Philippine Population Management Program (PPMP) Monitoring and Evaluation Alejandro N. Herrin and Aniceto C. Orbeta, Jr. August 28, 2003

2 Outline Monitoring and evaluation framework Some findings Information gaps Future directions

3 Objective Strategy Outputs (services, capacity- building, advocacy, organizational support) Basic inputs Utilization (intermediate outcomes Outcomes (achievement of policy objectives) Other factors Framework for PPMP Monitoring and Evaluation

4 Objective/ Strategy OutputsUtilization/ Intermediate Outcomes Outcomes Objective 1: To help couples/parents to achieve their desired family size within the context of responsible parenthood. Strategy 1: Responsible Parenthood and Family Planning (RP/FP)  Family planning services availability  Advocacy/ communication program  Training programs  Organizational support  Contraceptive prevalence rate: total and by method mix  Unmet need for contraception  Total fertility rate: wanted and unwanted Responsible Parenthood and Family Planning (RP/FP)

5 Use of Expenditures Amount (in million pesos) Percent Amount (in million pesos) Percent 1. Reproductive health/family planning (RH/FP) 12, , FP services and counseling 1, , RH services and counseling (excluding FP) 9, , Adolescent health and youth development (AHYD) Population and development integration (POPDEV) Policy making, data collection, etc. 1, , Mixed PPMP services and activities TOTAL EXPENDITURES 13, , PPMP Expenditures by Use, 1998 and 2000 Source: Racelis and Herrin (2003) Outputs

6 Uses of Expenditures Sources of Expenditures, 2000 NGFAPsLGU Phil- Health Donors and CAsNGOsHHsTotal 1. RH/FP FP RH (excluding FP) AHYD POPDEV Policy & data collection Mixed Total Expenditures Percent Distribution of Total PPMP Expenditures by Strategy/Activity and by Source of Expenditures, 2000 Outputs

7 Sources of supply of modern methods Source of Supply NDS 1993 NDHS 1998 FPS Total percent100.0 Public Sector Government hospital RHU/UHC BHS BSPO/BHW Private Private hospital/clinic Private doctor Private nurse/midwife Pharmacy/store NGO Industry-based clinic Other private Outputs

8 Sources: NDS 1968 to 1993 and NDHS 1998 Utilization

9 Fertility and CPR, Selected Countries 2002 TFRCPR All Methods CPR Modern Methods Thailand1.872%70% Indonesia2.357%55% Vietnam2.375%56% Philippines3.246%28% Source: UNESCAP (2003) Utilization

10 PoorestSecondThirdFourthRichestMean TFR ASFR (15-19) Use of modern contraception (%) Fertility and contraceptive use: 1998 NDHS Source: Gwatkin, et al. (2000) Utilization TFR=total fertility rate ASFR (15-19)= age-specific fertility rate among women years old.

11 Percent of Currently Married Women by Method, Poor and Non-Poor, 2000 and 2002 Type of Method 2000 FPS2002 FPS PoorNon-PoorPoorNon-Poor Any method Any modern method Pill IUD Injection Condom Female sterilization Male sterilization Mucus/billings/ovulation 0.1 LAM Any traditional method Utilization

12 Percentage of currently married women with unmet need for family planning 1993 NDS2002 FPS Total For Spacing For LimitingTotal For Spacing For Limiting Total Residence Urban Rural Education No educ Elem H. S College Utilization

13 Sources: NDS 1968 to 1993 and NDHS 1998 Outcomes

14 PoorestSecondThirdFourthRichestMean TFR ASFR (15-19) Use of modern contraception (%) Fertility and contraceptive use: 1998 NDHS Source: Gwatkin, et al. (2000) Outcomes

15 Total and Wanted Fertility Rates, 1993 and 1998 Background Characteristics 1993 NDS1998 NDHS Total Wanted Fertility Rate Total Fertility Rate Total Wanted Fertility Rate Total Fertility Rate Total Residence Urban Rural Education No education Elementary High school College or higher Outcomes

NDS1998 NDHS Urban Rural No education Elementary High school College Total Percent of Married Women Who Want No More Children Outcomes

17 Summary: Family planning Outcomes: Slow fertility decline, high unwanted fertility among the poor Utilization: Low contraceptive use of modern methods. More likely due to lack of access to high quality and preferred methods than lack of demand, especially among the poor. Outputs: Lack of consistency in policy to reduce fertility and promote FP, especially with the promotion of modern and effective “artificial” methods, which affect total effort as reflected in government allocation of resources to contraceptive supplies. Households finance close to half of total expenditures for direct FP services.

18 Objective/ Strategy OutputsUtilization/ Intermediate Outcomes Outcomes Objective 2: To reduce maternal mortality, infant mortality and child mortality through improved reproductive health. Strategy 2: Reproductive Health/Family Planning Program (RH/FP)  Reproductive health services availability  Advocacy/ communication program  Training programs  Organizational support indicators Utilization (coverage) rates of RH services  Maternal mortality  Infant mortality  Child mortality Reproductive Health /Family Planning (RH/FP)

19 10 elements of reproductive health (DOH AO 1-A, January 15, 1998) 1.Family planning 2.Maternal and child health and nutrition 3.Prevention and management of abortion complications 4.Prevention and treatment of reproductive tract infections including STDs and HIV/AIDS 5.Breast and reproductive tract cancers and other gynecological conditions 6.Adolescent reproductive health 7.Education and counseling on sexuality and sexual health 8.Men’s reproductive health 9.Violence against women and children 10.Prevention and treatment of infertility and sexual disorders Outputs

20 Use of Expenditures Amount (in million pesos) Percent Amount (in million pesos) Percent 1. Reproductive health/family planning (RH/FP) 12, , FP services and counseling 1, , RH services and counseling (excluding FP) 9, , Adolescent health and youth development (AHYD) Population and development integration (POPDEV) Policy making, data collection, etc. 1, , Mixed PPMP services and activities TOTAL EXPENDITURES 13, , PPMP Expenditures by Use, 1998 and 2000 Source: Racelis and Herrin (2003) Outputs

21 Uses of Expenditures Sources of Expenditures, 2000 NGFAPsLGU Phil- Health Donors and CAsNGOsHHsTotal 1. RH/FP FP RH (excluding FP) AHYD POPDEV Policy & data collection Mixed Total Expenditures Percent Distribution of Total PPMP Expenditures by Strategy/Activity and by Source of Expenditures, 2000 Outputs

22 MCHS Percent who received prenatal care Percentage who received from: Doctor Nurse/midwife Traditional birth attendant/hilot Others0.1* Percent who received Iron tablet/capsule Percent who received Iodine capsule Percent who received tetanus toxoid vaccine Note: * less than 0.1 percent Prenatal care, Utilization

23 PoorestSecondThirdFourthRichestMean To doctor To midwife/nurse Medically trained provider visits Pre-natal care visits (%): 1998 NDHS Source: Gwatkin, et al. (2000) Utilization

FPS Poor Total No. of children (000)3780 Doctor13.0 Midwife/nurse22.1 Hilot63.0 Non-poor Total No. of children (000)5840 Doctor46.2 Midwife/nurse30.6 Hilot22.7 Percent of children 0-59 months by type of delivery attendant Percentage for “Others” not shown. Utilization

25 PoorestSecondThirdFourthRichestMean By a doctor By midwife/nurse By medically trained provider In a public facility In a private facility At home Delivery attendance (%): 1998 NDHS Source: Gwatkin, et al. (2000) Utilization

26 MCHS All Women ('000) Percent who received postnatal care Percentage who received from: Doctor Nurse/midwife Traditional birth attendant/hilot Type of service Abdominal exam Breast exam Internal exam Family planning advice Breastfeeding advice Baby care advice Check-up of baby Postnatal care, Utilization

27 High risk fertility behavior, 1993 and 1998 Risk defined in terms of early ( 34) childbearing, short birth intervals ( 3) Outcomes

28 Sources: Flieger 1982; Flieger and Cabigon 1984; NSCB 1992; UNESCAP 2002 Outcomes

29 Sources: Flieger 1982; Flieger and Cabigon 1984; NSCB 1992; UNESCAP 2002 Philippines Thailand South Korea Outcomes

30 PoorestSecondThirdFourthRichestMean IMR Under 5 MR Infant and child mortality by income class: 1998 NDHS Source: Gwatkin, et al. (2000) Outcomes

31 Maternal mortality ratio estimates Estimates for other countries for : –South Korea: 20 –Malaysia: 39 –China: 65 –Thailand: 44 –Singapore: 6 –Indonesia: 450 –Philippines: 170 Source: World Bank (2001) Outcomes

32 Summary: Reproductive health Outcomes: slow decline in infant and child mortality; high infant and child mortality among the poor; high maternal mortality; high risk births; little information on other aspects of RH. Utilization: Low utilization of MCH services provided by trained medical providers among the poor. Subsidized public sector services captured by the better off. Outputs: Traditional services in place but public delivery now the main responsibility of LGUs probably not highly efficient nor of high quality. Households finance close to half of direct RH expenditures.

33 Objective/ Strategy OutputsUtilization/ Intermediate Outcomes Outcomes Objective 3: To reduce the incidence of teenage pregnancy, incidence of early marriage, and the incidence of other reproductive health problems. Strategy 3: To ensure that adolescents are provided with appropriate information, knowledge, education and services on population and reproductive health. (AHYP)  Education and counseling services availability  Advocacy/ communication program  Training programs  Organizational support  Attendance in education and counseling programs  Coverage of advocacy and communication program  Age at marriage  Fertility rate among teenagers and youth  Indicators of reproductive health behavior and problems among the adolescent and youth (e.g.,STD, HIV/AIDS?) Adolescent Health and Youth Development (AHYD)

34 Use of Expenditures Amount (in million pesos) Percent Amount (in million pesos) Percent 1. Reproductive health/family planning (RH/FP) 12, , FP services and counseling 1, , RH services and counseling (excluding FP) 9, , Adolescent health and youth development (AHYD) Population and development integration (POPDEV) Policy making, data collection, etc. 1, , Mixed PPMP services and activities TOTAL EXPENDITURES 13, , PPMP Expenditures by Use, 1998 and 2000 Source: Racelis and Herrin (2003) Outputs

35 Uses of Expenditures Sources of Expenditures, 2000 NGFAPsLGU Phil- Health Donors and CAsNGOsHHsTotal 1. RH/FP FP RH (excluding FP) AHYD POPDEV Policy & data collection Mixed Total Expenditures Percent Distribution of Total PPMP Expenditures by Strategy/Activity and by Source of Expenditures, 2000 Outputs

36 Age-specific birth rates (per 1,000 women) Age group 1973 NDS 1978 RPFS 1983 NDS 1986 CPS 1993 NDS 1998 NDHS Outcomes

37 Outcomes

38 PoorestSecondThirdFourthRichestMean Total fertility rate Age-specific fertility rate (15-19) Use of modern contraception (%) Fertility and contraceptive use: 1998 NDHS Source: Gwatkin, et al. (2000) Outcomes

39 Background characteristics 1993 NDS1998 NDHS Age Residence Urban Rural Education No education Elementary High school College or higher Total Teenagers who have begun childbearing, 1993 and 1998 Outcomes

40 Summary: Adolescent health and youth development Outcomes: Early childbearing and high fertility, especially among the poor. Utilization: Lack of information on services and their utilization. Outputs: Very little expenditures on AHYD. Current expenditures mainly coming from NGOs, suggesting that there is little public sector programs for AHYD.

41 Objective/ Strategy OutputsUtilization/ Intermediate Outcomes Outcomes Objective 4: To contribute to policies that will assist government to achieve a favorable balance between population distribution, economic activities, and the environment. Strategy 4: Integrate population variables, with emphasis on migration and urbanization, into development policies, plans and programs at all levels. (POPDEV)  Advocacy/IEC program on POPDEV integration  Training program on POPDEV integration  Program of research and conferences  Technical assistance program in place  Trained planners in selected provinces and cities.  Number of researches and conferences held  Number of LGUs receiving technical assistance  Integration of POPDEV in local development plans Population and Development Integration (POPDEV)

42 Use of Expenditures Amount (in million pesos) Percent Amount (in million pesos) Percent 1. Reproductive health/family planning (RH/FP) 12, , FP services and counseling 1, , RH services and counseling (excluding FP) 9, , Adolescent health and youth development (AHYD) Population and development integration (POPDEV) Policy making, data collection, etc. 1, , Mixed PPMP services and activities TOTAL EXPENDITURES 13, , PPMP Expenditures by Use, 1998 and 2000 Source: Racelis and Herrin (2003) Outputs

43 Uses of Expenditures Sources of Expenditures, 2000 NGFAPsLGU Phil- Health Donors and CAsNGOsHHsTotal 1. RH/FP FP RH (excluding FP) AHYD POPDEV Policy & data collection Mixed Total Expenditures Percent Distribution of Total PPMP Expenditures by Strategy/Activity and by Source of Expenditures, 2000 Outputs

44 Summary: POPDEV Outcomes: Not much expected if little activities are in place. Utilization: Not much expected if little activities are in place. Outputs: Not much activities during the period covered – 1998 to 2000 as reflected in the small expenditures for the POPDEV program.

45 Information gaps Reasonably updated data on FP use, source of supplies of modern methods, and fertility, but not so with infant, child and maternal mortality, and outcomes data on youth. Very limited utilization (intermediate outcomes) and outcomes data on the other components of RH. Limited disaggregation of utilization and outcomes indicators by major social groups, e.g., poor vs. non-poor. Limited disaggregation of expenditure data by major public/private and modern/traditional providers of RH/FP services. Limited indicators of utilization and outcomes for AHYD and POPDEV.

46 Future directions Greater effort at systematic development and application of POPDEV “tools” (data and analysis of interrelationships) to inform policy at both national and LGU levels. Monitoring of population welfare through a rights- based, gender and life cycle approach to ensure that gains in one stage of the life cycle are not lost in the next, or that disadvantages in one stage are adequately compensated in the subsequent stages.