Republic of the Philippines
HOUSE OF REPRESENTATIVES,
Quezon City

SEVENTEENTH CONGRESS
First Regular Session

House Bit No. 9485

Introduced by Representative Ruby M. Sahali

AN ACT PROVIDING FOR CREATION OF BASIC EMERGENCY OBSTETRIC AND
NEWBORN CARE UNIT IN EVERY RURAL HEALTH UNIE IN THE AUTONOMOUS,
REGION OF MUSLIM MINDANAO AND APPROPRIATING FUNDS THEREFOR

EXPLANATORY NO1

In 2010. the Department of Health (DOH) recorded 1,719 matemal deaths. These
deaths were due to complication related to pregnancy that occur in the course of labor, delivery
and puerperium, hypertension complicating pregnancy, and childbirth and puerperium
according to the DOH, The Maternal Mortality Rate (MMR) in the country although it
decreased from 221 per 100,000 livebirths in 2011 to 149 per 100,000 livebirths in 2015,
Philippines still did not meet its MDG target of 51 per 100,000 livebirths, Many women still
do not go to hospitals for birth delivery or avail of prenatal check-ups.

Autonomous Region of Muslim Mindanao (ARMM) lags behind most of the regions
in the Philippines in terms of social services with the lowest percentage of women accessing
mnatemal health care; has the highest percentage (87%) of delivery at home, and only one in
five births benefitted from the services of health professionals based on National Demographic
Health Survey 2013.

The ARMM has one of the highest MMR in the country. DOH ARMM reported that
there was an improvement in maternal health care when the MMR decreased from 245 per
100,000 livebirths in 2008 to 66 per 100,000 livebirths in 2013, ‘This improvement according
to the DOH ARMM, was attributed to Active Management of Third Stage Labor (AMTFL), a
technique that does not use sophisticated machines; deployment of additional health personnel,
rehabilitation and construction of health infrastructures, delivery of equipment and
enhancement of skills through training

However, MMR rose to 71,000 per 100,000 livebirths in 2014. This goes to show that
ite the efforts of the regional DOH these are not enough to consistently improve maternal


health care and reduce matemal mortality. There are limitations to the current techniques
being used

Republic Act 10354 otherwise known as “The Responsible Parenthood and
Reproductive Health Act” of 2012 mandates that there should be hospitals and facilities with
adequate and skilled personnel, equipment and supplies for provision of emergency obstetric
and newbom care services. The DOH has issued standards for Basic Emergency Obstetric
and Newbom Care (BEmONC) and Comprehensive Emergeney Obstetric and Newborn Care
(CEmONC) services that hospitals and facilities, including Rural Health Units have to meet.
Sec. 5 of Republic Act 10354 states that people in geographically isolated or highly
populated and depressed areas should have the same level of access to these health care
facilities.

This proposed bill aims to ensure the implementation of Section 6 of R.A. 10354 in
ARMM by providing for essential support to barangay health stations, rural health units,
district and community hospitals in ARMM so they can meet the standards of BEMONC and
CEMONC through provision of additional funds for operation; equipment, including steady
power supply, training, and hiring of health care personnel.

This proposed bill is also consistent with the priority of President Rodrigo Roa
Duterte to fully implement “The Responsible Parenthood and Reproductive Health Act of
2012.”

In view of the foregoing, approval of this bill is earnestly sought.

t f
RUBY 'M. SAHALI

Lone District, Tawi-Tawi



HOUSE OF REPRESENTATIVES
Quezon City

SEVENTEENTH CONGRESS
First Regular Session

i Bit. No, 9485

HOI

Introduced by Honorable Ruby M. Sahali

An Act Providing For Creation of Basic Emergency Obstetric and Newborn Care Unit in
Every Rural Health Unit in The Autonomous Region of Muslim Mindanao and Appropriating
Funds Therefor

Be it enacted by the Senate and House of Representatives of the Philippines in Congress
assembled:

Section 1. Short Title - This Act shall be known as
Care in ARRM Act”

“The Emergency Obstetric and Newborn

Section 2. Declaration of Policy ~ Itis a declared policy of the State to protect and promote
the right to health of women, especially mothers and those in geographically isolated, highly
populated and depressed areas, in fulfillment of the mandate of the Republic Act 10354
otherwise known as “The Responsible Parenthood and Reproductive Health Act of 2012” and
that prevention of maternal deaths require that women are attended to by skilled health
professionals in well-equipped facilities,

The State commits to promote the right of women to access a range of maternal health services,
including emergency obstetrics and newbom care.

‘The State also recognizes that pregnancy and birth delivery can pose threat to the life of a
woman and her child thus, maternal health and newbom care programs of the Department of
Health (DOH) shifted to risk approach to pregnancy management that gives emphasis to the
importance of access to emergency obstetrics and newborn care.

Toward this end, the State shall cnsure that mothers and expectant mothers in ARMM shall
have access to emergency obstetrics and newborn care by mandating the establishment of Basie
Emergency Obstetric and Newborn Care unit in every Rural Health Unit in the ARMM

Section 3: Definition of Terms

1. Basic Emergency Obstetric and Newborn Care (BEMONC) refers to lifesaving services
for emergency maternal and newbom conditions/complications being provided by a


health facility or professional to include the following services: administration of
parenteral oxytocic drugs, administration of dose of parenteral anticonvulsants,
administration of parenteral antibiotics, administration of matemal steroids for preterm
labor, performance of assisted vaginal deliveries, removal of retained placental
products, and manual removal of retained placenta. It also includes neonatal
interventions which include at the minimum: newbom resuscitation, provision of
warmth, and referral, blood transfusion where possible.

2. Basic Emergency Obstetric and Newbom Care (BEMONC) Unit can perform the
following six signal obstetric functions: (1) parenteral administration of oxytocin in the
third stage of labor; (2) parenteral administration of loading dose of anti-convulsants;
(3) parenteral administration of initial dose of antibiotics; (4) performance of assisted
deliveries (Imminent Breech Delivery); (5) removal of retained products of conception:
and (6) manual removal of retained placenta. These facilities are also able to provide
emergency newbom interventions, which include the minimum: (1) newbom
resuscitation; (2) treatment of neonatal sepsis/infection; and (3) oxygen support. It shall
also be capable of providing blood transfusion services on top of its standard functions.

3. Rural Health Unit refers to the main health center either at municipal or barangay level
with doctor, nurse, and midwife, and performs public health functions of the
Department of Health.

Section 4: Creation of Basic Emergency Obstetric and Newborn Care Unit As part of the risk
approach to pregnancy management, there is hereby created a BEMONC unit in’ every rural
health unit in ARMM

‘The BEmONC Unit shall be provided with adequate equipment and supplies, including steady
power supply, emergency transport and communication facilities, to meet the standards of
Basic Emergency Obstetric and New Bom Care (BEmONC). Provided that priority shall be
given to geographically isolated and depressed areas regardless of the number of population

Section 5 Implementing Rules and Regulations. Within 60 days upon the effectivity of this Act,
DOH shall formulate the rules and regulations for the effective implementation of this Act.

SECTION?: Appropriations: The amount necessary for the implementation of this Act shall
be included in the General Appropriations Act of the DOH. Funds may also be sourced from

international organizations provided the disbursement of funds shall be in accordance with the
Republic Act 9184 otherwise known as “The Government Procurement Reform Act”

SECTION 10. This Act shall take effect fifteen (15) days afler its publication in the Official
Gazette or in at least two (2) newspapers of general circulation

Approved,

Pa aig —