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Philippines
>> Regional Overview >> Philippines Overview ACTIVITY DATA SHEET
PROGRAM: Philippines
TITLE AND NUMBER: Reduced Fertility Rate and Improved Maternal and Child Health, 492-003
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $17,865,000 DA; $4,500,000 CSD
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $15,000,000 DA; $9,800,000 CSD; $2,000,000 ESF
INITIAL OBLIGATION: FY 1994 ESTIMATED COMPLETION DATE: FY 2004Summary: The 2000 census for the Philippines showed that the population growth rate has remained at 2.36%. At this rate, the Philippines' population will double by 2029. This demographic situation has grave consequences for economic growth, social welfare, and the environment. Because the population growth rate is largely fueled by high fertility, USAID will continue its focus on helping to reduce the fertility rate and improve maternal and child health.
Recent experience has shown that the central government health service delivery model has not produced the desired results. The 1998 Demographic and Health Survey and independent assessments of USAID's program confirmed a lack of progress and limited effectiveness. The focus of USAID's population program over the next five years will be on building the capacity of the private sector and local governments to deliver family planning and health services. In mid-1999, USAID helped establish the Friendly Care Foundation (FCFI), a private sector foundation that will provide financially sustainable, demand-driven family health and reproductive health services to lower-middle and middle-income groups-estimated to be more than two-thirds of the total population. The establishment of FCFI clinics will add to the growing network of midwife clinics under the highly innovative Well Family Midwife Clinic program.
USAID's public sector population and health activities, mainly implemented through its Local Government Performance Program (LPP), have been redirected toward the poorest sector of the population and concentrate on improving the quality of service delivery at the local level. Building on a Department of Health (DOH) reform initiative, USAID focuses on improving district health administration; local procurement and distribution of drugs; hospital management and fiscal autonomy; and an expanded and strengthened social insurance system. Both the public and private sector programs will provide accessible, high quality, affordable, and sustainable services to their clients.
These activities directly support the Agency's goal of stabilizing population growth and protecting human health, as well as the FY 2000-2002 U.S. Embassy's Mission Performance Plan goal of reducing the fertility rate from 4.1 in 1993 to 3.0 in 2004. Approximately 10.9 million women and two million children under age one are the direct beneficiaries of programs supported under this strategic objective.
Key Results: The Government of the Philippines' (GOP) commitment to making family planning (FP) and maternal and child health (MCH) services accessible to the population was never more apparent than in the past year. For the first time, the GOP included funding for contraceptives in the national budget. The GOP also issued an administrative order approving post-abortion care. The GOP launched the Health Sector Reform Agenda and developed a Food Fortification Strategy that is acknowledged by international experts as the first comprehensive strategy to be developed in Asia. The private sector's response to the urgent need for FP and MCH services was also laudable. A total of 57 clinics were added to the private sector network of health providers. These achievements, assisted by USAID-funded activities, were reflected in USAID's objective-level and intermediate results. The year 2000 showed steady progress in the performance of selected indicators. Compared to 1999 figures, the contraceptive prevalence rate for modern methods remained stable at 32%. High-risk births decreased dramatically from 55.7% to 39.8%. The percentage of fully immunized children increased from 64.5% to 65.2%. Tetanus toxoid coverage increased from 33.2% to 34.0%.
Performance and Prospects: The proposed FY 2001 obligation is $17.865 million Development Assistance (DA), and $4.5 million Child Survival and Disease (CSD). DA funds will allow USAID to strengthen the capacity of the public sector to provide quality and affordable FP and MCH services targeted at the poor, and support expansion of the private sector's share in the provision of FP and MCH services. Using CSD funds, USAID will implement activities in the following key child survival areas: acute respiratory infection, child immunization, oral rehydration therapy, and micronutrients (including Vitamin A supplementation and fortification). Because USAID is implementing an integrated FP and MCH program, both DA and CSD funds are used, when appropriate, to support most of the objective's activities.
Expanding the Private Sector: The FY 2001 planned obligation for this component is $5.06 million DA and $2.45 million CSD. USAID supports the expansion and improvement of private sector provision of reproductive health services to middle and lower income groups. USAID technical assistance and grants support an expanding network of 240 privately owned Well-Family Midwife Clinics and help support coordination and management mechanisms to maintain the brands, market and quality to ensure sustainability. The clinics provide quality FP and MCH services for a modest price to underserved communities in both urban and rural settings while, at the same time, the midwives, who have gained the skills and knowledge to become health entrepreneurs, have increased their personal incomes. In 2001, 190 clinics are expected to graduate from full dependence on USAID support and become paying clients of USAID-provided technical assistance. USAID also provides extensive technical assistance and operations support to FCFI, which aims to establish a network of low-cost, fee-for-service clinics in urban areas that provide a full array of family health services. This network has founded seven new clinics and is already attracting large numbers of clients for family planning services.
Strengthening the Public Sector: The FY 2001 planned obligation for this component is $9.81 million DA (including $3.0 million for contraceptives) and $1.4 million CSD. USAID is developing the capabilities of local governments to implement their FP/MCH interventions. This is particularly important in the Philippines, as health service delivery is one of the vital government functions that has been devolved to local government units. Through the LPP's base grant and matching grant programs, USAID provides technical assistance to provinces, municipalities and cities to plan and manage an integrated FP/MCH program. Participating provinces, municipalities and cities represent about 90% of the total population. LPP also supports public-private sector partnerships with selected local governments, leading to increasing DOH and local government funding as USAID funding drops. USAID also supports the Sentrong Sigla (Centers of Wellness) Program, a quality assurance program to improve health services at local health facilities. This program ensures that the country's public health facilities meet quality standards. Since its inception in 1998, the number of facilities certified as Sentrong Sigla has reached 1,000. Child survival interventions in 2002 are projected to result in further reductions in infant mortality rates and births in high-risk groups.
Creating the Enabling Environment for Provision of FP/MCH Services: The FY 2001 planned obligation for this component is $2.85 million DA and $650,000 CSD. USAID will continue to develop the enabling environment that is vital for successful implementation of FP and MCH programs for both the public and private sectors. USAID technical assistance to the Health Sector Reform Agenda, the flagship program of the DOH, is intended to correct inefficiencies and inequalities in the delivery and financing of health care and to improve the performance of the Philippine health sector. The focus of this assistance is to: 1) improve the benefit package by including outpatient benefits such as immunization, family planning services, TB treatment, and selected diagnostic services; 2) expand coverage with the ultimate goal of attaining universal coverage; and 3) increase the share of social health insurance as a percentage of total health spending. Because the poor shoulder most of their health costs out-of-pocket, this initiative will benefit them in particular. USAID is also assisting the GOP's Contraceptive Interdependence Initiative to phase in local health resources for oral contraceptives, and is working with the DOH toward self-reliance in FP service delivery. The DOH recently awarded a contract for procurement of contraceptives worth approximately $1.7 million. USAID will provide technical assistance for procurement, and for policy and legal changes to reduce reliance on government provided contraceptive commodities. In an environment where political support for family planning programs is uncertain, USAID will support advocacy efforts for greater government, private and public support for contraceptive commodities, and for policies that enhance population programs.
Possible Adjustments to Plans: As articulated in the USAID strategy approved in October 1999, adjustments will be made to integrate activities of the HIV/AIDS-ID special objective (592-007) and to further refine the program indicators. Future requests for funding for this objective will include HIV/AIDS and ID activities.
Other Donor Programs: While USAID remains the largest donor to the Philippines National Family Planning Program, other donors also made significant contributions. In 2000-2004, the United Nations Fund for Population Assistance will contribute about $30 million to strengthen public and private sector reproductive health at national and local government levels and through selected non-governmental organizations (NGOs). A combined World Bank and bilateral donor loan/grant program supports a five-year, $120 million Women's Health and Safe Motherhood program. The DOH, clearly signaling its support for family planning, increased the family planning service budget in 1998 by 50% over the 1997 allocation, and maintained an average annual increase of 30% to the year 2000, excluding the amount allocated for contraceptives.
Principal Contractors, Grantees, or Agencies: USAID implements activities through the DOH, the Philippine Commission on Population, local governments, and NGOs (U.S. private voluntary organizations and private commercial sector entities) involved in the Philippine National Family Planning Program. Major contractors include Management Sciences for Health; John Snow, Inc.; the Futures Group; the Population Council; Association for Voluntary Surgical Contraception (now Engender Health); Johns Hopkins University, and Macro International.
FY 2002 Performance Table
Philippines: 492-003
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Percent of children by 12 months of age who have been fully immunized. 89.8 65.3 64.5 65.2 67 69 71 Indicator 2: Percent of births in high-risk groups 56.2 57.0 55.7 39.8 55 54 53 Indicator 3: Percent of surviving children under 36 months of age who are protected at birth. 52.2 38 33.2 34 33 36 38 Indicator 4: Contraceptive prevalence rate (modern methods) 30.9 28.2 32.4 32 30 32 34 Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR Percent National Demographic and Health Survey; MCH Rider Survey to the Labor Force Survey Percent of infants, 12-23 months of age, who have been fully immunized by 12 months of age. "Fully immunized" means three injections for polio and DPT and one injection for both measles and BCG. This is a national rate. Indicator 2: IR Percent National Demographic and Health Survey (DHS); FP "Rider" to the Labor Force Survey Percent of births to women who are any of the following: 35 years or over, under age 18, who had a child in last two years, or who have had more than three children. This is a national rate. Indicator 3: IR Percent National Demographic and Health Survey; MCH "Rider" Survey to the Labor Force Survey The Department of Health definition for protected at birth are children whose mothers received at least 2 tetanus toxoid injections during pregnancy. This is a national estimate. Indicator 4: IR Percent National Demographic and Health Survey (DHS); FP "Rider" to the Labor Force Survey Proportion of married women of reproductive age (age 15-49) using a modern method of contraception (i.e., pills, IUD, injection, diaphragm/foam/jelly/cream, condom, female and male sterilization, mucus/billing/ovulation, temperature, LAM). This is a national rate. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 121,034 DA 89,074 DA 31,960 DA 4,782 CSD 4,782 CSD 0 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA 1,800 MAI 0 MAI 1,800 MAI 0 DCA 0 DCA 0 DCA Fiscal Year 2000 14,329 DA 21,385 DA 4,272 CSD 0 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA 0 MAI 71 MAI 0 DCA 0 DCA Through September 30, 2000 135,363 DA 110,459 DA 24,904 DA 9,054 CSD 4,782 CSD 4,272 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA 1,800 MAI 71 MAI 1,729 MAI 0 DCA 0 DCA 0 DCA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA 0 MAI 0 DCA Planned Fiscal Year 2001 NOA 17,865 DA 4,500 CSD 0 ESF 0 SEED 0 FSA 0 DFA 0 MAI 0 DCA Total Planned Fiscal Year 2001 17,865 DA 4,500 CSD 0 ESF 0 SEED 0 FSA 0 DFA 0 MAI 0 DCA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 15,000 DA 37,660 DA 205,888 DA 9,800 CSD 4,632 CSD 27,986 CSD 2,000 ESF 0 ESF 2,000 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA DFA 0 DFA 0 MAI MAI 1,800 MAI 0 DCA 0 DCA 0 DCA
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Last Updated on: May 29, 2002 |
