immunization and family planning (rajeev colaco)

8/6/2019 Immunization and Family Planning (Rajeev Colaco)

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Integrating Immunization and

Family Planning Services:

the Polomolok Experience in thePhilippines

Strengthening Governance for Health Project

(HealthGov)

June 20111


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Acronyms

LGU: Local Government Unit

FP: Family Planning

EPI: Expanded Program on Immunization

MCH: Maternal and Child Health

RHU: Rural Health Unit

BHS: Barangay Health Stations

DMPA: Depo medroxyprogesterone acetate injection

IUD: Intrauterine Device

BTL: Bilateral Tubal Ligation

LAM: Lactational Amenorrhea Method2


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Millennium Development Goals

Goal 4: Reduce child mortality rates

Target: Reduce by two-thirds, between 1990 and 2015, the

under-five mortality rate

Childrens immunization

Goal 5: Improve maternal health

Target: Achieve, by 2015, universal access to reproductive

health Contraceptive prevalence rate

Adolescent birth rate

Unmet need for family planning

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Why integrate Immunization andFamily Planning in Philippines?

90% of women within first year after delivery want to

space or limit pregnancy, high unmet need forFP Multiple contacts with mothers at service delivery point:

4-5 visits over newborns first 11 months

High access and awareness ofEPI services - at least

85% children fully immunized

Immunizations and FP provided by trained midwives: on

different days and times (referrals made)

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PolomolokMunicipality, Province of South

Cotabato (Mindanao)

5

L

k

SOUTH

COTABATO

Tiboli

Surralah

TupiBanga

Sto. NinoKoronadal

TantanganNoralla

Tampakan

Polomolok

To Isulan

To Tacurong

To General

Santos City

PhilippinesMap


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Implementation 10 month pilot test in one local government unit (LGU):

Polomolo Municipality

1 Rural Health Unit (RHU -- municipal health center) &

28 Barangay Health Stations (BHS) involved Began integration with 1-day orientation of all medical

personnel explained purpose, approach & ey

messages

Developed map of facilities and FP and MCH serviceproviders

Pre-tested 3 verbal messages (translated in local dialect)

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Messages:

Your child is young & you should be concerned about having

anotherpregnancy

Your health facility provides FP services that can help you

You should visit ourFP services after your immunization todayfor more information

Trained 25 rural health midwives (RHMs-based in BHS),

56 barangay health wor ers (BHWs), 2 RHU nurses and

1 doctor in FP messages

Study did not collect special immunization data but data

available from routine reporting to government7


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BHWadministered survey, registered children for

immunization & delivered messages

RHM administered immunization & delivered same

messages

Innovations in Poblacion-4 BHS: Stapled 3FP

messages to immunization records & posted messages

in entry way

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Key Findings

38% increase in New FP acceptors after 10 months,

Polomolok Municipality

YEAR MAR APR MAY JUN JUL AUG SEP OCT NOV DECTO-

TAL

2008 151 136 164 149 123 113 151 136 164 149 1,405

2009 176 205 235 178 191 164 176 205 235 178 1,943

%increase

16.6 50.7 43.3 19.5 55.3 45.1 16.6 50.7 43.3 19.5 38.3

(March-December, 2008 vs 2009)


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Shift in Method PreferenceHigher preference for modern methods, lower preference for

traditional methods after six months (June 2009 vs Dec. 2009,Polomolok)

0

5

10

15

20

25

30

Pills

DMPA IU

DBT

LLA

M

Condom

Calen

dar

With

draw

al

FP Methods

Percent

Jun-09

Dec-09


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13

Healt

hcenters are increasingly importantas primary source of FP information

47

191

1

7

4 5

0

10

20

30

40

50

60

7080

90

100

Health enter amily / elat ive riend / neighbor None

Source of Information

Percent Jun-09

Dec-09

(among FP users)

(June 2009 vs December 2009, Polomolok)


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126% increase in new FP acceptors over 3months in Poblacion-4 BHS

(written FP messages & posters provided in addition tooral messages)

YEAR MAR APR MAY JUN TOTAL

2008 8 7 12 16 43

2009 40 20 14 23 97

% 400.0 185.7 16.7 43.7 125.6

(March-June, 2008 vs 2009)


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Immunization Data(PolomolokMunicipalitysource: FHSIS)

o adverse impact on childrens immunization

Fully Immunized Child (FIC) coverage rates

2008: 96%

2009: 99%

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Potential Best Practices & ProcessesNeeded for Effective Integration

Local ownership and support (from local government and

health officials)

Posted and ta e-home written messages along with

verbal messages

Client follow-up to prevent FP drop outs

Assuring the availability ofFP commodities to meet

increased demand

Ongoing performance monitoring (at facility & LGU

levels)

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Potential Barriers to Integration

Lac of local political (elected) & technical (health

officials) support

Lac of contraceptive and immunization supplies

Lac of trained providers (in both services)

Social, linguistic norms that pose barriers in some

communities to accessing services (e.g. indigenous

populations)

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immunization and family planning (rajeev colaco)

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