Community Health in the Philippinesthththrough Field Trip (Mar. 4 to 17 2018)
N. Yamada1, G. Agulu1, SM. Naing1, A. Kobayashi1, D.Xaiyasack1, Y. Sakane1, M. Sato1
1: International Health Development Course, Nagasaki University School of Tropical Medicine and Global Health

Overview of community health in the Philippines• Background: The Philippines’ health care service is decentralized: the country has 17
Departments of Health(DOH) Regional Offices, 81 Provincial Health Offices, 38 City
Health Offices, and 865 Municipal Health Offices. The number of Rural Health Units(RHUs) is 2,599, and the number of Barangay* Health Stations (BHSs) is 20,523. Thecommunity includes both RHU and BHS in the Philippines settings. The smallest orprimary health care is implemented in BHS. The RHU conducts periodic facilitative
supervision of the BHS. It also supplies Barangay Health Workers (BHWs) withlogistics like community registers and IEC materials.
* Barangay is the smallest administrative division in the Philippines. There are morethan 42,000.
* IEC is information, education and communication.
• Objectives:
1. To learn about the importance of primary health care in the communities in thePhilippines.
2. To understand the contribution to health care of BHWs in the community
Figure. Organization of the Health System (Public sector)

Key Activities / Roles of RHU, BHS, and BHWs

- RHU: Minor surgery, dental care, laboratory, monthly clinic and immunization (visit BHS), TB diagnosis & treatment, family planning service, prenatal
check-up, EPI, maternal care, newborn screening, environmental health services, nutrition program etc.
- BHS: Basic health care, promoting EPI, family planning services, maternal and child health etc.
- BHWs: Health promotional activities (to catch people for monthly clinic and immunization), referral to health facilities, track pregnant women andnewborn babies, EPI, nutritional health services (micronutrient supplementation), education regarding health and teenage pregnancy lectures*Collaboration between CBOs and BHS/RHU * CBO: Community-based Organization such as women’s group and youth association- CBOs serve as liaison between community members and BHWs.
- CBOs help to provide local transportation to the community members. eg: bicycles- Helps the construction of bridges and roads leading to health facilities.
- BHS/RHU holds regular meetings with CBOs on how to improve health in communities.
- CBOs advocate for community members

StrengthChallenges

Humanresource(HR)management*Alangalang and Dulag are the name of municipalities we visited- Shortage of physician, nurse and midwife in community level due to
Human resource(HR) management
brain drain abroad and private sector- Distribution of adequate nurses from DOH to LGU or RHU to complement the- Not enough cash incentive for BHWs
lack of HR- Resignation of contractual nurse from LGUs because of high burden- Efforts to develop HR to contribute to isolated areas through the unique school
Activities/system and management
curriculum in University of the Philippines, School of Health Science- High burden of transportation fee for patients after referral
Activities/system and management- Inaccurate data due to “insufficient double check system” of each data
RHU:
- Systematic report problem by no internet connection at times- 0 Maternal Mortality Rate (Alangalang, Dulag*)
Health issues- 98% facility based delivery (Alangalang, Dulag)- High teenage pregnancy rate
- Use of Local Government Units (LGUs) scorecard to evaluate and access- Double burden of both communicable and non-communicable diseases
results/outcomes of per BHS current program implementationin vulnerable population- Cash incentives (300 peso per month) for BHWs as motivation- Deaths without medical attendance, and difficult to follow up theBHS:
registration- Data management using PC → directly report to RHU- Low coverage in all vaccines because of dengue vaccine side effects- Strong relationship with municipality(Dulag)
BHWs:- Follow-up of cases such as malnourished babies, pregnant women, defaultersof ANC women etc- Referral from community to health facility, participating in outreach activity

Recommendation- Embark on more training programs (capacity building) for BHWs on preventive andcurative health care activities in the communities.
- Provide incentive and motivational packages for health workers, especially the BHWs.
- Coordinate with department of education to tackle the teenage pregnancy issue- Encourage health promotion for caregivers to increase vaccine coverage- Reinforce data management and establish double check function system

Conclusion
Thanks to decentralization to LGU, the community health facility has an ownership, free from the central government orders. Each RHU is managed by
BHWs at their own discretion, and some RHU could have achieved 98% facility based delivery. Contribution to the community health by BHWs isessential in the Philippines community health context. For effective improvement of community health service in the community, it is very important tomotivate BHWs since they are the vital workforce and frontliners in the community health level in terms of primary health care (PHC) services.