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The Case of Candoni, Negros Occidental
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  • 1. Better Health Outcomes throughCommunity Involvement:The Case of Candoni,Negros Occidental 1(Period of the Case: 2007-2010)When Bien Nillos responded to the of his life in the U.S.A. He returnedrequest of Candoni for a Doctor to the country to challenge the My first task was to learn the ropesto the Barrio, he embarked on a “political clan”, which had been from the DOH representative andjourney that transformed him from dominating local politics for the last health staff. I also began to establisha clinician to a municipal health 20 years. relationships, especially with thesystem manager,and from an Municipal Mayor and the otheroutsider to a leader. He won on the platform of department heads. prioritizing health He even requestedHe connected to the community the Department of Health (DOH) Among our accomplishmentsand formed the Community Health for a Doctor to the Barrio (DTTB) to during this time was the revival andAllies and Reform Team (CHART). be deployed to Candoni. Upon my reorganization of the Local HealthCHART was organized as the arrival in Candoni,I observed four Board (LHB).community’s own organization for major and pressing issues:health reform. In only a few years’ Acts of Leadershiptime, CHART helped to realize 1. poor health indicators; Empowering health workers wasthe positive health outcomes in 2. inaccessibility of the health care easy for me. Empowering thematernal and child care, primary facilities; community was another thing.health care, and others. 3. limited human and financial So, I took inspiration from one resources; and of the Principles of the Alma AtaThe case is narrated in 4. poor health-seeking behavior of Declaration: “The people havethe first-person by the community. the right and duty to participateDr. Bien Nillos. individually and collectively in the Specifically, the fourth problem (an planning and implementation ofProblem analysis apathetic community with regard their health care.” to health matters) was the hardestI took a bus on my first trip to to address. If it were successfully The same document describedCandoni in December 2007. solved, the three other problems primary health care as requiring andCandoni was one of the poorest could also be worked out. promoting “maximum communitytowns in Negros Occidental. Its and individual self-reliance andeconomy was largely agricultural. The Leader participation in the planning,Common crops include rice, After medical school, I wanted organization, operation and controlsugarcane, and corn. to become a Doctor to the Barrio of primary health care, making (DTTB). Being a DTTB meant being fullest use of local, national andIn 2007, they had a newly elected in a good position to trigger other available resources.”mayor. The new mayor spent most change in society.1 This case summary was written by Tina Pavia based on the case written by Dr. Bien Nillos. This is prepared solely for the purpose of classdiscussion. It is neither designed nor intended as an illustration of correct or incorrect management of the problems or issues contained in the case.Copyright 2010. Z U E L L I G F A M I LY F O U N D A T I O N 1
  • 2. With fellow doctors, I formed Botika ng Barangay to provide regular services. It also establishedCHART. The idea was to gather access to cheaper drugs a surveillance system for monitoringnon-medical professionals in the diarrhea and infectious diseases.community and engage them CHART established a Botikain the planning, organization, ng Barangay (BnB) in all nine Resultsimplementation, and evaluation barangays, aided by the Inter-Local From 2008 to 2010, zero maternalof relevant health programs in Health Zone (ILHZ), LGU, and the deaths were achieved in Candoni.the municipality. DOH regional office in Western This was attributed to the mothers’ Visayas. For the first time, the use of facility-based delivery The people have the municipality had pharmacies even centers. Infant Mortality Rate (IMR) right and duty to in its remotest barangay. also dropped considerably and its participate individually downward trend was established. and collectively in Improved services af the Main In addition, the malnutrition rate also the planning and Health Center went down. People became more implementation of their conscious and started to participate The community patronized the Main in activities, like the Lung Month, health care. Health Center when they started to Heart Month, and other campaigns – Alma Ata Declaration become aware of its activities and promoting a healthy lifestyle.Technical InnovationsFacilities-based delivery todecrease maternal mortalityThe CHART pushed for a municipalresolution to fully support facility-based deliveries. This move aimedto decrease the high MaternalMortality Rate (MMR) in themunicipality. A savings program formothers was also started. Finally,a “Buntis Baby bag” containingessentials for the mother and hernewborn was also promoted.2 Z U E L L I G F A M I LY F O U N D A T I O N
  • 3. Better Health Outcomes throughCommunity Involvement:The Case of Candoni,Negros Occidental1 Abstract The case study looked into how the Doctor to the Barrio, Bien Nillos, served as a catalyst in transforming Candoni’s municipal health system by organizing, empowering, and institutionalizing a responsive community-based organization, namely, the Community Health Allies and Reform Team (CHART). Based on available data, the study explored CHART’s impact on achieving better health outcomes for the community, especially the poor. Specifically, the study examined: • the depth and scope of the factors that defined the issue; • the factors that perpetuated the issue; • the “trigger factor”; • the leadership role that Dr. Nillos played; • the transformation of the community, the opportunities and challenges that facilitated or hindered the transformation; and • the CHART’s impact on the health outcomes of the community. • The case study likewise looked at the insights and lessons gleaned by the leaders from the experience. The case study is written in the first person perspective.The Municipality of already expected, considering that I took a bus on my first trip toCandoni it was part of what they would Candoni in December 2007. TravelI am from Negros Occidental and called the CHICKS area. CHICKS from Bacolod to Candoni, includingwhile I had heard about the town stood for Candoni, Hinobaan, Ilog, a 15 to 20 minute stopover incalled Candoni, I could not locate Cauayan, Kabankalan, and Sipalay. Kabankalan city, took almostit in the map of Negros before my These are towns and cities located four hours. The travel time fromdeployment as DTTB of the DOH in the southern part of Negros Kabankalan city to Candoni tookin 2007. What I did know was that Occidental. Later on, I found out another one and a half hours. TheCandoni was a town very far from that Candoni was located right at district hospital for Souther Negroswhere I lived. the very center of these towns. was located in Kabankalan City. It was a landlocked municipality,It had the reputation of being mountainous and almost Candoni was a fourth-classdominated by members of the inaccessible due to poor roads. municipality. It was also one of theNew People’s Army, which was poorest towns of Negros Occidental.1 This case was written by Dr. Bien Nillos under the direction of Mike Juan. Research assistance was provided by Dr. Ramir Blanco and Ms. Ana Go.Support for the research was provided by the Zuellig Family Foundation. This case is prepared solely for the purpose of class discussion. It is neitherdesigned nor intended as an illustration of correct or incorrect management of the problems or issues contained in the case. Copyright 2010. Z U E L L I G F A M I LY F O U N D A T I O N 3
  • 4. Prior to my deployment, I learned Unit (RHU), but it was already 1. Poor health indicatorsthat the politics of the town had dilapidated. The health indicators of thebeen largely dominated by only It had been operating without municipality were worse thanone family in the last 20 years. The electricity and water. Thus, the the regional and nationalnew mayor, who was elected in health workers would only report average. The MMR was 5.8 (per2007, was a neophyte in Philippine in this dilapidated RHU during 1,000 live births), whereas thepolitics, but had strong historical daytime. regional and national rates wereties with Candoni. He was, after 0.92 and 0.63, respectively. Theall, the grandson of the founder of After office hours, they would IMR was also very high (26.5Candoni, which was formerly known proceed to the Emergency Unit per 1,000 live births) comparedas the Tabla Valley Settlement. situated beside a Day Care Center, to the regional and national which functioned as a “Night rates, which were 10.1 andThe new mayor, who had resided Emergency Clinic” (NEC). Due to the 9.2, respectively.most of his life in the US, had gone lack of a doctor, the NEC was moreback to the Philippines and decided of a Referral Unit, with the health Malnutrition was also persistentto challenge the dominating political workers giving merely first aid to the in the municipality. Moreover,clan. He won on the platform of patients. After giving first aid, they pulmonary tuberculosis wasprioritizing health. It also was upon send off their patients to the district included among the top fivehis request from the DOH, through hospital for appropriate treatment. leading causes of mortality.the local council, that a DTTB was Even minor injuries such as laceratedagain deployed to Candoni. I was wounds were referred by the NEC. 2. Inaccessibility of healthnot the first DTTB. In fact, there had Of course, if a doctor were present, care servicesbeen two other DTTB’s before me. suturing could have been done right There were no accredited there and then. Cases of moderate pharmacies within theThe first DTTB had been willing to to severe dehydration were also municipality. The Barangaybe absorbed by the LGU after his referred to the district hospital Health Stations (BHS) were alsotwo-year contract, but the LGU without initial administration of run-down and inaccessible.at that time was hesitant to hire a IV fluids. The NEC lacks IV fluids Specifically, Barangay Agboy,doctor. The second DTTB, on the and the health workers were the farthest barangay, hadother hand, had been unable to not confident enough to do the the most dilapidated healthfinish her two-year contract. She left procedure without the presence or station. It did not have a roomthe municipality due to peace and order of the physician. that could adequately servesecurity problems. as a delivery room. Moreover, So, when the new mayor assumed it took almost an hour for aThe municipality’s economy was office, he ordered to close the resident of Barangay Agboylargely agricultural. Common crops dilapidated RHU and to establish a to travel to the poblacionwere rice, sugarcane and corn. The main health center inside the NEC. area, where the mainestimated population was around The NEC provided medical care health center was located.22,000. Of the nine barangays in for emergencies after office hours. Furthermore, when the rainsCandoni, three were situated in It also served as a referral station were particularly strong, thethe poblacion area [town proper] for patients who needed a higher road to Barangay Agboy wasof the municipality, while two were level of care at the district hospital. inaccessible to all vehicleslocated in the remote areas of This was the health situation of the except for the habal-habal.2the municipality. municipality when I came as a DTTB. There were also no pharmacies Upon my arrival in Candoni, I also in Barangay Agboy, promptingHealth Indicators observed at least four major and people to resort either toPrior to my deployment, there pressing issues: “alternative” medicines or towas one existing Rural Health2 Habal-habal are motorcycles-for-hire which ply the interior highlands particularly the areas that are not accessible via public utility jeepneys. ,which routinely ply routes into the interior highlands. In most cases, a habal-habal is the only form of public transportation available within and tothe hinterland.4 Z U E L L I G F A M I LY F O U N D A T I O N
  • 5. travel to the poblacion to buy the rest of the people. It was My decision was a sacrifice my over-the-counter medicines crucial to make them aware of family and I had to make. My from sari-sari stores. their own responsibility with greatest sacrifice was not only my regard to health care. separation from my family for a long Due to the remoteness of some period, but the feeling of guilt. I felt other areas, facility-based The Leadership Journey guilty over the fact that delivery was very low (24%). I was a high school senior when I was supposed to be a doctor for The deliveries attended by I decided to be a doctor. Many in my family first before I could be a skilled birth attendants were school would have expected me to doctor for other people who I hardly also low (58%). enter the religious life because I was even knew. actively involved in the Campus Peer3. imited human and financial Ministry. On the other hand, most When I accepted the position resources members of my family thought I to be a Municipal Health Officer The budget for health would take pre-law because of my (MHO), I was a doctor fresh out of expenditures was small. skill and talent in public speaking. In medical school. However, being There was also not enough fact, I emerged victorious in many a leader was not new to me. Ever manpower to run the various of our interschool extemporaneous since I was in high school, I had health programs of the local speaking contests during my high always seen myself in a position of health unit. school. But I guess, it was my responsibility. Also, my friends and fascination for science (Thanks to acquaintances always consider me4. Poor health-seeking behavior my second-year biology teacher.) for a leadership position. The community was basically that made me think of taking apathetic when it came to up medicine. With regard to leadership style, health matters. Mothers, for I was more of a thinking leader example, would only bring their There had not been any doctor in than a “working” leader. I never children for consultation when the family and I felt that I could be ran out of ideas, especially when they perceive the illness to be the first. At the same time, I felt I was engrossed with a project. “severe”. In addition, whenever that being a doctor was as noble Furthermore, I had this keen sense health workers visited their as being a Religious Brother. Finally, of identifying the strengths and barangay to give immunization by being a doctor, I can serve the talents of other people. So, my vaccines, medicines, or health community while having a leadership style involved delegating classes, only a few of the stable profession. work to someone capable of doing community members would the job. This style was evident when show interest. Finally, the Admittedly, it was tough being a I held various key positions during community doesn’t follow the doctor while being a father to a my younger years as Editor-in-Chief proper referral system. Instead young family. Among the greatest of my high school and college of going to the BHS first, most challenges I faced was balancing yearbooks, president of the Campus patients immediately proceed to family time and work. They also Peer Ministry Organization and the main health center didn’t take my decision to be a DTTB president of the Medical Student for consultation. easily. Like most people, my own Government in medical school. family expected me to become a Of the four problems listed, hospital-based doctor - admitting While I was a doctor, the fourth was perhaps the patients and making rounds in the I did not have a hardest to address. However, if wards with my white coat – while monopoly of ideas it were successfully solved, the earning enough money to buy a when it came to public three other problems can also house and a car. So, I had to explain health. It was important be improved. Therefore, it was to them why I chose to become a for me to trust and important for me to empower DTTB. I told them that being a DTTB delegate tasks to people. the community, starting with will give me a good position to the health workers, followed by trigger change in society. Z U E L L I G F A M I LY F O U N D A T I O N 5
  • 6. Perhaps, the only difference the notable accomplishments during and implementation of theirbetween then and now was my my first 6 months was the revival health care.” The same documentfeeling of inadequacy as a doctor and reorganization of the LHB. described primary health care ashandling an unfamiliar leader requiring and promoting “maximumposition. Therefore, it was important community and individual selffor me to recognize that while I was Being a DTTB will give reliance and participation in thea doctor, I did not have a monopoly me a good position to planning, organization, operation,of ideas when it came to public trigger change in society and control of primary health care,health. It was important for me to making fullest use of local, national,trust and delegate tasks to people and other available resources.” Itwho were far more knowledgeable also said that “to this end”, primary Return to Alma Ataand experienced than I was. At the health care developed “through Empowering the health workerssame time, I was also conscious appropriate education and the was easy because they were allof the fact that there were people ability of communities very open minded and enthusiastic.depending on my lead. For them to to participate.” They were also really excited thatgain confidence, I should be their a doctor was coming their way.“leader”, confident of myself and During lunch break, I immediately My public health nurse becamewith my decisions. consulted with fellow DTTBs and my loyal confidant. Even the DOH came up with the acronym CHART, representative provided me with theAmong the most notable barriers which stood for “Community needed support. The chairpersonI encountered was the people’s Health Allies and Reform Team”. of the Committee on Health in theperception of my being a “young” The idea was to gather non-medical Local Council was also as supportivedoctor in the midst of “older” professionals in the community as the rest of the staff.and more experienced health and engage them in the planning,care workers. Being a first timer organization, implementation, On the other hand, empowering thein public health, I was not fully and evaluation of relevant health community was a challenging task.knowledgeable when it came to the programs in the municipality. It took a lot of time. In addition,protocol of every health program. while I was able to touch base withSo, I studied and did my research. After returning from the CME, I the community leaders, I knew thatMost importantly, I listened to my immediately discussed the idea I needed to harness the supportcolleagues and my patients. of CHART to the health workers and cooperation of the rest of the and barangay midwives. I also community and not just the leaders.My first six months as a DTTB was conducted a workshop as a way ofspent learning the ropes of the initiating the program. When I attended my firstMHO from my dependable DOH Continuing Medical Educationrepresentative and health staff. (CME) for the DDTB, I finally got anI also used this time to establish answer to my self-concocted riddle. I needed to harness therelationships, especially with During one of its sessions, there was support and cooperationthe Municipal Mayor and other of the rest of the a workshop based on the Principlesdepartment heads. Aside from community and not just of the Alma Ata Declaration. Ilearning from them, I also taught the leaders. had heard of this while I was stillmy staff about “new” ideas and a medical student, but it was onlyconsulted them about their ideas for during the workshop that I gotthe health center. enlightened. The Community HealthThe first six months was also about Allies and Reform Team Specifically, this sentence struck The CHART workshop started with“proving” myself to the community. me: “The people have the right a group of barangay captains andI wanted them to know that and duty to participate individually their kagawads for health, teachersalthough I was young, I was very and collectively in the planning and school heads, departmentcapable of the job. Perhaps, among6 Z U E L L I G F A M I LY F O U N D A T I O N
  • 7. chairpersons, and other local NGO’s, role was to help promote health was to make the community self-including representatives of church- advocacies. The RAM also assisted sufficient and resourceful. If therebased groups. other health workers in increasing was any budget appropriation, it the level of awareness of the was allotted for the establishmentDuring the workshop, I shared community through constant of a database in the MHO.the Alma Ata Declaration and engagement with the students andemphasized the role of the teachers, parents, and parishioners. CHART’s first project was thecommunity. Then, the invitation to development of the database.form a group of concerned non- Legislative Action Network (LAN) Through the Development Fundmedical professionals was presented Members of the Local Council of the municipality, we were ableto the group. After which, CHART and the department chairpersons to request for the purchase ofwas organized. of each government agency computer units for the database. formed the LAN. Their role was The database served as basis forCHART was envisioned to link all to push for the legislation of any recommendation that wesectors in Candoni towards one the health agenda and their would give to the municipal mayor.vision - a call for all to get involved subsequent implementation. The system’s design was simpletoward better health outcomes. The LAN became a strong ally in so midwives could easily inputSince CHART was composed of lobbying for policies that would data for reports and monitoringdiverse people, mostly professionals lead to the implementation of sheets (FHSIS, TB Registry, etc).from different work backgrounds, health programs in the community. After inputting, the computerit was best also to divide the With the engagement of other automatically computed the datagroup into interrelated working department heads, the approach and analyzed whether targets forcommittees. My being a “techie” to addressing health problems the year or quarter were met. Atperson resulted to the subdivisions became multidimensional, which the end of the year, the entireof CHART being based on a modern was appropriate considering the health staff would meet for theday computer’s set-up. CHART was many socio-cultural determinants annual program implementationdivided into the following: of health. review. During the review, we all go over the data and analyze ourCommunity Health Initiative Monitoring Team (MONITOR) programs’ gaps and strengths.Partners (CHIP) MONITOR was composed of Based on the gathered data, weCHIP was composed of the program coordinators in the health would formulated out plan for theleaders of the barangay, including center, the DOH representative, succeeding the year.the Sangguniang Kabataan, and other coordinators from thethe Women’s Health Team, and provincial and regional levels. The We also had a mid-year ProgramBarangay Health Workers. Its team was tasked to monitor the Implementation Review. Themembers included credible leaders progress of the programs being decision to go into “paperless”in the respective villages who implemented. They also provided reporting minimized human errorcould lead the community in the the feedback of all programs to in calculations. It also decreasedadoption of health programs. the community. work hours, especially in theTheir role was to initiate barangay- preparation and submission oflevel health projects in line with Initiating CHART was not difficult reports to the PHO.the objectives of the local health because I was able to obtain aagenda of the municipality. budget from the Mayor’s Office The OPD Registry was also for its first workshop. However, converted to a database. At theRelations Advocacy Managers for the succeeding assemblies end of each month, an OPD Census(RAM) of the CHART, we met during Report was prepared by the healthSchool heads, teachers, church- other scheduled events to save staff. The report cited the mostbased groups, and the local costs. No subsequent budget was common reasons for referrals andPhilippine National Police (PNP) appropriated for the program consultations in our OPD.belonged to the RAM. Their because the idea of the CHART Z U E L L I G F A M I LY F O U N D A T I O N 7
  • 8. Because of the existing database, gather the hilots and explain to center to deliver babies anymore.there was easy retrieval and them the new policy for facility- They could now focus on their othermonitoring of information in real- based deliveries. TBAs were given work and attend to deliveries intime. In turn, we were able to make new roles as partners of the skilled their own BHS.prompt recommendations to the birth attendants. Furthermore, theMunicipal Mayor for quick and TBAs were recognized as members Another innovation was theappropriate actions. of the Women’s Health Team. They implementation of Alkansiyang assisted in pre-natal and post-natal Pampamilya. In this program,Finally, the information gathered care. Nonetheless, the one who pregnant patients voluntarilyby the monitoring team from the would attend to the birth delivery “deposited” their “savings” indatabase was also shared with at would exclusively be the doctor, their BHS. These savings wereCHART assembly for analysis of nurse, or midwife. only withdrawn and used afternon-health professionals. delivery. The savings were used Most of the hilots seemed to have to buy diapers, gauze, and otherThe CHART in Action accepted these changes. They loved items needed during childbirth. InAfter the creation of CHART, the going to the RHU because even if addition, a Buntis Baby Bag wasmembers of the group chose a they were not directly attending to also given to every pregnant womanrepresentative who would sit in the the birth delivery, they were actively who delivered in the RHU. The bagLHB during its meetings. Since then, doing other things. They wore contained rice, diapers, and otherhealth programs in the municipality gowns and masks, and helped in essential items. This strategy washad been widely consulted by the post-natal care. They also took greatly appreciated by the mothers.the members of the CHART. At care of the children who were in the Eventually, through word of mouth,times, the ideas for program waiting room and cooked for the this practice reached other pregnantimplementation and improvements family, if needed. women and their communities.were initiated by its members. The LGU, through the LAN, It also became a practice at theFacility-Based Deliveries complemented CHIP’s action birthing facility to allow the by allocating a budget for the husband to witness the delivery ofAmong the many municipal renovation of the dilapidated his baby. The TBA was also thereresolutions made by the CHART was RHU. They converted it to an to assist in the car of the newborn.one stipulating the granting of full infirmary, equipped with a delivery Sometimes, they would evensupport to facility-based deliveries. room, labor rooms, trauma accompany the family waiting in theAll the nine barangays also passed room, clinics, and a TB-Directly ward and take care of them.a resolution in support of it. The Observed Treatment Scheduleresolution recognized the high MMR (TB-DOTS) laboratory. Additional Before being discharged from thein the municipality and considered equipments for maternal care were birthing facility, the new mothersall pregnancies high risk. It ordered also purchased. This was done were required to undergo a pre-that deliveries should be facility- in preparation for PhilHealth’s discharge counseling sessionbased and had to be managed accreditation of the RHU’s maternity conducted either by the MICDR orby competent health workers - a care package. an appointed family counselor.doctor, a nurse, or a midwife. The counseling was to be attendedMoreover, all hilots (TBAs) were To complement the possible increase by both the husband and the wiferequired to surrender their delivery in facility deliveries, a competent or, if unmarried, by the mother andkits. However, some hilots resisted midwife was appointed as Midwife- her parents. During the counseling,the ordinance because community in-Charge of the Delivery Room the new parent/s were taught howmembers who patronized their (MICDR) at the main health center. to care for their newborn, theservices opposed it. The MICDR handled all deliveries at importance of immunization and the main health center. In turn, the newborn screening, and tips onTo address challenges like this, the nine other barangay midwives did family planning.CHIP called a Hilot Assembly to not need to go to the main health8 Z U E L L I G F A M I LY F O U N D A T I O N
  • 9. Monitoring of non-facility based that the main health center would other reportable infections. Healthdeliveries was done by the BHWs. provide some mechanism to ensure workers were also taught how toThey report such incidents to the the sustainability of the botikas, use a simple computer programmidwife who forwards it to the the barangay captains threw in their where they could input the names,barangay captain. The barangay full support. addresses, and diagnoses of patients.captain would then reprimand the These files were used for monitoringmother and the hilot depending on Aided by the ILHZ and the and real-time analysis, especially inthe gravity of the deed to ensure DOH regional office in Western the event of a possible outbreak.compliance the next time. Visayas, the LGU supported the establishment of all nine botikas, As a result of all these initiatives, theThrough the foregoing initiatives, or one botika per barangay. For IMR dropped considerably and thefrom a low percentage (at 24%) of the first time ever, the municipality downward trend was established. Itfacility-based deliveries in 2007, the had pharmacies, even in its most slid from 26.5 per 1,000 live birthsnumber rose to 74 percent in 2008. remote barangay. in 2007 to 4.14 per 1,000 live birthsMoreover, by the end of 2009, in 2009. The malnutrition ratethe figure reached 85 percent. To help monitor and sustain the also went down. People becameMeanwhile, deliveries attended by pharmacies, the BnB Monitoring more conscious of their health.skilled birth attendants also rose Team, composed of the DOH Through various health bulletinsfrom a low of 58 percent in 2007 representative, BnB operator, posted strategically in all barangays,to 79 percent in 2008 and 87 municipal accountant, nurse they were educated about otherpercent in 2009. coordinator, and barangay health conditions, like pulmonary captains, was established. The tuberculosis.From 2008 until 2010, zero team was responsible for ensuringmaternal deaths had been achieved that the botikas sold medicines at In 2007, there were still deathsin Candoni. This was validated by the recommended price and were related to TB despite the existencethe Negros Occidental Community financially sustainable. of a TB DOTS program in theHealth Surveillance System municipality. While the cure rate was(NOCHES). They found out that Talk of the Town high, the detection rate remainedthis was true for all mothers, even very low (47% in 2007). In orderfor those who went directly to the Because of the high profile to increase awareness about PTBhospital in Bacolod or the provincial established by the main health and the services available in thehospital in Silay City. center, more people became aware main health center, the Lung of the services it offered. Each BHW Month celebrations were furtherBotika ng Barangay was also given a catchment area to intensified with emphasis on PTB. strictly monitor and facilitate the From village to village, a campaignCHART also established a Botika ng transport of sick patients, especially was launched against TB. TheBarangay (BnB) in all nine barangays children, to the nearest BHS for community was educated that deathafter noting the inaccessibility of appropriate medical care. In fact, from TB could be prevented throughcheap drugs. Initially, all barangay the main health center designated early consultation and the patient’scaptains were hesitant to start a Thursday as “Well Baby Clinic adherence to the treatment protocolBnB. They feared that they would Day”. Every Thursday, mothers for six months. Thereafter, from anot be able to sustain its operation. were encouraged to bring their low Case Detection Rate (CDR) ofThey cited experiences in the past children to the BHS for weight and 42 percent in 2007, we were ablewhere community members would growth monitoring, consultation, to increase the CDR to 88 percenttake out medicines from the botika immunization, and vitamin in 2009. They were also able toon credit and not pay back. supplementation. maintain the cure rate at 94 percent.Nonetheless, all nine barangays saw In addition, a strong surveillance In 2009, no mortality due to PTBthe importance of having a BnB. system was also established to was listed. The TB DOTS centerFurthermore, after being assured monitor occurrences of diarrhea and in Candoni was also accredited by PhilHealth in the same year. Z U E L L I G F A M I LY F O U N D A T I O N 9
  • 10. Moreover, other institutions force or voluntarily. I opted to situation as I experienced them. Ibecame more involved in leave voluntarily. After I left the challenged them to act and changehealth. For instance, the schools municipality, the main health center the situation. Recently, a group offocused on the Anti-smoking no longer had an MHO. medical students from the UniversityCampaign during the Lung Month of Saint La Salle invited me to becelebrations. From one school This meant that I one of the advisers of the groupto the other, health workers would have to leave they formed. TAMBAL (which meansconducted an Anti-smoking Class the municipality where “cure”) aimed to increase the levelto increase awareness on the of awareness of the local medical by force or voluntarily.dangers of smoking. They also community with regard to the I opted to leaveemphasized the importance of a Philippine health situation. Since its voluntarily.healthy lifestyle. In addition, every organization, TAMBAL had been ableFebruary, the entire LGU celebrated to conduct various symposia andHeart Month with a mountain seminars. One of which was a talk bymarathon and an inter-barangay Quo Vadis, Doctor? Dr. Jaime Galvez-Tan, who was also Where all of these would lead to, IHataw Aerobics competition. one of TAMBAL’s adviser. They also am not sure. However, I believe that released publications on local health we reap what we have sown. AsChallenges issues that were being circulated far as the fundamentals of primaryIt was not an easy journey for the within the local community. health care were concerned, I couldCHART and the rest of the RHU, say we had already established aespecially me. When the mayor In some ways, I could say my strong foundation in Candoni. Thesuffered a stroke, we also suffered leadership journey has moved people’s mindset, particularly witha major setback. Although he on. However, I will never forget regard to the role of TBAs andsurvived the stroke, he became the experiences I had as a DTTB the value of early consultation,physically dependent on people in Candoni. I learned a lot. I am had changed.in the office who had political forever grateful. But there are stillambitions of their own. a lot of things for me to learn in Therefore, even despite the absence the future - more opportunities of a Municipal Health Officer, theFor instance, when I went to for me to practice and hone my people would continue to go to theCandoni after my last CME for the leadership abilities. I am looking main health center to deliver theirDTTB, some people in the LGU forward to all these. babies. In turn, the health workersmanipulated the mayor to sign an would continue to have their jobs.appointment paper of a different I believe that we reap After all, the health programs weredoctor. This occurred after the DOH what we have sown. not personality dependent. We hadawarded me the Grand Distinction made it clear to the communityAward and after I told the LGU that that they would only get the kindI was willing to stay. Until now, I am of health care they deserved whenstill in the dark as to the motives of they participate.these people. Perhaps, they felt thatthey could use their doctor of choicefor their propaganda. Perhaps, after They would only getseeing how I managed the office the kind of health carewith transparency and conviction, they deserved whenthey got threatened. they participate.The people who manipulatedthe mayor regained their political Meanwhile, it had since becomepositions during the 2010 elections. my personal mission to share withThis meant that I would have to others, especially to my students,leave the municipality where by the realities of the Philippine health1 0 Z U E L L I G F A M I LY F O U N D A T I O N
  • 11. List of AcronymsBHS Barangay Health StationsBHWs Barangay health workersBnB Botika ng BarangayCHART Community Health Allies Reform TeamCHICKS Candoni, Hinoba-an, Ilog, Cauayan, Kabankalan and SipalayCHIP Community Health Initiative PartnersCME Continuing medical educationDOH Department of HealthDTTB Doctor to the BarrioLAN Legislative Action NetworkLGU Local Government UnitLHB Local Health BoardOPD Out-patient departmentMHO Municipal Health OfficerMICDR Midwives-in-charge of the Delivery RoomMONITOR Monitoring TeamNEC Night Emergency ClinicNOCHES Negros Occidental Community Health Surveillance SystemPhilHealth Philippine Health Insurance SystemPHO Provincial Health OfficePHS Provincial Health StationsPNP Philippine National PoliceRAM Relations Advocacy Philippine National PoliceRHUs Rural health unitsTB TuberculosisTB DOTS Tuberculosis Directly Observed Treatment ScheduleTBA Traditional birth attendants Z U E L L I G F A M I LY F O U N D A T I O N 1 1
  • 12. Annexes1. Copy of Candoni’s FHSIS for 2007. Accomplishment Eligible PerformanceIndicators Population Standard Number PercentPregnant women with at least 4 prenatal visits 757 80% 466 62%Pregnant women who had at least 2 doses of 757 80% 466 62%tetanus toxoid immununizationPregnant women that had taken the complete dose 757 80% 486 64%of iron supplementation for at least 6 monthsDeliveries attended by skilled workers 527 70% 305 58%Deliveries at health facilities 527 80% 127 24%Pregnant women given dental services- curative treatment 741 30% 0 0%- preventive treatment 741 30% 41 6%Post partum/lactating women given Vit. A within 527 100% 502 95%1 month after deliveryExclusive breastfeeding up to 6 months 527 100% 519 98%Fully immunized children 649 95% 551 85%Infant receiving DPT3 649 95% 538 83%No. of New Born screened 527 100% 12 2%Children under five years of age with pneumonia 599 100% 599 100%given antibioticsChildren under five years of age with diarrhea 209 100% 209 100%given ORSNo. of health personnel trained in IMCI 13 100% 9 69%No. of RHU/BHS implementing IMCI 10 100% 9 90%Children 6 to 71 months given Vit. A capsules - 6 mos. to 11 months Given Vit. A 324 95% 329 106% - 12 mos. to 71 months Given Vit. A 3243 95% 2907 90%Sick high-risk children 6-71 mos. Given Vit. A - Measles 0 100% 0 100% - Pneumonia 34 100% 34 100% - Persistent diarrhea 3 100% 3 100% - Underweight 16 100% 16 100%1 2 Z U E L L I G F A M I LY F O U N D A T I O N
  • 13. Accomplishment Eligible PerformanceIndicators Population Standard Number PercentFood retailers/food establishment selling 90 100% 90 100%iodized SaltContraceptive Prevalence Rate 2727 60% 640 23%No. of surgical sterilization provided - Bilateral Tubal Ligation 0 0% 0 0% - Vasectomy 0 0 0 0TB Case Detection Rate 28.75 70% 12 42%TB Case Notification Rate 5.50%TB Cure Rate 14 85% 13 93%Smear Negative X-ray Positive cases referred 7 100% 7 100%to TBDCQuality of Direct Sputum Smear MicroscopyHuman Rabies Deaths 0 0 0 0Dengue Cases 0% 17 17Avian Flu 0 0 0 0Environmental Sanitation% HH with access to safe water (Level I, II, III) 3603 91% 2975 83%% HH with sanitary toilets 3603 85% 3052 85%% of food establishments with sanitary permit 90 100% 90 100%% of HH with access to sanitary garbage disposal 3603 85% 2959 82%% of HH with complete basic sanitation facilities 3603 85% 3252 90%Budget appropriation for Health vs. Total LGU 35,044,856.30 20% 3173620 9%Budget% expenditure for Health vs. Total Budget for 3170620 100% 3170620 100%Health% increase in MOOE budget from the actual 504,943 10% 447,600 -6%budget of the previous year% of HH with PhilHealth enrolment (indigent) 1081 85% 0 0% Z U E L L I G F A M I LY F O U N D A T I O N 1 3
  • 14. 2. Comparison of Health Indicators and Access to Health Care for Candoni, Region 6 Western Visayas,and the Philippines for 2007Health Indicator Candoni Region 6 PhilippinesMaternal Mortality Rate1 5.8 0.92 0.63Infant Mortality Rate1 26.5 10.1 9.2Pulmonary TB Prevalence Rate Belongs to top 5 201.6 per 136 per 100,000 leading cause 100,000 population population of mortality (6th leading cause) (6th leading cause)Deliveries by 58% 70.3% 72.9%Skilled-Birth AttendantFully Immunized 85% 81% 83%Children Coverage13. Diagram of the CHART and Sub-committees and Members LOCAL HEALTH BOARD CHART GENERAL ASSEMBLY - composed of representatives from various CHART subcommittees - elects the CHART over-all Representative who sits at the Local Health Board CHIP RAM LAN MONITORing Community Health Relations Advocacy Community Health Team Initiative Partners Managers Legislative Action -DOH representative, Network Public Health Manager, - Barangay Captains, - School Heads, Program Coordinators, Barangay Kagawad teachers-in-charge, -SB Chairman Municipal for Health, Church-based on Health, Health Office Sangguniang Organizations, Department Heads, Kabataan, PNP, AFP, NGO Municipal Mayor, Barangay Vice Mayor. Health Workers1 4 Z U E L L I G F A M I LY F O U N D A T I O N
  • 15. 4. Comparison of Improvement in Health Indicators of Candoni for 2007-2009Health Indicator 2007 2009Maternal Mortality Rate1 5.8 0.92Infant Mortality Rate1 26.5 10.1Pulmonary TB Prevalence Rate Belongs to top 5 201.6 per(6th leading cause) leading cause of mortality 100,000 populationDeliveries by Skilled-Birth Attendant 58% 70.3%Fully Immunized Children Coverage1 85% 81%5.Current Status of Candoni’s Health Indicator Copy of Candoni’s FHSIS 2010 (3rd Quarter)Projected Population for 2010 24680 AccomplishmentIndicators Eligible Performance Number Percent Population StandardPregnant women with at least 4 prenatal visits 863 80% 347 40Pregnant women who had at least 2 doses of 863 80% 130 15tetanus toxoid immununizationPregnant women that have taken complete dose 757 80% 347 46of iron supplementation for at least 6 monthsDeliveries attended by skilled workersTotal Live Births 340Post partum/lactating women given Vit. A within 740 100% 347 471 month after deliveryInfant age 6 months seen 345Exclusive breastfeeding up to 6 months 740 100% 325 44Fully Immunized Children 666 95% 352 53Infant receiving DPT3No. of NB referred for screening 333Children Protected At Birth (CPAB) 863 334 39Children under five years of age with pneumonia 209 100given antibioticsChildren under five years of age with diarrhea 56 100given ORSContraceptive Prevalence Rate 2727 60% 640 23No. of surgical sterilization provided - BTL 0 0% 0 - Vasectomy 0 0 0TB Case Detection Rate 32.8244 70% 23 70TB Case Notification RateNew smear (+) cases cured 23 85% 16 70 Z U E L L I G F A M I LY F O U N D A T I O N 1 5