■ Hanna C. Lacsamana
In Baguio City, most residents trust their barangay health workers (BHWs) the most as sources of information on primary health care and services.
Not only that, BHWs in the city also serve as a sounding board of recipients of health services for many concerns because residents consider BHWs as persons of authority.
This assessment, among other findings, has been reached through a scoping study on Universal Health Care piloted in Baguio City and two other areas in the country with the support of The Rockefeller Foundation, a multi-country initiative implemented in Cambodia, India, and Philippines, and implemented by the Philippine NGO Council and Catalyst Management Group.
Kevin de Vera, research consultant for the scoping study that is part of the project Sikat sa UHC or Sama-samang Inisiyatiba para sa Kaunlaran ng Taong-Bayan sa UHC, said the study covered four core sectors – senior citizens, mothers, and youth as health care recipients; and BHWs as duty bearers in primary health care provision in the city, who underwent focused group discussions in April.
Based on the findings, de Vera said the respondents across all sectors who are recipients of primary health care recognize BHWs as reliable sources of health information.
It also found out that the best thing the public appreciates is the home visits, which have increased the level of respect and recognition of health centers and BHWs, especially during the Covid-19 pandemic where BHWs were among the frontliners, responsible in assuring primary health services were still provided during health emergency while observing minimum health protocols.
“Based on the study, that level of respect is attributed to the fact BHWs of the city underwent series of training. Although there are some gaps identified, they were trained on basic healthcare, on certain protocols and guidelines in different areas like the program on immunization, Covid-19 contact tracing, and tuberculosis case management. They are well trained by no less than the Department of Health and CHSO,” de Vera said.
The city also has a well-coordinated social and health sectors when it comes to UHC. The social sector, while mainly in charge of enrolling the most vulnerable and poorest population in the PhilHealth, has partnered with the CHSO and BHWs since they are the ones who have direct access to the residents.
“Hindi nga masyadong nag-surface ang social media as source of information. Rather, paulit-ulit sinasabi ng mga tao who were participants of the study that BHWs are very visible in the community and most of them have been visited in their homes by BHWs. Kapag may gusto silang tanungin, sa barangay health workers talaga pumupunta. Sila ‘yung main source of community information when it comes to health,” de Vera said.
The study also found out aside from BHWs, the participants, while also using social media platforms, rely on experts and other authorities about news and information on health, such as listening to the pronouncements of the local chief executive and health officials.
“Ang social media talagang expected sa mga young people as their main source of information. Meron ding mga adults, but they follow famous personalities and experts, not just anyone doing vlogs. Also, for the community at the ground, their authority figure is mostly not the barangay captain, not the public health nurse or midwife, but the BHW whom they first identified,” he said.
The study also assessed that the city has a well-promoted and well-communicated health program, as evidenced by the success of the smoke-free city campaign of the City Health Services Office, which led to a population that is aware smoking is prohibited in public places and there are penalties for its violation.
De Vera said it is well promoted because information are distributed to the different levels of the city’s population.
However, he said the city has other health programs that are not well known to the population, such as adolescent reproductive health and mental health, though intervention and reaching out programs have been intensified due to the alarming situation of mental health concerns in the city recently.
De Vera said another highlight of the scoping study is most of the participants are aware of their rights to accessible health care services, but this awareness is limited to those which they have personally experienced already or at least observed that were accessed by other members of their household or by others in their community from their health centers.
“Apart from that, hindi sila aware. For example, BHWs said the city has a program regarding teenage pregnancy or HIV prevention for young people, but most of the young people are not aware because they have not experienced it yet or they did know not there is such program. So parang merong gap,” de Vera said.
Overall, de Vera said the study showed Baguio City has good primary health care services and programs, but these are not accessed by the majority of its population because they are not aware of these services.
“We understand there are BHWs as frontliners, but if we really look at the burden on the health resource, kakaunti masyado ang frontliners na health workers, kahit na may mga volunteers tayo, if compared to the population. Overloaded na ang BHWs, parang ang dami nilang ginagawa, kaya although maraming services, hindi alam sa community.”
“In the demand generation side, which is the role of health workers, who in first place should not be treating patients, ang nangyayari puro sila treatment. ‘Yung health prevention na siyang spirit ng primary and Universal Health Care nawalala, so ito ang dapat ma-bridge later on,” de Vera said.
Based on the project’s estimate, he said there are about 16 public health physicians in Baguio City basing on the number of the city’s health centers, which translates to one physician per 37,000 population, a number that is low compared to the World Health Organization standard of one is to 10,000 and acceptable ratio in the country of one is to 20,000.
However, de Vera said the city is still in a better position compared to other LGUs, which have one physician to 60,000 population being taken care of.
He said another interesting finding about Baguio City is its high uptake of free commodities and services, which while also true in other places, is being seen as a gap because the participants would prefer services and commodities for health concerns they are already experiencing but not other services like vaccines, which was supposed to prevent them from being sick.
“So overall in terms of health seeking behavior, lumabas across different population groups, magpapatingin lang sila kapag malala na o kung may nararamdaman na. Second, hindi sila pumupunta sa health center kasi may mentality na walang doctor or walang supply ng gamot,” de Vera said.
There is also a mentality among the study participants attributed to what they do, like it would take them some time out of their work or school to go to a health center only to find out there is no available doctor or medicine supply so they would rather not go instead.
Some seniors also have a mindset about long lines at the health centers, even when there is a dedicated lane for them.
“And this we may attribute to lack of human resource,” de Vera said.
The Sikat sa UHC project aims to contribute to reducing data gaps on primary health indicators by coming up with baseline data on the pilot areas’ health situation to support the local government in improving the health-seeking behavior and address stigma and treatment hesitancy.
The city’s BHWs recently underwent training on communication planning with the PNGOC under the Sikat project to help promote the UHC and improve the community’s awareness on health services and health-seeking behavior.