Delivery of primary health care services in the rural Philippines : towards a comparative analysis of the PANAY and BICOL regional projects

Special evaluation - intended to provide background data and a conceptual framework for a proposed comparative analysis of the projects - covers the period 1976-7/84 and is based on public health data, document review, interviews with A.I.D. personnel, and field visits. The Bicol Integrated Health, Nutrition, and Population Project (BICOL) provided health, nutrition, family planning (FP), sanitation, and preventive health education services to residents of 400 rural barangays. Over 400 Barangay Health Aides (BHA's) were trained, 25,000 household toilets were constructed, 241 barangays had handpumps installed, and 13 springs were improved. Except for household toilets, sanitary infrastructure fell short of target, due to funding problems and lack of management personnel, lack of planning, and inadequate communication; in fact, poor coordination at barangay and regional levels has characterized the project as a whole. Community participation in identifying health problems and planning solutions was weak; participation in implementation was more adequate, though hindered by residents' dire poverty. The project monitoring and evaluation system was nonfunctional. The Panay Unified Services for Health Project (PUSH) also addressed health, nutrition, FP, and sanitation concerns. Some 450 Barangay Health Workers (BHW's) were trained, and 30,734 household toilets and 1,738 water supply facilities were constructed. The BHW's performed satisfactorily, although with more emphasis on environmental sanitation than on health care. Nonetheless, BHW's were instrumental in improving immunization, FP acceptance, and child nutrition, though not to projected levels; most people did not utilize BHW's for curative services. A fund for BHW's to spend on small activities was well utilized, but, due to inflation, available funding per project was too small. Although environmental sanitation targets were overambitious, significant changes in waste disposal and water sanitation occurred as a result of the project. Community participation was less than expected and project recordkeeping and financial management were egregious. Included are an annotated bibliography of BICOL and PUSH documents and suggestions for comparative analysis of the projects.