Philippines: Family Planning and Maternal, Newborn, and Child Health Logistics Management and Stock Status Report, September 2011 (LIAT Results)

Publication date: 2011

� � Philippines: Family Planning and Maternal, Newborn, and Child Health Logistics Management and Stock Status Report, September 2011 LIAT Results NOVEMBER 2011 This publication was produced for review by the U.S. Agency for International Development. It was prepared by the USAID | DELIVER PROJECT, Task Order 1. Philippines: Family Planning and Maternal, Newborn, and Child Health Logistics Management and Stock Status Report, September 2011 LIAT Results The authors' views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the United States Government. USAID | DELIVER PROJECT, Task Order 1 The USAID | DELIVER PROJECT, Task Order 1, is funded by the U.S. Agency for International Development under contract no. GPO-I-01-06-00007-00, beginning September 29, 2006. Task Order 1 is implemented by John Snow, Inc., in collaboration with PATH; Crown Agents Consultancy, Inc.; Abt Associates; Fuel Logistics Group (Pty) Ltd.; UPS Supply Chain Solutions; The Manoff Group; and 3i Infotech. The project improves essential health commodity supply chains by strengthening logistics management information systems, streamlining distribution systems, identifying financial resources for procurement and supply chain operations, and enhancing forecasting and procurement planning. The project also encourages policymakers and donors to support logistics as a critical factor in the overall success of their health care mandates. Recommended Citation USAID | DELIVER PROJECT, Task Order 1. 2011. Philippines: Family Planning and Maternal, Newborn, and Child Health Logistics Management and Stock Status Report September 2011. Arlington, Va.: USAID | DELIVER PROJECT, Task Order 1. Abstract A logistics system and stock status survey was conducted in 2011 to provide the Department of Health, U.S. Agency for International Development/Philippines, and other stakeholders with information on the availability of family planning and maternal, newborn, and child health commodities and logistics information at provincial- and municipal-level facilities. This report presents the findings of the assessment as well as recommendations to improve the contraceptive logistics systems in the Philippines. USAID | DELIVER PROJECT John Snow, Inc. 1616 Fort Myer Drive, 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 E-mail: askdeliver@jsi.com Internet: deliver.jsi.com � � � � � � � � � � � � � � � � Contents Acronyms. v Acknowledgments . vii Executive Summary . ix Background. 1 Assessment Purpose and Objectives . 3 Assessment Methodology . 5 Assessment Findings. 11 Product Management . 11 Conclusions and Recommendations . 37 Strengthen Stock Management Practices .37 Reference. 39 Appendices A. Complete Sampling List . 41 B. Additional Tables . 55 C. Logistics Indicator Assessment Tool (LIAT).81 D. List of Field Researchers . 111 Figures 1. Availability of Family Planning Products Managed at Facilities on the Day of Visit by Facility Types . 12 2. Availability of Maternal, Newborn, and Child Health Products Managed at Facilities on the Day of Visit by Facility Types . 13 3. Use of Forms to Manage Health Products by Facility Types* . 18 4. Personnel Trained in Completion of Forms/Records by Facility Types* .19 5. Decision Level for Total Quantity of Family Planning Products Requested for Service Delivery Points by Type* . 20 6. Decision Level for Total Quantity of Family Planning Products Service Delivery Points Receive by Type* . 20 7. Ways Facility Resupply Quantity is Determined . 21 8. Frequency of Ordering Family Planning Products. 21 9. Period of Waiting between Ordering and Receiving Family Planning Products .22 10. Placement of Emergency Orders . 22 11. Recent Supervision Containing Drug Management . 23 12. Responsibility for Transporting Family Planning Products to Service Delivery Points .24 13. Types of Transportation Used for Delivering Products to Service Delivery Points .24 14. Availability of Long-Acting and Permanent Family Planning Methods at Service Delivery Points .26 15. Reasons for Lack of Service at Service Delivery Points . 27 iii � � � � � � � � � � � � � � � � � � � � 16. Percentage of Facilities Meeting Acceptable Storage Condition . 28 17. Sources of Supply for Rural Health Units by Funding Type . 31 18. Sources of Supply for Hospitals by Funding Type.31 19. Primary Source of Supply by Facility Type . 32 20. Involvement of the Provincial Health Offices with Municipalities . 33 21. Determining Quantity of Family Planning Products for Reordering .34 22. Sources of Funding for Family Planning Products (Provincial Level)* .34 23. Main Source of Supply for Family Planning Products (Provincial Level) .35 Tables 1. Partial Sampling Frame. 6 2. List of Indicators. 7 3. Products Managed at Facilities . 11 4. Availability of Family Planning and Maternal, Newborn, and Child Health Products by Facility .14 5. Utilization of Stock Control Cards to Manage Family Planning Products by Facility Types .15 6. Utilization of Stock Control Cards to Manage Maternal, Newborn, and Child Health Products by Facility Types. 15 7. Updated Stock Cards for Family Planning Products Managed by Facility Types .16 8. Updated Stock Cards for Maternal, Newborn, and Child Health Products Managed by Facility Types . 16 9. Job Title of Primary Person Responsible for Management of Products by Service Delivery Point Type . 17 10. Stockouts in Previous Six Months According to Respondents .25 11. Common Reasons for Stockouts in Previous Six Months According to Respondents .26 12. Percentage of Facilities Meeting Individual Storage Conditions . 29 13. Percentage of Facilities Meeting Cold Chain Conditions . 29 14. Any and Primary Source(s) of Funding Used to Procure Family Planning Products .30 15. Availability of FP Products on the Day of the Visit by Facility Type . 55 16. Availability of MNCH Products on the Day of the Visit by Facility Type .55 17. Family Planning Products Managed at Facilities by Province . 57 18. Availability of Family Planning Products on the Day of Visit at Facilities by Province .63 19. Maternal, Newborn and Child Health Products Managed at Facilities by Province .69 20. Availability of Maternal, Newborn and Child Health Products on the Day of Visit at Facilities by Province. 75 iv Acronyms BTL Bilateral tubal ligation CHD Center for Health Development COC combined oral contraceptive CPR contraceptive prevalence rate CSR contraceptive self-reliance DOH Department of Health DPMA depo-medroxy progesterone acetate (Depo-Provera) FEFO first-to-expire, first-out FP family planning FPCMS Family Planning Commodity Monitoring Tool IUD intrauterine device LIAT Logistics Indicators Assessment Tool LGU Local Government Unit MNCH maternal, newborn, and child health MNCHN maternal, newborn, and child health and nutrition NDHS National Demographic and Health Survey ORS oral rehydration salts PHO provincial health office POP progestin-only pills RHU rural health unit SDP service delivery point SIMS Stock and Inventory Management System UNFPA United Nations Populations Fund USAID U.S. Agency for International Development v vi Acknowledgments We would like to thank the people at the Department of Health (DOH) for their support of this assessment, especially Dr. Eduardo C. Janairo, Dr. Honorata Catibog, and Dr. Florence Apale of the National Center for Disease Prevention and Control. We also thank Charito Remata-Redoblado, Ma. Victoria Dagohoy, and Helen J. Hipolito from the U.S Agency for International Development (USAID)/Philippines for their time and efforts. Many thanks go to the IMS Health/Philippines staff, especially Ruth Joy Natividad, Anna P. Sanchez, and Maria Alona Manaog-Reyes for their time before, during, and after the assessment as well as their team of field collectors and supervisors who helped make this study possible. In addition, thanks go to USAID |DELIVER PROJECT staff member Ariella Bock for her support of the survey, and for the analysis and report writing; and to project staff members Paul Dowling and Jaya Chimnani for their assistance and input during the startup of the study and technical review of the findings. We acknowledge all of the provincial health office staff members including the provincial family- planning (FP) coordinators, municipality maternal and child health and FP supervisors, store personnel, and service providers who took the time out of their schedules to sit down and talk with the field teams. Thanks also go to all of the stakeholders for sharing the valuable information, opinions, and perspectives that went into informing the assessment, and for showing us around their facilities. Finally thank you to U.S Agency for International Development (USAID) for it continuous support and assistance. We hope that this report will contribute to improving the reproductive health commodity security situation in the Philippines. vii viii Executive Summary The Philippines, as of 2011, has an estimated population of 96 million and an average annual growth rate of 1.9 percent (PRB, 2011). The total fertility rate (TFR) in the Philippines has steadily declined since the mid-1970s, from 6.0 children per woman to 3.3 children per woman in 2006. However, according to the 2008 National Demographic and Health Survey (NDHS), fertility varies substantially across residence types, where urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. Fertility also decreases with household wealth, where women in wealthier households have fewer children than those in poorer households (1.9 children in the wealthiest quintile compared with 5.2 children in the lowest) (NDHS, 2009). According to the 2008 NDHS, the contraceptive prevalence rate (CPR) among currently married women was 51 percent. Despite the remarkable increase in CPR from 17 percent in 1973 to 40 percent in 1993, and women’’s expressed desire to space or limit childbearing, the use of modern methods has only increased by 9 percentage points in the past 15 years and only three-quarters of a percent since the 2003 NDHS. Conversely, the level of unmet need increased from 17 percent in 2003 to 22 percent in 2008. In 1991, with the passage of the Local Government Code and the implementation of the policy of ““devolution,”” municipalities were given the power to plan, implement, and manage all population and development programs. Municipalities were encouraged to deliver primary health care, while the central, regional, and provincial health offices continued to provide supportive and enabling measures including setting standards of care, training of health service providers, procurement and delivery of drugs and equipment, monitoring and supervision, as well as managing secondary and tertiary levels of care. Starting in 2004, with the anticipated shortfall of family planning (FP) commodities brought about by the 2001 policy for the phasing out of donated contraceptive commodities, the Department of Health (DOH) began to implement the Contraceptive Self- Reliance (CSR) strategy. Under this strategy, municipalities were to assume the primary responsibility for assuring that sufficient quantities of contraceptives were available for free to the poorest users, thus ending the central government’’s role of distributing externally donated commodities. One of the challenges for CSR is that due to the decentralization of responsibility for procurement and logistics management to the municipalities, there are little data as to the availability of contraceptives at the municipality level, including whether products are provided for free or at a cost. The purpose of this study was to gather current information on national stock status of all contraceptive and selected maternal and child health commodities at the facility level, as well as to identify current commodity management practices throughout the system. The study was conducted in 224 municipalities within 33 provinces/independent cities. The study sample, calculated for a 5 percent margin of error and 90 percent confidence interval, included both randomly selected rural health units (RHUs) within selected provinces and a purposeful selection of hospitals in all three island groups. In addition, all provincial/independent city warehouses, where available, were included. Data was collected using the Logistics Indicators Assessment Tool, which was adapted specifically for the Philippines context and used to assess all contraceptives and selected maternal, newborn, and child health (MNCH) products through conducting physical inventory, observations, and interviews. Data was collected by Nokia E63 mobile phones using EpiSurveyor ix mobile, a mobile application designed by DataDyne, which facilitates transfer of data through pre- sent forms on smart phones and enables transmission of data from the phones directly to the Internet. Key Findings This study found that the products managed at facilities and warehouses varied between provinces and municipalities. Combined oral contraceptives (COC), depo-medroxy progesterone acetate, or DMPA (brand name: Depo-Provera), and intrauterine devices (IUDs) were the most common managed FP products, while oral rehydration salts were the most common MNCH product. Surprisingly, many hospitals, however, did not manage any of the FP or MNCH products being assessed or provide any FP services such as performing permanent method procedures. Lack of training was cited as the primary reason for the lack of services. Product availability on the day of the visit was relatively low: almost a quarter of all facilities were stocked out of any of the 14 products being assessed that they reported as managing. Those products include the following: 64 percent were stocked out of amoxicillin; 35 percent were stocked out of DMPA; and 30 percent were stocked out of COC and condoms. These figures are actually much higher when one assumes the products should actually be managed at the facilities. The study also confirmed that the practice of maintaining stock cards, which is the first step in inventory management, is essentially non-existent regardless of facility levels (warehouse, hospital, or RHU) or type of product (FP vs. MNCH). As a result, it was not possible to calculate key logistics indicators such as frequency of stockouts, average length of stockouts, average monthly consumption, or month of stock on hand. However, interviews with providers confirmed frequent occurrences of FP product stockouts, with the average length of stockout being three months or more. Most facilities reported using some type of record to manage health commodities, primarily dispense-to-user records; however, few were taught to complete them in a formal setting such as a logistics workshop. Reports of supportive supervision visits within the previous six months that included drug management were common. The study also found that a functioning FP logistics management system is essentially non-existent within the municipalities. Procurements occur on relatively ad hoc basis, with a lead time between placing the order and receiving ranging from less than two week to more than two months. Availability of funding or previous consumption appear to be the primary driving factors in terms of determining amounts to order; forecasting is not used to quantify demand. Additionally, storage conditions were generally poor with 50 percent of provincial warehouses and 41 percent of RHUs having below average scores. Mechanisms for funding varied among municipalities, though there does not seem be any correlation between funding mechanism and type of vendor. Recommendations Key recommendations include the following: x Review and strengthen current maternal, newborn and child health and nutrition (MNCHN)grants guidelines in terms of what the grant can be used for and how to qualify for it. Additionally, guidelines should be disseminated to the municipal and service delivery point level so that all those involved with procurement are aware of the benefits of the MNCHN grants. x x Review the current roles and responsibilities of level one and two hospitals; the roles and responsibilities should include guidance on the products that should be managed and services provided at the facilities. In addition, hospital-based providers should also receive training for how to perform all long-acting and permanent FP methods (i.e., IUD insertions, bilateral tubal ligation (BTL), and vasectomy) as these procedures are not necessarily intended to be performed at most RHUs but should be available at all hospitals. x Help strengthen stock management by providing continued support to allow HealthGov to further expand and implement both the paper based and electronic versions of the Stock and Inventory Management System, which is designed to help local government units track expendable commodities in health facilities, especially drugs and medical supplies in additional provinces. x Provide continued support for the roll-out of the Family Planning Commodity Monitoring Tool: given the decentralized supply chain for FP, and the need for policymakers to monitor how municipalities are meeting their responsibilities to maintain commodity availability, continued support should be provided . Centers for Health Development and provincial health offices should be encouraged to conduct quarterly supportive supervision visits and submit results to the appropriate level in a timely fashion. Additional training might be necessary to strengthen supportive supervision and routine monitoring of drug management. x Provide training on guidelines and/or reminders such as posters to help address issues with maintaining proper storage conditions to storeroom managers, particularly those at the provincial warehouses. x Consider implementing a mixed system for procurement to take advantage of the benefits of decentralization while negotiating and managing overarching contracts centrally that provide suppliers with minimum volume guarantees and help facilitate access to lower prices. x Encourage the use of forecasting demand to help enable more accurate procurements. xi xii Background The Philippines, as of 2011, has an estimated population of 96 million and an average annual growth rate of 1.9 percent (PRB, 2011). The total fertility rate (TFR) in the Philippines has steadily declined since the mid-1970s, from 6.0 children per woman to 3.3 children per woman in 2006. However, according to the 2008 National Demographic and Health Survey (NDHS), fertility varies substantially across residence types, where urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. Fertility also decreases with household wealth, where women in wealthier households have fewer children than those in poorer households (1.9 children in the wealthiest quintile compared with 5.2 children in the lowest) (NDHS, 2009). According to the 2008 NDHS, the contraceptive prevalence rate (CPR) among currently married women was 51 percent. Of the 34 percent of women using a modern method, the most common were pills (16 percent), followed by female sterilization (9 percent). Another 17 percent were using a traditional method, including periodic abstinence (rhythm) and withdrawal. Despite the remarkable increase in CPR from 17 percent in 1973 to 40 percent in 1993, and women’’s expressed desire to space or limit childbearing, the use of modern methods has only increased by 9 percent in the past 15 years and only three-quarters of a percent since the 2003 NDHS. Conversely, the level of unmet need has increased from 17 percent in 2003 to 22 percent in 2008.1 In 1991, with the passage of the Local Government Code and the implementation of the policy of ““devolution,”” municipalities were given the power to plan, implement, and manage all population and development programs. Municipalities were encouraged to deliver primary health care, while the central, regional, and provincial health offices continued to provide supportive and enabling measures including setting standards of care, training of health service providers, procurement and delivery of drugs and equipment, monitoring and supervision, as well as managing secondary and tertiary levels of care. Starting in 2004, with the anticipated shortfall of family planning (FP) commodities brought about by the 2001 policy for the phasing out of donated contraceptive commodities, the Department of Health (DOH) began to implement the Contraceptive Self- Reliance (CSR) strategy. Under this strategy, municipalities were to assume the primary responsibility for assuring that sufficient quantities of contraceptives were available for free to the poorest users, thus ending the central government’’s role of distributing externally donated commodities. However, recognizing that some municipalities were not in the position to acquire all essential medicine including FP commodities, the central government did not completely withdraw from procuring medicine and commodities. Instead, two different kinds of supply chains for health commodities in the Philippines have been created: one for supplies procured directly by municipalities, and one for priority ““program commodities,”” which are supplied directly by the DOH or another partner. Program commodities are intended for DOH priority programs, including those for tuberculosis and maternal, newborn, and child health and nutrition (MNCHN), where DOH funding or direct commodity support is available to supplement or replace municipality support from their own budget funds. 1 Unmet need for family planning is defined as “the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any family planning method” (Rutstein, 2006). 1 One of the challenges for CSR is that due to the decentralization of responsibility for procurement and logistics management to the municipalities, there are little data as to the availability of contraceptives at the municipality level, including whether products are provided for free or at a cost. Municipalities have little or no incentive to report logistics data, and no system exists for them to do so; service statistic data on client numbers are considered poor quality, and there is no systematic monitoring of product availability. To address this, the DOH, with support from the U.S. Agency for International Development (USAID) through HealthGov and the USAID | DELIVER PROJECT, began implementing a system, using the Family Planning Commodity Monitoring Tool, in 2010 which, if successful, will generate routine data on commodity availability. Meanwhile, there is a need to generate data in the short-term on key logistics indicators to assess how municipalities are doing in CSR and help determine future priorities and direction for the DOH and other stakeholders, particularly in light of the possible reintroduction of central DOH procurement. 2 Assessment Purpose and Objectives The purpose of this assessment was to gather current information on national stock status of all contraceptive and selected maternal and child health commodities at the facility level, as well as to identify current commodity management practices throughout the system. The information was also used to inform recommendations to improve commodity availability. The information provides program planners and managers, particularly the DOH and USAID, with current information on—— x Management and stock status of contraceptive methods and selected maternal and child health products x Logistics practices at municipalities including maintenance of logistics records and storage conditions logistics capacity of personnel x Sources of financing and procurement of family planning products. . 3 4 Assessment Methodology The Logistics Indicators Assessment Tool (LIAT), a standardized tool developed by the DELIVER Project, the predecessor to the USAID | DELIVER PROJECT, and applied in many countries around the world, was used in this study. The tool assesses health commodity system performance and commodity availability at health facilities, and provides stakeholders with up-to-date information on the current operating systems for commodities management. For the purposes of this survey, the instrument was adapted specifically for the Philippines and used to assess all contraceptives and selected maternal, newborn, and child health (MNCH) products. A copy of the final LIAT used for the purposes of this survey is attached as Appendix C. The USAID |DELIVER PROJECT partnered with IMS Health, an internationally recognized organization with a strong presence in the Philippines and knowledge of the Filipino health system, to carry out the survey. A list of field researchers who carried out the survey can be found in Appendix D. Data was collected through observations, conducting physical inventory, and conducting interviews with provincial/independent city-level FP coordinators, facility-level FP supply managers, and facility-level personnel responsible for providing FP products to clients. In order to ensure entrance into the facilities, a letter from the DOH was circulated, which was followed up by direct contact with the provincial and municipality health offices to provide them with background information on the purpose and objectives of the assessment. Visits to facilities were also scheduled in advance. Sample Frame The study was conducted in 224 municipalities within 33 provinces/independent cities. The study sample, calculated for a 5 percent margin of error and 90 percent confidence interval, included both randomly selected rural health units (RHUs) within selected provinces and a purposeful selection of hospitals in all three island groups.2 In addition, all provincial/independent city warehouses, where available, were included. In the first stage of sampling, 77 provinces and independent cities where USAID supported projects under Strategic Objective 3 were divided into six geographical groups. In the second stage, 26 provinces and 7 independent cities were selected based on probability proportional to size determined by the number of municipalities in each province. (Independent cities were considered as one province.) In the third stage, 225 municipalities were randomly selected based on the probability proportional to size results, thus entailing a larger representation of municipalities from the provinces with a higher number of municipalities. The sample of provinces and municipalities was slightly adjusted based on political, logistical, and geographical considerations. 2 Information on the total number of RHUs and locations within the country was unavailable at the time of sampling. Therefore, for purposes of calculating sample size based on total number of municipalities, two key assumptions were made: • There would only be one RHU in most municipalities. • In situations where there was more than one RHU in the local government unit, availability of commodities and any logistic system would be similar enough that only one RHU would be selected. 5 One hospital per province or independent city was also selected for the sample. As it was assumed that higher levels were less likely to be providing outpatient FP services or stocking FP commodities, only level one and two hospitals were eligible for inclusion. In provinces that had both level one and two hospitals, preference was given to the lower level. In the independent cities without level one or two hospitals, a hospital was selected from the surrounding province. The final sample size included 224 municipalities with one RHU in each, 33 hospitals, and 31 provincial/independent city warehouses for a total sample size of 288 facilities. It should be noted that researchers were denied access to one facility in Bohol so actual sample size was 223 RHUs, 33 hospitals and 31 warehouses. For a complete sampling list, please refer to Appendix A. (See table 1for a partial sample frame.) Table 1. Partial Sampling Frame Groups Region Province No. of RHU No. of Hospitals Warehouse Cordillera Administrative Region (CAR) Benguet 7 1 Yes Ilocos Region (Region I) Pangasinan 9 1 Yes Cagayan Valley (Region II) Cagayan 5 1 Yes Cagayan Valley (Region II) Isabela 7 1 Yes 1 Central Luzon (Region III) Angeles City 1 1 Yes Central Luzon (Region III) Bulacan 9 1 Yes Central Luzon (Region III) Pampanga 8 1 Yes National Capital Region (Manila) Marikina City 1 0 No CALABARZON (Region IV-A) Batangas 6 1 Yes CALABARZON (Region IV-A) Laguna 9 1 Yes CALABARZON (Region IV-A) Lucena City 1 1 Yes 2 CALABARZON (Region IV-A) Quezon 8 1 Yes Bicol Region (Region V) Camarines Sur 14 1 Yes Bicol Region (Region V) Sorsogon 6 1 Yes Western Visayas (Region VI) Bacolod City 1 0 No Western Visayas (Region VI) Iloilo 9 2 Yes 3 Western Visayas (Region VI) Iloilo City 1 0 Yes Western Visayas (Region VI) Negros Occidental 13 2 Yes Central Visayas (Region VII) Bohol 13 1 Yes Central Visayas (Region VII) Cebu 8 1 Yes Central Visayas (Region VII) Cebu City 1 1 Yes 4 Eastern Visayas (Region VIII) Leyte 11 1 Yes Eastern Visayas (Region VIII) Samar 5 1 Yes Eastern Visayas (Region VIII) Tacloban City 1 1 Yes 5 Zamboanga Peninsula (Region IX) Zamboanga del Norte 8 1 Yes Zamboanga Peninsula Zamboanga del Sur 9 1 Yes 6 Groups Region Province No. of RHU No. of Hospitals Warehouse (Region IX) Northern Mindanao (Region X) Bukidnon 8 1 Yes Northern Mindanao (Region X) Davao Region (Region XI) Davao Region (Region XI) Caraga Region (Region XIII) Misamis Oriental Compostela Valley Davao del Sur Agusan del Norte 5 6 6 6 2 1 1 1 Yes Yes Yes Yes 6 Autonomous Region of Muslim Mindanao (ARMM) Autonomous Region of Muslim Mindanao (ARMM) Tawi-Tawi Lanao del Sur 8 15 1 1 Yes Yes Indicator Choice A set of indicators was selected to provide a broader measurement of stock status and operating systems. The indicators can be used for comparison with future assessments, and they also provide stakeholders with up-to-date information on the current situation. Table 2. List of Indicators Indicator Data Source(s) 1. Percentage of facilities with availability of product at time of visit Stock card records, respondent, and physical inventory 2. Percentage of facilities with stock cards available for managing contraceptives* Presence of stock cards for each of the selected products 3. Percentage of facilities with stock cards updated by product Stock cards for each of the selected products 4. Percentage of facilities with accurate logistics records Stock cards, family planning register, tally sheet, stock control book 5. Percentage of sites stocked out of product in last six months Stock card records 6. Average number of days stocked out in six months Stock card records 7. Percentage of personnel trained in product management and type of training received Respondent 8. Percentage of facilities receiving supervision within a reasonable amount of time Respondent 9. Percentage of transportation type used for logistics management Respondent 10. Percentage of storage facilities that met selected storage conditions Observations of data collectors on the day of the visit 11. Percentage of municipalities using their own budget to procure family planning products Respondent *For purposes of this assessment, a “stock card” was defined as any type of record at the facility that recorded the following: product name, stock/quantity on hand, total issued, and total received by dates. This could include a log book or tally sheet. 7 Data Collection Data collection took place over the course of eight weeks, from March 29 through May 13, 2011. A total of 20 data collectors were dispatched to different provinces for an eight-week period to collect data from the selected health facilities. Data was collected by Nokia E63 mobile phones using EpiSurveyor mobile, a mobile application designed by DataDyne that facilitates transfer of data through pre-sent forms on a smart phones and enables transmission of data from the phones directly to the Internet. Before implementing the survey, field researchers participated in a five-day training course in Manila on the use of the LIAT instrument and using EpiSurveyor. As part of the orientation, data collection guidelines were discussed to identify the types of information to be gathered, to standardize the data collection process, and to promote comparability of results. Input from the field researchers was integrated into the survey tool, which was then pilot tested in five health facilities and one hospital in the metro Manila area. After the pilot test, modifications were made to the tool prior to its use in the assessment. Data Management and Analysis Records were uploaded directly from smart phones to the web-based EpiSurveyor database, where IMS Health staff inventoried, cleaned, and validated the records throughout the data collection period. Data cleaning and validation continued for two weeks following the completion of data collection. Some problems encountered during this process included receipt of duplicate records and failure of transmission of some records due to poor connectivity. The format of records received in EpiSurveyor allowed for easy transferring of data to Microsoft Excel. However, additional steps were required to format records for analysis in other packages such as SPSS. Analysis of the data was conducted in SPSS. For purposes of analysis, ““not applicable”” and ““missing”” responses were removed from the denominators. Results are disaggregated by type of facility (i.e., warehouse, hospital, and RHU). Quality Assurance Several methods were used to ensure quality adherence throughout the assessment process. The data collection instrument was reviewed before the training to ensure it was adapted to the current situation; the instrument was reviewed and modified again following a pilot test during the training, with input from data collectors. The training also included a comprehensive review of the tool to ensure data collectors were fully versed in the questions and methodology prior to field data collection. Each team consisted of one group leader and five field researchers. The group leader’’s responsibility was to check on the execution and accuracy of data entry on the mobile phones by observation of each field researcher. If the group leader was not able to accompany the field researcher during the actual visit, the group leader visited the facility to back check the work of the researcher. A back- checking team was also set up in Manila to call respondents in order to check the consistency of answers versus the encoded data, as well as to verify whether an interview and stock status took place in the facility. Several quality safeguards were incorporated into the data entry program, such as automatic skips where appropriate, range checks, and coding checks. A validating team was set up to manually ““edit”” 8 encoded data by checking consistency and completeness of answers. Those considered re-asks were sent back to the field team for verification. After data were entered into the SPSS database, quality checks and validation were completed to ensure accuracy of the database. Preliminary analyses and frequencies were run prior to full data analysis to ensure consistency within the database. Limitations There are several limitations of the survey: x As the sample size was calculated for the national level based on total number of municipalities, individual provincial level and hospital analysis is not representative. Therefore, one should be cautious when interpreting individual provincial and hospital level results. x During the month of April, data collection coincided with a national measles vaccination campaign. As a result, some interviews were conducted with staff who were only at the facility on a temporary basis or had only been there for a short period of time and were not necessarily very familiar with ordering, procedures, or what sources for funding and/or supplies were being used. x Due to limited availability of updated stock cards at facilities, it was not possible to calculate key logistics indicators such as frequency of stockouts, average length of stockouts, average monthly consumption, or months of stock on hand. Questions were included in the interview section to capture stockout information on four FP products. However, responses are subject to recall bias and could not be verified through stock cards. 9 10 Assessment Findings Product Management In this survey, stock status assessment was conducted for seven different family planning (FP) products, including both short and long term methods and seven maternal, newborn and child health (MNCH) products, selected based on discussions with key stakeholders, in particular the DOH. Because of the nature of decentralization and the ability for each municipality to select which products to maintain, it was expected that not all products would be managed in all facilities or provincial/independent city warehouses. A product was considered to be ““managed”” if it had been stocked in the facility in the previous year (i.e., from January 2010 and beyond). Table 3 shows the distribution of FP and MNCH product management by types of facilities. Table 3. Products Managed at Facilities Rural Health Units (%) (n = 223) Hospitals (%) (n = 32)* Warehouses (%) (n = 30)* FP Products Combined oral pills 96 (216) 22 (7) 97 (29) Cycle beads 52 (116) 3 (1) 57 (17) DMPA (e.g Depo Provera©) 95% (212) 19% (6) 97% (29) Intrauterine devices (e.g., Copper T Model TCu380A) 80 (180) 13 (4) 97 (29) Male condom 89 (200) 16 (5) 83 (25) One-month injectable (e.g., Norifam©) 8 (18) — 17 (5) Progestin-only pills 26 (59) 6 (2) 43 (13) MNCH Products Amoxicillin suspension (125 mg/5 mL) 61 (136) 34 (11) 40 (12) Amoxicillin tablet (250 mg) 61 (137) 28 (9) 53 (16) Ferrous sulfate tablet (ferrous sulfate 200 mg + 250 mcg folate) 52 (117) 22 (7) 50 (15) Magnesium sulfate (500 mg/mL) 12 (26) 22 (7) 13 (4) Mebendazole tablet (500 mg) 49 (109) 34 (11) 33 (10) Oral rehydration salts sachets 88 (196) 59 (19) 73 (22) Oxytocin (any formulation) 58 (131) 72 (23) 60 (18) *One hospital and one warehouse refused field researchers access to the storeroom Note: Actual numbers of facilities that managed the product are presented in parentheses. These numbers are the denominators for figure 1 and figure 2. 11 � � � � As shown in table 3, RHUs managed a greater variety of products as compared to hospitals. Combined oral contraceptives (COCs), depo-medroxy progesterone acetate (DMPA), and intrauterine devices (IUDs) are the three most common FP products managed in all types of facilities, while oral rehydration salts (ORS) were the most common MNCH product. However, very few hospitals managed any FP products. In fact, 45 percent (15 of 33) did not manage any of the FP products. Additionally, three hospitals did not manage any of the MNCH products. Stock Availability For those products that the facility reported managing, a physical count of the products was conducted to determine whether products were available or if the facility was experiencing a stockout on the day of the visit. Figure 1 and figure 2 present the stock availability findings on the day of the visit for the products assessed in the survey and managed by the facilities. (See table 15 and table 16 in Appendix B for results in table form.) On the day of visit, field researchers found some degree of variability in contraceptive availability. Of the 18 hospitals that actually managed any of the FP products, most generally had the product in stock. On the other hand, stockouts of managed products at the RHUs and warehouses were commonly found. Of the facilities that managed the commodity, only 70 percent of RHUs (177 of 252) and 69 percent of the warehouses (20 of 29) had COCs in stock on the day of visit; 51 percent of RHUs (30 of 59) and 54 percent of the warehouses (7 of 13) had progestin-only pills (POP) available on the day of visit. Additionally, only 66 percent of RHUs (140 of 212) and 48 percent of warehouses (14 of 29) had stocks of DMPA, while male condoms were only available in 70 percent of the RHUs (140 of 200) and 64 percent of warehouses (16 of 25). IUDs, for the most part, appeared to be relatively available, with 86 percent of the RHUs (154 of 180) and 72 percent of warehouses (21 of 29) having the product in stock. Figure 1. Availability of Family Planning Products Managed at Facilities on the Day of Visit by Facility Types 56 66 86 70 51 78 70 0 20 40 60 80 100 COCs Cycle beads DMPA IUDs Male condom Norifam POP Family planning products Pe rc en t o f f ac ili tie s RHUs Hospitals Warehouse Note: Hospital-level results should be interpreted with caution as the value for the denominator (i.e., n =) is a maximum of seven. COCs=combined oral contraceptives; DMPA=depo-medroxy progesterone acetate; IUDs= intrauterine devices; POP= Progestin-only pills 12 � � � � � � � � � � � � � Am x. su sp en sio n Am x. tab let Fe rro us su lfa te Ma gn esi um Me be nd azo le OR S Ox yto cin Similarly, although more frequently managed at hospitals, stockout rates for MNCH products were equally high. Despite being one of the most common products reported managed at facilities, only 65 percent of RHUs (127 of 196), 63 percent of hospitals (12 of 19), and 50 percent of warehouses (11 of 22) actually had ORS available on the day of visit. Similarly, less than 70 percent of facilities (82 of 117 RHUs, 2 of 7 hospitals, and 8 of 15 warehouses) had ferrous sulfate available. Oxytocin was also frequently available, with stock found at 63 percent at RHUs (82 of 131) and 83 percent at hospitals (19 of 23) (Figure 2). Figure 2. Availability of Maternal, Newborn, and Child Health Products Managed at Facilities on the Day of Visit by Facility Types RHUs Hospitals Warehouse 100 90 80 70 60 50 40 30 20 10 0 Pe rc en t o f f ac ili tie s 6365 39 27 70 3536 Maternal, newborn and child health products Note: Amx=Amoxicillin; ORS= oral rehydration salts. Although it was expected that not all products would be managed in all facilities or provincial/independent city warehouses, ideally, all the products should be. Therefore, when including facilities that have not managed the product within the previous year, actual availability of commodities at facilities within the country is considerably lower. As shown in table 4, over one- third of all RHUs would not be able to provide a client with a choice of the full range of most common short-term contraceptive methods (COC/POP, DMPA, or male condoms). Similarly, despite being on the DOH Integrated Management of Childhood Illness essential drug list, most RHUs and hospitals would not be able to treat a child with amoxicillin for pneumonia or ORS for dehydration due to diarrhea if one was brought into the facility on the same day as the survey visit. 13 � Table 4. Availability of Family Planning and Maternal, Newborn, and Child Health Products by Facility Rural Health Units Hospitals Warehouses Of facilities “managing products” (%) Of all facilities (%) (n = 224) Of facilities “managing products” (%)* Of all facilities (%) (n = 32) Of facilities “managing products” (%)* Of all facilities (%) (n = 30) Family Planning Products Combined oral contraceptives 70 67 (6/7) 19 69 67 Cycle beads 78 41 (1/1) 13 64 53 Depo-Provera 66 63 (3/6) 3 65 37 IUDs 86 69 (4/4) 9 48 47 Male condom 70 63 (4/5) 13 72 70 One-month injectable 56 4 (0) 0 (2/5) 7 Progestin-only pills 51 13 (1/2) 3 54 23 Maternal, Newborn and Child Health Products Amoxicillin suspension 34 21 (7/9) 25 50 27 Amoxicillin tablet 36 22 73 22 50 20 Ferrous sulfate 70 37 (2/7) 6 53 27 Magnesium sulfate 27 3 (3/7) 9 (0/4) 0 Mebendazole 39 19 36 13 (1/10) 3 Oral rehydration salts 97 57 63 38 50 37 Oxytocin 63 37 83 59 50 30 *Denominators vary by product ( see table 3). Percentages were not computed when fewer than 10 facilities manage the product. Actual number of facilities provided in parentheses. Availability of Stock Cards The value in logistics records lies in the extent to which they are used appropriately and consistently. In the case of stock cards, inventory information kept on the stock cards allows facilities as well as managers throughout the health system to make informed decisions about what and how much to order each month.3 Consistent and accurate use of stock cards is essential to successful inventory 3 As previously noted, for purposes of this assessment, a “stock card” was defined as any type of record at the facility that recorded the following: product name, stock/quantity on hand, total issued, and total received by dates. This could include a log book or tally sheet. 14 management. Consequently, the percentage of facilities with stock cards available and updated was also identified as an important indicator of logistics system performance. Table 5. Utilization of Stock Control Cards to Manage Family Planning Products by Facility Types Rural Health Units Hospitals Warehouses % n = % n = % n = Combined oral contraceptives 13 (27) 216 (0) 7 38 (11) 29 Cycle beads 2 (4) 116 (0) 1 12 (2) 17 DMPA 12 (35) 212 (0) 6 31 (9) 29 IUDs 11 (28) 180 (0) 4 28 (8) 29 Male condoms 13 (26) 200 (0) 5 24 (9) 25 One-month injectable 0 18 — — (0) 5 Progestin-only pills 2 (4) 59 (0) 2 23 (3) 13 Note: “n” represents the number of facilities that manage the product. Percentages were not computed when fewer than 10 facilities manage the product. Actual number of facilities provided in parentheses. Table 6. Utilization of Stock Control Cards to Manage Maternal, Newborn, and Child Health Products by Facility Types Rural Health Units Hospitals Warehouses % n = % n = % n = Amoxicillin tablet (250 mg) 7 (18) 136 27 (3) 11 38 (6) 16 Amoxicillin suspension (125 mg/5 mL) 4 (6) 137 (1) 9 17 (2) 12 Ferrous sulfate 4 (5) 117 (0) 7 13 (2) 15 Magnesium sulfate 0 26 (4) 7 (0) 4 Mebendazole (500 mg) 1 (1) 109 (0) 11 (1) 10 Oral rehydration salts 7 (13) 196 16 (3) 19 27 (6) 22 Oxytocin 5 (6) 131 35 (8) 23 17 (3) 18 Note: “n” represents the number of facilities that manage the product. Percentages were not computed when fewer than 10 facilities manage the product. Actual number of facilities provided in parentheses. Table 5 and table 6 present the percent of facilities with stock cards available for those products that they manage, by facility types. While utilization of stock cards was very poor in all three types of facilities, warehouses appeared to be slightly more consistent. None of the hospitals managing FP 15 products maintained any stock cards, although there appeared to be some use with for MNCH products, particularly for magnesium sulfate. RHUs have very low utilization for both FP products and MNCH products, with 10 percent or less maintaining a record. Updated Stock Cards As shown in table 7 and table 8, few facilities had updated stock cards for those products with stock cards in the 30 days preceding the survey, regardless of facility type or type of product. Table 7. Updated Stock Cards for Family Planning Products Managed by Facility Types Rural Health Units Hospitals Warehouses % n = % n = Combined oral contraceptives 59 (16) 27 — — 54 (6) 11 Condoms 46 (12) 26 — — (4) 6 Cycle beads (0) 2 — — (1) 2 DMPA 50 (13) 26 — — (5) 9 IUDs 50 (10) 20 — — (5) 8 One-month injectable — — — — — — Progestin-only pills (0) 1 — — (2) 3 Note: “n” represents the number of facilities that manage the product. Percentages were not computed when fewer than 10 facilities manage the product. Actual number of facilities provided in parentheses. Zero hospitals managed the product and had any stock cards. Table 8. Updated Stock Cards for Maternal, Newborn, and Child Health Products Managed by Facility Types Rural Health Units Hospitals Warehouses % n = % n = % n = Amoxicillin tablet (250 mg) (5) 9 (1) 3 (3) 6 Amoxicillin suspension (125 mg/5 mL) (1) 6 (1) 1 (2) 2 Ferrous sulfate (3) 5 — — (1) 2 Magnesium sulfate — — (0) 4 — — Mebendazole (500 mg) (1) 1 — — (1) 1 Oral rehydration salts 46 (6) 13 (2) 3 (5) 6 Oxytocin (2) 6 (5) 8 (1) 3 Note: “n” represents the number of facilities that manage the product. Percentages were not computed when fewer than 10 facilities manage the product. Actual number of facilities provided in parentheses. 16 Municipality-Based Logistics System Logistics records serve as the backbone of every logistics system. They are designed to capture critical logistics data at each level of the health system. The data captured on logistics records are then brought together to form logistics reports used for crucial decision making about resupply quantities, forecasting, and procurement. As mentioned previously, no central reporting system is in place because of the nature of decentralization within the Philippines. The findings in this section provide an indication of the most common systems in place as well a measure of the system performance. Information in this section was gathered through interviews conducted on the day of the visit at the service delivery points (SDPs) (i.e., hospitals and RHUs) with the person responsible for managing the drugs and medicine/FP products for the facility. Interviews were also conducted with personnel responsible for dispensing/providing FP products to clients (i.e., nurses or midwives.). In many SDPs, particularly in the RHUs, this was the same person. The respondent’’s average length of the time for working at the facility was one and a half years for both RHUs and hospitals. Ninety-one percent of respondents reported being the principal person responsible for managing the medicine and products. As mentioned previously, some respondents could have been relatively new to the facility due to the measles campaign. Table 9. Job Title of Primary Person Responsible for Management of Products by Service Delivery Point Type Rural Health Units (n = 224) Hospitals (n = 33) Municipal health officer 9 (21) Supply officer 0.5 (1) Nurse 67 (151) 61 (20) Midwife 20 (45) 6 (2) Medical officer 0.5 (1) Pharmacy assistant Pharmacist 0.5 (1) 21 (7) Other 2 (4) 12 (4) Chief of hospital (3) Clerk (1) Data encoder (1) Medical aid (1) Philhealth officer (1) Sanitation Inspector (1) Number of staff with title provided in parentheses. Title of “Other” presented in italics3 As shown in table 9, primary responsibility for management of drugs and medicine/FP products at the facility falls under a number of different job titles, but in most cases nurses or midwives manage supplies, with pharmacists also responsible in one in five hospitals. Eighty-seven percent of those 17 � � � � � � � � � � interviewed in RHUs and 82 percent of those interviewed in hospitals reported that supplies and stock management was their primary role at the facility. Utilization of Logistics Records Stock Cards The stock card, the most fundamental of all logistics records, captures essential inventory data such as stock balance, receipts, issues/consumption, and losses/adjustments. Therefore, utilization of stock cards was identified as an important indicator to assess logistics system performance. In addition to the stock card, five additional recordkeeping forms were identified during development of the tool: stock ledgers, dispense-to-user records, requisition and issue record/slip (RIS), and stock-on-hand/inventory reports. Figure 3 presents the percentage of facilities that report using a type of record to manage health commodities, by type of facility. Figure 3. Use of Forms to Manage Health Products by Facility Types* 18 21 30 18 3 1215 16 17 48 20 12 21 14 0 10 20 30 40 50 Stock card Stock ledger Dispense–– to––user None Pe rc en t o f r es po nd en ts RIS Inventory Other reports Logistics forms Hospitals n = 33 RHUs n = 224 *Multiple responses allowed so totals add to more than 100 percent. RIS= requisition and issue record/slip Interviews also confirmed earlier findings that stock cards were not routinely used in either RHUs or hospitals to manage products. The most frequent form used as a means of managing health products were the dispense-to-user forms. Four hospitals and twenty-seven RHUs (12 percent), however, reported not using any type of logistics form or record to manage their products. In addition, 80 percent of SDPs (179 of 224) had a computer at their facility. However, only 40 percent with a computer reported using computers to help manage health products. Personnel Training on Logistics Management In every logistics system, personnel managing commodities require training in the use of logistics forms and reports. Outside of pre-service training, logistics workshops provide the most focused and efficient means to build the capacity of health facility personnel. However, financial constraints can limit the use of this organized training on a large scale. Consequently, many personnel are 18 � � � � � � � � � trained on logistics activities by another staff member while on the job. Additionally, some personnel receive various levels of logistics training during their schooling, while other personnel rely on self-teaching to master the use of logistics forms and reports. Regardless of type of training, constant practice and reinforcement are necessary to ensure that forms are completed consistently and accurately. Figure 4 presents results on if and how respondents learned to complete logistics forms. It should be noted that training on logistics forms was self-reported and individual forms were not specified. As a result, training on logistics forms may be overstated and may not be representative of training on all logistics forms and reports. Figure 4. Personnel Trained in Completion of Forms/Records by Facility Types* 9 70 4 2423 63 4 15 0 20 40 60 80 100 Logistics workshop OJT Other Never Types of Training Pe rc en t t ra in ed Hospitals n = 33 RHUs n = 224 * Multiple responses allowed so totals add to more than 100 percent. OJT=On the job training The majority of respondents learned to complete logistics forms and reports through on-the-job training, either self-taught or taught by others, in both hospitals and RHUs. In addition, about 20 percent of RHUs and 10 percent of hospital respondents reported training during a logistics workshop. At the same time, however, over 20 percent of hospital and 10 percent of RHU respondents reported that they had never been trained to complete any type of logistics forms. Ordering Procedures The most important outcome of a logistics system is stock availability at the health facility. For this to occur, staff needs to monitor stock levels and follow inventory control procedures for ordering. The choices in terms of how much product to order and how much product is received can vary depending on types of inventory control systems, level of staff training, and availability of funding. As mentioned previously, it was expected that decisions on the quantities of FP product that were ordered and the quantities that were received would vary among municipalities because of the nature of decentralization. Figure 5 and figure 6 illustrate this range. It should be noted that these questions pertain to the order procedures of FP products only and not MNCH products. Therefore, these questions were skipped at hospitals were no FP products were managed. 19 � � � �� � � � � � � � �� � � � � � � � Figure 5. Decision Level for Total Quantity of Family Planning Products Requested for Service Delivery Points by Type* 80 13 7 87 8 6 1 0 20 40 60 80 100 Facility FP coordinator Provincial health office Don't know Level ordering for facility Pe rc en t o f r es po nd en ts Hospitals n=15 RHUs n=224 * Multiple responses allowed so totals add to more than 100 percent. As shown in figure 5, someone based at facility is usually responsible for deciding the amount of FP products to be requested. Similarly, when determining amount of FP products to be received, personnel at the facility (Figure 6) usually made this decision, though less consistently. Instead, FP coordinators and the provincial health offices (PHOs) seemed to make the decision in terms of how much product a facility received. Figure 6. Decision Level for Total Quantity of Family Planning Products Service Delivery Points Receive by Type* 20 13 78 10 13 1 67 0 20 40 60 80 100 Facility FP coordinator Provincial health office Don't know Level ordering for facility Pe rc en t o f r es po nd en ts Hospitals n = 15 RHUs n = 224 * Multiple responses allowed so totals add to more than 100 percent. Respondents also reported that the amount the facility would be resupplied was determined in a variety of ways. Figure 7 presents the different ways the resupply quantities for FP products are decided. 20 � � � � � � � � � � � � � � �� � � � � � � � Figure 7. Ways Facility Resupply Quantity is Determined 20 7 67 7 30 8 16 44 2 0 20 40 60 80 100 Formula Forecasting Available funding Previous consumption Don't know Pe rc en t o f r es po nd en ts Hospitals n = 15 RHUs n = 224 Most facilities (67 percent of hospitals and 44 percent of RHUs) report using the facility’’s previous consumption in determining quantity requested. However, in situations where the PHO was responsible for determining how much product a facility would actually receive, a formula was frequently used. Figure 8. Frequency of Ordering Family Planning Products 7 33 13 136 9 2 33 9 42 33 0 20 40 60 80 100 No defined period Monthly Quarterly SemiͲ annually Annually Don't know Period of ordering Pe rc en t o f r es po nd en ts Hospitals n = 15 RHUs n = 224 The study also found a range in terms of frequency of ordering FP products, as shown in figure 8. A quarterly basis appeared to be the most common, though over a third also mentioned that they did not have defined period of ordering FP products After ordering, facilities would receive their order as early as less than two weeks or as long as more than two months (Figure 9), with no one period being more common than another. Finally, as shown in figure 10, emergency orders for FP products were uncommon in both hospitals and RHUs. 21 � � � � � � � � � � � � �� � � � � � �� � � � Figure 9. Period of Waiting between Ordering and Receiving Family Planning Products Period of waiting 0 10 20 30 40 50 Less than 2 weeks 2 weeks to 1 month 1––2 months More than 2 months Pe rc en t o f r es po nd en ts Don't know Hospital s n = 15 RHUs n=224 Figure 10. Placement of Emergency Orders Emergency orders 52 3 3 88 9 1 1 0 20 40 60 80 100 None 1 2 3+ Pe rc en t o f r es po nd en ts 1 42 DK/DR Hospitals n = 15 RHUs n=224 DK/DR=Do not know/Do not remember Supervision Supervision, an important element of quality assurance for the performance of any logistics system, is related to all aspects of logistics management. Supervision helps to improve individual and system performance and can alert managers to potential problems such as stockouts, understocks and overstocks, poor storage conditions, and products near their expiry dates. Frequency of supervision is an essential element and is therefore identified as a useful indicator in assessing the potential quality of system management and its effect on system performance. Supervision also presents an opportunity to reinforce new systems and forms. 22 � � � � � � � � � Figure 11. Recent Supervision Containing Drug Management 24 12 21 15 27 15 29 25 14 17 0 10 20 30 40 50 No Visit Within last month 1––3 months 3––6 month >6 months Time received Pe rc en t t ra in ed Hospitals n = 33 RHUs n=224 Figure 11 illustrates the timing of the supervisory visits, which included assessment of drug logistics management of FP products. A majority of RHUs mentioned that they were visited by their supervisors within the last month or within the previous one to three months. Most hospital personnel, on the other hand, reported that they had not received any supervisory visit for more than six months before the date of visit, if at all. Transportation and Distribution Fundamental to the success of a health logistics system is the ability to reliably move commodities through the supply chain so they are available for use at health facilities when needed. In the Philippines, the transport network is generally good from the central level to the districts, with most roads tarred. Similarly, road networks are good and passable even during heavy rains from the districts to most health centers, which mean that most facilities are accessible. Figure 12 shows how products are transported to each facility. As previously mentioned, it should be noted that these questions pertained to transportation of FP products only and not MNCH products. Therefore, these questions were skipped at hospitals were no FP products were managed. 23 � � � � � � � � � � � � � � � � � � � � � � Fa cili ty ve hic le Pu bli c t ran sp ort ati on Pri va te ve hic le Bo at Tri /m oto rcy cle On foo t Ot he r Figure 12. Responsibility for Transporting Family Planning Products to Service Delivery Points 47 7 47 35 32 14 18 5 0 20 40 60 80 100 SDP collects Local supplier delivers Municipality delivers Province/ region delivers Other Commodity movement Pe rc en t o f re sp on de nt s Hospitals n = 15 RHUs n = 224 * Multiple responses allowed so totals add to more than 100 percent. As mentioned, it is up to the municipality, in a decentralized setting, to determine the mode of transportation for their products in connection with the supplier. Hospitals generally collect their supplies or have them delivered from provincial/regional health offices. RHUs, on the other hand, typically have the local supplier deliver the commodities to the facility in addition to collecting themselves. Combined, it could be concluded that SDPs were primarily responsible for collecting their FP products. However, it should also be noted the responsibility could vary depending on whether the commodities came from the DOH (donated or bought) or procured by the municipality itself. Figure 13 illustrates the type of transportation most typically used to deliver FP products to the SDP. Figure 13. Types of Transportation Used for Delivering Products to Service Delivery Points 87 7 7 42 14 37 4 1 3 1 0 20 40 60 80 100 Pe rc en t o f re sp on de nt s Hospitals RHUs Types of transportation 24 Regarding transportation responsibilities, most facilities confirmed that they utilize their own vehicles to transport the commodities, especially in hospitals. Respondents at RHUs also reported use of a private vehicle, with 76 percent of those also reporting that the local suppliers were responsible for the delivery. Among those that use public transportation (14 percent in RHUs and 7 percent in hospitals), only 43 percent mention that their transportation would be reimbursed by the facility. Availability of Products and Services Because there were expectations of stock keeping records being poor ahead of the study implementation, additional questions were added to the interview to capture data regarding length of stockouts for the most commonly used FP methods: condoms, pills (type unspecified), injectables (type unspecified), and IUDs. As shown in table 10, interviews with health personnel substantiate earlier findings regarding availability of stocks (p. 12––16), that is, stockouts of FP products are frequent occurrences at both hospitals and RHUs. Similarly, results also confirm that FP products are not managed at most hospitals. Table 10. Stockouts in Previous Six Months According to Respondents Rural Health Units Hospitals Reported stockout of condoms* n = 202 42% 1/3 Reported stockout of pills* n = 219 45% 1/5 Reported stockout of injectables* n = 215 53% 2/5 Reported stockout of IUDs* n = 181 17% 1/3 Condoms not managed n = 224 11% n = 33 84% PIlls not managed n = 224 39% n = 33 86% Injectables not managed n = 224 5% n = 33 81% IUDs not managed n = 224 20% n = 33 88% *Stockout percentages are for facilities that manage the product. . Percentages were not computed when fewer than 10 facilities manage the product. Over half (53 percent) of respondents at the RHUs reported experiencing a stockout of at least one of the four most commonly used FP products within the previous six months to the survey. IUDs appeared to have the lowest stockout rates, with just 18 percent of RHUs experiencing one in the previous six months. In comparison, injectables (any type) were the most frequent product to be out of stock at RHUs, with most stockouts (54 percent, 113 of 174) lasting over three month. Pills and condoms were also frequently out of stock, with over 40 percent of RHUs reporting a stockout for both these methods. The stockouts of pills and condoms lasted for over three months on average. While respondents at hospitals also mentioned stockout in the previous six months, it is hard to draw any direct conclusions on length of time given so few hospitals reported managing the product. Respondents who reported experiencing a stockout were asked to define what they thought the most common reasons were for the stockouts. As shown in table 11, the most common reason reported by RHU respondents was not enough funds followed by supplier delays. (Hospital-level results were considered too low to report.) 25 � � � � � � � Table 11. Common Reasons for Stockouts in Previous Six Months According to Respondents Rural Health Units (%) (n = 161)* Not enough funds 52 Supplier delays 12 Delays in procurement 11 Delays in obtaining funds 5 Poor forecasting/planning 4 Other 17 Don’t know 6 *Multiple responses allowed so totals add to more than 100%. In addition, regardless of whether they managed any FP product, all respondents were asked whether they offered long-acting and permanent FP methods as well as the reasons if they were not provided. As shown in figure 14, IUD insertions are available at only 21 percent of hospitals and 69 percent of RHUs. Additionally, only 27 percent of hospitals offered tubal ligations, while only 6 percent offered vasectomies. It should also be noted that 56 percent (18 of 33) of hospitals did not offer any of the procedures. Figure 14. Availability of Long-Acting and Permanent Family Planning Methods at Service Delivery Points 21 29 6 15 6 69 0 20 40 60 80 100 IUD insertions Tubal ligation (BTL) Vasectomy FP procedure Pe rc en t o f f ac ili tie s Hospitals RHUs When asked for the reasons why the procedure was not offered at the facility, the most common reasons for all three procedures were that no one was trained, while little demand was seen as an issue for IUD insertion and vasectomy, particularly at the RHU level (see figure 15). 26 � � � � � � � � � � � � � � � � � � � � � � Figure 15. Reasons for Lack of Service at Service Delivery Points % of re sp on de nt s 100 80 60 40 20 0 80 79 71 58 62 58 RHU Hospital Reasons why IUDs are not available RHU Hospital Reasons why BTLs are not available RHU Hospital Reasons why vasectomies are not available No one trained Lack of medical supplies Lack of kits No demand Other Storage Conditions To provide clients with high-quality products, each facility must have safe, protected and well- organized storage areas to help prevent damage and to ensure efficient handling of products. In assessing storage areas, the survey examined the level of compliance with guidelines for proper storage at the provincial/independent city warehouses, hospitals, and RHUs. The field researchers assessed each facility’’s adherence to these storage conditions through direct observation. The guidelines include the following: 1. Products that are ready for distribution are arranged so that identification labels and expiry dates and/or manufacturing dates are visible. 2. Products are stored and organized in a manner accessible for first-to-expire, first-out (FEFO) counting and general management. 3. Cartons and products are in good condition and not crushed due to mishandling. If cartons are open, determine if products are wet or cracked due to heat/radiation. 4. The facility makes it a practice to separate damaged and/or expired products from good products and remove them from inventory. 5. Products are protected from direct sunlight on the day of visit. 6. Cartons and products are protected from water and humidity on the day of the visit. 7. Storage area is visually free from harmful insects and rodents. 8. Storage area is secured with a lock and key but is accessible during normal working hours, with access limited to authorized personnel. 9. Products are stored at the appropriate temperature according to product temperature specifications. 27 � � � � � � � 10. Roof is maintained in good condition to avoid sunlight and water penetration. 11. Storeroom is maintained in good condition (i.e., clean, all trash removed, sturdy shelves, and organized boxes). 12. The current space and organization is sufficient for existing products and reasonable expansion (i.e., receipt of expected product deliveries for the foreseeable future). 13. Appropriate fire safety equipment is available and accessible. 14. Medicine stored separately from insecticides and chemicals. 15. Pallets/shelves available to ensure products are off the floor. At each facility, data collectors visually inspected and scored the storage areas based on these 15 conditions. Facilities that met more than 90 percent of the conditions were considered to have excellent storage conditions, those that met between 71 and 90 percent were acceptable, and those that met less than 70 percent were unacceptable. Most hospitals had acceptable or excellent storage conditions. However, 41 percent of the RHUs and half of the warehouses had unacceptable storage conditions (see figure 16). Figure 16. Percentage of Facilities Meeting Acceptable Storage Condition 41 22 50 0 20 40 60 80 100 RHUs Hospitals Warehouses Pe rc en t o f f ac ili tie s Excellent (> 90%) Acceptable (71––89%) Unacceptable (< 70%) As evident in table 12, results show that the least-met storage condition was not enough current space for existing medicines and supplies (62 percent in RHUs and 47 percent among hospitals). Facilities, particularly warehouses, also struggled with making sure dates and labels were visible and with shelving products in a way to allow them to follow FEFO. The most commonly met storage conditions were protection from direct sunlight and water for all facilities (100 percent in hospitals) as well as keeping products separated from chemicals. 28 Table 12. Percentage of Facilities Meeting Individual Storage Conditions Rural Health Units (%) (n = 224) Hospitals (%) (n = 33) Warehouses (%) (n = 30) Label/dates visible 54 (121) 72 (24) 47 (14) First-to-expire, first-out 53 (129) 72 (24) 50 (15) Good condition 75 (168) 78 (26) 63 (19) Separated damaged/expired 80 (179) 91 (30) 83 (25) Protected from sunlight 97 (217) 100 (33) 93 (28) Protected from water 93 (208) 94 (31) 90 (27) No harmful insects/rodents 85 (190) 91 (30) 70 (21) Area locked and access to key 85 (190) 91 (30) 93 (28) Appropriate temperature 90 (202) 84 (28) 83 (25) Roof maintained 96 (215) 94 (31) 83 (25) Storeroom cleaned 58 (130) 81 (27) 27 (8) Sufficient space 38 (85) 53 (17) 53 (16) Fire equipment available 55 (123) 72 (24) 63 (19) Separated from chemicals 93 (208) 97 (32) 93 (28) Actual number of facilities meeting individual storage conditions provided in parentheses In addition, storerooms at facilities that maintained products such as vaccines or oxytocin which require refrigeration were assessed for cold chain management. In total, there were 25 provincial/independent city warehouses, 26 hospitals, and 195 RHUs that maintained these products. However, three warehouses (11 percent), three hospitals (12 percent), and 11 RHUs (6 percent) did not appear to have any functioning refrigerators or coolers to maintain the cold chain. Of those with refrigerators, approximately two-thirds of RHUs and warehouses had working thermometers available for a temperature reading, while only 43 percent of hospitals had one (table 13). Table 13. Percentage of Facilities Meeting Cold Chain Conditions Rural Health Units (%) (n = 184) Hospitals (%) (n = 23) Warehouses (%) (n = 22) Working thermometer 61 (112) 43 (10) 64 (14) Refrigerator located away from objects 83 (153) 83 (19) 92 (20) Up-to-date temperature chart 34 (63) 43 (10) 50 (11) Availability of paraffin/liquid petroleum gas for cold chain and sterilization purposes 68 (125) 65 (15) 29 (6) Actual number of facilities meeting individual storage conditions provided in parentheses 29 Sources of Funding and Supplies To respond to fluctuations in supply and demand, a supply chain must be agile and function with speed and flexibility. Streamlined policies and procedures can lead to more effective procurement and ultimately contribute to improved commodity availability throughout the system. Setting up these streamlined policies and procedures in a decentralized system can be especially challenging. With a decentralized system such as that in the Philippines, a key aspect in streamlining the supply chain and being able to ensure adequate availability of stocks is to understand the modes of funding used and common sources of supplies. Respondents at facilities that reported managing FP products were asked about the types of funding mechanisms used at the facility to procure commodities and the source of supply used for each scheme. Suppliers included a range of possibilities including donor (UNFPA), government (DOH, and region/province), quasi-government (League of Municipalities), social marketing (DKT), and private.4 Because it is possible for a municipality to use multiple funding sources or receive their FP products from different suppliers, respondents were also asked about their primary sources. As shown in table 14, the most frequent source of funding used to procure FP products was the facility/municipality budget followed by the PHO. None of the hospitals reported using MNCHN grants for purchasing FP products. Table 14. Any and Primary Source(s) of Funding Used to Procure Family Planning Products Rural Health Units (n = 221) Hospitals (n = 15) Any* (%) Primary (%) Any* (%) Primary (%) Facility/municipality budget 62 48 40 40 Maternal, newborn, and child health and nutrition (MNCHN) grants 21 16 0 0 Donations 3 1 0 0 Provincial health office 12 11 20 20 Other 15 10 13 13 Don’t know 15 14 27 27 *Multiple responses allowed so totals add to more than 100 percent. It should be noted that the PHO response could in fact also refer to MNCHN grants since at times PHOs will use money from MNCHN grants to purchase the commodities directly on behalf of the municipalities rather than transferring the funds to the municipalities. Respondents, however, are only aware that the source of their funding is from the PHO. Regardless of funding type, however, multiple sources of supply are used for procuring FP products (see figure 17 and figure 18). The province/region appears to be the primary source of supply for 4 The League of Municipalities (of the Philippines)(LMP) is a formal organization of all the municipalities in the Philippines. Created by the Local Government Code of 1991, its mission is to provide municipalities “with relevant and adaptive best practices, linkages with pertinent international and local organizations, capacity development, research, and advocacy services.” (LMP 2010). Under the “Kung Maliit ang Pamilya, Kayang Kaya” (KMPKK) program, a population management program, LMP distributes low-cost, contraceptives to selected poor municipalities donated primarily by UNFPA. 30 � � � � � � � � � � � � � � � � � � � RHUs and hospitals. RHUs, however, are almost as equally likely to use local suppliers to obtain their FP products (Figure 19). As above, a ““local supplier”” could potentially be a DKT representative; yet the respondent, might not be aware of the connection. The same is true with ““League of Municipalities”” and the UNFPA, as well as the DOH and ““region/province”” responses. Figure 17. Sources of Supply for Rural Health Units by Funding Type 0 20 40 60 80 100 Facility MNCHN Donations Other Don't know Sources of funding % of re sp on de nt s DKT Rep DOH League of Municipalities Local supplier Region/province UNFPA Don't know *Multiple responses allowed so totals add to more than 100 percent. Figure 18. Sources of Supply for Hospitals by Funding Type 100 % of re sp on de nt s 80 60 40 20 0 Facility Other Don't Know Sources of funding DOH League of Municipalities Region/province UNFPA Don't know *Multiple responses allowed so totals add to more than 100 percent. 31 � � � � � � � � � � Pro vin ce/ reg ion Loc al s up plie r Lea gue of Mu nic ipa liti es DK T r ep res ent ati ve UN FPA DOH Do n't kno w Figure 19. Primary Source of Supply by Facility Type 10 40 13 27 67 10 14 24 29 7 13 0 10 20 30 40 50 % of re sp on de nt s RHU n=221 Hospital n = 15 Provincial Assistance and Logistics System In order to better understand the role of PHOs with assisting municipalities, in addition to conducting a physical inventory of the warehouses, the provincial/independent city FP coordinators were interviewed. Of the 33 provinces/independent cities included in the study, 31 had an individual designated as the FP coordinator; all but one reported providing some type of assistance to municipalities within the province. As shown in figure 20, most of the higher-level health offices provided guidance to municipalities on types of FP products to order as well as providing assistance with actually procuring and distributing product. It should be noted that PHO assistance varies between municipalities such that the responses outlined in figure 20 do not necessarily represent the actual assistance provided to the individual municipalities within the study sample. For example, while 96 percent of provincial FP coordinators reporting distributing FP products, this does not necessarily mean that they distribute to every municipality within their province. Additionally, as discussed previously, while all 31 provinces had a warehouse/storeroom, they did not necessarily maintain FP products. 32 � � � � � � � � � � � � � � � � � � � � Figure 20. Involvement of the Provincial Health Offices with Municipalities 75 46 71 68 96 0 20 40 60 80 100 Guidence on: when to order Procures FP products on behalf of municipalities Distributes FP products to Municipalities % of FP co or di na to rs re po rt in g a ss is ta nc e Guidence on: Guidence on: types to order amount to order According to the FP coordinators, 93 percent (31 out of 33) of the warehouses had a paper-based system for managing stocks (one warehouse’’s system was electronic based), which is consistent with earlier findings on the utilization of stock cards at warehouses. Fourteen of the thirty-one FP coordinators reported there had not been any stockouts of any of the FP products managed in the warehouse/storeroom. However, of those with a stockout, the average length of time was more than three months. Ordering Procedures Similar to results previously discussed, the 19 PHOs who ordered FP products on behalf of municipalities appear to have a range of practices for determining the amount to procure, the frequency for procurement, and the period of time it took to receive the product once ordered. As shown in figure 21, available funding is the primary factor used to determine how much product is ordered, followed by forecasting. Eight of the nineteen health offices (42 percent) reported ordering on an annual basis, while four reported ordering on a quarterly basis or no defined period. The remaining two offices ordered semi-annually, while one FP coordinator did not know the frequency. Finally, for the provinces that both procured and distributed products, the lag time between ordering and receiving product ranged from less than two weeks (3 out of 19) to two or more months (5 out of 19). Six FP coordinators reported a period of two to four weeks, while the remainder reported one to two months.5 5Results in this section and the following one should be interpreted with caution, as there are only 19 responses in total. 33 � � � � � � � � � � Figure 21. Determining Quantity of Family Planning Products for Reordering 16 32 37 11 5 0 10 20 30 40 50 % of FP co or di na to rs Formula Forecasting Available funding Previous consumption Other * Multiple responses allowed so totals add to more than 100 percent. Sources of Funding and Supply Information of modes of funding for ordering FP products on behalf of municipalities and sources of supply was also collected on the provincial level. As shown in figure 22, the most common source of funding used by the provinces was MNCHN grants followed by the province’’s own funds. Figure 22. Sources of Funding for Family Planning Products (Provincial Level)* 16 42 11 53 32 0 20 40 60 80 100 % of FP co or di na to rs Municipality Provincial funds Regional funds MNCHN grants Other funds * Multiple responses allowed so totals add to more than 100 percent. Main sources of supply were consistent with the results from local government units’’ primary sources of supply. As illustrated in figure 23, the primary source for FP products was the region/Centers for Health Development (CHDs). As mentioned earlier, ““DKT representative”” and the ““local supplier”” responses could be synonymous, as are ““League of Municipality”” and ““UNFPA””. 34 � � � � � � � � � Re gio n DK T rep res en tat ive Lo ca l su pp lie r DO H Le ag ue of M un icip ali tie s UN FP A Ot he r Do n't Kn ow Figure 23. Main Source of Supply for Family Planning Products (Provincial Level) 28 17 17 11 6 6 6 11 0 10 20 30 40 50 % of FP co or di na to rs Additionally, 29 of 31 FP coordinators reported that their province had received some type of FP products from the region/CHDs. Six of the twenty-nine (21 percent) stated that the province or a municipality had paid for this product using money from their budget, while the remaining twenty- three (79 percent) said that the product(s) had been donated by the region. Transportation and Distribution Of the 27 provinces/independent cities that distribute products to the municipalities, 52 percent reported that the municipality was responsible for transporting their products, while 48 percent said that the province was responsible. (A local supplier was responsible in one case.) Supporting previous results, provincial and municipal/RHU vehicles (45 percent and 30 percent, respectively) were used most often for transporting products. A private vehicle was mentioned three times followed by public transportation (2), boat (1), and did not know (1). 35 36 Conclusions and Recommendations Strengthen Stock Management Practices As a result of a combination of not being managed or being stocked out, availability of FP and MNCH products was very low across the board. This assessment also confirmed that the practice of maintaining stock cards, which is the first step in inventory management, is essentially non-existent regardless of facility levels or type of product. Currently, HealthGov is rolling out the Stock and Inventory Management System (SIMS) and an electronic version known as ““eSIMS.”” The tool is designed to help municipalities track expendable commodities in health facilities, especially drugs and medical supplies. It also helps organize and update records for quantities received, quantities dispensed to clients, quantities issued to midwives or Barangay Health Stations, and quantities in stock. Piloting of the tool occurred in four provinces in mid-2010 and began to expand to other provinces in early 2011. HealthGov has also been working to roll out the Family Planning Commodity Monitoring Tool (FPCMS). The purpose of the routine FPCMS is to collect stock status data on FP products and also provides information to the DOH and feedback to facilities on overall FP logistics performance. At the time of the survey, only one round of data had been collected over the course of a six-month period In addition to recordkeeping and routine reporting, proper storage is an essential component of stock management. The study, however, found poor storage conditions in most provincial warehouses as well as many RHUs. Additionally, most respondents reported that they had received a supportive supervision visit within the previous six months that included drug management. These findings raise concerns about the quality of supervision given the avenues for reinforcing good logistics management practices, including inventory control, recordkeeping, and reporting as well as maintaining key storage conditions such as FEFO and visibility of identification labels and expiry dates and/or manufacturing dates. Recommendation: Continued support should be provided to allow HealthGov to further expand and implement SIMS/eSIMS in additional provinces. CHDs and PHOs should also be encouraged to conduct quarterly supportive supervision visits and submit results using the FPCMS to the appropriate level in a timely fashion. Additional training might be necessary to strengthen supportive supervision and routine monitoring of drug management to ensure the success of the FPCMS and the SIMS/eSIMS. Storeroom managers, particularly those in the provincial warehouses, should receive training of guidelines and/or reminders such as posters to help address issues with maintaining proper storage conditions. Mechanisms for Funding Mechanisms for funding vary among municipalities. Results indicated that municipalities primarily used their own funds to procure FP products and used a variety of suppliers. MNCHN grants, provided by the DOH to supplement municipality health care budgets, did not appear to be adequately utilized. For example, facilities could use grant money to reimburse the travel cost of 37 collecting FP products, yet almost half of providers reported using their own money for collecting products. Additionally, providers also cited the lack of funding as the main reason for stockouts, yet based on sources external to the survey, release of 2010 and 2011 MNCHN funding was delayed due to the fact that local governments did not spend the money from previous years MNCHN grants (DOH, n.d.). Furthermore, less than 25 percent of respondents mentioned using MNCHN grants to purchase products. The limited use of the grants could be due to a lack of awareness or considered to be an extra burden as its work and financial plan are separate from their local family health budget. Recommendation: Current guidelines regarding what MNCHN grants can be used for and how to qualify should be reviewed and strengthened. Additionally, guidelines should be disseminated to the municipal and SDP levels so that all those involved with procurement are aware of the benefits of the MNCHN grants. Municipalities should also be encouraged to view the MNCHN grants as money to augment the local government’’s family health budget to improve the health service delivery system of the MNCHN program rather than being a separate entity. Procurement Procedures While municipalities were responsible for determining the quantities of FP products to order and how much an SDP actually received, the PHOs played an active role in the procurement and distribution process, especially as they, along with the CHDs, appear to be the primary supplier. The amount of funding available as well as previous consumption appeared to be the main driving factors for determining quantity to order; however, there is some evidence of ordering based on forecasting demand at the PHO level. Procurements occurred on a relatively ad hoc basis, with a lead time between placing and receiving the order ranging from anywhere between less than two weeks to more than two months. No clear trends appeared between funding sources and the type of supplier used. Recommendation: While the survey did not look at actual costs and prices of products or quality, a mixed system for procurement, which can take advantage of the benefits of decentralization while negotiating and managing overarching contracts centrally to provide suppliers with minimum volume guarantees and help facilitate access to lower prices, should be considered, based on external conversations and experiences in other decentralized countries. Additionally, as reporting systems are strengthened and more information and funding become available, the use of forecasting demand should be encouraged to help enable more accurate procurements. Family Planning Services in Hospitals Although the sample size was not statistically representative for all level one and two hospitals in the country, results suggest a serious lack of FP services being offered in the facilities. Almost half of the facilities (45 percent) surveyed did not manage any one of the seven possible FP products, while over half (56 percent) did not offer long-acting or permanent methods such as IUD insertions, BTL and vasectomies. These results were surprising given that these services were expected to be provided in the outpatient departments at this level. Recommendation: Ideally, all methods and services should be available at all level one and two hospitals. The role and responsibilities of the hospitals should be reviewed, and guidance on the products that should be managed and services that should be provided at the facilities should be included. Hospital-based providers should also receive training on how to perform all long-acting and permanent FP methods (i.e., IUD insertions, and vasectomies), as these procedures are not necessarily intended to be performed at most RHUs but should be available at all hospitals. 38 References Department of Health, Republic of the Philippines. n.d. ONA: Family Health Funds Accounted For. Available at http://dev1.doh.gov.ph/content/ona-family-health-funds-accounted (accessed September 2011) League of Municipalities of the Philippines. 2010. About Us: Missions and Visions. Available at http://lmp.org.ph/default/index.php?option=com_content&view=article&id=2&Itemid=15 (accessed October 2011) National Statistics Office (Philippines) and ICF Macro. 2009. National Demographic and Health Survey 2008. Calverton, Md.: National Statistics Office and ICF Macro. Population Reference Bureau. 2011. 2011 World Population Data Sheet. Available at http://www.prb.org/pdf11/2011population-data-sheet_eng.pdf (accessed October 2011) Rutstein SO and Rojas G. 2006. Guide to DHS Statistics. Calverton, MD: ORC Macro. 39 40 � Appendix A Complete Sampling List Region Province Municipality6 Facility Name7 CAR Benguet Bakun Bakun Rural Health Unit Bokod Dennis Molintas Memorial Hospital Itogon Itogon Rural Health Unit Kabayan Kabayan Rural Health Unit Kapangan Kapangan Rural Health Unit Kibungan Kibungan Rural Health Unit Tuba Tuba Rural Health Unit Tublay Tublay Rural Health Unit 1 Pangasinan Alcala Alcala Rural Health Center Asingan Asingan Medicare Community Hospital Basista Basista Municipal Health Office Rural Health Unit Bautista Bautista Rural Health Unit Calasiao Senor Divino Tesoro Health Center 6 Italicized municipalities were for location purposes for the hospitals and were not necessarily selected as part of the sample. 7 Selected hospitals provided in bold 41 � Region Province Municipality6 Facility Name7 Mangaldan Mangaldan Municipal Health Office San Fabian San Fabian Health Center Rural Health Unit 1 Santo Tomas Santo Tomas Municipal Health Center Sison Sison Municipal Health Center Urbiztondo Urbiztondo Health Center 2 Cagayan Abulug Abulug Rural Health Unit Alcala Alcala Rural Health Unit Baggao Baggao Medicare Community Hospital Claveria Claveria Rural Health Unit Lal-Lo Lal-Lo Rural Health Unit Santa Praxedes Santa Praxedes Rural Health Unit Isabela Benito Soliven Benito Soliven Rural Health Unit Cabagan Cabagan Rural Health Unit Delfin Albano Delfin Albano Rural Health Unit Jones Prospero G Bello Community Hospital (Former Jones Medicare Community Hospital) Quezon Quezon Rural Health Unit Quirino Quirino Rural Health Unit And Birthing Center San Mariano San Mariano Rural Health Unit Santa Maria Elvin Marasigan Integrated Memorial Hospital 3 Angeles City Angeles City Balibago Main Rural Health Center 42 � Region Province Municipality6 Facility Name7 Angeles City Rafael Lazatin Memorial Medical Center Bulacan Angat Angat Municipal Health Center Balagtas Balagtas Bulacan Rhu I And Lying-In Clinic Baliuag Baliuag Bulacan Rural Health Unit I Bocaue Bocaue Rural Health Unit I Bulacan/Bulakan Bulacan Rural Health Unit Bustos Bustos Community Hospital Guiguinto Guiguinto Rural Health Unit 1 Pandi Pandi Rural Health Unit Paombong Paombong Rural Health Unit 1 San Rafael San Rafael Rural Health Unit Pampanga Apalit Apalit Rural Health Center Bacolor Bacolor Rural Health Unit 1 Guagua Guagua Rural Health Unit 1 Lubao Lubao Rural Health Unit 2 Mabalacat Mabalacat Rural Health Unit 3 Main Mabalacat Mabalacat District Hospital San Simon San Simon Rural Health Unit Santo Tomas Santo Tomas Rural Health Center Sasmuan Sasmuan Rural Health Unit 43 � Region Province Municipality6 Facility Name7 NCR Marikina City Marikina City Marikina City Health Center 4A Batangas Agoncillo Agoncillo Rural Health Unit Alitagtag Alitagtag Rural Health Center Bauan Bauan Municipal Rural Health Unit 1 Cuenca Cuenca Municipal Rural Health Unit Lobo Lobo Municipal Hospital San Pascual San Pascual Community Hospital Santa Teresita Santa Teresita Rural Health Center Laguna Bay Pagamutang Pangmasa Ng Laguna Cabuyao Cabuyao Rural Health Unit Ii Los Baños Los Baños Health Care Center Luisiana Luisiana Laguna Rural Health Unit Lumban Lumban Rural Health Unit Nagcarlan Nagcarlan Laguna Rural Health Unit Pagsanjan Pagsanjan Health Center Pila Pila Laguna Rural Health Unit Santa Cruz Santa Cruz Health Center Victoria Pagamutang Bayan Ng Victoria Laguna Dator Memorial Health Center Lucena City Lucena City Camp Nakar Station Hospital, Pa Lucena City Lucena City District Health Unit II Quezon Candelaria Candelaria Rural Health Unit 44 � Region Province Municipality6 Facility Name7 Infanta Infanta Quezon Municipal Health Office Mauban Mauban Health Center Real Real Rural Health Unit Sampaloc Sampaloc Medicare Community Hospital Sampaloc Sampaloc Rural Health Unit Sariaya Sariaya Rural Health Unit Tayabas Tayabas Diagnostic Center Tiaong Tiaong Municipal Health Office 5 Camarines Sur Balatan Balatan Rural Health Unit Buhi Buhi Rural Health Unit I Cabusao Cabusao Rural Health Unit And Family Planning Center Goa Goa Rural Health Unit Lagonoy Lagonoy Main Health Center Minalabac Minalabac Rural Health Unit Nabua Nabua Rural Health Unit I Ocampo Ocampo Rural Health Unit Pamplona Pamplona Rural Health Unit Pasacao Pasacao Health Center Pili Pili Rural Health Unit Ii Presentacion Presentacion Main Health Center 45 � Region Province Municipality6 Facility Name7 San Fernando San Fernando Rural Health Unit Sipocot Sipocot Rural Health Unit Siruma Siruma Rural Health Unit Tinambac Tinambac Medicare Community Hospital Sorsogon Bulan Pantaleon G. Gotladera Mem. Hospital Gubat Gubat Municipal Health Center Irosin Irosin Rural Health Unit Juban Juban Rural Health Unit Matnog Matnog Rural Health Unit Prieto Diaz Prieto Diaz Rural Health Unit Santa Magdalena Santa Magdalena Rural Health Unit 6 Bacolod City Bacolod City Bacolod City Health Iloilo Badiangan Badiangan Municipal Health Office Barotac Viejo Barotac Viejo Municipal Hospital Cabatuan Cabatuan Rural Health Unit Dumangas Dumangas Rural Health Unit Dumangas Dumangas District Hospital Janiuay Janiuay Rural Health Unit Leganes Leganes Rural Health Unit New Lucena New Lucena Rural Health Unit Pavia Pavia Rural Health Unit 46 � Region Province Municipality6 Facility Name7 Santa Barbara Santa Barbara Rural Health Unit Zarraga Zarraga Rural Health Unit Iloilo City Iloilo City Iloilo City Main Health Center Negros Occidental Binalbagan Binalbagan Rural Health Unit Calatrava Calatrava Rural Health Unit Cauayan Cauayan Rural Health Unit Enrique B. Magalona Enrique B. Magalona Rural Health Unit Hinigaran Hinigaran Rural Health Unit Hinobaan Eleuterio T. Decena Memorial Hospital Ilog Ilog Rural Health Unit Manapla Manapla Rural Health Unit Moises Padilla Moises Padilla Rural Health Unit Murcia Murcia Rural Health Unit Pontevedra Pontevedra Rural Health Unit Salvador Benedicto Salvador Benedicto Rural Health Unit San Enrique San Enrique Rural Health Unit Toboso Toboso Rural Health Unit Valladolid Valladolid District Hospital 7 Bohol Alicia Alicia Main Health Center Anda Anda Rural Health Center 47 � Region Province Municipality6 Facility Name7 Catigbian Catigbian Rural Health Unit Dimiao Dimiao Main Health Center Dimiao Dimiao Municipal Infirmary Garcia Hernandez Garcia Hernandez Rural Health Unit Jagna Jagna Rural Health Unit Loay Loay Rural Health Unit Maribojoc Sweepstakes Health Center Bldg.,Maribojoc Pilar Pilar Municipal Health Office Sevilla Sevilla Health Center Sierra Bullones Sierra Bullones Rural Health Unit Ubay Ubay Bohol Rural Health Unit 1 Cebu Alcoy Alcoy Rural Health Unit Alegria Alegria Rural Health Unit Boljoon Boljoon Rural Health Unit Catmon Catmon Rural Health Unit Consolacion Consolacion Rural Health Unit Oslob Oslob Rural Health Unit San Remigio San Remigio Health Rural Unit Santa Rosa Santa Rosa Community Hospital Tabuelan Tabuelan Rural Health Center 48 � Region Province Municipality6 Facility Name7 Cebu City Cebu City Bario Luz Health Center Cebu City Guba Community Hospital 8 Leyte Alangalang Alangalang Rural Health Unit Babatngon Babatngon Rural Health Unit Dulag Dulag Rural Health Unit Hilongos Hilongos Rural Health Unit Hindang Hindang Rural Health Unit Inopacan Inopacan Rural Health Center Jaro Jaro Rural Health Unit Mahaplag Mahaplag Rural Health Center Mayorga Mayorga Health Unit Pastrana Pastrana Rural Health Unit Tunga Tunga Municipal Health Office Villaba Villaba Community Hospital Samar Calbiga Calbiga Municipal Health Center Catbalogan Camp Lukban Station Hospital, Pa Jiabong Jiabong Rural Health Unit Paranas Paranas Rural Health Unit Pinabacdao Pinabacdao Rural Health Unit Talalora Talalora Rural Health Unit 49 � Region Province Municipality6 Facility Name7 Tacloban City Tacloban City Sagkahan Rural Health Unit Tacloban City Tacloban City Hospital 9 Zamboanga Del Norte Liloy Liloy Municipal Health Office/Rural Health Unit Manukan Manukan Municipal Health Office/Rural Health Unit Mutia Mutia Municipal Health Center Pinan Pinan District Hospital Rizal Rizal Municipal Health Office Salug Salug Municipal Health Office Sergio Osmeña Sr. Sergio Osmeña Sr. Rural Health Unit Sindangan Sindangan Municipal Health Office/Rural Health Unit Sirawai Sirawai Municipal Health Office/ Rural Health Unit Zamboanga Del Sur Aurora Aurora Municipal Health Office Dumalinao Dumalinao Municipal Health Office/RHU Dumingag Dumingag Municipal Health Office Guipos Guipos Municipal Health Office Kumalarang Kumalarang Municipal Health Office Labangan Kuta Maj.Cesar Sang-An Station Hospital Ramon Magsaysay Ramon Magsaysay Municipal Health Office/Rural Health Unit San Miguel San Miguel Municipal Health Office San Pablo San Pablo Municipal Health Office Tabina Tabina Municipal Health Office 50 � Region Province Municipality6 Facility Name7 10 Bukidnon Damulog Damulog Health Center Kalilangan Bukidnon Provincial Hospital- Kalilangan Kibawe Kibawe Health Center Lantapan Lantapan Rural Health Unit Malitbog Malitbog Health Center Quezon Quezon Municipal Health Office San Fernando San Fernando Rural Health Unit Sumilao Sumilao Rural Health Unit Talakag Talakag Health Center Misamis Oriental Claveria Misamis Oriental Provincial Hospital- Claveria Gitagum Gitagum Health Center Jasaan Jasaan Municipal Hospital Lagonglong Lagonglong Health Center Libertad Libertad Health Center Opol Opol Health Center Sugbongcogon Sugbongcogon Rural Health Unit 11 Compostela Valley Compostela Compostela Municipal Health Office Laak Laak Municipal Health Office Laak Laak Municipal Hospital Mabini Mabini Municipal Health Office 51 � Region Province Municipality6 Facility Name7 Maco Maco Municipal Health Office Nabunturan Nabunturan Health Office Pantukan Pantukan Municipal Health Office Davao Del Sur Kiblawan Kiblawan Office Of The Municipal Health Office Kiblawan Gregorio Matas District Hospital Malita Malita Municipal Health Office Matanao Matanao Rural Health Center Padada Padada Municipal Health Office Santa Maria Santa Maria Municipal Health Office Sulop Sulop Municipal Health Office 13 Agusan Del Norte Carmen Carmen Rural Health Unit Jabonga Jabonga Health Center Jabonga Jabonga Municipality Hospital Kitcharao Kitcharao Health Center Magallanes Magallanes Health Center Santiago Arsenia M. Centeno Municipal Health Center Tubay Tubay Rural Health Unit ARMM Lanao Del Sur Balindong Balindong Rural Health Unit Balindong Balindong Hospital Buadipuso-Butong Buadipuso-Butong Rural Health Unit Bubong Bubong Health Center 52 � Region Province Municipality6 Facility Name7 Bumbaran Bumbaran Rural Health Unit Calanogas Calanogas Rural Health Unit Distaan-Ramain Bago A Ingud Rural Health Unit Madalum Madalum Rural Health Unit Marantao Marantao Health Center Masiu Masiu Rural Health Unit Piagapo Piagapo Rural Health Unit Poona Bayabao Poona Bayabao Rural Health Unit Saguiaran Saguiaran Health Center Tamparan Tamparan Health Center Taraka Taraka Health Center Wao Wao Rural Health Unit Tawi-Tawi Bongao Bongao Health Center Languyan Languyan Rural Health Unit Languyan Languyan Municipal Hospital Panglima Panglima Sugala Rural Health Unit Sapa-Sapa Sapa-Sapa Rural Health Unit Simunul Simunul Rural Health Unit South Ubian South Ubian Rural Health Unit Tandubas Tandubas Rural Health Unit 53 � 54 � Appendix B Additional Tables Table 15. Availability of FP Products on the Day of the Visit by Facility Type RHU Hospitals Warehouses n= n= n= FP Products Combined Oral (COC) 70% (151) 216 (6) 7 69% (20) 29 Condoms 70% (140) 200 (4) 5 64%(16) 25 Cycle Beads 78% (91) 116 (1) 1 65% (11) 17 DMPA 66% (140) 212 (3) 6 48% (14) 29 IUDs 86% (154) 180 (4) 4 72% (21) 29 Norifam 56% (10) 18 -- -- (2) 5 Progesterone Only Pills (POP) 51% (30) 59 (1) 2 (7) 13 Table 16. Availability of MNCH Products on the Day of the Visit by Facility Type RHU Hospitals Warehouses n= n= n= MNCH Products Amox. Tab. (250mg) 35% (47) 136 73% (8) 11 50% (8) 16 Amox. Susp. (125mg/5ml) 36% (49) 137 (7) 9 50% (6) 12 Ferrous Sulfate 70% (82) 117 (2) 7 53% (8) 15 Magnesium Sulfate 27% (7) 26 (3) 7 (0) 4 Mebendazole (500mg) 39% (43) 109 36% (4) 11 (1) 10 ORS 65% (127) 196 63% (12) 19 50% (11) 22 Oxytocin 63% (82) 131 83% (19) 23 50% (9) 18 55 � Table 17. Family Planning Products Managed at Facilities by Province Note: Results are not significantly representative at the provincial level Table should be read ““5 out of 7 SDPs in Agusan Del Norte managed COC”” # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP RHU 224 216 (96%) 116 (52%) 212 (95%) 180 (80%) 2 00 (89%) 18 (8%) 59 (26%) Hospital 32 7 (22%) 1 (3%) 6 (19%) 4 (13%) 5 (16%) 0 2 (6%) Warehouse 30 29 (97%) 17 (57%) 29 (97%) 29 (97%) 25 (83%) 5 (17%) 13 (43%) Agusan Del Norte SDP(s) 7 5 6 5 6 5 0 2 Warehouse 1 1 1 1 1 1 0 1 Total 8 6 7 6 7 6 0 3 Angeles City SDP(s) 2 1 3 1 1 2 0 0 0 1 1 2 0 1 1 1 1 2 0 0 0 0 0 0 Warehouse Total Bacolod City SDP(s) 1 1 0 1 1 1 0 0 Warehouse 0 -- -- -- -- -- -- -- Total 1 1 0 1 1 1 0 0 57 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Batangas SDP(s) 7 1 7 4 DK 4 2 DK 2 4 DK 4 3 DK 3 4 DK 4 0 DK 0 2 DK 2 Warehouse8 Total Benguet SDP(s) 8 8 8 8 7 7 0 4 Warehouse 1 1 1 1 1 0 0 1 Total 9 9 9 9 8 7 0 5 Bohol SDP(s) 13 1 14 12 1 13 4 0 4 11 1 12 10 1 11 12 1 13 1 0 1 4 1 5 Warehouse Total Bukidnon SDP(s) 9 8 3 8 8 8 1 2 Warehouse 1 1 0 1 1 0 0 1 Total 10 9 3 9 9 8 1 3 Bulacan SDP(s) 10 1 11 9 0 9 6 0 6 8 0 8 3 0 3 7 0 7 0 0 0 3 0 3 Warehouse Total Cagayan SDP(s) 6 5 1 4 5 3 0 0 8 Field Researchers were denied access to assess stocks in this warehouse 58 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Warehouse 1 1 0 1 1 1 0 0 Total 7 6 1 5 6 4 0 0 Camarines Sur SDP(s) 16 1 17 15 1 16 12 1 13 15 1 16 6 1 7 12 0 12 0 0 0 4 0 4 Warehouse Total Cebu SDP(s) 9 7 1 8 5 8 0 3 Warehouse 1 1 0 1 1 1 0 0 Total 10 8 1 9 6 9 0 3 Cebu City SDP(s) 2 1 3 1 1 2 0 0 0 1 1 2 1 1 2 1 1 2 1 0 1 0 1 1 Warehouse Total Compostela Valley SDP(s) 7 7 3 7 6 6 0 1 Warehouse 1 1 0 1 1 1 0 0 Total 8 8 3 8 7 7 0 1 Davao Del Sur SDP(s) 7 1 8 4 1 5 4 1 5 6 1 7 6 1 7 4 0 4 0 0 0 0 0 0 Warehouse Total Iloilo SDP(s) 11 9 1 9 8 9 0 0 59 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Warehouse 1 1 1 1 1 1 0 0 Total 12 10 2 10 9 10 0 0 Iloilo City SDP(s) 1 1 2 1 1 2 0 1 1 1 1 2 0 1 1 0 1 1 0 0 0 0 0 0 Warehouse Total Isabela SDP(s) 8 7 3 6 7 3 1 0 Warehouse 1 1 1 1 1 1 1 1 Total 9 8 4 7 8 4 2 1 Laguna SDP(s) 10 1 11 10 1 11 5 1 6 7 1 8 8 1 9 10 1 11 4 1 5 5 1 6 Warehouse Total Lanao Del Sur SDP(s) 16 14 14 15 14 15 1 0 Warehouse 1 1 1 1 1 1 0 0 Total 17 15 15 16 15 16 1 0 Leyte SDP(s) 12 1 13 12 1 13 8 1 9 10 1 11 12 1 13 11 1 12 0 0 0 5 1 6 Warehouse Total Lucena City SDP(s) 2 1 1 1 1 1 0 0 60 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Warehouse 1 1 1 1 1 1 0 0 Total 3 2 2 2 2 2 0 0 Marikina City SDP(s) 1 0 1 1 -- 1 1 -- 1 1 -- 1 1 -- 1 1 -- 1 0 -- 0 1 -- 1 Warehouse Total Misamis Oriental SDP(s) 7 5 3 5 5 5 2 4 Warehouse 1 1 0 1 1 1 1 1 Total 8 6 3 6 6 6 3 5 Negros Occidental SDP(s) 15 1 16 14 1 15 6 0 6 13 1 14 13 1 14 13 1 14 1 1 2 0 1 1 Warehouse Total Pampanga SDP(s) 9 8 4 8 2 8 1 7 Warehouse 1 1 1 1 1 1 0 1 Total 10 9 5 9 3 9 1 8 Pangasinan SDP(s) 10 1 11 10 1 11 4 1 5 10 1 11 10 1 11 10 1 11 5 1 6 8 1 9 Warehouse Total Quezon SDP(s) 9 7 2 8 7 5 0 1 61 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Warehouse 1 1 1 1 1 1 0 0 Total 10 8 3 9 8 6 0 1 Samar SDP(s) 5 1 6 5 1 6 0 0 0 5 1 6 2 1 3 3 1 4 0 0 0 1 0 1 Warehouse Total Sorsogon SDP(s) 7 6 5 6 5 6 0 0 Warehouse 1 1 1 1 1 1 0 0 Total 8 7 6 7 6 7 0 0 Tacloban City SDP(s) 2 1 3 2 1 3 0 0 0 2 1 3 1 1 2 2 1 3 0 0 0 1 1 2 Warehouse Total Tawi-Tawi SDP(s) 8 7 5 7 5 7 0 0 Warehouse 1 1 1 1 1 1 0 0 Total 9 8 6 8 6 8 0 0 Zamboanga Del Norte SDP(s) 9 1 10 8 1 9 1 0 1 8 1 9 7 1 8 8 1 9 0 0 0 2 0 2 Warehouse Total Zamboanga Del Sur SDP(s) 10 9 4 9 9 9 0 1 62 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Warehouse 1 1 1 1 1 1 0 0 Total 11 10 5 10 10 10 0 1 Table 18. Availability of Family Planning Products on the Day of Visit at Facilities by Province Note: Results are not significantly representative at the provincial level Table should be read ““5 out of 7 SDPs in Agusan Del Norte had COC available on the day of visit”” # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP RHU 224 67% 41% 63% 69% 63% 4% 13% Hospital 32 19% 13% 3% 9% 13% 0% 3% Warehouse 30 67% 53% 37% 47% 70% 7% 23% Agusan Del Norte SDP(s) 7 5 6 5 6 5 0 2 Warehouse 1 1 0 1 1 0 0 0 Total 8 6 6 6 7 5 0 2 Angeles City SDP(s) Warehouse Total 2 1 3 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 Bacolod City SDP(s) 1 1 0 1 1 1 0 0 63 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Warehouse 0 -- -- -- -- -- -- -- Total 1 1 0 1 1 1 0 0 Batangas SDP(s) Warehouse9 Total 7 1 7 4 DK 4 2 DK 2 4 DK 4 1 DK 1 2 DK 2 0 DK 0 1 DK 1 Benguet SDP(s) 8 7 8 7 6 6 0 3 Warehouse 1 1 1 1 1 0 0 1 Total 9 8 9 8 7 6 0 4 Bohol SDP(s) Warehouse Total 13 1 14 7 0 7 3 0 3 7 0 7 10 1 11 10 1 11 0 0 0 1 0 1 Bukidnon SDP(s) 9 4 3 6 8 7 1 1 Warehouse 1 0 0 0 0 0 0 0 Total 10 4 3 6 8 7 1 1 Bulacan SDP(s) Warehouse Total 10 1 11 7 0 7 4 0 4 5 0 5 3 0 3 6 0 6 0 0 0 1 0 1 9 Field Researchers were denied access to product availability 64 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Cagayan SDP(s) 6 4 1 3 5 1 0 0 Warehouse 1 1 0 0 1 0 0 0 Total 7 5 1 3 6 1 0 0 Camarines Sur SDP(s) Warehouse Total 16 1 17 4 0 4 3 1 4 5 0 5 2 0 2 7 0 7 0 0 0 0 0 0 Cebu SDP(s) 9 3 1 6 4 5 0 2 Warehouse 1 0 0 0 1 0 0 0 Total 10 3 1 6 5 5 0 2 Cebu City SDP(s) Warehouse Total 2 1 3 1 0 1 0 0 0 1 0 1 1 0 1 1 1 2 1 0 1 0 1 1 Compostela Valley SDP(s) 7 4 3 5 6 5 0 0 Warehouse 1 1 0 0 1 1 0 0 Total 8 5 3 5 7 6 0 0 Davao Del Sur SDP(s) Warehouse 7 1 4 1 2 1 3 0 4 0 2 0 0 0 0 0 Total 8 5 3 3 4 2 0 0 Iloilo SDP(s) 11 4 0 3 7 2 0 0 65 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Warehouse 1 1 0 1 1 1 0 0 Total 12 5 0 4 8 3 0 0 Iloilo City SDP(s) 1 1 0 1 0 0 0 0 Warehouse 1 1 0 1 1 0 0 0 Total 2 2 0 2 1 0 0 0 Isabela SDP(s) 8 7 3 5 7 2 0 0 Warehouse 1 1 1 0 1 0 0 0 Total 9 8 4 5 8 2 0 0 Laguna SDP(s) 10 9 5 4 7 5 3 0 Warehouse 1 0 0 0 0 0 0 0 Total 11 9 5 4 7 5 3 0 Lanao Del Sur SDP(s) 16 14 14 15 13 15 0 0 Warehouse 1 1 1 0 1 1 0 0 Total 17 15 15 15 14 16 0 0 Leyte SDP(s) 12 1 7 3 10 2 0 0 Warehouse 1 1 0 1 1 0 0 1 Total 13 2 7 4 11 2 0 1 Lucena City SDP(s) 2 1 1 1 0 0 0 0 Warehouse 1 1 1 1 1 1 0 0 66 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Total 3 2 2 2 1 1 0 0 Marikina City SDP(s) Warehouse Total 1 0 1 1 -- 1 1 -- 1 1 -- 1 1 -- 1 1 -- 1 0 -- 0 0 -- 0 Misamis Oriental SDP(s) 7 4 3 4 4 4 1 4 Warehouse 1 1 0 1 1 1 1 1 Total 8 5 3 5 5 5 2 5 Negros Occidental SDP(s) Warehouse Total 15 1 16 8 1 9 6 0 6 2 0 2 13 1 14 7 1 8 1 0 1 0 1 1 Pampanga SDP(s) 9 7 2 7 2 8 0 7 Warehouse 1 1 1 1 0 1 0 1 Total 10 8 3 8 2 9 0 8 Pangasinan SDP(s) Warehouse Total 10 1 11 8 1 9 3 1 4 8 1 9 9 1 10 7 1 8 3 1 4 4 1 5 Quezon SDP(s) 9 7 2 8 4 4 0 1 Warehouse 1 1 1 1 0 1 0 0 Total 10 8 3 9 4 5 0 1 67 � # of Facilities COC Cycle Beads DMPA IUD Male Condoms Norifam POP Samar SDP(s) 5 5 0 3 2 3 0 1 Warehouse 1 1 0 1 1 1 0 0 Total 6 6 0 4 3 4 0 1 Sorsogon SDP(s) 7 2 4 2 3 5 0 0 Warehouse 1 0 1 0 1 0 0 0 Total 8 2 5 2 4 5 0 0 Tacloban City SDP(s) 2 2 0 0 1 2 0 1 Warehouse 1 0 0 1 1 1 0 0 Total 3 2 0 1 2 3 0 1 Tawi-Tawi SDP(s) 8 7 5 7 4 7 0 0 Warehouse 1 1 1 1 1 1 0 0 Total 9 8 6 8 5 8 0 0 Zamboanga Del Norte SDP(s) 9 6 0 4 5 4 0 2 Warehouse 1 0 0 0 1 0 0 0 Total 10 6 0 4 6 4 0 2 Zamboanga Del Sur SDP(s) 10 8 0 7 9 8 0 0 Warehouse 1 1 0 0 1 1 0 0 Total 11 9 0 7 10 9 0 0 68 � Table 19. Maternal, Newborn and Child Health Products Managed at Facilities by Province Note: Results are not significantly representative at the provincial level Table should be read ““1 out of 7 SDPs in Agusan Del Norte managed Amoxicillin Tablets”” # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin RHU 224 136 (61%) 137 (61%) 117 (52%) 26 (12%) 109 (49%) 196 (88%) 131 (58%) Hospital 32 11 (34%) 9 (28%) 7 (22%) 7 ((22%) 11 (34%) 19 (59%) 23 (23%) Warehouse 30 16 (53%) 12 (40%) 15 (50%) 4 (13%) 10 (33%) 22 (73%) 18 (60%) Agusan Del Norte SDP(s) 7 1 4 3 1 2 5 6 Warehouse 1 1 1 1 1 1 1 1 Total 8 2 5 4 2 3 6 7 Angeles City SDP(s) 2 0 0 0 1 0 1 2 Warehouse 1 0 0 1 0 0 0 1 Total 3 0 0 1 1 0 1 3 Bacolod City SDP(s) 1 1 0 0 0 0 1 1 Warehouse 0 -- -- -- -- -- -- -- Total 1 1 0 0 0 0 1 1 Batangas SDP(s) 7 2 1 2 1 4 6 3 Warehouse 1 DK DK DK DK DK DK DK Total 7 2 1 2 1 4 6 3 69 � # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin Benguet SDP(s) 8 5 2 7 3 8 8 7 Warehouse 1 1 1 1 0 0 1 1 Total 9 6 3 8 3 8 9 8 Bohol SDP(s) 13 7 5 2 1 2 13 7 Warehouse 1 0 0 0 0 0 0 1 Total 14 7 5 2 1 2 13 8 Bukidnon SDP(s) 9 4 4 0 0 4 8 7 Warehouse 1 0 0 0 0 0 1 0 Total 10 4 4 0 0 4 9 7 Bulacan SDP(s) 10 7 8 5 1 7 8 5 Warehouse 1 0 0 1 0 0 0 0 Total 11 7 8 6 1 7 8 5 Cagayan SDP(s) 6 1 2 5 0 0 5 0 Warehouse 1 0 0 1 0 0 1 0 Total 7 1 2 6 0 0 6 0 Camarines Sur SDP(s) 16 11 11 1 4 9 14 2 Warehouse 1 0 0 0 0 0 0 0 Total 17 11 11 1 4 9 14 2 Cebu SDP(s) 9 7 8 5 3 4 8 8 70 � # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin Warehouse 1 1 0 0 0 0 1 0 Total 10 8 8 5 3 4 9 8 Cebu City SDP(s) 2 1 1 0 0 0 1 2 Warehouse 1 1 0 0 0 0 1 1 Total 3 2 1 0 0 0 2 3 Compostela Valley SDP(s) 7 5 3 5 0 1 5 3 Warehouse 1 1 1 1 0 0 1 0 Total 8 6 4 6 0 1 6 3 Davao Del Sur SDP(s) 7 3 3 6 3 6 7 5 Warehouse 1 0 0 1 0 0 1 1 Total 8 3 3 7 3 6 8 6 Iloilo SDP(s) 11 1 5 6 0 0 9 6 Warehouse 1 0 0 0 0 0 1 0 Total 12 1 5 6 0 0 10 6 Iloilo City SDP(s) 1 1 1 0 0 1 1 0 Warehouse 1 0 0 0 0 0 0 0 Total 2 1 1 0 0 1 1 0 Isabela SDP(s) 8 8 7 7 0 1 8 4 Warehouse 1 1 1 1 0 0 1 0 71 � # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin Total 9 9 8 8 0 1 9 4 Laguna SDP(s) 10 10 10 6 1 9 10 6 Warehouse 1 1 1 1 0 1 1 1 Total 11 11 11 7 1 10 11 7 Lanao Del Sur SDP(s) 16 2 2 10 0 6 4 7 Warehouse 1 0 0 1 0 1 1 1 Total 17 2 2 11 0 7 5 8 Leyte SDP(s) 12 11 8 9 2 7 11 8 Warehouse 1 0 0 0 0 0 0 0 Total 13 11 8 9 2 7 11 8 Lucena City SDP(s) 2 1 0 0 0 1 2 0 Warehouse 1 1 0 0 0 0 1 1 Total 3 2 0 0 0 1 3 1 Marikina City SDP(s) 1 0 0 0 0 0 1 0 Warehouse 0 -- -- -- -- -- -- -- Total 1 0 0 0 0 0 1 0 Misamis Oriental SDP(s) 7 2 3 1 2 4 5 5 Warehouse 1 1 0 0 0 1 1 0 Total 8 3 3 1 2 5 6 5 72 � # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin Negros Occidental SDP(s) 15 6 7 1 0 3 14 13 Warehouse 1 0 1 0 0 0 1 1 Total 16 6 8 1 0 3 15 14 Pampanga SDP(s) 9 7 9 7 2 6 9 5 Warehouse 1 1 1 1 0 1 1 1 Total 10 8 10 8 2 7 10 6 Pangasinan SDP(s) 10 9 10 10 1 9 10 4 Warehouse 1 1 1 1 1 1 1 1 Total 11 10 11 11 2 10 11 5 Quezon SDP(s) 9 8 8 6 0 4 8 4 Warehouse 1 1 1 0 0 1 1 0 Total 10 9 9 6 0 5 9 4 Samar SDP(s) 5 4 2 1 1 2 5 2 Warehouse 1 1 1 0 0 0 1 1 Total 6 5 3 1 1 2 6 3 Sorsogon SDP(s) 7 6 5 0 0 2 7 7 Warehouse 1 1 1 0 1 1 1 1 Total 8 7 6 0 1 3 8 8 Tacloban City SDP(s) 2 1 0 1 0 1 1 1 73 � # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin Warehouse 1 1 0 0 0 0 0 1 Total 3 2 0 1 0 1 1 2 Tawi-Tawi SDP(s) 8 1 3 7 0 7 2 8 Warehouse 1 0 0 1 1 0 0 1 Total 9 1 3 8 1 7 2 9 Zamboanga Del Norte SDP(s) 9 7 7 7 4 8 9 9 Warehouse 1 0 0 1 0 1 1 1 Total 10 7 7 8 4 9 10 10 Zamboanga Del Sur SDP(s) 10 7 7 4 2 2 9 7 Warehouse 1 1 1 1 0 1 1 1 Total 11 8 8 5 2 3 10 8 74 � Table 20. Availability of Maternal, Newborn and Child Health Products on the Day of Visit at Facilities by Province Note: Results are not significantly representative at the provincial level Table should be read ““1 out of 7 SDPs in Agusan Del Norte had Amoxicillin Tablets available on the day of visit”” # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml ) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin RHU 224 21% 22% 37% 3% 19% 57% 37% Hospital 32 25% 22% 6% 9% 13% 38% 59% Warehouse 30 27% 20% 27% 0% 3% 37% 30% Agusan Del Norte SDP(s) 7 1 3 3 1 2 5 6 Warehouse 1 0 0 0 0 0 0 0 Total 8 1 3 3 1 2 5 6 Angeles City SDP(s) 2 0 0 0 0 0 0 0 Warehouse 1 0 0 0 0 0 0 0 Total 3 0 0 0 0 0 0 0 Bacolod City SDP(s) 1 1 0 0 0 0 1 1 Warehouse 0 -- -- -- -- -- -- -- Total 1 1 0 0 0 0 1 1 Batangas SDP(s) 7 1 1 1 1 2 2 1 Warehouse 1 DK DK DK DK DK DK DK Total 7 1 1 1 1 2 2 1 75 � # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml ) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin Benguet SDP(s) 8 2 1 0 1 2 7 6 Warehouse 1 0 1 1 0 0 1 1 Total 9 2 2 1 1 2 8 7 Bohol SDP(s) 13 4 0 0 0 1 6 4 Warehouse 1 0 0 0 0 0 0 1 Total 14 4 0 0 0 1 6 5 Bukidnon SDP(s) 9 2 3 0 0 2 8 6 Warehouse 1 0 0 0 0 0 0 0 Total 10 2 3 0 0 2 8 6 Bulacan SDP(s) 10 4 4 2 1 3 6 4 Warehouse 1 0 0 1 0 0 0 0 Total 11 4 4 3 1 3 6 4 Cagayan SDP(s) 6 1 0 5 0 0 4 0 Warehouse 1 0 0 0 0 0 0 0 Total 7 1 0 5 0 0 4 0 Camarines Sur SDP(s) 16 1 2 0 0 0 5 0 Warehouse 1 0 0 0 0 0 0 0 Total 17 1 2 0 0 0 5 0 76 � # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml ) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin Cebu SDP(s) 9 2 4 0 2 1 5 5 Warehouse 1 1 0 0 0 0 1 0 Total 10 3 4 0 2 1 6 5 Cebu City SDP(s) 2 0 0 0 0 0 0 1 Warehouse 1 1 0 0 0 0 1 1 Total 3 1 0 0 0 0 1 2 Compostela Valley SDP(s) 7 4 2 4 0 1 3 3 Warehouse 1 0 0 0 0 0 0 0 Total 8 4 2 4 0 1 3 3 Davao Del Sur SDP(s) 7 1 1 6 2 3 4 2 Warehouse 1 0 0 1 0 0 0 0 Total 8 1 1 7 2 3 4 2 Iloilo SDP(s) 11 1 4 6 0 0 9 3 Warehouse 1 0 0 0 0 0 0 0 Total 12 1 4 6 0 0 9 3 Iloilo City SDP(s) 1 0 0 0 0 1 1 0 Warehouse 1 0 0 0 0 0 0 0 Total 2 0 0 0 0 1 1 0 77 � # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml ) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin Isabela SDP(s) 8 5 4 7 0 1 6 4 Warehouse 1 0 0 1 0 0 1 0 Total 9 5 4 8 0 1 7 4 Laguna SDP(s) 10 2 4 4 0 2 9 1 Warehouse 1 0 1 0 0 0 1 0 Total 11 2 5 4 0 2 10 1 Lanao Del Sur SDP(s) 16 1 1 9 0 6 4 6 Warehouse 1 0 0 1 0 0 0 1 Total 17 1 1 10 0 6 4 7 Leyte SDP(s) 12 4 1 2 0 7 8 6 Warehouse 1 0 0 0 0 0 0 0 Total 13 4 1 2 0 7 8 6 Lucena City SDP(s) 2 1 0 0 0 0 2 0 Warehouse 1 1 0 0 0 0 1 0 Total 3 2 0 0 0 0 3 0 Marikina City SDP(s) 1 0 0 0 0 0 1 0 Warehouse 0 -- -- -- -- -- -- -- Total 1 0 0 0 0 0 1 0 78 � # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml ) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin Misamis Oriental SDP(s) 7 0 0 1 1 1 5 4 Warehouse 1 0 0 0 0 1 0 0 Total 8 0 0 1 1 2 5 4 Negros Occidental SDP(s) 15 1 4 0 0 3 11 10 Warehouse 1 0 0 0 0 0 1 1 Total 16 1 4 0 0 3 12 11 Pampanga SDP(s) 9 2 2 6 0 3 4 1 Warehouse 1 1 1 1 0 0 1 1 Total 10 3 3 7 0 3 5 2 Pangasinan SDP(s) 10 2 3 10 0 1 5 1 Warehouse 1 0 1 0 0 0 1 0 Total 11 2 4 10 0 1 6 1 Quezon SDP(s) 9 1 5 6 0 3 6 2 Warehouse 1 1 1 0 0 0 1 0 Total 10 2 6 6 0 3 7 2 Samar SDP(s) 5 2 0 0 0 1 1 2 Warehouse 1 1 0 0 0 0 1 1 Total 6 3 0 0 0 1 2 3 79 � # of Facilities Amoxicillin Tablet (250mg) Amoxicillin Suspension (125mg/5ml ) Ferrous Sulfate Magnesium Sulfate Mebendazole Tablet (500mg) ORS Oxytocin Sorsogon SDP(s) 7 3 3 0 0 1 4 7 Warehouse 1 1 1 0 0 0 0 1 Total 8 4 4 0 0 1 4 8 Tacloban City SDP(s) 2 0 0 1 0 0 0 0 Warehouse 1 1 0 0 0 0 0 1 Total 3 1 0 1 0 0 0 1 Tawi-Tawi SDP(s) 8 1 1 7 0 0 1 5 Warehouse 1 0 0 1 0 0 0 0 Total 9 1 1 8 0 0 1 5 Zamboanga Del Norte SDP(s) 9 4 1 3 1 0 4 7 Warehouse 1 0 0 1 0 0 0 0 Total 10 4 1 4 1 0 4 7 Zamboanga Del Sur SDP(s) 10 1 2 1 0 0 2 3 Warehouse 1 0 0 0 0 0 0 0 Total 11 1 2 1 0 0 2 3 80 � Appendix C Logistics Indicator Assessment Tool (LIAT) Note: The format of the tool is based on ““specifications”” in EpiSurveyor Survey Name :1_Phil_FacilityID_4DC No of Questions:15 ================================================================ 1:FACILITY IDENTIFICATION. The questions in this form provide general information about the health facility/warehouse (label) 2:Date of Visit (date) Data Field Name : d__date 3:Facility/Warehouse Name (text) Data Field Name : T__facilityname 4:Facility ID (this will be used as the unique identifier for this facility) (text) Data Field Name : ID__FacilityCode 5:Region (multi) Data Field Name : ID__Region Possible responses: - Cordillera Administrative Region (CAR) .CAR - Ilocos Region (Region I).1 - Cagayan Valley (Region II) .2 - Central Luzon (Region III) .3 - National Capital Region (Manila) .NCR - CALABARZON (Region IV-A) .4A - Bicol Region (Region V) .5 - Western Visayas (Region VI) .6 Æ Skip to 7 - Central Visayas (Region VII) .7 Æ Skip to 7 - Eastern Visayas (Region VIII) .8 Æ Skip to 7 - Zamboanga Peninsula (Region IX).9 Æ Skip to 8 - Northern Mindanao (Region X) .10 Æ Skip to 8 - Davao Region (Region XI).11 Æ Skip to 8 - Caraga Region (Region XIII) .13 Æ Skip to 8 81 � - Autonomous Region of Muslim Mindanao (ARMM) .ARMM Æ Skip to 8 6:Province or Independent City (Luzon) (multi) Data Field Name : ID__province_Luzon Possible responses: - Angeles City - Batangas - Benguet - Bulacan - Cagayan - Camarines Sur - Isabela ÆÆGo to 9 - Laguna - Lucena City - Marikina City - Pampanga - Pangasinan - Quezon - Sorsogon 7:Province or Independent City (Visayas) (multi) Data Field Name : ID__province_Visayas Possible responses: - Bacolod City - Bohol - Cebu - Cebu City - Iloilo ÆÆGo to 9 - Iloilo City - Leyte - Negros Occidental - Samar - Tacloban City 8:Province or Independent City (Mindanao) (multi) Data Field Name : ID__province_Mindanao Possible responses: - Agusan del Norte - Compostela Valley - Davao del Sur - Lanao del Sur - Misamis Oriental - Tawi Tawi - Zamboanga del Norte - Zamboanga del Sur 82 � 9:Facility Type (multi) Data Field Name : ID__hf_type Possible responses: - Regional Hospital . 1 - Provincial Hospital . 2 - District Hospital . 3 Æ Skip to 11 (unless ““Other”” is selected) - Municipal Hospital . 4 - Rural health unit (RHU) . 5 - Provincial Warehouse . 6 - Regional Warehouse . 7 - Other . 8 10:Facility type (other) (text) Data Field Name : T__hf_type_other 11:Name of Municipality (text) Data Field Name : T__Municipality 12:Q1. Is the road into the facility paved? (multi) Data Field Name : Q01__tarmac Possible responses: - Yes . 1 - No . 0 13:Q2. Is electricity available in the facility on day of visit? (multi) Data Field Name : Q02__electricity Possible responses: - Yes . 1 - No . 0 14:Q3. Is running water available in the building on the day of the visit? (multi) Data Field Name : Q03__water Possible responses: - Yes . 1 - No . 0 15:Q4. Is there a telephone (land line or mobile) or radio on day of visit? (multi) Data Field Name : Q04__phone Possible responses: - Yes . 1 - No . 0 - Don`t Know . 98 16:This is the end of this form. Choose NEXT and on the following screen choose FINISH FOR NOW (label) 83 � Survey Name : 2_Philip_HFlog_4DC No of Questions:41 ================================================================ 1:FACILITY QUESTIONNAIRE.The questions in this form will be completed through interviews with the health facility personnel responsible for managing FP commodities. (label) 2:Enter Province (text) Data Field Name : T__Province 3:Facility Code (this will be used as the unique identifier for this facility) (text) Data Field Name : ID__Facility_code 4:Read objectives of the survey and record personnel name on supplemental form following any questions. Be sure to also record a phone number. (label) 5:Q1. What is your title? (multi) Data Field Name : Q01__Title_1 Possible responses: - Municipal health officer . 1 - Supply officer . 2 - Nurse . 3 - Midwife . 4 ÆSkip to Q2 (unless ““Other”” is selected) - Medical Officer . 5 - Pharmacy Assistant . 6 - Pharmacist . 7 - Other . 8 6:Q1a. Title-other specify (text) Data Field Q01a__Name : title1_oth 7:Q2. How long have you worked at this facility? (Enter total value in months. 1 year=12mo, 2yrs=24mo, 3yrs=36mo) (number) Data Field Name : Q02__timework 8:Q3. Are you the primary person responsible for managing drugs and medicine/ family planning products at this facility? (multi) Data Field Name : Q03__primary Possible responses: - Yes . 1 Æ If yes, skip to Q5 - No . 0 84 � 9:Q4. Who is the principal person responsible for managing drugs and medicine/family planning products at this facility? (multi) Data Field Name : Q04__primaryperson Possible responses: - Municipal health officer . 1 - Supply officer . 2 - Nurse . 3 - Midwife . 4 - Medical Officer . 5 - Pharmacy Assistant . 6 - Pharmacist . 7 - Other . 8 - Don`t know . 98 10:Q5. Is supplies/stock management the primary role of yours (or this other person) at this facility? (multi) Data Field Name : Q05__PrimaryRole Possible responses: - Yes . 1 - No . 0 11:Q6. Do you use any of the following stock keeping logistics forms to manage health products in this facility? (check all that applies) (multi) Data Field Name : Q06__logforms Possible responses: - Stock card/bin card/inventory control card . SC - Stock ledger . SL - Dispense-to-user record . DUR - Requisition and issue records (eg RIS) . RIS - Stock on hand (eg inventory reports) . SOH - Other form . Other - None . None 12:Q7. Do you have a computer that is used or could be used for commodity management (multi) Data Field Name : Q07__computer Possible responses: - Computer used for commodity management . 1 - Have computer but not used for commodity management . 2 - No computer . 3 13:Q8. Do you have internet at this facility (multi) Data Field Name : Q08__internet Possible responses: - Yes . 1 - No . 0 85 � 14:Q9. How did you learn to complete the forms/records used at this facility (check all that apply) (multi) Data Field Name : Q09__logtrain Possible responses: - During a logistics workshop - On-the-job training ÆSkip to Q10 (unless ““Other”” is selected) - Never been trained - Other (specify) 15:Q9a. Training to complete forms-Other specify (text) Data Field Name : Q09a__logtrain_oth 16:Q10. Who determines how much this facility orders when REQUESTING resupply of FP products? (check all that applies) (multi) Data Field Name : Q10__resupply_order Possible responses: - I do or someone at this facility . the facility - FP Coordinator/Municipality . FP Coordinator - Provincial Health Officer/coordinator . PHO - Regional Health Officer/coordinator . RHO ÆSkip to Q11 (unless ““Other”” is selected) - DOH . DOH - Other (specify) . other - Don’’t Know . DK 17:Q10a. Order resupply-Other specify (text) Data Field Name : Q10a__resupply_order_oth 18:Q11. Who determines how much product this facility RECIEVES for resupply? (check all that apply) (multi) Data Field Name : Q11__resupply_receives Possible responses: - I do or someone at this facility . the facility - FP Coordinator/Municipality . FP Coordinator - Provincial Health Officer/coordinator . PHO - Regional Health Officer/coordinator . RHO ÆSkip to 19 (unless ““Other”” is selected) - DOH . DOH - Other (specify) . other - Don’’t Know . DK 19:Q11a. Enter other for resupply receive (text) Data Field Name : Q11a__resupply_receive_other 20:Q12. How are the facility's resupply quantities determined? (multi) Data Field Name : Q12__quant_determine Possible responses: - Formula (any calculation) . 1 - Forecasting. 2 86 � - Available funding . 3 - Previous consumption . 4 ÆSkip to Q13 (unless ““Other”” is selected) - Other (specify) . 8 - Don`t know . 98 21:Q12a. Quantities determined other (specify) (text) Data Field Name : Q12a__quant_determine_oth 22:Q13. How frequently are FP products ordered? (multi) Data Field Name : Q13__freq_comm_order Possible responses: - No defined period . 1 - Monthly . 2 - Bi-Monthly . 3 - Quarterly . 4 - Semi-annually . 5 - Annually . 6 - Don`t know . 98 23:Q14. On average, approximately how long does it take between ordering and receiving products? (multi) Data Field Name : Q14__timebtword Possible responses: - Less than 2 weeks . 1 - 2 weeks to 1 month . 2 - Between 1 and 2 months . 3 - More than 2 months . 4 - Don`t know . 98 24:Q15. How many emergency orders for FP products have you places in the last 3 months (multi) Data Field Name : Q15__emergencyorder Possible responses: - None . 0 - 1 . 1 - 2 . 2 - 3 . 3 - More than 3 . 4 - Don`t know . 98 87 � 25:Q16. In the last 6 months, what sources of funding were used for ordering FP products? (Check all that apply) (multi) Data Field Name : Q16__fundingFPcomm Possible responses: - Facility Budget/Municipality . Facility - MCH/N Grants . Grants - Donations . Donations ÆSkip to Q17 (unless ““Other”” is selected) - Other (Specify) . Other - Don`t know . DK 26:Q16a. Source of funding-Other specify (text) Data Field Name : Q16a__fundingFPcomm_oth 27:Q17a. IF FACILITY BUDGET was NOT mentioned in Q16 then select NA, ELSE ask. ““What was the source of supply for the FP products when the FACILITY BUDGET was the source of funding.”” (multi) Data Field Name : Q17a__sourcesupply_facility Possible responses: - DKT Representative . 1 - DOH . 2 - League of Municipality . 3 - Local Distributor/Supplier . 4 - Region/Province . 5 - UNFPA . 6 - Don`t know . 98 - NA . 96 28:Q17b. IF MCH-N GRANTS was NOT mentioned in Q16 then select NA, ELSE ask. ““What was the source of supply for the FP products when MCH-N GRANTS was the source of funding?”” (multi) Data Field Name : Q17b__sourcesupply_MCHN Possible responses: - DKT Representative . 1 - DOH . 2 - League of Municipality . 3 - Local Distributor/Supplier . 4 - Region/Province . 5 - UNFPA . 6 - Don`t know . 98 - NA . 96 88 � 29:Q17c. IF DONATIONS was NOT mentioned in Q16 then select NA, ELSE ask…… ““What was the source of supply for the FP products when DONATIONS was the source of funding?”” (multi) Data Field Name : Q17c__sourcesupply_donations Possible responses: - DKT Representative . 1 - DOH . 2 - League of Municipality . 3 - Local Distributor/Supplier . 4 - Region/Province . 5 - UNFPA . 6 - Don`t know . 98 - NA . 96 30:Q17d. IF OTHER was NOT mentioned in Q16 then select NA, ELSE ask…… ““What was the source of supply for the FP products when _______ (OTHER) was the source of funding?”” (multi) Data Field Name : Q17d__sourcesupply_other Possible responses: - DKT Representative . 1 - DOH . 2 - League of Municipality . 3 - Local Distributor/Supplier . 4 - Region/Province . 5 - UNFPA . 6 - Don`t know . 98 - NA . 96 31:Q17e. IF DON’’T KNOW was NOT mentioned in Q16 then select NA, ELSE ask ““What was the source of supply for the FP products when DON'T KNOW is the source of funding?”” (multi) Data Field Name : Q17e__sourcesupply_dk Possible responses: - DKT Representative . 1 - DOH . 2 - League of Municipality . 3 - Local Distributor/Supplier . 4 - Region/Province . 5 - UNFPA . 6 - Don`t know . 98 - NA . 96 32:Q18. In the last 6 months, what has been your MOST frequent source of funding for family planning products? (multi) Data Field Name : Q18__sourcefunding_frequent Possible responses: - Facility Budget/Municipality . 1 - MCH/N Grant . 2 - Donations . 3 - Other (specify) . 4 - Don’’t know. 98 89 � 33:Q19. In the last 6 months, what has been your MOST frequent source of supply for family planning products (multi) Data Field Name : Q19__sourcesupply_frequent Possible responses: - DKT Representative . 1 - DOH . 2 - League of Municipality . 3 - Local Distributor/Supplier . 4 - Region/Province . 5 - UNFPA . 6 - Don`t know . 98 - NA . 96 34:Q20. Who is responsible for transporting products to your facility?(check all that apply.) (multi) Data Field Name : Q20__transport Possible responses: - This facility collects . facility - Local supplier delivers . Local supplier - LGU delivers . LGU Æ Skip to Q21 (unless ““Other”” is selected) -Province/Region delivers . Province - Other (specify) . other 35:Q20a. Transport to facilities-other specify (text) Data Field Name : Q20a__transport_oth 36:Q21. What type of transportation is most often used? (multi) Data Field Name : Q21__transportmostoften Possible responses: - Facility vehicle .1 Æ Skip to Q23 - Public transportation .2 Æ Skip to Q22 - Private vehicle .3 Æ Skip to Q23 - Boat .4 Æ Skip to Q23 - Motorcycle .5 Æ Skip to Q23 - Bicycle .6 Æ Skip to Q23 - On foot .7 Æ Skip to Q23 - Other (specify) .8 37:Q21a. Transport used most often-other specify (text) Data Field Name : Q21a__transportmostoften_other ÆÆ Go to Q23 90 � 38:Q22. Are facility funds provided for public transportation? (ONLY ASK if PUBLIC TRANSPORTATION was selected in Q21, otherwise select NA) (multi) Data Field Name : Q22__transportationfunds Possible responses: - Yes . 1 - No . 0 - NA . 96 39:Q23. When did you receive your most recent supervision visit? (Check visitors book, if necessary. If RESPONDENT does not know then select "never received") (multi) Data Field Name : Q23__ssvisit Possible responses: - Never received . 1 ÆIf ““never””, skip to 41 - Within the last month . 2 - 1 - 3 months ago . 3 - 3 - 6 months ago . 4 - More than 6 months ago . 5 40:Q24. Did your last supervision visit include drug management (e.g., stock cards checked, reports checked, expired stock removed, storage conditions checked)? (multi) Data Field Name : Q24__ssdrug Possible responses: - Yes . 1 - No . 0 - Don`t know . 98 41:This is the end of the interview. Thank the person for their time. Choose NEXT and on the following screen choose FINISH FOR NOW. (label) 91 � Survey Name : 3_Phil_HFdisp_Final No of Questions:30 =============================================================== 1:FACILITY QUESTIONNAIRE.The questions in this form will be completed through interviews with the health facility personnel responsible for dispensing/providing FP commodities to clients. (label) 2:Enter Province (text) Data Field Name : ID__Province 3:Facility Code (this will be used as the unique identifier for this facility) (text) Data Field Name : ID__Facility_code 4:Unless it is the same person interviewed on logistics, read objectives of the survey and record personnel name on supplemental form following any questions. Be sure to also record a phone number. (label) 5:Q1. Do patients receive any family planning products here for free? (multi) Data Field Name : Q01__freeFP Possible responses: - Yes . 1 - No . 0 - NA . 3 6:Q2. Do patients pay for any family planning products here? (multi) Data Field Name : Q02__payFP Possible responses: - Yes . 1 - No . 0 ÆIf no, skip to Q4 - NA . 3 7:Q3. How is the decision made for who pays for family planning products and who gets them for free (Only ask if YES to Q1 and Q2) (multi) Data Field Name : Q03__whopaywhofree Possible responses: - Free while supplies last . 1 - Free to the ““Poor”” . 2 - Depends on the type of product . 3 ÆÆ Go to Q4 (unless ““Other”” is selected) - Other (Specify) . 8 - NA . 96 8:Q3a. Who pays who free other (specify) (text) Data Field Name : Q03a__whopaywhofree_oth 92 � 9:Q4. In general, how much do patients pay or give as a donation for CONDOMS? (Put "0" if product is provided for free) (number) Data Field Name : Q04__pay_condoms 10:Q5. In general, how much do patients pay or give as a donation for PILLS? (Put "0" if product is provided for free) (number) Data Field Name : Q05__pay_pills 11:Q6. In general, how much do patients pay or give as a donation for INJECTABLES eg Depo? (Put "0" if product is provided for free) (number) Data Field Name : Q06__pay_injectable 12:Q7. In general, how much do patients pay or give as a donation for IUDs? (Put "0" if product is provided for free) (number) Data Field Name : Q07__pay_IUDs 13:Q8. In the past 6 months, have you been stocked out of CONDOMS at any time? If yes, for how long in total? (multi) Data Field Name : Q08__stkout_condoms Possible responses: - No not in the last 6 months . 0 - Less than 1 week. 1 - More than a week but less than 1 month (1-4 weeks) . 2 - Over 1 month . 3 - Over 3 months . 4 - NA Not managed at facility . 96 - Don’’t know / don’’t remember. 98 14:Q9. In the past 6 months, have you been stocked out of PILLS at any time? If yes, for how long in total? (multi) Data Field Name : Q09__stkout_pills Possible responses: - No not in the last 6 months . 0 - Less than 1 week. 1 - More than a week but less than 1 month (1-4 weeks) . 2 - Over 1 month . 3 - Over 3 months . 4 - NA Not managed at facility . 96 - Don’’t know / don’’t remember. 98 15:Q10. In the past 6 months, have you been stocked out of INJECTABLES (eg DEPO) at any time? If yes, for how long in total? (multi) Data Field Name : Q10__stkout_injectable Possible responses: - No not in the last 6 months . 0 - Less than 1 week. 1 - More than a week but less than 1 month (1-4 weeks) . 2 - Over 1 month . 3 93 � - Over 3 months . 4 - NA Not managed at facility . 96 - Don’’t know / don’’t remember. 98 16:Q11. In the past 6 months, have you been stocked out of IUDs at any time? If yes, for how long in total? (multi) Data Field Name : Q11__stkout_IUD Possible responses: - No not in the last 6 months . 0 - Less than 1 week. 1 - More than a week but less than 1 month (1-4 weeks) . 2 - Over 1 month . 3 - Over 3 months . 4 - NA Not managed at facility . 96 - Don’’t know / don’’t remember. 98 17:Q12. What do you think are the most common reasons for the stockouts (ONLY ASK if RESPONDENT said "Yes" to stockout in ANY of the previous 4 questions (Q8-Q11)) (check all that apply.) (multi) Data Field Name : Q12__stkout_reasons Possible responses: - Not enough funds . No funds - Delays in obtaining funds . Delay in funds - Delays in procurement . Delay in procurement - Poor forecasting/planning . Poor planning ÆÆ Go to Q13 (unless ““Other”” is selected) - Supplier delays . Supplier delays - Other (specify) . Other - Don’’t know. DK - NA . NA 18:Q12a. Reasons for stockout other (specify) (text) Data Field Name : Q12a__stkout_reasons_oth 19:Q13. Are IUD insertions available at this facility (multi) Data Field Name : Q13__IUD_availability Possible responses: - Yes . 1 ÆIf yes, skip to Q15 - No . 0 20:Q14. Why aren`t IUDs available here? (check all that apply) (multi) Data Field Name : Q14__IUDs_reasons Possible responses: - No one trained - Lack of medical supplies - Lack of IUD kits ÆÆ Go to Q15 (unless ““Other”” is selected) - No demand - Other (specify) 94 � 21:Q14a. IUDs available other (specfiy) (text) Data Field Name : Q14a__IUDs_reasons_oth 22:Q15. Are tubal ligations (BTL) available at this facility (multi) Data Field Name : Q15__BTL_availability Possible responses: - Yes . 1 ÆIf yes, skip to Q17 - No . 0 23:Q16. Why aren`t tubal ligations (BTL) available at this facility (multi) Data Field Name : Q16__BTL_reasons Possible responses: - No one trained - Lack of drugs/medicine ÆÆ Go to Q18 (unless ““Other”” is selected) - Lack of BTL kits - No demand - Other (specify) 24:Q16a. Tubal ligation other (specify) (text) Data Field Name : Q16a__BTL_reasons_oth ÆÆ Go to Q18 25:Q17. What type of anesthesia is given to the patient during the BTL? (multi) Data Field Name : Q17__BTL_anethesia Possible responses: - Local anesthesia . 1 - General anesthesia . 2 - Both depends on situation . 3 ÆÆ Go to Q18 (unless ““Other”” is selected) - Other (specify) . 3 - Don’’t know. 98 26:Q17a. Type of anesthesia other (specify) (text) Data Field Name : Q17a__BTL_anethesia_oth 27:Q18. Are vasectomies available at this facility? (multi) Data Field Name : Q18__vasectomy_availability Possible responses: - Yes . 1 ÆIf yes, skip to 30 - No . 0 95 � 28:Q19. Why aren`t vasectomies available at this facility? (multi) Data Field Name : Q19__vasectomy_reason Possible responses: - No one trained - Lack of drugs/medicine ÆÆ Go to 30 (unless ““Other”” is selected) - Lack of vasectomy kits - No demand - Other (specify) 29:Q19a.Vasectomies other (specify) (text) Data Field Name : Q19a__vasectomy_reason_oth 30:This is the end of the interview. Thank the person for their time. Choose NEXT and on the following screen choose FINISH FOR NOW. (label) 96 � Survey Name : 4_PhilStockStatus_FINAL No of Questions:19 ================================================================ ========= 1:This form will be used to assess the stock status of select products on the day of the visit. The answers to these questions will come from records at the facility, and by conducting a physical inventory. (label) 2:Enter Province name (text) Data Field Name : Enter_Province_name 3:Facility Code (this will be used as the unique identifier for this facility) (text) Data Field Name : ID__Facility_code 4:Q1. Select the next commodity to be assessed from the list of products below (multi) Data Field Name : Q01__CommodityName Possible responses: - 1-month injectable (Norifam . 1 - 3-month Injectable (medroxyprogesterone) . 2 - Condoms . 3 - Cycle Beads . 4 - IUD (Copper T Model TCu380A) . 5 - Pills-Combined Oral. 6 - Pills-Progesterone Only . 7 - Amoxicillin Tablet (250mg) . 8 - Amoxicillin Suspension (125mg/5ml). 9 - Ferrous sulfate tablet (Ferrous sulfate 200mg +250 mcg Folate) . 10 - Magnesium Sulfate (500 mg/ml) . 11 - Mebendazole Tablet (500 mg) . 12 - Oral Rehydration Salts (ORS)sachets . 13 - Oxytocin . 14 5:Q2. Is this commodity managed at this health facility? (multi) Data Field Name : Q02__Managed Possible responses: - Yes . 1 - No . 0 Æ If no skip to 19 6:Q3. What is the units of count (eg piece, vial, cycle) (text) Data Field Name : Q03__unitcount 7:Q4. What is the physical count of this commodity today (in the storm room)? (Use the smallest unit of count. E.g. piece or vial or cycle) (number) Data Field Name : Q04__Physical_Inventory 97 � 8:Q5. Is the facility stocked out of this commodity today? (multi) Data Field Name : Q05__Stockout Possible responses: - Yes . 1 - No . 0 9:Q6. What is the quantity of this commodity that is expired as of today's visit? (number) Data Field Name : Q06__QtyExpToday 10:Q7. Is the stock card available for this commodity? (multi) Data Field Name : Q07__StockCardAvailable Possible responses: - Yes . 1 - No . 0 Æ If no skip to 19 11:Q8. Has the stock card been updated for this commodity within the past 30 days? (If stock card was last update with balance of 0 and facility has not received any resupply, consider the stock card up to date) (multi) Data Field Name : Q08__StockcardUpdated Possible responses: - Yes . 1 - No . 0 12:Q9. What is the balance recorded on the stock card for this commodity? (number) Data Field Name : Q09__BalanceStockcard 13:Q10. According to the stock card, has there been a stockout of this product in the most recent six months? (multi) Data Field Name : Q10__Stockoutlast6months Possible responses: - Yes . 1 - No . 0 14:Q11. According to the stock card, how many stockouts have there been in the most recent six months? (number) Data Field Name : Q11__NumStockoutslast6months 15:Q12. According to the stock card, how many stockouts over the last six months lasted longer than three days? (number) Data Field Name : Q12__StockoutsLonger3Days 16:Q13. According to the stock card, what is the total number of days that this product was stocked out over the most recent six months? (number) Data Field Name : Q13__TotalDaysStockedout6mon 98 � 17:Q14. According to the stock card, how much of this commodity was issued from this facility during the most recent six months? (number) Data Field Name : Q14__Issued6Months 18:Q15. From the last six months, how many days of data are available in the stock card? (6 mo=180, 5 mo=150, 4 mo=120, 3 mo=90, 2 mo=60 etc) (number) Data Field Name : Q15__MonthsDataAvailable 19:You have completed the questions for this product. Check it off on the list of products on the paper form for this facility, select NEXT and select ADD NEW RECORD. If you have completed all products, select NEXT and select FINISH FOR NOW. (label) 99 � Form Name : 5_PhilipStorageCond_4DC No of Questions:29 ================================================================ 1:STORAGE CONDITIONS. This form will assess storage conditions at this facility through OBSERVATIONS of the storeroom. Before entering data, take a little bit of time to familiarize yourself with the general layout and conditions of the storeroom. (label) 2:Enter Province (text) Data Field Name : T__Province 3:Facility Code (this will be used as the unique identifier for this facility) (text) Data Field Name : ID__FacilityCode 4:Select facility type (multi) Data Field Name : Q00__ftype Possible responses: - Health Facility - Hospital - Warehouse 5:Q1.Products that are ready for distribution are arranged so that identification labels and expiry dates and/or manufacturing dates are visible (multi) Data Field Name : Q01__ProdArrange Possible responses: - Yes . 1 - No . 0 6:Q2. Products are stored and organized according to first-to-expire, first-out (FEFO), counting, and general management. (multi) Data Field Name : Q02__OrganizedFEFO Possible responses: - Yes . 1 - No . 0 7:Q3. Cartons and products are in good condition, not crushed due to mishandling and stacked right-side up (for Depo-Provera) (If cartons are open, determine if products are wet or cracked due to heat/radiation). (multi) Data Field Name : Q03__GoodCondition Possible responses: - Yes . 1 - No . 0 100 � 8:Q4. The facility makes it a practice to separate damaged and/or expired medicines and supplies from usable medicines and supplies and removes them from inventory. (multi) Data Field Name : Q04__SeparateDamaged Possible responses: - Yes . 1 - No . 0 9:Q5. Medicines and supplies are protected from direct sunlight on the day of the visit. (multi) Data Field Name : Q05__ProtectedSunlight Possible responses: - Yes . 1 - No . 0 10:Q6. Cartons and products are protected from water and humidity (multi) Data Field Name : Q06__ProtectedH2O Possible responses: - Yes . 1 - No . 0 11:Q7. The storeroom is free of rodents or insects in the storage area. (Visually inspect the storage area for evidence of rodents [droppings] or insects that can damage or contaminate the products.) (multi) Data Field Name : Q07__InsectsRodents Possible responses: - Yes . 1 - No . 0 12:Q8. Storage area is secured with a lock and key, but is accessible during normal working hours. Access is limited to authorized personnel. (multi) Data Field Name : Q08__LockKey Possible responses: - Yes . 1 - No . 0 13:Q9. Medicines and supplies are stored at the appropriate temperature on the day of the visit, according to product temperature specifications. (multi) Data Field Name : Q09__Temperature Possible responses: - Yes . 1 - No . 0 14:Q10. Roof is maintained in good condition to avoid sunlight and water penetration (multi) Data Field Name : Q10__Roof Possible responses: - Yes . 1 - No . 0 101 � 15:Q11. Storeroom is maintained in good condition (clean, all trash removed, sturdy shelves, organized boxes.) (multi) Data Field Name : Q11__Storeroom Possible responses: - Yes . 1 - No . 0 16:Q12. The current space and organization is sufficient for existing medicines and supplies, including room for reasonable expansion in the event of receipt of expected product deliveries. (multi) Data Field Name : Q12__CurrentSpace Possible responses: - Yes . 1 - No . 0 17:Q13. Is there appropriate fire safety equipment that is available and accessible? (any item identified as being used to promote fire safety should be considered) (multi) Data Field Name : Q13__FireSafety Possible responses: - Yes . 1 - No . 0 18:Q14. Are medicines stored separately from insecticides and chemicals? (multi) Data Field Name : Q14__SeparateChemicals Possible responses: - Yes . 1 - No . 0 19:Q15. Are there pallets/shelves available to ensure products are off the floor? (multi) Data Field Name : Q15__PalletsShelves Possible responses: - Yes . 1 - No . 0 20:Q16. Are products stored 1 ft. off the wall, 4 in from the floor (where appropriate) and stacked not more than 8 feet high? (multi) Data Field Name : Q16__StackedProperly Possible responses: - Yes . 1 - No . 0 - No stacked boxes/ NA. 96 21:Q17. In your estimation, does this facility adequately meet storage standards? (multi) Data Field Name : Q17__StorageStandardsOpinion Possible responses: - Yes . 1 - No . 0 102 � 22:Q18. Are there any products available at this facility that require cold chain management? (eg vaccines, Oxytocin) (multi) Data Field Name : Q18__ColdChain Possible responses: - Yes . 1 - No . 0 ÆIf no skip to 29 23:Q19. Are there functioning refrigerator(s) to store vaccines (multi) Data Field Name : Q19__Fridges Possible responses: - Yes . 1 - No . 0 ÆIf no skip to 29 24:Q20. How many refrigerators are there? (number) Data Field Name : Q20__NumFridges 25:Q21. What is the temperature in centigrade (if there are multiple refrigerators select the primary one) (number) Data Field Name : Q21__temp 26:Q22. Are refrigerators located away from any surrounding objects (approximately 1/2 meter)? (multi) Data Field Name : Q22__nearobjects Possible responses: - Yes . 1 - No . 0 27:Q23. Is the temperature chart up-to-date? (multi) Data Field Name : Q23__tempuptodate Possible responses: - Yes . 1 - No . 0 28:Q24. Is there a supply of paraffin or LPG for cold chain and sterilization purposes (multi) Data Field Name : Q24__paraffin Possible responses: - Yes . 1 - No . 0 29:You have completed the storage conditions for this facility. Select NEXT, and on the next screen choose FINISH FOR NOW. Record any observations on the paper form for this facility. (label) 103 � Survey Name : 6_Phil_ProvinceFP_4DC No of Questions:37 ================================================================ 1:PROVINCE FP. The questions in this form provide general information about the role of the provincial level in procurement and distribution of FP products. Data is conducted through INTERVIEWS with the Provincial FP coordinator or health officer. (label) 2:Date of Visit (date) Data Field Name : d__date 3:Provincial ID (this will be used as the unique identifier for the province) (text) Data Field Name : ID__ProvincialCode 4:Region (multi) Data Field Name : ID__Region Possible responses: - Cordillera Administrative Region (CAR) .CAR - Ilocos Region (Region I).1 - Cagayan Valley (Region II) .2 - Central Luzon (Region III) .3 - National Capital Region (Manila) .NCR - CALABARZON (Region IV-A) .4A - Bicol Region (Region V) .5 - Western Visayas (Region VI) .6 Æ Skip to 6 - Central Visayas (Region VII) .7 Æ Skip to 6 - Eastern Visayas (Region VIII) .8 Æ Skip to 6 - Zamboanga Peninsula (Region IX).9 Æ Skip to 7 - Northern Mindanao (Region X) .10 Æ Skip to 7 - Davao Region (Region XI).11 Æ Skip to 7 - Caraga Region (Region XIII) .13 Æ Skip to 7 - Autonomous Region of Muslim Mindanao (ARMM) .ARMM Æ Skip to 7 5:Province or Independent City (Luzon) (multi) Data Field Name : ID__province_Luzon Possible responses: - Angeles City - Batangas - Benguet - Bulacan - Cagayan - Camarines Sur - Isabela ÆÆGo to 8 - Laguna - Lucena City - Marikina City - Pampanga - Pangasinan 104 � - Quezon - Sorsogon 6:Province or Independent City (Visayas) (multi) Data Field Name : ID__province_Visayas Possible responses: - Bacolod City - Bohol - Cebu - Cebu City - Iloilo ÆÆGo to 8 - Iloilo City - Leyte - Negros Occidental - Samar - Tacloban City 7:Province or Independent City (Mindanao) (multi) Data Field Name : ID__province_Mindanao Possible responses: - Agusan del Norte - Bukidnon - Compostela Valley - Davao del Sur - Lanao del Sur - Misamis Oriental - Tawi Tawi - Zamboanga del Norte - Zamboanga del Sur 8:Job title of person being interviewed (text) Data Field Name : T__Jobtitle 9:Q1. Do you provide any assistance (e.g advice, purchasing, distributing etc. ) for FP commodities to any municipality within this province? (multi) Data Field Name : Q01__anyassist Possible responses: - Yes . 1 Æ If yes, skip to Q3 - No . 0 10:Q2. Why do you not provide assistance? (text) Data Field Name : Q02__noassistance ÆÆGo to Q17 105 � 11:Q3. Do you provide assistance/advice to the LGUs on types of FP products they should order? (multi) Data Field Name : Q03__advice_FPtypes Possible responses: - Yes . 1 - No . 0 12:Q4. Do you provide assistance/advice to the LGUs on amount of FP products to order? (multi) Data Field Name : Q04__advice_amount Possible responses: - Yes . 1 - No . 0 13:Q5. Do you provide assistance/advice to the LGUs on when they should order FP products? (multi) Data Field Name : Q05__advice_when Possible responses: - Yes . 1 - No . 0 14:Q6. Do you procure/purchase FP products on behalf of the LGU? (multi) Data Field Name : Q06__procureLGU Possible responses: - Yes . 1 - No . ………………………………0 ÆSkip to Q13 15:Q7. How do you determine the quantity that you procure? (multi) Data Field Name : Q07__quantprocure Possible responses: - Formula (any calculation) . 1 - Forecasting. 2 - Available funding . 3 - Previous consumption . 4 ÆSkip to Q8 (unless ““Other”” is selected) - Other (specify) . 8 - Don`t know . 98 16:Q7a. Enter "other" for Quantity Procured (text) Data Field Name : Q07a__quantprocure_other 17:Q8. On average, how frequently do you procure/order FP products for the LGUs? (multi) Data Field Name : Q08__frequentLGU Possible responses: - No defined period . 1 - Monthly . 2 - Quarterly . 3 - Semi-annually . 4 - Annually . 5 106 � - Don`t know . 98 18:Q9. What sources of funding are used for ordering FP commodities? (check all that apply) (multi) Data Field Name : Q09__sourcesFunding Possible responses: - Funds from LGU . LGU - Funds from Province . Province - Funds from Region . Region - MCH/N Grants . Grants - Donations . Donations - Other (Specify) . Other - Don`t know . DK 19:Q9a. Enter "other" sources of funding (text) Data Field Name : Q09a__sourcesFunding_oth 20:Q10. Do LGUs pay for the FP products that you procured for them? (multi) Data Field Name : Q10_LGUpay Possible responses: - Yes . 1 - No . 0 - Don`t know . 98 21:Q11. What sources of supply are used to procure FP products? (check all that apply) (multi) Data Field Name : Q11_FPsupply Possible responses: - DKT Representative . DKT - DOH . DOH - League of Municipality . League of Mun - Local Distributor/Supplier . Supplier - Region (CHD) . Region - UNFPA . UNFPA - Other (specify) . Other - Don`t know . DK 22:Q11a. Enter "other" for source of supply (text) Data Field Name : Q11a_FPsupply_other 23:Q12. In the past year, what has been the MAIN source of supply that are used to procure FP products? (multi) Data Field Name : Q12_mainsource Possible responses: - DKT Representative . 1 - DOH . 2 - League of Municipality . 3 - Local Distributor/Supplier . 4 - Region . 5 - UNFPA . 6 107 � - Other . 7 - Don`t know . 98 24:Q12a. Enter "other" main source of supply (text) Data Field Name : Q12a_mainsource_other 25:Q13. Do you/this province distribute any FP products to any LGU? (multi) Data Field Name : q13_distributeFP Possible responses: - Yes . 1 - No . 0 ÆÆIf no, Skip to Q17 - Don`t know . 98 26:Q14. Who is responsible for transporting the FP products to the LGU? (check all that apply) (multi) Data Field Name : Q14_transport Possible responses: - Province delivers . Province - Local supplier delivers . Local supplier - Region delivers . Region - LGU collects . LGU - Other (specify) . Other - Don`t know . DK 27:Q14a. Enter "other" for transport used most often (text) Data Field Name : Q14a_transport_other 28:Q15. What type of transportation is most often used? (multi) Data Field Name : Q15__transportmostoften Possible responses: - Provincial vehicle . 1 - LGU/RHU vehicle . 2 - Public transportation . 3 - Private vehicle . 4 - Boat . 5 - Other (specify) . 6 - Don`t know . 98 29:Q15a. Enter "other" for transport used most often (text) Data Field Name : Q14a_ transportmostoften_other 30:Q16. IF province DOES NOT procure and distribute FP products select NA, ELSE ask "On average, approximately how long does it take between ordering the FP products and the LGUs receiving them?" (multi) Data Field Name : Q16_lagtime Possible responses: - Less than 2 weeks . 1 108 � - 2 weeks to 1 month . 2 - Between 1 and 2 months . 3 - More than 2 months . 4 - Don`t know . 98 - NA . 96 31:Q17. Is there a provincial warehouse/store room where FP products are stored before being distributed to LGUs? (multi) Data Field Name : Q17_warehouse Possible responses: - Yes . 1 - No . 0 ÆÆIf no, Skip to Q21 - Don`t know . 98 ÆÆIf no, Skip to Q21 32:Q18. Is there a system for managing the stock at the warehouse/storeroom? If yes, ask "what type?" (multi) Data Field Name : Q18__warehousesystem Possible responses: - Yes-paper based - Yes-electronic - Yes-other - No - Don`t know 33:Q19. To the best of your knowledge, did the warehouse ever experience a stockout for any FP product in the previous 6 months? If yes, for how long? (multi) Data Field Name : Q19__stockoutFP Possible responses: - No not in the last 6 months ÆÆIf no, Skip to Q21 - Less than 1 week - More than a week but less than 1 month (1-4 weeks) - Over 1 month - Over 3 months - Don’’t know / don’’t remember 34:Q20. Which products were out of stock? (check all that apply) (multi) Data Field Name : Q20_prodoutofstock Possible responses: - 1-month injectable (Norifam) . Norifam - 3-month injectable (DEPO) . DEPO - Cycle beads . Cycle beads - Condoms . Condoms - IUD. IUD - Pills-Combined Oral. COP - Pills-Progesterone Only . POP 35:Q21. Does this province receive any FP products from the Region/CHDs? (multi) 109 � Data Field Name : Q21_productsregion Possible responses: - Yes . 1 - No . 0 ÆÆIf no, Go to 37 - Don`t know . 98 ÆÆ If no, Go to 37 36:Q22. Has the province or LGU provided funding for the products or has it been donated by the region? (multi) Data Field Name : Q22__regiondonate Possible responses: - Paid for . 1 - Donated . 2 - Don`t know . 98 37:This is the end of this form. Choose NEXT and on the following screen choose FINISH FOR NOW (label) 110 � Appendix D List of Field Researchers Project Manager Maria Alona Manaog-Reyes Field Manager Leny Aranzanso Field Supervisor Mylene Betiz Luzon Field Team Delfin Caido (Group Leader) Yarmie Guades Janice Olarte Amorsola Pabalan Maricel Garcia Analyn Opon Visayas Field Team Nancy Estilo (Group Leader) Ana Gloria Sy (Group Leader) Juliet Niñal Caroline Florita Cabudol Mia Villena Rie Octavio Jocelyn Lubrico Mindanao Field Team Grace Gallanero (Group Leader) Malyn Llanos (Group Leader) Suzette Atamosa Demma Flare Pueblos Aurorita Angub Rudina Montalban Marycris Pedrajas Barbara Van Gaabucayan Lovella Sumalpong Validation Team Julius Noguerras (DP Manager) Remie Lynne Rojo Dianne Camarao Melvin Buenavente Rachel Ragudo 111 � 112 � � For more information, please visit deliver.jsi.com. � � USAID | DELIVER PROJECT John Snow, Inc. 1616 Fort Myer Drive, 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: askdeliver@jsi.com Internet: deliver.jsi.com

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