Trends in National-Level Governance and Implementation of the Philippines’ Responsible Parenthood and Reproductive Health Law from 2014 to 2020

Vanessa T. Siy Van; Jhanna Uy; Joy Bagas; Valerie Gilbert T. Ulep

doi:10.9745/GHSP-D-21-00184

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FIGURE
The Centers for Disease Control and Prevention Policy Process²¹

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TABLE 1.

Organizations Included in Key Informant Interviews and Number of Respondents

Organization	Respondents
National Implementation Team	1
Department of Health	6
Commission on Population and Development	4
Department of Social Welfare and Development	2
Philippine Commission on Women	2
Philippine Health Insurance Company	1
Department of Education	1
Department of Interior and Local Government	1
Civil society/private sector	1
United Nations Population Fund	1

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TABLE 2.

Completion of RPRH Mandates Listed in RPRH Implementing Rules and Regulations (2017 Revision) by Subsection^a

Done	Doing	Not Done
DOH Governance: Guidelines
4.01 Service Delivery 4.04 Informed Choice 4.08 Care for GBV Survivors 4.12, 4.13 Policies on Life-Saving Drugs in Maternal Emergencies 5.07 FP Services at Establishments/Enterprises 5.08 Mapping Service Delivery Network (SDN) Facilities 5.22, 5.23 Exempting Private Providers 6.01, 6.03-6.05 Contracting and Training Health Professionals 8.03 Procurement of FP 10.10 LGU Awards/ Recognition 14.01 Maternal, Fetal, and Infant Death Reviews (M/FIDR)	5.07 FP Services at Establishments/Enterprises 5.11 Match Populations to Facilities in the SDN 5.14 Assistance to LGUs for Mobile Health Care Services (MHCS) Vehicles 5.17 Identification of Facilities for Upgrading 5.19 Support to LGUs 5.27 Training Counselors of Adolescents 6.06 Comprehensive Emergency Obstetric and Newborn Care (CEmONC) Curriculum 6.07, 6.08 Training Barangay (Community) Health Workers 10.02 Health Promotion Plan 12.01 except section h DOH duties	5.13 Standards of MHCS 5.18, 5.20 M&E for LGU Fund Utilization and SDN 6.02 Determine number of Skilled Health Professionals 10.06 M&E for New Health Promotion Plans
DOH Governance: Non-Guidelines
5.09, 5.10 Mapping Health Facilities and Priority Populations in the SDN 8.02 Budget to Procure FP 9.03, 9.04 Funds for Health Facilities and Public Awareness	6.10 Technical Assistance to Engage Private Providers in LGUs 14.07 M/FIDR Panel 15.03 Streamline Reporting	8.07, 8.10 Monitoring System for Procurement 12.01-h RH Bureau in DOH
DOH Service Delivery
4.11 Life-Saving Drugs in Maternal Care Emergencies 4.15 Maternal and Newborn Health Care in Crisis Situations 5.21 Assist Private FP Services 7.02, 8.01, 8.08 FP Logistics 13.02 RPRH in Anti-Poverty 15.01 Reporting Requirements	4.05-4.07 Access to FP (including minors) 4.09 PWD-RH Programs 4.10 Responding to Unmet Need 5.02, 5.05 RH Care in SDN 5.12 MHCS 6.09 SBCC Materials 10.01 Health Promotion
Other Implementers
5.10 Identify Priority Populations in the SDN (DSWD) 12.03, 12.04 Duties (DSWD) 7.04, 7.05, 7.08, 7.12 RH Product Certification (FDA) 7.06 Harmonize Standards (FDA) 9.06-9.08 Financing RH (PhilHealth) 10.07, 12.04 CSO Participation (Cross-Cutting) 11.02 Curriculum Development (DepEd)	4.02, 5.03, 5.15, 5.16, 8.09, 10.05 Service Delivery (LGUs) 5.07 FP Services at Establishments/Enterprises (Department of Labor and Employment) 9.01, 9.02 Appropriations (Cross-Cutting) 10.04 NGAs Assist DOH 10.08, 10.09 Health Promo in NGAs’ Programs (Cross-Cutting) 9.05 Funding for RPRH Education (PRC/CHED/TESDA/DepEd) 11.01, 11.05, 11.06 Provision of RPRH Education (DepEd)	4.14 Integrate RH in Health Professional Curriculum (PRC/CHED/TESDA) 6.11-6.13 Pro-Bono Services Requirements (PhilHealth) 7.07 Guidelines for FP Product Requirements (FDA) 7.09, 7.10 Post-Marketing Surveillance Unit (FDA) 11.04 Training Educators (DepEd)

Abbreviations: CHED, Commission on Higher Education; CSO, civil society organization; DepEd, Department of Education; DOH, Department of Health; DSDW, Department of Social Welfare and Development; FDA, Food and Drug Administration; FP, family planning; GBV, gender-based violence; LGU, local government unit; M&E, monitoring and evaluation; NGA, national government agency; PhilHealth, Philippine Health Insurance Corporation; PRC, Professional Regulation Commission; PWD, persons with disabilities; RH, reproductive health; RPRH, Responsible Parenthood and Reproductive Health; SBCC, social and behavior change communication; TESDA, Technical Education and Skills Development Authority.
↵^aSources: RPRH Implementing Rules and Regulations (2017 revision), annual accomplishment reports, key-informant interviews, and review of official documents and secondary literature.

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TABLE 3.

NIT Agenda by RPRH Element and Frequency in 71 NIT Meetings From 2014 to 2018^a

RPRH Element		Frequency
1	Family planning	60
2	Maternal, neonatal, child health, and nutrition	32
11	Adolescent reproductive health (RH) education in formal and nonformal settings (i.e., comprehensive sexuality education)	30
4	Adolescent youth and RH guidance and counseling	27
3	Proscription of abortion and management of abortion complication	15
7	Sexuality and RH education and counseling	14
6	Violence against women and children and gender-based violence	12
5	Sexually transmitted infections, reproductive tract infections, and HIV/AIDS	11
8	Breast and reproductive tract cancers and other gynecological conditions and disorders	3
9	Male responsibility and involvement and men’s RH	2
10	Prevention, treatment, and management of infertility and sexual dysfunction	1
12	Mental health aspect of reproductive care	0

Abbreviations: NIT, National Implementation Team; RPRH, Responsible Parenthood and Reproductive Health.
↵^aSource: NIT Meeting Transcripts 2014–2018.

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TABLE 4.

Annual Trends and Issues Identified in RPRH Implementation^a

		Years Identified
Area	Issues	2014	2015	2016	2017	2018
Cross-cutting	No overall plan or a single agency solely in charge of nationwide implementation	◉	◉	◉	◉	◉
	Weak M&E and data management	◉	◉	◉	◉	◉
	Weak link between demand generation and service provision; weak logistics system	◉	◉	◉	◉	◉
	Limited scope and scale of service delivery through public sector	◉	◉	◉		◉
	Capacity-building efforts of NGAs like DOH are limited to public sector	◉	◉	◉		◉
	Uncertainty of RPRH budget; limited absorptive capacity for incremental budgets	◉	◉
	Low utilization of RPRH benefits; lack in clarity for reimbursements and guidelines	◉	◉	◉	◉	◉
MNCHN	Limited access to services and stagnant/high MMR and IMR due to preventable causes	◉	◉	◉	◉	◉
MNCHN	Poor newborn, infant, child health and nutrition		◉	◉		◉
FP	High unmet need varying across population groups; LGU difficulty operationalizing FP SDN	◉	◉	◉	◉
	Variable training standards and requirements for FP licensing or accreditation; few HHR in facilities for competing priorities		◉
	Legal barriers to providing FP (i.e., TRO)		◉	◉
	Impractical FP targets and planning, including resolution of bottlenecks				◉	◉
ASRH	Lack of clear legal authority and evidence-based technical guidelines to direct ASRH programs and strategies		◉	◉	◉	◉
	Unavailability of routinely collected age and sex disaggregated data on health service utilization		◉	◉		◉
	Delay in adoption of CSE in K-12; limited IEC on ASRH for parents; ineffective awareness campaigns to raise demand for ASRH services			◉	◉	◉
	High unmet need of adolescents; minors need parental consent to access FP services; lack of youth-friendly treatment centers; stigma					◉
VAWC	Laws with dated or discriminatory content; gaps in local policies to address VAWC or GBV		◉		◉	◉
	Inadequate research and monitoring for GBV- and gender-responsive services		◉			◉
	Lack of comprehensive package of services for survivors (psychosocial, legal, and support)		◉			◉
	Unaddressed cases and slow access to justice		◉	◉		◉
	Lack of service provider capability (barangay VAW desks, WCPU in hospitals)		◉			◉
	Prevention of VAWC is not a priority					◉
STI-HIV/AIDS	Continuing growth of HIV epidemic; rising cases among children (vertical transmission)		◉		◉
	Limited access to HIV/STI services and info		◉	◉		◉
	Lack of data and research on HIV		◉	◉
	Lack of laws to protect key populations from discrimination and stigma				◉

Abbreviations: ASRH, adolescent sexual and reproductive health; CSE, comprehensive sexuality education; DOH, Department of Health; FP, family planning; GBV, gender-based violence; HHR, health human resources; IEC, information, education, and communication; IMR, infant mortality rate; LGU, local government unit; M&E, monitoring and evaluation; MMR, maternal mortality rate; NGA, national government agency; RPRH, Responsible Parenthood and Reproductive Health; SDN, service delivery network; STI, sexually transmitted infection; TRO, temporary restraining order; VAW, violence against women; VAWC, violence against women and children; WCPU, women and child protection unit.
↵^aSources: Annual accomplishment reports 2014–2018.

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TABLE 5.

NIT Agenda and Their Frequency of Discussion^a

Agenda: Areas of RPRH Implementation	2014(n=3)	2015(n=12)	2016(n=21)	2017(n=16)	2018(n=13)	2019(n=6)	Total(n=71)
Policy reviews and revisions 19 on proscription on abortion and management of complications (DOH AO 2018-03) 5 on requiring an ambulance for hospital licensing (DOH AO 2018-01) 5 on PhilHealth accreditation of stand-alone FP clinics (Circular 2018-05)	2	4	17	10	10	5	48
FP logistics Supply chain management issues (e.g., stock-outs), use of remaining progestin subdermal implants given SC TRO, and inventory counts	—	8	11	7	11	4	41
RPRH communication and health promotion National FP Conference, events, DOH-HPCS presentations on communication plan	—	3	9	10	11	3	36
Monitoring and evaluation FP Form 1, Annual report, data requests	—	8	15	6	4	1	34
Legal restrictions - SC-TRO	—	—	3	13	9	—	25
CSO funding Process of accreditation of grant funding	—	—	4	6	10	5	25
Capacity building for health care providers Training for FP, MNCHN, interpersonal communication and counseling; Accreditation of Training providers	—	3	4	6	5	5	23
Accreditation of health care providers Standardized certification programs and accreditation of CSOs and private providers	—	3	4	6	5	5	23
RPRH service delivery Various discussions on quality and access	1	4	3	6	8	—	22
PhilHealth claims/reimbursements	—	4	5	6	3	3	21
RPRH budget DOH budget cuts, augmentation, convergence budgeting	—	3	7	4	2	1	17
Sorsogon “Pro-Life City” (LGU issue)	—	4	9	2	2	—	17
ASRH technical working group NIT organizational challenge: Functionality and leadership	—	9	—	5	2	—	16
Regional implementation teams Organizational challenge: Functionality, reporting issues	—	1	8	—	4	2	15
Service delivery network PhilHealth facility accreditation and issues on DOH facility standards (e.g., need for ambulance)	—	5	5	1	2	—	13
Quantity of health care providers Deployments for nurses and family health associates	—	1	4	1	6	—	12

Abbreviations: AO, administrative order; ASRH, adolescent sexual and reproductive health; CSO, civil society organization; DOH, Department of Health; FP, family planning; HPCS, Health Promotion and Communication Service; LGU, local government unit; MHCHN, maternal, neonatal, and child health and nutrition; NIT, National Implementation Team; PhilHealth, Philippine Health Insurance Corporation; RPRH, Responsible Parenthood and Reproductive Health; SC, Supreme Court; TRO, temporary restraining order.
↵^aSource: NIT meeting transcripts 2014–2018.