My Leadership My Leadership Journey Journey Bien Eli Nillos, MD Bien Eli Nillos, MD Former Doctor to the Barrios Former Doctor to the Barrios Municipality of Candoni, Negros Occidental Municipality of Candoni, Negros Occidental
Oct 31, 2014
My Leadership My Leadership JourneyJourney
Bien Eli Nillos, MDBien Eli Nillos, MDFormer Doctor to the BarriosFormer Doctor to the Barrios
Municipality of Candoni, Negros OccidentalMunicipality of Candoni, Negros Occidental
Bien Nillos, MDBien Nillos, MDM.D. – 2006, University of Saint La SalleM.D. – 2006, University of Saint La SalleBS Biology – 2002, University of Saint La BS Biology – 2002, University of Saint La
SalleSalleDoctor to the Barrio – 2007 – 2010, Doctor to the Barrio – 2007 – 2010,
DOH/Municipality of Candoni, Negros DOH/Municipality of Candoni, Negros Occidental.Occidental.
Currently an Associate Professor for Currently an Associate Professor for Family and Community Medicine Family and Community Medicine (University of Saint La Salle)(University of Saint La Salle)
Fellow, Zuellig’s HLMP TrainingFellow, Zuellig’s HLMP TrainingAlumnus, U.S. State Department Alumnus, U.S. State Department
(Northern Illinois University)(Northern Illinois University)Alumnus, Global Health Course, Alumnus, Global Health Course,
University of Tampere (Finland)University of Tampere (Finland)
Candoni, Negros OccidentalCandoni, Negros Occidental
Population: 21,000Population: 21,0004-hour bus ride from 4-hour bus ride from
Bacolod City, 1 Bacolod City, 1 and half hours and half hours away from away from Kabankalan CityKabankalan City
Surrounded by other Surrounded by other towns and cities towns and cities (CHICKS)(CHICKS)
Problems EncounteredProblems Encountered
Poor Health IndicatorsPoor Health Indicators
Inaccessible health Inaccessible health care servicescare services
Limited Human and Limited Human and Financial ResourcesFinancial Resources
Poor Health Seeking Poor Health Seeking BehaviorsBehaviors
Maternal Mortality Maternal Mortality per 1,000 LBsper 1,000 LBs
3.6
5.8
0.920.63
0
1
2
3
4
5
6
2006 2007
CandoniRegion 6National
Facility based deliveries – 24% in 2007Skilled birth attendant deliveries – 74% in 2007Top Causes of MM – post-partum bleeding, Pregnancy Induced Hypertension
Infectious (Pulmonary Infectious (Pulmonary Tuberculosis)Tuberculosis)
0
20
40
60
80
2006 2007
Case Detection Rate
Candoni
National
Cure Rate – 93% in 2007No med. Tech. – only 1 midwife microscopistPracticing TB DOTS but not Philhealth accredited
Infant Mortality Infant Mortality per 1,000 LBsper 1,000 LBs
26.5
10.1 9.2
0
5
10
15
20
25
30
2007
CandoniRegion 6National
Top Causes of Mortality: Severe Pneumonia, Severe Diarrhea
Compounding FactorsCompounding Factors
“The greatest intelligence is precisely the one that suffers most from its own limitations” – Andre Gide (Nobel Prize for Literature, 1947)
POLITICS
ACCESS
LACK OF…
““We are limited but we can push back the borders We are limited but we can push back the borders of our of our limitationslimitations” – Stephen Covey” – Stephen Covey
““Change will come Change will come when those who when those who have the resources have the resources learn that they do learn that they do not have all the not have all the answers…they need answers…they need to learn how to to learn how to listen.” – Desmund listen.” – Desmund TutuTutu
Alma Ata DeclarationAlma Ata Declaration
“The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.” - Alma Ata Declaration of 1978
COMMUNITY HEALTH INITIATIVES COMMUNITY HEALTH INITIATIVES PARTNERS (CHIP)PARTNERS (CHIP)
Members: Barangay Captains, Brgy. Kagawads for Health, SK, BHW Federation
Role: Coordinate all health program implementation at the barangay level, initiate community-based health programs through original approaches.
Relations and Advocacy Managers (RAM)Relations and Advocacy Managers (RAM)
Members: Teachers, Faculty-in-charge, church-based organizations, PNP and other NGO’s
Role: help in the promotion of health advocacies in schools and communities through integration.
Legislative Action Network (LAN)Legislative Action Network (LAN)
Members: Political leaders, councilors, department heads, NGO’s
Role: provide strong legislative support for health programs, influence policy in favor of health initiatives
MONITORING team (MONITOR)MONITORING team (MONITOR)Members: Program coordinators, DOH representative, PHO/CHD/Philhealth, Public health managers, MPDO, Budget Officer
Role: Monitor progress of initiatives, plot outcomes and results and provide feedback to community at large.
Engaging the CommunityEngaging the Community
Assembly of hilots and Assembly of hilots and revival of Women’s revival of Women’s Health TeamHealth Team
Legislative support – Legislative support – barangay ordinancesbarangay ordinances
Increased advocacy Increased advocacy and social awarenessand social awareness
Training of midwives Training of midwives and nurses and nurses (refresher’s course)(refresher’s course)
““There go my people. I must find out where they There go my people. I must find out where they are going so I can lead them.” ~ Alexandre are going so I can lead them.” ~ Alexandre Ledru-RollinLedru-Rollin
““Example, whether it be good or bad, has a powerful Example, whether it be good or bad, has a powerful influence” – George Washington, quoted from his letter influence” – George Washington, quoted from his letter to Lord Stirling (March 1780)to Lord Stirling (March 1780)
Upgrading A Local Upgrading A Local Health SystemHealth System
Part Two on Candoni CasePart Two on Candoni Case
Bien Eli Nillos, MDBien Eli Nillos, MD
Former Municipal Health OfficerFormer Municipal Health Officer
Consider this…Consider this…
All 3 components are essential. All 3 components are essential. Hardware = equipments, logistics, physical environmentHardware = equipments, logistics, physical environment
Software = local health system, predominant cultureSoftware = local health system, predominant culturePeopleware = ActorsPeopleware = Actors
Why “Upgrade?”Why “Upgrade?”
Excellent Hardware and Software but illiterate Peopleware
Excellent Software and Literate Peopleware but Poor Hardware
Excellent Hardware and Efficient Peopleware but Poor Software
Slow rendering of output
Useless, ImpotentFrustrated, Lost,
Apathetic
Community Health Initiative Community Health Initiative Partners (CHIP)Partners (CHIP)
Relations Advocacy ManagersRelations Advocacy Managers(RAM)(RAM)
Legislative Action Network (LAN)Legislative Action Network (LAN)
MONITORing teamMONITORing team
3.6
5.8
0.920.63
0
1
2
3
4
5
6
2006 2007
Maternal Deaths per 1,000 Lb
Candoni
Region 6
National
26.5
10.1 9.2
0
5
10
15
20
25
30
2007
Infant Deaths per 1,000 Lb in 2007
Candoni
Region 6
National
01020304050607080
2006 2007
TB Case Detection Rate
Candoni
National
No Botika ng Barangays
Dilapidated RHU
Low number of deliveries attended by skilled birth attendants
No indigents enrolled in Philhealth
High malnutrition rate
Internal and External EnvironmentsInternal and External Environments
Challenge: Motivation to work (feeling of insufficiency, routine work, professional jealousies)
Strategy: Treating them as partners, important contributors
Activities: Workshops, team building, SOP’s, assignment of program coordinators, trainings and seminars
Internal and External EnvironmentsInternal and External Environments
Challenge: direct interest Challenge: direct interest and attention to health and attention to health (dole-out mentality, (dole-out mentality, political patronage, etc)political patronage, etc)
Strategy: Validation and Strategy: Validation and affirmation of Vision – affirmation of Vision – hopes for Candoni.hopes for Candoni.
Approach: Gather Approach: Gather influential leaders in the influential leaders in the community, and community, and empowering of empowering of community through community through these leaders.these leaders.
Issue No. 1: Maternal Mortality Issue No. 1: Maternal Mortality RatioRatio
““Hardware” – Dilapidated RHU, BHS not Hardware” – Dilapidated RHU, BHS not capable of handling normal deliveries, lack capable of handling normal deliveries, lack of supplies, inaccessible puroks, sitiosof supplies, inaccessible puroks, sitios
““Software” – poor referral system, lack of Software” – poor referral system, lack of tracking system for pregnant clients, tracking system for pregnant clients, policies on policies on hilot hilot delivery, “cultural”delivery, “cultural”
““Peopleware” – predominance of TBA, no Peopleware” – predominance of TBA, no Women’s Health TeamWomen’s Health Team
Assembly of Assembly of HilotsHilotsIntegrating the TBA’s Integrating the TBA’s
in the “new set-up”. in the “new set-up”. Important partners Important partners
and collaborators and collaborators (WHT)(WHT)
Support of the Support of the Barangay CaptainsBarangay Captains
Barangay Barangay OrdinancesOrdinances
New Protocols for RHU New Protocols for RHU StaffStaff
9 barangays with 9 9 barangays with 9 midwivesmidwives
1 midwife-in-charge of 1 midwife-in-charge of DRDR
BHW catchment BHW catchment areas (atrition policy)areas (atrition policy)
SOP on referral SOP on referral systemsystem
Lifesaving skills and Lifesaving skills and Perineal suturingPerineal suturing
Upgrading RHU/ Upgrading RHU/ equipping BHSequipping BHS
Selling the Idea to the CommunitySelling the Idea to the Community
““Alkansiyang Alkansiyang Pampamilya”Pampamilya”
““Buntis Baby Bags”Buntis Baby Bags”
24
58
5.8
7479
0
85 87
00
10
20
30
40
50
60
70
80
90
2007 2008 2009
FBD
SBA
MMR
FBD = Facility Based Delivery
SBA = Skilled Birth Attendant
MMR = Maternal Mortality Ratio
THE OUTCOMES
26.5
10.19.2
21.8
4.14
0
5
10
15
20
25
30
2007 2008 2009
Candoni
Region 6
National
Infant Mortality Rate Trend
Issue No. 2: Inaccessibility to Issue No. 2: Inaccessibility to Cheaper MedicinesCheaper Medicines
Hardware: “geographically challenging”Hardware: “geographically challenging”
Software: “dole-out mentality” “Credit is Software: “dole-out mentality” “Credit is good because I don’t have cash” mottogood because I don’t have cash” motto
Peopleware: “Barangay captains hesitant to Peopleware: “Barangay captains hesitant to start up a BnB due to fear of lack of start up a BnB due to fear of lack of sustainability” sustainability”
Establishment of Botika ng Establishment of Botika ng Barangays 9/9Barangays 9/9
Establishment of Botika ng Establishment of Botika ng Barangay Monitoring Barangay Monitoring Team: DOH Team: DOH representative, Municipal representative, Municipal Accountant, BnB Operator, Accountant, BnB Operator, Nurse Coordinator, Brgy. Nurse Coordinator, Brgy. CaptainCaptain
Under the LHB Under the LHB
Issue No. 3: TB or not TBIssue No. 3: TB or not TB
Hardware: “dilapidated RHU, Microscopy Hardware: “dilapidated RHU, Microscopy lab”lab”
Software: “while practicing TB DOTS, lack of Software: “while practicing TB DOTS, lack of aggressiveness in tracking symptomatics”aggressiveness in tracking symptomatics”
Peopleware: “less motivated(?) staff” Peopleware: “less motivated(?) staff” “community unaware”“community unaware”
One additional One additional midwife trained midwife trained as Microscopistas Microscopist
Aggressive TB Aggressive TB awareness awareness campaigncampaign
Lung Month Lung Month CelebrationsCelebrations
Philhealth Philhealth AccreditationAccreditation
TB DOTS ProgramTB DOTS Program
0102030405060708090
100
2007 2008 2009
CDR
Cure Rate
CDR = Case Detection Rate
My Role, The PontiffMy Role, The PontiffLatin Latin PontifexPontifex – pons (bridge) + facere (to make) = “bridge builder” – pons (bridge) + facere (to make) = “bridge builder”
"I pray that I may never meddle, interfere, dictate, give advice that is not wanted, or assist when my services are not needed. If I can help people, I'll
do it by giving them a chance to help themselves; and if I can uplift or inspire, let it be by example,
inference and suggestion, rather than by injunction and dictation. That is to say, I desire to be Radiant
-- to Radiate Life!"-- Elbert Hubbard
Struggles/ChallengesStruggles/Challenges
““Anything worth doing is Anything worth doing is difficult” – Patch Adamsdifficult” – Patch Adams
Quo Vadis, Doctor?Quo Vadis, Doctor?
“I seldom end up where I wanted to go, but almost always end up where I need to be.” – Douglas Adams
“It is the time you have wasted for your rose that makes your rose so important.“ – The Fox (The Little Prince, Chapter 21)