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Providing Primary / Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, Especially Women and Girls

Section Two - Nine AUICK Associate City (AAC) Reports

10. Olongapo, Philippines


Philippine Urbanization

Philippine Health Situation

The Intricacies of Reproductive Health Care

Historical Background of Reproductive Health in Olongapo City

Discussions and Analysis on Prevailing RH Issues

Objective RH Services Data

Summary and Conclusions


Mr. Fernando Moselina Magrata 

Acting City Administrator and Hospital Administrator, City Government of Olongapo (AUICK Liaison Officer) 
Dr. Arnildo Tamayo 
City Health Officer, City of Olongapo (Participant of AUICK Second 2007 and First 2010 Workshops) 
Dr. Victor dela Cruz Quimen, Jr. 
Dean, College of Nursing, Gordon College (Participant of AUICK First 2010 Workshop) 
Mr. Eric Sanchez 
Project Development Officer IV, Research Section, City Planning and Development Office, City Government of Olongapo (Resource Person of AUICK Second 2009 Workshop)

Olongapo Map

I. Philippine Urbanization

The Philippines is a low-middle income country located in Southeast Asia with one of the highest population growth rates recorded in the ASEAN region, at an annual average of 2.0% (National Statistics Office, 2007). While national census reported the population at 88.6 million by the end of 2007, it is projected to reach 102 million by the year 2015, and would have doubled its current population by the year 2029. 

The Philippine economy had been sluggishly moving compared to its other neighboring ASEAN countries; nevertheless, socio-economic conditions have invariably improved over the last three decades, with a gross domestic product (GDP) real growth rate at 7.34% in 2007, the highest so far. Poverty incidences may have decreased (40% to 32% from periods 1989 to 2006) but the gap between the rich and the poor had widened, as much between the urban and rural areas. There are reportedly 30 million Filipinos who are living on less than a dollar (US) per day (2006 Human Development Report) with a 2007 National Unemployment Rate of 7.35%. 

Philippine Population

This rural poverty phenomenon has arguably been one of the driving forces that push people to flock and migrate to urban centers, which may have shifted the country’s rural to urban ratio over the years. During the 1970s, the rural to urban population ratio was 70:30, in the 80’s it then became 50:50, and by the 1990s, it has already shifted as reflected in the 1998 National Demographic and Health Survey (NDHS) to 60:40. The shift from a predominantly rural into an urban set-up, the rapid exodus of people across porous borders and the prevailing poverty situations have huge implications for the country’s socio-economic viability that could pose unique challenges for respective local governments in the delivery of basic social services. 

II. Philippine Health Situation

For the last 60 years, while the Philippines’ socio-economic standing may have arguably lagged behind the rest of its Asia-Pacific neighboring countries, the health of its populace has nevertheless significantly improved. Although reductions in mortality rates may have slowed down for the last decade, life expectancies are generally better, basic health services have become more accessible, sanitation facilities have achieved significant coverage, and the country is arguably producing more than enough health human resources for health care delivery. 

The Philippines is considered one of the major exporters of health professionals across the developed world. While this arguably contributes to the country’s economic development, it otherwise fuels a massive brain drain in the country that could debilitate the public health care delivery system. Apart from this hemorrhaging human resource problem, the fragmented health system and poor national spending for health, local governments are left to tend on their own in a decentralized structure, to the expense that approximately 46% of health care costs are paid out-of-pocket. Health spending is still biased towards hospital or curative care, while funding for health promotions and preventative work is still very limited. 

The Philippines has a dichotomized health care delivery system characterized by a modestly efficient Private Health Care system composed of technologically advanced tertiary hospitals only accessible to the higher income population segments, co-existing with a Public Health Care system composed of overly-crowded and fairly deficient government hospitals, which the majority of poorer populations are using. This growing disparity creates a huge divide between the rich and the poor that considerably impacts the way people gain access to more efficient health care services. 

III. The Intricacies of Reproductive Health Care

Using the Millennium Development Goals (MDGs) as the standard measure for progress, the Philippines is fairly on track except for universal primary education and maternal mortality, according to the midterm progress report (National Economic and Development Authority, 2005). While reductions in maternal mortality have occurred over the years, it has slowed at a rate by which it has been identified as the MDG least likely to be achieved in the country. 

Philippine Maternal Mortality Ratio

In a country historically rooted in religious influences, with more than 80% of its inhabitants professing Catholicism, the implementation of a comprehensive reproductive health program becomes a highly contentious issue. While the state claims secularity and structurally separates itself from the church, government policies and programs otherwise reflect much religious influence, especially with matters of sexuality and reproductive health. The Reproductive Health Care Bill, since its inception two decades ago, has faced strong opposition from fundamentalist Catholic groups. While arguments afloat regarding the nature of the house bill, pro-life groups and reproductive health advocates are constantly thrown into heated debates. Up until today, the house bill has not been passed and was again suspended for further deliberation during the last legislative session. 

Amidst the hostile policy environment for reproductive health, basic services are otherwise deficient. Contraceptive prevalence remains constantly low, primary health care facilities are somewhat ill equipped, health human resources are maldistributed and the poorer sub-populations have restricted access to essential health services. This is further confounded by the breakthrough increases of HIV cases in the country, now exhibiting 200-300% increases from previous years, shifting modes of transmission through MSM (men having sex with men), more so affecting the younger working age group. Given the conservative culture, poor knowledge about HIV in the general population, poor information and education campaigns, within a country having one of the highest global TB prevalences, co-infection between the two diseases could otherwise complicate programmatic interventions in the future, demanding much resources from an otherwise struggling economy. 

Philippine Reported HIV Cases

IV. Historical Background of Reproductive Health in Olongapo City

Going through the earlier years of public health in the city, much like with what is more or less happening nationwide, reproductive health was essentially confined within the Maternal and Child Health Program. During the 1970s, the leading causes of morbidities and mortalities were primarily infectious / communicable in nature. The Rural Health Unit (RHU) program was underway with the establishment of Rural Health Midwives as frontline health workers, while a crude health reporting system was just barely functional. Malnutrition rates in the city were at their highest then, presumably owing to the still poor public health system, further disrupted by the proclamation of a nationwide martial law. 

Nonetheless, Olongapo was at that time already a chartered city, the US Naval Bases were operational, and in-migration was at its highest increasing trend with a population growth rate of 9.05%, and 107,790 individuals (1970). It was at this period likewise, that venereal diseases were on the rise, with increasing cases of gonoccocal infections, primarily affecting populations associated with the booming entertainment industry. Local ordinances were passed to possibly control this public health issue, otherwise reinforced with the establishment of the Social Hygiene Clinic. By the 1980s, a more responsive public health system began to shape up, as martial law was in its final years, socio-economic conditions were improving, and Olongapo was then re-classified as a highly-urbanized city. 

The period saw the introduction of more effective vaccines and immunizations, coupled by a strengthened community health workforce of midwives and volunteer health workers; as Primary Health Care (PHC) coming from the Alma Ata Declaration was in its full swing, morbidities and mortalities caused by infectious diseases were slowly being controlled. While gonococcal infections by this time were no longer within the ten leading disease causes, tuberculosis together with pneumonia and diarrheal diseases remained consistent, as diseases non-communicable in nature (hypertension, malignancies) had also begun to emerge. Malnutrition rates are likewise shown to improve during this period. While the Family Planning Program draws its beginning from the past decade, it was only during the 1980s that it began to take shape. By the end of the decade, with the Infant Mortality Rate (IMR) at 23.9/1,000 live births, and the Maternal Mortality Rate (MMR) at 52/100,000 live births, health indices in Olongapo were considerably better than the national average. From 1980 to 1990, the population grew from 156,430 to 193,330 with a population growth rate of 2.10%. With the continued influx of migrants and rapid urbanization, issues began to rise in population health, most notably concerning STIs, HIV and AIDS. From the period 1985 to 1990, 44 persons were already identified as HIV positive through a mass survey done by the US Naval Base. 

Going into the last decade of the century, the period 1990 to 2000, Olongapo witnessed highs and lows in its socio-economic landscape that proved much of a challenge to local governance and public health. The double burden of the Mount Pinatubo eruption and the eventual withdrawal of US Naval Bases demanded much of then City Mayor Richard Gordon to keep the city afloat and socio-economically viable. It was the only period in Olongapo’s history so far that registered a negative population growth rate at -1.40%. In 1993 and 1994, maternal mortality was at its highest at 152/100,000 live births and 136/100,000 live births respectively. 

Rising up to the challenge, Mayor Richard Gordon revived the ailing economy that would lay the future ground works to Olongapo’s path to socio-economic stability. The conversion of the naval bases into the Subic Bay Freeport Zone became a catalytic event that would bring tourism and trade into the area. Pioneering works in the public transport system, solid waste management, improving infrastructure, and a renowned volunteerism strategy made Olongapo one of the more dynamic cities in the region; so that by the end of the century, it registered one of the lowest maternal and infant mortality rates in the country. 

In the public health sector, while devolution may have brought in some constraints in local health governance, it nevertheless brought in reform areas in public health, which improved the hospital system, preventive and promotive health, health information, and health financing that brought corresponding improvements in reproductive health. In 1996, Olongapo City General Hospital was renovated to the state-of-the-art James L. Gordon Memorial Hospital, a DOH-licensed Level 4-Training Hospital that will become a major health referral facility within Central Luzon. 

Maternal Mortality Figure ComparisonOlongapo Maternal Health Indicators

With ongoing developments, a booming economy, and ensuing urbanization, one persistent issue that concerned reproductive health was the continued rise of sexually transmitted infections. Notwithstanding the withdrawal of the US bases, for which Olongapo was then the prime rest and recreation area, entertainment establishments continued to flourish until the present day, especially with the attraction of better trade and tourism. People from other parts of the country, hoping for better opportunities, flock to the city, while inadvertently siphoning the city’s resources for social services. Within an environment of at-risk sexual behaviour, the registry then documented 59 cases of HIV by the year 2000. Services for people living with HIV began to take shape, with the local government working to de-stigmatize the condition by providing livelihood, social and counseling support and organizations like the Olongapo City AIDS Foundation, Inc. (OCAFI), iCARE, Youth with a Mission and Precious Jewel Foundation operationalized in the city, providing ancillary support. 

Within the context of population issues associated with rapid urbanization, in-migration, urban-poor sub-populations in need of comprehensive RH services and a social environment with the risk of STIs, Olongapo City entered into a partnership agreement with the United Nations Population Fund (UNFPA) under its 6th Country Program. Working on areas of reproductive health, population development and gender and culture, the partnership program enabled the local government unit (LGU) to work progressively on addressing the functional needs of its multi-tiered population. 

Under the leadership of Mayor James Gordon, Jr. since the start of the program in 2005, Olongapo City became a pioneering example within UNFPA’s countrywide program on effective local governance and responsive reproductive health services. One of the very first cities to ever pass a Reproductive Health Code, this became the main policy framework by which programs for RH were implemented in the city. 

The Gender Code likewise promoted the rights of every woman and girl; children and people in need of special protection, and victims of gender-based violence. Basic Emergency Obstetric and Newborn Care (BEmONC) facilities were established in key strategic areas in the city to provide comprehensive RH services to targeted urban poor families. Adolescent Reproductive Health (ARH) had been incorporated into the school curricula to provide young adults with essential life skills. Population development strategies were implemented to upgrade the socio-economic information system, and develop programs for migrant populations and the untoward effects of climate change on population health. 

Far from being ideal, while Olongapo may have taken great strides in functionally incorporating reproductive health into the overall development agenda, certain issues remain that could very well deter its socio-economic viability later on. With massive migration, problems in the effective delivery of basic social services will ensue, as migration studies have touted the area only to be conducive for a population of less than a hundred thousand; this would entail a more strategic urban planning system, as the population currently stands at 227,000. While population growth rates have stabilized for the past few years below national standards, the city could not afford higher fertility rates, especially with persistent issues on low contraceptive use. Moreover, amidst an environment of at-risk sexual behavior, the city needs to strengthen its STI, HIV and AIDS prevention programs, as the country is now on the brink of a major HIV epidemic, following a rise in cases by 200 to 300%. In the course of the research project, the following senior officials and administrators were interviewed for their views, insights and information relative to reproductive health: 

a) Hon. James Gordon, Jr. - City Mayor, Olongapo City 
b) Mr. Fernando M. Magrata - City Administrator 
c) Hon. Edna Elane – Chairman, Committee on Health, Sangguniang Panlungsod
d) Dr. Arnildo Tamayo – City Health Officer 
e) Dr. Angelito Umali – UNFPA Program Coordinator, Olongapo City
f) Engr. Marivic Nierras – Officer-in-Charge, City Planning and Development Office 

Some graphs and figures which were incorporated in the Research Report were lifted from the 2008 and 2010 Socio-Economic Profile of Olongapo. 

V. Discussions and Analysis on Prevailing RH Issues

1. Sexually transmitted diseases, HIV and AIDS remain to be one of the more prevalent issues concerning RH in the city. Olongapo complies with the criteria for LGU vulnerability to STIs, HIV and AIDS, based on the 4th Philippine AIDS Medium Term Plan; being a highly-urbanized city and a major transit point for travel, and having a high migration rate and a high number of registered entertainment establishments. In comparison, while contraceptive use remains low for family planning, health indices on infant and maternal health currently remain at optimal conditions. 

Nevertheless, family planning for the health of mothers is given due importance and is considered one of the most important RH conditions, for it ensures the well being of the mother as well as the infant. When families are given the right information and services, morbidities and mortalities are kept to a minimum, and they could plan better for their future needs. 

A proactive methodology of tackling the control of STDs is the contract tracing method which has been part of the City Health Office (CHO) program since the 1990s. Over a 10-year period, the retrieved records of contract tracing show that there was a significant drop in traced cases after 2004. The tracing rate declined to less than 50% of the received or reported cases. The lowest recorded so far was in the year 2008, at 13.78% of the total reported cases. Incidentally, this was also the year of the highest number of STD recorded cases (at 255) within the 10-year period. Contact traced clients are those who have not voluntarily submitted for medical examinations, but were only traced by the CHO personnel through its linkages and network. 

Olongapo STD CasesAnother method of tackling the problem was through the use of the regulatory and compliance policy on health certificates issuances for employees, especially those in the entertainment industry. Applicants, under this regulatory procedure, pass through a series of required medical check-ups. The 11-year STD test and treatment graph shows that an average of 89% of the tested clients at the City Health Office were provided with appropriate treatment. Over the years, the rate was fluctuating. These clients are relatively less mobile and are clinic visitors, thus their treatments are more manageable than those of contact-traced clients. 

Olongapo STD Cases (Continued)

2. RH conditions in Olongapo City have been optimally good. Morbidities and mortalities are constantly below national threshold levels and kept to a minimum. Health human resources are continuously being capacitated to maintain technical competencies. Health service provision outposts are likewise strategically established within the city to cater to the RH needs of different segments of the population. 

Prevailing issues currently remain though on family planning. Contraceptive use is still arguably low and adolescent pregnancies are still considerably existent. But through the help of city administrators and health service providers, remaining RH issues are concomitantly being discussed and appropriate intervention contemplated. 

The City of Olongapo extends its medical and health program to the people of Olongapo through the following health institutions: 

• City Health Office 
• James L. Gordon Memorial Hospital 
• Network of health centers and stations located in the seventeen barangays (villages) of the City. 

All these institutions are certified “Sentrong Sigla” (Center for Health) facilities. Sentrong Sigla is a component of the Department of Health (DOH) Quality in Health Program (QIH) which seeks to institutionalize the Continuous Quality Improvement or CQI in health care. Augmenting the public medical and health care needs of the city are nine licensed private hospitals and 38 private medical clinics, including dental clinics and diagnostic laboratories. 

Among the nine private hospitals, only one has been categorized as a tertiary hospital and the rest are classified as primary and secondary hospitals by the Bureau of Health Facilities and Services of the DOH. These are non-departmentalized hospitals that provide clinical care and management on prevalent diseases in the locality. 

The James L. Gordon Memorial Hospital (JLGMH), a government hospital owned and managed by the City of Olongapo, is the only Level-4 training hospital in the city. It is a 300-bed capacity hospital with departmentalized service, and provides specialized and sub-specialized forms of treatment, surgical procedures and intensive care, as well as clinical care and management of the prevalent diseases in the locality. 

Aside from the existing hospitals, there are 17 DOH-“Sentrong Sigla” certified health centers which provide regular health services, including consultations with provision of medicine and immunizations. All health centers are manned by a doctor, nurse, midwife and barangay health workers. Dental services are available once a week and free clinics in depressed areas of the community are conducted regularly. 

Using the standard ratios on government health workers to population set by the Bureau of Local Government Supervision (BLGS) of the Department of the Interior and Local Government (DILG), Olongapo City presents a fair condition of its public health standard. 

Olongapo City Health Service StandardsMaternal Mortality Rate (MMR) – In a span of 27 years, the general trend of the Maternal Mortality Rate (the number of women who die as a result of child bearing per 1,000 live-births) is declining. Remarkable is the unusual surge in 1993, at 1.52 or an equivalent of eight deaths, which was the highest so far. It gradually dropped to 1.36 in 1994, and to 0.40 in 1995, or two maternal deaths. The surges could be attributed to stress and anxiety experienced during and in the aftermath of the Mount Pinatubo eruption. Currently, Olongapo City has the lowest maternal death rate in the country. 

Oliongapo Maternal Mortality Rate

Infant Mortality Rate (IMR) – The Infant Mortality Rate, or the number of deaths of infants less than one year of age per thousand live births, has been continually decreasing at the turn of the century. From a double digit mortality rate since the late 1960s, the highest of which was 51.17 per thousand live births, the rate significantly dropped to 5.85 deaths per thousand in the year 2008. This can be considered as a major achievement over the past four decades of health and medical services. 

Contraceptive Prevalence Rate (CPR) – The family planning program of the city has been effective in terms of increasing acceptors in the use of contraceptives. More couples were using contraceptives in 2005. There was an increase in the percentage of current users of various methods of family planning. The Contraceptive Prevalence Rate (CPR) has increased to 45.49% from 42.46%. This represents a 9% increase, or 421 more than the 4,725 registered new users during the previous year of 2004. 

In the year 2005, a total of 5,146 couples (new acceptors) were motivated to enroll in different family planning methods. The scientific natural method, LAM (Lactating Amenorrhea Method) is still the most practiced method among new acceptors, though it slightly declined in 2005. Pills, injectables and condom users increased among the new users, while tubal ligation dropped. An increase of more than 100% was evidently seen in condom users. On the other hand, there was a significant drop by 100% percent in the practice of the natural family planning method. 

RH conditions have been optimally good. Prevailing issues currently remain though in family planning, STI Prevention, and respective population health issues associated with urban migration. 

3. The city gives high priority over RH services. It sees reproductive health as an essential component by which sustainable human development could be essentially realized. With a well-served population enjoying the highest level of health, a better quality of life could paradoxically be achieved. While RH conditions have been functionally good, the city cannot remain complacent, especially on issues associated with rapid urbanization. The city values reproductive health and population development as an enabling tool to harness the people’s socio-economic potential. 

As a manifestation of its thrust in making RH services one of its priority concerns, the City of Olongapo, through the Sangguniang Panlungsod (Local Legislative Council), enacted the “Olongapo City Reproductive Health Care Code of 2007” on 1 August, 2007, under City Ordinance No. 23, Series of 2007. This makes Olongapo City one of the earliest Local Government Units (LGUs) which adopted the RH Code. 

The City Health Board, with the City Mayor as the Chairman, was mandated under the Code to promulgate the rules and regulations for the implementation of the RH Code and funded from the 5% of the Gender and Development (GAD) Fund. It shall carry-out programs and strategies in the following areas: 

a) Maternal health care; 
b) Infant and child health care; 
c) Family planning information and services; 
d) Services for the prevention of abortion and management of post-abortion and its complications; 
e) Adolescent and youth health services; 
f) Prevention and management of reproductive tract infections; 
g) HIV and AIDS and other sexually transmittable infections (STIs) h) Elimination of violence against women; 
i) Education and counseling on sexuality and sexual health; 
j) Treatment of breast, reproductive tract cancers and other gynecological conditions; 
k) Male involvement in reproductive health; and 
l) Prevention and treatment of infertility and sexual dysfunction. 

4. Available resources for reproductive health services are quite good for the time being. While resources had been properly allocated for basic social thrusts and sustainable development as spelled out in its H.E.L.P.S. Program, which stands for Health, Education, Livelihood, Peace and Order and Social Services, the city’s coffers will only be as adequate as the level of population being served. And as the population of Olongapo continues to rise, more resources for RH services will continually be needed. 

5. The specific needs of the city on RH services relate to funds and human resources. Funds will continually be needed to meet the demands of its growing population. Funds would still be needed to subsidize for the social service needs of the urban poor sub-populations. The population to health manpower ratio of Olongapo needs to be further improved. At certain population concentrations, more health personnel would be needed to respond to the growing needs. Concurrently, facilities would continually need to be upgraded to meet the growing demands. At present, with the 227,270-censal population of Olongapo City, there are 13 medical doctors, 12 nurses and 22 midwives manning the City Health Office and Village Health Centers. The meager 82 Community Volunteer Health Workers are covering 49,415 households spread across the 17 villages. This is still below national standards for the population to health manpower ratio. 

6. Available data from the National Statistics Office (NSO) show that in the year 2000, Olongapo City, with a total of 40,120 families, had an average annual family income of PhP 196,938.00 ($ 4,376.00) or an average monthly income of PhP 16,411.00 ($364.68). Around 12,975 families, or 32% of the total number of families, earned an annual income ranging from PhP 150,000 – Php 249,999.00 ($ 3,333 - $ 5,555) while only 0.7% earned an annual amount ranging from PhP 10,000.00 – PhP 19,999.00 ($ 222.20 - $ 444.40). 

In 2000, the Annual Per Capita Poverty Threshold, or the amount required to satisfy food and non-food basic needs declared by the National Statistical Coordination Board, stood at Php 13,760. Thus a family of five members should have a monthly income of PhP 5,733 ($ 127.40) or an annual income of P 68,800 ($ 1,528.88) to meet their food and non-food basic needs. 

Olongapo Average Family Income by ClassCompared against the official poverty threshold in the region, the average annual income of residents in Olongapo, at PhP 196,938 ($ 4,376), is way above the regional benchmark. About 5,603 families or 14% of the total families in the city fall below the regional poverty line of $ 1,528.88 per annum, or $4.18/day. 

Olongapo Population Earning Less than $4 per Day

7. There are but only a few concentrations of urban slums in Olongapo. While indigent families exist in these villages, a Rural Health Unit would optimally be present to provide primary health care services. Private clinics and hospital services are otherwise spread throughout the city to provide advanced health care. 

What could categorically be considered special populations are those residing in the uphill areas far from the village centers, where illegal squatting otherwise exists. Around 77% of Olongapo’s topography has slopes greater than 18 degrees, which are generally not suitable as residential areas. These pose challenges in the provision of basic social services owing to their geographic isolation. Poverty for this matter also becomes a major deterrent to access. 

8. The City Health Office regularly conducts outreach programs to villages situated farther from the city proper to provide essential health services, including those for reproductive health. Special considerations are given to indigent families and indigenous populations who are otherwise situated far from the village centers. 

BEmONC facilities are being established at key strategic areas in the city to provide comprehensive RH services at the primary health care level. These centers offer services specifically targeted at the indigent subpopulations. Teams of rural health physicians, public health nurses, and rural health midwives were trained at an obstetric-specialty hospital in Manila on providing BEmONC services, to functionally upgrade the capacities of frontline health workers. The city has currently established nine BEmONC Centers within its 17 villages. 

A conditional cash transfer program was recently piloted by the city with programmatic support from UNFPA, targeted at indigenous and indigent subpopulations. The project is operationalized by issuing cash vouchers through a demand-side financing scheme, designed to further discourage home deliveries and offer better alternatives for RH services in BEmONC facilities. The project has recently utilized around Php 500,000, and is relatively showing good accomplishments as facility based deliveries amongst targeted beneficiaries are continually rising and improving. 

9. The estimated size of the city’s new immigrant population (the new floating population) is shown in Table 5. 

Olongapo Estimated Immigrant Population Size

The reproductive health services that shall be dispensed by the city will be sufficient for the projected population by making appropriate budgetary adjustments and allocations. 

10. RH services are readily available at the 17 Rural Health Units (nine offering BEmONC services) in each of the villages for the entire population, including migrants. Thirty-eight medical clinics and nine hospitals are situated within the city, with the James L. Gordon Memorial Hospital serving as the primary referral facility for Comprehensive Emergency Obstetric and Newborn Care (CEmONC). 

Issues otherwise ensue with the migrant populations; ensuring the steady supply of medicines at the health provision outlets with the increasing demand, poverty being a deterrent to proper access, and migrants who engage in at-risk sexual behaviour. 

While poverty alleviation programs nonetheless exist, more alternative livelihood opportunities need to be explored. The Social Welfare Office could further work on institutionalizing its poverty alleviation program (Pantawid Pamilyang Programang Pinoy “4Ps”), and social health insurance with PhilHealth, including accreditation of health facilities could further be strengthened, with family memberships effectively sustained. 

11. The breakdown of the total budget for RH services is shown below in terms of percentage costs covered by the city government, the national government and other sources: 

Olongapo Annual Expenditure ReportOlongapo Annual CHO IncomeOlongapo Reproductive Health BudgetOlongapo UNFPA Financial Support

VI. Objective RH Services Data

Olongapo Objective RH Services Data

Basic health indices have been improving for the past three decades. Maternal and infant mortality rate figures have been better than national or regional standards. What remains an issue is the low contraceptive prevalence which is otherwise existent countrywide. While on the supply side, commodities are rationally available, issues otherwise ensue with socio-cultural norms affecting the way that information and services could be accessed. 

Olongapo Objective RH Services Data (Continued)Facility-based deliveries and skilled health attendance are continuously improving over the years. This is complimented by the decrease of home deliveries and those assisted by traditional birth attendants. 

Concerning HIV prevalence, while more cases are not being registered, they are still considered as being under-reported due to the stigma attached. Nevertheless, the city is continuously active in its prevention programs due to the inherent high risk environment for sexually transmitted infections. 

Olongapo Objective RH Services Data (Continued)

Data reflects government owned public facilities providing RH services. Apart from these are privately owned facilities who are likewise giving RH services. As previously mentioned, one of the primary issues for RH is contraceptive prevalence. The oral contraceptive pill is the most commonly used method. Immunization programs are otherwise optimally on track, both for mothers and children.

Olongapo Objective RH Services Data (Continued)Olongapo Objective RH Services Data (Continued)HIV remains an ongoing threat to Olongapo. Nevertheless, it had come up with comprehensive programs on prevention, control and management to combat the disease. This includes the maintenance of a Social Hygiene Clinic, ongoing collaborations with stakeholders and civic society groups, and health information and promotion programs designed to prevent further spread of the disease. 

VII. Summary and Conclusions

Olongapo City has taken great strides in functionally incorporating reproductive health into the overall development agenda. However, certain issues remain that could very well deter its socio-economic viability later on. 

With massive migration, problems with the effective delivery of basic social services will ensue, as migration studies have touted the area only to be conducive for a population of less than a hundred thousand; this would entail a more strategic urban planning system as the population currently stands at 227,000. 

While population growth rates have stabilized for the past few years below national standards, the city could not afford higher fertility rates, especially with persistent issues on low contraceptive use. Moreover, amidst an environment of at-risk sexual behavior, the city needs to strengthen its STI, HIV and AIDS prevention program, as the country is now on the brink of a major HIV epidemic, following a rise in cases by over 200 - 300%. 

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CONTENTS

Top

Foreword

Section One

The New Urban Challenge for Primary and Reproductive Health Care

Executive Summary

1. Background: Urban Growth and Urban Primary / Reproductive Health (RH) Services

2. An AUICK Research Project Report

3. Regional Findings

4. Individual City Findings

5. Summary and Implications

Section Two

Providing Primary / Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, Especially Women and Girls:

Nine AUICK Associate City (AAC) Reports

6. Kuantan, Malaysia

7. Khon Kaen, Thailand

8. Weihai, China

9. Surabaya, Indonesia

10. Olongapo, Philippines

11. Chennai, India

12. Faisalabad, Pakistan

13. Danang, Vietnam

14. Chittagong, Bangladesh

Annex I.
Research Instrument: AUICK Research Project Outline

Annex II.
AUICK Research Project Participants


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