The CIPP Model in evaluating the Affiliated Primary Health

Care Centers of Cebu Normal University

Julius Daňo and Aida Inabangan
julius_dano@yahoo.com
Cebu Normal University

ABSTRACT
“Health for All” becomes the battle cry of all nations. The key factor in attaining health for all is
the primary health care (PHC) as implemented in the Local Public Health System (LPHS). This
study aimed to assess the extent of implementation of the essential services in the local public
health system of the affiliated health center of Cebu Normal University College of Nursing during
the school year 2007-2008. This research were conducted in13 barangay centers affiliated with
CNU-CN, Cebu City. The affiliated health centers are the barangay Labangaon, Punta Princesa,
Kalunasan, Lahug, Carreta, Alumnos, Cogon Pardo, Poblacion Pardo, San Nicolas, Mabolo,
Hippodromo, Barrio Luz and Busay. Four personnel from each health center were involved as
respondents of the study for a total of 52 respondents but only 50 or 96% returned the
questionnaire. The health workers involved were the doctor, nurse, midwife and barangay
health worker (BHW). The instrument utilized to gather the needed data was the local public
health system performance assessment instrument developed by the National Public Health
Association of County and City Health Officials of the United States of America. Of the essential
services, six were partially implemented, three were less implemented and one service was not
implemented. The six partially implemented services were linking, evaluating, enforcing,
diagnosing and investigating, mobilizing, and assuring. The three less implemented services were
developing, informing and educating, empowering, and monitoring. The partial implementation
of the essential services was due to lack of awareness of essential services, political intervention
and inadequate budget. The community extension services of the Cebu Normal University
College of Nursing can help improve the level of implementation by providing a written copy to
every health center a checklist rating scale for the 10 essential services. The reasons for the
partial implementation of the ten essential services of the local public health system must be
addressed forcefully if the services are to be fully realized.

Keywords: primary health care centers, implementation, services, effectiveness

Background and Rationale of the Study

The progress of a nation is closely tied with the health of its people. Only
when citizens are healthy can they participate actively in nation building. Health
is a state of complete physical, mental and social well being and not merely the
absence of disease or infirmity (WHO, 1977). Thus, the attainment of health
becomes a major social target of governments.
 “Health for All” becomes the battle cry of all nations. The key factor in
attaining health for all is the primary health care (PHC) as implemented in the
Local Public Health System (LPHS). It is the first level of contact of individuals, the
family and the community with the national health system. Its mission is
partnership with the people to ensure equity, quality and access to health care
by making services available, by arousing community awareness, by mobilizing
resources, and by promoting the means to better health. Primary health care in
the Local Public Health System beings health care as close as possible to where
people live and work.
According to Romualdez et al, the health status has improved
dramatically in the Philippines over the last forty years: infant mortality has
dropped by two thirds, the prevalence of communicable diseases has fallen
and life expectancy has increased to over 70 years. However, considerable
inequities in health care access and outcomes between socio-economic
groups remain. In the international arena, the Philippine health status indicators
show that the country lags behind most of South-East and North Asia in terms of
health outcomes. While rapid improvements were seen during the last three
decades, these have slowed in recent years.
The mortality and morbidity rates from 1997 to 2005 is increasing with
communicable diseases leading such as pneumonia and tuberculosis and
respiratory tract infection which affects almost all age group (.Romualdez,
Alberto G. et al, 2011). However, there is a slowing trend of reduction in child
mortality, maternal mortality, as well as other indicators. This may be attributable
to the poor health status of lower income population groups and less developed
regions of the country.
The implementation of the Primary Health Care in the Philippines has not
attained its objectives. This is also reported in the study of Tan-Torres (1995), that
the primary health care services were less due to its limited expert services and
costly health services provided. The limited and costly services affects the health
status of the community.
In Cebu, the Visayas Primary Health Care Services, Inc. (VPHCS) has
continued to work with people’s organizations to develop and strengthen
primary health care programs in various marginalized communities in Cebu.
However, the health indicators are still considerably high.
The Philippines Department of Health Secretary, Francisco Duque,
asserted that the government overwhelming priority at this time is the delivery of
essential services to improve Primary Health Care particularly on maternal health
care in order to curb the high maternal mortality rate (Philippine Star
Newspaper, Friday, August 17, 2007, p. 2).
Likewise, the Department of Education bewailed the lack of health
providers to services for its primary health care system (Sun Star Daily
Newspaper, July 22, 2007, p.2). These indicate that essential services to deliver
primary health care as implemented are not done in its fullest extent. There is
therefore the need to assess the extent of implementation of essential services
as implemented in the local public health system if the delivery of primary health
care is to be improved. Towards this end, a tool to assess its implementation and
performance is called for.

Theoretical Framework

In this study, the researcher utilized Daniel Stufflebeam’s Context, Input,

Process, and Product (CIPP) evaluation model as a framework to systematically
guide the conception, design, implementation, and assessment of the local
public services implemented in the affiliated barangay health centers of Cebu
Normal University College of Nursing, and provide feedback and judgment of
the project’s effectiveness for continuous improvement. As Stufflebeam has
pointed out, the most fundamental tenet of the model is “not to prove, but to
improve”. The proactive application of the model can facilitate decision
making and quality assurance.
Specifically, the context evaluation component of the Context, Input,
Process, and Product evaluation model can help identify the local public health
services. The input evaluation component prescribed the essential primary
health care services. Next, the process evaluation component indicates the ten
essential services of the local public health system. Finally, the product
evaluation component measures, interprets, and judges outcomes and
interprets their extent of implementation in the local health system.
This study is based on the theory of Primary Health Care as a tool for
attaining “Health for All” in the local public health systems is not fully
implemented due to lack of standards that are expected to be done.
In 1977, member countries of the World Health Organization (WHO)
adopted a resolution during the 20th World Health Assembly which proclaimed
that the main social targets of government and WHI in the coming decades
should be attainment by all citizens of the world by the year 2000 of a level of
health that will permit them to lead a socially and economically productive life.
This they termed as “Health for All” (Bailon-Reyes, 2006, P. 30).
Essential services to carry out the Primary Health Care (PHC) were
identified as the key factor to achieving “Health for All” in 2000. In the Alma Ata
Declaration of 1978 (WHO, 1978), PHC was defined as an “essential health care
based on practical, scientifically sound and social acceptable methods and
techniques made universally accessible ton individuals and families in the
community through their full participation and at a cost the community can
afford to maintain at every stage of development in the spirit of self-reliance
and self-determination (Baum, 2002, p. 45).
Primary health care has eight essential elements. They are (1) education
concerning prevailing health problems and the methods of preventing and
controlling them, (2) promotion of food supply and proper nutrition, (3) an
adequate supply of safe water and basic sanitation, (4) maternal and child
health care including family planning, (5) immunization against major infectious,
(6) prevention and control of locally endemic diseases, (7) appropriate
treatment of common diseases and (8) provision of essential drugs.
“Health for All” remains an elusive dream. The road to this lofty goal is
blocked by non-implementation of basic essential services necessary to carry
out the eight essential elements. For developing communities, the main problem
is financial. Primary health care requires millions of funds if it is to reach everyone.
Clean drinking water, sanitary latrines, vaccines, essential drugs for common
diseases, and all need capital outlays. Besides, PHC workers need to be trained
and retrained and a back-up referral system needs to be developed.
“Health for All” through Primary Health Care services remains worthwhile
goal to pursue in the next millennium. An assessment of the implementation of
Primary Health Care essential services is necessary to discover strengths and
weaknesses. Intervention schemes would include enhancing and sustaining the
strengths and plugging or strengthening the identified weaknesses.
 Input Process Product
Primary Health Care Essential LPHS Services Extent of
Services •monitoring, Implementation
•education concerning •diagnosis and investigating, •Fully Implemented
prevailing health problems •informing, educating and •Partially Implemented
and the methods of empowering, •Less Implemented
preventing and controlling •mobilizing, •Least Implemented
them, •developing policies and
•promotion of food supply plans,
and proper nutrition, •enforcing the laws,
•an adequate supply of safe •linking,
Context water and basic sanitation,
•assuring,
LOCAL PUBLIC HEALTH •maternal and child health
care including family •evaluating and
SYSTEM planning, •researching
•immunization against major
infectious,
•prevention and control of
locally endemic diseases,
•appropriate treatment of
common diseases and
•provision of essential drugs.

Figure 1. Theoretical-Conceptual Framework of the Study

 The ten essential public health services includes 1) Monitor health status to
identify community health problems, 2) Diagnose and investigate health
problems and health hazards in the community, 3) Inform, educate, and
empower people about health issues, 4) Mobilize community partnerships to
identify and solve health problems, 5) Develop policies and plans that support
individual and community health efforts, 6) Enforce laws and regulations that
protect health and ensure safety, 7) Link people to needed personal health
services and assure the provision of health care when otherwise unavailable 8)
Assure a competent public and personal health care workforce, 9) Evaluate
effectiveness, accessibility and quality of personal and population-based health
services, and 10) Research for new insights and innovative solutions to health
problems.

Monitor health status to identify community health problems includes the

services such as accurate, periodic assessment of the community’s health
status, including identification of health risks, determinants of health, and
determination of health service needs; attention to the vital statistics and health
status indicators of groups that are at higher risk than the total population; and -
Identification of community assets that support the local public health system
(LPHS) in promoting health and improving quality of life; utilization of appropriate
methods and technology, such as geographic information systems (GIS), to
interpret and communicate data to diverse audiences; and collaboration
among all LPHS components, including private providers and health benefit
plans, to establish and use population health registries, such as disease or
immunization registries.
Diagnose and investigate health problems and health hazards in the
community are those services that investigate epidemiological disease
outbreaks and patterns of infectious and chronic diseases and injuries,
environmental hazards, and other health threats, active infectious disease
epidemiology programs, and access to a public health laboratory capable of
conducting rapid screening and high volume testing.
The essential service 3 is to Inform, Educate, and Empower Individuals and
Communities about Health Issues and the service includes health information,
health education, and health promotion activities designed to reduce health
risk and promote better health, health education and health promotion
program partnerships with schools, faith communities, work sites, personal care
providers, and others to implement and reinforce health promotion programs
and messages that are accessible to all populations, health communication
plans and activities such as media advocacy and social marketing, accessible
health information and educational resources, and risk communication
processes designed to inform and mobilize the community in time of crisis.
The essential service 4 is to Mobilize Community Partnerships to Identify
and Solve Health Problems. This service includes identifying potential
stakeholders who contribute to or benefit from public health and increase their
awareness of the value of public health, building coalitions and working with
existing coalitions to draw upon the full range of potential human and material
resources to improve community health, and convening and facilitating
partnerships and strategic alliances among groups and associations (including
those not typically considered to be health-related) in undertaking defined
health improvement activities, including preventive, screening, rehabilitation,
and support programs, and establishing the social and economic conditions for
long-term health.
The essential service 5 is to Develop Policies and Plans that Support
Individual and Community Health Efforts and this service includes an effective
governmental presence at the local level, development of policy to protect the
health of the public and to guide the practice of public health, systematic
community-level planning for health improvement and public health
emergency response in all jurisdictions, and alignment of local public health
system (LPHS) resources and strategies with a community health improvement
plan.
The essential service 6 is Enforce Laws and Regulations that Protect Health
and Ensure Safety. The services includes the review, evaluation, and revision of
laws, regulations, and ordinances designed to protect health and safety to
assure that they reflect current scientific knowledge and best practices for
achieving compliance, education of persons and entities obligated to obey or
to enforce laws, regulations, and ordinances designed to protect health and
safety in order to encourage compliance, enforcement activities in areas of
public health concern, including, but not limited to the protection of drinking
water; enforcement of clean air standards; emergency response; regulation of
care provided in health care facilities and programs; re-inspection of
workplaces following safety violations; review of new drug, biologic, and
medical device applications; enforcement of laws governing the sale of alcohol
and tobacco to minors; seat belt and child safety seat usage; and childhood
immunizations.
The essential service 7 is Link People to Needed Personal Health Services
and Assure the Provision of Health Care when Otherwise Unavailable and this
service includes identifying populations with barriers to personal health services,
identifying personal health service needs of populations with limited access to a
coordinated system of clinical care, and assuring the linkage of people to
appropriate personal health services through coordination of provider services
and development of interventions that address barriers to care (e.g., culturally
and linguistically appropriate staff and materials, transportation services).
The essential service 8 is Assure a Competent Public and Personal Health
Care Workforce. This service includes assessment of all of the workers within the
local public health system (LPHS) (including agency, public, and private workers,
volunteers, and other lay community health workers) to meet community needs
for public and personal health services, maintaining public health workforce
standards, including efficient processes for licensure/credentialing of
professionals and incorporation of core public health competencies needed to
provide the Essential Public Health Services into personnel systems, and
adoption of continuous quality improvement and life-long learning programs for
all members of the public health workforce, including opportunities for formal
and informal public health leadership development.
The essential service 9 is Evaluate Effectiveness, Accessibility, and Quality
of Personal and Population-Based Health Services. This service includes
evaluating the accessibility and quality of services delivered and the
effectiveness of personal and population-based programs provided and
providing information necessary for allocating resources and reshaping
programs.
The essential service 10 is Research for New Insights and Innovative
Solutions to Health Problems. This service includes a continuum of innovative
solutions to health problems ranging from practical field-based efforts to foster
change in public health practice, to more academic efforts to encourage new
directions in scientific research, linkages with institutions of higher learning and
research, and capacity to undertake timely epidemiological and health policy
analyses and conduct health systems research.

Statement of the Problem

It was the main purpose of the study to assess the implementation of

essential services in the Local Public Health System of the Cebu Normal University
College of Nursing affiliated Barangay Health Centers in Cebu City during the
school year 2007-2008. Specifically, the study answered the following specific
problems:
 1. What are the essential services provided in the Local Public Health

System?

2. To what extent were the essential services of the Local Public Health

system implemented?

Significance of the Study

The study is significant to the following:

Barangay Health Centers. A measurable performance standards that they
can use to ensure the delivery of public health services.
Clinical Teachers. That the identification of strengths and weakness of the
Local Public Health System maybe used as a basis for improvement in the
related learning experience of the students. That the findings will serve as a basis
for further research endeavours.

Definition of Terms

Health for All. Is a major target of the government of 134 countries for all
their citizens for them to attain that level of health that will permit them to lead
socially and economically prolific lives.
Local Public Health System (LPHS). Refers to all public, private and
voluntary entities as well as individuals and informal associations that contribute
to the delivery of public health services within a jurisdiction.
Essential services. They refer to the ten essential services to be done to
carry out the local public health system. The essential services are monitoring,
diagnosis and investigating, informing, educating and empowering, mobilizing,
developing policies and plans, enforcing the laws, linking, assuring, evaluating
and researching.
Intervention Schemes. Are the strategies utilized by the College of Nursing
to carry out the services to help the center staff implement the essential services
to carry out the primary health care.
Affiliated Health Centers. Refers to the 13 barangay health centers
adopted by the College of Nursing for their community extension services. The
affiliated health centers are the barangay Labangaon, Punta Princesa,
Kalunasan, Lahug, Carreta, Alumnos, Cogon Pardo, Poblacion Pardo, San
Nicolas, Mabolo, Hippodromo, Barrio Luz and Busay.

Methodology

Research Environment
This research was conducted in Cebu City but limited to 13 barangay
centers affiliated with CNU-CN. The affiliated health centers are the barangay
Labangaon, Punta Princesa, Kalunasan, Lahug, Carreta, Alumnos, Cogon
Pardo, Poblacion Pardo, San Nicolas, Mabolo, Hippodromo, Barrio Luz and
Busay.

Research Respondents
Involved as respondents are the doctor, nurse, midwife, and Barangay
Health Worker in each of the health centers. There will be four respondents in
each center for a total of 52 respondents from the thirteen affiliated barangay
health centers. Only 50 or 96% responded. Hence, the total respondents were
50.

Research Instruments
Since the study followed the descriptive-normative, it made use of a
questionnaire. The instrument delved into the extent of implementation of the
ten essential services as fully implemented or nor implemented. The essential
public health services are monitoring, diagnosis and investigating, informing,
educating and empowering, mobilizing, developing policies and plans,
enforcing the laws, linking, assuring, evaluating and researching (Core Public
Health Functions Steering Committee, 1994),
The Local Assessment Instrument is divided into ten sections; one for each
essential services. Each essential service section is divided into several indicators.
The indicators identify major components of the essential services. Associated
with each indicator are activities that are expected to be performed for local
public health systems.
There are four possible response options. The response options are
described below.
YES – greater than 75% of the activity described within the question is met
within the local public health system.
 HIGH PARTIALLY – greater than 50% but not more than 75% of the activity
described within the local public health system.
LOW PARTIALLY – greater than 25% but no more than 50% of the activity
described within the question is met within the local public health system.
NO – no more than 25 percent of the activity described within the
question is met.
To arrive at the extent of implementation, a response of yes is assigned to
a weight of 4, high partially a weight of 3, low partially a weight of 2, and no
response was assigned a weight of one. Thus, the weighted mean ranged as
follows:
3.26 – 4.00 – Fully Implemented
2.51 – 3.25 – Partially Implemented
1.76 – 2.50 – Less Implemented
1.00 – 1.75 – Least Implemented

Data Analysis
This study utilized the weighted mean to analyze the data collected. The
weighted mean (WM) (Nieswiadomy, 2008) otherwise called as average is used
to determine the level of implementation of the local public health services in
the affiliated barangay health centers of Cebu Normal University College of
Nursing.

Data Gathering Procedures

The researchers personally visited the affiliated barangay health centers
and administered the questionnaire. A specific time to retrieve the questionnaire
was arranged. The researchers then returned to retrieve the questionnaire.
Once the extent of implementation was determined, the researchers visited
again the health centers. The respondents were interviewed and were asked
this question, “What could be the reasons behind the non-full implementation of
the essential services? Their answer to this question were tabulated and ranked
according to the number of respondents who gave such answer. An interview is
a method of data collection in which an interviewer obtains responses from a
subject in a face-to-face encounter and the questionnaires used contains
questions that respondents are asked to answer in writing (Nieswiadomy, 2008).

Results and Discussions

 This chapter presents the data gathered from the questionnaire and
follow-up interviews. The data were grouped into two. One is the extent of
implementation of the ten essential services and the other pertains to the factor
identified as responsible for this level of implementation.

The Implementation of the Ten Essential Services

The Essential Public Health Services provide a framework by describing the

public health activities that should be undertaken in all communities. It provides
a working definition of public health and a guiding framework for the
responsibilities of local public health systems.

Essential Service 1: Monitor Health Status to Identify Community Health

Problems. This service includes accurate periodic assessment of the community’s
health status, utilization of appropriate methods and technology to interpret
and communicate data to diverse audiences and collaboration among LPHS
components. The indicators and activities to implement essential service 1 is
presented in table 1 on the next page.
Table 1
The Implementation of Essential Service 1
Monitoring Health Status to Identify Community Health Problem
Indicators Yes (4) High Low No (1) Total WM DR
Partiality Partiality
(3) (2)
N P N P N P N P N P

1. Prepared population based community

health profile
1.1 conducted community health 12 24.00 25 50.00 8 16.00 5 10.00 50 100 2.88 P1
assessment.
1.2 accumulated data on: demography, 9 18.00 16 32.00 21 42.00 4 8.00 50 100 2.60 P1
socio-economic health resource, quality of
life, social and mental health, maternal and
child health, death, illness and injury, and
communicable disease.
1.3 processed data into a community 5 10.00 7 14.00 18 36.00 20 40.0 50 100 1.94 L1
health profile.
2. Access to and utilize current technology 50 100
to manage display, analyze and
communicate population health data.
2.1 used state of the art technology to 3 6.00 5 10.00 15 30.00 27 54.00 50 100 1.62 N1
support health profile database.
2.2 prepared geocoded data. 4 8.00 7 14.00 9 18.00 30 60.00 50 100 1.70 N1
2.3 used graphic presentation to present 28 56.00 15 30.00 5 10.00 2 4.00 50 100 3.38 F1
information.
2.4 prepared information in an electronic 5 10.00 7 14.00 12 24.00 26 52.00 50 100 1.72 N1
version.
3. Maintained population health registries 2 4.00 6 12.00 18 36.00 24 48.00 50 100 1.72 N1
Average 2.19 L1
Fully Implemented (F1) – 3.26 – 4.00
Partially Implemented (P1) – 2.51 – 3.25
Less Implemented (L1) – 1.76 – 2.50
Not Implemented (N1) -1.00 – 1.75

As shown in the table on the next page, there are three indicators to show
implementation of essential service one. The first indicator was the presentation
of community health profile. The activities undertaken under this indicator were
the conduct of community health assessment and accumulated data on
demography, socio-economic, health resources, quality of life, social-mental
health, child and maternal health, death, illness and injury and communicable
diseases.
The weighted mean for the two activities were 2.88 and 2.60. This
indicated a partial implementation of preparing community health profile. This
showed that greater than 50 percent but no more than 75 percent not the
activity described within the question is met. The community health profile as
prepared is only 75 percent complete.
The third activity is processed the data gathered into a written health
profile. The weighted mean is 1.94 and it indicated a less implemented activity.
The data gathered were not processed and were not compiled into a written
health profile.
The second indicator was an access to and utilizes current technology to
manage, display, and analyze health data. This indicator was not implemented
since the activities like using state of the art technology, preparing geocoded
data and preparing information an electronic version. They registered weighted
mean of 1.62, 1.70 and 1.72. Only one activity was fully implemented. This was
the use of graphic presentation to present information. It had a weighted mean
of 3.38 which indicated full implementation. Charts and graphs were used to
present information to the public.
The third indicator was maintaining population health registries. This
registered weighted mean of 1.72 which meant that this indicator was least
implemented. The health centers did not keep health registers, although they
had scattered and desultory records of some health aspects.
The first essential service of monitoring health status to identify community
healthy problems was less implemented as shown in the weighted mean of 2.19.
This showed that greater than 25 percent but no more than 50 percent of the
specified activities were carried out.
Essential Service 2: Diagnosing and Investigating Health Problems and Health

Table 2
The Implementation of Essential Service 2
 Diagnose and Investigate Health Problems and Health Hazards in the Community

Indicators Yes (4) High Low No (1) Total WM DR

Partiality Partiality
(3) (2)
N P N P N P N P N P

1. Identify and conduct

surveillance of health threats.
1.1 developed comprehensive 15 30.00 18 36.00 14 28.00 3 6.00 50 100.00
surveillance system plan.
1.2 monitored changes in the 14 28.00 20 40.00 10 20.00 6 12.00 50 100.00
occurrence of health problems
and hazards.
1.3 utilized information 9 18.00 18 36.00 15 30.00 8 16.00 50 100.00
gathered.
1.4 adopted procedures to 10 20.00 21 42.00 11 22.00 8 16.00 50 100.00
alert communities about health
threats or disease outbreaks.
1.5 planned for public health 4 8.00 13 26.00 19 38.00 14 28.00 50 100.00
emergencies.
1.6 identified public health 14 28.00 24 48.00 7 14.00 5 10.00 50 100.00
disasters and emergencies.
1.7 adopted emergency 12 24.00 19 38.00 10 20.00 9 18.00 50 100.00
procedures and response plan
1.8 outlined protocols for 13 26.00 22 44.00 9 18.00 6 12.00 50 100.00
emergency response
1.9conducted simulation of 4 8.00 6 12.00 15 30.00 25 50.00 50 100.00
one or more mock events
2.75 P1
Average
2. Investigate and respond to
public health emergencies.
2.1 designated emergency 26 52.00 16 32.00 5 10.00 3 6.00 50 100.00
response coordinator
2.2 adopted epidemiological 3 6.00 6 12.00 15 30.00 26 32.00 50 100.00
case investigation protocol
2.3 kept a roster of personnel 2 4.00 5 10.00 19 38.00 24 48.00 50 100.00
who can respond to
emergencies.
Average 2.53 P1
3. Provided laboratory support
for investigation of health
threats.
3.1 accessed to laboratory 18 36.00 18 36.00 7 14.00 7 14.00 50 100.00
service
3.2 passed documentation 1 2.00 6 12.00 21 42.00 22 44.00 50 100.00
that laboratories are
licensed/accredited
3.3 maintained guidelines in 15 30 20 40.00 10 20.00 7 14.00 50 100.00
handling laboratory samples
Average 2.56 P1
Fully Implemented (F1) – 3.26 – 4.00
Partially Implemented (P1) – 2.51 – 3.25
Less Implemented (L1) – 1.76 – 2.50
Not Implemented (N1) -1.00 – 1.75
Hazards in the Community. Essential service 2 includes epidemiological
investigation of disease outbreaks and patterns of infectious and chronic
diseases and injuries, environmental hazards and other health threats, active
infectious disease epidemiology programs and access to public health
laboratory. The four indicators and activities to implement essential service no. 2
is presented in table 2 on the next page.
The first indicator was to identify and conduct surveillance of health
threats. The activities under this indicator are developing a comprehensive
surveillance system plan, monitored changes in the occurrence of health
problems, utilized information gathered, and adopted procedures to alert
communities about health threats and disease outbreaks. These activities
registered weighted means of 2.90, 2.84, 2.56 and 2.66 respectively. These
weighted means fall under the partially implemented categories which meant
that 51 to 75 percent of the activities to be accomplished were carried out.
The second indicator was having a plan for public health emergencies. To
carry out this indicator, the public health personnel must do the following
activities. They are identified public health disasters and emergencies, adopted
emergency procedures and response plancs, outlines protocols for emergency
response and conducted simulation of one or more mock events.
All of the above mentioned activities had weighted means ranging from
2.51 to 3.25. This showed that indicator number 2 which was planned for public
health emergencies was partially carried out which meant that not less than 50
percent but not more than 75 percent of the expected activities were carried
out.
The third indicator was investigating and responding to public health
emergencies. To carry out this indicator, three activities are expected to be
done. They are designating an emergency response coordinator which was fully
implemented with a weighted mean of 3.3. Most of the barangay health
centers has coordinators to respond to emergencies. With weighted mean of
1.70 and 1.72 that fall under least implemented category, less than 25 percent
of the health centers adopted epidemiologic case investigation protocol and
kept a roster of personnel who can respond to emergencies.
The fourth indicator was to provide laboratory support for the investigation
of health threats. The weighted mean of 2.94 sowed that they had access to
laboratory service and they had guidelines in handling laboratory samples but
they did not possess documentation that laboratories are licensed and
accredited. They just assumed that laboratories in the regional health centers
are duly licensed.
 The average weighted mean for essential service no. 2 was 2.56. Such
range fall under the partially implemented category. It showed that not less
than 50 percent but not more than 75 percent of the indicators in diagnosing
and investigating health problems and health hazards were carried out.
Essential service No. 3: Informing, Educating, and Empowering People
About Health Issues. This essential service 3 includes (1) health information,
health education, health promotion activities designed to reduce health risks,
(2) health communication plans and activities, (3) accessible health information
and educational resources, and (4) health education and health promotion
partnerships.
Table 3
The Implementation of Essential Service 3
Inform, Educate and Empower People About Health Issues
Indicators Yes (4) High Low No (1) Total WM DR
Partiality Partiality
(3) (2)
N P N P N P N P N P

1. Health education and health

promotion
1.1 provided information to the 11 22.00 25 50.00 10 20.00 4 8.00 50 100 2.86 P1
general public and policy leaders
on community health
1.2 used media to communicate 7 14.00 10 20.00 17 34.00 16 32.00 50 100 2.76 P1
health information
1.3 sponsored health education 23 46.00 20 40.00 5 10.00 2 4.00 50 100 3.28 F1
programs
1.4 assessed education activities 2 4.00 7 14.00 11 22.00 30 60.00 50 100 1.62 N1
within the past two years.
2.63 P1
Average
2. Implemented health promotion
activities to healthy living
2.1 assessed health promotion 1 2.00 8 16.00 18 36.00 23 46.00 50 100 1.74 N1
activities in the past year.
2.2 established collaborative 4 8.00 10 20.00 20 40.00 32 64.00 50 100 2.04 L1
network for health promotion.
1.89 L1
Average
Fully Implemented (F1) – 3.26 – 4.00
Partially Implemented (P1) – 2.51 – 3.25
Less Implemented (L1) – 1.76 – 2.50
Not Implemented (N1) -1.00 – 1.75

Table 3 shows the implementation of essential service no 3 which is

informing, educating and empowering people about health issues in terms of
indicators and activities. The first indicator was health education and health
promotion. There were four activities to carry out this indicator. Of the four
activities, sponsoring health education programs was fully implemented with a
weighted mean of 3.28; two were partially implemented with weighted means
of 2.86 and 2.76 and one activity was not implemented since the weighted
mean of 1.62 indicated non implementation category. This was the assessment
of education activities for the last two years; no evaluation of activities had
taken place.
The second indicator was the implementation of health promotion
activities to facilitate healthy living. To carry out this indicator, one activity is to
assess health promotion activities the past year. This was not implemented since
the weighted mean was 1.74. The other activity was the establishment of
collaborative network for health promotion. The weighted mean of 2.04
indicated a less implementation of this activity.
The average weighted mean of the second indicator was 1.89. This
showed a less implemented range of the weighted mean. This means that not
less than 25 percent and not more than 50 percent of the activities to carry out
this indicator was carried out.

Essential Service No. 4. Mobilize Community Partnership to Identify and

Solve Health Problems. Table 4 shows the implementation of essential service 4
which is to mobilize community partnership to identify and solve health
problems. In the table, there are two indicators to implement this service. One is
the development and identify constituents and the other is establishing
community partnership. Constituents are the residents in the community who are
to be served by the local public health system.
Table 4
The Implementation of Essential Service 4
Mobilize Community Partnerships to Identify and Solve Health Problem
Indicators Yes (4) High Low No (1) Total WM DR
Partiality Partiality
(3) (2)
N P N P N P N P N P

1. Development of Constituency
1.1 identify key constituents 29 58.00 10 20.00 7 14.00 4 8.00 50 100 3.28 F1
1.2 encourage participation of 18 36.00 20 40.00 7 14.00 5 10.00 50 100 2.95 P1
constituents in improving
community health
1.3 maintains directory of 17 34.00 18 36.00 9 18.00 6 12.00 50 100 2.92 P1
organizations who helped
1.4 inform constituent about 15 30.00 21 42.00 9 18.00 5 10.00 50 100 2.92 P1
health issues and services
3.02 P1
Average
2. Established community
partnership.
2.1 coordinated activities with 14 28.00 19 38.00 10 20.00 7 14.00 50 100 2.80 P1
partnership
2.2 created community health 4 8.00 7 14.00 9 18.00 30 60.00 50 100 1.70 N1
improvement committee
2.3 assessed effectiveness of 4 8.00 6 12.00 12 24.00 28 56.00 1.72 N1
community partnerships.
2.54 P1
Average
Fully Implemented (F1) – 3.26 – 4.00
Partially Implemented (P1) – 2.51 – 3.25
Less Implemented (L1) – 1.76 – 2.50
Not Implemented (N1) -1.00 – 1.75

Development of constituency required health workers to identify key

constituents which were fully implemented. Another activity was to encourage
constituents to participate in improving community health had a weighted
mean of 2.95 which fall under the partially implemented category. Keeping a
directory of organization that could help was partially implemented with a
weighted mean of 2.92. The same weighted mean also registered for informing
constituents about health issues and services.
The development of constituency by identifying them, encouraging their
participation, maintaining directory and informing them about health issues and
services registered an average weighted mean of 3.02 that indicated the
development of constituency was partially implemented. This means that from 1
to 75 percent of the expected activities were carried out.
Another indicator was the establishment of community partnerships. The
activities under this indicator was coordinated activities with partnership which
was partially implemented with a weighted mean of 2.80, created community
health improvement committee was not implemented since the weighted
mean was 1.20. This was also true to the activity of assessing effectiveness of
community partnership which was not also implemented since the weighted
mean was 1.72.
The implementation essential service 4 as shown by the weighted mean
of 2.54 which fall under the category of partial implementation. This indicated
that of the activities lined up to carry out this service, not less than 50 percent
but not more than 75 percent were carried out.

Essential Service 5. Develop Policies and Plans that Support Community and
Individual Health Efforts. This service includes an effective governmental
presence at the local level development of policy to protect the health of the
public and to guide the practice of public health, systematic community level
and state level planning and alignment of resources and strategies with the
community health improvement plan.
 Table 5
The Implementation of Essential Service 5
Develop Policies and Plans that Support Community and Individual Health Efforts
Indicators Yes (4) High Low No (1) Total WM DR
Partiality Partiality
(3) (2)
N P N P N P N P N P

1. Have government presence at the local

level.
1.1 included a local health government 29 58.00 14 28.00 5 10.00 2 4.00 50 100.00 3.49 F1
entity to ensure delivery of essential
service.
1.2 assured participation of relevant 13 26.00 16 32.00 14 28.00 7 14.00 50 100.00 2.95 P1
stakeholders
1.3 worked closely with state public 27 54.00 14 28.00 6 12.00 3 6.00 50 100.00 2.92 P1
health system
1.4 reviewed public health policies every 2 4.00 9 18.00 13 26.00 26 52.00 50 100.00 2.92 P1
two years
Average 2.78 P1
2. Developed public health policy
contributed to development of public
health policy.
2.1 contributed to development of public 6 12.00 8 16.0 19 38.00 17 34.00 50 100.00 2.40 L1
health policy
2.2 provided forum for constituents to 16 32.00 21 42.00 10 20.00 3 6.00 50 100.00 3.00 P1
raise issues
Average 2.70 P1
3. Developed community health
improvement process
3.1 is there a community health 8 16.00 10 20.00 17 34.00 15 30.00 50 100.00 2.22 L1
empowerment process?
3.2 is there a plan for it? 6 12.00 11 22.00 17 34.00 16 32.00 50 100.00 2.14 L1
3.3 developed strategies to address 14 28.00 17 34.00 11 22.00 8 16.00 50 100.00 2.74 L1
community health objectives.
Average 2.74 P1
4. Strategic planning and alignment
4.1 conducted planning process 7 14.00 8 16.00 21 42.00 14 28.00 50 100.00 2.16 L1
4.2 conducted planning activite 6 12.00 7 14.00 19 38.00 18 36.00 50 100.00 2.02 L1
Average 2.09 L1
Average 2.48 L1
Fully Implemented (F1) – 3.26 – 4.00
Partially Implemented (P1) – 2.51 – 3.25
Less Implemented (L1) – 1.76 – 2.50
Not Implemented (N1) -1.00 – 1.75

Table 5 presents the implementation of essential service 5 in terms of

indicators and activities. As shown in the table, there are four indicators to show
implementation of essential service 5. The first indicator was having a
government presence at the local level. To carry out this indicator, the activities
and their weighted mean are included local government entity to ensure
delivery of essential services had a mean of 3.40 and it was fully implemented,
assured participation of relevant stakeholders with a weighted mean of 2.70
showing a partial implementation, working closely with state public health
system was fully implemented as pointed out by the mean of 3.30 but reviewing
public health policies every two years was not implemented since the weighted
mean was 1.74.
The first indicator was partially implemented as shown by the average
weighted mean of 2.78. This showed that not less than 50 percent but not more
than 75 percent of the activities were carried out.
The second indicator was the development of public health policy. To
implement this indicator, the weighted mean and their level of implementation
were contributed to the development of public health policy mean of 2.40 was
less implemented, provided forum for the constituents to raise issues had a
mean of 3.0 was partially implemented the development of public health policy
was partially implemented since the average weighted mean was 2.7.
The next indicator was developed a community health improvement
process. The activities were having a community health improvement process
which was less implemented as indicated by the weighted mean of 2.22; having
a plan for the process was less implemented since the weighted mean was 2.14
and the development of strategies to address community health objectives was
partially implemented as pointed out by the weighted mean of 2.74. The
development of community health improvement process was less implemented
as shown by the average weighted of 2.36.
The last indicator was strategic planning and alignment. To carry out this
indicator, two activities were mentioned. They are conducting a planning
process and conducted some planning activities. Both had a weighted means
of 2.16 and 2.02 that fall under the less implemented category.
The average weighted mean of essential service 5 was 2.48 and it
indicated a less implementation of developing policies and plans that support
individual and community health efforts. This means that not less than 25
percent but no more than 50 percent of the activities listed to carry out essential
service 5 was accomplished.
Essential service 6. Enforcement of Laws and Regulations that Protect
Health and Ensure Safety. This service includes review, evaluation and revision of
laws and regulations, education of persons and entities obligated to obey or to
enforce laws and regulations and enforcement activities in areas of public
health concern.
 Table 6
The Implementation of Essential Service 6
Enforce Laws and Regulations that Protect Health and Ensure Safety
Indicators Yes (4) High Low No (1) Total WM DR
Partiality Partiality
(3) (2)
N P N P N P N P N P

1. Review and evaluate laws,

regulations and ordinances.
1.1 compile national and local 30 60.00 10 20.00 7 14.00 3 6.00 50 100.00 3.34 F1
laws.
1.2 identified public health 14 28.00 18 36.00 14 28.00 4 8.00 50 100.00 2.84 P1
issues that can be addressed
through laws and regulations
1.3 reviewed laws at least 3 6.00 4 8.00 15 30.00 28 56.00 50 100.00 1.64 N1
once every 5 years
1.4 availed of legal counsel in 4 8.00 7 14.00 8 16.00 31 62.00 50 100.00 1.68 N1
assessing laws
2.37 L1
Average
2. Involved community in the
review and improvement of
laws and ordinances.
2.1 identified issues not 12 24.00 22 44.00 8 16.00 8 16.00 50 100.00 2.78 P1
properly addressed
2.2 involved organizations in 2 4.00 4 8.00 15 30.00 29 58.00 50 100.00 1.58 N1
the modification of ordinances
2.3 provided technical 2 4.00 5 10.00 21 42.00 22 44.00 50 100.00 1.74 N1
assistance
Average 2.00 L1
3. Enforce laws, regulations and
ordinances
3.1 acquired authority to 30 60.00 10 20.00 7 14.00 5 10.00 50 100.00 3.34 F1
enforce
3.2 conducted enforcement 27 54.00 12 24.00 7 14.00 3 6.00 50 100.00 3.26 F1
activities in a timely manner
3.3 informed people about 26 52.00 14 28.00 8 16.00 2 4.00 50 100.00 3.28 F1
laws that are required to
comply
Average 3.27 F1
Average 2.56 P1
Fully Implemented (F1) – 3.26 – 4.00
Partially Implemented (P1) – 2.51 – 3.25
Less Implemented (L1) – 1.76 – 2.50
Not Implemented (N1) -1.00 – 1.75

As shown in the table, there are three indicators of essential service 6.

They are review and evaluate laws, regulations and ordinances which was less
implemented with a weighted mean of n2.37; involving the community in the
review and improvement of laws and ordinances with an average weighted
mean of 2.05 and it was less implemented and enforcing laws, regulation and
ordinances was fully implemented since the weighted mean was 3.27.
Of the activities listed, four activities registered weighted means falling
within the range of 3.26 to 4.0 which indicated that they are fully implemented.
They are compiled national and local laws, acquired authority to enforce laws,
conducted enforcement activities in a timely manner and informing people
about laws that they are required to comply.
Activities that were partially implemented were within the weighted mean
range of 2.51 to 3.25 which showed that they were partially implemented. They
are identified health issues that can be addressed through laws and regulations
and identifying issues that were not properly addressed. Considered not
implemented since their weighted means fall with 1.00 to 1.75 range: they were
reviewing laws and regulations every five years, availment of legal counsel in
assessing laws, involving organization in the modification of technical assistance.
The average weighted means of essential service 6 was 2.56 and it fall
under the partially implemented category. This indicated that of the activities
identified to carry out essential service 6 no less than 50 percent but not more
than 75 percent were carried out.

Essential Service 7: Linking People to Needed Personal Health Services

and Assure the Provision of Health Care when Otherwise Unavailable. This service
includes identifying population with barriers to personal health service needs of
populations and assuring the linkage of people to appropriate personal health
services through coordination of provided services and development of
interventions that address to barriers. Table 7 presents the implementation of
essential service 7 in terms of indicators and activities.
Table 7
The Implementation of Essential Service 7
Linking People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise
Unavailable
Indicators Yes (4) High Low No (1) Total WM DR
Partiality Partiality
(3) (2)
N P N P N P N P N P

1.Identify population with

barriers to personal health
service.
1.1 identified population 28 56.00 15 30.00 4 8.00 3 6.00 50 100.00 3.36 F1
groups who may encounter
barriers to receipt of health
services
3.36 F1
Average
2. Identified health service
needs of population.
2.1 defined health needs in all 31 62.00 8 16.00 7 14.00 4 8.00 50 100.00 3.32. F1
its catchment areas
2.2 accessed extent of 14 28.00 15 30.00 11 22.00 10 20.00 50 100.00 2.66 P1
providing health services
2.3 identified preventive, 18 36.00 17 34.00 9 18.00 6 12.00 50 100.00 2.94 P1
curative, and rehabilitative
services
2.93 P1
Average
3. Assured linkage of people to
personal health services.
3.1 provided the needed 28 56.00 12 24.00 6 12.00 4 8.00 50 100.00 3.28 F1
personal health services
3.2 provided outreach and 14 28.00 19 38.00 8 16.00 5 10.00 50 100.00 2.68 P1
linkage service
3.3 identified enrolment of 29 58.00 15 30.00 4 8.00 2 4.00 50 100.00 3.42 F1
beneficiaries of medical
assistance programs
3.4 coordinated delivery of 13 26.00 17 34.00 11 22.00 9 18.00 50 100.00 2.68 P1
personal health service to
populations
3.5 conducted an analysis of 18 38.00 16 32.00 8 16.00 8 16.00 50 100.00 2.88 P1
preventive services
Average 2.98 P1
Average 3.09 P1
Fully Implemented (F1) – 3.26 – 4.00
Partially Implemented (P1) – 2.51 – 3.25
Less Implemented (L1) – 1.76 – 2.50
Not Implemented (N1) -1.00 – 1.75

As reflected in the table, there are three indicators of essential service 7.

Indicator one was identifying populations with barriers to personal health
service. The activity was to identify population groups who may encounter
barriers to receipt of health services. With a weighted mean of 3.36, this activity
was fully implemented. Those with barriers were the old age, the physically
disabled and those residents who resided in far-flung isolated areas.
The next indicator was the identification of health services needs of
populations. This was partially implemented since the weighted mean was 2.93.
On the other hand, defining health needs in all its catchment areas was fully
implemented as indicated by the weighted mean was 2.66. Finally, the
identification of preventive, curative and rehabilitative services was partially
implemented as shown by the weighted mean of 2.94.
Another indicator was an assurance of linkage of people to personal
health services. Of the five activities listed to carry out this indicator, two had
weighted means falling within the range of 3.26 to 4.0 indicating that they were
fully implemented. They were provided the needed personal services and
initiated enrolment of beneficiaries of medical assistance programs. Three
activities were partially implemented since he registered weighted means of
2,68 and 2.88. These activities were provided outreach and linkage services,
coordinated delivery of personal health services to populations and conducted
an analysis of preventive services.
The implementation of essential service 7 was partial since the average
weighted means was 3.09 and it fall under the partially implemented category.
This means that of the indicators and activities to carry out the service only 50-75
percent were implemented.

Essential Service 8. An Assurance of a Competent Public and Personal

Health Care Workforce. This service includes assessment of workforce to met
community needs for public and personal health services, maintaining public
health workforce standards and the adoption of continuous quality
improvement and life-long learning programs for all members.
Table 8
The Implementation of Essential Service 8
An Assurance of a Competent Public and Personal Health Care Workforce
Indicators Yes (4) High Low No (1) Total WM DR
Partiality Partiality
(3) (2)
N P N P N P N P N P

1. Assessed workforce.
1.1conducted workforce 3 6.00 5 10.00 17 34.00 25 50.00 50 100.00 1.72 N1
assessment within the past five
years.
1.2 identified gaps within 4 8.00 7 14.00 10 20.00 29 58.00 50 100.00 1.72 N1
public and personal health
workforce
1.3 disseminated for use results 2 4.00 4 8.00 14 28.00 30 60.00 50 100.00 1.52 N1
of workforce assessment
1.66 N1
Average
2. Acquired public health
workforce standard.
2.1 required personnel 18 36.00 15 30.00 9 18.00 8 16.00 50 100.00 2.86 P1
licensure or certificate
2.2 prepared job standard or 22 44.00 21 42.00 5 10.00 2 4.00 50 100.00 3.26 F1
position description for all
personnel
2.3 conducted performance 24 48.00 19 38.00 6 12.00 1 2.00 50 100.00 3.32 F1
evaluation
Average 3.14 P1
3. Lifelong learning through
continuing education, training
and monitoring
3.1 identified education and 15 30.00 17 34.00 10 20.00 8 16.00 50 100.00 2.78 P1
training needs
3.2 supported or provided 13 26.00 20 40.00 9 18.00 8 16.00 50 100.00 2.76 P1
opportunities to develop
competencies
3.3 provided incentives to 15 30.00 18 36.00 12 24.00 5 10.00 50 100.00 2.86 P1
workforce for career
advancement
Average 2.80 P1
4. Developed public health
leadership
4.1 promoted development of 17 34.00 18 36.00 8 16.00 7 14.00 50 100.00 2.90 P1
leadership skills
4.2 monitored personnel in 12 24.00 19 38.00 11 22.00 8 16.00 50 100.00 2.70 P1
middle management
supervising positions
2.4 4.3 promoted leadership in 16 32.00 17 34.00 10 20.00 7 14.00 50 100.00 2.84 P1
all levels
4.4 promoted collaborative 3 6.00 7 14.00 10 20.00 30 60.00 50 100.00 1.52 N1
leadership through shared vision
and participatory decision
making
Average 2.49 L1
Average 2.52 P1
Fully Implemented (F1) – 3.26 – 4.00
Partially Implemented (P1) – 2.51 – 3.25
Less Implemented (L1) – 1.76 – 2.50
Not Implemented (N1) -1.00 – 1.75

Table 8 presents the implementation of essential service 8 in terms of

indicators and activities. The assessment of workforce was regarded as not
implemented since the weighted mean was 1.66 which falls under the range of
not implemented. This indicator was supported by the specific activities that
were also not implemented. These activities were failure to conduct assessment
within the past five years, failure to identify gaps within the public and personal
health workforce and non-use of results of workforce assessment.
The second indicator was to acquire public health workforce standard.
Two activities under this indicator were fully implemented as shown by the
weighted mean of 3.26 and 3.32. These activities were preparation of a job or
position standard for all personnel and conducting performance evaluation
every year. Partially implemented was the requirement for personnel to have
licensure or certificate.
The third indicator was lifelong learning through continuing education,
training and monitoring. Workforce must be encouraged to improve their
competence and performcne but first education and training needs must first
be identified which was partially implemented since the weighted mean was
2.78. Supporting and providing opportunities to develop competencies was also
partially done since the weighted mean was 2.76. finally providing incentives to
workforce for career advancement was also partially implemented.
 The fourth and last indicator of essential service 8 was developing public
health leadership of the four activities. Three were partially implemented and
one was not implemented since the registered weighted mean of 2.90, 2.70 and
2.84 respectively. The partially implemented activities were promoting the
development of leadership skills, monitored personnel in middle management
supervisory positions and promoted leadership skills in all levels. Not
implemented with a weighted mean of 1.52 was promoting collaborative
leadership through shared and participatory decision making.
The average weighted means for essential service 8 was 2.52 and it is
within the partial implementation range. This means that essential service 8
which is an assurance of a competent and personal health care workforce was
partially implemented. Not less than 50 percent but no more than 7 percent of
the identified activities were carried out. That is therefore the need to fully
implement this service through incentives and collaborative leadership.

Essential Service 9. Evaluate Effectiveness, Accessibility and Quality of Personal

and population Based Health Services. This service includes assessing the
accessibility and quality of services delivered and the effectiveness of personal
and population-based programs provided and providing information necessary
for allocating resources and programs.
Table 9
The Implementation of Essential Service 9
Evaluate Effectiveness, Accessibility and Quality of Personal and population Based Health
Services
Indicators Yes (4) High Low No (1) Total WM DR
Partiality Partiality
(3) (2)
N P N P N P N P N P

1. Evaluation of Population-
Based Health Services.
1.1 evaluated health services 2 4.00 5 10.00 20 40.00 23 56.00 50 100.00 2.72 P1
in the past three years
1.2 establishes criteria to 15 30.00 16 32.00 10 20.00 9 18.00 50 100.00 2.74 P1
evaluated services
1.3 determined extend of 17 34.00 18 36.00 9 18.00 6 12.00 50 100.00 2.92 P1
program to evaluate services
1.4 assessed community 17 34.00 20 40.00 8 16.00 5 10.00 50 100.00 2.98 P1
satisfaction of health services
1.5 used evaluation results to 14 28.00 21 42.00 8 16.00 7 14.00 50 100.00 2.84 P1
improve plans
2.86 P1
Average
2. Evaluation of personal health
services.
2.1 evaluated health services 18 36.00 19 38.00 7 14.00 6 12.00 50 100.00 2.98 P1
against established criteria.
2.2 assessed client satisfaction 15 30.00 17 34.00 10 20.00 8 16.00 50 100.00 2.78 P1
used results of evaluation to
improve plans
2.3 used results of evaluation 16 32.00 17 34.00 11 22.00 6 12.00 50 100.00 2.80 P1
to improve plans
Average 2.85 P1
3. Evaluation of the local public
health system.
3.1 assessed linkages and 3 6.00 10 20.00 16 32.00 26 52.00 50 100.00 1.70 L1
relationships among
organizations.
3.2 used results of evaluation 17 34.00 19 38.00 8 16.00 6 12.00 50 100.00 2.94 P1
to guide improvement
Average 3.32 F1
Average 2.63 P1
Fully Implemented (F1) – 3.26 – 4.00
Partially Implemented (P1) – 2.51 – 3.25
Less Implemented (L1) – 1.76 – 2.50
Not Implemented (N1) -1.00 – 1.75

The extent of implementation of essential service 9 was presented in table

9. As shown in the table, there are three indicators to determine implementation
of essential service 9 which is evaluation. Two indicators registered weighted
means of 2.86 and 2.85 and it fall within the partially implemented range. These
indicators were evaluation of population-based services and evaluation of
personal health services. This showed that 51 to 75 percent of the activities to be
carried out were implemented. With a weighted mean of 2.32, the third
indicator was less implemented. This was evaluating the local public health
system. No less that 25 percent and no more than 50 percent of the activities
expected to be accomplished were carried out,
As to activities, the following were partially implemented. Their weighted
means fall within the range of 2.51 to 3.25. The activities were evaluating health
services in the past three years, establishing criteria to evaluate services
determining extent the program goals were achieved, assessing community
satisfaction of health services and used evaluation results to improve plans.
More partially implemented activities were evaluating health services against
established criteria, assessing client satisfaction and using results of evaluation to
improve plans and to guide in improvement.
The average weighted mean for essential service 9 which is evaluating is
2.63 and it indicated a partial implementation. This showed that no less than 50
percent but no more than 75 percent of the activities were carried out. There is
therefore the need to improve this service to its full implementation.
Essential service 10. Research for New Insights and Innovative Solutions to Health
Problems. This service includes a continuum of innovative solutions to health
problems, linkages with institution of higher learning and research and the
capacity to mount timely epidemiological and health policy analyses and
conduct health systems research. The implementation of essential service 10
research is presented in table 10.
Table 10
The Implementation of Essential Service 10
Research for New Insights and Innovative Solutions to Health Problems
Indicators Yes (4) High Low No (1) Total WM DR
Partiality Partiality
(3) (2)
N P N P N P N P N P

1. Fastened innovations.
1.1 encourage staff to 3 6.00 8 16.00 10 20.00 29 58.00 50 100.00 1.70 N1
develop new solutions
1.2 proposed issues for 2 4.00 6 12.00 18 36.00 24 48.00 50 100.00 1.72 N1
inclusion in research agenda
1.3 monitored good practices 4 8.00 7 14.00 19 38.00 20 40.00 50 100.00 1.86 L1
of other agencies
1.4 encouraged community 3 6.00 5 10.00 16 32.00 27 54.00 50 100.00 1.72 N1
participation in development
and implementation of research
1.75 N1
Average
2. Linked with institutions of
higher learning.
2.1 partnered with at least one 23 46.00 17 34.00 6 12.00 2 4.00 50 100.00 3.26 F1
institution of higher learning.
2.2 developed collaboration 8 16.00 7 14.00 10 20.00 30 60.00 50 100.00 1.66 N1
with research organization
2.3 encouraged proactive 1 2.00 5 10.00 15 30.00 29 58.00 50 100.00 1.56 N1
interaction between academic
and practice communities.
Average 2.16 L1
3. Initiated or participated in
timely epidemiological health
policy and health system
research.
3.1 acquired resources to 4 8.00 6 12.00 8 16.00 32 64.00 50 100.00 1.64 N1
facilitate research
3.2 acquired access to 2 4.00 3 6.00 16 32.00 29 58.00 50 100.00 1.56 N1
researchers and results of
research
Average 1.6 N1
Average 1.66 N1
Fully Implemented (F1) – 3.26 – 4.00
Partially Implemented (P1) – 2.51 – 3.25
Less Implemented (L1) – 1.76 – 2.50
Not Implemented (N1) -1.00 – 1.75
 As reflected in table 10, the first indicator was to foster innovation. This was
not implemented because the weighted mean was 1.59 and it fall under the
non-implemented range. The activities that supported the indicator of fostering
innovations were also not carried out. The staff never develop new solutions to
problems nor did they propose issues for inclusion in research agenda. Although
they somehow monitored good practices but there was no community
participation in the development and implementation of research.
Linking with institutions of higher learning was partially implemented. Fully
implemented was the partnership with at least one institution of higher learning
but developing collaboration with research organizations and encouraging
proactive interaction between academic and proactive communities was not
implemented as pointed out by their weighted means of 1.34 and 1.20
respectively.
Initiating or participating in timely epidemiological health policy and
health system research was not carried out since its weighted mean was 1.46. Its
activities were also not carried out due to weighted means of 1.52 and 1.40 that
fall under the not implemented category. These activities were acquiring
resources to facilitate research and acquiring access to researches and results
of research.
Research as an essential service was not implemented as revealed in the
average weighted mean of 1.66. This showed that of the activities lined up
under the research not more than 25 percent were carried out. Although these
health centers had linkages with Cebu Normal University – College of Nursing,
yet they did not conduct research. They were just satisfied with doing what had
been established and practiced. There is therefore the need to develop new
solutions of problems through research.

The Extent of Implementation of the Ten Essential Services

Ranked according to level of implementation from most implemented to
least implemented is presented below.
Rank Essential Title Weighted Descriptive
Service Mean Rating
1 7 Linking 3.09 P1
2 9 Evaluating 2.63 P1
3 6 Enforcing 2.56 P1
4 2 Diagnosing and Investigating 2.55 P1
5 4 Mobilizing 2.54 P1
6 8 Assuring 2.52 P1
7 5 Developing, Informing, 2.48 L1
Educating
8 3 Empowering 2.26 L1
9 1 Monitoring 2.10 L1
10 10 Doing Research 1.66 N1

The strengths and weaknesses in the implementation of the ten essential

services are revealed. Six essential services were partially implemented. They are
linking, evaluating, enforcing, diagnosing and investigating, mobilizing, and
assuring. This meant that 51 to 75 percent of the activities were implemented.
There is a need to do something more since there is more room for
improvement. The implementers must be provided with a checklist of activities
to be done so that they would always be reminded and nothing would be left
out.
There are essential services were less implemented. They are essential
services no 5, 3 and 1 of developing, informing and educating and empowering
and monitoring. This meant that of the activities under these services, 26 to 50
percent were carried out. There is a need to encourage the workforce to
accomplish the task they had left out. These is a need to provide them with a
check out of activities so that they will be reminded of what more are to be
done.
The least implemented service and the weakest thereof is essential service
no. 10 which is research. The weighted mean showed that only 25 percent of
the specified activities were carried out and 75 percent were not
accomplished. There is a need to improve research. Local health workers must
collaborate with the institutions of higher learning that they are linked with.
Institutions of higher learning prepare the research design and the local health
workforce implements. In so doing, usual and practical activities, that were
carried out will be improved.

Factors Deemed Responsible for the Level of Implementation

When the researchers had known that the essential services were not fully
implemented, they went back to visit the health centers involved. The purpose
of the visit was to interview the respondents on what they believed was the
cause for the partial implementation of the essential services. Their answers were
reflected below.

Reasons Given Number Percentage

Unaware of mandated essential services 48 96%
Political Intervention 45 90%
Inadequate Funds 42 84%
 There were three reasons identified by majority of the respondents. The first
reason given by 48 or 96 percent of the respondents was lack of awareness that
there is list of essential services. They accomplished some of the indicators and
performed some of the activities they know that they had to do them. So their
implementation was informal and desultory. They are just being practical
without a formal guide. There is therefore the need to furnish each center a
checklist of essential services, their indicators and activities to remind the health
workers what they are expected to do. With the checklist, it will be easier for
them to assess their performance. Higher health authorities would find it easy to
evaluate the accomplishment of the staff.
The second reason identified by 45 respondents representing 90 percent
was political intervention. This is usually true in the case of barangay health
workers who are appointed by the barangay captains. The appointment does
not usually consider the qualifications of the appointee. The appointment
depended on the whims and caprices of the barangay captain who do not
observe security of tenure. A barangay health worker can be replaced anytime
by the barangay captain even due to a very flimsy reason.
The third reason identified by 42 or 84 percent of the respondents was
inadequate funds. Most often, budget for health is not a priority of the
barangay. In some cases, there is no budget for health needs. There is no
money for the purchase of the needed medicines for the destitute who could
not afford to but medicine. The health centers need money for referrals. They
had no allocation for laboratory examination or for transportation needs for
follow-up services. There is therefore the need to allocate a specific percentage
of the barangay budget for health services. After all, the strength of a nation
depends upon the health of its category.

Conclusion

Of the essential services, six were partially implemented, three were less
implemented and one service was not implemented. The partial
implementation of the essential services was due to lack of awareness of
essential services, political intervention and inadequate budget. The community
extension services of the Cebu Normal University College of Nursing can help
improve the level of implementation by providing a written copy to every health
center a checklist rating scale for the 10 essential services. The reasons for the
partial implementation of the ten essential services of the local public health
system must be addressed forcefully if the services are to be fully realized.

Recommendations
The following recommendations are offered:
1. Since the research was the least implemented service, there is a need

to improve the health centers by helping the staff of the barangay

health centers to identify issues and topics as subject for research. This

can be done by strengthening the linkage between the center and

College of Nursing. The personnel of the health centers should identify

topics for research, the college prepares the design, the center carries

out the research and the college writes the research. Both can claims

as co-authors of the research.

2. Politics should not interfere with the implementation of health services.

He should appoint qualified health workers, evaluate his performance

periodically and should not be replaced when the workers become an

expert in the performance of his/her job.

3. In the preparation of the barangay budget, the health department

must be included. They must also be made to submit their budget for

the year just like other department heads. They should be made to

justify their budget during budget hearings after which.

4. The health center must be provided with a copy of the Local /National

Public Health Performance Standard to guide them on what to do at a

certain time and to guide them in assessing what they had done and
 what else are to be done. In so doing, no service, no indicator, and no

activities will be left out.

References

Internet Sources

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http://www.who.int/about/definition/en/print.html

WHO, Alma Ata Declaration of Primary Health Care,

http://www.paho.org/english/dd/pin/alma-ata_declaration.htm

Core Public Health Functions Steering Committee, (1994), Essential Public Health
Services,
http://www.cdc.gov/nphpsp/documents/essentialservicespresentation.p
df

CIPP Model by Daniel Stufflebeam, http://www.scribd.com/doc/58435354/The-

Cipp-Model-for-Evaluation-by-Daniel-l-Stufflebeam

Romualdez, Alberto G. et al, Health Systems in Transition, Vol. 1, 2011. The

Philippines Health System Review. Accessed at
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Visayas Primary Health Care Services, Inc. (VPHCS), 2010, Accessed at

http://vphcs.org/vphcs/on January 16, 2013.

Tan-Torres, Tessa L., 1995, A Study on Primary Health Care Services in the
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http://dirp4.pids.gov.ph/ris/dps/pidsdps9520.pdf on January 16, 2013.

Books
Salvacion G. Bailon-Reyes, (2006), Community Health Nursing: The Basics of
Practice. National Book Store, Mandaluyong City.

Nieswiadomy, Rose Marie (2008), Foundations of Nursing Research, 5th ed.,

Pearson Education, New Jersey.

Published Articles

Sun Star Daily Newspaper, July 22, 2007, p.2

Philippine Star Newspaper, Friday, August 17, 2007, p. 2