OVERVIEW OF THE MATERNAL AND CHILD CARE PROGRAMS

Maternal, Newborn, Child Health & Nutrition (MNCHN) program focuses on crucial supports to enable
populations to both survive and thrive. Our work spans the value chain from discovery to delivery, and
use science and evidence to drive approach and efforts to achieve impact.

The program provides core technical support and expertise to enable communities to survive and thrive
by focusing on three broad, intersecting areas of work:

 Strengthening maternal and newborn care;

 Expanding nutrition policies, programs, and innovation; and
 Integrating early childhood development into the broader MNCHN environment.

The maternal and child care programs include pre-pregnancy services, antenatal, delivery, postpartum
care; also newborn care, immunization, breastfeeding, maternal and child nutrition through
micronutrient supplementation and food fortification, and integrated management of common
childhood illnesses, among others (DOH 2000).

Although all these services are provided by public providers, there is a parallel provision of these
services by the private sector, particularly those involving personal maternal and child health care like
antenatal, assisting in delivery, and management of common childhood illnesses. Public health
interventions like immunization and micronutrient supplementation are mostly provided by the public
sector. Thus, the financing of maternal and child care services come from mixed sources, mostly public
financing for those services provided at the public facilities and, until recently, private financing for
those services provided by the private providers. In 2000, the Philippine Health Insurance Corporation
(PhilHealth), the government’s health insurance system, developed a package for maternal care service
which was enhanced in 2003 to cover the LAVADO AND LAGRADA 55 continuum of maternal care
services including prenatal care, normal delivery, newborn care, postpartum care, and family planning
counseling that can be provided by both accredited hospital and nonhospital facilities.

Under this current health delivery system, there are several combinations of utilizing the different
maternal and child care services. For example, a woman utilizes family planning services at the health
center without cost (if free family planning commodities are available at that facility), goes to the health
center for prenatal care when she gets pregnant, delivers her baby at home with the family paying out-
of-pocket to whoever assisted in the delivery, and goes back to the health center again for postpartum
and postnatal care for her baby. In another scenario, a woman may utilize all these services through the
private sector and be financed through private sources.

The first example may be the reason for the 2003 Demographic and Health Survey (DHS) report that
while 86 percent of pregnant women access antenatal care (ANC) services from a health professional,
only 60 percent of them are assisted by a medical professional during birth. Although the quality of
antenatal care, measured as a composite of antenatal care from DHS 2003 data (Lavado et al. 2008), is
negatively correlated with maternal mortality rate (MMR) and under mortality rate (U5MR), facility-
based delivery is still critical in ensuring safe delivery.

The Family Planning Survey in 2004 shows that both the nonpoor and the poor deliver at the health
facility, with higher proportion among the non-poor (56.2% versus 17.4%). Moreover, both of these
groups utilize public health facilities more than the private ones, with 34.8 percent of the nonpoor and
14.9 percent of the poor utilizing public health facilities.

These different scenarios of delivering and financing maternal and child care services in the country
provide the background that emphasizes the three major gaps in the health care delivery system that
increase the risk of dying among mothers and children (DOH 2009).

These include:

1) gaps in the delivery of services, which may be breaks in the provision of continuum of services across
various stages of life cycle;

2) gaps in the utilization of these services, which occur when clients do not avail of recommended
services owing to lack of information, poor capacity to pay and poor geographic access, and personal
beliefs;

and 3) gaps resulting from weaknesses in the health system itself, which arise when the capacity to
deliver services is lacking, financing is inadequate, regulations fail, and governance is weak. To address
these gaps, the DOH through the years has taken innovative strategies to protect mothers and children
—from adopting the Safe Motherhood Initiative in 1988 to ensure that childbirth will be safe and will
not carry with it.

A composite measure of quality ANC is developed by assigning 1 point for the following antenatal care-
related questions asked in the DHS 2003: (1) weigh checked; (2) height checked; (3) blood pressure is
taken; (4) urine examination performed; (5) blood sample examination performed; (6) told about
pregnancy complications; (7) told where to go for pregnancy complications; (8) received tetanus toxoid
injection; and (9) received iron supplementation.

Levels of quality of care are classified as no antenatal care, poor quality ANC (1-3 points), fair ANC (4-6
points) and very good ANC (7-9 points).