The COVID-19 pandemic is having a profound health and socioeconomic impact in more than 80 countries around the world, as governments enact lockdowns and quarantine measures, many people shift to working from home, schools shut down, and businesses shutter their doors, unsure of when and if they will be able to reopen. But for governments, especially their health institutions, this is no time to halt essential services.
Instead, it is a time to ensure that these services are not interrupted. In the Philippines, the government has deemed family planning (FP) services as an essential health care service that must be continued in order to keep Filipinos safe during the pandemic. Two weeks into the lockdown of the Luzon group of islands, which are home to about half of the entire population of the Philippines, the Commission on Population and Development (POPCOM) and Department of Health (DOH) issued guidance calling for cooperation amongst health facilities, local government units (LGUs), and community volunteers in order to continue to provide FP and reproductive health services and commodities in the face of COVID-19.
Soon after the release of this guidance, the RTI-led USAID ReachHealth project, which works to strengthen and improve access to FP for Filipino families, swiftly developed a rapid survey to see if the health facilities and LGUs served under the project would be able to adhere to this guidance with most parts of the country under varying degrees of community quarantine.
It is important to leverage new methodologies for data gathering, existing connections with health institutions, and technology to inform evidence-based action as we continue to confront challenges in the health sector and beyond during COVID-19.” – Dr. Ophelia Mendoza, Monitoring, Evaluation, Research, Learning and Adapting (MERLA) Director for the USAID ReachHealth Project
The project team carried out the rapid survey on March 31, 2020 by conducting phone interviews with FP coordinators and staff of rural and city health centers, public hospitals, and provincial and city health offices. Thanks to good relationships with local health facilities and governments, the project was able to interview more than 91% of target institutions across all 32 provinces and cities served by ReachHealth, collecting data from 29 provincial and city health offices, 175 health centers, and 57 public hospitals.
The whole health system of the Philippines is under enormous pressure to provide health care not just to COVID-19 patients, but to continue with other essential services like immunization, prenatal and postnatal care, and FP. The enhanced community quarantine is an effective way to lessen the spread of COVID-19, but it also has a profound effect on the mobility of both health care providers and clients. Some staff are unable to report for duty as public transport is currently discontinued, and the limited transportation also puts a strain on the delivery of FP commodities. These are just some of the common challenges that the health facilities we interviewed are encountering as they work to continue providing these services. However, in spite of these challenges, the assessment also brought to light a number of ways in which facilities are adapting and finding creative solutions to ensure continuity of FP services. The figure below provides an overview of some noteworthy challenges and solutions that we identified.
While many thought that the impact of the lockdown and quarantine on the capacity of health facilities to provide essential health services would be reduced or result in closed facilities, the rapid assessment demonstrated that some health facilities are actually exceeding their usual operating hours while having less staff report for duty. This puts a huge burden not only on these facilities but more importantly on health providers who need to stay healthy in order to continue with their duties.
The government has mobilized Barangay Health Emergency Response Teams (BHERTs) to support the COVID-19 response at the community-level. These teams are composed of a barangay (community) executive officer, a barangay tanod (guard), and two barangay health workers, one of them a nurse or a midwife. BHERTs support risk communication activities, surveillance and contact tracing, help people safely access their medicines without going to health centers and risking exposure, and are valuable sources of health information to communities. They are provided with masks and gloves to ensure that they can conduct home visits safely and in accordance with social distancing guidance. Therefore, to address this problem of having limited staff at the health centers, the BHERTs have been mandated to support the provision of essential health services. The survey results show that 84% of community health centers have mobilized barangay health workers and barangay population volunteers to provide FP information to communities, and 77% have mobilized them to go house-to-house fulfilling resupply requests for commodities.
With most of the country under quarantine, clients are less inclined to go out and get their FP commodity or go to their community health facility for resupply or counselling. Even though many of the health facilities we interviewed are still offering FP services daily, more and more facilities are reporting a dwindling number of clients.
This has pushed facilities to come up with creative ways to continue to reach their clients. For example, the facilities we interviewed are ensuring the resupply of FP commodities by notifying current users using SMS regarding available services and commodities ready for pickup, conducting house-to-house visits, or using social media to reach more clients. Some LGUs also have come up with clever ways of ensuring the resupply of FP commodities by including condoms in food packs that are already being given to families.
Another issue looming on the horizon is the stock-out of FP supplies. The survey captured not only the stock-out status of commodities on the day of the survey, but also the projected stock-outs one month and three months after the time of the survey as self-evaluated and self-declared by the interviewed providers. Survey results show that as of the time of the survey, more than 10% of both health centers and public hospitals had a stock-out of all commodities except for intrauterine devices (IUDs) and combined oral contraceptive (COC) pills. In addition, the proportion of health centers reporting stock-outs of commodities was, in general, higher compared to hospitals, which is comparable with the situation prior to COVID-19.
Given the current rate of resupply and challenges with delivery and procurement of FP commodities, addressing stock-outs should be a priority for both policymakers and providers. Recommended solutions to prevent commodity stock-out include: arranging an immediate and one-time delivery of commodities from the DOH that will last for several months; having an efficient digital way to request commodity replenishment like through SMS; providing progestin sub-dermal implants, which have the highest stock-out rate, only to referral facilities that can accommodate these clients; and reallocating commodities among different facilities like hospitals and health centers, which we found some facilities are already doing.
Finally, the survey helped to identify a missed opportunity during this time of crisis.
The country’s provider of universal health coverage, the Philippine Health Insurance Corporation (PhilHealth), offers ease of claims and reimbursements for health facilities during public health emergencies like COVID-19. Unfortunately, only 52% of rural health units and 35% of public hospitals are aware of these special provisions, meaning that many facilities are not prepared to take advantage of this healthcare safety net.
USAID ReachHealth has been conducting a series of webinars for hospitals and LGUs to orient them on how to file claims and reimbursements for health services rendered during events such as the COVID-19 public health emergency.
ReachHealth has shared the results and methodology of this rapid assessment with local stakeholders such as POPCOM, the DOH and the LGUs, as well as other USAID projects in country, to serve as a guide as we all work together to help the Philippines achieve its FP goals during this health crisis. It is important to leverage new methodologies for data gathering, existing connections with health institutions, and technology to inform evidence-based action as we continue to confront challenges in the health sector and beyond during COVID-19. We hope that the results of this assessment can help implementers identify gaps in FP services and work to bridge those gaps with innovative solutions.
