Report - Social Watch Philippines

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Progress of work in improving maternal health care in the Philippines: policies and programs During the last decade, the Philippines put new knowledge into action to improve health care services and respond to the pressing issue of maternal mortality. These efforts were not without pitfalls and controversies but the issue remains for the government to scale up its actions to realize the MDG 5. For rapid maternal and neonatal mortality reductions, the DOH on September 2008 mandated the implementation of an integrated Maternal, Neonatal and Child Health and Nutrition Strategy (MNCHN). All pregnancies are considered at risk and thus ‘takes into consideration the three major pillars in reducing maternal mortality and morbidity, namely, emergency obstetric care, skilled birth attendants and family planning. The Philippines has taken a health system strengthening approach (HSS) to tackling MDGs 4 and 5. Maternal and child health services in the Philippines are implemented not through vertical programs, but through the existing financing and organizational mechanisms covering the Department of Health (DOH). In addition, there are ongoing innovative pilot programs such as: the pay-for-performance for barangay health workers to encourage more facility-based deliveries; the Sponsored Program, the PhilHealth Maternity Care Package, and more recently, the Conditional Cash Transfer Program (Pantawid Pamilyang Pilipino Program or the 4Ps) to address the demand-side barriers to the use of maternal and child health services. Despite the presence of many instruments to comprehensively tackle MDGs 4 and 5, somehow these instruments are not working synergistically. From a risk approach to an emergency obstetric care approach For rapid maternal mortality reduction, the DOH shifted its approach from a risk approach to an Emergency Obstetric Care (EmOC) approach. The risk approach is based on the identifi cation, within the total population of pregnant women, of those with a high risk of complications. It has been assumed that highrisk mothers can be identifi ed during prenatal visits. However, studies have shown that more than 80% of maternal deaths were due to complications for which no antenatal screening was possible: puerperal sepsis, 4 1993 and 1998 National Demographic and Health Survey (NDHS) 5 2006 Family Planning Survey 90 SOCIAL WATCH PHILIPPINES postpartum hemorrhage, and shock. These complications cannot be predicted or prevented, except those resulting from unsafe induced abortion. Several studies have also shown that the antenatal care’s screening and predictive values are poor and have no direct value in the prevention of maternal death. Therefore, all pregnant women are at risk of acquiring a life-threatening complication at any time during pregnancy, at delivery, or in the postpartum period. This is the main consideration in the emergency obstetric care approach Therefore, all pregnant women should have access – at any time, day or night – to health facilities that provide EmOC, a package of critical health services, which when provided immediately and competently can save women’s lives. About 85 percent of all maternal deaths are due to direct complications that require emergency obstetrics care. Emergency obstetric care has three essential elements: a skilled attendant at delivery; access to emergency obstetric care in case of complications; and a functioning health referral system in place to allow the unimpeded fl ow of services to any pregnant woman who needs them at any place and at any time. Field data shows another picture: While the Philippine government shows progress in reaching the targets for MDG 5 through programs and policies, fi eld data proves otherwise. Looking at the trend of maternal deaths over the years, the indicator on maternal health status is disturbing. MMR went down to 172 deaths in 1998 from a 1993 baseline fi gure of 209 deaths. 4 Though the decrease continued, it was at a sharply diminishing rate, and in 2006 had only reached 162 deaths, 5 still far from the target of 52 deaths per 100,000 live births by 2015. Because of this, the Philippines Midterm Development Goal report (2007) admitted that the country is lagging behind and is experiencing diffi culty in achieving MDG 5. The struggle for improving maternal health in the country is challenging especially when not all people benefi t. The National Commission on Indigenous Peoples (NCIP) admitted that indigenous communities are hardly reached by medical benefi ts and services. These include indigenous women living in remote and inaccessible areas that prevent them from getting suffi cient and quality health services. It is estimated
that there are 12-15 million indigenous people (approximately 15-20% of the total population) belonging to 110 ethnic communities. The majority (61%) of indigenous people live in Mindanao, while a third (33%) are in Luzon, and the remaining (6%) population are in Visayas. Maternal health Health related practices that affect maternal health are: antenatal care (ANC), including iron supplementation and tetanus toxoid vaccination; delivery care and services; and postnatal care. Antenatal care indicators include: type of provider, and number of antenatal care recipients, including whether a tetanus toxoid injection was received. Delivery services are assessed according to the person who assisted with the delivery, the place of delivery, and the number of caesarian sections. Antenatal care The DOH recommends that the fi rst ANC visit should occur in the fi rst trimester of the pregnancy for early detection of pregnancy-related health problems. Nine out of ten mothers (91%) received antenatal care from a skilled provider, in 2008. This was only a 5 percent increase over the 1998 fi gures (86%). The 2008 ANC results show that out of this percentage, 18 percent had fewer than the four recommended visits. The proportion of pregnant women who had three or more antenatal visits deteriorated from 1998 (77%) to 2003 (70%). The number increased in 2008 (77%) compared to 2003 but no higher than that recorded in 1998. Five percent of women received antenatal care from a traditional birth attendant, or hilot, while 4 percent did not have any ANC visits at all (see Table 2). Table 2. Antenatal Care 1998 2003 2008 Antenatal Care by Skilled Health Professional 86% 91% 91% At least 4 visits 77% Source: 1998, 2003, and 2008 NDHS 6 70% 77% Informed of Danger Signs 33% 50% 69% Tetanus Toxoid Injections 38% 37% 48% 6 The fi gure is based on at least 3 prenatal care visits instead of the current standard of 4. 7 World Health Organization (WHO). There are still more than forty percent of women who did not follow the recommended timing of the fi rst ANC visit. Three in ten women made their fi rst visit on the fourth or fi fth month of their pregnancy, while one in ten had their fi rst ANC visit when they were six or more months pregnant. Regional variations in antenatal care coverage occur with ARMM exhibiting the lowest coverage (49.8%), followed by Zamboanga Peninsula (77.1%). Central Luzon (92.4%) and NCR (92.1%) have the highest antenatal care coverage. All other regions’ percent coverage hovers between the 90’s and the upper 80’s. The ARMM also had the lowest number of pregnant women having prenatal check-ups with skilled health professionals at 47 percent compared to Central Visayas which at 97 percent had the highest percentage. Births attended by a skilled health professional A skilled attendant refers to “an accredited health professional, such as a midwife, doctor or nurse, who has been educated and trained to manage normal pregnancies, childbirth and the immediate postnatal period, and in the identifi cation, management and referral of complications in women and newborns 7 ”. Traditional birth attendants (TBA) – trained or not – are excluded from the category of skilled healthcare workers. In this context, the term TBA refers to traditional, independent (of the health system), nonformally trained and community-based providers of care during pregnancy, childbirth and the postnatal period. There are still a staggering proportion of births not being attended to by a skilled birth attendant: 36 percent of women were still assisted by hilots or TBAs alone. According to NDHS 2008, only 62 percent of births were assisted at delivery by health professionals: 35 percent by a doctor and 27 percent by a midwife or nurse. The proportion of births attended by a health professional has remained consistently low at 60-62 percent from 2003 to 2008. It also registered a lower rate of increase during this period – only 2 percent, compared with a 4 percent increase during 1998-2003 (56-60%) It also remains lower than the target set by the DOH (80 percent by 2004). The target for 2010 (also 80%) is unlikely to be reached based on the recorded data. Winning the Numbers, Losing the War: The Other MDG Report 2010 91
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Winning the Numbers, Losing the War
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ACKNOWLEDGEMENT Many deserve our th
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CLEEP Comprehensive Livelihood and
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MOA-AD Memorandum of Agreement on A
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ABOUT THE AUTHORS/CONTRIBUTORS Leon
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FOREWORD By ISAGANI R. SERRANO This
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An urgent MDG message: Inadequate f
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The use of the budget instrument fo
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MDG chances: stability and vulnerab
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may mean a short honeymoon period.
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what we got from Annex I countries
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(Php58.6 Billion) of GDP at current
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Fourth Assessment Report provide a
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Losing the war on poverty The Other
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Table 1. Philippines’ MDG progres
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(NER) and medium on both cohort sur
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incidence of 97.46 percent. The las
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special needs; (c) 228,928 women in
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cultural structures urgently needin
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capacity to confront the dreaded cl
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MDG Goal 1 Targets 1 and 3: On erad
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Table 1. Prevalence of undernutriti
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2007, women’s national unemployme
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in the service and production secto
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een generally positive—increased
Page 56 and 57: Table 9: Partial Listing of Big Lan
Page 58 and 59: and promote gender equality in all
Page 60 and 61: While many see this as an education
Page 62 and 63: seen in both public and private pre
Page 64 and 65: and therefore, limited coverage. Th
Page 66 and 67: Table 7. Education Expenditure as a
Page 68 and 69: Box 2. Education budget tracking (2
Page 70 and 71: This paper looks at highly vulnerab
Page 72 and 73: to education. 5 In practice, debt p
Page 74 and 75: Table 5. Distribution of Government
Page 76 and 77: Table 7. Average Daily Basic Pay by
Page 78 and 79: in the 80’s, according to Sibal,
Page 80 and 81: eports of female OFW deaths, sexual
Page 82 and 83: Table 13. Trafficked Migrants Assis
Page 84 and 85: plicating overpopulation and poor w
Page 86 and 87: CAN$318.8 billion. While they found
Page 88 and 89: . Women’s economic empowerment i.
Page 90 and 91: statistics-fs-violence-against-fi l
Page 92 and 93: New policies and programs meant to
Page 94 and 95: Table 2: Immunization Status 1998 2
Page 96 and 97: Table 4. List of Nutritionally Vuln
Page 98 and 99: percent), who gave birth at home (9
Page 100 and 101: protocol is another comprehensive s
Page 102 and 103: 5. Revamping the health insurance s
Page 104 and 105: Universalizing health care As we po
Page 108 and 109: Figure 2. Use of Skilled Birth Atte
Page 110 and 111: In terms of postnatal care, 77 perc
Page 112 and 113: Abortion Worldwide abortion rates h
Page 114 and 115: went down from 9.8 percent in 2005
Page 116 and 117: longer to health care centers in co
Page 118 and 119: However, USAID, with the concurrenc
Page 120 and 121: Box 1. Safe Motherhood: a brief his
Page 123 and 124: The rising challenge of HIV/AIDS an
Page 125 and 126: Sexual transmission remains to be t
Page 127 and 128: national response. Since health was
Page 129 and 130: Figure 7. Frequency distribution of
Page 131 and 132: Table 5. Annual estimated cost for
Page 133 and 134: tion of Public-Private Mix Departme
Page 135 and 136: Not much time, but not without opti
Page 137 and 138: Questions and more questions on the
Page 139 and 140: Figure 1: Biodiversity Hotspots Bio
Page 141 and 142: MDG’s, but more importantly, on b
Page 143 and 144: 8. Organic Agriculture Act of 2010;
Page 145 and 146: science Bureau (MGB) but funded by
Page 147 and 148: Problems and gaps Incoherent and cl
Page 149 and 150: must be able to provide for non-pro
Page 151 and 152: Trade, debt and aid: MDG retardants
Page 153 and 154: Table 1. Recent Trade and Investmen
Page 155 and 156: elated social spending; Three, ille
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eing proposed in Congress. But more
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Results - Developing countries and
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Mindanao situation Mindanao is the
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Table 1.Cohort Survival Rate by Reg
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MTPDP has not gained momentum to ef
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Seven provinces in Mindanao, almost
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a. Lobby for the crafting of laws a
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Moro situation after the Treaty of
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and Palawan movement and Mindanao I
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Appendix B Are the Moros Filipinos?
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Government with respect to the Moro
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legal and political shields behind
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Goals and Targets (from the Millenn
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