PA00XFKN

EngenderHealth
VisayasHealth Project
ANNUAL ACCOMPLISHMENT REPORT
October 1, 2015 – September 30, 2016 / Project Year 4

Submitted to
United States Agency for International Development
by
VisayasHealth
New York, NY, USA & Cebu, Philippines
under
Agreement No. AID-492-A-13-00007
October 30, 2016
This document is produced for review by the United States Agency for International Development
(USAID). The VisayasHealth Project is managed by the EngenderHealth with headquarters in 440
Ninth Avenue, New York City, NY 10001.The contents are the responsibility of EngenderHealth
and do not necessarily reflect the views of USAID or the United States Government.
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TABLE OF CONTENTS
Acronyms and Abbreviations ......................................................................................................................... 4
I. EXECUTIVE SUMMARY ....................................................................................................................... 7
II. YEAR 4 PROGRAM RESULTS AND ACCOMPLISHMENTS ............................................................. 8
A. Sustained High Level Provision of FP Services by Local Government and NGO Partners ................. 8
B. Enhanced Training Strategies for LAPM .......................................................................................... 10
C. Improving the Competence and Confidence of Trained Service Providers through Post-training
Monitoring and Evaluation (PTME) ................................................................................................ 11
D. Training and Certification of FP Providers ....................................................................................... 12
E. PhilHealth Accreditation of Providers of FP Services ....................................................................... 13
F. Claims under PhilHealth’s FP Benefit Package ................................................................................. 13
G. Technical Assistance in Localizing NHIP Implementation ............................................................... 14
H. Program for Young Parents (PYP) ................................................................................................... 15
I. Improving Exclusive Breastfeeding Practice ..................................................................................... 16
III. PROGRAM MANAGEMENT AND CROSS-CUTTING ACTIVITIES............................................. 17
G. Year 4 Quarter 4 Financial Reports (July 1 – September 30, 2016) .................................................... 19
H. Informed Choice and Voluntarism (ICV) Compliance Monitoring Report ....................................... 20
I. Environmental Mitigation and Management Plan Compliance Report .............................................. 20
J. Gender ............................................................................................................................................. 21
K. Cities Development Initiative (CDI) Report ..................................................................................... 22
L. Knowledge Management .................................................................................................................. 22
IV. CHALLENGES AND OPPORTUNITIES .......................................................................................... 23
A. Prohibition on the provision of implants by the public sector .......................................................... 23
A. Potential contraceptive security issues for the Philippines in the future ............................................ 23
B. Inconsistent interpretation and application of PHIC policies ............................................................ 23
C. Getting the DOH to spend its money .............................................................................................. 24

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D. Collaboration with International Care Ministries (ICM) .................................................................... 24
VII. NEXT STEPS ...................................................................................................................................... 24
ANNEXES .................................................................................................................................................. 24
ANNEX A: ICV Compliance (Semi-annual: Q2/Q4) Annual Report 2016 ............................................ xxv
ANNEX B: Stories from the Field ...................................................................................................... xxxvii
My name is Tzytel Castro. I am 19 years old and a proud mom of a healthy eight-month old baby boy. ..xliii
ANNEX C: VisayasHealth Project Fiscal Year 5 Workplan .................................................................... xliv
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Acronyms and Abbreviations
A/Y Adolescent and Youth
ALS Alternative Learning System
ANC Antenatal Care
AOR Agreements Office Representative
AYRH Adolescent and Youth Reproductive Health
BCSG Breastfeeding Community Support Group
BHS Barangay Health Station
BHW Barangay Health Worker
BTL Bilateral Tubal Ligation
CBT-1/2 Competency- Based Training – Level 1 / Level 2
CDI Cities Development Initiative
CHO City Health Office
COP Chief of Party
CPO City Population Office
CSG Community-based Support Group
Cum Cumulative
CYP Couple Year Protection
DepEd Department of Education
DHC District Health Centers
DMPA Depot Medroxyprogesterone Acetate (an injectable contraceptive)
DOH RO Department of Health Regional Office
DOH Department of Health
DQC Data Quality Check
DSWD Department of Social Welfare and Development
EBF Exclusive Breastfeeding
EH EngenderHealth
EMMP Environmental Monitoring and Mitigation Plan
EOP End of Project
EVRMC Eastern Visayas Regional Medical Center
F3 Fully Functioning Facility
FDA Food and Drug Administration
FP Family Planning
FPOP Family Planning Organization of the Philippines
FY Fiscal Year
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GAD Gender and Development
HKI Helen Keller International
HPDP Health Policy and Development Program
HSP Health Service Provider
ICM International Care Ministries
ICV Informed Choice and Voluntarism
IEC Information, Education and Communication
ILHZ Inter-Local Health Zone
IMAP Integrated Midwives Association of the Philippines
Inter-CA Inter-Cooperating Agency
IP Infection prevention
IIUD Interval IUD
IUD Intra-Uterine Device
IYCF Infant and Young Child Feeding
LAPM Long Acting and Permanent Method
LARC Long Acting and Reversible Contraceptive
LGBT Lesbian, Gay, Bisexual, or Transgender
LGU Local Government Unit
MCP Maternity Care Package
MLLA Minilaparotomy under Local Anesthesia
MNCHN Maternal, Newborn, and Child Health and Nutrition
MSI Marie Stopes International
MTU Meet the Unmet
NEDA National Economic Development Authority
NGO Non- governmental organization
NHIP National Health Insurance Program
NHTS National Household Targeting System (poor population)
NIR Negros Island Region
NIT National Implementation Team
NSV No-Scalpel Vasectomy
OB Obstetrics
PHIC Philippine Health Insurance Corporation (also referred to as PhilHealth)
PHO Provincial Health Office
PPFP Postpartum FP
PPIUD Postpartum IUD
PPM Private Practicing Midwife
PRIMEX Pacific Rim Innovation & Management Exponents Inc.
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PSI Progestin Subdermal Implant
PSPI Population Services Pilipinas Incorporated
PTME Post-Training Monitoring and Evaluation
PYP Program for Young Parents
RHM Rural Health Midwife
RHU Rural Health Unit
RPRH Responsible Parenthood Reproductive Health
RTA Regional Technical Adviser
SAMPI Society of Adolescent Medicine of the Philippines Inc.
SDN Service Delivery Network
SDP Service Delivery Point
SEC Security and Exchange Commission
SMS Short Messaging Service (Mobile Text Messaging)
SWOT Strengths, Weaknesses, Opportunities, and Threats
TA Technical Assistance
TAP Technical Assistance Package
TESDA Technical Education and Skills Development Authority
TRO Temporary Restraining Order
UNFPA United Nations Population Fund
UNIT Unmet Need Identification Tool
USAID United States Agency for International Development
USG United States Government
VH VisayasHealth
VSS Voluntary Sterilization Services
Y4 Year 4
Y5 Year 5
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I. EXECUTIVE SUMMARY
VisayasHealth (VH) is a USAID-assisted project aimed at improving maternal and child health and family
planning (FP) services in eight provinces in the Visayas. In the last four years, the project has been providing
technical assistance (TA) to the Department of Health (DOH) and Local Government Units (LGUs) in
strengthening supply, increasing demand and in improving systems and policies in support of the Philippines’
national Maternal, Newborn, and Child Health and Nutrition/ family planning (MNCHN/FP) program.
During its fourth fiscal year (FY4) the project generated 300,010 couple years of protection (CYP) from long
acting and permanent methods (LAPM) of contraception. This accomplishment is more than double the CYP
performance of the project in Year 4(YR4). The project was able to achieve this important milestone despite
the Philippine Supreme Court denying the petition raised by the DOH to lift the ban on the provision of
contraceptive implants in the public sector. This high level of performance is based on the following factors:
1. Increase in the number of trained providers for LAPMs. In YR4, the project was able to train
234 LAPM providers raising the cumulative total number of LAPM providers trained to 536;
2. Partnership with non-governmental organizations (NGOs) and the private sector to improve
access to FP services. VH partnered with NGOs with service delivery capacity to provide outreach
services to communities without trained providers. Likewise, in urban centers, the project trained
private practicing midwives (PPMs) who operate private birthing facilities in the provision of FP
services;
3. Reduction in contraceptive stock-outs. Health facilities in the Visayas region are fully stocked
with contraceptives and there were only few facilities that experienced stock-outs; and
4. Introduction of the unmet need for FP initiative. The introduction of this tool utilizes satisfied
users to provide FP information to limiters or men and women no longer interested in having
children.
Another key project milestone is the significant increase in FP benefit payments by the Philippine Health
Insurance Corporation (PHIC). Over the past three quarters, the project initiated an intensive campaign to
support the issuance of training certificates for providers who have received training. From October 1, 2015
until September 30, 2016, 234 additional LAPM providers successfully completed training requirements for
interval intrauterine device (IIUD), postpartum IUD (PPIUD), bilateral tubal ligation minilaparotomy under
local anesthesia (BTL-MLLA), and no-scalpel vasectomy (NSV). As a result, there are more service delivery
points (SDPs) able to provide these services and the amount of claims filed by accredited providers more
than doubled over a two-year period.
The last two quarters of this fiscal year saw the enhancement of adolescent and youth reproductive health
(AYRH) information and service provision through the Program for Young Parents (PYP). A rapid
assessment of PYP implementation was made in selected facilities. Results of this assessment provided the
basis for the recruitment, mentoring, and inclusion of peer educators in educational sessions, the addition of a
session on life skills, and linkages with other government agencies to broaden the options for teen moms
after graduating from the program. These options included access to the Alternative Learning System (ALS)
of the Department of Education (DepEd) and vocational skills from the Technical Education and Skills
Development Authority and Department of Social Welfare and Development (DSWD). These enhancements
were especially highlighted during the the first Visayas AYRH Technical Conference hosted by the project in
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Iloilo City on June 28-29, 2016. The conference was graced by USAID Mission Director Dr. Susan Brems, as
well as outgoing Secretary of Health, Dr. Janet Garin and former Secretary Esperanza Cabral. Also
represented was key staff from the DOH Regional Offices (ROs) and Provincial Health Offices (PHOs) in
the Visayas, as well as NGOs working on AYRH and other USAID implementing agencies.
II. YEAR 4 PROGRAM RESULTS AND ACCOMPLISHMENTS

A. Sustained High Level Provision of FP Services by Local Government and NGO
Partners
The combined outputs of government-owned facilities and that of NGOs in the Visayas accounted for
299,392 CYP equivalent to 93% of the project’s target for YR4 (Table 1). This high level of service provision
was attained despite the prohibition of the provision of progestin sub-dermal implants (PSIs) in government
facilities. The CYP performance in Y4 is more than double its CYP accomplishment in Y3. The difference in
the percentages of accomplishments between Y4 and Y3 is explained by a much higher CYP target in Year 4.
Table 1. Status of selected FP/MNCHN indicators, Year 3 and Year 4, VisayasHealth

Unit of Year 3 Year 4
INDICATORS Baseline
measure Target Accomp Target Accomp
Utilization of FP/MNCHN services Increased
Couple Years Protection in USG-assisted
No. 251,123 437,298 298,910 517,232 300,010
programs (USAID/W/PPR)
Short Term Methods 167,669
No. 205,337 300,395 194,296
(56%)
Long Acting Permanent Methods 131,241 300,010
No. 45,786 136,904 322,936
(95%) (93%)
Strengthening supply for FP/MNCHN services
Percent of USG-assisted service delivery
points (SDPs) providing FP counseling 48% 64% 89% 89% 88%
and services %
Numerator 235 313 420 494 483
Denominator 489 489 474^ 554^ 554
Percent of service delivery sites providing
post-partum IUD (PPIUD) services 3% 36% 45% 50% 51%
Numerator %
12 122 151 218 219
Denominator 383 337 337 437 437
voluntary surgical sterilization (BTL) 36% 58% 55% 85% 83%
Numerator %
41 66 63 69 67
Denominator 115 114 114 81^ 81
1% - - 10% 6%
non-scalpel vasectomy (NSV)
%
Numerator 3 46 27
Denominator 454 454 454
Demand Generation
No. of women reached with education on
No. 52 109,898 210,201 233,126 230,619
exclusive breastfeeding (USAID/W/PPR)
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Unit of Year 3 Year 4
INDICATORS Baseline
measure Target Accomp Target Accomp
No. of pregnant women seeking ANC and 132,116
provided with FP information (VH, cum) No. 248,218 277,014 310,269 360,353
(2012)
No. of postpartum women provided with 98,301
FP information (VH, cum) No. 184,169 145,350 229,427 172,768
(2012)
No. of adolescents and youth provided
with MNCHN/FP information (VH) No. 7,906 33,531 76,792 95,318 62,130
No. of men provided with FP information
No. 185 11,220 9,208 12,342 5,628
(VH)
Health Policies and Systems on FP and MCH improved
Percent of USG-assisted SDPs that
experience a stock-out at any time during
the defined reporting period of any
contraceptive method that the SDP is
expected to provide
Pills % 27% 11% 6% 2% 2%
DMPA (injectables) % 36% 19% 7% 3% 2%
IUD % 14% 6% 3.5% 1% 2%
% of LGUs doing Data Quality Check at
least once a year % 51% 6% 43% 75% 79%
^Denominators were adjusted; Community Hospitals were dropped, hard to reach areas were dropped also and private
birthing facilities were added in Y4.
Below are the reasons why the project was able to show consistently high CYP:
1. Increase in the number of trained providers, especially for LAPM. During the period of October
1, 2015—September 30, 2016, VH was able to train a total of 234 LAPM providers, bringing the total
number to 536 (Table 3). The training courses focused on developing provider skills on the provision
of LAPMs such as interval and PPIUD, BTL MLLA, and NSV. As a result, the number of facilities
able to provide IUD services increased from 45% in 2015 to 51% in 2016, while the percentage of
facilities providing BTL services increased from 53% to 81%.
To complement the intensification of efforts to train more providers, the project also prioritized the
application of the standard post-training monitoring and evaluation protocol to ensure that trained
providers are followed up with and that the skills acquired during the training are properly and
correctly applied and practiced.
2. Partnership with NGOs and the private sector in providing static and outreach FP services
especially to areas and communities without trained providers. VH partnered with service
delivery NGOs such as Mary Stopes International (MSI) and the Family Planning Organization of the
Philippines (FPOP) in the conduct of outreach FP services to areas that do not have access to FP
services mainly due to the lack of locally trained providers. Under this partnership, VH is responsible
for the generation of demand while the NGO partners are responsible for service provision.
In urban areas where there is a large demand for private sector services, the project partnered with
PPMs to provide FP services to clients willing to pay for private sector services. The project trained
these PPMs who operate birthing facilities on basic and advanced FP training, including FP counseling
and demand generation in addition to the development of clinical skills.
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3. Increase in the availability of program resources mobilized from the National Health
Insurance Program (NHIP). The project’s efforts to certify trained providers and facilitate
accreditation with PHIC are paying significant dividends as the amount of claims for the FP benefit
packages have increased significantly between calendar year 2014 and 2015 (Tables 6 & 7). The
increase in claims for PHIC reimbursements resulted in having more funds available to support
program implementation.
4. Reduction of contraceptive stock-outs. A majority of health facilities in the 3 regions of the
Visayas continue to enjoy a stock-out free spell during the past year. The number of facilities
that experienced stock-outs has been reduced to almost negligible numbers, especially for IUD (Table
1). Based on information provided by the DOH, the quantity of contraceptive supplies in DOH
warehouses are enough to last until 2018.
5. Introduction of unmet need reduction initiative. During the last quarter of 2016, VH intensified
the implementation of its unmet need reduction initiative, by demonstrating satisfied IUD users
success stories in FP information shared with interested clients who similarly wish to limit the size of
their families. This initiative has been successfully implemented in selected facilities in three Visayas
region: Negros Island Region (NIR), Region 7, and Region 8 (Table 2). The unmet need reduction
strategy is expected to create more positive traction on the project’s CYP performance in the coming
months.
Table 2. Number of clients provided IUD services using satisfied users as mobilizers, selected sites,
VisayasHealth covered sites September 2016
No. of Other
No. of No. of clients No. of Clients
No. of New Acceptors
Satisfied Users who came for Provided IUD
Acceptors (shifters and
Mobilized FP services services
restart)
Himamaylan, 39 69 29 17 12
Negros Occidental
Tabuelan, Cebu 5 10 6 1 5
South Cebu 6 12 8 0 8
Mabini, Bohol 14 75 69 37 36
Villareal, Samar 17 72 65 29 36
Baybay, Leyte 6 32 26 2 24
Palo, Leyte 2 9 9 1 8
Total 89 279 212 87 125
B. Enhanced Training Strategies for LAPM
The training of service providers in the provision of FP in YR3 and YR4 were conducted by VisayasHealth in
cooperation with (and through the mobilization of) local trainers and preceptors, except for BTL-MLLA.
This training enhances the completion of the required procedures needed for DOH certification. Through
these efforts, trainees also developed their skills and confidence in conducting procedures. For PPIUD, 80-
90% of the training courses in YR4 were conducted by local trainers in DOH Regional Training Centers,
local venues (hotels provincial and city health office conference rooms for didactic sessions), and practicum
sessions involved more preceptors in birthing facilities and provincial hospitals where they have more clients,
rather than in medical centers. The peer-to-peer skills enhancement strategy was also adapted for PPIUD
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trainees who inserted only one or were not able to insert actual PPIUDs during their training. Under this
scheme, providers who lack skills and confidence were sent to high performing providers or preceptors who
provided mentoring and coaching not only on PPIUD skills, but also in demand generation, counseling, and
record keeping/reporting. The same is true for interval IUD (IIUD) training where provincial and
municipal/city-based trainers and preceptors were mobilized in conducting the training, mentoring, and
coaching. Previously-trained providers who also lack the skills and confidence were likewise sent to preceptor
sites to enhance their skills and confidence. For the BTL-MLLA procedure, training activities were still
conducted by the project’s contracted trainers/consultants. However, the practicums were done in provincial
and city hospitals and DOH-retained hospital where there are more clients for the practicum rather than in
big medical centers where the trainers could not accommodate the request for training for this procedure.
Towards the end of Y4, a new training strategy–the Peer-to-Peer Experiential Competency-Based Level 2 for
PPIUD—was developed and pretested in Bohol. Under this strategy, participants embarked on self-paced
study in their stations, of the topics covered in the didactic sessions of the regular CBT course-reading, apply
their learning in performing certain task and take the modular examinations. They are given a maximum of
two weeks to complete the didactic sessions. From their station, they report to the preceptor sites, take mid-
course assessment test, and practice on PPIUD insertion in Zoe or Mama U models under supervision,
mentoring, and coaching by a trained preceptor. After they are appraised as able to satisfactorily do insertion,
they are then allowed to do insertions on actual clients, as well as demand generation, counselling, and
screening of PPIUD clients. Initial results of this strategy have been found to be encouraging.
The trainings for NSV were conducted by a VH-contracted consultant trainer with the MNCHN specialist
and/or a local trainer. Recruiting PPIUD clients for the practicum has improved with the mobilization of
some birthing clinics, but also remains a problem in some areas. Recruiting clients for the NSV practicum
remains a problem in all locals except for Bohol Province.
Table 3. No. of Trained Providers on LAPM, Y1-Y4
TYPE OF METHOD YEAR 1 YEAR 2 YEAR 3 YEAR 4 TOTAL
Visayas 22 56 224 234 536

PPIUD 22 56 137 119 334
IUD 73 64 137
BTL-MLLA 10 28 38
NSV 4 23 27
C. Improving the Competence and Confidence of Trained Service Providers through

Post-training Monitoring and Evaluation (PTME)
Post training and monitoring and evaluation have been integral part of the above training strategies. These
activities were conducted by the VH Clinical Support Team composed of clinical staff/trainers, locally-hired
consultants/trainers, Mobile Clinical Training Assistants, and selected high-performing/highly proficient
service providers in LGU and PPM clinics. The latter group was either trained as trainers or as clinic
preceptors.
PTME developed and enhanced the skills of the providers and improved provider confidence and proficiency
in performing FP procedures (including, IIUD, PPIUD, BTL-MLLA, and NSV). PTME is also a tool for
certification by the DOH and accreditation by PHIC or PhilHealth used for certifying providers and In YR4,
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a total of 215 LAPM service providers were visited for PTME. For the IIUD, 48 providers were visited
among which 33 were recommended for certification/certified by the DOH. At the time of the visits, the
remaining 15 providers still needed to complete the required number of IUD insertions. For PPIUD, 133
trained providers were visited for PTME, among which 94 were recommended for certification/certified by
the DOH. At the time of the visit, the remaining 37 providers needed to complete more insertions to meet
the required 10 insertions after the training. Two of the trained PPIUD providers had completed no actual
insertions after the training and their facilities are not Maternity Care Package (MCP) accredited. For NSV, 12
providers were visited for PTME and nine were certified by the DOH. For BTL-MLLA, 22 trained providers
were visited for PTME and all were certified.
Table 4. PTME Summary 2016

Interval IUD PPIUD
No.
No.
Recommen Not
No. Visited Recommended Not No. Visited for
REGION ded for Recommende
for PTME for DOH Recommended PTME
DOH d
Certification
Certification
Region 7 48 33 15* 68 46 22*
Region 8 48 33 15*
Region 6 & NIR 17 15 2**
TOTAL 48 33 15 133 94 39
NSV BTL-MLLA
No.
No. Visited Recommended Not No. Visited for No. Recommended for
REGION
for PTME for DOH Recommended PTME DOH Certification
Certification
Region 7 4 4 0 13 13
Region 8 4 4
Region 6 & NIR 8 5 8 5 5
TOTAL 12 9 0 22 22
*Reason for not being recommended for certification: Need for more clients
**Reason for not being recommended for certification: No insertions; Facility is not accredited as MCP
D. Training and Certification of FP Providers
The number of FP-trained providers in VH-assisted facilities stood at 788 at the end of August 2016, with
341 (43%) of them having successfully secured DOH certification during the same period. VH worked with
the DOH RO’s to conduct PTME for providers a few months after completion of an FP training course or
upon their completion of a prescribed number of on-the-job cases. Favorable PTME results are endorsed to
the proper DOH RO with a recommendation to certify the concerned provider. Delays in provider
completion of required cases, the availability of trainers to conduct PTME, and turn-around time of
documents requiring DOH action all influence the speed at which providers are eventually certified after
training.
PPIUD-trained providers were the most numerous at 386 or close to one-half of all trained providers. They
were followed by IIUD providers (295) and BTL (67). PPIUD-trained providers also comprised the largest
provider type certified by the DOH at 176 (52%), followed by IIUD with 140 (41%) of all certified providers.
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Cebu province had the most number of FP-trained providers with 241 (30.5%), followed by Bohol at 168
(21.3%). Cebu and Bohol also had the most number of DOH-certified providers at 64 (18.7%) and 56
(16.4%), respectively.
Table 5. Number of FP trained and certified providers by LGU and by type of FP service.
No. of trained providers in VH-assisted No. of DOH-certified providers in VH-assisted
AREA facilities as of August 2016* facilities as of August 2016**
IUD PPIUD BTL NSV Total IUD PPIUD BTL NSV Total
Bohol 74 77 11 6 168 27 23 2 4 56
Cebu City 21 32 5 0 58 19 5 3 0 27
Cebu Province 116 83 22 20 241 40 19 5 0 64
Iloilo Province 7 52 0 5 64 7 41 0 0 48
Leyte 43 49 8 0 100 21 30 4 0 55
Mandaue City 8 8 2 0 18 7 1 2 0 10
Negros Occ. 1 48 10 9 68 1 38 0 2 41
Samar 2 24 2 0 28 2 8 0 0 10
Southern Leyte 23 13 7 0 43 16 11 3 0 30
TOTAL 295 386 67 40 788 140 176 19 6 341
*Includes providers trained by the DOH prior to 2013 but were provided assistance by VH in securing DOH
certification, PhilHealth accreditation and case payments from PhilHealth.
E. PhilHealth Accreditation of Providers of FP Services
As of the end of August 2016, 93 FP providers have been accredited by PhilHealth and recognized by that
agency as eligible providers of the FP benefit package. PhilHealth requires accredited providers to show proof
of completion of DOH FP courses before they are able to file for claims under specific FP benefit packages.
There were 69 IIUD providers, 21 PPIUD providers, and 3 NSV providers. Cebu province had the highest
number of accredited providers with 25, followed by Bohol with 22. Only Bohol had NSV providers
accredited by PhilHealth.
Table 6. Number of providers accredited with PhilHealth and eligible to provide
the PhilHealth Benefit Package
AREA No. of providers accredited by PhilHealth and eligible
to provide FP Benefit Package
IUD PPIUD BTL NSV Total
Bohol 17 2 0 3 22
Cebu City 14 0 0 0 14
Cebu Province 22 3 0 0 25
Iloilo Province 0 0 0 0 0
Leyte 2 4 0 0 6
Mandaue City 7 1 0 0 8
Negros Occidental 0 0 0 0 0
Samar 0 4 0 0 4
Southern Leyte 7 7 0 0 14
TOTAL 69 21 0 3 93
F. Claims under PhilHealth’s FP Benefit Package

The project’s efforts to enable assisted-SDPs to avail of PhilHealth’s FP benefit package as a means to sustain
and expand FP service delivery paid-off in Y4 as evidenced by increases in: 1) the number of facilities availing
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of the FP benefit package in USG-assisted sites; 2) the number of claims; and 3) the value of claims under the
FP benefit package in the same sites. These trends were observed when comparing 2014 and 2015 annual
claims data as collected by PhilHealth ROs in Western, Central, and Eastern Visayas. Table 7 shows that the
number of facilities which filed and received claims in the three regions grew by 36% during the period of
2014-2015, with the highest rate of increase (62%) experienced in Central Visayas. On the other hand, the
combined number and value of claims in the three regions grew by 110% and 139%, respectively, with the
highest rates of increases recorded in Eastern Visayas.
Preliminary reports from project and PhilHealth sources have likewise revealed a similar pattern of rapid
increases in the same indices during the first two quarters of 2016. For instance, in the Eastern Visayas
region, the number of facilities claiming under the FP benefit package stood at 27 as of July 2016 or 12.5%
higher than the total number of claimant facilities for the entire year of 2015. The number of claims during
the first half of 2016 was also higher by 8% over the number of claims for the entire 2015.
Table 7. Number of facilities claiming PhilHealth’s FP benefit package,

number and value of claims, by region, 2014 and 2015.
No. of Facilities Value of Claims under the
No. of Claims under the
Claiming Under the FP FP Benefit Package (in
REGION FP Benefit Package
Benefit Package Millions of Pesos)
2014 2015 % Inc. 2014 2015 % Inc. 2014 2015 % Inc.
Western Visayas 16 19 19 683 1,441 111 13.7 30.3 122
Central Visayas 18 29 62 976 1,516 56 3.8 5.8 53
Eastern Visayas 19 24 27 339 1,221 261 5.9 19.7 234
TOTAL 53 72 36 1,998 4,178 110 23.4 55.8 139
G. Technical Assistance in Localizing NHIP Implementation
By the end of August 2016, only 22 (76%) of Fully Functioning Facility (F3) sites have been assessed in terms
of local NHIP implementation. Nine (31%) of these have been provided the assessment results and guidance
in planning improvements, while five (17%) were assisted in carrying-out the planned interventions. In Y5,
VH intends to investigate the low uptake of this TA package (TAP) among target LGUs, the slow pace of
implementation, as well as the results of implementation among those which have completed the intervention
process. To do this, VH plans to conduct a rapid assessment of at least five LGUs/sites and discuss the
assessment results with the DOH and PhilHealth with the view of determining ways of improving the
acceptability, practicability, and efficacy of the TAP. The revised TAP will later be turned-over to intended
users prior to project close-out.
Table 8. Number of F3 LGUs/facilities reporting completed activities in NHIP localization process

as of end of August 2016
REGION Activities Undertaken in NHIP Localization TA Process
Assessment Feedback & Planning Intervention
Western Visayas 7 2 0
Central Visayas 9 6 5
Eastern Visayas 10 1 0
TOTAL 26 9 5
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H. Program for Young Parents (PYP)
The Program for Young Parents (PYP) is VisayasHealth’s main response to the rise in teen pregnancy in the
Visayas. As of October 2016, there are 22 operational PYP centers: Three in the Negros Island Region (NIR);
three in Region 6; 12 in Region 7; and four in Region 8. Scheduled to be launched in the final year of the
project are PYP Centers in Ramon Tabiana Memorial District Hospital in Cabatuan, Iloilo; Anahawan
District Hospital in Anahawan, Southern Leyte; and Manuel B. Veloso Memorial Hospital in Palompon,
Leyte.
The PYP emphasizes joint responsibility and involvement of male partners towards 1) reducing rapid repeat
pregnancy and births to women below 19 years old (The DOH encourages a gap of three to five years
between births); 2) promoting facility-based delivery, including availing of PHIC or PhilHealth benefits for
the mother and infant; 3) promoting full breastfeeding for at least six months; and 4) increasing contraceptive
prevalence rates, particularly through LARCs.
Under the PYP, pregnancy women 19 years old and younger are:
1. Provided with pre-natal services on a dedicated day;
2. Encouraged to complete inter-active educational sessions on gender, life skills, the recognition of
danger signs and symptoms of pregnancy, birth planning (including compliance with requirements
to avail of PhilHealth benefits), FP, and breastfeeding;
3. Informed about the benefits of choosing to use FP, including the use of LARCs upon delivery, to
prevent rapid repeat pregnancy, particularly through interaction with satisfied users among their
peers; and
4. Endorsed to development partners to facilitate access to programs and services, helping them
pursue education and livelihood opportunities.
Enrollment in the PYP continues to increase, growing from 558 pregnancy teens (and their male partners) in
2014 to 4,060 in 2015 and to 7,696 by September 2016.
Table 9. Yearly PYP Enrollment per project area
AREA 2014 2015 2016*
Negros Island Region -- 297 704
Region 6 114 589 1,111
Region 7 188 2,363 4,046
Region 8 256 811 1,835
TOTAL 558 4,060 7,696
*January to September 2016 only
There has also been a significant (16.5%) increase in the use of LARCs among pregnant teens, specifically
PPIUD compared to the previous year.
Table 10. Use of LAPMs from 2015 and 2016

FP METHOD 2015 % 2016 %
NSV 0 0 0 0
BTL/ PP BTL 4 0.4% 0 0.0%
IUD/ PP IUD 162 17.2% 501 33.7%
Sub-dermal Implant 49 5.2% 0 0
15
FP METHOD 2015 % 2016 %
Oral Contraceptive Pills 35 3.7% 143 9.6%
Injectable/ DMPA 39 4.1% 96 6.5%
Condoms 4 0.4% 26 1.8%
LAM 648 68.9% 719 48.4%
Fertility Based Methods 0 0 0 0.0%
TOTAL 941 1485
Among the challenges related to the PYP that the project ctinues to address is the need to motivate clients to
comply with the DOH’s policy to attend four pre-natal consultations , as well as to seek antenatal care (ANC)
at the hospital. Relatedly, there is need to strengthen linkages with community-level facilities through the
Inter-Local Health Zone/Service Delivery Network (ILHZ/SDN) for referral from the community to the
hospital and back.
At the program implementation level, there is need to designate staff to handle specific PYP tasks, such as
recording and reporting; conducting educational sessions; training peer educators; building a body of
empirical evidence for the intervention through the conduct of operations research; and (most importantly),
adopting measures to ensure the sustainability of the program through the application of PhilHealth funds.
I. Improving Exclusive Breastfeeding Practice
To date, the project has supported the establishment of 51 LGUs with a Breastfeeding Community Support
Group (BCSG) in project-supported areas. A total of 924 Barangay Health Workers (BHWs) and mother
volunteers trained as Breastfeeding Counselors undertake home visits to pregnant and lactating mothers who
have infants age six months old and below. They utilize the DOH’s Infant and Young Child Feeding (IYCF)
Counseling Cards for these home visits using both the original Tagalog version and the translated Cebuano
version initiated by the project. Aside from exclusive breastfeeding, FP needs are also discussed and women
are referred to health facilities for counseling. This was with the ultimate goal of encouraging the visited
mothers to convince other mothers to exclusively breastfeed their babies as well.
These support groups are in various stages of implementation, from initial organization to fully functional
groups. They were supervised by the nurses/midwives of the respective Rural Health Units (RHU)/Barangay
Health Stations (BHS). However, during the initial assessment of the support group, the IYCF Counseling
Cards were not maximized by the Breastfeeding Counselors and the messages on Card 4 on exclusive
breastfeeding needed to be improved to emphasize that additional liquids or multivitamins should not be
given at all, especially when an infant get sick. Close mentoring and coaching with the Breastfeeding
Counselors were lacking. Hence, all these must be strongly considered in the next fiscal year of the project.
Table 11. Number of LGUs with at least one CHT/ community support group providing breastfeeding
information and referral to lactating mothers (cum)
Y3 Y4
Province Baseline
Target Accomp Target Accomp
Visayas 2 42 21 87 51
Iloilo 0 5 1 10 6
Negros Occidental 0 5 2 10 3
16
Y3 Y4
Province Baseline
Target Accomp Target Accomp
Bohol 0 5 2 10 9
Cebu province 0 5 4 15 7
Tri-Cities 0 2 1 2 1
Leyte 0 5 5 10 10
South Leyte 1 5 3 10 6
West Samar 1 5 2 10 3
North Samar 0 5 1 10 6
III. PROGRAM MANAGEMENT AND CROSS-CUTTING ACTIVITIES

In YR4, VH organized and implemented several staff development activities, coordination meetings, and
technical conferences. These meetings and conferences, listed below, provided an opportunity for project
staff and partners to discuss policy and implementation issues related to project interventions in the area of
MNCHN/FP and adolescent sexual and RH services. Highlights are as follows:
A. Attendance at the National Implementation Team (NIT) Meeting

VH was invited to attend the latest NIT meeting conducted September 2016 at the Disease Prevention and
Control Bureau (DPCB) conference room on the DOH compound. The meeting was chaired by the former
Secretary of Health, Secretary Esperanza Cabral. One of the presentations during the meeting was the
demonstration study on the re-establishment of the Tacloban City SDN which was presented by VH in
collaboration with the Health Development and Policy Program (HPDP).
The presentation focused on the results of the study, lessons learned, and recommendations. A significant
result of the demonstration study was the formulation of the Tacloban City business plan and the marked
increase in PhilHealth income. The presence of a champion, the city administrator, was vital in orchestrating
the enhanced operations of the city health office and city hospital.
Some of the recommendations proposed include specific preparatory activities prior to implementing the key
steps in establishing an SDN:
– Prepare detailed workplan that includes an estimation of the type and amount of resources
needed from the DOH and LGU.
– Consult with the provincial and municipal/city LGUs and other key stakeholders.
– Organize regional teams to manage the activities, including engaging provincial and
municipal/city LGUs in keeping with the detailed work plan.
– Assist the provincial and municipal/city LGUs and mobilize community health volunteers
(e.g., BHWs, CHTs), including orienting them on the necessary steps.
B. Participation in the Society of Adolescent Medicine of the Phil. Inc. (SAMPI) Biennial
Convention
17
VH was invited to participate in the SAMPI biennial convention from September 28-29, 2016 at the Marco
Polo Hotel in Manila. The theme for the convention was “The Wild, Wired World of Teens.” One of the
main topics was teen pregnancy and the Chief of Party of the VH project was in attendance to present on the
“Program for Young Parents: Preventing Rapid Repeat Pregnancies.”
The PYP presentation focused on the rationale for and steps needing to be taken in the establishment of the
PYP in the hospital setting. PYP success stories were shared with a video presentation of the Eastern Visayas
Regional Medical Center (EVRMC) PYP Center showing PYP champions and satisfied FP users talking with
PYP enrollees and conducting some of the educational sessions. The link to other government agencies such
as the DepEd, DSWD, and the Technical Education and Skills Development Authority (TESDA) was also
emphasized.
C. Formulation of Year 5 Plan

The planning workshop for the YR5 workplan was undertaken in the last quarter of YR4. The workplan had
special focus on reducing unmet need. An assessment and categorization of facilities in each province was
completed as the basis for determining the planned activities of VH Provincial Coordinators in YR5. This is
explained in detail in the overall workplan which is pending approval by USAID (Annex C).
D. Coordination Meetings and Activities

To maximize the use of project resources and to harmonize MNCHN/FP activities among stakeholders, it is
imperative to have coordination meetings with DOH and LGU partners, other development partners, and
NGOs. Project interventions were closely coordinated with the DOH and LGUs to prevent conflict of
activities and to identify areas requiring TA.
Coordination with the Integrated Midwives Association of the Philippines (IMAP) continued in terms of
providing training on FPCBT1 and 2. Likewise, coordination with MSI continued for the provision of
LAPMs. Just recently, the International Care Ministries (ICM) signified their intention to provide FP services
to their identified communities, the poorest of the poor.
E. Establishment of the Tacloban City SDN

In early 2015, the HPDP and VH had a series of meetings with officials from the Tacloban City Government.
Present in the meetings were representative from the DOH and PhilHealth. The meetings were chaired by
the city administrator. A strategic planning workshop with the Tacloban City Hospital staff and Tacloban City
Health Office staff was conducted, the output of which was used as the basis for the formulation of the
business plan. The business plan contained the following: a patient-friendly referral system, hospital and
district health center staffing standards, continuing education programs, information management system,
marketing plan, comprehensive preventive maintenance program, conversion of facilities to economic
enterprise, and pricing strategy and capital expenditure requirements.
PhilHealth income rose tremendously from P1, 550 in 2014 to P 906, 000 for January to May 2016.
Implementation of the business plan will hopefully continue under the new administration.
F. Status of Human Resource
As of September 30, 2016, the VH project has 43 full time staff and four consultants. A total of five staff
work under the project’s two sub-awardees—PRIMEX and HKI (Table 12).
18
Table 12. Staffing Summary
Regular Probationary Short Term TOTAL
Staffs
MANAGEMENT
COP and DCOP 2 2
TECHNICAL STAFF
Field Staff (Provincial Coordinators)
Region 6 4 4
Region 7 6 6
Region 8 10 10
Training Staff (Nurses/Specialists) 6 6
M&E/KM 4 4
BCC 1 1
Policy and Advocacy 1 1
SUPPORT STAFF
HR 1 1
ADMIN 2 2
FINANCE and Grants and Procurement 6 1 7
TOTAL 43 1 0 44
Seconded Staff (PRIMEX and HK) 5

Consultants 4
TOTAL 12
TURNOVER: During YR4, a total of eight regular full time staff left the project. The average turnover rate is
1.33%.
G. Year 4 Quarter 4 Financial Reports (July 1 – September 30, 2016)
Table 13. Itemized Project Expenditure (USD)

Expenditure 4th Quarter
Cumulative Cumulative % of
(Fiscal Year 2015 - 2016)
Expenses of Amount at Expenses
Cost Items Total LOP
Previous August End of This Based on
Quarters July 2016 September Quarter the LOP
2016
2016
Labor + Fringe
2,525,903.10 635,427.49 73,643.76 72,525.25 80,362.86 861,959.36 34%
Benefits
Travel and
2,163,086.00 595,467.27 26,156.05 32,900.49 35,483.19 690,007.00 32%
Transportation
Sub-grantees/
sub- 1,147,950.49 352,080.02 - - 59,769.31 411,849.33 36%
contractors
Other Program
1,591,923.16 436,024.09 8,652.11 8,626.20 21,844.81 475,147.21 29%
Direct Costs
Indirect Costs 3,243,759.30 728,915.64 71,926.90 66,806.30 82,469.14 950,117.98 29%
TOTAL 10,672,622.05 2,747,914.51 180,378.82 180,858.24 279,929.31 3,389,080.88 160%
19
H. Informed Choice and Voluntarism (ICV) Compliance Monitoring Report
From October 15, 2015—March 31, 2016, a total of 14 facilities were monitored for ICV compliance and no
violations were noted. Four FP day activities were monitored for ICV compliance with 83 participants (8
males, 75 females).
From April 2015 to September 2016, a total of 13 training/orientation activities conducted by VH, the DOH,
and LGU partners were monitored for ICV compliance with a total of 183 participants (21 males, 162
females), during which no violations were noted. A total of 75 facilities and service providers were monitored;
15 clients were interviewed; no ICV violations nor vulnerabilities were noted (Annex A).
I. Environmental Mitigation and Management Plan Compliance Report
1. Trainings:
A total of 196 service providers were trained on FP CBT 1, PPIUD/IIUD, NSV, and the Peer-to-Peer
Experiential Competency Base on IUD in the project areas supported by VisayasHealth. The standard DOH
protocol on infection prevention (IP) and hospital/general waste management are already integrated in all
training curriculum in adherence to the national policy on environmental mitigation to reduce the risk of
infection associated with the insertion or the procedure.
2. Table 14. Training Courses Conducted

Items Number
Number of training courses conducted that included a session on IP and waste disposal
 FP CBT 1 5
 PPFP/PPIUD/IIUD 7
 NSV 2
 Peer-to-Peer Experiential CBT on IUD 1
3. Monitoring:
To date, 69% of health facilities at the RHU level in project supported areas were monitored, and around
64% of hospitals. All health facilities in Cebu City and Samar province were visited and monitored.
Many trainees received post-training monitoring and evaluation.
Generally, waste was collected by the local government. However, in some facilities, proper waste disposal
and segregation were not properly observed nor labeled accordingly.
Table 15. Facilities Monitored/Supervised

Items Number
Number of facilities monitored/supervised 67
Number of facilities monitored/supervised during the PTME 71
Number of PPIUD/IIUD, NSV, and BTL-MLLA trained staff who received post- 113
training monitoring and evaluation
It is recommended that the remaining health facilities will be visited within this fiscal year of the project.
There is a need to revive waste segregation or color coding/labelling.
20
J. Gender
This year, the VisayasHealth Gender Action Plan for 2016 was submitted to the Office of Health-USAID,
which included results from the activities undertaken in the previous year’s action plan. Other documents
included the Gender and Development (GAD) Checklist for Project Management and Implementation and
the GAD Checklist for M&E which will also be submitted to the National Economic Development
Authority (NEDA) as part of the agency’s monitoring of Gender Action Plans of Cooperating Agencies of
the USAID.
VisayasHealth pursued the initiated TA designed to help facilities achieve high levels of sustainable
performance through clinical and community-based interventions, continuity of care, and the appropriate
application of technology. These facilities—called F3 sites—were identified in each of the three Visayas
regions. Region-wide, there were a total of 28 F3 facilities identified—nine in Region 6, eight in Region 7, and
11 in Region 8.
One of the criteria for consideration as an F3 health facility is whether it can be considered gender-friendly.
(Guidelines for what constitutes a “gender-friendly” facility are delineated in a Concept Note developed by
the project.) To begin sensitizing health service providers to these issues, gender reflective sessions on the
“definition of gender and sex” and “Act Like a Man, Act Like a Woman” were introduced to during F3
orientations.
Gender orientation sessions have been regularly conducted at each F3 facility. From the exercises in the
sessions, it was observed that only a handful were able to attend any gender orientation/seminar/training
conducted by other agencies. Some groups were also too shy and did not want to discuss body parts or share
what they felt was personal. VH will also consult other groups like LGBT, women’s group, men’s group,
students, and academe and present to them the concept of gender-friendly health facility in YR5.
Gender reflective sessions were also introduced to the PYP Management Team in the Abuyog District
Hospital in Abuyog, Leyte. Among the12 participants were the Chief of Hospital, nurses, and midwives. This
group was highly interactive and expressed the desire for another gender training. They were very interested
in accessing the 5% Gender Fund out of the total hospital fund, which was a new information to them.
Highlighting this year’s Gender Report was the integration of gender reflective sessions into the Enhanced
PYP Educational Sessions. The Enhanced PYP Educational Sessions contained a wider scope of topics and
incorporated adult learning methodologies in their conduct. It consists of topics packaged together in three
separate sessions and arranged in a complimentary manner.
One of these is the integration of “gender and sex” into the FP session where participants define attributes of
being a man or woman. The aim of this exercise is for participants to distinguish between gender and sex and
recognize gender roles and gender stereotypes that can impact health, particularly on decisions about the use
of FP. The enhanced PYP educational sessions have been tested at the PYP-EVRMC and were introduced in
another seven PYP facilities, including the Iloilo Provincial Hospital (Region 6), Eversley Childs Sanitarium
Hospital, St. Anthony Mother and Child Hospital, Danao City District Hospital and Bogo City Hospital
(Region 7), and EVRMC, Abuyog District Hospital and Southern Leyte Provincial Hospital (Region 8). There
are other PYP Centers now in the pipeline and ready to utilize these Enhanced PYP Educational Sessions.
21
K. Cities Development Initiative (CDI) Report
In YR4, CDI initiatives in the Cities of Iloilo and Tagbilaran focused on improving maternal and child health
and FP. In Iloilo City, the City Health Office in partnership with the City Population Office conducted joint
demand generation activities covering 180 barangays with 45,837 households. VisayasHealth provided TA
during its launch activities. Additionally, the project provided TA on implementing the "Meet the Unmet"
program strategy that was initiated during this period with the joint leadership of the DOH and CHO/CPO
in partnership with the FPOP. During the launching, the FPOP provided 32 clients with an implant service
and four chose to receive an IIUD services. The NHTS-prioritized population of poor women and men in
urban slums, as well as other couples from better economic standing, were continually provided FP services
that contribute to the reduction of unmet need for FP in the nine zonal health districts. To foster city-wide
demand generation for FP services, regular facility-based and community-based Usapan and health education
sessions are conducted at all levels by trained service providers.
During the Mom and Baby Expo: SWRA Congress at Robinsons' Mall and Tabuk Suba in August 2016, 38
clients chose to receive an FP service, including six implants and one IIUD. To improve policies and systems,
the LGU of Iloilo City has an approved policy that promotes adolescent and youth (A/Y) friendly services
through the A/Y Friday Clinics. They also worked to improve their A/Y friendly services to comply with
DOH standards for A/Y friendly facilities during the reporting period. The CPO, as part of the CDI LGU,
supported the establishment of the Youth Web Page as a means of providing information on AYRH and
health development, as well as referral of A/Y to DHC's A/Y Friday Clinic. Supportive supervision visits
were continually implemented in their respective DHCs among BHSs. During this period, the CHO is still
working to prepare additional facilities for MCP accreditation to their three MCP accredited DHC birthing
centers. Maternal Death Reviews were conducted quarterly throughout the year to analyze causes of maternal
deaths and posing remedial measures based on the three delays to prevent further maternal deaths.
In Tagbilaran City, VisayasHealth provided TA to Tagbilaran City Health Office which conducted training
for 30 young out-of-school leaders to become peer facilitators. These young leaders were invited to
participate in the campaign to prevent teen pregnancy and live healthy and fulfilling lives. The project also
provided TA to get DOH certification was the only IUD service provider of the Tagbilaran City Health
Office who successfully inserted 19 IUDs. She is now preparing to get her PhilHealth accreditation. FP
sessions are on-going every Tuesday at the CHO Main while breastfeeding community support groups in
Barangay, Dampas, and Taloto with 18 trained providers are continued to be monitored and provided with
TA.
L. Knowledge Management
1. AYRH Technical Conference.

A two-day conference on AYRH was
organized by VisayasHealth on the third
quarter of YR4 in Iloilo City with at
least 100 participants from Luzon,
Visayas, and Mindanao. The conference
USAID Mission Director to the Philippines Dr. Susan K. Brems (seated 4th
was organized to share successes and from left) is flanked by Western Visayas participants of the AYRH Technical
lessons learned among AYRH Conference held on June 28-29, 2016 where she gave a keynote message.
(CAlfafara/EngenderHealth)
implementing partners, to identify gaps
22
and constraints in AYRH implementation that need to be addressed, and to recommend measures that will
strengthen its implementation.
The first day was spent with parallel sessions on facility-based AYRH interventions, interagency AYRH
interventions, and community and school-based AYRH interventions. For each session, there were three or
four presenters sharing their successes and challenges in implementing AYRH interventions. A panel of
reactors initiated the discussions during the sessions.
On the second day, participants had the opportunity to visit and observe educational sessions being
conducted in the PYP Center of the Iloilo Provincial Hospital. The conference ended with an overview of
lessons learned from PYP implementation, an inspiring message from the USAID Mission Director, and a
very touching message from one of the PYP champions.
2. Stories from the Field. The VH project has continued to highlight stories throughout YR4 from all
project areas. Best practices and lessons learned from project activities and significant events that yielded
positive results for project beneficiaries were immortalized as written material under Stories from the Field and
USAID Weekly Highlights. Some of these works were published on USAID’s social media sites (Facebook and
Twitter). EngenderHealth also published a couple of these stories in its own website and social media site
(Twitter). Annex B of this report contains some of such stories.
IV. CHALLENGES AND OPPORTUNITIES

A. Prohibition on the provision of implants by the public sector
The decision of the Supreme Court to deny the motion of the DOH to lift the temporary restraining order
(TRO) on the provision of implants in the public sector has restricted access to many women of this very
effective and long active method of contraception. In FY 2015, the project was able to assist both public and
private providers to provide implant services to more than 25,000 women in the Visayas. The decision to
deny the motion to lift the TRO is a considerable setback to the project’s efforts to assist the government
and the private sector to offer women in the Visayas a wide range of FP options and services. While the
project continues to work with private sector providers in making this method available and accessible, the
project’s significant investments in training public sector providers and building local capacity to provide
contraceptive implant services are a missed opportunity for the time being.
A. Potential contraceptive security issues for the Philippines in the future

Another important hindrance to the implementation of the Responsible Parenthood and Reproductive
Health (RPRH) law is the decision of the Supreme Court to prohibit the Philippine Food and Drug
Administration from issuing products of registration (new or those for renewal) to contraceptive products
and devices. While there are still existing contraceptives in the market today, it is very likely that in 2018 all of
the commercially available contraceptives may no longer be available unless the TRO of the Supreme Court is
lifted.
B. Inconsistent interpretation and application of PHIC policies

One of the challenges faced by the project—related to facilitating the accreditation of service providers and
assisting them in filing claims for reimbursement—is the lack of consistency in the interpretation and
23
application of pertinent laws and regulations. Project staff is often frustrated that certain documentation
requirements that are no longer needed based on more recent policy issuances are still being required by some
PHIC staff. This situation creates confusion in the field, especially for local providers and subscribers
interested in availing of the benefit packages offered under the NHIP.
C. Getting the DOH to spend its money
During the last few years, the DOH has received hefty increases in its operating budget. However, increasing
its investment in the national FP program as a result has been challenging. Oftentimes, there is a mismatch
between the amount of funds released and the work and financial plans that were prepared and submitted by
DOH ROs. The budgets that are also released to the DOH oftentimes are accompanied by specific guidelines
on how the funds are going to be expended. Finally, the bulk of the increase in the DOH budget is allocated
for capital expenditures such as the construction of hospitals and health centers. Fewer amounts are available
to support operational activities such as training and procurement of FP-related supplies and instruments.
D. Collaboration with International Care Ministries (ICM)
One significant opportunity for the project in YR5 is its collaboration with ICM in the provinces of Iloilo,
Negros Occidental, Bohol, and Cebu. ICM is a faith-based organization that provides, among other forms
welfare assistance, health and FP services to the poorest of the poor in the communities they serve. Initial
discussions with ICM management showed that women in ICM-supported communities need assistance in
accessing FP services. The project’s current efforts to reduce unmet need for FP among poor families and
households are a perfect match to the ICM project’s identified needs. VH and ICM Philippines are in the
process of developing the framework for collaboration and translating the agreement into actual services for
the women who need FP counselling and services.
VII. NEXT STEPS

The VisayasHealth project is slated to close on February 28, 2018. As such, the YR5 workplan, which
discusses activity plans starting October 1, 2016, will extend towards the above-stated closeout date. The draft
YR5 workplan was developed an submitted to the USAID Philippines Office of Health through the VH
AOR and remains under review (Annex C).
ANNEXES
1. ICV Compliance Monitoring Report
2. Stories from the Field
3. Project Year 5 Workplan
4.
24
ANNEX A: ICV Compliance (Semi-annual: Q2/Q4) Annual Report 2016
This records all activities related to compliance to FP and abortion-related policies such as, but not limited to, orientation sessions on informed choice
and voluntarism, compliance monitoring tools, and systems or activities.
Part A: Technical Assistance, Inputs and Other Activities

Number of
Date Location Specific Activity/ Conducted By Participants Specific Audience Remarks/Results/
Topic or Content Whom M F Outputs
1 FPCBT 2 Interval IUD
April 26-29, LEX hotel Midwife-9
training EH/VH 0 9 Nurses and Midwives
2016 Cebu 18 PPIUD clients served
4 Doctors Trained
April 26-29, Summit Hotel 1 FPCBT 1 Training
EH/VH 3 15 Doctors and Nurses 5 nurses Trained
2016 Cebu
2 trainer
May 10-14, 10 Nurse Tained

Glory reborn 1 FPCBT 1 Training EH/VH 0 16 Nurses and Midwives
2016 7 midwives Trained
May 17-20, L Fisher EH/VH Doctor, Nurses and 3-Doctor,
PPIUD Training 1 11
2016 Bacolod City Midwives 2-Nurses and 7-Midwives
May 17-20, EH/VH Doctor, Nurses and 5-Doctor,
Iloilo City PPIUD Training 1 8
2016 Midwives 2-Nurses and 3-Midwives
May 16-20, SummitHotel 1 FPCBT 1 Training EH/VH
2 19 Nurses and Midwives 9-Nurses and 12-Midwives
2016 Cebu City
May 24-27, NSV Training EH/VH 4 Doctors and 3 Nurses
Ormoc City 5 2 Doctor and Nurse
2016 Client 1
June 15-17, L fisher NSV Training EH/VH 5 Doctors
4 1 Doctor and Nurse
2016 Bacolod City 9-Client
June 14-17, Harold Hotel PPIUD Training EH/VH
0 15 Nurses and Midwives 3-Nurses and 12-Midwives
2016
June 13-17, Summit Hotel TOT FPCBT 1 Training EH/VH Nurses and Midwives 1-Doctor,
2 6
2016 7-Nurses
August 9-12, Tugas, FPCBT 2 Interval IUD DOH/Vivian Midwife-19 C/O DOH
0 19
2016 DOH-RO 7 Training Durangparang
August 29- EH/VH DMO-6 none
FPCBT 1 Training for trainers
September 2, Summit Circle 1 15 Nurse-9
2016
September 9, Chocolate Peer-to-Peer Experiential Doctors – 6
EH/VH 2 20 None
2016 Hills Competency Based Training on Midwife- 10
Number of
Date Location Specific Activity/ Conducted By Participants Specific Audience Remarks/Results/
Topic or Content Whom M F Outputs
Complex, IUD Nurse - 1
Carmen Bohol
13 21 162
Total Number of Orientation/Training Activities conducted: _13______

Total Number of Participants Trained or Oriented: _183______
Males: __21______
Females: _162______
Part B. Summary Matrix of Service Providers/Facilities Monitored and Family Planning Clients Interviewed
Steps Taken/
Name/Designati No. of FP Results/Findings
Date Name of Location of Recommendations (please
on of Service Clients Monitored by (please be as detailed
Monitored Facilities Facilities provide as much detail as
Providers Interviewed as possible)
possible)
The nurse interviewed
recommended to verify with
the Municipal worker about
clients delisted when they do
It was reported that
not use FP method
Clients are delisted in
4P’s masterlist of
Further verification showed
beneficiaries in Brgy.
4/7/16 Clydiejun Ms. Dhaiana S. that they are delisted if they
Badian Rural Poblacion, Taytay when they
Baratbate, NDP 0 Laborte, Provincial do not attend FP seminar
Health Unit Badian, Cebu decide not to use any
1 Nurse Coordinator which is one of the
family planning
conditions for receiving
method.
benefits for 4Ps and not
because they are not using an
FP method as previously
reported. There is no ICV
violation nor vulnerability in
this case
Johnnie Alexis Ms. Dhaiana S. There is no violation
4/8/16 Moalboal Rural Poblacion East,
Hernandez, NDP 0 Laborte, Provincial on Informed Consent
2 Health Unit Moalboal Cebu
Nurse Coordinator and Voluntarism (ICV)
Maria Refran T. Ms. Dhaiana S. There is no violation
4/8/16 Barili Rural
Barili, Cebu Abella, Rural 0 Laborte, Provincial on Informed Consent
3 Health Unit
Health Midwife Coordinator and Voluntarism (ICV)
xxvi
Steps Taken/
possible)
Ma. Jocelyn S.
Ms. Dhaiana S. There is no violation
4/8/16 Barili Rural Bayaton,
Barili, Cebu 0 Laborte, Provincial on Informed Consent
4 Health Unit Sanitation
Coordinator and Voluntarism (ICV)
Inspector I
Hermelina P. Ms. Dhaiana S. There is no violation
4/8/16 Ronda Rural
Ronda, Cebu Mondarte, Rural 0 Laborte, Provincial on Informed Consent
5 Health Unit
Health Midwife Coordinator and Voluntarism (ICV)
4/8/16 Barili District Catherine P.
Barili, Cebu 0 Laborte, Provincial on Informed Consent
6 Hospital Lirazan, Nurse I
Arlene Magalso, Ms. Dhaiana S. There is no violation
4/8/16 Ginatilan Rural
Ginatilan, Cebu Rural Health 0 Laborte, Provincial on Informed Consent
7 Health Unit
Midwife II Coordinator and Voluntarism (ICV)
Malabuyoc Brianne Joy Ms. Dhaiana S. There is no violation
4/7/16 Malabuyoc,
Rural Health Pineda, NDP 0 Laborte, Provincial on Informed Consent
8 Cebu
Unit Nurse Coordinator and Voluntarism (ICV)
Mariano Jesus
Poblacion Ms. Dhaiana S. There is no violation
4/7/16 Cuenco Arnel Dave
Malabuyoc, 0 Laborte, Provincial on Informed Consent
9 Memorial Llarenas, Nurse I
Cebu Coordinator and Voluntarism (ICV)
Hospital
4/7/16 Alegria Rural Donnabelle L.
Alegria, Cebu 0 Laborte, Provincial on Informed Consent
10 Health Unit Tabanag
4/6/16 Oslob District Lydia L. Frejoles,
Oslob, Cebu 0 Laborte, Provincial on Informed Consent
11 Hospital Nurse II
Santander Catherine S. Ms. Dhaiana S. There is no violation
4/6/16
Rural Health Santander, Cebu Nuparanga, 0 Laborte, Provincial on Informed Consent
12
Unit Midwife Coordinator and Voluntarism (ICV)
Edna A. Lorazan, Ms. Dhaiana S. There is no violation
4/6/16 Oslob Rural Poblacion
Public Health 0 Laborte, Provincial on Informed Consent
13 Health Unit Oslob, Cebu
Nurse Coordinator and Voluntarism (ICV)
Aloguinsan Poblacion Ms. Dhaiana S. There is no violation
4/8/16 Elaine S. Morga,
Rural Health Aloguinsan, 0 Laborte, Provincial on Informed Consent
14 NDP Nurse
Unit Cebu Coordinator and Voluntarism (ICV)
4/6/16 Boljoon Rural Poblacion Diosdado A. 0 Ms. Dhaiana S. There is no violation
xxvii
Steps Taken/
possible)
15 Health Unit Boljoon, Cebu Rosada, RHMPP Laborte, Provincial on Informed Consent
4/6/16 Samboan Rural Poblacion Rochelle P.
0 Laborte, Provincial on Informed Consent
16 Health Unit Samboan, Cebu Canonigo
Client who refuses to
Ms. Dhaiana S. use family planning will
4/7/16 Badian District Poblacion Luz Villaflor,
1 Laborte, Provincial be delisted from the
17 Hospital Badian, Cebu Nurse I
Coordinator 4P’s Masterlist by the
Rural Health Midwife.
Mrs. Annie H. There is no violation
4/7/16 Eversly Child Mandaue City, Joy R. Casquejo,
0 Lucero, Provincial on Informed Consent
18 Sanitarium Cebu FP Coordinator
The primary facility
counsels clients about
Ms. Jaminnie Voluntary Sterilization.
4/6/16 Suba Health Aida O. Cabasa, Andrea Uy,
Suba, Cebu City 0
19 Center Nurse II Provincial The said primary
Coordinator facility has no copy of
the Informed Consent
form.
The consent form is retained
4/6/16 Tisa Health Cheryl B. Tambis, Andrea Uy,
Tisa, Cebu City 0 in the facility where the BTL
20 Center Midwife Provincial The said primary
is done
form
Ms. Jaminnie
Voluntary Sterilization.
4/6/16 Labangon Labangon, Cebu Ana Fe B. Ponsica, Andrea Uy,
0
21 Health Center City Midwife Provincial
The said primary
Coordinator
facility has no copy of
xxviii
Steps Taken/
possible)
form
Annie G.
4/6/16 Bulacao Health Bulacao, Cebu Andrea Uy,
Villanueva, Nurse 0
22 Center City Provincial The said primary
IV
form
4/6/16 Pasil Health Brenda T. Andrea Uy,
Pasil, Cebu City 0
23 Center Moronga, Midwife Provincial The said primary
form
Felisa P. Habasa,
4/7/16 Mambaling Mambaling, Andrea Uy,
Public Health 0
24 Health Center Cebu City Provincial The said primary
Midwife
form
Ms. Jaminnie
4/7/16 Kinasang-an Kinasang-an, Mary Ann J. Dado, Andrea Uy,
0 The said primary
25 Health Center Cebu City Midwife III Provincial
Coordinator
form
Ms. Jaminnie The primary facility
4/7/16 Alaska Health Alaska, Cebu Cristina Y. Andrea Uy, counsels clients about
0
26 Center City Tapado, Nurse II Provincial Voluntary Sterilization.
Coordinator
xxix
Steps Taken/
possible)
The said primary
form
Buhisan Health Buhisan, Cebu Marilyn C. Andrea Uy,
4/7/16 0
Center City Bacalso, Midwife Provincial The said primary
27
form
4/7/16 Basak San
Brotherhood Luzviminda Andrea Uy,
28 Nicolas, Cebu 0
Health Center Bulalo, Midwife Provincial The said primary
City
form.
4/5/16 Badiangan Dr. Joni Dichosa, There is no violation
29 Rural Health Badiangan, Iloilo Joepet B. Acanto 0 Regional Technical on Informed Consent
Unit Adviser and Voluntarism (ICV)
4/5/16 Lambunao Dr. Joni Dichosa, There is no violation
Valyn Jhen C.
30 Rural Health Lambunao Iloilo 0 Regional Technical on Informed Consent
Lagrana
4/5/16 Aleosan Dr. Joni Dichosa, There is no violation
31 District Aleosan, Iloilo Joseph Lim 0 Regional Technical on Informed Consent
Hospital Adviser and Voluntarism (ICV)
4/5/16 Dr. Joni Dichosa, Voluntary Sterilization.
Tigbauan Rural
32 Tigbauan, Iloilo Maolin Defacto 0 Regional Technical
Health Unit
Adviser The said primary
xxx
Steps Taken/
possible)
form.
4/5/16 San Joaquin Dr. Joni Dichosa,
33 Rural Health Tigbauan, Iloilo Reiza S. Murcia 0 Regional Technical
The said primary
Unit Adviser
form.
4/5/16 Dr. Joni Dichosa, There is no violation
Igbaras Rural Deepy Bernice
34 Igbaras, Iloilo 0 Regional Technical on Informed Consent
Health Unit Brana
Adviser and Voluntarism (ICV)
4/5/16 Shanta C. Dr. Joni Dichosa, There is no violation
Leon Rural
35 Leon, Iloilo Cabitlada, NDP 0 Regional Technical on Informed Consent
Health Unit
Nurse Adviser and Voluntarism (ICV)
4/5/16 San Miguel Dr. Joni Dichosa, There is no violation
San Miguel,
36 Rural Health Marinelle V. Salao 0 Regional Technical on Informed Consent
Iloilo
4/5/16 Rose Lyn M. Dr. Joni Dichosa,
Maasin Rural
37 Maasin, Iloilo Maestre, NDP 0 Regional Technical
Health Unit The said primary
Nurse Adviser
form.
Jesus M.
4/5/16 Eleanita Dr. Joni Dichosa, There is no violation
Colmenares
38 Balasan, Iloilo Alimodian, Nurse 0 Regional Technical on Informed Consent
District
II Adviser and Voluntarism (ICV)
Hospital
4/5/16 Dr. Joni Dichosa, There is no violation
Carles Rural Fria B. Mahilum,
39 Carles, Iloilo 1 Regional Technical on Informed Consent
Health Unit Nurse
Adviser and Voluntarism (ICV)
4/5/16 Dr. Joni Dichosa, The primary facility
Ofon Rural Rafeel Caruas,
40 Ofon, Iloilo 0 Regional Technical counsels clients about
Health Unit Nurse
Adviser Voluntary Sterilization.
xxxi
Steps Taken/
possible)
The said primary

form
Rhea Mae V. Mrs. Annie H.
4/7/16 Apas Health
Apas, Cebu City Bontilao, Public 0 Lucero, Provincial
41 Center The said primary
Health Midwife I Coordinator
form.
Mrs. Annie H.
4/7/16 Camputhaw Camputhaw, Laarni Solon,
0 Lucero, Provincial
42 Health Center Cebu City Nurse III The said primary
Coordinator
form.
Rizalie L. Maglinte, Mrs. Annie H.
4/7/16 Talamban Talamban, Cebu
Public Health 0 Lucero, Provincial
43 Health Center City The said primary
Midwife III Coordinator
form.
Marivic M. Mrs. Annie H.
4/7/16 Banilad Health Banilad, Cebu
Dionela, Public 0 Lucero, Provincial
44 Center City The said primary
Health Midwife Coordinator
form.
xxxii
Steps Taken/
possible)
Cebu City Mrs. Voluntary Sterilization.
Ronalisa T.
4/5/16 Alumnos Alumnos, Cebu Annie H. Lucero,
Labastida, Nurse 0
45 Health Center City Provincial The said primary
III
form.
Mrs. Annie H.
4/5/16 Quiot Health Jenalyn E.
Quiot, Cebu City 0 Lucero, Provincial
47 Center Talaboc, Midwife The said primary
Coordinator
form.
Gazene A. Abapo, Mrs. Annie H.
4/5/16 Guadalupe Guadalupe,
Public Health 0 Lucero, Provincial
48 Health Center Cebu City The said primary
Midwife I Coordinator
form.
Cecilia D. Mrs. Annie H.
4/5/16 Punta Princesa,
Punta Princesa Mosqueda, 0 Lucero, Provincial
49 Cebu City The said primary
Health Center Midwife I Coordinator
form.
Jovelyn S. Ponce, Mrs. Annie H. counsels clients about
4/5/16 Duljo Health
Duljo, Cebu City Public Health 0 Lucero, Provincial Voluntary Sterilization.
50 Center
Midwife Coordinator
The said primary
xxxiii
Steps Taken/
possible)
form.
Mrs. Annie H.
4/5/16 Kasambagan Kasambagan, Luna L. Cruz,
60 Health Center Cebu City Nurse III The said primary
Coordinator
form.
Mrs. Annie H. Voluntary Sterilization.
4/5/16 Calamba Calamba, Cebu Myrna G. Rey,
0 Lucero, Provincial The said primary
61 Health Center City Nurse
form.
Joylyn M. Mrs. Annie H.
4/5/16 Ermita Health Ermita, Cebu
Magallano, Public 0 Lucero, Provincial
63 Center City The said primary
Health Midwife Coordinator
form.
Mrs. Annie H.
4/5/16 Parian Health Parian, Cebu Perlita Latoy, Rural
64 Center City Health Midwife The said primary
Coordinator
form.
6/22/16 Corella Rural Elizabeth Jamil, Dr. Elaine R. The primary facility
Corella, Bohol 1
65 Health Unit Rural Health Teleron, counsels clients about
xxxiv
Steps Taken/
possible)
Midwife Regional Technical Voluntary Sterilization.
Adviser
The said primary
form.
Dr. Elaine R.
6/22/16 Sikatuna Rural Lilia Manlangit, Teleron,
Sikatuna, Bohol 0 The said primary
66 Health Unit Midwife II Regional Technical
Adviser
form.
Dr. Elaine R. Voluntary Sterilization.
Eleuteria
6/22/16 Balilihan Rural Teleron,
Balilihan, Bohol Bertumen, 0
67 Health Unit Regional Technical The said primary
RHMPP
Adviser facility has no copy of
form.
Two out of 4 clients
were given
Jenefa Ibarita, Mrs. Annie H. transportation
8/1/16 Carreta Health Carreta, Cebu
Public Health 4 Lucero, Provincial reimbursement in the
68 Center City
Midwife 1 Coordinator sum of 100 Php in
exchange for using a
family planning method
Consolacion Rosaline Mrs. Lurica June There is no violation
5/20/16 Consolacion,
RHU Birthing Tumongha, 0 Gambe, Provincial on Informed Consent
69 Cebu
Center Midwife Coordinator and Voluntarism (ICV)
Mrs. Lurica June There is no violation
7/20/16 Talisay Rural Brenda Pati,
Talisay, Cebu 1 Gambe, Provincial on Informed Consent
70 Health Unit 1 Midwife
5/6/16 San Remigio San Remigio, Mrs. Lurica June There is no violation
1
71 Health Center Cebu Gambe, Provincial on Informed Consent
xxxv
Steps Taken/
possible)
Catbalogan Ma. Maureen There is no violation
4/5/16 Catbalogan, Jonas Co, Public
Rural Health 1 Obregon, Provincial on Informed Consent
72 Samar Health Nurse
Unit Coordinator and Voluntarism (ICV)
Jeffrey Licardo, There is no violation
6/22/16 Candijay Pearla Tayugon,
Candijay, Bohol 2 Provincial on Informed Consent
73 Health Center Midwife
Rural Health Jeffrey Licardo, There is no violation
6/22/16 Hermila Felecio,
Unit – Mabini Mabini, Bohol 2 Provincial on Informed Consent
74 Midwife
Birthing Center Coordinator and Voluntarism (ICV)
Alicia Jeffrey Licardo, There is no violation
6/22/16 Pedirta Bernales,
Municipal Alicia, Bohol 2 Provincial on Informed Consent
75 Midwife
Health Office Coordinator and Voluntarism (ICV)
75 15
Total number of Facilities Monitored: 75

Number of facilities noted to be compliant to policies: 75
Total number of Service Providers Monitored: 75
Number of facilities with possible vulnerabilities: 0
Total number of FP clients interviewed: 15
Number of facilities with possible violations: 0
Part C. General Recommendations and Next Steps
Good points determined during this monitoring:

All facilities now have IEC Materials and ICV wall charts properly displayed in FP room or corners. Counseling conducted per client.
Points to improve on and recommendations/next steps:
Prepared by: Gerardito F. Cruz, MD Date: September 23, 2016
xxxvi
ANNEX B: Stories from the Field
Photos by JAUy & ALucero/EngenderHealth
1. Breastfeeding Counselor Training
Barangay Health Workers (BHWs) from Talamban, Cebu City train to become breastfeeding counselors, the
first of over 80 in the Cebu Tri-Cities (Cebu, Mandaue, and Lapu-Lapu) area. This two-day training covers
topics on the importance of exclusive breastfeeding, family planning counseling skills, and practice counseling
sessions with actual pregnant and lactating mothers (right photo). BHWs are responsible for Establishing
breastfeeding support groups with parent leaders and mother volunteers who help reach out to pregnant and
lactating mothers to encourage and improve breastfeeding in their respective communities. To date, seven
breastfeeding support groups have been organized by USAID through the VisayasHealth Project with
EngenderHealth, the Nutrition Coordinators of the Cebu City and Provincial Health Offices, and the
Department of Health Regional Office 7.
According to the World Health Organization (WHO), breastfeeding is one of the most effective interventions
to improve child survival. It is estimated that every year, breastfeeding could prevent more than 1 million
deaths among children five years old and below.
2. Reaching out to far flung Samar town for FP information and services
USAID recently worked together with the Department of Health Region 8 Office (DOH RO8) to reach
distant towns and communities in Samar where access to quality health care is a challenge, including access to
family planning (FP) information and services. Through its funded VisayasHealth Project (VH) with
implementing partner EngenderHealth, USAID introduced a demand generation strategy anchored on a
trained FP service provider. The strategy features the mobilization of satisfied FP users to provide FP
information aided by information, education, and communication (IEC) materials.
This approach was introduced in the island barangay of Guintarcan, which has the highest population in
Villareal, and a skilled provider for postpartum FP was identified. During a scheduled FP day, encouraged by
the trained provider, 22 mothers who have been identified with unmet need for FP came for counseling and
services. Out of these, 20 were eventually served according to their FP method of choice.
The strategy is intended to be introduced to other geographically isolated and difficult areas in Eastern
Visayas, and eventually throughout the Visayas region where unmet need for FP is prevalent. The successful
implementation of this approach is envisioned to help reduce the over 41,0001 unmet need for FP among
women of reproductive age in Samar Province and ultimately that of the entire Visayas.
PHOTOS (all by HSeverino/EngenderHealth):
During the coaching of satisfied FP users, participants

practice with each other on how to impart key messages
Identified FP users review the messages on the IEC
through their experiences.
materials shared with them.
Part of the strategy orientation conducted by USAID was to ensure that skilled providers are available during the
scheduled FP day to readily provide the services desired by clients. In the photo on the left, Ms. Mila Ontuca, the
midwife assigned in BHS Guintarcan, conducts screening and counseling to an IUD client before securing informed
consent. In the photo on the right, she performs the procedure on the client (right).
The Guintarcan Barangay Health Station is 40 minutes away by boat from the town proper of Villareal
Samar. It covers four Island Barangays where one midwife and one DOH Nurse Deployment Program
nurse are on duty, supported by community volunteers/BHWs.
1
Family Health Survey 2011
xxxviii
3. USAID introduces peer-to-peer coaching approach to boost confidence in LAPM service
provision
Tacloban City, Leyte - Among the major concerns expressed by trained service providers for non-
performance is the lack of confidence, mainly from limited cases during the training. This was the case of Ms.
Gina Bacuñata, a midwife at Sagkahan District Health Center in Tacloban City. She was trained in the
provision of long-acting and permanent methods (LAPMs), particularly in interval intra-uterine device (IIUD)
and postpartum IUD (PPIUD) insertion last 2014 under the USAID-funded project VisayasHealth with the
Department of Health. However, in order to be certified proficient in the procedure, she has yet to
successfully do 10 IIUD and 20 PPIUD insertions.
In order to boost the confidence of service providers like Ms.

Bacuñata, USAID is introducing the peer-to-peer coaching
approach. Other trained providers who have been certified
proficient and are actively performing LAPM services are
mobilized to coach trained low or non-performing service
providers. Ms. Bacuñata, who went through coaching by a fellow
midwife trainee on September 28, gave a positive response to the
approach saying, “It is comforting and inspiring to be coached by someone
who understands being nervous but is able to perform the procedure well. Now,
I know I can do the procedures with growing confidence.” At the end of the
coaching day, she was able to successfully serve five clients.
The peer-to-peer approach is being initiated in other project areas

where LAPM trainees, including those trained in no-scalpel
vasectomy, are not performing. It is envisioned that the more
Ms. Gina Bacuñata (seated) gets a little
help from a friend and fellow midwife confident service providers are in performing LAPM procedures,
trainee Ms. Alily Romo (standing) in more of the estimated 239,000 married women of reproductive
confidently performing interval IUD age (MWRA) in the Visayas region2 with unmet need for limiting
insertion on a client. of pregnancies will be addressed.
(Photo by ALargo/EngenderHealth)
The peer-to-peer coaching approach introduced by USAID through the VisayasHealth project implemented by
EngenderHealth is a comprehensive approach that also includes preparation of the necessary materials needed for the
LAPM procedure. Photos show Ms. Romo and Ms. Bacuñata preparing the IUD and the instruments.
(Photo by ALargo/EngenderHealth)
2
2016 Estimate from the Health Policy and Development Program
xxxix
4. Leyte Vice Mayor impresses urgency to address rising teen pregnancy rate
“NOW. Not Later!”
This was the emphatic statement given by Dr. Georgina Arevalo, Vice Mayor of Palompon municipality,
Leyte Province. Speaking during the orientation of the Program for Young Parents (PYP) at the Manuel B.
Veloso Memorial Hospital (MBVMH) before its PYP core team and other guests, the Vice Mayor pledged
her personal support and that of the Palompon Local Government Unit to the PYP. She proposed an
increase in the municipal budget for high school scholarships from 5% to 10% and the application of the
municipality’s Gender and Development budget to initiatives to keep pregnant teens in school. She also
suggested conducting educational sessions for parents of adolescents at the community level, with a special
effort to involve the fathers. In fact, Dr. Arevalo has herself volunteered to serve as a resource person for
educational sessions in schools and communities.
Philippine Statistical Authority (PSA) figures as of 2000

rank the municipality of Palompon as the sixth most
populous in the province of Leyte with 50,754
inhabitants. It has a very young population with 43.5%
less than 20 years old. As such, teen pregnancy is a critical
concern. According to Dr. Grace Fernandez, Chief of
Hospital of (MBVMH), births to women 19 years old and
younger account for around 16% of deliveries in the
hospital, a distressing rate compared to the national
average of 10%. MBVMH is the referral facility of the
Leyte West Coast Inter-Local Health Zone comprised of
the municipalities of Palompon, Tabango, Isabel, and
Villaba and as such is the delivery facility for young
As a practicing Obstetrics and Gynecology doctor, Vice
women from the surrounding municipalities. Mayor Dr. Georgina Arevalo said that she feels the
problem because she meets pregnant teens on a daily
Because of the growing concern for teen pregnancies, basis. She further reveals that she will start observing
Wednesdays as PYP days in her private clinic in
MBVMH requested technical assistance from the United synchrony with the PYP Day in the MBVMH.
States Agency for International Development (USAID) (Photo by ADeGuzman)
through its implementing partner the VisayasHealth
project to establish a PYP in the hospital.
5. USAID- organized AYRH gathering makes impact on high school attendee
In order to further address rising teenage pregnancy in Iloilo City, USAID together with the Iloililo City
Health Office conducted an Adolescent Symposium that emphasized Reproductive Health Education for
Adolescents. This was attended by 250 students from several high schools in the city who listened to
messages on sexuality and gender, presentations of the various health programs for adolescents and the
reproductive health services available for adolescents at the health facilities. At the end of the symposium, 14-
year old Krystal Pesano who is a Grade 8 student Fort San Pedro National High School (FSPNHS) in Iloilo
City, took center stage give a recap of the topics and her own reactions.
“The alarming case of teen age pregnancy worries me as a student of Fort San Pedro National High school. That worry has
been added with a case of a schoolmate who got pregnant at the age of 14 years old, so when I heard about this symposium, I
xl
gladly included myself as one of the participants. One of the key messages was on delaying sexual activity until ready was
emphasized. I learned that with the current trend of sexual promiscuity among my age group, the Health Centers can provide
information regarding contraceptive methods to help delay pregnancy. Teenage pregnancy is truly happening a lot these days. It is
good to know that there is the Program for Young Parents or PYP at Western Visayas Sanitarium and General Hospital at
Sta. Barbara and Iloilo Provincial Hospital in Pototan. It seems that the PYP centers are really a good place for adolescent
moms. I am sure being one is scary but from what I gathered from the presentation, centers are adolescent friendly facility that will
cater for their needed maternal care, provide information relevant in planning for the next pregnancy, and provide services in
family planning. I appreciated the open forum portion of the symposium because we were able to ask questions. My queries’
regarding the development of the reproductive organs and the changes that the adolescent will encounter were addressed well by the
speakers. I am grateful for the information I have received especially the Reproductive Health Education. All these have increased
me and my fellow students’ awareness to combat the problems we might encounter during this crucial time of my development to
adulthood.”
A staff of USAID’s VisayasHealth (standing

with microphone) makes a follow up question
to Krystal Pesano (on his right) after she gave
her reaction before her fellow high schoolers.
(Photos by MDichosa/EngenderHealth)
6. New Demand Generation Strategy Churns Up highest number of New FP Users In Mabini,
Bohol
The month of September turned a milestone for the usually laid back and quiet town of Mabini in the
province of Bohol when USAID introduced a new demand generation approach through its VisayasHealth
project with implementing partner EngenderHealth. Since implementation, the town was able to serve a total
of 38 new family planning (FP) users, particularly the intra-uterine device (IUD). This was the highest turnout
this year compared to the previous months’ 17 (August), 14 (July), 11 (June), six (May), and eight (April).
The approach involved the mobilization of the 10 satisfied FP users in the communities who would share
with other women their positive experience using FP. These satisfied users are provided technical coaching by
the health facility staff under the mentorship of VH staff. They would invite the women who would express
to them their interest to use an FP method on the FP Day schedule on Thursdays. The strategy also involved
consistent follow up text messaging and visits from the mobilized FP champions to encourage the attendance
of those women with FP unmet needs to the FP day. Given the significant rise of new users using this
strategy, sustained implementation is envisioned to address more of the unmet need for modern FP,
particularly on long acting and permanent methods in the municipality, and ultimately that of the entire
province of Bohol.
xli
At the FP Day in Mabini, mobilized FP satisfied users were able to bring in women and even the entire family (right photo) who
expressed interest in FP. At the Rural Health Center where the FP Day is held, the invitees go through in-depth information giving
through the Usapan sessions and counseling on the method they are interested in using (left).
(Photos by JLicardo/EngenderHealth)
A mother reviews the Usapan Action Card showing all the modern FP methods she can
choose from. The USAID-initiated Usapan sessions continue to be the main
information giving forum even during the FP Days held every Thursday at the Mabini
RHU. (Photos by JLicardo/EngenderHealth)
7. USAID Mission Director Urges Health Providers To

Help Young Parents Have “DREAMS” at AYRH
Conference
Speaking before participants at the Adolescent and Youth

Reproductive Health (AYRH) Technical Conference recently held in
Iloilo City, USAID Mission Director Dr. Susan K. Brems
emphasized the urgent need to address reproductive health of
adolescents, particularly the teen parents. Dr. Brems urged more
than 100 doctors, nurses, and midwives from selected government
“They (teen parents) need to make sure hospitals in the Visayas Region to help young men and women
they know how their bodies work, how the achieve their dreams. She gave this call based on the
body of the other sex works, should have acronym DREAMS – Determined, Resilient, Empowered, AIDS &
informed consent and informed choice if pregnancy-free (if they do not wish to be pregnant), Mentored by
they do decide to accept family planning. “. their peers, and Safe from harm.
DR. SUSAN K. BREMS

Mission Director
USAID Philippines
xlii
USAID Mission Director to the Philippines Dr. Susan K. Brems in her
keynote message stresses to participants of the AYRH the importance of
helping young people find determination to a good future, to be resilient in
overcoming challenges, to be empowered through education in reproductive
biology, towards being free or safe from unwanted pregnancy, HIV-AIDS
and other things that could possibly harm their health.
(JLicardo/EngenderHealth)
8. A Champion for Young Moms in the Philippines
My name is Tzytel Castro. I am 19 years old and a proud mom

of a healthy eight-month old baby boy.
It was last year when I learned that I was pregnant as I was

finishing my second year toward earning my Bachelor of
Science in Business Administration with a major in
Management. At the end of the school year, only my boyfriend
(who is now my husband) and closest friends knew about my
pregnancy... or so I thought. My mother asked me if I was
pregnant and all along she had been observing the subtle
changes in my body: slight weight gain and gentle broadening
of my hips. I admitted that I was indeed pregnant. Although
my mother was initially disappointed, I knew that she was
more concerned for my welfare and with the baby.
I began participating in educational sessions organized under the Program for Young Parents (PYP) at the
Iloilo Provincial Hospital. The PYP was developed by USAID’s VisayasHealth project implemented by
EngenderHealth. It aims to give holistic support to young pregnant women through provision of health
education, maternal and child health and family planning (FP) services, and psychosocial support. Through
the PYP, I learned how important it is to receive antenatal care and to deliver my baby at the hospital assisted
by trained health providers. I also learned about the benefits of breastfeeding for at least six months (which I
did). The program educated me about FP methods. In fact, after I delivered my baby, I chose the subdermal
implant, which I will keep using until I am ready to get pregnant again. This is important to me because I
really want to earn my college degree.
I became more involved with the PYP after I gave birth. I handle the lectures during the weekly PYP Gender
and Family Planning educational sessions. I share my story with other young pregnant women and mothers. I
visit young mothers at the postpartum ward of the hospital and talk to them about my experiences. When I
am able to encourage them to practice FP or breastfeed their infants, I feel that I am making a difference in
their lives.
My involvement in PYP has helped me become more mature as a person. I am more confident to face the
challenges of young parenthood. I am proud of what I do with the PYP. I am happy to support and inspire
other young people; it is the least I can do for the program that has helped me so much.
xliii
Tzytel leads the discussion on gender and family planning at the PYP education session.
ANNEX C: VisayasHealth Project Fiscal Year 5 Workplan
(see separate attachment)
xliv

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EngenderHealth

ANNUAL ACCOMPLISHMENT REPORT

October 1, 2015 – September 30, 2016 / Project Year 4

Acronyms and Abbreviations ......................................................................................................................... 4

I. EXECUTIVE SUMMARY ....................................................................................................................... 7

II. YEAR 4 PROGRAM RESULTS AND ACCOMPLISHMENTS ............................................................. 8

B. Enhanced Training Strategies for LAPM .......................................................................................... 10

D. Training and Certification of FP Providers ....................................................................................... 12

E. PhilHealth Accreditation of Providers of FP Services ....................................................................... 13

F. Claims under PhilHealth’s FP Benefit Package ................................................................................. 13

G. Technical Assistance in Localizing NHIP Implementation ............................................................... 14

H. Program for Young Parents (PYP) ................................................................................................... 15

I. Improving Exclusive Breastfeeding Practice ..................................................................................... 16

III. PROGRAM MANAGEMENT AND CROSS-CUTTING ACTIVITIES............................................. 17

G. Year 4 Quarter 4 Financial Reports (July 1 – September 30, 2016) .................................................... 19

H. Informed Choice and Voluntarism (ICV) Compliance Monitoring Report ....................................... 20

I. Environmental Mitigation and Management Plan Compliance Report .............................................. 20

K. Cities Development Initiative (CDI) Report ..................................................................................... 22

L. Knowledge Management .................................................................................................................. 22

IV. CHALLENGES AND OPPORTUNITIES .......................................................................................... 23

A. Prohibition on the provision of implants by the public sector .......................................................... 23

B. Inconsistent interpretation and application of PHIC policies ............................................................ 23

C. Getting the DOH to spend its money .............................................................................................. 24

VII. NEXT STEPS ...................................................................................................................................... 24

ANNEX B: Stories from the Field ...................................................................................................... xxxvii

ANNEX C: VisayasHealth Project Fiscal Year 5 Workplan .................................................................... xliv

II. YEAR 4 PROGRAM RESULTS AND ACCOMPLISHMENTS

Table 1. Status of selected FP/MNCHN indicators, Year 3 and Year 4, VisayasHealth

B. Enhanced Training Strategies for LAPM

Table 3. No. of Trained Providers on LAPM, Y1-Y4

TYPE OF METHOD YEAR 1 YEAR 2 YEAR 3 YEAR 4 TOTAL

Visayas 22 56 224 234 536

C. Improving the Competence and Confidence of Trained Service Providers through

Table 4. PTME Summary 2016

D. Training and Certification of FP Providers

E. PhilHealth Accreditation of Providers of FP Services

F. Claims under PhilHealth’s FP Benefit Package

Table 7. Number of facilities claiming PhilHealth’s FP benefit package,

G. Technical Assistance in Localizing NHIP Implementation

Table 8. Number of F3 LGUs/facilities reporting completed activities in NHIP localization process

Table 10. Use of LAPMs from 2015 and 2016

I. Improving Exclusive Breastfeeding Practice

III. PROGRAM MANAGEMENT AND CROSS-CUTTING ACTIVITIES

A. Attendance at the National Implementation Team (NIT) Meeting

C. Formulation of Year 5 Plan

D. Coordination Meetings and Activities

E. Establishment of the Tacloban City SDN

F. Status of Human Resource

Seconded Staff (PRIMEX and HK) 5

G. Year 4 Quarter 4 Financial Reports (July 1 – September 30, 2016)

Table 13. Itemized Project Expenditure (USD)

I. Environmental Mitigation and Management Plan Compliance Report

2. Table 14. Training Courses Conducted

Table 15. Facilities Monitored/Supervised

1. AYRH Technical Conference.

IV. CHALLENGES AND OPPORTUNITIES

A. Potential contraceptive security issues for the Philippines in the future

B. Inconsistent interpretation and application of PHIC policies

C. Getting the DOH to spend its money

D. Collaboration with International Care Ministries (ICM)