1. BACKGROUND

Reduction of maternal and neonatal morbidity and mortality remains to be a major challenge in the pursuit of the National Objectives for Health and the country's commitment as a member of the United Nations specifically to the 2015 Millennium Development Goals (MDGs). As such the Department of Health issued Administrative Order 2008-0029 Implementing Health Reforms for the Rapid Reduction of Maternal and Neonatal Mortality and Administrative Order 2009-0025 Adopting Policies and Guidelines on Essential New born Care. Towards efficient implementation of the said policies, there is a critical need to capacitate the health care workers to ensure the full functionality of health facilities in providing basic emergency obstetrics and neonatal services to improve health outcomes of mothers and neonates.

Capacity building and continuous professional education of midwives, nurses and physicians necessitate the identification and accreditation of training institutions and trainers all over the country, to accelerate current initiatives in rapidly reducing maternal and neo natal deaths. Such training activities will need to adhere to standards of care developed from updated evidence and clinical practice guidelines on essential intra-partum and new born care, quality health care services and patient safety, in addition to basic emergency obstetric and newborn care.

This Administrative Order is hereby issued to provide guidelines in the establishment of a consortium of training centers to build Emergency Obstetrics and Newborn Care (EmONC) capacity, with the end in view of accrediting training centers and providers.

II. GOALS AND OBJECTIVES

In general, this policy issuance sets the guidelines in the establishment of training centers for EmONC to ensure the provision of quality care. Specifically, it aims to:

1.  Be a guide in the development of a consortium of 3^rd and 4^th level hospital facilities with maternal and newborn care services as BEmONC training centers in strategically located areas.
2.   Be a guide in ensuring capability building of health care providers to deliver with proficiency the technical standards of quality care in health facilities with BEmONC capacity

III. SCOPE OF APPLICATION

This Order shall apply to all regional hospitals, medical centers, and similar institutions.

IV. DEFINITION OF TERMS/ACRONYMS

1.  BEmONC Training Center- a 3^rd or 4^th level hospital based training institution that has the staff complement and training infrastructure to conduct BEmONC capacity training courses for duly registered and licensed doctors, nurses and midwives
2  BEmONC Capacity - the functional ability of a health facility which can either be a primary/district hospital, RHU, birthing clinic or a birthing home operating 24/7 or an RHU and BHS to operate on an on-call basis after regular office/clinic hours to provide BEmONC services. Such facilities shall be certified by the DOH after meeting the standard requirements for certification.
3  Professional Societies - organization of health care professionals such as doctors ot the Philippine Obstetrics and Gynecological society (POGS), Philippine Pediatric Society (PPS) Philippine Society of Newborn Medicine (PSNbM), Perinatal Association of the Philippines (PAP), Philippine Academy of Family Physicians (PAFP); nurses of the Philippine Nurses Association (PNA) and midwives of the Integrated Midwives Association of the Philippines (IMAP), Philippine League of Government & Private Midwives Incorporated (PLGPMI) and the Midwive's Foundation of the Philippines (MFP) with the mandate for continuing education and accreditation for its members
4.  Proficiency - competency and skills of the health care professionals in the performance of desired and expected quality health care with the demonstration of professional expertise developed over time thru diligent practice.

V. IMPLEMENTING GUIDELINES

1. BEmONC Training Centers shall be established in regional hospitals, medical centers and other institutions upon compliance of these institutions with the following standards;

1.1 Existence of an Obstetrics and Gynecology Department accredited by the Philippine Obstetrics and Gynecological Society
1.2 Existence of a Pediatric Department accredited by the Philippine Pediatric Society
1.3 Accreditation as a Continuing Professional Education provider from the Professional Regulations Commission (PRC)
1.4 Availability of a designated pool of trainers

1.4.1 Composition - minimum of two (2) Obstetricians, (one) 1 Pediatrician, (one) 1 Nurse, and 1 Midwife
1.4.2 Training - had undergone the standard 5-day Training of Trainers on BEmONC capacity, presentation skills and the principles of Adult Learning

1.5 Designation of Administrative Support Staff consisting of at least two (2) Administrative Personnel
1.6 Availability of an adequate Training Infrastructure

1.6.1 Space and furniture
1.6.2 Training equipment such as: LCD; laptop; sound system; IV training arm; pelvic model; newborn mannequin, etc;

1.7 A network of training institutions may be established and may adopt mechanisms for resource sharing of qualified trainers, equipment, supplies and venue for training.

2.  The BEmONC Training

2.1  All BEmONC Training Centers shall utilize the BEmONC skills training course module developed by the Department of Health as adopted from the World Health Organization manual on Pregnancy, Childbirth, Postpartum and Newborn Care (PCPNC). A Certificate of Training as a BEmONC skilled health provider shall be granted to all trainees who completed the course.
2.2  The CHDs must ensure that all health care providers trained on the BEmONC course shall practice in BEmONC facility.
2.3  The trainers of the BEmONC training centers shall conduct mentoring visits at random to the trained service providers in their places of work using a standard tool
2.4  The CHDs in coordination with the LGUs shall conduct monitoring visits of the trained health professionals in their places of work using a standard monitoring tool

3.  Resource Requirements

3.1 Tuition fees of trainees

3.1.1  The Annual Operations Plan (AOP) of all provinces and cities shall indicate their BEmONC training resource requirements, using Department Order No. 2009-0084, as basis. The AOP should likewise indicate the source of funds for this initiative

3.1.2  Fund sources for BEmONC training shall come from funds which will include grants to the LGUs by this Department or from the LGU's Internal Revenue Allotment.

3.2  Incentives for trainers

3.2.1  Trainers in BEmONC training centers shall be provided training fee in accordance with Department Order No. 2009-0084
3.2.2  Training fees shall be sourced from the tuition fees paid to the institution by the trainees in accordance with Department Order No. 2009-0084

VI. REPEALING CLAUSE

All other Orders and related issuances inconsistent with the provisions of this issuance are hereby repealed and rescinded.

VII. EFFECTIVITY

This Order shall take effect immediately.


Adopted: 25 July 2011


(SGD.) ENRIQUE T. ONA, MD, FPCS, FACS
Secretary of Health