NATIONAL CONSULTANT: Maternal Health Strategy framework and development of the National Acceleration Plan for Ending Preventable Maternal Mortality (EPMM)

Scope of work:

Background and rationale 

To ensure rapid reduction of maternal and child mortality, the Department of Health (DOH) issued Administrative Order 2008-0029 entitled: “Implementing Health Reforms for the Rapid Reduction of Maternal and Neonatal Mortality”.  Its objective included the (1) Engagement of all province-wide or city-wide health systems to adopt and implement the integrated MNCHN strategy; (2) Provision of targeted support to province-wide or city-wide health systems and specific population groups where the maternal and neonatal mortality problem is most severe; (3) Achievement of national MNCHN program targets for modem contraceptive prevalence rate (mCPR) from 35.9% to 60%, percentage of pregnant women having at least four antenatal care visits (ANC) from 70% to 80%, percentage of skilled birth attendance (SBA) and facility-based births from 40% to 80% and percentage of fully immunized children (FIC) from 70% to 95%.  

By 2015, the country was unable to meet its goal for maternal mortality which stood at 114 (target: 90 maternal deaths per 100,000 live births).  

In 2021,  the maternal mortality rate further rose to 144 per 100,000 live births.   Any initial progress made by the country was significantly interrupted by the COVID-19 pandemic. The 2022 National Demographic Health Survey (NDHS) showed that mCPR is at 45% for currently married women, women receiving at least 4 ANC visits at 83%, skilled birth attendance at 90%, facility-based births at 88% and FIC at 72%. 

With the Universal Health Care Act law passed in 2019, latest data available from the NDHS 2022, National Objectives for Health 2024 - 2028 and 8-point health agenda, and the Omnibus Health Guidelines, there is a need to revisit the MNCHN strategy. Ironically, the progress in the improvement of MMR is slow despite the significant increase in intermediate indicators: FBD, SBA and ANC.

Following the more recent information on the maternal health landscape in the Philippines and the developments in health policies and national health priorities, it is imperative to revisit and review the existing strategy and update as necessary in order to support the acceleration in the reduction of preventable maternal deaths in the Philippines.  

In March 2024, the UNFPA Asia Pacific Regional Office organised a technical workshop to operationalize the Ending Preventable Maternal Mortality (EPMM) and Every Newborn Action Plan (ENAP): Accelerating progress in emergency obstetric and newborn care (EmONC) and midwifery in the Asia and Pacific Region.  The Philippines is one of the nine (out of 13 participating countries) in the APRO which developed its draft acceleration plan as one of the expected workshop outputs.  The draft acceleration plan has been revised and presented to a core group composed of UNFPA-UNICEF-WHO regional and country office staff (June 6) and then to a broader group of stakeholders on June 18, 2024 during a national consultation meeting.

Objectives and Scopes of the assignment

1. To assist the DPCB-Child Adolescent Maternal Health Division of the DOH, UNFPA, and stakeholders in reviewing the progress, challenges, and recommendations from the implementation of the MNCHN/Maternal Health Strategy 2008 to present, and relevant data and documents;
2. To develop the Maternal Health roadmap based on findings and recommendations of the review of the MNCHN/Maternal Health Strategy, other existing documents, and implementation experience from global, national and  sub-national actors; and
3. To finalise the Acceleration Plan for Ending Preventable Maternal Mortality (EPMM) (as part of the Philippine and Every Newborn Action Plan ENAP).     

The roadmap should ensure Universal Access to sexual reproductive health rights and the 2030 agenda in line with the SDGs 2030 and help the country meet global EPMM and ENAP targets. 

Duties and Responsibilities 

An independent consultant is being sought to support the DOH in developing the roadmap to reducing Maternal Mortality (2024 – 2030) based on new data, and evidence-based national and global policies and strategies. The development of the roadmap has been initiated through a consultative process with relevant stakeholders, including relevant DOH departments and programmes, other departments, development partners, NGOs and local government units. 

This MNCHN roadmap 2025 - 2030 should be concise with clear objectives and targets and be linked to national policies and strategies such as: 

• Philippine Development Plan 2023-2028
• The National Health Objectives 2023 – 2028 and the 8-point agenda, 
• The DOH Omnibus Health Guidelines
• The Universal Health Care Implementing Rules and Regulations
• The Philippine Sustainable Development Goals 2030 (CSDGs 2030)
• Assessment of the Philippine Emergency Obstetric and Newborn Care Initiative (Luzon, Visayas and Mindanao)
• The Global Strategy for Women’s, Children’s and Adolescent’s Health 2016-2030
• Draft DOH Acceleration Plan for Ending Preventable Maternal Mortality and Every Newborn Action Plan 2024
• Human Resource Development Plan (DOH - Health Human Resource Development Bureau) and Health Facility Development Plan (DOH-Health Facility Development Bureau)  
• Other key available documents.

 Detailed tasks and duties are set out below:

1. Review the MNCHN Strategy and relevant documents
   1. Thoroughly review the implementation status of the MNCHN Strategy, Emergency Obstetric Newborn Care Review, Health Management Information System (HMIS) data between 2013 and 2023 and other available documents; consider as well locally-developed HMIS and its adaptabilities;
   2. Meet and consult with the DOH bureaus and programmes, other relevant government agencies, development partners, NGOs and other stakeholders with a focus on consulting a wide range of partners including groups most left behind including persons with disabilities, female sex workers, LGBTQI,  migrant workers, factory workers, indigenous groups, women from geographically remote and isolated regions, women from lower wealth and education quintiles, adolescents; and
   3. Draft a succinct plan for the development of the new MNCHN Roadmap and acceleration plan.  
2. Develop a MNCHN Roadmap for 2025 – 2030
   1. Based on the review results, consult with stakeholders (wide group) on progress, challenges, lessons learned, and recommendations;
   2. Review and add, as needed, the key components of the sexual reproductive health and rights in the strategy framework, with a focus on evidence based approaches to reducing maternal and newborn mortality, emerging issues and targeted strategies ensuring leaving no one behind; 
   3. Add data available for baselines and as means of verification to track progress on key indicators and targets listed in the monitoring framework. Add new indicators if new activities have been added or modify indicators if activities have been modified including those that pertain to coverage, availability, accessibility, acceptability and quality of services; and
   4. Support the presentation of the findings and proposed roadmap for the MNCHN Strategy 2025 – 2030 through meetings and workshops, including  subnational level consultation (in UNFPA priority region/s).  

3.  Support the finalisation of the acceleration plan for EPMM 

1. Work with DPCB and UN agencies in the finalisation of the acceleration plan for EPMM (as part of the Philippine EPMM and ENAP)
2. As needed, coordinate with the UNICEF consultant who will support the ENAP part of the Acceleration Plan; and
3. Support the presentation of the acceleration plan for EPMM to all stakeholders and assist the DOH and UNFPA in identifying existing domestic resources as well as potential donors and resource partners for the implementation of the plan. 

Work schedule and arrangements

The consultancy will be a mix of desk review and face to face consultations. S/he will work closely with the DOH-DPCB Safe Motherhood Program Manager, Division Chief of the Child Adolescent, Maternal, Men Health Division of the Disease Prevention and Control Bureau, and with the UNFPA Philippine Country Office and Asia Pacific Regional Office. S/he is expected to meet with other DOH-DPCB officers and other relevant DOH bureaus (e.g. Health Human Resources and Development, Health Facility Development, Health Facilities and Services Regulation, Epidemiology, Health Policy Development and Planning, Health Emergency Management, Local Health Systems, International Health Cooperation, Centers for Health Development/Regional Offices, etc.), health development partners, professional societies, and NGOs. 

Expected Outputs and Timeframe

1. Review MNCHN Strategy and relevant documents listed above and produce a succinct report of the review. [est. 7 days]
2. Present the findings of the review of the MNCHN Strategy and propose/update its key components through consultative meetings and workshops, and APRO SRH Adviser recommendations; [est. 5 day]
3. Meet with beneficiaries to obtain their inputs [est. 7 days]
4. Produce the first draft of MNCHN Roadmap for comments by DPCB-CAMHD and stakeholders; [est. 7 days]
5. Enhance the Acceleration plan for EPMM, including prioritising interventions, timelines, indicators and responsible agencies [10 days]
6. Present the next draft to the DOH sub-Technical Working Group for Maternal and Child Health; [est. 3 days]
7. Produce the final draft of the MNCHN Strategy based on the inputs provided by the DOH-CAMHD, UNFPA, and DPs. [est. 5 days]

Manila-based. This consultancy is open for national experts. 

Working time and hours: Manila time zone. 8am to 5pm 

The consultant is expected to commence the work in August 2024 and finish by December 2024.  

The suggested payment schedule is detailed below:

1. The first payment of 30% will be made upon receipt and acceptance of the review report of Maternal Health Strategy, expectedly by 30 August 2024 (electronically);
2. The second payment of 40% will be made upon acceptance of the first draft of Maternal Health framework and revised Acceleration Plan (with priority interventions and indicators), by October 15, 2024;
3. The remaining 30% will be made upon approval by the Director of the DPCB and UNFPA of the final version of the Maternal Health Strategy Framework and the Acceleration Plan for EPMM, by 30 December 2024 (electronically).

Below is the table for ease of reference:

The consultant will report to the UNFPA Assistant Representative. 
The consultant is expected to work closely with the Director of DPCB and is expected to interact with Safe Motherhood Program Manager and other programme colleagues in the DPCB-CAMHD and other for matters related to their respective programmes and portfolios.

The supervisor and DPCB-CAMHD programme managers and officers will have frequent interactions with the consultant at various stages in order to:

• Brief the consultant and provide clarity on the assignment, the process and the deliverables;
• Provide key documents relevant to the deliverables;
• Introduce and facilitate the consultant to work with key stakeholders and counterparts if necessary; and
• Provide feedback and get agreement on the next steps of the assignment.

Upon completion of contract assignment, the supervisor will certify relevant documents, evaluate the consultant’s work and process/follow-up on the payments.

Qualifications and Experience

• Advanced degree in public health, sexual reproductive health, and/or strategic planning; 
• At least seven (7) years  of experience in working with policy and strategy development, sexual reproductive health, maternal and newborn health; 
• National experience in development of sexual reproductive health plans, reports, or strategies;  
• Experience working in or familiarity with the Philippine health system and health partners in the Philippines is an advantage; and
• Very good oral and written English language skills.