Barangay Health Workers Kaagapay Tungo sa Kaunlaran at Kalusugan Pangkalahatan

23 November 2012

Speech-Barangay-Health-WorkersSpeech of Senator Ferdinand "Bongbong" R. Marcos, Jr.
1st Regional Summit for Barangay Health Workers
San Juan Gymnasium, San Juan, La Union

Naimbag nga bigat yo amin! Good Afternoon!

Let me begin by congratulating the DOH Center for Health Development in Region I led by Dr. Myrna Cabotaje for organizing this very important “Summit for Barangay Health Workers”. I would also like to salute all the participants at this gathering – especially the Barangay Health Workers of our region.

Since the days of my father, the late President Ferdinand E. Marcos, Barangay Health Workers (BHWs) have been the backbone of government health service delivery in the Philippines. They are still the best hope for achieving the goals of Universal Health Care for our people – highlighting the relevance of this summit’s theme – Barangay Health Workers Kaagapay Tungo sa Kaunlaran at Kalusugan Pangkalahatan.

For most of the second half of the 20th century, health inequity has been recognized as the most important health problem in the Philippines. During my father's time, the health sector response was Primary Health Care - an approach promoted by international health organizations such as WHO and UNICEF. It was at this time that the Barangay Health Workers were organized trained and deployed as the vanguard of the government’s health services. For its efforts at that time, the Ministry of Health, through its head the late Minister of Health, Dr. Jesus Azurin received the First Sasakawa Memorial Award for Primary Health in 1984.

Needless to say, during the almost four decades since then, the health sector has not yet successfully addressed the issue of inequity. Disparities in healh between the rich few and the poor majority of Filipinos persist and may have worsened. Let me cite just two examples of inequitable outcomes resulting from unequal access to services as evidence.

Women in the highest twenty percent of income groups have an average desired fertility rate of 2 and actually bear an average of 2 children during their reproductive lives. In other words they attain their fertility goals. On the other hand, poor Filipinas in the lowest twenty percent of income groups desire a fertility of 3 children but actually bear 5 to 6 children during their fertile years. This means that those who can least afford have more children than they plan to have.

That these outcomes result from poor service access is evidenced by comparing Caesarian section rates for high income and low-income groups. I am sure you know that the internationally recognized "gold standard" C-section rate in a given population is 15 %. For low income Filipinas, the rate is barely 2% - meaning that most women who need the operation in this group will not get it even in circumstances of high risk for maternal morbidity and mortality. On the other hand, the rate for high-income women is not so good either; for the percentage is 30% - meaning that rich women will be subjected to the risk of surgery even when it is unnecessary.

To achieve the much needed health equity - meaning that all Filipinos have access to health information and services needed to ensure acceptable health outcomes - reforms are needed in the way the entire health sector operates. That is why I believe that barangay Health Workers are the key to instituting these reforms.
To help identify the specific reforms needed, I would like to use the analytical framework of the six building blocks of health systems as proposed by WHO. Today, let us look at the role of the BHWs in each of these building blocks.

Governance refers to how the system is run - the policy environment, how programs are planned and how services are delivered. The main problem in this area is that planning and policymaking are basically top down and have very little regard for the needs of familiies and communities. The involvement of BHWs is crucial to ensuring that people’s views contribute to the development of health policy.

In the financing of health care, stakeholders have agreed that social health insurance through Philhealth is the way we will meet the costs of Universal Health Care. The success of Philhealth is dependent on how the system can operate and connect with communities through Primary Health Care. Barangay Health Workers can contribute to this effort by ensuring that families and communities are informed about their status and options under coverage by Philhealth.

Regulation of Health Goods and Services determines the quality, quantity, and accessibility of medical supplies such as medicines. Barangay Health Workers can support the efforts of regulatory agencies such as the Food and Drug Administration by helping to monitor the availability of safe and effective supplies in their area of responsibility – the community.

Information systems for health decision-making are still in the paper and pencil era especially at the primary health service levels. When the health system finally adopts a uniform standard of information technology, it is imperative that such technology be initiated at the barangay level. If they are properly trained and equipped for IT, the Barangay Health Workers will constitute the best source of health information because of their physical proximity to the families from whom the data are to be collected and to be assisted.

Health workforce (doctors, nurses, midwives and other health providers) are supposed to work as a team in order to effectively meet the needs of families and communities. In this regard, I believe that the most important member of the health team who serves as the anchor of the primary health care system – is the Barangay Health Worker (BHW).

Finally, it is widely observed that the organization of health services in this country needs an overhaul. For it is presently perceived as fragmented, overspecialized, and individualistic. Therefore there is the need to improve the interaction between government health services and the communities they serve. Different levels of care must develop effective and formal referral systems, and emphasis must be given to primary care with a focus on families and communities – again, this is the level at which you the Barangay Health Workers play a most important role.

As you can see, there is a lot of work ahead for the health system as a whole. That being the case, the role of the Barangay Health Workers cannot be overemphasized. For it needs to be strengthened and defined more clearly in the context of Primary Health Care and the participation of families and communities in their own health care.

At this point, let me just mention that The Senate Committee on Local Government which I chair conducted a hearing last Thursday, November 15, 2012 on the proposal, among others, to include health workers as one among those to be given mandatory positions in the barangay, entitling them to barangay benefits presently given to other Barangay officials/employees. This development is a clear indication and recognition of the pivotal role played by all the barangay health workers all over the country.

If the health system at all levels recognizes this, including our policy makers and legislators, there is no reason why true universal health care at par with the best in the world will not be achieved within a single generation.

On that note, let me thank you all once again for being given me the chance to share with you.

Dios Ti Agngina Ka da kayo Amin! Mabuhay kayong Lahat!