NATIONAL SAFE MOTHERHOOD accountability using proven and

PROGRAM innovative approaches.

The Situation of Maternal and Newborn Objectives:

Care in the Philippines
The Program contributes to the national goal
• The Philippines registered a Maternal of improving women’s health and well-being
Mortality Rate (MMR). (National by:
Demographic Health Survey, 1998).
1. Establishing core knowledge base and
o 180 per 100,000 in 1995
support systems that facilitate the
o 172 per 100,000 in 1998
delivery of quality maternal and
newborn health services in the
country.
THE LEADING CAUSE OF MATERNAL
2. Collaborating with LGU in establishing
DEATHS: (1998 NDHS)
sustainable, cost-effective approach
• Postpartum hemorrhage of delivering health services that
• Hypertensive complications ensure access of disadvantaged
• Sepsis women to acceptable and high quality
• Obstructed Labor maternal and newborn health
• Unsafe abortion services and enable them to safely
give birth in health facilities near their
homes.
Vision
For Filipino women to have full access to
Program Components
health services towards making their
pregnancy and delivery safer. Component A: Local Delivery of the
Maternal-Newborn Service Package
Mission
• Supports LGUs in establishing and
• Guided by the DOH
mobilizing the service delivery
o FOURmula One Plus thrust
network of public and private
o Universal Health Care Frame
providers to enable them to deliver
• The National Safe Motherhood
the integrated maternal-newborn
Program
service package.
o Committed to provide rational
and responsive policy direction
to its local government
In each province and city, the following shall
partners in the delivery of
continue to be undertaken:
• quality maternal and newborn health
services with integrity and
 1. Establishment of critical a. Identification and profiling of
capacities to provide quality current FP users and
maternal-newborn services identification of potential FP
through the organization and clients and those with unmet
operation of a network of Service need for FP (permanent or
Delivery Teams consisting of: temporary methods)
a. Barangay Health Workers b. Mainstreaming FP in the
b. BEmONC Teams composed regions with high unmet need
Doctors, Nurses and Midwives for FP
2. In collaboration with the Centers c. Development and
for health Development and dissemination of IEC materials
relevant national offices: d. Advocacy and social
a. Establishment of Reliable mobilization for FP
Sustainable Support Systems 2. Network of Training Providers
for Maternal-Newborn Service a. 31 Training Centers that
Delivery through such provide BEmONC Skills
initiatives as: Training
i. Establishment of Safe 3. Monitoring, Evaluation,
Blood Supply Network Research, and Dissemination
with support from the with support from the
National Voluntary Epidemiology Bureau and Health
Blood Program Policy Development and
ii. Behavior Change Planning Bureau
Interventions in a. Monitoring and Supervision of
collaboration with the Private Midwife Clinics in
Health Promotion and cooperation with PRC Board of
Communication Service Midwifery and Professional
• Sustainable financing of maternal - Midwifery Organizations.
newborn services and commodities Component
through locally initiated revenue b. Maternal Death Reporting and
generation and retention activities Review System in collaboration
including PhilHealth accreditation and with Provincial and City Review
enrolment. Teams
c. Annual Program
Implementation Reviews with
Component B: National Capacity to Provincial Health Officers and
Sustain Maternal-Newborn Services Regional Coordinators

1. Operational and Regulatory

Guidelines
Partner Institutions Maternal Care: The Paradigm Shift
• LGU
• Development Partners

Policies and Laws (RPRH Act of 2012)

• Republic Act No. 10354:
• “Responsible Parenthood and
Reproductive Health Law

Current Situation (2008 NDHS)

• Health Systems NOT fully functioning
efficiently
• “Poor Access” to Health Services
• Poor health outcome

EMERGENCY OBSTETRIC AND

NEWBORN CARE: the DOH protocol
• BEmONC
• CEmOC

Maternal Neonatal Child Health

Nutrition Strategy – intermediate
results • The concept of emergency obstetric
newborn care (EmONC) was
• CPR – Every pregnancy is wanted,
introduced by WHO, UNICEF, &
planned, and supported
UNFPA in 1997 as an organizing
• ANC – Every pregnancy is adequately
framework for the delivery of
managed
evidence-based clinical services, as a
• FBD – Every delivery is facility based
critical component of any program.
& managed by skilled health workers
• To reduce maternal and newborn
• FIC – Every mother & newborn
mortality
secures proper postpartum, postnatal
• Skilled birth attendants (SBA)
care with smooth transitions to the
• Provide EmONC services
woman’s HCP for the mother & child
survival package newborn
 o Within context of community- • NC) 24/7
focused and facility-based • Comprehensive emergency obstetric
health systems, care (CEmONC) 24/7
o enabling timely prevention of
and intervention for these
complications and
o saving the lives of mothers and
newborns

Emergency Obstetric & Newborn Care

EmONC
• The elements of obstetrics & newborn
care that relates to the management
of pregnancy, child birth (delivery),
the postpartum and the newborn
period: 2 types of EmONC Services
• Early detection and treatment of
problem pregnancies to prevent • Basic Emergency Obstetric and
progression to an emergency. Newborn Care (BEmONC) provided
at:

Management of complications:
For the mother
• Hemorrhage
• Obstructed Labor o District Hospitals
• Preeclampsia o Rural Health Unit (RHU)
• Eclampsia o Barangay health station
• Infection 2 types of CEmONC Services
For the newborn • Comprehensive Emergency Obstetric
• Infection Newborn Care (CEmONC) provided
• Asphyxia at:
• Hypothermia o Hospitals

Essential Newborn Care

• Basic emergency obstetric care
(BemO
CEmONC Services

Other Elements of Maternal and

Newborn Care
Basic emergency obstetric and
• WHO standards for maternal and newborn care (BEmONC). 24/7
newborn care 2007
• Provision of effective antenatal care • Is a primary health care level initiative
o At least 4 visits at regular promoted in low and middle-income
intervals countries to reduce maternal and
newborn mortality.
Universal access to EmONC is
considered essential
• To reduce maternal mortality
• Requires that all pregnant women
and newborns with complications
have rapid access to well-functioning
facilities that include a broad range of
service delivery types and settings

Three Delays Model – Reasons for

Maternal Death
• Maternal deaths occur due to delays
in:
o Deciding to seek care for
perceived obstetrical
complications
o Identifying and reaching the
appropriate facility
o Receiving appropriate and
adequate care in the facility
BEmONC Services o RHU
o BHS
• Facilities
o Lying-In Clinics
o Administration of parenteral
o Birthing Home
antibiotics (initial loading dose)
• Accessibility within 1 hour from
o Administration of parenteral
residence or referring facility within
oxytocic drugs (for active
ILHZ (Inter-Local Health Zone)
management of the 3rd stage
of labor only)
o Administration of parenteral
anticonvulsants for
preeclampsia/eclampsia (initial
loading dose)
o Performance of manual
removal of placenta
o Performance of removal of
retained products of
conception Performance of
IMMINENT breech delivery
o Administration of
Corticosteroids in preterm Capable of performing the following
labor emergency obstetric functions:
o Performance of Essential • Parenteral administration of oxytocin
Newborn Care in the third stage of labor
• Parenteral administration of loading
dose of anti-convulsants drugs for
Ratio by the WHO eclampsia & pre-eclampsia MS04
+ • Parenteral administration of initial
dose of antibiotics
One BEmONC facility per 125,000 • Performance of assisted deliveries in
= (1:125,000) population imminent breech
• Removal of retained placental
products
• Manual removal of retained placenta

BEmONC facility shall consist of the It is also capable of providing neonatal

core district hospital; emergency interventions:

• For geographically • Minimum newborn resuscitation,

isolated/disadvantage areas/closely provision of warmth, and referral.
populated areas/the designated
BEmONC facilities :
 • The hospital BEmONC shall also be • Provides surgical delivery (caesarean
capable of providing blood section and blood bank transfusion
transfusion services. services
• Serve as high volume providers for • Other highly specialized obstetric
IUD (intra-uterine device) and VSC interventions
(voluntary surgical contraception) • It can also serve as high volume
services. providers for intrauterine device
• It can also be a single or standalone (IUD) and voluntary surgical
facility or part of a network of facilities contraception (VSC) services\
in an inter-local health zone.
It is also able to provide emergency
neonatal care
These expanded functions include such • Newborn resuscitation
services as: • Treatment of neonatal
sepsis/infection
• Infection prevention and
• Oxygen support
management for both mothers and
• Antenatal administration of
infants
(maternal) steroids for threatened
• Monitoring and management of labor
premature deliver
using the partograph
• Active management of the third stage
of labor
• Infant thermal protection, feeding,
and HIV prevention

Comprehensive Emergency Obstetrics

and Newborn Care (CEmONC)
1. Tertiary Level Regional Hospital
2. Medical Center
3. Provincial Hospital
4. Appropriately upgraded District
Hospital
5. Capable Privately Operated Medical
Center
Qualifications:
• Capable of performing emergency
obstetric functions as in BEmONC
provider facilities