NATIONAL SAFE MOTHERHOOD PROGRAM

THE PHILIPPINES has committed to the Unites States millennium declaration that translated into a roadmap a set of goals that targets reduction of poverty, hunger, and ill health. In the light of this government commitment, the Department of Health is faced with a challenge: to champion the cause of women and children towards achieving MDGs 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV/AIDS, malaria and other diseases). Pregnancy and childbirth are among the leading causes for death, disease and disability in women of reproductive age in developing countries. The Philippine government commitment to the MDGs is among others, a commitment to work towards the reduction of maternal mortality ratios by three-quarters and under five mortality by two-thirds by 2015 at all cost.

Confronted with the challenge of MDG 5 and the multi-faceted challenges of high maternal mortality ratio, increasing neonatal deaths particularly on the first week after birth, unmet need for reproductive health services and weak maternal care delivery system, in addition to identifying the technical interventions to address these problems, the DOH Safe Motherhood Program decided to focus on making pregnancy and childbirth safer and sought to change fundamental societal dynamics that influence decision making on matters related to pregnancy and childbirth while it tries to bring quality emergency obstetrics and newborn care facilities nearest to homes. This move ensures that those most in need of quality health care by competent doctors, nurses and midwives have easy access to such care.

Program Objectives
The program contributes to the national goal of improving women’s health by:

1. Collaborating with Local Government Units in establishing sustainable, cost-effective approach of delivering health services that ensure access of disadvantaged women to acceptable and high quality maternal and newborn health services and enable them to safely give birth in health facilities.

2. Establishing core knowledge base and support systems that facilitate the delivery of quality maternal and newborn health services with special focus in the upgrade of facilities designated to provide emergency obstetrics and newborn care within the Kalusugan Pangkalahatan framework.

Program Components
Component A: Local Delivery of the Maternal- Newborn Service Package
This Component supports LGUs in mobilizing networks of public and private providers to deliver the integrated maternal-newborn service package. In each province and city, the following are currently being undertaken.
1. Establishment of critical capacities to provide quality maternal-newborn services through the organization and operation of a network of Service of Delivery Teams consisting of:
a. Women’s/ Community Health Teams
b.BEmONC Teams
cCEmONC Teams

2.Establishment of Reliable Sustainable Support Systems for Maternal-Newborn Service Delivery through such initiatives as:
a.Essential BemONC Drugs and Supplies and Contraceptive Security
b.Establishment of Safe Blood Supply Network in collaboration with the National Voluntary Blood Program
c.Behaviour Change Interventions
d. Sustainable financing of local maternal-newborn services and commodities through locally initiated revenue generation and retention activities.
                        
Component B: National Capacity to sustain Maternal-Newborn services
1.Operational and Regulatory Guidelines
a. Manual of operation
b. Referral manual
c. Essential care practice guide for pregnancy, childbirth, postpartum and newborn care (BEmONC Protocol)
d. CEmONC curriculum and protocol for service delivery
e. Maternal death reporting and review protocol
f.Issuance of relevant policies

2.Network of Training Providers
a.Currently, 29 training centers that provide BEmONC skills training are operating in the country.

3. Monitoring, Evaluation, Research and Dissemination

II. INTERVENTIONS AND STRATEGIES EMPLOYED
The Department of Health through the National Safe Motherhood Program introduces strategies to address critical reproductive health concerns ( maternal and newborn health, adolescent health, family planning and STI prevention) while confronting both demand and supply side obstacle to access for disadvantaged women of reproductive age. Among the changes, the following have been systematically mainstreamed into the safe motherhood service delivery network:

• Strategic Change in the Design of Safe Motherhood Services
These changes involve (1) shift in emphasis from the risk approach that identifies high-risk pregnancies during the prenatal period to an approach that prepares all pregnant for the complications at childbirth- this change brought about the establishment of the BEmONC-CEmONC network, which is now part of the MNCHN service delivery network and the inter-local health zones or the Local Health Area Development Zones; (2) improved quality of FP counselling and expanded service availability, including the organization of more Itinerant Teams providing permanent methods and IUD insertion on an outreach basis and (3) the integration of STI screening into the antenatal care and Family planning protocols.

•  An Integrated Package of Women’s Health and Safe Motherhood Services
The above changes in the delivery also involved a shift from centrally controlled national programs (MC, FP, STI and AH) operating separately and governed system that delivers an integrated women’s health and safe motherhood service package. This service delivery strategy is focused on maximizing synergies among key services that influence maternal and newborn health and on ensuring a continuum of care across levels of the referral system.

• Reliable Sustainable Support Systems
Support systems for Maternal-Newborn service delivery include systems for (1) drug and contraceptive security, through a strategy of contraceptive self reliance (2) safe blood supply; (3) stakeholder behaviour change, through a combination of advocacy and communication; (4) sustainable financing, through a diversification of funding sources, principally driven by the development of client classification scheme so that the poor gets public subsidies and the non-poor are charged user fees.

•  Stronger Stewardship and Guidance from the DOH Program Managers
DOH provides stewardship and guidance through (1) evidence-based guidelines and protocols on maternal-newborn services (2) a system for accrediting providers of emergency obstetrics and newborn care (BEmONC and CEmONC) training program and (3) monitoring, evaluation and research on the maternal;-newborn strategies.

III. STATUS OF IMPLEMENTATION AND ACCOMPLISHMENTS
As of December 2012, the program accomplishment is 65%. This accomplishment is based on the accomplishments vis-a-vis the targets of the programs of 3 indicators. These are: antenatal care, facility-based delivery and post-natal care. The 2012 target for all indictors is 70%. The below target accomplishments is brought about by the low post-natal coverage of 52%. Among the operations issues that delays accomplishments of critical inputs relates to procurement and other external factors such as LGU organizational structures and priorities.

IV. PLANS FOR 2013
For the current year, the program hopes to pursue the completion of sustainable support systems to ensure the delivery of quality maternal-newborn health service package by the local health system. The following have been planned for implementation:
1.Development of Guidelines on EmONC training and amendment the policy on BEmONC training fees.
2.Development of the BemONC Module for Midwives and pursue the submission of its final version.
3.Development of a mechanism for EmONC Post Training Evaluation and supportive supervision of BEmONC Teams.
4.Collaborate with Training Centers on the conduct of BEmONC and CEmONC Skills Training.
5.Collaborate with Development Partners in the implementation of maternal-newborn initiative in selected sites.
6.Monitor and evaluate program targets accomplishments and compliance to program protocols
a.Maternal Death Reporting and Review
b.Training on Emergency Obstetrics and Newborn Care
c.BemONC provision – BEmONC provision assessment

OTHER SIGNIFICANT INFORMATION 
•The program participated in the multi-country survey on Maternal and Newborn Near-Miss Cases organized by the Reproductive Health Research Unit of WHO HQ and with the Program Manager as country coordinator. The study was published in the Lancet in its May  18, 2013 issue: Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. # Adapted News, Department of  Health (DOH)