Providing family planning, adolescent reproductive health services in Zamboanga del Sur
2nd of 3 parts
THE health system of Zamboanga del Sur (ZDS) has a strong family planning (FP) program, adolescent and youth-friendly health services (AYFHS), as well as a maternal and newborn program that functioned efficiently, even during the 14-month Covid-19 lockdown. The robustness of these programs can be attributed to the Integrated Provincial Health Office’s (IPHO) dynamic collaboration with the Department of Health (DoH) Center for Health Development (CHD) Region 9 (Zamboanga Peninsula), Commission on Population (PopCom) Region 9, Provincial Population Office (PPO) and with ReachHealth of RTI International, a USAid (United States Agency for International Development) Office for Health’s implementing partner whose project in 11 Philippine regions has been operating since 2018 and will end in 2024.
ReachHealth aims to strengthen and improve Filipino families’ access to critical health services by reducing the unmet need for family planning services, decreasing the teen pregnancy rate, and improving newborn morbidity and mortality, particularly among the marginalized and underserved.
Building the FP capacity of health providers (HPs) from all rural health units (RHUs), city health centers (CHCs), public hospitals and private practicing midwives’ lying-in clinics, conducting FP outreach activities in geographical isolated and disadvantaged areas (GIDAs), revitalizing the AYFHS in RHUs and CHCs, and extending FP services in a workplace are the main strategies of the foregoing partners in providing quality FP and adolescent health services. My column last Sunday focused on the FP training of 500 HPs from public and private facilities to highlight the capacitybuilding processes that enabled HPs to extend quality FP services to their clients.
I inadvertently failed to include in last week’s column that ReachHealth has introduced the enhanced usapan (conversation), i.e., the “carefully structured process for a facilitated group discussion on FP and maternal health care,” to improve the HPs’ demand generation skills. This activity is conducted by the HPs with clients of varying FP needs, prior to the one-on-one counseling, and the provision of FP methods. Aside from this tool, the HPs were trained to administer the client satisfaction survey questionnaire after the provision of FP services.
The DoH CHD also trained the HPs about its FP Data Reporting Electronic Tool for the Field Health Service Information System (FHSIS) of data recording, consolidation and reporting. This technology has hastened monitoring of FP performance including data quality check. To track the distribution (including stock out) of the FP commodities, and to provide a platform for the HPs to discuss issues and challenges and obtain suggestions for service provision improvements, a social media chat group was created by the IPHO provincial FP coordinator.
This Sunday’s column briefly presents the partners’ FP mobile outreach activities in GIDAs.
Aside from the comprehensive FP training that the HPs must go through before they are allowed to provide quality FP services, they are also reaching out to the marginalized and underserved population, risking their lives and limbs to ensure that no one is left behind from obtaining quality FP and other health services.
FP outreach activities to GIDAs
As mentioned in last week’s column, ZDS has several Subanen Indigenous People and some Moro cultural communities who live in faraway mountainous hinterlands or on isolated islands.
Poverty, difficult and distant terrains, as well as high transportation costs, are the major factors that hinder these ethnic groups from accessing health services, including FP. To address these difficulties, the IPHO and its partners decided to sustain the FP mobile outreach services to GIDAs, a strategy that was started by MindanaoHealth of Jhpiego, the previous (2013-2018) USAid implementing partner in 19 Mindanao provinces. Roxanne Alvarez, the provincial population officer for the past 10 years, recalled that the foregoing implementing partner has conducted FP outreach activities in some GIDAs in ZDS.
A core group of nurses comprised the current FP mobile outreach team, particularly the IPHO’s FP coordinator (Zefanie SiyLuy), the PPO (Roxanne Alvarez) and ReachHealth’s provincial technical officer (Mary Grace Espina). Agnes Nazareno, who used to be a public health midwife and is currently the proprietor of the Mom’s Birthing and Family Planning Clinic, recently joined the core group’s mobile outreach team. The outreach team collaborates with the RHUs’ FP teams in scheduling and extending FP outreach services. The outreach schedule must be observed faithfully by the partners because it would be difficult to inform FP clients from far-flung areas about timetable changes since the latter have no mobile phones or access to the internet. I learned that during the FP month of August, outreach activities are conducted almost every day, and this spills over to September because there are several GIDAs in ZDS.
The partners share the costs of conducting the mobile outreach activities. ReachHealth provides transportation, meals and FP educational and training materials, while the LGU (local government unit) partners take care of the FP commodities, the needed health equipment and medicine for some clients who have symptomatic illnesses like fever, cough and colds. According to Zefanie SiyLuy, the outreach team always brings food not only for the team members, but also for FP clients who hail from distant communities, and who have no provisions while obtaining FP services. In one of the team’s outreach activities, Zefanie vividly recalled a persistent foul smell, akin to a dead animal in the area where FP clients were gathered. A young Subanen mother disclosed that she and her daughter had no meal before they left their home in the mountains. They were so hungry after walking for several hours, and when they found a dead cat along the way, they skinned, cooked and ate its meat. This unfortunate incident provided a vital lesson to the outreach team that it is important to bring extra provisions because it would be difficult to extend FP services to hungry underserved FP clients.
Some GIDAs can be reached by land transportation or by pump boats. In these areas, the FP clients from some sitios (cluster of households in dispersed rural villages) are asked to go to a designated place like the barangay (village) health station or barangay hall, where FP services are provided from 9 a.m. until 2 p.m. Usapan and one-on-one counseling are conducted prior to the provision of FP services. For security reasons, the outreach team must leave these areas after they extend FP services. The barangay health station midwife or nurse reportedly follows up with the clients who obtained FP services from the outreach team.
Some GIDAs with several potential FP clients are too far, and it is more efficient for the outreach team to go to these sites. Charisse Angeli Imperial, Labangan municipality’s RHU FP
coordinator, shared that in a distant mountainous sitio, the outreach team members must sleep in one of the barangay houses the night before, so that they could start walking toward the sitio early the following morning. It takes about five to six hours of trekking to reach this place at 9 a.m. The barangay head usually lends a horse to help carry the outreach team’s materials through a hanging bridge and two rivers (which are shallow in the summer) to reach the place.
“Pwerting layu-a, unya mag-abut na ang imong tuhod ug naong pagsaka sa bukid, murag diyes na lang, langit na lang (It is very far, your knees can almost touch your face when you climb the mountain, like you pay 10 centavos, and you are already in heaven).” The sitio people are always grateful and welcoming, and they provide the team with their traditional food.
Leaving this mountainous sitio is often tiring and uneventful. But in one outreach activity, the team members experienced heavy rain, flash flood, landslide and mudslide on their way out of the sitio. Somehow, no one was hurt from this catastrophe.
To sustain the FP mobile outreach services to GIDAs, I learned that the 26 RHUs are now divided into six clusters (a cluster has four or five RHUs). Each cluster has an FP outreach team that plans the schedule and the HPs who will join the scheduled activities. They will also share their vehicles and other related costs. The IPHO and its partners will continue to extend technical assistance and other forms of support to these clusters’ FP outreach teams.
My last column will focus on the AYFHS in RHUs and FP in a workplace.
To be continued on Sunday, Feb. 26, 2023.