Establishing Basic Health Services

United Nations ESCAP
HRD Section

Establishing Basic Health Services

The work of the Institute for Primary Health Care of the Philippines

Like in many other countries of the region, basic health services are still not available for all in the Philippines. This results in poor public health standards, a problem that needs to be and have been addressed. Here is a description of the work of the Institute of Primary Health Care (IPHC).

This programme is set against a background of poverty and instability. The area in which it operates is characterized by very low income levels, high infant mortality rates, high levels of illiteracy, poor public health standards and a strong prevailing sense of apathy regarding community standards. Several specific health problems, such as schistosomiasis arose from a lethal combination of poor public health standards and a high level of ignorance concerning health matters generally. Many communities possessed no access to health services.

The second most significant aspect of the background was the high level of unrest. An insurgency movement was strong in the province, resulting in often violent incidents followed by government repressive action. An unfortunate consequence of the unrest was that government officers tended to avoid many areas, thus effectively excluding such areas from many services. A further consequence was that community work was always at risk of being seen as subversive.

It was in this context that the IPHC was founded in 1978. The Institute was established as one of four departments of the Davao Medical School Foundation, being in effect the community service component of the Foundation.

IPHC’s rural programme was aimed at illiteracy, malnutrition and child mortality among the poorer families in the region. Although in one sense the basic purpose of the Institute was to improve health standards, it effectively adopted a relatively comprehensive approach to rural development.

In addition to its health focus, its programmes focused on community development generally, agricultural extension, the provision of credit and child care. This range of activities was, however, effectively held together by a key focus on training. In this study, rather than take one programme only for analysis, material is drawn from several programmes to illustrate the strategies which rendered the work of the Institute so effective.

The IPHC's work emanated from and was driven by a team of workers whose nature and quality were a key to success. The Institute has been able to attract project officers of a high calibre and with a strong and very obvious commitment to rural development. These project officers are then welded into a strong team under inspiring and dynamic leadership.

The Institute recognizes the essential roles of, on the one hand, the people's organizations (POs) and smaller NGOs operating at the local level, and it seeks to build, strengthen and work with these organizations. On the other hand, the Institute recognized the importance of the government sector, in terms both of national and provincial governmental agencies entrusted with specific functions in the area of service delivery, and of local government structures and their key roles.

The Institute was established to develop services related to primary health care and located within a medical foundation. Despite the very obvious health needs in the region, the Institute never saw its task as confined to health. Its aims included reducing the levels of child mortality and upgrading both public health conditions and health services provision; however, the issue was whether such aims could be achieved best by a narrow focus on health or a broader focus on development, and clearly the Institute saw the latter as the preferable response.

One important project that the Institute conducted was named the CHILD Project. CHILD was a health delivery-community organization project designed to reduce infant and young child mortality. The population covered by project was family breadwinners being farmers, labourers, fishermen and small businessmen. More than 41 per cent of this entire population was 14 years of age or younger. The prevailing infant mortality rate was 50.4 per 1,000 live births.

A data base, containing births, deaths, human waste disposal, garbage disposal, water quality, nutritional status of children, immunisation status, family planning arrangements and the utilisation pre-natal services, was updated quarterly and displayed on a public community data board. This proved to be a very useful device in passing on vital information to the local communities in order to promote general awareness. The data board also acted as a social pressure on families, who were somewhat negligent in meeting public health standards.

The net effect of CHILD was that, in the period of 1984 to 1991 when the project operated, some 282 project communities each implemented between three and 20 projects. Outcome indicators verified the perceived direct benefits of the programme. Overall, health status improved by 17.3 per cent, use of safe water went from 17.4 to 61.3 per cent, and immunisation of young children rose from 30.1 to 57.2 per cent.

Taken from the publication: “Making an Impact: Innovative HRD Approaches to Poverty Alleviation”, ESCAP, 1997