LPP-Matcbing Grant Program performance :md Evaluation Report Digos, Davao del Sur Philippines Roy Dimayuga Te .esa Manganar C !cilia S. Acuin hI wilou Costello The Population Council hfanila LPP-Matching Grant Program Perfom ance and Evaluation Report, April 2001. This study was funded by the United State for International Development (LISMD) under the terms of Cooperative Agreement n lmber HRN-A-00-98-00012-00 and Subproject number 5801-13017.455. SUMMARY The Department of Health, w th support from USAID and technical assistance from Management Sciences for Htalth (MSH), implemented the Matching Grant Program (MGP) as a component of tl e Local Government Performance Prcgam (LPP) in February 1999. The goal of the ~rogram is to achieve greater impact and expand senice delivery capacity of municipdities and component cities, panicularly in four areas, namely: fully immunized chiliren (FIC), vitamin A coverage (VAC), tetanus toxoid two plus (M+) for women, ard, modem contraception (CPR). The FRONTERS Manila carried out two phases of the LPP-Matching Grant Program Evaluaticn Study, the program performance and impact evah ation. The program performance eva uation of the MGP activities in Digos, Davao del Sur was carried out from June 1999 tc March 2000. The objectives were: to evaluate the relative effectiveness of various interrentions funded by the MGP for reaching under￾served and high-risk population with nxded services, and to prowde immediate feedback to improve program irnplementatiol~. Adopting the "input-process-output-outcome" framework, the study utilized progrim-based data and careful monltonng of MGP activities and outputs. A review of the 1998 perfonna?ce indicators for RHUs I and 11 reveals chat of the four MGP indicators, Tn+ ranks low st, with a combined 52.5 percent covmge for the whole of Digos. This is followed b) contraceptive prevalence rate (modem methods). which was 67.7 percent in 1998 (PHUs I and I1 combined). The FIC and Vi1.A indicators were much better (82.7 percmt. and 92.3 percent, respectively). To achieve the MGP goals or the four health parameten. Digos proposed five interventions, namely: the Communit~-Based Managed and Owned information ?stern (CBMO), health and nutrition poss, tetanus toxoid integration into pre-marriage counseling (PMC), BTL referrals, ;nd, outreach to women in small 2nd medium enterprises. These activities featurd innovative and participatory processes of information gathering, focused on nmote and inaccessible barangqs, and aimed to LPP-Matching Grant Rogn m Perfo-e and Evaluation Repoil 2 Digw Dav lo dcl Sur, Philippines minimize missed opportunities. Exce~t for outreach to small and medium enterprises, which was not implemented at the time of the study, community actions have shown that these programs can promise importint impact in terms of generating the sense of ownership needed for true sustainabili. y. Data of May 2000 reveal that the coverage rates of the four program indicators increased in comparison to that of May 1999. FHIS and CBMO data show that from 83%. the rate of FIC increased to 93%. TT2+ from 32% to 75%. VAC from 75% to 96%. and CPR from 72% to 73%. These findings demonstrate that the implemented MGP activities may have been effective ir expanding health service delivery, especially on these four areas of health performance LPP-Matching Grant Rogr; m Performance aad Evaluation Rcpon Digos, Dav lo dcl Sur. Philippines CONTENTS Summary ............................................................................................................................ 2 List of Tables ...................................................................................................................... 1 List of Figures ..................................................................................................................... I . . Abbrenat~ons ..................................................................................................................... 2 Acknowledgment ............................................................................................................... 3 I. Background .................................................................................................................... 4 U. The MGP Application Process ................................................................................... 10 III. Municipal Background .............................................................................................. 1 1 IV. The MGP Program .................................................................................................... 15 V. Implementation .......................................................................................................... 18 VI. Conclusion and Recommendationj ............................................................................ 30 . . Appendix 1. Defiruhon of Terms .................................................................................. 32 Appendix 2. DOH and MGP Prop? Goals .................................................................. 33 Appendix 3. Early MGP Activities in Digos ................................................................... 34 Appendix 4. Tables of Input Process-Durput of MGP Intmentions ........................... 35 LPP-Matching Grant hogn rn Pmform~~c dEvaluatim Report Digos, Dav lo ckl Sur, Philiines LIST OF TABLES Table 1 Health Facilities of Digos, as llf June 1999 (Pre-MGP) .................................... 12 Table 2. Health Manpower of Digos, 1998 ...................................................................... 13 Table 3. Clients Served during the Bafanihan Outreach ................................................ 20 Table 4. Women given TT during PMC as of December 1999 ....................................... 21 Table 5. Women given IT during PMC as of March 2000 ............................................. 22 Table 6. TT Integration to PMC, Sept .mber-December 1999 ....................................... 22 Table 7. CBMO Accomplishment as of March 2000 .................................................. 26 Table 8. BTL clients send under M<;P as of March 2000 ......................................... 29 Table 9. Program Goals vis-i-vis 1998 NDS .................................................................... 33 LIST OF FIGURES Figure 1. Conceptual Framework Shox ing Links of the Program Componenb to the Outcome Indicators and the Diffe-ent Categories of Evaluation Indicators ............... 7 Figure 2. Map of Study Sites ............................................ Error! Bookmark not defined. Figure 3. Projected Population, Municipality of Digos ................................................... I1 Figure 4. Digos Health Budget, 1996-2 000 ...................................................................... 14 Figure 5 Health Budget as % of LGU Iludget .................................................................. I4 Figure 6. Health Performance Indicato s. RHU I ........................................................... 15 Figure 7. Health Performance Indicato s, RHU 11 .......................................................... 15 Figure 8. MGP Indicators Before and ifter the Program ............................................... 30 ABBREVIATIONS BCG BHW BHS BTL CBMO CHO CPR DHRFO DPT DOH FHSIS FIC FP LGU LPP MGP MOA MOE MSH MWRA NFP NGO OPV PHO PMC RHU SME TT TT2+ US AID VAC WRA - Bacille Caln en Gourain - Barangay Ht alth Worker - Barangay Ht alth Station - Bilateral Tut a1 Ligation - Community 3ased Managed and Owned (Infomatian System) - City Health (Iffice - Contraceptiv 2 Prevalence Rate - Department II~ Health Regional Field Office - Diphtheria, I ertussis Tetanus - Department 11f Health - Field Health Services Information System - Fully Imrnur ized mld - Family Plam ing - Local Gover unent Unit - LGU Perfonlance Program - Matching Gr mt program - Memorandur I of Agreement - Maintenance and Operation Expenses - Management Sciences for Health - Married Wor len of Reproductive Age - Natural Fam: ly Planning - Non-govemr lent Organization - Oral Polio Vzccine - Provincial H :alth Office - he-Marriage Counseling - Rural Health Unit - Small and M xiiurn Enterprises - Tetanus TOXI id - Tetanus Toxoid Two Plus - United State Agency for International Development - Vitamin A C >verage - Women of R lproductive Age LPP-Matching Grant Pmgn rn Performance and EvlhuwD Repon Digos, Dav 30 &I Sur. PMqpincs ACKNOWLEDGMENTS The Population Council app~eciates the support of USAIDManila - Office of Population, Health and Nutrition (3PHN) for providing financial assistance in the conduct of the program performance c valuation of the Matching Grant Program. Appreciation is also due to thc field coordinators of the Management Sciences for Health (MSH) for their technical issistance and cooperation during feldwork and consultations. The field evaluators of Pop1 lation Council also wish to commend the Local Government of Digos and the Department of Hedth XI Regional Office for helping in mobilizing designated point person: during information gathering done by the field evaluators of Population Council. .'he rural health physicians, nurses, nidwives and barango). health workers of the RH Js 1 and 2, as well as the local offices and non￾government organizations in the mun cipality, have also been very supportive and patient in assisting the field evaluators through data retrieval and indepth interviews. The hospitality and cooperat on of community leadm, program managers and local officials during the entire program evaluation are likewise gratefully acknowledged. Lastly, Population Council sir cerely expresses gratitude to the numerous men and women, who in more ways than ore, had been helpful in the various phases of the Matching Grant Program. LPP-Matehmg Grant Rog~am Performance and Evatuation Rcpon Dig- Dr 30 del Sur, Philippines I. BACKGROUND The LGU Performance Pr~gram (LPP) is a five-year (1995-2000) USAID￾assisted project with the objective .~f improving the "health of rnothm and children by increasing the utilization of Famil) Planning (FP), Maternal Child Health (MCH), and nutrition services". The LPP strive; to increase the capacity of local government units (LGUs) to manage health programs by providing both financial and techn.cal assistance. Provinces and highly urbanized component cities have been enrolled int~ the program through a memorandum of agreemc nt (MOA) "to implement a comprehensive plan on population, family planning and cild survival program". LPP Grants are therefore designed to serve as incentives, tncouraging LGUs to adopt best practices in the distribution of commodities, the trai ling of staff, the equipping of senice delivery sites. the provision of voluntary steri1izat:on services, and the use of Infonnatim, Extension and Communication or IEC.' Data from the 1998 NDS and -he Midterm Assessment in June 1998 raised the issue of whether the LPP has had any direct impact on delivery of RHFP (Reproductive HealWFamily Planning) senices. TI e assessment report, after weighing the evidence, concludes that while the LPP is%n e:Tective vehicle for developing LGU management and service delivery capability", it may not be the most appropriate means fcr achieving impact on health objectives. The repoit recommended a "follow-on initiative" that can put greater emphasis on impact, build ng on the strengths of the LPP. while cwercoming its limitations. The Matching Grant Program: The "Follow-Up Initiative" of LPP The above recommendation became the basis for the development of the Matching Grant Program (MGP). Ihe Matching Gran~ Program is thus designed to stimulate the LGUs to focus directly on strengthening senice delivery gir~ng the local LF'P-Matching Grant hgn n Pcrfonnancc and Evaluation Repon Digq Dav; o dcl Sur, Philippines government units more latitude in determining their local programs. Consequently, the MGP was developed with following v.elldefined features2 0 Targets mid-sized component tities and municipalities. initially those lvirh a population of 100,000 and abotz, where actual primaq health care senices are provided Employs a "grantee-friendly" application process, with the Local Govemmt nt Unit (LGU) defining its own goals and prograrl direction Provides flexible funding of up to 500,000 pesos and access to technical assistance Encourages LGUs to increase fmd allocation and expenditure for MGP-assi: ted programs through a "match" or counterpart f mding MGP Objectives. The MGP a ms to improve the capability of municipalities and component cities to expand service delivery, and to achieve significant and measurable impact on the following four Department of Health (DCtH) pro-gram areas: I. Fully immunized children (FIC) 2. Vitamin A supplementation co- ,erage (VAC) 3. Tetanus toxoid two plus (m+) coverage for women 4. Use of modem contraception ((:PR) to reduce unmet need for family planning. I Jack Reynolds, et al, 1998 "Midterm Aswssr mt of Lntennediate Result 1 of Stntcg~c Oh~~itlr-CS Z 'Increased Public Provision of Family Pkg and Mated and Child Services". POPTECH Repon No 97-127-067. ' MSH. 2000. "Matching Grant Pmgnm (MCP): An Inwvative and Responsive Program fcr Expand~~~g 3 MSH, 2000 Service Delivery and Enhancing (uabfy of Care.' pp. 1-2. LPP-Matching Grant Prop n Pcrfamancc and Evaluation Repon Dig% Dav; o &I Sur, Philrppims OBJECTIVES OF MGP EALUATI ON STUDY USAD Manila has called upot the FRONTIERS in Reproductive Health to work closely with the Management Science for Health (MSH) to conduct an evaluation of the MGP during 1999-2000. The objectiuts of the evaluation study are: 1. To evaluate the relative effectivenass of various interventions funded by the MGP for reaching undersewed and high-rid populations with needed se~ces, and 2. To evaluate evidence of direct impact in selected LGUs, as measlred by the contraceptive prevalence rate (CP:1), childhood immunizations (FIC), tetanus toxoid vaccination among pregnant and married women of reproductive age m+). and vitamin A use WAC) among child -en between the ages of 12-59 months. These objectives are directly r :lated to the FRONTIERS Program's ln~ermediate Result 1: Testing innovative solutions to reproductive health and family plarning senice delivery. The MGP evaluation study will provide detailed information on is operations and impact leading directly to improvilg program performance and refining ihe design of subsequent MGP programs in the Philippines. The study results will be used by DOH and local government officials to deve op policy and improve program management. RESEARCH DESIGN Due to the rapid implement;tion and timetable of the MGP, th.: evaluation proceeded in two phases. Phase One is the process or monitoring evaluation This phase is limited to providing as much infomation about process and outputs (@ormance) among the first set of MGP participmts. Phase Two consists of process and impact evaluation. This consists of assessin: both program performance and outcomes. The primary objective is to determine whtther different interventions (or mixes) will lead to significant increases in the four-target :d indicators (e.g., contraceptive prevrlence rates). LPP-Matching Grant Rogrr m Performance and Evaluation Repon Digos, Dav lo dcl Sur, Phhppines 1 The time he for observing changes was six months. The Evaluation used the "input￾process-output-outcome" framework a; shown in Figure 1. I Figun, 1. Conceptual Framework Showing Links of the Program Components to I the Outcome Indicators and the Differe it Categories of Evaluation Indicators lmpmved quality and access to RWFPMCH sewices INPUTS . 4 PROCESS . Specilic to ach LGU irnplmting MGP ** Lnng-cam bnpaa will m be marured in OUTCOMES . LONGTERM IMPACT" e-------* a 1. Process and Monitoring Evall~ation of Four MGP Sites d Phase I employed qualitative m:thods whereby MGP inputs, processes, and outputs are documented in the field thr,>ugh observation, in depth tntmiews of key informants and analysis of program-ba .ed data ' While every effon was made to enswe comp Me documentation of tbe MGP. tbm wm key activities &at 1 were not obxrved by the field evaluator. For aumple. the planning stage for om of tbe MGP areas au not observed because this occ~ned before ,.*tion rmdy team was organized. To addnss this gap. key informant iohniews were conducted to el cil information on what exactly happened dur.ng tbe 1 planning activities. Sites were observed on a regular, ongt~ing basis to ascertain whether program activities were being implemented according to plan, and assessed on how well these program activities were performed and utilized Site Selection. The selection )fa municipality or city into the MGP program was based on meeting a number of establis hed criteria. These included: P Clearly defmed match, activiti :s and budget 3 Activities that will increase utilization of services among target clientele > Activities should directly result in increasing coverage 3 Discrete activities with reasonable chance of obtaining measurable impact uiAithin 12 months or less The following LGUs were selected for Phase 1 of the evaluation stud:: Process and Monitoring Evaluatio~~ Sites 1. San Jose Det Monte, Bulacan--('luster A 2. Dasmarinas, Cavite-------- < luster B 3. Tacloban, Leyte--- -( luster C 4. Digos, Davao del Sur-------A (:luster D 2. Impact Evaluation of hlGP Sites Strictly speaking, Phase 2 is an outcome evaluahon (refer to Figure 1). It measures the immediate effects of the MGP interventions on specific propn indicators. utilizing a quasi-experimental design the pretest-posnest nonequivalent grsups design. The MGP program outcomes are el aluated using data from population surveys and situation analyses. Infemces abou impact are based on the empirical analysis of outcomes (i.e., the direct and immedia e result of program process and outputs.) LPP-Matching Gmt hgr. m Performance and EvIhutioD Repon Dig- Dav ro del Sw. Philippines Site Selection. The original I Ian for selecting the impact sites was to use random selection hm the second batch of MGP recruits4. However, because MGP was implemented on a "first come, first ierved" basis, it was not possible to rmdomize the selection procedure. In the end, the ntervention LGUs were selected mainly because of the availability of a suitable control -GU within their province. All the selected LGUs are first-class crties and municipaliti~s (i.e., they are all in the highest income category classification of the Department of 3nance). The three sites chosen were Ta)lay in Luzon, San Carlos in the Visayas, an81 Tagum in hlindanao. These sites should not have initiated MGP activities before base1ir.e assessment can be made. Program and control LGUs wtre matched on the follo~iing criteria: I I both come hm the same province to control for xhinistrative and other forms of suppxt provided at province level, 2) similar populatior~ sizes, 3) same income class, and 4) similar performance indicators on the four ou-comes of interest for the MGP (FIC. Tl2, VAC and FP). Because of considerable difl zrences in the state of economic development, impact pairs were selected for each of Luzon, Visayas and Mrndanao -the three major geographic divisions of the country. Tiytay￾Binangonan, San Carlos-Cadiz, and T.tgum￾Panabo are the three pairs of impact n d control sites that were chosen. Because of delays in the implementation of the pro- inter:entions in Tagum, the third set of impa:t sites - comparison (Tagum-Panabo) was iropped 1 . - d I I ' Tbe selection of (he rhra intervention LGUs was funber limited by fwo addition4 fuuwr: I) (he rate at which YGP is being intplemeoted (LGUs wh~ had not yet been oriented and did not have a wo& plan on which the baseline aswssmeot could be made :odd not be pa of the pool for sektioo of 5i.m for the impact evahtation), and 2) simc (he inlerventi 1n LGU had to have a conml LGU hrn ch ram pmhc, this pmludes the selection of LGUs where all MGPqualified units of the province have beem rmuilcd at the same time leaving no pibk control LPP-Matching GRnt Pmgn rn Perfom and Evaluation Report 9 Digm. Ihv to &I Sm, Phtlippincs from the final impact evaluation. In he end, only two sets of comparison sites, Taytay￾Binagonan and San Carlos-Cadis we e included in Phase 2 of the study. This report will present the p.ocess and monitoring evaluation resu!ts for Digos, which covers Phase 1 of the MGP evaluation study. A separate report will focus 01 the impact evaluation component of tie evaluation study. In the next section of this pa~ticular report, the major findings are described in each of the four study areas organized as follows: (a) a brief description of tf.e study area, (b) planning of the MGP interventio~a, with attention to the LGU analysis of problem areas and choice of interventions, (c) the findings with respect to the implementation of the MGP interventions are discussed focusing on such aspects of implemertation as the application of new health informatio i technology, the Community-based Management and Information System (CBMIS); mobilization of new resources for health and expansion in health services; and inn wations in health service delivery. and finally (d) data on outputs, and in some instances semce coverage of the four key senizes. The FRONTIERS Manila std'carried out a program performance evaluation of the MGP in Digos, Davao del Sur (Region XI, Southern Mindanao). bgos is the provincial capital and is one of the four sites in the first batch of MGP recipients throughout the Philippines representing the Mindanao cluster. It is the first hIGP recipient in the area. Its plan includeal an innovative, participatory process f obtaining information on clients in need of hcalth services, and a focus on difficult to reach barangays. Digos also planned to minimize missed opportunities by pro~iding tetanus toxoid immunization during pre-marr age counseling and in industrial establishments employing women workers. Digos also had one of the shor est application periods in terms of exxdiency of fund release. In February 1999, the MSH Field Coordinator and the DOH Regional Field Office (DHRFO) introduced the program to the LGU. The Ofice of the City Mayor received the letter of invitation from the DHRFO on March 22, 1999, and the Lener of Intent (L01) was submitted back to the DHRFO, passing through the Sangguniang Bayan on March 29, 1999. Dr. Salud Dela CNZ. RHU I physician. was desi-gated by ihe Mayor as the MGP Coordinator. Sometime in April 1999, the representatives from the two rural halth units of Digos drafted the MGP Plan. Tht activity was facilitated by Dr. Angel Libre, the Management Sciences for Health Rogional Technical Advisor (5fSH-RTA). Several weeks later, the DHRFO received an( approved the MGP Plan on May 20, 1999. On that same day, the MGP Memorandum of Agreement behveen DHRFO and the LGU of Digos was approved and signed. Finally, rhe MGP fund was released to the rntnicipality on May 24,1999. 111. MUNICIPAL BACKGROUND As of 1995. Digos reached up to a total of 109.828. and in the last Uuce decades, it showed an annual average growth ate of 5.26% between 1960-1970, 4.65% beween 1970-1980 and 3.83% between 19E0-1990 (see Figure 3). In 1998, Digoss had a projected population of 117, 846 v ith an annual groulh rate of 3.83% ;SO and OMPDC). it is a relatively young population. with 91. 8% in the 49-yean-o:d-and-below bracket. Sowce: SSO and OMPDC. 1990 Figure 2. Projected Pop ulaffon, Municipality of Dlgos LPP-Matching Grant hgra n Pcrfomancc and Evaluation Repon Digos. Dav; o del Sur, Philippines Of the 26 barangays in Digos, eight are classitied urban; the other 18 barangays are classified mral. In 1980, the urban-rural population distribution was 57.1% - 42.9% ratio, while in 1995, the distribution increased in favor of the urban population at 63:37. The average gross population densit) was 35 persons per hectare in the urban areas, and 2 persons per hectare in the rural areas. The upward trend of urban population indicates preferences for areas with greater av-ulability of schools, markets and housing. Health Infrastructure Llke many LGUs in the cocnhy, Digos lacks the health senice hhs&wture+ manpower and resources to serve its growing population. Table 1 shows the health facilities available in Digos as of Jure 1999. Digos has two Rural Health llnits (RHUs). The Davao del Sur Provincial Hospial is a government hospital in RHU I and the only government facility that provides pe:manent sterilization services in the entire province of Davao del Sur. Three of Digos' 26 barangays have no Barangay Health Station (BHS). Even if there are a number of privatc health facilities in each of the RHUs, they remain unaffordable to most of the low-incon~e residents. Table 1 Healfh FaciliUes of Digos, as ofJuno 1999 (he-MGP) 1 5 Private Clinics 5 15 - Source: Digos MGP proposa1:application 19( 9. Digos Municrpal Records. 1998 LPP-Matching Grant Prop m Ptrfmnuve rod Evaluation Report 12 Digos, Dav IO &I Sm. Pbilippi In tams of manpower for public health facilities, the following table shows that Digos is in need of physicians, nurses, med-techs, dentists and dental aides, and even barangay health workers (BHWs). (;ken the population and rapid population growth in Digos, health service providers are fo-ced to cover more people than the normal do. Table 2. Health Manpower of Eigos, 1996 l : 112,754 1 : 56,377 Baranaav Health Workers 1 199 234 I : 51 households 1 ~h~sician (RI-P) 1 Public Health Nurses HNs 3 Rural Health Midwives 10 - - J (BHLVS) i I Rural Sanitary Inspector 2 2 1 : 28,189 I : 22,55 1 1 : 5,370 I Dental Aide 1 1 1 : 56,377 I , TOTAL 218 252 1 : 240 Source RHU I & I1 Records, 1998. D~gos, D ir ao del Sur Health programs do not appea to receive the highest priority at the LGU level as reflected in the health budget allocaticn (see Figure 5). In addition, the local health board is not functional. Figure 4 illustrates Digos' hea th budget 6um 1996 - 2000. Like many LGUs, the bulk (about 90% for Digos) of the hedth budget goes to personnel smices. Betduse the Local Government Code stipulates th.1 no personnel be laid off as a result of devolution, LGUs are forced to support the per% el they inherited 6um the national government. They are therefore constrained to allocate a substantial portion of their health budgets for personnel at the sacrifice of operations money. Such is the case of Digos, nhere 15% of its LGU budget goes to health (see Fipre 5), but insufficient to aver drugs, equipment, repairs, and travel allowances to visit remote borangays. This has Eonsequences for the UP-Matching Gnot Pmp m Pcrfornnnce and Enhuh Report Digos, thv to &I Sw, Wilippina kinds of health services a\.ailatle particularly for community members from disadvantaged socioeconomic groups. 1996 1997 1998 1999 Year 2000 Figure 3. Digos Health Sudget, 19962000 1996 1997 1998 1999 2000 Year Figure 4 Health Budget as % of LGU Budget Health and Program Indicators A review of the 1998 perform.mce indicators for both RHUs I and I1 (see Figures 6 & 7, below) shows that among the four hlGP indicators6, TTZ+ rank; among the lowest, with a comb~ned 52.5% coverige for the whole of Digos. This is followed by the See APPENDIX for definition of terms LPP-&latching Grant Progr. m Performance and Evaluation Repon D~gos. Dav ro del Sur. PMqqina contraceptive prevalence rate, which in 1998 was 67.7% (RHU I & ll combined), and by FIC, 82.7%. Vitamin A supplementation had the best program performance 31 92.3%. Figure 5. Health Perfon lance Indicators, RHU I figure 6. Health Perfomlance Indicators, RHU 11 IV. THE MGP PROGRAM There were four major strate+es to be employed under the MatAing Grant Program in Digos, Davao Del Sur in ~jrder to increase coverage and performance on the four MGP health mdicaton. These :re 1) the react~vation of the Bayunihm Outreach activities, 2) integration of TT immuiization to the pre marital counseling (PMC), 3) adoption of a community-based manazed and ouned information system (C'BMO), and 4) establishing an inter agency IEC aid senice dellvery system for female workers in small and medium enterprises (SMEs). LPP-Matching Grant Rogra n Perfomr~nce and Evaluation Rm Digos, Davi o &I Sur, Philiiines 1) Reactivation of the Buyanihan Outreach activities To increase coverage and pxfonnance on the four MGP health indicators, the municipality of Digos identified the i activation of its Bayanihan Outreach program as a major strategy to be done in all its 26 barangays As proposed in the MGP pla~, activities for this strategy including .UI orientation and planning meeting with the Asiociation of Barangay Captains, an inventory of available supplies and procurement c f additional supplies, linkaging and networking for additional service providers, actual ctmnduct of Bayanihan Outreach, provisimm of support for FP clients and senice pmvide~, and food support for the conduct of Bayanihan outreach. 2) Integration of lT immunization :o Pre-Marriage Counseling (PhlC) To address the low turnout IJ~ TT recipients, Digos proposed to integrate TT immunization during pre-maniage ccunseling (PMC). PMC is an activity done mice a month in Digos. It is done as one gnup for both RHUs at the Women's Center, usually participated in by approximately 50 c~~uples per session or 100 couples a mcnth. As part of the MGP strategy, an information campaign on the TT immunization program was incorporated into the PMC, which hi Nights a screening procedure of TT nahls of the women. It intends to immunize on the spot and provide lT cards to women who have no or insufficient TT doses, and refers these who require additional doses to the midwives of their community. For MGP's purpose, this strat0:gy consisted in the following steps: s) passage of municipal ordinance, b) provision of .T cards, c) making EC materials on IT available to the general public, d) inventory an 1 procurement of needed medical supplies, and, e) linking and networking with influential groups, includmg religious groups. LPP-Matching Grant Prop m Perfommx and Evaluation Repon Digas, Dav; o del Sur, Philippims 3) ~doption of the Community Bas YJ Managed and Owned Information System The third strategy under the MGP in Digos is the adoption of the CBMO as a health information system. The purpse of the CBMO is to generate information of good quality that could be used in addressing health service related concerns. As commonly practiced, health information is gatheal by public health workers and volunteer worken alone. With the CBMO, the whcle community becomes involved i the health information gathering, from the asse:sment of the community's health statistics, to data gathering, utilization of informaticn gathered, direct mice delivery. up to the management and sustainability of the lealth services. Activities for this approach in:lude a) the training of Rural Health Physicians. b) Public Health Nurses, and Rural Health Midwives on participatory CBMO, c) actual conduct of the CBMO, and d) quarter1 community monitoring update meetings. 4) The Outreach to SmaU and Medilrm Enterprises (ShfEs) Another MGP strategy uniqut to Digos is the establishment of an inter-agency IEC and service delivery system for female workers in small and medium enterprises. The purpose of this strategy is to rea :h women who oAen work from early morning to early evening and do not have a chanc: to avail of public health services, particularly. FP services. As required by law, these womm are supposedly provided with health services by the establishments for whom they w >rk. In reality, however, most establishments are unable to comply with this legal labcr provision. While there are various government agencies catering to these workers in \ arious ways, many aspects of public hdth main unavailable to them, hence the importaice of reaching out to these workers either through an IEC campaign or actual service delivery. and developing an action tean that will ensure compliance to these labor provi:,ions. LPP-Matching Gnot Rogn n Perfommx ad Evaluation Repor( Digm. Dava 3 &I Sur, Phililrpina As proposed in the MGP >Ian, lhis strategy involves: a) orientation of the Songguninn members on the SME ou reach, b) development of directory of e~tablishments C) creation of an Interagency Action Team, d) conduct of planning workshop uith SME managedowners, e) implementation, md f) monitoring of the project. V. IMPLEMENTATION The following discussion deicribes how the four major MGP stategies were implemented. Important offshoots of these four strategies are also discussed. 1) Reactivation of the Baynnihnn Outreach activities7 The LGU appropriated P239, )o or 60% of its total MGP funds for rhis strategy. The first Bayanihan outreach was dor e in Kapatagan, Digos, Davao Del Sur on June 18, 1999. This was the first major activi y conducted under the MGP in Digos. In preparation for this activity, the MGP was introduced to Kapatagan community through a series of meetings and coordination H ith the BHWs as well as with the barargay council. The Bayanihan Outreach was conceptualized to address commurity members needing medical and othe-r related s-rvices, such as BTL, IUD insertion, provision of condom and pills, DMPA injection, circumcision, FP counseling, dental serricg and medical consultation. Though Kapatagan, where fie Bayanihan Outreach took place. is under the jurisdiction of RHU 2, both RHUs agreed to jointly make all the necessary mangements for the activity. They sought the ass stance of the Provincial Health Office to form the medical team composed of medical aloctors, medical technologists, OB tem. and civic organizations such as the REACT, I.ionls Club and Rotary Club. Inkitei also to the Bayanihan Outreach was the municip d mayor. The entire preparation for the fim activity was notably impressive, welcoming the USAtD delegates with streamers hung in the poblacion and in Kapatagan proper. ' See APPENDIX for easy to read index-proc is-output t.bk for thir intavention LPP-Matching Grant Rogr un Pcrfomrpw .Id Evduath Report Dig- Do! ao del Sur, Phllippioa On the day of the Outreach the medical team arrived on time. Hundreds of community members gathered and queued in the designated stations of the medical team. Although the expected visitors from USAID did not arrive, the activities went on. The medical team had to stay for three da /s to complete their work, running out of medicines, vaccines, and other supplies, and ircredibly serving more than 700 clierts in various services. In their assessment of the first Bayanihan Outreach, the two nual health physicians realized that such strateg, was difficult to sustain. As Dr. Dda Ctq the RHU I physician, put it, "When ore conducts a Bayanihan Outreach, th: community thinks that it is a medical mission, and everybody in the community suddenly gets sick." Both RHUs were faced with proble ns. First, they could not regularly mobilize a big medical team. Second, there are no enough medicines, supplies and vaccines in their respective RHUs. Third, they were n )t able to prioritize those clients who were really in need since the BHWs failed to make a list of the clients in need of health senices. For the succeeding outreach activities, the two RHU physicians decided to conduct Bayanihan ouheach separate'y. The health officers of each RHU imtially agreed on devoting Wednesdays as Bayanihen Outreach day through the medical team that they each independently created compose1 of a rural health physician, a dentist, a sanitary inspector, the nurse in charge for th: area, and two or three midwives, including the midwife in-charge of the target comm~mity. Later Dr. Tajon, physician of RHU 1, decided to defer the Bqnniiun outreach until the CBMO is conducted in th: community. By doing so, the IUlu can then prioritize clients in need of the heal0 services, and maximize the limited vaccines and other medicines available. Two monU s later, this approach was replicated in RHU 2. LPP-Matching Grant Rogra n Pcrformsnce and Evaluation Repm Digm, mv; o dcl Sm, Philippi Output The succeeding table summar zes their accomplishment. Table 3. Clients Sewed during the Bayanihan Outreach BTL 11 m I2 FP Consultation 10 Dental 88 I FP Circumcision Medical Consultation 686 Source: RHU 2, D~gos Davao del Sur 42 I 77 4 I 2. Tetanus Toxoid Integration into ~'MC? With the MGP, Tetanus Tox~id immunization was integrated in pre-marriage counseling (PMC), through a munici ~al ordinance endorsing such inclusion during the MGP. This ordinance, though not mandated, strongly encouraged women to receive Tetanus Toxoid immunization as a no1 mal part of PMC. During the initial conduct 01 TT integration to PMC, women w shing to be immunized had to go to the RHU 1 (\~hich is about 100 meters away from t?e Women's Center, the PMC venue) for immunic tion. The first Fridays of the month were handled by RHU I, and third Fridays, by RHU 2. By January 2000, IT immunizations were done at the Women's Center. Midwife representatives born both RHUs took tums in providing health-related lectures covering family planning, breastfeeding, and woman and child immunization. lT cards we-e likewise provided to women for easy backing of ' See APPENDIX for easy to mad index-procc 5s-oulpul labk for this intervention LPP-Matching Gml Rogrd m Perf0mkmce and Evaluab Reporr Digas, Dav; o del Sur, PMI@KS their TT status. Health providers lrom each of the RHUs were present to assist the design&d speaker in giving immunk ation to interested women. While information and lectun s on tetanus toxoid immunization had already been available during pre-marriage coun;eling prior to the MGP. the enrictunent of the educational component of PMC in ;everal respects, and the availability of the actual immunizations in that setting represnted a new model for sentice delivery. This is an effective way of capturing women who may have been missed opportunities. The following tables summarize the IT accomplishments during PMC of the two RHUs for first, December 1999 and sxond, March 2000. It is worth noting that the total number of women given TT increased dramatically from 158 in December to 328 only three months later. Table 4. Women given TT dud tg PUC as d December 1999 I I I TOTAL 1 99 1 68 1 158 I Source: RHUs 1 & 2, Digor. Davao &I Sw I I I I LPP-Matching Grant rn Performance and EVabfica Report Digas, Dav u, &I Sur, Phkppiiocs Table 5. Women given TT during PMC as of Mmh 200 In the table below, TT integation to PMC done from September to December 1999 accounts for 4.7% of the total LSU accomplishment. The table likewise shows that the most clients reached during Pb C availing of TTI is roughly 13.7%. of the TTI acceptors for that period. TT I 166 TI2 19 l-l-3 3 Tr4 1 Table 6. TT Integration lo PMC, September-December 1999 TT5 1 2 '3 d i TOTAL Source RHUs 1 & 2. D~gos. Davao dcl Sur 190 138 328 1 A 123 1 12 I LPP-Matching Grant Rogr. m Pcrfonnancc and Evaluation RcporI Digos, Dav IO del Sw, Phhppm -- 289 20 IS 2 -_j: IT4 Tr5 1029 898 * 293 580 ;q i 0.17 ; TOTAL 1 158 , 3381 4.7 Source. RHUs 1 & 2, D~goa, Davao del Sw 3. Adoption of the Community-Based Managed and Owned Informatiw System (CBMO)' Digos allocated PhP121, OOC of its MGP money for establishing a community￾based information system (CBMO) o 'which PhP 75,000 went to the conduct of training. The re-conceptualized CBMO was intended to modify the people's self-limiting mindset that health service concerls are to be addressed solely by bealth senice providers and volunteers. The CBMI) aims to change this mindset by actively invohing the community as a whole in health is sues In the creation of the CBMO, the RHUs had sought technical assistance hm a local NGO. The initial activity was 3 threeday facilitators training conducted on 2628 August 1999, held in Sulup, Digos, to assess the CBMO method and plan for its use during the MGP in Digos. This training was facilitated I y Mr. Eric Libre of Softskills Dev Cmltancy aod was participated in by all the nurses, midwives and the two rural health ph~iciars of Digos. There were essentially three nlajor parts of the training: discussion cf the existing monitoring system, an overview >f the CBMO concept, and the %stallation" workshop/exposure where the partia:ipants, pretending to be motbas hm a & (household cluster within a baran:ay), were walked through the spot mapping, masterlisting and family planning malules. After the training, health prov ders went back to their respective RHUs and began conducting the CBMO. In preparaticm for the activity, barangay officials and barangay health workers (BHWs) were informel of the schedule of the CBMO in their area and the processes to be done under the CBMD. They were asked to help gaher people for this activity and to select one representati\ e from each household. See APPENDIX for easy to read index-pmc soulp put tabk for this intaveolion A five-person facilitating tezm was selected hm the participants ro demoostrate the fainily planning module in one purok. Forty-three mothers, out of the estimated 80 households of the purok, came to the community assembly, which was held ir: an improvised tent 80 krn away from the highway. The assembly was organized by the Center for People's Integrated Dev-eloprnent and Services, Inc, a development KG0 based in Digos, together with a muni:ipal social worker. During the scheduled day for the CBMO, the trained facilitator set the tone for an informal group discussion. Each holmhold represmtative was asked to indicate whether there were women and children eligible for the MGP senices and the curmt SWUS of their immunization andl or 1 lanning use. The women were asked what method they were using and whether they wc re happy with their current method. Non-uses were asked why they do not use family planning. The output was given to the Emguy midwife who would then schedule .hose with unmet needs for service delivery. either during the Buyanihan outreach or thnbugh the routine clinics. Feedback hm the participants were: 1. Appreciation on the participa:ory nature that allows mothers to ion~bute to !he monitoring process 2. Appreciation on the group setling beiig able to provide opmrmnit). f3r information provision on FPIchild health issues 3. Expression of concerns on tke CBMO operationalization, e.g., t'me, iocentiva participation of BHWs and ba angay officials, and expenses Suggestions to improve the pr.m were: 1. Identify portions in the modula: which can be integrated to save time and effort 2. Existing resources or informat on in the community can be utilized 3. Mothers can be grouped accor ling to method use status 4. Mothers could be given cop) of the form containing the information needed and they could check the approlriate responses guided by a facilitatx who has a bigger cop of the form in hn t 5. The BHWs could be tapped lo assist the mothers and ensure that they are filling the forms correctly Though the CBMO, the conmunity members participated in all ~hases of the program including collecting commmity health statistics, using that information, and facilitating direct service delivery. These activities contributed to a sense of ownership among community members in htalth concerns and ultimately to the promise of sustainability of health services. Sir ce it is the community that manages the system, service providers are deloaded of the additional workload of information g~neration. At its best, the health senice informatior system is no longer limited to the senice providers of the community but also to the entire community, and system of this kind can contribute substantially to a sustainal~le model of service delivery in poor, isolated, and under funded locales. Output As of March 2000, the CBM the two RH( Js, with one barangay out of 12 in RHU I while one out of 14 barangays in RHU 2. In RHU 1, &e computed average of household surveyed is 2% out of the total 13,412 households while in RHU 2, the computed average of households surveyed is 8.8% of the total 10,691 households. A total of 1.21 1 househdds have already been surveyed or rcughly 5X of total households in both RHU 1 ant1 2. The table below shows a mlary of their CBMO accomplishment. LPP-Matching Grant Mrn Pafarmme and Evaluation Report Digas, Dilv to &I Sm, Ptuiippioa Table 7. CBMO Accompllshmrnt as of Mach ZOOO TOTAL 121 1 Source: RHUsl & 2, Digos, Davao del Sur 4) Establishing an Inter-agency IE(: and Senice Delivery System for Female Workers in ShlE This strategy was allotted PILP 19, 999 from the MGP funds, scneduled from August 1999 to June 2000. Activitie for this strategy supposedly include ite follouing: I) Orientation on SME outreach to Sanggunian members, which mill cover the importance of SME ouheach s an integral part in addressing this sjaific public health area of concern and stek concrete support of the LGU in the conduct of SME outreach. 2) Production of directory of esti blishments, which will involve human resources for the printing of the final copy directory of establishments. 3) Creation of an inter-agency. action team, which will involve orientation, discussions, consultations an I participation on different lines of work among SME managdowners and inter-agencies working with various government agencies, such as DOLE, D11, DSWD and Pop Corn in the actual conduct of SME outreach. 4) Conduct of planning worksh >p with SME managadowners, which will involve meetings, orientation, consult ations and participation of SME managedowners in the actual conduct of SME oureach. 5) Project implementation and monitoring, which will involve development of mechanisms for monitoring ;nd updating, and concrete monitoring mechanisms and system for SME. However, among the MGP strategirs, the SME outreach is the only sctivity that has hitherto been nsfulfiiled. So far, RAU 1 has only targeted 4 ShlEs and RRU U, 18. Discussion on the implementaticn process of this particular sk!egJ within the Population Council documentation period (June 1999-March 2030) :odd not be provided. @&shoots of the MEP The Health and Nutrition Post The Health and Nebition Pos was initially not an MGP siraregy bht ar; nffshoot of the implementation of the CB?IO. A coxern arising' from ihe CUM0 as an information systlm was identifymg a place where health information ad seiviccs can be accessible to the whole community. This concm stemmed hm the -eahtion of the two RHU pbysicims that some bmngays. -idly the far-flung oms. d:, llot bve BHSs, or if ever there is one in their wangay, it is too far from periphd villages. The RHU physicians thought that build rig a "Health and Nutrition where hezlth smkes acd icformkon we de1iver.d could make service delivery accc;.ihie wx iiu remote barangays. The RHG 1 physician then sought .support from barangay apt&$ tc promote the concept. The concept encouraged bvangay officials, particularly in the weas cavered by RHU I, to strengthen the program aid construct several health post! in ;hs hmngcy. Baranguy officials, with volunteers hm the conununity, dorated ma!erds !o build LPP-Matching Grant Rcgnm Pcrfcrmvna nod Enhuh fiepcir Digm Dav 30 &I Sur, health posts in each of the purokr 01 household clusters. The community shouldered the physical construction of the health a id nutrition posts so that "not a single centavo came !?om the Local Government Unit" The BHWs, the community members and the civic organizations such as the Lions Cljb, Rotary Club and REACT pooled resources in putting up posters and other paraphc malia Districts 1.2 and 3 of Barangay Dulangan, particularly, have examination room;, curtains, and creatively designed rexiving areas. vegetable gardens, bamboo fences, kitchens, comfort rooms and furnaces. Community members showel interest in the Health and Nutrition post because many barangays do not have a BHS. By establishing a Health and Nutrition post in their area, basic services usually found in 1lHSs are now accessible to them. These posts serve as outrexh venues as well as mini-health station for the volunteer health workers (BHWs) ard the designated health cuordina!on of each of the families. In each of these posts, infor nation on community health and nutrition status are hung or posted, and basic health smices are delivered. Examples of community health and nuhition information are electricity, water and sanitation, shelter. basic education and literacy, family care and Livelihood. For MGP's purpose, community starus information on family planning, child immuni:.ation, vitamin A and tetanus toxoid were also included. Herbal gardens are also fc und in the vicinity of the health and nutrition posts to complement the limited western m~dicines in these health service outlets. In February 2000, Barangay Sinawilan of RHU2 completed four Health and Nutrition Posts in puroks Mangga, Narra, Bayabas and Rosas. hrroks Balisong and Tuwal were still under construction. BTL Referrals Like the Health and Nutrition 'o$ BTL referral is originally not an MGP strategy but an offshoot of the implementatior of the CBMO. During CBMO, many jatieots were identified having unmet need in BTL recounting the fact that they alw~ls had to be rescheduled for this particular service since government docton could wt accommodate them during regular clinic hours. I: uring the first 6 months of the MGP, bilateral tubal ligations (BTL) were done on an hgular basis at the Provincial Hospital. Sometimes as many as 25 patients were accommcdated for operation in one day, exhausting the few doctors trained to do BTLs. To address this problem, a s :hedule was adopted with a limit of 10 patients per month as an MGP approach. In ordx to accommodate the demand for BTLs a refenal system was set up which allowed fo~ those unable to avail of sewices on a particular day to be rescheduled. Hence, if more tl an 10 patients queue up on a given day, they would be re-scheduled. The BTL is condu:ted he of charge. Anesthetic and manpower are provided by the PHO while post opt ration medicines and transportation ar: provided by the MHOs. During the launching of MGI in Kapatagan, 1 1 BTLs were perfornut This BTL accomplishment echoed the assessm mt of the health providers in Digos that there are a good number of clients wanting pernanent sterilization. Besides, pamanmt and semi￾permanent methods tend to stabiliz : their CPR compared to temporary methods also beiig offered by the two RHUs. B) providing them the opportunity, more clients were likely to avail of BTL. Output Table 8. Bn clhts served undv MGP a dMuch 2000 TOTAL 94 VI. CONCLUSION AND RECOMMENDATIONS The accomplishment of the I4GP in Digos can be summarized in the following figure, which illustrates the four indic aton before and after the program. Figurn 7. MGP Indicatws Belbre and Anw the Program The MGP activities in Digo.. highlighted a participatory process for obtaining information on clients needing servi xs; it consistently focused on mote. inaccessible barangoys. With the apparent increase in CPR, FIC, FIM and Vitamin A coverage rates shown above, it might be correct o infer that these MGP interventions have been effective in reaching out to undemrved and inaccessible communities, :n ddg missed opportunities, and, in inc~easu~g availability of health services to clients. Integration of tetanus toxoid unmunization into pre-marriage counseiing is able to capture "target"Imissed clients in th s fitting occasion. This intervention needs to be sustained, but requires senice providers to maintain a recording system that will enable them to monitor their clients closely. Since outreach to women in :mall and medium enterprises is the only proposed MGP program that has not yet been implemented, efforts to begin this activity should already be undertaken. The two RHU physicians should already be able to identify target establishments and send out letters to SME owners and managers. The two RHUs should pnmote the health and nutrition posts in districts other than the pilot areas through more outreach activities. To encourage bqwnihan spirit in the puroh, it may be necessary to grant district awards such as 'Best Health Post." Initiatives like this will motivate tmmunity members to participate and appreciate the value of the program in their ldty. Civic groups such as the Rotary Club need to help barangqys in canying out their pro ects. Coordination between mun~cipal LGU volunteers and NGO doctors is wccrsary in sustaining regular schedules fop ligation in different communities. Networking and participation among indigenous lezders and agencies are equally important in mobilizing trained community health workers lo assist in the surgical services. Aside from burangoy healt 1 workers, community volunteers are key partners in reaching out to individuals who may have met needs and in making service delivay more efficient. It will be nv. toequip these partners with skills ind information needed in service delivery. Lastly, program implementtion is dependent on the energy and :nitiative of the program implementers, and most ##ten. program irnplementers can on1:t be pushed to demonstrate efficiency when they a.e monitored and evaluated on. Therefore, monitoring and feed backing should always be a component in improving program implementation There is also a need to assign morc provincial or regional point peMns to help monitor the development of the program. Appendix 1. Definition of Terms 1. Contraceptive Prevalence Ratc (CPR): This rate is measured as the proportion of women 15-49 years of age remrting current use of any contraceptive metbod at the time of assessment The denominator consists of all women 15-49 years of age (WRA). However, in some DIH senice statistics, the denominator is defined as currently married women 15-49 years of age (MWRA). Whenever possible and if the information is available, a delineation between these two measuements ail1 be made. 2. Fully Immunized Child (FIC): This is the percent of living children 12-23 months of age who have been vaccin.~ted before their tint birthday with three doses of Oral Polio Vaccine (OPV), t~ree doses of Diphtheria-Pertusds-Tetanus (DPT) vaccine, one dose of Bacillus Calmene-Guerin (BCG) vaccine and one dose of measles vaccine 3. Vitamin A Coverage (VAC): "his refers to the percent of children 12-59 months of age who received a Vitamin A supplement in the last six months 4. Tetanus Toxoid two plus (TI2+): This is the percent of pregnant women and mothers of reproductive age (1 5-49 years) with children under 5 years of age who have received at least 2 doses c f tetanus toxoid. 5. Unmet need for family plann ng (FP): This refers to the percent of currently married women of reproducti\ e age (MWRA) who want to limit or space their next child but are not using an) family planning method and those using a method but are not satisfied with thei: current method. The denominator consists of all married women of reproductivt age 15-49 years of age. Appendix 2. DOH and MGP Program Owls DOH and MGP program g0.k for the four key indicators, as we!] as findings hm the 1998 National Demographic and Health Survey (NDHS) are shown in Table 3. Table 9. Prvgmm Owls vis-ibis 1998 NDS modan methods FuUy umnunued c~dnn PC) Tetanus toxo~d 2 pius (m+) Vitm A covmge (VAC) 90 LPP-Matching Gmt Prop n Pcrformwr and Ev+hutim Repal Dig- Dav; o &I Sur. philiwincs Appendix 3. Early MGP Advks h Digor do Dr. Angel Libre and Mrs. Vida / costa Letter of Invitation Received from tbe Dqamncnt of 1 Health Regional Field Office @ 4RFO) do Mayor I 1 Ammo Law Lmer of intent ~cnt May 29.1999 do Sangguruan Bayan MOA Received by DHRFO May 20, 1999 MGP Money Released May 24, 1999 Fmt Activity -Kapatagan Outreach June 16,1999 17 Tuba1 Ligation Climb hmc 18.1999 Rsohnion on TI2 into PMC Augw 4.1999 Barangay V~ls~tation and Oumach-on e a week July 1999-0ngolng I PR Manta1 Counvhg Sermnar -7th IT mtcgration Scptcmbn 1999-0ngomg Special Tuba1 Llgahon - 43 cllenb Novcmbn 23.1999 LPP-Matching Grant Pros ram Pcrformu~e .od Enhutio. Repon Digos. D; vao &I Sur. Pwincs Appendix 4. Tables of Input Prom ;Output of MGP Interventions 1) Bayanihan Outreach Sraff tiw From Baranw officials Venue, physical arrangements I From cominunity Food for health providers From ~rivate sector Mcdicinc dooations From MGP P 239,000 for nansponation & Supplies From DHRFOI PHO Vaccines, family planning & Vitamin A supplies, Manpower & supptis for BTL bnrangoys with most urga t health needs and difficult to reach prioritized Litially included all gov't services aside !?om healtl~; assessed as too diffic ~lt to sustain S ~bsequently focused on ffi lg. health services: cons1 ltation & check-up, Immt nization, Vit Supp: ementation, FP re￾SUPPI /, BTL, & circur lcision least once behveen June & Dec. 1999 Generated community interest and awareness of health programs leading to construction of health & nuhition posts Utilization of services, as seen in the increase in FIC and TI2 rates LPP-Matching Grant Rog ram Performance and Evaluation Repon Digos. Dz vao del Sur. Pbihppines 2) CBMO I Staff lime I contrwmial from MSH & borungo)'~. Dulangan for RHU I & Sinawilan for RHU2 I I . . From Baranrrav officials Generated interest & Venue, community mob~luation I awan ness 1211 households 1 From community Participation in commuolty assembly From private sector NGO conlmcted to provide rraining From MGP P 121,000 for training & community assemblies From MSH WOIW w/ NGO in conceptualizing CBMO process covered; 725' in Dulangan and 942 in Simwilan Utilization of services, as seen in the increase in FIC and TT2 rates (see Fig. 4) LPP-Matching Gmt Prog~ am Performance and Evaluation Rcporc Digos. Da ao dcl Sur, Philippines 3) Health and Nutrition Posts I Staff time ! constructed ia Dulangrm; 4 1 From Barangay officials BHWs provided posten 81 materials for CBMO data &lay i I I posts in Sinawilan From community I Land & materials 1 ! Staff time From DHRFOI PHO Vaccines & supplies ordin mce delaying implementation by 2 montlls B lilt upon existing lectures given by health staff implemented at the time of the study LPP-Matching Grant Pro ,m Pcrformamx d Evaluation Repon Digos, D wao &I Sur, Philippines From LGU Slamfftime / From MGP ' Post-op medicioes & ita at ion From DHRFOI PHO Manpower & oprratioo needs Fequired linkage w/ Prov ncial Hospital to have a s:hedule that suited ever) one's needs Lack of trained manr ower initially a probl ?m at the hospital and 56 from RHU U have bad BTL from June 99 - March ZOO0 LPP-Matching Grant Pq nm Perfo-e and Evaluation Report Digos. D vao del Sur, PIuhppioes