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12TH
CONGRESSIONAL INTERNSHIP PROGRAM FOR YOUNG MINDANAO LEADERS
Delivery Of Basic Maternal And Child Health Services To The Tri People In Region X:
A Policy Issue Paper
KISHRA T. DAWABI
Zamboanga City
RAINIDAH M. ISMAEL Iligan City
YASSER M. SALACOP
Lanao del Sur
OCTOBER, 2011
TABLE OF CONTENTS
Executive Summary ……………………………………………………….. 3 CHAPTER I – BACKGROUND OF THE PROBLEM a. Description of the problem …………………………………………….. 4
b. Outcome of prior efforts to solve the problem ……………………….. 5 CHAPTER II – SCOPE AND SEVERITY OF THE PROBLEM a. Assessment of past policy performance …………………………….. 7
b. Significance of problem situation ……………………………………… 7
c. Need for analysis ……………………………………………………… 8 CHAPTER III – STATEMENT OF THE PROBLEM a. Definition of the problem …………………………………………………. 10
b. Major stakeholders …………………………………………………………. 10
c. Goals and objectives ………………………………………………………. 11
d. Measures of effectiveness ………………………………………………... 11
e. Potential Solutions ………………………………………………………… 12 CHAPTER IV – POLICY ALTERNATIVES a. Description of alternatives ………………………………………………. 13
b. Comparison of future consequences ………………………………….. 13
c. Spillovers and externalities ……………………………………………… 14
d. Constraints and political feasibilities …………………………………. 15 CHAPTER V – POLICY RECOMMENDATIONS a. Criteria for recommending alternatives ……………………………… 17
b. Description of preferred alternative …………………………………… 17
c. Outline of implementation strategy …………………………………… 18
d. Provision for monitoring and evaluation …………………………….. 18 e. Limitations and unanticipated consequences ………………………. 19 REFERENCES ………………………………………………………………… 20 APPENDIX – A Problem Tree …………………………………………………………………… 21 APPENDIX – B List of Tables ………………………………………………………………….. 22
EXECUTIVE SUMMARY
Poverty alleviation has been the major concern not only of the country but
also worldwide. It is with this reason that the United Nations Development
Program launched its treaty together with the rest of the 189 nations that by 2015
the world would be free from poverty and all forms of deprivation (UNDP, 2000).
This agreement was named Millennium Development Goals or MDGs with 8
main goals that each nation is attempting to achieve: (1)Eradicate extreme
poverty and hunger; (2)Achieve universal primary education; (3)Promote gender
equality and empower women; (4)Reduce child mortality; (5)Improve maternal
health; (6)Combat HIV/AIDS, malaria and other diseases; (7)Ensure
environmental sustainability; and, (8)Develop a global partnership for
development.
Looking deeper into the Philippine situation, statistics related to these
goals are not painting a good picture of the national health and educational
situation. Goals 2, 5, and 6 have slow progress and low probability of achieving
them by 2015. Improvement of maternal health remains to be a dream for
mothers especially those in vulnerable situations such as living in conflict-
affected areas, extreme poverty and are part of the cultural minorities to name a
few. A huge number of cases come from the Land of Promise – Mindanao.
It is with this purpose that this policy paper has been dedicated to find
solution to the social issue on improving the health status of the Mindanaoan
mothers. Specifically, this paper seeks to achieve its objective of enhancing the
delivery of basic maternal and child health services to the Tri People in Mindanao
with focus on Northern Mindanao (Region X) which has been the haven for the
Lumads, Mindanao Migrants and Moros. Despite access to healthcare facilities,
Region X still has unfavorable health indicators, such as infant morbidity rate of
11.62/1,000 live births and maternal morbidity rate of 21.33/1,000 live births;
hence, the policy issue of lack of coordination in the delivery of basic maternal
and child health services to the Tri-People in Region X.
The preferred policy alternative that this paper presents is to strengthen
and improve the Local Health Board by extending its membership and functions.
Expanding the membership and broadening the functions of the LHBs can
significantly decrease the MMR and IMR by the impact of addressing the issue in
the municipal, provincial and city level of LGU in Region X.
CHAPTER I
Background of the Problem
A. Description of the Problem
Mindanao has various social concerns and issues with regards to the
delivery of basic health services. Lanao del Norte, Lanao del Sur, Maguindanao,
Basilan, Tawi-Tawi, Sulu and Sarangani are among the seven Mindanao
provinces which rank among the ten lowest provinces in the Philippines in terms
Human Development Index (HDI). In the past decade, Mindanao was marked by
a slow progress in the field of maternal and child health. In fact, most parts of
Mindanao have low progress in terms of reducing maternal morbidity ratio
according to the Subnational Progress Report on the MDGs. Northern Mindanao
has a relatively high maternal mortality rate which registers at an alarming 21.33/
1000 live births and infant mortality rate at 11.62/1000 live births despite the fact
that it has 931 barangay health centers out of 1158 barangays which constitutes
80.39% which is higher than the 27% national level. Higher incidences of
maternal and infant deaths occur among minority groups in the Mindanao,
indicating that this is a sector least served by available reproductive health
services (Lacuesta, 2010: p 18). It has been also shown that the disadvantaged
groups and indigenous people have poorer survival chances, suffer from heavier
burden of illness, experienced a blighted quality of life and failed to receive basic
maternal and child health care. Their health profiles demonstrate rising mortality
rate. According to Lacuesta, due to poverty and the lack of coordination in the
delivery of maternal health care, it is indicated that home delivery assisted by
traditional midwives or hilot is commonly practiced, which may contribute to the
relatively high maternal mortality rate. Infant mortality is also increasing, mainly
due to poverty-related malnutrition and poor health practices, negative health
seeking behaviors and the absence of sanitary toilets and potable water supply.
The lack of coordination in the delivery of basic maternal and child health
care to the Tri-People, composed of the following: (a)Lumads, such as
the Manobo tribes, the Higaonons, Matigsalugs, Talaandigs, Umayamnoms, and
the Tigwahanons; (b) Mindanao migrants from Luzon and Visayas; and, (c) and
the Moro tribes or Islamized Lumads, such as the Meranaos, Tausugs and the
Maguindanaons, in Mindanao has been one of the evident factors for the
negative statistics on the maternal and child health care. Several reasons have
been identified in contributing to the lack of coordination in the delivery of these
health care services which includes the following: (a) overspecialization of
government agencies; (b) absence of coordinating mechanism; (c) selective
distribution of services; (f) and political patronage and favoritism.
As an effect for the absence of coordination, there has been unequal
distribution of basic maternal and child health care services. Also, basic health
care services do not reach beneficiaries especially cultural minorities and
vulnerable sectors in far-flung areas.
B. Outcomes of Prior Efforts to Solve the Problem
The national government specially the Department of Health exerted
several efforts in addressing the health problems and in uplifting the health status
of the citizens in the country. However, despite of these efforts, health problems
in the country, especially in Mindanao, are still prevalent. The following are the
health programs and its outcomes:
i. Fourmula One of the Department of Health (F1)
“Better health outcomes, a more responsive health system, and more
equitable health financing” – this has been the goal of the Fourmula One (F1),
which is in line with the Millennium Development Goals. It involves the public and
private sectors, national government agencies, civil society organizations and the
local government units in the implementation of health reforms. It has four major
components: health financing, health regulation, health service delivery and good
governance in health. According to the Philippine NGO Network Report on the
Implementation of the International Covenant on Economic, Social, and Cultural
Rights (ICESCR), even though Fourmula One has been able to incorporate the
World Health Organization’s building blocks for health care, the health status in
the country is still dismal, hence, the failure to address the health problems of the
country.
ii. Health Sector Reform Agenda (HRSA)
The HRSA was expected to address the health problems in the country by
having changes in policy and financing structure. It argues that radical reform is
needed in improving the health care delivery. HSRA “describes the policies,
public investments, and organizational changes needed to improve the way
health care is delivered, regulated, and financed in the country” (PIDS,
2011). Despite of these efforts, the country is being confronted by different health
problems.
iii. Basic Emergency Obstetric Care (BeMOC)
BeMOC aims to prevent death and disability among pregnant women and
newborn babies. It also refers to the functions that can be provided by skilled and
trained birth attendants. Nevertheless, there is still a slow progress in uplifting the
maternal and child health in the country, especially in most parts of Mindanao.
CHAPTER II Scope and Severity of the Problem
A. Assessment of Past Policy Performance
Devolution of national government services such as agriculture,
environment, cooperatives, and health services were introduced in the country’s
administrative setting through the Local Government Code of 1991 or Republic
Act 7160. It was in 1992 when the national government devolved the
management and the delivery of health services from the Department of Health
to the local government units. It aimed to widen the decision making of the local
officials in improving the efficiency and effectiveness of health services
management and to implement the primary health care strategy in response to
the local basic health needs. With the devolution of health services to the local
government units since 1992, an assessment must be made in the delivery of
basic health services and how these affect the health situation of the populace in
the country especially to those indigenous peoples in the far flung areas in
Mindanao (Grundy, J. et. al, 2003).
Despite of the efforts of the national government in implementing health
programs, the health situation of the country has even worsened. The quality and
coverage of health services has declined in some locations, particularly in rural
and remote areas. This emphasizes the failure of the government in addressing
the health problems of the country and stresses the general inadequacy of health
care service delivery, as well as the failure on the part of the health information
and education system to serve its function. Problems to access to health care
remain common in rural and far flung areas, among poor and uneducated people
and the indigenous peoples or marginalized population groups.
B. Significance of Problem Situation
Mindanao is the second largest group of islands in the country wherein it
has high prospects for agri-industrial development. However, it is being
confronted by different challenges such as armed conflict, low level of
socioeconomic development and disharmony due to diverse cultures. The
presence of frequent armed conflict and political struggles resulted to the
destabilization of peace and order situation in Mindanao affecting the delivery of
basic services in Mindanao especially the health services to marginalized groups
(NEDA, 2004). This is substantiated by the significant decrease in the Human
Development Index (HDI) in Mindanao due to the poor delivery of basic services
from the government to the people. The 2006 Human Development Index (HDI)
which showed that the majority of the lowest-ranked provinces are from
Mindanao among which are Lanao del Norte, Lanao del Sur, Maguindanao,
Basilan, Tawi-Tawi, Sulu and Sarangani (NEDA, 2010; p.7). Mindanao also
revealed a slow progress in improving maternal and child health especially those
affecting the tri-people of Mindanao.
One major factor in the failure of delivering basic health services to the Tri-
People of Mindanao especially in the far-flung areas is the lack of coordination
among service actors and stakeholders.
This study focuses on the need for efficient coordination among
government agencies, nongovernment organizations and their beneficiaries- the
Tri People of Mindanao, in consolidating efforts to alleviate the depressing state
of maternal and child health in Mindanao. This could only be realized if the
government would provide and enhance mechanisms in improving the delivery of
basic maternal and child health services to the Tri People of Mindanao, which, as
an effect, will produce healthy, able and capable members of the society.
C. Need for Analysis
Results of the 2006 Human Development Index (HDI) showed that
majority of the lowest-ranked provinces are from Mindanao. Health conditions are
still dismal despite of the previous efforts of the government. Maternal and infant
mortality rate is still high in most regions in Mindanao. This resulted from the lack
of coordination in the delivery of basic maternal and child health services, as well
as inefficient implementation of development projects of the local government.
In order to alleviate the present situation, it is necessary that both sectors,
government and nongovernment, continue to develop new perspectives about
their respective development goals, programs and projects, and their basic
needs and requirements (IIRR,LGSP, SANREM CRSP/Southeast Asia. 2000;
p.47). There is a need to have a mechanism in the delivery of culturally sensitive
and preventive basic maternal and child health services not just to the
mainstream but also including the marginalized sector. Lumad tribal chiefs and
Moro leaders need to develop a community-based mechanism for delivery of
health services, then the government and the non-government organization take
both of these inputs so they may consider in the formulation of new workable
mechanisms of coordination.
CHAPTER III Statement of the Problem
A. Definition of the Problem
Mindanao has been a home for Tri-People for centuries – such a long time
has lapsed yet still the inhabitants of this rich land have been suffering from
hunger, illiteracy, unemployment, armed conflict, corruption and unresolved
poverty. The government has been providing ample services that address to
these concerns. However, the conventional means of delivery of services to a
culturally diverse Mindanao poses a problem to its marginalized cultural
minorities.
The problem that this policy paper seeks to answer is how the government
can maximize the delivery of basic maternal and child health services to the Tri-
People of Mindanao. The issue is whether the government should adapt
mechanisms that will ensure the delivery of equal, effective and culturally
sensitive basic maternal and child health services to its stakeholders.
B. Major Stakeholders
The main problem identified is related to the lack of coordination in the
service delivery to the Tri-People of Mindanao. The location of the social problem
is in Mindanao, specifically Region X which has a culturally diverse population
having high concentrations of families who have not received adequate
healthcare related to the Millennium Development Goals 4 (Reduce Child
Mortality) and 5(Improve Maternal Health).
Specifically, the focal location is the Local Health Board, currently
composed of the local government units, and representatives of nongovernment
agencies and civic volunteer organizations which are concerned with basic
maternal and child health service distribution in the communities. The following
are the major stakeholders of the policy:
1. Tri People – Composed by the Lumads (indigenous peoples),
Mindanao Migrants and Moros (Islamized Lumads), these three groups of
inhabitants of the island of Mindanao are collectively called as Tri People.
Specifically, the target clientele of this study are the mothers and their children in
key areas that are lagging behind in terms of the Millennium Development Goals
for maternal and child health.
2. Local Government Unit (LGU) – Since the devolution of health
services by the national government to the local government, the LGUs have
been the forerunner with the legal mandate of prioritizing basic services, and
delivering the same, to their constituents. The LGU has the power to enact and
enforce laws and regulations to its constituents within its political jurisdiction and
territory through ordinances and resolutions.
3. Nongovernment Organization (NGO) – Being one of the sectors
that deliver basic maternal and child health services to the Tri People at the
grassroots level, NGOs are also considered as one of the major stakeholders.
With the implementation of their community-based programs and projects, they
are vital sources of data which would be helpful to the LGU in the delivery of
basic maternal and child health services.
C. Goals and Objectives
The goal of this policy paper is to improve the maternal and child health
situation in Region X which has unfavorable health indicators, such as infant
morbidity rate of 11.62/1,000 live births and maternal morbidity rate of
21.33/1,000 live births, by selecting the best policy alternative in addressing the
said policy issue. Specifically, the following are the objectives:
1. To enhance the delivery of basic maternal and child health services
to the Tri-People in Mindanao.
2. To empower and provide opportunities to Tri People through their
active participation in the decision-making and planning of health programs and
projects needed in their communities that shall answer their need for basic
maternal and child health services.
3. To promote culturally sensitive maternal and child health projects
and programs which shall encourage cultural minorities and other marginalized
sector to avail the maternal and child health services rendered by the LGUs.
D. Measures of Effectiveness
A criteria matrix (See Appendix 1) is used to determine the best policy
alternative. The criteria has two components: (1) Effectiveness – referring to
which the proposed policy option shall be able to practically maximize the
delivery of basic maternal and child health care services resulting to solving the
policy issue; and (2) Feasibility – pertaining to the likelihood that the policy would
be acted upon not only by the concerned government agencies, but also, by
other major stakeholders as well.
The policy options are also influenced by factors such as cultural
acceptance, priorities of local chief executives, and anticipated costs over
benefits.
E. Potential Solutions
Efforts providing solution in the lack of coordination in the delivery of basic
maternal and child health services to the Tri People of Mindanao, especially how
the government can enhance the delivery of the said services should take into
account the following: (1) the issue position and power of the stakeholders; (2)
the effectiveness and feasibility of the proposed policy alternative; and, (3) and
the improvement of health statistics such as the maternal and infant mortality
rate. The policy option is more likely to be a potential solution to the problem and
be implemented if the abovementioned factors are satisfied.
CHAPTER IV
POLICY ALTERNATIVES
A. Description of Alternatives
a. Institutionalize a coordinating mechanism among government agencies,
nongovernment organizations and tribal leaders.
Through the establishment of an office, LGUs, NGOs, and tribal leaders
of the Lumad and Moro tribes can be frequently consulted before the
implementation and in the initiation of maternal and child health-related
projects and programs. With the institutionalization, the effectiveness in
answering the specific needs of the Tri People can be ensured since maternal
and child health care is a concern not only of the mother, child and family, but
also of the entire community needing every constituent’s contribution.
b. Strengthen and improve management of Local Health Boards (LHBs)
through the expansion of its membership and functions.
Expanding the membership and broadening the functions of the LHBs
can significantly decrease the MMR and IMR by the impact of addressing the
issue in the municipal, provincial and city level of LGU in Region X.
c. Consolidate resources of LGUs to ensure the continuous implementation
and success of maternal and child health-related projects implemented by
the member-LGUs.
This policy option is an inter-LGU cooperation which intends to
consolidate resources of contiguous LGUs to undertake a common project that
is beneficial to them. It requires the assignment of a full time staff to serve as
secretariat of the arrangement and ensure workability of the cooperation. The
full-time staff can provide the requisite administrative and technical
backstopping in the implementation of the common projects by the member-
LGUs (IIRR,LGSP, SANREM CRSP/Southeast Asia. 2000; p.54).
B. Comparison of future consequences
As proposed in the first policy alternative, the institutionalization of a
coordinating mechanism among the major stakeholders can be materialized with
the establishment of a coordinating council composed of representatives from the
LGUs, different nongovernment agencies and equal representation from the
Moro and Lumad tribes through their tribal chiefs and local leaders. This
proposition will be partially feasible since there is constrained funding and a need
for technical assistance for the implementation.
In the second policy option, the proposal aims to strengthen the already
existing Local Health Boards and improve their operations. By expanding its
membership and functions to include tribal chieftains and Muslim leaders, LHBs
will encourage them to actively participate in the deliberations where they can
promote the use of traditional medicine and culturally sensitive programs and
projects that shall address the maternal and child health care needs of the Tri
People in their particular communities. This will also encourage the women in the
vulnerable groups and cultural minorities to seek medical assistance or
intervention in ensuring their healthy perinatal condition and lessen possible risks
during pregnancy. If realized, a significant decrease in the maternal morbidity
rates and infant death rates is expected making this proposition effective.
Moreover, the policy option is also feasible since it is more cost-efficient for the
government compared to establishing a new office.
Finally, similar to the first two options, this policy alternative can be
effective; however, it is partially feasible due to the priorities and commitment of
Local Chief Executives for which the possibility of cooperation and
implementation is dependent.
C. Spillovers and externalities
With the inclusion of tribal chiefs of the indigenous peoples and Moros and
equal representation of the Tri People in government activities regarding health
concerns, certain spillovers and externalities are anticipated. These are the
following: (a) Communication gap among members due to language differences,
cultural orientation and possible preconceived notions; (b) Sense of ownership
for projects and programs decided upon by the members due to consolidated
efforts; (c) Increased demands for research documentation on traditional
alternative medicine and evidence-based practice in the health sector to cater
projects and programs aside from those addressing maternal and child health
care; (d) Appreciation of the culture of Tri People, as well as the promotion of
intercultural and interreligious understanding which shall foster a peaceful
environment; (e) Increased need for culturally sensitive health care professionals;
(f) Better understanding of health programs of the government by the target
constituents or recipients of services, thus promoting positive health-seeking
behaviours among the Tri People.
D. Constraints and political feasibility
The following are the possible constraints for the implementation of the
policy alternatives:
1. Political constraints, which may include the lack of political will or
minimal prioritization given by local chief executives;
2. Tribal leaders tend to be inferior in dealing with other people especially
those of authority; hence, there is a possibility of decrease in participation.
3. The need for allocation from the LGU budget is also considered part of
the financial constraint.
On the other hand, the Prince System is used in assessing the political
feasibility of this paper. The Prince System is a method for forecasting the
chances that the policy will be implemented. It is a technique used for assessing
the relative support and opposition of various individuals, groups, and
organizations for public policy decision (12th Batch of the CIPYML Reference
Material for Academic Course on Public Policy Development and Advocacy,
2011; p.37-38).
The method will estimate the Issue Position, Power, and Priority for
each Player or Stakeholders and is computed according to the following sets of
guidelines:
1. Identify the players likely to have direct or indirect impact on the
decision.
2. Determine the issue position – whether each player supports, opposes,
or is neutral toward the decision.
3. Determine the power – how effective each player is in blocking the
decision, helping make it happen, or affecting the implementation of a
decision.
4. Determine the priority – how importance the decision is to each player.
5. Calculate the likelihood that the policy will be implemented.
Issue position is defined as the current attitude of the player toward the
policy. It is expressed as a number ranging from +5 to -5 to indicate levels of
support or opposition. A +5 is assigned if the player is firmly in favor of the issue
and is unlikely to change; a +4, +3, +2, or +1 indicates lower levels of firmness
on the player’s support. A neutral position is expressed as ½. Similarly, a -5
indicates firm opposition, while -4, -3, -2 or -1 indicate lower degrees of
opposition.
Power is defined as the degree to which the player, relative to the other
players can directly or indirectly exert influence concerning the decision on the
policy implementation. The basis of the player’s power is based on such factors
as group size, wealth, physical resources, institutional authority, prestige and
political skills. It is expressed as a number ranging from 1 to 5; With 1 being the
slightest amount of power and 5 a substantial power or the so called veto power.
Priority, on the other hand, is defined as the importance that the player
attaches to supporting or opposing the decision relative to all other decisions with
which that player is concerned. Similar to power, it is also expressed as a
number ranging from 1 to 5 (12th Batch of the CIPYML Reference Material for
Academic Course on Public Policy Development and Advocacy, 2011; p.37-38).
PLAYERS ISSUE POSITION
POWER PRIORITY CALCULATION 1
Tri People +1 0 +3 (3)
LGUs +2 +5 +3 30
NGOs +5 +3 +5 45
Calculation 1: Table Calculation 2: Sum of all the positive scores plus ½ neutral scores = 76.5 Calculation 3: Sum of all scores ignoring signs and parentheses = 78 Calculation 4: Probability of support = calculation 2 divided by calculation 3 = 0.9807 or 98.07%
Interpretation: With the probability score of 0.9807 or 99.07%, the possibility of this policy
alternative to be implemented is most likely feasible. Strong support comes from
NGOs which had Prince Score of +45. The Tri People had a Prince Score of 3,
which is the lowest score in the computation.
CHAPTER V
Policy Recommendations
A. Criteria for Recommending Alternatives
Adopted in 2005 by the Philippines along with other countries at the UN
Special General Assembly, the eight MDGs collectively aim to halve poverty by
2015. Three of the eight are specifically health related: (a) reduce child mortality
(Goal 2); (b) improve maternal health (Goal 5); (c) combat HIV/AIDS, malaria and
other diseases (Goal 6).
With this, the following recommended measures to enhance health service
delivery were put forward:
a. Get Tri People involved in the identification of projects which they can
undertake and those requiring support of government, in response to their priority
needs. Participation of Tri People through their tribal leaders who can represent
them in local development councils or local special bodies.
b. There is direct consultation with the Tri People, through an assembly, to
validate the projects identified to resolve priority problems.
c. To validate barriers and enhancers to effective delivery health care
system.
d. To generate baseline data on access, quality, practices among Tri
People on health services. (Lacuesta, 2010: 31)
B. Description of preferred Alternative
After using the criteria matrix in measuring the effectiveness and the
feasibility of the three policy alternatives (as shown in Table 2.0), Policy
Alternative Two, which is strengthening the Local Health Boards (LHBs) and
improving their management and operation through the expansion of its
membership and functions, emerged as the best policy alternative.
Taking advantage of the existence of LHBs as a starting point in improving
the coordination in the delivery of basic maternal and child health services, the
Tri People will have the equal opportunity to avail the said services. LGUs can
also provide culturally sensitive maternal and child health programs and projects
that can directly answer the needs of the Tri People.
Table 2.0 Criteria Matrix
FEASIBILITY
HIGH MEDIUM LOW
EF
FE
CT
IVE
NE
SS
HIGH LHB Convergenc
e
MEDIUM Partnership
LOW
Measuring the effectiveness and feasibility of policy alternatives
C. Outline of Implementation Strategy
a. Validation of the problem through data collation will be initially done
through collaboration with various related government and nongovernment
agencies.
b. Discuss with the Local Health Board the proposed policy and include
their position on the said policy issue in the concept brief.
c. Drafting a concept brief and advocacy plan to be presented to political
leaders and local chief executives.
d. Identify influential political leaders and local chief executives such as
LGU officials, Provincial/ Municipal Board Members, City Councilors and other
influential individuals who highly prioritize the social issue as their advocacy and
encourage to possibly sponsor the proposed policy.
e. Coordinate with the local legislative units in passing a
municipal/provincial order or city ordinance that shall broaden the functions and
expand the composition of the regular membership of the local health board.
f. Enactment and actual implementation of the municipal/provincial order
or city ordinance plans and programs.
D. Provision for Monitoring and Evaluation
a. Regular meeting – and documentation of minutes of the meeting of all
the stakeholders and project team.
b. Regular progress and accomplishment report at least once a month,
financial statement and audit report of the Local Health Board.
c. Monitoring, evaluation and assessment of the programs and projects
initiated.
d. Gathering feedback and evaluation from beneficiaries, concerned
agencies and NGOs that are part of the LHB.
E. Limitations and Unanticipated consequences
The inclusion of tribal leaders in the Local Health Board can greatly help in
the creation of culturally sensitive health projects and programs which can lessen
the negative health seeking behaviors of the beneficiaries. However, one
limitation that can hinder the said preferred policy alternative is the inferiority of
some indigenous people and excluding themselves from actively participating in
government activities.
REFERENCES Grundy, J. et.al. (2003). Overview of Devolution of Health Services in the Philippines.
International Electronic Journal. Gumafelex, E., et.al (2003). A Review of the Health Sector Reform Agenda (HSRA)
Implementation Progresss.USAID. Lacuesta, C. (2010). Health Research Agenda of Mindanao: A Zonal Report 2006-2010.
Health R&D Agenda Setting. Lagrada, P. (2008). Are Maternal and Child Care Programs Reaching the Poorest
Regions in the Philippines?.PIDS. 2000. Enhancing Participation in Local Governance: Experiences from the Philippines. International Institute of Rural Reconstruction, Philippines-Canada Local Government
Support Program and SANREM. 2010. Addressing Maternal, Neonatal and Child Health and Nutrition Needs of
Indigenous Cultural Communities / Indigenous People (ICC/IP) and other Disadvantaged Communities in Mindanao. UNFPA.
2005. Philippine Human Development Report. Human Development Network. Internet Sources:
Priela, J. (2001). Health Sector Reform Agenda in the Philippines. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11696994. Date of access: October 20,2011.
Northern Mindanao Health Status. Retrieved from http://onlinemindanao.com/ health/news/tb%20day.html. Date of access: October 18, 2011.
Departrment of Health’s Programs. Retrieved from http://dev1.doh.gov. ph/health _programs_glossary. Date of access: October 18, 2011.
APPENDIX – A
PROBLEM TREE
Lack of coordination in the delivery of basic social
services to the Tri-People in Mindanao
Overspecialization of
government agencies
Political patronage and
favoritism
Selective distribution of
services
Unequal distribution of services
Basic services of government do
not reach minority groups
especially in far-flung areas
Absence of coordinating
mechanism
APPENDIX – B
LIST OF TABLES
Table 1: Number of Barangay Health Stations
Table 2: Number of Hospitals
Table 3: Number of Main Health Center