Philippines struggles to lower maternal mortality
The MDG-5 target is to reach 52 maternal deaths per 100,000 live births by 2015
Philippine ratios have been flat in the last 25 years, ranging at 110-130 deaths
Most needed are facilities, trained staff, medicines, supplies and leadership
The figures refer to the Philippines’ maternal mortality ratio of 162 maternal deaths per 100,000 live births and the fifth Millennium Development Goal (MDG) for maternal health of reducing these to 52 maternal deaths per 100,000 live births by 2015.
A coalition was created among interest groups from government, academia, non-government and business sectors to pursue this MDG-5 target on maternal health. 
Recently, Janette Garin, acting secretary of the Department of Health (DOH), reiterated the importance of multisectoral action on three related fronts: collective public-private sector leadership, accessible and affordable maternal care services and the greater use of these services by mothers.
“The 162 to 52 Coalition must continue to be a catalyst for change,” Garin told coalition members.
Previous health secretaries had made similar exhortations. I made mine in 2003 when maternal mortality was estimated at 170 based on UNICEF’s State of the World’s Children 2003 report. 
As I perused the UNICEF report recently, this time using my new lens as an academic, it dismayed me to see that Philippine figures have actually been flat over the last 25 years. This was clear from the consolidated 1990-2013 data compiled by the WHO Global Health Observatory from various sources (WHO, UNICEF, UNFPA, World Bank and UN Population Division Maternal Mortality): the mean values have hovered around 110 to 130, with low and high estimates ranging respectively from 80 to 190. 
In 2013, about 3,000 Filipino mothers died from childbirth out of 2.4 million deliveries. Maternal mortality had settled at an unacceptably high level and was in a steady state. 
But several strategic developments in the last five years may actually be breaking down this stagnant situation.
First is the policy of universal health coverage under the state-run Philippine Health Insurance (PhilHealth). Coverage has now reached 80 per cent of Filipinos nationwide, up from 60 per cent three years ago. This has been made possible with resources derived from the taxation of alcohol and tobacco products, called “sin taxes”. Survey data of the Ateneo Center for Health Evidence, Action, and Leadership (A-HEALS), a consortium of eight schools of Ateneo de Manila University, suggest that PhilHealth insurance payments for facility-based deliveries serve to motivate skilled birth attendants to do antenatal check-ups, bring their patients to the birthing facilities and follow up with postpartum care.
Second is the increase in facility-based deliveries in Eastern Visayas, one of the poorest regions in the country. Based on the A-HEALS survey, facility-based deliveries have been rising over the last five years: from 41 per cent in 2010 to 57 per cent in 2011 and 82 per cent in 2014.
Third is the designation of birthing facilities called BemONCs (basic emergency obstetric and newborn care facilities) and CemONCs (comprehensive emergency obstetrics and newborn care facilities). Unfortunately, the operational readiness of many of these birthing facilities leaves much to be desired. According to Jose Llacuna, DOH regional director for the Eastern Visayas: “Despite recent efforts to improve the birthing facilities and train personnel, the effective decrease in maternal deaths has not yet become evident.”
Elusive MDG-5 target
The coming years will tell if the mix of universal health care with sin taxes and local governance of birthing facilities will result in the progressive decline of maternal mortality. For now, however, it is unlikely that the Philippines will achieve its MDG-5 target of 52.
But I am optimistic that the situation will eventually improve. The survey in the Eastern Visayas tells me that even in this poor region, which was devastated by Typhoon Haiyan in November 2013, there are skilled birth attendants “out there” who step forward to provide maternal care services in the remotest areas. Ensuring consistent and adequate compensation and support for them will be critical for sustained success.
To conclude: while national health insurance coverage is necessary to improve maternal care in the country, it is not a sufficient condition for universal health care. As already envisioned by the 162 to 52 Coalition, the system will need to provide operationally-ready facilities, trained staff, medicines, supplies and effective leadership at national and local levels to achieve the target of eliminating high maternal mortality.
Manuel Dayrit served as the Philippines’ secretary of health from 2001 to 2005 and is the current dean of the Ateneo School of Medicine and Public Health. Throughout his 40-year career, he has focused on improving health care in the Philippines which include community-based health work in rural Mindanao. He was named Outstanding Young Scientist by the National Academy of Science and Technology in 1990 for his work in AIDS, cholera and red tide. In 2010, he played a key role in global efforts to create the WHO Code for the International Recruitment of Health Personnel.
This article has been produced by SciDev.Net's South-East Asia & Pacific desk.