Baseline Demographic Profile of Selected IP Communities in ... · indigenous peoples (IP) and other disadvantaged communities in Mindanao through a comprehensive and culturally acceptable

Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities / Indigenous People (ICC/IP) and Other

Disadvantaged Communities in Mindanao

Baseline Demographic Profile

of Selected IP Communities

in Selected Provinces in Mindanao

This Project is funded by the European Union

A project implemented by National Commission on Indigenous Peoples (NCIP)

with technical assistance provided through GFA Consortium

REPORT

August 2013

2

Work Team: Prof. Dr. Ralf Ulrich Amelita Atillo Rita Fe S. Cordova

The content of this publication is the sole responsibility of GFA Consulting Group GmbH in consortium with AEDES and FPOP and can in no way be taken to reflect

the views of the European Union.

3

FOREWORD

Research studies on Indigenous Peoples are known to be scarce especially here in the Philippines. This is besides the fact that such documents are necessary to develop sound policies and programs that will benefit indigenous people. As a consequence, the project “Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities / Indigenous People (ICC/IP) and Other Disadvantaged Communities in Mindanao” during its initiation phase in 2013 conducted a series of health-related research studies.

The IP-MNCHN Project is proud of the research undertaken specifically to guide the planning process for the interventions in the five project sites. These studies would not have been possible without the help and cooperation of many individuals and various stakeholder agencies. On behalf of the Project Task Force (PTF), I thank the leaders and communities of indigenous peoples from Dumingag, Zamboanga del Sur (Subanen), Sinuda, Kitaotao, Bukidnon (Matigsalug-Manobo), Montevista, Compostela Valley (Dibabawon Mangguangan), Bentangan, Carmen, North Cotobato (Arumanen-Manobo), and Binicalan, San Luis, Agusan del Sur, (Banwaon and Talaandig). Their trust and confidence in the project helped produce these informative studies that reflect their knowledge, attitudes and practices and their current circumstances and situations. I also want to thank the many people who worked tirelessly for the completion of these studies. Rest assured that all your efforts are for a good purpose and will benefit not only the indigenous peoples of today but those of future generations.

Dr. Lilibeth Malabanan, Project Director

National Commission on Indigenous Peoples

4

TABLE OF CONTENTS

LIST OF TABLES 5

1 EXECUTIVE SUMMARY 10

2 BACKGROUND 12

3 METHODOLOGY 14

3.1 The questionnaire 14

3.2 Total population and sampling 15

3.3 Interviewers and training 16

3.4 Field phase and data entry 17

3.5 Characteristics of respondents and interview situations 19

4 RESULTS AND DISCUSSION 23

4.1 The IP household population 23

4.2 The impact of typhoon Pablo 28

4.3 Housing characteristics and accessibility 30

4.4 Sources of drinking water, toilet facilities and garbage disposal35

4.5 Fertility in IP households 39

4.6 Breastfeeding 42

4.7 Immunization of children 43

4.8 Infant mortality 48

4.9 Use of contraception 48

4.10 Access to and use of health facilities 50

4.11 Membership in Phil Health 57

5 CONCLUSION 62

6 RECOMMENDATIONS 63

7 REFERENCES 64

5

L I S T O F T A B L E S

Table 1: Estimated total population (no year) 15

Table 2: Planned and actual sample size by project area 16

Table 3: Participants at the training of interviewers and supervisors 16

Table 4: Number of interviews over field time 18

Table 5: Language of interview 19

Table 6: Self-declared tribe of respondent 20

Table 7: Age of respondents 20

Table 8: Gender of respondents 21

Table 9: Relation of respondents to head of household 21

Table 10: Occupation of respondents 22

Table 11: Gender of household population 23

Table 12: Age of household population 24

Table 13: Household population by position in household 26

Table 14: Formal education of IP household members 27

Table 15: Size of households 28

Table 16: Impact of typhoon Pablo 29

Table 17: Residence of household members before/after typhoon Pablo 30

Table 18: Construction material used for the external wall of the house 31

Table 19: Construction material used for the roof of the house 32

Table 20: Construction material used for the floor of the house 33

Table 21: Accessibility of households 34

Table 22: Tenure status of houses 34

Table 23: Time needed to get to water source 35

6

Table 24: Sources of drinking water 36

Table 25: Toilet facilities 37

Table 26: Garbage disposal 38

Table 27: Fertility in IP households 39

Table 28: Adolescent fertility 40

Table 29: Delivery at home 40

Table 30: Help from traditional birth attendants at birth 41

Table 31: Registration of IP births 42

Table 32: Breastfeeding by IP mothers 43

Table 33: Availability of immunization cards 44

Table 34: Immunization of BCG 44

Table 35: Immunization against Hepatitis B 45

Table 36: Immunization against diphtheria, pertussis and tetanus (DPT) 46

Table 37: Immunization with oral polio vaccine (OPV) 47

Table 38: Immunization against measles 47

Table 39: Infant and neonatal mortality in the Philippines 48

Table 40: Use of contraception 49

Table 41: Health facilities nearest to house 50

Table 42: Transport to health facilities 51

Table 43: Knowledge about health services 52

Table 44: Health services availed 53

Table 45: Reasons for non-use 54

Table 46: Visits by Women/Community Health Teams in 2012 55

Table 47: Reason for visits by Women/Community Health Teams in 2012 55

7

Table 48: Satisfaction with health services 56

Table 49: Sources of knowledge about PhilHealth 58

Table 50: Membership of respondents in PhilHealth 59

Table 51: Type of PhilHealth membership among household members 60

Table 52: Start year of PhilHealth membership 60

Table 53: Reasons for not enrolling to PhilHealth membership 61

8

ABBREVIATIONS

AD Ancestral Domain

ADSDPP Ancestral Domain Sustainable Development and Protection Plan

ALS Alternative Learning System

ANC Antenatal Care

BHS Barangay Health Station

BHW Barangay Health Worker

BEmONC Basic Emergency Obstetrics and Newborn Care

BTL Bilateral Tubal Ligation

BLHD Bureau of Local Health Development

CADC Certificate of Ancestral Domain Claim

CHD Centres for Health Development

CHT Community Health Team

CSO Civil Society Organization

CEmONC Comprehensive Emergency Obstetrics and Newborn Care

CCT Conditional Cash Transfer

CSR Contraceptive Self Reliance

DOH Department of Health

DOST Department of Science & Technology

DSWD Department of Social Welfare and Development

EPI Expanded Program on Immunization

FBD Facility Based Delivery

FDS Family Development Session

FHS Family Health Survey

FP Family Planning

FPCBT Family Planning Competency Based Training

FPS Family Planning Survey

FHSIS Field Health Service Information System

FGD Focus Group Discussion

FNRI Food & Nutrition Research Institute

GIDA Geographically Isolated and Disadvantaged Areas

ICC Indigenous Cultural Communities

IP Indigenous People

IPBDS 2013 IP Baseline Demographic Survey 2013

IRA Internal Revenue Allotment

IUD Intrauterine Device

KAP Knowledge, Attitude, Practice

LGU Local Government Unit

MOP Manual Of Operations

MWRA Married Woman of Reproductive Age

MMR Maternal Mortality Rate

9

MNCHN Maternal, Neonatal, Child Health and Nutrition

MDG Millennium Development Goal

NCIP National Commission on Indigenous Peoples

NDHS 2008 National Demographic & Health Survey 2008

NHIP National Health Insurance Program

NSO National Statistics Office

NMR Neonatal Mortality Rate

NSV Non-Scalpel Vasectomy

NGO Non-Governmental Organization

4Ps Philippines CCT program, the Pantawid Pamilya Pilipino Program

PhilHealth Philippines Health Insurance Corporation

PMT Proxy Means Test

RHIS Regional Health Information System

RHM Rural Health Midwife

RHU Rural Health Unit

SBA Skilled Birth Attendant

STE Short Term Experts

TBA Traditional Birth Attendant

UFMR Under Five Mortality Rate

USAID United States Agency for International Development

VSS Voluntary Surgical Sterilization

WHO World Health Organization

10

1 E X E C U T I V E S U M M A R Y

The project "Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities/Indigenous Peoples and Other Disadvantaged Communities in Mindanao" is an integral part of the overall on-going EU support to the Philippine Health Sector Reforms implemented in close coordination with other partners in the Philippines.

The specific objective of the project is to improve access to and utilisation of quality essential reproductive health services of selected indigenous cultural communities (ICC) and indigenous peoples (IP) and other disadvantaged communities in Mindanao through a comprehensive and culturally acceptable implementation of Maternal, Neonatal and Child Health and Nutrition (MNCHN) strategy.

The demographic survey is one of the planned activities to develop a baseline understanding of the Lumad’s practices regarding maternal, newborn, child health and nutrition.

The objective of the survey is to determine the general demographic and social profile of families in selected IP communities and to determine the baseline data based on the monitoring and evaluation framework of the project.

The Indigenous Peoples Baseline Demographic Survey 2013 (IPBDS 2013), conducted in April 2013, was the first effort to determine a general demographic and social profile of selected IP communities in selected provinces in Mindanao. Respondents from 1,531 households in 5 Ancestral Domains (AD) were interviewed.

The IP population is a very young population, mostly living in two-generation households. On average five people live in a typical IP household. Fertility of IP women is higher than in the Philippines in general and in the rural populations as well. Of the five ancestral domains included in the survey, four are ethnically quite homogenous. Montevista is shaped by two tribes. IP households live mostly from agriculture and fishery.

The houses in which IP households live show their weak economic position, compared with the general rural population of the Philippines. This is evident not only with the construction materials used for walls, roof and floor, but also in the system of garbage disposal or toilet facilities. More important, for the health of household members and particularly children are the sources of drinking water, with a still small share of improved sources, like pipes to dwelling or plot. Many IP households have to walk outside their plot to get water. Many IP households from Sinuda and Gawasan are geographically isolated; more than half of them have to walk or travel more than one hour to reach the next access road.

Most children in IP households are born at home, most often with the help of traditional birth attendants. In the last two years the share of births in facilities has slightly increased. In Montevista already every fourth child is born outside home. Birth registration at IP households is still far from complete. Only every second child born in the 12 months before the survey has been registered. Some children are registered after their first or second birthday.

Breastfeeding is a factor supporting the health of infants in IP households. More than two out of three children in IP communities are breastfed for six months or longer. Immunization could play a more active role in the healthy upbringing of IP children, as immunization rates for IP children are substantially lower than the national average.

Barangay health stations are the nearest health facilities in three out of the five ancestral domains. Most people have to walk to reach health facilities; the mean distance is 17km. Respondents knew quite well about the health services offered, but used them only to a limited extent for curative care and mostly for immunization of children and preventive care.

11

Among the reasons keeping IPs from using health services are perceived financial constraints and distance. In four out of the five ancestral domains an important reason mentioned was also the respondent’s perception that the health facilities lack medical tools and equipment.

Only two out of three respondents knew about PhilHealth. Those who had heard about it mostly had learned from briefings by the barangay chair. Of those who had ever heard about PhilHealth 80 percent were members, mostly in indigent/sponsored memberships. For those who were aware about the existence of PhilHealth but had not been enrolled, lack of necessary documents to enrol or lack of funds for membership fees are perceived as the main reasons for not enrolling.

The results of IPBDS 2013 suggest the following recommendations to address maternal, neonatal and child health and nutrition needs for the indigenous cultural communities and

indigenous peoples and other disadvantaged communities in Mindanao:

1) Address distance as an obstacle to accessing health services.

a) Outreach programs like W/CHT should be streamlined, strengthened and extended through training and focused management.

b) Community based transportation solutions should improve access to barangay health centres and rural health units.

2) Address financial constraints to accessing health services.

a) Membership to PhilHealth should be advertised and more information about the PhilHealth membership for indigent populations should be disseminated. PhilHealth should also strengthen its partnership with the different Local Government Units from the Provincial down to the Sitio/Purok levels.

b) Households and individuals who lack the necessary documents such as marriage and birth certificates should be supported to obtain these documents.

3) Increase immunization rates by providing information on the advantages of immunization and by advertising immunization cards.

4) Improve access to safe drinking water in IP households with community based projects.

5) Establish full registration of births and deaths in IP communities.

6) Undertake further operational research on fertility preferences, experience with contraception, unmet need for family planning, child health as well as in-depth analysis of IPBDS 2013.

12

2 B A C K G R O U N D

The project "Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities/Indigenous Peoples and Other Disadvantaged Communities in Mindanao" is an integral part of the overall on-going EU support to the Philippine Health Sector Reforms through the Sector Development Approach for Health (SDAH) and being implemented in close coordination with and complementary to initiatives of other partners in the field. [1]

The project is founded "on a rights based approach, aiming at the fulfilment of the rights of ICC/IPs representing most vulnerable and marginalized population groups in the Philippines toward self-governance, self-determination and cultural integrity in line with the national legal framework, Indigenous Peoples Rights Act (IPRA) and international human rights conventions and EU policies. Specifically, it focuses on the rights of individuals to equitable access to essential health services, especially reproductive health (RH), including access to family planning and free choice of methods." [2]

It is focused to "address existing gaps in the delivery of essential maternal, neonatal and child health and nutrition services for indigenous populations (IPs) in Mindanao. The specificity of the project beneficiaries requires adopting a multipronged and flexible approach. To achieve the objectives outlined above, an innovative rights-based approach guided by the IPRA and universal human rights is being taken to combine supply and demand side interventions based at community level. The action brings together the ICC/IPs, the National Commission on Indigenous People (NCIP), the Department of Health (DoH) and local government units (LGUs), and the skills and experience of the United Nations Population Fund (UNFPA), to improve access to basic health services based on the principles of primary health care in a culturally acceptable and sensitive manner and within the framework of IPRA, as well as national policies and standards ensuring appropriate quality of services, and in view of efficient resource allocation. Given the safe motherhood focus of the main project, the UNFPA component will primarily address the existing gaps in family planning service delivery and adolescent and reproductive health of the IPs in Mindanao. As such, the action will tackle the issues from different perspectives: (i) self-governance and self-determination of ICC/IP communities, including Free and Prior Informed Consent; (ii) protection and promotion of indigenous health systems and practices; and (iii) access to mainstream health services." [2]

The project is aiming at four results:

1. Information regarding IP knowledge, beliefs and practices related to MNCHN, the barriers to service utilization and gaps in service provision as well as basic demographic information are gathered, analysed, documented and utilized.

2. Improved capacity of ICC/IP, NCIP and LGUs to plan and implement health interventions for better maternal, neonatal, child health and nutrition, and reproductive health outcomes within ICC/IP communities through more informed and productive engagement.

3. Selected ICC/IP and other disadvantaged communities have improved access to a culturally appropriate continuum of quality care related to reproductive health information, services and commodities.

4. Improved capacity of Indigenous Peoples Organizations (IPOs) and other Civil Society Organizations (CSOs) to engage in identification, formulation and implementation of health and nutrition development interventions for their specific

13

community and links to socio-economic interventions or livelihood strategies for a more sustainable approach.

In order to achieve results 2 to 4 it is necessary to gather household, demographic and health data and achieve a better understanding of the situation of IP households with regard to MCHN as part of result 1. A baseline demographic survey is expected to provide data for determining health needs and monitoring the health situation. "Its objective is to provide up-to-date information on health and population to show a general picture. The overall purpose of the technical assistance is to collect demographic and health data with a focus on the monitoring framework of the project. In addition, data gathered using the instruments from the National Demographic Health Survey (NDHS) conducted in 2008 and other health indicators relevant to indigenous peoples will also be collected. This data will be useful in designing the most appropriate interventions. This will improve the project’s impact on the lives and health of indigenous people in project sites." [2]

The baseline demographic survey plays a specific role in the early stage of the project. Usually sample surveys are designed to be representative for a certain total population and gather more detailed information for this sample than a census would do. In this case only very limited information about the total IP population of the five project areas was available during the preparation. In a later stage of the project other activities are planned to capture more extensive demographic information for the total of the IP population. Data collection instruments are to be developed and tribal leaders are to be involved in demographic data collection. [2]

Therefore the specific goals of the baseline demographic survey were:

1. To determine the general demographic and social profile of families in selected IP communities; and

2. Determine the baseline data based on the monitoring and evaluation framework of the project.

The “Knowledge, Attitudes, Practices, Health Seeking Behaviour and Health Service Needs of Indigenous Cultural Communities/Indigenous Peoples with regards to Maternal, Neonatal, Child Health and Nutrition” [3] study gives a very detailed analysis of the MNCHN situation in the Philippines. This analysis and the explorative results of the KAP study have been taken as a starting point for this analysis.

In its character, IPBDS 2013 is a population-descriptive study designed to give a profile of IP households. No causal relationships or hypotheses are tested. It might be worthwhile to analyse IPBDS 2013 later in greater depth and detail than is possible with this report.

14

3 M E T H O D O L O G Y

3 . 1 T h e q u e s t i o n n a i r e

A household questionnaire was prepared by project staff from the end of 2012 to March 2013 in English and in Cebuano. It was used as the basis for the preparation of an interviewer’s and supervisors manual and the training of interviewers and supervisors beginning April 2013.

In the cover sheet (1 page) the questionnaire asked for the usual circumstances of the interview, including language, tribe of the respondent and others. The respondent’s age, gender, marital status, education and occupation were also asked (1 page). From questions regarding the respondent the questionnaire went to the specific situation of households in Compostela Valley and Agusan del Sur as affected by typhoon Pablo (Bopha) in December 2012 (3 pages). The third section of the questionnaire asked the income and spending of households (2 pages). The fourth section went to characteristics of housing and accessibility (4 pages). The fifth section addressed health services (2 pages) and the following section dealt with membership in PhilHealth (2 pages). The last section asked about children born in the household, immunization and contraception (2 pages).

Some last changes in the questionnaire appeared to be necessary and were made in the last days of March 2013 after discussion with the project Team Leader:

A table of household members (HH7) was included, which allows to estimate household size, population structure and other characteristics demanded by the goals of the survey,

some questions were clarified in order to allow precise answers; in the case of breastfeeding it was asked not only “yes/no”, but the number of months breastfed; other necessary items for immunization were added,

some questions were harmonized with questions of the 2008 Demographic and Health Survey (NDHS 2008), in order to allow comparison and better understand the specifics of IP households, like characteristics of housing and other topics,

usually Demographic and Health Surveys interview all women in reproductive age in the household individually; since the IP survey was planned as a household-only survey it was necessary to ask information which related the children in table HC1 to their mothers in table HH7; only that way it would be possible to establish adolescent fertility and other important topics in the context of MNCHN,

questions regarding neonatal and infant mortality were added, which would allow the survey to address important goals of the survey.

The changes in the questionnaire were necessary to allow the survey to fulfil its goals and provide baseline information on MNCHN and indicators related to the log-frame of the project. Yet, these changes could be made only a few days before the start of training of interviewers and had to be translated into the Cebuano version and considered in the training. [4]

Parallel to these changes in the questionnaire it was decided to pre-test the questionnaire before the training of interviewers and supervisors. The pre-test took place in two project sites on Monday, April 1. The pre-test confirmed the viability of the questionnaire in its modified version. Some minor changes drawn from the experience of the pre-test were applied to the questionnaire on April 2, the day the training of interviewers and supervisors started. A few minor changes were also introduced out of the discussion with interviewers and supervisors during the training.

15

3 . 2 T o t a l p o p u l a t i o n a n d s a m p l i n g

The sampling strategy had been prepared earlier and is documented in the inception report. [5] The total population for IPBDS 2013 is the IP population as initially estimated by the five respective Ancestral Domain Sustainable Development and Protection Plan (ADSDPP) (see Table 1).

Table 1: Estimated total population (no year)

Dumingag Sinuda

Monte- vista

Gawasan Binicalan Total

Population 3,312 22,747 3,296 1,425 3,133 33,913

Estim. number of households

662 4,549 659 285 627 6,782

Source: [5]

According to these estimates the total population was 33,913 people in the five Ancestral Domains of Dumingag, Sinuda, Montevista, Gawasan and Binicalan. Unfortunately it was not possible to establish for which year the estimate by ADSDPP was established. It was assumed that this was 2012.

As established in the inception report a multi-stage cluster sampling was applied to select IP households. The cluster of Barangays and/or Sitios within the ancestral domain was selected based on the following criteria: 1) the IPs are the dominant population, and 2) accessibility or inaccessibility of the Barangay or Sitio to the main road [5].

In the context of demographic surveys the size and structure of a sample follows two considerations. One is the relative sample size which allows for external validity of results from the sample for the total population. This depends on the frequency of events measured. In case of IPBDS 2013 this was difficult to estimate, since it was the first attempt to do research in the IP population. Nation-wide results from previous surveys (like NDHS 2008), or results for the rural population of the Philippines, could give only a raw indication. One case where this came out differently than expected was immunization, where IPBDS 2013 had nothing else to estimate frequencies than NDHS 2008, but later learned that immunization rates in IP households were much lower.

An estimate for the expected frequency for most indicators of 50 percent was established by the team in the days before the training of interviewers.

The second consideration for sample size is the expected absolute number of certain events. One important indicator in the context of the project logical framework is the infant mortality rate. For the Philippines in total, about 25 infant deaths per 1,000 live births had to be expected [6]. To arrive at reliable estimates for this comparatively rare event, a much higher absolute number of households would have to be covered. However, this is an inherent problem of surveys for comparatively small total populations. Since it was assumed that it is possible to compute infant mortality from ADSDPP statistics, the sample size was determined mostly on the criteria of external validity, i.e. in relative sample size.

16

Table 2: Planned and actual sample size by project area

Planned and actual sample size in the project area, by number of households interviewed

Dumingag Sinuda

Monte- vista


planned sample size

312 536 316 164 238 1.566

actual sample size

312 535 277 161 246 1.531

Source: computation from IPBDS 2013, [5]

3 . 3 I n t e r v i e w e r s a n d t r a i n i n g

Due to the specifics of the IP population and the variety of languages spoken, it was decided to recruit interviewers from IP communities. They were nominated by tribal leaders based on a set of criteria. [5]

The training of interviewers took place from April 2 to 4, 2013, in the Ritz Hotel, Garden of Oases, in Davao City. 115 persons participated in the training, among them 83 interviewers. In addition Provincial Coordinators, NCIP Point Persons and representatives from rural health units/ Barangay Health Stations/ provincial health offices attended the training. Among them were also the field supervisors.

Table 3: Participants at the training of interviewers and supervisors

Dumingag Sinuda

Monte-vista


Enumerators 19 27 12 14 11 83

Provincial Coordinators 1 1 1 1 1 5

NCIP Point Persons 3 2

2 2 9

Rural Health Units/ Barangay Health Station/ Provincial Health Office

3

4 5 3 15

Others: BLGU, IPO

3

3

Total 26 30 20 22 17 115

Source: [7]

The aim of the training was to enable interviewers and field supervisors to:

1. Understand and articulate the general objectives of the project and the purpose of the household survey;

2. Participate in the simulation interviews of the various parts of the questionnaire;

3. For the enumerators and field supervisors to internalize their respective duties and responsibilities; and

4. Know their respective assignments, schedules and deadlines in the conduct of the survey thru the formulation of their respective Action Plan and Budget. [7]

17

The training comprised of four parts:

“Part I - Overview of the project and the baseline household project, training objectives and overview of the questionnaire. This was carried out through presentations aided with slides/PowerPoint, questions and answer, and plenary open forum. Ms. Melanie Joy M. Seville represented Dr. Lilibeth D. Malabanan, the project director, in the presentation of the overview of project IP-MNCHN. Dr. Umali of UNFPA gave an overview of the work of his organization and its contribution to IP-MNCHN. Mr. John Izard, the TA Team Leader, gave the welcome remarks. STE Melot B Atillo facilitated the presentation and discussion of the overview of the training and expectations setting.

Part II - Presentation and discussion on the duties and responsibilities of the field supervisors and the enumerators. This part introduced in detail the questionnaire through slides/PowerPoint presentation. The training participants were engaged in the plenary discussion, clarifications of terms used in the questionnaires, and the attendant protocols in filling up the questionnaire.

Part III - Simulation interviews in which the participants interviewed each other to capacitate themselves on interviewing skills. Simulation interviews were conducted for the following sections of the questionnaire: (1) Household Demographic and Socio-Economic Information, (2) Knowledge and Participation in Health Programs, (3) Maternal, Child and Newborn Health Care Situation; and the Household Satisfaction Rating on the Overall Quality of Services Provided by Health Care Providers. The assigned Field Supervisors (PCs, NCIP Point Persons, MHOs, RHM) observed the simulation interview process and facilitated the feedback sessions.

Part IV - Drawing up of Action Plan. Facilitated by the respective PCs and NCIP Point Persons, the participants were able to draw up the team’s schedule of activities and the enumerators’ assigned Puroks and number of households to be interviewed. They validated the sample size and the selected Barangays and Puroks for the household survey, using two criteria, i.e. 1) IP are the dominant population in the Barangay and Purok, and 2) accessibility to the main road.” [7]

One important part of the training of interviewers and field supervisors referred to the selection of households in the field. “The Senior STE illustrated the process of selection of sample households, to: 1) using a spot/sketch map or if not available, the PC or field supervisor can go around the Purok and sketch the location of the houses and assign numbers to these houses; 2) using the list that contains the household names which can be secured from the Barangay secretary, Barangay Captain or tribal chieftain; and 3) using the table of random numbers or rotation of pen. These processes can be used for both on-road and off-road sample households. Field supervisors were given copies of the Table of Random Numbers.” [7]

3 . 4 F i e l d p h a s e a n d d a t a e n t r y

The field phase of IPBDS 2013 went from April 11 to April 25, 2013. During this time 1,531 interviews were conducted (see Table 4).

During the field phase 83 interviewers were actually involved in the survey. On average each interviewer did 18 interviews. Yet, 24 interviewers did more than 20 interviews and 16 interviewers did less than 15 interviews.

18

34 field supervisors coordinated and checked the work of interviewers in the field. On average they supervised 66 interviews. Yet, some of them were very active. One field supervisor was responsible for 206 interviews, another for 119 interviews. 10 field supervisors controlled more than 50 interviews but less than 100 interviews. On the other hand there were field supervisors who were active only for a very short time. 6 field supervisors had supervised only 5 or less interviews.

Table 4: Number of interviews over field time

Date Number of interviews

04/11/2013 7

04/12/2013 67

04/13/2013 154

04/14/2013 117

04/15/2013 182

04/16/2013 210

04/17/2013 221

04/18/2013 158

04/19/2013 87

04/20/2013 59

04/21/2013 12

04/22/2013 90

04/23/2013 84

04/24/2013 38

04/25/2013 38

invalid dates 7

Total 1,531

Interviewers were asked to record the starting time and the completing time of the interview. The time needed to complete the interview varied a lot. A few interviewers completed the interview in less than 20 minutes; others needed more than three hours. The mean interviewing time needed was 65 minutes. One out of four interviews was conducted in 47 minutes or less. Another one out of four interviews needed 79 minutes or more to complete.

Data entry was conducted between May 6 and July 9 by the Social Research Training Development Office at the Ateneo de Davao University. First a template for data entry had been created and confirmed. Within the process, subsets of the entered data had been submitted and checked, with subsequent adjustments.

During data entry some problems of the quality of interviews became apparent, among them:

entries were incomplete, i.e. only the first name given, where full name was required,

dates entered for births and other events were in the future or in implausible ranges,

19

entries that were supposed to connect data about household members with other parts of the questionnaire were missing,

the answers used units different from what was asked in the questionnaire, i.e. hours instead of kilometres, and

some individuals seemed to be interviewed twice by different enumerators.

Many efforts were made to fix these kinds of problems during data entry. Special efforts were required to make the link between characteristics of household members and birth history,

contraception and other questions possible.

3 . 5 C h a r a c t e r i s t i c s o f r e s p o n d e n t s a n d i n t e r v i e w s i t u a t i o n s

Since interviewers were selected from the communities included in the survey they were instructed to translate the questionnaires into the languages used in their area and use local languages.

Table 5 presents the languages used for the interviews. They are quite different in the

various project regions. In Dumingag almost 2 out of 3 interviews were conducted in Cebuano, one third in Subanen. In Sinuda almost 95 per cent of interviews were conducted in Matisalug. In Montevista Cebuano was the dominant language (93.1 percent). In Gawasan almost 99 per cent of all interviews used Arumanen; in Binicalan Banuwaon had the same

dominance.

Table 5: Language of interview

Percept distribution of interviews by language in which the interview was conducted

Dumingag Sinuda

Monte-vista


Cebuano 61.5 5.4 93.1 0.6 1.2 31.5

Matigsalug 0.0 94.2 0.7 0.0 0.0 33.1

Banuwaon 0.3 0.4 0.0 0.0 98.8 16.1

Dibabawon 0.0 0.0 2.2 0.0 0.0 0.4

Mangguangan 0.0 0.0 4.0 0.0 0.0 0.7

Subanen 37.8 0.0 0.0 0.0 0.0 7.7

Arumanen 0.0 0.0 0.0 98.8 0.0 10.4

Others 0.3 0.0 0.0 0.6 0.0 0.1

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of households

312 535 277 161 246 1,531

Source: computation from IPBDS 2013

In the interview situation, it was in most cases obvious for the interviewers to which tribe respondents belonged. However, they were instructed to ask anyway and record the answer. Table 6 shows results for this question which reveal some resemblance to the languages used in the interviews. Four of the ancestral domains are strongly dominated by respondents from one tribe: Dumingag (99 per cent Subanen), Sinuda (99.1 per cent Matisalug), Gawasan (98.8 per cent Arumanen-Manobo) and Binicalan (99.2 per cent Banuwaon).

20

Table 6: Self-declared tribe of respondent

Percept distribution of interviews by tribe the respondent belonged to

Dumingag Sinuda Monte-vista


Arumanen-Manobo 0.0 0.0 0.7 98.8 0.0 10.5

Banuwaon 0.0 0.0 0.0 0.0 99.2 15.9

Dibabawon 0.0 0.0 17.3 0.0 0.0 3.1

Mangguangan 0.0 0.0 78.3 0.0 0.0 14.2

Matigsalug 0.0 99.1 0.0 0.0 0.0 34.6

Subanen 99.0 0.0 0.0 0.0 0.0 20.2

other 1.0 0.9 3.6 1.2 0.8 1.4

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of households 312 535 277 161 246 1,531


Respondents in Montevista were composed mostly from Mangguangan (78.3 percent) and Dibabawon (17.3 percent).

The majority of respondents were in the age range from 20 to 49 (see Table 7). In a few cases children up to the age of 14 were interviewed and in about 5 percent teenagers. Less than one fifth of respondents were older than 50 years.

Table 7: Age of respondents

Percept distribution of interviews by age of respondents

Dumingag Sinuda Monte-

vista Gawasan Binicalan Total

0-14 years 1.0 0.6 0.7 0.6 0.9 0.7

15-19 years 3.0 6.6 7.0 2.5 3.9 5.1

20-29 years 26.0 27.0 27.1 23.0 29.6 26.8

30-39 years 28.7 27.0 23.4 21.7 24.0 25.6

40-49 years 21.3 22.2 22.3 29.2 26.2 23.4

50-59 years 11.8 9.6 13.2 13.0 9.4 11.1

60 years+ 8.1 7.1 6.2 9.9 6.0 7.3

Total 100.0 100.0 100.0 100.0 100.0 100.0


296 519 273 161 233 1,482


Almost 60 percent of respondents were female, in Montevista more than 3 out of 4

respondents (see Table 8).

21

Table 8: Gender of respondents

Percept distribution of interviews by gender of respondents

Dumingag Sinuda Monte-


Male 41.3 42.5 23.4 45.9 49.6 40.3

Female 58.7 57.5 76.6 54.1 50.4 59.7

Total 100.0 100.0 100.0 100.0 100.0 100.0


310 527 273 157 244 1,511


As expected from the gender structure of respondents less than half of all respondents (44.2 percent) were the heads of the respective households (see

Table 9). Slightly more than half of respondents were either the wife or the husband of the

head of household. In Montevista only less than one third of respondents were head of

household and two thirds were either wife or husband of the head of household.

Table 9: Relation of respondents to head of household

Percept distribution of interviews by relation of respondents to head of household

Dumingag Sinuda

Monte-vista


Head of the Household 45.5 44.9 32.1 47.2 52.4 44.2

Wife or Husband of the Head of the Household

51.9 54.8 66.1 49.1 43.9 53.9

Other 2.6 0.4 1.8 3.7 3.7 2.0

Total 100.0 100.0 100.0 100.0 100.0 100.0



During the interviews respondents were asked about their occupation or source of income. Multiple responses to this question were possible, to reflect the possibility of a combination of occupations. More than three out of four responses given pointed to work as a farmer, farm/forestry worker or fisherman. This occupation/s constitute 77.9 percent of the total occupation mentioned in Table 10 which implies that the IPs highly rely on the agriculture sector for their income or means of livelihood.

22

Table 10: Occupation of respondents

Percept distribution of responses by occupation of respondents (multiple responses possible)

Dumin-

gag Sinuda

Monte-

vista

Gawa-

san

Binica-

lan Total

Office Worker in Government/Private Organizations (professionals, technical/non-technical staff, clerk, office driver, messenger)

6.7 2.0 4.0 3.5 9.7 4.9

Employed Service Worker and Shop/Market Sales Worker

0.8 0.2 2.2 0.0 1.9 1.0

Farmer, Farm/Forestry Worker or Fisherman 72.5 87.7 66.1 87.8 72.6 77.9

Trades and Related Worker 0.5 0.3 0.9 1.2 0.3 0.6

Laborer (skilled or unskilled) 5.9 5.5 7.8 2.3 0.0 4.7

Plant and Machine Operator and Assemble 0.0 0.2 0.6 0.0 0.6 0.3

Other Occupation 12.9 1.4 17.1 4.1 12.6 8.9

Unemployed 0.8 2.4 0.9 0.6 2.3 1.6

Retired 0.0 0.3 0.3 0.6 0.0 0.2

Total 100.0 100.0 100.0 100.0 100.0 100.0

Responses 389 586 322 172 310 1,779


The share of agricultural occupations was lowest in Montevista (66.1 percent) and highest in

Sinuda and Gawasan. The second most important occupational group is office workers in government or private organizations. Very few respondents declared themselves as unemployed. In Binicalan, Citizens Armed Force Geographical Unit (CAFGU) listed under

“other” contributed to employment.

23

4 R E S U L T S A N D D I S C U S S I O N

4 . 1 T h e I P h o u s e h o l d p o p u l a t i o n

Since there was only one questionnaire per household planned, a table with all household members was included in the questionnaire in the last week of March. In this table for every member of the household name, date of birth, gender, relation to the head of household and education were asked. Data from this table allows gaining a picture about the IP household population. There were 7,530 household members listed in the interviews.

The gender structure of the household population is more equal than the gender structure of the respondents. For the total project area 52 percent of household members are male.

Table 11: Gender of household population

Percept distribution of household member by gender

Dumingag Sinuda Montevista Gawasan Binicalan Total

Male 51.5 51.6 51.4 51.1 54.9 52.0

Female 48.5 48.4 48.6 48.9 45.1 48.0

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of HH members

1,513 2,715 1,328 795 1,179 7,530


The age structure of the household population reflects high fertility and rapid population growth. The share of children in the age below 5 years is with 15.7 percent male and 17.0 percent female quite high. For the rural population of the Philippines this share is 12.6 percent male and 11.8 percent female, reflecting the decline in fertility in the past decades.

There are 46 percent of males and 47 percent of females who belong to the age group of children and early teenagers, below 15 years. For the total population of the Philippines this share was much lower with 35.7 percent in 2008. Only the Census of 1970 reported a similar share of this age group for the whole country: 45.7 percent. [6] Already in 1980 this share had declined to 42 percent.

The age group of working age (15-64) constituted slightly more than half of the household members in the interviewed IP households. Only 2 percent of males and 1 percent of females were 65 and older in IP households – in contrast to 4 percent (male) and 6 percent (female) for the Philippines. The small proportion of people in the age of 65+ clearly indicates a lower life expectancy for the IP population.

24

Table 12: Age of household population

Percept distribution of household member by age


Male Female Male Female Male Fe-male Male Female Male Female Male Female

<5 14.6 16.9 16.4 18.1 15.0 15.8 12.3 14.9 18.4 17.3 15.7 17.0

5-9 16.4 15.7 17.5 17.3 15.5 17.0 14.0 13.6 15.8 15.2 16.3 16.2

10-14 13.6 14.3 15.2 14.4 12.0 12.5 10.1 17.0 14.5 13.3 13.7 14.2

15--19 11.4 11.2 11.9 11.3 12.2 11.3 13.8 11.1 8.8 9.8 11.5 11.0

20-24 9.2 7.8 7.2 7.5 7.9 8.4 10.3 7.5 9.0 10.5 8.4 8.2

25-29 5.5 5.9 6.5 5.9 7.0 6.3 9.1 8.0 7.3 6.8 6.8 6.3

30-34 6.3 6.1 4.3 5.6 6.9 5.9 7.1 5.4 5.3 5.3 5.6 5.7

35-39 5.6 4.8 5.0 5.6 5.3 5.1 3.4 5.1 4.2 7.0 4.9 5.5

40-44 5.4 5.7 5.1 5.6 6.2 5.3 6.2 4.6 5.1 6.0 5.4 5.5

45-49 3.9 4.1 3.9 2.4 3.7 3.7 4.2 4.1 5.3 3.0 4.1 3.2

50-54 2.4 3.3 2.6 2.3 2.8 3.1 3.4 2.6 2.3 2.8 2.7 2.7

55-59 2.3 1.8 1.1 1.8 2.9 2.8 3.0 1.3 0.8 1.1 1.8 1.8

60-64 1.4 1.1 1.1 0.8 0.9 1.7 1.5 1.3 1.7 1.1 1.3 1.1

65-69 0.8 0.7 1.2 0.5 0.7 0.6 0.2 1.3 0.6 0.6 0.8 0.6

70-74 0.8 0.3 0.6 0.5 0.7 0.2 0.2 1.0 0.5 0.0 0.6 0.4

75-79 0.1 0.4 0.2 0.3 0.0 0.2 0.5 0.8 0.2 0.0 0.2 0.3

80+ 0.1 0.1 0.2 0.2 0.3 0.2 0.5 0.5 0.5 0.2 0.3 0.2

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Nr. HH member

779 734 1,400 1,315 682 646 406 389 647 532 3,914 3,616


25

The position of household members within the household gives additional clues about the household structure (see Table 13). Almost 30 percent of males in IP households were head of the household, in contrast to only 2.9 percent of females. In Gawasan and in Dumingag the share of female heads of household is slightly higher. More than half of household members are children. Since the share of older people is so low, there are only few grandparents in the IP households. There are also few grandchildren in the IP households.

The data collected by IPBDS 2013 suggests that a two-generation household is typical for the IP population. With marriage people leave their parents’ home and found a new household. Since life expectancy is low and the proportion of older people is low as well, there are few three-generation households.

When respondents were asked to list all household members, the years spent in the formal education system were asked as well. For three out of four household members in the age 16 and older a concrete

answer was given (see Table 14). For those household members for which no answer could be given it

can be assumed that most of them never attended the formal education system. Their share was highest in Binicalan with more than 40 percent.

One fourth of household members in the age 16 and older completed less than 3 years of elementary school. 31.8 percent completed between 4 and 6 years of elementary school. Almost one in five household member did ever attend a high school. This share is even higher in women and is highest in the ancestral domains of Montevista and Gawasan. However, only 6.8 percent of household members attended 4 years of high school. Again this share is higher among women then among men.

Interviewers had asked not only about the formal education system, but also about the numbers of months spent in the Alternative Learning System (ALS). However, in the interviewed households only less than 2 percent of household members had attended the ALS.

26

Table 13: Household population by position in household

Percept distribution of household member by position to head of household


Male Female Male Female Male Female Male Female Male Female Male Female

Head of the family 28.9 3.5 28.8 1.7 26.3 4.8 34.9 3.7 32.4 2.1 29.6 2.9

Wife/husband/Partner 6.5 35.1 5.5 35.8 10.1 34.3 0.3 34.8 1.5 39.9 5.3 35.9

Grandfather/Grandmother 0.7 1.0 0.2 1.4 2.1 2.9 0.3 1.0 0.7 1.9 0.7 1.6

Son/Daughter 61.4 57.4 62.5 59.0 58.2 54.0 62.8 58.6 63.9 54.8 61.8 57.2

Son/Daughter-in-law 0.1 0.3 0.9 0.3 0.5 0.5 1.0 0.3 0.5 0.6 0.6 0.4

Grand-children, boy or girl 2.4 2.7 2.2 1.8 2.8 3.4 0.8 1.6 1.0 0.6 2.0 2.1

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Number of HH members 722 678 1,345 1,244 612 583 392 382 590 476 3,661 3,363


27

Table 14: Formal education of IP household members Percentage of household members in age 16 and older by years of education in the formal education system


Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total

No answer 12.9 17.4 15.0 28.6 32.3 30.4 11.2 15.1 13.0 14.6 19.5 16.8 38.2 42.3 40.1 22.0 26.2 24.0

Elementary level

1-3 years 30.2 21.2 26.0 32.0 26.0 29.1 31.9 21.6 27.0 30.1 23.0 26.9 18.3 13.2 16.0 29.2 21.9 25.8

4-6 years 37.2 32.2 34.9 27.7 26.4 27.1 38.6 38.5 38.5 37.4 31.5 34.8 28.3 27.6 27.9 32.9 30.6 31.8

High school

1-3 years 11.4 13.8 12.5 7.9 9.9 8.8 12.2 15.7 13.9 12.6 16.0 14.1 11.2 13.2 12.1 10.5 12.9 11.6

4 years 8.3 15.4 11.6 3.9 5.4 4.6 6.1 9.2 7.6 5.3 10.0 7.4 4.0 3.7 3.9 5.4 8.4 6.8

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

411 363 774 675 628 1,303 376 338 714 246 200 446 322 272 594 2,030 1,801 3,831


28

Table 15) is influenced by the type of household arrangements described. Only 12 percent of households are 1- or 2-person households. Households with 3 members are usually parents with one child, that is, in the beginning of family formation.

Table 15: Size of households Percept distribution of households by size and mean household size

Dumingag Sinuda

Monte-


1 4.9 2.7 2.6 5.6 3.3 3.5

2 8.5 8.3 8.4 9.3 8.3 8.5

3 15.1 16.1 20.1 17.4 14.0 16.4

4 19.7 18.0 17.2 13.7 22.3 18.4

5 12.8 16.1 18.2 16.8 14.5 15.6

6 15.4 11.4 10.6 9.9 13.2 12.2

7 10.5 10.4 10.2 13.7 14.0 11.3

8 4.3 8.1 7.3 6.8 3.7 6.4

9+ 8.9 8.9 5.5 6.8 6.6 7.7

Total 100.0 100.0 100.0 100.0 100.0 100.0


305 528 274 161 242 1,510

Mean 5.0 5.2 4.9 4.9 4.9 5.0


With every additional child the household continues to grow. The mean household size for the project area was 5.0, which suggests an average of three children. There were only small variations between the ancestral domains. Sinuda has a slightly higher household size. The slightly higher household size in Sinuda can be attributed to the fact that among the five (5) ADs, it is where general fertility rate (162.3) and non-use of contraception (67.2) is highest compared to other areas.

In the IPBDS 2013 questionnaire there had been items on household income and spending in kind and in cash included. Yet the results were very inconsistent and did not allow to draw any reliable conclusion, particularly since it was not possible to establish if the answers for income. In kind had to be considered on top of the given cash answers or if interviewers had estimated the in-kind values to cash. For these conversions no clear instructions had been given to interviewers.

4 . 2 T h e i m p a c t o f t y p h o o n P a b l o

The Philippines and particularly Mindanao have been hit several times in the past by typhoons. [8] Typhoon Pablo (or typhoon Bopha) in December 2012 was the strongest tropical cyclone to hit Mindanao in many decades. More than 600 fatalities have been estimated and thousands of people were left homeless. Within the project area the provinces of Agusan Del Sur and Compostela Valley were most affected by typhoon Pablo.

29

IPDBHS 2013 asked respondents from those two provinces if they were ever relocated to an

evacuation centre and how their households had been affected by typhoon Pablo (Table 16).

Respondents were allowed to name several effects.

Table 16: Impact of typhoon Pablo

Percentage of households by relocation to an evacuation centre and percentage of responses by impact due to typhoon Pablo on household (multiple responses possible)

Agusan Del Sur Compostela Valley Total

Have you ever relocated to an evacuation centre and utilized its services during the disaster period?

Yes 8.8 57.5 34.8

No 91.2 42.5 65.2

Total 100.0 100.0 100.0

Number of households 239 273 512

Effects of typhoon Pablo on household (more than one response possible)

Loss of livelihood 79.4 40.6 52.7

Loss of shelter 17.1 34.0 28.8

Loss of life of family members 0.0 0.5 0.3

Loss of properties 3.6 24.4 17.9

Reported cases of abuse and violence 0.0 0.3 0.2

Cases of early or unplanned pregnancy 0.0 0.2 0.1

Total 100.0 100.0 100.0

Responses 281 623 904


In Compostela Valley 57.5 percent of responses named relocation to an evacuation centre during the disaster period. Agusan Del Sur was much less affected: 8.8 percent of responses named relocation.

The most important effect on households was the loss of livelihood. 79.4 percent of responses in Agusan Del Sur and 40.6 percent of responses in Compostela Valley named that impact. Loss of shelter was the second most important impact, more so in Compostela Valley (34 percent of responses) than in Agusan Del Sur (17.1 percent). After loss of livelihood and loss of shelter, loss of property was the next important impact. Among the “other” items mentioned was the death of livestock animals.

Although the absolute number of fatalities due to typhoon Pablo in Mindanao was quite high, only 0.5 percent of responses in Compostela Valley mentioned the loss of life of a family member.

The question about effects of typhoon Pablo had been purposefully formulated to be quite broad, including cases of abuse and violence, unplanned pregnancies etc. Yet, these impacts were rather rare.

In the list of household members, two questions were included to identify who might have joined or left the household after typhoon Pablo. Only few household members left the

30

household after typhoon Pablo. In Compostela Valley this is true for 3.9 percent of household members, in Agusan Del Sur for 1.5 percent of household members.

Table 17: Residence of household members before/after typhoon Pablo

Percept distribution of household member by residence before/after typhoon Pablo

Agusan Del

Sur Compostela

Valley Total

Residence before and after typhoon Pablo

98.5 96.1 97.2

Residence only after typhoon Pablo 0.0 0.0 0.0

Residence before, but not after typhoon Pablo

1.5 3.9 2.8

Total 100.0 100.0 100.0

Number of household members 1,082 1,200 2,282


There are no household members who joined the household only after typhoon Pablo. This suggests that household structures had been restored after typhoon Pablo and families faced the challenges of building a new house and finding a new livelihood together.

4 . 3 H o u s i n g c h a r a c t e r i s t i c s a n d a c c e s s i b i l i t y

The physical characteristics of houses are an indicator for the wealth of households, but they create also conditions for health. In IPBDS 2013 respondents were asked of what construction material was made the externals walls, the floor and the roof in their house.

31

Table 18: Construction material used for the external wall of the house

Percept distribution of households by construction materials used for the external wall, project area 2013, in comparison Philippines 2008 from NDHS 2008


Philippines NDHS 2008

Urban Rural

Cane/ Palm 7.7 26.9 5.5 23.0 13.5 16.5 0.7 3.3

Dirt 0.0 0.0 0.0 0.0 0.0 0.0

Bamboo 67.6 33.6 53.1 31.1 8.6 39.8 6.8 24.9

Stone with Mud 0.0 0.0 0.0 0.0 0.0 0.0 … …

Uncovered Adobe 0.0 0.0 0.0 0.0 0.0 0.0 … …

Plywood 0.0 0.0 0.0 0.0 0.0 0.0 11.6 10.5

Makeshift/ Cardboard/ Reused Material 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.9

Cement 5.4 0.6 4.0 1.2 1.2 2.4 35.3 17.6

Stone with Lime Cement 0.0 0.0 0.0 0.0 0.0 0.0 0.8 0.2

Bricks 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.1

Cement Blocks 0.0 0.0 0.0 0.0 0.0 0.0 37.6 27.1

Covered Adobe 0.0 0.0 0.0 0.0 0.0 0.0 … …

Wood Planks/ Shingles 18.3 36.3 16.1 42.9 69.0 34.9 4.9 13.8

Galvanized Iron/Aluminum 0.0 0.0 0.0 0.0 0.0 0.0 0.8 1.1

Other 1.0 2.7 21.2 1.9 7.8 6.4 0.3 0.5

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Number of households 312 524 273 161 245 1,515 6,277 6,192


32

Urban houses in the Philippines nowadays are more than one third built with cement walls, more than another third built with cement blocks. Plywood is the next important building material for the walls in urban houses. For rural houses cement blocks are the most important building material for walls too, but closely followed by bamboo (24.9 percent). Houses of IP households use Bamboo as the most important building material for external walls (39.8 percent). Wood planks and shingles follow with another 34.9 percent. Together with cane and palm these materials constitute 91.2 percent of all building materials used for external walls. Cement is only used in 2.4 percent of IP houses. This describes a substantial difference to the rural population of the Philippines in total. Within the project area Dumingag and Montevista have a slightly higher share of houses with cement walls.

Table 19: Construction material used for the roof of the house

Percept distribution of households by construction materials used for the roof, project area 2013, in comparison Philippines 2008 from NDHS 2008

Dumin-gag

Sinuda Monte- vista



Urban Rural

No Roof 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0

Thatch/Palm/ Leaf (NIPA)

5.1 0.8 15.4 0.6 18.7 7.2 3.7 17.6

Sod/Grass (Cogon)

59.5 62.9 1.1 76.3 0.0 42.4 0.7 3.4

Rustic Mat 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0

Palm Bamboo 0.0 0.4 1.8 0.0 4.5 1.2 0.2 0.9

Wood Planks 0.0 3.8 1.8 0.0 0.8 1.8 0.0 0.1

Makeshift/ Cardboard/ Reused Material

0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.1

Galvanized Iron/Aluminum

35.4 28.2 65.8 23.1 55.3 40.3 91.8 76.4

Wood 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1

Calamine/ Cement Fiber

0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.0

Ceramic Tiles 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.0

Cement 0.0 0.0 0.0 0.0 0.0 0.0 1.7 0.5

Roofing Shingles

0.0 0.8 0.7 0.0 13.8 2.6 0.6 0.8

Other 0.0 3.2 13.2 0.0 6.9 4.6 0.2 0.1

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0


311 529 272 160 246 1,518 6,277 6,192


Sod and Grass is the material most often used for roofs in IP households in the project area. It is closely followed by galvanized iron / aluminium. However, Montevista is quite distinct in its building patterns. More than 2 out of three houses of IP households in Montevista have galvanized iron / aluminium roofs. Sod or grass is not to be found as building material for roofs in Montevista, yet thatch or palm leaves play a more important role than in the other project regions. For the Philippines galvanized iron / aluminium roofs play a much more

33

dominant role as a building material for roofs: 91.8 percent in urban areas and 76.4 percent in rural areas. Sod or grass, while in the project area at 42.4 percent, is to be found in this role only by 3.4 percent even in rural areas of the country.

The floor of IP houses is mostly built from palm / bamboo (45.3 percent). In Dumingag the share of IP houses with a floor from palm / bamboo is even higher: almost 72 percent, in Montevista 61.1 percent. Palm/ bamboo are much less relevant in other parts of the Philippines. Only 20.9 percent of rural houses and 8.1 percent of urban houses use this material for their floors. The second most often used material for the floors in IP houses is wood / planks: 29.6 percent of all houses. In Sinuda this material is even used by 54.9 percent of IP houses. Cement, while popular in the rest of the Philippines (urban: 57.7 percent, rural: 45.7 percent) is used by less than 5 percent of the IP houses in the project area, slightly more in Dumingag and Montevista.

Table 20: Construction material used for the floor of the house

Percept distribution of households by construction materials used for the floor, project area 2013, in comparison Philippines 2008 from NDHS 2008

Dumingag Sinuda

Monte- vista



Urban Rural

Natural Floor Earth/Sand

2.2 6.1 5.5 0.6 0.0 3.6 4.6 12.8

Wood Planks 16.0 54.9 2.9 49.4 9.4 29.6 8.1 11.6

Palm/Bamboo 71.8 32.9 61.1 40.6 23.7 45.3 4.8 20.9

Parquet or Polished Wood

1.6 1.9 10.9 1.9 57.1 12.4 0.6 0.4

Vinyl or Linoleum

0.0 0.0 0.0 0.0 0.0 0.0 4.9 2.8

Ceramic Tiles 0.0 0.0 0.0 0.0 0.0 0.0 16.5 5.0

Cement 8.0 2.7 9.8 2.5 0.8 4.7 57.7 45.7

Carpet 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.2

Marble 0.0 0.0 0.0 0.0 0.0 0.0 2.5 0.6

Other 0.3 1.5 9.8 5.0 9.0 4.3 0.1 0.0

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0


312 526 275 160 245 1,518 6,277 6,192


Almost half of the interviewed households need less than 10 minutes to reach the nearest

main access road (Table 21). Yet, there are substantial differences in accessibility. In

Montevista a majority of households is located directly at a road; the average travel time to the nearest access road is only 4 minutes. In Sinuda almost half of the households need more than 2 hours to reach an access road. The travel time needed to reach an access road is 116 minutes. Similar to Sinuda is Gawasan with 110 minutes average travel time to reach a road. The results from IPBDS2013 reconfirm the perception of IP settlements as geographically difficult to access, particularly in Sinuda and Gawasan.

34

Table 21: Accessibility of households

Percept distribution of households by minutes needed in walking or travelling from house to nearest main access road and mean time, project area 2013

minutes Dumingag Sinuda Monte- vista


up to 1 17.5 13.4 59.3 .7 46.5 26.4

2-9 26.2 19.6 25.3 2.8 22.9 20.7

10-19 3.3 4.5 7.9 0.0 2.4 4.1

20-59 23.3 5.0 6.6 5.6 1.8 9.0

60-119 19.6 8.4 0.8 62.2 7.6 15.6

120+ 10.2 49.3 0.0 28.7 18.8 24.3

Total 100.0 100.0 100.0 100.0 100.0 100.0

Mean time, minutes

37 116 4 110 49 67


275 404 241 143 170 1,233


Respondents had been asked about the tenure status of the house in which they live. In

Sinuda, Gawasan and Binicalan almost all houses were in an owner-like possession tilted

thru the Certificates of Ancestral Domain Claims (CADC). In Dumingag and Montevista was

an important type of ownership too, but it was complemented rent-free lots with the consent

of the owner.

Table 22: Tenure status of houses Percentage of households by tenure status


Owner, owner-like possession of house and lot, individually titled

7.1 0.0 7.9 0.0 0.0 2.9

Owner, owner-like possession of house and lot, tilted thru CADC

49.7 98.1 35.7 98.1 98.0 76.9

Rent house/room including lot 0.0 0.2 0.0 0.6 0.0 0.1

Own house/rent lot 2.9 0.2 2.2 0.0 0.0 1.0

Own house, rent-free lot with consent of owner

31.7 0.0 36.8 0.0 0.8 13.3

Own house, rent-free lot without consent of owner

0.3 0.0 2.2 0.0 0.0 0.5

Rent-free house and lot with consent of owner

6.7 0.7 7.2 0.0 0.4 3.0

Rent-free house and lot without consent of owner

0.0 0.0 0.0 0.0 0.4 0.1

Other tenure 1.0 0.2 6.9 0.0 0.0 1.5

No Answer 0.6 0.6 1.1 1.2 0.4 0.7

Total 100.0 100.0 100.0 100.0 100.0 100.0



35

4 . 4 S o u r c e s o f d r i n k i n g w a t e r , t o i l e t f a c i l i t i e s a n d g a r b a g e d i s p o s a l

Water-borne diseases are in many countries an important reason for health problems. Safe drinking water can contribute substantially to the health of adults, but it is very important for infants and children. For the daily use of water, the distance from the household to the water source is important.

Table 23: Time needed to get to water source

Percept distribution of households by time needed to get water in minutes and mean, project area 2013, in comparison Philippines 2008 from NDHS 2008

Dumingag Sinuda Monte- vista



Urban Rural

up to 1 13.4 18.2 6.7 23.2 20.5 16.1 84.4 59.0

< 30 min. 78.8 80.3 86.9 71.0 76.1 79.4 12.6 34.5

30-60 min. 4.6 1.1 1.6 1.3 2.6 2.2 1.0 5.9

60+ 3.2 0.4 4.8 4.5 0.9 2.3

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Mean time in minutes

12.7 6.7 19.1 9.1 8.8 10.8


283 467 252 155 234 1,391 6,277 6,192


While for 84.4 percent the urban population of the Philippines water is available in the house or on the premise, this is only true for 16.1 percent of households in the project area. In almost 80 percent of households members have to walk for less than 30 minutes. In Gawasan and Binicalan the share of households with water on the premise is slightly higher than in the other project regions.

36

Table 24: Sources of drinking water

Percept distribution of households by main source of drinking water for household members, project area 2013, in comparison Philippines 2008 from NDHS 2008

Dumin-

gag Sinuda

Monte- vista

Gawa-san

Binica-lan

Total


Urban

Rural

Improved source

50.2 80.8 76.8 66.5 63.4 69.4 60.3 79.5

Piped into dwelling

1.6 12.3 3.4 19.6 0.0 7.3

38.2 22.0 Piped to yard/plot

4.5 14.6 1.9 35.4 0.0 10.1

Public tap/stand pipe

30.1 43.3 15.0 5.1 59.3 34.1 3.2 7.0

Tube well or borehole

0.0 0.0 0.0 0.0 0.0 0.0 14.3 29.2

Protected Well

2.6 0.4 8.6 1.9 0.0 2.4 2.2 7.8

Semi-protected well

1.3 0.2 4.1 3.2 0.0 1.4 0.3 1.9

Protected Spring

10.0 8.7 43.8 1.3 4.1 13.7 1.7 10.7

Rainwater 0.0 1.3 0.0 0.0 0.0 0.5 0.4 0.9

Non-improved source

48.5 19.0 17.6 31.0 36.2 28.9 2.9 12.1

Unprotected Well

7.1 0.8 12.4 1.9 0.0 4.1 0.6 5.2

Unprotected Spring

41.4 18.3 5.2 29.1 36.2 24.8 0.5 5.2

Tanker Truck

0.0 0.0 0.0 0.0 0.0 0.0

1.6 1.3 Cart with small tank

0.0 0.0 0.0 0.0 0.0 0.0

Surface water

0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.4

Bottled Mineral Water

0.0 0.0 1.1 0.0 0.0 0.2 33.6 6.6

Other sources

1.3 0.2 4.5 2.5 0.4 1.5 3.2 1.8

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0


309 520 267 158 243 1,497 6,277 6,192


37

The quality of drinking water depends a lot on the source of water. Only 17.4 percent of households in the project area are connected with pipes, either to the yard/plot or to the dwelling.

This is half the share this source has for the urban households of the Philippines. Only in Gawasan this share is higher. For the IP households in the project area the single most important source of drinking water are public taps and pipe stands (34.1 percent). In Binicalan this is the main source of drinking water for 59.3 percent of households. Unprotected springs are the second most important source of drinking water. Generally they can provide water of good quality, but also of bad quality. In most cases household members would not know the actual quality of water from springs. Bottled mineral water plays an important role for urban households in the Philippines (33.6 percent as main source of

drinking water), much less in rural households. In the project area this is not yet relevant.

Table 25: Toilet facilities

Percept distribution of households by toilet facility, project area, end of 2012, in comparison Philippines 2008 from NDHS 2008

Dumin-gag

Sinuda Monte- vista



Urban Rural

To Piped Sewer System

3.9 6.7 0.4 8.1 3.7 4.6 3.0 2.7

To Septic Tank 14.2 8.9 19.4 6.9 13.0 12.3 66.9 40.0

To Pit Latrine 17.1 18.4 22.0 28.8 1.2 17.1 3.0 11.1

To Somewhere Else

0.0 0.0 0.0 0.0 0.0 0.0 0.8 0.8

Flush Don’t know Where

0.0 0.0 0.0 0.0 0.0 0.0

Ventilated Improved

3.9 0.8 0.0 5.6 2.0 2.0 0.2 1.0

With Slab 4.8 7.4 4.4 20.6 2.0 6.9 0.3 2.5

Without Slab/Open pit

49.0 35.7 50.9 17.5 1.6 33.7 0.9 3.4

Composting Toilet

0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.6

Bucket Toilet 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.2

Drop/ Hanging Toilet

0.0 0.0 0.0 0.0 0.0 0.0 0.3 1.5

No Facility/Bush/ Field/River

6.5 18.8 0.4 3.1 72.8 20.1 3.9 15.2

Other 0.6 3.2 2.6 9.4 3.7 3.3 20.5 21.0

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0


310 526 273 160 246 1,515 6,277 6,192


For urban households in the Philippines, a flush toilet to a septic tank is the most common toilet facility (66.9 percent). For rural households flush toilets to a septic tank are the most

38

important toilet facility as well (40 percent), but shared facilities with other households as well as the use of the bush or field are important too. The latter can be an important health hazard if any connection to drinking water or grown vegetables exists. Inadequate or no toilet facility can potentially pollute the water system; increase the incidence of water borne diseases or diseases transmitted by insects.

Specifically, comparing the result shows that the use of slab/open pit toilet in the project areas is much higher (33.7 percent) compared to the NDHS which (0.9 percent) for urban and (3.4 percent) for rural areas. This is highly used in Montevista with (50.9 percent) or half of the respondents, followed by Dumingag (49 percent). Also, worth noting is the absence of toilet or utilization of bush/field or river by a greater majority (79.8 percent) of the respondents in Binicalan. In the project area this unsafe toilet facility is used by one in 5 IP households. In Binicalan almost three out of four household use this type of toilet facility. Pit latrines without slab or open pits are problematic as well, but still used by one third of IP households or even every second household in Montevista.

Table 26: Garbage disposal

Distribution of households by garbage disposal used by percent of all answers (multiple responses possible), project area, end of 2012



Garbage collection 0.0 0.0 2.2 0.0 0.0 0.4

Burning 17.4 71.8 52.6 98.1 82.6 61.5

Composting 40.6 18.7 5.2 4.3 22.9 20.0

MRF/Recycling 5.2 3.7 8.2 0.0 0.0 3.8

Waste segregation 51.0 14.8 30.6 0.0 0.8 21.4

Compost pit with cover

11.0 24.9 26.5 0.0 0.0 15.6

Others 2.6 5.7 14.2 1.2 8.9 6.6

Total 100.0 100.0 100.0 100.0 100.0 100.0


310 507 268 161 236 1,482


Besides drinking water and toilet facilities the system of garbage disposal used in households is relevant for health. Garbage collection by municipal or private garbage collectors is not yet relevant in IP households. The most often used system is burning (61.5 per cent), except in Dumingag. The result is very high in Gawasan with (98.5 per cent). Open burning which appears to be common in the project areas is a very unhealthy method of garbage disposal not mentioning its effect on the environment. In the Philippines, open burning of waste is prohibited under Republic Act 9003 or the Ecological Solid Waste Management Act of 2000. Waste segregation is often used in Dumingag and Montevista but almost never in Gawasan and Binicalan. Composting is also quite popular, mostly in Dumingag, Sinuda and Binicalan.

39

4 . 5 F e r t i l i t y i n I P h o u s e h o l d s

The high percentage of children in the age group up to 5 years already suggests high fertility and population growth in the IP population.

Usually in Demographic and Health surveys, like NDHS 2008, a birth history is recorded for each woman of reproductive age in the household. In IPBDS 2013 a table of all births that ever occurred in the household was recorded. From this data two measures of fertility could be computed (Table 27). The crude birth rate gives the number of births per 1000 population. This indicator is considered crude because it relates the events to be measured (births) to the general population, including children and older people, who are generally not involved in fertility. In contrast, the general fertility rate relates births more precisely to the women of reproductive age, i.e. the risk population for births. Another measure of fertility, the total fertility rate, could not be computed in IPBDS 2013, since the sample size was too small in absolute terms. To compute age-specific fertility rates needed for the total fertility rate reliably for a period of three years, about 8,000 women would have been needed.

Table 27: Fertility in IP households

Crude birth rate (births per year per 1000 of the respective population) and general fertility rate (births per year per 1000 women in reproductive age) for the period of three years prior to the survey, comparison with NDHS 2008.

Dumingag Sinuda

Monte- vista



Urban Rural

Crude birth rate

32.8 34.4 30.8 29.4 30.5 32.3 23.4 24.6

General fertility rate

148.7 162.3 138.0 131.1 141.4 148.5 96.0 128.0


For the whole project area a crude birth rate of 32.3 and a general fertility rate of 148.8 were measured for the three years prior to the survey. This is substantially higher than what NDHS 2008 measured for the rural parts of the Philippines. As measured with the crude birth rate, the fertility of IP households is comparable to the countrywide fertility of Zimbabwe or with the fertility of the group of least developed countries.

The differences in the level of fertility between ancestral domains are not very big. The highest fertility is to be found in Sinuda and Dumingag and the lowest in Gawasan.

We don’t know the fertility preferences for the IP population, the ideal number of children or how big is the proportion of unwanted births in the total number of births. [9] From NDHS 2008 we know that for the rural population of the Philippines, the wanted total fertility is 2.7 children per woman and the actual fertility is 3.8 [6]. The higher fertility of IP women could be wanted fertility as well as unwanted fertility.

If teenage girls get pregnant and give birth they are often not able to provide the best conditions for their babies. In most cases it means also the end of the education for the young mother. Adolescent fertility in early teen years, before age 16, is often associated with health problems for mother and birth. In the IP communities adolescent fertility is not uncommon. Table 1 shows the percentage of births by age of young mother at birth; the lower part of the table gives cumulated percentages. 3.5 percent of all births in the 10 years preceding the survey had a mother of seventeen or younger. Among the ancestral domains Montevista has the highest adolescent fertility, with one in five births by a mother of age 19 or younger.

40

Table 28: Adolescent fertility

Percentage of births in the 10 years preceding the survey by age of mother at birth


14 0.0 0.8 1.0 0.0 1.5 0.7

15 0.7 1.3 2.0 1.3 0.0 1.1

16 0.9 2.2 1.7 1.3 1.5 1.7

17 4.0 4.2 5.4 2.7 2.1 3.9

18 3.1 4.8 4.9 2.7 4.1 4.2

19 5.8 5.2 5.4 3.6 4.1 5.0

cumulative percent

14 0.0 0.8 1.0 0.0 1.5 0.7

15 0.7 2.2 2.9 1.3 1.5 1.8

16 1.6 4.4 4.6 2.7 3.1 3.5

17 5.6 8.6 10.0 5.4 5.2 7.4

18 8.7 13.4 14.9 8.0 9.3 11.6

19 14.5 18.5 20.2 11.6 13.4 16.6


In the project area more than 88 percent of births in the two years before the survey were

delivered at home (see Table 29). This is slightly different in Montevista, where more than

one out of four births was delivered in a facility. There seems to be a change over time. The births in the period of 2 to 4 years were 93.7 percent delivered at home.

Table 29: Delivery at home

Percentage of births by place of birth

Dumingag Sinuda

Monte- vista


less than 2 years before survey

Home 85.6 91.9 71.6 97.8 95.6 88.3

Facility 11.3 4.8 25.9 2.2 4.4 9.4

Hospital 3.1 3.2 2.5 0.0 0.0 2.3

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of births

97 186 81 46 68 478

2 to 4 years before survey

Home 96.9 97.2 75.9 100.0 97.5 93.7

Facility 2.0 2.3 21.7 0.0 2.5 5.4

Hospital 1.0 0.6 2.4 0.0 0.0 0.8

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of births

98 176 83 41 81 479


41

For births at home help is in most cases welcome. As documented in Table 30, this help comes in most cases from traditional birth attendants (95.5 percent of all births in the 2 years before the survey). In Binicalan and Dumingag there were a number of births without any help.

Table 30: Help from traditional birth attendants at birth

Percentage of births in the two years before the survey by type of help



less than 2 years before survey

Traditional birth attendant or “Hilot”

91.6 98.2 98.3 100.0 87.7 95.5

SBA- Skilled birth attendant like Doctor, Nurse or Midwife

0.0 1.2 1.7 0.0 0.0 0.7

None 8.4 0.6 0.0 0.0 12.3 3.8

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of births 83 170 58 45 65 421


Not only for statistical matters but mostly for the sake of the children, registration of births is important. Table 31 lists the registration status of births that occurred in the 6 years before the survey – by year they occurred. From births that occurred in the project area 5 completed years before the survey, almost three out of four births are registered today. Yet, for the births that occurred less than a year before the survey, less than 50 percent are registered today. Obviously many parents tend to register children not in the first year after birth but later. Montevista and Gawasan are important exceptions; in Montevista close to 80 percent of births were registered within the first year, in Gawasan more than 90 percent.

42

Table 31: Registration of IP births

Percentage of births registered at the time of the survey by period birth occurred

Dumingag Sinuda

Monte- vista


0 years

Yes 38.5 42.7 79.6 90.5 10.3 49.4

No 61.5 57.3 20.4 9.5 89.7 50.6

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of births 52 96 49 21 29 247

1 years

Yes 73.7 59.5 75.0 84.0 16.7 59.7

No 26.3 40.5 25.0 16.0 83.3 40.3

Total 100.0 100.0 100.0 100.0 100.0 100.0


2 years

Yes 55.1 63.2 72.5 77.3 8.8 56.5

No 44.9 36.8 27.5 22.7 91.2 43.5

Total 100.0 100.0 100.0 100.0 100.0 100.0


3 years

Yes 75.6 72.0 92.9 94.4 23.7 70.2

No 24.4 28.0 7.1 5.6 76.3 29.8

Total 100.0 100.0 100.0 100.0 100.0 100.0


4 years

Yes 69.6 74.5 92.1 87.5 31.3 68.6

No 30.4 25.5 7.9 12.5 68.8 31.4

Total 100.0 100.0 100.0 100.0 100.0 100.0


5 years

Yes 73.8 74.2 87.0 100.0 20.8 73.9

No 26.2 25.8 13.0 0.0 79.2 26.1

Total 100.0 100.0 100.0 100.0 100.0 100.0



4 . 6 B r e a s t f e e d i n g

Starting at birth adequate nutrition of children is very important for their physical and mental development and their lifetime health experience. Mother’s milk is the best form of nutrition

43

for newborns in the first six months of their life. In the Philippines the Department of Health advocates breastfeeding strongly. Republic Act 7600, known as “The Rooming-In and Breastfeeding Act of 1992,” provides incentives to all government and private health institutions in the Philippines that support rooming-in and breastfeeding. The Act provides that newborn infants with normal deliveries be put to the mother’s breast immediately after birth, and roomed-in within 30 minutes; infants delivered by caesarean section should be roomed-in and breastfed within 3 to 4 hours after delivery.” [6]

IPBDS 2013 respondents were asked for each child born in the household how long the child

had been breastfed. Table 32 gives results for the period between one year before the

survey and 6 years before the survey. This period was chosen to avoid a truncation bias resulting from children born just a few months before the survey. Since only a small space was given to this subject in the questionnaire, knowledge about those children having never been breastfed is a little vague. Those children for which “no answer” was given by the respondent could be considered as never breastfed. Yet, in this number are also children for which the respondent simply did not know how long they were breastfed. NDHS 2008 gives the percentage of rural children who had never been breastfed as less than 8 percent.

Table 32: Breastfeeding by IP mothers

Percentage of children born in the period of 1 to 6 years before the survey by duration of breastfeeding

Dumingag Sinuda

Monte- vista


less than 3 months 2.6 9.8 4.0 2.8 4.6 6.0

3 to 5 months 40.0 33.3 25.1 22.2 23.0 30.6

6 to 11 months 48.7 40.8 53.3 66.7 52.0 48.5

12 to 17 months 1.7 9.4 12.1 0.0 11.7 7.9

18 months and more

0.0 1.3 1.5 0.0 0.0 0.7

no answer 7.0 5.3 4.0 8.3 8.7 6.2

Total 100.0 100.0 100.0 100.0 100.0 100.0

230 468 199 108 196 1,201


Only 6 percent of children born into IP households in the project area had been breastfed for less than 3 months. A total of 30.6 percent were breastfed 3 to 5 months and another 48.5 percent for 6 to 12 months. In Montevista, Gawasan and Binicalan breastfeeding is longer than in the other ancestral domains.

4 . 7 I m m u n i z a t i o n o f c h i l d r e n

Immunization can strengthen children’s immune system against various diseases. Active immunization has been named one of the ten great public health achievements of the 20th century. In the Philippines the Expanded Program on Immunization (EPI) was started in 1979. Wednesday is scheduled as immunization day. Immunizations are done monthly in Barangay Health Stations.

The World Health Organization (WHO) considers a child as fully immunized if it has received the following vaccinations before its first birthday: Bacillus Calmette–Guérin (BCG) at birth or

44

at the first clinical contact, three doses of vaccine against diphtheria, pertussis (whooping cough) and tetanus (DPT), three doses of oral polio vaccine (OPV) and a measles vaccination at about nine months of age. In the Philippines the EPI standard immunization schedule requires additionally three doses of hepatitis B vaccine. To support families in making use of these free offers at the right time vaccination cards are given to mothers.

In IPBDS 2013 respondents were asked about the immunization of the last-born child and the next-to-last-born child. After date of birth, respondents were asked about the availability of the immunization card. Table 33 shows results for this question.

Table 33: Availability of immunization cards

Percentage of answers regarding availability of vaccination cards for the two last-born children

Dumingag Sinuda

Monte- vista


Yes 34.3 27.1 34.1 85.8 23.2 36.4

No 58.7 57.4 60.4 12.3 53.1 52.5

No Answer 7.0 15.6 5.5 1.9 23.7 11.1

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of children 385 643 364 211 211 1,814


For slightly more than one in three of the children counted, respondents could positively claim to have the vaccination card available. That is less than what had been found out for the Philippines in total by NDHS 2008 (43 percent). For every second child respondents of IPBDS 2013 in the project area stated that they did not have a vaccination card, another 11.1 percent did not provide any answer to this question. The availability of vaccination cards was higher in Gawasan and lower in Binicalan.

Interviewers of IPBDS 2013 were instructed to record vaccinations from the vaccination card if available and to record respondent’s answers if the card was not available. From NDHS 2008 we know that the share of immunized children was higher from mother’s oral answer than from the immunization cards. However, within the interviewing situation of IPBDS 2013 it has to be considered that “No Answer” does not always mean “No immunization”. Some of the respondents revealed that they do not have their immunization cards because they left it at the health centre per instruction of the health worker, some claimed they lost it.

Table 34 shows results from cards (24 percent) as well as oral answers from respondents.

Table 34: Immunization of BCG

Percentage of the two last-born children by immunization with BCG

Dumingag Sinuda

Monte- vista


Yes 59.7 30.1 77.3 90.0 14.7 51.1

No 0.5 11.1 3.3 0.5 0.0 4.8

No Answer 39.7 58.8 19.5 9.5 85.3 44.1

Total 100.0 100.0 100.0 100.0 100.0 100.0



45

Only half of IP children in the project area had received BCG immunization. That is substantially lower than the 92.3 percent NDHS 2008 found for the total of the Philippines. The numbers are not directly comparable, since NDHS 2008 with a much higher sample size could restrict to children in age 12-23 months at the time of the interview vaccination by 12 months. Furthermore NDHS 2008 had interview mothers, who probably knew better about this subject.

Table 35: Immunization against Hepatitis B

Percentage of the two last-born children by immunization with BCG

Dumingag Sinuda

Monte- vista


Hepatitis-1st dose

Yes 53.2 28.8 76.2 81.0 10.4 47.7

No 0.8 6.2 0.0 4.3 0.0 2.8

No Answer 46.0 65.0 23.8 14.7 89.6 49.5

Total 100.0 100.0 100.0 100.0 100.0 100.0


Hepatitis-2nd dose

Yes 52.2 25.6 76.0 80.1 9.5 46.1

No 0.8 6.7 0.0 4.7 0.0 3.0

No Answer 47.0 67.8 24.0 15.2 90.5 50.9

Total 100.0 100.0 100.0 100.0 100.0 100.0


Hepatitis-3rd dose

Yes 51.7 23.1 76.1 81.0 8.5 45.1

No 0.8 7.3 0.0 4.3 0.0 3.2

No Answer 47.5 69.5 23.9 14.7 91.5 51.7

Total 100.0 100.0 100.0 100.0 100.0 100.0



Immunization against hepatitis B should also be delivered immediately after birth. Table 35 shows results of the respective question.

Less than half of the last two children born in IP households in the project area have been immunized against hepatitis B. Of those who were lucky enough to get the first dose of the hepatitis vaccine, most got the other two doses and can probably be considered protected against hepatitis B. Yet, this value is much lower than NDHS 2008 found for the total of the Philippines (86.5 percent first dose, 75.7 percent third dose). Montevista and Gawasan stand out much better than the other three ancestral domains.

According to EPI the three doses of DPT OPV each are to be delivered 6 weeks after birth. In order to avoid truncation it would be necessary to restrict the cases for these two vaccinations to births which occurred more than 6 weeks before the interview. Yet, for more than one third of the children no date of birth was recorded by interviewers. Therefore also

46

for these vaccinations all children had to be included, keeping in mind that the numbers might be a bit low for those children who were younger than 6 weeks at the time of the interview.

Table 36: Immunization against diphtheria, pertussis and tetanus (DPT)

Percentage of the two last-born children by immunization against DPT

Duming

ag Sinuda

Monte- vista


DPT-1st dose

Yes 59.7 32.5 79.1 83.9 13.7 51.7

No 0.0 5.2 0.3 2.8 0.0 2.2

No Answer 40.3 62.3 20.7 13.3 86.3 46.1

Total 100.0 100.0 100.0 100.0 100.0 100.0


DPT-2nd dose

Yes 57.1 31.4 79.4 82.0 10.4 50.2

No 0.3 5.5 0.0 3.8 0.0 2.4

No Answer 42.6 63.1 20.6 14.2 89.6 47.4

Total 100.0 100.0 100.0 100.0 100.0 100.0


DPT-3rd dose

Yes 54.5 27.4 78.5 82.9 9.0 48.0

No 0.5 6.0 0.0 3.8 0.0 2.6

No Answer 44.9 66.6 21.5 13.3 91.0 49.3

Total 100.0 100.0 100.0 100.0 100.0 100.0



The picture with DPT is very similar to the immunization against hepatitis. Half of all children received an immunization against DPT. Of these, nearly all received all three vaccinations. In Montevista and Gawasan more than three out of four of children had been immunized, in Binicalan less than 10 percent of children had received all three vaccinations against DPT.

An almost identical picture is given for immunization with oral polio vaccine (OPV, Table 37) and immunization against measles (Table 38).

47

Table 37: Immunization with oral polio vaccine (OPV)

Percentage of the two last-born children by immunization with oral polio vaccine

Dumingag Sinuda

Monte- vista


OPV-1st dose

Yes 57.9 30.3 78.0 86.3 12.3 50.4

No 0.3 6.0 0.0 2.4 0.0 2.4

No Answer 41.8 63.7 22.0 11.4 87.7 47.1

Total 100.0 100.0 100.0 100.0 100.0 100.0


OPV-2nd dose

Yes 55.1 30.4 77.9 85.3 8.5 49.3

No 0.5 5.7 0.0 2.8 0.0 2.4

No Answer 44.4 63.9 22.1 11.8 91.5 48.3

Total 100.0 100.0 100.0 100.0 100.0 100.0


OPV-3rd dose

Yes 53.8 27.0 77.0 84.4 8.5 47.5

No 0.8 6.2 0.0 2.8 0.0 2.6

No Answer 45.5 66.8 23.0 12.8 91.5 49.9

Total 100.0 100.0 100.0 100.0 100.0 100.0



In the case of immunization against measles, it has to be considered that the vaccine is usually delivered 9 months after birth. Within the 1,782 children counted there is a number of children who have not yet reached this age, since they were born less than 9 months before the interview. The real percentage of immunization will therefore be slightly higher than

shown in Table 38

Table 38: Immunization against measles

Percentage of the two last-born children by immunization against measles



Yes 51.7 26.4 79.5 80.6 13.3 47.5

No 1.0 6.0 0.0 3.8 0.0 2.7

No Answer 47.3 67.6 20.5 15.6 86.7 49.8

Total 100.0 100.0 100.0 100.0 100.0 100.0



48

4 . 8 I n f a n t m o r t a l i t y

As part of the demographic transition infant mortality declines from values of more than 100 infant deaths per 1,000 live births to values of around 25 (Philippines 2008) or even lower in developed countries. [10] Germany had an infant mortality rate of over 200 per 1,000 by the end of the 19th century and it is close to 4 per 1000 at present.

The measurement of infant mortality rates from surveys is subject to a range of errors and measurement problems. Due to the retrospective nature, respondents are often not able to give the exact date of death or birth, particularly if the event is more than 5 years ago. Chances for a precise answer are better if mothers are interviewed. The most important problem is absolute sample size.

For the Philippines, NDHS 2008 demonstrated a countrywide decline of infant mortality from the mid-1990s to 2008. NDHS 2008 sampled 12,469 households and interviewed 13,594 women. Even with a sample in that absolute size it was necessary to compute the infant mortality rate for five-year periods in order to get enough cases of infant mortality. The result of the infant mortality rate of 25 for the five years preceding NDHS 2008 would hold true at a confidence level of 95 percent only in the range from 21 to 29 deaths per 1,000 live births. [11]

Table 39: Infant and neonatal mortality in the Philippines

Neonatal, post neonatal and infant mortality for five-year periods preceding the survey

years preceding the survey

approximate calendar years

neonatal mortality

post neonatal mortality

infant mortality

0-4 2004-08 16 9 25

5-9 1999-2003 17 13 31

10-14 1994-1998 18 14 32

Source: [6]

IPBDS 2013 interviewed only 1,531 households and recorded a total of 3,221 births in these households in retrospect. Of these births 2,443 occurred in the 10 years preceding IPBDS 2013. For 19 of these births (male and female) respondents claimed a neonatal death and for 15 of these births respondents claimed a post neonatal death. Arithmetically this would make an infant mortality rate of 13.9 per 1000. However due to the small number of events and the fact that in many cases it was not the mother that were interviewed, this result cannot be considered as valid. A much larger absolute sample size and a different approach to the interview situation would have been needed to measure infant mortality rate. However, it might be possible to derive better estimates for infant mortality rates from the registration of births and deaths.

4 . 9 U s e o f c o n t r a c e p t i o n

Contraception is an important way for women to control the timing and the number of children they receive in their life. Yet, the use of contraception is not easy to measure. Demographic and Health surveys like NDHS 2008 usually take 20 questions or more to cover need of contraception (non-pregnant women in age 15-49 in marriage or relationship), to distinguish between current use and ever use and to find out in detail reasons of non-use, like side-effects. Usually they ask these questions to all women of reproductive age in the household individually.

49

In the IPBDS 2013 questionnaire and during training respondents should be asked to list all women in age 12-44, if they are currently pregnant and what method of contraception they use. However, during field time this was changed to the age 12 to 49 and actual data shows that women until the age of 70 were listed by interviewers. Therefore for analysis the

originally planned age group 12 to 44 was re-established with a filter. InTable 40 results for

non-pregnant women in age 12-44 are shown irrespective if they are married or in a relationship. It was assumed that all “no answer” or “not applicable” meant non-use of contraception. Yet, considering that the question was often not asked to the respective woman but to the head of household, there might be a margin of error in this assumption.

Within the project area 39.4 percent of women in this group had used a method of contraception in 2012. This is quite in line with results of the NDHS 2008: 32.5 percent of all women in age 15 to 49 were using a method of contraception at the time of the survey. In Dumingag and Montevista contraceptive use was more widespread than in Sinuda and Gawasan.

Table 40: Use of contraception

Percentage of non-pregnant women in age 12-44 in IP households by use of contraception in 2012

Dumingag Sinuda

Monte- vista


Use of contraception 43.4 33.1 45.3 37.3 42.8 39.4

IUD 2.8 8.5 0.8 1.6 2.3 4.1

Ligation or vasectomy 1.4 5.1 3.6 1.6 6.5 3.9

Pill 21.0 4.4 28.3 20.5 22.3 16.9

Injectable (DMPA) 2.8 1.5 1.2 4.9 0.0 1.9

Barrier method 1.8 0.0 1.2 0.0 0.0 0.6

Natural family planning 7.8 1.7 3.2 2.7 1.4 3.3

Withdrawal 2.5 3.6 5.3 2.2 0.5 3.0

Traditional methods (incl. herbal medicine)

3.2 8.3 1.6 3.8 9.8 5.7

Non-use of contraception

56.6 66.9 54.7 62.2 57.2 60.6

None of the above 2.5 5.3 5.3 4.3 0.0 3.8

No Answer 54.1 56.8 47.4 47.6 57.2 53.4

Not Applicable 0.0 4.9 2.0 10.3 0.0 3.4

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of women, age 12-44

281 472 247 185 215 1,400


The most popular method in all ancestral domains, with the exception of Sinuda, was the oral contraceptive pill. The second most popular method was ligation or vasectomy, followed by the IUD.

50

4 . 1 0 A c c e s s t o a n d u s e o f h e a l t h f a c i l i t i e s

An important part of the gap in living conditions of IP households and other parts of the population of the Philippines is access to health services. A pre-condition for actual access to health services is knowledge about them.

Respondents of IPBDS 2013 were asked what health facility was nearest to their

house(Table 41). Answers confirmed that the IP population relies mostly on the public

sector for health facilities. In Dumingag, Sinuda and Montevista predominantly the Barangay Health Station/Centre was mentioned. In Gawasan the Barangay Hall was mentioned as the nearest health facility under “Other”. In Binicalan the nearest health facility for most households is the Rural Health Unit, which is also relevant in Dumingag.

Table 41: Health facilities nearest to house

Percentage of households by type of nearest health facilities, mean distance to facility, in km

Dumingag Sinuda

Monte- vista


Public sector

Regional Hospital/ Public Medical Centre

0.0 0.0 0.0 0.0 0.0 0.0

Provincial Hospital 0.5 0.2 0.0 0.0 0.0 0.2

District Hospital 0.0 0.0 0.0 0.0 0.0 0.0

Municipal Hospital 0.2 0.6 0.0 0.0 0.3 0.3

Rural Health Unit 20.3 0.3 3.7 0.0 70.4 18.2

Barangay Health Station/Centre

50.8 83.3 64.5 6.1 1.5 50.9

Other Public Hospital 0.2 0.5 0.0 0.0 0.0 0.2

Private sector

Private Hospital 0.0 0.0 0.0 0.0 0.0 0.0

Lying in Clinic/Birthing Home 0.0 0.3 0.0 0.0 0.0 0.1

Private Clinic 0.0 0.3 0.0 0.0 2.1 0.5

Other Private Hospital, please specify

0.0 0.0 0.0 0.0 0.0 0.0

Alternative medical

Hilot/Herbalists 21.7 8.4 6.6 0.0 0.0 8.9

Therapeutic Massage Centre 0.0 0.2 0.0 0.0 0.0 0.1

Other Alternative Healing 3.5 2.4 0.7 0.0 0.0 1.7

Non-medical sector

Shop Selling Drugs/Market 0.9 2.8 0.0 0.0 0.0 1.1

Faith Healer 1.9 0.6 0.7 0.0 0.6 0.9

Other 0.0 0.0 23.9 93.9 25.1 16.9

51

Dumingag Sinuda

Monte- vista


Total 100.0 100.0 100.0 100.0 100.0 100.0

Responses 429 616 301 165 334 1,845

Mean distance to health facility, km

10.9 15.0 2.5 … 52.3 16.9


The private sector was almost never mentioned by respondents. Yet, alternative medical services were mentioned in Dumingag, Sinuda and Montevista.

In Montevista the nearest health facilities can be reached over a mean distance of 2.5km. Gawasan currently does not have a permanent health facility. Residents can avail of primary health care services only during the monthly visits of the midwife. In Dumingag and Sinuda more than 10km have to be covered to reach the nearest health facility. In Binicalan access to the next health facility is very difficult. The San Luis RHU is more than 50km away and respondents gave a mean distance of 52km to reach the nearest health facility.

The distance to the nearest health facility is very relevant for the IP households since most have to rely on walking to get to the health facilities (Table 42). In Gawasan this is the only way to get to health facilities. In Dumingag, Sinuda and Montevista walking is also the most often used mode of transportation to reach health facilities.

In Binicalan skylabs, motorcycles or habal-habals are the most often used mean of transportation to reach the rural health centre in San Luis Municipality. In Sinuda, Montevista and to a lesser degree in Dumingag, these vehicles are a common means of transportation for this purpose too.

Table 42: Transport to health facilities

Percentage of responses about usual means of transportation to health facility (multiple responses possible)

Dumingag Sinuda

Monte- vista


By Foot/Walking 86.8 71.6 57.3 100.0 16.6 65.7

Bicycle/Trisikad/Tricycle 2.6 0.9 20.7 0.0 0.7 4.9

Skylab/ Motorcycle/Habal-Habal

10.0 27.4 21.9 0.0 82.7 29.2

Banca 0.3 0.0 0.0 0.0 0.0 0.1

Banca or pumpboat 0.3 0.1 0.0 0.0 0.0 0.1

Total 100.0 100.0 100.0 100.0 100.0 100.0

Responses 341 694 347 161 283 1,826


Respondents of IPBDS 2013 were asked about services offered by the health facility they had mentioned as the nearest to the household, allowing them to give more than one response (Table 43). In the first place immunization and vaccination were mentioned. Primary care/preventive care, curative care and family planning counselling/consultation followed close. Yet, these results are influenced by the proximity of the respective health facilities. Usually patients use the nearest health facility for issues which can be solved there and go for more distant facilities with problems which cannot be solved in the nearest health facility.

52

Table 43: Knowledge about health services

Percentage of responses about knowledge of health services offered by nearest health facility (multiple responses possible)

Dumingag Sinuda

Monte- vista


Primary Care/Preventive Care (such as Exercise and Information)

12.9 9.8 12.5 11.1 15.4 12.0

Curative Care (treatment for illness)

8.0 17.9 13.2 6.3 22.9 13.6

Immunization/Vaccination 15.4 21.5 17.8 20.0 19.0 18.6

Birth Delivery 1.0 2.6 2.3 6.1 6.4 2.9

Family Planning Counselling/Consultation

12.7 16.2 13.3 12.3 10.1 13.5

Provision of Family Planning Supplies

9.3 9.2 11.4 11.8 6.8 9.6

Ante-natal 9.1 2.7 2.3 5.0 5.0 4.9

Post-natal 7.3 1.8 1.2 3.9 3.7 3.6

IEC of birth preparedness 10.3 6.2 11.6 9.4 4.7 8.6

Breastfeeding Counselling 10.8 10.8 11.4 8.7 5.9 10.2

Others 3.1 1.3 2.9 5.3 0.1 2.4

Total 100.0 100.0 100.0 100.0 100.0 100.0

Responses 1,865 1,956 1,363 619 781 6,584


Among the health services actually used in 2012 (Table 44) immunization and vaccination is

on the first place too, followed by curative care and by primary care/preventive care. As “other” items, respondents mentioned also the distribution of free vitamins and physical check-ups.

53

Table 44: Health services availed

Percentage of responses on health services availed by the respondents and their family members from the nearest health facility (multiple responses possible)

Dumingag Sinuda

Monte- vista


Primary Care/Preventive Care (such as Exercise and Information)

16.4 12.9 11.4 15.7 19.1 14.5

Curative Care ( treatment for illness)

9.7 21.8 16.8 5.0 26.4 16.2


Birth Delivery 1.6 1.9 1.4 4.8 2.9 2.1

Family Planning Counselling/Consultation

11.1 15.6 12.2 12.9 8.2 12.5

Provision of Family Planning Supplies

7.9 7.1 10.3 11.7 4.9 8.3

Ante-natal 7.8 1.3 1.3 3.8 3.1 3.5

Post-natal 6.2 1.3 0.8 2.7 2.9 2.8

IEC of birth preparedness 8.8 5.6 10.9 7.9 3.3 7.6

Breastfeeding Counselling 10.1 8.6 10.5 7.9 4.5 8.9

Others 3.4 1.4 5.6 6.7 0.2 3.3

Total 100.0 100.0 100.0 100.0 100.0 100.0

Responses 1,273 1,387 1,035 479 488 4,662


If access of IP households to health services should be improved, it is important to understand the obstacles preventing them to use health services. Therefore respondents were asked why they did not avail any of the health services (Table 45). Again it was allowed to give multiple responses to this question. The first reason restricting people from using health services is financial constraints. This is worth mentioning since the facilities most used are public facilities. It is not known to what degree financial constraints refer to official fees or lack of coverage by PhilHealth or unofficial fees demanded by health workers.

54

Table 45: Reasons for non-use

Percentage of responses about reasons not to use health services (multiple responses possible)



Financial Constraint 16.4 31.4 29.2 56.4 37.9 33.1

No companion in going to the facility 2.7 4.9 4.2 7.7 3.9 4.4

Health facility is too far 12.3 20.5 20.8 10.3 43.1 25.7

No trust in people manning the facility

6.8 1.6 0.0 0.0 1.3 2.1

Lack or no transport available 11.0 5.9 4.2 0.0 9.2 7.2

Facility lacks competent staff 12.3 2.7 0.0 0.0 0.0 3.0

Facility lacks medical tools and equipment

27.4 31.4 16.7 15.4 1.3 19.0

Others 11.0 1.6 25.0 10.3 3.3 5.5

Total 100.0 100.0 100.0 100.0 100.0 100.0

Responses 73 185 24 39 153 474


The second often mentioned reason for not using existing health services was lack of transportation. 43.1 percent of responses from Binicalan claimed that health facilities are too far. This was less mentioned in Dumingag and Gawasan.

The third important issue was a lack of equipment in the respective health facilities. Almost one out of three responses from Sinuda and Dumingag claimed that the nearest facility lacks medical tools and other equipment. Only in Binicalan where distance is a stronger obstacle this claim was not made. If lack of equipment is real or only perceived – it would explain the comparatively low share of curative services used by respondent and their family members.

Women/Community Health Teams (WCHT) visit households and can contribute to preventive care and family planning. Respondents were asked if and how often the household was

visited by these teams in 2012 (Table 46). In Sinuda and Montevista, WCHT seem to have

visited almost all households, with less than 10 percent of household having no visit in 2012. In Binicalan, on the other hand, almost three out of four households did not receive such a visit in 2012.

55

Table 46: Visits by Women/Community Health Teams in 2012

Percentage of households by number of visits by Women / Community Health Team in 2012

Dumingag Sinuda

Monte- vista


no visit 38.5 9.2 7.6 19.3 72.5 25.8

1 13.6 22.7 8.7 16.1 0.4 14.1

2 13.3 35.5 8.0 50.9 3.4 22.6

3 8.7 12.0 10.1 1.9 2.5 8.5

4 5.2 7.3 7.2 0.0 1.3 5.2

5-9 3.6 3.6 4.7 0.6 16.1 5.4

10-19 15.9 9.4 45.3 8.7 0.8 15.9

20+ 1.3 0.2 8.3 2.5 3.0 2.6

Total 100.0 100.0 100.0 100.0 100.0 100.0



It is remarkable that a substantial part of households received more than 10 visits by Women/Community Health Teams in 2012. In Montevista 8.3 percent of households were visited 20 times and more in this year.

Table 47: Reason for visits by Women/Community Health Teams in 2012

Percentage of responses describing the reasons for visits by Women / Community Health Team in 2012

Dumingag Sinuda

Monte- vista


Health Prevention and Promotion Services

23.1 13.2 17.1 12.1 19.0 16.2

Curative Care (treatment of illness)

4.1 15.4 13.2 4.0 8.7 11.4


Birth Delivery 0.9 2.4 2.1 5.7 4.1 2.5

Family Planning IEC 16.3 17.6 13.3 12.1 13.3 15.5

Provision of Family Planning supplies

8.2 7.3 9.1 7.4 12.3 8.2

Antenatal care 6.8 2.9 3.1 4.4 4.6 3.9

Post-natal care 5.7 1.4 0.9 2.3 1.0 2.1

IEC on Birth Preparedness 11.6 4.0 7.0 4.4 3.1 6.1

Breastfeeding counselling 7.7 6.2 5.3 7.4 4.1 6.2

Referral Services 2.0 0.9 2.6 1.7 0.0 1.5

Others 8.2 3.9 6.2 18.8 0.0 6.4

Total 100.0 100.0 100.0 100.0 100.0 100.0

Responses 558 1,314 811 298 195 3,176


56

What were the reasons for Women/Community Health Teams to visit IP households? Respondents were asked that question and allowed to give more than one response (Table 47). The most important reason in all ancestral domains – except Dumingag – was immunizations and vaccinations. On second place were health prevention and promotion services – again with the exception of Dumingag, where this service was on the first rank. Information about family planning was the next in importance, followed by the actual provision of family planning supplies on fifth position.

At the end of the interview respondents were asked about their satisfaction with the health services provided by the nearest health facility. They were given a visual representation of a ranking from 1 (lowest satisfaction) to 10 (highest satisfaction).

Table 48: Satisfaction with health services

Percentage of households by level of satisfaction with health services provided by the nearest health facility, with 1 the lowest satisfaction and 10 the highest satisfaction



1 7.4 11.5 1.4 4.3 5.9 7.2

2 19.0 13.6 1.1 2.5 13.4 11.2

3 19.0 16.4 1.1 3.7 15.5 12.7

4 12.9 10.7 5.1 5.0 13.4 10.0

5 17.4 18.1 11.6 18.0 21.8 17.3

6 5.5 7.0 4.7 4.3 6.7 5.9

7 5.1 4.5 4.7 8.7 5.5 5.3

8 4.5 4.7 13.0 9.3 5.9 6.9

9 2.9 4.9 12.0 11.2 2.5 6.1

10 6.4 8.7 45.3 32.9 9.2 17.5

Total 100.0 100.0 100.0 100.0 100.0 100.0

311 531 276 161 238 1,517


The lowest ratings for health services provided were given in Dumingag, 45.3 per cent gave a rating of 3 or lower. In Sinuda 41.4 pe rcent rated that low. In Montevista only 3.6 per cent of respondents gave a rating between 1 and 3, in Gawasan only 10.6 per cent. Looking at the bright side almost one third of all respondents gave a rating of 8 or higher. In Montevista the satisfaction was highest, with 70.3 percent giving 8 and higher and 45.3 alone giving 10.

Yet, it would be wrong to extrapolate from the nearest health facility, in most cases a Barangay Health Station/Centre, to the whole spectrum of health services. It is in the nature of medical services that patients are referred to municipal, district or provincial hospitals if medically indicated. The quality of this referral process and of services provided by these hospitals has not been investigated in this survey.

Respondents were asked about the reasons for their rating. The reasons given for ratings were varied. It must be noted that one respondent sometimes gave multiple reasons, while others did not give reasons at all.

57

The reasons given were the following:

Lack or no medicine available in the centre with 559 or 40.6 percent;

Contented with the medical service with 452 or 32.8 percent;

Far distance and no money for transportation with 309 or 22.4 percent;

Discontented with the medical services offered with 169 or 12.3 percent;

Lacking or no available medical equipment and facilities with 123 or 8.9 percent;

Infrequent or no available medical personnel in the area with 119 or 8.6 percent;

Moderately or slightly discontented with the medical services offered with 119 or 8.6 percent;

Choose not to go to the centre because they use alternative medicine (herbal and tribal).

Comparing the results by province, Montevista topped the list of respondents who said that they are contented with the medical services offered with 174 or 12.6 per cent; followed by Sinuda with 103 or 7.5 per cent; Gawasan with 97 or 7.0 per cent; Binicalan and Dumingag, both with 39 or 2.8 percent, respectively.

Top of the list of those who said there is lack of medicine or no available medicine in the centre are respondents from Sinuda with 248 or 18.0 per cent; followed by Dumingag with 169 or 12.3 per cent; then Binicalan with 73 per cent.

In Dumingag top of the list of provinces whose respondents said that there is infrequent or no available medical personnel in the area with 72 or 5.2 percent.

Far distance or no money available for transportation, discontentment with the medical services offered as well as lack or no available medical equipment and facilities are great concerns/issues/problems in Sinuda with 107 or 7.8 percent.

4 . 1 1 M e m b e r s h i p i n P h i l H e a l t h

Founded in 1995 with the aim to create universal health insurance coverage for all Filipinos, PhilHealth is owned and controlled by the Philippine government. The benchmark to reach universal coverage was 2010, which has been reached with 86 percent of the population by some accounts. [12] For the indigent population, special subsidies apply and special Outpatient and Diagnostic Package have been designed to address their needs.

Figure 1: Knowledge about PhilHealth In percent

84

55

76

55 59 66

16

45

24

45 41 34

00

10

20

30

40

50

60

70

80

90

100


Yes No

58


Two thirds of respondents of IPBDS 2013 confirmed that they knew about the existence and operation of PhilHealth. The awareness about PhilHealth was best in Dumingag and worst in Sinuda, Gawasan and Binicalan, where a little above one half of respondents confirmed that they were aware about the existence of PhilHealth.

Table 49: Sources of knowledge about PhilHealth

Percentage of responses (multiple responses possible)

Dumingag Sinuda

Monte- vista


Information campaign thru tri-media (radio, TV, and/or newspaper)

1.8 4.0 20.7 14.3 1.3 8.5

Posters or Ads in Barangays 19.5 26.6 13.5 12.1 10.2 18.5

Briefings by Barangay Chair 59.0 45.7 34.0 24.3 80.9 47.5

Briefings by Tribal Leaders 6.3 14.5 16.9 19.3 3.2 12.4

Posters or Ads in Churches 0.0 0.2 0.2 0.0 0.0 0.1

Briefings by Church Leaders 1.0 0.4 1.4 0.0 0.0 0.8

Posters or Ads in Hospitals/Clinics

0.5 2.9 2.6 2.1 0.6 1.9

Briefings by Hospital/Clinic Staff

1.5 3.1 1.4 1.4 1.3 1.9

Posters/Ads/Briefing in Schools

0.0 1.0 0.0 2.9 0.6 0.6

Mothers’ Classes 1.8 0.6 0.2 7.9 0.0 1.4

Door-to-door visits 2.3 0.4 1.2 2.1 1.3 1.3

Others 6.5 0.4 7.8 13.6 0.6 5.1

Total 100.0 100.0 100.0 100.0 100.0 100.0

Responses 400 477 421 140 157 1,595


Most respondents had learned about PhilHealth from briefings by the Barangay chair. Particularly in Binicalan and Dumingag barangay chairs have been effective in spreading this knowledge. The second important source of awareness about PhilHealth has been posters and ads in the Barangay. Briefings of tribal leaders obviously have also contributed substantially to this awareness. Among the “other” items mentioned by respondents as sources of information was the personnel of the Department of Social Welfare and Development (DSWD) that promotes the Pantawid Pamilyang Pilipino Program (4Ps).

Respondents of IPBDS 2013 were asked if they were members of PhilHealth and what was

the type of this membership in 2012 (Table 50). In Dumingag and Gawasan universal

membership, defined as 85 percent, has been reached. For the other three ancestral

59

domains this is not true yet. The lowest membership share has Montevista with only two out of three respondents.

Table 50: Membership of respondents in PhilHealth

Percentage of respondents by membership in PhilHealth and type of membership in 2012

Dumingag Sinuda

Monte- vista


Yes 92.3 76.7 66.3 86.4 75.0 79.4

No 7.7 23.3 33.7 13.6 25.0 20.6

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of households 261 292 199 88 140 980

Type of membership

Paying member/employed 1.3 0.0 7.2 3.9 27.5 5.7

Individually paying 1.3 1.4 5.8 2.6 19.6 4.7

Overseas foreign worker 0.0 0.0 0.7 0.0 0.0 0.1

Indigent/sponsored member 97.5 98.6 86.3 93.4 52.9 89.5

Total 100.0 100.0 100.0 100.0 100.0 100.0

Number of households 239 218 139 76 102 774


The predominant type of membership was the indigent/sponsored membership, covering most members in Dumingag and Sinuda. In Binicalan there was more than one out of four members of PhilHealth who was paying membership fees and another 20 percent who paid individually.

The results from the question to respondents have to be interpreted with caution. Neither the questionnaire nor the interviewer’s manual were specific about whether membership in this question was related to the respondent personally or to the household covered by the membership of another member of the household.

In another question respondents were asked to list all members of the household who were

PhilHealth members and give start year, status and type of membership (Table 51). The

picture is very similar to results from the previous table.

60

Table 51: Type of PhilHealth membership among household members

Percentage of PhilHealth members in the household by type of membership by the end of 2012



Paying member/employed 4.6 6.6 12.0 22.4 29.4 11.6

Individually paying 1.2 1.2 3.0 1.3 11.8 3.0

Overseas foreign worker 0.0 0.0 0.6 0.0 0.0 0.1

Indigent/sponsored member

93.5 86.4 72.5 75.0 47.9 79.5

Lifetime (senior citizen/retired)

0.0 0.8 0.0 0.0 0.0 0.2

inactive 0.8 5.0 12.0 1.3 10.9 5.6

Total 100.0 100.0 100.0 100.0 100.0 100.0

Household members with PhilHealth membership

260 242 167 76 119 864


When asked about each household member who is specifically a PhilHealth member, the share of paying members comes out larger (Table 51) Still indigent/sponsored membership accounts for four out of five PhilHealth members. The differences between the five ancestral domains remain the same.

Table 52: Start year of PhilHealth membership

Percentage of PhilHealth members in the household by start year of membership

Dumingag Sinuda

Monte- vista


before 2000 0.4 3.0 0.6 6.3 1.7 1.9

2000 to 2009 8.2 56.5 23.8 10.0 32.5 27.9

2010 and later 91.4 40.5 75.6 83.8 65.8 70.2

Total 100.0 100.0 100.0 100.0 100.0 100.0


256 232 172 80 117 857


The large majority of PhilHealth members in IP households joined PhilHealth within the last 3 years. Only in Sinuda there is a larger proportion of members who joined the programme between 2000 and 2009.

What are the obstacles that keep members of IP households from becoming a member of PhilHealth, given the advantages and the subsidized character? Respondents who answered that they were not a member of PhilHealth were asked what the reasons for not enrolling had been(Table 53). The most important obstacle perceived by respondents was the lack of the necessary documents to submit for PhilHealth membership. This applies particularly to Sinuda and Binicalan, less for Montevista and Gawasan. The other important reason quoted by respondents was the lack of funds for the PhilHealth membership fee.

61

Table 53: Reasons for not enrolling to PhilHealth membership

Percentage of responses to questions about reasons, asked to respondents who were no member of PhilHealth

Dumingag Sinuda

Monte- vista


No available document to submit

50.0 63.6 35.5 32.5 58.8 51.9

No funds for membership fee

38.5 32.1 40.9 67.5 36.8 39.1

No time to enrol 3.8 1.9 0.0 0.0 0.0 1.0

Others 7.7 2.5 23.7 0.0 4.4 8.0

Total 100.0 100.0 100.0 100.0 100.0 100.0

Responses 26 162 93 40 68 389


62

5 C O N C L U S I O N

The IP Baseline Demographic Survey 2013 was the first effort to determine a general demographic and social profile of the IP population in the Philippines. It faced challenges specific to such a pioneer endeavour.

IPBDS 2013 established the IP population as a very young population, mostly living in two-generation households. On average five people live in a typical IP household. Fertility of IP women is higher than in the Philippines in general and in the rural populations as well. Of the five ancestral domains included in the survey four are ethnically quite homogenous and Montevista is shaped by two tribes. IP households live mostly from agriculture and fishery.

The houses in which IP households live show their weak economic position, compared with the general rural population of the Philippines. This can be seen with the construction materials used for walls, roof and floor, but also in the system of garbage disposal or toilet facilities. More important for the health of household members and particularly children are the sources of drinking water, with a still small share of improved sources, like pipes to dwelling or plot. Many IP households have to walk outside their plot to get water. Many IP households from Sinuda and Gawasan are geographically isolated; more than half of them have to walk or travel more than one hour to reach the next access road.

Most children in IP households are born at home, most often with the help of traditional birth attendants. In the last two years the share of births in facilities has slightly increased. In Montevista already every fourth child is born outside home. Birth registration at IP households is still far from complete. Only every second child born in the 12 months before the survey had been registered. Some children are registered after their first or second birthday.

Breastfeeding is a factor supporting the health of infants in IP households. More than two out of three children in IP communities are breastfed for six months or longer. Immunization could play a more active role in the healthy upbringing of IP children, as immunization rates for IP children are substantially lower than the national average.

Barangay Health Stations are the nearest health facilities in three out of the five ancestral domains. Most people have to walk to reach health facilities; the mean distance is 17km. Respondents knew quite well about the health services offered, but used them only to a limited extent for curative care and mostly for immunization of children and preventive care. Among the reasons keeping IP people from using health services are perceived financial constraints and distance. In four out of the five ancestral domains an important reason mentioned was also the respondent’s perception that the health facilities lack medical tools and equipment.

Only two out of three respondents knew about PhilHealth. Those who had heard about it mostly had learned from briefings by the Barangay chair. Of those who had ever heard about PhilHealth, 80 percent were members, mostly in indigent/sponsored memberships. For those who were aware about the existence of PhilHealth but had not enrolled, lack of necessary documents to enrol or lack of funds for membership fees were perceived as the main reasons for not enrolling.

63

6 R E C O M M E N D A T I O N S

The results of IPBDS 2013 suggest the following recommendations to address maternal, neonatal and child health and nutrition needs for the indigenous cultural communities and indigenous peoples and other disadvantaged communities in Mindanao:

Address distance as an obstacle to accessing health services.

Outreach programs like W/CHT should be streamlined, strengthened and extended through training and focused management.

Community based transportation solutions should improve access to Barangay Health Centres and rural health units.

Address financial constraints to accessing health services.

Membership to PhilHealth should be advertised and more information about the PhilHealth membership for indigent populations should be disseminated. PhilHealth should also strengthen its partnership with the different Local Government Units from the Provincial down to the Sitio/Purok levels.

Households and individuals who lack the necessary documents such as marriage and birth certification should be supported to obtain these documents. Importance of a birth certificate as a permanent legal document must be promoted.

Increase immunization rates by providing information on the advantages of immunization and by advertising immunization cards and ensuring that medical personnel are available in the area on a regular basis.

Improve access to safe drinking water in IP households with community based projects.

Establish full registration of births and deaths in IP communities.

Undertake further operational research on fertility preferences, experience with contraception, unmet need for family planning, child health as well as in-depth analysis of IPBDS 2013.

64

7 R E F E R E N C E S 1. National Commission on Indigenous People (NCIP), [The Republic of the Philippines],

General Budget of the European Union. Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities / Indigenous People (ICC/IP) and Other Disadvantaged Communities in Mindanao: Terms of Reference for Short Term Experts. Manila; 2012.

2. National Commission on Indigenous People (NCIP), [The Republic of the Philippines], General Budget of the European Union. Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities / Indigenous People (ICC/IP) and Other Disadvantaged Communities in Mindanao: Annual Programme Estimate 1. Operational period from 01 December 2012 to 31 December 2013. Manila; 2012.

3. National Commission on Indigenous People (NCIP), [The Republic of the Philippines], General Budget of the European Union. Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities / Indigenous People (ICC/IP) and Other Disadvantaged Communities in Mindanao: Knowledge, Attitudes, Practices, Health Seeking Behaviour and Health Service Needs of Indigenous Cultural Communities/Indigenous Peoples with Regards to Maternal, Neonatal, Child Health and Nutrition. Davao City; 2013.

4. National Commission on Indigenous People (NCIP), [The Republic of the Philippines], General Budget of the European Union. Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities / Indigenous People (ICC/IP) and Other Disadvantaged Communities in Mindanao: Baseline Survey Questionnaire. Manila; 2012.

5. National Commission on Indigenous People (NCIP), [The Republic of the Philippines], General Budget of the European Union. Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities / Indigenous People (ICC/IP) and Other Disadvantaged Communities in Mindanao: Inception Report Baseline Demographic Survey. Davao City; 2013.

6. National Statistics Office (NSO) [Philippines] and ICF Macro. National Demographic and Health Survey 2008. Calverton, Maryland: National Statistics Office and ICF Macro.

7. National Commission on Indigenous People (NCIP), [The Republic of the Philippines], General Budget of the European Union. Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities / Indigenous People (ICC/IP) and Other Disadvantaged Communities in Mindanao: Enumerators Training Report. Baseline Demographic Survey. Davao City; 2013.

8. McCurry J. Philippines struggles to recover from Typhoons. The Lancet. 2009;374:1489.

9. Casterline JB, Perez AE, Biddlecom AE. Factors Underlying Unmet Need for Family Planning in the Philippines. Studies in Family Planning. 1997;28:173–202.

10. Fort AL, Kothari MT, Abderrahim N. Association between Maternal, Birth, and Newborn Characteristics and Neonatal Mortality in Five Asian Countries. DHS Working Papers; 2008.

11. Republic Of The Philippines, editor. National Safe Motherhood Survey 1993. Calverton, Maryland USA: National Statistics Office Manila, Philippines, Macro International Inc. Calverton, Maryland USA; 1994.

12. http://www.gmanetwork.com/news/story/218278/news/nation/conservative-and-sluggish-philhealth-misses-healthcare-target (accessed July 31, 2013).

Documents

Baseline Demographic Profile of Selected IP Communities in ... · indigenous peoples (IP) and other disadvantaged communities in Mindanao through a comprehensive and culturally acceptable