UNIVERSITY OF CALOOCAN CITY

GRADUATE SCHOOL

CALOOCAN CITY: BASIS FOR PROGRAM DEVELOPMENT TO

PREVENT THE SPREAD OF COMMUNICABLE DISEASES

IN BARANGAYS

(PROPOSED TITLE)

RESEARCH METHODS AND TECHINIQUES IN

PUBLIC ADMINISTRATION
MPA 301

SUBMITTED BY:
PAUL JOHN RICO, RN

SUBMITTED TO:
DR. FLORENTINO MAROTO
 Chapter I

Introduction

I. Background of the Study

Corona Virus, a communicable disease that became a worldwide phenomenon. On

December 31, 2019, the World Health Organization’s (WHO) office in China received

reports of a previously-unknown virus behind a number of pneumonia cases in Wuhan, a

city in Eastern China with a population of over 11 million. Considering the disease as an

epidemic, Wuhan and nearby cities was immediately placed under de-facto quarantine to

prevent further spread of the said infection. But despite this precautionary measures,

Chinese health authorities had acknowledged over 81,032 cases and 3,204 deaths, on

March 11, 2020.

In mid-February, the spread of the disease started picking up outside of China, affecting at

least 143 countries and territories. On March 11, 2020, being alarmed by the level of

severity and spread of the disease, the WHO officially considered Corona Virus outbreak as

pandemic- which means that it has already spread rapidly among several countries.

Adhanom (2020), was reluctant to use the word pandemic for it might cause unreasonable

fear or unjustified acceptance that it can’t be resolved, which may lead to unnecessary

suffering or death.
In the Philippines, the first case was confirmed on January 30, 2020, a 38 year old Chinese

women who was confined at San Lazaro Hospital in Manila. The second case was confirmed

on February 2, a 44-year-old Chinese man who died a day earlier, which was also the first

confirmed death from the disease outside mainland China. The first case of someone with

no travel history abroad was confirmed on March 5. On March 23, 2020, there’s already a

total of 396 confirmed cases of the coronavirus disease in the Philippines. Out of the 396

cases, 33 deaths were recorded and 18 patients recovered from the disease, (Department

of Health, 2020).

Caloocan city was one with confirmed case of the disease, along with other cities in the

National Capital Region. The City Health Office verified the first confirmed case of

coronavirus was admitted at Dr. Jose N. Rodriguez Memorial Hospital located at barangay

Tala, Caloocan City. The patient was admitted to the hospital after she experienced fever,

cough, and shortness of breath on March 4. Five days later, she tested positive for the

disease. On March 24, 2020, there are currently 230 Persons Under Monitoring (PUM), 74

persons under monitoring (PUI) and 8 confirmed cases.

WHO officially named the Coronavirus disease: Covid-19. The virus that causes that disease

is likely to be called Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-CoV-2).

Coronavirus are large group of virus that might affect animals and humans. Infected

humans might experience mild to severe respiratory illness such as pneumonia and

bronchitis which might lead to death. These can be particularly dangerous to older

patients, or people who have existing health conditions. This appears to be the case with
Covid-19, where more than 80 percent of those who died from the disease were over 60

years old and they typically had pre-existing health conditions such as diabetes or

cardiovascular disease, (WHO, 2020).

The National Center for Immunization and Respiratory Diseases (2020), observed that the

virus that causes COVID-19 seems to be spreading easily and sustainably in the community

in some affected geographic areas. The virus is thought to spread mainly from person-to-

person, between people who are in close contact (within about 6 feet) through droplet

transmission and also, there is a minimal possibility that a person can be infected by

touching surface or object that is contaminated by the virus and then touching their own

mouth, nose, or possibly their eyes.

Our health systems always seemed to be overwhelmed when such disease outbreaks

emerges. In fact, in 2019 the Philippines struggled to cope with 3 consecutive

communicable disease outbreaks namely. The Measles outbreak on February 2019, where

the DOH recorded 8,443 cases in Metro Manila from January 1 to February 18, 2019 with

135 of these cases resulting to deaths. DOH was alarmed of the 550% increase in the

number of cases, compared to 2018. Vaccination against measles is available for free in

government hospitals and health centers but Duque III (2018), believed there was a

lowered trust in vaccination in the country due to the Dengvaxia controversy in 2018.

Survey conducted by the London School of Hygiene and Tropical Medicine (2018), shows

that among 1500 Filipinos, only 32 percent trusted vaccines. However, decline in Measles
vaccination began as early as 2014, four years before the Dengvaxia controversy happened,

(UNICEF, 2018).

Another communicable disease that resurfaced on the same year was leptospirosis. On July

5, 2019, the Department of Health declared a leptospirosis outbreak in Metro Manila

neighbourhoods. Reports from January 1 and July 3, shows a total of 368 leptospirosis

cases in Manila Metro resulting to 52 leptospirosis-related deaths. In 2018, there have been

1,030 cases of leptospirosis in the Philippines and 93 deaths as of June 9; this is a 41%

increase in reported cases in comparison with the first 6 months of 2017. (Philippines

Epidemiology Bureau, 2019)

Lastly, a disease that has resulted in an average of 12,000 deaths per year worldwide:

Dengue (Sinnon, 2017). On August 13, 2019, the Department of Health has recorded a total

of 10,103 cases and 43 deaths due to dengue, affecting 10 out of 17 local government units

(LGUs) in the National Capital Region. Data from January 1 to July 27, 2019 shows 942

dengue cases in Caloocan City from 1,301 cases in 2018.

The study will focus on Caloocan City which was one of those cities that recorded the

highest measles cases during the 2019 outbreak along with Quezon City, Manila, Marikina,

Pasig, Navotas, Parañ aque, Pasay, and Malabon, (Duque III, 2019). The city specifically

barangay 176 was also affected by leptospirosis outbreak on 2018.

With this alarming incidents that puts thousands of lives in danger, efforts to strengthen or

develop health programs to prevent spread of such communicable diseases is a must to

avoid epidemics or disease outbreaks hence this study aims to contribute to these efforts.

II. Statement of the Research Problem and Objectives

Due to the increasing incidents of outbreaks in the National Capital Region particularly

in Caloocan City and possible pandemics nowadays, it is important to know the

capabilities of our current Healthcare System to prevent or control the spread of

communicable diseases. Hence, the objectives will be:

1. General Objective:

a. To identify the capabilities of the current Local Healthcare System to prevent

and control the spread of communicable diseases outbreaks in the primary level

of care.

2. Specific Objectives:

a. To identify the current programs of the local government of Caloocan City to

prevent and control the spread of communicable diseases in the community.

b. To determine the effectiveness of the existing programs implemented by the

Local Government of Caloocan City in preventing or controlling the spread of

communicable diseases in the community.

c. To determine what interventions should be prioritize to prevent community

spread of communicable diseases.

 d. To determine how this programs are implemented in the community and how

the people are educated about these programs.

e. To determine the limitations of the services that Barangay Health Centers can

provide in cases of communicable diseases.

III. Scope and Limitations

The study will focus on the primary level of care provided under the Local Government of

Caloocan City, which means it will not include clinics and primary hospitals under the

private sector. It will focus on the capabilities and existing programs of the Caloocan City

Government Healthcare system to prevent and control community spread of serious

communicable or infectious diseases such as COVID-19, Measles, Leptospirosis and Dengue

which are examples of recent disease outbreaks that emerged or re-emerged for the past 3

years that may causes mortality. The study will only include on-going health programs

implemented by the City Health Department and Barangay Health Centers in some

barangays in Caloocan City. The study will only cover existing programs, policies and

interventions done to community spread of infection before, during and after outbreaks of

such diseases.

IV. Significance of the Study

The main rationale of this study is to contribute to the efforts of enhancing the Local

Healthcare system of Caloocan City in prevent or control to the spread of serious

communicable diseases that might causes fatality and to formulate programs to respond to
future disease outbreaks such as COVID-19, Measles, Dengue and Leptospirosis to promote

better health for Caloocan City residents.

The researcher would like to aid in increasing the preparedness, response capabilities, and

improvement of health facilities of the LGU to respond to such cases of serious health

threats of infectious diseases. This study also aims to identify the strategic initiatives to

advance countermeasures to diagnose, mitigate, prevent, and how the LGU coordinate or

refer such cases to a National Level facility if needed.

Hence, this study is helpful to those government agencies like the DOH, Caloocan City

Health department and its Barangay Health Centers to strengthen activities and measures

taken in before or during the presence of serious communicable diseases to ensure

effective timely and effective response to the impact of such health hazards.

V. Study Framework

A. Theoretical Framework

1. Health Promotion Theory: The Tannahill Model

Tannahill (1980), believed that health promotion is consists of three overlapping factors:

Health education, prevention and health protection. Health education changes the

knowledge, belief, attitudes and behaviour that might result to better a health outcome.

Disease prevention aims to decrease risk factors and minimize the consequences of
disease; it includes primary, secondary and tertiary prevention. Health protection focuses

on fiscal and legal controls and policies and voluntary codes of practices aimed at

preventing illness and enhancing well-being.

Tannahill (2009), reconsidering community-based factors, proposed a new definition of

health promotion as sustainable fostering of positive health and prevention of illness

through policies, strategies and activities that focuses on five overlapping factors: (1)

social, economic, physical, environmental, and cultural factors; (2) equity and diversity; (3)

education and learning; (4) services amenities and products; (5) community led and

community based activities. (p. 397)

2. Health Promotion Theory: Ecological Systems Theory

Bronfenbrenner (1979), believes that health behaviour is affected by factors are related

one another, namely: (1) intercultural influences, (2) community-level influences,

(3)organizational influence and (4)interpersonal or individual influences.

Interpersonal influence consist of the roles an individual plays within his/her social

context. These influences can be learned but are also ingrained based on gender, ethnicity,

generation and culture. Individual’s environment continuously affects personality,

knowledge and beliefs. Community influence involves norms, standards, social networks

and the media even an individual is not an active part of it. Organizational or institutional

factors refers to the policies, acceptable etiquette and norms of behaviour that acts to
shapes ones individual behaviour. Cultural influence primarily involves religion.

(Bronfenbrenner, 1979)

According to Stokols (1996), strategied that focus on the environment benefits a large

number of people, not just an individual. Policy level interventions include passive

interventions that do not require sustained effort on the part on individual.

B. Operational Framework

The study aims to identify the capabilities of the Caloocan Local Government unit to

promote health in the presence of health threats such as infectious diseases. Interactions

between individuals’ behaviour and the environment contributes to health promotion.

Interventions or programs that involves individuals, the community, and the institution or

the government is important to achieve a better health outcome.

Individual interventions should focus on education in consideration of gender, ethnicity,

generation and culture, community focuses on the evaluation and monitoring of the

effectiveness and priorities for health promotion and institutional interventions should

focus on developing public policies and programs to respond to any health hazards in the

local government unit.

 Institution/Government
(Policies & Programs)

Health

Promotion

(Controlling
Communicable
Diseases)
Community Individual

(Effectiveness & Priorities) (Knowledge)

 Figure 1: Research Paradigm

VI. Definition of Terms

a) Communicable Disease – also: infectious disease; refers to a type of disease that can

be transmitted from human to human through different mode of transmissions that

might cause fatality; it doesn’t include transmittable diseases that doesn’t usually

cause deaths such as common colds.

b) Community – refers to the residents of the barangay as a whole including the

barangay officials.

c) Government – refers to the Caloocan Local Government Unit; particularly City

Health Department

d) Health Promotion – refers to the improved health status resulted from the collective

efforts from the individuals, community and government.

e) Individuals – refers to the residents of the barangays; with or without illness

f) Local Healthcare System – refers to the policies, programs and facilities of the

Caloocan City Local Government Unit.

g) Outbreak – refers to the occurrence of communicable diseases affecting large

number of people in a certain community or barangay

h) Primary Level of Care – refers to the interventions done within the capabilities of a

Barangay Health Center

 Chapter 2

Review of Related Literature

A. Communicable Disease and Mode of Transmissions

Communicable diseases, also known as infectious diseases or transmissible diseases, are

illnesses that result from the infection, presence and growth of pathogenic (capable of

causing disease) biologic agents in an individual human or other animal host. Infections

may range in severity from asymptomatic (without symptoms) to severe and fatal. The

term infection does not have the same meaning as infectious disease because some

infections do not cause illness in a host. (Wisconsin Department of Health Services, 2016)

Infectious diseases result from the interaction of agent, host, and environment. More

specifically, transmission occurs when the agent leaves its reservoir or host through

a portal of exit, is conveyed by some mode of transmission, and enters through an

appropriate portal of entry to infect a susceptible host. This sequence is called the chain of

infection. (Centers for Disease Control and Prevention, 2012)

Reservoirs which is the habitat of an infectious agent can be humans, animals and the

environment. Many common infectious diseases have human reservoirs which are

transmitted from person to person. Carriers commonly transmit disease because they do

not realize they are infected, and consequently take no special precautions to prevent
transmission. Symptomatic persons who are aware of their illness, on the other hand, may

be less likely to transmit infection because they are either too sick to be out and about, take

precautions to reduce transmission, or receive treatment that limits the disease. (Centers

for Disease Control and Prevention, 2012)

An infectious agent may be transmitted from its natural reservoir to a susceptible host in

different modes of transmission such as direct, indirect and droplet transmission. Direct

transmission usually occurs through skin-to-skin contact, indirect contact is through air

particles, vehicles (inanimate objects) or vectors which are usually insects such as

mosquitoes, flies and fleas.

According to Edemekon & Huang (2019), the most common forms of spread include fecal-

oral, food, sexual intercourse, insect bites, contact with contaminated fomites, droplets, or

skin contact. They believed that improving understanding of communicable diseases that

must be reported will lead to better patient outcomes.

B. Public Health Importance

Knowledge on the manner in which a pathogen enters a susceptible host through these

modes of transmission provides a basis for determining appropriate control measures,

which are usually directed at containing or eliminating the agent from the source of

transmission, protecting portals of entries and increasing host's defences against infectious

pathogens. (Centers for Disease Control and Prevention, 2012)

Public health law and guidelines plays a vital role in preventing and minimizing the spread

of infectious diseases. Clearly-defined legal powers with appropriate implementation are

needed to respond during outbreaks of fatal communicable diseases. (Magnusson, 2017)

Magnusson (2017), sees that coercive powers should be exercised for implementing

specific measures to prevent or reduce the community spread of diseases on the basis of a

demonstrable threat to public health. Governments should monitor the effectiveness of

public health interventions and ensure that they are based on sound science. Governments

must strive to ensure that there is a reasonable fit between the coercive measures imposed

on individuals, and the public health benefit that they seek to achieve. Governments should

consider the least burdensome measure available that is reasonably appropriate to

mitigate the risks for overstepping ethical boundaries.

The risks, benefits and burdens of public health interventions should be shared fairly. The

public should have an opportunity to participate in the formulation of public health

policies, and governments should give reasons for policies and decisions that restrict

individual freedoms. Openness and accountability are essential to generating public trust,

and are likely to improve public health decision-making. Without public trust and

voluntary cooperation, governments will find it harder to achieve their goals and to act in

the public interest. (Magnusson, 2017)

 C. Healthcare System of the Philippines

Health as a basic human right is enshrined in the 1987 Philippine Constitution (Article II,

Section 15), which declares “the State shall protect and promote the right to health of the

people and instil health consciousness among them”. The Department of Health (DOH),

served as the national technical authority on health, responsible to ensure the highest

achievable standards of health care, from which Local Government Units (LGUs), Non-

Government Organizations (NGOs), the private sector and other stakeholders anchor their

health programmes and strategies. (Office of the President of the Philippines, 1999).

As mandated under Republic Act 7160 or the Local Government Code of 1991, the delivery

of basic health services, which includes the operation and maintenance of local health

facilities such as provincial hospitals and health centers will be devolved from the

Department of Health (DOH) to provinces, cities and municipalities. Local government

units (LGUs) will be self-reliant and shall exercise the following duties and functions: (1)

general control and supervision over personnel and facilities, (2) the operation and

maintenance of local health facilities, (3) promotive, preventive, curative and rehabilitative

health programs and services, and (4) regulatory functions such as formulation and

enforcement of ordinances related to health, nutrition, sanitation and other related

concerns. (pp 9-10) In a devolved set –up, the DOH exercises oversight and regulatory

functions, provides technical assistance, formulates standards and guidelines, and manages

the operation of retained hospitals, regional medical centers, regional training and/or
teaching hospitals, specialized health facilities and national government hospitals. (pp 50-

51)

Dayrit et al. (2018), described that the Philippine health system is composed of the public

and private sectors. Health services provided in the public health facilities are managed by

the national and local governments financed through a tax-based budgeting system.

With the enactment of the Local Government Code of 1991, a decentralized system was

organized, wherein LGUs have full autonomy to finance and operate the local health

systems. As mandated by law, provincial governments are tasked with providing primary

and secondary hospital care, while city and municipal governments are tasked with

providing primary health care, promotive and preventive health programmes and basic

ambulatory clinical care.

The Department of Health (DOH), as the national health agency, is mandated to lay down

national policies and plans, develop technical standards, enforce health regulations, and

monitor, evaluate and deliver tertiary and specialized hospital services. The LGUs, on the

other hand, are responsible for managing and implementing local health programmes and

services. A local health board chaired by the local chief executive (governor or mayor)

serves as an advisory body to the local chief executives and the local legislative council

members (sanggunian) on the local health system, while the DOH Regional Health Office is

represented by either a DOH representative or Development Management. (Dayrit et. al.

2018)
The devolution implemented under RA 7160 transferred the management of programs and

services to locally elected politicians and their bureaucracies, fundamentally changing

relationships among health care providers, their managers and their sources of funds.

(Grundy, 2003). Health facilities are managed by the following administrative units: 1.)

Barangay health unit (managed by the barangay and municipal governments); 2.) rural

health unit (by municipal governments); 3.) city health offices (by city governments); 4.)

Municipal or “district hospitals (by provincial governments); 5.) provincial hospitals (by

provincial governments); and 6.) regional hospitals and medical centers (by the

Department of Health).

Clearly, there have been serious problems in the devolution of health services as mandated

under Republic Act 7160. Assessments of the quality of health services since the advent of

devolution conducted by independent experts have confirmed the “slow decay” in the

delivery of health services in some areas of the country. (Grundy, et al. 2003)

According to Grundy, et al (2003), among the problems that attended the devolution of

health programs and services were the absence of a strategic plan to introduce devolution,

no prior development of health staff or local executives and officials for their new roles, the

loss of regulatory control by DOH and the resulting conflict between health and political

objectives, fragmentation and lack of integration in services, and under financing.

The lack of preparation and strategic plan resulted in decreased hospital occupancy and

health center utilization rates; untimely and ineffective procurement of medicines and
supplies; decreased maintenance and operating expenses for health facilities; loss of

managerial and fiscal control of hospitals by hospital administration; resignation of key

personnel causing low staff morale. (Grundy et al, 2003)

Despite the effort of national government to augment LGU budgets, under financing

remains a serious problem. This is clearly indicated by lack of personnel, low utilization

rates and poorly maintained infrastructure and equipment. Provincial health expenditure

statistics, for instance, indicate very high expenditure on personnel but very low

expenditures on the delivery of services and capital expenses. (Grundy et al, 2003)

Untrained health staff or local officials for their new roles showed dysfunctional or simply

lack the technical administrative capacity such as generating statistics, profile, facts or data

for local planning and decision-making purposes; Low level of citizen involvement and

participation in local governance due to alienation, exclusion and poverty; Lack of

innovation and creativity in adapting measures for resource generation, mobilization and

asset management at the LGU level; Poorly designed training and development programs

for building capabilities of local officials including new health personnel causing rapid turn-

over and demoralization. (Grundy et al, 2003)

There is lack of collaboration and coordination among line agencies, without anyone

integrating, consolidating, and clustering mandates into a coherent and simplified system

to facilitate the delivery and provision of basic services; poor Referral System among health

institution is at a dismal state, contributing to mismanagement of resources and

detrimental to the delivery of health services particularly in times of emergencies. (Grundy

et al, 2003)

Grundy et al (2003), suggested specific recommendations to respond to these gaps which

should focus on the following categories: 1.) Increasing the benefits and salaries of Local

Healthcare Personnel and allow development of career path, 2.) Improving capability of

local health personnel and capacity to formulate coherent health plans and budgets , 3.)

Establish and strengthen the collaboration and referral of inter-local health systems and

their sub-systems , 4.) Increasing financial support for both national and local health

services to make it more responsive to the needs of the urban and rural poor.

, and 5.) Good governance by evaluation of health services and ensuring continuity of

relevant health programs regardless of change in leadership.

The World Health Organization (2011), sees that devolution has resulted to fragmentation

of administrative control of health services between the rural health units and hospitals

and between the different levels of political structure.

In July 2011, the DOH issued another policy on local health development through

Administrative Order N0. 2011–0008, outlining the framework for an intersectoral

approach to support the development of urban health systems in highly urbanized and

rapidly urbanizing cities. The policy goal is to improve health system outcomes in support

of UHC goals, taking into consideration the social determinants of health in urban settings
and focusing on the reduction of health disparities among the urban poor population.

(Department of Health, 2011).

Health Facilities Enhancement Program (HFEP) of the DOH is continually being pursued in

support of one of the DOH’s strategic approaches to improve the delivery of basic, essential

as well as specialized health services through the rationalization and critical upgrading of

health facilities nationwide. DOH (2016), aimed to upgrade priority Barangay Health

Stations (BHS) and Rural Health Units (RHUs), nearest to the communities, in order to

provide Basic Emergency Obstetrical & Neonatal Care (BEmONC). This is also in line to

upgrade clinics to provide emergency/primary care services, thus improved “gatekeeping”

function of primary care facilities. It also seeks to upgrade government Level 1 (primary)

hospital to Level 2 (secondary); and Level 2 hospital to Level 3 (tertiary) and provide

Comprehensive Emergency Obstetrical & Neonatal Care (CEmONC) services to prevent

congestion of large tertiary hospitals. Upgrading of health facilities assists government

hospitals to meet DOH Licensing & Philippine Health Insurance Corporation (PHIC)

accreditation requirements to provide quality and appropriate services, responsive to the

priority health needs of their catchment population.

In terms of physical infrastructure, the Philippine health sector has 1224 hospitals, 2587

city/rural health centres and 20 216 village health stations (2016 figures). Sixty-four per

cent of hospitals are Level 1 nondepartmental hospitals with an average capacity of 41

beds, and 10% are Level 3 medical centres and teaching hospitals, with an average capacity

of 318 beds. . Almost two thirds of hospital beds are in the island of Luzon, which includes
the National Capital Region (NCR). There are 23 hospital beds for 10 000 people in the NCR

while the rest of Luzon, Visayas and Mindanao have only 8.2, 7.8 and 8.3 beds, respectively.

(Dayrit et. al. 2018)

Dayrit et. al. (2018) added, that in terms of human resources for health, the top four cadres

of institution-based health workers are nurses (90 308), doctors (40 775), midwives (43

044) and medical technologists (13 413) based on 2017 figures. The first point of contact

for government-provided health services is the health centre and its satellite village health

station(s), which typically employs an average of one doctor, two nurses and five midwives.

D. Remaining Challenges of the Healthcare System

Since the Fourmula One for Health was implemented in the country, the Health sector has

made a significant progress in implementing these health reforms. However, present

efforts are not enough considering the challenges still remains. (DOH, 2016)

Health outcomes are generally improving, but there is a sluggish rate of improvement in

health outcomes compared to neighbouring countries. Many Filipinos suffer from diseases

that are preventable and treatable with cost-effective interventions such as HIV, TB,

dengue and VPDs such as measles and diphtheria. Addressing health system inefficiencies

and health inequities due to disorganized governance, fragmented health financing, and

devolved and pluralistic service delivery remain critical challenges to the Philippine health

system. (Dayrit et. al. 2018)

The country continues to combat pneumonia 52.5% per 100,000 population and TB 23.8%

per 100,000 population, as the leading causes of death among Filipinos (DOH, 2014). Data

from Institute for Health Metrics and Evaluation (2018), shows that among the leading

causes of disability-adjusted life years (DALYs) lost, are infectious diseases such as TB and

lower respiratory tract infections. This may be indicate the need to improving access to

health services and advances in the management and treatment of infectious diseases such

as pneumonia and TB.

Strategies to ensure the attainment of the goals include: (1) deploying community health

teams (CHTs) to assist families in navigating the health system; (2) using the life-cycle

approach for providing health care, including family planning, ANC, delivery in health

facilities, essential newborn and postpartum care, and the Garantisadong Pambata package

for children 0–14 years of age; (3) aggressively promoting healthy lifestyles to reduce

NCDs; and (4) ensuring public health measures to prevent and control communicable

diseases, tighten health surveillance, and prepare for emerging and re-emerging diseases.

(Dayrit, 2018)

Despite the advances in the management and treatment of infectious diseases, many

Filipinos continue to suffer from diseases for which effective interventions are available.

These include human immunodeficiency virus (HIV) infection, TB and vaccine-preventable

diseases (VPDs) such as measles and diphtheria. (Dayrit, 2018) DOH Epidemiology Bureau

(2014), nationwide data shows that, Acute Respiratory Infection is the most common cause

of morbidity with a total of 1,445,320 cases. This is a 33.5% and 34.8% decrease in number
from the 2013 with 2,174,740 cases Measles showed an increase both in number of cases

and number of deaths, as compared to 2013. The diseases reported as the leading causes of

morbidity in 2014 were much lower in rates and in number as compared to 2013.

However, Measles cases were five times higher in 2014 as compared in 2013. It recorded a

513% increase from 2.3 cases per 100,000 population in 2013 to 14.1 per 100,000

population in 2014. On the other hand, Malaria and Dengue recorded the highest percent

decrease in rate from 2013 to 2014, with 95.0% and 72.3% consecutively.

Communicable Diseases were among the top reported diseases that cause morbidity in the

National Capital Region. Bronchitis with 46,132 reported cases, TB (other forms) with

18,513 cases, chicken pox with 5,270 cases, Measles with 3,956 cases, influenza with 3,880

cases, followed by Acute Lower Respiratory Tract Infection (ALRTI) and Pneumonia with

1,857 reported cases and dengue fever with 1,816 cases. (DOH Epidemiology Bureau,

2014)

In 2019, the country has reported outbreaks of dengue, diphtheria, measles and polio. Data

shows that there was a 371,717 dengue cases which is a 106% increase on compared to

2018 leading DOH to declare national dengue epidemic. For Diphtheria there were 197

reported cases, which is a 47% increase in cases compared to 2018. In addition, over

42,000 cases were affected by the measles outbreak. These outbreaks of communicable

diseases indicates that efforts on vaccination which is usually done in the primary

healthcare level is insufficient. (The Lancet, 2019)

The national objectives for health have well-specified targets, but Dayrit et. al. (2018),

observed that progress of local governments towards these targets remains highly uneven

due to devolved health financing and service delivery. Strong political support and wider

fiscal space do not automatically impact on health system performance, as there is lack of

institutional capacity to translate policy into effective programme implementation,

monitoring and evaluation.

The health system is generally unable to respond to the growing population as shown by

the stagnant number of hospitals and RHUs (World Bank, 2011b). Government health

facilities have deteriorated due to inadequate investments in upgrading their capacity and

improving the quality of services.

As of October 2010, 892 RHUs and 99 public hospitals did not qualify for PhilHealth

accreditation (Department of Health, 2010). Hospitals categorized as Level-1, which

account for almost 56% of the total number of hospitals, have very limited service capacity,

comparable only to infirmaries (Department of Health, 2009). To address the low capital

investment in health facilities, the DOH lobbied for creation of the HFEP in 2007 to

revitalize PHC facilities and rationalize the various levels of hospitals to decongest end-

referral hospitals.

Although the Philippines is one of the largest exporters of health personnel in the world,

there are shortages of physicians and nurses in the country. In particular, LGUs have

difficulty in attracting and retaining medical professionals to comply with the staffing
required by the DOH licensing policy. This is often due to the low level of remuneration and

widespread partial compliance with Magna Carta benefits22 (World Bank, 2011).

E. Utilization of Primary Healthcare

The absence of a facilitated referral system robs the patient of the opportunity to navigate

the health system effectively – from identifying the appropriate health-care provider, to

getting advice on needed medical tests or procedures and referral back from hospitals to

primary care for continued health care. Patients often bypass the first (primary care) level

to seek care in hospitals, as there is no effective referral system or gatekeeping at the

primary care level, which also contributes to inefficiencies and increasing cost of care.

(Dayrit et. al. 2018)

According to Picazo OF (2016), in an RHU or city health centre, the average number

patients seen daily was 50 but this number could be as high as 250 with the recent

upgrading of facilities through the hospital facilities enhancement program of the DOH.

In the 2008 National Demographic and Health Survey (NDHS), 50 percent of the clients

who sought medical advice or treatment consulted public health facilities, 42 percent went

to private health facilities, and almost 7 percent sought alternative or traditional health

care. Rural Health Units (RHUs) and Barangay Health Centers (33 percent) were the most

visited health facilities in almost all the regions except for NCR and CAR, where most of the

clients visited private hospital/clinic for medical advice or treatment. The most common
reasons for seeking health care were illness or injury (68 percent), medical checkup (28

percent), dental care (2 percent), and medical requirement (1 percent) (National Statistics

Office, 2008).

The NDHS 2013 showed that more patients seek consultation in public facilities compared

to private facilities. Of 7482 persons surveyed, 11% had sought consultation at a primary

facility 30 days before the survey: 7% went to public facilities, while 4% visited private

facilities. The reasons given for seeking health care were: sickness/injury 60.5%; medical

checkup/medical requirement 24.3%; requirement of CCT programme 5.6%;

prenatal/postnatal check-up 4.8%; immunization 2.9%; dental care 1%; gave birth 0.5%;

family planning 0.2% (Philippine Statistics Authority and ICF International, 2014).

The poorest quintile went to government facilities, while the wealthiest went to private

facilities. Of the lowest quintile, 83.4% went to government facilities compared to 9.8%

who visited private facilities. Of the highest quintile, 20.6% visited government facilities

while 72.6% went to private facilities (Philippine Statistics Authority and ICF International,

2014).

Social Weather Station (2006), found out that majority of Filipinos specifically the low

income households prefer to seek treatment in a government hospital if a family member

needs confinement. Affordability is the main reason for going to a government medical

facility, while excellent service is the main reason for going to a private medical facility

(DOH, 2010). The net satisfaction with services given by government hospitals has slightly
improved from +30 in 2005 to +37 in 2006. Excellent service and affordability are the main

reasons for being satisfied whereas poor service is the main reason for being dissatisfied

with the services given by government hospitals (Social Weather Stations, 2006)

Maessener et al (2007) believes that the main contributions of Primary healthcare in a

community are the following: 1) accessibility to needed health services. 2) better quality of

care 3) greater focus of prevention 4) early management of health problems 5) cumulative

management of main primary care delivery characteristicsreducing unnecessary or

potentially harmful interventions. Primary healthcare teams serves as the “navigator”

through cost-effective care. Co et al (2018), pinpoint the persistent need for national level

public health interventions to focus on community health and social determinants of health

as well as individual health, with the assumptions that good community-level health care

and holistic development can redound to good national health outcomes, and that ideal

community health and development can only be attained by participation and

empowerment. It was therefore recommended that standard metrics for community

empowerment should also be developed and implemented by government, in order to

ensure sustainable health and development, and the scientific validity of community health

interventions.

The DOH & WHO (2019), highlight the need to strengthen primary health care as the

foundation for the Universal Health Care (UHC) Act. The newly-signed RA 11223 or

Universal Healthcare Law, aims to develop a healthcare system that will provide all
Filipinos access to full continuum quality and cost-effective, promotive, preventive,

curative, rehabilitative and palliative health services.

The law requires every Filipinos to be enrolled with a primary health care provider of their

choice. Primary care provider refers to a health care worker, with defined competencies,

who has received certification in primary care as determined by the Department of Health

(DOH) or any health institution that is licensed and certified by the DOH. They will also

serve as the person in charge of referring and coordinating with other health centers if

patients need further treatment. (RA 11223, 2019)

The law also requires the DOH to work with the Department of the Interior and Local

Government (DILG) to have province- and city-wide health systems or network.

Provinces and highly urbanized cities will now be in charge of overseeing health services in

areas as opposed to the current set-up where municipalities are tasked with managing

their own health centers. (RA 11223, 2019)

The law also mandates both public and private hospitals and health insurers to maintain a

health information system that will contain electronic health records, prescription logs, and

“human resource information. This system will be developed and funded by DOH and

PhilHealth. (RA 11223, 2019)

The Act aims that all Filipinos get the health care they need, when they need it, without

suffering financial hardship as a result. Although there is much work to be done to

implement the UHC Act, it takes a critical step towards achieving health for all in the

Philippines. It is a new dawn for health care and real progress towards achieving UHC.

(WHO,2019)

F. Synthesis

In a large, populated rural and urban areas across the country, healthcare delivery system

is fragmented, caused by devolution and primary healthcare was not given priority by local

government units. Programs for health reforms have already been initiated, however,

effectiveness on implementation is constrained by varying priorities of political leaders and

even the DOH through time. Sustainability of health programs is always a challenge

because of political traction and leadership, unless programs are covered under a law.

Mainstreaming of health policy reforms through enactment of national laws might ensure

sustainability of these reforms.

Thus, implementation of the Universal Healthcare Law might lead to sustainability of heath

programs and improve Philippines healthcare system, especially in the primary level of

care which was given less priority. Giving importance to primary healthcare helps with the

following: (1) increase access to essential health services especially for deprived residents,

(2) provides strong foundation for health prevention (3) early disease detection which is

vital for controlling spread of infectious diseases, and (4) promotion of effective

coordination and referral to higher level facilities if needed.

Strengthened response and preparedness for public health threats such aid in prevention

and control of outbreaks or possible pandemics. Strategies, policies, and institutional and

management structures, that are geared to helping at-risk communities safeguard their

lives and assets by being alert to such health hazards and taking appropriate action is a

priority. There is an old adage that states that "an ounce of prevention is worth a pound of

cure."
 Chapter 3

Methodology

A. Research Design

This is a descriptive study that aims to describe systematically the primary healthcare

system of the Caloocan LGU in responding to infectious diseases. The study will employ

both quantitative and qualitative approaches in gathering data from the Caloocan City

Health department and its barangay health centers to identify the capabilities of its health

system to prevent community spread of communicable diseases.

Qualitative method will describe the current and existing programs for controlling

infectious dieases; the priorities of the primary healthcare system; the interventions to

implement and disseminate information to the community involve; and the limitations of

the services the LGU and Baranggay Health Centers can provide in response to

communicable dieases. On the other hand, Quantitative method will measure the

effectiveness of these health services and programs based on the participants view.

B. Research Instruments

The study will use survey method in gathering the data needed to describe the capabilities

to the Caloocan City Healthcare system in controlling and preventing spread of infectious

dieases. The researcher will use questionnaire and interview based participants’

willingness and availability. The questionnaire seeks to identify the following:

A. The current health programs of the LGU or Baranggay Health Center offers

regularly.

B. The current health programs of the LGU or Baranggay Health Centers to prevent

communicable diseases.

C. The current services or interventions done by the LGU or Barangay Health Centers

to respond in the presence of communicable diseases in an individual.

D. The current services or interventions done by the LGU or Barangay Health Centers

to respond in the presence of communicable diseases in the community.

E. What are the health programs that the LGU or Barangay prioritized for the past 6

months.

F. The health programs that the LGU or Barangay Health Center prioritized for the past

6 months.

G. The health programs that the LGU or Barangay Health Center prepared in cases of

infectious diseases outbreaks.

H. The necessities of the barangay Health Centers to provide service to respond to

communicable diseases outbreaks.

I. The limitation of the health service offered in the Barangay Health Center.

J. The process of Barangay Health Center in referring cases of communicable diseases

to the City Health department.

K. The community participation in preventing spread of infectious diseases.

L. The programs of the LGU and Barangay Health Center to educate the community to

ways of preventing spread of infectious diseases.

M. The level of satisfaction on the service that Barangay Health Center provides.
 N. The level of completeness of primary health services that the Barangay Health

Center provides.

O. The areas of improvement needs to be addressed and prioritize in the Barangay

Health Center.

C. Population and Samples

The survey questionnaire will be answered by health staffs from the Caloocan City Health

Department and 10 barangay health centers in the city through Simple Random Sampling.

Health staffs will include doctors, nurses, midwifes and barangay health workers

considering that the participants should be working for at least 6 months in the

organization.

D. Data Gathering Procedure

The researcher will sought permission from the Caloocan LGU to be allowed to distribute

questionnaire or conduct an interview to the health staffs of the City Health Department

and selected Barangay Health Centers of Caloocan City.

E. Data Analysis

The researcher will use content analysis method in the interpretation of the data gathered

through survey. Answers by the respondents will be thoroughly analyse to describe the

healthcare system of Caloocan City to attain the objectives of the study.