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Technical Assistance to the
Health Sector Policy Support Programme
ESTABLISHING THE WOMEN’S HEALTH AND
SAFE MOTHERHOOD FACILITY NETWORK
IN FOURmula ONE for Health Program Provinces
A Report
Submitted by:
Bienvenido P. Alano Jr., PhD
Consultant
October 2007
Technical Assistance to the Health Sector Policy Programme in the Philippines
An EU funded programme managed by the EC Delegation and the DoH
TABLE OF CONTENTS
Executive Summary 3
Acknowledgements 8
Report Objective and Design 9
Rationale 11
The DOH Strategy in Reducing Maternal Deaths in the F1 Context 14
The Facility Mapping Exercise 18
The Facility Maps of F1 LGUs 20
Ifugao 21
Ilocos Norte 28
Nueva Vizcaya 34
Pangasinan 40
Oriental Mindoro 45
Romblon 53
Capiz 61
Negros Oriental 67
Biliran 75
Eastern Samar 80
Southern Leyte 92
Misamis Occidental 97
North Cotabato 101
Agusan del Sur 107
Lessons Learned 117
Next Steps 119
References 120
2
EXECUTIVE SUMMARY
This paper reports on the results of an effort to identify in each of the provinces covered
by the FOURmula ONE for Health Program (F1), the network of health facilities that
could cost-effectively provide an integrated package of women’s health and safe
motherhood services. This mapping activity represents the initial step in implementing
the DOH strategy for addressing the persistently high rate of maternal death in the
country. Implementation experience in the F1 provinces is envisioned to guide the roll-
out effort towards nationwide coverage.
An international consensus on the best way to address high maternal mortality rates in
developing countries underlies the DOH strategy. It involves a basic paradigm shift in
managing pregnancy and child birth. For the past twenty or so years, the strategy of
choice emphasized the importance of antenatal care in predicting pregnancy risks and the
training of traditional birth attendants to make pregnancy and childbirth at the grassroots
level safer. However, recent studies revealed the ineffectiveness of this strategy in
reducing maternal mortality in poor countries. The current consensus is that a strategy of
encouraging mothers to give birth in adequately-equipped primary level facilities so that
they could be attended by a team of skilled providers would be a more effective approach
to addressing high mortality rates.
The strategy of the Department of Health (DOH) hews to such an approach. It seeks to
establish in every province a network of health facilities that could cost-effectively
provide basic emergency obstetric care (BEmOC) during childbirth and comprehensive
emergency obstetric care (CEmOC) for high-risk and complicated cases. To help ensure
that each pregnancy has a favorable outcome and to avoid missed opportunities, the
above services are integrated with other interventions that are deemed critical to the
mother’s reproductive health, e.g., family planning and STI and HIV/AIDS prevention.
This integrated package of service is envisioned to be delivered by highly trained teams
of skilled health providers in strategically-located health facilities.
To ensure that the facility network is tailored to specific needs of the province and
adequately addresses local health concerns, important stakeholders are encouraged to
conduct a facility mapping exercise. The exercise therefore usually involves the
provincial health officer, the provincial health staff, municipal health officers and heads
of hospitals. The facility mapping exercises in F1 sites were facilitated by representatives
of the DOH central office, with assistance from representatives of the Centers for Health
Development (CHDs).
3
In an effort to ensure that the facilities in the network are accessible, adequately staffed
and are well positioned to sustainably deliver the above package of interventions, the
process of choosing BEmOC and CEmOC facilities was guided by the following criteria:
1. Population coverage
There should be at least 1 BEmOC facility for a population of 125,000 and at least 1
CEmOC facility for a population of 500,000.
2. Travel time
A BEmOC facility should be not more than 30 minutes away from each barangay in
the catchment and a CEmOC facility should be not more than 1 hour away from a
BEmOC in the catchment.
3. Adequacy of human resource
A BEmOC Team should have a full staff complement of doctor, nurse and midwife.
For BHS BEmOC, a midwife should be assigned to the BHS full time with the
municipal health officer or nurse alternately making supervisory visits. (Thus, the
number of BHS BEmOCs is constrained by the ability of the doctor or the nurse to
supervise them, especially if the BHSs are in remote barangays). On the other hand, a
CEmOC Team should be headed by an obsteric-gynecology specialist or a general
practitioner trained on CEmOC service provision and at least 1 operating room nurse
providing duty time per 8-hour shift.
4. Financial and Operational Sustainability
Careful selection of BEmOC and CEmOC facilities should be observed to ensure that
catchments do not overlap significantly as to hamper operational and financial
sustainability. (This serves as an additional consideration in the application of the
travel time criterion. For the catchment areas not to overlap significantly, BEmOCs
should be at least 30 minutes away from each other and CEmOCs 1 hour apart).
The report shows the resulting map of the women’s health and safe motherhood (WHSM)
facility network for each of the F1 provinces covered by this engagement. A map
indicating the incidence across municipalities of diseases targeted by the Disease-Free
Initiative is also shown.
Lessons Learned
The mapping experience has generated lessons that could guide subsequent mapping
efforts in other provinces. Among the most important are:
1. Parochial concerns eventually give way to the greater good of establishing a
cost-effective provincial facility network. The initial tendency of most MHO
participants is to lobby for the designation of their RHU as a potential BEmOC, as
this would result in the RHU being a recipient of grants for upgrading. However,
after the intervention model and its objectives have been fully explained to them,
such parochial objectives eventually take a backseat to the higher goal of identifying
4
strategically-located BEmOCs to comprise the provincial facility network. This shift
in outlook is facilitated when the PHO exercises leadership during the deliberations
and is seen to be adept at handling the touchy task of explaining to the political
hierarchy (especially the municipal mayors) the resulting deployment of grant funds
across municipalities.
2. Flexibility is key. While a major objective of the exercise is to advocate for the
adoption of the DOH strategy for addressing maternal mortality and while the choice
of facilities that would receive DOH grants is to be guided by a set of objective
criteria, it is crucial not to be too prescriptive in implementation. It is important to
keep in mind that the model will only be effective if it responds to the needs of the
local population and that its effectiveness rests on a deployment that adapts well to
the local situation and melds seamlessly into the local health system. Adopting such
an attitude eases acceptance of the model and lays the foundation for eventual
ownership over it by those tasked with frontline implementation.
3. Timing is important. Although most workshop participants initially viewed the
activity with reluctance, they eventually come around to appreciate the activity as
one that offers them an effective tool for objectively allocating their resources and
for amicably settling conflicting claims over these resources. However, the universal
lament is that why such an activity, which logically should precede an investment
planning process, is introduced at such a late stage in the process. Hopefully, this
would be remedied in the succeeding roll-out provinces.
4. Consider the political context. The workshop discussions emphasize that nothing
much can happen at the local level without involving the local chief executive in the
loop. Public health is no exception. There should therefore be efforts to generate
political support for the undertaking.
5. Be sensitive to the capability and will of frontline providers. Some MHOs are
aggressive in ensuring that their constituents have easy access to BEmOC facilities,
while others are reluctant to take on the responsibility of having to supervise these
facilities, especially if they are remotely located. An issue of common concern is the
legal liability that the MHO assumes whenever the midwife attends to a facility birth.
6. However, do not underestimate their (MHOs) willingness to collaborate and
help each other out. The discussions on the issue of supervising remote facilities
have revealed a deep sense of camaraderie among frontline health workers in a
province. They are usually ready to pitch in to assist an MHO in a neighboring
municipality. Many appear willing to contribute their time to help fill in the staff
time needed to keep a neighboring RHU BEmOC operational on a 24-hour basis (the
model requires a doctor to be always available on call).
7. Enlist the active involvement of the Center for Health Development (CHD). The
CHD staff is usually familiar with the territory and the people. This knowledge
becomes invaluable during issue-resolution sessions, especially if the regional
5
representative is someone the participants look up to. Besides, they will inevitably
become involved when the time comes to ramp up coverage. One should therefore
try to keep them in the loop from the start.
Next Steps
The objective of incorporating the results of the mapping exercise into the investment
plans (PIPH) of the F1 provinces would be realized by undertaking as a next step a Needs
Assessment Exercise for those facilities that were designated to be part of the WHSM
provincial network. This could expeditiously be accomplished by using the Integrated
Needs Assessment Tool which was developed and field tested in WHSMP2 sites. The
tool seeks to determine what each facility needs to be upgraded to either BEmOC or
CEmOC by first taking stock of current resources and capabilities and then comparing
these with the requirements of the service delivery model. The Needs Assessment
Exercise is envisioned to generate the following outputs:
A strategy for human resource development and training
Needed infrastructure improvement
A list of equipment and drugs that need to be procured
Systems that need to be developed to enhance financial sustainability
Recording mechanisms that need to be put in place to allow progress monitoring
From these, one could generate inputs to the PIPH that are focused on enhancing the
capability of the provincial service delivery network to address the maternal and neonatal
mortality situation of the province.
6
SUMMARY TABLE OF WHSM FACILITIES
Province Number of BEmOC Number of CEmOC
Facilities Facilities
Ifugao 27 2
(4 Hospitals, 5 RHUs, 18 BHSs)
Ilocos Norte 21 4
(3 Hospitals, 18 RHUs,)
Nueva Vizcaya 11 3
( 2 Hospitals, 5 RHUs, 4 BHSs)
Pangasinan 7 6
(3 Hospitals, 3 RHUs, 1 BHSs)
Oriental Mindoro 21 3
(4 Hospitals, 5 RHUs, 12 BHSs)
Romblon 9 5
( 3 Hospitals, 6 RHUs)
Capiz 20 2
(3 Hospitals, 10 RHUs, 7 BHSs)
Negros Oriental 24 4
(10 Hospitals, 13 RHUs, 1 BHSs)
Biliran 17 1
(8 RHUs, 9 BHSs)
Eastern Samar 36 5
(4 Hospitals, 14 RHUs, 18 BHSs)
Southern Leyte 14 4
(3 Hospitals, 9 RHUs, 2 BHSs)
Misamis Occidental 7 3
( RHUs, 1 Puericulture Center)
North Cotabato 11 3
(3 Hospitals, 6 RHUs, 2 BHSs)
Agusan del Sur 28 3
(1 Hospital, 5 RHUs, 22 BHSs)
7
ACKNOWLEDGMENTS
Establishing the Women’s Health and Safe Motherhood Facility Network in the
FOURmula ONE for Health Program Provinces is a great challenge made easy by the
cooperation and enthusiasm of the Local Health Officers. The consultant is truly
appreciative of the LGU effort and acknowledges the hard work of the Provincial Health
Officers, all the Municipal Health Officers, Chief of Hospitals, Local Government
Planning Officers and Finance Officers who participated in the workshops as well as the
Technical Staff of the Provincial Health Office, the Nurses and Midwives of the
Municipal Health Offices and Hospitals of the following Provinces: Ifugao, Ilocos Norte,
Pangasinan, Nueva Vizcaya, Oriental Mindoro, Romblon, Capiz, Negros Oriental, Biliran,
Eastern Samar, Southern Leyte, Misamis Occidental, North Cotabato, Agusan del Sur.
The consultant is likewise grateful to the following offices of the Department of Health
for the technical assistance extended: National Center for Disease Prevention and Control,
especially Ms Zenaida Dy Recidoro, Chief Health Program Officer and Program
Manager of the National Safe Motherhood Program, who expertly and conscientiously
performed the task of Technical Coordinator for this undertaking and ably represented
her office (NCDPC) and DOH in all the provinces visited, Bureau of International Health
Cooperation, Health Policy Development and Planning Bureau, Bureau of Local Health
and Development and the Centers for Health Development in CAR, Ilocos, Southern
Tagalog (MIMAROPA), Central Visayas, Eastern Visayas, Western Visayas, Northern
Mindanao, Central Mindanao and Caraga.
Thanks are also due the Staff of the Center for Economic Policy Research, for the
invaluable staff work.
Lastly, this consultancy will not be possible without the technical and funding support of
the Technical Assistance to the Health Sector Policy Programme in the Philippines, a
European Union funded program managed by the European Commission Delegation and
the Department of Health.
It is to all of you that this Project is truly beholden.
B. P. Alano Jr., PhD
8
REPORT OBJECTIVE AND DESIGN
Current trends in maternal mortality in the country call for urgent attention. The
challenge is for the Department of Health (DOH), to achieve the Millennium
Development Health Goals (Health MDGs) by 2015, a Philippine government
commitment to the international community. Among the Health MDGs, meeting the goal
on maternal health by 2015 - including the target that seeks to reduce the maternal
mortality ratio (MMR) by three-quarters - poses a challenge and has become the focus of
investments by the DOH. While the MMR target is ambitious, the goal is attainable.
There are inspiring examples of success from countries that experienced remarkable
drops in the maternal mortality ratio, an indicator of the safety of pregnancy and
childbirth. These examples remind us that with the right policies and conditions in place,
dramatic and rapid progress is possible.
A new approach to reduce maternal death has been adopted for implementation under the
FOURmula ONE for Health Program (F1). The new approach calls for a paradigm shift
in maternal and newborn care service delivery that is simple and relatively inexpensive.
The new paradigm views all pregnant women to be at risk of complications and should
have easy access to both basic and comprehensive emergency obstetric care.
Relative to the Philippine government’s robust bid to achieve MDG 5 the national
advocacy is for all local governments to establish facilities that can provide emergency
obstetric care in places nearest to homes and to integrate related basic services into a
single service package so that missed opportunities in health particularly those that target
women are avoided. The service package seeks to improve public health service in the
areas of maternal and newborn care, family planning and STI prevention and HIV control,
important elements of reproductive health that are viewed as having the greatest impact
on women’s health.
Establishing these facilities starts with two critical activities: Facility Mapping and Needs
Assessment. These activities seek to 1) identify a province-wide network of strategically
located health facilities that could cost-effectively pursue the above objective and 2)
generate a rational investment plan that would rapidly and effectively upgrade the
capability of each facility to address maternal mortality in the province.
Activity Objective
The main objective of this Report is to present the Facility Maps which are customized to
fit the local situation in each of the 14 provinces participating in the F1 for Health
Program. The maps identify strategically-located facilities that can effectively deliver the
women’s health and safe motherhood service package, especially, basic and
comprehensive emergency obstetric and newborn care services.
9
This Report is presented in 5 parts:
I. Rationale gives a brief account of the debate on how best to address the high
maternal mortality ratios in the developing world and describes the current consensus
and how it was arrived at. To complete the context, the Philippine situation is also
briefly described. This section serves as a backdrop for a description of the DOH
strategy for achieving MDG 5.
II. The DOH Strategy for Reducing Maternal Deaths in the F1 Context is a discussion
of the women’s health and safe motherhood integrated intervention model which was
designed in the context of the F1 reform pillars.
III. The Facility Mapping Process explains how the Facility Maps are tailored to fit
local situations through a participative approach. It describes the consensus-building
process and the issue-resolution mechanisms used to generate agreement on the
facility maps.
IV. The Facility Maps is a presentation the Provincial Facility Maps and convey the
result of the consultations with LGU stakeholders. It describes specific
circumstances that apply to each province, the unique factors considered in each and
the dynamics of the discussions with the local health officers.
V. Lessons Learned and Next Steps reflects on what could be done to improve the
planning process in the roll out sites and the immediate next step.
10
RATIONALE
The Global view
During the 20 years of international and national advocacy for safe motherhood, an estimated 10
million women have died of maternal causes. For this to happen in a world where we state that
“we know what works” and that “88-98% of maternal deaths are preventable” is obscene.
(Campbell OMR, Graham WJ, Lancet 2006).
The above statement expresses the collective frustration of the international community
over the persistent failure to address the problem of high maternal mortality ratios in
developing countries. This section tries to give a brief account of “what works” in order
to serve as a backdrop for the attempt to apply these strategies to the Philippine situation.
But first, it would be useful to review those strategies that have been found to be
ineffective and to try to cull lessons learned from their implementation.
What Has Not Worked
Two basic strategies have underpinned past efforts to address high maternal mortality
ratios: applying the risk approach through antenatal clinics and TBA training
(traditional birth attendants). (De Brouwere, et al. 1998). The risk approach takes the view
that a sufficient number of antenatal visits would allow the attending health provider to
identify at-risk pregnancies and anticipate complications. (Tucker J, Florey CdV, Howie P,
i
Mellwaine G and Hall MH. 1994, in De Brouwere, et al. 1998). Thus the focus during the 1970s
and 80s was to promote the development of antenatal clinics and to encourage mothers to
make the necessary number of antenatal visits (V. De Brouwere et al. 1998).
The risk approach went practically unquestioned until a series of studies were done in the
80s, which revealed the low predictive value of antenatal visits. In a study of antenatal
clinics in Aberdeen, Hall et al. (1980) showed that antenatal clinics were not effective in
predicting and identifying obstetric problems. This finding was subsequently reinforced
by the results of the Kosongo study (Kosongo Project Team 1984) showing women at risk to
be only a small proportion (29%) of all women with obstructed labor. Maine et al. (1991),
in turn, used this finding to argue that antenatal clinics could not effectively identify most
complications that threaten a mother’s life (V. De Brouwere et al 1998). “The current
consensus is that even in developing countries where the prevalence of risk is higher,
antenatal screening has low predictive value because of its low sensitivity (30%) and its
relatively low specificity (around 90%) (Chang et al. 1980; Hall et al. 1980; Koblinsky et al. 1994;
Walsh et al. 1994; Acharya 1995; Rohde 1995; Yuster 1995; Dujardin et al. 1996; McDonagh 1996)”
(quote from V. De Brouwere et al. 1998).
TBA training was the other strategic axis. It was justified by the observation that there
were not enough professional health providers to attend to mothers in need of maternal
care. TBAs, on the other hand, were highly accessible, especially in the rural areas. They
were also culturally acceptable and were usually able to influence a mother’s health-
seeking behavior. Training them on modern methods of childbirth was therefore widely
11
seen as a logical solution to the health provider gap. Moreover, community
empowerment was at the core of the primary health care strategy in the 70’s and training
TBAs was fully consistent with this overarching objective.
The mid 80’s saw the emergence of studies evaluating TBA performance and voicing
skepticism about the strategy (Namboze 1985, Ross 1986). This gradually developed into a
shared conclusion that “the training of TBAs has had little impact on maternal
mortality and that the most effective measures were those that which make it
possible to reach a well-equipped hospital” (Greenwood et al. 1990; Maine et al. 1991;Fauveau
& Chakraborty 1994; Koblinsky et al. 1994; Turmen & AbouZahr 1994)” (quote from De Brouwere et al.
1998).
De Brouwere attributes the failure of the TBA training strategy to a number of important
elements that were underestimated by its proponents (De Brouwere et al. 1998). First was
the degree of variability of the function, knowledge and experience of TBAs. In some
regions, the TBA is an experienced woman who has survived several pregnancies herself
and carries out several dozen deliveries a year. Elsewhere, the TBA may be a woman
whose sole role is to reassure and give comfort to the mother during the few deliveries
that she attends. Framing a strategy that does not take into account this wide variation
would be technically invalid. Second was the amount of supervision needed to ensure the
safety of TBA-attended childbirth. Since this amount is inversely proportional to the level
of training, the TBA therefore needs much more supervision than a professional midwife.
This need is underscored by the observation that some TBAs tend to delay or even
discourage women with complications from going to the hospital (Estrada 1983; Catfish 1987;
Viegas et al. 1987). However, such supervision intensity is hard to sustain in a situation
where the rural health physician is already overextended.
What Works
There is a global consensus on what works to address maternal death. This is embodied
in a joint statement by WHO, UNFPA, UNICEF and the World Bank in 1999, calling on
countries to “ensure that all women and newborns have skilled care during pregnancy,
childbirth and the immediate postnatal period” (Reducing maternal mortality. A joint statement by
WHO/UNFPA/UNICEF/World Bank. Geneva, World Health Organization, 1999). Such care is to be
provided by a skilled attendant - an accredited health professional (midwife, doctor or
nurse) who has been educated and trained in the skills needed to manage the above-
mentioned stages in pregnancy and childbirth as well as in the identification,
management and referral of complications. To ensure the best possible outcome,
childbearing women should have access to a continuum of care provided by a
“functioning health care system with the necessary infrastructure in place, including
transport between the primary level of health care and referral clinics and
hospitals” (WHO 2004).
In 2006, the Lancet came out with a 5-article series on maternal survival called The
Lancet Maternal Survival Series. In the 2nd article, the authors contend that while “ the
concept of knowing what works in terms of reducing maternal mortality is complicated
by a huge diversity of country contexts and of determinants of maternal health only a few
12
strategic choices need to be made” to attain the objective. They go on to make a
compelling case for prioritizing just “one strategy based on delivery in primary-level
institutions (health centers), backed up by access to referral-level facilities”, labeling
it their “best bet to bring down high rates of maternal mortality” (Campbell et al 2006).
They argue on the basis of the observation that “most maternal deaths occur during labor,
delivery or the first 24 hour postpartum, and most complications cannot be predicted or
prevented” (this quote from Campbell et al. is based on the results of the first report in the series:
Ronsmans C, Graham WJ. 2006). They further argue that while the necessary level of skilled
care could very well be delivered at home for mothers who prefer to give birth there, a
strategy encouraging home deliveries has distinct disadvantages. For one, home
conditions can be very basic and could limit the ability of the skilled attendant to deal
with emergencies, especially since the attendant has only the family to rely on to assist
rather than other providers such as doctors or nurses in health centers or hospitals.
Moreover, home-based childbirths are inefficient in terms of not only the skilled
attendant’s time but also that of the supervisor (who is most likely the already
overburdened rural health physician).
Therefore, based on the evidence that they present, the authors conclude “ that the best
intrapartum-care strategy is likely to be one in which women routinely choose to
deliver in a health centre, with midwives as the main providers, but with other
attendants working with them in a team” (Campbell et al. 2006).
The Philippine Situation
The maternal mortality ratio in the Philippines is 162 per 100,000 live births (NSO, 2006
Family Planning Survey). The 2003 National Demographic and Health Survey (NDHS)
shows that 38% of live births in the five years preceding the survey were delivered in a
health facility and 61% were born at home. The survey also shows that 60% of the births
in the 5 years preceding the survey were assisted by health professionals (34% by a
doctor, 25% by a midwife and 1% by a nurse) although 88% of women who had a live
birth during the period saw a health professional for antenatal care. On the other hand, a
“hilot” or TBA attended 37%.
If the MDG goal for maternal mortality reduction is to be met, there is a need to
implement a highly cost-effective intervention and to quickly ramp up its coverage.
Facing this challenge may be made more difficult by a looming shortage of skilled health
professionals, particularly in the rural areas. An informal survey of municipal health
officers (MHOs) who participated in the mapping workshops reveals that most of them
are either already nurses or studying to become one in the hope of joining the exodus for
more lucrative nursing jobs abroad. This makes a strategic and cost-effective approach to
addressing maternal mortality even more important.
13
THE DOH STRATEGY IN REDUCING MATERNAL DEATHS IN THE F1 CONTEXT:
The Sustainable Delivery of an Integrated Package of Women’s Health and Safe
Motherhood Services in Strategically Located Health Facilities
The strategy described in this report is based on the design of the Second Women’s
Health and Safe Motherhood Project (WHSMP2) currently being piloted in two
provinces: Sorsogon and Surigao del Sur. This section therefore draws heavily from the
Project Implementation Manual of WHSMP2. The current effort being reported here is
the consequence of a policy decision to expand the pilot exercise to cover the sixteen
FOURmula ONE sites, to further assess the feasibility of a nationwide rollout.
The Intervention Model
An integrated package of services that are critical to preventing maternal and neonatal
death is delivered in selected health facilities. Facility selection is guided by a set of
criteria, which tries to ensure comprehensive and effective coverage of populations at risk
(with a focus on the poor and underserved) and the sustainability of facility finances and
operations, mainly by ensuring the presence of sufficiently skilled staff and avoiding the
designation of facilities with catchments that overlap significantly. This is envisioned to
result in making emergency obstetric and newborn services available at facilities closest
to homes while observing cost-effectiveness considerations as well as the need to provide
facilities, particularly those in the frontline, with operating environments that are
conducive to their operational and financial sustainability. To further this objective,
DOH investments in the selected facilities shall not only be towards their upgrading to
model standards but shall also ensure their compliance with DOH licensing and
PhilHealth accreditation requirements.
The package of services consists of maternal and newborn care, family planning and STI
screening. The package is envisioned to be offered to women of reproductive age who
may call on designated facilities for reproductive health concerns covered by any of the
above services. Such an integrated approach to service delivery seeks to maximize client
visits and avoid missed opportunities, aside from helping to ensure cost-effectiveness in
the delivery of these critical interventions.
The maternal and newborn care package is characterized by a paradigm shift from the
risk approach which tries to identify at-risk pregnancies and anticipate complications
through antenatal care visits to one which views complications as unpredictable and seeks
to provide mothers with easy access to emergency obstetric care services (the EmOC
approach). The strategy seeks to encourage women to give birth in strategically located
facilities suitably equipped to render Basic Emergency Obstetric and newborn Care
(BEmOC). Complicated pregnancies and those needing caesarian sections and blood
transfusions are referred to facilities rendering Comprehensive Emergency Obstetric
and newborn Care (CEmOC). The network of referral facilities is deployed in such a
manner as to allow women to access the services they need within a timeframe that
ensures a safe outcome.
14
The effectiveness of the service delivery model is further enhanced by putting in place
support systems that allows the delivery of 1) a reliable supply of safe blood for obstetric
emergencies and 2) appropriate and adequate training for critical health staff.
Demand Generation through a Behavioral Change Strategy
Key to addressing the high maternal mortality ratio is the reduction of the incidence of
home birth, especially those attended by TBAs. Estimates cited indicate that more than
half of current births are at home, mostly attended by TBAs - a situation that is seen to
have led to the current high mortality ratio. The TBA is usually seen as the neighborhood
healer, consulted for various illnesses as well as for childbirth. The TBA’s childbirth
services usually go beyond assisting in the delivery. Massaging the mother, helping in
household chores and minding the children are often part of the package.
The effort to encourage the mother to give birth in health facilities instead of at home
should therefore include measures to address the TBA’s influence on the mother’s choice
on where to deliver. The strategy is to make the TBA an ally in pursuing advocacy
objective. It is vital to recognize that the shift from home to facility birth would deprive
the TBA of an important source of livelihood since she attends to the majority of home
deliveries in the community. Thus, the goal should be not to remove the TBA from the
scene but instead make her an important part of it by designating her member of the
community-level Women’s Health Team (WHT) led by the rural health midwife. The
WHT may also include the Barangay Health Workers (BHWs) and has the following
functions:
1. To track every pregnancy occurring in the community using the pregnancy tracking protocol.
2. To assist pregnant women accomplish a birth plan and to monitor compliance at each prenatal
visit.
3. To provide the following maternal care services: prenatal, childbirth and postnatal.
4. To accurately record findings in the woman’s birth plan at every prenatal visit.
5. To counsel each expectant woman on:
Care during pregnancy, childbirth and immediately after childbirth.
Importance of newborn screening and the implications of its findings.
Importance of follow-up visit to the facility after childbirth.
Proper newborn care to include breastfeeding, nutrition and immunization.
6. To refer clients to the appropriate health facility.
7. To organize outreach activities for family planning and STI control.
8. To provide counseling services to clients and act as agents for behavior change through
interpersonal communication.
9. To identify women of reproductive age (WRA) with unmet need for FP and STI services.
10. To provide the following FP services:
Re-supply of pills
IUD insertion
Distribution of condoms
Counseling
11. To discuss relevant women’s health issues with the community.
15
By assigning the TBA to assist the midwife in carrying out the functions of the WHT,
one therefore merely changes the TBA’s job description and opens the door for her to
still look to childbirths as an important source of job satisfaction and livelihood (although
facility births will be attended by a skilled professional, the TBA can still be tasked to
perform auxiliary functions such as comforting the mother during labor, looking after the
children and the household, etc.).
Focused-group discussions with TBAs in the WHSMP2 sites reveal that TBAs look
favorably at such an arrangement for the following reasons:
1. Being part of the formal health system adds to their stature in the community;
2. Monetary incentives offered by WHSMP2 to the WHTs for facility referrals (the
Project pays WHTs 1,000 pesos for every referral of a poor mother to the facility and
the RHU physicians have agreed to share their Philhealth reimbursements with the
WHT) are seen by TBAs as a more predictable source of income than their current
practice of providing home-based deliveries, despite the fact that it has to be shared
with other providers involved in facility delivery and her share would most likely be
less than the fees she normally charges for home deliveries. This is because not all of
the TBA’s clients in the community could afford to pay the fee that she charges. A
significant number pay in kind (in terms of produce or livestock) while others just
promise to pay if and when their finances allow.
Reinforcing Incentives to Ensure Sustainable Financing
To further reinforce the shift, WHSMP2 requires the local chief executive (LCE) to allot
500 pesos as the LGU counterpart towards the facility birth of every poor mother. This is
to help defray the mother’s expenses for transport, food and medicine. This scheme not
only serves to break down the financial barrier to facility birth that poor mothers face but
also encourages a behavioral change on the part of the LCE that would help sustain the
shift to facility birth over the long term.
Through advocacy, WHSMP2 encourages LCEs to enroll poor mothers in the PhilHealth
sponsored program with the message that as mothers shift to facility birth as a result of
the above incentives coupled with the advocacy efforts of WHSMP2, the LCE’s
constituents would expect the same level of financial support for the poor even beyond
the life of the project. The best option is for the LCE to enroll the poor in the PhilHealth
Sponsored Program. This would assure sustained financial support not only for facility
births but for other services as well. To further strengthen the impact of this message,
WHSMP2 reimburses half of the amount paid for premiums by the LGU if the LGU
meets the annual target set by PhilHealth for enrollment in the Sponsored Program.
To ensure the sustainable implementation of the service delivery model, a financing
strategy is also put in place to enhance the financial autonomy of service delivery
16
facilities. The strategy seeks to broaden financing sources by encouraging (1) the
collection of user fees from non-poor users and the use of such revenue to fund
operations as well as incentives for health workers and (2) PhilHealth accreditation of
facilities and making full and effective use of insurance reimbursements.
Regulation
The model imposes facility standards in terms of infrastructure, equipment and staff skills.
These standards are compliant with DOH licensing and Philhealth accreditation
requirements. Investments are therefore focused on upgrading facilities to these
standards.
Governance
A performance-based approach to the allocation of DOH grants to LGUs helps ensure the
delivery of LGU counterpart inputs to implementation. Among these inputs are the
enactment of LGU ordinances that provide a favorable policy environment for the
implementation of the service delivery package as well as the enhancement of financial
sustainability of facilities.
17
THE FACILITY MAPPING EXERCISE
To ensure that the intervention model is implemented in a manner that is tailored to the
local situation and responds to local needs, a participative facility mapping workshop is
carried out at the provincial level. The workshop is participated in by the Provincial
Health Officer and the technical staff of the provincial health office, the heads of hospital
and the Municipal Health Officers. The workshop objective is to generate a consensus on
the appropriate BEmOC-CEmOC network of facilities in the province. DOH
representatives from both the central and regional levels help facilitate the discussions
aside from contributing their own inputs. Their presence and active participation ensure
that whatever agreements are reached result from a consensus – at least at the technical
level – not only among the LGU participants but also between the DOH and the LGUs
represented.
To initiate the activity, participants are first given fairly comprehensive presentations on
the rationale for establishing EmOC facilities, the Integrated Service Delivery Model and
its support structure, and the facility mapping process. The workshop is then conducted
in 2 stages. The first stage involves the selection of CEmOC facilities and is done in
plenary. The second stage involves the selection of BEmOC facilities, where the
participants are grouped by inter-local health zones (ILHZ) and are asked to map the
BEmOCs within their respective ILHZ. The mapping activity is guided by the following
criteria:
1. Population coverage
There should be at least 1 BEmOC facility for a population of 125,000 and at least 1
CEmOC facility for a population of 500,000.
2. Travel time requirement
A BEmOC facility should be as much as possible not more than 30 minutes away
from each barangay in the catchment and a CEmOC facility should be not more than
1 hour away from each BEmOC in the catchment.
3. Adequacy of human resource
A BEmOC Team should have a full staff complement of doctor, nurse and midwife.
For BHS BEmOCs, a midwife should be assigned to the BHS full time with the
municipal health officer or nurse alternately making supervisory visits. Thus, the
number of BHS BEMOCs is constrained not only by coverage and sustainability
considerations but also by the availability of a permanently assigned midwife
(preferably a resident of the community) and by the ability of the doctor or the nurse
to supervise the proposed BEmOCs, especially if the BHSs are in remote barangays.
18
A CEmOC Team should be headed by an obsteric-gynecology specialist or a general
practitioner trained on CEmOC service provision and at least 1 operating room nurse
providing duty time per 8-hour shift.
4. Financial and Operational Sustainability
Careful selection of BEmOC and CEmOC facilities should be observed to ensure that
catchments do not overlap significantly as to hamper operational and financial
sustainability. (This serves as an additional consideration in the application of the
travel time criterion. For the catchment areas not to overlap significantly, BEmOCs
should be at least 30 minutes away from each other and CEmOCs 1 hour apart).
Each group is subsequently asked to present their BEmOc recommendations to the group
in a plenary session to allow a wider discussion. Aside from justifying their choice of
BEmOC facilities in terms of the above criteria, each group is asked to delve on the
following issues as well:
1. Geography: to include presence of a road network and its condition and other natural
obstacles common in the area e.g. terrain, island, etc.;
2. Potential communities and population that will be served, to include communities
outside of the regular catchment;
3. Travel time from farthest catchment to the referral facility; and
4. Current maternal care capability, including human resource adequacy.
Since the process is mainly dependent on the accuracy of the information provided by
LGU participants, heads of facilities proposed as BEmOCs or CEmOCs are asked to
render a written justification of their recommendations, in addition to the above reporting
requirement. The hope here is that more careful thought and prudence would be
encouraged if proponents know that their inputs become a matter of record. The presence
of provincial and regional staff also serves as a validating mechanism since they usually
do not hesitate to challenge inaccurate claims made by their municipal counterparts. In
fact, in provinces where the provincial staff is seen as capable and willing to help (most
are), their assistance is sought in facilitating the discussions and in resolving issues,
especially if the resolution requires the intervention of one who is familiar with local
conditions. Issues raised in plenary are thoroughly discussed. Only after all issues are
resolved to everyone’s satisfaction is the map deemed final. Experience has shown that
the ease and speed with which this is achieved is usually heavily dependent on the
leadership exercised by the Provincial Health Officer and his or her staff. Most PHOs
performed this task well, apparently partially driven by the need for them to subsequently
defend the choices indicated in the map not only before the political hierarchy of the
province but possibly before DOH management as well.
19
THE FACILITY MAPS OF F1 LGUs
Two types of maps are presented: 1) Facility Map that identifies the CEmOC-BEmOC
network in the province and 2) Infectious Disease Map that identifies endemic areas for
diseases under the disease free-zone initiative: filariasis, leprosy, malaria, rabies and
schistosomiasis.
While the selection of facilities was guided by technical criteria, some degree of
flexibility was observed in its application in an attempt to tailor the model according to
the unique needs and characteristics of each province. This section attempts to describe
the facility mapping process and the unique features of each province’s facility map as
well as the health officers’ justification for the choice.
20
IFUGAO BEmOC/CEmOC Facility Map
Alfonso
Banaue Mayoyao Lista
Aguinaldo
Hingyon
Hungduan
Lagawe
Kiangan CEmOC
BHS BEmOC
Tinoc
RHU BEmOC
Lamut
Asipulo HOSP BEmOC
ILHZ
AMADHS
Teraces
Tinoc
Hungduan
21
IFUGAO Endemic Disease Map
Alfonso
Banaue Mayoyao Lista
Aguinaldo
Hingyon
Hungduan
Lagawe
Kiangan
RHU
Tinoc Lamut HOSP
Asipulo
Endemic Diseases
Malaria
Leprosy
Filariasis
Schistosomiasis
Rabies
IFUGAO
22
Ifugao, known for its magnificent rice terraces lies on the southeastern portion of the
Cordillera mountain range. It is bounded on the north by Mountain Province, on the east
by Isabela, on the west by Benguet and on the south by Nueva Vizcaya. The terrain is
rugged, with mountains cutting across the viewpoint with elevations reaching beyond
1,000 meters and peaks above 2,000 meters. The mountains, however gradually slopes
towards the flat lands of Nueva Vizcaya in the east. The province covers a total land area
of 251,778 hectares characterized by river valleys and massive forest. It has a total
population of 161,623 scattered in its 11 municipalities and 175 barangays.
(http://en.wikepedia.org/wiki/ifugao).
The Ifugaos are indigenous and have their own culture and tradition. Their belief systems
are deeply rooted in their way of life. Their ethnicity coupled with the terrain and other
natural obstacles could prove to be a challenge in times of health emergency. Thus home
births are preferred by 71% (2,430 out of 3418) of pregnant women with around 30% of
them assisted by traditional birth attendants (TBAs), with the rest having been attended
by midwives, husbands, or gave birth by themselves as is commonly practiced. The
Provincial Health Office (PHO) reported 6 maternal deaths in 2006, a ratio of 176 deaths
due to pregnancy, labor and delivery for every 100,000 live births.
The above maternal health situation and JICA’s (Japan International Cooperation
Agency) funding a Maternal and Child Health Program in the province resulted to the
crafting of the Rationalization Plan that considered women’s health and safe motherhood
as an important program. In the Plan, the local health officials expressed the will to
establish facilities that can provide comprehensive and basic emergency obstetric and
newborn care (CEmOC and BEmOC). They however need technical assistance in
identifying appropriate facilities for upgrading and in making sure that all women in
Ifugao will have access to the service.
A facility mapping exercise was thus conducted in the province last 23-24 May 2007. All
Municipal Health Officers, Chief of Hospitals, Center for Health Development - CAR
(Cordillera Administrative Region) Reproductive Health Program Coordinator, JICA
Project Officer and staff assigned in Ifugao and the PHO technical staff actively
participated in the activity. The occasion was used to clarify the rationale for establishing
emergency obstetric and newborn care facilities in the province and investments in the
women’s health and safe motherhood intervention model, which has been adapted for
implementation in all F1 sites. The exercise resulted to the identification of 2 facilities
proposed to be CEmOC providers: Ifugao Provincial Hospital and Mayoyao District
Hospital and 27 proposed BEmOCs: 4 Hospitals, 5 RHUs, and 18 BHSs, none of these
are MCP (maternal care package) accredited.
Ifugao needs to upgrade more BHSs to BEmOC standard because of the difficult terrain
and the fact that people have to hike the trail in a number of communities.
23
The CEmOC-BEmOC-municipality catchments in the province are configured as
follows:
CEmOC Facility: IFUGAO PROVINCIAL HOSPITAL (IPH)
Catchment Municipalities: Asipulo, Alfonso Lista, Banaue, Hingyon, Hungduan,
Kiangan, Lamut, Tinoc, Lagawe
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
1. Alfonso Lista District Alfonso
Hospital Travel time from the farthest
catchment is 1 – 2 hours.
2. Asipulo Rural Health Unit Asipulo Travel time to the hospitals is 5-
6 hours.
There is no hospital in Asipulo.
3. Camandag BHS, Asipulo Camandag and the surrounding This BHS is 8 hours away from
sitios. the Asipulo RHU. Some sitios
can be reached only by hiking
the trail for 3 – 4 hours.
Had 1 maternal death in 2006.
4. Duli BHS, Asipulo Duli and adjacent barangays This BHS is 9 hours away from
the Asipulo RHU.
5. Banaue Rural Health Unit Banaue Travel time to Banaue is less
than 1 hour.
6. Batad BHS, Banaue Batad, Bannao and Cambulo
Travel time to Batad from the
Poblacion of Bannao is 2 hours;
to Cambulo, it is 2 hours of
hiking the trail.
Bannao has no roads;
transportation is only until
Ducligan, a drop-off point.
7. Pula BHS, Banaue Pula, Ducligan, Bannao Pula has no road and therefore
accessible only by hiking the
trail.
8. Umalbong BHS, Hingyon Umalbong Umalbong is a depressed
barangay that would take an
hour to travel to the IPH.
9. Hungduan Rural Health Unit Hungduan The facility needs to be upgraded
to BEmOC since there is no
hospital in the municipality. The
nearest hospital is not as
accessible.
10. Abatan BHS, Hungduan Abatan Travel time to Hungduan RHU
is 30 minutes to 1 hour.
The community is accessible by
road and has transportation
facilities.
24
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
11. Kiangan Rural Health Unit Kiangan Travel time from the RHU to
IPH is 45 minutes to 1 hour by
tricycle.
The facility needs to be upgraded
to BEmOC since there is no
hospital in the municipality.
12. Nagacadan BHS, Kiangan Barangay Ducligan and Cababuyan is more than 30
Cababuyan minutes travel time to the IPH,
a CEmOC facility.
13. Duit BHS, Kiangan Duit Travel time from the
catchments to the proposed
BHS BEmOC is 30 minutes to 1
hour.
Serves remote barangays of
Kiangan.
14. Caba BHS, Lagawe Caba Road access of Caba is via
Lamut, travel time is 1 – 2
hours.
15. Tupaya BHS, Lagawe Tupaya and other remote Travel time from the
barangays of Tupaya catchments to this proposed
BHS BEmOC is from 30
minutes to 1 hour.
16. Lamut Rural Health Unit Barangays of Lamut Travel time from this RHU to
the Panopdopan District
Hospital is 1 hour and 15
minutes; to IPH, a CEmOC
facility, about an hour.
This proposed RHU BEmOC can
serve as a satellite of the hospital.
17. Tinoc District Hospital Barangays of Tinoc, some This hospital is located 5 to 6
barangays of Benguet and Nueva hours away from the capital
Vizcaya town of Lagawe via Hungduan
or 2 to 3 hours passing through
Kaingan.
The area is prone to landslides.
18. Binablayan BHS, Tinoc Remote barangays of Tinoc Travel time from the
catchments is 30 minutes to 1
hour.
The facility mapping exercise noted that Camandag, Duli and Nagcak are 3 barangays of
Asipulo that are hard to reach and not very accessible as the travel time suggests:
Camandag BHS to Asipulo RHU: 5 hours
Camandag BHS to Nueva Vizcaya: 6 hours
Duli BHS to Asipulo RHU: 5 to 6 hours
Nagcak BHS to Asipulo RHU: 12 hours
Nagcak BHS to Nueva Vixcaya: 5 hours hike and 8 hours ride
25
The BHSs are in fact the only health facility in the community and despite the
recommendation to upgrade them to BEmOC standard, the travel time requirement
of 30 minutes from the homes is difficult to comply. Duli and Nagcak residents usually
access services provided at the Veterans Regional Hospital in Nueva Vizcaya or the
Nueva Vizcaya Provincial Hospital, which could be reached by 5 hours of hiking the trail
and 8 hours travel.
Currently, the Ifugaos are hoping that the plan to build a road to connect their villages to
the center of Ifugao and Nueva Vizcaya will be realized soon.
CEmOC Facility: MAYOYAO DISTRICT HOSPITAL (MDH)
Catchment Municipalities: Mayoyao, Aguinaldo, Part of Lamut Alfonso Lista, Part of
Banaue.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
1. Aguinaldo People’s Hospital Barangays of Aguinaldo and Travel time from the
(APH) some barangays of Mayoyao catchments is 1 hour to 2 hours
and 20 minutes; to Isabela
about 5 hours.
This hospital needs to be
developed as a BEmOC provider
since the RHU in the
municipality do not provide
childbirth services.
2. Ubao BHS, Aguinaldo Barangay Ubao, Muenaan and Travel time from this proposed
Chalalo BHS BEmOC to Aguinaldo
People’s Hospital (APH) is 1
hour and 30 minutes; to nearby
Alfonso, 1 hour.
3. Mungayang BHS, Aguinaldo Barangay Mungayang Travel time from this facility to
APH is 3 to 4 hours and to
nearby Natonin, 5 hours.
4. Tulaed BHS, Mayoyao 6 barangays of Mayoyao Travel time to IPH is 45
minutes.
5. Alamit BHS, Mayoyao 3 barangays of Mayoyao Travel time to IPH is 45
minutes.
6. Potia District Hospital, Barangays of Lamut, lower part This hospital is only 5minutes
Lamut of Aguinaldo, Paracelis town of away from the Lamut RHU and
Mountain Province, and some about an hour to Santiago City
barangays along the border with in Isabela.
Isabel.
Rather than closing the hospital
as recommended by a DOH
consultant, the province will
enhance its BEmOC capability.
7. Namillagan BHS, Alfonso Namillagan and Halag Halag is accessible by boat.
Lista
26
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
8. Caragasan BHS, Alfonso Barangay Caragasan Travel time to the facility is
Lista within the 30-minute standard.
Considered more strategic by the
health officers for upgrading to
BEmOC than the RHU.
9. Ducligan BHS, Banaue Ducligan Travel time to Banaue RHU is 2
hours.
27
ILOCOS NORTE BEmOC/CEmOC Facility Map
CEmOC
CEmOC Pagudpud
No investment
Bangui
BHS BEmOC
Burgos Dumalneg
RHU BEmOC
HOSP BEmOC Adams
Pasuquin
Vintar
Bacarra
Carassi
Laoag
City
Piddig
San Nicolas
Solsona
Sarrat
Paoay
Batac Dingras
Marcos
Currimao
Banna
Pinili
Nueva Era
Badoc
ILHZ
Double North
Great Eastern
Metro Laoag
Metro Batac
ILOCOS NORTE
28
Ilocos Norte is the northernmost province on the western side of Luzon.
Rugged mountains that are part of the Cordillera range seal it from
Cagayan, Apayao and Abra on the east. A narrow coastal plain connects
the province to Ilocos Sur to the south. The South China Sea lies to the
west and the Babuyan Channel forms the northern coast. Except for the
coastal plains and the Laoag River lowlands, most of the land is rugged
and rocky. The province has a land area of 3,452 square kilometers and
an estimated population of 517,140. It has 21 municipalities, 2 cities and
557 barangays. (http://www.geocities.com/lppsec/pp/ilocosnor.htm?200717).
In terms of infrastructure, the Manila north road serves as the major
artery to Ilocos Norte and links the province to other parts of the Ilocos
region, Central Luzon and Cagayan Valley. The province has good major
and secondary roads that provide access to the Cordilleras. It also has an
international airport and 2 seaports.
The province has a maternal mortality ratio of 90/100,000 live births,
which is significantly lower than the national ratio. This could be largely
due to the high percentage of births attended by a skilled provider. Of
the 10,918 total live births recorded in 2005, 7,273 women or 67% opted
to give birth at home attended by midwives and barely 4% by traditional
birth attendants. (Rationalization Plan of Ilocos Norte). The Provincial
Health Office is determined to continue the downward trend in MMR by
encouraging women to give birth in facilities capable of providing
emergency obstetric and newborn care (EmOC). The women’s health and
safe motherhood intervention model is therefore a timely input to their
Rationalization Plan, which is part of their overall investment plan for
health.
The facility mapping exercise for the province was conducted on 26-27
July 2007. Thirty-nine (39) health officials and staff from the province
and Center for Health Development – Ilocos attended the workshop. The
exercise resulted in the identification of 4 CEmOCs (1 of these is
Mariano Marcos Memorial Medical Center, a tertiary hospital operated
by the Department of Health) and 21 BEmOCs (18 RHUs and 3
hospitals).
The CEmOC-BEmOC network in the province is configured as follows:
29
CEmOC Facility: BANGUI DISTRICT HOSPITAL (BDH)
Catchment Municipalities: Adams, Dumalneg, Bangui, Burgos, parts of Cagayan
Valley and Apayao
BDH is 1 hour away from the Ilocos Norte Provincial Hospital.
Proposed BEmOC Facilities Catchment Travel Time/other
Justifications
1. Adams RHU Adams Travel time to the RHU
from the farthest barangay
is 2 hours.
Adams is a remote
municipality with unpaved
roads. The trek to the RHU
sometimes involves river
crossings.
2. Dumalneg RHU Some parts of Bangui and Travel time from the
Adams catchment barangays
ranges from 30 minutes to
1 hour.
3. Pagudpud RHU Pagudpud Roads are unpaved but travel
time from the farthest
barangay in the catchment
to the RHU is 30 – 45
minutes.
4. Bangui RHU Bangui Travel time from the
barangays in the catchment
ranges from 30 minutes to
1 hour.
5. Burgos RHU Remote and isolated Travel time from farthest
barangays of Burgos barangay in the catchment
is 45 minutes.
CEmOC Facility: DINGRAS DISTRICT HOSPITAL (DDH)
Catchment Municipalities: Dingras, Solsona, Marcos, Nueva Era, Carassi, Banna.
In designating DDH for upgrading to CEmOC, the plan to merge DDH and Dona
Josefa Edralin Marcos Memorial Hospital (DJEMMH) (mainly because of the very
low occupancy rate of the latter) was taken into account. The merger would be put
into operation by having DJEMMH act as a satellite BEmOC to DDH, catering to the
NSD cases from the catchment, Such a scheme would not only serve to decongest
DDH of non-complicated cases but would also result in higher occupancy rates for
DJEMMH, especially when mothers begin to shift from home to facility birth.
30
Proposed BEmOC Facilities Catchment Travel Time/other
Justifications
1. Dingras RHU Remote barangays of Average travel time from
Dingras and part of Sarrat all barangays in the
catchment is 30 minutes to
1 hour.
2. Solsona RHU Solsona Average travel time from
all barangays in the
catchment is 30 minutes to
1 hour.
3. Marcos RHU Marcos Average travel time from
all barangays in the
catchment is 30 minutes to
1 hour.
4. Nueva Era RHU Nueva Era Travel time from the
farthest barangay is 3 – 4
hours.
However, patients from 2
remote barangays are
brought to Badoc and
Pinili.
Currently does not have an
MHO, but the MHOs of
Banna, Marcos and Solsona
take turns in providing duty
time to the RHU.
5. Carassi RHU Carassi No road link to Nueva Era.
6. Banna RHU Banna The RHU has already been
operating on a 24-hour basis
for 1 year, providing
childbirth services
CEmOC Facility: ILOCOS NORTE PROVINCIAL HOSPITAL (INPH)
Catchment Municipalities: Pasuquin, Bacarra, Vintar, Sarrat, Laoag City, Piddig.
31
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
1. Pasuquin RHU Mountain barangays along Travel time from the
the border of Pasuquin and farthest barangay is 1 hour.
Vintar.
Located 18 kms from Laoag
City.
2. Bacarra RHU Bacarra Although travel time from
the RHU to INPH is 15
minutes, upgrading the
RHU to BEmOC would not
only serve to decongest
INPH of NSD cases but also
help ensure that the remote
barangays in the
municipality are catered to.
Travel time to the RHU
from the farthest barangay
is 45 minutes.
Bacarra has a mountainous
terrain with rough roads. It
also has an island barangay.
3. Tandayan Community 10 barangays of Vintar Travel time from the farthest
Hospital, Vintar barangay is 1 hour.
Vintar has the biggest land area
in the province with a
population of 17,858.
The location of the hospital is
remote and is bounded by rivers
and mountains.
4. Tandayan RHU, Vintar 22 barangays of Vintar 5 of Travel time from the
which are in the Poblacion. Tandayan Community
Hospital to the RHU is 1 hour
and 30 minutes.
5. Laoag City General Hospital Part of Sarrat The hospital will help decongest
INPH of childbirth admissions,
particularly NSD cases.
6. Piddig Medicare Hospital Piddig Travel time from Sta
Catalina, the farthest
barangay is 45 minutes.
32
CEmOC Facility: MARIANO MARCOS MEMORIAL MEDICAL CENTER
(MMMMC)
Catchment Municipalities: Badoc, Pinili, Currimao, Batac City, Paoay.
Mariano Marcos Memorial Medical Center is already a CEmOC-capable facility and will
need no additional investments.
Proposed BEmOC Catchments Travel Time/other
Facilities Justifications
1. Badoc RHU Remote barangays of Pinili, The municipality owns a DPS
Banna, and Nueva Era (Department of Safety)
ambulance that can transport
clients to MMMMC within the
standard travel time of 1 hour.
2. Pinili RHU Remote barangays of Banna, Travel time from the catchment
Batac and Nueva Era barangays ranges from 30
minutes to 1 hour.
3. Batac City RHU II Batac and some barangays of San The RHU, a mere 5 minutes
Nicolas from MMMMC, would help
decongest the hospital of NSD
cases.
4. Paoay RHU Paoay and 2 barangays of Paoay is prone to flooding. Some
Currimao sitios are hard to reach and travel
to the RHU involves a 1-hour
boat ride and a 1-hour hike.
The LGU is currently upgrading
the RHU to a lying-in clinic.
33
NUEVA VIZCAYA BEmOC/CEmOC Facility Map
Diadi
Villaverde Bagabag
Ambaguio Solano
Bayombong
Quezon
Kayapa
Bambang
Kasibu
Aritao
Dupax
Del Norte
Sta. Fe
Dupax
Del Sur
CEmOC
CEmOC Alfonso
No investment Castaneda
BHS BEmOC
RHU BEmOC
HOSP BEmOC
ILHZ
Province-Wide
ILHZ
34
NUEVA VIZCAYA Endemic Disease Map
Diadi
Villaverde
Bagabag
Ambaguio Solano
Bayombong
Quezon
Kayapa
Bambang
Kasibu
Aritao
Dupax Endemic Diseases
Del Norte
Malaria
Sta. Fe Leprosy
Dupax Filariasis
Del Sur
Schistosomiasis
Rabies
Alfonso
Castaneda
RHU
HOSP
35
NUEVA VIZCAYA
Nueva Vizcaya is located in the Cagayan Valley Region in Northern Luzon, at the
juncture of the Cordillera and Caraballo mountain ranges. The province connects 2 broad
expanses of flat plains: Ifugao on the north, Isabela on the northeast and Quirino to the
east. Aurora province lies to the southeast, Nueva Ecija to the south and Pangasinan
towards the southwest. It shares a long common border with Benguet in the west. The
Caraballo mountain range, which cuts transversely between the southern part of the
Cordillera and Sierra Madre mountain ranges on the eastern seaboard, dominates the
province. Nueva Vizcaya is generally mountainous and rugged, cut by hills and valleys.
http://www.geocities.com/lppsec/pp/nvizcaya.htm?200717).
The province has a land area of 4,378.80 square kilometers, composed of 15
municipalities and 275 barangays and a population of 366,962 as of the 2000 census.
More than 60% of the population is Ilocano while the rest are Ifugaos, Ibalois, Gaddangs,
Isinais, Ikalahans, and Ilongots. Most of the inhabitants are concentrated in the narrow
Magat River Valley region along the national highway that runs through the province.
The Isinais occupy villages in the municipalities of Bambang, Aritao and Dupax Sur. The
Gaddangs inhabit villages in the towns of Bagabag, Solano and Bayombong. The
Ikalahans are Igorots that dwell in the highlands of Imugan and Kayapa in the
southwestern part of the province. http://www.geocities.com/lppsec/pp/nvizcaya.htm?200717).
The Provincial Rationalization Plan identified Maternal and Child Health (MCH) as one
of the priority programs. The Plan, however, is not clear as to what approach is to be
taken to achieve the desired reduction in maternal and infant mortality.
The women’s health and safe motherhood intervention model adopted by the DOH for
implementation in all F1 sites is a logical move that the province should take on in the
light of its current maternal health situation. The PHO reported 8,880 live births in 2006
and 6 maternal deaths: post-partum hemorrhage (a preventable condition) has caused the
death of 4 women while 2 were cases of eclampsia from far flung Aritao and Kayapa.
This translates to a maternal mortality ratio (MMR) of 68 per100,000 live births.
Although TBA-assisted childbirths are relatively low (25% in 2006 and 22% from
January – June 2007), most cases of maternal deaths are attributed to delayed referral by
the attending TBA, in a home birth setting.
The facility mapping exercise for the province was conducted on 14-15 August 2007. The
health officers and staff of the province actively participated in the exercise. The resulting
facility map consists of 3 CEmOCs (including Veterans Regional Hospital, a DOH-
operated Regional Hospital) and 11 BEmOCs (2 hospitals, 5 RHUs and 4 BHSs).
Maternal care package (MCP) accreditation has not been granted by PhilHealth to any of
the facilities in Nueva Ecija. One (1) facility, the Kayapa RHU is Sentrong Sigla Level 2
certified.
36
Proposed CEmOC Facility: NUEVA VIZCAYA PROVINCIAL HOSPITAL (NVPH)
Catchment Municipalities: Bambang, Aritao, Sta Fe, Dupax Sur, Dupax Norte, Alfonso
Castaneda, Kasibu.
NVPH is located in Bambang, an area that is accessible to transportation because
of the municipality’s good road network.
Its catchments include 5 barangays of Kayapa: Nansiakan, Magpayao, Baan, San
Fabian and Pinayag and 3 barangays of Dupax Norte and Sur: Lamo, Mabasa,
and Gabut.
Travel time form the barangays of Kayapa ranges from 30 minutes to 4 hours;
from barangays of Dupax: 15 – 30 minutes.
Serves an estimated population of 108,000.
Current staff complement: 2 obstetric-gynecology specialist, 3 nurse anesthesists
and operating room nurses every shift.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
1. Sta Fe Rural Health Unit Sta Fe Travel time to NVPH: 1
hour.
2. Kinabuan BHS, Dupax Sur Barangay Kinabuan and other Travel time to NVPH: 4
remote barangays of Dupax hours
Sur
3. Belance BHS, Dupax Norte Barangay Belance and other Travel time to NVPH: 6
remote batangays of Dupax hours; to Dupax District
Sur Hospital: 5 hours
4. Dupax District Hospital, 4 barangays of Dupax Norte, 6 Travel time to NVPH is 30
Dupax Norte barangays of Dupax Sur and minutes
some barangays of Kasibu
The roads are not passable
during the rainy season, thus
travel time to the proposed
hospital BEmOC involve a
1-6 hour hike to avail of
public transportation.
The facility serves a
population of 52,555.
Travel time to NVPH: 6
5. Alfonso Castaneda RHU hours.
The municipality is an isolated
area with no road connection
to neighboring towns. The
only access is via Bambang. It
has no hospital but residents
have access to hospitals in San
Jose City Nueva Ecija
Proposed BEmOC Catchment Travel Time/other
37
Facilities Justifications
6. Konkong BHS, Kasibu 5 remote barangays of Kasibu Travel time to NVPH: 4-5
hours
Travel time to Kasibu
Municipal Hospital: 1 hour.
The facility serves a population
of 2,000. The roads are good and
public transport is accessible.
7. Kasibu Municipal Hospital Barangays of Kasibu and Travel time to NVPH: 5-6
neighboring towns hours.
Proposed CEmOC Facility: VETERANS REGIONAL HOSPITAL (VRH)
Catchment Municipalities: Bagabag, Solano, Bayombong, Quezon, Villaverde, Diadi,
Ambaguio
VRH is located along the highway in Bayombong and is strategically located to serve
clients from remote municipalities. Some residents of the catchment have access to
facilities in neighboring provinces:
Residents of the municipality of Diadi may access health facilities in Ifugao and
Santiago City in Isabela. Travel time is 2-3 hours.
Ambaguio residents prefer to go to the Ifugao Provincial Hospital, which is 2-3
hours away and where most providers share their ethnic background.
The town of Solano has 2 private hospitals that can serve those who can afford
private rates.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
1. Bagabag Rural Health Unit Barangays of Diadi, Solano,
Bagabag, Quezon and some Travel time to VRH: 30
barangays of Ifugao minutes
Travel time to Ibung BHS,
Villaverde: 30 minutes
Travel time from the catchment
barangays to the RHU ranges
from 10 – 30 minutes.
Serves a population of 125,000.
2. Quezon Rural Health Unit
Travel time to VRH: 1 hour
Travel time to Bagabag RHU:
30 minutes
3. Ibung BHS, Villaverde 9 barangays of Villaverde and Travel time to VRH: 30
some barangays along the minutes
boundary with Solano
Serves a population of 18,445.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
38
4. Ambaguio Rural Health Unit 8 barangays of Ambaguio, 2 Travel time to VRH: 2 hours
barangays of Kayapa and some Travel time to Ibung BHS,
barangays of Ifugao. Villaverde: 3 hours
Travel time from the
catchments to the RHU is 1-4
hours by walking.
Ambaguio is a mountainous
municipality with only 2
barangays having road access.
Serves a population of around
12,000.
Proposed CEmOC/BEmOC Facility: LT TINDANG MEMORIAL HOSPITAL
(LTMH)
Catchment Facilities: Kayapa, some barangays of Sta Fe, Ambaguio and neighboring
Ifugao.
The proposed CEmOC facility is located in Kayapa, a remote mountain municipality on
the southwestern side of the province with difficult terrain. Kayapa has 30 barangays, but
only 18 have access to the RHUs and hospital. In fact, access to the hospital from the
remote barangays could involve 4 to 18 hours of hiking. However, residents of Kayapa
have other options: those from upper Kayapa may opt to travel 2-3 hours to Baguio or
Ifugao, while those from lower Kayapa may go to NVPH in Bambang which is 1 hour
away. Eighty percent of the population is indigent with only 10-20% enrolled with
PhilHealth.
There is no other health facility in the area that could be upgraded to BEmOC. Thus, it
was decided that LTMH would double as BEmOC facility. This is not seen to be a
problem since the relatively small population of the catchment minimizes the possibility
of client congestion.
39
PANGASINAN BEmOC/CEmOC Facility Map
ILHZ
CEmOC
LAYUG Health Zone
CEmOC
No investment PILGRIMs Health Zone
Bolinao PALARIS ILHZ
BHS BEmOC
Hundred Islands Health Zone
Anda
RHU BEmOC
MANGABUL Health Zone
HOSP BEmOC
MANLELUAG Health Zone
Bani
Sison
Alaminos
Agno San Fabian
San Nicolas
Pozorrubio San
Sual Dagupan San Jacinto Manuel
Burgos Mangaldan
Mabini Manaoag Binalonan
Mapandan Laoac Natividad
Labrador Binmaley Tayug
Dasol Asingan
Lingayen Calasiao Sta.
Barbara Urdaneta San Quintin
Bugallon City Sta. Maria
San Carlos
City Malasiqui Villasis
Infanta Balungao Umingan
Aguilar Basista
Rosales
Urbiztondo Alcala
Sto.
Bayambang Tomas
Bautista
Mangatarem
PANGASINAN
40
Pangasinan is located on the west central area of the island of Luzon along the Lingayen
Gulf. A crescent-shaped province occupies 5,368.82 square kilometers of verdant
farmlands, hills, forests and rivers. It is bounded by the mighty Cordillera Mountains to
the east, the Zambales ranges to the west, the rice plains of Tarlac to the south and the
Lingayen Gulf and the China Sea to the north.(http://en.wikipedia.org/wiki/Pangasinan).
The 2000 census places the population of the province at 2,434,086 distributed in 44
towns, 4 cities and 1,364 barangays. (http://www.pangasinan.gov.ph).
Relative to health, the province has 14 hospitals with a total capacity of 505 beds, 68
Rural Health Units (RHUs), and 414 Barangay Health Stations (BHSs). All 6 core
referral hospitals are PHIC (Philippine Health Insurance Corporation) accredited and
Sentrong Sigla certified. Of the 68 RHUs, 38 are PHIC accredited and 61 are Sentrong
Sigla certified.
The Rationalization Plan of the province proposes the upgrading of primary hospitals to
BEmOC standards. These primary hospitals were previously recommended for closure or
merging with RHUs by a health consultant engaged by DOH. LGU health officials
attending the Facility Mapping Workshop are of the view that the recommendation, while
it may have merit from the financing viewpoint, is not politically feasible. They are more
receptive to the alternative of taking advantage of the strategic location of these hospitals
and have them focus on the provision of BEmOC services. They are optimistic that the
shift from home to facility birth would eventually improve currently low occupancy rates.
Although the current maternal mortality ratio (MMR) for the province is relatively low at
37/100,000 live births, traditional birth attendants (TBAs) still attend to around 12% of
childbirths at home. (PHO Report 2006, Pangasinan). The establishment of more accessible
BEmOCs should further encourage the shift to facility birth and lead to a continued
decline in maternal mortality.
To guide the provincial health officials in identifying which among the facilities should
be tasked to provide BEmOC and CEmOC services, and to make sure that these services
are equitably distributed across the province, a facility mapping activity was organized
and conducted from 24 to 25 July 2007. All Municipal Health Officers (MHOs) and
Chief of Hospitals (COHs) as well as the technical staff of the Provincial Health Office
(PHO) attended the activity.
The facility mapping exercise resulted in the recommended upgrading of 6 hospitals to
CEmOC and 7 facilities to BEmOC, of these, 3 are hospitals, 3 are RHUs and 1 BHS.
Because of the relatively good road network in Pangasinan, it was not difficult to comply
with the travel time requirement in the choice of strategically located facilities. All the
recommended facilities for CEmOC upgrading are at most 1 hour away from BEmOCs in
its catchment. However, these hospitals have heavy patient loads, partly because of their
accessibility. Care was therefore exercised to ensure that the facilities that would
comprise the CEmOC-BEmOC network are dispersed in such a manner as to allow the
network to absorb the expected increase in loading (as a result in the shift from home to
facility birth) in a way that would enable each facility to effectively perform its assigned
function.
41
On the other hand, the facilities recommended for BEmOC upgrading are so located as to
comply with the required 30 minute maximum travel time from the catchment barangays.
However, as in most provinces, there are exceptions: mothers from a few hard to reach
barangays will need to travel at least 1 hour to reach their proposed BEmOC facility.
The following shows the configuration of the CEmOC-BEmOC clusters in Pangasinan:
CEmOC Facility: MANGATAREM DISTRICT HOSPITAL (MDH)
Catchment Municipalities: MANLELUAG ILHZ: Aguilar, Bugallon, Labrador,
Lingayen, Mangatarem, Urbiztondo
MDH is very accessible and can easily be reached using available public transportation
facilities. It has the capacity to serve a large population with 2 obstetric-gynecology
specialists and an anesthesiologist. Its current occupancy rate is 80%.
Proposed BEmOC Catchment Travel Time/other
Facilities Justification
1. Aguilar RHU Aguilar, Labrador, Lingayen, Travel time from barangays in
Labrador, Bugallon the catchment is 30 minutes
Only 1 BEmOC facility is proposed for this cluster because of the proximity of the
catchment municipalities to facilities in the neighboring inter-local health zones (ILHZs).
CEmOC Facility: BAYAMBANG DISTRICT HOSPITAL (BDH)
Catchment Municipalities: MANGABUL ILHZ: Alcala, Basista, Bautista, Bayambang,
Sto Tomas.
BDH is 30 minutes away from the Pangasinan Provincial Hospital. However, its heavy
patient load necessitates the designation of another capable CEmOC hospital within the
area.
BDH will double as a BEmOC provider and will serve clients from Camiling, Tarlac as
well.
This ILHZ is prone to flooding because of its proximity to the Agno River.
CEmOC Facility: PANGASINAN PROVINCIAL HOSPITAL (PPH) AND
REGION I MEDICAL CENTER (RMC)
Catchment Municipalities: PALARIS ILHZ: Binmaley, Calasiao, Malasiqui,
Mangaldan, Mapandan, Sta Barbara, San Fabian, and San Jacinto, San Carlos City
PPH and RMC will share the load of high-risk maternity clients in this cluster. PPH is
located in San Carlos City while RMC is in Dagupan City. Both hospitals are accessible
to the catchment municipalities. RMC is a DOH operated tertiary hospital.
For this cluster, only Mapandan Community Hospital is recommended for upgrading to
BEmOC because 1) there is a lying-in clinic in San Carlos City, 2) there is another
42
hospital in Malasique that is BEmOC capable, and 3) Mangaldan Infirmary can provide
childbirth services. The other barangays within the catchment can access these facilities
for NSDs.
Proposed BEmOC Catchment Travel Time/other
Facilities Justification
1. Mapandan Community Binmaley, Calasiao, Malasiqui, MCH will help decongest
Hospital (MCH) Manaoag, Mangaldan, Pangasinan Provincial Hospital of
Mapandan, Sta Barbara, San childbirth admissions.
Fabian, San Jacinto
CEmOC Facility: DASOL COMMUNITY HOSPITAL (DCH)Catchment
Municipalities: WESTERN PANGASINAN ILHZ: Agno, Anda, Bani, Bolinao, Burgos,
Dasol, Infanta, Mabini and Sual.
The terrain in the area is difficult. Thus, transportation modes include boats, “kuligligs”
and motorcycles. Peace and order is a problem because of its remoteness
.
Proposed BEmOC Catchment Travel Time/other
Facilities Justification
1. Bolinao Medicare Barangays of Bolinao, Anda, Serves a population of around
Hospital Bani 100,000.
2. Bolinao RHU II 6 barangays and 1 Island The RHU is located in Santiago
barangay of Bolinao, and 3 Island and is the only facility that
barangays of Anda is accessible to residents.
3. Agno RHU I Barangays of Agno, Burgos, Travel time from the barangays
some barangays of Mabini, Dasol in the catchment is between 30
minutes to 1 hour.
While the workshop participants noted the need for a BEmOC facility to serve the
municipality of Infanta, it was decided not to recommend Infanta RHU 1 for BEmOC
upgrading because it currently does not have a doctor and nurse. Patients from this
municipality will have to access services in neighboring Sta Cruz, Zambales or
BEmOCs in nearby municipalities.
CEmOC Facility: URDANETA DISTRICT HOSPITAL (UDH)
Catchment Municipalities: PILGRIMS ILHZ: Urdaneta City, Asingan, Binalonan,
Laoac, Manaoag, Pozorrubio, San Manuel, Sison and Villasis.
Because of limited funding for a huge province like Pangasinan and the relative ease
experienced by residents in catchment municipalities to reach UDH and the BEmOCs
in nearby municipalities, the workshop participants decided not to propose for the
upgrading to BEmOC of a facility in this ILHZ. UDH shall therefore double as a
BEmOC provider.
The Lying-in Clinic in San Manuel will continue to provide childbirth services.
CEmOC Facility: EASTERN PANGASINAN DISTRICT HOSPITAL (EPDH)
43
Catchment Municipalities: LAYUG ILHZ: Balungao, Natividad, Rosales, San Nicolas,
San Quintin, Sta Maria, Tayug, and Umingan.
EPDH is located in Tayug. It will be serving 8 municipalities with a population of around
286,515. Its location is strategic enough for a CEmOC facility that could be reached
within an hour travel from municipalities in the catchment area.
Proposed BEmOC Catchment Travel Time/other
Facilities Justification
1. Umingan Medicare Hospital Barangays of Umingan, The terrain is difficult thereby
Balungao, some barangays of making access to transportation
San Quintin, Sta Maria difficult as well. Thus,
upgrading the hospital to
BEmOC to serve the residents
of catchment communities is
imperative.
4. Fianza BHS, San Nicolas Remote barangays of San The road network does not
Nicolas reach the area. Travel is
therefore along narrow hiking
trail. An accessible BEmOC
BHS is therefore a necessity.
44
ORIENTAL MINDORO BEmOC/CEmOC Facility Map
Puerto
Galera
Calapan
San
Teodoro
Baco Naujan
Victoria Pola
Socorro
Pinamalayan
Gloria
Bansud
CEmOC
BHS BEmOC
RHU BEmOC Bongabong
HOSP BEmOC
ILHZ Roxas
North Mansalay
Central
South
Bulalacao
ORIENTAL MINDORO
45
Oriental Mindoro is an island province located in the MIMAROPA region of Luzon that
shares the eastern half of the large Mindoro Island. On the north, the narrow Verde Island
Passage lies between the province and the Batangas coast. To the east, the Tablas Strait
separates Mindoro from the islands of Romblon. Southwards lie the Semirara and Panay
islands. (http://www.geocities.com/lppsec/pp/ormindoro.htm?200717). The varied topography of
the province is dominated by rugged mountain ranges on the west and fertile valleys
towards the eastern coast. The Halcon mountain range runs from north to south and
serves as a natural boundary with Occidental Mindoro. Lake Naujan is in the northern
part of the province. The plains stretch from Baco, Calapan, Naujan and Victoria in the
north, Pinamalayan and Bonganbong in the middle and Roxas to Mansalay in the south
(http://www.fortunecity.com/oasis/acapulco/215/region4/ormindoro/ormindoro.htm).
The province has a total land area of 4,364.7 square kilometers subdivided into 1 city, 14
municipalities and 426 barangays. Its projected population as of 2004 is 738,043 of which around
10 – 15% is considered cultural minorities known locally as mangyans. There are at least 7
mangyan tribes in the province: 1) Alangans occupy a distinct area in the municipalities of
Naujan, Baco, San Teodoro and Victoria.2) Bangons populate the interior part of the mountains
of Bongabong, Bansud and Gloria. 3) Taubuids known as “pipe smokers” occupy parts of
Socorro, Pinamalayan and Gloria. 4) Buhids are pot makers and they dwell in small villages of
Roxas, Bansud, Bongabong and Mansalay. 5) Hanunoos inhabit the municipalities of Mansalay,
Bulalacao and Bongabong. 6) Tadyawans occupy the remote areas of Naujan, Victoria, Socorro,
Pola, Gloria, Pinamalayan and Bansud. 7) Irayas reside in Puerto Galera, San Teodoro and Baco.
(Rationalization Plan of Oriental Mindoro).
The mangyans are spread throughout the island and have a distinct culture and a way of life that
clearly distinguish them from the rest of the population. For instance, among the mangyans,
pregnancy and childbirth is strictly a family affair. Thus, no one but the husband attends to the
wife during childbirth. Prenatal and postnatal care is also considered not necessary, even
considered taboo sometimes. Civil registration of marriages, births and deaths is also not done in
this culture. (Rationalization Plan of Oriental Mindoro).
The Provincial Health Office (PHO) reported in 2004, a maternal mortality ratio of 61/100,000
live births, an increase of more than 50% from the 2003 MMR of 25/100,000. The 2004 infant
mortality rate (IMR) on the other hand, was 8/1,000 live births with pre-maturity and stillbirth
affecting 2/1,000. (PHO Accomplishment Report, 2004 as cited in the Provincial Rationalization Plan).
The facility mapping exercise noted 17 infant deaths in 2006, 16 of which happened in
only one municipality, Bansud. In the same year, Bansud, Gloria and Bulalacao reported
1 maternal death each. The count most probably did not include deaths among the mangyan
tribes.
While the Rationalization Plan failed to include maternal and infant mortality reduction among
the objectives, the PHO nevertheless expressed awareness of the gravity of the issue and agreed
to undertake activities that will lead them to implement the integrated women’s health and safe
motherhood (WHSM) intervention model (Rationalization Plan of Oriental Mindoro).
The facility mapping exercise for the province was participated in by all Municipal
Health Officers (MHOs), Chief of Hospitals (COHs) and the technical staff of the PHO.
It resulted in the identification of 3 facilities proposed to be CEmOC providers and 21
46
facilities proposed to be BEmOC providers, 4 of which are hospitals, 5 are RHUs and 12
are BHSs. The following CEmOC-BEmOC cluster configuration for the province shows
how these facilities are strategically deployed:
CEmOC Facility: ORIENTAL MINDORO PROVINCIAL HOSPITAL (OMPH)
Catchment Municipalities: Calapan City, Baco, San Teodoro, Puerto Galera, Victoria, Naujan
OMPH is MCP acrredited.
Proposed BEmOC Catchment Travel Time/Other
Facilities Justifications
1. San Teodoro RHU San Teodoro Travel time to OMPH is 1
hour.
Travel from the farthest
barangay is a 1-hour hike.
This RHU should be upgraded
to BEmOC since there is no
other health facility in the area
and it houses the only doctor.
2. Puerto Galera RHU 13 barangays of Puerto Galera Travel time to the RHU from
of which 6 are mangayan the farthest barangay is 4
barangays: Baclayan, Villaflor, hours due to rough roads.
Aninuan, Sabang, Tabinay and
San Isidro. Travel time from the RHU to
OMPH is 1 ½ - 2 hours; to San
Teodoro RHU, a BEmOC - 1
hour.
The most common modes of
transportation are: jeepney,
tricycle, motorized banca.
3. Naujan East BHS, Naujan 4 coastal barangays: Masaging, Travel time from the BHS to
Herrera, Montemayor and the Naujan Community
Montelago. Hospital is 1½ hour.
Located in barangay Masaging,
Naujan. Access to the BHS is
mostly by motorized banca and
is therefore difficult when the
sea is rough.
4. Naujan West BHS, Naujan 9 barangays 1 of which is a Travel time to Naujan
Mangyan barangay. Community Hospital is 1 ½
hours; another 1 ½ hours to
reach the CEmOC facility.
Located in barangay Inarawan.
2 barangays in the catchment
can be very hard to reach during
the rainy season.
Proposed BEmOC Facilities Catchment Travel Time/Other
Justifications
5. Naujan Community Hospital 70 barangays of Naujan. Travel time to OMPH, is 30
minutes to 1 hour.
47
Naujan is a big municipality in
terms of land area and population.
The hospital is adequately staffed
and operates 24 hours. It has an
ambulance.
The hospital is MCP accredited.
6. Victoria RHU 32 barangays of Victoria, 8 of Travel time from the barangays is
which are coastal barangays, 6 are 30 minutes.
upland barangays inhabited by
Mangyans. Travel time to OMPH, a CEmOC
is 1 hour.
7. Bayanan BHS, Baco Barangays of Baco Requested by the PHO.
CEmOC Facility: PINAMALAYAN COMMUNITY HOSPITAL (PCH)
Catchment Municipalities: Pinamalayan, Gloria, Socorro, Pola, Bansud
PCH is located along the Strong Republic Nautical Highway in barangay Papandayan. It
is approximately 4 kilometers from Pinamalayan town proper and has an accessible
transportation system. The town also has a domestic airport with 2 flights per week to
Manila.
PCH, a proposed CEmOC facility is currently applying for a secondary hospital license.
It is adequately staffed with 2 general surgeons, 1 anesthesiologist, 5 pediatricians, 1
internist, 2 obstetric-gynecologists, 6 general practitioners, a visiting cardiologist,
dermatologist, and radiologist. The hospital also accepts referrals from nearby towns of
Concepcion, Romblon and Marinduque.
Travel time from the proposed BEmOCs to PCH takes 1 to 2 hours. However, travel from
the municipalities of Bansud and Gloria is difficult because of the insurgency problems in
the area.
The CEmOC-BEmOC – municipality cluster is as follows:
Proposed BEmOC Facilities Catchment Travel Time/other
Justifications
1. Socorro BHS, Socorro 7 barangays of Socorro: Batong Travel time from the
Dalig, Mabuhay I and II, Happy barangays is 30 to 45 minutes.
Valley, Pasi I and II and Lapog. Travel time from the
mountain barangays is 45
2 barangays of Pola: Tagbakin minutes to 1 hour by
and Matulatula motorcycle.
Travel time to PCH is 1 hour.
2 mountainous barangays:
Bugtong na Tuog and Located in barangay Pasi I.
Concepcion.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
2. Pola RHU 23 barangays of Pola Travel time from the
48
barangays to the RHU ranges
from 15 minutes to 1 hour and
45 minutes using jeepney,
tricycle, motorcycle or boat
Pola is a mountainous
municipality with 2 barangays
inhabited by Mangyans:
Matulatula and Putting Cacao.
There is no other health facility
in the area except this RHU.
An increased number of
stillbirths have been noted in
recent years.
Serves a population of 34,000.
3. Pinamalayan West BHS, Remote barangays of The BHS is located in barangay
Pinamalayan Pinamalayan and some Pambisan Malaki. Travel time
barangays of Gloria. from the BHS to the CEmOC
(PDH) is 45 minutes to 1 hour.
Travel time from the BHS to
the RHU is 30 minutes to 1
hour.
4. Pinamalayan East BHS, 22 barangays and adjacent Travel time to the BHS is 30
barangays of Pola and minutes to 1 hour
Socorro
Located in barangay Ranzo.
5. Bansud RHU 6 barangays and 8 sitios Travel time to CEmOC
inhabited by Mangyans facility is 2 hours.
Bansud is a remote barangay
where travel is by foot only. The
remoteness of the communities
and the absence of
transportation have resulted in
16 infant deaths and 1 maternal
death in 2006.
The RHU is centrally located.
6. Gloria BHS, Gloria Remote barangays of Gloria Travel time from the farthest
as well as Bansud and Pulang barangay is 2 hours by
Lupa. tricycle. Travel time from the
BHS to the CEmOC facility is
2 ½ hours.
Located in barangay Banutan.
Recorded 1 maternal and infant
death in 2006
CEmOC Facility: ROXAS DISTRICT HOSPITAL (RDH)
Catchment Municipalities: Bongabong, Roxas, Mansalay, Bulalacao
49
RDH is located in barangay Odiong and is strategically located. It can easily be
reached within an hour from the proposed BEmOC facilities. It has the potential to
serve an estimated population of 200,000.
It also accommodates referrals from Tablas Island of Romblon. It has an authorized
capacity of 25 beds, and has a women center, 2 operating rooms, 2 delivery rooms
and 1 labor room.
RDH is a PhilHealh MCP accredited and is adequately staffed with 1 obstetric-
gynecology consultant and 1 on-call private obstetric-gynecologist.
Proposed BEmOC Catchment Travel Time/other
facilities Justification
1. Bongabong Community 36 barangays and adjacent Travel time to RDH is 1 hour.
Hospital (BCH) barangays of neighboring Average travel time from the
municipalities. barangays in the catchment is
30 – 45 minutes.
The hospital is MCP accredited,
DOH licensed and fully
operational
2. Roxas BHS Roxas 4 remote barangays of Roxas Located in barangay San
inhabited by mostly Mangyans: Mariano, Roxas.
San Vicente, Maraska, San
Rafael and Happy Valley The presence of armed groups
in the area makes it vulnerable
3 barangays of Bongabong: to social and health problems.
Batangan, Morente and Lisap
The barangays in the catchment
1 barangay of Mansalay: are so remote that the BHS is
Bonbon reached by either horseback or
hiking.
3. Mansalay Medicare Mansalay Mansalay has the largest
Hospital Mangyan population in the
province.
The facility is MCP
accredited.
4. Mansalay BHS, 50-70 sitios inhabited by The sitios are accessible
Mansalay Mangyans in mountain only by foot, thus travel
communities. time to the BHS is 1 to 4
hours.
Located in barangay
Panaytayan.
Proposed BEmOC Catchment Travel Time/other
facilities Justification
5. Bulalacao BHS, Bulalacao 2 island barangays, 2 mountain Travel time to the Bulalacao
50
barangays inhabited by Community Hospital is 1 hour
Mangyans: San Isidro and by either motorcycle or boat.
Cabugao
Travel to the CEmOC is a 3½
hour jeepney ride.
Travel time from the
mountain barangays is 1 – 1 ½
hours by motorcycle.
Located in barangay Milagrosa;
access is on rough road that is
inaccessible during the rainy
season.
The community also has to deal
with problems related to
insurgency.
The BHS recorded 1 maternal
death in 2006.
6. Benli BHS, Bulalacao Requested by PHO.
7. Milagrosa BHS, Bulalacao Requested by PHO
8. Bulalacao Community 15 barangays of Bulalacao and 1 Travel time to the Bulalacao
Hospital island barangay (barangay Community Hospital is 1 hour
Maasin) by either motorcycle or boat.
Travel to the CEmOC is a 3½
hour jeepney ride.
Travel time from the
mountain barangays is 1– 1 ½
hours by motorcycle.
Travel time from the farthest
barangay to the community
hospital is 45 minutes to 1
hour.
Roads are rough and unpassable
during the rainy season,
isolating 9 barangays.
The facility is MCP accredited
The LGU health officials consider the establishment of BEmOC facilities particularly
in the remote areas inhabited by mangyans crucial to reducing infant and maternal
death in the province.
For the past years, the PHO succeeded in having facilities in the province MCP
(maternal care package) accredited. Facility accreditation and the Philhealth
reimbursements that it allows encourage mothers to give birth in a facility and health
workers to provide quality service. Below are the MCP accredited facilities, all of
which have been recommended for upgrading to either BEmOC or CEmOC. Among
51
those proposed to be CEmOC facility, only Pinamalayan Community Hospital has
been granted MCP accreditation.
Oriental Mindoro Provincial Hospital
Roxas District Hospital
Bongabong Community Hospital
Mansalay Medicare Hospital
Gloria Medicare Hospital
Naujan Community Hospital
Pinamalayan RHU
Bulalacao Community Hospital
Mansalay Medicare Hospital
52
ROMBLON BEmOC/CEmOC Facility Map
Banton
Concepcion
Cocuera
Calatrava
Romblon
San
Andres Magdiwang
San Cajidiocan
Agustin
Odiongan
Sta. Maria
San
Ferrol Fernando
Alcantara
Looc
CEmOC ILHZ
Sta. Fe
BHS BEmOC
Southern Tabias
RHU BEmOC
RoCoBaCon
HOSP BEmOC
Northern Tabias
San Jose
MagCaiSa
53
ROMBLON
Romblon province located in the MIMAROPA region (Region IV-B) spans the Sibuyan
Sea and forms the link between the Tagalog Region and Bicol Region. The province’s
main islands are Tablas, Romblon and Sibuyan forming the largest and most populated
areas. These islands are surrounded entirely by the Sibuyan Sea on the north, east and
south while the Tablas Strait separates the islands from Mindoro. Further south, the
island of Panay lies across a narrow channel from Carabao Island. It lies south of
54
Marinduque and Quezon, east of Mindoro, north of Aklan, and west of Masbate. It has a
total land area of 195 square kilometers subdivided into 17 municipalities and 219
barangays. It is a small province with a population of 264,357 as of the 2000 census.
(http://en.wikipedia.org/wiki/Romblon).
The province’s Rationalization Plan indicated an urgent need for health reforms in the
light of a worsening health situation seen to be brought about by a decline in the public
health service delivery system due to budgetary and human resource constraints. Access
within the province is also difficult given the natural obstacles that are unique to
Romblon with its small island municipalities. It is therefore no surprise to find 73% of
pregnant women opting to deliver at home with 44% attended by traditional birth
attendants (TBAs). Three maternal deaths were reported in 2006. (PHO Report, August 2007).
The facility mapping activity for Romblon was conducted on 5-6 June 2007 as part of the
activities that would lead to a Rationalization Plan for the province. This Plan would
serve to guide current and future investments in health. The exercise was participated in
by the Municipal Health Officers, Chief of Hospitals, and the Provincial Health Office
Technical Staff. This resulted in the identification of 5 hospitals for upgrading to CEmOC
and 9 facilities for upgrading to BEmOC. Of the 9 proposed BEmOC facilities, 3 are
hospitals and 6 are RHUs.
The CEmOC-BEmOC cluster in Romblon is configured as follows:
CEmOC Facility: ROMBLON PROVINCIAL HOSPITAL (RPH)
Catchment Municipalities: Ferrol, Odiongan and Calatrava
RPH is located in Odiongan, Romblon, one of the main islands. The workshop noted the
following special considerations:
San Andres Municipal Hospital is only 30-45 minutes away from the RPH,
however, it has to be upgraded to BEmOC since it will service patients coming
from Calatrava, who have no access to Tablas Island District Hospital in San
Agustin or other health facility near the island.
Travel time from Ferrol takes 25 minutes, from Calatrava, 1 hour and San
Andres: 30 – 45 minutes.
Proposed BEmOC Catchment Travel Time/other
Facility Justifications
55
1. San Andres Municipal Barangays of San Andres and Estimated travel time to the
Hospital Calatrava. proposed CEmOC is 45
minutes.
Travel time to the hospital
from the farthest barangay
is 2 hours.
Travel time to the hospital
from the municipality of
Calatrava is 1 hour.
Located in Barangay
Calatrava in San Andres
town, with a catchment
population of 15,000. The
roads are rough and
mountainous.
CEmOC Facility: ROMBLON DISRICT HOSPITAL (RDH)
Catchment Municipalities: Banton, Malipayon (Corcuera), Concepcion,
Magdiwang and Romblon.
RDH will be providing general health services to the 38,828 people of mainland
Romblon and 3 small barangays surrounding the mainland: Alad, Logbon and
Cobrador. Access is not difficult because Romblon has a seaport. Travel time from
the farthest catchment within the mainland is 1 hour. However, coming from the
municipal islands of Banton, Malipayon and Magdiwang, travel time is 1.5 – 2.5
hours.
Proposed BEmOC Catchment Travel Time/other
Facility Justifications
1. Banton RHU Banton Travel time from the
farthest barangay to the
RHU is 30 – 45 minutes by
motorcycle and 45 minutes
to 1 hour by boat.
The RHU is 2.5 hours away
from the proposed CEmOC.
Banton is an island mountainous
community with narrow and
steep roads. The estimated
population is 6,972.
56
Proposed BEmOC Catchment Travel Time/other
Facility Justifications
2. Malipayon Municipal 15 barangays of Corcuera Travel time from the farthest
Hospital, Corcuera barangay is 30-45 minutes by
motorcycle.
Travel time to Romblon
District Hospital (CEmOC)
2.5 – 3 hours by motorboat.
Coprcuera is an island
municipality with mountainous
terrain and rough, narrow roads.
It has an estimated population
of 12,000.
3. Concepcion RHU Concepcion Concepcion is a mountainous
island municipality with rough
and narrow roads and with an
estimated population of 5,500.
Travel time from the farthest
barangay to the RHU takes
20-40 minutes.
Will refer patients needing
CEmOC services to Oriental
Mindoro Provincial Hospital
(OMPH), Calapan City via
Pinamalyan where there’s a
regular boat trip from Romblon.
Travel time via this route is 2-
3 hours by boat and another
2-3 hours by land transport to
OMPH
CEmOC Facility: SIBUYAN DISTRICT HOSPITAL (SDH)
Catchment Municipalities: Cajidiocan, Magdiwang and San Fernando
The facility mapping exercise noted the following:
Travel time from SDH to Romblon is 5 hours by boat. Travel time from the
farthest catchment is 2 hours by jeep, another 2 hours by boat for a total of 4
hours.
Barangay Agtiwa in San Fernando is so remote and its road so bad that it is
usually “washed out” during the rainy season, isolating the barangay. The mayor
plans to construct a BHS in the area and suggests that this be eventually
upgraded to BEmOC.
Also accommodates referrals from Masbate.
57
Potential population to be served: 80,000.
Proposed BEmOc Catchment Travel Time/other
Facilities Justifications
1. Magdiwang RHU 9 barangays of Magdiwang, 2 Travel time to the proposed
barangays of Cajiodiocan: CEmOC facility is 1 - 4 hours.
Cantagda and Danao, 3
barangays of San Fernando: Magdiwang is part of Sibuyan
Agtiwa, Mabini and Mabolo) island. Rough roads
and the Burias settlers of characterize the municipality
barangay Poblacion.
2. San Fernando RHU 12 barangays of San Fernando Travel time from the farthest
barangay is 1 hour and from
the RHU to the proposed
CEmOC, 45 minutes.
San Fernando is a coastal,
mountainous municipality in
Sibuyan Island. It has a
population of 22,731.
Roads in the island are rough
and rendered impassable during
the rainy season. Transportation
is difficult as there is only 1
jeepney trip a day. However,
when emergencies arise, there
are private vehicles for hire
although the fee may be beyond
the reach of poor mothers.
CEmOC Facility: DON MODESTO MEMORIAL HOSPITAL (DMMH)
Catchment Municipalities: Looc, Sta Maria, Alcantara and Ferrol
This proposed CEmOC facility is located in Looc and is 24 kms (1 hour travel) from the
Provincial Hospital. DMMH also caters to patients coming from nearby municipalities of
Sta Fe and Tablas Island. The following were given consideration during the facility
mapping workshop:
Ferrol RHU is only 30 minutes away from Looc and Odiongan.
Travel time from Alcantara is about 1 hour and from Sta Maria, it is about 1.5
hours.
San Jose Municipal Hospital is proposed to be upgraded to BEmOC, a move that
is supported by the Mayor. This facility currently does not have a doctor, but the
San Jose RHU doctor currently provides duty time to the hospital. The
occupancy rate of the hospital is “poor at 15 patients per month” and has been
recommended to be merged with the RHU, a move that the LGU strongly
58
opposes. One way to operationalize the merger is to upgrade the hospital to
BEmOC so that it operates in tandem with the RHU. Occupancy should improve
as mothers shift from home to facility birth, attracted in part by the improved
services occasioned by the facility upgrading.
Proposed BEmOc Catchment Travel Time/other
Facilities Justifications
1. Sta Fe RHU 11 barangays of Sta Fe Travel time from RHU to
proposed CEmOC is 1 hour.
Sta Fe has a mountainous
terrain, traversed by rough
and narrow roads.
The RHU serves a population
of 14,459.
2. Alcantara RHU Barangays of Alcantara as Travel time to the RHU
well as some barangays of Sta from Calagonsao, the
Maria. farthest barangay is 30- 45
minutes, but from the
mountain barangays, travel
time is 1 – 2 hours.
Travel time from the RHU
to the proposed CEmOC is
20-30 minutes.
The municipality of Alcantara
has bad roads
3. San Jose Municipal Hospital 5 island barangays The farthest barangays:
Inihawan and Tipoc-poc are 45
minutes away.
San Jose is an island
municipality with an estimated
population of 9,000. Its roads are
bad and hardly passable during
the rainy season. Being an
island, it becomes isolated when
weather is bad and the sea
rough.
59
CEmOC Facility: TABLAS ISLAND DISTRICT HOSPITAL (TIDH)
Catchment Municipalities: Sta Maria, San Agustin and Calatrava
TIDH, the only hospital in the island is located in the municipality of San Agustin, which
is 1.5 hours away from the farthest catchment municipality. From TIDH to Romblon
Provincial Hospital is about 1- hour on rough and mountainous road that could be almost
impassable during the rainy season.
Since the population is small (40,526), the participating health officers decided not to
upgrade any more facility in the island to BEmOC. TIDH is therefore envisioned to
double as a BEmOC facility. It is seen to be well-equipped to perform these functions.
TIDH is fairly accessible. Travel time from Sta Maria is 45 minutes, from Alcantara
RHU, a BEmOC travel time is 30 minutes, and from Calatrava, 30-45 minutes.
60
CAPIZ BEmOC/CEmOC Facility Map
CEmOC
BHS BEmOC
Roxas
RHU BEmOC
Ivisan
HOSP BEmOC Panay
Sapian
Sigma Panit-an Pontevedra
Mambusao Pilar
Pres.
Roxas
Jamindan
Dao
Ma-ayon
Cuartero
Dumalag
Tapaz
Dumarao
ILHZ
RMPH
Bailan
SIMASJA
Dao
DUTA
61
CAPIZ Endemic Disease Map
Roxas
RHU
Ivisan
HOSP Panay
Sapian
Pontevedra
Mambusao Sigma Panit-an Pilar
Pres.
Roxas
Jamindan
Dao
Ma-ayon
Cuartero
Dumalag
Tapaz
Dumarao
Endemic Diseases
Malaria
Leprosy
Filariasis
Schistosomiasis
Rabies
CAPIZ
62
The province of Capiz is located in the Western Visayas Region at the
northeastern portion of Panay Island (an island formed by the Panay and
Banica rivers). It borders Aklan and Antique to the west, Iloilo to the south
and faces the Sibuyan Sea to the north. Bodies of water bound it: the
Mindoro sea and the rivers of Panay, Loctugan, and Ibisan. The coast is flat
and irregular with extensive swamps and marsh land that extend towards the
southwest into the mountainous interior of Panay. It has a total land area of
2,633.2 square kilometers occupied by 1 city, 16 municipalities, 473
barangays and a population of 654,156 as of the 2000 census.
(http://en.wikipedia.org/wiki/Capiz and http://www.geocities.com/lppsec/pp/capiz.).
The geographic characteristics of the province subject the people of Capiz to
natural obstacles that appear to affect even their health seeking behavior.
The province has had 2 maternal deaths in 2006 and 4 as of June 2007. The
numbers reflect a gap in maternal care service delivery that needs to be
addressed.
In an effort to generate a Rationalization Plan that would guide investments
in health, the Provincial Health Office (PHO) spearheaded a province-wide
mapping of public health facilities. The resulting map identifies the various
health facilities in the province and their location, as well as services that
each offers. The map shows 8 public hospitals, 16 Sentrong Sigla certified
Rural Health Units (RHUs), 1 Sentrong Sigla Phase 2 Level 1 certified City
Health Office (CHO) and 189 Barangay Health Stations (BHS), 51 of which
are functioning as birthing clinics. (Rationalization Plan, Province of Capiz). Maternity
Care Package (MCP) accreditation has been granted by PhilHealth to 2
RHUs and the CHO.
The WHSM facility mapping exercise was carried out on 13-14 June 2007.
All Municipal Health Officers, Chief of Hospitals and the technical staff of
the Provincial Health Office attended the activity. Overall, the MHOs and
COHs actively participated and gave insightful inputs. As a result, 2
hospitals: Roxas Memorial Hospital and Mambusao District Hospital were
recommended for upgrading to CEmOC and 20 facilities were proposed to
be BEmOC providers (3 hospitals, 10 RHUs and 7 BHSs). Three (3) of the 9
RHUs are already MCP accredited.
As agreed, the CEmOC – BEmOC configuration for Capiz is as follows:
63
CEmOC Facility: ROXAS MEMORIAL PROVINCIAL HOSPITAL (RMPH)
Catchment Municipalities: Roxas City, Panay, Ivisan, Panit-an, Pilar, Pres Roxas,
Pontevedra, Maayon.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
1. Roxas City Health Office Roxas City, some barangays of The city health office is less than
Panti-an 30 minutes from RMPH and
would normally not qualify to be
a BEmOC. The designation of
the CHO as BEmOC is mainly to
decongest RMPH of NSD cases
so that it could focus on attending
to complicated deliveries.
The CHO is MCP accredited.
The city has a population of
137,380.
2. Loctugan BHS, Roxas City 15 barangays of Roxas City Travel time from farthest
catchment barangay is 30
minutes.
3. Panit-an RHU Barangays of Panit-an Currently providing childbirth
service with high service
utilization.
Its proximity to Roxas City,
and its ability to attract clients
will help further decongest
RMPH of NSD admissions.
4. Bantigue BHS, Panay 2 other island barangays of Travel time from the
Panay farthest catchment is about
40 minutes by boat and
another 30 minutes by land
transport.
5. Ma-ayon RHU 32 barangays (10 upland Travel time from the
barangays) of Ma-ayon and farthest barangay is 1 hour.
barangays of neighboring
municipalities of Dao
(barangay Ilas), Panit-an
(barangays Cabangahan,
Ambilay and Cabugao), and
Cuartero ( barangays
Sinabsaban, Maindang and
San Antonio)
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
64
6. Pilar RHU 5 coastal barangays: Dayhangan, Travel time from farthest
Balogo, Casanayan, San Ramon barangay is 30 to 45 minutes.
and Binauhan The catchment is generally
coastal with rough roads
accessible only to motorcycles.
The community has had 2
maternal deaths in 2007 due to
post-partum hemorrhage. Both
were home deliveries.
7. Pres Roxas RHU Pres Roxas, adjacent upland and The RHU is MCP accredited.
lowlan barangays of Pilar, 5
barangays of Pontevedra, and 1
barangay of Maayon.
8. Ivisan RHU Ivisan and adjacent barangays Has a small island that can be
reached only by boat (45
minute trip).
The road is generally
mountainous and steep.
9. Bailan District Hospital, Barangays of Pontevedra, Travel time to RMPH is 40
Pontevedra Panit-an, Panay and Maayon minutes.
Note that Barangay Dayhangan in Pilar town is at the border of Iloilo. Thus most of its
residents go to Iloilo health facilities for health services.
CEmOC Facility: MAMBUSAO DISTRICT HOSPITAL (MDH)
Catchment Municipalities: Mambusao, Jamindan, Sigma, Sapian, Dao, Dumarao,
Cuartero, Tapaz, Dumalag.
Proposed BEmOC Facilities Catchments Travel Time/other
Justifications
1. Dumalag Rural Health Unit Dumalag Travel time from the farthest
barangay is 30 – 45 minutes. It
takes 45 minutes from this
RHU BEmOC to MDH.
Has a slightly mountainous
terrain.
The RHU is MCP accredited.
2. Dumarao Rural Health Unit 33 barangays of Dumarao, Located in a remote and
barangay Passi of Iloilo and some mountainous area. The RHU
barangays of Dumalag and reported 2 maternal deaths in
Cuartero. 2007.
3. Dacuton BHS, Dumarao Dacuton, barangay San Antonio Located in an upland area.
of Cuartero and barangays
Lemery and San Rafael of Iloilo.
Proposed BEmOC Facilities Catchments Travel Time/other
Justifications
65
4. San Nicolas BHS, Tapaz San Nicolas Travel time to Tapaz District
Hospital is 45 minutes to 1 hour
by motorcycle.
Located in an upland area with
road and foot access. Road
condition is difficult during the
rainy season.
5. Tapaz District Hospital Tapaz, part of Dumalag, Travel time to MDH, a
Jamindan, Bingawan and CEmOC facility, is 1 hour and
Calinog 20minutes.
6. Sapian RHU Sapian Travel time from the farthest
barangay is 30 to 45 minutes.
7. Cuartero RHU 5 barangays in the Poblacion area The RHU currently functions as a
birthing facility.
Reported 2 maternal deaths in
2006.
8. Carataya BHS, Cuartero Barangay Carataya and Travel time to RHU is 40
neighboring barangays minutes and to RMPH 50
minutes
9. Mangoso BHS, Sigma Mangoso, adjacent barangays of Travel time from the farthest
Mansacul, Balucuan and barangay ranges from 45
Matinaba. minutes to 1 hour by tricycle.
The road is generally rough.
10. Sen Gerry M Roxas Dao, Dumarao, Dumanlag, Travel time to the facility is
Memorial District Hospital, Cuartero and part of Sigma. about 40 to 45 minutes.
Dao
Relatively accessible to
transportation because of good
roads.
Serves a population of 295,000.
The hospital is PhilHealth
accredited and provides newborn
screening services.
Lucero BHS, Jamindan Lucero, 8 other adjacent Travel time to the BHS is about
barangays, and barangay Altavas 20 to 30minutes.
in Aklan.
Generally an upland community.
Serves a population of 853.
Buruias BHS, Mambusao Burias and 5 neighboring Travel time is 20 minutes.
barangays
A mountainous community near
the border of Jamindan and
Sapian in the Province of Aklan.
66
NEGROS ORIENTAL BEmOC/CEmOC Facility Map
CEmOC Kanlaon
City Vallehermoso
BHS BEmOC
RHU BEmOC
HOSP BEmOC
Guihulngan City
ILHZ
CVGLJ
La Libertad
BINATA
MAMABATAPA Jimalalud
METROPOLITAN Tayasan
STA BAYABAS
Ayungon
SIAZAM
Bindoy
Mabinay
Bayawan Manjuyod
City
Bais City
Tanjay City
Basay
Amlan
Pamplona
San Jose
Sibulan
Valencia Dumaguete City
Santa
Catalina Bacong
Dauin
Zamboangita
Siaton
67
NEGROS ORIENTAL Endemic Disease Map
Kanlaon
City Vallehermoso
RHU
HOSP
Guihulngan City
Endemic Diseases
Malaria
Leprosy
La Libertad
Filariasis
Schistosomiasis Jimalalud
Rabies Tayasan
Ayungon
Bindoy
Mabinay
Bayawan Manjuyod
City
Bais City
Tanjay City
Basay
Amlan
Pamplona
San Jose
Sibulan
Valencia Dumaguete City
Santa
Catalina Bacong
Dauin
Zamboangita
Siaton
NEGROS ORIENTAL
68
The province of Negros Oriental occupies nearly all of eastern Negros, which faces the
Tanon Strait. It is separated from Negros Occidental by a chain of rugged mountains
along the length (north to south) of the island. The mountains of Kanlao and Cuernos de
Negros (Horns of Negros) are the highest peaks in the range. Much of the island is hilly
except for a narrow area of flat land along the coast. The shoreline is irregular and
fringed with coral reef. (http://www.geocities.com/lppsec/pp/negor.htm200717)
Negros Oriental is more culturally oriented towards Cebu and the people have always
considered themselves “Bisaya” (a reference to Cebuanos) rather than “Ilonggo”. The
province has a total population of 1,130,088 (2000 census) occupying a land area of
5,097 square kilometers and consists of 4 cities, 21 municipalities and 557 barangays.
Dumaguete City is its progressive capital.
The Rationalization Plan of the province attributed the high infant and under-five
mortality rates to “inadequate supply of medicines, untrained hilots assisting in deliveries,
failure to give mothers tetanus toxoid injections and non-performance of newborn
screening.” Maternal deaths have largely been attributed to the “lack of training of
midwives, untrained birth attendants, mothers not submitting to prenatal care and poor
access to health facilities.” The Plan thus expressed the need to conduct a maternal death
review to ascertain the cause of maternal deaths and lamented that not one of their
facilities have the capability to provide emergency obstetric care, whether comprehensive
or basic.
The concern over maternal health is understandable. In 2006, of the 21,071 total births
recorded, 78 % occurred at home with 45% being assisted by traditional birth attendants
(TBAs). This resulted to 11 deaths or a maternal mortality ratio (MMR) of 52/100,000
live births. From January to June this year, 6 maternal deaths (an MMR of 90/100,000
live births) have already been reported out of the total 6,688 live births. Seventy percent
of mothers gave birth at home and 34% of them were attended by a TBA.
The provincial facility mapping exercise held on 7-8 August 2007 was well attended.
Present were all the local health officers (provincial and municipal) as well as
representatives of the Center for Health Development – Central Visayas (the Assistant
Regional Director and the MCH Coordinator). It is worth noting that there was an effort
made during the facility mapping exercise to be consistent as much as possible with the
existing Inter-local Health Zone arrangements and the Rationalization Plan.
Four hospitals were designated as CEmOC providers: 1) Negros Oriental Provincial
Hospital, 2) Guihulngan District Hospital, 3) Bais District Hospital and 4) Bayawan
District Hospital. Their location ensures a comprehensive coverage for CEmOC services
across the province. The number of facilities identified is justified by the population
(almost 1.2 million) and the geography of the province.
The geographic characteristics of the province (e.g., being an island, the terrain, road
conditions, etc.) played a more important role in the choice of BEmOC facilities. Twenty
69
four (24) were chosen, consisting of 10 hospitals, 1 barangay health station (BHS), and
13 city/rural health units (CHO/RHU).
Currently, the province only has 2 facilities that are MCP (maternity care package)
accredited: Amlan RHU and Bindoy RHU. Amlan RHU is proposed for BEmOC
upgrading. There are also facilities currently providing childbirth services that were not
considered in the facility map because it did not pass the criteria for selection of CEmOC
and BEmOC facilities: Siaton RHU, Dauin RHU, Bacong RHU, Valencia RHU and San
Jose RHU. As agreed, these RHUs will continue to provide NSD (normal spontaneous
delivery) service to low risk women until such time that their respective LGUs are able to
finance their upgrade to BEmOC standard.
CEmOC Facility: NEGROS ORIENTAL PROVINCIAL HOSPITAL (NOPH)
Negros Oriental Provincial Hospital (NOPH) is the main CEmOC facility for the
Metropolitan and SIAZAM Inter-local Health Zone (ILHZ) and will serve as the main
referral facility for the following BEmOC facilities projected to serve a population of at
least 400,000:
Proposed BEmOC Facilities Catchment Travel Time /other
Justifications
1. Dumaguete City Health Office 11 barangays of Dumaguete City Travel time to the CHO
from the farthest barangay
is 30 minutes by jeepney or
tricycle.
Located adjacent to the
NOPH, however, its
designation as a BEmOC
facility will help decongest
the NOPH of childbirth
admissions.
The city government also
plans to build a 10-bed lying
in clinic that will be attached
to the CHO.
The city has good roads and
easy access to transportation.
Will serve an estimated
population of 100,000.
2. Amlan Rural Health Unit Amlan, San Jose Travel time to NOPH is
40 minutes. Travel time
to Sibulan is 30 minutes.
This RHU is MCP
accredited.
Proposed BEmOC Facilities Catchment Travel Time /other
Justifications
70
3. Sibulan Rural Health Unit Sibulan, San Jose, Dauin, Bacong, Travel time to NOPH is
Valencia 15 minutes.
The catchment area is
generally mountainous
with poor roads.
4. Siaton Dsitrict Hospital Siaton This facility is 20 minutes
away from the Siaton
RHU and 30 minutes
away from the
Zamboanguita RHU.
5. Zamboanguita Rural Health Unit 10 barangays of Zamboanguita of Travel time to the RHU
which 3 are hard to reach, some from the farthest
residents of Siaton and Dauin catchment is 15 – 20
minutes by ambulance.
Travel time to NOPH, a
CEmOC facility is 1
hour.
Serves a population of
29,000.
The only transportation
available in the remote
barangays is the LGU
provided vehicle for its
“Libreng Sakay” Program.
CEmOC Facility: BAIS DISTRICT HOSPITAL (BDH)
Catchment Municipalities: Bais, Bindoy, Tayasan, Mabinay, Tanjay, Pamplona
Bais District Hospital (BDH) serves as the main CEmOC facility that will receive
referrals from the BEmOC facilities within the BINATA and MAMABATAPA ILHZ.
Proposed BEmOC Facilities Catchment Travel Time/other
Justifications
Bindoy District Hospital Bindoy Travel time to Nabilog
Community Hospital is 45
minutes; to BDH, 30
minutes.
Nabilog Community Primary Tayasan This facility is 45 minutes
Hospital, Tayasan away from Bindoy District
Hospital.
Mabinay Medicare Hospital Mabinay Located in the Poblacion,
the travel time to Inapoy
Community Hospital is 45
minutes.
Travel time to Bais is 1
hour.
Proposed BEmOC Facilities Catchment Travel Time/other
Justifications
71
Inapoy Community Hospital, Mabinay, particularly the Travel time from the
Mabinay mountain barangays, some barangays is 30 minutes
barangays from nearby Negros to 1 hour.
Occidental
Bais City Health Office Bais City This facility is 1 hour
away from Dumaguete
City and more than an
hour away from the
municipality of
Bayawan.
Tanjay City Rural Health Unit 1 14 barangays of Tanjay City Located 15 kms from
BDH.
The city government
plans to set up an
emergency clinic within
the RHU and the health
officers envision this to
be a good input to
BEmOC service
provision..
Tanjay City Rural Health Unit 2 10 barangays Tanjay City of Travel time from the
which 5 is considered hard to farthest barangay is 1 –
reach 3 hours to Bais City.
Located 9 kms away from
the city.
Serves a population of
40,640 and will thus help
decongest BDH of
childbirth admissions.
Pamplona Rural Health Unit Pamplona Travel time from the
catchment barangays is
30 minutes; while to
RHUs of neighboring
towns, the travel time is 1
hour or more.
CEmOC Facility: BAYAWAN DISTRICT HOSPITAL (BDH)
Catchment Municipalities: Bayawan City, Sta Catalina, Basay,
Bayawan District Hospital will be the main CEmOC facility for the STA BAYABAS ILHZ,
which has a potential client population of around 220,000. It is strategically located at the center
of the ILHZ, between the municipalities of Basay and Sta Catalina. The following are the
BEmOC facilities under its cluster:
Proposed BEmOC Facilities Catchment Travel Time/other
Justification
72
Amio Community Primary Hospital, Sta Catalina Will serve residents of
Sta Catalina remote barangays .
Kalumbuyan Community Primary Bayawan City Will unload Bayawan
Hospital, Bayawan City District Hospital of
childbirth admissions once
the latter starts providing
CEmOC services.
Basay Rural Health Unit Basay Travel time to Bayawan
District hospital is 30
minutes.
Has an existing lying-in
clinic.
This workshop noted that Sta Catalina RHU is a childbirth service provider and will
continue to provide the service until such time that Amio Community Primary Hospital
(ACPH) is able to provide the service efficiently to the whole catchment.
CEmOC Facility: GOV WILLIAM VILLEGAS MEMORIAL HOSPITAL (GWVMH)
(formerly Guihiulngan District Hospital)
The health officers of the CVGLJ ILHZ agreed to designate Gov William Villegas
Memorial Hospital (GWVMH), formerly Guihulngan District Hospital as the main
referral facility for women who will need CEmOC services. GWVMH will receive
referrals from the following BEmOC facilities:
Proposed BEmOC Facilities Catchment Travel Time/other
Justification
Canlaon District Hospital Canlaon City This proposed BEmOC
hospital will share the
patient load with the City
Health Office.
Luz Sikatauna Community Primary Guihulngan Will help decongest the
Hospital, Guihulngan proposed CEmOC facility
Guihulngan Rural Health Unit 2 Guihulngan Travel time from the
barangays in the
catchment is 30 minutes
to 1 hour.
Magsaysay BHS, Guihulngan Mountain Barangays of Guihulngan Travel time to
Guihulngan RHU is 1
hour and 30 minutes.
Pacuan Community Primary Poblacion barangays of La Libertad Will help decongest the
Hospital, La Libertad proposed CEmOC facility
of childbirth admissions.
La Libertad Rural Health Unit Remote barangays of La Libertad Travel time to Pacuan
Community Primary
Hospital is 1-2 hours
Proposed BEmOC Facilities Catchment Travel Time/other
Justification
73
Vallehermoso Rural Health Unit Vallehermoso Travel time is 30 minutes.
Travel time to
neighboring towns is
more than 1 hour.
Jimalalud Rural Health Unit Jimalalud Travel time is 30 minutes.
Travel time to
neighboring towns is
more than 1 hour.
It is noted that while the health units recommended for upgrading to BEmOC standard
appear to be near each other with travel time that ranges from 15 – 30 minutes, the rural
health units will serve clients from the difficult to reach areas with the hospital BEmOCs
serving the rest of the municipalities and helping to decongest the CEmOC facility of
childbirth admissions.
Further, the City Health Office of Canlaon City as well as the Rural Health Unit 1 of Guihulngan
will continue to provide childbirth services since they have existing LGU funded lying-in clinics.
However, because they were not seen to be strategically located, the workshop participants
agreed that investments in these facilities may not be cost-effective.
74
BILIRAN BEmOC/CEmOC Facility Map
ILHZ CEmOC
Biliran ILHZ BHS BEmOC
RHU BEmOC
HOSP BEmOC
Maripipi
Kawayan
Almeria Culaba
Brgy Hinatangan
Caibiran
Naval
Biliran
Cabugcayan
75
BILIRAN Endemic Disease Map
RHU
HOSP
Maripipi
Endemic Diseases
Malaria
Leprosy
Filariasis
Schistosomiasis
Rabies
Kawayan
Almeria Culaba
Brgy Hinatangan
Caibiran
Naval
Biliran
Cabugcayan
BILIRAN
76
Biliran is an island province in the Eastern Visayas region that has a total land area of
555.42 square kilometers. It is bounded by the Visayas Sea to the north, by Carigara Bay
to the south, by the Samar Sea to the east and by the Strait of Biliran to the west. It is
composed of 8 municipalities and 132 barangays with a population of 140,274 as of the
2000 census. (www.biliran.lgu.gov.ph).
The main island has a slightly flat to rolling and rough terrain with narrow coastal areas
and mountainous interiors except for the municipalities of Naval and Caibiran that have
wider plains and rolling terrain extending about 7 kilometers from the coast. Mountain
ranges occupy the major portion of the island municipality of Maripipi.
(www.biliran.lgu.gov.ph).
While Biliran is an island, it is not isolated from the rest of the region. A bridge connects
the island to the province of Leyte. The province is therefore considered a gateway to
cities of Ormoc and Tacloban as well as other parts of the country that are accessible by
land transportation. Ferryboats also ply the Naval – Cebu route. (www.biliran.lgu.gov.ph).
In terms of health infrastructure, the province has 8 Rural Health Units (RHUs), 35
Barangay Health Stations and 4 Community Hospitals, 3 of which function as emergency
clinics. Despite easy access to these health facilities, the maternal and infant health
picture of the province is not encouraging. In 2006, the Provincial Health Office (PHO)
recorded 3,606 childbirths, 1,876 or 52 % of which were diagnosed as risk pregnancies.
Traditional birth attendants (TBAs) assisted in 1,831 (51%). Understandably, maternal
and infant deaths for the year were high with a Maternal Mortality Ratio (MMR) of
277/100,000 live births and an Infant Mortality Rate (IMR) of 19/1,000 live births. (2006
Natality Mortality Report, PHO, Biliran). This situation has lead the Provincial Board to pass
Resolution 166 in the same year regulating the practice of TBAs and supporting the
Maternal and Child Health Program of the province. Currently, this program is being
supported by a grant from the Japan International Cooperation Agency (JICA).
The Rationalization Plan of the province under the FOURmula One for Health Program
(F1) sought to have obstetrics-gynecology specialists in hospitals, accredit 8 RHUs under
the PhilHealth Maternal Care Package (MCP), and procure MCH equipment for all levels
of care.
The Facility Mapping exercise for the province was undertaken 2-3 August 2006 and was
actively participated in by municipal health officers and the provincial health staff. Since
the province is already a recipient of JICA assistance, it is important to ensure that the
entry of additional funds from other donors does not result in redundant inputs. The
Facility Mapping Exercise and the subsequent Needs Assessment Exercise would be
useful in this regard.
CEmOC Facility: BILIRAN PROVINCIAL HOSPITAL (BPH)
77
Catchment Municipalities: Naval, Biliran, Cabugcayan, Calbiran, Culaba, Kawayan,
Maripipi, Almeda.
Proposed BEmOC Catchments Travel Time/other
Facilities Justification
1. Culaba Rural Health Unit Culaba 1 ½ - 2 hours travel to BPH.
Serves a population of 13,285
MCP accredited.
2. Bacolod BHS, Culaba Currently functioning as birthing
facility
3. Caribiran Rural Health Unit Caribiran 1 ½ - 2 hours travel to BPH.
Serves a population of 22,978
4. Maripipi Rural Health Unit Maripipi An island municipality with a
population of 9,750; is 1 ½ hours
from BPH.
MCP accredited.
5. Viga BHS, Maripipi Currently functioning as birthing
facility
6. Agutay BHS, Maripipi Currently functioning as birthing
facility
7. Cabucgayan Rural Health Unit Cabucgayan Travel time to BPH is 1 hour.
Serves a population of 20,734.
MCP accredited
8. Pawikan BHS, Cabucgayan Currently functioning as birthing
facility
9. Balaquid BHS, Cabucgayan Currently functioning as birthing
facility
10. Naval RHU Barangays of Naval Currently providing BEmOC
services
11. Higatangan Barangay Health Barangay Higatangan, Naval Travel time to BPH is 1 hour.
Station, Naval
An island barangay with a
population of 2,206.
Assigned midwife resides in the
island.
12. Kawayan RHU Barangays of Kawayan Currently a BEmOC service
provider
13. Tucdao Barangay Health Barangay Tucdao, Kawayan Travel time to BPH is 1 hour.
Station, Kawayan
The barangay is remote with bad
roads and a population of 4,678.
14. Madao BHS, Kawayan Currently functioning as birthing
facility.
15. Tucdao BHS, Kawayan Currently functioning as birthing
facility.
78
Proposed BEmOC Catchments Travel Time/other
Facilities Justification
16. Biliran RHU Barangays of Biliran Currently a BEmOC service
provider
17. Julita Barangay Health Barangay Julita, Biliran Travel time to BPH is 1 hour.
Station, Biliran
Serves a population of 3,423
18. Almeria RHU Almeria Currently a BEmOC service
provider
As agreed during the workshop, only the Biliran Provincial Hospital (BPH) will be
designated to provide comprehensive emergency obstetric care (CEmOC). Given the
geographic characteristics of the province, BPH is easily accessible to most
municipalities particularly client referrals from the facilities chosen to provide basic
emergency obstetric and newborn care (BEmOC). Exceptions are clients referred from
Culaba, Caribiran and Maripipi RHUs, as travel from these BEmOCs would be around 30
minutes longer.
With JICA committing to provide assistance in terms of maternal and child health inputs
on a province-wide scale, investments in the facilities recommended for emergency
obstetric care upgrading is expected to be minimum.
79
EASTERN SAMAR BEmOC/CEmOC Facility Map
Jipapad
Arteche
San Policarpio
Oras
Maslog
Dolores
Can-avid
Taft
Sulat
San Julian
Borongan
CEmOC
BHS BEmOC Maydolong
RHU BEmOC Balangkayan
HOSP BEmOC
Llorente
ILHZ Hernani
Borongan Gen. McArthur
Balagiqui
Salcedo
Qu
Guiuan
Mercedes
ina
La
Taft
pon
Gip
wa
Ba
dan
Oras-Arteche
lan
an
o
rlo
g
Guiuan
iga
s
Manicani
Suluan
Homonhon
80
EASTERN SAMAR Endemic Disease Map
Jipapad
Arteche
San Policarpio
Oras
Maslog
Dolores
Can-avid
Taft
Sulat
San Julian
Borongan
Maydolong
RHU Balangkayan
HOSP Llorente
Endemic Diseases Hernani
Malaria Gen. McArthur
Leprosy
Salcedo
Filariasis
Qu
ina
Schistosomiasis Mercedes
La
po
wa
Gip
Ba
nd
Rabies
la
an
an
orl
ng
Guiuan
os
iga
Manicani
Suluan
Homonhon
EASTERN SAMAR
81
Eastern Samar is part of the Eastern Visayas region. As its name implies, the province is
located at the eastern portion of the Samar Island, facing the Philippine Sea to the east
and Leyte Gulf to the south. Bordering the province to the north is Northern Samar and to
the west is Samar Province. It has a total land area of 4,339.6 square kilometers and is
subdivided into 22 municipalities, 1 city and 597 barangays with a population of 375,822
as of the 2000 census. (http://www.eastern samar.gov.ph)
People’s access to health services varies widely as the geography of the province is
characterized by mountainous terrain with rough roads and flood prone areas, thereby
making travel by land difficult especially during rainy weather. The presence of
numerous natural obstacles such as rivers and small islands also restricts health service
utilization.
The provincial website includes a discussion on the “Objectives for Health, Nutrition and
Family Planning”. The third objective mentioned is about reducing the maternal mortality
ratio (MMR) from 260 (“2.6/1,000 live births) to 200/100,000 (2.0/1,000 live births) live
births and the infant mortality rate (IMR) from 12 to 10/1,000 live births. To allow the
province to device a cost-effective strategy to address maternal mortality, a facility
mapping exercise was conducted on 2-3 August 2007 participated by the municipal
health officers (MHOs), chief of hospitals (COHs) and Provincial Health Office (PHO)
technical staff as well as representatives from the Center for Health Development (CHD)-
Eastern Visayas.
The exercise resulted in the identification of 5 facilities proposed to be CEmOC
providers: Eastern Samar Provincial Hospital in Borongan, Albino Memorial Hospital in
Balangiga, Taft District Hospital, Felipe Adrigo Memorial Hospital in Guian, and Oras
District Hospital. On the other hand, 36 facilities were proposed to be upgraded to
BEmOC, of which 4 are hospitals, 14 are RHUs and 18 are BHSs. The choice of BHS
BEmOCs was influenced by several factors: 1) many areas are so remote, that getting a
transportation is difficult (if available at all) and usually the only way to get to a facility
is by walking, 2) the presence of island municipalities and island barangays that could be
isolated by bad weather, 3) the need to assign at least a midwife to serve in the proposed
BHS BEmOC and for the MHOs and Public Health Nurses (PHNs) to commit to conduct
supervisory visits and to be available “on call” when the midwife attends to deliveries in
the BHS.
The facility mapping exercise also tried to conform to the inter-local health zone
arrangement of the province. The CEmOC-BEmOC clusters are configured as follows:
CEmOC Facility: EASTERN SAMAR PROVINCIAL HOSPITAL (ESPH)
Catchment Municipaliies: Borongan City, San Julian, Maydolong, Balangkayan,
82
and Llorente; with a total population of 123,315.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
Borongan RHU 1 Remote barangays of To reach the facility, women
Borongan: Amantacup, will have to walk for 3 – 4
Balacdas, San Pablo and Can- hours.
aga.
The catchment includes
satellite barangays that could
be accessed only by traversing
dangerous terrain.
Borongan RHU 2 Other barangays of Borongan The farthest barangay could
not covered by RHU 1 as well be reached by either hiking
as barangays along its or taking a pump boat, for a
boundaries with Maydolong: 4 ½ hour ride.
Patag and Camada
The RHU will likewise cater
to clients from barangays that
are hard to reach mainly
because of their remoteness,
the difficult terrain and the
unstable peace and order
situation.
San Julian RHU Whole municipality of San The facility can be reached
Julian by 2 hours of hiking a
rugged trail.
Maydolong RHU Pobalacion area of the
municipality as well as other The RHU can easily be
adjacent barangays reached within 30 minutes
due to the good road
conditions and the presence
of adequate transportation.
The RHU also has an existing
lying-in clinic.
San Gabriel BHS, Maydolong Catchment barangays and 2 Travel time from the
interior barangays of farthest barangay is 4 hours
Balangkayan: Malvar and due to poor roads.
Magsaysay.
Cabay BHS, Balangkayan Catchment barangays The facility can be reached by a
5-hour hike from the farthest
barangays: Malvar, Magsaysay,
Hulag, Balogo.
No access roads to satellite
barangays.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
83
Llorente Community Hospital Whole municipality of Llorente; Travel time from Babanikhon,
2 barangays of Balangkayan: Burak, Magtino, Makaanga
Maramag and Cabay and and Canduros to the hospital is
barangay San Miguel of Hernani. 2 hours by motorized banca.
Poor roads characterize the
peripheral barangays of the town
of Llorente.
CEmOC Facility: ALBINO M MEMORIAL HOSPITAL (AMMH)
Catchment Municipalities: Balangiga, Giporlos, Lawaan, Quinapondan
Travel time to AMMH: from Balangiga: 5 minutes
from Giporlos: 15 minutes
from Lawaan: 20 minutes
from Quinapondan: 30 minutes
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
4 barangays of Balangiga: Travel time from the barangays
Guinmaayohan BHS, Balangiga Guinmaayohan, Maybunga, to the BEmOC BHS is 1 – 4
Bangon and Cag-ulango. hours of hiking the trail from
Bangon and Maybunga; 30
Barangay San Isidro of minutes by boat from Bangon
neighboring Lawaan. and by motorcycle from Cag-
ulango. Travel time to the
CEmOC facility is 2 hours.
The mountainous roads of the
catchment area is usually rocky,
muddy and slippery and can be
negotiated only by motorcycles.
Serves a population of 1,604.
Roxas BHS, Giporlos 3 barangays of Giporlos: Roxas, This BHS can be reached by
Huknan and San Miguel. either a 1-hour hike from
Huknan and San Miguel or a
30-minute motorcycle ride from
Huknan. The CEmOC facility
can be reached in 2½ hours by
motorcycle from the BHS.
The area is generally
mountainous with very rough
road, which is not accessible even
by motorcycle during the rainy
season. Rivers also cuts across
some barangays, further isolating
them during heavy rains.
Serves a population of 1,184.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
84
Anislag BHS, Quinapondan 4 barangays of Quinapondan: The BHS can be reached by
Anislag, San Isidro, Cagdaja 30 – 45 minutes of hiking the
and Cantenio. trail from the catchment
barangays.
Travel time to the CEmOC
is 2 ½ hours. The trip
involves a hike and a bus
ride.
The area is generally
mountainous with very rough
road, which could not be
accessible even by motorcycle
on rainy days.
Rivers also cuts across some
barangays further isolating
them during heavy rains.
Serves a potential population
of 2,100.
For this cluster, 3 BHSs are recommended for upgrading to BEmOC to provide services
to women in remote barangays.
The RHUs in the catchment were not recommended for upgrading because of their
proximity to the CEmOC facility, which will double as BEmOC service provider.
However, the RHUs of Lawaan and Balangiga being already MCP accredited, will
continue to provide childbirth services as the LGUs concerned upgrade these facilities to
BEmOC standards.
The facility mapping exercise also took into account the planned turnover of the
Quinapondan Community Hospital to the Quinapondan Municipal LGU for its
subsequent merger with the Quinapondan RHU. This is part of the LGU health facility
rationalization effort.
CEmOC Facility: TAFT DISTRICT HOSPITAL (TDH)
Catchment Municipalities: Taft, Sulat, Can-avid, Dolores and Maslog
o TDH is more than 1 ½ hours to ESPH
o It has a complete human resource complement for a CEmOC facility. The
Chief of
o Hospital is a diplomate in obstetric and gynecology.
o It has an operating and delivery room.
o TDH is PhilHealth accredited.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
85
Malinao BHS, Taft 7 barangays of Taft: Malinao, Travel time from the farthest
San Rafael, Binalo-an, San barangay is 1 hour and 25
Pablo, Mabuhay, Lumatod and minutes.
Gayam
This BHS will serve a
population of 4,784.
Sulat Rural Health Unit 9 barangays of Sulat: Mara- Travel time to TDH is 30
mara, Riverside, Bay-bay, minutes.
Loyola Heights, Tabi,
Maglipay, Abucay, San Will serve a population of 7,087
Francisco, Del Remedios
PhilHealth accredited
San Vicente BHS, Sulat Barangay San Vicente Travel time from the farthest
barangay is 1 hour by boat or
tricycle
It is an island barangay.
Serves a population of 1,257
The LGU of Sulat is willing to
invest in a sea ambulance.
Sto Tomas BHS, Sulat 4 barangays of Sulat: Sto Travel time from the farthest
Tomas, Sto Nino, Candalakit, barangay is 45 minutes.
and San Isidro
Serves a population of 4,341.
San Juan BHS, Sulat 4 barangays of Sulat: San Juan, Travel time from the farthest
San Mateo, Mabini, A-et barangay is 45 minutes
Serves a population of 1,778.
A midwife assigned at the BHS
also resides in the barangay.
Can-avid Community Hospital 8 barangays of Can-avid: Travel time from the
Guibuangan, Mabuhay, barangays to the BEmOC
Canteros, Carolina, Rawis, hospital is 30 minutes to 1½
Solong, Obong, Malogo hours. Common modes of
transportation within the
Poblacion are motorcycle and
pedicab. The rest of the
barangays are accessible only by
motorboat or hiking the trail.
The hospital is about 17 kms
away from TDH, a CEmOC
facility.
The hospital is PhilHealth
accredited.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
86
Camantang BHS, Can-avid 8 barangays of Can-avid: Travel time to the facility
Jepaco, Barok, Balogon, Boco, ranges from 30 minutes to 4 ½
Salvacion, Can-ilay, Caghalong, hours by motorized banca.
and Pandol Barangay Jepako however is
accessible only via a 45-minute
hike.
Travel time from Camantang
to the RHU is 1 hour and 30
minutes.
Generally characterized by
difficult and mountainous
terrain with rivers cutting across
the area. Transportation is
therefore expensive, if at all
available.
Dolores Rural Health Unit 46 barangays of Dolores Travel time to TDH is only 40
minutes.
Serves a population of 39,000.
The LGU of Sulat has recommended 3 of its BHSs for upgrading to BEmOC standard
and is willing to provide an emergency stand-by vehicle in each of the BHSs for
emergency purposes.
This report also notes the recommendation by the health officers to upgrade Can-avid
Community Hospital to BEmOC rather than the RHU despite the planned merging of
the 2 facilities, with the RHU becoming the “main” facility as reflected in the
Rationalization Plan. The LGU is contesting the recommendation to merge the
facilities as they view the hospital as a necessary infrastructure in the locality. The
low occupancy rate of 24% is understandable of the 10-bed hospital given that the
population of the municipality is also small at 18,000. Upgrading the hospital to
BEmOC will enhance its capacity to be responsive and deliver quality health service.
Its occupancy rate is also expected to improve as mothers shift from home to facility
birth.
CEmOC Facility: FELIPE ADRIGO MEMORIAL HOSPITAL (FAMH)
87
(Formerly: Southern Samar General Hospital)
Catchment Municipalities: Guiuan, Mercedes, Hernani, Salcedo, Gen MacArthur
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
Homonhon Island Community 7 barangays of Homonhon Travel time from farthest
Hospital Island barangay: 2 hours
Travel time to FAMH: 3
hours by boat.
An island within the
municipality of Guiuan with a
population of 5,250.
Staff Complement: 1 doctor, 3
nurses, 6 midwives
This is a 10-bed hospital.
Manicani BHS, Guiuan 5 barangays and 1 adjacent Manicani is an island barangay,
small island which is 30 minutes to 1 hour
away from FAMH by boat.
Travel time from the farthest
barangay to this BHS
BEmOC is 1 hour.
Serves a population of 2,635.
A resident midwife is assigned
in the area.
Sulangan RHU, Guiuan 4 mainland and 9 island Travel time from farthest
barangays of Guiuan barangay to this BEmOC
RHU is only 30 minutes.
The Public Health Nurse resides
in the area. Two midwives are
assigned to the facility and 1 of
them resides in the area.
Suluan BHS, Mercedes Barangay Suluan, Guiuan Travel time to FAMH is 3-4
hours by boat.
An island barangay, generally
isolated and depressed, with a
population of 1,241.
Staffed by a resident midwife.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
88
Hernani RHU 13 barangays of Hernani and 3 No road network, thus the RHU
barangays of Llorente BEmOC could be reached by
walking for 6 – 8 hours from
the farthest barangay.
The CEmOC Facility could be
reached in 1 ½ - 2 hours from
the poblacion.
A remote municipality with a
population of 7,144.
A doctor, a nurse and a midwife
staff the facility.
Salcedo Rural Health Unit 38 barangays including an Travel time from the farthest
island barangay barangay: 1 ½ - 1 hour and 45
minutes either by land or
water transport facility.
The municipality has 41
barangays with poor roads and
no regular transport.
A doctor, a nurse and a midwife
staffed the RHU, which is MCP
accredited.
General MacArthur Community Municipality of MacArthur and Travel time to the CEmOC
Hospital barangays along the boundaries facility is 45 minutes to 1
of Salcedo, Hernani and hour.
Quinapondan.
The hospital is a 10-bed facility
with full staff complement:
doctor, nurses, and midwives.
Pinggan BHS, Gen 8 barangays of MacArthur Travel time from the farthest
MacArthur barangay is 7 hours by land.
This BHS BEmOC staffed by a
midwife serves communities
with difficult terrain, with no
regular transport.
Camcueves BHS, Gen 6 Barangays of Gen Travel time to the CEmOC
MacArthur MacArthur facility is 3 hours.
Travel time to BHS
BEmOC from the farthest
barangay is 6 hours by land
transport.
CEmOC Facility: ORAS DISTRICT HOSPITAL (ODH)
Catchment Municipalities: Oras, Maslog, San Policarpio, Jipapad, Dolores and Arteche
89
Catchment population: 80,000.
Travel time: to ESPH: 2 ½ hours
From Maslog and Jipapad: 4 – 5 hours
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
Oras RHU 1 4 barangays of Oras 2 of Travel time from farthest
which are hard to reach: catchment is 4 hours by
Trinidad and Naga hiking the trail.
Travel time to ODH is 45
minutes.
The RHU is located along the
Oras river in barangay
Agsam with a total
population served of 2,238.
Oras RHU2 (located in 15 barangays of Oras Travel time to the RHU is
barangay Cadian) 15 minutes to 1½ hours
from the barangays. ODH
can be reached within 1 – 2
hours.
Rivers characterize the
catchments thus, the main
mode of transportation is
motorized banca.
Maslog RHU 12 barangays of Maslog, 2 of Considered an interior
which are considered hard to municipality of the province,
reach. it would take 4-5 hours of
travel to the nearest
community hospital and 5 –
6 hours to reach ODH, a
CEmOC facility.
This RHU has an MCP
accreditation.
San Policarpio RHU 17 barangays of San The Center is
Policarpio. geographically accessible to
all barangays by
motorcycle. However,
access to 3 barangays is
only by hiking,
Agsaman BHS, Jipapad 3 remote barangays of The catchments are hard to
Jipapad reach. Travel time to the
Main Health Center is 4
hours of hiking.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
90
Arteche RHU Poblacion area and Travel time to ODH, a
neighboring barangays CEmOC facility takes 2 – 2
½ hours.
Accessible to all barangays
either by using a public
utility vehicle, motorcycle or
by hiking.
Serves a population of
15,047
This facility is PhilHealth
accredited.
Concepcion BHS, Arteche 5 barangays along the Travel time from the
riverbank. farthest barangay is 15
minutes to 1 hour by
motorboat and by hiking
the trail. Travel time to
ODH is 2-3 hours.
The BHS is located along the
Oras river.
Carapdapan BHS, Arteche 2 remote barangays of The BHS can be reached in
Arteche 15 minutes via motorcycle.
Tangbo BHS, Arteche 5 barangays of Arteche, 4 of Travel time from the
which are hard to reach. barangays of Campacion,
Tibalawan and Inayawan is
approximately 2 – 4 hours
by hiking the trail and
riding a motorcycle.
Travel time to ODH is 30
minutes.
91
SOUTHERN LEYTE BEmOC/CEmOC Facility Map
Silago
CEmOC
BHS BEmOC Sogod
RHU BEmOC
HOSP BEmOC Hinunangan
Bontoc
Hinundayan
Libagon
St. Bernard Anahawan
Tomas
San Juan
Oppus
Maasin
City Malitbog
Macrohon Liloan
Padre
Burgos San
ILHZ San
Francisco Ricardo
Sogod ILHZ
Maasin ILHZ Pintuyan
Pacific ILHZ Limasawa
Panaon ILHZ
SOUTHERN LEYTE
92
Southern Leyte, one of the 6 provinces of Eastern Visayas, straddles the southern third of
the island of Leyte and includes under its jurisdiction, the islands of Panaon and
Limasawa. The deep Surigao Strait separates the island of Panaon from Mindanao. The
province’s coastal areas are relatively flat while the interior is mountainous. It is bounded
by the province of Leyte to the north, by the Surigao Strait to the east, Bohol Sea to the
south and Canigao Channel across Bohol to the west.
(http://www.geocities.com/lppsec/pp/sleyte.htm?200717).
Southern Leyte has numerous small rivers in addition to at least 11 major rivers:
Canturing River in Maasin, Amparo River in Macrohon, Divsoria River in Bontoc,
Subang Daku River in Sogod, Lawigan and Hitungao Rivers in San Juan, Das-ay and
Pondol Rivers in Hinunangan and Maag River in Silago. Its total land area is 173,480
hectares subdivided into 1 city, 18 municipalities and 501 barangays.
(http://www.geocities.com/lppsec/pp/sleyte.htm?200717).
The geographic characteristics of the province affect people’s access to social services.
As the 2006 Provincial Health Office Report pointed out, 50 % of women who gave birth
in the same year opted to deliver at home with 17% availing of the services of traditional
birth attendants. Risk pregnancy was noted in 43% of pregnant women.
The Provincial Health Office (PHO) sought technical assistance to enable them to
rationally plan for an investment in women’s health and safe motherhood. While the
province reports no maternal death, provincial health managers appear aware of the need
to be proactive for them to be able to sustain this situation. The facility mapping exercise
for the province was conducted on 30-31 July 2007. The exercise was meant to guide the
health officers identify facilities that can be upgraded to CEmOC and BEmOC based on
defined criteria. This activity is an initial step towards setting up a responsive program
aimed at improving women’s health.
The facility mapping exercise was attended by the Municipal Health Officers, Chief of
Hospitals and PHO technical staff. It resulted in the selection of 4 hospitals for upgrading
to CEmOC and 14 facilities for upgrading to BEmOC, 3 of which are hospitals, 9 are
RHUs and 2 are BHSs. The following is the CEmOC-BEmOC network configuration in
the province:
CEmOC Facility: SOUTHERN LEYTE PROVINCIAL HOSPITAL (SLPH)
Catchment Municipalities: Maasin City, Limasawa, Macrohon, Malitbog and Padre
Burgos.
SLPH is located in Maasin City. Except for Limasawa Island, the rest of the catchment
municipalities have easy access to this facility. Two of its catchment municipalities have
facilities that were granted maternal care package accreditation: Limasawa Island RHU
and Malitbog RHU
93
Proposed BEmOC Catchment Travel Time/other
Facilities Justification
Maasin City Health Unit 2 Catchment barangays within This facility should be
the city proper and upgraded to BEmOC to help
neighboring barangays decongest SLPH of childbirth
admissions.
Maasin City Health Unit 3 24 barangays of Maasin City From the farthest barangay,
the facility can be reached in
45 minutes.
All barangays have access to
transportation.
Serves a population of 25,000.
Macrohon RHU 15 barangays Travel time to the facility is
45 minutes to 1 hour.
Mountainous terrain and bad
roads characterize the
municipality.
Limasawa Island RHU 6 barangays Travel time to the mainland
is 2 hours by boat.
Limasawa is an island
municipality that becomes
isolated during the “habagat”
or southwest monsoon season.
The RHU is MCP accredited.
Padre Burgos Community 7 hard to reach barangays. This facility has a lying –in
Hospital unit.
The terrain is generally
mountainous with bad roads.
Malitbog RHU 37 barangays 12 of which are Travel time to the facility
in the mountains from the mountainous
barangays is 1½ hours by
hiking the trail and riding a
motorcycle.
The RHU is MCP accredited
The workshop decided to recommend the upgrading of Maasin City Health Units 2 and 3
to BEmOC to help decongest the SLPH of childbirth admissions considering the heavy
patient load of the hospital.
CEmOC Facility: SOGOD DISTRICT HOSPITAL (SDH)
94
Catchment Municipalities: Sogod, Bontoc, Libagon, Liloan, Tomas Oppos
Travel time from Libagon to Sogod: 30-40 minutes
From Bontoc to Sogod: 30-40 minutes
This cluster has 1 municipality whose facility was granted MCP accreditation by PHIC:
Tomas Oppos RHU.
Proposed BEmOC Catchment Travel Time/other
Facilities Justification
Liloan Community Hospital Liloan and neighboring The facility is accessible to all
barangays barangays in the catchment and
will help decongest SDH of
childbirth admissions.
CEmOC Facility: ANAHAWAN DISTRICT HOSPITAL (ADH)
Catchment Municipalities: Anahawan, St Bernard, Silago, San Juan, Hinundayan
Travel time to SLPH: 3 hours from the farthest catchment municipality.
One municipality has 2 facilities with MCP accreditation: Silago RHU and St Bernard
RHU.
Proposed BEmOC Catchment Travel Time/other
Facilities Justification
St Bernard RHU 12 coastal barangays and 7
mountain barangays Travel time to the facility
from the farthest coastal
barangay is 1 hour; from the
farthest mountain barangay,
1½ hours.
Travel time to ADH 30 – 45
minutes.
The roads are good.
The RHU serves a population
of 26,297.
The RHU is PhilHealth and
MCP accredited, has Sentrong
Sigla Level 1 certification, and
has applied for newborn
screening accreditation.
Proposed BEmOC Catchment Travel Time/other
Facilities Justification
95
Ma Asuncion BHS, St Bernard Remote indigenous people Travel time to the RHU is only
communities of St Bernard 30minutes.
The community is generally
mountainous.
This BHS is currently providing
childbirth services.
Silago RHU 15 barangays Silago and 9 Travel time to the RHU from
disputed barangays; 2 hard to the farthest baranagy is 30
reach barangays: Catmon and minutes to 1 hour.
Puntana
The RHU is MCP accredited.
Hinatunggan BHS, Silago Remote barangays of Silago Travel time to Silago RHU is 20
– 30minutes.
Currently functioning as a
birthing facility.
Because of the difficult terrain,
transportation is not always
available.
CEmOC Facility: PINTUYAN DISTRICT HOSPITAL (PDH)
Catchment Municipalities: Pintuyan, San Francisco, San Ricardo, Hinunangan
Travel time to ADH: 4 hours
to SDH: 3 hours
PDH is categorized as level 1 facility, which means, it is not allowed to perform surgeries
and has been recommended to be merged with the Pintuyan RHU. However, this move is
being opposed by the local government units involved. The workshop recommended that
the merger be put into operation by upgrading the hospital to BEmOC operating in
tandem with the RHU. Its occupancy problem may also be addressed by encouraging
mothers to give birth in the facility instead of at home.
Proposed BEmOC Catchment Travel Time/other
Facilities Justification
San Francisco RHU San Francisco The area is hard to reach and
residents have difficulty
accessing health facilities in
neighboring municipalities.
San Ricardo RHU San Ricardo Same as above
Hinunangan Community Hospital 2 municipalities: Hinunangan Travel time to this hospital
with 40 barangays of which 2 are BEmOC from the farthest
islands and 5 are hard to reach barangay is 2 – 3 hours by
with 2 sitios. and motorcycle.
Silago with 15 barangays 9 of
which are disputed with Abuyog,
Leyte.
96
MISAMIS OCCIDENTAL BEmOC/CEmOC Facility Map
Baliangao
Plaridel
Calamba CEmOC
BHS BEmOC
Sapang Lopez Jaena RHU BEmOC
Dalaga HOSP BEmOC
ILHZ
ZAMBOANGA Oroquieta
Tangub
DEL NORTE
Concepcion Ozamis
Oroquieta
Aloran Calamba
Panaon
Don Victoriano
Chiongbian Jimenez
Sinacaban
Tudela
Clarin
Ozamis
ZAMBOANGA
DEL SUR
Bonifacio Tangub LANAO
DEL NORTE
MISAMIS OCCIDENTAL
97
Misamis Occidental occupies a bend of the Zamboanga peninsula that stands sentinel to
the long narrow Panguil Bay. It is bounded on the west by the provinces of Zamboanga
del Norte and Zamboanga del Sur and separated from Lanao del Norte by Panguil Bay.
The terrain is rolling and rises sharply towards Mount Malindang in the west. The
province is lucky to lie outside the typhoon belt, giving it an even climate and mild
weather throughout the year. (http://www.geocities.com/lppsec/pp/micamisocc.htm?200717).
The province has a total land area of 2,207 square kilometers and an estimated population
of 491,825. It consists of 3 cities, 14 municipalities and 490 barangays.
(http://www.misocc.gov.ph/all_abouthtml).
The Rationalization Plan submitted by the Provincial Health Office reflects the concern
over the outcomes of the current maternal and child health service delivery system. The
plan aggressively pushes for the upgrading of health facilities to enable them to deliver
basic and comprehensive emergency obstetric care (BEmOC and CEmOC) to their
constituents. This effort is mainly driven by the occurrence of 6 maternal deaths in the
province in 2006, 4 of which were caused by postpartum hemorrhage, a preventable
condition. This brings the maternal mortality ratio (MMR) of the province to 161/100,000
live births. While midwives assisted 62% of these childbirths, a considerable 38% are
still being handled by traditional birth attendants (TBAs).
To assist the province plan for their women’s health and safe motherhood (WHSM)
investments, a facility mapping exercise was conducted on 8-9 May 2007. The exercise
initiates the effort to identify local needs in so far as implementation of the WHSM
intervention model is concerned. The exercise was attended by all health officers from
the different municipalities and cities as well as the technical staff of the PHO and
coordinators from the Center for Health Development-Northern Mindanao. It resulted in
the identification of 3 hospitals proposed to be CEmOC providers and 7 proposed for
BEmOC upgrading: 6 RHUs, 1 Puericulture Center. The Misamis Occidental Provincial
Hospital, will function as a BEmOC provider as well in its catchment area. No facility in
the province has been accorded MCP (maternal care package) accreditation by Philhealth
yet. The health officers therefore welcome the prospect of speeding up the effort towards
accreditation with the planned facility upgrades that the facility mapping and needs
assessment generates
CEmOC Facility: CALAMBA DISTRICT HOSPITAL (CDH)
Catchment Municipalities: Calamba, Sapang Dalaga, Baliangao and Concepcion
Proposed BEmOC Catchment Travel Time / other
Facilites Justifications
Sapang Dalaga RHU Sapang Dalaga Travel time is 30 minutes from
the barangays in the catchment
to the RHU
Proposed BEmOC Catchment Travel Time / other
Facilites Justifications
98
Baliangao RHU Baliangao Travel time is 30 minutes
from the barangays in the
catchment to the RHU
Concepcion RHU Concepcion Travel time is 30 minutes
from the barangays to RHU
This facility needs to be
upgraded to BEmOC, since
travel time from the RHU to
the core referral hospital is 2
½ hours by public utility
jeepney.
CEmOC Facility: MISAMIS OCCIDENTAL PROVINCIAL HOSPITAL (MOPH)
Catchment Municipalities: Oroquita City, Lopez Jaena, Aloran and Panaon
The facility mapping considered the following recommendations from the health
officers:
Since MOPH is centrally located and is connected to the catchment municipalities by
good roads and efficient public transport system, it can be reached within 30 minutes
from each of the catchment municipalities. For this reason, it will double as a
BEmOC provider.
The Puericulture Center in Ozamis City, which has been proposed to be BEmOC
provider, will help decongest the MOPH of childbirth admissions. It is less than 30
minutes away from the MOPH.
CEmOC Facility: S. M. LAO MUNICIPAL HOSPITAL (SMLMH)
Catchment Municipalities: Ozamis City, Sinacaban, Tangub, Bonifacio, Jimenez,
Clarin, Don Victoriano Chiongbian
Proposed BEmOC Facilities Catchment Travel Time/other
Justifications
Sinacaban RHU Sinacaban and Tudela Travel time is 30 minutes
from the barangays to RHU
Tangub RHU Tangub, Bonifacio and Travel time is 30 minutes
Jimenez from the barangays to RHU
Ozamis City Health Office Ozamis City and Clarin Travel time is 15 – 30
minutes from the barangays
to the CHO Puericulture
Center
Puericulture Center, Ozamis Ozamis City To help decongest the
City SMLMH, a CEmOC facility of
childbirth admissions.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
99
Don Victotiano Chiongbian Don Victoriano Chiongbian Travel time is within 30
RHU minutes to 1 hour from the
barangays to the RHU.
Travel time from the RHU to
the core referral facility is 2
to 4 hours.
Reported 1 maternal death in
2006.
The workshop participants made a conscious effort to make the facility map consistent
with the Rationalization plan. For instance, the workshop decided not to recommend
either Tudela Municipal Hospital or the Tudela RHU for BEmOC upgrading as these
facilities had been previously identified for merging. The decision actually conforms to
the mapping criteria since Tudela is only around 10-15 minutes away from Ozamis City
which will host a BEmOC and CEmOC facility.
100
NORTH COTABATO BEmOC/CEmOC Facility Map
Alamada
Banisilan
Pres.
Roxas
Arakan
Carmen
Pigkawayan
Antipas
Libungan
Aleosan Matalam Pres.
Midsayap Roxas
Kabacan Magpet
Pikit
Kidapawan
M’Lang
CEmOC Makilala
BHS BEmOC
RHU BEmOC
HOSP BEmOC
Tulunan
ILHZ
M3K2C2 / PALMA-PB
Arakan Valley
MAT
NORTH COTABATO
101
North Cotabato is a landlocked province located in the SOCCSKSARGEN region of
Mindanao. It is bounded on the north by Bukidnon, on the northwest by Lanao del Sur,
on the southwest by Maguindanao, on the south by Sultan Kudarat and on the east by
Davao del Sur. Mountains to the east peak at Mount Apo. The Piapayungan Range along
the west side separates the province from Lanao del Sur. The Pulangi River basin runs in
the middle of these 2 highland areas and spreads towards the southwest to the plains of
Maguindanao. (http://www.geocities.com/lppsec/pp/cotabato.htm?200717).
Indigenous people consisting of the Manobos, T’bolis, Iranun and Maguidanaos inhabit
the province. The Manobos are the most populous. In fact, Kidapawan, the capital city, is
a Manobo cultural center. (http://www.geocities.com/lppsec/pp/cotabato.htm?200717).
Well-paved roads link North Cotabato to the progressive cities of Gen Santos City,
Davao City and Cagayan de Oro City. The province has a total land area of 8,250 square
kilometers and consists of 1 city, 17 municipalities and 543 barangays with an estimated
population of 973,134. (http://www.geocities.com/lppsec/pp/cotabato.htm?200717). The province
however has been the center of armed encounters between the Philippine Armed Forces
and Mindanao’s rebel groups. Kidnappings and petty crimes are rampant. This conflict
has affected health service delivery and consequently, people’s health. In 2006, 7
maternal deaths were reported.
A facility mapping for the province was held 12-13 July 2007. This resulted in the
identification of 3 CEmOC facilities and 11 BEmOC facilities of which 3 are hospitals, 6
are RHUs, and 2 are BHSs.
Proposed CEmOC Facility: NORTH COTABATO PROVINCIAL HOSPITAL (NCPH)
Catchment Municipalities: Kidapawan City, Magpet, Tulunan, Carmen, M’lang,
Makilala, Kabacan, some barangays of Lower President Roxas, some baranagys of
Matalam
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
1. Kidapawan City Hospital 40 barangays of the city, some Located in barangay Amos,
barangays of adjacent which is far from the city proper.
municipalities: Magpet,
The hospital is a 10-bed facility
Makilala, President Roxas
with delivery room and serves a
population of 124,595.The city
had 3 maternal deaths in 2006
due to eclampsia.
The city is relatively peaceful.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
102
2. Magpet Rural Health Unit 35 barangays of Magpet. Travel time from the farthest
barangay is 1 hour by
motorcycle.
The municipality of Magpet is
located in the northeastern tip of
the province. Rolling to scattered
hills, wide and narrow valleys
and mountain ranges with plains
and small lakes dominate its
landscape. Its forest cover is the
largest in Mindanao. Mt Apo is
located in the eastern part of the
municipality. The peace and
order situation is relatively stable.
The municipality had 2 maternal
deaths in 2006.
Serves a population of around
45,000.
3. Father Tulio Favale Municipal Barangays of Tulunan 11 of Travel time from the
Hospital, Tulunan which are hard to reach and farthest barangay is 30
neighboring municipality of
Maguindanao.
minutes to 1 hour.
Tulunan has a rugged,
mountainous terrain.
4. Carmen RHU 28 barangays of Carmen Travel time from the
catchments to the RHU
ranges from 30 minutes to 2
hours and from the RHU to
NCPH, 1 hour.
Serves a population of 55,889.
The municipality is also
characterized by difficult to reach
sitios and peace and order
problems.
The RHU is a Level 1 Phase 2
Sentrong Sigla certified.
Proposed CEmOC Facility: ARAKAN VALLEY DISTRICT HOSPITAL (AVDH)
103
Catchment Municipalities: Antipas, Arakan, Upper President Roxas, some barangays of
Lower President Roxas, Matalam, some barangays of Carmen.
The proposed CEmOC facility is located in the municipality of Antipas.
Proposed BEmOC Catchment Travel Time/other
Facilities Justifications
1. Arakan RHU 28 barangays of Arakan, some Travel time to the RHU from San
barangays of Magpet, Antipas, 5 Miguel, the farthest barangay is
barangays of Pres Roxas and 1.5 hours by motorcycle
those along the borders of Davao
Arakan is characterized by rolling
and 5 barangays of the
and scattered hills, wide and
Municipality of Kitaotao,
narrow valleys and mountain
Bukidnon.
ranges. It also has patches of
plains and small lakes. There is
no threat to peace and order.
The RHU recorded 2 maternal
deaths in 2006.
2. Sarayan BHS, Upper Pres. Barangays of Carmen, Antipas, Travel time to AVDH is 1 hour.
Roxas upper and lower Pres Roxas,
Arakan and Matalam Travel time from the catchment
barangays to the proposed BHS
BEmOC is 30 minutes to 1 hour
using “skylab” or jeepney.
Characterized by a sloping,
mountainous terrain with rough
roads. The municipality of
Carmen has been the site of
intermittent armed encounters.
Barangay Sarayan and its
surrounding barangays have the
Manobo tribe and Muslims as
members.
Proposed CEmOC Facility: DR AMADO DIAZ PROVINCIAL FOUNDATION
HOSPITAL (DADPFH)
Catchment Municipalities: Midsayap, Banisilan, Alamada, Pigcawayan, Pikit, Aleosan,
Libungan
The proposed CEmOC facility is located in the municipality of Midsayap and can be
reached within the standard travel time of 1 hour from each of the proposed BEmOC
facilities within the cluster.
In determining the facilities proposed for BEmOC upgrading, individual views of the
health officers were carefully considered especially in “conflict” areas where the safety of
the health staff is a major consideration. Attention was particularly given to the case of
Banisilan, a municipality that is occupied by Manobos and Muslims and is considered
104
“critical” for 2 reasons: 1) there is “armed conflict” in the area, and 2) the political
leadership was still being contested months after the election. But despite this apparent
difficult situation, the MHO was committed to remain in the area to serve. He remained
hopeful that upgrading the Salama BHS to BEmOC would bring about significant
improvements in health services despite the unstable peace and order situation.
Proposed BEmOC Catchmen Travel Time/other
Facilities Justifications
1. Banisilan RHU 20 barangays of Banisilan. The RHU is projected to serve a
population of around 47,000 and
is only about 30 – 45 minutes to
Wao, Lanao del Sur, where
patients needing higher level
service are currently referred.
Banisilan is a rural municipality
with flat and rolling terrain.
2. Salama BHS, Banisilan Difficult to reach barangays of The proposed BHS BEmOC is
Banisilan. only 1 hour from the proposed
CEmOC.
Located south of Banisilan, it
serves a population of around
17,000 mostly Muslims and
Manobos.
The area has been considered
“critical” because of the presence
of “armed insurgents” resulting in
years of continued poor health
service delivery.
2. Alamada Provincial Community 17 barangays of Alamada, settlers Travel time from Dado, the
Hospital from Kaolo, Davao del Norte, some farthest sitio is 1 – 2 hours.
barangays of Banisilan and Libungan,
some barangays of Bukidnon and Travel time from barangays in
barangay Wao of Lanao del Sur. Banisilan (Bao and Malitbug) is 2
hours via Kitub river.
The facility is located in Sitio
Magsaysay, Barangay Kitacubong,
Alamada, an area surrounded by the
mountains of Banisilan and Lanao del
Sur. The roads that leads to the
facility are passable using “habal-
habal”
This hospital is the only health
facility in the area that serves a
population of 50,173 Christians and
Muslims.
This 10-bed hospital is PHIC
accredited.
Proposed BEmOC Catchmen Travel Time/other
Facilities Justifications
105
3. Pigcawayan RHU 40 barangays of Pigkawayan Travel time to the CEmOC
facility is 20 – 25 minutes.
Travel time from the farthest
barangay to the proposed RHU
BEmOC is 1 hour.
4. Pikit RHU 42 barangays Pikit is composed of 70%
Muslims and is another
municipality that is the site of
a number of bloody
encounters between the
military and Muslim rebels.
The encounters lead to
displacement of families that
often result in a worsened
health situation for those
affected.
106
AGUSAN DEL SUR BEmOC/CEmOC Facility Map
ILHZ
CEmOC Sibagat D.O. Plaza Area Health Zone
BHS BEmOC Bunawan Area Health Zone
RHU BEmOC Special Area
HOSP BEmOC Bayugan Bunawan
Prosperidad
Esperanza
San Francisco
San Luis
Talacogon
Rosario
La Paz
Bunawan Trento
Loreto
Sta.
Veruela Josefa
107
AGUSAN DEL SUR Endemic Disease Map
Sibagat RHU
HOSP
Endemic Diseases
Bayugan
Malaria
Leprosy
Filariasis
Prosperidad
Schistosomiasis
Rabies
Esperanza
San Francisco
San Luis
Talacogon
Rosario
La Paz
Bunawan Trento
Loreto
Sta.
Veruela Josefa
AGUSAN DEL SUR
108
Agusan del Sur prides itself as the largest province in the CARAGA region in terms of land area,
estimated at 8,965.5 square kilometers. Along its borders (starting on the north going clockwise)
are the provinces of Agusan del Norte, Surigao del Sur, Davao Oriental, Compostela Valley,
Davao del Norte, Bukidnon and Misamis Oriental. (http://en.wikipedia.org/wiki/Agusan_del_Sur)
The province is an elongated basin formation with mountain ranges on the eastern and western
sides forming a valley, which occupies the central longitudinal section of the land giving its
characteristic flat and rolling landscape crisscrossed by an abundance of rivers and streams. The
Agusan River flows from the Compostela Valley in the south towards Agusan del Sur in the north
runs along the middle of the valley and empties into Butuan bay. The river has 12 waterways
supplied by streams and creeks: Wawa, Gibong and Simulao rivers on the eastern side and Ojot,
Pusilao, Kasilayan, Libang, Maasam, Adgawan, Cawayan, Umayam, and Ihaon rivers on the
western side. These waterways divide the province into 7 highway municipalities: Prosperidad,
San Francisco, Rosario, Bunawan, Trento, Sta Josefa, and La Paz and 7 geographically isolated
river towns: Sibagat, Bayugan, Esperanza, San Luis, Talacogon, Veruela and Loreto. It has at
least 5 tribal groups: Aeta, Mamanwa, Bagobo, Higaonon and Manobo. The Manobos live along
the national highway and river towns towards the boundary with Compostela Valley, while the
Higaonons occupy the western side of Agusan River, mostly in the town of Esperanza towards
the boundary with Bukidnon. The other tribes are scattered among the other towns. It has an
estimated population of 559,294 as of the 2000 census, composed predominantly of immigrants
from the Visayas. (http://en.wikipedia.org/wiki/Agusan_del_Sur)
The landscape of the province play an important role in people’s lives and heavily influence their
health seeking behavior. A health situation report prepared by the Provincial Health Office (PHO)
in 2003 showed a high preference towards homebirths at 83.71%, 42% of which were assisted by
traditional birth attendants (TBA) and 44% by midwives. The preference for TBA assisted
homebirth persists despite a 48.99% risk pregnancy. (Agusan del Sur PHO Report, 2003).
Relative to their current maternal care index, the Rationalization Plan of the province calls for the
upgrading of strategically located primary and secondary level facilities to enable them to provide
emergency obstetric care and save women’s and children’s lives. (Rationalization Plan of Health
Facilities, Agusan del Sur).
A facility mapping exercise was conducted in the province on 18-19 July 2007. The Municipal
Health Officers, Chief of Hospitals, Provincial Health Office Technical Staff as well as the
Maternal and Child Health and FOURmula One for Health Program Coordinators of the Center
for Health Development - Caraga actively participated in the activity. The exercise resulted in the
identification of 3 facilities for upgrading to provide CEmOC services: Democrito O Plaza
Memorial Hospital, La Paz Municipal Hospital and Bunawan District Hospital and 28 facilities
for upgrading to BEmOC, of which 1 is hospital, 5 are RHUs (Rural Health Units), and 22 are
BHSs (Barangay Health Stations). Three facilities have Maternal Care Package (MCP)
accreditation from PhilHealth: Trento RHU, Talacogon RHU and Zillovia BHS also of Talacogon.
Trento RHU was not recommended for further upgrading to BEmOC because of its proximity to
other BEmOC facilities and to the CEmOC facility in Banawan. Instead the MHO of Trento
proposed that Sta Maria BHS be upgraded to BEmOC to serve the interior barangays of the
municipality, all of which are accessible only by motorcycle because of the rough road.
The health officers originally wanted to have 45 (1 hospital, 8 RHUs, 36 BHSs) of their facilities
upgraded to BEmOC standard. The recommended number is actually justifiable given the
geographic (rough terrain isolated by rivers) and demographic (populated by indigenous minority
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groups) characteristics of almost 50 % of their municipalities. Moreover, while the recorded
maternal death was only 1 in 2006 and 1 this year, again given the remoteness of a substantial
number of villages and the indigenous population in the province, it is highly possible that there
were more that were not reported. However, given the limited resources allotted to the province,
the group decided to recommend only the most strategically located facilities. The following
shows the CEmOC and BEmOC Cluster configuration:
CEmOC Facility: DEMOCRITO O. PLAZA MEMORIAL HOSPITAL (DOPMH)
Catchment Municipalities: Prosperidad, San Francisco, Rosario, San Luis, Talacogon, Bayugan,
Sibagat, Esperanza
Proposed BEmOC Facilities Catchment Travel Time/other
Justification
Azpetia BHS, Prosperidad 6 hard to reach barangays with Travel time to the CEmOC
IP communities of facility is 45 minutes.
Prosperidad:
Magsaysay , San Martin, San Travel time from the barangays
to the proposed BHS BEmOC
Lorenzo, Libertad , Mabuhay,
ranges from 30 minutes to 1
Salimbogaon hour.
The barangays are hard to reach
because of the difficult terrain
and irregular transportation
schedule. A motorcycle is the
only mode of transportation
available.
Its remoteness sometimes makes
the catchment vulnerable to peace
& order disruptions.
This BHS BEmOC will serve a
population of 9,078.
Sta Irene BHS, Prosperidad 4 barangays of Prosperidad, 3 Travel time from Sta. Irene
of which are hard to reach:La BHS to CEmOC Facility is 45
Purisima, San Jose, San minutes.
Joaquin, La Perian
Travel time from the barangays
to proposed BHS BEmOC: 15
minutes to 3 hours; La Purisima
is the farthest barangay.
The proposed BEmOC BHS is
accessible since it is located
along the highway. It serves a
population of 9,379.
Proposed BEmOC Facilities Catchment Travel Time/other
Justification
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Lucena BHS, Prosperidad 7 barangays of Prosperidad, 5 of The CEmOC facility is just 40
which are hard to reach: San minutes away from the BHS
Pedro, Napo, Aurora, San Roque, BEmOC.
La Union,San Vicent, San Rafael
From the barangays, travel tine
to the proposed BEmOC BHS
is from 30 minutes to 2 hours,
with San Roque being the farthest
barangay.
This proposed BEmOC BHS is
very accessible to transport
facilities and serves a population
of 13,358.
Lapinigan BHS, San Francisco 5 barangays of San Francisco: Travel time from the barangays
Mati,Caimpogan, Buenasuerte, to the proposed BHS BEmOC
Pasta, Ormaca is about 15 minutes to 1 hour
with Pasta as the nearest and Mati
and Buenasarte as the farthest.
The catchment area is
characterized by rough road (with
only the national highway being
cemented), rolling terrain and
muddy portions that can be
reached only by motorcycle.
Mati registered 1 maternal death
this year.
The BHS is a Sentrong Sigla
Level 1 accredited and serves a
population of around 8,000, 30%
of which are IPs.
Rosario Rural Health Unit 11 barangays of Rosario Travel time to the RHU from
the farthest barangay is 1 hour.
The municipality has a
population of 32,000, of which
60% are considered
indigenous people.
The RHU has a birthing home
attached to it.
Proposed BEmOC Facilities Catchment Travel Time/other
Justification
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Marfil BHS, Rosario Remote barangays of Rosario Travel time to the BHS is 1
hour.
Serves an indigenous population
of 2,400.
The catchment barangays are
located in a hilly area along the
boundary with Surigao Sur.
The remoteness of the area made
the LGU decide to construct a
birthing facility.
Laminga BHS, San Luis 4 barangays of San Luis: San The proposed BHS BEmOC
Pedro, Baylo,Coalicion,Laminga could be reached 8 hours of
hiking the trail from the
farthest sitio.
The area is prone to flash
flooding during the rainy season.
The BEmOC will serve a total
population of 7,261, 90% of
which are IPs.
Talacogon Rural Health Unit 3 barangays of Talacogon: Travel time to the CEmOC
Labnig, Sabang, Gibong and the facility is 1 hour by jeepney
whole Poblacion area. Roads are cemented in the
Poblacion.
Sabang and Gibong are “river
barangays” and the main mode of
transport is pumpboat. The travel
time to the proposed BEmOC
facility is 2 to 3 hours.
This proposed BEmOC facility
will serve a population of 26,800
and is MCP accredited
Zillovia BHS, Talacogon Zillovia, Talacogon and Travel time to this proposed
barangays along the BEmOC BHS is 1 hour.
boundaries with San Luis
The area is characterized by
rough roads and is prone to
flooding.
This proposed BEmOC BHS
serves a population of 13,000 and
is MCP accredited
Proposed BEmOC Facilities Catchment Travel Time/other
Justification
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Bayugan Rural Health Unit 18 barangays of Bayugan within The 18 barangays with an
the Poblacion area and outlying estimated population of 46,000
barangays: Taglatawan, Bucac, would gain access to the facility
Fili, JCA, Hamogaway, Osmena, within 30 minutes.
Noli, Maygatasan, Pinagalaan,
Mahayag, Sto. Nino, Mabuhay, Travel is on an all weather road,
Tagubay, Cortez, Del Carmen, with rough patches and
Sta. Irene, Panaytay and mountainous terrain.
Canayugan
Grace Estate BHS, Bayugan 6 barangays of Bayugan: Travel time from the farthest
Magkiangkang, Mt. Olive, Mt. barangay would take 30
Carmel, Villa Undayon, New minutes.
Salem and Getsemane.
Serves an estimated population of
10,000.
Berceba BHS, Bayugan 3 barangays of Bayugan: Travel time from the farthest
Calaital, Mt. Ararat and San Juan barangay is within 30 minutes.
Serves an estimated population of
6,775.
Magsaysay BHS, Sibagat 6 barangays of Sibagat: San Travel time from the barangays
Isidro, Sta Cruz, del Rosario, Sta to the proposed BEmOC BHS
Maria, Magcalape, Villangit ranges from 30 minutes to 1
hour.
The area is generally
mountainous.
Padiay BHS, Sibagat 3 barangays of Sibagat: Travel time from the barangays to
Banagbanag, Perez, Kulambugan the proposed BEmOC BHS
ranges from 30 minutes to 1 hour.
The terrain is generally
mountainous.
Guadalupe BHS, Esperanza 5 barangays of Esperanza Travel time from the 5
barangays to the Poblacion
could take 1 to 2 hours.
Travel is on an all weather road
with rough patches.
Salug BHS, Esperanza 3 barangays of Esperanza Salug is a mountainous barangay
where access is dependent on the
weather. When the weather is
good, travel time could take 1
hour. On bad weather, it could
take the whole day to reach the
Poblacion.
Balobo BHS, Esperanza 4 barangays of Esperanza The BHS will serve
mountainous barangays.
Travel time to the Poblacion
could take 1 to 3 hours.
CEmOC Facility: LA PAZ MUNICIPAL HOSPITAL (LPMH)
Catchment Municipalities: La Paz, Talacogon and Loreto
Travel time from LPMH to DOPMH: 2 – 3 hours.
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Travel Time /other
Proposed BEmOC Catchment Justifications
Facilities
Loreto Municipal Hospital Loreto The area is virtually isolated from
the rest of the province by
mountains and rivers.
Transportation is difficult.
Thus, upgrading the hospital to
BEmOC standard is considered
by the health officers as very
necessary.
San Vicente BHS, Loreto 5 barangays of Loreto: Sta Travel time from the barangays
Teresa, San Mariano, San Isidro, to the BHS ranges from 35
Sto Nino, Johnson minutes to 1 hour.
Roads to the barangays are rough
and can be accessed only by a
motorcycle.
Binucayan BHS, Loreto 5 barangays of Loreto: Generally mountainous and can
Kauswagan, Sabud, Mabuhay, be reached only by motorcycle
Bugdangan, Ferdinand with a travel time that ranges
from 1 ½ - 3 hours to the
Poblacion.
The BHS serves a population of
75% indigenous people, some of
whom are displaced by armed
conflict.
Langasian BHS, La Paz 2 brgys of La Paz: Angeles & Travel time to the Poblacion is
Bataan 1 to 2 hours using the following
5 sitios: Minangkig, Madga, modes of transport: motorcycle
Manguingi, Pinamuyanan and Ipil (which has a very irregular
schedule), outboard motor, dug
canoe or bamboo raft.
This BHS will serve a population
of 95% indigenous people. Sitio
Manguingi registered a maternal
death in 2006.
Comota BHS, La Paz 2 brgys of La Paz :San Patricio & Travel time to the Poblacion is
Lydia 1 to 2 hours using the following
6 sitios: Libon, Manguicao, Leyo, mode of transport: motorcycle,
Balitos, Asuncion & Magbuya which has a very irregular
schedule, outboard motor, dug
canoe or bamboo raft.
This BHS will serve a population
of 95% indigenous people.
CEmOC Facility: BUNAWAN DISTRICT HOSPITAL
Catchment Municipalities: Bunawan, Trento, Sta Josefa and Veruela
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Travel Time /other
Proposed BEmOC Catchments Justifications
Facilities
San Marcos BHS, Bunawan Barangay Mambalili, Mambalili is a remote
Bunawan barangay that could be
accessed from the Poblacion
either by a 2-hour pumpboat
ride or 1hour motorcycle
ride during the dry season.
The community is a river
barangay, with flood prone
areas and rough roads.
This proposed BEmOC BHS
will serve a population of
1,049.
Nueva Era BHS, Bunawan Sitio Mandayao part of Is a river barangay, with flood
Poblacion (Tabuk), Bunawan prone areas and rough roads
accessible only by
motorcycle”. Travel time
from the Poblacion is 1½
hour.
This proposed BEmOC BHS
will serve a population of 722.
Sta Maria BHS, Trento 5 barangays of Trento: San Will serve interior barangays
Roque, San Isidro, Cebolin, with rough roads that can be
Pangyan, Salvacion accessed only by motorcycle.
Travel time ranges from 1
hour to 2 ½ hours.
This proposed BHS BEmOC
serves a population of
8,252.
Trento RHU is MCP accredited
Sta Josefa Rural Health Unit 9 barangays of Sta Josefa: Travel time is 30 to 45 minutes
Tapaz, Aurora, Patrocenio,Sta. from the farthest barangay.
Isabel,- Angas, San Jose,
Concepcion,, Awao, Sayon Located in the Poblacion and is
accessible to all barangays in the
municipality.
Travel Time /other
Proposed BEmOC Catchments Justifications
Facilities
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Veruela Rural Health Unit 3 barangays of Veruela: San Travel time from the
Gabriel, Magsaysay, La catchments to the BEmOC
Fortuna and some barangays facility: 1 to 2 hours
of Talacogon
La Fortuna BHS, Veruela 3 remote barangays of Travel time to the BHS from
Veruela: Bacay II, Don Mateo, the barangays: 2 to 3 hours.
Caigangan
This proposed BHS BEmOC
will serve remote interior
barangays that are prone to
flooding.
LESSONS LEARNED
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The Facility Mapping Exercises conducted in the F1 sites generate the following
important lessons which should prove useful as the activity is rolled out to other
provinces:
1. Parochial concerns eventually give way to the greater good of establishing a
cost-effective provincial facility network. The initial tendency of most MHO
participants is to lobby for the designation of their RHU as a potential BEmOC, as
this would result in the RHU being a recipient of grants for upgrading. However,
after the intervention model and its objectives have been fully explained to them,
such parochial objectives eventually take a backseat to the higher goal of
identifying strategically-located BEmOCs to comprise the provincial facility
network. This shift in outlook is facilitated when the PHO exercises leadership
during the deliberations and is seen to be adept at handling the touchy task of
explaining to the political hierarchy (especially the municipal mayors) the
resulting deployment of grant funds across municipalities.
2. Flexibility is key. While a major objective of the exercise is to advocate for the
adoption of the DOH strategy for addressing maternal mortality and while the
choice of facilities that would receive DOH grants is to be guided by a set of
objective criteria, it is important not to be too prescriptive in implementation. It is
helpful to keep in mind that the model will only be effective if it responds to the
needs of the local population and that its effectiveness rests on a deployment that
adapts well to the local situation and melds seamlessly into the local health
system. Adopting such an attitude eases acceptance of the model and lays the
foundation for eventual ownership over it by those tasked with the challenge of
frontline implementation.
3. Timing is important. Although most workshop participants initially viewed the
activity with reluctance, they eventually came around to appreciate the activity as
one that offers them an effective tool for objectively allocating their resources and
for amicably settling conflicting claims over these resources. However, the
universal lament is that why such an activity, which logically should precede an
investment planning process, is introduced at such a late stage in the process.
Hopefully, this would be remedied in the succeeding roll-out provinces.
4. Consider the political context. The workshop discussions emphasize that
nothing much can happen at the local level without involving the local chief
executive in the loop. Public health is no exception. It is unfortunate that the
mapping activity coincided with the national elections (another lesson learned on
scheduling). The takeover of new incumbents made it difficult for some MHOs to
commit (most did commit after consulting with their LCEs). The elections also
sometimes led to an escalation of armed conflict, especially in remote barangays.
This made some MHOs reluctant to propose BEmOCs in areas where the political
situation remained unstable.
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5. Be sensitive to the capability and will of frontline providers. Some MHOs are
aggressive in ensuring that their constituents have easy access to BEmOC
facilities, while others are reluctant to take on the responsibility of having to
supervise these facilities, especially if the facilities in question are remotely
located. An issue of common concern is the legal liability the MHO assumes
whenever the midwife attends to a facility birth. The concern understandably
becomes serious enough when the facility is remote and hard to supervise that it
acts as a constraint to proposing the facility for BEmOC upgrading even if
technical considerations require that it to be so upgraded. There are times when
the wishes of the local chief executive (who is the MHO’s employer) figures into
the decision matrix. All of these factors need to be identified and discussed in the
process of navigating towards a group decision.
6. However, do not underestimate their (MHOs) willingness to collaborate and
help each other out. The discussions on the issue of supervising remote facilities
has revealed a deep sense of camaraderie among frontline health workers in a
province. They are usually ready to pitch in to assist an MHO in a neighboring
municipality. Many appear willing to contribute their time to help fill in the staff
time needed to keep a neighboring RHU BEmOC operational on a 24-hour basis
(the model requires a doctor to be always available on call). Of note is an
instance during one of the provincial workshops when an MHO volunteered to
help supervise deliveries in a BHS that was proposed for upgrading to a BEmOC
when the MHO who had jurisdiction expressed reluctance to travel to it at night
because of the remoteness of the facility and the uncertain peace and order
situation in the area. Sometimes all it takes is for the facilitator to try to maintain
an environment that encourages a free and open discussion of these issues for
such collaborative solutions to emerge.
7. Enlist the active involvement of the Center for Health Development (CHD).
The CHD staff is usually familiar with the territory and the people. This
knowledge becomes invaluable during issue-resolution sessions, especially if the
regional representative is someone the participants look up to. Besides, they will
inevitably become involved when the time comes to ramp up coverage. One
should therefore try to keep them in the loop from the start.
NEXT STEPS
118
The next activity should focus on generating the inputs that F1 provinces need to update
their Provincial Investments Plans in accordance with the results of the Facility Mapping
Exercise. This could expeditiously be accomplished by using the Integrated Needs
Assessment Tool which was developed and field tested in WHSMP2 sites. The tool
seeks to determine what each facility needs to upgrade services to either BEmOC or
CEmOC standard by first taking stock of current resources and capabilities and then
comparing these with the requirements of the service delivery model. The Needs
Assessment Exercise is envisioned to generate the following outputs:
o A strategy for human resource development and training
o Needed infrastructure improvement
o A list of equipment and drugs that need to be procured
o Systems that need to be developed to enhance financial sustainability
o Recording mechanisms that need to be put in place to allow progress
monitoring
From these, one could generate inputs to the PIPH that are focused on enhancing the
capability of the provincial service delivery network to address the maternal mortality
situation of the province.
References
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De Brouwere V, Tonglet R, Van Lerberghe W. Strategies for reducing maternal mortality in developing
countries: what can we learn from the history of the industrialized West? Tropical Medicine and
International Health, Vol. 3 No. 10 pp. 778-782, October 1998.
Tucker J, Florey CdV, Howie P, Mellwaine G and Hall MH. Is antenatal care apportioned according to
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De Brouwere, et. al.
Oona M R Campbell, Wendy J Graham, on behalf of The Lancet Maternal Survival Series steering group.
Strategies for reducing maternal mortality: getting on with what works. Lancet 2006;368: 1284-99.
Reducing maternal mortality. A joint statement by WHO/UNFPA/UNICEF/World Bank. Geneva, World
Health Organization, 1999.
Making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO/ICM/FIGO.
Making Pregnancy Safer,Department of Reproductive Health and Research. Geneva. World Health
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National Statistics Office. National Demographic and Health Survey, 2003.
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