i

EXTENT OF EFFECTIVENESS OF THE HEALTH CARE SERVICES AS PERCEIVED BY IN-PATIENTS AND OUTPATIENTS IN THE NEW BILIBID PRISON: BASIS FOR AN IMPROVED HEALTH CARE PROGRAM FOR INMATES

A Masters Thesis Presented to The Faculty of Graduate School of Education University of Perpetual Help System DALTA Las Pias City

In Partial Fulfillment of the Requirements for the Degree Master of Arts in Nursing Major in Nursing Administration

HASMIN P. SESCAR, RN. November 2011

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APPROVAL SHEET This thesis entitled EXTENT OF EFFECTIVENESS OF THE HEALTH CARE SERVICES AS PERCEIVED BY IN-PATIENTS AND OUTPATIENTS IN THE NEW BILIBID PRISON: BASIS FOR AN IMPROVED HEALTH CARE PROGRAM FOR INMATES prepared and submitted by HASMIN P. SESCAR in partial fulfillment for the degree of Master of Arts in Nursing Major in Nursing Administration has been examined and recommended for acceptance and approval of final oral examination.

ALBERTO P. MENDOZA, EdD. Adviser

ORAL EXAMINATION COMMITTEE Approved by the Committee on Oral grade of __________________ . Examination with a

FLORENCIA C. MARFIL, EdD. Member

IMELDA O. JAVIER, RN. MAN. Member

HAZEL N. VILLAGRACIA, EdD. Chairman Accepted and approved in partial fulfillment of the requirements for the degree of Master of Arts in Nursing Major in Nursing Administration.

IRENEO F. MARTINEZ JR., LLB, MBA, PhD. Dean, Graduate School

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ACKNOWLEDGMENT The author would like to express her deepest gratitude to a number of people who made it possible for her to finish this research work. First and foremost, her profound gratitude to her adviser, Dr. Alberto P. Mendoza, who provided his valuable inputs and insights which contributed greatly to the fulfillment of the study. His unselfish and untiring guidance, patience and support throughout this study have provided encouragement to the accomplishment of this study. Likewise, this work will not be a reality without the incontestable knowledge of her statistician, Dr. Jesus B. Gollayan, for his expertise in the formulation of the statistical treatment of this study. Furthermore, the author expresses her appreciation to the distinguised panel, Dr. Eric D. Olivarez, Dr. Naomi De Aro, Dr. Florencia C. Marfil, Ms. Imelda O. Javier, RN., MAN., and the chairman Dr. Hazel N. Villagracia, who shared their expertise in the improvement of this research study as well as their brilliant ideas and insights. The author also expresses her appreciation to the experts who validated the instrument: Dr. Dominador M. Narag, Dr. Mericia

L. Bolivar, and Dr. Gloria M. Alberto.

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Expression

of

deepest gratitude is due to her

excellent

professor, Dr. Hazel N. Villagracia, for her wisdom and humility and demonstrated her sincerest support. The author felt her utmost concern that encouraged and inspired her to be a good educator and hopefully a future nursing leader. Most importantly, the author expresses her deepest gratitude and love to her family, who serves as her inspiration in life. Mr. Henry A. Pareja and Mrs. Aurora E. Pareja, her supportive and loving parents, whose love and upbringing made her the person she is now. Her siblings, nephews and niece, for their love and concern inspired the author to go on despite of the hindrances that have occurred along the way. Mr. Manuel L. Sescar Jr., the loving and patient, understanding and responsible husband of the author, for being her inspiration and strength during the undertaking of this study. His selfless support and unconditional love soothe the authors anguish encountered during the endeavor of this study. Her loving children, Jayman, Januelle and Jashuel, are the reasons of her aspirations. Their effort in studying well and achieving in school creates a sense of fulfillment.

For those who have helped in one way or the other in the fulfillment of this work, a million thanks to you; The realization and success of this work is owed to our God Almighty, for the countless blessings, love and guidance, health and strength He has bestowed her.

H. P. S.

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ABSTRACT Name of the Institution: University of Perpetual Help System DALTA Address: Title: Pamplona, Las Pias City Extent of Effectiveness of the Health Care Services as Perceived by In-Patients and Outpatients in the New Bilibid Prison: Basis for an Improved Health Care Program for Inmates Author: Degree: Major: Date of Completion: Hasmin P. Sescar, RN. Master of Arts in Nursing Major in Nursing Administration November 2011

STATEMENT OF THE PROBLEM: This study was designed to determine the extent of effectiveness of the health care services as perceived by in-patients and outpatients in the New Bilibid Prison: basis for an improved health care program for inmates. Specifically, it sought answers to the following questions: 1) What is the demographic profile of the inmate-respondents according to:

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1.1. Age; 1.2. Existing patient classification (in-patient and outpatient); and 1.3. Length of stay in the New Bilibid Prison, Bureau of Corrections? 2) What is the demographic profile of the inmate-respondents in the year 2009 and 2010 in terms of: 2.1. Morbidity; and 2.2. Mortality? 3) What is the extent of effectiveness of the health care services in the New Bilibid Prison according to DOH Standards of Care? 3.1. Mission and vision; 3.2. Staffing; 3.3. Medical supplies; 3.4. Programs; and 3.5. Facilities and equipment? 4) Are there significant differences in the extent of effectiveness of health care services as perceived by in-patients and outpatients in the New Bilibid Prison? 5) What improved health care program for inmates may be proposed?

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METHODOLOGY: The descriptive design of research was employed in this study. A survey instrument was prepared to determine the demographic profile of the in-patient and outpatient respondents, their perception on the extent of effectiveness of the health care services in the New Bilibid Prison as a basis for the improved health care program for inmates. Moreover, the study also made use of documentary analysis of the morbidity and mortality of inmate-respondents during the fiscal year 2009-2010. The respondents in this study included the in-patients of the New Bilibid Prison Hospital, irregardless of their illness and length of hospital confinement and outpatients who sought regular consultations at the Out Patient Department (OPD) during the fiscal year 2009 - 2010. Purposive sampling was used since the respondents were chosen on the basis of their current patient classification, capability to write and the regularity of check up at the OPD for outpatients. Tagalog questionnaire was utilized for 100 in-patient and 300 outpatient respondents and responses would depend on the choices of a five point scale. Likewise, the researcher utilized frequency count, percentage, weighted mean, and ranking to facilitate the description of important features of the data. Inferential Statistics was applied particularly, t-test

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for independent samples, to compare the perceptions of the in-patients and the outpatients on the extent of the effectiveness of the health care services in the New Bilibid Prison. Significance of difference was tested at five per cent level. FINDINGS: Based on the analysis and interpretation of the data gathered for this study, the following results were disclosed: 1. Relative to specific problem number 1, the demographic profile of inmate respondents showed that: a) according to age, majority of the in-patients and outpatients were found to be in age brackets 41-50 and 51-60, b) according to patients classification, majority of the respondents were outpatients, comprised of 60 per cent of the total number of patient, c) and according to length of

stay in prison, both group respondents who have the lowest length of stay in prison have a high frequency and percentage. 2. With reference to specific problem number 2, the demographic profile of inmate respondents showed that: a) in terms of

morbidity, there was a substantial decreased in total number for in-patients, while there was an increased in total number for outpatients from fiscal year 2009 to 2010, b) in terms of mortality,

there was a slight decreased in total number from fiscal year 2009 to 2010. 3. Pertaining to specific problem number 3 on the perception of two groups of inmate respondents on the extent of effectiveness of the health care services in relation to the mission and vision, staffing, medical supplies, programs, facilities and equipment, the following results surfaced: a) both groups perceived that the mission and vision of the health care system were well employed and assessed as N-Nasusunod, b) both groups perceived that the staffing of the NBP was organized and adequate and assessed as N-Nasusunod, c) the in-patients perceived that there were enough medical supplies available to sustain their health needs, their assessment were N-Nasusunod, while the

outpatients perceived that there were slight deficiency in medical supplies to sustain their health needs and were assessed as B-NBahagyang Nasusunod, d) both groups perceived that the health program of the NBP was proper and acceptable and was assessed as N-Nasusunod, e) the in-patients perceived that

the facilities and equipment were enough to accomodate various health situations and were assessed as N-Nasusunod, whereas the outpatients perceived that the present facilities and

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equipment

were partly insufficient to meet enormous health

conditions and were assessed as B-N-Bahagyang nasusunod. 4. With reference to specific problem number 4 on the significant differences in the extent of effectiveness of the health care services in the New Bilibid Prison as perceived by the in-patients and outpatients, the results revealed that there were no significant differences between the perceptions of the

respondents. 5. Relative to the specific problem number 5 on the proposal of an improved health care program for inmates, formulation of an attainable proposed health program based on the perception of the respondents. CONCLUSIONS: In the light of the above findings, the following conclusions were drawn: 1. The middle-age patients in both group respondents exhibited substantially higher cases of illness than those of the other age brackets. As the number of prisoners continues to grow and to age, timely prevalence estimates of chronic health conditions as well as acute diseases become increasingly manifested, further aggravated by various prison environmental factors.

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2. Between the two group respondents the outpatients comprised the majority of patients than the in-patients in the New Bilibid Prison. 3. Inmates with the shortest years stay in prison exhibited a greater incidence and prevalence of illnesses than those with long years of stay in prison. The following factors may have contributed to prisoners disease prior to incarceration such as: low

socioeconomic status, poor access to health care in their home communities, and high risk behaviors. Following incarceration, a number of environmental factors including crowded living

conditions, lack of ventilation, poor sanitation, and increased psychological stress may further contribute to it. 4. Morbidity and mortality decreased from fiscal year 2009 to 2010. 5. There was an effective health care service in the New Bilibid Prison in relation to: mission and vision; staffing; medical supplies; programs; and facilities and equipment, as perceived by the inpatients. 6. The outpatients perceived that there was an effective health care service in relation to the mission and vision, staffing, and programs. However, in relation to the medical supplies, facilities

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and equipment, the said areas were partly not effective in terms of health care services. 7. The overall perception of both group respondents on the extent of the effectiveness of the health care services is assessed as NNasusunod. Both group respondents perceived that the current health care program is able to meet the overall health needs of inmate patients. 8. The inadequacies perceived by the outpatients as to the medical supplies such as, medicines, syringes, cotton, gauze, intravenous fluids, intravenous tubes, nasogastric tubes, insulin, etc., facilities and equipment such as blood pressure apparatus, nebulizer, suction apparatus, electrocardiogram machine, X-ray machine, oxygen tank, stethoscope, defibrillator, cardiac monitor, operating room, emergency room and equipment, wards, etc. are some of the inherent problems of the New Bilibid Prison (NBP). 9. There were no significant differences in the extent of effectiveness of the health care services in the New Bilibid Prison as perceived by in-patients and outpatients. 10. The proposal on the improved health care program depends on the perception of the respondents in the effectiveness of the health care services of the New Bilibid Prison.

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RECOMMENDATIONS: Based on the findings and conclusions made in this study, the following recommendations were recommended: 1. To organize efficient delivery of health care in prison systems, correctional administrators should study the detailed information on the disease patterns of their populations. The officials of the Bureau of Corrections should have regular coordination and collaboration to be able to come up with a precised resolutions pertaining to the inmates health conditions. Bureau officials should come up with new policies based on ascertain needs. 2. There should be continuity on the current health care program to determine the effectiveness of such. 3. Regular and efficient monitoring on the availability of medical supplies such as, medicines, syringes, cotton, gauze,

intravenous fluids, intravenous tubes, nasogastric tubes, insulin, etc. should help determine the need for an additional purchase order as needed. Availability of medical supplies is necessary especially in prison camps, for the reason that emergency cases are inevitable in such a place. These would lessen mortality cases in times of aggression among gangs. Equal distribution of medical supplies for in-patients and outpatients should be

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strictly

implemented. This would reduce hospital confinement

for outpatients and lessen mortality among in-patients. 4. A health promoting prison should be created with the participation of each member of the staff. 5. Giving recognition to the staff for purposes of motivating them to effectively carry on with the current excellent provision of health care. Recognizing the effort of the health care personnel would make them feel valued and would inspire them. 6. Given the current health problems in prisons, staff members should know and understand how there could be minimized and how health and well-being could be promoted. 7. Physicians and nurses and other professionals working in prisons have a unique leadership role in developing the health promoting prison. They should start from a sound basis of

professional training in which issues such as confidentiality, patient rights and human rights have been fully covered and discussed. They should also have some knowledge of how diseases spread and of how lifestyles and socioeconomic background factors can influence ill health. They should also be aware of human nutrition and of the importance of exercise and fresh air in promoting health. They should be alert to potential

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threats to health and able to detect early signs of mental health problems. 8. Top level management of the hospital should have a firm stand on the need for increased budgetary allocation for the needed equipment and for the improvement of facilities. 9. Regular contact with local community services should be established and the involvement of voluntary agencies should be solicited to promote health and well-being in prisons. Where possible, prisoners should be connected to key

community services before leaving the prison cell, such as probation or parole and social services.

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TABLE OF CONTENTS PAGE TITLE PAGE APPROVAL SHEET ACKNOWLEDGMENT ABSTRACT TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES i ii iii vi xvii xx xxiii

CHAPTER I THE PROBLEM AND ITS BACKGROUND Introduction Setting of the Study Theoretical/Conceptual Framework Conceptual Paradigm Statement of the Problem Hypothesis of the Study Scope and Limitations of the Study Significance of the Study Definition of Terms 1 6 8 14 15 17 17 18 19

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REVIEW OF RELATED LITERATURE Related Literature Related Studies Synthesis 21 40 56

METHODOLOGY The Research Design Population and Sampling Respondents of the Study The Research Instrument Validation of Instrument Data-Gathering Procedure Statistical Treatment of Data 60 61 61 63 65 65 66

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS Summary Findings Conclusions Recommendations

68

113 115 118 120 124

REFERENCES

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APPENDICES A Letter Request for the Director, Bureau of Corrections Letter Request for the Officer-In-Charge of the New Bilibid Prison Hospital Certification of Statistical Treatment Letter for the Respondents Questionnaire for the Inmate Respondents

128

129 130 131 132 137

C D E

CURRICULUM VITAE

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LIST OF TABLES TABLE 1 Frequency and Percentage Distribution of Patient Classification According to Leading Illnesses (2009 2010) 2 Frequency and Percentage Distribution of Inmate-Respondents According to Age Distribution of Respondents According to Patient Classification Frequency and Percentage Distribution of Inmate-Respondents According to Length of Stay in Prison Frequency and Percentage Distribution of In-Patients According to Monthly Morbidity (F.Y. 2009-2010) Frequency and Percentage Distribution of Outpatients According to Monthly Morbidity (F.Y. 2009-2010) Frequency and Percentage Distribution of Inmate-Respondents According to Monthly Mortality (F.Y. 2009-2010) Mean Scores According to In-patientRespondents in Relation to Mission and Vision (n=100) Mean Scores According to In-patientRespondents in Relation to Staffing (n=100) Mean Scores According to In-patientRespondents in Relation to Medical Supplies (n=100) PAGE

62

69

70

71

73

75

77

78

81

10

83

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11

Mean Scores According to In-patientRespondents in Relation to Programs (n=100) Mean Scores According to In-patientRespondents in Relation to Facilities and Equipment (n=100) Mean Scores According to OutpatientRespondents in Relation to Mission and Vision (n=300) Mean Scores according to OutpatientRespondents in Relation to Staffing (n=300) Mean Scores According to Outpatient Respondents in Relation to Medical Supplies (n=300) Mean Scores According to Outpatient Respondents in Relation to Programs (n=300) Mean Scores According to Outpatient Respondents in Relation to Facilities and Equipment (n=300) T- Computed Value on the Significant Differences between the Perceptions of In-patients and Outpatients in the Mission and Vision of the Health Care Services T- Computed Value on the Significant Differences between the Perceptions of In-patients and Outpatients in the Staffing of the Health Care Services T- Computed Value on the Significant Differences between the Perceptions of In-patients and Outpatients in the Medical Supplies of the Health Care Services

85

12

88

13

90

14

93

15

95

16

97

17

100

18

102

19

103

20

104

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21

T- Computed Value on the Significant Differences between the Perceptions of In-patients and Outpatients in the Programs of the Health Care Services T- Computed Value on the Significant Differences between the Perceptions of In-patients and Outpatients in the Facilities and Equipment of the Health Care Services T Computed Value on Summary of Significant Differences in the Extent of Effectiveness of the Identified Areas of Health Care Services

105

22

106

23

107

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LIST OF FIGURES

FIGURES 1 Conceptual Paradigm of the Study

PAGE 14

1 Chapter 1 THE PROBLEM AND ITS BACKGROUND

Introduction Health is a universal right. The state recognizes health as a basic human right. It protects and promotes the right to health of the people and instills health consciousness among them. Although this provision is guaranteed by the 1987 Constitution (Article II, Section 15) and the health care system in the Philippines is generally extensive, access to health services, especially by the poor, is still hampered by high cost, physical and socio-cultural barriers, (DOH). People who are in prison have the same right to health care as everyone else, Andrew Coyle (2004). A continuing challenge in public health is to get services to the people who need them the most,

especially those who are hardest to reach. Yet it is a sad reality of life that, at any one time, a high proportion of those with multiple health problems are incarcerated in the prisons of each country. They are

certainly reachable, for a certain period at least. It is increasingly being recognized that good prison health is Nata good public health, by Dr.

Menabde, Deputy Regional Director, WHO Regional Office for

Europe, (2008).

2 One of the strongest lessons from the end of the last century is that public health can no longer afford to ignore prison health. societies try As all

to cope with these serious health problems, it becomes

clear that any national strategy for controlling them requires developing and including prison policies, as prisons contain, at any one time, a disproportionate number of those requiring health assistance,(WHO). Health care systems are designed to meet the health care needs of target populations. There are a wide variety of health care systems around distributed made more religious, or the world. In some countries, health care system planning is among market participants, whereas in others planning is centrally among governments, trade unions, charities,

other coordinated bodies to deliver planned health care populations they serve. However, health care

services targeted to the

planning has often been evolutionary rather than revolutionary, (WHO). All prisons are different, but they share common challenges. Countries vary considerably in the resources available for improving prison services. The current position of prison health services varies prisons throughout the world. Some countries with

substantially in

basic or rudimentary services will need support to introduce their different approaches. Others are in more favorable positions. But the organization believes that all countries will find some areas of their

3 prison health services that could be improved and will gain from careful consideration of this guide, (WHO). Sustainability can best be achieved if strong links are

created between prison health care services and the health services of the local community and if they work in close cooperation. Such

collaboration will help to prevent prisons from being used as default health care services. Many essential components are required to achieve a health promoting prison, including political leadership, management leadership and leadership by each staff member. Health care staff members have a special role to play, but prisoners also have a role, and community support is important, National Commission on Correctional Health Care (NCCHC). Good prison health creates considerable benefits. It prevents the spread of diseases and promotes health through awareness of what everyone can do to help maintain their own health and well-being and that of others. In addition, however, it can help to improve the health status of communities, thus contributing to health for all. It is not sufficiently recognized that the prison service is a public

service and meeting some fundamental needs of society, such as the need to feel safe and to feel that crime is sufficiently punished and

reparations made. With all public services, of provision depend on a political decision.

the extent and the

quality

Political support for healthier

prisons should be based on the

recognition that, good prison health is essential to good public health; good public health will make good use of the opportunities presented by prisons; and prisons can contribute to the health of helping to improve people in society. The need to change and improve practices can best be accepted, and change achieved, if the people concerned have the knowledge, appropriate attitudes and the understanding as to why their practice should be different. This guide should help countries that seek reform these needs, but the guide will have to be available in a communities by

the health of some of the most disadvantaged

in meeting

language the staff

can understand.

The most important immediate step for policy-makers to take may be to ensure that this guide is translated for their prison staff. Prisons in modern societies are complex places to manage. The phenomenon of prison overcrowding, the epidemics of for serious housing

life-threatening diseases, the continued use of prisons mentally ill people

and the high levels of substance abuse in many

5 countries have all contributed to increasing the pressures on management at all levels. The goals for health systems, according to the World Health Report 2000 Health systems: improving performance (WHO, 2000), are good health, responsiveness to the expectations of the population, and fair financial contribution. Duckett (2004) proposed a two dimensional approach to evaluation of health care systems: quality, efficiency and acceptability on one dimension and equity on another. Likewise, the Bureau of Corrections Operating Manual (2000), Republic of the Philippines, Department of Justice, Part V, Chap. 1., Sec. 2., states that health care and services shall be given to inmates similar to those available in the free community and subject to prison regulations. A prison shall have at least one qualified medical doctor and a dentist. As a staff nurse in the New Bilibid Prison Hospital for fifteen (15) years, the researcher walks a fine line between maintaining security and delivering optimal nursing care. Nurses who work in prison camps

must have strong assessment skills and be fearless in their approach because a patient is depending on them. The general objective of the study is to determine the extent of effectiveness of health care services in the New Bilibid Prison and to be able to ascertain if the existing health programs are still effective in

6 meeting the health needs of inmates. Thus, this research is intended to raise health service standards of the New Bilibid Prison towards the improvement of inmates well-being. Setting of the Study

This study was focused on the New Bilibid Prison, Bureau of Corrections, Muntinlupa City. The Bureau of Corrections (BuCor) is

an agency under the Department of Justice tasked to effectively safekeep and rehabilitate national prisoners those sentenced to

three (3) years one (1) day and above. It is composed of seven (7) operating institutions strategically located all over the country accept national prisoners from t he nearest to

region, pursuant to

Department Circular No. 4 dated January 15, 1991, signed by then Secretary Franklin Drilon on the subject Commitment of National

Prisoners to the Penal Institution Under the Bureau of Corrections. The Central Office of the BuCor is located in the New Bilibid Prison, where the Director, the 2 Assistant Directors and administration staff are holding their official functions. Noteworthy is the fact that the New Bilibid Prison has become a tourist attraction not only with the presence of 5 Historical Sites which was declared by the Historical Commission in 1999, namely (1) Administration Building, (2) Directors Quarters, (3) Jamboree the general

7 Lake, (4) Grotto and (5) Japanese Shrine; but because of the improvements in the physical structure and cleanliness of the area. Inside the maximum compound of the Bureau of Corrections is where the New Bilibid Prison Hospital is located. It is a secondary health care facility, thus referral to a tertiary government health care facility is warranted. At present, the Bureau of Corrections has its own Mission and Vision quoted hereunder: Mission: To maximize the assets value of the Bureau of Corrections to effectively pursue its responsibility in safely securing and transforming national prisoners through responsive rehabilitation

programs managed by professional correctional officers. Vision: A world class correctional organization that provides an opportunity to develop professional, disciplined, spiritually guided environment for Bureau of Corrections stakeholders and for inmates to become productive, responsible and law-abiding citizen. Whereas, the mission and vision of the New Bilibid Hospital are stated as follows: Mission: The optimum provision of health care services for Prison

their inmates and the employees within the resources afforded by the government through quality medical services.

8 Vision: A competitive modern BuCor with a well equipped

hospital complemented with ample qualified medical personnel and consultants duly supported with adequate medical and nursing resources so that every inmate remains healthy while inside prison for him to be economically productive once he returns to the community.

Theoretical/Conceptual Framework

The underpinnings came from a focus of study known as General Systems Theory. Ludwig von Bertalanffy, a biologist, is considered the father of General Systems Theory, and almost every field of science (physical, social, and mathematical) has contributed to its development. The basic tenet of General Systems Theory is that all systems share certain characteristics that allow them to function as systems, regardless of their type or level of organization. General Systems Theory attempted to identify and document the characteristics common to all systems. For a system to function as a system, rather than a collection of parts, it must have ways of self-organizing and even directing behavior. A wild ecosystem is chaos driven. An organism or organization is purpose driven.

9 General System Theory (GST) is symptomatic of a change in our worldview. No longer do we see the world in a blind play of atoms, but rather a great organization. According to GST, nothing can be understood in isolation but must be seen as part of a system. General System Theory in its "Humanistic" Features would imply that the Bertalanffian GST is inherently ethical and ecological because it aims at increasing the awareness in every human of the need of being functionally interconnected with each other, with his or her community, with the whole humanity, with the immediate terrestrial surroundings and with the biosphere. As an ideological tool, scientifically structured it may help to conceive, design and implement the research needed for allowing every scientist to develop his intuition and capabilities, for learning consistently to discover the laws that govern the manifestation of biological, psychological and social systems. For dealing humanely with all kinds of local concerns supported by and taking into account the global circumstances and terrestrial limits. Being GST de facto a kind of reconciliation between humanities and science, between materialism and idealism, between body and mind, it has become a humanistic alternative that may help overcome frameworks determined through mechanistic values; an alternative that

10 recognizes frankly that 'the organism is not a passive automaton reacting to stimuli but rather is an autonomously active system', a conceptual interpretation indispensable for the healthy evolvement of human interactions. GST will play a humanitarian role in the continuous

evolvement of a civilized humankind, because it aims at creating the circumstances needed for offering reasonable, then humanitarian

perspectives for all the members of the Homo sapiens who need to be continuously aware of the role that humans ought to play on the planet sharing every aspect of every terrestrial space with of all the other living species. In the domain of GST the humans, should other not see each the members

as embodiments of one or several human traits, but instead as

complex and ever changing systems that may achieve a revolution of harmony, if and only if every human learns to view life with a certain awe. Then everybody might tend to treat life with reverence, and also tend to treat each other with respect. General Systems Theory aims at seeking principles common to systems in general that may allow scientists and researchers to think more clearly about the goals of any possible system and about the methods for reaching them.

11 The Systems Movement has evolved and is getting increasingly involved in processes organized under the assumption that they may improve the manifestation of human actions related with the

development of the civilization that prevails at present. Many systems are constituted according to interests and motivations of people located in powerful positions related to privileged situations. Other systems remain in operation and even improve it simply because they are considered necessary stimuli for the evolvement of trends of the prevailing civilization. Many intelligent human affairs do not improve at all the civilizing processes, neither the human way of life. In recent years an increasing deterioration of the way humanity is still surviving has become the main challenge for the Systems Community. The General Systems Theory conceived originally by Bertalanffy need to be developed from now onward through a systematic confrontation with the numerous problems that serious crisis ever faced by humankind. System scientists must engage responsible in discovering the laws intrinsic to the dynamical features of, first, those problems that nowadays are increasing the deterioration of the human society: unfair trade, poverty, hungry, intolerance, violence, corruption, second, those policies that need to be conceived and designed for reducing the gap composed the most

between rich and poor people and countries, for solving gradually

12 shortcomings in education and health care, for negotiation among conflicting entities, for embedding ecological questions into economic intentions and also vice versa for embedding economic questioning into ecological intentions, and finally, those programs needed for recognizing humans as creative and responsible wholes, who need to develop their physical, biological and psychological capabilities for learning how to perform actively in every community in order to contribute consciously to increase the survival chances of the human species on this unique planet. The issues of managing for a system to function as a system, rather than a collection of parts, it must have ways of self-organizing and even directing behavior. If command and control is distributed to the subsystems, then we must look elsewhere for the self-organizing capabilities of the complex system. What the complex system provides is coordination and communication for the self-stabilizing subsystems. The paradigm shift, then, is one of moving from a central command and control model to a distributed command and control model with central communication and coordination. In system Theory, the world is a system of subsystems (also called systems), interdependent and interconnected, to form a wholistic or holistic system; that within any one system is an infrastructure that is analogous across systems, irrespective of physical appearance.

13 The Gaia Hypothesis, in different words but saying the same thing, adds a spiritual dimension to systems theory, stating that the world is a living, breathing, organism, irreducible to its parts; that what affects one part affects all parts; that in the name of saving spaceship earth we must change our society. These are the two hypotheses which undergird system governance and the transformation of American society to the total quality, outcomebased, environment of a managed economy in a communist society in which every aspect of that society is micromanaged by the all powerful government to achieve goals established to attain a humanist created future the sustainable global environment. This is happening nationwide, in every branch, office and department of government; in industry; in health care; in education at all levels; in property rights, growth management and land use planning; in ecology, there is nothing that is not being affected by this. This is

a total and complete transformation or paradigm shift of our society. In system thinking the idea that changes need to be

conceptualized is the context of the total system. Most educators are no accustomed to thinking in a systems fashion. This suggests that Total Quality Management is a means by which systems-level thinking can be both encouraged and translated into action. Hence, outcome-

14 based education is introduced, described, and analyzed as the framework within which systems redesign occur. The foregoing concepts and theories which are relevant to the present study are being synthesized and illustrated in Figure 1, adapted from Rossi, Lipsey, and Freeman (2004), Logic Model. INPUT
1. Demographic profile of the inmates according to: 1.1. Age; 1.2. Patient Classification (in-patient and outpatient); and 1.3. Length of stay in prison? 2. Demographic profile of the inmates in the year 2009 and 2010 in terms of: 2.1. Morbidity; and 2.2. Mortality? 3. Extent of Effectiveness of the Health Care Services in relation to: 3.1. Mission & Vision; 3.2. Staffing; 3.3. Medical supplies; 3.4. Programs; and 3.5. Facilities and equipment?

PROCESS

OUTPUT

Analysis of the perceptions of the outpatients and inpatients on the extent of effectiveness of the Health Care Services in the New Bilibid Prison.

Improved health care program for inmates

FEEDBACK LOOP Figure 1. Conceptual Paradigm of the Study.

15 A system is a set of components arranged to carry out a particular function. All systems have inputs, processes and outputs; often they will have feedback as well. It could be gleaned from the paradigm that under input are the data on the profile of inmates according to age; patient classification (inpatient and outpatient); and their length of stay in prison. Likewise, it shows the profile of inmates in the year 2009 and 2010 in terms of morbidity and mortality. It also includes the extent of effectiveness of the health care services in relation to its mission & vision; staffing; medical supplies; programs; facilities and equipment. The process indicates the analysis of the perceptions of the outpatients and in-patients on the extent of effectiveness of the health care services in the New Bilibid Prison. The output states the improved health care program for inmates of the New Bilibid Prison. The feedback is simply a way of changing the input or process as a result of what happens at the output.

Statement of the Problem This study sought to determine the effectiveness of the health

care services of the New Bilibid Prisons, towards the development of a proposed health care program for inmates.

16 Specifically, it seeks to answer the following questions: 1) What is the demographic profile of the inmate-respondents according to: 1.1 Age; 1.2 Existing patient classification (in-patient and outpatient); and 1.3 Length of stay in the New Bilibid Prison, Bureau of Corrections? 2) What is the demographic profile of the inmate-respondents in the year 2009 and 2010 in terms of: 2.1. Morbidity; and 2.2. Mortality? 3) To what extent is the effectiveness of the health care services in the New Bilibid Prison being implemented in relation to: 3.1. Mission and vision; 3.2. Staffing; 3.3. Medical supplies; 3.4. Programs; and 3.5. Facilities and equipment 4) Are there significant differences in the extent of effectiveness of the health care services as perceived by in-patients and the outpatients in the New Bilibid Prison?

17 5) What improved health care program for inmates may be proposed?

Hypothesis of the Study

There

were

no

significant

differences

in

the

extent of

effectiveness of the health care services as perceived by in-patients and outpatients in the New Bilibid Prison.

Scope and Limitation of the Study

The study focused in the New Bilibid Prison Hospital (NBPH), Bureau of Corrections, Muntinlupa City and its present health care services. Respondents of the study were the in-patients and outpatients of the NBPH. The respondents were limited to one hundred (100) inpatients and three hundred (300) outpatients. The researcher utilized survey questionnaire. Survey questionnaires were distributed to only selected in-patient and outpatient inmate respondents and documentary analysis was done in obtaining sufficient data. These were done during fiscal years 2009 and 2010. The results therefore gave a reasonable representation of the factors affecting health care program within the New Bilibid Prison, Bureau of Corrections.

18 Significance of the Study

The findings of the study will be of benefit to the following sectors: The Community. The system and the factors associated with

the findings of the study would have a long-term impact on the inmates situation in prison and their families who live in a free society. Bureau of Corrections and Bureau of Jail Management & Penology. This would inform and influence managers and policy-makers of the wider contextual issues affecting mental and physical health within prison settings. Other Researchers. The findings of the study may be useful for other researchers to continuously conduct assessment about other problems inside prison camps which are commonly unknown to the free society. Government. This will serve as a basis for the Philippine law maker to review existing laws pertaining prison system and the need for a change to uplift the prison system in the country. Inmates. This study will motivate the in-patients and outpatients to be productive while incarcerated, and that they will feel the concern

of the officials and health providers in the bureau.

19 Definition of Terms

To facilitate better understanding and interpretation of the study, the following terms were operationally defined: Bureau of Corrections. The institution where offenders who were sentenced to a prison term of three (3) years, one (1) day and above are confined for the correction and rehabilitation. Health Care. The prevention, treatment, and management of illnesses and the preservation of mental and physical well-being of inmates through the health care services by the medical and allied health professions in the New Bilibid Prison. Health Care Services. The mission and vision, staff, medical

supplies, health program, facilities and equipment of the New Bilibid Prison, which carries out the tasks of ensuring appropriate health care to the inmates. Health Care Program for Inmates. The health agenda for inmates. Incarcerated. The situation of inmates. Inmate. The person confined in the New Bilibid Prison after being convicted and sentenced by the court. In-patient. The inmate who are confined or admitted as patients at the New Bilibid Hospital, Bureau of Corrections. Maximum security prisoners. The inmate whose sentence is

20 ranging from twenty (20) years and above and with pending cases. Morbidity. The number of in-patients and outpatients irregardless of illness during the fiscal year 2009 and 2010. Mortality. The number of death during the fiscal year 2009 and 2010. New Bilibid Prison. Corrections. Outpatient. The inmate patients who seek regular medical consultations at the Out Patients Department of the New Bilibid Prison, Bureau of Corrections. System. The structure of the organization of the New Bilibid The main prison camp of the Bureau of

Prison, Bureau of Corrections.

21 Chapter 2 REVIEW OF RELATED LITERATURE

This chapter presented the literature and studies reviewed by the researcher that have significant bearing to the present undertaking. These related literature and studies, refer to information gathered from books, journals, periodicals, magazines, on-line sources and

unpublished masters theses and dissertations. Citations follow the Publication Manual of American Psychological Association (APA), 5 th edition.

Related Literature

Health Care Administration in Prison Health care administration is a significant branch of the prison management. As the Prisoners have unalienable rights bestowed upon them by international treaties and covenants, they have a right to health care, and most indeed have a right not to contract diseases in prison. Prison jurisprudence recognizes that prisoners should not lose all their rights because of imprisonment. However, there is a loss of rights within custodial institutions, which continue to happen. Public health policies are intended to ensure the best possible

22 living conditions for all members of society, so that everybody can be healthy. Prisoners are repeatedly forgotten in this equation. They are in steady contact with all kinds of people who come in and out of prison

every day. This constant movement in and out of prison makes it all the more vital to control any contagious disease within the prison so that it does not multiply into the outside community. Under the Eighth Amendment to the United States Constitution, it has been resolute that prisoners (or inmates) have a constitutional right to passable health care. Government has codified societys requirement to give care to its incarcerated persons, and requires state prisons to provide health care. An inmate is defined as a person incarcerated in or otherwise confined to a correctional institution. Correctional Institution is defined as any penal or correctional facility, jail, reformatory, detention center, work farm, halfway house, or residential community program operated by, or under contract to, the United States, a state, a territory, a political subdivision, of a state or territory, or an Indian tribe, for the confinement or rehabilitation of persons charged with or convicted of a criminal offense or other persons held in lawful custody. Central guidance state that health care in prisons should promote the health of prisoners; identify prisoners with health problems; review

23 their needs and deliver treatment or refer to other specialist services as suitable. It should also continue any care started in the community,

contributing to a seamless service and ease through care on discharge. The majority of health care in prisons is of a primary care nature, with higher occurrence in the spectrum of mental health problems, substance abuse, and related communicable disease problems such as Hepatitis B and HIV. The health care service has made noteworthy improvements in recent years but has a challenging work program ahead to ensure broad similarity with wider health care services. Health Care in Californias Prison Improving the Delivery of Health Care at State Prisons The delivery of health care is the fastest growing cost factor in California's $5.7 billion adult correctional system. Without immediate

and comprehensive reforms, Californias adult correctional health care bill will exceed $1 billion over the next year, with no end in sight to substantial annual cost increases. As in the private sector, the factors behind the rising costs in the prison health care system, in part, mirror the 30 percent and higher hikes confronted by employers who provide health care for their workers. These factors include higher pharmaceutical costs and higher

hospitalization costs are, in part, driving this increase. But the medical

24 cost increases at the California Department of Corrections (CDC) far outpace any in the private sector hikes. Averaged foremost or most of the past six years, CDC's adult inmate population has stayed about the same (160,000 per year), doubled. while the cost of medical care has nearly

However the inmate population has begun to increase,

reaching a record high of 164,207 in August 2004. The increase is likely to lead to higher correctional health care costs than anticipated. There are a variety of reasons why inmate health care is costly. CDC health care costs are on a rocket trajectory. First significant portion of the inmate population suffers from serious lifestyle diseases, as described below and as a result linked to long time alcohol and drug abuse, i. e., inmate demands on health services differ from those of posed by the general population. For example, there are reportedly over 27,000 California adult prison inmates who suffer from mental illness. Second, any time an inmate needs health care and when inmates need care outside of a prison, costs increase for custody and transportation, since staff must guard inmate patients around the clock. Third, the prison health care system is also plagued by inefficient management practices and inadequate primary health care practices that critics say promote illnesses and help spread disease. As a result clearly, the CDC has become a target for costly medical lawsuits. In brief, the health care system at the California Department of Corrections

25 (CDC) is in a crisis. Over the last five years a substantial number of legislative hearings, government reports and court orders have documented wrongs and offered possible corrective actions that CDC might pursue, and in some cases must pursue, to make its delivery of health care

more efficient and effective. Two major themes arise: First, the primary health care provided to CDC inmates is inadequate. In order to fix this costly systemic problem, which leads to expensive outside medical referrals, individual suffering and sometimes tragedy and lawsuits, the department needs to establish a well managed primary care system. The basic focus should be on preventative care, following the example of effective managed health care systems. Second, the healthcare business practices utilized by the CDC are costly, inefficient and archaic. This includes contracting practices, data collection and Many jurisdictions do a better job of There is no excuse for this poor

utilization, and procurement.

managing correctional healthcare. management.

The Health Care Delivery System: A Blueprint for Reform Concern about the state of the American health care system has reached a slow boil. Health care consistently ranks among the top three issues that the American public wants policymakers to address, and it is increasingly intertwined with growing worries about economic insecurity.

26 High costs, gap-ridden coverage, and sporadic quality are the health care problems that most concern Americans. Yet most of the policy discussion is focused on the issue of coverage. To ensure that the other problems are not forgotten and that delivery system reform is central to any plan, the Center for American Progress and the Institute on Medicine as a Profession partnered to

develop the book, The Health Care Delivery System: A Blueprint for Reform. In the health policy arena there is a dearth of specific policy recommendations to improve the delivery system. Yet these ideas are often disconnected from the current system, with no policy pathway, backed by leadership and organization, to get from here to there. This offers recommendations and pathways to systematically promote quality, efficiency, patient-centeredness, and other salient characteristics of a high-performing health system. The blueprint it lays out is a vision of how different parts of the system should be structured and how they should function. Even more specifically, it proposes policies that the next administration and Congress could enact over the next five years to improve our health system. Health care depends on a highly trained, balanced, and motivated workforce; current and accurate information; and technologies that enable health professionals to use information in the right place, in the right way, and at the right time. People, knowledge, and the means for

27 their application are the foundation upon which an efficient, high-quality health system rests. The most effective way to address our cost and quality challenges are to confront the root causethe chaos in everyday health care. Efforts should focus on accelerating the organization of health care providers into team-like configurations so that they can adopt systems that are likely to reduce errors of overuse, underuse, and misuse, and improve the overall coordination of care. Improving the quality of services delivered is paramount to enhancing health system performance. Currently, an apparent

contradiction exists between the fact that the United States has the highest quality health care in the world, yet also has a quality chasm. To truly improve the quality of the health care delivery system, policies must focus on the individual and population level. Provider payment structures play an important role in how well the health care delivery system meets the goals of delivering efficient and high-quality care. Policies must work to align the desires of practitioners and health organization managers to serve patients with the incentives that come from how they are paid. Polices on the demand side of the equation must focus on how best to engage individuals in their own health and care. This is increasingly important in the face of a growing chronic disease epidemic.

28 Improving the health care delivery system is the key to improving the health of all Americans. Even if the access, quality, and cost problems in the medical system are resolved, a traditional view of the delivery system must expand to include population-wide programs in order for the system to reach its full potential. The signs that such a debate could take place in the near future are strong. Both presidential candidates have proposed to reform the health care system, demonstrating the political ripeness of the issue. When that opportunity presents itself, it will be essential to be ready with grounded policies that are more than patches and can serve as pathways toward a high-performing health system. Blueprint for Universal Health Care 2010-2015 and Beyond Health is a basic human right guaranteed by our constitution. However, the great disparity in access to and use of health care, resulting in significant differences in health status, between the rich minority and the poor majority of Filipinos constitutes a grave violation of this right for Filipinos. Conventional health status indicators of life expectancy at birth (LEB), infant and child mortality (IMR), and maternal mortality ratio (MMR) show considerable variation when disaggregated according to income groups and geographic location. Rich urban communities like those in Metro Manila, Cebu, and Davao, with access to modern

29 facilities, have outcomes comparable to those of developed countries. In contrast, poor rural communities, such as those in Bicol, the Samar provinces and ARMM, have results that approach those of least developed countries. While not quite as bad as those of least

developed countries, urban poor communities have indicators that are from two to five times worse than their neighbors in gated villages. These disparities are the result of the following deficiencies in our health system: First is that, the basic health services as well as tertiary care for the majority of Filipinos are inadequate, fragmented,

inefficient, and incomplete. At least in part due to this, for lowest income groups these services are largely inaccessible and unaffordable. Another is the Philippines health sector is dominated by commercial interests of a segment of the system that is not really about health outcomes but is primarily about bottom-line profits. Third, human resources for health are insufficiently educated, inappropriately trained, and poorly motivated to address the health care concerns of most Filipinos in the setting in which they live. As a result, poorly

compensated government health workers are unable to influence behaviors of their high earning private sector counterparts within the change-resistant environments of their respective professional

organizations. Lastly, much of this commercial dominance of our health care system is the result of a failure, so gross as to constitute a default,

30 of public financing for health. The combined weight of the uncoordinated spending for health by the national government, local governments and our national social health insurance program has been so low and so weak that it has driven our health system into a debilitating dependence on out-of-pocket payments by patients. To address these deficiencies, radical reforms in all components of the Philippine health system are required. Such reforms must be aimed at achieving UNIVERSAL HEALTH CARE in the country over a reasonable period of time (10-15 years). This means that every Filipino should have access to high quality health care that is efficient, accessible, equitably distributed, adequately funded, fairly financed, and directed in conjunction with an informed and empowered public. The overarching philosophy is that access to social services is based on needs and not on the capability to pay. This ultimately places people at the center of socio-economic development. Health System Reform Strategies Based on WHOs Framework for Action towards strengthening health systems, the approaches to reform set forth in this document are categorize under six components or building blocks that are interconnected and must function together in order to be effective (WHO, 2007). The six building blocks are health financing, service delivery,

31 health workforce, health information system, medical products, vaccines and technologies, and lastly, leadership and governance. Prison medicine: ethics and equivalence Prison healthcare in England and Wales is undergoing major reform. The principle behind this, providing prisoners with a standard health care equivalent to that in the wider National Health Service (NHS), but it does not do justice to the complex reality of imprisonment. The

argument of being a prisoner is not the same as being an ordinary citizen and ignoring the realities of the differences between prisoners and ordinary NHS patient leads to complex ethical dilemmas for prison healthcare staff. Illustrate some of the areas where prison

healthcare is different: access to care and allocation of NHS resources; patient choice and independence. Many of the examples given refer to psychiatric care, but the dilemmas apply to general medical care. Prison Service, the NHS could exclude prisoners from health services. However, Department of Health guidance specifies that the NHS must now work in partnership with the Prison Service to provide healthcare in prisons. In addition, by 2006, primary care trusts will become fully responsible for commissioning these services (England, Department of Health, 2005). This has been formulated clinically as the principle of

32 equivalence. This states that prisoners are entitled to have access to the same range and standard of treatment as any other potential NHS patient (Joint Prison Service and National Health Service Executive Working Group, 1999). This suggests that prisoners live in a community of their own. Their penance is their loss of liberty. Deprivation of

healthcare is an additional punishment which the state is not entitled to inflict. There is no equivalent of a prison healthcare centre in the wider NHS and statutory powers to treat mental disorder do not apply in prison, so, if patients refuse treatment, they must remain untreated and mentally ill in prison (Wilson, 2004). Rarely, in such cases the doctor has to resort to common law to justify enforcing treatment for mental disorder without the prisoners consent (Wilson & Forrester, 2002; Earthrowl etal, 2003). Prison doctors quite often refer prisoners with serious mental health problems to the NHS, seeking transfer to hospital for treatment only to find that they are rejected (Coid, 1999). The NHS encourages patients to exercise control over the doctor they see. Prisoners do not get this choice. Recruiting suitably qualified and trained doctors to work in prison has always been difficult (England, Department of Health, 2001). National Health Service patients have increased rights to

33 determine what happens to information about them. The principle of

equivalence implies that prisoners have the same rights. However, prisoners are not routinely informed about the limits of confidentiality on entry to prison. Prisoners are in an institution that owes them a duty of care. In the community, people with personality disorder who are suicidal

might be offered packages of treatment and support, but they might be turned away from services altogether. The principle of equivalence dictates that the same approach should apply in prison. However, the consequences of a self-inflicted death may be very different in these two settings. Suicides in prison are seen as a failure of the system, perhaps including healthcare, whereas it is perhaps easier to allow that sometimes bad things happen to people in the community. Understanding Georgia's Correctional Standards of Health Care: What Policymakers and Stakeholders Need to Know The Office of Health Services of Georgia Department of Corrections is responsible for overseeing the correctional health care system of state prisons. The Department adheres to its mission to provide the required constitutional level of health care in the most

efficient, cost effective and humane manner possible, while protecting the public health interests of the citizens of the State of Georgia.

34 Georgia has recently moved ahead of Ohio and Illinois and now has the nations sixth largest prison population. Georgia currently has 46,591 inmates; the census is largely driven by the amount of time served in prison due to the states Two Strikes law passed in 1995 and the Parole 90% Policy implemented in 1998. The number of inmates

also doubled during the past ten years and is expected to continue to grow by almost 7 percent annually. Annual health care costs per inmate for physical, mental and dental care have been rising at 8 percent. Projections calculated by the Department of Correction's Office of Health Services through the year 2005 anticipate that 18 percent of the entire prison population will have mental illness. Many factors pressure officials to deliver the constitutionally

mandated basic health care while staying within budgetary limits. Barriers to Effective Prevention, Screening, and Treatmentand Overcoming Them Despite the compelling reasons for improving the prevention, screening, and treatment of disease among inmates, significant barriers may make it difficult for prisons and jails to improve these services, National Commission on Correctional Health Care (NCCHC). Most barriers fall into one of four categories: Lack of leadership, such as failure to recognize the need for improved

35 health care services; reluctance to consider that improving public health is a correctional responsibility; and unwillingness of public health agencies to advocate for improving correctional health care or to collaborate to promote improvement. Logistical barriers, such as short periods of incarceration, security-conscious administration procedures for distributing

medications, and difficulty coordinating discharge planning. Limited resources that require difficult budgeting decisions to meet the high cost of many health care services and some medications, and that make it difficult to provide adequate space for medical services. Correctional policies, such as failure to specify minimum levels of required care in contracts with private health care vendors, delays to escort inmates to medical treatment, poor health agencies and prisons and jails,

caused by the need

communication between public

and lack of adequate clinical guidelines. Most of these barriers to improved health care for inmates can be overcome. First, position statements that a number of well-respected, national professional groups have developed describing appropriate health care for inmates can be used as leverage to encourage correctional administrators to find ways of resolving barriers to providing adequate care. Second, collaboration among correctional agencies, public health departments, and

36 community-based organizations can help overcome the lack of correctional health care funds and staff. Public health departments may be willing to contribute funds, staff, and expertise if they understand that this use of their resources can advance the cause of public health in their communities. Public health departments in some jurisdictions already contribute significantly to testing and screening of inmates, providing prevention and treatment programs in prisons and jails, and following up on inmates after release to ensure a continuum of care. Many community-based organizations are interested in and willing to provide services inmates equivalent to that of a free individual. Technical Guidelines for Implementing DOTS Strategy in Jails and Prisons Republic of the Philippines Administrative Order No. 2009 0003, dated January 8, 2009 Subject Technical Guidelines for Implementing DOTS Strategy in Jails and Prisons. In 2008, it was estimated that of the total of about 130,000 prison inmates in the country, 28% or 36,000 had symptoms of TB. In a study of 7,282 inmates in five (5) jails and one (1) prison in Davao Region, the prevalence of sputum smear positive among inmates was

8.7/1,000 compared to the 2/1,000 for the general population based on the 2007 National TB Prevalence Survey. Globally, the estimated

37 number of people detained on any given day is over 9 million and the prevalence rate of TB in prisons usually exceeds that of the civilian population. The increased vulnerability of this group to TB can be attributed to several factors such as overcrowding and lack of ventilation in many jails/prison facilities, late case detection secondary to lack of access to health services and stigma, lack of health human resource and trained staff servicing inmates and presence of other risk factors such as malnutrition and co-morbidities. Considering that more than a half of the inmate population are detainees awaiting case resolution and that a large majority of them shall be re-integrated with the society at large, the Department of Health (DOH) intends to implement Directly Observed Treatment Short-Course (DOTS) Strategy to this captive population in order to reduce TB transmission, morbidity and mortality within jails and prisons, and to render inmates non-infectious by the time they are released to mainstream society. The controlled, supervised situation of the inmates in jails and prisons, on the other hand, is also expected to yield success rates and cure rates that are higher than those for the civilian population. Thus, implementing DOTS Strategy in jails and prisons has the potential of

38 significantly expediting the achievement of National and Millennium Development Goal (MDG) targets related to TB control. Universal healthcare to help reduce inequities in health The Philippines continues to promote itself as a medical tourism hub, it is sad to note that 60 percent of Filipinos who succumb to sickness die because quality healthcare remains elusive to them. The Aquino administration is more than aware not only of the difficulties and challenges being faced by the Philippine healthcare system, but also of its inability to provide the poor Filipinos with adequate healthcare assistance. During the second Philippine Health Outlook Forum held recently by the Zuellig Family Foundation, Pres. Aquino stated that the present administration aims to change that landscape of the present healthcare system by implementing comprehensive reforms. One of the solutions that the administration is looking at to address these challenges is the implementation of the so-called universal poor. Having healthcare, which focuses on the welfare of the

such a program in place is seen to help reduce the

inequities in healthcare, which is a result of the widening gap between the rich and the poor. Universal health care is both a vision and a

strategy of the Aquino administration. It is a vision of how things ought to

39 be, where Filipinos are healthy, free from disease and infirmity and having access to quality basic health services. The Department of Health presented during the forum several policy directions that the national government plans to implement in order to change the present state of the healthcare industry. Some of these policies, which are geared toward having universal healthcare, include a refocused Philhealth to be able to respond to the needs of the poor; the need to rehabilitate and enhance present health facilities; improved access to quality and affordable drugs and

medicines; a more aggressive promotion of healthy lifestyle; and continuing efforts in improving governance and regulation to eliminate graft and corruption in all areas of healthcare. The administration is quick to admit that with the countrys limited resources, these initiatives needed to be backed by a collaboration among public, private, multilateral and civil society stakeholders, in order to be successful. Given the limited resources, the Department of Health will enter into public-private partnerships in securing health key investments particularly in health facilities and information technology. It is in this regard that Zuellig Family Foundation (ZFF), with its aim to help the local government address the present healthcare

situation, selected a number of municipalities to implement various programs aimed at improving the healthcare delivery.

40 Among ZFFs programs included funding renovation and upgrading of several health facilities that can help improve access to quality healthcare. It also conducts dialogues and trainings to educate the local community, including the mayors and other stakeholders, about the various health issues being faced by their respective towns and municipalities. Such information awareness campaigns also help them come up with possible solutions to these problems. Despite all these developments, ZFF and Ona are one in saying that there remain a number of important issues that need to be addressed to improve the local healthcare system. Both, however, are still hoping that with the new administrations aggressive policy drive, a better future for the healthcare industry. In the Philippines, there are different religious groups who give their endless assistance to the inmates and they are vocal about asking the government to address the inmates needs.

Related Studies Foreign Based on the principle of human rights and equity of access, healthcare services provided to prison inmates should be equivalent to those provided to the general population.

41 Health throughout the problems world are by being investigated and monitored and

both

international

organizations

governments. It is well recognized that prison inmates are a vulnerable group of the population. Research on this group is minimal compared with the general population. The problem of drug use and health consequences among this subpopulation is significant and needs to be explored, (WHO). Recent findings indicate that a higher prevalence of drug use is found among prison inmates than among the general population.

The health status of prison inmates seems to be lower because of both the inmates' behavior and the prison environment. Various

communicable diseases are commonly found such as hepatitis C virus, HIV, and syphilis. Rapid changes in correctional health care have emerged and subsequent legislation stimulated correctional health care reform and has led to the establishment of standards for prison health care aiming to meet the needs of inmates and health personnel, especially nurses which comprises more than fifty percent of health work force. Condon, L. et, al. (2007) have done a study that aims to know the views of prisoners about health services provided in prisons. The background of the study is that prison provides an opportunity for a 'hard to reach' group to access health services, primarily those provided by

42 nurses. Prisoners typically have high health and social needs, but the views and experiences of prisoners about health services in prison have not been widely researched. The method utilized was semi-structured interviews were carried out with 111 prisoners in purposively selected 12 prisons in England in 2005. Interviews covered both prisoners' views of health services and their own ways of caring for their health in prison. Interviews were analyzed to develop a conceptual framework and identify dominant themes. It was found out that prisoners considered health services part of a personal prison journey, which began at imprisonment and ended on release. For those who did not access health services outside prison, imprisonment improved access to both mental and physical health services. Prisoners identified accessing services, including those

provided by nurses, confidentiality, being seen as a 'legitimate' patient and living with a chronic condition as problems within the prison healthcare system. At all points along the prison healthcare journey, the prison regime could conflict with optimal health care. The conclusion was theres a lack of autonomy and it is a major obstacle to ensuring that prisoners' health needs are fully met. Their views should be considered when planning, organizing and delivering prison health services.

43 Further research is needed to examine how nurses can ensure a smooth journey through health care for prisoners. Condon L, Gill H, & Harris F. (2007) have conducted a review of prison health and its implications for primary care nursing in England and Wales: the research evidence. The objectives of the study is to provide a systematic overview of the policy and practice literature concerned with the primary healthcare needs of prisoners in England and Wales and to address the implications of these health needs for nurses working in prisons. The recent reorganization of the prison healthcare system, which has brought prison health services in England within the National Health Service, and Wales

has major implications for the

role of prison nurses. Nurses in prisons are increasingly providing services to promote the health of prisoners, in addition making assessments of health need and treating health problems. The findings are identified in three main areas: the general health needs of prisoners, health promotion and chronic disease management. In all these areas, the greater than the health needs of the prison population are

community as a

whole, resulting in a high demand

for primary care services in prison. However, the prison setting can militate against providing good primary care services in prison. Health information technology including telemedicine offers potential to improve patient care outcomes. As part of the response to

44 Hurricanes Katrina and Rita in 2005, the Louisiana State University Health Care Services Division expanded its statewide telemedicine program. Glaser M, et. al. (2010) study was to evaluate provider satisfaction and patient outcomes associated with telemedicine when used for the administration of prisoner medical care. Providers completed a survey following each patient encounter in real-time; questions were adapted from standard satisfaction indices. bi-, and multivariable including Statistical ordinal methods included uni-, methods to

regression factors

characterize unadjusted and

adjusted

associated with

telemedicine use and provider satisfaction, and patient outcomes. Data were collected between December 2007 and May 2008 and were analyzed using Statistical Analysis System (SAS). Out of 737 patient visits, the majority of patients were African American (68.6%), men (92.9%), seen for either infectious disease or mental health (46.2% and 50.2%), with most surveys completed by a physician (63.1%). Most telemedicine encounters were completed (92.8%), a treatment plan was established (97.0%), the provider perceived that the technology was adequate to conduct visit (93.4%), and a follow-up telemedicine appointment was requested (90.8%). Most providers were satisfied with telemedicine for the visit overall (87.0%), believed that telemedicine improved patient prognosis (88.2%), and perceived that the patient was

45 satisfied (83.0%). This study suggests that telemedicine was an effective and accepted method of healthcare provision. The use of primary health care in the prison population is considerable compared with the general community. Health needs of prisoners are diverse and complex. Prisoners are more

preoccupied with their health than the general population. Relative to the general population, prison inmates experience poorer physical, mental and social health, including both acute and long standing physical and mental illness and disability, drug, alcohol and tobacco dependency, sexual health problems, suicide, self -harm, physical, psychological and sexual violence, lower life expectancy and breakdowns in family and other relationships. Its a grim reality that prison health care does not only affect inmates but it goes with the doctors, nurses and inmates suffer inside broken system, by James Sterngold, Chronicle Staff Writer (2005). This reality causes dispute between health care providers and inmates. The BioMed Central (BMC) Health Services Research (2010) carried out a review of structural and support services in primary care in Irish prisons, March 2010, the study was commissioned by the Irish Prison Service (IPS), and with the agreement of the Irish Medical Organization. This arose as a consequence of an industrial dispute

46 between prison doctors and the IPS. The data was used from that review to describe the primary medical care infrastructure in the IPS. The study is about the industrial dispute between prison doctors and the Irish Prison Service (IPS) that took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University

Department of Primary Care. The review took place in 2008 and a report was made about the principal findings. The study utilized mixed methods approach. An independent expert medical evaluator inspected the medical facilities, equipment

and relevant custodial areas in eleven of the fourteen prisons within the IPS. Semi-structured interviews took place with personnel who had operational responsibility for delivery of prison medical care. Prison

doctors completed a questionnaire to elicit issues such as allocation of clinician's time, nurse and administrative support and resources available. It was found out that there was a wide variation in the standard of medical facilities and infrastructure provided across the IPS. The range of medical equipment available was generally below that of the equivalent general practice scheme in the community. There is inequality within the system with regard to the ratio of doctor-contracted time relative to the size of the prison population. There is limited

47 administrative support, with the majority of prisons not having a medical secretary. There are few psychiatric or counseling sessions available. It was concluded that people in prison have a wide range of medical care needs and there is evidence to suggest that these needs are being met inconsistently in Irish prisons. Fazel, S. et. al (2001) carried out an assessment of the health of men aged 60 and over in England and Welsh prisons. The methods include semi-structured interviews covering chronic and acute health problems, and recording of major illness from the medical notes and

prison reception health screen. Respondents include 203 men from 15 prisons, comprising one-fifth of all sentenced men in this age group in England and Wales. The results of the study were 85% of the elderly prisoners had one or more major illnesses reported in their medical records, and 83% reported at least one chronic illness on interview. The most common illnesses were psychiatric, cardiovascular,

musculoskeletal and respiratory. It was concluded that the rates of illness in elderly prisoners are higher than those reported in other studies of younger prisoners and surveys of the general population of a similar age. The increasing number of elderly people in prison poses specific health challenges for prison health-care services. Powell, J, et, al. (2010) conducted a study about nursing care of prisoners: staff views and experiences. The study aims to determine the

48 views and experiences of nurses and other prison healthcare staff about their roles and the nursing care they provide to prisoners. The background of the study is centered about nurses who have become the key providers of healthcare in prison settings in England, replacing the previous prison service-run system. However, there is very little evidence about the health services they provide to meet the health needs of prisoners. An ethnographic study was conducted. Participants were 80 healthcare staff working in 12 prisons of all security categories in England. Twelve individual interviews with general healthcare managers and 12 key informant focus group discussions with healthcare staff were undertaken in 2005 using a semi-structured interview investigated included schedule. Issues

participants' thoughts and experiences of

nursing roles and delivery of primary healthcare. The group discussions and interviews were analyzed to identify emerging themes. The findings were noted on participants gave accounts of day-today processes and the healthcare routine. They saw their work as identifying and meeting the health needs of prisoners and maintaining their health, and identified major influences that shaped their daily work, including new ways of working in primary care. They identified how policy and organizational changes were affecting their roles, and

49 acknowledged the conflict between the custody regime and healthcare delivery. It was concluded that the move towards a NHS-led primary healthcare service within prisons, predominantly delivered by nurses, has made positive changes to healthcare. Healthcare managers have benefited from the involvement of the local NHS in improving the health of prisoners.

Local There were limited studies conducted in the Philippines about the condition of prisons which may be due to the economic status of the country. Tessa Tan-Torres (June 1995) study on Primary Health Care Services in the Philippines, a 10-year review of economic evaluations and their impact on health policy in the Philippines. The study was done at Clinical Epidemiology Unit, University of the Philippines College of Medicine Manila. The objectives of the study are the following: inventory, critically appraise and describe the impact of economic evaluations in the country. The survey of electronic and manual search for relevant studies, mail researchers and interview of key informants are the to have an

on health policy

50 methods used inclusion criteria: comparison of two or more alternatives in terms of costs and outcomes and completed/published from September 1984 to March 1994. 2. Critical appraisal using guidelines published by Drun et.al. 3. mail survey of investigators re: source of funding, dissemination of results and impact on policy. The results stated that a total of 20 economic evaluations, of which 2 were cost-outcome descriptions, 14 cost-effectiveness analysis, and 4, cost-benefit analysis. 60% were on public health issues and the remaining 40% were on hospital concerns. The median quality score was 8 out of a perfect score of 10. All evaluations were investigator initiated, with a single unit carrying out 60% of the evaluations. 80% received funding, half from local sources. Seven were published with five appearing in international journals. All were presented in scientific conferences. Only 5 influenced health policy, 2 influenced the research agenda 5 supported pre-existing policy and 8 had no impact. The conclusions, there is limited expertise in the country regarding economic evaluations. The few studies done were

methodologically sound. Despite good dissemination, only 25% had impact on policy. Recommendations are: Capacity building for expertise in

economic evaluations; dissemination of standards for carrying out and

51 reporting of economic evaluations to enhance comparability and generalizability; awareness-raising among policy makers re: value of economic evaluations and a more interactions with other disciplines, including economics, social sciences and media to enhance impact on policy. This is why public health education becomes a necessary tool to aid people against the spread of potential diseases and illnesses. People are able to adopt a healthier behavior to lessen the risk of diseases being spread among themselves, thus lessening the expenses in medications. Conception, A A. (2002) conducted a cross-sectional study among the male prisoners in Davao City Jail. It sought to determine the knowledge of the male prisoners on HIV/AIDS and describe the forms of HIV/AIDS-related risk behaviors they engaged in during incarceration. Data were generated from a survey of 155 randomly selected male prisoners. The survey had two stages. First, the 155 respondents were asked to participate to determine how many of them engaged in any of the HIV/AIDS-related risk behaviors. Then, the respondents were reduced to 60 for the individual face-to-face interviews. It was found that almost half of the respondents had low level of knowledge about HIV/AIDS, less than a third had average level of

knowledge, and less than a fourth had high level of knowledge. The

52 study also revealed that of the 16 male prisoners who engaged in

HIV/AIDS - related risk behaviors, several engaged in piercing or wounding activities with sharing of used instruments. Very few engaged in tattooing with sharing of used instruments while only one engaged in unprotected orally receptive sex with multiple male partners. Bivariate analysis of the respondents' level of knowledge regarding HIV/AIDS and their HIV/AIDS-related risk behaviors in prison showed that those with high level of knowledge were less likely to engage in HIV/AIDS-related risk behaviors than those with low level of knowledge. found to be related with the Other factors

respondents' HIV/AIDS-related risk

behaviors in prison included age, civil status, educational level, length of stay in prison, recidivism, having visitors and receiving financial and material support. It is recommended that a comprehensive, prison-based

STD/HIV/AIDS Education and Prevention Social and demographic factors must be

Program be developed.

considered in setting up such

institution-based health programs. Marginalized groups like the prisoners deserve such attention. In 2003, the Supreme Court of the Philippines, with the financial assistance of the United Nations Development Programme, released

The Final Report of the National Survey of Inmates & Institutional Assessment, the salient findings of which, for legal research purposes,

53 are digested below: The survey of inmates is a national study covering representative samples from persons in confinement in national penitentiaries and in already been released from incarceration through the different early release schemes. The demographic data of the Inmates from National Capital Region (NCR) are: Mean age is 30; median age is 29; Single; High school undergraduate; Roman Catholic; Speaks Tagalog at home; Born in the same place where detained or in other Luzon

provinces; Employed before detention; Mean duration from the date of arrest until last hearing of case is 1.1 years. On knowledge of any agency that helps the poor when they

have cases in court and when they cannot afford to pay lawyers for the purpose, the survey indicates that only one out of five inmates in city jails within NCR and the national prisons know that such mechanism exists. Inmates in jails outside NCR likewise know that there are agencies that provide legal assistance. However, those that are in other jails are not aware of any agency which can provide them legal assistance. Only one-fourth of the total number of inmates surveyed knows of any office where one could lodge his complaints against delays in the prosecution of cases in court.

54 Generally, inmates are aware of certain legal remedies and options that are available to them such as the right to bail, serving of search warrant, right to legal counsel, and presence of laws and rules on the protection of juvenile offenders and women. However, about 53% male and 60% female inmates in the national prisons do not know their right against involuntary admission. A big percentage of inmates indicate that they are not aware of the appropriate procedures to follow up detention. According to the survey, the major barriers to equitable

access to justice by inmates are: Scarcity of legal services/assistance for prisoners and detainees who lack sufficient income; complexity of the judicial system, delay in legal proceedings and poor information quality of

about legal processes; Lack of knowledge and

understanding by inmates of the justice system, which includes widespread distrust and low levels of confidence of the justice system. Shimkhada, R. et. al (2008) conducted a study on the quality improvement demonstration study: an example of evidence-based policy-making in practice. Randomized trials have long been the goldstandard for evaluating clinical practice. There is growing recognition that rigorous studies are similarly needed to assess the effects of policy. However, these studies are rarely conducted. We report on the Quality Improvement Demonstration Study (QIDS), an example of a large

55 randomized policy experiment, introduced and conducted in a scientific manner to evaluate the impact of large-scale governmental policy interventions. Method used was experimental design by randomizing matched blocks of three communities into one of the two policy interventions plus a control group. Based on the reform agenda, one arm of the experiment provided expanded insurance coverage for children; the other introduced performance-based payments to hospitals and physicians. Data were collected in household, hospital-based patient exit, and facility surveys, as well as clinical vignettes, which were used to assess physician practice. Delivery of services and health status were evaluated at baseline and after the interventions were put in place using difference-indifference estimation. It was found and addressed numerous challenges conducting this study, namely: formalizing the experimental design using the existing health infrastructure; securing funding to do research coincident with the policy reforms; recognizing biases and designing the study to account for these; putting in place a broad data collection effort to account for unanticipated findings; introducing sustainable policy interventions based on the reform agenda; and providing results in real-time to policy makers through a combination of venues. It was concluded that QIDS demonstrated a large, prospective, randomized controlled policy

56 experiment can be successfully implemented at a national level as part of sectoral reform. While we believe policy experiments should be used to generate evidence-based health policy, to do this requires opportunity and trust, strong collaborative relationships, and timing. This study nurtures the growing attitude that translation of scientific findings from the bedside to the community can be done successfully and that we should raise the bar on project evaluation and the policy-making process.

Synthesis

Prison has several purposes. Among these are separation from society, punishment for crimes, correction and rehabilitation to the community. Prisons are not, primarily, concerned with the health of the prison population. Health care must coexist with the fundamental

mission of the correctional facility, which is first and foremost, public safety and security. This poses unique dilemmas for those responsible in providing health care. As noted by the researcher from the several reviewed studies, health care in prisons is an area of overwhelming concern. Different regions in the world are engrossed to make reforms in their current prison health care delivery system. There are different health care

57 delivery systems that are being adopted by both international and local prisons. The studies of Condon, L., et. al. (2007) and Glazer M., et. al. (2010) aimed to know the views and satisfaction of prisoners about health services. These studies were parallel to the researchers study on the extent of effectiveness of the health care services in the New Bilibid Prison. Their studies have provided a useful guide in the improvement of the present study and have given an opportunity for a 'hard to reach' groups to access health services. The study of BioMed Central (BMC) Health Services Research (2010) was about the industrial dispute between prison doctors and the Irish Prison Service. Though this study differed from the present study, hence, the objectives of both studies were focused on the effectiveness health care services on the extent in prison as a whole. The present study

of effectiveness of health care services in NBP would

somehow convey idea to be able to foresee such problem, thus preventing them to happen. Powell, J, et. al. (2010) study was about nursing care of prisoners and staff views and experiences. The background of the study was centered about nurses who have become the key providers of healthcare in prison settings, whereas the present study was focused on the inmates views of prison health services. Their studies have aided the

58 researchers present study to determine how policy and organizational changes have affected the conflict between the custody regime and healthcare delivery. The Tessa Tan-Torres (June 1995) study on Primary Health Care Services in the Philippines, a review of economic evaluations and their impact on health policy in the Philippines contributed a vital component in the researchers journey in determining the extent of effe ctiveness of health care services in the New Bilibid Prison. Conception, A. A. (2002) cross-sectional study among the male prisoners in Davao City Jail sought to determine the knowledge of the male prisoners on HIV/AIDS and describe the forms of HIV/AIDS-related risk behaviors they engaged in during incarceration. This study had assisted the researcher to distinguish points to improve in the present study on prison health programs as a basis in improved inmates well being. Shimkhada, R. et. al (2008) study on the quality improvement demonstration study: an example of evidence-based policy-making in practice. Policy experiments should be used to generate evidence-based health policy, to do this requires opportunity and trust, strong collaborative relationships, and timing. This study nurtures the growing attitude that translation of scientific findings from the bedside to the community can be done successfully and that we should raise the bar on

59 project evaluation and the policy-making process. This study had provided scheme on how to determine the effectiveness of health care services in the New Bilibid Prison, adjunct to the perception of the inpatients and outpatients. The aforementioned studies have facilitated and inspired the researcher in the study on the extent of effectiveness of the health care services as perceived by the in-patients and outpatients in the New Bilibid Prison.

60 Chapter 3 METHODOLOGY

This chapter features a discussion about each of the following parts: Research Design, Population and Sampling, Respondents of the Study, Instrumentation, Validation of Instrument, Data-Gathering

Procedure, and Statistical Treatment of Data.

Research Design

This undertaking utilized the descriptive method of research, which focused on the effectiveness of present health care services and the condition of inmates inside the New Bilibid Prison maximum compound. The descriptive research design enabled researcher to describe or present a picture of a phenomenon under investigation. According to Burns and Groves (2001), this type of research design may be used for theory development, practice problems, rationale for current practice, or clinical decision making based on what others are doing. The methodology involved in such a design is mostly quantitative in producing descriptive data. The present study used a survey questionnaire and documentary analysis in order to determine the effectiveness of the health care

61 services of the New Bilibid Prison through its current health care programs and to assess the health condition of prisoners in

maximum security.

Population and Sampling

The population of inmates in the study consisted of one thousand (1,000) outpatients, and four hundred (400) in-patients of the New Bilibid Prison Hospital. Purposive sampling was used as sampling technique. The respondents of the research included one hundred (100) inpatients and three hundred (300) outpatients. Distribution of respondents is illustrated on table 1.

Respondents of the Study

The respondents were identified through purposive sampling which was based on the following criteria: In-patients must be currently confined in the New Bilibid Prison Hospital irregardless of medical conditions and length of confinement. Outpatients must have a regular consultation in the Out Patient Department within the fiscal year 2009 2010 irregardless of illness. Table 1 shows the classification of inmate-respondents according

62 to leading illnesses. Table 1 Frequency and Percentage Distribution of Patient Classification According to Leading Illnesses (F.Y. 2009-2010)
Leading Illnesses In-patient (n=100) Frequency Percentage 2,016 18.14% 840 1,440 1,560 720 960 1,200 1,536 840 7.56% 12.96% 14.04% 6.48% 8.64% 10.80% 13.82% 7.56% Outpatient (n=300) Frequency 20,272 2,180 1,564 5,466 1,608 3,952 4,124 4,720 1,632 Percentage 46.06% 4.95% 3.55% 12.42% 3.65% 8.98% 9.37% 10.72% 3.71%

Respiratory Tract Diseases Gastrointestinal Tract Diseases Integumentary/Skin Diseases Cardiovascular Diseases Ear, Nose & Throat Diseases Endocrine Diseases Skeletel/Bone & Joint Diseases Psychiatric/Mental Disorders Surgical Cases

Total

11,112

100%

44,012

100%

Source: NBP Hospital Leading Illnesses Monthly Report

It could be gleaned in Table 1 that there were 2,016 or 18.14 per cent of the in-patients who were admitted due to respiratory tract diseases, and 1,560 or 14.04 per cent who were admitted due to

cardiovascular diseases. One thousand five hundred thirty six (1,536) or 13.82 per cent were admitted due to psychiatric or mental disorders, and 1,440 or 12.96 per cent were admitted because of integumentary or skin diseases. Seven hundred twenty (720) or 6.48 per cent of in-patients

63 were admitted due to ear, nose throat diseases. There were a total of 11,112 hospital admissions for the year 2009-2010 due to above listed leading illnesses. It could also depicted in this table that there were 20,272 or 46.06 per cent of the outpatients who sought consultation due to respiratory tract diseases, and 5,466 or 12.42 per cent who consulted due to cardiovascular diseases. Four thousand seven hundred twenty (4,720) or 10.72 per cent sought consultation due to psychiatric or mental disorders, and 4,124 or 9.26 per cent of OPD consultations were due of skeletal or bone and joint diseases. One thousand five hundred sixty four (1,564) or 3.55 per cent of outpatients consulted due to integumentary or skin diseases. There were a total of 44,012 outpatients who sought consultation at the Out Patient Department for the year 2009-2010 due to above listed leading illnesses. This table disclosed that respiratory tract diseases have the highest frequency and percentage among the leading illnesses in the New Bilibid Prison during the fiscal year 2009 2010.

Research Instruments

Survey Questionnaire The main research instrument is a researcher-developed question-

64 naire, which gathered information that helped determine the status of the present health care programs as perceived by admitted inmate or inpatient and outpatient respondents. In the questionnaire, information required from the inmate respondents is their personal profile. Likewise, information about their perception regarding the effectiveness of the health care services and their level of appraisal on the health care programs being implemented by the New Bilibid Prison was required. Questionnaire was purposely translated to Filipino for easy understanding of the inmate respondents. To measure respondents' attitudes on the extent to which they agreed or disagreed with a particular question or statement, the questionnaire required responses according to five-point rating scale as follows: Rating Scale 5 4 3 2 1 Documentary Analysis The documentary analysis was conducted to achieve a contextual understanding of the health care program its impact on inmates well being. Relevant documents concerning on the morbidity and mortality Verbal Classification Lubhang Nasusunod Nasusunod Bahagyang Nasusunod Di Nasusunod Lubhang Di Nasusunod

65 from fiscal year 2009 to 2010 were obtained and analyzed.

Validation of Instrument

For validation purposes, the researcher initially submitted a drafted survey questionnaire to the adviser for corrections. It was then subjected to face and content validation of experts assigned by the Dean of Graduate Schools of Education at the University of Perpetual HelpDalta for reading, comments and suggestions. Survey questionnaire was distributed for pilot testing, after the survey questionnaire was answered, the researcher asked the respondents for any suggestions or any necessary corrections to ensure further improvement and validity of the instrument. The researcher again examined the content of the survey questionnaire to find out the reliability of the instrument. The researchers excluded irrelevant questions and changed words that were deemed difficult to the respondents, to much simpler terms. Then revisions were made in accordance with the suggestions and recommendations.

Data-Gathering Procedure

To successfully accomplish the objectives of the study, the

66 following process in the gathering of data was followed: Once the questionnaire was revised and approved, a letter of permission was presented to the Chief, New Bilibid PrisonHospital and to the Director of the Bureau of Corrections, for their approval of the participation of inmate patients. The letter likewise included the

request to acquire information from patients medical records. A ttached to the letter was a copy of the questionnaire and procedure to be followed in the distribution. The researcher personally attended to whatever questions that was raised in the process of accomplishing the questionnaires. Collation and retrieval of the accomplished questionnaire was done by the researcher. Once data were completed through survey and subjected to data analysis, interpreted. they were tabulated, analyzed, treated statistically and

Statistical Treatment of Data In answering the problem raised in the study the statistical tools applied were descriptive and inferential statistics. Descriptive Statistics was used to describe the basic features of the data in the study. They provide simple summaries about the sample

67 and the measures. Together with simple graphics analysis, they form the basis of virtually every quantitative analysis of data. Frequency count and percentage were utilized in determining the distribution of demographic profile of inmate respondents according to age, patient classification, and length of stay in prison. Likewise, frequency count and percentage were used in distribution of monthly morbidity and mortality of inmate respondents. Weighted mean was employ in rating the responses of respondents on the areas of health services in the New Bilibid Prison. Obtained weighted means were

verbally described based on statistical limits constructed as follows: Statistical Limits 4.5 5 3.5 4.49 2.5 3.49 1.5 2.49 1 1.49 Numerical Response 5 4 3 2 1 Verbal Description Lubhang Nasusunod Nasusunod Bahagyang Nasusunod Di Nasusunod Lubhang Di Nasusunod

Inferential

Statistics

was

applied

particularly,

t-test

for

independent samples, to compare the perceptions of the inpatients and the outpatients on the extent of implementation of the health care

delivery system in the New Bilibid Prison. Significance of difference was tested at five per cent level.

68 Chapter 4 PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

The presentation and analysis of data gathered from documentary analysis and surveys among the outpatients and in-patients of the New Bilibid Prison Hospital, Bureau of Corrections and the interpretation of the results presented were based on the specific problems previously raised in the study. In this regard, part one showed the demographic profile of the respondents, and part two tackled the extent of effectiveness of the health care services as assessed by the respondents.

Problem No. 1: The demographic profile of the inmate-respondents according to: 1.1. Age; 1.2. Existing patient classification (in-patient and outpatient); and 1.3. Length of stay in the New Bilibid Prison, Bureau of Corrections? 1.1. Age Profile of the Inmate Respondents Table 2 presents the frequency and percentage distribution of inmate- respondents according to age.

69 Table 2 Frequency and Percentage Distribution of Inmate-Respondents According to Age

Age Groups
30 years old and below 31 40 years old 41 50 years old 51 60 years old 61 70 years old 71 years old and above

In-patients (n=100) Frequency Percentage

8 16 25 29 16 6 8% 16% 25% 29% 16% 6%

Outpatient (n=300) Frequency Percentage

13 65 91 87 41 3 4% 22% 30% 29% 14% 1%

Total

100

100%

300

100%

It could be gleaned in Table 2 that there were 29 or 29 per cent of the in-patients who belong to the age bracket of 51- 60 years old, and 25 or 25 per cent belong to age ranging from 41 to 50 years old. Sixteen (16) or 16 per cent were ages 31-40 years old, and 16 or 16 per cent were ages ranging from 61 to 70 years old. Six (6) or 6 per cent were ages 71 years old and above. For outpatients, there were 91 or 30 per cent with age ranging from 41to 50 years old, and 87 or 29 per cent belong to age bracket of 51-60 years old. Sixty-five (65) or 22 per cent were within the age bracket of 31-40 years old, and 3 or 1 per cent belong to age ranging from 71 years old and above. These data disclosed that most of the inmate respondents were in their middle age. It is probable that middle age inmates have a high level of anxiety or stress due to numerous limitations while in prison knowing that they could be doing something

70 productive for themselves and most especially for their family if they

were free. Stress combined with faulty lifestyle predisposed them to acquire various diseases. Middle age is that point in your life when you shift from seeing the future in terms of your potential and begin to see it in terms of your limitations. Limitations cause stress especially with incarcerated individuals, Psychologist Sheldon Cohen has found that stress was a contributing factor in human disease, and in particular depression, cardiovascular disease and other chronic diseases. 1.2. Existing Patient classification (in-patient and outpatient) Table 3 presents the population and percentage distribution of respondents according to patient classification. Table 3 Distribution of Respondents According to Patient Classification Respondents In-patients Outpatient Total Population 400 1,000 1,400 Percentage 40% 60% 100%

It could be gleaned in Table 3 that there were a total number of 1,400 which consisted of 100 per cent of the respondents. As showed, 40 per cent consisted of 100 in-patients and 60 per cent included 300 outpatients. For proportionate distribution of respondents, 100 out of 400

71 in-patients and 300 out of 1,000 for outpatients were utilized in this study. Perhaps, it could be that even in a free society patients who sought consultations were proportionately numerous than patients who needed hospital admissions. Thus, there were a vast number of outpatients than in-patients. There were seriously ill patients that required hospital admissions, while others who have manageable illnesses only required outpatient consultations. Outpatient can refer to any type of service offered that does not involve an overnight stay in a medical facility, (About.com.Health Careers). 1.3. Length of stay in the New Bilibid Prison, Bureau of Corrections Table 4 exhibits the frequency and percentage distribution of inmate-respondents according to their length of stay in prison.
Table 4

Frequency and Percentage Distribution of Inmate-Respondents According to Length of Stay in Prison

Length of Imprisonment (number of years in prison) 10 years and below 11 20 years 21 30 years 31 years and above In-patient (n=100) Frequency Percentage 47 43 8 2 47 43 8 2 Outpatient (n=300) Frequency Percentage 127 143 27 3 42 48 9 1

Total

100

100

300

100

Table 4 depicted the length of stay in prison of the respondentts. For in-patients there were 47 or 47 per cent of patients that belong to those who were sentenced to 10 years and below. There were 43 or 43

72 per cent who were sentenced to 11-20 years, 8 or 8 per cent belong to the years bracket of 21-30 years. There were 2 or 2 per cent who were sentenced to 31 years and above. For outpatients, there were 127 or 42 per cent with prison sentence of 10 years and below, 143 or 48 per cent were those with prison sentence of 11- 20 years. There were 27 or 9 per cent who were

sentenced to 21-30 years, and there were 3 or 1 per cent who were sentenced to 31 years and above. As presented in the table, inmates with the lowest years of imprisonment demonstrated a significant number of various diseases than those with higher years of imprisonment. It would be possible that infection was acquired prior to inmates conviction and finally brought to correctional facility. contribute to prisoners disease The following factors may

prior to i ncarceration such as: low

socioeconomic status, poor access to health care in their home communities, and high risk behaviors. Following incarceration, a number of environmental factors including crowded living conditions, lack of temperature control, poor sanitation, and increased psychological stress may further contribute to it, (Baillargeon, J. et,al). Problem No. 2: The Demographic profile of the inmate-respondents in the year 2009 and 2010 in terms of: 2.1. Morbidity; and 2.2. Mortality?

73 Morbidity of inmate-respondents Table 5 shows the frequency and percentage distribution of inmate-respondents according to monthly morbidity from fiscal year 2009 to 2010. Table 5 Frequency and Percentage Distribution of In-Patients According to Monthly Morbidity (F.Y. 2009-2010)
Month January February March April May June July August September October November December Total Frequency (2009) 494 463 476 471 452 490 458 453 476 469 455 486 5,643 Percentage 8.75% 8.20% 8.44% 8.35% 8.01% 8.68% 8.12% 8.03% 8.44% 8.31% 8.06% 8.61% 100% Frequency (2010) 429 415 405 373 375 367 399 407 367 373 378 406 4,694 Percentage 9.14% 8.84% 8.63% 7.95% 7.99% 7.39% 8.50% 8.67% 7.82% 7.95% 8.05% 8.65% 100%

Source: New Bilibid Prison Hospital Patient Census Logbook

It could be described from table 5 that there was a decreased in monthly morbidity from fiscal 2009 to 2010. It was noted that the month of January had the highest morbidity of 494 in 2009. Four hundred ninety (490) or 8.68 per cent for the month of June, and 486 or 8.61 per cent for December were the second and third highest frequency, respectively. May had the lowest frequency of 452 or 8.01 per cent. For the year 2010, it was noted that January had the highest morbidity of 429 or 9.14 per cent, and 415 or 8.84 per cent for the month

74 of February. Four hundred seven (407) or 8.67 per cent for the month of August was the third highest frequency of morbidity. Three hundred sixty seven (367) or 7.82 per cent for the month of June and September have the lowest frequency of morbidity for the year 2010. Fiscal year 2009 had a total morbidity of 5, 643 and fiscal year 2010 had a total number of 4, 694, there was a difference of 949 which was substantial indication of improvement. The leading illnesses in the New Bilibid Prison as presented in table 1 were respiratory tract diseases, gastrointestinal tract diseases, integumentary/skin diseases,

cardiovascular, ear, nose and throat, endocrine, and bone diseases, psychiatric/mental disorders and surgical cases taken from data analysis gathered from New Bilibid Prison Hospital Patient Cencus Logbook and NBP Hospital Leading Illnesses Monthly Report during the fiscal year 2009 2010. It is probable that the current approach in the provision of health care generated the improvement. The emphasis of approach was focused in the prevention of illness and health promotions have improved awareness and have empowered inmates to modify lifestyle. Lifestyle modification decreases chronic illnesses, (Willet, W.C. et,al).

75 Table 6 shows the frequency and percentage distribution of outpatients according to monthly morbidity from fiscal year 2009 to 2010. Table 6 Frequency and Percentage Distribution of Outpatients Respondents According to Monthly Morbidity (F. Y. 2009-2010)

Frequency Percentage Frequency Percentage (2009) (2010) January 1,424 8.04% 1,519 8.09% February 1,460 8.24% 1,515 8.07% March 1,586 8.95% 1,605 8.54% April 1,573 8.88% 1,673 8.91% May 1,472 8.31% 1,575 8.38% June 1,490 8.41% 1,567 8.34% July 1,458 8.23% 1,599 8.51% August 1,493 8.43% 1,517 8.08% September 1,436 8.11% 1,557 8.29% October 1,469 8.29% 1,573 8.37% November 1,405 7.93% 1,568 8.35% December 1,446 8.16% 1,516 8.07% Total 17,712 100% 18,784 100% Source: Out-Pa
Source: Outpatient Department (OPD) Record

Month

It could be described from table 6 that there was an increased in outpatients monthly morbidity from fiscal 2009 to 2010. It was noted that the month of March had the highest morbidity of 1,586 or 8.95 per cent in 2009. Month of April had 1,573 or 8.88 per cent of morbidity, and 1,493 or 8.43 per cent for the month of August. The month of November had the lowest morbidity of 1,405 or 7.93 per cent for the year 2009. For the year 2010, it was noted that the month of April had the

76 highest frequency of 1,673 or 8.91 per cent of morbidity. Month of March had 1,605 or 8.54 per cent, and 1,599 or 8.51 per cent for the month of July. The lowest morbidity was in the month of February with a frequency of 1,515 or 8.07 per cent. Fiscal year 2009 has a total morbidity of 17, 712 and fiscal year 2010 had a total rate of 18, 784. The leading illnesses in the New Bilibid Prison as presented in table 1 were respiratory tract diseases, gastrointestinal tract diseases, integumentary/skin diseases,

cardiovascular, ear, nose and throat, endocrine, and bone diseases, psychiatric/mental disorders and surgical cases taken from data analysis gathered from New Bilibid Prison Hospital Patient Cencus Logbook and NBP Hospital Leading Illnesses Monthly Report during the fiscal year 2009 2010. It would seem that the increase in outpatient morbidity rate was merely due to a discharged inpatient from hospital confinement and their conditions were manageable as outpatients, thus were added to the number of outpatients. Outpatient care describes medical care or treatment that does not require an overnight stay in a hospital or medical facility. 2.2. Mortality of inmate-respondents Table 7 presents the frequency and percentage according to monthly mortality from fiscal year 2009 to 2010.

77 Table 7 Frequency and Percentage Distribution of InmateRespondents According to Monthly Mortality (F. Y. 2009-2010)
Month January February March April May June July August September October November December Total Frequency (2009) 21 23 20 18 25 24 30 23 23 25 26 21 279 Percentage 7.53% 8.24% 7.17% 6.45% 8.96% 8.60% 10.75% 8.24% 8.24% 8.96% 9.32% 7.53% 100% Frequency (2010) 30 19 20 13 27 21 23 26 16 22 26 26 269 Percentage 11.15% 7.06% 7.43% 4.83% 10.04% 7.81% 8.55% 9.67% 5.95% 8.18% 9.67% 9.67% 100%

Source: New Bilibid Prison Hospital Mortality Report

It could be gleaned from table 7 that the mortality had decreased from fiscal year 2009 to 2010. There were months that the mortality rates have increased from year 2009 to 2010, such as the months of January 21 to 30, May 25 to 27, August 23 to 26, and December 21 to 26. The total number of mortality for the year 2009 was 279 and 269 for the year 2010. The leading caused of death was due to respiratory tract diseases as per data analysis taken from the mortality report of the New Bilibid Prison during the fiscal year 2009 2010. It is possible that a decreased in total mortality rate was attributed to the collaborative efforts of health care providers. Based on the recorded decreased in mortality rate, decline in mortality reflected the joint influences of environmental, social,

78 nutritional, and genetic factors and effect of the health services, (The Lancet). Problem No. 3: Extent of the Effectiveness of the Health Care Services in the New Bilibid Prison in relation to the following: 3.1. In-patients 3.1.1. Mission and Vision Table 8 presents the effectiveness of health care services as perceived by the in-patients in relation to its mission and vision. Table 8 Mean Scores According to In-patient-Respondents in Relation to Mission and Vision (n=100)
Indicators 1. Alam ko ang misyon at bisyon sa pangkalusugan ng New Bilibid Prison Hospital 2. Naiintindihan ko ang ibig nitong ipahiwatig 3. Nakatuon ito sa pagkakapantay-pantay 4. Nakasaad dito ang magandang maidudulot sa bawat bilanggo 5. Kasama sa hangaring pangkalusugang ito ang pamilya ng bawat bilanggo 6. Nakasaad dito ang pagbabago para sa maunlad na programa sa kalusugan 7. Nakasaad dito ang mga positibong hangaring pangkalusugan 8. Nakasaad dito na matutugunan ang pangangailangang medikal ng bawat bilanggo 9. Gabay ito sa bawat bilanggo upang maging handa sa pagharap sa malayang lipunan 10. Nagagawa, nakikita at nasusunod ang mga nakasaad sa misyon at bisyon ng NBP Hospital Overall Mean Legend: L-N Lubhang Nasusunod (4.5 5) N Nasusunod (3.5 4.49) B-N Bahagyang Nasusunod (2.5 3.49) Weighted Mean 3.52 3.55 3.58 Interpretation Nasusunod Nasusunod Nasusunod

3.75

Nasusunod

3.63

Nasusunod

3.71

Nasusunod

3.72

Nasusunod

3.56

Nasusunod

3.82

Nasusunod

3.61

Nasusunod

3.65 Nasusunod D-N Di-Nasusunod (1.5 2.49) L-DN Lubhang Di-Nasusunod (1 1.49)

79 Table 8 presented the mean scores and interpretations of responses of the in-patients on the ten indicators regarding mission and vision. Result of the analysis showed that all indicators were described as N Nasusunod, the highest mean response of 3.82 was manifested in indicator 9, Gabay ito sa bawat bilanggo upang maging handa sa pagharap sa malayang lipunan, which signified that the in-patients believed on what the mission and vision of the health program intents to achieved correlated with the overall program of the Bureau of Corrections per se. Moreover, indicators 4, Nakasaad dito ang magandang maidudulot sa bawat bilanggo, indicator 7, Nakasaad dito ang mga positibong hangaring pangkalusugan, indicator 6, Nakasaad

dito ang pagbabago para sa maunlad na programa sa kalusugan, these results indicated that in-patients were aware about the health benefits as indicated in programs mission and vision. Furthermore, indicators 5, Kasama sa hangaring pangkalusugang ito ang pamilya ng bawat bilanggo, indicator 10, Nagagawa, nakikita at nasusunod ang mga nakasaad sa misyon at bisyon ng New Bilibid Prison Hospital and indicator 3, Nakatuon ito sa pagkakapantay-pantay, these findings signified that respondents appreciated the idea that their family was part of the mission and vision. Likewise, indicator 8, Nakasaad dito na matutugunan ang pangangailangang medical ng bawat bilanggo,

indicator 2, Naiintindihan ko ang ibig nitong ipahiwatig , indicator 1, Alam

80 ko ang misyon at bisyon sa pangkalusugan ng New Bilibid Prison Hospital, these findings indicated that the in-patients fully understand the mission and vision of the health care program. The means range from 3.5 to 4.49, described as N- Nasusunod. Of the ten items, indicator 9 had the highest mean rating of 3.82 and indicator 1 had the lowest mean rating of 3.52. It would seem that in-patients have not given much attention on what was stated in the mission and vision instead they were more concerned on how it was employed and the benefits they acquired from it. In-patients received first hand services from the New Bilibid Prison Hospital, thus, the perception of the in-patients reflected on how they

have experienced the services. Mission is an action statement enabling the vision to be carried out and long-term objectives to be established. It establishes the unique purpose for which Chrysalis exists, as well as its scope of operation, and reflects the values of the entire organization (Pearce-Robinson, 2003). 3.1.2. Staffing Table 9 presents the extent of effectiveness of the health care services as perceived by the in-patients in relation to staffing.

81 Table 9 Mean Scores According to In-patient-Respondents in Relation to Staffing (n=100)

Indicators
1. Maayos na pagtrato sa pasyente 2. Laging handa sa pagtugon sa medikal na pangangailangan 3. Pantay na pagtrato sa lahat 4. Pinag-iisipan ang mabuting epekto ng panggagamot 5. Nagtatrabaho nang maayos 6. Kayang magbigay ng serbisyo kahit sa panahon ng kaguluhan sa loob ng bilangguan 7. Nagtutulungan para sa maayos na daloy ng trabaho at serbisyo 8. Naglalaan ng dagdag oras para sa ibang programang pangkalusugan 9. Pinag-iisipan ang kapakanan ng mga pasyente at ng pamilya nito 10. Iginagalang ang relihiyon ng bawat pasyente

Weighted Mean
3.90

Interpretation
Nasusunod

3.86 3.79

Nasusunod Nasusunod

3.94 4.05

Nasusunod Nasusunod

3.84

Nasusunod

3.85

Nasusunod

3.74

Nasusunod

3.76 4.22

Nasusunod Nasusunod

Overall Mean Legend: L-N Lubhang Nasusunod (4.5 5) N Nasusunod (3.5 4.49) B-N Bahagyang Nasusunod (2.5 3.49) D-N Di- Nasusunod (1.5 2.49) L-DNLubhang Di-Nasusunod (1 1.49)

3.90

Nasusunod

Table presented the mean scores and interpretations of responses of the in-patients on the ten indicators regarding staffing. Result of the analysis showed that all indicators were described as N Nasusunod, the highest mean response of 4.22 was indicator 10, Iginagalang ang relihiyon manifested in

ng bawat pasyente, which

signified that inmate patients believed that the staff treated them with respect. Likewise, indicator 5, Nagtatrabaho nang maayos, indicator 4,

82 Pinag-iisipan ang mabuting epekto ng panggagamot, and indicator 1, Maayos na pagtrato sa mga pasyente, these findings signified that patients were treated fairly. Furthermore, indicator 2, Laging handa sa pagtugon sa medikal na pangangailangan, indicator 7, Nagtutulungan para sa mas maayos na daloy ng trabaho at serbisyo, and indicator 6, Kayang magbigay ng serbisyo kahit sa panahon ng kaguluhan sa loob ng bilangguan, these answers indicated that patients perceived that staffing was well organized. Moreover, indicator 3, Pantay na pagtrato sa lahat, indicator 9, Pinag-iisipan ang kapakanan ng mga pasyente at ng pamilya nito, indicator 8, Naglalaan ng dagdag na oras para sa ibang programang pangkalusugan, these results indicated that the patients

perceived the care and concern of the staff. The means range from 3.5 to 4.49, described as N- Nasusunod. Of the ten items, indicator 10 had the highest mea n rating of 4.22 and indicator 8 had the lowest mean rating of 3.74. It is probable that in-patients have experienced and appreciated the wholistic care rendered by health personnel that reflected on the result of the mean responses. Indicator 10 ranked first which signified that inpatients valued the respect showed by the health personnel to

their religion. According to Garland (1990), throughout the history of penal practice religion has been a major force in shaping the ways

83 in which offenders are dealt with, while even today in a practical

sense, religion is a central aspect of the modern prison system. 3.1.3. Medical Supplies Table 10 presents the extent of effectiveness of health care services as perceived by in-patients in relation to medical supplies such as medicines, syringes, gauze, intravenous fluids, oxygen, alcohol, cotton, etc. Table 10 Mean Scores According to In-patient-Respondents In Relation to Medical Supplies (n=100)
Indicators
1. Sapat 2. Epektibo 3. Laging mayroon 4. Pangmatagalan 5. Nakikita 6. Nagagamit ng wasto 7. Nabibigay ng tama 8. Angkop 9. Nakalaan sapasyente 10. Kapaki-pakinabang

Weighted Mean
3.64 3.94 3.52 3.60 3.75 3.95 3.91 3.83 3.86 3.97

Interpretation
Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod

Overall Mean Legend: L-N Lubhang Nasusunod (4.5 5) N Nasusunod (3.5 4.49) B-N Bahagyang Nasusunod (2.5 3.49) D-N Di- Nasusunod (1.5 2.49) L-DN Lubhang Di-Nasusunod (1 1.49)

3.80

Nasusunod

Table 10 presented the mean scores and interpretations of responses of the in-patients on the ten indicators regarding medical

84 supplies. Result of the analysis showed that all indicators were

described as N Nasusunod, the highest mean response of 3.97 was manifested in indicator 10, Kapaki-pakinabang, in-patients perceived which signified that

the importance of the medical supplies to their

health needs. Moreover, indicator 6, Nagagamit ng wasto, indicator 2, Epektibo, and indicator 4, Nabibigay ng tama, these findings indicated that the inpatients appreciated how medications were given and why it was given. Furthermore, indicator 9, Nakalaan sa pasyente, indicator 6, Angkop, and indicator 5, Nakikita, these results indicated that the inpatients have witnessed the availability of medical supplies. Likewise, indicator 8, Sapat, indicator 4, Pangmatagalan, and indicator 3, Laging mayroon, these results indicated that the inpatients perceived that medical supplies were sufficient. The means range from 3.5 to 4.49, described as N- Nasusunod. Of the ten items, indicator 10 had the highest mean rating of 3.97 and indicator 3 had the lowest mean rating of 3.52. It would seem that in-patients were aware on the importance of the medical supplies as stated in indicator 10, and indicator 3 was ranked last would connote

that inavailability of medical supplies affected them. Inmates relied so much with the available resources inside prison camps, especially those who did not have regular visits. In times of sickness they mainly relied on

85 what can be offered to them by the hospital staff. Prisons should

recognize that most prisoners need considerable health care. Adequate resources should be devoted to prison health care to provide

prisoners with a standard of health care that is at least equivalent to that provided in the community outside, World Health Organization (WHO). 3.1.4. Programs Table 11 presents the extent of effectiveness health care services as perceived by in-patients in relation to programs. Table 11 Mean Scores According to In-patient-Respondents in Relation to Programs (n=100)
Inidicators 1. Alam ko ang mga programang pangkalusugan ng NBP 2. Naiintindihan ko ang ibig sabihin nito 3. Nagbibigay ito ng mga kaalamang pangkalusugan 4. Nagtutulungan ang mga empleyado at bilanggo sa ibat ibang programang pangkalusugan 5. Dahil sa mga programang ito, nabago ang aking pananaw sa buhay 6. Ginagamit ko ang aking mga natutunan sa pang araw araw na buhay 7. Nagkaroon ng tiwala at kontento sa sistemang pangkalusugan sa NBP 8. Nagbibigay ng oportunidad sa pagkakaisa sa loob ng bilangguan 9. Nagdadagdag ng mga bagong konseptong pangkalusugan para sa kabutihan ng lahat 10. Natutugunan ng programa ng NBP ang layuning pangkalusugan ng Bureau of Corrections Overall Mean Legend: L-N Lubhang Nasusunod (4.5 5) N Nasusunod (3.5 4.49) B-N Bahagyang Nasusunod (2.5 3.49) Weighted Mean 3.63 3.62 3.62 3.82 Interpretation Nasusunod Nasusunod Nasusunod Nasusunod

3.78

Nasusunod

3.79

Nasusunod

3.74

Nasusunod

3.85

Nasusunod

3.75

Nasusunod

3.69

Nasusunod

3.73 Nasusunod D-N Di-Nasusunod (1.5 2.49) L-DN Lubhang Di-Nasusunod (1 1.49)

86 Table 11 presented the mean scores and interpretations of responses of the in-patients on the ten indicators regarding programs. Result of the analysis showed that all indicators were described as N Nasusunod, the highest mean response of 3.85 was manifested in indicator 8, Nagbibigay ng oportunidad sa pagkakaisa sa loob ng bilangguan, these signified that in-patients perceived that the health program was a way to convey unity in prison. Furthermore, indicator 4, Nagtutulungan ang mga empleyado at bilanggo sa ibat ibang programang pangkalusugan, indicator 6, Ginagamit ko ang aking mga natutunan sa pang araw araw na buhay, indicator 5, Dahil sa mga programang ito, nabago ang aking pananaw sa buhay, these findings indicated that the in-patients believed that the health care program can improve their outlook in life. Moreover, indicator 9, Nagdadagdag ng mga bagong konseptong pangkalusugan para sa kabutihan ng lahat, indicator 7, Nagkakaroon ng tiwala at kontento sa sistemang pangkalusugan sa New Bilibid Prison, and indicator 10, Natutugunan ng programa ng NBP Hospital ang layuning pangkalusugan ng Bureau of Corrections, these results signified that in-patients believed that the program was for the improvement of the health care system. Likewise, indicator 1, Alam ko ang programang panhkalusugan ng NBp, indicator 2, Naiintindihan ko ang ibig sabihin nito, indicator 3, Nagbibigay ito ng

87 mga kaalamang pangkalusugan, these results indicated that the inpatients were aware on the existence of the health care program. The means range from 3.5 to 4.49, described as N Nasusunod. Of the ten items indicator 8 had the highest mean rating of 3.85 and indicator 2 and 3 had the lowest mean rating of 3.62. It would seem that health care programs facilitated the overall objective of the institution and maybe even the goal of every human kind, which is unity. Most governments recognize the importance of public health programs in reducing the incidence disease, disability, and the effects of aging and other physical and mental conditions, although public health generally receives significantly less government funding compared with medicine, (WHO, 2006). 3.1.5. Facilities and Equipment Table 12 presents the extent of the effectiveness of the health care services as perceived by in-patients in relation to facilities and equipment such as blood pressure apparatus, nebulizer, suction apparatus, electrocardiogram machine, X-ray machine, oxygen tank, stethoscope, defibrillator, cardiac monitor, operating room, wards, etc.

88 Table 12 Mean Scores According to In-Patient-Respondents in Relation to Facilities and Equipment (n=100)
Indicators 1. Abot nito ang pangangailangang medical ng mga pasyente 2. Kayang tumugon sa pagdami ng mga pasyente 3. May magandang pagbabago 4. Nagagamit nang wasto 5. Pangmatagalang gamit 6. Kumpleto 7. Laging nakalaan sa pangangailangan ng mga pasyente 8. Malinis 9. Angkop sa sitwasyon at kondisyon 10. Moderno Overall Mean Legend: L-N Lubhang Nasusunod (4.5 5) N Nasusunod (3.5 4.49) B-N Bahagyang Nasusunod (2.5 3.49) Weighted Mean Interpretation

3.63 3.51 3.76 3.66 3.60 3.35

Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod Bahagyang Nasusunod

3.62 3.75 3.60 3.28 3.58

Nasusunod Nasusunod Nasusunod Bahagyang Nasusunod Nasusunod

D-N Di-Nasusunod (1.5 2.49) L-DN Lubhang Di-Nasusunod (1 1.49)

Table 12 presented the mean scores and interpretations of responses of the in-patients on the ten indicators regarding facilities and equipment. Result of the analysis showed that indicators 1 to 5 and 7 to 9 were described as N Nasusunod, while indicators 6 and 10 were described as B-N Bahagyang Nasusunod, the highest mean response of 3.76 was manifested in indicator 3, May magandang pagbabago, which signified that in-patients perceived the improvements as to the facilities and equipment for health services. Moreover, indicator 8,

89 Malinis, indicator 4, Nagagamit ng wasto, and indicator 1, Abot nito ang pangangailangang medikal ng pasyente, these findings indicated inpatients perception that the facilities and equipment were well stored and efficient. Likewise, indicator 7, Laging nakalaan sa pangangailangan ng mga pasyente, indicator 5, Pangmatagalang gamit, indicator 9, Angkop sa sitwasyon at kondisyon, indicator 2, Kayang tumugon sa pagdami ng mga pasyente, these findings indicated the inpatients

perception that the equipment can sustain their health needs. Result of the analysis showed that under B-N Bahagyang Nasusunod, indicator 6, Kumpleto, and indicator 10, moderno, have the lowest mean of 3.35 and 3.28 respectively, these results signified that in-patients perceived that the facilities and equipment were partly not conforming with the health needs of patients. The means range from 3.5 to 4.49, described as N- Nasusunod and the means range from 2.5 to 3.49, described as B-N Bahagyang Nasusunod. Of the ten items, indicator 3 had the highest mean rating of 3.76 and indicator 10 had the lowest mean rating of 3.28. It is probable that in-patients have noticed and experienced the improvement in the health facilities and equipment of the institution. The New Bilibid Prisons strived hard to be able to meet the needs of the inmates, specifically the patients. The Bureau of Corrections received several donations from

90 government organizations, non-government organizations and religious groups. These donations somehow have bridge some inadequacies. Tulong- Sulong sa Kalusugan is a program of the government to uplift the health status of every Filipino, especially the poor, through vital reforms in our health system, (Dr. Manuel Dayrit, DOH). 3.2. Outpatients 3.2.1. Mission and Vision Table 13 presents the perception of outpatients on the extent of effectiveness of the health care services in relation to mission and vision. Table 13 Mean Scores According to Outpatient-Respondents in Relation to Mission and Vision (n=300)
Indicators Weighted Mean 1. Alam ko ang misyon at bisyon sa pangkalusugan ng NBP Hospital 3.65 2. Naiintindihan ko ang ibig nitong ipahiwatig 3. Nakatuon ito sa pagkakapantay-pantay 4. Nakasaad dito ang magandang maidudulot sa bawat bilanggo 5. Kasama sa hangaring pangkalusugang ito ang pamilya ng bawat bilanggo 6. Nakasaad dito and pagbabago para sa maunlad maunlad na programa sa kalusugan 7. Nakasaad dito ang mga positibong hangaring pangkalusugan 8. Nakasaad dito na matutugunan ang pangangailangan medikal ng bawat bilanggo 9. Gabay ito sa bawat bilanggo upang maging handa sa pagharap sa malayang lipunan 10. Nagagawa, nakikita at nasusunod ang mga nakasaad sa misyon at bisyon ng New Bilibid Prison Hospital Overall Mean Legend: L-N Lubhang Nasusunod (4.5 5) N Nasusunod (3.5 4.49) B-N Bahagyang Nasusunod (2.5 3.49) 3.66 3.57 3.87 Interpretation Nasusunod Nasusunod Nasusunod Nasusunod

3.69

Nasusunod

3.84 3.86

Nasusunod Nasusunod

3.63

Nasusunod

3.92

Nasusunod

3.66

Nasusunod

3.73 Nasusunod D-N Di Nasusunod (1.5 2.49) L-DN Lubhang Di-Nasusunod (1 1.49)

91 Table 13 presented the mean scores and interpretations of responses of the outpatients on the ten indicators regarding mission and vision. Result of the analysis showed that all indicators were described as N Nasusunod, the highest mean response of 3.92 was manifested in indicator 9, Gabay ito sa bawat bilanggo upang maging handa sa pagharap sa malayang lipunan, which signified that believed in the mission and vision of the health the outpatients program and its

intention to prepare them back to the free society, preparing inmates for their release and reintegration into society is key to helping them succeed outside prison. Moreover, indicators 4, Nakasaad dito ang magandang maidudulot sa bawat bilanggo, indicator 7, Nakasaad dito ang mga positibong hangaring pangkalusugan, indicator 6, Nakasaad

dito ang pagbabago para sa maunlad na programa sa kalusugan, these answers indicated that inmates were aware about the program s mission and vision. Furthermore, indicators 5, Kasama sa hangaring

pangkalusugang ito ang pamilya ng bawat bilanggo,

indicator 10,

Nagagawa, nakikita at nasusunod ang mga nakasaad sa misyon at bisyon ng New Bilibid Prison Hospital and indicator 2, Naiintindihan ko ang ibig nitong ipahiwatig, these results signified that respondents perceived that the mission and vision was well taken and acceptable. Likewise, indicator 1, Alam ko ang misyon at bisyon sa pangkalusugan

92 ng New Bilibid Prison Hospital

,

indicator 8, Nakasaad dito na ng bawat

,

matutugunanang pangangailangang medikal

bilanggo,

indicator 3, Nakatuon ito sa pagkakapantay-pantay

these findings

indicated that the outpatients were fully aware that the mission and vision of the health care program was fair and just. The means range from 3.5 to 4.49, described as N- Nasusunod. Of the ten items, indicator 9 had the highest mean rating of 3.92 and indicator 1 had the lowest mean rating of 3.57. It would seem that outpatients perceived that the mission and vision molded them to be a reformed person and preparing them to face the free society once released from prison. Both people and organizations need to establish a strategic framework one of which is mission and vision, for significant success. The organization's success and your personal success depend on how well you define and live by each of these important concepts, (Heathfield, ST., 2000). 3.2.2. Staffing Table 14 presents the perception of outpatients on the extent of effectiveness of the health care services in relation to staffing in the New Bilibid Prison, Bureau of Corrections

93 .Table 14 Mean Scores According to Outpatient-Respondents in Relation to Staffing (n=300)

Indicators 1. Maayos na pagtrato sa mga pasyente 2. Laging handa sa pagtugon sa pangangailangang medical 3. Pantay na pagtrato sa lahat 4. Pinag-iisipan ang mabuting epekto ng panggagamot 5. Nagtatrabaho ng maayos 6. Kayang magbigay ng serbisyo kahit sa panahon ng kaguluhan sa loob ng bilangguan 7. Nagtutulungan para sa maayos na daloy ng trabaho at serbisyo 8. Naglalaan ng dagdag na oras para sa ibang programang pangkalusugan 9. Pinag-iisipan ang kapakanan ng mga Pasyente at ng pamilya nito 10. Iginagalang ang relihiyon ng bawat pasyente Weighted Mean 3.75 3.56 3.52 3.78 3.76 Interpretation Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod

3.79

Nasusunod

3.84

Nasusunod

3.80

Nasusunod

3.67 4.07

Nasusunod Nasusunod

Overall Mean Legend: L-N Lubhang Nasusunod (4.5 5) N Nasusunod (3.5 4.49) B-N Bahagyang Nasusunod (2.5 3.49)

3.76 Nasusunod D-N Di-Nasusunod (1.5 2.49) L-DN Lubhang Di-Nasusunod (1 1.49)

Table 14 presented the mean scores and interpretations of responses of the outpatients on the ten indicators regarding staffing. Result of the analysis showed that all indicators were described as N Nasusunod, the highest mean response of 4.07 was manifested in indicator 10, Iginagalang ang relihiyon ng bawat signified pasyente, which

that the respect showed by the staff were valued by the

outpatients. Likewise, indicator 7, Nagtutulungan para sa mas maayos na daloy ng trabaho at serbisyo, indicator 8, Naglalaan ng dagdag na

94 oras para sa ibang programang Kayang magbigay ng serbisyo pangkalusugan, and indicator 6, kahit sa panahon ng kaguluhan sa

loob ng bilangguan, these results indicated that outpatients perceived that there was an organized staffing. Moreover, 4, Pinag-iisipan ang mabuting epekto ng panggagamot, indicator 5, Nagtatrabaho nang maayos, and indicator 1, Maayos na pagtrato sa mga pasyente, these findings signified that patients were treated fairly. Furthermore, indicator 9, Pinag-iisipan ang kapakanan ng mga pasyente at ng pamilya nito, indicator 2, Laging handa sa pagtugon sa medikal na pangangailangan, indicator 3, Pantay na pagtrato sa lahat, these answers indicated that the outpatients perceived the care and concern of the staff. The means range from 3.5 to 4.49, described as N- Nasusunod. Of the ten items, indicator 10 had the highest mean rating of 4.02 and indicator 3 had the lowest mean rating of 3.52. Perhaps, it could be that outpatients have experienced and valued the fair treatment and

how staff respected their religion and culture. Health care personnel vowed to render wholistic care to their patients irregardless of religion. Many essential components are required to achieve a health promoting prison, including political leadership, management leadership and leadership by each staff member, (NCCHC).

95 3.2.3. Medical Supplies Table 15 presents the perception of outpatients on the extent of effectiveness of health care services in relation to medical supplies. Table 15 Mean Scores According to Outpatient-Respondents in Relation to Medical Supplies (n=300)
Indicators 1. Sapat 2. Epektibo 3. Laging mayroon 4. Pangmatagalan 5. Nakikita 6. Nagagamit ng wasto 7. Nabibigay ng tama 8. Angkop 9. Nakalaan sapasyente 10. Kapaki-pakinabang Weighted Mean 3.18 3.40 3.00 3.12 3.30 3.52 3.50 3.53 3.54 3.74 Interpretation Bahagyang Nasusunod Bahagyang Nasusunod Bahagyang Nasusunod Bahagyang Nasusunod Bahagyang Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod

Overall Mean 3.38 Bahagyang Nasusunod Legend: L-N Lubhang Nasusunod (4.5 5) D-N Di-Nasusunod (1.5 2.49) N Nasusunod (3.5 4.49) L-DN Lubhang Di-Nasusunod (1 1.49) B-N Bahagyang Nasusunod (2.5 3.49)

Table 15 presented the mean scores and interpretations of responses of the outpatients on the ten indicators regarding medical supplies. Result of the analysis showed that indicators 1 to 5 were described as B-N Bahagyang Nasusunod, 10 were described as N Nasusunod, the of 3.74 and highest indicators 6 to

mean response

was manifested in indicator 10, Kapaki-pakinabang, which

signified that outpatients perceived the importance of the medical

96 supplies to their health needs. Moreover, indicator 9, Nakalaan sa pasyente, indicator 8, Sapat, indicator 6, Angkop, and indicator 7, Nabibigay ng tama, these findings indicated the outpatients perceived that medical supplies were adequate and appropriate. Furthermore, result of the analysis showed that under the B-N Bahagyang Nasusunod, with a lower mean response of 3.40 to 3.00 and ranked 7 to 10 was manifested in the following indicators: indicator 2, Epektibo, indicator 5, Nakikita, indicator 1, Sapat, indicator 4, Pangmatagalan, and indicator 3, Laging mayroon, these findings indicated that the outpatients perceived that medical supplies were not quite sufficient to meet their health needs. The means range from 3.5 to 4.49, described as N- Nasusunod and the means range from 2.5 to 3.49, described as B-N Bahagyang Nasusunod. Of the ten items, indicator 10 had the highest mean rating of 3.74 and indicator 3 had the lowest mean rating of 3.00. It is possible that outpatients recognized the benefits of the medical supplies. An effective and efficient procurement system is designed to obtain the correct medicines and products of good quality, at the right time, in the required quantities, and at favourable costs. Essential medicines save lives and improve healthbut only when they are available, affordable, of good quality, and properly used. (Jonathan D. Quick, 2002).

97 3.2.4. Programs Table 16 exhibits the perception of the outpatients on the extent of effectiveness of the health care services in relation to Health Programs. Table 16 Mean Scores According to Outpatient-Respondents in Relation to Programs (n=300)
Indicators 1. Alam ko ang mga programang pangkalusugan ng NBP 2. Naiintindihan ko ang ibig sabihin nito 3. Nagbibigay ito ng mga kaalamang pangkalusugan 4. Nagtutulungan ang mga empleyado at bilanggo sa ibat ibang programang pangkalusugan 5. Dahil sa mga programang ito, nabago ang aking pananaw sa buhay 6. Ginagamit ko ang aking mga natutunan sa pang araw araw na buhay 7. Nagkaroon ng tiwala at kontento sa sistemang pangkalusugan sa NBP 8. Nagbibigay ng oportunidad sa pagkakaisa saloob ng bilangguan 9. Nagdadagdag ng mga bagong konseptong pangkalusugan para sa kabutihan ng lahat 10. Natutugunan ng programa ng NBP ang layuning pangkalusugan ng Bureau of Corrections Overall Mean Legend: L-N Lubhang Nasusunod (4.5 5) N Nasusunod (3.5 4.49) B-N Bahagyang Nasusunod (2.5 3.49) Weighted Mean Interpretation 3.82 3.81 3.91 3.96 3.96 3.94 3.75 3.86 Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod Nasusunod

3.82

Nasusunod

3.72 Nasusunod 3.86 Nasusunod D-N Di-Nasusunod (1.5 2.49) L-DN Lubhang Di-Nasusunod (1 1.49)

Table 16 presented the mean scores and interpretations of responses of the outpatients on the ten indicators regarding programs. Result of the analysis showed that all indicators were described as N Nasusunod, the highest mean response of 3.96 was manifested in indicator 4, Nagtutulungan ang mga empleyado at bilanggo sa ibat ibang programang pangkalusugan, and indicator 5, Dahil sa mga

98 programang ito,nabago ang aking pananaw sa buhay, these findings indicated that the outpatients believed that the health care program can improve their outlook in life. Moreover, indicator 6, Ginagamit ko ang aking mga natutunan sa pang araw araw Nagbibigay ito ng mga na buhay, indicator 3,

kaalamang pangkalusugan, and indicator 8,

Nagbibigay ng oportunidad sa pagkakaisa sa loob ng bilangguan, these signified that outpatients perceived that the health program was a way to convey unity in prison. Furthermore, indicator 9, Nagdadagdag ng mga bagong konseptong pangkalusugan para sa kabutihan ng lahat,

indicator 1, Alam ko ang mga programang pangkalusugan ng NBP, and indicator 2, Naiintindihan ko ang ibig sabihin nito, these findings

indicated that the out-patients were aware on the existence of the health care program. Likewise, indicator 7, Nagkaroon ng tiwala at kontento sa sistemang pangkalusugan sa New Bilibid Prison, and indicator 10, Natutugunan ng programa ng ng NBP Hospital ang layuning

pangkalusugang

Bureau of Corrections, these findings signified

that outpatients believed that the program was for the improvement of the health care system. The means range from 3.5 to 4.49, described as N- Nasusunod. Of the ten items, indicator 4 and 5 have the highest mean rating of 3.96 and indicator 10 had the lowest mean rating of 3.72. It would seem

99 that outpatients have seen the effort of the health personnel to

execute and model what is stated in the program, thus, empowered them to abide and consequently helped them see life in a better

perspective. According to the Federal Bureau of Prisons website, preparing inmates for their release and reintegration into society is the key to helping them succeed outside prison. Programs vary according to location and budget, but can include resume preparation, job training and education certificates, release clothing or gratuity and contact with community-based organizations that act as intermediates to help released inmates reintegrate into society. 3.2.5. Facilities and Equipment Table 17 exhibits the perception of the outpatients on the extent of effectiveness of health care services in relation to facilities and equipment such as blood pressure apparatus, nebulizer, suction apparatus, electrocardiogram machine, X-ray machine, oxygen tank, stethoscope, defibrillator, cardiac monitor, operating room, emergency room and equipment, wards, etc. in the New Bilibid Prison, Bureau of Corrections.

100 Table 17 Mean Scores According to Outpatient-Respondents in Relation to Facilities and Equipment (n=300)
Indicators 1. Abot nito ang pangangailangang medikal ng mga pasyente 2. Kayang tumugon sa pagdami ng mga pasyente 3. May magandang pagbabago 4. Nagagamit nang wasto 5. Pangmatagalang gamit 6. Kumpleto 7. Laging nakalaan sa pangangailangan ng mga pasyente 8. Malinis 9. Angkop sa sitwasyon at kondisyon 10. Moderno Weighted Mean Interpretation

3.24 3.17 3.52 3.53 3.30 3.00

Bahagyang Nasusunod Bahagyang Nasusunod Nasusunod Nasusunod Bahagyang Nasusunod Bahagyang Nasusunod

3.39 3.34 3.32 3.07

Bahagyang Nasusunod Bahagyang Nasusunod Bahagyang Nasusunod Bahagyang Nasusunod

Overall Mean Legend: L-N Lubhang Nasusunod (4.5 5) N Nasusunod (3.5 4.49) B-N Bahagyang Nasusunod (2.5 3.49) D-N Di- Nasusunod (1.5 2.49) L-DN Lubhang Di-Nasusunod (1 1.49)

3.29

Bahagyang Nasusunod

Table 17 presented the mean scores and interpretations of responses of the outpatients on the ten indicators regarding facilities and equipment. Result of the analysis showed that indicators 3 and 4 were described as N Nasusunod, and indicators 1 and 2, and indicators 5 to 10 were described as B-N Bahagyang Nasusunod, the highest mean response of 3.53 was manifested in indicator 4, Nagagamit which signified that equipment ng wasto,

the outpatients perceived that the facilities and Moreover, indicator

for health were properly utilized.

101 3, May magandang pagbabago, which indicated that there were perceived improvements in health facilities and equipment. Result of the analysis showed that under B-N Bahagyang Nasusunod, a low mean response of 3.39 to 3.00 were manifested in the following indicators: indicator 7, Laging nakalaan sa pangangailangan ng mga pasyente, indicator 8, Malinis, indicator 9, Angkop sa sitwasyon at kondisyon, indicator 5, Pangmatagalang gamit, indicator 1, Abot ang

pangangailangang medikal ng mga pasyente, indicator 2, Kayang tumugon sa pagdami ng mga pasyente, indicator 10, Moderno, and indicator 6, Kumpleto, these findings signified that the outpatients

perceived that the facilities and equipment slightly not conforming with the health programs, thus, have not met their health needs. The means range from 3.5 to 4.49, described as N- Nasusunod and the means range from 2.5 to 3.49, described as B-N Bahagyang Nasusunod. Of the ten items, indicator 4 had the highest mean rating of 3.53 and indicator 6 with the lowest mean rating of 3.00. It is probable that outpatients have witnessed and experienced the accommodation despite with the limited health facilities and equipment. Inmates that have chronic or acute medical conditions or diseases may be transferred to special prisons that have facilities for advanced care. If that's not possible because of security reasons, ambulatory care and

102 necessary equipment is provided to the prison where the inmate is housed, (Diana Bocco, 2010). Problem No. 4: Comparison of Perceptions of In-patients and Outpatients in the Identified Areas of Health Care Services. Table 18 reveals the t-computed value on the significant differences between the perceptions of in-patients and outpatients in the area of mission and vision of health care services. Table 18 T- Computed Value on the Significant Differences between the Perceptions of In-Patients and Outpatients in the Mission and Vision of the Health Care Services
Area Mission & Vision Respondents In-patient Outpatient Weighted Mean 3.65 3.73 t-computed value -1.019 t-critical value -1.966 Interpretation Decision Null hypothesis accepted

Not Significant

Table 18 depicted the t-computed value on the Significant Differences in the Extent of Effectiveness Identified Areas of Health Care Services. Result of the analysis showed the mission and vision exhibited that out-patients have a greater means than in-patients, 3.73 and 3.65 respectively. The t-test showed that in the area of mission and vision, the t-computed value = -1.019 did not exceeded the t-critical value = -1.966 which indicated that the respondents did not differ significantly in their mean rating regarding the different indicators under the mission and vision. The t-test difference signified that the respondents did not differ significantly in their mean ratings regarding the stated indicators.

103 Table 19 shows the t-computed value on the significant differences between the perceptions of in-patients and outpatients in the area of staffing of the health care services. Table 19 T- Computed Value on the Significant Differences between the Perceptions of In-Patients and Outpatients in the Staffing of the Health Care Services
Area Respondents In-patient Staffing Outpatient Weighted Mean 3.90 3.76 t-computed value 1.501 t-critical value 1.966 Interpretation Decision Null hypothesis accepted

Not Significant

Table 19 illustrated the t-computed value on the Significant Differences in the Extent of Effectiveness Identified Areas of Health Care Services. Result of the analysis showed the staffing exhibited that inpatients have a greater means than outpatients, 3.90 and 3.76 respectively. The t-test showed that in the area of staffing, the tcomputed value = -1.501 did not exceeded the t-critical value = -1.966 which indicated that the respondents did not differ significantly in their mean rating regarding the different indicators under the staffing. The ttest difference signified that the respondents did not differ significantly in their mean ratings regarding the stated indicators. Table 20 presents the t-computed value on the significant differences between the perceptions of in-patients and outpatients in the area of medical supplies of the health care services.

104

Table 20 T- Computed Value on the Significant Differences between the Perceptions of In-Patients and Outpatients in the Medical Supplies of the Health Care Services
Area Respondents In-patient Medical Supplies Outpatient Weighted Mean 3.80 3.38 t-computed value t-critical value Interpretation Decision Null hypothesis rejected

Significant 3.982 1.966

Table 20 depicted the t-computed value on the Significant Differences in the Extent of Effectiveness Identified Areas of Health Care Services. Result of the analysis showed the medical supplies such as medicines, syringes, gauze, intravenous fluids, oxygen, alcohol, cotton, etc. presented that the in-patients have a greater mean rating of 3.80 than outpatients with mean rating of 3.38. Noticeably, result of the t-test showed that the t-computed value =3.982 exceeded the t-critical value =1.966 which signified that the respondents differ substantially in their mean rating pertaining the different indicators stated under medical supplies. Table 21 presents the t-computed value on the significant differences between the perceptions of in-patients and outpatients in the area of programs of the health care services in the New Bilibid Prison.

105

Table 21 T- Computed Value on the Significant Differences between the Perceptions of In-Patients and Outpatients in the Programs of the Health Care Services
Area Respondents In-patient Programs Outpatient Weighted t-computed Mean value 3.73 3.86 -1.437 t-critical value Interpretation Decision Null hypothesis accepted

-1.966

Not Significant

Table 21 described the t-computed value on the Significant Differences in the Extent of Effectiveness Identified Area of Health Care Services. Result of the analysis showed the programs exhibited that outpatients have a greater means than in-patients, 3.86 and 3.73 respectively. The t-test showed that in the area of programs, the tcomputed value = -1.437 did not exceeded the t-critical value = -1.966 which indicated that the respondents did not differ significantly in their mean rating regarding the different indicators under the programs. The ttest difference signified that the respondents did not differ significantly in their mean ratings regarding the stated indicators. Table 22 presents the t-computed value on the significant differences between the perceptions of in-patients and outpatients in the area of facilities and equipment of the health care services in the New Bilbid Prison.

106 Table 22 T- Computed Value on the Significant Differences between the Perceptions of In-Patients and Outpatients in the Facilities and Equipment of the Health Care Services
Area Respondents In-patient Facilities and equipment Outpatient Weighted Mean 3.58 3.29 t-computed value t-critical Interpretation value Decision Null hypothesis rejected

2.803

1.966

Significant

Table 22 demonstrated the t-computed value on the Significant Differences in the Extent of Effectiveness Identified Area of the Health Care Services. Result of the analysis showed the facilities and equipment such as, blood pressure apparatus, nebulizer, suction apparatus, electrocardiogram machine, X-ray machine, oxygen tank, stethoscope, defibrillator, cardiac monitor, operating room, emergency room and equipment, wards, etc., the analysis showed that the inpatients have a greater means range of 3.58 than the outpatients with a means range of 3.29. Result of the t-test presented that the t-computed value =2.803 exceeded the t-critical value =1.966 which signified that the respondents differ significantly in their mean rating regarding the different indicators stated under facilities and equipment. Table 23 presents the summary of significant differences in the extent of effectiveness in the identified areas of health care services in the New Bilbid Prison.

107 Table 23 T- Computed Value on Summary of Significant Differences in the Extent of Effectiveness of the Identified Areas of Health Care Services
Categories Mission and Vision Staffing Medical Supplies Program Facilities and equipment Difference -0.088 0.140 0.414 -0.126 0.287 t-computed value -1.019 1.501 3.982 -1.437 2.803 t-critical value -1.966 1.966 1.966 -1.966 1.966 Interpretation Not Significant Not Significant Significant Not Significant Significant Decision Null hypothesis accepted Null hypothesis accepted Null hypothesis rejected Null hypothesis accepted Null hypothesis rejected

Table 23 illustrated the Summary of Significant Differences in the Extent of Effectiveness Identified Areas of Health Care Services as perceived by in-patients and outpatients in the New Bilibid Prison. Result of the t-test showed that under the category of mission and vision, the t-computed value =-1.019 did not exceeded the t-critical value =-1.966 (in absolute value) which indicated that the respondents did not differ significantly in their mean ratings regarding the different indicators of the health services of the New Bilibid Prison. Apparently, there was a quite narrow difference to which no significant differences in the mean ratings could be attributed. Hence, the null hypothesis differences in the mean ratings on Mission and Vision perceived by the two groups of respondents was not rejected. Likewise, in staffing, the t-computed value =1.501 did not exceeded the t-critical value =1.966 which signified that the respondents did not differ substantially in their mean ratings. Thus,

108 the null hypothesis differences in the mean ratings could be recognized. Furthermore, in program, as result showed the t-computed value =-1.437 did not exceeded the t-critical value =-1.966 which indicated that the respondents did not differ significantly in their mean ratings regarding the stated indicators on health care services. Though there were two areas in the health care services which t-computed value exceeded the tcritical value and rejected the null hypothesis, it did not affect the significant differences in the overall mean ratings of the respondents which accepted the null hypothesis. Problem No. 5: Improved health care program I. Introduction/Rationale: Plan of Action to enhance health care services in the New Bilibid Prison reflected the common vision and guiding principles of for inmates.

every health care program, the New Bilibid Prison Hospital of the Bureau of Corrections exerted every possible effort to achieve the ideal health care services needed to meet the needs of the patients it caters which is grounded in principles and practices of: Recovery and rehabilitation; Mutual patient and staff respect ; A culture of non-violence and safety; Strengths-based and person-centered care and treatment; Psychosocial rehabilitation; Integrated hospital and community services. It is

addressed to professional organizations and individuals concerned with

109 the health. It is an invitation to expand plans, activities, and programs designed to promote health and prevent disease, especially

to reduce the health disparities that affect those who are geographically isolated. It is the hope that the Plan of Action will inspire others to join in the effort, bringing their interest, expertise and experience to enrich collaboration and thus accelerate a movement to enhance the health and general health and well-being of all inmates. The rationale was based on the data of the diseases and disorders, that although there has made substantial improvements in health services, more must be done. The New Bilibid Prison Hospital (NBPH) operates under the Bureau of Corrections (BuCor), which further operates under the Department of Justice (DOJ). The NBPH depends purely with the fund allotted by the government, with 500 bed capacity though considered a secondary health care facility. There are inherent difficulties in the implementation of activities pertaining to the improvement of the health care services of the New Bilibid Prison (NBP) as a whole. First, the scope and breadth of the program were not clearly defined. This resulted in an assortment of activities being credited to the program. This gives the NBPH poor management control over the program and makes program evaluation difficult. Second, the hospitals budgets have been dependent on the

110 government allocation. This situation has made it difficult for hospital personnel to support and achieve their goals. Third, prisons are not, primarily, concerned with the health of the prison population. Health care must coexist with the fundamental mission of the correctional facility, which is first and foremost, public safety and security. This poses unique dilemmas for those responsible in providing health care. Getting a

preventive program operational in the hospitals will always be second priority. Fourth, the hospital staff in addition to their basic tasks, are made to implement the preventive program. Thus, a usually overloaded staff cannot devote a 100% support for the preventive program. Fifth, the central NBPH structure to oversee/support the program needs to be reviewed to give clearer directions and to lobby for financial support. II. General Objective The program intends to promote and improve the quality of life of inmates through the establishment and provision of basic health services, formulation of policies and guidelines pertaining to inmates, provision of information and health education, provision of basic and essential training of manpower dedicated to facilitate services to inmates, and conduct of basic and applied researches. To demonstrate a consistent endeavor to deliver optimal care in an environment of minimal risk. To improve management that allows for a systematic,

111 coordinated, and continuous approach in the enhancement of

performance of the organization.

Existing Health Care Program Enhanced Health Care Program

Health Care Programs/Services Upon his initial commitment to the Reception and Diagnostic Center (RDC), the inmates medical history is recorded and properly documented by the Medical Specialist. Medical information and mental status examinations are given to ascertain his overall physical / mental fitness and whether he would be fit for work. This forms part of the diagnostic process which will eventually determine the most appropriate rehabilitation program for the inmate. The principal medical care of inmates is provided through a 500-bed capacity hospital at the New Bilibid Prisons and at six (6) other mini-hospitals or clinics in the six (6) other prison and penal farms. All correctional facilities have a full and competent staff of medical practitioners in charge of clinics, infirmaries and hospitals. These centers are capable of minor surgical operations, laboratory examinations, radiology, psychiatric, rehabilitation and dental treatment. Other government and private hospitals are also tapped in the implementation of standards pertaining to nutrition and protective health services for the prison community. Medical services also include a wide range of counseling techniques and therapy programs which address the psychological problems of inmates, including suicidal thoughts and feelings of rejection which may lead to disruption of peace and order within the prison compounds. When an inmates ailment is beyond the competence of the in-house medical doctors, the inmate is referred to a government hospital in accordance with prison rules and under proper security escorts.

Program Strategies/Components: Five program components: health promotion and education, manpower development and capabilities strengthening, service delivery, monitoring/evaluation, and research. 1. Health Promotion and Education Collaboration is necessary to educate inmates on the nature and extent of acute and chronic illnesses including its risks factors, complications and the need for early detection and management. This includes upon inmates entering the correctional facility up to the time he finished serving his sentence, in preparation to going back to a free society. 2. Manpower Development and Strengthening of the existing management capabilities Continuing training and education shall be provided to health care providers. This also includes strengthening of existing treatment/management capabilities of the New Bilibid prison Hospital. 3. Service delivery/Integration of prevention and control The program shall provide for the integration and provision of services, health care interventions, from primary to tertiary prevention. 4. Monitoring/Evaluation A periodic process and impact evaluation in all aspects of health care delivery shall be conducted every six months and yearly thereafter and/or depending on the need of the program. 5. Research The program shall support research/studies in the clinical, behavioral, and epidemiological areas.

112

ACTION PLAN FOR AN IMPROVED HEALTH CARE PROGRAM FOR INMATES

Objectives

Program

Activities

Budget Allocation N/A

Lead Person/s

Evaluative Criteria Number of empowered inmates and/or patients

Identify the ways in which health education can improve the health care program.

Health Promotion and Education

Health Teaching Counseling

Reception and Diagnostic Center Personnel Medical Officers Nurses

Develop/modify policies and programs

Manpower development and strengthening of the existing management capabilities

Updates through seminars/trainings of the health care personnel

Funded by the Bureau of Corrections

Administrative Level Officials

New knowledge acquired in the improvement of the system Decreased number of acute illnesses and reduced occurrence complications on chronic illnesses

Provide a comprehensive health care

Service delivery/integration of prevention and control

Provision of hospital services Maximized the utilization of the Hospital Resources Health Education Counseling Information dissemination through reading materials

Fund from the Bureau Donations from NonGovernment Organizations and other Government Organizations N/A

Nurses Nursing Attendants Other Hospital Personnel Lay Educators

Devise evaluation strategies

Monitoring/Evaluation

Conduct an outcome evaluation every six months and yearly thereafter and/or depending on the need

Health Care Providers

Effectiveness of the strategies reflected on the report done after six months and yearly thereafter Acquisition of new ideas on various health care methods

Link with research/studies on prison health reforms

Research

Gather needed data for the improvement of the prison condition

N/A Health Care Providers Researchers

*Budget of the Bureau of Corrections depends on the approved General Appropriation Act. *Three (3) pesos per inmate per day is the present budget for health needs of each inmate. *Proposed Program Components patterned on DOH DM Prevention and Control Program 2011.

113

Chapter 5 SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the summary of findings, conclusions and recommendations of the study. Summary This study aimed to determine the extent of effectiveness of the health Care services as perceived by in-patients and outpatient in the New Bilibid Prison Hospital during the fiscal year 2009-2010. Specifically, it sought answers to the following questions: 1) What is the demographic profile of the inmate-respondents according to: 1.1. Age; 1.2. Existing patient classification (in-patient and outpatient); and 1.3. Length of stay in the New Bilibid Prison, Bureau of Corrections? 2) What is the demographic profile of the inmate-respondents in the year 2009 and 2010 in terms of: 2.1. Morbidity; and 2.2. Mortality? 3) What is the extent of effectiveness of the health care services in the

114 New Bilibid Prison according to DOH standards of care? 3.1. Mission and vision; 3.2. Staffing; 3.3. Medical supplies; 3.4. Programs; and 3.5. Facilities and equipment? 4) Are there significant differences in the extent of effectiveness of health care services in the New Bilibid Prison as perceived by in-patients and outpatients? 5) What improved health care program for inmates may be proposed?

METHODOLOGY: The descriptive design of research was employed in this study. A survey instrument was prepared to determine the demographic profile of the in-patient and outpatient respondents, their perception on the extent of effectiveness of the health care services in the New Bilibid Prison as a basis for the improved health care program for inmates.

Moreover, the study also made use of documentary analysis of the morbidity and mortality of inmate-respondents during the fiscal year 2009-2010. The respondents in this study included the in-patients of the New

115 Bilibid Prison Hospital, irregardless of their illness and length of hospital confinement and outpatients who sought regular consultations at the Out Patient Department (OPD) during the fiscal year 2009 - 2010. Purposive sampling was used since the respondents were chosen on the basis of their current patient classification, capability to write and the regularity of check up at the OPD for outpatients. Tagalog questionnaire was utilized for 100 in-patient and 300 outpatient respondents and responses would depend on the choices of a five point scale. Likewise, the researcher utilized frequency count, percentage,

weighted mean, and ranking to facilitate the description of important features of the data. Inferential Statistics was applied particularly, t-test for independent samples, to compare the perceptions of the in-patients and the outpatients on the extent of effectiveness of the health care services in the New Bilibid Prison. Significance of difference was tested at five per cent level. FINDINGS: Based on the analysis and interpretation of the data gathered for this study, the following results were disclosed: 1) Relative to specific problem number 1, the demographic profile

116 of inmate respondents showed that: a) according to age, majority of the in-patients and outpatients were found to be in age brackets 41-50 and 51-60, b) according to patients classification, majority of the respondents were outpatients, comprised of 60 per cent of the total number of

patient, prison, both group respondents who have the lowest length of stay in prison have a high frequency and percentage. 2) With reference to specific problem number 2, the demographic profile of inmate respondents showed that: a) in terms of morbidity, there was a substantial decreased in total

number for in-patients, while there was an increased in total number for outpatients from fiscal year 2009 to 2010, b) in terms of mortality, there was a slight decreased in total number from fiscal year 2009 to 2010. 3) Pertaining to specific problem number 3 on the perception of two groups of inmate respondents on the extent of effectiveness of the health care services in relation to the mission and vision, staffing, medical supplies, programs, facilities and equipment, the following results surfaced: a) both groups perceived that the mission and vision of the

health care system were well employed and assessed as N-

117 Nasusunod, b) both groups perceived that the staffing of the NBP was organized and adequate and assessed as NNasusunod, c) the in-patients perceived that there were

enough medical supplies available to sustain their health needs, their assessment were N-Nasusunod, while the outpatients perceived that there were slight deficiency in medical supplies to sustain their health needs and were assessed as B-N-Bahagyang Nasusunod, d) both groups perceived that the health program of the NBP was proper and acceptable and was assessed as N-Nasusunod, e) the in-patients perceived that the facilities and equipment

were enough to accomodate various health situations and were assessed as N-Nasusunod, whereas the outpatients

perceived that the present facilities and equipment were partly insufficient to meet enormous health conditions and were assessed as B-N-Bahagyang nasusunod. 4) With reference to specific problem number 4 on the significant differences in the extent of effectiveness of the health care services in the New Bilibid Prison as perceived by the inpatients and outpatients, the results revealed that there were no significant differences between the perception of the

118 respondents. 5) Relative to the specific problem number 5 on the proposal of an improved health care program for inmates, formulation of

an attainable proposed health program based on the perception of the respondents. CONCLUSIONS: In the light of the above findings, the following conclusions were drawn: 1. The middle-age patients in both group respondents exhibited substantially higher cases of illness than those of the other age brackets. As the number of prisoners continue to grow and to age, timely prevalence estimates of chronic health conditions as well as acute diseases become increasingly manifested, further aggravated by various prison environmental factors. 2. Between the two group respondents the outpatients comprised the majority of patients than the in-patients in the New Bilibid Prison. 3. Inmates with the shortest years stay in prison exhibit a greater incidence and prevalence of illnesses than those with long years of stay in prison. The following factors

119 4. may have contributed to prisoners disease prior to incarceration such as: low socioeconomic status, poor access to health care in their home communities, and high risk behaviors. Following incarceration, a number of

environmental factors including crowded living conditions, lack of ventilation, poor sanitation, and increased

psychological stress may further contribute to it. 5. Morbidity and mortality decreased from fiscal year 2009 to 2010. 6. There is an effective health care service in the New Bilibid Prison in relation to: mission and vision; staffing; medical supplies; programs; and facilities and equipment, as perceived by the in-patients. 7. The outpatients perceived that there was an effective health care services in relation to the mission and vision, staffing, and programs. However, in relation to the medical supplies, facilities and equipment, the said areas were

partly not effective in terms of health care services. 8. The overall perception of both group respondents on the extent of effectiveness of the health care services is assessed as N Nasusunod. Both group respondents

120 perceived that the current health care program is able to meet the overall health needs of the inmate patients. 9. The inadequacies perceived by the outpatients as to the medical supplies, facilities and equipment are some of the inherent problems of the New Bilibid Prison (NBP). 10. There are no significant differences in the extent of effectiveness of the health care services in the New Bilibid Prison as perceived by in-patients and outpatients. 11. The proposal about the improved health care program depends on the perception of the respondents in the effectiveness of the health care services of the New Bilibid Prison. RECOMMENDATIONS: Based on the findings and conclusions made in this study, the following recommendations were suggested: 1. To organize efficient delivery of health care in prison systems, correctional administrators should study the detailed information on the disease patterns of their populations. The officials of the Bureau of Corrections

should have regular coordination and collaboration to be able to come up with a precised resolutions pertaining to

121 the inmates health conditions. Bureau officials should come up with new policies based on ascertain needs. 2. There should be continuity on the current health care program to determine the effectiveness of such. 3. Regular monitoring on the availability of medical supplies such as, medicines, syringes, cotton, gauze, intravenous fluids, intravenous tubes, nasogastric tubes, insulin, etc. should help determine the need for an additional purchase order as needed. Availability of medical supplies are

necessary especially in prison camps, for the reason that emergency cases are inevitable in such a place. These would lessen mortality cases in times of aggression among gangs. Equal distribution of medical supplies for in-patients and outpatients should be strictly implemented. This

would reduce hospital confinement for outpatients and lessen mortality among in-patients. 4. A health promoting prison should be created with the participation of each member of the staff. Giving

recognition to the staff for purposes of motivating them to effectively carry on with the current excellent provision of health care. Recognizing the effort of the health care

122 personnel would make them feel valued and would inspire them. 5. Given the current health problems in prisons, staff members should know and understand how there could be minimized and how health and well-being could be promoted. 6. Physicians and nurses and other professionals working in prisons have a unique leadership role in developing the health promoting prison. They should start from a

sound basis of professional training in which issues such as confidentiality, patient rights and human rights have been fully covered and discussed. They should also have some knowledge of how diseases spread and of how lifestyles and socioeconomic background factors can influence ill health. They should also be aware of human nutrition and of the importance of exercise and fresh air in promoting health. They should be alert to potential threats to health and able to detect early signs of mental health problems. 7. Top level management of the hospital should have a firm stand on the need for increased budgetary allocation for the needed equipment and for the improvement of facilities.

123 8. Regular contact with local community services should be established and the involvement of voluntary agencies should be solicited to promote health and well-being in prisons. Where possible, prisoners should be connected to key community services before leaving prison, such as probation or parole and social services.

124 REFERENCES Bachmeier, K. (2003)Addressing Quality Health Care in the Correctional Setting. Publication: Corrections Today. North Dakota State Penitentiary in Bismarck, October. Baillargeon J, Black SA, Pulvino J, Dunn K. (2000) The disease profile of Texas Prison inmates.Department of Pediatrics, University of Texas Health Science Center, San Antonio ,USA. Binswanger IA, Krueger PM, Steiner JF. (2009) Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population. J Epidemiol Community Health. Binswanger IA, Merrill JO, Krueger PM, White MC, Booth RE, Elmore JG. (2009) Gender Differences in Chronic Medical, Psychiatric, and Substance-Dependence Disorders Among Jail Inmates. Am J Public Health. Boswell, C. & Cannon, S. (2007) Introduction to Nursing Research, Incorporating Evidence-Based Practice. Jones and Bartlett Publishers Inc. Sudbury, Massachusetts. Condon L, Hek G, Harris F, Powell J, Kemple T, Price S. (2007) Users' views of prison health services: a qualitative study. Faculty of Health and Social Care, University of the West of England, Glenside, Bristol,UK. May. Condon L, Gill H, Harris F. (2007) A review of prison health and its implications for primary care nursing in England and Wales: the research evidence.Faculty of Health and Social Care, University of the West of England, Glenside, Blackberry Hill, Stapleton, Bristol, UK. July. Conley, D. T. (1993) Roadmap to Restructuring; Eugene, Oregon: University of Oregon; ERIC. Coyle, A. (2005) Understanding Prisons: Key Issues in Policy and Practice. Open University Press. University of London, December.

125 Diza, F. (2011) Diabetes Mellitus Prevention and Control Program. Department of Health-National Center for Disease Prevention and Control (DOH-NCDPC), San Lazaro, Sta. Cruz, Manila. October Fazel, S. et. al (2001) Health of elderly male prisoners: worse than the General population, worse than younger prisoners. British Geriatrics Society, UK. Green, E. (2010) State health Care System for Inmates makes some Progress, Audit Says. Corrections Agency Working Toward Timely Exams, Independent Reviews Report. The Baltimore Sun Article Collection, April. Jaye Anno, Ph.D., CCHP-A, (December 2001) Guidelines for the Management of an Adequate Delivery System. Correctional Health Care U.S. Department of Justice National Institute of Corrections 320 First Street NW. Washington, DC. Lincoln, T., Miles, J. & Scheibel, S. (2007) Community Health and Public Health Collaborations. Public Health Behind Bars. Lincoln, T. (2006) Health Care Continuity in Jail, Prison and Community. Hampden County Correctional Center & Baystate Brightwood Health Center. Springfield, MA. Lines, R. (2007) Prison health is Community Health: Prisons, Health and Human Rights. Irish Penal reform Trust. Denmark, January. Mayor, E. et. al (2008) TB Control in Prisons in Region XI. FETP Scientific Papers vol. 19. No 2, NEC DOH, Philippines. Moller, L. , Gatherer, A. & Jurgens, R. (2007) Health in Prisons: a WHO Guide to the Essential in Prison Health. Health in Prisons. Europe. Neuman, B. (2005) A Model for Teaching Total Person Approach to Patient Problems. Neumans Health Care System Model, Published 1972. Nieto, M. (1998) Health Care in California State Prisons. California Research Bureau, California State Library. Sacramento, California. June. Operating Manual. Bureau of Corrections, Department of Justice (2000).

126

Powell, J. et. al. (2010) Nursing care of prisoners: staff views and experiences. Reader Health Economics University of the West of England, Bristol, UK. June. Ramaswamy, M. & Freudenberg, N. (2007) Health Promotion in Jails And Prisons: An Alternative Paradigm for Correctional Health Services. Public Health Behind Bars. Shimkhada, R. et. al. (2008) The Quality Improvement Demonstration Study: An example of evidence-based policy-making in practice. School of Economics, University of the Philippines, Diliman, Quezon City, Philippines. Smith, S. E. (2010) California Judge Says State of California is Still Providing Inadequate health Services to Inmates. Health in Prisons. California, September. Tauxe, JD. (2010) Philippines: ICRC to Consolidate Efforts in 2010. International Committee of the Red Cross. Resource Center, February. Willet, W. C. et al, (2006) Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. Disease Control Priorities in Developing Countries. 2nd edition., Washington (DC). Wilper AP, Woolhandler S, Boyd JW, et al. (2009) The Health and Health Care of US Prisoners: Results of a Nationwide Survey. Am J Public Health. Beam, C. (2009) Whats the Health Care System like in Prison?. Jailhouse Doc. California, March. Cohen, S. (2007) Stress Contributes to Range of Chronic Diseases. Science Daily, Cohen JAMA Article, Carnegie Mellon University. October. Conception, A. A. (2002) Cross-sectional study among the male prisoners in Davao City Jail, Philippines. International Conference on AIDS. De La Salle University Health Sciences Campus, Dasmarinas, Cavite, Philippines. July.

127 Ramos, M. & Endozo, P. (2011) DOJ exec discovers Bilibids secret Rich areVIPs. Philippine Daily Inquirer. May. Torres, T.T., (1995) A Study on Primary Health Care Services in the Philippine Philippine Institute for Development Studies, Makati. June. Watson, R. , Stimpson, A. & Hostick, T. (2003) Prison health care: a review of the literature. International Journal of Nursing Studies. England, United Kingdom, June. Benefits for Inmates: http://www.livestrong.com/ Midlife... What You Need to Know: http://www.midlife-men.com/ Outpatient: http://healthcareers.about.com/od/n/g/outpatient.htm.

128 APPENDIX A LETTER REQUEST FOR THE BUCOR DIRECTOR

129 APPENDIX B LETTER REQUEST FOR THE OIC, NBPH

130

APPENDIX C

CERTIFICATION OF STATISTICAL TREATMENT

This is to certify that the thesis entitled Extent of Effectiveness of the Health Care Services as Perceived by Inpatients and Outpatients in the New Bilibid Prison: Basis for an Improved Health Care Program for Inmates, of Hasmin P. Sescar was statistically analyzed using appropriate measures by the undersigned.

(SGD) DR. JESUS B. GOLLAYAN Statistician GSE

NOTED:

(SGD) DR. ALFONSO H. LORETO Dean, GSE

131 APPENDIX D LETTER FOR THE RESPONDENTS

Ika 18 ng Setyembre, 2011

Mga Kapatid Kong Inmates, Ako po ay kasalukuyang nagsasaliksik tungkol sa Lawak ng Epekto ng Serbisyong Pangkalusugan sa New Bilibid Prison. Dahil po dito nais kong hingin ang inyong suporta sa pamamagitan ng pagsagot sa mga katanungan sa mga susunod na pahina. Ang inyong suporta ay lubhang mahalaga upang matapos ko ang nasabing pagsasaliksik. Ang inyong mga kasagutan ay mananatiling kompidensyal. Maraming salamat po sa inyong oras at atensyon.

(SGD)HASMIN P. SESCAR, RN. Researcher

132 APPENDIX E QUESTIONNAIRE FOR THE INMATE RESPONDENTS EXTENT OF EFFECTIVENESS OF THE HEALTH CARE SERVICES AS PERCEIVED BY IN-PATIENTS AND OUTPATIENTS IN THE NEW BILIBID PRISON: BASIS FOR AN IMPROVED HEALTH CARE PROGRAM FOR INMATES

MGA KATANUNGAN PARA SA RESPONDENT UNANG PARTE PAGKAKAKILANLAN NG MGA RESPONDENT Direksiyon: Basahing mabuti ang bawat kataga at lagyan ng tsek ( ) para sa inyong sagot. 1. Pangalan : ____________________________________________ (opsyonal) 2. Sitwasyong Medikal ______ naka-admit sa ospital ______ nagpapacheck-up lamang (OPD) 3. Edad _____ _____ _____ _____ _____ _____ 30 taong gulang pababa 31 40 taong gulang 41 50 taong gulang 51 60 taong gulang 61 70 taong gulang 71 taong gulang - pataas

4. Taon ng pagkakakulong _______ 10 taon pababa _______ 11 20 taon _______ 21 30 taon _______ 31 taon pataas

133 PANGALAWANG PARTE PAGKILATIS SA SERBISYONG PANGKALUSUGAN SA NEW BILIBID PRISON Direksiyon: Basahing mabuti ang mga sumusunod na mga aytem at bilugan lamang ang numero na tugma sa inyong obserbasyon o nalalaman tungkol sa sistemang pangkalusugan sa NBP. Ibase ang inyong kasagutan sa mga sumusunod na grado: 5 Lubhang nasusunod 2 Di nasusunod 4 Nasusunod 1 Lubhang Di-nasusunod 3 Bahagyang Nasusunod a) Misyon at Bisyon ayon sa programang pangkalusugan 1. Alam ko ang misyon at bisyon sa pangkalusugan ng NBPH 2. Naiintindihan ko ang ibig nitong ipahiwatig 3. Nakatuon ito sa pagkaka pantay-pantay 4. Nakasaad dito ang magandang maidudulot sa bawat bilanggo 5. Kasama sa hangaring pangkalusugang ito ang pamilya ng bawat bilanggo 6. Nakasaad dito ang pagbabago para sa maunlad na programa sa kalusugan 7. Nakasaad dito ang positibong hangaring pangkalusugan 8. Nakasaad dito na matutugunan ang pangangailangang medikal ng bawat bilanggo 5 4 3 2 1

9. Gabay ito sa bawat bilanggo 5 upang maging handa sa pagharap sa malayang lipunan

134 10. Nagagawa, nakikita at nasusunod ang mga nakasaad sa misyon at bisyon na NBPH b) Mga Empleyado ng Ospital 1. Maayos na pagtrato sa mga pasyente 2. Laging handa sa pagtugon sa medikal na pangangailangan 3. Pantay na pagtrato sa lahat 4. Pinag-iisipan ang mabuting epekto ng panggagamot 5. Nagtatrabaho nang maayos 6. Kayang magbigay ng serbisyo kahit sa panahon ng kaguluhan sa loob ng bilangguan 7. Nagtutulungan para sa mas maayos na daloy ng trabaho at serbisyo 8. Naglalaan ng dagdag na oras para sa ibang programang pangkalusugan 9. Pinag-iisipan ang kapakanan ng mga pasyente at ng pamilya 10. Iginagalang ang relihiyon ng bawat pasyente k) Gamot 1. Sapat 2. Epektibo 5 5 4 4 3 3 2 2 1 1 5 4 3 2 1

5 5

4 4

3 3

2 2

1 1

5 5

4 4

3 3

2 2

1 1

135 3. Laging mayroon 4. Pangmatagalan 5. Nakikita 6. Nagagamit nang wasto 7. Nabibigay nang tama 8. Angkop 9. Nakalaan sa pasyente 10. Kapaki-pakinabang 5 5 5 5 5 5 5 5 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1

d) Programang Pangkalusugan 1. Alam ko ang mga programang pangkalusugan ng NBP 2. Naiintindihan ko ang ibig sabihin nito 3. Nagbibigay ito ng mga kaalamang pangkalusugan 4. Nagtutulungan ang mga empleyado at bilanggo sa ibat ibang programang pangkalusugan 5. Dahil sa mga programang ito, nabago ang aking pananaw sa buhay 6. Ginagamit ko ang aking mga natutunan sa pang araw-araw na buhay 7. Nagkaroon ng tiwala at kontento sa sistemang pangkalusugan sa NBP 5 4 3 2 1

5 5

4 4

3 3

2 2

1 1

136 8. Nagbibigay ng oportunidad sa pagkakaisa sa loob ng bilangguan 9. Nagdadagdag ng mga bagong konseptong pangkalusugan para sa kabutihan ng lahat 10. Natutugunan ng programa ng NBP Hospital ang layuning pangkalusugang ng Bureau of Corrections 5 4 3 2 1

e) Pasilidad at Kagamitang Pangkalusugan 1. Abot nito ang pangangailangang medikal ng mga pasyente 2. Kayang tumugon sa pagdami ng mga pasyente 3. May magandang pagbabago 4. Nagagamit nang wasto 5. Pangmatagalang gamit 6. Kumpleto 7. Laging nakalaan sa pangangailangan ng mga pasyente 8. Malinis 9. Angkop sa sitwasyon at kondisyon 10. Moderno 5 4 3 2 1

5 5 5 5 5

4 4 4 4 4

3 3 3 3 3

2 2 2 2 2

1 1 1 1 1

5 5

4 4

3 3

2 2

1 1

137

Curriculum Vitae Personal Circumstances Name Address : Hasmin P. Sescar, RN. : Type B, NBP Reservation, Poblacion, Muntinlupa City : Female : July 9, 1972 : San Ramon, Zamboanga City : Married : Manuel L. Sescar Jr. : Jayman P. Sescar Januelle P. Sescar Jashuel P. Sescar Religion Present Position School Address : Catholic : Nurse 1 : Alabang Zapote Road, Pamplona, Las Pinas City : hasmin_sescar@yahoo.com.ph

Gender Date of Birth Place of Birth Civil Status Name of Spouse Name of Children

E-mail Address

138 Educational Background Post Graduate : Training-Diabetes Nurse Educators, April 15-28, 2009 PADE-ADNEP, ISDFI, Apitong Street, Marikina Heights, Marikina City : Center for Family Ministries, June October, 2011 Assessment and Initial Interventions of Individual and Relationship Disorders &Pastoral Psychology and Counseling Ateneo de Manila University, Quezon City Tertiary : Graduated-Year 1992 Bachelor of Science in Nursing Ateneo de Zamboanga University La Purisima St., Zamboanga City Secondary : Graduated-Year 1988 Ayala National High School Ayala, Zamboanga City Elementary : Graduated-Year 1984 San Ramon Elementary School San Ramon, Zamboanga City

Examinations Passed Nurses Licensure Examination : Passed-Year 1992 Rating: 81.2% : Passed-Year 1990 Rating: 84.24%

Career Service Sub-Professional Examination

139

Work Experience

Diabetes Nurse Educator (DNE)

: May 2009 to present New Bilibid Prison Hospital Bureau of Corrections Muntinlupa City 1776 : August 2009 February 2010 Tokyo Health Clinic Madrigal Business Park Alabang, Muntinlupa City : June 2009 January 2010 Global Care Medical Group Specialists Inc., SM Tunasan, Muntinlupa City

Nurse I/Staff Nurse

: June 1996 to present New Bilibid Prison Hospital Bureau of Corrections Muntinlupa City 1776

Seminars/Trainings Diabetes Nurse Educators: Empowered for Independent Practice ADNEP 21st Founding Anniversary and 2012 General Assembly, New Horizon Hotel, Mandaluyong City, January 20, 2012 Excel Data Analysis Applied to Basic Study Designs Research Workshop for Graduate Students, Ampitheather University of Perpetual Help DALTA, Zapote, Las Pinas City, September 26, 2011 Listen, Empower, Transform PADE-ADNEP 9th Joint Annual Convention, Century Park Hotel, Manila, August 26-27, 2011

140 The Chronicles of the PAST, the Gift of the PRESENT, and the Roadmap for the FUTURE ADNEP 20th Founding Anniversary and General Assembly, Diamond Hotel, Roxas Blvd., Manila, January 21, 2011 The Anatomy of Nursing Malpractice Acts Health Tower, University of Perpetual Help DALTA, Las Pias City, October 12, 2010 Values Integration in Different Learning Areas towards Human Capital Development General Assembly and Seminar 2010, Amphitheater, University of Perpetual Help DALTA, Las Pias City, July 24, 2010 10th Annual Convention on Preventive Cardiology Foundation for Lay Education on Heart Diseases, Carlos P. Romulo Auditorium, RCBC Plaza, Ayala Avenue, Makati City January 28 30, 2010 Diabetes Education:Linking Good Practice and Quality Care 7 th Joint PADE-ADNEP Annual Convention, Diamond Hotel, Roxas Blvd., Manila. August 28-29, 2009 Workshop on Insulin Injection Techniques for Skills Development, 7th Joint PADE-ADNEP Annual Convention, Diamond Hotel, Roxas Blvd., Manila, August 29, 2009 Workshop on Blood Glucose Monitoring for the Skills Development, 7th Joint PADE-ADNEP Annual Convention, Diamond Hotel, Roxas Blvd., Manila, August 29, 2009 Effective Motivation: The Art, Science and Practice, Association of Diabetes Nurse Educators of the Philippines, ISDFI, Apitong Street, Marikina Heights, Marikina City, June 25, 2009 Adult Basic Life Support Training Course, Philippine Heart Center, Quezon City, March 17, 2009 Training on Cardiovascular Disease Prevention and Control Through Lifestyle Modification, New Bilibid Prison Hospital, Muntinlupa City, March-April, 2008

141 The Art and Science of Diabetes Education: From Womb to Tomb, Philippine Association of Diabetes Educators and Association of Diabetes Nurse Educators of the Philippines, Century Park Hotel, Manila, July 1, 2006 Sharing Visions, Creating Missions: Convergence of Global Perspective in Critical Care 3rd Congress World Federation of Critical Care Nurses, Century Park Hotel, Manila, February 2628, 2006 Insulin Adjustment-When, How and Who? Association of Diabetes Nurse Educators of the Philippines, Philippine Heart Center, Quezon City, February 4, 2006 Nursing on the Move: Knowledge, Innovation and Vitality, 83 rd Foundation Anniversary, 48th Nurses Week Celebration and National Annual Convention, Philippine Nurses Association, Inc., Astorias Regency, Pasonanca, Zamboanga City, October 25-28, 2005 Resource Speakership ADNEP, Post Graduate Training, Introduction to Diabetes ISDFI, Apitong Street, Marikina Heights, Marikina City April 27, 2011 Lifelink Program Facilitator Ayala Town Center, c/o Novartis Philippines March 4 & 11, April 22, 2011 LifeLink Program Facilitator Global Care Medical Group Specialists Inc., SM Muntinlupa November 2 & 16, 2009 July 15 & August 5, 2009 May 5, 2011 Team Building Lead Facilitator New Bilibid Prison, Bureau of Corrections, Muntinlupa City November, 2009 & February, 2010 Diabetes Education Program (I.N.E.E.D.S. Model) Facilitator New Bilibid Prison, Bureau of Corrections, Muntinlupa City November 3 & 17, 2009

142

Publications/Research: Prison Break-New Bilibid Prison Diabetes Management Program using the I-NEEDS Approach- approved Abstract for Poster Presentation, 36th Annual Meeting of the American Association of Diabetes Educators, Atlanta, Georgia, USA, Aug. 5, 2009 Prison Break-New Bilibid Prison Diabetes Management Program using the I-NEEDS approach Singapore Diabetes Educators, December 2008

Membership/Affiliations Member, Association of Diabetes Nurse Educators of the Philippines Member, Philippine Association of Diabetes Educators Member, Philippine Diabetes Association