Wednesday, October 3, 2018

‘Pause and Reflect’ Approach Helps Accelerate Progress in Family Planning

Partners from regional, provincial, municipal health offices and regional, district and city hospitals discuss ways to expand access to family planning services during a series of Pause and Reflect workshops organized by USAID’s LuzonHealth Project. (Photos: RTI International)
In January 2017, the Philippine Government mandated implementation of strategies intended to accelerate the uptake of family planning services. National and regional health offices were tasked to expand access to quality family planning services to individuals and couples who want to space or limit births but are not currently using contraception. Despite this mandate, regional program managers noted slow and uneven progress.

USAID, through the LuzonHealth Project implemented by RTI International, saw this as an opportunity to introduce a new approach to its Project sites. The collaborating, learning and adapting (CLA) approach fosters the idea of sharing of knowledge about what works and promotes learning and agility to make adjustments as needed. It promotes use of performance monitoring to pause and reflect on implementation. It fosters iterative course corrections and improvements throughout the lifespan of a project.

Through a series of Pause and Reflect workshops, USAID assisted its project partners to better understand the issues involved in expanding access to family planning services. The workshops allowed partners to learn from each other’s good practices in generating demand and providing services, and re-examining the responsiveness of their strategies using facility-level data. These pause and reflect sessions created a sense of urgency that prompted participants to implement focused actions.

Six months later, some provinces have demonstrated improved family planning performance. For instance, in Batangas Province, the average monthly new family planning acceptors for the first six months of 2018 increased by 43 percent compared to the same period in 2017. Cavite Province, on the other hand, posted a 13 percent increase. The local government units believe that as they continue to collaborate, adapt and learn from each other, family planning indicators will continue to improve. The regional health office in Central Luzon has replicated this approach for its family planning program implementation review in non-USAID-assisted provinces.

Dr. Ruth Punzalan, Municipal Health Officer of Tanza, expressed her appreciation of the CLA process, which has been used in two program implementation reviews in her province. “The CLA is very helpful to health center service providers particularly in making sure that our programs move in the right direction. We have been able to adopt new strategies and innovations to improve family planning and maternal health services in our municipality.”

Wednesday, August 22, 2018

USAID Continues to Guide City to Improve its Health Services

Ms. Ann Marie Yastischock, USAID Deputy Assistant Administrator for Asia visits a birthing clinic and teen health center in Quezon City.  She is joined by USAID/Philippines Mission Director Lawrence Hardy II, Deputy Mission Director Patrick Wesner, and USAID/Washington Desk Officer for Asia, Melissa Kennison (Photos: RTI International)

One of the most populated cities in the National Capital Region, Quezon City has shown remarkable improvements in maternal and child health - reducing maternal deaths from 69 in 2013 to 37 in 2018, and seeing declines in newborn deaths from 1,187 to 692 during the same period.

In recognition of Quezon City’s health accomplishments and to learn more about the USAID-supported family planning and maternal and child health initiatives, USAID officials led by Deputy Assistant Administrator for Asia, Ann Marie Yastishock, and USAID/Philippines Mission Director, Lawrence Hardy II, recently visited one of the city’s health facilities.

The successes today were not present five years ago. In 2013, key challenges facing Quezon City included missed opportunities to provide family planning services among postpartum women, limited number of certified family planning health providers, and inadequate health resources, all contributing to high maternal and neonatal deaths.

In partnership with the local and national government, USAID, through the LuzonHealth project implemented by RTI International, responded to these challenges by training health providers, accrediting health facilities by the Philippine Health Insurance Corporation (PhilHealth), strengthening the health referral system, and advocating for increased local budgets for health.

USAID trained health providers in birthing clinics to improve their skills in basic family planning, postpartum intrauterine contraceptive device (PPIUD) insertion, and basic emergency obstetric and newborn care. Where previously there were missed opportunities for postpartum family planning, a broad range of contraceptive methods are now readily accessible for postpartum mothers, contributing to an estimated 40 percent increase in family planning users in Quezon City from 2013 to 2017.

To date, the city has 48 certified PPIUD providers, all of the eight public birthing facilities in the city have been accredited by the government, and 44 private facilities have received the Quezon City Seal of Excellence for quality standards in maternal, neonatal and child health services. The certified providers and accredited facilities have helped the city to generate about $26,000 in reimbursements from PhilHealth for its family planning program.

USAID also helped to strengthen the family planning and maternal and child health service delivery network of one of the city’s districts that now has a well-functioning referral system from the primary to tertiary level facilities. Dr. Esperanza Arias, head of Quezon City’s Family Planning Division shared, “With a functional service delivery network, some of the barangays (villages) are now using their ambulances to transport clients for referral.” The city now plans to replicate the service delivery network structure in the other districts to ensure sustained improvements in maternal and child health in the entire city.

“We were hoping to convince the local government units to allocate budget for health program implementation,” Arias added. Because of its improved performance, the city’s budget for the family planning program increased by 50 percent from $280,000 in 2013 to $420,000 in 2017.

Tuesday, June 19, 2018

Supportive Supervision Boosts Competence of Health Workers

Harlene Villanueva (right) counsels a mother on family planning while being observed by Adelaida Quizon, a midwife from Lipa City District Hospital and member of the Provincial Supportive Supervisory Team

Harlene receives feedback from Adelaida on how to improve conduct of family planning counseling. 
(Photos by JBonifacio/RTI International)

Harlene Villanueva is a midwife at Cuenca Rural Health Unit in Batangas, south of Manila. Since undergoing the Department of Health’s Family Planning Competency Based Training Basic Course, she has been counseling men and women who desire to either limit or space childbearing. “There were times, however, when clients would ask questions that I could not answer right away…I usually just refer them to either our doctor or nurse who can better address their concerns,” Harlene shared.

These were the sentiments expressed by Harlene when the Provincial Supportive Supervisory Team of Batangas initially visited her and her fellow midwives to coach them on how to improve family planning service provision. With the coaching and mentoring, Harlene received technical updates on family planning from the visiting supervisors and her knowledge on family planning was reinforced.

Coaching and mentoring are integral parts of further developing the skills of health service providers after they undergo training. The Province of Batangas, with support from USAID's LuzonHealth Project implemented by RTI International, organized a Provincial Supportive Supervisory Team for Family Planning composed of selected program managers and service providers trained in supportive supervision. The team is tasked to conduct supportive supervisory visits every other month that include coaching and mentoring of health service providers assigned in barangay (village) health stations, rural health units, and district hospitals.

Recently, supportive supervision has also been linked to the conduct of diagnostic workshops which are now being used as an alternative process for the certification of health service providers. Through diagnostic workshops, the skills of trained health service providers in various areas of family planning service provision are assessed. Those found competent are endorsed for proficiency certification, while those who need further improvement in certain areas are scheduled for succeeding supportive supervisory visits. By doing this, service providers are assisted in improving their skills and building their confidence further as they provide quality service until they are ready for certification.

Since April 2018, the Batangas Provincial Supportive Supervisory Team has conducted supportive supervisory visits to 20 family planning-trained health service providers who have undergone the diagnostic workshop. To date, nearly 900 health service providers in USAID-assisted areas in Luzon, including Batangas, have been trained in supportive supervision. In Batangas, the sustained practice of supportive supervision is expected to further improve the quality of family planning services being provided by its 335 family planning-trained providers to benefit some 99,000 women with unmet need for family planning.

Friday, June 1, 2018

USAID Helps Sustain Family Planning Services in Times of Disaster

Using the Rapid Assessment Checklist, the Provincial Family Planning Program Coordinator of Albay (left), interviews a nurse assigned at an evacuation center. (Photo by VEstevez/RTI International) 
Mayon Volcano’s eruption in January 2018 displaced over 17,000 families (66,500 individuals) from three cities and six municipalities of Albay province, south of Manila. The Mayon Volcano — which rises some 8,077 feet (2,462 meters) above the Albay Gulf — is the Philippines most active volcano. By the end of March 2018, the disaster alert level was lowered and families were allowed to get back to their homes from 58 evacuation centers. 

In February 2018, USAID and RTI International’s LuzonHealth project, in collaboration with local health offices and local government units in Albay, tested its newly-developed Family Planning Rapid Assessment checklist to help ensure continuity of family planning services to these displaced families. Using the checklist, Albay provincial and municipal health offices staff conducted an inventory of current family planning users among women in the evacuation centers. Women with unmet need for family planning were also identified. Family planning supplies were then sent to the evacuation centers and health providers were mobilized to provide family planning counseling to potential clients and to dispense commodities to current users. 

Through this initiative, nearly 2,000 women of reproductive age were identified, 40 percent of whom were family planning current users. About 85 percent of these current users were provided with family planning supplies. Nearly 800 potential new users of family planning also received counseling services at the evacuation centers.

“This is the first time that we have used this type of tool,” said Olga Belen, Albay Provincial Family Planning Coordinator. “We are familiar with rapid assessments and disease surveillance but this checklist helps us to assess the capacity of the local government unit to ensure continuity of family planning service delivery. It also helps us to maintain quality recording and reporting of family planning services provided to displaced populations,” Olga shared.

The development and use of the Family Planning Rapid Assessment checklist is part of LuzonHealth’s climate risk management plan. Climate risk management is a USAID policy that involves assessing, addressing and adaptively managing climate risks to ensure resilience of development efforts amidst changing climatic conditions, such as community displacement. The checklist is being further tested based on its application in Albay before it is adopted and used in other disaster-prone areas.

Monday, April 30, 2018

USAID-Assisted Areas Bag Purple Ribbon Awards

Bayugan City, Agusan del Sur's Health Office Public Health Nurse Helen Saligan (2nd from left) accepts from regional and provincial health officials the Purple Ribbon Award conferred to the city that scored 100 percent based on the award criteria. (Photo by Gina Canonoy) 

Representatives from the six USAID-assisted Metro Manila cities pose for posterity after receiving their Purple Ribbon Award from the Department of Health. (Photos by RTI International) 
Eleven USAID-assisted cities and municipalities in Metro Manila and Mindanao received Purple Ribbon Awards from the regional offices of the Department of Health for exemplary accomplishments in family planning and reproductive health, paving the way for more women to access quality health service.

The Department of Health launched the Purple Ribbon Award in 2016 to recognize local government units and civil society organizations with exemplary accomplishments, practices and innovations in the implementation of the Reproductive Health and Family Planning Program. The Award aims to encourage institutions to bolster efforts to help couples achieve healthy timing and spacing of births and reduce maternal deaths.

“The Purple Ribbon Award serves as an inspiration to keep our commitment alive in providing quality services to all our clients,” said Dr. Bernadette Bordador, Family Planning Coordinator of Valenzuela City Health Department. Valenzuela City won the award along with other USAID-assisted cities -- Quezon City, Caloocan City, Malabon City, Pasig City, and Marikina City. The six bested 11 other local government units in Metro Manila.

In Mindanao, five USAID-supported areas were conferred with the Purple Ribbon Award. These were Bayugan City and Veruela Municipality in Agusan del Sur province, as well as Tagoloan, Villanueva and Lugait municipalities in Misamis Oriental. They won from among 12 nominees. Department of Health Northern Mindanao Family Planning Coordinator Fe Sumagpao shared, “These local government units showed excellent performance in delivering family planning and reproductive health services, most notably in the conduct of health outreach activities reaching clients, including those in far-flung communities.”

With USAID assistance, the award-winning cities and municipalities either established or strengthened their respective service delivery networks to ensure that clients receive services through a functional referral system. They identified clients with unmet need for family planning and tracked family planning commodity supply to prevent stock-outs. Their health facilities secured accreditation from the Philippine Health Insurance Corporation for their maternity and newborn care packages, enabling them to claim for reimbursements used in further improving their services. They increased demand for and improved supply of family planning services while observing the principles of informed choice and voluntarism in family planning.