In the island-municipality of Daram in Samar, 11 midwives oversee a population of 40,567. This equates to about one midwife for every 3,700 people, which is a sufficient ratio. Despite this, a look into their maternal and child-related health statistics shows a serious problem exists. In 2010, there were 844 maternal deliveries. Out of these, only 383 or 45.37% were attended by skilled health workers. Worse, only 69 or 8.17% occurred in a health facility.
These numbers are actually modest improvements when compared to those of 2009 when only 38.35% of deliveries, which totalled 691, had the assistance of a skilled health worker while just 4.48% took place in a health facility. Three maternal deaths were recorded in 2010 while there were two in 2009.
Daram is a fourth class municipality that got into the Zuellig Family Foundation’s Community Health Partnership Program in mid-2010. For five straight years until 2011, it had no municipal health officer (MHO). Their rural health unit (RHU) was a dilapidated structure that could hardly accommodate the number of patients seeking medical attention.
Recently, a bigger and better-equipped RHU was inaugurated. This was done through the local government’s partnership with ZFF and the Asissi Development Foundation. The new facility along with a campaign for facility-based deliveries (FBD)somehow improved FBD ratio, which stood at 15.7% as of the third quarter of the year.
However, health personnel-assisted births remained low in the same period at 39.26%. No maternal death was recorded in 2011.
The ZFF has also been providing health leadership training for the town’s mayor, its new MHO and the president of its association of barangay (village) health workers (BHWs). These training activities are meant to make the leaders more accountable to the health of their constituents.
Health skills training were also given to their midwives and BHWs to increase their competency in maternal and emergency care.
Despite these programs, their health status remains worrisome. Eleven infant deaths were recorded in both 2009 and 2010. In 2011, infant deaths reached 21.
Frontline health workers, particularly midwives, though sufficient in number and competent enough, were found to be lacking in initiative to visit as regularly as possible the four villages assigned to each of them. One of the reasons given is the high cost in going to these villages which may run from P200 to P1,400 a month.
Similar costs can be incurred by locals who need to visit health facilities; hence, majority of pregnant women opt to seek the help of a hilot (traditional birth attendant) when giving birth while the sick do not get to see health professionals.
In efforts to address these, the ZFF discussed strategies with the local health leadership of Daram. One is the early deployment of Community Health Teams. The CHTs program of the Department of Health is envisioned to give direct health assistance to every family especially the poorest by making door-to-door visits. The municipality of Daram will be one of the municipalities in the country to implement this immediately in all its villages.
Among the main purposes of Daram’s CHT, which is composed of a local health councilor, village chief, village health worker and midwife, is to create a master list of all pregnant women to be able educate each woman about proper natal care and track their progress throughout their pregnancy.
Plans are also afoot to rationalize the distribution of midwives to different clusters of villages. Midwives will be assigned based on the proximity of their residences to the clusters. Regrouping of clusters will also be done such that each village is assured of a regular visit from the midwife.
An ordinance will also be made requiring the mandatory presence of midwives in their assigned posts.
Training programs focusing on Basic Emergency Obstetric and Newborn Care will also be given by the Foundation to the midwives. Local Community Health Teams will be strengthened through various meetings and dialogues to encourage the regular master listing and monitoring of pregnant women.
The Foundation has been supporting the health infrastructure and medical equipment needs of Daram and has also been seeking other organizations to support the same. Apart from the new RHU, a village health station funded by ZFF was also inaugurated last year. A “Buntis Congress” which is a gathering of pregnant women and their partners was held to educate attendees about proper natal care and the government health programs available to them.
These measures are expected to have an immediate and direct impact on the health status of the locals. It is hoped that with the continued cooperation shown by the local health leadership team, tough challenges in Daram will soon be overcome.
With reports from Jenny Macaraan