YOLANDA E. OLIVEROS, MD, MPHYOLANDA E. OLIVEROS, MD, MPHDirector IVDirector IV

National Center for Disease Prevention and Control, National Center for Disease Prevention and Control, Department of HealthDepartment of Health

33rd Annual International Conference on Global Health33rd Annual International Conference on Global HealthMay 30-June 2, 2006May 30-June 2, 2006

Supported in part by USAID under the Local Enhancement and Development (LEAD) for Health Project and Management Sciences for Health

Contraceptive Self Reliance (CSR) StrategyThe Philippine Experience

Profile

Tropical country: 7,107 islands

Population: 84M Annual Growth Rate: 2.32% (2003)

Urban = 47.6%

Rural = 52.4%

Total Fertility Rate: 3.5 children/woman

Total Contraceptive Prevalence Rate: 49% (2003 NDHS)

Maternal Mortality Rate: 172/100,000 LB

Neonatal Mortality : 17/1,000 LB

Infant Deaths : 29/1,000 Live births

Under Five Mortality Rate: 40/1,000 LB

Situation

Unmet Need for Family Planning: 17.3% of married women of reproductive age

(about 2 million) 9.4% wanted to limit 7.9% wanted to space pregnancies

1 in 6 pregnancies ends up in abortion because they are unplanned or unwanted

Incidence of abortion rising from 320,000 to 400,000 annually

Need for Family Planning

All modern methods (artificial and natural FP) will be provided to clients based on informed choice

Family Planning is a health intervention initiative by: preventing high risk pregnancies reducing maternal deaths responding to unmet needs

Policy Statements

Implementation of Family Planning program shall abide by the following principles:

Responsible ParenthoodRespect for LifeBirth SpacingInformed Choice

General Principles: 4 Pillars of FP

To address the need to help couples and individuals achieve their desired

family size within the context of responsible parenthood and to

improve their reproductive health to attain sustainable development

Objective of FP Program

Focus service delivery to the urban & rural poorRe-establish the FP Outreach ProgramStrengthen FP provision in regions with high unmet needPromote frontline participation of hospitalsMainstream modern natural FPPromote Contraceptive Self Reliance Strategy

Program Strategies

FP program dependence on contraceptive donation for 30 yearsContraceptive Independence Initiative (July 1999)

January 2000: unified plan formulatedNovember 2000: Contraceptive Interdependence Initiative2001: Contraceptive Self Reliance (CSR)

Background/Rationale for CSR

Policy Project conducted the Market Segmentation to ascertain if the clients who use FP commodities are willing and able to pay

Findings: 60% are capable to buy their own supply22% are getting supply from private sector (13.2% are from low income group)

Methodology

Phase down of donated contraceptive supplies

Condom supply - April 2003Pills and injectables - gradual phase down from 2004 – 2008

Government Response: formulation and implementation of a Contraceptive Self Reliance (CSR) Strategy

Methodology

At the national level:

formulation of the national policy and implementing guidelinescoordination with Local Government Unitsdevelop complementary means of financingexpands complementary privates sources

Because basic health services in the Philippines were devolved in 1991, the Phil. Gov’t. response to CSR has been two fold:

At Local Government Level:

Empower local government units (LGUs) to meet the needs of the poor while segmenting the market with those who can afford to pay and refer to the private sector

The contraceptive donation phase down process:

Batch 1 (accelerated phase): cities & provinces with lowest poverty incidence

Batch 2 (longer phase-out period): LGUs with higher rates of poverty incidence

Batch 3 (last, longest phase-out period): LGUs with highest rates of poverty incidence

Administrative Order #158. s. 2004

DOH, MSH-LEAD, JSI & Project Deliver assisted the roll-out of CSR Initiatives in the LGUs\

Series of orientation workshops on AO 158

Training on CSR logistics policy guidelines formulation

Planning activities capacitating LGUs to forecast, mobilize resources, procure and deliver/distribute good quality, & affordable contraceptive supplies

Survey of 892 LGUs

Findings:15% LGUs intend to fully cover the gap in contraceptive requirements58% of LGUs intend to partially cover the gap0.5% LGU opt the DOH commodity swap scheme26.5% LGUs w/o any plan of covering the gap

Results

Top 5 Financing Options # of LGUs % to Total

1. Increase in budgetary allocation 183 88.0

2. Avail of PHIC capitation fund 174 83.7

3. Cost recovery scheme 129 62.0

4. Increase existing health fees /imposed new health fees

122 58.7

5. Donation partnership with NGOs 98 47.1

TOTAL 208

ResultsFinancing options for contraceptives identified during the CST strategic planning activities:

Procurement options of LGUs:

Top 5 Procurement Options # of LGUs % to Total

1. Community-based drug outlet 108 51.0

2. Procurement thru PTIC 83 39.9

3. Regular procurement 75 36.1

4. Consignment 70 33.7

5. ILHZ pooled procurement 45 21.6

TOTAL 208

Results

The success of the Philippines Contraceptive Self Reliance Strategy relies heavily on the synergy, coordination & cooperation of the DOH, the LGUs, donors, private sector/NGO providers and media

The varied socio-economic conditions and priorities of LGUs will influence the options chosen by the LGU to operationalize CSR.

Conclusion

There is still much to be done:

National level policies & services that would enable LGUs to succeed in CSR responses (e.g. procurement guidelines, M & E of LGUs responses to CSR, etc.)

Continuous advocacy effort

Strengthen community support

Conclusion

Commitment, systems & capacities of provinces, cities and municipalities as managers of local FP servicesCommitment, systems & capacities of employers to facilitate FP provision in the workplacePrivate sector players replace donated supply and expand domestic market

Conclusion