The DTTB ExperienceSharing Experiences that Worked

By Bien Eli Nillos, MD DTTB Batch 23

BackgroundCandoni, Negros Occidental

• 4th class municipality, one of the poorest towns in Negros Occidental

• Infamous for its history of insurgency – CHICKS area

• Mountainous, no costal areas, largely agricultural

• No health system in place

Top Concerns• Maternal and Child Care – high maternal mortality

ratio, high infant mortality ratio, low facility-based delivery, low rate of delivery attended by Skill birth attendants, high incidence of malnutrition

• TB Deaths still in top five causes of mortality – low TB case detection rate

• No licensed pharmacies – lack of access to cheaper drugs

Maternal Mortality per 1,000 LBs

3.6

5.8

0.920.63

0

1

2

3

4

5

6

2006 2007

CandoniRegion 6National

Facility based deliveries – 24% in 2007Skilled birth attendant deliveries – 74% in 2007Top Causes of MM – post-partum bleeding, Pregnancy Induced Hypertension

Infectious (Pulmonary Tuberculosis)

0

20

40

60

80

2006 2007

Case Detection Rate

Candoni

National

Cure Rate – 93% in 2007No med. Tech. – only 1 midwife microscopistPracticing TB DOTS but not Philhealth accredited

“Primary health care starts with people. Our common humanity compels us to respect people’s universal aspiration for a better life. It compels us to respect the resilience and ingenuity of the human spirit, and the great capacity of individuals and communities to solve their own problems.” (Margaret Chan, WHO Director-General)

“We will lead and the rest of the world will follow. That’s what they want, to be like us.” – George Bush

“Change will come when those who have the resources learn that they do not have all the answers…they need to learn how to listen.” – Desmund Tutu

COMMUNITY HEALTH INITIATIVES PARTNERS (CHIP)

Members: Barangay Captains, Brgy. Kagawads for Health, SK, BHW Federation

Role: Coordinate all health program implementation at the barangay level, initiate community-based health programs through original approaches.

Relations and Advocacy Managers (RAM)

Members: Teachers, Faculty-in-charge, church-based organizations, PNP and other NGO’s

Role: help in the promotion of health advocacies in schools and communities through integration.

Legislative Action Network (LAN)

Members: Political leaders, councilors, department heads, NGO’s

Role: provide strong legislative support for health programs, influence policy in favor of health initiatives

MONITORING team (MONITOR)Members: Program coordinators, DOH representative, PHO/CHD/Philhealth, Public health managers, MPDO, Budget Officer

Role: Monitor progress of initiatives, plot outcomes and results and provide feedback to community at large.

Engaging the Community• Assembly of hilots and

revival of Women’s Health Team

• Legislative support – barangay ordinances

• Increased advocacy and social awareness

• Training of midwives and nurses (refresher’s course)

• Upgrading of facilities

• Assignment of Midwife-in-charge of DR

• Alkansiyang Pampamilya

• Buntis Baby Bag

• Barangay Surveillance of “Hilot Activities”

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10

20

30

40

50

60

70

80

90

2007 2008 2009

FBD

SBA

MMR

FBD = Facility Based Delivery

SBA = Skilled Birth Attendant

MMR = Maternal Mortality Ratio

• One additional midwife trained as Microscopist

• Aggressive TB awareness campaign

• Lung Month Celebrations

• Philhealth Accreditation

TB DOTS Program

0102030405060708090

100

2007 2008 2009

CDR

Cure Rate

CDR = Case Detection Rate

Infant and Child Health Care• Under-five Clinic

Thursdays – follow up immunizations, feeding activities, consultations, etc.

• Newborn Screening Facility accreditation

• Intensified EPI – BHW surveillance

• Establishment of Botika ng Barangays 9/9

• Establishment of Botika ng Barangay Monitoring Team: DOH representative, Municipal Accountant, BnB Operator, Nurse Coordinator, Brgy. Captain

• Under the LHB

Struggles of a DTTB

“Between the great things that we cannot do and the small things we will not do, the danger is that we shall do nothing.” -Adolph Monod

“Anything worth doing is difficult”

-Patch Adams