Community Needs Assessment Sample Barangay Health Workers

NEEDS ASSESSMENT OF BARANGAY HEALTH WORKERS (BHWs) IN DELIVERING HEALTH CARE PROVISIONS IN BARANGAY DAWIS, DIGOS CITY, PHILIPPINES PROF. DENNIS JOHN F. SUMAYLO Assistant Professor 1, Department of Humanities College of Humanities and Social Sciences University of the Philippines Mindanao

MS. MA. TERESA R. ESCANO, Instructor 7 MR. DOYLE FELIX T. ABRIO, Instructor 1 College of Humanities and Social Sciences University of the Philippines Mindanao ABSTRACT It is the objective of this paper to document the needs of Barangay Health Workers in the provision of health care program of the Department of Health in the Philippines. Furthermore, this paper also documents the current communication tools used by the BHWs for both internal and external publics of the Barangay Health Center to provide justifications of the needs of the BHWs in the provision of health care programs. Provided with the current framework of operation, the top-down model of communication is widely implemented rendering all directives and communication are from the Department of Health Central Office. The Central Office also provides a Manual on Interpersonal Communication and Counseling as basis for the BHWs in implementing various health care programs. However, this method is linear in nature and not transactional which is what health communication should be. In the implementation of various health care programs in the barangay level in the Philippines, it must be noted that inputs from those familiar with the locale and the people are important for a successful communication flow. A transition from top-down to bottom-up communication is necessary in situation where the focus of information is based on the needs of a community. This communication system stresses the importance of empowerment of BHWs in event organization, strategic communication planning and message development, and highlighting transactional communication in the process. The Barangay Health Workers (BHWs) need to come up with their own strategies in delivering health care provisions to their clients/patients is a clear indication of this. This communication flow provides top organization personnel with ideas/feedbacks from those working at the grass-roots level.

Keywords Interpersonal Communication and Counseling, Health Communication, Health Promotion – Methods, Health Service Accessibility, Public Relations, Transactional Communication, and Development Communication

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I.

INTRODUCTION

Barangay Dawis is home to people coming from different cultures. The place was originally inhabited by the Indigenous People called Calagan before other settlers came. It is a coastal area facing Davao Gulf. Its northern boundary is Barangay Aplaya, Digos City while the southern boundary is the Municipality of Hagonoy in Davao del Sur. Living near a body of water is a common trait of the Calagans in other parts of Mindanao. Most of the residents are Catholics and the source of livelihood is fishing. Since the area of study is a coastal area, it is expected that there are resorts and inns as well.

The systemic flow of communication in the provision of health care services in the Philippines starts with the Department of Health (DOH) Central Office down to its Regional Offices. From the Regional Offices, the information/directives are passed on to the Provincial and City Health Offices under each region and then down to the Barangay Health Centers (BHCs) manned by a government-paid midwife and volunteer residents called Barangay Health Workers (BHWs). This system is known as top-down system of communication. The inversion of the process follows when information/data is submitted from the grass-roots level of implementation of health care provisions to the DOH Central Office. Given this particular organizational structure and flow of information, it is assumed that communication breakdown may occur in any of the channels involved.

Barangay Dawis is called Lawis by the IP (Indigenous People) group Calagan which means a body of water that has no outlet. It has a total land area of 175 hectares which is divided into residential and commercial lots. The Barangay is divided into nine puroks with 899 households. As of 2007, the total population of the Barangay is 3,884. The first inhabitants of the Barangay are the Calagans but Dawis, as it progressed into a commercial area with beach resorts and apartelles as major businesses, became a melting pot of several other local cultures which resulted to its having several dialects (B’laan, Tagakaulo, Bagobo, Muslim, Cebuano, Bol-anon, etc) spoken in the area.

This paper then documents the communication tools used in this kind of communication situation and further identifies the needs of the implementers of health care provisions in the grass-roots level. This involves the volunteer residents or BHWs since most of the data will emanate from them. This paper also tries to present a needs assessment base on a specific case in Barangay Dawis, Digos City, Philippines in the form of surveys and interviews of all fourteen BHWs in the barangay.

Currently, the barangay has 899 households divided into nine puroks. Each purok has several households as follows and serviced by 14 BHWs: Purok Number of Household Bangus 145 Tanguigue 156 Maya-Maya 119 Talakitok 156 Bariles 32 Barongoy 47 Lapu-lapu 64 Kitong 124 Bolinao 56 Total 899 Table 1: Number of Households

Furthermore, this paper enumerates variables that are deemed important by the BHWs in a specific area of study. Its main purpose is to document the needs of the implementers rather than generalize. II.

BARANGAY DAWIS

III. RESULTS This paper documents the needs of Barangay Health Workers in delivering health care provisions from the government focusing on

Figure 1: Map of Barangay Dawis

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communication tools intended for both internal and external publics of the Barangay Health Center. This involves inter-agency communication and communication within the Barangay Health Center and communication between BHWs and clients/patients. It is also necessary to establish the common health problems in the area to know if these are properly addressed by the communication tools used. Table 2 : Com mon Disea ses in Baran gay Dawis , Digos City

Disease High Blood Pressure Tuberculosis Malnutrition Diabetes Skin Diseases Dengue Hepatitis

Frequency 13

Percentage 92.86

13 13 4 3 2 2

92.86 92.86 28.57 21.43 14.29 14.29

In the survey conducted, respondents were asked to identify the various communication tools used in delivering health care provisions to clients/patients and communicate with the City Health Office. Each respondent was allowed to choose more than one tool to properly document the commonly used tools in these communication scenarios. The commonly used communication tool between the Barangay Health Center and the City Health Office is monthly reports. Every month, the Barangay Health Center, through its head, receives monthly reports of the activities and projects of the City Health Office. Meetings ranked second. On the other hand, Face-to-Face Interaction is common between Barangay Health Center and the Barangay as Local Government Unit. This is attributed to proxemics. The Barangay Health Center is located at the Barangay Hall. The office of the Barangay Captain is directly above the Barangay Health Center, which is located at the first floor of the building. Sending memoranda is not necessary because the Barangay Health Center is under the City Health Office and most of the communication through memos is coming from the mother organization.

Each of the 14 respondents was asked to identify the common diseases in the Barangay. Majority of them answered Tuberculosis and Hypertension as the most common diseases among the adults while Malnutrition is common among children. This data is necessary to establish the problems in the area and the tools used to address these problems. The data in Table 2 is useful in the process of understanding the strength of the communication tools and the need of the BHWs in crafting these tools.

It should also be noted that some of the respondents answered text messaging as an alternative way of sending information. They rely on technology depending on the urgency of the message.

Base on initial studies, the following communication tools were used in communicating with the City Health Office (CHO) and the Department of Health Region 11 (DOH-RXI) and in delivering health care services to clients/patients in the area: Communication Situation Communication within the Barangay Health Center and other Agencies Communication between Clients/Patients

Meetings and face-to-face interactions are common when communication is within the Barangay Health Center. This means communication situations involving the midwife and the BHWs.

Communication Tools

Memoranda, Monthly Reports, Semi-Annual Reports, Annual Reports, Face-to-Face Interaction, Meetings Flyers, Leaflets, Posters, Brochures, Fact Sheets, Public Service Announcements, Faceto-Face Interaction, Text Messaging Table 3 : Communication Tools used by BHWs with the System of Communication

Table 4 summarizes the commonly used tools in communicating within and outside the Barangay Health Center. Organization City Health Office

Communication Tools

Monthly Reports Face-to-Face Barangay (LGU) Interaction Face-to-Face Barangay Health Worker Interaction Table 4 : Effectiveness of Handling Information Per Organization

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Within the parameters of the system’s framework of operation, as shown in Table 5, 85.71% or 12 respondents said that the framework of operation does not affect the delivery of the message while 14.29% or 2 respondents said that it is affected by the framework.

Communication and Counseling, but in other communication tools as well. There is only one computer in the Assistance Needed Event planning Strategic Communication Planning Message Development Audience Selection Public Speaking Media Relations Materials Development Public Service Announcements Internet Outreach Advertising

Responses Frequency Percentage Yes 2 14.29 No 12 85.71 Table 5 : Effect of the System’s Framework of Operation to the Communication Process

Despite this belief that the Framework of Operation does not necessarily affect the communication process, BHWs still encounter problems, which include delays of notices in program implementation, the inability to organize programs and conduct their own activities, and information lag from the City Health Office.

Modal Rank 1 2

Importance st 1 nd 2

3

3

4 4 5 7

4 th 4 th 6 th 7

9

8

9 10

8 th 10

rd

th

th

th

Barangay and it is not owned by the Barangay Health Center. Moreover, only eight of the BHWs have access it. Also, the respondents answered that they need training in using the Internet and designing communication tools.

It is understood that there are some projects conceptualized by the Barangay Health Workers specifically designed for the immediate community that could be put on hold or worst, trashed. This is attributed to the framework of operation wherein all activities of the Barangay Health Center require approval from the City Health Office. The implication of this problem is that there is a greater possibility that in due time and because of immediate need, the Barangay Health Center will conduct an activity without the approval of the City Health Office.

Table 6 : Assistance Needed

Table 6 shows the kind of assistance the Barangay Health Workers need to improve their delivery of health services. Event Planning ranks first in terms of importance followed by Strategic Communication Planning and Message Development. Event Planning involves organizing effective events while Strategic Communications Planning involves developing and implementing a targeted communications blueprint for the organization. Message Development, on the other hand, means figuring out what to say for an intended audience.

However, in an interview with Mary Divene C. Hilario, RN, MPH, the officer in charge of the Health Advocacy and Promotion Unit of the Department of Health Region XI, she emphasized that Barangay Health Centers can actually come up with their own communication tools without approval from the City Health Office nor the Regional Office provided that it follows the DOH Guidelines.

Event planning ranks first because most of the time, the Barangay Health Center organizes community meetings and consultations. These community meetings and consultations require a strategic communication plan and a specific message before its implementation. The modal ranking of the assistance needed coincides with this model.

This particular situation is an example of a communication breakdown. Therefore, it is appropriate to look at the capacity of the 14 Barangay Health Workers in terms of designing communication tools. To them, lack of training in designing communication tools is a major problem followed by lack of resources. This further emphasizes the need of the BHWs to gain more skills not just in Interpersonal

IV. IMPLICATIONS Given the current framework of operation, BHWs are still equipped with the basic knowledge in delivering health care provisions in

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their assigned areas since the City Health Office has trained these volunteers in Interpersonal Communication and Counseling (IPC/C). Furthermore, Hilario also emphasized the importance of delivering correct medical information to their clients/patients.

a response and then an adjustment or follow-up by the person who first acted.” There is a need to go beyond statistics in the implementation of health care programs in the grass-roots level. Andres (1988) highlighted the fact that trainers/facilitators/community leaders should go beyond information dissemination and statistics. As Hovland (2007) reiterated, communication planners should be equipped with planning and monitoring tools to implement community-based projects. In fact, going beyond information dissemination is practiced since 1947 starting with Radio Sutatenza in Colombia. (Dagron, 2001) Hovland (2007) also highlighted to package the message in various ways like stories and highlight persuasion in the message rather than pure information dissemination.

Given this, the IPC/C Manual from the Department of Health Central Office focuses only on factual information in delivering health care provisions. The manual’s way of monitoring is very clinical in nature relying on statistics as sole measurement of success in any health care program of the government. The same set of statistics is often used to generalize. However, these volunteers take their tasks beyond the statistics it can provide. They want to be able to come up with their own strategies in delivering health care provisions to their clients/patients. Despite the problems identified with this kind of framework of operation, these volunteers still believe that it is still a good operational framework. As Max Weber’s Theory of Bureaucracy explains, the best way to manage the complexity of an organization compose of individuals with one aim is to come up with three basic rules - authority, specialization, and rules. (Littlejohn, 2008) According to this theory, the BHWs are considered legitimate authorities since the City Health Office formally authorizes them. Furthermore, in this framework of operation, people are categorized according to what they can contribute in achieving the goal thus creating specializations. The BHWs specializes in the grass-root implementation of various health care programs of the government since they are the ones familiar with the locale and the people. Lastly, the BHWs follow the same set of rules and guidelines coming from the Department of Health Central Office.

The need of the BHWs to use the Internet is also relevant in the delivery of health care provisions. As cited in Speaking of Health: Assessing Health Communication for Diverse Population (2002), health communication should be more interactive. Face-to-face interaction is still important but with the continuous change in the communication landscape, alternative tools should be developed or widely implemented. Monitoring is also beyond statistics but rather on the significant change that happened to the individual. Hovland (2007) proposed several methods of monitoring that are not included in the IPC/C Manual. Most Significant Change (MSC) is used in most Strategic Communications Planning. Other monitoring tools include Outcome Mapping and Communication for Social Change (CFSC) Integrated Model. (Hovland, 2007) Health Communication is Transactional Communication and the current communication scenario in the provision of health care services in the Philippines is purely linear. Given this change in the communication landscape, further trainings for BHWs on Event Planning, Strategic Communication Planning and Message Development are deemed important.

The simplicity of Weber’s Theory of Bureaucracy is not enough to document the on site implementation of various health care programs. The Cybernetic Tradition of Karl Weick as cited in Littlejohn (2008) explains the BHWs situation in a detailed way. According to Weick as cited an Littlejohn (2008), an “interaction that forms an organization consist of an Act, or a statement or behavior of an individual…an Interact that involves an act followed by a response…and a Double Interact that consists of an act followed by

V. BIBLIOGRAPHY

Andres, Tomas Quintin D. (1988). Community Development: A Manual. New Day Publishers, Quezon City, Philippines.

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Dagron, Alfonso Gumucio. (2001) Making Waves: Stories of Participatory Communication for Social Change. The Rockefeller Foundation, New York.

Organisations. Overseas Development Institute. London.

Department of Health and HealthPRO. (2012) Interpersonal Communication and Counselling Manual for Health Service Providers.

Institute of Medicine of the National Academies. (2002). Speaking of Health: Assessing Health Communication Strategies for Diverse Populations. The National Academies Press. Washington, DC.

Hovland, Ingie. (2007) Successful Communication: A Toolkit for Researchers and Civil Society

Littlejohn, Stephen W., & Karen A. Foss. (2008). Theories of human communication (8th ed.). Thomson

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