Family and Community Med III RURAL AND URBAN POOR Rosa Marie N. Flores, M.D.

, MPH, FPAFP, DFM 2nd Shifting /August 29, 2008 Trans group: JaViCi Code
[Classmates, eto yung lec dapat ni Dra. Flores last week, kaya lang di ma-open yung file. Ngayong Wed na lang nya nbigay powerpoint. Self-study na l ang. Un lang. =)]

iron drops to LBW and diagnosed anemic infants 6-11 months old. (Baseline data is established in 2000) 6. Increase the percentage of severely and moderately underweight under 5 –year-old children registered in feeding programs. 7. Increase the percentage of couples provided with family planning service.(Baseline data is established in 2000) 8. Increase the percentage of households with sanitary toilets. (Baseline data is established in 2000) 9. Increase the percentage of households with access to safe water supply. 10. Develop a package of health services for rural poor families. POVERTY

RURAL and URBAN POOR RURAL POOR Goal  Health and nutrition of rural poor families are improved NATIONAL OBJECTIVES FOR HEALTH by 2004 Health National Objectives 1. Reduce the percentage of newborns with birth weights less than 2.5 kilograms (Baseline data is established in 2000) 2. Reduce the percentage of severely and moderately underweight children under five years old. (Baseline data is established in 2000) 3. Reduce the incidence of diarrhea cases among children below five years old. (Baseline data is established in 2000) 4. Reduce the percentage of death due to preventable causes (Baseline in 2000) Risk Reduction Objectives 1. Increase the percentage of infants breastfed for at least six months (Baseline data is established in 2000) 2. Increase the percentage of poor families availing health services (Baseline is established in 2000) 3. Increase the percentage of families utilizing any type of sanitary toilet (Baseline data established in 2000) Service and Protection and Objectives 1. Increase the percentage of pregnant and lactating mothers provided with iron and iodine supplements. (Baseline data established in 2000) 2. Increase the percentage of deliveries attended by trained personnel 3. Increase the percentage of fully immunized children (Baseline data is established in 2000) 4. Increase the percentage of pregnant women given two or more doses of tetanus toxoid . (Baseline data is established in 2000) 5. Increase the provision of food supplements using indigenous / local processed foods to underweight infants aged 6-24 months old and

“A deprivation in relation to a social standard, or a lack of the minimum entitlements of households in society, which the government must seek to provide either directly or indirectly.”

POVERTY in the context of human development  “The sustained inability of a household to meet its minimal set of basic needs (MBN).”  Extending people’s capabilities sufficiently for them to meet their MBN makes the alleviation of poverty a human development approach. POVERTY THRESHOLD  In the Philippines, poverty is measured against a total poverty threshold.  This threshold is determined by a “minimum income requirement needed by a family to purchase a specific set of freely provided basic goods and services”. POVERTY INCIDENCE  The proportion of families falling below the threshold is called poverty incidence.  Between 1988 and 1991 the poverty incidence in the country hardly improved from 40% (1988) to 39% (1991).  The number of poor families actually increased by 11%. The Presidential Commission to Fight Poverty broadly categorized MBN indicators into three: (1) Survival; (2) Security; and

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY TLE JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE ESTHER JOEL GLENN TONI

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(3) Empowerment (or enabling needs). Eight Basic Indicators of the Index of Deprivation in the country relating to the MBN(set by the Commission) 1. Number of families below the official poverty line. 2. Incidence or proportion of poor families below the poverty line 3. Infant mortality rates 4. Malnutrition rates 5. Cohort survival rates 6. Adult illiteracy rates 7. Proportion of households without access to safe water. 8. Proportion of households without access to sanitary toilets The 10 provinces with the lowest MBN index 1. Sulu 2. Maguindanao 3. Masbate 4. Cotabato 5. Ifugao 6. Zamboanga del Sur 7. Basilan 8. Zamboanga del Norte 9. Lanao del Sur 10. Agusan del Sur The Specific Groups of the Poor Predominant in Each Area: (For which the content of the government’s anti-poverty programs in each of these provinces depended on) 1. Lowland landless agricultural workers 2. Lowland small farm owners and cultivators. 3. Upland farmers 4. Subsistence fisherfolks 5. Industrial wage laborers 6. Hawkers and macroenterpreneurs 7. Scavengers o Low productivity and income is the result of the low level of literacy and skills among the poor. o This situation is worsened by the lack of access to basic infrastructure services that can raise production outputs. o Moreover, an inadequate basic social service results in poor health and welfare that limits its prospects of the rural poor for a better life. o Since the rural poor have the least occupational alternative they depend on inferior resource bases that yield low income. o Migration to urban centers and resource-rich areas becomes an option. o Mechanisms that deliver basic services to the rural poor are often unresponsive to their fate and needs.

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Because the nature and intensity of their needs are diverse and the causes of poverty vary, solutions to their problem differ. The approach to poverty alleviation needs to distinguish between the different poor groups , between the poor and the “core poor” ,between the less poor and the “subsistence poor”. o

Five Principal Strategies Adopted by the Commission: (Because the poor has different causes of poverty and because their needs are diverse) 1. Revive economic growth to create employment and livelihood 2. Sustain growth based on people friendly approaches 3. Expand social services to provide MBN 4. Foster sustainable income generating community projects 5. Build capabilities of the poor to help themselves. 6. Emphasize the importance of local action The MBN approach to poverty alleviation which focuses program resources on identified priority poor municipalities aptly addresses social inequities among various groups of the poor. Top Five MBN identified in the country 1. Family with income below subsistence threshold level 2. Family without sanitary toilet 3. Family without access to potable water within 250 meters 4. Children 3 to 5 years old not attending day care or preschool 5. Housing not durable for five years, The CIDSS set a 20% target to meet unmet MBN in priority provinces for one year, but achieved a higher average of 52% reduction of the top MBN. MBN Projects for the Rural Poor include:  Nutrition  Maternal and child health  Dental health  Care for the elderly  Communicable disease prevention, and control  Traditional medicine These community health projects were provided especially to fifth and sixth class municipalities using poverty alleviation funds. ________________________________________ URBAN POOR GOAL  Health and nutrition of urban poor families are improved.

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NATIONAL OBJECTIVES FOR HEALTH BY 2000 1. Reduce the infant and child mortality and morbidity rates in the urban poor areas. (Baseline data is established in 2000) 2. Reduce the maternal mortality and morbidity due to direct obstetrical causes. 3. Reduce protein- energy malnutrition (PEM) and micronutrient deficiencies among children below 5 years old. (Baseline is established in 2000) Risk Reduction Objectives 1. Increase the practice of multi-mix daily diet among under- two- year old children to 90%. (Baseline data is established in 2000) 2. Increase the practice of multi-mix daily diet among women to 90 %. 3. Increase the percentage of infants exclusively breastfed up to six months to 80% (Baseline 58% in 1996, UHNP) 4. Improve personal hygiene and sanitary practices (Baseline data established in 2000) 5. Increase the percentage of mothers and children availing of maternal and child health services to 90%. (Baseline data is established in 2000) Service and Protection Objectives 1. Increase the percentage of urban poor with access to quality MCH care, nutrition and other health services at the local level to 90% . (Baseline is established in 2000) 2. Increase the percentage of infants fully immunized to 95%. (Baseline data is established in 2000) 3. Formulate and concretize the urban poor development plan at the local level 4. Establish empowered community level health and social support groups. (Baseline is established in 2000) 5. Increase the percentage of households with access to safe water to 80%. 6. Increase the percentage of households with access to sanitary toilet facilities to 70%. (Baseline 64.6 % in 1996, UHNP) 7. Develop a package of health services for urban poor communities. DOMESTIC ENVIRONMENT – Urban Poor • Rapid urbanization and migration have brought about negative consequences such as slums and squatters , overcrowding , poor sanitation, environment degradation and pollution. • Studies and field researches have shown that the that the urban poor have less access to educational services. Only about 6% of urban poor had no schooling whereas 10% of rural poor had none.

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Overall 35.9 % had an income below the poverty line and 21.3% had an income below the food line. About three-fourths were employed. The median monthly income was P933. Based on a study of urban poor communities, 72.2 % of households had access to piped water or tube wells. Seventeen % of water samples were heavily contaminated by fecal organisms at source. Two thirds of households tried to protect their drinking water and more than one-fourth boiled it. Many households lacked sufficient water to wash utensils properly and their water containers and water handling practices were inadequate. Over 16% of households lacked toilet. The consequences were that 21.4 % of people defecated into a waterway and 14 % used the so-called “wrap and throw” method. 28 % of households reported that garbage was not collected at all. Most commonly uncollected garbage was burnt (17. 6 %) dumped elsewhere (14. 6 % ) or thrown into waterways (8.1 % ). Other environmental problems include the proliferation of mosquitoes and other insects, rats, and domestic animals. The commonest cooking methods was gas, followed by kerosene and electricity. The remainder used biomass fuels such as wood, coconut shell and charcoal. Households were unlikely to store uncooked food. Most households slept in one room. The mean number of persons who slept in the house was 5.5

MATERNAL HEALTH  The total fertility rate of urban poor women 1549 years old (4. 04 births) was lower than rural women (4.82 births).  The crude birth rate was 34 per 1000 among the urban poor much higher than the rural poor population (30.9 per 1000)  Maternal death rate in the urban poor communities under the Urban Health and -Nutrition Project (UNHP) was at least 3 deaths per 1000 live births a year Prenatal Visits • Seven percent of women had three prenatal visits to a health facility and 62.2 % made four or more visits. Only 8% of women failed to have prenatal visits at all. • Problems related to the quality of prenatal care include inadequate laboratory examination; inadequate iron tablet supplementation and poor referral of high risk group.

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Delivery at home • Reasons for delivering at home were cost, convenience and presence of a supportive social network. • Even after delivery the overall quality of postnatal care is low. Weaning Practices  Most mothers introduced weaning foods between the fourth and six months of life. Breastfeeding Practices  About 86% of mothers had ever breastfed their babies.  By age 7 to 9 months about 58 % were still breastfeeding. Reasons commonly given for not breastfeeding:  Insufficient milk  Illness, or weakness of the mother  Refusal by the infant  Problem with the breast or nipple Advantages of Breastfeeding include: ♥ emotional bonding between the mother and child and cost. Child Health The infant death in the urban poor population is at least 50 per 1000 livebirths based on UHNP reports. Immunization • By age 12 months, 92.5 percent of infants had received BCG vaccine, their third dose of diphtheria, pertussis and tetanus vaccine (88 percent) • On the other hand only 38.6% had received measles vaccine by age 12 months and 67% by age 15 months. • Coverage showed little correction with maternal background factors Leading Causes of Mortality  Acute respiratory infections (ARI) are the leading cause of death in early childhood.  Unfortunately in the survey made a high % of mothers failed to see the significance of cough with fast breathing or chest indrawing. Leading Causes of Morbidity  Diarrhea and ARI are leading causes of illness.  Traditional home treatment is frequently practiced.  Problems on late referrals to the hospital occur because dehydration and pneumonia are not recognized at once.  Over 50% of the urban poor children carried intestinal parasites with the highest prevalence in children 5-9 years old.

Over 7.5 % of the urban poor were stunted as a sign of chronic malnutrition as against 5.6% of the general population.

Attitude towards health services  The women were conscious that health services were free easily accessible and provided satisfactory child health services.  On the other hand they criticized poor interpersonal relationships with the staff, long waiting tlmes and the absence of particular health staff.  They thought that existing government health services were providing narrow support for maternal and child health (MCH) and saw the need for wider range of services.

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Hate That I Love You That's how much I love you That's how much I need you And I can't stand you Must everything you do make me wanna smile? And then I like you for a while But you won't let me You upset me girl and then you kiss my lips All of a sudden I forget that I was upset Can't remember what you did But I hate it You know exactly what to do so that I can't stay mad at you for too long That's wrong but I hate it You know exactly how to touch So that I don't wanna fuss and fight no more Said I despise that I adore you And I hate how much I love you boy I can't stand how much I need you And I hate how much I love you boy But I just can't let you go And I hate that I love you so And you completely know the power that you have The only one that makes me laugh Sad and it's not fair How you take advantage of the fact that I... Love you beyond a reason why (whyyy) And it just ain't right One of these days maybe your magic won't affect me And your kiss will make me weak But no one in this world Knows me the way you know me So you'll probably always have a spell on me... It's how much I love you It's how nuch I need you It's how much I love you It's how much I need you And I hate that I love you Sooooo And I hate how much I love you boy

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Page 5 of 6 I can't stand how much I need you And I hate how much I love you boy But I just can't let you go And I hate that I love you so (“,)

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