According to FP2020, the modern contraceptive prevalence rate was 23.5% for all women and, according to the World Bank, the maternal mortality rate was 136 per 100,000 live births in the Philippines in 2013 when the VisayasHealth program began. The program partnered with the Philippines Department of Health and its local government units to increase demand for and improve the delivery of services and to strengthen health system support for the national FP and MNCHN programs.
Drawing on EngenderHealth’s SEED Model, VisayasHealth used an integrated approach to address barriers to FP services associated with supply, demand, and the enabling environment. To address demand, we engaged satisfied FP users to act as community-based educators and dispel myths and misconceptions and we supported community health workers and conducted community events (special FP days) to generate interest in FP and provide information, services, and (as necessary) referrals to health facilities. To address supply-side barriers, we trained providers and strengthened community and facility service provision. For instance, we developed and introduced a cost-effective, blended-learning, clinical training methodology—the Self-Learning Instructional Materials with Practicum (SLIM-P) to improve availability of intrauterine device (IUD) services. Incorporating self-instructional materials that participants could complete independently not only reduced training costs, it also allowed participants to spend less time away from their facilities, thereby reducing the impact on ongoing service provision. This approach demonstrated success—with all evaluated trainees achieving competency in line with established proficiency standards. A key component to the program’s enabling environment efforts involved working with the National Health Insurance Program (PhilHealth) to develop an accreditation and certification program to enable certified providers and accredited facilities to be reimbursed for FP services.
By mobilizing 9,415 community health educators and providers (including 1,845 satisfied FP users) and facilitating 282 special FP days, we facilitated a 264% increase in people receiving FP information—from 238,508 in 2013 to 868,309 in 2018. On the supply side, we trained 30 master trainers in long-acting and permanent method service delivery (namely, implants, IUDs, and sterilizations) and strengthened the capacity of 1,129 FP providers—532 of whom were certified by the Department of Health to claim reimbursements for care from PhilHealth. By the end of the project, all 513 supported facilities were able to offer FP counseling and services (a notable increase from 235 at project start), 420 of which were able to a full range of FP methods. We similarly strengthened ambulatory/itinerant services to complement facility-based care through trainings and coordination support; these services alone provided long-acting and permanent methods to 147,471 clients. Overall, we contributed to a significant increase in couple years’ protection—from 136,550 in 2013 to 1,334,820 in 2018. Lastly, as a result of our coordination with PhilHealth and the success of our training activities, the number of FP insurance claims filed in the region increased dramatically—from 1,998 in 2014 to 10,481 in 2017.