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Pangasinan Province:Contraceptive Self-Reliance
ExperiencePhilippines
&Excellence
Innovation InfluencePATHWAYS TO
RESULTS
Author
Luzviminda N. Muego
33rd Annual International Conference on Global Health
May 30-June 2, 2006Omni Shoreham Hotel, Washington D.C., U.S.A.
Local Enhancement and Development (LEAD) for Health Project
Management Sciences for Health
October 2003 – September 2006
Funded by USAID
p a n g a s i n a n
Population – 2.5 Million
Land Area – 5,300 sq. km.
Census 2000 PGR – 1.90 (2.36 Phil)
p a n g a s i n a n
Family Planning Program
1991 Local Government Code
Under Local Autonomy: Re-instituted
Population and Family Planning Program
The province’s population program built its capacity for a Management Information System (MIS)
Since the 1970’s, relied on USAID assistance (providing 80% of nation’s contraceptives)
p a n g a s i n a n
Census & DemographicHealth Surveys:1995 and 2001
0.0
0.5
1.0
1.5
2.0
2.5
1970 1980 1990 2000
Census Year
Po
p G
row
th R
ate
Source: NSO, NTSCB
Population Growth Rate
p a n g a s i n a n
35.0
36.0
37.0
38.0
1995 2001
DHS Survey Year
Rat
e o
f C
urr
ent
Use
rs
Source: Pangasinan DHS
Current Users, 38.00%
Non Users, 37.00%
With Unmet Need, 25.00%
Source: Pangasinan DHS
Current FP Users
Census & DemographicHealth Surveys:1995 and 2001
p a n g a s i n a n
The Context of CSR
25% 100%100%
70%
85%
30%
65%
0
30%
0 0
0
10
20
30
40
50
60
70
80
90
100
Per
cen
t Red
uct
ion
o
f Co
mm
od
ity A
ssis
tan
ce
2004 2005 2006 2007 2008Commodity Assistance Year
Pills
Injectable
Source: DOH-AO: 158, 2004
High Unmet Need for
Family Planning Services
USAID Phase
Down Plan
for donated
commodities
in place
p a n g a s i n a n
Contraceptive Self-Reliance
“The ability to forecast, finance, procure and deliver good-quality and reliable
contraceptives to
all men and women
who need them…
when they need them.”
CSRProcesses
p a n g a s i n a n
Major Challenges to CSR:Political & Socio-cultural
National & local governments’ weak policy and political will to sustain population & family planning program.
Local governments have limited resources and no policy & budget for contraceptives procurement.
Political sensitivity of FP targeted service. Distribution system gives free access to poor
(62%) and non-poor (38%).
p a n g a s i n a n
Major Challenges to CSR:Operational Barriers
Highly dependent on the public sector for FP Services (86%)
As program front-liners, LGUs capacity,competence and preparedness for CSR
is low
Minimal participation byprivate sector in
FP service delivery (14%)
p a n g a s i n a n
Pangasinan CSR VISION
“Sustainable and Quality Family Planning Program in Pangasinan”
p a n g a s i n a n
CSR “Road Map”
Policies & systems for transition in-place at the LGUs
2004
Participation of the private sector in FP market
2005
FP services operational at facility level
2006
Funding & processes institutionalized
2007
Pangasinan: CSR PROVINCE
2008
Goal: To promote LGU’s ability to sustain the provision of good quality and affordable FP services and commodities
Expected Outcomes
p a n g a s i n a n
Initiating the CSR Strategy
Political Will & Leadership by the Governor Issued legal basis for CSR Set policy agenda for
reforms Allocated funds for CSR
implementation Institutionalize all the reforms
Achieve CommoditySelf Reliance
Encourage PrivateSector Participation
Segment FPMarket
StrengthenNatural FP
Reduce UnmetNeed for FP
p a n g a s i n a n
Phases of CSR Implementation
Organizing the CSR
Implementation Structures
Social Preparation of
Implementers & Stakeholders
CSR Performance
Capacity Building,
formulation & adoption of policy
p a n g a s i n a n
CSR Performance: Results
Policy approval and adoption by LGUs
Commodity supply ensured during the Transition Period 2004 - 2008.
Provincial Logistics Management Information System in place.
29 out of 47 LGUs with contraceptives budget and procurement system in-place.
p a n g a s i n a n
CSR Performance:Results
731,760
750,000 2,405,397
1,600,000
2,685,500
3,000,000
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
Am
ou
nt
Ap
pro
pri
atet
d
2004 2005 2006
Budget Year
Province
LGUs
Increasing budgetary allocations for commodities by the province and LGUs
p a n g a s i n a n
CSR Performance: Results
Increasing contraceptives procurement
0
0.5
1
1.5
2
2.5
3
Am
oun
t A
ppr
opri
ated
(m
illio
ns)
2004 2005 2006
Budget Year
Province
Towns
p a n g a s i n a n
CSR Performance: Results
Mobilizing Private Sector Participation
Commercial Sector - Increasing volume of contraceptive sales
Capability building for private providers -
More midwives being trained as providers and entrepreneurs
2456,699
35,556
0
5000
10000
15000
20000
25000
30000
35000
40000
2003 2004 2005
132,502106,874
81,806
0
20000
40000
60000
80000
100000
120000
140000
2003 2004 2005
Injectables Sales (vials)
Pills Sales (cycles)
p a n g a s i n a n
CSR Performance: Results
Market Segmentation for FP targeted services
Client ClassificationAt the Public Sector Health
Facility
Living Standard Survey For ranking households
Groundwork forClient segmentation
Towards FPMarket
Transformation
• Enhanced Information Generation
- Willingness to pay- Facility Mapping- Private Sector
Mapping
p a n g a s i n a n
CSR Performance: Results
Service delivery strategies in place to reduce FP Unmet Need
Tool to identify married women with unmet need for FP in-place and functional
Client referral system in public & private facilities and providers
Outreach support for client generation intensified
p a n g a s i n a n
CSR Performance Results:Moving Forward
Replication of CSR Strategies Province-wide
20032003 9 LGUs 9 LGUs
20042004 24 LGUs24 LGUs20052005 45 LGUs45 LGUs
20062006 47 LGUs 47 LGUs
p a n g a s i n a n
Partnership Works for CSR Initiative
“…we commend you in looking at the issue of reduced donor contraceptive commodity support in the broader perspective by working towards CONTRACEPTIVE SELF-RELIANCE.”
From a letter to Gov. Victor E. Agbayani, USAID-Philippines
Dec 2002
p a n g a s i n a n
Partnership Works for CSR
Champions for Self-Reliance in Local Governance for the LGUs
Corporate Social Responsibility in Private Sector
The general population, Contraceptive Social Responsibility
p a n g a s i n a n
THANK YOU!
For more information…
Provincial Population Office2/F Kalantiao Bldg., Capitol ComplexLingayen, PangasinanPhilippines
Tel/Fax: (+6375) 542.6349Email: [email protected]