Population Policy and Program Monitoring and Evaluation

1. Population Policy and Program Monitoring and Evaluation Alejandro N. Herrin and Aniceto C. Orbeta, Jr. May 29, 2003

2. POPCOM and PIDS Project Reports • Herrin, A. N., 2002, “Population Policy in the Philippines, 1969-2002”. • Orbeta, A. C., Jr. et al., 2002, “Review of the Population Program: 1986-2002”. • Racelis, R. H. and A. N. Herrin, 2003, “Philippine Population Management Program (PPMP) Expenditures, 1998 and 2000”. • Herrin, A. N., A. C. Orbeta, Jr., F. del Prado, I. Acejo, and J. Cuenca, 2003, “An Evaluation of the Philippine Population Management Program” (in progress).

3. Outline • Part I: Population policy and program review, with attention to population growth and family planning, 1969-2002 • Part II: Monitoring and evaluating the PPMP: a strategy, some results, and information gaps • Part III: Some conclusions regarding future directions

4. Part I: Population policy and program review, with attention to population growth and family planning, 1969-2002

5. Population Policy and Program, 1969-2002 • Marcos administration (1967-1986) • emphasis on negative consequences of rapid population growth • adopted FP that provided both information and services plus advocacy of a small family size norm • Aquino administration (1986-1992) • emphasis on rights of couples to determine number of children • FP program emphasized maternal and child health

6. Population Policy and Program, 1969-2002 • Ramos administration (1992-1998) • recognized role of rapid population growth in constraining socioeconomic progress • adopted FP in the context of reproductive health • Estrada administration (1998-2001) • FP to assist couples achieve desired fertility and promote health • contraceptive mix - scenarios to achieve faster reduction in fertility

7. Population Policy and Program, 1969-2002 • Arroyo administration (2001- ) • FP emphasizes objective of assisting couples to achieve desired fertility and promote health • FP program emphasis on promoting modern Natural Family Planning • Will not fund purchase of contraceptives for distribution to public health facilities in the event bilateral and multilateral donors stop providing supplies.

8. Factors Influencing Population Policy • International commitments e.g., International Conference on Population and Development (ICPD) • Opposition of the Catholic Church hierarchy (especially on the promotion of artificial contraceptives) • Views of the general public (national demographic surveys and opinion polls)? • Views of partner GOs and NGOs?

9. Some conclusions from the policy and program review • Broaden population concerns but address the issue of rapid population growth and fertility reduction once and for all. • Need for clear and consistent statements of national policy to guide national and LGU programs – need to forge a stable consensus. • In formulating policy, consider also the views of partner GOs and NGOs, and the larger, albeit unorganized and silent constituency – the married couples with unmet needs for contraception.

10. Some conclusions from the policy and program review • There are opportunities for working closely with the Catholic Church and other groups in some areas of population policy and family planning.

11. Part II: Monitoring and evaluating the PPMP: a strategy, some results, and information gaps

12. Framework for PPMP Monitoring and Evaluation Outputs (services, capacity- building, advocacy, organizational support) Basic inputs Objective Strategy Utilization (intermediate outcomes Outcomes (achievement of policy objective) Other factors Other factors

13. Responsible Parenthood and Family Planning (RP/FP)

14. PPMP Expenditures by Use, 1998 and 2000 Source: Racelis and Herrin (2003)

15. 10 elements of reproductive health (DOH AO 1-A, January 15, 1998 • Family planning • Maternal and child health and nutrition • Prevention and management of abortion complications • Prevention and treatment of reproductive tract infections including STDs and HIV/AIDS • Breast and reproductive tract cancers and other gynecological conditions • Adolescent reproductive health • Education and counseling on sexuality and sexual health • Men’s reproductive health • Violence against women and children • Prevention and treatment of infertility and sexual disorders

16. PPMP Expenditures by Source, 1998 and 2000 Source: Racelis and Herrin (2003)

19. Sources of supply of modern methods

20. Sources: NDS 1968 to 1993 and NDHS 1998

21. Sources: FPS, various years.

22. Fertility and contraceptive use: 1998 NDHS Source: Gwatkin, et al. (2000)

23. Percent of Currently Married Women by Method, Poor and Non-Poor, 2000 and 2002

24. Percentage of currently married women with unmet need for family planning

25. Fertility and contraceptive use: 1998 NDHS Source: Gwatkin, et al. (2000)

26. Total and Wanted Fertility Rates, 1993 and 1998

27. Reproductive Health /Family Planning (RH/FP)

28. Prenatal care, 1999-2002

29. Pre-natal care visits (%): 1998 NDHS Source: Gwatkin, et al. (2000)

30. Percent of children 0-59 months by type of delivery attendant Percentage for “Others” not shown.

31. Delivery attendance (%): 1998 NDHS Source: Gwatkin, et al. (2000)

32. Postnatal care, 1999-2002

33. High risk fertility behavior, 1993 and 1998 Risk defined in terms of early (<18) and late (>34) childbearing, short birth intervals (<24 months), and high birth order (>3)

34. High risk fertility behavior, 1995 and 2002 FPS

35. Infant, child and maternal mortality, 1970-1995

36. Infant and child mortality: 1998 NDHS Source: Gwatkin, et al. (2000)

37. Adolescent Health and Youth Development (AHYD)

38. Age-specific birth rates (per 1,000 women)

40. Fertility and contraceptive use: 1998 NDHS Source: Gwatkin, et al. (2000)

41. Teenagers who have begun childbearing, 1993 and 1998

42. Population and Development Integration (POPDEV)

43. Information gaps • Reasonably updated data on FP use, source of supplies of modern methods, and fertility, but not so with infant, child and maternal mortality, and outcomes data on youth. • Very limited utilization (intermediate outcomes) and outcomes data on the other components of RH. • Further disaggregation of utilization and outcomes indicators by major social groups, e.g., poor vs. non-poor. • Further disaggregation of expenditure data by major public/private and modern/traditional providers of RH/FP services. • Further development of indicators of utilization and outcomes for AHYD and POPDEV.

44. Part III: Future directions

45. Future directions • Greater effort at systematic development and application of POPDEV “tools” (data and analysis of interrelationships) to inform policy at both national and LGU levels. • Monitoring of population welfare through a rights-based, gender and life cycle approach to ensure that gains in one stage of the life cycle are not lost in the next, or that disadvantages in one stage are adequately compensated in the subsequent stages.

46. Annex: Views of GOs and NGOs

47. Views of partner GOs and NGOs • Role of population growth in development. (88%) agree that a slower population growth is likely to confer greater net benefits than a faster population growth • Role of government in fertility decision-making. About 42% agreed on the need to provide information and services to couples in order to assist them achieve their fertility goals; another 45% noted that fertility decisions of couples have external effects and that in addition to providing information and services, the government can be justified to advocate a small family size norm.

48. Views of partner GOs and NGOs • Family planning objectives. About 22% of believe that the objective of a FP program should be to help couples achieve their desired family size, while 75% said that in addition to the above goal, the FP program should also strive to reduce national fertility and population growth. • Public sector FP service delivery. 93%, view that the government should promote a wide range of legal and medically safe methods from which couples can choose from to achieve their fertility goals; only 5% said that the government should promote only a preferred method, e.g., natural family planning.

49. Views of partner GOs and NGOs • Financing public sector family planning services. 79% said that the government should charge full cost to those who can afford and subsidize those who cannot; 17% want to subsidize all users. • GO and NGO views. In all of the above areas of policy, government and NGO partner agencies expressed similar views. GOs constituted 74% of the total sample of 271 respondents.