MDG 4 and 5Facilitating a Reliable Outcome

Presented during the Local Roundtable Discussion for the Formulation of the Philippine

MDG Acceleration Plan for Maternal Health, Astoria Plaza, Ortigas Center,

Pasig City, 21st June, 2012

2

“Every Pregnancy Is at Risk”“Every Pregnancy should end at

the health facility with assistance by skilled health professional”

Current Approach to Reduction of Maternal Mortality

Most Effective Intervention to Prevent Maternal Deaths

Skilled attendant at childbirth is the most effective intervention

WHO 1999.

The Problems

Vital Indicators(2010 vs. 2011)

• Total Population – 2.3% increase from 11.552 M in 2010 to 11.819 M in 2011• CBR – 11% decrease from 20.1 to 17.9• CDR – 7% decrease from 5.6 to 5.2• IMR – 8% increase from 17.3 to 18.7• UFMR – 12% increase from 23.3 to 17.3• MMR – 24% increase from 58 to 72

Trend in Infant and Under-five Mortality Rates NCR, 2005-2011, FHSIS

MDG Progress on Maternal Mortality Reduction

NCR, 2005-2011

MMR Per LGU and Rate of Change, NCR2009-2011

Source: FHSIS

LGU No. of Deaths MMR and 3-Year Trend Analysis

2009 2010 2011 2009 2010 2011 2010-2011 Change

2009-2011Net

Change

Caloocan 5 3 NR 20 9↓ 0↓ -100 -155%

Malabon 0 2 1 0 83↑ 42↓ -49% +34%

Navotas 1 1 2 25 21↓ 55↑ +162% +146

Valenzuela 10 10 8 113 114↑ 91↓ -20% -19%

Pasig 12 31 15 218 266↑ 184↓ -31% -9%

Pateros 0 0 2 0 0→ 248↑ +248% +248%

Marikina 9 4 12 101 42↓ 136↑ +224 +165%

Taguig 8 8 7 139 108↓ 74↓ -31% -53%

Quezon City 32 33 46 68 76↑ 110↑ +45 +57%

MMR Per LGU and Rate of Change, NCR2009-2011

Source: FHSIS

LGU No. of Deaths MMR and 3-Year Trend Analysis

2009 2010 2011 2009 2010 2011 2010-2011 Change

2009-2011Net Change

Manila 23 18 20 35 29↓ 33↑ +14% -3%

Makati 5 5 10 46 49↑ 105↑ +114 +120%

Mandaluyong 4 4 2 66 67↑ 36↓ -46% -44%

San Juan 0 0 1 0 0→ 31↑ +31% +31%

Muntinlupa 0 4 10 0 52↑ 129↑ +148% +200%

Pasay 4 4 4 54 58↑ 58→ 0 +7%

Paranaque 5 1 5 61 13↓ 61↑ +369% +290%

Las Pinas 4 6 6 47 81↑ 81→ 0 +72%

NCR 122 134 151 54 58↑ 66↑ +14% +21%

Maternal Deaths in Metro Manila(Absolute Number and Rate Per 100,000 LBs)

2011, FHSIS

Causes of Maternal DeathsNational Capital Region, 2010

Source: FHSIS

33%

43%

7%

17%

Eclampsia

Hemorrhage

MedicalComplications

Infections

Causes of Maternal DeathsNational Capital Region, 2011

Source: FHSIS

Delivery Profile, NCR, 2010Deliveries By Place

4

31 29 27 3040

1129 25

012

4 1

34

12

34 35 2930

2441

5364

042 11

42 90 6462

78

46

70 28

5449

6646

3020

6

6047

60

33

1023

3421 19 18

38

1022

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Home Hospital Other Place

Proportion of Deliveries By Place by LGUNCR,2011

Source: FHSIS

Trend in Selected Delivery IndicatorsNCR, 2008-2011

Source: FHSIS

Indicator 2008 2009 2010 2011

Home Delivery Rate (As % of TLBS)

23.3(51,361)

19(43,061)

14.5(33,816)

14(29,246)

TBA Del Rate (As % of TLBs)

9.9(21,912)

8.2(18,580)

6(13,570)

6.8(14,329)

Midwife Delivery Rate (As % of TLBs)

13.4(24,449)

10.8(24,471)

8.7(20,246)

7(14,917)

Health Facility Delivery Rate (As % of TLBs)

76.7(169,052)

77.3(175,100)

85.4(198,724)

86.2(182,271)

Delivery Profile, NCR, 2011Deliveries By Place

Deliveries by AttendantsNCR, 2011

Source: FHSIS

Contributory to high MMR/IMR1. MM as central referral region ( facilities cater to outside MM)2. Referred pregnant women mostly

pathological/complicated cases3. MWs because of unbundled

PhilHealth payment refer late or do not refer at all

4. No or late registration of live births5. Wrong recoding or entry (e.g. NBM

also counted in UFM

Contraceptive Prevalence RateNCR, 2005-2011

Source: FHSIS

Contraceptive Prevalence Rate Per LGU, NCR, 2011

Source: FHSIS

• Acumen and competency for research

• Recognition and credits for training

• Sustaining irreversible reforms on trainings; research; and, data/information generation

“ PLAN AND PREPARE”

Tactical Plans1. micro management/individual

care (service)2. Reliable data (information technology)

Regional Center for Monitoring Maternal and Child Health

orRegional Center for Public Health

Leadership and Governance

Why UMak …

• More facilitating than hindering factorsPolitical and Institutional LeadershipPrestige and credibilityHealth is a priority in MakatiGeographically at the center of MetroManila Distance from CHD-MMFacilities and human resource complement

The Center … General • Research

• ICT

• Evaluation/Assessment

• Trainings

Specific • Disaggregate addresses

and other delivery/deaths variables

• Daily or weekly reporting• Maternal/Infant Death

Review/PathoConference• Cause of Death• Others

Application: Pregnant Women in …

CCTPL with CHTCL with DOHRepCHO with RNHeals/MWs

NHTSCHT with DOHRep and CLCHO with RNHeals/MWs

OthersCHO with DOHRep &RNHeals/MWs

Health Center Lying-in

Higher referral level (service)University of Makati(as Maternal and Child Health

Monitoring Center)

(For provision of health service)(For ICT monitoring and research)

Data Gathering and Report Generation

HospitalsLGUs/CHOsKP Nurses

ICT Surveillance

• Data Collection•Verification

•Analysis•Segregation •Report Generation

Research,Statistics and

ActionProgram

Managers

Six (6) Buntis Connections(Health Plan)

• Health facility and referral network• Health Professional/s up to referral

facility/ies• Source of blood if needed• Transportation• Communication• Pre- and Post- natal visits

Other Variables/Indicators

• Prenatal and Postnatal Visits ( with TT and Supplements)

• Prenatal and Postnatal Complications• Teenage Pregnancies• Breastfeeding/Nutrition• EPI• FP (commodities and 3-yr gap)

Immediate Actions from CHDMM• Makati Health Board Presentation done

• MOA with UMak• Conference/Summit of Civil Society Groups, Non-

Government Organizations and People’s Organizations to:- present CHDMM Plans and Programs/Roadmap- gather info on the participants’ organizations to make into compendium- agreements on individual organizations’ partnership activities with DOH indentifying specific areas and activities/services to be carried out

• With ZFF/?Umak meet all NCR Mayors

Expectations from LCEs• Take the lead to consolidate efforts as a team

(CHT, CL, PL, RNHeals, PHMWs, CHO)• Support to CHTs (financial for transportation

and meals; in-kind for forms, bags umbrellas, etc.

• Assign ICT person-in-charge• ICT maintenance and support• E-link to UMak and maintenance• Declare all pregnancies as an “emergency case”

Expectations from Umak …

• Office space• Human resource complement• Other facilities that can be provided• Coordination and conduct of trainings• Generation of data and information• Conduct of research• Maintenance

Thank You!