women's’ health and safe motherhood project 2 results of whsmp ii survey heritage hotel june...

Women's’ Health and Safe Motherhood Project 2

RESULTS OF WHSMP II SURVEY

HERITAGE HOTEL

JUNE 26,2009

1. To assess adequacy and appropriateness of services related to Maternal Care and Family Planning

2. To assess adequacy and appropriateness of services related to Sexually Transmitted Illnesses

3. To gather information and insight into the medical and allied staff’s knowledge and appreciation of the policies, procedures and implementation of services

4. To generate information on the perception, knowledge and practices of the users of services

5. To determine the presence and effectiveness of the logistic management system

6. To determine the presence, adequacy and functionality of equipments and instruments as prescribed in the Sentrong Sigla Standards

Survey 1. Completion of the Household Based Survey

(undertaken by SWS, 2004) Analysis of Data

Survey 2. Facility Based Survey (FBS), 2007 Conduct of Survey

• Maternal Care (MC) and Family Planning (FP) Clients• Social Hygiene Clients (SHC)• Health Care Provider (HCP)• Inventory of Health Facility (IHF)

Analysis of Data

Integration of Results

Pilot Sites: Sorsogon and Surigao del Sur

Comparison Site: Western Samar

Facility Based Survey All Government Hospitals, Urban/Rural

Health Units and Social Hygiene Clinics Sampled Barangays Sampled Clients and Health Care Providers

Survey Sorsogon

Surigao del Sur

Western

Samar

Total

Household Based Survey

1,200 1,200 1,200 3,600

Facility Based Survey

MCFP Clients 400 300 350 1,050

SHC Clients 20 28 7 55

Health Care Providers

Doctors 14 24 7 45

Nurses 42 41 36 119

Midwives 44 56 53 153

Health Facility 38 45 42 125

HBS 2004 HBS – Household Based Survey

MCFP 2007MCFP – Facility Based Survey, Maternal Care and Family Clients

HCP 2007HCP – Facility Based Survey Health Care Provider

IHF 2007IHF – Facility Based Survey Inventory of Health Facility

(sample)

Pilot Sites: S Sorsogon SdS Surigao del

Sur Comparison Site: WS Western

Samar

HBS 2004 Maternal Care

MCFP 2007Maternal Care ServicesProfile of Respondents• Prenatal Care 45%S, 46%SdS, 62%WS• FP-Cont. User 25%S, 36%SdS, 27%WS• Childbirth, Postpartum Care, FP-new user, 10% or less

HCP 2007Maternal CareMost Common Services• Temporary FP 80%S, 72%SdS, 87%WS• Postpartum Care 80%S,70%SdS, 83%WS• Normal Birth 73%S, 63%SdS, 92%WS• Uncom. Birth 57%S, 55%SdS, 74%WSNot Commonly Given • Caesarian Section 12%-14%• HIV/AIDS: Lab, 18%S, 11%SdS, 9%WS• Blood Transfusion 16%-24%

IHF 2007Maternal CareExamination Rooms for Maternal Care • 96% S, 89% SdS, 89% WS• Average of 1 examination room

Maternal Care services provided by facilities focus more on Postpartum counseling, Postpartum care and Prenatal care

Less than a third were aware of the PhilHealth benefit package for maternal care except for SdS respondents in 2007 survey

Although respondents and results cannot be compared statistically, it appears that Facility Based respondents were more aware of a birth plan and its components.

HCP in the 2007 survey had inadequate knowledge of the components of a birth plan. Fewer respondents in Sorsogon could mention the components of a birth plan compared to the other provinces.

HBS 2004 Prenatal CareHCP Consulted• 84% S, 92% SdS, 67% WS consulted a health professional• Midwife 65% S, 81% SdS, 47% WS • Doctor 16% S, 10% SdS, 18% WS• Hilot 11% S, 5% SdS, 27% WS Practice• Started prenatal care at 3-4 months• Had 4-5 prenatal visits• Had their last prenatal in the 9th month.

MCFP 2007Prenatal CareHCP Consulted• 91% S, 85% SdS, 83% WS consulted a health professional• Midwife 84% S, 92% SdS, 74% WS• Doctor 26% S, 25% SdS, 21% WS • Hilot 7% S, 13% SdS, 7% WSPractice • Started prenatal care at 3-4 months• Had 3-4 prenatal visits• Had their last prenatal in the 7th month.

HCP 2007Prenatal CarePractice• 92% S, 97% SdS, 90% WS ask about the number of prenatal visits during the last pregnancy • 97% S, 97% SdS, 94% WS discuss the past pregnancy history.

IHF 2007

In 2004 and 2007, majority of respondents consulted a health professional for prenatal care. More household based respondents in WS consulted a TBA or did not consult anyone

Most common prenatal care services include weighing

and measuring BP. Although majority of HCP in Sorsogon and Surigao del Sur were familiar with routine urinalysis and blood examination, they were not commonly performed.

HBS 2004 Prenatal CareDanger Signs• 52% S, 39% SdS, 39% WS received information about danger signs• 40% S, 50% SdS, 65% WS could not recall any sign

Place to consult in the presence of danger sign• Gov’t Facility 82% S, 89% SdS, 78% WS

MCFP 2007Prenatal CareDanger Signs• 55% S, 69% SdS, 33% WS were informed of danger signs• 62%S, 27%SdS, 44%WS could not recall any danger sign• Most Common Symptom Known - Vaginal Bleeding 38%S,73%SdS,66%WSPlace to go in presence of danger sign: • Gov’t Facility 95% S, 94% SdS, 91% WS

HCP 2007Prenatal CareKnowledge on Preventing Complications• Advise on Danger Signs 50%S, 66%SdS, 52%WS • Not Common – Provision of Anti-TB and Anti-Malaria DrugsDanger Signs: Most mentioned• Vaginal Bleeding 84%S,87%SdS,84%WS • Hypertension 80%S, 90%SdS, 70%WS• Edema 67%S, 87%SdS, 63%WS

IHF 2007

Around the same proportion of 2004 respondents could not recall any of the danger signs of pregnancy compared to 2007 respondents who could recall at least a danger sign of pregnancy.

Knowledge on danger signs across the provinces was incomplete since less than half knew about danger signs other than vaginal bleeding.

Sorsogon HCP respondents generally fared less than the respondents in the other two provinces regarding danger signs.

Around a half of HCP advice clients on danger signs of pregnancy.

Government facilities, including Rural Health Units, were the choice for consultation in the event of an occurrence of danger signs of pregnancy.

HBS 2004DeliveryHCP Assistance• TBA/Hilot 50% S, 61% SdS, 45% WS • Midwife 30% S, 22% SdS, 35% WS • Doctor 18% S, 15% SdS, 15% WS

Caesarian Delivery• Last 5% S, 2% SdS, 2% WS • Prior to Last 2% S, 3% SdS, 2% WS

MCFP 2007DeliveryHCP Assistance• TBA/Hilot 18% S, 43% SdS, 36% WS • Midwife 33% S, 23% SdS, 29% WS • Doctor 18% S, 15% SdS, 11% WS • Nurse 18% S, 9% SdS, 11% WS Caesarian Delivery• Last 4% S, 2% SdS, 5% WS • Prior to Last 2% S, 2% SdS, 6% WS

HCP 2007Knowledge on Signs of Labor• Not yet in labor 54%S, 67%SdS, 49%WS • Early labor 43%S, 60%SdS, 42%WS• Late labor 20%S, 47%SdS, 32% WS• Imminent Delivery 41%S, 66%SdS, 41% WS

IHF 2007Delivery•74% S, 41% SdS, 71% WS provide Delivery/Childbirth Services

Majority of HBS deliveries across the three provinces was attended to by traditional birth attendants. Less than 50% of facility-based respondents had births attended to by a TBA.

Majority of Health Professionals attending to deliveries were Midwives, 23%-35%. There is variation among the provinces on who assisted in the delivery.

More HCPs in Surigao del Sur were able to identify the different signs of labor

Very few underwent Caesarean section in the three provinces.

Majority delivered at home. There was a decreasing trend for home deliveries comparing next-to-last to last deliveries in both 2004 and 2007 surveys.

There was minimal knowledge on tasks performed in uncomplicated birth, basic and comprehensive emergency obstetric care

Blood transfusion and caesarian section service is available in a minority of facilities. This is critical since post-partum hemorrhage is a leading cause of maternal mortality. The same may hold true for the availability of Caesarean section, although the more appropriate site for this service may be the district hospital.

The availability of blood transfusion and caesarean section may be influenced by the availability of personnel, equipment, and infrastructure.

Majority of clients received free prenatal services, >50%.

Majority paid for the delivery from out-of-pocket in both the 2004 and the 2007 survey, >90% .

Less than 20% of facilities in the three provinces charged user fees for their services except for delivery services.

Prices of services were considered reasonable.

Only a third to a quarter in Sorsogon and Surigao del Sur had post-natal check-up after their delivery. More respondents in Western Samar did not go for check-up.

There were differences among the three provinces regarding who attended to the post natal check up.

There were also differences among the three provinces where check-up was performed. Respondents had their check up at home, a health center, or a government hospital in various combinations depending on the province.

Postnatal care focused on aspects of the baby’s health rather than on breast examination, internal examination, and family planning for the mother.

SdS respondents were more well versed regarding post-natal services including newborn care.

There were more HBS respondents who breastfed their children than FBS clients interviewed.

The more common danger signs known to HCP were vaginal bleeding, elevated BP and fever. Other danger signs not commonly known.

A majority of respondents in both surveys said that at the time of the interview they wanted the pregnancy except for Sorsogon HBS respondents. Around a quarter to a third wanted their pregnancies at a later time or not at all.

Statistical tests indicate that age has a significant correlation with desire to be pregnant considering the effect of province of residence of the respondent. The older the woman is, the more she would not want to be pregnant .

Provision of temporary FP methods and FP counseling and IEC were more common than those for permanent methods.

Tasks on cancer screening services, provision of BTL and NSV were not commonly known.

In 2004, less than 50% of those who did not want a child practiced family planning.

In 2007, there were more respondents who did not want a child and used contraceptive methods, >55%.

A larger majority in SdS were able to mention “asking about desired family size”, preferred FP methods, desire to limit or space pregnancy, physical contraindications and obstetric history,

Surigao del Sur HCP were more aware on what to ask clients who want to practice FP, on physical contraindications and obstetric history.

The most commonly used and known method was the pill.

Other forms of family planning methods, aside from pills (e.g. diaphragm, implant, condoms, mucus/billings/ovulation, basal body temperature, etc.) were known to less than 2% of respondents.

Use of Modern FP methods is least known to HCP in Sorsogon.

The manner of use of implants and spermicides are the least known to respondents.

Use of Modern Natural FP methods are less known in fewer facilities compared to artificial methods.

Very few respondents had an HIV/AIDS test during their prenatal visit,<3%

Surigao del Sur HCP respondents were more aware of the components of STI services than those from Sorsogon and Western Samar. There is some variability among provinces regarding knowledge of components of STI services.

Majority knew about sex as a mode of HIV/AIDS transmission, >75%, but very few knew about other modes of transmission.

Less than half of facilities gave condoms.

According to clients, less than 50% of HCP talked about STI risks. Of note is that the source of information for STI risk behaviors was not the HCP for 50% and less respondents.

The most commonly known of HIV transmission was through sex with an infected partner while the modes of prevention were not commonly known.

MCFP respondents were slightly more aware of sexual contact as a mode of transmission but there was variability among the provinces regarding knowledge of symptoms in women and symptoms in men.

When HCP have clients with vaginal discharge, they commonly order laboratory test and conduct a physical examination. Not commonly done is taking STD and treatment history and assessing the signs and symptoms

HBS 2004

TBA/Hilot 50% S, 61% SdS, 45% WS

Midwife 30% S, 22% SdS, 35% WS

Doctor 18% S, 15% SdS, 15% WS

Around 48% S, 37% SdS, 50% WS were delivered by skilled attendants

Majority were assisted by hilots/traditional birth attendants.

MCFP 2007

TBA/Hilot 18% S, 43% SdS, 36% WS

Midwife 33% S, 23% SdS, 29% WS

Doctor 18% S, 15% SdS, 11% WS

Nurse 18% S, 9% SdS, 11% WS

Around 69% S, 47% SdS, 51% WS were delivered by skilled attendants

Sorsogon had the least percentage of births attended to by a hilot and the highest percentage of births attended to by midwives.

HBS 2004

Last Home 72% S, 82% SdS, 75%WS Gov’t Hos. 22% S, 14% SdS, 13% WS Other Public 1% S, 2% SdS, 2% WS Private 5% S, 2% SdS, 10%WS Prior to Last Home 74% S, 86%SdS, 84% WS Gov’t Hos. 20% S, 9% SdS, 10% WS Other Public 1% S, 3% SdS, 1% WS Private 5% S, 2% SdS, 5% WS

Majority gave birth at home 28% S, 18% SdS, 25% W S gave

birth in a health facility

MCFP 2006

Last Home 47% S, 75% SdS, 71% WS Gov’t Hos. 38% S, 19% SdS, 22% WS Other Public 12% S, 3% SdS, 3% WS Private 2% S, 3% SdS, 3%

WS Prior to Last Home 60% S, 83% SdS, 70%WS Gov’t Hos. 33% S, 13% SdS, 20% WS Other Public 6% S, 3% SdS, 2% WS Private 6% S, 2% SdS, 7% WS

Majority gave birth at home 42% S, 25% SdS, 28% WS gave birth

in a health facility

HBS 2004 Less than 1% of deliveries

by the poor financed through DOH-LGU Performance grant.

Less than 2% of the respondents in all the provinces had their last births paid for by PhilHealth and the government.

96% S, 94% SdS, 94% WS were paid for from out of pocket of the mother or her family.

These were similar data for next-to-last births.

MCFP 2007 Only 1% of respondents in

WS and in SdS claimed that the government paid for the delivery.

Less than 7% said that PhilHealth paid for the delivery.

94% S, 96% SdS, 90% WS had their last births paid on their own or by their families.

HBS 2004 For those who used Family

Planning methods, the most common method used across all provinces is the pill: 53% for S, 37% for SdS, 44% for WS.

The next preferred methods vary. 18% respondents from SdS used IUD and Calendar/Rhythm/ Periodic Abstinence and 30% from WS used Withdrawal.

However for all other methods, usage was less than 15%.

MCFP 2007 Some 32% in S and 42% in

SdS, 57% in WS, used the pill;

21% in WS, 15% in S and SdS used injectables.

Very few used the other family planning methods.

HBS 2004

11% S, 35% SdS, 29% WS

HCP prepared birth plan

Base – those aware of a birth plan

MCFP 2007

50% S, 71% SdS, 88% WS


Base– those aware of a birth plan

27% S, 73% SdS, 76% WS


Base– pregnant respondents

HBS 2004

Less than 2% of respondents from all provinces had HIV-AIDS test.

MCFP 2007

Less than 3% of respondents from all provinces had HIV-AIDS test.

HBS 2004

Abstinence 64% S, 53% SdS, 51% WS

Monogamy 26% S, 26% SdS, 17% WS

Condom 13% S, 23% SdS, 17% WS

MCFP 2007

Abstinence 36% S, 45% SdS, 65% WS

Monogamy 57% S, 69% SdS, 51% WS

Condom 39% S, 52% SdS, 43% WS

HBS 2004

4% in S, 6% in SdS and 6% in WS

had ligation

Less than 2% had vasectomy.

MCFP 2007

5% in S, 8% in SdS and 6% in WS

had ligation.

IHF 2007

Pills 57% in WS, 52% in S and 64% in SdS

Injectables 57% in WS, 26% in S, 62% in SdS

IUD 51% in WS, 22% in S and 61% in SdS

DOH to develop a communication strategy to promote among clients:Knowledge about maternal care specifically on birth

plan,Awareness about STI (including HIV/AIDS) signs,

modes of transmission and prevention, Knowledge about PhilHealth package of services

particularly on deliveries;

DOH to encourage the health facilities to provide all types of services (MC, FP, SH) any day of the week;

DOH to institutionalize regular trainings of HCPs on: Prenatal services, including birth planning, danger signs of

pregnancy, Recognition of the different stages of labor, Family planning services especially those less popularly

known, STI, including HIV/AIDS evaluation, screening, treatment, and

other related services, safe handling of sharps and other activities related to

HIV/AIDs;

DOH to offer training on supply management and logistics;for nurses or other personnel who are responsible

Local health facilities should have capability to provide services like: Caesarean section, Blood supply, Complicated deliveries, Other gynecological conditions;

PhilHealth to take a more aggressive stance to inform public re support for: Birth expenses, Family planning expenses, Other MCFP packages.

Patient records should be complete and updated for easy retrieval of data, accurate and fast reporting and policy development.


THANK YOU

women's’ health and safe motherhood project 2 results of whsmp ii survey heritage hotel june...

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