Accessibility-of-healthcare-among-poor-women-and-their-children-in-coastal-communities-1.docx

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Accessibility of Healthcare Among Poor Women and their Children in Coastal Communities: The Case of Paombong CHAPTER I THE PROBLEM AND ITS BACKGROUND Introduction Health, aside from education, is one of the fundamental aims of development. It is the primary idea of extensive meaning of human capabilities that indicates the true meaning of development. It is necessary to increase productivity in work and thriving education is dependent on sufficient health as well (Todaro & Smith, 2012). Respectively, a vast number of studies confirm that there is a very strong relationship between health and economic growth (Mayer, 2014). Thus, healthcare is undoubtedly essential for every people in maintaining health status and promoting human development. Access to healthcare is important especially for women for they are vulnerable and more prone to suffer from illnesses. Data reveals that maternal mortality rate remains surprisingly high. According to World Health Organization (WHO) 135 million women give birth per year, an estimated 20 million of them suffer from pregnancy related illness, and about 303,000 women die while giving birth every day. With regards to nutrition, it is said that girls aged 15-19, more than 1/3 of them are vulnerable to anemia because of poor iron diets and monthly menstruation period which leads to cognitive and physical deficiencies.

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Similarly, healthcare access is also significant for children because their physical development has an immediate effect in overall development of their future (Child encyclopedia, 2017). New bourns are specifically vulnerable to malnutrition and infectious illness. Hence, healthy growth and development of the children are unarguably, should be the basic concern of the society. According to WHO (2017) malnourished children are more likely to have weak immune system resulting to a greater chance of getting sick like pneumonia, diarrhea, and malaria or in severe cases, death. In developing countries, 10.4 million malnourished children die. Furthermore, it is said that in 2016, 5.6 million under age five suffer from death and 83 % of deaths are caused by infectious, neonatal or nutritional conditions, worldwide. In the Philippines, around 11 Filipino mothers die due to complications in childbirth every day. Around 4,500 die every year due to excessive bleeding, hypertensions disorder, infections and other complications related to obstructed labor and abortion. Additionally, infant mortality remains unchanged with 35 deaths per 1000 birth. It is also believed that a huge number of Filipino children are undernourished. Around 3.6 million 0-59 months old are underweight and 4 Million are stunted. In fact, Philippines is included among 68 countries that causes the 97% of maternal, neonatal and child health deaths globally (United Nation Children’s Fund, 2017). Health challenges among women and children indicate the deprivation of proper nutrition, water, sanitation facilities, shelter and access to healthcare. Poverty, distance and unavailability of services are factors that hinder them from seeking healthcare. Disadvantaged people like poor, women and children, rural dwellers, and indigenous groups are twice likely to be denied of proper healthcare (WHO, 2017).

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Communities in geographically isolated and disadvantaged area (GIDA) like islands and/or coastal areas, encounters a multiple challenges in establishing their health systems. In particular, lack of access and inadequacy of basic health services is one of its major challenges that often directs to health consequences that are worse than those in other impoverished areas of the Philippines (Bam, 2014). Poor coastal communities often translate into poor access to health services because of its remote location (World Wide Fund, 2012). These communities are too small and isolated to support their needs of health services that’s why residents are required to go to urban health centers to access healthcare (Wakerman et. Al, 2012). Geographical

accessibility,

availability,

affordability,

accommodation

and

acceptance are relevant conditions on measuring accessibility to health care. According to WHO (2017), 400 million people are unable to access the needed health services. Considering the importance of health among women and children, and the health challenges that still remains unsolved specifically in coastal areas, healthcare systems must be then organized, regulated properly and be able to access. That is why, this study focuses on accessibility of healthcare among poor women and their children in Paombong. The researchers choose this topic because health has a crucial and critical role in achieving economic growth and development. It is also one of indicators of poverty as to what Multidimensional Poverty Index indicates. Economic students will have a better understanding and expand their knowledge about the contribution of health to society and its perceived barriers in accessing healthcare. The barrier that will be analysed will served as an eye opener that geographical and affordability alone, are

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not enough to tell if healthcare is accessible or not. The results will be used in improving healthcare system in Paombong. Statement of the Problem The general problem of the study is: How may accessibility to health care among poor women and their children in coastal communities in Paombong, Bulacan be described? The study will seek to answer the following questions: 1. What are the existing healthcare programs of the government in the coastal communities? 2. How may accessibility to heath care among poor women and their children be measured in terms of : 2.1 geographic accessibility; 2.2 availability; 2.3 affordability 2.4 accommodation; and 2.5 acceptability? 3. What are the barriers identified in healthcare accessibility based on the experience of participants? 4. How do participants address those identified barriers relating to healthcare accessibility? 5. What are actions taken by the government to improve accessibility of healthcare among participants in the coastal communities?

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6. What measures may be proposed to improve the accessibility of healthcare in coastal communities based on the findings of the study? Significance of the Study Geographical access, availability, affordability and acceptability are relevant conditions on measuring accessibility to health care. A household may be geographically accessible to healthcare units but suffers from unavailability of doctors, expensive healthcare utilization, or continuous rejection of healthcare workers. Thus, the aforementioned indicators are crucial on telling whether a healthcare facility is accessible particularly for poor women and children. Also, families who live in coastal areas have difficulties with regards to their geographical location, for it hinders them from accessing healthcare facilities. The study will provide empirical evidence concerning the current status of healthcare access in Paombong. In addition, the study will also explain the barriers that prevent the residents in accessing health. The knowledge obtained from the study will be useful as a starting point for projects that aim to improve accessibility of healthcare. In general, the research carried significance to the following stakeholders: Department of Health (DOH) Officials.

The study will provide significant

information to the DOH Officials about the occurring interventions to healthcare access, use and cost. Additionally, it will help them to discover the major types of illness that is present on the area and what are the common causes of death in the coastal communities of Paombong. The DOH will be aware on what kinds of medicine and medical equipment are mostly needed so that they can provide it.

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Municipality of Paombong. The study will help the officials for further enhancement of their healthcare system brought by in-depth analysis on how people access healthcare. It can be used to improve the health status of Paombong. Residents of Coastal Communities. The study will help the residents of coastal areas to improve their access to healthcare because this paper can guide policy makers to refine their healthcare system which will be beneficial for the dwellers. This can also help people in coastal communities to become aware about their right to health. Management Economics Students. The study may help to expand their knowledge on development economics because the findings of the study can be used in the measurement of the barangay`s development by using Human Development Index (HDI) since health is one of the key factor and important indicator for development. Future Researchers. The study will provide empirical evidence and will serve as a reference to future researchers that have the same topic. They can also use the findings of the study to strengthen the foundation of their research. Scope and Delimitation The study focuses on the accessibility of healthcare in coastal communities in Paombong, Bulacan. Specifically, it is limited to three (3) barangays namely Masukol, Binakod and Sta. Cruz. The accessibility of healthcare will be measured in terms of: (a) geographic accessibility, (b) availability, (c) affordability, (d) acceptability; and (e) accommodation. There will be a total of one hundred twenty-eight (128) participants. The 90 poor women and children will be picked through stratified sampling approach, while the other

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28 will be chosen through purposive sampling with the criteria based on the researchers. The study will be limited to women and their children living within the three (3) barangays. Additionally, women and their children living outside the barangays are excluded in the study. Survey questionnaire, focus group discussion guide, key informant interview guide and secondary data are the instruments that will be used in the study. The study will be conducted from January to May 2018.

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CHAPTER II REVIEW OF RELATED LITERATURE This chapter presents the relevant theories, related literature and conceptual framework which researchers have pursued to shed light on the topic under study. Relevant Theories The Theory of Access was developed by Roy Penchansky and J. William Thomas in 1981. The theory defined access as the degree of fit between the patient and the healthcare system. Access has independent yet interconnected dimensions that represent distinctive measurements which are known as the 5 A’s; availability, accessibility, acceptability, affordability, and accommodation. Availability refers to sufficiency of health resources. Accessibility refers to the connection between location of patients and location of supply. Acceptability is defined as the relationship of client’s attitude to accept the service and the provider’s attitude towards the personal characteristics of the client. Affordability is the relationship of prices of goods and services, and client’s perception of value. Accommodation is where the health resources are organized to accept and meet the patients’ needs. The theory also states that access is the center of these dimensions which cannot be isolated from it. The theory will help as a foundation in measuring the accessibility of healthcare in coastal communities. The 5 A’s of access will be used to identify and to measure the existing issues encountered by poor women and their children in terms of accessing healthcare.

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Related Literature This section provides the reviews of related literature which will give a clear overview in the study Universal Health Care (UHC) Universal Health Care also known as Universal Health Coverage (UHC) is a health system from WHO constitution of 1948, stating that health is an essential human right, and from the Health for all agenda prepared by Alma Ata declaration in 1978. This means that the entire people and community receive quality health services while also assuring the affordability of health services. The given definition mirrors its three related objectives particularly equity in excellent health services that is enough to improve the health of the users and the security of people against financial risk of obtaining health services. It also includes all component of health system like health delivery system, health facilities, health personnel, information system, governance and legislation. It also encompasses population based services such as health campaign. Tracking progress toward UHC focus on two things: the portion of the population that can access the indispensable quality health services and the portion of the population that pay a huge amount of family income on health. WHO, together with the World Bank, has developed the framework to monitor the progress of UHC by tracing both categories. Moving toward UHC demands strengthening health systems and successful financing structures (WHO, 2017). In the Philippines, Universal Healthcare (UHC) also known as Kalusugang Pangkalahatan (KP) is described by Aquino administration, that healthcare services

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should be available and accessible for every Filipino. It aims to guarantee that Filipinos shall be able to afford and acquire quality health benefits. This includes supplying sufficient resources such as health facilities, health professionals and health financing. To achieve UHC in the Philippines, there are 3 goals to be pursued namely: Financial risk problem, improved access to quality hospitals and healthcare facilities and attainment of health-related Millennium Development Goals (MDGs) (DOH, 2017). Healthcare Programs and Services Primary Healthcare Service The WHO (2017) defines the primary health care as necessary healthcare provided to be universally acceptable to each people in the community. It is acceptable to them, by their full participation and in the cost that the public can afford. In addition, according to American Academy of Family Physicians (2017), Primary care includes health promotion, disease prevention, health maintenance, counselling, educating patients, diagnosis and treatment of acute and chronic illness. In Philippines primary healthcare is provided by private and government sector. The government mandated the local government code 1991 for the LGUs to be the main providers of this primary healthcare. Each municipality has the Barangay Health Centers (BHCs) and Rural Health Units (RHUs) to accommodate patients that need it. BHCs workers are Barangay Health Workers, Volunteer Community Health Workers, and Midwives while in RHU personnel are the Doctors, Nurses, Midwives, Medical Technologist, Nutritionist, Sanitary Inspectors and Volunteer Health Workers. These people are the one that deliver the primary care in the public (Romualdez et al., 2017). In rural health units available healthcare are sub centers, chest clinics, malaria eradication units, and

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Schitomiasis central units operated by DOH. Also, there are puericulture centers, tuberculosis clinics and hospitals. The Philippine Medicare operates the community hospitals and health centers that give primary healthcare (Williams & Tungpalan, 2017). Inpatient Care The inpatient care is the medical treatment that is given in a hospital or other health facility that requires overnight stay for health observations (Santiago, 2017). The patients of this care are afflicted by the illness or disease that threatens their health and requires highly technical and specialized knowledge of the facilities and personnel to treat effectively (Williams & Tungpalan, 2017). This type of care can be reimbursed to the government by the Philippine Health Insurance Corporation or PhilHealth. The Inpatient Benefits of the Philhealth includes the deduction on the member’s total bill in all case rates and it covers the professional fees of the physician prior to discharge (PhilHealth, 2017). Outpatient Care Outpatient care or sometimes called ambulatory care, is the treatment as medical care that the patients don’t need to stay overnight in the hospital or any medical facility. Outpatient care can be delivered in a medical offices, hospitals and clinics. This care involves routine service like check-ups or visiting to clinics (Santiago, 2017). PhilHealth also provides benefits for the outpatients. First is the day surgery – the surgical procedures that is major or minor operations which patients can discharge safely within the same day for post-operative care. The case rates shall be deducted in member’s total bill including the hospital and professional fee charges. Second, for those who

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undergo in Radiotheraphy, it includes the radiation treatment delivery using cobalt and Linear accelerator. Multiple sessions can be filed by one (1) form and has a 45 days benefit limit. The third one is Hemodialysis, can cover the inpatient and outpatients involving emergency dialysis procedures and has 90 days benefit limit. The last one blood transfusion, it covers outpatient blood transfusion and the Drugs & medicine, Xray, Laboratory test, operating room and others. One-day transfusion of blood regardless to number of bags is equivalent to one session and has 45 days limit (PhilHealth, 2017). Emergency Service The Emergency service is the service that is delivered to treat an immediate unscheduled medical condition (ACEP, 2016). The emergency care in the Philippines is governed by Republic Act No. 344. This is an act of penalizing the refusal of hospitals and medical clinics to administer an immediate treatment and support in emergency cases. This is an Act of prohibiting the medical facilities to require deposits or advance payments for the admission or treatment of the patients in hospitals and medical clinics in certain cases (Romualdez et al., 2017). Long-Term Care A long-term care refers to continuous medical and social service that support the needs of those persons with disability or even the elderly (McCall, 2015). The Act of 2010 granted that all senior citizens has a direct discount in all pharmaceutical expenses as well as 12% Vat exemption on pharmaceutical purchases. This benefit covers the goods and services from hospital pharmacies, medical and optical clinics.

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PhilHealth members may benefit from lifetime coverage (Romualdez et al., 2017). Social Security System (2017), also gives their senior citizen pensioners financial assistance that may help for their health expenses. Department of Social Welfare and Development (2017) also has a haven offered for the elderly and also gives social pension program for indigent senior citizens (SPISC). Furthermore, there is the national program for Persons with Disabilities’(PWDs) health by the DOH was based on the Act of providing self-reliance and rehabilitation for person with disability also known as the “magna carta for disabled person” (DOH, 2014). Mental Health Care Mental Care is a service devoted for treating mental illness, and improving the mental health of people with mental disorders or problems (Collins dictionary, 2017). The National Center for Mental Health (NCMH) is committed to deliver preventive, curative and rehabilitative mental health services. NCMH services are hospital services like general adult psychiatry, child & adolescent psychiatry, forensic psychiatry and general medicine & surgery for out-patients such as emergency psychiatry, acute crisis interventions, out-patient psychiatric interventions, and public health & domiciliary psychiatry. Last the Anicillary Service, which are the Clinical and Anatomic Laboratory, psychological services and occupational and physical therapy (NCMH Gov, 2017). Palliative Care The Palliative care is an approach that aims to improve the quality of life on both patient and the family facing the problem in connect with the life-threatening illness, through prevention and relief from suffering by means of early identification and treating

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the pain and other physical or psychological (DOH, 2015). On year 2015, DOH released an administrative order about National Policy on Palliative and Hospice Care in the Philippines. This order aims to set an overall policy to identify the roles and functions of DOH when it comes to the provision of palliative and hospice care in all Health Facilities, communities and home-based levels. This includes the primary level facilities like RHUs shall provide palliative and hospice care through community home-based care approach. Secondary and Tertiary Health Facilities such as Hospitals and Clinics shall give consultation services, Inpatient palliative care units and shall provide access to support service from health professionals. DOH and the local government units should ensure the funding, generation and mobilization of resource to sustain palliative care for the people who need it (DOH, 2015). Dental Care This Dental Care is the maintenance of Healthy teeth pertaining to oral hygiene to prevent dental disorders (Medical Dictionary, 2017). The government launch programs to reduce the commonness of dental caries. Government offers dental services such as oral prophylaxis, gum treatment, tooth restoration, cosmetic dentistry and root canal treatment. Oral surgery such as, tooth extraction, odontectomy, gingivoplasty,

alveoloplasty,

sequestrectomy,

apicoectomy,

cystectomy,

marsupialization, neuroctomy, open and close reduction and functional orthodontic which are the brackets and retainers. Through dental examination determines the the type of dental treatment required (GOVPH, 2017).

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INSTITUTION CATERING HEALTHCARE Department of Health (DOH) DOH is the Philippines' central health agency. It manages the inclusive technical authority of health. "Basically, DOH as three major roles in the health sector: (1) leadership in health; (2) enabler and capacity builder; and (3) administrator of specific health services" (p.1) It’s mandate is to formulate national plans, technical standard and rules or instructions on health. The agency is also accountable for assuring access to basic public health services to all Filipinos. Dr. Francisco Duque III, MSc is the current secretary of the department. In 2008, DOH started its program on Neonatal, and Child and Nutrition Strategy (MNCHN) and Universally Accessible Cheaper and Quality Medicines Act of 2008. This year DOH intensifies its program on access to safe drinking water (GOVPH, 2017). PHILHEALTH

Philippine Health Insurance Corporation (PhilHealth) is a government Health insurance corporation, government owned and controlled corporation of the Philippines. PhilHealth administer the National Health Insurance program that covers the Inpatient hospital care, room, board, service of health professionals, diagnostics, laboratory, and other medical services. The use of medical or surgical equipment and facilities. Also, the drugs, biomedicine and inpatient educational package. For out-patients, the diagnostic, laboratory and medical examinations, personal and preventive services, prescription of drugs and other biologicals, and the service of health professionals. The

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Corporation collects, deposits, invest, administer and disburse the National Health Insurance Fund. (Philhealth, 2017)

Commission on Population (POPCOM) Commission on Population (POPCOM) is an organization that leads population management in the Philippines. POPCOM helps Filipino couples and individuals to achieve the desired number, spacing and timing of children. They provide different kinds of program like Responsible Parenthood-Family Planning, Responsible ParenthoodReproductive

Health,

Adolescent

Health

and

Development,

Population

and

Development Integration and Gender and Development. The said programs are made to ensure that the Philippines is going to have a controlled population growth. (POPCOM, 2017) Accessibility to Healthcare Geographic Accessibility Health And Place Initiative also known as HAPI (2014) defined geographic access to healthcare as the time when patients can physically access the services in the health centers from their community. In the article of HAPI (2014), greater distances and travel times are considered barriers in using health services. Rural areas and remote island areas especially have less geographic access to healthcare services in terms of long distances and/or travel time to care and less service are available. According to Kumar, Dansereau & Murray (2014), distance and travel time are one of the barriers in access to health care in India. Places that are way too far from

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health care provider have big impact in utilization of healthcare and outcome in health. Some families in India are forced to travel longer just to have proper medication. Household, on some cases doesn’t have the means to acquire healthy life because they often lack resources for transportation and travel time takes too long. As a result, geographic access was considered as a barrier to healthcare access. According to the article, some Indian families are unable to acquire proper health service because they are far away from health facilities. Geographic access is more important than socioeconomic factors especially in rural and remote areas with scarce health services. In Solomon Island of southwestern Pacific Ocean, there are some cases of mothers who are about to give birth and experienced difficulties in terms of geographic access in rural health facilities. People who need to go to the health facilities must look for a boat first in order to transport pregnant women to the nearest health facilities and travel for about an hour. Distance and lack of transport to the nearest health center is a huge challenge for people in the community of Solomon Islands. According to one of the official in Solomon island, some mothers chose not to visit health center when they are sick even their children, as it is far and expensive to hire a boat and travel for an hour or more (World Vision,2012). In the Philippines, people who live in rural remote areas are isolated by distance, terrain and poverty from healthcare access. Lack of basic infrastructure (bridges and roads) and access to transport services makes it difficult for poor people to access health centers. There is clear indication that rural isolation is associated with poor health status. Access to health care in rural and remote island, transport infrastructure and means of transport are crucial to overcoming the decision to seek

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medical services, the travel time to reach care and the treatment within the healthcare system are all depend on access to transport. Where people are far from health centers, the decision to travel is all influenced by difficulties to access transportation (Starkey and Hine, 2014). Availability Availability is having a functional and adequate health facilities, programs, goods, and services (Gijsel, 2016). Chen, Yin, & Xie (2015) found out that one of the problems in healthcare is the unequal distributions of healthcare resources in rural and urban areas due to the fact that rural areas have a much poorer economic condition, lack of government investments, and low resident’s payment capability. According to Titus, Adebisola, and Adeniji (2014), accessibility of household to medical facilities are very low because of the inadequate and unequal distributions of public health facilities. There are also disparities between patients and health personnel because of the inadequate supply of health workers. Filipinos are also experiencing urban and rural disparities in terms of public health services. Public health services are very poor in the country whereas, there’s only one (1) hospital bed available per 1000 people and only one (1) doctor, three (3) nurses, and seven (7) mid-wives available for 100,000 people. Even though nursing has the highest amounts of graduates, the country is still experiencing shortage in public health workers due to a massive amount of export in other countries (Gijsel, 2016). Affordability

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Affordability is defined as a measure of someone’s ability to purchase a good or service. However, Penchansky and Thomas (2015), describes affordability as the relationship of prices of services and client’s insurance. It also refers to a person’s income being sufficient enough to pay for healthcare cost. There are plenty of people who are unable to obtain medical care because it is expensive (Glynn, MacKenzie & Fitzgerald, 2016). Low income is one of the factors that contribute in having poor health. Often, people who have low income or living in poverty cannot afford checkups and medications that’s why most of the time they are the ones who have illness and disease. Those people who experience an abrupt decline in health frequently become poorer after losing their job. Furthermore, people with illness often experience difficulty in accessing health care because there are only few health care providers nearby and most of the time it is expensive (Neighmond, 2015). In the Philippines, health care costs are becoming quite expensive. Many Filipinos living in poverty are wondering whether they can afford hospitalizations and medicines with their income alone. Usually, the answer is no. With the high cost of health care, they cannot afford it without the use of health insurance. A treatable illness can be a catastrophe for poor Filipinos who have low income and do not have insurance because they might be financially ruined or bankrupt. Some might think that this is an exaggeration but it is the truth because even if it is a treatable illness, costs like hospital, surgery, medicines and doctor’s fee should be taken in consideration, these costs are becoming more expensive for Filipinos to afford (Ng, 2017) Acceptability

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The factors influence acceptability of healthcare services by consumers includes need, desires, expectations, beliefs, values and levels of independence on the people around you. The cultural and religious beliefs affect the delivery and acceptance of healthcare. In some cases, gender is a barrier in accepting healthcare. In certain cultures, women are not allowed to see and be examined by the male health workers. Additionally, there is some inappropriate behaviour the health care providers some humiliate and abuse health consumers. Dr. Tello stated that most physicians are not explicitly racist yet they are under the racist system. Furthermore, poor patients are more likely to cure themselves naturally before seeing the doctors. Accepting treatment to official healthcare workers sometimes tend to be second on their choices. The satisfaction of consumers in the services bases on how they trust their provider (Tello, 2014). The cultural division exists between the patient and health professionals (Winkelman, 2009). Philippines have approximately 175 ethno linguistic groups with different cultural identity and health practices. Filipino culture is a mixture of indigenous as well as imported and borrowed element this case affects the acceptability of the Filipinos when it comes to healthcare. Filipinos tend to cure themselves first through their traditional or cultural beliefs. As they continue to follow their beliefs relying through natural and traditional way of curing them these prohibits them in consulting the physicians. These presumptions sometimes tend to cause more diseases. For example the namamaligno or Sumpa supernatural belief of Filipino in urban areas they more likely consult albularyo first than a physician the medication that the albularyo may give can cause another illness for the patient. This case can be prevented if only this people

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are advised to consult physicians than relying to traditional treatment (Abad et al., 2014). Accommodation Saurman (2015) mentioned in his article that accommodation involves a sufficient service is well organized to receive clients and clients are able to use the service. This include hours of operation, appointment system, waiting hours and the like. In the Philippines, long lines and overcrowding are the challenges encounter which is very evident at the six city run hospitals in Manila. The hospitals are limited to accommodate enormous number of patients that is why Mayor Manila Joseph Estrada increases the budget allocation to refine its Community- Health Centers (CHC) (Alcantara, 2015).

Healthcare Status and Challenges of Coastal Communities In the case of coastal area in Australia, women who live in coastal remote locations experienced difficulties in getting antenatal health care due to their distance from the health facilities, cost of the healthcare and scare supply of services and equipment. In some cases, women who are required to give birth or to consult doctors in health facilities are forced to travel away from their community, lead to additional cost of care, and separated temporarily from family especially to other children. Reported neonatal death, wherein a baby dies on 28 th to 30th day after birth, are high among women who live in rural areas and fetal death, the death of a fetus during pregnancy, are much higher in coastal community of Australia. Women tend to suffer more because

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healthcare is not close to their homes which makes difficult for them to access (Department of Health Australia, 2014). In the Philippines, according to Turnek (2017), poor families located at remote coastal and rural areas have limited access to healthcare due to availability, distance and involved cost. One of the leading causes of disease among Filipino women is because of maternal health related issues. Additionally, according to Visconti (2013),on some part in the island of Samar in Visayas, is often described as in dire situation because of insufficient services, few doctors and nurses and have become a serious problem particularly for poor women due to the existing issues in maternal health. Women that reside in coastal areas in some part of Samar Island suffer from difficulties in accessing healthcare. UNICEF (2015) conducted a report in the case of Philippines specifically in Barangay Matarinao, Eastern Samar, a poor coastal village. Due to the difficulties in accessing the healthcare facilities, midwives and doctors are the ones who travel for hours, three times per week from Rural Health Unit in Salcedo in order to reach Brgy. Matarinao because women and their children in the barangay cannot afford to do so. Barangay Matarinao has reported cases of high number of malnutrition, diarrhea and other preventable cases in children. Due to insufficient health facilities and health personnel in the community of Matarinao village, children’s diseases are more likely to remain untreated. Related Studies

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A study made by Dill (2011) entitled Healthcare Seeking Behaviour, Barriers in Accessing Medicines and Coping Strategies in Africa: Evidence from Koboko District focus on identifying where do households seek healthcare, challenges in accessing healthcare and coping strategies of acute illness costs. The study used interview, focus group discussion and survey questionnaires as the method to gather data and conduct the study. The study limits the study on acute illness costs, excluding the chronic diseases. It concluded that most household in Koboko District, even richer households, seek healthcare from public sector. Regarding barriers in accessing medicines the study found out that unavailability of drugs and high prices are the challenges that households encounter, while geographical access and quality of medicines were not a severe problem. A large number of households sell assets or even their food for consumption, to cope with acute illness costs. The author made a great examination of the data through quality and quantitative techniques that resulted to a more comprehensive finding. The author also made sure that all details in their study are well defined. On the contrary, the authors provide a limited information about the accessibility of medicines because the instrument used particularly the

questionnaires did not include about accommodation

and/or

acceptability which is included in her parameter. The above study is similar to the current study in terms of the method it used in order to collect data which is interview, focus group discussion, and survey questionnaires. Both study also focus on coping strategy and accessibility. It was then different in terms of setting and respondents. The relevance of his research is that it

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provides basis on accessibility and barriers obtaining healthcare that can be help the present study being taken up. The study of Sulemana and Dinye (2014) entitled Access to Healthcare in Rural Communities in Ghana: A study of Some Selected Communities in PRU District focused on evaluation of the healthcare access of the poor, the problems encountered, coping strategies and suggestions to assess such problems. The researchers performed case study as the method and technique to gather the data from PRU District. The data were collected from the sampling size of 200 in selected seven rural community households. Qualitative and quantitative data were also collected from focus group discussion and key informant interviews for chiefs, assemblymen, teachers and youth for additional information. The study revealed that people in rural communities experienced difficulty on physical healthcare accessibility in terms of health facilities and also financial cost. This includes unavailable health facilities, health equipment and health personnel, poor system in transportation, long travel distance and lack of financial means. The study concludes factors hindering access to health facilities and services in Ghanaian context are numerous especially in rural communities ranging to physical access problem, financial problem and technological problem. The author of the study made a good evaluation of the information through different strategies that came about to a more comprehensive finding. The study analyzed the factors affecting the healthcare accessibility based from the result of data collection and provides a clear assessment on the relationship to each other. However, the researcher didn’t explain further the travel distance or geographic accessibility which the author included as factors accounting to healthcare access.

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The above study was similar to the study undertaken currently by the researchers for it both focused on assessment of accessibility of healthcare especially for the poor, challenges encountered and coping strategy of the respondents and for techniques to be used. It was then different to the current study in terms of the setting because researchers will emphasize on coastal area while the authors used rural setting and other factors such as acceptability, accommodation are not present in the study conducted by researchers of Ghana. The study made by Garcia-Subirats, Vargas, Mogollón-Pérez, De Paepe, Ferreira da Silva, Unger & Vázquez (2014) entitled Barriers in access to healthcare in countries with different health systems: A cross-sectional study in municipalities of central Colombia and north-eastern Brazil focus the comparison of factors that influence the access of health care in two countries with different health systems. The study used survey research to gather data by means of a population survey questionnaire conducted in central Colombia and north-eastern Brazil. A univariate analysis was used to describe the distribution of outcome and bivariate analysis to compare the results between two countries. The study limits its respondents to the people residing in the study area, people who had at least one health problem or had visited a health facility three month prior to the survey. The study found out that there is a notable difference in the barriers in accessing health care between two countries. In Colombia, the barriers encountered were geographical and economic barriers and the need for authorization from insurers. Whereas in Brazil, the limited availability of health centers, doctors and medicines are the greatest barrier which leads to longer waiting time.

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The researchers made a well-founded study by using two countries as the setting and comparing them. The use of quantitative method allows the study to be remade in different areas or over time with the production of comparable findings. However, the researchers did not elaborate the meaning of health care and the different kinds of health care system. This study is similar to the current study in terms of using two or more setting and the analyzation regarding the barriers that prevent the residents of central Colombia and north-eastern Brazil in accessing health care. The study differs in terms of the respondents and study area. The study is relevant because it serves as a basis and reference to the current study. The study made by Yamashita, Suplido, Ladines-Llave, Tanaka, Senba & Matsuo (2014) entitled A Cross-Sectional Analytic Study of Postpartum Health Care Service Utilization in the Philippines focus on analyzing the current state of postpartum health care service use in the Philippines and the challenges experienced while accessing postpartum care. The study used survey research by the use of questionnaire and knowledge test to gather data, and they analyzed it by using SPSS Statistics. They limit the study to women who received postpartum checkups in Philippine General Hospital (PGH) and women who participated in the postpartum health education seminar conducted in Muntinlupa City Hall. The study found out that women who delivered their child at home had a lower rate of postpartum health care service use than those who delivered at medical facilities. The barangay health workers may educate postpartum women regarding the health care service utilization so that they can improve their knowledge on the utilization of health care services.

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The researchers made a great effort in meticulously choosing their respondents by including only those women who received postpartum checkups in Philippine General Hospital (PGH) and women who participated in the postpartum health education seminar conducted in Muntinlupa City Hall. However, they did not precisely discuss the meaning of postpartum care and what services are included in postpartum care. This study is similar to the current study in terms of using women as the respondent and the country used which is Philippines. The difference is that the study is concentrated in postpartum care and not health care as a whole. The study is relevant because it will serve as a basis and reference to the current study. The study conducted by Kosai et al. (2015) entitled Incidence and Risk Factors of Childhood Pneumonia-Like Episodes in Biliran Island, Philippines – A Community-Based Study focuses on determining the caregivers’ healthcare-seeking behavior, incidence and mortality rates of pneumonia-like episodes, as well as the risk factors associated with the occurrence of pneumonia-like episodes. The respondents of the study were picked using cluster sampling and systematic random sampling. They used a semi-structured questionnaire and retrospective survey by interview to gather data and to conduct the study. According to the findings, low socioeconomic status (SES), a history of asthma, the age of the child, a preterm birth, and travel time to the healthcare facilities are the risk factors that affects the occurrence of pneumonia-like episodes. During severe pneumonia-like episodes only 44% of children sought care in health facilities, due to the fact that children with long travel time going to the hospital

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were less likely to receive healthcare. Therefore, travel time is the most important factor in healthcare-seeking behavior including SES. The author had properly gathered and explained the relationship of risk factors to pneumonia-like episodes, and the association between these factors and healthcareseeking behavior of the caregivers. However, a further study is still needed as to why children living in far places don’t go to hospitals often. The study is relevant in our research since we want to find out what factors affect the children on seeking care in health facilities. However, their study focuses on the healthcare-seeking behavior while our study focuses on the accessibility of healthcare. The location in our study are the ones located in remote areas while their study excluded isolated areas.

Definition of Terms Accessibility. According to Research and Development (RAND, 2017) access to healthcare refers to the ease of an individual to attain essential medical services. While in this study, accessibility pertains to geographical accessibility, financial affordability of health service, availability of health personnel, equipment and resources, cultural acceptability, and accommodation of the organization.

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Geographical Accessibility. In this study the researchers used the term geographical accessibility as the relationship of healthcare units and clients. It includes travel time, distance, and transportation cost to reach the healthcare units. Availability. The researchers described availability as the relationship of health resources supply to demand of the patients. Affordability. According to Saurman (2015) affordability pertains to the price of health services, insurance to the user’s ability to pay and/or income. Acceptability. According to Penchansky and Thomas (1981) acceptability is the attitude of providers and clients concerning the characteristics of the services provided. In this study, the researchers describe acceptability as the attitude of healthcare providers to accept the clients regardless of their status in life. Accommodation. According to Penchansky & Thomas (1981) accommodation is the manner of the organization to accept patients. It includes patient’s waiting time and hours of operation. Coastal Area. According to FAO (2017) it is the place or area at which land and sea interface. In this study, coastal areas meant the same. It also refers to the 3 barangays namely Binakod, Masukol, and Sta. Cruz. Healthcare. According to Triotree (2016) it is a systematic way of medical care that involves the maintenance of the whole body. In this study, healthcare meant the same and it is the healthcare provided by the Municipality of Paombong.

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Poor women. Are those who lack access to economic resources, education and health. Poor women are paid less than men as where gender inequality at work exists. Also, women have minimal participation in the decision making in the family (UN Women, 2017).