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12TH CONGRESSIONAL INTERNSHIP PROGRAM FOR YOUNG MINDANAO LEADERS

Delivery Of Basic Maternal And Child Health Services To The Tri People In Region X: A Policy Issue Paper

KISHRA T. DAWABI Zamboanga City RAINIDAH M. ISMAEL Iligan City YASSER M. SALACOP Lanao del Sur

OCTOBER, 2011

TABLE OF CONTENTS Executive Summary ……………………………………………………….. CHAPTER I – BACKGROUND OF THE PROBLEM a. Description of the problem …………………………………………….. b. Outcome of prior efforts to solve the problem ……………………….. CHAPTER II – SCOPE AND SEVERITY OF THE PROBLEM a. Assessment of past policy performance …………………………….. b. Significance of problem situation ……………………………………… c. Need for analysis ……………………………………………………… CHAPTER III – STATEMENT OF THE PROBLEM a. Definition of the problem …………………………………………………. b. Major stakeholders …………………………………………………………. c. Goals and objectives ………………………………………………………. d. Measures of effectiveness ………………………………………………... e. Potential Solutions ………………………………………………………… CHAPTER IV – POLICY ALTERNATIVES a. Description of alternatives ………………………………………………. b. Comparison of future consequences ………………………………….. c. Spillovers and externalities ……………………………………………… d. Constraints and political feasibilities …………………………………. CHAPTER V – POLICY RECOMMENDATIONS a. Criteria for recommending alternatives ……………………………… b. Description of preferred alternative …………………………………… c. Outline of implementation strategy …………………………………… d. Provision for monitoring and evaluation …………………………….. e. Limitations and unanticipated consequences ……………………….

3 4 5

7 7 8

10 10 11 11 12

13 13 14 15

17 17 18 18 19

REFERENCES ………………………………………………………………… 20 APPENDIX – A Problem Tree …………………………………………………………………… 21 APPENDIX – B List of Tables ………………………………………………………………….. 22

EXECUTIVE SUMMARY Poverty alleviation has been the major concern not only of the country but also worldwide. It is with this reason that the United Nations Development Program launched its treaty together with the rest of the 189 nations that by 2015 the world would be free from poverty and all forms of deprivation (UNDP, 2000). This agreement was named Millennium Development Goals or MDGs with 8 main goals that each nation is attempting to achieve: (1)Eradicate extreme poverty and hunger; (2)Achieve universal primary education; (3)Promote gender equality and empower women; (4)Reduce child mortality; (5)Improve maternal health; (6)Combat HIV/AIDS, malaria and other a diseases; (7)Ensure for

environmental development.

sustainability;

and,

(8)Develop

global

partnership

Looking deeper into the Philippine situation, statistics related to these goals are not painting a good picture of the national health and educational situation. Goals 2, 5, and 6 have slow progress and low probability of achieving them by 2015. Improvement of maternal health remains to be a dream for mothers especially those in vulnerable situations such as living in conflictaffected areas, extreme poverty and are part of the cultural minorities to name a few. A huge number of cases come from the Land of Promise – Mindanao. It is with this purpose that this policy paper has been dedicated to find solution to the social issue on improving the health status of the Mindanaoan mothers. Specifically, this paper seeks to achieve its objective of enhancing the delivery of basic maternal and child health services to the Tri People in Mindanao with focus on Northern Mindanao (Region X) which has been the haven for the Lumads, Mindanao Migrants and Moros. Despite access to healthcare facilities, Region X still has unfavorable health indicators, such as infant morbidity rate of 11.62/1,000 live births and maternal morbidity rate of 21.33/1,000 live births; hence, the policy issue of lack of coordination in the delivery of basic maternal and child health services to the Tri-People in Region X.

The preferred policy alternative that this paper presents is to strengthen and improve the Local Health Board by extending its membership and functions. Expanding the membership and broadening the functions of the LHBs can significantly decrease the MMR and IMR by the impact of addressing the issue in the municipal, provincial and city level of LGU in Region X.

CHAPTER I Background of the Problem

A. Description of the Problem Mindanao has various social concerns and issues with regards to the delivery of basic health services. Lanao del Norte, Lanao del Sur, Maguindanao, Basilan, Tawi-Tawi, Sulu and Sarangani are among the seven Mindanao provinces which rank among the ten lowest provinces in the Philippines in terms Human Development Index (HDI). In the past decade, Mindanao was marked by a slow progress in the field of maternal and child health. In fact, most parts of Mindanao have low progress in terms of reducing maternal morbidity ratio according to the Subnational Progress Report on the MDGs. Northern Mindanao has a relatively high maternal mortality rate which registers at an alarming 21.33/ 1000 live births and infant mortality rate at 11.62/1000 live births despite the fact that it has 931 barangay health centers out of 1158 barangays which constitutes 80.39% which is higher than the 27% national level. Higher incidences of

maternal and infant deaths occur among minority groups in the Mindanao, indicating that this is a sector least served by available reproductive health services (Lacuesta, 2010: p 18). It has been also shown that the disadvantaged groups and indigenous people have poorer survival chances, suffer from heavier burden of illness, experienced a blighted quality of life and failed to receive basic maternal and child health care. Their health profiles demonstrate rising mortality rate. According to Lacuesta, due to poverty and the lack of coordination in the delivery of maternal health care, it is indicated that home delivery assisted by traditional midwives or hilot is commonly practiced, which may contribute to the relatively high maternal mortality rate. Infant mortality is also increasing, mainly due to poverty-related malnutrition and poor health practices, negative health seeking behaviors and the absence of sanitary toilets and potable water supply.

The lack of coordination in the delivery of basic maternal and child health care to the Tri-People, composed of the following: (a)Lumads, such as

the Manobo tribes, the Higaonons, Matigsalugs, Talaandigs, Umayamnoms, and the Tigwahanons; (b) Mindanao migrants from Luzon and Visayas; and, (c) and the Moro tribes or Islamized Lumads, such as the Meranaos, Tausugs and the Maguindanaons, in Mindanao has been one of the evident factors for the negative statistics on the maternal and child health care. Several reasons have been identified in contributing to the lack of coordination in the delivery of these health care services which includes the following: (a) overspecialization of government agencies; (b) absence of coordinating mechanism; (c) selective distribution of services; (f) and political patronage and favoritism. As an effect for the absence of coordination, there has been unequal distribution of basic maternal and child health care services. Also, basic health care services do not reach beneficiaries especially cultural minorities and vulnerable sectors in far-flung areas. B. Outcomes of Prior Efforts to Solve the Problem The national government specially the Department of Health exerted several efforts in addressing the health problems and in uplifting the health status of the citizens in the country. However, despite of these efforts, health problems in the country, especially in Mindanao, are still prevalent. The following are the health programs and its outcomes:

i. Fourmula One of the Department of Health (F1) “Better health outcomes, a more responsive health system, and more equitable health financing” – this has been the goal of the Fourmula One (F1), which is in line with the Millennium Development Goals. It involves the public and private sectors, national government agencies, civil society organizations and the local government units in the implementation of health reforms. It has four major components: health financing, health regulation, health service delivery and good governance in health. According to the Philippine NGO Network Report on the Implementation of the International Covenant on Economic, Social, and Cultural Rights (ICESCR), even though Fourmula One has been able to incorporate the

World Health Organization’s building blocks for health care, the health status in the country is still dismal, hence, the failure to address the health problems of the country.

ii. Health Sector Reform Agenda (HRSA) The HRSA was expected to address the health problems in the country by having changes in policy and financing structure. It argues that radical reform is needed in improving the health care delivery. HSRA “describes the policies, public investments, and organizational changes needed to improve the way health care is delivered, regulated, and financed in the country” (PIDS, 2011). Despite of these efforts, the country is being confronted by different health problems.

iii. Basic Emergency Obstetric Care (BeMOC) BeMOC aims to prevent death and disability among pregnant women and newborn babies. It also refers to the functions that can be provided by skilled and trained birth attendants. Nevertheless, there is still a slow progress in uplifting the maternal and child health in the country, especially in most parts of Mindanao.

CHAPTER II Scope and Severity of the Problem

A. Assessment of Past Policy Performance

Devolution of national government services such as agriculture, environment, cooperatives, and health services were introduced in the country’s administrative setting through the Local Government Code of 1991 or Republic Act 7160. It was in 1992 when the national government devolved the management and the delivery of health services from the Department of Health to the local government units. It aimed to widen the decision making of the local officials in improving the efficiency and effectiveness of health services management and to implement the primary health care strategy in response to the local basic health needs. With the devolution of health services to the local government units since 1992, an assessment must be made in the delivery of basic health services and how these affect the health situation of the populace in the country especially to those indigenous peoples in the far flung areas in Mindanao (Grundy, J. et. al, 2003). Despite of the efforts of the national government in implementing health programs, the health situation of the country has even worsened. The quality and coverage of health services has declined in some locations, particularly in rural and remote areas. This emphasizes the failure of the government in addressing the health problems of the country and stresses the general inadequacy of health care service delivery, as well as the failure on the part of the health information and education system to serve its function. Problems to access to health care remain common in rural and far flung areas, among poor and uneducated people and the indigenous peoples or marginalized population groups. B. Significance of Problem Situation Mindanao is the second largest group of islands in the country wherein it has high prospects for agri-industrial development. However, it is being

confronted by different challenges such as armed conflict, low level of socioeconomic development and disharmony due to diverse cultures. The presence of frequent armed conflict and political struggles resulted to the destabilization of peace and order situation in Mindanao affecting the delivery of basic services in Mindanao especially the health services to marginalized groups (NEDA, 2004). This is substantiated by the significant decrease in the Human Development Index (HDI) in Mindanao due to the poor delivery of basic services from the government to the people. The 2006 Human Development Index (HDI) which showed that the majority of the lowest-ranked provinces are from Mindanao among which are Lanao del Norte, Lanao del Sur, Maguindanao, Basilan, Tawi-Tawi, Sulu and Sarangani (NEDA, 2010; p.7). Mindanao also revealed a slow progress in improving maternal and child health especially those affecting the tri-people of Mindanao. One major factor in the failure of delivering basic health services to the TriPeople of Mindanao especially in the far-flung areas is the lack of coordination among service actors and stakeholders. This study focuses on the need for efficient coordination among government agencies, nongovernment organizations and their beneficiaries- the Tri People of Mindanao, in consolidating efforts to alleviate the depressing state of maternal and child health in Mindanao. This could only be realized if the government would provide and enhance mechanisms in improving the delivery of basic maternal and child health services to the Tri People of Mindanao, which, as an effect, will produce healthy, able and capable members of the society. C. Need for Analysis Results of the 2006 Human Development Index (HDI) showed that majority of the lowest-ranked provinces are from Mindanao. Health conditions are still dismal despite of the previous efforts of the government. Maternal and infant mortality rate is still high in most regions in Mindanao. This resulted from the lack

of coordination in the delivery of basic maternal and child health services, as well as inefficient implementation of development projects of the local government. In order to alleviate the present situation, it is necessary that both sectors, government and nongovernment, continue to develop new perspectives about their respective development goals, programs and projects, and their basic needs and requirements (IIRR,LGSP, SANREM CRSP/Southeast Asia. 2000; p.47). There is a need to have a mechanism in the delivery of culturally sensitive and preventive basic maternal and child health services not just to the mainstream but also including the marginalized sector. Lumad tribal chiefs and Moro leaders need to develop a community-based mechanism for delivery of health services, then the government and the non-government organization take both of these inputs so they may consider in the formulation of new workable mechanisms of coordination.

CHAPTER III Statement of the Problem

A. Definition of the Problem Mindanao has been a home for Tri-People for centuries – such a long time has lapsed yet still the inhabitants of this rich land have been suffering from hunger, illiteracy, unemployment, armed conflict, corruption and unresolved poverty. The government has been providing ample services that address to these concerns. However, the conventional means of delivery of services to a culturally diverse Mindanao poses a problem to its marginalized cultural minorities. The problem that this policy paper seeks to answer is how the government can maximize the delivery of basic maternal and child health services to the TriPeople of Mindanao. The issue is whether the government should adapt mechanisms that will ensure the delivery of equal, effective and culturally sensitive basic maternal and child health services to its stakeholders. B. Major Stakeholders The main problem identified is related to the lack of coordination in the service delivery to the Tri-People of Mindanao. The location of the social problem is in Mindanao, specifically Region X which has a culturally diverse population having high concentrations of families who have not received adequate healthcare related to the Millennium Development Goals 4 (Reduce Child Mortality) and 5(Improve Maternal Health). Specifically, the focal location is the Local Health Board, currently composed of the local government units, and representatives of nongovernment agencies and civic volunteer organizations which are concerned with basic maternal and child health service distribution in the communities. The following are the major stakeholders of the policy:

1.

Tri People – Composed by the Lumads (indigenous peoples),

Mindanao Migrants and Moros (Islamized Lumads), these three groups of inhabitants of the island of Mindanao are collectively called as Tri People. Specifically, the target clientele of this study are the mothers and their children in key areas that are lagging behind in terms of the Millennium Development Goals for maternal and child health. 2. Local Government Unit (LGU) – Since the devolution of health

services by the national government to the local government, the LGUs have been the forerunner with the legal mandate of prioritizing basic services, and delivering the same, to their constituents. The LGU has the power to enact and enforce laws and regulations to its constituents within its political jurisdiction and territory through ordinances and resolutions. 3. Nongovernment Organization (NGO) – Being one of the sectors

that deliver basic maternal and child health services to the Tri People at the grassroots level, NGOs are also considered as one of the major stakeholders. With the implementation of their community-based programs and projects, they are vital sources of data which would be helpful to the LGU in the delivery of basic maternal and child health services. C. Goals and Objectives The goal of this policy paper is to improve the maternal and child health situation in Region X which has unfavorable health indicators, such as infant morbidity rate of 11.62/1,000 live births and maternal morbidity rate of 21.33/1,000 live births, by selecting the best policy alternative in addressing the said policy issue. Specifically, the following are the objectives: 1. To enhance the delivery of basic maternal and child health services

to the Tri-People in Mindanao. 2. To empower and provide opportunities to Tri People through their

active participation in the decision-making and planning of health programs and

projects needed in their communities that shall answer their need for basic maternal and child health services. 3. To promote culturally sensitive maternal and child health projects

and programs which shall encourage cultural minorities and other marginalized sector to avail the maternal and child health services rendered by the LGUs.

D. Measures of Effectiveness A criteria matrix (See Appendix 1) is used to determine the best policy alternative. The criteria has two components: (1) Effectiveness – referring to which the proposed policy option shall be able to practically maximize the delivery of basic maternal and child health care services resulting to solving the policy issue; and (2) Feasibility – pertaining to the likelihood that the policy would be acted upon not only by the concerned government agencies, but also, by other major stakeholders as well. The policy options are also influenced by factors such as cultural acceptance, priorities of local chief executives, and anticipated costs over benefits. E. Potential Solutions Efforts providing solution in the lack of coordination in the delivery of basic maternal and child health services to the Tri People of Mindanao, especially how the government can enhance the delivery of the said services should take into account the following: (1) the issue position and power of the stakeholders; (2) the effectiveness and feasibility of the proposed policy alternative; and, (3) and the improvement of health statistics such as the maternal and infant mortality rate. The policy option is more likely to be a potential solution to the problem and be implemented if the abovementioned factors are satisfied.

CHAPTER IV POLICY ALTERNATIVES

A. Description of Alternatives

a. Institutionalize a coordinating mechanism among government agencies, nongovernment organizations and tribal leaders.  Through the establishment of an office, LGUs, NGOs, and tribal leaders of the Lumad and Moro tribes can be frequently consulted before the implementation and in the initiation of maternal and child health-related projects and programs. With the institutionalization, the effectiveness in

answering the specific needs of the Tri People can be ensured since maternal and child health care is a concern not only of the mother, child and family, but also of the entire community needing every constituent’s contribution.

b. Strengthen and improve management of Local Health Boards (LHBs) through the expansion of its membership and functions.  Expanding the membership and broadening the functions of the LHBs can significantly decrease the MMR and IMR by the impact of addressing the issue in the municipal, provincial and city level of LGU in Region X.

c. Consolidate resources of LGUs to ensure the continuous implementation and success of maternal and child health-related projects implemented by the member-LGUs.  This policy option is an inter-LGU cooperation which intends to consolidate resources of contiguous LGUs to undertake a common project that is beneficial to them. It requires the assignment of a full time staff to serve as secretariat of the arrangement and ensure workability of the cooperation. The full-time staff can provide the requisite administrative and technical

backstopping in the implementation of the common projects by the memberLGUs (IIRR,LGSP, SANREM CRSP/Southeast Asia. 2000; p.54).

B. Comparison of future consequences

As proposed in the first policy alternative, the institutionalization of a coordinating mechanism among the major stakeholders can be materialized with the establishment of a coordinating council composed of representatives from the LGUs, different nongovernment agencies and equal representation from the Moro and Lumad tribes through their tribal chiefs and local leaders. This proposition will be partially feasible since there is constrained funding and a need for technical assistance for the implementation. In the second policy option, the proposal aims to strengthen the already existing Local Health Boards and improve their operations. By expanding its membership and functions to include tribal chieftains and Muslim leaders, LHBs will encourage them to actively participate in the deliberations where they can promote the use of traditional medicine and culturally sensitive programs and projects that shall address the maternal and child health care needs of the Tri People in their particular communities. This will also encourage the women in the vulnerable groups and cultural minorities to seek medical assistance or intervention in ensuring their healthy perinatal condition and lessen possible risks during pregnancy. If realized, a significant decrease in the maternal morbidity rates and infant death rates is expected making this proposition effective. Moreover, the policy option is also feasible since it is more cost-efficient for the government compared to establishing a new office. Finally, similar to the first two options, this policy alternative can be effective; however, it is partially feasible due to the priorities and commitment of Local Chief Executives for which the possibility of cooperation and

implementation is dependent.

C. Spillovers and externalities With the inclusion of tribal chiefs of the indigenous peoples and Moros and equal representation of the Tri People in government activities regarding health concerns, certain spillovers and externalities are anticipated. These are the following: (a) Communication gap among members due to language differences, cultural orientation and possible preconceived notions; (b) Sense of ownership for projects and programs decided upon by the members due to consolidated efforts; (c) Increased demands for research documentation on traditional alternative medicine and evidence-based practice in the health sector to cater projects and programs aside from those addressing maternal and child health care; (d) Appreciation of the culture of Tri People, as well as the promotion of intercultural and interreligious understanding which shall foster a peaceful environment; (e) Increased need for culturally sensitive health care professionals; (f) Better understanding of health programs of the government by the target constituents or recipients of services, thus promoting positive health-seeking behaviours among the Tri People.

D. Constraints and political feasibility The following are the possible constraints for the implementation of the policy alternatives: 1. Political constraints, which may include the lack of political will or minimal prioritization given by local chief executives; 2. Tribal leaders tend to be inferior in dealing with other people especially those of authority; hence, there is a possibility of decrease in participation. 3. The need for allocation from the LGU budget is also considered part of the financial constraint. On the other hand, the Prince System is used in assessing the political feasibility of this paper. The Prince System is a method for forecasting the chances that the policy will be implemented. It is a technique used for assessing

the relative support and opposition of various individuals, groups, and organizations for public policy decision (12 th Batch of the CIPYML Reference Material for Academic Course on Public Policy Development and Advocacy, 2011; p.37-38).

The method will estimate the Issue Position, Power, and Priority for each Player or Stakeholders and is computed according to the following sets of guidelines: 1. Identify the players likely to have direct or indirect impact on the decision. 2. Determine the issue position – whether each player supports, opposes, or is neutral toward the decision. 3. Determine the power – how effective each player is in blocking the decision, helping make it happen, or affecting the implementation of a decision. 4. Determine the priority – how importance the decision is to each player. 5. Calculate the likelihood that the policy will be implemented.

Issue position is defined as the current attitude of the player toward the policy. It is expressed as a number ranging from +5 to -5 to indicate levels of support or opposition. A +5 is assigned if the player is firmly in favor of the issue and is unlikely to change; a +4, +3, +2, or +1 indicates lower levels of firmness on the player’s support. A neutral position is expressed as ½. Similarly, a -5 indicates firm opposition, while -4, -3, opposition. Power is defined as the degree to which the player, relative to the other players can directly or indirectly exert influence concerning the decision on the policy implementation. The basis of the player’s power is based on such factors as group size, wealth, physical resources, institutional authority, prestige and political skills. It is expressed as a number ranging from 1 to 5; With 1 being the slightest amount of power and 5 a substantial power or the so called veto power. -2 or -1 indicate lower degrees of

Priority, on the other hand, is defined as the importance that the player attaches to supporting or opposing the decision relative to all other decisions with which that player is concerned. Similar to power, it is also expressed as a number ranging from 1 to 5 (12th Batch of the CIPYML Reference Material for Academic Course on Public Policy Development and Advocacy, 2011; p.37-38).

PLAYERS Tri People LGUs NGOs

ISSUE POSITION +1 +2 +5

POWER 0 +5 +3

PRIORITY +3 +3 +5

CALCULATION 1 (3) 30 45

Calculation 1: Table Calculation 2: Sum of all the positive scores plus ½ neutral scores = 76.5 Calculation 3: Sum of all scores ignoring signs and parentheses = 78 Calculation 4: Probability of support = calculation 2 divided by calculation 3 = 0.9807 or 98.07%

Interpretation: With the probability score of 0.9807 or 99.07%, the possibility of this policy alternative to be implemented is most likely feasible. Strong support comes from NGOs which had Prince Score of +45. The Tri People had a Prince Score of 3, which is the lowest score in the computation.

CHAPTER V Policy Recommendations

A. Criteria for Recommending Alternatives Adopted in 2005 by the Philippines along with other countries at the UN Special General Assembly, the eight MDGs collectively aim to halve poverty by 2015. Three of the eight are specifically health related: (a) reduce child mortality (Goal 2); (b) improve maternal health (Goal 5); (c) combat HIV/AIDS, malaria and other diseases (Goal 6). With this, the following recommended measures to enhance health service delivery were put forward: a. Get Tri People involved in the identification of projects which they can undertake and those requiring support of government, in response to their priority needs. Participation of Tri People through their tribal leaders who can represent them in local development councils or local special bodies. b. There is direct consultation with the Tri People, through an assembly, to validate the projects identified to resolve priority problems. c. To validate barriers and enhancers to effective delivery health care system. d. To generate baseline data on access, quality, practices among Tri People on health services. (Lacuesta, 2010: 31) B. Description of preferred Alternative After using the criteria matrix in measuring the effectiveness and the feasibility of the three policy alternatives (as shown in Table 2.0), Policy Alternative Two, which is strengthening the Local Health Boards (LHBs) and improving their management and operation through the expansion of its membership and functions, emerged as the best policy alternative.

Taking advantage of the existence of LHBs as a starting point in improving the coordination in the delivery of basic maternal and child health services, the Tri People will have the equal opportunity to avail the said services. LGUs can also provide culturally sensitive maternal and child health programs and projects that can directly answer the needs of the Tri People.

Table 2.0 Criteria Matrix FEASIBILITY HIGH EFFECTIVENE SS HIGH MEDIUM LOW LHB MEDIUM Convergenc e LOW

Partnership

Measuring the effectiveness and feasibility of policy alternatives C. Outline of Implementation Strategy a. Validation of the problem through data collation will be initially done through collaboration with various related government and nongovernment agencies. b. Discuss with the Local Health Board the proposed policy and include their position on the said policy issue in the concept brief. c. Drafting a concept brief and advocacy plan to be presented to political leaders and local chief executives. d. Identify influential political leaders and local chief executives such as LGU officials, Provincial/ Municipal Board Members, City Councilors and other influential individuals who highly prioritize the social issue as their advocacy and encourage to possibly sponsor the proposed policy. e. Coordinate with the local legislative units in passing a

municipal/provincial order or city ordinance that shall broaden the functions and expand the composition of the regular membership of the local health board.

f. Enactment and actual implementation of the municipal/provincial order or city ordinance plans and programs. D. Provision for Monitoring and Evaluation a. Regular meeting – and documentation of minutes of the meeting of all the stakeholders and project team. b. Regular progress and accomplishment report at least once a month, financial statement and audit report of the Local Health Board. c. Monitoring, evaluation and assessment of the programs and projects initiated. d. Gathering feedback and evaluation from beneficiaries, concerned agencies and NGOs that are part of the LHB. E. Limitations and Unanticipated consequences The inclusion of tribal leaders in the Local Health Board can greatly help in the creation of culturally sensitive health projects and programs which can lessen the negative health seeking behaviors of the beneficiaries. However, one limitation that can hinder the said preferred policy alternative is the inferiority of some indigenous people and excluding themselves from actively participating in government activities.

REFERENCES

Grundy, J. et.al. (2003). Overview of Devolution of Health Services in the Philippines. International Electronic Journal. Gumafelex, E., et.al (2003). A Review of the Health Sector Reform Agenda (HSRA) Implementation Progresss.USAID. Lacuesta, C. (2010). Health Research Agenda of Mindanao: A Zonal Report 2006-2010. Health R&D Agenda Setting. Lagrada, P. (2008). Are Maternal and Child Care Programs Reaching the Poorest Regions in the Philippines?.PIDS. 2000. Enhancing Participation in Local Governance: Experiences from the Philippines. International Institute of Rural Reconstruction, Philippines-Canada Local Government Support Program and SANREM. 2010. Addressing Maternal, Neonatal and Child Health and Nutrition Needs of Indigenous Cultural Communities / Indigenous People (ICC/IP) and other Disadvantaged Communities in Mindanao. UNFPA. 2005. Philippine Human Development Report. Human Development Network.

Internet Sources: Priela, J. (2001). Health Sector Reform Agenda in the Philippines. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11696994. Date of access: October 20,2011. Northern Mindanao Health Status. Retrieved from http://onlinemindanao.com/ health/news/tb%20day.html. Date of access: October 18, 2011. Departrment of Health’s Programs. Retrieved from http://dev1.doh.gov. ph/health _programs_glossary. Date of access: October 18, 2011.

APPENDIX – A PROBLEM TREE

Basic services of government do Unequal distribution of services not reach minority groups especially in far-flung areas

Lack of coordination in the delivery of basic social services to the Tri-People in Mindanao

Overspecialization of government agencies

Absence of coordinating mechanism

Selective distribution of services

Political patronage and favoritism

APPENDIX – B LIST OF TABLES Table 1: Number of Barangay Health Stations

Table 2: Number of Hospitals

Table 3: Number of Main Health Center