Partial Accomplishment Report
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Partial Accomplishment Report Annual health Plan and Project Implementation Evaluation BIEN ELI NILLOS, MD DTTB Batch 23 Candoni, Negros Occidental
About Candoni: The Municipality of Candoni is a 4th class municipality located in the Southern region of Negros Occidental. It is a landlocked area, mountainous in terrain with most of its residents situated within what is called the Tabla Valley. It is located 130 kilometers away from Bacolod City, the gateway to the sugar island of Negros. It is located 40 kilometers away, about one hour and a half bus ride, from the Queen City of South Negros, Kabankalan City. It is an active member of the South Negros Interlocal Health Zone, formerly known as the CHICKS area. It became infamous for its being a hotbed of NPA insurgency, especially in the early 1980’s and 1990’s. Most of its economics is agricultural. It is largely IRA-dependent. When it comes to its health indicators, it is among the municipalities in Negros Occidental with a high rate of maternal mortality, infant mortality, prevalence of malnutrition and low performance in its EPI and TB Case detection rate. Among its top morbidities are infectious and communicable, with PTB among the top ten. Among its top mortalities are lifestyle-related diseases and preventable diseases, with severe bleeding secondary to all forms of trauma as among the top ten. Doctor to the Barrio I am the third DTTB deployed in Candoni, Negros Occidental. Upon my deployment, the following problems were identified as priority problems which need to be addressed within the 2 years. • • • •
Substandard Health Indicators – Maternal Mortality, Infant Mortality, FIC, M&M, etc. Inaccessibility of Health Care Services – Lack of pharmacies, facility-based deliveries, far-flung sitios Limited Human and Financial Resources – Low budget, office organization, systems Poor Health Seeking Behavior – Community participation
Based on these identified problems, projects and activities were proposed and implemented, thanks to a newly rejuvenated Local health board under the administration of first-timer Mayor Cicero Borromeo.
Annual Health Plan and Status Problem 1: Substandard Health Indicators Problem 1.a: Reduce Maternal Mortality Activity/Strategy Description
Target Outcome
Facility Upgrade
To increase FBD rate facility-based increased from deliveries 24% in 2007 to 74% in 2008 To have upgraded Delivery Room Delivery Room upgraded, with new equipments. Source of Fund is ECCD and 20% Dev. Fund
To sustain FBD and increase to at least 85% in 2009.
To have each barangay produce a resolution of support and implementation of FBD.
To sustain improvements and make persistently erring hilots more accountable.
Ordinance for Facility Based Deliveries
Training for MDR and Life-saving skills
To complement the advocacy for facility-based deliveries, facilities must be upgraded to provide quality service and encourage mothers to have their babies delivered at the Main Health Center During an assembly of hilots where the A.O. was presented, Barangay captains and hilots were made to pledge to support the facility-based deliveries program. In order to answer the increase demand for health care workers, health care workers must be trained with proper skills.
Status
9 out of 9 barangays have resolutions in support of Facility-based deliveries
Remarks
To extend upgrading facilities down to the BHS with funding from the ECCD.
Deliveries attended by skilled workers increased from 58% in 2007 to 79% in 2008. To establish a Pending Activity will be local MDR sponsored by Interlocal Health To have staff Zone and is trained on subject to partographing availability of and IV insertion trainers, however, training is already scheduled To increase rate of deliveries attended by skilled workers.
RESULT: Maternal Mortality Rate has decreased from 5.69 per 1000 in 2008 to 0 in 2008. Problem 1.b: Reduce Infant Mortality Rate
Activity/Strategy Description
Target Outcome
Intensified Immunization
Increased FIC to Increase of FIC at least 90% from 85% in 2007 to 100% in 2008.
Newborn Screening Program
Well-baby Clinics
Immunizing children from preventable diseases is one effective means of preventing occurrences of these diseases. Newborn Screening is another tool which can help in the prevention of occurrences of diseases among children and newborns To encourage mothers to have their babies checked up even if they are not complaining of any sickness. This is to ensure continuing follow-up among babies, especially their nutrition and immunization records.
To have facility accredited as Newborn Screening Facility To increase NBS rate to at least 50% To have Thursday declared as WellBaby Clinic Day. To decrease morbidities among infants.
Status
Remarks This FIC must be sustained, to include even farflung sitios which have irregular schedules of EPI.
As of February 2009, Candoni RHU is NBS accredited
To provide free NBS services to indigents, covered by ECCD fund and As of Q1 of Philhealth. 2009, NBS rate is 45% (from 7.1% in 2007) Done. New Further trainings policies in the on IMCI for new RHU now staff are require BHS scheduled in midwives to order to provide spend their them the skills to Thursday diagnose and mornings as manage diseases well-baby clinic of childhood. day.
RESULT: Infant Mortality Rate has been decreased from 26.56 per 1000 in 2007 to 21.82 per 1000 in 2008, breaking the increasing trend for the past 3 years.
Problem 1.c: Reduce Morbidities and Mortalities, particularly lifestyle-related and preventable diseases. Activity/Strategy
Description
Institutionalization Since most of Healthy Mortalities are LIfestyle CVD and lifestylerelated, it is important to inculcate a culture of increased health awareness among the public. Thus, activities such as Heart Month celebrations, weekly HATAW (3x a week) and counseling programs have been implemented Renovation of To provide Dispensary quality health care, OPD and Main health center must be renovated and equipped TB DOTS To increase accreditaiton TB Case detection rate, TB DOTS facility must be upgraded and accredited in order to be self-sustaining
Target Outcomes To have resolution of support on the implementation of Healthy Lifestyle
Status
Remarks
Done.
Although CVD is still the top leading cause of death in 2008, rate has slightly To decrease decreased. mortalities from CVD.
Proposed plans are to establish a fully functional Smoking cessation clinic and support groups for Diabetic and hypertensive patients
To have one Done. renovated Main Renovated health Center Main Health Center opened in Sept 15, 2008.
5 Identified BHS will be renovated with funds coming from the ECCD.
To have TB DOTS center PHILCAT and PHILHEALTH accredited
Case Detection rate has increased from 42% in 2007 to 62% in 2008.
Done. TB DOTS facility was accredited in December 2008 by PHILCAT and accredited by PHILHEALTH this 2009.
Problem 2: Inaccessibility of Basic Health Care Services Activity/Strategy Description
Target Outcomes Establishment of In 2007, there To have at least Botika ng was only 1 4 Botika ng Barangay functioning Barangays Botika ng situated Barangay. strategically. There were no pharmacies within the Poblacion area. RHU medicines were not enough.
Status
Remarks
Done. There are now 10 Botika ng Barangays, with 1 for every barangay. Two BnBs are located in one barangay, with one BnB managed by a local NGO.
Establishment of No laboratory Laboratory is present to provide even routine lab procedures.
Pending. Rationalization Plan in on going and the establishment of a laboratory within a Level I hospital in Candoni is being included in the PIPH.
To ensure sustainability of BnB’s, a BnB monitoring team is being assembled by the Local Health Board in order to monitor and provide technical assistance to the BnBs. Funding for a laboratory has already been approved and about 500,000 pesos have been allotted through the Dev. Fund for 2009.
To have one certified laboratory at the Main health center
Problem 3: Limited Financial and Human Resources
Activity/Strategy Description
Target Status Outcomes OPB/TB To ensure To have 3-in-1 2-in-1: with DOTS/MCP sustainability accreditation MCP pending. Accreditation of services, extra source of funds, such as Philhealth Capitation, is necessary Enrollment of In order to To have at least Done. With a Philhealth have high 15% of combined LGU indigents Capitation indigent and Fund, indigents Households Congressional are to be enrolled. enrollees, enrolled. enrolled indigents increased from 0% in 2007 to 223% in 2008. Ordinance on In order to To have User Pending. Final User’s Fee ensure that Fee Ordinance Reading has those who can enacted been afford must accomplished. also contribute Public to the Hearings are sustainability now scheduled of services, for June 2009. User’s Fee Ordinance has been proposed through the Local Health Board. Magna Carta Hazard pay has To have at least Pending. Implementation never been 5% of the Budget Office given to the Hazard Pay has yet to health workers implemented. provide source since of funds. enactment of the law
Problem 4: Poor Health Seeking Behavior
Remarks Target for MCP accreditation is late June or early July 2009.
Congressional enrollees have already been re-enrolled for 2009 and LGU has already identified and enrolled some 500 households for 2009.
Activity/Strategy Description
Remarks
Establishment of CHART (Community Health Allies and Reform Team)
Among the accomplishments of the CHART is the Alkansiyang Pampamilya Project where pregnant mothers are encouraged to save money in preparation for their deliveries and newborn screening.
Activate Local health Board; active participation in ILHZ; tap BHW federation.
Target Status Outcomes A consultative Establishment Done. assembly of CHART composed of with minutes of non-health assemblies and professionals in meetings order to make the community actively involve in the planning and implementing of various health programs. Projects and Done. minutes of meetings.
Among the successes of the Local Health Board is when it was awarded by the CHDWestern Visayas in 2008 with a Very Satisfactory Rating.
About Candoni: The Municipality of Candoni is a 4th class municipality located in the Southern region of Negros Occidental. It is a landlocked area, mountainous in terrain with most of its residents situated within what is called the Tabla Valley. It is located 130 kilometers away from Bacolod City, the gateway to the sugar island of Negros. It is located 40 kilometers away, about one hour and a half bus ride, from the Queen City of South Negros, Kabankalan City. It is an active member of the South Negros Interlocal Health Zone, formerly known as the CHICKS area. It became infamous for its being a hotbed of NPA insurgency, especially in the early 1980’s and 1990’s. Most of its economics is agricultural. It is largely IRA-dependent. When it comes to its health indicators, it is among the municipalities in Negros Occidental with a high rate of maternal mortality, infant mortality, prevalence of malnutrition and low performance in its EPI and TB Case detection rate. Among its top morbidities are infectious and communicable, with PTB among the top ten. Among its top mortalities are lifestyle-related diseases and preventable diseases, with severe bleeding secondary to all forms of trauma as among the top ten. Doctor to the Barrio I am the third DTTB deployed in Candoni, Negros Occidental. Upon my deployment, the following problems were identified as priority problems which need to be addressed within the 2 years. • • • •
Substandard Health Indicators – Maternal Mortality, Infant Mortality, FIC, M&M, etc. Inaccessibility of Health Care Services – Lack of pharmacies, facility-based deliveries, far-flung sitios Limited Human and Financial Resources – Low budget, office organization, systems Poor Health Seeking Behavior – Community participation
Based on these identified problems, projects and activities were proposed and implemented, thanks to a newly rejuvenated Local health board under the administration of first-timer Mayor Cicero Borromeo.
Annual Health Plan and Status Problem 1: Substandard Health Indicators Problem 1.a: Reduce Maternal Mortality Activity/Strategy Description
Target Outcome
Facility Upgrade
To increase FBD rate facility-based increased from deliveries 24% in 2007 to 74% in 2008 To have upgraded Delivery Room Delivery Room upgraded, with new equipments. Source of Fund is ECCD and 20% Dev. Fund
To sustain FBD and increase to at least 85% in 2009.
To have each barangay produce a resolution of support and implementation of FBD.
To sustain improvements and make persistently erring hilots more accountable.
Ordinance for Facility Based Deliveries
Training for MDR and Life-saving skills
To complement the advocacy for facility-based deliveries, facilities must be upgraded to provide quality service and encourage mothers to have their babies delivered at the Main Health Center During an assembly of hilots where the A.O. was presented, Barangay captains and hilots were made to pledge to support the facility-based deliveries program. In order to answer the increase demand for health care workers, health care workers must be trained with proper skills.
Status
9 out of 9 barangays have resolutions in support of Facility-based deliveries
Remarks
To extend upgrading facilities down to the BHS with funding from the ECCD.
Deliveries attended by skilled workers increased from 58% in 2007 to 79% in 2008. To establish a Pending Activity will be local MDR sponsored by Interlocal Health To have staff Zone and is trained on subject to partographing availability of and IV insertion trainers, however, training is already scheduled To increase rate of deliveries attended by skilled workers.
RESULT: Maternal Mortality Rate has decreased from 5.69 per 1000 in 2008 to 0 in 2008. Problem 1.b: Reduce Infant Mortality Rate
Activity/Strategy Description
Target Outcome
Intensified Immunization
Increased FIC to Increase of FIC at least 90% from 85% in 2007 to 100% in 2008.
Newborn Screening Program
Well-baby Clinics
Immunizing children from preventable diseases is one effective means of preventing occurrences of these diseases. Newborn Screening is another tool which can help in the prevention of occurrences of diseases among children and newborns To encourage mothers to have their babies checked up even if they are not complaining of any sickness. This is to ensure continuing follow-up among babies, especially their nutrition and immunization records.
To have facility accredited as Newborn Screening Facility To increase NBS rate to at least 50% To have Thursday declared as WellBaby Clinic Day. To decrease morbidities among infants.
Status
Remarks This FIC must be sustained, to include even farflung sitios which have irregular schedules of EPI.
As of February 2009, Candoni RHU is NBS accredited
To provide free NBS services to indigents, covered by ECCD fund and As of Q1 of Philhealth. 2009, NBS rate is 45% (from 7.1% in 2007) Done. New Further trainings policies in the on IMCI for new RHU now staff are require BHS scheduled in midwives to order to provide spend their them the skills to Thursday diagnose and mornings as manage diseases well-baby clinic of childhood. day.
RESULT: Infant Mortality Rate has been decreased from 26.56 per 1000 in 2007 to 21.82 per 1000 in 2008, breaking the increasing trend for the past 3 years.
Problem 1.c: Reduce Morbidities and Mortalities, particularly lifestyle-related and preventable diseases. Activity/Strategy
Description
Institutionalization Since most of Healthy Mortalities are LIfestyle CVD and lifestylerelated, it is important to inculcate a culture of increased health awareness among the public. Thus, activities such as Heart Month celebrations, weekly HATAW (3x a week) and counseling programs have been implemented Renovation of To provide Dispensary quality health care, OPD and Main health center must be renovated and equipped TB DOTS To increase accreditaiton TB Case detection rate, TB DOTS facility must be upgraded and accredited in order to be self-sustaining
Target Outcomes To have resolution of support on the implementation of Healthy Lifestyle
Status
Remarks
Done.
Although CVD is still the top leading cause of death in 2008, rate has slightly To decrease decreased. mortalities from CVD.
Proposed plans are to establish a fully functional Smoking cessation clinic and support groups for Diabetic and hypertensive patients
To have one Done. renovated Main Renovated health Center Main Health Center opened in Sept 15, 2008.
5 Identified BHS will be renovated with funds coming from the ECCD.
To have TB DOTS center PHILCAT and PHILHEALTH accredited
Case Detection rate has increased from 42% in 2007 to 62% in 2008.
Done. TB DOTS facility was accredited in December 2008 by PHILCAT and accredited by PHILHEALTH this 2009.
Problem 2: Inaccessibility of Basic Health Care Services Activity/Strategy Description
Target Outcomes Establishment of In 2007, there To have at least Botika ng was only 1 4 Botika ng Barangay functioning Barangays Botika ng situated Barangay. strategically. There were no pharmacies within the Poblacion area. RHU medicines were not enough.
Status
Remarks
Done. There are now 10 Botika ng Barangays, with 1 for every barangay. Two BnBs are located in one barangay, with one BnB managed by a local NGO.
Establishment of No laboratory Laboratory is present to provide even routine lab procedures.
Pending. Rationalization Plan in on going and the establishment of a laboratory within a Level I hospital in Candoni is being included in the PIPH.
To ensure sustainability of BnB’s, a BnB monitoring team is being assembled by the Local Health Board in order to monitor and provide technical assistance to the BnBs. Funding for a laboratory has already been approved and about 500,000 pesos have been allotted through the Dev. Fund for 2009.
To have one certified laboratory at the Main health center
Problem 3: Limited Financial and Human Resources
Activity/Strategy Description
Target Status Outcomes OPB/TB To ensure To have 3-in-1 2-in-1: with DOTS/MCP sustainability accreditation MCP pending. Accreditation of services, extra source of funds, such as Philhealth Capitation, is necessary Enrollment of In order to To have at least Done. With a Philhealth have high 15% of combined LGU indigents Capitation indigent and Fund, indigents Households Congressional are to be enrolled. enrollees, enrolled. enrolled indigents increased from 0% in 2007 to 223% in 2008. Ordinance on In order to To have User Pending. Final User’s Fee ensure that Fee Ordinance Reading has those who can enacted been afford must accomplished. also contribute Public to the Hearings are sustainability now scheduled of services, for June 2009. User’s Fee Ordinance has been proposed through the Local Health Board. Magna Carta Hazard pay has To have at least Pending. Implementation never been 5% of the Budget Office given to the Hazard Pay has yet to health workers implemented. provide source since of funds. enactment of the law
Problem 4: Poor Health Seeking Behavior
Remarks Target for MCP accreditation is late June or early July 2009.
Congressional enrollees have already been re-enrolled for 2009 and LGU has already identified and enrolled some 500 households for 2009.
Activity/Strategy Description
Remarks
Establishment of CHART (Community Health Allies and Reform Team)
Among the accomplishments of the CHART is the Alkansiyang Pampamilya Project where pregnant mothers are encouraged to save money in preparation for their deliveries and newborn screening.
Activate Local health Board; active participation in ILHZ; tap BHW federation.
Target Status Outcomes A consultative Establishment Done. assembly of CHART composed of with minutes of non-health assemblies and professionals in meetings order to make the community actively involve in the planning and implementing of various health programs. Projects and Done. minutes of meetings.
Among the successes of the Local Health Board is when it was awarded by the CHDWestern Visayas in 2008 with a Very Satisfactory Rating.
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