Contraceptive Self Reliance (CSR) Strategy
The Philippine Experience
YOLANDA E. OLIVEROS, MD, MPH
Director IV
National Center for Disease Prevention and Control,
Department of Health
33rd Annual International Conference on Global Health
May 30-June 2, 2006
Supported in part by USAID under the Local Enhancement and Development
(LEAD) for Health Project and Management Sciences for Health
Profile
Tropical country: 7,107 islands
Population: 84M
Annual Growth Rate: 2.32% (2003)
Urban = 47.6%
Rural = 52.4%
Total Fertility Rate: 3.5
children/woman
Total Contraceptive Prevalence
Rate: 49% (2003 NDHS)
Situation
Maternal Mortality Rate: 172/100,000 LB
Neonatal Mortality : 17/1,000 LB
Infant Deaths : 29/1,000 Live births
Under Five Mortality Rate: 40/1,000 LB
Need for Family Planning
Unmet Need for Family Planning:
17.3% of married women of reproductive age
(about 2 million)
9.4% wanted to limit
7.9% wanted to space pregnancies
1 in 6 pregnancies ends up in abortion
because they are unplanned or unwanted
Incidence of abortion rising from 320,000 to
400,000 annually
Policy Statements
All modern methods (artificial and natural
FP) will be provided to clients based on
informed choice
Family Planning is a health intervention
initiative by:
preventing high risk pregnancies
reducing maternal deaths
responding to unmet needs
General Principles: 4 Pillars of FP
Implementation of Family Planning
program shall abide by the following
principles:
Responsible Parenthood
Respect for Life
Birth Spacing
Informed Choice
Objective of FP Program
To address the need to help
couples and individuals achieve
their desired family size within
the context of responsible
parenthood and to improve their
reproductive health to attain
sustainable development
Program Strategies
Focus service delivery to the urban &
rural poor
Re-establish the FP Outreach Program
Strengthen FP provision in regions with
high unmet need
Promote frontline participation of
hospitals
Mainstream modern natural FP
Promote Contraceptive Self Reliance
Strategy
Background/Rationale for CSR
FP program dependence on
contraceptive donation for 30 years
Contraceptive Independence Initiative
(July 1999)
January 2000: unified plan formulated
November 2000: Contraceptive
Interdependence Initiative
2001: Contraceptive Self Reliance
(CSR)
Methodology
Policy Project conducted the Market
Segmentation to ascertain if the
clients who use FP commodities are
willing and able to pay
Findings:
60% are capable to buy their own supply
22% are getting supply from private
sector (13.2% are from low income
group)
Methodology
Phase down of donated contraceptive
supplies
Condom supply - April 2003
Pills and injectables - gradual phase
down from 2004 – 2008
Government Response: formulation
and implementation of a Contraceptive
Self Reliance (CSR) Strategy
Because basic health services in the
Philippines were devolved in 1991, the Phil.
Gov’t. response to CSR has been two fold:
At the national level:
formulation of the national policy and
implementing guidelines
coordination with Local Government Units
develop complementary means of financing
expands complementary privates sources
At Local Government Level:
Empower local government units
(LGUs) to meet the needs of the
poor while segmenting the market
with those who can afford to pay
and refer to the private sector
Administrative Order #158. s. 2004
The contraceptive donation phase down
process:
Batch 1 (accelerated phase): cities &
provinces with lowest poverty incidence
Batch 2 (longer phase-out period): LGUs
with higher rates of poverty incidence
Batch 3 (last, longest phase-out period):
LGUs with highest rates of poverty
incidence
DOH, MSH-LEAD, JSI & Project Deliver assisted
the roll-out of CSR Initiatives in the LGUs\
Series of orientation workshops on AO 158
Training on CSR logistics policy guidelines
formulation
Planning activities capacitating LGUs to
forecast, mobilize resources, procure and
deliver/distribute good quality, & affordable
contraceptive supplies
Results
Survey of 892 LGUs
Findings:
15% LGUs intend to fully cover the gap in
contraceptive requirements
58% of LGUs intend to partially cover the
gap
0.5% LGU opt the DOH commodity swap
scheme
26.5% LGUs w/o any plan of covering the
gap
Results
Financing options for contraceptives
identified during the CST strategic planning
activities:
Top 5 Financing Options
# of LGUs % to Total
1. Increase in budgetary allocation
183
88.0
2. Avail of PHIC capitation fund
174
83.7
3. Cost recovery scheme
129
62.0
4. Increase existing health fees /
imposed new health fees
122
58.7
5. Donation partnership with NGOs
98
47.1
TOTAL
208
Results
Procurement options of LGUs:
Top 5 Procurement Options
# of LGUs % to Total
1. Community-based drug outlet
108
51.0
2. Procurement thru PTIC
83
39.9
3. Regular procurement
75
36.1
4. Consignment
70
33.7
5. ILHZ pooled procurement
45
21.6
TOTAL
208
Conclusion
The success of the Philippines
Contraceptive Self Reliance Strategy
relies heavily on the synergy,
coordination & cooperation of the DOH,
the LGUs, donors, private sector/NGO
providers and media
The varied socio-economic conditions
and priorities of LGUs will influence the
options chosen by the LGU to
operationalize CSR.
Conclusion
There is still much to be done:
National level policies & services
that would enable LGUs to
succeed in CSR responses (e.g.
procurement guidelines, M & E of
LGUs responses to CSR, etc.)
Continuous advocacy effort
Strengthen community support
Conclusion
Commitment, systems & capacities
of provinces, cities and
municipalities as managers of local
FP services
Commitment, systems & capacities
of employers to facilitate FP
provision in the workplace
Private sector players replace
donated supply and expand
domestic market