Informed Choice and Volunteersim

Ensuring Quality in Family Planning Service Delivery:
Toolkit for Monitoring Compliance on Informed Choice

and Voluntarism and Environmental Mitigation
Ensuring Quality in Family Planning Service Delivery:
Toolkit for Monitoring Compliance on Informed
Choice and Voluntarism and Environmental Mitigation
December 2014
This document is made possible by the support of the American People through the United
States Agency for International Development (USAID). The contents of this document are the
sole responsibility of Chemonics International, Inc. and do not necessarily reflect the views of
USAID or the United States Government.
Toolkit for Monitoring Compliance on Informed Choice and Voluntarism and Environmental Mitigation | i
TABLE OF CONTENTS

Acronyms............................................................................................................................................................................. ii
Background.......................................................................................................................................................................... 1
Introduction ........................................................................................................................................................................ 1
Planning for ICV Compliance Monitoring .................................................................................................................... 2
Necessary Actions to Ensure ICV Compliance .......................................................................................................... 3
Orientation of Partners and Service Providers on ICV............................................................................................ 5
Monitoring of Compliance to ICV Policy Requirements.......................................................................................... 6
Training of Staff and Partners on ICV Monitoring ..................................................................................................... 7
Ensuring Compliance with Environmental Mitigation Policies ................................................................................ 9
Annexes ............................................................................................................................................................................. 11
Annex A: Matrix of Possible Actions to Ensure Compliance with ICV Mandates ...................................... 12
Annex B: Contractual Provisions Relevant to ICV in Family Planning ........................................................... 16
Annex C: Partner Level Checklist for Implementation of ICV Policy Requirements ................................. 19
Annex D: Commitment to Compliance with ICV Policy Requirements ....................................................... 21
Annex E: ICV Policy Compliance Information Dissemination Certificate ..................................................... 22
Annex F: Informed Choice and Voluntarism as a Quality Issue in FP-MCH (PowerPoint) ...................... 23
Annex G: The Rights of Clients ............................................................................................................................... 47
Annex H: National Family Planning Program Policy (DOH AO 50-A s. 2001)............................................ 48
Annex I: Pre/post-Test for ICV Orientations and Trainings............................................................................. 49
Annex J: ICV Monitoring Questions for Facility Managers, Supervisors and Providers ............................ 52
Annex K: ICV Monitoring Questions for Clients ................................................................................................ 54
Annex L: ICV Monitoring Observation Checklist ............................................................................................... 55
Annex M: Narrative Report of Vulnerability or Possible Violation of Family Planning Policies ............... 56
Annex N: Conducting an ICV Monitoring Practicum ......................................................................................... 57
Annex O: Guidance for Conducting an ICV Monitoring Planning Workshop ............................................. 59
Annex P: Joint DENR and DOH AO 02, series of 2005 ................................................................................... 60
Annex Q: PhilHealth Benchbook Quality Standards for Health Provider Organizations ........................ 76
Annex R: Orientation and Compliance to Health Care Waste Management (PowerPoint) .................... 79
Annex S: Environmental Compliance Assessment Tool................................................................................... 91
ACRONYMS
AO Administrative order
DENR Department of Environment and Natural Resources
DOH Department of Health
DOH-RO Department of Health Regional Office
FP-MCH Family planning and maternal and child health services
ICV Informed consent and voluntarism
LGU Local government unit
PhilHealth Philippine Health Insurance Corporation
USAID United States Agencies for International Development
Toolkit for Monitoring Compliance on Informed Choice and Voluntarism and Environmental Mitigation | 1
BACKGROUND
USAID places a high priority on ensuring that family planning activities supported by the agency adhere
to the mandates of the Philippine government on the principles and practices of voluntarism and informed
choice and environmental mitigation. These policies are very important in ensuring quality of care in
family planning service provision. Given these requirements, it is incumbent upon all USAID projects to
develop plans of action for ensuring the project’s and its partners’ implementation of these
commitments.
This document describes strategies to ensure compliance with these requirements. The focus of the
document is primarily informed choice and voluntarism (ICV) compliance and monitoring, but in the
latter sections of the document there is discussion of specific activities and tools related to
environmental compliance. Integration of environmental compliance initiatives with those related to ICV
is an efficient and effective way to work with project teams and partners to address these two
important issues. The document focusses on effort that can be implemented by USAID projects to
strengthen their own teams’ efforts in these areas and to build the capacity of their partners to ensure
ICV and environmental mitigation compliance.
INTRODUCTION
An individual’s decision to use a specific method of family planning or to use any method of family
planning is considered voluntary if it is based upon correct information and the exercise of free choice,
and is not influenced by any constraints, special inducements or any element of force, fraud, deceit,
duress, or other forms of coercion or misrepresentation.
Clients have to be provided with adequate service options such as broad range of family planning
services, appropriate information, counseling, privacy and confidentiality as regular features of quality
client-provider interaction. These are mandated in the Philippine laws and Department of Health
(DOH) Family Planning Program policies and principles. Informed and voluntary decision-making in
family planning is one of the four pillars of the national family planning program as embodied in DOH
Administrative Order (AO) 50-A series of 2001. In June 2011, the DOH issued, an improved policy, AO
2011-0005 providing Guidelines on Ensuring Quality Standards in the Delivery of Family Program and
Services through Compliance to Informed Choice and Voluntarism. The Magna Carta of Women also
provides for ensuring Filipino women’s right to information, choice, family planning and maternal health
services. Above all, the Philippine laws prohibit abortion and classify it as a criminal offense.
Projects funded by USAID have to comply with several U.S. legislative and statutory policy requirements
relating to informed choice and voluntarism in the provision of family planning services.
The United States legislative and statutory requirements are as follows:
A. Tiahrt amendment mandates that:

1. Service providers or referral agents in the project shall not implement or be subject to
quotas, or other numerical targets, of total number of births, number of family planning
acceptors, or acceptors of a particular family planning method; although quantitative
estimates or indicators used for budgeting or planning purposes are permissible;
2. The project shall not include payment of incentives, bribes gratuities or financial reward to
a. an individual in exchange for accepting family planning, or
2 | Toolkit for Monitoring Compliance on Informed Choice and Voluntarism and Environmental Mitigation
b. program personnel for achieving a numerical target or quota of total number of births,
number of family planning acceptors, or acceptors of a particular method of family
planning;
3. The project shall not deny right or benefit, including the right of access to participate in
any program of general welfare or the right to access to health care, as a consequence of
any individual’s decision not to accept family planning services;
4. The project shall provide family planning acceptors comprehensible information on the
health benefits and risks of the method chosen, including those conditions that might
render the method inadvisable and those adverse side effects known to be consequent to
the use of the method; and,
5. The project shall ensure that experimental contraceptive drugs and devices and medical
procedures are provided only in the context of a scientific study in which participants are
advised of potential risks and benefits.
B. The Population Policy of 1982, provides for specific requirements for USAID-supported
programs that include voluntary sterilization. These requirements include informed consent,
ready access to other methods, and guidelines on incentive payments, which define payments
to acceptors, providers and referral agents. This is referred to as the PD-3 provision.
C. USAID strongly restricts the use of its resources for activities that directly or indirectly help
promote abortion as a family planning method. These principles are embodied in the
provisions of the different US Government family planning statutory and policy requirements.
Although, the Mexico City Policy was rescinded in January 2009 and is no longer relevant, all
other abortion-related legislative and statutory requirements remain intact and shall be
enforced:
1. The Helms amendment prohibits the use of funds for the performance of abortion as a
family planning method or to motivate or coerce any person to practice abortions.
2. The Leahy amendment clarifies the term “motivate” as it relates to family planning
assistance saying it shall not be construed to prohibit the provision, consistent with local
law, of information or counseling about all pregnancy options.
3. The Siljander amendment prohibits US government funds from being used to lobby for or
against abortions.
4. The Biden amendment restricts the use of funds for biomedical research that relates to
performance of abortions or involuntary sterilization.
5. The Kemp-Kasten amendment guards against using US funds for involuntary sterilization
or coercive abortions.
6. The DeConcini amendment provision limits the use of funds only to voluntary family
planning projects which offer, either directly or through referral to, or information about
access to, a broad range of family planning methods and services.
7. Livingston-Obey amendment requires that in awarding grants for natural family planning,
no applicant shall be discriminated against because of such applicant’s religious or
conscientious commitment to offer only natural family planning; and, additionally, all such
applicants shall comply with the requirements of the DeConcini Amendment.
PLANNING FOR ICV COMPLIANCE MONITORING

USAID-funded projects are required to develop ICV compliance monitoring plans. These plans contain
recommended plans of actions that continually improve quality of care by ensuring ICV is protected and
upheld at all times and that would prevent the commission of violations and reduce vulnerabilities
against ICV principles.
There are three levels in which projects can develop plans of action to avoid violations. These are:
1. Project- level – actions that project staff can do in collaboration with other USAID projects.
a. Activities that individual staff will conduct for internal use or benefit (such as annually
accomplishing the US Government’s online e-learning course on family planning legislative
compliance)
b. Activities that projects will conduct to help others (the next level) preempt, prevent or
avoid vulnerabilities or outright violations of the policies (such as develop ICV materials to
be used in orienting staff)
2. Project-partners level – these are activities that projects should expect partners to conduct or
comply with as part of the terms of partnership.
a. Internal or intra-organizational activities – among its staff or as assistance to its own
partners (such as heads or leaders of the partner organization are expected to orient their
own staff on ICV policies)
b. Activities to be conducted by the partner-organizations’ partner implementers or actual
service providers (such as post the all-family planning methods posters in every clinic under
the partner organization)
3. In areas not directly covered by the project, some minimum activities will have to be conducted
to ensure compliance and prevention of vulnerabilities or violations (such as conducting ICV
orientations for health officers through the DOH Regional Offices (DOH-ROs)).
Proposed types of actions and specific activities for each level are collated and summarized in the matrix
in Annex A. This matrix guides staff in the conduct of activities relating to the project, its partners, and
the context in which the project operates. Implementing activities at these three levels has three overall
objectives for ensuring ICV policy compliance: 1) expand or increase the awareness on ICV policies
from project central and field personnel to project partners, grantees, and allied service providers; 2)
strengthen project implementation of internal controls and partner organization’s capabilities; and 3)
improve monitoring, evaluation and feedback systems to provide better information, decision-making,
and further improvement of operational policies.
NECESSARY ACTIONS TO ENSURE ICV COMPLIANCE

To ensure full compliance with local and US policies on informed choice and voluntarism, and the
unacceptability of abortion as a method of family planning, projects should exhaust all efforts, including
but not necessarily limited to the following:
1. The inclusion of US government family planning policies and statutory requirements as standard
provisions in grants and sub-contracts (see Annex B),
2. Inclusion of Philippine government family planning policies related to ICV as standard provisions
in grants and subcontracts
3. ICV-related activities for grants and subcontracts awardees, such as:
a. explanation to the grantees/subcontractors the conditions for funds utilization provided for
in the various family planning and abortion-related policy requirements as early as cost
negotiations stage
b. orientation on ICV for grants and subcontracts recipients
c. in the course of the partners implementation of its activities, the partner (grantee or
subcontractor) should be required to accomplish a Partner Level Checklist for
Implementation of ICV Policy Requirements (sample in Annex C)
d. partners submit signed forms of Commitment to Compliance with ICV Policy Requirements
(see Annex D).
e. grantees/subcontractors to obtain from its partners/implementers signed compliance
commitment forms (Annex D).
f. grantees/subcontractors integrate in their information provision, monitoring activities
regarding ICV compliance, utilizing the recommended forms in this plan.
g. grantees/subcontractors integrate ICV orientation into its general human resource
orientation for newly hired staff.
h. grantees/subcontractors monitor and submit reports on ICV compliance on a quarterly
basis
4. Inclusion of orientation on ICV as an issue of quality of care and as basic information and
principles imparted to recipients of project-funded training for family planning service providers.
a. inclusion of signed commitment to comply with ICV policies in registration forms for
supported training courses (Annex D)
b. requiring all trainers to submit at the end of each training course ICV Policy Compliance
Information Dissemination Certificate (Annex E) certifying that the trainees had received
information on these policies during the training and had understood the implications of
non-compliance with the same.
5. Distribution of the latest family planning reference book, the Family Planning: A Global
Handbook for Providers, to grantees, subcontractors and project partner family planning service
providers.
6. Distribution of the all-methods family planning wall poster and desk flipcharts to all partner
family planning service providers.
7. Require grantees/subcontractors to ensure that the all-methods family planning wall posters and
desk flipcharts are available in their network of clinics and providers.
8. Mandatory annual accomplishment of the web-based e-learning course on United Stattes
government family planning policies and statutory requirements for all project staff
9. Technical staff participation in inter-agency ICV compliance monitoring orientation-training
workshops.
10. Formation of a committee, or ICV compliance core team, with the following core members:
a. a point or focal person who will be responsible for all activities related to the
implementation and monitoring of ICV compliance in all project-assisted areas as part of
their scope of work;
b. a focal person as secretariat at the national office who shall be responsible for
documentation, submission and filing of all ICV compliance-related documents
c. a quality specialist, or equivalent, designated as over-all focal person for ICV at the national
level, mandated to collate/consolidate all reports from project sites, document
vulnerabilities, organize trainings or orientation, and materials
11. Whenever and wherever applicable and practicable, inclusion of ICV policies and compliance
discussions in all meetings, presentations and conferences whether as formal orientations or
informal reminders to audiences – such as grants pre-award orientations, private practicing
midwives consultative working group meetings, grants final technical and cost negotiations with
proponents, regular visits to partners, and others.
12. Regular reporting of ICV compliance activities from the field and regional office based staff.
13. Development and implementation of a functional monitoring and reporting system within the
project.
14. Train public and private partners to enact local policies and ensure programs are consistent with
Philippine laws respecting, upholding, enabling Filipinos to exercise their right to be informed,
choose, act on their choices, access quality family planning and maternal and child health services
(FP-MCH) information, products and services.
ORIENTATION OF PARTNERS AND SERVICE PROVIDERS ON ICV

This section of the document presents details of how to conduct an orientation on ICV for project
partners and service providers. The one-day orientation is designed for public and private service
providers in different settings, including rural health units, community health stations, public and private
hospitals, birthing homes and private midwife clinics. A similar general orientation design and tools can
be used for project grantee and subcontract partners.
While the focus of this orientation is on ICV, the conduct of this orientation with partners is also a good
opportunity to consider including additional modules on environmental impact mitigation and/or gender.
Objectives
General Objective: To enable public and private hospitals to strengthen its family planning provision and
use in compliance with government policies on ICV [and promotion of gender equality and
environmental mitigation, if desired].
Specific Objectives: At the end of the one-day orientation the participants will be able to: (1) understand
the principles of ICV-compliant [gender responsive and environment-friendly] family planning
information, product and service provision to clients based on relevant Philippine Government family
planning statutory and policy requirements; (2) determine what is ICV-compliant family planning
provision and discuss what constitutes vulnerability or violation; (3) adapt the provisions/guidelines of
the DOH AO on ICV [and environmental mitigation] measures to local realities of the hospital; and (4)
plan for next steps to strengthen family planning program implementation.
Preparation
The orientation is supported by a PowerPoint presentation (Annex F), thus requiring the availability of
some technology where this orientation will take place. Otherwise, the presentation may be printed and
converted into transparencies, or participants may be given printed hand-outs to take home or make
notes on during the presentation.
The PowerPoint presentation includes suggested talking points or script to help the facilitator present
the material. Answers and explanations to case studies are included. The presenter must study the notes
well ahead of the presentation itself in order to be familiar with the content and script. It would be best
to get additional background information on quality of care in family planning in order to provide clear
examples or illustration for each of the client’s rights and provider’s needs. (Annex G is a summary of
these clients’ rights and providers’ needs. This was taken from EngenderHealth’s COPE: Client-Oriented
Provider-Efficient Services Manual which is a good resource material on the subject).
The presenter must likewise be familiar with the National Family Planning Program Policy (DOH AO 50-
A s. 2001), a copy of which is attached here as Annex H. The slide deck also includes additional slides on
the Magna Carta of Women and the DOH Administrative Order 2011-0005, Guidelines on Ensuring
Quality Standards in the Delivery of Family Planning Program and Services through Compliance to
Informed Choice and Voluntarism.
Suggested Activity Flow
Time Activity Person Responsible

8:30 – 9:00 Registration Host
Pre-test (see Annex I)
Invocation
National Anthem
Introduction of Participants
Welcome Message
Objectives
9:00 – 11:00 Session 1 - Presentation: DOH family planning program DOH-RO
Session 2 - Presentation: Broad range of family planning Local government
methods unit (LGU) Family
Planning
Coordinator
11:00 – 12:00 Session 3 - Presentation: Overview and review of national Project
laws and policies related to ICV presented as quality of care in
the Philippine setting; DOH Administrative Order 2011- 005:
Guidelines on Ensuring Quality Standards in the Delivery of
Family Planning Program and Services through Compliance to
Informed Choice and Voluntarism
1:30 – 2:30 Session 4 - Workshop: Identification of gaps related to DOH Host and Project
AO on ICV, and responsiveness of family planning services in
your health care facility
Session 5 - Workshop: Planning workshop in response to
identified gaps
2:30 – 3:30 Session 6 – Plenary Discussion: Issues and concerns regarding Project
the identified activities/strategies to improve FP-MCH
provision
3:30 – 4: 00 Synthesis Host
Post-test (see Annex I) Project
Closing Remarks Host
MONITORING OF COMPLIANCE TO ICV POLICY REQUIREMENTS

Annexes J, K and L provide the tools necessary to monitor ICV compliance at the facility level.
The tool in Annex J is for use with facility managers, supervisors and providers. It is intended to serve as
a rapid assessment of national family planning policy compliance. It is not necessary to follow this tool
verbatim, but rather during the course of conversation to obtain the information requested it may be
necessary to ask additional questions and probe deeper to obtain details about a given issue. It is the
responsibility of the user to continue the in-depth discussion to the point necessary to gather all the
necessary information and provide a comprehensive report to the ICV compliance core team. This tool
is intended to serve as a guide to the interviewer. It is not necessary to fill in the guide during the
interview. However, for record keeping purposes, please fill in the tool immediately following the
interview and submit the form to the appropriate entity within your respective office.
When all pertinent questions in the interview have been asked and answered, all feedback and
comments have been taken, be sure to address the service provider’s questions, issues or concerns. Do
not leave the interview without addressing issues that you had noted during the interview.
Annex K provides a tool for interviewing family planning clients at the facility. The results of this tool
must be reported jointly with the results of the assessment tool for facility managers and providers. If
the results obtained by the two tools do not match, further investigation will be required. When
conducting site visits for interviews, ICV monitors should also briefly take the time to make some
observations at the facility. A checklist for this purpose is in Annex L.
Based on the answers to the questions in this tool and the facility tool, the interviewer will draw a
conclusion as whether there is a potential vulnerability in a service delivery site or whether there is a
potential violation of legislative and policy requirements to ensure quality of care initiatives in family
planning. If during the use of the tool there is a ‘red flag’ that indicates a potential violation, it is
necessary to report the potential violation immediately to the ICV compliance core team and
appropriate USAID representative to initiate an in-depth investigation.
Should vulnerabilities or violations occur at anytime, anywhere, the project partner or staff who
identifies such a situation must immediately report it to the project focal person or team for ICV. The
latter shall then help facilitate the documentation of the alleged possible vulnerability or violation by
filling up a reporting or incident report form (sample in Annex M). This signed report will then be faxed
or scanned/emailed immediately to the project focal person who will then notify the Chief of Party. The
project Chief of Party is required to notify the USAID Office of Health through its Agreement/Contract
Officer Representative within 72 hours of being aware of the possible vulnerability or violation, if it is
related to targeting or coercive issues.
USAID will conduct the investigations together with the DOH to determine whether a violation has
been committed or not. USAID Philippines will then communicate with USAID Washington for the next
steps. In the event that a violation has indeed been committed, USAID Washington is required by law to
report such violation to the United States Congress. The project will await instructions from USAID for
the next steps. Relationships should continue. Feedback must be given to the partner and the DOH-RO
explaining the situation and the steps being taken.
TRAINING OF STAFF AND PARTNERS ON ICV MONITORING

To build the capacity and stewardship role of local partners, particularly DOH-ROs and LGUs, to
monitor ICV related issues in their locality, it is advisable to also work with these partners to establish
ICV monitoring teams at the local level. Training of these teams is described in this section of the
document. The same training outline can be used for training project staff. Environmental mitigation
monitoring may also be included in the training, if this component is included in the remit of the ICV
compliance monitoring team.
Objectives
General Objective: To enable project personnel/local stewards to facilitate attainment of family planning
outcomes by strengthening information, service, product provision and use.
Specific Objectives: At the end of training participants will be able to: (1) understand the principles of
ICV in family planning service provision; (2) determine what ICV-compliant family planning provision is;
(3) demonstrate the use of monitoring tools for family planning clients and service providers for the ICV
compliance; (4) identify needs for improvement of the local service delivery network in relation to
provision of ICV-compliant family planning information, product and services to clients; adopt a
monitoring and reporting system for family planning policy compliance in relation to local realities; and
(5) plan for next steps to strengthen family planning provision and use, and the local health referral
system, as mandated by the DOH AO on ICV;
Preparation
All preparatory activities outlined in the section above are also relevant to this training for ICV
monitoring teams. In addition, it is important that all participants in this training have a basic, scientific,
evidence-based knowledge of all family planning methods, and have read and understood the DOH
Administrative Order on ICV.
Program of Activities
Date/Time Activity/Topics Facilitator/Speaker
DAY 1
9:00- 10:00 Pre-test (see Annex I) Project
Opening Message DOH-RO
Objectives and Expectations DOH-RO
10:00 – 11:00 Session 1 - Presentation: DOH family planning DOH-RO
program
Session 2 - Presentation: Broad range of family
planning methods
11:00 – 12:00 Session 3 - Presentation: Overview and review of Project
national laws and policies related to ICV presented as
quality of care in the Philippine setting; DOH
Administrative Order 2011- 005: Guidelines on
Ensuring Quality Standards in the Delivery of Family
Planning Program and Services through Compliance to
1:00 – 3:00 Session 4 – Workshop: Identification of gaps related to Project and DOH-RO
ICV compliance in respective geographical areas
Followed by plenary session
3:00 – 4:00 Session 5 – Presentation: Familiarization with the Project
monitoring tools, reporting forms, reporting systems
and lines of reporting
Followed by open forum
4:00 – 5:00 Session 6 – Workshop: Familiarization with the Project and DOH-RO
monitoring tools through role playing, and discussions
DAY 2
8:30 – 9:00 Recap of Day 1 Project
9:00 – 11:00 Session 6 – Practicum: Hands-on ICV compliance Participants travel to
monitoring in family planning (Annex N) identified facilities
11:00 – 12:00 Session 7 – Plenary: Discussions on issues and Project
concerns regarding compliance to ICV and
environmental mitigation as experienced during the
practicum
1:00 – 4:15 Session 8 - Workshop: Planning for next steps in Project and DOH-RO
implementing ICV compliance (Annex O)
4:15 – 5:00 Synthesis DOH-RO
Post-test (see Annex I) PRISM2
Closing Remarks DOH-RO
ENSURING COMPLIANCE WITH ENVIRONMENTAL MITIGATION POLICIES

Healthcare waste contains potentially harmful microorganisms which can infect patients, healthcare
workers and the general public. Healthcare service provision generates waste, 80% of which is
considered to be general waste in nature, while, 20% is considered hazardous—infectious, toxic or
radioactive. About 1% of the total waste is composed of sharps. Annually, an estimated 16,000 million
injections are administered worldwide, but not all needles and syringes are properly disposed of
afterwards. About 3% of healthcare waste are chemicals and pharmaceuticals. Around 1% of the total
healthcare waste contains genotoxic waste, radioactive matter and heavy metal content.
There are policies that govern healthcare waste management. The DOH has published the Health Care
Waste Management Manual1. Likewise, the DOH and Department of Environment and Natural
Resources (DENR) issued the Joint Administrative Order 02, series of 2005 which presents policies and
guidelines for the effective and proper handling, collection, transport, treatment, storage, disposal of
healthcare waste (Annex P). The Philippine Health Insurance Corporation (PhilHealth) likewise has its
accreditation standards related to environmental mitigation (Annex Q).
It is therefore incumbent upon health projects to comply with these policies, including projects that
conduct activities that do not directly produce waste. Projects can develop a work plan on
environmental compliance monitoring. Some of the activities to be considered are described below.
1. Internally within the project, develop reporting mechanisms, reporting tools

 Collaborate with field staff in the conduct of compliance monitoring
 Utilize compliance monitoring reports to tighten technical assistance to partners
 Integrate environment mitigation and monitoring with relevant project technical initiatives
2. In collaboration with other USAID partners, develop reporting mechanisms and tools
 Collaborate with other USAID partners at the national level to improve tools, monitoring
and reporting systems
3. Assist DOH, LGUs and project partners to develop local policies/program on environmental
mitigation monitoring related to management/disposal of potentially hazardous waste in FP-
MCH provision and use:
 Orient grantees on environmental compliance and monitoring. A sample PowerPoint
presentation, designed for use with private practicing midwives, which could be adapted for
this purpose is included in Annex R.
 Collaborate with grantees and other partners regarding activities related to environment
mitigation monitoring and reporting
 Collaborate with grantees and other project partners on support activities related to
environmental mitigation specifically on health care waste management such as simple
product inventory mechanisms, expired pharmaceutical products, sharps, etc
 Together with grantees, conduct monitoring among health care facilities of partners
 Feedback the information that will be generated to local stewards to be used in their
program implementation reviews, annual operational planning, regular technical meetings for
immediate operational resolution and to fast track compliance to LGU, DOH and PhilHealth
standards on environmental mitigation and protection
1
http://www.doh.gov.ph/sites/default/files/Health_Care_Waste_Management_Manual.pdf
 Together with local stewards, gather local policies passed and programs implemented by
LGUs and other partners in relation to environmental mitigation. Evaluate these policies as
their relevance to FP-MCH provision and use
 Develop technical initiatives to assist partners in improving implementation of environmental
mitigation and protection measures in relation to FP-MCH services, product provision and
use
4. Support DOH-ROs and local stewards in institutionalizing LGU-wide continuous quality

improvement in localities that include environmental mitigation and monitoring as part of
improving safety in FP-MCH provision and use:
 Package the process documentation, results of quality assessment and monitoring,
environmental [and ICV] compliance monitoring as basis of strategic and annual operational
planning
 Develop materials, activity designs, planning tools for local planning to improve quality FP-
MCH services, products, information provision and use
Project staff, together with LGUs and partners can conduct a baseline assessment of environmental
mitigation and decide on the frequency of monitoring visits. A simplified environmental compliance tool
is found in Annex S.
Stewards and public health managers of DOH-ROs and LGUs can utilize the results of the environment
compliance monitoring to further assist health care providers to set up structures and mechanisms to
ensure that their practices protect the environment and do not further contribute to its degradation.
Further, the results can then be forwarded to the regulatory bodies of the DOH-RO and LGUs, as well
as to the local PhilHealth office, to ensure compliance of individual health care providers. Figure 1 below
shows a simplified workflow on monitoring and feedback.
Figure 1. Operationalizing the Environmental Compliance Monitoring
Technical experts assess & monitor compliance

of health care facilities to policies related to
environmental protection
Results are forwarded to licensing offices of Results are fed back to managers of health
DOH RO & LGU, accreditation body of local care facilities for them to improve their
Philhealth office practices & structures, if necessary
DOH RO, LGU, Philhealth conduct individual

assessment prior to awarding of license &
accreditation
ANNEXES
Annex A: Matrix of Possible Actions to Ensure Compliance with ICV Mandates

Annex B: Contractual Provisions Relevant to ICV in Family Planning
Annex C: Partner Level Checklist for Implementation of ICV Policy Requirements
Annex D: Commitment to Compliance with ICV Policy Requirements
Annex E: ICV Policy Compliance Information Dissemination Certificate
Annex F: Informed Choice and Voluntarism as a Quality Issue in FP-MCH (PowerPoint)
Annex G: The Rights of Clients
Annex H: National Family Planning Program Policy (DOH AO 50-A s. 2001)
Annex I: Pre/post-Test for ICV Orientations and Trainings
Annex J: ICV Monitoring Questions for Facility Managers, Supervisors and Providers
Annex K: ICV Monitoring Questions for Clients
Annex L: ICV Monitoring Observation Checklist
Annex M: Narrative Report of Vulnerability or Possible Violation of Family Planning Policies
Annex N: Conducting an ICV Monitoring Practicum
Annex O: Guidance for Conducting an ICV Monitoring Planning Workshop
Annex P: Joint DENR and DOH AO 02, series of 2005
Annex Q: PhilHealth Benchbook Quality Standards for Health Provider Organizations
Annex R: Orientation and Compliance to Health Care Waste Management (PowerPoint)
Annex S: Environmental Compliance Assessment Tool
Annex A: Matrix of Possible Actions to Ensure Compliance with ICV Mandates
Actions Within Scope of Project Operations

Types of Actions Project Activities Activities of Project Partners Activities in Project Context
Informing those  Reproduce and distribute to staff the  Project partners participation in  Inclusion of ICV policies as part
concerned about summary sheet of US government training-orientation session on ICV of advocacy messages when
standards of ICV family planning policies and legislative policy compliance monitoring paying courtesy calls on local
compliance mandates  Project partners’ partner- chief executives
 Develop ICV policy summary sheet implementers’ participation in  Sharing/distribution of ICV
similar to above for project partners training-orientation session on ICV policy summary sheets to local
 Require staff to attend at least one policy compliance monitoring chief executives, etc.
training-orientation workshop on  Dissemination of ICV policy  Suggest inclusion of ICV policies
ICV policies and compliance summary informational sheets to into health education sessions
monitoring partners and implementers for mothers, volunteer
 All staff complete the on-line course community health workers, etc.
on the subject as required by USAID
on an annual basis
 Update, reproduce, distribute and
utilize ICV compliance monitoring
orientation tools
Training on effort  Use updated ICV compliance  Trained facilitators among partners  Open invitation to
to meet standards monitoring orientation toolkit as to ensure roll out of the orientation representatives from non-
trainers’ guide among their implementers USAID direct recipient areas to
 Conduct training of facilitators for  Incorporate ICV module or session participate in ICV policy
ICV compliance orientation sessions into orientation activities for compliance monitoring training-
among project staff (and partners) partners orientation workshops
 Maintain pool of trained trainers or  Conduct of post-training follow up
facilitators who know how to orient of trained/oriented partner-
trainees and/or project partners on implementers
ICV policies
 Continue inter-agency collaboration
for ICV

Applying  Develop ICV compliance module  Proper conduct of ICV training  Sharing of ICV compliance
standards in within providers and service sessions monitoring tools with health
providers and managers training  Regular follow-up of trained officers or supervisors from
service managers  Ensure ICV policy compliance in all partners’ implementers determining non-USAID areas
training service delivery training materials ICV compliance of trained service
 Whenever applicable, participate in providers
USAID updates or discussions on 
ICV especially with the DOH central
Applying  Check materials to ensure that they  Wide distribution of all-methods  Share with non-USAID areas the
standards in are ICV compliant such as: posters among partner all-family planning methods
providing incentives or financial rewards for FP Implementers posters in the vernacular
information to acceptance are not included  Incorporate ICV in partners’  Distribute as number of copies
clients and  Procure, request and ensure activities or advocacies such as in would allow
potential users availability of all-methods posters in their regular publications or  Challenge local health officers to
relevant languages websites reproduce and distribute
 Develop potential ICV compliance
champions among partners
Applying  Include ICV policies and monitoring  Ensure that proponent’s ICV
standards in in solicitation request, pre-award/ compliance plan is implemented;
grants, sub- implementation orientation.  Accomplish monitoring
contracts and  Include proponent ICV compliance forms/checklists;
donations in kind plan in RFP/A;  Submit compliance reports;
 Prepare ICV compliance monitoring  Sign certification of ICV orientation
checklist; participation and understanding as
 Require ICV compliance report well as commitment to monitoring
prior to tranche releases

Applying  Develop ICV monitoring system  Regular conduct of ICV monitoring  Local health officers from non-
standards in  Develop ICV reporting system integrated into partners’ regular USAID recipient areas may join
monitoring and  Standard ICV monitoring tools project monitoring activities in the monitoring activities
evaluation available  Correct use of appropriate
monitoring tools
 Propose recognition of
partners/implementers with regular
monitoring activities and best ICV
compliance practices
Applying  Regular reminders and monitoring of  Regular monitoring of ICV  Provision of ICV compliance
standards in partners compliance orientation and monitoring materials such as
providing other  Update ICV status and collate monitoring; tools, posters, reporting forms,
technical monitoring reporting results  Ensure functional referral systems etc in non-assisted areas
assistance broad range of family planning
methods availability
Documenting and  Secretariat regular monthly  Inclusion of ICV-related activities  Inclusion of ICV compliance in
reporting actions reminders to senior managers and monitoring results in partners’ regular reports from LGUs (as
to comply with regarding monitoring reports accomplishment reports should be embodied in the
standards submission coming AO on ICV)
 Inclusion of ICV-related activities
and monitoring results in quarterly
accomplishment reports
Reporting  Standard ICV Vulnerability or  Ensure access to ICV related  DOH-RO partners shall orient
incidents of Violation Incident Report Form standard forms non-assisted sites on ICV
possible violations available  Close coordination with project field vulnerability or violation
of standards teams for monitoring and reporting reporting forms and system
possible vulnerabilities or violations

Reviewing status  Regular project staff meetings to  Project partners provide feedback to  DOH-ROs and LGUs in non-
of implementing include reports, discussions and project field staff on status, issues, assisted areas provide venues
planned actions feedback on ICV compliance concerns and recommendations for for review of ICV status
monitoring status, issues, concerns ICV compliance monitoring incorporated in regular activities
and recommendations for  Inclusion of ICV reports, results, such as during maternal death
improvement best practices, updates, etc. in reviews,
 ICV focal persons to regularly project reviews by partners
review ICV compliance monitoring
status, make necessary
recommendations and implement
such needed actions to ensure active
vigilant awareness raising and
compliance among staff and partners
Annex B: Contractual Provisions Relevant to ICV in Family Planning
H. 38: VOLUNTARY POPULATION PLANNING (June 2008)
a. Requirements for Voluntary Sterilization Program. None of the funds made available under this
contract shall be used to pay for the performance of involuntary sterilization as a method of family
planning or to coerce or provide any financial incentive to any individual to practice sterilization.
b. Prohibition on Abortion-Related Activities:
(1) No funds made available under this award will be used to finance, support, or be attributed to
the following activities: (i) procurement or distribution of equipment intended to be used for the
purpose of inducing abortions as a method of family planning; (ii) special fees or incentives to any
person to coerce or motivate them to have abortions; (iii) payments to persons to perform
abortions or to solicit persons to undergo abortions; (iv) information, education, training, or
communication programs that seek to promote abortion as a method of family planning; and (v)
lobbying for or against abortion. The term "motivate", as it relates to family planning assistance, shall
not be construed to prohibit the provision, consistent with local law, of information or counseling
about all pregnancy options.
(2) No funds made available under this award will be used to pay for any biomedical research which
relates, in whole or in part, to methods of, or the performance of, abortions or involuntary
sterilizations as a means of family planning. Epidemiologic or descriptive research to assess the
incidence, extent or consequences of abortions is not precluded.
c. The contractor will insert this provision in all subcontracts.
H.39: VOLUNTARY POPULATION PLANNING ACTIVITIES - SUPPLEMENTAL REQUIREMENTS

(JANUARY 2009)
a. Voluntary Participation and Family Planning Methods:
(1) The recipient agrees to take any steps necessary to ensure that funds made available under this
award will not be used to coerce any individual to practice methods of family planning inconsistent
with such individual's moral, philosophical, or religious beliefs. Further, the recipient agrees to
conduct its activities in a manner that safeguards the rights, health and welfare of all individuals who
take part in the program.
(2) Activities which provide family planning services or information to individuals, financed in whole
or in part under this agreement, shall provide a broad range of family planning methods and services
available in the country in which the activity is conducted or shall provide information to such
individuals regarding where such methods and services may be obtained.
b. Requirements for Voluntary Family Planning Projects:
(1) A Family planning project must comply with the requirements of this paragraph.
(2) A project is a discrete activity through which a governmental or nongovernmental organization

or public international organization provides family planning services to people and for which funds
obligated under this award, or goods or services financed with such funds, are provided under this
award, except fund solely for the participation of personnel in short-term, widely attended training
conferences or programs.
(3) Service providers and referral agents in the project shall not implement or be subject to quotas
or other numerical targets of total number of births, number of family planning acceptors, or
acceptors of a particular method of family planning. Quantitative estimates or indicators of the
number of births, acceptors, and acceptors of a particular method that are used for the purpose of
budgeting, planning, or reporting with respect to the project are not quotas or targets under this
paragraph, unless service providers or referral agents in the project are required to achieve the
estimates or indicators.
(4) The project shall not include the payment of incentives, bribes, gratuities or financial rewards to
(i) any individual in exchange for becoming a family planning acceptor or (ii) any personnel
performing functions under the project for achieving a numerical quota or target of total number of
births, number of family planning acceptors, or acceptors of a particular method of contraception.
This restriction applies to salaries or payments paid or made to personnel performing functions
under the project if the amount of the salary or payment increases or decreases based on a
predetermined number of births, number of family planning acceptors, or number of acceptors of a
particular method of contraception that the personnel affect or achieve.
(5) No person shall be denied any right or benefit, including the right of access to participate in any
program of general welfare or health care, based on the person's decision not to accept family
planning services offered by the project.
(6) The project shall provide family planning acceptors comprehensible information about the health
benefits and risks of the method chosen, including those conditions that might render the use of the
method inadvisable and those adverse side effects known to be consequent to the use of the
method. This requirement may be satisfied by providing information in accordance with the medical
practices and standards and health conditions in the country where the project is conducted
through counseling, brochures, posters, or package inserts.
(7) The project shall ensure that experimental contraceptive drugs and devices and medical
procedures are provided only in the context of a scientific study in which participants are advised of
potential risks and benefits.
(8) With respect to projects for which USAID provides, or finances the contribution of,
contraceptive commodities or technical services and for which there is no subaward or contract
under this award, organization implementing a project for which such assistance is provided shall
agree that the project will comply with the requirements of this paragraph while using such
commodities or receiving such services.
(9) (i) The recipient shall notify USAID when it learns about an alleged violation in a project of the
requirements of subparagraphs (3), (4), (5) or (7) of this paragraph; (ii) The recipient shall investigate
and take appropriate corrective action, if necessary, when it learns about an alleged violation in a
project of subparagraph (6) of this paragraph and shall notify USAID about violations in a project
affecting a number of people over a period of time that indicate there is a systemic problem in the
project; (iii) The recipient shall provide USAID such additional information about violations as
USAID may request.
c. Additional Requirements for Voluntary Sterilization Programs
(1) None of the funds made available under this award shall be used to pay for the performance of
involuntary sterilization as a method of family planning or to coerce or provide any financial
incentive to any individual to practice sterilization.
(2) The recipient shall ensure that any surgical sterilization procedures supported in whole or in part
by funds from this award are performed only after the individual has voluntarily appeared at the
treatment facility and has given informed consent to the sterilization procedure. Informed consent
means the voluntary, knowing assent from the individual after being advised of the surgical procedures
to be followed, the attendant discomforts and risks, the benefits to be expected, the availability of
alternative methods of family planning, the purpose of the operation and its irreversibility, and the
option to withdraw consent at any time prior to the operation. An individual's consent is considered
voluntary if it is based upon the exercise of free choice and is not obtained by any special inducement
or any element of force, fraud, deceit, duress, or other forms of coercion or misrepresentation.
(3) Further, the recipient shall document the patient's informed consent by (i) a written consent
document in a language the patient understands and speaks, which explains the basic elements of
informed consent, as set out above, and which is signed by the individual and by the attending
physician or by the authorized assistant of the attending physician; or (ii) when a patient is unable to
read adequately a written certification by the attending physician or by the authorized assistant of the
attending physician that the basic elements of informed consent above were orally presented to the
patient, and that the patient thereafter consented to the performance of the operation. The receipt of
this oral explanation shall be acknowledged by the patient's mark on the certification and by the
signature or mark of a witness who shall speak the same language as the patient.
(4) The recipient must retain copies of informed consent forms and certification documents for each
voluntary sterilization procedure for a period of three years after performance of the sterilization
procedure.
d. Prohibition on Abortion-Related Activities:
(1) No funds made available under this award will be used to finance, support, or be attributed to the
following activities: (i) procurement or distribution of equipment intended to be used for the purpose
of inducing abortions as a method of family planning; (ii) special fees or incentives to any person to
coerce or motivate them to have abortions; (iii) payments to persons to perform abortions or to
solicit persons to undergo abortions; (iv) information, education, training, or communication programs
that seek to promote abortion as a method of family planning; and (v) lobbying for or against abortion.
The term "motivate", as it relates to family planning assistance, shall not be construed to prohibit the
provision, consistent with local law, of information or counseling about all pregnancy options.
(2) No funds made available under this award will be used to pay for any biomedical research which
relates, in whole or in part, to methods of, or the performance of, abortions or involuntary
sterilizations as a means of family planning. Epidemiologic or descriptive research to assess the
incidence, extent or consequences of abortions is not precluded.
e. The recipient shall insert this provision in all subsequent subagreements and contracts involving
family planning or population activities that will be supported in whole or in part from funds under
this award. The term subagreement means subgrants and subcooperative agreements.
Annex C: Partner Level Checklist for Implementation of ICV Policy Requirements
Name of Organization:: ____________________________________
Name of Respondent:: ____________________________________
Position in the Organization: ____________________________________
Date: ____________________________________
A. Project Partner Awareness of Family Planning Policy Requirements
1. Project partner personnel have attended an orientation on the ICV Policy Requirements from any
USAID supported project?
Yes  No
2. Is the project partner aware of any member/ /beneficiary/partner within the project that:
a. Requires or subjects family planning service providers and/or referral Yes  No

agents to meet predetermined quota or target on numbers of births, family
planning acceptors, or acceptors of a particular family planning method?
b. Provides incentives to individuals in exchange for becoming acceptors or Yes  No
to program personnel for achieving targets or quotas for numbers of
births, family planning acceptors, or acceptors of a particular family
planning method?
c. Withholds rights or benefits of employees or patients or clients who Yes  No
decide not to become family planning acceptors?
d. Provides experimental family planning methods in the context of a scientific Yes  No
study in which participants are advised of potential risks and benefits?
If response is “YES” to any of the above, kindly provide details (please include name of provider,
brief description, and action taken by project partner):
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
B. Activities for Implementing ICV Policy Requirements
1. What activities have the project partner undertaken to ensure compliance of its staff, member firms,
family planning service providers, or other partners?
Sub-agreements/memorandum of understanding with participating firms or Yes  No

grantee-partners include provisions for meeting ICV Policy Requirements.
Letter of commitment.
Orientation of participating firms/partners on ICV policy requirements Yes  No
conducted
Monitoring visits to assess grantee-partners/providers’ compliance to policy Yes  No
requirements conducted
Personnel designated to monitor and evaluate firm level provider’s Yes  No
compliance to the family planning ICV policy requirements
Poster containing information on all methods as well as information on Yes  No
health benefits, risks of method chosen, inadvisability, and adverse side
effects disseminated and posted in clinics
Facilitated the orientation or training of its partners or members’ firms’ Yes  No
service providers (doctors/nurses/midwives), etc. in family planning
counseling
2. The project partner is aware that their partners’ project management teams at the mid-level
managers, as well as service providers are required to report any alleged possible violation of the
restrictions on quotas, incentives, withholding benefits or experimental activities.
Yes  No
3. Has the grantee developed or have access to tools for monitoring and evaluating its member firms
or grantee-partners’ compliance to the family planning ICV Policy Requirements?
Yes  No
4. Are there procedures in place to report possible violations to the project?
Yes  No
Date Accomplished: ______________ Signature: ________________________

Annex D: Commitment to Compliance with ICV Policy Requirements
I,__________________________, _____________________, as a legally authorized representative

(Printed Name) (Title)
of __________________________________do hereby certify that, to the best of my knowledge and
(Organization Name)
belief, this organization's management and the employees responsible for project implementation are
aware of the policy requirements placed on the organization by […name of project…] in relation to the
following informed choice and voluntarism (ICV) policy requirements:
1. No targets or quotas shall be imposed on individual family planning service providers or referral
agents
2. No incentives shall be provided to family planning providers and family planning clients in exchange
for accepting family planning methods.
3. No denial of rights or benefits shall be imposed on those who do not accept family planning
methods
4. Comprehensible information shall be provided to family planning clients on the family planning
method they have chosen
5. Experimental family planning methods shall be used only in the context of a scientific study and with
full disclosure of information to the family planning clients
6. Informed consent shall be documented prior to procedures for those choosing sterilization services
7. Ready access to other (temporary) methods shall be ensured for those who choose sterilization
services
8. No incentive payments shall be provided to clients for undergoing sterilization services and for
family planning personnel for doing the procedure
9. To ensure informed choice, a broad range of methods shall be offered to family planning clients
directly or indirectly by family planning service providers
10. The project partner shall have no relationship with organizations managing programs of coercive
abortion or involuntary sterilization or practices that may be illegal
11. No USAID funds will be used to perform or motivate/coerce people to practice abortions
12. No USAID funds will be used for lobbying for or against abortion
13. No USAID funds will be used for any biomedical research related to abortion
14. The grantee further certifies that they will not perform or actively promote abortion as a method of
family planning.
I understand that to ensure compliance to the above mentioned informed choice and voluntarism policy
requirements, project partner will accomplish and submit to […name of project…] the Partner Level
Checklist for Implementation ICV Policy Requirements and allow […name of project…] staff and
partners to conduct formal ICV policy compliance monitoring as integrated in the regular project
monitoring visits.
I further agree that if, in spite of the efforts to comply with the ICV Policy Requirements, a possible
violation occurs at any time anywhere in the project, our organization will extend full cooperation with
[…name of project…] in immediately reporting the situation to […name of project…] and cooperating
with any subsequent investigation that may be conducted thereafter.
I declare under penalty of perjury that the foregoing is true and correct.
______________________ _____________________
Signature over printed name Date of Execution
Annex E: ICV Policy Compliance Information Dissemination Certificate
I,_________________________, ___________________, as a legally authorized trainer/facilitator

(Printed Name) (Title)
of _________________________________do hereby certify that, to the best of my knowledge and
(Organization Name)
ability I have exerted all possible efforts to disseminate accurate and comprehensive information related
to the following informed choice and voluntarism policy requirements (ICV) to all my trainees and
relevant partners responsible for project implementation:
1. No targets or quotas shall be imposed on individual family planning service providers or referral
agents
2. No incentives shall be provided to family planning providers and family planning clients in exchange
for accepting family planning methods.
3. No denial of rights or benefits shall be imposed on those who do not accept family planning
methods
4. Comprehensible information shall be provided to family planning clients on the family planning
method they have chosen
5. Experimental family planning methods shall be used only in the context of a scientific study and with
full disclosure of information to the family planning clients
6. Informed consent shall be documented prior to procedures for those choosing sterilization services
7. Ready access to other (temporary) methods shall be ensured for those who choose sterilization
services
8. No incentive payments shall be provided to clients for undergoing sterilization services and for
family planning personnel for doing the procedure
9. To ensure informed choice, a broad range of methods shall be offered to family planning clients
directly or indirectly by family planning service providers
10. The project partner shall have no relationship with organizations managing programs of coercive
abortion or involuntary sterilization or practices that may be illegal
11. No USAID funds will be used to perform or motivate/coerce people to practice abortions
12. No USAID funds will be used for lobbying for or against abortion
13. No USAID funds will be used for any biomedical research related to abortion
14. The grantee further certifies that they will not perform or actively promote abortion as a method of
family planning.
Furthermore, I understand that the trainees or participants are not just expected to be aware of these
policy requirements but, more importantly, to comply with all of them as well. In order to ensure
compliance, I have coordinated with the responsible organization regarding their responsibility to
proactively and deliberately inform and monitor their trainees, staff and all project partners whenever
and wherever the need arises.
I further agree that if, in spite of the efforts to inform and comply with the ICV policy requirements, a
possible violation occurs at any time anywhere in the project, I will extend full cooperation to […name
of project…] by immediately reporting the situation to […name of project…] and cooperating with any
subsequent investigation that may be conducted thereafter.
I declare under penalty of perjury that the foregoing is true and correct.
______________________ _____________________
Signature over printed name Date of Execution
Annex F: Informed Choice and Voluntarism as a Quality Issue in FP-MCH (PowerPoint)
NOTE: This orientation slides were prepared by the ICV

Inter CA TWG headed by PRISM II, HealthGov, and SHIELD
WELCOME
Informed Choice and

Voluntarism as a
Quality Issue in FP-MCH
Greetings
The Family Planning Program is special in a sense because,

Compliance with Policies for Ensuring unlike the other health programs that refer to their so-called
Informed Choice & Voluntarism customers as “patients”, FP customers are called “clients”
as a
Quality of Care Issue in
NOT “patients”.
Family Planning Service Delivery
Because they are NOT sick to begin with, it is very important
in FP program implementation and in the provision of its
services that due diligence is given to ensuring that Quality
of Care is provided or observed.
In the Philippines, the constitution and DOH have placed

provisions and policies in order to ensure quality of care in
FP programs.

What are the provisions in the Philippine constitution that
are relevant to the Philippine Family Planning Program?
Philippine Constitution Also, what policies have been put in place by the DOH to
Magna Carta of Women ensure quality of care in the provision of FP?
and
Department of Health
Family Planning
Program Policies
Family Planning supports this provision of the constitution in

1987 Constitution that by protecting the health and welfare of the mother and
child, FP in fact saves their lives and strengthens the family
Art. II, Sec. 12: as a basic unit of society.
The state recognizes the sanctity of
family life and shall protect and
strengthen the family as a basic The last statement of this article refers to ABORTION as
autonomous social institution. It shall being illegal in the country. FP has always been consistent
equally protect the life of the mother
and the life of the unborn from
with this article – abortion was never a method of FP in the
conception. country.
By practicing Family Planning, families are given more

1987 Constitution opportunities to improve not only their health but also their
economic status.
Art. XV, Sec. 1:
The state recognizes the family as a
Furthermore, the constitution ensures that in strengthening
foundation of the nations. the family, each individual family’s religious conviction is
Accordingly, it shall strengthen its respected. This is embodied in the next article.
solidarity and actively promote its
total development.
In fact, in order to execute the above provisions of the

1987 Constitution constitution, Executive Order 119 was issued.
Art. XV, Sec. 3.1:

The state shall defend the right of
spouses to found a family in
accordance with their religious
convictions and the demands of
responsible parenthood.
Magna Carta of Women

• Comprehensive
women’s human rights
law
• Seeks to eliminate
discrimination against
women by recognizing,
protecting, fulfilling and
promoting the rights of
Filipino women
Magna Carta of Women

• Comprehensive health services and health
information and education
• Covering all stages of a woman’s life cycle
• Addresses major causes of women’s mortality
and morbidity including access to
– maternal care
– responsible, ethical, legal, safe, and effective
methods of family planning
• Encouraging health lifestyle activities to

prevent diseases
In compliance with this executive order, the DOH has

Executive Order 119 developed their FP Program Policies and Guidelines
through it Administrative Order 50-A series of 2001 as
• Identifies Family Planning as a follows:
priority health issue and points
out that the DOH shall
“formulate plans, programs,
standards and techniques, relative
to FP in the context of family
welfare, provide consultative,
training and advisory services to
implementing agencies”.
(it is strongly suggested that the presenter read, study and

DOH FP Program Policies (DOH AO 50-A s. 2001)
internalize the A.O. 50-A s. 2001 to be totally familiar with
FP services shall be promoted based on the the provisions and to come up with illustrations or examples
ff. program policies: FP as a:
to drive home each point.)
..\..\DOH\Administrative Orders\ao50A-
01.pdf
Briefly discuss each of the 7 policy statements as they are
described in ao 50-a s.2001 that embodies the DOH FP
program policy. Remember to put a positive spin to these
presentations emphasizing overall improvement in the
general health of mothers, children, eventually communities
leading to improved quality of life for individuals and
societies/communities.
Low Levels of Contraceptive Use Threaten Filipino

Women’s Health and Undermine their Childbearing
Briefly discuss each of the 7 policy statements as they are
Desires. described in ao 50-a s.2001 that embodies the DOH FP
1.more than half of the 3.4 million annual pregnancies are program policy.
unintended,
owith 92 percent occurring to women who do not use
any contraceptive method or use a traditional one
You may want to share the FF. Findings as reported in the
2.“expanding access to contraception could result in Guttmacher Institute News Release. Low Levels of
a.800,000 fewer unplanned births,
b.500,000 fewer induced abortions Contraceptive Use Threaten Filipino Women’s Health and
c.200,000 fewer miscarriages. Undermine their Childbearing Desires. April 29, 2009. NY,
d.prevention of as many as 2,100 maternal deaths
each year—nearly half of all deaths from pregnancy- USA.
related causes.
- findings as reported in the Guttmacher Institute News Release.
• more than half of the 3.4 million annual pregnancies are
- April 29, 2009. NY, USA.
unintended,
o with 92 percent occurring to women who do not use
any contraceptive method or use a traditional one
• “expanding access to contraception could result in
• 800,000 fewer unplanned births,
• 500,000 fewer induced abortions and
• 200,000 fewer miscarriages.
• Prevention of as many as 2,100 maternal deaths
each year—nearly half of all deaths from
pregnancy-related causes.
DOH FP Program Service Delivery How do these program policies translate to service delivery?
Program Principles (Four Pillars in FP As a guide to service providers, the DOH came up with the
Program Implementation) following program principles…
1. Respect for the sanctity of life.
2. Respect for human rights. Again, discuss each one briefly as they are described in the
3. Freedom of choice and voluntary A.O.
decisions.
4. Respect for the rights of the clients to
determine their desired family size.
DOH Memo
In memorandum to all regional directors of all the regional
June 29, 2006 health offices or Centers for Health Development nationwide
Re: issued June 29, 2006, the DOH reiterated the importance of
Reiterating
Compliance
complying with these four pillars or guiding principles in the
with Various implementation of the FP program in the country and
Issuances
Regarding the
providing further explanations by restating the four pillars as
Guiding follows: .
Principles or
“Four Pillars”
of the Family
Planning
Program
Ensuring Informed & For example, as far as Respect for Life is concerned…
Voluntary Decision-Making:
Program Principles (Four Pillars in FP Program
Implementation)
1. Respect for life
• No to abortion; illegal in the Revised Penal Code
2. Informed choice
• Full information and voluntary decision-making
3. Birth spacing
• Birth spacing of 3 to 5 years
4. Responsible parenthood.
• The right to determine family size according to couple’s
capacity , beliefs, etc.
Aside from the fact that the actual performance of abortion is

Respect for life illegal, motivating or coercing women to practice abortions is
Not allowed: NOT allowed.
 to perform or motivate/ coerce people to Neither is it allowed to conduct biomedical research related
practice abortions
to abortions
 any biomedical research related to abortion In addition, if your NGO or the LGU or other stakeholders
are receiving funds from the U.S. government, aside from
the above prohibitions, you are also not allowed to use US
Government monies to lobby either for or against abortion.
This last provision is not stated in this slide because funds

from any other source (other than US Government) may be
used for whatever purposes those funds recipients may
want to use them – including for lobbying for or against
abortion.
However, the management or treatment of women with

Respect for life injuries or illnesses resulting from abortion – whether
induced or spontaneous – is allowed. There should be no
Care of post-abortion women is discrimination or preferential treatment of women with
allowed:
spontaneous abortion as against those who had their
abortions intentionally carried out.
Organizations or service providers
may and should treat injuries or
illnesses caused by abortions –
whether spontaneous or induced.
Ensuring Informed & Let’s now discuss the second pillar – Informed choice
Voluntary Decision-Making:
Program Principles (Four Pillars in FP Program We ensure this by doing good family planning counseling:
Implementation)
the objective of which is – client makes the decision and that
1. Respect for life
• No to abortion; illegal in the Revised Penal Code
decision is made based on adequate information…
2. Informed choice
• Full information and voluntary decision-making
3. Birth spacing
• Birth spacing of 3 to 5 years
4. Responsible parenthood.
• The right to determine family size according to couple’s
capacity , beliefs, etc.

• effective access to information on a wide
variety of family planning choices and
services;
• accurate information is provided,
including the benefits of using family
planning and the health benefits and
risks of particular methods;
• allow people to choose voluntarily and
freely whether to use family planning or
a specific family planning method;
Private Sector Mobilization for Family Health -
Phase 2 (PRISM 2)

• Counseling is important in ensuring that
clients make informed choice
• The face-to-face meeting between a client and

provider may be the only chance the client has
to;
• ask questions,
• express concerns, or
• learn about different methods from someone who is
knowledgeable and concerned.

Phase 2 (PRISM 2)

Freedom to use FP or not to use:
• Without coercion or constraint
• No pressure to use one method over the

other

Phase 2 (PRISM 2)

Broad range of FP methods and
services:
• are available WHERE and WHEN they

are needed
• Referrals and linkages are ACTIVE

Phase 2 (PRISM 2)
To ensure that there is no coercion in the decision making of

Informed choice and voluntary decisions FP clients, FP service providers are prohibited from having
numerical targets, quotas on number of births, number of FP
1. Service providers or referral agents acceptors or methods.
shall not implement or be subject to
quotas, or other numerical targets, of
total number of births, number of
The DOH through a memorandum issued last September
family planning acceptors, or 2006 reiterated this prohibition of setting targets and quotas
acceptors of a particular FP method
DOH Memo It should be noted that targets and quotas for FP programs
Sept. 1, 2006 per se is actually allowed for as long as these targets are
Re: not passed on as targets or quotas assigned to or required
of individual FP service providers. Targets for programming
Prohibition of
Setting and budgeting purposes are actually allowed but these
Service numbers should not be passed on to individual health
Quotas or
Targets For workers or referral agents as assigned or required target
Family numbers or quotas.
Planning
Program
Let us further define these terms…
No targets or quotas This guideline states that: “service providers or referral

agents in the project shall not implement or be subject to
• Service providers or referral agents shall not quotas, or other numerical targets, of total number of births,
implement or be subject to quotas, or other
numerical targets, of total number of births,
number of family planning acceptors, or acceptors of a
number of family planning acceptors, or particular method of family planning (this provision shall not
be construed to include the use of quantitative estimates or
• Permits numerical estimates for planning and
indicators for budgeting and planning purposes)…”
budgeting
• Manufacturer, distributor, retailer overall sales

targets permitted “Target” is a word that is often loosely used in family
planning and other public health programs.
Targets that are not allowed under this provision are those
that are:
(1) predetermined;
(2) assigned to a specific health worker and
(3) enforced, or of consequence.
For example, if a fieldworker develops monthly targets for

herself based on door to door
surveys in which she asks about women’s desire to have
more children and she is not
required to meet those targets, these are not “targets” that
are prohibited.
On the other hand, “production” targets -- defined in terms of

predetermined numbers of birth or family planning
acceptors, which are assigned to a fieldworker and which
the fieldworker is required to achieve -- are prohibited.
Assigning of targets to a mid-level health program manager

or supervisor would also be considered problematic or a
possible source of vulnerability because these supervisors
are quite likely to pass on their targets to the individual field

workers.
Sales targets are considered standard practice and are,

thus, not prohibited.
Developing targets for planning purposes, e.g. to influence

resource allocation, is not a
problem. However, provider-level targets, which are
assigned and required, are prohibited.
The following case studies will serve to illustrate and provide

Clarification us with a better understanding of these guidelines.
Quota or target = a predetermined

number of births, FP acceptors or
acceptors of a certain FP method that a
service provider or referral agent is
required to achieve
Case Studies: Targets and Quotas

EXAMPLES FOR THE PRIVATE SECTOR:
1) Case # 1: A private midwife’s business plan 1) A private midwife’s business plan states that for her to
states that for her to break even, she needs
to have at least 10 deliveries and 10 IUD
break even, she needs to have at least 10 deliveries and
insertions in her clinic a month. 10 IUD insertions in her clinic a month.
While there seems to be target setting here, this does not

2) Case # 2: When the midwife-owner of the
clinic discovers that her employed midwife constitute a violation since these targets are part of the
failed to insert the required 5 IUD insertions clinic’s business plan. The monitor however must make
per month, she deducts 10% from her salary.
sure that these are NOT pre-determined numbers of
births, or FP acceptors, or of FP acceptors of a particular
method, that are passed on as quotas or target
accomplishments to individual midwives or volunteer
health workers as basis for their salaries or performance
ratings, or rewards, benefits, this is not a violation.
2) When the midwife-owner of the clinic discovers that her

employed midwife failed to insert the required 5 IUD
insertions per month, she deducts 10% from her salary.
This is quite clearly a violation of the FP policy against

setting pre-determined targets that individual service
providers will be required to achieve.
Case Studies: Targets and Quotas

EXAMPLES FOR THE PUBLIC SECTOR:
3) Case # 3: Community health workers have 1) Community health workers have annual workload
annual workload projections for family projections for family planning clients, based on community
planning clients, based on community needs
assessments.
needs assessments.
4) Case # 4: Outreach workers are scolded, In some countries, community needs assessments are used
salary is withheld, or they may be transferred to help field workers learn the needs for reproductive,
to other sites when they do not achieve their maternal, and child health services as defined by the clients
workload projections.
themselves. The field worker then estimates what proportion
of the demand can be met during the year, in order to plan
for supplies and other requirements. This is not a violation,
unless there are consequences for individual health
workers for achieving (or not) the workload projected
(see Case study #2).
In order to confirm whether “annual workload projections”

are violations or not, one needs to review the process by
which these numbers are derived (e.g. whether they are
“predetermined” by managers), whether they are assigned
to individual workers as performance goals, and what
happens if the numbers are not achieved.
2) Outreach workers are scolded, salary is withheld, or they

may be transferred to other sites when they do not achieve
their workload projections.
If a health worker could prove that he or she was punished

in some way for not achieving workload projections, then
these projections would be functioning as “quotas” and this
could be a violation. However, finding and addressing the
cause for poor performance (of a site or an individual) is a
routine part of supervision. An effective supervisory system
would document whatever steps were taken to determine
why workload projections were not met. An investigation of
this situation would include tracking the communication of
job expectations between the supervisor and the workers, to
confirm whether “predetermined” numbers were being used
to measure job performance, and whether the action taken
in regards to the worker reflected qualitative as well as
quantitative measures of performance.
READ THE CONTENTS OF THE SLIDE

Informed choice and voluntary decisions
1. Service providers or referral agents shall not implement or be subject
to quotas, or other numerical targets, of total number of births,
The second provision under the freedom or choice and
number of family planning acceptors, or acceptors of a particular FP
method voluntary decision-making is the prohibition of providing
2. No payment of incentives, bribes, gratuities incentives to FP clients or to service providers.
or financial reward to:
a. An individual in exchange for becoming a
FP acceptor; or, “Incentives, bribes, gratuities, or financial reward” are
b. program personnel for achieving a defined to require the transfer of an item of value in order to
numerical target or quota of total number
of births, number of FP acceptors, or influence a specific behavior (e.g. acceptance of a family
acceptors of a particular FP method planning method, or recruiting clients to achieve targets).
The policy requirements prohibit the payment of “incentives”

to individuals for becoming acceptors. In order to qualify as
an “incentive”, such payments must be a material or
significant factor in the client’s decision to become an FP
acceptor. Reasonable reimbursement for medicine, food,
medical supplies, or transportation expenses paid by the
client are not considered incentives.
With respect to program personnel, a violation occurs only if

Clarification the clinic makes a payment or reward to an individual worker
for achieving a numerical quota or target, expressed as a
Provider payments violate the provision only
when payment is based on a quota or “predetermined number” of FP acceptors, acceptors of a
target set as a predetermined number of particular method of FP, or total number of births.
total births, or number of FP acceptors,
or, number of acceptors of a particular
FP method.
The following would be permitted:

Clarification
• Fee for service payments to family planning providers
Provider payments violate the provision only when payment is based on
a quota or target set as a predetermined number of total
births, or number of FP acceptors, or, number of acceptors
of a particular FP method. •Non-financial, small-value items that are provided across
Permitted: the board to project personnel or to individuals to
•Small-value items given to all providers not acknowledge general good performance
connected to a target; or as reward for
general overall good work; •Distribution of promotional items, e.g. social marketing
•Per case payment to all providers materials
•Standard commercial discounts in social marketing
programs
Case Studies: Incentives for Clients 5) The best “performing” health centers in a program receive
and/or Providers supplies and/or equipment as rewards, based on health
indicators including family planning acceptance.
5) Case #5: The best “performing” health
centers in a program receive supplies and/or
The FP Policy Requirement applies to incentives or rewards
equipment as rewards, based on health being given to “program personnel for achieving a numerical
indicators including family planning acceptance. target or quota” only the following three items: on total
number of births, number of FP acceptors or number of
acceptors of a particular method. Such “personnel” are not
limited to providers or outreach workers, but can also
include program managers. When a health center as an
institution is rewarded for the performance of its staff
overall, the rewards are presumably not given to
individual staff, and it would not be a violation.
However, it would still be wise to determine if the group

performance goals are in any way translated into
targets or quotas for individual staff members, and if
clients perceive any pressure in their decision-making
that can be linked to providers wanting to meet
performance targets in order to receive the rewards for the
institution.
Third item under freedom of choice and voluntary decisions

Informed choice and voluntary decisions involves the denial of rights and benefits to those NOT
1. Service providers or referral agents shall not implement or be
subject to quotas, or other numerical targets, of total number
accepting FP
of births, number of family planning acceptors, or acceptors of a
particular FP method
2. No payment of incentives, bribes, gratuities or financial reward

to:
a. An individual in exchange for becoming a FP acceptor; or,
b. program personnel for achieving a numerical target or
quota of total number of births, number of FP acceptors, or
3. No denial of rights and benefits for those

who do not accept FP
No Denial of Rights or Benefits Based on FP projects shall not deny any right or benefit, including the
Decision not to Accept FP
right of access to participate in any program of general
Examples: welfare or the right of access to health care, as a
consequence of any individual's decision not to accept
• Food assistance or health benefits not family planning services…”
dependent upon accepting FP services
FP Policy requirements prohibits the tying of rights or
• Employment positions or privileges not
limited to FP users benefits, including legal privileges and powers, to the
decision to accept a method of family planning, or not.
Examples of violations would include denying access to
health care, access of food programs, or employment to
those people who do not accept family planning.
The service delivery site project is usually considered as the

“actor” in this denial of benefits. An example of a violation is
a threat of the denial of free health services to a client
unless she agreed to be sterilized.
Also, service delivery programs may express strong

preferences for fieldworkers who are currently using
contraception or have small families. Such conditions can be
encouraged in job applicants, but they cannot be required.
6) Government jobs are limited to those who have no more

Case Studies: Denial of Rights or Benefits
than two children.
6) Case # 6: Government jobs are limited to The “denial of benefits” relates to consequences of not
those who have no more than two children. accepting family planning. But having a small family is not
the same as being a family planning acceptor, so there’s no
7) Case # 7: Community-based distribution
direct connection between this situation and the policy of
(CBD) workers must be family planning informed choice. However, the impact of this policy on
acceptors themselves. decision-making by couples should be considered, to see
what effect it may have on informed choice and whether it
reflects positively or negatively on family planning services
in general (e.g., that they are seen as being driven by the
government’s needs and priorities and not reflecting the
needs and concerns of individuals).
7) Community-based distribution (CBD) workers must be

family planning acceptors themselves.
By definition, the CBD workers would be part of a “service

delivery project”. Selection criteria that strictly require that
CBD workers must use family planning themselves
would constitute a violation of the policies that “the project
shall not deny any right or benefit…as a consequence of
any individual’s decision not to accept family planning
services”. However, it is generally true that the majority of
CBD workers use family planning and that they feel that
their credibility is strengthened as a result. Therefore, the
wording of selection criteria for CBD workers should refer to
“family planning acceptors preferred” or “family planning
users encouraged to apply”.
The policy guideline provides that FP projects MUST
Informed choice and voluntary decisions provide family planning acceptors comprehensible
information on the health benefits and risks of the method
chosen, including those conditions that might render the
4. Comprehensible information on use of the method inadvisable and those adverse side
chosen FP method
effects known to be consequent to the use of the method…
Comprehensible Information Clients choosing a particular FP method must be provided

all pertinent information regarding the method they have
chosen in a language that they can understand – this
Clients must receive comprehensible information includes what the method is, how it works,
information about risks, benefits, side advantages, disadvantage, possible side-effects, how to use
effects, and contraindications of their
the method, where to get it, what warning signs to watch out
chosen method
for and what to do if these occur and other information.
One of the ways that service providers can at least

Clarification demonstrate efforts to ensure informed choice in FP is by
•“Comprehensible” does not guarantee making available conspicuously displayed wall charts
information is comprehended containing the different FP methods.
•Information should be provided in accordance
with local standards
•Requirements can be met through counseling,

posters, and/or package inserts
The poster on the left is the currently available poster – this

should be prominently displayed in all clinics that
provide FP services. The poster at the right side of this
slide is the latest version that is currently still being ordered.
The latest version is now available in Tagalog and Cebuano

dialects
Although it probably is not applicable, it would be good to be

Informed choice and voluntary decisions reminded that full disclosure of information is needed for
experimental contraceptive methods – currently there is no
such experimental study going on in the country.
4. Comprehensible information on chosen FP
methods
5. Full disclosure for experimental

contraceptive methods and
procedures
(5) Full Disclosure for Experimental This provision is not relevant since there are no
Contraceptive Methods
experimental studies going on with FP methods in the
country.
• Experimental FP methods and procedures to be
provided only in the context of a scientific study
Suffice it to say that experimental contraceptive drugs and
devices and medical procedures are allowed only in the
• Client’s rights to informed consent to participate
in the study, including the knowledge of the risks context of a scientific study in which participants are advised
and benefits, as well as other options for of potential risks and benefits.
services, must be ensured
For clients choosing permanent methods, in order to ensure

Informed choice and voluntary decisions informed choice, the informed consent forms are explained
and signed by the clients prior to performance of the
4. Comprehensible information on chosen FP methods
procedure.
5. Full disclosure for experimental contraceptive
methods and procedures The next slide will show the contents of the informed
6. Informed consent documented prior to consent form
permanent methods: BTL or vasectomy
The ultimate responsibility of securing documentation of the

Informed Consent for VS informed consent – meaning, getting the Voluntary
Key requirements
Sterilization (VS) clients to sign the informed consent forms
• Informed consent documented prior to – falls on the shoulders of the FP counselor or operating
procedure room nurse assisting in the procedure at the VS site or
venue. However, all trained FP counselors and service
• Ready access to other FP methods providers are expected to explain the contents of the
informed consent forms to all potential VS clients before the
• No incentive payments actual day of the VS procedures. This is part of a normal FP
counseling session for client who chooses VS.
Included in the informed consent form is the assurance that

the VS clients were made aware of and were provided easy
access to temporary methods that they can choose from
either through direct provision or by referrals.
Again, VS clients must not be subjected to incentive

payments that will influence their decision to accept VS as
their FP method.
Guidance on payments
•Payments cannot be used as an incentive to
accept, provide, or refer for VS services.
•Certain types of payments are not considered
incentives provided they are “reasonable” and
related to the procedure.
•Determination of “reasonable” payment must be
based on country and program-specific basis
using knowledge of social and economic
circumstances.
Acceptors:
Recompense for legitimate, extra VS-related

expenses (transport, food, medicine,
lost wages during recovery period) are
not generally considered incentives if
“reasonable” and related to the
procedure.
VS Providers:
per-case payments, and compensation for

related items, are acceptable provided
they are “reasonable” so that no
financial incentive to do VS is created
Referral agents:
Payments for extra expenses incurred in

informing or referring VS clients are
acceptable provided that they are
“reasonable” and related to the
procedure.
Case Studies: Incentives for Clients and/or 8) Sterilization clients receive money, food, and/or clothing
Providers
after completing the sterilization procedure.
8) Case # 8: Sterilization clients receive money, The definition of an incentive, bribe, gratuity or financial
food, and/or clothing after completing the
sterilization procedure. reward requires the transfer of an item of value, in order to
influence or induce specific behavior by clients or program
9) Case # 9: Government employees get a pay personnel -- that is, an action occurred because of the
increase if they provide documentation of
sterilization after the birth of the second
payment. In the case of clients, such payments must be a
child. significant factor in the client’s decision to become a family
planning acceptor, in order for it to be a violation. Money,
food, or clothing given to sterilization clients is usually done
to reimburse clients for lost wages and/or out-of-pocket
expenses, and to remove cost barriers in their voluntary
choice of methods, and are not normally considered (by
providers) to be significant factors in the client’s decision.
However, client interviews are needed to confirm whether
such reimbursements are perceived as incentives and may
actually be a factor in their decision-making.
9) Government employees get a pay increase if they provide

documentation of sterilization after the birth of the second
child.
Violation would be possible if this policy of getting a pay

increase was in fact being implemented. AS IS, this is a
HUGE vulnerability that can easily turn into a violation.
However, if the benefit is not actually provided, then this

would not constitute an “incentive” as described by the
policies. Still, the impact of this policy on decision-making by
couples should be considered, as a factor limiting informed
choice, and potentially generating negative public opinion
about family planning services in general (i.e., that they are
seen as being driven by the government’s needs and
priorities and not those of individuals).
Case Studies: Incentives for Clients and/or 10) Providers receive per-case payment for sterilization
Providers
clients.
10) Case # 10: Providers receive per-case There can be legitimate reasons for being paid more for a
payment for sterilization clients.
greater number of acceptors of a specific FP method (e.g.
sterilization) because it requires more work or skill. Thus,
providers can make more money by providing more
services, as long as there is no “predetermined number”
that they are required to achieve in order to receive
payment.
However, paying providers per “session” (that is, they are

paid for showing up and providing services over a given time
period) would probably have less risk of putting pressure on
individual clients to become acceptors, than paying
providers per client.
Informed choice and voluntary decisions
7. FP programs/projects must provide

information about and access to a broad
range of FP methods and services, either
directly or through referral.
Informed Choice (& voluntary decision-making) as a Better method use and client compliance leads to reduction
good program strategy in unplanned pregnancies and improved health
Ensuring informed choice leads to: Continued method use results from clients getting the
method they want and being prepared for side effects –
better method use and client compliance
continued method use This results in more clients that are satisfied with their
methods because they get to choose the method that is
satisfied clients are good ads
appropriate for them and are well prepared to handle
possible side effects that may or may not come with the use
of the method. These satisfied clients will be the best
promoters of the use of family planning.
Client-centered communications make

a difference!
Research tells us...
The interpersonal and informational dimensions
of services are key to clients’ perception of
service quality
Client-oriented communication that tailors
information to the individual has positive
impact on method adoption, continuation
and client satisfaction
( Abdel-Tawab and Roter, 1996; Koenig, 1997)
Giving people a choice makes a difference
Research tells us...
Use of contraception is highest when people

have access to a range of contraceptive
methods (Ross et al, 2002)
Clients who receive the method they want are

more likely to continue use (Pariani, 1991)
Informing clients about what to expect, and what is normal,

Research also tells us… reduces fear and dissatisfaction, and eases adjustment to
proper method use and client satisfaction.
A major reason clients discontinue pills and
injectables is that they are not adequately
informed about side effects
(EngenderHealth studies in Cambodia 2000 and
Nepal 2001)
Conversely, counseling about side effects

significantly increases continuation
(Lei et al, 1996, FHI Network, 1991)
These are the policies to ensure quality of care for our FP

BOTTOMLINE: and MCH clients and patients – the bottomline really is
Quality Care for Every Client quality care for every one…
A significant step towards attaining this quality of care is by

complying with these policies and thereby ensure that all
clients make voluntary and informed decisions regarding
their reproductive plans.
When we talk about quality of care in Family Planning, what

Quality of Care in FP
exactly do we mean? What comes to mind when this topic
comes up?
get responses and ideas from the participants before

providing the answer (by clicking)
These issues can be summarized into two: meeting clients’

rights and providers’ needs. When we say that we are
approaching meeting clients’ rights and making sure that
providers have what they need to provide good care, then
we are approaching delivery of quality services.
To explain further…
In the provision of FP services, quality of care is defined as

Quality of Care in FP
meeting clients’ rights and providers needs…
Clients’ Rights Providers’ Needs
More specifically, this means
•Information
•Access •Training
•Choice
•Adequate supplies and
(You may ask again what participants think are clients’ rights
•Privacy and
confidentiality good working
environment
and summarize by mentioning them one by one as you click
•Safety
•Comfort, dignity and
on the items. do the same to elicit providers’ needs. be sure
free expression •Good management
support and
to cite at least one example for each item. for your
•Continuity of care supervision reference, please read in advance appendix a: “the rights
of clients and the needs of health care staff)
TRANSITION: Let us focus our attention this morning on at

least three items on the clients’ rights’ list in order to provide
the context for discussing compliance with FP policies in
service delivery.
Annex G: The Rights of Clients

Annex H: National Family Planning Program Policy (DOH AO 50-A s. 2001)

Annex I: Pre/post-Test for ICV Orientations and Trainings
This pre/post-test contains a number of case studies. As part of the post-test each case should be
discussed in a plenary session.
1. Translating the national target for contraceptive prevalence into numerical targets for individual
health service providers is a violation of the DOH Administrative Order on Ensuring Standards in
the Delivery of Family Planning Program and Services through Compliance to Informed Choice and
Voluntarism.
____ True ____False
CORRECT ANSWER: TRUE. The specific guidelines of the DOH AO on ICV, DOH AO 2011-0005
reiterate that “Service providers shall not be subjected to target/quota, or other numerical targets
of total number of births, number of family planning acceptors or acceptors of a particular method
of family planning that may run contrary to clients’ decision”.
2. The performing LGU in Mainit province wanted to increase its contraceptive prevalence, among
other indicators, to facilitate the release of a performance-based grants by DOH. To ensure the
increase in contraceptive prevalence, the LGU provided educational assistance to two children of
mothers who agreed to under-to bi-tubal ligation. Is this an ICV-violation?
___Yes ____ No
CORRECT ANSWER: YES. The specific guidelines of the DOH AO on ICV, DOH AO 2011-0005
reiterate that incentives and financial rewards, gratuities and bribes shall not be provided in
exchange of or to influence clients’ decision for becoming an family planning acceptor or for service
provider to achieve a target or quota.
3. Our midwife saw that the public health nurse in the city of Ilang-ilang provided each vasectomy
client with Ph1,000, 10 kilos of rice, 21 capsules of antibiotics, 10 tablets of pain reliever. She
thought that this is a probable ICV vulnerability, but since this happened three months ago, she did
not report it to the local ICV monitoring committee. Do you agree with the midwife’s decision?
___Yes ____ No
CORRECT ANSWER: NO. The DOH AO mandates to do monitoring and reporting every three
months.
4. Since committing an abortion is a criminal offense, the health service provider with whom the client
consulted to manage her high fever and vaginal bleeding due to abortion should turn the client away
because treating the client will incriminate her and her license is in danger of being revoked. Do you
agree?
___Yes ____ No
CORRECT ANSWER: NO. It is the client’s right to be provided with the necessary health services.
5. A 28-year old woman, pregnant of her first child, is in labor and suffers from eclampsia (with
hypertension, seizure, maybe unconscious). The service provider asks her to sign a consent for bi-
tubal ligation, saying that having another pregnancy will endanger her life. Do you agree with the
health service provider’s action?
___Yes ____ No
CORRECT ANSWER: NO. The client is suffering from eclampsia. Therefore, she is not in her
proper state of mind to decide whether to undergo ligation or not. The health provider should wait
until the client has fully recovered or until such time that she can understand the procedure and its
consequences.
6. LGUs must ensure that their maternal health service, product and information provision follow the
four pillars (respect for the sanctity of life, respect for human rights, freedom of choice and
voluntary decisions or ICV, respects of the rights of clients to determine their desired family size) of
the DOH policies on family planning as a quality measurement of their family planning program
implementation.
____ True ____False
CORRECT ANSWER: TRUE. DOH has been consistent in these principles as explicitly expressed in
DOH AO 50-A series of 2001, Memorandum issued on Sept. 1, 2006 to all DOH-ROs and in DOH
AO 2011-0005.
7. A 32 year-old mother, who did not finish Grade 1 and has four children consulted the government
city hospital of Malinis LGU, together with her husband. The mother does not want to get pregnant
anymore and her husband supports her. The nurse-on-duty, thinking that there was no trained
doctor on surgical sterilization, told the couple that the hospital could not provide any services of
that nature and just sent them home without telling them on where they could get information and
services. Do you agree with the nurse’s action? Why?
____ Agree, why?____________________________________________________________
____ Disagree; what should the nurse have done? ____________________________________
CORRECT ANSWER: DISAGREE. The nurse-on-duty is duty bound to refer the couple to other
health facilities offering family planning information, product and services. The DOH AO on ICV
mandates that private and public health facilities shall provide universal access to quality family
planning information and services to men and women whenever and wherever needed and enable
them to make informed choice and voluntarism. Further, the DOH AO states that family planning
services shall be part of the basic core packages of both public and private health care facilities.
8. The provincial Family Planning Coordinator of Masigla LGU found out that a private hospital
conducted a bi-tubal ligation without counselling and without securing an informed consent from the
client. The Family Planning Coordinator reported this to the Provincial Health Officer and the
Regional ICV compliance committee. She also discussed the AO on ICV with the Medical Director
and management of the private hospital. Are private health care facilities also mandated to follow
the DOH AO on ICV?
_____ Yes ____No

CORRECT ANSWER: YES. The DOH AO on ICV “applies to all DOH units and attached agencies
such as the Commission on Population and Philippine Health Insurance Corporation, non-
government organizations and the private sector.” “Compliance to ICV policy requirements shall
cover the operations of both public and private health facilities providing FP services under the local
government units and other government agencies in so far as their health service operations are
governed by technical guidelines, standards and policies mandate by DOH.”
Annex J: ICV Monitoring Questions for Facility Managers, Supervisors and Providers
My name is _______________ and I work for _____________________ as a ________________.

I am here to collect some information about family planning services in this region/province/
municipality. I will ask you some questions about family planning services at this facility. The results of
our discussion and data collection will be used to better understand the current situation in this area
and to identify areas that might be strengthened. We are also interviewing family planning clients to
learn more about their perception of the family planning services they receive. Thank you for your
assistance in helping us better understand the family planning services in this facility.
Do you have any questions?
Name of health facility and address: _________________________________________________

Date of site visit: _______________________________________________________________
USAID project agreement or sub-agreement supporting the site: ____________________________
Type of USAID-supported family planning activity/services conducted:
__ clinical __ education __ other (specify): ________
Person contacted and title: ________________________________________________________
1. Can you tell me a bit more about your family planning program and the type of family planning
services you provide? Which family planning methods are currently available for clients?
 Pills
 Injectables
 IUD
 Condoms
 BTL
 Vasectomy
 Others (please specify)_________________________________
If services are not provided at the facility, do you refer clients to another provider/facility? If so,
what is your relationship with that provider/facility? Do you have an existing referral agreement? Is
the referring provider given compensation for making referrals?
2. Clinic Level: For family planning, how is your clinic performance evaluated? Do you have planned
family planning targets or goals? If yes, what kind of targets do you have for this facility?
Provider Level: Are you required to achieve any assigned specific targets/goals for family planning? If
so, what are these targets? What happens if you meet/fail your targets?
3. Benefits and Incentives:

 How do you encourage clients to avail of the clinic’s family planning program?
 Do clients receive any benefits for participating in the family planning program (e.g. food,
money)?
 Are any benefits denied if clients choose not to participate?
4. Comprehensive Information:
 What information do you provide to clients interested in family planning? Do you provide
specific information for family planning methods chosen? If so, what?
 Do you have materials (wall chart, brochure, flipchart etc.) that explain the various family
planning methods and their risks and benefits?
5. Have clients ever asked you advice about abortion? If so, what do you do?
6. Have clients ever asked you about regulation of menstruation? If so, what do you do?
7. Sterilization Services:
 What kind of information do you provide to clients interested in bitubal ligation or vasectomy?
 Do you ask the client to sign an informed consent form before any surgical sterilization
procedure? If so, do you keep client record of informed consent?
 Are any benefits (food, money etc.) provided to clients who choose to undergo surgical
sterilization?
Closing Remarks: Thank you very much for your participation in this interview. We really appreciate
your feedback and please do not hesitate to contact us if you have any questions or additional
information you would like to share.
[Provide interviewee contact information]

Annex K: ICV Monitoring Questions for Clients
My name is _______________ and I work for _____________________ as a ________________.

I am here to collect some information about family planning services in this region/province/
municipality. I will ask you some questions about family planning services at this facility. The results of
our discussion and data collection will be used to better understand the current situation in this area
and to identify areas that might be strengthened. We are also interviewing family planning clients to
learn more about their perception of the family planning services they receive. Thank you for your
assistance in helping us better understand the family planning services in this facility.
Do you have any questions?
Name of health facility and address: _________________________________________________

Date of site visit: _______________________________________________________________
USAID project agreement or sub-agreement supporting the site: ____________________________
Type of USAID-supported family planning activity/services conducted:
__ clinical __ education __ other (specify): ________
Name of person interviewed: _______________________________________________________
1. Are you currently using any family planning method?
 If so, which one? Why did you choose that method?
 If not, please proceed to question 5.
2. Family planning counseling:

 Who provided counseling on the family planning methods?
 What kind of information did the nurse/midwife/doctor provide?
 Do you feel you received all the information necessary to make a decision about your family
planning needs?
3. Did you feel any pressure from anyone to use family planning? If yes, from whom?
4. Did someone give you anything in exchange for using a family planning method (e.g. food, money,
gift)? If yes, what did they give you and how much?
5. Was there a time that you preferred not to use a family planning method? Why?
 If so, were you denied any benefits or access to any programs at this facility?
 Do you know someone whose benefits are denied because of not accepting family planning?
6. Surgical sterilization clients:

 Before you had the procedure, did you sign a form saying you understand what the procedure is
about? Did someone explain the form to you?
 Did you receive anything after the procedure? If so, what and how much?
Closing Remarks: Thank you very much for your participation in this interview. We really appreciate
your feedback and please do not hesitate to contact us if you have any questions or additional
information you would like to share.
[Provide interviewee contact information]

Annex L: ICV Monitoring Observation Checklist
Family planning wall chart  Yes If yes, language used _____________

displayed  No
Other family planning  Yes

information materials  No
available If Yes, what are these?
 Flip Chart Language_____________
 Brochure Language_____________
 Leaflet Language_____________
 Flyer Language_____________
 Poster Language_____________
 Other Specify _____________
Language_____________
Family planning record  Yes If yes, how much _________________

review: Sharp increases  No
in number of family
planning acceptors
Family planning record  Yes If Yes, what is it___________________
review: Inconsistencies in  No
family planning data
Annex M: Narrative Report of Vulnerability or Possible Violation of Family Planning

Policies
Date of monitoring: ______________________

Name of facility: ______________________
Address of facility: ______________________
Reported by: ______________________
Witnessed by: ______________________
Complete name(s) of service providers or source of information: ____________________________
Nature of the incident/possible violation:
Specific ICV policy possibly violated:
Evidence/result or outcome of the possible violation committed, if any:
Action taken by reporter/eyewitness:
Printed name and signature of eyewitness or reporter:
______________________________________________
Noted by (signature of) the reporter's immediate superior:
______________________________________________
Annex N: Conducting an ICV Monitoring Practicum
At least 2 to 4 weeks prior to the actual training, the organizers should choose and prepare the
practicum sites. The practicum sites shall be varied as follows:
a. Public or private hospital
b. Public or private birthing home
c. Population program office
d. Rural or city health unit
The organizers will need to write to the heads of these health care facilities, mentioning the objectives
of the practicum visit, points for discussion, and the data that the participants may look at.
The following matrix will help the organizer in prepping for the practicum. It contains the sample matrix
of practicum sites.
Practicum Site Classification Address Contact Person Facilitator
Practicum guide
Participants should be briefed on the practicum on the day prior to the actual site visit. Herewith is a
sample practicum guide.
1. Each group shall identify a group leader.
2. Before leaving for the site:

a. call or text the point person of the practicum site to inform them that you are coming
b. check the information materials to bring for the practicum site, if there are to be brought
3. Upon arrival at the facility, the facilitator, together with the group, shall pay a courtesy call to the
contact person whose name is indicated in the practicum site list.
4. The facilitator shall:

a. introduce the group to the contact person and other health center staff present
b. inform them regarding the purpose of the field visit and
c. inform them that the group shall interview a service provider and an family planning client, if
possible;
d. inform them that the group shall take a look at the facility’s record on family planning.
5. After the introduction and courtesy call, the group shall start to interview the service providers and
clients:
a. If there are enough service providers and clients for each of the group members then they shall
work individually.
b. But if the facility does not have enough service providers, they may work in pairs.
c. If at the time of the visit there is only one service provider and one family planning client, the
group members shall divide themselves into two. One group shall interview the health provider
and the other group shall interview the family planning client.
d. Assign somebody from the group to look at the data of the facility on family planning.
6. The interviewer should:

a. introduce her/himself and state the purpose of the interview
b. always be respectful and courteous
c. always deliver the questions in a manner that the interviewee will understand.
7. After the interview, thank the respondent for their participation and cooperation.
8. If the interviewees have questions, and none of the group members are sure of the answer, kindly
discuss the question and the answer with the facilitator.
9. Once all members of the team have completed their respective service provider and client
interviews, the group leader shall return to the contact person and thank her/him for welcoming the
group into the facility and for the cooperation given.
10. If possible, the group leader will:

a. feedback very briefly the highlights of the interview results (both client and service provider
interview results) to the contact person.
b. commend the contact person on the good practices observed by the group.
c. gently point out if there are things that need to be improved (e.g. the family planning wall chart
is not properly posted in its appropriate location, or it cannot be seen by clients because it is
hidden behind a door, etc.)
d. gently recommend steps to stop a particular practice that is considered to be not ICV compliant
(e.g., on comprehensive information: if a client said that the counseling on injectables did not
include information on side effects.)
Annex O: Guidance for Conducting an ICV Monitoring Planning Workshop
The following are sample guide questions

a. Kindly look at each of the guidelines of the DOH AO on ICV [and environmental mitigation];
b. Identify the gaps related to each guideline/parameter in your area of assignment;
c. Write each gap in one metacard;
d. Identify interventions in response to the gaps you have written,
e. Identify your indicative time frame, responsible unit, and corresponding budget
The following is the planning matrix that can participants can fill up during the workshop:
DOH Gaps Strategy Activity Time Person or unit Budget

Guidelines Frame responsible requirement
ICV
ICV
ICV
Health care
waste
management
Annex P: Joint DENR and DOH AO 02, series of 2005

Annex Q: PhilHealth Benchbook Quality Standards for Health Provider Organizations
From section VI – Safe Practice and Environment
1. Patient and staff safety
Goal: Patients, staff & other individuals within the organization are provided a safe, functional and
effective environment of care
Standards:
 The organization plans a safe & effective environment of care consistent with its mission,
services & with laws and regulations
Criteria:
o The organizational environment complies with structural standards and safety codes as
prescribed by law
o There are management plans which address safety, security, disposal and control of
hazardous materials and biological wastes, emergency and disaster preparedness, fire safety,
radiation safety and utility systems
o There are management plans for the safe and efficient use of medical equipment according
to specifications
 The organization provides a safe & effective environment of care consistent with its mission,
services & with laws and regulations
Criteria:
o Policies and procedures that address safety, security, control of hazardous materials and
biological wastes, emergency and disaster preparedness, fire safety, radiation safety and
utility systems are documented and implemented
o Policies and procedures for the safe and efficient use of medical equipment according to
specifications are documented and implemented
o The design of patient areas provides sufficient space for safety, comfort and privacy of the
patient and for emergency care
o All personnel understand and fulfill their role in safe practice
o Risks are identified, assessed and appropriately controlled. Where elimination or
substitution is not possible, adequate warning and protection devices are used.
o A coordinated security arrangement in the organization assures protection of patients, staff
and visitors.
 The organization routinely collects & evaluates information to improve the safety and adequacy
of the environment of care
Criteria:
o The effectiveness of safety procedures and devices are routinely tested, monitored and
improves
o An incident reporting system identifies potential harms, evaluates causal and contributing
factors for the necessary corrective and preventive action.
2. Maintenance of environment of care
Goal: Comprehensive maintenance program ensures a clean and safe environment:
Standards:
 Emergency light and/or power supply, water and ventilation systems are provided for, in keeping
with relevant statutory requirements and codes of practice
 Regular maintenance of grounds, facilities & equipment in keeping with relevant statutory
requirements, codes of practice or manufacturers’ specifications are done to ensure a clean and
safe environment
 Only people trained in the maintenance of that equipment shall be allowed to provide service to
said equipment. Registers and records of equipment and related maintenance are kept
 Current information and scientific data from manufacturers concerning their products are
available for reference and guidance in the operation and maintenance of plant and equipment
3. Infection control
Goal: Risks of acquisition and transmission of infections among patients, employees, physicians and
other personnel, visitors and trainees are identified and reduced
Standards:
 An interdisciplinary infection control program ensures the prevention and control of infection in
all services
 The organization uses a coordinated system-wide approach to reduce the risks of nosocomial
infections
Criteria:
o The organization undertakes case finding and identification of nosocomial infections
o The organization takes steps to prevent and control outbreaks of nosocomial infections
 The organization uses a coordinated system-wide approach to reduce the risks of infections
acquired by the staff in the performance of their duties
Criteria:
o There are programs for prevention and treatment of needlestick injuries and policies and
procedures for the safe disposal of used needles are documented and monitored
o There are programs for the prevention of transmission of airborne infections and risks from
patients with signs and symptoms suggestive of tuberculosis or other communicable diseases
are managed according to established protocols.
 Cleaning, disinfecting, drying, packaging and sterilizing of equipment and maintenance of

associated environment, conforms to relevant statutory requirements and codes of practice
 When needed, the organization reports information about infections to personnel and public
health agencies
4. Equipment and supplies
Goal: The provision of equipment and supplies supports the organization’s role.
Standards:
 Planning of facilities and selection and acquisition of equipment and supplies involve input from
relevant staff and is undertaken by appropriately qualified personnel.
Criteria:
o Appropriate equipment and supplies that support the organization’s role and level of
service are provided with due considerations to at least, the intended use, cost benefits,
infection control, safety, waste creation and disposal, storage.
 Specialized equipment is operated according to specifications and only by appropriately trained

staff
 Items designated by the manufacturer for single use are not reused unless the organization has
specific policies and guidelines for safe reuse which take into consideration relevant statutory
requirements and codes of practice
5. Energy and waste
Goal: The organization demonstrates its commitment to environmental issues by considering and
implementing strategies to achieve environmental sustainability
Standards:
 The handling, collection and disposal of waste conform to relevant statutory requirements and
codes of practice
 The organization implements a waste disposal program which involves reuse, reduction and
recycling
Annex R: Orientation and Compliance to Health Care Waste Management (PowerPoint)
Slide 1
Orientation and Compliance to Health

Care Waste Management
Slide 2
The elements of infection in the context of Healthcare Waste

(HCW) are:
• Some components of HCW are potential reservoir of disease-causing

microorganisms such as culture dishes, liquid blood, pathological
waste, etc.
• The infective dose depends on the virulence of the microorganisms,
the portal of entry, and the susceptibility of the host.
• Modes of transmission may involve contact (e.g. contaminated
needles or blood splatter), vehicle-borne (e.g. contaminated
wastewater), air-borne (e.g. aerosolized pathogens from broken culture
dishes or the rapture of yellow bags), and vector-borne (e.g. rodents in
an HCW storage area) transmission.
• Portals of entry include breaks in the skin and mucous membranes
(e.g. needle-stick injuries or blood splashes into the mucous
membranes), the respiratory tract (inhalation of pathogenic aerosols),
etc.
• Potential susceptible host include HCF workers, waste handlers,
patients and visitors in the HCF, landfill operators, scavengers and the
general public.
Slide 3
The consequences of improper handling and disposal of HCW

are serious.
For example, the reuse of improperly discarded needles by

intravenous (IV) drug users or accidental needle stick injuries
suffered by recyclers sifting through waste dumps could lead to
the spread of hepatitis B, HIV-AIDS and other blood-borne
diseases.
Slide 4
Slide 5
Slide 6
DENR ADMINISTRATIVE ORDER No. 29 Series 1992
Subject: IMPLEMENTING RULES AND REGULATIONS OF

REPUBLIC ACT 6969
Pursuant to provisions of Section 16, Republic Act 6969,

otherwise known as “Toxic Substances and Hazardous and
Nuclear Wastes Control Act of 1990”, the Department of
Environment and Natural Resources hereby adopts and
promulgates the following Rules and Regulations:
Slide 7
DENR ADMINISTRATIVE ORDER No. 29 Series 1992

Subject: IMPLEMENTING RULES AND REGULATIONS OF
REPUBLIC ACT 6969
Section 1. Title. These Rules and Regulations shall be known as the Implementing
Rules and Regulations of Republic Act 6969.
Section 2. Declaration of Policy. It is the policy of the State to regulate, restrict or

prohibit the importation, manufacture, processing, sale, distribution, use and disposal of
chemical substances and mixtures that present unreasonable risk and/or injury to health or
the environment; to prohibit the entry, even in transit, of hazardous and nuclear wastes and
their disposal into Philippine territorial limits for whatever purpose; and to provide
advancement and facilitate research and studies on toxic chemicals and hazardous and
nuclear wastes.
Section 3. Scope. These Rules and Regulations shall cover the importation,
manufacture, processing, handling, storage, transportation, sale, distribution, use and
disposal of all unregulated chemical substances and mixtures in the Philippines including
the entry, even in transit, as well as the keeping or storage and disposal of hazardous and
nuclear wastes into the country for whatever purpose.
Slide 8
JOINT DENR-DOH ADMINISTRATIVE ORDER No. 02, series of

2005
SUBJECT : Policies and Guidelines on effective and proper

handling, collection, transport, treatment, storage and disposal
of health care wastes.
I. RATIONALE
The Department of Environment and Natural Resources (DENR)
and the Department of Health (DOH) hereby jointly provide the
following guidelines on the management of health care wastes
pursuant to, among others, the following laws, rules and regulations:
Slide 9
• Clean Air Act of 1999 (Republic Act 8749);

• Toxic Substances, Hazardous Waste, and Nuclear Waste Control
Act of 1990 (Republic Act 6969);
• Ecological Solid Waste Management Act of 2000 [Republic Act
9003)
• Refuse Disposal of the Sanitation Code of the Philippines
[Chapter XVIII, Implementing Rules and Regulations, Presidential
Decree 856);
• Clean Water Act of 2004 [Republic Act 9275];
• Environmental Impact Statement (EIS) System (Presidential
Decree 1586);
• Hospital Licensure Act [Republic Act 4226]
Slide 10
II. OBJECTIVES
A. To provide guidelines to generators, transporters and owners or

operators of treatment, storage, disposal (TSD) facilities of
health care waste on the proper handling, collection, transport,
treatment, storage and disposal thereof;
B. To clarify the jurisdiction, authority and responsibilities of the

DENR and DOH with regard to health care waste management;
and
C. To harmonize efforts of the DENR and DOH on proper health

care waste management.
Slide 11
III. SCOPE AND COVERAGE
These policies and guidelines shall apply to health care waste

generators, transporters and owners or operators of TSD and final
disposal facilities.
IV. DEFINITION OF TERMS
A. Health Care Wastes - include all wastes generated as a result

of the following:
1. Diagnosis, treatment, management and immunization of
humans or animals;
2. Research pertaining to the above activities;
3. Producing or testing of biological products; and
4. Waste originating from minor or scattered sources (i.e. dental
clinics. alternative medicine clinics, etc.)
Slide 12
Health Care Waste Generators - include health care facilities,

institutions, business establishments and other similar health care
services with activities or work processes that generate health care
waste.
1. Hospitals (Primary Care, Secondary Care and Tertiary Care)

2. Infirmaries
3. Birthing homes
4. Clinics
Slide 13
“Healthcare Facilities” (HCF), for this purpose, are public, private and
non-governmental institutions/facilities that contribute to the
improvement of the health status of an individual, which includes:
• Clinics and healthcare units related to patient care including but not limited to
dispensaries, alternative medicine clinics; obstetrics and maternity lying-in clinics;
out-patient clinics; dialysis centers; drug testing centers; transfusion centers;
military medical services; prison hospital and clinics; emergency medical care
services; physician’s offices/clinics; dental clinics; specialized healthcare
establishments such as convalescing homes and Differently Abled Person (DAP)
centers; derma, vein and skin clinics
• Rehabilitation centers, hospices, psychiatric centers, and centers providing long-
term healthcare services
• Related laboratories and research centers such as medical and bio-medical
laboratories, biotechnology laboratories and institutions, medical research
centers, blood banks and blood collection services, nuclear medicine laboratories,
animal research laboratories
• Ambulance and emergency care mobiles (including medical mission and health
services provided in evacuation centers)
• Teaching and training hospitals and medical schools
Slide 14
Slide 15
Slide 16
Slide 17
Slide 18
Infectious Waste
Slide 19
Sharps
Slide 20
Pathological and Anatomical Waste

Slide 21
Slide 22
Slide 23
Thank you!
Annex S: Environmental Compliance Assessment Tool
As part of the baseline quality assessment and monitoring on environmental compliance, the team or the
assessor can look at the following documents at the facilities:
1. At the hospital level:
a. Memorandum or order designating certain staff as the environmental compliance officer or

members of the waste management committee and their functions
b. Staff development or capability building on waste management
c. Waste management plan, monitoring results of the plan’s implementation
d. Minutes of meetings conducted by the waste management committee and results of the
agreement in the meetings if there are
e. Hospital policies on environmental protection, waste management, etc.
f. Evidences of compliance with sanitation (sanitation permit) , Department of Environment
and Natural Resources if so warranted, (Environmental Compliance Certificate), with fire
and safety
g. Benchbook checklist and look for the score (self-administered and the score by PhilHealth)
in each indicator on safe practice and environment
These documents can be found in the facility’s manual of operations if it has.
2. At the birthing home level:
a. Evidences of compliance with sanitation (sanitation permit), Department of Environment and

Natural Resources if so warranted, (Environmental Compliance Certificate), with fire and
safety
b. Policies on environmental protection, waste management, etc.
These documents can be found in the facility’s manual of operations if it has.
3. At the DOH-RO level:
a. Results and recommendations of the licensing division regarding environmental protection in

general and waste management in particular
All these documents are pertinent and have to be available if the facilities are licensed by the
DOH and the LGU or accredited by PhilHealth.
Further, to verify what is written in their documents, the team can inspect on-site and look at the
following in the facilities:
1. If the facility is generally clean
2. Waste segregation scheme
a. How does the facility do its waste segregation scheme

b. What kind of waste does it segregate
c. Presence of sharps’ container
3. Disinfection of waste prior to disposal
4. Manner of disposal for
a. Sharps (presence of separate vault for sharps)

b. Placenta (presence of separate septic tank for placenta or does the facility allow family to
bring it home)
c. Used supplies, commodities, etc. (ex. IUD, used supplies generated from the conduct of
BTL/NSV)
d. Waste products from the laboratory, regular human waste from kitchen, wards, etc.
5. If the segregated waste is collected by the LGU’s garbage collector
a. What are the waste products that the LGU’s garbage collector collects (sharps, placenta,
commodities, etc.)
b. How are they collected (dumped together with the other regular household waste)
c. Where are they disposed of
d. Distance of septic tank/vault from source of water in meters
Checklist of Environment Compliance Practices and Measures

Facility has policies on environmental mitigation Yes □ No □
Facility is generally clean Yes □ No □
Waste segregation scheme Yes □ No □
Describe the waste segregation scheme of the facility
Sharps’ container Yes □ No □
Disinfection of sharps Yes □ No □
If disinfection is done, how is this done?
Separate septic tank for general waste Yes □ No □
Separate vault for sharps Yes □ No □
Separate vault for placenta Yes □ No □
Allow family to bring placenta home Yes □ No □
Separate washing place for instruments, equipment, etc. Yes □ No □
Distance of septic tank/vault from source of water in meters

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Ensuring Quality in Family Planning Service Delivery:

Toolkit for Monitoring Compliance on Informed Choice

The United States legislative and statutory requirements are as follows:

A. Tiahrt amendment mandates that:

PLANNING FOR ICV COMPLIANCE MONITORING

NECESSARY ACTIONS TO ENSURE ICV COMPLIANCE

ORIENTATION OF PARTNERS AND SERVICE PROVIDERS ON ICV

Suggested Activity Flow

Time Activity Person Responsible

MONITORING OF COMPLIANCE TO ICV POLICY REQUIREMENTS

TRAINING OF STAFF AND PARTNERS ON ICV MONITORING

ENSURING COMPLIANCE WITH ENVIRONMENTAL MITIGATION POLICIES

1. Internally within the project, develop reporting mechanisms, reporting tools

4. Support DOH-ROs and local stewards in institutionalizing LGU-wide continuous quality

Figure 1. Operationalizing the Environmental Compliance Monitoring

Technical experts assess & monitor compliance

DOH RO, LGU, Philhealth conduct individual

Annex A: Matrix of Possible Actions to Ensure Compliance with ICV Mandates

Annex A: Matrix of Possible Actions to Ensure Compliance with ICV Mandates

Actions Within Scope of Project Operations

Actions Within Scope of Project Operations

Actions Within Scope of Project Operations

Actions Within Scope of Project Operations

Annex B: Contractual Provisions Relevant to ICV in Family Planning

H. 38: VOLUNTARY POPULATION PLANNING (June 2008)

b. Prohibition on Abortion-Related Activities:

c. The contractor will insert this provision in all subcontracts.

H.39: VOLUNTARY POPULATION PLANNING ACTIVITIES - SUPPLEMENTAL REQUIREMENTS

a. Voluntary Participation and Family Planning Methods:

b. Requirements for Voluntary Family Planning Projects:

(2) A project is a discrete activity through which a governmental or nongovernmental organization

c. Additional Requirements for Voluntary Sterilization Programs

d. Prohibition on Abortion-Related Activities:

Annex C: Partner Level Checklist for Implementation of ICV Policy Requirements

Name of Organization:: ____________________________________

Name of Respondent:: ____________________________________

Position in the Organization: ____________________________________

A. Project Partner Awareness of Family Planning Policy Requirements

a. Requires or subjects family planning service providers and/or referral Yes  No

B. Activities for Implementing ICV Policy Requirements

Sub-agreements/memorandum of understanding with participating firms or Yes  No

4. Are there procedures in place to report possible violations to the project?

Date Accomplished: ______________ Signature: ________________________

Annex D: Commitment to Compliance with ICV Policy Requirements

I,__________________________, _____________________, as a legally authorized representative

Annex E: ICV Policy Compliance Information Dissemination Certificate

I,_________________________, ___________________, as a legally authorized trainer/facilitator

Annex F: Informed Choice and Voluntarism as a Quality Issue in FP-MCH (PowerPoint)

NOTE: This orientation slides were prepared by the ICV

Informed Choice and

The Family Planning Program is special in a sense because,

In the Philippines, the constitution and DOH have placed

Informed Choice and Voluntarism

Family Planning supports this provision of the constitution in

By practicing Family Planning, families are given more

In fact, in order to execute the above provisions of the

Art. XV, Sec. 3.1:

Magna Carta of Women

Magna Carta of Women

Date Accomplished: Signature: __________

I,______, _, as a legally authorized representative

I,_______, _, as a legally authorized trainer/facilitator