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Women's’ Health and Safe Motherhood Project 2

Women's’ Health and Safe Motherhood Project 2. RESULTS OF WHSMP II SURVEY. HERITAGE HOTEL JUNE 26,2009. Project Objectives. 1. To assess adequacy and appropriateness of services related to Maternal Care and Family Planning

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Women's’ Health and Safe Motherhood Project 2

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  1. Women's’ Health and Safe Motherhood Project 2 RESULTS OF WHSMP II SURVEY HERITAGE HOTEL JUNE 26,2009

  2. Project Objectives 1. To assess adequacy and appropriateness of services related to Maternal Care and Family Planning 2. To assess adequacy and appropriateness of services related to Sexually Transmitted Illnesses 3. To gather information and insight into the medical and allied staff’s knowledge and appreciation of the policies, procedures and implementation of services

  3. Project Objectives 4. To generate information on the perception, knowledge and practices of the users of services 5. To determine the presence and effectiveness of the logistic management system 6. To determine the presence, adequacy and functionality of equipments and instruments as prescribed in the Sentrong Sigla Standards

  4. Scope of Work • Survey 1. Completion of the Household Based Survey (undertaken by SWS, 2004) • Analysis of Data • Survey 2. Facility Based Survey (FBS), 2007 • Conduct of Survey • Maternal Care (MC) and Family Planning (FP) Clients • Social Hygiene Clients (SHC) • Health Care Provider (HCP) • Inventory of Health Facility (IHF) • Analysis of Data • Integration of Results

  5. Scope of Work • Pilot Sites: Sorsogon and Surigao del Sur • Comparison Site: Western Samar Facility Based Survey • All Government Hospitals, Urban/Rural Health Units and Social Hygiene Clinics • Sampled Barangays • Sampled Clients and Health Care Providers

  6. Actual Samples

  7. PROJECTRESULTS Women's’ Health and Safe Motherhood Project 2

  8. Presentation Format (sample)

  9. Acronym • Pilot Sites: S Sorsogon SdS Surigao del Sur • Comparison Site: WS Western Samar

  10. MATERNALCARE Women's’ Health and Safe Motherhood Project 2

  11. SummaryMaternal Care • Maternal Care services provided by facilities focus more on Postpartum counseling, Postpartum care and Prenatal care • Less than a third were aware of the PhilHealth benefit package for maternal care except for SdS respondents in 2007 survey • Although respondents and results cannot be compared statistically, it appears that Facility Based respondents were more aware of a birth plan and its components. • HCP in the 2007 survey had inadequate knowledge of the components of a birth plan. Fewer respondents in Sorsogon could mention the components of a birth plan compared to the other provinces.

  12. Prenatal care Women's’ Health and Safe Motherhood Project 2

  13. SummaryPrenatal Care • In 2004 and 2007, majority of respondents consulted a health professional for prenatal care. More household based respondents in WS consulted a TBA or did not consult anyone • Most common prenatal care services include weighing and measuring BP. Although majority of HCP in Sorsogon and Surigao del Sur were familiar with routine urinalysis and blood examination, they were not commonly performed.

  14. SummaryPrenatal Care: Danger Signs • Around the same proportion of 2004 respondents could not recall any of the danger signs of pregnancy compared to 2007 respondents who could recall at least a danger sign of pregnancy. • Knowledge on danger signs across the provinces was incomplete since less than half knew about danger signs other than vaginal bleeding. • Sorsogon HCP respondents generally fared less than the respondents in the other two provinces regarding danger signs. • Around a half of HCP advice clients on danger signs of pregnancy. • Government facilities, including Rural Health Units, were the choice for consultation in the event of an occurrence of danger signs of pregnancy.

  15. DELIVERY/Child birth Women's’ Health and Safe Motherhood Project 2

  16. SummaryDelivery • Majority of HBS deliveries across the three provinces was attended to by traditional birth attendants. Less than 50% of facility-based respondents had births attended to by a TBA. • Majority of Health Professionals attending to deliveries were Midwives, 23%-35%. There is variation among the provinces on who assisted in the delivery. • More HCPs in Surigao del Sur were able to identify the different signs of labor • Very few underwent Caesarean section in the three provinces. • Majority delivered at home. There was a decreasing trend for home deliveries comparing next-to-last to last deliveries in both 2004 and 2007 surveys.

  17. SummaryDelivery • There was minimal knowledge on tasks performed in uncomplicated birth, basic and comprehensive emergency obstetric care • Blood transfusion and caesarian section service is available in a minority of facilities. This is critical since post-partum hemorrhage is a leading cause of maternal mortality. The same may hold true for the availability of Caesarean section, although the more appropriate site for this service may be the district hospital. • The availability of blood transfusion and caesarean section may be influenced by the availability of personnel, equipment, and infrastructure.

  18. fees Women's’ Health and Safe Motherhood Project 2

  19. SummaryFees • Majority of clients received free prenatal services, >50%. • Majority paid for the delivery from out-of-pocket in both the 2004 and the 2007 survey, >90% . • Less than 20% of facilities in the three provinces charged user fees for their services except for delivery services. • Prices of services were considered reasonable.

  20. ACCESSIBILITY Women's’ Health and Safe Motherhood Project 2

  21. SummaryPostnatal Care • Only a third to a quarter in Sorsogon and Surigao del Sur had post-natal check-up after their delivery. More respondents in Western Samar did not go for check-up. • There were differences among the three provinces regarding who attended to the post natal check up. • There were also differences among the three provinces where check-up was performed. Respondents had their check up at home, a health center, or a government hospital in various combinations depending on the province.

  22. SummaryPostnatal Care • Postnatal care focused on aspects of the baby’s health rather than on breast examination, internal examination, and family planning for the mother. • SdS respondents were more well versed regarding post-natal services including newborn care. • There were more HBS respondents who breastfed their children than FBS clients interviewed. • The more common danger signs known to HCP were vaginal bleeding, elevated BP and fever. Other danger signs not commonly known.

  23. FAMILY PLANNING Women's’ Health and Safe Motherhood Project 2

  24. SummaryFamily Planning • A majority of respondents in both surveys said that at the time of the interview they wanted the pregnancy except for Sorsogon HBS respondents. Around a quarter to a third wanted their pregnancies at a later time or not at all. • Statistical tests indicate that age has a significant correlation with desire to be pregnant considering the effect of province of residence of the respondent. The older the woman is, the more she would not want to be pregnant .   • Provision of temporary FP methods and FP counseling and IEC were more common than those for permanent methods. • Tasks on cancer screening services, provision of BTL and NSV were not commonly known.

  25. SummaryFamily Planning • In 2004, less than 50% of those who did not want a child practiced family planning. • In 2007, there were more respondents who did not want a child and used contraceptive methods, >55%. • A larger majority in SdS were able to mention “asking about desired family size”, preferred FP methods, desire to limit or space pregnancy, physical contraindications and obstetric history, • Surigao del Sur HCP were more aware on what to ask clients who want to practice FP, on physical contraindications and obstetric history.

  26. SummaryFamily Planning • The most commonly used and known method was the pill. • Other forms of family planning methods, aside from pills (e.g. diaphragm, implant, condoms, mucus/billings/ovulation, basal body temperature, etc.) were known to less than 2% of respondents. • Use of Modern FP methods is least known to HCP in Sorsogon. • The manner of use of implants and spermicides are the least known to respondents. • Use of Modern Natural FP methods are less known in fewer facilities compared to artificial methods.  

  27. STI/HIV/AIDS Women's’ Health and Safe Motherhood Project 2

  28. SummarySTI/HIV/AIDS • Very few respondents had an HIV/AIDS test during their prenatal visit,<3% • Surigao del Sur HCP respondents were more aware of the components of STI services than those from Sorsogon and Western Samar. There is some variability among provinces regarding knowledge of components of STI services. • Majority knew about sex as a mode of HIV/AIDS transmission, >75%, but very few knew about other modes of transmission. • Less than half of facilities gave condoms.

  29. SummarySTI/HIV/AIDS • According to clients, less than 50% of HCP talked about STI risks. Of note is that the source of information for STI risk behaviors was not the HCP for 50% and less respondents. • The most commonly known of HIV transmission was through sex with an infected partner while the modes of prevention were not commonly known. • MCFP respondents were slightly more aware of sexual contact as a mode of transmission but there was variability among the provinces regarding knowledge of symptoms in women and symptoms in men. • When HCP have clients with vaginal discharge, they commonly order laboratory test and conduct a physical examination. Not commonly done is taking STD and treatment history and assessing the signs and symptoms

  30. WHSMP TARGETINDICATORS Women's’ Health and Safe Motherhood Project 2

  31. Indicators under the WHSMP Results Framework80% of births delivered by skilled attendant, in either a facility or at home HBS 2004 TBA/Hilot 50% S, 61% SdS, 45% WS Midwife 30% S, 22% SdS, 35% WS Doctor 18% S, 15% SdS, 15% WS • Around 48% S, 37% SdS, 50% WS were delivered by skilled attendants • Majority were assisted by hilots/traditional birth attendants. MCFP 2007 TBA/Hilot 18% S, 43% SdS, 36% WS Midwife 33% S, 23% SdS, 29% WS Doctor 18% S, 15% SdS, 11% WS Nurse 18% S, 9% SdS, 11% WS • Around 69% S, 47% SdS, 51% WS were delivered by skilled attendants • Sorsogon had the least percentage of births attended to by a hilot and the highest percentage of births attended to by midwives.

  32. Indicators under the WHSMP Results Framework75% of births delivered in a health facility HBS 2004 Last Home 72% S, 82% SdS, 75%WS Gov’t Hos. 22% S, 14% SdS, 13% WS Other Public 1% S, 2% SdS, 2% WS Private 5% S, 2% SdS, 10%WS Prior to Last Home 74% S, 86%SdS, 84% WS Gov’t Hos. 20% S, 9% SdS, 10% WS Other Public 1% S, 3% SdS, 1% WS Private 5% S, 2% SdS, 5% WS • Majority gave birth at home • 28% S, 18% SdS, 25% W S gave birth in a health facility MCFP 2006 Last Home 47% S, 75% SdS, 71% WS Gov’t Hos. 38% S, 19% SdS, 22% WS Other Public 12% S, 3% SdS, 3% WS Private 2% S, 3% SdS, 3% WS Prior to Last Home 60% S, 83% SdS, 70%WS Gov’t Hos. 33% S, 13% SdS, 20% WS Other Public 6% S, 3% SdS, 2% WS Private 6% S, 2% SdS, 7% WS • Majority gave birth at home • 42% S, 25% SdS, 28% WS gave birth in a health facility

  33. Indicators under the WHSMP Results Framework75% of deliveries by the poor financed through PhilHealth HBS 2004 • Less than 1% of deliveries by the poor financed through DOH-LGU Performance grant. • Less than 2% of the respondents in all the provinces had their last births paid for by PhilHealth and the government. • 96% S, 94% SdS, 94% WS were paid for from out of pocket of the mother or her family. • These were similar data for next-to-last births. MCFP 2007 • Only 1% of respondents in WS and in SdS claimed that the government paid for the delivery. • Less than 7% said that PhilHealth paid for the delivery. • 94% S, 96% SdS, 90% WS had their last births paid on their own or by their families.

  34. Indicators under the WHSMP Results FrameworkIncrease contraceptive prevalence rate by 10 percentage points HBS 2004 • For those who used Family Planning methods, the most common method used across all provinces is the pill: 53% for S, 37% for SdS, 44% for WS. • The next preferred methods vary. 18% respondents from SdS used IUD and Calendar/Rhythm/ Periodic Abstinence and 30% from WS used Withdrawal. • However for all other methods, usage was less than 15%. MCFP 2007 • Some 32% in S and 42% in SdS, 57% in WS, used the pill; • 21% in WS, 15% in S and SdS used injectables. • Very few used the other family planning methods.

  35. Indicators under the WHSMP Results Framework80% of women who delivered in the past 6 months had birth plans HBS 2004 • 11% S, 35% SdS, 29% WS HCP prepared birth plan Base – those aware of a birth plan MCFP 2007 • 50% S, 71% SdS, 88% WS HCP prepared birth plan Base– those aware of a birth plan • 27% S, 73% SdS, 76% WS HCP prepared birth plan Base– pregnant respondents

  36. Indicators under the WHSMP Results Framework100% of FP users and ante-natal clients screened for STI according to prescribed protocol HBS 2004 • Less than 2% of respondents from all provinces had HIV-AIDS test. MCFP 2007 • Less than 3% of respondents from all provinces had HIV-AIDS test.

  37. Indicators under the WHSMP Results Framework70% of women who know the 3 ways (abstain, be faithful, consistent, correct condom use) of preventing the sexual transmission of HIV) HBS 2004 Abstinence 64% S, 53% SdS, 51% WS Monogamy 26% S, 26% SdS, 17% WS Condom 13% S, 23% SdS, 17% WS MCFP 2007 Abstinence 36% S, 45% SdS, 65% WS Monogamy 57% S, 69% SdS, 51% WS Condom 39% S, 52% SdS, 43% WS

  38. Indicators under the WHSMP Results FrameworkIncrease to 16% from baseline the total proportion of women or their partners using permanent methods HBS 2004 • 4% in S, • 6% in SdS and • 6% in WS had ligation • Less than 2% had vasectomy. MCFP 2007 • 5% in S, • 8% in SdS and • 6% in WS had ligation.

  39. Indicators under the WHSMP Results Framework100% of RHUs have not experienced stock-outs of pills, injectables and IUDS for the past 6 months (Stock-outs is the absence of supply) IHF 2007 • Pills 57% in WS, 52% in S and 64% in SdS • Injectables 57% in WS, 26% in S, 62% in SdS • IUD 51% in WS, 22% in S and 61% in SdS

  40. RECOMMENDATIONS Women's’ Health and Safe Motherhood Project 2

  41. Recommendations • DOH to develop a communication strategy to promote among clients: • Knowledge about maternal care specifically on birth plan, • Awareness about STI (including HIV/AIDS) signs, modes of transmission and prevention, • Knowledge about PhilHealth package of services particularly on deliveries;

  42. Recommendations • DOH to encourage the health facilities to provide all types of services (MC, FP, SH) any day of the week;

  43. Recommendations • DOH to institutionalize regular trainings of HCPs on: • Prenatal services, including birth planning, danger signs of pregnancy, • Recognition of the different stages of labor, • Family planning services especially those less popularly known, • STI, including HIV/AIDS evaluation, screening, treatment, and other related services, • safe handling of sharps and other activities related to HIV/AIDs;

  44. Recommendations • DOH to offer training on supply management and logistics;for nurses or other personnel who are responsible • Local health facilities should have capability to provide services like: • Caesarean section, • Blood supply, • Complicated deliveries, • Other gynecological conditions;

  45. Recommendations • PhilHealth to take a more aggressive stance to inform public re support for: • Birth expenses, • Family planning expenses, • Other MCFP packages.

  46. Recommendations • Patient records should be complete and updated for easy retrieval of data, accurate and fast reporting and policy development.

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