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    Facility-Based Newborn Care: Philippines Successes and Challenges

    Unang Yakap: The FirstEmbrace to Reforms in

    Newborn Care Practice

    ANTHONY CALIBO, MD, DPPSNational Center for Disease Prevention and Control (NCDPC),

    Department of Health (DOH), Republic of the Philippines

    Manila

    17 April, 2013

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    The Way We Were

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    Births Attended by Skilled Health Professionals

    and Place of Delivery

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

    Births Attended by Skilled Health

    Professionals (Physicians, Midwives and

    Nurses)

    Proportion of Births Occurring at Health

    Facilities and At Homes

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    1988-1998: 40%

    1998-2008:

    20% Stagnant NMR

    Neonatal Mortality Rate

    Under-5 and

    Neonatal Mortality Rates (NMRs)

    #of

    deathsper1000liv

    ebirths

    20 19

    15 15

    10

    0

    5

    10

    15

    20

    25

    Lowest Second Middle Fourth Highest#

    ofdeaths

    per

    1000

    live

    births

    Wealth Quinti le

    High NMR forRich and Poor

    Under Five Mortality Rate

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

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    Formative research, 2008

    Potentially harmful NB care practices(N = 481 in 51 Philippine hospitals; Acta Pediatrica 2011)

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    Policy Reforms

    Maternal, Newborn, Child Health and Nutrition(MNCHN) Strategy (Department of Health AdministrativeOrder 2008-0029)

    Adopting Policies and Guidelines on EssentialNewborn Care (DOH AO 2009-0025)

    Universal Healthcare / Kalusugang Pangkalahatan(DOH AO 2010-0036 )

    Essential Newborn Care Protocol (DOH/WHO/UNICEFClinical Pocket Guide)

    Clinical Practice Guidelines on Essential Intrapartumand Immediate Postpartum Care (DOH/WHO/POGS )

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    The Unang Yakap Campaign

    VISAYAS (1): Eastern Visayas Regional Medical Center

    (EVRMC)

    MINDANAO (2): General Santos City Hospital,

    Cotabato Regional and Medical Center (CRMC)

    LUZON (8): Quirino Memorial Medical Center (QMMC), Philippine

    General Hospital (PGH), Dr Jose Fabella Memorial Hospital,

    JRRMMC, EAMC, TMC, SLRWH, JNRMH

    Project

    Sites

    Board of MedicineBoard of NursingBoard of Midwifery

    Professional Regulations Commission

    Association of Deans of Philippine Colleges of

    Nursing (ADPCN)

    Association of Philippine Schools of

    Midwifery (APSOM)

    Association of Philippine Medical Colleges(APMC)

    Academic Organizations in the PHL

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

    Where We Are: State of the Art Interventions

    at Philippine Health Facilities

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    40

    343029

    2522

    17 1614

    0

    5

    10

    15

    20

    25

    30

    35

    40

    45

    NDHS 2003 NDHS 2008 FHS 2011

    Under-five Mortality Rate Infant Mortality Rate Neonatal Mortality Rate

    Attendant at birth and place of delivery,

    Philippines 2006, 2008 and 2011

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

    Skin-to-Skin Contact Practices at Birth in

    Health Facilities at subnational levels

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

    Per1000L

    ive

    Births

    MDG Targets for2015 (U5MR 26.7and IMR 19) are

    ACHIEVABLE

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    Challenges

    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 adecentralized health system

    Inconsistent guidelines between licensing andaccreditation

    Inadequate local capacity for supportive supervision andmonitoring

    Inconsistent / incomplete engagement and commitmentof private sector

    The Way Forward:

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    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: