Provincial Government of Quezon

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
For the past 5 years, the health profile of Quezon Province has been below par, specifically in malnutrition, as well as maternal and infant deaths. Compared to national acceptable figures, Quezon remains to have high maternal and infant mortality rate of 75 and 6.76 respectively among the 5 provinces in the CALABARZON Region. Quezon also has the lowest GDP or economic underdevelopment of Php14.6T and despite the implementation of national health programs, the statistics of the province in these areas still do not favour the targets set by national standards. In addition, poverty incidence over the last decade had not been improving. Many are still in need of medical attention and this inevitably resulted to economic underdevelopment. Moreover, poor health-seeking behaviour of the general public is evidenced through the very common traditional practice of seeking health aid among quack or witch doctors. As such, this overall behavior reflects hostility to most government programs. Even public-private partnerships have difficulty raising approval among the change-resistant communities. Hence, low outputs and frustrating outcomes illustrate the overall paradigm.

B. Strategic Approach

 2. What was the solution?
Bearing in mind the objective to lower the maternal and child mortality rate, and the immense possibility of improving quality of life based on the Human Development Index, the Quezon Provincial Government thoroughly examined the national government implemented programs and identified the ineffectiveness and present gaps that needed to be addressed. Hence, in 2015, the birth of Quezon’s First One Thousand Days of Life Program, dubbed as Q1K, was formulated and implemented by the Provincial Government in order to address these gaps and ultimately break the cycle of malnutrition and poverty by investing on the most vulnerable stage of human life, the first 1000 days.

 3. How did the initiative solve the problem and improve people’s lives?
Q1K envisions a child, well-nourished in mind and body by providing optimal health care services and appropriate interventions in the first 1000 days of life. It is a comprehensive approach in addressing the health needs of the unborn child until the baby reaches the second year of life. The following are the general objective of the Q1K program. •Reducing the maternal and neonatal mortality through a focused and comprehensive preventive health care services, •Improving the quality of life through reduction of malnutrition in Quezon province by implementing strategic and responsive food and nutrition programs and •Generating behavioral change among parents and community in child rearing through health education, seminars, value infusions and triggering mechanisms. The program is initially being implemented in twelve pilot towns of the province with a total of 1000 pregnant mothers who are 19 years old and above, in their first trimester, living below poverty line and prefers to seek consultation in government health facilities. The 1,000 pregnant beneficiaries underwent all activities under the three main aspects of Q1K interventions, mainly: health care and sanitation, food and nutrition, and social care, to wit: a.Through the linkages established by Q1K Council and Technical Working Group, the beneficiaries are able to receive and complete all 8 prenatal visits and were provided with ANC (antenatal care services) for preparation for birth and parenthood prenatal visits: once a month until the 7th month of pregnancy; twice a month from 7 months to 8 months of pregnancy; and weekly on the 9th month of pregnancy b.free baby and mama book c.free seeds and seedlings for home gardens d.free pelvic ultrasound on the first and last visit e.mandatory building of sanitary toilets f.provision for clean drinking water g.free laboratory work-up (CBC, UA, blood typing) h.180 days of iron and folic acid supplementation during pregnancy i.Tetanus toxoid immunization j.Deworming of pregnant mother k.Parent effectiveness sessions l.Facility-based deliveries m.Essential newborn and infant care n.Newborn screening test o.Initiation to breastfeeding p.Exclusive breastfeeding from 0-6 months old q.Immunization of 0 to 9 months old babies r.Post partum iron and folic acid supplementation for 90 days s.Vitamin A supplement t.120 days of Complementary feeding for 6 months old babies Overall, the province accomplished 100% of target, or 1,000 beneficiaries, and rendered pre-natal checkups, ultrasound and laboratory program packages of Q1K. The Q1K program recorded that there is only 0.1 % of maternal death and 0.4 % of infant death while 8.1 % of babies had low birth weights. A very palpable significant impact of the initiative’s intervention was observed.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The initiative promotes the following innovation and creativity: a.The initiative paved way for the formulation of the First 1,000 Days of Life Manual of Procedures as guidelines as the first comprehensive maternal and child care program in the Philippines produced by a local government unit. b.MAMA Book and Baby Book were published to provide all information, measures and guidelines necessary to learn and observe during a child’s journey in his/her first 1,000 days. c.Under the social care aspect of the Q1K, the program involves the active role of the father/partner in taking care of the baby commencing from the time of conception. d.The program not only concentrates on the nutritional aspect of both mother and her baby, but also the ill-effects of poor environmental sanitation, poor personal hygiene and community’s awareness in providing a conducive environment (noise-free, smoke-free) e.Inclusion of food security ensures that the family has ample source of daily sustenance and possible source of income through the home gardens. f.The program also addresses the behaviour of the parents in child-rearing through attendance in the parent effectiveness sessions once a month for 10 months.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
With the issuance of Executive Order No. 17 series of 2015 of the Provincial Government of Quezon, the Q1K Council and the Q1K Technical Working Group (TWG) were created to act as the implementing arm of the program. The TWG formulated the guidelines and came up with a Manual of Procedures that served as the bible for its thorough implementation from day 1 up to 1,000. The Local Government Units which comprise of the local chief executives, key department heads, barangay captains and councilors served as our partners and vital links in securing all necessary interventions are delivered at the municipal and barangay level. Although the program was limited to 1000 beneficiaries, the 12 towns were briefed into giving the same interventions to all the pregnant mothers in their town. For purposes of the study, the 1000 beneficiaries were monitored and reported using monitoring and reporting tools designed for the program and encoded in our website.
 6. How was the strategy implemented and what resources were mobilized?
The initiative took a scholarly approach in implementing the health interventions to to maternal and childcare during the first 1,000 days of life. Through a two-day workshop of intensive orientation and consultation to maternal and child care experts, medical practitioners and health care providers, the council was able to point out all the issues and gaps in the first 1,000 days of life of a child. Taking into consideration all necessary initiatives and interventions in the aspect of maternal and childcare, the Q1K Council and TWG was able to draft the framework for the manual of procedures of the first 1,000 days. After the formulation of the manual of procedures and the criteria for determining the beneficiaries based on the data collated by the province, the council and TWG began to establish the necessary links for the delivery of the program to its beneficiaries through partnership with Local Chief Executives of 12 municipalities. The action plan included the signing of pledge of commitment from the stakeholders of the program, followed by the intensive program briefing and orientation to the different municipalities and stakeholders involved. The orientation involved the participation of Municipal Health Officers, Barangay Captains, barangay health workers, barangay nutrition scholars, barangay health station midwives, social workers and Q1K coordinators. The Provincial Government of Quezon allocated an amount from the General Fund for the implementation of Q1K. The selection of the 1,000 beneficiaries were conducted by the Q1K TWG based on the determined criteria from the data collated by the province. The Quezon Provincial Government hired a third party evaluator, the Southern Luzon State University, for the task of collating and evaluating all data of the beneficiaries while the Q1K TWG is assigned to the implemenation, monitorship and evaluation of the program activities and the program beneficiaries. As a necessary unit of implementation, the Provincial Government established the Q1K Office that focuses on the information dissemination campaign, program implementaion and monitorship of the Q1K program. The first province-wide Buntis Congress was conducted by the Provincial Government to the 1,000 beneficiares that improved the significance of first 1,000 days of life and empowered the strong partnership and involvement of both partners, mother and father, in caring for their unbirth child. Set of activities were conducted to the 1,000 program beneficiaries during their 9 months of pregnancy that involved 8 visits to the heath stations or prenatal checkups and packages, and social care orientation. Another set of activities were conducted after successful births with postnatal packages and exclusive breastfeeding program, all monitored and recorded by Q1K coordinators.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The conceptualization and formulation of the manual of procedures for Q1K program involved the Provincial Government of Quezon, the participation, learning experience and advise of renowned maternal and child care experts in the Philippines, a consultant from Unicef, chief of hospitals from the province, barangay health worker representatives including midwives and nutrition scholars, and the Southern Luzon State University. On the side of program implementation, the Q1K established a network of collaborative stakeholders such as the local chief executives, municipal health officers, provincial, community and district hospitals, rural health stations, social workers, and volunteers such as barangay health workers, nutrition scholars, day care workers, and local barangay officials. The Provincial Government also sought for complimentary programs from national agencies that can partner with the supplementary needs of the Q1K program such as the departments of health and agriculture, as well as partnership with the national government insurance (Phil Health) for enrollment to the maternal package of beneficiaries.

 8. What were the most successful outputs and why was the initiative effective?
There are notable outputs of the initiative, to wit: 1.Stronger partnership of parents was established during seminars on early stages of parenthood and child care that breaks the traditional Filipino culture of leaving general childcare to the pregnant women. 2.Health-seeking behavior of pregnant women has evidently improved, with more than 4 prenatal visits during their pregnancy stage. 3. Early detection and interventions for high risk pregnancies were address due to effective monitorship of Q1K coordinators. 4.A record of improved adherence to the intake of vitamins, eating of healthy food, clean environment were accessed by the beneficiaries because of the interventions provided by the initiative. 5.Through the efforts of Q1K Office, Provincial Information Office, Quezon Provincial Government Radio and Television program, and Q1K website, a massive information campaign was launched for the awareness of the importance of first 1,000 days of life in a child’s life which intensified the support of the general public and collaboration of other LGUs in the program.

 9. What were the main obstacles encountered and how were they overcome?
Initially, the acceptance and coordination of the local chief executives and their municipal/ city department heads vary from one aspect to another. Some town officials did not fully support the program and not all beneficiaries easily accepted the benefits of adhering to the guidelines. Some believe that the activities strongly oppose their culture and traditional beliefs. Since the reluctance in participation of these stakeholders are due to their prioritization of other local government programs, said reluctance was addressed through the efforts of the Provincial Government to continually campaign for the rationale behind the significant project during provincial development council meetings and regular municipal visits of the province for other programs being implemented in their respective municipalities. In addition to that, the province devised an incentive program in a form of provincial government projects for Q1K municipal and barangay champions. Eventually, these hesitations were changed to excitements as they participate in the new challenge.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The 1,000 beneficiaries of the initiative were taken from the pool of data of below poverty line in the 12 selected municipalities. They have littlest access to health care and had no awareness of the importance of 1,000 days of life. They are now aware of parents’ joint responsibility in caring for the child. They have become more aware of the child’s rights to survive and maximize his/her potential and be given the optimal healthcare needs. The impact of this program is measured by national standard in maternal and childcare through the provincial health office. Data were collected by Q1K coordinators from the municipal and barangay level and were analyzed in the Q1K office for program evaluation. The Southern Luzon State Univerity also evaluates and measures the data collected. Due to the close monitorship observed by Q1k coordinators, barangay health workers and nutrition action officers, the beneficiaries were easily and effectively checked and accommodated in order to access the maternal and childcare program in the nearest rural health unit or municipal health or community hospitals.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The Q1K initiative thwarted the increase in wastage of vaccines and unnecessary selling of supposedly free services, since the initiative itself provided for measures of making sure these vaccines are available and are accessed by the pregnant women beneficiaries and other pregnant women through inventory reports and interviews. Local Chief Executives are now aware and conscious of the health performance of their municipality in making sure that their health stations are supplied with free vaccines.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The initiative caters to the poor families, especially, the poor pregnant mothers. Social workers were mobilized to ensure that the beneficiaries are truly belonging to the underprivileged. Because of the social care aspect of this initiative, pregnant beneficiaries and their partners/ husbands were informed of the psycho-social needs of a child in their early stage of development.

Contact Information

Institution Name:   Provincial Government of Quezon
Institution Type:   Government Department  
Contact Person:   DAVID SUAREZ
Title:   Program Chief Implementer  
Telephone/ Fax:   042-373-6008
Institution's / Project's Website:  
E-mail:   pgo_executive@yahoo.com  
Address:   Brgy. 10, Capitol Compound
Postal Code:   4301
City:   Lucena
State/Province:   Quezon

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