The curious case of CAR (Cordillera Administrative Region): Healthcare workers are key to improving maternal health outcomes

Introduction@#Understaffed and underfunded Rural Health Units (RHUs) in Luzon struggle to provide Basic Emergency Obstetric and Newborn Care (BEmONC) services, resulting in high rates of maternal morbidity and mortality. The Cordillera Administrative Region (CAR) is different. Despite limited BEmONC-capable facilities, the region has maintained excellent maternal health outcomes. @*Objectives@#This study describes the status of BEmONC-capable RHUs in CAR and how these relate to the maternal and child health outcomes in the region. @*Methods@#This study uses the BEmONC Survey Toolkit to determine facility functionality based on the three categories of institutional capacity, service capacity, and personnel capacity. Focused Group Discussions were conducted to gather insights from community members, health personnel, and local stakeholders. @*Results@#The study evaluated 31 facilities; only one was adequately functional. The service capacity of BEmONC RHUs in CAR (7.19) was significantly lower than that of Luzon (14.16). The overall functionality score of CAR (58.10) was also slightly lower compared to that of Luzon (60.42). Yet CAR still had some of the best outcomes in terms of maternal and child health. Maternal mortality from 2000 (23 deaths) to 2018 (13 deaths) was consistently low. @*Conclusion@#The case of CAR reiterates the importance of having health personnel on the ground, maintaining the trust of the populace for health promotion to increase health awareness, and timely intervention in difficult situations. These directly impact health service delivery and improve health outcomes.

Mothers’ perspectives on utilization of maternal health services in Rural Health Units in Luzon: A qualitative study

Introduction@#Despite implementing various maternal health care programs and integrating these into Service Delivery Networks, the Philippines continues to have high maternal mortality. Identifying factors that impede the utilization of available maternal care services may help reduce maternal morbidity and mortality and bridge the gap between the need and actual use of such services among mothers in the community. @*Objectives@#This study identified barriers, hindrances, and other factors influencing mothers in availing maternal health services in Luzon, the largest island in the country and the area that accounted for more than half of total maternal mortality. @*Methods@#Eight focus group discussions participated in by a total of 78 pregnant women and mothers were conducted across all of the eight regions of Luzon. In each session, the participants were asked to answer questions based on a semi-structured interview guide. The interviews were recorded, translated and back-translated, transcribed, and compiled before analysis by the deductive-dominant approach using NVivo12. @*Results@#Factors affecting maternal health service utilization center on the capacity of health facilities to provide services like evaluation of the progress of pregnancy, laboratory examinations, free medicines, and immunizations; and on region-bound individual factors. The availability of skilled health personnel and lack of financial resources were the most common subthemes. @*Conclusion@#This study identified some key factors that deter patients from availing of existing maternal health services in Luzon. Eliminating these barriers will not only help strengthen local health infrastructure and improve service delivery but also promote the utilization of such services, leading to better maternal outcomes.

Selecting indicators for assessing the functionality of basic emergency obstetric and newborn care facilities in the Philippines: A Delphi process

Introduction@#To address the problem of high maternal death, the Department of Health implemented the Basic Emergency Obstetric and Newborn Care (BEmONC) services at the level of primary care health facilities. These are key life-saving interventions that treat obstetric emergencies. Over a decade later, we need to assess and improve the program’s implementation. @*Objective@#The study aims to select indicators for assessing the functionality of BEmONC facilities. @*Methods@#Electronic Delphi process was used to select the indicators. @*Results@#The two-round Delphi process was accepted by 21 respondents, with a 100% response rate. All 30 proposed indicators were retained following the criteria. @*Conclusion@#Thirty indicators to assess the functionality of BEmONC facilities have been selected through the consensus of an expert panel using the Delphi process. These indicators help evaluate BEmONC facilities, formulate policy, and guide new programs that promote maternal health.

The development of Basic Emergency Obstetric and Newborn Care (BEmONC) and Maternal Health in the Philippines: A historical literature review

Introduction@#Implementation of Basic Emergency Obstetric and Newborn Care (BEmONC) aims to curb maternal mortality. However, the Philippines failed to significantly reduce the maternal mortality rate (MMR) targeted in the Millennium Development Goals (MDGs). Currently, the country is still far from the targeted Sustainable Development Goals (SDGs). This review describes the historical development of BEmONC in the Philippines over the past 13 years and provides insights on its role in decreasing MMR. @*Methods@#We searched online for journal articles, publications, reports, policies, and other issuances related to BEmONC and maternal health in the Philippines. We accessed updates and data via correspondence with the Department of Health (DOH). Statistics were compiled from public databases. The identified citations were screened, appraised, synthesized, and analyzed in a historical approach. @*Results@#A direct result of the Emergency Obstetric Care Approach, BEmONC was developed to respond to the high MMR in the Philippines, in line with global efforts to improve maternal health. However, BEmONC functionality generally remained inadequate. @*Conclusions@#Although the provision of BEmONC services increased facility-based deliveries and skilled birth attendance during childbirth, this failed to decrease MMR and achieve targeted goals substantially. Further capacity-building is needed, especially in rural and resource-poor areas. Government issuances at the national and local levels should be aligned to complement each other. There should be a health systems approach that considers the building blocks of an efficient health care system and the social determinants that impact them.

A systematic review on Vitex negundo (NIRPROMP formulations) for the treatment of acute cough of mild to moderate severity in pediatric patients

Objective@#The aim of this systematic review was to evaluate the efficacy and safety of Vitex negundo (lagundi) for the treatment of acute cough of mild to moderate severity among pediatric patients.@*Methods@#A systematic review of randomized controlled trials (RCTs) comparing lagundi to placebo for acute cough of mild to moderate severity in children and adolescents aged two to twenty one years in ambulatory settings was performed. Authors of unpublished clinical trials with existing patent numbers were contacted and permission was obtained to access and include their studies in this review. @*Results@#Seven studies were included, with a total of 308 participants. Lagundi increased the peak exploratory flow rate (PEFR) at the end of therapy compared with placebo but this was not statistically significant (p=0.36). The increase in PEFR was consistent with the results of the mechanistic isolated tissue studies that showed bronchodilating effect of lagundi. Studies using lagundi syrup showed decrease in the frequency of cough by 44–71%.@*Conclusion@#Lagundi therapy in acute cough of mild to moderate severity among pediatric patients has a bronchodilating effect and decreases the frequency and duration of coughing, with no serious adverse effects.