QUALITY OF HEALTH CARE SERVICES RENDERED BY HEALTHCARE

PROVIDERS TO THE SENIOR CITIZENS IN KILICAO ALBAY

A Thesis Presented to the Faculty of College of Health Sciences

University of Santo Tomas-Legazpi

In Partial Fulfillment of
the Requirements for the
Degree of Bachelor of
Science in Nursing

Papa, Christian M.
Sallan, Jon Andrei L.
Tan, John Gabriel C.
Tuiza, Amanda Joy M.

May 2023
 INTRODUCTION

Background

The extent to which health services for people and groups increase the chances of

desired health outcomes is known as quality of care. Quality, as an attribute of health

care, is usually held to be proportionate to the improvements in health that health care can

achieve. But the ability to achieve improvements in health is limited by the state of

knowledge and technology. It is essential for establishing universal health coverage and is

focused on professional knowledge supported by evidence. As the population of older

adults increases dramatically, there is limited evidence that sufficient resources are

available to meet the challenges of providing health care and quality of life to older adults

and their families.

With the growing number of elderly people in China, the demand for long-term

care services is growing faster. With the service conditions of “maintenance integration”,

the elderly with disabilities, diseases or strange feelings are increasingly favored by the

combination of medical and nursing institutions. From the perspective of supply and

demand of long-term care services, Findings indicate that there is a contradiction between

the supply and demand of long-term care services in medical and nursing institutions due

to the lack of government guidance in funding investment, unclear positioning of medical

and nursing institutions, lack of professional nursing personnel and imperfect long-term

care security system. It is suggested to resolve the contradiction between supply and

demand of long-term care services from optimizing resource allocation, perfecting the

needs assessment system of elderly, cultivating nursing talents, and perfecting the long-

term care security system. (Zhu, 2022).

 In the Philippines, when President Rodrigo Duterte signed the Universal Health

Care Bill into law in February 2019, the Philippine health system underwent considerable

changes. Through a variety of healthcare system changes, the UHC Law prioritizes

population, service, and financial coverage growth. With UHC, they ensure that every

Filipino is healthy, safe from health hazards and dangers, and has access to affordable,

high-quality, and easily accessible health care that meets their needs. The Sustainable

Development Goals (SDGs) push for the attainment of Universal Health Coverage

(UHC), which encompassess access to high-quality basic healthcare and protection from

financial risk. But in many circumstances, it is difficult to deliver high-quality treatment,

which increases avoidable mortality, human suffering, and considerable economic losses

(WHO). The foundation of healthcare services should be effective and people-centered

health care. Many senior citizens lack access to quality healthcare.

The Philippines still faces significant challenges in gaining access to basic

healthcare services. Kilicao is one of the most populated barangay of Daraga, and

although having many senior citizens residents, they often receive inadequate attention

and struggle with limited access to healthcare services and the distance traveled when in

need of health care is almost long. This study aims to gather data regarding the

experiences of senior citizens living in Kilicao regarding accessing health care services,

existing health programs, and health care services offered. Additionally, the study aims to

assess the availability of the healthcare system to address various health concerns and

evaluate the accessibility of basic health care services. Overall, studying the topic helps

create awareness, generate data-driven insights, and drive the government and other

organizations to implement specific programs to improve and satisfy the health and

standard living conditions of senior citizens in Kilicao.

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Rationale

The Expanded Older Citizens Act of 2010 Republic Act no. 9994 is a law that

provides additional benefits and privileges to senior citizens. One of its purposes is for the

government to adopt a comprehensive and integrated approach to health development,

with the goal of making commodities, health care, and other social services affordable to

all older residents. Priority shall be given to the needs of the disadvantaged, the sick, and

the handicapped elderly. It also includes actions to assist elderly residents, acknowledge

their contributions to society, and develop a program that benefits senior citizens, their

families, and the rest of the community.

The goal of this social welfare law is to help the elderly Filipinos and provide

them more benefits. The benefits and privileges provided by RA 9994 are available to all

Filipino residents aged 60 and over. Senior citizens are entitled to the following benefits:

discounts, free services, exemptions, incentives, government financial support, and

express lane priority. In connection to the study, this law can assist in determining if such

free services have an impact on the quality of health care services provided to senior

citizens, as well as reminding them that they are entitled to the following free medical

benefits: medical and dental services, diagnostic and laboratory tests requested by the

physician such as but not limited to X-rays, computerized tomography scans, and blood

tests availed of by senior citizens, including professional fees of attending doctors in all

government hospitals, medical facilities, outpatient clinics, and home health care services,

free pneumococcal and influenza vaccine for indigent senior citizens.

The Senior Citizens Center Act of the Philippines Republic Act No. 7876,

outlines the State's stated policy of delivering appropriate social services and increasing

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people's quality of living. With this aim, the state will take an integrated and

comprehensive approach to health development, prioritizing the elderly among others.

The term "center" as used in this Act refers to a facility created by this Act that provides

recreational, educational, health, and social activities and facilities for the enjoyment and

benefit of elderly people in the city or municipality.

This law can assist in establishing a senior citizens center if one exists; thus, it is

proposed that this center should be created in every city and municipality in the

Philippines in partnership with the local government unit involved. It identifies senior

citizens' needs, opportunities in cities and municipalities, promotes and maintains links

with provincial government units and other non-governmental organizations for the

delivery of health care services, facilities, professional advice services, volunteer training,

and community self-help projects, and carries out the purpose for which the centers are

established.

Current State of the Researcher in the Field

The objective of this scoping review was to examine the factors that facilitate or

hinder older adults in Southeast Asian (SEA) countries from accessing healthcare

services. The review focused on older adults residing in SEA countries who were

evaluating healthcare services. The primary enablers and barriers identified in this review

were related to the accessibility and acceptability of healthcare services. Another

significant factor that emerged was the influence of social and family support. These

factors were found to have a particularly negative impact on older adults living in rural

areas. It is crucial to prioritize accessibility and acceptability when designing healthcare

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services for older adults in Southeast Asia, with the aim of promoting their healthy aging

and overall well-being. (Abd Rahman et al., 2022).

The findings of the review revealed several factors that either enabled or hindered

older adults from accessing healthcare services in SEA countries. Accessibility and

acceptability were the two most frequently identified factors affecting access to

healthcare. Geographic location, travel distance, and transportation costs were significant

barriers to accessibility, particularly for older adults living in rural areas. On the other

hand, financial constraints, such as low income and high healthcare costs, posed

challenges to affordability. Availability of healthcare services, particularly in rural areas,

was identified as a barrier, with a shortage of healthcare professionals and limited service

options being reported. To promote healthy aging, optimal healthcare, and well-being

among older adults in Southeast Asia, the review suggests that healthcare planning should

consider the factors of accessibility and acceptability. Addressing geographical barriers,

improving transportation options, reducing healthcare costs, and ensuring trust and

acceptance of healthcare providers are crucial steps in enhancing access to healthcare

services for older adults in the region.

As the longevity and number of elderly adults increase in many nations, a major

concern is whether this demographic aging will be accompanied by sustained or better

health, an improving quality of life, and sufficient social and economic resources. As

such, this study aimed at defining an aged care system that will bridge the gap between

the expanding needs of the Filipino elderly and the current structures and practices in the

delivery of services to the aging population at the fundamental level. (Brodit & Noroña.,

2021).

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 This study revealed that various factors, including age, residence, marital status,

employment, pension, and income, significantly influence the quality of life and health of

the elderly. The study also examined the living conditions of senior citizens in different

types of dwellings, existing policies and practices in the Philippines, and the effects of

these provisions on the elderly. The findings indicate that a considerable number of senior

citizens in the Philippines require improvements in their health and quality of life. It is

essential to address their health issues, including chronic illnesses, provide assistance for

disabilities, and implement measures to prevent accidents among this population.

Synthesis of the Art

The related literature and studies were gathered and reviewed thoroughly, and

well search was done by the researchers. It provided them with baseline information,

helpful insights and contributed conceptualization to the current study. Both local and

foreign, which supports the researchers on this study. It is also a review of existing

studies on the topic of the quality of health care services among individuals.

The health and wellness program of DOH entitled healthy and productive aging

program for senior citizens intends to provide the following: focused service delivery

packages and integrated continuum of quality care, capacitated health providers in the

implementation of health programs for senior citizens, and provision of influenza and

pneumococcal vaccines. The following are the health care services provided by the

Zamboanga Peninsula Senior Citizens Program: vaccination of flu and pneumonia

vaccine, medical assistance regionwide, provision of medicines, provision of walker,

canes, wheelchairs, eyeglasses and health kits. (Vinluan, 2019; Bucoy, 2017)

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 The purpose of this study was to evaluate the availability and quality of radiology

services in the Philippines, including X-ray services. The study discovered that X-ray

service availability varied across the country, with some areas having limited access.

The system includes pulse rate monitoring, temperature monitoring, fall detection, and an

SMS notification system that alerts personnel in the event of an accident or when the

patient's vital signs fall below normal. (Laya et al., 2019; Silverio et al, 2020)

This study aimed to investigate how critical access hospitals (CAHs) provide

additional imaging services given their low patient volumes and high resource costs. The

study found that CAHs with greater financial resources of network affiliations are more

likely to offer imaging services such as MRI, CT, ultrasound, mammography, and

PET/CT. The study suggests that encouraging CAHs’ participation in larger systems or

networks could improve access to specialized imaging services in rural and underserved

areas. (Khaliq et al., 2017)

Every year in October, the Department of Social Welfare (DSWD), the OSCA

Office, and other non-governmental organizations (NGOs) arrange medical and dental

missions. Senior citizens can use the mobile van to get medical checkups and treatment,

dental checkups and treatment, blood pressure checks, blood typing, blood sugar tests and

monitoring, height and weight checks, and x-rays. During the medical and dental

missions, the SM Foundation Inc. distributes free medicines to the patients (Toring,

Nuevo, Gabuya, & Maming, 2021).

Seasonal influenza is a serious illness that causes morbidity and economic

disruption every year. Elderly and immunocompromised people are particularly at risk.

With changing demographics, there are important implications for public health and

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medicine. Immunization can help reduce the impact of flu, but older people may not be

fully protected due to aging. Additionally, younger people who hesitate to get vaccinated

can contribute to the spread of flu. While more effective vaccines are needed, current

vaccines are still highly effective in reducing illness and death when matched to

circulating strains, as demonstrated by clinical trials. (Smetana et al., 2017)

Receiving vaccinations against pneumococcal and influenza disease lessens

negative health impacts in older individuals. The Australian National Immunization

Program offered free vaccinations against pneumococcal and seasonal influenza to

individuals under 65 years old. Additionally, all individuals over 65 years old should

receive a single dose of the 23-valent pneumococcal polysaccharide vaccine, regardless of

their risk of acquiring the disease. However, the vaccination rates for pneumococcal

illness were notably lower than those for seasonal influenza. (Briggs et al., 2019)

The aim was to identify the methods used by individuals with hypertension in

Indonesian rural communities to obtain their antihypertensive medication supplies, as

well as the types of antihypertensive drugs used, and variables related to where and how

they acquire their medication supplies. A researcher-administered questionnaire was used

to gather information on individuals with hypertension who were 45 years of age or older

from eight rural communities in the Bantul district, Yogyakarta province, Indonesia. The

results indicated that out of the 384 patients, 203 (52.9% of them) received

antihypertensive medications from either public or private healthcare providers.

(Rahmawati & Bajorek, 2018)

The aging population in South Korea has grown rapidly, leading to an increased

need for healthcare and services. However, it can be difficult for seniors to access

8
suitable healthcare facilities. To address this issue, a program proposed using

smartphones' GPS and push system to aid seniors in finding suitable medical facilities.

The program includes a monitoring service to provide high-quality healthcare services.

(Huh & Kim, 2019)

Overall, the related literature and studies above provide a broader context and

insights into different aspects of healthcare services, including vaccinations, radiology,

imaging services, medication access, and innovative programs. While not all directly

relate to Kilicao, they contribute to understanding the range of services available, the

challenges that may exist, and potential areas of improvement in the quality of healthcare

services provided to senior citizens.

Immunization barriers may have a major influence on vaccination rates, and hence

the frequency and prevalence of vaccine-preventable illnesses. They are also expected to

have an impact on the implementation of successful vaccination and surveillance

initiatives, as well as the achievement of national and global immunization targets. A

global report, the factors affecting the supply and distribution of vaccines are lack of

manufacturing capacity, misdistribution, financial constraints, lack of political

commitment, and limitations in vaccination storage or capacity. In the Philippines, the

decline in vaccine coverage is mostly due to repeated challenges in the supply side of the

government's immunization program (Bates & Rosado, 2017).

The vaccine stock out of the country can be related in part to the failure of local

bidding. She stated that the procurement procedure for vaccinations and other supplies

takes a year. Another concern is the DOH's lack of vaccination storage capacity. She also

mentioned a lack of an organized system for vaccine distribution in local government

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units, a lack of investment in service delivery channels, a lack of an electronic monitoring

system for the proper inventory of vaccines and supplies in local health facilities, and a

lack of collaboration between the government and private sector in terms of Expanded

Program on Immunization “EPI” (Uy, 2021).

A shortage of access to medicines is influenced by health system inefficiencies in

regard to medicines administration by municipal governments. Municipalities lacked an

established Drug and Therapeutics Committee (DTC) to monitor medicines management.

Local leaders were unaware of their responsibilities and were inadequate to create an

effective medications management system. Municipal leaders and health personnel in all

municipalities lack technical competence and capability (e.g., an employed pharmacist

and trained people) to estimate and quantify medication requirements (Nieva and Robles,

2019).

The unavailability of medicines at healthcare facilities is often due to stock

depletion or supply shortages. Government policies aimed at improving drug access and

reducing prices play a major role in drug availability. A review of National Drug Policies

is needed to address the factors. Generic medicines are more available than innovator

brand drugs, especially in the public sector, and some developing nations have limited

medication availability. Proper government policies can enhance drug availability in low

to upper middle-income nations by improving drug access and reducing prices. (Latifah et

al, 2019).

Elderly in Metro Dumaguete are unsatisfied with the limited budget for

miscellaneous healthcare services like medical assistance, family care or group homes for

neglected older persons, and monthly stipends for medicine. The National Research

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Council of the Philippines (NRCP) is recommending policy changes to improve

healthcare benefits, privileges, and systems for the elderly. Dr. Oracion of the NRCP

provides policy solutions for senior citizens who cannot afford healthcare. (Daquioag,

2020).

Health insurance is offered by both the public and private sectors. PhilHealth was

established in order to provide broad coverage and low-cost services, while upper- and

middle-class Filipinos seeking higher-quality benefit packages and who could afford them

moved to private insurers and providers. This indicated that the majority of persons

utilizing the services provided by government-owned institutions were the

underprivileged. This raises the view of 'poor services for poor people,' considering that

there is no visible difference in quality or efficiency between the sectors (Oberwann,

2018).

The study investigated the impact of access to healthcare on health outcomes

among adult residents of a disadvantaged central Florida area, as healthcare disparities are

cause of concern for economically disadvantaged populations in the United States. The

results indicated that income affected insurance status, provider relationships, and health

outcomes. The study also examined where residents received healthcare and how they

paid for it. These findings suggest that it is crucial to involve individuals with personal

experience in shaping the access and availability of healthcare for marginalized

communities. (Holmes et al, 2022).

Inadequate healthcare services were reported due to insufficient staff, shortage of

medicine supply, and poor accessibility of health centers. Senior citizens raised concerns

about the availability of doctors, as some barangays shared doctors, causing occasional

11
absences in certain areas. Health providers explained that new doctors were required to

attend seminars for a few days, resulting in their absence. (Asis, 2019).

This research aimed to identify potential barriers among the elderly population to

healthcare access influenced by the economic crisis and the troika agreement focusing on

the Memorandum of Understanding on Specific Economic Policy Conditionality (MoU)

in Lisbon metropolitan area, Portugal. A study by Laranjeira revealed that nurses

perceived themselves to be less attentive to and patient with elderly patients due to higher

time constraints and increased workload deriving from the induced MoU measures,

impairing the quality of care towards elderly patients. (Doetsch et al., 2017)

Canadians were healthier than ever before and had access to better healthcare,

there were still significant gaps in the quality of care provided. The definition of "quality"

in healthcare, as defined by the Institute of Medicine, was adopted by many jurisdictions,

but improving quality was a complex task influenced by broader contexts. The

responsibility of providing quality care was not limited to individual clinicians, but also

other actors in the healthcare system. The article mainly focused on the national level but

overlooked important differences within Canada and between different groups. The

importance of social determinants of health, such as income, housing, education, and

social networks, was not diminished. (Dhalla and Tepper, 2018)

The literature review aimed to find a suitable model for clinical leadership

development among frontline healthcare providers in LMICs, especially for maternal and

perinatal care in South Africa. Previous interventions for clinical leadership development

were found to be mainly focused on high-income countries, limiting their transferability

to LMICs. Work-based learning was considered the most appropriate educational

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approach, and multiple time-spaced contact sessions were found to be the most suitable

approach to delivering in-service training programs. However, most studies only used

post-test evaluation to measure the effectiveness of the interventions, which limited their

ability to attribute observed changes to the intervention. The authors suggested that pre-

post-test evaluation would be more accurate. (Mianda and Voce, 2018).

This study aimed to investigate access to primary healthcare for elderly in

Essaouira province and identify factors affecting it. The study found that there are

discrepancies in access to primary healthcare among the elderly, and several factors

influence this access. Advanced age, female gender, living in rural areas due to isolation

and remoteness, and having a low level of education are some socio-demographic

characteristics of the elderly that negatively impact their use of primary healthcare

services. These findings align with international studies on healthcare utilization and

highlight the role of sociodemographic profile in determining primary healthcare usage.

(Mejdouli et al., 2021)

In summary, these related studies provide insights into various factors that can

affect the availability and accessibility of healthcare services rendered to senior citizens.

These factors include immunization barriers, vaccine stockouts, medication access,

government policies, healthcare budgets, health insurance, staff shortages, and socio-

demographic characteristics. While not all information directly pertains to Kilicao, they

provide a broader understanding of the potential challenges and factors influencing the

quality of healthcare services for senior citizens in terms of availability and accessibility.

Effective methods from global experiences that can enhance access to primary

healthcare in rural areas were discovered by this study. Strengthening PHC is crucial in

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achieving universal health coverage and reducing health disparities among rural

communities. Challenges in providing healthcare services in rural areas, such as financial

inaccessibility, lack of funding, and personnel shortages, were addressed. The Astana

Declaration highlighted the need for an accessible, cost-effective, and sustainable

healthcare system that can adapt to emerging healthcare threats. This systematic literature

review provides healthcare professionals, researchers, and policymakers with useful

insights to improve healthcare service delivery in rural communities. (Zemichael et al,

2020).

The proposed program to improve the quality of the healthcare system of Level 1

Hospitals includes recommendations for policy changes and healthcare reform. The

number of older persons is predicted to increase, which will likely result in a rise in the

need for services and assistance for seniors and the families that provide care for them.

Policymakers and government officials must plan for this expansion, due to the country's

distinctive history and vibrant culture, its people have different perspectives on aging and

have higher expectations for informal caregiving for elderly relatives. To effectively meet

the demands of the Philippines' aging population, research on aging and current policies

must be improved. (Caelian and Geroso, 2020; Andel and Badana, 2018)

It is difficult for people in certain rural parts of the Philippines to acquire basic

healthcare services as well as disseminate health information or announcements through

local barangay health centers, making it harder for them to receive the help they require.

Their study is to create a mobile and online application for rural Barangay health centers.

In other words, the application intends to improve patient monitoring and distribute health

14
announcements to minimize their issues throughout the rural community (Garcia et al.,

2021).

To improve basic services to develop a quality service model as a result of the

barangay strategy, improve local service delivery and address the rights-based needs of

residents, especially the poor and marginalized. Providing adequate access to healthcare

for older adults, particularly for those living in rural areas in developing countries such as

China. (Abalos, 2019; Dupre et al, 2019)

In the Philippines healthcare system, Barangay health workers (BHWs) played an

important role. They provided primary care services in the community, such as first aid,

maternity, neonatal, and child- and community-based initiatives. The majority of

barangay health stations had the essential equipment, instruments, and supplies to offer

health care services. However, water, sanitation, and hygiene facilities needed

improvement. The timetable of health services was determined by the midwife, while

municipal rules regarding BHWs were limited. BHWs' work environment could have

been improved if they were given the resources they needed to provide excellent services,

and deficiencies in water, sanitation, and hygiene facilities were rectified. (Ibo, 2019).

Several recommendations were put forward for consideration, including the

enhancement of the quality of training for primary healthcare physicians, implementing

performance accountability to encourage high-quality care, integrating clinical care with

basic public health services, and enhancing coordination between primary healthcare

institutions and hospitals. Moreover, it was suggested that China could modernize its

primary healthcare system by establishing a learning health system that utilizes digital

data and innovative technologies. (Li et al, 2020)

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 The study focused on the programs and services offered to senior citizens in three

barangays of Datu Saudi Ampatuan Municipality. It gathered demographic data on age,

gender, educational attainment, and monthly income of respondents. The weighted mean

was used to analyze the extent of programs and services available. Results showed that

most respondents were female, aged 60-64, and had elementary education. Programs and

services were found to be less extensive, with common problems including a lack of

companionship and updated medical prescriptions. Respondents recommended the

provision of a lifetime identification card, abolition of membership fees, and home visits

by OSCA representatives. (Ali & Kasim, 2022).

Noncommunicable diseases and visual disorders were the most common medical

problems among university workers 55 and older who lived on campus. Programs for

older people are advised to minimize NCDs, maintain functional independence, and

improve quality of life, particularly among the retired. They include drug access, better

health finance, and elder wellness initiatives both during and after work. The recent

findings will assist in comprehending and formulating a relevant Framework for Active

Aging specific to their academic community. (Fabito et al., 2021).

There is a considerable need for medical consultations and medication in Makati

City, Philippines, due to the expanding population of individuals with disabilities and

senior citizens. Process improvement is required to respond to the health tracking and

prescriptive medicine delivery monitoring system. Prior research on delivery methods and

automated scheduling encouraged the development of a web-based solution that allows

people with disabilities and senior citizens to easily overcome the COVID-19 constraints.

The results of the user acceptance testing show that the developed web application met all

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of the requirements specified in their study, and the process followed the Makati City

local government process as well as standard medical practice (Samonte, 2022).

The high-quality healthcare services provided by professionals and institutions are

in line with the increasing life expectancy of elderly Filipinos. While some older

individuals have access to sufficient healthcare services, benefits, and privileges, there are

disparities in how they are enjoyed and appreciated, as shown by varying ratings.

Although both healthcare quality and sufficiency are evaluated positively, the difference

in ratings implies that there is a need to make healthcare services more accessible.

Frequent use of specific healthcare services and facilities by elderly leads to a greater

appreciation of their quality and sufficiency compared to those who are unaware of them.

(Oracion et al., 2020).

In many low- and middle-income countries (LMICs), community health worker

(CHW) programs are a vital asset for implementing universal health coverage (UHC). In

countries with decentralized health systems, such as the Philippines, the quality and

efficiency of CHW programs may vary due to differences in budget allocation and local

politics. Increasing capacity within local governments to effectively resource CHWs and

CHW programs will improve these programs' capacity to act as a connection between

community health needs and the public health system. (Dodd et al., 2021).

Despite significant flaws, like the Covid-19 Epidemic, and several criticisms, they

hope that universal healthcare services in the Philippines would remain progressive.

Future revisions and amendments from PhilHealth, DOH, PMA, and other Professional

Health Organizations in the Philippines are possible, but most importantly, the public

policies on Universal Health Care (UHC) Law will provide affordable healthcare

17
services, as well as better help and healthcare assistance to our healthcare systems in the

Philippines (Lee et al., 2023).

The key dental comorbidities that affect the older population's quality of life,

access to dental treatment barriers for the elderly, and strategies to promote dental health

are highlighted in this study's main objective. In order to identify dental pathology and

effectively treat it, older people and their caregivers need to be informed about dental care

and its significance. The entire society—elders, caretakers, dentists, the public sector,

health policymakers, and the private sector—is involved in ensuring dental health. In

order to improve the quality of life for the elderly, healthcare professionals and

government organizations place a high priority on promoting their health. (Janto et

al.,2022).

The purpose of this study is to expand rural care Facilities in China's rural

population ages, which has become a health and social policy challenge. Although the

quality of life (QoL) of the elderly is enhanced by the living environment, little is known

about how the physical environment and care services affect her QoL. This study

investigated how the built environment and care services affect the quality of life (QoL)

of elderly people in rural care homes in China. Six structural environmental factors (room

distance, space, barrier-free design, indoor climate, fire protection and supportive

facilities) and three service factors (daily care services, cleaning services, and health

services) were identified. (Yu et al, 2017)

This study shows that the primary healthcare facilities in Qidong County in

Jiangsu, China, have implemented the full coverage of essential medicines (FCEMs)

program for rural elders. This study aims to investigate the long-term impacts of FCEMs

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policy adoption on senior beneficiaries' access to and use of primary healthcare services.

The retrospective study was carried out in China's Jiangsu province's Qidong County.

91,444 records of health insurance claims for inpatients aged 70 and older in primary

healthcare facilities were examined throughout the course of a 47-month longitudinal

dataset. (Wang et al., 2019)

This study examines the current state of supply and demand for community care

services in various villages around the province of Zhejiang and evaluates service

efficacy for healthy aging. The growing diversity in care service needs is a result of

population trends and economic prosperity. Yet, the widespread availability of

community care services has largely replaced traditional family support for older people.

Enhancing the socio-economic potential of rural communities and expanding the range of

social care services are necessary for improvement. Additionally, policies and strategies

should promote private sector engagement in delivering care services to older individuals

in rural areas. (Zhoual.,2022)

The aim of this research was to investigate the perspectives of healthcare workers

in rural Tanzania regarding the provision of health insurance benefits for elderly

individuals. Healthcare workers play a vital role in ensuring the availability, quality, and

effective management of health insurance services for their clients. Despite the

implementation of a national health insurance program in the 1990s, there has been no

study that specifically explored the experiences of medical staff in providing these

services in Tanzania. (Amani et al., 2023)

This study shows that age, income sufficiency, depression, social support, and the

affordability of healthcare services were found to significantly affect older individuals'

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quality of life (QOL), which was the goal of the study. This study offers unique treatment

options for frail older persons that take into account the problems that contribute to

geriatric depression. The government can use the information in this article to evaluate

income increases, stimulate family and community involvement for social support, and

lower the cost of health care for senior citizens. (Samadarshi et al., 2021)

Based on the information provided in these related studies, the proposed measures

to improve the quality of healthcare services for senior citizens could include:

strengthening primary healthcare services by addressing financial inaccessibility, lack of

funding, and personnel shortages; implementing policy changes and healthcare reform to

improve the quality of Level 1 Hospitals and meet the increasing needs of the aging

population; involving healthcare workers in proposing measures to improve the quality of

healthcare services and considering their perspectives in policy development; developing

mobile and online applications for rural Barangay health centers to enhance patient

monitoring and disseminate health information effectively; establishing a learning health

system that utilizes digital data and innovative technologies to modernize the primary

healthcare system; enhancing the training and performance accountability of primary

healthcare physicians and integrating clinical care with basic public health services;

improving the work environment and resources for Barangay health workers to provide

excellent healthcare services; evaluating and addressing the specific needs and demands

of senior citizens including dental care, access to essential medicines, and community

care services; and promoting community involvement and support for senior citizens'

healthcare, including the provision of companionship, home visits, and advocacy for their

rights and privileges. These proposed measures aim to address the challenges and

improve the quality of healthcare services provided to senior citizens. By implementing

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these measures, policymakers, healthcare professionals, and communities can work

together to enhance access, affordability, and the overall quality of healthcare for senior

citizens, promoting their well-being and improving their quality of life.

Problem in the Field

The most common problem that has been stated in the studies is mainly about the

access of healthcare, provision of influenza and pneumococcal vaccines, lack of

information in rural areas particularly for older individuals. The lack of access is caused

by factors like staff shortage, medicine supply, health center accessibility, and limited

resources. Factors affecting global vaccine supply and distribution include manufacturing

capacity, misdistribution, financial constraints, political commitment, and storage

limitations. (Bates & Rosado, 2017; Uy, 2021).

Access to primary healthcare is a crucial aspect of public health, especially in

low- and middle-income countries where people may not have access to essential health

services. In rural areas, this problem is more pronounced, as people have to travel long

distances to access healthcare facilities, which can be expensive and time-consuming.

Lack of access to primary healthcare can lead to poor health outcomes, increased

mortality rates, and higher healthcare costs. According to Zemichael et al. (2020),

effective methods from global experiences can enhance access to primary healthcare in

rural areas, and the Astana Declaration highlighted the need for an accessible, cost-

effective, and sustainable healthcare system that can adapt to emerging healthcare threats.

The other identified factors that led to the insufficient effectiveness of the

healthcare services rendered by healthcare providers in the country include the lack of

infrastructures of healthcare facilities nearby their homes. Other factors included a

21
shortage of skilled healthcare workers, poverty, limited information, inadequate services,

and cultural practices. The study found that obtaining assistance was complicated for

individuals with low socioeconomic status, insufficient awareness, and low rural

earnings.

Addressing these factors requires a multi-faceted approach. Governments and

healthcare organizations should prioritize increasing healthcare workforce capacity

through recruitment and training programs. Efforts should also be made to alleviate

poverty among senior citizens, such as implementing social protection programs and

providing financial support for healthcare expenses. Improving access to information

through community outreach programs, telehealth services, and tailored educational

campaigns can empower senior citizens to make informed healthcare decisions. Investing

in healthcare infrastructure and promoting cultural competence are key to reducing

disparities and improving the effectiveness of healthcare for seniors.

Research Gap

Majority of the studies focused on improving the quality of health care in various

countries to senior citizens. However, the present study concentrates on local participants,

specifically the senior citizens of Barangay Kilicao. In the previous discussion, the study

focused on the national level; which inevitably obscures important differences within

Canada, between provinces and territories, and among indigenous people and non-

indigenous groups. The current study focuses on the quality of health care services

rendered by the health care provider to the senior citizens. This aims to answer the

variables such as health care services rendered by the healthcare providers to the senior

citizens; the factors affecting health care services rendered by healthcare providers to

22
senior citizens. Lastly, propose measures to improve the quality of health care services.

Along with that, researchers used quantitative research design as well as Slovin’s formula

to determine the sample size per purok and employed the fishbowl method to randomly

select a respondent. The researcher utilized stratified random sampling to choose the

respondents of the study. Structured survey questionnaire is used and distributed to the

respondent. By employing the mentioned sampling method, the researchers aim to collect

precise and necessary data, thereby those are the gaps that the researchers are trying to

bridge.

Objectives of the Study

This study aims to determine the quality of health care services rendered by health

care providers rendered by healthcare providers to the senior citizens in Kilicao, Albay.

Specifically, it aims to:

1. To determine the health care services rendered by the healthcare providers to the
senior citizens

2. To identify the factors affecting health care services rendered by the healthcare
providers to the senior citizens in terms of availability and accessibility

3. To propose measures to improve the quality of health care services

Theories

Orem's Self-Care Deficit Nursing Theory defines self-care as the act of assisting

others in improving human functioning at the home level of effectiveness through the

provision and management of self-care. In relation to the study, the researchers will

emphasize on the theory of self-care. The theory of self-care encompasses self-care,

which is the practice of actions that an individual initiates and executes on his or her own

behalf to sustain life, health, and well-being. This approach signifies that all patients

23
prefer to be in control of their own care, which is a significant benefit to them.

Individuals who take responsibility for their health can, to the utmost degree possible,

quicken and maximize their recovery.

This study may be supported by Orem's Self-Care Deficit Nursing Theory since

self-care may be defined as activities undertaken to guarantee one's own well-being. With

this theory, it determines if elderly individuals are aware of and attend health care

services provided to them by their health care provider, as well as whether they seek and

obtain necessary medical treatment. It may be easily adapted to many situations due to the

generality of its ideas and concepts, making healthcare staff and the elderly may work

together to ensure that they receive the best healthcare possible while still being able to

care for themselves. Furthermore, this self-care theory is aligned with current principles

of health promotion and health maintenance.

Nola J. Pender's Health Promotion Model is focused on optimizing a patient's

degree of well-being. The health promotion model highlights the multidimensional

persona of individuals as they interact with their surroundings to achieve health. The set

of factors relating to behaviorally specific knowledge and effect is very significant from a

motivational standpoint. The intended behavioral outcome in the Health Promotion

Model is health-promoting behavior. Its goal is to aid nurses in understanding the

important factors that influence health behaviors as a basis for behavioral counseling that

promotes well-being and healthy lives.

This study may be supported by Nola J. Pender's Health Promotion Model since it

is concerned with how senior citizens' health beliefs and other factors influence their

capacity to get necessary health care services. Perceptions and cognitions of any given

scenario or setting can either help or hinder health behavior. Biological factors (such as
24
age, gender, and strength), psychological factors (such as self-esteem, self-motivation,

and health definition), and socio-cultural factors (such as race, ethnicity, and education)

are all indicative of a particular behavior and influence it. Elderly people should modify

their cognitions, feelings, and the interpersonal and physical environment to develop

healthy actions in order to fully adhere to a health-promoting behavior.

Conceptual Framework

This part represents the conceptual paradigm of study. Orem’s Self-Care Deficit

Nursing Theory and Nola J. Pender’s Health Promotion Model was used by the

researchers as a guide to identify the quality of health care services rendered by

healthcare providers, as well as its factors in terms of availability and accessibility. The

researchers will attempt to propose measures and improved the quality of healthcare to

the senior citizens.

Orem’s Self- Care Nola J. Pender’s

Deficit Nursing Health Promotion
Theory Model

Health Care Factors that

Quantitative Availability
Services rendered affect healthcare
Survey by the Healthcare services Accessibility
Providers

Proposed Measures

25
 Improved Quality
of Health Care to
the Senior

Figure 1. Conceptual Framework Model

26
 METHODOLOGY

The methods utilized to gather and analyze the data for this study include the

Research Design, Sample and Setting of the Study, Data Collection and Analysis,

Statistical Tool, Ethical Consideration, and Survey Questionnaire. The method used in

this study is aimed at obtaining necessary data through the process of data collection and

analysis based on the information obtained from the target respondents.

Research Design

The research study is Quantitative Research which adopted the Survey design. It

covers a collection of strategies, techniques, and assumptions used to investigate

numerical patterns in order to study health care services and healthcare providers. The

collection of quantitative data enables researchers to carry out basic to very complex

statistical analyses that aggregate the data and show correlations between the data. In this

study, the researchers used a survey research design to describe or explain the quality of

health care services in barangay Kilicao. This approach aims to briefly collect relevant

data on a population of interest to prepare for a more focused and in-depth study.

Sample and Setting

The researchers obtained data on the total population of senior citizens at the

barangay hall in Kilicao. After collecting the total population of senior citizens, the

researchers utilized Slovin's formula with the margin of error 0.10 to determine the

sample size and the sample size per purok required to attain a certain interval when

sampling a population. Following that, the researchers employed the fishbowl method

from the sample size of 81, in which the surname of each senior citizen is assigned on

26
separate slips of paper, which are then mixed, and each slip is randomly selected one at a

time.

The researchers utilized stratified random sampling since Kilicao has a total

population of 425 senior citizens and seven (7) puroks. Then the researchers divide the

population into smaller subgroups, or strata, based on the shared characteristics of the

individuals and then draw a random sample from these strata. The researchers next gather

data from the chosen subgroups or strata in order to establish a sample population that

fully represents the total population under study.

Table 1
Population and Sample of the Study
PUROK POPULATION SAMPLE
1 66 12
2 92 18
3 69 13
4 37 7
5 41 8
6 82 16
7 38 7
TOTAL 425 81

Data Collection and Analysis

The researchers prepared a letter to the Barangay Official of Kilicao, Albay,

requesting permission to use their community as the researchers' data collection location.

Following the approval of the request for permission for the said location, the researchers

prepared a survey questionnaire that would serve as the study's instrument in collecting

data from the selected senior citizens of Barangay Kilicao as respondents.

Following the questions prepared by the researchers, the respondents

acknowledge the researcher's permission to be the respondents of the study, and the

28
survey take place. The completed survey that the clients completed then is analyzed,

aggregated, and assessed by the researchers to serve as their input, information for the

study, and the required output.

Statistical Tool

The data source is a collection of statistical and non-statistical facts that the

researcher may adopt to do more investigation. The study utilized both primary and

secondary resources to gather data. The researchers used structured interviews and survey

questionnaires as primary sources. The researchers used official barangay statistics and

documents (health care services rendered) as secondary resources. All of this information

must be gathered through primary or secondary research for data analysis.

Ethical Consideration

Prior to conducting the survey-interview, each respondent of this study was

provided with written informed consent. The respondents were informed about the study's

purpose, objectives, benefits, potential risks, and challenges of participating. They were

also advised that they had the right to refuse or withdraw from the study at any time if

they felt uncomfortable or disturbed without any repercussions from the researchers. The

confidentiality of information obtained at all levels was ensured, and personal identifiers

such as real names were not publicly disclosed. All information obtained from the

respondents was exclusively utilized for research purposes. The researchers emphasized

the value of honesty throughout all stages of the research and took great care to give

proper credit to avoid plagiarism and respect the work of others.

29
 RESULTS

This part of the study presents the findings and results derived from the collected

responses obtained through the survey questionnaire. Specifically, this will present the

overview of the results obtained from the respondents, offering valuable insights into

their perspectives and opinions pertaining to the research topic. By examining the

acquired answers, this aims to present a concise summary of the findings, enabling a

better understanding of the study's objectives and making a valuable contribution to the

existing knowledge in the field.

I. Health Care Services rendered by the Health Care Provider to the Senior Citizens

The provision of high-quality healthcare services to senior citizens is a critical

concern in many communities, including Barangay Kilicao in Albay. As part of this

study, the researchers sought to investigate the healthcare services being provided to

senior citizens in this community. To do this, the researchers collaborated with the

Daraga Rural Health Unit to compile a comprehensive list of healthcare services typically

provided to senior citizens in the area. The respondents are asked to check a box if they

received the particular health care services. The results of the survey questionnaire

provided valuable insights into the types of healthcare services being offered to senior

citizens in the community and the extent to which they were being utilized. This section

of the study focuses specifically on the healthcare services rendered by the healthcare

provider to senior citizens in Barangay Kilicao. The statistics of the health care services

received by the majority of Kilicao's senior citizens are shown below.

30
 Table 1
Health Care Services rendered by the Health Care Provider to the
Senior Citizens
Indicators Frequency Percentage
Immunization of Pneumonia Vaccine 66 81.48
Immunization of Influenza vaccine 48 71.60
Giving of Anti-hypertensive drugs 52 51.85
Giving of Anti-Diabetic drugs 18 22.22
Complete Blood Count 13 16.04
Tuberculosis Screening 12 14.81
Basic Oral Health Care 10 12.34
Screening of Visual Acuity 7 8.64
X-Ray 5 6.17
Electrocardiogram (ECG). 4 4.93
Urinalysis 1 1.23

This part of the study reveals the findings of the health care services rendered by

the health care provider to the senior citizens. Table 1 shows that “Immunization for

Pneumonia Vaccine” got the highest response of 66 or 81.48%. Secondly, the indicator

“Immunization for Influenza Vaccine'' got a frequency of 58 or 71.60%. Lastly, the

“Giving of Anti-Hypertensive Drugs' ' got a frequency of 42 or 51.85%.

In terms of the least voted, Table 1 shows that “Urinalysis” got the lowest

response of 1 or 1.23%. Secondly, the indicator “Electrocardiogram (ECG)” has a

frequency of 4 or 4.93%. Lastly, the “X-ray” got a frequency of 5 or 6.17%.

II. Factors Affecting Health Care Services Rendered by the Health Care Provider to
the Senior Citizen

This section of the study reveals the factors that affect health care services

provided by the health care provider to senior citizens in barangay Kilicao in terms of

availability and accessibility. The respondents are asked to check if they have

experienced such factors when receiving health care services. The statistics of the factors

31
affecting health care services encountered by the majority of Kilicao's senior citizens are

presented below.

Table 2
Factors Affecting Health Care Services Rendered by the Health
Care Provider to the Senior Citizen

Indicators Frequency Percentage

A. Availability
Non-availability of medicines prescribed 44 54.32
Non-availability of vaccines 33 40.74
Presence of healthcare providers all the time in the area 30 37.03
Availability of the healthcare provider 28 34.56
Clean and safe environment where the service is 28 34.56
offered
Delay in the service offered due to non-availability of 25 30.86
personnel
Lack of knowledge of available services 25 30.86
Negative past experience about the services 19 23.45
Lack of time/other commitments or duties to avail the 15 18.51
services

B. Accessibility
Expertise of the healthcare providers 35 43.20
Expertise of the physicians 34 41.97
Attitude of the health care provider 20 24.69
Lacks dissemination of information on scheduled 19 23.45
medical treatment
Patient satisfaction of the healthcare provider services 15 18.51
Amenities provided by the healthcare provider 5 6.17
Untoward behavior of the healthcare provider towards 3 3.70
senior citizen
The efficiency of the service 3 3.70
Reasonable cost of the service 2 2.46

This part of the study reveals the findings of the factors affecting health care

services rendered by the healthcare provider to the senior citizens. The variables involved

in this part are the availability and accessibility.

32
A. Availability

In availability, Table 2 shows that “Non-Availability of Medicines Prescribed”

got the highest response of 44 or 54.32%. Secondly, the indicator “Non-Availability of

Vaccines” got the frequency of 33 or 40.74%. Lastly, the indicator “Presence of

Healthcare Providers All the Time in the Area” got a frequency of 30 or 37.03%.

In terms of the least voted, Table 2 shows that "Lack of Time/Other Commitments

or Duties to Avail the Services" got the lowest response of 15 or 18.51%. Secondly, the

indicator “Negative Past Experience about the Service” got the frequency of 19 or

23.45%. Lastly, the indicator “Lack of Knowledge of Available Services” and “Delay in

the Service Offered due to Non-Availability of Personnel” got a frequency of 25 or

30.86%.

B. Accessibility

In terms of healthcare provider, Table 2 shows that “Expertise of the Healthcare

Providers” got the highest response of 35 or 43.20%. Secondly, the indicator “Expertise

of the Physicians” got the frequency of 34 or 41.97%. Lastly, the indicator “Attitude of

the Healthcare Provider” got a frequency of 20 or 24.69%.

In terms of the least voted, Table 2 shows that “Reasonable Cost of the Service”

got the lowest response of 2 or 2.46%. Secondly, the indicator “Efficiency of the Service”

and “Untoward Behavior of the Healthcare Provider Towards Senior Citizen” got the

frequency of 3 or 3.70%. Lastly, the indicator “Amenities Provided by the Healthcare

Provider” got a frequency of 5 or 6.17%

33
III. Proposed Measures

This section of the study reveals the proposed measures to improve the quality of

health care services rendered by the health care provider to the senior citizens in barangay

Kilicao. The respondents are asked to check a box if these concerns answer their needs

regarding the health care services in their barangay. The statistics of the proposed

measures that are needed by the majority of Kilicao's senior citizens are shown below.

Table 3
Indicators Frequency Percentage
Medicines must be available all the time in the center 61 75.30
Vaccines must be readily available 32 39.50
Proper dissemination of the available health care services 9 11.11
must be done
Monitor and check of master list of Senior Citizen 2 2.46
regularly
Purchase of more equipment and materials needed for the 1 1.23
center (e.g., sphygmomanometer)
Increase the Budget on Health for Senior Citizen 1 1.23
Proposed Measures to Improve the Quality of Health Care Services

This part of the study reveals the findings of the proposed measures to improve

the quality of health care services. Table 3 shows that “Medicines must be available all

the time in the center” got the highest response of 61 or 75.30%. Secondly, the indicator

“Vaccines must be readily available” got the frequency of 32 or 39.50%. Lastly, the

“Proper dissemination of the available health care services must be done” got a frequency

of 9 or 11.11%.

34
 DISCUSSION

By analyzing the information presented in the previous section, further discussion

can focus on exploring the implications of these findings and identifying potential

strategies to address the identified challenges. This discussion can contribute to the

ongoing efforts to improve the healthcare services rendered to senior citizens in Barangay

Kilicao, Albay, and potentially serve as a foundation for future research and interventions

aimed at enhancing the well-being of the elderly population in the community.

I. Health Care Services rendered by the Health Care Provider to the Senior Citizens

The majority of respondents in this study indicated that this is one of the most

frequently obtained and administered drugs to them, these drugs are used to prevent the

rapid spread of pneumonia and influenza diseases, particularly among senior citizens. To

support the findings, pneumococcal and influenza immunizations help older persons

experience fewer negative health effects. For adults under 65 years old, the Australian

National Immunization Program (NIP) offers free pneumococcal and seasonal influenza

shots. Regardless of their risk of developing an invasive pneumococcal disease,

recommendations call for all persons over 65 to receive one dose of the 23-valent

pneumococcal polysaccharide vaccine (23vPPV). Yet, compared to seasonal influenza,

pneumococcal disease vaccination rates are known to be substantially lower. Effective

vaccination promotion tactics for this age group must take into account the identification

and comprehension of the older population's viewpoint on the topic (Briggs et al., 2019).

In addition, almost half of the respondents indicated that anti-hypertensive drugs are

given to them, although not always due to a lack of supply; however, it is one of the most

commonly provided by the barangay since it is one of the most needed by senior citizens

35
to prevent hypertension. This study was to identify the factors that influence where and

how people in rural Indonesian communities acquire their anti-hypertensive drug

supplies, as well as the type of hypertension medication consumed. This study also

demonstrates some of the difficulties in managing individuals with chronic illnesses like

hypertension in settings with limited resources. It offers crucial conclusions for methods

of quality improvement that ought to be taken into account to lengthen healthy lifespans

(Rahmawati & Bajorek, 2018).

These three demonstrate that they have the lowest rate percentage because ECG,

Urinalysis, and X-ray services are rarely provided for seniors in Kilicao; instead, they are

typically performed in hospitals. unlike other drugs or vaccinations that have been given.

To support the findings, in rural and underdeveloped areas, patients are frequently at a

disadvantage when trying to find trustworthy and reasonably priced healthcare. The

study's overall goal is to provide simple and quick diagnosis to detect albumin,

urobilinogen, nitrite, as well as pH and glucose levels in urine. The majority of

underprivileged populations find it challenging to access individualized care due to the

isolation their location provides and the escalating costs of doctors (Bren-Cardali et al.,

2018). In addition, it aimed to assess the availability and quality of radiology services in

the Philippines, including X-ray services. The study found that the availability of X-ray

services varied across the country, with some areas having limited access. The authors

recommended increasing the number of radiologists and radiologic technologists in

underserved areas (Laya et al., 2019). In addition, it evaluated the satisfaction of the

patient with diagnostic imaging services, including X-ray services, in several hospitals in

the Philippines. The study revealed high patient satisfaction overall but identified areas

36
for improvement in reducing waiting times and enhancing procedure explanations

(Garcia et al., 2016).

Orem's Self-Care Deficit Nursing Theory emphasizes the importance of self-care

in maintaining and promoting health. In the context of the provided paragraphs, the

theory of self-care aligns with the finding that seniors prefer to be in control of their own

care. By providing health care services such as immunizations and medications, the

health care providers enable senior citizens to take proactive steps in maintaining their

health. This supports Orem's theory by empowering individuals to initiate and execute

actions that sustain their life, health, and well-being.

Nola J. Pender's Health Promotion Model focuses on optimizing well-being by

considering various factors that influence health behaviors. In the context of the provided

paragraphs, the health care services provided to senior citizens aim to promote health and

prevent diseases such as pneumonia, influenza, and hypertension. By offering

vaccinations, medications, and diagnostic services, the health care providers support the

behavioral outcomes of health-promoting behaviors, as highlighted in Pender's model.

These services contribute to enhancing the seniors' level of well-being and empowering

them to make choices that promote a healthy lifestyle.

This implies that health care services should focus on promoting self-care and

encouraging seniors to take an active role in managing their health. Moreover, efforts

should be made to improve access to essential diagnostic services and ensure equitable

distribution of health care resources, especially in rural and underserved communities.

Additionally, partnerships with community organizations and non-profit groups can help

bridge the gap in healthcare services and provide support to seniors in need. Quality

37
improvement initiatives should be implemented to address any concerns and enhance the

delivery of services.

II. Factors Affecting Health Care Services Rendered by the Health Care Provider to
the Senior Citizen

A. Availability

Despite the availability of some medicines and vaccines in their barangay health

center, the majority of respondents in this study indicated that they do not acquire their

needed medicines and vaccines due to the limited supply. Furthermore, one of the

respondents that answered the survey questionnaire who works as a barangay health

worker in their barangay stated that their budget is insufficient to accommodate all of the

senior citizens in their barangay. To support these statements, the healthcare systems in

low and middle-income countries encountered many difficulties in delivering high-

quality health care due to the scarce financial resources that result in the non-availability

of medicines (Kretchy et al., 2020). Lack of funding may lead to insufficient medication,

supplies, and equipment for the services and a large out-of-pocket payment by

community (Plummer and Boyle, 2017). This suggests that healthcare systems in low and

middle-income countries, as well as a lack of funding, have an impact on the availability

of medications, supplies, and service equipment.

The third highest-voted indicator is the presence of healthcare providers all the

time in the area. Several respondents stated during the survey that when they go to the

barangay health center to get a specific health care service, the healthcare providers are

always available to accommodate them. To support this statement; According to Republic

Act No. 7305, when all the time a public health worker is required to be on active duty or

in a specific workplace, it should be included in the hours worked. This suggests that the
38
presence of healthcare providers in the area all the time is due to the law or the barangay

health center policy requiring them to work during regular working hours.

Some of the respondents do not get health care services from their healthcare

provider at their barangay health center due to their busy schedules and other

commitments in their daily life. To support this; limited knowledge about illnesses and

treatments, as well as a lack of perceived need significantly affected care seeking, as did a

lack of time or other responsibilities. This was more commonly observed for women in

Low- or Middle-Income Countries (LMICs) who have caring responsibilities or are 'busy

with household'. In High-Income Countries (HICs), the reasons were frequently

associated with jobs or other social obligations (Dawkins, 2021). This suggests that

respondents' busy schedules and other responsibilities in their everyday lives limit their

utilization of such health care services.

The indicator of negative past experience about the service indicates that some of

the respondents stated that they encountered negative attitudes toward the healthcare

staff, a lack of availability of the medications they need, and a lack of prioritization of

older people when obtaining healthcare services. In the study of Kelly, Mrengqwa, and

Geffen (2019), the difficulties faced by older people included long waiting periods and

the lack of prioritization, unwelcome attitudes of healthcare providers, staffing shortages,

rushed consultations, and inadequate assessments by doctors, poor continuity of care, a

lack of patient education, and the non-availability of medication. This suggests that

negative experiences with healthcare services can contribute to health disparities by

limiting some individuals' ability to obtain timely and appropriate treatment.

39
 The indicator lack of knowledge of available services indicates that during data

collection, some of the respondents stated that information about available services did

not reach their purok, and others stated that only certain people were informed due to

connections. According to WHO, informants highlighted a lack of awareness and

information, particularly health-related information, as an additional barrier to access to

services. Discussions in focus groups revealed that many older persons were unaware of

the availability of any government services or programs. This suggests that there is a

disparity in the dissemination of available health care services, which explains why some

older people are unaware of the services or programs.

The indicator delay in service offered due to the non-availability of personnel

indicates that during data collection, one of the respondents stated that there is a medical

mission at times in their barangay where nurses visit them from house to house to assess

them. In the case of this respondent, the nurse advised her that she needed to fast for the

glucose test the next day, then she did not meet the nurse that day. In Low and Middle-

Income Countries, delays in service mean a shortage of any/all healthcare personnel, and

few, or sometimes a complete absence of, facilities within a distance feasible to travel

(Dawkins et al., 2021). This suggests that shortage or non-availability of healthcare

providers results in delays in providing such services.

Orem's Self-Care Deficit Nursing Theory emphasizes the importance of

individuals taking responsibility for their own care. The theory suggests that seniors

should be empowered to actively participate in managing their health, including

accessing necessary medications and vaccines. Limited availability of medicines and

40
vaccines can be addressed by promoting self-care and enabling seniors to acquire their

needed supplies through education, support, and facilitating access.

Pender's Health Promotion Model focuses on optimizing individuals' well-being.

In the context of availability, the model suggests that providing comprehensive health

care services, including medications, supplies, and equipment, is essential for promoting

seniors' health. Ensuring the availability of necessary resources aligns with the goal of the

model, which is to support individuals in engaging in health-promoting behaviors and

achieving optimal well-being.

Implications for healthcare systems and policymakers include allocating adequate

funding and resources to meet the healthcare needs of senior citizens, particularly in low-

and middle-income countries where resource constraints may be more pronounced. This

can contribute to early detection, prevention, and management of health issues.

Furthermore, it can lead to increased confidence, self-efficacy, and a sense of control

over their own health.

B. Accessibility

The majority of respondents indicated that the healthcare providers and physicians

at their barangay health center are competent about the procedures they conduct.

Furthermore, they provide information on the health care services to the senior citizens,

such as when to take the medicine, the side effects, when to seek a follow-up check-up,

and other therapeutic interventions. To support these statements, supplying patients with

information is the foundation for building trust with them. Maintaining trust requires

open lines of communication with patients and transparency in all aspects of their

wellness. The greater the provider-patient relationship, the better communication,

41
compliance, and health outcomes (Gourley, 2023). This suggests that the competence of

healthcare providers improves patient satisfaction when accessing healthcare services.

The indicator attitude of the healthcare provider indicates that many respondents

consider their barangay's healthcare providers as welcoming and polite. Studies suggest

that patients benefit from nurses who have better knowledge, enough skill, and a good

attitude toward older persons, which results in shorter hospital stays and reduced

readmission rates (Sedri et al., 2022). This suggests that a positive attitude of healthcare

providers can improve patient care in many ways, including increased patient satisfaction

and trust in their healthcare providers.

Most health care services provided in their barangay are free and efficient;

however, a few respondents stated that some health care services are not covered by their

barangay health center and that they must go outside of their barangay to pay and acquire

the specific health services they need. To support these statements, participants are

frequently given a prescription for medicine as well as requests for more diagnostic

testing (e.g., blood work, medical imaging). Despite a few participants explaining that

PhilHealth covered medications and diagnostic tests for certain health problems, other

participants indicated that they had to pay out of pocket to fill prescriptions or for

additional diagnostic tests (Luu et al., 2022). This suggests certain prescription

medications are not available at barangay health centers and that sophisticated tests are

usually performed in advanced healthcare facilities.

The indicator of untoward behavior of the healthcare provider towards senior

citizens indicates that some healthcare providers at their barangay health center have

issues with behavior or attitude. Several studies have found that conversations between

42
healthcare providers and elderly individuals can be patronizing and ineffective. Elderly

individuals are less commonly involved in medical decisions made by healthcare

providers than younger patients. Furthermore, when compared to younger patients,

healthcare providers are less patient, respectful, involved, and optimistic with older

patients (Wyman, Shiovitz-Ezra, and Bengel, 2018).

The indicator amenities provided by the healthcare provider indicate that few

respondents stated that their barangay health center lacks some convenient features such

as waiting area chairs and accessible rooms for patient-provider privacy. Physical

infrastructures such as a generator, a waiting area, a private examination room, a couch in

the room, a clean bathroom, and water are either unavailable or inaccessible (Hussen and

Worku, 2022). This suggests that the lack of amenities is due to a limited budget, which

limits the range of readily accessible amenities in order to keep expenses balanced.

Orem's Self-Care Deficit Nursing Theory emphasizes individuals' control over

their own care. In the context of accessibility, the theory supports the importance of

competent and informative health care providers. When healthcare providers demonstrate

competence, provide clear information about procedures and interventions, and establish

trust, seniors are more likely to access and engage in necessary health care services.

Pender's Health Promotion Model recognizes the significance of behavioral

factors in health promotion. The model suggests that seniors' attitudes and perceptions of

healthcare providers can influence their decision to seek care. A positive attitude of

healthcare providers, as described in the paragraph, can foster trust, improve

communication, and increase seniors' willingness to access health care services.

43
 It implies that by addressing attitudes, perceptions, and beliefs about healthcare

providers, healthcare systems can create an environment that supports seniors in seeking

and utilizing healthcare services effectively. Healthcare providers who demonstrate

competence, provide clear information, and establish trust can enhance senior citizens’

willingness to access healthcare services. Furthermore, it can empower seniors to make

informed decisions, comply with treatment plans, and actively engage in their healthcare.

III. Proposed Measures

The highest percentage in this table is "Medicines must be available all the time in

the center," which 75.30% of the respondents selected as their preference. The main

reason for this is that when people need free medicine for the elderly, such as anti-

diabetic drugs or anti-hypertensive drugs, they want to have a source of medicine rather

than having to go to the hospital just like the vaccines which is the second highest

percentage in the table.

To support the measures, the study aimed to investigate the current state of

programs and services available for senior citizens in Datu Saudi Ampatuan

Municipality. The researchers collected demographic data on the respondents, including

their age, gender, educational attainment, and monthly income. The study used the

weighted mean to analyze the extent of programs and services available to the

respondents. The study also revealed that programs and services for senior citizens in the

municipality were less extensive, with common problems including a lack of information

and updated medical prescriptions. The respondents recommended the provision of a

lifetime identification card, abolition of membership fees, and home visits to improve the

programs and services (Ali & Kasim, 2022).

44
 To support the findings, the study emphasized the need to increase the

socioeconomic potential of rural communities and expand the variety of social care

services. The study also suggested that policies and strategies should be implemented to

encourage private sector participation in providing care services for elderly rural

residents. Local governments should understand the prospective need for community care

services and implement practical recommendations to improve service quality (Zhou et

al., 2022).

In addition, the importance of having suitable infrastructure, diagnostic medical

equipment, drugs, and trained medical experts to provide high-quality healthcare services.

At the time of the study, the Nigerian health sector was offering its services; however, to

ensure more equitable access to healthcare facilities and support the achievement of

health-related Sustainable Development Goals (SDGs), the quality of healthcare services

in Nigeria should be improved (Oyekale, 2017).

In addition, the purpose of the study is to evaluate the accessibility and cost of

oral anti-diabetic medications in Shaanxi Province, Western China. the accessibility of

medications, particularly for people living in rural areas. To ensure the Chinese people

have greater access to more cheap anti-diabetic medications, effective measures should be

put in place (Yang et al., 2019).

Orem's Self-Care Deficit Nursing Theory: This theory emphasizes individuals'

control over their own care and the importance of self-care. The proposed measures, such

as ensuring the availability of medicines all the time and providing lifetime identification

cards, align with the theory's focus on empowering individuals to take responsibility for

their health. By making medicines readily available, seniors can have a source of

45
medication without having to rely solely on hospitals. Similarly, the provision of

identification cards can enhance seniors' access to services and enable them to actively

manage their own care.

Pender's Health Promotion Model: This model focuses on optimizing individuals'

well-being and promoting health-promoting behaviors. The proposed measures, such as

increasing socioeconomic potential, expanding social care services, and improving

service quality, align with the model's goal of creating an environment that supports

individuals in engaging in health-promoting behaviors. By addressing the socioeconomic

factors and expanding care services, the model emphasizes the importance of

comprehensive healthcare services, including medications and access to facilities, which

can contribute to seniors' well-being and promote their active participation in managing

their health.

This implies the importance of empowering individuals, enhancing accessibility,

comprehensive healthcare services, and a supportive environment in promoting seniors'

well-being and active engagement in managing their health. By addressing

socioeconomic factors and expanding care services, seniors have access to a range of

resources, including medications, facilities, and support, leading to holistic care and

improved overall well-being. This, in turn, can lead to better health outcomes, reduced

healthcare costs, and increased satisfaction among seniors and healthcare providers.

46
 CONCLUSION

This part of the study outlines the results and discussion presented in the previous

chapter. Therefore, the conclusions provided below will answer the objectives of the

current study.

The highest health care services rendered by the health care provider to the senior

citizens are immunization of Pneumonia and influenza vaccine since it is easy for the

elderly to get infected. Anti-hypertensive medications are also their first priority because

their main focus is senior citizens, who are known to be prone to high blood pressure. In

contrast, the lowest health care services rendered by healthcare providers to senior

citizens are x-ray, electrocardiogram (ECG), and urinalysis since the availability and

quality of diagnostic and radiology services in barangay is limited, and there are few

diseases that require those services based on the health conditions of the senior citizens.

This indicates that the healthcare services are primarily focused on common diseases and

lack notice of other diseases that might become more serious if left untreated.

The highest responses that affect health care services rendered by the healthcare

provider to the senior citizen in terms of availability indicate that the non-availability of

medicines and immunizations is mostly due to the barangay's limited resources such as

supply and budget. Thus in terms of accessibility, the competency and attitude of

healthcare providers imply that it contributes to the establishing and maintaining of trust,

as well as the strengthening of the provider-patient relationship. On the contrary, the

47
lowest responses factors that affect health care services rendered by the healthcare

provider to the senior citizen in terms of availability indicate that the lack of time/other

commitments or duties and delay in the service offered due to the non-availability of

personnel are due to some senior citizens may not have the time to avail of health care

and shortage or non-availability of healthcare providers which results in delays in

providing such services. Thus in terms of accessibility, some of the healthcare providers

at their barangay health center have problems with behavior or attitude, and the amenities

provided by the healthcare provider lack some convenient features such as waiting area

chairs and accessible rooms for patient-provider privacy.

The highest response proposed measures to improve the quality of health care

services were explored, with a focus on the availability of medicines and vaccines, as

well as the dissemination of available health care services. This indicates that ensuring a

consistent supply of medicines and vaccines is crucial in improving the quality of

healthcare services. In addition, the findings suggest that proper dissemination of

available health care services is necessary, propose that effective communication of

available services is important, it may not be as high a priority for patients. Additionally,

healthcare providers may benefit from considering the need of effective communication

in keeping patients aware of available services. These results may be useful in directing

future efforts to improve patient health outcomes.

48
 RECOMMENDATIONS

This part of the study outlines the recommendations presented in the previous

chapter. Therefore, the recommendations provided below will answer the conclusion and

objectives of the current study.

Several recommendations have been formed based on the conclusions drawn from

this research study. First, in order to effectively maintain the medications offered in

barangay Kilicao, such as the influenza vaccine and pneumococcal vaccine, one needs

access and availability of healthcare services such as the barangay head to provide free

services to seniors citizen of barangay Kilicao and if possible, combine it with free

services such as X-ray, ECG and other services that do not reach the barangay so that

they do not have to spend.

Second, collaborations with nonprofit organizations or private companies can help

barangay health centers acquire additional funding for the provision of healthcare services

to senior citizens. Collaborating with these organizations could provide funds, equipment,

or expertise to barangay health centers that concentrate on senior citizen wellness

programs. Establishing these collaborations enables additional sources of funding that are

not simply dependent on government assistance. To address seniors' health concerns

away from the institution's premises due to lack of time/other commitments to avail of

health care services and delay in the service offered, the barangay health center should

form partnerships with local home care providers, community volunteers, or registered

nursing associations specializing in home visits.

Third, healthcare infrastructure needs to be improved to ensure that healthcare

services are delivered in a safe and effective environment. This includes the provision of

49
adequate medical equipment, medication, and other essential supplies. Patient-centered

care is an approach to healthcare that places the patient at the center of the care process.

Healthcare providers should listen to senior citizens' concerns and involve them in the

decision-making process. Healthcare providers need to receive continuous education and

training on the specific health needs of senior citizens. This will help them provide better

care to senior citizens and improve the overall quality of healthcare services.

50
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