{"id":2301,"date":"2021-09-03T11:09:33","date_gmt":"2021-09-03T10:09:33","guid":{"rendered":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/?p=2301"},"modified":"2021-09-03T11:09:33","modified_gmt":"2021-09-03T10:09:33","slug":"multisectoral-governance-for-reproductive-health-challenges-and-lessons-from-the-philippines","status":"publish","type":"post","link":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2021\/09\/03\/multisectoral-governance-for-reproductive-health-challenges-and-lessons-from-the-philippines\/","title":{"rendered":"Multisectoral Governance for Reproductive Health: Challenges and Lessons from the Philippines"},"content":{"rendered":"

By Vanessa T. Siy Van (Health Sciences Program, Ateneo de Manila University) and Jhanna Uy (Research Department, Philippine Institute for Development Studies; Health Sciences Program, Ateneo de Manila University)<\/strong><\/p>\n

What is Multisectoral Governance?<\/strong><\/p>\n

Since the twentieth century, governments have recognized that health is as much a product of social, economic, and political conditions<\/a> as it is of health system performance. Many of these determinants fall outside the purview of health programs, and thus improving health requires multisectoral action. In the case of reproductive health (RH), multisectoral action is instrumental<\/a> to not only improving indicators such as maternal and child mortality, but also empowering individuals and the sustainable growth of populations, human capital, and economies. However, governing multisectoral action has historically been difficult, especially in low-and-middle-income countries (LMICs)<\/a> because of weak public administration, chronic underfunding, and limited skilled human resources. While laws are usually deemed the most formal and binding<\/a> form of policy, many LMICs<\/a> struggle with obtaining the commitment of non-health sector leaders to commit and operationalize policy implementation in their spheres. Such has been the case for the Philippines, where we found<\/a> that even with a policy-neutral, rights-based national law, the interest and buy-in of non-health state actors cannot be assumed. The case presents lessons for implementing multisectoral policies, as the presence of policy may not always translate into practice.<\/p>\n

Philippines\u2019 Reproductive Health Law<\/strong><\/p>\n

The Philippines is a unitary democratic LMIC where legislation and priority-setting are done at the national level, and social services are decentralized<\/a> to regional offices and delivered by local government units (LGUs). The Responsible Parenthood and Reproductive Health (RPRH) Law of 2012<\/a> was passed in this context after decades of opposition and public debate. Immediately after passage, the RPRH Law\u2019s enactment was delayed twice by the judiciary. Only after concerted efforts by national government agencies (NGAs), civil-society organizations (CSOs), and multilaterals, restrictions were lifted in 2017<\/a>. Despite these challenges, the law remains one of few national RH policies in Southeast Asia and is celebrated for its explicit call for collaboration among health, education, economic, and social welfare sectors. However, nearly a decade later, the landmark legislation did not translate into significant improvements in RH outcomes: maternal mortality<\/a> is twice that of the target set by the Sustainable Development Goals; Philippine HIV incidence<\/a> is one of the fastest-growing in the region; and in 2020, a-third of Filipino children were stunted<\/a>.<\/p>\n

Challenges of Putting Policy into Practice<\/strong><\/p>\n

Through semi-structured interviews with national RPRH implementers, we examined<\/a> national multisectoral governance practices and identified intersectoral coordination challenges. These were supported with document reviews and meeting transcripts of the RPRH National Implementation Team (NIT), composed of government agencies, CSOs, and multilaterals.<\/p>\n

Our analysis found three main themes over seven years of RPRH operations:<\/p>\n

1.National leaders, particularly the health sector, were unable to rally non-health sector actors around RPRH.<\/strong><\/p>\n