Primary Health Care

Reconstructing the Functions of Government:

The Case of Primary Health Care in the Philippines

By: Victoria A. Bautista (2003)

Prepared by:

Jerry L. Roxas - Discussant

Professor: Dr. Jo B. BitonioDPA 102 Philippine Administrative System – Ist Semester 2011

LNU Dagupan City

Definition of Primary Health Care (PHC):

World Health Organization (WHO) defines PHC as essential care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford at every stage of development.

Background:

Primary Health Care (PHC) was declared during the First International Conference on Primary Health Care held in Alma Ata, Russia on September 6-12, 1978 by the World Health Organization (WHO). The goal was “Health for All by the Year 2000”. This was adopted by the in the Philippines through Letter of Instruction 949 signed by President Marcos on October 19, 1979 and has an underlying theme of “Health in the Hands of the People by 2020.”

• This approach has influenced many countries including the Philippines. Its innovativeness is indicated by the call for participatory development management since community members are expected to take an active role in managing their own health requirements, instead of depending on the government. PHC also gives importance to the participation of various sectors of government and the private sector in local health activities.

Periods in PHC Implementation and Approaches to Reconstruction

Pre-devolution Institutionalization Devolution

PRE-DEVOLUTION Pilot Testing Stage: A.Area Selection on the Basis of NeedB.Social PreparationC.Identification of VolunteersD.Creation of Intersectoral Structures

A. Area Selection on the Basis of Need

The introduction of PHC begun in 1979 by pilot testing the methodology in one province in each of the 12 regions.

In 1982 the UPCPA revealed an important approach to ensure the outreach of the government to the underserved areas. This was done through the selection of the 12 provinces on the basis on “need” such as;

•Low health personnel ratio, absence of any province-wide PHC activities and inaccessibility to the regional centers;

•Receptiveness of the local government since a new methodology was to be implemented necessiting its support;

•Presence of functional organizations for managing projects at the provincial and municipal levels;

•Peace and order.

B. Social Preparation

The DOH conducted preparatory activities among health and other sectoral implementers for effective utilization of resources.

Trainers were also identified at the provincial levels in order to echo the essence of PHC at the municipal level.

C. Identification of Volunteers

An important component of preparatory activities for PHC was the identification and mobilization of voluntary health workers(VHW’s).

D. Creation of Intersectoral Structures

The government mobilizes PHC committees at the national and local levels. e.g. •World Vision – conducted orientation seminars for BHW’s

•UP Institute of Health Science – served as the institutional base for health manpower training

•Davao Medical School Foundation – involved in the training of BHW’s in region XI

Institutionalization

A.Bureaucratic Innovations

B.Identification/Preparation of Volunteers

C.Validation of Indigenous Methodologies

D.NGO's as Conduits of Funds and as chief Mobilizers for PHC

E.Incentives for Community Involvement

A. Bureaucratic Innovations

• 1981 – under President Marcos, nationwide implementation of PHC took place through the vigorous effort of the top leadership of Minister Jesus Asurin.

• 1982 – administrative innovations started to put in place which could facilitated the implementation of

PHC. This enabled local field offices of then Ministry of Health to have greater unity in pursuing health activities.

B. Identification/Preparation of Volunteers

Three years after the nationwide orientation programs for health workers, PHC was initiated in 99% of the barangays.

1982 - 1 BHW/70 households1986 – 1 BHW/29 households

C. Validation of Indigenous Methodologies

•Herbal gardening was encourage to solve the existing shortage of supplies and high cost of drugs. This program was supported through the dissemination of manuals, seedlings and plants.

•Oral Rehydration Therapy using oral rehydration (ORESOL) was a key innovation by the Ministry of Health. This simple inexpensive solution was proven effective in preventing diarrhea-related deaths.

•Strengthening the Botika sa Barangay (BSB).

D. NGO's as Conduits of Funds and as Chief Mobilizers for PHC

•In 1986 President Corazon Aquino gave importance to NGO’s in the promotion of PHC.

•The DOH experimented new approach which is the Partnership for Community Health Development (PCHD) which entailed financial assistance to NGO’s which serves as conduits of funds to mobilize partnership effects among Local Government Units (LGU’s), NGO’s and peoples organizations to undertake health and related development activities in the barangays.

•In 1991, the government issued Administrative Order No. 112 in the 1st National Convention for NGO’s which conducted by the DOH. It is a policy on Collaboration between Public and Private Sectors on Health Policies and Programs.

•According to studies from 1991-1995, the impact of PCHD pointed to the reduction of preventable diseases. e.g. malaria - 50% acute respiratory infection – 42%

E. Incentives for Community Involvement

•In the year 1994, various incentives and measures were implemented by the DOH; this included the provision to BHW’s such as free medical and dental check-up, bloodtyping, supply of drugs and medicines, laboratory examination and tetanus toxiod immunization.

•Income generating projects were also encourage through the provision of financial grants to BHW’s for livelihood.

DEVOLUTION

Direct responsibility for PHC is now assumed by mayors of municipalities and cities due to the Local Government Code of 1991.

Implications of Devolution on PHC

•Lack of understanding and appreciation by local chief executives of health services of PHC as an innovative strategy.

•The government launched the Minimum Basic Needs (MBN) approach as the management technology for supporting the Social Reform Agenda to improve the quality of the poorest of the poor.

Mechanisms for Propagating PHC Under Devolution

A.Capability BuildingB.Support to LGU's Through NGO'sC.Policy FormulationD.Research/Documentation

A. Capability Building

•The UPCPA assists in the conduct of seminars to convey the meaning of PHC.

•Under Ramos administration, the DOH had strong commitment to enforcing the “health in the hands of the people.” Strong advocates of PHC among professional civil servants urged the continuation of this motto.

B. Support to LGU's Through NGO's

•The DOH sustains its support to PCHD in order to provide assistance to LGU’s not able to employ participatory method in their area.

•Retained also by the DOH to propagate PHC was the provision of support for innovative strategies.e.g. The grant to cooperatives to engage in the operation of drugstore to reduce the cost of drugs in a locality.

C. Policy Formulation

•BHW’s Incentives Act or Republic Act 7883 of 1995

-directing the LGU’s to provide subsequent allowance for BHW’s as they cater to hazardous areas.

D. Research/Documentation

Due to lack of information regarding the status of PHC implementation, the government has adopted the conduct of researches subcontracted to private institutions to determine the status of PHC.

Problems/IssuesThe implementation of PHC has not been spared from

problems and difficulties.

•Lack of political will of the top leadership of the DOH for the continued implementation of PHC.

•Passage of BHW’s Incentives Act which violated the principle of volunteerism and could be a tool for politicking by local executives since the volunteer workers could beholden to them instead of the community.

•The transfer of responsibility of PHC to local executives under devolution is not easy. PHC could not be fully achieved if the bureaucracy itself is not empowered.

Reference: Introduction to Public Administration

A Reader 2nd Edition

National College of Public Administration & Governance

University of the Philippines Diliman, Quezon City, 2003