etails Hits: 13657 Republic of the Philippines PROVINCE OF BOHOL Municipality of Pres. Carlos P.

Garcia 12
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Sangguniang Bayan

Municipal Hall, Barangay Pitogo

EXCERPT FROM THE JOURNAL AND RECORD OF THE PROCEEDINGS OF THE SEVENTY-FIRST REGULAR TH SESSION OF THE 12 SANGGUNIANG BAYAN OF PRESIDENT CARLOS P. GARCIA, BOHOL HELD ON 9 JANUARY 2012 AT THE CONFERENCE HALL IN THE OFFICE OF THE MUNICIPAL VICE-MAYOR, OF THIS MUNICIPALITY.

Municipal Ordinance No. 12-233 Series of 2012

INSTITUTING THE BASIC EMERGENCY OBSTETRIC AND NEWBORN CARE-BASED DELIVERIES FOR ALL PREGNANT WOMEN IN THE MUNICIPALITY OF PRESIDENT CARLOS P. GARCIA, BOHOL.

(Authored by the Committee on Health & Social Services) (Sponsored by SB Member Renato B. Zapanta) (Co-Sponsored by Municipal Vice-Mayor Nestor M. Abad; and) (SB Member Rosalinda B. Cutamora-Garcia)

Whereas, Section 12, Article II of the 1987 Philippine Constitution provides, in part, that the State shall equally protect the life of the mother and the life of the unborn from conception;

Whereas, Section 17 (b) (2) (iii) of Republic Act No. 7160, otherwise known as the 1991 Local Government Code, provides, among other matters, that the Municipal Government shall exercise its powers and discharge such functions and responsibilities as are necessary to efficient and effective provision of basic health services that deliver programs and projects on maternal and child care and purchase of medicines, supplies and equipments;

Whereas, hemorrhage, hypertensive disorders during pregnancy and obstructed labor constitute the majority of complications relating to maternal fatalities; all of these problems are preventable and can be addressed through adequate medical care, such as, the presence of skilled birth attendants, emergency obstetric and newborn care (EmONC), and when necessary, access to family planning services;

Whereas, the establishment of the basic emergency obstetric and newborn care (BEmONC) facility-based deliveries will surely address the three (3) delays associated with saving the lives of the mother and the child; namely: (1) the decision when to seek care (due to inadequate knowledge on danger signs, or no empowered decisionmaking); (2) reaching the health facilities (due to costly expenses especially for transportation, clinic or hospital services); and (3) receiving appropriate care in the facility ( due to unavailability of gender and culture-sensitive skilled birth attendants, inadequate medicine supplies, blood and equipment and facility);

Wherefore, the 12 Sangguniang Bayan of President Carlos P. Garcia, Bohol in session duly assembled hereby ordains and enacts that

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Article A General Provisions

Section 01. Short Title This Ordinance shall be known as the Basic Emergency Obstetric and Newborn Care (BEmONC) Ordinance of the Municipality of President Carlos P. Garcia, Bohol and hereinafter be referred to as the BEmONC Ordinance.

Section 02. Declaration of Policy The Municipal Government shall adopt the correct and appropriatetimed interventions that will benefit both the newborn and the mother to avert avoidable newborn and maternal death through the provision of globally-accepted evidenced-based essential newborn care and services, which follow a prescribed sequence of interventions.

Consistent with these principles, it shall guarantee access to information and education and to safe, affordable and quality BEmONC for pregnant mothers.

Section 03. Objectives Generally, this BEmONC Ordinance aims to:

(a) Provide all pregnant mothers with adequate and affordable basic emergency obstetric and newborn care and full access to these health facilities during deliveries; and

(b) Enhance accurate information dissemination and education on the value of preventing maternal and newborn deaths.

Section 04. Guiding Principles In the implementation of this BEmONC Ordinance, the following shall be the guiding principles; to wit:

1. Evidence-based Interventions The Municipal Health Office shall ensure that continuous update of policies and guidelines must be in accordance to the recommended international standard proven effective and applicable to the country. It shall exert efforts to generate information to guide in the planning and implementation of this BEmONC Ordinance and related newborn care and services program.

2. Integrated Service Delivery The Municipal Health Office shall assure the provision of integrated and functional service packages where the mother and the newborn are seen as a unit but with varying needs, to respond to the interrelated health needs of mothers and newborns and ensure provision of a more effective and efficient care using a similar approach.

3. Human Rights-based Approach The Municipal Health Office shall recognize the person as the key actor to his or her own development and not as passive recipient of services. It shall also recognize that human rights are indivisible whether they are cultural, economic or social; they are inherent to the dignity of every human person. Therefore, soliciting the participation of the clients should be emphasized as both a means and a goal.

4. Life Cycle-based Intervention The continuum of care framework aims to veer away from the traditional approach of utilizing single, disease-specific interventions. Critical to its success are the delivery of essential services and the implementation of improved practices at key points in the life cycle, linking mothers, newborns and their households and communities with quality basic health care and maternity services.

5. Multi-sectoral Collaboration Networking with local health stakeholders must be proactively pursued and sustained. The government agencies, nongovernment organizations, private volunteers, civil society organizations and educational institutions can contribute to the newborn care through their respective capabilities, expertise, resources and networks.

Section 05. Definitions For purposes of this BEmONC Ordinance, the following terms shall be defined as follows:

(a) Basic Emergency Obstetric and Newborn Care Facility refers to health facility that is capable of performing six (6) signal obstetric functions, which include: [1] Parenteral administration of oxytocin in the third stage of labor; [2] Parenteral administration of loading dose of anticonvulsants; [3] Parenteral administration of initial dose of antibiotics; [4] Performance of assisted deliveries; [5] Removal of retained products of conception; and [6] Manual removal of retained placenta.

This BEmONC facility is also capable of providing neonatal emergency interventions which include at the minimum: [1] newborn resuscitation, [2] treatment of neonatal sepsis/infections; and [3] oxygen support. It shall also be capable of providing blood transfusion services on top of its standard functions.

(b) Community Level Providers refer primarily to the Barangay Health Stations and its personnel staff and volunteer health workers, who typically comprise the Barangay Health Team, which implement Maternal, Newborn Child Health and Nutrition (MNCHN) services identified for the community level.

Their functions include advocating for birth spacing and counseling on family planning services; the tracking and master listing of pregnant women; assisting pregnant women and their families in formulating a birthing plan; early detection and referral of very high-risk pregnancies; and reporting maternal and infant deaths.

(c) Comprehensive Emergency Obstetric and Newborn Care Facility refers to the facility that can perform the six (6) signal obstetric functions of a BEmONC and in addition, perform cesarean section and provide blood banking and transfusion services along other highly specialized obstetric services.

(d) Maternal Death refers to the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

(e) Skilled Birth Attendants refer to licensed midwives, nurses and physicians.

(f) Traditional Birth Attendants refer to homegrown or self-made midwives who obtained their skills and learning through experience and observation; they are locally known as mananabang.

Article B Establishment of BEmONC Facility and Birthing Centers

Section 06. BEmONC Facility There is hereby established BEmONC facility located within the Municipal Health Office compound in Barangay Pitogo, of this municipality.

Section 07. Designation of BEmONC Facility Criteria such as pricing, service load, quality of care, location, topography, transport system, utilization patterns and other similar parameters may be used to determine on upgrading and designating a BEmONC facility. However, the BEmONC facility shall be accessible within thirty (30) minutes of travel time.

Section 08. BEmONC Facility Staff A BEmONC facility may have a minimum staff complement of, at least, a physician, a nurse and a midwife. The facility shall operate on a 24/7 basis and shall have access to communications and transportation facilities to facilitate referrals.

Section 09. Other BEmONC Facility The President Carlos P. Garcia Municipal Hospital and other private clinics, lying-in clinics and birthing homes currently managing deliveries but have no capacity to provide the six (6) signal obstetric functions and neonatal emergency services shall be encouraged to acquire new capacities and be designated as BEmONCs.

Section 10. Pilot Birthing Centers Pilot birthing centers are hereby established in the Barangays of Aguining, Bonbonon, Popoo, Tugas and Villa Milagrosa.

Section 11. Birthing Centers in All Barangays There shall be established birthing centers in all the remaining component barangays of this municipality within ten (10) years after the effectivity of this BEmONC Ordinance.

Section 12. Designation of Birthing Centers (a) Criteria such as service load, quality of care, location, topography, transport system, utilization patterns and other similar parameters may be used to determine on upgrading and designating a Birthing Center. This birthing center shall be accessible to less than thirty (30) minutes of travel time.

(b) In addition to the five (5) pilot birthing centers located in Barangay Aguining, Barangay Bonbonon, Barangay Popoo,Barangay Tugas and Barangay Villa Milagrosa, the Municipal Health Officer shall have the sole responsibility to designate and declared, in writing, any Barangay Health Station/Center as additional Birthing Center.

Section 13. Birthing Center Staff A Birthing Center may have a minimum staff complement of at least a nurse, two (2) midwives and five (5) barangay health workers. The birthing center shall operate on a 24/7 basis and shall have access to communications and transportation facilities to facilitate referrals.

Article C Prenatal Care, Delivery and Postnatal Care

Section 14. Compulsory Prenatal and Postnatal Care (a) Any pregnant woman shall be compulsorily required to have prenatal care within the following period of pregnancy; to wit:

(i)

Once within the first trimester or three (3) months of pregnancy;

(ii) Once within the second trimester or three (3) months of pregnancy;

(iii) Once in every two (2) weeks within the third and last trimester or three (3) months of pregnancy.

(b) Immediately after delivery, the mother and child/children shall be compulsorily required to have postnatal care visit.

Section 15. Compulsory Delivery in BEmONC Facility or Birthing Center (a) There is hereby imposed compulsory childbirth delivery in the designated BEmONC Facility located in Barangay Pitogo or in any designated and declared Birthing Centers within the municipality.

(b) However, the pregnant woman may have the preference and prerogative to choose the health facility where she would be admitted to and gave birth.

Section 16. Birth Attendants Only those skilled birth attendants, as defined on this BEmONC Ordinance, shall perform the childbirth delivery in BEmOnc facility and birthing center.

Article D Protocols in BEmONC Facility

Section 17. Newborn Care Practices and Guidelines Hereunder enumerated are the standard essential newborn care practices and guidelines; to wit:

A.

Ensure Quality Provision of Time-Bound Interventions

1.

Within the first thirty (30) seconds, provide dry and warmth to the newborn and prevent hypothermia.

2.

After thorough drying, facilitate bonding between the mother and her newborn through skin-to-skin contact to reduce likelihood of infection and hypoglycemia.

3.

While on skin-to-skin contact up to three minutes post-delivery, reduce the incidence of anemia in term newborns and intraventricular hemorrhage in pre-term newborns by delaying or non-immediate cord clamping.

4.

Within 90 minutes of age, facilitate the newborns early initiation to breastfeeding and transfer of colostrums through support and initiation of breastfeeding and prevent ophthalmic neonatorum through proper eye care.

B.

Non-Immediate Interventions

5. 6. 7. 8. 9.

Give Vitamin K Prophylaxis. Inject Hepatitis B and BCG Vaccincation. Examine the newborn. Check for birth injuries, malformations or defects. Cord Care.

C. D. E.

Newborn Resuscitation Additional Care for a Small Baby or Twin Unnecessary Procedures

10. Routine Suctioning

11. Early Bathing/Washing 12. Foorprinting 13. Giving Sugar Water, Formula or Other Prelacteals and the Use of Bottled or Pacifiers 14. Application of Alcohol, Medicine and Other Substances on the Cord Stump and Bandaging the Cord Stump or Abdomen

F.

Discharge Instructions

Article E Implementing Mechanism

Section 18. Governance The above-enumerated protocol will be implemented utilizing the current MNCHN service delivery network, the referral system and other pertinent existing public health service delivery initiatives of the provincial health office, the municipal health office, and other competent authorities.

Section 19. Organization of Barangay Health Teams At the community level, there shall be organized a BarangayHealth Team in all barangays of this municipality. It shall be the duty of the punong barangay concerned, the sangguniang barangay committee on health chairperson and the midwife assigned in the barangay to organize the team members and provide its internal rules.

Each Barangay Health Team shall be comprised of Purok Health Teams corresponding to the number of puroks in a certain barangay.

Section 20. Composition of Purok & Barangay Health Teams The members of the Purok and the Barangay Health Teams shall be as follows:

(a)

Each Purok Health Team shall be composed of

i. ii. iii. iv.

Purok Leader, as team leader; Sangguniang Barangay Member assigned in that purok, as assistant team leader; At least three (3) Barangay Health Workers, as members; and Other barangay-paid workers or volunteers, who manifested to get involved, as members.

(b)

A Barangay Health Team shall be composed of

i. ii. iii.

Punong Barangay, as team leader; Midwife assigned in that barangay, as assistant team leader; All Purok Health Team Members, as members; and

iv.

All Barangay Nutrition Scholars, other barangay-paid workers or volunteers, who manifested to get involved, as members.

Section 21. Duties of Purok & Barangay Health Teams The members the Barangay Health Teams shall have the following duties and responsibilities; namely:

of

the Purok and

(a) Track every pregnancy in their respective purok and/or barangay;

(b) Assist the pregnant mother in accomplishing the birth plan, as well as, in the sinking fund method or the pre-payment for their financial obligations during delivery;

(c) Provide quality maternal care, family planning, sexually transmitted infections (STI) prevention and human immunodeficiency virus (HIV) control and adolescent and youth health services appropriate at community level;

(d) Make accurate recordings;

(e) Provide good counseling and information dissemination services;

(f)

Refer clients appropriately;

(g) Report maternal death; and

(h) Discuss relevant womens issues with the community.

Section 22. Composition and Duties of BEmONC Teams At the facility level, there shall be organized a BEmONC Team that comprises also the Itinerant Teams and the Social Hygiene Teams. It shall be the duty of the Municipal Health Officer to organize these teams and to provide their internal rules.

These BEmONC Team, Itinerant Teams and Social Hygiene Teams shall be dispersed throughout the municipality to ensure timely access to obstetric and newborn emergency care by mothers. They shall provide the full maternal and newborn care, family planning, adolescent reproductive health and STI and HIV service packages to the general population as well as child survival packages.

Section 23. Integrated MNCHN Services The current MNCHN services, consisting of clinical and public health interventions for women and children, include the following:

1.

Pre-Pregnancy Services

i.

Provision of correct information and responsive counseling for fertility awareness, maternal nutrition, birth spacing and adolescent reproductive health; Active identification and servicing of population segment with unmet needs for family planning and referral to alternative sources of services and supplies when these are not available in one service outlet or facility; Assurance of a safety net of free family planning services and supplies for indigent potential users; and Provision of other basic and essential services for young females and women in the reproductive age.

ii.

iii.

iv.

2.

Antenatal Care

i.

Consistent coverage of all eight essential antenatal care functions (monitoring height and weight, taking blood pressure, blood testing, uribe testing, iron and folate supplementation tetanus toxoid immunization, malaria prophylaxis where appropriate and birth planning); Focused attention to individualized birth preparedness counseling about the place od delivery and transport arrangement to increase the mothers readiness to deliver in BEmONC facility; and Discussion with household members and preparation for childbirth with partner support and involvement in care-seeking decisions.

ii.

iii.

3.

Care during Delivery

i.

Proper channeling of patient workloads with aggressive promotion of shifting from home-based deliveries to delivery in either a BEmONC or a CEmONC, especially for women with medical conditions and other special needs by classifying them as priority for transport and servicing by the appropriate delivery/birthing facility; Deliberate planning and special provisions for hard-to-reach segments of the population within the municipality to promote facility-based deliveries; Active conversion and mobilization of traditional birth attendants into advocates and agents of facility-based deliveries; and Correct and updated monitoring and reporting of the number and proportion of facility-based births.

ii.

iii.

iv.

4.

Postpartum and Postnatal Care

i. ii.

Provision of proper postpartum/postnatal care for mothers and neonates; and Provision of the whole range of womens health care services for mothers and of the child survival package for children.

Section 24. Financing The implementation of this protocol on newborn care services as part of the enhanced Normal Spontaneous Deliveries and Maternal Care Packages of the Philippine Health Insurance Corporation (PhilHealth) will be one of the drivers for health facilities to be accredited and for individual professionals to qualify for in PhilHealth benefits.

Any fund available will be mobilized to finance the provision of the necessary equipments and supplies and the conduct of capability-building activities and human resources management trainings and team-building.

For this purpose, the Municipal Government shall appropriate funds from its mandated allocations of the Gender Advocacy and Development (GAD) fund for the following:

a.

the upgrading of the Municipal Nutrition Center to become BEmONC facility, or the establishment of another BEmONC facility, or the provision of subsidy to the barangay governments for their upgrading of its Barangay Health Stations to become birthing centers; the procurement and maintenance of emergency vehicles and/or sea ambulance, medical equipments and supplies, and drugs and medicines in the delivery of BEmONC services; and the implementation of an intensive information drive on this program.

b.

c.

For the barangay level, the Barangay Government shall appropriate funds, from its mandated allocations of Health, Environment and Social Service (HES) fund or the GAD fund, for the upgrading of its Barangay Health Stations/Centers to become Birthing Centers, and if deemed necessary, a BEmONC Facility; (b) the procurement and maintenance of medical equipments and supplies, and medicines in the delivery of BEmONC services in their birthing centers.

Section 25. Financial Sustainability There is hereby instituted strategies and mechanisms to implement and enhance financial sustainability and self-sufficiency, such as but not limited to, the following:

(a) Identification of the poor/indigent The Purok Health Teams and the Barangay Health Teams shall identify an indigent pregnant woman, who shall be assisted to cope up with the financial obligations during and after delivery through the Sinking Fund method. A pregnant woman, during her prenatal consultations, may be required to deposit an amount as pre-payment of her financial obligations during delivery. The Barangay Health Team shall designate a treasurer to keep these pre-payments.

(b) Endowment or Emergency Fund The Barangay Government shall establish and appropriate funds, from its mandated allocations of Health, Environment and Social Service (HES) fund or the GAD fund, as special emergency fund or an endowment fund, which shall be used by the pregnant woman only in the case of emergency, wherein the pregnant woman is referred to higher health facility. The immediate family member of the pregnant woman shall be made to replenish the amount incurred, either through equivalent service or installment payment, or any other method of repayment.

(c) Revenue Generation and Collection of User Fees There is hereby established an affordable users fees; as follows:

i.

For active PhilHealth members Free of charge; however, only up to the fourth delivery will be covered by the PhilHealth benefit package. The term delivery includes miscarriage.

ii.

For qualified indigent patient A corresponding fee will be collected to cover supplies and medicines used during the delivery. The Municipal Social Welfare and Development Officer, upon effectivity of this BEmONC Ordinance and every year thereafter, shall provide to the Municipal Health Officer a certified copy of the list of indigent residents of this municipality.

iii.

For pregnant woman who is not an active PhilHealth member or not a beneficiary of the same but is not classified as indigent A corresponding fee will also be charged.

(d) PhilHealth Accreditation and Reimbursements It shall be the obligation of the Municipal Health Officer to cause the PhilHealth accreditation of the BEmONC facility and the Birthing Centers. The Municipal Government shall designate a career service employee to handle the processing of PhilHealth reimbursements.

(e) Social Marketing Arrangements with drug companies and contraceptive suppliers. Other mechanisms to implement and enhance financial sustainability shall also be encouraged.

Section 26. Service Delivery (a) Standard for the physical structure, equipment and human resource for Implementing Health Reform towards the Rapid Reduction of Maternal and Neonatal Mortality Manual of Operations shall be strictly followed in relation to the implementation of this BEmONC Ordinance. For this purpose, the Municipal Health Officer shall exert efforts to include all skilled birth attendants for orientation training on the aforementioned Manual of Operations.

(b) Home care for the newborn shall be integrated with the training course for Barangay Health Teams and the PurokHealth Teams, as provided hereof. The respective Barangay Government shall authorize the members of the Barangay Health Teams and the Purok Health Teams to undergo this training course.

(c) Inclusion of Communication for Behavior Impact (COMBI) or Behavior Change Communication strategy shall be utilized targeting of all major stakeholders from the mothers to the health workers to the policy makers.

Section 27. Emergency Communication and Transportation Systems The municipal health system shall be supported by an adequate and effective emergency communications and transportation system. This communication system shall facilitate consultation, referral and coordination from and by peripheral facilities all the way up to the end referral facility level.

The Municipal Government shall invest in modern communications system and a transportation system that will bring patients to and from facilities during referrals and transfers. This may be done through an organized ambulance network that series the entire municipality or locally available transportation with explicit arrangement for use and financing during referrals and transfers.

Section 28. Regulation The PHIC/PhilHealth Benchbook will be integrated with the key Essential Newborn Care protocol interventions. The Benchbook will enforce the standards of care along with other auxiliary issuances from the Department of Health. Each health worker, especially those involved in BEmONC, shall be provided with a copy of this PHIC Benchbook.

Section 29. Monitoring and Evaluation Systems Within three (3) months after the effectivity of this BEmONC Ordinance, the Municipal Health Office and the Sangguniang Bayan Committee on Health & Social Services, shall develop and establish a monitoring and evaluation mechanism for the implementation of the BEmONC and the MNCHN strategies in this municipality. Appropriate methodologies (e.g. maternal and perinatal death reviews) shall be employed to establish baseline, track progress and assess the impact of various interventions to improve the delivery of services in the local health system. This monitoring and evaluation system shall be transparent and developed incrementally and may begin with a limited set of readily available and verifiable indicators and have established dissemination channels that feed into formal feedback mechanisms to policy and management that is sustainable given local constraints and conditions.

Article F Roles and Responsibilities

Section 30. Municipal Government The Municipal Government, through the office of the Municipal Mayor, theSangguniang Bayan and other concerned municipal offices shall

(a) Adopt further measures, policies and regulations implementing this protocol on emergency obstetric newborn care services;

(b) Ensure availability of budget support to all programs on maternal and newborn care and related activities;

(c) Conduct orientations, trainings and information-education campaigns for private and public health workers and the general populace at purok level on the implementation of the maternal and newborn care policies, regulations and orders; and

(d) Monitor and evaluate the implementation of maternal and newborn care activities and program including this protocol and BEmONC Ordinance.

Section 31. Municipal Health Office The Municipal Health Officer, as head of the municipal health office, shall

(a) Perform general supervision and control in all birthing centers and BEmONC facility, as the lead agency in the implementation of this BEmONC Ordinance;

(b) Ensure that systems, programs and services are available at all times;

(c) Serve as the central advisory, planning and policy-making body with the Municipal Mayor, as Chairperson, and in collaboration with other stakeholders;

(d) Recommend to the Sangguniang Bayan and/or to the Sangguniang Barangay concerned the enactment of legislations to support this program; and

(e) Adopt further measures, policies and regulations implementing this protocol on emergency obstetric newborn care services measures to reduce maternal deaths.

Section 32. Barangay Governments The Barangay Governments, through the office of the Punong Barangay and theSangguniang Barangay, shall

(a) Ensure that all pregnant women in their respective barangay, particularly the poor and disadvantaged, are adequately served with this BEmONC;

(b) Lead in the effort in convincing pregnant mothers to shift from home-based birth delivery to facility-based birth delivery;

(c) Monitor and evaluate the implementation of maternal and newborn care activities and program including this protocol and BEmONC Ordinance;

(d) Adopt further measures, policies and regulations implementing this protocol on emergency obstetric newborn care services;

(e) Equip its barangay health center to be qualified as birthing center upon designation and declaration of the Municipal Health Officer;

(f) Allocate funds and provide the sufficient supplies, facilities and equipments relative to its operation and maintenance as herein provided in this BEmONC Ordinance; and

(g) Collect the users fees and other charges for the services rendered by the Birthing Center and grant the cash incentives to the personnel, who provided such services, as provided hereof.

Section 33. Private-Public Partnership and Civil Society Organizations As local health stakeholders, civil society organizations and private businesses are encouraged to form a private-public partnership in the implementation of local health programs, through the review of the current functionality of their respective local service delivery network. Functionality includes, among other things, the level and quality of coordination across the various activities and functions of public and private provides. All local health stakeholders shall be enjoined to take part in activities that address maternal and newborn health.

Article G Incentives and Benefits

Section 34. Referral by Traditional Birth Attendants (a) To facilitate the shift from home-based deliveries to facility-based deliveries, the Municipal Government, pursuant to this BEmONC Ordinance, hereby authorized the grant and payment of cash incentive in the form of subsidy to traditional birth attendants (mananabang), who would refer a pregnant woman to the BEmONC facility or birthing center. Per referral, the TBA shall receive the amount of One Hundred (PhP100.00) Pesos.

(b) The Barangay Governments are enjoined to appoint these TBAs as members of the Barangay Health Team, or PurokHealth Team, or as Barangay Health Worker. The Municipal Government, through the recommendation of the Municipal Health Officer, may provide the qualified TBAs educational assistance to become midwifes.

Section 35. Subsidy to Health Team Members The Municipal Government, pursuant to this BEmONC Ordinance, hereby authorized the grant and payment of performance-based cash incentive in the form of subsidy to the members of theBarangay Health Team and of the Purok Health Team in the amount of Fifty Pesos (PhP50.00) per month.

Section 36. Overtime Pay of Skilled Birth Attendants The Municipal Government, pursuant to this BEmONC Ordinance, hereby authorized the grant and payment of overtime pay to all skilled birth attendants, whether permanent or hired through job order, who actually engaged in labor watch until delivery beyond government hours, including those number of hours during which the pregnant woman was referred to and admitted to a hospital. The computation of the number hours of overtime shall be based on the record indicated on the partograph (a vital tool for health care providers who need to be able to identify complications in childbirth in a timely manner and refer pregnant women to an appropriate facility for treatment.) A photocopy of it shall be attached as one of the supporting documents. Further, the computation of the overtime pay shall be based on the claimants basic monthly salary divided into daily basis (or 22 days); which shall further be divided into eight-hour basis. The computation for the daily-wage-paid skilled birth attendant is also divided into eight-hour basis.

Article H Prohibited Acts and Penalties

Section 37. Delivery by TBA (a) It shall be unlawful for any traditional birth attendant (TBA) to engage in home-based childbirth delivery. Likewise, it shall be unlawful for the pregnant woman, or any of her immediate family members, to allow a TBA to do the childbirth delivery.

(b) Any person who violates the provision of this section shall be penalized, upon conviction and ordered by the municipal adjudication board or any competent court, as follows:

i.

In the case of TBA, an administrative fine in the amount of Two Thousand (PhP2,000.00) Pesos; and

ii.

In the case of the pregnant woman or her immediate family member, an administrative fine in the amount of One Thousand Five Hundred Pesos (PhP1,500.00).

(c) If the offender, through a written affidavit duly notarized, would declare his or her incapacity to pay, the municipal adjudication board, in case the compliant had been filed before it, shall order him or her to do any appropriate community service equivalent for one (1) month.

Section 38. Delivery at Home It shall be unlawful for any pregnant woman to insist on home-based childbirth delivery. A violation of this provision shall be penalized, upon conviction and ordered by the municipal adjudication board or any competent court, as follows:

i.

An administrative fine in the amount of Two Thousand Five Hundred (PhP2,500.00) Pesos; and

ii.

If the offender, through a written affidavit duly notarized, would declare her incapacity to pay, the Certificate of Live Birth shall not be signed by the attending or any skilled birth attendant.

Section 39. Failure to Visit for Prenatal or Postnatal Care It shall be unlawful for any pregnant woman, who failed to visit for prenatal or postnatal care. A violation of this provision shall be penalized, upon conviction and ordered by the municipal adjudication board or any competent court, as follows:

i.

For failure to visit for prenatal care or consultation in the first and second trimester, the offender shall be summoned before the Lupong Tagapamayapa and explained why she failed to visit for prenatal care as mandated in this BEmONC Ordinance. Thereafter, she shall undergo four-hour counseling seminar by any authorized representative of the office of the Municipal Health Officer and, afterward, would be accompanied for the mandated prenatal care or consultation;

ii.

For failure to visit for prenatal care or consultation in the third and last trimester, the offender shall be refused from giving birth in the BEmONC facility or in any birthing facility in this municipality.

iii.

For failure to visit for postnatal care or consultation, the offender shall be summoned before the Lupong Tagapamayapaand explained why she failed to visit for postnatal care as mandated in this BEmONC Ordinance. Thereafter, she shall undergo counseling seminar by any authorized representative of the office of the Municipal Health Officer and, afterward, would be accompanied for the mandated postnatal care or consultation.

Section 40. Administrative Liability Any skilled birth attendant, elected municipal or barangay official, or government employee, who willfully obstruct, caused to be obstructed, delayed or caused to be delayed, any action or implementation to BEmONC Ordinance shall be held liable and appropriate administrative case shall be filed against such concerned official or employee.

Section 41. Filing of Case Where a person commits an act or omission which is punishable under the provisions of this BEmONC Ordinance, the complainant or the public prosecutor shall have the option of determining the appropriate and proper forum where such complaint shall be lodged; the case may be filed before the Lupong Tagapamayapa, or the Municipal Adjudication Board, of this Municipality, or the criminal court which has jurisdiction of this municipality or of the case itself.

Article I Miscellaneous Provisions

Section 42. Property Accountability In addition to the pertinent provisions of Municipal Ordinance No. 11-080, Series of 2007, on the system of public accountability, the Municipal Government shall institute detailed accountability measures to curtail waste of health resources, such as, but not limited to drugs and medicines, supplies and medical equipments.

Section 43. Source of Fund & Annual Allocation The appropriation for the operational expenses of the implementation of this BEmONC Ordinance shall be allocated annually in the Gender Advocacy and Development (GAD) appropriation of the Municipal and Barangay Governments. It shall be the responsibility of the Municipal Health Officer to prepare and submit, or cause to be prepared and submitted, the budget allocation and Work and Financial Plan for the program implementation of this BEmONC Ordinance. This includes the expenses for official travel and training, registration fees and other related programs, activities and projects, the payment of overtime pay of the skilled birth attendants and the BHWs and other volunteers, the municipal subsidies as aforementioned and authorized in this BEmONC Ordinance. The Municipal Health Officer shall cause to be submitted the names of these registered TBAs, BHT members and BHWs to their respective barangay treasurers for their payments.

Section 44. Endowment Fund The Municipal Government shall establish a separate endowment fund in the government hospitals located in Ubay, Talibon, City of Tagbilaran, all of the Province of Bohol; and in Maasin City of Southern Leyte to subsidize the medical and/or surgical expenses incurred by any referred pregnant woman.

Article J Transitory Provisions

Section 45. Seed Money Upon effectivity of this BEmONC Ordinance, the Municipal Government shall grant seed money for the procurement of facilities, equipments, supplies, drugs and medicines to the BEmONC facility and the pilot Birthing Centers, or any subsequently designated birthing center subject to the auditing and accounting rules and guidelines.

Section 46. Advocacy and Scholarship for Midwifery Students The Municipal Government, pursuant to this BEmONC Ordinance, shall advocate and provide scholarship assistance for Bachelor of Science in Midwifery students, who are residents of this municipality.

Section 47. Oversight Committee There is hereby created a Sanggunian Bayan Oversight Committee to monitor and oversee the implementation of the provisions of this BEmONC Ordinance. The said Committee shall be composed of the Municipal Vice-Mayor, as chairperson; and the Chairpersons of the Committees on Health & Social Services, Rules & Public Accountability; Women, Children & Family; and Barangay Affairs, as members. The other members of the said Committee shall be the authorized representatives of any women or health-involved peoples organizations in the municipality as determined by the Sangguniang Bayan.

Section 48. Sunset Review Within five (5) years after the effectivity of this BEmONC Ordinance, or as the need arises, the Sangguniang Bayan Oversight Committee shall conduct a sunset review. For purposes of this BEmONC Ordinance, the termsunset review shall mean a systematic evaluation by the said Oversight Committee of the accomplishments and impact of this BEmONC Ordinance, as well as the performance and organizational structure of its implementing agencies, for purposes of determining remedial legislation.

Article K Final Provisions

Section 49. Separability Clause If any part or section of this BEmONC Ordinance shall be held to be invalid, the other parts or provisions hereof which are not affected thereby shall continue to be in full force and effective.

Section 50. Repealing Clause All ordinances inconsistent with this BEmONC Ordinance are hereby repealed or amended accordingly.

Section 51. Effectivity Clause This BEmONC Ordinance shall take effect upon its approval.

Enacted and Approved.

-oOoI hereby certify to the correctness of the above-quoted Municipal Ordinance No. 12-232, Series of 2012.

GREGORIO BOISER TAMSI, III Secretary to the Sanggunian CONCURRING:

COSME S. ANDO SB Member

NARCISO A. BACULPO SB Member

(Absent) PELAGIO B. BOISER Member RENATO B. ZAPANTA SB Member SB

(Absent) ARTHUR T. BOYONAS OLVIDO SB Member CECILIO B. SB Member

(Absent) DIONISIO T. BOYONAS, JR. SB Member ROSALINDA B. CUTAMORA-GARCIA SB Member

(Absent) RICARDO B. GALO, JR. LBMF President RIZAL DENNIS D. BARTIDO SKMF President

DISSENTING: ABSTAINING:

None. None.

ATTESTED TO BE DULY ENACTED AND APPROVED: NESTOR M. ABAD Municipal Vice-Mayor Presiding Officer

APPROVED:

TESALONICA A. BOYBOY Municipal Mayor

Date Signed: _________