Good Health through Good Governance
Surigao del Sur
The province of Surigao del Sur faces two major health issues, namely: (1) high maternal mortality rates due to traditional birth delivery practices of untrained birth attendants, and (2) the lack of utilization of hospital facilities and services.
In 2005, Surigao del Sur recorded the highest Maternal Mortality Ratio of 2.69 or roughly 3 deaths per 1,000 live births. The problem was traced to the preference (77.5%) of expectant mothers to deliver at home rather than in hospitals, which recorded only 22.5%. It was customary for expectant mothers in the rural areas to give birth at home.
Surigao del Sur has no provincial hospital but it has eight provincial government-run hospitals. Of these, five are district hospitals while three are community hospitals. There is also one DOH-retained hospital. The provincial-run hospitals record an average bed occupancy rate of only 71.6%. This means that the people hardly rely on the hospitals in the area for their medical needs.
This situation prompted the provincial government to pursue the rehabilitation of the existing hospitals, upgrading of birthing facilities, and enhancing the skills of hospital personnel. It also sought to increase equitable access to and utilization of hospital services.
In order to attain its goals, the provincial government worked closely with the Local Area Health Development Zones or LAHDZ. These zones are composed of clustered municipalities which are organized to deliver health services within the health zones. In these zones, the municipalities agree to share resources and help upgrade health facilities and equipment. Today, the province has six LAHDZ, three of which are registered with the Securities and Exchange Commission. Through the LAHDZ, the hospitals were able to acquire ambulances and provide incentives to on-call midwives. They were also able to tap the services of municipal health workers, who were rotated among the hospitals when they suffered shortages in personnel.
The hospital chiefs continually worked with the local chief executives to ensure that the health zones remained active and functional. Meanwhile, the Municipal Local Chief Executives helped sustain hospital operations by increasing the number of beneficiaries of their “PhilHealth para sa Masa” program. This effort also enabled the indigent patients to avail of medical services for free.
In March 2008, the provincial government acquired a P32M loan under LOGOFIND for the procurement of birthing facilities and the rehabilitation of hospital buildings. Half-way houses were also constructed beside hospital buildings to house expectant mothers and their watchers who come from far flung areas.
The LGU also initiated capacity building of the health personnel, particularly the organized Women’s Health Team (WHT), which was composed of doctors, nurses and midwives. The trainings prepared the WHT for the upgrading of the hospitals and so that they can provide BEmONC (Basic Emergency Obstetric and\ Newborn Care) or CEmONC (Comprehensive Emergency Obstetric and Newborn Care), and handle delicate birthing procedures. Health education and awareness raising activities were also undertaken with all the pregnant women during prenatal care.
To buttress the project, the Provincial Government also increased its health budget allocation from 7% (taken from the IRA share) in 2006 to 17% in 2008. This made the province among the top 13 provinces with a high budget allocation for health services.
As a result, the district hospitals were able to purchase OB kits which were necessary for birth deliveries. Among the direct beneficiaries were PhilHealthcovered patients. Indigent patients who were not PhilHealth members were subsidized by the LGU of the patient. Most of the hospitals agreed to accept payment in kind such as vegetables, fish, native chicken and manual services as well.
Meanwhile, the Sangguniang Panlalawigan provided legislative support through the passage of an ordinance mandating the PhilHealth payment in hospitals as trust funds which can be used for emergency purposes. It also passed an ordinance prohibiting traditional midwives from carrying out deliveries and barring health professionals from conducting birthing procedures outside the hospitals.
These interventions led to improvements in maternal health care and medical services. The 2009 Provincial Field Health Information Service (FHSIS) report indicate a 204% increase in facility-based deliveries and a 274% increase in physician-attended deliveries since 2005.
Moreover, Maternal Mortality Ratio was significantly reduced from 2.69 in 2005 to 0.99 in 2009. These deaths occurred in far flung barangays and in the communities of indigenous peoples. Among the cited causes of maternal death were retained placenta, hypertension, eclampsia, and postpartum bleeding.
In terms of access to and utilization of hospital facilities and services, the average length of stay of patients ranged from 2.6 to 3 days. This indicates a significant increase in hospital maximization. The Bislig District Hospital recorded the highest Bed Occupancy Rate (BOR) of 142.35% followed by Madrid District Hospital with 103.13%. As a result, hospital income also increased from PhP7.6 million in 2005 to PhP12.7 million in 2006. By 2009, hospital income has almost doubled to PhP22.5 million. By 2009, the province had also enrolled all indigent families into PhilHealth.
The project employed coordinative and participatory processes which involved the Provincial and Municipal governments, the Provincial Health Office, the Local Area Health Development Zones, the different stakeholders at the barangay level, and the beneficiaries themselves. The composite teams who were trained and organized to manage obstetric emergency care in every hospital reflect the coordinative and participatory processes. The teams are composed of midwives, traditional birth attendants, and community volunteer health workers who are responsible for taking care of expectant mothers. They are in charge as well of bringing the pregnant mothers to the hospital to ensure their safe delivery. On the part of the beneficiaries, their willingness to subject themselves to proper medical attention and procedure is a clear manifestation of their active participation in the project.
The project has been designed to be sustainable even beyond the present administration through the passage of relevant ordinances.
Through the project, the provincial government of Surigao del Sur has shown that good governance can go a long way towards improving health care services.