DELIVERY OF MATERNAL AND CHILD HEALTH CARE SERVICES

IN THE RURAL HEALTH UNIT (RHU)

OF VIGAN CITY, ILOCOS SUR

A Thesis
Presented to
The Faculty of Graduate School
University of Northern Philippines
Vigan City, Ilocos Sur

In partial Fulfilment
Of the Requirements for the Degree
Masters of Arts in Nursing

By
Bernadette R. Arde, RN

Introduction

We all have fundamental responsibility for our health. We have the primary
obligation to do all that is possible to assure the attainment and maintenance of our health
through behaviour. In addition, we must insist that a social agencies are responsive o our
health needs that they function within their capabilities and within the limitations
established by law. No social institution should be allowed to be negligent when it comes
to matters concerned with health. Access to health care involves two specific
components: the availability of services acceptable to those who seek and affordability of
those services.
Universal Health Care (UHC), also referred to as Kalusugan Pangkalahatan (KP),
is the provision to every Filipino of the highest possible quality of health care that is
accessible, efficient, equitably distributed, adequately funded, fairly financed, and
appropriately used by an informed and empowered public.1 The Aquino administration
puts it as the availability and accessibility of health services and necessities for all
Filipinos.
It is a government mandate aiming to ensure that every Filipino shall receive
affordable and quality health benefits.This involves providing adequate resources health
human resources, health facilities, and health financing.
Improved access to quality hospitals and health facilities shall be achieved in a
number of creative approaches. First, the quality of government-owned and operated
hospitals and health facilities is to be upgraded to accommodate larger capacity, to attend

to all types of emergencies, and to handle non-communicable diseases. The Health

Facility Enhancement Program (HFEP) shall provide funds to improve facility
preparedness for trauma and other emergencies. The aim of HFEP was to upgrade 20% of
DOH-retained hospitals, 46% of provincial hospitals, 46% of district hospitals, and 51%
of rural health units (RHUs) by end of 2011.
Financial efforts shall be provided to allow immediate rehabilitation and
construction of critical health facilities. In addition to that, treatment packs for
hypertension and diabetes shall be obtained and distributed to RHUs.
The DOH licensure and PhilHealth accreditation for hospitals and health facilities
shall be streamlined and unified.
Further efforts and additional resources are to be applied on public health
programs to reduce maternal and child mortality, morbidity and mortality from
Tuberculosis and Malaria, and incidence of HIV/AIDS. Localities shall be prepared for
the emerging disease trends, as well as the prevention and control of non-communicable
diseases.
The organization of Community Health Teams (CHTs) in each priority population
area is one way to achieve health-related MDGs. CHTs are groups of volunteers, who
will assist families with their health needs, provide health information, and facilitate
communication with other health providers. RNheals nurses will be trained to become
trainers and supervisors to coordinate with community-level workers and CHTs. By the
end of 2011, it is targeted that there will be 20,000 CHTs and 10,000 RNheals.

Monitoring the growth and development of children at regular intervals allows for
the early detection of developmental delay. One of the key aims of Maternal and Child
Health (MCH) nursing practice is the early detection and the referral of children with a
developmental delay. In the transition from suspicion and concerns about their childs
development, to the confirmation of the diagnosis of developmental delay, the lived
experience for the family takes on a whole new chapter. This is unique to each family
situation, although there are common elements shared to varying degrees by families.
Depending on the degree of severity and permanence of the developmental delay, families
may face a rollercoaster journey of therapies, testing and appointments. Families may also
face the loss of the sense of normality of their child eventually growing into an
independent adult, as well as mounting financial burdens. In the context of the impact on
the family, this essay explores the question of what happens following a diagnosis of
developmental delay. MCH nursing practice has a role to play in supporting families
beyond the diagnosis.
Statement of the problem
This study aims to determine the extent of delivery and the level of satisfaction on
the maternal and child health services of the Municipal health unit of Vigan City.
Specifically, it seeks to answer the following questions:
1. What is the socio-demographic profile of the respondents In terms of:
A. Mother-related factors:
a. Age,
b. Number of children
c. Educational attainment
d. Monthly family income
e. Position in the barangay

f. Religion and
g. Occupation
B. MHO Personnel-related factors
a. Age
b. Civil status
c. Gender
d. Educational attainment
e. Status of appointment
f. Length of service in MHO
g. Position and
h. Salary?
2. What is the extent of delivery of the maternal and child health care services
rendered by the Municipal Health Unit personnel in terms of:
A. Maternal Care Services
a. Maternal care program
b. Family planning program
B. Child Care Services
a. Immunization program
b. Dental care program
c. Nutrition program and
d. Other child and health care program?
3. What is the level of satisfaction of the mother respondents on the delivery of
maternal and child health care services of the Municipal Health Unit in terms of
A. Maternal Care Services and
B. Child Care Services?
4. Is there a significant relationship between the extent of delivery of maternal and
child health care services and the Municipal Health Unit personnel-related
factors?
5. Is there a significant relationship between the level of satisfaction of the motherrespondents on the delivery of maternal and child health care services and motherrelated factors?

Conceptual Framework
This research paradigm will be utilized in this study is presented below.
The paradigm shows the extent of delivery and the level of satisfaction on the
delivery
of the maternal
andof child
Socio-Demographic
Profile
the health care services as influenced by the sociorespondents:
demographic factors of the Municipal Health Unit personnel and the mother-repondents,
A. MHU Personnel-Related Factors
respectively.
a. Age
b. Civil status
c. Gender
Independent Variables
Dependent Variables
d. Educational attainment
e. Status of appointment In the
Extent of Delivery of the Maternal
MHU.
and Child Care Services rendered by
f. Length of service in the
the MHU personne;
MHU
A. Maternal Care Services
g. Position
Maternal; Care Programs
h. Monthly Salary
Family Planning Programs
B. Monthly-Related Factors
B. Child Care Services
a. Age
Immunization
Level of
Satisfaction Program
of the Motherb. Number of children
Dental
are
Prgrams
Respondent on the delivery of the
c. Educational attainment
Nutrition
Programs
Maternal
and Child
Care Services of
d. Monthly family income
Other Child
and
the MHU Health care
e. Position in the barangay
Programs
C. Maternal Care Services
f. Religion
Maternal; Care Programs
g. occupation
Family Planning Programs
D. Child Care Services
Immunization Program
Dental are Prgrams
Nutrition Programs
Other Child and Health care

COMPARISON OF THE ECONOMIC STATUS BEFORE AND AFTER THE

IMPLEMENTATION OF 4Ps (PANTAWID PAMILYANG PILIPINO PROGRAM)
OF THE BRGY. BEEFICIARIES OF VIGAN CITY

A Thesis
Presented to
The Faculty of Graduate School
University of Northern Philippines
Vigan City, Ilocos Sur

In partial Fulfilment
Of the Requirements for the Degree
Masters of Arts in Nursing

By
Bernadette R. Arde, RN
Introduction
Dr. Virola (2011), Secretary General of the National Statistical
Coordination Board, said in his presentation of the 2009 Official Poverty
Statistics that a Filipino needed PhP 974 in 2009 to meet his or her monthly food
needs and PhP 1,403 to stay out of poverty. In 2009, a family of five needed PhP
4, 869 monthly income to meet food needs and PhP 7, 017 to stay out of poverty.
Results of the latest Social Weather Stations (SWS) survey also revealed that one
in every five Filipino households, or an estimated 4.3 million families,
experienced involuntary hunger in the third quarter of the year 2011
The Conditional Cash Transfer (CCT) programs serves as the
governments answers to the pressing issues regarding poverty. Calvo (2011)
defines the CCT as programs that provide cash benefits to finance the basic needs
and foster investment in human capital to extremely poor households. These
benefits are conditioned on certain behaviors, usually related to investments in
nutrition, health, and education.

The emergence of CCT programs occurred during the late 1990s, with
Mexicos innovative Progresa (now Opurtunidades) program emerging as one of
the earliest schemes in 1997. The evidences highlighting the effectiveness of
Progresa motivated a rise in similar programs across Latin America. Throughout
the late 1990s and into the early part of the new century, CCT programs were
implemented in Honduras, Brazil and Nicaragua.
CCT programs are presently being implemented in several Latin American
countries including Brazil, Chile, Colombia, Jamaica, Mexico, and several more.
Indonesia and Pakistan are only some of the Asian countries which employ the
CCT programs as a major tool of their social policy. In general, these programs
provide money and financial assistance to poor families under the condition that
those transfers are used as an investment on their childrens human capital, such
as regular school attendance and basic preventive health care. The main mission
of most CCT programs is to prevent inter-generational transference of poverty,
that is to say, investing in young children and providing them with the provisions
necessary for better opportunities in the future.
It aims to eradicate extreme poverty in the Philippines by investing in
heath and education particularly in ages 014.[2] It is patterned on programs in
other

developing

countries

like

Brazil

(Bolsa

Familia)

and

Mexico

(Oportunidades).[3] The 4Ps program now operates in 17 regions, 79 provinces and

1,484 municipalities and 143 key cities covering 4,090,667 household
beneficiaries as of 25 June 2014.

Objective
The program have focused on two objectives:
1. Social assistance: provide cash assistance to address the short-term
financial need.
2. Social development: by investing in capability building they will
be able to break intergenerational poverty cycle.
Eligibility
The poorest among poor families as identified by 2003 Small Area
Estimate (SAE) survey of National Statistical Coordination Board (NSCB)
are eligible. The poorest among poor are selected through a proxy-means
test.[6] Economic indicators such as ownership of assets, type of housing,
education of the household head, livelihood of the family and access to
water and sanitation facilities are proxy variables to indicate the family
economic category.[7] Additional qualification is a household that has
children 014 years old and/or have pregnant women during the
assessment and shall agree on all the conditions set by the government to
enter the program.
Conditions
Health conditionalities

1. Pregnant Household Member/s should visit their local

health center to avail of pre- and post-natal care starting
from the first trimester of pregnancy
2. Children 0-5 Years Old - members of the household who
are 05 years old shall visit the health center and avail of
Immunization/vaccination,

weight

monitoring,

and

management of childhood disease

3. Children aged 614 years old should receive deworming
pills twice a year
Education conditionalities
1. Children aged 35 years old enrolled in Day Care Program
or pre-school program and maintain a class attendance rate
of at least 85% per month (still subject to evaluation/study)
2. Children aged 614 years old enrolled in elementary and
secondary schools and maintain a class attendance rate of at
least 85% per month
Other conditionalities
1. Parents should attend Family Development Sessions at
least once a month

2. Participate in community activities to promote and

strengthen the implementation of the program
In the Philippine governments version of the conditional cash transfer in
the provision in cash grants for education and health activities, poor families need
to comply with a set of conditionalitys such as ensuring school attendance of
children, regular visit to health canters for immunization preventive health checkups and maternal care and the program lasts for 5 years household-beneficiaries
(Briones, 2012). These programs are an important relief in measure because many
poor Filipinos are desperate to survive these trying times and it seems that 4Ps is
like a magic bullet for poverty reduction. It was designed to address issues on
maternal mortality and child mortality, and as well as keep children in school for
five years but these vulnerable groups like senior citizens, chronically sick and
disabilities people. Some of the beneficiaries are not contented in the cash grants
that they received even though it reveals that most of them expressed gratitude
that with the cash grants, the health and education status of their families were
improving, thus, they need jobs. This program was supported by the local
government in the contribution to the Pantawid Pamilya. They said that they will
continually work to find ways on how they can improve the program and they will
provide tighter mechanisms to get views and recommendations on the program.

Statement of the problem

This study is conducted to compare the economic status of the beneficiaries in Vigan City
of Pantawid Pamilyang Pilipino Program. It is designed to answer the following
questions:
1. What are the effects of 4Ps implementation to the selected beneficiaries of
Vigan City?
2. Is there any improvement on their economic status after the implementation?
3. Does the 4Ps program eradicate the poverty experienced by the
respondents?

Conceptual Framework

Typical Roles of the

Family (eg. Father,
Mother, Children)

Pantawid Pamilya
Pilipino Program
(4Ps)
Co-responsibilities
of family that must
be followed)

Study on the Effects of Ilocos Sur National High School Male Students Exposure to
and Recall of Anti-Smoking Advertisements to Their Perceptions of and Attitudes
Toward Smoking

A Thesis
Presented to
The Faculty of Graduate School
University of Northern Philippines

Vigan City, Ilocos Sur

In partial Fulfilment
Of the Requirements for the Degree
Masters of Arts in Nursing

By
Bernadette R. Arde, RN
Introduction
Many Filipinos die due to smoking-related diseases. On a daily basis, 240
Filipinos die because of these smoking-related diseases such as heart failure,
stroke, chronic obstructive pulmonary disease, peripheral vascular disease and
many cancers. This accounts for 87,600 deaths due to smoking-related diseases in
the country every year (WHO, 2009b).
Direct and indirect exposures to cigarette smoking cause these diseases.
Direct
exposure or first- hand is the actual smoking, while indirect exposure may be
secondhand or inhaling the smoke when a person smokes near and third-hand
smoke or exposure to chemicals that remain after the cigarette is put out

(Apelberg, 2007). In connection with these dangers of smoking, there are

increasing numbers of Filipino smokers and an alarming number of youth
smokers. Republic Act of 9211(as cited in Department of Education
[DepEd],2011), or the Tobacco Regulation Act of 2003, specifies the smoking
prohibition in public places: Section 5. Smoking in Public Places - Smoking shall
be absolutely prohibited in the following public places: a. Centers of youth
activity such as playschools, preparatory schools, elementary schools, high
schools, colleges and universities, youth hostels, and recreational facilities for
persons under eighteen (18) years old (p.1).2

Thus, this law of the country protects specifically the youth from being
exposed
to smoking. The Global Youth Tobacco Survey (2007) estimates that there
are 17% or 4 million Filipino youths with ages 13-15 years who are smoking. Of
these early starters, 2.8 million are boys and 1.2 million are girls. With these
alarming statistics, a number of anti-smoking campaigns are being implemented
around the country. The Department of Education (DepEd) through their program
Oplan Balik-Eskwela integrates anti-smoking campaign in schools for the
protection of the students against the hazards of smoking. The main goal of the
campaign is to ensure the implementation of the anti-smoking policies in schools
(DepEd , 2011).

Most of the anti-smoking advertisements are in the form of advocacy

advertising. Advocacy advertising aims to influence publics attitudes toward a
particular issue (Shivani, 2009). Anti-smoking advertisements are tools to
disseminate information about the dangers of smoking. They also aim to increase
nonsmoking intentions (Pechmann, Goldberg, & Reibling, 2003). In contrast,
most smoking advertisements which sell cigarette products to people are in the
form of product advertising. Product advertisings main purpose is to promote
certain products (Shivani, 2009). Anti-smoking advertisements as well as other
Information, Education and Communication (IEC) health programs against
smoking can greatly diminish the prevalence of smoking in the country especially
among the youth sector. Efforts to strengthen these health promotions by further
studies related to anti-smoking advertisements are a must hence this study aims to
contribute to those anti-smoking efforts.
Statement of the Problem
Because of the prevalence of smoking in the youth sector
nowadays, it is important to know their exposure to the current anti-smoking
advertisements that help minimize the number of youth who are smoking. Hence
the research problem and objectives will be:
1.) How do the extent of exposure to and recall of anti-smoking advertisements on
male high school students affect their perceptions of and attitudes toward
smoking?

Conceptual Framework
The study focuses on Anti-Smoking advertisements and how exposure and
recall of these advertisements affect the Vigan City male high school students
knowledge, perceptions, and attitudes toward smoking. Exposure and recall of antismoking advertisements are the main entities that this study will concentrate on. The
availability heuristic principle focuses on the ease of recall of student to anti-smoking
messages and their sources while the mere exposure theory in this study dwells into the
students exposure to anti-smoking messages. the cues to action are the male high school
students sources of information about anti-smoking. Their exposure to anti-smoking
messages will affect their ability to recall what these messages are and where they come
from. Their ability to recall is defined to be the availability heuristics or the information
readily available in the mind. The study focuses on the top-of-the mind memory of the
students or which information they can easily recall. Modifying factors such as age, sex,
personality, socio-economic and knowledge affect the perception on susceptibility and
severity of smoking-related diseases and the perception of benefits against the barriers
.The perceived susceptibility and severity of having smoking-related diseases influence
the perception on the threat of these smoking related diseases. It, therefore, affects the
likelihood of action which is not smoking.

Integrated Conceptual Framework:

Individual Perceptions

PERCEIVED
SUSCEPTIBILITY/
PERCEIVED
SEVERITY OF
DISEASE
(Perceived
susceptibility/
severity of having

AGE, SEX,
PERSONALITY,
SOCIOEONOMICS
KNOWLEDEGE

PERCEIVED
BENEFITS
MINUS
PERCEIVED
BARRIERS
(Perceived
benefits minus
perceived

PERCEIVED
THREAT OF
DISEASE
(Perceived
threat of
smokingrelated

LIKELIHOOD OF
BEHAVIOR
(Likelihood to
not smoke)

AVAILABILITY HEURISTICS
(Availability heuriotic or the case of the person is recalling antismoking advertisement and their messages)

EXPOSURE
(Exposure to Anti- Smoking Messages)

CUES TO ACTION
(Sources of information about anti- smoking)