I. Background and Rationale:

In line with the broad objectives and directives of the Guidelines of the Management of Donated Commodities under the Contraceptive Self-Reliance Strategy (CSR), Local Government Units (LGUs have been oriented and provided with tools to facilitate CSR localization and operationalization in their respective localities. Based on the 2008 CSR Rapid Assessment survey commissioned by DOH, it was reported that half of the 76 provincial LGUs procured oral contraceptives in 2007 but most purchases were below the required volume of commodities. Moreover, a majority of the independent cities have procured commodities however approximately 17 city LGUs (37 percent) procured their full requirement.

Based on the recent Millenium Development Goals (MDG) report, MDG 5 which targets the reduction of maternal deaths by 75% and universal access to reproductive health services by 2015 is the MDG least likely to be achieved by the country. Evidences have shown that providing access to reproductive health services such as safe deliveries and family planning services have the combined potential of lowering maternal mortality by 75 percent and significantly reducing newborn deaths as families plan the number and spacing of their children. Despite efforts towards this goal, the 2008 National Demographic and Health Survey (NDHS) data showed no significant change over the years in contraceptive prevalence rate (CPR) and total fertility rate (TFR), especially in the poor regions and among households belonging to the poorest economic quintiles.

The CPR for modern methods among married women of reproductive age (MWRA) remained almost unchanged (34 percent in 2008 versus 33 percent in 2003). Similarly, despite efforts to reduce the use of traditional methods through œmassive  promotion of œscientific  Natural Family Planning methods, the 2008 survey demonstrated that the practice of traditional family planning methods remained at 16 percent, and of œscientific  Natural Family Planning methods at about 1%. In 2008 NDHS, the total unmet need for FP increased to 22 percent (with the lowest wealth quintile at 28 percent) as compared to the 2003 NDHS Report of 17 percent. While adolescents (15-19 year old) who started childbearing have increased over the years, the CPR for modern method among 15-49 year-old women of reproductive age (WRA) remained at 22 percent. Pregnancy at a very young age results in a higher risk of dying due to pregnancy-related complications, inability of the girls to finish their education and will also compromise the health of the newborn.

Poor women have more children than they desire compared to rich women. Due to the lack of access to FP commodities, women from lower socio-economic status bear more children as compared to the rich women. The bottom line is that poor women are at the disadvantage of not being able to access the appropriate services they need to ensure that they will have healthier and more productive lives for their families and communities.

In keeping with the constitutional mandate that the State shall protect and promote the people ™s right to health, the country ™s national family planning program was promulgated as an essential health program of the Government of the Philippines. Its basic policy centers on the premise that couples have the right and responsibility to decide how many children to have, in accordance with their beliefs, preferences and needs, the laws of the country and the demands of responsible parenthood.

The current policy A.O No. 158, s. 2004 dated 9 July 2004 is hereby amended to incorporate policy directives crucial to the overall framework of contraceptive self-reliance strategy to ensure reproductive health commodity security (RHCS).

This Administrative Order provides guidelines regarding the orderly, fair and beneficial disposition of available contraceptives in a manner that maximizes the opportunities for all domestic stakeholders of the national family planning program to take appropriate pro-active steps to protect and assure continued access to contraceptives of all Filipinos who need these vital public health commodities. In line with the Government ™s commitment to the MDGs, particularly in the attainment of MDG 5, and the Maternal, Newborn, Child Health Nutrition (MNCHN) Strategy, the efficient management of limited public sector resources including FP/RH commodities is extremely important.

II. Goal and Objectives

Overall Goal: To ensure the availability and accessibility of all family planning methods including modern family planning and RH commodities.

A. General Objective

To formulate and implement critical policies and plans, complementary actions and supportive measures which are necessary to improve access to FP services and to ensure RH commodity security to eliminate unmet needs for FP/RH services.

B. Specific Objectives

1. To ensure provision of free FP/RH commodities to poor women who want and need them.
2. To establish procurement systems that will ensure efficient, adequate and timely supply of RH commodities.
3. To revitalize the Logistic Management Information System (LMIS) in tracking down the distribution, storage and utilization of those commodities.
4. To develop mechanisms for RH commodity security at all levels.

III. Coverage

This Administrative Order shall apply to all DOH offices, bureaus, units and facilities including all of its attached agencies. Also within the scope of this Order are other offices and other instrumentalities, which include but are not limited to the following: local government, or non-governmental or private organizations, agencies or entities that provide FP and RH services.

IV. Definition of Terms

1. Contraceptive Self-Reliance (CSR) - A multi-sectoral effort which seeks to ensure the country ™s self-sufficiency in Family Planning services. It requires tha capacity to forecast, finance, procure and deliver Family Planning services and contraceptives to all men and women who need them, when they need them.

2. Contraceptive Prevalence Rate (CPR) - A measure of the extent of contraceptive practice among a defined population group at a time. The numerator consists of the number of women practicing contraception, including male-partner oriented methods. The total number of women of reproductive age in the group is used as denominator.

3. Local Government Units (LGUs) - LGUs are defined, for this purpose, as provincial and chartered city governments contained in the DOH Contraceptive Distribution and Logistics Management Information System (CDLMIS) list, and are therefore directly receiving their contraceptive supplies from the Department of Health. In turn, provincial LGUs distribute to their component cities and municipalities.

4. Reproductive Health Commodity Security (RHCS) - is defined as ensuring a secure supply of quality contraceptives to meet every person ™s needs at the time that he/she needs it.

5. Contraceptive Distribution and Logistics Management Information System (CDLMIS) - is a nationwide contraceptive delivey system that is operated and maintained by the Department of Health (DOH). The system ensures an adequate and continuous flow of supply of contraceptives to all the delivery sites and service facilities covered by CDLMIS, including Provincial/City Health Offices (P/CHOs), Rural Health Units (RHUs) Hospitals, other Government Offices (GOs), Non-Governmental Organizations (NGOs) and affiliated industry-based clinics.

V. Policy Goals/Statements

A. The attainment of the desired family size and spacing of children shall be ensured through the use of family planning methods.

B. The government is committed to ensuring that all Filipino couples can attain their desired family size and birth spacing according to their respective beliefs, preferences, and needs in accordance with Philippine Laws and the demands of responsible parenthood.

C. The government ™s commitment to supporting couple ™s attainment of their desired family size and birth spacing is consistent with increasing the overall contraceptive prevalence rate (CPR).

D. Potential users of FP who are poor shall have, within the means available to LGUs and the DOH, priority access to free or subsidized public sector-provided/supported commodities.

E. Potential users who are NOT poor should also have ready sources of affordable, accessible and convenient contraceptive supplies through their own purchaseS or through subsidized provisions by better-off local government units which can afford to do so.

VI. Contraceptive Self-Reliance (CSR) Framework towards RH Commodity Security

A. Contraceptive Self-Reliance Strategy

1. The national government shall work with local governments and partners to assure that FP/RH commodities are accessible at all times to current and potential users particularly disadvantaged women and men with unmet needs.

2. Government and donor financing schemes that support free or subsidized distribution of contraceptives is an appropriate mechanism for meeting the needs of the poor with no or little means to pay.

3. Development of complementary means of financing contraceptive and RH commodity supply shall be initiated through a variety of options such as but not limited to Philippine Health Insurance Corporation (PhilHealth), employer benefits, cooperatives, and out-of-pocket financing of affordably priced contraceptives and RH supplies.

4. A mechanism of procurement of FP and RH commodities shall be established using the most cost-efficient mode of procurement such as the United Nations (UN) procurement system and other reliable procurement systems that will ensure cost effective, economical and quality products

5. National and local governments shall receive donations of contraceptives and RH commodities from any local and foreign sources and shall distribute these commodities for free to eligible users using centrally-managed logistic information system.

6. Expansion of complementary outlet as source of contraceptive supplies and RH commodities shall be instituted, in addition to government facility outlets which are currently the main source for serving disadvantage communities. Routine access and greater coverage of these services can also be done for the population through self-help community-based distribution systems, non-government organization (NGO) outlets, private and commercial providers and workplace-based outlets.

Section B. Support Mechanisms:

1. Information, communication and public education should be provided with key messages and essential knowledge appropriately designed to specific target population

2. Technical assistance needs of stakeholders shall be identified and be linked with appropriate technical assistance providers.

3. Training needs shall be assessed and be supported.

4. Support with other reproductive health commodities will be established and maintained.

5. Localities included in project/program sites of development partners shall include CSR/RHCS as part of their activities.

VII. General Guidelines:

1. The DOH and development partners will build on the experience from the national CDLMIS, development partner cooperation, local government know-how in devolved settings, and private sector for-profit FP/RH commodity distribution and logistics system.

2. The CDLMIS which was previously limited to the management of donated supplies, shall now cover the total market for FP/RH and the DOH shall monitor FP/RH commodities from all sources including private commercial supplies.

3. The operation of the CDLMIS by the DOH will be reactivated and enhanced. The distribution of donated contraceptives will continue to be based on forecasts and estimates of actual consumption.

4. The DOH and partners in the FP/RH and MNCHN strategy will expand the volume of commodities and the range of FP method choices.

5. The DOH will encourage alternative sources of subsidies and FP/RH commodities like companies complying with the Department of Labor and Employment (DOLE) guidelines, PhilHealth-accredited health facilities, DOH grant mechanisms and others.

6. DOH-financed and procured supplies intended as safety nets for the poor shall be given for free using public sector distribution system such as government health facilities, hospitals and pharmacies.

VIII. Coordination and Implementation Arrangements

1. The provincial and city government shall be encouraged and assisted by the DOH to adopt an enhanced CDLMIS as the basic recommended local distribution and logistics system for comprehensive management of all sources of contraceptive supplies in the whole province or city. They shall develop sound forecasting, estimates and plans for meeting the total consumption needs for contraceptives.

2. The DOH shall require the LGUs to provide prompt, complete and accurate reports of actual consumption and forecasts of need using the DOH prescribed monitoring and reporting tool to enable it to allocate and distribute centrally-managed contraceptives such as those financed by national and local governments or donated by partners. The DOH will encourage cooperative arrangements like pooled procurement and the inter-local health zone (ILHZ) as FP/RH management mechanisms.

3. The DOH will coordinate with the Population Commission (PopCom) for the use of their warehouses, and monitor supply chains to maintain prescribed storage conditions for injectable contraceptives and other RH commodities which require cooler temperatures. Arrangements will be made with government agencies and private partners for supply of FP/RH commodities.

4. As far as the contraceptive supplies dispensed by various local FP outlets are concerned, the following shall be observed:

a. DOH financed/procured supplies shall be distributed for free through DOH hospitals and LGUs;
b. Donated supplies exclusively for free distribution;
c. LGU financed/procured supplies either for free distribution, for sale at cost recovery basis, or for sale at margins above cost shall be distributed through the LGUs;
d. Commercially consigned supplies either for free distribution with payment by LGU, or for sale with payment of clients shall be distributed /sold through LGUs and private partners; and
e. Socially marketed supplies shall be sold on cost recovery basis.

IX. Roles and Responsibilities

A. Offices and Units of DOH Central Office:

1. National Center for Disease Prevention and Control

a. Provide technical assistance to CHDs/LGUs relative to the implementation of this AO. It may organize a Technical Working Group to do the following: 

- Develop plans, policies, guidelines and/or system to assist the LGUs to achieve CSR and RHCS;
- Identify appropriate FP/RH service delivery scheme;

- Define market segmentation methodology;
- Develop targeting approach;
- Enhance PhilHealth and private sector participation
- Strengthen cost-recovery and referral system.

b. Set up the enhanced CDLMIS to monitor and evaluate progress of distribution, and utilization of supplies and commodities.

2. Material Management Division

a. Receive, encode, analyze, and consolidate the distribution and consumption report submitted by the LGUs;
b. Submit a copy of the consolidated LGU distribution and consumption report to the NCDPC;
c. Reactivate and continue managing the commodities of the LGUs consistent with the enhanced CDLMIS guideline;
d. Recommend modification(s) to the CDLMIS, consistent with the guidelines in this order;
e. Continue conducting periodic table/field monitoring in accordance to CDLMIS procedure; and
f. Provide technical assistance to LGUs with regards to distribution of contraceptives and RH commodities.

3. Food and Drug Administration (FDA)

a. Ensure quality and safety of FP/RH commodities
b. Facilitate registration of FP/RH commodities

4. National Center for Pharmaceutical Access and Management (NCPAM)

a. Formulates essential drug policy to support contraceptive self-reliance strategy and RHCS in collaboration with the National Drug Formulary (NDF) Committee
b. Ensure affordable and accessible FP/RH commodities through established outlets.

5. Health Policy Development and Planning Bureau (HPDPB)

a. Ensure that the subsequent policies and issuances emanating from this AO are consistent with the overall health sector reform initiatives and attainment of MDG targets.

6. Bureau of Local Health Development (BLHD)

a. Provide technical assistance in setting up systems for inter-LGU cooperation, cost-sharing schemes, pooled procurement and referral; and
b. Support CHDs and LGUs in the formulation of RHCS plan and in the identification of technical inputs and packages for implementation.

7. Bureau of International Health Cooperation (BIHC)

a. Ensure that the concerned development partners shall provide program support in the implementation of the enhanced CDLMIS and RHCS.
b. Ensure that international agreements between countries, regional bodies and association shall include and support efforts on FP/RH programs.

8. DOH Centers for Health Development (CHDs) and Regional ARMM

a. Assist the provincial and chartered city governments to formulate and implement their own contraceptive distribution guidelines and commodity security plan;
b. Collect on a quarterly basis and conduct a preliminary analysis of the enhanced CDLMIS reports of the provinces and cities;
c. Monitor the FP/RH and CSR strategy implementation in their respective regions; and d. Provide technical assistance in the expansion and improvement of FP/RH services.

9. Attached Agencies of the DOH

a. Attached agencies of the DOH, specifically the Philippine Health Insurance Corporation (PhilHealth) and Population Commission (POPCOM), are enjoined to formulate complementary policies in support of the CSR/RHCS strategy.

10. Local Government Units (Province and City)

a. To ensure provision of direct family planning and RH services in their respective areas, LGUs are expected under this AO, to undertake the following roles and responsibilities:

i. Develop contraceptive distribution guidelines to cover their catchment cities, municipalities, and devolved health facilities;
ii. Conduct campaigns to inform their catchment cities, municipalities and devolved health facilities, of the LGUs contraceptive distribution plans;
iii. Provide resources for the delivery of contraceptive/RH services to their catchment cities, municipalities and devolved health facilities;
iv. Undertake measures to guarantee local availability of contraceptives to include any or all of the following:
- Allocate budget to procure contraceptives/RH commodities for free distribution to poor clients;
- Make available contraceptives/RH commodities for sale at cost recovery basis or at margins above cost for non-poor clients; and/or
- Allow consigned supplies from social marketing sources or commercial sources to be made available to clients in LGU outlets,
v. Continue with the quarterly distribution and inventory of the contraceptive/RH commodities stocks at the public health and NGO facilities;
vi. Consolidate the enhanced CDLMIS reports.

IX. Repealing Clause

Provisions of Administrative Order No. 158, dated 9 July 2004 not affected by this amendment shall remain in force.

X. If for any reason, any section or provision of this order is declared invalid or unenforceable, such invalidity or unenforceability shall not affect the other provisions of this Order, which shall remain in full force and effect.

XI. Effectivity

This Order shall take effect immediately 15 days after publication in a major newspaper.

(SGD) ESPERANZA I. CABRAL, MD
  Secretary of Health