User:Lorraineador/sandbox

= Lorraine Ador Dionisio's Sandbox =

Area (** indicates my additions to article)
= Health in the Philippines = Health care in the Philippines varies with private, public and barangay health centers (many in rural municipalities). Most of the national burden of health care is taken up by private health providers.

Overview
** The Ministry of Health, or the Department of Health, provides national health policies and standards.The the provision of health services is overseen by local government units (LGUs) and private sector agencies, both of which are responsible for providing health services to communities. Health services are brought by barangay health units, rural health units, city health offices, municipal or district hospitals, provincial and regional hospitals, and medical centers. **

In 2000 the Philippines had about 95,000 physicians, or about 1 per 800 people. In 2001 there were about 1,700 hospitals, of which about 40 percent were government run and 60 percent private, with a total of about 85,000 beds, or about one bed per 900 people. The leading causes of morbidity as of 2002 were diarrhea, bronchitis, pneumonia, influenza, hypertension, tuberculosis, heart disease, malaria, chickenpox, and measles. Cardiovascular diseases account for more than 25 percent of all deaths. According to official estimates, 1,965 cases of human immunodeficiency virus (HIV) were reported in 2003, of which 636 had developed acquired immune deficiency syndrome (AIDS). Other estimates state that there may have been as many as 9,400 people living with HIV/AIDS in 2001.

Expenditures on health in 2002 totaled about USD$2.2 billion, or about 2.9 percent of gross domestic product (GDP). Government expenditures on health accounted for only about 15 percent of total health expenditures, 30 percent of per capita health expenditures, and about 0.9 percent of all government spending. Per capita health expenditures in 2002 totaled USD$28, of which government spending accounted for USD$8. Both total and per capita expenditures on health have continued to decline since at least 1990, leading to a decrease in the share of GDP attributable to health expenditures. The main cause of this decline has been due to the high population growth rate. The total government share in healthcare spending has steadily declined and less money is available to spend per person from both government and private sectors.

History
** The 1991 Republic Act No 1760, or the Local Government Code, gave local health boards the authority over decisions about the delivery of health services and financial management. In 1995, the National Health Insurance Act led to the implementation of universal health coverage as it was among the first compulsory health insurance systems in developing countries. It established the Philippine Health Insurance Corporation as a form of single payer national health insurance. **

In response to the Millennium Development Goals' focus on maternal and child health, the Philippines began the National Demographic and Health Survey in 1968 to assess the effectiveness of public health programs in the country.

Barriers to Healthcare
** Poor communities suffer a higher burden of disease due to inequities in access to services and health status. Since financing for local government units (LGUs) often vary and the benefits package for insurance plans may be unfavorable, some communities face difficulties accessing public health services. Shifting the responsibility of healthcare from the federal government to the local governments has increased local authority and has made communities susceptible to lack of access to basic services. In addition, most healthcare payments are made out of pocket, especially when receiving care from privately owned institutions. Barangay health stations serve as primary public health facilities and are staffed by doctors, nurses, midwives, and barangay health volunteers. **

** Large areas of the Philippines do not have daily access to any pharmaceuticals due to high drug prices. Medicines are supplies account for the largest share of household medical expenses, at 49%, compared to 33% share of bills for hospital stay and 10% for consultation and treatment. **

The proposed National Health Budget for 2010 is P28 billion, about US$597 million, or about 310 pesos (US$7) per person in the Philippines. Generic medicines in the Philippines are highly competitive versus branded medicines due to the high out of pocket expenses in the Philippines in terms of value even with the 81% coverage of the country's healthcare system.

Miscellaneous
Health professionals, such as doctors, nurses, nursing aides, midwives, caregivers, and health administrators can all train for their profession in the Philippines. However, those who migrate to different countries often encounter difficulty practicing abroad.

There is no requirement in the Philippines for causes of death to be medically determined prior to registration of a death, so national statistics as to causes of death in the Philippines cannot be accurately substantiated. In the provinces, especially in places more remote from registries, births and deaths are often not recorded unless some family need arises, such as entry into college. When there is no legal process needed to pass on inheritance, the recording of deaths is viewed as unnecessary by the family.

= Barangay Health Volunteers = The Barangay Health Volunteer, also known as Barangay Health Worker, is a category of health care providers in the Philippines. They undergo a basic training program under an accredited government or non-government organization, and render primary care services and treatments for minor injuries and illnesses in the community. They provide services such as first aid, maternal, neonatal, and child health, and community-based interventions including immunization clinics for barangays (local neighborhoods).

History
** With the decentralization of healthcare through the 1991 Local Government Code, the responsibility of delivery of primary health services were transferred from the central government to locally elected provincial, city, and municipal governments. Health services were previously funded and managed by the Department of Health but were transferred to the local governments after the devolution of the healthcare system. **

Training and practice
Barangay Health Workers are accredited to function as such by the local health board in accordance with the guidelines promulgated by the Philippines Department of Health, as defined in Sec. 3 of Republic Act No. 7883. This act, also known as "Barangay Health Workers' Benefits and Incentives Act of 1995", recognizes the need for primary health care and organizes health workers to promote health empowerment.

** Barangay health workers are a type of community health workers and act as health advocates and educators within their communities. ** They live in the communities they serve and receive about five weeks of training, ranging from administering immunizations, weighing children, birthing services, etc. They provide information, education and motivation services for primary health care, maternal and child health, child rights, family planning and nutrition.

On average, each volunteer is expected to work with around 20 families in their community. However, the scarcity of trained individuals has narrowed down the number of volunteers, especially in some remote areas, where only one or two volunteers service an entire barangay.

Research
Research by Fe Espino at the Research Institute for Tropical Medicine on dengue prevention in the Philippines shows how community trust of the BHV is vital to the success of behavior change programs. In 2010, the number of dengue cases in the Philippines rose from 37,101 in 2006 to 118,868. Dengue fever is caused by a virus transmitted by mosquitoes which are born in still water. Due to water shortages, households are forced to store water throughout the year. Espino’s research team engaged the local Barangay Health Workers (BHWs) to introduce a household water container management system to control dengue in 2 communities in "Masagana City" in Metro Manila.

In both village ‘A’ and ‘B’, BHWs were trained to teach households to inspect water containers for immature mosquitoes. An instructional guide was provided along with a container management checklist, collected during monthly visits. The team also provided a video of dengue control techniques. Village A, however, encountered many problems and there was a poor response to the program. In Village B participants reported not only that the visits made residents more aware of dengue control, but they were more inclined to take action. Although behavior change results have not yet been reported, it appears the difference is that the BHWs in Village B were more active and more trusted by the community. This shows that when engaging change agents, it’s important to understand both how the community feels about them and how they feel about their community.

Limitations
** Despite the efforts of barangay health volunteers, they are constrained within the political leadership of local government units. There is a perception that barangay health stations provide low-quality health services and have low-client satisfaction. With funding limitations, barangay health stations struggle with lack of medicines and supplies, long wait times, declines in quality of facility infrastructure, and lack of proper training and staffing. The rural poor are the most susceptible to poor sanitation, malnutrition, and lack of hygiene efforts. These communities that depend heavily on barangay health services are affected by political, social, and economic decisions made by local authorities.

Volunteers may often be limited in knowledge due to new advances in medicine and lack of proper training. Training is crucial for barangay health workers to improve their health knowledge and competency and provide the best quality care.**

Sector
= Community health worker = Community health worker (CHW) are members of a community who are chosen by community members or organizations to provide basic health and medical care to their community capable of providing preventive, promotional and rehabilitation care to these communities. Other names for this type of health care provider include village health worker, community health aide, community health promoter, and lay health advisor.

** Community health workers contribute to community development and can help communities improve access to basic health services. They are most effective when they are properly trained to provide information and services to the community. Community health workers are the most promising form of delivering health services to resource-constrained areas. They are seen as secondary health services in most low-income countries are available as a service to the community. **

History
** Comments: should i separate them by country sub-headings**

It is unclear where the usage of community health workers began, although China and Bangladesh have been cited as possible origins. Melinda Gates, co-founder of the Bill & Melinda Gates Foundation, said the nongovernmental organization BRAC in Bangladesh "pioneered the community health worker model."Catherine Lovell writes that BRAC's decision to train locally recruited paramedics was "based on the Chinese barefoot doctor model then becoming known worldwide." **comment: not cited**

Scientific medicine has evolved slowly over the last few millennia and very rapidly over the last 150 years or so. As the evidence mounted of its effectiveness, belief and trust in the traditional ways waned. The rise of university-based medical schools, the increased numbers of trained physicians, the professional organizations they created, and the income and attendant political power they generated resulted in license regulations. Such regulations were effective in improving the quality of medical care but also resulted in a reduced supply of clinical care providers. This further increased the fees doctors could charge and encouraged them to concentrate in larger towns and cities where the population was denser, hospitals were more available, and professional and social relationships more convenient.

In the 1940s Chairman Mao Tse Tung in China faced these problems. His anger at the "urban elite" medical profession over the maldistribution of medical services resulted in the creation of "Barefoot doctors". Hundreds of thousands of rural peasants, chosen by their colleagues, were given rudimentary training and assigned medical and sanitation duties in addition to the collective labor they owed the commune. By 1977 there were over 1.7 million barefoot doctors. As professionally trained doctors and nurses became more available, the program was abolished in 1981 with the end of agricultural communes. Many Barefoot Doctors passed an examination and went to medical school. Many became health aides and some were relieved of duty.

Brazil undertook a medical plan named the Family Health Program in the 1990s that made use of large numbers of community health agents. Between 1990 and 2002 the infant mortality rate dropped from about 50 per 1000 live births to 29.2. During that period the Family Health Program increased its coverage of the population from 0 to 36%. The largest impact appeared to be a reduction of deaths from diarrhea. Though the program utilized teams of physicians, nurses and CHWs, it could not have covered the population it did without the CHW. Additionally, there is evidence in Brazil that the shorter period of training does not reduce the quality of care. In one study workers with a shorter length of training complied with child treatment guidelines 84% of the time whereas those with longer training had 58% compliance.

Iran utilizes large numbers of para-professionals called behvarz. These workers are from the community and are based in 14,000 "health houses" nationwide. They visit the homes of the underserved providing vaccinations and monitoring child growth. Between 1984 and 2000 Iran was able to cut its infant mortality in half and raise immunization rates from 20 to 95%. The family planning program in Iran is considered highly successful. Fertility has dropped from 5.6 lifetime children per woman in 1985 to 2 in 2000. Though there are many elements to the program (including classes for those who marry and the ending of tax incentives for large families), behvarz are extensively involved in providing birth control advice and methods. The proportion of rural women on contraceptives in 2000 was 67%. The program resulted in profound improvement in maternal mortality going from 140 per 100,000 in 1985 to 37 in 1996.

The Government of Liberia launched the National Community Health Assistant Program in 2016 to accelerate progress towards universal health coverage for the most vulnerable populations, especially those in remote communities. Liberia's program seeks to transform an existing cadre of unpaid and poorly coordinated CHWs into a more effective workforce by enhancing recruitment, supervision and compensation. The health ministry has organized a coalition of funding and implementation partners to support this new program, which aims to train, supervise, equip and pay 4000 Community Health Assistants, supported by 400 clinical supervisors, to extend primary care services to 1.2 million people living in remote rural communities.

Limitations
In many developing countries, especially in Sub-Saharan Africa, there are critical shortages of highly educated health professionals. Current medical and nursing schools cannot train enough workers to keep up with increasing demand for health care services, internal and external emigration of health workers, deaths from AIDS and other diseases, low workforce productivity, and population growth. Community health workers are given a limited amount of training, supplies and support to provide essential primary health care services to the population. Programs involving CHWs in China, Brazil, Iran and Bangladesh have demonstrated that utilizing such workers can help improve health outcomes for large populations in under-served regions.[citation needed] "Task shifting" of primary care functions from professional health workers to community health workers is considered to be a means to make more efficient use of the human resources currently available and improving the health of millions at reasonable cost.

Scope of Programs
** Comments: should I create country sub-headings

The World Health Organization estimates there are over 1.3 million community health workers worldwide. In addition to the large-scale implementation by countries such as China, Brazil, and Iran, many countries have implemented CHW programs in small-scale levels for a variety of health issues.

In India, community health workers have been utilized to increase mental health service utilization and decrease stigma associated with mental illness. In this program respected female members of the community were chosen to participate. All of the women were married, came from a good social standing, displayed a keen interest in the program, and were encouraged by their family to participate. The women chosen were then trained in identification and referral of patients with mental illnesses, the common myths and misconceptions prevalent in the area and in conducting community surveys. The training lasted 3 days and included lectures, role plays and observation of patient interviews at the psychiatry outpatient department at St. John's Medical College Hospital. A population of 12,886 were surveyed using a brief questionnaire. Out of this population, 574 were suspected patients. Out of this 242 suspected patients visited the clinic after follow up from the community health worker. Also in India, The MINDS Foundation has developed a grassroots program targeted at providing mental health services to rural citizens. They leave the responsibility in the hands of local rural citizens who are trained as Community Mental Healthcare Workers (CMHWs).

In Tanzania, village health workers were part of a community-based safe-motherhood approach. The VHWs assisted pregnant women with birth planning, which included timely identification of danger signs, preparation, and accumulation of two or more essential supplies such as soap, razors, gloves for clean delivery, and mobilizing household resources, people and money to manage a possible emergency. Approximately one year after the CBRHP's major interventions ceased in these communities, most of the VHWs continued to do health promotion by visiting pregnant women, teaching them about birth planning and danger signs, and assisting them in obtaining both prenatal and obstetric services. Local VHW associations are forming with support from local political leaders, the Ministry of Health, and the non-governmental organization CARE to sustain the work of the VHWs. The community development officers, some of who were also the master trainers, are involved in spearheading the formation of VHW organizations.

In Mali, community health workers with the Mali Health Organizing Project in Bamako have helped reduce child mortality (under 5 years old) in their community to less than 1%, compared to a national average of 19%.

The use of CHWs is not limited to developing countries. In New York, CHWs have been deployed across the state to provide care to patients with chronic illnesses like diabetes that require sustained, comprehensive care. They work in both rural communities where access to primary care is sparse, and in urban communities where they are better able to bridge communication gaps that may arise between patients and doctors. They are seen to play an important role in assisting patients with navigating a complex, uncoordinated health care system.

A randomized controlled intervention on the U.S.-Mexico border, used promotoras or "female promoters" to increase the number of women utilizing routine preventive examinations. The control group received a postcard reminding women to get preventive screening. The free comprehensive clinical exam included a Pap test, a clinical breast exam, human papillomavirus (HPV) testing, blood draw for total cholesterol and blood glucose, and a blood pressure measurement. The other group received the same postcard and a follow-up visit from a promotora. The group that was followed up by a promotora saw a 35% increase in visits to get the free screening.

A program in Karnataka, India took a slightly different approach now referred to as the "link worker" model. The Samastha project developed a network in which trained workers, village health committees, government facilities, people living with HIV (PLHIV) networks, and participating NGOs collaborated to improve recruitment and retention of PLHIV while strengthening and supporting their adherence to treatment. Link workers were PLHIV who were selected by Samastha from a small number of HIV-positive candidates proposed by their community; they received an allowance for their work. The link workers' key tasks revolved around prevention, stigma reduction, and support for PLHIV that included adherence support to both treatment and care. Ultimately, the link workers' coordinating role became a hallmark of Samastha's interventions in high prevalence rural areas. Link workers formed the essential connection between PLHIV, government and community structures, and HIV care and treatment services, commonly accompanying persons from their catchment area to these services.

Community health workers have also been utilized to assist in research. Martin et al. found that the Latin-American population in the United States frequently does not benefit from health programs due to language barriers, distrust of the government, and unique health beliefs and practices, and specifically that providing effective asthma care to the Latino population is an enormous challenge.In addition, they found that Latinos are also often excluded from research due to a lack of validated research instruments in Spanish, unsuccessful study recruitment, and a limited number of Latino researchers. Thus, Martin and colleagues decided to use community health workers to recruit participants. To gauge the effectiveness of their recruitment strategy to other more traditional recruitment models they looked at two studies. Both these studies offered significant monetary incentives for participation while the CHW study offered nothing for the initial participation. Martin et al. found that individuals who chose not to participate in the study went on to receive other services in the areas of diabetes and cancer prevention, which was not the case for the other studies.

Current status
Cost and access to medical care remain problems of worldwide scope. They are particularly severe in the developing world and it is estimated one million more health care workers are needed in Africa to meet the health-related Millennium Development Goals.Doctors are few and concentrated in cities. In Uganda, some 70% of medical doctors and 40% of nurses and midwives are based in urban areas, serving only 12% of the population. Medical training is long and expensive. It is estimated that to meet health workforce needs using the American or European model, Africa would need to build 300 medical schools with a total training cost of over $33 billion and it would take over 20 years just to catch up.In many countries salaries of doctors and nurses are less than that of engineers and teachers. Bright young medical professionals often leave practice for more lucrative opportunities. Emigration of trained personnel to countries with higher salaries is high. In Zambia of the 600 doctors trained since independence it is estimated only 50 practice in their home country. In some countries, AIDS is killing experienced nurses and doctors amounting to 30-50% of the number trained yearly. Though many countries have increased their spending on health care and foreign money has been injected, much of it has been on specific disease-oriented programs. Health systems remain extremely weak, especially in rural areas. The World Health Assembly in 2006 called for, "A health workforce which is matched in number, knowledge and skill sets to the needs of the population and which contributes to the achievement of health outcomes by utilizing a range of innovative methods".

Community health workers are thought to be part of the answer.They can be trained to do specialized tasks such as provide sexually transmitted disease counseling, directly observed therapy for tuberculosis control, or act as trained birth attendants. Others work on specific programs performing limited medical evaluations and treatment. Others have a far broader primary care function. With training, monitoring, supervision, and support such workers have been shown to be able to achieve outcomes far better than baseline and in some studies, better than physicians.

Important attributes of community health workers are to be a member of and chosen by the community they serve. This means they are easily accepted by their fellows and have natural cultural awareness. This is crucial because many communities are disengaged from the formal health system. In Sub-Saharan Africa, 53% of the poorest households do not seek care outside the home. Barriers include clinic fees, distance, community beliefs and the perception of the skills and attitudes of medical clinic workers. Community health workers are unable to emigrate because they do not have internationally recognized qualifications. Finally, the variation in incentives between areas of the country tends to be low. All these factors combined with strong community ties, tend to result in retention at the community level.

Much remains to be learned about the recruitment, training, functions, incentives, retention and professional development of community health workers. Learning developed in one country may not be applicable to another due to cultural differences. Health worker adaptability to local requirements and needs is key to improving medical outcomes. That being said, it has been estimated that six million children’s lives a year could be saved if 23 evidence-based interventions were provided systematically the children living in the 42 countries responsible for 90% of childhood mortality. Over 50% of this benefit could be obtained with an integrated, high-coverage, family-community care based system.Community health workers may be an integral and crucial component of the health human resources team needed to achieve such goals.

= Bibliography =

= Work Space = Selecting Possible Articles

PE Area

https://en.wikipedia.org/wiki/Laguna_(province)

https://en.wikipedia.org/wiki/San_Pablo,_Laguna

https://en.wikipedia.org/wiki/Barangay

PE Sector

https://en.wikipedia.org/wiki/Barangay_Health_Volunteers

https://en.wikipedia.org/wiki/Health_in_the_Philippines

Evaluating Two Articles

Health in the Philippines (Area)

The article is informative and gives background about the structure of healthcare in the Philippines (mostly private instead of public). It gives an overview about the lack of access to pharmaceuticals and lack of accurate death reporting but is not properly backed with citations. It also goes into depth about the national healthcare budget and compares it to the US. The avenues for further learning that is relevant to my PE preparation includes reading more about the role of barangay health clinics within the greater healthcare system of the Philippines. It would be useful to learn more about the demographics of healthcare access and the approximate costs of healthcare by privately owned hospitals. The article is fairly neutral but voices highly on the fact that there is a shortage in healthcare access. In regards to citations, the references section is fairly lacking and needs to be updated. It would be useful to add links to barangay health volunteers and community health workers. More work needs to be done in finding reliable sources for the information provided in the article. While the three references are reputable, coming from the Philippine government website and an academic journal, more citations are needed. In addition, there are grammatical errors that can be fixed, such as changing "pormal study" to "formal study". Upon looking at the talk page, there is not much discussion except for the modification of external links. I do not see any ratings for the article but it is of interest to the following WikiProjects - Health and Fitness, Medicine, and Tambayan Philippines. Wikipedia discusses this topic differently from what I am learning in GPP by not addressing issues of poverty and its effect on access to healthcare. Although the article acknowledges that there is a need for improvements in healthcare, it does not discuss the current demographics of this issue and possible solutions.

Barangay Health Volunteers (Sector)

The article is relevant but is lacking of more substantial information. It provides background about the training and practice as well as research done on the effectiveness of health workers. This article will be helpful for my practice experience as editing it will allow me to learn more about the Philippine healthcare system and the role of barangay health volunteers. The article is neutral and provides an example of the effectiveness of volunteer outreach for the health of communities. The information come from reliable sources such as the Philippine Department of Health website, RedCross, and PubMed. However, some of the citation links are broken and some citations on the references are duplicated. This could easily be fixed by updating the links and finding more recent sources. In addition, it would be useful to add links to other Wikipedia articles such as barangay, health in the Philippines, and community health worker. More information is needed about the barangay health workers such as, their history, their structure within government and where/how much funding barangays receive for healthcare projects, legislative accountability, and demographics of which areas have access to barangay health volunteers. Upon looking at the talk page, there are suggestions about merging the terms barangay health worker and barangay health volunteer, putting more information about the history from 1970s to the 2000s, and fixing external links. The article is rated as a stub class, is of low importance, and is not part of any WikiProjects. Wikipedia discusses this topic differently from what I have learned in GPP so far by not highlighting that this is a type of poverty alleviation practice.

 Bibliography 

Area

Can use this to cite first paragraph and add more information such as history -- 1) 1991 Republic Act No. 7160, the Local Government Code, which delegated decision-making of the delivery of health services to the local health boards, 2) 1995 National Health Insurance Act. Also, add a sentence about how payments for healthcare is predominantly out of pocket.

Can cite this to add subtopic about PhilHealth. Also, can add information about underserved populations - pregnant women, newborns, infants, and children.

Provincial governments are primarily mandated to provide hospital care through provincial and district hospitals and to coordinate health service delivery provided by cities and municipalities of the provinces. City and municipal governments are charged with providing primary care including maternal and child care, nutrition services and direct service functions through public health and primary health care centers linked to peripheral barangay health centers or health outposts.

http://iris.wpro.who.int/bitstream/handle/10665.1/5536/9789290615583_eng.pdf

To supplement the local health force, the Barangay Health Workers’ Benefit and Incentives Act of 1995 provided for training volunteer workers and providing minimal incentives to convince them to join barangay health stations. These volunteers assist in clerical tasks and minor health procedures, such as weighing and measuring patients. However, these workers do not effectively cater to the health needs of the population.

In the Philippines, each local government similarly manages its own system of drug procurement, inventory, dispensing, and financing. The quality of locally procured drugs is generally poor, the purchase price is often higher than in private pharmacies, stock shortages are frequent, and irrational drug use occur

Sector

Can cite this to add to barangay article to talk more about funding resources. The barangay is funded by revenues collected from local (Real Property Tax, business tax) and external (Internal Revenue Allotment) sources.

Barangay Health Stations is technically the first contact point in the health sector for households, and along with Rural Health Units is responsible for delivering primary care to the population. A BHS provides first aid, maternal and child health services, and community-based interventions including immunizations. A BHS is staffed by doctors, midwives, nurses, and volunteers (Barangay Health Workers). Services provided in the BHS are free of charge, as are medicines. Some expensive medicines may be subsidized. BHS would be responsible for referral to an RHU. (26)

It is obvious that people suffering from diabetes, cancer, and heart problems need to seek quality health care that is largely provided by public and private hospitals and private clinics in the Philippines. Since the poor suffer a greater burden of these diseases than the nonpoor, the poor necessarily have greater need for health care than the nonpoor. (14)

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1616951

Recommendations for barangay health workers.

** Everything written below is my own prose, with exception to the cited sources, which I restated in my own words.**

Summarizing and Synthesizing

AREA

Health in the Philippines

The Ministry of Health, or the Department of Health, governs healthcare and provides national health policies and standards.The the provision of health services is overseen by local government units (LGUs) and private sector agencies. They are responsible for providing health services to communities. The Philippines healthcare system has three tiers of levels of care: primary services brought by barangay health units, rural health units, and city health offices, secondary services by municipal or district hospitals, and tertiary services by provincial and regional hospitals as well as medical centers. (Grundy)

History

The 1991 Republic Act No 1760, or the Local Government Code, gave local health boards the authority over decisions about the delivery of health services and financial management. In 1995, the National Health Insurance Act replaced the Medicare Act of 1969 and led to the implementation of universal health coverage. It established the Philippine Health Insurance Corporation to be a form of single payer national health insurance. (Chakraborty)

Barriers to Healthcare

Poor communities suffer a higher burden of disease due to inequities in access to services and health status. Since financing for LGUs often vary and the benefits package for insurance plans may be unfavorable, some communities face difficulties accessing public health services. In addition, most healthcare payments are made out of pocket, especially when receiving care from privately owned institutions. Barangay health stations serve as primary public health facilities and are staffed by doctors, nurses, midwives, and barangay health volunteers.

Pharmaceutical prices in the Philippines are high and can often defer people from utilizing health systems due to an inability to pay. (Son) Despite the existence of a national health insurance, most healthcare payments are made out of pocket. Medicines are supplies account for the largest share of household medical expenses, at 49%, compared to 33% share of bills for hospital stay and 10% for consultation and treatment. (World Bank)

Barangay Health Volunteers

They provide preventive health services and treatments for minor injuries and illnesses, such as first aid, maternal and child health services, and community-based interventions including immunizations. Services are free of charge and most often cover medications for patients. (Chakraborty)

The Barangay Health Workers' Benefit and Incentives Act of 1995 provided training for volunteer workers. (East Asia)

History

With the decentralization of healthcare through the 1991 Local Government Code, the responsibility of delivery of primary health services were transferred from the central government to locally elected provincial, city, and municipal governments. Health services were previously funded and managed by the Department of Health but were transferred to the local governments after the devolution of the healthcare system. (Lakshminarayanan)

Limitations

Volunteers may often be limited in knowledge due to new advances in medicine. Training is crucial for barangay health workers to improve their health knowledge and competency.

There is a perception that barangay health stations provide low-quality health services and have low-client satisfaction. With funding limitations, barangay health stations struggle with lack of medicines and supplies, long wait times, declines in quality of facility infrastructure, and lack of proper training and staffing. (World Bank) However, because some rural areas do not have access nearby to private and government services, the poor heavily depend on these primary facilities.

SECTOR

Community Health Worker

Community health workers contribute to community development and can help communities improve access to basic health services. They are most effective when they are properly trained to provide information and services to the community.

Thinking points:

How are CHWs similar to BHWs?

Community health worker is an umbrella term that encompasses the roles of barangay health workers. They are similar in many ways, most importantly, their ability to facilitate community development and goal to improve access to information and resources. Barangay health worker is a term specific to the Philippines.

Why is CHW a good idea?

Community health workers are a good idea because they incorporate community engagement. In having community members encourage others in accessing information an resources to better health, there are many potential benefits, such as increased social interactions and community building.

Why is CHW a bad idea?

The responsibility of health can be shifted from the state to the individual (i.e. community). There could be a deep reliance on community health workers to fill the gaps in resources, especially to poor/rural communities. Training that community health workers receive may be limited and thus may not be enough to effectively help the community.

How effective are community health workers?

Community health workers are the most promising form of delivering health services to resource-constrained areas. They are seen as secondary health services in most low-income countries are available as a service to the community.

Barangay corruption

According to the World Bank, many observers have claimed that the poverty in the Philippines is a direct result of corruption. Shifting the responsibility of healthcare from the federal government to the local governments has increased local authority and has made communities susceptible to lack of access to basic services. Community Health

Need at least 14 sources !!

Peer-Reviewed Sources