SRH Watch Surveillance Model

The conduct of Maternal Death Review has been identified as one of the main provision of the Responsible Parenthood and Reproductive Health Law [10354] Implementing Rules and Regulation. Under RULE 14 – Section 14.01 Maternal Death Review and Fetal and Infant Death Review. All LGUs, national and local government hospitals, and other public health units including private health facilities within the SDN is mandated to conduct an annual Maternal Death Review (MDR) and Fetal and Infant Death Review (FIDR), in accordance with the guidelines set by the DOH in consultation with the stakeholders. Such review should result in an evidence-based programming and budgeting process that would contribute to the development of more responsive reproductive health services to promote women’s health and safe motherhood. The Team shall be composed of at least seven (7) members, including the PHO or CHO as the head. Members of the Team shall include but not be limited to the following:

• Selected Municipal and/or City Health Officers;
• Staff from selected health facilities under the management of the province or city;
• Private practitioners or ‘representatives from the local chapters of relevant specialty societies;
• One (1) CEmONC doctor from a CEmONC-capable facility;
• One (1) BEmONC doctor from a BEmONC-capable facility;
• Technical staff from the DOH Center for Health Development (CHD)

The design of the Annual Maternal Death Review shall focus on identifying the systemic gaps, clinical factors, and the institutional issues that contributed to the reported deaths, examples of which include, but are not limited to issues and concerns on human resources, blood services, emergency transportation arrangements, accessibility to health facilities, and availability of life-saving drugs.

Disruptions to health systems, displacement and breakdowns in societal protection and social structures during emergencies often results to increased Sexual and reproductive health (SRH) needs. Pregnancies, complications, risk of STI and HIV transmission and the wish to access contraceptives do not stop when an emergency strikes. In addition, the risks of unsafe abortions, unsafe deliveries and sexual- and gender-based violence can worsen during times of crisis and exacerbate the existing vulnerability of women, girls, marginalized and underserved groups. To mitigate these risks, access to quality SRH care in emergencies is essential. The MISP includes the SRH services that are most important in preventing morbidity and mortality while protecting the right to life with dignity in humanitarian settings. It is one of the chapters of the Inter-Agency Field Manual (IAFM) on Reproductive Health in Humanitarian Settings, the authoritative source for global guidance on addressing SRH in emergencies. several evaluations on MISP implementation showed that essential SRH services are still not consistently implemented. Greater efforts are needed to ensure availability of SRH care for all during emergencies and this includes strengthening preparedness efforts. [2]

The MISP Readiness Assessment was International Planned Parenthood Federation in collaboration with Inter-Agency Working Group on Reproductive Health in Crises and United Nations Population Fund, 2020. It includes sets of questions that can be used to assess the preparedness in the provision of MISP services during emergencies at the national, sub-national and implementation level. It will be interesting to consider monitoring the preparedness of pilot areas along the suggested parameters/ indicators as part of the SRH surveillance.

Source: MISP Readiness Assessment, 2020

PROPOSED APPROACH/ TA PLAN IN ESTABLISHING THE SRH WATCH SURVEILLANCE MODEL IN THE SELECTED REGIONS AND PROVINCES

1. Development of the SRH Surveillance System Design (i.e. Finalization of the indicators to be included in the surveillance system)
2. Prepare TA plan to assist the regions on how they can provide support/ assistance along the implementation of the SRH high impact strategies in the LGU pilot sites.
3. Presentation and consultation with the Regional Partners
4. Identification of the LGU pilot areas to be included in the SRH surveillance. This shall also include mapping of the health service facilities specifically those situated in the vulnerable/ high risks areas where support is most needed. (e.g. areas with high maternal morbidities and mortalities; high unmet needs for modern family planning; GIDA areas)
5. Courtesy call to the LGUs to get their “buy in” of the project
6. Engagement and orientation of potential pilot implementation partners at the local level (i.e. Provincial/ City LGUs and Municipal LGUs) on the SRH Surveillance Model
7. Installation of the SRH surveillance system and capacity building
8. Documentation on the results of SRH surveillance (monthly/ quarterly)
9. Conduct of monthly/ quarterly SRH surveillance monitoring meeting together with LGU stakeholder and regional partners (this will depend on discussion/ agreement of the project team); operational challenges identified; proposed interventions/ resolution for action
10. Final documentation of key findings during the surveillance, analysis, and proposed policy recommendations.

PROPOSED LIST OF INDICATORS FOR THE SRH WATCH SURVEILLANCE SYSTEM

FAMILY PLANNING INDICATORS:

1. Number of New Acceptors of Modern Family Planning Methods – Refers to the number of women/individuals who accepted a modern FP method for the first time (never accepted MFP methods) Note: If possible can we measure this parameter at all primary care level facilities (BHS, RHUs, District level hospital and the Provincial hospital), and tertiary care level facilities?
   • New acceptors of modern FP methods provided in Regular Public Health Facilities – Refers to the number of new acceptors who were provided modern FP method through routine activities of the health facility. These maybe walk—in clients who came for the FP services.
   • New acceptors of modern FP methods through Outreach Missions – Refers to the number of women/individuals who accepted a modern FP method for the first time (never accepted MFP methods) through outreach activities — where FP services are brought to the people or communities especially in hard to reach areas by the itinerant teams. This may include in-reach activities – where clients in the health facility who perhaps came in for other health reasons (i.e. parents with their babies scheduled for immunization, WRA/individuals visiting for check-up, etc.) are gathered in a place where they can access FP information and services.
     • May want to include an indicator on the Number of Outreach Missions conducted by the facility
     • Also an indicator on the number of itinerant teams doing outreach missions
   • New acceptors of modern FP methods through Post Partum FP – Refers to the number of women of reproductive age who just recently gave birth/delivered (within 42 days or 6 weeks) in a health facility and has never accepted any modern FP method. With the intervention from the. FP service providers, these post-partum women eventually accepted a modern FP method.
     • Facility based deliveries
     • Community based pregnancy tracking (one of the strategies under PPFP)
   • Number of Current mFP Users
   • Number of mFP Drop outs
   • Number of facilities reporting stock outs of FP supplies

MATERNAL HEALTH INDICATOR

• Number of Maternal Deaths – Refers to the number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.

References:

National Family Planning costed Implementation Plan [Technical Report 2021-2022]

RMNCAHN Strategic Framework, DOH/ DPCB, 2021

MISP Readiness Assessment, International Planned Parenthood Federation in collaboration with Inter-Agency Working Group on Reproductive Health in Crises and United Nations Population Fund, 2020. https://fp2030.org/sites/default/files/ready_to_save_lives/MISP_readiness_assessment.pdf

[1] RMNCAHN Framework developed by the DOH RMNCAHN Technical Working Group in 2021

[2] MISP Readiness Assessment, International Planned Parenthood Federation in collaboration with Inter-Agency Working Group on Reproductive Health in Crises and United Nations Population Fund, 2020. https://fp2030.org/sites/default/files/ready_to_save_lives/MISP_readiness_assessment.pdfwat