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Healthy mother and child: The face of universal health coverage in the Cordillera
Jane B. Cadalig

BEST FOR BABIES -- The Department of Health is aggressively promoting breastfeeding among lactating mothers to ensure optimum health and proper nutrition of their infants. -- Harley Palangchao

 

 
If the yardstick of effective and efficient health service delivery is the establishment of a functional health care system for mother and child, then health stakeholders in the Cordillera can assert their claim to such feat.

Thanks to a maternal and child health program being implemented through a partnership between the Japan International Cooperation Agency (JICA), the Department of Health (DOH), and local government units (LGUs), the region can boast of having an outstanding achievement in responding to the government’s move towards ensuring Universal Health Coverage (UHC).

Achieving UHC is among the political commitments of leaders of the Association of South East Asian Nation-member countries and has become an important element of any government’s move towards sustainable development and poverty alleviation and in minimizing social inequities.

One of the goals under the ASEAN Post-2015 Health Development Agenda is the strengthening of health system and access to care. To achieve this, leaders of the member-countries must ensure that they achieve UHC and health-related priorities under the Millennium Development Goals (MDGs).

Luckily for the Cordillera, it was chosen as the pilot area in the implementation of the JICA-assisted maternal and child care program, an initiative that made the region the country’s model in effective mother and child care, which is among the goals under the ASEAN health agenda.

“The success of the Cordillera-wide strengthening of the local health system for effective and efficient delivery of maternal and child health services is a testament of how government and its partners can efficiently respond to the health needs of its people,” according to DOH Usec. Herminigildo Valle.

The program, launched in 2010, is aimed at reducing maternal mortality rate by ensuring that every mother, especially in the remotest areas of the Cordillera, is attended by a skilled birth attendant in a well-equipped facility during delivery.

The project has reduced the ratio of mothers dying during delivery from 65 mothers per 100,000 live births in 2010 to 45 in 2015. Also, facility-based delivery rates rose from 68 percent in 2010 to 92 percent in 2015. The project wound up in February.

“Maternal and child health is the most basic health care service that any government and community can offer its citizens. Globally, the success of maternal and child care is the basis of judging the success of a government’s health system,” Valle said during the national forum that aimed to disseminate the project’s best practices, held in Baguio City in January.

“This JICA-assisted project can serve as a model for other regions to emulate if we are to be proactive in meeting the health needs of our communities because of the results and impact it had on our health delivery,” Valle added.

In May 2015, DOH-Cordillera announced in Baguio that it has achieved the MDG’s target of lowering maternal mortality and infant mortality rates in the region ahead of the deadline set by the United Nations. The UN has set the end of 2015 as a deadline for MDG targets or goals.

DOH-CAR has lowered MMR or mothers dying during childbirth by 52 deaths for every 100,000 live births in the Cordillera. In 2014, it has lowered regional MMR up to 49.64 percent, which is far better than other regions in the country. Infant mortality rate (IMR), which includes three segments – under five-year-old deaths, infant deaths, and neonatal deaths – has been lowered to an average of eight deaths per 1,000 live births.

Records show that from the 25 maternal deaths recorded in the whole region in 2012, it was lowered to 23 in 2013 then further slipped to 18 in 2014. And from the 7,840 live births from January to March 2015, only four deaths were recorded.

Improving maternal health and reducing child mortality are among the eight MDG targets set by the United Nations in October 2007. The Philippines and over a hundred other nations have committed to achieve the MDG targets.

DOH reported that MMR would be even lowered with the implementation of key strategies like pregnancy tracking and hiring of additional health responders. Increasing antenatal and post natal care through availability of portable ultrasound and trained personnel per rural health unit were among the targets set by the agency.

DOH-Cordillera also reported in 2015 that infant mortality rate had its marked decrease from 11.63 percent in 2009 to 8.16 percent in 2014. Neonatal mortality rate in the Cordillera was reduced from 9.68 percent in 2013 to 8.30 percent in 2014. The leading causes of neonatal deaths in the region are sepsis, prematurity, asphyxia and respiratory distress syndrome.

Philippine Health Agenda towards UHC

The Philippine government’s 2016-2022 agenda for health envisions financial protection for Filipinos, especially the poor, marginalized, and vulnerable are protected from high cost of health care; better health outcomes, which aspires that Filipinos attain the best possible health outcomes with no disparity; and responsiveness, which provides that Filipinos feel respected, valued, and empowered in their interaction with the health system.

In realizing these visions, the DOH, among other strategies, is advancing primary healthcare and quality and increasing the protection of Filipinos from financial health risk by expanding the coverage and benefit delivery of the health insurance program.

With its mandate to provide financial risk protection for all, the Philippine Health Insurance Corporation (PhilHealth) included maternity care in one of its benefit packages.

To increase the health-seeking behavior of expectant mothers, PhilHealth included in its list of benefits the Maternity Care Package (MCP), which is worth P8,000 if availed in PhilHealth-accredited MCP providers like birthing homes or maternity clinics. If mothers deliver in hospitals, PhilHealth’s reimbursement is P6,500.

The MCP package covers services during prenatal, normal delivery, and post-partum period, including follow-up visits within 72 hours and one week after delivery.

Encouraging mothers to ensure

healthy pregnancy and delivery

PhilHealth-Cordillera Information Officer Maggie del Rosario said the worth of MCP benefit package is higher for deliveries in community birthing facilities as one of the ways of encouraging mothers to avail the services of birthing homes, thereby declogging hospitals.

“Pregnancy is not a sickness, so we encourage mothers to deliver in birthing homes if their pregnancy is not high risk,” del Rosario said. The P8,000 MCP benefit package is applicable for normal deliveries or those with no complications.

The strategy is also one way of making sure that women have pre-natal consultations at the earliest time. PhilHealth requires expectant mothers to have pre-natal visits to detect and manage danger signs and complications of pregnancy and reduce risk of deaths.

DOH Asec. Gerardo Bayuga, who also attended the January national dissemination forum on the JICA-sponsored maternal and child care program in Baguio, said there should be no reason for mothers to not be prepared for their delivery.

“Expectant mothers have nine months to prepare for child birth so they also have the responsibility of ensuring their health and their baby’s. While the DOH will continue to work with JICA in all the activities that will benefit public health, we cannot do it alone. We need the support of the community and our private partners,” Bayuga said.

As of December 2016, there are 147 MCP providers (birthing facilities, clinics, infirmaries, and dispensaries) that are accredited by PhilHealth all over the region.

Benguet had the most number of PhilHealth-accredited MCP providers, which is 48, followed by Ifugao, 35; Apayao, 22; Abra, 19; Kalinga, 13; Mountain Province, eight; and Baguio City, two.

In terms of the amount of MCP claims paid by PhilHealth, Kalinga had the highest, which is P5,172,450 for the 1,107 claims followed by Ifugao (P5,066,300 for 1,033 claims); Abra (P2,652,950 for 550 claims); Benguet (P2,028,250 for 550 claims); Apayao (P1,813,400 for 376 claims); Mountain Province (P445,350 for 121 claims); and Baguio (P9,550 for two claims).

The MCP is just one of the many health benefit packages covered by PhilHealth.

Del Rosario said the state insurance company is supportive of any effort that will expand the health insurance coverage.

“We want every citizen to really feel the benefit accorded to them by the government,” she said.

Need for sustainability

Because the maternal and child care project has been successful, JICA said there is no need for it to be extended.

Dr. Takahiro Morita, JICA senior representative, said what the project needs is sustainability.

“Normally, we extend projects if we fail to achieve our targets. For this maternal and child care project, there is no need to extend it because it has been very successful. What the DOH needs to do is to sustain it,” Morita said.

He said JICA will continue working with the DOH for other projects aimed at achieving the government’s health agenda.

“We will definitely continue our assistance to DOH. We are open to any request from the Philippine government and we will continue to discuss what kind of program or project that can be done towards the achievement of the Philippine Health Agenda,” Morita said during the project’s closing forum in January.

DOH-Cordillera Director Lakshmi Legaspi said the agency and the LGUs have prepared their sustainability plans, which lay out the strategies that will be implemented to make sure that no mothers die while giving birth and to ensure overall well-being of mothers and their babies.

The maternal and child health program was first implemented in Benguet and has expanded to other areas including Ifugao, Kalinga, Mountain Province, 21 municipalities in Abra, and in Baguio City.

HI-5 PROGRAM -- The launching in 2015 of the Hi-5 program of DOH in line with the attainment of the Millennium Development Goals particularly its regional target of lowering maternal mortality and infant mortality rates greatly helped the agency and its partner, Japan International Cooperation Agency, achieved the target. Launching the program then were DOH USec. Gerardo Bayugo, DOH CAR ARD Amelita Pangilinan and JICA Deputy Chief Fude Takayoshi. -- Harley Palangchao

 

 
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