Guidelines in Achieving Desired Family Size through Accelerated and Sustained Reduction in Unmet Need for Modern Family Planning Methods

March 30, 2017

DOH ADMINISTRATIVE ORDER NO. 2017-0005

 

I. BACKGROUND AND RATIONALE

According to the National Demographic Health Survey (NDHS) 2013, forty-three percent (43%) of women in the Philippines consider two children as the ideal family size, while 28% prefer three children. The average wanted fertility rate is two but the actual total fertility rate is three children. This means that on average, Filipino couples have one child more than what was planned or wanted. The prevailing high fertility rate especially among poor women is due to the lack of access to modern family planning (MFP) services. It is estimated that 35% of women have unmet need for MFP. This is roughly equivalent to six million women with unmet need, of which two million are poor. cHDAIS

The Responsible Parenthood and Reproductive Health Act of 2012 (RPRH Law) mandates the universal provision of reproductive health (RH) services including family planning (FP). This is to ensure that unmet need for MFP are met in order to prevent unplanned and mistimed pregnancies that are associated with higher risk of complications during pregnancy and childbirth as well as have long-term socio-economic implications.

The Socio-economic agenda and Philippine Health Agenda (PHA) under the current administration includes, among others the strengthening of the RPRH Law, its implementing rules and regulations (IRR) and corresponding Department of Health (DOH) policy issuances.

The Executive Order (EO) No. 12 on Attaining and Sustaining "Zero Unmet Need for Modern Family Planning", signed by President Rodrigo Roa Duterte on January 9, 2017, recognizes the need to address the unmet needs for any modern method of contraception. Pursuant to this, the DOH as the lead agency in the implementation of the RPRH Law shall issue policies and guidelines to create a significant impact in addressing the unmet need for MFP to help the poor and marginalized families achieve their desired family size.

II. OBJECTIVE

This Order aims to provide guidelines to the health sector and other stakeholders in the implementation of the strategies necessary to accelerate and sustain reduction in unmet need for MFP and eventually attain the desired family size especially among the poor and marginalized.

III. SCOPE AND COVERAGE

This Order shall apply to all DOH Offices, Retained Hospitals, DOH-attached Agencies, other national agencies, Local Government Units (LGUs, government, private, and civil society organization (CSO) providers, and all other organizations/institutions that shall perform various roles and responsibilities in the implementation of this Administrative Order (AO).

IV. DEFINITION OF TERMS

1. Unmet Need — Couples and individuals with unmet need are those who are fecund and sexually active, and report not wanting any more children or wanting to delay the next pregnancy but are not using any modern method of contraception (natural and artificial methods). This also includes couples and individuals' who expressed their desire to shift from traditional method to modern FP.

2. Desired Family Size — The desired number of children as agreed by a couple based on informed choice.

3. Poor — families and individuals that are listed in the National Household Targeting System for Poverty Reduction (NHTS-PR) of Department of Social Welfare and Development (DSWD) and/or list of Sponsored Program families profiled by PhilHealth.

V. GENERAL GUIDELINES

A. Guiding Principles

1. The reduction of unmet need for modern family planning shall respect the personal preferences of individuals involved. It shall be contextualized as a human rights-based intervention guided and anchored on the following principles: respect for the right to life, respect for human rights, informed choice and voluntarism (ICV) (AO No. 2011-0005), and respect for the rights of the clients to determine their desired family size (RPRH IRR Rule 2 Section 2.01 item o).

2. While EO 12 emphasizes the need to address the needs of the poor, note however, that other couples/individuals that do not belong to these groups but expressed their desire to use modern family planning services or are already using modern FP services shall also be served.

B. Priority Population

The priority population shall consist of men and women of reproductive age listed in the NHTS-PR (those belonging to the lowest or poorest, first to third economic quintile) or similar mechanisms to identify poor families and other marginalized groups. ISHCcT

C. Priority Strategies

In addition to the routine provision of services, other strategies to intensify delivery of modern FP services shall be implemented, which include but are not limited to: 1) conduct of demand generation activities utilizing platforms like the Family Development Sessions (FDS), school sessions, community based "Usapan" series, etc.; 2) holding FP outreach missions in urban poor communities and Geographically Isolated and Disadvantaged Areas (GIDAs); and 3) provision of post-partum FP counseling and services.

D. Enabling Factors

The presence of enabling factors shall be ensured in support to the strategies identified in this AO that includes the following:

1. Effective leadership and management systems which include the establishment of FP Unit, designation of province-wide management teams (province/city, and municipalities), operation of a demand driven supply chain management system, adequate and competent human resources, and functional monitoring and evaluation system utilizing modern information and communication technology.

2. Adequate financing and incentives that include budgets for the implementation of various activities, procurement of commodities and services, system for recognition and awards for good performance and enhanced PhilHealth benefits linked with quality of care.

3. Effective information, education, and communication to improve behavior in seeking reproductive health services through targeted information campaigns, community mobilization, and effective counseling.

VI. SPECIFIC GUIDELINES

A. Identify Priority Areas

Each region shall determine areas with high unmet need as priority areas. These areas are expected to have the highest concentration of poor families and unmet needs for modern FP. These identified priority areas intend to: 1) reduce unmet needs in areas where it is highest and, 2) generate lessons to guide implementation during the rollout to the rest of the region.

B. Improving Utilization of Modern Family Planning Services:

1. Identify the poor families through the use of existing platforms/database like the NHTS-PR. Alternatively, poor families can also be identified using the list of profiled families by PhilHealth or other available lists by LGUs.

2. Determine unmet needs from the priority population by providing information and assessing unmet need status of clients through activities, which include but are not limited to: a) conduct of FDS on family planning, b) community assemblies, and c) household visits.

3. Ensure the functionality of the service delivery networks (SDNs) at all levels providing modern FP and other RH services by: a) identifying and assessing the capability of government, private, and CSO facilities (health centers/clinics, hospitals, workplaces), and b) designating facilities where clients can be referred or assigned to avail of services.

4. Improve the delivery of quality, cultural and gender-sensitive FP and other RH services by adopting practices which include, but are not limited to; a) providing information on FP services to all women of reproductive age (WRA) and their partners that seek care in health facilities at all points of contact and integrated with other health services; b) providing FP information, counseling and services to all women who gave birth in health facilities; c) conducting regular FP outreach services in health facilities and through mobile clinics, and d) expanding the provision of FP and other RH information in schools and FP/RH services in workplaces as mandated under the RPRH law. Faith-based organizations shall also be involved in the conduct of demand generation activities. In times of emergency/disaster, services shall not be disrupted based on AO on Minimum Initial Service Package for Reproductive Health in Health Emergencies, Natural, and Manmade Disasters. CAacTH

C. Building the Capacity of Family Planning Providers

1. DOH shall standardize all trainings for the provision of modern FP services (e.g., Family Planning Competency-Based Training Levels 1 and 2, Interpersonal Communication and Counseling (IPCC), Usapan, etc.). The standardized training programs shall be provided through accredited training institution as governed by DOH AO 2014-0041.

2. Provincial hospitals and DOH medical centers shall serve as designated training centers and referral facilities as appropriate based on their capacity to provide such services including recording and reporting system using the DOH operational guide.

3. DOH shall provide training grants to support capacity building of public, private and CSO providers in the priority areas.

D. Providing Adequate Financing, Logistics and Other Support Mechanisms

1. The DOH shall provide grants and commodity allocation to LGUs, private providers and CSOs involved in the implementation of this AO.

2. The DOH shall procure and distribute family planning commodities consistent with the following principles:

a. Forecasting and volume of procurement shall be based on the needs of current users (from LGU utilization reports) and estimated new acceptors based on method mix assumptions.

b. Distribution of commodities to various providers shall be based on availability of stocks, other sources of commodities like LGU procurement, and donations from development partners.

c. Monitoring of consumption shall be based on reports of FP hotline and the FP Commodity Inventory and Consumption (CIC).

3. A system for recognition of good performance including a mechanism to share lessons across sites shall be developed by the DOH.

E. Improving Monitoring and Reporting of Performance

1. Monitor utilization and provision of health services through the conduct of follow-up visits with clients, checking of administrative records to determine unmet need for modern FP of priority population.

2. The RPRH Monitoring & Evaluation (M&E) Framework shall be used as basis to monitor and evaluate the performance of both government, private sectors and CSOs in the RPRH implementation.

3. In addition, quarterly progress within the first two years of implementing this AO shall also be measured in terms of: a) number of poor families located; b) number of clients from poor families assessed with unmet needs, c) number of clients from poor families provided with counseling and services on MFP and other RH services, d) number of clients from poor families referred for other MFP services.

4. Real-time tracking of the progress of operations, focusing on how problems and gaps are identified and addressed shall be maintained at all levels. Inventory of available resources and capacities (budget, infrastructures, and trained personnel) for modern FP services from the central, regional, and local levels, coming from the DOH, LGUs, Development Partners, private and CSO sector providers shall be determined and documented.

VII. ROLES AND RESPONSIBILITIES OF THE DIFFERENT STAKEHOLDERS

Department of Health shall:

a. In consultation with other government agencies and stakeholders, formulate and implement a comprehensive plan of action to accelerate and sustain the reduction of unmet need for modern FP.

b. Define and delegate tasks for the implementation of the comprehensive and specific plans of action for RH services among the various government agencies, LGUs, CSOs, the private sector through the National Implementation Team (NIT) and Regional Implementation Teams (RITs)

c. Review gaps in the implementation of the FP Program in the RPRH Law, and issue corresponding Orders and operational guidelines that shall enhance the effective technical support, financing, coordination, and delivery of MFP services to the priority population;

d. Ensure the availability of funds to support the implementation of this AO at the various levels of operation to include LGUs, CSOs, and the private sector providers;

e. Review procedures towards streamlining requirements for the accreditation of NGOs and CSOs, particularly those that can be engaged to provide FP services and information;

f. Set up a project management team (PMT) within DOH and in close coordination with the NIT that shall provide technical oversight and the necessary technical assistance in the implementation of this AO specifically to the identified priority population.

g. Prioritize the creation of the Family Planning Unit as an interim to the Family Health Bureau.

DOH Regional Offices shall:

a. Design, develop, and implement plans based on analysis of current situation to address factors that cause high levels of unmet need and missed cases;

b. Estimate the needs of beneficiary families for services concerning FP, including adolescent youth and reproductive health at the minimum;

c. Harmonize database for unmet need with Commission on Population (POPCOM) and DSWD;

d. Assist the LGUs in the fast-tracking of the implementation of this AO;

e. Determine the service capacities and quality of both government, private, and CSO health care providers within the immediate and nearby catchment areas and provide assistance as needed;

f. Ensure that all DOH hospitals shall provide quality, cultural and gender-sensitive FP and other RH services; IAETDc

g. Engage and collaborate with the private sector, CSOs, and Faith-based organizations in the implementation of this AO. Contract private health care providers/and CSOs, as needed, for the implementation of programs pursuant to relevant government procurement laws, rules and regulations;

h. Ensure functionality of the Regional Implementation Team to provide the necessary support in the implementation of the AO.

i. Conduct timely tracking of progress of operations using the annual operational plan at the regional level through the Provincial/City DOH Office. Evaluate the changes in the utilization of FP services by immediately resolving persistent but well-known bottlenecks in service delivery (e.g., logistics/supply chain) and in demand generation activities with notification to its DOH Geographic Operations Cluster Head;

j. Provincial DOH Office shall consolidate the validated report submitted by the LGUs noted by the Provincial Health Office (PHO);

k. Report on program accomplishment using the RPRH M&E Framework refer to Annex;

l. Identify and recommend good performing LGUs for recognition in the Purple Ribbon Awards.

Commission on Population shall:

a. Coordinate with the DOH in the development of national policies and guidelines on demand generation activities.

b. Facilitate and assist LGUs to conduct demand generation strategies and activities (i.e., Responsible Parenthood and Family Planning (RPFP) classes) through various communication modalities and always linked to service provision;

c. Maintain offline and online database of unmet need for MFP methods and share with DOH and LGUs;

d. Provide technical inputs to the DOH in the estimation of the level of unmet need for MFP and forecasting of FP commodities;

e. Conduct advocacy for the full implementation of the RPRH law and in coordination with the DOH Health Promotion and Communication Service (HPCS);

f. Provide Secretariat functions to the National and Regional Implementation Teams;

g. Provide training for non-health service providers and community volunteers for the demand generation (e.g., IPC and Usapan series); and

h. Review and revise the annual Work and Financial Plan (WFP) to allocate the needed resources for the implementation of this AO.

Food and Drug Administration shall provide timely certification and re-certification of FP product registration.

Philippine Health Insurance Corporation (PhilHealth) shall review and expand its benefit packages to ensure maximum benefits for FP services, in addition to other mandates provided for by the RPRH Law and its IRR. Ensure that these benefit packages are being implemented and monitored. The Regional PhilHealth shall facilitate the release of the updated list of sponsored NHTS poor families and provide copies to concerned agencies (DOH, LGUs, POPCOM, among others).

National Economic and Development Authority (NEDA) shall ensure that the RPRH strategies are integrated in the Philippine Development Plan and Regional Development Plans and their accompanying monitoring framework.

Department of Education (DepEd) shall:

a. Facilitate issuance of approved policy on Comprehensive Sexuality Education (CSE);

b. Update, enhance and implement CSE in the school curriculum;

c. Train teachers on the updated CSE from both public and private schools;

d. Institute mechanisms to monitor the conduct of training on CSE modules nationwide;

e. Provide age-appropriate and gender-sensitive FP information and referral services; and,

f. Collaborate with DOH and POPCOM in the establishment of school-based teen centers.

Department of Social Welfare and Development (DSWD) shall:

a. Integrate RPRH strategies in the national poverty reduction and social protection programs;

b. Share the updated DSWD LISTAHAN of poor families with the inter-agency members upon request by the concerned members to serve as reference for program development and implementation;

c. Enhance modules when necessary on Reproductive Health (RH) to guide the service provision in handling Family Development Session (FDS), youth development sessions (YDS), and other community-based programs; and,

d. Conduct FDS on RH and family planning in close coordination with POPCOM and other concerned agencies to empower women and girls in accessing reproductive and sexual health services and further identify the unmet need for modern Family Planning.

National Youth Commission (NYC)

Shall integrate in their adolescent and youth development plans strategies to address the unmet need among the youths and adolescents.

Department of the Interior and Local Government (DILG) shall:

a. Issue a circular on the establishment, operationalization, and sustainability of the service delivery network (SDN) for maternal, newborn and child health and nutrition (MNCHN) and family planning;

b. Ensure RPRH funding is included in the Comprehensive Development Plan and Executive Legislative Agenda of the LGUs;

c. Include gender sensitive and rights-based RPRH-related trainings in the Local Government Academy;

d. Include performance measures on RPRH particularly in meeting unmet needs for family planning as one of the indicators for the Seal on Good Governance;

e. Monitor timely submission of reports by the LGUs using the RPRH M&E Framework;

Department of Labor and Employment (DOLE) shall:

a. Enforce full implementation of FP services in the workplace and shall facilitate access to training and commodities from the DOH; and,

b. Endorse good performing FP program in the workplace for recognition and awards.

Philippine Commission on Women (PCW)

a. Shall promote reproductive health rights in their initiatives for women's empowerment and gender equality. As well as promote the utilization of the Gender and Development (GAD) Budgets for RPRH-related programs, projects and activities in accordance to the GAD Planning and Budgeting Guidelines

b. Shall build gender-sensitive, competent health workforce through capacity building of modern FP providers

c. Shall provide training on gender-sensitive handling of clients to ensure non-judgmental and humane delivery of all reproductive health care services and information, including the respect for the right to privacy and the privilege of confidentiality of clients DcHSEa

National Council on Disability Affairs

a. Shall promote reproductive health rights of persons with disabilities in their Disability Orientation for LGUs and Organizations of Persons with Disabilities, and advocacy campaigns.

b. Provide information and technical assistance to health service providers on assisting persons with disabilities' access to MFP services.

Local Government Units shall:

The following functions shall be undertaken by the respective local government units (i.e., province, city, municipal levels) as appropriate according to their specific mandates:

a. Conduct community based demand generation activities and provision of modern FP service, particularly in GIDAs and urban poor communities;

b. Take lead in mapping areas to locate couples and individuals with unmet need for modern FP and ensure the provision of quality MFP information and services by accelerating the following steps:

i. Identify the barangay/s where the poorest households are located (Local Social and Welfare and Development Office (LSWDO) may coordinate with the concerned DSWD Regional Office for the updated LISTAHAN on poor families;

ii. Determine the number of Barangay Health Workers (BHWs) and community volunteers (on health, population, nutrition, etc.) to be deployed to conduct house-to-house visits for the identification of clients with unmet need for MFP;

iii. Conduct an intensified door-to-door campaign to identify clients with unmet need for MFP with support from the DOH;

iv. Establish a support mechanisms for the community volunteers (i.e., minimum allowance, transportation reimbursement, etc.) to ensure that all clients with unmet needs have been reached and identified/visited, reported and referred to appropriate facilities for services.

c. Capacitate and mobilize local stakeholders, to accelerate demand generation and provision of MFP commodities and services, including the designation of family planning point persons in health facilities;

d. Establish, ensure functionality and sustainability of SDN;

e. Upgrade capacities of provincial/city hospitals as referral facility for the provision of all modern FP methods especially long acting and permanent methods in the LGU;

f. All LGU hospitals shall implement a recording and reporting system using the DOH operational guide on FP performance;

g. Allocate local funds necessary for ensuring universal access to reproductive health care services, including demand generation for FP and family planning training, commodities and services and other medical supplies;

h. Facilitate PhilHealth accreditation of healthcare providers for modern FP and utilization of PhilHealth reimbursements to support FP services;

i. Engage, collaborate, and/or partner with CSOs and the private sector in provision of modern FP services in their respective localities;

j. Develop local resolutions and ordinances in support to the implementation of this AO;

k. Ensure timely submission of RPRH reports and WFP;

l. Create and ensure the functionality of the Provincial Implementation Team (PIT), City Implementation Team (CIT) and the Municipal Implementation Team (MIT) to oversee smooth implementation and coordination of this AO; and,

m. Provide supportive supervision, capacity building functions, program implementation reviews (as applicable).

Private Partners, Civil Society Organizations (CSOs) and Faith based organization, in close coordination with DOH and LGUs, shall:

a. Provide/assist in the provision of quality, cultural and gender-sensitive health services (in the context of ICV) especially in urban poor communities and GIDAs;

b. Create an enabling policy environment for FP by working with legislators, national and local chief executives (LCEs) and members of the judiciary to align the policies with the RPRH Law;

c. Monitor, document and act to address violations of the right to FP as provided in the RPRH Law, including the denial of services and coercion to use FP;

d. Use its technical capabilities, including research, academic, and media (including social media) to influence the national discourse regarding the health and social benefits of FP;

e. Provide capacity building and trainings on FP in accordance to DOH standards and accreditation;

f. Support functionality and sustainability of SDN;

g. Conform to the DOH policies to maximize effectiveness by, among others, applying for accreditation in order to access grants, establishing partnerships with regional and local health offices, and submitting reports to the appropriate partner government offices using the standard government forms; and,

h. Conduct peer education and other appropriate education and organizing strategies to enhance women's and communities' understanding on FP, debunk myths and misconceptions, and strengthen the link between women and communities with FP providers.

d. n  Development Partners shall, in accordance with their agreements with the Government:

a. Assist in the development of necessary guidelines in support of this AO;

b. Assist in building the capacity in the implementation of the guidelines set forth above;

c. Support efforts to address operational challenges such as those identified in the background and rationale of this AO, among others; and,

d. Develop technical packages to assist in executing LGUs and other partners' tasks as identified in the general and specific guidelines of this AO.

MANAGEMENT ARRANGEMENTS

1. The NIT shall coordinate the interagency action at the national level as stipulated in EO 12. It shall also include the integration of all accomplishment reports in the implementation of various FP related activities that shall form part of their agencies' performance in the RPRH Annual Report. It shall also facilitate and support the formation and operation of the RITs, and coordinate their activities to attain the objectives of the RPRH Law and this AO. SCaITA

2. The DOH shall create a Project Management Team (PMT) that shall lead in the implementation of this AO in close coordination with the NIT. The PMT shall provide technical oversight and full support to the "accelerated approach" in implementing this AO. The PMT tasks shall ensure internal coordination (within the various offices of the DOH) on policy development, standard setting, advocacy, resource mobilization, capacity building, networking and coordination, monitoring and evaluation. The PMT shall be chaired by the OTS Assistant Secretary and co-chaired by Office of Field Implementation and Management (OFIM) Cluster Head, shall identify its technical members from the various offices and bureaus as deemed necessary including the four Geographic Operations Clusters for Luzon, Visayas, and Mindanao. The FP Unit of the Family Health Office shall serve as the Secretariat. The PMT shall report directly to the Secretary of Health on the organizational, programmatic, and communication arrangements to implement this Order and shall also provide accomplishment reports to the NIT.

3. At the Regional level, RITs shall be in charge in providing the necessary technical support and assistance to the priority province identified with high unmet need.

4. At the provincial or city level, a PIT/CIT shall lead in the implementation of the AO, including reporting and recording of accomplishments.

5. At the municipal level, a MIT shall likewise be in charge of the implementation of the AO and shall ensure that reports of accomplishments are submitted as required in the RPRH M&E framework.

X. ANNEXES:

Annex A: RPRH M&E Monitoring Framework

Annex B: Monitoring Indicators for Modern Family Planning.

XI. REPEALING AND SEPARABILITY CLAUSE

All orders, rules, regulations, and other issuances inconsistent with or contrary to this Order are hereby repealed, amended, or modified accordingly. All provisions of existing issuances which are not affected by this Order shall remain valid and in effect.

In the event that any provision or part of this Order is declared unconstitutional or rendered invalid by any Court of law or competent authority, those provisions not affected by such declaration shall remain valid and effective.

XII. EFFECTIVITY

This Order shall take effect immediately.

(SGD.) PAULYN JEAN B. ROSELL UBIAL, MD, MPH, CESO IISecretary of Health

ANNEX A

RPRH Law Monitoring & Evaluation Framework

ANNEX B

Monitoring Indicators for Family Planning

	Indicators
Impact	Wanted fertility rate vs. Total fertility rate
Outcome	Contraceptive prevalence rate (modern methods)
Unmet need for family planning
Output	Percentage of RHUs (with possible expansion to include hospitals) with no stock-out of contraceptives in the last six months (pills, IUD, DMPA, condom)
No. of new Modern FP acceptors

Input/Process

Pillars	Indicators	Target
Policy Issued	No. of national and local policies issued in support or hindering universal access to FP	Executive Orders, Administrative Orders, Memorandum Circulars, Ordinances, etc.
Demand Generation	No. of LGUS with mechanism to track or map unmet need FP in the public and private sector	All LGUs (provinces, cities, municipalities)
No. of women of reproductive age with unmet need on FP identified	Regional/LGU-specific breakdown of targeted WRAs based on the DOH CIP-FP (provinces, cities, municipalities)
Capability Building	No. of LGUs with public and private providers trained on FPCBT 1	All LGUs
No. of LGUs with public and private providers trained on FPCBT 2	All LGUs
No. of provinces with public and private hospitals providing BTL MLLA services	All provinces
Commodities Procured and Consumed	No. of LGUs that have submitted commodity consumption reports from public and private providers (w/ detailed breakdown of commodities consumed)	LGU-specific breakdown of targeted commodities based on the DOH CIP-FP (provinces, cities, municipalities)
Service Delivery	No. of WRAs with unmet need on FP provided post-partum FP services	Regional/LGU-specific breakdown of targeted WRAs based on the DOH CIP-FP (provinces, cities, municipalities)
No. of WRAs with unmet need on FP provided services through FP outreach missions	Regional/LGU-specific breakdown of targeted WRAs based on the DOH CIP-FP (provinces, cities, municipalities)
Governance Mechanism	No. of provinces with functional SDN on FP services (w/ referral mechanism & clients served)	All provinces
No. of private/CSO/NGO sector engaged with the Government	All priority provinces
No. of LGUs whose FP data have undergone data quality check (DQC)	All LGUs
Budget and Financing Secured	% of LGU budget allocation on FP	All LGUs
No. of public and private facilities submitting claims for FP services	All RHUs
No. of public and private facilities' claims on FP reimbursed by PhilHealth	All claims reimbursed

n Note from the Publisher: Copied verbatim from the official copy.