Building Community-based Health Programs to Promote Health and Prevent Disease in Bohol

The Visayas Primary Health Care Services, Inc. (VPHCS), with the support of the Asian Community Trust (ACT) has been implementing a project “Building community-based health programs to promote health and prevent disease in Bohol.”

The project areas are Barangay Sto. Nino in the Municipality of San Miguel and Barangay Caluasan in the Municipality of Dagohoy in Bohol. The communities have been affected by the failure of the Malinao Dam Project which has worsened their economic situation that in turn affected their health conditions.

The project which started in April 2010 works with the farmers’ organization in Sto. Nino, the Hugpong Mag-uuma sa San Miguel (HUMASA) or the Farmers Association in San Miguel and the farmers’ organization Mga Mag-Uuma sa LACALSANDA Apektado sa Land Levelling (MALALA) (Farmers in Lacalsanda affected by Land levelling) in Caluasan.

A basic health skills training was conducted last August 9 – 14 for community health workers (CHWs) in order to equip them with knowledge and skills to build community based health programs which shall address the common health problems in their communities.


Capacity building is a primary strategy in the project which will enable the CHWs and the leaders of the people’s organizations to launch health campaigns that will address the prevalence of common preventable and communicable diseases. Direct health services by project staff and volunteer health professionals shall also address the diseases in the communities.

The Asian Community Trust (ACT), Japan's first fund raising-style charitable trust, was established in 1979 to assist people at the grass-roots level in Asian developing countries. It has supported projects in more than five Asian countries, in fields spanning health, medical treatment, education, youth training, and development of rural communities. It has funded several projects in urban poor settlers and fishermen communities in Cebu.

Health programs that answer the health needs of the communities shall be instituted in the project by the trained CHWs together with the leaders and members of their people’s organizations. Community participation and involvement in designing the health programs appropriate for the communities shall be ensured as it is a hallmark in community-based health programs and is the cornerstone in the primary health care approach of health service delivery.

The health programs are based on results of surveys and key informant interviews that gathered data on the socio-demographic profile and health data including common health problems, causes of deaths, the immunization status and nutritional status of preschoolers, health services available in the community, methods of family planning and nutritional and food practices of the families.

Medical mission in Totolan, Dauis, Bohol

Nearly 100 children were rendered health services in a medical mission organized by the Visayas Primary Health Care Services (VPHCS) and the Nagkahiusang Mangigisda sa Totolan (NAMATO) (United Fisherfolks in Totolan) in Dauis, Bohol last July 24, 2010.

Volunteers Dr. Jose Edgar Alonso, Dr. Aira Baroro, five nurse members of the Students Alliance for Community Health Services (SACHS) in Tagbilaran City, a nursing graduate of the Cebu Doctors University Hospital and staff of the VPHCS led by Dr. Petty Orbeta-de Castro and Dr. Grace Molina rendered the services which included visual acuity, height and weight determination, urinalysis, dental check-up and medical check-up.




Totolan is a fishing community located in Dauis. It is one of the community-based health program (CBHP) areas of the VPHCS in a continuing project supported by the Action Solidarite Tiers Monde. It has a population of 3,626 or 330 households.

The PEOPLE’S HEALTH AGENDA

Health is a right that continues to be denied of Filipinos. Addressing the worsening state of the people’s health is one of the biggest challenges facing the Aquino administration.

The Filipinos continue to suffer from dismal health situation amidst projection from the past Arroyo administration of improved health outcomes. Infectious and preventable diseases continue to top causes of mortality and morbidity. Malnutrition and diseases of poverty like tuberculosis plague poor communities. Needless deaths of pregnant women remain high at 170 per 100,000 live births.

The inadequacy and inaccessibility of public health services is worsening. Seventy percent of Filipinos cannot afford to buy their medicines, even with the passage of the Universal Cheaper Medicine Law and the lowering of prices of medications through the Maximum Drug Retail Price (MDRP). Public hospitals have been charging for every supply, laboratory and diagnostic procedures that used to be free. Privatization of public hospitals has made health services more expensive.

Doctors, nurses and other health care providers are witnesses to the hardships of Filipino patients in the hospitals and the communities. Poor patients whose welfare should be prioritized by the government are drained of hard-earned income whenever they get sick or hospitalized. Many patients delay consulting with health personnel because they cannot afford the high cost of hospitalization and medicines.

Even with the presence of the National Health Insurance Program (Philhealth), there are still gaps in its coverage. Card issued by Phil health is not accepted by most private hospitals and also meaningless in poorly-provisioned public hospitals with no medicines.

Despite the commitment of health professionals and health workers to serve, with the prevailing condition – many of them are pushed to go abroad by extreme poverty, unemployment, low salaries and benefits, inhumane working conditions, and political instability. Some 3,000 Filipinos including health care providers leave for abroad everyday. This leads to the aggravation of present health crisis.

There are disparities in the distribution of the health workforce. Seventy percent of all health workers employed in the private sector serve 30 percent of the population, while 30 percent employed in government services cater to the majority. Vast majority of health care professionals are in lucrative private practice in urban areas despite the fact that 60 percent of Filipinos die without the benefit of health professional attention.

Local health systems are weakened due to loss of key staff and decreased capacity to deliver essential front-line health services by rural health units (RHU), barangay health stations (BHS) and private health sector. Referral hospitals (core referral and end referral) run mainly by provincial, city governments and the Department of Health (DOH) are unresponsive to current constraints and inefficient, near-empty hospitals coexist with overcrowded and resource-poor provincial and tertiary hospitals.

Health workers are still overworked yet underpaid. Salary increases under the Salary Standardization Law are inadequate based on experiences of health workers considering the high cost of basic commodities. There is no line allotment for Magna Carta benefits in many hospitals. Understaffing problems continue to exist as there is no allotment for additional plantilla positions despite increased bed capacity and building expansions. Volunteers and trainees fill up the staffing deficiencies as free labor force while paying for their “training”.

Due to poor working condition of the health workers, they are pushed to work abroad. The Philippines has been the number one exporter of nurses and number two exporter of doctors in the world for several years. Yet hundreds of hospitals have closed down throughout the country due to the lack of health personnel, with hundreds more on the brink of closure. Health workers working in rural communities are also subjected to various forms of harassment by the State, including arbitrary arrests like the Morong 43 health workers.

The onslaught of natural calamities has made worse the inadequacy of dismal state-run health care facilities.

During the term of Pres. Arroyo, the national health budget did not address the chronic health distress. This year 2010, a minuscule P33.7B budget for the Department of Health and attached agencies reflects the callousness of the administration of the then Arroyo administration to people’s health and welfare. The health budget comprises a measly 2.2 percent of the P1.54 trillion national budget. This translates to a measly P0.98/day per Filipino.

Spending on health is only 3 percent of the annual Gross National Product, a far cry from the recommendation of the World Health Organization of 5 percent spending. Most of spending for health is out of pocket at 49 percent, while government spends 40 percent and social insurance at 11 percent.

The dismal condition of our people’s health reflects the apathy of the outgoing Arroyo government to the plight of the poor. Hold the Arroyo government accountable for the worsening health situation of the people!

For this reason we are calling on the incoming Aquino administration to immediately (on its first 100 days) act on the following health agenda :

1. Free the 43 illegally arrested and detained health workers.
2. Provide an adequate health budget. Immediately increase the national budget for health to at least P 90 billion.
3. Provide free health services for the poor in all levels of health care.
4. Provide free essential medicines for the poor in rural health centers and public hospitals.
5. Full implemention of salary increase for health workers: Immediately implement legislated P3,000 increase in base pay. Implement Salary Grade 15 (P24,887) for entry position of Nurse I. Inrease salary of doctor to P50,000 monthly.
6. Ensure full implementation of health workers benefits like Cost of Living Allowance (COLA), subsistence pay and hazard pay. Allocate funds for benefits.
7. Stop privatization/commercialization of government hospitals.
8. Provide adequate number of health professionals like doctors, nurses, midwives and dentists to far flung areas nationwide.
9. Prosecute the Arroyo administration for human rights violations and other crimes against the people.

For substantial change, let us work for following people’s health agenda:

1. Ensure the people’s right to health

 Provide an adequate health budget that is commensurate to the needs of Filipinos. Allocate at least 5 percent (P440 billion) of the Gross National Product (GNP) for health in the national government budget. Immediately increase the national budget for health to at least P 90 billion.
 Provide efficient, affordable and accessible healthcare for the people. Provide free health services for the poor at all levels of care.
 Provide safe, affordable and accessible medicines for all. Provide free essential medicines for the poor in rural health centers, and government hospitals.
 Develop and strengthen public health care system. Promote and set up community-based approach to health care nationwide. Put emphasis on the following nutrition, immunization and environmental sanitation.
 Provide effective and efficient programs aimed to eliminate TB, malaria, dengue and other infectious diseases, as well as emerging and rising diseases like HIV/AIDS.
 Ensure adequate tertiary and curative healthcare. Set up public hospitals in far flung areas. Upgrade and rehabilitate existing hospitals --primary, secondary, and tertiary in far flung areas.
 Ensure the equitable distribution of health personnel, resources, and funds throughout the archipelago.
 Nationalize drug industry so as to provide safe, accessible, affordable, and effective medicine. Regulate operations of transnational pharmaceutical companies.

2. Promote and uphold the interests of health professionals and health workers

 Provide adequate remuneration for health personnel both public and private. Promote the viable personal and career development of health personnel to encourage them to stay and serve in the rural areas.
 Ensure job security and stop contractualization, job-order schemes, and similar anti-health workers programs in government hospitals, health institutions and agencies.
 Immediately provide benefits. Ensure safe and humane working conditions.
 Uphold the rights of health workers to organize and unionize. Promote their participation in decision-making.
 Uphold and protect the rights of community health workers as health care providers.

3. Implement progressive health policies and programs

 Institutionalize participatory decision and policy-making. Strengthen transparency and accountability at all levels of health governance.
 Ensure people’s participation in health policy and program formulation.
 Strengthen public health care. Stop privatization as the core health policy. Stop the corporatization and commercialization of public hospitals.
 Promote nationalist, scientific, and mass-based healthcare services and health education.
 Develop and train health human resources based on health needs of the Filipino people. Stop commercialization of nursing and medical education.
 Implement the national drug policy.
 Promote and develop indigenous health care knowledge and practices.
 Develop self-reliant research program anchored primarily on the needs of the Filipino people.
 Stop policies, programs and projects that are hazardous and inappropriate to the needs of the Filipino people, the like Japan Philippine Economic Partnership Agreement (JPEPA), and the Philippine Mining Act.
 Stop the labor export policy and brain-drain of health professionals.

4. Ensure the people’s overall well-being and address the social determinants of health

 Provide jobs. Provide living wages for workers and ensure job security.
 Ensure food security and eradicate malnutrition. Implement genuine land reform program and national industrialization.
 Ensure adequate shelter/housing and other social services for the people.

HEALTH SECTOR SUPPORTS PEOPLES’ AGENDA

Health is a direct result of the socio-economic well being of the people. In order to achieve better health for the Filipino people, genuine change in political and economic fields should take place. With this, the health sector actively supports the following people’s agenda for change:

1. Prosecute GMA and cohorts for crimes against the Filipino people:
• Human rights violations – enforced disappearances, extrajudicial killings, torture, illegal detention including the case of 43 health workers
• Electoral fraud
• Corruption
2. Provide immediate economic relief for the people:
• Repeal of VAT reform Law. No to additional taxes.
• Passage of a substantial legislated wage hike nationwide
• Moratorium of demolition of poor communities
• No tuition fee increase
• Provide free health services and medicines for the poor
3. Ensure that adequate resources are available to meet the people’s pressing needs:
• Ensure that the 2011 budget will provide adequate budget for social services
• Repeal the automatic appropriation act
4. Review/repeal the Visiting Forces Agreement (VFA), Japan Philippine Economic Partnership Agreement (JPEPA), and other anti-people laws
5. Resume peace negotiation. As confidence building and goodwill measures free all political prisoners including the 43 health workers
6. Legislate a genuine agrarian reform bill (GARB).

* Photo credit - People's Health Movement website http://www.phmovement.org/en

Global health care needs in rural areas: An essay

By Lilia G. Hernandez, MD

There is a town in south central Washington, between the more progressive cities of Yakima and the Tri Cities (comprised of Pasco, Richland and Kennewick). Speed limit is at 35mph, 25 at most streets, 20 when children are present. And there are many of them, giving me a first impression this must be a town of young families. (Pop: 38.1% <18 yrs.)

I first arrived here March 15th 2010, when the temperatures were 30s Fahrenheit at night, 50s during the day. My first impression was of a flat land, most are planted, miles of vineyards and hops along the highway. There are small rolling hills into which the vineyards are inching up. In the early morning, the cool air smells of cow dung, which the locals call the smell of money, the sure reminder you are at Sunnyside, WA. This was desert land until damming of Columbia River provided irrigation that transformed the land and wealth of the area.

I came to work at a Pediatric Clinic to help a doctor who has been the only Pediatrician in this town for over 20 years. When the local hospital wanted to expand services, it opened clinics around the hospital and in neighboring towns. Dr. Anne Nealen used to be a missionary in Africa, working there for over 2 years, before getting married and settling in this town. Her pediatrics practice was absorbed into the Sunnyside Community Clinics and after over 2 years of recruiting, the hospital hired a 2nd pediatrician who stayed for 2 ½ years. Dr. Mario Tobia was of Filipino heritage, married to a Caucasian Canadian lady. When he left, I came as a locum tenens to fill in until a new doctor could be hired.

I soon learned the obvious, that this is a farming community. The population are >85% Hispanic who work the fields and farms. The Clinic population reflected this. Darigold and other dairy farms are located here, so are acres and acres of farmland for apples, grapes, hops. Many of the mothers I see are seasonal workers, many of the fathers work “en el campo” or with cows. One of the large clinic systems here is the Yakima Valley Farm Workers Clinics (YVFC). The Yakima TV station (KIMA) estimated the undocumented aliens here are as much as 40% of the Hispanic population.

As I go through my day at the Clinic, I quickly note that most of my patients do not speak English. The office workers are very ready to assist me in translating if the case is more complicated (ADHD, congenital defect, etc) but I am so glad for the Spanish we had to take in college and the vocabulary I had picked up practicing in California, before “retiring” and doing locum tenens.

On my first week, I was struck by the number of congenital anomalies I was seeing: 2 girls of about the same age with only 1 normal external ear, the other side had no ear canal, and only a small stub for pinna (microtia). Children born here (documented citizens) with various congenital defects and developmental delay. Seattle’s Children’s Hospital have specialists see many of them at the Children’s Village at Yakima, a site created so parents and children can see multiple specialists at the same site in one day. After a couple of weeks, I started asking if there were data showing the percentage of the population with congenital anomalies, ADHD, depression and various mental illness. It just seemed inordinately higher to me compared with populations of other towns I had been to before. I was wondering if this was simply an impression on me. After all, the waiting period to get into the Children’s Village for neurodevelopmental or other specialists’ evaluation was over 7-9 months. No one seems to be aware of any data. No one thought the presence of the Columbia River, once polluted by the Hanford nuclear facilities in WWII would be a cause or a factor. Much of the economy of the TriCities was fueled by the nuclear clean-up (Google Hanford).

As I see these children in the streets, and their parents, the immigration debate came to my mind. Here is another dimension that is not talked about. Clearly, these men and women work the fields to get America fed at the price we pay in the groceries. The American Academy of Pediatrics has noted in one email that fertilizers may be responsible for learning and developmental defects. Are many of these men and women, in their effort to earn for their families, who risk their lives crossing the river, irrigation canal, or the desert at the border, also inadvertently risk the future of their children? If these are not “undocumented” “illegal immigrants”, would there be a study made, a louder outcry? Or is this just an impression, not based on statistical analyses, on a pediatrician who has dedicated over 25 years of her adult life to the care of children in the United States?

I have a Hispanic last name but of Asian descent. I am a citizen of the world, an immigrant before becoming a citizen of this country, and my travels have helped me look at the human race as inherently one.

The People’s Health Agenda for the Aquino administration

The Visayas Primary Health Care Services, Inc (VPHCS) and the Alliance of Health Workers (AHW)-Cebu Chapter have joined the campaign for the adoption of the People’s Health Agenda by the Aquino administration.

It was launched last June by various national health groups including the Health Alliance for Democracy (HEAD), the AHW and the Council for Health and Development (CHD).

The People’s Health Agenda calls for the prioritization of people’s health and measures to improve health and health workers’ conditions.

The Agenda was presented by AHW National Secretary-general Jossel Ebesate during a forum sponsored by the VPHCS and AHW-Cebu Chapter on August 6, 2010 at the Visayas Community Medical Center (VCMC). The forum was attended by various health professionals, students and workers.





The Agenda includes among others, namely:

• Immediate release of 43 illegally-detained health workers arrested last February 6 in Morong, Rizal.
• Immediate increase of the national health budget to at least P 90 billion.
• Provision of free health services for the poor in all levels of health care.
• Provision of free essential medicines for the poor in rural health centers and public hospitals.
• Full implemention of salary increase for nurses, doctors and other health workers
• Full implementation of health workers benefits like Cost of Living Allowance (COLA), subsistence pay and hazard pay.
• A stop to privatization/commercialization of government hospitals.
• Provision of adequate number of health professionals like doctors, nurses, midwives and dentists to far flung areas nationwide.

The People’s Health Agenda shall be presented to President Aquino this month.

The VPHCS and AHW-Cebu lamented that patients and health workers have suffered long enough in the past years from decreasing health and hospital budget, inadequacy and increasing cost of public health services, and low salaries and inhumane working conditions that push most health professionals to go abroad. Poor patients are dying because they cannot afford medicines and health services even in public hospitals. Health workers are demoralized because they cannot give quality and effective health services despite their best efforts.




“Like most of our fellow Filipinos, we are hopeful that the new administration will listen and be responsive to our people’s health needs,” VPHCS physician Dr. Erlinda Posadas said.

The AHW is a 21,000-strong national organization of health workers from national government hospitals, rural health units, private hospitals, clinics and organizations. It has been in the forefront of health workers’ fight for health workers’ concerns and better services for patients. It is instrumental in pushing for the Magna Carta of Public Health Workers (RA 7305), the law that provides for economic benefits and rights to public health workers.