Second Women’s Health and Safe Motherhood Project INDIGENOUS PEOPLE’S DEVELOPMENT PLAN (IPDP) FOR SURIGAO DEL SUR October 2004 Public Disclosure Authorized I. Introduction The WHSMP 2 hopes to demonstrate in selected project sites an affordable model of delivering health services that increases access of vulnerable and disadvantaged women of reproductive age to acceptable, high quality, and cost-effective reproductive health services essential for safely attaining their desired spacing and number of children. Indigenous peoples, youth, poor women, commercial sex workers are among the vulnerable and disadvantaged groups that the project hopes to effectively reach and benefit. WHSMP2 has the following objectives: (i) increase the access (in selected sites) of disadvantaged women (including indigenous people) of reproductive age to high quality and cost-effective reproductive health services; and (ii) develop and implement sustainable and replicable systems, Public Disclosure Authorized within the framework of the Health Sector Reform Agenda, for the financing and delivery of reproductive health services. The project consists of two parts: a Local Delivery of the Integrated WHSM Service Package (Part A) and a National Capacity to Sustain WHSM Services (Part B). The Province of Surigao del Sur is among the first batch of Project Sites selected for the project, which will be assisted through the establishment and operation of a network of Women’s Health and Safe Motherhood teams (WHT), provision of assistance in the upgrading of health facilities, development and implementation of cost-effective and sustainable approaches to reach vulnerable and high risk groups. Selected health facilities in the province will be improved and upgraded to increase access of women, particularly the disadvantaged women, to emergency obstetric care. Women’s Health Public Disclosure Authorized Tams (WHTs) composed of the Rural Health Midwife as Team Leader, Barangay Health Workers (BHWs) and Traditional Birth Attendants (TBAs), shall be organized to help pregnant women develop their respective Birth Plans that would cover prenatal activities, childbirth and postpartum care. They shall also encourage mothers to shift from home to facility births by helping them address identified barriers to such a shift, which include the logistic requirements, transport and temporary shelter arrangements. A social assessment (SA) conducted in the Province revealed the existence of Indigenous Cultural Communities and Indigenous Peoples (ICC/IPs) in all the municipalities of Surigao del Sur where around 125,000 IPs belonging to the Manobo-Mandaya-Mamanwa cultural-minority groups are known to reside. To obtain a better understanding of the situation of the indigenous peoples in the province, the SA included the conduct of interviews and discussions with IPs in two barangays in Lanuza, Public Disclosure Authorized Surigao del Sur. Subsequent discussions were made by the project preparation team with IP leaders from the different municipalities and the Provincial Health Team. This culminated in an IPDP workshop in August 6, 2004 where this plan was drafted (Participants to the IPDP workshop is shown in Annex A). 1 This IPDP outlines the measures to be taken to maximize the engagement of indigenous people in the planning and implementation of various project interventions in areas with IP population and come up with culturally-sensitive/appropriate strategies in improving the access of IPs to maternal and child care. It lays out a general workplan to ensure that indigenous peoples (IPs) are informed, meaningfully consulted and mobilized to participate in the various stages of project design and implementation as they are seen as an important stakeholder. The IPDP for Surigao del Sur described herein aims to ensure compliance with the Philippine Indigenous People’s Rights Act (RA 8371) and the World Bank’s OD 4.20 on Indigenous Peoples, as reflected in the project’s Indigenous People’s Strategy. II. Objectives of the IPDP In line with the overall project objectives, the IPDP aims to increase the access of IP women in Surigao del Sur of reproductive age to acceptable, high quality and cost-effective reproductive health services and enable them to safely attain their desired spacing and number of children in a manner compatible with their practices and situation. This is envisioned to eventually result in the reduction in both maternal and infant mortality rate in the Province. Related to this, the plan aims to a) Attain 100% PhilHealth coverage of IP women in the province; b) Double the number of births by IP women in a health facility; c) Have 80% of births by IP women delivered by skilled attendant (health professional), either in a facility or at home; and d) Improve awareness and acceptance among IP women of reproductive age on birth planning, and FP services. III. Legal Framework The contents of this IPDP are based on laws and policies of the Government of the Philippines and policies of the World Bank, as follows: a) The Philippine Constitution of 1987 recognizes the rights of the IPs to their ancestral domains and their power of dominion over their lands and resources, and provides that the rights of IPs to natural resources pertaining to their lands shall be especially safeguarded (ART. XII Section 5). These rights include the right of the IPs to participate in the use, management, and conservation of natural resources; b) Republic Act 8371, otherwise known as the Indigenous Peoples Rights Act or IPRA, provides that the IPs have the right to an informed and intelligent participation in the formation and implementation of any project, government or private, that will impact on their ancestral domain, and that the IPs have the right to participate in decision- making, in all matters which may affect their rights, lives and destinies; c) World Bank Operational Directives on Indigenous Peoples (OD 4.20) requires Bank- assisted projects to ensure that interventions avoid or minimize detrimental impacts on indigenous peoples/cultural minorities and that measures are made to maximize project benefits on IPs. It likewise requires Bank-assisted projects in areas with IPs to guarantee the informed and meaningful participation of IPs in various stages of project development and implementation. Moreover, this directive expects that IPs 2 receive social and economic benefits that are compatible with their cultural practices and tradition. IV. Baseline Data Indigenous Cultural Communities/Indigenous Peoples (ICC/IP) are known to reside in all the municipalities of Surigao del Sur. Breakdown of IP population per municipality is as follows: Municipality estimated IP population IP sub-tribes a. Barobo 9,784 Manobo-Mandaya b. Bayabas 302 Manobo c. Bislig 36,933 Manobo d. Carmen 2,230 Manobo-Mandaya-Mamanwa e. Cagwait 1,790 Manobo f. Cantilan 2,470 Manobo g. Carrascal 1,553 Manobo-Mandaya-Mamanwa h. Cortes 396 Mamanwa i. Hinatuan 13,360 Mandaya j. Lanuza 2,713 Manobo-Mandaya-Mamanwa k. Lianga 3,014 Manobo l. Lingig 25,712 Manobo-Mandaya m. Madrid 507 Manobo n. Marihatag 1,850 Manobo o. San Agustin 1,561 Manobo-Mandaya p. San Miguel 18,242 Manobo q. Tagbina 8,912 Mandaya r. Tago 1,527 Manobo s. Tandag 1,217 Manobo-Mandaya-Mamanwa Most Manobos, Mandayas and Mamanwas rely on farming, fishing and gathering of forestry products. Others are also engaged in carpentry and handicrafts making. Average household income is less the Php1,000. Childbirth is largely dependent on the support of traditional birth attendant in the community, referred locally as “hilot”. Hilots are paid between Php300 to Php500 for their services. However, because of inaccessibility and financial constraints some Manobo-Mandaya-Mamanwa women are not at all assisted by trained and traditional birth attendants, and had to rely on their husbands or other family members for support during childbirth All IPs interviewed during the conduct of the social assessment signified their preference to give birth at home rather than in a clinic or hospital due to cost and distance. Moreover, support from the husband and other relatives, and availability of traditional birth attendants in the community makes home childbirth a preferred option. Issues and problems related to childbirth is not felt as a priority concern by most IPs in the Province, unlike issues related to livelihood and source of income which is seen as a major problem. Prenatal care is also not common especially for those situated in far-flung areas. Majority rely on certain herbs (i.e. uway, warm young banana leaves, dangdang leaves) to help them become strong during pregnancy and obtain relief from certain discomfort. 3 Manobo-Mandaya-Mamanwa women also observe certain peculiar practices prior to and after childbirth. Prior to child delivery, some women drink a mixture of milk-and-egg and an herbal concoction. They also eat plenty of rice to improve their stamina. A few days after childbirth, most women take a warm bath with a concoction of sambong, citrus, Pili wood and paglibas leaves to be relieved from body pain and recover easily. Eating lots of papaya and drinking water is believed to help in producing breast milk for the baby. To ensure cleanliness of the baby’s cord, they use alcohol to wash the cord stump. Some use “pulbos ng putot” (young coconut fruit powder) to speed up the drying of the cord stump. PhilHealth coverage among the Manobo-Mandaya-Mamanwas in the province is rather low. Some attribute this to the relative inaccessibility of some IP areas and political interventions in the identification and prioritization of indigents. Among those who have PhilHealth cards, utilization is very low because of lack of awareness on its usage. Except for a few who live near the urban/barangay centers, most IP women in the Province do not avail of the RHU services. This is because of the difficulty of access due to the generally poor road conditions. Moreover, even with the deployment of Barangay Health Workers (BHWs) by the Provincial and Municipal LGUs to cover all the barangays in the Province, far-flung sitios where most IPs reside are yet to be visited by the BHWs.