Overall, the health of women and children in the Philippines has improved with substantial
reductions in maternal and child mortality observed during the 1990s. However, since this time
the rate of decline has slowed. The maternal mortality ratio (MMR) has decreased little in
recent years with the most recent estimate at 162 deaths per 100,000 live deliveries in 2006.
Under-5 mortality in 2008 was estimated at 34 deaths per 1000 live deliveries. The current
slow rate of decline in child mortality is mainly attributed to the large number of deaths during
neonatal and post-neonatal periods. At the current rate of decline, the Philippines is unlikely
to meet the MDG (Millennium Development Goal) of reducing the MMR to 52 deaths per
100,000 live deliveries and the under-5 mortality rate to 27 deaths per 1000 live deliveries.
There is large disparity across the country in both maternal, neonatal and child health (MNCH)
outcomes and in the coverage of critical interventions. Poverty, lack of education, difficult
terrain and indigenous ethnicity are generally associated with poor MNCH health outcomes
and service utilisation. The rapid growth of cities has led to significant urban poverty
presenting specific challenges to improving access and utilisation of health services and
improved MNCH outcomes among these populations.
MNCH is considered by the national Department of Health (DOH) to be a priority area for
action. Recognising the need to achieve more rapid improvements in this area, the DOH
recently adopted the Integrated Maternal, Neonatal and Child Health and Nutrition (MNCHN)
Strategy. The MNCHN Strategy calls for coordinated actions at each life stage with the end goal
of rapidly reducing maternal and child mortality and attaining the MDGs. It operates on the
approach jointly recommended in 1999 by the WHO, UNFPA, UNICEF and World Bank of
setting the maternal and child health interventions on a wider perspective that incorporates a
spectrum of critical services. The integrated MNCHN Strategy aims to target the worst
performing and most vulnerable areas to support more rapid improvements among these
populations.
The Philippine public health system operates within a devolved system. The national
government, through the DOH and its regional offices, the Centres for Health Development
(CHD), is the lead national agency for health. The DOH is responsible for the development and
implementation of national policies and plans, regulations, standards and guidelines on health,
as well as the innovation of strategies in national health facilities and sub-national health
facilities. Provincial governments and their component municipal and city governments are
the main implementers of health programmes and chief mobilisers of local providers of health
services.
Existing gaps and inequities in the delivery and utilisation of health services, as well as
persisting weaknesses in the health system, have contributed to the slow rate of improvement
in health. The Philippine government, through the Department of Health, has responded to the
existing situation by launching a reform strategy for health. This strategy aims to achieve
better health outcomes, a more responsive health system and more equitable health
financing, in line with its commitment to the National Objectives for Health (NOH) and the
MDGs. Since the launching of health reform in the late 1990s, the DOH has led the sector in
addressing priority areas of health concern including health care financing, regulation, service
delivery and governance, as defined in the national health reform policy– the FOURmula ONE
for Health, or F1. Province-wide and city-wide reform programmes are the main vehicles of F1
implementation. A key component of this is the development by each province and
independent city of a 5-year Province-wide or City-wide Investment Plan for Health
Investment Case MDGs 4 & 5 – Country Mapping Report – Philippines xi
(PIPH/CIPH). However, there is a recognised need to strengthen the capacity of these local
government units (LGUs) to develop effective and efficient plans and budgets that respond to
identified health priorities.
This mapping report represents Phase 1 of the Investment Case in the Philippines. It provides
a comprehensive overview of policy and planning documents that constitute the framework
for MNCH delivery, datasets available for analysis and key analytical work within the
Philippines relevant to MDGs 4 and 5.
The mapping exercise identified published reports describing inequities in MNCH outcomes
and intervention coverage across national wealth quintiles and regions. However, the extent
of inequity within sub-national units and trends over time will require further analysis. Data
sets and existing analytical work have been identified describing the status of MNCH in the
Philippines at both the national and sub-national level, the MNCH strategies that are currently
in place and the extent of their coverage. Local evidence describing health system,
demographic, economic and other factors that facilitate or impede the delivery and utilisation
and expansion of key MNCH interventions have also been identified. However, there are some
limitations in the analyses available and several areas where data are lacking. Estimates of
maternal and child mortality from civil registry and facility-based data are not adjusted to
account for under coverage and underreporting bias. As under coverage and underreporting
may vary across sub-national units, a reliable picture of sub-national differences from official
data is not available. More importantly, analysis of the causes of maternal, neonatal and child
deaths at the national and sub-national level is sparse. There are no firm estimates of the
amount of resources allocated towards MDG 4 and 5. Available estimates from existing studies
are highly aggregated and the estimation methodologies used suggest potential under and
over estimation of these resources. Private sector spending on MNCH services has also not
been accounted for in available studies. The mapping exercise identified that, while the
situational analyses undertaken by LGUs in the context of provincial planning and monitoring
can be a rich source of data regarding system constraints and priority areas, there is some
scope for improvement in the way these analyses and health outcome reviews are conducted.
The information gathered from the mapping exercise has been used to guide the strategic
direction of the project and will be used to inform the analysis in Phase 2 of the project. As a
result of the mapping exercise undertaken during Phase 1 of the project, recommendations for
Phase 2 activities in the Philippines are as follows:
? Perform a comprehensive equity analysis to analyse trends amongst the different
disadvantaged groups over time and in terms of specific interventions;
? Perform a scaling-up analysis in selected LGUs and at the national level.
These sub-national activities will bring together the evidence for system constraints, strategies
for scale up and the associated costs. This will enable the development of a MNCH sub-plan for
each participating LGU to be incorporated into their broader health planning activities. This
can be used by the LGU to access additional financial resources for MNCH from the national
level. Completion of a national Investment Case aims to support the ongoing availability of
resources for MNCH at the national level and enable prioritisation and efficient allocation of
these resources.
These recommendations are consistent with the project approach that aims to ‘add value’ to
existing in-country work. To ensure that the project delivers the most relevant information to
governments to inform their planning and budgeting for MNCH interventions, activities during
Phase 2 will also involve ongoing consultation with state governments, UNICEF and other
development partners.