 SOURCE: THE WORLD BANK (2019).

PREPARING FOR THE TRANSITION: SUPPLY-SIDE READINESS

OF PRIMARY HEALTHCARE IN THE BANGSAMORO AUTONOMOUS REGION IN MUSLIM
MINDANAO:TOWARDS A MORE EQUITABLE AND BETTER-PREPARED PUBLIC PRIMARY HEALTH
CARE SYSTEM. WORLD BANK PUBLICATIONS, WASHINGTON DC USA

While maternal health outcomes have improved, inequity by region persists with ARMM lagging far
behind: while 91.9 percent of births in the National Capital Region (NCR) were in a health facility and
96.1 percent assisted by skilled providers, these figures in ARMM were 28.4 percent and 34 percent,
Respectively.

Just 28.4 percent of pregnant women gave birth at a facility, compared to the national average of 77.7
percent (PSA and ICF International 2018)

The target under DOH-ARMM, aligned with national target, was a density of
1 RHU per 20,000 population and 1 BHS per barangay… Basilan is the closest to the national target for
RHU coverage (approximately 1 RHU per 22,650 population),

1:33, 975 doctors (target 1:20,000); 1: 2363 nurses (target 1:10,000); 1:2384 midwives (target 1:5,000)

A 2012 United Nations Children’s Fund (UNICEF) report estimated that 13 Filipino mothers
die each day because of complications related to childbirth (UNICEF 2012). The most recent estimate of
the maternal mortality rate (MMR)—114 deaths per 100,000 live births in 2015—indicates a lack of
significant progress at the national level in the years since (“World Databank.” World Bank (Online).
Available: http://www.worldbank.org/. Accessed: February 25, 2018.)

A 2008 DOH Administrative Order (A.O.) aims to eliminate traditional birth attendants by authorizing only
trained midwives, nurses, and doctors to assist women at delivery (A.O. 2008-0029: Implementing Health
Reforms for Rapid Reduction of Maternal and Neonatal Mortality.)

34 LGUs nationwide are expected to ensure that local facilities have the resources needed to deliver
effective intrapartum care, while PhilHealth reimbursements are applicable for normal delivery at
accredited facilities through the MCP and for newborn services through the complementary Newborn
Care Package (NCP).

BARMM has the lowest ANC utilization rate in the country. In 2013, 95.4 percent of pregnant women
nationwide received ANC from a skilled provider (PSA and ICF International 2014). In BARMM, however,
this figure was just 52.8 percent.

Basilan FBD
2013: 17.7
2014: 9.7
2015:17.2
2016:30.3

ANC
BONC
81.8
82.8
45.5
17.2

Further reading
Mujer Quintos, M. A. 2017. “Regional Differences in Maternal Mortality in the Philippines.” Asia Pac. J.
Educ. Arts Sci. 4 (1).

UNICEF (United Nations Children’s Fund). 2012. “Philippines: Maternal and Newborn Health Country
Profiles.”

https://aboutphilippines.org/documents-etc/Yakan.pdf

Ms. Zenaida Dy Recidoro, RN, MPH

e-mail address: zenydyrn@yahoo.com.ph

 https://www.ibon.org/no-home-birthing-policy-burden-to-filipino-mothers/
this article is based on the book Critical Condition: Privatized Health in the
Philippines,which features IBON’s research on maternal and child health and
nutrition conducted in seven provinces and one city in Metro Manila in 2014.)
According to the Aquino government, home birthing is the cause of high maternal
deaths, hence the Maternal, Newborn and Child Health and Nutrition Strategy (MNCHN),
dubbed as the “No Home Birthing” Policy.

The policy mandates public facilities or local government units (LGUs) to generate
income to upgrade birthing facilities or otherwise enter into public-private partnerships
or accredit private facilities as Basic Emergency Obstetric and Newborn Care (BEmONC).
Essentially, it pushes mothers to give birth in private or privatized facilities while public
providers remain ill-equipped if not totally absent.

The “no home birthing” policy has revealed itself to be burdensome and even dangerous,
punitive and costly for the majority of Filipino mothers.

The MNCHN strategy was first articulated through Administrative Order 2008-0029
under President Arroyo and updated under President Aquino through the MNCHN Manual
of Operations (MOP) released in 2011. The MOP is clear on the prohibition of the
traditional birth attendant (TBA)-assisted delivery (even by those trained by the
government) and the promotion of facility-based delivery.

The “no home birthing” policy relies on punishing women and the poor to ensure
compliance. Without ample public consultation, the policy is merely announced to
midwives and barangay health workers (BHWs) who are then tasked to relay it to the
communities.

A “no home birthing” policy is not culturally acceptable to indigenous groups that
practice their traditional home birthing. For example, Mangyans have a traditional way
of giving birth, which is done in a squat position with the pregnant woman holding on
to a rope tied to the ceiling.

The husband or a companion can assist her by holding her torso while she holds on to
the rope. Then they cut the umbilical cord with a blade from a plant called bagacay, a
local species of bamboo. But now some of the Mangyan women are afraid of giving birth
at home, because health workers from the health center say that if something happens
to the newborn or to the mother, a case will be filed against those who assisted in the
delivery.

This is implemented more stringently to members of the poverty program, Pantawid

Pamilyang Pilipino Program (4Ps) and the Conditional Cash Transfer (CCT), who were
informed that they would not receive their cash grant if they do not give birth in a health
facility.

Results of the IBON maternal and child health and nutrition survey reveal that 43.3% of
mothers surveyed gave birth at home, in a tricycle, in kuligligs (farm hand tractor), and
other means of transportation or other places. Interestingly, 22.6% of mothers who did
not give birth in a health facility said that the reason for not giving birth in a health
facility is “sa bahay na inabutan” (inadvertently gave birth at home).

This corroborates the 2013 National Demographic and Health Survey (NDHS) report that
only 4% of women who gave birth in the five years preceding the survey delivered free
of charge or paid in kind. The average payment during their last live birth was
Php2,982.00. There was not a big difference in the amount paid by women in urban and
rural areas.

Note: search for the research paper

  https://www.asianscientist.com/2013/05/health/mixed-messages-home-
deliveries-philippines-2013/
Mixed Messages On Home Deliveries In Philippines
The DOH policy known as the Maternal, Newborn, and Child Health and Nutrition (MNCHN) was issued in March 2011
to address the country’s stagnant maternal mortality ratio (MMR).

According to the 2011 Family Health Survey (FHS), the number of Filipino women who died from childbirth rose from
162 in 2009 to 221 in 2011. The 2008 National Demographic Health Survey (NDHS) shows that 56 percent of births
take place at home under the care of a traditional birth attendant (TBA) known locally as a ‘hilot.’ Read more from Asian
Scientist Magazine at: https://www.asianscientist.com/2013/05/health/mixed-messages-home-deliveries-philippines-
2013/

In the province of Samar, southeast of the country’s biggest island of Luzon, Samuel Baldono, a municipal health
officer, says an incentive of US$8-10 is given to the TBA for referring and accompanying the woman to the health
facility to have her baby delivered at no cost to her. “We have seen a dramatic increase in facility-based delivery since
this incentive was implemented and a corresponding decrease in maternal death. For the past two years, facility-based
delivery has risen to about 89 percent and we have had zero maternal deaths,” said Baldono. Read more from Asian
Scientist Magazine at: https://www.asianscientist.com/2013/05/health/mixed-messages-home-deliveries-philippines-
2013/

In Sultan Kudirat, in the southern island of Mindanao, a birthing policy pushing for facility-based delivery was passed
with an imposition of a $50 fine for home births. “There was a lot of protest, so the fine was never implemented, but the
provision is there,” said Renan Kasan, an area program officer with the UN Population Fund (UNFPA). Read more from
Asian Scientist Magazine at: https://www.asianscientist.com/2013/05/health/mixed-messages-home-deliveries-
philippines-2013/

“However, what we are worried about is maternal deaths that occurred at a homebirth going unreported because of
fear and confusion about this policy,” added Daniels. Read more from Asian Scientist Magazine at:
https://www.asianscientist.com/2013/05/health/mixed-messages-home-deliveries-philippines-2013/

Source: IRIN; Photo: Ana Santos/IRIN. Read more from Asian Scientist Magazine at:
https://www.asianscientist.com/2013/05/health/mixed-messages-home-deliveries-philippines-2013/