May 2016 – April 2018
The Visayas Primary Healthcare Services, Inc. implemented a project, “Sustaining community-based health programs to promote health and prevent disease in urban poor communities in Cebu” in Sitio Sawsawan, San Roque, Talisay City, Purok Tambis, Umapad, Mandaue City, and Sitio Intramuros, Barangay Poblacion, Cordova from May 2016 – April 2018.
The project was supported by the Committee of German Doctors for Developing Countries based in Bonn, Germany.
The three areas were part of the 16 areas where the Committee had rolling clinics for the past ten years before they ended in June 2017. The project aimed to capacitate volunteers in the rolling clinics in the three areas to be community health workers who could deliver basic promotive, preventive and curative primary health care, respond to the health needs of the residents, raise their awareness, develop good health-seeking behavior, and develop health programs.
The project primarily consisted of three levels of basic health skills trainings and one special skills training for 15 CHWs in each area, monthly health education classes for the residents, distribution of health information materials, health services by the trained CHWs during the rolling clinics, in home visitations and community clinics, herbal medicine production, and health programs on hypertension control, nutrition program for preschool children, environmental sanitation, tuberculosis control program, and maternal health.
The first level of BHST consisted of topics that equipped the CHWs with basic knowledge and skills on how to manage common illnesses using health education, promotion of good health seeking behaviour, and natural and indigenous but scientific methods of healing without the use of Western medicine, and when to refer patients to medical personnel for ailments they cannot manage.
The topics included the following, namely: (1) local health situation and social determinants of health, (2) theory and practice of community-based health programs (CBHPs) and primary health care, (3) vital signs, that is blood pressure, pulse rate, respiratory rate, weight, and temperature, (4) control of acute respiratory tract infection, (5) home remedies for common ailments including water therapy, ventusa, herbal medicine, and acupressure, (6) environmental sanitation, (7) nutrition, (8) immunization, (9) hypertension, (10) tuberculosis and (11) safe motherhood and family planning.
The second level of BHST topics included the following topics, namely, (1) human anatomy and physiology, (2) taking history and physical examination, (3) using medicines correctly and some common medicines, (4) first aid in common emergencies that can occur in the household, (5) wound care, (6) patient’s record keeping, and (7) health campaigns.
The third level of BHST was conducted in the second year of the project. The topics included the following, namely: (1) CHWs as effective agents of behavior change, (2) nutrition, (3) growth monitoring, (4) proper sanitation and environmental sanitation, (5) management of cough for children under five years old, (6) management of diarrhea of children under five years old, (7) management of diabetes mellitus, and (8 ) cardiovascular diseases. Although some of the topics were already conducted in the previous trainings, they were reviewed in the third level because the CHWs expressed the need to do so in order for them to be more effective in dealing with these problems.
Finally, the special skills training was conducted at one setting on January 2018 for all 45 CHW in the three communities. The first topic on leadership provided the CHWs with the knowledge and skills to be more capable of leading the residents in their various activities including the health education classes and mobilizing them to get involved in the health campaigns such as the nutrition program, production of herbal plants and cultivation of vegetables in their backyards and cleanliness campaigns. The second topic on basic organizing taught the CHWs on the requisites needed in order to establish their people’s organization in their communities. The third topic on resource generation taught the CHWs how to develop networks and tap government agencies and non-government organizations for material, human, financial and technical support in order to sustain their project activities particularly since the project is about to end.
The rolling clinics in Cordova and Sawsawan every Wednesday and Monday, respectively, and the rolling clinic in Umapad every other Thursday were opportunities for the trained CHWs to apply the knowledge and skills they learned in the BHST. The CHWs searched for the patients’ records, took the weights, blood pressure, pulse rate, temperature and ushered them to the German doctors. The CHWs also conducted health education before the rolling clinics started.
In between rolling clinics, the CHWs did home visitations and conducted simple health teachings applying what they learned in the training. Health education classes using the tarpaulins made in the project on the topics hypertension, tuberculosis, nutrition, diabetes, care of child with cough and diarrhea, family planning, and dengue fever were conducted by the project staff and the CHWs. Leaflets on the topics were distributed to the residents.
Positive outcomes of the project included the following. Mothers knew how to treat common cough and colds, diarrhea, skin infections and other illnesses among children with natural medicine and bring children with pneumonia, diarrhea with severe dehydration and other serious illnesses to health centers. Families practiced proper disposal of garbage and wastes and proper storage of household water. A nutrition program was established. Weights, heights and nutritional status of preschoolers were monitored and malnourished children underwent nutritional rehabilitation with cultivated gardens of vegetables. Hypertensive and diabetic patients were identified, monitored, referred to the health centers, and advised by the CHWs to take their medications daily and have regular check-ups. Persons with symptoms of tuberculosis were identified by the CHWs and referred to the government health centers and availed of the government’s TB control program.
There was an improvement in the health seeking behavior of the residents and improved health situation. Residents were able to address preventable illnesses and treat them using local natural remedies.
In order to sustain the project even after its termination in April 2018, there were efforts of the CHWs together with the project staff to initiate the formation of their people’s organizations (POs) in their respective communities. A PO is needed in order to unify the residents along a common vision, mission and goals (VMG), including the promotion of primary health care for better health of the residents. After the special skills training where this was discussed, the CHWs took steps to recruit members of the PO and to draft the constitution and by-laws of the PO with the help of the VPHCS staff.
In summary, a total of 45 community health workers in the three areas were trained in three basic health skills training and one special skills training that provided them with knowledge and skills to render preventive, promotive and selective curative care to their residents and to organize their communities. They have voluntarily served, without any monetary compensation, their fellow community residents.
More than 2,500 persons were attended to by the CHWs. These included the residents who attended the health education classes, had blood pressures and blood sugar tests taken, children weighed, availed of services of the CHWs through home visits and community clinics, and many others who benefitted from the health campaigns on hypertension and diabetes control program, tuberculosis control program, environmental sanitation, nutrition program and maternal health.
The estimated total households and population in the three communities were as follows, Purok Tambis, 400 households (2,000 population; average size of 5 per family), Sawsawan, (350 (1,750 population), and Intramuros, 200 households (1,000 population).
Indeed, they were very fruitful two years. Although funding for the project ended, the fruits that the CBHPs developed in the three communities continue to be visible through our trained community health workers who have benefitted from it and the health campaigns as well as the enhanced health seeking practices of the general community residents.