RHU Exit Report:

ALFONSO

BLOCK V
UPCM Class 2020
1
HEALTH SYSTEMS
ANALYSIS
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MATAGBAK II

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MATAGBAK II

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MATAGBAK II

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Summary of Health System Analysis

▰ Kaytitinga I
▻ In the setting of Kaytitinga I, we are presented with a barangay which mostly
resemble other rural barangays in terms of the health building blocks wherein we
have a good health team with capable and reliable leadership and governance
with an outdated health information systems implementation, inadequate
number coming from the health workforce, and constraints when it comes to
health financing which limits the community’s access to essential medicines
and technology as well as impede on the health services delivery. Not much can
be done in the intern’s level to address the identified problems, although small
incremental goals can be made to enable the health system to function to its
fullest capacity

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Summary of Health System Analysis

▰ MANGAS II
▻ Governance has poor to moderately efficient effect on
Health Workforce and Health Financing because of their
ambivalence towards health.
▻ Insufficient support for the Health Workforce results to
no new workforce added and trained in the barangay.
▻ Moderately insufficient Health financing can be seen
when they do not prioritize health in their budget but
sometimes provides out of pocket financing if necessary.
▻ They also have moderate support for Service Delivery -
they participate in the projects, they lend transportation

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Summary of Health System Analysis

▰ MANGAS II
▻ Health Workforce has moderate to good effect on
Service Delivery
▻ They also have moderate efficiency when it comes to
their Information System
▻ Organized data keeping even if pen-paper
▻ Masterlist of records
▻ Inefficient use of Medications and Technology
▻ Still Intern dependent
▻ Good relationship with Governance

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Summary of Health System Analysis

▰ MANGAS II
▻ Health financing, it has a poor effect on service delivery
and health workforce
▻ The current financing also has a poor effect on Access
to Medications and Technology as well as Informations
Systems
▻ Service Delivery, Access to Medication and
Technology → poor service delivery and poor access to
medications and technology; the Community health
needs are not being met adequately
▻ This reflects to the Governance → do not prioritize
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supporting their health team.
Summary of Health System Analysis

▰ Luksuhin Ilaya
▻ Leadership and Governance values the Health Committe,
but only provides support in terms of petty cash
▻ Poor Healthworkforce, 1BHW:33household
▻ Insufficient opportunities for knowledge and skills
development
▻ Only 3 BHW capable BP measurement
▻ NO midwife, NDP only 3 x a week
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Summary of Health System Analysis

▰ Luksuhin Ilaya
▻ Health information systems
▻ Pen and paper
▻ Masterlist is outdated incomplete and unusable
▻ Always lose charts
▻ Suggest to shift to electronic
▻ Financial
▻ 1% of IRA, very low
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Summary of Health System Analysis

▰ Luksuhin Ilaya
▻ Service delivery
▻ No follow ups
▻ Low screening rate
▻ Underdiagnosis in DM
▻ Medical supplies and Technology
▻ Always lacking CBG strips
▻ No stored medications in Health center
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“ <Summary slide>

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2
CENSUS
Alfonso Clusters 2-6 + RHU

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Cluster 4: Sex Distribution

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Clusters 2-6: Sex Distribution

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Cluster 4 : Age Distribution

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Clusters 2-6: Age Distribution

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Cluster 4: Organ System Distribution

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Cluster 4: Organ System Distribution

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Cluster 4: Organ System Distribution

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3
COMMUNITY
INTERVENTIONS
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CLUSTER 4

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OUTCOMES CHAIN
 Matagbak II

• With the end-goal of achieving a 25% increase in the proportion of

Hypertensives and Diabetics with Controlled disease, the PhilPEN strategy has
been implemented which requires the risk assessment, screening,
stratification, and management of NCDs particularly Hypertension and
Diabetes Mellitus
• Based on the outcomes chain analysis, our focus are Health Literacy, Health
Information Dissemination, Implications on follow-up.

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 Matagbak II

• Objective 1: After the 6 weeks rotation, the Matagbak II BHW’s and NDP,
along with the medical interns would be able to at least give one possible
strategy to increase the screening and follow-up rate of individuals at risk for
NCD’s.

• Objective 2: After the 6 weeks rotation, the Matagbak II BHW’s would be able
to provide basic health education regarding NCD’s (mainly hypertension and
diabetes) including complications and basic lifestyle modifications.

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 Matagbak II

• Objective 3: After the 6 weeks rotation, the Matagbak II BHW’s, NDP, along
with the interns, would be able to design and produce a culturally-sensitive
communication tool as a supplement to their house-to-house health
education.

• Objective 4: After the 6 weeks rotation, the Matagbak II BHW’s and NDP
would be able to briefly discuss the contents of the designed and
formulated communication tool in the context of patient education and
counseling.

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Matagbak II

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Matagbak II

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Matagbak II

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Matagbak II

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Matagbak II

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CLUSTER

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 Kaytitinga I

• In line with the end-goal of achieving a 25% increase in the proportion of

Hypertensives and Diabetics with Controlled disease, the PhilPEN strategy has
been implemented which requires the risk assessment, screening,
stratification, and management of NCDs particularly Hypertension and
Diabetes Mellitus
• Based on the current problems faced with the implementation, the CHDP
interns focused on capacity building for the BHWs of Kaytitinga I aiming to
address the inadequate number of BHWs capable in measuring and
interpreting capillary blood glucose levels

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 Kaytitinga I
Objective Activities Human Material Evaluation
Resources Resources
At the end of the CBG Measurement Medical Interns ● Laptop Return demonstration
6-week Community Training Session with BHW ● Markers of acquired skills to be
Medicine Rotation of Return Demonstration ● Manila Paper evaluated using a
Block V Interns, at ● Glucometer checklist on the proper
● CBG strips
least 4 of the 7 BHWs steps in using a
● Alcohol
will be able to perform ● Cotton swabs Glucometer
proper measurement ● Micropore tape
of capillary blood ● Faucet
glucose among adult ● Disinfectant soap
patients in barangay
Kaytitinga I using their
barangay-provided
Glucometer.
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CLUSTER 5

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OUTCOMES CHAIN

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 Strengths Weaknesses
SWOT-TOWS MATRIX 1.Basic medical supplies and equipment are available. 1.Less than 1% of the annual budget is allocated for health
2.Most of the BHWs are equipped with knowledge 2.Lack of some necessary supplies for PhilPEN screening (e.g. CBG
regarding VS assessment and diseases (HPN and DM) strips)
3.BHWs are very active regarding PhilPEN screening 3.Undermanned BHWs, ratio of BHWs to households is still low
4.Organized charts with numerical coding 4.Patient’s charts are prone to getting lost
5.BHWs are very active and enthusiastic about their 5.Limited availability of Midwife
work 6.No trained pharmacy assistant
6.Existing programs to promote healthy lifestyle 7.Poor information dissemination about health programs
(Weekly Zumba) (e.g. Zumba, Health Club Day)

Opportunities Future Internal Fix-it

1.Good relationship of BHWs with their 1.Utilize the established knowledge of the BHWs during 1.More budget allocation for supplies and programs for health
respective assigned purok health clubs by teaching patients on the importance of 2.Suggest electronic health record system
2.Some medications unavailable in the proper and regular monitoring of VS 3.Efficient communication between BHWs and Brgy.
BHS are available at RHU 2.Establish a fixed date for monthly health clubs (e.g. Every Officials about program implementation and equipment
3.BHC is accessible since it is located 1st Wednesday of the month) acquisition
along the main highway 3.Make a list of available medications in BHS and RHU for 4.Strategy formation on proper information dissemination
a more efficient referral of where to get medications for target population of existing health programs

Threats External Fix-it Survival

1.Termination of the AMIGA- UP-CHDP 1.Interactive workshop sessions to refresh competencies 1.Suggest recruitment of new BHWs in the community
partnership on VS assessment 2.Strategy implementation on proper information
2.Newly appointed MHO who is not that 2.Encourage open communication between BHWs and dissemination for target population of existing health
oriented wit the UP-AMIGA partnership kagawad for health regarding the needs of the BHS programs
as compared to the previous MHO 3.Team bonding to strengthen the relationship between the workforce
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for health in the barangay
PROBLEM

What is the best strategy that our barangay health

team can use for information dissemination in our
community?

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FOCUSED OBJECTIVE

MAIN OBJECTIVE:
By the end of the 6-weeks rotation, the BHWs, with the help of the Medical
Interns, must be able to formulate and implement a strategy in proper
information dissemination for the barangay’s current health programs
JOURNAL UTILIZED

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FOCUSED OBJECTIVE

SPECIFIC OBJECTIVES:
▰ To profile PhilPEN screened patients
▰ To perform customer orientation to determined the most effective
channel for health information and health project dissemination in the
barangay among a select population of profiled patients screened for
PhilPEN
▰ To be able to formulate a strategy for health information dissemination in
the barangay
 ACTION PLAN

ACTIVITIES HUMAN MATERIAL TIME EVALUATION

RESOURCES RESOURCES FRAME

◇ CHDP ◇ All
Profiling of 2 days Profile of the
interns patient
PhilPEN screened patients at
◇ President records and
screened Brgy. Mangas II
of BHWs PhilPEN
patients
logbook
◇ Pen
◇ Paper
◇ Laptop
LUKSUHIN ILAYA UNIQUE OBJECTIVE

At the end of 6 weeks, 6 out of 11

Barangay Health Workers can correctly
stratify 90% of the residents they have
screened for PhilPEN during the month of
August.

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Outcomes Chain

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4
PHILPEN UPDATES
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PhilPEN : Luksuhin Ilaya

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PhilPEN : Luksuhin Ilaya

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PhilPEN : Luksuhin Ilaya

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PhilPEN : Luksuhin Ilaya

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Cluster 4: PhilPEN

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Cluster 4: PhilPEN

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 ACTION PLAN
ACTIVITIES HUMAN MATERIAL TIME EVALUATION
RESOURCES RESOURCES FRAME

Focused group ◇CHDP ◇Pen 2 days List of possible

discussion with BHWs interns ◇Paper locations,
and PhilPEN ◇BHWs ◇Laptop channels, and
screened patients to ◇Kagawad medium for
identify the most for Health information
effective channels for ◇Midwife dissemination
information ◇Brgy.
dissemination Council
◇Patients
FOCUSED GROUP DISCUSSION

◇Print media: most effective medium

for information dissemination
◇Content: schedule, misconceptions,
health benefits of Zumba, fixed date of
monthly health club
◇Locations: sari-sari stores, barangay
outpost, church, health center
◇Funding: Barangay Councilor willing
to shoulder funds
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 ACTION PLAN

ACTIVITIES HUMAN MATERIAL TIME EVALUATION

RESOURCES RESOURCES FRAME

◇CHDP ◇ Pen ◇ Formulated

Workshop on 1 day
interns ◇ objectives
development
◇ BHWs Paper ◇ Draft of the content
of a strategy
◇ Midwife of the publicity materials
for information
◇ Kagawad ◇ Timetable of the
dissemination
for health production and
distribution of the
publicity materials
DRAFT OF PUBLICITY MATERIAL

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RECOMMENDATIONS

▰ Establish a fixed schedule of Health club every month

▰ Conduct re-assessment and training of BHWs for basic VS assessment
▰ Develop a system of dispensing medications in BHS
▰ More active PhilPEN screening; make it a goal to screen a majority of the
eligible population for screening in the community
▰ Find avenues to subsidize necessary equipment (e.g. CBG strips)
▰ Recruit more BHWs to improve BHW to household ratio
▰ Facilitate execution of the production and placement of publicity materials
▰ Monitor the attendance of the weekly Zumba and monthly health clubs
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INSIGHTS
▰ Health is a basic human right – not all are aware of this right
▰ We are citizens first, physicians second.
▰ Not everyone is as privileged as we are à be empathic towards your
patients
▰ As physicians, we are generalists first no matter what specialty we
choose to pursue

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INSIGHTS
▰ Improvement requires efforts from all stakeholders
▰ The government have the responsibility but the people also need to
participate
▰ Health is multi-factorial and is affected by cultural, political and
socioeconomic factors
▰ Inequality is never acceptable

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CLUSTER 6

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 Implementation of PhilPEN by DOH & RHU
OUTCOMES CHAIN Incomplete
Capacity building of BHWs on competencies of PhilPEN screening /
Generated screening data
incomplete
generated data
Stratification/ categorization of screened patients

Identification of Identification of Identification of

HTN & DM patients patients at risk patients without
& their control status of HTN & DM risk of HTN & DM

Targeted interventions for patients

based on risk & control status

Alternative community
Regular monitoring Dispensed
activities for lifestyle
of patients medications
modification conducted

Improved health outcomes

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 STRENGTHS WEAKNESSES
SWOT-TOWS MATRIX 1. Organization of BHWs, such that they are 1. Limited understanding of PhilPEN forms
assigned to specific puroks, allowing them to
2. Incomplete filling-up of PhilPEN forms due to lack of supplies
be familiar with their “constituents”.
(CBG strips) and data (laboratory results of patients)
2. Voluntary work & willingness to learn by BHWs
3. No formal training on use of PhilPEN forms
3. Supportive barangay officials and good
4. Heavy reliance of BHWs on NDP, midwife, or interns
relationship with the BHWs since most were
5. Manual recording of data into workbooks and logbooks
personally tapped and handpicked by them.
6. No second copy of the recorded data
4. Unified patient records used by BHS & RHU
7. Heavy workload of the BHWs
5. Presence of a masterlist of screened patients

OPPORTUNITIES S-O (Future Quadrant) W-O (Internal Fix-its)

1. Newly deployed nurse (via NDP program) ● [S5, O5] Allow BHWs access to the computer ● [W1, W4, O1, O2] Retraining / reorientation on PhilPEN on a
2. Change of leadership (new MHO and possibly for the creation of an electronic database barangay- and/or municipality-level spearheaded by the NDP/
some RHU staff) and system using the hardcopy masterlist, which can be new MHO respectively
3. Deployment of interns to area updated monthly. ● [W1, O3] Determine the perception of
● [S5, O4] Conduct a best practices session
4. Planned BHW summit, which will gather all BHWs on the PhilPEN program/form
among BHWs of various barangays regarding
the BHWs of various barangays
data management ● [W4, O2, O4] Identify and incentivize high-performing BHWs
5. Presence of a computer at barangay hall
who can be tapped and trained to help oversee PhilPEN
implementation

THREATS S-T (External Fix-its) W-T (Survival Quadrant)

1. Low barangay budget allocation for health ● [S1, S2, T1] Explore alternative ● [W2, W5, T1] Re-allocate a bigger percentage of the barangay
2. DOH Nurse/midwife deployment not constant income-generating efforts, with the help of the budget to purchase supplies (e.g, xerox of PhilPEN forms) or
3. UP-AMIGA partnership already in barangay council and community equipment (e.g, laptop or tablet) and to subsidize laboratory
disengagement phase testing for constituents
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PROBLEM

What are the perceptions of Barangay Taywanak

Ibaba health workers on the PhilPEN program and
screening tool?

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FOCUSED OBJECTIVE

MAIN OBJECTIVE:
By the end of four weeks, the medical intern should be able to determine
perception and experience of the barangay health workers and nurse with
regard to the PhilPEN program and screening tool, using the following
parameters:
▰ Simplicity (ease of understanding)
▰ Relevance
▰ Ease of use
▰ Effectiveness
▰ Suitability of use by BHW
FOCUSED OBJECTIVE

SPECIFIC OBJECTIVES:
▰ To create a tool that can qualitatively and quantitatively assess the
perception of participants on PhilPEN
▰ To explore in-depth and clarify observed discrepancies and to promote
discussion on perceptions that arose from the interview/ survey through a
focused group discussion.
 ACTION PLAN
Specific Persons
Activity Resources Time/ Venue Evaluation
Objective needed

Properly accomplished
To create a tool Crafting of August 12-13 survey form/ interview
Computer Medical interns,
that can survey/ interview questionnaire
Journals consultant
qualitatively and questions PGH
quantitatively Feedback from consultant
assess the
perception of Aug 14-15 and 22,
participants on Barangay health Feedback from the
PhilPEN Interview and Pen workers, nurse participants
10-15 mins per person
survey proper Survey form (NDP), medical
interns Survey & interview results
BHS T. Ibaba
 ACTION PLAN
Specific
Activity Resources Persons needed Time/ Venue Evaluation
Objective
To explore in-depth Focused group PhilPEN form, Barangay health Aug 29, 30 mins Open forum
and clarify observed discussion survey results workers, nurse (NDP),
discrepancies and to medical interns BHS T. Ibaba Feedback from the
promote discussion on participants
perceptions that arose
from the interview/
survey
QUANTITATIVE Qs

Simplicity (to learn/

understand how to use
the screening form)

Ease of use (to use

screening form)

Relevance

Effectiveness

Suitability of use
by BHW

Sample Survey Form 76

QUALITATIVE Qs

Sample Survey Form 77

IMPLEMENTATION: Results
DEMOGRAPHIC PROFILE
▰ Respondents:
▻ 9 BHWs (out of 11, 1 on sick leave)
▻ 1 former BHW
▻ 1 nurse (NDP)
▰ Age Range:
▻ 38 to 86 yrs old
▰ Years in service
▻ 1 yr 8 months - 36 years
▰ # of forms accomplished per month
▻ 3 to 20
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IMPLEMENTATION: Results
QUANTITATIVE DATA
MEAN MODE
Simplicity 4.5 5
Ease of Use 4.2 4
Relevance 4.7 5
Effectiveness (HTN) 4.8 5
Effectiveness (DM) 3.5 2, 4, 5
Suitability 4.4 5
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IMPLEMENTATION: Results
QUALITATIVE DATA (Themes)
▰ Goal/relevance:
▻ To identify and treat HTN/DM patients
▻ To prevent sudden deaths
▻ To help and get to know community
▰ Requirement
▻ Out-of-necessity: “walang ibang gagawa”, “inatasan kami”
▻ Rewards-punishment: “may dagdag budget”, “mapapagalitan kami”

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IMPLEMENTATION: Results
QUALITATIVE DATA (Themes)
▰ Mismatch of skills/knowledge
▻ Too technical
▻ “Hindi naman namin alam ang ilan diyan”
▻ No formal orientation (dependent on interns/nurses)
▻ “Madali basta’t maturuan”
▻ Physical limitations
▻ “Hindi na madaling makabasa at makasulat”

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IMPLEMENTATION: Results
QUALITATIVE DATA
▰ Gaps
▻ Lack of CBG strips for DM monitoring
▻ Lack of laboratory results to accomplish forms
▻ Passive screening doesn’t capture working population
▻ Flow of screening to diagnosis and treatment disrupted
▻ No proper filing/data management

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IMPLEMENTATION: Results
▰ Quantitative data showed generally high scores
▰ Qualitative data revealed several issues/gaps needed to be addressed
▰ Observed discrepancy between quantitative and qualitative data

▰ Strategy to clarify discrepancies: more in-depth focused group

discussion

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 Participant Position

IMPLEMENTATION: Results Anna Beatrice Tan Medical intern

Joanne Jennifer Tan Medical intern

Melisa Telo NDP

Focused Group Discussion Participants
Marilou Mojica Barangay health worker
▰ 2 medical interns (facilitators)
Joelita Herrera Barangay Health Worker
▰ 1 NDP, 9/11 BHWs (1 on sick leave)
Monica Olarve Barangay Health Worker (president)

Zenaida Digma Barangay Health Worker

Nenita Payad Barangay Health Worker

Celia Rodrigo Barangay Health Worker

Ederlina Gamboa Barangay Health Worker

Anabele De Castro Barangay Health Worker

Ligaya Patropio Barangay Health Worker 84

IMPLEMENTATION: Results
▰ Issues raised in the FGD
▻ On simplicity and ease of use
▻ All BHWs agreed on the form having some technical terms
(particularly polyphagia, polydipsia, polyuria)
▻ “The CBG part is difficult”
▻ Difficulty remembering/computing for the BMI
▻ Some do not understand waist circumference is taken
▻ Parts are skipped

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IMPLEMENTATION: Results
▰ Issues raised in the FGD
▻ On effectiveness
▻ Effective in screening but not in following-up
▻ They find it hard to track all the patients already screened
▻ Many mentioned some patients do not even take the
medications and show up at the health center

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IMPLEMENTATION: Results
▰ Issues raised in the FGD
▻ On suitability
▻ When asked whether PhilPEN is suitable or appropriate to
BWHs in terms of skill, they mentioned that they needed
more training
▻ No official training at municipal level, only by initiatives of
nurses and interns

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IMPLEMENTATION: Results
▰ Issues raised in the FGD
▻ On general understanding
▻ Most only mentioned the PhilPEN is for screening
▻ Some mentioned about BP and CBG monitoring but all were
not aware nor trained to record and monitor control status
▻ Discontinuous screening process

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IMPLEMENTATION: Results
▰ Issues raised in the FGD
▻ Other issues
▻ When to administer clonidine in cases of “high BP”
▻ Need to photocopy own forms
▻ Still a lot of people to screen

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RECOMMENDATIONS
▰ Training needs assessment on the PhilPEN program and training proper for
BHWs in T. Ibaba
▰ Larger cohort
▻ Use the survey tool in other barangays with similar bottlenecks in terms
of generating data
▻ Possible municipality-wide training instead with consolidated data

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RECOMMENDATIONS
▰ Best practices sessions with other barangays
▻ PhilPEN day (to address disruption of flow of consults)
▻ Alternative screening forms (to address difficult-to-understand parts)
▻ Records-management strategies (to address problem on data
generation)
▻ Lobbying of needs (to address mismatch)

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INSIGHTS
▰ Some aspects are good
▻ Patient turnout
▻ General barangay officials’ and BHWs’ relationships
▰ Some need to be worked on
▻ Poor PhilPEN screening
▻ Attempted revival of health club
▰ Things may seem okay on the outside but on further investigation there
are often significant issues not being addressed
▰ Demanding without orienting

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INSIGHTS
▰ Expectation vs. reality
▻ Mismatch
▻ Learn how to adjust
▰ Top-down vs. bottom-up approach
▻ Ownership and participation are cornerstones
▻ Programs should have appropriate context (not just health situation)
▰ The whole is greater than the sum of its parts
▻ Domino-effect
▰ A different lens
▻ See it from “the other side”
▻ Importance of primary health care
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 PhilPEN Status Update (Kaytitinga I - Cluster 3)
No. of
No. of No. of new No. of new
No. of No. of Target new High-risk
screened patients patients
Target 25 25 years old patients Adults
Month Population clients using screened screened
years old and above screened (>30% CVD
PhilPEN with HPN with HPN
and above per month with DM Risk)
protocol only and DM
only
January 22 0 0 0 0
February 22 2 0 0 0
March 27 2 0 0 0
April 2103 420 35 22 3 1 1 0
May 17 1 0 0 0
June 17 4 0 0 0
July 19 2 1 1 0
TOTAL 146 14 2 2 0
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PhilPEN Status Update (Kaytitinga I - Cluster 3)

• As of the start of 2019, there is a total of 420 community

members who are eligible to be screened based on the criteria
of age > 25-years old and above

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 PhilPEN Status Update (Kaytitinga I - Cluster 3)

• As of July 2019, only 35% have been screened using the

PhilPEN protocol, which may indicate that the screening rate is
inadequate to completely screen the total number of eligible
community members by the end of the year 2019

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 PhilPEN Status Update (Kaytitinga I - Cluster 3)

• From the screened community

members, a total of 16 patients
were identified to have
non-communicable diseases, with
the most prevalent NCD identified
being HPN only. Those identified
with DM only and with both HPN
and DM showed equal prevalence.
• Among the 16 patients identified,
none were stratified to be high-risk
having >30% risk of developing CVD

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THANK YOU!
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