Hope in the ARMM

By his own account, Dr. Kadil Jojo Sinolinding, health secretary of the Autonomous Region in Muslim Mindanao, admits that the ARMM is the poorest region in the country, “both in state of health and economy.”

Name any health indicator, such as maternal mortality, infant mortality or under-5 survival, and chances are the figures in the ARMM would be worse than the national average. And yet in recent years there has been a big change not just in the health of the people of the ARMM, but also in the way they perceive their region and themselves.

In 2008, says Dr. Sinolinding, the ARMM had the highest maternal and child death rates among the country’s 17 regions, and so when he took over its Department of Health in 2010, he knew that addressing the problem of unsafe pregnancies and deliveries needed to be top priority among the region’s health programs.

As part of a USAID-Shield Project that began in 2007, the ARMM-DOH embarked on a massive training project for health workers in the region. Part of this training was orienting midwives and birth attendants on proven interventions such as oxytocin injections within a minute after delivery, gentle extraction of the placenta, and intrauterine massage to keep the uterus contracted (and prevent bleeding). Proven steps to ensure the survival of the newborn, such as keeping the infant warm and using “skin-to-skin” contact between mother and infant to enhance and speed up early bonding, were also instituted. At the same time, the national and ARMM governments began a massive effort to upgrade health facilities and recruit more health personnel (not a small problem given the peace and order situation), as well as keep the facilities stocked with essential medicines.

The good news is that just a few years later, such steps have proven their worth. More mothers and babies in the ARMM are surviving pregnancy and childbirth. In 2008, the maternal mortality rate (MMR) in the region was 245 (while the national rate was 162), but just three years later (2011), it was brought down to 66, even as nationwide, the figure was rising. At the same time, the infant mortality rate has gone down from 55 (compared to the national rate of 25) to 18, even better than the national Millennium Development Goal of 19 by 2015.

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The ARMM success story deserves a more detailed telling. But such figures are providing bracing evidence of how good governance—coupled with strategic and focused decision-making—are changing things in the ARMM, most importantly for the ordinary folk  who are finding that life can be brighter even in the poorest region of the country.

And things can only become better. Yesterday, a most important initiative took flight: the signing of a memorandum of understanding for the “South-South Cooperation Initiative.” The initiative involves the sharing and exchange of training between the BKkbN, the family planning and reproductive health agency of Indonesia, and its counterpart, the Population Commission in the Philippines.

The initiative will take place mostly in the ARMM, where it is hoped that the success of family planning in Indonesia, a Muslim-majority country (in fact the biggest in the world), can inform the work of ARMM health authorities and workers. While both countries started their population programs at about the same time, Indonesia has largely stayed the course, implementing a successful reproductive health program that has, among other things, halved the average family size and saw the contraceptive prevalence rate (the proportion of couples using family planning) rising from 10 percent in the 1970s to about 60 percent today.

While the Philippines and specifically the ARMM can benefit from Indonesia’s “wealth of experiences,” Popcom executive director Tom Osias pointed out that Indonesia in turn can benefit from the Philippines’ exploration of “gender-sensitive and culturally respectful” means of promoting reproductive health.

Also significant was that among the officials at the head table was Dr. Sugiri Syarief, who is set to step down as chair of the BKkbN, thus making his presence at the signing ceremony one of his last official acts. Also present at the signing held at the Manila Hotel were a good number of BKkbN officials and a delegation of Indonesian parliamentarians, who will certainly find most interesting the ongoing debates over the pending passage of the RH bill here.

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Jose Ferraris, a Filipino who heads the UNFPA office in Indonesia, noted the striking similarities between our two countries—including a history of colonization—and voiced the hope that one lesson Indonesia could impart to the Philippines was the role that “constructive dialogue” could play in creating a national consensus over matters of mothers’ and babies’ survival.

Ugochi Daniels, the UNFPA representative in Manila, noted that the signing of the agreement “is just the beginning of a journey.” But while she stressed that Popcom and the BKkbN are “in the driver’s seat,” she assured them that “you will have many passengers supporting you all the way.”

Daniels added that while Indonesia ranks as the fourth largest country in the world (without the BKkbN’s efforts, it would be No. 2), and the Philippines is No. 12, “there is a country in between.” She was referring to her native Nigeria, which ranks eighth in terms of population, and its people are about 50-50 Christian and Muslim. She expressed the hope that even her homeland could learn a thing or two from the era of cooperation that UNFPA has helped put in place.

Certainly, the people of the ARMM stand to benefit immensely from this mode of South-South cooperation. But I have a feeling the rest of the Philippines and the developing world will come away with many lessons, too.