Challenge: Maternal mortality

The Philippines has been making progress in meeting its 2015 Millennium Development Goals, but some targets are more challenging. One of which is reduction in maternal mortality ratio (MMR). By 2015, the country’s MMR should be 52 per 100,000 live births. However, latest official statistics showed that instead of falling, MMR rose from 162 in 2008 to 221 in 2011.

That MMR rise was not surprising according to Health Secretary Enrique Ona because of the very limited family planning programs implemented in the past decade and the neglect of health services for the poor.

When the RH bill was still being deliberated in Congress, Ona said that legislation was needed to “mandate the provision of modern family planning practices to those who need them, but are unable to acquire on their own.”

Based on the 2009 joint report of the Guttmacher Institute and the University of the Philippines Population Institute entitled “Meeting Women’s Contraceptive Needs in the Philippines,” over half of pregnancies in the country are unintended.

Poor women are even more vulnerable. The report showed that 35 percent of poor women between 15 to 49 years old accounted for 53 percent of unmet need for contraception; thus, these women end up having up to two more children than they want to have. The same report noted that without the use of contraceptives, there would be 3,500 more cases of maternal deaths annually.

With the enactment of the Responsible Parenthood and Reproductive Health Act (RA 10354), everyone, especially the poor will have access to information and family planning commodities. It also stipulates budgetary appropriations for the upgrade of health facilities to be able to provide emergency obstetric and new-born care as well as for the deployment of more skilled health workers.

Staunch RH advocate Rep. Edcel Lagman says the law will help the country meet the MDG targets on MMR, infant mortality rate etc., as well as have the long-term effect of eliminating extreme poverty. But he says it is not a quick fix to the problem. He said the full benefits of the law will be realized only after five years.

PPP in health

Complementing government efforts to improve maternal health outcomes are private sector initiatives. Last week the Zuellig Family Foundation (ZFF) and MSD, the global pharmaceutical company, together with DOH partnered to improve maternal and child health care service in the 21 geographically isolated and disadvantaged areas (GIDAs) in the three provinces of Samar Island. The collective MMR in these GIDAs is 392 in 2010 which is higher than the national average. MMR reduction depends on how responsive the local health leaders-mayors and municipal health officers-are in making their health systems pro-poor. This is an excellent example of how Public Private Partnerships can work in areas other than infrastructure .

Dramatic results in two years

These deaths can be reduced if proper ordinances and services are in place.

Such is the case in the fifth class municipality of Lapuyan, Zamboanga del Sur (a ZFF partner), where Mayor Daylinda Sulong had to deal with traditional birth practices prevalent among the Subanens who make up 80% of the population. She introduced many changes. Pregnant mothers were identified and provided with prenatal care. She consulted Subanen leaders before coming up with an ordinance on facility-based deliveries with a Sangguniang Bayan in attendance. The traditional hilots were incorporated into the health team but could not perform the delivery. Maternal shelters were provided for mothers from far-flung barangays to use while waiting for their deliveries. There was no out-of-pocket cost whether she was a PhilHealth member or not. As a result, MMR fell from 1,600 in 2009 to zero in 2011. No mother has died since.

Mayor Daylinda’s story should not be unique. If her story is replicated in other areas with high maternal deaths then the challenging MMR target of 52 by 2015 is within reach.

US-Philippines Society

Further to my last column, I would like to highlight the fact that the local board members from the private sector made a substantial multi-year pledge. They did so because the Society needs to have a sustained effort and not just a one shot affair. It is support given to enhance the footprint of the Philippines beyond the term of any administration.

There are similar organizations in the US: the Korea Society, US-Indonesia Society, China Society, Japan America Society. They have been in existence for many years and have proven their sustainability because their respective private sectors support them. Sustainability of the US-Philippines Society requires more pledges from other large corporations such as the top banking institutions, the power distribution and generation companies, the beverage industries and the transport/logistics sector.

In my previous column, I described the very successful visit of the American side of the board in Manila. I described their schedule which included meetings with the President, briefings from cabinet secretaries, dialogue with the Makati Business Club and a tour of Clark. This was not a business as usual procedure. It required the untiring efforts of Ambassador Jose L. Cuisia who is ex-officio member of the board. He had to overcome the obstacles presented by bureaucratic red tape aside from repeated follow-ups with cabinet members and business executives on the telephone and emails. It is an excellent template for visits of similar VIP organizations from other parts of the world.

Complaints: LTO and Immigration/Customs at airports

1. Many car owners are frustrated at the inefficient and inconvenient practices of the LTO. I know of an individual who bought his automobile last June and has yet to receive the license plates. On the other hand, I recently sent my car for renewal which, after payment, only requires a sticker to be affixed to the original license plate. My driver was informed that the sticker was not available. WHY???

2. Upon departure in Manila airports, I am required to fill out a form specifying name, date of birth, passport number etc. On arrival from abroad another form is required with the same data requirements aside from a customs form which requires almost the same data. I cannot understand why there cannot be one consolidated embarkation/disembarkation/customs form with a duplicate page as is done in other countries. Explanation PLEASE!!!