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PROVINCIAL HEALTH STRATEGIC PLAN
2006-2010
PROVINCIAL HEALTH OFFICECompostela Valley
Philippines
TABLE OF CONTENTS
Introduction 1Executive Summary 2Chapter 1 Provincial Profile 3
Demographic Profile 4Chapter 2 Health Status 5
CBR & CDRMMR & IMRLeading Cause of MortalityLeading Cause of MorbidityLeading Cause of Infant MortalityLeading Cause of Maternal Mortality
Chapter 3 Health Resources 8Chapter 4 Tabular Summary of Priority Health Programs 11
Safe MotherhoodNatalityFamily PlanningExpanded Program of ImmunizationNational Tuberculosis ProgramNutrition & Rehabilitation ProgramEnvironmental & Sanitation ProgramRabies Control ProgramFilariasis Control ProgramDengue Control Program
Chapter 5 Summary of Current Situations & Identified Problems 19Opportunities & ThreatsCauses of MortalityCauses of MorbidityOther Emerging Concerns on HealthPrioritization of Health ProblemsStrengths & WeaknessesOperational Performance Problems
Chapter 6 Summary Statement of Priority Problems 29Major Goals
Chapter 7 Objectives & Target Setting 30APPENDICES 33Annual Operation Plan 2006
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ABBREVIATIONS
Accomp. - Accomplishment
AMHOC - Association of Municipal Health Officers in Compostela Valley
AO - Administrative Order / Administrative Officer
ARI - Acute Respiratory Infection
AURI - Acute Upper Respiratory Infections
BFAD - Bureau of Food and Drugs
BHS - Barangay Health Station
BHW - Barangay Health Worker
Bldg. - Bldg.
BnB - Botika ng Barangay
BNS - Barangay Nutrition Scholar
Brgys. - Barangays
CARI - Control of Acute Respiratory Infection
CBR - Crude Birth Rate
CDD - Control of Diarrheal Diseases
CDR - Crude Death Rate
CHD - Center for Health Development
COH - Chied of Hospital
Comm. - Community
Comval - Compostela Valley
CPR - Contraceptive Prevalence Rate
CVD - Cardiovascular Disease
DMPA - Dimethyloxy Progesterone Acetate
DOH Reps. - Department of Health Representatives
DOH - Department of Health
DOTS - Directly Observed Treatment Short Course
DRH - Davao Regional Hospital
Dse./dses. - Disease / diseases
EO - Executive Order
EPI - Expanded Program of Immunization
FIC - Fully Immunized Children
FIM - Fully Immunized Mother
FP - Family Planning
GA - Government Agency
Gen. - General
GO - Government Offices
Gov’t - Government
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Hosp./hosps. - Hospital / hospitals
HPN - Hypertension
IEC - Information Education Campaign
ILHZ - Inter-Local Health Zone
IMCI - Integrated Management on Childhood Illnesses
IMR - Infant Mortality Rate
IUD - Intauterine Device
Lab. - Laboratory
LB - Livebirth
LCE - Local Chief Executive
LCR - Local Civil Registrar
LGU - Local Government Unit
LHB - Local Health Board
LMH - Laak Municipal Hospital
MCH - Maternal and Child Health
MD - Medical Doctor
MDH - Montevista District Hopsital
Med. Tech. - Medical Technologist
Med. - Medical
Mgt. - Management
MHC - Main Health Center
MHO - Municipal Health Officer
MMH - Maragusan Municipal Hospital
MMR - Maternal Mortality Rate
MOA - Memorandum of Agreement
MOOE - Maintenance and Other Operating Expenses
Mun. - Municipality
Nat’l - National
NB - Newborn
NFP - Natural Family Planning
NGO - Non Government Office
NHIP - National Health Insurance Program
NSO - National Statistics Office
NSV - Non Scalpel Vasectomy
NSVD - Normal Spontaneous Vaginal Delivery
NTP-DOTS - National Tuberculosis Program
OB-Gyne - Obstetrics-Gynecology
OR / DR - Operating Room / Delivery Room
PAB - Protected At Birth
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PDH - Pantukan District Hospital
PGO - Provincial Government Office
PHC - Primary Health Care
PHIC - Philippine Health Insurance Corporation
PHN - Public Health Nurse
PHO - Provincial Health Office
PHTL - Provincial Health Team Leader
PIR - Program Implemenation Review
PMC - Pre Marriage Counselling
PNV - Pre-natal Visits
Pob. - Poblacion
Pop. - Population
PP - Post Partum
Prov. / Prov’l. - Province / Provincial
PSI - Provincial Sanitary Inspector
Pts. - Patients
RA - Republic Act
Rehab. - Rehabilitation
RHIS - Regional Health Information System
RHM - Rural Health Midwife
RHU - Rural Health Unit
RSI - Rural Sanitary Inspector
Schisto.- Schistosomiasis
SP - Sangguniang Panlalawigan
SS - Sentrong Sigla
STD - Sexually Transmitted Diseases
SVI - Systemic Viral Infection
TB - Tuberculosis
Tx - Treatment
UTI - Urinary Tract Infection
VAC - Vitamin A Capsule
Yrs. - Years
INTRODUCTION
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The Strategic Provincial Health Plan 2006-2010 is a presentation of relevant accomplishments and major issues on different programs of the Provincial Health Office. It also provides vital information on the current health status and performance of the province through comparative trend on health statistics, demography and the affected age-grouping population of disease summary, SWOT analysis from the consolidated updates coming from the 11 Rural health units, 4 government hospitals of the province - Montevista District Hospital, Pantukan District Hospital, Maragusan Municipal Hospital and Laak Municipal Hospital.
On this plan, attached is the Annual Operational Plan of the Province. This is to elaborate the various setbacks and problems in health with its suggested strategies and activities to be undertaken, targets to be pursued, facilities to be improved and possible resources to be adhered.
This plan can also be used as a reference in the decision-making, policy-making and development health planning processes. It is hoped that through this integrated planning system, the local government units, government agencies, non-government offices and other private health sectors will be guided in identifying health problems associated with risk behaviors of people leading to a particular disease, the emerging concerns and the technical and financial needs to address such problems. It also allows LGUs to plan health services with their own needs and priorities, encourage research and studies on the incidence of the disease in their locality and deal with the operational and management problems and issues, provide quality assurance indicators of a health facility, introduces a logical process for health service requirements which is useful in advocating and promoting the need for health resources to funding organizations.
With this strategic presentation, it is hoped that the national government would take into consideration that Compostela Valley province is indeed a jewel in Mindanao given all the possibilities and opportunities to meet all its health needs and resources to achieve its health priorities and problems.
EXECUTIVE SUMMARY
The Province of Compostela Valley – the golden frontier of the south through its 8 th year of existence has fully blossomed and continues to shine anchored by the provincial governance initiating economic development. Amidst the adversities, it has surmounted the odds and risen above the challenges of the times. In each year, it continued to move on to strengthen its advantages and confront threats and weaknesses so that the unity, peace and progress banners through its existence will be sustained. It overcame challenges despite its limited resources and in spite of the difficult macroeconomic realities that challenged the efficacy of governance across our country.
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Despite the year’s early start of political bickering and clashes that only beget policy impasse and unnecessary delays in the turning of the wheels of provincial governance, the Caballero administration has accomplished and moved things for the betterment of Comvaleños more specifically in the health sector.
This Strategic Provincial Health Plan 2006-2010 was developed to continually guide and supervise the pathway of all the Health Sector Areas with the application of the new components of the Fourmula 1 strategies: Health Financing, Health Regulation, Service Delivery and Good governance. Planning is one essential tool for effective management that could eventually improve the delivery of health services to the people of this province. It is hoped that the national government as well as the local government units, private agencies and other stakeholders in health will be encouraged to participate more to generate initiative and more creative efforts that could increase resources of health.
With the strong support of the Governor, Honorable Jose R. Caballero, Sangguniang Panlalawigan team, other LCE’s, LGU’s, MHO’s, COH, NGO’s, GA’s, private sectors, PHO and with the infinite provision and assistance of DOH, together hand in hand will enjoin for the one true aim to enhance all the health areas of concern for the betterment Compostela Valley Province.
Chapter 1 - PROVINCIAL PROFILE
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VISIONVISION:: A healthy & productive citizenry working together for a A healthy & productive citizenry working together for a better quality of life.better quality of life.
MISSIONMISSION:: Ensure genuine commitment & dedicated involvement, Ensure genuine commitment & dedicated involvement, partnership & collaboration among the people, health partnership & collaboration among the people, health workers, LGUs & health care providers in the quest for workers, LGUs & health care providers in the quest for a a better quality health for the people of Compostela better quality health for the people of Compostela Valley.Valley.
Compostela Valley, the 78th province in the country, was created into a separate and district province from Davao del Norte by virtue of Republic Act No. 8470, signed by Pres. Fidel V. Ramos on January 30, 1998. On March 7, 1998 the law was ratified through a plebiscite in the 22 mun. of the mother province.
Honorable Jose R. Caballero, the former Vice-governor of Davao del Norte, is the first elected governor of Compostela Valley. He assumed office on July 1, 1998. He envisions Compostela Valley as a dynamic community where citizenry will achieve a better quality of life and live under the regime of a peaceful and balanced ecology within the context of equitable development, with the mission to provide open and accessible government and to deliver basic services so everyone can enjoy a better quality of life.
Location: Located at southeastern part of Mindanao Island & north-central part of Region XI. It is bounded by Agusan del Sur on the north, Davao Oriental on the east & south, Island Garden City of Samal on the southwest & Davao del Norte on the west & northwestern part.
Capital: NabunturanNo. of district: 2 No. of municipalities: 11 No. of barangays: 235Total land area: 4,666.93 sq.km.Mother Tongue: Cebuano / VisayaIncome class: FIRST
Topography: Flat, rolling, hilly & mountain
Climate: Generally tropical with no marked rainy or dry season Economic resources: Agriculture, fishing, mining & quarrying, tradeMajor crops: Rice, cornIndustrial crops: Coconut, coffee, abaca and rubberFruit crops: Banana, mango, pineapple, durian, calamansi, mandarin and lanzones
DEMOGRAPHIC PROFILE
Population: 580,244 (NSO 2000)
Population density: 124
Average household size: 4.64
No. of Indigenous people: 62,187 (NCIP-Comval 2000)
Economic dependency rate: 78.9%
Employment rate: 91.70 (NSO 2001)
Literacy rate: 88.64
Table 1. PROJECTED POPULATION 2005 Compostela Valley
THE 11 MUN. OF COMPOSTELA VALLEY
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Laak
New Bataan
Nabunturan
Montevista
Monkayo
MawabMaragusan
Mabini
Maco
Compostela
Pantukan
MUNICIPALITY POPULATION NO. OF HOUSEHOLDS GROWTH RATE (%)
CompostelaLaakMabiniMacoMaragusanMawabMonkayoMontevistaNabunturanNew BataanPantukan
69,47269,86234,87572,82551,97234,345
113,74934,62364,90941,79067,463
12,15111,9046,52413,0908,7626,69420,2386,57012,9308,59213,311
2.473.311.762.312.561.495.610.871.46-0.391.83
COMVAL PROVINCE 655,885 120,766 2.38Source: DOH-Davao Region Population Projection based on NSO 2000 of Population & Housing
The total population provincewide is 655,885 with the annual growth rate of 2.38% based from the updated Population Projection Records disseminated by the National Statistics Office 2005. Monkayo has the greatest number of population with 5.61% growth rate and with the biggest share number of households with 20,238. This is attributed to the influx of migrants coming from neighboring municipalities, cities and provinces when gold was discovered in Mt. Diwata popularly called as Diwalwal in the late 1980s. But with presence of the newly established mining zone in the District 2 area it is expected to have an invasion of migration among Mabini, Maco and Mawab municipalities. On the other hand, Mawab has the least population with 34,345 dwellers but according to survey, Mabini got the smallest number of household population with only 6,524.
Chapter 2 - HEALTH STATUS
Figure 2-1. CRUDE BIRTH RATE AND CRUDE DEATH RATE
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In the 8-year comparative trend of Crude Birth and Crude Death Rate, Year 2004 has the highest CBR with 22.64% and Year 2002 has the least with 17.36% per 1,000 population. While in CDR, year 2005 has the most number of death occurred with 4.29% and year 1998 has the least number of recorded death with 3.20% per 1,000 population. It is the initiative of PHO to conduct active retrieval of death masterlisting starting Year 2002 covering all Local Civil Registrar’s Office provincewide including Tagum and Davao City and all major hospitals undocumented and unrecorded Davaowide to achieve the true picture of Leading Cause of Death in the Province. Indeed, there has been an elevation on the movement of the trend starting the Year 2002 as shown in the figure above.
Figure 2-1. MATERNAL MORTALITY RATE AND INFANT MORTALITY RATE
The MMR 2005 has increased by 30% from 2004 with the rate of 100,000 livebirth but apparently MMR in 2002 has a sudden rise with 237%, while the Infant Mortality Rate maintained with 16% with a rate of 1,000 livebirth. Strong intensification of advocacy has been conducted to every barangay on Safe Motherhood to achieve quality Maternal Care and Child Care.
Figure 2-3. LEADING CAUSE OF MORTALITY
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The cases of all forms of accidents with the rate of 57 per 100,000 population are very alarming. During the consolidation of this report almost all municipalities has a consistent no. 1 cause of death and Accidents mostly by Assault cases by Stab and Gunshot incidents emerged to be the top source followed by all forms of Vehicular accidents. It is also a worrying scenario that Diabetes Mellitus with the rate of 8 per 100,000 population came into view among the leading cause of Mortality of this province. Evidently, unhealthy lifestyle is the main component on the causes of death mentioned above because eight of the disease problems pertain to the harmful and injurious habits and ways of living.
Figure 2-4. LEADING CAUSE OF MORBIDITY
Acute upper respiratory infection continues to be always the no. 1 cause of illnesses of this province, with the rate of 1,124 per 100,000 population and AURI pertains to a common cold, laryngitis, acute pharyngitis, rhinitis, sinusitis and tonsillitis whilst Tuberculosis is keep on going down on to its 11th position with the rate of 175 per 100,000. This must be attributed to the strong advocacy of the National Tuberculosis Program.
Figure 2-5. LEADING CAUSE OF INFANT MORTALITY
Pneumonia has always been the No. 1 cause of death in the Infant Stage (below 1 yr. old) with 38% per 10,000 livebirth but with the intensive implementation of the IMCI program it is expected to drop next year,
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and the least was the Neonatal tetanus case of which there are still mothers who continues to seek the help of untrained hilots to handle the delivery mainly because of the easy accessibility specially in the far flung areas.
Figure 2-6. LEADING CAUSE OF MATERNAL MORTALITY
Post-partum hemorrhage emerged as the no. 1 cause of maternal death in the year 2005 and also in previous years with 70% per 100,000 livebirth and maternal sepsis and Abortion shared the last ranking with only 14% per 100,000 livebirth. Delayed referral of hilots handling delivery to higher facility can eventually cause the prevalence of mother to have further complications and in the long run can lead to death. But with the current strong campaign and close monitoring of all pregnant women on the quality pre-natal and quality portpartum care on Safe Motherhood it is hoped maternal deaths in Comval will be lowered.
Chapter 3 - HEALTH RESOURCES
Table 3-1. NUMBER OF HEALTH PERSONNEL AND STATUS OF EMPLOYMENT, 2005
FACILITY REGULAR CASUAL JOB ORDER TOTAL
Provincial Health Office 33 5 1 39
Montevista District Hospital 28 11 6 45
Pantukan District Hospital 26 5 3 34
Maragusan Municipal Hospital 15 10 1 26
Laak Municipal Hospital 19 4 0 23
TOTAL 121 35 11 167
Under the umbrella of the Provincial Health Office management, there are a total of 167 employees in the health workforce, 121 have the regular item status, 35 are casuals and 11 are Job-orders. All in all there
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are 128 health workers who are hospital staff caregivers serving Comvalwide but apparently it is soon expected to have a great turn-over of health personnel exodus lined-up because of the better life and financial compensation offered abroad.
Table 3-2. NUMBER OF HOSPITAL HEALTH PERSONNEL, 2005
PARTICULARS MDH PDH MMH LMH
Service capability Secondary Primary Infirmary Primary
Bed capacity 25 25 10 10
Occupancy rate 96% 55% 111% 62%
Actual implementation 50 25 13 10
Doctors 6 3 2 3
Nurses 6 3 4 3
Midwife / Attendant 10 11 4 3
Med. Technologist 1 1 2 1
Dentist 1 1 - -
Admin. Support 17 13 12 12
Pharmacist 2 1 1 1
Radio technician 2 1 - -
Nutritionist - - 1 -
MDH has the Secondary service capability in terms of health competent service provider. The Prov’l. gov’t. has allocated funds for the big transformation of MDH into a Provincial Hospital purposely for the benefit of every Comvaleños easy-access of hospital assistance during health crisis. Nearby residents like those coming from Monkayo, Compostela, New Bataan, Maragusan and Nabunturan would be an advantage for them to reach the healthy facility because of proximity of location.
Table 3-3. NUMBER AND RATIO TO POPULATION OF MHC AND BHS BY MUNICIPALITY, 2006
MUNICIPALITYPROJECTEDPOPULATION
2005NO. OF BRGYS.
MAIN HEALTH CENTER BARANGAY HEALTH STATION (w/ own bldg.)
NO. RATIO TO POP. NO. RATIO TO
POP.Compostela 69,472 16 1 1:69,472 15 1:4,631Laak 69,862 40 1 1:69,862 24 1:2,911Mabini 34,875 11 1 1:34,875 10 1:3,488Maco 72,825 37 1 1:72,825 15 1:4,855Maragusan 51,972 24 1 1:51,972 21 1:2,475Mawab 34,345 11 1 1:34,345 9 1:3,816Monkayo 113,749 21 1 1:113,749 18 1:6,319Montevista 34,623 20 1 1:34,623 11 1:3,148Nabunturan 64,909 28 1 1:64,909 20 1:3,245New Bataan 41,790 14 1 1:41,790 12 1:3,483Pantukan 67,463 13 1 1:67,463 12 1:5,622
COMPOSTELA VALLEY 655,885 235 11 1:59,626 167 1:3,927
Source: DOH-Reps & PHTL Comval
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Using the projected population there are 655,885 people living in ComVal and there are 235 barangays with only 11 main health centers mostly located in the poblacion area. Monkayo has always been the biggest coverage of ratio and proportion with 1:6,319 and Maragusan has the smallest unit with 1:2,475. With the presence of BHS provincewide, delivery of health services are continuously administered and conducted with the supervision of the DOH and its component health programs through PHO and DOH-reps as partners for constantly providing health advocacies and monitoring the province health status.
Table 3-4. FIELD HEALTH FACILITIES, 2006
MUNICIPALITYHEALTH FACILITY DENTAL
CLINICSDRUG
STORESBOTIKA NG BARANGAY
FOOD ESTABLISHMENT
GOV’T HOSP.
PRIVATE CLINICS w/o LTO w/ LTO
Compostela - 3 4 13 4 38 10Laak 1 - - 3 20 25 2Mabini - - - 1 7 17 1Maco - 4 1 5 - 33 6Maragusan 1 1 1 7 7 45 9Mawab - 3 2 3 - 40 7Monkayo - 4 2 5 8 16 8Montevista 1 1 1 6 6 18 4Nabunturan - 7 6 10 9 35 9New Bataan - 1 - 2 8 24 4Pantukan 1 2 1 8 6 10 3COMPOSTELA
VALLEY 4 26 18 63 75 301 63
Source: DOH-Reps, PHTL, FDRO ComvalImmense intensification campaign for license to operate on different facility establishments are closely monitored by health authorities and provincial officials. For Comval, there are 26 existing private clinics, 18 Dental clinics, 66 drugstores and 60 food establishment registered according to DOH-BFAD records.
Table 3-5. NUMBER OF SELECTED HEALTH MANPOWER IN MAIN HEALTH CENTERS, 2006
MUN. DOCTORS
DENTISTS
NURSES
MIDWVS
MEDTCHS SI NUTRI
TNISTDENTLAIDE BHW BNS LAB
AIDEADMIN
Compostela 1 1 2 12 2 1 - 1 334 26 - 2
Laak 1 1 1 23 1 2 - 1 292 51 - 3
Mabini 1 - 1 9 1 1 - - 97 16 1 3
Maco 1 1 4 12 2 1 1 1 211 37 - 4
Maragusan 1 1 1 20 1 1 - 1 216 27 - 1
Mawab 1 1 1 6 1 2 - 1 151 19 - 1
Monkayo 2 1 3 25 4 2 - 233 24 - 8
Montevista 1 1 1 7 1 1 - - 185 21 - -
Nabunturan 1 1 2 14 1 2 1 1 187 30 1 1
NewBataan 2 1 2 17 1 1 1 104 30 1 1
Pantukan 1 1 1 13 1 2 1 174 32 1 1
PHO 3 2 4 2 3 2 2 1 - - - 16
TOTAL 16 12 23 160 19 18 4 9 2,184 313 4 41Source: DOH-Reps, PHTL Comval
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Health workers in health centers have a great impact for the service delivery in the community. In Comval, there are only 16 doctors, 12 dentists, 23 nurses 160 midwives, 19 med. techs. and 19 sanitary inspectors who are health performers in every area provincewide. But despite of the shortages & insufficiencies, Comval health staff are committed and hardworking and in fact performing multi-tasking for the provision of health assistance and service delivery in the province.
Table 3-6. FUNDS FOR HEALTH IN THE PROVINCIAL HEALTH OFFICE, 2005
FACILITY YEAR PS MOOE CO TOTAL
Provincial Health Office
2005 9,488,592.98 12,582,355.00 2,500,000.00 24,570,947.982004 10,271,105.00 14,789,600.00 340,000.00 25,400,705.00
2003 10,189,847.00 13,789,600.00 - 23,979,447.00
Montevista District Hospital
2005 6,735,769.72 4,800,000.00 50,000.00 11,585,769.722004 6,677,992.00 5,000,000.00 - 11,677,992.00
2003 6,630,621.00 4,609,075.00 - 11,239,696.00
Pantukan District Hospital
2005 6,340,521.00 3,859,783.82 40,000.00 10,240,304.822004 6,273,825.00 3,500,000.00 - 9,773,825.00
2003 6,226,116.00 3,152,500.00 - 9,378,616.00
Maragusan Municipal Hospital
2005 4,012,660.72 2,694,020.00 54,000.00 6,760,680.762004 3,886,901.00 2,000,000.00 - 5,886,901.00
2003 3,871,113.00 5,248,913.00 - 9,120,026.00
Laak Municipal Hospital
2005 3,850,219.92 2,735,907.00 - 6,586,126.922004 3,874,075.00 2,000,000.00 - 5,874,075.00
2003 3,869,676.00 1,407,450.00 - 5,277,126.00The 3-year comparative budget for PHO, MDH and PDH has been very tight and in fact there has been a slight decrease for the total amount in 2005 comparing to 2004, while MMH and LMH continuously having an increase each respective year. Despite of the constricted budget given, health operation still continue to function well using all the initiative resources so as not to hamper the health undertakings.
Chapter 4 - TABULAR SUMMARY OF PRIORITY HEALTH PROGRAMS
SAFE MOTHERHOOD
These are the province accomplishments on the Maternal Care program reflecting both the pre-natal and post partum status per municipality with its corresponding target in each health indicator.
Table 4.1 MATERNAL HEALTH – PRENATAL CARE, 2005
MUNICIPALITY
PRENATAL CARE
% Pregnant women w/
1st PNV
% Pregnant w/ 1st PNV during 1st
tri
% of Fully
Immunized Pregnant women
% Prevalence of Anemia
amongpregnant women
% Quality
Prenatal Care
%Women del. w/ 5
PNV during preg.
%Women del. w/
hgb det.during preg.
NATIONAL TARGET 80% 80% 80% 38% 80% 80% 80%
Compostela 73.4 33.2 87.1 32.2 0.3 3.0 34.9Laak 65.6 47.9 77.8 24.0 1.8 24.7 72.2Mabini 60.5 43.3 56.3 12.2 0.3 24.4 71.9
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Maco 68.5 54.6 73.6 22.4 2.0 9.2 67.2Maragusan 69.9 46.6 81.2 21.4 9.3 15.6 63.5Mawab 58.3 45.4 40.7 31.8 2.3 4.9 47.6Monkayo 53.8 50.8 53.1 22.3 31.0 34.1 82.5Montevista 88.1 44.3 88.7 33.8 0.7 12.6 46.1Nabunturan 72.9 81.3 78.3 19.8 57.6 60.2 78.0New Bataan 73.5 72.5 80.3 21.3 36.2 45.5 73.4Pantukan 70.6 37.9 78.9 49.9 6.6 14.1 55.4COMPOSTELA
VALLEY 67.1 50.8 72.1 26.9 14.0 22.4 63.4
Table 4.2 MATERNAL HEALTH – POSTPARTUM CARE, 2005
MUNICIPALITY
POSTPARTUM CARE%
Women del.
received complete
iron
%Women
del. initiated
BF
%Women del. w/ at least 1
PP visit
%Women w/ PP clinic visit 4-6
wks. after delivery
%Women del. w/ 3 PP home
visits
% Quality
Post Partum
Care
%Birth
delivered in
health facilities
NATIONAL TARGET 80% 90% 80% 100% 80% 80% 70%
Compostela 0.3 92.6 35.0 53.1 25.0 8.8 23.4Laak 3.7 71.7 71.6 91.2 58.8 60.6 10.3Mabini 25.2 92.1 51.5 67.0 55.9 39.7 23.4Maco 3.8 91.2 64.7 58.0 21.5 11.0 28.4Maragusan 12.7 91.1 71.7 74.6 61.8 53.2 29.4Mawab 3.9 88.1 28.2 75.7 18.2 10.2 19.2Monkayo 38.3 91.7 77.1 78.3 65.7 68.3 22.9Montevista 1.9 89.8 66.1 48.6 28.6 21.7 17.4Nabunturan 62.5 93.9 87.3 95.3 82.0 84.1 27.3New Bataan 38.3 91.8 84.8 86.6 81.2 76.3 15.4Pantukan 11.2 90.4 77.5 80.0 55.1 49.2 20.7COMPOSTELA
VALLEY 18.2 89.4 66.9 62.8 50.9 45.9 22.0
NATALITY REPORT
The pie diagram shows the province’ overall attainment for the outcome of pregnancy under the Natality program. The largest pie share belongs to the livebirth outcome with 88%, late registration has 9%, stillbirth with 2% and abortion with 1%. These accomplishments were taken from the regional health information system booklets from the rural health centers.
Figure 4-2. PLACE OF BIRTH, 2005Figure 4-1. OUTCOME OF PREGNANCY, 2005
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Under the place of birth indicator, people of Compostela Valley mostly resort to home deliveries with 72%, hospital deliveries got only 22% and no information has 6%. But under the new thrusts of the DOH enforcing the Fourmula 1 strategies, massive advocacy intensification will be made to bring mothers into safe and aseptic technique of delivery under the health facility management to bring out quality care of safe motherhood and avoid further complications and infections of both mother and the baby.
Figure 4-3. % ATTENDANCE AT BIRTH, 2005Home deliveries are usually attended by hilots. Hilots are those persons who are conducting the traditional way of deliveries performed usually at home. 45% were the trained performers under the supervision of a medical personnel and 8% were the untrained ones. But under the new thrusts of DOH, total eradication of hilots will be made because of the high incidence of Maternal and Perinatal Death most specifically in Compostela Valley.
FAMILY PLANNING
Figure 4.4 FAMILY PLANNING BY METHOD, 2005
Compostela Valley has a total population of 654,974 of the revised National Statistic Office Records for the 2005 Population Projection. Of these, 12.33% or 80,726 are married couples of reproductive age.
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80% of the current users indulged in the Modern methods which include those who are users of pills, IUD, condom and DMPA. Permanent method such as the bilateral tubal ligation for women and vasectomy for men comprises the 14% and the Natural method users like LAM, SDM and NFP are 6%.
Figure 4.5 CONTRACEPTIVE PRELAVANCE RATE PER MUNICIPALITY, 2005
For the Contraceptive Prevalence Rate, Nabunturan municipality got the highest rate seconded by Maco and Monkayo respectively with 69% and the least accomplishment rate is 47% were garnered by Mawab and Montevista. Fortunately 7 municipalities out of 11 have achieved the regional target which is 54%. The over-all accomplishment of the province is 61% CPR. This must be attributed to the strong campaign under the MSH-LEAD project of DOH.
EXPANDED PROGRAM OF IMMUNIZATION
Figure 4.6 FULLY IMMUNIZED CHILDREN, 2005
For this program, the national target to be attained is 95% based on the 3% DOH standard target population of children. Unfortunately the province wasn’t able to reach the object goal. Montevista almost reached its target with 90% while Monkayo got the lowest with 66%. Health frontliners were in fact
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complaining for the unachievable target and projected number of children in their vicinity, and were constantly monitoring every pregnant women and children to obtain such target in the EPI program.
Figure 4.7 PROTECTED AT BIRTH, 2005
Three municipalities were able to achieve the PAB standard target which is 80% and these are Compostela, Montevista and Pantukan. Three municipalities also got the very low benchmark performance on children’s protection at birth and these are Mabini, Monkayo and Mawab. The over-all accomplishment of the province is 68%.
NATIONAL TUBERCULOSIS PROGRAM
The graphs below are the NTP accomplishment for 2005. Yearly accomplishments of cure rates, case detection rates updates shown. Also displayed were the comparative 2000-2005 TB cases treatment statuses of the province and the CR, CDR condition per municipality.
Figure 4.8 CURE RATE Figure 4.9 CASE DETECTION RATE
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Figure 4.10 TB CASES - TREATMENT STATUS, 2000-2005
Figure 4.11 CASE DETECTION RATE & CURE RATES OF NEW SMEAR (+) TB CASES, 2005
NUTRITION AND REHABILITATION PROGRAM
The virtual elimination of Vitamin A and Iodine Deficiency Disorder is a priority thrust of the Department of Health. Strategies towards the attainment of this goal include universal Vitamin A supplementation and the iodization of salt. Hereunder are the Vitamin A supplementation accomplishment per municipality, with Montevista attained the highest mark of 93% and Monkayo has the lowest attainment with 70%. The entire province has only 82% accomplishment.
Figure 4-12 VITAMIN A SUPPLEMENTATION ACCOMPLISHMENT, 2005
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Figure 4-12 PREVALENCE OF MALNUTRITION, 2005
The province of Compostela Valley is being awarded for its 2 consecutive terms of Nutrition awardee for the good governance implementation of the provincial government of Nutrition program. One of the criteria it has being considered is the low incidence of malnutrition. On this data above it has been clearly stated that Compostela has the most numbered malnutrition cases provincwide seconded by Laak and Montevista. While Nabunturan, Mawab and Mabini has the least number cases of malnutrition incidence.
ENVIRONMENTAL HEALTH SANITATION PROGRAM
One of primary concentration of the provincial government is the stipulation of clean and safe environment to the constituents of this province. One of the major provisions is the development of safe, clean toilet thru distribution of toilet bowls plus one sack of cement to far flung communities provincewide. Another provision is to supply safe water to all; water is a vital natural resource. An adequate and potable water supply is essential for daily life function, such as drinking, food preparation, personal hygiene and sanitation. Hereunder are the consolidated number of toilet bowls distributed per municipality and the 3-year comparative provincial accomplishment of toilet and water facilities.
Table 4-3 NO. OF TOILET BOWLS GIVEN PER MUNICIPALITYMUNICIPALITY 2000 - 2004 2005
TOTAL NO. OF TOILET BOWLS DISPENSED TO MUNICIPALITIESCompostela 315 155Laak 348 198Mabini 368 27Maco 568 233Maragusan 385 -Mawab 304 25Monkayo 941 157Montevista 360 -
21
Nabunturan 333 77New Bataan 329 77Pantukan 518 212
TOTAL 4,769 1,161
Figure 4-13 HOUSEHOLDS USING SANITARY TOILETS & ACCESS TO SAFE WATER SUPPLYCompostela Valley Province
2003 - 2005
RABIES CONTROL PROGRAM
The Provincial government has allocated budget for the rabies vaccine and all rabies cases in the province were given immediate treatment through injecting anti-rabies medication from Rabies satellite centers. Three rabies satellite centers were created and these are the Montevista District Hospital, Pantukan District Hospital and Maragusan Municipal Hospitals. The diagram reveals the 3-year provincial rabies status of morbidity and mortality provincewide.
Figure 4.14 RABIES CASES, 2000-2005
FILARIASIS CONTROL PROGRAM
Although Filariasis is not a killer disease, it is considered the second leading cause of permanent, long term disability among infectious diseases. World Health Organization has defined it as one of the eradicable diseases and
has called for its global elimination. The diagram shows the 3-year provincial Mass Drug administration coverage accomplishment.
22
Figure 4-15 MDA COVERAGE, 2003-2005
DENGUE CONTROL PROGRAM
During the first quarter of the year Dengue cases were all over in the hospitals most particularly in the major hospitals in Tagum City. The Provincial health office conducted massive campaign against the prevention aspect of the dengue disease. As of 2005, there was a gradual decrease of dengue cases from year 2004, all these cases were clinically diagnosed through obtaining the laboratory results of the patient. Numerous dengue activities were undertaken to control the rapid spread of the incidence and environmental sanitation is the most effective way in controlling the mosquito killer.
Figure 4-15 DENGUE CASES, 1999-2005
Chapter 5 – SUMMARY OF CURRENT SITUATION & IDENTIFIED PROBLEMS
The table below illustrates the province consolidated summary of major issues, concerns and problems on the external environment showcasing the opportunities and threats with regards to the peripheral aspect perceived that has a great impact on the province current situation.
Table 5-1. EXTERNAL ENVIRONMENT – MAJOR ISSUES, CONCERNS AND PROBLEMS Provincial Health Office, Compostela Valley
EXTERNAL FACTORS OPPORTUNITIES THREATS
LGU / LCE
-Strong support for implementation of necessary legislation to support health initiatives. -Presence of AMHOC to foster close ties with other municipalities.-Magna Carta implementation.
-No continuity if admin. changes.-Short period between elections affecting support.-Political differences.-Inadequate & limited health budget
23
DOH
-Provision of trainings & seminars to the health sector.-Technical assistance & logistics.-Financial support for capability building.-Financial support for gov’t. hosps & RHUs unmet needs in structures & equipments repairs.-Regular validation of RHIS & other reports
-Implementation of EO 366.-Possible reduction of health workforce due to decreasing Nat’l Budget.
Other GA, NGO’s & Private sector
-Inclusion in the list of priority mun. & brgys for various health related gov’t programs.-Presence of private clinics & dental practitioners in the community.
-Overburdened health service providers due to increase needs.
People’s origin; community
-Presence of private & gov’t donors willing to provide health support.
-Increase social problems.-Insurgency.-Inability of patient’s to pay cost of health care.
Geography-Rich water supply from rainfall / springs.-Easy access to services in areas with transportation facilities.
-Unproductive land (mountainous & rocky).-Inaccessibility to health service facility due to terrain.-Accidents.
Plantations, mining access
-Employment opportunity.-Increased workforce / income.
-Chemical hazard & envi’l pollution.-Exposure to mercury.-Rising cases of STD.-Denudation of forest & illegal logging for flash floods & landslides during rainy season.-Rising cases of prostitution.-Pollution causes high cases of ARI & skin dses.
Migration (influx from other province)
-Increased workforce / income.
-Possible dse carriers.-Increase number of clients & patient’s need.-Peace & order is affected.-Scarcity of medical health staff.
CAUSES OF MORTALITY
Hereunder is the 2005 leading cause of death in Compostela Valley reflecting its total no. of cases, contributing factors, areas of municipalities affected with precipitating cause and age-group distribution.
Table 5-2. TOP 10 LEADING CAUSE OF MORTALITY, 2005 Provincial Health Office, Compostela Valley
CAUSES OF DEATH
TOTAL NO. OF CASES
CONTRIBUTING FACTORS
MAGNITUDE OF THE PROBLEMAFFECTED
AREAS AFFECTED POPULATION
MUN. No.=% AGEGROUP No.=%
SEXMALENo.=%
FEMALENo.=%
1) Accidents, all forms
375 -Presence of Mining Industry.-Political differnces
MONKCOMPNAB
84=22%48=13%
Mid.adult:25-49
yrs. old
53=63%25=52%22=47%
48=91%
21=84%
5=9%4=16%4=18%
24
-Insurgency.-Poverty.
47=13%
18=82%
2) CVD (Cerebrovas- cular dses)
321
-Unhealthy lifestyle.-Delayed referrals & consultations. -Advocacy problem.
MONKNWBTMACO
60=19%44=14%34=11%
Late adult55-85
yrs. old
39=65%33=75%12=35%
16=41%
19=56%
9=75%
23=59%14=44%3=25%
3) Pneum- onia 258
-Poverty.-Poor nutrition.-Inadequate meds.-Overcrowding.
MONKMACONAB
61=24%60=23%37=14%
Late adult 60-
85yrs. old
43=70%47=78%25=66%
22=51%
26=55%
8=32%
21=49%21=45%17=68%
4) Cancer, all forms
231
-Unhealthy lifestyle. -Poor health seeking -behavior.
COMPNABMACO
42=18%35=15%27=12%
Mid.adult20-49
yrs. old
19=45%16=46%9=33%
9=47%6=38%7=78%
10=53%10=62%2=22%
5) TB (Pul. Tuberculosis)
185
-Poor compliance w/ prog. protocols-Overcrowding.-Social stigma.
COMPNABMONK
29=16%27=15%26=14%
Late adult 60-
85yrs. old
19=66%16=59%10=38%
13=68%
13=81%
7=70%
6=32%3=19%3=30%
6) HPN (Hyper- tension)
181
-Unhealthy lifestyle.-Lack of knowledge on proper nutrition.-Unavailability of services for complicated cases in the community.
COMPNABMONK
45=25%40=22%21=12%
Late adult 50-
85 yrs. old
39=87%36=90%8=86%
25=64%
19=53%
10=56%
14=36%17=47%8=44%
7) Other forms of heart dses
179
-Unhealthy lifestyle, smoking, alcohol, lack of physical activity, high cholesterol diet
NWBTCOMPMACO
15=8%9=5%9=5%
Late adult 50-
85 yrs. old
12=80%7=78%2=22%
6=50%3=43%2=100
%
6=50%4=57%
0=0
8) Renal failure 98
-Unhealthy lifestyle. -Lack of diet promo tion on kidney dses-Advocacy problem.
MONKMACO
18=18%12=12%
Late adult 65-
85 yrs. old
9=50%6=50%
8=89%2=33%
1=11%4=67%
9) Birth asphyxia / Intrauterine hypoxia
87
-Accessibility of trained & untrained hilots. -Poor quality pre- natalcare.
PANTNABMAB
14=16%11=13%10=11%
Neonatal stage
14=100%11=100%10=100%
9=64%5=45%4=40%
5=36%6=55%6=60%
10) Chronic lower resp. dses
77
-Untrained new staff on CARI,IMCI-Pollution.-Smoking.
MACOMABNAB
16=21%9=12%9=12%
Late adult 50-
85 yrs. old
13=81%9=100%8=89%
9=69%8=89%5=63%
4=31%1=11%3=37%
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CAUSES OF MORBIDITY
Hereunder, 2005 leading cause of illnesses in Compostela Valley reflecting total number of cases, contributing factors, areas of municipalities affected, precipitating cause and its age-group distribution.
Table 5-3. TOP 10 LEADING CAUSE OF MORBIDITY, 2005 Provincial Health Office, Compostela Valley
CAUSES OF
ILLNESSES
TOTAL NO. OF
CASES
CONTRIBUTING FACTORS
MAGNITUDE OF THE PROBLEMAFFECTED
AREAS AFFECTED POPULATION
MUN. No.=% AGEGROUP No.=%
SEXMALENo.=%
FEMALENo.=%
1) AURI (Acute upper respiratory infection)
7,360
-Sudden change of weather condition. -Pollution.-Poor housing facility.-Overcrowding -Poor nutrition
MONKMACO
3870=53%1316=18
%
15-495-14
1165=30%395=48%
516=44%189=48%
649=56%
206=52%
2) Accidents all forms of injuries
5,064
-Lack of safety measures-Lack of capability to attend to trauma cases.
MONK 1633=32% 15-49 883=54% 604=68%
279=32%
3)Pneum- onia 2,870
-Poor nutrition.-Inadequate meds. -Untrained new staff on CARI & IMCI.
NABMONK
457=16%
436=15%
Under 11-4
145=32%163=37%
88=61%80=49%
57=39%83=51%
4) Int. Parasitism 2,026
-No sanitary toilet.-Poor personal hygiene -Unhygienic food preparation.
MACOMONK
988=49%
653=32%
15-49 297=30%205=31%
189=64%143=70%
108=36%62=30%
5) UTI (Urinary tract infection)
1,917
-Unhealthy lifestyle.-Eating of food w/ high preservatives & salt content.
MONKMONT
447=23%
391=20%
15-49 318=71%235=60%
59=19%93=40%
259=81%142=60%
6) Diarrhea & gastro-enteritis
1,871
-Unsafe water supply-Improper disposal of garbage & human waste.-Unhygienic food preparation.
MACOPANTMONK
362=19%
336=18%
305=16%
5-14under 1
1-4
110=30%125=37%98=32%
53=48%91=73%58=59%
57=52%34=27%40=41%
7) Anemia 1,422
-Poor nutrition.-Increase cases of STH & other parasitoses.
MONK 797=56% 15-49 432=54% 72=17% 360=83%
8) HPN(Hypertension)
1,329
-Unhealthy lifestyle.-Lack of knowledge on proper nutrition.-Delayed referrals & consultations.
MONT 405=30% 50-64 333=82% 142=43% 191=57%
9) Sepsis / Septicemia 1,273
-Poor health seeking behavior.-Delayed referral to health facility.
COMPMACO
224=18%
205=16%
15-49 108=48%92=45%
38=35%30=33%
70=65%62=67%
10) CVD (Cerebrovas- lar dses)
1,179-Unhealthy lifestyle.-Poor advocacy intensification.
MACO 647=64% 50-64 321=50% 164=51% 157=49%
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OTHER EMERGING CONCERNS ON HEALTH
The table shown below is the status of the province emerging concern on other health and health-related problems. This is to facilitate the assessment of the contributing factors and magnitude of the identified occurrences and rising matters in the most affected areas and population groups.
Table 5-4. OTHER HEALTH & HEALTH-RELATED PROBLEMS / EMERGING CONCERNS, 2005 Provincial Health Office, Compostela Valley
EMERGING CONCERNS CONTRIBUTING FACTORS
MAGNITUDE OF THE PROBLEM
AFFECTED AREAS
AFFECTED POPULATIONAGE
GROUPSEX
MALE FEMALE
1) Diabetes mellitus
-Unhealthy lifestyle.-Too much intake of sweets.-Sedentary activity / Obesity.-Poor health seeking behavior.
ALL MUNICIPALITIE
S
Adult:25-50
yrs. old
No sex preferences.All sex status are
involved.
2) Maternal mortality
-Poor quality prenatal care.-High risk pregnancies.-Home deliveries.-Delayed referral to hosp facilities-Maternal hypertension.
ALL MUNICIPALITIE
S
15-49 yrs. old.
Women of reproductive
age
3) Pregnancy w/ abortive outcome
-Poor quality prenatal care.-Accessibility of untrained & trained hilot-Unwanted pregnancy.-Teenage premarital sex.
ALL MUNICIPALITIE
S
15-49 yrs. old.
Women of reproductive
age
4) Dengue fever
-Poor environmental sanitation.-Storage of uncovered water container in the vicinity.-Delayed referral to hosp facility.
MACONAB.
COMP.
School children(mostly)
No sex preferences.All sex status are
involved
5) Perinatal / Infant deaths
-Home deliveries w/o aseptic technique-Congenital malformations.-Accidents.
ALL MUNICIPALITIE
SUnder 1
No sex preferences.All sex status are
involved
6) Rabies
-Lack of intensification on implementing pet ownership ordinance.-Inadequate rabies vaccine availability.
ALL MUNICIPALITIE
S
ALL AGES
No sex preferences.All sex status are
involved.
7) Schistoso- miasis / Heterophy- Diasis
-Improper human waste disposal-Eating of raw & half cook fish / food.-Unhygienic food preparation.
ALL MUNICIPALITIE
S except of ComvalMabini
15-49 yrs. old
No sex preferences.All sex status are
involved.
8) Prostitution / STD cases
-Poverty.-High level of migration.-Unsafe sexual activity.-Social stigma.
ALL MUNICIPALITIE
S
15-49 yrs. old
Men & women of
reproductive age.
9) Alcohol liver dses
-Unhealthy lifestyle.-Excessive intake of alcohol.-Depression.-Family problem.-Unemployment.
ALL MUNICIPALITIE
S
Adult25-50
yrs. old
75% of men engages to
heavy drinking
25% of women
also participate
s to alcoholism
27
.
10) Drug addiction
-Peer, group & social pressure. -Family problem.-Curiosity, ignorance & alienation.-Parental negligence.
ALL MUNICIPALITIE
S
ALL AGES
No sex preferences.All sex status are
involved.
PRIORITIZATION OF HEALTH PROBLEMS
The table shown below is the tabulated and consolidated health problems priority in the province. All the enumerated health threats below were considered to be among the top 5 health menace to every municipality. Each column correspond a percentage of which it is being rank according to the indicated criteria: urgency, magnitude, availability of technology to solve the problem, implication of inaction, cost effectiveness.
Table 5-5. PRIORITIZATION OF HEALTH PROBLEMS Provincial Health Office, Compostela Valley
HEALTH PROBLEMS
UR-GENCY
MAGNI-TUDE
AVAILABILITY OF
TECHNOLOGY TO SOLVEPROBLEM
IMPLICA-TIONS OFINACTION
COSTEFFEC-
TIVENESS
TOTALPOINTS RANK
( % ) ( % ) ( % ) ( % ) ( % ) ( % )
ARI dses. 20 20 20 20 20 100 1
Tuberculosis 20 20 15 20 20 95 2
Maternal death 20 15 15 20 20 90 3
Cerebrovascular dses 20 15 15 20 15 85 4
Hypertension 20 15 15 20 10 80 5
Diabetes 20 10 20 10 15 75 6
Dengue fever 20 5 5 20 10 60 7
Cancer, all forms 10 18 10 10 8 56 8
Schistosomiasis & other STH 15 10 10 10 10 55 9
Accidents, all forms 15 8 8 10 8 49 10
Legend: TOTAL POINTS: HIGH = 76 to 100%MEDIUM = 50 to 75%LOW = below 50%
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HEALTH PROBLEMS – STRENGTHS AND WEAKNESSES IN ADDRESSING THEM
The table below reveals the summary of the prioritized health setback which has the utmost occurrences affecting the health condition of the province with its corresponding strengths and weaknesses.
Table 5-6. HEALTH PROBLEMS - STRENGTHS AND WEAKNESSES Provincial Health Office, Compostela Valley
PRIORITIZED HEALTH
PROBLEMSSTRENGTHS WEAKNESSES
1) ARI dses.
-RHU staff are trained in IMCI programs.-RHUs have nebulizers & other equipments-Strong advocacy to reinforce the counting of Respiratory Rate to those with ARI.-Augmentation of drugs, meds & other logistics from PHO & DOH.
-New staff are not trained on ARI cases management.-Poor implementation of IMCI program.
2) Pulmonary tuberculosis
-RHU staff are trained in DOTS program.-All med. techs are trained in TB-DOTS for case finding & case holding.-BHW are active as treatment partners in management protocols.-Regular supply of drugs & meds.-Presence of lab. equipment & facilities.-Augmentation of drugs & meds & other logistics from DOH & PHO.-Conducts monthly monitoring, slide validation-With budget for TB program implementation.
-Creates social stigma among patients.-Children are exposed to their family and friends with active infection.-Poor compliance on treatment protocols.
3) Maternal death
-All RHU personnel specially midwives were tasked to monitor all pregnant women to their community or station.-PHO active retrieval of death records in the hospital & local civil registrars.-Conduct maternal death orientation.-DOH reps monthly & regular validation of RHIS & target client lists.-MSH & LEAD commodities.
-Poor quality prenatal check-up.-High risk pregnancies.-Accessible trained & untrained hilots. -Unsafe abortion.-Home deliveries w/ no aseptic techniques -Delayed referral of hilots handling delivery-Late referrals aggravated by lack of medical mgt & poor access to hosp.-Lack of emergency obstetric care.-Lack of info & means to recognize & manage complications in difficult labor pregnancies.-Health staff are not trained for BEmOC.-MSH & LEAD project has terminated.-No provincial maternal death review.
4) Cerebrovascular
-Provincial & government offices conduct -Unhealthy lifestyle.
29
dses stress management & other sports activities.
-Inadequate supply of drugs & meds.-Delayed referral to hospital facility.-Poor patient’s health seeking behavior.-No provincial program implementation.
5) Hypertension -Availability of equipment for BP screening.-RHU conducts regular HATAW activities.
-Unhealthy lifestyle & obesity.-Inadequate supply of antihypertensive drugs & meds.-Poor compliance on meds maintenance.-No provincial program implementation.
6) Diabetes mellitus
-Non gov’t agencies & private sectors conducts diabetes screening to RHUs.-With available IEC materials.
-Patient resort to unhealthy lifestyle.-Sedentary activities & obesity.-Poor compliance on management of meds as maintenance.-Inadequate supply of drugs & meds.-Lack of advocacy intensification.-Can be acquired thru parental inheritance-No provincial program implementation.
7) Dengue fever
-Conduct massive campaign on dengue awareness to private agencies, GOs & NGOs -Creation of dengue brigade to schools & communities.-Conduct dengue symposia to elem., hi- school students & communities.-PHO conduct case finding mgt & vector control among households.-PHO mobilized the creation of Dengue task force to every brgy.-PHO has its own manpower to facilitate blood processing assigned in DRH.-Regular data gathering to all dengue cases in the major hospitals.
-Poor environmental sanitation. -Delayed referral to hospital facility. -Affected families are usually those not active in voluntary blood donation.
8) Cancer, all forms
-Conduct regular pap smear & breast self exam activities during outreach & other provincial initiated programs.-With available IEC materials.
-Unhealthy lifestyle.-Unavailability of financial resources for treatment & chemotherapy.-Can be acquired thru parental lineage inheritance.-No provincial program implementation.
9) Schistosomiasis & other STH parasitoses / Intestinal Parasitism
-Presence of DOH & PHO itinerant team & sanitary inspectors for monitoring of Schisto & other STH parasitoses.-Conduct case finding & mass treatment if found positive on Schisto.-Conduct health education & ocular house- hold survey to communities for their water sources & toilet facilities.-Creation of schisto team at mun. level. -PGO and PEO conducted channeling, deepening, desilting of snail colonies, & vegetation clearing.-Augmentation of meds from DOH & other logistics from PHO.-Presence of lab equipments & facilities.
-Poor environmental & personal hygiene-Unhygienic food preparation.
30
10) Accidents, all forms
-Improvement of Comval main roads is now on going through a foreign project.-Improvement of Comval brgy. roads from the prov. gov’t.-Provision & construction of bridges & lighting facilities to brgys from prov’l. gov’t.-Police visibility.
-Insurgency.-Geographic location.-Lack of precautionary & safety measures. -Unavailability of resources to performs emergency cases in the health facility.-Rampant assault cases due to influence of alcohol & prohibited drugs.
OPERATIONAL PERFORMANCE PROBLEMS
The data below shows the consolidated operational implementation of the health office set-up. For each identified problem a column for the strengths and weaknesses are enumerated using the 7 M’s. Each area of concern tackles on the existing assets or resources available addressing them to be as the strength category. While all internal deficiencies that hamper the functioning level of the province are referred to as the weakness category.
Table 5-7. STRENGTHS AND WEAKNESSES Provincial Health Office, Compostela ValleyOPERATIONAL PERFORMANCE
PROBLEMSTRENGTHS WEAKNESSES
MONEY
-Enrollment of more clients to Indigency prog. from congress to brgy. level.-With RHU budget for med. assistance / LGU -With available disaster & crisis intervention for prov. & mun. level. -With prov. & cong. med. assistance funds for monthly bill-out sys. in DRH pts.-Nabunturan & New Bataan implement cost recovery scheme.-MDH, PDH, MMH & LMH: increase collection & revenues for 3 terms.-PHO, MDH, PDH, MMH & LMH: funds can be provided thru supplemental budget.-MDH: trust fund available but for MOOE.-MMH: LGU Maragusan have subsidized pts in procurement of needed meds.-MMH: LGU Maragusan have subsidized fuel for ambulance to patients for referrals.-MMH: Maragusan board members extends financial help to hosp in special occasion.
-Minimal increase of health budget.-Delayed processing of fund utilization reports.-Inadequate funds for travel, meds, supplies & logistics.-Inadequate funds for capability building & trainings.-Dole-out mentality has been tolerated.-Unfunded position at PHO, hosp & RHU-Inadequate funds on PHIC enrollment.-PHO, MDH, PDH, MMH & LMH: lack of funds for hosp. equipments, computers, purchases & repairs.-PHO, MDH PDH, MMH & LMH: needs add’l funds for ambulance repair & maintenance.-MDH, PDH, MMH & LMH: over-utilized budget of due to 100% occupancy rate.-MDH, PDH, MMH & LMH: no funds for structure set-up for PHIC requirement.
MANAGEMENT -The Governor major goal zero backlog of his priority projects in infrastructure, agriculture & health sector.-Strong linkages to health stakeholders,
-Inadequate logistical support for hosp. programs & projects.-Poor document processing & needs liason intervention.
31
GOs, NGOs & other private agencies.-Well organized Peacekeeper’s, Women’s BHW, SrCitizen, Youth & Handicapped org.-Presence of Lamdag Panginabuhi project w/c provides livelihood sources to farmers, indigents & far flung communities.-Prov. initiated activities - med, surgical, dental, lab & nut. outreach to brgys.-Adopt a malnourished child per office.-BHW benefits from prov gov’t.-Coordination with Dep-Ed on nephrology, dental & lab services.-Nab. RHU is TB-DOTS center certified.-MDH, PDH, MMH & LMH: PHIC accredited-LMH: 2-way referral system in place.
-Delayed procurement processing.-Program / policies & guidelines not strictly practiced & observed.-Magna Carta partially implemented.-Poor referral system.-Inactive LHB.-No INTER LOCAL HEALTH ZONE.-Political differences of elected govt officials
MANPOWER
-All health staff are resourceful, committed, hardworking & good mobilizer.-Availability of health workers in all BHS.-Majority of RHU health personnel were trained in IMCI, CARI-CDD, NTP-DOTS, FP, EPI, NTP & Nutrition programs.-Well supportive BHW treatment partners.-DOH & PHO facilitates trainings & seminars among health workers.-Presence of hosp. private practitioner.-Presence of DOH reps in all RHUs. -Presence of community organizer for Malaria program.-MDH: have 4 specialized MD’s.-LMH: with available Pathologist.
-Multiple tasking of health personnel.-PHO, MDH, PDH, MMH & LMH: with unfilled-up positions still available.-MDH, PDH, MMH & LMH: inadequate staff (MD, RN, RM, Admin.)-MDH, PDH, MMH & LMH:staff have low access in trainings for capability building-MDH & MMH: hosp staff will soon leave-MDH: COH have resigned, COH of PDH was temporarily assigned.-PDH: Asst. PHO was assigned as COH.-PDH:no medtech during night &holidays-PDH: staff are not computer literate.-PDH: no Pharmacy Aide -MMH: factionalism among employees.-MMH: no Cashier & Liason officer.
MANSION
-PHIC accreditation to 3 RHUs & 4 hosp.-Construction & renovation of hosp, rhu & bhs structures from different donor agency-Assistance from outside sources for upgrading facility in hosp & BHS.-All RHU are SS certified Phase 1 Level 1 & 8 are certified Phase 2 Level 1.-MDH: with approved allocations from Natn’l Office to fully equipped & meet standards as prov. hosp.-MDH: Philhealth accredited Secondary hosp. with a functional OR.-MDH: with on-going expansion & construction of a 2-storey building.-MDH & MMH: with available semi-private rooms for paying clients.-PDH: with available standard space Pharmacy building area.-PDH: functional laboratory.-MMH: available spacious surgical room.-MMH: spacious & comfortable workplace.
-Dilapidated structures in hosp & RHUs-No staff house for employees in hosp.-MDH, PDH, MMH & LMH: building is dilapidated & needs renovations, repairs form roof to floor & other room stations.-MDH, PDH, MMH & LMH: needs upgrade for lab facilities.-MDH: non-renewal of Philhealth.-PDH: Pharmacy is not visible to clients. -PDH: limited space for work & ward.-PDH: has no room for storage of Pharmaceutical products & supplies.-PDH: leaking roofs in lab area.-PDH: has hospital land conflict.-MMH: comfort room is clogging.-MMH: worn-out paint hosp. facilties.-MMH: incomplete fencing on premises.-MMH: deed of donation docs unlocated. -MMH: certificate property title is vague.-MMH: Philhealth license may be suspended due to poor amenities.
MACHINES -25% of brgys. has multicab in District 1. -MDH, PDH, MMH& LMH: previous
32
-With new vehicles for PHO & hosps.-Existence of computers to RHUs & hosps.-Medical record database available at DOH.-Presence of HMS to repair equipments.-PHO: available mobile hosp on wheels.-PHO: with cold chain room for vaccines-MDH, MMH & LMH: 1 functional computer.-MDH: with available spectrophotometer but tie up with a private company.-MMH: has brand new model X-ray.
ambulance is dilapidated & unreliable.-MDH, PDH, MMH, LMH: med. equipmnts are worn-out & inaccurate.-MDH, PDH & LMH: needs add’l computer-MDH & MMH: 2 computer not function-MDH: no cart meds cabinets.-PDH: no available bloodchem for exam-PDH: electrical fluctuations often occurs-PDH: no spectrophotometer.-PDH: no storage for wastes & products.-PDH: aging ward beds.-PDH: no OR lights & DR anes. machine-MMH: no consumable materials for Xray-LMH: non-functioning gen-set.-LMH: no X-ray machine & transformer-LMH: no aircon for ER, OR & DR.-LMH: needs another microscope.
MATERIALS
-With existing IEC materials, charts, manuals to some health programs.-Regular supplies of meds, drugs, office supplies, reagents & other logistics assistance from DOH & PHO.-On-line database procurement will be established next year.-MDH: tight control of procurement process & safety net observed.-MDH: w/ sub-allotment per COA circular.
-Inadequate logistics for materials, drugs, meds & other supplies. -Delayed updating of records & reports.-Unavailability of hosp info sys database.-MDH: circuitous procurement process thus delay acquisition of hosp needs.-MDH: unsatisfactory performance of hosp due to inadequate facilities lead to loss of lives & negative hosp image.-PDH: delay updating of logistics, data, hospital & record keeping.
MESSAGES-Existing means of communication, radio- base, cell phones, cellists.-Presence of AM/FM stations reach brgys,-MMH & LMH: w. handheld radio comm. sys
-Improper & abusive sending of text messages.-MMH & LMH: no 2-way radio base. -Not all can buy cellphones & load.-Comm. from PHO is sometimes delay in spite of communication lines.-MMH: with unlicensed hand-held radio.
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Chapter 6 - SUMMARY STATEMENT OF PRIORITY PROBLEMS
Table 6-1. SUMMARY STATEMENTS OF PRIORITY PROBLEMS Provincial Health Office, Compostela ValleyA. HEALTH / DISEASE PROBLEMS
1. High prevalence of communicable diseases. Acute respiratory infection and pneumonia Tuberculosis Malaria and other vector borne disease such as dengue fever and filariasis Schistosomiasis and other parasitoses such as heterophyidiasis and capillariasis.
2. Increasing prevalence of lifestyle / non communicable disease. Cardiovascular diseases Hypertension Diabetes mellitus Cancer Maternal mortality
3. Increasing incidence of accidents / injuries. Wounds Assaults Vehicular accidents
B. INSTITUTIONAL OR OPERATIONAL PROBLEMS1. Human resources do not meet required population ratio, health workers are performing multi-tasking.2. Limited health budget.3. Inadequate medicines and hospital commodities and equipment.4. Present procurement system increase likelihood of delay in the availability of meds and other supplies.
C. CLIENT-BASED PROBLEMS1. Poor health seeking behavior.2. Unhealthy lifestyle.3. Poor compliance to treatment.4. Dole-out mentality.
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Table 6.7 MAJOR GOALS Provincial Health Office, Compostela Valley
1. Reduce incidence of communicable, non-communicable dses & other emerging dse problems.
2. Increase enrollment of Philhealth Indigency program.
3. Assure quality health facilities, reinforcement of health regulations and access to affordable quality meds.
4. Improve the management support system for health system performance.
Chapter 7 - OBJECTIVES AND TARGET SETTING
FOURMULA 1 Component No. 1: HEALTH SERVICE DELIVERY
GOAL # 1. REDUCE PREVALENCE OF COMMUNICABLE DISEASES
OBJECTIVEBASELINE
DATA2005
YEAR2006
YEAR2007
YEAR2008
YEAR2009
YEAR 2010
OUTPUTINDICATOR
G 1.1 TUBERCULOSISTo increase CDR from 89% in 2005 to 90% in 2010.
89% 90% 90% 90% 90% 90% Increased case detection rate.
To increase CR from 85% in 2005 to 90% in 2010.
85% 86% 87% 88% 89% 90% Increased cure rate.
OBJECTIVEBASELINE
DATA2005
YEAR2006
YEAR2007
YEAR2008
YEAR2009
YEAR 2010
OUTPUTINDICATOR
G.1.2 MOSQUITO Borne : MALARIA, FILARIA and DENGUETo reduce morbidity of Malaria from 1.92/100,000 pop. in 2005 to 1.0% in 2010.
1.92% 1.8% 1.6% 1.4% 1.2% 1.0%Decreased
malaria morbidity.
To increase mass tx coverage for Filariasis from 81% in 2005 to 90% in 2010.
81% 84% 86% 88% 90% 90%Increased mass
treatment coverage.
To decrease mortality rate of Dengue from 6.52% in 2005 to >1%in 2010.
6.52% 5.0% 4.0% 3.0% 2.0% >1% Decreased case fatality rate.
OBJECTIVEBASELINE
DATA2005
YEAR2006
YEAR2007
YEAR2008
YEAR2009
YEAR 2010
OUTPUTINDICATOR
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G.1.3 SCHISTOSOMIASISTo reduce prevalence rate of Schistosomiasis in 10 endemic mun. from 1.88% in 2005 to 1% in 2010.
1.88% 1.75% 1.60% 1.5% 1.55 1.0%Decreased occurrence
rate of schisto.
To increase case finding from the pop at risk from 78% in 2005 to 85% in 2010.
78% 80% 81% 82% 83% 85%Increased
case finding of schisto.
OBJECTIVEBASELINE
DATA2005
YEAR2006
YEAR2007
YEAR2008
YEAR2009
YEAR 2010
OUTPUTINDICATOR
G.1.4 DOG BITES AND RABIES
To reduce cases of dog bites & maintain zero case of rabies from 2005-2010.
95 cases
0 rabies
85cases
0rabies
75cases
0 rabies
65cases
0 rabies
50cases
0 rabies
50 cases
0 rabies
Decreased cases of dog bites & no
death from rabies.
GOAL # 1.2. TO REDUCE AND PREVENT NON-COMMUNICABLE DISEASES
OBJECTIVEBASELINE
DATA2005
YEAR2006
YEAR2007
YEAR2008
YEAR2009
YEAR 2010
OUTPUTINDICATOR
G.2.1 REPRODUCTIVE HEALTHTo reduce incidence of MMR from 182/100,000 LB to 120/100,000 LB.
182/100TLB
170/100T LB
160/100TLB
140/100TLB
120/100TLB
100/100TLB
Decreased maternal mortality
rate.To increase CPR from 61% in 2005 to 65% in 2010.
61% 62% 63% 64% 65% 65%Increased
contraceptive prevalence rate.
To increase % of pregnant w/ quality prenatal care from 14% in 2005 to 80% in 2010.
14% 30% 50% 60% 70% 80%Increased % of
pregnant w/ quality prenatal care.
To increase % of mothers w/ quality PP care from 45.9% in 2005 to 80% in 2010.
46% 50% 55% 60% 70% 80%
Increased % of mothers & received quality postpartum
care.To increase % of FIM from 72% in 2005 to 80% in 2010.
72% 73% 74% 75% 76% 80%Increased % fully
immunized mothers.
OBJECTIVEBASELINE
DATA2005
YEAR2006
YEAR2007
YEAR2008
YEAR2009
YEAR 2010
OUTPUTINDICATOR
G.2.2 TO REDUCE AND PREVENT CHILDHOOD ILLNESSESTo increase % of FIC from 79% in 2005 to 90% in 2010.
79% 82% 85% 86% 90% 95%
Increased % of fully
immunized children.
To reduce IMR from 15/1,000 LB in 2005 to 5/1,000 LB in 2010.
15/1,000 LB 13/1,000LB
11/1,000LB
9/1,000LB
7/1,000LB
5/1,000LB
Decreased infant mortality
rate.
To reduce PMR 20/1,000 LB 18/1,000 16/1,000 14/1,000 12/1,000 10/1,000 Reduced
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from 20/1,000 LB in 2005 to 10/1,000 LB in 2010.
LB LB LB LB LBperinatal mortality
rate.
To decrease prevalence of malnutrition from 14.7% in 2005 to 10% in 2010.
14.7% 11% 10% 10% 10% 10%Decreased
occurrences of malnutrition.
FOURMULA 1 Component No. 2: HEALTH FINANCING
OBJECTIVEBASELINE
DATA2005
YEAR2006
YEAR2007
YEAR2008
YEAR2009
YEAR 2010
OUTPUTINDICATOR
GOAL # 2. TO INCREASE ENROLLMENT OF PHILHEALTH INDIGENCY PROGRAM.To increase PHIC enrollment from 20,000 enrollees in 2005 to 50,000 in 2010. 20,000
plus10,000
plus15,000
plus20,000
plus25,000
plus30,000
Increased PHIC enrollee.
FOURMULA 1 Component No. 3: HEALTH REGULATION
OBJECTIVEBASELINE
DATA2005
YEAR2006
YEAR2007
YEAR2008
YEAR2009
YEAR 2010
OUTPUTINDICATOR
GOAL # 3. TO ASSURE QUALITY HEALTH FACILITIES, ENFORCEMENT OF HEALTH REGULATIONS & ACCESS TO AFFORDABLE QUALITY MEDS.To upgrade RHUs as Sentrong Sigla phase 2 level 1 from 8 in 2005 to 11 in 2010.
8RHUs
9RHUs
11RHUs
11 RHUs
11RHUs
11RHUs
100% of RHUs are phase 2 & level 1
accredited.
To upgrade RHU to SS Phase 2 level 2 from 0 in 2005 to 11 in 2010.
0RHUs
2RHUs
3RHUs
4 RHUs
2RHUs
11RHUs
100% of the RHUs are phase 2 level 2
accredited.To increase Botika ng Barangay establishments from 45 Bnb in 2005 to 200 Bnb in 2010.
45 BnB 70Bnb
100Bnb
125Bnb
150Bnb
200Bnb
Increased BnB establishments.
FOURMULA 1 Component No. 4: GOOD GOVERNANCE
OBJECTIVEBASELINE
DATA2005
YEAR2006
YEAR2007
YEAR2008
YEAR2009
YEAR 2010
OUTPUTINDICATOR
GOAL # 4. IMPROVE THE MANAGEMENT SUPPORT SYSTEM FOR HEALTH SYSTEM PERFORMANCE.To create Inter-local health zone from 0 in 2005 to 2 in 2010.
0 0 1 1 2 2 Inter-local health zones functioning.
To activate local health board by having a meeting every month.
Once a year once Quarterly Monthly Monthly Monthly
Monthly meeting instituted & organized.
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To provide 100% Magna Carta privilege to all health workers.
10% partial
15%partial 25% full Full Full Full Full implementation
G.2.3 HOSPITAL REFORMSOBJECTIVE MDH PDH LMH MMH Remarks
To increase manpower.
Manpower answers the need of a prov’l hosp.
Fill up vacant positions.
Fill up vacant positions.
Fill up vacant positions.
Filled-up all plantilla
positions.To allocate amt. for hospital renovation.
Needs 2M for renovation of phase 1 bldg.
1M for renovation. 1M for
renovation.1M for
renovation.
Dilapadated structures renovated.
To procure additional equipment.
To procure Ultrasound.
To procure Ultrasound.
To procure X-ray machine.
To procure new ECG machine.
Equipments procured.
APPENDIX
SUMMARY OF OVER-ALL HEALTH INITIATIVE OF THE PROVINCE
Year 2005 was a very tough and taxing year in the Provincial Health Office. From the first quarter up to the last quarter tons of works were already pushed to the limit to all health workers. But the unending support of the Provincial Government and the headship of our compassionate Governor JOSE R. CABALLERO brought the realization of the PHO Magna Carta and additional grant to our benefits. Thus, we thank the Honorable Governor for all the provision and sustenance to our needs. We continue to improve the conveyance of our health services far and wide to all Comvaleños.
HE
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HEALTH SECTORThe provision & realization of Magna Carta to all health workers in the province.Philhealth insurance expansion coverage which entails automatic membership given to all Senior Citizens, Prov’l Peacekeepers, Barangay Health Workers, Barangay Health Workers & Physically Disabled individuals plus additional budget was allocated.The Blood Processing fee for Blood Sufficiency Program has increased covering the 11 municipalities. Regular outreaches to far flung barangays despite of the limited resources but maximize all efforts to serve the deprived communities.A total of 1,161 toilet bowls plus 1 sack of cement given & distributed to all municipalities.Adopt a malnourished child per office in coordination of the Nutrition Council & Comval has received 2 successive awards for the good implementation & decreasing cases of malnutrition in the province.Comval’s answer to poverty or food insufficiency has narrowed down due to the prov’l gov’t dispersal of marine, agricultural resources & other sources of livelihood to indigent families & communities.Purchased new ambulance each for the 4 gov’t hosp.Rehabilitation of Montevista district hospital to be a Provincial Hospital.Activation of the Eye Care Program & Diabetic Club which has been inactive for many years..Fully supported Women empowerment & has caused the inclusion of R.A. 9262 Violence against women & children Act in 2005 ratified mandates through the BLEW (Barangay Legal Education on Wheels) program.
Prepared:
ROSE CHERYL P. REYNES-EYAS JOCELYN B. ACA, M.D.Statistician I Medical Officer V–Planning Division Head
Noted:
RENATO B. BASAÑES, M.D.Provincial Health Officer
Approved:
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Hon. JOSE R. CABALLEROGovernor
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