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P L C P D P O L I C Y B R I E F

Philippine Policies on Maternal, Newborn,


and Child Health and Nutrition:

Towards Achieving
MDGs 4 and 5
Carlos O. Tulali

Introduction

I
n the Philippines, 3.4 million pregnancies occur every year, half are unintended, one-third
of which end in abortions.1 An estimated 11 mothers die of pregnancy-related causes
every day, most of these deaths could have been avoided in a properly functioning
health care delivery system. Among the leading direct causes of maternal deaths in the
country are: post-partum hemorrhage, hypertensive disorders of pregnancy, abortion-
related complications and obstructed labor. Beyond the glaring data of mortality lies a
huge toll of ill health and disability due to pregnancy-related complications and infant and
child deaths and deepening poverty in families where a mother has died. It is estimated
that for every maternal death there is at least 20 to 30 other women who suffer from serious
complications, some of which are life-long. Maternal health conditions are the leading
causes of burden of disease among women.

Based on the State of the World’s Children of maternal, newborn and child health
2009 report of the United Nations Children’s and nutrition (MNCHN) for the Philippines
Fund (UNICEF), the Philippines is among 68 to achieve Millennium Development Goals
countries, which contributed to 97 percent 4 (Reduce child mortality) and 5 (Improve
of maternal, neonatal, and child health maternal health). This paper identifies
deaths worldwide.2 Statistics also show that and discusses currently available data
almost half of the deaths of Filipino children used to monitor the potential and actual
under five years old is within the first 28 days effects of Philippine government policies
of life’3 According to UNICEF, complications on maternal, newborn and child health
in childbirth are brought by hemorrhage, and nutrition (MNCHN) status. In addition,
sepsis, hypertension and abortive outcomes, recommendations will be made on how
which are actually preventable.4 to better meet the data needs for timely
analyses of the effects of policy on Filipino
Due to these reasons, monitoring and mothers and their children. The paper also
evaluation (M&E) system in health programs identifies critical gaps in MNCHN services and
play a crucial role in addressing the issue suggests a set of priorities for action to extend

Expanding choices, uplifting lives through responsive population and human development legislation
 PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5

and strengthen them. The aim of this paper declines in the fertility rates of women
is to provide access to, and understanding ages 25 to 34 have continued to be
of, this information to help legislators, more noticeable. The fertility rates of
policymakers, and health professionals to plan women ages 15-19 and 45-49 have
effective MNCHN programs and mobilize remained almost unchanged in the last
additional resources to improve the lives of 15 years while the rate of birth remains
Filipino mothers, newborns, and children. higher among women aged 25 to 29.

2. Maternal Mortality Trends - According


Maternal, Newborn, and Child Health and to the 2006 Family Planning Survey
Nutrition in the Philippines (FPS), the maternal mortality ratio for
the seven-year period prior to the
The quality of care that both mother and survey was 162 deaths per 100,000
newborn receive during pregnancy, at births.8 This implies a slight decline from
delivery, and in the early postnatal period the level of about 172 estimated from
is essential to ensuring women remain the 1998 NDHS. However, because of
healthy and that children get a strong start.5 the 95 percent confidence intervals
Many stillbirths and newborn deaths could around the point estimates of the two
be averted if more women were in good surveys, the apparent decline cannot
health, well-nourished, and receiving quality be considered statistically significant.
care during pregnancy, labor, and delivery, The 2008 NDHS did not collect
and if both mother and newborn received maternal mortality data.
appropriate care in the postpartum period.6
3. Infant and Child Mortality Trends
Most recent government surveys reveal the - Preliminary results of the 2008 NDHS
following state of MNCHN in the Philippines: show that there has been a decline
in under-five mortality rate in 15
1. Fertility Trends - The current fertility years, from 54 deaths per 1,000 live
rate, according to the National births during the period 1988-1992 to
Demographic Health Survey (NDHS) 34 deaths per 1,000 live births in the
2008 preliminary results, is at 3.3.7 The period 2003-2007. The infant mortality
NDHS 2008 also reports that fertility rate has declined, from 34 deaths per
levels in the Philippines declined 1,000 live births to 25 deaths per 1,000
gradually in the last 15 years. The live births.9

Box 1. Facts on maternal; and neonatal health in the Philippines:

- 160 women for every 100,000 births die.


- Roughly over 11 women die every day.
- 7 out of 10 deaths occur at child birth or within a day after delivery.
- 4 out of 10 deaths are due to complications and widespread infections
- For every death, 40 more women get sick.
- 8 out of 10 births in rural areas are delivered outside a health facility.

Source: UNICEF Philippines website, http://www.unicef.org/philippines/8889.html


Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 

4. Immunization of Children - The 2008 use iodized salt. The proportion of


NDHS preliminary report shows that households whose salt tested positive
overall, 80 percent of children ages for iodine is 56.4 percent.
12-23 months have received all of
the recommended vaccinations. 6. Childhood Illness - Acute respiratory
Immunization coverage is generally illness (ARI), malaria, and dehydration
high for each type of vaccine: 94 from diarrhea are the major causes
percent of children have received the of childhood mortality. In the 2008
BCG vaccination, 93 percent have NDHS, mothers were asked whether
received the first DPT dose, and 92 each child under age five had
percent have received the first polio experienced cough with short, rapid
dose. Coverage against measles is 84 breathing (symptoms of ARI), fever
percent. Only 6 percent of children (symptom of malaria), or diarrhea
have not received any immunization, in the two weeks prior to the survey
a decrease from 8 percent of children and the treatment given to those
not immunized in 2003. who experienced the symptom. The
survey results show that treatment was
5. Nutritional Status of Infant and Children sought from a health facility or health
- The 6th National Nutrition Survey provider for 50 percent of children
2008 initial results show that among with symptoms of ARI in the two weeks
children under age five, 27.6 percent before the survey. The survey results
are underweight and 1.4 percent also show that treatment was sought
are overweight. Among pregnant for 34 percent of children under age
and lactating women, 26.6 percent five who are reported to have had
and 11.7 percent, respectively, are diarrhea in the two weeks prior to the
underweight. The prevalence of survey, and 47 percent were given
anemia among 6 months to below solutions prepared from packets
1 year, and 1 year and 11 months of oral rehydration salts (ORS).
old children, is at 66 percent and 53 Fifty-nine percent of children with
percent, respectively. The prevalence diarrhea were given oral rehydration
of anemia among pregnant and therapy (ORT), which includes
lactating women is at 43.9 percent solution prepared from ORS and
and 42.2 percent, respectively.10 recommended homemade fluids.

The 2008 NDHS results show that 8


percent of infants under two months
old are not breastfed. Furthermore,
only 34 percent of infants under 6
months old are being exclusively
breastfed, most are mixed fed with
other milk or plain water or given
complementary feeding. By age 6-9
months, only 63 percent of infants
are being breastfed with 58 percent
receiving complementary food. Eighty
percent of households (mothers)
claim they are aware of iodized
salt, but only 38 percent actually
 PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5

Global Mandates on Maternal, Newborn, Effective advocacy to attract governments’


and Child Health and Nutrition attention and to mobilize resources is very
important. Consistent with the principles
The Philippines, together with the rest of the of the 1994 ICPD, MDGs, and the UN’s
other nations, is a signatory to international rights-based approach, three evidence-
conventions which recognize these rights based approaches to maternal and
such as the International Covenant on neonatal mortality reduction have been
Economic, Social and Cultural Rights in recommended by UN agencies (i.e. WHO,
1976, the Convention on the Elimination of UNICEF and the UNFPA) to address or avoid
All Forms of Discrimination Against Women the delays in service delivery:
(CEDAW) in 1979, the Convention on
the Rights of the Child (CRC) in 1989, the 1. All women must have access
International Conference on Population to reproductive health services,
and Development (ICPD) in 1994, the including contraception to determine
Beijing Declaration, Platform of Action the number and spacing of their
during the Fourth World Conference on children;
Women (WCW) in 1995, and the Millennium 2. Antenatal care, all deliveries, and
Development Goals in 2000, among others. post partum care must be attended
Most of these international conventions by skilled birth attendant with
were ratified by the Philippine Congress/ timely access to quality emergency
Senate and, therefore, the country is obstetric and newborn care, when
bound to implement and report progress in needed; and
achieving them. 3. All mothers and newborns must
benefit postpartum visits.
International Conference on Population and
Development

Access to reproductive health (RH) services


is a human right. This is explicitly stated in
the 1994 ICPD Programme of Action (PoA)
of which the Philippine Government is a
signatory to both. Against this background,
the ICPD, through the PoA marked the
willingness of the Philippine government,
international community, and civil society
to integrated SRHR concerns into all
economic and social activities. The PoA
of the 1994 ICPD, for example, calls on
governments and international donor
agencies to expand and transform existing
programs, and to offer services that are
comprehensive, integrated, universally
accessible, and delivered in a manner
consistent with health and rights objectives.

If maternal and neonatal mortality is to be


reduced, a comprehensive program and
strong political commitment are needed.
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 

alliance of some 280 governments,


Millennium Development Goals (MDGs) donors, NGOs, health care professionals,
academics, and multilateral agencies.
The Philippines has committed to fully support Its mission is to support the global health
the Millennium Development Goals (MDGs) community to work successfully towards
along with 191 other UN member states achieving MDGs 4 and 5 by advocating
when it signed the Millennium Declaration for national, regional, and global political
in 2000, particularly on improved maternal commitments, and by raising funds to
and neonatal health by tracking progress reduce maternal and child mortality. It
on reducing maternal and child mortalities. enhances partners’ interactions and uses
The Goals include reducing under-five their comparative advantages to: (1) build
mortality by two thirds (Goal 4) and reducing consensus on and promote evidence-
maternal mortality ratio by three quarters based, high-impact interventions, and
(Goal 5) between 1990 and 2015.11 In 2005, deliver them through harmonization; (2)
the UN General Assembly highlighted further contribute to raising US$30 billion (for 2009-
the need to incorporate the attainment of 2015) to improve maternal, newborn,
universal access to reproductive health (RH) and child health through advocacy;
by 2015 under MDG 5. and (3) track partners’ commitments
and measurement of progress for
Partnership for Maternal, Newborn, and accountability.12
Child Health
Global Consensus for Maternal, Newborn,
On September 12, 2005, the global and Child Health
Partnership on Maternal, Newborn, and
Child Health (PMNCH) was officially A new global Consensus for Maternal,
launched. The PMNCH is an international Newborn, and Child Health, setting out five
key action steps to save the lives of more
than 10 million women and children by
2015, was launched on September 23, 2009
at a high-level event at the United Nations.
The Consensus, strongly endorsed by the
Group of Eight (G8) at its meeting in Italy
in July, was agreed this year by a broad
range of governments, NGOs, international
health agencies, and individuals, through
the PMNCH, and formally launched by Dr.
Margaret Chan, Director-General of the
World Health Organization (WHO).13 The UN
event, attended by several heads of state,
heads of government, and other dignitaries,
reflected the united political will of the
international community.

Political will is in fact the first of five pillars


of the global Consensus, which lists
the priority actions that are needed to
accelerate progress on the MDGs for
maternal and child health. They are: (1)
 PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5

political leadership Though not directly specifying the state


and community duty on maternal and child health, the 1987
engagement; (2) a Philippine Constitution clearly mandates
quality package of the government to promote it by fulfilling
evidence-based its mandate on the health of the people
interventions, in general. Section 15 of Article II expresses
delivered through this state’s duty: “The state shall protect and
effective health promote the right to health of the people and
systems; (3) the instill health consciousness among them.”15
removal of barriers
to access, with It is only in the 1987 Philippine Constitution
services ideally being where health was enshrined as a
free at point of use for fundamental right of all Filipinos, particularly
all women and children; the poor. In the 1973 Constitution, it was only
(4) skilled and motivated included as part of the social services. In the
health workers, in the right place at the right 1935 Constitution, there was no mention of it.
time; and (5) accountability for results.14
1991 Local Government Code

Legal Bases With the passage of the 1991 Local


Government Code (LGC), health services
1987 Philippine Constitution. delivery was devolved to the LGUs.
Corresponding to the new powers and
The Philippine constitution has mandated functions of the different structures of the
the state to provide a comprehensive and health sector are the new responsibilities
accessible healthcare program to every that each LGU should assume. This
citizen. The constitution also prohibits any assumption of new powers, functions, and
discrimination due to religion and beliefs. responsibilities (to be discussed later in the
The State has the responsibility to provide institutional analysis) entails an institutional
information, assistance, and access to all restructuring of the DOH as the main national
types of FP methods. Thus, the government is agency responsible for overseeing health
expected to develop policies including health services delivery, financing, regulation,
programs based on these general principles. and governance of the health sector. The
1991 LGC mandates DOH to continue
Under the 1987 Constitution Article 13, Sec. to “formulate policies, standards, and
11: The State shall adopt an integrated regulations, as well as provide tertiary care in
and comprehensive approach to health tertiary hospitals and special hospitals, while
development which shall endeavor to the LGUs are responsible for the primary and
make essential goods, health, and other secondary cases in the hospitals and some
social services available to all people of the general tertiary hospitals, which are
at affordable cost. Moreover, Sec 14 provided by the provincial hospitals”16
states that the State shall protect working
women by providing safe and healthful Complementing the new functionality of
working conditions, taking into account the LGUs are the local health boards (LHBs).
their maternal functions, and such facilities These are special bodies that exist in all levels
and opportunities that will enhance their of LGUs, except in the barangays. An LHB is
welfare and enable them to realize their full composed of the local chief executive (i.e.,
potential in the service of the nation. governor for the provincial health board,
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 

city mayor for the city, and life cycle, and which addresses
municipal mayor for the the major causes of women’s
municipality) as chair; mortality and morbidity,
local health officer including access to among
(i.e., provincial, city, or others, maternal care,
municipal health officer) responsible, ethical, legal,
as vice-chairperson; the safe and effective methods
committee chair on health of family planning, and
of every local legislative encouraging healthy lifestyle
body sangguniang activities to prevent diseases;
panlalawigan (provincial 2. Leave benefits of two
board), sangguniang (2) months with full pay based
panlunsod (city board), and on gross monthly compensation,
sangguniang bayan (municipal for women employees who undergo
board), a representative from the private surgery caused by gynecological
sector or NGO involved in health services, disorders, provided that they have
and a DOH representative (provincial, city, or rendered continuous aggregate
municipality). The main function of the LHB is employment service of at least six (6)
to formulate policies on budget allocations months for the last twelve (12) months;
and act as advisory committee for the 3. Equal rights in all matters relating to
sanggunian. marriage and family relations. The State
shall ensure the same rights of women
Magna Carta of Women (RA 9710) and men to: enter into and leave
marriages, freely choose a spouse,
On August 15, 2009, Philippine President decide on the number and spacing
Gloria Macapagal-Arroyo signed Republic of their children, enjoy personal rights
Act 9710, also known as the Magna Carta of including the choice of a profession,
Women, which is a comprehensive women’s own, acquire, and administer their
human rights law that seeks to eliminate property, and acquire, change, or
discrimination against women by recognizing, retain their nationality. It also states that
protecting, fulfilling, and promoting the rights the betrothal and marriage of a child
of Filipino women, especially those in the shall have no legal effect.
marginalized sectors. All rights in the Philippine 4. Review amendment or repeal of laws
Constitution and those rights recognized that are discriminatory to women.
under international instruments duly signed 5. Mandate access to information and
and ratified by the Philippines, in consonance services pertaining to women’s health.
with Philippine laws, shall be rights of women
under the Magna Carta of Women. These There are several other national laws
rights shall be enjoyed without discrimination and issuances that support maternal and
since the law prohibits discrimination against child health interventions and services in
women, whether done by public and private particular, and public health affecting
entities or individuals. maternal and child health in general.
Among these are:
Features of the law include:
- Newborn Screening Law (RA 9288);
1. Comprehensive health services and - An Act Increasing Maternity Benefits
health information and education in Favor of Women Workers in the
covering all stages of a woman’s Private Sector (RA 7322);
 PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5

- Magna Carta of Public Health Workers MDG target to cut maternal and child
(RA 7305); deaths by 2015.
- Barangay Health Workers’ Benefits
and Incentives Act of 1995 (RA 7883); With pregnancy and childbirth posing
- The Paternity Leave Act of 1995 (RA serious risks to Filipino mothers and their
8187); and newborn, the country recognizes the need
- Philippine Midwifery Act of 1992 (RA to accelerate the reduction in maternal and
7392). child mortality. In response to this need, the
Department of Health (DOH) has initiated
Other MNCHN-related government key health reforms for the rapid reduction
issuances are: of maternal and neonatal mortality through
- maternal package for normal the DOH Administrative Order (AO) No.
spontaneous vaginal delivery in non- 2008-0029 on Implementing Health Reforms
hospital facilities (PhilHealth Circular for Rapid Reduction of Maternal and
No. 6); Neonatal Mortality.17 This mandates the
- supplemental guide for implementation of an Integrated Maternal,
“Garantisadong Pambata” (DOH Neonatal and Child Health and Nutrition
Circular 265-A); Strategy within the framework of the F1. It
- setting standard labeling for adopts a unified strategic framework for
breastmilk substitutes, infant formula, maternal and newborn health that is linked
other milk products, foods and with child survival strategies, maximizing the
beverages (DOH Circular 2008-0006); delivery of service packages, and ensuring
- Bright Child Program (EO 286); and a continuum of care across the life cycle
- national commitment for “Bakuna stages. Under this strategy, all pregnancies
and Una sa Sanggol at Ina” (EO 663). are considered at-risk. Likewise, it takes
into consideration the three major pillars in
reducing maternal mortality and morbidity,
Government Policies and Programs namely, emergency obstetric care, skilled
birth attendants and family planning.
Integrated Maternal, Neonatal, and Child
Health and Nutrition Strategy AO 2008-0029, issued on September 9,
2008, outlines specific actions for national
The health of mothers and children were and local health systems to systematically
placed at the center of health sector address health risks with the end goal of
reform, consistent with rapidly reducing maternal and neonatal
the advocacy that deaths. It states that the “strategy shall
all women have guide the development, implementation,
the right to safe and evaluation of various programs aimed
and quality at women, mothers and children, with the
emergency ultimate goal of rapidly reducing maternal
obstetric and neonatal mortality in the country.”18 It
services aims to address service delivery, regulation,
(EmOC) financing, and governance of the Philippines’
to prevent health system. The integrated MNCHN
maternal strategy, implemented in all provinces
and newborn and cities, is aimed to meet the following
deaths, and reproductive health (RH) indicators by 2010:
achieve the - increase CPR to 60 percent;
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 

- increase the way for a globally accepted, and evidence-


proportion of based essential newborn care health system.
pregnant
women having Women’s Health and Safe Motherhood
at least four Project
antenatal
care visits to As a measure to accelerate efforts on
80 percent; MMR reduction, the Philippine government
- increase has adopted Women’s Health and Safe
skilled birth Motherhood as its flagship program under
attendance the sector-wide F1 for Health with the
and facility-based help of other stakeholders such as the
births to 80 percent; World Bank, ADB, EU/GTZ, JICA, USAID,
and WHO, UNICEF, and UNFPA. The Second
- increase percentage of fully- Women’s Health and Safe Motherhood
immunized children to 95 percent. Project (WHSMP2) will contribute to the
national goal of improving women’s
On September 18, 2009 the Philippines’ health by: Demonstrating in selected sites
Department of Health (DOH) announced a sustainable, cost-effective model of
that the three United Nations (UN) agencies delivering health services that increases
- UNFPA, UNICEF, and WHO - have joined access of disadvantaged women to
forces and resources to undertake a joint acceptable and high quality reproductive
program on rapidly reducing maternal and health services and enables them to safely
neonatal deaths in the country and meet attain their desired spacing and number
the MDGs. The new project, with the support of children. The main objectives of the
of the Australian Agency for International WHSMP2 in the Philippines are the following:
Development (AusAID) is divided into two 1. To increase the access of
significant phases: the Transition period disadvantaged women of
(2009-2011), which will cover the provinces reproductive age to acceptable,
of Eastern Samar, Ifugao, Lanao del Sur, high quality, and cost-effective
Maguindanao, North Cotabato, and reproductive health services and
Saranggani, and the urban poor areas enable them to safely attain their
in Tacloban, General Santos, Taguig, desired spacing and number of
Navotas, Parañaque and Makati; and the children; and
Full Operationalization Period covering the 2. To assist in the development and
years 2011-2016.19 implementation of sustainable
and replicable systems within the
On December 7, 2009, the DOH released framework of the Health Sector Reform
a new Administrative Order on the subject Agenda for financing and delivery of
“Adopting New Policies and Protocol on reproductive health services.
Essential Newborn Care (ENC),” which details
specific policies and principles to follow for Family planning
all health care providers involved in newborn
health care.20 Consistent with AO 2008- A national mandated priority public health
0029, the newly-released AO will provide program to attain the country’s national
key behaviors and appropriately-timed health development: a health intervention
interventions to make the post-natal period for program and an important tool for the
newborns safer. It is also seen to help pave the improvement of the health and welfare of
10 PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5

mothers, children, and other members of the development. It encourages the active
family. It also provides information and services involvement of parents and communities.
for the couples of reproductive age to plan The implementation of this system shall be
their family according to their beliefs and the responsibility of the national government,
circumstances through legally and medically LGUs, NGOs, and private organizations.
acceptable family planning (FP) methods. The rearing of a child is a traditional role
of mothers. With the enactment and
Philippine National Strategic Framework for implementation of this law, raising a child is
Plan Development for Children, 2000-2025 no longer solely the responsibility of mothers.
(Child 21) The community, the national and local
governments, and other institutions are now
The health sector’s contribution to the obliged to assist in providing for the basic
Philippine National Development Plan for holistic needs of young children. ECCD
Children defines the vision for children by programs include: child care programs;
2025, formulates cost-effective interventions, parent effectiveness seminars; child
and outlines a budget that will reflect minding centers; family day care services;
contributions of different national and local parent-child development programs; and
government units, the private sector, NGOs, kindergartens in public schools.
and international organizations. It serves as a
framework for local government units (LGUs) Promotion of Breastfeeding program /
in the formulation of their development plans. Mother and Baby Friendly Hospital Initiative
Children’s Health 2025, a subdocument of
Child 21, realizes that health is a critical and Realizing optimal maternal and child health
fundamental element in children’s welfare. nutrition is the ultimate concern of the
Promotion of Breastfeeding Program. Thus,
The vision of Child 21 has been concretized exclusive breastfeeding in the first four to
through the formulation of the National six months after birth is encouraged as well
Plan of Action for Children for the period as enforcement of legal mandates. The
2005-2010, aimed at reducing disparities Mother and Baby Friendly Hospital Initiative
in development indicators for children. (MBFHI) is the main strategy to transform all
Subsequently, there will be a National Plan hospitals with maternity and newborn services
of Action 2011-2015 (Catching up with the into facilities which fully protect, promote,
Millennium Development Goals); a National and support breastfeeding and rooming-in
Plan of Action 2016-2020 (Sustaining the practices. The legal mandate to this initiative
gains); and a National Plan of Action 2021- are the RA 7600 (The Rooming-In and
2025 (Achieving the Child 21 vision). Breastfeeding Act of 1992) and the Executive
Order 51 of 1986 (The
Early Childhood Care and Development Milk Code). National
Program assistance
in terms of
Republic Act 8980, known as the Early financial
Childhood Care and Development (ECCD) support for
Act of 2000, defines the ECCD System as this strategy
the full range of health, nutrition, early ended in
education, and social services programs 2000, thus
that provide for the basic holistic needs LGUs were
of young children from birth to age six (6), advocated to
to promote their optimum growth and promote and
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 11

sustain this initiative. To sustain this initiative, diseases. The Expanded Program on
the field health personnel has to provide Immunization is one of the DOH Programs
antenatal assistance and breastfeeding that has already been institutionalized
counseling to pregnant and lactating mothers and adopted by all LGUs in the region. Its
as well as to the breastfeeding support objective is to reduce infant mortality and
groups in the community; there should also morbidity through decreasing the prevalence
be continuous orientation and re-orientation/ of six immunizable diseases (TB, diphtheria,
updates to newly hired and old personnel, pertussis, tetanus, polio and measles).
respectively, in support of this initiative.

Food Fortification program Government Financing for MNCHN

The Food Fortification program is the Health care financing system refers to
government’s response to the growing various structures, methods, processes and
micronutrient malnutrition, which have procedures in which financial resources
been prevalent in the Philippines for the are made available to fund health sector
past several years. Food Fortification is the activities, and how it is used on the delivery
addition of Sangkap Pinoy or micronutrients of health services. The purpose of health
such as Vitamin A, Iron and/or Iodine to food, financing is to make funding available,
whether or not they are normally contained to set the right financial incentives for
in the food, for the purpose of preventing or providers, as well as ensure that all
correcting a demonstrated deficiency with individuals have access to effective public
one or more nutrients in the population or health and personal health care.21 Poor
specific population groups. Micronutrients women, their children, and families use
are vitamins and minerals required by the public-funded maternal and child health
body in very small quantities. These are (MCH) services worldwide. However, with
essential in maintaining a strong, healthy, the decline in public-funded health services
and active body; sharp mind; and for and the growing role of private-financed
women to bear healthy children. systems, poor women and their children
are at risk of falling through the cracks of
Expanded Program on Immunization business-driven health systems.22

Children who are not fully immunized are Based on the 2003 Philippine National
more susceptible to common childhood Health Accounts (PNHA) estimates,

Box 2. State of Health Care Financing in the Philippines

Current health financing:


• Total health expenditures only 3% of GNP
• 59% from out-of-pocket payments
• 16% from national budget (DOH and ODA)
• 13% from LGU budgets
• 11% from PhilHealth
We are not spending enough on health
• 3% of Phil GNP vs. WHO 5% of GNP standard
12 PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5

the Philippine national government reproductive health as well as other priority


expenditures for preventive and public health programs.
health services went to programs for
prevention of communicable diseases PhilHealth
(34%) and non-communicable diseases
(23%), and maternal and child health (9%). The Philippine Health Insurance Corporation
Similarly, expenditures of foreign-assisted (PhilHealth) is the government agency
projects mostly paid for programs for responsible for managing the National
prevention of communicable diseases (32%) Health Insurance Program (NHIP). As
and non-communicable diseases (23%), such, it is a major source of financing
and maternal and child health (22%).23 health services through its various benefit
packages including the maternal care
The recent increases in the Philippines package for normal deliveries and the new
national health budget (approximately born screening package.
100% in 2008 and an additional 30%
increase in 2009) are changing the way PhilHealth provides a viable source for
that the Department of Health (DOH) financing FP and maternal and child
makes fiscal transfers to regions and local health services and products. The range
governments. Starting in October 2008 of PhilHealth benefit packages include
the DOH moved away from input-based a maternity care package for normal
allotments in favor of performance based deliveries that includes the first cycle of oral
block grants. The RHR Department is contraceptives, the first dose of injectable
supporting a rapid assessment of two of contraceptive postpartum, and the first
these performance based grants: grants to dose of BCG for the infant. Philhealth
fund reproductive health also covers IUD insertion and voluntary
commodities; and sterilization. PhilHealth benefit packages
women’s health also include a newborn care package
teams. Results will that covers the cost of newborn screening.
be used by the However, utilization of these benefit
government packages remains low. Furthermore, the
as it plans issues on accreditation and reimbursement
to increase still need to be addressed.
substantially
the use of FOURmula One for Health and MNCHN
performance
based funding In 2005, under national leadership of the
modalities for DOH, based on a deeper understanding of

Box 3. Health Insurance Coverage


The Philippines’ 2008 National Demographic and Health Survey (NDHS)
included a module of questions concerning health care utilization and costs.
Based on the NDHS 2008 results, only 42 percent of Filipinos are covered by
some form of health insurance.
Source: National Statistics Office (NSO), and ICF Macro, 2009. National Demographic and Health
Survey 2008. Calverton, Maryland: NSO and ICF Macro.
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 13

the requirements of implementation, and Investment in maternal health programs


coordinated support from development can be tracked by measuring inputs (such
partners, the Government formulated a as midwifery training), outputs (such as the
new health reform implementation strategy, number of midwives posted) and processes
known as “FOURmula One for Health” (such as the uptake of skilled delivery
(F1). The strategy organizes the reforms into care). 25 These indicators are necessary for
four implementation components, namely: planning, implementing and monitoring
Health Financing, Health Sector Regulation, initiatives to improve maternal health.
Health Service Delivery (covering both
public health and hospital reforms), and The F1 strategy coordinates health reform
Health Sector Governance in Health more closely with public expenditure
(covering DOH’s internal management management and governance reform,
and its sector coordination and leadership including public procurement reform,
role, of stewardship over the whole health and measures to increase transparency
system). The new implementation strategy and accountability in public expenditure
emphasizes the role of PhilHealth’s national management. Reform implementation
social insurance program as the main lever planning has been integrated with the
to effect desired changes and outcomes formulation of a medium term Health
in all four implementation components at Sector Expenditure Framework, and the
national and local levels. annual budget process. A performance
monitoring framework for DOH, PHIC, and
The objective of financing reforms under convergence provinces, will link budgeting
F1 is to secure more, better, and sustained and resource allocation to outputs and
investments in health to provide equity and intermediate results.
improve health outcomes, especially for
the poor.24 Mobilizing additional resources The DOH budget for family planning and
for health will entail increasing revenue maternal and child health has significantly
generation capacities of health agencies increased in the last two years. While the
without compromising access by the poor. DOH does not have a specific line item
This may include revenues from user fees for procurement of contraceptives, the
and charges for personal health care General Appropriations Act of 2008 has an
and regulatory services, and rationalized earmark in the DOH budget P180 million to
use of real property assets belonging to the DOH for operational costs associated
government health agencies. with providing contraceptive services;
P30 million for the routine functions of
F1 specified clear targets and identified DOH in support of FP and,
priority projects and activities of the DOH through congressional
for the medium and long term, emphasizing initiative, another
the needs to focus attention toward the P150 million to be
attainment of the MDGs and the National sub-allocated
Objectives for Health (NOH) for 2005-2010. to LGUs for
purchasing RH
commodities
Monitoring and Evaluation and conducting
FP seminars.26
Government commitments to maternal The GAA of
and child health can be monitored using 2008 again
financial indicators and policy approvals. had an earmark
14 PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5

in the DOH budget of P2 offices are also responsible for


billion for contraceptives coordinating the efforts of
and related training, NGOs to ensure the broadest
promotional and possible coverage for
other costs. P1.2 services and to facilitate
billion of this earmark information transfer to the
is for contraceptives local and national MIS.
and downloaded to The DOH has retained
the LGUs to facilitate responsibility for overall
LGU procurement of monitoring and evaluation
contraceptives. The of local programs, projects,
guidelines for operationalizing facilities, setting of standards,
this financing mechanism, while and for technical support services
already developed, have yet to be fully such as logistics, training, IEC, and
understood by DOH staff and have yet to information systems.
be uniformly applied across regions, with
the exemption of ARMM where guidelines At the local level, a number of LGUs have
may have to be adjusted to respond to budgets for FP and maternal and child
realities in the region. health, including the procurement of
contraceptives and essential maternal
Monitoring at the Local Level and child health drugs and supplies. This
makes the LGU a significant market for
Since 1991, DOH has also had to deal private sector products. However, issues
with the implementation of the Local around procurement and willingness of
Government Code, which devolved suppliers to serve the LGU market still need
responsibility for the provision of social to be addressed. Equally important is the
services, including health and family availability of private sector providers in
planning, to local government units (LGUs). the community. While these are available,
LGUs are subdivided into 81 provinces, there is very little appreciation of the role of
136 cities, 1,495 municipalities and 42,008 private sector in the delivery of basic public
barangays as of December 31, 2008.27 health services. Hence, the private sector
The LGUs are grouped into seventeen is rarely tapped for family planning and
(17) regions based on their geographical maternal and child health services and local
locations. environments for private sector practice
are not always favorable. Local policies for
Provinces and cities are responsible mobilizing the private sector in the delivery of
for planning, overall coordination of public health still need to be developed and
population/family planning/maternal regulating systems are not strong.
and child health (MCH) activities, and for
family planning services provided through Based on the monitoring of 87 municipalities
provincial and city hospitals. Municipalities and 41 independent cities conducted by
are responsible for delivery of family the United States Agency for International
planning/MCH services through a network Aid and Development (USAID), and the
of clinics and outreach services. Nearly University of the Philippines School of
all provinces and cities have a Population Economics, the total amount released
Office and a Health Office and staff by the DOH to LGUs, as of May 15, 2009
responsible for planning and monitoring amounted to P90,131,728.94 or 60.09
of family planning-related activities. These percent of the P150 million DOH budget
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 15

sub-allocated to LGUs under the GAA monitoring and


2008 for purchase of RH commodities evaluation.32 All the
and conduct of FP seminars. Seventy above factors have
seven percent of the municipalities and created large gaps
63 percent of the cities that have been in maternal and
monitored have already accessed the newborn health. For
funds.28 example, antenatal
care is limited, with
low rates of tetanus
Policy Gaps toxoid immunization
and iron and iodine
Low government expenditures for health supplementation,
with virtually no folic acid
In 2005, the Philippines’ total health supplementation. As a result, a
expenditure went up by 9.4 percent, from large number of babies, including low
P165.3 billion in 2004 to P180.8 billion in 2005. birth weight infants, are at higher risk for
However, the share of health expenditure morbidity and mortality. Coupled with this
to GDP was lower at 3.3 percent in 2005 are low exclusive breastfeeding rates and
compared to 3.4 percent in 2004. It is poor feeding practices contributing to high
still below the 5 percent standard set by neonatal, infant, and under-five mortality
the WHO for developing countries.29 The rates.
WHO database showed total per capita
expenditure on health in the Philippines was Lack of a national reproductive health law
at $177 from 2000–2004. This is relatively low
by comparison to neighboring countries like In the Philippines, the passage of a national
Malaysia ($355) and Thailand ($257).30 law to address the RH care needs of
women still remains a major challenge. The
With increasing costs of health care, devolution of health services, alongside the
aggressive marketing of social health present administration’s policy of leaving
insurance, and growth of HMOs, health the responsibility of providing RH services to
financing has become a major concern LGUs, resulted to major disparities in access
to ensure optimal mobilization of financial to RH services. While some LGUs already
resources for health care. Health financing have their own RH ordinances, there were
is one of the major programs under the F1 recorded cases of local public health
Framework that aims to acquire better and facilities denying women of information and
sustained health investments and provide services on the full range of contraceptive
equitable services and improve health methods in other LGUs.
outcomes especially for the poor.31
Government promotes natural family
Lack of a comprehensive newborn health planning only
program
The Philippine constitution has mandated
Instead of a comprehensive newborn the state to provide a comprehensive and
health program, various interventions are accessible healthcare program to every
embedded in maternal or child health citizen. The constitution also prohibits any
programs. The scattered efforts weaken the discrimination due to religion and beliefs. The
potential political will and fiscal ‘dedication’ separation between the church and state
needed for adequate implementation, is mandated as well. There are many non-
16 PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5

Catholics the state must also serve. The State - Advocating with national and local
has the responsibility to provide information, authorities the importance of having
assistance, and access to all types of FP systems for regular maternal, infant,
methods. Thus, the government is expected and child mortality monitoring;
to develop policies including health - Selection of indicators and
programs based on these general principles. procedures, by consensus;
- Design and implementation of local
The government violates the constitution and national maternal, infant, and
when it promotes and emphasizes particular child mortality monitoring plans; and
programs that are discriminatory to certain - Performance audits and maternal,
groups either because of religious or political infant, and child mortality monitoring
beliefs. The government’s promotion of the processes.
natural family planning (NFP) method over
the other methods available to our people is Monitoring at the local level provides
a de facto violation of our constitution in this information for planning and improving
regard. This policy is obviously designed to interventions, and for building consensus
please the Roman Catholic church. among stakeholders: service providers,
policymakers, women, community
leaders, and local authorities. Local
Policy Options and Recommendations: monitoring should include indicators
of access to quality obstetric care, as
Strengthen monitoring system at national well as socioeconomic determinants
and local levels of risk of maternal deaths, such as
health infrastructure, institutional and
At the national level, policies and plans social responsibilities, levels of local
concerning maternal, infant, and child government commitment, and community
mortality outcomes should be monitored, participation.
including legislation and reforms, policies,
and programs that promote healthy The monitoring of maternal, infant, and child
pregnancy, contraceptive services, and death is the responsibility of health workers
gender-based violence prevention. Equally and community members who should
important are indicators of stakeholder represent different sectors and groups (age,
participation in determining and monitoring sex, and ethnicity) to ensure the participation
progress, which includes their role in of the populations most affected by
communication, organization, training, maternal, infant, and child deaths.
supervision, planning,
local and social These stakeholders should organize
management, committees that provide immediate
emergency information and actions for interventions to
networks and local authorities and program managers at
referral systems, the local, district, and health center levels.
and budget Monitoring committees play an important
appropriations. role in:
- Strengthening the information systems
National by involving community organizations;
monitoring - Selecting priority areas for
systems should, intervention;
therefore, include: - Strengthening administrative
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 17

structures and resources for On TBAs and


intervention implementation; and community health
- Introducing complementary methods workers:
of analysis such as qualitative - Defining
research. roles and
incentives
Increase investment for maternal and child in “women’s
health facilities and personnel health team”
- Training TBAs
Essential to the MNCHN strategy are as professional
facilities that can provide basic emergency midwives
obstetric and neonatal care (BEmONC). - Regulating TBA
These facilities operate on a 24-hour basis, practices
and are accessible within 30 minutes of
travel, equipped with communication and The World Bank estimated that a total of
transportation systems for referrals. Every three US dollars per person a year can
BEmONC facility should have a physician, provide basic family planning, maternal,
nurse, and midwife. Also essential to the and neonatal health care to women in
MNCHN strategy are the comprehensive developing countries.34 The services would
emergency obstetric and neonatal care include:
(CEmONC) facilities which are accessible - Routine maternal care for all
within one hour travel time, operational pregnancies, including a skilled
on a 24-hour basis, and capable to carry attendant (midwife or doctor) at birth;
out emergency responses. A CEmONC - Medical training for traditional birthing
facility should be staffed with at least attendants might be one way to help
one obstetrician/surgeon, pediatrician, provide this service;
anesthesiologist, six nurses, medical - Emergency treatment of
technologist, and six midwives.33 complications during pregnancy,
delivery, and after birth;
Part of the additional investment needed to - Postpartum family planning and basic
reach MDGs 4 and 5 should be allocated neonatal care;
to recruit, train, equip, and deploy more - Educating women and their
health workers. Targets should be set for communities about the importance of
expanding the number of trained and maternal health care, and according
properly equipped health workers in the women the social status to make
country, particularly to meet the needs health care decisions and seek
of the poorest and most marginalized medical attention;
communities. - Any form of education, even 6 years
worth of education for girls can
On midwives, nurses and doctors: drastically improve overall maternal
- Upgrade skills of midwives, nurses and health;35
doctors for BEONC, BEmONC and - Research on social and psychological
CEmONC factors affecting maternal health; and
- Mandates for midwives - Development of better interventions
- Develop as team of professionals (and evaluations of interventions) for
- Midwives at basic level complex problems (e.g., behavioral,
- Midwives, nurses and doctors at social, biological, cultural) arising in
BEmONC and CEmONC marginalized communities.
18 PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5

Expand PhilHealth’s enrollment coverage seek the active


involvement of
The NHIP should be further strengthened men in finding
by expanding enrollment coverage, solutions to
improving benefits and leveraging the following
payments on quality of care. As the lead problems in
implementer of the health financing reform the country:
component, PhilHealth (a) ending
needs to recognize that gender
changes in enrollment, inequities;
benefits, and provider (b) promoting
payments need to be adequate child
well orchestrated to spacing intervals;
become effective. and (c) reducing the
Moreover, PhilHealth levels of teenage pregnancy.
has to recognize that
it operates in local Promote public-private partnerships
markets and would
have to continue In an increasingly business-driven health
engaging partners at care environment, public health advocates
that level. face the major challenge of how to
integrate health programs with population-
Involve health care professionals based social, economic, psychosocial,
and their organizations and environmental services. To integrate
these services, MNCHN advocates should
Health care professionals and their emphasize the role of public-private
organizations have central roles to play partnerships at local, national, and
in the partnership for promoting MNCHN. international levels in addressing MNCHN
These organizations represent highly trained issues. The ultimate goal of the partnership
professionals (physicians, nurses, midwives, is to harness scarce public and private
and pharmacists) with the following rules: resources and to coordinate the use of such
- They serve in all sectors: public, resources to meet the needs of MNCHN
private, and non-governmental; clients.36 A public-private partnership
- They provide informed leadership in can only be considered a success if it
MNCHN, and constitute the core of leads to measurable improvements in
health care for mothers, newborns, the health status of defined MCNCHN
and children at national and local target populations. NGOs, multinational
levels; corporations, professional associations,
- They also have vital roles to play in the and community-based organizations will
education and training of all levels of become essential participants in these
health care personnel. partnerships.

Stronger involvement of males in MNCHN Pass a national reproductive health law


issues and services
Couples have the right to information and
Although Filipino men become visible access to the right contraceptive method
in MNCHN issues, their roles often are at the right time and at the right place.
peripheral. MNCHN advocates should Furthermore, it is estimated that there are
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 19

3.1 million pregnancies in the Philippines The issue of the


every year, half of which are unplanned, sustainability of
with one third ending in abortions. The existing MNCHN
passage of a RH national law seeks to program
bring down cases of maternal deaths by commitments must
allowing better access to services on RH also be addressed.
and FP, making FP commodities affordable, Enshrining national
and providing information and education commitments in
to women and couples on pregnancy a legal framework
and family planning. Strategies to reduce can provide the
high levels of newborn mortality should be necessary continuity in
linked to policies and strategies in related support of scaling up the
fields, such as reproductive health, safe continuum of care beyond
motherhood, child survival, and early the political lifespan of its initial
childhood development, and incorporated champions. Development of maternal,
in national health plans. newborn, and child health approaches
should take place within a national policy
framework (e.g. through a reproductive
Conclusion health law). This longer-term political
agenda requires partnerships between
The health of women and their newborns government, civil society organizations, and
and children are inextricably entwined. development agencies to maintain the
Neonatal deaths are frequently the result political momentum, overcome resistance
of poor maternal health, inadequate to change, and mobilize resources. A well
care during pregnancy, inappropriate functioning health system also requires
management of complications during accountability mechanisms and checks
pregnancy and delivery, poor hygiene and balances. Finally, sustained investment
during delivery and the first critical hours in both time and resources is required
after birth, and lack of newborn care. over many years to steadily take MNCHN
Several factors such as women’s status programs to scale.
in society, their nutritional status at the
time of conception, early childbearing,
frequent and closely spaced pregnancies,
and harmful practices are deeply rooted
in the cultural fabric of societies and
interact in ways that are not always clearly
understood.37

Government must be committed to


support health programs of health-system
administration at the national and local
levels. Reductions in maternal, newborn,
and child mortality are needed at the LGU
level to achieve the ambitious MDG of
reducing maternal and child mortality by
three quarters and two-thirds, respectively,
by 2015.
20 PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5

Endnotes
1
Darroch JE, Singh S, Bal H, Cabigon JV, “Meeting women’s 17
http://home.doh.gov.ph/ao/ao2008-0029.pdf
contraceptive needs in the Philippines,” Issues in Brief, Alan 18
http://www.doh.gov.ph/files/ao2008-0029.pdf.
Guttmacher Institute 2009;1:1-8. 19
http://www.doh.gov.ph/node/2423.
2
United Nations Children’s Fund. The State of the World’s 20
http://www.doh.gov.ph/node/2506;
Children 2009, New York: UNICEF, December 2008. 21
Department of Health, National Objectives for Health
3
“UN urges DoH to probe why 11 mothers die due to pregnancy 2005-2010 (Manila: DOH, 2005).
or childbirth,” UNICEF Philippines, 11 May 2009. Available at 22
Akukwe C., “Maternal and child health services in the twenty-first
http://www.unicef.org/philippines/8891_10641.html; century: critical issues, challenges, and opportunities,” Health Care for
4
Senate of the Philippines, “Accelerate efforts on maternal Women International, 07399332, Oct/Nov2000, Vol. 21, Issue 7.
and newborn deaths prevention thru research – Angara,” 23
Ibid.
23 February 2009. Available at http://www.senate.gov. 24
http://www2.doh.gov.ph/f1primer/F1-Page.htm#pg6a;
ph/press_release/2009/0223_angara1.asp. 25
Wardlaw T and Maine D, “Process indicators for maternal
5
Anne Tinker et al., “A Continuum of Care to Save Newborn mortality programmes,” in Reproductive Health Matters.
Lives,” The Lancet Neonatal Survival Series, No. 3 (March 2005). Safe Motherhood Initiatives: Critical Issues, Oxford:
6
Anne Tinker, “Safe Motherhood is a Vital Social and Economic Blackwell, 1999:24-30.
Investment” (paper delivered at Technical Consultation on 26
Darroch JE, Singh S, Bal H, Cabigon JV, “Meeting women’s
Safe Motherhood, Colombo, Sri Lanka, Oct. 18-23, 1997). contraceptive needs in the Philippines,” Issues in Brief, Alan
7
National Statistics Office (Philippines), 2008 National Guttmacher Institute 2009;1:1-8..
Demographic and Health Survey, Preliminary Report. 27
Department of the Interior and Local Government (DILG)
8
http://www.census.gov.ph/data/pressrelease/2007/ website, http://www.dilg.gov.ph.
pr0718tx.html. 28
Libo-on, D. “Family planning budget for 2007 and 2008:
9
http://www.census.gov.ph/data/pressrelease/2009/ What has happened? Research paper submitted and to be
pr0930tx.html. published by PLCPD. (May 2009).
10
Food and Nutrition Research Institute, “6th National Nutrition 29
World Health Organization, “The World Health Report
Survey Results.” Available at http://www.fnri.dost.gov.ph/ 2006: working together for health” (Geneva: WHO, 2006).
files/fnri%20files/nns/6thnns.pdf. 30
World Health Organization,, National Health Accounts,
11
International Monetary Fund (IMF), Organization for Economic World Health Statistics, 2006.
Co-operation and Development (OECD), United Nations (UN) 31
http://www.doh.gov.ph/fourmulaone/primer.
and World Bank Group (WBG), 2000 A Better World for All: 32
Basics Support for Institutionalizing Child Survival Project (BASICS
Progress towards the International Development Goals (2000). II), “Newborn Health in the Philippines: A Situation Analysis,”
12
The Partnership for Maternal, Newborn, and Child Health published by the BASICS II for the United States Agency for
(PMNCH) website, http://www.pmnch.org/.. International Development: Arlington, Virginia, June 2004.
13
The Partnership for Maternal, Newborn, and Child Health, “New 33
Ibid.
Global Consensus on maternal, Newborn and Child Health to save 34
http://www.globalhealth.org/view_top.php3?id=225.
10 million lives,” 23 September 2009 Available at http://www. 35
UNICEF website, http://www.unicef.org/;
familycareintl.org/UserFiles/File/PMNCH_pressrelease_final.pdf. 36
Akukwe, C. “The growing influence of non government organizations
14
Ibid. in international health: Challenges and opportunities.” Journal Royal
15
1987 Constitution of the Republic of the Philippines. Society of Health, 1998, 118, 107-115.
16
The Local Government Code of the Philippines (Republic Act 37
Neonatal and Perinatal Mortality: Country, Regional and
No. 7160). Global Estimates, WHO 2006.

PEOPLE COUNT
PLCPD POLICY BRIEF March 2010

A publication of the Philippine Legislators’ Committee on Population and Development Foundation, Inc. (PLCPD)
with support from the United Nations Population Fund (UNFPA).
2/F AVECSS Building, #90 Kamias Road. cor. K-J Street, East Kamias, Quezon City, 1102
Tel. nos.: (+632)925-1800 • (+632)436-2373
E-mail: plcpdfound@plcpd.org.ph Since 1989
Website: http://www.plcpd.org.ph
Executive Director: Ramon San Pascual, MPH
Editors: Ernesto M. Almocera Jr., Romeo C. Dongeto and Floreen Simon
PLCPD
Philippine Legislators’ Committee

Layout: Dodie Lucas


on Population and Development
Foundation, Inc.

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