“Health for all”: The staying power of community-based health programs

By Aurora Fernandez, R.N.

Rosario was quiet and subdued as she slowly walked towards us. Coming closer, it was plain to see how pale and weak she was. Three weeks earlier, she had agonized through 14 hours of breech childbirth, soaking five blankets with blood and without a midwife, delivered a stillborn baby. Shortly afterwards, the midwife showed up to assess the afterbirth and without any compunction, asked for P100.00.

The 33-year-old mother of four, complacent that her previous deliveries had been problem-free, had no prenatal care, even though her husband had urged her several times to see the doctor at the nearby Barangay Health Unit.

Now she was bleeding again, with blood clots the size of fists. She urgently needed hospitalization for a blood transfusion and dilatation and curettage (D & C).

But how to pay for it? Her husband was a gravedigger at the Liloan cemetery, and when there were no funerals, he cut down and pounded buli (a palm tree) trunks all day long to produce enough landang (palm flour) for binignit (a dessert with coconut milk). Lack of money meant their 12-year-old eldest son didn’t start school until last year.

Despite her protests, Rosario was persuaded to go to Vicente Sotto Memorial Medical Center by volunteers and staff of the Visayas Primary Health Care Services (VPHCS). Dr. Erlinda Posadas of VPHCS admitted her and coordinated her treatment, even obtaining the medications and supplies on credit from an outside pharmacy. Working with the radiologist and OB-GYN physician, Dr. Posadas made sure the patient was promptly seen and a successful D & C performed at 11:00 PM the same day, following an ultrasound which showed placental fragments. Since Rosario’s husband had a fever, a friend, Julie, stayed with her overnight at the hospital.

Julie described the chaos at the emergency room that night as a scene straight out of Dante’s Inferno: nightmarish, frightening, and harrowing, with bloody patients moaning and screaming in pain while others waited desperately for medical attention. Two other postpartum patients lay on cots in the ER hallway while their families tried to find the money for a D&C. It was the kind of moral dilemma that drove doctors to despair. But Julie was also left with the unforgettable image of a no-nonsense doctor – Dr. Erlinda Posadas – whose compassion for a patient far exceeded ordinary expectations.

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Trying to make sense of the Philippines’ health care system where “those with the greatest need have the least access” is an exercise in futility. Barely propped up by Philhealth, the government health insurance system only covers 15 percent of hospitalization, medications and selected outpatient procedures, but NOT regular preventive medical check-ups – and the patient still gets slapped with a huge bill on discharge from the hospital.

Rosario’s designation as a charity case meant no doctors’ fees, but other services had to be paid for. Julie helped her obtain reimbursement for the loaned medications from the municipal government, but bureaucratic red tape at the local DSWD (Department of Social and Welfare Services) forced her to return three times before finally getting financial aid.

With the support of VPHCS, Rosario did not have to pay anything, but the whole episode was sobering. It pointed to the need for a rational health care system accessible to those without the means to pay, throwing into sharp relief the necessity for systematic reproductive health education and outreach not just to women of childbearing age and adolescents, but to entire barangays and local government units (LGUs). At the very least, it showed the need for easier access to financial assistance in LGUs -- services paid for by tax monies.

If not for timely intervention from VPHCS, Rosario would now be another statistic in the unrelenting maternal mortality data of this country, where eleven women die from maternal causes every single day, a tragic loss which not only has a profound personal and societal impact but also has economic consequences for years to come. Rosario’s stillborn infant did become a statistic: Philippine infant mortality rate remains at 34/1000 (Thailand’s is 18.23/1000).

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What is Visayas Primary Health Care Services and what does it do? As a community-based health program (CBHP), VPHCS, which has been in existence for 30 years, provides free or low-cost health care services to indigents in urban and remote rural areas in Cebu and Bohol. It is a limited safety net for those who fall through the cracks of government health care, but its proven ability to network with other health care practitioners – the specialists in tertiary care, for example – tremendously facilitates provision of services. One of its strong points is its ability to navigate the bureaucratic hospital maze and coordinate essential services. Another is its holistic orientation which includes the promotion of integrative medicine and appropriate technology, specifically acupuncture, homeopathy, reflexology and herbal meds.

In July 2006, VPHCS initiated a reproductive health program called YO! Lead or Youth on the Lead. Funded by Planned Parenthood Federation of America, YO! works with youth organizations in schools and local communities, developing leadership and life skills and providing information and access to reproductive health care services in office clinics and mobile medical missions.

CBHPS embody the principles of primary health care declared at the 1978 Alma Ata International Conference on Primary Health Care: fair, equitable and efficient health care services; community participation in decision-making; and an emphasis on education and preventive health. These principles are evident in the medical missions requested by various barangays and the annual training and skills update of community health workers.

CBHPs work without fanfare and with modest remuneration, their vision carried out by dedicated and selfless staff and volunteers in numerous communities throughout the Philippines - and in the United States. Seminal and groundbreaking, CBHPs deserve a place in the country’s Bantayog ng mga Bayani (Monument to Heroes) for their proven record of public service which has saved – and continues to save – the lives of countless Filipinos.

Aurora Fernandez, R.N. is a retired public health nurse based in California who believes that health care is a human right that should be accessible to everyone regardless of ability to pay. For her, a healthy, productive population strengthens and contributes to nation-building.