Herrin CSR Strategy and AO 158

8/6/2019 Herrin CSR Strategy and AO 158

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CSR Strategy and AO 158



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Outline

� CSR and key points of AO 158� Local health sector response to CSR:

financing and delivery issues� Consequences of inadequate response



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B ackground

� For 30 years, the FP program had alwaysrelied on contraceptive donations.

� Donations made contraceptive supplieswidely available, but may have made theFP program too dependent on donations.

� Starting 2 004 , gradual phase-down of

foreign donations of contraceptivecommodities (pills, condoms andinjectables) to end in 2 00 8.



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B ackground

� Phase-down of donated contraceptivesupplies provides an opportunity for the

country to assume responsibility for assuring availability of contraceptivesupplies for current and future users.

� Government response: formulation andimplementation of a Contraceptive Self-Reliance (CSR) strategy.



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CSR Strategy andKey Points of AO 158



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Wh at is CSR strategy?

T he CSR strategy is a set of measures toassure that supplies for FP services willcontinue to be provided for increasingnumbers of current and potential users toeventually eliminate unmet needs for FP.

In the provision of these services all sectorshave roles to play and each share in theresponsibility for the outcome.



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CSR encourages response of keysectors along t h ree broad

directions:� Assure no disruption in contraceptive supplies

to current users during the phase out of externaldonations particularly among the poorest users.

� Develop complementary means of financingcontraceptives through a variety of options suchas PhilHealth, employer benefits, out-of-pocketfinancing.

� Expand complementary private sources of contraceptive supplies through such optionsas self-help community based distribution, NGOoutlets, private and commercial providers, andworkplace-based outlets.



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Mandate of LGUs under LGC

T he responsibility for the provision of basichealth services, including FP services,was devolved to LGUs. T his is specificallyprovided for in Section 1 7 of Republic Act7 16 0 (Local Government Code of 1991).



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Key Players in CSR

ImplementationNational

Government:

DOHP h ilHealt h

POPCO M

LocalGovernment:

ProvincesMunicipalities

CitiesB arangays

PrivateSector

CSR



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Summary: Key Points of t h e CSR

Strategy and AO 158� Eliminating unmet need for FP remains the goal� Phase-down of contraceptive donation should

stimulate positive domestic response� Desired domestic response has three parts:

± government guarantees availability; more immediatelyto prevent disruption in supplies especially among thepoor

± increased financing to include government and other sources

± expanded service sources to include government andothers



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PhilHealth;other financing

agents

Local andnational

government

Providers/dispensers:Public andprivate

user charges

net subsidy

premium

premium

reimbursements;capitation funds

Increase budget for FP and others

Mobilizeadditional revenues

servicesHouseholds:economic &socialgroups

Identify the poor / private demand

Charge fees

Taxes and other sources of revenues

No disruption of contraceptivesupplies, especially for the poor



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PhilHealth;other financing

agents

Local andnational

government


user charges

net subsidy

premium

premium


E nroll indigents

Upgrade

facilities, e.g.,SS certification &PhilHealthaccreditation

Identify the poor / private demand

Ex pand insurancecoverageof IPP and

privateemployees.


Tap other privatesources


Develop complementary means of

financing



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PhilHealth;other financingagents

Local andnationalgovernment


user charges

net subsidy

premium

premium


Increase budget

for FP and others

E nroll indigents

Ex pand privatesector

participation

Upgradefacilities, e.g.,SS certification &PhilHealthaccreditation, and improve quality of servicesIdentify the poor /

private demand


Mobilizeadditional revenues

Charge feesReferral systemVoucher system

Ex pand insurancecoverageof IPP and

privateemployees.

Tap other privatesources


Provide FP

information;advocatesmall family size norm

T otal health sector response to CSR



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Why is there an urgent needto respond positively

(or the consequencesof inadequate response)?



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Wealth status

TotalLow Second Middle Fourth High

Unmet need for spacing 10 .9 8. 6 7 .7 6 .5 6 .1 7 .9

Unmet need for

limiting 15.8 11 7 .3 6 .9 6 .2 9. 4

Total unmet need 26 .7 19. 6 15 1 3 .4 12. 3 17 .3

Source: NSO and ORC Macro, 2003 NDHS , 2 003

T he goal of CSR strategy is to eliminate unmetneed. We are still a long way from achieving this

goal, especially among the poor.



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Th e p h ase-down of donated pills and injectableswill affect public sector delivery of modern

meth

odsF. ster. Pill IUD Inject. Condom Total

Public 7 5.8 5 6 .6 80 .1 92.5 2 7 .0 6 7 .2

Hospital 68. 3 1 .0 10 .8 3 .4 1 .8 2 4.5

RHU/BHS 7.0 55.5 69.2 89.2 25.2

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.4Others 0 .5 0 .0 0 .0 0 .0 0 .0 0 .2

Private 2 3 .2 38. 6 18. 0 7 .5 59. 6 29. 3

Hospital 22 .1 1 .4 1 4.8 5. 2 0 .8 10 .2

Pharmacy 0 .0 3 5. 0 0 .0 1 .2 57.7 1 7. 2

Others 1 .1 2 .2 3 .1 1 .1 1 .0 1 .7

Other source 0 .0 4 .5 2. 0 0 .0 11.5 2. 7

No. of women 9 47 1,1 48 359 2 6 8 1 6 9 2,92 0

Source: NSO and ORC Macro, 2003 NDHS , 2 003



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Wealth status


Total fertility rate 5.9 4 .6 3 .5 2.8 2. 0 3 .5

FP use, any method 37 .4 48.8 52. 7 54 .4 50 .6 48.9

FP use, modernmethods 23 .8 33 .8 35. 7 37 .9 35.2 33 .4

FP use, traditionalmethods 13 .6 15. 0 17 .0 16 .5 15. 3 15.5Source: NSO and ORC Macro, 2003 NDHS , 2 003

Modern FP use methods maydecline, especially among the poor



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Wealth status


Total fertility rate 5.9 4 .6 3 .5 2.8 2. 0 3 .5

Wanted fertility rate 3 .8 3 .1 2. 6 2.2 1. 7 2.5

Difference ( T FR-WT FR) 2.1 1.5 0 .9 0 .6 0 .3 1.0Source: NSO and ORC Macro, 2003 NDHS , 2 003

T he poor will be less able toachieve their fertility goals than the

rich



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Wealth status


Infantmortality 42 32 2 6 22 19 30

Under-fivemortality 66 47 32 2 6 21 42

*Rates refer to the 1 0 -year period preceding the survey.Source: NSO and ORC Macro, 2003 NDHS , 2 003

Due to high fertility, the poor willsuffer the most in terms of infant

and child mortality



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Population Growth: Philippines

19.2

27.1

6.7

48.1

6 .7

76.5

2.9.

2.7

2. 2.

1

20

30

40

50

60

70

80

90

1948 196 0 1970 1980 1990 2000

i l l i o n s

0

0.5

1

1.5

2

2.5

3

3.5

4

P e r c e n

tPopulation

Growth rate

S our ce : NSO

Population growth will re main hi gh ,implying a dou b ling of the population

over a s hort perio d o f time



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T he Future?How the results of the 2 00 8 and 2 013 NDHS

would look like depend on how far wesucceed in implementing the CSR strategy



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Success is in your hands!

Herrin CSR Strategy and AO 158

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