1. Population Policy and Program Monitoring and Evaluation Alejandro N. Herrin and Aniceto C. Orbeta, Jr. May 20, 2003

2. 2 POPCOM and PIDS Project Reports Herrin, A. N., 2002, “Population Policy in the Philippines, 1969-2002”. Orbeta, A. C., Jr. et al., 2002, “Review of the Population Program: 1986-2002”. Racelis, R. H. and A. N. Herrin, 2003, “Philippine Population Management Program (PPMP) Expenditures, 1998 and 2000”. Herrin, A. N., A. C. Orbeta, Jr., F. del Prado, I. Acejo, and J. Cuenca, 2003, “An Evaluation of the Philippine Population Management Program” (in progress).

3. 3 Outline Part I: Population policy and program review, with attention to population growth and family planning, 1969-2002 Part II: Monitoring and evaluating the PPMP: a strategy, some results, and information gaps Part III: Some conclusions regarding future directions

4. 4 Part I: Population policy and program review, with attention to population growth and family planning, 1969-2002

5. 5 Population Policy and Program, 1969-2002 Marcos administration (1967-1986) –emphasis on negative consequences of rapid population growth –adopted FP that provided both information and services plus advocacy of a small family size norm Aquino administration (1986-1992) –emphasis on rights of couples to determine number of children –FP program emphasized maternal and child health

6. 6 Population Policy and Program, 1969-2002 Ramos administration (1992-1998) –recognized role of rapid population growth in constraining socioeconomic progress –adopted FP in the context of reproductive health Estrada administration (1998-2001) –FP to assist couples achieve desired fertility and promote health –contraceptive mix - scenarios to achieve faster reduction in fertility

7. 7 Population Policy and Program, 1969-2002 Arroyo administration (2001- ) –FP emphasizes objective of assisting couples to achieve desired fertility and promote health –FP program emphasis on promoting modern Natural Family Planning –Will not fund purchase of contraceptives for distribution to public health facilities in the event bilateral and multilateral donors stop providing supplies.

8. 8 Factors Influencing Population Policy International commitments e.g., International Conference on Population and Development (ICPD) Opposition of the Catholic Church hierarchy (especially on the promotion of artificial contraceptives) Views of the general public (national demographic surveys and opinion polls)? Views of partner GOs and NGOs?

9. 9 Some conclusions from the policy and program review Broaden population concerns but address the issue of rapid population growth and fertility reduction once and for all. Need for clear and consistent statements of national policy to guide national and LGU programs – need to forge a stable consensus. In formulating policy, consider also the views of partner GOs and NGOs, and the larger, albeit unorganized and silent constituency – the married couples with unmet needs for contraception.

10. 10 Some conclusions from the policy and program review There are opportunities for working closely with the Catholic Church and other groups in some areas of population policy and family planning.

11. 11 Part II: Monitoring and evaluating the PPMP: a strategy, some results, and information gaps

12. 12 Objective Strategy Outputs (services, capacity- building, advocacy, organizational support) Basic inputs Utilization (intermediate outcomes Outcomes (achievement of policy objective) Other factors Framework for PPMP Monitoring and Evaluation

13. 13 Objective/ Strategy OutputsUtilization/ Intermediate Outcomes Outcomes (Achievement of policy objective) 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 (available in outlets; wide range of methods)  Advocacy/ communication program  Training programs  Organizational support (planning, monitoring, evaluation, coordination, mobilize political support)  Contraceptive prevalence rate: total and by method mix  Percent of users by source of supply or service.  Unmet need for contraception  Total fertility rate: wanted and unwanted Responsible Parenthood and Family Planning (RP/FP)

14. 14 Source of expenditures 19982000 Amount (in million pesos)Percent Amount (in million pesos)Percent National government2,892.420.9 4,242.125.1 Foreign-assisted projects1,469.210.6 1,247.67.4 Local government2,725.419.7 3,567.621.1 Health Insurance (PhilHealth)633.74.6 1,497.98.9 Donors and CAs823.0 6.0 431.42.6 NGOs235.81.7 495.92.9 Households5,049.736.5 5,430.732.1 Total13,829.3100.0 16,913.2100.0 PPMP Expenditures by Source, 1998 and 2000 Source: Racelis and Herrin (2003)

15. 15 Use of Expenditures 19982000 Amount (in million pesos) Percent Amount (in million pesos) Percent 1. Reproductive health/family planning (RH/FP) 12,423.689.8 14,166.0 83.8 FP services and counseling 1,162.58.4 1,401.2 8.3 RH services and counseling (excluding FP) 9,203.166.5 11,157.6 66.0 2. Adolescent health and youth development (AHYD) 23.30.2 17.3 0.1 3. Population and development integration (POPDEV) 45.40.3 40.2 0.2 4. Policy making, data collection, etc. 1,247.09.0 2,351.2 13.9 5. Mixed PPMP services and activities 90.10.7 338.4 2.0 TOTAL EXPENDITURES 13,829.3100.0 16,913.2 100.0 PPMP Expenditures by Use, 1998 and 2000 Source: Racelis and Herrin (2003)

16. 16 Percent Distribution of Total PPMP Expenditures by Strategy/Activity and by Source of Expenditures, 1998 Uses of Expenditures Sources of Expenditures, 1998 NGFAPsLGU Phil- Health Donors and CAsNGOsHHsTotal 1. RH/FP 17.3 10.2 15.0 4.2 5.1 1.4 36.589.8 1.1 FP 0.7 0.2 1.6 0.0 1.6 0.4 3.98.4 1.2 RH (excluding FP) 16.1 0.1 13.5 4.2 0.0 0.1 32.666.5 2. AHYD 0.1 - - - - -0.2 3. POPDEV 0.1 0.3 - - - 0.0 -0.3 4. Policy & data collection 3.4 0.2 4.7 0.3 0.4 0.0 -9.0 5. Mixed 0.1 - - - 0.5 0.1 -0.7 Total Expenditures 20.9 10.6 19.7 4.6 6.0 1.7 36.5 100. 0

17. 17 Uses of Expenditures Sources of Expenditures, 2000 NGFAPsLGU Phil- Health Donors and CAsNGOsHHsTotal 1. RH/FP 17.4 7.2 15.4 7.8 2.1 1.8 32.1 83.8 1.1 FP 0.7 - 1.8 0.0 1.5 0.5 3.7 8.3 1.2 RH (excluding FP) 16.1 0.0 13.6 7.8 0.1 28.4 66.0 2. AHYD 0.0 - - - - 0.1 - 3. POPDEV 0.0 0.2 - - 0.0 - 0.2 4. Policy & data collection 6.9 - 5.7 1.0 0.3 0.0 - 13.9 5. Mixed 0.8 - - - 0.2 1.1 - 2.0 Total Expenditures 25.1 7.4 21.1 8.9 2.6 2.9 32.1 100.0 Percent Distribution of Total PPMP Expenditures by Strategy/Activity and by Source of Expenditures, 2000

18. 18 Sources of supply of modern methods Source of Supply NDS 1993 NDHS 1998 FPS 199520002002 Total percent100.0 Public Sector71.572.078.473.770.1 Government hospital32.622.726.525.423.6 RHU/UHC12.422.716.126.521.6 BHS25.023.933.819.622.1 BSPO/BHW1.51.92.02.22.6 Private26.526.317.924.728.5 Private hospital/clinic16.415.49.810.610.5 Private doctor2.61.91.5 1.3 Private nurse/midwife 0.3 0.40.3 Pharmacy/store7.58.56.611.616 NGO 0.1 0.50.3 Industry-based clinic 0.2 0.1 Other private1.71.41.91.1

19. 19 Sources: NDS 1968 to 1993 and NDHS 1998

20. 20 Sources: FPS, various years.

21. 21 Percent of Currently Married Women by Method, Poor and Non-Poor, 2000 and 2002 Type of Method 2000FPS2002 FPS PoorNon-PoorPoorNon-Poor Any method40.150.242.951.5 Any modern method26.335.029.537.6 Pill13.313.814.515.6 IUD3.03.43.83.6 Injection3.02.33.72.8 Condom0.81.61.31.8 Female sterilization5.113.25.813.3 Male sterilization0.10.2 0.1 Mucus/billings/ovulation 0.1 LAM0.90.40.30.2 Any traditional method13.915.113.413.9

22. 22 Percentage of currently married women with unmet need for family planning 1993 NDS1998 NHDS2002 FPS Total For Spacing For LimitingTotal For Spacing For LimitingTotal For Spacing For Limiting Total26.212.413.819.88.611.220.510.69.9 Residence Urban23.511.412.116.37.39.019.59.89.7 Rural29.113.615.623.39.813.421.511.410.2 Education No educ.33.618.415.228.414.014.5 Elem.29.811.618.123.98.115.8 H. S.25.613.512.118.79.19.6 College20.311.58.815.68.17.5

23. 23 Percentage of currently married women with unmet need for family planning 1993 NDS2002 FPS Total For Spacing For LimitingTotal For Spacing For Limiting Total26.212.413.820.510.69.9 Residence Urban23.511.412.119.59.89.7 Rural29.113.615.621.511.410.2 Education No educ.33.618.415.2 Elem.29.811.618.1 H. S.25.613.512.1 College20.311.58.8

24. 24 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 Total2.94.12.73.0 Residence Urban2.63.52.33.0 Rural3.34.83.34.7 Education No education4.04.93.95.0 Elementary3.75.53.35.0 High school2.93.92.73.6 College or higher2.42.82.52.9

25. 25 Objective/ Strategy OutputsUtilization/ Intermediate Outcomes Outcomes (Achievement of policy objective) 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 and family planning services (Available in outlets; wide range of methods)  Advocacy/ communication program  Training programs  Organizational support indicators (planning, monitoring, evaluation, coordination, mobilize political support) Utilization (coverage) rates of RH/FP services  Maternal mortality  Infant mortality  Child mortality Reproductive Health /Family Planning (RH/FP)

26. 26 MCHS 1999200020012002 Number of women ('000)5,0625,7864,7816870 Percent who received prenatal care94.293.994.694.1 Percentage who received from: Doctor44.745.541.345.4 Nurse/midwife49.449.954.050.3 Traditional birth attendant/hilot5.84.5 4.2 Others0.1*0.20.1 Percent who received Iron tablet/capsule78.678.581.182.2 Percent who received Iodine capsule58.964.564.4 Percent who received tetanus toxoid vaccine69.970.471.470.4 Note: * less than 0.1 percent Prenatal care, 1999-2002

27. 27 1993 NDS1998 NDHS2002 FPS Total No. of Children ('000) 8,803 7,5669,621 Doctor26.030.933.2 Midwife/nurse26.825.527.2 Hilot45.341.338.5 Poor Total No. of children (000) 3780 Doctor 13.0 Midwife/nurse 22.1 Hilot 63.0 Non-poor Total No. of children (000) 5840 Doctor 46.2 Midwife/nurse 30.6 Hilot 22.7 Percent of children 0-59 months by type of delivery attendant Percentage for “Others” not shown.

28. 28 MCHS 1999200020012002 All Women ('000)5062578647816870 Percent who received postnatal care63.160.064.571.0 Percentage who received from: Doctor47.551.747.1 Nurse/midwife37.537.139.9 Traditional birth attendant/hilot14.910.812.8 Type of service Abdominal exam55.355.458.456.9 Breast exam36.236.437.136.3 Internal exam30.234.630.235.9 Family planning advice40.840.342.240.6 Breastfeeding advice58.256.156.355.2 Baby care advice67.164.267.562.6 Check-up of baby77.877.979.578.2 Postnatal care, 1999-2002

29. 29 High risk fertility behavior, 1993 and 1998 Risk defined in terms of early ( 34) childbearing, short birth intervals ( 3)

30. 30 High risk fertility behavior, 1995 and 2002 FPS Risk Category Births in last 12 months preceding the survey Percentage of Births Percent of currently married women 1995 FPS Single risk category35.732.8 Multiple risk category24.848.2 In any high risk category60.581.0 2002 FPS Single risk category32.728.9 Multiple risk category23.648.7 In any high risk category53.677.6

31. 31 Infant, child and maternal mortality, 1970-1995

32. 32 Objective/ Strategy OutputsUtilization/ Intermediate Outcomes Outcomes (Achievement of policy objective) 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 (available in outlets? content?)  Advocacy/ communication program  Training programs  Organizational support indicators  Attendance in education and counseling programs  Coverage of advocacy and communication program  Age at marriage  Pregnancy rate among teenagers and youth age 15-19 and 20-24 years  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)

33. 33 Age-specific birth rates (per 1,000 women) Age group 1973 NDS 1978 RPFS 1983 NDS 1986 CPS 1993 NDS 1998 NDHS 15-19565055485046 20-24228212220192190177 25-29302251258229217210 30-34268240221198181155 35-39212179165140120111 40-441008978625140 45-492827201587

34. 34

35. 35 Background characteristics 1993 NDS1998 NDHS Age 150.5 161.31.6 173.65.0 1810.310.5 1919.021.3 Residence Urban4.84.7 Rural8.910.8 Education No education15.217.3 Elementary13.515.9 High school5.55.7 College or higher1.84.5 Total6.57.2 Teenagers who have begun childbearing, 1993 and 1998

36. 36 Objective/ Strategy OutputsUtilization/ Intermediate Outcomes Outcomes (Achievement of policy objective) 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  Technical assistance in managing urban settlements in place.  Technical and financial support to regional centers in place.  Support system in place (provision of dormitories and housing?)  Technical and vocational education in place  Enforcement system in place.  Trained planners in selected provinces and cities.  Number of researches and conferences held  Number of LGUs receiving technical assistance  Number of regional centers receiving technical and financial support.  Number of LGUS receiving technical assistance in managing urban settlements.  Number of migrants provided dormitory and housing (?)  Number of migrants provided technical and vocational education.  Number of environmental law violations seen or handled  Integration of POPDEV in local development plans  Improved management of urban settlements (?)  Rapid and balanced growth of regional growth centers (?) Population and Development Integration (POPDEV)

37. 37 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. Further disaggregation of utilization and outcomes indicators by major social groups, e.g., poor vs. non-poor. Further disaggregation of expenditure data by major public/private and modern/traditional providers of RH/FP services. Further development of indicators of utilization and outcomes for AHYD and POPDEV.

38. 38 Part III: Future directions

39. 39 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.

40. 40 Annex: Views of GOs and NGOs

41. 41 Views of partner GOs and NGOs Role of population growth in development. (88%) agree that a slower population growth is likely to confer greater net benefits than a faster population growth Role of government in fertility decision-making. About 42% agreed on the need to provide information and services to couples in order to assist them achieve their fertility goals; another 45% noted that fertility decisions of couples have external effects and that in addition to providing information and services, the government can be justified to advocate a small family size norm.

42. 42 Views of partner GOs and NGOs Family planning objectives. About 22% of believe that the objective of a FP program should be to help couples achieve their desired family size, while 75% said that in addition to the above goal, the FP program should also strive to reduce national fertility and population growth. Public sector FP service delivery. 93%, view that the government should promote a wide range of legal and medically safe methods from which couples can choose from to achieve their fertility goals; only 5% said that the government should promote only a preferred method, e.g., natural family planning.

43. 43 Views of partner GOs and NGOs Financing public sector family planning services. 79% said that the government should charge full cost to those who can afford and subsidize those who cannot; 17% want to subsidize all users. GO and NGO views. In all of the above areas of policy, government and NGO partner agencies expressed similar views. GOs constituted 74% of the total sample of 271 respondents.