Saturday, July 16, 2016
Philippines - Some good news on motherhood
BY THE time you read this, I will be in Copenhagen, Denmark, to attend the Fourth Women Deliver Conference, a global gathering that focuses on the role of women in advancing the health agenda.
As the conference title suggests, women “deliver” not just because they literally and physically deliver babies, but also because, when their energies, genius, and voices are recognized, respected and harnessed, they deliver as well health services and policies for the greater good.
In the Philippines, women indeed deliver health for all. The vast majority of health workers, the grassroots, frontline service providers, many of them volunteers, are women. As health workers, they are also community organizers, community builders, conduits to officials at the town center, trusted confidants, and sources of information and counsel.
In the health centers, the people in charge are mostly women—midwives and nurses—while many of the doctors who have eschewed high-salaried professional posts in the cities are women as well.
As a side story, one municipal official once told me that about the first thing officials like him do when a woman doctor who is single is assigned to the town’s health center is to go hunting for a possible groom for her. “That way, we are sure that she will stay long in the town and build roots here,” he declared. And he claimed that such a matrimonial strategy has had a number of success stories.
MATERNAL health and survival have become a focus of the Department of Health, and by extension the national government, said Dr. Jondi Flavier, executive director of the Philippine Center for Population and Development.
In a Facebook post shared by the hosts of the radio program “Magandang Gabi, Dok” (Good Evening, Doc), Flavier, who was a program guest, discussed the efforts of the DOH to more purposively address the problem.
And it is a major problem. Despite developments elsewhere in the world, where maternal mortality rates have fallen, in the Philippines the MMR increased from 162 in 2006 to 221 in 2011, reversing a downward trend. This is why the country failed to meet its Millennium Development Goal of bringing down the rate of maternal deaths to 52.
Part of the effort to bring down the number of maternal deaths, said Flavier, was the construction of health stations in barangays or villages countrywide, usually on the grounds of the local public school. These health stations make it possible for schoolchildren and for pregnant mothers to come for regular and prenatal checkups.
Also part of the maternal health approach is the Maternity Package offered by PhilHealth, said Flavier, that provides to members four free prenatal checkups, blood work, immunization, delivery services and postnatal care, as well as neonatal screening.
Significantly, the radio interview was carried out during “Safe Motherhood Week,” which is observed in the second week of May, providing a bit of refreshing good news on the largely dismaying landscape of maternal health in these islands.
ALSO good news, as mentioned by Flavier, is the policy of universal health coverage under the state-run PhilHealth (a keystone of the campaign platform of presumptive senator Risa Hontiveros, by the way).
Under the P-Noy administration, PhilHealth aggressively expanded its coverage, such that it now provides health insurance for 80 percent of Filipinos. This, said observers, was made possible with resources derived from the so-called “sin taxes.” The expanded PhilHealth coverage translated to better services for mothers, because the influx of funds, said a study of the Ateneo Center for Health Evidence, Action and Leadership (A-HEALS), served to “motivate skilled birth attendants (midwives, mainly) to do antenatal checkups, bring their patients to the birthing facilities, and follow up with postpartum care.”
But first, mothers have to be convinced to visit the health centers or stations. This is where, I think, the 4Ps (for Pantawid Pamilyang Pilipino Program), the government’s title for the conditional cash transfer program, has played an important role.
Part of the “conditionalities” of the 4Ps, which means “Bridging the Filipino Family,” is that school-age children be brought for regular health checkups (including immunization) to health centers, while pregnant mothers pay at least four visits for their regular checkups. At the same time, beneficiary families (but mostly mothers) are expected to attend the monthly “family development” sessions, where, among other topics, family health and maternal health (including family planning) are discussed.
Targeting poor families with young children, the 4Ps doubtless played a big role in convincing parents that it pays to look after the health of the whole family. The cash transfers may have eased the situation of the most desperate parents, but it also gave them a cushion of security to prioritize health in their hierarchy of needs.
PART of the economic agenda of the incoming Duterte administration, we are told, is “expanding” the 4Ps (or whatever name they choose to call it). I have yet to read details of how this expansion is to be achieved, but I hope it is not to put it under the purview of local or national officials, who doubtless see it as a highly effective political tool and who had been chafing because they had no hand in its implementation or access to its funds.
But the 4Ps succeeded mainly because P-Noy chose to keep a “hands off” policy with regard to it, allowing the policies to be dictated by nothing but the common good. I hope someone in the Duterte camp, if not the presumptive President himself, protects the 4Ps from exploitation and corruption.