Pangato, I. V., Jr. (2015). Increasing facility based delivery as a means of reducing maternal mortality rate in the Autonomous Region in Muslim Mindanao: The Sharia way (Unpublished master's thesis). Public Management Development Program, Development Academy of the Philippines.

Public Management Development Program Senior Executives Class Batch 4 Thesis (SEC)--Development Academy of the Philippines.

The Autonomous Region in Muslim Mindanao is home to the five million Muslim Filipinos in the Philippines. It is also one of the poorest regions in the entire archipelago and is affected by a continuous threat of conflict between the Armed Forces of the Philippines (AFP) and the ideological Moro Islamic Liberation Front (MILF) together with the breakaway Bangsamoro Islamic Freedom Fighters (BIFF). The ARMM has been regarded by the no less than President Benigno C. Aquino III as a failed experiment. The ARMM has been labeled and stereotyped with different names. These included terms such as "the bombing capital of the Philippines" and "the kidnapping and terrorist haven of the Philippines". Through, these labelling can be easily disputed, as these are just manufactured ideas of the media and the handiwork of some people who do not wish to see the homeland of the Bangsamoro developed and be successful. However, there are some realities cannot be ignored and one of this is the current health situation in the ARMM areas. The facts presented herein are factual and continue to be a great challenge to both the elected and appointed officials of the ARMM especially the health care providers. Questions on whether the ARMM's health condition has improved with the current DOH-ARMM leadership or has worsened will depend on whose point of view, depending on their interest. There may be some groups that would support arguments that the present ARMM situation has gone from better to worst but some will also argue that health conditions are far better off six to eight years ago. The Philippines' report with regard to its commitment to the Millennium Development Goals (MDG) will officially be transmitted and reported on December 2015 and realistically some of the country's accomplishments are way below the target objectives especially on the reduction of the maternal mortality rate. The Philippines' has committed to decrease Maternal Mortality Rate (MMR) to 52 by year 2015 however, in the 2014 fifth progress report on the MDG, the country's MMR currently stands at 221 which is much higher than the 2006 data. Although the task may seem impossible to accomplish by the time we report our commitment, there is some glimmer of hope especially in the ARMM. The region was able to decrease its MMR from 245/100,000 live births in 2006 to 61/100,000 livebirths in 2013. A great feat for the once regarded - one of the poor performing regions in terms of the delivery of quality health care. However, the big decline in MMR of the region should still be carefully evaluated because there is some disacordance on some of the presented and reported vital health indices. Among those worthwhile looking is the region's steep MMR decline vis-a-vis its facility based delivery, which is still among the lowest in the country with only 24 percent. Studies have shown that one of the foremost reasons of a declining MMR is when delivering mothers are attended by skilled birth attendants and pregnant mother delivers in health care facilities. These studies have revealed that facility based delivery of laboring women increases their chance of survival and to have a safe and complication free delivery. Again, DOH -ARMM is face with a gargantuan task of improving and increasing facility based delivery in the entire region. DOH - ARMM has embarked on innovative and pioneering health measures on continuing to improve delivery of basic health services especially in the far flung areas or the geographical and isolated and depressed areas (GIDAs) but there still there is still much work to be done. The National DOH leadership together with its DOH-ARMM counterparts has begun instituting health reforms which included the Maternal, Neonatal, Child Health and Nutrition strategy otherwise known as the MNCHN strategy and the recently launched Hi-impact 5 which aims to focused on specific services critical to the attainment of the Universal Health Care that will prioritized the poor and provide tangible outputs that can be felt within a breakthrough period of 15 months. Despite these efforts, quality health care delivery in the ARMM remained to be elusive and a challenging task particularly when it comes to safe pregnancy and facility based delivery. Hence, there is a need to continue finding innovative ways to further improve the current health condition and offer better policy alternatives. The policy options that this paper aims to present have been evaluated based on the five criteria of effectiveness, efficiency, social acceptability, legal and administrative feasibility. These criteria are set in order to properly weigh the appropriateness and the probable success of the presented policy alternatives. Option number 1 is the professionalization of the traditional birth attendants or the TBAs. The TBAs have been around for decades and they will continue to exist as long as people and families continue to trust and need their services. There is a saying among locals that the advantage of having a TBA or a "hilot" in their midst is like having a trusted companion who will take care of the needs of a particular patient and the entire family from the time of conception up to the time if death (from womb to tomb). They are readily available whenever they are needed because they live amongst them in the same community. Thus, it is high time for the DOH leadership to fully utilize their potential and take advantage of the benefit that they can give to the genera; population particularly within the ARMM areas where most of the delivering mothers still prefer these informal health workers than the skilled birth attendants. These TBAs are also suffering from the discrimination and the lack of support for their craft. It is time to let them feel that they are part of our health care delivery system and its time to organize them and professionalize their ranks. Another option that is presented in this paper is the adoption of a sharia compliant hospital. A sharia compliant hospital does not entail a huge budget to implement for it can be readily incorporated in the present budget of an existing health facility. This option will have an immense impact on the Bangsamoro homeland for its would be revolutionize health care service delivery in this part of the archipelago. With the looming era of the Bangsamoro Basic Law for the Autonomous Region (BBLAR) and the ASEAN integration accompanied by the increasing demand for the halal industry and halal tourism, a sharia compliant hospital is the next logical step that should be explored. Bearing in mind that majority of the ARMM's population are dedicated followers of the Islamic faith, it is only fitting that health service delivery is both effective and culturally sensitive to the needs of its target population, There are some perceptions that the present health care system along with its infrastructure are too westernized, hence patients and their companions are not too comfortable in coming to our health facilities and seek consultations much more to give birth. With the adoption of a sharia compliant health system, there would be greater possibility that it would be able to address issues such as low facility based deliveries and more importantly, it would address issues such as lack of cultural sensitivity in our health facilities. The last and third option proposed a behavior changing approach which incorporates Islamic values. This approach is called the Value Transformation Training or VTT. This life changing workshop aims to establish a pool of community leaders that would act as catalyst for change with deep understanding, appreciation and practice if Islamic Values. One major objective of the VTT is to inculcate the guiding principles and standards of behavior necessary for the development of key actors and players in the community to effect change and development. Challenges on low facility based delivery have a no cure all solution and entails a multi-dimensional approach. A single stand-alone option among the three presented choices cannot lay claim as the best single possible answer in solving low facility based delivery in the ARMM area however a three pronged approach using the presented option might be able to help increase facility based delivery.