When the USAID-donated contraceptives began being phased out in 2001, Philippine President Gloria Macapagal Arroyo touted the Department of Health's "Natural Family Planning" emphasis, even saying that there would be no funds allocated for modern family planning. She also announced that her reasons included her own "traditional Catholic views" about family planning.
While the President's position continues to be a problem, those in the reproductive health advocacy have not been left entirely without options. Edwin "Aljed" Alejo, Field Operations Manager of DKT Philippines, explains that despite the limiting conditions of the politics around reproductive health in the country, DKT's "POPSHOP" offers a viable alternative at the local level: "We are delighted by the fact that many local government units and even midwives are taking the POPSHOP as their alternative to the diminishing supply in contraceptives. We have close to two hundred POPSHOP Social Franchises already serving as distribution points for our family planning products."
As a company known for its social marketing goals, DKT in the Philippines has long focused on the distribution of affordable modern family planning supplies to low income households, as well promoting condom use for HIV/AIDS prevention.
Since DKT started marketing condoms in the country in 1991, however, local politics around the issues of family planning and reproductive health have changed quite dramatically. During the high point of the gains for reproductive health rights in 1994 with the International Conference on Population and Development, the country had a Protestant President and an outspoken Health Secretary who had progressive views on reproductive health. This openness regarding reproductive choices continued till the term of actor-turned President, Joseph Estrada, but was abruptly changed when following his ouster in 2001, Arroyo assumed the Presidency.
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While DKT's "TRUST" remains a high-selling condom and sales of most of DKT's contraceptives have gone up, it has not always been easy to engage local government units on the issue of reproductive health. "While we already have a handful of success stories, many local government units (LGUs) still do not have a development perspective or framework to approach family planning and reproductive health, " Aljed says. Not all local officials are prepared or properly able to plan and let alone implement a system of service delivery of reproductive health services, he notes: "The lack of planning in health services are a constant concern…LGUs also have problems with their budgets, the lack of trained personnel and facilities. What POPSHOP is trying to do is to address not only product availability but to also assist them forecast their needs through training."
POPSHOP offers two support packages for interested franchise holders. A "standard full package" is a stand-alone package for a single franchise holder, ideally midwives or well family clinic service providers. The second package is targeted at bigger franchise holders, usually the local government units, which have other satellite or distribution outlets. An example would be a Provincial Health Office (at the provincial government level) serving as the main franchise unit and satellite outlets would be the Municipal and Barangay Health outlets.
In both cases, operations training is included and will prove important in insuring that the delivery of quality reproductive health services becomes fully integrated at the level of local governance.
Aljed quips that the POPSHOP concept is so new, especially in the Philippines that DKT realizes it is also quite a risky investment:
"Social franchising remains new in the local set-up and quite difficult to implement with meager resources. There are greater risks involved in implementing the POPSHOP unlike commercial transactions. Thanks to the United Nations Population Fund (UNFPA), so far we have 18-months support for the POPSHOP, helping us to pilot and better the system. We are still worried that the idea of 'dole-outs' will still plague the RH care delivery systems. Even as government is facing a total pull-out of supplies (the last batch of IUDS will be phased out this year), no concrete mechanism to help LGUs develop contraceptive self-reliance is available." That is, even as DKT's POPSHOP is a concept whose time has come, without clear-cut state policy, victories will continue to be piecemeal and even difficult to sustain.
At the moment, DKT reports that over sixty percent of its franchise holders are local government units. This is promising news (in the face of a national government unwilling to support RH) but also reveals an even bigger challenge of sustainability. Local elected officials have a term of only three years and this means that more than ever, social marketing here plays a key role in setting the standards not only for quality RH care delivery, but also for good governance.