ORDINANCE NO: 2024-590 Sponsored by: Committee on Health and Social Services "AN ORDINANCE ESTABLISHING AND ADOPTING A SET OF MEASURES AND SYSTEMS TO ENSURE EFFECTIVE AND EFFICIENT IMPLEMENTATION OF THE MATERNAL NEWBORN CHILD HEALTH AND NUTRITION (MNCHN), INCLUDING THE SETTING UP OF MANAGEMENT STRUCTURES TO OVERSEE IMPLEMENTATION AND COORDINATING MECHANISMS TO IMPLEMENT MNCHN SERVICES, AND ENSURING COMMODITY SELF-RELIANCE IN THE CITY OF PAGADIAN" WHEREAS, Section 15, Article II of the 1987 Philippine Constitution explicitly provides that "The State shall protect and promote the right to health of the people and instill health consciousness among them"; Thus, the MNCHN is an essential program of the Philippine Government, with its basic policy focusing on the maternal, newborn and child health care including the responsibility of couples to decide how many children to have, consistent with their religious belief, preferences and needs. Republic Act 7160, otherwise known as the Local Government Code (LGC) of 1991, the responsibility of providing basic health services, including Maternal Newborn Child Health and Nutrition (MNCHN) services, was devolved to the local government units; this is specifically provided for under Section 17 of the LGC. WHEREAS, the DOH AO 2008-0029, (Implementing Health Reforms for Rapid Reduction of Maternal and Neonatal Mortality), recommends the implementation of the Maternal Newborn and Child Health and Nutrition (MNCHN) Strategy, and states that the risk of mistimed, unplanned, unwanted and unsupported pregnancy which leads to maternal, infant and neonatal deaths, can be prevented if appropriate health interventions are introduced, such as interventions that support the achievement of couple's desired family size. WHEREAS, the DOH AO 1997-16-A states that Sexually Transmissible Infections (STIs) including syphilis are high-risk factors for HIV transmission and that pregnant women with STIs can transmit the infection to their children, resulting in significant morbidity and mortality. It is therefore imperative that all pregnant women accessing Ante-natal Care (ANC) should be provided with information on STI, including symptoms, means of prevention and protection and risks of mother to child transmission of STI including Syphilis and HIV. WHEREAS, the DOH AO 2010-0036 establishes the need to implement the Universal Health Care Program (UHC) that is directed towards achieving better health outcomes, sustained health financing and more responsive health system while ensuring that all Filipinos especially the disadvantaged groups, have equitable access to affordable health care. It recognizes National Health Insurance Program (NHIP) as the prime mover of improving financial risk protection (particularly of the poor), generating resources to modernize and sustain health facilities and improve the provision of public health services to achieve the Millennium Development Goals (MDGs) of reducing maternal mortality and infant mortality. WHEREAS, the City of Pagadian supports families' desire to attain desired number and spacing of children through the elimination of unmet needs in accordance with the provisions of DOH Administrative Order No. 50-A, series 2001 and supports critical policies and plans, complementary actions and supportive measures that are necessary to prevent disruptions in the delivery of health services with the phase-out donated commodities by 2008. WHEREAS, The City of Pagadian currently experiences some health problems with the following health indicators in the first quarter of 2024: Contraceptive Prevalence Rate is 58% Antenatal Care rate is 58.68%, compared to the national benchmark of 95%, with an estimated service utilization gap of 36.32% Fully Immunized Children is 55.58%, compared to the national benchmark of 95%, with an estimated service utilization gap of 79.42%. Maternal Mortality Ratio of 75 per 100,000 live births, compared to the national benchmark of 70 per 100,000 live births Infant Mortality rate of 13.88 per 1,000 live births, compared to the national benchmark of 9.8 per 1,000 live births; NOW THEREFORE, be it ordained by the Sangguniang Panlungsod (14th City Council) of Pagadian City in session assembled that: ARTICLE - I TITLE AND DECLARATION OF PRINCIPLES SECTION 1. TITLE. - This Ordinance shall be known as "An Ordinance Establishing And Adopting A Set Of Measures And Systems To Ensure Effective And Efficient Implementation Of The Maternal Newborn Child Health And Nutrition (MNCHN), Including The Setting Up Of Management Structures To Oversee Implementation And Coordinating Mechanisms To Implement MNCHN Services, And Ensuring Commodity Self-Reliance In The City Of Pagadian." SECTION 2. POLICY. - It shall be the policy of the City of Pagadian to fully support and ensure effective implementation of the Maternal Newborn Child Health and Nutrition and CSR strategy as part of its strong commitment to local health sector reform implementation. It shall support the engagement of all concerned health care facilities to form a coordinated MNCHN service delivery network, mobilize the participation of the community to be covered and served, and strengthen collaboration with other groups of stakeholders within and outside the health sector and beyond its administrative jurisdiction. SECTION 3. DEFINITION OF TERMS. - For purposes of this Ordinance, the following terms and phrases are hereby defined: 1) MNCHN Core Package of Services or Integrated MNCHN Services - refers to a package of services for women, mothers and children covering the spectrum of (1) known appropriate clinical case management services in preventing direct causes of maternal and neonatal deaths, and which are within the capacity of the health system to routinely provide; and (2) known cost-effective public health measures capable of reducing exposure to and the severity of risks for maternal and neonatal deaths, that are within the capacity of the health system to routinely provide. 2) MNCHN Service Delivery and Network - refers to the network of facilities and providers within the city-wide health system offering MNCHN Core Package of Services, including the communication and transportation systems supporting this network. The following health providers are part of the MNCHN Service Delivery Network: a. Community level providers - refer primarily to Barangay Health Stations (BHS) and its health staff (e.g. midwife) and volunteer health workers (e.g. barangay health workers, traditional birth attendants) that typically comprise the Community Health Team or Barangay Health Team. These teams implement MNCHN Core Package of Services identified for the community level. Their functions include advocating for birth spacing and counseling on family planning services; the tracking and master listing of pregnant women; assisting pregnant women and their families in formulating a birthing plan, early detection and referral of high-risk pregnancies, and reporting maternal and infant deaths. The teams shall also facilitate discussions of relevant community health issues, particularly those affecting women and children. b. Facilities both public and private with Skilled-Birth Attendants are capable of attending to uncomplicated deliveries. These shall be appropriately linked to the nearest BEmONC- or CEmONC-capable facilities. c. Basic Emergency Obstetric and Newborn Care (BEmONC)-capable facilities are capable of performing the following six signal obstetric functions: (1) parenteral administration of oxytocin in the third stage of labor; (2) parenteral administration of loading dose of anticonvulsants; (3) parenteral administration of initial dose of antibiotics; (4) performance of assisted deliveries; (5) removal of retained products of conception; and (6) manual removal of retained placenta. These facilities are also able to provide emergency neonatal interventions, which include the minimum: (1) newborn resuscitation; (2) treatment of neonatal sepsis/infection; and (3) oxygen support. It shall also be capable of providing blood transfusion services on top of its standard functions. d. Comprehensive Emergency Obstetric and Newborn Care (CEmONC)-capable facilities can perform the six signal obstetric functions as in BEmONC facilities, as well as provide caesarean delivery services, blood banking and transfusion services, and other highly specialized obstetric interventions. It is also capable of providing neonatal emergency interventions, which include at the minimum, the following: (1) newborn resuscitation; (2) treatment of neonatal sepsis/infection; (3) oxygen support for neonates; (4) management of low birth weight or premature newborn; and (5) other specialized neonatal services. Province-wide or city-wide health system refers to the default catchment area for delivering integrated MNCHN services. It is composed of public and private providers organized into systems such as Inter Local Health Zones (ILHZ) or health districts for provinces and integrated urban health systems for highly-urbanized cities. Service arrangements with other LGUs may be considered if provision and use of integrated MNCHN services across provinces, municipalities and cities become necessary. e. Service Coverage Indicators are parameters which reflect coverage or utilization of services. For MNCHN Strategy, the following indicators are monitored: i. Antenatal care coverage (ANC) is an indicator of access and use of health care during pregnancy. It constitutes screening for health and socioeconomic conditions likely to increase the possibility of specific adverse pregnancy outcomes, providing therapeutic interventions known to be effective; and educating pregnant women about planning for safe birth, emergencies during pregnancy and how to deal with them. ii. Contraceptive Prevalence Rate (CPR) is the proportion of women of reproductive aged 2015-49 reporting current use of any method, i.e. pill, intrauterine device (IUD), injectables, male condom, mucus/Billings/ovulation, Standard Days Method (SDM), and Lactational Amenorrhea Method (LAM). iii. Fully Immunized Children (FIC) is the ratio of children under 1 year of age who have been given BCG, 3 doses of DPT/Pentavalent and OPV and measles vaccine to the total number of 0-11 months old children iv. Vitamin A supplementation coverage (VAS) - is the proportion of 6-59 months preschooler given Vit A capsules twice a year f. Traditional birth attendants (TBA) - or known as "hilot/manghihilot" is a traditional, independent, non-formally trained and community-based providers of care during pregnancy, childbirth, and postnatal period. g. Contraceptives - pertain to the modern methods of family planning, such as, but not limited to, pills, condoms and injectables. h. Commodity Self-Reliance (CSR) - is a multi-sectoral effort which seeks to ensure the self-sufficiency in MNCHN services and commodities in its ability to sustain the provisions of affordable quality health services to eliminate unmet needs. It requires the capacity to forecast, finance, procure and deliver MNCHN services and commodities to all men and women who need them, when they need them. i. LGU/s - refer to the Provincial Government and its component cities and municipalities. j. Commodities - refer to the supplies to be used such as TB drugs, Vit A, zinc supplements, ferrous sulfate with folic acid, contraceptives, syringes and needles, STI screening supplies and medicines. k. NHTS families - National Household Targeting System refer to individuals as determined and defined by the DSWD's NHTS-PR as the poorest of the poor and priority for the distribution of MNCHN commodities. l. NHTS-PR - National Household Targeting System for Poverty Reduction - is a data management system that identifies who and where the poor are in the country. Specifically, the system aims to: (a) formulate a unified criteria for the selection of the poorest population, (b) facilitate the sharing of solid database for public and private social protection stakeholders; and (c) reduce leakages (exclusion and under-coverage of poor, as well as inclusion of non- poor). m. Pantawid Pamilyang Pilipino Program (4Ps) - a poverty reduction strategy that provides grants to extremely poor households to improve their health, nutrition and education particularly of children aged 0-14. It provides cash assistance to the poor to alleviate their needs (short term poverty alleviation) and invests in human capital to break the intergenerational poverty cycle. n. Kalusugang Pangkalahatan (KP) - continuing health sector reform program which aims to primarily: (a) improve financial risk protection of the poor, (b) upgrade and modernize health facilities; and (c) implement key interventions to achieve health-related Millennium Development Goals SECTION 4. MATERNAL NEWBORN CHILD HEALTH NUTRITION-COMMODITY SELF RELIANT FRAMEWORK. - The City of Pagadian believe that the goal of rapidly reducing maternal and neo-natal mortality shall be achieved through effective population-wide provision and use of integrated MNCHN services as appropriate to any locality in the country. MNCHN reforms, improvement and changes in local health systems shall, among others results, create the following intermediate results that can significantly lower the risk of dying secondary to pregnancy and child birth: 1. Every pregnancy is wanted, planned, and supported. 2. Every pregnancy is adequately managed throughout its course. 3. Every delivery is facility-based and managed by skilled birth attendants. 4. Every mother and newborn are provided with safe, effective, affordable post- partum and post-natal services. The City of Pagadian likewise believe that the Commodity Self-Reliance (CSR) Strategy shall create the following supply conditions necessary to eliminate the unmet needs and ensure the availability of MNCHN packages of interventions: 1. The phasing up of domestically provided supplies to replace those quantities of foreign-donated commodities; 2. The increase in levels of domestic supplies of commodities made available to meet the needs of additional future users of commodities; 3. The increase in levels of other commodities such as TB drugs, Vit A capsules, zinc supplements, ferrous sulfate with folic acid, syringes, and needles, STI screening supplies and medicines to meet the needs of mothers and children; ARTICLE II MNCHN/MNCHN-CSR PROGRAM IMPLEMENTATION The City of Pagadian shall institute measures towards establishing systems and mechanisms for an effective implementation of MNCHN strategy city-wide. The City of Pagadian encourages facility-based deliveries either public or private, attended by skilled birth professionals, with the participation of traditional birth attendants (TBAs) or "hilots" in the community health teams. Community Health Teams (CHT) and private professional health providers and private health facilities shall advocate for birth spacing and counseling on responsible parenthood, refer pregnant women to facilities, track and master list pregnant women, assist pregnant women and their families in formulating a birthing plan, early detection, and referral of high-risk pregnancies and report maternal and infant deaths to the CHO. CHT shall participate in regular maternal and neonatal death review and discussions of relevant community health issue The City of Pagadian realizes the need to support all efforts including public and private partnership for MNCHN towards ensuring quality in the process of generating, maintaining and reporting of all MNCHN indicators and that they are valid and can be utilized for LGU planning, financing and policy decision-making the engagement of all concerned health care facilities and providers, both public and private to a coordinated MNCHN service delivery network, mobilize the participation of the community to be covered and served, and strengthened with other groups stake holders within and outside the health sector and also beyond its administrative jurisdiction. The City of Pagadian fully supports the implementation of the MNCHN/ MNCHN-CSR Strategy that includes, among others, the implementation of the following interventions: 1. It shall organize the City-Kalusugang Pangkalahatan MNCHN Coordinating Council. Building the MNCHN/CSR Service Delivery Network and ensuring its sustainability would entail analysis of the existing situation in the locality and assessment of gaps in service delivery, utilization, and health systems in general as well as identifying and planning appropriate interventions to address these gaps. To begin this process, the LGU shall organize a team coming from the City Health Office and other relevant members of the locality like PDOHO, nutrition council, donors, non- government organizations (NGOs), civil society groups and the like. From this team, the LGU can assign a coordinating body to oversee the direction and progress of implementation of the MNCHN Strategy after assessment and initial planning. 2. It shall know the MNCHN/MNCHN-CSR Situation. The MNCHN/CSR Technical Working Group's initial work shall be to assess the MNCHN situation in the LGU. Assessing the LGUs' current level of performance against national data would provide the city an idea of targets they should set to be able to contribute in achieving target MNCHN indicators. The MNCHN Management Team can use Health Outcome Indicators or Health Service Coverage Indicators to assess the LGUs' situation. Health indicators shall be collected and used to monitor the health status of a population. The City of Pagadian recognizes that these health indicators either (1) reflect impact or outcomes or (2) coverage or utilization of services. For MNCHN, health outcome indicators are Maternal Mortality Ratio (MMR), Neonatal Mortality Rate (NMR), Infant Mortality Rate (IMR), Under five Mortality Rate (UFMR) and proportion of underweight 6- to 59-month-old children while Service Coverage indicators are Contraceptive Prevalence Rate (CPR), Antenatal Care (ANC), Facility-based Deliveries (FBD), and Fully Immunized Children (FIC) and Vit A supplementation coverage. Note: will include STI/HIV/AIDS. The City of Pagadian shall likewise validate the data or report received from local health sources (both private and public). If the health information system has not been revisited or revised to comply with standards, available data may not reflect an accurate health situation of the locality. 3. It shall prioritize population groups and areas. 3.1 City of Pagadian shall compare performance of the city with national targets using MNCHN/CSR Health Outcome or Service Coverage Indicators 4. It shall designate facilities in the Service Delivery Network through public private partnerships. The City of Pagadian shall: 4.1. organize the Community Health Team (CHT) and its Facility 4.2. designate the CEmONC-capable Facility 4.3. designate the BEmONC-capable Facility 4.4. designate the community based BEmONC Facility (i.e., lying-in) 4.5. identify Skilled-birth Attendant Facilities 5. It shall install Mechanisms to Ensure Access to MNCHN Services. Aside from providing the MNCHN Core Package of services, the City Government shall ensure presence of support services that would ensure access by priority populations, a source of safe blood supply and health promotion activities to increase demand for services. 6. It shall plan appropriate interventions for service delivery, governance, regulations, and financing. 7. It shall take the lead in implementing strategies and activities meant to improve health-seeking behavior among communities that will result in women and families seeking health care providers for their MNCHN needs. 8. It shall determine and manage funding sources for planned interventions. 9. It likewise supports the implementation of key activities for MNCHN/MNCHN-CSR implementation covering key interventions in the areas of: 9.1. Policy 9.2. Financing 9.3. Service Delivery 9.4. Governance and Systems Development for Sustainability 9.5. Monitoring and Evaluation To focus on key MNCHN/MNCHN-CSR interventions, among others, City of Pagadian shall: a. Organize, train, and deploy community health teams (CHT) to transform needs to effective demand, specifically, help family members assess health risk, deliver key messages and formulate health implementation plan as well as guide these families navigate through the health system and provide adequate information to families on PhilHealth. b. Build capacities of health staff for effective MNCHN/MNCHN-CSR service provision (FPCBT1, FPCBT2, AMSTL, LAPM, EINC, BEMONC, QAP). c. Implement MNCHN integration to reduce unmet needs for and deliver key messages for mothers. d. Provide orientation/information to LGUs on the DOH AO on ICV compliance, including the roles and key activities on ICV compliance. e. Formulate the local NHIP plan that includes key interventions such increasing coverage/enrollment, accreditation of health facilities, provision of information to members and providers on benefits/ access to Philhealth benefits, improving claims management and effective implementation of "no-balance billing scheme". f. Allocate funds and procure MNCHN/MNCHN-CSR commodities and ensure free access of CCT and NHTS families. g. Conduct regular Data Quality Check (DQC) and generate reliable data on CPR as bases for planning, financing, and policy development, and ensure sustained DQC activities and support through dedicated personnel and availability of forms. h. Establish and implement the Stock and Inventory Management System (SIMS) to build LGU capacities in tracking MNCHN/MNCHN-CSR commodities in health facilities, including related medical supplies. ARTICLE III FINANCING OF THE MNCHN/MNCHN-CSR PROGRAM SECTION 5. FUNDING. - The Program shall allocate an amount of THREE HUNDRED THOUSAND PESOS (P300,000.00) to be funded from the Regular Budget of the City Health Office or Lump Sums and other trust funds from the 20% Development Fund and Gender and Development (GAD) Fund. ARTICLE IV PROGRAM MANAGEMENT SECTION 6. CREATION AND COMPOSITION. - There shall be created a MNCHN/MNCHN-CSR Coordinating Council, hereinafter referred to as "Council," which shall be composed of the following: Chairman - The Honorable City Mayor Co-Chairman - SP Chairman, Committee on Health Members - City Health Officer Local Council for Protection of Children City Planning Office City Budget Office City Population and Nutrition Office City Social Welfare and Dev't. Officer City DepEd Local PhilHealth City PNP Local Association of Barangay Chair/ ABC Sanggunian Kabataan Provincial DOH Office Public and Private Hospitals, Birthing Clinic, and Lying-In Centers SECTION 7. DUTIES AND FUNCTIONS. - The Council shall be the over-all coordinating and implementing body for the implementation of the MNCHN/MNCHN-CSR Strategy and Plan in the City of Pagadian. In addition, the Council shall perform and exercise the following duties and responsibilities: Formulate and recommend to the Sangguniang Panlungsod the full implementation of a comprehensive MNCHN/MNCHN-CSR plan for the entire Pagadian City in consultation with other stakeholders and oversee its implementation; Undertake program monitoring and evaluation and provide a program feedback mechanism; In close coordination with the barangay governments and other agencies concerned, conduct and update data on MNCHN; Provide support in strengthening capacities for MNCHN/MNCHN-CSR service provision through the conduct of training courses and other capacity building activities Provide support in the conduct of activities related to MNCHN education and counseling of clients about spacing and limiting and safe motherhood Perform such other duties and function as it may deem fit for the efficient and effective implementation of the program. Establish and maintain linkages with local, national, or even international population-serving organizations or institutions; SECTION 8. MEETINGS AND QUORUM. - The Council shall meet at least twice (2x) a year or as often as necessary at an expressed call of the Chairman or at least fifty percent of the members of the Council. Provided, that a notice shall be sent to the members at least seventy-two (72) hours or three (3) days before the meeting will be held. The Council shall decide by a majority vote of all the members present during a meeting, with the existence of a quorum, on any matter before it. ARTICLE V MISCELLANEOUS AND FINAL PROVISIONS SECTION 9. REPEALING CLAUSE. - All ordinances, resolutions and other issuances that are inconsistent with the provisions of this Ordinance are hereby amended, repealed, or modified accordingly. SECTION 10. SEPARABILITY CLAUSE. - If any part of this Ordinance is held unconstitutional or invalid, the other provisions not otherwise affected shall remain in full force and effect. SECTION 11. IMPLEMENTING RULES AND REGULATIONS. - The Council shall, within a period of six (6) month/s after the approval of this Ordinance, formulate the Implementing Rules and Regulations which shall form an integral part of this Ordinance and the same shall take effect after proper dissemination and publication in the offices concerned and after posting at two (2) conspicuous places in the City. SECTION 12. EFFECTIVITY CLAUSE. - This Ordinance shall take effect after fifteen (15) days following the completion of its publication in a newspaper of local circulation for three (3) consecutive weeks or after posting in at least two (2) conspicuous places of the city. ENACTED AND APPROVED by the Sangguniang Panlungsod (14th City Council) during its 94th Regular Session on 16 October 2024 at the SP Session Hall, 4th Floor City Commercial Center (C3), Santiago District, Pagadian City.