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QAP Orientation &

QMT Planning Session


QUALITY ASSURANCE PACKAGE
FOR MIDWIVES

Rev. Primitivo N. Fostanes, D.D


Deputy Program Manager, CMSU

QUALITY ASSURANCE PACKAGE


FOR MIDWIVES
a collaboration between

Private Sector Mobilization for Family Health


Phase 2
(PRISM2)

BACKGROUND:
2007 DOH-HHRDB and PRISM1: recognized need for
quality standards of care for midwives (DOH:
midwives to the barrios/PRISM1 QMT for PPMs)
2010 DOH-NCDPC and PRISM2*: worked on revisions
to align with BEmONC for midwives, EINC, AMTSL
and other updates
2012 DOH Secretarys Message/Foreword
Value: standardizes professional midwifery
practice

General Objectives
To ensure that midwives, in both public
and private practice, adhere to quality
standards in the provision of MNCHN
(Maternal, Neonatal and Child Health and
Nutrition) services, either in government
birthing facilities or in private clinics,
throughout the country.

To provide continuing quality


improvement by setting standards of
quality care and by providing an
opportunity for midwives to conduct their

Quality Assurance Package for


Midwives
(A Toolkit for Practicing Professional
Midwives)

5 Booklets :
1 Introduction to the Manuals and 4 main sections:

Clinical Care for Midwives


o
o

Management
Special Procedures

Clinical Operation Standards


o
o

Standard Operating Procedures


Standard Clinic Forms

Monitoring Tool for Practicing Midwives


o
o

Midwives Portion
Supervisors Portion

Guide to Organizing and Managing the


Conduct of Clinical Case Conference for
Midwives

Section 1

CLINICAL CARE MANUAL


FOR MIDWIVES

Section 1: Clinical Care Manual


for Midwives
Part 1 : Management
guidelines in the management of the
different phases of pregnancy, labor and
delivery (prenatal, intrapartum,
postpartum and newborn care)

Part 2 : Special Procedures


a review of the correct steps in
performing some basic and special
procedures
Special procedures that ONLY previously
trained midwives are expected to perform

Section 2: The Clinic Operation


Standards Manual
Part 1: Standard Operating Procedures
guidelines for the professional midwife as
she performs various clinic tasks such as
outpatient consultations, admissions,
infection prevention practices, referral
systems, waste management

Part 2: Standard Clinic Forms


different forms for recording patients
data

Section 3: Monitoring Tool for


Practicing Midwives
Part 1: Midwife Portion
the self-assessment portion which
determines the midwifes perspective of
the level of quality of MCH/FP services
she provides, and
the action plan that addresses the things
that need to be improved as identified in
the self-assessment portion

Midwife Self-Assessment Tool/


Supervisors Monitoring Tool
Six (6) components that can be assessed:
1.
2.
3.
4.
5.
6.

Facility
Technical Competence
Continuity of Care
Management
Community Involvement
Business Practices (for private MWs)

Six (6) Components


Component 1: Physical Environment This
refers to the facilitys ability to provide a safe environment
for health care and examines equipment, supplies, and
medicines in facilities and the condition of the clinics
infrastructure.

Component 2 Technical Competence:


Examines providers performance and determine if it meets
acceptable standards. These include performance in
counseling, infection prevention (IP), antenatal care,
immediate newborn care, postpartum care, family
planning, and immunization.

Component 3 - Continuity of Care: Examines


functional referral systems when care is needed outside of
what you can do in your clinic. It includes knowing when
and where to refer, procedures for referral, use of referral
forms and client follow-up.

Component 4 - Management: Refers to the


provider capacity to plan, organize, implement, and
maintain effective health delivery services. It includes
utilizing data for decision-making and proper tracking of
finances and supplies.

Component 5 Marketing: Refers to providers


knowledge of the people in their communities and how
effectively they market their services to maintain their
clients and attract new ones.

Component 6 Business Practices:


Examines providers goals, financial-management
practices (including record keeping), resources for
adequate financing, and allocation of resources.

Midwife Self-Assessment Tool


COMPONENT I: FACILITY

ASSESSMENT
Y

Indicator A. Conditions/Amenities (12 items)


Does the clinic have:
1. A sign that bears the name of the facility?
2. A big sign inside and outside the facility that lists the
services offered?
3. Sufficient seats for patients in a well-ventilated waiting
area?
Indicator B. Facility/Infrastructure (12 items)
Does the clinic have:
1. A generally clean environment?
2. Adequate potable water?
Indicator C. Educational Materials for Clients (3 items)

NI NO NA

Midwife Self-Assessment Tool


COMPONENT II: TECHNICAL COMPETENCE

ASSESSMENT
Y

Indicator A. Attitude, Behavior of Midwife (10 items)


As a midwife, are you:
1. Punctual?
2. Cordial in greeting clients?
Indicator B. Standards of Care (3 items)
1. Do you have a copy of the most recent midwifery
service delivery guidelines?
2. Do you use the guidelines during your work?
Indicator C. Basic Counseling Guidelines (6 items)
Indicator D. Infection Prevention (10 items)
Indicator E. Prenatal Care (21 items)

NI NO NA

Midwife Self-Assessment Tool


COMPONENT II: TECHNICAL COMPETENCE

ASSESSMENT
Y

Indicator F. Obstetrical (Physical) Exam (11 items)


Initial Visit
Succeeding Visits
Indicator G. Labor and Delivery (29 items)
During Labor
During Delivery
Indicator H. Postpartum Care (11 items)
Indicator I. FP : Info-giving and Counselling (16 items)
Indicator J. STI: Patient Counselling and Education (1 item)

NI NO NA

Midwife Self-Assessment Tool


COMPONENT III: CONTINUITY OF CARE 3 Indicators

ASSESSMENT
Y

COMPONENT IV: MANAGEMENT


Indicator A. Review of Practice, incl Review of Action Plan
(5 items)
Indicator B. Client Records (5 items)
Indicator C. Supplies, Consumable Drugs, incl Vaccines (8
items)
Indicator D. Medical Equipment, instruments, furniture (2
items)
Indicator E. Information on Clinic Hours (3 items)
COMPONENT V: COMMUNITY INVOLVEMENT
Indicator A. Client Feedback (3 items)
Indicator B. Advertising (2 items)

NI NO NA

Midwife Self-Assessment Tool


COMPONENT VI: BUSINESS PRACTICES (for privatepractice MWs)

ASSESSMENT
Y

Indicator A. SMART Goals (2 items)


Indicator B. Financial Practices (6 items)
Indicator C. Pricing and Collection System (3 items)
Indicator D. Profitable Facility/Practice (1 item)
Indicator E. Adequate Financing (3 items)

NI NO NA

Action Plan

Compon
ent

I. Facility

Indica
tor

Issues

Root
causes
(WHY)

A.7

No
contaminati
on soln

Not aware
of the
need

Solution
s

Action/
Next Steps

Prepare &
always
make
available

Buy Zonrox,
container;
prepare

By Whom

MW

By When

Tomorrow

STATUS
(After
some
time)
(1 week
after) DONE

Section 3: Monitoring Tool for


Practicing Midwives
Part 2: Supervisors Portion
to validate the midwifes assessment of
her own quality of services and her
facility; and
determines the midwifes progress in
improving the quality of FP/MCH services
based on her validated numerical scores
and the action plans developed during
the midwifes self-assessment portion.

Monitoring Tool for Practicing Midwives:


SUPERVISOR PORTION

Two parts:
Supervisors Assessment Tool
The same checklist as that of the midwife portion
With helpful tips, reviewers, instructions,
comments, etc.

Supervisors Scoring Sheet


Numerical score summary (2 points for
YES/Satisfactorily done; 1 point for Needs
Improvement; 0 point for NO/Not satisfactorily
done; NA for Not Applicable)
Objective measurement of quality of service
provision

Supervis
ors
Assessm
ent Tool

Supervisors (Numerical) Scoring Sheet

I. FACILITY
Indicator C.

Indicator D.

Indicator A.

Indicator B. Facility/

Educational

Professional

Conditions/Amenities (12

Infrastructure (12

Materials for

Appearance of

items)

items)

Clients

Provider

(3 items)
1

10

10

11

11

12

12

Score: _18_/_24_

Score: _20_/_24_

Score: __0_/_6_

Total Score
(28 items)

(1 item)
1

Score: _2 / 2___

Score: _40_/_56__

Comments

Monitoring Tool for Practicing Midwives:


SUPERVISOR PORTION: Suggested Steps

There are several advantages to


conducting the monitoring this way:

the supervisors assessment will not be


influenced by the midwifes answers;
time will be saved;
the midwifes business need not be interrupted;
the presence of the midwife will be required only
during the exit feedback;

Using the Supervisors Assessment


Tool, rate the clinic or the midwifes
performance by doing the following:

actual client-service provider interaction


Presence or absence of the item in the clinic
Conduct of regular business in the clinic
Or by interviewing the midwife, assistants,
patients or clients (least priority)

Record your own assessment rating


under the column heading
SUPERVISOR RATING as follows:

put number 2 in the box under SUPERVISOR


RATING if you assess the item as
Yes/satisfactorily done,
put number 0 in the box if you assess the item
as No/not done,
put NA in the box if the question is not
applicable to her clinic,
put number 1in the box if your assessment is
Yes, but needs improvement.

After answering the questions in each


of the six components in the
assessment tool, proceed to
computing for the scores for each of
the component and accomplish the
Supervisors Scoring Sheet

Supervisors Scoring Sheet


Instructions:

Go back to the Supervisors Assessment Tool


and review your rating of each of the items in the
indicators under the six components.
Use the scoring sheet to record the score for
each question (copy your ratings on to the
appropriate blanks provided for in the scoring
sheet).
Record the answers in the scoring sheet per
component, per indicator, and per question.

MW

COMPONENT I. FACILITY

RATING

SUPERVISOR
RATING

Indicator A. Conditions/Amenities:
Does the clinic have:
1. A signage that contains the name of the facility?

2. A big sign inside and outside of the facility that


contains the services offered?

3. Sufficient seats for patients in a well ventilated


waiting area?

4. A separate private area/space with a desk, two chairs,


examining table for counseling, physical
examinations, and procedures that can not be
observed or overheard by others?

5. A locked cabinet for storage of medicines?

6. A sheet in the examining table to cover client?

I. FACILITY
Indicator A.
Conditions/Amenities (12
items)
1.

2 .

8.

2.

1 .

9.

3.

1 .

10.

4.

1 .

11.

5.

1 .

12.

6.

0 .

7.

Score: __/__

Supervisors Scoring Sheet


Instructions: (cont)

Computing the score per indicator.

To get the numerator for each indicator, add all the


numerical answers (that is, all 2s, 1s, or 0s).
To get the denominator, subtract the number of items
with NA answers from the total number of items for
the indicator, and multiply the answer by 2.

I. FACILITY
Indicator A.
Conditions/Amenities (12
items)
1.

2 .

8.

2 .

2.

1 .

9.

1 .

3.

1 .

10. NA .

4.

1 .

11. 1 .

5.

1 .

12. 1 .

6.

0 .

7.

2 .

Score: __/__

I. FACILITY
Indicator A.
Conditions/Amenities (12
items)
1.

2 .

8.

2 .

2.

1 .

9.

1 .

3.

1 .

10. NA .

4.

1 .

11. 1 .

5.

1 .

12. 1 .

6.

0 .

7.

2 .

Score: __/__

Togetthenumeratorforeachindicator,
addallthenumericalanswers
(thatis,all2s,1s,or0s).

I. FACILITY
Indicator A.
Conditions/Amenities (12
items)
1.

2 .

8.

2 .

2.

1 .

9.

1 .

3.

1 .

10. NA .

4.

1 .

11. 1 .

5.

1 .

12. 1 .

6.

0 .

7.

2 .

Score: __/__

Togetthenumeratorforeachindicator,
addallthenumericalanswers
(thatis,all2s,1s,or0s).

13
NUMERATOR=_____

I. FACILITY
Indicator A.
Conditions/Amenities (12
items)
1.

2 .

8.

2 .

2.

1 .

9.

1 .

3.

1 .

10. NA .

4.

1 .

11. 1 .

5.

1 .

12. 1 .

6.

0 .

7.

2 .

Score: __/__

Togetthedenominator,subtractthe
numberofitemswithNAanswers
fromthetotalnumberofitemsforthe
indicator,&multiplytheanswerby2.

I. FACILITY
Indicator A.
Conditions/Amenities (12
items)
1.

2 .

8.

2 .

2.

1 .

9.

1 .

3.

1 .

10. NA .

4.

1 .

11. 1 .

5.

1 .

12. 1 .

6.

0 .

7.

2 .

Score: __/__

Togetthedenominator,subtractthe
numberofitemswithNAanswers
fromthetotalnumberofitemsforthe
indicator,&multiplytheanswerby2.

22
DENOMINATOR=____

I. FACILITY
Indicator A.
Conditions/Amenities (12
items)
1.

2 .

8.

2 .

2.

1 .

9.

1 .

3.

1 .

10. NA .

4.

1 .

11. 1 .

5.

1 .

12. 1 .

6.

0 .

7.

2 .

Score: __/__

13
22
SCORE=_____/_____

Supervisors Scoring Sheet


Instructions: (cont)

Computing the score per component.

To get the numerator, add the numerators of all


indicators.
To get the denominator, add the denominators of all
indicators.

Each component will then have a total score


which is expressed as a fraction, e.g.,
component 1 score may be recorded as 48/56.

I. FACILITY
Indicator C.
Educational
Materials for
Clients (3)

Indicator A.
Conditions/Amenities
(12 items)

Indicator B. Facility
Infrastructure (12)

1.

2 .

8.

2 .

1.

2 .

8. 2

1. __1__

2.

1 .

9.

2.

2 .

9. 1 .

2. _2___

3.

1 .

10.

3.

10. 2 .

3. __1__

4.

1 .

11.

1 . 4. NA .

5.

1 .

12. 1 .

6.
7.

5.

2 .

0 .

6.

2.

7. 1

24
Score: 14
__/__

Indicator D.
Professional
Appearance of
Provider (1)

Total Score
(28 items)

1. __1__

11. NA
12.

16 20
Score: ___/__

1.

4 6
Score:__/__

1 2
Score: __/__

Score: 35
__/_52

Supervisors Scoring Sheet


Instructions: (cont)

The very first time these component scores are


recorded will comprise the clinics baseline
component scores.
Scores recorded from subsequent monitoring
visits will objectively document whether the
facility is improving or deteriorating in the quality
of its provision of FP/MCH services and supplies.

Once the Scoring Sheet is completed,


the supervisor can request the midwife
to participate in an exit feedback
session.
The following steps may comprise the
exit feedback:

Request for the accomplished Midwife Profile


sheet (keep this as record for the database on
midwives or simply as a baseline record for your
office);
Review with the midwife her self-assessment
answers either by going through each question
one by one, or, by.

Look(ing) at the comments table after each


component:

Agree or disagree and discuss with the midwife her


identified good points and areas needing improvement;
Be sure to compliment and congratulate the midwife on
her good points and encourage her to work on the
areas needing improvement.

Review and discuss the midwifes Action Plan

Agree or disagree with the items


As much as applicable and appropriate, confirm or
congratulate the midwife on recommendations she
herself had made and recorded in the action plan;
Ask for updates on each of the recommendations
made;

The following steps may comprise the


exit feedback:

Review and discuss the midwifes Action Plan


(cont)

Add or deduct actions or interventions that are not


appropriate;
Add recommendations especially if the supervisor has
access or ability to mobilize outside resources that will
help address the identified gaps in quality care. This
will encourage the midwife and convince her of the
supervisors commitment to her quality improvement .

The supervisor will then provide a


recap of the agreed recommendations
and next steps, together with the
assessment scores.

It would be ideal to leave a copy of the


accomplished Supervisors Scoring
Sheet with the midwife for her record
and reference.

Thank the midwife.

Private Sector Mobilization for Family Health - Phase 2


(PRISM2)

Monitoring done
Actual clientservice provider
interaction

Conduct of
regular business
in the clinic

Presence or
absence of the
item in the clinic

Interviewing the
midwife, assistants,
patients or clients
(least priority)

Monitoring
Observation IS the ideal and
recommended method of
monitoring. Therefore, the
presence of patients in the clinic
should NOT be a hindrance
rather it is a facilitating factor in
monitoring because then the
supervisor can simply and
quietly observe how the midwife
conducts herself during a
regular day at the clinic and
then record her (the
supervisors) findings on the

Section 4 - The Guide to Organizing and Managing the


Conduct of Clinical Case Conference for Midwives

technical meeting between midwives


and medical experts
user-friendly manual that provides
step-by-step guidelines

Five parts:
Organizing guidelines
Conference objectives
Structure of the conference
Steps in organizing
Appendices

The Bohol Experience:


Joint Quality Monitoring
Team

Background

DOH-CHD7 Office Order No. 0231 series of 2011

Establishment of Regional Technical Working Group


(RTWG) for Public Private Partnerships (PPP)

DOH-CHD7 Regional Circular No. 033 series of 2011

Recording and Reporting System for Private FPMCH Service Providers and Hospitals

PHO Special Order No. 001 series of 2011

Creation of Public Private Partnership (PPP) for


Family Planning and Maternal and Child Health (FPMCH) Provincial Technical Working Group (PTWG)
to improve FP-MCH outcomes in the Province

Institutionalization of CCC cum MDR at the PHO


level

Inclusion of regular conduct of CCC cum MDR


Involvement of CHD, PHTL, PHO, CHO, POGS,
PPS, IMAP
Updating of midwives clinical skills
PPP for FP-MCH Resolution No. 001 series of 2012

A Resolution Creating A Public Private Partnership


(PPP) Quality Monitoring Team to ensure
compliance of DOH and PHIC standards in
delivering FP-MCH in the Province of Bohol
effective May 7, 2012

PPP for FP-MCH Joint QAP Team

RESOLVED, to constitute a joint public-private quality


monitoring team to ensure the compliance of DOH and PHICset quality standards for the delivery of family planning and
maternal and child health products and services among
public and private providers to include compliance with the
principle of Informed Choice and Voluntarism (ICV) as
stipulated by DOH AO 2011-0005;
RESOLVED, that the following shall compose the said
quality monitoring team for the province:

One representative from the PHO as team leader


One representative from the DOH-CHD7 Provincial Health Team
One representative from the local PHIC service office
One representative from the NGO
One representative from the MHO/RHU of the area being monitored
One representative from the ILCI/IMAP local chapter

RESOLVED, that the PHO shall allocate funds to


cover the expenses related to the conduct of
quality monitoring activities of the joint quality
monitoring team;
RESOLVED, that the team shall initially focus its
monitoring activities among public and private FP
and birthing facilities in the province;
RESOLVED, that the monitoring team shall
initially use the USAID PRISM2-developed Quality
Measurement Tool (QMT) for use among
FP/birthing facilities but which shall be later
modified / enhanced / expanded to cover other
areas of quality monitoring as may be deemed
necessary by the joint quality monitoring team;

The Provincial Monitoring Teams


Group

NAMES

OFFICES/
AGENCIES

1.
2.
3.
4.

Ruth Cecilia del Prado


Josiane T. Pepito
Anecita Leopandao
Pilar Estafia

DOH-PHTL
PHO
CHO
IMAP

1.
2.
3.
4.

Machiavilla Loida M. Caliao


Gloria Caipang
Estrella Dumadag
Corazon L. Paras

PHO
CHO
IMAP
IMAP

1.
2.
3.
4.

Dr. Portia D. Reyes


Rosalina Amodia
Neneta Relamida
Dionisia Gacayan

DOH-PHTL
PHO
CHO
IMAP

Clustering of Municipality
PHIC Accredited MCP/NCP
Municipality

Public

Tagbilaran City

Private
1.
2.
3.
4.

IMAP
IMAP
IMAP
IMAP

Main
Dao
Bool
UB

Dauis, Panglao
Loon, Calape,
Tubigon,
Inabangga

Sikatuna,
Catigbian,
Carmen

5. IMAP Tinago
6. IMAP Songculan
1. Calape RHU

7.
8.
9.
10.
11.

IMAP
IMAP
IMAP
IMAP
IMAP

Catagbacan
Calape
Tubigon
Inabanga
St Jerald

2. Sikatuna RHU
3. Catigbian RHU
4. Carmen RHU

Jagna, Duero,
Guindulman

5. Jagna RHU
6. Duero RHU

Mabini, Alicia

7. Mabini RHU
8. Alicia RHU

Talibon, Trinidad

PPP BHs

9. Talibon RHU
10. Trinidad RHU

13. IMAP Guindulman

14. IMAP Talibon

12. Sandingan BHs

Implementation Plan (May-Dec


2012)
Joint QAP Team to undergo orientation on
QAP
Request Clinic Staff to fill up the selfassessment portion
Conduct actual clinic visits
Interview (3 groups)
Feed-backing
Action planning
Sharing of results and experiences (IMAP
Office)
Scheduling of next clinic visits (IMAP Office)

Summary of Findings
Name of
Clinic

Address

IMA Bool Ligones St.,


Branch
Bool,
District,
Tgbilaran
City, Bohol
IMAP
Main

Status

Clinic is
PHILHEALT
H
Accredited

Deficiency/ies

-Signage is too
small
-Lacking chairs
-Sink out of order

Recommendation
s

-Go to printing
shop
-Buy more sofa
/chairs
-Inform
plumber
New
PHILHEALT -Placentas are
-Construct
Calceta St., H
given to watchers placenta vault
Tagbiaran
accredited for bringing at

City, Bohol for 6 years home

already.
-Breast inspection -Breast
Botika
was omitted
inspection
Outlet soon during prenatal
must be
to open
check-up
included
-Alligator forceps
was missing
-Buy alligator
forceps

Summary of Findings
Name of
Clinic

IMAP UB
Branch

Address

R. Palma St.,
Tagbilaran
City, Bohol

IMAP Dao Purok 3, Dao


Branch
District,
Tagbilaran
City, Bohol

Status

Deficiency/ies

Accreditable
clinic, staff is
preparing
set-up for
PHILHEALTH
inspection

-Signage too small


that contain the
services
-No eye goggles
-Breast inspection
during pre-natal not
applying
-No FP acceptor

Recommendation
s

-Go to printing
shop

-Buy goggles
-Performing
breast inspection
-Advice client
and do
counseling for FP
Accredited
-Medicine cabinet
-Requested
clinic, Botika was not lack
made
Outlet soon -sharps container

to open
-IEC MCH posted
-Requested to
-Boiling and sucking PHO
of instruments-Request to IPHO
method of
-Informed to
sterilization
staff to
autoclave
instrument to
GCGMH at all

Gaps and Limitations


Public Birthing Homes (BHs) were not
visited
Private Birthing Homes (BHs) were not revisited after 6months
CHO staff were not given permission to go
outside the City
PHO did not infuse budget for the Joint
QMT

Lessons Learned
Expand the membership of the Joint QMT
to include Mayors or MHOs (MCP
accredited RHUs)
Tie up the QAP/QMT to the PHIC
accreditation renewal
PHO to integrate QMT to AOP (Budget
purposes)
Strengthen the P-TWG for FP-MCH

SUMMARY
The Quality Assurance
Package for Midwives is
a Toolkit for the
Practicing Professional
Midwives. It has been
developed as a
collaboration between
the Department of
Health and PRISM2, in
support of the
Millennium
Development Goals
(MDG) of the country .

Quality Assurance Package for


Midwives
Midwives are at the forefront of
community, usually being the firstcontact health care provider. Use
of the QAP by Midwives as a
guide/reference in their daily
clinical practice can help improve
and sustain the quality of practice
of professional midwives and this
is expected to lead to better
maternal & neonatal outcomes.

QUESTIONS???

Action Planning
KRAs
Establish
database on
Health Facilities
and Providers

Activities
Updating of
Inventory of
Facilities and
providers in
Davao Sur

Timeframe
July 31, 2014

Person
Responsible
Mai2x Suralta

Action Planning
KRAs
Information,
Education &
Communication

Activities

Timeframe

Person
Responsible

Audience with
the IHLZ
technical
management
committee
meetings

July - September

Mai2x Suralta

Issue and Send


Office Order to
ILHZ
coordinators to
schedule
committee
meeting for the
QMT to attend

July 14, 2014

Mai2x Suralta

Send letter to
DMO on the

July 14

Mai2x Suralta
Dr Anthony

Action Planning
KRAs
Monitoring Visits
and Reporting

Activities

Timeframe

Person
Responsible

Actual Clinic Monitoring Visits


DATES GROUPs/MEMBER
s
Sep 23 DOH-RO/PO Joy
PHIC Asha
Sep 24 PHO Esme
Sep 25 IMAP Millicent
APSOM Raquel
MH Tes Wood

Sep 26

AM Private
PM - Public

FACILITIES /
PROVIDERS

Digos, Sta Cruz


Sulop, Padada
Magsaysay,
Bansalan
Malita, Sta Maria,
Malalag

Next Steps
Next Round by January 2015, focus on the
mentoring
Joy Dinalo as liaison to the DOH-RO
Director for the signing of certificates
Mentor-Mentee Midwives capacity Building
(EINC, FPCBT1 &2, PPIUD, EBF) July to
October 2014