Friday, August 23, 2013

Health programs from different regions decry DOH’s “No Home Birthing Policy” as mere smokescreen of the sorry state of maternal and neonatal health

(Quezon City, Philippines) NGOs and Community Health Workers from Luzon, Visayas, and Mindanao are outraged by the decentralized implementation of DOH Administrative Order 2008-0029 “Implementing Health Reforms for Rapid Reduction of Maternal and Neonatal Mortality” more popularly known as the “No Home Birthing Policy.” Community Based Health Programs (CBHP) all over the Philippines cited Quezon City, Manila, Nueva Ecija, Bicol, Iloilo, Zamboanga, and CARAGA among others that have local ordinances prohibiting home births. Upon knowing that they gave birth at home, some mothers were even prevented from registering the birth of their newborns.

They said that the policy “narrows public health care” and “gears government health service to privatization and profit.”

In Iloilo, a pregnant mother had to endure 16 hours of grueling rough road travel just to reach the “nearest” birthing facility. The same ordeal is true with the provinces of Nueva Ecija, Bicol, Iloilo, Zamboanga, and CARAGA.

CBHPs pointed out that the government is not ready to accommodate all births in facilities because its health human resources are low and infrastructures are scarce and can only be found in cities, town centers, and provincial centers. For the 42,028 barangays, there are only 17,000 Barangay Health Stations that have very few or no health personnel, lack equipment, medicines and supplies.

They also decried Philhealth’s promise of “free delivery” or “no balance billing” which is just a smokescreen of different charges in the birthing facility/hospital and professional fees. Philhealth only covers a mere fraction of hospital/facility bills and “does not eradicate out-of-pocket expenses” of patients. A midwife who worked for a private lying-in clinic in Metro Manila divulged that on top of Philhealth’s Maternity Care Package (MCP) amounting to P8,000 for normal spontaneous delivery, the facility charges an additional P7,500 for the professional fee of the OB-Gyn doctor or P5,500 as professional fee of the midwife.

They said that based on Philhealth’s Geographic Information System, the MCP covers 539 facilities in 14 regions (there is no available data for Region XI). The CBHPs said that this data translates to 1 MCP facility available to a staggering 78 barangays.

They are campaigning for the recall of the DOH’s “No Home Birthing” policy because this will just increase maternal and neo-natal mortality by prohibiting Community Health Workers and traditional birth attendants or hilot from doing what they have done for decades sans government support -- bridge the gaps in health care delivery by being at the frontline of people’s health.

Community Based Health Programs (CBHP) promote alternative health system, train Community Health Workers, and work for people’s empowerment.

Sixty (60) CBHP members representing different provinces in Luzon, Visayas and Mindanao are in Quezon City to attend the 3-day 11th General Assembly of Council for Health and Development (CHD) with the theme “Ipagbunyi ang 40 taon ng CBHP! Higit pang palakasin ang CBHPs para sa ibayong paglilingkod sa sambayanan!” (Celebrate the 40 years of CBHP! Further strengthen the CBHPs for greater service to the people!). Council for Health and Development is the national organization of Community Based Health Programs in the Philippines.


Marcelinda Tambalque
Community Health Worker, Traditional Birth Attendant
Nueva Ecija Community Health Workers Association
Carranglan, Nueva Ecija

Grace Cuasay
Registered Midwife, Director of Health Education and Training
Council for Health and Development

Sunday, August 11, 2013

No home Birthing Policy: Higher maternal mortality and neonatal deaths

Manila, Philippines - The government implements “No Home Birthing Policy” as an answer to the soaring number of maternal and neo-natal deaths. It blames the rise in Maternal Mortality Rates to home births unsupervised by skilled health professionals. The policy states that all pregnant women should give birth only in facility-based centers attended by skilled health personnel. In addition, DOH has encouraged doctors, nurses and midwives to put up lying-in centers, facilities and hospitals which become part of their social delivery network.

Midwives, traditional birth attendants (hilots), mothers, and community leaders will hold a protest action in front of DOH Main Gate at Rizal Avenue, Manila on August 12, 2013, Monday, 8:30-10 am.

Grace Cuasay, a registered midwife and director of Health, Education, Training and Services department of the Council for Health Development, said “Birthing facilities are few and very far. Giving birth in a facilty-based center is expensive. This policy is not a solution, and on the contrary endangers the lives of women and their babies.

There is no government infrastructure and health budget to improve ill-equipped barangay health stations and hire additional government health personnel. According to DOH 2011 data, of 41,000 barangays, only 17,000 have barangay health stations. There is only one midwife for 13,160 population, one nurse for 37,998 population and one doctor for 67,987 population . Cuasay cited that the Basic Emergency Obstetric Newborn Care (BEmONC) facility in Iloilo serves four to five barangays. Pregnant women have to travel three days to reach this birthing station. The case is worse In the Lumad areas of Agusan del Sur where there is no barangay health station. Lina Tambalque , a community health worker from CBHP-Nueva Ecija, also said that midwives are not allowed to deliver babies at home. A mother had to rent a jeep and cross a flooded river to get to the nearest birthing station. The mother and her child died before reaching their destination. In Metro Manila, reports cited by a Manila newspaper stated that at least 14 babies were delivered at LRT-1 from 2010 to 2012. Eight were delivered at the station platform and six inside the moving train. The pregnant mothers were on the way to Jose Reyes Memorial Hospital or Philippine General Hospital to give birth.

Women could not afford birthing facilities. Before, home birthing with a midwife costs only a few hundreds of pesos which mothers pay in installment or even in kind through goods like rice, fruits, vegetables or chicken. With the new policy, they have to pay P2,500 to P3,500 in to give birth in barangay health stations or lying-in centers. Some mothers may have PhilHealth cards but the card is rendered useless since most barangay health stations are not PhilHealth accredited. In government or private hospitals and lying-in centers, PhilHealth maternity care package for normal delivery in hospitals is P6,500 to P8,000. But this covers only 30 to 50 percent of expense, forcing out of pocket expenses. In addition, a huge chunk of the population living in far-flung barrios are not PhilHealth members.

According to Cuasay, a significant decrease in maternal mortality rate is impossible to achieve in a reactive public health care system that loyally subscribes to foreign-dictated maternal and child health programs like the “No Home Birthing Policy.” The policy further diminishes the public health care system while paving the way for increased private business in health. In conclusion, Cuasay called on the government to provide more doctors, nurses and midwives in communities. She called on the government to rescind the “No Home Birthing Policy” and to allocate 5% of the gross domestic product or P575B to health to be able to strengthen the public health care system.##

Reference :
Grace Cuasay
Director of Health, Education, Training and Services
Council for Health and Development
Contact no: 0927 925 9413
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