Community-based Health Program in Bohol

January 2007 – December 2011

Since 1997 until December 2011, the Action Solidarite Tiers Monde (ASTM) persevered in supporting the community-based health programs in several municipalities in Bohol.

The last five years prior to the end of the project in December 2011 saw the project implementation among the peasants and fishermen of Barangays Pinayagan and Panaytayon, Municipality of Tubigon and Barangays Dulho and Tangnan, Municipality of Panglao and in the last two years in Barangays San Isidro and Busao, Municipality of Maribojoc; and Barangays Mayacabac and Totolan, Municipality of Dauis.

The community-based health programs in these barangays have indeed increased the health awareness and improved health practices of the residents, and decreased the incidence of highly preventable and communicable diseases.

Now, they are more empowered to take care of their own health and their children’s.

A series of health education classes was conducted in the barangays where residents shared with one another how they have been able to solve their common health problems.

On child health care, the women constantly pointed out that whenever their children came down with cough, colds and fever, they knew what to do. They always resorted to the use of lagundi, sambag and kalamansi herbal plants as first remedy. These plants are now grown in their backyards. Some women also said that they would take note of the signs of pneumonia, that is, fast breathing, which would tell them that it was urgent to bring their children to the health centers. A few mothers had children who came down with pneumonia but recovered with antibiotics.

A health education class on tuberculosis

There were a few cases of diarrhea in spite of the campaign on proper disposal of garbage and wastes, and proper storage of household water for drinking brought from the springs. Nevertheless, the mothers treated their children with homemade oral rehydration salt solution in order to prevent them from having dehydration. However, those with continuous diarrhea which were a very few cases had to be referred by the CHWs to the health facilities for medical help.

Growth monitoring of their children was ensured by the mothers, noting that their infants should have a weight gain of 0.5 kilograms per month before their first birthday, and a gain of two kilograms for every year of age. Mothers whose children did not have the ideal weight and were noted to be malnourished were advised by their fellow mothers to give their children more protein-rich food such as eggs, beans and fish rather than having a diet more of rice and noodles.

Nutrition was thus a favorite topic of the mothers. The mothers were glad that with their nutrition program, their children were now much healthier and had less episodes of cough and colds. They had food campaigns such as cultivation of vegetable gardens in their backyards. The feeding program was stopped since it was not necessary anymore there was a drop in the number of malnourished children. Nevertheless, the community health workers (CHWs) were still careful and noted the children who remained small for their age in order to follow them up during home visits.

Pregnant mothers continued to have regular pre-natal care in the local health centers and had their deliveries done in the health centers as well. While it was a tradition to have their babies delivered at home by traditional birth attendants or government midwives, this was discouraged by the Department of Health due to complications that could occur with home deliveries. Thus, there were fewer cases now of home deliveries.

Mothers who delivered continued to breastfeed their infants; unlike in urban cities where mothers have to work and often stop breastfeeding after two months following delivery, in rural areas, mothers stay at home and take care of their children.
Mothers said that they saw to it that they were well-nourished so that that they have enough nutrition in their breast milk for their children.

During the health education classes, mothers shared with one another how they were trying to limit and space the number of their children since they did not want to add more mouths to feed during these difficult times. They used the information given by their CHWs on family planning and methods of birth control such as the natural methods and the use of condoms and pills. A few who had irregular menstrual period and had to use pills sought medical attention in the government health centers and bought pills since they were not available in the centers. Pills however were cheap and affordable.

Tuberculosis and hypertension, two chronic ailments, continued to affect the rural men and women. However, the problems were still addressed as the CHWs continued to refer patients with chronic cough to the health centers for sputum examination while there were those who went directly to the health centers having learned that their cough could already be symptoms of TB.

Tuberculosis continues to remain as one of the top ten leading causes of deaths in our country and our government has an intensive program on TB control as mandated by the World Health Organization. However, it is common that people do not easily seek consultation for their chronic cough as this has been deemed to be “natural” and does not need treatment. It is only when the symptoms worsen when they have hemoptysis and difficulty in breathing that patients find it urgent to seek medical help. However, with the information drive that the CHWs have intensified, the symptoms did not have to worsen before those with chronic cough sought consultation and sputum examination in the health centers.

Like tuberculosis, cardiovascular diseases including hypertension have remained one of the top ten leading causes of deaths in the country and worldwide. Hypertension is a silent killer and does not present with symptoms until the body organs are affected, such as edema with kidney disease, chest pains and dyspnea with heart failure, or stroke which could leave one paralyzed. Fearing that these complications would occur in their communities, the CHWs strived to control hypertension. Operation blood pressure taking was sustained by the CHWs either through home visitations or through community clinics. Those with hypertension were advised to get medicines from the government health centers. Cheap generic medicines are now available in the market which costs less than five pesos a tablet. Thus, hypertensive people were now more conscious to have their blood pressure monitored and to buy medicines if they are not available in the health centers.

Home remedies such as water therapy, ventusa, acupressure and herbal plants were constantly resorted to by the mothers for ordinary complaints such as fever, cough and colds, stomach ache, headache, body aches and body malaise. The use of common, cheap and essential Western drugs was resorted to by the mothers only when these traditional forms of medicine failed or to complement their use. These included paracetamol for fever, amoxicillin for ordinary infections, antacids for hyperacidity, mebendazole for intestinal parasitism, and mefenamic acid for pain.

A series of health skills trainings was conducted for the CHWs of all the barangays so that they will be equipped to handle common health problems in their communities, sustain their health programs manage their health centers and village pharmacies and strengthen their networking with their barangay councils, municipal governments and civic organizations in order to generate financial and material resources for their projects.

With their skills learned, the CHWs consistently served their communities, handling problems such as ordinary cough and colds, pneumonia, tuberculosis, diarrheal diseases, peptic ulcer disease, hypertension, osteoarthritis, nutritional deficiencies, among other medical problems, and sustaining their health campaigns.

The VPHCS staff and volunteer health professionals rendered services in a series of medical missions in the five years. Members of the Students Alliance for Community Health Services (SACHS) coming from different nursing schools in Tagbilaran City also rendered services in the missions. The CHWs greatly assisted during the missions, applying their medical knowledge and skills to treat patients.

Although the project funded by the ASTM ended in December 2011, we are positive that their community-based health programs shall be pursued more vigorously in order to meet the health needs of the people in the face of the increasing cost of health care and economic crisis facing our country. The health centers, the services of the health committees and the improved health seeking behavior and general health situation of the people shall remain as indelible hallmarks of the project in the years to come.

Indeed, even if funding for the programs has ended, the people’s health movement in our CBHP areas in Bohol shall move on.