1. My Leadership Journey Bien Eli Nillos, MD Former Doctor to the Barrios Municipality of Candoni, Negros Occidental

2. Bien Nillos, MD

M.D. 2006, University of Saint La Salle

BS Biology 2002, University of Saint La Salle

Doctor to the Barrio 2007 2010, DOH/Municipality of Candoni, Negros Occidental.

Currently an Associate Professor for Family and Community Medicine (University of Saint La Salle)

Fellow, Zuelligs HLMP Training

Alumnus, U.S. State Department (Northern Illinois University)

Alumnus, Global Health Course, University of Tampere (Finland)

3. Candoni, Negros Occidental

Population: 21,000

4-hour bus ride from Bacolod City, 1 and half hours away from Kabankalan City

Surrounded by other towns and cities (CHICKS)

4. Problems Encountered

Poor Health Indicators

Inaccessible health care services

Limited Human and Financial Resources

Poor Health Seeking Behaviors

5. Maternal Mortalityper 1,000 LBs Facility based deliveries 24% in 2007 Skilled birth attendant deliveries 74% in 2007 Top Causes of MM post-partum bleeding, Pregnancy Induced Hypertension 6. Infectious (Pulmonary Tuberculosis) Cure Rate 93% in 2007 No med. Tech. only 1 midwife microscopist Practicing TB DOTS but not Philhealth accredited 7. 8. 9. Infant Mortalityper 1,000 LBs Top Causes of Mortality: Severe Pneumonia, Severe Diarrhea 10. 11. Compounding Factors The greatest intelligence is precisely the one that suffers most from its own limitations Andre Gide (Nobel Prize for Literature, 1947) POLITICS ACCESS LACK OF 12.

We are limited but we can push back the borders of our limitations Stephen Covey

13.

Change will come when those who have the resources learn that they do not have all the answersthey need to learn how to listen. Desmund Tutu

14. Alma Ata Declaration The people have the right and duty to participate individually and collectively in the planning and implementation of their health care. - Alma Ata Declaration of 1978 15. CHART (Community Health Allies and Reform Team) 16. 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. 17. Relations and Advocacy Managers (RAM) Members: Teachers, Faculty-in-charge, church-based organizations, PNP and other NGOs Role: help in the promotion of health advocacies in schools and communities through integration. 18. Legislative Action Network (LAN) Members: Political leaders, councilors, department heads, NGOs Role: provide strong legislative support for health programs, influence policy in favor of health initiatives 19. 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. 20. Engaging the Community

Assembly of hilots and revival of Womens Health Team

Legislative support barangay ordinances

Increased advocacy and social awareness

Training of midwives and nurses (refreshers course)

21.

There go my people. I must find out where they are going so I can lead them. ~ Alexandre Ledru-Rollin

22.

Example, whether it be good or bad, has a powerful influence George Washington, quoted from his letter to Lord Stirling (March 1780)

23. Upgrading A Local Health System Part Two on Candoni Case Bien Eli Nillos, MD Former Municipal Health Officer 24. Consider this

All 3 components are essential.

Hardware = equipments, logistics, physical environment

Software = local health system, predominant culture

Peopleware = Actors

25. Why Upgrade? Excellent Hardware and Software but illiterate Peopleware Excellent Software and Literate Peopleware but Poor Hardware Excellent Hardware and Efficient Peopleware but Poor Software Slow rendering of output Useless, Impotent Frustrated, Lost, Apathetic 26. CHART (Community Health Allies and Reform Team) 27.

Community Health Initiative Partners (CHIP)

Relations Advocacy Managers (RAM) Legislative Action Network (LAN) MONITORing team 28. No Botika ng Barangays Dilapidated RHU Low number of deliveries attended by skilled birth attendants No indigents enrolled in Philhealth High malnutrition rate 29. Internal and External Environments Challenge: Motivation to work (feeling of insufficiency, routine work, professional jealousies) Strategy: Treating them as partners, important contributors Activities: Workshops, team building, SOPs, assignment of program coordinators, trainings and seminars 30. Internal and External Environments

Challenge: direct interest and attention to health (dole-out mentality, political patronage, etc)

Strategy: Validation and affirmation of Vision hopes for Candoni.

Approach: Gather influential leaders in the community, and empowering of community through these leaders.

31. Issue No. 1: Maternal Mortality Ratio

Hardware Dilapidated RHU, BHS not capable of handling normal deliveries, lack of supplies, inaccessible puroks, sitios

Software poor referral system, lack of tracking system for pregnant clients, policies onhilotdelivery, cultural

Peopleware predominance of TBA, no Womens Health Team

32.

Assembly ofHilots

Integrating the TBAs in the new set-up.

Important partners and collaborators (WHT)

Support of the Barangay Captains

Barangay Ordinances

33.

New Protocols for RHU Staff

9 barangays with 9 midwives

1 midwife-in-charge of DR

BHW catchment areas (atrition policy)

SOP on referral system

Lifesaving skills and Perineal suturing

34.

Upgrading RHU/ equipping BHS

35. Selling the Idea to the Community

Alkansiyang Pampamilya

Buntis Baby Bags

36. FBD = Facility Based Delivery SBA = Skilled Birth Attendant MMR = Maternal Mortality Ratio THE OUTCOMES 37. Infant Mortality Rate Trend 38. Issue No. 2: Inaccessibility to Cheaper Medicines

Hardware: geographically challenging

Software: dole-out mentality Credit is good because I dont have cash motto

Peopleware: Barangay captains hesitant to start up a BnB due to fear of lack of sustainability

39.

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

40. Issue No. 3: TB or not TB

Hardware: dilapidated RHU, Microscopy lab

Software: while practicing TB DOTS, lack of aggressiveness in tracking symptomatics

Peopleware: less motivated(?) staff community unaware

41.

One additional midwife trained as Microscopist

Aggressive TB awareness campaign

Lung Month Celebrations

Philhealth Accreditation

42. TB DOTS Program CDR = Case Detection Rate 43. My Role, The Pontiff

LatinPontifex pons (bridge) + facere (to make) = bridge builder

"I pray that I may never meddle, interfere, dictate, give advice that is not wanted, or assist when my services are not needed. If Ican help people, I'll do it by giving them a chance to help themselves; and if I can uplift or inspire, let it be by example, inference and suggestion, rather than by injunction and dictation. That is to say, I desire to be Radiant -- to Radiate Life!" --Elbert Hubbard 44. Struggles/Challenges

Anything worth doing is difficult Patch Adams

45. Quo Vadis, Doctor? I seldom end up where I wanted to go, but almost always end up where I need to be. Douglas Adams 46. It is the time you have wasted for your rose that makes your rose so important. The Fox (The Little Prince, Chapter 21)