The local health care centers are often the first step for locals who seek family planning advice.
The former President of the Philippines – President Estrada – officially stopped asking for family planning assistance from USAID. One assumes that he felt that the Philippines was “developed enough” to support its own family planning norms. This is obviously not the case in the rural areas
The Pill and the Injection – the two most common types of contraceptives given out at the Local Health Care Centers – are often in short supply. The Health Care Center asks for a donation for the items. This can be anyway from zero to twenty pesos for the pill, and about twenty for an injection.
When the centers run out, the ladies are faced with a tough decision: Pay for a trip to the town (anywhere up to fifty pesos) and pay an increased price for the contraception from a commercial pharmacy, or risk going “contraception-free” for the next month or so. The relative prices are summarized in below.
Oral Contraception
Health Care Centre: 0-20 Pesos
Commercial Pharmacy: 85-90 pesos
Injectables
Health Care Centre: 20 Pesos
Commercial Pharmacy: 85-90 pesos
According to the local staff, there are no STDs on the island, and nobody gets abortions.
Many of the health care centers are in sorry state of repair. Many lack a decent ceiling and suffer when it rains. Many of the health care centers are also not fenced off so local people often use the center as a shortcut, which stifles any privacy the center might have.
Midwives and BHWs work at the center.
Midwives
The midwife is responsible for much of the technical work at the healthcare centres. “Nurse” might be a better description as they perform several public health functions. They perform pre and post-natal checkups; distribute vitamin supplements (vitamins A and C, and iron tablets); distribute de-worming tablets and give family planning advice.
An example of some recent activity will help explain the roles.
Many of the local midwifes attended a government sponsored natural family planning seminar. The natural methods – SDM, LAM, Calendar, BBT and Two Day Method – were discussed. Condoms, the pill, injections and other methods that either provide a physical barrier or chemically block pregnancy were not discussed.
The midwife will pass the information unto the BHWs (see below) who will alert people living in the puroks (sub unit of village) of an upcoming talk. The midwife will then give the talk and invite couples back to the healthcare centre for a family planning session.
A source of frustration for the midwife is couples with no access to contraception. This might be ignorant of the methods, or refuse for religious or monetary reasons. One of the local midwives interviewed said that she felt about 50% refused for religious reasons and about 50% refused to lack of money. Many ladies will not pay for contraception because they feel the money is better spent on keeping their existing children healthy and well feed.
Barangay (Village) Healthcare Workers (BHWs)
BHWs are volunteer healthcare workers. There are generally eight or so that volunteer in each barangay (village). A typical barangay has 2,000 people. They work under the supervision of an assigned midwife. A midwife typically serves three barangays.
Sources of frustration for the BHWs include travelling long distances in the mountainous area of Tablas and mothers who refuse to immunisations for their babies (as it makes the babies “sick”) and couples who continue to have more babies when they plainly can’t afford them.
The BHWs perform the following roles:
- Help deliver healthcare info.
- Help promote health initiatives.
- Help malnourished kids
The kids are often provided nutritious food.
- Limited pre and post natal care.
They will weigh babies and other simple tasks. The local midwife performs the more technical duties.
- Limited contraceptive advice.
The BHWs will often inform clients that contraceptives are available and refer them to a nurse of midwife. The most common contraceptives given are: the Pill, three monthly injections and natural family planning methods. Note that some BHWs don’t even mention family planning
- Supply vitamins to pregnant females.
A healthy mum means a healthy baby… Sometimes the expectant mothers come to the local health care center, and sometimes the BHWs deliver the vitamins direct to their door.
- Refer pregnant women to the midwife.
If they see an obviously pregnant women in the community, the will record simple demographic info and refer them to a midwife for prenatal care.