ICPD +10 Official Report by Paolo Antonio Fernando

Putting People First

ICPD

at Philippines Country Report

Commission on Population United Nations Population Fund 2004

Acknowledgments Acknowledgment goes to the following who helped prepare the Philippine Country Report for the ICPD+10:

Overall Coordinators

Tomas M. Osias Executive Director Mia C. Ventura Deputy Executive Director

Task Force/Writers Victoria D. Corpuz Chairperson Albert P. Aquino, Ph.D. Nolito M. Quilang, LL.B. Co-chairpersons Marla S. Casimiro Lydio M. Espa単ol, Jr. Tanya Mia M. Hisanan Lyneth Therese C. Monsalve Lourdes P. Nacionales Riela A. Ramos Jackylin D. Robel Members Marilou Costello, Ph.D. Technical Editor Jose Ibarra Angeles Raya Media Services, Inc. Style Editors Victoria D. Corpuz Ma. Rosalinda L. Diaz Raymunda P. Espena Tanya Mia M. Hisanan Gloria I. Mendoza Lourdes P. Nacionales Raya Media Services, Inc. Layout/Editing Team Benjamin Espartero Photographer Acknowledgment also goes to the POPCOM Central Office Divisions, POPCOM Regional Population Offices, and our partner agencies at the national, regional and local levels.

Contents MESSAGE of Secretary Manuel Dayrit ............................................................................................................ MESSAGE of Dr. Zahidul Huque ................................................................................................................. FOREWORD .................................................................................................................................................

v vi vii

ACRONYMS .................................................................................................................................................... viii EXECUTIVE SUMMARY ................................................................................................................................ 1 SECTION 1.INTRODUCTION ...................................................................................................................... 2 SECTION 2.SITUATIONAL ANALYSIS ....................................................................................................... 6 I. Population and Development ....................................................................................................................... 7 A. Population Size, Structure and Dynamics .................................................................................... 8 1. Population growth rate ............................................................................................................. 8 2. Total fertility rate ...................................................................................................................... 9 3. Elderly ....................................................................................................................................... 9 4. Internal migration and urbanization ........................................................................................ 10 5. International migration ........................................................................................................... 12 B. Health, Morbidity and Mortality .................................................................................................. 12 1. Infant mortality rate and under-5 mortality rate ...................................................................... 12 2. Maternal mortality ratio ........................................................................................................... 12 3. Life expectancy at birth ............................................................................................................ 13 C. Education ...................................................................................................................................... 14 D. Poverty .......................................................................................................................................... 14 II. Reproductive Health .................................................................................................................................... 15 A. Unmet Need ................................................................................................................................ 15 B. Contraceptive Prevalence Rate .................................................................................................... 16 C. Adolescent Health and Sexuality ................................................................................................. 17 D. HIV Prevalence Rate .................................................................................................................... 18 III. Gender and Development .......................................................................................................................... 18 SECTION 3. PROGRAM OF ACTION â&#x20AC;&#x201D; ASSESSING THE IMPLEMENTATION ......................... 20 I. Population and Development ................................................................................................................ 20 A. Policy Development ...................................................................................................................... 20 B. Plan Development ........................................................................................................................ 22 C. Progress in Sectoral Concerns ...................................................................................................... 24 1. Health ....................................................................................................................................... 24 2. Education .................................................................................................................................. 26 3. Population education ................................................................................................................ 27 4. Elderly ....................................................................................................................................... 28 5. Population distribution, urbanization and internal migration ................................................. 28 6. International migration ............................................................................................................ 30 II. Reproductive Health and Reproductive Rights ................................................................................... 31 A. Reproductive Health Program ...................................................................................................... 31 1. Policy ........................................................................................................................................ 32 2. Programs and projects ............................................................................................................... 33 3. Challenges ................................................................................................................................ 36 B. Adolescent Reproductive Health ................................................................................................ 36 1. Policy ....................................................................................................................................... 36 2. Programs and projects ............................................................................................................... 37 3. Challenges ................................................................................................................................ 39 C. HIV/AIDS ..................................................................................................................................... 40 1. Policy ......................................................................................................................................... 40 2. Programs and projects ............................................................................................................... 41 3. Challenges ................................................................................................................................ 42 III. Gender Equality, Equity, and Empowerment of Women ........................................................................... 42 IV. Crosscutting Concerns ................................................................................................................................ 44

iii

A. IEC, Advocacy and ICT ...............................................................................................................

B. Technology, Research and Development ..................................................................................... 1. Basic data collection, analysis and dissemination .................................................................... 2. Philippine population database information system ................................................................ C. Resource Mobilization and Allocation .......................................................................................... 1. Local funding for population and reproductive health ............................................................. 2. Priority issues: local funding ...................................................................................................... 3. Foreign funding for population and reproductive health .......................................................... D. Partnership with LGUs and the Non-government Sector ............................................................. 1. DOH partnerships with local governments ............................................................................... 2. Partnership between government and NGOs ........................................................................... 3. Partnership among GOs, media and the private sector ............................................................ 4. The unique role of parliamentarians ......................................................................................... 5. Forging partnerships with the religious sector ........................................................................... 6. Strengthening PPMP coordinating mechanisms ...................................................................... E. Summary of Crosscutting Concerns .............................................................................................. SECTION 4. EMERGING CHALLENGES AND OPPORTUNITIES: THE CAIRO AGENDA .......... A. Millennium Development Summit in 2000 .................................................................................. B. Fifth Asian and Pacific Population Conference in 2002 .............................................................. C. Asia-Pacific Conference on Population and Reproductive Health in 2001 and 2003 ............... D. Summary of Challenges ................................................................................................................. SECTION 5. TOWARD A STRATEGY TO STRENGTHEN IMPLEMENTATION OF THE ICPD PROGRAMME OF ACTION .................................................................... A. On Population and Development ................................................................................................. B. On Gender Equality, Equity, and Women Empowerment ............................................................ C. On Reproductive Rights and Reproductive Health ...................................................................... D. On Adolescents and Youths .......................................................................................................... E. On HIV/AIDS ............................................................................................................................... F. On Data and Research ................................................................................................................... G. On Partnership and Resources ....................................................................................................... REFERENCES ..................................................................................................................................................... LIST OF TABLES Table 1 Population Growth Rate: 1980-1990 to 1990-2000 ...................................................................... Table 2 TFR from Various Surveys, 1973- 2003 ......................................................................................... Table 3 Growth Rates of Urban, Rural, and Philippine Population .......................................................... Table 4 The Urban-Rural Divide in the Philippines: 1960-1995 .............................................................. Table 5 Trends in Infant and Under-Five Mortality Rates (1988-2002) ................................................... Table 6 Maternal Mortality Ratio: Philippines, 1993-1998 ....................................................................... Table 7 Life Expectancy at Birth by Sex: Philippines, 1960-1995 ............................................................. Table 8 Regional Poverty Incidence (in %), by Family in 1985-2000 ....................................................... Table 9 Bottom 10 Provinces by Poverty Incidence, IMR, MMR, AND TFR ......................................... Table 10 Unmet Need for Family Planning Services, Philippines 2002 ...................................................... Table 11 Contraceptive Prevalence Rate of Currently Married Women, 1973-2002 ................................ Table 12 Youthâ&#x20AC;&#x2122;s Proportionate Share of the Total Population, Sex Ratio, and Median Age and Growth Rate: Philippines, 1970-2000 .................................................................................... Table 13 TFR and Fertility Rates of Women 15-24 Years ............................................................................ Table 14 Percentage with any RH Problem, by Sex: 1994-2002 ................................................................. Table 15 School Participation Rates, by Sex and Level of Education, 1999 ............................................... Table 16 Population Investment Plan by Fund Source, 2002-2004 ............................................................ Table 17 Funding of the PPMP, 1994-1998 (in Million Pesos) ................................................................... LIST OF FIGURES Figure 1 The PPMP Overarching Framework .............................................................................................. Figure 2 Population and Sustainable Development Framework ................................................................. Figure 3 Age-Sex Population Pyramid, Philippines: 2000 .......................................................................... Figure 4 Poverty Incidence (in %) by Number of Children in 1991-2000 ................................................ Figure 5 PPMP Expenditures, by Sources and by Use, FY 1998 and 2000 .................................................

44 48 48 48 50 50 53 54 54 54 54 55 55 56 57 57 58 58 59 60 61 62 62 63 64 65 66 66 67 68

8 9 10 11 12 12 13 14 15 15 16 16 17 17 19 52 52

4 7 9 14 63

Message v

Message vi

Foreword vii

The Program of Action (PoA) of the 1994 International Conference on Population and Development (ICPD) endorsed a new strategy that emphasized the integral likages between population and development and focuses on meeting the needs of individual women and men rather than on achieving demographic targets only. Ten years after the PoA was first implemented, moderate achievements and progress have been made but the impact has been far-reaching in terms of improved health, especially for mothers, adolescents and children, and gender equality in reproductive health which will lead to the attainment of a better quality of life. This report highlights the accomplishments of the Philippines, as signatory to the ICPD Program of Action, within a ten-year period of implementation (1994-2004), specifically in line with: population and development; reproductive health and reproductive rights; and gender equality, equity, and empowerment of women. The links of ICPD with the Millennium Development Goals will also be emphasized. To further improve the progress made in all the ICPD commitments, the Philippines will continue to push ahead with and intensify efforts in meeting and resolving the challenges discussed in this report, and pursue strategies to strengthen the operationalization of the ICPD PoA.

Tomas M. Osias Executive Director Commission on Population

Acronyms viii

ADB AEE AGI AHYDP AO APCRH APIS APPC ARH ARMM AusAID BCC BSPO CAA CAIS CAR CBDIS CBFM CBMIS CBT CCA CHED CII CPR CWC DBM DECS DENR DepEd DILG

Asian Development Bank Accreditation and Equivalency Examination Alan Guttmacher Institute Adolescent Health and Youth Development Program Administrative Order Asia Pacific Conference on Reproductive Health Annual Poverty Indicator Survey Asian and Pacific Population Conference Adolescent Reproductive Health Autonomous Region for Muslim Mindanao Australian Agency for International Development Behavior Change Communication Barangay Supply Point Officer Comprehensive Action Agenda Communication and Advocacy Information System Cordillera Administrative Region Community-Based Demographic Information System Community-Based Forest Management Community-Based Management Information System Competency-Based Training Common Country Assessment Commission on Higher Education Contraceptive Interdependence Initiative Contraceptive Prevalence Rate Council for the Welfare of Children Department of Budget and Management Department of Education, Culture and Sports Department of Environment and Natural Resources Department of Education Department of the Interior and Local Government

DLP DOH DOLE DP DSEIS DSWD EASE EIA EPI FAD FHEP FHSIS FI FIES FNRI FP FPOP FWP GAA GAD GASTPE GNP GO GOP GISP GST HB HDI HDR HES HIV/AIDS

Distance Learning Program Department of Health Department of Labor and Employment Directional Plan Demographic and SocioEconomic Indicator System Department of Social Welfare and Development Effective and Affordable Secondary Education Environment Impact Assessment Expanded Program in Immunization Foundation for Adolescent Development Feminine Hygiene Education Program Field Health Service Information System Field Inquiry Family Income and Expenditure Survey Food and Nutrition Research Institute Family Planning Family Planning Organization of the Philippines Family Welfare Program General Appropriations Act Gender and Development Government Assistance to Students and Teachers in the Private Sector Gross National Product Government Organization Government of the Philippines Government Information Systems Plan Gender Sensitivity Training House Bill Human Development Index Human Development Report Human and Ecological Security Human Immune-Deficiency Virus/Acquired Immune Deficiency Syndrome

HLURB HSRA ICPD ICT IEC IMR INC IPs IRA JICA KALAHI KAP KfW LAN LAP LEPOPHIL LFS LGC LGU LPP MBN MCH MCHS MDGs MGP MIC MMR MRL MTPDP MTPDP-S MTPIP NAPC NCR

Housing and Land Use Regulatory Board Health Sector Reform Agenda International Conference on Population and Development Information Communication Technology Information, Education, and Communication Infant Mortality Rate Iglesia ni Cristo Indigenous Peoples Internal Revenue Allotment Japan International Cooperation Agency Kapit-bisig Laban sa Kahirapan Knowledge, Attitudes and Practices Kreditanstalt fur Weideranfpan Local Area Network Local Advocacy Project League of Population Officers in the Philippines Labor Force Survey Local Government Code Local Government Unit LGU Performance Program Minimum Basic Needs Maternal and Child Health Maternal and Child Health Survey Millennium Development Goals Matching Grant Program Migration Information Center Maternal Mortality Ratio Muslim Religious Leaders Medium-Term Philippine Development Plans Medium-Term Philippine Development Plan for Shelter Medium-Term Philippine Investment Program National Anti-Poverty Commission National Capital Region

NCRFW NDHS NDS NEDA NFP NGO NHIP NPDIS NSB NSCB NSMS NSO NYC OEDB OFW OSH OSY OWWA PA PCUP PDDS PDS PDE PES PGR PHDR PHIC PIDS PIP PIS PMTYDP

National Commission on the Role of Filipino Women National Demographic and Health Survey National Demographic Survey National Economic and Development Authority Natural Family Planning Non-Government Organization National Health Insurance Program National Population Database Information System National Seaman’s Board National Statistical Coordination Board National Safe Motherhood Survey National Statistics Office National Youth Commission Overseas Employment Development Board Overseas Filipino Worker Occupational Safety and Health Out-of-School Youth Overseas Workers’ Welfare Administration Philippine Agenda 21 Presidential Commission for the Urban Poor Policy Development Database System Population and Development Strategies Population Development and Environment Philippine Elderly and Near Elderly Survey Population Growth Rate Philippine Human Development Report Philippine Health Insurance Corporation Philippine Institute for Development Studies Population Investment Program Population Information System Philippine Medium Term Youth Development Plan

PNAC PNGOC PoA POEA

POPCOM POPDEV PopEd POPIN PPAOP PPET PPGRD PPIC PPLL PPMEIS PPMP PPR PRE PSD PVOs RA RAPID RDS RH RHAN RHMIS SAPP SCARTY SEDIP

Philippine National AIDS Council Philippine NGO Council for Population, Health and Welfare Program of Action Philippine Overseas Employment Administration Commission on Population Population and Development Population Education Population Information Network Philippine Plan of Action for Older Persons Philippine Placement and Equivalency Test Philippine Plan for Gender Responsive Development Philippine Population Information Center Population and Development Planning at the Local Level Plans, Programs, Monitoring and Evaluation Information System Philippine Population Management Program Philippine Progress Report Population, Resources and Environment Population and Sustainable Development Private Voluntary Organizations Republic Act Resources for the Awareness of Population Impact in Development Research Database System Reproductive Health Reproductive Health Advocacy Network Reproductive Health Management Information System Situational Analysis of the Philippine Population Sorsogon City Advocacy for Responsible Team of Youth Secondary Education Development Improvement Project

SEMP SHAPE SIMS SK SOMIS SOP SPPR SRA SRTC STD STI SY TESDA TFG TFR TOP TUCP TWG UCCP UDHA UNAIDS UNFPA UNICEF UPPI USAID VAW WB WHO WID WSSD YAFSS YHES

Social Expenditure Management Project Sexually Healthy and Personally Effective Adolescents Self-Instructional Modules Sangguniang Kabataan Social Development Management Information System Strategic Operational Plan State of the Philippine Population Report Social Reform Agenda Statistical Research and Training Center Sexually Transmitted Diseases Sexually Transmitted Infections School Year Technical Education and Skills Development Authority The Futures Group Total Fertility Rate Technology of Participation Trade Union Congress of the Philippines Technical Working Group United Christian Churches of the Philippines Urban Development and Housing Act United Nations Programme for HIV/AIDS United Nations Population Fund United Nations Childrenâ&#x20AC;&#x2122;s Fund University of the Philippines Population Institute United States Agency for International Development Violence Against Women World Bank World Health Organization Women in Development World Summit for Social Development Young Adult Fertility and Sexuality Survey Youth for Human and Ecological Security

Executive Summary This Philippine Country Report for the International Conference on Population and Development (ICPD +10) assesses the implementation of the Key Actions to the Program of Action (PoA) over the period 1994-2004. The assessment covers three major areas: population and development strategies; reproductive health and reproductive rights; and gender empowerment. The report also discusses the link of the ICPD with the Millennium Development Goals (MDGs). There remain numerous concerns on population and development (POPDEV) strategies that should be addressed, although there have been substantial gains to integrate population concerns in the programs and policies of the national government and of local government units. POPDEV advocacy activities need to be pursued more aggressively, particularly owing to the rapidly changing times and political environment. On reproductive health (RH) and reproductive rights (RR), significant strides have been made in generating support from the national government and local government units, the private sector (especially the business sector), nongovernmental organizations, and the donor agencies. All legal and medically safe family planning (FP) methods continue to be made available. This has resulted in a gradual decline in the total fertility rate (TFR)â&#x20AC;&#x201D;from 4.1 in 1993 to 3.5 in 2003. The contraceptive prevalence rate (CPR) increased from 40 percent in 1993 to 49 percent in 2003. Unfortunately, this performance is still low compared with that of neighboring Asian countries.

48 per 1,000 live births in 1998 to 40 in 2003. The maternal mortality ratio (MMR) appears to exhibit a downward movement, from 209 deaths per 100,000 live births in 1993 to 172 in 1998. Owing to sampling errors, however, it is difficult to make a definite conclusion that MMR has indeed gone down. There has been some success in reducing infant and child mortality, but much still needs to be done in terms of maternal health and access to reproductive and sexual health services, including family planning. Advocacy is also required to change the perception of a number of sectors in Philippine society that the exercise of Reproductive Health/ Reproductive Rights is equivalent to abortion. Another major RH/FP concern is the provision of adequate family planning supplies, especially because the main donor of these supplies, the United States Agency for International Development (USAID), is phasing out contraceptive grants. To respond to this, the Philippines pursues a Contraceptive Self-Reliance strategy (CSR). Formerly known as the Contraceptive Interdependence Initiative, the CSR aims to come up with concrete operational strategies to ensure the security of quality family planning services in the country. As a market segmentation strategy, the CSR draws on the help of community-based volunteers and workers to determine the subsidies required from government.

As regards HIV/AIDS, the number of confirmed cases in the Philippines is very low in number. The prevalence rate is, at most, 0.02 percent of the total population.

The Philippines has made the most significant progress in gender equality and empowerment. A sizeable number of legislative measures has been adopted. Training programs, research activities, and advocacy campaigns have also been conducted. This has inspired the countryâ&#x20AC;&#x2122;s program stakeholders to promote further concerns related to gender empowerment.

As part of the comprehensive maternal and child health program, immunization and Vitamin A supplements are provided to children. This has helped reduce infant mortality rate (IMR) and child mortality rate (CMR). In 1998, the IMR decreased from 35 per 1,000 live births to 29 in 2003; the under-five mortality rate decreased from

The hope is that the achievements in gender empowerment will cascade into the RH, RR, and POPDEV strategies since these areas are interrelated. The challenges in policy reforms and program operations will continue to be addressed, as articulated in this report, through purposive advocacy building and resource mobilization.

SECTION I

Introduction 2

THE UNITED NATIONS (UN) launched the 1994 International Conference on Population and Development (ICPD) three years after the Economic and Social Council, in 1991, explicitly cited the importance of the link between population and development. ICPD received a broader mandate on development issues than previous population conferences since it reflected the growing awareness that population, poverty, patterns of production and consumption, and the environment were so closely interconnected that none could be considered separately. ICPD reiterated the agreements and outcomes of other international conferences, such as Agenda 21 of 1989, the 1990 World Summit for Children, the 1992 United Nations Conference on Environment and Development, the 1992 Rio Declaration, and the 1993 World Conference on Human Rights. The themes in these conferences revolved around population, sustained economic growth, and sustainable development (UN-ICPD, 1995). The ICPD made an impact on other international conferences on population, environment, and social development where the population variable was integrated and discussed such as the 1995 World Summit on Development (WSSD) in Copenhagen, the 1995 4th World conference on Women in Beijing, and the 1996 2nd United Nations Center for Human Settlements (UNHABITAT II) in Istanbul. ICPD endorsed a new strategy that emphasizes the numerous links between population and development. It focused on meeting the needs of individual women and men rather than on achieving demographic targets. A key to this new approach is empowering women and providing them with more choices through expanded access to education and health services, skills development, and employment and enabling them to have full involvement in the policy and decision-making process at all levels. Thus, one of the greatest milestones of the Cairo Conference is the recognition that empowering women is the key to improving the quality of life of everyone.

Much of the information in this section was gathered from the following Web sites and documents: http://www.unfpa.org/goals, accessed01-13-2004, and http://www.UNFPA%20ICPD%20MDG% 20FOLLOW UP.htm, accessed 01-13-2004, the 1994 Summary of the Programme of Action of the International Conference on Population and Development, the ICPD+5 Philippines Country Report, the 2002 Philippines Country Report to the 5th Asian and Pacific Population Conference, the Philippines Progress Report on the Millennium Development Goals and other ICPD- related materials provided by UNFPA and culled out from POPCOM sources (e.g., guidance note and project proposal).

Selected ICPD Concerns Reduction of IMR and CMR

2000 50 & 70 per 1,000 live births

2010

2005

2015 Below 35 & 45 deaths per 1,000 live births

Below 50 & 60 deaths per 1,000 live births At least 40% of all births should be assisted by skilled attendants where the MMR is high

At least 50% of all births should be assisted by skilled attendants where the MMR is high

At least 60% of all births should be assisted by skilled attendants where the MMR is high

Universal access to reproductive health services

At least 60% of FP facilities should offer the widest achievable range of safe and effective FP methods and other RH-related services

At least 80% of FP facilities should offer the widest achievable range of safe and effective FP methods and other RH-related services

At least 100% of FP facilities should offer the widest achievable range of safe and effective FP methods and other RH-related services

Reduction in HIV infection rates in persons aged 15-24

At least 90% of young men and women, aged 15-24, should have access to preventive methods, e.g., condoms, voluntary testing, counseling and follow-up

At least 95% of young men and women, aged 15-24, should have access to preventive methods, e.g., condoms, voluntary testing, counseling and follow-up

Reduction of MMR

HIV infection rates in persons 15-24 years of age should be reduced by 25% in the most affected countries and by 25% globally by 2010.

ICPD’s Program of Action (PoA) reflects the recommendations arising from earlier conferences. Its conceptualization was pushed by the World Population Plan of Action adopted at the 1974 World Population Conference in Bucharest, and the recommendations adopted at the 1984 International Conference on Population in Mexico City. The table above shows the main goals of the ICPD PoA set in 1994 under the following concerns: infant mortality rate (IMR) and child mortality rate (CMR), maternal mortality ratio (MMR), reproductive health (RH), and human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS). The Philippines’ major contribution to the ICPD+5 PoA was the steady shift of the Philippine population program away from the divisive strategy of setting demographic targets, a strategy imposed in the 1970s. ICPD stimulated a review of the population program as a development intervention for improving the quality of life of Filipinos. The Philippine Population Management Program (PPMP) seeks to meet the reproductive health needs of individual women and men so that they could achieve their desired

family size in a healthy manner. The premise is that, in the long run, fulfilling individual reproductive health needs – instead of macro demographic targets — will contribute to social, economic, and environmental benefits that ultimately will result in an improved quality of life. ICPD+10 is the second review of the PoA, the first one in 1995 (ICPD+5). In this year 2004 review, a consideration is how ICPD goals and targets link with the Millennium Development Goals (MDGs), which are global targets set by world leaders in 2000. Set for completion in 2015, the MDGs affirm and reinforce the goals and targets of global conferences held in the 1990s, including ICPD. The MDGs have been accepted as a framework for measuring development progress. The goals focus on the efforts of the world community in achieving significant, measurable improvements in people’s lives. As agreed upon in ICPD, the MDGs cannot be achieved without addressing population and reproductive health issues. This means stronger efforts are needed to promote women’s rights. Greater investments need to be made in education and health, to include reproductive health and family planning. Universal

The 1999-2004 Philippine Medium-Term Youth Development Plan (PMYDP) as the government’s blueprint of all programs and projects geared towards Filipino youth participation and development to mainstream them into nation-building and policy-making; The 1999-2004 Philippine Plan of Action for Older Persons (PPAOP), which addresses the concerns of older persons; The Health Sector Reform Agenda for 19992004 which took a bold step towards improving the performance of the health sector by improving the way health services are being provided and financed. This program of change is directed mainly at a) expanding effective coverage of national and local public health programs; b) increasing access, especially by the poor, to personal health services delivered by both public and private providers; and c) reducing the financial burden on individual families through universal coverage of the National Health Insurance Program (NHIP); and, The 1995-2025 Philippine Plan for Gender Responsive Development (PPGRD) that provides the framework to guide policies, programs, and projects in making men and women equal participants and beneficiaries of development.

Figure 1: The PPMP Overarching Framework IMPROVEMENT IN QUALIT Y OF LIFE

Reduction of poverty & inequalities in human dev’t. opportunities Reduction of infant and maternal mortality Promotion of gender equality Ensuring envir onmental sustainability Achievement of desired population gr owth & distribution

ICPD Universal access to RH services particularly FP and ARH

RH Increased utilization of integrated/ quality R H services to women, men, adolescents gender- sensitive information/ knowledge counseling towards behavior change.

PDS Ensured pr ioritization of Population & RH Issues in the national agenda to facilitate policy decision-making.

Advocacy Increased political, institutional and community support at the national and local levels for the dev’t. & implementation of a gender and culture-sensitive population and RH policies and pr ograms Data management, Resear ch and Monitoring Resource Mobilization & Partnership

P a r t I c Ip at o ry G o ve r n a n ce

Righ ts -bas e d

G e n d e r - re s p o n s I ve

access to education and reproductive health care information and services are therefore crucial. Meeting the ICPD goals will pave the road toward the MDGs — and eradicating poverty. During the period in review (1994-2004), the Philippine government, nongovernment organizations, people’s organizations, the private sector, local government units (LGUs), the academe, and other population stakeholders undertook initiatives in support of the PoA agreed upon in 1994 and 1999. These initiatives were integrated in different national planning documents, such as: The PPMP Directional Plan 2001-2004, which serves as the blueprint of all the programs, projects and activities under the four concerns/ thrusts of the PPMP, namely: reproductive health/family planning (RH/FP), adolescent health and youth development (AHYD), population and development (POPDEV) integration, and resource generation, programming and mobilization. It also includes an advocacy plan that outlines the framework wherein population advocacy efforts can be carried out more efficiently and effectively at all levels; The Medium Term Philippine Development Plan (MTPDP) 2001-2004, which highlights the need to address poverty and population issues;

Philippine population initiatives are integrated with the countryâ&#x20AC;&#x2122;s development plans, and aim for a better quality of life. Aside from being integrated in national planning documents, population was consistently advocated by the population community as an important variable in all development concerns. The Commission on Population (POPCOM) has developed an Overarching Framework (Figure 1) that illustrates the fundamental links between population and other development concerns. International, national, and local levels embrace the ultimate goal of the countryâ&#x20AC;&#x2122;s development efforts, which is to achieve an improved quality of life. In the population sector, this is defined in terms of reduction of poverty and inequalities in human development opportunities, reduction of infant and maternal mortality, promotion of gender equality, ensuring environmental sustainability, and desired population growth and distribution. Consistent with the goals of ICPD, POPCOM works for universal access to reproductive health services, specifically family planning (FP) and adolescent and reproductive health (ARH) services. In preparing this Country Report, POPCOM conducted several activities to ensure objectivity of assessment and wide coverage (national, regional, and local experiences, where appropriate). One major activity that ensured maximum participation in gathering and processing relevant inputs to the Country Report was a Field Inquiry (FI) conducted in April 2003. Respondents consisted of national, regional, and local partners in the population community such as government agencies, regional offices, local government units, nongovernment organizations, academe, and civil society. The results of the FI were integrated in this report. Additional workshops, forums, and

writeshops gave various stakeholders opportunities to comment on the draft Country Report. Likewise, results of the fora conducted by NGOs, specifically by the Reproductive Health Advocacy Network (RHAN), were included in this report. Finally, POPCOM engaged the services of technical experts, including a professional technical editor, to ensure accuracy and integrity of information and data, and a writing style that met the standards of international publications. This Country Report covers 10 years (19942004) of ICPD implementation. Main sources of data include the 1998 and 2003 National Demographic Health Survey (NDHS), 2000 Census of Population, 2003 Young Adults Fertility and Sexuality Study (YAFSS), and other related researches. Where appropriate and available, data covering years 2003 and 2004 are cited. Based on a suggestion by the United Nations Population Fund (UNFPA), the following outline was followed: 1. Philippine situation in terms of ICPD accomplishments and initiatives relative to population, gender, and reproductive health and rights; a substantive backdrop for the entire report with selected 14 indicators that have a bearing on the ICPD-PoA. 2. Assessment of the implementation of ICPDPoA for the period 1994-2004. 3. Emerging challenges and opportunities and the Cairo agenda, with focus on ICPD-PoA accomplishments. 4. Strategies to strengthen further ICPD-PoA implementation.

SECTION 2

Situation Analysis 6

THIS SECTION DISCUSSES major trends and issues in population and development, gender equality, and reproductive health and rights. The analysis includes both quantitative and qualitative indicators. It covers a period of 10 years (1994â&#x20AC;&#x201C;2004). The benchmarks provide a substantive backdrop for the entire report. This section also discusses the link between the ICPD goals and the 2000 Millennium Development Goals and gauges how much progress was achieved and how much still remains to be done. The PoA of the 1994 ICPD has the following main goals: Universal access to reproductive health services by 2015. Universal access to primary education and closing the gender gap in education by 2015. Reducing maternal mortality by 75% by 2015. Reducing infant mortality. Increasing life expectancy. During the 1999 ICPD review (ICPD+5), benchmarks were focused on population and reproductive health as highlighted in different population reports, such as the State of the Philippine Population Report, 2001. By taking into consideration the MDG benchmarks, the scope of ICPD has broadened. The following benchmarks2 were adopted in ICPD+5 to measure the achievements made in the two international commitments: Reduction of the 1990 illiteracy rate for women and girls by half in 2005; at least 90 percent net primary school enrolment ratio for children by 2010. Sixty percent of primary health care and FP facilities offering the widest achievable range of safe and effective FP methods, essential obstetric care, RTI prevention and management by 2005; 80 percent offering such services by 2010; and 100 percent by 2015. At least 40 percent of all births assisted by skilled attendants where the maternal mortality rate is very high, 80 percent globally by 2005; 50 percent and 85 percent, respectively, by 2010; and 60 percent and 90 percent by 2015.

These benchmarks were adopted from the United Nations, 1999 Report of the Ad Hoc Committee of the Whole of the Twenty-first Special Session of the General Assembly (A/S-21/5/Add.1) as cited by the State of the Philippine Population Report 1, published by the Commission on Population in 2001.

Figure 2. Population and Sustainable Development Framework. POPULATION

PRODUCTIVE CAPACITY

Size Structure Distribution

Natural Resources & Environment

Fertility Mortality Migration

Human Resources

7 DEVELOPMENT GOODS & SERVICES

Capacities/ Well-being - longer life - to achieve desired fertility -others

PARTICIPATORYGOVERNANCE Sources: PPMP Directional Plan, 2001 and Country Report-APPC 2002

Reduction by half of any gap between the proportion of individuals using contraceptives and those desiring to space or limit their families by 2005; by 75 percent by 2010, and by 100 percent by 2015. At least 90 percent of young men and women aged 15 to 24 having access to preventive methods by 2005; 95 percent by 2010; reduction of HIV infection rates in persons 15 to 24 years of age by 25 percent in the mostaffected countries by 2005 and by 25 percent globally by 2010. I.

POPULATION AND DEVELOPMENT

The Philippines faces considerable socioeconomic challenges despite greater development efforts over the last decade. Development planners have tried systematically to integrate population and development interrelationships in the various stages of planning — from plan formulation to implementation to monitoring and evaluation. However, more effort is needed to achieve the 2015 targets, especially in reducing extreme poverty and hunger and in reducing maternal mortality. Sustainable development is the provision of the needs of the present generation without sacrificing the ability of future generations to meet their needs. It is closely connected to population

because, for one, they share a common agenda — to achieve a better quality of life. Quality of life involves the capacity “to be” (e.g., to be educated, to be healthy and well-nourished, to be secure from harm) and the capacity “to do” (e.g., to do productive and creative work, to participate in community affairs, to bear and rear the desired number of children, to travel in search of economic and social opportunities). Underlying these capacities is the freedom of choice. Hence, sustainable development is also about expanding the range of choices for people (Sen, 1988; UNDP, 1990). Given the link between population and development, there is greater recognition of the fact that addressing population issues is one of the keys to sustainable development. Hence, population issues such as rapid population growth, unmet needs, unbalanced spatial distribution, and reproductive health concerns must be appropriately considered in the formulation, implementation, monitoring, and evaluation of policies and programs relating to sustainable development. Development strategies must also reflect the short, medium, and long-term implications of and consequences on population dynamics. The Population and Sustainable Development (PSD) Framework (figure 2) illustrates in more detail the interconnectedness of population and development. Specifically, it explains how population factors affect and are in turn affected

by development factors. The framework can be described as follows (Herrin, 2002):

Population. The demographic processes of fertility, mortality, and migration affect the size (e.g., number of population), age-sex structure (number of male and females or number of women of reproductive age, and others) and distribution (population density or urban/rural, and others) of the population. For example, if the total fertility rate, or the average number of children born to a woman of reproductive age (15 to 49 years old), increased from 3 to 4 children per woman, this would translate to an increase in the pace of population growth. This would also translate to a population structure characterized by a large cohort of children aged 0 to 14. Productive capacity. Change in population outcomes in terms of size, age-sex, and distribution of the population would in turn affect the formation and use of productive resources, referring to aspects of productive capacity such as natural resources and environment as well as human resources. For example, population pressure on natural resources can contribute to deforestation, erosion, and degradation of the environment, which can affect the availability of goods and services and contribute to declining productivity per worker. Rapid growth of labor supply relative to demand tends to depress the real wage, adversely affecting incomes, especially of the poor who depend mainly on labor income. Rapid growth of labor supply relative to demand also contributes to greater inequality in incomes as labor income declines relative to income from capital. This would in turn impact on the household income, which partly determines the quantity of goods and services the household can purchase and make available to its members. The consumption of goods and services is partly determined by their availability. Poor households with low purchasing power because of low income can increase their consumption of goods and services if they have access to subsidized goods and services made available by the public sector or private donors. Development. The indicators of well-being are partly determined by the consumption of goods and services. Thus, better health is partly determined by the consumption of various types of preventive and curative health services; educational attainment is partly determined by the consumption of education services; and fertility is partly determined by the use of contraceptive services. In turn, the achievement of well-being, that is to be healthy, to be educated, to bear and rear the desired number of children, and to travel in search of economic opportunities, impacts on fertility behavior, mortality patterns, and migration, all of which contribute to a more manageable

population growth (size and age-sex structure) and distribution. In the long run, helping people achieve their fullest potentials in life and providing them with the needed information and services on fertility management can contribute to the achievement of sustainable development. Governance. Sustainable development at the macro level and well-being at the micro level is largely dependent on good governance. This would include government actions to protect human rights, ensure peace and order, and implement various economic, social, and population policies to correct “market failures,” including the direct provision of goods and services such as reproductive health and family planning services.

A. Population Size, Structure and Dynamics 1. Population growth rate Public policy in the country has long been concerned with how population growth can be managed to achieve sustained growth of national income and ensure a fair sharing of the fruits of prosperity (POPCOM, SPPR 2001). The 2000 Philippine population census recorded a population of 76.5 million. The population was estimated at 84 million in 2004, growing at the rate of 2.34 percent annually (table 1). It has grown by 25.8 percent in 10 years, from 60.7 million in 1990 to 76.5 million in 2000. At this rate, the population will double in only 29 years. The rapid population growth is largely due to a slow decline in the total fertility rate, from 4.1 in 1993 to 3.5 in 2003. Of the estimated 37.1 million increase in population from 1995 to 2020, 66.3 percent will be due to population momentum, 18.1 percent to high family size preferences, and 15.6 percent to unwanted fertility (Herrin and Costello, 1996). Table 1: Population Growth Rate: 1980-1990 to 19902000. Period

Population

PGR (in %)

1980 - 1990 1990 - 2000

60,703,206 76,498,735

2.35 2.34

Source: 2000 Census of Population and Housing as cited in the State of the Philippine Population Report (SPPR), 2001.

The population of the Philippines today is still relatively young. This is a direct result of the high birth rates in the past. In 2000, about 4 out of every 10 Filipinos were estimated to be under 15 years of age; around 6 were between 15 to 64 years old (the so-called working, or productive ages); and less than 1 aged 65 and older. Even if we assume that replacement level fertility is reached, the population would still continue to increase. This is because of the large number that joins the reproductive age group each year. The country’s population’s age structure (figure 3) shows that the young populations, which form the base of the pyramid, composed 37.01 percent. The old

Table 2: TFR from Various Surveys, 1973- 2003

Figure 3. Age-Sex Population Pyramid, Philippines: 2000

Year

Age Group

Male

80 & over 75 - 79 70 - 74 65 - 69 60 - 64 55 - 59 50 - 54 45 - 49 40 - 44 35 - 39 30 - 34 25 - 29 20 - 24 15 - 19 10 - 14 5-9 0-4

1973 1978 1983 1986 1993 1998 2003

Female

4 2 0 2 4 (Percent to Total Population)

Total Fertility Rate NDS RPFS NDS CPS NDS NDHS NDHS

5.97 5.24 5.08 4.42 4.09 3.73 3.50

Source: NSO, 2003 National Demographic and Health Survey.

Source: NSO 2000 Census of Population and Housing.

population (65 and over) accounted for 3 percent, while 59.16 percent represented the 15-64 years old who are the economically active population (NSO, 2000). Based on the recent 2000 Census on Population and Housing, the dependency ratio was 69.04. This meant that every 100 persons in the working age group (15-64 years old), had to support about 63 young dependents and about six old dependents. In 1995, the dependency ratio was 69.60. These figures show that after five years, the dependency ratio had not shown any improvement. This current trend of Philippine population growth, as well as its effects on the population structure, continues to exert tremendous pressure on the economy. Generating job opportunities for the young population entering the labor force each year poses a serious challenge. The effects are reflected in the unemployment rate, which increased from 8.4 percent in 1995 to 9.4 percent in 1999. The Labor Force Survey (LFS) showed that 13.9 percent of the labor force was unemployed in 2001. 2. Total fertility rates The country has actually achieved a modest decline in fertility. However, based on the 2003 National Demographic and Health Survey (NDHS), the Philippines is still far from achieving a replacement fertility of 2.1. While the desired fertility rate in the country is 2.7 children per woman, the total fertility rate (TFR) was 3.5 in the 1998-2003 periods. This represents a mere 0.2 decline from the 1993-1998 TFR of 3.7 children. The TFR is still about one child away from replacement level. Table 2 shows that the fertility rates of women aged 15-49 declined from 5.97 in 1973 to 3.50 in 2003. This is still much higher compared with other Asian countries such as Thailand

(1.8),Vietnam (2.3), Indonesia (2.3), and Malaysia (3.1) (UN 2001). Given the high fertility rate, the Philippines will continue to find it difficult to achieve a replacement level fertility of about 2.1 children by 2020, which is among the commitments it made in international conferences and assemblies such as the 1992 fourth Asia-Pacific Population Conference in Bali, (APPC 2002). In the countryâ&#x20AC;&#x2122;s regions, the gap between wanted and achieved fertility was larger than average in Eastern Visayas, Bicol, and Northern Mindanao, reaching almost two children. Women living in rural areas reported having 1.5 children more than they planned. Substantial changes occurred in some regions. The largest increases in unplanned childbearing were in Central Mindanao (57 percent of recent births in 1998, approximately twice the 29 percent in 1993); Cagayan Valley (41percent vs. 23 percent); and Metro Manila (47 percent vs. 31 percent) (AGI Research in Brief, 2003). 3. Elderly Like many countries in Asia, the current proportion of older Filipinos remains lower than in Western countries. The proportion is expected to expand dramatically in the coming years because of sustained fertility declines and mortality improvements. The Philippines, though, still has to experience considerable aging. As of 1995, the elderly population (defined as those aged 60 and over) composed 5.4 percent, or 3.7 million people, of the countryâ&#x20AC;&#x2122;s population. It is projected to increase by one million in five years from 1995 to 2000 and about 2 million between 2000 and 2010 (Cabigon, 2002). This trend is also suggested by this age groupâ&#x20AC;&#x2122;s fast growth rate, which has been higher than that of the general population since the 1970s. Elderly females outnumbered elderly males in 1995. There were about 87 elderly males for every 100 females (NSO, 1995). This increasing feminization of older persons is an important aspect of aging in the Philippines. This may be partly explained by the higher life expectancies of females (higher by about 5 years on average). Women who reach the age of 60 are also expected to live for another 18.5 years compared to 16.5 years for men (UN Population Division, 2000). Results of the 1996 Philippine Elderly and

Near Elderly Survey (PES) reveal significant differences between male and female older persons in terms of marital status. About 4 of every 5 elderly males in the country were currently married. The corresponding figure is about half (49.2 percent) among the females. To a certain extent, this can be explained by menâ&#x20AC;&#x2122;s greater tendency to remarry. The same survey revealed that 38.2 percent of the elderly were working, 48.4 percent used to work but were looking for a new job, and 13.4 percent never worked at all (Cabigon; 1996)). This evidence discredits the common notion that elderly people are idle, tired, and retired (Cabigon, 1996). A larger proportion of older males was working (52.3 percent) compared with older females (28.1 percent). More elderly women than men never worked for a living (21.7 percent vs. 1.7 percent). This may be due to the Filipino tradition of women staying home to keep house and take care of the children. 4. Internal migration and urbanization In the Philippines, internal and international migration represents family strategies for survival that have been associated with social and economic transformation (Lauby, 1985; Traeger, 1987). Migration and urbanization are major factors that shape and are consequences of development. Poverty in the countryside is a significant factor that propels urban-ward migration, which contributes to the environmental deterioration of highly urbanized cities (Perez, 1998). Unmanaged rural-to-urban migration has resulted in a mismatch between population and urban physical infrastructure and basic services (HLURB, 1994, as cited in the PPMP Directional Plan 2001-2004). Slum and squatter settlements, sanitation problems, water and air pollution, and traffic congestion are urban-specific issues. The rate of population growth in cities far exceeds job creation, leading to more unemployment and worsening poverty. Populations displaced by lowland industrialization and not absorbed in urban or industrial economic activities are forced to seek refuge in the uplands. Upland and coastal migration plays an important role in increasing forest population density, adding stress to the increasingly unstable natural environment. The tight relationship between migration, urbanization, and poverty is a priority concern of the PPMP. Low and unsustained economic growth of the past decade has deepened poverty in many parts of the country. Limited opportunities in less developed areas and the increasing constraints in the more developed areas are major factors that have influenced the movement of people since the 1920s. There are three major internal migration streams (Perez, 1998, as cited in Herrin, 2002). The first is a unidirectional, frontier-ward, male-

Table 3: Growth Rates of Urban, Rural and Philippine Population Year

Urban

Rural

Total

1948-1960 1960-1970 1970-1980 1980-1990

3.76 3.76 4.32 4.82

2.55 2.78 1.93 0.6

3.48 3.08 2.75 2.35

Source: Cabegin and Arguillas, 1997.

dominated stream from rural to rural destinations. This consisted of migrants from Luzon and the Visayas to Mindanao in the 1950s and 1960s (Perez, 1998). The second stream was in the 1970s. It was largely female-dominated and urban-ward (Perez, 1983; Engracia and Herrin, 1984). The primary destination was the National Capital Region (NCR) and surrounding regions. The third stream is urban to urban, from overcrowded Metro Manila to peripheral areas of the metropolis. The rural-to-urban movement continues to be an important stream. Table 3 shows the contrasting growth patterns of urban and rural areas. The National Anti-Poverty Commission identifies rural poverty as the root cause of high out-migration. Migration data show that most migrants to the NCR come from the poorest regions in the country (Go, Collado, Abejo, 2001). Rural-to-urban migration continues in less developed regions and urban-to-urban migration has become more significant in recent years in most urbanized regions. Except for the NCR and Cagayan de Oro, which continue to have higher growth rates in the 1995 period compared with those in 1980-1990 (UNFPA, 1999), large cities continue to attract people, although at a lower pace, suggesting some degree of urban deconcentration. Statistics indicate that rural-to-urban migrants increasingly consist of unmarried women below 25 and married young women in their peak childbearing ages (25-29) (UNFPA, 1999). Their migration is motivated by their limited participation in income-earning opportunities in their communities of origin (Perez, 1998). In their areas of destination, they usually end up in jobs in the service sector, where they work longer hours for lesser pay. The PoA calls on governments to increase the capacity and competence of city and municipal authorities to manage urban development and respond to the needs of all citizens. It also urges them to give migrants, especially women, greater access to work, credit, basic education, health services, child-care centers, and vocational training. To finance the necessary infrastructure and services in a balanced manner, it recommends that government agencies, bearing in mind the interests of the poor segments of society, consider introducing equitable cost-recovery schemes and

Table 4. The Urban-Rural Divide in the Philippines: 1960-1995 Indicators

1960

1970

1975

1980 1990

1995

Percent urban

29.8

31.8

33.3

37.2

48.6

54.1

Urban Growth Rate (%)

2.7

4.0

3.0

4.9

5.0

Rural Growth Rate (%)

2.5

2.6

1.5

0.3

Adopted from UNFPA Country Assessment, 1999 p. 24. Note: The 1995 estimates are based on a 1990 projection on urban population by Eduardo T. Gonzalez, et al. “Population and Urbanization: Managing the Urbanization Process under a Decentralized Framework,” Settlements, Growth Zones and Urbanization (Manila, December 1998). Source: NSO 1960-1995 Census of Population and Housing.

other measures to increase revenues. Today, urban problems are so acute that they are no longer viewed as mere local government problems but as major subregional and national concerns (Cabegin and Arguillas, 1997). The Philippines has about 230 urban areas with populations exceeding 50,000. These include Metro Manila and Metro Cebu, which are counted as single metropolitan areas and not as multiple local jurisdictions. The number of urban areas is expected to increase as new cities and urban clusters are formed around the older settlements. Some studies estimate that by 2020, the Philippines may have as many as 600 urban centers (World Bank, 2000). The Philippines is classified among the world’s fastest urbanizing countries. Urbanization grew by 5 percent annually between 1980 and 1990. If this trend continues, an estimated 65 percent of the total population will be living in urban areas by 2020. The population classified as urban rose steadily, from less than 30 percent in 1960 to 37.2 percent in 1980 and 48.6 percent in 1990. By 1995, the level of urbanization reached 54.1 percent, exceeding the urban shares of total population in Indonesia (35 percent) and Thailand (20 percent). The country’s high urbanization rate is attributed to the high national growth rate, urban-ward migration, limited land area, progressive concentration of economic development in few locations, and concentration of land ownership in the hands of a few (World Bank, 2000). In 1995, urban residents became the majority for the first time, with 54.1 percent of the total population living in urban areas as shown in Table 4 (Gonzales et al., 1998; NSO, 1995). Most of the urban population is concentrated in growth centers such as Cebu, Bacolod, Iloilo, Cagayan de Oro, Davao, General Santos City, and the National Capital Region. About 9.4 million Filipinos or 13.7 percent of the total population live in the NCR, the nation’s prime urban area. With an average growth of 3.3 percent a year, the NCR’s

population is expected to double in 21 years (UNFPA, 1999). The NCR continues to be the center of human activity and absorbs the fastest growing segment of the national population. One-third of the population can be found in 14 major cities (UNFPA, 1999), which gives the Philippines the highest level and rate of urbanization in Southeast Asia (POPCOM, 2000a). Inadequate social services, proliferation of squatter areas, traffic congestion, severe problems in water supply, inadequate sewerage system, uncollected garbage, deteriorating quality of health and education services are the most likely consequences of rapid urbanization taking place without the benefit of improved economic activity. The poor suffer the most from this deterioration of the quality of life in urban areas. Due to the limited choices available to them, the urban poor are forced to locate themselves either at the fringes, where access, employment, and livelihood opportunities are limited, or at the urban core where they suffer from overcrowding, lack of services, and lack of suitable housing. Latest figures from the Technical Working Group (TWG) on Income and Poverty Statistics of the National Statistical Coordination Board show that while the incidence of urban poverty declined between 1985 and 1997, the urbanization of poverty rose again following the onset of the Asian financial crisis. The urban poor live mostly in high-risk areas such as along riverbanks or highly sensitive coastal areas, canals, railroad tracks, utility corridors and watersheds. The TWG data show that in 1999, 35 percent of the urban population lived in areas where access to services is either poor or non-existent. The Medium Term Philippine Development Plan for Shelter (MTPDP-S) estimates the country’s housing need at 3.362 million units for the period 1999-2004. This consists of around 2.224 million units composing future need resulting from population growth, plus some 1.138 million units in total housing backlog. It is a huge target that the government would be hard pressed to attain. The historical performance of government housing institutions indicates that they can only address some 30 to 40 percent of the country’s housing needs due to limited resources. For the period 1998-2000, government provided 279,538 households with shelter security units — 8 percent of the total estimated housing need for the period. Some P44.53 million in government funds was spent for this purpose (Alonzo and Esguerra-Villamor, 2002). 5. International migration The Philippines is the second largest labor exporter in the world, second only to Mexico. There are around 7.5 million Overseas Filipino Workers (OFWs). Ten percent of the total population are classified as OFWs, distributed in 182 foreign countries. On the average, about 2,500 Filipinos leave the country every day (POEA, 2000). Foreign exchange remittances from OFWs

have significantly helped to prop up the Philippine economy over the years. Gender stereotyping of OFW occupations exists. Women dominate the service workers (9 out of 10), as well as the professional and technical workers categories (3 out of 4). In 2000, some 600,000 women OFWs were domestic helpers in 19 major destinations worldwide. There are at least 47,017 Filipino entertainers in five countries in Asia of whom 95 percent are in Japan. The rest are in Hongkong, Macao, South Korea, and Saipan (POEA, 2000). Official statistics clearly reveal an increasing number of women both in the internal and international migrant flows. The percentage of deployed women OFWs has steadily increased from 12 percent in 1975, to 47 percent in 1987, to 58 percent in 1995, and 61 percent in 1998 (POEA, 2000). These figures point to a continuing trend of feminization of overseas employment. While this provides greater opportunities for women to join the labor force and to contribute to economic development, this also serves to underscore their vulnerable status in society. Numerous cases of physical abuse, financial exploitation, and sexual abuse of female OFWs have been documented. They are exposed to reproductive health problems and to higher risks of contracting RTIs and HIV-AIDS.

B. Health, Morbidity and Mortality 1. Infant mortality rate and under-5 mortality rate Reduction of infant and child mortality is one of the primary goals of the ICPD and the MDGs. ICPD member countries were urged to strive to reduce their infant and under-5 mortality rates by one-third or to 50 to 70 per 1,000 live births by 2000. By 2005, countries with intermediate mortality levels should aim to achieve an infant mortality rate below 50 deaths per 1,000 live births and under-5 mortality rate of 60 deaths per 1,000 live births. The Philippines experienced a downward trend in infant and under-5 mortality rate in 19902002. Table 5 presents infant and under-5 mortality rates for the five-year period preceding the 2003 NDHS, as well as the two earlier NDHS in Table 5. Trends in Infant and Under-Five Mortality Rates (1988-2002) Survey Year

Approximate Calendar period

Infant Mortality Rate (Per 1,000 live births)

Under-5 Mortality Rate (Per 1,000 live births)

1993 1998 2003

1988 - 1992 1993 - 1997 1998 - 2002

34 35 29

54 48 40

Source: NSO, 2003 National Demographic and Health Survey (Preliminary Report).

Table 6. Maternal Mortality Ratio: Philippines, 1993-1998 Census Year

MMR (per 100,000 births)

1993 1998

209 172

Source: NSO, 1993 and 1998 National Demographic and Health Survey

the Philippines. The data show that the IMR has declined in the past 10 years, from 34 to 29 deaths per 1,000 live births. At the same time, the under-5 mortality rate went down from 54 per 1,000 live births in 1990 to 40 deaths per 1,000 live births 10 years later. In immunization coverage (one program to address/reduce high IMR and MMR), the Maternal and Child Health Survey (MCHS) reported that in 2000, 65 percent of all children aged 12-23 months were fully immunized before turning 1 year old. The preliminary results of the 2003 National Demographic and Health Survey (NDHS) indicated that 60 percent of all children aged 12-23 months were fully immunized. These figures show an improvement from the survey of 1997 when only 50 percent were fully immunized. 2. Maternal mortality ratio The ICPD Program of Action states that countries should strive to effect significant reductions in maternal mortality by at least half of the 1990 levels by 2000. The MDG affirms this by targeting a reduction in the MMR of about half or 105 per 100,000 live births in 2000 and further reducing it by half in 2015. In the Philippines, the absence of accurate data on the pace of MMR decline makes it difficult to assess whether the ICPD and MDG goals are achievable (NSO, 2002). The well-being of mothers can be assessed in terms of the maternal mortality ratio (MMR). The MMR in the Philippines is 209 deaths per 100,000 live births on the 1993 NDS; the ratio was reduced to 172 deaths per 100,000 live births based on the 1998 NDHS (table 6). The large sampling error associated with these estimates (Stanton et al., 1997: 44 as cited in NSO et al., 1999), however, does not provide conclusive evidence that the MMR has declined (NSO et al., 1999). The lifetime risks of dying from pregnancy were 1:100 in 1999, but in remote areas, it went as high as 1:35 (DOH, 1993 and 1999). This figure reflects the lack of access to services that characterize rural areas in the country. Maternal deaths made up less than 1 percent of the total deaths in the country in 1998, but they contributed about 14 percent of all deaths of women aged 15-49 (NSO, 1999). Major causes of maternal deaths identified are postpartum hemorrhage, eclampsia, and severe infection

(UNFPA, 1999). High incidence of high-risk births, inadequate prenatal care, and lack of information and means to manage complications in difficult pregnancies account for much of the increased risks of dying during pregnancy and childbirth. Around 2.4 million Filipino women become pregnant every year, resulting in 2 million fullterm births annually. Some 300,000 of these women experience a major obstetrical complication requiring hospitalization. Forty percent (960,000) develop some other pregnancy- and delivery-related disease or condition. Of the 10.43 million married Filipino women of reproductive age in year 2000, about 7.2 million were regarded as being at high risk (UNFPA-SAPP, 2003). Primary health care services are not yet widely accessible. Not all pregnant women are reached by trained prenatal care providers. Problems in the devolution of health care services to local governments continue to thwart efforts to reduce maternal mortality rate. Many local governments do not have adequate institutional preparation to take on the responsibility for health care (e.g., shortages of technical workers for health operations, lack of equipment, inadequate health facilities, and inadequate referral systems among health facilities) (Philippine Progress Report-MDG, 2003). Complications attending delivery or “obstetric deaths” account for 75 percent of maternal deaths (World Health Organization (WHO), United Nation Population Fund (UNFPA), United Children’s Fund (UNICEF). Both the 1993 NDS and the 1998 NDHS data showed that urban women were more likely to receive adequate prenatal care than women in rural areas. Access to trained prenatal care providers was much greater among women with some college education than among those with lower education. Of women who received prenatal care, few obtained complete care. Most women received only 6 to 11 of the 12 required elements of antenatal care (UNFPA, 1999). The 1998 NDHS data further showed that only 56 percent of deliveries were attended by skilled health professionals while 59 percent of women received postpartum care. Further improvement of the country’s current MMR means putting resources and energies into the management of complications or emergency obstetric care. It means critically assessing the current practice of relying on traditional birth attendants. It also means more prenatal care and more spending on curative care rather than preventive. Nevertheless, the services provided to mothers relative to pregnancy are higher than the benchmark of 60 percent. Overall, attaining the developmental goal of reducing MMR will depend very much on the success of the government’s efforts to address the main causes of maternal deaths. Obviously, more needs to be done in service provision, especially

in managing emergency complications of pregnancies, addressing the reproductive needs of adolescents and other high-risk pregnancies. These services should be made accessible, especially to the rural populations, by setting up transport facilities to allow emergency cases to be attended to immediately. 3. Life expectancy at birth By 2005, countries should aim to achieve a life expectancy at birth greater than 70 years and by 2015 a life expectancy at birth greater than 75 years. The decline in life expectancy at birth slowed down in recent years compared with the rapid decline during the early postwar period. Table 7 shows that Filipino males born in 1970 Table 7. Life Expectancy at Birth by Sex: Philippines, 1960-1995. Year 1960 1970 1990 1995 2000

Male 55 57 62 64.5 67*

Female 59 61 67 69.7 72*

Source: Cabigon and Flieger (1999). *Projection made by the Technical Working Group on Population Projections, NSCB based on 1995 Census data.

could expect to live for about 57 years and females for about 61 years. In 1990, life expectancies for males and females increased to 64.5 years for males and 69.7 for females. This continued to be so as shown by the Philippine Human Development Index Report in 2000, which recorded the average total life expectancy of both sexes as 67.4 years in 1994, 68.9 in 1997, and 69.5 in 2001 (71.6 for females and 67.6 for males). Compared with other Asian nations, however, Philippine gains in life expectancy were modest. In 2001, life expectancies in Thailand were estimated at 68.9 years for both sexes (73.2 years for females and 64.9 years for males). In the Republic of Korea, the corresponding expectancies were 75.2 years for both sexes (79 years for females and 71.4 years for males) (HDI, 2003). Access to health care services for all people, especially for the most underserved and vulnerable groups such as the older persons, must be ensured. Governments should seek to make basic health care services more sustainable financially.

C. Education Rapid population growth in the Philippines leads to a rapid increase in the school age population, resulting in ever increasing school enrolment. However, lack of resources for providing basic quality education and the pervading poverty among households have adversely affected the school survival rates. The poor are the most affected.

or e

or m

Over the years, the Philippine government has

0 1

D. Poverty

N at io na l

had limited success in bringing down poverty In 2000, simple literacy rates for the populalevels. Poverty incidence increased continuously tion 10 years old and older stood at an almost from 35.5 percent in 1991 to 28.1percent in 19973 equal 92.7 percent for females and 92.5 percent for and to 28.4percent in 2000. It registered a considmales. These figures are lower than in the 1990 erable decrease from 1994 to 1997,3 but showed a census year when literacy rates declined from 94.0 very slight increase of 0.3 percentage points in percent for males and 93.2 percent for females. 2000. This translates to about 4.3 million families Women tended to stay longer in school and a or 26.5 million Filipinos, meaning more than onegreater number pursued higher education. While third (34.0 percent) of the countryâ&#x20AC;&#x2122;s population slightly more boys started school (in 2000-2001, 51 lived below the poverty line in 2000. percent versus 49 percent among girls), slightly more girls proceeded to secondary school (51 Table 8 shows that except for the four regions percent versus 49 percent). This is evident in the located in Luzon (NCR, Regions II, III, and IV), school participation rates, which have been rising poverty incidence remains high. In fact, 12 out of for girls, but not for boys (NCRFW, 2004). 16 regions have a poverty incidence higher than that of the national average. The Autonomous The 2000 Philippine Human Development Region in Muslim Mindanao (ARMM) registered Report (PHDR) noted that the participation rate for the highest poverty incidence (57 percent) among high school had been more or less maintained at 64 the 16 regions in 2000. Other regions with high percent in 1997 and 65 percent in 1999. It also poverty incidence were Region V (Bicol) with noted, however, that the high school completion rate 49.0 percent, Region XII (Central Mindanao) was significantly lower than at the elementary level. with 48.4 percent, and CARAGA with 42.9 In general, the figures for 1997-1999 are significant percent. improvements over the 1990-1991 figures. It seems that the country has coped with the growth of At the micro level, the profile of a poor enrolment, which has increased by more than 2 household in the Philippines is characterized as a percent annually for elementary school and more household in a rural area, headed by a 30-50-yearthan 3 percent for high school since 1981. old male farmer with elementary schooling (UNCCA, 2003). It can also be said that poorer With more access to basic education, the literacy rate has improved. The 89.8 percent Table 8. Regional Poverty Incidence (in %), simple literacy rate in 1989 rose to 93.9 percent in by Family in 1994-2000. 1994 or by 4.1 percentage points, without a significant difference between men and women. Area 1994 1997 2000 The functional literacy rate of 75.4 percent in 1989 improved to 83.8 percent in 1994 with no Philippines 35.5 28.1 28.4 NCR 8.0 4.8 5.7 marked gender bias. CAR 51.0 35.9 31.1 The overall access of the school age population Region I 47.9 31.4 29.6 to elementary education reached 97 percent in Region II 35.5 27.1 24.8 Region III 25.2 13.9 17.0 school year 2002, up from 85 percent in school year Region IV 29.7 22.8 20.8 1993. The government has embarked on a oneRegion V 55.1 46.9 49.0 school-one barangay program. This has increased Region VI 43 37.2 37.8 access to education. On the other hand, the particiRegion VII 32.7 29.8 32.3 pation rate at the secondary level has moved from Region VIII 37.9 39.9 37.8 Region IX 44.7 31.9 38.3 only 57 percent to 73 percent for the same period. Region X 49.2 37.8 32.9 The participation rate at the elementary Region XI 40.3 31.1 31.5 education level in both public and private schools Region XII 54.7 45.3 48.4 improved from 85.1 percent in 1991 to 96.9 ARMM 60.0 50.0 57.0 CARAGA 44.7 42.9 percent in 2000. However, many of the children who enroll do not complete the school year as seen Source: NSCB, 2003. in the low cohort survival Figure 4. Poverty Incidence (in %) by Number of Children in 1991-2000 rate. The cohort survival rate declined from 68.4 percent to 70 67.1 percent over the same 1991 2000 period. Completion rate, 60 however, slightly increased 50 from 65.5 percent in 1991 to 40 66.1 percent in 2000 30 (DepEd, Philippine Progress 20 Report on the MDG, 2003)

Source: PIDS, 2003 Population, Poverty and Development: Review and Research Gaps

Table 9: Bottom 10 Provinces by Poverty Incidence, IMR, MMR, AND TFR.

Region

Province

Poverty TFR Incidence 2000 2000

IMR 1995

MMR 1995

PHILIPPINES

28.4

3.38

48.93

179.74

ARMM

Sulu

63.2

2.31

84.08

333.60

Masbate

62.8

5.01

64.34

216.02

ARMM

Tawi-Tawi

56.5

2.52

60.21

299.14

CAR

Ifugao

55.6

4.49

64.57

236.36

Romblon

55.2

3.62

57.22

218.03

ARMM

Maguindanao

55.1

4.17

59.81

278.32

ARMM

Lanao del Sur

55.0

3.56

69.62

346.01

XII

Sultan Kudarat

54.3

4.05

57.97

267.00

Camiguin

53.1

3.71

54.36

231.97

Camarines Norte 52.7

4.33

61.60 218.68

Sources: 2003 NSCB; 1995 NSO TFR Projections as computed by the TWG on Population Projections, SPPR 2000.

households are those with more children. The Philippine Institute for Development Studies (PIDS) infers that as family size increases, the incidence of poverty is also correspondingly higher as shown in Figure 4. This scenario shows that the size of family is linked to problem of poverty. Table 9 shows the poverty incidence and RH situation of the 10 poorest provinces in the country. In general, it can be observed that the poorest provinces have also high IMR, MMR, and TFR. II. REPRODUCTIVE HEALTH Various international conferences have recognized the need to strengthen reproductive health policies and implement comprehensive, integrated RH care including family planning. The 1994 ICPD and the 1992 Bali Declaration emphasized the need to broaden FP programs through a reproductive health approach. This approach calls for universal access to a full range of safe and reliable FP methods and the provision of related reproductive and sexual health services. The Philippines has a reproductive health program. Through this program, many couples and individuals have access to good RH information and services. As a signatory to the ICPD Program of Action, the Philippine government has adopted

policies in line with this RH program. However, changes in the strategies of the present national administration hinder the continuity of the program. The reproductive health care package includes 10 core service elements: 1) family planning; 2) maternal and child health care; 3) prevention of abortion and management of its complications; 4) prevention and treatment of reproductive tract infections including STDs, HIV, and AIDs; 5) prevention and appropriate treatment of infertility and sexual disorders; 6) prevention and treatment of breast cancers, cancers of the reproductive system, and other adverse gynecological conditions; 7) counseling and education on sexuality and sexual health; 8) adolescent reproductive health; 9) male reproductive health; and 10) prevention and management of violence against women.

A. Unmet Need The State of the Philippine Population Report (SPPR) 2001 highlights unmet need for FP services in the country. Since the adoption of the ICPD PoA, the integration of family planning with the reproductive health and rights of men and women has become a major strategy of the PPMP. In carrying it out, the government recognizes the basic right of couples and individuals to choose freely the number and spacing of their children. Unmet need reflects a woman’s reproductive intentions. Women who prefer to space or limit births but are not practicing family planning are considered to have an “unmet need.” About 9 percent of currently married women who want to space births and 11 percent of women who want no more children do not practice contraception. Unintended pregnancies and induced abortions could be an additional indicator of unmet need (NSO-NDHS, 1998). The SPPR 2001 states that the problem of unmet need is brought about by a number of factors. These include lack of information and access to high-quality family planning services. This is suggested by the “fear of side effects” as among the reasons for not using contraception. The reasons currently married women do not use a contraceptive method are: they want children (20.1 percent); lack of knowledge (6 percent); costs too much (0.4 percent); hard to get methods (0.4 percent); side effects (21.6 percent); health concerns (10 percent); inconvenient (2.1 percent); old, difficult to get pregnant, infrequent sex or husband away (18.6 percent); menopausal or had hysterectomy (10.7 percent). Unmet needs for contraception

In 2003, the National Statistical Coordination Board (NSCB) modified its method for computing poverty incidence and revised the computation of data since 1997 onwards. This explains the abrupt decrease of poverty incidence from 1994 to 1997.

Unmet need of women stems largely from the high cost associated with practicing contracep-

Table 10: Unmet Need for Family Planning Services, Philippines: 1998-2002 Charac- Unmet Need for Family Planning (in %) teristics 1998 2002 For For Total For For Spacing Limiting Spacing Limiting

Table 11: Contraceptive Prevalence Rate of Currently Married Women, 1973-2002

Total

Residence Urban 7.3 Rural 9.8

9.0 13.4

16.3 23.3

9.8 11.4

9.7 10.2

19.5 21.5

Total

11.2

19.8

10.6

9.9

20.5

8.6

Source: NSO, 1998 NDHS and 2002 Family Planning Survey

tion or obtaining FP services (NSO-NDHS, 1998). Fertility surveys reveal that married couples in the Philippines exceed their “wanted fertility” by one birth. Rural couples have an unintended fertility as high as 1.4 births compared to 0.7 for couples in the urban areas. In 1993, the unmet need for FP was 26.2 percent. This declined to 19.8 percent in 1998 and increased to 20.5 in 2002 with 10.6 percent for spacing births and 9.9 percent for limiting births. In rural areas, total unmet need was 21.5 percent, which is two percentages points higher than 19.5 percent in urban areas (Table 10). Other than price and income, there are factors that contribute significantly to unmet need for family planning in the Philippines. These are: 1) strength of fertility preferences; 2) perceived risk of conceiving; 4) perceived effects on health of contraception among both husbands and wives; 5) husbands’ fertility preferences; and 6) husbands’ and wives’ acceptance of family planning.

B. Contraceptive Prevalence Rate Table 11 shows the level and trends of use of various contraceptive methods. The Contraceptive Prevalence Rate (CPR) is the most important measure of the success of the Philippine Family Planning Program. The trend in CPR has increased from more than 17 percent in 1973 to around 49 percent in 2002. The use of modern contraception increased steadily from around 11 percent in 1973 to 35 percent in 2002. This is mainly due to a significant rise in the percentage of women who had tubal ligation, which increased

Year

Types of FP Method Modern Traditional

CPR

1973 1978 1983 1988 1993 1996 1997 1998 1999 2000 2001

10.7 17.2 18.9 21.6 24.9 30.2 30.9 28.2 32.4 32.3 32.4

17.4 38.5 32.0 36.1 40.0 48.1 47.0 46.5 49.3 47.0 49.3

2002

6.7 21.3 13.1 14.5 15.1 17.9 16.1 18.3 16.9 14.7 16.9

35.1

13.8

48.8

Source: NSO, 2002 Family Planning Survey.

to around 18 percent in 1998. The use of traditional methods also increased from around 7 percent in 1973 to 18 percent in 1998. However, CPR decreased to 48.8 percent in 2002 from 49.9 percent in 2001. The slight decrease is attributed to the 2.6 percentage-point decrease in the prevalence rate for traditional methods, from 16.4 percent in 2001 to 13.8 percent in 2002, although the prevalence rate for modern methods rose from 33.1 percent to 35.1 percent (NSO-FPS, 2002). Prospects for improving contraceptive prevalence might be uncertain in the next few years, given the continued lukewarm support of government for the family planning program and the recent withdrawal of support for contraceptive procurement by traditionally active donor agencies supporting the program such as the United States Agency for International Development (USAID).

C. Adolescent Health and Sexuality Based on the 2000 census, Filipino youth aged 15-24 accounted for 15.1 million out of the national population of 76.5 million. Their number is expected to double in 33 years. Their proportionate share of the total population remains at 20 percent with an annual growth rate of 2.1 percent as shown in Table 12. A profile of Filipino youth published by the National Statistics Office in 2000 revealed that

Table 12 : Youth’s Proportionate Share of the Total Population, Sex Ratio and Median Age and Growth Rate: Philippines, 1970-2000 Census Year

Philippine Population (in millions)

Youth (ages 15-24) Populations (in millions)

Youth’s Proportionate Share of Population

Youth Sex Ratio

Youth Median Age

Youth Population Growth

1970 1975 1980 1990 1995 2000

36.7 42.1 48.1 60.6 68.6 76.5

7.2 8.8 9.8 12.4 13.7 15.1

19.6 20.9 20.5 20.5 20.0 19.7

99.3 99.4 99.4 101.8

19.6 19.3 19.6 19.7

4.1 2.2 2.3 1.9 2.1

Source: NSO, 2000 as cited in the State of the Philippine Population Report (SPPR), 2002.

Table 13: TFR and Fertility Rates of Women 15-24 Years

Table 14: Percentage with Any RH Problem, by Sex: 1994-2002

Year

Percent Growth

TFR

RH Problem

1973 1978 1983 1986 1993 1998

2.4 2.5 2.6 2.7 2.9 3.0

1.42 1.31 1.38 1.20 1.20 1.12

Source: NSO, 1998 National Demographic and Health Survey.

the fertility rate of those 15-24 years old was 1.12 children per woman by the time she reached 25. Adolescent fertility, particularly among those below 20, is low. These young women number 3.6 million and compose 5.2 percent of all women of reproductive age. The total fertility rate of women aged 15-49 was estimated at 3.7 in 1998. This rate has been consistently declining since 1973 when the total fertility rate was at a high of 6 children per woman by the end of her childbearing years. Table 13 shows that the fertility rates of young women aged 15-24 also declined from 1.42 in 1973 to 1.12 in 1998. While fertility rates have declined, the number of births is increasing because more and more young people are entering their reproductive years. The Young Adult Fertility and Sexuality Study (YAFSS II & III) conducted by the University of the Philippines Population Institute in 1994 and 2000 revealed for the first time youth sexual behavior on a national scale, (Raymundo et al., 1999 & 2002). The findings of these studies showed interesting, sometimes alarming trends. YAFSS II and III described the situation of adolescents in the Philippines according to major background variables. Data reflect a high rural-tourban migration rate for young people, with disproportionate numbers for females and single youth migrants. Large proportions of young people transfer among households while still young, leave their parental homes, and have non-familial living arrangements with other young people. The studies also show that many young people are being raised in homes where the father or mother or both are increasingly absent. Both YAFSS II and III show a fairly high incidence of reproductive health problems and sexual activity among Filipino adolescents and a low incidence of treatment and utilization of FP services for all population groups. The two studies highlight a relatively low but already significant level of sexual activity among the youth. Young people practice three types of premarital sex: 1) committed sex; 2) commercial sex; and 3) casual sex. Table 14 shows that twice as many females (about 70 percent) as males (about 35 percent) reported having experienced any reproductive health problem. Their levels have not changed much over 1994-2002. However, RH problems

Male (%)

Female (%)

1994

2002

1994

2002

Percent with any RH problem

34.1

35.7

71.7

73.4

Percent with any serious problem

23.1

25.5

18.7

22.9

Percent with any less serious RH problem

20.5

21.5

69.0

70.0

Source: 2002 Young Adult Fertility and Sexuality Survey, as cited in The State of the Philippine Population Report 2002.

among females are less serious compared with males although a significant increase in the levels of serious RH problems (18 percent in 1994 to 23 percent in 2002) was observed among females. On the other hand, males had significantly higher levels of serious RH problems than females (25 percent vs. 23 percent) in 1994. The levels of serious RH problems among males increased slightly from 23 percent in 1994 to 26 percent in 2002 (POPCOM-SPPR 2002). Today, in the Philippines, females reach menarche at increasingly younger ages, and males are attaining sexual maturation much earlier. Menarche usually occurs between ages 10 and 12. Age at menarche has declined from 16.2 years in the 1950s to 13.2 in the 1990s (Raymundo, 1990). Early sexual maturity coupled with delayed age of marriage exposes the young to unplanned sexual activities earlier and over a longer period of time. This poses risks of all kinds, including STDs, HIV/ AIDS, and unplanned pregnancies (UNFPA, 1999). The health of adolescents and the youth is at risk because they generally lack accurate and appropriate information and complete understanding of the many aspects of sexual behavior, reproductive health, and their sexuality. One aspect of the problem is the historical lack of attention to the health needs of this segment of the population. Adolescent medicine is only starting in the Philippines. This is compounded by the poor health-seeking behavior of adolescents. Risky behaviors and practices have resulted in illness, and even death, and include the following: Early sexual activity. The timing of first sexual intercourse marks the initiation to sexual activities, which if unprotected can lead to adverse consequences. In the Philippines, YAFSS II showed that, on average, boys and girls had their first sexual encounter at the age of 18 and 18.3, respectively. At the time of YAFSS II, some 2.5 million or 18 percent of the youth (1.8 million boys and 670,000 girls) already had premarital sex and around 80 percent of them were not using any method of protection. YAFSS III found that 23

percent of the 15-24-year-olds had experienced premarital sex. There were also indications that about 10 percent of the girls with sex experience were forced into sexual relations by their partners and that many young people engaged in premarital sex without adequate knowledge about how to avoid pregnancy or STDs.

Forming union or early marriage. Delayed age at first marriage is characteristic of Filipino males and females. In 1995, 80 percent of the youth were single and 20 percent were either married, widowed, or separated/divorced. The percentage of those who are single has moved upward in the last few decades. Between 19601990, for ages 20-24, single males increased from 66 percent to 73 percent, and females from 44 percent to 56 percent (Xenos and Raymundo, 1999). In 1994, 13 percent of young Filipino women were already married by age 18; 43 percent by age 21 and 60 percent by age 24 (Balk and Raymundo, 1999), percentages higher than in most other Asian countries. Among adolescents who had married or formed unions, the rate of dissolution was slightly higher than the adult rate (0.23 percent among married adolescents versus 0.17 percent among adults). Early childbearing/teenage pregnancy. The number of teenagers who have begun childbearing is increasing, although still below 10 percent of all women in the NDHS sample (Cabigon, 2002). Teenage childbearing is much higher among rural and low-educated females. Fertility among adolescent women declined by about 8 percent in the five years before the 1998 NDHS. More women today delay childbearing past their teen years compared with the previous generation. The opposite is true among less-educated women. Young women today generally want smaller families. According to YAFSS III, 23 percent of young women between 15 and 24 are already married compared with 8 percent of young men. Young pregnancies account for 17 percent of induced abortion cases. Teenagers who have unprotected sex or unwanted pregnancies are more likely to resort to abortion. The largest proportion (28 percent) of women who had induced abortion complications belonged to the 20-24 age group (Raymundo et al., 2001). Restricted access to contraceptive supplies and RH services, plus social pressure leading to shame and guilt for seeking abortion-related information, supplies or services, influence the relatively high rates of abortion among young women (Cabigon, 2002). Sexually transmitted diseases including HIV/ AIDS. The prevalence of HIV/AIDS in the Philippines is still low, although patterns of sexual behavior and several socio-cultural conditions could precipitate an AIDS epidemic. As of May 2001, the HIV/AIDS registry of the country confirmed 766 cases of HIV seropositive children and youth, with 6 percent belonging to the 10-19 age group and 90 percent to the 20-29 bracket.

The Advocates for Youth place the 1999 HIV prevalence to be a low 0.04 percent among young women and 0.01 percent among young men.

D. HIV Prevalence Rate The National Epidemiology Center (NEC) of the Department of Health (DOH) reported that from January 1984 to June 2004, there were 2,107 HIV Ab seropositive cases, of which 1,442 (68%) were asymptomatic and 665 (32%) were AIDS cases. A total of 1,411 (69%) were in the 20-39 age groups and 1,320 (63%) were males. Out of the 2,107 cases, 676 (32%) were OFWs, of which 249 (37%) were seafarers, 119 (18%) were domestic helpers, 66 (10%) were employees, 40 (6%) were entertainers and34 (5%) were nurses. Some 505 (75%) were males and 171 (25%) were females. Sexual intercourse (93%) was the leading mode of transmission for both sexes. For the period 1984 to 1994, the annual number of cases is continuously increasing (2 to 118) and from 1995 to 2004 shows an erratic pattern (number of cases recorded for the period 1995-2004: 116, 154, 117, 189, 158, 124, 173, 184, 193 and 106(. 3. GENDER AND DEVELOPMENT Since the adoption of the ICPD Program of Action 10 years ago, increasing emphasis has been put on women empowerment. This was further strengthened since one of the MDG goals is to eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education not later than 2015. Achieving gender equality in the developing world is one of the most daunting measures to reduce poverty identified by the Millennium Development Goals (MDGs). MDG Goal 3 — to “promote gender equality and empower women” — specifically includes targets to improve the education of women and girls. The ICPD Programme of Action states that countries must recognize the value of ensuring that women begin and complete their education and of eliminating gender bias in all types of educational materials that enforce and reinforce inequalities between men and women. This recent trend shows that universal access to primary education by 2015 is attainable if resources are devoted to this end and reforms are pursued with determination. This is particularly true for participation rate at the elementary level in both private and public schools. However, maintaining the current participation rates also requires thousands of additional school buildings annually. A report on the 2002 essential indicators of Asia-Pacific countries emphasized that in order to achieve the promotion of gender equality and women empowerment, women should have equal

of women (48.9 percent) was almost half that of men’s. In the period spanning 1990 to 1999, this figure rose from 47.5 percent to 52.9 percent. Despite Level of Education/Sex 1996 1999 this increase, the labor force participation rate for men was still higher than for women at 81.2 percent Elementary 94.33 96.95 in 1990 and 86.3 percent in 1999. Men consistently Male 95.27 96.80 dominate agricultural production, while women Female 93.36 97.11 dominate the informal sector such as sales, animal Secondary 63.36 65.44 Male 58.65 62.63 and vegetable raising, community services, and Female 68.22 68.33 personal services. More women than men do unpaid family work, although the number of male unpaid Source: DepEd, as cited in the 2003 MDG-Philippine Progress family workers increased by 41 percentage points in Report. 1989-1999, compared with the 29-percentage point increase among female unpaid family workers access to health care, educational institutions, (NSCB, 2000). employment opportunities, and positions of leadership. High-quality reproductive health While women have lower participation rates services are an essential element that would than men in local employment, the reverse is seen increase the prospects for safe motherhood and in overseas employment, with nearly two women afford women more effective reproductive control. OFWs for every one male (NSO, 2000). However, women receive lower wages than men, as shown by There have been considerable positive the remittances they send home. These disparities changes in women’s socioeconomic condition. As are obviously due to the differing nature of work noted by the Alan Guttmacher Institute (AGI) in for men and women both in the local and overseas its Research in Brief for Improving RH in the labor market. Philippines 2003, there has been an increase in women’s educational attainment and a steady rise In governance, women are increasingly in women working for pay over the period 1993 to becoming visible as leaders and decision-makers in 1998. This is accompanied by the rising levels of various sectors. However, males continue to exposure to media. It is strongly associated with dominate political participation and decisionthe diffusion of new ideas, including the advanmaking. Although the Philippines has had two tages of having a small family, the acceptability of female presidents, at present there are only three women working, and gender equity. However, it is women out of 24 senators and 33 out of 205 disturbing that these positive socioeconomic legislators in the House of Representatives (PPRchanges in women’s lives have not led to greater MDG, 2003). fulfillment of their reproductive health needs. The bureaucracy is slightly dominated by Education is one area where women and women employees, accounting for 53 percent of men have almost equal status, with even the the total work force, but more men (65.2 percent) former having an advantage. This observation is are appointed to third-level managerial positions. validated in the 2002 Human Female professional and Development Report. Data technical workers, who show that in SY 1999-2000 compose 66 percent of the (table 15), girls had higher bureaucracy, are employed in participation rates in both the second-level positions elementary (97.1 percent) and (PHDR, 2002). There also are high school (68.3 percent) more male justices in the levels than boys (96.8 percent Court of Appeals and the and 62.6 percent respecSandiganbayan as well as in tively). Enrolment in the the regional and local courts. elementary level for SY 2000The 2003 Human 2001 shows an equal number Women’s improved socioeconomic Development Report puts the of girls and boys. The propor- condition has not led to greater fulfillcountry’s gender-related tion was higher for girls in the ment of their reproductive health needs. development index for 2001 secondary level, with 105 girls at 0.748, placing the Philipto 100 boys. pines 85th among 175 countries. This put the The female adult literacy rate was almost country at the level of “medium human developequal to that of the males (95.1 percent for girls ment” in terms of gender. This is slightly lower and 95.5 percent for boys in 2000). Combined compared with the country’s overall human primary, secondary and tertiary gross enrolment development index (HDI) of 0.751. Average ratio in 1999 showed 84 percent for females achievements in human development are still not compared with 80 percent for males (HDR, 2002). equitably distributed between women and men. However, modest gains have been achieved in this The Integrated Survey of Households in area. In the previous report, the Philippines 1997 reported that there were more women (23.3 ranked 100th among 174 countries, with an HDI million) than men (22.8 million) in the labor index for gender of 0.677. force. However, the labor force participation rate Table 15: School Participation Rates, by Sex and Level of Education, 1996-1999

SECTION 3

Program of Action — Assessing the Implementation 20

THIS SECTION PRESENTS an assessment of Philippine accomplishments in the implementation of the ICPD Program of Action (PoA) for 1994 and 1999. The primary sources of data are the two PoAs, the Philippines Country Report to the 5th APPC prepared by POPCOM in December 2002, the Philippine Progress Report for the Millennium Development Goals (MDGs) in January 2003, and the Field Inquiry on ICPD+10 conducted by POPCOM in coordination with stakeholders in April 2003. I.

POPULATION AND DEVELOPMENT

Efforts to slow population growth, reduce poverty, achieve economic progress, improve environmental protection and reduce unsustainable consumption and production patterns are, generally, mutually reinforcing. Sustained economic growth within the context of sustainable development is essential to reduce poverty. Reducing poverty will contribute to slowing population growth and to achieving early population stabilization. The status of women will be a major factor because women are, in general, the poorest of the poor. They are also important actors in the development process. Eliminating all forms of discrimination against women is thus a prerequisite for eradicating poverty, promoting sustained economic growth, ensuring quality family planning and reproductive health services, and achieving balance between population and available resources (ICPD 1994).

A. Policy Development The PPMP Policy Evaluation Research Project conducted by POPCOM and the Philippine Institute for Development Studies (PIDS) in 2001 provided a comprehensive inventory of completed, ongoing and planned policies, programs, and researches on population from 19692002. It provided an in-depth review and analysis of existing policies. It identified research gaps in population and evaluated relevant population policies. The results of the project reveal that the Philippines does not have a strong and consistent population policy (Herrin, 2002). The country’s population policy, which is based on the 1987 Constitution, states that “couples have the responsibility to decide the number of children that they want to have in accordance with their

religious beliefs and the demands of responsible parenthood for sustainable development” (Article XV Section 3.1 of the 1987 Constitution). A government policy is deemed good if the government actually mobilizes the resources needed to implement the policy effectively. In terms of population, one indicator is that the government actually appropriates money to purchase contraceptives for distribution to outlets. Data from 1994 and 1998 family planning expenditures by sources show that Congress did not appropriate a single centavo to purchase contraceptives during those years (Herrin, 2002). The contraceptive supplies have all been financed from donor contributions, mainly from USAID and to some extent from UNFPA. A Contraceptive Interdependence Initiative (CII) by POPCOM and DOH during the Estrada administration was launched to increase reliance on government funding to compensate for the decline in donor funds. To enhance the capability of POPCOM to formulate policies, which relate to PPMP, the Population Policy Operations Project (1994-1999) was implemented by POPCOM in coordination with different partner agencies. Among the major outputs of the project were the compilation of major population policies that relate to: a) RH/FP, b) Urbanization, Land Use and Migration, c) Human Resource Development, d) Water Resources Management, e) Food Security, and f) Environment. Given the controversial nature of population as an issue, clear statements of policy are needed. There are several views that could be taken with respect to fertility and population growth reduction, and several possible objectives for the family planning program. The government must therefore state clearly its position with respect to these alternatives and then forge a stable consensus on the path to be taken (Herrin, 2003). The lack of a policy consensus across political administrations has slowed down fertility transition. As evidence, the country’s fertility decline has been very slow compared with those of South Korea and of Thailand. The Philippines squandered the advantage of a more favorable age distribution (the so-called demographic bonus) that these countries had which contributed to their sustained economic growth and higher standards of living. During the Ramos administration (19921998), support to the family planning program from the Executive branch of the government was

much stronger. The fertility reduction objective was emphasized within the context of a population-resources-environment (PRE) framework. The PRE framework promotes a balance between and among population level, resources, and the environment. During the Estrada administration (19982001) the efforts of the director general of the National Economic and Development Authority (NEDA) and the secretaries of DOH and the Department of Education (DepEd) resulted in a broadened Population and Sustainable Development (PSD) framework. The PSD framework affirmed people’s capabilities, including the capability to have the number of children they desire and the capability to move around freely. The framework had a poverty alleviation dimension. It was during this period that POPCOM, DOH and NEDA successfully included a budget in the General Appropriations Act (GAA) for the procurement of FP commodities. However, this was realigned to other family health programs during the Arroyo administration. In a speech at the Asia-Pacific Conference on Reproductive Health (APCRH) held February 2001 in Manila, President Gloria Macapagal Arroyo underscored the need for the government “to adopt policies that will take into consideration population and reproductive health approaches that respect culture, values, and equality between men and women.” She also called on local government units (LGUs) to support and fund population and RH initiatives. On family planning, she emphasized the responsibility of the government “to provide information on medically safe and socially acceptable means to address our high birth rate and its consequences on maternal and child health as well as population growth.” Toward the conclusion of her speech, President Arroyo welcomed efforts to develop more natural family planning (NFP) methods. In succeeding speeches, the President noted that the program in the past had been biased toward artificial family planning methods; hence, the national government would now promote NFP “to level the playing field.” In 2003, President Arroyo advocated the implementation of the four pillars of her population and family planning (FP) policy: •

Responsible parenthood. This is the will and ability to respond to the needs and aspirations of the family. Couples are free to decide on the timing of pregnancies and the size of their families in pursuit of a better life. It is a

shared responsibility between men and women to achieve a desired number and spacing of their children according to their own family aspirations. Alongside responsible parenthood is responsible parenting, which is the proper upbringing and rearing of the children for a healthy and productive citizenry. •

Respect for life. The 1987 Constitution protects the life of the unborn from the moment of conception; abortion is unacceptable as a method of family planning.

•

Birth spacing. Three-year birth spacing within the context of responsible parenthood is needed so that women could recover from pregnancy and improve their potential to be more productive.

•

Informed choice. Couples and individuals will be provided with all the information and services on the natural and artificial methods of family planning to be able to make an informed choice. In legislation, there were important bills filed in Congress. House Bill (HB) 6123 was filed to establish an integrated population and development policy and to strengthen its implementing mechanisms. This bill, which replaced an earlier version under HBs 31 and 1662, has reached second reading, with the Committee Report already submitted. Another bill, HB 4529, was filed to establish a population office in all local government units and transfer control and supervision to the Commission on Population. HB 2660 was filed to create and appoint the barangay population worker, granting benefits, and appropriating funds therefore.

B. Plan Development The Philippine government recognizes the interrelationships among population, economic growth, and sustainable development. The negative implications of rapid population growth on the achievement of sustainable development was clearly stated in Section 1 of the Medium Term Philippine Development Plan (MTPDP) 19931998. The MTPDP 2001-2004 also states that a population management program should push for sound reproductive health of women, men, and adolescents. A large population impedes economic growth, since large families cannot raise enough savings to bequeath adequate amounts of human, financial, and physical capital to their children. Population pressure also weakens the government’s capacity to provide enough investments in human capital, say, in education, training, and health. Moreover, high population density contributes to the degradation of the environment, making it exceedingly difficult to provide for future generations. Even before ICPD, planners had tried system-

A large population weakens government’s capacity to provide enough investments in human capital. atically to integrate population and development in planning. At the national level, population variables had been integrated in the formulation of the MTPDPs and Medium Term Philippine Investment Program (MTPIP), PPMP Directional Plans, National Objectives for Health (especially its FP aspect), and computation for the allocation of funds for LGUs (Internal Revenue Allocation). Population and development concerns are also integrated in the following documents: a) Report on the Environmental Impact Assessment on the MTPDP, b) National Framework for Women, c) Status of Commitments to the Agenda 21 Chapter on “Across Ecosystems,” d) Philippine National Development Plan for Children (Child 21), (e) Medium Term Youth Development Plan, f) Comprehensive Action Agenda for the 20/20 Initiative, and other planning documents at the national and regional levels. The PPMP Directional Plan for 1998-2003 and 2001-2004, the PPMP SOP and PPMP PIP 2002-2004, and other documents formulated by POPCOM call on the government (NEDA, DOH, LGUs, and others) and other population program stakeholders to: 1) assist couples in achieving their desired fertility goals and prepare individuals to become responsible parents, with special focus on poor couples and adolescents with unmet need for RH/FP information and services; 2) improve the reproductive health of individuals and contribute to the lessening of maternal mortality, infant mortality and early child (under 5 years of age) mortality; 3) reduce the incidence of teenage pregnancy, incidence of early marriage, and incidence of other reproductive health problems; and 4) contribute to policies that will assist government achieve a favorable balance between population distribution, economic activities, and the environment. Under the PPMP DP for 1998-2003, the major programs were: a) Population and Develop-

ment (POPDEV) Integration, b) Promoting Equality and Women Empowerment, c) Reproductive Health and Family Planning (RH and FP), d) Adolescent Health and Youth Development (AHYD), and e) Migration and Urbanization. For PPMP DP 2001-2004, the programs were a) POPDEV Integration, b) AHYD, c) RH/FP, and d) Resource Generation and Mobilization. Since 2000, the Philippines has worked to integrate the attainment of these goals in its medium-term development plans. The MTPDP 2001-2004 is a comprehensive set of policies and programs directly aimed at addressing the needs of the poor. Its core strategies include those that target macro-economic stability, agricultural and fisheries modernization with social equity, comprehensive human development and protection of the vulnerable, and good governance and the rule of law (as cited in the Philippines Progress Report on the MDG, 2003). The government’s anti-poverty agenda is also consistent with its international commitments. It has five major strategies: 1) asset reform, 2) human development services, 3) employment and livelihood, 4) participation in basic sectors in governance, and 5) social protection and security against violence. The government further committed itself to the development and adoption of innovative financing mechanisms for health care, education, social welfare and housing services, and the prioritization of basic social services, like primary health care, nutrition, basic education, water and sanitation facilities. The MTPDP 1993-1998 under the Ramos administration explicitly recognized the influence of rapid population growth on sustainable development. The plan aimed to reduce the population growth rate from 2.36 percent in 1990 to less than 2 percent by 1998. In promoting a balance between population, resources, and environment to ensure sustainable development, one of the strategies adopted was to “implement vigorously the Family Planning Program to moderate population growth.” The pursuit of family planning with a fertility reduction objective returned to the development agenda while continuing to intensify family planning efforts to improve health. To strengthen the population program, the plan also sought the passage of a bill to strengthen POPCOM. The bill provided for the reorganization of POPCOM and its transfer to the Office of the President. In June 2003, POPCOM and DOH had a strategic planning workshop where the primary objective was to advocate the Philippine Family Planning Program using responsible parenthood as a guiding concept. One of the major outputs of the workshop was the identification of the following key conditions that should be present in the LGUs to ensure that localities manage their population adequately: political will, local advocates, adequate service delivery structure, multisectoral support/client mobilization, and utilization of information for local decision-

THE PHILIPPINE POPULATION MANAGEMENT PROGRAM (PPMP) ONE- SCRIPT Population and sustainable development are closely connected. They share a common agenda, that is, to achieve quality of life. Quality of life includes the capacity to be free from avoidable illness, be wellnourished, and be educated. It means having access to employment and income opportunities. It means being able to move about in search of better opportunities, and to enjoy social justice and equity. It is having the capacity to meet fertility preferences (including the right to bear and rear children). The complexity of the relationship between population and development calls for appropriate mechanisms of governance that enhance participation in decision making. These mechanisms must be put in place so that people can fully participate in the economic, political, cultural and social affairs of society. In line with this, the Secretary of Health stated that the population program should not focus only on fertility management but also on the whole gamut of socioeconomic and cultural issues. Accordingly, the Commission on Population formed a committee to draft a document that would guide the pursuit of the population program not in isolation but in tandem with the policies and programs of other sectors. The result is the PPMP 1-Script, a document reflecting the interrelationship between population and other sectors, namely health, education, employment, housing, food security and environment. Discussions of the sectoral frameworks linking population and the other sectors are pegged on the Population and Sustainable Development Framework, with particular articulation on fertility management and with governance as the cross-cutting element for human development and population management. Other crucial elements that were reflected on the script are improved quality of life, human development, specific sector situationers, and general action areas. The PPMP 1-Script, although conceptualized and drafted by POPCOM, was enhanced through several consultations and meetings with the Department of Health (DOH), the Department of Education (DepEd), the Department of Labor and Employment (DOLE) as represented by the Bureau of Labor Relations (BLR), the Department of Agriculture (DA), the Department of Environment and Natural Resources (DENR), and the Housing and Urban Development Coordinating Council (HUDCC) as lead agencies of at least eight other agencies within their respective sectors. POPCOM and the above-mentioned agencies each occupies a place in the whole bureaucracy of population and sustainable development. To date, the PPMP 1-Script is being used as one of the major references in the development of a POPDEV Planning Guide and as a tool in the development of advocacy materials for population and sustainable development.

making. POPCOM and DOH were able to identify their own organizational roles and responsibilities in the LGUs to attain the five key conditions. Another milestone is Philippine Agenda 21 (PA 21). This sets the broad framework for sustainable development in the country. It integrates population factors in national and sectoral development plans. The Summit on Human and Ecological Security (HES) in 1995 mandated the allocation of resources for human and ecological concerns by both public and private sectors. Consequently, a provision was incorporated in the General Appropriations Act (GAA) starting in 2002 requiring all government offices to provide funds for HES. Human security and ecological security are recognized as interlinked and mutually dependent. Two most recent documents produced by POPCOM are the PPMP One Script and the POPDEV Planning Guide. The PPMP One Script basically shows the interrelationship between population and other important sectors such as health, education, employment, food security, environment, and housing. The POPDEV Planning Guide was conceptualized and developed to make the POPDEV Planning Approach userfriendly. It aims to provide an easy reference to planners and program managers on how to integrate population and development interrelationship in plan and program development. It basically builds on the experiences of planners at all levels in the development, implementation, monitoring,and evaluation of plans. At the local level, some LGUs continue to maintain Population and Development Councils. These consist of representatives of LGUs, NGOs, civil society, and the academe. Meant to address issues on population and development, they integrate poverty concerns at the local levels. The poverty reduction strategies being considered are: a) livelihood assistance program b) PhilHealth coverage (formerly Medicare) for the poor, c) identifying and monitoring the status of minimum basic needs (MBN), and d) scholarship program for poor but deserving students. POPCOM, with funding assistance from UNFPA, developed the four training modules for Population and Development (POPDEV) Planning at the Local Level (PPLL) in 1998. These modules were used in conducting capabilitybuilding activities for local planners. They resulted in many â&#x20AC;&#x153;POPDEV-sensitiveâ&#x20AC;? initiatives in the provinces and cities. The POPDEV Planning Approach explicitly considers the interrelationships of population and development variables in the entire planning process. LGU participation in the PPMP has been difficult to monitor. Under the newly installed Policy Compliance Monitoring, Local Development Watch, Customer Satisfaction Index, and Productivity Performance System of the Department of Local and Interior Government (DILG), local government units are required to report the

status of the social service activities they undertake in pursuit of their mandated tasks. These are provided by national laws and programs (e.g., the Social Reform Agenda, Philippine Agenda 21, and Human and Ecological Security). These systems do not give a comprehensive picture of the state of development in a locality because it measures outputs in terms of LGU performance in implementing their tasks. It does not measure outcomes in terms of effects and impacts. More specifically, the system cannot assess the status of efforts toward sustainable development because it does not capture the interactions among population, development, and environment (PDE) (Cabrido, Jr. et al., 2000). On environment and natural resources, the Department of Environment and Natural Resources (DENR) formulated a Forest and Management Program through Executive Order No. 192 where population and environment interactions were considered. Migrants to forest areas as well as indigenous peoples were provided with tenurial instruments. Gender issues and women empowerment were also considered in the Community Based Forest Management Program. Likewise, the DENR carries out Environment Impact Assessments (EIA) to mitigate the negative impact of development projects. It also has these programs: a Community-based Forest Management (CBFM) Program, Coastal Resource Management and Development, and Protected Areas and Wildlife. In all these programs, population issues (particularly migration to protected and critical areas) are considered in land management and ownership.

C. Progress in Sectoral Concerns 1. Health Government efforts to reduce mortality levels can be seen in priority health programs for children and mothers. The major goal of health planning efforts for children in the first year of life is to improve survival, growth, and development. Health programs also seek to increase the awareness of mothers and caregivers about proper child rearing practices. To achieve its Millennium Development Goals, the government continued to strengthen the Health Sector Reform Agenda (HSRA) in 2000. The objective was to address more effectively the public health needs of the population, especially the poor. The HSRA aims to improve health care financing, health regulation, hospital systems, supply of essential medicines, and public health programs that have a direct impact on mortality and morbidity. It addresses in the medium term the following concerns: â&#x20AC;˘ The persistently high rates of infectious diseases and prevalence of chronic and degenerative diseases.

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The large variation in health status across population groups, income classes, and geographic areas, largely due to inequities in access to health facilities and services and the limited coverage of social health insurance. • Inadequate funding and management systems, which have limited the impact of public health programs. Part of the mechanisms for implementing the HSRA at the community level is the Health Passport Initiative, which increases access of the poor to quality health services through subsidized health care financing schemes. The Health Passport drew its mandate from the National Health Insurance Act of 1995. The Act targeted health insurance coverage for 25 percent of the population with the lowest incomes within five years, and universal coverage within 15 years. Reducing maternal mortality and disability will depend on identifying and improving those services that are critical to the health of Filipino women and girls, including antenatal care, emergency obstetric care, adequate postpartum care for mothers and babies, family planning, and STI/HIV/AIDS services. High priority is given to women’s health through programs like the Safe Motherhood and Women’s Health Program, which employs strategies such as skills upgrading so that as many births as possible are attended by knowledgeable, caring, and skilled care providers. The government also carries out IEC to encourage informed decisions and promote better healthseeking behavior. There are also quality assurance schemes such as the “Sentrong Sigla,” which sets certain minimum standards for public health facilities at various levels. The government further implements an Expanded Program in Immunization (EPI) that aims to reduce infant and child mortality caused by six immunizable diseases (infant TB, diphtheria, tetanus, pertusis, poliomyelitis, and measles). Moreover, the government has a nationwide program that provides Vitamin A supplements to children 12 to 59 months old. Postpartum mothers nationwide are provided with Vitamin A capsules. Various groups and donor agencies such as USAID support the government’s interventions to boost Vitamin A coverage in the seven lowest performing regions in the Philippines. These interventions include: (a) support for the social mobilization of health workers and volunteers to provide all pre-school children with Vitamin A capsules; (b) technical assistance to organize communication campaigns to increase Vitamin A coverage; and (c) tapping local-level partners and leveraging donors to assist in awareness-raising and service implementation. These interventions support the DOH’s National Immunization Day or Garantisa-dong Pambata campaign. The USAID assists the Philippine government to improve the capacity of private voluntary organizations (PVOs) and their local partners to carry out effective child survival interventions

and improve infant and child health and nutrition. At present, three PVOs are implementing child survival activities (immunization, Vitamin A supplementation, breastfeeding, control of diarrhea and respiratory infections, and integrated management of childhood illness, among others.) in three depressed areas in the country. Strong community participation and social mobilization

Immunization and child survival activities aim to reduce infant and child mortality. characterize these projects. As part of the anti-poverty program of the Arroyo administration, DOH-retained hospitals provide medical, pediatric, surgical, dental, and laboratory services in Kapit-bisig Laban sa Kahirapan (KALAHI) Project areas identified by the National Anti-Poverty Commission (NAPC) and the Presidential Commission for the Urban Poor (PCUP). A total of 156,309 urban poor families were enrolled in the indigency program of PhilHealth (which has provisions for some RH services) from March to December 2001. Advocacy with local chief executives is ongoing, with PhilHealth negotiating with LGUs to enroll their indigents. About 40 percent of the urban poor have already been identified and awareness of the indigency program has increased (Philippine Yearbook, 2003). Efforts to improve mortality and morbidity levels in the country face issues and challenges related to health care financing, including the imbalance between health needs and expenditures. National health expenditure patterns show that more funds are spent on curative health services than on preventive health care programs and services. Access and sustainability of health care constrain the country’s efforts to attain its healthrelated goals. Subsidized health care and insurance financing schemes catering to the poor are needed to address this. The challenge is to put in place effective health care financing mechanisms, especially at the grassroots. A further challenge is the devolution of health care services to local governments. Many

local governments do not have adequate institutional preparation to take on the responsibility for health care. They don’t have enough technical manpower for health operations, lack equipment, deal with inadequate health facilities, and have inadequate referral systems among health facilities. At the forefront of the reproductive health campaign and services is the Department of Health, which closely coordinates with the Health and Nutrition Center, DepEd, CWC, and DSWD in providing basic reproductive health and life skills education programs. It has continuously conducted capability-building programs for school nurses to undertake advocacy and information dissemination on reproductive health in secondary schools, especially among adolescents and female teaching and nonteaching staff. This is over and above the reproductive health services rendered by the school nurses. 2. Education Among the recommended actions in the ICPD are: a) to achieve universal access to quality education, in particular to primary and technical education and job training; b) to combat illiteracy and eliminate gender disparities in educational opportunities and support; c) to promote nonformal education for young people; and d) to introduce and improve the content of the curriculum so as to promote greater responsibility towards and awareness of, the interrelationships between population and sustainable development; health issues, including reproductive health; and gender equity. The formal basic education system provides for 10 years of study (six years of elementary and four years of secondary education). This is two years shorter than what is typically a 12-year basic education in most countries worldwide. Elementary education is free and compulsory while secondary education is free but not compulsory. In addition, nonformal education is provided for outof-school youth and adult 15 years of age and above. An accreditation and equivalency system caters to people who wish to obtain education outside the formal system. The major challenge is in expanding access to secondary education, particularly in the rural areas. The increasing pressure at this level is aggravated by the continuing shift of enrollees from private schools to public schools, especially after the Asian crisis in 1997. To address this, the Department of Education is seeking to expand a program called “Government Assistance to Students and Teachers in the Private Sector” (GASTPE). Instead of building more public secondary schools, the government through GASTPE will enroll overflow students from public schools in private schools and subsidize their tuition. A closer look at the performance of the basic education sector showed that for the past 10 years the disparity across gender is insignificant and at times biased against the male population. It has

been observed that households tend to pull out their male children from school to help augment the family’s income. In response, the DepEd has put in place programs that provide equal opportunities to children whose falling family incomes prevent them from attending school. These programs include the Dropout Intervention Program; Project EASE (Effective and Affordable Secondary Education) Project; Distance Learning Program (DLP) for high school students; Self Instruction Program; and the system of multigrade instructions for students who are at risk of dropping out of formal schooling. Parallel to this is the livelihood- and skills-based literacy training provided by the nonformal education program of the Department of Education. To attract students who are outside the school system, a scheme for accreditation-based access to education is offered by the National Education, Testing and Research Center (NETR) for students. The scheme is intended for those who have dropped out of school, are doing home study, taking their education outside of the country, or studying in schools that have no DepEd accreditation. These students can enter the mainstream by taking the appropriate examination such as the Philippine Placement and Equivalency Test (PPET) and the Accreditation and Equivalency Examination (AEE). For instance, the Philippine Non-Government Organization, Incorporated (PNGOC) has reached out to more than 250,000 out-of-school youth and adults through the Nonformal Accreditation and Equivalency project of the DepEd. Through the project, PNGOC has successfully integrated RH, FP and ARH in the learning sessions. Other programs directed at enhancing access of vulnerable sectors are Third Elementary Education; Secondary Education Development Improvement Project (SEDIP), and Social Expenditure Management Project (SEMP). These programs gave priority to the 26 provinces identified in the Social Reform Agenda (SRA). The DepEd has instituted measures to improve the quality of education by restructuring the curriculum, installing computers in public high schools, teacher training, improving basic education facilities and testing programs, and providing preschool and early childhood services (Philippine Progress Report on the MDG, 2003). Based on the Philippine Progress Report on the MDG, these are the priorities for action: • Setting basic requirements like facilities, teachers, and instructional materials as offshoots of a growing school population. • Instituting a new educational outcome assessment system to address the quality of basic education. • Undertaking innovative approaches to complement traditional delivery systems that will involve reaching out to youths outside the school system. • Improving the delivery of quality education

through identification and removal of hindrances and adoption of enabling or enhancing mechanisms, namely, a) decentralization, including the delegation of certain functions and authorities from the central office to the local levels; b) rationalization measures relative to the use and allocation of education-related resources; and c) performance accountability within the budgetary process.

nents of the PPMP. Through the UNFPA Fourth Country program, POPCOM has also implemented innovative projects for both in-school and out-of-school youth. In addition, nongovernmental organizations have set up teen centers to assist adolescents manage their sexuality-related experiences and needs. As part of its public awareness efforts, the

3. Population education Greater public knowledge, understanding, and commitment at all levels, from the individual to the international, are vital to the achievement of the goals and objectives of the PoA. The primary aim, therefore, is to increase this knowledge, understanding, and commitment. Other aims are: a) to encourage attitudes in favor of responsible behavior in such areas as environment, family, sexuality, reproduction, gender and racial sensitivity; b) to ensure the government’s commitment to promote private and public sector participation in the design, implementation, and monitoring of population and development policies and program; and c) to enhance the ability of couples and individuals to exercise their basic right to decide freely and responsibly the number and spacing of their children and to have the information, education, and means to do so. The DepEd integrated population education in the basic curriculum through such projects as the secondary education population education program and policy directives such as the issuance of Memorandum Order 132, series of 1999, for school teacher training in population education and adolescent and reproductive health. The department created the Task Force on Adolescents’ Health, which provided for continuous training of school nurses on population education and on adolescent and reproductive health. Among the country’s goals is to broaden the citizens’ understanding of population-related issues. They need to learn how to make responsible decisions concerning their life situation and their reproductive options. Population Education (PopEd) responds to this need and is a vital component of the PPMP. Through its formal and nonformal programs, PopEd develops among young people and adults awareness and appreciation of population issues, and inculcates proper values on family life and responsible parenthood; gender equity; resources and sustainable development; and, reproductive health. PopEd was instituted by the Department of Education in the elementary and high school levels. At the tertiary level, PopEd is carried out by the Commission on Higher Education (CHED). The Department of Social Welfare and Development (DSWD) spearheads population education for out-of-school youth. POPCOM runs an Adolescent Health and Youth Development Program (AHYDP), which is among the compo-

PopEd develops young people’s appreciation of population and reproductive health issues. PopEd program publishes a monthly newsletter to help maintain a nationwide Population Education Information Network. It also conducts national competitions among the young. There are three national competitions: the National Pop Quiz, the National Poster Making Contest, and the Essay Writing Contest. The DepEd has been implementing the PopEd Program since the 1970s. To strengthen and revitalize population education in schools, the DepEd enlisted the Commission on Higher Education (CHED) at the tertiary level and the Technical Education and Skills Development Authority (TESDA) at the vocational level to take part in the program and adopt the PopEd curriculum. The project evaluates PopEd and constantly introduces improvements in program content. The comprehensive assessment on population and development, reproductive health, and gender empowerment showed the gains, gaps, and additional areas needed to be addressed in the near future. From focusing largely on population and development, family life, and responsible parenthood, the project has introduced new areas of concern such as gender equality, HIV/AIDS, sexuality, and reproductive health.

Relative to this, the DepEd and the Commission on Population conduct an annual Population Quiz at the national and regional levels to inculcate population issues and concerns at the secondary or high school level. 4 . Elderly

Recognizing the seriousness of the challenge of addressing the needs of the elderly, the Philippine government has made great strides in enhancing the well-being of older persons and promoting their positive contribution to the society. In line with the Philippine Constitution, laws that recognize the positive role of older persons in society have been enacted, encouraging them to contribute to nation building and to mobilize their families and their communities to reaffirm the Filipino tradition of caring for older persons. The 1987 Constitution recognizes the significant role that older persons play in society. It reaffirms the duty of the family to provide care and support for their elderly. Two Philippine laws concern this sector: Republic Acts (RA) 7432 and 7876. Passed in 1992, RA 7432 is known as the Act Maximizing the Contribution of Senior Citizens, Granting Benefits and Special Privileges and for Other Purposes. An important provision of this law is the 20 percent discount it gives to senior citizens when buying medicines and patronizing public transport, restaurants, recreational facilities, lodgings and places of culture. It also gives free medical and dental services to the elderly in government hospitals anywhere in the country. The other law, RA 7876, was enacted in 1995, and is known as an Act Establishing a Senior Citizensâ&#x20AC;&#x2122; Center in All Cities and Municipalities of the Philippines and Appropriating Funds Therefore. The center is a place where senior citizens can get together to meet and discuss their common needs and aspirations. However, there are concerns regarding the implementation of these laws. Foremost is the inability of older persons to avail themselves of the benefits and privileges provided in RA 7432. This is probably due to the incorrect interpretation of the law, the presence of too many requirements before the elderly can get their senior citizenâ&#x20AC;&#x2122;s ID cards, and in many cases, noncompliance. As regards RA 7876, many local governments, particularly fifth- and sixth-class municipalities, reportedly do not have enough resources, including sites, to set up Senior Citizensâ&#x20AC;&#x2122; Centers. At present, there are advocacy efforts to promulgate a Magna Carta for Older Persons. The Magna Carta covers a national comprehensive plan and delineates the socioeconomic and political rights of senior citizens. With the Vienna Plan of Action on Aging and the Macao Plan of Action on Aging for Asia and the Pacific as guides, the DSWD in 1999 led the preparation of the Philippine Plan of Action

for Older Persons (PPAOP) for 1999-2004. This addresses the following concerns: Older Persons and the Family; Social Positions of Older Persons; Health and Nutrition; Housing; Transportation and Built Environment; Income Security; Maintenance and Employment; Social Services and Community; Continuing Education and Learning; Older Persons and the Market.

There remains a need to empower and deliver social services to old people. Despite the progress made, five areas continue to be critical: the need to empower communities of older persons; understanding issues and implications that population aging bring to society; preparation of the populace for an aging process that is both satisfying and productive for an individual; development of service infrastructure and environment based on both traditional and modern institutions; and delivery of social services needed by the growing number of the elderly. Finally, in view of the adoption of Executive Order 266 approving and adopting the Philippine Plan of Action for Older Persons, 1999-2004, and creating an interagency committee chaired by DSWD, Republic Acts 7432, 7277, and 7876 and Proclamation 240 declaring the Philippine Decade for Disabled Persons for 2003-2012, a joint circular signed by the heads of DSWD and the Department of Budget and Management set the implementing guidelines of Section 29 of the General Appropriations Act for Fiscal Year 2003, which set aside one percent of the government agency budget for programs/projects related to senior citizens and the disabled. The implementation and its impact are yet to be assessed. 5 . Population distribution, urbanization, and internal migration In the ICPD PoA, the objective is to foster a more balanced distribution of population by promoting sustainable development in both major migration sending and receiving areas. The PoA urges countries to adopt strategies that encourage the growth of small or medium-sized urban centers and seek to develop rural areas.

There is no law prohibiting internal migration. Filipinos are free to move around freely in search of better opportunities. However, macroeconomic policies like countryside development have indirectly resulted in the movement of people from urban to rural areas. One relevant policy with regard to migration and urbanization is Section 37 Article IX of the Republic Act 7279, otherwise known as the â&#x20AC;&#x153;Urban Development and Housing Act (UDHA) of 1992. The law requires local governments to act upon an effective mechanism, together with the appropriate agencies like POPCOM, NEDA and the National Statistics Office (NSO) to monitor trends in the movement of people from rural to urban, urban to urban, and urban to rural areas. They shall identify measures by which such movements can be influenced to achieve balance between urban capabilities and population, to direct appropriate segments of the population into areas where they can have opportunities to improve their lives and contribute to national growth. They shall also recommend legislation to Congress, if necessary. To improve housing conditions for people in urban centers, UDHA included a provision under Section 20 to grant incentives for private sector participation in socialized housing by way of exemption from payment of transfer tax for both new projects. POPCOM is mandated through Local Finance Circular 1-97 to certify sites as urbanizable in order for land developers to avail themselves of the exemptions. UDHA also mandated POPCOM, NEDA, and NSO to provide advanced planning information to national and local government planners on population projections and the services needed in particular urban and urbanizable areas. These services will include early-warning systems on expected dysfunctions in a particular urban area due to population increases, decreases, or age structure changes. In other words, the UDHA offered many opportunities to manage settlements in the urban centers. However, there is a need to strengthen observance of the law. So many LGUs need to be informed and educated on the provisions of this law so that they can also work on the opportunities it offers. One of the major problems posed by fast urbanization is the rising number of squatting and homeless people. In December 2002, Executive Order 152 was issued by the President designating the Presidential Commission for the Urban Poor (PCUP) as the sole clearing house for demolition and eviction activities involving homeless and underprivileged citizens. The PCUP was also mandated to establish mechanisms to ensure strict compliance with the requirements of just and humane demolition and eviction under the Urban Development and Housing Act of 1992. In the recent past, development continued to be skewed toward urban centers. As a result, migration to urban areas also continued. In particular, it was heavily oriented to Metro

Manila. The crowding of people in Metro Manila led to a lot of social dysfunctions and ecological problems. The government established the Metro Manila Development Authority (MMDA) to develop strategies to solve the problems of the metropolis. The MMDA closely coordinates with various organizations such as the Pasig River Rehabilitation Commission and the Department

Uncontrolled migration has given rise to problems of squatting and homeless people. of Public Works and Highways (DPWH), as well as the local government units of the component cities and municipalities. However, in the course of implementation, it was observed that the MMDA lacks authority to manage and protect urban ecosystems since it has no jurisdiction over the local governments in Metro Manila. The efforts of the MMDA have been more focused on solving traffic congestion and related problems in Metro Manila. Under the MTPDP 2001-2004 chapter on â&#x20AC;&#x153;Pursuing Balanced Regional Development,â&#x20AC;? NEDA put in place mitigating strategies such as the development of urban centers outside Metro Manila and the decongestion and management of the metropolis. Migration Information Centers (MICs) have been established by some LGUs, particularly in the cities of Tagbilaran, Muntinlupa, and Calamba (Barangay Parian) and the municipality of Malvar, Batangas (Barangay Santiago) to assist migrants in their information and services needs. Among the major objectives in setting up these centers are: preventing land squatting, maintaining peace and order, monitoring migration and the socioeconomic profile of the migrants, and monitoring compliance to zoning ordinances. Some of the strategies to monitor and influence population movement are: a) designation of Barangay Supply Point Officers (BSPOs) as population registrars to monitor migration at the barangay level, b)

installation of demographic surveillance in URBAN AREAS, c) Balik Probinsiya (Back to the Province) Program which gives informal settlers transportation assistance in going back to their provinces, and d) assignment of NGOs to specific settlement areas. Industrial economic zones are now being set up outside Metro Manila and other key cities in the country to distribute development and decongest the population in highly urbanized areas. In the people-oriented forestry program, the policy is that only those who live in the forestland before 1981 can benefit from the program. This is to discourage migration toward fragile forestland areas. The government is also trying to improve the peace and order situation in rural areas with rebel activities since this helps to lessen outmigration. In 1996, there was an attempt to systematize access of the people to social services. It was intended to make delivery of services more efficient by considering the size of the population in a particular area. The government issued Administrative Order 308 establishing a National Identification (ID) Reference System. It called for a computerized system to properly and efficiently identify persons seeking basic services on social security and reduce, if not totally eradicate fraudulent transactions and misrepresentations. However, in the absence of a law to implement such a system, it became controversial. On April 8, 1997, the Supreme Court issued a temporary restraining order against the implementation of AO 308. To date, the Arroyo administration still intends to push for the implementation of the national ID system as part of the government effort to stop kidnapping and other unlawful activities, but this will depend on legislation to be enacted by Congress. President Arroyo included in her priority agenda the decentralization of the government and the decongestion of Metro Manila, where crowding has become detrimental to the population and the environment. The President has set in motion plans to transfer certain government offices to places outside Metro Manila. It was noted that moving some departments to other locations has practical and symbolic purposes. It is one way of bringing development to other areas. This is one way of showing that the government is giving importance to other areas in view of criticisms that all decisions come from Metro Manila,” Already, the President has ordered the transfer of the Department of Transportation and Communication (DoTC), to Clark Field, Pampanga; the Department of Tourism (DoT) to Cebu; the Department of Agriculture (DA) to Mindanao; and the Department of Agrarian Reform (DAR) to Iloilo. 6. International migration About 10 percent of the country’s total

population are classified as overseas Filipino workers (OFWs) distributed in 182 foreign countries (POEA, 2000). The 1974 Labor Code spelled out the government’s policy on overseas employment. It created the Overseas Employment Development Board (OEDB) and the National Seaman’s Board (NSB), both of which became the precursors of the Philippine Overseas Employment Administration (POEA). The two agencies were mandated to undertake a systematic program for overseas employment, which included the banning of direct hiring by foreign employers and the mandatory remittance of overseas workers’ earnings. The mission of the present POEA is to ensure quality employment opportunities for OFWs. The Overseas Workers’ Welfare Administration (OWWA) was created to protect the interests and well-being of OFWs and their families. From funds derived from employer contributions, OWWA finances several programs and services for migrant workers and their families. These include legal, livelihood, welfare, enterprise, career development and skills upgrading assistance, and benefits. Republic Act 8042, or the Migrant Workers and Overseas Filipinos Act of 1995, spells out the benefits of overseas employment through the provision of a mechanism for the full protection of migrant workers even while still in the Philippines. More important, the law contains provisions protecting OFWs in the host countries, where, as shown in many instances, they are vulnerable to abuse and exploitation. Through the years, legislative and policy measures promoting the welfare and protection of migrants have been pursued actively by both the executive and legislative branches of government. Some of these are: a) imposing a minimum age requirement for those wanting to work abroad as domestic helpers; b) enactment of RA 6955, which forbids the operation of marriage bureaus and pen pal clubs matching Filipino women with foreigners for marriage; and c) issuance of DFA Order 15-89, which requires all Filipinos who are fiancées or spouses of foreign nationals to attend guidance and counseling sessions at the Commission on Filipino Overseas prior to acquiring a passport. Furthermore, Article II of Republic Act 8042 seeks to protect Filipinos against illegal recruitment. It defines illegal recruitment as any act of canvassing, enlisting, contracting, transporting, utilizing, hiring, procuring workers and includes referring, contracting services, promising or advertising employment abroad, whether for profit or not, when undertaken by a non-licensee or non-holder of authority contemplated under the Labor Code of the Philippines, as amended. The law specifies the penalties for persons found guilty of illegal recruitment. The latest development is the creation of task force for stopping illegal recruitment. The President created the task force as a response to the increasing number

of victimized migrants by illegal recruiters. In line with these provisions, some programs and projects were institutionalized to protect the rights of migrant workers. The Replacement and Monitoring Center (RPMC) was launched at the Philippine Overseas Employment Administration (POEA) on June 7, 1999, highlighting the celebration of the Migrant Workers Day. The RPMC was set up along with the installation of the The Technology Livelihood Resource Center (TLRC) which conducted the training sessions for free. The establishment of the RPMC is considered one of the governmentâ&#x20AC;&#x2122;s contingency for the benefit of OFWs who lost their jobs because of retrenchment in host countries. Among the tasks of the center are: 1) develop livelihood programs and projects for returning OFWs in collaboration with the private sector; 2) ensure full usage of OFWs skills; 3) set up a database on returning workers whose potentials can be tapped by local employers; and, 4) assist returning workers in looking for jobs or provide training to prepare them for their future undertakings. The RPMC facilitates employment of returning workers through referrals to foreign or local companies, skills enhancement, and opening up opportunities for self-employment. In consonance with RA 8054, or the Philippine AIDS Prevention and Control Act of 1998, POEA tied up with the Department of Labor and Employment (DOLE) and nongovernment organizations in seeking greater protection for OFWs from HIV/AIDS. Some Philippine medical institutions support the efforts by providing OFWs with the necessary screening, testing, and counseling to increase their awareness and encourage them to practice healthy lifestyles. In June 2002, the Action for Health Initiatives (ACHIEVE), an NGO, highlighted a celebration honoring OFWs through a photo exhibit showing efforts and programs designed to help OFWs understand and avoid AIDS. It emphasized mandatory testing, and attendance of the seminar was required of OFWs before they leave to work abroad. The HIV/AIDS seminar, required by RA 8054, is similar to the pre-departure orientation or the pre-employment orientation seminars for OFWs. In 2003, the government endeavored to transfer part of the OWWA-Medicare Fund to the Philippine Health Insurance Company (PhilHealth), the prime agency tasked to implement the national health insurance program. The fund transfer is intended to ensure comprehensive medical and health care services to more overseas Filipino workers and their families. The funds retained are being used to expand the medical benefits of OFWs in addition to the health care package of PhilHealth. The transfer of the medical and health care components of OWWAâ&#x20AC;&#x2122;s services will allow the OWWA to focus on core programs and services that include welfare assistance at job sites, insurance coverage, repatriation/airport assistance, scholarship, livelihood, and other

programs for the welfare of OFWs and their families. II. REPRODUCTIVE HEALTH AND REPRODUCTIVE RIGHTS

A. Reproductive Health Program The ICPD calls upon all countries to strive to make reproductive health services accessible, through the primary health care system, to all individuals of appropriate age as soon as possible and no later than 2015. In the MDG, the target is 100 percent access to reproductive health services by 2015. Available data indicate, however, that the prospects for achieving the MDG target are low. Ten women die every day from pregnancy- and childbirth-related causes and most maternal complications and deaths are due to limited access to reproductive health services (NDHS, 1998). Only 77 percent of mothers receive at least three pre-natal check-ups, 57 percent receive iodine, 33 percent receive tetanus toxoid immunization, 56 percent of all deliveries are attended by health professionals, and only 57 percent receive postpartum care. The number of abortions in the Philippines is estimated at 400,000 cases annually, with teenagers accounting for 17 percent of these cases (Perez et al., 1997). Based on DOH records, 12 percent of all maternal deaths in 1994 were due to complications related to abortion, making it the fourth leading cause of maternal deaths in the country. The most vulnerable women, whether married or unmarried, are the poor. The top three reasons for terminating pregnancies are economic difficulty, too many pregnancies, and large number of children. (POPCOM, 2001). There has been little or no service available to infertile couples. Data on infertility show that 10-15 percent of couples are not able to conceive after a year of unprotected, adequately timed intercourse (WHO, 1986). Two percent of women are considered infecund [1998 NDHS and 1993 National Safe Motherhood Survey (NSMS) as cited in POPCOM, 2001a]. There are no data at all for infertile men, and services for infertility are provided only by a few training hospitals in the country. Infertile couples, particularly in rural areas, resort to traditional rituals and the use of herbal medicines in the hope of bearing children. As to family planning services, data generally show patterns of increasing contraceptive use (46.5 percent in 1998 to 48.9 percent in 2003) and declining fertility (3.7 percent in 1998 and 3.5 percent in 2003). However, regional differences in the use of family planning are large, ranging from 16 percent of married women in ARMM to 55 percent of those in Southern Mindanao (Region XI) and Central Luzon (Region III). Unmet need for family planning services

has declined, but rates of contraceptive discontinuation are high, with around 40 percent of contraceptive users stopping use within 12 months (NDHS, 1998). Despite the increase in contraceptive use, it is still low compared with that of a neighboring country like Thailand, which had a CPR of 74 percent. The PPMP Directional Plan 2001-2004 gives

• • • • • •

tract infections, including STDs, HIV, and AIDS. Prevention and appropriate treatment of infertility and sexual disorders. Prevention and treatment of breast cancers, cancers of the reproductive system, and other adverse gynecological conditions. Counseling and education on sexuality and sexual health. Adolescent reproductive health. Male reproductive health. Prevention and management of violence against women.

1 . Policy

The program recognizes that there is increasing demand for family planning services, especially among women with reproductive problems. emphasis to meeting the high unmet need for family planning of Filipino couples, especially those in the poor and disadvantaged groups. Specifically, the population policy aims to achieve the following objectives: • Help couples and individuals to achieve their desired family size within the context of responsible parenthood and sustainable development. • Improve the reproductive health of individuals and contribute to further reduction of infant mortality, maternal mortality, early childhood mortality. • Reduce the incidence of teenage pregnancy, early marriage, and reproductive health problems. • Contribute to policies that will assist the government achieve a favorable balance between population distribution, economic activities, and the environment. The DOH’s Philippine Family Planning Strategy for 1996-2000 recognized the increasing demand for family planning commodities and services, particularly in cases of high-risk births among women with reproductive health problems. The program was implemented within a reproductive health framework and a quality of care approach. The RH package has 10 core service elements: • Family planning. • Maternal and child health care. • Prevention of abortion and management of its complications. • Prevention and treatment of reproductive

To underline the high priority given to the reproductive health program, the DOH has issued various administrative orders supporting it. These include AO 1-B, s. 1998 for the establishment of women and children protection units in all DOH hospitals; AO 1-A, s. 1998 and AO 43, s. 1999, spelling out the RH policy; AO 34-A, s. 2000, the policy on adolescent and youth health; AO 45, s. 2000, the policy on the prevention and management of abortion and its complications; AO 79, s. 2000, on safe motherhood; AO 50-A, s. 2001, or the national family planning; AO 125, s. 2002 on the National NFP Strategic Plan Year 2002-2006; AO 132, s. 2004, on the creation of the DOH NFP Program and its management; AO 158, s. 2004, the guidelines on the management of donated commodities under the Contraceptive Self-Reliance Strategy; and others. The department has also developed manuals such as Counseling and Training Manual for PMAP, Standard Premarriage Counseling Manual, Training Manual of VAWC, and Clinical Guidelines for Adolescents. The proposed Reproductive Health Care Act (HB 4110), which aims to address the need for reproductive health information and services, is pending in Congress, at the House Appropriations Committee, and has no committee report yet. A number of sectors have criticized this bill, stating that some of the provisions implied abortion and encourage irresponsible sexual behavior among the young. As a result, HB 4110 was replaced with a substitute bill that would address these concerns. The bill is being deliberated in Congress. Another proposed law, Senate Bill 2325, an act establishing a reproductive health care policy, introduced by Senator Rodolfo Biazon, is pending at the Senate appropriations committee. The DOH has issued a number of administrative orders to provide the policy framework for RH and FP. Administrative Order 50 contains the National Family Planning Policy. It refocuses the FP program from a demographically driven program to one that upholds FP as a health intervention. The policy shift aims to promote the health of all Filipinos, with special attention to women and children; help couples of reproduc-

tive age to attain their desired fertility; and promote a rate of population growth that matches the pace of economic growth, thereby contributing to sustainable development. This AO prescribes essential policies for family planning as an element of RH (DOH, 2002). The most recent policy instrument is AO 125, which is the National Natural Family Planning (NFP) Strategic Plan for 2002-2006. This plan focuses on the policies, standards, strategies, and activities needed to mainstream NFP methods in the Philippine Family Planning Program for 2002-2006 (DOH, 2002). Other orders in support for Natural Family Planning (NFP) and Philippine FP program and RH are: 1) DOH Circular 101-A, s. 1994, which dropped calendar/rhythm from the method mix and included the three NFP methods–mucus method (MM) or ovulation method (OM), basal body temperature (BBT), and symptothermal method (STM); 2) EO 307, s. 1996. which requires that NFP methods be included and provided through government programs; 3) DC 63-A, s. 1996 (amendment of DC 50, s. 1994) declaring the month of May of every year as NFP month to drum up awareness and advocacy for NFP; and 4) DC 130, s. 1997, NFP implementing rules and guidelines ensures availability of information and services at appropriate levels adhering to standard and quality care as promulgated by the national program, In 1991, the Local Government Code paved the way for the Philippine government to shift governance from the central to the lower levels of government. This entailed the transfer of many basic services to local governments, including health services such as family planning. The DOH has since been working to reinforce and support the devolution of family planning and reproductive health programs. In 1996, former President Fidel V. Ramos issued Executive Order 307, instructing local governments to provide FP information services, including NFP, in their respective health facilities. In the workplace, the Labor Department issued Department Order 56-03, series of 2003, rationalizing the implementation of the family welfare program (FWP) in DOLE.” From its original thrust of promoting family planning, the program will shift its focus to providing family welfare services to workers. The 10 dimensions of the program, which is implemented by DOLE and the Trade Union Congress of the Philippines (TUCP), will guide both labor and management in the implementation of programs and projects consisting of the following: a) reproductive health and responsible parenthood; b) education/gender equality; c) spirituality or value formation; d) income generation/livelihood/cooperative; e) medical health care; f) nutrition; g) environmental protection, hygiene and sanitation; h) sports and leisure; i) housing; and j) transportation. Employers with more than 200 employees are required to form a family welfare committee to

ensure that all the 10 dimensions of the FWP are implemented. Establishments with less than 200 employees are encouraged to implement the 10 dimensions of the program. At the local level, the increasing awareness of the RH program among local officials and community leaders made them more actively involved in addressing population issues. Resolutions and orders supporting the program were issued by the Regional Population Executive Board (RPEB) and other local government units, and some areas adopted policies creating advocacy teams. In Pangasinan province, to cite one example, Governor Victor Agbayani issued Executive Order 2003-02, known as the “Pangasinan Province Initiative on Addressing Unmet Need for Family Planning and Working Toward Contraceptives and Self-Reliance.” Resolutions passed at the local level supporting the RH program included RPEB Resolution 1, s. 2003, of Region 5 supporting the passage of HB 4110 and, at the National Capital Region, in Quezon City, a resolution creating the population, welfare and development council of the city government. A milestone in the promotion of reproductive health in the Philippines over the past 10 years is in networking, partnership, and alliance building. The emergence of the population and RH movement created a major impact in RH advocacy. There is also recognition of NGO efforts in pushing RH into the legislative agenda. Twenty-three institutions representing RH service delivery organizations, women’s groups, and advocacy organizations have united to form the Reproductive Health Advocacy Network (RHAN). Their common vision is to pursue RH rights and quality RH care for all. The RHAN has a lawyers’ group that conducts studies of the constitutional and legal basis of population and RH programs. This group helped to file House Bill 4110 in Congress on December 19, 2003. The bill seeks to establish an integrated national policy and program on RH, recognizing women’s reproductive rights, gender equality, and universal access to RH services, information, and education. 2 . Programs and projects One major program introduced in 1999 by the DOH was the Women’s Health and Development Program. This aims to ensure women’s health and development through participatory strategies that enable women to have control over their health and their lives. The government’s RH program was further improved by the adoption of the Health Sector Reform Agenda (HSRA). The agenda integrates all existing and emerging health programs, including reproductive health. The HSRA has two basic principles. The first is health regulatory reform. This includes quality assurance for health services, to be achieved by strengthening the licensing and regulatory functions of the

DOH and implementing a recognition and certification program (Sentrong Sigla Movement) for public and, eventually, private health facilities. The second principle is health operation reform. The core concept is “making devolution work” or putting “health in the hands of the people.” Reforms include strengthening preventive and promotive strategies, reform of government

The Health Sector Reform Agenda emphasizes preventive and promotive health strategies. hospitals, and reestablishment of the district health system and two-way referral work. To help local governments, USAID provided funding and technical assistance to DOH programs— the Local Performance Program (LPP) and the Matching Grant Program (MGP) — designed to augment the capability of local governments in delivering health services with a special focus on FP, maternal and child health, and nutrition. Both the LPP and MGP contributed to a reduction in total fertility rate and maternal and child mortality rates by helping increase the contraceptive prevalence rate, increase immunization coverage for children and pregnant mothers, and enhance feeding programs. The Local Performance Program was designed to strengthen the capacity of LGUs to plan and implement effective population, family planning, and selected child survival programs. Through the LPP, LGUs were introduced to innovative approaches and tools for improving and sustaining FP/MCH services at the local level. The goal was to increase coverage for family planning, maternal and child immunization, and Vitamin A supplementation programs. The LPP gave financial and technical assistance to LGUs so that that they could expand and improve their FP/MCH services. The financial assistance augmented whatever the LGUs were spending on their own. It operated on a performance-based disbursement scheme where an LGU has to achieve progressive annual goals or “performance benchmarks” to be eligible for funds for the next years. The technical assistance was intended

to develop management capability, improve quality of care, and ensure program sustainability at the local level. For the first five years, the LPP provided support to provinces and chartered cities for capacity building in infrastructure, program and staff development. By 1999, LPP had covered more than 90 LGUs. A mid-term assessment led to a redirection of support to municipalities and cities, with emphasis on service delivery. The second phase of the LPP, known as the Matching Grant Program (MGP), required the LGUs to provide counterpart resources to improve FP/MCH services. In 2001, MGP was carried out in 50 municipalities and medium-sized cities throughout the country (SPPR 1, 2001). The UNFPA has been a firm supporter of the country’s reproductive health programs. In its Fourth Country Program (1995-1999), it assisted a pilot project to integrate the four core RH elements (gender-sensitive quality RH services for FP; maternal and child health (MCH); prevention and treatment of reproductive tract infections; and, STD/HIV/AIDS and sexuality education) in the public health services of selected municipalities of Nueva Vizcaya province. The program emphasized the need to create viable referral systems and promoted the concept of a constellation of services that operated on many levels from the primary level of health care to the highest tertiary referral health facility. It also gave priority to establishing strong linkages with other organizations within and outside the health sector, including local and foreign donor agencies. Through 1995-1999, major donors that included the World Bank, Asian Development Bank, Australian Agency for International Development, the European Commission, and Kreditanstalt fur Weideranfpan (KfW) gave substantial support to the Women’s Health and Safe Motherhood Project. This project enhanced the quality and range of women’s health and safe motherhood services by upgrading the service delivery capacity of local governments and enhancing the ability of the DOH to provide policy, technical, financial, and logistical support. It also employed mechanisms to raise the participation of NGOs and communities. The project included FP and the treatment of RTIs, STDs, and cervical cancer. It covered 40 provinces for maternal care activities, 10 provinces for RTIs/STDs, and 15 provinces for cervical cancer care. The World Bank and AusAID also supported the Urban Health and Nutrition Project (19941998), which addressed health and nutrition problems in Metro Manila, Metro Cebu, and Cagayan de Oro City. The project focused on MCH, FP, nutrition, STDs, and diarrheal diseases. AusAID supported the expansion of the FP/MCH/ safe motherhood and women enhancement program in selected urban communities. The Japan International Cooperation Agency and the Japanese Organization for International Coopera-

tion in Family Planning also have supported FP/ RH projects in the country. The initiatives of national and local governments and NGOs are considered milestones in the effort to respond to the population’s RH needs. PhilHealth covers sterilization services. As an offshoot of the UNFPA Sub-Programme on Reproductive Health, pilot municipalities in Cagayan Province (Region II) set up communitybased birthing centers. These centers expand and improve on the quality of FP/RH services offered by Rural Health Units. Located in barangays, they are managed by trained volunteer health workers with the help of traditional birth attendants known as “hilots.” The goal is to achieve zero morbidity and mortality. The David and Lucille Packard Foundation, through the Philippine NGO Support Program (PHANSuP), implements a program on Accelerating Community-Based Responses to Family Planning and Reproductive Health in the Philippines. It aims to enhance the quality of life of women, adolescents, and men in underserved areas by ensuring the implementation of appropriate, effective, high-quality, and sustainable family planning and reproductive health services at the community level. Its overall objective is to contribute to the goal of the Philippine Family Planning Program by increasing the accessibility and use of quality FP/RH services at the community level. The pilot municipalities are experimenting with a prepaid prenatal services project. Pregnant women are assured of getting a prenatal services by agreeing to pay an initial fee of P1,000. The other charges can be paid in installments within the duration of their pregnancy. The project develops self-reliance and a sense of solidarity among pregnant mothers, who become a support group to each other at the time of delivery. Another initiative by the pilot municipalities is the Botika sa Birthing Home (Birthing Home Drugstore), which aims to make essential drugs and emergency medicines affordable and available at all times in the community. Other notable efforts to promote reproductive health care include: A pilot project by public hospitals in Pangasinan province (Region I) to prevent abortion and manage its complications. Mobilizing community participation in RH services in partnership with local governments, as exemplified by the projects of NGOs like the Family Planning Organization of the Philippines in Catbalogan and Samar (Region VIII), and the LIKHAAN project in Pasay and Malabon in the National Capital Region and Bulacan (Region III). The Well-Family Midwife Clinic network of 200 clinics operating in the country with technical assistance from USAID and the John Snow International-Research and

IMPROVING THE QUALITY OF REPRODUCTIVE HEALTH OF FILIPINOS

Back when the Commission on Population was barely a year old, and Filipino women bore an average of six children in their lifetime, the United Nations Population Fund (UNFPA) was already behind major government initiatives to address population concerns. The Philippines has been a recipient of UNFPA support since 1972 and there have been five UNFPA Country Program of Assistance to the Philippines since, with a cumulated funding of US$106.9 million. The current 5th Country Programme, implemented from 2000 to 2004, aims to contribute to the improvement in the quality of life of all Filipinos through: better reproductive health; attainment of population outcomes that are in harmony with available resources and environmental conditions; and reduction of poverty and inequalities in human development opportunities. The 5th cycle of assistance consists of three subprogramme areas: Reproductive Health; Advocacy and Population; and Population and Development Strategies (PDS). The RH subprogramme, at least in the nine pilot areas of UNFPA, has aided in increasing the awareness and utilization of RH services and information among women, men and adolescents. Although major challenges remain at the national level, the Advocacy subprogramme was able to facilitate the creation of legislative measures supportive of population and reproductive health, at least at the local level. The subprogramme also provided the appropriate venue for alliance-building efforts of NGO partners for population and RH issues. The PDS subprogramme, through the State of the Philippine Population Report and the Demographic and Socioeconomic Indicator System, has contributed to greater availability and accessibility of gender-disaggregated and updated information on population and RH. This, in turn, contributed to building consensus on pertinent issues such as unmet need in RH and adolescent reproductive health. The Country Programme has 30 component projects, the implementation of which is spearheaded by the Department of Health (DOH), POPCOM, nine provincial local government units (LGUs), and seven nongovernment organizations (NGOs). It includes two Mindanao-based projects: the “GOP-UN Multi-Donor Programme Phase 3 (MDP3)”; and the project on “Strengthening the Capacity of Muslim Religious Leaders to Promote Reproductive Health in Muslim Mindanao” supported by the Arabian Gulf Fund (AGFUND). UNFPA is guided by, and promotes, the principles of the Programme of Action of the 1994 International Conference on Population and Development (ICPD). UNFPA’s contribution has successfully born fruit as the organization’s overall vision and framework fitted well with the mission and principles of the Philippine Population Management Program (PPMP). Both put emphasis on the right of couples and individuals to decide freely and responsibly the number and spacing of their children, as well as the right to the information and means to do so.

Training Institute. Projects involving men as FP and RH motivators in selected towns in Bataan, Zamboanga, and the National Capital Region. Partnership projects of PNGOC with other NGOs, LGUs, the academe, and national government such as: (1) RH advocacy training for 170 media practitioners, (2) local advocacy project (LAP), and (3) mass mobilization RH/ FP advocacy to integrate population RH/FP concerns in the electoral agenda of local and national candidates. The RH program also focuses on the needs of men. The leading cause of cancer deaths in men 20-35 years old is testicular cancer. The incidence is 35 times higher among men with undescended testes (NSCB, 1998). The second most common cancer in men is cancer of the prostate. Its incidence has been increasing from 12.5 per 100,000 males for the period 1980-182 to 19.6 per 100,000 males in 1993-1995. Other male RH concerns are sexual dysfunctions such as impotence, premature ejaculation, and erection dysfunctions. RH programs for men also deal with their participation in household responsibilities and in women’s health projects. In a review of 177 women’s projects in five cities, it was found that 47 percent of the projects involved men in the areas of RH, domestic violence prevention, and STD/ HIV-AIDS, although male participation in RH was peripheral (Lee, 1996). Other surveys show that men are beginning to share in household chores such as caring for sick members of the family, shopping for food, and preparing household budgets (POPCOM, 2001a). 3 . Challenges The most serious challenge is the anticipated shortage in family planning commodities. USAID, which donates 80 percent of contraceptives in the country, has informed Philippine health officials that it will phase out its contraceptive donations within the next two years. With stock-outs expected to begin in the last quarter of 2004, the government foresees problems related to accessibility and affordability of various contraceptives and other RH services by the poor who are completely dependent on the free services and supplies provided by public health facilities. It is not clear if the government has the resources and political will to purchase contraceptive supplies. Health accounted for only 2.08 percent of total government expenditure in year 2001 (DBM, 2001). Other challenges as noted in the Fifth Asian and Pacific Population Country Report (2002) are: The RH approach to health care can be mainstreamed only through a broad multisector network of national and local partners. The common ground of this network should be unified understanding of reproduc-

tive health. There is a need to concretize a concept of reproductive health that is based on the culture and complex value systems of Filipinos and on the universal rights to reproductive health of all women and men. The government needs to improve access, especially by the poor, to quality RH and FP services, through appropriate budget support for contraceptive supplies and related RH/FP programs. There remains a need to establish a strong partnership of all stakeholders (NGO, GO, LGU, private and commercial sectors, civil society) in the formulation, implementation, and monitoring and evaluation of RH/FP strategies. There is a need to address the RH needs not only of women and children but also of underserved groups such as men and adolescents, and older persons. There is a need to strengthen male involvement in reproductive health. There is a need to create an environment for more open discussion of emerging RH issues such as abortion, emergency contraception, and abortion. There is a need to fill in the RH data gaps for all 10 key elements. It should also be noted that many of the current programs and projects on RH are funded by international organizations. There is a need to generate more resources from within particularly the LGUs.

B. Adolescent Reproductive Health 1 . Policy The ICPD PoA requires countries to protect and promote the rights of adolescents to reproductive health education, information and care, and to reduce greatly the number of adolescent pregnancies. Governments are urged to adopt appropriate mechanisms to respond to the special needs of adolescents. Consistent with its commitment to the 1994 ICPD PoA, the Philippine government has taken steps to create an enabling environment to protect adolescent and youth sexual reproductive health and rights. One policy objective of the PPMP is to reduce the incidence of teenage pregnancies, early marriage, and other adolescent reproductive health problems. Similar directions are found in the 1999-2004 Philippine Medium Term National Youth Development Plan (PMTYDP) and in the Compendium of Philippine Youth Programs of the “Youth Doors” of the National Youth Commission (NYC). The NYC serves as the official policymaking and coordinating body of all youth programs and projects of the Philippine government. The PMTYDP provides a clear policy for

developing responsible reproductive health behavior among adolescents through an integrated and comprehensive package of preventive and curative health care services for the youth at all levels of health care. Recognizing that adolescents and the youth are a special population group and that the challenges are numerous since they are in the stage where experimentation and unhealthy behaviors and habits start, eventually leading to chronic illness and disability, the Department of Health issued Administrative Order 34, s. 2000, otherwise known as the Adolescent and Youth (AYH) Policy. Geared toward healthy development and reproduction maturation; healthy lifestyles to avoid illnesses, diseases, injuries and disabilities; information, education, counseling care, and rehabilitation of common health problems; and healthy adolescents and youth-friendly settings, this policy is intended to make sure that adolescents and youth have access to quality comprehensive care and services in an adolescentand youth-friendly environment so that they will become well-informed, empowered, responsible, and healthy. 2 . Programs and projects The Adolescent Health and Youth Development Program (AHYDP) has been adopted as a major component of the PPMP DP 2001-2004 to provide for scientific and policy-consistent information, knowledge, education, and services on population and reproductive health for adolescents and youth. Following are the projects and initiatives under the AHYDP of PPMP: National level projects. In 1995, POPCOM worked closely with a network of national government agencies, NGOs, and local governments on this program. Participating local governments undertook 18 innovative projects to reach the young. These consisted of media outreach, skills training and enhancement, peer counseling, and support to other programs and projects. The program launched a nationwide IEC campaign called Hearts and Minds to reach young Filipinos with messages about preparing themselves for adulthood and parental responsibilities. Training modules for peer helpers, youth, youth leaders, health and program workers, and parents on “Sexually Healthy and Personally Effective Adolescents (SHAPE)” were produced and widely utilized. With funding assistance from UNFPA, POPCOM produced the SPPR 2, which has Adolescent Reproductive Health as its main theme. SPPR 2 presents a comprehensive account of the trends and issues about the sexuality, health, and fertility of Filipino adolescents and youth. It is an instrument for promoting policy decisions at both national and sub-national levels,

A CELEBRATION OF YOUTH, BUT WITH A WORD OF CAUTION

The 2003 State of the Philippine Population Report (SPPR2) focused on the youth, and was entitled “Pinoy Youth: Making Choices, Building Voices.” Published by the Commission on Population (POPCOM) with assistance from the United Nations Population Fund (UNFPA), the report was launched through a free music concert on November 28, 2003 at a public gymnasium in Mandaluyong, Metro Manila. The concert, which featured the country’s leading bands, solo artists and dancers, drew an overflow crowd of young people estimated at about 10,000. The report’s key findings and core messages were encapsulated in the creative handle – which also served as the concert title – “Hoy-hoy-HOY! Ingat o Engot!.” Various concert elements carried the message to the youth “to take care (ingat) and choose wisely or end up being a foolish loser (engot)” – from the hosts’ spiels to the artists’ performances to videotaped dramatizations. The coherence of the show and the balance between entertainment and advocacy were so engaging that the crowd left the concert with “ingat o engot” ringing in their ears and upon their lips. Prior to the concert, a National Youth Congress was held highlighting the findings and advocacy issues of SPPR2. The Congress drew in around 200 Sangguniang Kabataan officers, youth leaders and representatives from youth-serving organizations. A youth congress declaration addressing point-by-point the advocacy issues of the report was crafted and adopted by the congress delegates. This declaration will serve as an important input to the advocacy campaign activities of POPCOM’s central and regional population offices, as well as those of the delegates’ respective local government units or organizations. The behavior change communication strategy and advocacy for policy change employed in the SPPR2 campaign was deemed effective not only in terms of the scope of audience reached but also in terms of its potential impact to both audience groups – youth and policymakers. Coupled with this is the impeccable timing of the SPPR2 given the build-up of youth-oriented international and national activities such as the World Population Day, the launch of the State of World Population Report, the National Social Science Congress on the Filipino Youth, and Young Adult Fertility and Sexuality Survey, which paved the way for greater acceptability of the SPPR2 issues. Central level efforts will be further enhanced by the regional advocacy campaign activities currently being undertaken in all 15 regional population offices. Among the activities lined up per region are the development of regionalized and popularized versions of the SPPR, conduct of media campaign and other popularization activities, and users’ forum. Ownership of the issues proved critical in the implementation of the campaign activities as these opened venues for innovation and resource mobilization, especially on the part of regional population offices and partner agencies. Filipino youth, defined as the 15 to 24 age group, comprise about 20 percent or 15.1 million of the total population. In addition to the issues posed by the youth population’s big number and rapid growth, the SPPR reveals that a growing number of them are engaging in risky behaviors. The report warns that if unchecked, these trends could translate to less opportunities and unfulfilled potentials for our youth, and will impact immensely on the level of development the country could achieve. The Report also identifies major advocacy issues that need to be addressed to give greater attention to youth needs and rights. It also shares current innovative efforts to help young people learn more about their reproductive health. The entire report can be downloaded in HTML and PDF formats from its website: www.popcom.gov.ph/sppr/spp02.

with decision-makers and policy-makers as the primary audience. The DOH developed the Adolescent and Youth Health Development Program to institutionalize the provision of information, counseling and clinical services to adolescents and youth, including reproductive and sexual health issues and concerns. It also developed a training module and facilitator’s guide for a Training Program on Adolescents, for Health and Non-Health Service Providers. The University of the Philippines Population Institute (UPPI) implements YAFSS III (Young Adult Fertility and Sexuality Study) with funding support from the David and Lucile Packard Foundation. YAFSS III is a major effort to update information about sexuality-related values, knowledge, attitudes, and behavior of adolescents. It covers a wide range of sexual, nonsexual, and health- risk behaviors of young people. Like its predecessors, YAFSS III is a useful source of policyand program-relevant information. School-based and out-of-classroom initiatives. The Population Education Program (PopEd) has been implemented by DepEd since the 1970s. One in-school initiative is the Strengthening and Revitalizing the Population Education Program implemented by DepEd, which enlisted participation of the Commission on Higher Education (CHED) at the tertiary level and the Technical Education and Skills Development Authority (TESDA) at the vocational level. Along the same lines, the Philippine Center for Population and Development in collaboration with the Bureau of Secondary Education implemented a project to institutionalize revitalized homeroom guidance in 12 regions in the country. Students gained new skills in becoming more assertive and in improving their relationships with the opposite sex. They also acquired new knowledge on STDs, HIV/AIDS, courtship, friendships, dating, and other aspects of personal development. IEC materials on value formation of young people toward becoming responsible adults were developed and produced. The project set up a Teen Health Center inside an industrial park. PHANSuP, under the European Commission-supported program on Accelerating Community-Based Responses to Reproductive and Sexual Health, STI/HIV/AIDS Concerns of the Filipino Youth, is envisioned to enhance the quality of life of target beneficiaries in underserved areas in the Philippines. The programs aims to decrease the youth’s vulnerability to sexually transmitted infections, HIV/AIDS, and other reproductive health problems through peer education and counseling, participatory community-based education approaches, and medical services. The project runs parallel but complementary adolescent health promotion programs—one for inschool and the other for out-school youth. Parents

and community members will also be targeted by the project to ensure a more comprehensive and holistic approach. The Foundation for Adolescent Development (FAD), an NGO that focuses on young people’s health and sexuality needs, carries out SEXTERS, an out-of-classroom program to nurture socially, emotionally, and sexually respon-

Youth programs provide sexual health information, counseling and services to adolescents. sible teenagers. This program trains college students as peer counselors to provide information, counseling, and referrals on adolescent health and sexuality. It assigns a trained peer counselor on campus. School administrators support the program because they recognize that their students can benefit from the information and counsel provided by enlightened peers. The program has produced a Trainers Guide for training potential peer educators. Capability building for youth leaders and organizations in colleges and universities on adolescent health sexuality and development has also been provided. FAD also has implemented the “Teen Health Quarters” that offer medical services to the youth. The Philippine NGO Council, Inc. (PNGOC) has reached out to more than 250,000 out-of-school youth and adults through the nonformal accreditation and equivalency (NFE A&E) project of the DepEd, which integrated RH, FP and ARH in the learning sessions. Modules on RH, FP, population and environment were produced and used for the learning sessions. Other NGO initiatives that focused on adolescent health and youth development are XYZ’s tri-media campaign, Women’s Media Circle with its BODYTALK TV series, and Remedios AIDS Foundation’s Youth Zone. In 1994, the DepEd and Kimberly Clarke Philippines started Feminine Hygiene Education Program (FHEP) for elementary and secondary school students. Under this program, school

nurses of the regions are trained and mobilized to counsel and lecture on the physiological and biological changes experienced by boys and girls, good grooming, personality development, and clarification of myths and fallacies about menstruation and feminine hygiene. The positive impact of the program has been noted in the improved perception of the target group of feminine hygiene. The DepEd is also involved in a School-Based Women’s Health Project in partnership with Johnson and Johnson, and the ASEA Consumer Group of Companies in the promotion of reproductive and adolescent health. Intersectoral and community-based initiatives. A nationwide training program of the DSWD for municipal and city social welfare and development officers was undertaken to enhance their understanding of and effectiveness in providing technical assistance and capability building to LGU workers and other service providers in implementing the Unlad Kabataan Program. This program develops new approaches and strategies to address the emerging needs of out-of-school youth (OSY) and help them become more actively involved in community activities. Several projects are geared to establishing places where teenagers can interact. These come in the form of teen and youth and drop-in centers, ARH Corners and Tambayans, or hangouts. Teenagers use these facilities to get information, counseling, and referrals for health services. There are also projects that provide telephone counseling (e.g., “Dial a Friend” and “Friends on Line”), counseling through the Internet (www.teenfad.ph and “Email a Friend”), and counseling-on-air services on adolescent development, sexuality and reproductive health issues. The performing arts have been employed effectively in influencing youth values related to sexuality and reproductive health. For example, the Foundation for Adolescent Development produced Enter-Educate videos that provide youth audiences with behavioral modeling on relevant health and sexuality issues. The Cordillera Administrative Region and Zamboanga City use folk theater performances to deliver RH messages. Some initiatives provide useful ARH information at the local level and in the workplace. For example, members of the Sorsogon City Advocacy for Responsible Team of Youth composed of Sangguniang Kabataan officers act as lead persons in ARH programs and activities. The province of Leyte has two youth projects. The first is the Movement for Young “Rurban” Women, where single young women learn about reproductive rights and access to reproductive health services. It also campaigns against illegal recruitment of domestic helpers, the treatment of women as commodities, and acts of violence against women. The other Leyte project, called Youth for Human and Ecological, trains youth leaders in adolescent and youth development,

environmental protection, livelihood, gender awareness, and the theatre arts. 3. Challenges The prospects of a brighter future for adolescents are threatened by emerging major youth issues related to their reproductive health and development as a whole. According to the 5th APPC Country Report of 2002, the reproductive health needs of adolescents and youth have been neglected for many years by the public health system. Few services address the specific health concerns of this segment of the population and most are provided by NGOs. There is a problem of coverage and, therefore, of accessibility and availability. Efforts must continue to mainstream adolescent reproductive health by putting in place culturally sensitive, high-quality, accessible, and user-friendly services. These services must respect the right of adolescents and the youth to privacy, confidentiality, and informed consent. ARH care providers need to be specially trained and oriented so that they become competent and sympathetic in how they relate to adolescents seeking RH-related preventive and curative care services. The State of the Philippine Population Report (2003) posed the following challenges: A considerable number of the youth engage in premarital sex. Their health and future are at risk because they generally lack accurate and appropriate information and incomplete understanding of the many aspects of sexual behavior and reproductive health. Appropriate and relevant information should be made accessible to adolescents to enable them to protect themselves and learn how to access available health services. PopEd needs to be broadened and strengthened as do efforts of religious groups. This could be strengthened by incorporating elements of adolescent reproductive health education, the life-planning approach, and the peer counseling strategy. There is a continuing need to build the life skills of adolescents and the youth to help them deal more effectively with the demands of everyday life and avoid high-risk behaviors. To help parents to better understand the situation of the young, they should be provided with appropriate information and adequate communication skills so they can help give meaningful reproductive health counseling. The media, being the new “surrogate parents” of the youth and fast becoming the main source of information and guide to “what is right” and “what is wrong” by young people, must be involved in youth issues, especially in the dissemination of correct information on youth health and development.

YOUTH CONGRESS DECLARATION 28 November 2003, Century Park Sheraton Hotel, Manila

Some of us engaging in risky behavior without understanding its consequences: We urge for a sustained information drive to increase our level of awareness on ARH issues and concerns; We call for the integration of ARH concepts in the school curriculum and in human relations development programs of companies and/or businesses, to ensure that we are informed on the consequences of engaging in risky sexual practices; We appeal for the conduct of trainings, orientations on ARH by the academe, local government units, religious and business sectors; We appeal for the conduct of campaigns on substance abuse prevention and awareness raising on various issues on AHYD. Adults not knowing how to communicate openly about sexuality with us: We urge for the implementation of programs that promote responsible parenthood and involvement of parents in sexuality education and ARH; We call for the conduct of seminars for parents and children, including employers, to intensify parentadolescent, and employer-young employee relationships; We call for the active involvement of parent-teacher associations, and human resource managers in responding to adolescent reproductive health challenges. Media playing a bigger role in our lives: We propose that the Adolescent Health and Youth Development Program (AHYDP) be a part of the information campaign of the Office of the Press Secretary (OPS) and Philippine Information Agency (PIA); We pledge to create and maintain e-mail groups and websites to serve as regular updates on ARH; We strongly urge that media focus on and develop the competencies of young people rather than solely on their issues and challenges. Reproductive Health (RH) and other related policies, programs and services ignoring our needs: We advocate for clear policies and laws that support implementation of ARH such as the Local Youth Development Council Act of 2003 and the Reproductive Health Care Act (in this Congress known as House Bill No. 4110 and Senate Bill No. 2325) and to review PD 603 (Child and Youth Welfare Code) and the Family Code;

C. HIV/AIDS 1 . Policy The ICPD PoA calls on governments to mobilize all segments of society to control the AIDS pandemic and give high priority to IEC campaigns in programs to reduce the spread of HIV infection. The ICPD urges governments to ensure that at least 90 percent of young men and women, aged 15-24, should have access by 2005 to preventive methods, such as female and male condoms, voluntary testing, counseling, and follow-up, and at least 95 percent by 2010.

We call on local government units to put in place institutional mechanisms to maintain and sustain Adolescent Health and Youth Development Programs (AHYDP) including allocation of funds, putting in place of staff and strengthening of linkages among various stakeholders; We propose the establishment and improvement of more youth-friendly and gender-sensitive centers in all local government units (LGUs), ideally with outreach-based services and programs, where gender-sensitive and ageappropriate health services and information are accessible and available; We pledge to develop and implement innovative programs and projects that will enhance our well-being and reduce our tendency to engage in risky sexual behaviors; We call for a responsive system of recognition for fellow youths with outstanding contribution in community development relative to ARH initiatives; We propose the creation of a national ARH network that would coordinate the different groups in the different regions. Our voices not being heard in some youth-related efforts: We pledge our more active participation in the development and dissemination of information, education and communication (IEC) materials on ARH and gender/sexuality awareness; We pledge to maximize our involvement in youth sports activities, as well as in environmental protection; We commit ourselves specifically to help fight the battle against ignorance, violence against women, children, and persons with disabilities; unplanned pregnancies, sexually transmitted infections, gender-based and other forms of discrimination, HIV/AIDS and other reproductive health issues that plague us; We appeal for our greater participation and involvement in planning, formulation, implementation, monitoring and evaluation of policies, programs and projects that directly or indirectly affect us. Excerpts from the Youth Declaration, prepared by around 300 youth delegates (SK leaders, youth counselors and leaders, among others) at the National Youth Congress held 28 November 2003.

In the MDG, the target is to reverse the spread of HIV/AIDS. The prospects for achieving this target are high. International experts consider the situation in the country as a â&#x20AC;&#x153;nascent epidemicâ&#x20AC;? due to the very low number of confirmed cases and its slow rate of increase. The official number of recorded HIV Ab seropositive cases is 1,611 since 1984 and the annual number of confirmed cases has not exceeded 200 from 1993 to 1999. Although Philippine epidemiologists estimate the probable number of HIV cases at anywhere from 5,000 to 13,000, the current HIV prevalence rate is at most 0.02 percent of the total population.

The Philippine National AIDS Council (PNAC) is the legally established body to coordinate and direct the nationwide implementation of the Philippine AIDS Prevention and Control Act of 1998. The PNAC is the central advisory, planning, and policy-making body for the comprehensive and integrated HIV/AIDS prevention and control program in the Philippines and is a multisectoral body composed of government and nongovernment institutions. It was created through Executive Order 39 signed by President Fidel V. Ramos on December 3, 1992. EO 39 mandated PNAC to “advise the President regarding policy development for the prevention and control of AIDS…” As an advisory body, it serves as a venue for intensive policy discussion between the government and NGOs. This ensures that policies to be formulated and actions to be taken truly respond to HIV and AIDS as a social development issue requiring multisectoral attention. HIV/AIDS-related policies include:

2 . Programs and projects

A government policy on the use of condoms. A policy on regular (twice-a-year) serological testing among high-risk groups such as commercial sex workers. Provision of basic health services not only to HIV positives but also to high-risk individuals. Nondiscrimination of HIV/AIDS persons. Of the recorded 1,611 HIV Ab seropositive cases, 61 percent are men and 39 percent are women. The 30-39 age group has the highest number of infected men, while the 19-29 age group has the highest number of infected women. Of these cases, 28 percent are overseas Filipino workers, 38 percent of them seafarers. The primary mode of transmission is sexual intercourse. Female sex workers, men who have sex with men, and intravenous drug users have higher –thanaverage prevalence rates (PPR-MDGs, 2002). One factor contributing to the low prevalence of HIV infection in the Philippines is the early and multisectoral response. To date, the country’s efforts to curb the epidemic can be summarized through the three Medium Term Plans (MTP) formulated (Seizing the Opportunity: the 2000-2004 Medium Term Plan for Accelerating the Philippine Response to HIV/AIDS):

Prohibition of compulsory testing for HIV. Respect for human rights, including the privacy of HIV-infected individuals. Integration of HIV/AIDS education from intermediate to tertiary levels of schooling. Provision of basic health and social services for individuals with HIV. Promotion of safety precautions in practices where there is a risk of HIV transmission. Prohibition of discrimination against persons living with HIV/AIDS in the workplace, schools, hospitals, and in insurance services. Important ongoing nationwide activities include the following:

Medium Term Plan I - Focused on awareness raising. Medium Term Plan II - Prioritized the prevention of transmission and reduction HIV/AIDS. Medium Term Plan III - Focused on five strategies as an integrated package. Although HIV infection has not reached the critical level, an epidemic still could break out for the following reasons: Surveillance is not comprehensive since it focuses only on registered persons in prostitution, men having sex with men, and injecting

drug users and hence should also be done in other areas aside from the 10 ASEP sites. Preference for private physicians to ensure high awareness of HIV/AIDS not translated to protective action (e.g., condom use). Limited ability of the DOH to provide for free (as in other countries) antiretroviral drugs, which could prevent transplacental transmission.

The Philippines has intensified its programs on responsible parenthood and reproductive health, including advocacy for the increased availability and accessibility of reproductive health information and services aimed at reducing the risk of HIV/AIDS infections. The initial national governmental response to HIV/AIDS was in 1989 through orders issued by the Secretary of Health. This became the basis for a 1992 executive order that embodies the national HIV/AIDS policy. Later, this was made into a law known as the Philippine AIDS Prevention and Control Act of 1998. Serving as a model for HIV/ AIDS-related human rights legislation, the law has the following important provisions:

Pilot research and development work of academic institutions, government agencies, and NGOs. Ongoing serological and behavioral surveillance, including annual dissemination of surveillance results. Efforts to incorporate knowledge of HIV/AIDS in the educational programs of the formal and nonformal education system. Continuing assessment of vulnerability to HIV infection of various areas and regions of the country. Efforts to incorporate HIV/AIDS knowledge in the pre-departure orientation of overseas Filipino workers. Efforts to reach all workers in their workplaces with basic information and knowledge about HIV/AIDS.

Social marketing efforts to promote condom availability and sale as well as facilitate dispensing and use of standard full-course treatment packs for the syndromic treatment of STDs. Development and printing of AIDS educational modules for integration in appropriate learning areas. Conduct of national and regional surveys on the knowledge, attitudes, and practices (KAP) of students on HIV/AIDS. Adaptation of the etiological reporting of STDs to improve surveillance. Notable local responses include: Passing of local ordinances to improve the quality and expand the operation of social hygiene clinics for better prevention and control of STDs. Local government efforts to absorb the operating costs of HIV/AIDS surveillance activities (for example, in Cebu, the municipality of Balamban has set up an STI Clinic through a municipal resolution; also in Cebu, the Cebu Medical Society established a Center for Infectious Diseases and a laboratory for HIV and STI testing; in Region II, there are surveillance and monitoring activities through serologic testing of so-called “guest relations officers” (night club hostesses) and volunteer clients at social hygiene clinics). Establishment of local AIDS councils to coordinate multi-sectoral work in the localities. Community outreach and preventive education activities of several NGOs directed at various groups such as commercial sex workers, minors in the sex trade, men who have sex with men, and adolescents. Adoption of local ordinances requiring 100 percent condom use policies in registered entertainment enterprises. HIV/AIDS counseling and establishment of telephone hotlines and information centers. There are indications that current national and local efforts are making progress. There is greater availability of reliable scientific and research-based information about the current levels of HIV infection and the risks for spreading the infection. Awareness of HIV/AIDS issues is now higher among leaders and opinion makers; there is more vigorous response from many stakeholders to forestall an HIV/AIDS epidemic. Condoms, STD treatment packs, HIV testing services, preventive counseling and education services, and proper clinical care and support of AIDS patients are now more widely available and accessible. 3 . Challenges According to UNAIDS (2002), the Philippine AIDS Law and the National Medium Term

Plan on HIV/AIDS have not been fully implemented. The government budget for HIV/AIDS has steadily decreased over the years, moving from P20 million (US$400,000) at the start of the program to P9 million today, or ($180,000) (UNAIDS, 2002). In addition, the HIV/AIDS program faces these other challenges (Synergy, 2001; POPCOM, 2002): Full implementation of the new national strategic plan for the prevention and control of HIV/AIDS, which includes education and information drive, HIV/AIDS high-risk groups testing and establishment of hotlines and information centers. Raising levels of condom use through intensification of condom promotion while taking into account the objection of some religious groups. Address the needs of the commercial sex industry with focus on its regulation and the establishment of a practical system to register “free-lance” commercial sex workers. Improving social hygiene clinic facilities nationwide and conducting regular social hygiene classes. Making STD/STI drugs and testing agents widely available that will later on manifest in the reduction of STI/STD prevalence and resistance to STI/STD drugs. Reduction of tuberculosis incidence, which is among the highest in the world. III. GENDER EQUALITY, EQUITY, AND EMPOWERMENT OF WOMEN The Philippine government committed to promote gender equality and women empowerment in the 1994 ICPD PoA. In the MDG, this is further affirmed with the target of eliminating gender disparities in primary and secondary education preferably by 2005, and at all levels of education not later than 2015. Following extensive participatory workshops, the Philippine Plan for Gender Responsive Development (PPGRD) for 1995-2025 was formulated to guide policies, programs, and projects in making men and women equal participants and beneficiaries of development. It identifies prevailing gender issues in all sectors (trade, education, credit, reproductive health, and others) and addresses these issues through a collaborative effort among government and the civil society. The National Commission on the Role of Filipino Women (NCRFW) is implementing and monitoring the PPGRD. The NCRFW depends on monitoring reports from other government agencies as the basis for its policy and program advocacy. This is now being addressed by NCRFW with the assistance of the Department of Budget and Management (DBM) by coming up

with a monitoring format for all agencies to accomplish. To complement the implementation of PPGRD, the financial support for Gender and Development (GAD) activities was institutionalized. This consists of a mandate for all agencies to set aside at least 5 percent of their total budget for gender-related activities. This “GAD budget” provision has been incorporated in the General Appropriations Act since 1995. The government also has adopted a gender-responsive population program framework to improve current population planning and policy development. Gender equality and women empowerment cut across all the four major components of the PPMP. One tool developed is the Framework Several laws have been for Analyzing Gender passed to protect and Responsive Population empower women. Policies with the RH Perspective. PPMP managers use this to ensure that the effects and benefits of policies and projects are shared equitably between men and women. Using the framework, policies can be viewed from a three-dimensional perspective — social and institutional levels of development, the development factors affecting them, and crosscutting issues of gender and reproductive health. The country has made significant gains in mainstreaming gender and development. This can be seen in the sizeable number of legislative measures, training programs, research activities, and advocacy campaigns. Important laws that empower women include: the New Family Code, which eliminates discriminating provisions in the previous law; the Anti-Sexual Harassment Law, which declares sexual harassment unlawful in employment, education, and training institutions; Republic Act 7610, which protects children against abuse, exploitation, discrimination, prostitution, and trafficking; the Anti-Rape Law, which classifies rape as a crime against persons rather than a crime against chastity; RA 8505, which strengthens the government mechanism to respond to violence against women through the establishment of a women’s crisis center in every province; and, RA 9262, which is the AntiVAWC Law (violence against women and children), which is the consolidated version of the Domestic Violence and the Anti-Abuse of Women in Intimate Relationships (anti-AWIR) bills. In 1995, Republic Act 7877, or the AntiSexual Harassment Act, was promulgated to

declare sexual harassment unlawful in the employment, education or training environment, and for other purposes whereby “…any person who, having authority, influence or moral ascendancy over another in a work or training or education environment, demands, requests or otherwise requires any sexual favor from the other, regardless of whether the demand, request or requirement for submission is accepted by the object of said act.” Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of sexual nature constitutes sexual harassment when submission to or rejection of this conduct explicitly or implicitly affects an individual’s employment, unreasonably interferes with an individual’s work performance or creates intimidating, hostile or offensive work environment. A considerable number of cases have already been tried and decided upon in the courts of law. The Philippine government has continuously undertaken activities to strengthen institutional mechanisms to advance the adoption of the PPGRD. These activities include the following: Organization of GAD focal points in national and sub-national agencies and LGUs. At present there are more than 70 GAD Focal Points organized in more than 20 line agencies (NCRFW, 1996). Development and dissemination of a standard guide entitled “Gender Mainstreaming: A Handbook for Local Development Workers.” Installation of a monitoring system for GAD mainstreaming to facilitate coordination between NCRFW and other government agencies and systematize the assessment of the GAD-related accomplishment of different agencies. Conduct of gender development advocacy activities and various gender sensitivity training seminars on gender planning and budgeting. Various projects and activities have been undertaken at the sub-national level. Part of the country’s advocacy activities is the sensitivity to the generation and utilization of sex-disaggregated data and statistics for planning, programming, and project development. Gender and Development Indicator Systems are being installed in local government offices to institutionalize the incorporation of gender in regional development plans. The series “Women and Men: 2000 Statistical Handbooks” has been developed and produced for Regions I, II, III, IV, and V. Training on statistics for gender planning also has been done for local development planners. Starting in 1995 POPCOM, with support from the Japan International Cooperation Agency (JICA), conducted the In-Country Training Program on Gender and Development Toward the Improvement of Women’s Health and Family Welfare. The general objective was to increase the participants’ knowledge and awareness of women,

gender and development. The training enabled them to formulate and implement gender-responsive population and development programs designed to enhance family welfare. Four batches of participants, including city and provincial population officers, planning and development officers, health professionals and social workers working at the city and provincial offices, were trained from 1995 to 1996. A number of local government units, particularly provinces and cities,enacted gender and development codes to institutionalize the structure, mechanisms, and interventions leading to gender-fair and responsive communities. These LGUs include Cotabato, Davao City, Cebu City, and Negros Oriental. Local government units at the city and municipal levels have been very active in establishing Women’s Desks to attend to victims of VAW. The Department of Social Welfare Development is currently piloting a National Family Violence Prevention Program, a community-based strategy of preparing family members to protect themselves against violence, in four baranggays in Region V. The program has activated 95 baranggay councils for the protection of children and has trained officials, volunteers, teachers, policemen, and social workers on the prevention of family violence and to counsel and as sist victims of violence. In several LGUs in Mindanao, particularly in Surigao, Cotabato, and others, a Gender and Development Office has been established within the Provincial Population Office. IV. CROSSCUTTING CONCERNS

A. IEC, Advocacy and ICT A primary aim of the PoA is to increase knowledge, understanding of all issues surrounding population, and development and commitment to the program at all levels, from the individual to the international. Other aims are: a) to encourage attitudes in favor of responsible behavior in such areas as the environment, family, sexuality, reproduction, gender and racial sensitivity; b) to ensure the government’s commitment to promote private and public sector participation in the design, implementation, and monitoring of population and development policies and programs; and c) to enhance the ability of couples and individuals to exercise their basic right to decide freely and responsibly the number and spacing of children, and to have the information, education, campaigns, and means to do so. Through the years, communication to change behavior and influence policy has been an integral part of the Philippine government’s population, reproductive health, and family planning programs. The information, education, and communication (IEC) campaigns of the Department of Health carry various messages that

focus on proper spacing of births and reflect a shift from number of children to quality of life. The current slogan used nationwide is “Kung sila’y mahal n’yo, magplano” (If you love them, plan your family). A number of nongovernment organizations complement the DOH efforts. For example, DKT International has launched multi-media campaigns promoting the use of condoms and pills under its HIV/AIDS Prevention and Control Project and Family Planning Project. ReachOut Foundation, with its reproductive health campaigns, has promoted the use of modern FP methods, including emergency contraception. Other private sector groups, including women’s groups, also have carried out similar information drives to attract more FP acceptors. The most important indicator of the effectiveness of these campaigns is the increasing contraceptive prevalence rate (CPR), which is now 49 percent of all married couples of reproductive age (1999 Family Planning Survey). Advocacy and IEC for a supportive policy environment. The government, through POPCOM, developed advocacy plans from 1996 to 2004 to guide the population program in effectively coordinating and implementing population advocacy activities at the national, regional and local levels. National Development Advocacy Plans were prepared for 1996 to 2000, and for 2001 to 2004. The current plan aims to improve the policy environment for population, reproductive health, and responsible parenthood/family planning programs. Among the strategies adopted are: a) capability and capacity building; b) broadening of partnership and advocacy networks, establishment of new and maintenance of existing advocacy groups; c) development/production and dissemination of advocacy materials; d) conduct of special population events (e.g., launching of the State of the Philippine Population Report and the State of the World Population Report; and, e) strengthening of national and local population information centers. These strategies have been found relevant. However, there is a need to improve the advocacy monitoring and evaluation mechanisms, and expand advocacy work to include other religious sects, aside from the Muslim and Catholic religions. Also, strategic alliances with stakeholders should be initiated and enhanced to overcome the continuing problem of policy ambivalence. Ongoing multimedia advocacy campaigns promote reproductive health and reproductive rights. The DOH Women’s Health and Development Program, with funding assistance from the Women’s Health and Safe Motherhood Project, has launched an intensive media campaign on women’s empowerment dubbed “Hindi Kailangang Magtiis” (You Don’t Have to Suffer) that featured, among others, issues related to reproductive health and reproductive rights. The campaign promotes

people’s right to make decisions based on informed choice, respect for individual sexual orientation, and the like. The POPCOM and DOH, with funding support from USAID through the Johns Hopkins University, have oriented various national and local media practitioners on reproductive health and family planning. The objective was to encourage more population-related news releases, columns, and opinions in national and community newspapers. Another multimedia advocacy campaign that promoted modern family planning methods was developed by the Social Acceptance ProjectFamily Planning (TSAP-FP) with financial assistance from the Academy for Educational Development (AED) and USAID. The information campaign used the tagline: “Sa modern methods, sigurado ka, walang pa-tsamba-tsamba” (You’re sure with modern methods. You don’t take chances). Viewers were assured that modern methods are more effective and safer to use than the withdrawal and calendar/rhythm methods. The campaign communicated its message with the use of humor and familiar Filipino scenes. For example, the TV ad entitled “Oops!” took place in a typical Filipino home where a housewife narrated how her children were conceived using either withdrawal or rhythm. With her children playing about, she advised her friend to consult her doctor on modern methods. The first airing of these TV ads was on January 16, 2004. At the local level, public information officers and media professionals are involved in the integration of population issues and reproductive health rights in program planning and information campaign activities. At the national level, entertainment personalities have been hired to do TV public service advertisements on reproductive health and reproductive rights. Media people have also been oriented on RH. Some of them are members of the Task Force on ARH. Following are the country’s notable advocacy activities and initiatives: Capability-building. In the 1980s and early part of the 1990s, POPCOM conducted combination Workshops-Writeshops on Local Population Planning Information, Education and Communication (IC); Prototype Development Skills Training and Values Orientation Workshop; and Interpersonal Communication Skills Training. With the assistance of the Japan International Cooperation Agency, POPCOM organized an incountry training program in the early 1980s on Gender and Development Toward Improvement of Women’s Health and Family Welfare wherein individual action plans were formulated on mainstreaming gender into various organizations and projects. From 1996 onward POPCOM also trained regional offices and local government units on basic demographic concepts and the use of the RAPID software with support from USAID and UNFPA.

BUILDING ALLIANCES FOR POPULATION AND REPRODUCTIVE HEALTH

While presidential hopefuls were all ablaze campaigning to win the votes of millions of Filipinos in the last elections, a consortium of advocates were also stepping in to put population and reproductive health issues in the election agenda. A group of seasoned advocates from the Philippine NGO Council, Philippine Legislators Committee on Population and Development, Foundation for Adolescent Development, and Friendly Care had converged to ensure that population and RH became part of the platform of government of candidates for public office in the May 2004 elections. More than this, the consortium of advocates aimed to create an enabling and sustainable environment that provides adequate national government resources for reproductive health. In partnership with the media, people’s organizations and various sectoral groups at both local and national levels, the consortium of advocates employed a twopronged strategy to influence the opinion of both the general public and the election candidates and other influentials on the urgency and importance of supporting population and RH issues. A massive campaign was launched as part of the agenda-setting strategy to get public attention on the most pressing population and RH concerns, such as an inquiry on the non-use of government funds to buy contraceptive supplies despite the existing budget for such. Soon the campaign focused on the results of a nationwide opinion survey on the perceptions of Filipinos about reproductive health and population issues and their appraisal of candidates who support these issues. A political mapping survey was also conducted to determine national and local candidates’ support for population and RH issues. The results would serve as input to the advocacy campaign activities of the consortium during the election period and beyond. Mass mobilization and media strategies were also employed to, as initial goal, put more pressure on election candidates to make public their stance on population and RH. Venues were also provided for candidates to present their platform of government to civil society groups and engage them in meaningful debates for the inclusion of population and RH in their platforms. With these strategies, the consortium hoped to create recognition among the target audiences that population and development, particularly RH, are integral to the poverty alleviation and economic development strategies of the government. This also means that men and women should have the information they need to plan their families and the means to do so.

From the late 1990s to the present, POPCOM conducted Monitoring and Evaluation Training; Training on Gender and Sensitivity and Reproductive Health; seminars on Program Awareness and Team Building; Advocacy Campaign Management and Media Relations; Advocacy Plan Development; Power Communications; Occupational Safety and Health (OSH); and Male Involvement in Reproductive Health. As support to the more recent training activities, the POPCOM, with assistance from the UNFPA developed a “Practical Guide on Advocacy for Reproductive Health, Broadcaster’s Manual” as well as various curricula on advocacy. Broadening of partnership and advocacy network; establishment of new, and maintenance of existing advocacy groups. One of the significant accomplishments is a more heightened awareness among planners, legislators, and government executives of the need to integrate population perspectives in development activities. Advocacy efforts have helped to produce legislation supportive of the population program. At the national level, the Department of Health advocates local government support for its programs, particularly those that relate to reproductive health, through the enactment of local ordinances, creation of local programs, and provision of funds. The health workers, in collaboration with other government, nongovernment and people’s organizations, employ social mobilization strategies, mainly with IEC as tool. Educators are trained on behavior change communication (BCC). The campaigns include the development, production, and dissemination of advocacy and IEC materials, television and radio guestings, and news releases. Other successful strategies relevant especially to high-risk groups include: a) educational packages; b) training for GROs and men having sex with men; c) trimedia campaign that inform people of the ill effects of HIV/AIDS; d) bulletin board display on RH in companies and publication of RH articles in company newsletters. An advocacy consortium was established by the PNGOC, PLCPD, the Foundation for Adolescent Development (FAD), and the Friendly Care foundation with the aim of putting population and RH issues in the election agenda. The consortium also aims to prod presidential and other candidates to have a definite stand on these issues. Advocacy work has targeted religious groups. The most recent is the creation of a pool of advocates composed of Muslim religious leaders (MRL) through the ULAMA and ALIMA project of Mindanao. In January 2004, the Grand Mufti of Egypt (highly regarded Islamic leader among Filipino Muslims) endorsed the Fatwah (religious decree) supporting the Reproductive Health and Family Planning Program. An MRL Assembly

will be held in March 2004 in Davao City to pronounce the Fatwah officially and publicly. The creation of local advocacy teams is a major strategy employed by POPCOM in generating support and commitment from local governments. Members of these advocacy teams include development officers, health officers, local legislators and department heads, NGOs, media, women’s and youth groups, and religious groups. These local advocacy teams develop, carry out, coordinate, and harmonize advocacy efforts in their locality and serve as the prime movers of the advocacy campaign. Central to this strategy is the capability and capacity building of the members in advocacy planning, advocacy skills, crafting of core messages, and materials development. In close cooperation with the Philippine NGO Council, the Philippine Legislators’ Committee on Population and Development, and selected local government units, POPCOM also spearheaded a Local Advocacy Project (LAP) with assistance from USAID and the Policy ProjectThe Futures Group International. A sequel to the LAP is the Provincial Advocacy Network to be implemented by POPCOM in selected areas, also with help from USAID and the Policy ProjectThe Futures Group International. The networks will consist of civil society groups working alongside the government. Another advocacy activity is the Policy Champions Project, a concept of the Population Council that is being implemented by POPCOM with funding support from the Philippine Center for Population and Development. This project promotes the utilization of population research findings in formulating population policies. Finally, at the community level, NGOs have actively contributed to creating communitybased advocacy networks. In the region of Caraga, the Women’s Health and Safe Motherhood Project established community-based advocacy groups in 14 municipalities. These include women and auxiliary groups of husbands, the youth, and children. The project has empowered women in the community through capability building and livelihood support. Development, production, and dissemination of advocacy materials. POPCOM, with assistance from donor agencies, particularly UNFPA and USAID, has developed many advocacy materials and references, including: “The State of the Philippine Population Report”; “Local Governments and Filipino Families and Partners for Peace and Progress”; “Hearts and Minds for ARH”; and “The RAPID Model.” POPCOM has also conducted communication campaigns in coordination with the media. The major themes include “Tao Para sa Mundo, Mundo Para sa Tao” (People for the Earth, Earth for the People) and “Pamilyang Nakaplano, Panalo” (A Well-Planned Family Is a Winner). This involved issuance of press releases, audio-

visual presentations, and other IEC activities to raise program awareness and support. In 2003, POPCOM produced a coffee-table book entitled “Population, Politics and Persuasion: 30 Years of Editorial Cartoons in the Philippines.” It is a novel attempt to capture and analyze the dynamics of the population debate in the Philippines. It represented an interesting collection of media’s interpretations of key population and development issues, as illustrated in editorial cartoons that appeared in major newspapers and magazines. While the images had local context, their implications were wide and farreaching. The intention of the publication was for the national leadership to seize the opportunity to build consensus and to ensure decisive and concerted action around population policies and programs. Special population events. POPCOM has organized various institutional activities to get the support of stakeholders. Foremost of these is the annual celebration of Population and Development Week. Major activities include a regional and national Population Quiz Show, Local Government Unit Awards, National Population Congress, and the Rafael M. Salas Population and Development Awards. The National Population Congress, which is replicated at the regional level, is a high-level policy forum on current policy and program concerns. The Salas Awards publicly recognize outstanding individuals, groups, and local government units that have made significant contributions to the population program. In 2000, POPCOM coordinated the Philippine hosting of the Global Media Awards for Excellence in Population Reporting. Among UNFPA-assisted countries, the Philippines was one of the few that commemorated the symbolic day (October 12, 1999) when the world population reached the six-billion mark. On this date, POPCOM and UNFPA selected baby girl Lorrize Mae Guevarra, born at the government-owned J. Fabella Hospital, as the Filipino counterpart of the world’s six billionth baby. As the representative of her generation, Lorrize was also chosen as the Symbolic Child 21 model for the Philippine National Strategic Framework for Plan Development for Children (2000-2025). The Council for the Welfare of Children will be monitoring Lorrize until she reaches 25 years old to find out whether Filipino children are receiving the necessary services to enable them to live healthy lives. In 2001, POPCOM led the launching of the State of the World Population Report and the State of the Philippine Population Report in various parts of the country. Other special population events by government agencies include, National Family Planning Day and AIDS Awareness Month by the Department of Health and the Women’s Month by NCRFW. Regional Population Offices conduct their own special events to promote and gain more support for the program.

TRAILBLAZING FAITH-BASED ADVOCACY*

Eight years ago, the United Nations Population Fund (UNFPA) started work in the Autonomous Region of Muslim Mindanao (ARMM) in partnership with the Department of Health-ARMM under the 4th UNFPA Country Programme. ARMM, as we all know, is the poorest region with the highest infant and maternal mortality rates and the lowest contraceptive prevalence rates. Cognizant of the major cultural and religious barriers to the adoption of healthy reproductive health practices among the Muslim population, UNFPA embarked on an innovative strategy of organizing and mobilizing Muslim religious leaders (MRLs). Considering their respected stature and major influence in the villages, the MRLs were seen to have two major roles. First, in IEC, they are to assist the Provincial Health Offices in providing information and education to the men, women and adolescents about family planning and RH and encourage them to go to the nearest health facility to avail themselves of FP/RH services. Second, in advocacy, they are to mobilize and generate support from their fellow MRLs and other community leaders aimed at the issuance of a national fatwah which will formally declare Islam’s support for RH and FP. It was Maguindanao that first successfully organized the MRLs to support the RH activities of the province. The three ARMM provinces, namely Sulu, Tawi-tawi and Lanao del Sur followed suit. In 1998, the efforts expanded to the three provinces and three cities of Region 12, namely Sultan Kudarat, Cotabato Province, Lanao del Norte, Marawi City, Iligan City and Cotabato City. Under the GOP-UN Multi-Donor Programme Phase 3, the coverage further expanded to Regions 9, 10 and 11 in 2002. Today marks the culmination of eight years of hard work. Our grassroots organizing has paid off as evidenced by the hundreds of enlightened MRLs from the various provinces of Mindanao who joined us today to celebrate the launch of this historic fatwah... The fatwah, however, is only a beginning. There is much work to be done. The National Government, LGUs, civil society, media, private sector, the donor community and the MRLs must all unite efforts in order to help ARMM and the rest of Mindanao rise above poverty and deprivation and bring about lasting peace in this region. We must all work hand in hand to create the reproductive health conditions necessary for nurturing more happy, healthy, peaceful and prosperous Muslim, Christian and lumad families! *Statement of UNFPA Representative Dr. Zahidul Huque for the Launch of the National Fatwah on Reproductive Health and Family Planning, 10 March 2004, Davao City

Among these are the Search for Model Family, the Women’s Health Arts Festival, Outstanding Population Workers and Volunteers, and various loyalty and recognition awards.

Strengthening national and local population information centers. When POPCOM assumed direct administration of the Philippine Population Information Center (PPIC), networking strategies were adapted. “Population Information” or POPIN satellite centers were established in all regional population offices. The PPIC performs library management, which includes data gathering, documentation, and circulation; referral services; and, development of corporate publications such as Popinews. The PPIC serves as the link to regional population information centers and to international information centers. It promotes the sharing and acquisition of information on population and related issues that can be used in policy and advocacy work. Regional Population Information Centers and Satellite Centers have expanded network links with school libraries. The PPIC has not yet reached its full potential. Information Communication Technology (ICT) is being introduced to expand further its reach. However, overall efforts show that IEC, advocacy, and ICT initiatives can still be advanced further through the following endeavors: • • • •

• •

Strengthen IEC/advocacy efforts to reach out to industry-based managers and workers. Improve monitoring and evaluation mechanisms of advocacy campaigns. Scout, target, and recruit potential advocates from among politicians at all levels, NGOs, and civil society organizations (Lacson, 2002). At the national level of advocacy, a policy of strategic alliance with concerned stakeholders should be initiated to overcome the continuing problem of policy ambivalence (Lacson, 2002). Expand advocacy work to other religious sects aside from Muslim and Catholic religions (Lacson, 2002). Enhance IEC activities at the community level so that these are based on research, and implemented, monitored, and evaluated by professionals.

The NSCB and the NSO undertake the National Demographic and Health Survey (NDHS), Family Planning Surveys and Censuses, which provide essential data and information useful for population policy formulation, plan and program development, and monitoring population indicators. The SRTC on the other hand, was a major partner in the development and selection of the 109 (later reduced to 27) PopDev Indicators. 2 . Philippine population database information system On July 12, 2000, the Philippine government adopted a plan for computerizing the information of key frontline and common government services to enhance overall efficiency and effectiveness of the bureaucracy. The government also approved the setting up of RPWEB. In line with these moves, POPCOM is developing a Philippine Population Database Information System (PIS) to be available on-line. The information in the database will be quantitative (statistical and financial), qualitative (textual and descriptive), and geographic (graphical and illustrative). Conceived in 2001, the PIS contains two major information systems: the National Population Database Information System (NPDIS), which has five subsystems, and the Administrative and Fiscal Support System, which has three subsystems. The NPDIS is designed to be the portal or central source of data for policy and plan formulation. It also will be a tool of the PPMP for monitoring and evaluating the country’s commitments to the ICPD Programme of Action, following the Asia-Pacific Population Information Network (POPIN) framework. The Asia-Pacific POPIN has two objectives. First, to promote awareness of emerging issues in population and sustainable development with emphasis on priority areas identified at the ICPD. Second, to promote and encourage the use of population data in formulating and implementing national population and development policies, plans, and programs. There are five NPDIS subsystems currently being developed. These are: •

B. Technology, Research and Development 1 . Basic data collection, analysis and dissemination Data collection, processing, and analysis of vital population data and indicators have been provided by government statistical agencies, particularly the National Statistics Office (NSO), National Statistical Coordination Board (NSCB), Statistical Research and Training Center (SRTC).

•

Demographic and Socioeconomic Indicators System. This will have timely and relevant statistics disaggregated by gender, main age groups and geographic coverage among others. It also contains sectoral data on demography, health, economy, education, environment, and agriculture. Plans and Program Monitoring and Evaluation. This is designed to monitor the progress and accomplishments of PPMP projects. Budgets and expenditures will form part of this subsystem. Policy Development. This will contain policy instruments that support the PPMP issued at the national, regional, or local level.

•

Communication and Advocacy. This will have a bibliographic database of all types of information, education, and communication (IEC) and advocacy materials that support PPMP. Research and Evaluation. This will be a database of abstracts of all research outputs relevant to population management. It will

Systems are being developed to expand the database and improve sharing of population information. also have research studies that evaluate the impact of programs and projects. An Administrative and Fiscal Support System contains basic data internal to POPCOM, i.e., human resource management, fiscal support, and property and supplies management. These subsystems guide and direct operational decisions so that support services are strategically positioned and synchronized with program activities. One result is that, surveys on child labor, violence against women, and other related issues are now included as inputs in the population data system. At present, the PIS is lodged at the POPCOM MIS. It is available through the Local Area Network (LAN) of POPCOM Central Office. Staff training on database management and hardware upgrading will support the efforts to maximize the use of these systems nationwide.

Sources of data Since 2000, POPCOM has been producing an annual State of Philippine Population Report, which contains the most recent studies on the pressing population issues in the country. The first issue focused on unmet need for family planning. The second was on adolescent sexuality, fertility, and health. The NSO, through its Vital Statistics Report, provides data on annual crude birth rate, crude death rate, and total fertility rate. Data on the country’s population growth, sex, and age

distribution, and data on household facilities down to the municipal level are derived through the census of population and housing conducted by NSO every 10 years. The highlights of the 2000 census are available through the NSO’s Web site. The DepEd’s Statistical Bulletin or Basic Education Statistics provides annual data on elementary and secondary cohort survival rates down to the municipal level. The DOH has its Philippine Health Statistics, which gives data on doctor- and hospital bed-population ratio, percentage of births attended by health personnel, and leading causes of morbidity. Among the national surveys conducted regularly is the National Demographic and Health Survey (NDHS) by the NSO. The latest NDHS was for 2003. Also by the NSO is the Family Planning Survey, an annual survey that is the source of data for determining contraceptive prevalence rate, among other things. The Integrated Survey of Households and the Labor Force Survey of the Labor Department are two surveys used to estimate labor force participation and unemployment rates by sex every quarter. The NSO’s Family Income and Expenditures Survey (FIES) is the basis for estimating average family income and is conducted every three years (the latest was in 2000). The Food and Nutrition Research Institute (FNRI) makes an update of the nutritional status of Filipino children every two years through its Updating of Nutritional Status of Filipino Children Survey. The NSO’s Annual Poverty Indicator Survey provides data on poverty incidence down to the regional level. The University of the Philippines Population Institute conducted a Young Adult Fertility and Sexuality Study (YAFSS) in 1982, 1994, and 2000. The survey covers knowledge, attitudes, and practices of the youth related to sexuality and reproductive health. Several agencies in Southern Mindanao and the National Capital Region are engaged in a study on Enhancing Male Involvement in RH. The National Economic and Development Authority is currently doing a study on the Population Poverty Nexus in Rural Areas. This gives simulated data on poverty in the rural areas. POPCOM has initiated other researches, including a Policy Evaluation Research of the PPMP, Proposed Operational Definition of Urban Areas in the Philippines, and Estimation and Institutionalization of PPMP Expenditures. The PPMP has local information systems that complement the national databases. Among these are: •

• •

Contraceptive Delivery and Logistics Management Information System, which gives annual data on the delivery and use of contraceptives in every community. Field Health Service Information System on the health status of the community. Reproductive Health Management Information System on the overall RH situation of the

• •

•

communities in Nueva Vizcaya. CAVANET, a more effective sharing of information among government and privates sectors in Cagayan Valley in Northern Luzon. Community-based Management Information System on the socioeconomic profile of the community, including the movement of people. Community-based Demographic Information System on POPDEV indicators being pilot tested in Eastern Visayas.

Population and development (POPDEV) indicators and databases. The National Statistics Coordinating Board recently approved 27 POPDEV indicators that will be collected and updated periodically by various national agencies and institutions through surveys and statistical reports. These 27 indicators are categorized into four groups: population processes, population outcome, development processes, and development outcomes. When completed, the POPDEV indicators will be used for local policy formulation, planning, and monitoring. They also will be used in determining the level of development of municipalities. Local governments will be encouraged to make available the POPDEV indicators databases down to the community level to complement official statistics, which usually provide provincial data only. The databases will then become part of the NPDIS Demographic and Socioeconomic Indicators System database.

Training on data and information management Basic data and information management training has been given to POPCOM staff and program workers of other agencies. The range of training topics cover basic computation, analysis, interpretation, and presentation of data through the SPECTRUM computer models developed by USAID. Specific training modules include the Demographic Projection or DemProj model; Family Planning or FamPlan model; the Cost Benefit or CostBen analysis model; the Resources for the Awareness of Population Impact on Development or RAPID model; and Policy Environment Survey or PES model.

Future prospects and directions To adopt fully the Government Information Systems Plan (GSIP) and the Asia-Pacific POPIN framework, the PIS has to continue to enhance its Web site, fully develop its NPDIS, and facilitate and ensure its availability and accessibility through a variety of channels. These include hard-copy reports, local area networks, wide area networks, the Internet, and possibly CD-ROM.

Priority will focus on the following concerns: There are not enough timely, accurate, and official data, including census data, at the national and local levels. Local planners need more updated and localized data on such demographic events as births, deaths, and migration; the census is done at 10-year intervals. There are logistical problems related to upgrading computer software, hardware, required skills, and physical network layouts. These problems have to be resolved so that even regional population offices can be upgraded. There remains a need for continuous training in database management, systems testing, data sourcing, validation, standards and analysis, profiling and/or analysis of data users.

C. Resource Mobilization and Allocation 1 . Local funding for population and reproductive health Based on the annual survey on resource flows for population activities, which NEDA did for UNFPA, the country’s expenditure for population activities grew from P318.3 million in 1996 to P1.03 billion in 1999. POPCOM’s own estimates show that during the 1994-1998 period, the Philippine government contribution to population funding grew by an average of 15.4 percent a year. Racelis and Herrin (2003) estimated the PPMP Expenditure Accounts for 1998 and 2000. The Expenditure Accounts show the sources and uses of expenditures according to major population activities under the PPMP. Total expenditures increased from P14.37 billion in 1998 to P17.55 billion in 2000. In 2000, about 44.5 percent of total expenditures for PPMP activities were paid for by national and local governments. A large proportion was paid for through out-of pocket payments (34.6percent). The expenditures were basically used for reproductive health and family planning (program, services, and counseling), Adolescent Health and Youth Development (AHYD), Population and Development (POPDEV) Integration, other program aspects (policy-making, coordination, resource-generation, and general administration, basic data collection), and other mixed PPMP expenditures. Reproductive health accounted for 84.3 percent of total expenditures in 2000, of which 11.6 percent was for family planning. The other PPMP activities, i.e., AHYD and POPDEV Integration accounted for only onetenth to two-tenths of a percent of total expenditures. It is difficult to estimate the resources for population and reproductive health because the

costs of population and RH components are integrated in the total cost of some health programs. Resources invested in the program, especially at the LGU level, are also difficult to disaggregate since they are often incorporated in local health and other development programs. While there is yet no established mechanism to extensively estimate, analyze, and compare the level of resources available, resource needs, and absorptive capacity for the population and reproductive health programs, efforts in this direction have been started at the national level. POPCOM has initiated the formulation of the PPMP Population Investment Plan (PIP) as part of its efforts to estimate the budgetary requirements for the population program for CY 20022004, particularly for the 15 and 45 bottom poor provinces. It also tried to determine the budget allocation for each program component and the budgetary requirement for each of the strategic action areas, namely, service delivery, IEC/advocacy, and capacity building. Estimates put the budgetary requirements for CY 2002-2004 for all regions in the country at P3.087 billion. This amount is distributed to the following program components: POPDEV Integration; RH/FP; AHYD; and Resource Generation and Mobilization. At current rates of funding for PPMP, estimated at P1 billion in 1999, a gap in available resources and funding requirements can be projected. The PPMP-PIP is also an effort of the government to gather together the investments of different sectors and inform each other of planned activities so that they can collaborate and

reinforce each other, through their own initiatives or through the coordination of POPCOM. It will also serve as a tool for raising additional resources for the population program and in coordinating the resource allocation for specific program components. This way, the allocation of resources or channeling of funds can be better rationalized. Estimates of investments in population for 2002-2004 (Table 16) by fund source also show that the funding sources for 56 percent (P1.7 billion) of the budgetary requirement are not yet identified. Given this, a gap in adequacy of funds for the program is expected. Since 1994, the total funding for the program has reached P1.0 billion, 58 percent of which was provided by foreign sources (Table 17). Increased domestic funding in the future is likely to be modest, given the current economic crisis and the huge government deficit. Local government units provide financial support to the program mostly by absorbing staff salaries, maintenance costs, and other operating expenses. Lack of documentation, however, makes it difficult to determine the total value of their financial assistance. The DOH allocated budgets for the purchase of contraceptives in 2000 (P63 million), in 2001 (P86 million), and in 2002 (P76 million). Funds for this, however, have been realigned to purchase family health supplies and upgrade government hospitals. The Speaker of the House of Representatives has allocated P50 million from the congressional budget to promote NFP nationwide.

ENHANCING THE EVIDENCE BASE FOR POPDEV INTEGRATION For years, the Commission on Population has been advocating to policymakers and planners the POPDEV integration approach to thinking and planning. This approach “explicitly considers socioeconomic and demographic interrelationships in the formulation of development plans, policies and programs” (Herrin, 1987). Strides have been made in this field, but more work has to be done to increase and sustain its acceptance and use. Essential to POPDEV integration is the availability of quality data so that planners could take account of the interrelationships between population and development variables. Unfortunately for some groups, especially local government units (LGUs), such data have been difficult to gather since these come from various sources not easily accessible to them. Some data, if at all available, are dated and thus no longer reflect the current situation. This is perhaps one of the deterrents to the full adoption of the POPDEV integration approach. Aside from POPDEV integration, other advocacy initiatives also need data as guide in determining and strengthening the issues to be pushed. The more data there are to support an issue, the better the chance to succeed in advocacy. To address the inadequacy of data on population and RH, POPCOM, with assistance from the United Nations Population Fund, has made the Demographic and Socioeconomic Indicator System (DSEIS) available online. The system can now be accessed at www.popcom.gov.ph/ dseis. The website has increased the subprogramme’s

contribution to greater availability and accessibility of population and RH data not only at the central and pilot regional level, but nationally and globally as well. However, data validation is still ongoing for the rest of the sectors (Health, Agriculture, Employment, Education, among others); data for these sectors were expected to be online by the first semester of 2004. As part of the institutional capacity building of POPCOM in managing the DSEIS, the UNFPA supported the upgrade of hardware and Internet connection of the commission. In terms of institutional capacity for population and RH information and data consolidation and management, all regional focal persons were trained on database and web page development and management. These laid the groundwork for the enhancement not only of the Central Office’s capacity to manage and maintain the DSEIS, but also of the regional population offices, which are envisioned to serve as regional data consolidation nodes of the DSEIS. At present, efforts are being made to conceptualize the possible link between the DSEIS and the CommunityBased Management Information System (CBMIS) of Nueva Vizcaya. This is to expand the potential utility and data gathering system of the DSEIS from the national down to the local level or vise-versa. The enhancement of the DSEIS will also address the needs of the LGUs both for information and for the means of accessing such information (e.g., many may not be able to access information online due to lack of internet facilities).

Table 16: Population Investment Plan by Fund Source, 2002-2004 Fund Source

LGU

NGO

Foreign

Natl Gov’t

Uncategorized

Budgetary Requirement Percent of Total

253,690,872 8.22

556,404,628 18.02

374,162,624 12.12

177,305,447 5.74

1,725,711,066 55.89

Total PhP

3,087,277,724

Table 17: Funding of the PPMP, 1994-1998 (in Million Pesos). Year

GOP

Foreign

Total

1994 1995 1996 1997 1998

58.5 (11.88%) 73.5 (79.03%) 85.4 (70.64%) 106.7(62.40%) 101.0 (75.49%)

434 (88.12%) 19.5 (20.97%) 35.5 (29.36%) 64.3 (37.60%) 32.8 (24.51%)

492.5 93.0 120.9 171.0 133.8

586.1(57.96)

1011.2

Grand Total 425.1 (42.04%)

Source: POPCOM, Population Investment Plan (PIP), 1999.

Senator Juan Flavier has allocated P36 million from his countrywide development fund to increase contraceptive supplies and support health promotion activities, especially voluntary surgical contraception. The funds allocated have not been released so far. Formulation of 10-year RH Investment Plan. The 10-year RH plan of the DOH spelled out major strategies and activities and the required budget from 2001 to 2010. The plan estimated the commodity requirements of the national family planning program based on trend of contraceptive method use and population program goals. With declining donor support, the share of the Government of the Philippines (GOP) and the Philippine Health Insurance Corporation (PHIC) is expected to increase. The desired sharing scheme by 2010 is: GOP – 30 percent; Donor support – 10 percent; PHIC – 20 percent and NGO/Private sector – 40 percent. The guiding principle is that those who can pay should pay for contraceptives. This way, the resources of both government and donor agencies can be used to subsidize the needs of the very poor. Contraceptive Interdependence Initiative (CII). There is a looming contraceptive supply crisis as USAID grants will phase out by 2007. In fact, the last shipment of condoms was in 2003. Assuming that the desired family size of 2.7 will be reached by 2007, the annual cost of commodities the country has to generate is P1 billion a year to ensure contraceptive security for FP users. To push the family planning program toward greater self-reliance, the government drew up a National Family Planning Program (NFP) Policy in 2001 with DOH Administrative Order 50-A issued on September 17, 2001, and strengthened it with the creation of a Technical Working Group on Contraceptive Self Reliance (TWG-CSR) in

2003. The NFP program policy articulates the Philippine government’s intention to assume greater responsibility for the program. As part of its operational policy to encourage self-sufficiency and eliminate dependence on foreign donors for FP services and commodities, the following recommendations of the TWG should be adopted: a) only health facilities will continue to receive contraceptive supplies from the national government, b) in the distribution of the subsidized commodities, public health facilities shall give priority to the contraceptive requirements of poor clients; c) NGOs and industrial establishments shall no longer receive any allocation as soon as the phase-out plan takes effect; d) the Contraceptive Delivery and Logistics Management Information System (CDLMIS) shall be the main source of data in determining the current stock level and average monthly consumption of contraceptives, and e) a maximum of 20 percent increase in the quarterly contraceptive allocation levels shall be allowed per LGU. Additional contraceptive requirements beyond 20 percent shall be shouldered by the LGU. There is also a need to implement the three CSR components: market segmentation, advocacy, and capacity building on systems. In market segmentation, clients for FP commodities are categorized as A, B, C, D, and E based on their income. Couples belonging to class D and E (about 2.7 million) will be served and subsidized by public health facilities and ABC (about 2.6 million) and part of D (about 1.5 million) family planning users will be served by the private sector for a fee. Under CSR, the ideal scenario is that the private sector will serve 62 percent (4.54 million) of FP users for a fee, while the public sector will serve the poor, who compose 38 percent of FP users (2.76 million). In this manner, scarce government resources will be primarily allocated to the poor. Advocacy (especially media advocacy) is intended to articulate the need for FP commodity security, change mindsets from sense of entitlement and free commodity, and gain political will for contraceptive security. The third component is the building of systems and competency for contraceptive forecasting, procurement, delivery, distribution, and storage. The CII is the government’s strategic response to the need of sustaining the country’s family planning program. Through the CII, the

government, NGOs, and the private commercial sector can cooperate in securing the countryâ&#x20AC;&#x2122;s contraceptive supply to meet the family planning needs of couples. The action agenda includes a study on alternative schemes for the procurement of contraceptives, conduct of advocacy at national and local levels to support CII, capability building, and maintenance of institutional mechanisms for coordinating CII efforts. The CII was recently renamed Contraceptive Security Reliance. Implementing allocations for Women In Development (WID), Gender and Development (GAD) and Human and Ecological Security (HES). Republic Act 7192 or the Women in Development and Nation Building Act provides that a portion of Official Development Assistance funds should support WID programs. The General Appropriations Act of l995 (Section 27) and of 1998 (Section 28) instructed all national government agencies and all local government units to set aside a portion of their budgets to GAD projects. In response to a directive from then President Fidel Ramos, the Department of the Interior and Local Government issued an order in 1997 directing local governments to allocate a certain percentage of their Local Development Funds to HES programs. The 1997, 2000, and 2002 General Appropriations Acts contain provisions that require all national government agencies to set aside an amount from their budgets for HES programs. The implementing guidelines for HES has been developed and signed by all POPCOM board members. Mobilization of the National Health Insurance Program (NHIP). The NHIP of 1995 offered important opportunities for more efficient, equitable, and potentially larger sources for financing health services. The NHIP is a means for mobilizing health insurance financing for family planning and reproductive health services. However, NHIP coverage is limited at present and covers surgical contraception only. Philippine 20/20 Initiative. â&#x20AC;&#x153;The Philippine 20/20 initiative: A Comprehensive Action Agenda (CAA) for the 21st Centuryâ&#x20AC;? outlines the framework and strategies to meet the goals and action to fulfill the commitments made at the World Summit on Social Development. The Philippine government commits to allocate 20 percent of its national budget for basic social services such as primary health care, including RH, basic nutrition, basic education, early child care, basic social welfare, low-cost water supply, and sanitation. Mobilization of Local Funds. POPCOM continues to advocate increased spending by local governments on population and RH programs, POPDEV activities, productivity skills training and capability building for women and youth, and establishment of local population offices.

Formulation of Strategic Operational Plan (SOP) for PPMP for 2002-2004. Recently, POPCOM drew up a strategic operational plan for 2002 to 2004. This SOP focuses on the limited resources of government and available foreign funding to address unmet family planning need in the country, particularly for poor families. 2 . Priority issues: local funding A new formula for computing the Internal Revenue Allotment (IRA) share of local governments should be developed. Population size as a factor in determining the IRA should be minimized. Financial and income-generating capabilities, socioeconomic conditions, and human development status, among others, must be considered in determining the IRA share. The new scheme also must adjust revenue share to reflect the unjust distribution of the cost burden of devolved functions among local governments. POPCOM and the DOH should continue to encourage local governments to commit more funds to support population and RH programs by offering and extending national government support in return. Various approaches for mixing and matching national and local government funding to achieve common purposes could be developed and tried out. Local government spending for population and RH should be monitored effectively and in a timely fashion. Periodic utilization reviews should be done at the national and local levels to ensure that the use of funds available for population and RH programs is maximized. The activities and projects included in the CII action agenda should be implemented and monitored rigidly. Priority should be given to the study of alternatives on how to procure contraceptives. The national government, through the DOH, should be required to buy contraceptives using government funds. Other donor agencies should be tapped for funding assistance. A strong advocacy campaign using mass media should be conducted to help enhance the sustainability of the family planning program. The NHIP coverage should be expanded to include out-patient services so that all RH services, including family planning, can be financed as benefits. This will ensure that not only surgical contraception but also contraceptive dispensing, counseling, and in-patient education will become part of program benefits. The Philippine Health Insurance Corporation should be encouraged to accelerate its Indigent Program and the general expansion of its membership coverage. It should target

first the cities and metropolitan areas, where local governments have more available resources to finance their counterpart premium subsidies to the poor. 3 . Foreign funding for population and reproductive health

In 1999, 58 percent of total funding for the population program came from foreign sources. Foreign donors that have supported the program include USAID, UNFPA, World Bank, UNICEF, AusAID, ADB, JICA, KfW, GTZ, Ford Foundation, and the David and Lucile Packard Foundation. Foreign funding has been declining both in absolute amounts and in terms of share in total program costs. It is difficult, however, to determine the exact figures or estimate the international assistance for the implementation of population and reproductive health programs since the costs of population and RH components are integrated in the total cost of some health programs. However, some attempts to estimate the amount of resources spent for the program started in year 2000. Estimates of the National Family Planning Expenditures for the Philippines show that total expenditures rose from P1.5 billion in 1994 to P2.8 billion in 1998. The increase in 1994 was about 30 percent, from P1.5 billion in 1994 to P2.01 billion in 1998. In terms of expenditure shares by source of funds in 1994, the governmentâ&#x20AC;&#x2122;s share rose from 25 percent in 1994 to 35 percent in 1998, while that of donors declined from 36 percent in 1999 to 19 percent in 1998. Estimates of 1998 and 2000 expenditures for the PPMP, including family planning, showed that total expenditures increased from P14.37 billion in 1998 to P17.55 billion in 2000. Donorsâ&#x20AC;&#x2122; share declined both in absolute figures, from P823 million in 1998 to P431.4 million and in terms of share in total, from 5.7 percent in 1994 to 2.5 percent in 2000.

D. Partnership with LGUs and the Nongovernment Sector Good governance promotes cooperation among the government, civil society, and the private sector in improving the quality of life of all Filipinos, especially the poor. It builds on the principles of strategic partnership and critical collaboration. The 1990s saw increased collaboration between the government and civil society as a result of the 1994 ICPD and the countryâ&#x20AC;&#x2122;s commitments to the ICPD PoA. The environment favored the nurturing of effective partnerships in policymaking, planning, implementation, and monitoring. Leading the government side in these partnerships were the National Economic and Devel-

opment Authority, Department of Health, and POPCOM. The partnership made it possible to position population management as an important strategy for comprehensive human development and protection of vulnerable groups in the Medium Term Development Plan 2001-2004. POPCOM has formed a grand alliance among interfaith groups, the business community, the private sector, NGOs, the academe, legislators, media, government executives, and youth leaders. The ICPD has strongly encouraged NGOs to take part in the promotion of RH-related programs. The NGOs initiated the shift from a purely family planning to a life cycle approach. With this new paradigm, NGOs have seen opportunities to innovate, test program models, and intensify IEC and advocacy both at the national and local levels. As trailblazers, NGOs have explored more viable and challenging strategies. There is still a need to expand the participation of NGOs and the private sector in the provision of RH/FP information and services. The 1998 National Demographic and Health Survey reported that only 29 percent of family planning users get their services from the private sector. Clearly, the need is to increase the NGO and private sector share of family planning service delivery. To do this, it is necessary to assess the operational drawbacks and limitations of NGOs and private sector providers, identify strategic areas for NGO and private sector interventions, and tap community-based private associations (e.g., midwives and other paramedical personnel). Local governments at the municipal level should expand their health services to include comprehensive RH services, particularly family planning. Local governments should coordinate with NGOs and the private sector to come up with area coverage schemes for paying and nonpaying clients. This will help to ensure that both public and private resources are maximized and that quality standards will not suffer. 1 . DOH partnerships with local governments The 1991 Local Government Code transferred the responsibility of providing health care services from the DOH to the local governments. To meet their new responsibilities, many local governments asked for additional resources and technical guidance. With funding assistance from USAID from 1995 to 2000, the DOH responded through the Local Performance Program or LPP. 2 . Partnership between government and NGOs NGOs have been collaborating actively with the government either directly as individual NGOs or through umbrella organizations like the Philippine NGO Council on Population, Health and Welfare (PNGOC). NGOs provide RH services by providing innovative and holistic approaches to

quality health care, reaching out to underserved 3 . Partnerships among GOs, media and the segments of the population through communityprivate sector based RH programs, creating livelihood schemes The private sector is involved in social and opportunities, and conducting wide-ranging marketing programs that make low-priced contraadvocacy and IEC activities to increase modern ceptives available through commercial channels. contraceptive use. In addition to RH and family The sector also is engaged in providing RH planning, NGOs provide supplementary health information, education, and counseling services care services. These include laboratory work, Pap for employees and local communities. Private smears, pregnancy tests and other diagnostic services, surgical services and lyingin facilities for deliveries, and family health care. NGOs engage in allied development activities in the areas of women’s rights, youth development, education and livelihood support for indigenous peoples, poverty alleviation, environmental protection, and others. The DOH and POPCOM recognize NGO expertise in reproductive health and tap them for national-level training, Alliances -- a key to achieving the country’s population goals. IEC, advocacy, and research projects. Some of the NGOs engaged in these projects are the Women’s Health Care Foundation, groups collaborate with the government, multilatthe Institute for Social Services and Action, eral organizations, and international NGOs to Family Planning Organization of the Philippines, minimize barriers and facilitate cost reductions so Institute of Maternal and Child Health, Institute that RH services, including contraceptive comof Maternal and Child Care Services and Developmodities, can become more accessible and affordment, Foundation for Adolescent Development, able. The private sector also provides RH and Inc., and FriendlyCare Foundation. At the local family planning services to their employees. A level, NGOs have been active in organizing number of business enterprises practice corporate stakeholder groups to address RH concerns. social responsibility through their nonprofit In February 2000, the NGO umbrella group foundations. These corporate foundations underPNGOC successfully hosted the first Asia-Pacific take programs that help ease the plight of underConference on Reproductive Health in Manila. privileged youth, women, and other sectors. Some 1,300 delegates from 37 countries attended Several professional organizations promote a this gathering. Among the results of the conferconducive environment through advocacy and ence was the formation of the Asia-Pacific Allicommunication for policy reforms to achieve the ance for Reproductive Health, a network of country’s population goals. These include the individuals and organizations working in the field Philippine Medical Association, Philippine of RH. Obstetrical and Gynecological Society, Philippine The Philippine Center for Population and Academy of Family Physicians, Integrated MidDevelopment is another major NGO partner. wives Association of the Philippines, Philippine Since 2000, the center has shifted its social League of Government Midwives, and Philippine development role from being an implementing Nurses Association. agency to a grant-giving institution. Its grants are The media (radio, TV, newspapers, and mainly in population and development and policy magazines) have played a vital role in information research. Grants also are given to promote comdissemination. From time to time, POPCOM munity-based projects and responsible parenthood officials and other population stakeholders are in the industrial sector. interviewed by radio and TV stations on different The Trade Union Congress of the Philippines topics related to RH/FP. Press releases are issued (TUCP), the largest trade union confederation in periodically to increase the level of public awarethe country with an estimated 1.25 million ness on population issues. worker-members, has pioneered in integrating RH and FP in collective bargaining agreements in 4. The unique role of parliamentarians Cebu, Bacolod, and Davao. It has an ongoing project to institutionalize RH/FP programs in the Parliamentarians play an important role in workplace. The TUCP has adopted coalition population and development programs. The building as one of its major strategies in five of the essential groups are the Philippine Legislators’ country’s regions. These coalitions are made up of Committee on Population and Development, the partners from the government, NGOs, trade House Committee on Population and Family unions, employers’ groups, and the academe. Relations, the Senate Committee on Health and Demography, and the Presidential Legislative and Liaison Office.

The vision of the Philippine Legislators’ Committee on Population and Development is to improve quality of life through population and human development legislation. PLCPD works with legislative bodies at all levels, from national to local, to introduce substantive changes in population legislation. It builds networks with NGOs, government agencies such as POPCOM and DOH, the academe, the church, business, and citizen’s groups. The House Committee on Health and Family Relations reviews and processes population- and family-related bills at the House of Representatives. The Committee on Health and Demography is its counterpart in the Senate. Government agencies and NGOs conduct wide-ranging advocacy and IEC activities to increase modern contraceptive use. In addition to RH and family planning, NGOs provide supplementary health care services. These include: laboratory work, Pap smears, pregnancy tests and other diagnostic services, surgical services and lying-in facilities for deliveries, and family health care. NGOs engage in allied development activities in the areas of women’s rights, youth development, education, and livelihood support for indigenous people, poverty alleviation, environmental protection, and others. Enlightened legislation has resulted from the partnership between parliamentarians, national government agencies, local governments, and civil society. New laws focus on human development, greater protection of youth and children, women empowerment, family welfare, sexual harassment, and AIDS protection, among others. At the city and municipal level, some local legislators have passed ordinances on adolescent health, youth development, and gender. Some of the ordinances INTER-FAITH GROUPS PROMOTE FAMILY PLANNING AND RESPONSIBLE PARENTHOOD Some 120 leaders and members of different religious faiths, national and local legislators, civil society representatives and government officials found common ground in promoting family planning and responsible parenthood in various conferences organized by the Interfaith Partnership. The Interfaith Partnership is a gathering of various faithbased organizations and support partners to discuss reproductive health, family planning and related population and development issues. Members of the group include the National Council of Churches in the Philippines (NCCP), Council of Christian Bishops of the Philippines (CCBP), Iglesia ni Cristo (INC), Jesus Is Lord Church (JLC), Philippine Council of Evangelical Churches (PCEC), Philippines for Jesus Movement (PJM), Catholic and Muslim groups and individuals, and policymakers from the Philippine Legislators’Committee on Population and Development (PLCPD) headed by Senator Rodolfo Biazon and Representative Bellaflor Angara-Castillo. Funding support is

call for setting up a system of collecting data on local migration. 5. Forging partnerships with the religious sector The population program has always endeavored to maintain dialogues with Catholic, Muslim, and interfaith groups. At the local level, POPCOM has been working closely with the Catholic Church in promoting responsible parenthood and natural family planning (NFP). This can be seen in Region I, where the Regional Population Office, the Archdiocese of Lingayen and Dagupan, and the Provincial Government of Pangasinan have forged a viable partnership on responsible parenthood and NFP. There are similar collaborations in Region V and Region IX. In other regions, POPCOM is exploring joint programs involving parent education in adolescent reproductive health and sexuality, and the establishment of a migration information center. With UNFPA support, POPCOM is mobilizing Muslim religious leaders to promote RH in seven provinces and four cities in Muslim Mindanao. The religious leaders have received technical assistance and resources to build their capability to be advocates of reproductive health and responsible parenthood in ways consistent with the Qur’an and the Sunnah of Prophet Muhammad. The Iglesia ni Cristo (INC) is a long-time program partner in the provision of family planning and related services. The INC works with the Family Planning Organization of the Philippines and the United Christian Churches of the Philippines (UCCP) on a project to implement an RH program for INC and UCCP members.

provided by the Academy for Educational Development (AED) and the United Nations Population Fund (UNFPA). The group has pledged to prevent abortion, promote family planning, work for a decent standard of living for all Filipinos, conduct adolescent sexuality education, and support the enactment of Reproductive Health Care and Integrated Population and Development bills pending in the Twelfth Congress as part of concerted efforts to rally around the cause of responsible parenthood. Legislators like Senator Biazon and Representative Angara-Castillo have spoken in the various conferences organized by the Interfaith Partnership. They have likewise clarified issues pertaining to the RH and POPDEV bills, as well as called on other policymakers to consult, listen and work with various churches to provide meaning to the Constitutional provision on responsible parenthood. Position papers have also presented by Bishop Ephraim Endero (PCEC), Reverend Rey Cortes (NCCP), Brother Isaias Samson Jr. (INC), Director Tapz Umal of the Office of Muslim Affairs (UCCP), Mr. Diodisio Bautista (Couples for Christ), and Bishop Art Separtero (Philippine Independent Church).

6 . Strengthening PPMP coordinating mechanisms The PPMP recognizes the critical role of various partners, including legislators, NGOs, civil society organizations, and the religious sector, in all stages of population policy-making, planning, implementation, and monitoring. Hence, the government consistently involves these sectors in various consultations. It maintains multisectoral coordinating mechanisms, and undertakes orientation and capability-building activities with them to obtain collaboration in the implementation of population and development programs, including those on gender equality, adolescents, and genderbased violence. Occasionally, POPCOM conducts orientation and workshop sessions with multisectoral groups (particularly NGOs, parliamentarians, CSOs, donor agencies, the academe and media) to provide updates on the latest population policies, program issues, surveys, and research findings. In cooperation with donor partners and institutions, POPCOM provided training on Basic Demographic Concepts, Technology of Participation (TOP), Advocacy Skills, Policy Environment Survey, and Gender Sensitivity Trainings (GST), among others, to several NGO groups and selected local legislators. POPCOM Central Office and its 15 regional population offices have established coordinating mechanisms at the national and regional levels. At the national level, the involvement of the private sector in policy-making is ensured through the participation of three NGO commissioners in the POPCOM Board. A private sector desk within POPCOM provides support to the NGO commissioners. The NGO representatives also sit in various interagency bodies in the formulation and updating of medium-term population program plans. NGOs, the pharmaceutical/commercial sector, and the leagues of cities and municipalities are represented in an interagency body working to achieve selfsustainability in contraceptive supplies. At the regional level, NGOs and local governments are represented in the Regional Population Executive Board, the Regional Population and Development Coordinating Committee, and the Regional Population Committees. Other active interagency coordinating bodies that build partnerships are the POPDEV committees, Population, Health and Nutrition committees, Gender and Development committees, and the RH Task Force. At the local level, the 1991 Local Government Code has institutionalized the participation of NGOs in local affairs by giving them the right of access to and representation in the decisionmaking process. By law, provincial, city, and municipal development councils and local health boards must have NGO representatives. The population executives of local governments nationwide have incorporated themselves into the League of Population Officers in the Philippines or LEPOPHIL. LEPOPHIL has been working closely

with POPCOM in supporting the PPMP and the passage of population bill. The Local Advocacy Project (LAP) shows the synergy among POPCOM, PNGOC, PLCPD, local NGOs, and the LGUs in promoting RH and effecting local policies to allocate funds for RH and FP. The Futures Group provided technical support to help actualize advocacy and networking techniques and practices. NGOs promoting women’s reproductive rights and empowerment such as LIKHAAN, Women’s Health Care Foundation, Women LEAD, and Women’s Media Circle have led in grassroots advocacy and participation. The Family Planning Organization of the Philippines, one of the largest networks, has expanded its services from providing family planning services to advocacy. PNGOC, through the assistance of Packard Foundation, has trained more than 180 media practitioners to help in RH advocacy. ReachOut Foundation has forged partnerships with the private sector to promote RH through a trimedia approach.NGOs are the leaders in promoting adolescent RH. The Foundation for Adolescents has pioneered in establishing Teen Centers, in reaching out to in-school youth through innovative approaches such as Dial-A-Friend, peer counseling, and IEC. The Baguio Center for Young Adults, Kabalaka Development Foundation, and Ilog Kinderhome have introduced teen centers, in partnership with local government units and private sector groups.

E. Summary of Crosscutting Concerns Crosscutting concerns for ICPD+10 are the following: a) IEC, advocacy and ICT, b) technology, research and development, c) resource mobilization and allocation, and d) partnership with the NGO sector. The Philippine government has been including communication to change behavior and influence policy in its population and RH/FP programs. This has resulted in increased CPR and more POPDEV-sensitive plans and programs. In technology, research and development, valid, official, timely and culturally sensitive and internationally comparable population data are regularly gathered and updated by government agencies such as the NSO, NSCB, and SRTC for planning, monitoring and evaluation of programs, projects, and policies. Country expenditures on population and RH/FP are growing. This means that more and more resources are coming in from different program stakeholders such as the government, nongovernment organizations, the private sector, and foreign donors. The Philippine government is promoting partnerships among program stakeholders in the implementation of the PPMP.

SECTION 4

Emerging Challenges and Opportunities:

The Cairo Agenda 58

THIS SECTION ANALYZES emerging issues pointed out and deliberated upon in post-ICPD conferences. It will also try to show how actions dealing with these emerging issues are linked with the Cairo agenda. For a decade now, the Philippines has been undertaking programs to carry out its commitments in the ICPD. Poverty reduction strategies and sustainable development continue to top the governmentâ&#x20AC;&#x2122;s agenda of action. Despite many challenges, the Philippine government continues to lead all sectors in the pursuit of the ICPD agenda. The Philippines has recognized international cooperation in addressing various issues. This recognition provided opportunities for more collaborative effort in responding to problems, especially those that call for common global response. The Philippines took part in many postICPD conferences, including the World Summit for Social Development (WSSD) held in March 1995 in Copenhagen, the World Conference on Women held in Beijing in September of the same year, the Habitat II held in Istanbul in 1996, and the 1996 World Food Summit held in Rome. More recent meetings include the United Nations Millennium Development Summit held in New York in 2000, the Asia Pacific Conference on Population and Reproductive Health (APCRH) held in Manila, in 2001 and in Bangkok in 2003, and the Fifth Asian and Pacific Population Conference (APPC) held in Bangkok in 2002. These conferences provided opportunities to review the progress made by signatory states in pursuing their respective goals. Participating countries reaffirmed their commitments and set new benchmarks and medium-term goals. The gatherings also provided the opportunity to identify existing gaps and propose strategic approaches in addressing them.

A. Millennium Development Summit in 2000 In September 2000, 147 governments adopted the Millennium Development Goals

(MDGs) that were formulated during the UN Millennium Development Summit in September 2000 in New York. The Millennium Declaration is a global agenda with interconnected and mutually reinforcing development goals. It synthesizes the targets set in various international conferences and summits concerning sustainable development, including population and reproductive health. The summit called upon all nations to pursue eight major goals, namely: Eradicate poverty and hunger. Achieve universal and primary education. Promote gender equality and empower women. Reduce child mortality by two-thirds. Reduce maternal mortality by three-fourths. Halt/reverse HIV/AIDS, malaria and other diseases.

Ensure environmental sustainability. Develop a global partnership for development. Recent studies show that with the magnitude of estimated resource gaps, it is unlikely that the MDGs will be achieved unless more resources are mobilized for human development programs. In the case of the Philippines, a study by Manasan (2002) underscored the incompatibility between the program targets set under the Medium Term Philippine Development Plan (MTPDP) and the budgetary resources actually available. Further analysis highlighted the importance of not just the quantity but also the quality of essential inputs devoted to specific programs under the MTPDP, including teachers, textbooks, and health care providers and facilities. Among the challenges presented in the study are as follows: Pursuing budget reforms that give priority to basic social services and adopt cost-effective modes of service delivery to reduce waste and inefficiency. Exert maximum efforts, e.g., procurement reforms and other good governance initiatives, to ensure efficient use of resources. Pursuing a stronger population management program. One advantage observed is the multisectoral support given to the MDGs. In the Philippines, for instance, various sectors heed the call of the United Nations during the multisectoral consultation meant to assess the socioeconomic situation vis-Ă -vis the MDGs. The consultation served as the basis for planning and formulating the program cycle of the United Nations for the Philippines. It also served as a useful reference to other sectors and institutions supporting specific development programs. This has offered opportunities for strengthening the population management program in this country. Many discussions on meeting the MDGs stagnated for lack of data that would measure the progress of undertakings. There is a realization that statistical agencies and data generation agencies need to work closely and collaboratively to maximize their resources and ensure that pertinent data are made available. NEDA initiated the development of the Social Development Management Information System (SOMIS). This system aims to monitor compliance to international commitments, including the MDGs. POPCOM developed the National Population Database Information System (NPDIS). These two databases are in-

tended to ensure greater access to populationrelated statistics. However, the databases are dependent on data-generation agencies for updated data. The success of the SOMIS and NPDIS depends, therefore, on closer collaboration between NEDA and POPCOM, on one hand, and the data-generation agencies, on the other. Another challenge is getting the cooperation of local government units in undertaking datageneration activities at their level so that the MDGs can be measured at each level of governance (i.e., barangay to national level). Yet another challenge is integrating the LGU data with a national database to make data readily available so that planning and policy-making will be more effective, efficient, and equitable. It is noted that many LGUs do not have the capacity to improve their databanking activities primarily for lack of skilled staff and lack of financial resources. There is already a friendly policy environment for achieving the MDGs. The MTPDP includes development goals set at the Millennium Summit. The Health Sector Reform Agenda (HSRA) of the DOH highlights policies and priorities responsive to the MDG like the primary and preventive health care programs. However, sectors noted the need to strengthen the political will in providing resources to support social sector programs, particularly population and RH programs where unequivocal support from top-level government officials is still much desired.

B. Fifth Asian and Pacific Population Conference in 2002 The Fifth Asian and Pacific Population Conference (5th APPC), held in Bangkok, on December 11-17, 2002, reaffirmed the commitment of countries in Asia and the Pacific to the recommendations adopted at the ICPD and the Bali Declaration. These recommendations constitute a population and sustainable development agenda for the 21st century. The members and associate members of the Economic and Social Commission for Asia and the Pacific (ESCAP) who assembled at the 5th APPC recognized that there remain major issues and challenges in the areas of population, sustainable development, poverty reduction, migration, ageing, gender, reproductive health including the needs of adolescents, HIV/AIDS, and resource mobilization. The major issues and challenges

are as follows:

Poverty remains high and persistent in many countries of the region despite the overall tangible progress. Poverty eradication requires a broad approach, taking into account not only the economic aspect but also the human dimensions. Population, development and poverty are closely interrelated, and achieving sustained economic growth and a balance between population, resources, and environment is essential to sustainable development, eradication of poverty, and improving the quality of life of current and future generations. Women, who compose half of the population, remain disadvantaged and marginalized in accessing social and economic opportunities, participating in the development process, and assuming political and administrative responsibilities. Protection of human rights is central to human development and forms the fundamental pillar in actions toward the alleviation of poverty. Population policies must be an integral component of development policies and planning, taking into account differential population and demographic dynamics and challenges. In general, the APPC held that poverty eradication requires increased focus on good governance, an enabling environment for economic development, and investments in health and education. There was increased recognition that the improvement of human capital and protection of human rights are fundamental factors in development. The APPC underscored the view that population policies must be integral components of development policies and planning. Such policies must uphold voluntary and informed decision-making and choices, as well as protect human rights. Through the APPC, the population sector had the opportunity to explicitly link population and poverty variables in explaining the pace of the countryâ&#x20AC;&#x2122;s socioeconomic development. The linkage of population and poverty became one of the bases for lobbying for national funds for the attainment of contraceptive security and population program sustainability.

C. Asia-Pacific Conference on Population and Reproductive Health in 2001 and 2003 The Philippine report to the 2001 and 2003 APCRH highlighted the countryâ&#x20AC;&#x2122;s five-year experience in implementing its population and reproductive health programs as guided by the principles of the ICPD. It exposed existing issues and challenges in the PPMPâ&#x20AC;&#x2122;s four program areas (reproductive health and family planning, adoles-

cent health and youth development, population and development integration, and resource generation, programming and mobilization). The major challenges are: a) lack of access to quality RH/FP services, b) need to strengthen organizational and strategic support for policy development and advocacy, planning and monitoring, and services, c) need to address ARH issues and concerns, d) need to include migration and urbanization in Population and Development (POPDEV), and e) need to respond to declining contraceptive support from USAID. In adolescent health and youth development, strategies for enhancing youth access to information and services on ARH are still inadequate. Other issues are the need to involve sectors such as parents, teachers, and youth organizations in ARH programs and the need for a reliable database for program planning and implementation. In POPDEV, issues identified include the need for the inclusion of migration and urbanization concerns. The perceived lack of experts, adequate data, and statistics on POPDEV also needs to be addressed. More aggressive advocacy for the integration of the POPDEV approach to planning at the national, subnational, and local levels is necessary. On the issue of resource mobilization, the need to address declining donor support, particularly for contraceptives, should be confronted. The government is enjoined to maximize available funds for population and RH programs by improving resource management and mobilizing alternative sources of support. As to partnership and collaboration, the Philippine experience has shown that the ICPD has strengthened the involvement of NGOs, civil society, and LGUs. However, there is a need for greater involvement in service delivery. There is a need to augment the diminishing national budget for both LGUs and GOs. Development of plans that ensure the sustainability of population and RH programs must include vigorous advocacy for the inclusion of RH services in the package of basic health subsidies offered by LGUs. Emerging concerns that accompany the increasing number of Overseas Filipino Workers (OFWs) must be considered. Some of these deal with the protection of human rights and dignity of migrants, and mitigating the risks of HIV/AIDS. The challenges provided an opportunity to work for a legal framework for population and RH in order to strengthen population and reproductive health programs in the country. The challenges led to the creation of the Reproductive Health Advocacy Network (RHAN), which spearheaded the efforts to push for legislation embodying the legal framework. The efforts were commendable but not enough to cause the enactment of the pertinent law. However, RHAN efforts were crucial in increasing public awareness

of reproductive health and rights.

D. Summary of Challenges The three major gatherings pointed out issues and challenges that countries should address. At the national level, the following

for proactive and multisectoral response. The national government has to take the lead in ensuring funding for the purchase of the contraceptives and make them accessible to individuals who need them. With the planned phase-out of USAID support for contraceptives, the government must come up with clear strategies and messages on how to

The still high unmet need for family planning remains a major challenge. challenges have to be given priority: Population and RH programs continue to have minimal support from policy-makers. National and local governments need to show unequivocal support and political will to push for stronger population and RH programs. These programs must be in the priority agenda of each government, whether national and local. A substantial proportion of Filipinos continue to be poor and do not have adequate access to quality reproductive health services, especially family planning. Governments need to address the unmet need for family planning and other health goods and services. Data also show an increasing demand of the young people for RH and other medical services. Communities continue to have low awareness of population and RH issues. Structures and mechanisms for service delivery at the community level are unstable and need to be strengthened. In many areas, these structures and mechanisms are absent or not functional. The declining supply of contraceptives calls

address the issue. The presence of community champions and advocates needed to empower communities in taking care of their RH needs and in coming up with interventions to take care of the reproductive health and rights. Decision-making is still the domain of few individuals. It is still a top-level activity for many executives. Good governance is still much to be desired, particularly in many local government units. There is a need to strengthen civil society participation and make decision-making a product of democratic processes. There is a need to come up with a common POPDEV agenda that will require multisectoral support and participation. Effective monitoring and evaluation of the commitments is possible with accurate and readily available data. National and local governments need to give priority to establishing databases and promoting evidence-based policy and decision-making. Information campaigns must be based on evidence and supported by the latest and accurate data.

SECTION 5

Toward a Strategy to Strengthen Implementation of the ICPD Programme of Action 62

THIS SECTION OUTLINES a Philippine strategy to further strengthen and accelerate the implementation of the PoA and Key Actions of the ICPD. The ICPD PoA has five key areas, namely: (a) Population and Development, (b) Gender Equality, Equity and Women Empowerment, ( c) Reproductive Rights and Reproductive Health, (d) Adolescents and Youth, and (e) HIV/ AIDS. The ICPD PoA has also crosscutting concerns, namely: (a) Behavioral Change Communication and Advocacy, (b) Data and Research, ((c) Partnership and Resources, d) Best Practices, and (e) Indicators. A. ON POPULATION AND DEVELOPMENT 1 . Advocate greater appreciation of POPDEV integration and mainstream POPDEV interrelationships in various planning processes. There is a need to intensify advocacy efforts for greater appreciation of POPDEV integration. Beyond greater appreciation, POPDEV interrelationships must be explicitly included in national, sectoral, and local planning processes. All policies and plans, including the MTPDP, CLUP, MTYDP, plans for older persons, poverty reduction plans, local development plans, and other plans should be sensitive to the interaction of population and

development variables. There is a need to build up and capacitate more champions and advocates that will ensure mainstreaming of POPDEV linkages in the guidelines as well as in making plans POPDEV-sensitive. Capacity building for POPDEV integration must now be mainstreamed in various training institutions to make them accessible and ensure increased number of advocates and champions.

With the manual for POPDEV planning and the PPMP one script, advocates and champions can now be brought to the LGUs and communities. The application of POPDEV interrelationship should improve the design and implementation of targeted programs. The experience with previous poverty reduction strategies underscores the need for more precise targeting of government expenditures and improved delivery mechanisms so that social services can reach the poor. Projects have to be retooled, especially those that are under the KALAHI program to pinpoint specific target areas and population groups where unmet needs are greatest. Hence, an indicators system, particularly on poverty incidence, asset reform gaps, presence of vulnerable sectors, and impact of specific crises (i.e., natural disaster or armed conflict), should be used in the selection process of target LGUs. As recommended by the National Anti-Poverty Commission (NAPC), good family planning services should be an integral part of the poverty reduction package as an intervention at the community level. 2.

Make urban management efficient and improve social services in rural areas.

Inaccessibility of social services in some rural areas has resulted in undesirable demographic consequences, particularly the fast out-migration of people from rural areas. With devolution, LGUs should emphasize efforts in providing or improving basic amenities and social services (e.g., education, employment, health, and others). However, while the LGUs are urged to give priority to basic social services, the national government itself must systematically address the continued exodus of people to cities and the burgeoning population in urban areas. It must enforce the Urban Development and Housing Act, especially the monitoring of population movements. This would require technical assistance to local planners in managing rural and urban areas. There is a need to coordinate with various agencies and institutions in order to provide technical assistance to provinces and cities in planning and managing rural and urban settlements. Technical assistance could be in the form of training, orientation, or seminars on urban and rural management for local planners, administrators, and executives. Fostering a more balanced spatial distribu-

tion of the population can be done by promoting population-sensitive development policies and strategies, installing mechanisms to monitor population movements (aside from the migration information centers), and institutionalizing the conduct of a national migration survey to regularly assess interrelationships between migration, urbanization, poverty, employment, and human settlement patterns. 3. Provide skills training to urban and lowland residents. Hand in hand with better enforcement of environmental laws, a clear definition of environmental rights and proper pricing should guide the use of natural resources, particularly in partially protected and ecologically sensitive areas. It has been observed that less skilled individuals who cannot get jobs in urban or lowland areas often resort to activities that threaten ecologically sensitive areas. To address this issue, residents in lowland areas should be given skills training so they can be readily absorbed in the labor force. Schools should be encouraged to offer technical and vocational subjects to facilitate their studentsâ&#x20AC;&#x2122; absorption in the labor sector should they fail to finish their studies. In relation to this, schools can also be pushed to incorporate environmental issue awareness in their science and values education curriculum. B. ON GENDER EQUALITY, EQUITY, AND WOMEN EMPOWERMENT 1 . Strengthen monitoring mechanisms to womenâ&#x20AC;&#x2122;s education, training, and job matching. Data show that more and more women are trained in traditionally male-dominated fields such as engineering, science, technology, and architecture. However, data are unavailable to determine if women get equal opportunities with men in job placements and promotions in male-dominated fields. Hence, the database on womenâ&#x20AC;&#x2122;s education and job matching should be strengthened through field researches and sharing of data from different sectors. 2 . Continue to monitor strictly the implementation of the Gender and Development Plan The General Appropriations Act (Section 27) requires all government agencies to formulate a

Gender and Development (GAD) Plan. To implement the GAD Plan, all government agencies are required to allocate at least 5 percent of their budgets to GAD projects. To optimize resource and ensure efficient use of the 5 percent allocation, there is a need to strengthen the monitoring mechanisms and enhance the capacity of agencies, particularly LGUs to carry out the GAD thrusts.

3 . Strengthen and sustain linkage of gender equality and reproductive rights (Philippine context). This is to ensure implementation of GADrelated programs, projects and activities and eliminate discriminatory practices and policies against women (e.g., women are usually last to be hired but first to be fired; women have less chances of promotion than men in some establishments). This can be done by developing IEC and advocacy materials and conducting GAD orientations. This also means integration of the culturesensitive reproductive rights perspectives in GAD projects.

THE NATURAL FAMILY PLANNING PROGRAM

In 2002, an Administrative Order on National Natural Family Planning (NFP) Strategic Plan Year 2002-2006 was issued. Included here was the creation of multisectoral NFP committees at the national, regional and local level which will oversee the planning and coordination of NFP mainstreaming activities. The program has started to mainstream NFP within the public sectorâ&#x20AC;&#x2122;s health facilities, initially in four regions (CHD 5, 8, 9 and NCR). Efforts undertaken include the orientation of regional staff, creation of regional NFP Management Committees, and dialogue/consultation/planning with stakeholders. Hand in hand with these, information, education and advocacy activities and capability building for trainers and service providers were also undertaken. With the budgetary support from the government, the remaining 12 regions have also have strengthened the capability of their trainers and service providers on NFP information and service provision.

C. ON REPRODUCTIVE RIGHTS AND REPRODUCTIVE HEALTH 1 . Strengthen market segmentation for RH/FP services. With the phasing out of contraceptive supplies from USAID, the Philippines has to assume the responsibility of providing RH/FP information, services and contraceptives to the population. The central issue is the role of the government. The prevailing sentiment is that, if private sector participation is to be encouraged, the government must provide free FP services to poor families. Middle and upper-class households will have to pay for their RH/FP information, services, and commodity requirements. Welldesigned market segmentation has to be developed to target poor beneficiaries. This will maximize the utilization of government resources and ensure greater access to RH services among the poor. 2 . Work strategically toward multi-stake holder collaboration and strengthen the role of civil society groups and the private sector. This strategy will ensure continuous access to family planning information and services by the majority of the population, especially poor families, in order to achieve the desired fertility rate of 2.7 (as of 1998). Collaboration with the LGUs, NGOs, and the religious sector should be continued in areas where they can work together (e.g., artificial FP methods for the LGUs and the NGOs and natural family planning for the religious sector). The Arroyo administration emphasizes the four pillars

of population policy: a) responsible parenthood; b) respect for life; c) birth spacing; and d) informed choice. At the national level, the President is actively promoting natural family planning. However, the President encourages LGUs and NGOs to ensure delivery of basic health services, including the promotion of all the FP methods. The multi-stakeholder collaboration is crucial in pushing for national and local legislation that will protect the reproductive health of people and fulfill commitments in the ICPD. 3 . Empower communities to exercise RH rights within the framework of the National Objectives for Health. It is also strategic to link with community and religious leaders as well as indigenous groups to make reproductive health/family planning widely acceptable and make it a part of the basic health packages for the communities. It is recognized that RH goals cannot be achieved outside of national goals and objectives for health in general. Reproductive health should therefore be carried out as a fundamental part of basic health services. The exercise of reproductive rights through information dissemination and networking must be promoted to enable individuals and communities to take part actively in achieving RH goals and objectives. 4 . Strengthen partnership with LGUs, NGOs, and the private sector in integrating services, emphasizing quality and expanding coverage.

The RH theme will create an environment for participation of different stakeholders in providing quality RH information and services. Special attention should be given to the underserved sectors. The integration of RH information and services in all health facilities as part of the basic package of health services should be strengthened. This partially can be ensured by a comprehensive referral system between primary and tertiary, public and private health facilities. A strong referral system will result in greater efficiency and effectiveness because it will promote sharing of resources and minimize duplication of functions. We need to strengthen STI care, management and treatment services in the Rural Health Units (RHUs) to ensure greater access by communities. The issuance of a DOLE department order expanding FP to include RH should also mean strengthening cooperation and partnerships to ensure availability and quality of RH services in the workplace. 5 . Update/upgrade capability-building of workers in the primary health care facilities. Health workers in primary health care facilities need to be trained on the new RH/FP approaches. Training modules on RH/FP, sexuality, gender sensitivity, violence against women, among others, are already available. Other training modules that could be used include the new RH/FP training strategy, which uses self-instructional modules (SIMS) and competency-based training (CBT). Efforts should be made to mainstream scientific natural family planning services in health outlets managed by GOs, NGOs, and the private sector. D. ON ADOLESCENTS AND YOUTHS 1 . Continue to provide adolescent and youth counseling services. Several government agencies, NGOs, and LGUs provide programs for adolescents and youths. Counseling must be included as one of the services for adolescents and youths. The expected outcomes of counseling for youths include increased knowledge on adolescent reproductive health, change in behavior so as to avoid risky sexual practices, reduced incidence of premarital sex, reduced teen-age pregnancy and abortion, reduced alcoholism, and delayed marriage. 2 . Provide interactive information to adolescents/youths using the latest information and communication technologies. Most program strategies for adolescent/youth development and health education fail to incorporate interactive, educational, and entertaining features in their design. Most strategies are limited

to traditional activities like slogan, jingle, and essay writing contests, and mural painting contests. Youth programs dealing in ARH information dissemination have failed to tap interactive media such as the Internet and the cell phone network. To keep up with the pace of modernization, interactive information dissemination for adolescent program strategies should be devel-

Special attention should be given to the underserved sectors. oped. Noting the influential role of media in the lives of young people, efforts should be done to sensitize media on ARH and increase their involvement in addressing ARH issues. There is a need to work closely with LGUs and NGOs in implementing youth programs and livelihood projects. Several agencies have been undertaking youth programs and projects, but many young people are not aware of them. There is a need therefore to coordinate the efforts of different agencies in implementing youth programs and livelihood projects in order to create greater impact. Aside from the livelihood component, activities for the youth should include developing life-skills. These include skills to avoid risky behavior such as alcoholism, smoking, drug addiction, and early sexual practices. 3 . Mobilize adolescents and youths in adolescent health and youth develop ment programs and projects. Active participation at all levels of the various groups of adolescents in program and project development and implementation is the most effective way to ensure the relevance, commitment, gender sensitivity and responsiveness of programs. To mobilize adolescents and youths, the Sangguniang Kabataan (SK) and youth organizations must be tapped in all stages of the program and project processes. Financial assistance should be provided to youth organizations, if necessary. 4 . Involve more organizations and stake

holders in monitoring AHYD activities.

There is a need to increase participation of NGOs and the private commercial sector in monitoring AHYD activities. This can be done through the existing Technical Working Groups (TWGs) created for the AHYD at the national and regional levels. The TWGs for AHYD consist of representatives from government agencies, NGOs, and the private sector. With the multisectoral monitoring of AHYD activities, TWG members will develop programs and projects for the sustainability of youth projects and activities. 5 . Lobby for the formulation and legislation of specific policies on Adolescent Reproductive Health for implementation at the local level. It is recognized that there are adolescent reproductive health (ARH) issues and concerns (such as teaching of sex education in all secondary schools in public and private schools, establishment of teen health quarters for counseling and information services in all LGUs) that are not yet addressed by specific policies. At present, legislation and programs dealing with the youth hardly consider the important aspects of reproductive health. Existing programs dealing with RH issues do not directly state or categorically include adolescents in those programs. It is therefore necessary to lobby for specific policies on ARH. There is a need to revisit the population education program, particularly on adolescent sexuality, and come up with inputs to a more vibrant and revitalized population education program. 6 . Reorient service providers and youthserving professional workers (teachers/ guidance counselors/health workers). Many of todayâ&#x20AC;&#x2122;s youth have probably met professional workers who show suspicious, judgmental, or even hostile attitudes toward them while giving RH information or medical services. These attitudes could stem from a largely conservative culture and partly from the absence of parent and adult education on sexuality. For services and educational programs to be effective, they must operate within the realities of adolescent sexual behavior. There is a need, therefore, to reorient teachers, guidance counselors, and health workers on adolescent sexuality. There is also a call for upgrading health workersâ&#x20AC;&#x2122; skills and strategies in order to meet the demands of married youth for family planning, information, and medical services. 7 . Develop and maintain a database on Adolescent Reproductive Health. Data on the composition, size, behavior, and practices of the 15-24 age group should be regularly updated. Research has to be undertaken to

gain insights into the adolescent attitudes, values, and behavior, especially toward sexuality and reproductive health. Gender analysis should be carried out as part of the baseline research to ensure that the perspective and needs of young men and women are addressed, including equal access to information and services. Many of the efforts to address ARH have been uncoordinated. The development of a database for the youth will help in determining the services available for program development, replication, and referral. E.

ON HIV/AIDS

1 . Intensify information dissemination on HIV/AIDS. Information, education, and communication (IEC) materials should be developed for distribution in schools, hotels, and malls to increase the level of public consciousness and ensure proper protection against the disease. This also should be done through the Internet, by setting up a specific Web site on the Philippines and HIV/AIDS. 2 . Enforce the Philippine AIDS Law. Included in the Philippine AIDS Law is a call for sustaining HIV/AIDS-related activities. Both NGOs and local governments have undertaken activities to help prevent an HIV/AIDS epidemic in the country. 3 . Strengthen support to persons living with AIDS (PLWA). F. ON DATA AND RESEARCH 1 . Strengthen database and monitoring systems for social indicators. The database on population and RH indicators should be improved further for easy tracking of performance and providing early warning systems for impending social crises. A community-based monitoring system needs to be institutionalized in order to provide local government units and program administrators with the necessary information for identifying eligible beneficiaries. The strengthening of database and monitoring systems for social indicators should be coupled with the acquisition of more and better computer hardware and software, and provision of appropriate training. 2 . Strengthen collaboration among data bases and data-generation agencies to avoid duplication and at the same time ensure updated data in the databases. A databank must be set up for the 27 core indicators for POPDEV planning. These indicators are institutionalized through a board resolution of the National Statistical Coordination Board (NSCB).

G. ON PARTNERSHIP AND RESOURCES 1 . More vigorous campaign for resource mobilization from international donors. Social development commitments should be backed up not only by policies and programs but also by financial resources for capacity building among population program workers, planners, RH/FP

Social development commitments should be backed by financial resources. service providers, and youth leaders (at the national, regional and local levels). Advocacy is needed at both national and international levels to increase funding support for the population program. 2 . Make contraceptives available and accessible despite declining donor support. Despite high levels of popular support and use among well-informed communities and clients, contraceptives have remained a target of organized opposition by some sectors. Public funding for contraceptives has not been secured. Many donors have supported the provision of contraceptives for the program through the years. However, as donor resources decline, funding for contraceptive supplies will grow increasingly at risk. The government (especially local government units) must find alternatives for ensuring the availability and accessibility of a desired range of contraceptives. 3 . Strengthen networking and collaboration with NGOs and the private sector for possible sharing of resources and for counterpart funding. 4 . Identify and tap other financing schemes in support of population programs, projects, and activities. Review other existing sources of funds such as the Human and Ecological Security, the 20/ 20 initiative, Economic Development

Fund, and the Gender and Development Fund. There is a need to expand the governmentâ&#x20AC;&#x2122;s National Health Insurance Program benefit package to include other reproductive health services aside from the surgical family planning procedures already within the package. 5 . Lobby for population program implementation at the LGU level For most LGUs, particularly the poorest LGUs, Internal Revenue Allotment (IRA) shares are practically their only source of funds. The current IRA system gives localities with large population sizes with corresponding larger IRA shares. Many progressive local officials recognize that their interest in capturing higher IRA shares could contradict their wish to improve local population management efforts. Among LGUs of the same level, the IRA formula is applied uniformly, which may exacerbate income differentials. At present, variations in opportunities for incomegenerating activities among localities and local human development indicators do not play a part in determining IRA shares. Given this reality, there is a need to intensify advocacy efforts among local chief executives, their planners, and their department heads through one-on-one meetings, to discuss both regional and national level population concerns. In this way, LGUs will be able to understand the need to implement the population program at their level of governance. 6 . Draft bills and executive orders on the creation of a capital fund and revolving fund with initial seed money coming from the national government. This requires a study on how capital fund for contraceptives can be raised. 7 . Review the existing tax exemption privilege for contraceptives provided to the private sector and subsidies provided to government agencies. There is a need to further study Section 105 of the Tariff and Customs Code to determine if program equipment related to family planning and reproductive health can be included among the items exempted from tax. Appropriate amendments to the code will be proposed to the President and the Legislature. 8 . Develop a cost recovery scheme as an initial step toward self-reliance by providing contraceptives and other FP/RH services at minimal cost to certain types of users.

References 68

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Putting People First