Title
Inclusion of Progestin Implants in FP Program
Law
Doh Administrative Order No. 2015-0006
Decision Date
Feb 9, 2015
DOH Administrative Order No. 2015-0006 mandates the inclusion of progestin subdermal implants as a modern method of contraception in the Philippines to address high maternal mortality rates and meet reproductive health goals, providing guidelines for procurement, distribution, training, and monitoring.
inclusion
progestin subdermal implant
modern methods

Legal basis, policy rationale, and intent

  • The Order aligns implementation with the Responsible Parenthood and Reproductive Health (RPRH) Act of 2012, Republic Act No. 10354.
  • The Order implements the DOH mandate in Section 19.2 of Republic Act No. 10354 and Rule 12 of its Implementing Rules and Regulations (IRR) requiring access to modern family planning (FP) services.
  • The Order’s objective is to include progestin subdermal implants as modern FP methods deemed safe and effective by the National Family Planning Program.
  • The Order is directed to address unmet need for modern FP as a means to reduce maternal mortality and support universal access to reproductive health services.

Coverage and application across health sector

  • The Order applies to the whole health sector, including public and private sectors.
  • It covers DOH Central Office, Regional Offices, and DOH-retained hospitals.
  • It covers POPCOM (Central Office and regional units), PhilHealth, and other DOH attached agencies.
  • It applies to LGUs, ARMM, development partners, private health care providers, and all others concerned.

Defined terms: key participants and method

  • A Progestin Subdermal Implant (PSI) is a long-acting reversible contraceptive effective for at least three years, usually inserted in the inner aspect of the arm.
  • Private Health Care Providers (PHCPs) are health providers (both for-profit and not-for-profit) not operated or controlled by the state or any of its instrumentalities, and may be natural or juridical persons providing health care services or goods, including practicing health professionals and non-government organization clinics among others.

General guidelines for adoption in FP program

  • Implementation must be aligned with the continuing implementation of Republic Act No. 10354, its IRR, and the related national strategies and reproductive health policies.
  • The progestin subdermal implant is included as a modern method of the National Family Planning Program pursuant to Sec. IV.A.3 of AO No. 2012-0009.
  • Use of progestin subdermal implants must adhere to the Philippine Clinical Standards Manual on Family Planning 2014 Edition (DM 2014-0311) or its subsequent updated versions.
  • Introducing progestin subdermal implants must use an implementation strategy with essential elements including orientation and engagement of program stakeholders, baseline evaluation and integration into SDN, selection and preparation of health facilities plus the referral hospital, social preparation and demand generation activities, preparation of training and IEC materials, preparation of updated clinic records and reporting forms, training of service providers (MDs), nurses/midwives, BHWs/CHTs, quality service provision, and supportive supervision and monitoring.
  • Recommended specifications for each strategy element are set out in Annex A.

Specific implementation and service delivery rules

  • Procurement of progestin subdermal implants must follow mechanisms and steps in relevant issuances, including Rule 4, Sec. 4.10 of the RPRH IRR, the Guidelines on the Estimation of Unmet Need for Family Planning (AO 2014-0043), and AO 2012-0009.
  • Distribution of modern FP commodities and supplies, including progestin subdermal implants, must be done through a full-service logistics management system with deliveries made direct to service delivery points, pursuant to the Guidelines on Engaging the Services of a Full Service Logistics Provider (DO 2014-0184).
  • Provision of progestin subdermal implants must be primarily carried out by frontline skilled health professionals in LGU and DOH health facilities and by private sector providers within the service delivery network (SDN).
  • The DOH must exercise technical oversight and supervision and facilitate establishment of a SDN following the Guidelines in Establishing Service Delivery Networks (DM 2014-0313).
  • Provision must adhere to informed choice and voluntarism as mandated in DO 2011-0005.
  • Progestin subdermal implants and related counseling must be provided at service delivery points (including RHUs, private clinics, and public or private hospitals) as part of the full range of modern FP methods.
  • All DOH-retained hospitals must include progestin subdermal implants in their modern FP method range, except special and specialty hospitals not focusing on women’s health.
  • Progestin subdermal implants must also be provided in outreach settings following the Guidelines on Implementation of Mobile Outreach Services for Family Planning (AO 2014-0002).
  • FP clinical competencies must be continually enhanced and must include training on progestin subdermal implants, including monitoring and evaluation systems prior to certification.
  • All DOH regional hospitals and medical centers must be designated as training centers for provision and use of progestin subdermal implants.
  • Other training institutions may be recognized as providers following the Guidelines on the Recognition of Family Planning Training Providers of the DOH (AO 2014-0041).
  • SBCC (social and behavioral change communication) activities must include information on progestin subdermal implants and must be customized and targeted for interpersonal-level delivery to prospective clients with unmet need.
  • Modern FP program information and education materials and family health use plans must be revised/amended to include necessary materials on progestin subdermal implants.
  • Recording and reporting must use existing FHSIS recording and reporting forms, including FP Form 1.
  • Public FP health care providers must follow existing FHSIS guidelines for submitting reports from different levels of care.
  • Private sector and NGO providers must submit service statistics reports to their designated LGU health facilities.

Institutional roles and responsibilities

  • The Disease Prevention and Control Bureau–Women and Men’s Health Development Division (WMHDD) must ensure implementation of the Order, including:
    • Developing, in coordination with the Health Policy Development and Planning Bureau (HPDPB), policies, standards, guidelines, and tools for progestin subdermal implant provision.
    • Developing training design and curriculum, in coordination with the Health Human Resource Development Bureau (HHRDB) and partners.
    • Ensuring training of qualified providers by DOH-accredited institutions at regional, provincial, and city levels.
    • Providing technical inputs for a communications plan and IEC materials, in coordination with the Health Promotion and Communications Service (HPCS).
    • Providing technical assistance to DOH Regional Offices and other implementing partners.
    • Ensuring availability of progestin subdermal implants at identified LGU health facilities, in coordination with the DOH-ROs.
    • Mobilizing technical assistance and leveraging resources from development partners to mainstream activities.
    • Establishing a comprehensive FP recording and reporting system that includes progestin subdermal implants, in coordination with KMITS and the Epidemiology Bureau, to develop an FP database for monitoring reach and utilization.
  • The Logistics Management Division (LMD) must oversee a full-service logistics management system implemented by a competent, capable, efficient, and affordable public and/or private sector provider, subject to procurement and contracting laws and rules, and must monitor and evaluate use of a logistics database management information system such as NOSIRS.
  • The Health Promotion and Communication Service (HPCS) must develop and implement an FP communication plan and prototype materials at national, regional, and local levels, particularly on progestin subdermal implants, in coordination with DPCB, POPCOM, and other development partners.
  • The Epidemiology Bureau must:
    • Provide technical oversight on implementation of FHSIS for data collection, processing, and reporting on modern FP use (including progestin subdermal implants).
    • Assist in estimating unmet need for modern FP services for various methods to support commodity forecasting.
  • The DOH Regional Offices and DOH-ARMM must implement the Order at the local health system level by:
    • Coordinating and providing technical assistance (including logistics management support within the overall system used by LMD) to LGUs, NGO partners, and other stakeholders.
    • Reproducing and distributing IEC and training materials.
    • Monitoring and evaluating LGU, NGO, and partner implementation, including use of FHSIS to streamline data collection, processing, and reporting.
    • Ensuring capacity building and quality service provision at provincial/city/municipal levels.
    • Certifying and accrediting training institutions and service providers.
  • DOH-retained hospitals (except special and specialty hospitals not focusing on women’s health) must:
    • Include progestin subdermal implants in the full range of modern FP methods available at their level.
    • Create FP outreach teams available for dispatch to respond to insertion/removal needs, especially in urban and rural poor communities.
    • Serve as resource and learning centers for technical assistance, training, and research on progestin subdermal implants.
    • Serve as referral facilities complementing LGU and other facility progestin subdermal implant services, including management of complications.
  • The Food and Drug Administration (FDA) must continually conduct appropriate tests on all progestin subdermal implants prior to issuance of appropriate authorizations to ensure safety, efficacy, quality, and a non-abortifacient property.
  • PhilHealth must review existing benefit packages for modern FP and give due consideration to developing mechanisms to finance provision of progestin subdermal implants.
  • POPCOM must assist in generating demand for modern family planning services including progestin subdermal implants, coordinate with DPCB and HPCS, and ensure identified prospective clients with unmet need are referred to appropriate health care providers.
  • LGUs are encouraged to manage program implementation at provincial/city/municipal levels, including ensuring modern FP services (including progestin subdermal implants) in local facilities, ensuring quality and patient safety through supportive supervision, leading advocacy and demand generation, coordinating with DOH data management and information systems, monitoring and evaluating implementation, and identifying functional referral facilities within service delivery networks.
  • Private-sector health care providers are encouraged to provide modern FP services and products including progestin subdermal implants within their respective service delivery networks.
  • Development Partners must ensure their assistance and support to DOH family planning programs and activities is consistent with the Order, and international development partners must coordinate FP projects and activities with the Bureau of International Health Cooperation (BIHC) and DPCB.

Repealing, separability, and continuing effect

  • All other orders, rules, regulations, and related issuances inconsistent with or contrary to the Order are repealed, amended, or modified accordingly.
  • Existing issuances such as AO No. 1-A s.1998, AO No. 43 s.2000, AO No. 50-A s.2001, AO No. 2011-0005, and AO No. 2012-0009 remain valid and in effect to the extent not affected by the Order.
  • If any provision or part of the Order is declared unauthorized or rendered invalid by a court of law or competent authority, the remaining provisions not affected by the declaration remain valid and effective.

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