
Date Monitored
Name of Facilities
Location of facilities
Name/Designation of Service
Providers
No. of FP Clients
Interviewed Monitored by
Results/Findings
Steps Taken/
Recommenda-tions
9/23/16 Getafe Rural Health Unit
Getafe, Bohol
Risabel Bancale, Midwife
0 Dr. Elaine Teleron, Regional Technical
Adviser
The primary health unit provides only counselling on BTL but the Informed Consent form is further explained and signed in the referral hospital.
The said primary facility has no copy of the Informed Consent form.
9/22/16
2
Sierra Bullones Rural Health
Unit
Sierra Bullones, Bohol
Gerlie Jaso, Midwife
1
Dr. Elaine Teleron, Regional Technical
Adviser
The primary health unit provides only counselling on BTL but the Informed Consent form is further explained and signed in the referral hospital.
The said primary facility has no copy of the Informed Consent form.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |56
Date Monitored
Name of Facilities
Location of facilities
Name/Designation of Service
Providers
No. of FP Clients
Interviewed Monitored by
Results/Findings
Steps Taken/
Recommenda-tions
11/16/16
Mabini Rural Health Unit
Mabini, Bohol 2 Jeffrey Licardo,
Provincial Coordinator
There is no violation on Informed Consent and Voluntarism (ICV)
3/1/17 BHS
Guibawian Guimbawian,
Pinamungahan
Monica Tuguib
Midwife 1
Lurica Gambe
Provincial Coordinator
There is no violation on Informed Consent and Voluntarism (ICV)
3/3/17 Carreta Health
Center Carreta, Cebu
City
Esmeralda Coming,
Midwife
2
Carlo Dale Pacana, MCTA
Jaminnie Andrea Uy,
Provincial Coordinator
There is no violation on Informed Consent and Voluntarism (ICV)
3/3/17 Samboan RHU Samboan, Cebu Basiledes Repunte,
Midwife 0
Dr. Elaine Teleron, Regional Technical
Adviser
There is no violation on Informed Consent and Voluntarism (ICV)
3/3/17 Alegria RHU Alegria, Cebu 1 Dr. Elaine Teleron, Regional Technical
Adviser
There is no violation on Informed Consent and Voluntarism (ICV)
3/3/17
6
Mambaling Health Center
Mambaling, Cebu
Felisa Habasa, Midwife
1
Jaminnie Andrea Uy,
Provincial Coordinator
There is no violation on Informed Consent and Voluntarism (ICV)
3/9/17 Candijay RHU Birthing Center
Candijay, Bohol Juanita Iballa,
Midwife 3
Annie H. Lucero,
Provincial Coordinator
Although the facility does not provide sterilization services like BTL/Vasectomy, the RHU do counselling on this services but does not tackle about Informed Consent.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |57
Date Monitored
Name of Facilities
Location of facilities
Name/Designation of Service
Providers
No. of FP Clients
Interviewed Monitored by
Results/Findings
Steps Taken/
Recommenda-tions
3/8/17 Ajuy RHU Ajuy, Iloilo Susie Canoso,
Midwife 0
Cielo M. Alcuino, MCTA
There is no violation on Informed Consent and Voluntarism (ICV)
3/8/17 Banate RHU Banate, Iloilo Amalia Felicidario,
Midwife 0
Isabella Esguerra,
MCTA
There is no violation on Informed Consent and Voluntarism (ICV)
3/9/17 Passi CHO Passi City, Iloilo Gladys Bernales,
Nurse 0
Cielo M. Alcuino, MCTA
There is no violation on Informed Consent and Voluntarism (ICV)
3/9/17 FPOP Iloilo
Chapter Iloilo City Razel Cabrera 0
Cielo M. Alcuino, MCTA
There is no violation on Informed Consent and
Voluntarism (ICV)
3/9/17
6 Mina RHU Mina, Iloilo
Lorne Leano, Midwife
0 Isabella Esguerra,
MCTA
There is no violation on Informed Consent and
Voluntarism (ICV)
3/16/17 Sambag 2
Health Center Cebu City Vercel Belvestre 1
Antonia Lucero, Provincial
Coordinator
There is no violation on Informed Consent and
Voluntarism (ICV)
1
Number of Facilities monitored - 15
Number of Provider Interviewed- 15
Number of Client’s Interviewed- 10
Number of Vulnerabilities noted- 0
ANNEX VII: Stories from the Field
1. STORIES RELATED TO THE FIRST IPH PYP GRADUATION
USAID-supported young parent program links clients to education and employment
opportunities
POTOTAN, ILOILO PROVINCE
Adolescent mothers enrolled in the Program for Young Parents (PYP) of the Iloilo Provincial Hospital (IPH)
will now have opportunities to pursue careers after giving birth. This was the good news that the 22 young
mothers, aged 18-20 years old, received along with the Certificates of Completion from IPH PYP during its
first graduation rites on February 10, 2017. A PYP client is considered a “graduate” if she submitted for four
(4) ante-natal consultations, attended the four (4) educational sessions, delivered in the facility, and used a
family planning method to delay the next pregnancy.
Beyond these services, IPH Chief Dr. Prem Parcon explained, “Our next step is to help these young mothers and/or
their partners find the resources to support their family.” He went on to announce that the Department of Education
(DepEd), Technical Education and Skills Development Authority (TESDA), Department of Labor and
Employment (DOLE), and Department of Social Welfare and Development (DSWD) have gladly agreed to
partner with the PYP by offering opportunities for the teen moms and/or their partners to continue their
education, pursue skills training, and find employment. USAID, through its VisayasHealth project, facilitated
linkages with these agencies with the IPH PYP team, together with the Department of Health Region 6 office
and the Provincial Government of Iloilo.
Left photo shows some of the 22 Graduates of the Program for Young Parents of Iloilo Provincial Hospital together with PYP Focal Person, Ms. Wilma Ponta-oy (foreground). Right photo shows them with IPH staff and PYP Team.
(Photos by CAlfafara/EngenderHealth)
DEMAND GEN
o COMMUNITY AND CLINIC-IDENTIFY UNMET NEEDS
o DISCUSS ISSUES ON IUD WITH SATISFIED USERS
“Teen pregnancy is not just a medical issue. Beyond caring for
the young mothers and their babies, we are now linking them
to other agencies that can help them face the many challenges
of parenthood.”
DR. PREM PARCON Chief of Hospital Iloilo Provincial Hospital
Ph
oto
by
CA
lfaf
ara/
Enge
nder
Hea
lth
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |59
Teen Mom found hope for her future with USAID’s AYRH program
Jonah Lloyd Intong was only 17 and on her first year in
Agricultural Engineering when she became pregnant. Being the
second child and only daughter of 3 children, it was difficult for
her to deal with the disappointment of her family upon learning
about her pregnancy. Her partner’s family was more accepting
of her situation and her own family slowly came to terms with it
as well. They encouraged her to seek maternity care at the Iloilo
Provincial Hospital (IPH), which eventually led to her
enrollment in the Program for Young Parents (PYP), a USAID
initiative adopted by IPH.
Now 19 years old and a mother of a one-year old baby girl, she
recently received a Certificate of Completion from IPH PYP,
along with 21 other young moms. She and her fellow teen
moms received recognition at IPH as graduates of PYP for
completing prenatal, delivery, and postpartum services and
completing especially designed education sessions on
Recognition of Danger Signs of Pregnancy; Gender; Exclusive
Breastfeeding; Family Planning / Responsible Parenthood to
postpone subsequent pregnancies, and Life Skills to help them
deal with challenges they are likely to encounter as they
transition to adulthood.
Asked about her best experiences with PYP, Jonah replied it
was the education sessions that had great impact on her. She
learned how to take care of her baby and how to be a good
parent. She appreciated the opportunity to share life stories with
other young mothers, gaining inspiration from them and
spurring them to rise with hope and not despair.
Jonah’s resolve to complete her education was strengthened along with her emotional strength as she had to
take a different course due to financial constraints. She is now on her second year of Bachelor of Elementary
Education and optimistic that things will work out, saying “I think I will enjoy teaching children in the future.”
Should other young women find themselves in the same position, Jonah says they should work doubly hard
to pursue their dreams for their own and their children’s sake. She is grateful for the care of the IPH PYP and
the help of development partners.
USAID Young parents program inspires young mother to help fellow teen parents
Distraught and apprehensive of her family’s reaction to her situation, Joy Pelenia was only able to disclose
her pregnancy on the second month. While upset with the turn of events, her family supported Joy and
encouraged her to seek medical care at the IPH
“The Program for Young Parents
helped me find strength to get up
and move forward with my life for
myself and for my baby. I am
thankful for the opportunity given
to me to pursue my dreams. ”
~ JONAH LLOYD INTONG, 19 IPH PYP Graduate
Ph
oto
s b
y C
Alf
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a/E
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ealt
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VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |60
“Being a PYP Peer Educator
is my way of thanking the
kind health service providers
of the IPH PYP. I feel
fulfilled when I see my fellow
teen moms with hope in their
eyes after I share my story”.
~ JOY PELENIA, 20 IPH PYP Graduate & Peer Educator
Joy had dreamt of being a cruise ship attendant and was on her
second year. The early, unexpected pregnancy posed a
seemingly insurmountable obstacle to attaining her dream.
Fortunately, the PYP helped Joy “find strength to get up and move
forward with my life for myself and for my baby”. Through the PYP’s
recently forged partnership with the Technical Education and
Skills Development Authority (TESDA), Joy is confident that
she can still pursue the bright future she dreamed of through a
career in health care.
Joy Pelenia is now 20 years old and the mother of an 11-
month old baby boy. She has become one of the active peer
educators of Iloilo Provincial Hospital (IPH) Program for
Young Parents (PYP). She helps the IPH staff with routine
tasks like having clients sign attendance and making
nameplates. Most important, she shares her life experience
with other teen parents during the weekly PYP day at the
facility. She is grateful for the solicitous care she received from
IPH PYP staff which she credits for the change in her outlook
from a sad, young pregnant girl to the hopeful individual she is
now. Joy finds fulfillment in sharing her life story with other
young parents. The PYP facilitates the formation of natural
support groups, especially among the young women who find
comfort and draw strength from each other.
2. STORIES RELATED TO THE FACILITY TURNOVERS
Looking Forward To Better Service Provision
for Dagami Clients with New USAID-Built RHU and
TB-DOTS Facility
DAGAMI, LEYTE
There is never a dull day at the Rural Health Unit (RHU) of
Dagami, Leyte. Ms. Letecia Flores, a 64-year old Public
Health Nurse (PHN) and 57- year old midwife Ms. Myrna
Cabidog, have seen a lot in the last 37 years of service at the
RHU. As population of the municipality grew over the
years, the number of clients at the RHU has also increased.
Prenatal days are scheduled every first and last Wednesday
of the month. On these days, about 15-25 pregnant mothers
composing of first time mothers, teen mothers, and those
who’ve had other children gather for their prenatal consultations. Immunization days happen every second
and third Wednesday where about 50-65 babies are attended to. However, on some days, the RHU gets
Dagami RHU’S Ms. Letecia Flores, PHN (left) and Midwife Ms. Myrna Cabidog (right) have been serving the RHU for 37 years and 36 years respectively and look forward to more good things at the newly completed RHU.
(Photo by HSeverino/EngenderHealth)
Ph
oto
by C
Alfafara/
En
gend
erHealth
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |61
crowded and the RHU staff are barely able to attend to all the clients who come to the client for varying
health issues including Tuberculosis treatment and family planning (FP) services.
Prior to the onslaught of Typhoon Yolanda in 2013, Dagami RHU assisted an average of 10-15 births a
month. The following year, the RHU recorded 20 deliveries a month. According to Ms. Cabidog, “in spite of
dilapidated walls; rundown delivery and recovery rooms; small and humid waiting areas; and examination rooms, the RHU staff
tirelessly received clients even from other municipalities.” It was only when private birthing clinics started
mushrooming in neighboring towns in 2015 that the RHU‘s monthly average of deliveries reportedly went
down to 1-7 deliveries. Still, the problem of congestion and discomfort remained.
A typical day at the current Dagami RHU is a crowded scene at registration and waiting rooms even in the early hours of the morning. The crowd expands during dedicated days like EPI, Prenatal, and FP days. (Photos by CAlfafara/EngenderHealth)
Ms. Flores meanwhile relates clients’ expressed wish for the RHU saying, “Mothers who are here for prenatal say
they want a more conducive and comfortable space to deliver their baby. As you can see our place is exactly the opposite on what
they want for their baby. Sometimes during heavy rains, clients had to be moved to more elevated areas of the RHU as the water
comes in and starts flooding the facility.”
Asked about their thoughts on the building of a new RHU and Tuberculosis –Directly Observed Treatment
Short-course (TB-DOTS) facility by USAID, Midwife Cabidog said, “Finally, our clients would be comfortable when
they go for consultations or to deliver their babies. As among the USAID-trained providers on FP, I and other trained staff of
the RHU will be more inspired to give FP services in a more comfortable facility. I’m grateful for all the (USAID) support we
received. All the FP training and supplies, IEC materials, orientations and seminars you had provided for Dagami have been
very useful and now with the beautiful new facility you built for us, this is truly a big help especially for third class municipalities
like ours. We hope that we could sustain the momentum of change””
Operations at the current RHU meet physical challenges as the staff take in clients in humid and dilapidated facilities, flood-prone floors, peeling paint, and lack of storage places for files and supplies. Leftmost photo shows boxes and supplies stacked on top of the other on benches to avoid flood waters destroying these during heavy rains. Middle and rightmost photos show the maternity ward and hallways in disrepair. (Photos by HSeverino/EngenderHealth)
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |62
“Thank you for all the help. I am
thankful that there are Family
Planning services here in Carigara. It
is really a big help to us mothers, to
our family. It is why I am always
willing to share my experience to my
fellow mothers about the benefits of
Family Planning are, especially to
those teen age mothers. These young
moms should be given full attention on
this information.” ~Sarah Faye Esmero
The new Dagami Rural Health Unit and TB-DOTS facility is part of the U.S. government’s over Php 6.3 billion ($143-million) assistance to Eastern Visayas, which was severely hit by the Typhoon Haiyan (Yolanda) in 2013. The new Dagami RHU is nearing completion and will then be turned over to the Dagami LGU to serve its 35,147 population (Source: 2015 Census of Population, Philippine Statistics Authority) from its 65 barangays and those from nearby towns. (Photos by HSeverino & CAlfafara/EngenderHealth)
Nurse Flores on the other hand also expressed her gratitude saying, “Absurd to say, but we are also thanking
Typhoon Haiyan, because of that catastrophe we are receiving this blessing now. We will truly cherish this. We will surely be able
to provide better quality service to our people as what you gave to Dagami. With the new building, rooms and equipment, there is
no reason for us not to excel in health. Aside from the mothers and their babies, TB patients will find greater hope for cure with
effective TB diagnostics and treatment with the new facility. Thank you (USAID) from our hearts ‘damo nga salamat’ (Thank
you very much)!”
Mother Gives Back to RHU Out Of Gratitude to
Care Received
Sarah Faye Esmero is a 33 y.o. housewife and mother of a
baby boy aged 2 years and 3 months. She has been a recipient
of prenatal, birthing, and FP services of the Carigara Rural
Health Unit (RHU), under the care of USAID-trained service
providers. Sarah Faye expressed great satisfaction with the care
she has received because it has also impacted the life of her
family.
The thorough care Sarah Faye got through information and
service provision on maternal and newborn care and family
planning has enabled her family to attain utmost health and
well-being. She claims her baby is healthy because the health
providers always emphasized the importance of completing
antenatal visits and exclusive breastfeeding through the
information (Usapan) and counseling sessions she attended. She
also learned how important proper birth spacing is to her
reproductive health. After accepting family planning (FP), she
also found its impact in her family’s quality of life. She explains,
“Financially we can be stable. Now, I can follow up the
growing years of my child not worrying. It is also a big
help, financially and emotionally “. She added that she and
her husband are able to spend more quality time together
without fear of getting pregnant too soon.
Ph
oto
by H
Sev
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/E
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ealth
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |63
Joy Abuyabor, a midwife from Leyte, and other USAID-trained midwives are helping more parents across the Philippines access quality health care.
(Photo by CAlfafara/ EngenderHealth)
Today, out of her appreciation for the services she received, she is giving back to the RHU as one of the
fifteen (15) FP satisfied users who share their experiences with their FP method of choice to other clients at
the RHU during the FP Days that are now regularly held at the Carigara RHU. Through Sarah Faye, several
mothers are now also sharing that same improved quality of life and are considering being FP champions like
her.
She looks forward to even better service provision quality when the new Carigara District Hospital Expansion
Maternity Ward and TB DOTS Center built by USAID is turned over to the local government of Carigara.
“Now that we will soon benefit from you (USAID) an additional building in our Hospital that I
believe will continue the good services currently done here in the RHU or better.”.
3. OTHER
BRINGING SAFER DELIVERIES TO MOTHERS AND NEWBORNS IN THE PHILIPPINES
One midwife’s relentless determination to give families a healthy start
(See also https://www.usaid.gov/results-data/success-stories/bringing-safer-deliveries-to-mothers-and-
newborns-in-the-philippines)
“We mentor one another, which helps us give the right
information and the right services to our clients.”
February 2017—Joy Abuyabor is a midwife from
Leyte, in the central region of the Philippines called
Visayas. Since 2008, she has been operating her family
health care and maternity clinic so more babies can be
delivered safely and parents can seek family planning
options.
Abuyabor’s work reflects the national government’s
objectives to reduce maternal and infant deaths and
meet family planning needs. In 2015 alone, about
2,700 Filipino mothers lost their lives to preventable
causes related to pregnancy and childbirth, and almost
30,000 newborns lost their lives before reaching 1
month old.
To help the Philippine Government address this, USAID, in partnership with EngenderHealth, launched the
VisayasHealth Project in 2013.
Project staff train health workers on patient-centered counseling so parents can make informed decisions
about family planning. The project also supports public-private midwives networks, where experienced
midwives mentor other members on skills like caring for pregnant women or inserting and removing
intrauterine devices.
VisayasHealth Project Year 5 Quarter 2 Progress Report (January 1 – March 31, 2017) |64
Top Left photo shows the clinic devastated after Typhoon Yolanda
hit in 2013. Undaunted, Joy Abuyabor continued to provide services
to the women of Tacloban City and Palo, Leyte even under difficult
circumstances (right photos). With much perseverance and support
from partners, she was able to rebuild her clinic. Lower left photo
shows the clinic after the completion of the reconstruction.
(EngenderHealth)
Through these networks, the providers coordinate services to better serve clients. For example, a woman may
learn about family planning methods in a private clinic, but can be referred to a nearby public clinic for free
products and services.
In 2013, Abuyabor joined one of these networks. That same year, on Nov. 8, Typhoon Haiyan made landfall
in the Philippines. It was one of the most powerful storms on record and Abuyabor had just delivered a baby
in her clinic.
Storm surges battered the building while seawater washed away equipment, medical supplies and records.
Abuyabor took her staff, the new mother and the baby to the roof for safety. When the water subsided, she
salvaged supplies to care for survivors. She resumed services in just weeks and even delivered babies. Over
time, she fully restored her clinic.
“I never lost hope,” says Abuyabor smiling.
Today, she provides antenatal care to about 400 women and delivers around 25 babies per month. She
counsels parents seeking options for family planning, and gives them the method best suited to their needs.
The network convenes regularly to improve members’ skills and collaboration. Abuyabor is a mentor now
and hosts workshops. “This network has enhanced my skills and knowledge,” she says. “We mentor one
another, which helps us give the right information and services to our clients.”
USAID has trained and provided technical
support on maternal care and family
planning to more than 11,000 community
health workers nationwide. By educating
parents and providing quality services,
these health workers have contributed to
the Philippine Government’s achievement
in 2015 of assisting more than 77 percent
of deliveries with a skilled birth attendant.
And in 2016 alone, almost 90 percent of
service delivery sites supported by the U.S.
Government also provided family planning
services.
These measures allow more Filipinos to
access quality health care and raise healthy,
stable families.