Facility-Based Newborn Care: Philippines Successes and Challenges

Unang Yakap: The First Embrace to Reforms in Newborn Care Practice

17 April, 2013
National Center for Disease Prevention and Control (NCDPC), Department of Health (DOH), Republic of the Philippines Manila

ANTHONY CALIBO, MD, DPPS

The Way We Were

Births Attended by Skilled Health Professionals and Place of Delivery

Births Attended by Skilled Health Professionals (Physicians, Midwives and Nurses)

Proportion of Births Occurring at Health Facilities and At Homes

Philippines National Demographic and Health Survey (NDHS) 88, 93, 98, 03, 08

# of deaths per 1000 live births

Under-5 and Neonatal Mortality Rates (NMRs)

Under Five Mortality Rate

High NMR for Rich and Poor

# of deaths per 1000 live births Neonatal Mortality Rate

25 20 15 10 5 0

20

19 15 15 10

1988-1998: 40% 1998-2008: 20% Stagnant NMR

Lowest Second Middle Fourth Highest

Wealth Quintile

Philippines National Demographic and Health Survey (NDHS) 88, 93, 98, 03, 08

(N = 481 in 51 Philippine hospitals; Acta Pediatrica 2011)

Potentially harmful NB care practices

Formative research, 2008

Policy Reforms
Maternal, Newborn, Child Health and Nutrition (MNCHN) Strategy (Department of Health Administrative
Order 2008-0029)

Adopting Policies and Guidelines on Essential Newborn Care (DOH AO 2009-0025) Universal Healthcare / Kalusugang Pangkalahatan
(DOH AO 2010-0036 ) Clinical Pocket Guide)

Essential Newborn Care Protocol (DOH/WHO/UNICEF Clinical Practice Guidelines on Essential Intrapartum and Immediate Postpartum Care (DOH/WHO/POGS )

Project The Unang Yakap Campaign Sites

LUZON (8): Quirino Memorial Medical Center (QMMC), Philippine General Hospital (PGH), Dr Jose Fabella Memorial Hospital, JRRMMC, EAMC, TMC, SLRWH, JNRMH

VISAYAS (1): Eastern Visayas Regional Medical Center (EVRMC) MINDANAO (2): General Santos City Hospital, Cotabato Regional and Medical Center (CRMC)

Professional Regulations Commission Board of Medicine Board of Nursing Board of Midwifery

Academic Organizations in the PHL

Association of Philippine Medical Colleges (APMC) Association of Deans of Philippine Colleges of Nursing (ADPCN) Association of Philippine Schools of Midwifery (APSOM)

Where We Are: State of the Art Interventions at Philippine Health Facilities

Philippines DOH/WHO Philippines/Joint Programme on Maternal and Neonatal Health, 2011 (33,421 livebirths)

Attendant at birth and place of delivery, Philippines 2006, 2008 and 2011

Skin-to-Skin Contact Practices at Birth in Health Facilities at subnational levels

Under-Five, Infant and Neonatal Mortality Rates (2003-2011)

Per 1000 Live Births

45 40 35 30 25 20 15 10 5 0

40 34 29 17 25 16 30 22 14

MDG Targets for 2015 (U5MR 26.7 and IMR 19) are ACHIEVABLE

NDHS 2003 Under-five Mortality Rate

NDHS 2008 Infant Mortality Rate

FHS 2011 Neonatal Mortality Rate

Philippines Family Health Survey 2011: National Statistics Office, Department of Health, USAID Philippines

The Way Forward:

Resistance and inertia to practice among specialists Slowed momentum to scale-up Limited number of trainors and advocacy partners to scale-up efforts Paucity of models for institutionalization of reform in a decentralized health system Inconsistent guidelines between licensing and accreditation Inadequate local capacity for supportive supervision and monitoring Inconsistent / incomplete engagement and commitment of private sector

Challenges

How We Address These

Strong policy and administrative support Renewed high-level commitment to scale-up National roadmap for scaling-up Strong team of private sector advocacy partners and champions Strengthened Social Marketing campaign Increase utilization of Newborn Care Package (NCP) under the National Health Insurance Program Incorporation in the licensing appendix and checklist Partnership with health professional organizations

The Way Forward: