Assessment of the Philippine Basic Emergency Obstetrics and Newborn Care (BEmONC) Initiative Outline of Background and Rationale

I. Magnitude of the problem (for both maternal and newborn / neonatal mortality) a. Trends in maternal and neonatal mortality ratios (10 to 15 year review, if possible) b. Causes of maternal and neonatal mortality b.i. Clinical causes b.ii. Health systems-related causes c. Comparison of trends in maternal and neonatal mortality (stratify according to the following variables, if possible, to examine equity issues) c.i. Geographic location / place of residence c.ii. Education level of mother c.iii. Income level or socio-economic status of mother d. Comparison of national MMR and NMR trends with other Southeast Asian countries (focus on Thailand, Indonesia, Vietnam) National Safe Motherhood Program (NSMP) a. Historical Context / Evolution b. Rationale (include relationship with universal health care) c. Objectives d. Indicators e. Components, interventions / strategies e.i. Local delivery of womens health and safe motherhood (WHSM) services [expand this further to eventually put BEmONC in the context of the NSMP; BEmONC is subsumed under this topic level] e.ii. National capacity f. Accomplishments and status of implementation [latest data if possible] Basic Emergency Obstetrics and Newborn Care [at this level, we should have already determined the relationship between NSMP and BEmONC] a. End-users of services (This should provide the framework for answering items 3a and 3b of the scope of work: Are there enough facilities that provide BEmONC? Are they well distributed?) a.i. Results of national facility mapping a.ii. Results of national needs assessment b. Service delivery (including service sub-components) c. Financing of services d. Governance and regulation of services

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Functionality of facilities designated as providers of BEmONC services a. Commonly accepted components and frameworks of facility functionality [essential if we are to learn of frameworks used in previous similar functionality assessments] a.i. International a.ii. National / local b. Conceptual and operational definitions of the components of facility functionality [focus on operational definitions, that is, how were these domains measured in previous studies / projects] b.i. Accessibility of facility b.i.1. Geographic accessibility b.i.2. Financial accessibility b.ii. Availability of service b.iii. Human resource b.iii.1. Quantitative (i.e. conformity with standards) b.iii.2. Qualitative (i.e. functionality, technical competence, and other health care provider characteristics) b.iv. Materials b.iv.1. Equipment, drugs and supplies b.iv.2. Infrastructure b.v. Methods b.v.1. Work flows / processes b.v.2. Completion times and waiting times b.v.3. Recording and reporting b.v.4. Networking and referral mechanisms c. Quality of care c.i.1. Definition of quality of care c.i.2. Components of quality of care c.i.3. Measuring quality of care [focus on the patient satisfaction survey) d. Instruments and tools (from the Averting Maternal Death and Disability Initiative of the Columbia University Mailman School of Public Health) [these tools were explicitly stated in the call for proposal; we are supposed to streamline our data collection tools using these documents as reference] d.i. Checklists d.ii. Interview guides / questionnaires d.iii. Chart review forms

Objectives General To determine the functionality of facilities designated to provide basic emergency and newborn care (BEmONC) in provinces under the Reproductive Health and Rights th Component of the 7 Country Programme Assistance of the United Nations Population Fund (UNFPA) Specific 1. To characterize adequacy and equity in the distribution of facilities that provide BEmONC (3a & 3b) 2. To describe patterns of utilization of services in facilities that provide BEmONC (3c & 3d) 3. To describe functionality of facilities that provide BEmONC in terms of (3e): a. Accessibility of facility / service b. Availability of service c. Human resource factors d. Materials d.i. Equipment, drugs and supplies d.ii. Infrastructure e. Methods e.i. Work flows / processes e.ii. Completion times and waiting times e.iii. Recording and reporting e.iv. Networking and referral mechanisms 4. To characterize quality of care and underlying causes of quality of care issues in facilities that provide BEmONC using a patient satisfaction survey (3f) 5. To identify immediate, intermediate and long-term recommendations to facility functionality issues using participatory approaches (3g)