ROJ-ZFF-MMRR-ZAMBOP White Paper

ROJoson-ZFF Project on Maternal Mortality Ratio /Rate Reduction (MMRR) in Zamboanga Peninsula

Reynaldo O. Joson, MD, MHA, MHPEd, MScSurg

February 25, 2015

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Backgrounder and Qualifiers in Title of Project:

ZFF (Zuelig Family Foundation) through Dr. Ramir Blanco invited me in February 15-17-24, 2015 to serve as its consultant for its project on reduction of maternal mortality rate in Zamboanga del Sur, Zamboanga del Norte, and Zamboanga Sibugay.

After being personally oriented and briefed by Dr. Ramir Blanco on February 17, 2015 in Atrium Hotel in Pasay City on the ZFF Project in Zamboanga del Sur, del Norte and Sibugay, I accepted the invitation for 3 reasons:

1. The project is aligned with and support my personal advocacy (Education for Health Development in the Philippines – link to website) which I started in 1989.

2. The project is aligned with and support my personal project in helping Zamboanga Peninsula through education on health [Department of Surgery of Zamboanga City Medical Center (1991 to 1997); Ateneo de Zamboanga University School of Medicine (1993 -1997); and Ciudad Medical Zamboanga (2009 – 2014)].

3. I was told I was the popular demand to be their consultant / coach / mentor by the people currently handling the ZFF project in Zamboanga Peninsula.

ROJoson-ZFF Project on Maternal Mortality Ratio/Rate Reduction in Zamboanga Peninsula just means that I will serve as a consultant and as a collaborator in the project of ZFF in Zamboanga Peninsula. In future documents, one will be seeing the following that specify or identify further the other collaborators such as ROJ-ZFF-DOH; ROJ-ZFF-DOH-ZDS; ROJ-ZFF-DOH-ZDN; ROJ-ZFF-DOH-ZS; ROJ-ZFF-DOH-ZDS-ZDSMC; ROJ-ZFF-DOH-ZDN-ZDNMC; ROJ-ZFF-DOH-ZS-ZSMC; etc.

The political map of Zamboanga Peninsula consists of Zamboanga City, Isabela City, Zamboanga del Sur, Zamboanga del Norte, and Zamboanga Sibugay. The current invitation of ZFF for my consultancy covers only Zamboanga del Sur, Zamboanga del Norte, and Zamboanga Sibugay. On my own, I will include Zamboanga City as it is within the peninsula and its resources may be useful to tap for the projects in Zamboanga del Sur, Zamboanga del Norte, and Zamboanga Sibugay.

Duration of ROJoson-ZFF Project MMRR-ZAMBOP

As stipulated by ZFF, the duration for my consultancy is 6 months (February to July, 2015 or March to August, 2015).

Expectations from ROJoson as Consultant of ZFF Project on MMRR in Zamboanga Peninsula

1. Coaching and supervision of Provincial Health Team (Provincial Health Officer, Chief of Hospital) of selected provinces (Zamboanga del Sur, Zamboanga del Norte, Zamboanga Sibugay) including transfer of coaching/supervision skills to Regional Account Officer/ Provincial Account Officer and DOH Regional Office personnel (eg. PHTL).

*PHTL - Provincial Health Team Leader - "PHTL is the Provincial DOH Representative or the DOH Team Leader in the province who serves as the supervisor to the DOH Representatives in the province." (from DOH Website - 15mar20)

A. Level of Effort per Coaching and Supervision

B. Workprogram and Total Level of Effort for Coaching 3 Provinces

*Note (15mar20): Coaching and supervision of PHO and Chiefs of Hospitals; Coaching of RAO/PAO and DOH RO personnel

Zamboanga Sibugay - PHO and Chiefs of Hospitals (Identify - Dr. Arthur Luspo .......)

Zamboanga del Sur - PHO and Chiefs of Hospitals (Identify - Dr. ......................)

Zamboanga de Norte - PHO and Chiefs of Hospitals (Identify - Dr. ...............)

ZFF - Regional Account Officer - Dr. Sherryl Ann Macrohon-Sew

ZFF - Provincial Account Officer - Mr. Charlou Peligro

DOH RO Personnel -

- Provincial Health Team Leaders

- Dr. Augusto Manolo Alpichi - PHTL, Zamboanga Sibugay

- Dr. - PHTL, Zamboanga del Sur

- Dr. - PHTL, Zamboanga del Norte

Note: I am willing to coach other people in the Zamboanga Peninsula on top of the above list. (15mar20)

ZFF Health Change Model and Bridging Leadership Framework

Since I was invited by ZFF to serve as its consultant, for alignment purposes, I will use the ZFF Health Change Model and Bridging Leadership Framework in the ROJ-ZFF-MMRR-ZAMBOP.

See also Zuellig Family Foundation and Bridging Leadership Framework.

Since I was asked to focus my consultancy on hospitals, I will use the following framework adapted from the original ZFF Health Change Model:

Below are the geographic and political maps for the communities under ROJ-ZFF-MMRR-ZAMBOP.

ROJOSON's Strategic, Tactical, and Operation Planning (Project Management - as Consultant)

Be very clear on the Goals / Objectives.

MMRR-ZAMBOP

Be very clear on Key Result Areas / Key Performance Indicators.

MMRR-ZAMBOP ----- 52 / 100,000 Live Births or better for each (ZDS, ZDN, ZS, and ZC) ----- by December 2015 or earlier (based on trending from May to July or August)

Be very clear on Strategies to use.

ZFF Health Change Model

ZFF Bridging Leadership Process

Facilitation

Stakeholders

Commitment

Education

Communication

Coordination and Collaboration (Partnership and Teamwork)

Budget

Tactics and Operations

Baseline database

Cause mapping of maternal deaths

Action plans based on causes identified

Deployment and implementation

Tracking and monitoring and evaluation and continual improvement

Strategies as a Consultant

Know the issue.

Know all the stakeholders.

Gather commitment.

Educate.

Develop a communication management system.

Develop a monitoring management system.

Develop an evaluation management system.

Problem-based Learning Issues:

Maternal Mortality Ratio vs Maternal Mortality Rate

Measure of Maternal Mortality in Service Facilities

No home-birthing ordinance

PHIC

POGS' Strategies on MMR

Definition of Terms:

Maternal Mortality Ratio - the number of maternal deaths per 100,000 live birth.

A maternal death (as cited in International Classification of Disease or ICD-10, [WHO, 1992]) is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, and can stem from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Late maternal deaths refer to deaths caused by direct or indirect obstetric causes more than 42 days but less than one year after the termination of pregnancy.

Pregnancy-related deaths are deaths while pregnant or within 42 days of the termination of pregnancy, irrespective of the cause.

Maternal deaths fall into two groups, direct and indirect, as follows:

Direct obstetric deaths

Direct obstetric deaths result from obstetric complications of the pregnant state (pregnancy, labor, and puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above.

Indirect obstetric deaths

Indirect obstetric deaths result from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancy.

The maternal mortality ratio is calculated as:

What is the ideal MMR?

Ideally, ZERO. However, this is not realistic. Near ZERO.

Estonio was able to achieve 2 / 100,000 (2010 Mundi). Singapore was able to achieve 3 / 100,000 (2010 Mundi).

What is the target of Philippines on MMR?

The Millenium Development Goal Target on MMR is 52/100,000 by 2015.

What is the current status on MDG 5 as of December 2014?

The maternal mortality as a community health problem may be tackled at various levels.

The maternal mortality as a health problem can also be tackled at health facilities like hospitals and lying-in clinics.

Where to get the data and statistics on MMR? How accurate are they?

Vital registration

Service facilities

Community-based survey or surveillance

The target is to track maternal death in the defined community and service facilities - WHO definition of maternal death - death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, and can stem from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

The number of maternal deaths is then divided by the number of live births in the community to get the maternal mortality ratio.

In hospital and lying-in clinic setting, the maternal death rate is computed as such: total number of direct maternal deaths over a period divided by the total number of maternal discharges including deaths for the same period. The quotient is then multiplied by 100.

What is an acceptable maternal death rate in the hospital or lying-in clinics?

What is the current status on MMR (Maternal Mortality Ratio) and MDR (Maternal Death Rate) in

Zamboanga del Sur; Zamboanga del Norte; Zamboanga Sibugay; and Zamboanga City?

ROJ@15feb25;15mar20