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