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Pidsbk82-Health.Pdf INTEGRATION, PARTICIPATION AND EFFECTIVENESS: AN ANALYSIS OF THE OPERATIONS AND EFFECTS OF FIVE RURAL HEALTH DELIVERY MECHANISMS Ledivina V. Cadi_o and Associates THE PHILIPPINE INSTITUTE FOR DEVELOPMENT STUDIES I11 AllRights Reserved by THE PHILIPPINE INSTITUTE FOR DEVELOPMENT STUDIES, 1982 The Philippine Institute for Development Studies is a non-stock, non-profit government research institution engaged in long-term, policy-oriented research. It was established on September 26, 1977 by virtue of Pi'esidential Decree No. 1201. Through the Institute's activities, it is hoped that policy- oriented research on Philippine social and economic development can be ex- panded in such a manner as to more directly and systematically assist the government in planning and policy making. PIDS publishes the output of its research program as part of its effort to promote the utilization of research findings and recommendations. The views expressed in published reports, however, do not necessarily reflect those of the Institute. No partof this book may be reproduced in any sort or any means, except brief quotations for a review, without proper acknowledgment. Printed in the Philippines by REGAL PRINTING COMPANY, INC. 1729 J.P. Laurel Street, San Miguel Manila 2804 Philippines IV CO-AUTHORS Rebecca P. Albano served ass. Research Associate of the Project and head of the Research Team at Sudtonggan. An Economics graduate of the University of the Philippines, Miss Albano has been with projects of the Research and Publications Program (RPP) since 1972 and has authored or co-authored many research reports, most recently, "The Barangay Volunteer Medics (BVM) in Bukidnon: A Case Study of a Community- Based Health Project" and "The Support for Health Programs: A Func- tional Analysis of the Ministry of Health" (with Ledivina V. Carifio and Ma. Concepcion P. Alfiler). Francisco G. Balitaan was Research Associate of the Project and headed the Research Team at Pilar. He is currently writing his thesis on "Planning and Implementation of Integrated Area Development Projects in the Philippines" for his Master of Public Administration degree. He ac- quired an AB (Pol. Sc.) degree from the University of the Philippines in 1975. Mr. Balitaan's most recent works include "Regional Development Planning: The Bicol Experience" (Prepared for Urban Functions in Rural Development Project, Center for Policy and Development Studies, U.P. at Los Bafios, July 1978). Victoria A. Bautista was the Deputy Project Leader and served as over-all coordinator for the household surveys. She is Associate Professor of Public Administration at the University of the Philippines. She majored in Sociology for her undergraduate (U.P., 1966), masteral (U.P., 1970).. and doctoral (Michigan State University, 1976) studies. An abridged ver- sion of her doctoral dissertation, "Technocrats in the Philippine Rice" Program: Middlemen in Masagana 99" was published in the Philippine Journal of Public Administration (Vol. XX, No. 2, April 1976). She also co-authored (with J.C. Azurin, F. Bayan and C.R. Maceda) "Voluntary Sterilization Education Program for Public Health Professionals in the Philippihes" which was published in the Philippine Journal of Public Health. January-June 1979, XXI, No. 1 issue. ,lessiea J. Baelva was a Research Assistant for the Project and was a fresh graduate (B.S. Business Economics, U,P., 1979) when she was recruited. She doubled as our human computer, cleaning up the coding and pro- ducing tables almost at a moment's notice. Reynaldo N. Caraso was a Research Assistant for the Project and is also a B.S. Business Economics (U.P., 1979) graduate. He was the Project's ProCom expert and prepared the groundwork for the subsequent administrative and household surveys in Teresa. V Josie H. de Leon served as Research Associate for the Project and headed both the Bay and Liwayway research teams. Besides being with the RPP staff, Ms. de Leon is also a lecturer of Political Science at the UP College Manila, having obtained her AB (Pol. Sc.) from the University of the Philippines in 1968. Dante T. Fernando was Research Assistant of the Project. He has since joined the Management Staff of the National Economic and Development Authority as Economic Development Analyst. A B. S. (Mathematics) graduate of U.P. (1977), Mr. Fernando also served as programmer of the Project. Ma. Loutdes S. Joves is Assistant Professor of Public Administration and Served as Project Coordinator, in charge of the survey of health delivery mechanisms and the interviews, documents study and other data collec= tion for the administrative portion of the study. Miss Joves is an AB History (cum laude) graduate of Stella Maris College (1970) and has a • Master of Public Administration degree (1975) from the University of the Philippines. A member of the RPP staff from 1970 to 1981, she was the author of "Accessibility of Government Health Services in the Bicol River Basin Area" (August 1979). VI ACKNOWLEDGMENTS The research discussed in this volume was commissioned by the Philippine Institute for Development Studies, under the title "The Assessment of In- tegrated Mechanisms for Delivering Health and Related Social Services to the Poor." The Research and Publications Program of the U.P. College of Public Administration originally submitted the report in nine volumes -- five representing separate studies of each of the intensively studied case organiza- tions, i_corporated here in Chapters IV to VIII, and four integrating reports (Chapters I-III and IX-XII). The printing of this volume and the conduct of the research project would not have occurred without the faith and assistance of a number of people. Heading the list is Dr. Filologo Pante, Jr., President of the Philippine Institute for Development Studies of the National Economic and Development Authority who encouraged and supported the enterprise from the time it was a germ of a research idea until its submission as a report, and its revision for publication. We are grateful to him and his successor, Dr. Romeo M. Bautista, and their staff at PIDS for giving us a wide berth in designing and undertaking the project, in providing and releasing funds with a minimum of red tape and in being tolerant of our errors and delays. Many colleagues at the College of Public Administration, University of-the" Philippines, served as morale boosters and incisive critics at all stages of the project. We want to specially mention Dean Raul P. de Guzman who original- ly broached the research topic to Dr. Pante, and who served as our ever- available consultant throughout the project life; Prof. Ma. Concepcion P. Alfiler, Director of Graduate Studies, with whom we frequently discussed dif- ficult questions; and Prof. Mila A. Reforma, present Director, Research and Publications Program (RPP) whose criticisms on our methodology we could not always satisfy. Amongthe medical professionals who read our work, we wish to make par- ticular mention of Dr. Andres Angara, retired Consultant of the World Health Organization, who patiently went through all the nine original volumes of the. research report. He not only provided wide-ranging comments on a number of issues but also provoked further thought and analysis. Every interaction with Dr. Angara was a profitable learning experience. Unfortunately, we could not present all of the lessons into this volume. We likewise acknowledge the cooperation ann support ol all the ad- ministrators of the programs we studied. They have been gracious in accepting our criticisms and thoughtful in pointing out some errors we have overlooked. We mention here the heads of the programs at the localities we studied because we spent the most time with them and their staffs. (However, by this, we do not intend to overlook their national level administrators from whom we also received a lot of encouragement and blessings.) They are: Dr. Angelito I. Baluyot, Municipal Health Officer, Pilaf, Balaan; Dr. Sergio Gazmen, Direc- tor, Comprehensive Community Health Program (CCHP); Mr. Pedro VII l i . i Mauleon, Team Leader, Project Compassion, Teresa, Rizal; Sister Leonor Barrion, Coordinator, Makapawa; and Mr. -Ben Potot, Chairman of the Board, Sudtonggan Human Development Project. At the same time, we wish to thank the residents of the communities where we made our interviews for their understanding, patience and hospitality. Parts of ttiis volume were presented in three seminars in 1979 and 1981. The original compendium of health delivery mechanisms, then entitled "Services to the Poor: A Preliminary Look at Existing Mechanisms for Meeting Health Needs" was read in the Annual Convention of the Philippine Economic Socie- ty in December 1979. "Integration, Participation and Effectiveness: An Analysis of Five Health Delivery Mechanisms and their Effects,"iwhich served as the main integrating report of the Project, was presented in two occasions: I. At the meeting of the NEDA Social DeveloPment Committee, Technical (Deputy Minister)iLevel on March l i, 1981, and 2. At the seminar on Social Service Delivery and Policy Education and Research at the College of Public Administration, University of the Philip- pines on June 2, 1981. We are grateful to this varied audience of policy makers, administrators, economists, public administration scholars, sociologists and public health specialists for their enthusiastic interest and thoughtful comments which we have attempted to incorporate, albeit incompletely, into this final draft. Interviewing and subsequent coding were accomplished
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