A team of four staff members from the Philippine Society for Responsible Parenthood, Inc. or PSRP SRH Watch and BTTS projects conducted monitoring visits to selected facilities in Eastern Samar from June 13 to 17, 2023. The team members were: Omar Emmanuel Sto. Niño, the Monitoring and Evaluation Consultant for SRH Watch; Mary Ann Lanuza, the Monitoring and Evaluation Assistant for SRH Watch; Reuben James Ilagan, the BTTS Assistant; and Warren Bajado, the Local Area Coordinator for Eastern Samar. The purpose of the visits was to evaluate the implementation of the SRH Watch and BTTS systems in the region.
The team selected the visited sites based on their review of the BTTS Web Application at these facilities. They assessed the performance of the sites in terms of data entry, data quality, data synchronization, and stock management. The sites visited included Salcedo RHU, Mercedes RHU, Quinapondan RHU, San Julian RHU, Borongan CHO I, Borongan CHO II, and Llorente RHU. These sites were prioritized for monitoring and evaluation because they had either high or low-performance indicators or had issues or concerns that needed to be addressed.
During the monitoring visits, the following agenda/topics were discussed:
SRH Watch
A demonstration of the features and functions of the SRH Watch.Info website, which provides various data and information on maternal health and family planning in the province, was conducted. The demonstration showed how to access and view the maternal mortality, Family Planning (FP) data, and the BTTS stock status, stockouts, and overstock on the site without logging into the web application. It was also emphasized that the Eastern Samar Provincial Health Office (PHO) requested the province-wide implementation of SRH Watch and BTTS in August 2022 to enable timely analysis for planning and decision-making regarding maternal health issues. Some visited Local Government Units (LGUs), such as Mercedes RHU, Borongan CHO I, Llorente RHU, and Salcedo RHU, experienced delays in submitting FP data for May 2023 due to the Supplemental Immunization Activities (SIA) conducted by the Department of Health (DOH) the previous month. A discussion with the PHN/FP focal person at Salcedo RHU on the importance of submitting their FP data on or before the 5th day of the following month, as required by the system, was conducted. The PHN/FP focal person at Salcedo RHU explained that this requirement could not be complied with due to the need to validate/verify the data. Instead, a commitment to submit their FP data every 15th day of the following month was made by the PHN/FP focal person at Salcedo RHU.
Barcode Track and Trace System (BTTS)
Several challenges that hindered the full implementation of the BTTS were observed during the monitoring and re-training activities. These challenges involved technical, logistical, and operational aspects of the system. Some of the challenges included: difficulties in installing the ODK BTTS on certain mobile devices due to compatibility issues faced by midwives; issues related to internet connectivity that affected the synchronization of data; lack of awareness about the offline functionality of the mobile app that allowed data entry without an internet connection; concerns regarding the assignment of client’s family serial numbers that were used to identify and track FP clients; instances of over-issuance and failure to use the mobile app for issuing FP commodities, which resulted in inaccurate data and inventory. Borongan CHO I had no buffer stock of FP commodities in their office after distributing all their stocks to their BHSs.
Implementation of IUD and PSI FP Modern Family Planning Methods
The implementation of IUD and PSI FP modern family planning methods faced some challenges in the province, as reported by some CHOs/RHUs. Four facilities, namely Mercedes RHU, San Julian RHU, Borongan CHO I, and Borongan CHO II encountered difficulties in providing training for their staff on these methods. This was due to the retirement of previously trained personnel. In addition, Borongan CHO II also lacked the necessary equipment to perform IUD insertion and removal. These factors resulted in the inability to offer these specific family planning methods to their clients.
RHUs with Local Procurement of FP Commodities
Some RHUs in the province have resorted to local procurement of FP commodities to ensure adequate supply and availability for their clients. For example, Salcedo RHU purchased COC pills, DMPA injectables, and condoms from local suppliers, while Llorente RHU bought COC pills and DMPA injectables for their respective facilities. These RHUs used their own funds to procure the FP commodities, as they did not receive a sufficient allocation from the national level.
BTTS Retraining Activities
Not all facility staff members were proficient in using the Web and Mobile Applications of the BTTS during the monitoring visits, as noticed. However, key personnel, including Public Health Nurses (PHNs) and Nurse Deployment Program (NDP) staff, had received the necessary training. A focused walkthrough of the Web and Mobile Applications was conducted during the re-orientation session, highlighting the importance of tasks expected from all implementers in the contraceptive supply pipeline. Specific instructions were also provided, such as inputting zero for contraceptives that are not in stock, and setting the expiration dates. The facilities were instructed to enter the actual inventory of FP commodities using the mobile app and their commitment to do so the day after the training was obtained. Moreover, the CHOs/RHUs were encouraged to use the BTTS mobile app for all future transactions involving the receipt and issuance of FP commodities.
The strengths and weaknesses of the implementation of SRH Watch and BTTS systems in Eastern Samar were revealed by the monitoring visits. Several challenges that affected the performance of the systems, such as BTTS installation, training, internet connectivity, and commodity management, were identified. These challenges need to be resolved to ensure the smooth and effective operation of the systems. Based on the findings, some recommendations for improvement were suggested, such as targeted training sessions for staff who need to refresh their skills or learn new features, enhanced technical support for device compatibility to ensure that all devices can run the mobile app, increased awareness of the offline functionality of the mobile app to enable data entry without internet connection, and establishing adequate buffer stocks of FP commodities at all facilities to prevent stockouts and overstock.
Further proactive interventions to address these challenges and improve the SRH Watch and BTTS systems’ contribution to maternal health issues in Eastern Samar were recommended. These interventions may include regular monitoring and feedback, coordination and collaboration with relevant stakeholders, advocacy and communication activities, and resource mobilization and allocation.
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Video created by Norvin Bonifacio