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Abstract

Background: The Philippine Barangay Health Worker (BHW) program extends the accessibility of health care services at the community level. BHWs are trained volunteers who perform various health-promoting and health-educating tasks and provide primary health care (PHC) services within their communities. However, the weak implementation of policies meant to protect their welfare, like the BHW Benefits and Incentives Act (Republic Act No. 7883), translates to challenges that impact the sustainability of the BHW program. This qualitative study aimed to explore the BHWs' experiences with RA 7883 and how its implementation shaped their overall role as frontline health workers during the pandemic.

Method: The researchers conducted key informant interviews in selected barangays in Biñan, Laguna, and Project 7, Quezon City. The participants included BHWs, community health workers (CHWs), co-workers, supervisors, clients, city program coordinators, and BHW district presidents. The researchers thematically coded the interview transcripts to analyze the data.

Results: The experiences of the BHWs showed how the gaps in RA 7883 implementation influenced the different aspects of their position. The BHWs expressed the need for sufficient support through remuneration and training opportunities to strengthen their competence and confidence in accomplishing their extensive tasks. The politicization of BHW through patronage politics also created inefficiencies that were detrimental to achieving the program's goals.

Conclusion: The poor implementation of RA 7883 undeniably affected the BHWs' motivation and the full realization of their roles. These inadequacies hindered the program's goal of equitable and accessible health services.

Keywords: Barangay health workers, BHW policy, BHW program, Community health, Philippines

References

[1] Mallari E, Lasco G, Sayman DJ, Amit AML, Balabanova D, McKee M, et al. Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines. BMC Health Serv Res. 2020; 20(1): 860. doi: 10.1186/s12913-020-05699-0

[2] Department of Health [DOH]. The Barangay Health Workers' Benefits and Incentives Act of 1995 (R.A. 7883): Implementing Rules and Regulations. [cited 2023 Jan]. Available from: https://doh.gov.ph/sites/default/files/basic-page/RA%20No.%207883%20Implementing%20Rules%20and%20Regulations.pdf.

[3] Phillips DR. Primary health care in the Philippines: banking on the barangays? Soc Sci Med. 1986; 23(10): 1105-17. doi: 10.1016/0277-9536(86)90269-8

[4] Aytona MG, Politico MR, McManus L, Ronquillo K, Okech M. Determining staffing standards for primary care services using workload indicators of staffing needs in the Philippines. Hum Resour Health. 2022; 19(Suppl. 1): 129. doi: 10.1186/s12960-021-00670-4

[5] Department of Interior and Local Government. The Local Government Code of the Philippines, Book III - Local Government Units. [cited 2023 Jan]. Available from: https://www.dilg.gov.ph/PDF_File/reports_resources/dilg-reports-resources-2016120_5e0bb28e41.pdf.

[6] Department of Health. Barangay Health Workers’ pocket handbook: towards effective service provision and improved health outcomes. Manila: Health Human Resource Development Bureau; 2015.

[7] Strengthening Partnerships, Results, and Innovation in Nutrition Globally [SPRING]; Advancing Partners & Communities [APC]. How do community health workers contribute to better nutrition?: Philippines. Arlington, VA: SPRING Project; 2016. [cited 2023 Jan]. Available from https://www.spring-nutrition.org/sites/default/files/publications/tools/spring-apc_country_slide_doc-phillippines_29_nov_2016.pdf.

[8] Yamashita T, Suplido SA, Llave C, Tuliao MT, Tanaka Y, Matsuo H. Understanding postpartum healthcare services and exploring the challenges and motivations of maternal health service providers in the Philippines: a qualitative study. Trop Med Health. 2015; 43(2): 123-30. doi: 10.2149/tmh.2014-40

[9] Philippine Statistics Authority. Number of nutritionists, medical technologists, sanitary engineers, sanitary inspectors, and active barangay health workers (BHW). [updated 2018; cited 2023 Jan]. Available from: https://openstat.psa.gov.ph/PXWeb/pxweb/en/DB/DB__3E__CH__HN/0053E3D5170.px/?rxid=9e8cdefb-4c0e-4c38-a22c-5e4e13eafb42.

[10] Commission on Population and Development [POPCOM]. History. [updated 2020; cited 2023 Jan]. Available from: https://popcom.gov.ph/history/.

[11] Department of Health [DOH]; Commission on Population and Development [POPCOM]. 2020 Annual report: Responsible Parenthood and Reproductive Health Act of 2012. Manila: POPCOM; 2021.

[12] Bayani DBS, Tan SG. Health systems impact of COVID-19 in the Philippines. CGD Working Paper 569. Washington DC: Center for Global Development; 2021. [cited 2023 Jan]. Available from: https://www.cgdev.org/sites/default/files/WP569_Health_systems_impact_of_COVID_in_the_Philippines.pdf.

[13] Querri AG, Ohkado A, Kawatsu L, Bermejo J, Vianzon A, Recidoro MJ, et al. Assessment of the role of community health volunteers in delivering primary health care in Manila, the Philippines. Journal of International Health. 2020; 35(1): 15-25. doi: 10.11197/jaih.35.15

[14] Pérez LM, Martinez J. Community health workers: social justice and policy advocates for community health and well-being. Am J Public Health. 2008; 98(1): 11-4. doi: 10.2105/ajph.2006.100842

[15] Lacuesta MC, Sarangani ST, Amoyen ND. A diagnostic study of the DOH health volunteer workers program. Philipp Popul J. 1993; 9(1-4): 26-36.

[16] Lehmann U, Sanders D. Community health workers: what do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: WHO; 2007.

[17] Sacks E, Morrow M, Story WT, Shelley KD, Shanklin D, Rahimtoola M, et al. Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all. BMJ Glob Health. 2018; 3(Suppl 3): e001384. doi: 10.1136/bmjgh-2018-001384

[18] House of Representatives (Philippines). An Act Providing for the Magna Carta of Barangay Health Workers. H. No. 10699. 2022. [cited 2023 Jan]. Available from: https://hrep-website.s3.ap-southeast-1.amazonaws.com/legisdocs/third_18/HBT10699.pdf.

[19] World Health Organization Department of Reproductive Health and Research [WHO/RHR]; Johns Hopkins Bloomberg School of Public Health. Family planning: a global handbook for providers. (2018 edition). Baltimore and Geneva: CCP and WHO; 2018.

[20] The Seventeenth Congress of the Philippines. An Act Instituting Universal Health Care for All Filipinos, Prescribing Reforms in the Health Care System, and Appropriating Funds Therefor. The Official Gazette. 2019. [cited 2023 Jan]. Available from: https://www.officialgazette.gov.ph/downloads/2019/02feb/20190220-RA-11223-RRD.pdf.

[21] Herrin A. Development of the Philippines' family planning program: the early years. In: Robinson WC, Ross JA, editors. The global family planning revolution: three decades of population policies and programs. Washington, DC: World Bank Group; 2007.

[22] Haw NJ, Pecache NE, Albiola N, Chan KF, Dela Cruz KG, Gotianse CS, et al. Factors affecting family planning service delivery by community health workers in District 2, Quezon City, Philippines: a cross-sectional study. Social Medicine. 2016; 10(1): 22-9.

[23] Laing JE. Family planning community outreach in the Philippines: major findings of the community outreach surveys. Philipp Sociol Rev. 1982; 30(1/4): 101-11.

[24] Nagai M, Bellizzi S, Murray J, Kitong J, Cabral EI, Sobel HL. Opportunities lost: Barriers to increasing the use of effective contraception in the Philippines. PLoS One. 2019; 14(7): e0218187. doi: 10.1371/journal.pone.0218187

[25] Creswell JW, Creswell JD. Research design: qualitative, quantitative, and mixed approaches. California: SAGE; 2018.

[26] Given L, editor. The SAGE encyclopedia of qualitative research methods. Volume 1. California: SAGE; 2008.

[27] Campbell C, Cornish F. How can community health programmes build enabling environments for transformative communication? Experiences from India and South Africa. AIDS Behav. 2012; 16(4): 847-57. doi: 10.1007/s10461-011-9966-2

[28] Philippine Statistics Authority. 2020 Census of population and housing (2020 CPH) population counts declared official by the president. [updated 2021 July; cited 2023 Jan]. Available from: https://psa.gov.ph/content/2020-census-population-and-housing-2020-cph-population-counts-declared-official-president.

[29] Philippine Statistics Authority. Highlights of the Philippine population 2020 census of population and housing (2020 CPH). [updated 2021 July; cited 2023 Jan]. Available from: https://psa.gov.ph/population-and-housing/node/164811.

[30] Gita-Carlos R. Addressing teenage pregnancies declared as ‘national priority’. [updated 2021 June; cited 2023 Jan]. Available from: https://www.pna.gov.ph/articles/1145373#:~:text=The%20Philippines%20has%20re corded%20a

[31] Pierson D, See AB. The pandemic is fueling a baby boom in the Philippines. For some, that's bad news. Los Angeles Times. [updated 2021 January 6; cited 2023 Jan]. Available from: https://www.latimes.com/world-nation/story/2021-01-06/the-philippines-girds-for-a-baby-boom-after-years-of-declining-birth-rates.

[32] National Economic Development Authority, Region IX. Couples urged to continue family planning amid COVID-19 crisis. [updated 2021; cited 2023 Jan]. Available from: https://nro9.neda.gov.ph/couples-urged-to-continue-family-planning-amid-covid-19-crisis/

[33] United States Agency for International Development [USAID]; Department of Health; Human Resources for Health 2030. Human Resources for Health Masterplan: Situational Analysis. [updated 2019 December; cited 2023 Jan]. Available from: https://hrh2030program.org/wp-content/uploads/2020/08/x12.3_HRH2030PH_HRHMP_Situation-Analysis.pdf

[34] Dodd W, Kipp A, Nicholson B, Lau LL, Little M, Walley J, et al. Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines. BMC Health Serv Res. 2021; 21(1): 451. doi: 10.1186/s12913-021-06452-x

[35] World Health Organization Representative Office for the Philippines. Call for proposals: technical assistance for the revision of barangay health worker’s (BHW) reference manual and development of online training modules. [cited 2023 Jan]. Available from https://www.who.int/docs/default-source/wpro---documents/countries/philippines/calls-for-proposal/call-for-proposals_barangay-health-worker-s-(bhw)-reference-manual_revised.pdf?sfvrsn=dbc31b16_5.

[36] Asweto CO, Alzain MA, Andrea S, Alexander R, Wang W. Integration of community health workers into health systems in developing countries: Opportunities and challenges. Fam Med Community Health. 2016; 4(1): 37-45. doi: 10.15212/FMCH.2016.0102

[37] Official Gazette. Republic Act No. 7883. 1995. [cited 2023 Jan]. Available from: https://doh.gov.ph/sites/default/files/policies_and_laws/Ra07883.pdf.

[38] World Health Organization [WHO]. Task shifting: rational redistribution of tasks among health workforce teams. Global recommendations and guidelines. Geneva: WHO; 2008.

[39] Berman PA, Gwatkin DR, Burger SE. Community-based health workers: head start or false start towards health for all? Soc Sci Med. 1987; 25(5): 443-59. doi: 10.1016/0277-9536(87)90168-7

[40] Rifkin SB. Lessons from community participation in health programmes: a review of the post Alma-Ata experience. Int Health. 2009; 1(1): 31-6. doi: 10.1016/j.inhe.2009.02.001

[41] World Health Organization [WHO]. Decentralization of health-care services in the South-East Asia Region. Report of the Regional Seminar, Bandung, Indonesia, 6-8 July. New Delhi: WHO; 2010.

[42] Kananura RM, Ekirapa-Kiracho E, Paina L, Bumba A, Mulekwa G, Nakiganda-Busiku D, et al. Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda. Health Res Policy Syst. 2017; 15(Suppl. 2): 107. doi: 10.1186/s12961-017-0274-9

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