2008 O - 59 - ESTABLISHING FACILITY-BASED DELIVERIES FOR ALL PREGNANT MOTHERS IN OLONGAPO CITY

EXCERPTS FROM THE MINUTES OF THE REGULAR SESSION OF THE SANGGUNIANG PANLUNGSOD OF OLONGAPO, HELD ON NOVEMBER 05, 2008 AT THE CITY HALL.

PRESENT:

Hon. Cynthia G. Cajudo - - - - City Vice-Mayor & Presiding Officer
Hon. Gina Gulanes-Perez - - - - - - - City Councilor
Hon. John Carlos G. Delos Reyes- - - - - - - “ “
Hon. Rodel S. Cerezo - - - - - - - - - - - - - - “ “
Hon. Sarah Lugerna Lipumano-Garcia- - - “ “
Hon. Edwin J. Piano - - - - - - - - - - - - - - “ “
Hon. Angelito W. Baloy - - - - - - - - - - - - “ “
Hon. Aquilino Y. Cortez, Jr.- - - - - - - - - “ “
Hon. Anselmo A. Aquino- - - - - - - - - - “ “
Hon. Elena C. Dabu- - - - - - - - - - - - - - “ “
Hon. Jonathan G. Manalo- - - - - - - - - - “ “
Hon. Carlito A. Baloy - - - - - - - - - President, Liga ng mga Barangay

ABSENT:

Hon. Cheenee F. Hoya- - - - - - - - SK Federation President

WHEREAS, every year, almost 500,000 lives are lost around the world due to maternity-related causes, 99% of such deaths occurring in developing countries and almost all of them preventable;

WHEREAS, in the Philippines, almost 4,600 women die giving birth each year translating into more than 10 mothers dying everyday, leaving more than 30 children motherless;

WHEREAS, the Philippine government reaffirmed its commitment to reduce maternal deaths and contribute to the achievement of Millennium Development Goals (MDG) in the recently concluded 2005 World Summit in New York participated in by President Gloria Macapagal-Arroyo;

WHEREAS, hemorrhage, hypertensive disorders during pregnancy and obstructed labor constitute the majority of complications relating to maternal fatalities. All of these problems are preventable and can be addressed through adequate medical care such as the presence of skilled birth attendants, emergency obstetric and newborn care (EmONC), and when necessary, access to family planning services;

WHEREAS, in an effort to reduce this burden, the Department of Health (DOH) adopted a new paradigm shift where each pregnancy is to be considered as “High Risk”;

WHEREAS, the DOH has further adopted a 3-pronged strategy to address the three delays associated with saving a woman’s life: (1) the decision when to seek care (knowledge on danger signs, empowered decision-making), (2) reaching the health facilities (expenses especially for communication/transportation, clinic or hospital services are of significant concern), and (3) receiving appropriate care in the facility (availability of gender and culture-sensitive doctors/health staff, adequate medicine supplies, blood and equipment);

WHEREAS, 6 out of 10 births in the Philippines take place at home making it crucial to follow a woman from prenatal to postnatal stage thus contributing to a high maternal mortality ratio (MMR) in the country. As MMR in the Philippines was 209 in the early 1990s, the target MMR for 2015 has been set at 52. In 1998, MMR fell from 209 to 172 but seems to have plateaud thereafter, stagnating at 162 in 2006. At this pace of reduction, by 2016 MMR will have only declined to 140 and the target of 52 will be unachievable;

WHEREAS, maternal deaths occur also in Olongapo City, thus suggesting the need to address the root causes of this problem and contribute to the attainment of MDG in 2015:

a) Olongapo City has annual population growth rate of 1.68% translated into more than 5,000 births yearly. The city population is growing steadily every year and every pregnant mother is at risk.

b) In 2006, two mothers have died and at present, three maternal deaths have been reported in just the first quarter;

WHEREAS, steadfast on its duties and commitment to uphold and protect the lives of its constituents, the City of Olongapo deems it necessary and appropriate to adopt and establish measures to reduce and finally eliminate maternal deaths in the city.

NOW, THEREFORE, on motion of Councilor Angelito W. Baloy, with the unanimous accord of the Members of the Sangguniang Panlungsod present,

RESOLVED, AS IT IS HEREBY RESOLVED, by the Sangguniang Panlungsod in session duly assembled, to enact the following Ordinance:

ORDINANCE NO. 59
(Series of 2008)

AN ORDINANCE ESTABLISHING FACILITY-BASED DELIVERIES FOR ALL PREGNANT MOTHERS IN OLONGAPO CITY

BE IT ORDAINED, BY THE SANGGUNIANG PANLUNGSOD IN SESSION ASSEMBLED, THAT:

SECTION 1. TITLE – This Ordinance shall be known as the Basic Emergency Obstetric and Newborn Care (BEmONC) Ordinance of Olongapo City.

SECTION 2. DECLARATION OF POLICY – The City Government of Olongapo shall adopt measures to uphold and protect the lives of its constituents in line with its pursuit of sustainable human development that values human dignity and offers full protection to women and their unborn babies.

Consistent with these principles, the City Government of Olongapo shall guarantee access to information and education, and universal access to safe, affordable and quality basic emergency obstetric and newborn care (BEmONC) for pregnant mothers.

SECTION 3. OBJECTIVES

a) Provide the high risk pregnant mothers with adequate and affordable basic emergency obstetric and newborn care.
b) Ensure that all pregnant mothers are encouraged to access the health facilities during deliveries.
c) Enhance accurate information dissemination and education on the value of preventing maternal deaths.
d) Elicit the support of the barangay officials through the passage of barangay resolutions encouraging all pregnant mothers in their respective areas to access and take advantage of health facilities for safe deliveries.

SECTION 4. DEFINITION OF TERMS - For purposes of this ordinance, the following terms shall be defined as follows:

1. Maternal Mortality Ratio (MMR) - is the number of maternal deaths during a given time period per 100,000 live births. It measures the risk of death once a woman has become pregnant.
2. Maternal Death - is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
3. BEmONC - is defined as Basic Emergency Obstetric And Newborn Care provided to pregnant mothers during deliveries.

SECTION 5. ROLE AND FUNCTIONS OF THE CITY HEALTH OFFICE (CHO)

1. The City Health Office (CHO) will be the lead agency in the implementation of this ordinance and ensure that systems, programs and services are available at all times.
2. The CHO in collaboration with other stakeholders will serve as the central advisory, planning and policy-making body with the City Mayor as Chairperson.
3. Recommend the enactment of legislation to support this program and adopt measures to reduce maternal deaths in the city.

SECTION 6. PROTOCOLS ON THE EXECUTION OF THE MATERNAL HEALTH PROGRAM

1. Approaches for Measuring Maternal Mortality
 Routine Maternal Death Reporting
 Community death reporting c/o Women's Health Teams
 Facility death reporting c/o BEmONC and CEmONC Teams

2. Periodic Maternal Death Review
 Quarterly/Yearly Review

3. Improve women’s health and ensure safe pregnancy and childbirth
 Capability or means of entry into the health care system
 Presence / “obtainability” of the product or service
 Increase access for the poor and disadvantaged
 Provide services as one single package to:
 Avoid duplication of services
 Optimize resources
 Improve service delivery and utilization

4. Maternal Care Paradigm Shift

5. Understanding the Implication of the “Shift”

At the Individual Level:

Every mother will have access to skilled care during pregnancy

 Skilled attendants: midwife, nurse, doctor
 Emergency treatment for all complications during pregnancy, childbirth and after birth
 Post-partum family planning
 Basic neonatal care

At the Service Level:

A transition to a more appropriate distribution of childbirths along the continuum of care

 More childbirths in basic emergency obstetric and newborn care (BEmONC) facilities
 More emergency referrals to intermediate level facilities comprehensive emergency obstetric and newborn care (CEmONC)
 Fewer childbirths at home and at higher levels

6. Ensuring Success of the “Shift”

7. Establishing the Women’s Health Teams

Rationale:
 To ensure that all pregnant women in the community, particularly the poor and disadvantaged, are adequately served
 To lead the effort in convincing mothers to shift from home birth to facility birth

FUNCTIONS OF THE WHT:
1. To track every pregnancy in the community.
2. To assist in accomplishing the birth plan.
3. To provide quality maternal care, family planning, STI prevention and HIV control and adolescent and youth health services appropriate at community level.
4. To make accurate recordings.
5. To provide good counseling and information dissemination services.
6. To refer clients appropriately.
7. To report maternal death.
8. To discuss relevant women’s issues with the community.

SECTION 7. APPROPRIATIONS – Recognizing the program gaps, the City Government of Olongapo shall appropriate funds for the following:

1. There shall be funds for the upgrading of health centers to become BEmONC facilities
2. There shall be funds for equipment and supplies in the delivery of EmONC services
3. There shall be funds for intensive information drive on this program concern

On the other hand, mechanisms to implement and enhance financial sustainability is also encouraged.

1. Attain financial Self-Sufficiency through:

 Identification of the poor
 Revenue generation
 Collection of user fees
 PhilHealth accreditation and reimbursements
 Social marketing arrangements with drug companies and contraceptive suppliers
 Others

2. Implement uniform and affordable charges:

For Philhealth Cardholders – Free of charge ( reimbursement of PHP4,500 per patient by Philhealth)

For Non-Philhealth Members but are not classified as Indigents - A corresponding fee of PHP4,500 will also be charged

For Indigents – A corresponding PHP1,500 will be billed to cover supplies and medicines used during the delivery

SECTION 8. SOURCE OF FUND – The budget for this ordinance shall be taken from the 5% of the GAD Fund of the Annual Appropriations of the City Government. The budget will focus on the upgrading of health centers in the total amount of PHP1.5 Million/year.

SECTION 9. SEPARABILITY CLAUSE – If any part, section, or provision of this ordinance is declared invalid or unconstitutional, other provisions not affected thereby shall remain in full force and effect.

SECTION 10. EFFECTIVITY – This Ordinance shall take effect upon approval.

APPROVED UNANIMOUSLY, November 05, 2008.

CYNTHIA G. CAJUDO
City Vice-Mayor & Presiding Officer

GINA GULANES-PEREZ JOHN CARLOS G. DELOS REYES
City Councilor City Councilor

RODEL S. CEREZO SARAH LUGERNA LIPUMANO-GARCIA
City Councilor City Councilor

EDWIN J. PIANO ANGELITO W. BALOY
City Councilor City Councilor

AQUILINO Y. CORTEZ, JR ANSELMO A. AQUINO
City Councilor City Councilor

ELENA C. DABU JONATHAN G. MANALO
City Councilor City Councilor

CARLITO A. BALOY CHEENEE F. HOYA
President, Liga ng mga Barangay SK Federation President
(Absent)


ATTEST:

ELFLIDA S. SALMON
Council Secretary


APPROVED BY HIS HONOR, THE CITY MAYOR ON______________________.


JAMES GORDON, JR.
City Mayor

ATTEST:

DELFIN A. JUICO, JR.
Secretary to the City Mayor