Maternal, Child

and Adolescent
Health Services
Rizza G. Francisco, RN MN
Current Situation
DOH AO 2008-0029: Implementing Health Reforms for
the Rapid Reduction of Maternal and Neonatal Mortality
– a response to the slow decline in maternal and child
mortality
▪ Maternal Newborn Child Health and Nutrition
(MNCHN) services
▪ For each stage of life – prepregnancy, pregnancy,
delivery, postpartum, newborn and childcare
Current Situation
Maternal Newborn Child Health and Nutrition
(MNCHN) services
▪ To ensure:
✓ Every pregnancy is wanted, planned and supported
✓ Every pregnancy is adequately managed throughout
its course
✓ Every delivery is facility-based and managed by
skilled birth attendants or skilled health
professionals
✓ Every mother and newborn pair secures proper
postpartum and newborn and childhood care
Current Situation
- Remarkable gains were recorded afterwards:
- FHSIS (Field Health Service Information System) in
2018 showed that maternal mortality rates
decreased from 209/100,000 livebirths (1990), 162
(2006) and 74 (2015) to 54/100,000 livebirths in
2018
- Despite this, women are still dying from
hemorrhage, hypertension, and infection
Current Situation
- Other challenges were encountered on perinatal mortality
(fetal deaths of 22 weeks or more) and infant health
- Weak national immunization coverage (2008)
- Service utilization for maternal gradually increased in
2018: increase in number of women with at least 4 ANC
(antenatal consultations which should commence in the
first trimester of pregnancy)
- Reports on women seeking prenatal care only when
quickening is felt (around 17th to 20th week AOG)
Current Situation
- Facility-based delivery (FBD) and skilled birth attendance (SBA)
were 94% and 95% respectively (2018)
- An indication of women’s preference to give birth in licensed
facilities and attended by skilled health professionals as well as
the support of PhilHealth provided for women giving birth in
health facilities through its maternity and newborn care packages
and resolutions prohibiting deliveries at home

- 5% of pregnant women still give birth at home assisted by

traditional birth attendants (TBA) or hilots
Current Situation
Challenges in the delivery of maternal and child health
services
1. Low utilization of Family Planning Packages of
PhilHealth
2. Decrease in the number of PHilHealth-accredited
Maternal and Child Program facilities
3. Antenatal and postpartum care lags
4. Measles and polio outbreaks and increase in measles-
related mortalities
Safe Motherhood Program
- A series of initiatives, practices, protocols, and
service delivery guidelines
- To ensure that women receive high-quality
gynecological family planning, prenatal, delivery
and postpartum care to achieve optimal health for
the mother, fetus and infant during pregnancy,
childbirth and postpartum
Safe Motherhood Program
Strategic changes in the design of services provided
which include:
1. Shift in handling pregnancy clients from risk-
approach to preparing all pregnant women to
complications at childbirth.
❖ All women are considered at risk for pregnancy and
childbirth complications
❖ Establishment of BEmONC-CEmONC network within
the bigger Service Delivery Network (SDN)
Safe Motherhood Program
Strategic changes in the design of services provided
which include:
2. Improved quality of FP counselling and expanded
service availability of postpartum FP in hospitals
and primary birthing centers
3. The integration of cervical cancer, syphilis,
hepatitis B, and HIV screening among others into
the antenatal care protocols
Safe Motherhood Program
- A shift from centrally-controlled national programs to
an LGU governed system that delivers an integrated
system
- A woman who seeks care for reproductive health
concerns could expect a comprehensive array of
services that addresses her most critical reproductive
health needs
- MNCHN was expanded to Reproductive Maternal
Newborn Child Adolescent Health and Nutrition
(RMNCAHN)
Safe Motherhood Program
- Anchored on PhilHealth accreditation of birthing
centers and individual membership
- Ensures sustainable financing and eliminate out-of-
pocket expenditures for antenatal, facility delivery
and postnatal care
- Includes systems for safe blood supply and stakeholder
behavior change through a combination of advocacy
and interpersonal communication during clinic visits
Related Policies and Laws
❑ Strategic
Framework and Implementing Guidelines
for FOURmula One Plus for Health (F1+)
- DOH AO 2018-0014
- Alignment of health initiatives into 4 strategic
pillars: Financing, Regulation, Service Delivery
and Governance plus Performance
Accountability
Related Policies and Laws
❑ The National Objectives for Health 2017-2022
- A roadmap for the F1+ towards the
achievement of Universal Health Care
- Specifies the objectives, strategies and targets
of DOH F1+ for Health
Related Policies and Laws
❑ RA 10354: Responsible Parenthood and Reproductive Health
Act of 2012
❑ RA 11148: The “Kalusugan at Nutrisyon ng Mag-Nanay” Act
- Scaling up of the national and local health nutrition
programs for pregnant and lactating women, adolescent
girls, infants and young children in the first 1,000 days of
life
❑ RA 11210: The 105-Day Expanded Maternity Leave Law
- 105 days of maternity leave with option to extend for
an additional 30 days (without pay) and additional 15
days (solo mothers)
Related Policies and Laws
❑ AO 2008-0029: Implementing Health Reforms to Rapidly
Reduce Maternal and Neonatal Mortality
❑ Department Order 2009-0029: Guidelines Governing the
Payment of Training Fees relative to the attendance of
Health Workers to BEmONC Skills Training Course at Duly
Designated Centers
❑ AO 2011-0011: Establishments of BEmONC Training
Centers in Regional Hospitals and Medical Centers
❑ AO 2015-0020: Guidelines in the Administration of Life
Saving Drugs During Maternal Care Emergencies by Nurses
and Midwives in Birthing Centers
Related Policies and Laws
❑ AO 2018-0003: National Policy on the Prevention of
Illegal and Unsafe Abortion and Management of Post-
Abortion Complications
❑ AO2016-0035: Guidelines on the Provision of Quality
Antenatal Care in All Birthing Centers and Health
Facilities Providing Maternity Care Services
❑ RA10028: Expanded Breastfeeding Promotion Act of
2009
Related Policies and Laws
❑ RA 11166: Philippine HIV and AIDS Policy Act of 2018
- Strengthening of the country’s policy on HIV/AIDS
prevention, treatment, care and support.
- Lowered the minimum age requirement from 18 yo
to 15 yo in availing HIV testing and counselling
without parental or guardian’s consent
RMNCAHN core package of services
❑A health systems-oriented, multi-sectoral approach in
strengthening the continuum of care for women,
children, families and communities
❑ Toenable all adolescents to make informed choices
on reproductive health issues particularly about
pregnancy by creating awareness and providing access
to information, education, support, services and
necessary treatment pertaining to reproductive
health
RMNCAHN core package of services
1. Known appropriate clinical case management
services including emergency obstetric and newborn
care
2. Known cost-effective public health measures capable
of reducing exposure to and severity of risks for
maternal and newborn deaths that are routinely
being provided by LGUs.
RMNCAHN core package of services
MCNHN Service Delivery Network (SDN)
- Refers to the network of facilities and providers
within the province-wide or city-wide health system
offering the MNCHN core package of services in an
integrated and coordinated manner
- Includes the communication and transportation
system
RMNCAHN core package of services
1. Reproductive health
- RA 10354: Responsible Parenthood and
Reproductive Health (RPRH) Law in 2013
- Life-span approach: reproductive health is a
concern that affects different age brackets
- Client-centered approach (not program-focused):
provision of services the client needs
RMNCAHN core package of services
1. Reproductive health
A. Responsible parenthood
- The will and ability of a parent to respond to the
needs and aspirations of the family and children
- A shared responsibility between parents
➢ Determine and achieve the desired number of
children
➢ Spacing and timing of their children
➢ Awareness of their reproductive health rights
RMNCAHN core package of services
1. Reproductive health
B. Family planning
- The program which enables couples and
individuals to
➢ decide freely and responsibly the number and
spacing of their children
➢ To have access to full range of safe, affordable
and effective, nonabortifacient modern natural
and artificial FP methods
RMNCAHN core package of services
B. Family planning
- Target modern contraceptive Prevalence Rate
(mCPR) is 65% of married women
- 4 pillars of FP
1. Responsible parenthood
2. Child spacing – 3-5 years
3. Respect for life – abortion is considered illegal
4. Informed choice
RMNCAHN core package of services
2. Maternal-newborn health
A. Prepregnancy services
➢ Provision of iron and folate supplementation
➢ counselling and provision of FP methods,
➢ Prevention and management of infection and
lifestyle-related diseases
RMNCAHN core package of services
2. Maternal-newborn health
B. Antenatal care services
➢ RA 11148: Kalusugan at Nutrisyon ng Mag-Nanay
Act
➢ To scale up the national and local nutrition
programs for maternal, neonatal child health
and nutrition
➢ In the first 1000 days
RMNCAHN core package of services
2. Maternal-newborn health
B. Antenatal care services
1. Pregnancy Tracking and Enrollment to
Antenatal Care (ANC)
➢ To scale up the national and local nutrition
programs for maternal, neonatal child
health and nutrition
➢ Tracking is done by the BHWs
RMNCAHN core package of services
2. Maternal-newborn health
B. Antenatal care services (first 270
days)
1. Pregnancy Tracking and Enrollment to
Antenatal Care (ANC)
➢ Health history
➢ Prenatal assessment
➢ Birth preparation and Emergency Plans
RMNCAHN core package of services
2. Maternal-newborn health
B. Antenatal care services (first 270
days)
2. DT immunization
3. Consumption of iodized salt
4. Micro- and macronutrient supplementation
➢ For iron deficiency anemia, Vit A deficiency,
Iodine deficiency disorder and Calcium
supplementation
RMNCAHN core package of services
2. Maternal-newborn health
B. Antenatal care services (first 270
days)
5. Early identification and Management of
Nutritionally at-Risk Pregnant Client
6. Counselling on maternal nutrition,
breastfeeding and rooming-in, appropriate
infant and young child feeding practices
7. Assessment of risk for parasitism
RMNCAHN core package of services
2. Maternal-newborn health
B. Antenatal care services (first 270 days)
8. Provision of oral services
9. Counselling on proper handwashing,
environmental sanitation and personal hygiene
10. Counselling on nutrition, smoking cessation and
adoption of healthy lifestyle practices
11. PHIC enrollment and linkage with health workers
RMNCAHN core package of services
2. Maternal-newborn health
C. Intrapartal services
- facility-based delivery to ensure safe labor,
availability of intrapartum interventions and to
safeguard the welfare of women and newborns
- A network of public and private healthcare
providers
- BEmONC-capable facility – to be reached within 30
minutes from home
- CEmONC-capable facility within an hour from each
BEmONC-capable facility
RMNCAHN core package of services
2. Maternal-newborn health
D. Postpartal services
- 1st visit – within 24 hours
- 2nd visit – within 1 week
- Micronutrient supplementation
- Birth registration
- Lactation support and counselling
- Nutrition assessment
RMNCAHN core package of services
2. Maternal-newborn health
E. Birth and newborn (28 days)
- AO 2005-0014
➢ Early initiation of breastfeeding
➢ Exclusive breastfeeding for the first 6 months
➢ Expanded bf for 2 years and beyond
➢ Appropriate complementary feeding
➢ Micronutrient supplementation
➢ Universal salt iodization
➢ Food fortification
RMNCAHN core package of services
2. Maternal-newborn health
F. Expanded NBS test and hearing
screening test
RMNCAHN core package of services
3. The National Immunization Program
Goals:
▪ To immunize all infants against vaccine preventable
diseases
▪ To sustain polio-free status Philippines
▪ To eliminate measles infections
▪ To eliminate maternal and neonatal tetanus
▪ To control Diphtheria, Pertussis, Hepatitis B infection
and German Measles
▪ To prevent extrapulmonary TB among children
RMNCAHN core package of services
5. Adolescent Health
❖ Adolescent Health and Development Program (AHDP)
Strategic Directions for 2018-2022
❖ To guide the improvements of health status of
adolescents, enabling them to enjoy their right to
health
❖ Strategies: health education and promotion, life skills
building and medical service provision
❖ Encourage the use of adolescent sexual and
reproductive health (ASRH) services
RMNCAHN core package of services
4. Child Health Services
❖ Nutrition program – complementary feeding,
micronutrient supplementation, food fortification,
deworming program
❖ IMCI
Thank you!