Philippine Health Care Delivery System at Grassroots Level

Philippine Health Care Delivery System at Grassroots Level

I. Introduction

The Philippines is a third world country in Asia where poverty and corruption is very rampant. It encompasses poor health care facilities, infrastructures, government, employment, and majority of the people can’t afford to go to school. According SWS survey as of 2006, 52% of Filipinos said that they belong to the poor sector and according to Feud Art as of 2006 in Philippines by income class, low class (poor) represents 26.9% of the total population. This sector is usually deprived of their basic needs and necessities in life especially in health care. In fact majority of them suffer from different diseases and die of unknown reasons without having seen by a health care provider. In addition, most of them are uneducated and misinformed as they are the common victims of violence, social discrimination, immorality, and devious acts.

As health care professionals, we must act as an advocate for them through disseminating essential information and providing proper knowledge in order for them to become aware, correct misconceptions, to learn and practice health promotion towards independence to promote quality life. These interventions would help in truly making health in the hands of the people.

II. Issues

Community involvement is an integral part in making a program designed for the community a success. A community health nurse would perform ocular visitation, he or she would visit some areas in the community, conduct interviews and maybe even hand out surveys or ask for the masses’ opinions regarding the needs of the district. Upon collecting the data the community health care workers identify issues, prioritize and develop a plan to get the program started. A dilemma that the group has noticed while still in their college days is that when a community is being engaged to attend seminars, lectures and embody the program they lack the enthusiast and they fail to realize the utility of the plan and its benefit in their lives. What else can be done to entice the people to take more action?

With all the different plans and programs nursing schools and even the local government have for the community they become very dependent and just wait for the provisions that will be coming from these groups of health care facilitators. The goal of these groups is to help the community realize what they need and then together with the community health care team assigned in their area act upon those need. But in most cases the community lack the initiative to act on their own and that they have to be prodded and periodically checked to make sure that the program is being carried out. Another problem with this is that there are only a handful of people to supervise the community periodically, it is possible that because of this the people lose interest in the project there is no one to motivate them.

To make a plan spring into action there would be a need for some funding. It would be difficult for a project to start running without the budget. In the Philippine setting, sometimes it takes too long for a budget to be approved and it seems like health issues is not high on the government’s list of priority. Although lawmakers do make up programs for the poor however those programs are not enough and it is not reaching the people in far and hard to reach rural areas, with a budget that is minimal and manpower that is lacking, what can be done to address this issue? What else can the government do for the health of its people?

III. Guide Questions:

1. It is evident in the Philippine Health Care Delivery System that every barangay health center lacks health care professionals as well as medical supplies and equipments. We cannot deny the fact that in most barangay health centers, we seldom find nurses and doctors, and equipments and supplies are either lacking or insufficient. What can we do with this?

2. Training of midwives and the barangay health workers can greatly affect the quality of health care rendered to the community. What trainings/seminars/continuing education can you suggest?

3. Does community health nursing in the BSN curriculum of the Philippines really make the community independent, or does it make the community dependent because of the student nurses rotating in their communities every semester?

4. Low salience or no salience attitude of the community will make it impossible to foster changes if the community itself refuses to recognize the problem. How can we address the problem regarding “salience” as a hinder for community empowerment and in extension, community development?

5. Core groups are organized to address concerns of the people within their community. But most often than not, when the immersion has already ended, core groups will go dormant. Same is true with other barangay projects such as livelihood projects, herbolarium, among others. What can we do about this?

6. There are programs for the community people but sometimes they cannot participate not because they cannot go but because they are unaware that these programs exist. Information dissemination has posed a problem for nurses particularly for far-flung barangays where transportation is a major hindrance. How can we make sure that people get the information about all these health programs? What resources can we tap to pursue information dissemination?

7. How about the budget for health by the government? There is a budget but how can we make sure that the budget goes all the way at barangay levels?

I think the best subject we should be focusing on is the indigenous communities. How about this people? Limited accessibility on health care were available unlike the communities that most be likely to have given such attention already. How will this community be reformed?

the group agrees that the indigenous people and those who are in far flung areas should be provided with better health care services. I believe that DOLE has a program where they hire nurses for far-off areas, the government may wanna hire more nurses and further develop their health program in general.

is it effective? I think you are talking about the NARS program. But one of the requirements is,a resident of the identified municipalities(http://www.nars.dole.gov.ph/). How we nurses can help the indigenous people? What suggestions can we raise to government/ community to help them?

The government should have a better program for the health sector, according to our guest lecturer the local/regional government are the ones that should be implementing such programs/projects. I suppose we, as nurses, we can go to a local government unit, or maybe start at the smallest government unit-the barangays and raise our concerns to them, perhaps we can work together to develop and carry out a plan that would be most beneficial to the chosen area.

Your proposal and recommendations are ideal and should be implemented. you should focus your attention to the indigenous areas, those who are mainly at the far-off regions in which there are no health facilities available? the main adversary that you need to address first is our goverment's action plan to solve this matters. as nurses, we should act as advocates to speak in behalf of those who cannot voice out their concerns. we can also bridge the gap between the health sector and the LGU for them to work collaboratively to solve these issues.

I agree with you zen that the government should have a better program for the health sector especially those in the far-flung areas. Unfortunately, admit them or not, these are all just plans and most of these plans don’t materialize due to lack of funding (possibly also because of the graft and corruption rampant in the government). Your view is very idealistic, I really hope that is also the reality.

We can always try to talk to the concerned government unit, though. Let’s just hope that they hear it out and take appropriate actions to remedy our concerns.

Thank you for the comments.You are right Nina and Abby that is why we want to be a means of communication to address to government that these issues (poor health car to far-flung areas)are existing and should be solved. It is true that the LGU should collaborate with the health sector because according to the Devolution of Health Services in the Philippines,the Philippines Government devolved the management and delivery of health services from the National Department of Health to locally elected provincial, city and municipal governments. (http://www.ncbi.nlm.nih.gov/pubmed/15877513)

According to a research, Overview of the Devolution of Health Services in the Philippines conducted by Grundy et. al (2003), the primary aim of decentralizazation is to increase the resource base for primary care by shifting as many resources as possible from central to peripheral locations. The experience in the Philippines is that the LGU often lacked sufficient financial commitment or capability to fund a District Health Sector post-introduction of post-introduction of devolution. This is particularly relevant to the funding of the district hospital sector.
(http://www.pcij.org/stories/2005/devolution.pdf)

May we ask for your comments and suggestions about our recommendations, and if these can be possible.

Recommendations:

1. Training of Midwives and Brgy. Health Workers (BHW)

We are recommending that the midwives and the Brgy. Health Workers of every Brgy. should undergo continuing education like attending seminars to make them more competent as caregivers. Since midwives are also functioning as a nurse in the real setting, these seminars would incorporate studies about nursing the community. Let us admit that not all midwives are knowledgeable about nursing the people. Considering that they are the “head of the health center” in most areas, they should become more knowledgeable and skillful as they are dealing with life.

2. Employed Group Of Community Nurses

We are suggesting that there will be group of nurses in each town or community in the Philippines who will be employed by the local government unit. The number of nurses will depend on how big the population is. These nurses will work hand in hand with midwives and BHWs. These nurses have many roles to do to facilitate change in a community such as:

• Assessing every Brgy. regarding the over-all health of the community, the health practices of each family, the over-all cleanliness of the surroundings, and the communicable and non-communicable diseases present in the community. Same nursing process with community immersion will be done but in this case, not only the prioritized problems will be the target plan of care but all the problems. This group is more active than the student nurses having community immersion as the over-all performance of the community will lie on their hands.

• After accumulating these problems in the community, these nurses will then channel it to the Municipal Health Officer (MHO) and together they will formulate plan of care for the whole community and the MHO will be the one responsible to address it to the Municipal Mayor.

• Implementation of plan of care and disseminating information in every household. Through flyers or courtesy call, these nurses will be the facilitators of learning through health teaching. The nurses will be an aide to health promotion also evaluate if there is a change with regards to the community people.

• Being channel of communication of the community to address the community problems to the MHO and to the Municipal Mayor. These nurses will report incidences and cases that are happening in the community such as donations given by the community people for consultation, syringes, etc. They will be a voice to the government and stand firm in persuading them to prioritize the health sector and allot more funds for the health budget. The Mayor will then channel these problems to the higher officials.

• These nurses will see to it that health policies and regulations are being implemented in each community. There should be a teamwork of the nurses and the MHO.

3. Strict government

We would like to propose that we should have a strict government. The government should become firm with the laws implemented. They should be able to make their constituents move. They should give necessary punishments to the law-breakers and to government officials and employees not performing well with their tasks and responsibilities. We have allotted budget for health but sometimes these budget is not used wisely for the betterment of the community people. They can enforce laws such as fines for littering in the community, memorandum and fines for families that use burning as waste management, etc. Also, they should become strict in implementing the cleaning and maintaining of the front yard and backyard of one’s own house. Lack of discipline is the central problem. Progress starts within ourselves. We nurses would want to be an avenue for change as we can help the government with regards to health teaching as why these laws should be strictly implemented.
Recommendations:

1. Training of Midwives and Brgy. Health Workers (BHW)

We are recommending that the midwives and the Brgy. Health Workers of every Brgy. should undergo continuing education like attending seminars to make them more competent as caregivers. Since midwives are also functioning as a nurse in the real setting, these seminars would incorporate studies about nursing the community. Let us admit that not all midwives are knowledgeable about nursing the people. Considering that they are the “head of the health center” in most areas, they should become more knowledgeable and skillful as they are dealing with life.

2. Employed Group Of Community Nurses

We are suggesting that there will be group of nurses in each town or community in the Philippines who will be employed by the local government unit. The number of nurses will depend on how big the population is. These nurses will work hand in hand with midwives and BHWs. These nurses have many roles to do to facilitate change in a community such as:

• Assessing every Brgy. regarding the over-all health of the community, the health practices of each family, the over-all cleanliness of the surroundings, and the communicable and non-communicable diseases present in the community. Same nursing process with community immersion will be done but in this case, not only the prioritized problems will be the target plan of care but all the problems. This group is more active than the student nurses having community immersion as the over-all performance of the community will lie on their hands.

• After accumulating these problems in the community, these nurses will then channel it to the Municipal Health Officer (MHO) and together they will formulate plan of care for the whole community and the MHO will be the one responsible to address it to the Municipal Mayor.

• Implementation of plan of care and disseminating information in every household. Through flyers or courtesy call, these nurses will be the facilitators of learning through health teaching. The nurses will be an aide to health promotion also evaluate if there is a change with regards to the community people.

• Being channel of communication of the community to address the community problems to the MHO and to the Municipal Mayor. These nurses will report incidences and cases that are happening in the community such as donations given by the community people for consultation, syringes, etc. They will be a voice to the government and stand firm in persuading them to prioritize the health sector and allot more funds for the health budget. The Mayor will then channel these problems to the higher officials.

• Overseeing the implementation of health policies and regulations and if it is continous. There should be a teamwork of the nurses and the MHO.



3. Strict government

We would like to propose that we should have a strict government. The government should become firm with the laws implemented. They should be able to make their constituents move. They should give necessary punishments to the law-breakers and to government officials and employees not performing well with their tasks and responsibilities. We have allotted budget for health but sometimes these budget is not used wisely for the betterment of the community people. They can enforce laws such as fines for littering in the community, memorandum and fines for families that use burning as waste management, etc. Also, they should become strict in implementing the cleaning and maintaining of the front yard and backyard of one’s own house. Lack of discipline is the central problem. We want to focus on behavioral change. Progress starts within ourselves. Before we can discipline other people, we should discipline ourselves first. We nurses would want to be an avenue for change as we can help the government with regards to health teaching as why these laws should be strictly implemented.

I agree with the recommendation. If only these things were firmly imposed by the higher-ups, then community health care delivery would be much more effective. Strong determination, big amount of discipline, and compassionate heart for each nurses will also make this things possible.

The recommendations are great to hear and it seems that's all there is for the proposed projects, they're just hearsays. No matter how many health plans and new policies the DOH produce it is very sad and unfortunate that they do not get implemented. Especially in the far flung areas where no one is really checking if the policies are being carried out and if the indigenous people are given the health services that is rightfully theirs.

Actually there is budget for health especially in the far flung areas but the government allocate that budget more on health care facilities in businesses areas here the Philippines like Makati which they intend to attract foreign investors because foreign investors won't invest in far flung areas.

Carlo, you are right. I hope that the government will use wisely the allocated budget for health and prioritize more the needy ones. Makati is a city and there are many health care facilities around the area. I think if these officials will try to live in such far flung areas, that's the only time they'll realize that these people are oppressed.