Chapter 4.2 Expanding and Equalizing Access to Quality Family Planning Services

A major strategy to reduce unintended fertility and improve reproductive health is to increase and equalize access while continuously improving the quality of reproductive health services. Quality improvement has several components, including making available a wide range of family planning methods and eliminating some medical barriers. This entails training outreach workers who can provide information and resupply contraceptives to clients. Ano ther component consists of mainstreaming national family planning (NFP) by training health providers, establishing referral systems with a network of community-based NFP-NGOs, upgrading facilities and equipment in the health clinics, and institutionalizing counseling in these facilities.

Consistent with the access and quality objectives of the population program, the Department of Health (DOH) has launched Sentrong Sigla (Box 4), a nationwide movement in partnership with local government units (LGUs). This movement is part of the larger Health Sector Reform Agenda of the DOH. The movement integrates all DOH efforts into one initiative with a common goal: quality health.

BOX 4

Sentrong Sigla: Towards Quality Health

A health initiative is proving effective by harnessing the help of local government units (LGUs). This is the Sentrong Sigla Movement, a nationwide project of the Department of Health (DOH) in partnership with LGUs. Sentrong Sigla, roughly translated as Center of Vitality, integrates all DOH efforts into a concept with one goal: quality health. It devolves health services through the active participation of all sectors of society in institutionalizing health systems and good health practices. In short, Sentrong Sigla ensures quality health in the hands of the people. The main part of the movement is the certification and recognition program that develops and promotes standards for government health facilities. The facility will be certified with the yellow sun logo once it meets quality standards. In this facility, people who drop by can expect the health providers to consciously look for ways to improve, maintain and sustain the quality of services. The movement aims to foster better and more effective collaboration between the DOH and the LGUs, with the DOH providing technical and financial assistance packages for health care and the LGU directly carrying out the health programs and developing health systems. In order to be certified and provided with a Sentrong Sigla seal, a health facility should conduct a self-assessment based on the standards disseminated by the DOH. The facility should request for an assessment visit from the regional health office (RHO). The RHO endorses a list of qualified facilities to the DOH central office, which will then send a gradation team. The DOH provides a certification if the facility meets the standard. The first Sentrong Sigla Awards were handed out in December 1999 in Manila. Another program that addresses people's unequal access to health service owing to physical and financial barriers is the Health Sector Reform Agenda. The basic principles of the agenda are: w Quality assurance for health services to include reproductive health/family planning (RH/FP) to ensure a high level of standard for service delivery. This can be achieved through strengthening of the accreditation, licensing and regulatory functions of the DOH. All standards and concepts of Sentrong Sigla will be applied on all aspects of the RH/FP implementation. w Health operations reforms to include empowering the people to identify their health problems and needs and be part of providing solutions. This will be the central principle in health operations and program reforms. Reforms will include strengthening preventive strategies, corporatization of hospitals and reestablishing the district health system. w Health care financing as an idea to lessen out-of-pocket expenditure and increase the share of the national and local governments in providing health care services through health insurance and community health care financing.

Meanwhile, the provision of reliable, balanced and accurate information to clients remains important. High discontinuation rate of family planning users has plagued the program for many years. Two of the often-cited reasons for this high rate, according to a number of surveys and qualitative studies, are health reasons, such as fear of side effects (perceived or real), and husband's lack of support.

To address these problems, among other ways, service providers have been trained in tackling side-effect issues when counseling clients and in improving client-provider interaction. They help clients distinguish normal side effects from symptoms that constitute warning signs. Clients who understand that some side effects are normal and temporary are less inclined to drop out immediately. Before a counseling session is over, the provider now makes it a point to advise clients when to come back, and makes sure that he or she is technically prepared for the return visits.

Studies have shown that family planning counseling is virtually non-existent in RHUs and BHS facilities throughout the country.⁷⁰ This shortcoming is due to lack of resources for regular refresher skills training for health providers and congestion from a very high client-personnel ratio in the facilities mentioned.

In response, local efforts have started in the last five years to assess and improve the quality of care in selected LGU facilities, such as those in Nueva Vizcaya, Davao del Norte, and Compostela Valley. The intervention consisted of training providers in improved information giving and identifying women with unmet need for family planning to determine the order of priorities for service delivery.

The pilot project in Nueva Vizcaya lasted for three years, long enough to allow assessment of the impact of the intervention. Seeing the positive results of the experiment, the provincial health office raised the scale of the projects throughout the province. At this stage, plans for replication throughout the region are under way.⁷¹

Government provision, however, is not enough. Private sector initiatives are needed to sustain such a project. In this regard, The Friendly Care Foundation Inc. (FCFI) was recently established to provide high-quality, easily accessible and affordable health care services, including reproductive health and family planning services to middle and lower middle-income families nationwide. The FCFI now operates clinics in Masinag, Antipolo and Shaw Boulevard, Mandaluyong City. It plans to open clinics in the cities of Davao and Cebu. Its clinics provide comprehensive family health and reproductive health services in a humane, compassionate and friendly manner.

There are paying clients, however, who still do not have access to affordable contraceptives. To address this concern, policy reforms are being made to lift restrictions on the entry of low-cost imports of contraceptives and maintain sufficiently low tariff rates on these items.

The initiatives of the government and some private organizations in increasing access and improving the quality of reproductive health services have drawn support from official donors. The United Nations Population Fund (UNFPA), for example, is now into its Fifth Country Program (CP) of Assistance on Reproductive Health (RH) and National Advocacy for Population and RH. The activities of the Fifth CP for the period 2000-2004 are continuations of efforts started in the Fourth CP cycle, 1994-1999. (Box 5)

In addition, the POPCOM-executed subprogram on National Advocacy for Population and RH intends to formulate common guidelines on advocacy for RH and rights, male involvement in RH, adolescent and youth concerns, gender equality and women's empowerment to be carried out nationally and locally. It also aims to increase the support for population and RH activities among various influential groups such as policymakers, administrators, religious leaders, community leaders, media producers and practitioners, among others. The resources for this subprogram come from the UNFPA (US$1.38 million) and the government (P11.10 million pesos, also largely non-cash). (See also Box 6)

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