USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | i
EVALUATION:
USAID/PHILIPPINES HEALTH PROJECT
MULTIYEAR WHOLE-OF-PROJECT PERFORMANCE
EVALUATION (2018–2021)
FEBRUARY 2022
DISCLAIMER
The authors’ views expressed in this publication do not necessarily reflect the views of USAID 
or of United States government.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | ii
Cover Photo: The COVID-19 pandemic disrupted local health systems, including the provision of family 
planning (FP) services. The United States Agency for International Development (USAID) Health Project 
pivoted to help service providers develop adaptive solutions to address the challenges of this unprecedented 
time. This included providing FP informational material for health workers going house to house to reach 
more people who need FP supplies. Source: USAID/RTI International
This publication was produced at the request of the United States Agency for International Development. It 
was prepared independently by Orville Solon, Ma. Soledad Antonio, Frances Mamaril, Mario Festin, Kathryn 
Roa, Julienne Baldo-Cubelo, Ermi Amor Figueroa-Yap, Fatima Verzosa, Noel Juban, Oscar Picazo, Arturo 
Ongkeko Jr., and Chamuel Michael Joseph Santiago.
USAID Contract No. IDIQ No. AID-OAA-I-15-00025, Task Order No. 72049218F00001
Period of Performance: July 2021–February 2022
Contracting Officer’s Representative (COR): Helen Hipolito 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | iii
ACKNOWLEDGMENTS
We express our gratitude to those who shared their expertise, experience, and ideas, which were 
instrumental in helping us complete this evaluation report. We appreciate their patience and willingness to 
participate in our virtual interviews.
We also extend our thanks to the officials of the Department of Health and its attached agencies, the local 
government units, United States Agency for International Development /Philippines, and other development 
partners for facilitating this evaluation by helping us schedule the key informant interviews, allowing us access 
to reports and data, and providing us insightful comments and suggestions that helped shape this report
Finally, we thank the patients and service providers who participated in the focus groups for sharing their 
valuable experiences, expectations, and personal thoughts about the country’s health care delivery system. 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | iv
PREFACE
The whole-of-project evaluation (WOPE) of the United States Agency for International Development 
(USAID)/Philippines Health Project (HP) comes at an important juncture: The Philippines—indeed the entire 
world—is still reeling from the COVID-19 pandemic, which has severely disrupted health services and 
derailed ongoing health reforms and innovations, including the 13 USAID-supported health activities covered 
under the WOPE. Meanwhile, a new government will take over in June 2022, after the national elections in 
May. The findings of the WOPE, therefore, are expected to provide insights on how USAID should configure 
its assistance to the sector in the remaining life of the activities and for its new program cycle (2024–2026), 
and also offer an independent assessment of the host government on how USAID-supported interventions 
have performed.
I. Setting the Scene
The COVID-19 pandemic has overwhelmed the Philippine health system and economy. As a middle-income 
country, the Philippines has struggled to bring universal health care to its people, and the grim impact of 
COVID-19 on service delivery and financing will make this dream even more challenging. Despite this cloudy 
outlook, strengths and opportunities exist that could allow the health sector to regain the traction that was 
lost as a result of the pandemic. First, a new government will be installed in June 2022, after the national 
elections in May. Second, the Mandanas-Garcia ruling is expected to infuse more budgetary resources into
local government units (LGUs). Third, the economic recovery is expected ensure this year, and prospects 
for growth in the country are good. Fourth, the insurgency problem, which has bedeviled many rural areas 
and halted local health sector development and citizens’ access to basic health services, is predicted to end 
soon, or at least be severely mitigated, bringing normalcy to formerly strife-torn communities.
Although strengths and opportunities exist for the health sector to be revitalized and made more resilient, 
long-term weaknesses and threats that have hindered health sector development should get more attention, 
principally from the national government and ultimately from all health sector stakeholders. First, 
institutional development and staff skills have lagged behind the requirements of a modern health system that 
a middle-income country (and hoped-for upper-middle-income country) requires. Important skills in health 
leadership, health policy analysis and dialogue, program management, and key highly technical areas are 
increasingly in short supply. Technical areas include health technology assessment; social health insurance; 
impact and evaluation; health planning, budgeting, and costing; information systems; informatics; and data 
analytics.
Second, organizational development, especially at the Philippine Health Insurance Corporation (PHIC or 
PhilHealth), has lagged behind because of frequent institutional disruptions. PhilHealth is envisioned to be the 
principal funder of the health system in the future and, therefore, a potential major player, especially in 
interventions including tuberculosis (TB) treatment, some family planning, and reproductive health (FP/RH) 
procedures, drug rehabilitation, and treatment of infectious diseases such as COVID-19. 
Third, the uncertainty and lack of clarity over who pays for what services, commodities, and health 
personnel has been a lingering issue for years and continues to result in suboptimal allocation of resources, 
especially at the health facility level.
Fourth, a few critical policies and program impediments remain that directly inhibit wider, more sustainable 
USAID HP performance. For instance, the Responsible Parenthood and Reproductive Health limits the 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | v
teaching of RH and access to contraceptives among adolescents (below the age of 18 years) without parental 
consent.
These upstream (higher-level) issues need to be resolved or at least eased before the Philippines can realize 
sustained, downstream (lower level) results. These obstacles directly impinge on the performance of the 
USAID HP’s 13 activities that the WOPE team evaluated. Although these factors are outside the scope of 
the WOPE, we invoke them as reminders that performances do not happen in a vacuum and that any theory 
of change (ToC) has critical assumptions that need to hold for sustained positive project performance to 
occur.
The USAID HP’s ToC posits that “strengthening key aspects of the health system will contribute to the 
health of underserved Filipinos, and the overall health profile of the country will improve.” There are two 
key assumptions of the ToC that USAID did not fully meet. First, the Project Approval Document assumed 
that “public sector funding levels at the central and regional levels will be maintained at current levels and 
increased throughout the life of the project.” Budget appropriations to the health sector were indeed 
maintained and even increased, but disbursement rates left much to be desired, especially in key 
interventions. The disbursement rate of the National TB Program in 2021, for instance, was only 54 percent. 
Also, USAID assumed that “health services will be continued or resumed during periods of natural disaster 
or political unrest.” However, the global COVID-19 pandemic proved to be far more serious than any health 
disaster ever imagined. Thus, although the project hypothesis remains generally valid, USAID must adjust a 
few key elements to make future engagements more attuned to changing realities.
II. Conclusions on the WOPE
We can draw seven conclusions from the WOPE findings. First, although there were significant project 
achievements, there were also significant performance gaps compared to the life-of-activity (LOA) targets. 
The USAID HP met only around half of its LOA targets. Low performance (less than 50 percent of 
achievement of LOA target) was reported for: couple-years of protection in project sites (47 percent), 
number of new FP acceptors (28 percent), and number of individuals reporting exposure to FP/RH messages 
(34 percent), TB treatment coverage rate (9–12 percent), drug-resistant TB notification rate (29–45 
percent), functional adolescent-friendly service delivery points (17 percent), and number of health workers 
who received in-service training in nontraditional platforms (30 percent).
In contrast, high performance (65 percent or more achievement of LOA target) was reported for: the 
treatment success rate for multidrug-resistant TB (60–67 percent t); treatment success rate for drug￾sensitive TB (91 percent); the number of community health workers (CHWs) providing information, 
referral, and services (90 percent); service delivery sites providing FP/RH services (89 percent); adolescents 
availing of FP/RH services (140 perc, and pulmonary TB bacteriological service coverage (65–77 percent).
Second, natural, and human-made disasters hampered the implementation and rollout of USAID HP 
activities, causing the use of USAID services to stall or fail in project sites. As of February 2, 2022, 3.5 million 
Filipinos have been infected with COVID-19, and 54,000 have died (3.4 million have recovered, and 160,300 
remained active cases). The epidemic hit hardest in the USAID HP’s three focus regions—the National 
Capital Region, Region III, and Region IV-A—as they are the densest and most urbanized. COVID-19 
crowded out other public health services as the government redeployed health assets (facilities, staff, beds, 
ICUs, equipment) to control the epidemic. As a result, the patient/client backlog in services such as TB, FP, 
RH, maternal, and child health has increased.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | vi
The Marawi Siege in 2017 between government security forces and militants affiliated with the Islamic State 
and local jihadist groups became the longest urban battle in modern Philippine history. It caused the 
displacement of 200,000 people in the city of Marawi and neighboring areas. All of Mindanao was placed 
under martial law, with attendant population mobility controls. 
Third, USAID HP targets were generally too ambitious, and data problems constrained proper performance 
assessment. A review of the LOA targets in relation to performance achievements indicates that most 
targets might not be met. Key informant interviewees noted that many of these targets were set too high, 
perhaps to encourage partner institutions to achieve more. Some of the targets, however, rested on 
assumptions that were made before the COVID-19 pandemic struck or were based on limited data available. 
Fourth, the plethora of USAID HP’s activities makes it easy to lose sight of the forest for the trees. In the 
laser-sharp focus on project implementation, it is easy to get fixated on urgent matters and lose sight of non￾urgent but important ones. In interventions that rely heavily on sectoral factors—financing, human 
resources, local leadership, and management—looking at these peripheral issues is just as important as 
managing the technical service delivery requirements of the HP activities. Technical relevance is necessary 
but is not sufficient to achieve and sustain performance. More to the point, the process of innovation, 
prototyping and scale-up focuses too much on technical aspects and often glosses over the availability of 
leadership, management, financial, and coordination inputs. 
Fifth, although the linear process of innovation, prototyping, and scale-up of HP interventions is logically 
sound, multiple partnerships and input sources often challenge sequencing during actual implementation. As a 
result, although certain innovations and models have been scaled up, some have not. Models that have 
earned unanimous or an official endorsement can be stalled by supply problems (logistics, HR, funding), but 
others can be stalled by demand problems (for instance, low utilization due to weak messaging of the 
intervention or lack of promotion). And even an innovation that a previous DOH administration has 
endorsed, like service delivery networks, can be neglected because the subsequent administration has 
different priorities or is swamped by more urgent concerns.
Sixth, the planning and implementation horizon of some USAID HP activities, especially in the area of 
strengthening health systems, is too short, and the assumed implementation sequence is linear with minimal 
risks. But evaluations of similar efforts worldwide show that it is necessary to have long-term engagement. In 
the Philippines, the short-term tenure of elected officials (three years for LGU executives) often leads to 
policy and program slippage. PHIC changes leadership frequently (once every two years on average), and 
programs such as Konsultasyong Sulit at Tama (or Konsulta, a primary benefit package) have been renamed 
with each leadership change. Thus, at every implementation level (LGU, Department of Health, PHIC), there 
are risks that should be accounted for.
Seventh, the complex USAID HP activities and the equally complex environments they are implemented in 
require more intensive and strategic inputs from USAID staff. USAID HP activities include 
prototyping/innovation to scale up platforms, health policy and regulation, health technology, health financing 
in various modalities, public-private partnerships (PPPs), and health informatics and data analytics. 
Implementation settings involve the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), 
devolved LGUs, metropolitan governments, social health insurance, and corporate social responsibility 
programs.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | vii
HP activities introduced a wide range of adaptations to allow interventions to proceed under challenges 
posed by the pandemic, including, for example, the conduct of rapid assessment for TB, FP, and ARH 
services, development of the National TB Control Program Adaptive Plan, development of guidelines for 
continuous FP/ARH services, and adoption of alternative training modalities for healthcare service providers. 
However, the WOPE team did not have sufficient time to assess the effectiveness of these adaptive 
measures. Various adaptive management and interventions were introduced in the past two years and a 
separate assessment was done.1
The above findings show the critical contextual factors that contributed to USAID HP’s varied performance 
in achieving its LOA targets.
III. Looking to the Future 
The Philippine health sector is in transition, with much remaining policy and programmatic constraints as 
well as impending challenges brought about by an evolving economy and changing burden of disease. In 
addition to highlighting the unfinished public health agenda in traditional areas, the COVID-19 pandemic has 
overburdened the country with a new infectious disease, creating a massive challenge of an old service 
backlog plus new service demands. The new political administration that will emerge from the May 2022 
elections will have its health priorities, which are expected to be couched not only in terms of response to 
COVID-19 (as it moves from a pandemic to an endemic) but also in terms of the long-term economic 
trajectory (from crisis to recovery to evolution into a middle-income and, eventually, an upper-middle￾income country). The envisioned higher economic status also has implications on the type of health system 
and financing the country needs and the institutional setup and management skills required to run such a 
system. The next planning horizon, therefore, will be more complex and challenging.
The current program pillars remain valid, but USAID must adjust them to fit the health sector’s evolving 
needs.
● Health service delivery: Operational measures of care quality should be re-introduced so that they can 
be monitored and linked to input use (e.g., use of clinical vignettes). Also, moving most in-service training 
to pre-service programs should continue rapidly, because pre-service programs are more cost-effective 
and lead to better outcomes.
● Health workforce: Future USAID programming should distinguish between service delivery workers 
(also known as “frontliners”)—which has been the focus of traditional USAID training—and those 
involved in health service integration, health economics, and financing, health technology assessment, and 
other new skills needed by a modernizing health system that is increasingly devolved, privatized or under 
PPP, and funded by third-party payors and LGUs. The further professionalization of CHWs (from 
volunteers to paid workers, with the requisite training, the scope of work, and stature) should continue. 
Substantial training investment, management, and supervision are needed to make this cadre of CHWs 
provide consistently high-quality care at their level.
1 USAID/Philippines. Joint Learning on Adaptations in the Era of COVID- 19: An Assessment of Intervention Adaptations 
and Adaptive Management Processes among USAID Health Projects. March 2022.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | viii
● Health information system: Evidence-based decision-making requires the continuation of USAID support 
in increasing the reliability of the Field Health Service Information System, increasing the interoperability 
of multiple data systems, and conducting big data analytics on social media engagement.
● Medical products, vaccines, and technologies: Continuing USAID support is needed in this area to 
evaluate and use new TB and COVID-19 testing and treatment regimens, especially because of the rapid 
pace at which these are being developed and introduced to the market. Institutional support is also 
necessary (including staff skilling) to implement specific provisions of the Health Technology Assessment 
Law that are relevant to USAID-supported interventions.
● Health financing: The USAID HP could focus on continuing policy and programmatic reforms in this area, 
including: (a) under PhilHealth, scale-up of the Konsulta primary care package to as many service delivery 
points as possible, plus full PhilHealth coverage of TB treatment, including multidrug-resistant TB; (b) 
under the national government budget, full financing of the National TB Control Program and 
consideration of providing social-care support (Ayuda) to TB patients whose treatment regimen is long; 
(c) under LGUs, assisting health teams in provinces, cities, and municipalities to advocate, budget, plan 
for, and spend expected additional local resources under the Mandanas-Garcia ruling and wisely using 
the 5 percent of LGU budget appropriated for Gender and Development to support women’s and 
children’s health concerns; (d) for both national government and LGUs, budgeting for COVID-19 
response (new facilities, vaccines, treatment, and social support).
● Health governance: The PPP response to COVID-19 has shown that PPP can be done on a large scale on 
other health interventions, such as TB, FP/adolescent reproductive health (ARH), and community-based 
drug rehabilitation. Doing so would require determined governance efforts that USAID should support. 
Stronger health regulation, especially in health technology assessment (TB, COVID-19, and other 
infectious disease interventions) is another key area USAID could support. Finally, the Philippines needs 
assistance in knowledge management in health, especially the documentation and impact evaluation of 
interventions.
The magnitude of unfinished work in FP/RH and TB services and the backlog caused by COVID-19 are large, 
and the demand for technical assistance will be significant. Two years of intermittent lockdowns, travel 
restrictions, economic slowdowns, staffing, and funding redeployment to address the pandemic, and other 
coping mechanisms enforced by the government have led to supply restrictions of non-COVID health 
services. A massive crowding out has occurred, leading to a short supply of FP/ARH, maternal and child 
health, and other essential health services. Demand for these services, especially elective/non-emergency 
care, has also shrunk because households became hesitant to go to health facilities full of COVID-19 
patients. The Philippine health sector needs technical assistance to reprogram these services and bring them 
back to normal—or the “new normal.”
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | ix
ABSTRACT
This whole-of-project evaluation (WOPE) report assesses the performance of the United States Agency for 
International Development (USAID)/Philippines Health Project (HP) from 2017 to 2022 in 13 discrete 
activities clustered around three service-delivery efforts: family planning and adolescent reproductive health, 
tuberculosis control, and community-based drug rehabilitation. The activities spanned three cross-cutting 
areas: health systems strengthening/governance, social and behavior change communication, gender equality 
and women’s empowerment. The WOPE team reviewed documents and performance indicators, analyzed 
secondary data, conducted key informant interviews, and held focus group discussions.
The report is organized by USAID HP contributions to (a) improved social norms and behaviors, (b) 
continuous quality improvement in care service delivery, (c) the strengthening of health systems and the 
operationalization of universal health care in the Philippines, and (d) improving health outcomes among the 
underserved. The evaluation team then considered investments needed to achieve desired health outcomes 
and sustainable systems changes in the Philippines.
The WOPE team found that to date, USAID HP achieved only around half of its life-of-activity targets. Key 
constraints were: (a) the prolonged COVID-19 pandemic, which stalled project activities because of frequent 
lockdowns and the redeployment of the nation’s health assets; (b) the lingering policy and programmatic 
obstacles—budget and financing, human resources, management, and coordination—characteristic of a long￾term health system reform program; and (c) institutional constraints at the Department of Health, the 
Philippine Health Insurance Corporation, and devolved local government units.
The report then recommends changes in the portfolio’s priorities, including input on training and technical 
assistance.
TABLE OF CONTENTS2
Acknowledgments.............................................................................................................................................................iii
Preface .................................................................................................................................................................................iv
Abstract...............................................................................................................................................................................ix
List of Tables.......................................................................................................................................................................x
List of Figures......................................................................................................................................................................x
Acronyms and other abbreviations...............................................................................................................................xi
Executive Summary............................................................................................................................................................1
What is WOPE? .................................................................................................................................................................7
Evaluation Objectives....................................................................................................................................................7
Evaluation Questions....................................................................................................................................................8
WOPE Methodology ....................................................................................................................................................9
Methodological Limitations.................................................................................................................................. 10
Data Collection Activities.................................................................................................................................... 10
Context of the current HP portfolio ......................................................................................................................... 12
How have the USAID HP interventions improved social norms and behaviors among the underserved 
seeking treatment and prevention services?............................................................................................................. 14
Overall findings in the assessment of performance indicators for improved social norms and healthy 
behaviors....................................................................................................................................................................... 15
Overview of interventions and innovations supported by the HP to strengthen healthy behaviors..... 18
On interventions for behavioral change on FP/ARH..................................................................................... 18
On interventions for behavior change on TB ................................................................................................. 20
On interventions for behavior change on CBDR........................................................................................... 21
Role of CHWs............................................................................................................................................................. 22
How has the USAID HP led to continuous quality improvement in service delivery? .................................. 23
Overall findings in the assessment of performance indicators to improve quality of service delivery.. 23
On FP/ARH.............................................................................................................................................................. 23
On TB....................................................................................................................................................................... 25
Overview of interventions and innovation supported by HP to improve quality of service delivery.... 26
On HP interventions to improve quality of FP/ARH services..................................................................... 26
On HP interventions to improve quality of TB care..................................................................................... 27
On HP interventions to improve quality of CBDR services ....................................................................... 28
How has the USAID HP supported the strengthening of health systems and the operationalization of 
UHC in the Philippines?................................................................................................................................................. 29
Overall findings in the assessment of performance indicators for HSS/G.................................................... 29
On stockout rates of contraceptive commodities and anti-TB drugs and TB laboratory tracer 
commodities ................................................................................................................................................................ 30
Overview of HSS/G interventions and innovations supported by HP........................................................... 32
On HSS reforms implemented and their impact on health outcomes.......................................................... 32
On HP interventions that have improved the effectiveness of DOH and other stakeholders in 
delivering their mandates.......................................................................................................................................... 33
2
Supplementary Materials A to L have been submitted to USAID/Philippines and are available upon request: (A) Family Planning 
and Adolescent Reproductive Health, (B) TB Control, (C) Community-Based Drug Rehabilitation, (D) Social Behavior Change and 
Communication, (E) Health Systems Strengthening and Governance, (F) Gender Equality and Women’s Empowerment, (G) An 
Approach to Conduct an Independent Whole-of-Project Evaluation of the USAID Health Project, (H) Initial Findings from 
Documentary Review of the Whole-of-Project Evaluation of the USAID Health Project, (I) Review of Performance Indicators, (J) 
Report on Secondary Data Analysis; (K) Comparison of Health Project Performance Indicators Baseline, End-of-Project Targets,
and Accomplishments as of Q2 FY2021; and (L) Inventory of HP Outputs.
On HP interventions that have improved national and local health system capacity ................................ 35
On HP interventions that helped expand and build provider capacity and improve supporting 
supervision and mentoring................................................................................................................................... 36
On HP interventions that helped ensure health commodity security nationally and locally ............... 37
On HP support to improve health information systems.............................................................................. 37
How has the USAID HP contributed to improving health outcomes among the underserved?................. 38
Overall findings............................................................................................................................................................ 38
On FP/ARH .................................................................................................................................................................. 39
On critical state-of-the-art training........................................................................................................................ 41
On TB............................................................................................................................................................................ 41
On CBDR..................................................................................................................................................................... 44
On challenges and barriers....................................................................................................................................... 45
For the next USAID program cycle (2022–2026), what type of support should the HP invest in to 
achieve desired health outcomes and sustainable systems changes in the Philippines? ................................. 45
Nature of future HP support................................................................................................................................... 45
On priority health systems pillars........................................................................................................................... 46
On technical assistance for FP/ARH, TB, and CBDR......................................................................................... 48
On mechanisms for delivery of support—working with partners ................................................................. 51
Summary of key recommendations........................................................................................................................ 53
General references......................................................................................................................................................... 55
Documents related to USAID/Philippines Health Project................................................................................ 57
Philippine Government Laws/Administrative Orders........................................................................................ 58
Online Resources....................................................................................................................................................... 59
Annex A. Scope of Work.............................................................................................................................................. 60
Annex B. Evaluation Frame, Analytical Protocol, Data Collection Methodology and Tools........................ 80
Annex C. All Sources of Information .......................................................................................................................132
Persons Interviewed ................................................................................................................................................132
Annex D. Consolidated Report on Key Informant Interviews..........................................................................136
General Findings...................................................................................................................................................136
1. On Partnerships with Stakeholders...................................................................................................136
2. ReachHealth.............................................................................................................................................136
3. TB Innovations........................................................................................................................................136
4. DOH..........................................................................................................................................................136
5. LGUs .........................................................................................................................................................137
On facilitators and enabling factors identified by key informants ............................................................137
On challenges and hindering factors ...............................................................................................................137
6. Monitoring................................................................................................................................................137
7. Availability of Data .................................................................................................................................137
8. Issues with Partners...............................................................................................................................137
Program-specific findings....................................................................................................................................138
9. FP Program ..............................................................................................................................................138
10. TB Program.........................................................................................................................................139
11. CBDR ...................................................................................................................................................140
12. Health Systems Strengthening ........................................................................................................141
13. Gender Equality and Women’s Empowerment..........................................................................142
Synthesis of Key Insights ....................................................................................................................................143
14. Social Behavior Change ....................................................................................................................143
15. Effect of Gender in Supply Chain Management..........................................................................143
16. Monitoring of Funds at the LGU Level.........................................................................................143
17. Approaches Used ..............................................................................................................................143
18. Sustainability and Future Activities and Projects........................................................................143
Annex E. Disclosure of Any Conflict of Interest...................................................................................................144
Certification No. 1...............................................................................................................................................144
Certification No. 2...............................................................................................................................................145
Certification No. 3...............................................................................................................................................146
Certification No. 4...............................................................................................................................................147
Certification No. 5...............................................................................................................................................148
Certification No. 6...............................................................................................................................................149
Certification No. 7...............................................................................................................................................150
Certification No. 8...............................................................................................................................................151
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | x
List of Tables
Table 1. Number of new FP acceptors in USG-assisted sites...................................................................................... 15
Table 2. Number of individuals in the target population reporting exposure to USG-funded FP messages 
through radio, television, electronic platforms, community group dialogue, interpersonal 
communication, or in print (by channel/# of channels) ................................................................................. 16
Table 3. Number of USAID-assisted CHWs providing FP information, referrals, or services during the year in 
USG-assisted sites................................................................................................................................................... 16
Table 4. TB detection rates (TB treatment coverage)................................................................................................... 16
Table 5. Drug-resistant TB notifications............................................................................................................................ 17
Table 6. Childhood TB notifications................................................................................................................................... 17
Table 7. Percentage of community contribution to TB notification ........................................................................... 17
Table 8. Percentage of USG-assisted SDPs providing FP counseling and/or services ............................................ 23
Table 9. Number of functional adolescent-friendly SDPs.............................................................................................. 23
Table 10. Number of adolescents using FP/SRH services in supported adolescent-friendly SDPs..................... 24
Table 11. Percentage of USG-assisted DOH regional offices and LGUs with functional ICV compliance 
committee/monitoring team.............................................................................................................................. 24
Table 12. Bacteriological diagnosis coverage (pulmonary TB) ..................................................................................... 25
Table 13. Private-sector TB notifications......................................................................................................................... 25
Table 14. Percentage of new and relapse TB patients tested using a WHO-recommended rapid test at the 
time of the diagnosis, USG-assisted sites........................................................................................................ 25
Table 15. Average stockout rates of contraceptive commodities, disaggregated by method at USG-assisted 
FP service delivery points in USG-assisted sites........................................................................................... 30
Table 16. Reported average stockout rate of contraceptive commodities, disaggregated by method, at USG￾assisted FP service delivery points in USG-assisted sites (MTaPS FY 2021 AMEL/PITT) ................... 31
Table 17. Average stockout rates of selected anti-TB drugs and TB laboratory tracer commodities at USG￾supported NTP facilities in USG-assisted sites.............................................................................................. 32
Table 18. CYP in USG-supported programs.................................................................................................................... 39
Table 19. Number of health workers who received in-service training using nontraditional learning platforms 
in FP and TB in USG-assisted sites................................................................................................................... 41
Table 20. Treatment success rates for MDR/RR-TB cases, CY 2019–2021............................................................. 41
Table 21. DS-TB treatment success rate, CY 2019–2021 ............................................................................................ 42
List of Figures
Figure 1. HP log frame (2017 PAD).................................................................................................................................... 10
Figure 2. CYP growth rates, 2018–2020 ........................................................................................................................... 40
Figure 3. TB treatment success rates, 2018–2020.......................................................................................................... 43
Figure 4. Percentage of provinces and cities that reached TB treatment success rates, 2018–2020................. 44
 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | xi
Acronyms and other abbreviations
4Ps Pantawid Pamilyang Pilipino Program
AI artificial intelligence
AO administrative order
ARH adolescent reproductive health
BARMM Bangsamoro Autonomous Region in Muslim Mindanao
BARMMHealth Bangsamoro Autonomous Region in Muslim Mindanao Health Capacity-Building
BHW barangay health worker
BIHC Bureau of International Health Cooperation, DOH
BNS barangay nutrition scholar
CBDR community-based drug rehabilitation
CBMS community-based monitoring system
CDCS Country Development Cooperation Strategy
CHD Center for Health Development
CHW community health worker
CiTEC Citywide TB Elimination Campaign
CLA collaborating, learning, and adapting
CLAimHealth Collaborating, Learning, and Adapting for Improved Health
CMSU2 Community Maternal, Neonatal, Child Health & Nutrition Scale-up
CQI continuous quality improvement
CSE comprehensive sexual education
CY calendar year
CYP couple-years of protection
DBM Department of Budget and Management, GPH
DDB Dangerous Drugs Board, GPH
DepEd Department of Education, GPH
DID difference-in-difference
DILG Department of the Interior and Local Government, GPH
DOAg Development Objective Agreement
DOH Department of Health, GPH
DOTS directly observed treatment, short course (for TB)
DPCB Disease Prevention and Control Bureau, DOH
DR-TB drug-resistant tuberculosis
DS-TB drug-sensitive tuberculosis
DSWD Department of Social Welfare and Development, GPH
eLMIS electronic logistics management and information system
EO executive order
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | xii
EQ evaluation question
FAB fertility-awareness-based
FAST Find Actively, Separate Safely, Treat Effectively
FDA Food and Drug Administration
FGD focus group discussion
FHSIS Field Health Service Information System
FP/ARH family planning/adolescent reproductive health
FPCBT family planning competency-based training
FY fiscal year
GAD Gender and Development
GBV gender-based violence
GEWE gender equality and women’s empowerment
GPH Government of the Philippines
HCPN health care provider network
HHRDB Health Human Resources and Development Bureau, DOH
HP Health Project, USAID/Philippines
HPB Health Promotion Bureau, DOH
HPPE Health Project performance evaluation
HRH human resources for health
HRH2030 Human Resources for Health 2030/Philippines
HSS/G health systems strengthening/governance
HTAC Health Technology Assessment Council
ICV informed choice and voluntarism
IEC information, education, and communication
IHLGP Institutionalization of Health Leadership and Governance Program
IMAP Integrated Midwives Association of the Philippines
IP implementing partner
IRR implementing rules and regulations
ITIS Integrated Tuberculosis Information System
IUD intrauterine device
KII key informant interview
KMITS Knowledge Management and Information Technology Service, DOH
KRA key result area
LGU local government unit
LOA life of activity
M&E monitoring and evaluation
MDR/RR-TB multidrug-resistant/rifampicin-resistant TB
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | xiii
MEL monitoring, evaluation, and learning
MNCHN maternal, neonatal, child health, and nutrition
MOH Ministry of Health, BARMM
MRL Muslim religious leader
MTaPS Medicines, Technologies, and Pharmaceutical Services Program
NCR National Capital Region
NTP National Tuberculosis Control Program, DOH
NTRL National TB Reference Laboratory 
OH Office of Health, USAID/Philippines
PAD Project Approval Document
PFG Partnership for Growth
PhilCAT Philippine Coalition Against Tuberculosis
PhilHealth or PHIC Philippine Health Insurance Corporation
PhilSTEP1 Philippine Strategic TB Elimination Plan, Phase 1
PITT performance indicator tracking table
POPCOM Commission on Population and Development
PPP public–private partnership
PRM Program Resource Management Office, USAID/Philippines
ProtectHealth Health Equity and Financial Protection Platform
PSI progestin-only subdermal implants
PWUD people who use drugs
RA Republic Act
ReachHealth FP/MNH Health Innovations and Capacity-Building Platforms
RenewHealth Expanding Access to Community-based Drug Rehabilitation Program in the Philippines
RHU rural health unit
SBCC social and behavior change communication
SBIRT screening, brief intervention, and referral to treatment (for CBDR)
SCM supply chain management
SDM standard days method (for FP)
SDN service delivery network
SDP service delivery point
SHF Special Health Fund
SRH sexual and reproductive health
TB tuberculosis
TB IHSS TB Innovations and Health Systems Strengthening
TB LON TB Local Organizations Network 
TB Platforms TB Platforms for Sustainable Detection, Care, and Treatment
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | xiv
ToC theory of change
TPT TB preventive treatment
TSR treatment success rate
UHC universal health care
UIS UHC integration sites
USAID United States Agency for International Development
USG United States government
WHO World Health Organization
WISN Workload Indicators of Staffing Need
WOPE whole-of-project evaluation
WRA women of reproductive age
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 1
EXECUTIVE SUMMARY
I. Purpose of the Report 
Using a whole-of-project evaluation (WOPE) approach, this report examines the extent to which the U.S. 
Agency for International Development (USAID)/Philippines Health Project (HP) has achieved its purpose in 
four areas: (a) improving Philippine health outcomes among the underserved, (b) improving social norms and 
behavior change in health, (c) establishing and nurturing innovations in continuous quality improvement 
(CQI) in service delivery, and (d) operationalizing health systems’ support for and governance toward 
universal health care (UHC). The evaluation team analyzed three areas of USAID’s interest: family planning 
and adolescent reproductive health (FP/ARH), tuberculosis (TB) prevention and treatment, and community￾based drug rehabilitation (CBDR). They used findings from these analyses to identify priorities for USAID’s 
next program cycle (2024–2026).
This WOPE relied on document reviews, review of implementing partners’ project performance data, 
secondary data analysis, key informant interviews between October 14 and December 2, 2021, and focus 
group discussions among FP acceptors and TB patients in Tanza, Cavite, on November 15, 2021. However, 
because of the COVID-19 pandemic, the evaluation team did not conduct extensive field visits. Moreover, 
sites supported by the United States government (USG) were compared to non-USAID sites, and there are 
inherent shortcomings in these direct comparisons.
II. HP Contributions in Improving Philippine Health Outcomes among the 
Underserved
Although the USAID HP made significant achievements in reaching intermediate outputs (e.g., trained 
workers, innovations started and nurtured), performance outputs—in terms of FP acceptors, couple-years of 
protection (CYP), and TB case finding—fell short of life-of-activity (LOA) targets. Although major policy 
reforms have been achieved at the macro level, in part due to USAID support—such as the Responsible 
Parenthood and Reproductive Health (RPRH) Law, the UHC Law, the TB Law, and their implementing rules 
and regulations (IRR) and manuals of operations—difficult implementation challenges remain, including the 
Government of the Philippines’ (GPH) partially budgeted activities, staff shortages, and weaknesses in 
management and coordination.
At best, USAID HP has met 50 percent of its LOA targets. This checkered performance happened during the 
COVID-19 pandemic, which stalled critical activities in the last two years and severely affected people’s 
utilization of services. In hindsight, many LOA targets were overly optimistic, and some implementation 
challenges were under-appreciated; scaling up is difficult in the context of unfinished devolution with multiple 
stakeholders. The planning and implementation of institutional changes, such as the Department of Health 
(DOH) management of human resources, also require horizons further than what was envisioned in the HP. 
Many project activities happen within the complications of bureaucracy and local politics, with their inherent 
incentive issues and problems of short political tenure, which we must make allowances for, even with well￾intentioned managers in place. Finally, the Philippines faces a lingering scarcity of leadership and management 
in key public health interventions and policy, planning, programmatic, and evaluation requirements, which 
must be dealt with.
The progress achieved during 2017–2022 reflects an incremental achievement in health reform and program 
agenda in USAID’s focus areas of FP/ARH, TB, and CBDR, even with the emergence of new challenges and 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 2
threats, such as COVID-19 and its economic and sector impact. This incremental progress also sets the 
stage for what the new Philippine government administration will do to advance these focus areas starting in 
mid-2022.
FP/ARH: The USAID HP has provided technical assistance to more than 2,000 service delivery points (SDPs) 
providing FP services, which is 86 percent of the LOA target. However, the number of functional adolescent￾friendly health SDPs that the HP assisted was only 36 in the Bangsamoro Autonomous Region in Muslim 
Mindanao (BARMM), which is 65.5 percent of the LOA target, and only 18 in the rest of the country, which 
is 6.8 percent of the LOA target). The HP also provided institutional support to the DOH and local 
government units (LGUs) for FP/ARH.
HP’s fiscal year (FY) 2021 midyear report shows USAID sites have reached close to nine million CYPs, 
representing only around half (48 percent) of its LOA target. Moreover, 2018–2020 data show that HP￾assisted cities and provinces had the same CYP as those that did not receive HP assistance. Finally, statistical 
analysis of the performance of USG sites versus non-USG sites over time did not show significant differences 
between the two groups. In BARMM, the use of adolescent-friendly health SDPs has been low, owing in part 
to the region’s cultural views of teenage pregnancy.
Although these findings may appear weak traction of USAID assistance, non-USG sites could very well be 
receiving other forms of FP/ARH assistance from other sources, which would clearly demonstrate the 
shortcomings of directly comparing sites. Note also that USG sites were specifically chosen for their higher 
burden of disease with extremely low baseline performance. There are also questions about the reliability of 
Field Health Service Information System data used in the comparison analysis and about the over-optimism 
of the FP/ARH LOA targets, given the ensuing COVID-19 pandemic, with the epicenter in USAID’s “big 
three” regions: the National Capital Region, Region III, and Region IV-A. More analyses are also needed on 
the “dosage effect” (program intensity) of USAID HP interventions. Researchers should undertake a more 
careful impact evaluation and cost-effectiveness analysis of USAID interventions receiving significant funding 
and management attention.
Key challenges in reaching the LOA targets are resolving the status of barangay (community) health workers 
(CHWs) regarding professionalization, full budgeting of primary package (Philippine Health Insurance 
Corporation [PhilHealth or PHIC], LGUs), further reducing contraceptive stockouts, and resolving the legal 
impediments regarding teenage access to contraceptives under the RPRH Law. The program introducing FP 
in hospitals reached sufficient maturity for broader adoption.
TB: At the regional level, for quarter two (Q2) FY 2021, success rates for treating drug-sensitive TB (DS￾TB) cases in USAID regions were 90–91 percent, the same as the National TB Control Program (NTP) 
target of 91 percent. Success rates for treating multidrug-resistant/rifampicin-resistant TB were 60–67 
percent, compared to NTP’s 66 percent target. It is harder to establish comparative trends at provincial and 
city levels because of the highly differing baseline burdens of disease.
In terms of program innovations, the Find Actively, Separate Safely, Treat Effectively (FAST) Plus program for 
TB, implemented in 59 hospitals (54 in the NCR and five in other USG-supported regions), has been 
effective. Also, the Philippine Private Diagnostics Consortium (with 20 members), established with USAID 
support, ran 5,000 tests, and detected 1,100 DS-TB cases. However, despite these programmatic 
achievements, the TB detection rate, even in USAID sites, remains low. 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 3
In light of the large funding gaps in implementing the TB Law, the key challenge in reaching the LOA targets 
is the creation of national and local government TB budgets. Fund disbursement also remains a big problem, 
with only 54 percent of funds being spent for the calendar year (CY) 2019 and CY 2020. Sustaining the city￾led TB campaigns is crucial, as TB is largely found in dense areas.
CBDR: As of Q2 FY 2021, only 723 people who use drugs (PWUD) were reported to have undergone 
CBDR in USAID sites, representing 3.5 percent of the LOA target of 20,926. Although COVID-19 has 
definitely slowed CBDR activities, the underlying challenge is the intricate multi-agency CBDR framework 
involving the Philippine Drug Enforcement Agency, Dangerous Drugs Board, DOH, Department of Interior 
and Local Government, and host LGUs. Much more can be done in this area, but the stigma remains strong 
and the capacity of CBDR workers is still limited. Moreover, due to the enormous needs and operation gaps 
at the community levels, the current project appears to be spreading itself too thinly across many activities, 
and multiple stakeholders have not yet agreed on a common set of CBDR indicators that link performance 
to national CBDR goals. 
III. HP Contributions in Improving Social Norms and Behavior Change in Health 
FP/ARH: In Q2 FY 2021, USAID HP reported: (a) 900,000 new FP acceptors, representing 27.9 percent of 
the LOA target, and (b) 12.3 million people exposed to FP/RH messages through USAID’s various platforms, 
representing 34.2 percent of the LOA target. These seemingly low-performance achievements may be due 
to underreporting, as the most measurement is being done in traditional platforms (direct patient dialogue) 
but is not yet comprehensively done in social media, which has gained popularity. Compared to FP/RH 
clients, USAID HP was more successful in reaching health workers, with 90 percent of the LOA target of 
89,735 community health workers (CHWs) met.
Of the 13 USAID interventions in this area, seven have buy-in from the government (i.e., DOH, the 
Commission on Population and Development, and the Department of Education). The DOH Health 
Promotion Bureau has deemed USAID’s support, in terms of upgrading skills and formulating communication 
strategies, effective. Muslim religious leaders (MRLs) have been tapped in BARMM to endorse FP and help 
clarify pertinent issues. Usapan (conversation) sessions and their variants have reached almost 6,000 people, 
but interventions oriented to male clients (e.g., Katropa and Usapang Maginoo) need to be replicated. Social 
media campaigns such as “It’s OK to Delay,” “Konektado Tayo,” and “Usap Tayo sa FP” have reached millions 
of online users. However, converting messages into behavior change and utilization of services—and the 
impact measurement of this process—remains challenging. Expanding male involvement in FP remains 
difficult because of the scarcity of male FP counselors and other providers. The Lunas Collective, a feminist 
initiative supporting women experiencing gender-based violence, although innovative, has attracted only 272 
clients.
TB: For Q2 FY 2021, TB detection rates in USG-supported regions were 7–9 percent, lower than baseline 
rates and the 12 percent LOA target. For DR-TB notifications, the 6,841 cases detected in USG-supported 
regions represent only 35.9 percent of the LOA target. Childhood TB case notification posted a higher 
achievement of 67.5 percent of the LOA target of 64,506.
Through the HP, USAID supported DOH in developing the National TB Health Promotion and 
Communications Strategy 2020–2023. Among the key interventions were the social media campaign 
#TBFreePH, the Tibay ng Dibdib storybook campaign for children, and the Ayos Ka Lungs campaign involving 
entertainment personalities. However, there has not been much analysis of the performance and 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 4
effectiveness of these engagements using appropriate metrics. Data analytics of Facebook, Twitter, and 
YouTube TB engagements would shed light on the reach of these programs. Feedback mechanisms that 
answer clients’ queries also need to be built into these activities.
CBDR: Testing of the Lusog Isip (Healthy Mind) mobile app for mental health and substance abuse help will 
be rolled out in 2022. In USG sites,100,772 PWUD (64 percent of target LOA) have sought help.
IV. HP Contributions Leading to Continuous Quality Improvement in Service Delivery 
FP/ARH: In areas outside BARMM, a Q2 FY 2021 survey of clients in 33 USAID-assisted sites showed that 
92 percent gave a rating of 3–4 out of 5 for quality factors involving providers’ interpersonal skills and the 
quality of service. In BARMM, a Q1 FY 2021 survey in four provinces showed an average satisfaction rating 
of 3.8 out of 5. This increased to 4.8 out of 5 in a separate survey in Q2 FY 2021 in five provinces. These 
numbers confirm that, in general, service quality is acceptable in USG-assisted sites. 
USAID has supported 32 LGUs in setting up their CQI initiatives. The FP in Hospital Program, currently 
running in 162 public and private hospitals nationwide, has built-in CQI elements. Despite the COVID-19 
pandemic, this program continues in 46 facilities through the Makeshift Teleconsultation platform. In 
BARMM, the HP supported provincial health offices in establishing 68 CQI sites and conducted CQI training 
for health providers.
TB: The 2020–2021 pilot survey among patients showed an average satisfaction score of 4.6 out of 5, 
indicating excellent quality of TB care in USG-supported sites. The coverage of bacteriological diagnosis of 
pulmonary TB in USG-supported regions ranged from 39 percent in NCR to 46 percent in Region III (or 65 
percent and 77 percent of LOA targets, respectively). Technology-based innovations abound in USAID￾supported TB interventions. With USAID assistance, DOH introduced the all-oral short-term regimen for 
MDR-TB. The HP is also validating the accuracy of the new Xpert MTB/RiF Ultra for TB diagnosis. Digital 
adherence tools such as Video Observed Treatment and ConnecTB improve treatment compliance.
CBDR: In June 2020, the New Client Flow for PWUD was launched, which standardized screening tools, 
placing them in the appropriate treatment mode according to risk level. As of Q3 FY 2021, 50,635 PWUD 
have been screened, representing 64 percent of the LOA target. The HP conducted online webinars and 
training-of-trainers programs as part of the rollout of the CBDR screening tool. For example, 248 screening 
providers have been trained on screening, brief intervention, and referral to treatment.
V. HP Contributions in Operationalizing Health Systems Strengthening/Governance 
(HSS/G)
The HP measures overall HSS/G performance using three indicators: (a) the percentage of people in USAID￾assisted areas enrolled in PhilHealth, which is high at 88 percent; (b) PhilHealth support values, which 
measure financial protection but are not available for FP and TB services; and (c) budget disbursement rates 
(FY 2020), which were low for both TB (54 percent) and FP (16 percent) because of disruptions by the 
COVID-19 pandemic. Key activities in this area are supply chain management (SCM), implementing UHC and 
strengthening local health systems, and improving the management of training programs in health. 
SCM: Stockout rates of key FP commodities in USG-assisted sites are generally better than those in non￾USG-supported sites, and performance in the USG-assisted sites is close to meeting the LOA targets. The 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 5
LOA target for stockout rate at the USG-assisted sites was set at 7 percent across all FP commodities; by 
Q2 FY 2021, stockout rates for pills, injectables, and intrauterine devices (IUDs) had gone down to 8.5–10.0 
percent. Only condoms, progestin-only subdermal implants (PSI), and standard days method beads continue 
to experience high stockouts. The HP also appears headed to achieve its stockout targets for TB 
commodities, except for pediatric TB drugs and drugs for TB preventive treatment.
USAID helped the DOH secure an open-source electronic logistics management and information system 
(eLMIS), which is being tested in DOH warehouses, selected regional DOH offices, and LGUs. USAID 
expects the total number of test sites to reach 170 by June 2022.
UHC Implementation and Local Health Systems Strengthening: At the policy level, USG helped the 
government draft the IRR of the new UHC Law. UHC is being rolled out nationwide. At the operational 
level, USAID helped PHIC develop the Konsulta primary care benefit package (which now covers TB 
treatment, IUD insertion, and PSI placement) being pilot tested among 130 providers as of September 2021.
The HP supports LGUs in UHC integration. As of November 2021, 35 out of 58 LGUs in UHC integration 
sites have signed a memorandum of understanding. However, because of COVID-19, most of these sites 
have not yet set up their organizational key result areas (KRAs) to achieve such integration, and half the sites 
have yet to start KRAs in human resource management.
Managing State-of-the-Art Training in Health: USAID assisted in setting up and operationalizing the 
DOH Academy, particularly its e-learning portal. However, the number of health workers who went 
through in-service training using nontraditional learning platforms reached only 7,706 participants or 29.8 
percent of the LOA target.
VI. Summary of Key Recommendations
On HP support for the DOH: (a) size up and cost out the FP and TB backlog due to the COVID-19 
pandemic; (b) help develop a strategy for the regularization of CHWs/BHWs/barangay nutrition scholars 
(BNS); (c) link CQI with budgets and incentives; (d) rationalize the Gender and Development (GAD) budget; 
(e) undertake capacity-building for the newly organized DOH Disease Prevention and Control Bureau 
(DPCB); (f) build on the momentum generated by COVID-19 containment, especially private-sector 
engagement; and (g) organize a region-wide UHC implementation lab using TB and FP-maternal, neonatal, 
child health, and nutrition (MNCHN) as tracers (possibly within the “big three” regions).
On current HP interventions for testing, documentation, and replication: (a) Citywide TB Elimination 
Campaign; (b) Philippine Private Diagnostics Consortium; (c) eLMIS; (d) Workload Indicators of Staffing 
Need; (e) CBDR screening, brief intervention, and referral to treatment; (f) ConnecTB; and (g) Catastrophic 
TB Package in PhilHealth.
On HP interventions for scaled implementation: (a) FP in hospitals, (b) MRLs as public health leaders, (c) 
FAST Plus, (d) Institutionalization of Health Leadership and Governance Program in regions, (e) Konsulta
package, (f) Katropa, (g) comprehensive sexual education-ARH Convergence Program, (h) adolescent-friendly 
health facilities, and (i) men’s reproductive health.
In future HP activities: (a) one TB implementing partner (IP) with distinct components on innovation design, 
testing, replication, and planning for institutionalization; (b) a distinct BARMM component within an umbrella 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 6
FP IP; (c) independent monitoring, evaluation, and learning/collaborating, learning, and adapting IP, with the 
mandate to collect, analyze, and monitor the performance of HP activities and to share lessons with the 
DOH; and (d) additional role for an HSS/policy/finance IP that will validate institutionalization and scale-up 
strategies for HP interventions. Moreover, technical capacity, perhaps by way of a facility similar to an 
indefinite-quantity contract, may be considered to augment HP management’s ability to supervise increasingly 
complex and challenging interventions. Such additional capacity may be needed in sorting and assessing the 
design, technical soundness, approaches to replication, and institutionalization for eventual scaled 
implementation.
An approach that ties all these recommendations together in a way that allows for scaled implementation is 
to package HP support and focus its activities to help the DOH implement UHC at a regional level. Support 
for a UHC regional laboratory should involve two or more provinces containing consumers and providers of 
health services representing a continuum of care from disease prevention to primary curative care to 
treatment and rehabilitation in tertiary and specialty facilities.
Replication and eventual institutionalization might be easier at the regional level, given existing administrative 
and budgetary mechanisms at the regional level through the DOH, PhilHealth, the Commission on 
Population and Development, and other institutions. It may be in the context of supporting regional UHC 
labs, where the LGU pivot initiated by current HP activities might become more meaningful. The regional 
level is also where USAID could concentrate future efforts to build capacity to manage increasingly complex 
financing and delivery system. A particular concern is the need to expand and strengthen the number and 
availability of middle-level managers at regional and LGU health offices. USAID also needs to complement 
this proposed expansion of health management capacity with the appropriate enhancement of health 
management information systems. Finally, following the experience with efforts to contain COVID-19, it may 
be easier to engage the private sector and civil society organizations at levels that involve both consumers 
and providers of the continuum of care.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 7
WHAT IS WOPE?
Evaluation Objectives
The evaluation team uses a whole-of-project evaluation (WOPE) approach to examine the extent to 
which the United States Agency for International Development (USAID) Health Project (HP) has 
achieved its intended purpose and sub-purposes. Toward this end, the WOPE is expected to:
1. Inform future strategic directions and approaches of the USAID HP
2. Recommend adaptations in the design of current interventions that could be implemented in the 
remaining years
3. Determine whether currently supported activities contribute to achieving HP goals
4. Determine facilitating and hindering factors affecting the achievement of HP goals
5. Determine the validity of the HP theory of change (ToC), value perceptions of stakeholders on 
USAID assistance, and unintended results that affect HP outcomes
The mid-cycle WOPE covers the 13 HP activities organized by the USAID/Philippines Office of Health 
(OH) since 2018. These activities have asynchronous project start-up and closeout dates, but the end of 
the current HP program cycle is in 2024.3 The HP focuses on family planning and adolescent 
reproductive health (FP/ARH); tuberculosis (TB) control; and community-based drug rehabilitation 
(CBDR), as well as three cross-cutting activities covering health systems strengthening and governance 
(HSS/G), social and behavioral change communication (SBCC), and gender equality and women’s 
empowerment (GEWE). 
This report is intended for the information and use of the leadership and technical staff of the 
USAID/Philippines OH, USAID/Philippines Program Resource Management (PRM) Office, and the 
Development Objectives Agreement (DOAg) management committee and steering committee.
3
Health Project Activities 2018–2024: (1) Community Maternal, Neonatal, Child Health & Nutrition Scale-up (CMSU2) (August 2016–December 
2019); (2) FP/MNH Health Innovations and Capacity Building Platforms (ReachHealth) (December 2018–November 2023); (3) Bangsamoro 
Autonomous Region in Muslim Mindanao Health Capacity Building (BARMMHealth) (February 2019–February 2024); (4) Treat TB: Supporting 
MDR-TB Activities in the Philippines (September 2016–March 2019); (5) TB Innovations and Health Systems Strengthening (TB IHSS) (February 
2018–February 2023); (6) TB Platforms for Sustainable Detection, Care and Treatment (TB Platforms) (April 2018–April 2023); (7) TB Local 
Organizations Network (TB LON) (October 2020–September 2023); (8) Institutionalization of the Health Leadership and Governance Program 
(IHLGP) (July 2017–September 2020); (9) Health Equity and Financial Protection Platform (ProtectHealth) (March 2019–March 2024); (10) 
Medicines, Technologies, and Pharmaceutical Services Program (MTaPS) (September 2018–September 2023); (11) Human Resources for Health 
2030/Philippines (HRH2030) (October 2017–June 2020); (12) Expanding Access to Community-based Drug Rehabilitation Program in the 
Philippines (RenewHealth) (May 2019–May 2024); and (13) Collaborating, Learning, and Adapting for Improved Health (CLAimHealth) (March 
2018–March 2022)
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 8
Evaluation Questions 
The scope of work for the WOPE specifies 14 main evaluation questions (EQs), with corresponding 
sub-questions to clarify the intent of the main questions. In subsequent meetings with USAID/Philippines, 
five questions were deemed most critical and essential in meeting the evaluation objectives. These are:
EQ1. How have the USAID HP interventions improved social norms and behaviors among the underserved 
seeking treatment and prevention services? 
● What demand-generation platform and messaging were most effective for: men, adolescent 
youth, urban poor, women with unmet needs for FP, and people who use drugs (PWUD)?
● What HP interventions have improved health-seeking behavior and treatment adherence?
EQ2. How has the USAID HP led to continuous quality improvement in care service delivery? 
● How has the HP improved the skills of FP/ARH health providers?
● How has HP expanded FP and other FP services?
● What were the TB projects’ key contributions to TB control in the Philippines, and to what 
extent have the projects addressed key TB issues and gaps?
● What are the three most effective packages of TB and FP interventions that could be scaled up 
nationwide?
EQ3. How has the USAID HP supported the strengthening of health systems and the operationalization of 
universal health care (UHC) in the Philippines? 
● What HSS reforms are in place because of USAID interventions? How are these HSS reforms 
impacting health outcomes?
● What HP interventions have improved the effectiveness of the Department of Health (DOH) 
(Disease Prevention and Control Bureau [DPCB], Health Promotions Bureau [HPB], 
Pharmaceutical Division, Health Human Resources and Development Bureau [HHRDB],
Dangerous Drugs Abuse and Prevention and Treatment Bureau, its information systems); the 
Ministry of Health (MOH) of the Bangsamoro Autonomous Region of Muslim Mindanao 
(BARMM); the Philippine Health Insurance Corp. (PHIC or PhilHealth); and the Dangerous
Drugs Board (DDB) in delivering their mandates?
● What HP interventions have improved local health system capacity for policy formulation, 
budget planning and execution, inter-local cooperation, program implementation, and 
monitoring and evaluation (M&E)?
● What HP interventions have increased national and local capacity in health systems management 
in sustainably supporting TB and FP/ARH programs?
● What HP interventions have helped expand and build health provider capacity for quality health 
care delivery for TB, CBDR, and FP/ARH programs?
● What HP interventions have helped in improving supportive supervision and mentoring of 
human resources for health (HRH)?
● What HP interventions have helped ensure TB and FP/ARH health commodity security at the 
national and local levels?
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 9
● How has the HP supported the improvement of the TB, FP/ARH, and CBDR information 
systems?
EQ4. How has the USAID HP contributed to improving health outcomes among the underserved? 
● To what extent have HP activities contributed to achieving the targets (i.e., the extent of 
performance relative to the annual targets and end-of-project targets)? 
● What were the critical enabling factors associated with achieving HP targets?
● What were the challenges and barriers to achieving HP targets?
● What innovations contributed to improving health outcomes?
EQ5. For the next USAID program cycle (2024–2026), what type of support should the HP invest in to achieve 
desired health outcomes and sustainable systems changes in the Philippines? 
● Which health system pillars should be prioritized?
● What type of technical assistance should be provided for TB, HSS/G, FP/ARH, and CBDR? 
● What mechanisms should be used for the delivery of support? 
The evaluation team addressed the remaining questions and the factors contributing to specific HP 
performance in various parts of the evaluation. We adopted the final set of questions underscored in 
Technical Direction No. 2 provided by the USAID/Philippines PRM Office.
In our approach to this WOPE, we view the USAID/Philippines OH as the principal body that exercises 
both technical and administrative leadership over the HP. The OH is responsible for HP’s design and 
implementation strategy. It is ultimately accountable for the performance. Additionally, the DOH, local 
government units (LGUs), and other entities are implementing partners (IPs) of the HP that are engaged 
at various levels. The IPs are contracted or have cooperative agreements with the OH to implement the 
HP and produce deliverables at specified levels of effort with specified resources. We assumed the IPs 
exercise due diligence by engaging the OH in ways that would allow necessary adjustments for better 
implementation of HP tasks. Using this perspective, the evaluation team delineated the roles of these 
key HP players.
WOPE Methodology
The evaluation team employed four inter-related methods of analysis given the available information, 
time, and resources. The team:
1. Compared and explained the differences between the original HP design and the implementation 
strategy described in the Project Approval Document (PAD) of 2017
2. Explained changes in performance over time from the start of HP activities (baseline measures) 
to life-of-activity (LOA) performance measures
3. Explained variations between targets and accomplishments
4. Compared the differences in program performance between sites where HP interventions were 
introduced against those of sites where HP interventions were not present (specifically at the 
province and highly urbanized city levels).
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 10
We used the logical framework in the 2017 PAD to compare the HP design with its actual 
implementation (Figure 1). Key sections in the 2017 PAD that served as the yardstick for the evaluation 
were the comparative advantages of USAID built by predecessor projects and the ToC for HP,
particularly the recommendations referred to as big shifts. The detailed evaluation method is discussed 
in Annex B.
Figure 1. HP log frame (2017 PAD)
Methodological Limitations
Ideally, the evaluation should be able to determine outcomes and attribute these to specific 
interventions that the HP introduced. However, because the HP was not designed with a built-in 
evaluation frame, complete with sufficient controls, we implemented an approach that approximated a 
full difference-in-difference (DID) analysis using selected data from the Field Health Service Information 
System (FHSIS) and the Integrated TB Information System (ITIS). A full description of the DID 
methodology is in Supplementary Material J. Ideally, the analysis should have been conducted at the 
municipal level, where, according to reports, current HP interventions have gained traction. However, 
because of issues with data quality and the availability of reliable FHSIS and ITIS data at the municipal 
level, we limited our secondary data analyses to the provincial level and highly urbanized cities.
Data Collection Activities
The evaluation included a review of relevant project documents such as the IPs’ annual reports and 
work plans and the yearly HP performance evaluations (HPPEs); a review of performance data (baseline, 
target, annual, and LOA); analyses of secondary data from the FHSIS and ITIS; key informant interviews 
(KIIs) with USAID/OH, IPs, government counterparts, and other stakeholders; and focus group 
discussions (FGDs).
Document Review. During the incipient stage of the evaluation, we conducted an initial review of the 
2017 PAD, annual reports submitted by IPs, HPPEs, and other background documents related to the 
project. This review provided the team with deeper insights into HP operations to date. It also allowed 
us to finalize the evaluation design, data collection tools, and relevant probing questions to help us dig 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 11
deeper into specific issues. The initial document review for this evaluation is provided in Supplementary 
Material H.
Review of IP Reports and Performance Data. The team examined the performance indicator 
tracking tables (PITTs) submitted by IPs and compared the baseline measures with targets and actual 
accomplishments in the years, regions, provinces, cities, and municipalities for which data are available. 
We took note of the explanations of observed differences that the IPs and partners reported in official 
documents. The team also performed an in-depth analysis of several initiatives and innovations 
implemented by the HP that are expected to have a high impact, have taken root, or have gained 
traction where they were introduced and have the potential for being scaled up and sustained beyond 
the HP. The full review of performance data (baseline, targets, and accomplishments) and an assessment 
of performance indicators are provided in Supplementary Material K.
Secondary Data Analysis. We selected measures available in the FHSIS and ITIS to determine HP’s 
contribution. In evaluating the impact on its target goals, we analyzed changes across sites (HP-assisted 
and non-HP-assisted provinces and cities) and across time (fiscal year [FY] 2018–2020) using the DID 
method. The DID approach compared the changes between HP-assisted and non-HP-assisted provinces 
and cities using various regression models (e.g., logit, fractional logit, and ordinary least squares) to 
evaluate the statistical significance of the observed differences between these groups through time while 
controlling for the provincial and independent/highly urbanized cities’ internal revenue allotment. 
However, it should be noted that the DID analysis provides an estimate of how selected performance 
indicators vary between sites supported by the United States government (USG) and non-USG-assisted 
sites over the years covered in the report.
The analysis found no statistically significant differences between sites and over time, but this should not 
be taken as evidence that HP interventions are ineffective. In other sections of this report, we note that 
HP interventions have only started to gain traction and cannot be expected to have affected outcomes 
at scale. It should also be considered that HP-assisted sites were chosen particularly for having a high 
disease burden and unmet needs. While we have been unable to explicitly account for interventions by 
other donor agencies, such influences may be accounted for to the extent that they vary across 
provinces, cities, and regions. What we cannot discern from the analysis would be the joint influence of 
other donors in sites also supported by the HP.
The full report on the secondary data analysis of select FHSIS and ITIS indicators is provided in 
Supplementary Material J.
KIIs. The team completed 75 online KIIs between October 14, and December 2, 2021. Annex C lists 
the persons we interviewed and their institutional affiliations. We have not identified respondents by 
name to maintain confidentiality.
FGDs. We conducted two FGDs among FP acceptors and TB patients in Tanza, Cavite, on November 
15, 2021. The evaluation team was led by Dr. Orville Solon, professor and former dean of the School of 
Economics, University of the Philippines Diliman. He is supported by: Dr. Ma. Soledad Antonio, ex-officio
member and director of the DOH Bureau of International Health Cooperation; Ms. Frances Mamaril, ex￾officio member and ad interim director, DOH Health Policy Development Program Bureau; Dr. Mario 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 12
Festin (FP/ARH specialist), professor at the College of Medicine, University of the Philippines Manila and 
a former medical officer at the World Health Organization (WHO) Headquarters in Geneva; Dr. 
Kathryn Roa (TB specialist), infectious disease specialist at the Davao Doctors Hospital and Southern 
Philippines Medical Center; Dr. Julienne Baldo-Cubelo (CBDR/SBCC specialist), professor and former 
chairperson of the University of the Philippines Mass Communication Research Department; Ms. Ermi 
Amor Figueroa-Yap (HSS/G specialist), economist and former consultant of USAID’s Collaborating, 
Learning, and Adapting for Improved Health (CLAimHealth); Ms. Fatima Verzosa (GEWE specialist), 
former gender advisor in USAID/Philippines, USAID/Afghanistan and USAID/Burma (Myanmar); Dr. 
Noel Juban† (data collection specialist); Mr. Oscar Picazo (technical editor); Mr. Arturo Ongkeko, Jr. 
(evaluation associate); and Mr. Chamuel Michael Joseph Santiago (evaluation coordinator/technical 
assistant).
The main report describes the team’s overall findings across all three program areas and cross-cutting 
themes answers the five key EQs and provides strategic recommendations for consideration. Individual 
team members prepared the following supplementary materials: Family Planning and Adolescent 
Reproductive Health, TB Control, Community-Based Drug Rehabilitation, Social Behavior Change and 
Communication, Health Systems Strengthening and Governance, and Gender Equality and Women’s 
Empowerment. Other supplementary materials include the following: An Approach to Conduct an 
Independent Whole-of-Project Evaluation of the USAID Health Project, Initial Findings from 
Documentary Review of the Whole-of-Project Evaluation of the USAID Health Project, Review of 
Performance Indicators, Report on Secondary Data Analysis, Comparison of Health Project 
Performance Indicators Baseline, End-of-Project Targets and Accomplishments as of quarter two (Q2) 
FY2021, and Inventory of HP Outputs. Supplementary materials will be made available upon request.
The following required annexes are attached to the main report: WOPE Scope of Work; Evaluation 
Frame, Analytical Protocol, Data Collection Methodology, and Tools; Source of Information; 
Consolidated Report on Key Informant Interviews; Statement of Difference; and Disclosure of any 
Conflict of Interest.
CONTEXT OF THE CURRENT HP PORTFOLIO
USAID/Philippines’ Country Development Cooperation Strategy (CDCS) served as the guiding 
framework in implementing the current HP. The HP straddles two CDCSs. From 2013to –2019, the 
focus was on the Partnership for Growth (PFG) to attain the goal of a more stable, prosperous, and 
well-governed nation. Building on the gains of 2018 and 2019, the current HP support is guided by the 
new CDCS (2019–2024), which focuses on good governance and self-reliance to achieve the goal of the 
Philippines becoming “A Well-Governed and More Self-reliant Indo-Pacific Partner.”4 The three 
development objectives of the CDCS are: (1) democratic governance strengthened; (2) inclusive, 
market-driven growth expanded; and (3) environmental and community resilience enhanced. The CDCS 
also emphasizes three cross-cutting strategies: increased private-sector engagement, enhanced gender
and social inclusion, and civil society strengthened.
4
USAID Philippines. (October 28, 2019). Country development cooperation strategy 2020–2024. Available at 
https://www.usaid.gov/sites/default/files/documents/1861/Philippines_CDCS_2019-2024.pdf
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 13
In line with the CDCS, the purpose of the USAID/Philippines HP 2018–2024 is “Improved Health for 
Underserved Filipinos.” In keeping with the PFG, the Health Portfolio aligns with the Philippine Health 
Agenda 2016–20225 of DOH and was developed with guidance from the USAID/Philippines Health 
Portfolio Evaluation in August 20166 and the PAD.7 Three sub-purposes contribute to the HP purpose: 
(1) health behaviors strengthened, (2) quality of services fortified, and (3) key health systems bolstered 
and institutionalized. The HP consists of four primary health programs: (1) FP/ARH, (2) TB control, (3) 
CBDR, and (4) HSS. Under each program, USAID/Philippines funds one or more mechanisms also 
referred to as activities.
The HP focuses on geographic areas where the health burden is the greatest—in other words, where 
the TB disease burden is the highest, where unmet needs for FP are the highest, where there are high 
teenage pregnancy rates, and where there is a high evidence-based need for drug demand reduction 
services. This is in addition to the inherent structural weaknesses of a devolved public health system, 
resulting in fragmented service delivery and financing, high transaction costs of stakeholder engagement, 
and widening inequity in access to quality public and private health care.8 The Mandanas-Garcia ruling, 
while expected to increase LGU funding by close to 30 percent, may not necessarily lead to increased 
investments in health. Moreover, outstanding issues remain, especially regarding the implementation of 
milestone health legislation, as discussed below.
The enactment of the UHC Law (Republic Act [RA] 11223) in July 2018 led the HP IPs to refocus some 
of their resources to support the DOH, PhilHealth, and USG-assisted sites in establishing the necessary 
soft infrastructures to improve access to health services for the underserved. However, delays in the 
development and approval of RA 11223 implementing rules and regulations (IRR) led to postponements 
in the implementation of planned activities. In terms of health financing, PhilHealth provided coverage for 
98 percent of the population in 2018. However, it is hounded by charges of inefficiency and corruption. 
By the end of 2019, PhilHealth owed approximately 174 million Philippine pesos (PHP) for primary care 
benefit payments. 
Budget planning and execution, as well as procurement and supply chain management, remain 
problematic, even with the provision of training and bureaucratic remedies. While there is a steady rise 
in the DOH’s annual budgets, delays in budget approval and the persistent problem of low disbursement 
of funds at the DOH have led to delays in implementation of activities, hindrance of the procurement 
process, and stockouts of drugs and commodities. 
The Comprehensive TB Elimination Plan Act of 2016 mandated the adoption of a multisectoral response 
to TB. This law paved the way for the 2017–2022 Philippine Strategic TB Elimination Plan, Phase 1 
(PhilSTEP1). However, the fragmentation of service delivery and financing has prevented the effective 
5
Department of Health, Republic of the Philippines. Philippine Health Agenda 2016–2022.
6
USAID Philippines. (August 2016). Health portfolio evaluation.
7
USAID Philippines. Project appraisal document: USAID/Philippines Health Project 2017–2022.
8
Panelo, C. I. A., Solon, O. J. C., Ramos, R. M., Herrin, A. N. (2017). The challenge of reaching the poor with a continuum of care: A 25-year
assessment of Philippine health sector performance.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 14
control of TB. Despite efforts based on the globally accepted directly observed treatment, short-course 
(DOTS) strategy, there has been no significant decline in TB burden since 2007, as confirmed by the 
findings of the 2016 National TB Prevalence Survey. 
The Responsible Parenthood and Reproductive (RPRH) Law provided a fresh mandate to centrally 
finance and deliver FP services. However, the late disbursement of funds, combined with the lack of 
storage space and disruptions in delivery due to Food and Drug Administration (FDA) requirements, 
exacerbated stock-outs of drugs and commodities. Furthermore, a moratorium on the implementation 
of the RPRH Law and a global shortage of progestin-only subdermal implants (PSI) have aggravated the 
resupply issue.
COVID-19 and Private Sector Engagement. In 2020, the COVID-19 pandemic diverted the time 
and resources of the Philippine’s national and local governments away from other public health 
programs like TB and FP. It overburdened the country with reemerging infectious diseases, such as 
polio. Lockdowns, travel restrictions, and distancing protocols disrupted the provision of essential health 
services such as immunization for children and antenatal care. Health providers employed adaptive 
measures to mitigate the effects of the mobility restrictions, such as reducing the number of health staff 
and transport constraints of clients. However, even with adaptive measures, we can expect significant 
backlogs in non-COVID-19 health programs.
Despite these challenges, the pandemic demonstrated unprecedented private-sector participation. The 
private sector was forced to take a more proactive role in supporting the health system to thwart the 
threat to business continuity and survival. Actions have included mass testing and procurement of 
personal protective equipment needed by those on the front line, especially health care workers. The 
private sector collectively stepped up and did more than its fair share in addressing this crisis and 
supporting communities at large. At present, the public and private sectors are working on the scaled 
and swift rollout of the country’s COVID-19 vaccination program. Several companies are contributing 
financial resources, contacts and networks, intellectual capital, and logistics assets to help the 
government meet its vaccination objectives.
HOW HAVE THE USAID HP INTERVENTIONS IMPROVED SOCIAL NORMS 
AND BEHAVIORS AMONG THE UNDERSERVED SEEKING TREATMENT AND 
PREVENTION SERVICES?
Although SBCC is understood as the framework for improving health behavior through communication, 
it is hardly given any significant discussion in HP activity work plans and reports. Much of the HP work 
on SBCC continues to be measured in terms of participation in or attendance at face-to-face 
communication sessions. Often, meetings or conversations on SBCC among government agencies, 
providers, and beneficiaries are deemed as evidence of strengthened health behavior. In lieu of “reach” 
metrics, USAID may want to consider pilot-testing exit survey interviews to get a sense of the narratives 
and sentiments of the clients on HP-supported services and activities. This can be done by way of 
reception analysis, which is a qualitative method that explores the extent to which the client makes 
sense of media content. In addition, this can be complemented by a textual analysis, which refers to the 
review of content in media and popular culture. 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 15
There is a divide between two mindsets: SBCC as delivery of services and SBCC as capacity-building. 
SBCC as delivery of services refers to the provision of information to targeted clients to influence health 
care utilization. SBCC as capacity-building refers to the provision of training and related assistance to 
health care providers so that they can relay the information their clients need. Given limited resources, 
the current HP portfolio was designed to prioritize building the capacity of health providers and health 
program managers to design and provide SBCC. The trade-off is to limit reach for now in exchange for 
greater reach when capacitated providers can act as force multipliers.
Overall findings in the assessment of performance indicators for improved 
social norms and healthy behaviors
On FP/ARH
The USAID HP reported having achieved more than 900,000 new acceptors in Q2 FY 2021. This 
represents 28 percent of its LOA target (Table 1). During the same period, HP reported that 12.3 
million people were exposed to HP-funded messages through various platforms (Table 2). This gap in 
numbers indicates more work is needed to get people to reflect on and establish the link between 
SBCC strategies and health outcomes. To do this, social media, and on-ground SBCC activities ideally 
must include direct, individualized follow-up discussions on particular topics that can likely influence 
individuals to make better health care decisions. This can be in the form of a phone or social media 
hotline where an adolescent can talk to a peer advocate to clarify and follow up on information. 
In terms of establishing metrics to link SBCC strategies to outcomes, USAID may want to consider using 
“engagement” metrics such as a brief survey tool that simply asks questions such as: What prompted 
you to use the service? What health information have you come across lately that helped you in your 
decision to come here? These questions can be incorporated into the facility intake form. In addition, 
the HP can measure the number of times an SBCC material has been shared. 
Because the indicators refer to individuals reporting exposure to messages, the HP needs to address 
whether 12 million individuals were asked questions. HP reports should indicate if such reports are 
based on estimates. Although the target platform is radio, social media use can be measured or 
estimated using the number of views and likes. The HP should also include other methods to improve 
the reporting of reach of USAID-supported messages.
Table 1. Number of new FP acceptors in USG-assisted sites
Baseline LOA 
Target
Accomplishment as of Q2 
FY2021
Percentage 
Accomplished
Health 
Project 754,672 3,419,909 952,509 27.9%
Source: HP PITT_210701.xlsx, FP indicators-FY2021_MY sheet
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 16
Table 2. Number of individuals in the target population reporting exposure to USG-funded 
FP messages through radio, television, electronic platforms, community group dialogue, 
interpersonal communication, or in print (by channel/# of channels)
Baseline LOA Target Accomplishment as of Q2 
FY2021
Percentage 
Accomplished
Health 
Project 836,162 36,116,740 12,341,645 34.2%
Source: HP PITT_210701.xlsx, FP indicators-FY2021_MY sheet
However, it is notable that the HP reached 90 percent of its target, representing more than 80,000 
community health workers (CHWs) trained to provide FP information, referrals, and services (Table 3). 
The HP must continue to harness the skills of the CHWs to reach more women of reproductive age 
(WRA) with unmet needs for FP. CHWs are on the front lines, and USAID may want to explore with 
the DOH and the LGUs how to professionalize and support them. The HP can assist the DOH and 
LGUs in reviewing RA 7883 or the Barangay Health Workers (BHWs) Benefits and Incentives Act of 
1995. USAID should explore how the current training programs for BHWs may be integrated into the 
Barangay Health Services NC2 vocational courses of the Technical Education and Services Development 
Authority. USAID should also consider supporting the National Confederation of BHWs of the
Philippines.
Table 3. Number of USAID-assisted CHWs providing FP information, referrals, or 
services during the year in USG-assisted sites
Baseline LOA Target Accomplishment 
as of Q2 FY2021
Percentage 
Accomplished
Health Project 52,166 89,735 80,771 90.0%
Source: HP PITT_210701.xlsx, FP indicators-FY2021_MY sheet
On TB
TB detection rates reported in USG-assisted sites remain low. For FY 2020, detection rates for the 
National Capital Region (NCR), Region III, and Region IV-A were 7 percent, 7 percent, and 9 percent, 
respectively. These rates are lower than what was reported at baseline in 2018. The detection rates are 
no more than 12 percent of LOA targets for these regions (Table 4).
Table 4. TB detection rates (TB treatment coverage)
Baseline LOA Target Accomplishment 
as of FY2020
Percentage 
Accomplished
NCR 12% 75% 7% 9.3%
Region III 10% 75% 7% 9.3%
Region IV-A 13% 75% 9% 12.0%
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 17
Source: HP PITT_210701.xlsx, TBR1 sheet
In terms of drug-resistant TB (DR-TB) notifications, USG-assisted regions in Q1 of calendar year (CY) 
2021 reported the cumulative number of cases notified representing 44.5 percent, 35.5 percent, and 
28.7 percent of LOA targets for NCR, Region III, and R VI-A, respectively (Table 5).
Table 5. Drug-resistant TB notifications
Baseline LOA Target
Accomplishment 
as of Q1 CY 
2021
Percentage 
Accomplished
NCR 1,701 6,235 2,776 44.5%
Region III 785 5,582 1,984 35.5%
Region IV-A 968 7,261 2,081 28.7%
Source: HP PITT_210701.xlsx, TB indicators-CY2021 Q1 sheet
Childhood TB cases notified are over half the LOA targets. In Region III, the number of childhood TB 
cases notified reached over 90 percent of LOA target. It is important to carefully document this 
accomplishment and determine what underlying factors may be used in other sites (Table 6).
Table 6. Childhood TB notifications
Baseline LOA Target Accomplishment 
as of Q1 CY2021 % Accomplished
NCR No baseline 20,987 13,472 64.2%
Region III No baseline 18,866 17,273 91.6%
Region IV-A No baseline 24,653 12,766 51.8%
Source: HP PITT_210701.xlsx, TB indicators-CY2021 Q1 sheet
From these data, one gets the impression that the TB program has focused on multidrug￾resistant/rifampicin-resistant TB (MDR/RR-TB) and childhood TB cases. It is important to review the 
strategies that worked in these interventions and find ways that they can be applied to improve drug￾sensitive TB (DS-TB) case detection. 
In terms of percentage of community contribution to TB notification for NCR, Region III, and Region IV￾A, the HP reported 8 percent, 10 percent, and 11 percent, respectively (Table 7).
Table 7. Percentage of community contribution to TB notification
Baseline LOA Target Accomplished as 
of Q1 CY2021
Percentage 
Accomplished
NCR No baseline Indicator not 
carried over to 
8% N/A
Region III No baseline 10% N/A
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 18
Table 7. Percentage of community contribution to TB notification
Baseline LOA Target Accomplished as 
of Q1 CY2021
Percentage 
Accomplished
Region IV-A No baseline Updated 
PhilSTEP1. 11% N/A
Source: HP PITT_210701.xlsx, TB indicators-CY2021 Q1 sheet
Overview of interventions and innovations supported by the HP to 
strengthen healthy behaviors
The HP can track how many people SBCC interventions have reached, but the final effects on health￾seeking behaviors have yet to be observed. The HP needs to translate the number of people reached 
into the number of people using health services and test this mechanism in a local setting.
The COVID-19 prevention and control experience in the Philippines offers opportunities to determine 
how messages and communications convert to actual behaviors (e.g., mask wearing, vaccination) and 
subsequently on disease incidence. The HP work on FP/ARH, which has directly engaged the DOH’s 
HPB, regional DOH offices, and the Commission on Population and Development (POPCOM), is in the 
best position to sum up these lessons and help translate, for the DOH and LGUs, how these might be 
used to meet SBCC goals for FP/ARH, TB, and CBDR.
DOH officials point out that HP support to the HPB has been useful and effective, and helped build staff 
skills in developing communication materials. HP also helped develop communications strategies of 
programs for health schools and the Healthy Pilipinas campaign. Many of the interventions to strengthen 
healthy behaviors are expected to indirectly affect output targets, with medium- and long-term gains to 
be realized. For FP/ARH, of the 13 interventions, seven have buy-in from the DOH, POPCOM, and the 
Department of Education (DepEd). For TB, 20 of 25 interventions have buy-in from health facilities, 
LGUs, regional offices, and private provider groups. Many of these interventions include help designing 
and evaluating possible pilot and demonstration activities. In these activities, there are no explicit 
expectations on how much such interventions will translate into utilization of services for FP/ARH and 
TB. For CBDR, gains are expected to be realized mostly in the long term. The WOPE team finds these 
interventions to be sound in design and in the form of assistance piloting or demonstrating activities (see 
Supplementary Material L). The DOH also appreciates HP support in assessing the needs of various 
population groups, which allows for tailored communications strategies.
An inventory of interventions directed at improving social norms and behaviors that lead to seeking 
treatment and prevention services is in Supplementary Material L.
On interventions for behavioral change on FP/ARH
Engagement of Muslim religious leaders (MRLs) and other religious leaders
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 19
MRLs or Ulama were engaged in BARMM as active partners in addressing misconceptions of FP in Islam 
and promotion of FP use. MRLs clarify questions raised by potential users. Because MRLs also indicate 
which FP methods cannot be used, the HP should focus on the methods that are endorsed, especially 
those with available supply, and focus its monitoring on these.
For men, avenues for discussing FP, especially about their roles, show potential for improved health￾seeking behavior. The Usapan (conversation) sessions with MRLs provide a venue to discuss masculinity, 
family leadership, and responsibility and how they relate to spirituality. The MRLs as spiritual leaders 
help dispel myths and outdated notions about FP. The MRLs’ facilitation in these sessions provides a 
sense of safety around traditionally difficult topics to discuss among men. 
Little progress has been made on dialogue with Catholic leaders. These have been difficult, as they 
involve spiritual, moral, and philosophical concepts that may not lead to easy conclusions and may lead 
to more confusion. However, USAID may want to explore other Christian denominations that are more 
progressive in their views on FP.
Usapan sessions (and its variants)
Usapan is a group communication technique developed to directly link clients to FP service delivery. 
USAID succeeded in getting buy-in from the DOH and POPCOM on this activity. However, it has not 
been scaled up and is not well known among FGD participants. The challenge for the HP is to scale up 
this intervention by attaching it to social networks such as the regular family development session of 4Ps 
(Pantawid Pamilyang Pilipino Program) or the conditional cash transfer program.
Opportunities for Usapan scale-up include integrating it with the regular clinic sessions (like antenatal 
classes) and putting forth a deliberate effort to engage special groups like out-of-school youth, older 
clients, men, and post-pregnancy clients. As pointed out by FGD participants, the main source of 
information on FP are rumors or casual conversations among neighbors and peers, typically involving 
details that are false. In engaging these special groups, it may be worthwhile for the HP to identify where 
these conversations take place and explore how to integrate correct and valid information. 
Usapan is a good demand-generation tool. However, it targets those who are already open to using FP. 
It is a service-oriented FP dialogue designed to allow clients to listen to concerns from people who are 
less aware or are ashamed to ask questions. To address concerns that only those who are about to 
decide, or have already decided, to use FP are likely to join these sessions, Usapan should be monitored 
systematically, including follow-up with attendees. Usapan sessions need to balance discussions on 
decisions, preferences, and choices, which can be discussed privately during individual counseling 
sessions. 
Social media campaigns and IEC materials for FP/ARH
The HP effectively used social media to create demand for FP/ARH. Social media campaigns such as “It’s 
Okay to Delay,” “Konektado Tayo,” and “Usap Tayo sa FP” reached millions of potential beneficiaries. 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 20
However, we cannot ascertain the effectiveness of these online engagements in translating reach into 
actual behavior change. The HP also developed FP videos with songs and messages to address fear and 
anxiety about FP, such as the “Sama-sama Tayong Mag FP” video with English and Tagalog subtitles, with 
30- and 60-second versions for TV and radio spots, plus infographics and flyers. 
These IEC materials are best used if lodged in well-planned SBCC platforms with specific message 
strategies. Visible SBCC work also reinforces community-level efforts, especially in indirect and 
peripheral routes to expanding and changing mindsets. If media content is available, health care 
providers can not only point their clients to this content, but they themselves can continually upgrade 
and update their health education.
On interventions for behavior change on TB
Social media campaigns for TB
The HP supported the DOH in developing the National TB Health Promotion and Communication 
Strategy 2020–2023, but there is a gap in terms of systematic implementation of interventions. Various 
approaches were used, such as the #TBFreePH campaign via social media; “Tibay ng Dibdib,” a storybook 
campaign for children; and the “Ayos Ka Lungs?” campaign, which included engagements with 
entertainment celebrities.
The effectiveness of these campaigns can only be partially determined. For example, for the Tibay ng 
Dibdib campaign, the number of subscribers for each platform of the media partner was mentioned in 
one IP’s annual report, but there were no metrics to determine engagements. The report mentioned 
249,000 YouTube subscribers for Net 25 TV. These reach metrics should be substituted with 
engagement metrics, such as a brief survey asking the clients what prompted them to use the service 
and their sources of service information. 
The creation of the Tibay ng Dibdib campaign can be considered an empowering spontaneous SBCC 
innovation. However, there is a need to establish a more systematic feedback mechanism from the 
health care providers/implementers. The impact of SBCC, although often long-term in fruition, can 
provide windows for provisional appraisal through the stories from the ground noted by the health care 
providers. This implies the importance of IP staff having a strong SBCC mindset and experience. They 
are the ones who could be quick to pick up these experiences and transport them into creative ideas 
for a scalable SBCC campaign.
The #TBFreePH FB page/group is a gold mine for SBCC data generation that has potential for the 
creation of both specific and universal messaging for SBCC. Inside the online support group, there are 
frequently asked questions showing common myths about TB treatment and recovery; narratives of 
coping and treatment; and even stories of personal encounters with health care providers. This can be 
strengthened by a supplemental social media portal that gives compact media content that can be passed 
around without requiring membership. Group membership can still appear as an important commitment 
to many, therefore deterring potential TB patients from moving closer to seeking treatment. An open￾to-all social media page can be a one-stop shop for health care providers and TB patients and their 
families. 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 21
HP-supported online patient support groups for TB can be a platform for the analyses of patient 
preferences and sentiments to improve healthy behaviors. An example that can be used in TB is “social 
listening,” which the DOH uses to correct publicly provided information on COVID-19.
HP support of active case finding
The HP supported active case finding in communities and enhanced facility-based case finding. These are 
not demand-generation activities but are effective alternatives to passive case finding. As of FY 2021, 
Find Actively, Separate Safely, and Treat Effectively (FAST) Plus is being implemented in 54 hospitals in 
the NCR, four hospitals in Regions IV-A and VIII, and eight hospitals in Region III.9 FAST Plus is an 
effective strategy for identifying, isolating, diagnosing, and managing patients coupled with infection 
prevention and control and health care worker surveillance for TB. 
HP support of TB advocacy
Although the TB Local Organizations Network (TB LON) supports the Philippine Alliance to Stop TB, 
which has a strong focus on TB patients, it is not clear whether TB LON differentiates itself from similar 
work by the Philippine Coalition Against Tuberculosis (PhilCAT), given that PhilCAT counts community 
service organizations, individual providers, and public agencies as members and seems to be doing the 
same activities. Cooperation and coordination between these two organizations can lead to scaled 
effects. 
TB LON does advocacy work to increase TB funding at the national and local levels. This needs to be 
connected to activities that ensure programs are accessible to, and addressing health behaviors of, the 
underserved. TB LON should seek out more nontraditional and non-TB organizations representing 
vulnerable groups, such as farmer cooperatives, public transport driver associations, and other 
organizations representing marginalized sectors.
TB LON should conduct research on stigma to determine its pervasiveness and its patterns across 
population groups so that the right interventions can be designed. It is also important to determine 
SBCC strategies to promote primary care practices (e.g., hand washing, cough etiquette, distancing, use 
of masks) that are effective for a class of communicable diseases, including TB.
On interventions for behavior change on CBDR
Although HP support focuses on the client journey to recovery and reintegration, many LGUs still 
subscribe to “fear mode” on the rehabilitation of PWUD. A crucial step is for HP and its government 
partners to finalize and agree on a common set of CBDR indicators linked to national CBDR program 
goals.
Formative research on PWUD influenced the branding of CBDR programs, including Katatagan Kontra 
Drogas sa Komunidad (Resilience against Drugs in the Community) and Katatagan, Kalusugan at Damayan 
9
These figures are from the FY 2021 Annual Report of TB Innovations. The Q1 FY 2022 report of TB Platforms state that 219 hospitals have 
been covered.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 22
ng Komunidad (Resilience, Health, and Care in the Community) to minimize stigma and highlight drug use 
as a health issue. 
Lusog Isip (Healthy Mind) is an online app that encourages seeking help and facilitating self-awareness and 
self-love among PWUD. It has been pilot-tested and will be rolled out in FY 2022 through the DOH 
mental health program. The HP’s work on CBDR shows that at the end of FY 2021, a total of 100,772 
PWUD have sought help for their substance abuse problem (or 64 percent of the life-of-project target).
The HP’s work on CBDR, specifically on the SBCC paradigm, is manifold. It is working toward changing 
many behaviors in a general sense. USAID should sift through the identified behaviors that PWUD are 
encouraged to change and zero in on more specific aspects of health behaviors that are obstacles to 
change. For example, from the general target of removing stigma against addiction, CBDR should 
sharpen the focus on collective care as the pathway to recovery. In this pathway, HP can magnify the 
role of health care providers, communities, and the families of PWUD. Materials are available in 
government portals and the HP IP’s portal informing stakeholders of the role of community in CBDR. 
However, a strong SBCC program that targets specific behaviors and mindsets—among PWUD as well 
as the general population—has yet to be drafted.
Role of CHWs
CHWs (and MRLs, in the case of BARMM) play a key role in supporting FP and TB service provision. 
CHWs have successfully assisted the community by providing preventive and primary health care 
services, particularly during the pandemic. As residents of geographically isolated and disadvantaged 
areas in BARMM are less receptive to FP, CHWs work in tandem with MRLs to provide information 
based on fatwa. In Lapu-Lapu City, 90 percent of CHWs are treatment partners for TB.
A recurring concern is that CHWs are overworked and underpaid. CHWs, who are predominantly 
women, serve as the backbone of the health system at the lowest organizational level and carry on their 
shoulders the success of FP/ARH and TB interventions. However, they are often shifted to do multiple
tasks. Before 2018, a ratio of 1:20 households per CHW was the basis for tasking for all FP and TB 
concerns of adults, children, and adolescents. Now, the assignment is over 1:100 households, with at 
least two days of task-sharing duty at rural health units (RHUs) for client intake, registration, and 
cooking.
CHWs are key to reaching adolescents and engaging male clients. CHWs with the barangay and youth 
organizations are also effective in reaching adolescent out-of-school youth. There are very few male 
CHWs, although the MOH in BARMM estimates that 30 percent of its CHWs are male. Some gay males 
were cited as effective in connecting with both men and women in barangays. 
Legislation to support CHWs has been pending for years and has not been considered a priority. Most 
CHWs get an allowance of only PHP 500 to PHP 3,000 per month.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 23
HOW HAS THE USAID HP LED TO CONTINUOUS QUALITY IMPROVEMENT 
IN SERVICE DELIVERY?
a. How has the HP improved the skills of FP/ARH health providers?
b. How has the HP expanded FP services?
c. What were the TB project’s key contributions to TB control in the Philippines, and to what extent has HP 
addressed key TB issues and gaps?
d. What were the three most effective packages of TB and FP interventions that could be scaled up 
nationwide?
There were fewer interventions directed at continuous quality improvement (CQI) initiatives in health 
centers compared to public and private hospitals. Moreover, while USAID wanted to shift the HP away 
from health service delivery to HSS activities (training, policy, logistics), many LGUs still express a 
preference for continued USAID support in providing additional staff and a steady supply of 
commodities and educational materials, especially for FP and TB. But efforts to institutionalize CQI have 
been stalled in many sites that were closed during the COVID-19 pandemic, including those for 
adolescents and postpartum women and TB cases. The HP needs to support the DOH and LGUs in 
developing a catch-up strategy to address delays and disruption owing to the pandemic.
Overall findings in the assessment of performance indicators to improve 
quality of service delivery 
On FP/ARH
The HP provided technical assistance to more than 2,000 service delivery points (SDPs) providing FP 
counseling and services. This represents 85.6 percent of its LOA target (Table 8). However, in terms of 
functional adolescent-friendly SDPs, HP support in non-BARMM areas achieved only 6.8 percent of the 
LOA target. In BARMM, around 36 facilities, or about 65.5 percent of the HP’s LOA target, was 
achieved (Table 9).
Table 8. Percentage of USG-assisted SDPs providing FP counseling and/or services
Baseline LOA Target Accomplishment 
as of Q2 FY2021
Percentage 
Accomplished
Health Project 75.6% 97% 83.1% 85.6%
Numerator 1,643 2,622 2,126
Denominator 2,173 2,698 2,557
Source: HP PITT_210701.xlsx, FP indicators-FY2021_MY sheet
Table 9. Number of functional adolescent-friendly SDPs
Baseline LOA Target Accomplishment 
as of Q2 FY2021
Percentage 
Accomplished
ReachHealth N/A 266 18 6.8%
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 24
BARMMHealth N/A 55 36 65.5%
Source: HP PITT_210701.xlsx, FP indicators-FY2021_MY sheet
Although there are fewer functional adolescent-friendly health SDPs in non-BARMM-supported areas, 
the HP catered to 148,568 adolescents, or 184.2 percent, of its LOA target (Table 10). The low 
utilization in BARMM may be associated with adolescents’ cultural and social norms and family influence 
in the region. Given this, USAID may want to promote a wide range of services offered in adolescent￾friendly facilities, such as mental health support and nutrition, and not just associate adolescent services 
in the facilities with sexual and reproductive health (SRH). 
Table 10. Number of adolescents using FP/SRH services in supported adolescent￾friendly SDPs
Baseline LOA Target Accomplishment 
as of Q2 FY2021
Percentage 
Accomplished
ReachHealth 69,350 80,650 148,568 184.2%
BARMMHealth 0 27,055 2,489 9.2%
Source: HP PITT_210701.xlsx, FP indicators-FY2021_MY sheet
The HP established only one informed choice and voluntarism (ICV) compliance committee (out of the 
LOA target of 32) in the HP-assisted LGUs, excluding BARMM. At the regional level, there was none 
reported among the 11 regional offices supported by the HP. In BARMM, three of six ICV committees, 
or half of the LOA target, are already in place. Because this is a requirement by law and is mandated by 
DOH Administrative Order (AO) No. 2011-0005, HP may want to shift its support to the validation and 
monitoring teams and ensuring quality standards for FP service delivery.
Table 11. Percentage of USG-assisted DOH regional offices and LGUs with functional 
ICV compliance committee/monitoring team
Baseline LOA Target Accomplishment as 
of Q2 FY2021
Percentage 
Accomplished
ReachHealth 0.0%
CHDs 100% 0.0% 0.0%
Numerator 0
Denominator 11
LGUs 0.0% 100% 3.1% 3.1%
Numerator 1
Denominator 32
BARMMHealth 0.0% 100% 50.0% 50.0%
Numerator 3
Denominator 6
Source: HP PITT_210701.xlsx, FP indicators-FY2021_MY sheet
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 25
On TB
HP support of bacteriological diagnosis coverage for pulmonary TB achieved 39 percent in NCR, 46 
percent in Region III, and 45 percent in Region IV-A (Table 12). We suggest the reporting of actual 
numbers in addition to percentages to better assess the scale and coverage of continuing assistance.
Table 12. Bacteriological diagnosis coverage (pulmonary TB)
Baseline LOA Target Accomplishment as 
of Q1 CY2021
Percentage 
Accomplished
NCR 60% 39% 65.3%
Region 3 60% 46% 77.0%
Region 4A 60% 45% 74.8%
Source: HP PITT_210701.xlsx, TB indicators-CY2021 Q1 sheet
In terms of private-sector TB notifications, the HP achieved close to 50,000 in NCR, more than 66,000 
in Region III, and more than 89,000 in Region IV-A (Table 13). These accomplishments may have to be 
compared with the burden of TB cases in these regions to assess the scale and coverage of support 
provided.
Table 13. Private-sector TB notifications
Baseline LOA Target Accomplishment as of Q1 CY2021 Percentage Accomplished
NCR No data 49,406 N/A
Region 3 No data 66,106 N/A
Region 4A No data 89,217 N/A
Source: HP PITT_210701.xlsx, TB indicators-CY2021 Q1 sheet
For the percentage of new and relapse TB patients tested using a WHO-recommended rapid diagnostic 
test for NCR and Regions III and IV-A, the HP reported 27 percent, 40 percent, and 35 percent actual 
accomplishment, respectively, as of Q1 CY 2021.
Table 14. Percentage of new and relapse TB patients tested using a WHO￾recommended rapid test at the time of the diagnosis, USG-assisted sites
Baseline LOA Target Accomplishment as 
of Q1 CY2021
Percentage 
Accomplished
NCR 30% 70% 27% 39.0%
Region 3 15% 70% 40% 56.6%
Region 4A 11% 70% 35% 50.7%
Source: HP PITT_210701.xlsx, TB indicators-CY2021 Q1 sheet
Average client satisfaction score of clients who came for FP/RH and TB services
As of Q2 FY 2021, the HP work on FP/ARH (excluding BARMM) included surveying 1,520 clients in 33 
HP-supported sites. About 92 percent of clients gave an average rating of 3–4 (out of 5) for each of the 
following: health facility factors, interpersonal skill of providers, and service delivery factors. In BARMM, 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 26
in a survey conducted during Q1 2021, the average satisfaction reported was 3.8 out of 5 among 
randomly selected WRA in four HP-supported provinces. In Q2 FY 2021, the HP surveyed 43 clients in 
five HP-assisted provinces, who gave an average satisfaction rating of 4.8 out of 5. 
It is useful to analyze feedback from both clients and nonclients and pay attention to the comments from 
those who gave low feedback, because these indicate areas where services were deficient or 
unsatisfactory. Feedback can also be taken from the health providers regarding their perceptions of the 
program’s strengths and weaknesses. For TB, the HP pilot-tested client satisfaction from Q4 FY 2020 to 
Q1 FY 2021. The survey reported an average satisfaction score of 4.6 (out of 5) among the 550 TB 
patients surveyed. USAID must make efforts to expand measurement of client satisfaction ratings to 
inform current and future needs of FP/ARH, TB, and CBDR clients. The HP has yet to report its actual 
accomplishment on contact investigation coverage for pulmonary TB, TB preventive treatment 
coverage, and the number of people with improved access to services.
Overview of interventions and innovation supported by HP to improve 
quality of service delivery
On HP interventions to improve quality of FP/ARH services
The HP conducts regular CQI initiatives in public and private hospitals. Key characteristics the HP looks 
at are client satisfaction, privacy, cleanliness of clinical areas, efficiently used waiting times, and respectful 
and knowledgeable providers. In BARMM, the HP supported the provincial health offices in establishing 
68 CQI sites and trained 195 health care providers. Meanwhile, USAID also supported 32 LGUs outside 
BARMM in establishing their CQI initiatives. These CQI methods may be adapted for health centers, 
although quality indicators and parameters need to be defined within the context, workflow, and scope 
of services offered in a primary health care setting. There are several CQI frameworks and indicators, 
which include key quality indicators, certain infrastructure standards such as privacy and cleanliness of 
facilities, client satisfaction, and availability of commodities. Analysis of quality indicators in the HP 
results framework will provide information on areas that need improvement. The analysis should involve 
the DOH and LGUs as part of the process in determining standard quality indicators for FP/ARH. In 
health care, it is especially important to pay close attention to CQI monitoring to make timely local 
adjustments.
The FP in Hospital Program is another HP intervention that has reached sufficient maturity for broader 
adoption. The program acknowledges the key role of hospitals in increasing demand for FP, providing 
quality FP services, and creating an enabling and respectful environment for FP/RH. The program is 
running in 162 public and private hospitals nationwide. While the WOPE team recognizes that hospital￾based providers are more than capable of providing counseling services, especially for teenage mothers, 
the challenge is to implement the program without overburdening hospital staff. 
Despite the COVID-19 pandemic, the FP program in hospitals continues to run in 46 health facilities 
through the Makeshift Teleconsultation platform developed with HP support. “Makeshift” connotes 
using a basic laptop, mobile phone, and Internet access sans more sophisticated computers and complex 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 27
databases. The core component of this package is the manual of operations, which specifies the 
requirements, workflows, and processes to conduct the teleconsultation. The WOPE team encourages 
hospitals implementing teleconsultation to provide it as a permanent alternative service for those unable 
or afraid to attend an in-person visit because of the pandemic. 
The WHO published two global guidance documents on task shifting10 and task sharing.11 Using these 
guidelines, USAID should explore how it can expand training on Family Planning Competency-Based 
Training (FPCBT) Levels I and II for health providers such as nurses and midwives. The training includes 
management of complications (a referral process to a high-level cadre or specialist care). However, 
because of the limitations brought about by the COVID-19 pandemic, no FPCBT training was held 
during the lockdowns, particularly from March 2020 to August 2021. The HP started migrating the 
FPCBT training online and will scale its implementation at the DOH e-Learning Academy. 
The HP tapped the services of BHWs to deliver FP information and commodities, especially during the 
initial onslaught of the COVID-19 pandemic. The HP provided support in developing materials and tools 
for training the BHWs on basic FP service delivery tasks. Coverage of these materials and tools includes 
information dissemination, mapping of WRA, providing condoms and pills, addressing missed pill 
concerns, helping clients correctly use the lactational amenorrhea methods, and transitioning to a more 
effective FP method.
On HP interventions to improve quality of TB care
With the HP’s assistance, DOH introduced and implemented an all-oral short-term regimen nationally 
for MDR-TB. This support is expected to ease administration and shorten treatment duration, enabling 
better adherence and improving treatment outcomes. This was a rare instance when the pilot phase of 
innovation leapfrogged to the scale-up phase. Another example is the video technology to undertake 
DOTS, which selected LGUs had already introduced and employed.
The HP supported the establishment of the Philippine Private Sector Diagnostics Consortium, which 
addressed the high cost of GeneXpert testing in the private sector, especially because most patients 
prefer to seek diagnostic and treatment services from private providers. As of August 2021, the 
consortium, which currently has 20 members, performed 5,798 tests, and detected 1,161 DS-TB cases 
and 101 RR-TB cases using the Xpert MTB/Rif test. The National TB Control Program (NTP) wants to 
continue this consortium, with commitment from PhilCAT to host it when the HP ends.
Technology-based innovations abound in many of the HP-supported activities on TB. The challenges are 
(a) how to pick which ones are high yielding versus “boutique”-type interventions, (b) how to identify 
difficulties in introducing these at scale, (c) how national and local partners can pay for and sustain these 
innovations, and (d) how to resolve operational issues (such as legal and privacy issues). 
10 World Health Organization. (2008). Task shifting: Global recommendations and guidelines. World Health Organization.
11 World Health Organization. (2017). Task sharing to improve access to Family Planning (No. WHO/RHR/17.20). World Health Organization.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 28
The HP also currently supports validation of the new Xpert MTB/Rif Ultra, which is more sensitive than 
Xpert MTB/Rif; however, validation has been done only for certain specimens. There is also a possible 
issue of getting many trace results with Xpert MTB/Rif Ultra if it is used in a highly endemic setting. The 
HP and DOH should consider these possible challenges with Xpert MTB/Rif Ultra rollout plans. 
Regarding improving compliance to treatment, some technology-based innovations include digital 
adherence tools such as the Video Observed Treatment and ConnecTB. Results from the 414 patients 
enrolled in ConnecTB are promising thus far, showing over 95 percent adherence, with improved 
reporting and management. These new technologies introduced by the HP are likely to realize desired 
outputs well beyond project life. Because many HP innovations being introduced are still in the pilot and 
evidence-generation phase, the challenge is for these innovations to generate substantial benefits during 
the remainder of the HP’s life. The operational costs involved in developing and implementing these 
technologies may be helpful for future evaluations by the DOH Health Technology Assessment Council 
(HTAC).
On HP interventions to improve quality of CBDR services
The DOH had already unfolded its program for PWUD before the HP’s CBDR program, hence USAID￾supported activities and inputs had to work their way through an existing approach which is facility￾based rehabilitation and mindsets (fear factor in Operation Tokhang). USAID’s CBDR program has made 
its presence felt in DOH and DDB communication/social media portals and in providing technical 
assistance in capacity-building. 
In June 2020, the New Client Flow process was launched, providing a clearer path forward for CBDR 
implementation in its second year. New Client Flow standardized screening tools and placement of the 
PWUD in the appropriate treatment mode depending on their risk level. This was the HP’s most 
substantial early project support in CBDR, as it cemented its presence through this collaborative 
relationship with the government. The HP provided training inputs (through the DOH Academy), 
including videos, webinars, client primers, and a service directory.
The HP’s support of CBDR is perceived as model-building and, therefore, indirectly includes providing 
services to the community’s PWUD and their families. It equips LGU and health care provider 
stakeholders with tools for CBDR processes. As of Q3 FY 2021, the LGU project sites have screened 
50,635 PWUD in LGU partner sites, which is 64 percent of its LOA target.
As part of its culturally appropriate screening training provision, the HP conducted online webinars and 
train-the-trainers’ sessions as part of the rollout of CBDR screening tools. To date, the HP has trained 
248 screening providers on screening, brief intervention, and referral to treatment (SBIRT). Partner 
agencies have validated these technical assistance inputs on screening as helpful. In FY 2019, the CBDR 
program also conducted formative research, needs analyses with PWUD, baseline surveys, and 
consultations, and advanced the policy environment for community-based rehabilitation.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 29
HOW HAS THE USAID HP SUPPORTED THE STRENGTHENING OF HEALTH 
SYSTEMS AND THE OPERATIONALIZATION OF UHC IN THE PHILIPPINES?
a. What HSS reforms are in place because of USAID interventions? How are these HSS reforms impacting 
health outcomes?
b. What HP interventions have improved the effectiveness of DOH (DPCB, HPB, Pharmaceutical Division, 
HHRDB, Dangerous Drugs Abuse and Prevention and Treatment Bureau, its information systems); 
MOH BARMM; PHIC; and DDB in delivering their mandates?
c. What HP interventions have improved local health system capacity for policy formulation, budget 
planning and execution, inter-local cooperation, program implementation, and M&E?
d. What HP interventions have increased national and local capacity in health systems management in 
sustainably supporting TB and FP/ARH programs?
e. What HP interventions have helped expand and build health provider capacity for quality health care 
delivery for FP/ARH, TB, and CBDR?
f. What HP interventions have helped in improving supporting supervision and mentoring of HRH?
g. What HP interventions have helped ensure TB and FP/ARH health commodity security nationally and 
locally?
h. How has the HP supported improvement of the TB, FP/ARH, and CBDR information systems?
Overall findings in the assessment of performance indicators for HSS/G
Three sets of indicators are used to track performance related to HSS/G. The first set refers to the 
extent that financing for TB and FP services are being secured via social health insurance and health 
budgets: (a) percentage of people covered under financial protection programs in HP-assisted sites, (b) 
ratio of total claims paid over benefits claimed for FP and TB, (c) proportion of domestic financing for 
TB, (d) disbursement rates of government budgets for TB and ITIS, and (e) proportion of domestic 
financing for TB.
As of Q2 FY 2021, 88 percent of people in HP-assisted sites have been enrolled in PhilHealth. This figure 
varies by source of estimates. PhilHealth records tend to show higher figures, but there is an ongoing 
need to regularly update enrollment data to account for births, changes in membership status, and 
deaths. 
PhilHealth has attempted to clean up its membership data and keep it up to date. A more effective 
approach would be to condition the release of national government-funded premium subsidies to 
verified PhilHealth members, starting with matching indigent program members with those in the 4Ps 
roster of DSWD.
The ratio of claims paid over total claims filed (or support value) is a measure of the extent of 
PhilHealth’s financial protection. Support value data for FP and TB are not available.
Key informants reported the budget disbursement rate for TB in 2020 to be 54 percent and the budget 
disbursement rate for the Family Health and Responsible Parenthood Unit for 2020 to be 18 percent. 
Budget disbursement rates are likely to remain low, especially with delays and disruptions due to the 
COVID-19 pandemic.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 30
As of 2021, NTP program managers reported the domestic financing for TB to be 26 percent. Key 
informants have raised concerns that foreign assistance for TB may be a preferred funding source due to 
its less complicated and more transparent procurement processes.
On stockout rates of contraceptive commodities and anti-TB drugs and TB 
laboratory tracer commodities
The second set of HSS indicators being monitored refers to the efficiency and effectiveness of the 
logistics and supply chain management (SCM). In the case of FP commodities, reported stockout rates in 
HP-assisted sites are mostly better than baseline, and some (pills, injectables, intrauterine devices 
[IUDs]) are close to LOA targets. But the reported performance in BARRM needs to be carefully 
examined. Key informants from USAID and the DOH reported that these figures may not reflect actual 
conditions.
The reported low stockout rates in USG-assisted sites do not jibe with the key informants’ concern 
about the need to improve the supply chain for commodities. The HP collects two sets of FP 
commodities stockout data, but only one is reported in all three HPPE annual reports and the HP PITT 
(Table 15). For example, the HP Medicines, Technologies, and Pharmaceutical Services (MTaPS) reports 
higher stockout rates across commodities at the USG-assisted sites (Table 16), which are closer to the 
rates the DOH reports. 
Table 15. Average stockout rates of contraceptive commodities, disaggregated by 
method at USG-assisted FP service delivery points in USG-assisted sites
Baseline LOA Targets Actual LOA average rates 
as of Q2 FY2021*
ReachHealth
Pills 23.4% 7% 8.5%
Injectables 18.4% 7% 9.9%
Condoms 27.8% 7% 19.9%
IUD 13.9% 7% 8.5%
PSI 23.9% 7% 33.3%
Standard days method (SDM) 
beads
49.8% 7% 32.7%
BARMMHealth
Pills 4.2% <10% 0%
Injectables 7.5% <10% 16.6%
Condoms 7.5% <10% 18.9%
IUD 0% <10% 0%
PSI 0% <10% 8.8%
SDM beads 27.5% <10% 0%
Sources:
ReachHealth data are based on total USGA SDPs reporting stockouts in USGA sites as of Q2 FY2021
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 31
Table 15. Average stockout rates of contraceptive commodities, disaggregated by 
method at USG-assisted FP service delivery points in USG-assisted sites
BARMMHealth data are based on total USGA SDPs reporting stockouts in USGA sites at midyear FY 2021
In the case of stockout rates, the use of USAID’s traffic light system for assessing performance does not 
appropriately show performance. Stockout rate is a ceiling (i.e., an upper limit threshold), so if the actual 
rate is higher than the target, it is not a positive accomplishment. Table 16 shows that the HP missed the 
full year FY 2021 target stockout rate for FP injectables by 53.3 percent ([23 percent-15 percent/15 
percent] x 100). The HP missed the target for FP implants by only 5 percent, but it exceeded the target 
for FP male condoms by 16.7 percent. There are wide variations in the baseline stockout numbers, and 
the LOA targets for some can be considered ambitious—for example, the baseline rate for 
progestogen-only oral contraceptive pills is 69 percent, yet the LOA target is 15 percent; the same can 
be said for SDM beads. The HP should include a more in-depth assessment of the drivers of utilization 
of each commodity—which can be collected from facility intake data—to inform commodity 
quantification, allocation, and distribution and program development
Table 16. Reported average stockout rate of contraceptive commodities, 
disaggregated by method, at USG-assisted FP service delivery points in USG-assisted 
sites (MTaPS FY 2021 AMEL/PITT)
FP Method Baseline
FY 2021 Q4 FY 2021 Full Year LOA
Target Actual Target Actual Target
Injectable 30% 15% 31% 15% 23% <10%
Subdermal implant 53% 40% 39% 40% 42% <15%
Combined oral contraceptive pill 26% 10% 25% 10% 14% <10%
Progestogen-only contraceptive pill 65% 25% 21% 25% 24% <15%
IUD 37% 30% 42% 30% 42% <15%
Male condom 39% 30% 20% 30% 25% <15%
SDM beads 75% 30% 73% 30% 79% <15%
Except for TB medicines for pediatric cases and drugs for TB preventive treatment (TPT), the HP seems 
well on its way to achieving LOA targets for stockout rates. The discussion below raises similar 
questions that were raised for FP: What are the incremental gains from efforts to reform the supply 
chain and logistics for TB drugs? Is there a system problem, or are the reported stockout rates specific
to drugs for childhood TB? Because the state-of-the-art system that was planned to solve SCM problems 
has not been operationalized—and its effective institutionalization by the end of LOA is uncertain—the 
impact of the planned reforms cannot be ascertained at this time.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 32
Table 17. Average stockout rates of selected anti-TB drugs and TB laboratory 
tracer commodities at USG-supported NTP facilities in USG-assisted sites
Baseline FY 2021 
Targets
Actual as of Q2 
FY2021
Accomplishment as of Q2 FY 
2021
TB first-line drugs, 4 drug 
regimen
41% 25% 22% Exceeded target by 12%
Pediatric TB, 4 drug 
regimen
91% 45% 46% Missed target by 2.2%
TPT drugs 64% 50% 79% Missed target by 58%
Levofloxacin 500 mg 49% 10% 18% Missed target by 80%
Moxifloxacin 400 mg 4% 10% 6% Exceeded target by 40%
Linezolid 600 mg 20% 10% 8% Exceeded target by 20%
Bedaquiline 21% 10% 8% Exceeded target by 20%
Xpert cartridge 15% 15% 1% Exceeded target by 93.3%
Overview of HSS/G interventions and innovations supported by HP 
Over 130 interventions, innovations, and policies and regulations were introduced with support from 
the HP. Several interventions are expected to directly benefit quality of service delivery at scale but can 
be expected to yield impacts over the medium- and long-term. An example is HP support of local 
procurement and SCM with its act-on-site mechanism. 
Interventions with large-scale but indirect effects over the medium term include policy advisories on the 
effects of the COVID-19 pandemic and recommendations on how these might be mitigated. Advisories 
on the development of PhilHealth benefit packages (e.g., Konsultasyong Sulit at Tama or Konsulta) have 
potential scale effects but can be realized only in the long term. The HP needs to consider alternative 
indicators that reflect the true nature of progress in these HSS/G areas. Thus, USAID might need to 
focus the HP on fewer sets of HSS/G interventions, especially those with large-scale and direct effects 
on target outcomes such as the support provided in the development and rollout of Konsulta and the 
eLMIS.
An inventory of these HSS/G-related interventions is provided in Supplemental Material L.
On HSS reforms implemented and their impact on health outcomes
HP supported the development of the UHC Law’s IRR and the Memorandum Circular 2021-0001 by the 
Department of Budget and Management (DBM), the DOH, DILG, and PHIC, which established the 
guidelines for allocation, utilization, monitoring, and accountability for the Special Health Fund (SHF). 
The HP also helped formulate more than 50 policy guidelines in the UHC integration sites (UIS). These 
enabling policies are crucial in ensuring that poorer LGUs have the capacity to continue providing the 
health services that will be developed but likely without the equivalent local fiscal resources, even with 
the Mandanas-Garcia ruling. 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 33
Moreover, the HP assisted PHIC in developing the Konsultasyong Sulit at Tama (Konsulta) package. This 
new primary care benefit package under the UHC Law is being pilot tested in more than 130 providers 
as of September 30, 2021. Konsulta was built on the expanded primary care package and now includes 
coverage for screening and diagnostics for TB that are used in public health facilities. Future integration 
of TB-DOTS services in the Konsulta package is one way to increase access and utilization of services 
through the participation of more public and private providers. 
While FP services are still not formally covered under the Konsulta package, accredited providers can 
provide services such as IUD insertion, PPIUD, and PSI implant and can file claims through the usual 
PhilHealth claims process.
The USAID HP was also instrumental in establishing the DOH Academy, particularly its e-learning 
portal, which was helpful during the pandemic, when in-person training was suspended. While we cannot 
ascertain competencies gained, there has been an explosion of access to the online courses. The 
effectiveness of these nontraditional learning platforms remains to be assessed.
The HP also assisted the DOH in securing an open-source electronic logistics management and 
information system (eLMIS). The DOH will soon complete the system’s configuration. User acceptance 
is being tested among DOH warehouses, select Centers for Health Development (CHDs) and LGUs, 
and health facilities. Once this is completed, the DOH can roll out the eLMIS to more CHDs, LGUs, and 
facilities, with a goal of around 170 sites by June 2022. It is expected that by June 2023, the system will 
be operational in all DOH warehouses, CHDs, and public facilities and in LGUs that have signified 
concurrence or commitment. 
However, the eLMIS is only as good as the skills of the people entering and analyzing the data and the 
ability to supply the required commodities. Without concurrent improvements in these two areas, there 
is no assurance that the system will be fully functional or that its use will continue. 
Finally, USAID supported the DOH in establishing the HTAC as mandated by the UHC Law. The HTAC 
is expected to improve assessment and fast-track the approval process for medical technologies. This 
was particularly highlighted during the pandemic, when emergency use applications for COVID-19-
related technologies like testing kits had to be quickly processed.
On HP interventions that have improved the effectiveness of DOH and other 
stakeholders in delivering their mandates
The assistance in budget analysis and financial planning has contributed to improving the use of funds at 
the DOH. This has multiple positive effects on health outcomes beyond FP and TB, as a more efficient 
budget utilization improves all aspects of DOH operations. Training and mentoring support for the 
DOH from previous HPs and the current HP contributed to increasing the budget obligation rate to 94 
percent in 2018 before it went down to 88 percent in 2020. However, disbursement rates went from 58 
percent in 2018 to 83 percent in 2020. For the TB program, the NTP has been constantly hovering 
around PHP 1 billion (from 2014 to 2021), with obligation rates rising from 65 percent in 2014 to 99 
percent in 2020 and disbursement rates increasing from 26 percent in 2014 to 54 percent in 2020 (zero 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 34
disbursement in 2018 despite obligating 61 percent, due to procurement issues). On the other hand, the 
National Family Planning Program budget has been increasing but disbursement rates remain low, 
reportedly at only 18 percent in 2020. DOH program officers particularly appreciated the budget 
analysis assistance because they could track funds utilization as they received regular updates from the 
HP.
To sustain the gains in this area, HP should continue assisting the DOH in budget analysis and financial 
management. In addition, it should extend more intensive training and mentoring of staff on 
procurement planning, particularly in taking advantage of multiyear budgeting, pooled procurement, and 
contracting or outsourcing. According to some informants, inadequate human resource staffing, staff 
transfers, and the inability of trained staff to share knowledge and skills all contribute to persistent 
procurement planning issues. The reorganization of the DPCB might enable this sharing of technology by 
requiring staff members to share knowledge and skills in their new assignments.
In addition to budget analysis, the HP helped with cost estimates for responding to COVID-19 
requirements, which was instrumental in fund allocation for the Bayanihan 1 and 2 Laws. Moreover, 
estimates of COVID-19 cases were used in case rates implemented by PhilHealth in setting claims.
Multiyear financing grants/contracts and pooled procurement affords the DOH the advantages of 
economies of scale and allows it to use its size and volume to negotiate for lower costs and better 
services. The HP facilitated the development of a Technical Advisory on the Guidelines and Procedures 
in Implementing Framework Contracting and Pooled Procurement for Drugs, Medical Devices and 
Supplies. The use of multiyear financing agreements was also presented to local executives, including in 
BARMM, as a viable option for procuring essential goods and services. However, this financing 
mechanism, implemented by the DBM, was not used in 2020 due to lack of time to complete 
requirements and processes.
In light of the Mandanas-Garcia ruling, the DOH should start coordinating and negotiating with the 
LGUs the management (rational quantification, purchase, distribution) of supplies using the scale 
advantages afforded by pooled procurement and multiyear financial agreements. 
Technical assistance on pharmacovigilance, health technology assessments, and FDA approvals is crucial 
in ensuring a capable and efficient health system that provides high-quality goods and services. Upgrading 
the pharmacovigilance system ensures quality of drugs, although partners would appreciate the support 
more if the system upgrade would apply to all drugs and medicines. The support in streamlining the FDA 
assessment and approval process was especially useful during the pandemic, when emergency use 
applications for medicines were enforced. The challenge is to ensure that staff members in the relevant 
offices can apply the knowledge, skills, and technologies learned to other concerns that are not the HP’s 
primary focus, and that they can make sure the results of the technical assistance and interventions are 
sustained. 
At subnational and local levels, the HP also helped develop tools that enabled POPCOM, PhilHealth, the 
DOH, and other partners to deliver services during the pandemic. Notable tools included: (a) an Excel 
spreadsheet to quantify FP commodities for subnational allocation, (b) models to estimate COVID-19 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 35
case management costs as a basis for PhilHealth case rates and to conduct budget analysis; and (c) a 
mobile application (ITIS Lite) to encourage providers to report cases to ITIS.
Future HP efforts to help LGUs get facilities certified and accredited should include advocating for 
amendments in the PhilHealth requirements and addressing delays in processing and reimbursements to 
expand services and encourage more lying-in centers, health centers, and providers.
On HP interventions that have improved national and local health system 
capacity 
Some LGUs have been receptive to assistance provided to local chief executives and health officials 
through the HP’s Institutionalization of Health Leadership and Governance Program (IHLGP). One CHD 
has partnered (through memoranda of agreement and scholarship funds) with local universities to 
conduct the program for local health executives and integrate the program into the universities’ regular 
courses for health professionals. The IHLGP could help more local chief executives and health officials if 
it is institutionalized in regional academic and training institutions or national institutions such as the 
Development Academy of the Philippines, Local Government Academy of the DILG, or the UP National 
College of Public Administration and Governance.
HP is actively supporting 12 out of 58 LGUs in planning for the UHC integration. As of November 2021, 
35 out of 58 (60 percent) of the UIS have signed a memorandum of understanding with the Department 
of Health, although the remaining UIS have not completed their preparatory key result areas (KRAs) on 
strategic and investment planning for health. Almost all (98 percent) of the sites have yet to achieve 
organizational KRAs in financial management. The UIS have three years to prepare and set up all 
necessary KRAs, but the HP can accelerate these preparations, particularly in establishing SHFs and 
strengthening the capacity of provincial/city health boards to manage provincewide and citywide health 
systems. Half of the UIS have yet to start organizational and functional KRAs in HRH management. The 
HP can employ the Workload Indicators of Staffing Need (WISN) method to help the LGUs respond to 
this UHC integration requirement, but local HR managers should be given sufficient training to 
implement WISN. In terms of information management, 22 UIS (38 percent) have already achieved 
preparatory KRAs, indicating they are ripe for possible engagement as participants in the eLMIS rollout.
The COVID-19 pandemic has affected the ability of many of the UIS to achieve the KRAs because their 
attention has been diverted to infection prevention. Moreover, there appears to be a lack of 
commitment from some LGUs to achieve UHC integration because they lack a sense of ownership of 
the KRA results. The HP can focus some of its resources to address these challenges and respond to 
UIS areas that need support.
The design and establishment of service delivery networks (SDNs) through the previous HPs under the 
Health Sector Reform Agenda was taken up in the design of the Sin Tax Law (RA 10351), the RPRH Law 
(RA 10354), and the UHC Law (RA 11223). It was expected that the DOH would scale up SDNs with 
existing AOs (DOH AO 2017-0014 and 2018-0014), but this effort may have been given a low priority 
due to competing demands. Although the HP funds are earmarked for TB, FP, and CBDR activities, 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 36
technical assistance to expand the SDNs need not be constrained by these earmarks, because SDNs are 
system wide interventions supportive of TB, FP, and CBDR.
For TB, the HP facilitated the development of TB advisories in LGUs, which led to secured funding 
commitment for TB. The HP obtained PHP 50 million local TB funds from 56 LGUs, according to 
WOPE team calculations from TB IPs’ annual reports. HP also supported the creation of policies and 
plans for the National TB Reference Laboratory (NTRL). The HP should take a closer look at how these 
plans are being implemented at the local level. The Citywide Tuberculosis Elimination Campaign (CiTEC) 
initiated by the HP is not expected to generate a significant number of diagnosed cases because the 
coverage area is too small (only two barangays out of 80). However, this can be a rich learning ground 
to inform future expansion to other areas. 
For CBDR, although the current activities are in their infancy, an important milestone was achieved 
when the DDB passed a resolution citing Katatagan, Kalusugan at Damayan ng Komunidad (Resilience, 
Health, and Care in the Community) as a model for community-based treatment (DDB Board 
Resolution 6, 2021). For SBCC, there is no strong indication from key informants that local partners 
have been capacitated to develop their own SBCCs. However, the HP must educate local partners on 
the proper use or optimization of SBCCs developed at the national level and made available online.
On HP interventions that helped expand and build provider capacity and improve 
supporting supervision and mentoring 
A significant HP contribution is the institutionalization of the DOH Academy eLearning portal, where 
training modules and orientation programs have been made more accessible to public and private 
providers. Enrollment and visits to the portal dramatically increased during the COVID-19 pandemic. 
Enrollment in the Adolescent Health Education and Practical Training module rose from 77 in 2018 to 
5,059 in 2021. There was also a big jump in enrollment (mostly in NCR) in the e-learning modules 
“Introduction to Seven Major Recommendations to Prevent TB Transmission” and “Overview of TB and 
Xpert MTB/Rif Assay.”
The establishment of SDNs and health care provider networks (HCPNs) ensures clients receive the full 
range of services from a network of accredited providers, but capacities across LGUs are uneven, with 
few able to reach UHC maturity level for full UHC integration. Participation in the Konsulta package, 
developed with HP support, requires accreditation and certification that incentivize providers to 
upgrade equipment and facilities, enhance skills, and perform better quality services to secure a viable 
client population. 
In FP/ARH, training programs such as FPCBT are needed to ensure competent delivery of FP/ARH 
services. However, when in-person training was suspended and health providers were asked to assist in 
the COVID-19 response, training was moved online, which some saw as inadequate. In terms of 
supervision and mentorship, the Integrated Midwives Association of the Philippines (IMAP), through the 
continuous support from the HP, can now offer courses and supportive supervision and mentoring of 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 37
midwives. This can be expanded with additional HP support. The same model may be explored to 
provide remote or online supportive supervision and mentorship for FPCBT programs.
The HP supported the training of 7,708 public and private providers on TB topics such as adaptive 
strategies to COVID-19, the sixth edition of the NTP Manual of Operations, mandatory notifications, 
and the use of the ITIS Lite mobile application. Another 1,546 providers were trained on the FAST Plus 
strategy.
For SBCC, the HP provided scholarships to four DOH and POPCOM personnel for social media 
training conducted by the Johns Hopkins University. The training had an immediate effect on the 
POPCOM and DOH staff’s competency to design and carry out SBCC campaigns. HP-supported training 
programs in CBDR include coaching and counseling as well as accreditation of medical doctors for drug 
screening and the SBIRT/e-SBIRT training program.
On HP interventions that helped ensure health commodity security nationally and 
locally
This year, an eLMIS provider has been selected, and pilot implementation is set to commence with HP 
assistance. Although there were delays in the procurement of eLMIS, activities to enhance the capacity 
of staff for its efficient operation have been conducted at the DOH central and regional offices and even 
at selected public-facility pharmacies. However, the planned pilot implementation has yet to test its full 
functionality. Because of ongoing COVID-19 restrictions and possible delays due to the elections in May 
2022, the institutionalization could be pushed beyond the LOA. USAID should consider extending 
support beyond the current LOA to ensure full operationalization. 
Concurrently, the HP supported the FP program, NTP, POPCOM, and LGUs to ensure availability of 
commodity and drug supplies, especially during the COVID-19 pandemic. These entities used POPCOM 
warehouses, created a list of local logistics providers to work around transport constraints, and 
instituted alternative delivery mechanisms to ensure supply availability and treatment adherence.
On HP support to improve health information systems 
The Pharmaceutical Management Information System will be integrated into the eLMIS to harmonize 
data encoding and inform SCM. However, interoperability with the DOH’s many other information 
systems has not been ensured. One of the concerns raised is the harmonization of data systems to 
reduce burden on health workers at the facilities and to generate standard consistent data from one 
credible source. For example, the RPRH annual reports, the DOH Family Health Office, and the HP 
report different FP stockout rates for the same period. In the case of the DOH Knowledge Management 
and Information Technology Service (KMITS), it is important to determine the basic driver for using 
data, knowledge, and information. 
For the information systems to be relevant and useful, HP support to TB and FP may have to be 
delivered in a way that would benefit the entire DOH information system, which covers a wide range of 
programs.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 38
For purposes of policy reform and program implementation, indicator definitions and data should be 
standard, consistent, comparable across time and space, and readily accessible. One local partner 
suggested the use of the Community-Based Monitoring System (CBMS) established by law (RA 11315 in 
April 2019 with IRR approved in May 2020) as the primary monitoring and data source for community 
indicators, including those of FP, TB, HIV, CBDR, and PhilHealth membership and availment. The CBMS 
uses the cities and municipalities as the primary data processing authorities. Thus, it would be 
advantageous to use this information system as the consolidated system for LGUs in their local health 
investment planning and HCPN management. Key informants from the DOH and LGUs appreciated HP￾supported training on measuring and interpreting data indicators, which increased their understanding of 
the principles of data collection and analyses and why and how data are used.
HOW HAS THE USAID HP CONTRIBUTED TO IMPROVING HEALTH 
OUTCOMES AMONG THE UNDERSERVED?
a. To what extent have the HP activities contributed to achieving the targets (i.e., extent of performance 
relative to annual targets and end-of-project targets)?
b. What were the critical enabling factors associated with achieving HP targets?
c. What were the challenges and barriers in achieving HP targets?
d. What innovations contributed to improving health outcomes?
HP contributions to health outcomes are monitored using the following performance indicators: for 
FP/ARH, couple-years of protection (CYP) and total fertility rate; for TB, treatment success rates (TSRs) 
in DS-TB cases and MDR/RR-TB cases; and for CBDR, number of PWUD who completed treatment. 
Performance progress is tracked relative to baseline and end-of-project targets. The team reviewed this 
using data as of Q2 FY 2021, published in the PITT maintained by CLAimHealth.
Overall findings
At best, HP activities are close to meeting 50 percent of LOA targets. Many of the interventions have 
completed their design and initial implementation phases but have yet to gain enough traction and scale 
to register in regional-, city-, and provincial-level outcome indicators.
The average contributions over time and across sites are verified using DOH FHSIS and ITIS data. The 
team performed a DID analysis using data on selected FP- and TB-related outcome measures from 2018 
to 2020 across different provinces and cities. The team did not detect significant differences over these 
years and across sites. This is consistent with the observation that many of the HP-supported 
interventions remain in early implementation phases.
Lockdowns and travel restrictions during the COVID-19 pandemic disrupted and delayed the 
implementation of interventions, many of which had just been introduced and were beginning to gain 
traction at the time. Interventions have gained traction where the HP effectively engaged national, 
subnational, and local health authorities and built on the gains of previous HP activities.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 39
HP interventions deemed ready for scaled implementation because of their initial traction and sustained 
support from partners include FP in hospitals; MRLs as public health leaders and SBCC champions; FAST 
Plus; IHLGP at DOH CHDs; Konsulta; Men’s reproductive health, including Katropa; the Comprehensive 
Sexual Education (CSE) ARH Converge program; and adolescent-friendly health facilities. There are also 
HP interventions that may have to be tested further and replicated to more priority sites so we can 
learn from the contextual nuances of implementation. These are: CiTEC, the Philippine Private 
Diagnostics Consortium, eLMIS, WISN, SBIRT, ConnecTB, and PhilHealth’s Catastrophic TB Package. 
The HP can benefit from diligent documentation of design concepts, iterations, and analyses of different 
interventions introduced and expanded by USAID support.
Addressing issues regarding definitions, data sources, delays in data submission, and other 
inconsistencies could improve measurement of performance outcomes. This is critical if an impact 
evaluation of key HP interventions would be undertaken. Findings related to data and measurement gaps 
in the PITT are presented in detail in Supplementary Material I.
On FP/ARH
Based on the HP Midyear Report for FY 2021, HP-supported sites have reached close to 9 million CYP, 
representing 48 percent of the LOA target (Table 18).
Table 18. CYP in USG-supported programs
Baseline LOA Target Accomplishment as 
of Q2 FY2021 Percentage
CYP in USG-supported programs 2,865,360 18,053,938 8,614,086 47.7%
Source: HP PITT_210701.xlsx, FP indicators-FY2021_MY sheet
Analysis of FHSIS data from 2018 to 2020 showed that sites in HP-assisted cities and provinces have the 
same CYP performance as non-HP-assisted sites. The CYP was calculated by multiplying the quantity of 
the FP method distributed to clients (available and as reported in the FHSIS) by a conversion factor. This 
suggests that HP contributions are not yet substantial enough to be detected by service utilization data 
at the provincial and city levels. A full analysis of this indicator, including a description of the 
methodology, can be found in Supplementary Material J.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 40
Figure 2. CYP growth rates, 2018–2020
The 2020 annual FHSIS report published by the DOH already includes data on adolescent birth rate. 
The highest birth rates are recorded in Region X (47 percent) and Region XI (49 percent). HP may want 
to consider assisting subnational and local health authorities in these regions to see how this can be 
addressed. 
The questions regarding the reliability of FHSIS data remain. Hence, performance, especially on 
adolescent fertility, may be effectively assessed only once the results of the 2022 National Demographic 
and Health Survey are available. Meanwhile, the HP relies on intermediate inputs as custom indicators to 
track performance. These are (a) the number of functional adolescent-friendly SDPs, (b) the number of 
adolescents using FP/ARH services in adolescent-friendly SDPs, and (c) the number of adolescents 
exposed to HP-supported FP messages. It would be helpful to know how these measures ultimately 
affect adolescent fertility rates. In addition to these proxy indicators, the HP is conducting sentinel 
monitoring of adolescent births in selected hospitals in HP-supported regions and cities. 
The critical enabling factors that may be associated with the reported HP contributions include buy-in 
from the DOH, POPCOM, and selected LGUs for interventions, such as the establishment of 
adolescent-friendly SDPs, FP in hospitals, and various training programs for FP/RH providers. Another 
enabling factor may be sharing knowledge and lessons from the implementation of those interventions, 
which leads to replication in other sites.
While the Mandanas-Garcia ruling would have major advantages in the allocation of local resources for 
the LGUs’ health needs, this should include the assurance that FP or contraception services would 
continue. The experience of one major metropolitan city where the mayor prohibited FP methods other 
than natural, or fertility-awareness-based (FAB) methods, should not be repeated anywhere. While 
there can be FAB methods that are highly effective, this would be a narrow range of options and would 
deny clients the opportunity to use other highly effective methods that they prefer. Technical assistance 
to LGUs on the use of various contraceptive methods would be needed along with enhancing the role of 
the private sector to provide services in areas with limited or restricted FP services.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 41
However, there were reported barriers in the implementation of various interventions that need to be 
addressed, including difficulties in managing implementation in BARMM due to peace and order 
conditions, geography, special population needs, gaps in capacities of local health authorities, and 
reported delays and disruptions due to the COVID-19 pandemic.
Performance in the FP indicators is encouraging, and there should be efforts to ensure sustainability of 
the programs—for example, online teleconsulting for regular checkups, use of BHWs in the information 
drive and distribution of pills and condoms, and use of the SDNs/HCPNs for referral of clients 
experiencing problems associated with contraception use.
On critical state-of-the-art training
Halfway through the LOA, the number of health workers who have gone through in-service training 
using nontraditional learning platforms is a third of LOA targets (Table 19). Unless efforts are ramped 
up, it is unlikely the LOA targets will be achieved. More importantly, from a system-strengthening 
perspective, it is essential to find out whether those who have been trained can provide sufficient 
evidence of improved competency levels that have led to better service delivery and evidence that this 
alternative platform is as effective as traditional learning platforms and is readily scalable.
Table 19. Number of health workers who received in-service training using 
nontraditional learning platforms in FP and TB in USG-assisted sites
LOA Target Accomplishment as of 
Q2 FY2021
Percentage 
Accomplished
Health Project 25,863 7,706 29.8%
Source: HP PITT_210701.xlsx, HSS indicators-FY2021_MY sheet
On TB
The indicators used to monitor HP contributions to TB control are TSRs in DS-TB cases and MDR/RR￾TB cases. For Q1 CY 2021, DS-TB TSRs in NCR, Region III, and Region IV-A exceeded NTP targets 
(Table 21). During the same period, the reported TSRs for MDR/RR-TB cases ranged from 60 percent 
to 67 percent, representing over 70 percent of NTP targets (Table 20). The TSRs would have to be 
examined together with other indicators, such as case detection, to get a better picture of the 
continuum of TB prevention and control. 
Table 20. Treatment success rates for MDR/RR-TB cases, CY 2019–2021 
CY 
2019
CY 
2020
CY 
2021 Target Accomplishment as 
of Q1 CY 2021 Percentage
National 56% 66% 55% 85% 66% 78%
Numerator 2,642 3,564 3,564 
Denominator 4,718 5,376 5,376 
NCR 48% 60% 55% 85% 60% 71%
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 42
Table 20. Treatment success rates for MDR/RR-TB cases, CY 2019–2021 
CY 
2019
CY 
2020
CY 
2021 Target Accomplishment as 
of Q1 CY 2021 Percentage
Numerator 657 1,010 ,010 
Denominator 1,369 1,672 1,672 
Region III 43% 62% 53% 85% 62% 73%
Numerator 118 488 488 
Denominator 275 784 784 
Region IV-A 53% 67% 50% 85% 67% 78%
Numerator 489 281 281 
Denominator 924 422 422
Source: HP PITT_2021-0714.xlsx, TB indicators-CY2021 Q1 sheet 
Table 21. DS-TB treatment success rate, CY 2019–2021 
CY 
2019
CY 
2020
CY 
2021
Targe
t
Accomplishment as 
of Q1 CY 2021 Percentage
National 91% 91.0% 53% 90% 53% 101%
Numerator 94,694 293,986 117,851 117,851 
Denominator 324,297 
323,158 220,772 
220,772 
NCR 90% 89.7% 60% 90% 60% 100%
Numerator 45,874 47,398 17,180 17,180 
Denominator 50,870 52,865 28,745 28,745 
Region III 91% 90.8% 54% 90% 54% 101%
Numerator 31,590 32,456 13,206 13,206 
Denominator 34,855 35,733 24,516 24,516 
Region IV-A 92% 90.8% 53% 90% 53% 101%
Numerator 46,982 44,583 15,974 15,974 
Denominator 51,341 49,112 30,177 30,177 
Source: HP PITT_2021-0714.xlsx, TB indicator-CY2021 Q1 sheet
Analysis of ITIS data at the city and provincial levels shows that the TSRs of non-USG-supported sites 
for all forms of TB did not change from 2018 to 2020, at 89 percent (Figure 3). On the other hand, 
USG-supported sites started at the same TSRs for all forms at 90 percent but dropped to 80.9 percent 
in 2020. The following explanations can be offered: The areas supported by the HP are where TB is 
highly prevalent, and the “big three” regions, where HP support for TB is focused, were badly hit by 
COVID-19. While we can possibly link private-sector mandatory TB notification as a contributing factor 
to the TSR decline, treatment outcomes from the private sector are not routinely reported, and reports 
on TSRs are not organized based on source of contribution (community vs. private).
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 43
In the case of MDR/RR-TB, the average TSR significantly improved from 2018 to 2020, by 20 percentage 
points regardless of location. A full analysis of this indicator and other relevant TB indicators in ITIS is 
included in Supplementary Material J. It should be noted, however, that by design, USAID selected sites 
estimated to have large numbers of undetected or untreated persons with TB.
Figure 3. TB treatment success rates, 2018–2020
In terms of provinces and cities hitting the target TSR for all forms of TB, 74 percent of non-USG￾supported sites achieved at least 90 percent TSR in 2018–2020 (Figure 4). On the other hand, among 
USG-supported provinces and cities, 74 percent reached the 90 percent target in 2018 only. By 2019, 
only 22.4 percent of the HP-supported areas had a TSR of 90 percent for all TB forms. In 2020, this 
nearly doubled to 39.4 percent but was still only a little over half of the areas that reached the 90 
percent goal two years prior. 
Regarding treatment of MDR/RR-TB, seven out of every 10 provinces and cities were able to reach the 
target 66 percent TSR regardless of HP support. The number of provinces and cities reaching the target 
66 percent nationwide remained unchanged from 2018 to 2019 but improved by a third in 2020. The full 
report on the secondary analysis of TB data from ITIS is provided in Supplementary Material J. Although 
this could be a result of the adoption of short-course treatment regimens, we cannot validate this 
possibility because TSRs are not disaggregated by type of treatment received.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 44
Figure 4. Percentage of provinces and cities that reached TB treatment success rates, 2018–2020
The reported performance levels need to be compared with the number of TB cases detected and then 
treated. The starting point of the TB cascade of care is detecting cases, and this is what a catch-up plan 
for TB prevention and control should focus on. But for active and enhanced case-finding approaches to 
be employed at scale, the HP needs to address funding and staffing issues at the NTP, as well as the 
challenge of engaging the private sector.
SBCC is a vital component of TB prevention and control. Rather than implementing a unidirectional 
approach where clients merely receive information, the HP can sustain engagements or calls to action by 
providing an online or physical space for continuing advice and guidance to link clients to services.
There are several promising interventions (active case finding in high-risk communities, intensified case 
finding in facilities, FAST Plus, shorter all-oral regimen for MDR-TB) that the HP will need to implement 
at scale for improvements in TB outcomes to be detected at the subnational and provincial levels. Many 
of these interventions are resource intensive, so sustainability becomes a critical concern. Another 
critical concern is how to sustain community-level active case finding and the use of more effective 
diagnostic technologies. Follow-up HP activities should focus on helping DOH align national health 
budgets and PhilHealth benefit payments with public and private resources at the local level to sustain 
the entire TB cascade of care.
On CBDR
The LOA number of PWUD completing evidence-based drug rehabilitation interventions in USG￾supported sites is 20,926 persons. The baseline measure in the same sites is 9,811 persons. As of Q2 FY 
2021, it was reported that 723 PWUD had undergone USG-supported CBDR. This accomplishment 
represents only 3.5 percent of target, suggesting that HP interventions in this area have only started and 
that USAID is still trying to navigate the intricate structural framework of CBDR. However, HP 
engagement with national and local authorities operating the government’s CBDR program has gained
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 45
ground, according to the USAID HP IP on CBDR. The initial “handshakes” allowed the HP to advocate 
its mandates by presenting an alternative CBDR approach. 
On challenges and barriers
The significant shift in focus to COVID-19 response efforts caused displacement, disruptions, delays, and 
demand reduction, which have resulted in considerable backlogs in achieving FP, TB, and CBDR targets. 
The DOH DPCB might need assistance in determining the extent of the backlogs. 
There were several notable HP supports to UHC, but conceptual, operational, and financial difficulties in 
implementing UHC remain at the local level. The challenge for USAID is how to cascade support to 
USG-assisted LGUs that are not among the UHC UIS.
The Mandanas-Garcia ruling is both a challenge and an opportunity. The increased funding to LGUs may 
not necessarily lead to increased investments in health, as much depends on LGU capacity to program 
and use these resources. Meanwhile, the RPRH Law’s restrictive provisions on the need for parental and 
spousal consent to use FP services discourage adolescents to fully exercise their sexual and reproductive 
rights. HP work on Konektado Tayo may need expansion and strengthening. Studies have shown that 
adolescent girls’ connectedness to parents contributes to delayed first sex.12,13
Numerous KIIs have pointed out the funding gaps from TB Law and in achieving the UN General 
Assembly High-Level Meeting on TB targets. However, reported TB budgets are not fully used (not 
more than 54 percent disbursement for CY 2019 and CY 2020).
FOR THE NEXT USAID PROGRAM CYCLE (2022–2026), WHAT TYPE OF 
SUPPORT SHOULD THE HP INVEST IN TO ACHIEVE DESIRED HEALTH 
OUTCOMES AND SUSTAINABLE SYSTEMS CHANGES IN THE PHILIPPINES?
a. Which health system pillars should be prioritized?
b. What type of technical assistance should be provided for TB, HSS/G, FP/ARH, and CBDR?
c. What mechanisms should be used for the delivery of support?
Nature of future HP support
The challenge for the next USAID HP cycle is implementation at scale. Previous and current HP support 
have contributed to the enactment of new laws and regulations, have introduced and tested innovations, 
and have helped develop mechanisms to improve health systems. But for impacts to reach intended 
beneficiaries, all these interventions and innovations need to be institutionalized, made operational and 
more inclusive, and funded with an explicit bias for the health of poor families.
12 Karofsky, P. S., Zeng, L., & Kosorok, M. R. (2001). Relationship between adolescent–parental communication and initiation of first intercourse 
by adolescents. Journal of Adolescent Health, 28(1), 41–45.
13 Weinman, M. L., Small, E., Buzi, R. S., & Smith, P. B. (2008). Risk factors, parental communication, self, and peers’ beliefs as predictors of 
condom use among female adolescents attending family planning clinics. Child and Adolescent Social Work Journal, 25(3), 157–170.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 46
The drive to implement at scale proven approaches to improve access to quality health services will be 
met with difficulties, some of which are inherent to the way the Philippine health system is organized 
and financed. Such difficulties arise from an overly decentralized public health delivery system, a large 
private sector with considerable but mostly untapped potential to contribute to priority public health 
goals, and multiple fairly uncoordinated sources of public financing for health that have yet to be used to 
improve overall health performance.
But potential drivers and platforms for scaled implementation are in place, established in part with 
support from USAID. Possible drivers include the Konsulta primary care package, premium subsidies, 
national health budgets, and health regulations determining quality standards, clinical practice, and 
professional training. Platforms include the DepEd’s CSE program and the DSWD’s 4Ps program. 
Potential partners for scaled implementation include the Philippine Obstetrical and Gynecological 
Society, PhilCAT, Employees Confederation of the Philippines, Philippine Business for Social Progress, 
and foundations associated with large corporations (e.g., Shell, Zuellig, Ayala, Aboitiz). In addition, the 
following partners may also have to be engaged: IMAP, Philippine League of Government and Public 
Midwives, and Philippine Nurses Association. The common thread among these partners, in addition to 
their interest in advancing public health goals, is that they operate at a scale that can be sustained over 
extended periods. 
HP-supported interventions with high potential for scaled implementation include the widespread use of 
Xpert in diagnosing a range of infectious diseases, sustained promotion of ARH through the CSE-ARH 
convergence program in high schools, SCM outsourcing, piggybacking CBDR via the DSWD’s 4Ps 
program, and using the 5 percent allotment of the GPH budget for GAD to sustain health care programs 
for adults and adolescents.
Future HP support must also deal with challenges that will continue to affect developments in the health 
sector in the medium term. The COVID-19 pandemic caused significant backlogs in FP, TB, and CBDR 
targets, as well as an increase in cases of gender-based violence (GBV). It is important that future HP 
support is informed by the magnitude and gravity of these consequences.
The HP must address the difficulties (conceptual, operational, and financial) and transaction costs in 
implementing elements of UHC that are key to advancing FP and TB goals. While supporting UHC 
implementation at the local level, the HP must find a balance between assisting LGUs in promoting FP 
and TB in the face of specific local conditions and at the same time generating evidence and lessons 
general enough to be useful for scaling up in other localities. This challenge may even be more difficult 
with the Mandanas-Garcia ruling, which is expected to reduce national health budgets and subsidies but 
may not necessarily lead to increased LGU investments in health. Many senior DOH officials support the 
view that HP support might be more valuable if directed at LGUs. However, they also emphasize that 
this be done in coordination with the DOH, especially with subnational DOH offices.
On priority health systems pillars
USAID must maintain support for all the health system pillars but would have to focus on key elements 
within each. In service delivery, for example, there may be a need to introduce operational measures of 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 47
quality of care so that these can be monitored and linked to inputs like training, budget, and incentives.14
Results of a randomized social experiment in the Philippines show that by explicitly linking insurance 
payments to concrete measures of the quality of care being delivered, patients’ health outcomes, 
measured in terms of biomarkers, anthropometrics, and personal ratings, are significantly improved.
For FP/ARH, USAID can start with analyzing quality indicators in the HP results framework to get a 
sense of what areas to improve on. The analysis should be conducted with the DOH and LGUs as part 
of the process in determining standard quality indicators for FP/ARH. Due to the highly contextual 
nature of health care, it is important to pay close attention to CQI monitoring. 
For TB, competent and high-quality care means all patients are managed according to the latest 
evidence-based guidelines. We recommend continuing USAID’s support in training health care workers 
on the latest TB Manual of Procedures. Another area in which to ensure quality care is diagnostic 
accuracy that will lead to immediate initiation of appropriate treatment regimens. The HP is currently 
addressing this by monitoring the coverage of bacteriological diagnosis. Future HP activity to consider 
includes conducting a survey of lag time from when the client seeks their first consult to treatment 
initiation. Survey results can provide insight on the factors of treatment delays. More research is also 
needed to determine the best indicators and approaches to improve a client’s care experience. Factors 
USAID can consider include accessibility, ease of use, affordability, and patient values.
Quality education and training of health professionals are important prerequisites for quality care. 
USAID’s work with the Professional Regulation Commission, particularly with the Board of Midwifery, 
facilitated the inclusion of the Mentoring and Monitoring Midwives Program within the bachelor’s degree 
program for midwifery and its link to the Career Progression of Midwives program. This initiative 
demonstrated a continuum of learning from preservice to in-service training, which can lead to 
graduates who are competent at the time of entry into the workforce and enable continuous 
professional development at various stages of their careers. 
Given this experience, USAID should continue working with and expanding its network of influence with 
the Professional Regulation Commission and professional organizations. It may be beneficial for USAID 
to scale up its comprehensive portfolio of training programs for FP/ARH, TB, CBDR, SBCC, HSS/G, and 
GEWE.
On the health workforce, it might be worthwhile to make a distinction between those who are involved 
in service delivery and those who are involved in managing systems. Future USAID support might also 
have to include investigating and addressing gaps in the capacity of the health system managers, 
particularly in light of health system integration to implement UHC.
The support provided by the BHWs or CHWs has proved effective in extending the reach of needed 
essential health services in the communities amid the pandemic, particularly in FP/ARH. However, in a 
systematic review by Lehmann and Sanders (2007)15, the BHWs—even though they can provide 
14 Peabody, J., Shimkhada, R., Adeyi, O, et al. (2017). Quality of care. In D. T. Jamison, H. Gelband, S. Horton, et al. (Eds.), Disease control 
priorities: Improving health and reducing poverty (3rd ed., pp. 185–214). The International Bank for Reconstruction and Development/The 
World Bank. https://www.ncbi.nlm.nih.gov/books/NBK525309/ doi: 10.1596/978-1-4648-0527-1_ch10
15 Lehmann, U., & Sanders, D. (2007). Community health workers: what do we know about them. The state of the evidence on programmes, 
activities, costs, and impact on health outcomes of using community health workers. World Health Organization.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 48
adequate support to improve health outcomes—deliver inconsistent quality of service, hence the need 
for substantial investments to support training, management, supervision, and logistics. USAID might 
want to consider reviewing the RA 7883 (the BHW Benefits and Incentives Act of 1995) and see how 
BHWs may be professionalized and provided with secure compensation and continuous professional 
education and development.
On health information systems, although a lot of data are being collected, they are not easily analyzed 
and are often not disaggregated by sex and age. By intensifying the analyses of existing data, the HP can 
help stimulate further development of the information system. An example is the national health 
accounts developed with USAID assistance in the mid-1990s and the information and communication 
directed at young people on how to deal with TB and unwanted pregnancies. A key observation is that 
the elements of a health information system that are used for payment, budget planning, and routine 
decision making tend to be more developed. Government procurement and PhilHealth payments need 
to be seen as drivers to improve data quality at SDPs.
On medical products, vaccines, and technologies, the HP must ride on the widespread use of modern 
diagnostics for COVID-19, which are beneficial for TB prevention and control. Once COVID-19 is 
under control, the HP should be able to help the DOH and LGUs redirect excess diagnostics capacity to 
address primary care issues, including TB. The HP needs to carefully study how interagency managers of 
the COVID-19 pandemic worked around existing gaps and weaknesses in the public health system’s 
procurement and supply chain management. The HP must pay attention to procurement systems 
outside the DOH; active participation of the private sector, including big business; and the engagement 
of scientific and research capacities in public and private universities.
On financing, HP should support PhilHealth to focus on insurable cases who need financial risk 
protection, such as for the treatment of MDR/RR-TB, which has catastrophic financial consequences. A 
possible approach for the next HP is to address operational challenges of pursuing benefits delivery to a 
specific set of beneficiaries. For example, the HP can drive the needed changes in operations by 
increasing the TB treatment support value and widening the reach of the Konsulta package. In addition, 
the next HP should provide technical assistance to build PHIC mid- and top-level management capacity 
for strategic and policy development of UHC.
Finally, on governance, the HP might focus on promoting broad-based public–private partnerships for 
FP/ARH and TB at a similar scale as with COVID-19, which spans decision making, funding, and service 
delivery.
On technical assistance for FP/ARH, TB, and CBDR
Although HP support is expected to remain focused on FP/ARH and TB, UHC implementation must 
become the platform through which HP support is delivered. From a “program” lens, USAID’s FP and 
TB support might be coursed through support for the financing and delivery of a primary care package. 
By supporting FP/ARH and TB via an inclusive package, USAID can address health system gaps and 
bottlenecks better, especially budget execution and SCM.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 49
USAID might also consider consolidating its support in one or two regions with high unmet needs for 
TB and FP/ARH services. We can refer to these as “UHC laboratories,” which should be large enough 
so that the challenges of implementing UHC at scale are better understood and enough evidence is 
generated to test implementation solutions. By proposing that the HP support UHC labs, the HP is in 
effect better able to leverage its finite resources by showing better, more effective ways for national and 
local health authorities to exercise their mandates and apply their resources.
These UHC labs might also serve as drivers to upgrade and promote interoperable health information 
systems, especially as demand for more and better information is needed to advance inclusive reform 
initiatives. In UHC labs, support to strengthen health systems and governance mechanisms can be 
consolidated to allow for tested interventions for TB, FP/ARH, and CBDR to be scaled up. USAID may 
want to tap ideas and lessons from the WHO Global Learning Laboratory for Quality UHC, which is a 
platform for sharing knowledge, experiences, and ideas.16
Within the UHC lab, the HP can renew its strategic focus on the “big three” regions and can focus 
FP/ARH on two regions (including BARMM). It also can continue to assist the CHDs and LGUs in all 
aspects of the UHC integration—including health information systems; HRH capacity-building; local 
health investment planning; budget and SCM; and engagement of private-sector facilities, pharmacies, and 
service providers.
The proposal for the HP to consider having one activity for FP that covers BARMM can allow joint use 
of limited expertise and resources. In the case of TB, the HP may gain better coordination at the 
technical and administrative levels if the two interdependent functions of innovation and scale-up are 
managed under a single activity.
The next generation of USAID support for TB and FP/ARH will come in the wake of massive efforts to 
contain the COVID-19 pandemic. We expect a continued focus on COVID-19, in terms of policy 
decision making, health personnel, and investments. Although lessons and opportunities from the 
campaign to control the pandemic relevant to TB and FP/ARH need to be derived and applied, it is 
equally important for the DOH and the HP to be able to present a credible estimate of the backlog in 
the utilization, financing, and delivery of other priority public health programs, including FP/ARH and TB. 
These estimates of the non-COVID-19 public health backlog are critical in supporting national and local 
efforts to secure or reclaim pre-pandemic investment levels in public health.
Currently USAID might consider helping the DOH and selected LGUs estimate the backlog created by 
COVID-19 on priority programs like FP/ARH and TB. Two years of intermittent lockdowns, travel 
restrictions, economic slowdown, and redeployment of HRH and funds to address the pandemic have 
reduced demand and supply of essential health services. There is a need to estimate the backlog, identify 
its location, and determine how HP can support efforts by the DOH and LGUs to address the backlog.
Meanwhile, the government is likely to invest further in disease surveillance, public health diagnostic 
laboratories, and logistics and SCM to ensure that present and future pandemics are held at bay. It is 
16 World Health Organization. (n.d.). WHO Global Learning Laboratory for Quality UHC. https://www.who.int/initiatives/who-global-learning￾laboratory-for-quality-uhc
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 50
important for USAID to seize the opportunity to ensure investments in such systems are broad enough 
to address similar weaknesses and gaps that apply to FP/ARH and TB. The nationwide implementation of 
ARH-friendly facilities and FP in hospitals might be integrated in that larger campaign to reduce teenage 
pregnancy.
USAID support needs to focus greater on reducing teenage pregnancy, given its individual and social 
burden. Such support might have to emphasize SBCC interventions to effectively reach both in-school 
and out-of-school adolescents of all genders. POPCOM recommends that support be given to assist 
developing social protection and a comprehensive plan for teenage mothers, including an M&E system 
for monitoring adolescent pregnancies. 
HP support for FP/ARH might include: (a) SBCC for adolescents in school and out of school, with 
adolescent males as a target, including educating parents to deal with ARH; (b) a push for the nationwide 
implementation of an integrated FP program in hospitals, including a mechanism for the DOH to 
leverage local government and private-sector participation and grants; and (c) mainstream use of Katropa 
and a scale-up Usapan under POPCOM.
Although SBCC and CSE may be important in reaching out to adolescents, they are not enough to 
prevent unplanned pregnancies and sexually transmitted infections, including HIV/AIDS. Interview data 
showed that sexually active teens are effectively reached by CHWs. Hence, USAID may conduct more 
intentional outreach and counseling of adolescents to avoid teen pregnancy. USAID may also give 
attention to providing safe and quality access to post-abortion services to reduce death and suffering 
from unsafe abortions. 
Moreover, there is a need to monitor and evaluate the implementation of the RPRH mandate to 
generate data in support of policy development to expand reproductive and health services for 
adolescents and services for GBV, as well as to bolster the implementation of the new Republic Act No. 
11596, also known as An Act Prohibiting the Practice of Child Marriage and Imposing Penalties.
The only SBCC intervention that is targeting childhood TB is the Tibay ng Dibdib, an SBCC strategy 
integrated in all public elementary schools in NCR to raise public awareness and promote positive 
health-seeking behavior. Future support for TB might have to emphasize childhood TB, especially given 
the challenge of more effective diagnosis. This is also an urgent concern, given that childhood TB may 
lead to latent infection, maintaining the pool of infected people. HP can consider linking the campaign to 
actual services at various levels of care. 
TPT is another area that needs stronger USAID support. USAID supported the development of the TPT 
Roadmap and implementation guide. Health care providers and eligible individuals will need to be 
informed on this to increase uptake and adherence. HP can consider providing technical assistance to 
LGUs in conducting contact investigation activities. Moreover, future USAID support for TB control 
may still focus on NCR, Region III, and Region IV-A, where cases remain high. Using the 4Ps platform to 
intensify childhood TB awareness, prevention and treatment can be tested at scale in these regions.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 51
Although the Philippine Private Diagnostics Consortium expanded access to Xpert MTB/Rif by 
decreasing the procurement cost, the cost of the cartridge17 in the market is still widely variable—from 
PHP 2,000 to PHP 9,000—driving private sector partners to express a need for public subsidies that 
might be based on performance and service delivery quality. HP should ensure that these GeneXpert 
machines are strategically deployed in areas with high TB burdens.
Other technical assistance for TB includes developing and executing national and local health budgets for 
TB and intensifying TB awareness and health-seeking through the 4Ps platform. For both FP and TB, 
USAID might consider an activity designed to help the DOH use its budget and commodities to increase 
LGU performance and private-sector participation or engagement.
For CBDR, USAID may want to continue on strengthening counselor training that targets working not 
only with PWUD but working with their families and significant others. In a controlled trial conducted 
by Kirby and colleagues (1999)18, counseling sessions with PWUD that included family members and 
concerned significant others increased the likelihood that PWUD enter treatment and decreased the 
drug use of PWUD. Additionally, USAID may want to intensify its efforts to engage faith-based 
organizations in CBDR work. According to Grim and Grim (2019),19 these organizations are effective in 
community mobilization and are well versed in facilitating quality group interactions focusing on 
overcoming past experiences, which are often drivers of emotional and spiritual despair that feed mental 
illness and substance abuse.
Technical assistance in the area of HSS includes: (a) reforms in logistics management and SCM; (b) 
implementation research on primary care packages mandated under UHC to ensure sufficient coverage 
for priority programs, including FP/ARH and TB; and (c) revitalization of the DOH Field Epidemiology 
Training Program and graduate programs in UHC, health economics, or health systems integration, 
including reforms in the information systems to support effective surveillance and knowledge sharing.
On mechanisms for delivery of support—working with partners
Key informants appreciated the HP support but perceived the HP as operating as vertical programs. As 
the DOH attempts to integrate programs, technical and administrative supervision over priority public 
health concerns other than COVID-19 could be neglected. 
Success in introducing and sustaining innovations is also limited by local partners’ capacity to adopt and 
scale up innovations. The basis and prospects for future success of USAID and DOH collaboration may 
need to be reviewed in the light of the COVID-19 pandemic, UHC, and other new mandates. The 
coordination of various government agencies is a serious challenge. 
17 Note: this is for the cartridge only (consumable). The machine itself is expensive. Sometimes, labs just lease or borrow this from Cepheid as 
long as a quota of purchased cartridges is met.
18 Kirby, K. C., Marlowe, D. B., Festinger, D. S., Garvey, K. A., & LaMonaca, V. (1999). Community reinforcement training for family and 
significant others of drug abusers: A unilateral intervention to increase treatment entry of drug users. Drug and alcohol dependence, 56(1), 85–
96.
19 Grim, B. J., & Grim, M. E. (2019). Belief, behavior, and belonging: How faith is indispensable in preventing and recovering from substance 
abuse. Journal of Religion and Health, 58(5), 1713–1750.
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Program-level data like the ITIS and FHSIS are important for M&E, yet gaps remain in data collection and 
quality, analysis, and interpretation, including gathering gender-sensitive data. HP can support further 
development of these data sources by engaging with partners to conduct analyses to address policy 
questions. 
The HP may have to further improve how it engages partners. Coordination of multiple activities can 
help deepen partner involvement and buy-in. As an example, managing four functionally differentiated TB 
activities is difficult. Similar issues have been raised regarding the effectiveness of having a separate HP 
activity for BARMM. FP work in BARMM continues to face challenges in project management and in 
dealing with geographic distances, coordination difficulties, special population needs, and social norms 
and religious beliefs on FP and early marriage. We recommend creating a single umbrella project for FP 
with a distinct BARMM component to take advantage of shared capacities, especially in technical 
supervision over complex interventions or innovations.
New start-up activities should be given sufficient time to germinate. Work on CBDR has a 
comprehensive profile of interventions, but some are expected to have less impact than others. 
Different government agencies oversee different services in the treatment and support of PWUD: DILG 
and its Bureau of Jail Management and Penology for law enforcement, DOH for facility-based 
rehabilitation, DSWD for aftercare support, and CBDR for LGUs. As a unifying project for PWUD, the 
HP can provide technical assistance in streamlining and integrating the care cascade, which can 
eventually facilitate smooth transition of PWUD from one part of the cascade to another.
HP activities that engage experts have been found to be highly effective. HP work in SBCC related to 
FP/ARH has made a difference because of the presence of a team of SBCC experts. Such expertise is 
needed in dealing with partners who are conversant with SBCC principles but are able only to translate 
these operationally as “knowledge translations and communication,” “communications and dissemination 
activities,” and “materials development.”
USAID should intensify engagement of partners from private corporate institutions with interests in 
public health (e.g., Ayala, Aboitiz, MVP, Razon, Shell). Their track record of participation in the 
prevention and control of COVID-19 provides the momentum for them to do the same for TB and 
FP/ARH.
USAID should consider engaging a separate independent M&E outfit tasked to (a) collect and analyze 
data to track progress of priority programs, and (b) transfer the technology of an independent, 
evidence-based M&E platform to national and local health entities.
Several key informants raised questions about how best to organize HP activities in view of the challenge 
of managing BARMM activities and the reality that different entities manage functionally different 
activities (e.g., platform vs. innovation). An important consideration is how to optimize USAID capacity 
to provide both administrative and technical supervision of HP activities. The push for national and local 
actions and innovations requires more intensive and strategic input from USAID technical staff. In the 
next program cycle, USAID may want to set up one project for TB with distinct components on 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 53
innovation design, testing, replication, and planning for institutionalization. This may solve coordination 
issues among different USAID staff and IPs. 
At the national level, consider focusing assistance to the DOH DPCB and PhilHealth, where most 
USAID assistance is concentrated. Designating a USAID focal point at the DOH may be beneficial to 
streamline coordination of all matters related to USAID support to the GPH and reduce transaction 
costs. 
The DOH should be preparing a transition program for a new administration in July 2022—it would be 
useful for USAID to participate in these proceedings, partly as a way of determining priorities that might 
be included in the DOAg for the next round of HP activities. The transition program should have a clear 
catch-up strategy to close the gap in FP, ARH, TB, and CBDR targets brought about by the COVID-19 
pandemic.
Summary of key recommendations
On HP support for the DOH: (a) size up and cost out the FP and TB backlog due to the COVID-19 
pandemic; (b) help develop a strategy for the regularization of CHW/BHW/BNS; (c) link CQI with 
budgets and incentives; (d) rationalize the GAD budget; (e) undertake capacity-building for the newly 
organized DOH DPCB; (f) build on the momentum generated by COVID-19 containment, especially 
private-sector engagement; and (g) organize a region-wide UHC implementation lab using TB and FP￾MNCHN as tracers (possibly within the “big three” regions).
On current HP interventions for testing, documentation, and replications: (a) CiTEC, (b) Philippine 
Private Diagnostics Consortium, (c) eLMIS, (d) WISN, (e) SBIRT, (f) ConnecTB, and (g) a Catastrophic 
TB Package in PhilHealth.
On HP interventions for scaled implementation: (a) FP in hospitals, (b) MRLs as public health leaders, (c) 
FAST Plus, (d) IHLGP in regions, (e) Konsulta package, (f) Katropa, (g) CSE-ARH Converge, (h) 
adolescent-friendly health facilities, and (i) men’s reproductive health.
On future HP activities: (a) one TB IP with distinct components on innovations design, testing, 
replication, and planning for institutionalization; (b) a distinct BARMM component within an umbrella FP 
IP; (c) independent monitoring, evaluation, and learning/collaborating, learning, and adapting IP with a 
mandate to collect, analyze, and monitor performance of HP activities and share lessons with the 
DOH20; and (d) an additional role for an HSS/policy/finance IP that will validate institutionalization and 
scale-up strategies for HP interventions. Moreover, technical capacity, perhaps by way of an indefinite 
quantity contract–like facility, may be considered to augment HP management’s ability to supervise an 
increasingly complex and challenging set of interventions. Such additional capacity may be needed in 
sorting and assessing the design, technical soundness, approaches to replication, and institutionalization 
for eventual scaled implementation.
20 It may be argued however, that the IPs must be given the opportunity to learn, to collect the data, and to analyze them—for real-time 
feedback and adaptation.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 54
An approach to tie all these recommendations together in a way that allows for scaled implementation is 
to package HP support and focus its activities to assist the DOH in implementing UHC at a regional 
level. Support for a UHC regional laboratory should involve two or more provinces containing 
consumers and providers of health services representing a continuum of care from disease prevention 
to primary curative care, up to treatment and rehabilitation in tertiary and specialty facilities. 
Replication and eventual institutionalization might be easier to facilitate at the regional level, given 
administrative and budgetary mechanisms available through DOH, PhilHealth, POPCOM, and other 
institutions. It may be in the context of supporting regional UHC labs, where the LGU pivot initiated by 
current HP activities might become more meaningful. It is also at the regional level where future efforts 
to build the capacity to manage an increasingly complex financing and delivery system may be 
concentrated. A particular concern is the need to expand and strengthen the number and availability of 
middle-level managers at regional and LGU health offices. This proposed expansion of health 
management capacity also needs to be complemented with the appropriate enhancement of health 
management information systems. Finally, following the experience with efforts to contain COVID-19, it 
may be easier to engage the private sector and civil society organizations at levels that involve both 
consumers and providers of the continuum of care.
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 55
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USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 60
ANNEX A. SCOPE OF WORK
Scope of Work
Collaborating, Learning, and Adapting for Improved Health
IDIQ No. AID-OAA-I-15-00025, Task Order No. 72049218F00001
Health Project Multi-Year Whole of Project Evaluation (WOPE) Scope of Work
1. Description of the Evaluation Statement of Work
Evaluation Information 
Item Details
I. Title Health Project Multi-Year Whole of Project 
Evaluation (WOPE)
II. Requester/Client USAID 
Mission/Division: Philippines
III. Funding Account Source(s)
IV. Cost Estimate
V. Performance Period
Expected Start Date (on or about) July 19, 2021
Anticipated End Date (on or about) January 31, 2022
VI. Location(s) of Assignment Philippines
VII. Type of Analytic Activity/
EVALUATION
Multi-year Project Evaluation
• Performance Evaluation
• Process Evaluation
2. Background
2.1 Background of the USAID/ Philippines Health Project
The goal of the Health Project (HP) 2018– 2024 is Improved Health for Underserved Filipinos. 
“Underserved” in the primary context of the HP refers to people exposed to or with drug-susceptible 
tuberculosis (DS-TB) or multidrug-resistant TB (MDR-TB), youth and adults at risk for unwanted, early 
pregnancy and childbirth, people in need of voluntary community-based drug rehabilitation (CBDR) 
services, and people most at risk for HIV. The HP focuses on geographic areas where the health burden 
is the greatest, i.e., where the TB disease burden is the highest, where unmet need for family planning 
(FP) is the highest, where there are high teenage pregnancy rates, and where there is a high, evidence￾based need for drug demand reduction services.21
21 Development Objective Grant Agreement between the United States of America and the Republic of the Philippines for Development 
Objective “Improved Health for Underserved Filipinos.” USAID Grant Agreement No. 492-DO-IHUF. May 18, 2020. 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 61
Health systems strengthening (HSS), which spans across all these four programs, is national and local in 
scope. At the national level, HSS supports various funding streams to help develop relevant policies and 
guidelines and assist the Department of Health (DOH) and other government agencies and other 
partners with systematic implementation of these policies and guidelines at the regional and local 
government unit (LGU) levels. At the LGU level, the HP is also supporting implementation of the 
Universal Health Care (UHC) Law in 12 UHC Integration Sites located within HP project sites. HP 
activities also prioritize work in Cities Development Initiative cities where high health burden overlap with 
technical areas where USAID works.1
The HP 2018– 2024 of the USAID/Philippines consists of four primary health programs: (1) FP and 
adolescent reproductive health (FP/ARH); (2) TB control; (3) CBDR; and (4) HSS. Under each program, 
USAID/Philippines funds one or more mechanisms, also referred to as activities. These activities have 
varying start-up and close-out dates, with several carried over from the previous HP cycle (2012 –
2018). (Table 1. Details on each implementing mechanisms/activity are provided in Annex A). 
Table 1. Health Project Activities 2018 – 2024*
Implementing 
mechanism/activity by 
project
Type of 
mechanism 
Start date End date Implementi
ng partner 
(IP)
Name of 
AOR/COR
Community Maternal, 
Neonatal, Child Health & 
Nutrition Scale-up 
(CMSU2)
Cooperative 
Agreement
August 2016 December 
2019
IMAP Ma. Teresa 
Carpio
FP/MNH Health 
Innovations and Capacity 
Building Platforms 
(ReachHealth)
Cooperative 
Agreement
December 
2018 
November 
2023
RTI Yolanda 
Oliveros
Bangsamoro Autonomous 
Region in Muslim 
Mindanao Health Capacity 
Building (BARMMHealth)
Cooperative 
Agreement
February 
2019 
February 
2024
URC David Dereck 
Golla VI
Treat TB: Supporting 
MDR-TB Activities in the 
Philippines
Cooperative 
Agreement 
(through field 
support)
September 
2016 
March 2019 Vital 
Strategies
Tito Rodrigo
TB Innovations and Health 
Systems Strengthening 
(TB IHSS)
Cooperative 
Agreement
February 
2018 
February 
2023
FHI 360 Tito Rodrigo
TB Platforms for 
Sustainable Detection, 
Care and Treatment (TB 
Platforms)
Cooperative 
Agreement
April 2018 April 2023 URC Ernesto 
Bontuyan
TB Local Organizations 
Network (TB LON)
Grant October 
2020 
September 
2023
Action for 
Health 
Tito Rodrigo
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 62
Table 1. Health Project Activities 2018 – 2024*
Implementing 
mechanism/activity by 
project
Type of 
mechanism 
Start date End date Implementi
ng partner 
(IP)
Name of 
AOR/COR
Initiatives, 
Inc.
Institutionalization of the 
Health Leadership and 
Governance Program 
(IHLGP)*
Cooperative 
Agreement
July 2017 September 
2020
Zuellig Family 
Foundation
Ma. Teresa 
Carpio
Health Equity and 
Financial Protection 
Platform (ProtectHealth)*
Cooperative 
Agreement
March 2019 March 2024 Palladium Joseph Lachica
Medicines, Technologies, 
and Pharmaceutical 
Services Program 
(MTaPS)*
Contract 
(through field 
support)
September 
2018 
September 
2023
Management 
Sciences for 
Health
Helen Hipolito
Human Resources for 
Health 2030/Philippines 
(HRH2030)
Cooperative 
Agreement 
(through field 
support)
October 
2017
June 2020 Chemonics 
International, 
Inc.
Yolanda 
Oliveros
Expanding Access to 
Community-based Drug 
Rehabilitation Program in 
the Philippines 
(RenewHealth)
Cooperative 
Agreement
May 2019 May 2024 URC Yolanda 
Oliveros
Collaborating, Learning, 
and Adapting for 
Improved Health 
(CLAimHealth)
Contract March 2018 March 2022 Panagora 
Group, LLC
Maria 
Guadalupe 
David**
Helen 
Hipolito***
 * For the multi-year whole-of-project evaluation, the HIV activity will not be covered as it was only launched in
 September 2020.
** up to Aug 14, 2021
*** from Aug 15, 2021 to March 29, 2022
The HP midterm evaluation will cover the four health programs being supported by USAID/ Philippines: 
TB, FP/ARH, CBDR, and HSS. It will evaluate the various activities (mechanisms) under these four 
programs to determine their contributions in reaching the HP’s goal of ‘Improved health for 
underserved Filipinos’ under USAID/ Philippines’ Country Development Cooperation Strategy (CDCS) 
2019 – 2024, which focuses on good governance and self-reliance to achieve the goal of the Philippines 
becoming “A Well-Governed and More Self-reliant Indo-Pacific Partner.”22 The three development 
22 USAID/Philippines. Country Development Cooperation Strategy 2019 – 2024. USAID, Manila, Philippines. 2019. Available at: 
https://www.usaid.gov/sites/default/files/documents/1861/Philippines_CDCS_2019-2024.pdf
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 63
objectives (DO) of the CDCS are: DO1: democratic governance strengthened; DO2: inclusive, market￾driven growth expanded; and DO3: environmental and community resilience enhanced. The CDCS also 
emphasizes three cross-cutting strategies: increased private sector engagement, enhanced gender and 
social inclusion, and civil society strengthened. Please see the HP’s results framework below (Figure 1).
 
Figure 1. Framework of the USAID/Philippines Health Project, 2019–2024
2.2 Development Context
The USAID/Philippines CDCS provides the overall frame in which the HP operates. The focus for the 
CDCS covering the period 2013–2019 was on Partnership for Growth (PFG) to attain the goal of a 
More Stable, Prosperous and Well-Governed Nation. While looking back at 2018 and 2019 with the 
PFG lens, the HP trajectory for the present and future will be guided by the new CDCS (2019–2024), 
which focuses on good governance and self-reliance to achieve the goal of the Philippines becoming “A 
Well-Governed and More Self-reliant Indo-Pacific Partner.” The three DOs of the new CDCS are: DO1: 
democratic governance strengthened; DO2: inclusive, market-driven growth expanded; and DO3: 
environmental and community resilience enhanced. The new CDCS also emphasizes three cross-cutting 
strategies: increased private sector engagement, enhanced gender and social inclusion, and civil society 
strengthened.23
The CDCS goals are consistent with and complement those of the Philippine Health Agenda 2016–2022, 
which focuses on financial risk protection, better health outcomes, and a responsive health system that 
provides access to services. The Philippine Health Agenda was framed at a time when the country was 
making considerable headway in addressing inequities and inefficiencies in service delivery, financing, 
regulation, and demand generation. The CDCS is also aligned with the medium-term National 
Objectives for Health (NOH) 2017–2022 of the Department of Health which serves as a roadmap for 
23 USAID/Philippines. Country Development Cooperation Strategy (CDCS), November 25, 2019 – November 25, 2024. Available at: 
https://www.usaid.gov/philippines/cdcs
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 64
the Philippines to achieve universal health care. The NOH is the guiding post for implementing 
FOURmula One Plus (with the tagline “Boosting Universal Health Care”), which provides the medium￾term strategic framework for revitalizing the health reform agenda. FOURmula One Plus focuses on the 
four pillars of health reforms (i.e., service delivery, regulation, financing, and governance) with emphasis 
on accountability. The CDCS and the HP strategy are likewise aligned with the Philippine Development 
Plan (PDP) 2017 – 2022, which aims to lay the foundation for inclusive growth, a high-trust and resilient 
society, and a globally competitive knowledge economy. The PDP goal is supported by three pillars: 
Malasakit (building trust), Pagbabago (reducing inequalities), and Patuloy na Pag-unlad (sustainable growth 
and development). These pillars are further supported by strategic policies and macroeconomic 
fundamentals, and built on a solid bedrock of safety, peace and security, infrastructure, and a healthy 
environment.
Years 2018 – 2019. The enactment of the UHC Law (Republic Act [RA] 11223) in July 2018 gave the 
impetus to the HP IPs to refocus some of their resources to supporting the DOH and PhilHealth, and 
more critically the local governments in the sites assisted by the United States Government (USG), in 
putting in place the necessary infrastructure (systems, networks of providers) to improve access of the 
underserved and the poor to health services. However, the RA 11223 Implementing Rules and 
Regulations (IRR) were released only in November 2019, postponing the actual implementation of 
planned activities. Numerous consultations at the national and local levels as well as issues of corruption, 
claims fraud and leadership changes at the helm of the Philippine Health Insurance Corporation 
(PhilHealth) during the year caused delays in the development and approval of the IRR. 
While the annual budgets of the DOH steadily rose from about PhP7 billion in 1991 to PhP93 billion in 
2019,24 the delay in the congressional approval of the 2019 government budget curtailed the 
implementation of activities, impeded the procurement process, and led to stock-outs in needed drugs 
and medicines. This lag in budget approval exacerbated the persistent problems of low disbursement of 
funds at the DOH. Even as the obligation rates averaged 88 percent in the last five years (with high rates 
of 95 percent in 2017 and 94 percent in 2018), the disbursement rates were in the low 60 – 65 percent. 
Despite efforts to train staff and impose bureaucratic remedies, budget planning and execution, 
procurement bottlenecks, and supply chain management issues remain. 
The budget obligation rate of the Family Health and Nutrition and Responsible Parenting (FHNRP) unit 
under the DOH Disease Prevention and Control Bureau (DPCB) decreased from 62 percent in 2018 to 
51 percent in 2019, while the very low disbursement rates improved marginally from 1 percent to 6 
percent during the same period. The average obligation rate in the DCPB was 82 percent in 2018 and 80 
percent in 2019, while the average disbursement rate was only 12 percent in 2018 but increased to 26 
percent in 2019. The National TB Control Program (NTP) had zero disbursement in 2018, despite 
obligating 61 percent of its budget. The DOH acknowledged that procurement problems – bidding and 
contracting issues – caused this non-disbursement of obligated funds. However, the NTP performed 
better in 2019, showing an obligation rate of 99 percent and a disbursement rate of 51 percent. 
24 The 2018 budget for DOH was higher at PhP 106 billion. The decrease in the 2019 budget was because the budget subsidy for PhilHealth is 
no longer included in the 2019 DOH budget. 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 65
The late disbursement of funds, compounded by the lack of storage space and interruptions in delivery 
due to the requirements of the DOH Food and Drug Administration, aggravated the stock-outs of drugs 
and commodities. In the case of subdermal implants, local stocks expired due to a moratorium on the 
Responsible Parenthood and Reproductive Health (RPRH) Law implementation (lifted only in late 2018) 
and a global shortage of implants worsened the resupply problem.
The procurement and hiring ban prior to and immediately after the election of local and congressional 
officials in May 2019 likewise contributed to the lags in purchase and delivery of goods and services. 
While the IPs were not directly affected by the bans, the DOH and the LGUs were significantly affected. 
Moreover, the IPs’ priorities and approaches to project implementation were affected by changes in 
leadership at the LGUs and members of both houses of the Philippine Congress, with whom they had to 
discuss policy concerns and/or program implementation. 
The outbreaks of measles and dengue were anticipated and the DOH had the resources and protocols 
to respond. But the public and congressional uproar over the outbreaks, particularly the re-emergence 
of polio, distracted the attention of the DOH administration and disrupted the implementation of its 
program plans, which were already seriously compromised by budget approval delays. However, in 
response to these outbreaks, the disbursement rates for the National Immunization Program (NIP) and 
Prevention and Control of Other Infectious Diseases (PCID) Program dramatically increased in 2019. 
The disbursement rates for the NIP rose from 16 percent in 2018 to 42 percent in 2019; those for the 
PCID increased from 11 percent in 2018 to 42 percent in 2019. 
Year 2020 and COVID-19. In 2020, the HP continued to assist PhilHealth and the DOH in the 
analysis of the financial impact of the UHC Law’s full implementation, and in presenting options within 
the available public fiscal space given the expanded Sin Tax Law and other excise taxes earmarked for 
health, and the budgetary burden and future requirements for responding to the COVID-19 pandemic. 
The National Expenditure Program 2020 set aside PhP172.4 billion for the UHC Law implementation 
and allocated PhP71.4 billion for PhilHealth premium subsidies. However, funding shortfalls were 
expected since there was no increase in premium subsidies from 2019 levels and the requirements for 
the national COVID-19 responses were tremendous. Moreover, there was an expected uptick in 
utilization arising from a combination of universal enrollment and immediate eligibility to benefits 
packages. The collection from the formal sector that usually mitigates the shortfall was imperiled, given 
the loss in premium payments due to job losses and business closures during the community quarantines 
in response to the COVID-19 pandemic. As of end September 2020, PhilHealth received a total of 
PhP112.5 billion in premium contributions from all sources, a slight increase (3.7 percent) from 2019, 
and had paid benefit claims of around PhP110 billion, almost 30 percent more than in 2019, likely due to 
the costs of treating COVID-19 cases. 
The total benefit claims include estimated payments for primary care benefits (actuarial estimates as of 
December 2019 based on the primary care benefits per family payment rate) but not yet released. 
Primary care benefit payment cheques, still in the possession of PhilHealth, representing claims 
processed, amounted to approximately PhP132 million as of September 30, 2020, and approximately 
PhP174 million as of December 31, 2019. Charges of inefficiency and corruption continue to hound 
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 66
PhilHealth, jeopardizing the approval of any requests for more subsidies or increase in premium rates to 
recover and offset reductions in premium contributions due to job losses and business closures. 
The total budget allocated for the DOH in 2020 was approximately PhP105 billion, higher than the 
PhP93 billion in 2019. The biggest increases were for hospital operations (a budget of close to PhP40 
billion), with a PhP8.7 billion increase for 2020 as hospitals bore the brunt of the COVID-19 response. 
The Family Health and Nutrition and Responsible Parenting (FHNRP) Unit was appropriated a budget of 
18 percent less than the 2019 total (PhP2,033,916,000 vs. PhP2,472,022,000, respectively) and it was 
almost half (44 percent reduction) of that in 2018 (PhP3,639,663,000). Approximately PhP100 million of 
its budget (i.e., the budget for Public Health Management that funds soft components such as training 
and monitoring) was realigned to the COVID-19 response. The 2020 total budget for the National TB 
Control Program (NTP) increased by 4 percent (PhP949 million) from the 2019 budget (PhP880 million) 
and increased 16 percent from the 2018 budget (PhP785 million). 
Available information up to the end of the CY 2020 Q3 showed that the budget obligation rate of the 
FHNRP Unit was 42.5 percent (51 percent in the entire 2019) but the disbursement rate was only 5 
percent. The NTP had a 96 percent obligation rate, but the disbursement was only 10 percent by the 
end of CY 2020 Q3. This slow utilization of current year budgets is compounded by the need to first 
spend the previous year’s continuing appropriations. By the end of September 2020, the FHNRP Unit 
had obligated only 73 percent of its 2019 continuing appropriations, of which only 23 percent was 
disbursed. The NTP obligated almost all of its 2019 continuing appropriations (98 percent) and 
disbursed 88 percent of it. 
While this slow movement of funds in the early part of the year is common in government agencies, it 
appears that procurement problems such as bidding and contracting issues, which were already 
recognized in 2019, were not immediately addressed in early 2020.The slow disbursement of funds 
could have been affected by the enhanced community quarantine, which started in mid-March 2020, 
when even government offices slowed down operations. Likewise, the Taal volcano eruption in January 
2020 and subsequent displacement of the population in the surrounding areas, diverted the attention of 
the DOH and local health officials to provide emergency response in these areas. 
The budget for the Prevention and Control of Other Infectious Diseases Unit increased by 38 percent, 
from PhP738,347,000 in 2019 to PhP1,018,345,000 in 2020. However, this is still less than the Program’s 
2018 budget of approximately PhP1.6 billion. By the end of CY 2020 Q3, 86 percent was obligated, but 
only 4 percent was disbursed. This could have been a case of the unit using the collected funds 
specifically for the COVID-19 pandemic response, instead of its own 2020 appropriations. The budget of 
the Epidemiology and Surveillance Unit, which is at the forefront of COVID-19 case monitoring and 
analysis, was reduced by 56 percent from around PhP266 million in 2019 to PhP115 million in 2020. 
USAID’s IPs operations were affected by the community quarantines imposed in almost the entire 
country due to COVID-19. Expanded community quarantine was imposed the longest in the National 
Capital Region (NCR), Region III, and Region IV-A, and other hotspots like Cebu City and Baguio City. 
The first of these lockdowns started in mid-March 2020 and various versions were imposed at different 
localities and at varying times throughout the year depending on COVID-19 case rates. Because most IP 
activities work with and engage DOH officials, local health professionals, and community health workers, 
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they were negatively affected when it became extremely difficult to secure time to discuss policies and 
programs with health officials who were fully occupied managing the responses to the pandemic. 
Moreover, the travel restrictions and distancing protocols halted face-to-face community engagements 
(e.g., conduct of Usapan sessions and trainings) and interactions with health facilities staff on data 
monitoring and reporting. Likewise, closures of small private health clinics limited collaboration with the 
private health sector, while the re-deployment of health staff and conversion of health facilities, including 
laboratories, to COVID-19 case treatment and testing affected data recording and reporting, and more 
importantly the provision of services other than for COVID-19. 
Nevertheless, local health offices and providers continued to serve the public and navigate through 
imposed quarantine protocols and associated limitations to comply with the DOH Circular 2020-0167 
dated March 23, 2020 on Continuous Provision of Essential Health Services during the COVID-19 
pandemic. The IPs also responded quickly to assess the situation in USG-assisted sites by conducting 
rapid surveys of local health facilities’ operations during the community quarantine period. These rapid 
assessments showed that almost all health care providers contacted (more than 90 percent) reported 
that their facilities remained open and were able to deliver essential services, including for family 
planning (FP). 
Health providers employed adaptive measures, such as house-to-house delivery of FP commodities in 
quantities good for longer periods, and deployment of more barangay volunteers (e.g., Barangay Health 
Emergency Response Teams) to mitigate the effects of the mobility restrictions, such as reduced number 
of health staff and transport constraints of clients. In the case of TB services, anti-TB drugs were 
provided in health facilities and were also delivered to the homes of patients in quantities good for a 
month. Additional barangay health volunteers were engaged to monitor treatment compliance at home, 
and TB testing centers were re-zoned to ensure continued access in spite of the conversion of some 
laboratories to COVID-19 testing laboratories. 
However, even with these measures, significant adverse impact of the COVID-19 pandemic was 
expected on the FP/ARH, TB, and CBDR programs, and the country as a whole. While the government, 
health facilities, and the IPs were able to utilize various digital platforms (e.g., mobile phone apps and 
online meetings), many locations faced unstable mobile phone and internet connections and remote 
areas lacked the required digital infrastructure (i.e., smart phones, computers, internet connections) to 
perform their tasks, participate in meetings and trainings, and report and coordinate with other health 
facilities and clients.
2.3 Coordination Mechanisms
USAID/Philippines has a synchronized and integrated approach among its HP activities in coordinating 
and collaborating with national agencies, LGUs, and other stakeholders. Through the signed 
Development Objective Grant Agreement (DOAG), USAID and the Philippine Government convened a 
DOAG Management Committee and a DOAG Steering Committee composed of representatives from 
national agencies and USAID, which oversee the implementation of the provisions of the DOAG and 
conduct program implementation reviews. 
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The USAID Office of Health (OH) also organizes regular coordination meetings and learning sessions 
among its implementing partners for TB, FP, CBDR and HSS activities to effectively track, monitor, and 
adapt key operational activities across the phases of the program cycle. CLAimHealth supports OH in 
implementing collaborating, learning, and adapting (CLA) approaches to ensure a harmonized, evidence￾based whole-of-project planning and implementation of the HP. 
2.4 Theory of Change
The underlying Theory of Change (ToC) of the HP 2018–2024 is: 
If key aspects of the health system are strengthened and institutionalized, then the health of 
underserved Filipinos will improve, and the overall health profile of the country will improve. By 
addressing the needs of the individual, the quality and equity of services, and the sustainability of 
services and systems, underserved Filipinos will be able to develop and maintain healthy 
behaviors and seek and receive quality health care.
In line with the CDCS and based on the 2016 Health Portfolio Evaluation25 and the Project Appraisal 
Document,26 the appropriate strategy to influence desired change is to bolster and institutionalize a 
system for the GPH health sector, which reinforces healthy behavior, quality services, and agile system 
functions. This is a significant shift from a strategy of providing technical assistance to fill service and 
management gaps, to a GPH partner that strengthens sustainable systems through evidence-based 
innovative approaches that deeply engage actors at both national and local levels in the context of an 
increasingly decentralized governance system.27
The assumptions for positive change through the HP are: 
• Reasonable access to the underserved Filipinos (regions/sites with the highest TB burden 
and unmet need, and low-income groups in these areas)
• Political support to effectively implement the RPRH (Republic Act 10354, also called the 
RPRH Law), the Comprehensive TB Elimination Plan Act of 2016 (TB Law, Republic Act No. 
10767), and the UHC Law (Republic Act 11223)
• Public sector funding levels at the central and regional levels will be, at least, maintained at 
current levels and/or increased
• Services will continue or resume during periods of natural disaster or political unrest
• USAID funding and staffing levels from USAID will be, at least, maintained at current levels 
and/or increased
25 USAID Philippines. Health Portfolio Evaluation. August 2016.
26 USAID Philippines. Project Appraisal Document: USAID/Philippines Health Project 2017 – 2022.
27 Ibid.
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• For TB, funding from the Global Fund will be, at least, maintained and/or increased until 
public sector funding can sufficiently fill the funding gap
The change expected from implementing the HP activities will be measured through a set of indicators 
at the level of outcomes and outputs for the three sub-purposes (see Figure 2).
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 Figure 2. USAID Health Project Results Framework, 2019–2024 (with updates to performance indicators as of May 2021)
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2.5 Geographic Coverage
The HP has identified project sites based mainly on ‘underserved populations,’ i.e., where the TB disease 
burden is the highest, where unmet need for FP is the highest, where there are high teenage pregnancy 
rates, and where there is a high, evidence-based need for drug demand reduction services.
Table 2 lists the 14 regions of the Philippines where the HP Activities provide technical assistance for 
FP/ARH, TB, and CBDR. At the national/central level, the HP provides technical support on health financing 
for UHC and procurement and supply chain management to DOH, POPCOM, and PHIC. A list of sites 
covered by specific HP Activities is provided in Annex B. 
Table 2. Regional Coverage of the Health Project
Region
FP Activities 
(ReachHealth & 
BARMMHealth)
TB Activities 
(TB IHSS & TB 
Platforms)
CBDR 
(RenewHealth)
NCR   
Region III   
Region IV-A  
Region IV-B 
Region V 
Region VI 
Region VII   
Region VIII 
Region IX 
Region X  
Region XI 
Region XII  
Region XIII 
BARMM   
3. Purpose
This multi-year whole-of-project evaluation (WOPE) of USAID/Philippines’ HP for the period FY 2018 to FY 
2021 aims to:
1) Inform the future strategic direction and approach of the USAID/Philippines HP. It will 
identify key aspects of the political, economic, social, and HSS context that have influenced and will 
influence health programming in the future. It will recommend strategic shifts considering current 
realities and future anticipated changes, particularly for TB.
2) Validate the HP theory of change and determine, based on available evidence, whether 
current USAID-supported activities are contributing to output and outcome indicators 
for these health programs and to the achievement of the HP purpose as a whole. 
Depending on the findings and results, it will recommend adjustments or modifications in the design 
and implementation of current approaches and interventions to improve their effectiveness in the 
remaining three years of the current project cycle as well as key directions and interventions for the 
next project cycle.
3) At the activity level, determine factors that contribute to or hinder the achievement of 
FP/ARH, TB, and CBDR outcomes and high-level program indicators as well as HSS for 
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UHC. It will identify packages of interventions and proven innovative solutions for these programs 
that may be recommended for replication and scaling up in the next project cycle, taking into 
consideration the factors required for the interventions to work optimally. It will also recommend 
adjustments to the design of current interventions that could be implemented in the remaining years 
of the HP activities. It will also identify gaps in the current USAID health programming to inform the 
design of the health strategy for FY 2024−2029.
4. Evaluation Questions
The overarching questions of this Multi-year WOPE aim to: (1) inform future strategic directions and 
approach of the USAID/Philippines HP; (2) recommend adaptations in the design of current interventions 
that could be implemented in the remaining years of current HP activities; (3) determine whether current 
USAID-supported activities contribute to the achievement of the HP purpose and sub-purposes; and (4) 
determine facilitating and hindering factors affecting the achievement of the HP goals for TB, FP/ARH, CBDR, 
and HSS. Other learning questions for consideration are to examine the validity of the HP ToC, value 
perceptions of stakeholders on USAID assistance, and/or unintended results that contributed to the HP 
outcomes.
The WOPE will address the primary and secondary learning questions comprising the HP Learning Agenda 
for 2018 – 2024 provided below.
Evaluation/analytic question Secondary questions
1. For the next USAID program cycle (2022 –
2026), what type of support should the HP 
invest in to achieve desired health outcomes 
and sustainable systems changes in the 
Philippines?
• Which health system pillar/s should be prioritized?
• What type/form/nature of technical assistance should 
be provided for TB, HIV, FP/ARH, and CBDR?
• What mechanisms should be used for the delivery of 
support?
2. How has the USAID HP contributed to 
improve health outcomes among the 
underserved? [Improving Health Outcomes]
• To what extent have the HP Activities contributed to 
achieving the targets (i.e., extent of performance 
relative to the annual targets and end-of-project 
targets)? 
• What were the critical enabling factors associated with 
achievement of HP targets? 
• What were the challenges and barriers to achieving 
HP targets? 
• What innovations contributed to improving health 
outcomes? 
3. How has the USAID HP interventions 
improved social norms and behaviors among 
the underserved seeking treatment and 
prevention services? [Improving Demand]
• What demand generation platform and messaging 
were most effective for: men, adolescent youth, urban 
poor, women with unmet need for FP, and persons 
who use drugs (PWUD)? 
• What HP interventions have improved health seeking 
behavior and treatment adherence? 
4. How has the USAID HP increased client 
satisfaction? [Improving Demand and Supply]
• How does the HP operationalize people-centered care 
in delivery of health services? 
• How does the HP measure client satisfaction? 
• How have USAID health interventions increased and 
sustained FP use, increased TB treatment compliance, 
and reduced CBDR discontinuation rates?
5. How has the USAID HP led to continuous 
quality improvement in care service delivery? 
[Improving Supply]
• How has HP improved the skills of FP/ARH health 
providers?
• How has HP expanded FP services?
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Evaluation/analytic question Secondary questions
6. How has the USAID HP contributed to 
improving financial risk protection? [Improving 
Health Systems]
• What HP interventions have helped reduce out- of￾pocket cost for TB and FP/ARH for the underserved?
• What HP interventions have improved the social and 
financial benefit packages related to TB and FP/ARH? 
• What HP interventions have improved the delivery of 
social and financial benefit packages related to TB and 
FP/ARH?
• What HP initiatives have helped to increase and/or 
secure program budgets for TB, FP/ARH, and CBDR 
at the national and local levels? 
7. How has the USAID HP supported the 
strengthening of health systems and the 
operationalization of UHC in the Philippines? 
[Improving Health Systems]
• [General] What HSS reforms are in place because of 
USAID interventions? How are these HSS reforms 
impacting health outcomes?
• [Governance and Policy] What HP interventions have 
improved effectiveness of DOH (Disease Control and 
Prevention Bureau, Health Promotions Bureau, 
Pharmaceutical Division, Health Human Resources and 
Development Bureau, Dangerous Drugs Abuse & 
Prevention & Treatment Bureau, its information 
systems), , Ministry of Health BARMM, PHIC, and 
Dangerous Drugs Board in delivering their mandates?
• [Governance and Policy] What HP interventions have 
improved local health system capacity for policy 
formulation, budget planning & execution, inter-local 
cooperation, program implementation and M&E?
• [Governance and Policy] What HP interventions have 
increased national and local capacity in health systems 
management in sustainably supporting TB and FP/ARH 
Programs?
• [Human Resources for Health] What HP interventions 
have helped in expanding and building health provider 
capacity for quality health care delivery for TB and 
FP/ARH Programs?
• [Human Resources for Health] What HP interventions 
have helped in improving supportive supervision and 
mentoring in HRH?
• [Logistics] What HP interventions have helped ensure 
TB and FP/ARH health commodity security at the 
national and local levels?
• [Information System] How has the HP supported 
improvement of the TB, FP/ARH, and CBDR 
information systems?
8. How has private sector engagement 
contributed to achieving better health 
outcomes? [Improving Private Sector 
Engagement]
• How has the USAID HP contributed to the greater 
involvement of the private sector? 
• What limits the private sector engagement in 
effectively contributing to better health outcomes? 
• What engagement models increased private sector 
engagement?
9. How has CSO engagement contributed to 
achieving better health outcomes? [Improving 
Civil Society Engagement]
• How has the USAID HP contributed to the greater 
involvement of CSOs? 
• What limits the civil society engagement in effectively 
contributing to better health outcomes? 
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Evaluation/analytic question Secondary questions
• What engagement models increased civic 
participation?
10. How has the USAID HP contributed to 
addressing GEWE concerns in accessing health 
services? [GEWE] 
• How many people were reached and provided with 
services related to gender-based violence? 
• How many people were trained to advance outcomes 
consistent with GEWE though their roles in public or 
private sector institutions or organizations? 
• How can access of males to TB services be increased?
• How can access of men, women, and adolescents to 
FP services be improved?
• How can access of male, female, and adolescent 
PWUD to CBDR services be improved?
• How did HP Activities contribute to the above?
11. How has the USAID HP improved the ability 
of health service delivery points to mitigate 
environmental risks and withstand climate 
risks? [CRM]
• What interventions have been effective in improving 
resiliency of service delivery points? 
12. How has the USAID HP ensured that 
interventions for the underserved are 
sustainable beyond project life? [J2SR]
• What interventions have contributed to the resilience 
of national and local health systems? 
• What processes have led to reforms or adoption of 
high impact interventions by the GPH at the national 
and local levels? 
13. To what extent are CLA practices integrated 
in the USAID HP? [CLA Mainstreaming]
• [Collaboration] How have IP collaboration & 
coordination improved project performance? 
• [Learning] What learning platforms were most 
effective in supporting evidence generation and 
utilization? 
• [Adaptive Management] What adaptive management 
platforms were most effective in supporting decision 
making and adoption? 
14. What innovative technologies and adaptations 
are being introduced, given the current 
environment and realities? [Innovation]
For the consideration and guidance of the evaluation team, supplemental guide questions, as suggested by 
USAID/Philippines OH, are found in Annex C.
5. Audience
The main audience of this multi-year WOPE of the USAID HP include the following: (1) leadership and 
technical staff of the USAID/Philippines OH and USAID/Philippines Program Resource Management Office, 
(2) the DOAG Management Committee and Steering Committee, (3) leadership and technical/field staff of 
the nine HP Activities currently in place, and (4) local stakeholders of the HP, including technical and 
program staff of the DOH including Center for Health Development (CHDs), the National Economic
Development Authority (NEDA), Commission on Population and Development (POPCOM), Philippine 
Health Insurance Corporation (PhilHealth), local chief executives (LCEs) and provincial health offices, and 
private sector and civil society organization (CSO) partners. 
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6. Methods
6.1 General description of methods
This portfolio evaluation is a multi-year, cumulative WOP exercise that spans the entire HP cycle and all 
component activities. This is designed as a mixed-methods evaluation, drawing on both quantitative and 
qualitative data and triangulating the data gathered.
The mixed-method evaluation design will employ a mix of quantitative and qualitative data collection 
methods and tools. The primary quantitative data sources will be regular reports from IPs on their 
accomplishments vis-à-vis targets for OH indicators and selected activity-level indicators, as well as 
secondary data from national, regional, and provincial databases, where available and applicable. The data 
sources for the results for the OH indicators are multiple: records of DOH (e.g., the NTP’s Integrated TB 
Information System [ITIS]), LGU-level health facilities such as FHSIS reports where possible, and the 
PhilHealth; and, where needed, primary data collection through rapid online surveys. Information on the 
quality of data, derived from data quality assessments and data validation exercises, will also be gathered.
Qualitative data collection methods will be used to dive deeper into why and how interventions work or do 
not work. This will involve key informant interviews and focus group discussions with IPs and their AORs, 
and selected stakeholders such as DOH, POPCOM, PhilHealth, LGUs, clients and communities served, and 
other partner agencies. Records of pause-and-reflect sessions and after-action reviews will also be valuable 
sources of information to understand performance. In addition, results of implementation research and case 
studies of good practices and promising interventions (GPPI) conducted by the IPs will be reviewed and 
analyzed to provide supplementary evidence on what works (or does not work). 
6.2 Document and Data Review
The desk review will be used to provide background information on the HP and will also provide relevant 
data for this evaluation. Indicative documents and data to be reviewed include:
Phase 1
• Existing HP documents, including:
o USAID Philippines. Health Portfolio Evaluation. August 2016.
o USAID Philippines. Redacted Project Appraisal Document: USAID/Philippines Health Poject 2017 
– 2022. 
o Updated HP MEL Plan, HP Learning Plan, HP Dissemination Plan (as of May 2021)
o Annual HP Performance Evaluations (CY 2019 and CY 2020)
o HP Performance Evaluation Report (FY 2018)
o HP Mid-year Reports (FY 2019 and FY 2020)
o HP GPPI Reports
▪ FP in Hospitals
▪ Program for Young Parents
▪ FP Days
▪ Journey to Self-Reliance: Integrated Midwives Association of the Philippines (IMAP)
▪ Service Delivery Network
▪ Engaging Local Chief Executives
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▪ Midwives Mentoring & Monitoring (3Ms) and Supportive Supervision Visits Plus
o HP secondary data analysis
▪ Socio-demographic patterns, knowledge, attitudes, and health-seeking behavior among 
persons with presumptive pulmonary tuberculosis in selected regions of the Philippines: 
Secondary analysis from 2016 and 2017 national survey datasets
▪ Secondary data analysis on unmet need for postpartum family planning
▪ Rapid assessment on the effect of the COVID-19 pandemic on TB case finding activities 
(April 2021)
▪ Rapid assessment of DS-TB and DR-TB situation in the Philippines (May 2021)
• Existing Activity/IP documents, including:
o RFP/A and corresponding proposals/applications (for each Activity/IP)
o Redacted copies of current contracts and cooperative agreements with USAID cooperating 
agencies, including modification documents if related to substantive programmative changes 
rather than budgets/incremental funding
o HP performance indicators and HP performance tracking table (PITT), including targets
o Annual reports
o Activity monitoring, evaluation, and learning plans (AMELPs) and activity PITTs
o Activity annual implementation plans and similar related documents
o Formative research or technical products developed by IPs
• National Demographic and Health Survey (NDHS) Reports (2017, 2013)
• Responsible Parenthood and Reproductive Health, National Implementation Team (RPRH NIT) 
Annual Reports (2020, 2019, 2018)
• National FP Program Costed Implementation Plan (2018 – 2022) 
• National TB Prevalence Survey (2016)
• Expansion of social protection is necessary towards zero catastrophic costs due to TB: The first 
national TB patient cost survey in the Philippines (Florentino, Arao, et. al, 2021)
• Updated PhilSTEP1 2020-2023
• National TB Adaptive Plan (June 2020)
• National TB Health Promotion and Communication Strategy
• TB Joint-Program Review (2019)
• TB Joint Program Review 2019 Epidemiological Report
• TB Preventive Treatment Roadmap 2020–2023
• TB Roadmap Plan and Reports
• National Health and Expenditure Survey (ongoing)
• Philippine National Health Accounts
• Annual Reports of the Philippine Health Insurance Corporation
• CBDR background documents (to be specified)
• HSS background documents (to be specified)
• Relevant policy documents (to be specified)
• Other Documents:
o Research studies, surveys, evaluation reports and similar documents and literature related to: (i) 
SBCC and demand generation, (ii) provision of FP/ARH, TB, and CBDR services and (iii) policy, 
systems, and financing support to FP/ARH, TB, and CBDR
o TB modeling studies from AuTuMN, STOP TB, and others
o The Global Fund to Fight AIDS, TB and Malaria – strategic initiatives and strategy papers on 
private sector engagement, human rights, and gender equality
o Activity strategy papers, concept paper of Activity approaches
o Evaluation reports and other relevant reports of similar nature
o FP/ARH, CBDR, TB-related surveys
• Databases
o NDHS
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▪ 2017 (https://dhsprogram.com/data/dataset/Philippines_Standard￾DHS_2017.cfm?flag=0&flag=0)
▪ 2013 (https://dhsprogram.com/data/dataset/Philippines_Standard￾DHS_2013.cfm?flag=0&flag=0)
▪ DHS STATcompiler (https://www.statcompiler.com/en/)
o DOH NTP ITIS/ Race to End TB Dashboard (http://racetb.doh.gov.ph/#!/layouts/dashboard￾fullview.html)
Phase 2
Additional review of Phase 1 documents and data, as needed, plus any additional documents and data not yet 
reviewed that are identified during Phase 1. 
6.3 Secondary Analysis of Existing Data
Secondary data analyses will be initiated in Phase 1 and supplemental analyses conducted in Phase 2. For FP, 
the latest data set available is the NDHS 2017 data, which will not capture the results of HP interventions in 
2018 to 2021. However, for TB, data from NTP’s ITIS and the WHO database can be utilized to assess the 
intermediate results and effect of USAID-assisted TB interventions, i.e., statistically significant increases 
across time of selected TB indicators. Specifically, the performance in USG-assisted provinces and non-USG￾assisted provinces on the following indicators, among others, can be analyzed in terms of: (i) treatment 
success rate; (ii) case notification rate; (iii) percent of successfully treated MDR-TB cases, and, to the extent 
possible, all 10 core TB Accelerator indicators28.
To the extent possible, the WOPE will analyze performance in terms of the high-level indicators (e.g., for FP 
-- new acceptors and current users; for TB – case notification and treatment success rate), taking into 
consideration baseline data, annual performance, annual targets, and end-of-project targets. To the extent 
possible, data disaggregation of high-level indicators will be done up to the local level 
(province/city/municipality) by type of health facility. 
6.4 Key informant interviews and FGDs
Interviews (via video/teleconference, but preferably face-to-face) will be conducted to identify strengths, best 
practices, gaps, obstacles to health program and project efficiency, management, coordination, collaboration, 
learning, adaptation, institutionalization, and sustainability. Key informants will include, but not limited to:
• USAID/Philippines OH staff
• FP/ARH, TB, HSS, and CBDR IP staff, including subcontractors
• DOH (Disease Control & Prevention Bureau, specifically, NTP, Family Health Office, Health Policy 
Development & Planning Bureau, Health Promotions Bureau, Bureau of International Cooperation, 
Procurement & Supply Chain Management Team, Pharmaceutical Division, Health Human Resource 
and Development Bureau, Food and Drugs Administration, Field Implementation & Control Teams, 
Centers for Health Development, Dangerous Drugs Abuse & Prevention & Treatment Program), 
POPCOM (central and regional), and PHIC (central and regional).
• Other national government agencies (Dangerous Drugs Board, Department of Social Welfare and 
Development
28 USAID. Global Accelerator to End TB. Available at: https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/news-and￾updates/global-accelerator-end-tb
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• LGU representatives at project sites (local chief executives, provincial/city/municipal health officers, 
NTP and FP Coordinators)
• Local private sector and CSO/NGO partners who have been engaged through the HP activities
• Local public and private service health care providers who have been engaged through the HP 
activities
• Development agencies supporting FP/ARH, TB, CBDR programs, and health systems activities
Some key informants can be clustered into small groups for interview. The evaluation team will give due 
consideration to any potential power differentials within a group and to ensure that all participants in a 
group feel comfortable sharing their opinions.
Focus group discussions will be conducted to gain further insight into the relevance and context of the HP 
activities. Participants in these discussions can include, but are not limited to:
• Adolescents 
• Women of reproductive age (to include groups of young mothers: 15-19 and 20-24 years old)
• Males
• Other community members who are the target of SBCC interventions (for CBDR, TB, FP, ARH) 
and beneficiaries of selected high-impact interventions
• Health care providers (public and private) at different levels of care
• Community health workers
6.5 Remote surveys and/or site visits
For selected activities and specific interventions, the evaluation team will do field visits and observations (to 
the extent possible) and/or rapid online surveys. 
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ANNEX B. EVALUATION FRAME, ANALYTICAL PROTOCOL, DATA 
COLLECTION METHODOLOGY AND TOOLS
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ANNEX C. ALL SOURCES OF INFORMATION
Persons Interviewed
USAID/Philippines
Director, Office of Health
Deputy Director, Office of Health
Project Development Specialists (8), Office of Health
USAID/Washington
Senior TB Technical Advisor
Technical Assistance Support to Country
STAR Advisor
USAID Implementing Partners
Family Planning and Maternal and Neonatal Health Innovations and Capacity-Building Platforms 
(ReachHealth)
Chief of Party
Deputy Chief of Party
MERLA Director
Behavior Change Communication Specialist
Health Capacity-Building in BARMM (BARMMHealth)
Chief of Party
Deputy Chief of Party
M&E Specialist
Gender Specialist
TB Innovations and Health Systems Strengthening (TBIHSS)
Chief of Party
Deputy Chief of Party and Private Sector Engagement Advisor
Demand Generation Advisor
DR-TB Technical Advisor
Laboratory and Diagnostic Advisor
Strategic Information Lead 
Operations Research Specialist
M&E Specialist
Operations and Compliance Manager and Gender Specialist
Senior Health Systems Specialist
iNTP Specialist
KM and Communication Specialist
Health Systems Specialist
TB Platforms for Sustainable Detection, Care, and Treatment (TB Platforms) Activity 
Chief of Party
M&E Advisor
Technical Team Lead
MEL Officer and Gender Specialist
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Tuberculosis Local Organizations Network: Strengthening Civil Society Movement Towards a People￾Centered TB Response (TB LON)
Chief of Party
Health Equity and Financial Protection Platform (ProtectHealth)
Chief of Party
Deputy Chief of Party
Senior Advisor for HSS and Health Financing
M&E Officer 
KM Officer
Gender Specialist
USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program 
Chief of Party
M&E Officer
Gender Specialist
Expanding Access to Community-Based Drug Rehabilitation (CBDR) Project (RenewHealth)
Chief of Party
Deputy Chief of Party
M&E Officer
Gender Specialist
SBCC Specialist
Human Resources for Health in 2030 Philippines’ Activity (HRH2030/Philippines)
M&E Associate
Collaborating, Learning, and Adapting for Improved Health (CLAimHealth)
Chief of Party
Deputy Chief of Party
Senior M&E Specialist
Senior Research and Learning Specialist
Senior Engagement, Learning, and Adapting Specialist
Data Management and Analytics Specialist
Communications Specialist
Learning and Capacity Building Specialist
M&E Associate
Monitoring, Evaluation, and Learning Coordinator
Commission on Population and Development (POPCOM)
Executive Director
Executive Assistant / Planning Officer III
Chief Administrative Officer, Administrative Division
Program Assistant, POPCOM NCR
Department of Health
Undersecretary of Health, Public Health Services Team
Undersecretary of Health, Field Implementation and Coordination Team (FICT) – NCR and North Luzon
Undersecretary of Health, FICT – Visayas and Mindanao
Director IV, Disease Control & Prevention Bureau and Health Promotions Bureau
Officer-in-charge, Director IV, Health Policy Development and Planning Bureau
Officer-in-charge, Director IV, Health Human Resource Development Bureau
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Program Manager, Pharmaceutical Division
Program Manager, Family Health Office
Program Manager, National TB Control Program
Deputy Head, National TB Reference Laboratory, Research Institute for Tropical Medicine
Program Manager, Dangerous Drug Abuse Prevention and Treatment Program (DDAPTP)
Director IV, Knowledge Management and Information Technology Service
Director General, Food and Drug Administration
Director IV, Bureau of International Health Cooperation (BIHC)
Senior Health Program Officer, BIHC
Department of Health – Regional Health Office NCR
Chief, Local Health Support Division
TB Program Coordinator
FP/ARH Program Coordinator
FP Program Coordinator
DDAPTP Coordinator
Department of Health – Regional Health Office 3
Chief, Local Health Support Division 
Medical Officer, Non-Communicable Disease
TB Program Coordinator
FP Program Coordinator
HSS Coordinator 
Department of Health – Regional Health Office 4A
Director IV
Department of Health – Regional Health Office 7
Director IV
Chief of Hospital III
Ministry of Health, BARMM
Minister of Health
Planning Officer IV
Medical Officer
Philippine Health Insurance Corporation
Acting Senior Manager, Benefits Development and Research Department
Local Government Unit and Public Health Facility Contacts
Province of Cavite
Infectious and Non-Communicable Disease Cluster Head
Family Health Cluster Head
NTP Coordinator
Maternal Health and FP and GAD coordinator
Chief of Technical Services Office
Municipality of Tanza, Cavite
Municipal Health Officer
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Province of Rizal
FP/MNCHN Coordinator, Rizal Provincial Health Office
Quezon City
City Health Officer
Data Management and Field Operations Officer
Medical Officer, FP Division
Mental Health, and Adolescent Health Program
TB Coordinator
Caloocan City
Assistant City Health Officer
Manila City
Division Chief and MNCHN Coordinator
Medical Officer, Doña Aurora Quezon Health Center
Two (2) other staff of Doña Aurora Quezon Health Center
Cebu City
City Health Officer and TB Coordinator, Cebu City Health Office
Lapu-Lapu City
Assistant CHO and TB Coordinator, Lapu-Lapu City Health Office
Mandaue City
City Health Officer, Mandaue City Health Office
Province of Maguindanao
Provincial Health Officer, IPHO Maguindanao
Technical Division Chief, IPHO Maguindanao
Lamitan City
Nurse, Lamitan RHU West
Sultan Kudarat
CBDR focal person, Sultan Kudarat Balay Silangan Reformation Center
Private Health Facilities
Vice-Chancellor for Research, De La Salle Medical Center and Health Science Institute
Executive Director, Mary Johnston Hospital
Faculty member, University of Cebu Medical Center
Other Partners/International Health Agencies
Country Medical Officer, WHO
Tuberculosis Technical Officer, WHO
Program Manager, Philippine Business for Social Progress
Executive Director, Philippine Coalition Against Tuberculosis
Founder, Lunas Collective
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ANNEX D. CONSOLIDATED REPORT ON KEY INFORMANT INTERVIEWS
General Findings
The COVID-19 pandemic was a particularly significant event that triggered necessary adaptations. As a result, 
projects have fallen behind targets. Restrictions imposed because of COVID-19 increased the difficulty in 
performing tasks required by projects. Some people did not anticipate restrictions to last as long as 
expected, and this resulted in further difficulty implementing programs. New needs related to COVID-19 also 
posed opportunity costs for the projects, such as laboratories that had to cope with the new burden of 
testing for COVID-19. News on COVID-19 has also overshadowed most other health concerns, policies, and 
messages, hindering information dissemination and awareness.
USAID/Philippines continues to support the projects despite pandemic-related disruptions. The participants 
in key informant interviews cited similar experiences in the Asia-Pacific region. Tapping into lessons in similar 
settings like other Asian countries is helpful. The respondents also appreciated the supplementation in 
commodities due to government limitations in procuring essential items for various health services. 
Respondents cited the UHC pilot as a positive example. The pilot’s initial plan was to focus on the central 
levels, but the implementers realized that health programs needed more localized support.
1. On Partnerships with Stakeholders
Respondents have identified UNICEF, UNFPA, EU, World Bank, and private industries as potential partners. 
They also recognized gaps in mechanisms to engage the private sector in health program partnerships 
effectively. These opportunities were seen especially in the BARMM region. 
2. ReachHealth
Partnership with ReachHealth appears to be working, as respondents cited this was a good collaboration for 
FP. Respondents expressed favorable views on establishing a separate COVID-19 team while maintaining 
their family planning programs. Their positive performance has garnered continuous support for their 
activities and has encouraged funding for new activities. 
3. TB Innovations
Respondents described FHI as a good collaborating partner for TB. FHI has abundant experience with TB 
laboratories and was able to apply it to COVID-19. However, there is a need to re-examine the capacities of 
laboratories regarding COVID-19 and TB testing to decongest them and figure out a more efficient system.
4. DOH
There is a shift in government focus to more integrated approaches to assistance. This change emphasizes 
cross-cutting projects, primary care, UHC, and capacity-building. This contrasts with the usual vertical 
approach, which focuses on particular diseases or health care aspects. The respondents cited the DOH as a 
good partner for profiling adolescents in their various health programs.
There is a need for higher-level training and capacity-building to develop skills and expertise within the DOH 
for emerging health leaders. A specific example provided was an opportunity for the Health Promotions 
Bureau to send a staff to the Johns Hopkins Center for Communication for training.
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5. LGUs
There is a need for more transparency and traceability of funding given to LGUs, as funding earmarked for 
health can get lost. There is also a plan by the Health Project’s health systems strengthening activities, such 
as ProtectHealth, for expanded collaboration at the LGU level in the future.
On facilitators and enabling factors identified by key informants
USAID can establish regular partnerships with other organizations, such as UNICEF, UNFPA, EU, World Bank, 
and the DOH, which already have a presence in the selected project sites. These partnerships can enable a 
deeper understanding of the context of the areas. Respondents cited a clear geographical scope of work to 
facilitate better work processes.
During the COVID-19 pandemic, USAID-supported comprehensive information campaigns allayed fears and 
promoted proven measures that improved the public’s confidence in going out of their homes while still 
practicing COVID-19 prevention measures.
On challenges and hindering factors
6. Monitoring
Monitoring was challenging, specifically in BARMM. There is also difficulty relaying changes to health 
program indicators and their definitions to local health systems.
7. Availability of Data
Regularly updated data should be available. Health programs use real-time data to respond faster to a 
dynamic health environment. The data provided by the government are usually released two to three years 
after data gathering. Respondents cited a need for localized data that are integrated into nearby hospitals. 
Respondents suggested expanded surveillance at hospitals as a possible solution. The data are vital to 
provide better perspectives on quality, insurance, and services.
8. Issues with Partners
Respondents observed that partners might not always see themselves as part of the larger team. There is a 
need for improved collaboration among organizations. Specifically, respondents identified gaps in DOH in 
private-sector engagement mechanisms such as bureaucratic bottlenecks in bidding and partnerships. There 
were also problems coordinating between partners. DOH program leaders initially preferred top-down 
coordination processes and felt bypassed when partners directly engaged LGUs. 
However, the DOH has recently seen the value of coordinating with LGUs. There is also a shift in leadership, 
staff position, and DOH priorities. The shifting priorities make it challenging to capitalize on the progress of 
previous projects.
The DOH has cited a lack of a central liaison or coordinating officers for all projects. Although all official DOH 
communications are addressed to the USAID/Philippines Office of Health Director, coordination has involved 
separate discussions with various USAID staff and implementing partners.
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Program-specific findings
9. FP Program
Some stakeholders gave a favorable assessment of the project with reasonable satisfaction for coordination 
and support by USAID. Cited was an ability to adapt and incorporate new techniques such as facilitating 
deployment of FP commodities, tele medicine outreach, and use of social media, especially in the setting 
of COVID-19, which positively affected meeting performance targets and expectations. However, the use of 
RPRH indicators has been paused due to COVID-19 system disruptions. USAID accomplished assistance and 
activities for health promotion, with some still ongoing. 
USAID and Agreement Officer’s Representative (AORs) were described as generally supportive. There was 
involvement and support from a communication team to develop plans. USAID also provided technical 
support for partners and assistance in service delivery and developing policies such as IEC materials for FP 
and training for implant insertion and bilateral tubal ligation. The FP programs have adapted to the COVID￾19 pandemic by facilitating deployment of FP commodities, telemedicine, outreach, and the use of social 
media. Respondents have suggested expanding implementation to take advantage of opportunities such as a 
partnership with POPCOM and the DOH. 
The program has provided a strategic partnership for POPCOM and the DOH. The partnerships could provide 
opportunities to ramp up activities.
BARMM is still experiencing transition; some areas are devolved while others are still centralized. 
Respondents noted opportunities for connecting with other organizations in the region. However, the 
Universal Health Initiative and other initiatives encountered problems due to the region’s uncertain status 
(e.g., no planned interventions in Maguindanao and Cotabato City because the status of Cotabato is still in 
limbo). This also presents difficulties in access and monitoring. The principles of Islam guide the BARMM 
government officials, and organizations such as the Darul Ifta are authorized to represent the religious sector 
and speak on behalf of the BARMM government. These organizations are de facto parts of the government 
itself.
Activities for improving health-seeking behaviors of the various partners for FP have varied approaches. 
Some are focused on behavior change, but others are not. Counseling customized to the needs of specific 
geographic areas (e.g., BARMM, rural areas) or groups (e.g., adolescents) is provided. Radio stations have 
continually aired messages and programming that discuss FP. The informants, midwives, nurses, and 
religious leaders are invited to radio programs to discuss FP and respond to questions.
An essential intervention in the past has been interpersonal approaches through Usapan sessions, wherein 
the implementers adopt a more personalized, community-engaged approach. The project team in BARMM is 
focused on meetings with women and community members to discuss specific FP issues. Muslim religious 
leaders have received training to discuss FP in a proper Islamic context to alleviate the concerns of 
community members. This is considered a key initiative.
Preventing early childhood marriages needs a different approach. It’s not about making sure they have FP 
commodities, but about increasing the conversation between parents and adolescents, enforcing policies 
and laws against childhood marriages, and getting communities involved in the discussions. The use of a 
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gender lens in providing health services has also been instrumental. In the BARMM region, integration, and 
acceptance of health topics in the Islam sociocultural context have been important in their activities. Gender 
transformative processes are part of interventions to ensure that women participate in decision making, 
have control over decisions, and gain the support of men and their partners, and that the community 
respects the role of women as leaders.
Some partners conduct regular data quality checks. The number of patients educated through health 
programs is used as an indicator of program effectiveness (e.g., number of participants who adopt a modern 
FP method). Some partners also researched to supplement data from the NDHS and FHSIS. This is done 
through key informant interviews and focus group discussions.
Instability in the BARMM region, particularly in conflict-affected areas, has hindered the region’s activities 
and discouraged potential project staff. However, working conditions and security have been improved in 
the area to attract potential project staff. Improving the perspective of coming to frontline work and 
supporting the transition for more lasting peace in BARMM have also attracted more potential staff for the 
Health Project staff based in BARMM. There has also been increasing acceptance of USAID projects that have 
facilitated activities.
Respondents identified a need to develop health promotion materials appropriate to different audiences. 
This includes different versions for different demographic segments (e.g., age, occupation) of the same area. 
They have also stated that quality improvement efforts continue as they provide services at their facilities. 
Respondents also described a need for assistance for organizational development such as team-building 
activities.
To sustain the projects, continued technical assistance and support in terms of training and updates are 
needed. Respondents have stated the need for continued provision of commodities by the BARMM Ministry 
of Health due to partners’ procurement limitations. While assistance for postpartum FP is being provided, 
respondents suggested continuing this as a possible point of intervention in the future. Integration of FP 
services along the continuum of care is needed. Respondents have also described plans for research on 
demand generation for FP.
10.TB Program
The partnership with CiTEC started through a collaborative meeting between the DOH, Cebu City 
government, PhilHealth, and USAID representatives. A plan to implement a pilot of UHC was envisioned, 
with the hope that strategies for implementation, strengths, and weaknesses could be gathered. CiTEC sites 
were selected because of a high incidence rate of TB. The selected barangays also had a high proportion of 
informal settlers.
CiTEC was envisioned to be a screening program. The program would screen residents of Pasil and 
Mambaling barangays through chest X-ray using an active case-finding strategy. Suspicious densities and
findings on chest X-rays warranted sputum microscopy exams. The previous USAID-supported TB project, 
IMPACT, also had a “screen-all” approach to TB and provided chest X-ray vouchers to encourage TB 
screening. They also conducted training on policy development for LGUs as well as on the TB Manual of 
Procedures, which TB Platforms has continued in its project sites.
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The ProtectHealth activity of the Health Project planned to create new criteria for barangays to expand 
CiTEC coverage to 10 other barangays. TBIHSS, on the other hand, spearheaded the coordination and close 
monitoring of the program, including coordination with health center staff such as nurses, midwives, and 
CHWs of Pasil and Mambaling. They provided daily counts of residents or households profiled and refusals 
for screening and monitoring of problems that occurred. There was also a collaboration with the DOH 
National TB Program.
At the LGU level, when the number of individuals who underwent chest X-ray screening was low, the Health 
Project met with barangay officials to plan for increased demand for services. Project funding is supposedly 
sourced from multiple public funds such as PAGCOR and the Cebu City government, but the projects 
encountered problems with city ordinance legislation.
The COVID-19 pandemic disrupted program implementation through limited participation because of 
restrictions on travel and misconceptions. In Mambaling, there was hesitation due to a misconception that 
their saliva would be used for COVID purposes, and they were afraid to be quarantined. 
Respondents described a lot of passion and good effort around the TB program. Barangay officials influenced 
health-seeking behaviors by telling residents about the advantages of X-ray and discussing TB screening. IPs 
also engaged barangay health workers, senior citizens, purok leaders, and other NGOs because residents 
respected these groups. Barangay counselors also went to houses in their sitios to tell constituents about the 
benefits of TB screening. IPs also used online group chats, senior groups, open group activities, and virtual 
meetings.
Respondents cited COVID-19 as one of the factors that hampered execution of activities. An adaptation plan 
was developed in time for the pandemic. Areas of improvement cited include establishing laboratories with 
COVID-19 testing that is balanced with testing for other diseases, including TB.
Activities were focused on TB screening. There have been calls to ramp up the project. There is also room to 
grow on the ground by improving laboratories and hospitals. Learnings from other Asian countries can be 
tapped, especially during the COVID-19 pandemic.
The project was hindered by inadequate staffing and pushed to do more beyond the current team’s capacity. 
Respondents cited a need to focus on the primary task of finding cases. There were also sociocultural 
challenges that made implementation difficult. Additionally, local officials started to engage with different 
priorities, especially during the COVID-19 pandemic and the upcoming election in 2022. There were also 
concerns about the confidentiality and anonymity of participants.
For the project’s sustainability, a stable source of funding is needed. Co-funding from the city government 
through the ordinance was expected but did not push through because the proposal did not pass into a city 
ordinance. There are also plans to scale up to include more barangays, but this will have to go through LGU 
approval. 
11.CBDR
Respondents reported good coordination with USAID. Parties are well-informed of plans and activities, and 
regular meetings are held. Respondents rated support and coordination of USAID as moderate. Key activities 
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frequently highlighted by key informants included the translation of the SBIRT toolkit into the local language 
and the development of an online resource within the DOH Academy, with rollout in 2022.
The project team showed adaptation. Although they started slow, they found their footing and figured out 
how to move forward in the pandemic. Part of their work was to train more trainers. Respondents cited a 
need for the project team to rethink its approach, such as working at the regional level.
The project was hindered by challenges in coordination in the beginning and challenges in reporting. There 
was also a need to harmonize functions with different agencies to develop the program. Support for 
disseminating IEC materials on drugs between partners is needed to sustain future activities. Drug abuse 
treatment using comprehensive approaches through the entire continuum of care can also be explored in 
the future. Additionally, USAID can expand the reach of drug rehabilitation services through developing 
trainers, training programs, and supporting drug abuse councils that incorporate monitoring and evaluation 
aspects.
12.Health Systems Strengthening
USAID supported the development of a digital platform and e-modules, aligning efforts of USAID with the 
needs of PhilHealth. However, there was a varied rating of the support and coordination of USAID.
Respondents noted assistance on costing models and development of benefit packages. There was also 
coordination regarding the pilot of UHC and healthcare provider networks (HCPNs), particularly for Konsulta, 
a takeoff point for the model. Different strategies such as pamphlets and live streaming on Facebook were 
used for orientation on PhilHealth benefits for members, including some information on. FP, maternal care, 
and TB. However, in the information dissemination to paying members, there was not much focus on 
specific benefits and the value of their membership. USAID also used DOH’s regional offices, through their 
public affairs unit, for information dissemination. However, lack of expertise about UHC at certain levels of 
the health system was also viewed as a hindering factor to UHC implementation, especially when the private 
institutions are the primary decision makers.
Key informants suggested continuing assistance for policies on the Konsulta package. They also preferred 
hiring local digital education providers rather than international companies. Suggested activities or areas to 
explore in the future include social marketing of PhilHealth, assistance in developing policies regarding 
HCPN, provider payment, and management of the global budget. 
With respect to human resources for health as a pillar of the health system, key informants noted that the 
HRH2030 project abruptly ended even though their deliverables were not yet completely accomplished. 
Respondents also stated that there was no satisfactory or helpful output from MTaPS and no progress on the 
eLMIS project. The human resources management tool that was being promoted by HRH2030, the Workload 
Indicators for Staffing Needs (WISN), was also interrupted and not sustained during the pandemic because of 
COVID-19 among the DOH staff. The brain drain of health care workers also hindered the Health Project. 
There is still a mindset that CHWs leave the country because they lack nationalism and not because of 
socioeconomic factors. Although the DOH and the Health Project promoted many e-courses during the 
COVID-19 pandemic, informants still expressed a preference for live and in-person interactions for capacity 
building. Informants observed that the e-modules being developed for clinical practice guidelines are already 
organized according to a primary health care framework and life stages and not by disease. Barriers 
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identified by the informants against the effective dissemination of online learning materials were: 
inadequate telecommunications facilities and equipment; need for IT and graphic artists to scale up the 
online courses; lack of engagement of private institutions; and insufficient training of trainers.
13.Gender Equality and Women’s Empowerment
Activities include hospitals’ assistance in establishing referral systems between women and children 
protection units, gender sensitivity training, and help with gender balance on boards. LGUs are also assisted 
in establishing referral systems, particularly in nine provinces without women and child protection units. The 
Gender Responsive Family Planning Service Delivery Point is a checklist that is also being developed to 
ensure responsiveness in FP services. In response to the issue of disrespect and abuse of women clients in 
health facilities, a pilot for continuous quality improvement in Batangas integrated client feedback related to 
disrespect and abuse. A men’s health program manual is being developed, with the policy signed in January 
2021. 
The project can draw on partnerships with other organizations such as the Women and Child Protection 
Network, which has great expertise in women and child protection.
Integrated into the other FP projects, using a gender lens has been instrumental, but progress has been 
slow. Gender transformative processes are part of interventions to ensure that women participate in 
decision making, have control over decisions, and gain the support of men and their partners, and that the 
community respects the role of women as leaders.
There is also an active call for a holistic approach to TB management where gender-specific issues must be 
addressed to find and manage more cases within the community. Health-seeking behaviors between males 
and females differ in such a way that males usually seek medical help at a much later time, when the disease 
has progressed (TB in males has an increased mortality rate compared to females). In contrast, females 
would delay care and prioritize other family members’ medical conditions. Activities such as targeted active 
case finding were done in predominantly male occupations to maximize hours of productivity. Health 
indicators should have an end-user impact and not just count initiatives’ inputs. The training of reproductive 
health counselors is an identified bottleneck in scaling the impact of reproductive health services.
Only physical and sexual abuse cases against women and children are being considered. Verbal abuse is only 
noted and is reported to barangays. Most IEC materials on reproductive health are also written for women 
and seldom for men. GBV is highly targeted among LGBTQ individuals, subject to psychosocial counseling. 
Reorganization of the DOH, the COVID-19 pandemic, and the push for integration left the status of the men’s 
health program remains unclear, as no one was sure who would take over the program. 
USAID programs during the COVID-19 pandemic have managed to boost GBV awareness and have reached 
over three million people through online engagements, 68 percent of whom are women aged 18 to 24. 
Partnerships facilitated this, with celebrities aligned to help increase awareness of GBV.
There were initial commitments to initiate a fatwa against GBV, although it has not yet materialized. 
BARMM can be a priority site for GEWE-related activities in the future. It is highly suggested that 
stakeholders and partners use a gender-sensitive lens in formulating health programs to address specific 
health concerns related to being male, female, a child, or LGBTQ.
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Synthesis of Key Insights
14.Social Behavior Change
Partners should consider monitoring behavior change indicators of target populations during project 
evaluation. Ultimately, the activities aim to change attitudes through the provision of services. Platforms 
have been developed to try to get away from number counting. USAID is assessing the impact along with the 
changes in numbers and movement regarding targets. USAID is using information gathered during 
consultations with partners and discussing work plans. Key informants cited work with religious leaders in 
the BARMM area as promising. There is room for progression, especially in adapting to the COVID-19 
pandemic.
Major work plan strategies should be evaluated to determine how best to improve and institutionalize 
activities to achieve particular targets. Projects should continue participating in deep-dive analysis and 
impact evaluation of the results and impact of active case finding strategies (e.g., increasing chest X-ray
screening for TB should increase notifications). Lessons gained during the COVID-19 pandemic regarding 
behavior change include consistent iteration of public health interventions and feedback from communities 
in crafting messaging; importance of private-sector engagement in propagating health messages; and 
support from medical experts to reinforce the credibility of health messages.
15.Effect of Gender in Supply Chain Management 
The HP included gender analysis to deepen the understanding of access to health services. There has been 
progress in increasing a gender lens approach in health programs. Recently, MTaPS examined supply chain 
management of and access to FP and TB commodities through a gender lens. A respondent said that this 
kind of analysis has not been done widely and that it is fascinating to understand gender issues in relation to 
supply chain management. 
16.Monitoring of Funds at the LGU Level
LGUs are given financing but tracking and accountability for the use of the funds may not always be as 
transparent. There is difficulty in tracing the utilization of funds earmarked for health. The monitoring of 
funds is important.
17.Approaches Used
The Pareto principle [which states that 80 percent of results come from 20 percent of actions] is a useful 
concept in prioritizing high-burden areas, i.e., address the problems where there is the highest burden of 
disease, for example, the “big three” regions with the highest burden of TB. On-the-ground approaches were 
effective, and USAID should consider possible adoption in other communities. There was also a shift to 
regional CHDs for the training of local personnel, with plans to expand the capability of regional CHDs in 
training staff in their areas.
18.Sustainability and Future Activities and Projects
Key informants suggested more focused and direct communication with LGUs for future activities and 
projects. They also projected an increased need for high-level training and specialization, specifically for 
middle-level employees. 
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ANNEX E. DISCLOSURE OF ANY CONFLICT OF INTEREST
Certification No. 1
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Certification No. 2
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Certification No. 3
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Certification No. 4
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 148
Certification No. 5
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 149
Certification No. 6
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 150
Certification No. 7
USAID/Philippines Health Project Whole-of-Project Evaluation (2018–2021) | 151
Certification No. 8