Report - Social Watch Philippines

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However, USAID, with the concurrence of the Philippine government, decided to withdraw and gradually phase-out donations of FP commodities. The phasing-down of donated contraceptives started in 2004 and completed in 2008. In 2004, the supplies of condoms gradually tapered down until they eventually ran out, pill donations completely phased-out in 2007, and injectables, in 2008. In 2004, POPCOM projected the phasing-out will affect an estimated 4.6 million women of reproductive age who use modern methods of contraception. It will also affect another 2.3 million women who are currently not using modern methods but reported their intent to use. Further, some 18.8 million young Filipinos (15 to 27 years of age) who have had a premarital sex experience are likewise going to be affected by the phase-down. Contraceptive Self-Reliance Strategy, AO No.158, s. 2004. In response to the decision of donors to phase out donated contraceptives, the Department of Health issued AO No.158, S.2004, Guidelines on the Management of Donated Commodities under the Contraceptive Self-Reliance Strategy (the second policy implemented during the previous Arroyo administration implicated for the slow progress in contraceptive prevalence rate). CSR is an attempt on the part of government to put in place a set of measures that would ensure continued use and increase of contraception and other FP methods to eventually eliminate unmet need. In addition, the CSR strategy aims to reduce public sector dependency and increase local government units and private sector participation. In turn, this would enable the government to focus on public family planning services and supplies for the poor, and move those who can afford it to the private sector. The Contraceptive Self-Reliance Program (DOH AO 158 2004) states that the Government shall act as guarantor of last resort assuring that contraceptives remain available for current users who depend on donated supply. After 6 years, principally, the government failed to fi ll in the gap caused by the withdrawal of USAID supplies. It refused to spend for modern contraceptives. The government, in the face of opposition from the Catholic Church, has taken the position that it would not use its funds to purchase contraception. Worse, it even impounded the Php 2 billion budget allocation for family planning in the 2008 General Appropriations Act. By default, the government’s position goes against the spirit and intent of RH approach. 102 SOCIAL WATCH PHILIPPINES Managing the complications of abortion in health facilities is a medico-legal case. As abortion is illegal in the <strong>Philippines</strong>, the Post Management of Abortion Complication (PMAC) policy is the next best effort that the DOH could do. Implementation of this policy, however, faces severe challenges. In the fi rst place, post-abortion cases are considered “medico-legal” and obligate the attending health staff to report these to the police or the designated authorities. Thus, there is a tendency for health staff to refuse to manage these women in need. If, on the other hand, health staff takes on these cases, they deliberately miss-classify them as either medical or surgical cases or consciously make omissions that suggest induced abortions. Once again, they obviate the need to fi le forms with the police. Data on post-abortion cases are therefore diffi cult to fi nd in health facilities. Reproductive Health Bill There is a lack of a clearly pro-poor reproductive health policy. While the national policy on the reproductive health (RH Bill) has been languishing in legislative debates for two decades now, to date there are 51 local ordinances, including 4 provincial laws (Aurora, Sulu, Ifugao, Mountain Province) in support of reproductive health service provision and LGUs have been taking advantage of performance grants in part for providing family planning services. However, performance is patchy in a policy environment which varies arbitrarily from LGU to LGU and supply is subject to political and other whims. Responsibility relegated to the LGU The responsibility of crafting, funding and implementing basic services including reproductive and family planning programs has been relegated to the LGUs. Thus, we are witness to uneven reproductive and family planning policies and programs across LGUs. Emergency obstetric care services are either not functioning properly or non-existent in most poor areas. Note that these areas are the greatest contributor to maternal mortality. The DOH supported the provision of FP services and contraceptives of LGUs, and has worked with LGUs on how to operationalize the Contraceptive Self Reliance guidelines. Budget has been allocated since 2007 for capacitating LGUs on their reproductive health services including the provision of family planning.
Although the delivery of public health services is largely devolved to LGUs in accordance to the provision of the Local Government Code, however, the good nature of public health services suggests that the central government cannot fully abdicate its role in this subsector despite devolution. PhilHealth Support PhilHealth has approved the inclusion of Maternity Health Package as an outpatient service in 2001, after years of covering only inpatient care. However, it has not included in its package of benefi ts oral contraceptives and injectables. Oral contraceptives and injectibles listed in the Philippine National Drug formulary, however, are compensable when prescribed but only during hospital confi nement. To respond to this problem, LGUs may use capitation funds to procure oral contraceptives for the use of their enrolled indigent member. Family planning contraceptives have never been included as essential drugs. According to a study by the Philippine Population Management Program, 46 percent of family planning expenditures are still outof-pocket. Conclusions and Recommendations “Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving” (Dr Mahmoud Fathalla) Despite the fact that technical solutions to most of the problems associated with mortality and morbidity in pregnancy and childbirth are wellknown, 4,700 women still die due to complications developed during pregnancy and childbirth every year. With the Safe Motherhood initiative of 2005 and the MNCHN which was launched in 2008, the Philippine government shows progress in attaining MDG 5 through programs and policies, but field data proves otherwise. Health outcomes (total fertility rate, CPR, and unmet need) have not significantly improved. Adolescent births and unsafe abortions have not diminished. Since most obstetric complications cannot be predicted or prevented, except those that result from unsafe induced abortions, all pregnant women are at risk of acquiring a life-threatening complication and they must have access – at any time, day or night – to health facilities that provide life-saving emergency obstetric care. Access to this package of critical services is sorely lacking, especially for poor women. Women continue to die from the complications of unsafe abortion. Given that contraceptive commodities are unavailable and unaffordable, unwanted pregnancies remain to be a problem in this country where abortion is illegal and where services that terminate a pregnancy are non-existent. Thus, women resort to illicit abortions and run the risk of acquiring life-threatening complications. Until such time that contraceptive commodities and FP services will be made much more available and accessible than they are now; and until such time that women are provided quality-post abortion care, this country will not lower its maternal mortality ratios. Over all government spending on health still remains low. The signifi cant increase in attention to RH and maternal death issues in terms of greater awareness, better internal cohesion, and high-level engagement underscores the need to ensure that investments must be made. And investments must be directed towards solutions that are technically seen as essential to reducing maternal mortality. At the minimum, this would include improved access to quality family planning services, skilled birth attendance, emergency obstetric care, and postnatal care for mothers and newborns But central to making these services accessible is addressing inequities in a functioning health system. Dr Alberto Romualdez and Dr Ernesto Domingo who drew up recommendations to reform the health system towards Universal Health Care state: “This means that every Filipino should have access to high quality healthcare that is effi cient, accessible, equitably distributed, adequately funded, fairly fi nanced, and directed in conjunction with an informed and empowered public. The overarching philosophy is that access to services is based on needs and not based on the capability to pay.” “There should be one standard care for all, regardless of their capacity to pay. Every citizen is all entitled to quality health services and packages that are available. Equity refers to both horizontal and vertical equity. For those with equal health needs, they have equal access to the health care of the same quality. Similarly, there should also be equal access to health care across the different social and economic classes.” Beyond these, what is needed is the sustained commitment and strong political will of the government to ensure that strong systems and services are in place. Winning the Numbers, Losing the War: The Other MDG <strong>Report</strong> 2010 103
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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
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Table 9: Partial Listing of Big Lan
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and promote gender equality in all
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While many see this as an education
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seen in both public and private pre
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and therefore, limited coverage. Th
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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 106 and 107: Progress of work in improving mater
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 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
Page 157 and 158: eing proposed in Congress. But more
Page 159: Results - Developing countries and
Page 162 and 163: Mindanao situation Mindanao is the
Page 164 and 165: Table 1.Cohort Survival Rate by Reg
Page 166 and 167: 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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