Philippines: How to Attract People to Health Centers
The town of Casiguran in Sorsogon province has shown that if you build a quality health facility that makes quality services accessible to the poor, the people will come.
In Sorsogon, the average family size is five and abortions gone wrong are among the top ten causes of hospitalization.
Meanwhile, the devolution of health care to LGUs under the Local Government Code of 1991 has not improved services to the most needy, due to the lack of preparation at the local level on the basics of health delivery and health financing.
The Second Women’s Health and Safe Motherhood Program demonstrates a sustainable, cost-effective way to increase access of poor women to quality reproductive health services and enable them to safely attain their desired number and spacing of children.
SORSOGON, PHILIPPINES, March 18, 2009 - “Health-seeking behavior is modified if you have good facilities. Caring service and good equipment will make people come to the health center,” said Dr. Salvador Destura, municipal health officer of Casiguran, a fourth class municipality in Sorsogon province. A graduate of the University of the Philippines College of Medicine’s step-ladder curriculum, he placed tenth in the professional licensing exams for doctors and second in the exams for midwives in 2004.
In Casiguran, Mayor Ester Hamor built a spacious new rural health unit (RHU) and equipped it with the right equipment and efficient health services, in order to qualify as a Basic Emergency Obstetric Care (BEMOC) facility under the World Bank-funded Second Women’s Health and Safe Motherhood Program (WHSMP-2). The health center has an air-conditioned birthing room that can handle natural and uncomplicated births, and two recovery rooms. It also provides a newborn screening service, which is unheard of anywhere else in the province.
Casiguran is now a leader in maternal health services in Sorsogon.
Lack of LGU preparation
As of July 2008, in Sorsogon, the average family size is five and abortions gone wrong are among the top ten causes of hospitalization. Meanwhile, the devolution of health care to LGUs under the Local Government Code of 1991 has not improved services to the most needy, due mainly to the lack of preparation at the local level on the basics of health delivery and health financing.
Piloted in the provinces of Sorsogon and Surigao del Sur, WHSMP-2 demonstrates a sustainable, cost-effective way to increase access of poor women to quality reproductive health services and enable them to safely attain their desired number and spacing of children by building the capacity of the Department of Health to help LGUs manage and sustain the delivery of WHSM.
Changing behavior
WHSMP-2 aims to change the behavior of women and men of reproductive age, health workers, LGU executives and the entire community. Through advocacy, communication and performance-based grants (PBG), it encourages traditional birth attendants and barangay health workers to undergo training in childbirth and encourage women to deliver in BEMOC facilities. Mothers are given financial incentives for transportation and other costs of facility-based deliveries. LGUs are provided PBGs for enrolling poor families in PhilHealth and ensuring that they have enough essential supplies for women’s health.
In the Casiguran BEMOC, Dr. Destura has a trained staff of four nurses, 10 midwives, a dentist, a sanitary inspector and a medical technologist. The midwives, who are the first liners in the delivery of health services, fan out to the barangays to attend to the needs of the communities and encourage women to have their babies at the health facility.
Facility-based births
Facility-based deliveries began in Casiguran in October 2006, aided by an ordinance prohibiting mothers from giving birth at home. From 492 home births in 2005, the number went down to 109 in 2007. Of the 14 municipalities and one city in Sorsogon, Casiguran had the highest percentage of facility-based birth deliveries – 603 or 93.2 percent of all childbirths the area in 2007. In contrast, of 15,630 babies born in Sorsogon in 2007, only 41.6% were born in formal facilities.
“There is no reason why the women shouldn't come here,” says Dr. Destura. “If they are PhilHealth members, they can give birth for free. If they are non-members, they pay only from P300 to P500.”
Birth plan
Every mother-to-be who comes to the Casiguran RHU is provided a ‘Birth Plan’, a complete record of her pregnancy along with a checklist of danger signs and things to consider before, during and after she gives birth. After giving birth, the women are given counseling regarding family planning, breast feeding and other safe motherhood practices, and are sent home after 24 hours.
Casiguran's reputation for WHSM has spread. Women from surrounding towns opt to give birth in its clean and airy lying-in clinic. Nursing students from Legazpi come for exposure and training, and other LGUs visit to observe its facilities and services.
Casiguran has shown that if you build a quality facility that makes quality services accessible to the poor, the people will come.
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