Embed Size (px)
Citation preview
Calvin de los Reyes, PhD College of Arts and Sciences
University of the Philippines - Visayas ([email protected])
The Case of Tagbanua Mothers and Children of Coron Island, Palawan
Maternal and Child Health Handbook and the Indigenous Mothers and Children in the Philippines:
§ One effective public health measure used to aid in meeting the
continuum of care approach is the Maternal and Child Health (MCH)
Handbook. It is defined as “a book that contains essential information,
kept by the family, to promote and maintain the health of mothers and
children” (International Committee on MCH Handbook, 2009).
§ It functions as a health education material which contributes to the
mother’s knowledge and as a comprehensive health record book
which integrates health records.
MCH Handbook
• Address MCH problems by providing promotive, preventive, curative and rehabilitative services for mothers in the communities
• Participation of people individually and collectively in the planning, implementation and evaluation of their health care
• Health in the hands of the people
MCH Handbook and Primary Health Care
MCH Handbook in the Philippines
• The MCH Handbook is nationally initiated and decentralized to the local government units.
• Design was by the central office of the Department of Health, with reprinting as a responsibility of the local government unit.
• The handbook is useful from pregnancy until the child reaches the age of five.
• 63-pages, mostly in black and white.
• Currently being updated by the Department of Health
Booklet ni Nanay at Baby
• Availability of MCH Programs • Slow expansion (2013) • Sustainability of reproduction, limited copies • Fragmented local health system
• Exodus of health professionals • Lack of research
• Language barrier (Filipino, English) • Technical terminologies and usage
Challenges of MCH Handbook Program
HOW ABOUT THE INDIGENOUS POPULATIONS???
Indigenous Peoples in the Philippines
§ Known as cultural minorities, or tribal Filipinos, lumped in the generic term ‘indigenous cultural communities’ or the more politically correct term ‘indigenous people’ of the Philippines.
§ Refer to a group of people or homogenous societies, who have continuously lived as organized community on communally bounded and defined territory, under claims of ownership since time immemorial; occupied, possessed and utilized such territories, sharing common bonds of language, customs, traditions and other distinctive cultural traits.
ETHNOGRAPHIC REGIONS CAR and Region I
Region II
Region III and Rest of Luzon
Island Group
Southern and Eastern Mindanao
Central Mindanao
Northern and Western Mindanao
(Source: National Commission on Indigenous Peoples – Philippines)
Indigenous Peoples in the Philippines
§ 14,184,645 IP POPULATION (16%)
§ 7 .7 M HAS. (25.84%) § 110 ETHNOLINGUISTIC GROUPS
• Inaccessibility to health care (access) • Many IP families can not afford the
high costs of health care services including hospitalization, medicines and consultations
• No disaggregated data about IPs in terms of relevant indicators, and dearth of data and information on indigenous health knowledge and practices and traditional medicine
• Lack of IP-specific health interventions
• Appreciation of the holistic nature of indigenous knowledge on health is often compartmentalized or lacking
• There is an assumed high incidence of preventable and communicable diseases as well as malnutrition and infant mortality in indigenous communities
Issues on IP Health
POOR IP MCH
Geographic loca-on
Socio-‐economic status
Inadequate services
Tradi-onal beliefs
Tagbanua of Coron Island, Palawan
§ “TAGA” meaning “people from” and “BANUA” meaning “countryside.”
§ Most widely distributed IP in Palawan province.
§ They live in small groups, with livelihood as fishing.
Coron Island in Palawan is the habitat of the Tagbanua
Indigenous Group
Tagbanua of Coron Island, Palawan
Tagbanua mothers at HIGH RISK before introduction: Pregnancy § There is also one mother who experienced pregnancy 11 times. § Twenty-seven (54%) have been pregnant four times or more. § The mean number of experienced pregnancy for all the mothers surveyed is 4 (±2.21). Abortion/Stillbirths § Seven mothers or 14% have at least one abortion. § Nine mothers who experienced stillbirths, 7 or 14% experienced it once, while 2 or 4% have experienced it twice. Offsprings § Sixteen (32%) surveyed have more than four children. § The mean number of living children for all the mothers surveyed is 3.28 (±2.12).
None of the Tagbanua children completed the prescribed immunization schedule!
Baseline
MCH Handbook and IP Mothers and Children
Sustainable indigenous-specific health interventions?
Effect of the MCH Handbook on the Knowledge and Behavior of Tagbanua mothers in Coron Island, Palawan,
Philippines: Five Years After
To determine the effect of utilizing MCH handbook on the knowledge and behavior on MCH of Tagbanua mothers in Coron Island, Palawan five years after the introduction of the handbook (2008 to 2013)
Development of the MCH Handbook: § A one-day workshop was conducted among:
§ (1) municipal health officer, § (2) local midwives, § (2) barangay/community health workers, § (2) Tagbanua mothers, and § (2) NGO-representatives.
§ This was conducted to discuss the current status of MCH, existing health recording system/health education tools and the development of the Tagbanua MCH handbook.
§ Constant community consultation (among Tagbanua mothers and local midwives) in developing the contents.
Development of the MCH Handbook
Contents of the Tagbanua MCH Handbook: § The members of the core group developed and finalized the contents of the Tagbanua MCH handbook.
Antenatal Care Card
Immunization Card
Growth Card
Existing Health Information Materials
Additional Information
Development of the MCH Handbook
34-paged in black and white
Gabay ng Ina at Sanggol, 2007
Basic information on Maternal and Child Care
Gabay ng Ina at Sanggol, 2007
Gabay ng Ina at Sanggol, 2007
Additional information on diarrheal diseases, tuberculosis, malaria and filariasis.
MCH Handbook Program: § The Tagbanua MCH handbook was distributed among mothers during a mothers’ class.
Distribution of the MCH Handbook
MCH Handbook Program: § The Tagbanua MCH handbook was distributed among mothers during a EPI program in the island.
Phase II: Distribution of the MCH Handbook
Interview Survey: 2008 (at baseline) Tagbanua mothers of reproductive age, who are pregnant and or with children ages 5 and below (n=50) 2013 (five years after) Tagbanua mothers of reproductive age, who are pregnant and or with children ages 5 and below (n=67) .
Assessment of the MCH Handbook (5 years after)
Knowledge Baseline 2008
(n=50)
Post-evaluation
2013 (n=67)
p-value
No. % No. % First prenatal consultation should be done during the first trimester of pregnancy
14 28.0 40 67.8 <0.0001
Pregnant woman should consult a healthcare provider more than three times during the duration of her pregnancy
18 36.0 54 80.6 <0.0001
Risk factors during pregnancy 5 10.0 20 29.8 0.012 Pregnant woman needs tetanus toxoid immunizations
36 72.0 63 94.0 0.002
Additional iron sources are needed during pregnancy
26 52.0 59 88.1 <0.0001
Mothers should consume more food during her pregnancy
12 24.0 31 46.3 0.020
Appropriate birth attendants are the health personnel
25 50.0 65 97.0 <0.0001
Knowledge on post-natal care 21 42.0 50 74.6 0.001
Changes on Knowledge on Maternal Health
Knowledge Baseline 2008
(n=50)
Post-evaluation
2013 (n=67)
p-value
No. % No. % Mothers know that exclusive breastfeeding should be 6 months
5 10.0 46 68.7 <0.0001
Importance of the regular monthly weighing of the youngest child
35 70.0 65 97.0 <0.0001
Importance of vaccines 38 76.0 65 97.0 0.001
Importance of Vitamin A supplementation 32 64.0 62 92.5 <0.0001
Baseline and Follow-up Changes on Knowledge on Child Health (n=50)
Phase III: Assessment of the MCH Handbook (5 years after)
Phase III: Assessment of the MCH Handbook (5 years after)
Practice Baseline 2008
(n=50)
Post-evaluation
2013 (n=67)
p-value
No. % No. % Had prenatal consultation during her last pregnancy
33 66.0 49 73.1 0.422
Mothers had their first prenatal consultation during the first trimester
7 14.0 11 16.4 0.800
Mothers had at least two TT immunizations 12 24.0 33 49.2 0.007 Health personnel were the birth attendant 8 16.0 7 10.4 0.412
Mother uses a family planning method 3 6.0 14 20.9 0.033
Mothers exclusively breastfed for 6 months 5 10.0 37 55.2 <0.0001 Complete vaccines were given 0 0.0 25 37.3 <0.0001 Monthly weighing of the child 28 56.0 65 97.0 <0.0001
Changes on Behavior on Maternal and Child Care
Applying the Tagbanua MCH Handbook Experience § The MCH Handbook development presented the significance of indigenous people’s participation in creating a public health measure. § In planning, designing or developing of any health interventions directed among indigenous communities, it is of great value to maintain community participation. § In assessing the influence on the Tagbanua mothers’ maternal and child health knowledge after the introduction of the handbook the results showed significantly improved knowledge of mothers from baseline to follow-up
§ Improving health among IP will mean mainstreaming their rights into the local policies, as well as devising some specially-adapted programs to overcome the numerous barriers they face.
§ Ensure that health services are extended to the more remote geographical areas and are culturally sensitive.
MCH Handbook and IP Mothers and Children
1. Adap-ng to the needs of the IP
2. Valuing IP rights
3. Accessible healthcare
BETTER IP MCH
IP Mothers’ and Children’s Health
Typhoon Haiyan/Yolanda
Tagbanua boy and his own MCH Handbook after Yolanda
• All households were victims of Typhoon Yolanda.
• 2/3 of Tagbanua mothers kept their MCH Handbook with them.
• Disaster preparedness and response the MCH Handbook Program.
Maraming salamat po!
A Tagbanua mother showing her own recording system of her children’s birthdays (2006)
Tagbanua mother and her own “recording” plank
An irregularly shaped plank served as a recording system of a Tagbanua mother’s children’s birthdays (April 2007)
Tagbanua mother and her own “recording” plank
An irregularly shaped plank and a part of the wall served as a recording system of a Tagbanua mother’s children’s birthdays (April 2007)
Tagbanua mother and her own “recording” plank
A Tagbanua mother showing her OWN recording system, the MCH Handbook (September 2007)
Tagbanua mother and her own “recording” plank
