title: A systems approach to improving maternal health in the Philippines.
abstract: OBJECTIVE
  To examine the impact of health-system-wide improvements on maternal health outcomes in the Philippines.
  
  
  METHODS
  A retrospective longitudinal controlled study was used to compare a province that fast tracked the implementation of health system reforms with other provinces in the same region that introduced reforms less systematically and intensively between 2006 and 2009.
  
  
  RESULTS
  The early reform province quickly upgraded facilities in the tertiary and first level referral hospitals; other provinces had just begun reforms by the end of the study period. The early reform province had created 871 women's health teams by the end of 2009, compared with 391 teams in the only other province that reported such teams. The amount of maternal-health-care benefits paid by the Philippine Health Insurance Corporation in the early reform province grew by approximately 45%; in the other provinces, the next largest increase was 16%. The facility-based delivery rate increased by 44 percentage points in the early reform province, compared with 9-24 percentage points in the other provinces. Between 2006 and 2009, the actual number of maternal deaths in the early reform province fell from 42 to 18, and the maternal mortality ratio from 254 to 114. Smaller declines in maternal deaths over this period were seen in Camarines Norte (from 12 to 11) and Camarines Sur (from 26- to 23). The remaining three provinces reported increases in maternal deaths.
  
  
  CONCLUSIONS
  Making health-system-wide reforms to improve maternal health has positive synergistic effects.
authors.affiliation: Reproductive Health and Research Department, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. huntingtond@who.int
authors.forename: Dale
authors.initials: D
authors.lastname: Huntington
authors.forename: Eduardo
authors.initials: E
authors.lastname: Banzon
authors.forename: Zenaida Dy
authors.initials: ZD
authors.lastname: Recidoro
mesh_terms: D005260:Female; D033161:Government Regulation; D006801:Humans; D008428:Maternal Mortality; D008429:Maternal Welfare; D010679:Philippines; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D016730:Program Development; D015397:Program Evaluation; D011634:Public Health; D012189:Retrospective Studies; D013598:Systems Theory