herrin csr strategy and ao 158
TRANSCRIPT
8/6/2019 Herrin CSR Strategy and AO 158
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CSR Strategy and AO 158
8/6/2019 Herrin 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
Providers/dispensers:Public andprivate
user charges
net subsidy
premium
premium
reimbursements;capitation funds
E nroll indigents
Upgrade
facilities, e.g.,SS certification &PhilHealthaccreditation
Identify the poor / private demand
Ex pand insurancecoverageof IPP and
privateemployees.
servicesHouseholds:economic &socialgroups
Tap other privatesources
Taxes and other sources of revenues
Develop complementary means of
financing
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PhilHealth;other financingagents
Local andnationalgovernment
Providers/dispensers:Public andprivate
user charges
net subsidy
premium
premium
reimbursements;capitation funds
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
Taxes and other sources of revenues
Mobilizeadditional revenues
Charge feesReferral systemVoucher system
Ex pand insurancecoverageof IPP and
privateemployees.
Tap other privatesources
servicesHouseholds:economic &socialgroups
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
42
.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
TotalLow Second Middle Fourth High
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
TotalLow Second Middle Fourth High
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
TotalLow Second Middle Fourth High
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!
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