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Hl!!1! COUNCIL FOR
LiFibJ health and development, inc.
Deepening Our Commitment
to People’s Health
to Face the Challenges
of the 1990’s
Proceedings of the Second General Assembly
January 10-16, 1991
De Meester Residence, St. Theresa’s College
Quezon City
TABLE OF CONTENTS
Page
Day 1
Welcome Remarks
Orientation to the General Assembly
1
Regional Reports on the Stress and Calls
5
Executive Committee Report
Synthesis of the Regional Reports
Medical Ethics, International Codes
and Humanitarian Laws (Protocol II)
CBHP Evaluation Results
30
47
Day 2
Day 3
55
62
Day 4
Current National Trends and their
Implications to NGOs and POs
National Health Situation
81
89
Day 5
People's Development: Concepts and
Current Status
100
The Situation of Women in the Philippines 107
Day 6
CBHP Summing Up Results
Final Form
Organizational Meeting
Workshop:Health Work in the Current
Context
113
128
Workshop Synthesis: Health Work
Resolutions
Organizational Structure
Implementing Guidelines
Amendment to the Constitution
and By-Laws
Elections
Closing Remarks
131
135
137
141
130
Day 7
145
145
146
Appendices
A.
B.
C.
D.
List of Handouts/Contents of Kit
List of Participants
Group Reports: Workshop on
Health Work
Songs
a
d
k
r
*
10 January 1991
Thursday
Ssusht' CHD„i
3
Q
1
DAY 1
Over-all facilitator
Dr. Jojo Carabeo
SCHEDULE
2:00 PM
4:50 PM
5:00 PM
6:50 PM
Arrival
National Anthem
Dr. Tess Umipig
Invocation
Sr. Eva Varon, SCMM
Welcome Remarks
Dr. Ruben Caragay
Introduction of Participants
Orientation to the Conference
Presentation of Collated
Expectations
Committee Formation
Orientation on Regional Caucus*
WELCOME REMARKS
Ruben Caragay, M.D
Chairperson, Board of Trustees
Council for Health and Development (CHD)
I would like to thank all of you who came to the 2nd
General Assembly despite the crisis we have had and the
present crisis we are being confronted with.
In the past,
we experienced the killer quake and presently we are
apprehensive of the effects of possible outbreak of the Gulf
War.
Despite all of these, we have made a quorum for the
General Assembly.
It is notable that many of the delegates are women.
We hope that despite our heavy schedules this year, we
can still hold inter-regional hopping, to share and look into
the results of the CBHP evaluation and to unite on the
implementation schemes.
Based on the theme of our assembly, we will be facing
the challenges of the 1990 decade so* we will need to know
the national
situation and
the results of the CBHP
evaluation.
I am extending a very warm welcome to all of you,
participants, observers
and guests of the 2nd CHD General
Assembly and we hope that this will be a success.
4
2
PRESENTATION OF PARTICIPANTS
The facilitator of the day (FOD) explained that the
participants will introduce themselves according to their
position in
the program/organization, their strengths,
weaknesses and their expectations.
OBJECTIVES OF THE CONFERENCE
The Facilitator of the Day presented and explained each
of the objectives of the General Assembly:
1. ' To have an overview of the current status of CBHP's
based on regional updates and results of the summing □P
and impact evaluation.
2.
To discuss current national issues and their implication
to people and their health situation.
3.
To contextualize CBHP work with development work in
in general.
4.
To understand the principles and strategies for health
work in the current context.
5.
To formulate resolutions on organizational matters' and
elect a new set of members for the Board of Trustees.
6.
To draw up stresses and plans’ of the consortium for the
next two years.
PRESENTATION OF THE CONFERENCE PROPER
ORGANIZING COMMITTEE-STEERING COMMITTEE '
I
i
i
i
FODs
DOCUMENTATION
I.
STEERING COMMITTEE
- Over all Coordinator
- Over all Facilitator
- Regional representatives
Visayas - Tess Umipig
Mindanao - Ann Kadile
Luzon:
NCR
- Cel
SL
- Vicky
CL/NL - Patrick
i
SECRETARIAT
Yayen Barcelon
Jojo Carabeo
i
SYNTHESIS *
COMMITTEE
3
II .
DOCUMENTATION
Mar’ivic
Teth
Helia
Nelson
Flora
Coralyn
Grace
Nene
Glenda
Ill . SECRETARIAT
Gemma
Nitz
Efren
Del
Sr. Ester
Teng
IV.
SYNTHESIS COMMITTEE
Lyn
Mel,
Leni J.
Stella
The Facilitator of the Day explained the committees of
the conference. Changes were made as the body decided to
have one representative from each region: Visayas, Mindanao,
National Capital Region (NCR), Southern Luzon (SL), Central
Luzon (CL) and Northern Luzon (NL).
ORIENTATION TO THE CONFERENCE
The Facilitator of the Day explained that the CHD has
invited also non-members to the General Assembly.
CHD
members will participate and attend the whole conference.
Non-members will be listed as observers and may participate
in the workshops and discussions but will have no voting
powers.
Only CHD
members will
participate in the
organizational part of the General Assembly (Days 6 and 7).
PRESENTATION OF HOUSE RULES
The facilitator of the day explained the do's and dont's
for the 7 days live-in General Assembly. He also reminded
them to settle their reimbursements with the Secretariat and
to pay their membership dues.
4
COMMITTEE FORMATION
The participants were grouped into committees to help
in the smooth flow of the conference:
a.
Socials
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
b.
Buzz Session Groupings
NL
CL
c.
committee
- NL
- CL
- NCR
- SL 1) ST
2) Bicol
Vis
M inda
NCR
SL
VIS
MINDA
Regional Caucuses Groups
Same group as in Socials Committee
ORIENTATION ON REGIONAL CAUCUSES
The
groupings for
Regional Caucuses
were made
per
region.
The facilitator presented the guide questions for
Regional Reports which includes the status of the program,
the stresses and summing up (See Appendix B).
The said
questionnaire would help them assess the program in terms of
the quantity and the quality of their work.
f
Il January 1991
Friday
5
DAY
2
Facilitator Of the Day: Tfeth Guevarra
SCHEDULE
.8:10 8:25 -
8:25
9 :’ 00
9:00 - 12:00
12:00 - 2:00
2:00 - 7:00
7:00 -. 8:00
8:00 - 9:00
9:00
9:30
Morning Praise
Announcements: Change in Schedule
Update, on Gulf Crisis
Continuation of Regional Caucuses
’
Lunch
Regional Reports
Supper
Continuation of. Regional Reports
Buzz Session
OBJECTIVE OF THE DAY
To have an overview of the current status of CBHP'.s
based on regional updates .
The facilitator of the day welcomed’ - the . other late
participants who arrived this. morning from Kalinga Apayao,
Dicol and Quezon Province..
The' participants requested for extension of time
regarding regional caucuses' so it was agreed upon that the
regional reports would be presented in the afternoon.
GUIDE QUESTIONS:.
ACTION; TAKEN ON .THE CONSORTIUM’S STRESSES AND CALLS TWO
.
YEARS (1989-1990)
1.
Did you conduct consultations with local leaders/
people's organizations?° If yes, how many times within
If
were the resolutions reached?
the 2 years?’ IWhat
——
no / why?.
A
Sv •
i
.6
2.
Have' you. directed
program efforts
organizing? If yes,
yes. how did you. do it?
■ problems you encountered?
: No. of program areas !
old
to
community
What are the
expansion
I org’d : unorg'd Forg'd I .unorg'd!
'
i
*!
.3.
4.
i
■
Have you conducted a program summing-up within the last
2 years? If yes., when (inclusive dates)? Format used
(.CHD or otherwise .please indicate) . ' What were the
significant lessons learned (summary statements)?( If •
possib!' ? per component) . If no, cite reasons why not
’done.
Have you conducted a comprehensive community diagnosis
within the past two years? If yes, how many.barangays
were covered? What instrument was us'ed? Problems
encountered ’? How did you utilise the results?
If no CDx was done, what were the bases for your program
planning? •
5.
Have you conducted SDS focused on value and attitudinal
formation? What topics were discussed?
Was there an echo session of the 1988 consultation
(staff level, CHW level, board level)? If yes,, what are
the feedback from them? If no, cite reasons why not
done?
♦
6.
Have you developed a continuing development education
for CHWs? . What topics were discussed and what were the
results? % of CHWs bene fitting from the dev-ed.
7.
Did you have a Staff Development Seminar on program
management? Were there any significant changes,
introduced towards improving program management?
Problems encountered?- •
■p-
►
7
•
•
8.
•
’
•
’
.
*
Specific .people’s health issues addressed by the
program?
Specific campaigns participated in-.
issue
inc 1 iis-ive date. !
forms
; lead agency
What were the. results and significant gains for. the.
people?
■
How did you prepare the staff and community for the
campaigns?
What were the problems met.in projecting the people's
health issues?
9.
.What health services were’ given by your program in the
past 2'years? What were the bases, for such services?
Were criteria set? What methods were used in
unorganized and organized communitties?
.10. Have you identified and prioritized contact groups and
•individuals in the loc&l and international levels? What
were the-basis of your relationship? What are the
significant gains for the program and the people?
Problems encountered?
REGIONAL REPORTS
V
A.’
%
.’CORDILLERA
Report er: Dr.. Chandu Cl aver
There are four health programs- in Cordillera namely:
a.
CHESTCORE - Community Health Evaluation, Services
and Training for the Cordillera Region.
MCDC - Mining Communities Development Center
c . ■ IMHES -- Integrated Medical Health Services
d J CHECK- Community Health Concerns’.for Kalinga Apayao
These health programs provide health services
in five provinces composed of .Kalinga, Apayao, Abra,
Benguet which includes Baguio, Ifugao and MtProvince.
I
Quantitative Data
! Completed BHST: Active.: Inactive
321
197 •
‘(61%)
85
(26%),
:
Drop-outs :
47
(14.6%)
:
:
8
*
From .1988 1990 the number of CHWs trained in BUST
totaled 321. 197(61%') .active ClIW’s, .
85(26%) inactive CHW’s, 47 (14.6%*) drop outs due to
’ military harassment.
The four health programs are presently handling 50
program areas (50 barrios).
II. Qualitative Data
.A.
Sign! f leant-tDeve lopments
$
.1 . . Training
- expansion was not the stress for the last two ,
years, mostly consolidation work and follow-up
training. .
focus^was on improvement of existing modules.
A significant development is the participation
of CHWp as trainers.
2.
Services
. ~ Have started giving regular and sustained
.health services focused, on immunization, goiter •
•and control program, botica, nutrition instead
of barangay clinics, medical and surgical
missions.
’
•
There is act.ive involvement- i n . rehabi i i tat ion
and-relief work.
J.
Research
-Community diagnosis(CDx) was developed and
conducted. The programs were also.'able to
Update Community-diagnosis in' old areas.
One. program was able to update the community
diagnosis of its 13 old areas.
.
t
- Research on herbal medicines is still going on.
For. the- last two years, focus was on the
subject of domesticating- the plants and
propagating therft for mass distribution.
- launched province and region wide Sis’
4. Organizing
After July 16, organizing’efforts (CO & HSO)'
were greatly accelerated by NGO participation
in rehabilitation.work.
Of the four programs, MCDC has an organiz-ing
component.
.
«J-
9
Action Taken on Stress and Calls
1.
Consultations with People Organizations have always been ..
an integral part of implementation.
Cordi1lera hea1 th
programs have always stressed that health programs must'
only be set up in organized areas. They are not
comfortable with the idea of using the health program as•
entry point for organising.
2.
Organized areas are prioritized but coordination
problems exist between organizers and health programs.
3.
Three-year summing-up (’87-89) was conducted in one
health program.
4.
CDx was used but collated results. although used were
not formally written up', The programs were also able to ’
update Community diagnosis in old areas.
5.
.Exposures were used widely as a. form of value and
attitude .formation. There is a call f.or stress on
value and attitude formation among the staff. The •
program used the exposure technique wherein staff will
be exposed to other advance program or the,program will
be exposed to well organized areas..'
6:
Cantinuing Educat ion for CHWs s-uch as leadership
trainings were-given?
■'
7
The staff recognizes the importance-of program
management.
However, the staff as well as the CHWs
encounter difficulty in its actual application.
►
8.
Projection of ■ part icu l'ar health issues. The Baguio
based programs launched campaigns on health and
pollution,
logging and mining.
9. Health services include surgical missions, dental
services, laboratory, acupuncture, referrals,
goiter control, immunization and medical relief. The
programs have started giving regular and sustained health
services focused on immunization, goiter control program,
botica, and nutrition instead of launching barangay
clinics, medical and surgical mission. There is active
involvement 'in rehabilitation
and relief work.
10. Linkages were forged- but mostly on, individual basis.
Follow-up was not systematic nor organized.-
I •
■
■
10
.B.
CAGAYAN VALLEY
Reporter:
Tita Rillorta, R.N.
The Cagayan Valley programs'cover 3 provinces, These
——- ar^.
—the following:
programs
Communit
1 Based Health Development Program0 (CBHDP)
1. . (
Isabela '<5’ ■
2.. CBHDP - Nueva Vis’caya and Quirino.
w
n
..
Action Taken bn Stress and Calls
1.
After the first genera 1. assembly, the programs held
consultations with the peasants and church workers for
the formation of a health program structure within the
.parish and vicariate. Inter-regional program
' cbnsu1 tat iohs wore held once a year.
»
2-
.CBlips gave program orientation to barangays .■ The- whole
community -as- well as the leaders requested for the; CBHP
oriental ion. •So the programs conducted community
assemblys. The topics discussed were:
general
■ >, national situation
’> head th s ituation
> program orientation
criteria.for selection of CHW1s
3.
4.
’
The progi’tin:- conducted regular quarterly eva 1 ua t i ori a nd
difnua I eval ii.il i,<»n.
They also conducted a summing u.p m
.1989 and were able to identify the strengths and
• weaknesses, problems and; came up with recornme nd a 11 ons .
■ Before the CDx’training, the programs used PSI forms'.’But t hrsre was a weaknes’s . i ri collation arid i n d o< • umen 11 ng
the results, That is why the survey results were not
fully max iin i zed . Tl^e data were hot' analyzed.
In 1989, after'the.CDx seminar, the•programs used the
‘Cdx form.drafted .by CHD-. National Secretariat,. They
conducted CDkx in late 1990’ to update their records, Tenbarangays have been surveyed..- Collation is on-going.
5.
The following trainings were given: theobiblical
theobibli ca1 study,
study,
• community orq.arnzing/leadership trainings (qualities of
a good leader,and errors to be avoided), Rational' Drug
Use (RDU), Minor .surgery, Community Diagnosis (GDx),
Medical Neutrality, Acupuncture, Under Fives Clinic
(UFC), Disaster Preparedness, TLS, Program Management,
Course on -Community Development. (CCD) towards total
i
11
human development. The staff coordinated with the
Center for Nationalist Studies for their seminar, on
Philippine History.
6.
CHWs were also given continuing development education
which also covered- the above topics. SDS also included
attendance to/participat ion in campaigns and symposia.
7.
Trainings on program management were conducted.
8.
The following campaigns were launched:
ISSUE
FORM
: Medical Neutral rty Sympo
! NDP
DATE
SPONSOR
. Dec . 1989
CBHDP
Sympo
Jan. 27, 1990
CBHDP
!US Bases
Sympo
July 1988
CBHDP/SARANAY
!
f PCAP
■
Campaign
Jan - July 1989
Peasants Orgf/.
’
:cawa
Campaign
Nov. 30, 1990
TFD/Isabe1 a
[Human Rights Day
Campaign
Dec. 10,
Ji ■
1 88-'90 TFD
Significant; Gams?
Medical Neutrality - strengthened staff and CHWs commitment
National Drug Policy
- recognition of. banned drugs'
• - there are initiatives among the CHWs to have botica
hopping and prescriptions collectiqn.
US Bases - People in the community are not aware of the
effects of US mi 1itary.bases.
Campa ign
against
warrantless arrest
shari ng
about
warrantless arrests.
9.
Barr io-c 1 ini cs were' held upon the request of the
community. Medical and surgical missions were conducted
for indigent patients from CBHP areas. The programs
also conducted
fact finding missions, medical missions
(Cayapa) for disaster victims. There is a Referral
Center in Isabela with subcenters which continue to
i;
_
1
I II
i i i iimiii ■mu11mu ■ i
■s
12
serve Viscaya and Quirino. Under Fives Clinics (UFCs)
have been set up in 4 areas. Other Services: TB/Malaria
case finding.
Immunization . ■• Campaign and
Safe water
supply project.
10. The programs have many contacts.These health
professionals provided services but do not necessarily
accept the CBHP orientation.
Ga i ns:
C.
free, service
resources. '•
financial support
moral support
NATIONAL CAPITAL REGION (NCR)
Reporter:
Isay Villayuan
The NCR has the following programs:
1.. Tuason- Community Center Foundation, Inc.
2.. Programa sa Pag-oorganisa at PangkaLusugan sa
Sitio Ruhat (Popsir)
3. Kaisahan ng mga Programa sa Pagpapaunlad ng
Kabuuang Pagkatao (KAPPAG-BULONG).
4.
Paranague Development Foundation, Inc.(PDFI)
Al 1 are' urban base ranging 6-8- years, Program
component is education, training, organizing, linkages and
Income Generating Programs.
Their ■ m,ain problem iiss the
rapid . turnover of staff.
•
Action. Taken on Stress and Calls
1.
All programs were able to launch a consultation with
local leaders, • people organizations and the community.
Consultation were launched -monthly and quarterly wh^n
necessary.
•
> Fo’rmatifTn of coordinating body
- there'^was coordination on issues and program
implementation »
I
mi
13
2.
In the program areas, the stress-was on organizing. ■
This was attained by setting-up a health committee;
levelling off with CHWs, cg’nducting consultations with
the POs.
I No. of ‘program areas !
old ’
expansion
org'd : unorg1d ! org'd ! unorg’dr
NCR ,are$s
! 0
-
Total
13
9
0
3
14
v
3.
Summing-up was done.
Some.used their own format, others
used, the guidelines sent by the Notional Secretariat,
but these were not completed because of. other
priority tasks.
Lesson:
Multiple tasks and rapid turn-over of
some of the cahses of delays in work.
4.
All were able to conduct CDx but one program did not
adopt the CHD guidelines, CDx became the basis for
planning of each program. The CDx covered 20 areas.
Problem:
5.
staff are
Lack of Technical Manpower
All the programs conducted SDS like
‘> process retreat
> spiritual upliftment
> self awareness
> inter-personal relationship
> team buiIding
<.
6.
.The.programs conducted continuing education
for the ..CHWs,. This included updates' oh the national
situation,health situation,
politica1 -issues, oil price
increase, and'US bases. These helped in the awareness •
raising of■at least 20-30% of CHWs.
7.
■Program management was given little attention due to the
July earthquake disaster, wherein the attention or focus,
of work was on relief operations.
8.
The programs launched a <campaign
' _/ on environmental
sanitation and also joined-campaigns of other
'institutions.
’
14
9.
Health services- rendered for the last two. years' were •
acupressure,acupuncture, nutrition education,
referral/K.B.. Community Clinic, Medica1/Denta1,
Immunization-, MCH/We 11 baby/ Growth Monitoring,’ PreNatal, Post Partum Care, and .Hea1 th Awareness Building.
Basis:
This is the actual need of the- Community,
Methods Used:
> hea1 th education
> home visits
> referral procedures
•
’>'community clinic
> health .campaign
sma11 . sea 1e
\
"
.
■
.
'
'
.
.
10 . Loca 1 cont act s
facilitated servi ces/smooth
coordination and mutua1 support.
Venue for awareness
ia ising of individuals .and other groups.
Ga i ns
provided tree service
- sustained relationship with the.GO*s
International
financial support
-- maximization of resources within the area. ..
Problems
•D .
>' There. is difficulty in linkage work it .contacts
have a different orientation.
. • GO'S tend to regard and use t-he.CBHPs as
extension programs.
CENTRAL LUZON
Reporter : Patrick' Chuidi-an
Programs:.
1, H DE - Nueva Ecija started in 1987
2
Pampanga
started 1983
3.
Baco 1 or■
started-1906
*
CL
is 'a support program which started in
1990 •
*
..4. MCBHP-Munoz NE, started in 1982
Action Taken on Stresses.and Cal Is
1.
Reg iona1
Consultations were made ’with local leaders, PC
PO'..s, and
sectoral groups. But as a whole the resolutions, reached were
about the- cooperation in launching . specia 1. projects.' Some
barangays in N.E.- agreed to implement
imp 1 erne nt a ’comprehensive
'program but these plans were
were, 'hampered by problems like
militarization surfaced.
*
A
*
15
Problems encountered:
> Health work is not a priority’ of P.O's
i
There were efforts in community organizing but the CBHPs
were not able to form a program for organization.
Of 37 barangays, only one fits the criteria of an
organized •rea.
'2.
'
3.
’
*
'
/
■
T
7
■
'■
'
'
Program Summing-up
.
Ln the program summing-up conducted the following
strengths were identified:
provided services for the basic, health needs of the
a.
community.
.
v
able’to tap health professionals to render- services
b.
- in the areas'.
c.' some GHWs were able to give training and
services.
in organizing, there are 21 advanced CflWs who can
d.
function as'members of Barangay Health Commjtee insome areas in Nueva Ecija. Core group were
formed among women and youth particularly in
Bacolpr.
e.
linkages were established and there is now an
extensive referral network.
In the program summing-up conducted the following
weaknesses were identified:
CBHP work is not systematic:'
a. Training
Consultation with trainees was not
• implemented. Training modules were not updated, as
well as the visual aids and kits. There was no
evaluation of trainees and the staff's training
capacity were not evaluated.
b.
Services — Delivery of headth services is not
enough. There is a- need to develop services in
order to. respond to the needs of the community.
Types of services were basically barrio clinics and
individual consultation..
c.
Organizing - There is no comprehensive program for.
organizing.
■
d.
Staff - Ski IPs and knowledge are not broad enough.
There is a need to develop skills in program ' '
management and health.
e.
Program Management - There are weaknesses in
•systematization and professionalization of program
management.
«
i
t
• '16-.
4.
•I
Commu'nity Diagnosis
f
.
.. •-./ .
The programs were able to start the process ofCDx but
were not able to finish if.” The problems they identified
was the lack of personnel
personnel.who
who will attend to it.
The
planning was based on the condition of the area .
'
•<
5.
As a whole, CL. programs, were able to launch-staf f
development sessions on value and attitudinal formation
through the training on ways of giving feed-backs,
leadership training, .CBHP orientation, recollection,
retreat and'situationers.
' The . 1J’88 CBHP Conference results were echoed to the
staff in the Pampanga and Bacolor projects and also to the
staff and CHWs in ,Nueva Ecija.
Feedback:.
It
boosted the staff’s & CHWs’ morale and
provided'motivation '’Marami palang dapat gawin ang bigat ng
trabaho''.
6.
There is continuing development education which focused
oh the advancement of CHW's’ in terms of knowledge, .
attitude and skills. This.helped deepen their commitment
that, is why they spend, more time and are more active in
the program. Particularly .in Munoz, the families, of
CHWs not only understood their work but alsd got : involved in the program.
7.
Staff of trie three programs of HIDS attended the SDS on
program management and from this they realized tlrat
tfere fs a need to systematize the program.
Tn the
latter part, of 1.990, HIDS was able to take some steps
towards systematization and sought outside help.
'8. •
Health campaigns were launched but the problem was how
to sustain them and the lack of funds in non-health ■
campaign issues. The participation was only .through
attendance but this was not included in the planning
because the programs prioritized program work.
9'.
There are simi larit ies‘'in services although there • are
some particularities bas’ed on the health needs.
Problems:'
/•
.
\
•
The program could not cope with the health service
needs like minor,surgery and disaster management.
10. There is no programmed;networking activities.
Networking is usually conducted at the local levels..
The HIDS-BacoTor has international contact groups aside
from FA’s who were able to support the program in other
needs. ..The basis of relationship is services, finances
, and resources.
:■
I
17
GAIN:
Promotion of program,
consclentization of’ health .
professionals and
contacts a nd u nd e r s t a nd i ng of
the
conditions of the country.
/
PROBLEMS:
- no program for networking
- unable to prioritize networking due to lack of staff.
For clarification'and levelling .of of teh participants,
the OF reviewed the definition of terms concerning Organized
Communities (as agreed upon in the 1988 CBHP Conference).
E.
SOUTHERN TAGALOG
Reporter:
Rocky Agyapac
• *■
The’re are 8 Ilea 1th Programs namely-:
• • 1 . MAT Welfare Development Foundation
2 . Mindoro Institute- for Development, Inc'
3. UCCP
- United Council of Churches .in the Philippines(HAND)- Palawan
4. AUSCULTA
'Ambagang Udyok ng Sandiwaan ng mga
Congregasyong4may Ugnayang'Lingkod
para sa Taong Aba
5 . FMT
Formation Mission Team
6 . Rural Missionaries (ST)- Cavite
7. CDC1
Caysasay Development Center, Inc.
8 KSK
kilusang Sambayanan/sa Kalusugan;
h
Action Taken on Stress and Calls
1.
2..
One to 3 consultations with the POs • were done within
two years.
'* The «ResolUt ions/agreements vzere:
> 1 egal11les
the program should be registered, with
the Securities and Exchange .Commissionand should issue identification cards
. to its 'staff.
> endorsement of program
> support assistance
> establish good relationship with respected' persons
in the community
> coordination with Peoples Organization in
setting up health programs
Courtesy
courtesy calls with
With GO*s
GO’S and NGO'’s„ community meetings
to introduce- the programs, trainings -for awareness *
building, services and formation of CHWs: were all
done ;by the programs.
55?
18
Problems::
> Lack of skills (organizer)
•
•
> Difficulty in sustaining a program-w/o PO's
.> Slow organizing work
> Harassment of health workers
> If the area.is militarized.it is.hard.to get the trust of
the people
---------------
, b.ld
J No. of program areas !
__ _______________ 1
Southern. Tagalog,
areas •
Tot.al
3.
expansion
I org1d : unorg'd ! org'd ! unorg'd!
!• 8
I 1
9’
5
1 •
1 .
9
2
6.
1
11
Three programs, conducted summing up: CDCI, HAND,. •
and AUSCULTA but they still., need to. use the guide
formulated by the National Secretariat.
Significant Lessons Learned/Highl ights ..
.
•
> found out the needs for proper endorsement 'of work
\ lack of staff slowed-down program implementation
> importance of CDx-and PO's
• > criteria for CHW. selection should be set to prevent
drop-outs
> need -to str'enghten org. component
> need for health prof.
> focus should be on the quality of CHW1s not on the.
quantity>. need to re-emphasize the preventive aspect
> need for Rap.id Rural Assessment
4
Six programs, conducted
CDx, while-2 have not .
No. of barangays covered -
17
Problems encountered during CDx
1.
the questionnair.es for the beneficiaries are too
■ Tong
.
expensive ’ on the part*of program
2. expensive'
3. ■ -lack of skills in analysis and presentation
4.
lack of proper .orientation and trainings
5 . •health programs were already established before
the conduct of. CDx
t..
3
■
/•
-
A
CDx was used
•
1.
Project proposal making
2
Result of. Cdx
not utilized.3.
as basis to corne-up with the situation of the area
■ Those programs that did .not conduct CDx based their
plans on
1.
consultation with the POs
2. ' requests *of the community
5.
Focus on value and attitudinal formation was done thru
> psychological tests
> retreats’
*
> informal CSC accomplished thru activity
Ohly one program was able to echo the 1988 and
' 1989 CBHP Conference results; the rest did not.
6.
In sene areas, CHWs were able to-complete the BHST
Topics taken:
/
■ > case conference's (method)
> leadership training
.
>. dental prophylaxis and extraction .
> disaster preparedness
> IGP trainings like soap making/ biscuit making
> advance herbal medicine :
> Rational Drug Use
> feminism
_> growth monitoring - UFC
.
7. .The staff of two programs were given'training
on program
management. Job descriptions were clarified.
■
/
19.
• 20
8.
Campaigns participated
:ISSUES
,
!Pol lotion
DATES
FORMS
LEAD AGENCY
Nov.
* 90
MPT
PO
Oct.
' 90
•Kampong Bayan
• PO
Oct.
* 90 '
Mobilizat ion
PO-
:•
• i.,
:Oi1 Price
rCalabarzon
up
fPreservation of April'90
Rally
Haribon
PAL
Forest'
I US Bases.
9.
June '90
Protest-rally
Services given are:
> mental feeding
> Operation Timbang
> Acupressure/Shiatzu
>.-IV insertion of in - pt .
> Maternal Child Health
> Medical Mission
* .
> Dental prophylaxis and extraction
> Laboratory examination
■
.
Emergency Care of Patients
- trauma
- minor surgery
’
•
Services given were based on the'health needs of the
area.
'
10. The bases of relationship of local and international
contacts are orientation and services.
Gains:
> support
> security
. > moral
> financia1. ■
> resources
> assistance/technical/Personne1
!j
21 .
F. BICOL REGION
Reporter: Minda Cortez
Bicol Region is composed of 4 health programs namely:
BIHS -- Bicol Integrated Health Services.
TABI - covers- two provinces Sorsogbn and Albay and
three towns Daraga, Legaspi City and Densol
BP -7 Bagong Paglaom
SIPAGRO - Sentro ng Inisyatibong Pagsasari l-i ng
Kmunidad
TABI and BIHS are members of CHD and the other two are
observers. From 1986- 1990 period.of reviving PO's
through health.
•
.r
•Action TaRenon Stress and Calls
1 •.
Consultations with POs were launched twice a year with
special consultations if needed.
Resolutions reached:
. endorsement of program by community leaders
- adh-oc committee building after the assembly
assertion of legality in times of military harassment
- to revive the People's Organization
2.
Community Organizing Process:
a) without People's Organization
organizing the
Community Health Committeeb) with People's Organization - coordinate- with
People's Organization
!.Noi of program areas !
old
expansion
j
I
—T————«-—.—V.—
j
J
I org'd : gnorg'.d i org’d
Bicol Region
areas
36
10
1
. unorg' d;
1
.Problem encountered:
- People are passive and apatheti.c to CBHP.
; ''n
The eve ts -of 1986 has considerably weakened a lot of ■ ' l,j
our organized areas. Areas have expressed the need for
services but have remained apathetic t'o the concept of CBHP.
There is a need to strengthen our organizing work in order ,
to answer the challenge of reviving the^e weak POs.
22
3.
On CBHP Components
a . Health services: Mainly medical/dental services plus
referral based on felt needs. Services are used as
entry point fox. organizing.
b. Training
based on the ne.eds of the community or
upon request.
Trainer's capacity - can handle BHOS/BHST.
c. Organizing to define specific program and direction
toward* health sector organizing.
<
/
d. Linkage building- breakthrough in <consolidating a
network of health NGO1s in the region.
4.
In CDx, there is conscious efforts to implement CDx.
Form used:
Level:
Period of .Social Investigation
- there has. been an attempt to advance into
comprehensive- -CDx.
Prob 1em:
5.
Survey
Passive response f.rom the area.
Staff development, focused not only on attitudinal aspect
but also on the skills that are needed by the’ staf f.
The result of the first GA was,shared with the program
staff.
.
<7
6.
The Continuing Development Education for CHWs has been
included in the programs* plans but these plans
have not
yet been implemented.
7.
On prdgra i management, on the job training has been the
norm supp emented with consultancy with other agencies;
formal trainings’ were ‘ not given to the staff.-
8.
On the projection of health issues
- no health issue projected
— participated in the multi-sectoral campaign e. g. ■
signature campaign? march-rallies.
.Results : C
'
Clearly
defined stand of CBHP on burning issues
and, ensures active participation
of- -PO1js and health workers.
.
■ n .
fh-
23
9.
On Health Care Services: rendered basic medica1/denta1
services
in community clinics.
Bases: — felt needs'in the community
- upon the request. conduct medical mission
Method used:
Organized
- direct to PO/partnership
- health as a support service to PO
Unorganized:.- Health programs’ started from organizing
towards PO building
’
10. Networking;
Basis:
'Program orientation
Significant Gains
mutual support and coord i na t4i on
- consultancy
...
Non CBHP
basis of unity is issue oriented e.g. provincial
disaster .management l earn.
Problems encountered:
Weak in network expansion due to lack of systematization
and clear programming of networking work .
G.
VISAYAS
Reporter: Hersie Mitaran
Eastern Visayas - Samar and Leyte
Central Visayas
Bohol and Cebu
.
Western Vi.sayas - Iloilo, Panay, Negros Occidental
Eastern Visayas - Negros Oriental
General Problems met in the- last two years.:
- economic crisis
- demolition issue particularly in Cebu
- disasters, man made and natural
- militarization
.
'
’
Health problems are measles,- hepatitis and comrriunicabl e
diseases.
•
•
i
24
Action Taken on Stress and Calls
1.
On consultation with P.O.s:
- all programs•consul ted with the leaders of PO’s,
socio-economic groups and other NGO's as well as with
parishes and bishops..
In other areas,- the agenda set were:
- clarify roles and programs or organization
- review orientation and- philosophy
- consider programs in the next activities.
Problem:
The programs cannot enter the areas because of
militarization.
•
,
Resolutions:
- lines of coordination were cleared
- to have a continuous activity in the area even
without staff
- need to observe protocols in organized and
unorganized area.
2.
On directing program efforts to Community Organizing:
-all the programs are trying their best to direct
efforts to community organizing..
In some areas, the programs held consultations with POs
and clarify roles of program and POs.
Problems:
- Lack of staff to focus on Community Organizing, 'Also,
available personnel still need to develop their
organizing skills.
3. . All programs conducted summing up.
Samar - 3rd quarter 1990 (August, 1984 - June, 1990)
Central Visayas
- 1st quarter 1989 .
Iloilo - midyear 1990
Leyte - last quarter of 1989
Significant lessons learned:
- realized mistakes in the area selection and corrected
these in 1986
lack of staff development and CHW value formation
< — re-orientation and re-direction at all levels
(management, staff, community) towards the
realization of its vision and philosophy
- areas for improvement: time and
program management
- realized the importance of defining short term and
long term plans
- need for level ing^-off of the staff on knowledge,
skills
and attitude.
25
t
4.
All.conducted
CDx.
8
Out of 31 barangays covered by the CDx, only 9 were
finished. CDx results were used as basis for regional
health situation and services.
Problem: Lack or manpower to. conduct the survey
- difficulty in entering the area due to militarization
- lack of staff to conduct analysis and interpretation
CDx result was uspd for program implementation, planning
of program activities, and as a means for organizing.
5.
All programs conducted value formative SDS except in
some areas where' there were problems like militariza
tion. Topics: renewal and deepening one's commitment,
realizing the kind of work, knowing one's self and
knowing others, and reflection sessions.
6.
All programs were able to conduct continuing
development education. Topics included immunization,
disaster.preparedness refresher courses, CDx, para-legal
training, food survival technology and some reflection
sessions.
On staff level management’scheme: majority of the
programs recognized the importance of program
management. •
Some program^ were able to finish the program management
training, while for others, only selected topics were
finished.
Gains:
- lines of authority and coordination of desks and
departments were clarified
- more systematic planning and evaluation method
- more systematic monitoring of activities ’
8.
On the projection of Health Services: campaigns
concentrated on medical neutrality, rational drug use,
US bases and primary health care, in the form of
symposium, forum, radio hopping and informal
discussions..
Gains: - helped in the promotion of program
- helped in the consolidation of the program with the
local organization.
*
26
Problems:
- lack of a folow-up mechanism
- lack of sustaining activities
Professionals and students benefited from the campaign.
There was minimal -community involvement.
9.
On Health Care Services, majority conducted basic health
services.
The health services given are:
health awareness,
- nutrition
I
- safe water supply
• -'mobile clinics particularly in Negros
- immunization
- management of common diseases
Basis: - felt need of-the areas and request of PO‘s
- area assessment conducted by'staff f and CHW
10;
On all programs ident i f ied contact groups,
g
especiaI ly in
the local level.
International networkingr was. not
done.
Problem:
H.
Poor communication lines with the national
secretariat especia1ly during typhoons.
MINDANAO
Reporter:
Ann K’adil-e
Programs:
1.
2.
.3,
4.
. 5.
CBHS - Butuan
’ ’
BSMS - Butuan City
* '
CBHS - Lanao/Iligan
Interfaith Program for Health Cocnerns Cotabato
CBHS - Marbel (data not included.)'
Area Report:
1 . S i tuat' on :
a. Economy**
.
.
’
- the products of the farmers were cheap 1 ike
copra; banana, corn, palay, abaca and others
- basic'Commodities like rice, oil and soap
are expensive
many are unemployed
- usury is rampant; mostly affected are farmers
'
27
b. Pol itics
Mi 1itarizat ion
- "Silent Military Operations" - 5 barrios affec
ted. Soldiers borne helicopters to identify
organized barrios.
creation of Bantay Bayan, Barangay Brigade
- immersion of soldiers with the people (they live
in the community area)
.
.
“ they gather people in one place and. project' them
as " rebel surrenderees"
* Encounter between the military and the rebel
forces (MNLF, NPA)
.
'
* Massive evacuation
- Lanaodel Norte
- Agusan Sur/Norte (Noble Coup)
,
- Pikit North Cotabato (MNLF vs.'Mi 1itary)
/ * There was a coup
in'Butuan•City, Cagayan de
Oro and Iligan City last October 4 and 5 1990.
* Increased in crimes
Socio - Cultural
- many Born. Again .groups (Fundamenta 1 istj ,
preaching in’ the bus and market
- rampart gambling ("last two", pyramid) ■■
- drug addiction
■0!
c. Health Situation
- upper respiratory tract infection •
- typhoid fever
- measles
- parasitism
- dengue fever
- bronchitis
/ ’
amebiasis
•
- pneumonia
- APD'
•
- malaria
- PTB
.
- schistosomi.asis
2 . Stresses and Calls:
1.
Consultations were conducted with local leaders',,
(traditional leaders,, religious, barangay
officials., community people, and Pos)
— consultations were held once or twice a week
. especially if the program and activity/is newly
formed.
'
J ' '•
in h
r
28
Resolutions:
- Services used as entry point in reactivating
people's organizations in the areas
- services directed to organized areas with. GO
surgeon
develop CBHP in the Moro/TF communities and
since the•communities are sti11. unorganized the
Ciy-lP will help to initiate.
2
Th< "e are concerted attempts and efforts in
coiijiunity organizing.
- consultations
- contact building
- services
’■
Problems:
- At first, there are difficulties in entering
former areas pushing the organizations to use.
services, linkages, and coordination with COGs
(programs)
- Language barriers: resolutions
- integrate with.the people (Moro)
- conduct studies regarding Moro
! No.. of - program aroas . !.
: org'd
4
old •
i*
(
orpa.nsiH.n • ;
: unorg'dl org'd : unorg'dl
: 63 *
:
8 *
: 2 *
!15 towns: 3 towns I
25 *,
:
6 towns.!
Note : * communities
4.
CDx was conducted in thirty communities.
Problems encountered:
- take a long’time to analyze
- you still have.to talk to many people before you
can conduct a survey
- during the survey, the military is still
doubting your presence.
5.
On value and attitudinal formation: conducted from
staff to trainers level
6.
CHWs ’ knowl edge., skills and commitment were
upgraded. Most of those who were able to-get
advance, training ,were.able to continue with their
work..
• 7.
On program management: these studies helped the
staff to systematize their work
29
8., On-the projection of isstfeS: programs joined
campaigns launched by other
sector.
Issues
involved were human rights violations, US bases,
Ecology (Earth Day),, transport strike, WB, HR day.'
9.
Services were used as entry point in areas where
POs need to. be revived.
Method used:
Unorganized area: referra 1s
Organized:
Most of the services are fo'cused
here .
Methods:
1. Request coming from POs.
2. Survey/preparation in area.
3. Organize health teams.
10. Most of the contacts are religious people,
(RC, PIC, UCCP, slam) health professionals and
(Individual)'
other health concerns.
Basics:
Coordination and Networking
Gains:
It helped 'in the- del ivery of services
and in the promotion of program.
e
It also boosted the morale of the workers.
♦
Problems:
- how to sustain contacts in order to sustain their
active participation
- lack of consolidation
/ S'
/
z
l -> Jlanuary 1991
Saturday
a1
Q
n
30
DAY
3
Facilitator of the Day:
Dr; Tess Burgos
SCHEDULE
8:00
8:15
10:00
10:30
-8:15
- 10:00
- 10:30
- 12:00
12 : 00
2:00
4:00
4:30
2:00
4:00
4 : 30
7:00
7:00
8 : 00
9 .-<30
8:00
9 : 30
10:00-
Morning Praise
Executive Committee Report Dr . Len Barce Ion
Break
Synthesis of Regional
Dr . Leni Jara
Reports
Lunch
Continuation of Synthesis
Break
Medical Ethics, International
Codes and Humanitarian Laws
(Protocol 2)
Dr. Au Parong
Supper
CBHP Impact Eva I uat - n
Me 1 G a r c i a
Buzz Session
EXECUTIVE COMMITTEE
REPORT
Len Barce Ion, M.D.
Executive Director
CHD National Secretariat
INTRODUCTION
The past two years have been marked by major events in
the history of the development of Community-Based Health
Programs in
the Philippines.
As the programs have
consistently maintained,
their development has always been
intertwined with societal events, especially the development
of the popular movement for social transforrnation. So, as
the people's organizations continued to evolve in the midst
of a deepening social crisis, the process gave rise to everburgeoning needs.
Cause-oriented groups and people-based
programs like the CBHPs have tried to face the challenges of
more refined visions and directions, advance ski
skills,
new
1 Is,
strategies,, higher
levels of
services and
technical
expertise, more
comprehensive concerns
and integrated
intersectoral approaches with long term perspectives.
For the CUHF’s in the network,
the process of gearing
ourselves to face these challenges involved several forms of
reflecting and evaluating what we have done so far.
After
which we.had to ask the question: Where do we go from here?
The process was started in a consu11ation late in 1987
among some regional and national CBHP coordinating bodies
>' .•
• • ■■...h
31
and major programs which recommended a comprehensive review
and evaluation of then existing strategies,
strategies, approaches
orientation.
As an initial step in this evaluation, the programs
gathered in December 1988 for an assessment of * the most
recent period of the CBHPs' 15-year history — from 1984 to
1988.
Apart from the results of the program assessments
synthesized into a national picture of the CBHP status, the
conference output included several important resolutions,
These were the resolutions for all the programs to conduct
summing-up evaluations from the start of the program to the
current period, to review and re-orient the programs towards
focusing their services to organized areas and people's
organizations, and the resolution to set up a national body
for coordination and common concerns of the different
programs.
This step was in recognition of the need for us to
close ranks and accelerate the development of our programs
to keep up with ‘ the pace of the growing needs of the
people's organizations and other efforts towards social
crans format ion.
These were the beginnings of the CHD. The
consortium was
later formed in July 1989 through an
organizational conference with representatives from the
programs and regional bodies.
During the same period,
the? major partner agencies of
the CBHPs initiated the process of an impact evaluation of
their partner programs and institutions to be done by
external evaluators,
There was thus at this time ongoing
summing up evaluation being conducted internally by program
personnel and the impact evaluation by an external team of
evaluators which would be able to validate and supplement
each other's data and findings.
Thus, for the network, the past two years may be
The member
characterized as a period of transition.
programs were undergoing a period of evaluation <uid working
towards new directions after the period of setback in the
development of CBHPs as identified in December 1988. At the
national and regional coordinating centers, the setting.up
of the national center which would be staffed by the
secretariat was a priority concern.
Negotiations and
consultations with
the existing
coordinating
centers
resulted in the composition of a team of personnel from at
least 3 major agencies involved with CBHPs to staff the
national secretariat.
•. o;-.. ^wssfAW.
32
THE CHD
NATIONAL
ORGANIZATION
SECRETARIAT
PRESENT
CONCERNS
AND
The fields of work and concerns of the CHD fall into
five clusters which have been delegated to the departments
of the national secretariat. These are the following:
1.
Management Training and Consultancy which holds the
key to the vision of community-managed programs
through its work in local capacity buiIding in
management, and assistance in the project
development cycle from needs assessment to
conceptualization and evaluation;
2.
Health Education and Training fnr further skills,
attitudes and knowledge for improved health
services, leadership and organizational growth of
the programs communities we serve;
3.
Health Care Services which assists member programs
in improving strategies and methods in rendering
health care and supplements the services currently
offered by the programs through its missions and
projects;
4.
Research, Documentation and Information which
facilitates the exchange of positive experiences
and insights in health work and its dissemination
to others; and
5.
Special Projects for pilot experiences in new
fields work such as urban CEHP, health work in
minority groups, community-based approaches to
major infectious diseases such as malaria. hea1 th
financing schemes.
Networking,
1inkage-bui1 ding
and coordination
are
built-in components in all fields of work and are undertaken
by the secretariat as a whole with the members of the
executive committee taking the lead role.
In addition,
addition. the
executive committee also supervises the national secretariat
and particularizes decisions, plans and policies set by the
Board of Trustees.
During the last 18 months since the CHD’s formation,
the national secretariat strove to implement the tasks and
functions designated by the CHD general assembly and at the
same time undertake the requirements of the transition
stage.
The process has been difficult and complicated with
many learnings for the staff members and the network as
well.
33
Initially the transition process was slow and prolonged
the
secretariat tried to meet the requirements of the old
as
agency partners and the new demands and needs of the
network, resulting in backlogs in the general work of each
department.
There was
also initial
difficulty
in
maintaining a balance between external services and center
based work, between work in the capital region and in the
other regions, and between internal secretariat concerns
(i.e’. staff upgrading and development) and assistance /
services to the regional member programs among the different
departments.
■
The BOT met during the designated schedules (4x) to
help guide the consortium operations during the past one and
a half years’while the executive committee was convened five
times between these meetings to further concretize plans and
programs.
HIGHLIGHTS AND OBSERVATIONS
A. Management Training and Consultancy (MTC)
*
♦
Assistance in the summing up evaluation of nine out
of 13 member programs that conducted summing up
(35% of members) .
(This data, was based on summing
up reports received by the NS as of January 10,
1990. So those submitted alter this date were not
included.)
Series of area visits, consultations with people's
organizations and sectoral groups that requested
for assistance in program conceptualization and
setting up;
*
Assistance in setting up of 5 programs in 4 areas;
mainly in Southern Luzon, Cavite, Mindoro, Quezon,
as requested by the POs in the areas;
*
Facilitation of CBHP Evaluation and participation in
the national coordinating committee for this
activity;
*
Deployment of community health volunteers J!5) in
priority areas for assistance - Negros, Bicol,
Quezon;
*
Assistance in program services and management
through temporary staff deployment to assist the
programs in different aspects of PIME in Negros,
Panay and consultations with POs in Samar and
Southern Tagalog;
34
*
Drafting of Implementation Scheme for CBHPs and
Program Management Manual up to discussion of
framework and topic outline;
*
Projects development and proposal making - 2
, proposals for community volunteers, facilitated
proposals for Training programs for Bicol (3) and
AUSCULTA, Health relief projects (2) for earth
quake victims;
In general, the MTC functions were focused during the
past 18 months on assistance and consultancy to member
programs, people's organizations, sectoral organizations and
other agencies in program conceptualization, development and
PIME. No management training activities were conducted yet,/
which may be one of the projections of MTC for the coming
period.
Also, the special assembly on the implementation
guidelines for CBHPs had to be deferred.
B. Health Education and Training (HET)
*
Total number of trainings conducted: 28
- Mainly as per request, by regions although a
breakthrough experience- in terms of launching
or initiating a course on Trainer's Training
was done.
A
Scope of Training:
- Nationally coordinated: 2 (CDx and Immunization)
- Regional CB's:
4 (RDU, TLS and DDx)
*
Levels of Training:
; Level
Requesting Organization
: Total
: Member Program : New Contacts/Affi1iates
BHST
11
A.HST
8
BHOS
9
2
7
Total
28
4
18
11
: 2 (Regional CB):
35
- Trainings were availed mainly by new contacts /
affi1iates rather than by our member programs, and
most trainings conducted for the latter were AHST
and BEOS. Eowcver, two (2) out of four (d) AHST
were also participated in by a number of member
programs. We still would like to pose questions
to this assembly regarding the trend of our
training work which will have implications on our
projections:
Does this mean that our member programs can
already handle the BEST conducted, and that the
assistance needed from the national secretariat
is in other forms or levels in our training and
education work?
*
Level of Participants
Note: The level of training participants may vary
in one training. Program staff, CHWs and health
professionaIs/students may all be participants in
one training.
; Leve1 : Community/P.0.
: CHW : Staff :Health Professionals/ ;
Students
!
5
6
: BHOS
1
! BEST
: AHST
6
6
2
7
- Many AEST were for staff level, BEST were
conducted for both staff and CHWs. As expected,
BHOS were for outside groups specifically
health
professionals and students who requested these
seminars;
•
*
Other Observat ions:
- Training activities were directed to organized
groups and were in line with CHD consortium
stresses.
- Training services for members were mainly from
areas in Luzon with SL, CL and CV sending the
most requests.
36
- Training resource development (manuals, visual
aids) are presently under review based on
revision of curricula, training designs and
concepts in relation to CBJ1P transition/reorientation.
- Training personnel.: no new trainers were
mobilized but the concepts of the. National Pool
of Trainers (NPT) / Regional Pool of Trainers
(RPT) were reviewed and guidelines were .drawn up.
- Implementation of training process and guide 1ines
continued to be problematic even in conducting
training needs assessment. Some pre- training
consultations and identification of needs of
participants did not push through.
*
*
Major weak points in our training work:
- Irregular HET Department meetings.
- Inadequate turnover/endorsements of work
assignments when staff were out of town for
trainings.
- Delay in production of manuals and kits.
- Proper operationalization of systems of work and
guidelines as agreed upon in the past as a
consort ium.
Factors affecting implementation of HET plans and
activities.
, - Simultaneous field deployment of three (3)
trainers for a duration ranging from 1-2
months.
- Failure to review and make adjustments in
department plans after the earthquake and
disaster relief operations actively partici
pated in by the HET staff.
C. Health Care Services Department (HCS)
1 . Clinic services were operationalized by the first' quarter
of 1990.
- Emphasis was on referral services for patients
referred by member programs/beneficiary
organizations (POs, etc.) from the region needing
specialty care.
,
a. Number of Patient Consultations:
(January to November 1990)
New Patients - 158
Male
Old Patients - 123
Female
. Total
281
95
186
281
37
b. Referrals coming from programs from the regions:
Patients from Regions - 58
Patients from NCR
- 223
- Of these, six (6) were surgical cases and
275 were medical cases.
c. Sources of Referral
1 . POs
- 50
2. CBHPs
-108
3. Other Agencies/Institutions 94
4. Individuals
. 33
- Majority of our patients came from CBHPs
(beneficiaries)
- Patients from other agenci.es/institutions were
usually their staff and members of POs.
- A consultation with other NGOs and POs was
conducted in June 1990 to discuss guidelines for
the referral system.
- There is still room for improvement of our system
and the utilization of our referral services.
d. Common Diseases.1. Upper Respiratory
Tract Infections (URTI)
24
2. Pulmonary Tuberculosis (PTB)
14
3. Obstetrics and .Gynecological
cases (OB-Gyne)
7
4. Asthma
- 6
5. Neuralgia
- 5
6 . Heart Diseases
- 5
7. Urinary Tract Infections(UTI) 2
8. Dermatitis
- 2
9. Hyperacidity
- 2
10. Errors of Refraction (EOR)
- 2
- Some illnesses were still treatable at the
community level.
e. P.atient Referrals.1. To Out-Patient Department
(OPD) clinics
2. Tertiary Hospitals
3. Admissions to tertiary Hospitals
57
6
6
- Many patients were referred to OPD clinics but
there were, also admissions to tertiary hospitals.
While cases of URTI, PTB, etc. were seen, most
patients also needed specialty treatment.
38
2. Mobile Health Services:
A. Missions and Community Clinics:
A'
C ommu n i t y Clinic s
Medical Missions
3
Internal Refugee Clinics
2
(Services provided to IRs m NCR.)
- Regions reached were ST (Laguna), CL (Tarlac),
and NCR (Antipolo, Sta. Mesa and Quezon City).
*
Total number of Medical Patients - 883
Total Number of Dental Patients
67
*
Total number of Volunteers Mobilized
MD
•
5
6
DMD
5
RN
PT
1
Medical Students - 10
Nursing Students - 1
*
Preparatory stage for Medica1/Surgica1/Denta1
missions to Panay and Bicol this' 1991 is ongoing.
28
B. Health Re 1ief/Disaster Response and Management:
*
Organized and mobilized relief teams to NL/CL
during the July 16 earthquake.
*
Resource generation both locally and with
international friends/partners.
*
Cooperated with other NGOs through Inter-Agency
Network for Disaster Response (IANDR).
*
Observed that- initiatives for assistance came from
the national secretariat and the member programs
tended to work things out on their own. On one
hand, we have the tendency to be self-reliant but
on the other hand, we also have to realize that
we can also tap other resources and this is but
one essence of being a consortium - mutual
assistance and sharing of resources.
39
3. HCS Projects
(Presented for the information of our member programs
that are
interested in
in
launching their own services
component. )
*
Projects currently being implemented:
1 . Immunization campaign (1990-1992)
2 . Disaster management training (1990)
-■ c/o HET Department
3. Health Relief and Medical Assistance to
Disaster Victims (1990)
*
Conducted 2 Immunization Campaign Training/
Consultations (Cebu and Manila) and came.up with a
module on Immunization Campaign which can
be used/availed of by member programs.
4. Assistance
to member
programs
through
temporary
deployment of 1 physician,
2 nurses and 4 volunteers to
program areas in Negros, Panay and Quezon.
Deployment
ranged from one to six months.
months, The deployed personnel also
helped the programs in networking and referral system
building, conceptualization of services components, health
services for evacuees on IRs.
5. Networking
*
11 MD's reached for referral services and community
clinics
1 Social Worker
3 Institutions for referral
1 Institution for training facilities
*
★
*
D.
Research, Documentation and Information (RDI)
1. Assistance
diagnosis (CDx):
to
Programs
in
conduct i ng
community
*
Finalization and use of module and instruments for
CDx;
*
National training and consultation on CDx (1989);
*
50% of programs who attended the 1989 training /
consultation are conducting CDx;
40
*
*
Implementation of CDx has been intensified through
the national CDx training and other trainings / '
consultation visits to regional and local
programs. However, its conduct has been hampered
by such factors as lack of staff and resources as
well as other urgent program activities or
priorities.
2.
The
department
has
actively
assisted
in
documentation and
publication of
other CHD
national
CUD
secretariat activities,
information dissemination and media
linkages.
An example was the Samar experience wherein RDI
actively disseminated information to media and helped 1aunch
a press conference re: harassment of medical teams that
conducted medical missions during a measles epidemic in
KAPPS areas.
3. The
library set-up
and inventory
has
been
systematized, and continues to provide reference materials
and takes
charge of publication exchange which added
resources to our library.
4. Databanking of CHD and program operations is still
in the initial stages. We are in the process of getting the
updated regional program profile for consortium area.
5. Current projects include video production on CBHP
historical development
and slides
production on CBHP
orientation.
E.
Special Projects (SP)
1. NCR coordination and linkage:
*
NCR CBHP conference was launched in 19-89 to
discuss CBHP conference results of 1989;
★
NCR Secretariat/Coordinating Body was set up with
7 participating programs;
*
Services consultation re: basic services at
community level, referrals and mobilization of
community members for health services;
*
Current network includes:
8 people's organizations (Pasig,Paco, Nova 1iches
and Quezon City)
11 health programs and institutions
5 parishes (Caloocan, Tondo, Sta. Ana).
2. Assistance in program building and re-orientation to
4 POs and 3 parishes.
41
As a regional
3. Education and Training act ivi t ies.
Special Projects Department was able to
network,
the
conduct:
- standardization of selected curriculum designs
- 17 training and education activities as follows:
CDx
-3
BHO
-3
BHO-ST
-7
RDU
-1
Awareness Building Issues . 2
“ 3
Disaster Preparedness
4. Health Services of the local unit consisted of
referrals, dental community cjinics, supplementary feeding,
first aid for people's mobilizations, QRTs and formation of
disaster response teams in several areas.
5. CHW- organizing was focused on strengthening local
level structures of Health Committees or CHW organizing.
Thus NCR-wide activities were limited to 1-2 times/year
sharing and discussion of vital issues.
6. There was a re-focusing of NCR desk work from local
area operations to NCR-wide activities.
In genera 1,
the NCN desk was able to respond to needs
and requests of POs and' programs for health education and
training but there is a need to launch more community level
health education.
For other special projects on Leprosy, Malaria and Moro
CBHP, draft concept papers have been presented to the
Executive Committee for comments.
Preparatory activities
such as
program area consultation and visit,
initial
discussions and coordination with other agencies have been
started with the Philippine Leprosy Mission, and Research
Institute for Tropical Medicines.
F. National Secretariat Administration and Management
1. Office management systems have been developed and
are currently implemented but not fully operationalized.
Staff development pl»ans have not been implemented
regularly especially during the late half of the year due to
other urgent activities (i.e. disaster relief).
The organizational structure has functioned moderately
well with regular meetings of the BOT, Executive Committee
and National Secretariat staff.
However, status for the
different management concerns of the departments varied.
42
2. Finance Management
The secretariat is currently operating on funds from
old projects turned over by the 3 agencies and we are right
now in the process of developing new projects. Other desks
have submitted new project proposals for implementation.
PABTNSRS
Training
Center for Urban PHC
CBHP Consultancy
Services
Immunization
BW/NCOS
SCLF
0URATWN
1991
1992
MISEREOR - 1990
Third World
Relief
- 1992
Disaster Preparedness
- Caritas
Training
CBHP Evaluation Results
CEBEMO
Dissemination
APHEDA
AIDS Education
1991
- 1991
- 1992
3. Coordination and Networking
A. External Linkages:
1. Local linkages and guidelines for relations with .
sectoral organizations were worked out during the
first General Assembly. Based on this, the BOT
has come up with, decisions on some interorganizational relations.
a. On BUKAS invitation for membership. The BOT
decided not to involve the consortium as a
whole because it is the GA's mandate to
decide.
However, this can still be changed
based on the decision of this assembly..
But
the BOT thinks member programs can join the
BUKAS network and continue our support to
setting-up their regional counterpart;
b. Membership invitations from BUNSO and
LAMBATLAYA which came in recently will be
decided upon by this GA or the incoming Board
of Trustees so this will be part of our
discussion later;
2 . Intersectoral Linkages
CHD's major linkage is with the Council for
People’s Development (CPD), in which RMP and CPHC
were members, representing the health sector in
development work, and the BOT decided to continue
43
our membership as a consortium. Again it will be
up to the GA whether or not to change this
decision.
CPD is also a consortium of NGOs1 network from
different regions and sectors involved in the Caucus
of Development NGOs. This involves broad coalition
promotion with other NGOs of varied affiliations and
approaches, which we think is a new challenge in
working with other NGOs.
3. International Linkages
Continued affiliation with the following
organizations/agencies :
- Asian Community Health Action Network (ACHAN) the
previous agencies were part of this network.
This includes: AHI or Asian Health Institute
which sent us invitations lor training which some
of the member programs have
availed. We
received invitations from them
which we can
discuss during our organizational meeting.
Volunteer Health Association of India (VHAI)
invited us for a conference on Community Financing
Scheme and we sent a staff of the national
secretariat.
- Catholic Hospital Association.of India (CHAI) RMP
is engaged in an exchange program with CHAI and
invited participation from other members of CHD.
- International Breastfeeding Action Network
(IBFAN) other programs are also* involved here.
One concrete result was the establishment of
linkages with Latin American Community Health
Groups with similar orientation as ours. There
is a standing invitation for an exchange
program but this is still pending due to
funding constraints. Some regions are already
aware of this.
- We attended the International Women and Health
Meeting (IWHM) where we met advocates of other
alternative health programs including those from
countries with similar to our with conflict
situations; and others with liberation movements.
ft
44
New links, more on people to people level:
*
Research group based in Holland, an InterUniversity/Inter-Country Research Group.
* Third World
Health Group in Australia.
* Other Foreign Volunteers Organizations
in the
Philippines that expressed interest in
coordinating*with CHD and fielding volunteers to
our programs.
This can be discussed later, as
to the needs of our programs on this.
B. Internal Coordination within the CHD:
- Despite the implementing guidelines drawn up by
the first GA, we have had problems in coordination
within the consortium itself.
Relationship with other organizations both
sectora1/non-sectora 1:
Re:
- Uti1ization/avai1ing of services of the
national secretariat; services do not reach
other members;
- Relationship with some CB’s and member
programs.
Problem:
The agreed system of sending through the
Regional Bodies (RBs) all communications intended for
the local programs did not work as expected. There is
a need to review this during the organizational
meeting.
OPEN FORUM
Important Points Raised:
A.
What were significant events that happened in the
National Secretariat for the past 2 years?
1.
In terms of regular workings as a national
secretariat
> established different desks and formed into
different working teams. Considering that the
staff were from different institutions with
different approaches to CBHP components,
it
took us some time to get together as a working
team.
45
2.
In terms of highlights
> launched a campaign for Samar in which KAPPS
areas were the beneficiaries - first major
activity of CHD (Waray Bugas an Samar: A
Campaign Against Poverty, Hunger and Disease,
Sept.-Dec. 189)
> provided relief services to earthquake victims
(CL, CV, NL and Cordillera July 16-August ’90)
> these were big undertakings since majority of
the planning to actual implementation was
participated in/initiated by the national
secretariat.
It entailed generation and
mobilization of resources (both personnel and
material/financial) within Metro Manila, to be
sent to the regions.
3.
In terms of networking and promotions
> established identity as CHD by introducing the
consortium to other sectors/NGOs/Networks
> launched a book on CBHP evaluation results
(November '90)
> earthquake relief efforts helped us get in touch
with other NGO's/agencies involved in relief,
services and development work
> conducted consultation with different PO's/
sectors to exp 1ain/discuss health work in rela
tion to the whole context of development work
* the ongoing development work is .seen as a
process towards change. What then is the
role of health in this process?
★ it was observed that most health programs/
CBEPs concentrated on the services compo
nent of the program.
* other sectors/POs recognized health only
in. terms of its traditional role as mere
providers of services not as a sector with
issues and concerns, with goals and direc
tions, similar to theirs. So that every
time health problems/ needs arise these
groups would call on the program to res
pond to such situation
★ it was recognized that the Pt)s, with their
potentials as groups/sectors, carry an
important role in health care by
integrating/inc 1 tiding
health services/ work in their program so
they can address health needs/problems
within their ranks and not .always rely on
the health sector to do so.
46
>
B.
Collation of experiences of different CBHPs, so
we can discuss it in this Generaj Assembly, ■was
also considered a big gain.
' collated experiences will enable the GA
to situate itself in the present context
*: it can help the body to discuss/decide
on future thrusts and stresses, to
address questions and concepts and to
■ make adjustments to o»ld concepts.
Problems/Di fficulties
i.
Communication and coordination with member programs
> consultations were conducted to discuss some
projects requiring comments/decisions of member
programs involved and/or targetted for the
project, but attendance is poor.
In some
instances, discussion' as to concepts, etc., of
the project was approved, however, during the
mid-implementation phase, it turned out that the
requirements were not met, and what has been
agreed upon by the secretariat and the member
programs was not implemented.
2.
The National Secretariat had difficulty in really
functioning as a "secretariat1’ of the
consortium
> member programs tend to always go back to
dealings with previous institutions (CPHC, RM,
UM) which made the transition phase somewhat
difficult for both the National Secretariat and
member programs
> it seemed that for some member programs, CHD is
not clearly seen/identified as a consortium
C.
Recommendations:
1.
2. 3.
Update member programs re: revisions of training
materials
Send staff of HET to other member program
Clearly define the roles and responsibi1ites of
the national secretariat and the member programs
of the consortium *
All points raised were well taken.
47
SYNTHESIS:
STRESS AND CALLS
Eleanor Jara, M.D.
Member, Synthesis Committee
(Refer to Table No. 1: Total Number of Participants and
Observers & Table No. 2: Total Number of CBHPs' Human
Resources)
1.
Consultation with P.O.
- all programs had conducted consultations with PO's
- Frequency - 2 to 4 consul tations/year
- 2 programs did not have regular
consultations due to militarization
Results of Consultations:
- coordination was systematized
- the roles of the program were defined:
A assist people's organizations
* revive PC's
* provide direct services
2. . Direct Program Efforts To Community Organizing
-all programs directed their efforts in organizing the
community except for 2 regions. The 2 regions had
limited staff to do linkage work with different programs
which have different organizing work;
- 3 regions stated that majority of their areas are
unorganized;
- Problems encountered in organizing:
* mi 1itarization/harassment - 3 regions
* coordination with organizations
* lack of staff
* weakening of PO's
* staff
staff's
' s lack of experience in organizing
- How to direct the programs
In Unorganized Communities - community assembly
started with courtesy call and with training
formation of BHC (Barangay Health Committee)
In Organized Communities - consultation with P.O.
3.
Conduct Program Summing-Up
CV
Isabela
1/2
CORDI
CL • NCR
ST
BKL.
VIS
MINDA
TOTAL
1/4
4/4 1/1 +
3 observers
3/4
2/2
4/4
2/2
17/21
48
Summing-up Observations:
a. Training
- no systematic training modules, kits
- no evaluation of training capacity of staff and
CHW' s
- recognized the importance of CDx
- trainings given were based on the needs of the
community
b. Services
- rendered assistance in answering the needs
- health professionals tapped for services
- CHW’s were able to give services
- inadequate services based on the needs of the
community
c . Organizing
- Barangay Health Committees are functional
- recognized the importance of linkage with the
P.O.'s
- there is a need to define the specific program
and direction of Health Sector Organizing
- recognized the poor selection of areas.
d. Program Management
- lack of systematization and professionalization
- staff and CHWs lack the attitudinal development
- recognized the importance of short and long
term plans
- areas for improvement were recognized.
4.
Community Diagnosis
- 2 regions were not able to write the results
of the CDx
- 4 regions have not completed the process of CDx
- 2 islands, Visayas and Mindanao have partially
completed the CDx
PROBLEMS:
- lack of writing skills
- lack of staff
- lack of skills in analysis
- long questionnaire
- militarization
RESULTS OF CDx
results of CDx were used as entry point
in the community and in planning data
obtained from CDx fulfilled partner
agency requirements
49
5.
SDS on value and attitudinal formation
Top 3 forms - orientation seminar
recollections
CSC
- all programs had conducted SDS
6.
Continuing Development Education For CHWs
-all programs had their continuing education
for CHWs except for Bicol.
Generally, SDS were not programmed and systematized.
TOPICS:
HEALTH
- Under-Five Clinic (UFC), Acupuncture(AQ),
TB Microscopy, Rational Drug Use(RDU). Dental
Prophylaxis and Extraction. Immunization. Goiter
Control, Herbal Medicine Preparation, Minor Surgery
HEALTH RELATED
- Disaster Preparedness, CDx. TLS. Appropriate
Technology, Soap and Biscuit-Making
NON-HEALTH
- Oil price hike, food survival, paralegal
training updates; situationers, feminism,
leadership training, community building, organic
farming, reflection sessions, value formation.
Effects on Continuing Education
- deepening of CHW commitment
- understanding .of the work of the health worker
by the members of the family
7.
Development of Appropriate Staff Level Program
- all programs except NCR had conducted program
management training
- there is difficulty in applying program
management principles
- the training made the staff realize the need to
systematize the program
- it clarified the training on program management
made job descriptions clearer
- it clarified also the lines of authority, coordina
tion of different desks and departments and
resulted in the systematization of planning
and evaluation methods.
- there was some systematization of their management
work but this still needs further refinement
50
8.
Projection of People’s Health Issues
- All programs had projected health issues
- 5 programs conducted Health Campaigns in
Mindoro, Southern Tagalog, Central Luzon,
Cagayan Valley and Visayas
* Advancement of Drug Policy
* Medical Neutrality
* National Drug Policy
A Primary Health Care
* Ant i--Pol lut ion
t
* Preservation of forests
A Demand immunization services from the
government
- Most of the programs participated in multisectora1 campaigns
A US Bases
A Human Rights
A Oil Price Hike
i cipated in mu It isectora 1
programs part
participated
generalf
but
only 4 out of 8 regions
campaigns on national issues
were able to initiate campaigns on people’s health issues.
In
9.
Services given by the Program
- Clarified basis for delivery of services
* mosquito control
A- barri.o clinic
(10 barangays/year)
* fact-finding missions
* under-five clinics
* TB-Malaria control
* safe water supply
* medical and surgical missions
* health awareness building
* environmental sanitation
* referral during Klinikang Payan
* Health Education
* Immunization
* medica1/denta1
- Upgraded the level of services on
* minor surgery
A Disaster preparedness and management
A
mental
A
operation timbang
acupressure/acupuncture
training on minor surgery
first aid
mobile clinics
blood typing
herbal preparation
A
A
A
A
A
A
feeding
51
A
laboratory examination
* klinikang bayan
A
relief and medical missions
10. Identification and prioritization of contact groups
and individuals
&
*
provided orientation
others gave services
In general, programs lack systematic programming
contact building and networking
for
glSNIFieANT ggVgWMSNT®
through CBHPs, areas that were left behind were
recovered and POs were reactivated
National Capital Region - standardized curriculum design
- conducted NCR.wide conference
Central Luzon - provided relief and rehabilitation service
during the calamities
- reactivated good working relationship
through inter-provincial regional and
national activities
- provided a venue for PO to recognize that
the program is not only for services
Mindanao
OPEN FORUM
ADDITIONAL SIGNIFICANT DEVELOPMENTS
VISAYAS - conducted Visayas-wide Immunization Campaign
Training
-- relief and rehabilitation services
- assistance of CHW's during mobilization
ISABELA -- development of cooperatives
- self reliance of CHW organization
RURAL MISSIONARIES
Socio-Eco, health, relief and rehabi
litation assistance to different
regions
CORDILLERA - active participation in environmental
health issues
- CHW as trainer
A'SOC haRAX*1
pH - \ (TO
NJ-^I
52
1.
On consultation with PO's
Content: - many programs presented did not have
consultation with PO's and entered areas
with no PO's
Ef feet: - served as a venue to orient PO regarding
CBHP
Lessons: - be conscious about consultation with PO
because we do not intend to own the community
- CBHP is only a part of the development work
and consultation is the key in order to
define our work in the over-all development
work
- in consultation, we clarify concepts and role
of CBHP in the over-all development work on
different types and level of the area.
2.
On Organizing
Quest i on: Are we going to enter in unorganized areas?
: Yes, but we have requirements such as:
Answer
1 . The area must have the potential to
become an organized area
2 . We must have an organizer
3. We must link up with different, organizing
ef f orts in the area.
3.
Summing-up
Reasons Why Some Programs Were Not Able To
Conduct Summing-up:
1.
2.
3.
It was scheduled but was postponed of the calamity
that happened.
There were problems in data gathering especially
when previous staff resigned.
There is difficulty in joining together 2 different
areas with the same management.
RESOLUTION: CHESTCORE and KSK will conduct summing-up on
the first quarter of 1991.
4.
Community Diagnosis:
Problems Encountered in Community Diagnosis
1 . There were problems in the implementing guidelines
in CDx
2 . The staff lack the skills and knowledge in colla
tion and analysis of data.
Feedback:
1 . CDx was the first major research project2.
CDx stopped program operations and took too much
time
3. The tool must be examined again
53
4.
5.
5.
The primary objective of
planning or for national CDx (whether for program
Frogram staff dislike paperwo
p- data)rk was not clarified
he community participated in
collation of data but '
not in ana lysis
Staff Development Seminar
BSe@MMgNBATXON®
6.
1. Request for ra module c~
on value and attitudinal formation because the module
used by all
-1 the programs is
from the church.
2. It is not <—
enough to show/teach 1the
'
importance of
sacrifice but the meaning of sacrifice?
ment to serve the poorest of the poor/ the commitProcess
retreat was introduced ;; it is a
liberating
form of
staff development.
3. Basic trust in staff as well
important and helps iminimize as teamwork are
competition.
Continuing Development Education
OBSTACLE: It is not
yet systematized.
RECOMMENDATION: Formulate
a tool for CHW skills
assessment
- develop continuing development
education for CHW's'
7.
Program Management
The scheduled national
did not push through because training on Program Management
on 1 y a few programs submitted
their summing up results.
8.
Campaigns
All programs had initiated health
campaigns on other issues of different campaigns and joined
sectors.
the ^JcaL^utr^nrcJmpaigr1^:?
CHWs in the regions
Secretariat.
were
dUring
noP
P
harassment
of
th© National
"
reported to the
RECOMMENDATION: Cases should be
the National Secretariat so that reported right awav to
we can project these
issues.
54
9.
Services
The concept/reconimendations of health care services wi1i
comprehensively during the
be tackled
and discussed
regional sharing of the results of the summing-ups and
impact evaluation.
10. Relationship with Contacts
Linkages with contacts was not prioritized and
systematized.
RECOMMENDATIONS ON THE RELATIONSHIP WITH GOVERNMENT
AGENCIES;
* It is the responsibility of the government to give
health services so it is right to avail of their
resources.
* We must be conscious on the line and extent of
coordination with government organizations.
filename: Ssynthrg.doc
disk no: 001
89
55
MEDICAL ETHICS, INTERNATIONAL CODES AND HUMANITARIAN LAWS
Aurora Parong, M.D.
Executive Director
Medical Action Group (MAG)
I.
Def initions
A.
Medical Ethics - a body of norms, values, principles
and perspectives of the medical profession
B.
International Medical Codes
covenants, codes and
guidelines embodying medical ethics approved, accep
ted and implemented by international bodies or
groups encompassing generations, peoples and nations
of varying cultures
Examp 1es:
C.
Declaration of Geneva
International Code of Medical Ethics
International Code for Nurses
international Humanitarian Laws - laws for the
protection of victims of armed conflicts and the
personnel responsible for taking care of them;
approved by international bodies where various
governments are represented; during times of
conf 1 lets, whether internal or i nterna11ona1
Examp 1es:
Geneva Conventions (1949) - respect and
protection in time of armed conflict
without discrimination of all persons who
do not or no longer take active part m
the hostilities
Protoco1 I
internatlona1 armed conflict
Protocol II-
i nterna1 armed conflict
Protocol Additional to the Geneva Conventions
of 12 August 1949. and Relating to the
Protection of Victims of Non-Internatlona1
Armed Conflicts (Protocol II)
Article 7
Protection and Care
1 . All the wounded, sick and shipwrecked, whether'or
not they have taken part in the armed conflict,
shall be respected and protected.
a
56
2.
In all circumstances they shall be treated humanely
and shall receive, to the fullest extent practicable
and with the least possible delay, the medical care
and attention required by their condition. There
shall 'be no distinction among them founded on any
grounds other than medical ones.
Article 9
Protection of Medical
Personne1
nd Religious
1 . Medical and religious personnel shall be respected
and protected and shall be granted all available
help for the performance of their duties. They shall
not be compelled to carry out tasks which are not
compatible with their humanitarian mission.
2. In the performance of their duties medical personnel
may not be required to give priority to any person
except on medical grounds.
Article 10 - General Protection of medical duties
1. Under no circumstances shall any person be punished
for having carried out medical activities compatible
with medical
ethics, regardless of the person
benefitting therefrom.
Article 11
Protection of medical units and transports
1. Medica1 units and transports shall be respected and
protected at all times and shall not be the object
of attack.
2. The protection to which medical units and transports
are entitled shall not cease unless they are used to
acts, outside their humanitarian
hosti1e
commit
function.
Article 13 - Protection of the Civilian Population
1. The civilian population as such, as well as
individual civilians, shall not be the object of
attack. Acts or threats of violence the primary
purpose'of which is to spread terror among the
civilian population are prohibited.
57
II . Principles embodied in International Medical Codes and
Humanitarian Laws
A. International Medical Codes
1.
2.
3.
4.
5.
6.
health and life of the patient is foremost
consideration
service of humanity
non-consideration of race, party politics,
religion, sex, socio-economic status,
nat iona1ity
confidentiality
non-profit
respect for colleagues and mentors
B. International Humanitarian Laws particularly
Protocol II
1.
respect for the human person especially of groups
including:
a. wounded, sick and shipwrecked (incl. hors d'
combat)
b, medical personnel
c . religious personnel
d. civilian population
- children
- women
e . detainees
2.
1 ~ 4 principles reiterated
III. Importance of International Code of Ethics (ICE) and
International Humanitarian Laws (IHL)
A.
ICE and IHL respect and assert principles of
humanity and civilization which are embraced,
promoted
and defended by peoples and nations of
various cultures and generations. Any individual
or group upholding such principles attains a high
moral ground even as any individual or group
disregarding and violating such principles is
discredited.
B.
ICE and IHL render protection to the sick and
wounded without considerations of race, party
politics, religion, sex, nationality and eco
social standing.
C.
ICE and IHL uphold principles of confidentiality.
D.
IHL protects special groups not involved in the
hostilities and also those rendered incapacitated
in the course of war. Medical personnel,
facilities and transport are included.
*
58
IV.
Limitations of International Codes and Humanitarian
Laws
A.
Subject to national law which may mean disregard or
watering down of the principles upheld in the codes
and laws.
- different interpretations of governments though
monitored by ICRC
- disregard or violation by governments (PD 169,
EO 212)
B.
Control or strong influence of world superpowers of
international bodies such that their positions
greatly affect the outcome of any deliberations.
example: draft made by KRC of Protocol II was
subjected td so many amendments by the US
("subject to national law")
C.
V.
Seeming disregard (?) of important social and poli
tical considerations: need to further study these
issues for objectivity
1.
liberation movements -- IHL (specifically Proto
col II) piovides for the protection of some
special groups as long as they have not taken
part or have ceased to take part in hostilities
which brings to question the right even of
civilians who are part of the people "to
reform, alter and abolish government" which
becomes unresponsive to the needs and wishes
of the people. Abraham Li neo 1n/Thomas
Jefferson/Patrick Henry/Justice Black;
Declaration of Independence/ Declaration of the
Causes and Necessity of Taking Up Arms/.
Universal Declaration of Human Rights
2.
reproductive rights and responsible parenthood
abortion vis-a-vis "respect for human life from
the. time of its inception"
Application in Community Health in the Philippine
Context
A.
Characteristics of Community Health Workers
1.
2.
3.
committed to serve
interested and committed to health work
with empathy and concern for the sick/patient
and the needy
59
4.
5.
B..
Relations with Patients
1.
2.
3.
4.
5.
C.
relate to them with equal respect
relate to them without arrogance
assist each other: strengthen unity for the
sake of the patient
Relations with Enemies
1.
2.
3.
4.
5.
VI .
treat and assist the sick to the best of one's
ability without considering material rewards
ensure actual needs of patients and manage in
the most effective way and as soon astpossible
do not harm patients: refer to more capable
health workers if in doubt
do not violate confidences to discredit the
patient, however, information to protect the
health of the majority should be reported
to proper authorities for appropriate action
must show concern for the patient, when relating
to gain confidence and trust of the patient
and show willingness to assist in some other
ways
Relations with Co-Heal th Workers
1.
2.
3.
D.
with self-confidence and bearing-but recognizes
capacities and limitations
conscientious to raise level of knowledge and
skills for better health work
with initiative, patience and industry to
implement work
enemy patients are considered just like any
other patient who deserve treatment and health
services to the best of one's ability
do not use health knowledge to change normal
mental functions just to extract information
do not use health knowledge to weaken or kill
do not experiment
torture is absolutely prohibited.
Need to Assert the International Medical Codes and
Humanitarian Laws BUT MAY GO BEYOND THEM IF THERE ARE
MORE HUMANE PRINCIPLES NOT CONSIDERED.
60
SWUM
Important points raised:
1 . Regarding the limitation of these laws and codes
a. On the issue of being sexist
Oath of Hippocrates refers to his colleagues as
his brothers
b. On the issue of conception
the controversial issue of life beginning at
conception as opposed to the issues of plight of
the child especially with the present economic
difficulties and the need of the chi I’d for
proper upbringing (considering the emotional
and psychological needs of a child)
* We are not saying that we must change these laws and
codes now but there is a need to openly discuss these
controversial issues.
2. Regarding the status of Executive Order 212
E.O. 212 is still being enforced. Government officials
in the Department of Health have admitted that it violates
the international
law but they say that because it is in
place it must be imp 1emented.
In Congress, a law repealing E.O. 212 is still pending.
3. Recommendation:
a. The conceptualization of an urgent action network
- to include the mechanisms on cooperation, role
of the CHD national secretariat and CBHPs
A basic need of this quick action network is proper /
prompt documentation and reporting of these incidents to t^e
National Secretariat
o--- (also . to Reporting
MAG).
of HRVs can
cover incidents which affected the implementation of the
health program as well as incidents of individual.cases.
Foreign friends (delegates in the IFFM Conference held
last February 1990) have signified,
signified their willingness to
support issues concerning Human Rights Violations
(HRVs)
involving the health workers.
Support of these foreign
workers,
friends Can be in the form of letters of appeal to
or the sending of international fact
government officials
finding teams.
But there are- disadvantages to the inclusion
of foreigners in the fact finding team like
the added
difficulty of entering the target areas.
61
b. Formulation of resolutions/statement of the
continuing HRVs in the CBHP areas
The seeming trend that HRVs of health workers have
lessened is deceptive. This trend is due to non-reporting of
HRVs and military actions that affect the implementation of
CBHPs.
c. Draft of the Community Health Worker Code of Ethics
There is a need to draft
a code ' of ethics for the
community health workers. The existing code of ethics (e.g.
Oath of Hippocrates for doctors) is elitist although it can
also cover the health workers. Protocol II protects all
health workers including the ambulance drivers.
But a code of ethics drafted for community health
workers is still necessary to better define their rights
and responsibilities.
*
62
EVALUATION OF CBHP INSTITUTIONS AND SOME CBHPs
IN THE PHILIPPINES
Mel Garcia, R.N.
Department Director
Management Training and Consultancy Department
Council for Health and Development - National Secretariat
Out line:
I.
Objectives of
Focus: A.
B.
C.
II.
the Evaluation
CBHP impact at the community
Institutional Capabi1ity
Community Health Worker's knowledge, ski 1 Is
and attitude (KSA)
Methodology
A. Household Survey
B. CHW KSA Test
C. Case Study
III. Results of the Evaluation
A.
Household
1 . Socio-economic conditions in the CBHP areas
2. Implications to CBHPs
B.
CHW TEST
1. Knowledge
2. Skills
•3. Attitude
C. Institutional Capability
IV.
Recommendations
A. On the program content
B. On the organization
63
I.
Objectives of the evaluation
The objectives of the evaluation have three areas as
focus: program Impact on the community, institut iona1
capability, ,and CHW knowledge and skills, The objectives
were:
A.
To determine the impact of CBHP on the community:
1. to determine the socio-cultural and health impact
of the program on the health status, of the community;
2. to determine the extent of community participation
and involvement of the people in the whole process;
3. to determine how CBHP facilitated community selfre 1iance;
4. to determine the current level of implementation of
CBHPs at the communities.
B. To determine the capability of the
Mindanao in implementing CBHP:
RMP, CPHC and CBHS
1. to determine the efficiency of service delivery by
the service institutions as well as their representatives at
the regional and community levels;
2.
to find out the extent of linkages and coordination,
between institutions tapped and maximized existing resources
(of both GOs and NGOs) in support of CBHP.
C.
To determine the type and level of skills of CHWs.
D. To determine main strengths and weaknessess; failure and
success factors in the implementation of the CBHPs.
E. To come up with recommendations on which to base the
future implementation of CBHP.
II.
Methodology
In line with the above-mentioned objectives and with
the intention of doing the evaluation participative, the
following methodologies were identified:
A.
B.
C.
Household Survey -- for the Community Impact
Case Study - for the institutional capability
CHWs Skills,
Knowledge and Attitude Test
Respondents of the Evaluation Study
A. Households
:Total
J of
B. CH^’s
: Total 1
: of sample
:Barangays: Barangays
: Actual Respondents/ : Total
: Total Number of :
: Served
; C. Institutions
: Sample
Case Studies
: Unserved :
Luzon : 29
: 5 (1*)
: 84/100 : 51/70
14
:CPHC - Cavite
: and HIDS-Pam: panga
Visa- : 15
yas
: 5(1*)
: 105/100 : 63/70
14
: RH-CBHDP
: Isabela
:Hindu- : 590
: nao
: 20(12*)
: 398/400 : 254/260
54
. CBHS: Kidapayan
TOTAL : 634
30 (14*)
: 587/600 : 378/400
p;/
: Total = 965/1000
Note;
- substitution
O'.
65
III. The Results of the Evaluation
A. Household
1. Socio-economic conditions in the CBHP areas
1.1. Socio-economic and Health Related Background o'f
Household (HH)
a. Socio-economic conditions of households
V
> large families ( 5 -6 )
> engage in multiple kinds of livelihood that
hardly give livable wage
> Luzon and Mindanao - economic earnings less than
5 years ago
> P 10.5 T to 14 T per annum income ’
> Water - Luzon 4/5 access to piped or pumped
water: Mindanao 20% spring /rain sources
> Toilet - Visayas - 30-40% with no toilet
> Garbage disposal --
burning and dumping
Visayas - 36- 40 % increase in earnings than 5
years ago
Conclusion: Economic Stagnation
b. Household Diets and Nutrition
> Luzon and Mindanao - rice but Luzon shifting to
rootcrops during certain periods of the year
Visayas - 80% buy rice
> 70% grow vegetables (gabi, malunggay, Kangkong)
grow food to supplement their food intake
50% raise chicken and pigs
> Luzon and Mindanao - buy bagoong (50%)
coffee/sugar (90%)
fish (8.8%)
Conclusion: Below Nutritional Standard
c . Health faci1 ities
> Luzon:
over 5 km.
RHU
40 km. average
Hospital
> Visayas: Hospital
> Mindanao: Hospital
RHU
4 km.
7-8 km.
within 4 Km.
Observation: No private clinics or doctors in
surveyed harangays
66
1) RHUs more common facility in survey areas
Government hospitals and private clinics are
less common and therefore their services are
less frequently availed of by households
2) Ut11ization of
health facilities
Mindanao : 75 % of HH availed of the RHU
services
Luzon and Visayas : HH patronize hospitals
more than the RHUs
3) Considerable number of households are not
reached by RHUs
4) Households do not fully utililize the
services of existing health facilities
1.2.
Prevalence of Illnesses, Deaths and
Disabi1ities
(Note: No standard procedures for estimating
these from surveys)
a. Serious illnesses (on preceding year)
> relatively high incidence
Luzon -• 41-51%
Visayas
- > 20%
«
Mindanao - 34-41%
> afflict older family members
- 17 year old has increased and above
Visayas - < 6 year old
> Nature: Luzon -- respiratory (asthma/pneumonia)
gastroenteritis, malnutrition,
malaria. Flu, TB
Visayas - Flu, asthma, diarrhea,
pneumonia
Malaria, diarrhea, flu, and
Mindanao
wounds/injuries (6%) related to counter -
ipsurgency
b. Minor illnesses
> more incidence of minor illnesses
Gastroenteritis
> afflicts more young children
and respiratory diseases
67
c . Child deaths
> Luzon - 26 %
Visayas - 30 %
,Mindanao - 28 %
> Causes: Pneumonia. Diarrhea ( for Visayas and
Mindanao), tetanus (Luzon). starvation
(Luzon)
d. Perception of Health Status 5 years ago
> Improvement of health status
- Luzon and Visayas - 46
58 %
- Mindanao - 43- 45 %
1.3. Health Indicators and Practices
a. Patterns of Health Consultations:
> More likely to seek advise/assistance in
times of serious illness, during childbirth,
for family planning
> less likely to go for medical assistance in
minor cases and Pre-post natal care
> Households increasingly turning to CHWs
b. Maternal Health
> number of pregnancies, and living children
living children
pregnancies
:
4
5
6
:
- Luzon : 4
3
5
4
- Visayas 4
and
Mindanao:
30 % : at least 1
miscarriage
> Pre-natal consultation:
Visayas: 9 - 14%
Luzon and Mindanao:
20
30
> Miscarriage
Luzon
Observation:
7
and.Mindanao : consult doctors
low average in pre- and post-natal
consultations
*
Mothers unable to follow advice
68
> Delivery
ma j or i ty give birth at home;
hi lots assist 47 - 75%
less than 15% give birth in clinics and
hospitals
in cutting the umbilical cord
Luzon : more than 80% use scissors
Visayas : 32 - 34% use blade, bamboo
and banana fronds
Mindanao
> family planning (FP)
- 44 - 79 % : No longer wish to have
chiIdren
50 % : Never tried family planning
*
9 % - strongly object to FP
3
2
*
11% - do not need FP
. *
50 % - the FP methods they
21
*
used failed
> Breast Feeding
Practice of Breastfeeding in CBHP areas
is at 63 -77 % and shifted towards mixed
feeding
Below the National percentage which is
80 - 83 %
1.4. CHW Services and Relationship with Households
a. CHW services
> % HH visited by CHW
Luzon: 90%
Visayas and Mindanao: 80%
81 %
> % HH which consulted the CHWs: 72
k Treatment of common i1Iness: use of
herbal medicine
Luzon: 87% - taught herbal
taught sanitation, immu
10%
nization. nutrition
Mindanao: 2/3 - herbal medicine
1/3 - sanitation
> % of household who receives reading
materials
Luzon: 20 %
Visayas: 9 %
Mindanao: 25 %
b. Relationship
> minority participated in the selection
of CHWs
Luzon: 7 %
Visayas: 40 %
Mindanao: 28%
69
> %-HH which contributed to the^maintenance
of CHWs
Luzon
55 %
Visayas
43 %
Mindanao 59%
c . Community Problems and Health Needs
>
1.5.
Most families identified these problems:
economic
1 ack of emp1oyment
lack of land, capital and
f ood
Fewer families consider lack of social
services ( incl. HEALTH) and education
and criminality as urgent social
prob1ems
Summary of the socio-economic conditions in
CBHP areas
The study shoyzs that the areas reached by the
CBHPs consists of poor communities which suffer from
different forms of deprivation:
- households in the areas engage in various
unrenumerative on farm and off-farm
activities that hardly give them livable
wages and income;
- families in the program areas must endure the
inadequacy of basic facilities as roads,
electricity, water and irrigation,- government social and technical or extension
services rarely reach communities.
Problems of low income, poor harvest, i nadequate
nutrition, inadequacy of basic facilities, and lack/
absence of government services adversely affect the
health condition of the people and also impede the
growth and the general progress of the communities.
The LUZON communities are the most cash-strapped
and economically disadvantaged:
- low household incomes
- low agricultural yields (sometimes only
rootcrops and bananas)
- suffering from starvation due to lack of food
70
The MINDANAO households have slight advantage they•
have :
- more land to grow food (more varied diets)
-.greater access to government health services
- but, least serviced by basic infrastructures
like water and electricity: and
- the already precarious economic and
health conditions is aggravated by
continuing insurgency conflict
The VISAYAS households are less dependent on
subsistence agri-cultural activities:
- they lived in more urbanized places
- better reached by infrastructural amenities
except for water
- not better off economically or socially
2.
2.1.
Uplifting and improving the health of communities
with a continuing poor economic base is doubly •
formidable.
2.2.
Findings show that because of these conditions,
the preventive aspect of CBHPs is very low.
Also, this may be a result of the following:
a.
Due to lack of public
CHWs tend to be overworked,
it
is
the
CHWs who perform:
health facilities,
caring
the sick
1) organizing tasks 2)
initiating
various
kinds
of
health-related
3)
Because
of
this,
they
neglect other
activities.
of
preventive
health
care,
their
health
areas
assistance has been largely curative.
b.
Training/curriculum design is partial to the
curative rather than preventive aspect of health
care .
c.
Reality remains that the need for curative health
in the communities is high.
In practice, the CHWs
'have no choice but to respond to the immediate
needs of the beneficiaries in the communities.
2.3.
*
«
Observations and the implications of the socio
economic conditions to the CBHPs:
Some CHWs tend to relate and identify health
problems as results of the societal structure,
always broad problems. They fail to see the
immediate, short range problems in the
communities. They are fixated at long term goals
71
like social transformation (ultimate proven
five solution to our health problems). CHWs
should be able to’balance both the long term and
immediate needs of the communities.
2.4.
There is a neglect of the-maternal care/family
planning aspect, of the health program, Decrease
in breastfeeding of served communities is
alarming. Breastfeeding is actually one of the
best preventive measures to maintain health
communities.
In the main, despite its many limitations and
problems, the study points out that CBHPs have
existed in far flung poor, marginalized communities
where these services are most needed.
B.
CHW EVALUATION (KNOWLEDGE. SKILLS & ATTITUDE)
1.
Profile of the CHWs evaluated
A total of 82 CHWs were evaluated for the study,
profile of the CHWs evaluated:
1.
2.
3.
4.
5.
Occupation - 70% housewives & farmers
Sex
- 83% female
Status
- 86% married
Age
- 18 yr. old to 63 yrs. old
1 yr. to 13 yrs.
yrs. as CHW
No. of yrs.
(average 3 yrs.)
2.
Results of the tests
a.
Knowledge portion
The
There were 50 questions asked. These were based on
the major health problems confronting the general
population.
- range of scores were from 26 to 49: majority
got scores ranging from 41 to 45.
-- the result shows that:
* 74% still believe that TB is i nheri ted
* 68% think that BCG cures TB
* 51% do not recognize the'multi factorial causes
of malnutrition* 46% do not know the drug of choice for
pneumonia
*■ 34% could not distinguish a low grade fever
* 31% do not know the right time to give measles
immunization
72
The results indicate that:
- Knowledge of the CHWs on rational drug use
is still weak. This may be explained .that CBHPs •
have given more emphasis to herbal medicines.
- CHWs are very strong in the following
knowledge: home remedies for cough and fever;
transmission and complications Of measles;
duration of TB therapy; oral
ora 1 rehydration; signs
and symptoms of dehydration;
treatment of minor
wounds; use of tourniquet and need for butterfly
bandages: and the predisposing factors in causing
pneumonia.
b.
Attitude Portion
The main values and attitude seen among CHWs
were: perseverance and determination; compassion
and sense of duty; dedication and commitment;
honesty and humility.
Values and attitudes are best evaluated in
concrete and actual situations.
c.
Skills Portion
There were 3 skills tested on the following
topics: Maternal and Child Health; Ora 1
.rehydration: and Herbal Medicine.
On MCH, CBHPs have been weak in areas of
breastfeeding,, family planning, preparing for
delivery, knowing danger signals of pregnancy and
the rational
use of drugs in pregnancy.
Trainers should concentrate their efforts on
. the proper steps in ORS preparation.
It would
be good to review if CBHPs have indeed adopted a
standard formula for the sugar-salt solution.
Herbal medicine has been one of the major
strengths of CBHPs.
3.
Cone 1usions
The results provide insights on what areas need
strengthening particularly in the training and services
components of CBHPs.
The results coincide with the result of the
household survey that the preventive aspect of the program
needs improvement.
73
C.
CASE STUDIES OF 3 CBHP* INSTITUTIONS:
1.
RURAL MISSIONARIES. - COMMUNITY BASED HEALTH
DEVELOPMENT PROGRAM (RM-CBHDP)
The RM-CBHDP had made a mark in the history of ‘
CBHPs since its inception 13 years ago:
a.
Quantitatively., there is a growth in the number
of areas:
- from 27 to 432 villages
-- from 15 to 79 towns
- from 3 to 15 dioceses
In addition to these, more and more medical and
health professionals have become involved in
CBHPs at the barrio level.
b.
Qualitatively,
1) it has been responsible for propagating and
popularizing the use of alternative treatment
methods particularly herbal medicine and
acupressure.
2) it has made possible accessible and low cost
health services to villagers through the
services of the CHWs and through parish medical
consul tat ions
3) the program's approach in relating the
health problemsto societal conditions has
contributed greatly in raising the
consciousness particularly among the health •
sector.
4) leaders for health and non-health
organizations emerged from among the village
health workers.
After more than a decade of operation, RM-CBHDP
must now address a number of issues to ensure its
growth and continuity. The CBHDP must now deal with
the task of strengthening the managerial and technical
capability of the program — data recording and
reporting should be improved. CHWs skills should be
assessed and evaluated, management methods should be
improved.
74.
2.
COUNCIL FOR PRIMARY HEALTH CXRE (CPHC)
The CPHC's decade-long history has been
characterized by continuous efforts to learn from
accumulated positive and- negative experiences in the
promotion of the community-based approach to PHC.
CPHC is distinguished from other CBHP institutions
in its unique mandate to primarily coordinate the
different agencies, programs and groups committed to
the cause of
PHC.
It has no direct health delivery services but
instead
offers more technical services such as
training, publication and dissem»ination of materials
and networking.
In its early years, it had difficulty in enforcing
the :idea of a coordinating body ( "coordinating * still
other coordinating bodies)) and assuming its primary
function of coordinating all efforts for PHC*’. ’But
through the years it has developed/contributed the
fol lowing:
a) New structures have been established in CPHC's
services in pursuit of its principal mandate. .
CPHC carries out its coordinating and networking
role in three levels:
1) it links CBHPs around the country with
each other thi'ough island-wide, regional and
sub-regional coordinating bodies which meet
periodically in various conferences and
consultations sponsored by CPHC.
2) CBHPs are also linked with each otherthrough CPHC publication and the newly
created National Pool of Trainers.
3) indirectly, CPHC linked.CBHPs by gathering
individual program information on which can
come up with a comprehensive view of CBHP in
the country.
b) CPHC links CBHP with health professional and
other sectors so that possible areas of exchange
and assistance can be explored and developed.
The possibility of reviving the "Friends of
PHC" (1984) to gather a group of physicians and
other health professionals sympathetic to the
CBHP phi1osophy.
4
75..
o) CPHC links CBHPs with international groups and
networks mainly through exposure visits, referrals
and information exchange’
PROBLEMS:
(1) One of the basic problems of CPHC is that it is
unable to monitor on a sustained basis the developments
the programs it helps to set up.
of
(2) Many good resolutions or plans made during
conferences and consultations remain on paper for lack
of follow-up.
(3) Though there.has been marked improvement in its
content and form, the publication continues to be
de 1ayed.
3.
COMMUNITY BASED HEALTH SERVICES (CBHS - Mindanao)
has
After more than seven years of existence, the CBHS
gone a long way with these achievements:
a) the quantitative growth of the number of areas
and ■ the number of CHW's trained
- from a single diocese in 1975
- now (1989) ’ll dioceses covering 911
remote baranggays
- 2,309 active CHWs
b) the program has contributed in raising the
people's awareness of the root causes of the
health and other
societal problems.
c) it has encouraged health and other intermediate
sectors to share their resources, knowledge and
skills in the services of the people.
d) through the development of local and
international
linkages, the program has drawns
support for the people's desire for social
transformation.
Despite these achievements, the study reveals that
CBHS must now respond to a number of issues/weaknesses.
a) Organizational weaknesses have been observed
*like functions of the various organizational units
have not been clearly distinguished; there are
units included in the organizational chart which
do not actually operate while there are positions
76
(like Program Coordinator) that have given
important functions but are not included
in the organizational chart; and. the functions of
tlie organizational units are confused with those
of positions within those organizational units.
b) Diocesan programs must clarify their
organizational relationship with the church.
c) Relationships of the Diocesan Program with CBHS
Central office and the Diocesan programs with
those of the Parish programs need to be clarified.
d) Inadequacy of progress reports.
Activities
reported were consistently similar through the
years. Progress reports do not clearly show the
program's growth and the extent to which plans for
a given period has been realized and therefore
have not been helpful in evaluating performance
and in planning directions.
e) Weakness of the reporting system is related to
weakness in the planning system
- Measurable targets could not be set resulting in
weak monitoring and evaluation procedures.
f) Problems of high rate ofpersonnel and CHW turn
over .
IV.
Summary of Recommendations
A.
On the Program Content
1.
From the Household Survey
a. Reassessment of the role of CHWs towards
defining their services and functions more
realistically and conserving their energies and talents
for longer-term service to communities;
b. CBHPs should review their activities and
prioritize the kinds of services they wish to bring to
communities;
Prioritize program goals and services and align
these better with implementing strategies and the
resources that the programs have at hand;
c . CHWs should make health of mothers and women
their special concern;
77
*
d. CHWs can devote their attention to encouraging
mothers to breastfeed, to have their children
immunized, bring their babies to health clinics for
periodic check-up:
e. ’They can further educate mothers on the
nutritional needs of babies and growing childrenand
inform them not only on use of herbal for treating
common children's illnesses but on the use of simple
and inexpensive treatments like ORT;
f. CHWs can also conduct health education sessions
on household hygiene and on the value of teaching
children clean habits from early on:
g. Health education classes can further be
supplemented with related reading materials;
h. CHWs can help identify which crops must be grown
in the communities to meet household consumption
requirements and improve diets and nutrition of
fami lies.
2.
From the CHW Skills, Knowledge and Attitude Test
a. Develop parameters for evaluating training
outcome.
b. CBHPs should improve their standards of training
CHWs.
c. Fine tune evaluation instruments to measure
CHWs ' Skills, Knowledge and Attitude and make them
relevant and attuned to the Philosophy and objectives
. of CBHP.
3.
From the Case Studies
a . for CPHC
1) A catalogue of training materials, modules, etc.
currently available should be made and sent to
CBHPs for easy accessing.
2) A complete directory of all CBHPs in the
Phi 1ippines .should be made containing updated basic
information about each of them.
3) Stricter measures in editing, production work
and meeting deadlines should be enforced on TAMBALAN
and other CBHP publications.
78
4) Standardized format for tip- CPHC Progress Report
should be developed to f. -:.i. 1 it at-, future evaluations..
5) Improve the traditional health care component of
CBHPs by developing conveniently located herbal
gardens.
6) Intensify local and regional initiatives in
research on herbal medicines and home nursing
practices.
7) Set up cooperative pharmacies in the
communit les.
b.
for RM-CBHDP
1) A comprehensive study of CHWs to arrive at a
profile of socio-economic background, health skills
levels and the number of years they stay with the
program..
2) Data recording must be improved and include
indicators which should help assess program
achievements and/or failures.
3) Reassess the amount of time given to direct
organizing work.
4) Document experience in the different areas and
popularize them nationwide.
B.
On the Organization •
1.
From the Household Survey
a CBHPs should take stock of the number of their
program areas and CHWs and arrive at a more judicious
ratio for the area assignment and/or household
coverage of CHWs.
b. CBHPs should cultivate and not only develop
working linkages with those groups engaged in
delivering Community Organizing, livelihood, skills
training and other forms of assistance to communities.
c. Have a ready directory of nearby or alternative
health facilities to which CHWs can refer their cases
or clients.
•
&
■
79
d. Other health facilities and personnel who are
obligated to provide health services must be pressured
further to respond to the health needs or demands of
households.
e. Pursue linkages with other government and non
government groups engaged in the larger scale
production of herbal medicines to ensure the wider use
of herbal.
f. Linkages with agencies/organizations engaged in
assisting rural households with agricultural production
should be done.
2.
From the CHW Skills, Knowledge, Attitude Test
a. For those in government to legitimize and
formally recognize the work done by CHWs to give them
protection from harassments.
b. Provide CHWs with avenues for welfare
opportunities.
3.
From the Case Studies
a . for CPHC
1) The CBHP Coordinating Body should make
regular short, medium and long-term planning targets on
the local, provincial, regional and national levels on
points such as CBHP expansion areas.
e
2) For greater efficiency, a clearer delineationbetween direct and indirect services of the four
secretariats can be made.
3) Find some solutions to alleviate the economic
aspect of the staff's and CHWs' salaries.
4) GO-NGO cooperation and exchange should be
explored and work for the sustenance of such a link by
pressuring for a PHC officer/desk/unit within the DOH.
b. for RM-CBHDP
1) Set up a CHW desk to concentrate on CHW
training. development and retention needs.
2) More realistic programming should be done in
terms of setting-up new health programs or answering
requests to assist health programs of other Church
groups and need to consolidate existing network of RM.
tt
80
3) Records and reports should be consolidated
and systematized to provide the basis of new plans and
the future monitoring and evaluation of the program.
4) Bring in technical assistance to upgrade
internal managerial and administrative capacities in
running the program.
c. for CBHS
1) Review of CBHS organizational structure must
be done and must lead to the preparation of a
functional chart*which shows the summary of functions
per organizational unit and an organizational structure
showing the position titles and incumbents per
organizational unit.
2) Relationship with Bishops and ‘Parish Priests
must be clarified.
3) Diocesan health programs should clarify their
relationship with the church.
4) Clarify relationship of Diocesan Health
Programs with the CBHS central office and Diocesan
Health Programs with those of the Parish Health
Programs.
5) Reporting system should be improved with a
suggestion that reporting by objective be done.
6) Planning system should be improved.
7) Review staff selection process and new
strategies for keeping personnel must be considered.
8) CBHS must broaden its financial support base.
Reference:
Virginia Miralao, An Evaluation of Selected Community Based
Health Programs and Institutions in the Philippines
1990. A report on CBHPs in the Philippines.
4
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13 January 1991
Sunday
81
Day 4
Facilitator of the Day:
Patrick Chuidian
SCHEDULE
8:15
8:30
9 : 30
8:00
8:15
8:30
Morning Praise
RECAP
Regional Workshop:
Results of Summing-Up and CBHP Impact
Evaluation
»»
12:00 Current National Trends and Issues and their
Implication to NGO1s and PO's Liddy Nakpi1-Alejandro
1 : 00 Lunch
2:30 Continuation of Regional Workshops
5:30 National Health Situation - Dr. Mike Tan
6:00 Supper
10:00 Cultural Night:
"Kahapon. Ngayon at Bukas
(PETA Play)
10:30 •Buzz Session
•9:30
12:00
1:00
2:30
5:30
6:00
10:00
NATIONAL SITUATION
CURRENT NATIONAL TRENDS AND ISSUES
AND THEIR IMPLICATIONS TO NGO's AND PO's
Liddy Nakpi1-Alejandro
Secretary General
Bagong Alyansang Makabayan (BAYAN)
Object ives:
1.
2.
A.
To present a framework for understanding the national
crisis situation and to appreciate the data presented in
daily newspapers
To present an update of the current trends in the
strategic aspects of the situation
ECONOMIC SITUATION
1.
The Gulf Crisis and its implication to our economic
crisis
Presently, the Gulf crisis and the imminence of war
in the Gulf region is the object of attention of the whole
nation especially the government, the curious bystanders and
the increasingly apprehensive Filipino people.
not
However, a great number also say that the war is
likely to happen since both parties do not want the War
82
and that they will not benefit from it. -The issue is.being
exaggeratedly projected in our country and overshadows the
real and decisive issues and problems in our own country,
In fact, the Gulf Crisis was the best event that could
happen to the Cory Aquino Government (CAG). The government
is exploiting the issue to explain our economic crisis
situation, particularly, on the oil price increase.
2.
The Real Effects of the Gulf Crisis in our Economy
Actually, the Gulf Crisis has some effects on our
economy. Clearly, these are the following:
a. Massive dislocation of Filipino overseas
workers.
This has grave effects on individual migrant
workers.
In the national level, there is the
slowing down of dollar remittances, thus
depleting the country's much needed dollar
reserves.
b. The increase in oil price.
The continuous fluctuation of crude oil price
and the possible outbreak of war will create higher
crude oil price and reduction of oil supply.
Principally, thl Philippines uses oil for its
energy supply, but only a small percentage of it
comes from Kuwait.
c . Other effects on the economy.
The Gulf crisis gave the government a
convenient excuse to lay the blame of the present
economic problems particularly on the oil price
increase. Actually, the three successive *
increases from September 21, to December 5, 1990
that reached up to 100% was not precipitated by the
market price of crude oil import. Rather, it was
precipitated by the IMF dictates to reduce our
national budget deficit. And one way to reduce
this was to increase the prices of oil which was
done through the Oil Price Stabilization Fund
(OPSF) reimbursements to the oil companies in our
country. OPSF is part of our budget. Therefore,
the Gulf Crisis is not the real reason for the
oil price increase in our country.
83
3.
The Real Causes of our Crisis in the Philippines
When we talk about the crisis the Filipino
people face; we are talking of two things:
a.
b.
poverty of the vast majority
Philippine economy in crisis
The Philippine Economy is characterized by
1.
2.
3.
import- dependency
foreign-dominated capital
e1ite-owned economy
The Implications
1.
import-dependency
Since we are import dependent, we need
dollars to finance our economy and problems
arise when dollar reserves are depleted.
2.
import-orientation is also debt dependent
3.
foreign capitalists do not invest when they
are unsure of getting profits.
4.
foreign capitalists repatriate their profits
and wealth generated in the country. This
means that for every $1 capital they bring
in, they still borrow $2 from our banks.
Whatever profits they earn are being
repatriated to their mother country. These
are not really foreign investments because they
deplete our much needed capital.
Artificial Gross National Product (GNP) growth
rate
The year 1986-1988 registered GNP growth
rates but they were not the result of increased
productivity but was only due to a consumer-led
growth. It did not sustain the GNP growth.
4.
The Crisis Situation the Government Faces
- there was an increase in the export earnings by
15% but there was a 120% increase in importation
resulting in a negative trade balance
- debt servicing
- capital flight
Such factors contribute to the severe and
continuous depletion of the economy so much so that we have
84
large budget deficits,
oil and other imports.
Definitely, we have no money to buy
Furthermore, the policy of import liberalization
will bring about closures of many business firms and
companies.
Adding gravity to the economic crisis is the'
International Monetary Fund's (IMF) dictated conditions on
how the government will be able to pay the $700 -$750M
foreign debt.
Some of the conditions set by the IMF were:
1 . reduction of the national budget deficit and
2 . import liberalization
In genera 1, the IMF orientation requires us to
sacrifice more so that we can pay our debts so that we can
get more loans.
With this orientation, the people in government
have to institute measures that will further aggravate the
already suffering Filipino people.
B.
POLITICAL SITUATION
1.
Trends in the Cory Aquino Government (CAG)
a.
The Gulf War
The hysteria of the Gulf War created by the
government itself among the people further
aggravated the political and economic situations.-
b.
Crisis of governance
The present government does not only govern
ineffectively, it is also notorious for aggravating
the situation thus creating mass unrest.
c.
Rise, in political forces seeking solutions
and change in governance
Because of the crisis in governance, political
forces, legal and underground, are formed and
strengthened.
85
General Effects of these Trends.The effects of these trends are either GOOD or
BAD.
-
2.
It is BAD because:
it will have immediate and serious effects on the
people as a whole
political instability brings about repression,
though this is a natural consequence in the
process of change
such situation offers opportunities to other
political forces whose intentions are not really
pro-people.
It is
C----for
--- people who want change and who
GOOD
want to hasten the
LLa process of change.
Political Forces
a.
The Cory Aquino Government (CAG)
Trends:
1)
A broken up coalition of:
-.PDP with Pimentel
- LP with Salonga
- LDP with Mitra
- Laurel
~ Cardinal Sin and the
- Big Businessmen
What is left of the coalition is the
Council of Trent led by Estanislao and Cuisia
though it is now becoming isolated in Makati.
Such broken coalition is manifested by:
— the sympathetic attitude by businessmen
to rallies and such other activities
staged by the mass organizations
~ the Philippine Chamber of Commerce and
Industry (PCCI) of Periquet
- the distancing of Cardinal Sin and
his being critical to the CAG with his
pro-people statements. However,
he remains supportive of the status quo
Mitra, FRamos and Salonga are making
their ways; ffor the presidency while
Pimentel is hoping to be Cory*’s running
mate
Laurel has an f---■ uneasy position
among the
four presidential aspirants
.•a
2)
Massive disenchantment among the people
86
3)
Probable "melt down" of the CAG
There, is a probability that the CAG will
just "melt down" naturally, instead of a
forcible removal of those in power because
presidential aspirants would like to reach 1992
for the elections.
Meanwhile, Laurel has his Cory Aquino
• Resign Movement Agad or CARMA, a mass
movement carrying the line of "Cory resign.
Laurel take over". But this can still wait for
the 1992 election.
Cojuangco on the other hand is for
elections".
snap
Estrada, though sincere in many
nationalist issues, has some limits.
b.
The Rebel Military Forces
The rebel military forces is a coalition of
several factions -- RAM, YOU and SFP - which are not
consolidated in terms of principles, visions, ties
with the U.S. and its strength of influence.
RAM - tries to assert itself as an entity
- works out and clarifies its own vision and
program
- carries a general platform to overthrow the
government, turn power over to a new
government and return to the barracks. But
while its vision is not yet so articulated,
they can still stage another coup if they
will not agree with the new government they
helped institute.
- to understand this group/coa1ition better, we
must also study the nature of the Coups that
happened in other countries.
It must be known that they are still part of
the military. So, we should be more critical and a
little more open to other people's organizations.
c.
Other Armed Groups
Other armed groups like the New People's Army
(NPA) which is under the National Democratic Front
(NDF) are waging a peace process.
The NDF and its member organizations have
interests in participating in this peace process.
t
The NPA is not just for a ceasefire, the agenda
which is always being pursued by the Cory Aquino
Government (CAG).
It is for the discussion on
the real causes of the mass unrest with the
government and other forces, to arrive at a
political settlement.
However., the CAG viewed the insurgency as the
biggest threat to government and therefore has to be
resolved immediately. The CAG would like to
compromise but carries a different agenda. It uses
the ceasefrre agenda to diffuse the attention of the
people to enable itself to give,attention to
political-military factions within its ranks.
d.
The Mass Movements
The political upsurge on the streets of the
growing mass movements heightens the political
crisis situation.
This situation makes it Vimely to raise and
popularize the issue of an alternative government.
There is a need to unite with the broad progressive
front to pursue this alternative government.
For instance. BAYAN carries the slogan. ’’Oust
the CAGH. But what is the alternative? How shall we
do it? What must be done? Now people want to know
what is the alternative and how will it be done.
The hroad front tries to do the same but they
are not ready to face the challenge.
CARMA must be given some basis to recognize
their movement to heighten the issue of an alter
native government.
It will be the organized groups that will lead
the people to change the Situation in an organized
and systematic, not in a chaotic process.
In view of the recent developments brought about
by the Gulf crisis, the People's Caucus organized a
People's Crises Conference with the following
objectives:
1 . To critique the Gulf War with NGO's and
GO'S and take position on this.
2. To establish alternative economic measures
for governance.
3. To define and clarify what can be done novz,
and
4. To discuss other issues relating to the
present problem.
87
88
C.
THE CRISIS SITUATION AND ITS IMPLICATIONS TO HEALTH
The present economic and political crises have w grave
implications on the general health conditions of the people.
There will’ be severe deterioration of the state of health of
the people, especially the poor in urban and rural areas who
are already living in poor health conditions.
In case of shortage of medicine we.must be ready with
alternative medicine.
89
«
NATIONAL HEALTH SITUATION
Dr. Michael Tan, DVM, PH.D.
Executive Director
Health Action Information Network
It seems that there are no significant changes i n the
health situation since the first time we looked at it in
1974.
MORBIDITY FIGURES (see Table 1)
The latest
those of 1987.
available figures
from the
DOH are
still
The top ten diseases for 1987 were generally the same
as in the previous five years; only their ranks changed.
Although it
is believed
that
the
cases
were
underreported, it would be still be useful to look at these
f igures.
This underreporting is quite apparent in the
number of cases of influenza and tuberculosis shown.
For 1987, there was an increase in the figures and this
had been going on since 1985.
The report shows that about one out of every 100 people
had bronchitis,
the no.
1 morbidity cause, and this figure
could still
be
very
much
higher
considering
the
underreporting of cases.
The no.
2 cause covered a wide range of diarrheal
diseases, which did not only include the ordinary diarrheal
diseases but notably the many serious cases which were
admitted in hospitals.
No. 7 was accidents, which included injuries due to
war/c ivi1 stri fe/LIC—injuries
that
were
not
rea1ly
accidenta1.
MORTALITY FIGURES (see Table- 2)
9
For the past years it seemed that pneumonia being the
no. 1 cause of death was becoming a "normal" fact. But in
reality it is very much possible to control pneumonia as in
China where it is no longer the leading cause of death.
This is
attributed to their control of environmental
sanitation and other factors.
The diseases of the heart ar^l the vascular system, nos .
2 and 3 respectively in the leading causes of death, were
mentioned in some DOH reports as a sign of development in
the Philippines.
But
this is very deceptive since
89a
Databank'
TABLE 1
1
Morbidity: Ten (10) Leading Causes
Number & Rafe/100,000 Population
PHILIPPINES
5-Year Average (1982-1986) & 1987
5-Year Average
(1982-1986)
Cause
1987
/
Number
Rate
Number
Rate
(466)
485807
911.0
642777
1120.6
(004-009)
465159
872.3
607148
1058.5
(487)
356212
668.0
495161
863.3
(480-486)
163834
307.2
183143
319.3
5. Tuberculosis, All forms (010-018;137)
134314
251.9
163740
285.5
6. Malaria
89826
168.5
121097
211.1
1. Bronchitis
2. Diarrheal Diseases
3. Influenza
4. Pneumonias
(084)
t
7. Accident*
(800-999;E800-E949)
75574
141.7
114445
199.5
8. Measles
(055)
55459
104.0
81896
142.8
9. Diseases of the Heart*
(390-398;402-402;410-429)
72442
135.9
79214
138.1
10. Malignant Neoplasms
25630
48.1
27195
47.4
(140-239)
* Declared Notifiable Diseases in 1984.
Source: Computed from Department of Health’s Philippine Health Statistics 1987.
Health Alert 100
89 b
TABLE 2
Mortality: Ten (10) Leading Causes
♦
Number & Rate/100,000 Population
PHILIPPINES
5-Year Average (1982-1986) & 1987
5-Year Average
(1982-1986)
Cause
Number
Rate
1987
% of Total
Deaths
Number
Rate
% of Total
Deaths
/
1. Pneumonias
(480-486)
48701
91.3
15.1
52700
91.9
15.7
2. Diseases of the Heart
> (390-398;402-404;410-429)
35178
66.0
10.9
38840
67.7
11.6
3.. Diseases of the Vascular
System (401 ;403;405;430-438;
440-448:451-459)
26438
49.6
8.2
29905
52.1
8.9
4. Tuberculosis, All forms
(010-018:137)
29428
55.2
9.1
28697
50.0
8.6
5. Malignant Neoplasms
(140-239)
17813
33.4
5.5
20367
35.5
6.1
6. Measles
(055)
7340
13.8
2.3
12431
21.7
3.7
7. Accidents
(800-999;E800-E949)
10162
19.1
3.2
11630
20.3
3.5
(001-009)
12347
23.2
3.8
10589
18.5
3.2
9. Chronic Obstructive Pulmonary
Diseases (COPD) (490-496)
6316
11.8
2.0
7343
12.8
2.2
10. Avitaminoses and other
Nutritional Deficiency
(260-269)
6642
12.5
2.1
5229
9.1
1.6
8. Diarrheal Diseases
—
Source: Computed from Department of Health’s Philippine Health Statistics 1987.
90
cardiovascular diseases
are not
necessarily signs of
affluence.
Heart diseases here were in fact different from
the heart diseases of Western nations; many of the cases
here were rheumatic heart disease which is infectious in
etiology.
Likewise, hypertension cases here were not
exclusive to businessmen as any kind of stress could cause
them.
And with the increase of hypertension cases in males
between 20 to 30 years old especially in the rural areas, we
would look
‘into the linkage between hypertension and
pesticide poisoning.
It is also intriguing to know that there was a very
very big difference between the mortality rate of rheumatic
heart disease between the women and the men.
Was it
possible that the higher death rate in women was because
women were not getting the necessary treatment as compared
to male members of the family?
Tuberculosis went down from no. 2 to 4. Could this be
a sign of development or just that something else came up?
However, visits to the rural areas revealing many untreated
cases would point to the underreporting of cases. Even then
it had still a very high death rate and we still had the
highest death rate for TB among the ASEAN countries and in
the Western Pacific region.
With the worsening financial crisis, this death rate is
expected to rise some more since treatment will also become
more expensive.
For although the DOH says that the
medicines are free, it is very hard to avail of them because
of the bureaucratic process required.
Cancers have also been on the rise and again it would
be wrong to attribute this to a more modern society since
the pattern here would point to agrarian/underdeve1 oped
society factors like for instance its linkage to pesticides.
There was an increase in the percentage of total deaths
of measles from 2.3 to 3.7. This notably was already after
the EDSA revolution.
There could have been an increase in
immunization coverage as the government claims,w but the
problem was that they concentrated.on the infants and we saw
that deaths due to measles were mostly among the 2 to 6
years old.
According to UNICEF, all
a 11 vulnerable children
were supposed to be immunized.
Avitaminoses and other nutritional deficiencies were
still in the top ten and although there was a decrease in
the cases from 2.1 % to 1.6%, we should be careful in its
interpretation.
This would have meant only that it was not
just malnutrition itself that killed the person but some
other disease like measles.
91
The government itself admits that the nutritional
status of children did not improve--!! worsened in 1985,
improved a little in 1986-87, deteriorated in 1988 and most
probably will continue to deteriorate.
deteriorate.
Thirty percent of
Filipino pre-school children are moderately to severely
undernourished; if we count the mildly undernourished the
figure may reach 80%.
In 1987
when there
was an
improvement of the
nutritional status ,of pre-school children,
chi Id ren, it was observed
that undernutrition cases were high among the 7-10 years
old.
These were the survivors of the 1984-86 crisis; they
were then the pre-schoolers.
So whatever happens in 1991 we
will be seeing the consequences of that as late as 1995 and
in some instances, maybe in a longer time, Like when we talk
about the problem of goiter which is endemic in the
Cordilleras and other areas, we will also talk about cretin
children which is a lifelong problem.
Looking at the pattern of disease in the Philippines,
we could keep on reporting that most of the causes of death
are preventable and curable.
DEATHS BY OCCUPATION AND AGE (see Table 3)
It is time if possible, to also use our community
diagnosis for figures from our communities and to take a
more critical look at national figures and find some
important differences.
The infant mortality rate in the Philippines was abqut
55/1,000 live births (and we know that this is underrated).
This means that 5 out of. 100 died before the age of one
year.
Further another two died before reaching the age of
five years.
The mortality Rate continues to be quite high
until the age of around 10 to 15 years.
The first row in table 3 shows that at a certain age it
seems that it would be a continuous survival up to the age
of life expectancy but as we will see there are differences '
according to the occupational groups.
For the professionals, they tended to die at an older*
age but not quite at the range of >65 (24% for the
professionals and 30% for all) which may be due to their
being prone to cardiovascular diseases,
The average however
represented the extremes for those going beyond 65 years.
As seen, a very high percentage of elementary teachers died
between the ages of 20-49 and very few reached beyond 65.
And we know how hard the life of teachers is and that they
are paid very low wages, comparatively speaking..
For clerical
an early age and
workers, it is notable that many died at
perhaps this could be attributed to poor
91a
TABLE J
Deaths 1987 by Usual Occupation and Age of Death
Gainful
Percent
All 20-30 30-39 40-49
75091 10721 11250 11263
14.28 14.98 15.00
50-59
13150
17.51
>65
60-65
22536
6171
8.22
30.01
r
PROF
Percent
3000
/r-—.. . ■
258
427
550
8.60 14.23 18.33
725
24.17
308
10.27
722
24.07
Physicians 150
Percent
5
3.33
8
5.33
13
8.67
31
20.67
18
12.00
75
50.00
Lawyers
Percent
190
1
0.53
1219 •
6.32 10.00
. 59
31.05
30
15.79
118
62.11
Elem teac
Percent
468
60
138
33
7.05 12.82 29.49
128
27.35
53
11.32
56
11.97
CLERICAL
Percent
581
124
129
101
21.34 22.20 17.38
116
19.97
40
6.88
71
12.22
SALES
4306
Percent
521 -: ^<646 ■ 763 >
12.10 14.98 17.72
840
19.51
406
9.43
1131
26.27
SERVICE 2797
Percent.
740
26.46
668
508
23.88 18.16
431
15.41
122
4.36
328
11.73
AGRIC 39820
Percent •
4103 4312 5034
10.30 10.83 12.64
6638
16.67
3588
9.01
16145
40.54
PROD
18407
Percent
3659
19.34
3653 3264
19.85 17.73
3259
17.71
1270
6.90
3402
18.48
Miners
Percent
188
78
41.49
61
32.45
18
9.57
14
7.45
3
1.60
14
7.45
E1ectr
Percent
283
57
20.14
79
50
27.92 17.67
53
18.73
20
7.07
24
8.48
Transport 3457
Percent
601
17.39
957
748
27.68 21.64
637
18.43
210
6.07
304
8.79
744
532
161
46/10 32.96 9.98
76
4.71
25
1.55
76
4.71
AFP
Percent
1614
1
92
working conditions.
A relatively high percentage of sales
workers, which may include sales workers of big companies
like the medical representatives, died beyond the age of 65.
Notable in agricultural workers is that >20% of them
died before reaching the age of 40 years.
A research in
Nueva Ecija revealed that there was an increase of deaths of
males due to cardiovascular diseases since the advent of the
green revolution leading to the speculation that those may
have not been only cardiovascular disease cases but may have
been cases of pesticide poisoning.
Almost half of the production workers died before the
age 40. This could be attributed to occupational hazards.
It is very apparent from the figures that working with
the AFP was the most dangerous occupation. More than a
thousand
died
in 1987 and most of these were enlisted
men belonging
to poor and peasant families. Almost 1/2
died before
the age of 30 and about 1/3 before the age
of 40; many of these deaths occured in encounters. Around
5% were more than 65 years old and almost all o.f these were
off icers.
It is shown here that age range of deaths differed in
the different occupations.
occupations. The factors that could be cited
here are the occupational hazards and perhaps the type of
diseases associated
with the
respective
occupations.
Political factors could also be contributory,
such as the
low intensity conflict (LIC), where the peasants were
affected,
forcing their children to join the AFP for
economic reasons and to die at very early ages, These young
soldiers were victims themselves.
INFANT MORTALITY RATE (IMR) BY CAUSE OF DEATH AND OCCUPATION
OF FATHER (see Table 4)
This table shows that socio-economic status or the
class factor already had a bearing even in the cause of
death of infants.
It is seen that more infants died due to intestinal
infection,
nutritional
deficiencies,
pneumonia and
deficiencies,
pneumonia
influenza,
and
other
respiratory
respiratory
diseases
diseases
in
in
the
agricultural workers than in the professional and technical
workers.
The dramatic difference in the nutritional
deficiencies (around three-fold) points out that the kind of
family an infant is born to makes a difference on the
infant's nutritional status.
•Congenital anomalies were higher in the professional
and technical workers than in the agricultural workers.
This could be possibly because in the former, mothers had
more access to drugs.
Another theory is that fetuses with
92a
TABLE 4. ITOaCNTAGE DISTRIBUTION OF INFANT MQm’AI.ITY BV CAUSE OF DKAIH
AND OCCUPATION OF FATHER: PHILIPPINES, 1983
PROFESSIONAL
& TKCHNH71L
WORKERS h
OTHERS IN
GROUP 1
CLERICAL h
RETjATED
WORKERS &
OTHERS IN
GROUP 2
AGRICULTURAL
WORKERS &
OTRHRS IN
GROUP 3
OTHER
WORKERS
IN
GROUP 4
ALL
GROUPS
INTESTINAL INFECTION
6.0G
7.21
7.91
5.55
7.19
NUTRITIONAL DEFICIENCIES
1.30
2.37
3.74
1.73
2.80
VIRAL DISEASES
2.60
1.70
1.41
1.36
1.56
PNEUMONIA &. INFLUENZA
9.52
20.21
20.68
13.28
18.94
OTHER RESPIRATORY
DISEASES
3.46
2.40
4.24
2.37
.3.19
CONGENITAL ANOMALIES
13.85
7.24
5.40
6.46
6.58
CONDITIONS ORIGINATING
IN PERINATAL PERIOD
49.78
46.05
44.19
56.78
47.12
Disorderfl relating
to short gestations
39.13
38.84
29.79
41.99
35.96
Intrauterine hypoxia
& birth asphyxia
9.57
8.51
13.10
6.09
9.65
Respiratory distress
syndrome
12.17
12.68
6.55
13.78
10.50
Other respiratory
conditions of
fetus k newborn
10.43
9.07
7.83
8.49
8.53
Infections specific
to the perinatal
period
9.57
13.96
11.98
12.02
12.67
Other conditions
originating in
perinatal period
19.13
16.93
30.75
17.63
' 22.49
ALL OTHER CAUSES OF DEATH
13.42
12.62
12.42
12.47
TOTAL
100
100
ICO
.100
CAUSE OF DEATH
■
•
>.
12.62,
.
100
■' iv-•
93
congenital anomalies in mothers of farmers' familieE; usually
were not delivered alive at al]; as we see in the community
diagnosis of CBHPs, the rates of abortion and miscarriage in
the communities are quite high.
LOW BIRTH WEIGHT (LBW) INFANTS (see Figures 1 and 2)
Low birth weight infants are those born weighing less
than 2.5 kilograms (5.5 pounds).
In Figure 1, we see a U-shaped configuration, The high
incidence of LBWs in first born children (21.12%) could be
due to the fact that the mothers still had no experience,
hence still lack the education about child bearing. This
may stress the need for CBHPs to give more effort in
educating women who are in their first pregnancy. The start
of increase of LBWs in the fourth children may suggest that
the ideal number of children is two to three.
Child bearing at a very young age does not only
increase the possibility of a LBW infant, as shown in Figure
2, but also the risk of maternal death,
The maternal
mortality rate for women <15'years of age is around 50% as
compared to the national average which is <1%.
Figure 2 also shows that based on the risk of LBW
infants, the ideal age to give birth was between 25 to 35
years of age and that giving birth after the age of 35 was
much safer than giving birth before the age of 20.
There is a need for the. CBHPs to address this problem
of child mothers,
This birthing before the age of 15 years
still constitutes
around 2,000 de 1iveries/year in our
country.
THE INTERNATIONAL MONETARY FUND
(IMF) CONDITIONALITIES
There are economic, political
leading to this health situation.
.
and
economic
factors
For the Philippine government to get more loans, the
IMF is imposing the following conditionalities:
1.
Reduce government budget by P30B. The budget for 1991
was reduced by P25B but surely the PSB’Will be made up in
the other conditionalities.
2.
Reduce/e1iminate government subsidies on oil, rice, etc .
(deregulation).
This will mean that the government will no
longer set prices for the commodities concerned. As for oil
for instance,
this would mean that the pricing will be left
to the oil companies to determine.
This would definitely
♦
9 3 8.
PercchtaF.c Distribution, of Infants (
Belov? Standard Birth Weight By Birtl
FIGURE K
Order.
’
..
22------
BIRTH
ORDER
1
2
3
4
5
6
7
8
9
10
% OF INFANTS
W/ LOW'BWGT
21.12
17.18
15.72
16.22
'16.92
18.59
18.72
19.19
• 19.31
21.70
Pl
20 I
19
?!
£
!fi -
\
/
b
17 -
IK -
15 - ■
I
2
J
5
F
104*
8
1
!•
HP TH 0»0fl?
FIGURE 2<
Percentago Distfibutibh o£ thfants
Belov/ Standard Birth Weight1By Age
of Mother
4 0 -i—
38
AGE OF
MOTHER'
% OF INFANTS
LOW BWGT
<15’’
15 - 19
20 - 24
25 - 29
' 36.18
25.. 35
20.23
16.76
16.50
17.93
21.20
20.39
’21.90
y>
A\
:k •
30 -'34
35 - 39
40 -44
45 - 49
50
\
32 30 -
6Q
5<t
I
\\
20 '
2K .
24 ’
k
22 20 -
«
in -
u
16----< 15
15-19
20-24
23 - 29
30 - 34
ADE Of MOTHER
35 - 39
-i
« - 44
45 - 49
50 4 '
94
result in higher prices; we will expect a series of price
increases in the near future.
As a matter of fact even
today, our oil prices here are already higher than in Canada
and America, that in absolute terms.
3.
Raise government revenues.
Examples:
*
9% import .tax - This is a reversa 1 of the import
liberalization policy but although i t may seem that it is
based on nationalist reasons, it is not, because it is being
done simply because the government is in need of money.
This could even be dangerous since we do not have selfreliance ’programs making us very dependent on imported raw
materials as in the manufacture of drugs. This tax increase
will be passed on to the consumers through the higher prices
and high inflation rates that will result.
*
increase in income taxes
- In Metro Manila the minimum
wage
has
been increased to P118/day from P89 or equal to
about P2,596/month.
However, there has been an observation
that this increase in wage has resulted to a lower take home
pay because it also raised the income' brackets of your taxes
—consequently you have to pay higher income taxes. What
is needed here is to reform the income tax system wherein
the rich will be made to pay higher taxes and the poor given
more tax exemptions.
*
increase in SSS and Medicare premiums - We may opt to
give more non-wage benefits and maximize r ei mburs eme n t s,
which are non-taxable, than outright salaries.
These IMF conditionalities are supposed to reform the
government's economic system for a more efficient government
— a solution to our economic problems.. But we very well
know that these have been used since the time of Marcos and
we know that these are not the solution.
The government can raise taxes through other means 1 ike
real estate taxes especially on idle lands; in Metro Manila
for instance an aerial survey revealed that 15% of the lands
is still idle. However, it seems the increase of taxes for
idle lands cannot be done because the people in Congress,
who<1 owns them, will be the ones to be affected.
There are also the controversial sin taxes (increased
taxes for cigarettes, hard and soft drinks). The increase
in the taxes of cigarettes and hard drinks some argued, only
affected the consumption of the poor. Does that mean that
they are going to be healthier? •
»
Ik
95
TREASURY BILLS (T-BILLS)
Presently half of the debt servicing goes to payment of
domestic debt.
To finance this, the government floated T~
bills wherein you may put money in (minimum is P100,000) and
in turn get high interest of 27-32%. .So that if you put P1M
in T-bills, • your interest would reach P32,000/year.
So
people are lured to put their money here instead of
investing it in some business which can generate productive
employment but which has risks.
This may be tempting to
those who have money but with these T-bills,
the economy
does not move and the government debt gets higher and higher
because it has to pay the monthly interests.
BLOATED AND EMACIATED BUDGETS (see Tables 5 and 6)
The national budget reflects the political will of the
government.
Because, the government lacks funds, the budget
for 1991 is the same as that for 1990 minus P25B.
to a certain
According to the DOH national office.
extent the department is affected by the P25B cutback.
(A
participant shared that according to the regional director
of Central Luzon,
Luzon, their regional hospital was made to slash
expenses for 1991 by 30%.)
Looking at Tables 5 and 6, let us compare some items of
the bloated and emaciated budgets and see for ourselves the
distorted priorities of the government.
1. The health services for the the AFP General Headquarters
has a budget of P43M for 20,000 personnel or that would be
P2,063.31/person/year.
The four main services of the AFP
have the following budgets for their health services (per
person/year): Air Force P2,400; Army 1,668; Navy Pl,863.33;
and PC Pl,028'39.
Further, the AFP Medical Center and
Veterans Memorial 'Hospital have separate budgets of P130M
and P126M respectively.
Compare these with the budget of
DOH of P7B to take care of the health of 60M Filipinos orthat
would
translate
to
P 127zyperson/year
or
P0.30/person/day.
Also compare those bloated budgets with
that of the
Research and Promotion of School Health and
Nutrition under DECS which is P11M for 10M schoolchildren or
that would
be approximately
Pl/year for each child.
Included in this P11M budget is the 2.3M or P0.20/child/year
for medical and dental services of the schoolchildren.
2.
The Office of the Press Secretary under the Office of
the President has 24.01M. Compare this with the P2M for the
Public Information and Health Education Services of the DOH
which is in-charge of keeping the SOM Filipinos informed on
95a
TABLE 5
Bloated Budgets (1990)
Figures in millions of pesos
Department of National Defense
P22,962
AFP General Headquarters
2,618 .
Intel1igence. Services
214
Civil Military Operations
108
Health Services
43
(Staff 21,102.
Per capita health: 2063.31)
Philippine1 Air Force
2 298
Intelligence Services
49
Health Services
. 46
Civil Relations
~
6
(Staff- 19,117.
Per capita health: 2391.43)
Philippine Army
Intelligence Services
Health Services
Civil Relations
(Staff 91497.
Per capita health:
5,179
72
153
29
1668.13)
Philippine Constabulary
Intelligence
Health Services
Civil Relations
(Staff 45226.
Per capita health:
3,399
57
47
1028.39)
Philippine Navy
intelligence
Health ServicesCivil Relations
(Staff 27657,
Per capita health:
3,193 •
37
52
14
1863.33)
Integrated National Police
(Staff 73798)
4,745
Presidential Security Group
39
AFP Medical Center
(Staff 1173)
130
Veterans Memorial Medical Center
(Staff 1534)
126
CAFGU
(Staff 72000)
523
Philippine Military Academy
(Staff 2009)
221
Government Arsenal
• 130
95b
Manufacture of Arms
(Staff 1131)
91
Office of Civil Defense
(Staff 306)
16
Office of the President
2,145
National Intelligence Coordinat-ing
Agency
106
Presidential Commission on Good
Government
85
Presidential Committee on the
Philippine Nuclear Power Plant
244
Other Executive Offices
Office of the Press Secretary
Games and Amusement Boards
National Police Commission
National Stud Farm
Philippine Gamefowl Commission
Philippine Racing Commission
401
10
186
8
9
19
95c
TABLS 6
Emaciated Budgets
Figures in millions of pesos
Department of Health
7.655.
National TB Control Program
150
Subsidies to indigent patients
9
(excluding subsidy of P37 million for indigent patients at
Heart Center)
Assistance to PTS
8
Purchase of drugs and medicines
363
Community health services
2
Public information and health
education services
>
2
Health intelligence services
4
Dangerous Drugs Board’
30
Bureau of Food and Drugs
19
(Staff 73,124)
DOH annual budget per Filipino: 127.53 )
Department of Labor
Appropriate. Working Conditions
and standards
Rural Workers" Welfare
Appropriate working conditions
and welfare of women and minors
and family planning
578
Department of Science and Technology
Food and Nutrition Research
Insti tute
Philippine Science High School
Philippine-. Council for Health
Research and Development
920
Department of Social Welfare
Commission on Population
Council for Welfare of Children
and Youth
National Council for the Welfare
of Disabled Persons
836
60
Department of Agriculture
National Nutrition Council
Fertilizer and Pesticide Authority
Department of Trade and Industry
Product Standards
Consumer protection and regulation
of domestic trade
7
'/r
5
54
38
17
4*
9.
26
14
10
5
95d
Department of'Education, Culture
and Sports
26,894
Research and Promotion of School
Health and Nutrition
11
(Including 2.3 milion for field operations of
medical/dental health services)
(Total staff; 435,590, excluding
(
Institute of Philippine
Languages, National Library,
,, National Museum, National
Historical Institute)
State Universities and Colleges
Philippine Normal College
(Staff 604)
Polytechnic University of the Phil
(Staff 2051)
University of the Philippines
Health services and training of
medical students-at PGH
(Staff 12811)
4,600
79
309
1,170
203
Department of Agrarian Reform
904
Department of Environment &
Natural Resources
National Power Corporation
6,868
995
V
Office of the President
Presidential Commission for the
Urban Poor
Other Executive Offices
Commission on Filipinos Overseas
Energy Regulatory Board
National Commission on the Role
of Women
*
19
12
24
8
96
how to handle respiratory diseases, diarrhea, etc.
The
P401M of the Press Secretary is very high to the P578M of
the Department of Labor and Employment which is in-charge of
taking care of the labor problems of the country.
3.
The National Stud Farm has P8M while the DOH Community
Health Services has only P2M.
4.
The Philippine Gamefowl Commission has P9M while the
Council for the Welfare of Children and Youth of the DSWD
gets P4M. The welfare of children gets <50^6 of what goes to
cockf ight i ng .
5.
The Philippine Racing Commission and the Bureau of Food
and Drugs of the DOH has a budget of P19M each. The same
budget but try to look at the functions of the two agencies.
The two agencies have the same budgets, but not the same
importance and functions.
This could be the reason why we
have so many problems with the National Drug Policy and the
Generics Law.
There is only one inspector per province to
check all the drugstores.
6.
The Philippine Military Academy has P221M to train the
future right-wing soldiers who keep on launching coups
d1etat whi1e the Philippine Science High School gets P38M
to train our future scientists. , Compare also the P221M of
Philippine Military Academy (PMA) to the P203M of the
Philippine General Hospital.
7.
The Department of National Defense which has a total
personnel of 250,000 gets P23B almost the same as that of
the P27B of the Department of Education, Culture and Sports
which however has a total personnel of almost half a
mi 11 ion.
The government budget is very problematic in terms of
priority.
We are fighting for the increase of the DOH
budget but in the DOH itself there are already mispriorities
— their organization is quite top heavy with so many underand assistant secretaries. A lot of the DOH budget goes to
the top while in the fields they are made to cut back in •
their expenses.
THE GULF CRISIS
*
The government is now inflating the threat of the Gulf
crisis to hide its own defects, when in fact we have so many
domestic problems.
Of course the Filipinos are affected
since there are many Filipinos in the Middle East.
But
precisely they are there in the Middle East because of our
current economic situation.
97
r
‘
THE HEALTH CARE SYSTEM (HCS) *
as they would
x^x^***^ about sustainable development,
Talking
say in Western countries, let-us keep what we have right now
and pass it on to our children, But in the Philippines what
we are leaving to our children is not what we can keep but
problems that would emerge out of the problems that we are
creating today.
It is still being said that our problems are due to
Marcos but we must also think of the . problems created in
1986-91 that aggravated those Marcos problems. The present
government started some good things but its intensification
If
of the total war policy aggravated the economic crisis.
we look at health services, for all that rhetoric on the
Rational Drug Policy and the Generics Law, that is only the
peak, the bottom is still the same situation. There is no
change.
Over-all the present situation will affect the health
care system.
The decrease in government budget will result
The economic
in a decrease in the delivery of services.
'“
crisis will also have its toll even on CBHPs.
We are
already feeling the crunch of the higher transportation
rates and increased prices of other commodities.
It is the role of the state to deliver health care
But despite the increase in
services to the people.
Medicare* premiums, subsidy.for medical expenses is still not
enough. The inability of the state to do its role paves the
way for more involvement of the private sector. We already
hear plans for the sale of the Heart, Kidney and Lung
Centers.
Indeed privatization brings in modern technology
but the
services that
it could
provide are
still
inaccessible to the majority of the people.
DOH educational
materials are usually either not
distributed or aare inappropriate.
The production of Astra
Pharmaceuticals of a First Aid Manual using relatively high
still have a'
cost materials shows that private companies
lot. of money despite the crisis.
Could we sti11,accomplish an alternative
System given this direction .of the government?
Health Care
98
OPEN FORUM
The following points were made regarding the question
raised on
what alternative
measures can
our sector
formulate, still in the direction of an alternative HCS,
to answer the health needs of our beneficiaries in Che light
of the present crisis:
1.
Present pressure on the government is concentrated on
the wage issue; but this should not be all. The body may
pass and publish a resolution to express opposition to the
IMF conditionalities and to express its stand regarding the
dipyrone issue which has been sitting in the DOH for a long
time now.
2.
Regarding RDU, we could discuss how to meet the crisis
in terms of providing medicines, which is one of the biggest
expenses of CBHPs. For a short term measure, there has been
a request for a national procurement body that could
purchase drugs on a wholesale basis for more bargaining
leverage; and a long term measure moves for self reliant
industries.
We could also make po1itical ‘moves to decrease
the profit of drug companies.
There is a need for the
continuous promotion of the essential drugs concept.
3.
On the vision of a nationalist HCS, BUKAS is presently
working on a material based on a framework--Mode1 of a
Nationalist HCS by the World Health Organization (WHO). If
endorsed it will be shared with CBHPs for comment of its
contents especially on the aspect of what the components of
a nationalist HCS should be and how to attain that system.
It is intended to be popularized in the communities. They
expect to finish it next month.
4.
Even though we have already been
promoting herbal
medicines, it is known that it is yet not that well accepted
in the communities.
One of the reasons for this is the
inconvenience in preparing and using them.
In response to
the present crisis, there is a need to further study and
adapt measures to continue the promotion and development of
the use of herbal medicines.
5.
The impact evaluation showed that CBHPs are really
identified with herbal medicines.
It should be emphasized
that CBHP also includes nutrition, educat
ion, empowerment.
education,
among many others. The use of capsules in herbal medicines
reinforces the fixation of the people that health comes from
tablets or capsules. There may be a need to find other ways
to prepare herbal medicines;
the use of tea bags as in the
now commercialized pito-pito could be more appropriate.
99
The recommendation of a revolving drug fund. i.e. to
6.
sell drugs with the proceeds going to the CBHP creates some
fear. This could be counterproductive since if you tie fund
raising to the sale of drugs there will be a tendency to
money.
sell more drugs for more money.
You cannot use‘drugs to
receive funds because it penalizes the sick.
7.
Regarding health insurance system, there is an idea to
set-up our own health maintenance system for all the causeoriented groups.
It is not only the health sector that
needs it there are also the women's group, peasants' group.
etc.
k
■
M
kYvl
I
14 January 1991
Monday
100
DAY 5
Facilitator of the Day:
Dr. Tess Umipig
SCHEDULE
8:00 - 8:15
8:15 - 8:30
8:30 - 12 : 00
12:00 - 2:00
2:00 - 4:00
4:00 - 4:30
4:30 - 7:00
7:00 8:00 -
8 : 00
9:00
Morning Praise
RECAP
Continuation of Regional Workshops
Lunch
People's Development Work
Bimboy Penar and. a
Break
The Situation of Women in the Philippines
- GABRIELA
Supper
♦
Continually of Regional Workshop on
Results of Summing-ups of CBHPs
DEVELOPMENT WORK CONCEPTS
Bimboy Penaranda
Director General
‘Council for People's
Development (CPD)
DEFINITION of Development Work
Development’ work is all efforts to answer the immediate
needs of the people and at the same time raise their
awareness to demand their rights for basic services.
CONCEPTS of Development Work
Framework
In this concept, there is one very important -question
that we need to answer: What is the relationship of
organizing to development work?
Organizing and development work are closely linked
together.
During organizing, we must answer the immediate
needs of the people by
providing services.
We cannot
provide services effectively if we don't organize. We look
at it as a process,
When you organize, education is an
essential component,
In organizing and education work, the
first thing is to launch a project or activity that answers
the immediate needs of the people and at the same time, not
to neglect working or fighting for their rights.
101
' I in in ed i a t e n e ed s
Process
Organizing
>
Demand for basic rights
Education
1 . D e v e 1 o p m e n t W o r k in u s t an swe,
t he immed i ate needs.
If we talk about development work .
the immediate needs of the people.
we need to answer
2 . Development’ work involves (icmanding for people's
basic rights through advoency, promotion and
mobilization.
In answering
the immediate needs of the people,
Ad vet? .'>>• y work is fighting for
advocacy is a 1 s o i in p o r t a. n t.
your r ights as citizens of this c-ountry .
F o. r in s t a nee o n
t he
question of literacy, there a r e available schools but
what you are fighting1 for is the right of your children to
free education,
What you are f i g h t i n g f o r is your right to
basic services to answer your basic needs.
Government
Cannot
Answer
All Our Basic Needs
Most of the time, you demand basic services from the
government but the government cannot
give
these basic
services.
And so we in the non-government agencies offer
alternatives by
forming organizations like CBHP. You are
giving alternative health care services.
We fight for our basic rights because GOVERNMENT IS
INEFFECTIVE, This means that- a government cannot afford to
provide the basic needs or services.
Or these basic
services are not the priority of the government.
«
For example,
in the community the ratio of midwife to
population is 1:5,000;
health center to population is
1: 28,-000 . The ratio of nurses to population being served is
lower and the ratio of doctors to population, is even much
lower.
If that is the case, delivery of health care
services is not effective.
It is
the responsibility of the government to provide
all of these basic services but • if.we look back at the
1940's and 1950's, the government did not deliver basic
services,
especially health care services,
effectively.
During those times there were civic clubs like Rotary, Lions
etc. They were the ones providing medicines.
The GOVERNMENT CANNOT AFFORD to provide these
services that is why ever since the government's ca 1 1
basic
5OPH6A-SOCHARA
Bangalore -
J°
102
mobilize the private sector and citizenry in order to do its
job for them, because the government cannot do its role of
providing services.
So it is justified to form alternative organizations or
mechanisms for effective delivery o-f health care services.
Sometimes we ask why we still need to form health programs
or organizations when we already have the government to
provide health care services.
For instance, if you are an
employee of the government, you do not encourage your
clients to fight for their rights to demand health care
services from DOH. But if you're with the NGO's .or PO1s you
will encourage them. People’s autonomy and independence is
important in development work.
Development Work Must Be a Coordinated Effort
Services in
development
work
such
as
health,
agricultural production, marketing, ecological management,
livelihood,
ive1ihood. literacy and numeracy and
sma11 scale industry, 1
and
rehabilitation
should
be
closely
also
relief
rehabi
1itation
coordinated. You will notice that NGO’s have sectoral
In the peasants’ sector
sector,, for example, there is an
services.
organization that deals only with agricultural production.
ecological development is their focus,
For others,
sometimes. there is
They are not multi-purpose that is why sometimes,
good production in agriculture but the rate of malnutrition
is high.
The point here is, these basic services must be
They
must work hand in hand, There
closely coordinated.
will be no impact in the community if for example agribusiness and health services work, are not coordinated.
In terms of impact, we cannot measure the effect in the
It
community if there is only one NGO providing services.
is important that the advocacy work should be closel.y
coordinated with the integrated approach of answering the
If we have difficulty in coordination.
there
basic needs,
is no impact.
If there is no impact, we will not be able to
answer the people's basic .needs effectively.
The Concept of Integrated Area Development
An example of an integrated area development plan is
that of
10 nearby barrios that formulate a plan; this plan
must be well represented by different types of advocacy work
such as health, literacy,
livelihood etc.
If it is not
possible to plan these together, a memo of agreement can be
utilized.
This can also be done through coordinated
advocacy work,
formulation of plans and the creation of a
management committee.
In setting up a cooperative, it is
103
not necessary that all sectors have a cooperative.
If 10
barrios will set up 10 cooperatives it will
lead to
confusion unless close coordination is done.
Then there
will be no effective development in that area.
The Concept of Process and System
I f we talk about process and system, we talk about
organizing.
In organizing we must have the right attitude
and virtues or ability to persevere. and of course we must
have c ommi tme n t.
Here we have to undergo a process.
It is
not advisable to make short-cuts ] n t h i s process.
You must have an educ a t i oi'i compo ne n t because it is
difficult to relate the problems of the community to the
nati ona1 prob 1em.
If you undergo a process. you must have a
system.
Yon systemat i ze
the operation of hea 1 th workers.
Example:
Paramedics somehow
in the system
become
veterinarians. . This system aims to empower the People's
Organization.
A systematic training activity coupled with
good coordination will help upgrade the abi1ity/capabi1ity
of the people’s organization.
For example,
putting up cooperatives is not easy for
the peop1e's organization especially if they lack the
capability or skills.
For instance, one problem in health
work is the difficulty in sustaining the training of
paramedics, usually because of financial constraints in the
project.
So we must build a social capital, However, this
is not the issue of additional
income,
The. role of the
cooperative of the people's organization is to generate more
resources for the organization. Without a cooperative, the
organization wi 11 weaken'.
It should not depend only on
NGO's.
Some
organizations
avail
of
credit
from
institutions.
The Concept of Empowerment
In simple words, empowerment means a shift of power or
political decision from one group to another group.
For
example, from oppressor to oppressed, from elite to the
poor. Development work is not neutral.
It is always biased
for the poor. The bias here is in transferring skills: to
help them
fight for their rights,- developing alternatives
towards the transfer of political decision making to the
people's organization.
For example,
an organized community has
right to say no to any project or program.
always the
This is the
/ -
104
>
of the
people's organization.
Through
first right
experience, the •NGO's and the GO’S introduced many program
For
interventions especially in agricultural production.
the NGO's, usually it is a demonstration of a particular
^technology, but for the people's organization, or the poor
it is a matter of life and' -death because if the
community,
project or program is not successful, the community will
suffer.
It is really hard to introduce new technology, that is
why demonstration farming is a practice in agricultura1
production projects.
But the point here is they will not
There is a Iso.a
such innovations,
lives
for
gamble their
need
to try new
bee
aus
e
we
re
a
11
y
need to
do this
no
investigation.
say,
if
there
is
As they
technology.
So respect* their right to say
their is no right to speak!
no. They know very well their situation because it is their
Respect their integrity while correcting their
own life,
That is the work of a development worker and
situation.
Organizing work .and service delivery must go
organizer.
As a development worker you must also have
hand in hand.
skills in organizing.
Therefore shifting power from one group to another is
This as what we call
itself part of development work.
in
If there is no change in the relationship
empowerment.
production of one group to another group, there is no
What is the use of development work if one is
development.
subordinated?
Empowerment has to do with changing relations in
society.
That means the shift of power from one group to
another and the bias is for the poor. Always the process
If the process is not empowering.
should be
empowering,
there is a problem there.
It is necessary for the people's organization and even
process.
People’s
the development worker to undergo a process,
organizations have developed paramedics. parateachers etc.
In simple words. they now have what
and this is empowering,
they did not have before.
The Need to Assess (Document Experiences)
Part of being systematic is being able to assess.
Here,
problems arise.
For instance, people find it
When there is no documentation, it
difficult to document,
will be difficult to produce an educational curriculum for
others to learn or to propagate or popularize experiences,
Basically,
if you want to sustain training until the
people’s organizationi has gained skills or capability, you
*
105
need documentation.
If you want clear policy, you need
policy research.
One important thing in documentation has
something to do with international relations or cooperation.
There is a spiritual dimension effect in development
work.
It is controversial because the connotation here is
you have to be religious in institutional terms.
The arts is included in development concerns, Somehow,
it is important for people to express themselves whether
the experience is one of hardship or success. They have to
express it in other terms. Not only in terms of service or
doing something for material good, but to express themselves
as
individuals or as a group. This is what you call leap
in consciousness or "diwa" in Tagalog. There will be a need
for other formulations that separate arts from education and
the usual cultural works.
Creativity in Development Work
Lastly,
creativeness
is part of development work
especial ly in an environment where there is not much
resources.
Appropriate technology is applicable.
It is
important thatt the project is based on the situation and
that requires a certain degree of creativity. Without this,
the project will not survive in the community.
There is
always a bias towards the rural environment but this should
also apply to both rural and urban.
Considerations:
*
It is important to consider social groups like in the case
of women because of role transformation; the tribal groups
situation
and
culture
because of
their
different
transformation of socio-cultural structures; and the-n the
youth because they are the first ones to be affected by the
many problems being experienced.
* The Importance of ecology is also to be considered, the
environment is the material basis of the people's 1 ives
which the next generation will inherit.
* Child care and responsible parenthood
considerat ion.
This involves a concept
its importance.
is also another
of t he f am i1y , a nd
106
OPEN FORUM
Main Points Raised in the Open Forum:
1.
The relationship of non-government organizations and
people's organizations.
* need to build-up relationships and c1oser
coordination.
Criteria:
a. level of organization/method in selecting leaders
b. what are the strengths/capacities
c. members' level of participation in decision
making
2.
Social movements.- there is a relationship with the
historical development of the people.
Social Movement is composed of people's organizations.
Example: religious, nationalist, individual movements
with political- economic issues.
Social institutions
influence the awareness building
of the people.
Examp1e: church, educational institution. mass media
3.
Development projects are parts of the system
usually to expand constituency.
Example: Cooperatives
4.
The Stand of CPD on the Present Gulf Crisis:
undertaken
* The contingency to the current crisis in terms of
emergency is to have lucid minds and deliberate action.
What the coalition notices is the growing climate of anxiety
surrounding us. The atmosphere is almost panicky.
Now there are ways that NGO's and PO’s can agree to work out
in times of the crisis:
a . education
can be in the form of group discussion or
symposium
systematic
information
dissemination and exchange
b.
c. there should be a public coordinating center
d.
launch a program with survival tactics and techniques •
t
107
DAY 5
THE SITUATION OF WOMEN IN THE PHILIPPINES
Wilma Balistoy
Li let Usoy
Lina Anastacio
Education Department
GABRIELA
Out 1ine:
Introduction
I.
The
Plight of Filipino women m the field, of:
II.
A. Economics
B. Politics
C. Reproduction
c. Violence
III. General Perspective on Women's Development
I.
Introduction
Community Based Health Work is an approach by which
health services can be accessible to the people and the
community.
The important point, however,
is not only the
effort to serve them but also the ef.fectivity of the
services we render in relation to their needs.
As we look at the health workers and beneficiaries
of health services in the community, we notice half of them
are women.
If we could only understand their present
situations and
conditions only
then can
we respond
effectively to their health needs through services, Women
can even participate in improving their health.
II.
The Plight of Filipino Women
> Slide presentation on the roles and issues of
Filipino women in the present context of society.
> It is a concrete reality in our present society
that women as a distinct social group are facing
various problems and dilemmas.
Factors Showing the Condition of Women in Society:
a. Multiple Burden of Women
The women sector is largely composed of workers,
students, teachers and peasants who suffer
oppression, exploitation and hardship. They are seen
as weak, plain housewives, objects of sexual
pleasure, and are considered second class citizens
of society.
108
b . Additional burden as a result of being a woman
The problem of class oppression and difficulties
in the case of a woman-farmer landlord relationship
A,
ECONOMY
The present economic crisis in our country brought by
poverty to
the majority of the Filipinos is further
aggravated by unemployment. The women is one of the sectors
affected
when it comes
to employment priorities because
companies see them as weak.
To big business, they entail
additional expenses, especially the married women, like the
benefits of maternity leave.
This situation has prompted
women to seek other means of earning money like going into
prostitution. As of 1989, we have an estimate number of
100,000 adult prostitutes and 20,000 child prostitutes.
There is also discrimination in the types of jobs, For
example, most women work as secretaries, nurses or in jobs
which
require menial tasks.
Women also occupy lower
positions in their field of work and have less opportunity
for promotion than men. They are usually sexually exploited
by their employers in order to be hired or to keep their
jobs.
B.
POLITICS
In our society in general,
the women do not have a
voice in decision-making processes.
In the government ,for
example, majority of those who are in control are men. If we
use the gender classification in our government, xonly a
small portion are women.
Also, our present law does not deal equally with both
men and women.
Fox' example,
the Penal Code states that
adultery is punishable.
Women who commit adultery will be
imprisoned from 6 months - 12 years while men who commit
the same will only be imprisoned from.6 months to 2 years.
C.
REPRODUCTION
Reproduction
and reproduction
society.
is defined in the context of production
as determining factors in development of
In the field of labor we define reproduction as the
production and maintenance of labor power. We can relate
this also to human reproduction as to the propagation of the
species and to childbirth and rearing.
109
Issues of Reproduction and Its Implications:
1. Reproduction was relegated by society as a
*
primary responsibility of the women.
Implications:
a. Undernutrition among mothers especially when
breastfeeding. This is also due to inadequate
income and the preference given to the child
and the husband.
b. Mothers are confined to household chores which'
hinder their comprehensive human development.
c . Reproduction is not given equal value in our
society. For example, pre and postnatal care
are very limited to lower income bracket
mothers compared to affluent ones who can afford
it. The woman has also less authority especially
in decision making within the household.
Factors That Control Reproduction
State
Church
Men —
direct bearing on family
planning
IMPLICATION:
- not recognizing the reproductive rights of women.
- women are mere'objects of pleasure to their
husbands and private property of men.
- adverse effects of contraceptives amongiwomen.
Issues on Reproductive Rights:
1.
2.
The right of women to bear children: maternal and
child care
The right to bear; Prevention and termination of
pregnancy
~ reproductive technology issue related to
both and made available for both.
- maternal care:
-- inadequate
~ curative approach
110
D.
VIOLENCE AGAINST WOMEN
Scope of Violence:
Individual Violence
1.
2.
Institutionalized Violence
Example : prostitution, mail order bride and
other forms of commodification.
Causes : Economic crisis and general decay
- dehumanization
Ef f ects:
- numbing sensibilities
- warped cultural value
- diseases
3.
State Violence
- ongoing militarization
Cause: state repression vs. peoples resistance
Types Of Individual Violence (see Table)
Sexual abuse, rape and harassment.
In highly militarized zones like Negros,
women are left behind to take care of the
children.
Vulnerable in cases of wanted men.
example:
hostaging
Women suffer gender question oppression.
1.
2.
3.
4.
•r
Ill
III. General Perspective in Women's Development
1.
a.
Task
1. AOM women for emancipa
tion
General Perspective
Based on the analysis of the
present condition of women in
society in recognition of the
importance of societal trans
formation towards women’s
emancipation.
Issues:
eco. field - to have a pro
ductive and progressive
economy to support the class
demands of peasants, students
and other sectors.
Advance the struggle for
the interest of women
in all the fields.This
involves mass action
and activities towards
tactical gains in
relation to women’s right.
2.
Peal representation in the
government as to ensure lower
class participation and
substantial representation
of women.
3.
Real independence from foreign
domination.
3. participation in the
over-all struggle for
• social transformation.
4.
Ensure equal right to both
men and women in all fields.
4. to make sure of the
democratization of women
within the family
2
5. Internat ipna1 So1idarity
among women.
112
General Points in the Women's Movement
1.
2.
3.
The women's movement firmly believes in the
importance of determination and struggle for
women's emancipation.
Advantages of solidarity of women in addressing
major issues.
There is an inadequacy of women in leadership
and social responsibility in the lower strata and
women's movement is towards leadership and
social responsibility in the lower strata.
OPEN FORUM
Main Points Raised in the Open Forum:
Probable disparity of opinion between single and
married women in view of equality between men
and women.
2. Most men are still conservative on issues regarding:
- reproductive rights as a basic human rights
issues
>
- women's liberation is not basically a gender
question but more so on societal structure.
-patriarchal culture plays an influential factors
on the issue of women orientation on the diffe
rent aspect like among health workers.
- recognized that one major step in liberating
women is through national liberation. . However,
social transformation does not guarantee women's
emancipation.
It is a contincus process and it
goes beyond social change.
■ 1.
Recommendations:
Raise the level of awareness on women's orientation
through education.
2. Health workers doing social investigation in the
community must be sensitive to gender issue.
3. On the contraceptive issue, women need to be informed
and that information has to be accessible to be able
to make an intelligent choice.
’So
’89
Ky l^/^i
uesday
113
DAY 6
Facilitator of the
Day :
Dr1. Jo jo Carabeo
SCHEDULE
8:00
8: 15
8:30
8:15
8:30
8:30
12:00
2:00
4:00
4:30
7:00
8:00
2:00
4:00
4 : 30
7:00
8:00
9:00
Morning Praise
*
RECAP ,
Plenum: Synthesis of Regional Workshop on
Summing-Up and CBHP Impact Evaluation
Lunch
Organizational Meeting
Break
Workshop on Health Work
Supper
Continuation of Workshop on Health Work
PRESENTATION OF COLLATED COMMENTS ON THE SUMMING-UP RESULTS
Lyn de la Cruz, RN
Deputy Executive Director
Council for Healt’h and Development (CHD)
Lyn presented the synthesis in the framework of how the
body validated
the results, points for clarification,
reactions. realizations or learnings and recommendations.
. 115
II. Summing-up Results (Qualitative)
A. Project Concept and Orientation
. 1973 to 1976
1. The general orientation was to develop a health
program responsive to the needs of the poor in the rural
areas.
2. Analysis of the health
awareness of social injustices.
situation
was
based
on
3. Setting-up of 3 pilot areas and the first pilot area
evaluation was launched. The term CBHP was introduced.
1977 to 1979
1. The orientation was to help in Community Organizing.
2. The CBHPs were maximized in Social Investigation
work, formation of liaison groups and organizing groups, but
these also had negative effects on the security of the
program and staff.
The programs began to recognize its limitations for
Community Organizing work (up to Consolidation) and realized
that:
there should be good coordination with staff doing
consolidation work (COs)
there should be definite timeframe for turn-over of
formed groups (organizing group will turn-over to
core group handling the community organizing)
the health component and organizing component of
the program should be balanced.
Also, the programs provided a venue for involving the
middle classes in the struggles of the basic sectors.
3. Structural analysis was used as a framework in
presenting the health situation, but seminars conducted
tended to equate CBHPs as a solution to national problems.
4. The second pilot area evaluation was conducted. A
national conference was launched and CBHP concepts and
methods were formulated and popularized.
116
1980 to 1982
1. CBHPs started shifting to support group building
among the middle class while some areas continued with its
orientation as entry point to organizing.
2 . The health conditions were used as starting point
for discussing general political issues and health issues in
raising the social consciousness of the middle classes;
health professionals (HPs), bishops, nuns and.priests;
3. Structural analysis was no longer utilized as
framework.
Discussion of the problems of the Philippine
society was used instead.
instead.
fCBHPs were cited as one way of
contributing to laying the foundations for a relevant health
care system.
4. The Council for Primary Health Care (CPHC) was set
up with the objectives of national coordination of CBHPs and
to serve as resource center.
1983 to 1984
1. The orientation: Entry point for organizing (in
unorganized areas),
linking the middle classes to the basic
sectors, and building international support groups.
2. The concept promoted was that health programs are
part of the comprehensive people's response.
3. Setting-up and strengthening of regional or islandwide CBHPs and agencies to coordinate and answer the needs
of local CBHPs.
4. Unity on CBHP
nationwide level.
objectives and components attained a
1985 to 1988
1. Orientation - help lay the foundation of a relevant
health care system.
Community Organizing (CO):
- Entry point for organizing and help in the
consolidation of people's organizations
Health Sector Organizing (HSO):
- Contact building for referral network
- Facilitate in the setting up of organizations
and alliances
- Allocate personnel and materials for HSO
117
2. Started the popularization of progressive health
mass movement concept.
3.
In general, CBHPs were not able to adapt to the .
level of development of community organizing and to the
increasing and heightening health needs of the people's
popular movement for social transformation.
4. Launched first national CBHP assessment/evaluation
and agreed to set up a national consortium of CBHPs.
5. The orientation and functions of health committees
were defined.
Criteria for
membership to
CBHPs and
relationships with existing51 CHW Organizations and other
Health Programs and Institutions were clarified,
clarified.
Also
clarified were the methods and approaches that CBHPs use .
* On CHW organization
- island wide in Mindanao, 8 provinces
- regional organization in the Visayas
~ provincial level in NL (Saranay)
* Role of CHW organization (refer to 1988 proceedings
handout)
6. Concepts
regarding organizing work, levels of
organizing and definitions of terms such as organized areas,
unorganized area and genuine people's organiztions were also
clarif ied.
7. A call to conduct a series of consultation
dialogue with groups and organizations working in
communities.
and
the
1989 to 1990
1. Orientation:
- assist in areas of reactivation of peoples
organization
- assistance to consolidation work of peoples
organization
- network buiIding/organizing among health
professionals for referral services
- technical, material and financial assistance for
organizing efforts
2. Refocusing of CBHP efforts towards organized groups
and communities for maximization and effectivity
3.
Review of
orientation of CHW Organizations and
focusing their activities to health within the direction in
helping organized areas.
118
4.
A call to develop services work at all levels and
upgrading of skills and leadership capabilites of staff and
community health workers
5.
Train ing,
given stress.
Education
and
Services
work
were
6.‘Working towards area integrated approach.
SUMMARY:
The concept and orientation of CBHPs developed starting
from the purpose of responding to. health needs at the rural
poor. CBHP has proven its potential in* organizing people to
respond to their needs and problems, Hand in hand with the
development of people's concerted efforts towards social
change is the CBHP's response to their health needs. All
these resulted from various sectors’, the broad unity and
movement towards social transformation.
CBHPs contributed greatly to the people's movement by
helping plant the seeds of a people-oriented and relevant
health care system.
In general, the development of CBHPs is
closely linked with the development of the people's popular
movement towards social transformation.
Over-all Realizations:
*
*
*
*
*
lack of internalization of organizing work and
efforts
there are calls for organizing but still the program
lacks efforts in this work
lack of grasp of the CBHP orientation and there's
always a recommendation to review the CBHP
orientation in order- to adapt it to the present
condition
the difficulty of adapting the orientation to
the concrete situation
programs are united to follow the proposal of the
National Secretariat regarding basic services.
• -
Recommendations:
*
*
*
*
*
do not separate organizing work from CBHP work
equip the people with organizing skills because it
is the role of the P.O.
develop proper orientation based on concrete
conditions
staff should write the orientation paper adapting
the program orientation to concrete conditions
program staff must have an orientation manual
119
B . Components and Activities (levels attained)
1. SERVICES
a. CBHPs
health services have remained at the basic
CBHPs'
level.
Not all the aspects or components of each basicservice are implemented.
implemented. CBHPs have not yet united on what
basic health services to set up in the community.
Recommendation: to unite on the level of services based on
the level of community development.
* b. The
bases for
delivering
services are the
following:
the
needs of the community, assistance to
organizing and promotion of CBHPs in the areas.
c. The scope of CBHP services is still generally at the
barangay level.
d. Services given to organized areas or groups are not
programmed (irregular and unsystematic); they merely respond
to requests.
e . Services‘given became dole-out because most programs
directed these to unorganized communities.
Added to this
was the mechanical implementation and the lack or absence of
the active, participation of the community members which
starts from identification
ident if icat ion of problem conceptualization,
program
implementation,
management
and
evaluation
implementation,
aspect(Program staff are the ones directly giving services).
Qualify: more on input of services rather than on developing
a process of empowering the people.
Also, the method of service delivery is not applicable
to the level of organizing reached in those areas.
In
effect, the services given by the programs in these areas
tend to make up for or support the government's inefficiency
in delivering services.
We are in the process of empowering the
building their capacity to respond to their
needs.
people and
own health
f . Most of the time, CHWs were mobilized in giving
services, while health professionals outside the CBHPs were
not maximized.
Recommendation: Review role of CHW in the delivery of
services and come up with methods and
approaches in HSO.
*
120
g. Health
sevices given
focused on curative or
symptomatic care, based on 2 separate evaluators, the trend
of health care given was more on the curative aspect.
Recommendation:
focus also on referral system.
SUMMARY:
Through their services work,- CBHPs were able to respond
to the immediate health needs of their areas, However, CBHP
services ^ork is still at the basic level, These services
are generally curative and dole-out. There is a need to lay
down and develop comprehensive health care services (basic
and advanced) in priority CBHP areas (see proposed Health
Care System), and bringing our work to the forefront of the
struggle.
We should be able to assert and bring our health
agenda to the people's ageftda.
Realizations:
* focus on technical skills
* training approaches are mechanical and are not based
on the level of CHW
* trainings given was not commensurate t*j the output of
services
* there is a need to stress on practicum (70-30)
* staff and CHWs do not have the right attitude in
giving trainings, lacking in value and attitudinal
aspect
* still lacking in monitoring and follow-up
* training content lacks awareness raising component
both on staff and CHW level
2. TRAINING
a. CBHPs have already trained quite a*large number of
CHWs, but these are still not enough compared to the vast
areas covered by the CBHPs.
Also, the level of services
that CHWs are now able to deliver is still not equal to the
level of trainings that they have reached.
this is because
of the following factors:
- most of the trainings given to ti^ CHWs are
theoretical; there is a lack of^constant practice
of skills
- CHWs lack guidance monitoring and supervision from
the program staff
- there is a lack of systematic program to develop the
capabilities of CHWs
- CHWs perfo]$i too many tasks
- there is a lack of support from the people's
organizations and level by level development of CHWs.
121
b. The content of trainings launched was based on
community needs as perceived by the start or verbalized by
community leaders. Most of the time these do not go through
there is
the process of comprehensive community diagnosis,
still a need to adapt the types of training, to the CDx
results and to the services needed by the people.
c . Several training modules and manuals have already.
been developed, but most of. these are for program staff
there is
level.
t
_. - still a great need to develop popular forms
other
that could be used not only by the CHWs hut by
community members as well.
d. CBHP trainings have already reached the advanced
level, but still seriously need to systematize the basic
health skills training (BHST) to be able to develop the
ability to give basic services w h i 1 e developing their
advance skills.
Recommendations:
1. Immersion of trainer in the community to monitor the
impact.
2. Develop monitoring scheme.
SUMMARY
CBHP training work, was able to help respond to the
However,
health needs of the community by developing CHWs.
had
minimal
impact
if
Compared
to
the
level
of
this has
to
the
community.
Also,
training
work
has
services given,
in the strengthening and consolidation of
not helped lmuch
.~
people's
empowerment because most of the
GPOs towards
focused
on
technical skills.
trainings were
3. ORGANIZING
a. Health Sector Organizing (HSO)
There was an effort to help in organizing health
professionals in the form of launching fora, symposia, and
inviting them to the activities of the program, but the bulk
of the resources of the sectors for the people and the
community have not yet been harnessed due to:
lack of capacity of the staff and correct
methods of organizing at varying degrees of
community organizing
absence of
c programmed education and training and
follow-up of contacts in the health sector to
encourage them to give continuous assistance.
Program staff lack grasp of the importance of HSO and
In
its relationship to and implications on CBHP work.
H
122
general there . is a
lack of
understanding
of
the
characteristics, issue and role of the health sector in the
overall people's efforts for social transformation.
b. Community Organizing
Majority of
the programs
cannot cope
organizing requirements in their covered areas.
In unorganized areas:
CBHP was used as an entry
communities.
with
the
During, the period 1975-1983,
point to organizing in several
However, in 1984-1988, 80/o of the CBHPs concentrated on
health services work and gave less attention to setting up
groups and organizations.
There was a noticeable lack of
consultation/coordination with the groups and sectors doing
organizing work or focusing on organized areas. Although
they had organizing work among CHWs and health committees,
using training,
services and support network building for
the programs, there was a lack or absence of conscious
recognition that these should help in consolidating the GPO.
There were
also ident if led CBHPs in areas where
organizing work has not yet been started by the people or
other agencies.
By 1989, some CBHPs
regarding coordination.
launched consu I I.h I. i > uis
with GPOs
In general,
there is still a n e e d t o systematize
integration of health work in the program and the work of
the GPO in the area as part of the overa J 1 thrust of the
PCs .
Realization:
Organizing in*the community level was done
by the PO because there is a lack of staff to
concentrate on organizing.
c . CHW‘ Organizing
CHW organizations continue to increase and have started
to function as an alternative health machinery.at the barrio
level.
Some of these have the capacity to stand as a
separate machinery, but majority are still part of the
program.
For some,
the level of organizjng has reached
island-wide, provincial and municipal or parish levels.
However, most of these are still under the health program.
In general., CHWs of CBHPs have performed several tasks
at different levels of organization, A need to clarify the
focus and direction of their work was seen .
1
123
On skills: . In general, majority of the CHWs are not
capable of giving the basic level training and services,
while some CHWs have the capacity to render some topics of
the basic level training and provide basic health services.
On attitude: Dominant* attitudes seen were sense of
duty, dependability,
commitment, honesty and humility,
perseverance, courage and determination. But some use their
skills and knowledge for personal advancement,
They became
elitist due to the following reasons:
concentration of skills and knowledge
awareness-raising was neglected
weakness in clarifying area of r espon s i b i l*i ty in
terms of organizing and ensuring transfer of
knowledge to co-workers and development of second
liners
SUMMARY
Despite the programs' organizing efforts, these failed
to adapt to the organizing requirements of the area and
sectors concerned.
This is due to the lack of unity and
grasp of CBHP orientation and directi on of organizing work,
-lack of staff with organizing skills, the absence of clear
coordination with the GPOs, and the lack of integrated area
development plan.
C . PROGRAM MANAGEMENT AND ORGANIZATIONAL SET-UP
1. Organizational structure
a.
Most ■ of the programs are within the Church
structure, although
not ’directly under their supervision,
while 8 out of 30 programs were set up by non-sectarian
organizations.
As long as church-based or church initiated
program accepts concepts, orientation and principles of CBHP
and will
not hinder
in its
program of
work,
the
organizational structure will not be a negative factor.
b.
All CBHP structures have a board of directors,
but usually these are
not functional or ttheir
he i r role is
advisory in nature.
Most o f the time,
t h e program staff
t,tie
make major decisions with mini ma1 consuItation w i t h t h e
board and the CHWs/beneficiaries.
Recommendation:
Board of Directors should be functional and
should understand the program.
c. There is a need to improve management and
organizational set up from program level to community level.
124
d. One trend seen is that most of the health
professionals tend to concentrate a large part of their time
on managerial and administrative work.
We must consider
where the services of our health professionals can be most
maximized.
2. Program Planning, Monitoring and Evaluation
Planning was done regularly, usually ’quarterly,
a.
semi-annually and annually.
Inspite of being able to line
up the tasks/activities every period, there is a weakness in
adapting these activities to the philosophy, objectives and
stresses.
In effect, planning for each program component
becomes mechanical,
lacks clear and specific' targets and a
programmed raising of the level of implementation towards
achieving its mission, vision and goals (MVG).
Cf
b. . Assessments conducted were based on the periods
planned (quarterly, semi-annually and annually). There is a
tendency to focus only on the qualitative assessment’ and
there is a lack of deepening or analysis of the points or
data gathered. Also, assessment results and recommendations
are seldom used to answer the seen weaknesses/problems . One
serious weakness is the failure to draft implementing
guidelines for every recommendation agreed upon leading to
the observation that the same errors and weaknesses have
been cropping up over a long period of time.
Lesson Learned:
Assessments done were too mecliari ical.
Staff lack analytical and facilitation
skills.
c. Regarding monitoring of work, plans arid tasks are
followed up or checked during meetings, but there is still a
lack of close monitoring up-to the CHW and community levels.
3. Management of Resources
a. The community has
greatly
contributed its
counterpart to CBHPs, especially in the form of material and
human resources.
Initial efforts have been made in raising
funds through income-generating projects (IGPs).
b. Almost all
sources of funds.
Recommendation:
I
programs have
depended on-external
Study local sources of funding.
4 . Staff Building and Development
CBHPs have developed committed staff who are
a.
willing to serve despite ‘ difficult situations and problems
125
of personal
safety.
CBHPs
considerable number of CHWs.
have
a 1so
developed
a
b. Inspite of the presence of committed staff to run
the program,
they are not enough when compared to the vast
needs of the program.
Another observation is the quick
turn-over of staff because of the lack of internalization,
and because of security, economic and personal problems
c . Most of the program staff were developed m the
course of doing their work; no comprehensive program was
done to raise their knowledge, skills and attitudes (KSA).
There is
also a
lack of
regular staff performance
evaluation.
GENERAL STRENGTH
CBHPs have continued to grow and are now
n o V' able to adapt
to various
situations brought
about by
the present
political climate in the country.
These have greatly
contributed to answering the primary health services in the
community, and have been able to develop committed staff and
CHWs through training and services delivery.
Other Strengths
1.
CBHPs have propagated and popularized the use of
.alternative treatment methods, particularly herbal medicine,
acupressure and acupuncture.
2.
CBHPs were able to provide low cost health services to
villagers through the services of CHWs and parish medical
consultations.
3.
CBHPs created a venue for raising the c o n s c i. o u s n e s s o f
the middle classes, particularly the members of the health
sector, as well as for involving health professionals in
community work..
WEAKNESSES
1.
CBHPs have not sufficiently directed most of its
efforts to its primary target groups (organized PODE).
2. ’ Continuous health sector organizing' was neglected.
work
3.
International relations work (IRW) as part of CBHP
has lagged behind .
4. There
has been
comprehensive services.
no
un i ty
on
t he
concept
of
. .. .. . ■
_ ______ - —-X
i
126
5. CBHPs are still weak in promotion,
advocacy work.
6.
information and
Program management
Main Trends:
* Institutionalization of CBHPs
*'Alienation from the dynamics and direction of genuine
people's organizations (GPOs)
* Weak preventive aspect of CBHPs
* Move towards health committee (HC) building
* Moving towards institutionalization
POINTS FOR REFLECTION:
1. Ensuring availability of primary, secondary and tertiary
services in our area of responsibility.
2.
Distribution of health personnel in relation to the
number of population in our areas of responsibility.
3. Appropriate health structure for effective delivery of
care and its interrelationship.
- What.basic health unit will be built by CBHP?
- Is it on a Municipal, Provincial level?
- How?
4. Appropriate drugs and medical equipment needed in the
program at the different levels of health structure.
- centralized procurement; other
5.
Full participation of the citizenry in health.
6. HSO -- towards what direction, and how to maximize their
skills and potential?'
*
7.
Integration of health work with other development
programs.
8. Clarifying and defining our relationship with
counterpart health and development agencies in the
international scene.
127
9.
Relationship with GO and other social agencies working
for change but using other approaches to the development
perspective.
10. Working out all concepts of alternative health care
services..
- Unity on how to attain
content
components
11. Financing scheme to sustain our program and projects.
RECOMMENDATIONS
1. Always review program orientation and formulate stresses
and implementing guidelines after every program assessment/
evaluation.
2. Prepare specific guidelines and concept papers needed
for implementation of projects/activities to ensure concrete
program output.
3. Conduct community diagnosis (CDx) and use this as a
basis for planning and adapting to community conditions.
4.
Review the role and functions of community health
workers (CHWs) in the program. CHW skills should be’
assessed and evaluated .
5.
Review the orientation and functions of CHW
organizations.
6.
Integrate and stress on preventive and promotive health
care in all aspects of program activities and planning.
7.
Review curriculum designs based on the levels of health
care services.
8.
Study and develop health services work at different
levels and define the types of services needed for each
level.
9.
Study existing curriculum module and prepare separate
curriculum and training modules for staff, CHWs and health
professionals.
10.
Develop health committee building concept as part of
health organization building in CBHP areas.
11.
Improve managerial and technical capability
- data gathering
- reporting must be improved
- develop management methods applicable to CBHPs
128
improve follow-up of implementation of
conference/consuItation resolutions and plans
12. Develop popular education materials and ensure
distribution up to community level.
13. Ensure that health work and GPO work are both smoothly
implemented. Study the applicable orientation and methods in
implementing health programs in unorganized areas.
14 . Give attention to health sector organizing work and
define role of HSO and apply this together with other
aspects of CBHP work to be able to heighten other health
professionals' involvement in CBHPs.
ORGANIZATIONAL MEETING
FLOW
I.
II .
Roll Call of New Members
Health Work
A. Workshop
B. Unity on Health Work
1. Definition of HW
- Principles of HW
- Scope of HW
2. Role of CBHP's
III. Resolutions
A.
Identification of Stresses and Priorities
B. Plans
IV. Amendments
V. Elections
ROLL CALL OF NEW MEMBERS
Sr. Eva Varon announced the new member programs and
ind ividuals, as approved by the Board and affirmed by the
General Assembly.
She as well announced those whose
applications for
membership
are
still
pending
for
del.iveration by the BOT.
They are as follows:
A.
New members and affiliates of the CHD as approved by the
Board of Trustees on January 10, 1991:
1. Mining Community Development Center (MCDC),
affiliate member
2. Kaisahan Ng Mga Programs Sa Pagpapaunlad Ng
Kabuuang-Pagkatao (KAPPAG), affiliate member
129
3. Paranaque Development Foundation, Inc . (PDFI),
affiliate member
4. Saluri at Ayat Ragsak, Anus Naanep nga Agserbi Iti
lyawat ti Ken Maysa (SARANAY)
(Health, Love, Joy,
Patience and Perseverance), regular member
5. Programa sa Pag-oorganisa at Pangkalusugan sa Sitio
Ruhat (POPSIR), regular member
6. Butuan Socio-Medical Services (BSMS), regular member
7. Formation Mission Team (FMT), regular member
B.
Programs endorsed by the Board but membership approval
are still pending for processing.
1. MAI Welfare and Development Foundation
2. Mindoro Institute for Development (MIND)
3. Agustinian Missionaries of the Philippines Health
Integrated Response (AMPHIRE)
C.
Individual Members
1.
2.
3.
4.
5.
Marie Therese Burgos
Sr. Gloria Coquia, FMM
Pearl Domingo
Sr. Mary Grenough, MM
Luz Pambid Dones
WORKSHOP:
HEALTH WORK
Group I
Sr. Eva
Violy
Adette
Vicky
Petty
Angie
Tess A.
Patrick
Bro. Recto
Gemma
Sr. Vene
Group II
Sr. Mayang
Tess B.
Tita
Tess U.
Paz
Lina 0.
Emy
J anet
Tata
Gio N.
Sr. Eliza
130
Group III
Sr. Oyie
Chandu
Cora
Elena
Hershie
Gio V.
Rocky
Neneng
Dennis
Y am
Sr. Willy
Group IV
Jessie
Dorns
Anne
Cel
Lina M.
Nitz
Emma1 ine
B ad e 11 e
Isay
Gina
Vang ie
WORKSHOP GUIDE QUESTIONS ON HEALTH WORK:
1. In the context of the national situation and over
all development work, describe the over-all health work.
a. What are the guiding principles?
b. Define its coverage scope.
c. How will it be implemented?
2. What
is the
role of
CBHP's in the over-all health
work?
Workshop Results by Groups (see Appendix C)
PLENARY OF WORKSHOP
Only
Each group presented their workshop result.
clarifications, as to meanings of statements and the like,
No critique on the content of each report was
were allowed.
made to avoid the other groups from presenting their own
outputs.
raised in the plenary regarding
Important points
setting-up of an alternative health care system (AHCS):
1. Details on how to set-up an AHCS should be tabled as
a separate major agenda.
2. A bigger body should discuss and conceptualize AHCS
m another venue.
3.
Setting-up of AHCS is not part of HW and by
experience, CBHP is also part of assisting in its settingup .
©Bi
a
CIO
/ffe 'W
o1
iliSj i^ra>
I ® ®»
r—
I
16 January 1991
Wednesday
131
DAY 7
Facilitator of the Day
Dr. Jojo Carabeo
SCHEDULE:
8:00
8:15
12:00
1:30
4:30
5:45
6:00
6:30
6:45
8: 15
12:00
1 : 30
4 : 00
5:45
6:00
6:30
6:45
7:15
SYNTHESIS:
Morning Praise
Workshop Synthesis:
Health Work
Lunch
Continuation of Workshop Synthesis
Resolutions
Organizational Structure
Implementing Guidelines
Amendments to the Constitutions
Elections
WORKSHOP ON HEALTH WORK
Tess Umipig, M.D.
Member, Steering Committee
HEALTH WORK IN THE
DEVELOPMENT WORK
CONTEXT OF
THE PRESENT
SITUATION
AND
DEFINITION:
Health work
(HW) is
the process of setting up
structures and systems to empower the PDOE to answer their
health needs
struggle ■ for genu ine people's
in their
development.
This entails provision of services and
mobilization of the sector and people.
PRINCIPLES:
HW 'is an integral of development work because
1.
health and
development are
interrelated.
A healthy
citizenry is attainable only in a developed society where
people can realize their productive capacity.
2.
HW is biased towards the PDOE, working people's
empowerment towards social transformation.
- demoqyratic
- in close coordination with POs
- with full people's participation
innovative, scientific
3.
HW should be creat ive,
(theory-practice-theory), and at the same time, culturally
sound, with
appropriate technology,
e.g., traditional
medicine.
4. HW is a responsibility of all sectors, as- health is
a basic human right.
132
PREMISES:
1.
Nature and extent of
organization of the area.
2.
HW based
on the
leve 1
of
The health sector (HS) plays a key role in HW.
3.
The health sector is done in close coordination
‘ with other social institution/NGOs and POs working towards
social transformation.
MAIN CONCERN:
To assist in developing, strengthening and popularizing
the AHCS
(qualities:
democratic,
active
people's
participation, nationalistic, relevant to present situation)
in the present context of people's popular struggle.
SCOPE/AREAS OF HEALTH WORK:
1.
HEALTH HUMAN RESOURCE DEVELOPMENT (HHRD)
- Holistic development (SKA, programmed) of:
a. formal health sector:
i health professionals
ii allied professionals/institutions workers
iii students
b. CHWs includes workers or trained by other
organ izat ions/groups
c . Traditional healers
Strategies/Methods:
exposures
exchange programs
programmed training /
education (Community-based,
learner-centered, reality oriented, dialogical in
process)
reflection sessions
direct involvement in HW
(OJT)
* The priority group for HHRD is the health sector
because it plays a major/key role in AHCS
2.
PROVISIONS OF COMPREHENSIVE HEALTH SERVICES
promotive, preventive, curative,
rehabi1itat ive
basic, advanced (please, refer to
1 eve 1:
prepared comprehensive health services
handout included in kits)
health and health-related
type :
nature:
133
Strategies/Methods :
actual delivery
facilitation and referral
networking
health education
health campaigns
* The level of organizing/organization determine
the nature, level, and type of services provided.
3.
SETTING UP OF APPROPRIATE STRUCTURES
a. Organizational: HC building
CHW organizing
CBHP building
HS organizing
health center, field clinics,
b . Physical:
hospitals, offices
c . Educational Structure/Resource Center
Strategies/Methods :
4.
s e 11 i ng-u p/ac c e s s ing
FINANCE AND RESOURCE GENERATION
a. Local:
Local: - IGP's/fund raising project
- Community health insurance scheme
(for further study)
- Coordination with other NGO's
’■twinning’”* - people to people
b . Foreign: - "twinning
relation, similar to sponsor-approach
example:
1 . an overseas Filipino organization.to
support to CBHP
2. School outreach program to be done
in CBHP areas
3. Sister congregation to support it
Philippine ’counterpart/congregation
- project proposals
- availing overseas
development
assistance (ODA)
(still a pending question for
various reasons)
Additional insight centralized
Strategies/Methods:
procurement of ^material resources (e.gdrugs, supplies,
equipments, etc/)
5.
a
ADVOCACY
- Critique of present HCS and promotion of the ABCS
Direction: ' a. services
b. broad political movement
c . mobilization on sectoral and
subsectoral issues
d . resource generation
134
Strategies/Methods: 6.
fora, symp osia
petition-signing, statements
exposures
mass media
cultural forms
INTERNATIONAL RELATIONS WORK(IRW)
- Direction: a. resource generation includes human/
material/moral
b. mutual development and cooperation
in all aspects of HW which also
includes political support and
sharing of relevant experiences
After the big group discussion on the role of CBHP, the
synthesis committee has come up with the following 13 points
/ tasks of CBHP's in the over-all HW:
1.
All-sided development of the staff and CHWs to
fulfill, their tasks in responding to the health needs of the
commun ity.
2.
Setting-up of a barangay health committee/center.
services
care
3.
Eurovision of comprehensive health
with the barangay as basis level.
for
4.
Setting-up of appropriate health structure
regular and sustained health services, e.g., clinics.
5. ‘ Mobilizing the formal
services to the community.
Setting-up
6.
tertiary).
of
a
sector
health
referral
system
to
render
(primary
7.
Conducting systematic CDx and continuous
analysis as basic for services and trainings.
to
needs
8.
’ <Conducting simple reseraches and documentations of
‘ . experiences
‘----) raise
them in a higher
community hea’ltfi
to
theory.
9.
Critique of present health care system
popularization of the alternative health care system.
people's
10.
Supporting
human, financial, moral)
11. Drawing
people's program.
up systems
mobi1izat ions
of financing
to
and
(technical,
sustain
the
135
12. Fostering international relations work.
13. Coordination of efforts with other NGO's working
for social transformation and CBHP's on local, regional, and
national levels.
RESOLUTIONS IN THE CHD SECOND GENERAL ASSEMBLY
The following resolutions have been agreed upon by the
The first six resolutions plus the 13th
General Assembly,
been
considered as stresses by the body.
resolution have
11
resolution
will.be implemented by the health
The no.
programs in the National Capital Region.
Develop comprehensive Health Care Services (HCS) based
1.
on the level of Community Organizing.
level of people's organizing efforts - type of
services per level
b. health organizational structure
c . methodologies for rendering services
a.
2.
Clarify the role of CBHP in community organizing.
3.
Develop CHW capacity in terms of:
grasp/understanding of orientation
clarification of roles and functions
Knowledge, Skills and Attitude (KSA) assessment
forms of support: accreditation, welfare and CHW
organization
c/o National
e. special study: Profile of CHWs
Secretariat
a.
b.
c.
d.
4.
Develop the concept of Barangay Health Committee (BHC)
a. definition
b. role/Tasks
c. formation/setting up BHC
5.
Concepts of Health Sector Organizing (HSO)
a. role of CBHP in HSO
b. direction, strategies and methodologies of HSO
6.
On training
a. Review curriculum design based on level of HCS
organization.
b. Develop curriculum organizing KSA for staff, CHW,
community health education.
136
c. Develop monitoring scheme for training.
d. Combine/balance curative/preventive,
theoretical/practice, technical/comprehensive.
e. Develop tooIs/guide 1ines in evaluation of KSA (staff
and CHW).
f. Develop popular education materials.
7.
Community Diagnosis (CDx)
a. Conduct CDx and utilize result as basis for planning
b. Upgrade skills on CDx - analysis of data form.
c. Review CDx tools and instruments used.
8.
Formulate health agenda as part of people's agenda.
a. Clarify and unite critique of present Health Care
System.
b. Fully conceptualize the Alternative Health Care
System (AHCS).
c . Project health issues.
9.
Improve Managerial and technical capability.
a.
b.
c.
d.
data gathering
reporting
management methods applicable to CBHPs
follow-up of implementation of conference /
consultation resolutions and plans
e . preparation of specific guidelines and concept
papers needed for implementation of
projects/activities to ensure concrete program
output
10. Study the optimum ratio of health personnel to
population and levels of Health Care (HC).
11. Sum up the experiences of CBHP implementation in urban
areas to identify proper orientation and methods.
12. Economic support system.
a. Study appropriate insurance scheme pilot,
b. Develop a health financing scheme.
. 13. Coord inat ion
a. Clarify and formulate guidelines in relationship
with GO and other NGOs.
b. Strengthen coordination of consortium members.
c . Facilitate close coordination among development
groups in a given area towards integrated area
development.
’
•
137
The body agreed to assign regions to develop concept
papers based on the resolutions stressed.
Drafts of the
concept papers called for shall be made by regions assigned
as follows:
#1
#2
#3
#4
#5
#6
U13
secondary resolution #11
M indanao
Cagayan Valley
Visayas
Cordillera
Bicol
Southern Tagalog
Central Luzon
NCR*
priority resolution
Concept papers shall be submitted to the National
Secretariat during the Board of Trustees meeting.
These
should include implementing guidelines.
Regions may contact
the National Secretariat for references needed.
AND
ORGANIZATIONAL
STRUCTURE,,
STRUCTURE
DEPARTMENTS
FUNCTIONS OF THE NATIONAL SECRETARIAT
DEPARTMENT
Len Barcelon presented the Board of Trustees' proposed
changes in the consortuim, national secretariat departments
and functions. The General Assembly ratified these changes:
Organizational Structure
A
/General Assembly/
/Board of Trustees/
/ Executive Committee/
i
i
i
i
i
i
i
i
N a t i o n a 1
Sec r e tar i a t
i
i
/MTC Dept/
i
i
/SP Dept/
/HCSD Dept/
/HET Dept/ /RDI Dept/
138
t
/Executive Director/
/Deputy Executive Director/
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
.i
i
i
-/Administrative/
/
Director
/
i
/
/Admin istrat ive/
Staff
/
i
i
MTC
Director
SP
Director
i
i
HCS
Director
HET
Director
RD I
Director
i
i
i
i
Trainer/
Consultant
Health Proj.
Off icer
i
i
i
i
i
i
Health Trainer/
Organizers
Clinic
Administrator
i
i
Clinic Nurse
i
i
i
i
Health
Trainers |
i
i
Community
Physician
i
i
Community
Nurse
B
Researcher
i
Editor
i
i
i
i
i
i
i
Research
Assistant Writer
i
i
i
i
Librarian Artist
The Departments of the National Secretariat
1.
2.
3.
4.
5.
*
i
i
i
i
i
Management Training and Consultancy (MTC)
Special Projects (SP)
Health Care Services (HCS)
Health Education and. Training (HET)
Research, Documentation, and Information (RDI)
139
The Functions of the Different Departments of the
National Secretariat
In line with its assistance function,
the National
Secretariat shall have the following departments with their
corresponding functions:
A.
Management Training and Co ns.ul tanc y
1. Help upgrade the management and operational
capability of the members of the consortium by:
a.
conducting management training
b.
providing assistance regarding program PIME
c.
conducting organizational diagnosis and
recommending appropriate interventions.
2. Provide consultancy services to the members and
affiliates regarding:
a. General NGO Management
b . Health Program Management and
Implementation.
3. Assist local programs and people's
organizations in the conceptualization of new
health programs and projects.
4 . Assist in setting the direction of CBHPs
(strategy formulation). Help unify programs on
the direction and orientation of CBHP Work in
relation to the current situation.
5. Hold regular consultations with people's
organizations regarding the status of health
work.
6. Provide technical assistance in health project
development (project analysis and evaluation).
Special Projects
1. Plan and supervise implementation of
breakthrough programs and/or projects based on
needs.
a. Supervise . implementation of the Moro Health
Program.
b.
Implement special health projects: Leprosy
and Malaria Care Projects.
2. Supervise implementation of the NCR-Urban
Health Program.
3. Develop and pilot implementation of a
cooperative health ins 'rance scheme for NGOs.
140
1. Assist in the development of additional
relevant and timely health care services of the
CBHPs.
2.
Maintain a regular clinic to include the
following services: Medical Consultation,
“Pharmacy with the Basic Drugs, Maternal and
Child Health, Psychological Rehabilitation, and
Referrals.
3.
Establish a referral network for patients of
CBHPs who need secondary and tertiary levels of
care .
4 . Provide health relief services to organized
groups/sectors during epidemics and natural or
manmade calamities.
5. Launch surgical, dental, and medical missions
to organized areas covered by the program.
6. Supervise implementation of the Immunization
and Tuberculosis Care Programs.
7. Gather necessary resources (human and material
resources) for health care services of the CHD.
nx
Health Education and IrsiiiLinR
1. Develop and upgrade the capacity of CBHP
personnel/staff/trainers on the national,
interregional, and regional levels by:
a. conducting Trainers' Training
- Basic and Special Trainers' Training
conducting Health Skills Training
b.
- ADHST and Basic HST Trainers' Training
2. Provide continuing education and professional
development (SDS/Value Formation) to CBHP staff
and advocates.
3. Develop and popularize appropriate and relevant
training curricula, methodologies, training
aids, and materials.
4. Coordinate CBHP training work and monitor
implementation of training thrust and stresses
set by the General Assembly.
141
. 5. Conduct Basic Health Orientation seminars in
schools, institutions, and other groups who are
interested in CBHP Work (Advocacy Work).
IL. „Jfes ear olu __£) q c_u me.rLta.ti .q n
and In tomiation.
1’. Document experiences and breakthroughs' in CBHP
work .
2 . Work out research designs and protocols and
conduct.research on health and related matters.
3. Take charge of public information regarding
CBHP work.
4. Popularize existing studies through a regular
publication, manuscripts, manuals, and
read ings.
5. Publish a regular publication that reflects the
experiences and aspirations of the CBHPs and
individual members.
6. Publish pertinent and timely statements and
declarations on relevant issues in health and
development.
7 . Take charge of the databank and library.
IMPLEMENTING
Development
GUIDELINES
of
the
Counci 1
for
H e a 11 h
and
The body deliberated on the proposed implementing
guidelines and after s’ome changes, ratified them.
The following
are the
ratified
guidelines (changes are in bold type).
I.
CHD
implementing
Membership
A.—Erxm£S£U_crlieria^_tQ±.ing rights.K_ce 1 leciion of
ja^i^r.s.h.lp_fee.
1.
All convenors will be founding members of the
consortium and may exercise full rights as member programs
or institutions or individual members.
142
2.
Criteria for New Members
a. For program or institutional membership,
a recommendation from the Regional Body
(RB)
b. For individual membership, recommendation
from CBHP or individual member
c . For affiliate membership, a recommendation
from the RB
3.
Process
a. Application for membership has to be
recommended by the RB or by two (2)
consortium members in good standing.
b. The RB will forward their positive or
negative advice to the Secretary of the
Corporation.
c . The Secretary shall properly submit the
same to the BOT for approval and/or
confirmation.
d . The application will become official
during the meeting of the GA.
4.
Voting rights
a. Each member program/institution shall be
entitled to two (2) votes.
b.
Each individual member shall be entitled
to one (1) vote.
c.
Each member of the Board of Trustees
(BOT) shall be entitled to one (1) vote
during BOT meetings.
5.
Collection of membership dues and fees
a. Upon approval of BOT, new members shall
pay the corresponding membership fee: ,
P500.
institution/program
100 .
ind ividual
b. Members 'shall pay yearly dues - deadline:
end of January,
P500.
institution
200.
programs
50.
individual
Affiliates shall pay the same rates as
c.
full members.
143
II .
Conduct of Elections
GeneraLAs. s^inbly
1. The General Assembly mandates the regional
representatives to form, a caucus and elect their members to
the Board of Trustees.
Individual members are nominated from the floor
2.
and elected at large by secret ballot.
No individual or representative of any regional
body, program or institution can be elected to the Board of
Trustees unless he/she is present during the elections held
in the General Assembly, or unless there are vajlid reason^
for the absence, and the representative has expressed
willingness to be elected in absentia.
In succeeding General Assemblies, an individual or
representative of any regional body, program, or institution
cannot be elected to the Board’ of Trustees if he/she is not
present throughout the period of the General Assembly.
3.
Representation to the Board of Trustees
The body approved the following breakdown
regional representation in the Board of Trustees:
Cordillera
- 1 representative
Cagayan Valley
- 1 representative
Central Luzon
- 1. representative
Southern Tagalog
- 1 representative
Bicol
- 1 representative
Visayas
- 2 representatives
Mindanao
- 4 representatives
Individuals
-3
Executive Director of the National Secretariat
Total of 15 BOT members.
Election of Officers of_ the Board of Trustees
1.
Election of BOT officers shall be done, during
the BOT meeting.
2.
Positions in the Board of Trustees are the
following:
* Chairperson
* Vice-Chairperson
*• Secretary
* Treasurer
* PRO
of
144
The definition and formulation of the roles and
functions of the Board Officers shall be the responsibility
of the Board of Trustees.
III . Relationship of the National Secretariat to Programs,
Regional Bodies and other Institutions and vice versa.
The
guidelines:
Genera 1
Assembly
agreed
on
the
to
A. National Secretariat -- > Regional Body
CBHP
fo1 lowing
to
--- >
1 . Tn line with Stress/Calls which have been
decided during the General Assembly, the
National Secretariat (NS) can communicate
directly with the CBHPs but has to inform the
RBs regarding these.
For major activities such as trainings
and services to be launched between Assemblies,
the National Secretariat must consult with the
Regional Bodies to synchronize these
activities.
to
B. CBHP -- > Regional Body
to
-- > National. Secretariat
1. For Normal Operations The Regional Body is consulted by the CBHP
about th© request. The RB has the
responsibilities of facilitating and updating
the National Secretariat.
2. Emergency Cases:
trouble shooting, security
matters, administrative matters and relief
emergencies -The CBHP can go directly to the
NS but it should still inform the RB.
With the Regional Body properly informed,
the National Secretariat can go directly to the
local programs with or without an emergency
situation.
145
to
C.. Other Institutions --- >
to
-> CBHP
Natl on a. 1 Se c r e t. a r i a t -
Other health inst itutions (such as MAG, ‘ CIHC,
NEHCC-NCCP, HAIN, PYHP, IACHS, BUKAS, A H W ) m u s t c o 6 r d i n a t e
with the National Secretariat who in turn will consult the
programs.
AMENDMENT TO THE CONSTITUTION
•The following amendment was ratified by the body:
Article V
Section 10:
.Members .of the Board of Trustees may be
represented by proxy only by another member
of the board and only during meetings of the
Board but not during the General Assembly.
BOARD OF TRUSTEES ELECTIONS
A.
Roll Call of Voters
The facilitator called the roll of voters and
reiterated the rules for voting:
- the vote of each program will be counted as two votes
- each individual member will have one Vote.
The body will break up .into regions to select their
representatives to the Board of Trustees (BOT). Three
individual members to the BOT shall be elected by the
body .
B.
Elections
The following are the new regional representatives
to the Board of Trustees:
1
Cordillera
- Chandu Claver, M.D
2
Cagayan Valley
-- Tita Rillorta, R . N .
3
Central Luzon
- Patrick Chuidian
4
Southern Tagalog - Eulalia U^rera, M.D.
5
Bicol
- Bernadette Abiso
6
Visa yas
■■ Alice Lab ado, R.N.
7
Mindanao
- Ann Kadile, R ,’N .
146
The General
Assembly elected the fo1lowing individual
members to the Board of Trustees (ROT) who garnered the
following number of votes:
CANDIDATE
VOTES'
Sr. Mary Ann Grenough, MM
Sr. Eva Varon, SCMM
Ruben Caragay, M.D
.Marie Therese Burgos, M . D .
52
38
39
38
Special Resolution
Because of the tie in the number of votes for Sr. Eva
Varon and Dr. Therese Burgos, (both third placers),
the
Assembly passed
a special resolution to include both
candidates in the Board of Trustees.
The representatives from Mindanao agreed that one of
the slots for Mindanao be allotted to an individual member
of the consortuim (Mindanao is allowed 4 slots in the BOT).
QLQMW REMARKS
Sr. Mayang, one of the newly elected Board members
of the consortium
gave a short message to the general
assembly.
She expressed her happiness in becoming a part
again of
CBHP.
Her encouraging words to the
General
Assembly were to ORGANIZE... GO BACK TO YOUR AREAS AND
ORGANIZE...
APPENDICES
♦
a
APPENDIX A
’ LIST OF HANDOUTS
A.
Publications/Newsletters
1.
2.
3.
4.
5.
6.
7.
8.
9.
10 .
11.
12.
B.
Readings on the National/International Situation
1.
2.
*
3.
4.
5.
6.
7.
C.
Pulso ng Bayan: Educational Series No 43-44,
July-August 1990
Pulso ng Bayan: Educational Series.No 45
September 1990
Development Monitor: Issue 3 December 1990
Council for People's Development
December 1990 (CPAR)
Agrarian Reform Monitor:
Agrarian Reform Monitor: October 1990
May - June 1989
Progress Notes
Progress' Notes . July 1989
February 1990
Progress Notes
March - April 1990
Progress Notes
June - July 1990
Progress Notes
December 1989
TAMBALAN: October
ARI News: August 1990, Issue No. 17
Batas na Nagtatatag ng Programang Repormang Agraryo
ng Sambayanan at nagtatakda ng mekanismo sa pagpapatupad nito - Congress for a People's Agrarian
Reform (CPAR)
Vital Signs: A Brief Survey of Crisis of 1990 Newstep
Assessment of the Second Year of Republic Act 6657
- CPAR
What Arabs know and you don't -Eqbal Ahmad:
•
Philippine Daily Inquirer,
January 12, 1991
Langis, Bala at ang Krisis sa Gitnang Silangan:
Implikasyon sa Pilipinas: Prof. Roland G. Simbulan
On the Middle East Situation's Effect on the
Philippines: Food for All Coalition (FFAC)
January 12, 1991
An Open Letter to Our Fellow Members in the Health
Sector: BUKAS
Readings on Development Work
1.
2.
3.
Foundation Bulletin
October 1990
Networking: One of the New Directions Transforming
our Lives: John Naisbitt
Appropriate Technology as Ideology: Michael Tan
Earth Day Objectives
D
4.
5.
6.
7.
8.
D.
Readings on Protocol 2
1.
2.
3.
E.
2.
3.
4.
5.
How to conduct a successful medical/surgical
mission
Managing a Botika ng Barangay
Refugee Health Care
Concept Paper on Community Clinic
Concept Paper on Emergency Services
CHD Forms
1.
2.
3.
G.
1977 Geneva Protocol II Additional to the Geneva
Conventions of 12 August 1949, and relating to the
Protection of victims of Non-International Armed
Conflicts
The Human Right to Participate in Armed Revolution
and Related Forms of Social Violence; Testing the
Limits of Permissibility: Jordan J. Paust
Rights and Duties of Medical Personnel in Times
of Armed Conflict - Center for International
Humanitarian Legal Studies
CHD Draft Concept Papers
1.
F.
Strategies and Mechanisms for Empowerment of People
• in the Rural Sector: Horacio Morales-, Jr.
The Limits and Possibilities of Philippine NGOs in
Development - Karina Constantino-David from:
Lambatlaya National Conference on Networking in the
90's: Affirming Commitment to the Decade of
Nationalism; November 22-24, 1999, ■ University of
the Philippines, Diliman, Quezon City
What Ought a Network be? Ponciano L. Bennagen
Stepping in the Paddy: Jose F. Bartolome
Networking: One of true New Directions Transforming
our Lives: John Naisbitt
Program Profile Form
Council, for Health and Development (CHD) General
Assembly.’ January 10-16, 1991 - Guidelines for
Reporting
Activity Report Form
CHD 2nd General Assembly Papers
1.
2.
3.
4.
5.
Unities in the 1988 National CBHP Conference
November 26 - December 3, 1988, Baguio City
Working Paper No. 2 - Definition of Terms
Summary of Recommendations; Chapter 5, Page 2
Health Education and Training Department's
Library Book List
List of CHD Training Materials
c
H.
Readings on CBHPs and Health Work
1.
2.
3.
1.
Are we ready for a Disaster? Mercedes B. Ap t lado
Ang Karanasan ng Medical Committee: Jess F uen t e s
Health in Our Hands: Community Based Health
Programs in the Philipppines:
Ma. Sophia LizaresBodegon
Other Materials
1.
2.
Some Golden Rules for Good Time Management
Seven Basic Habits of Highly Effective People:
Stephen R. Covey
d
APPENDIX B
LIST OF PARTICIPANTS
(Note: Names in bold type are CHD board members)
REPRESENTATIVE
PARTICIPATING COMMUNITY
BASED HEALTH PROGRAMS
NATIONAL CAPITAL REGION
4
KAPPAG-Bulong Health
Services
Luisa Villayuan
AUSCULTA Service Consortium
Eulalia J. Botin, M ,D.
Community Medicine Foundation,
Inc .
Gemma Arlene M. Munar, M.P.H
Paranaque Development
Foundation, Inc.
Gloria Navarro
Programa sa Pag-oorganisa at
Pangkalusugan (POPSIR)
Bro . Recto Frades, CSSR
Tuason Community Center
Foundation, Inc.
(TCCFI)
Celeste Bertiz
Rural Missionaries of the
Philippines (RMp)Socio-Eco Desk
Emaline Ducay
NORTHERN LUZON
Gloria ValdezCommunity Based Health
Development Program - Nueva
Vizcaya-Quirino (CBHDP-NVQ)
Community Health Concerns for
Raiinga-Apayao
Constancio Claver, M.D.
Edailina Manigas
Community Based Health
Development Program-Isabela
(CBHDP-Isabela)
Mining Communities
Development Center
Angie Salio-An Gasmena, M.D.
e
Saranay
CHW Organization
Angelina L. Obena
Dominga Anosan, R.N.
Community Health Education
Services and Training in
the Cordillera Region (CHESTCORE)
CENTRAL LUZON
Health Integrated Development
Services-Bacolor (HIDS)
Sr . E]i za An a noria, R.N, OSB
Health Integrated Development
Services (HIDS) - Nueva Eci.ja
Nen i ta Gregor i o, M.D.
Health Integrated Development
Services (HIDS) - Pampanga
Munoz Community Based Health
Prpgram (MCBHP)
■ Miriam Grafil
Pacita C. de Guzman
«
SOUTHERN TAGALOG
Caysasay Development Center
Aorea Jeanette Macaraig
Kilusang Sambayanan Sa
Kalusugan (KSK)-Quezon
Corazon Ruzol
Mindoro Institute For
'Development, Inc.
(MIND)
Gina Nabong
Rural Missionary ST-Cavite
(RM-Cavite)
Sr. Willibrorda Laccay,CFIC, RN
BICOL REGION
Bicol Integrated Health
Services (BIHS)
Bernadette Aviso
Tabang sa mga Biktima
sa Bicol (TABI)
Victoria Listana
f
VISAYAS
Center for the Advancement on
Training Community Health
Services (CATCHS)
Bernadette Basan
Operation Himsog (OH)
Petty Orbeta
Hermosilla Mitaran
Programa Han Kati1ingbanon
Para 'Han Maupay Nga Panlawas
(MAKAPAWA)
Training and Educational
Assistance for Community
Health (TEACH)
An t on i a Sum a 1i n og
Katilingbanon nga Programa
Ha Panlawas Han Samar-Center
for Community Based Health
Development Program, Inc.
(KAPPS-CCBHDP)
Maria Teresa Umipig, M.D.
MINDANAO
Butuan Socio-Medical
Services
Remedies Blanco
Community Based Health Services
Iligan (CBHS-Iligan)
Evangeline Jimenez
Community Based Health Services
Butuan (CBHS-Butuan)
Ma . Theresa Anoba. R.N .
Community Based Health ProgramMarbe1
Melinda Mission
Interfaith Program for
Health Concern Cotabato
Mary Ann Kadile, R.N .
PARTICIPATING
INDIVIDUAL MEMBERS
UP College of Nursing
Gerardo Andamo, R.N .
American Friends Service
Committee
Marie Therese Burgos M.D
Council for Health and
Development-National Secretariat
(CHD)
Joseph Carabeo, M.D.
UP College of Public Health
Ruben Caragay., MD
g
St. Clare Patronage
Pandacan Community Center
Sr . Gloria Coguia, FMM
National Council of Churches in
the Philippines (NCCP)
Pearl Domingo
UP College of Nursing
Luz Pambid-Dones
Maryknoll Sisters
Sr. Mary Grenough , MM
Bukluran Para Sa
Kalusugan Ng
Sambayanan (BUKAS)
Deien de la Paz, M .0 .
National Council of
Churches in the
Philippines (NCCP)
Jessie Racimo, R. N .
Health Unit
Community Based Health Development
Program - Quirino and Nueva Viscaya
(CBHDP-QNV)
Sr. Eva Varon
OBSERVERS
NATIONAL INSTITUTIONS *
Community Medicine Foundation,
Inc. (COMMED)
Dennis Batangan, M.D.
Philippine Rural ReconsTruction Movement (PRRM)
Goyena S. San Pascual
NATIONAL CAPITAL REGION
Formation Mission Team
(FMT )
Aurelia Manalo
SOUTHERN TAGALOG
MAI Welfare Development
Foundation
Raquel B. Agyapac
United Church of Christ in
the Philippines (UCCP)
Health Action Network for
Development (HAND)-Palawan
Cariota G. Lopez
h
BICOL
Bagong Paglaom, ‘Inc.
■ Sentro ng Inisyatibang
Pagsasarili ng Komunidad
(SIPAGKO)
Luzviminda D. Cortez
Angie Relucio
VISAYAS
Agustinian Missionaries
Sr. Ma . Veneranda Poral, AMP
of the Philippines Health
Integrated Response
(AMPHIRE)
CONFERENCE
STAFF
Joseph Carabeo, M.D.
Magdalena Bareelon, M.D.
Belinda de la Cruz, R.N.
Josefina Pambid-Supan, R.N.
Delia Obera
Sr. Ester Vite, SCMM
Nelson George de la Fuente, M.D.
Antonia Nenen Mendez
He 1ia Ang, R.N.
Eleanor Jara, M.D.
Myrna Velasco, R.N.
Cecilia Ciudadano
Julie Valerio, R.N.
Ma, Gemma Bunag, R.N.
Violeta Villanueva, M.D.
Emelina Repuno, R.N.
Marivic Barriga-Babiano
Ma. Teresa Guevarra
Stella Maris Gonzales, R.N .
Flora Dimacali, R.N.
Coralyn Ocampo
Grace Puno
Imelda Garcia, R.N .
Lovinia Royo
Glenda Flores-Go
Nenita Crescini
Nenette Maranan
Elena Tejada, R.N.
Efren Gusi
Celest Dizon
i
BOARD OF TRUSTEES
(July 1989 - Jan.1990)
9
Chairperson
Ruben Caragay, M.D.
UP College of Public Health
Vice-Chairperson
Sr. Eva Varon. SCMM
Community Health Development
Program Quirino and Nueva
Viscaya (CHDP-QNV)
Secretary
Treasurer
Bicol Region:
Marie Therese Burgos, M.D.
American Friends Service
Comm i t tee
Central. Luzon:
Patrick L. Chiud ian
Health Integrated Development
Services-Central Luzon
(HIDS-CL)
Members:
Cord i1lera:
Dominga Anosan, R.N.
Program Director
(CHESTCORE)
Community Health Education
Services and Training in the
• Cordillera Region (CHESTCORE)
National Secretariat:
Magdalena Barcelon, M.D.
Executive Officer CHD-NS
Council for Health and
Development-National. Secretariat
M indanao:
Mary Ann Kadile R ..N .
Program Coordinator
Interfaith Program for Health
Concerns Cotabato (IPHCC)
Visayas:
Alice Lab ado, R.N.
Project Coordinator
(CATCHS)
Center for the Advancement on
Training Community Health
Services (CATCHS)
Cagayan Valley:
Tita Rillorta, R.N.
Michael Tan, D.V.M, ,PhD
Executive Director-HAIN
t
Community Based Health
Development - Isabela (CBHDP. Isabela)
Health Action Information
Network (HAIN)
J
Eastern Visayas
Maria Teresa Umipig, M.D.
*
I
Ts
♦
Kati1 ingbarwn Nga Programs Ha
Panlawas Han Samar-Center For
Community Based Health Develop
ment Program, Ififc.(KAPPS-CCBHDP)
k
APPENDIX C
GROUP REPORTS:
WORKSHOP ON HEALTH WORK
GROUP I
VISION:
Change and Social Transformation
I.
Health Work in the context of over-all development work
and the present national situation:
The nation in crisis rooted in extreme poverty, relate
it to the concept of empowerment, we facilitate this and
make sure it is related to social transformation,
We have
to re-orient our approach because when we started as a
health program, we did not have much impact so we became an
integrated program.
our health program in Negros started as health but
expanded to IGP: mothers: CHW; fathers: IGP
crises
HEALTH WORK >
------------- >
Immediate needs
DEVELOPMENT >
lack of social services
need for finance work/resourcing
A. Principles
1. Health as a basic human right and responsibility
of all
2. Bias for the PDOES
3. People have the potential, they are change agents
4 . Empowerment, confidence, participa*tion
5. Geared towards self-reliance
6. Health work is an integral part of over-all
development.
1
B. Scope/Coverage
Methods/Strategies
1 . Resourcing
networking ;
human
i
i
material
i
f i n an c i a 1
2. Organizing
i
i
i
i
3. Development and popula
popuia
rization of alternatives!
I
I
V
4 . Development of different;
levels of services based!
on the level of organi- ]
zing
i
5. Advocacy
i
i
i
i
i
IRW, • IGP, coordinating, netw o r k i n g , education, training
- HSO, health committee
building, CO and all of
abov.-’, mobilization and
par t. j c i| at ion in struggle
- Research work on traditional
med icin e, dpp ropriate technology , publication
Referrals, network, provision
of appropriate facilities and
reson rues
Fora, symposia, petition
signing, statements, etc.
C. Methods/Strategies
1. active and full participation of the people
2. networking/coord inat ing
3. education
II . The role of the CBHP in Health Work
- initiator, catalyst, facilitator
- CBHP's carry the objectives of HW
GROUP II
I. Health Work in the context of the present national
situation and over-all development work.
A. Principles
1. HW is by and for the PDOE: itoward people's
empowerment for social transformation,> i.e. democratic,
linked to the PO' s, etc.
is r
the reg?OnHWnation^
ar
' comprehensive development of
nation. and world^ .taking into consideration the
various cultures and levels
----- of
— organization and development.
in
3. HW should be innovative/creative and scientific
(theory-practice-theory) in process.
B . Scope
1. Health Human Resource Development (HHRD)
including staff, CHW, and formal health sector.
2. Develop, strengthen, and popularize alternative
health care system.
3. Comprehensive direct services.
4. Develop and ensure appropriate health and health
related structures and services.
Example:
services directly related to health such as
health centers/facilities.
services indirectly related to health such
as economic, agriculture, housing.
5. Develop and sustain financing scheme and resource
generation.
6. Criticize and expose existing HCS particularly,
its anti-people policies, priorities, decision-making
process and apply pressure on the government (pressure
politics)
7. International relations work based on mutual
gains.
Note :
HSO was not included in the scope, but it was
considered as a given premise and can be used as a
strategy to attain the scope given above.
C. Strategies/Methodologics
(With consideration of the levels of organizing.)
1 . For Health Human Resource Development (HHRD)
- appropriate and relevant training and education
(correct theory and practice)
Example:
appropriate coordination and training of health
and CO skills training and education (varies
according to area)
2. For popularizing ABCS
a. Advocacy at all levels and major social
institutions (scheme, government, church), including
maximization and development of masa media and arts and
cultures as forms for popularizing AHCS.
I
v.-.'W
JI. W
n
b. Setting-up and ensuring the functional health
organizational structure to implement system.
Example:
CHW organization and BHC
c . Enlarge coverage of effective and functional
CBHP's.
d. Exchange of personnel, i.e., local and
international sharing of experiences.
3 . For comprehensive health services
a. promotive, preventive, curative and
rehabilitation.
b'. Basic services package, i.e., balancing or
considering the level of organization of the community.
4. For buiIding/setting-up of support structures with
defined criteria depending on the level of organization of
the community.
There must be indicators to ensure the utilization and
maximization of facilities.
Example:
Health Center/C1 inic:
stable program
health committee capable
of running the barangay
health center
stable PO
5 . For financial scheme and resources generation.
a . Local
- IGPS, community health insurance
- services "fees“/donations '
- coordinate with other NGO's
b. Foreign
- overseas development assistance (ODA)
(through this in still in question)
- "twinning": exchange of technical know-how
- pledges such as "adopt a CHW"
- project proposals
II. The role of CBHP' s in HW
A. Support and complement ‘organizing work at the
community level for social transformation (as part of
integrated development not by ourfeelves)
B . Help in laying the foundation of setting-up of AHCS.
o
P r ime
C . Serve as catalysts., initiators.,
movers, and liberating educators.
GROUP III.
I. Health Work in the context to the over-all development
work and the present, national situation.
A. Principles
1 . HW must develop people s empowerment.
2. It must answer effectively the immediate needs of
the people towards total human development.
3. It must serve the vast majority of the people, the
PDOE and must serve as the venue in raising their level of
social consciousness.
B. Scope/Coverage
1. Health services must be based on the capacity of
the program.
- capacity of the area
- level of struggle
2. Training - continuous and systematic skills
training and graded education towards the development
(HHRD).
3. Organ iz ing
<Health
>
>
HW : - <
<Organ iz ing>
4 . Management:
5 . Advocacy:
HSO
CHW
People
organizational matters
- financial matters
issues
principles of HW
health policies
C. Methods/Strategies
1. For health services: P r i m a r y , secondary and
tertiary levels
- giving emphasis on traditional medicine
- using appropriate technology towards selfre I iance
- giving relevant services
»»
p
2. For HHRD
- needs assessment
- plaining
- imp 1 emen tat i on
- monitoring and evaln^ti >n
3 . Organ i ing
HSO :
referral networking towards services
prog r am med alii ance bui 1 ding
broad health orientation'
CO
CHW
Peoples organization
programming
make good the
* Define within the network the scope and
organized and
limitation of the level of organizing to:
unorganized management must be:
- democratic and representative
- generating finances that do not depend on
foreign funding
4. Advocacy
- advocacy for AHCS
TI. The role of CBHP's in HW
CBHP rs are part of the over-a11 health work.
GROUP IV
I. Health Work in the context of the present national
situation and over-all development work. '
Vision:
Health work must respond to the people's
issues and must support in building of an a 1 t€jrnative health
care systems that is integated with community development.
A. Principles
1. Health is a social phcn-omenon . Therefore, it must
be in the context of the people's struggle towards social
transformation.
2 . Health is a basic human right.
3. Health work must be an empowering undetaking
health in the hands of the people.
4. The principle of coord Lnation/comp 1 imentati'on must
be had with other health organ i.-ationo and health advocates.
B. Scope
must respond t.o the needs of the
1. Services
genu ine people's organization (GBO's) and Ln the context of
their struggle.
2. HSO - in two (2) leveJs (comp 1 imen tat ion of HS’O
was not discussed):
- com m un i ty iev e1
- program level
3. Assistance/in setting-up of an alternative health
care system, in consultation with other socially oriented
advocate NGO's.
C. Implementation
1. Community level - facilitation
- direct services
- transfer of skills
- organizing (health sector and
CHW)
- support to people's issues
- research and transfer of
appropriate technology
- generation of FTMS
- health committee building as
component of PC's
organizational structure
- 1 inkages bu iId ing
II . The role of CBHBs in HW
A. Research and development of appropriate
technology
B. Health services and trainings
C . Venue for networking and HSO
0 . Advancement of people's agenda
E . Assist in setting-up of alternative health
care system
r
APPENDIX D
SUMASAATIN ANG ESPIRITU
Sumasaatin ang Espiritu ng Panginoon
Tayo'y hinirang niya upang tumugon
Sa daing ng mga aba at ihatid sa mga dukha
Ang magandang balita ng kaligtasan.
II .
Sinugo tayo upang ipahayag
Ang kalayaan sa mga bihag
Bigyang paningin ang mga buJag> dalhin
ang nasa dilim sa may liwanag.
REPEAT STANZA I
III . Ang inaapi at mga sinisiil ay hahanguin
sa mga hilahil.
Ipapahaya^g ang pagsapit ngayon
Ang tanging pagliligtas ng Panginoon.
REPEAT STANZA II
BIBLE READING:
Luke 5:17-26
Silent Reflection:
Closing Song:
3 mins.
AMA NAMIN
ACTION SONG
Si Uncle Sam 2x namingwit'sa Karagatan
nakakuha 2x, mataking kayamanan
Iniuwi 2x sa sari ling bayan
ang bansang inaapi 2x
ngayon ay lumalaban.
ST. FRANCIS SONG
1,
Lord, make me a channel of Your peace
When there is hatred let me bring Your love
Where there is injury, Your pardon Lord
Where there is doubt, true faith in You
Refrain:
Oh Master grant that 1
So much to be consoled
To be understood as to
To be loved as to love
may never seek
as to console
understand
with all my soul.
- I*
s
2.
Make me a channel of Your peace
Where there is despair in life let me bring hope
Where there is darkness only light
Where there is sadness ever joy.~
(repeat refrain)
3.
Make me a channel, of Your peace
It is in pardoning that we are pardoned
In giving to all men that we receive
And in dying that we're -born to eternal life,
(repeat refrain)
BUTTERFLY
(to the tune of Paru-Parong Bukid)
B-U-T-T-E-R-F-L-Y,
butterfly
MAG-ISIP-ISIP
Mag-isip-isip, ng 1,2,3 (3x)
Sundan. mo ako
ref . :
Sundan (3x) ako
Sundan (3x) ako
Sundan (3x) ako
Ikaw naman dito
THE MUSICAL ROOT
it
Eat camote the musical root
The more you eat, the more you toot,
The more you foot, the better you feel
Eat camote the musical root.
HAGIT SA EBANGHELYO
I.
Ang hagit sa ebanghelyo
Alang kanato, bigugwaon to
Ang atong ibig katawa, apan
Kon tinud-on ta ang pagserbisyo
Masubay tag kalbaryo
Sama sa atong Ginoo.
Chorus:
Dili sayon ang pagsunod kang Kristo
Daghang tunok ang daLan
Nga giagian mo
Bug-at ang Krus, nga pas-anon mo
Ug kamatayan, naa naghulat kanimo.
t
II. Si Kristo mismo nag-ingon
Sa mga tinun-an
Pagbantay kay panakpon
Kamong biay-biayon
Prisohon kamo, ng ang naa sa gahuni
Hukman kamog silutan.
FATHER ABRAHAM
(Igorot Translation)
Si Amo'y Abraham
Pito nan anak na
Pito nan anak na
Wada nan an-ando
Wada nan ap-aptik
Makne-makneg de amin
Esa'y Lima, Duay Lima
Esa'y Siki, Duay Siki
Esa'y kimot, Duay Kimot
Esay ulo.
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