Chapter 6

Maternal, child and

adolescent health services
Lawrence Ryan A. Daug, RN, MPM
CHN 1 - Instructor
Learning Objectives:
1. Appraise current status of maternal and child health situation in the Philippines.

2. Discuss the different health care packages at a specific life stage based on Republic

Act 11148.

3. Enumerate various initiatives of the government to promote maternal and child

health in the country,

The current maternal,
situation
Antenatal care is relatively low compared to facility-based delivery as reporting for

ANC should commence in the first trimester of pregnancy. Pregnant women who

failed to visit during the first trimester are automatically not counted in the ANC

indicator. Field reports also showed that women usually seek prenatal care when

quickening is felt, usually at 20 weeks age of gestation or at the second trimester of

pregnancy.
Challenges in the delivery of maternal and child health
services (DOH RPRH Report, 2018):

1. Low utilization of Family Planning Packages of PhilHealth. This low utilization may arise from
confusion between patients and providers brought about by differing interpretations in the
implementation of the guidelines;

2. Decrease in the number of PhilHealth accredited Maternal and Child Program (MCP) facilities;

3. Antenatal and postpartum care services lag and,

4. Measles and polio outbreaks and increase in measles-related mortalities.

RA 11148: Ang
Kalusugan ng Magnanay
Act (First 1,000 days)
This will provide a comprehensive, sustainable, multi-sectoral strategies and approaches to
address health and nutrition problems of newborns, infants and young children, pregnant
and lactating women, and adolescent females by providing policy environment, evidence-
based nutrition interventions, and institutionalized first 1000 days’ program in all
development plans of both the national and local government.

RA 11148 also identifies all the services needed, from prenatal check-ups, immunization of
pregnant and children, dietary supplementation programs for the target groups, training of
health and nutrition workers, provision of other health and nutrition services, psychosocial
stimulation, and provision of other assistance that each stakeholder may offer.
The policy also mandated the Department of Health, the National Nutrition
Council, Department of Agriculture, in coordination with other national
government agencies, local government units, civil society organizations, and other
stakeholders to create the implementing rules and regulation of the policy. It shall
cover all nutritionally-at-risk population, with focus on pregnant and lactating
women, all Filipino children who are newly born up to two years of age. The policy
should also prioritize population living in geographically isolated and
disadvantaged areas (GIDAs), unserved and underserved communities such as the
indigenous people, areas with high prevalence of malnutrition, persons in the
vulnerable sectors, and those communities affected by a crisis or arm conflict.
Safe Motherhood Program
The Philippines faces unique challenges in aligning its health system with the needs
of its inhabitants, primarily because of the country's geography and income
distribution. Several communities are in isolated mountain regions of the country or in
coastal areas which are difficult to reach. Further, there are wide disparities in the use
of health services across income levels The Philippine government placed health
general, and maternal health on its high political agenda of reform.
The project aimed to strengthen the ability of the health system to deliver a package
of interventions, including maternal care family planning control of sexually
transmitted infections, and adolescent health services—with a priority on serving
disadvantaged women.
Set of interventions of the program:
Sector governance: improving accountability and regulatory oversight;

Infrastructure and essential medical products and equipment;

Human resource development: clinical skill. building and formation of village-

based women's health teams (composed of a midwife, a pregnant woman, and a
traditional birth attendant [TBA));

Financing: results-based financing mechanisms and social health insurance

coverage;

Service delivery: availability, quantity and quality of essential health services.

This program envisions that
Filipino women have full access
to health services to ensure safe
pregnancy and delivery
1. Shift in handling pregnant clients from risk approach to
preparing all pregnant women for the complications at
childbirth. It follows the rule that there is no such thing as low
or high-risk pregnant woman. Instead, all women are
considered at risk for pregnancy and childbirth complications.
This brought about the establishment of BemONC, CEmONC
network within the bigger Service Delivery Network (SDN);
2. Improved quality of Family Planning counselling and

expanded service availability of postpartum family planning in

hospitals and primary birthing centers; and,

3. The integration of cervical cancer, syphilis, hepatitis B, and

HIV screening among others into the antenatal care protocols.

The Reproductive Maternal Newborn Child Adolescent Health and
Nutrition core package of services

The MNCHN program takes a health systems-oriented, multi-sectoral approach in

strengthening the continuum of care for women, children, families, and
communities. The main objective of this core package is to enable all adolescents
to make informed choices on reproductive health issues, particularly about
pregnancy, by creating awareness and providing access to information, education,
support. services and necessary treatments in the field of reproductive health.
The following health providers are pan of
the MNCHN Service Delivery Network:
1. Community level service providers or Community Health Team (CHT) comprise of

out-patient departments, Barangay Health Stations, Rural Health units, and private

clinics which are manned by community health volunteers and led by a midwife. Its

primary functions are to conduct health risks and needs assessment and provide basic

service delivery functions such as birth spacing and counselling.

2. BEmONC - capable facility maybe a Barangay Health Station, lying-in, or birthing home that

provides the parenteral administration of oxytocin (3rd stage), loading anticonvulsant, initial dose of

antibiotic; assisted imminent breech deliveries; removal of retained products and placenta; and,

emergency newborn interventions such as resuscitation, sepsis, and oxygen treatment. BEmONC

capable facilities may also transfuse blood products, if needed.

3. CEmONC - capable facilities provide all services rendered in BEmONC facilities with the addition

of cesarean section, blood banking and transfusion, highly specialized obstetric intervention,

management of low birth weight and preterm babies, and other newborn specialized services.

Intrauterine device insertion, vasectomy, and bilateral tubal ligation are likewise performed in these

facilities. An itinerant team composed of a physician, a nurse, and a midwife is in-charge for the

outreach services. One CeMoNC facility caters to at least 500,000 population.

Reproductive Health
According to the World Health Organization (WHO, 2008), reproductive health is the
state of complete physical, mental and social wellbeing and not merely the absence
of infirmity in all matters relating to reproductive system and to its functions and
processes. Reproductive health is based on the right to access appropriate health care
services which enables women to go safely through pregnancy and childbirth and
provides couples with the best chance of having a healthy infant (WHO, 2008). On
the other hand, reproductive health care refers to the constellation of methods,
techniques, and services which contribute to reproductive health and well-being by
preventing and solving reproductive health problems (WHO, 2008).
The Magna Carta of Women (R.A. 9710), which was enacted in 2009, stipulated that,
"the State shall, at all times, provide for a comprehensive, culture sensitive, and
gender responsive health services and programs covering all stages of a woman's life
cycle and which addresses the major causes of woman's morbidity and mortality. "
This law states that in the provision of comprehensive health services, due respect
shall be accorded to women's religious convictions, the rights of the spouses to find a
family in accordance with their religious conviction, and the demands of responsible
parenthood, and the right of women to protection from hazardous drugs, devices,
intervention, and substances. It also stated that the full range of reproductive health
services shall be ensured by the government (Congress of the Philippines, 2009).
Republic Act 10354, also known as the Responsible Parenthood and Reproductive
Health (RPRH) Law signed by Benigno Aquino Il on January 17, 2013, is an act with
the declaration that the State recognizes and guarantees the human rights to
sustainable human development, health, education and information, and the right to
choose and make decisions and in accordance with one's religious convictions, ethics,
cultural beliefs, and demands of responsible parenthood.
QUEZON PROVINCE 1,000 DAYS
FIRST 1,000 DAYS
FIRST 1,000 DAYS
CASE ANALYSIS
ANSWER THE FOLLOWING
QUESTIONS
1. WHY DID ROSARIO DIED?

2.WHAT ARE THE RESPONSIBILITY OF LGU AND NATIONAL

GOVERNMENT IN ROSARIO’S CASE?

3. AS FUTURE NURSES OF OUR COUNTRY, WHAT INITIATIVES WILL YOU

IMPLEMENT TO ADDRESS THE CASE OF ROSARIO?