Professional Documents
Culture Documents
DOH-JICA Project for Strengthening Maternal and Child Health Services in Eastern Visayas
IC NET LIMITED/HANDS
May 2016
Abbreviations
Abbreviation
Term in Full
AHA
BEmONC
BHS
BHW
BNS
BSPO
CHO
CHT
C/P
DHC
DOH
DOH RO8
DSWD
EVRMC
EPI
FBD
FHSIS
Hi-5
ILHZ
IMC
IMR
IRA
KP
LGU
MCAP
MC Book
MCH
MDG
MMR
MNCHN
NDP
NHTS-PR
OECD-DAC
OJT
PhilHealth
PHO
PNV4
PPC
RHU
TWG
USAID
WHT
4Ps
Photos
Table of Contents
CHAPTER 1
BACKGROUND ........................................................................................................... 1
1.1
1.2
1.3
CHT PROGRAM IN THE JICA PROJECT AND HARMONIZATION WITH THE KP PROGRAM .................. 2
1.4
CHAPTER 2
2.1
METHODOLOGY ............................................................................................................................... 5
2.2
2.3
2.4
2.5
2.6
LIMITATIONS .................................................................................................................................... 8
2.7
CHAPTER 3
RESULTS .......................................................................................................................... 13
3.1
RELEVANCE.................................................................................................................................... 13
3.2
EFFECTIVENESS ............................................................................................................................. 14
EFFICIENCY .................................................................................................................................... 22
3.3.1 Appropriateness of the tools and resources provided to the CHT program .............................. 23
3.3.2 Efficiency of the required tasks in the CHT program ................................................................ 25
3.3.3 Support environment of the CHT program ................................................................................ 26
3.3.4 Other factors affecting efficiency .............................................................................................. 29
3.4
IMPACT ........................................................................................................................................... 29
3.5
SUSTAINABILITY ............................................................................................................................ 30
OTHERS .......................................................................................................................................... 33
CHAPTER 4
CHAPTER 5
RECOMMENDATIONS ................................................................................................... 37
List of Tables
Table 1: Areas of CHT Program supported/promoted by JICA and DOH .............................................. 3
Table 2: Basic components of JICA-supported activities and tools in CHT program ............................. 3
Table 3: Evaluation Criteria .................................................................................................................... 5
Table 4: Sample size and sampling methods employed for interviews ................................................... 7
Table 5: Background data of health workers who participated in the interviews .................................. 10
Table 6: Socio-demographic data of the mothers who participated in the interviews ........................... 10
Table 7: Socio-demographic data of the CHT volunteers in assessment ............................................... 12
Table 8: Accomplishment of CHT volunteers on FBD and PNV4 ........................................................ 14
Table 9: Comparison of the accomplishments between JICA target and non-JICA target areas ........... 15
Table 10: Pregnancy tracking accomplished by CHT volunteers (January to September 2015) ........... 17
Table 11: Accomplishment of home visits (4 times) during the prenatal period by CHT volunteers .... 18
Table 12:Types of services provided by CHT volunteers (multiple answers) ....................................... 19
Table 13: Tools developed by the Project .............................................................................................. 23
Table 14: Use of MC book by CHT volunteers during home visits ...................................................... 24
Table 15: Views on availability of adequate resources .......................................................................... 25
Table 16: Assistance in any form received by CHT volunteers (by source) .......................................... 28
Table 17: Breakdown of the content of the assistance........................................................................... 28
Table 18: Status of MCIP ordinance and implementation in Leyte and Ormoc .................................... 30
Table 19: Results of interviews with CHT volunteers ........................................................................... 32
Table 20: Transition of the number of active CHT volunteers from 2011 to 2015................................ 32
List of Figures
Figure 1: Schedule of the CHT Assessment ............................................................................................ 8
Figure 2: Results of the interviews on the importance of CHT activities (5 key areas) ........................ 13
Figure 3: Opinions on the CHT program in improving three key MCH services ................................. 16
Figure 4: Person who provides MCH services in community ............................................................... 16
Figure 5: Trends of CHT accomplishment in JICA priority barangays ................................................. 18
Figure 6: Number of home visits by CHT volunteers during prenatal and postnatal periods ............... 20
Figure 7: Clients satisfaction with CHT volunteers service ................................................................ 20
Figure 8: Sources of information on MCH care .................................................................................... 21
Figure 9: Personnel influencing mothers decision on using MCH services ......................................... 22
Figure 10: Evaluation on the tools developed by the Project ................................................................ 24
Figure 11: Status of recording on clients MC book.............................................................................. 25
Figure 12: CHTs opinions on their workload ....................................................................................... 25
Figure 13: Health workers opinions on their workload........................................................................ 26
Figure 14: Satisfaction with the support to CHT volunteers ................................................................. 27
Figure 15: Perceived recognition of the importance of CHTs work by others ..................................... 27
Appendixes
Appendix 1
Appendix 2
Appendix 3
Chapter 1
1.1
BACKGROUND
In the Philippines, the Maternal Mortality Ratio (MMR) in 2006 of 162 per 100,000 live births had
increased to 221 in 2012. It was still far from the National Millennium Development Goals (MDGs) of
MMR to 52 per 100,000 live births by 2015. Therefore, the Government of the Republic of the
Philippines (GRP) needed to reduce the MMR at a faster rate to achieve the national MDGs. The DOH
gave priority to the maternal and child health program and issued the Maternal, Neonatal and Child
Health and Nutrition (MNCHN) policy, which focuses on improving the quality of services and delivery
care. The GRP promoted enhancement of Maternal and Child Health (MCH) activities based on the
MNCHN policy and its manual of operations (MOP).
From 2006 to 2010, the Japan International Cooperation Agency (JICA) conducted the Maternal and
Child Health (MCH) Project in the provinces of Ifugao in the Cordillera Administrative Region and
Biliran in the Eastern Visayas Region. The project aimed to introduce the Emergency Obstetric and
Neonatal Care (EmONC) system and improve the quality of MCH services in accordance with the
MNCHN policy. With the success of the project, the DOH requested Japan to provide technical
assistance to scale up project achievements in other provinces in the Eastern Visayas region. In response,
JICA started a technical assistance project named the Project for Strengthening Maternal and Child
Health Services in Eastern Visayas (SMACHS-EV; hereinafter the Project) in Leyte Province
(excluding Tacloban City) and Ormoc City for the four-year period from July 15, 2010, to June 14, 2014.
The Project was extended for two years when the Super Typhoon Yolanda hit the region in November
2013.
The Project has its target areas in 18 municipalities in the Province of Leyte and five districts
in Ormoc City. The purpose of the Project is to increase the number of pregnant women and
newborns receiving safe pregnancy, safe delivery, and postpartum care services in the target
areas in the region wherein five output indicators were set to achieve this purpose.
Institutionalization and operation of the Community Health Teams (CHTs) is one of the five
outputs of the Project, which aims to strengthen the link between health facilities and the
community through the work of health volunteers.
1.2
The Community Health Team (CHT) was formerly known as a Womens Health Team (WHT). In 2006,
it was first introduced by the Department of Health (DOH) as an essential component of the Second
Womens Health and Safe Motherhood Project. The creation of the WHT aimed to establish an effective
community-based support system to ensure that all women were adequately served for potential obstetric
complications and to lead the efforts in convincing mothers to pursue facility-based delivery (FBD)1.
Following this national strategy, JICA promoted the WHT activity in the previous MCH project and
continued its support in accelerating the attainment of Millennium Development Goals 4 and 5 in the
1
Dale Huntington and others A system approach to improving maternal health in the Philippines. Bulleting of the World
Health Organization; 2011. Available from http://www.who.int/bulletin/volumes/90/2/11-092825/en/#
CHT Program in the JICA Project and Harmonization with the KP Program
The Project started implementing the activity during the transition period between the existing and new
policy after the presidential election in June 2010. The first set of training materials was developed by
the Project and the counterpart (C/P) before the announcement of the AHA. The content was based on
the WHT manual developed by the DOH Central Office at that time. The training of CHT volunteers by
the Project started in early May 2011. By September 2011, the Project had trained 237 regional and
provincial trainers and 3,169 CHT volunteers in the Project areas of Leyte and Ormoc. However, it was
at this very moment that the DOH Central Office introduced new instructions and a guideline for CHT
volunteers related to the KP program.
The new guideline for CHT volunteers had many differences in the tasks and responsibilities from the
previous CHT program, which the JICA has been promoting in the region (see the appendix 1 Matrix
of Differences in CHT Strategy). The wider scope of health issues and the specific target population
with which CHT volunteers have to follow up did not completely fit in with the strategy to meet the
expected outcome or purpose of the Project (See Table 1). Therefore, a number of consultations and
discussions were held in the DOH Central Office for the Department of Health Regional Office VIII
(DOH RO8) and JICA to come up with a solution. In 2012, the DOH RO8 and the Project agreed on
2
Administrative order No. 2010-0036 The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos
Department of Health 2010
3 DO No. 2011-0188 Kalusugan Pangkalahatan Execution Plan and Implementation Arrangement (August 2011)
4 National Household Targeting System for Poverty Reduction (NHTS-PR) is a data bank and an information management
system that identifies who and where the poor are in the Philippines
harmonizing and integrating the activities as one, and all required tasks by both the Project and the KP
program became essential work of CHT volunteers. Region-wide orientation on the harmonized CHT
program was conducted by the DOH RO8 from 2013 to 2014.
Table 1: Areas of CHT Program supported/promoted by JICA and DOH
Maternal and Child Health: Pregnancy & PostCHT program supported by the Project
partum
Newborn Health
Infant Health
Family Planning
PhilHealth Enrollment
Based on the background above, the Project continued to support the following key areas of the CHT
program in JICA target sites, as shown in Table 2.
Table 2: Basic components of JICA-supported activities and tools in CHT program
CHT Organization
CHT volunteers
Barangay Health Workers, Barangay Nutrition Scholars and any volunteers who completed an
orientation on a CHT course and is willing to serve the community. Each volunteer has assigned
catchment area for work.
Midwife/NDP
Supervisor of the CHT volunteer in her assigned catchment. Nurse in Nurse Deployment Program
serves as the assistant of the midwife for CHT program.
CHT volunteers
Midwife
PHN/MHO/MO
In addition, the Project at the beginning selected priority barangays from 18 Rural Health Units (RHUs)
and five District Health Centers (DHCs) in the JICA target areas as a pilot group. These barangays
represent 50% of the population in the respective RHUs and DHCs. The Project prioritized support and
monitoring of the activity in these priority barangays throughout the implementation of the Project while
3
the same activity was also implemented in non-priority barangays as an initiative of the Provincial
Health Office (PHO) and City Health Office (CHO) to harmonize all activities.
1.4
Assessment Objectives
Since the first deployment of CHT volunteers in 2011, the Project has implemented a number of
activities to strengthen CHT operation in the JICA target areas. As the end of the Project approaches, it
is necessary to determine the effect of the CHT program supported by the Project on the project goal of
improvement in MNCHN service delivery. The findings of the assessment and recommendation shall
be used to inform stakeholders such as the DOH and PHO/CHO on ideas to enhance the intervention
and to advocate for policy support from the national and local governments. In addition, the report shall
be used to improve the design for the future strategy of the CHT program or any community-based
intervention in the health sector.
In general terms, this study focused on assessing the CHT programs current and potential contribution
to the improvement of MNCHN service delivery. The Project believes that the general findings of the
current assessment can be a good reference for the evaluation of a national CHT program even though
the current assessment only highlights the components of the CHT program supported by JICA
intervention.
Chapter 2
2.1
Methodology
The Project employed a mix of office-based research; review of reports, documents and secondary data,
and face-to-face semi-structured interviews. Reviewing the document includes the review of statistical
data and the record of CHT monthly reports to analyze the performance of CHT volunteers and health
facilities on MNCHN service delivery. A semi-structured interview tool was used for key informants
such as mothers, CHT volunteers, and health workers at RHUs and DHCs. The sampling methods will
be discussed in Section 2.3.
The assessment analyzes the effectiveness of the CHT program in terms of its impact on MNCHN
indicators. To evaluate the effectiveness, the Project employed OECD DAC evaluation criteria5 for
analysis. Table 3 bellows summarizes those criteria.
Table 3: Evaluation Criteria
Criterion
Relevance
Effectiveness
To what extent did the CHT program contribute to the improvement of the health
of mothers and babies and MNCHN service delivery?
Efficiency
Impact
What are the bottlenecks and gaps in the CHT program that keep CHT volunteers
from functioning as a link between health facilities and community to improve
MNCHN service delivery?
To what extent do the DOH RO8 and/or the local government demonstrate
ownership and capacity or resource mobilization to continue the program?
Sustainability
2.2
Survey Team
The survey team (hereinafter the Team) consists of the members of the CHT Technical Working Group
(TWG), including the PHO of Leyte, the CHO of Ormoc, the DOH RO8, and the Project. In addition,
one local consultant was hired during the preparation period, and seven surveyors were recruited to
conduct the interviews. The Team held a number of meetings to design the survey strategy and
questionnaires and review the results of CHT assessment. All surveyors were hired by the Project and
were fluent in local dialects such as Waray and Visayan. The Project trained the surveyors on interview
and survey skills, technical terminologies, and use of the questionnaires and protocols for this
assessment.
5
2.3
The CHT assessment targets mothers, health workers at RHUs/DHCs, and CHT volunteers in the JICA
target areas (18 RHUs of Leyte and 5 DHCs of Ormoc). As mentioned in Chapter 1, the Project had
focused its intervention in priority barangays of JICA target areas. This assessment, therefore, only
reviewed the performance of the CHT program in JICA priority barangays, and the Team selected CHT
volunteers assigned in these barangays for interviews.
Table 4 shows the sample size and the methods employed for the interviews in this assessment. Because
of the time and the budget constraints, the Team had to limit the sample size in this assessment. In
addition, the Team had to allocate a different proportion of the sample size to Leyte and Ormoc because
of their difference in the population and size of the coverage area. In fact, the projected population of
the JICA project area in Leyte is about four times the one in Ormoc. The Team subjectively set the
proportion as 6065% of the total sample size to Leyte and 3540% of those to Ormoc in this assessment.
For assessment of the accomplishment of CHT volunteers, the data of a CHT monthly report (from 1 st
to 3rd quarters of 2015) were collected from all JICA priority barangays of RHUs and DHCs.
For selection of health workers, the Team first developed a list of health workers in RHUs/DHCs of the
JICA project areas. This list only includes midwives, nurses, and doctors who are full-time and have
been working at the same health facility for more than a year. Nurses in the Nurse Deployment Program
(NDP) are not included in this list. It is because they are also a contractual health worker and most of
them work less than one year. In addition, the current assessment aims to ask the impact and opinion of
the CHT program at health facility (RHU and BHS), and the Project considered it is more appropriate
to ask health workers, rather than NDP nurses, who are responsible for overall performance of health
facility. The Team randomly selected the names of health workers to reach the intended number of
samples.
For selection of the mother, the Team employed a combination of different sampling methods. The Team
set the criteria as a mother who delivered the baby in September 2015. The number of mothers who met
these criteria was identified through the CHT monthly report submitted from health facilities in the
Project area. In Leyte, because of a wide geographical area, only one RHU per Inter Local Health Zone
(ILHZ) was selected randomly. Subsequently, the Team used the varying probabilities sampling methods
to take into account the possible importance of the size of each health facility with the mother. The
number of mothers who met the criteria in a health facility was used as a size measure, and RHUs/DHCs
were taken as sampling units. The allocation of the mother for interview in each RHU/DHC was
determined by these methods. Because the Team only knew the number of deliveries at the Barangay
Health Station (BHS) in each RHU/DHC, the random selection of BHSs was conducted until the number
of mothers for interview reached the allocated number at RHUs/DHCs. During the survey, the surveyor
occasionally had to use a convenient sampling method to select mothers because of unavailability of
health workers at the intended BHS; therefore, some mothers outside of the originally selected BHSs
were invited for the interviews.
Target
45 (48)
146
Ormoc
25 (26)
33
Health
Workers
Leyte
60 (55)
381
Mothers
Ormoc
40 (44)
223
Leyte
60 (60)
385
Ormoc
40 (40)
106
CHT
volunteer
The Team aimed to examine the factors contributing to the good performance of CHT volunteers in this
assessment. With the intention of comparing CHT volunteers in high-and low-performing health
facilities, the Project first selected health facilities based on the performance of the CHT program and
then randomly selected CHT volunteers from these health facilities. In Leyte, a total of four facilities
(two high-performing and two low-performing) were selected, and 15 CHT volunteers were randomly
withdrawn from the inventory of each health facility. In Ormoc, one health facility was identified per
high and low performance, and 20 CHT volunteers were randomly selected from each.
2.4
Assessment Tools
The Team developed a set of tools for the assessment. Three sets of questionnaires were developed for
the interviews with mothers, health workers, and CHT volunteers. The first draft of the questionnaires
was developed in English, and then the questionnaires for mothers and CHT volunteers were translated
into Waray and Visayan dialects to ensure understanding of the questions by the respondents. The
translated questionnaires were pre-tested by the Project and the surveyor and then revised for
7
improvement accordingly. The final version of the questionnaires was finalized by the Team at a CHTTWG meeting. There were cases in which Waray-speaking respondents better understood some words
in English as there are no equivalent words in Waray. The surveyors therefore used Waray and English
interchangeably. The questionnaires developed for this assessment are attached in Appendix 2
Questionnaires for CHT assessment.
2.5
The Team started the preparation of the CHT assessment in September 2015. Figure 1 shows the
schedule of the CHT assessment. While conceptualizing the design, the team started the collection of
the necessary data such as statistical data, inventory of CHT volunteers, and CHT monthly reports since
March 2015. The draft of the design was discussed with the members during the TWG and CHT core
team meetings from September to October 2015. During this period, the preliminary study was also
conducted at RHUs/DHCs in the JICA target areas to see the availability of the intended data at health
facilities. As the assessment was implemented in conjunction with other CHT assessment necessary for
the terminal evaluation of the Project, most of the work was focused on data collection and data encoding,
which were necessary for the terminal evaluation at the beginning. The assessment was in full swing
from mid-November to mid-December 2015. The data encoding of the results of interviews and data
validation started in January 2016, but, because of the data inconsistencies, the validation of the data ran
until mid-April 2016. The results of the data were then reviewed and analyzed by the Team from April
to May 2016.
Figure 1: Schedule of the CHT Assessment
Stage
Activity
Sept.
2015
Oct. Nov.
Dec.
Jan.
Feb.
2016
Mar.
April
May
2.6
Limitations
The time and financial constraints limited the sample size in this assessment. This is especially the case
in Leyte as the Province has a land area of 6,313.33 km2, and health facilities in the JICA target areas
are geographically spread out throughout the province. Thus, the survey results could present the
dominant trends in the JICA project areas, and it is noted that simple generalization of the findings
should be avoided. In addition, there is a concern on the quality of data, especially the CHT monthly
report, submitted from RHUs/DHCs. The Project only validated the data on the submitted CHT monthly
reports from RHUs/DHCs that were already consolidated at RHU/DHC levels. The data of the CHT
monthly report at the BHS level were not validated by the Project; therefore, the Team is not 100%
confident about the accuracy of the data on the CHT monthly report, which is related to the
accomplishment of the CHT program on key MNCHN indicators.
8
Furthermore, in the assessment of the impact of the CHT program on MNCHN service delivery, the
results also should be viewed with a clear understanding of the methodological limitations such as
controlling other factors contributing to MNCHN service delivery. For example, the Team looked at the
impact of the CHT program on the accomplishment of four prenatal care visits (PNV4) and FBD in 2015
through the comparison of statistical and collected data from the PHO and CHO. The Team
acknowledged that accomplishment of these indicators is the result of multiple factors including
availability and accessibility of services at health facilities or other related programs implemented by
other international donors and the DOH. For example, two health facilities, Alang-Alang (Leyte) and
San Pablo (Ormoc), had a temporary closure of the birthing facility due to the re-construction of the
facility after super-typhoon Yolanda. Many international organizations such as, but not limited to,
UNICEF, Save the Children, International Medical Corps (IMC), and USAID, conducted activities
related to maternal and child health particularly after the supertyphoon. Meanwhile, the DOH Central
Office has been also implementing since April 2015 the Universal Health Care High Impact Five (UHC
HI-5) Plan in the JICA target areas to intensify operations and coverage in priority programs of the DOH
including maternal and child care.
2.7
74
Age
(mean )
(range)
Gender
Position
45.8911.30
Female
69
(22------64)
Male
PHN
MHO/MO
57
17.2111.02
8
9
(1------41)
(2) Mothers
The socio-demographic data of the mothers who participated in the interviews are listed in Table 6.
Table 6: Socio-demographic data of the mothers who participated in the interviews
(n=99)
Socio-demographic data
Age
(mean ) (range)
Marital Status
Single
Common Law Spouse
Married
Separated
Widow
Educational Attainment
(mean ) (range)
Number of Children
(mean ) (range)
Occupation
Housewife
Food vendors
Farmers
Sari-Sari Store
Others
Monthly Household Income
Less than Php 1,000
Php 1,000 to 3,999
Php 4,000 to 6,999
Php 7,000 to 9,999
Php 10,000 to 14,999
Php 15,000 and above
Philhealth Membership
Yes with ID
Yes without ID
No, but beneficiary
No
4P's Membership
Yes
No
(N)
(%)
Characteristics of Residence
Within town proper/commercial area
Near downtown/town proper
Mountain area
Coastal area
Interior barangay
Length of living in the current barangay
Less than 6 month
6 month to less than year
1 to less than 3 years
3 to less than 6 years
6 years or more
Travel time to health facility
0-15 minutes
16-30 minutes
31-45 minutes
46-60 minutes
61-90 minutes
120 minutes
Means of Transportation to health facility
By walking
Motorcycle/Habal-habal
Pedicab
Tricycle
4
63.6
28.3
3.0
1.0
87.9
3.0
2.0
1.0
6.1
10
45
30
7
4
3
10.1
45.5
30.3
7.1
4.0
3.0
29
23
16
31
29.3
23.2
16.2
31.3
28
71
28.3
71.7
(N)
(%)
13
51
16
5
14
13.1
51.5
16.2
5.1
14.1
0
3
10
17
69
0.0
3.0
10.1
17.2
69.7
78
13
3
2
0
1
80.4
13.4
3.1
2.1
0.0
1.0
31
23
17
15
7
2
2
1
1
31.3
23.2
17.2
15.2
7.1
2.0
2.0
1.0
1.0
48
41
1
6
2
1
48.5
41.4
1.0
6.1
2.0
1.0
As noted in the previous chapter, the Team interviewed 99 mothers (55 in Leyte and 44 in Ormoc) who
met the criteria during the assessment period. Most of the mothers who took part in the interviews were
relatively young (mean age of 27.2 years old); average educational attainment was eight years (high
school incomplete); and they had an average of three children (mean = 2.94), although it ranged from 1
to 10 children. The majority of the mothers were either common law spouses (63.3%) or married
(28.3%), and the remaining 8% were either single, separated, or widowed.
10
The majority of the mothers were housewives (87.9%), and only few reported having a job such as sales
people, food/sari-sari store vendors, farmers, or labors. The data showed a great range of monthly
household income among the mothers; however, the first 55% had an income level below PHP 3,999
per month. Only 28% were enrolled in the Pantawid Pamilyang Pilipino Program (4Ps)6, and 52.5% had
membership in PhilHealth with or without a proper ID. It is important to note that 30% of the mothers
were not enrolled in Philhealth.
Regarding the residence of the mothers, 64.6% lived either within the town proper or nearby, and the
remaining mothers lived in the mountain or coastal areas and interior barangays. No transient mothers
were identified; the majority of mothers had lived in their current residence for six years or more, and
the shortest length of living in the area was more than six months.
In terms of the travel time to health facilities, the majority of the mothers (80.4%) answered that they
could reach the health facility within 15 minutes; 18.6% could access it within one hour, and only one
mother mentioned two hours as her travel time to the health facility. As for the means of transportation,
the majority of them walked or used motorcycles, pedicabs, or tricycles to access the health facilities.
Of all mothers, 48 had delivered their last babies at RHUs/DHCs followed by 41 at district hospitals and
6 at private clinics. The remaining had delivered either at the Eastern Visayas Regional Medical Center
or Schistosomiasis hospital, and one did not specify the place.
(3) CHT volunteers
The Team interviewed a total of 100 CHT volunteers (60 in Leyte and 40 in Ormoc). Table 7 summarizes
key socio-demographic data of the CHT volunteers. The age of CHT volunteers ranged from 22 to 66
years old with an average age of 47 years old in both Leyte and Ormoc. The majority of them were
women, and men accounted for only 3%. Average educational attainment was nine years or incomplete
high school. The data show that approximately 70% of CHT volunteers belonged to families with less
than PHP 3,999 income per month; however, the majority (55.9% in Leyte, 75% in Ormoc) did not have
4Ps memberships.
The average number of years worked by respondents in the CHT program was approximately three (3.7
years; 3.4 years). The number of households each CHT covered ranged significantly with an average of
66 households in Leyte and 100 households in Ormoc. CHT volunteers in Ormoc seemed to have more
households to cover than those in Leyte.
The majority of the CHT volunteers held Barangay Health Worker (BHW) positions (71.7%; 72.5%);
however, the composition of the remaining CHT volunteers differed in Leyte and Ormoc. In Leyte, CHT
volunteers without any position (13.3%) were the second most frequent followed by Barangay Nutrition
Scholars (BNS) (8.5%) and the rest such as a barangay officers, day care workers, and parent leaders.
On the other hand, in Ormoc, CHT volunteers with BNS positions ranked second (22.5%), and the
remaining were either volunteers or parent leaders. As for the reason for becoming a CHT volunteer,
6
The Pantawid Pamilyang Pilipino Program (4Ps) is a human development measure of the national government that
provides conditional cash grants to the poorest of the poor, to improve the health, nutrition, and education of children aged 018.
11
90% of the respondents in Leyte were either recommended or recruited while 56% in Ormoc selfvolunteered.
Table 7: Socio-demographic data of the CHT volunteers in assessment
Leyte (N=60)
(N)
(%)
Background data
Age
(mean ) (range)
Gender
Female
Male
Educational Attainment
(mean ) (range)
Monthly Household Income
Less than Php 1,000
Php 1,000 to 3,999
Php 4,000 to 6,999
Php 7,000 to 9,999
Php 10,000 to 14,999
Php 15,000 and above
4P's Membership*
Yes
No
Number of years working as a CHT volunteer**
(mean ) (range)
Number of households in charge
(mean ) (range)
Position (aside from CHT volunteers)
None/Volunteers
BHW
BHW and other positions (BNS/Kagawad/parent leader)
BNS
BSPO
Barangay Officers/Kagawad
Parent Leader
Daycare Worker
Reason for becoming a CHT volunteer**
Through recommendation
Recruitment
Self-volunteerd
Automatically assigned
47 9.32 (26------66)
59
1
98.30
1.70
95.0
5.0
3
40
11
2
2
2
5.0
66.7
18.3
3.3
3.3
3.3
3
25
11
1
0
0
7.5
62.5
27.5
2.5
0.0
0.0
26
33
44.1
55.9
10
30
25.0
75.0
8
34
9
5
1
1
1
1
13.3
56.7
15.0
8.3
1.7
1.7
1.7
1.7
1
29
0
9
0
0
1
0
2.5
72.5
0.0
22.5
0.0
0.0
2.5
0.0
28
26
6
0
46.7
43.3
10.0
0.0
8
5
22
4
20.5
12.8
56.4
10.3
*One respondent in Leyte had no answer; **One respondent in Ormoc had no answer.
12
Ormoc (N=40)
(N)
(%)
Chapter 3
RESULTS
Findings presented in this chapter are structured to provide answers to key areas for evaluation outlined
for the given criteria in the previous chapter. In this chapter, special emphasis was given to the
effectiveness of the program in terms of MNCHN service delivery. For the detail of the interview results,
please refer to the Appendix 3 Results of CHT assessment.
3.1
Relevance
This section examines relevance of the CHT program in terms of facilitating a national MNCHN strategy
and addressing the needs in the target area based on the review of the document and the results of the
interviews.
The CHT program backed by the Project was meant to mitigate the following problems in the region.
High maternal and neonatal mortality rates: The region is ranked as the seventh highest region
for MMR and the fifth highest region for NMR in the country.
Low status in key MNCHN service indicators: In Leyte and Ormoc, the low status of MNCHN
service indicators was a serious concern. According to the baseline data of 2010, the FBD rates
were 56% in Leyte and 65% in Ormoc; the PNV4 rates were 22% and 29%; and the postnatal care
visit (two times) rates were 53% and 61% in Leyte and Ormoc, respectively. In the CHT
assessment, 43 (66.2%) of the health workers in the JICA project area perceived a difficulty in
attaining PNV4 coverage in their target area.
The relevance of the CHT program with regard to government policy is also high. The Project started
implementation of the CHT program in line with the national policy and strategies such as the MNCHN
policy, AHA, and KP. The approach of CHT institutionalization as a bridge between the client and
health service is also supported by the national KP strategy.
Furthermore, in the interviews with 74 health workers, more than 90% agreed on the importance of
five key activities of the CHT program in the improvement of MNCHN service delivery (Figure 2).
This means that the activities promoted by the Project match the needs of health workers in the
intervention through health volunteers.
Figure 2: Results of the interviews on the importance of CHT activities (5 key areas)
13
3.2
Effectiveness
This section examines the effectiveness of the CHT program by looking at the following areas.
Effectiveness of the CHT program to strengthen the function of health volunteers as a link between
the community and health facilities
The findings were summarized based on the results of a CHT monthly report and the interviews
conducted with health workers, mothers, and CHT volunteers.
3.2.1
Table 8 shows the accomplishment of FBD and PNV4 among the mothers who were tracked by CHT
volunteers based on the results of CHT monthly reports from January to September 2015 in the JICA
priority barangays. The accomplishment was compared with the Field Health Service Information
System (FHSIS) reports of 2015 and 2010 and the target accomplishments set by the JICA project. The
Project uses the FHSIS report of 2010 as the baseline data for the project. The data of the CHT monthly
report exceeds the target accomplishment of the Project and shows higher accomplishment than those
of the baseline and the province and city in 2015. One exception is the FBD coverage in the FHSIS
report from 2015 in Ormoc. The accomplishment in the FHSIS report from 2015 in Ormoc shows
slightly better performance of FBD coverage than in the CHT monthly report.
Table 8: Accomplishment of CHT volunteers on FBD and PNV4
(From January to September 2015)
1. LEYTE PROVINCE
Data Source
Facility-Based
Delivery (FBD)
coverage
Prenatal Visit 4
(PNV4) coverage
2. ORMOC CITY
Data Source
Facility-Based
Delivery (FBD)
coverage
Prenatal Visit 4
(PNV4) coverage
To analyze the impact of the CHT program, the accomplishment of MNCHN indicators was compared
between JICA project areas (18 RHUs and 5 DHCs) and non-JICA project areas (23 RHUs and 1 DHC)
14
in both Leyte and Ormoc, as shown in Table 9. Although the CHT program has been expanded to nonJICA target areas since 2012, the Project continued to prioritize the JICA target areas in conducting all
follow-up activities such as capacity enhancement, monitoring activities, and distribution of CHTrelated logistics. The Team expects higher achievement in JICA target areas than non-JICA target areas
as a result of such extensive intervention by the Project.
Table 9: Comparison of the accomplishments between JICA target and non-JICA target areas
1. LEYTE PROVINCE
Category
Eligible Population
Maternal Care Program
PNV (4 or more)
PP (at least 2 times)
Deliveries
Total number of deliveries
FBD
Home Deliveries
Others
JICA Areas
(18 RHUs)
Non-JICA Areas
(23 RHUs)
Leyte Province
15,097
23,740
38,837
7,622
11,055
50.5%
73.2%
10,298
16,575
43.4%
69.8%
11,116
10,734
308
74
96.6%
2.8%
0.7%
17,536
15,872
90.5%
1,583
9.0%
81
0.5%
17,920
27,630
46.1%
71.1%
28,652
26,606
92.9%
1,891
6.6%
155
0.5%
2. ORMOC CITY
Category
Non-JICA Areas
(1 DHC & nonresident)
1,250
JICA Areas
(5 DHCs)
Eligible Population
Maternal Care Program
PNV (4 or more)
PPC (at least 2 times)
4,496
2,857
3,417
Deliveries
Total number of deliveries
FBD
Home Deliveries
Others
3,436
3,233
195
8
Ormoc City
5,746
63.5%
76.0%
752
881
60.2%
70.5%
3,609
4,298
62.8%
74.8%
94.1%
5.7%
0.2%
3,594
3,577
17
0
99.5%
0.5%
0.0%
7,030
6,810
212
8
96.9%
3.0%
0.1%
The JICA target areas showed higher accomplishment than non-JICA target areas in most of the coverage
areas except one. Again, the coverage of FBD in Ormoc in non-JICA target areas was higher than in the
JICA target areas. The Team believes that this is because the non-JICA target areas are located in the
city proper with better access to hospitals and private birthing facilities. In addition, there is the effect
of non-Ormoc residents, who were accounted for in non-JICA target areas. In Ormoc, many clients from
outside the city were referred to or voluntarily came to the hospital for delivery, which contributes to
higher accomplishment of FBD in the area than JICA target areas. Nonetheless, the abovementioned
results show the positive impact of the CHT program on selected indicators. While the Team
acknowledges that other factors, such as other relevant activities or programs by the Project or other
organizations, contributed to the accomplishment of MNCHN indicators, much of the accomplishment
in the above indicators is believed to be attributed to the work and effort by the CHT program.
A total of 74 health workers in the JICA target areas were also interviewed regarding the improvement
15
of MNCHN service delivery in relation to the CHT program. All health workers (100%) answered that
there was improvement in performance of MNCHN service delivery after the introduction of the CHT
program. The health workers were further asked for their opinions on the CHT program contributing to
the improvement of three key MCH service delivery areas: antenatal care service, FBD service, and
postnatal care service. As seen in figure 3, the large majority of health workers answered that the CHT
program is very helpful in improving these services.
Figure 3: Opinions on the CHT program in improving three key MCH services
3.2.2
The effectiveness of the CHT program was also evaluated with regard to strengthening health volunteers
as a link between community and health facilities to ensure client access to necessary maternal and child
care services. The following findings were also based on the analysis of CHT monthly reports and the
results of the interviews.
(1) Visibility of the Community Health Team
The CHT is composed of different types of volunteers and supervisors. The KP strategy strongly
emphasized the establishment of a CHT as a mechanism of linking communities with health services.
Therefore, the Project supported the promotion of the awareness of the CHT program and CHT
volunteers from municipal to barangay
levels. To measure the impact of the
activity
and
the
program,
the
Among the interviewed mothers, the most popularly known figure in providing MCH services in the
community was the BHW, as shown in Figure 4. It is noted, however, that, aside from BHWs, other
people such as BNSs, Day Care Workers, Parents Leaders, and Barangay Service Point Officers were
also recognized people who provided MCH services. This shows that many people with different
positions were now involved in MCH service at the community level, and their function as CHT
volunteers was recognized by the clients despite the slightly low visibility of the name Community
Health Team.
(2) Performance of CHT task
The Team reviewed the performance of CHT volunteers on pregnancy tracking and four home visits
(HV4) during the prenatal period. These were key activities promoted and monitored by the Project.
Identification of the possible pregnant women is the first task of CHT volunteers in the community. CHT
volunteers need to track these women at the early stage of pregnancy to ensure their clients avail
themselves of all necessary prenatal care services, which leads to the accomplishment of PNV4. The
accomplishment of pregnancy tracking by CHT volunteers is assessed based on comparison with the
expected number of pregnant women calculated as projected population 2.7%. Table 10 below shows
the result of the accomplishment from January to September 2015 based on CHT monthly reports. CHT
volunteers showed a high accomplishment rate (98% in Leyte and 100% in Ormoc) in tracking the
possible pregnant women.
Table 10: Pregnancy tracking accomplished by CHT volunteers (January to September 2015)
Area
Population in JICA
priority barangays
(2015)
Expected number of
pregnant women
(for a 9-month period)
Accomplishment
rate
Leyte
421,887
8,543
8,355
98%
Ormoc
105,433
2,135
2,136
100%
Note: The expected number of the pregnant women per year was computed based on FHSIS definition (population x 2.7%),
and then the expected number of a nine-month period was calculated for this study.
CHT volunteers were expected to conduct at least four home visits synchronized with the schedule of
clients prenatal care visits in each trimester. This is because part of their task aims to remind the clients
of their scheduled prenatal check-ups at the health facility. The accomplishment rates of the completed
four home visits by CHT volunteers were 67.7% in Leyte and 74.4% in Ormoc (Table 11). The Team
further analyzed the success rate of CHT home visits in convincing the clients based on the
accomplishment of PNV4 among the women tracked by CHT volunteers. As a result, a relatively high
success rate was observed in Ormoc (93.3%) while Leyte still has a little more room for improvement
(78% in Leyte).
The percentage of non-attainment of HV4 was approximately 30% in JICA priority areas. This
percentage coincides with the results of CHT interview in terms of the difficulty in identifying the
pregnant women in the early stage of pregnancy. Of the 100 CHT volunteers, 29 acknowledged such
difficulty, and the majority mentioned denial of the pregnancy by the client as a reason.
17
Table 11: Accomplishment of home visits (4 times) during the prenatal period by CHT volunteers
(January to September 2015)
Area
No. of women
who delivered
(A)
Leyte
5,996
4,059 (67.7%)
3,164 (52.8%)
Success rate of
convincing the client to
avail PNV4 through 4
home visits
(D: CB)
78%
Ormoc
1,560
1,161 (74.4%)
1,083 (69.4%)
93.3%
answers was not given to the respondent unless the respondent had difficulty in understanding how to
answer. In addition, multiple answers were encouraged. Four activities by CHT volunteers were
identified by the majority of the participants: 1) home visits during the prenatal period, 2) home visits
during the postnatal period, 3) health education, and 4) reminding of or encouraging to visit the health
center (see Table 12). These are the key activities of CHT volunteers according to the Project, as
mentioned in Chapter 1. By contrast, health education scored relatively low considering the number of
respondents who mentioned home visit. Another area of concern is the smaller number of the clients
(n = 30) who mentioned confirmation of a birth and emergency plan by CHT volunteers. Confirmation
of clients birth and emergency plan was important for the Project to ensure the client had an emergency
plan for delivery, and availability of the plan among the clients was one of the project indicators to
evaluate success. The team arrived at two possible reasons. First, some CHT volunteers may not focus
on confirmation of a birth and emergency plan because, in the case of Ormoc, a birth plan is mostly
followed by the midwife. Second, many of the clients in the interviews may have considered the
confirmation of a birth and emergency plan as part of health education or health advice, which has
resulted in a lower number of responses on this service. This analysis was supported by the confirmation
of clients Mother and Child book (MC book) during the analysis of efficiency. Eighty-three mothers
had a completed birth and emergency plan, which resulted in the high accomplishment of the follow-up
on clients birth and emergency plan by the CHT volunteer.
Table 12: Types of services provided by CHT volunteers (multiple answers)
Home Visits (during prenatal period)
Home Visits (during postnatal)
Health Education/Advice
Reminding/Encouraging the visit to health center
Confirmation of a birth & emergency plan
Referral/accompany to the health center
Distribution of vitamins, medicines and de-worming
Follow-up on Immunization
Family Planning
Processing PhilHealth
Weighing children
Giving information regarding health center
Total
(N)
97
80
74
67
30
27
12
7
2
1
1
1
(%)
24.3%
20.1%
18.5%
16.8%
7.5%
6.8%
3.0%
1.8%
0.5%
0.3%
0.3%
0.3%
399
100.0%
Home visits
The interview further questioned those mothers who had received home visits by CHT volunteers
regarding the number of such visits and the average length of time the CHT volunteer spent on each
home visit. For the home visits during the prenatal period, the average was seven times. As shown in
Figure 6, the majority of the mothers (61%) reported three to four visits by the CHT volunteers. For the
postnatal period until 42 days after delivery, the average was four visits, and the most common answer
was one to two visits (36.8%) followed by three to four visits (31.6%). One client mentioned that a CHT
volunteer visited the client every day during the prenatal and post-partum periods. Because the minimum
requirement of home visits promoted by the Project was four times per prenatal and postnatal period,
these results met the expectations of the CHT program.
19
Figure 6: Number of home visits by CHT volunteers during prenatal and postnatal periods
In response to the length of time CHT volunteers usually spent on each of their home visits, the clients
gave a wide range of answers from 2 to 240 minutes. The median, the middle value of all the answers,
was 30 minutes, which accounts for 32.3% of the responses. Sixty minutes (22.6%) was the second most
common answer. Twelve mothers (12.9%) mentioned that CHT volunteers stayed less than five minutes
during each home visit.
(5) Satisfaction with the Service by CHT Volunteers
To measure the quality of the service by the CHT volunteers, the mothers were asked about their
satisfaction with the four types of key services mentioned in the previous section; 1) home visits during
the prenatal period, 2) home visits during the postnatal period, 3) health education, and 4) reminding or
encouraging to visit the health center. As seen in Figure 7, the majority of the respondents reported their
satisfaction with each of the services provided by the CHT volunteers, and only 12% of mothers
mentioned their dissatisfaction with the service by the CHT volunteer.
20
(6) Effectiveness of the CHT activity to encourage change in clients health-seeking behavior
The CHT program aimed at demand creation for quality maternal and child care and health-seeking
behavior through information and education of mothers by CHT volunteers. Therefore, the Team
assessed effectiveness of the program based on the following results of the interviews with mothers:
clients source of information about maternal and child care, personnel who influenced the client to use
MCH-related service, and importance of CHT volunteers in their maternal experience. These questions
were asked to the mothers during the interviews, and the respondents were allowed to give more than
one answer.
Source of information on maternal and child health care
Figure 8 shows that CHT volunteers were
the top source of information received by
the mothers (n = 81). Family (n = 79) was
second, and followed by health personnel
(n = 69). The MC book was also mentioned
by 58 mothers as another important source
of information. These are additional
positive results as the Project has been
promoting the use of the MC book as part
of the CHT program. Mass media or
magazines did not play a big role as
information sources for the clients on
MCH care.
21
Efficiency
Evaluation of efficiency in general involves the analysis of resource use; however, the current
assessment cannot analyze the efficiency of the CHT program in this area. The assessment of the
efficiency of resource use was constrained by two main factors. Detailed information on the total cost
used for the CHT program in JICA priority areas was unavailable. This is because the majority of CHT
activities in JICA project areas were funded by the DOH RO8 and different sections of the DOH RO8
such as the Family Health Unit and Health Systems Development Unit, allocating budgets under
different expense items. Based on the data provided by the DOH RO8, the DOH RO8 spent
approximately PHP 223 million on the CHT program in the region from 2011 to 2015, and
approximately PHP 70 million of the amount was spent in Leyte and Ormoc; however, it is difficult to
obtain a breakdown of the cost with which the Team can identify the amount of resources used for
specific activities or only in JICA priority barangays. Furthermore, although a possibility exists to work
out costs of intervention for further analysis, it is difficult to identify relevant activities supported by the
DOH or other donors for fair comparison of analysis. For these reasons, this assessment will focus on
the analysis of the efficiency in the following operational aspect of the CHT program:
22
Efficiency of the required task in terms of existing workload or capacity of CHT volunteers and
health workers
3.3.1
Description
Primary User
CHT handbook
CHT volunteers
Health Workers
CHT volunteers
CHT volunteers
Reference guide of MC
book and home visit
CHT volunteers
CHT volunteers/
Health Workers
CHT database
Health Workers
The interviews asked health workers and CHT volunteers about the usefulness or importance of these
tools in the CHT program. Figure 10 shows the results of answers by each group. All tools received high
evaluationeither very useful/important or useful/importantby both health workers and CHT
volunteers. There are two tools for which a relatively large number of respondents failed to give any
answer or considered as not applicable. These are a CHT database for health workers (n = 12) and a
reference guide for the MC book for CHT volunteers (n = 21). As for the CHT database, the Team
believes that the CHT database is usually used to consolidate CHT monthly reports at the RHU/DHC
level, and some health workers who were not in charge of such consolidation at the RHU/DHC level
may not be familiar with the tool. As for the reference guide for the MC book, because the distribution
of the reference guide was only done once during the first orientation of the CHT program, a few CHT
volunteers, especially those who did not give any answer on this question, may have already stopped
23
Mothers
(N)
(%)
Discussion of the content of MC book by CHT volunteers during home visits (N=98)
Yes
77
78.6
No
21
21.4
Very good
43
55.8
Good
29
37.7
Fair
3.9
Poor
1.3
No answer
1.3
checked with 90 mothers who had brought their MC books during the interview. The following pages
of the MC book were checked by the surveyors: 1) birth and emergency plan (P14), 2) schedule of home
visits (by CHT volunteers) (P63), 3) present pregnancy (P3), 4) post-partum care within 42 days (P18),
and 5) postnatal care (P21). Midwives or health workers at RHUs/DHCs are responsible for filling out
24
the abovementioned pages of the MC book except the page of home visits, which is done by CHT
volunteers. As shown in Figure 11, a big
gap was identified in the recording status
between pages concerning prenatal and
postnatal periods.
The results showed that maximization of
MC book use is still limited by health
workers and CHT volunteers; however,
the usefulness of the MC book as a tool or
resource
for
health
education
was
(N)
Strongly agree
20
Agree
67
Disagree
12
Strongly disagree
1
100
Appropriateness of the task and workload related to the CHT program were assessed based on the results
of the interview with health workers and CHT volunteers. As for CHT volunteers, the results of their
opinions on their workload differed between Leyte and Ormoc (Figure 12). In Leyte, the majority of
CHT volunteers (53.3%) mentioned that their workload was just enough while CHT volunteers in
Ormoc had evenly spread-out answers with a slightly high frequency of too much. The backgrounds
of the interviewed CHT volunteers
gave some insights into such difference
in their opinion. CHT volunteers in
Ormoc seem to have heavier workload
than those in Leyte. For example, the
average numbers of households in a
CHT volunteers catchment area were
65 in Leyte and 100 in Ormoc. In
addition, the average working hours of
CHT volunteers per week were slightly
longer among the CHT volunteers in
Ormoc than in Leyte (seven hours in
Leyte; nine hours in Ormoc). In addition, according to the CHO, all CHT volunteers in Ormoc are
required to have duty at DHC and BHS during the daytime and sometimes even at night.
As for the ratio of households per health volunteer, the DOH sets the ideal ratio of the number of
households as one CHT volunteer per 20 households; however, in reality, CHT volunteers cover more
than three times the expected number of households in both Leyte and Ormoc.
Health workers were asked about the appropriateness of the required task of CHT volunteers by the
program in relation to their capacity; the majority (50.7%) consider the task appropriate. Slightly
difficult and difficult were also mentioned by 24.7% and 9.6% of the respondents, respectively. The
remaining respondents (15.1%) answered that the task of CHT volunteers was easy. Those who
answered difficult or slightly difficult said these were due to low educational level or old age of
CHT volunteers followed by lack of incentives. Health workers were further asked for their suggestions
on any CHT task to be removed from or added to the Program. The majority answered that no task
should be either removed (90%) or added (77%). Four health workers suggested adding commitment
on work as the task of CHT volunteers.
The
majority
of
health
workers
decreased.
The
remainder
from the
results
the
efficiency
of
the
and
26
In a similar manner, CHT volunteers were asked about their perceived recognition by others of the
importance of their work. The results showed similar trends as their answers to the previous question
except that MHOs/MOs received higher evaluation by CHT volunteers this time (Figure 15). Many CHT
volunteers felt they were being appreciated by health workers when health workers treated and
cooperated with them as part of their team at the health facility, coaching and mentoring them on skills
and knowledge. CHT volunteers also felt their importance being acknowledged by health workers when
their referred clients were accommodated well by health workers. It is noted that about 1020% of CHT
volunteers felt the importance of their work not being recognized by the LGU and barangay officials.
all sources of assistance they had received. The results presented limited assistance provided to the CHT
volunteers in general. Only barangay and the DOH were mentioned for assistance by about half of the
respondents.
Table 16: Assistance in any form received by CHT volunteers (by source)
CHT volunteers (n=100)
Area
Leyte
Ormoc
60
40
Total
100
DOH
30
(50%)
31
(77.5%)
PhilHealth
9
(15%)
28
(46.6%)
LGU
5
(8.3%)
18
(30%)
Barangay
46
(76.7%)
29
(48.3%)
61
37
23
75
(61%)
(37%)
(23%)
(75%)
As seen in Table 17, the majority mentioned the cash incentive from the DOH as the content of the
assistance. The DOH started providing cash incentive (PHP 3,000 per year) for CHT volunteers in 2012
as part of the national CHT program; however, this cash incentive ended in June 2015. In Ormoc, many
CHT volunteers mentioned the monetary assistance by PhilHealth. This is a sharing of Maternity Care
Package reimbursement which CHT volunteers are entitled to receive per their service. The amount of
such sharing depends on DHC. In addition, each barangay has an annual budget, which comes from the
Internal Revenue Allotment (IRA). Some barangays provide CHT volunteers with a monthly
honorarium or financial assistance (e.g., transportation) through the use of the IRA in the barangay.
In Ormoc, the LGU provides a relatively high monthly honorarium to BHWs and BNSs; however, some
CHT volunteers or BHWs/BNSs are not yet included in the payroll because of the limitation of the
number of slots available for such a benefit at the LGU.
Table 17: Breakdown of the content of the assistance
28
3.3.4
One area that became a hindrance to the efficiency in the CHT program was the timing of the
implementation of the CHT program. As mentioned in Chapter 1, the DOH central office introduced
their plan for KP-CHT implementation in August 2011 with a set of new guidelines and training
materials. The Project had just completed CHT orientation with more than 3,500 people using a set of
tools developed by the Project. Because of this, the Project and the C/P spent a considerable amount of
time developing a strategy to harmonize the activities such as revising the training materials and
guidebook and re-training CHT supervisors and CHT volunteers. Based on the training cost spent on the
first CHT orientation in Leyte, approximately PHP 2 million was additionally spent by the DOH RO8
on the harmonization of the CHT program in 2012.
3.4
Impact
The impact of the CHT program was examined to identify other areas where the CHT program was able
to have a positive influence. As a result, the following positive impacts were observed.
Contribution to other areas of health service delivery: A total of 82.4% of health workers
mentioned that the CHT program has contributed to delivery of health services aside from MCH
care. Other areas of such health services include the following: 1) MNCHN-related service (e.g.,
Expanded Program for Immunization, family planning, and nutrition); 2) communicable disease;
3) environment and sanitation; and 4) barangay-related activities.
Strengthened policy support for MCH service delivery: With the effort of PHOs, CHO and
RHUs, 35 LGUs in Leyte (both JICA and non-JICA target areas) and Ormoc city have passed the
ordinance on implementation of the maternal care incentive program (MCIP) by PhilHealth (Table
18). The program aims to provide cash incentives to the mother and the CHT volunteer in charge
of the client based on the clients use of expected MCH service at a health facility. CHT volunteers
are entitled to financial incentives based on the client and their performance. This scheme was
originally discussed among the C/Ps at the beginning of implementation as an alternative method
to increase PNV4 and help promote the activity by CHT volunteers. As a result, it created another
opportunity to strengthen political support for MNCHN service delivery. Of 36 LGUs with the
ordinance, 12 LGUs (11 LGUs from JICA target areas) in Leyte and Ormoc City have already
started actual implementation of the program.
Establishment of a regional initiative in promotion of MNCHN service: The DOH RO8 has
rolled out CHT orientation throughout the region to harmonize all CHT activities. The component
of CHT activities related to the Project was introduced to the rest of the region as a regional
initiative in the promotion of MNCHN service. As of now, all provinces and cities in the region
have adapted the component of the CHT program supported by the Project. Other donors, such as
USAID and IMC, have also supported training and meetings related to the CHT program.
29
Table 18: Status of MCIP ordinance and implementation in Leyte and Ormoc
ILHZ
Municipality
(with ordinance and
implementation)
Leyte Gulf
Golden Harvest
Maharlika
Calesan
Leyte West Coast
Mainbay
Mabahinhil
Alangalang, Pastrana
Javier
Kammao
Ormoc
3.5
Municipality
(without ordinance)
Leyte Plain
Goodwill
Municipality
(with Ordinance)
Ormoc
Sustainability
The Team examined the sustainability of the CHT program with regard to the ownership and the capacity
and resource mobilization to sustain the program.
3.5.1
DOH-RO VIII Special Order No. 069s, 2016 Clarification on the Operation of Community Health Team (CHT) in the
Region
7
30
program in the region with the introduction of the national CHT program, it required the effort of the
program manager to localize and harmonize the national program to fit into the existing system for
sustainability of the current CHT program. In addition, the effort must be made before the roll-out of
the program to avoid any possible confusion regarding the program at the local level. This mostly relies
on the capacities of the program manager in charge and his or her individual effort.
(2) Local government level
The level of ownership at PHOs and CHOs is high; however, one constraint noticed especially in PHOs
is the limited leverage to mobilize resources in support of the CHT program. In most cases, LGUs
depend on the funds by the DOH RO8 or other international donors for implementation of training
sessions and meetings or sometimes even provision of most logistics because of the limitation of their
budget or the cumbersome approval process at LGU. Nevertheless, they continue to take every
opportunity to monitor and sustain the program. It is also fair to say that the ownership of and
commitment to continuing the CHT program is high at the municipal and district levels. The results of
interview with health workers revealed that 97% think the CHT program should be continued at health
facilities. Some of them even mentioned in the interview that the program is already an established
system in their facility.
3.5.2
Quality of service and human resources are other important areas of consideration for sustainability of
the CHT program. In the interview with health workers, training needs for CHT volunteers were
confirmed with 82% of health workers, especially in the areas of report making (n = 45), client tracking
(n = 45), and knowledge on maternal and newborn care (n = 44). Mothers also attested to the importance
of maintaining good service by the CHT during the interview, and a few (n = 5) voiced that CHT
volunteers need more training to provide the service.
Table 19 shows the results of the interview with CHT volunteers on the different questions concerning
their performance and experiences. The top five responses by the CHT volunteers are arranged in
descending order. Training needs were mentioned in all areas as negative or positive factors affecting
performance, challenges, and suggestions for improving the program.
For the CHT program to continue to deliver expected services and outcomes, continuous training of
CHT volunteers is essential. This is relevant because of their low educational attainment and old age.
The constraint is that such training requires a large amount of money if the DOH RO8 or PHOs/CHOs
must be the ones to fund. For sustainability, it is ideal for training to take place on a much lower scale
and mainly at health centers. Some good practices shared by health workers during the interview were
conduct of a refresher training or on-the-job training activity for CHT volunteers and a monthly peer
review among CHT volunteers at health facilities. Some health workers use their monthly meeting as an
opportunity to conduct these activities. These practices can be strengthened throughout RHUs/DHCs.
31
Challenges or difficulties
experienced
Own commitment to
serve (81)
Training (74)
Availability of monetary
incentives (38)
Knowledge
enhancement (57)
Provision of
monetary incentives
(40)
Recognition by the
community (22)
Provision of logistics
(29)
Availability of IEC
material (25)
Supervision by health
workers (29)
Availability of logistics
(23)
Transportation (18)
Benefits related to
work (12)
Provision of IEC
materials (28)
As for human resources, the decreasing number of CHT volunteers has been a major concern in Leyte.
As seen in Table 20, the number of CHT volunteers in Leyte has decreased by more than 1,000 since
2011 when the first CHT orientation was conducted by the Project. An average 15.2% attrition rate per
year was recorded in Leyte. Unfortunately, the current assessment did not conduct an interview with
health workers and CHT volunteers to find out reasons of resignation by other CHT volunteers. However,
based on the experiences of the Project, CHT volunteers usually became inactive when they found a job
or other financial opportunities, or they decided to go back to school, or had health problems. The
attrition rate is likely to increase more in 2016 due to the termination of cash incentives by the DOH. In
contrast, a low attrition rate was observed in Ormoc. This is because the majority of CHT volunteers in
Ormoc are BHWs or BNSs who receive relatively high monthly honorarium by the LGU.
Table 20: Transition of the number of active CHT volunteers from 2011 to 2015
JICA priority
areas
2011
2013
2014
2015
Average per
year
Leyte
3,005
2,095
1,898
1,786
-406.3
-15.2
Ormoc
164
206
210
220
18.7
10.8
Total
3,169
2,301
2,108
2,006
-387.7
-13.5
Note: No data were available in 2012 because of the training of CHT orientation.
The decreased number of CHT volunteers will lead to increase of workload among the remaining CHT
volunteers, which will further jeopardize the service provided by CHT volunteers. Availability of
financial incentives for CHT volunteers is certainly one solution to keep CHT volunteers active in their
service. In Table 19, financial factors were also mentioned by CHT volunteers in all categories. For the
time being, CHT volunteers are highly motivated, as seen in the majority answering that their
motivational factor was their own commitment to serve the community. These are mainly sustained by
the enthusiasm of applying their new skills and knowledge and better relations with the clients and health
workers that show gratitude for the service. Contrary to the training needs mentioned by CHT volunteers,
100% of CHT volunteers also answered that they were very confident (52%) or confident (48%)
with their knowledge and skills to give health education to clients. Such high self-confidence is likely
32
to be boosted by both the expansion of their knowledge and competency due to the application of skills
into practice. In doing so, they have gained the trust of the client or even the community, who appreciate
the benefits coming from their service. In the long run, such motivation may deteriorate if basic
necessary changes like provision of financial assistance do not take place. As mentioned in section 3.4,
many RHUs have now started implementation of the MCIP in Leyte. The success of implementation of
the MCIP is crucial, as it will certainly contribute to the sustainability of the CHT program if no other
alternative solution is identified. Meanwhile, it is important to note that 30% of the mothers who
participated in the assessment was not enrolled in the PhilHealth. The source of MCIP funds comes from
the reimbursement of the PhilHealth through the utilization of the service by the client with PhilHealth.
It is equally important for RHUs to strengthen enrollment of the PhilHealth among the client to secure
the financial source of MCIP.
One cannot overlook the political influence at the local level. In the interview with health workers, a
few health workers mentioned the problem of barangay politics over CHT volunteers. In some cases,
CHT volunteers were replaced or recruited by barangay officials, and the level of support given to the
CHT volunteers is sometimes limited owing to the difference in their political affiliation with the
barangay. This tendency was also observed over the course of the Project. In the Philippines, as local
elections take place every three years, it is part of the sustainability risk of the CHT program over human
resources.
3.6
Others
The assessment originally aimed to analyze factors contributing to the functionality of the CHT program
through the comparison of health facilities with high and low accomplishment on the CHT program.
The assessment identified six facilities (four in Leyte; two in Ormoc) based on the review of the CHT
monthly report. These facilities were examined with regard to 1) policy support, 2) health financing, 3)
service quality based on the skills of Basic Emergency Obstetric and Newborn Care (BEmONC) service
delivery, and 4) geographic characteristics. CHT volunteers were also selected from these facilities for
the interview to examine any difference in their attitudes and characteristics. The Team identified health
facilities with low accomplishment of the CHT program in Leyte as being located in a geographically
challenged area, but this was not applicable in Ormoc. No other clear factors contributing to the
functionality of the CHT program were identified in this part of the assessment.
33
Chapter 4
The findings of the assessment reveal a positive impact of the CHT program on MNCHN service
delivery. More than 90% of the interviewed health workers appraised the concept of the CHT program
by the Project as suitable to the regional needs and the national strategy, and deemed as important the
programs key activities such as tracking of pregnant and post-partum women and newborns, home visits
during prenatal and postnatal periods, and health education.
The statistical data and the interview outcome also confirmed the effectiveness of the CHT program.
The data show a tangible achievement of the CHT program in improving the status of MNCHN service
in the JICA target area. CHT volunteers in the area served successfully as an important link between
mothers and health facilities. The interview results also showed that CHT volunteers are considered as
a mothers source of information on MCH care and a contributing factor in a mothers decision making
on seeking MCH services at a health facility.
The efficiency of the CHT program seems acceptable. Health workers and CHT volunteers evaluated
highly all the tools developed by the Project for the program. The strategy of institutionalizing the MC
book as a tool for the CHT program helped CHT volunteers provide standardized health information to
their clients and increased the use of the MC book by health workers and mothers. However, it is still
necessary to increase the use of the MC book among health workers and CHT volunteers. An
environment supportive of the CHT program was established firmly within health facilities while limited
support at the community level was identified among a few CHT volunteers. A major obstacle to the
efficiency of the CHT program was the initial overlapping in the CHT program activities between the
Project and the DOH central office. It took much time and money to harmonize the activities and retrain the facilitators and CHT volunteers during the second year of the Project.
The CHT program produced a few positive impacts on strengthening other areas of health service
delivery by CHT volunteers, strengthened LGUs policy support for MCH service delivery, and helped
the DOH RO8s establishment of the regional initiative in promoting MNCHN service delivery. The
latter two impacts also helped enhance the sustainability of the CHT program. PhilHealth initiated the
Maternal Care Incentive Program (MCIP) to create an incentive provision system for women. With the
growing recognition of the importance of CHT volunteers, the volunteers also became beneficiaries of
the MCIP. They are entitled to a financial incentive based on the performance of both their clients and
their tasks. Thirty-five LGUs of Leyte and Ormoc City have passed the required ordinance for the MCIP,
and a few have started implementing the MCIP (refer to Table 18). The MCIP will enhance the
sustainability of CHT volunteers greatly because the lack of financial assistance is a major reason for
the high attrition rate of CHT volunteers. Meanwhile, policy makers must meet the challenge of
protecting active CHT volunteers from the influence of local politics because lack of recognition on this
matter by barangay officials caused a few volunteers to resign or be replaced.
The CHT program in the region gave the DOH RO8 an opportunity to implement an additional strategy
to strengthen MNCHN services. The DOH RO8 has adopted the activities introduced by the Project
34
component in national CHT program as its regional initiative. The ownership of the DOH RO8 became
another backbone of the sustainability of the program in the region. By contrast, the advent of a new
administration in the country may require the DOH RO8 to cope with a new national strategy in
MNCHN services. The DOH RO8 must come up with a strategy to localize any future national program
and make it fit into the existing system of the CHT program in the region for the CHT programs
sustainability.
The Team identified the following lessons learned through the intervention of the CHT program. These
lessons should be taken into account to improve the CHT program and implement effectively any
relevant future programs involving communities.
1. Selection of CHT volunteers: To meet the national target ratio of one health volunteer per 20
households, the Project and the C/Ps tried to recruit many CHT volunteers in the JICA target areas in
such a way that the number of CHT volunteers in each JICA target area would be appropriate for the
areas population. Because of the emphasis on reaching the expected number of CHT volunteers, the
qualifications of the volunteers were not given the priority that they deserved in the recruitment process.
As attested by the results of the current assessment, there are CHT volunteers with low educational
attainment and of old age. Many health workers stated that these factors affected the performance of
CHT volunteers and the implementation of the program. Meanwhile, the feasibility of recruiting the
expected number of qualified people as CHT volunteers was questionable because the incentive to the
volunteers was meager. It is necessary to provide a suitable incentive to recruit qualified and dedicated
people for any work.
2. Legalization of CHT volunteers: The CHT program deployed many CHT volunteers who were
willing to serve a community regardless of their positions in the community. challenge in the
program is how to ensure the status of these volunteers. Unlike BHW whose status was backed by law
as a community health volunteer8, CHT volunteers have no legal evidence or backup to secure their
status. This affects some CHT volunteers with regard to receiving support such as financial assistance
or incentives from barangays or LGUs.
3. Involvement of barangay and community: The Project conducted the CHT program only up to the
RHU/DHC level because of the large size of the JICA project area; therefore, not many activities were
either supported or implemented in mobilizing CHT volunteers at the community level. To obtain proper
understanding of the program and solicit more support to CHT volunteers at the barangay level, more
active intervention is necessary to enhance the performance of the program. This is evidenced by a
barangay captain allocating some IRA funds to support CHT volunteers for logistics and travel costs
because of her familiarity with and engagement in the CHT program.
4. Establishment of a system for the benefit of CHT volunteers: With the confirmed needs of support
to CHT volunteers, especially in the logistical and financial spheres, it is necessary to provide each CHT
volunteer with tangible benefits for his or her service. The volunteers serve a highly useful purpose by
R.A. 7883 Barangay Health Workers Benefits and Incentives Act of 1995.
35
being part of the system to promote good health in the communities. Those CHT volunteers who serve
but are not commensurately rewarded for their work may be demoralized and resign. Thus, a supportive
environment with a sustainable financial and non-financial benefit scheme must be established for the
CHT program at the beginning.
5. Efficient use of tools and maximizing local resources: Given the limited budget available at health
facilities, the strategy of minimizing the number of tools and maximizing resources is important for the
sustainability of the CHT program. Reporting formats used for CHT volunteers in the Project were
mainly the pregnancy tracking form and the post-partum tracking form. A sheet of each of the two forms,
which is printed on both sides of a piece of paper, can accommodate 16 clients and be used for the entire
duration of the prenatal and post-natal periods. Tanauan and Linao have the largest population sizes in
the JICA priority barangays of Leyte and Ormoc: Tanauan has 48,356 people; and Linao, 29,831. Based
on the number of available CHT volunteers and the expected number of pregnant women per year, each
CHT volunteer tracks average one to three women per month. Two sheets of each reporting format used
in the CHT program are good for one year if they are used appropriately. The cost of those sheets
(approximately PHP 8.00 per set) is a worthwhile investment for the program considering the benefit of
the tracking using them in MCH service. Another format introduced by the Project is a CHT monthly
report, which is used once a month at BHS and RHU/DHC. The Project also introduced the CHT
database to RHUs/DHCs, PHO/CHO and the DOH RO8 for possible computerization of the CHT
monthly report to reduce the logistical cost. The use of the MC book as an education tool has brought a
few advantages such as the standardization of health information, the maximization of the use of national
resources, and the reduction in the cost of producing another educational material that would require
sustainable funds for reproduction.
36
Chapter 5
RECOMMENDATIONS
Based on all the findings and lessons learned, the Team submits the following recommendations for
improving the CHT program in the region and its sustainability.
Recommendation 1: Sharing the results of CHT assessment:
The results of the current assessment showed the effectiveness of the CHT program and the importance
of CHT volunteers at the community level. The challenges regarding the CHT program were also
addressed well. These results should be shared with the DOH central office, donors and respective LGUs
for improving the CHT program and any future interventions.
Recommendation 2: Coordination with the DOH central office and other donors:
The DOH RO8 should take necessary actions to harmonize and localize similar national programs or
projects by other donors in the future to ensure the sustainability of CHT program. This does not prevent
the implementation of other important programs but enables the DOH RO 8 to give consistent policies
and instructions to health officers and workers at the local level. Technical working group meetings with
relevant program managers should be held for any new intervention which may affect the CHT program
in region.
Furthermore, it would be useful if the DOH Central Office developed a national policy to encourage all
the regional offices to harmonize a new program with their existing system to maximize the benefits of
all programs.
Recommendation 3: Strengthening policy support to the CHT volunteers:
To provide sustainable assistance to the CHT volunteers, PHO and CHO, in cooperation with the DOH
RO8, should continue to advocate policy support to the CHT volunteers through the MCIP. The
implementation of the MCIP will not only help CHT volunteers receive financial assistance but also
help convince their clients of the merit of the use of MCH services in health facilities. At the same time,
PHO and CHO must expand the enrollment and ensure the continued enrollment of PhilHealth among
the client to secure the financial resource to implement the MCIP.
PHO and CHO should also strive to establish a system to protect active CHT volunteers from local
politics. The Team suggests that a barangay or municipal resolution be formulated to prevent barangay
officials from replacing registered or accredited health volunteers without consulting RHUs or DHCs.
Furthermore, the DOH RO8 should train existing active CHT volunteers with no position on BHW
functions to be registered and accredited as BHWs. Simultaneously; the DOH should develop criteria
such as qualification and the ratio of health volunteers for appropariate recruitment of health volunteers.
It is strongly recommended that the criteria be feasible enough for LGUs to implement by considering
the characteristics of the area (e.g., urban and rural) and availability of financial resource to support
health volunteers.
37
38
Area of Concerns
Organizational Structure and Management
Composition of Community Health Team
DOH/JICA SMACHS-EV
National KP Program
4. Lobby to the local health board for the establishment of a public-private service
delivery network that includes public and private providers;
6. Coordinate with the MHO/ CHO to secure validated list of NHTS-PR families
in coordination with the PHO and CHD.
7. Ensure that community volunteers selected are comprehensively trained,
evaluated, and are able to perform expected tasks
8. Continuously assess performance and capabilities of the community health team
members and provide technical assistance/guidance as needed and make the
necessary adjustments (to CHT matching / allocation of NHTS families) based on
the results of assessment.
9. Lobby to the LCE (BC, Mayor) and local health board for: 1) Securing
resources and policy support for CHT-related activities, 2) Establishing a
functional public-private service delivery network
10. Review HUP compliance forms and support preparation of the HUP
compliance consolidation forms
No
Area of Concerns
DOH/JICA SMACHS-EV
National KP Program
2. Conducting a Maternal/Neonatal Death Review Meeting at municipal/city Level 2. Provides technical guidance to RHMs in the management of CHT
3. Conducting monitoring and follow-up on CHT activities
3. Links CHTs to resources and other forms of support at various levels (LGU,
PHO, CHD, development partners)
4. Consolidating the data of the reports from each BHS, and updating the
monitoring tools
5. Organizing and providing training and orientation to CHTs in their
municipality/district
3.1 CHT volunteers
CHT as a Team
No
Area of Concerns
DOH/JICA SMACHS-EV
National KP Program
B
1
Meeting
Home Visits
Not Clearly stated as to how many visits, depending on the families needs based
on the health risks identified (or monthly)
CHT tools/forms
1. CHT Guidebook (Kept by CHT member, not given for the family) * It was 1. CHT Guidebook (developed by National KP-CHT program)
renamed as "Handbook for Community Health Team" in 2014 by the Project.
Focusing on "Pregnant/Postpartum Women and newborns " and "MCH related Focusing on Maternal Health (Pregnant/Postpartum Women), Newborn, Infant,
services" based on "MC book "
Child and Adolescent Health, Children, Family Planning, TB and PhilHealth.
2. MC Book (Kept by Mother & CHT members): MC book is issued to the mother 2. Family Health Guide and Family Guide on PhiliHealth (kept by family,
by the Midwife and kept at house, and CHT will refer the book during their issued/distributed by the CHT member)
Homevisits
3. Tracking Forms (Pregnancy, Postpartum and Newborn) for the use of CHT
3. Forms on:
(1) Family Profile
(2)Health Plan Implementation for Newborn Health
(3)Heallth Plan Implementation for Infant Health
(4) Health Plan Implementation for Child Health
(5) Health Plan Implementation for Maternal Health : Pregnancy
(6)Health Plan Implementation for Maternal Health : Post-partum
(7) Health Plan Implementation for Maternal Health: Family Planning
(8)Health Plan Implementation for Chornic Cough Management
4. CHT monthly report: tools to consolidate the data of pregnancy/postpartum 4. Logbook and Summary report of Health Visits* likely to be changed
tracking forms for use of CHT leader during the meeting
CHT Target
All household
Date
Surveyor Statement
I have carefully explained to the subject the nature of the above protocol. I hereby certify that to the best of my knowledge
the subject signing this consent form understands the nature, demands, risk and benefits involved in participating in this
survey.
Date
Location
Code Number
Contact # (Mobile)
ID No
Starting Time
Ending Time
RHU
Questions
A1 Gender
1) Female
2) Male
years old
A3 What is your educational attainment?
1) College degree
4) Other: specify________________________
A4 What is your position in the health center? How many years have you been working in this facility?
3) MHO/MO (_________years)
1) Yes
2) No
Proceed to Question A7
A6 In providing prenatal care, do you find it difficult to achieve the coverage of 4 prenatal check-up to all your target
clients?
1) Yes Why? What are the issues and problems?
A7 In your opinion, was there any improvement in the performance of MNCHN service delivery in your facility after
A8 In your opinion, how helpful was the CHT program in improving MNCHN service delivery in your facility?
1) Slightly helpful
3) Mostly helpful
2) Helpful
4) Very helpful
A9 How helpful was the CHT program in improving the following services related to MNCHN? You have six selections
from: Not at all; Slightly helpful; Helpful; Mostly helpful; Very helpful; or I don't know.
(1) Antenatal Care service (ANC)
1) Not at all
3) Helpful
5) Very helpful
2) Slightly helpful
4) Mostly helpful
6) I dont know
(2) Facility Based Delivery Service
1) Not at all
2) Slightly helpful
3) Helpful
4) Mostly helpful
5) Very helpful
6) I dont know
3) Helpful
4) Mostly helpful
5) Very helpful
6) I dont know
A10 Are there any other health services in your facility in which CHT program helps to improve? If yes, what are those?
1) Yes
2) No
Specify:
A11 In your opinion, how much do you agree on the importance of the following activities by CHT members to help
improve MNCHN service delivery at your facility? Please select your answer from the following: Strongly Agree;
Agree; Disagree; Strongly Disagree; Not Sure for each activity.
[SURVEYOR] Please start by asking "How much do you agree on the importance of "******"?, per item. If the
answer is "Strongly Agree" or "Strongly Disagree" , please follow-up on the reason. If the Participant mentioned
the reason, please take notes in the column also. Please check "Not Sure" if the participant is not familiar with the
activity.
Strongly
agree
(4)
Agree
(3)
Not sure
(2)
Strongly
disagree
(1)
Reason
4 Home Visits during client's postpartum period
Reason
5 Health Education
Reason
6 Health Profiling of the client
ITEM
1 Pregnancy Tracking of the Client
Reason
2 Home visits during client's pregnancy period
Reason
3 Post-partum and Newborn Tracking of the
client
Disagree
(0)
Reason
A12 How do you evaluate the usefulness of the following tools provided by DOH or JICA for CHT program? Please
select your answer from: Very Useful; Useful; Slightly Usefult; Not Useful; or N/A for each item.
[SURVEYOR] Start by asking, "Do you know ******? How do you evaluate its usefulness?" If the interviewee is
not familiar with the item, please mark as "N/A". IF THE ANSWER IS EITHER:" Very Useful" or " Not Useful" ,
PLEASE ASK FOR THE REASON. At the end, please ask "Anything else?" for the answer in (10) Others.
Very
useful
(4)
Useful
Not
Useful
(1)
N/A
(3)
Slightly
useful
(2)
Reason
2 CHT Handbook (SMACHS-EV)
Reason
3 Health Use Plan
Reason
4 Pregnancy Tracking Form
Reason
5 Postpartum and Newbon Tracking Form
Reason
6 CHT monthly report
Reason
7 CHT database (SMACHS-EV)
Reason
8 MC Book
Reason
9 CHT reference guide (laminated)
ITEM
1
KP-CHT Guidebook
(0)
Reason
10 Others: Specify_______________________
Reason
A13 In general, how do you assess the required task of the CHT member in relation to their capacity?
1) Difficult
1) Yes
Move to A16
2) No
Move to A17
A16 If you answered "Yes", in what areas do CHT members need to have training?
* Multiple answers
1) Knowledge on Maternal and Newborn Care (Please specify:
2) Skills on making required reports (e. g., Tracking Report/Health Use Plan)
3) Tracking of pregnant women
4) Tracking of post-partum women and newborn
5) Others: Specify:
A17 Among the tasks given to CHT members, is there any task which should be removed from them?
2) No
A19 How is your workload after the implementation of the CHT program?
1) Increased
3) Same as before
2) Slightly increased
4) Slightly decreased
5) Decreased
A20 Do you think the CHT program should be continued in your facility?
1) Yes
Why?
2) No
Why?
A21 What is the most challenging activity in the implementation of the CHT program in your facility, if any?
Specify:
A23 What are the necessary activities to sustain the implementation of the CHT program, if any?
* Multiple answers
1) Regular training of CHT volunteers
2) Regular meetings conducted by PHO/CHO/DOH8
3) Deployment of adequate number of CHT volunteers/members
4) Deployment of additional health workers (either contractual or permanent, e. g. DTTB, NDP, RHMPP, etc.)
5) Provision of financial incentives to CHT volunteers
6) Provision of financial incentives to health workers
7) Ordinance
Specify:
8) Other
Specify:
A24 What advantages did the CHT program bring to you or your facility, if any?
A25 What disadvantages did the CHT program bring to you or your facility, if any?
A26 What areas in the implementation of the CHT program need improvement?
A27 Based on your experience, can you give any suggestions to the DOH to improve the implementation of the CHT
program?
A28 Could you share any innovative activity done by you, or by your facility to improve performance of CHT program, if
any?
2015/6 (D/M)
Waray
Contact # (Mobile)
Name of Barangay
Name of BHS
Name of RHU
ID No
Starting Time
Ending Time
A. Background Information
A1 Pira it imo edad?
(How old are you?)
years old
A2 May asawa ka na ba?
(What is your marital status?)
1) Single
2) Common Law Spouse
3) Married (Legal)
4) Separated
5) Widow
Place of delivery/Name of
facility
4) College
6) Post graduate
2) Elementary School
5) Vocational School
3) High School
(Pls specify: Grad, 1, 2, 3, 4)
A7 May ada ka ba pakabuhi ha gawas hit balay? Gin babayaran ka ba para hiton nga trabaho?
(Do you have work outside home? Are you paid for work?)
1) Yes, I have paid work (Specify the kind of work:
2) Yes, I have unpaid work (Specify the kind of work:
3) No, I don't have any work
DOH/JICA SMACHS-EV Project-Questionnaire for Mother-Waray Waray
)
)
Waray
5) 10,000 to 14,999.00
6) 15,000.00 and above
5) 6 years or more
3) Mountain area
4) Island
5) Others: specify
A13 Ano it imo kasagaran nga sinasakyan tikang ha iyo balay tikadto ha ______________________(ngaran han iya health
center)?
(What is your usual means of transportation from your house to ________________________(name of her health
center)?)
*Multiple answers. Please use the name of RHU/BHS where she used the service when asking the respondent.
Travel
Means of transportation time (in
minutes)
Is there a regular
trip?
1. By walking
2. Motorcycle
(Habal-habal)
Yes
No
3. Tricycle
Yes
No
4. Jeepney
Yes
No
5. Multicab
Yes
No
Yes
No
6. Other: (specify)
Waray
A14 Ano ka dako it imo problema, kun may ada man, hiunong hit imo pagsakay tikadto ha health center?
(How much problem do you have with your transportation in going to the health center?)
1) Not a problem
3) Big problem
2) Somewhat problem
A15 Nagkukuri ka ba pagkadto ha health center para hit imo regular nga prenatal check-up o check-up kahuman panganak?
(Do you have a difficulty in going to health center for regular prenatal or postpartum check-ups?)
1) Yes
2) No
Proceed to B1
A16 Ano an mga nangunguna nga rason hit imo kakurian?
(What are the main reasons of your difficulty?)
1) Cost of Transportation
4) Travel Distance
2) Cost of health service
5) Household work
3) Family's disagreement
6) Outside work/job
Proceed to B3
2) No
B2 Nakilala ka ba han tawo nga naghahatag hin serbisyo panlawas para han mga nanay ngan mga bag-o nga gin anak ha
iyo komunidad?
(Do you know the person who is providing maternal and newborn services in your community?)
1) Yes
2) No
B3 Hin-o nga tawo o mga tawo nga naghahatag hini nga mga serbisyo?
(Who are the person/people who provide such services?)
*Multiple answers. Please read the following to the respondent.
1) Barangay Health Worker (BHW)
4) Barangay Nutrition Scholars (BNS)
2) BSPO
5) Parent's leader
6) Others: specify
B4 Maaram ka ba hit ngaran hit CHT/BHW/BNS/BSPO nga nakapot hit iyo komunidad?
(Do you know the name of the CHT/BHW/BNS/BSPO who is assigned in your community?)
* Please confirm the name of CHT at the office after interviews, and mark "confirmed". The respondent may
give a nickname instead of the actual name. If so, please record as it is.
1) Yes : please tell me the name of CHT
2) No
Waray
B5 Ano nga mga klase hin serbisyo an gin hahatag ni ___________________________(ngaran han CHT nga baton ha
igbaw) ha imo? Alayon pag grado tikang ha 1 ngada ha 4 han imo kakuntento han kada serbisyo nga gin hatag. An 4
komo kuntento hin duro.
(What kind of services does _______________(name of CHT answered the above) provide you?)
What is your satisfaction of each service you mentioned?
* Multiple answers. Please do not give any answer key to the respondent, but "Probe" (E.g. "What else?") .
Very
Somewhat
Not
Dissatisfied
satisfied satisfied satisfied
(1)
(4)
(3)
(2)
Services
N/A
(0)
B6 (Only for those who answered "Home Visit" in the above question in B5.)
Pira ka beses nagbisita an CHT ha imo?
(How many times did CHT visit you?)
Time Period
Waray
B9 Gintagan ka ba hin Mother and Child Book dida han imo urhi nga pagburod? Kun waray, ano an rason?
(Were you given a Mother and Child Book for your last pregnancy? If no, what was the reason?)
*(Interviewer) Please show the MC book to the Client.
1) Yes
Proceed to next question
2) No
Specify reason and proceed to B16
Reason:
B10 Aada pa ba ha imo an Mother and Child Book han imo urhi nga pagburod? Kun waray, ano an rason?
(Do you still have a Mother and Child book for your last pregnancy? If no, why?)
1) Yes
2) No
Specify reason and proceed to B12
Reason:
B11 (Ask the respondent to show you her MC book & check the status of the following pages)
Pages
Properly filled-out?
1
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Remark
B12 Ano kadako an naibulig han MC Book ha imo han imo urhi nga panganak?
(Was the MC Book useful for your latest delivery?)
Very useful (4)
Useful (3)
Somewhat useful (2) Not useful at all (1)
B13 Ano an rason han imo gin baton ha igbaw?
(What is the reason of your answer above?)
B14 Gin tutdo ba ni ____________________ (ngaran han CHT) an sulod han MC Book?
(Did _________________(name of CHT) discuss the content of MC book?)
1) Yes
2) No
Go to B16
B15 Ha grado tikang ha 1 ngada 4, 4 komo maupay hin duro, ano kaupay an pagtutdo ni _____________________(ngaran
han CHT) han sulod han MC Book dida han iya pagbisita
(On the scale of 1 to 4, 4 being very good how well did _______________________(name of CHT) discuss the
content of MC book during her/his visit?)
Very good (4)
Good (3)
Fair (2)
Poor (1)
Waray
B16 Ano ka importante an CHT han imo eksperyansya ha pagburod ngan han panganak?
(How do you evaluate the importance of CHT in your maternal experience?)
Very important (4)
Important (3)
B18 Hin-o o ano an imo kinukuhaan hin impormasyon hiunong han pagataman han panlawas han nanay ngan bata?
(Who or what are your sources of information about maternal and child health care?)
1) Family/relatives
5) RHU/BHS/DHC staff
2) Friends
6) MC book
3) CHT members
7) Others
4) Mass media/magazine
*Multiple Answers
Specify:
8) No information/ Did not know
Specify:
B19 Ha imo opinyon, ano kaimpluwensiya han mga masunod han imo desisyon pangita hin serbisyo panlawas para nanay
ngan bata ha pasilidad nga panlawas? Alayon pag grado tikang ha 1 ngada ha 4, 4 komo makusog hin duro it
impluwensiya.
(In your opinion, how influential are the following in your decision of seeking Maternal Child Care Services at health
facility? Please answer on the scale of 1 to 4, 4 being the most influential.)
Item
Very
influential
(4)
Influential
Not
influential
(1)
N/A
(3)
Slightly
influential
(2)
(0)
Husband
Parents
Community's opinion
CHT:(Name:
Midwife
Nurse
Doctor
Ordinance
Other: Specify
Waray
B20 Nakatagamtam ka ba han mga masunod nga mga serbisyo dida han imo urhi nga pagburod? Kun oo, hin-o an nag
impluwensya ha imo para makakuha hini nga mga serbisyo? Kun waray, ano an imo rason o mga rason?
(Have you availed of the following services for your last pregnancy? If yes, who influenced you to avail of these
services? If no, what is/are your reason/s?)
Services
Yes, I
availed
Who influenced?
No, I didn't
avail
3. Facility based
Delivery (FBD)
4. Post-partum Care
5. Immunization
6. Family Planning
C2 Alayon pagsumat hit imo mga ideya kun uunan-un hit CHT it pagpauruupay hit ira serbisyo para ha mga nanay ngan
(Please share your ideas on how CHT can improve their service for mothers and babies?)
Visaya
Contact # (Mobile)
Name of Barangay
Name of BHS
Name of RHU
ID No
Starting Time
Ending Time
A. Background Information
A1 Pila ang imong edad?
(How old are you?)
years old
A2 Minyo na ka?
(What is your marital status?)
1) Single
2) Common Law Spouse
3) Married (Legal)
4) Separated
5) Widow
Place of delivery/Name of
facility
6) Post graduate
2) Elementary School
5) Vocational School
3) High School
(Pls specify: Grad, 1, 2, 3, 4)
Visaya
A7 Aduna ba kay trabaho gawas sa imong balay? Gibayaran ba ka sa imong trabaho?
(Do you have work outside home? Are you paid for work?)
1) Yes, I have paid work (Specify the kind of work:
2) Yes, I have unpaid work (Specify the kind of work:
3) No, I don't have any work
A8 Pila ang tibuok nga kita sa imong pamilya sa usa ka buwan?
(How much is your average family monthly income?)
3) 4,000.00 to 6,999.00
1) Less than Php 1,000.00
2) 1,000.00 to 3,999.00
4) 7,000.00 to 9,999.00
)
)
5) 10,000 to 14,999.00
6) 15,000.00 and above
A9 Miyembro ba ka sa PhilHealth?
(Are you a PhilHealth member?)
* Please ask the respondent the membership ID if she is a member
1) Yes with a PhilHealth ID
3) No, but a Philhealth beneficiary
2) Yes without a PhilHealth ID
4) No
A10 Miyembro ba ka sa 4P's?
(Are you a 4P's member?)
1) Yes
2) No
A11 Unsa ka dugay na ka nagapuyo sa imong barangay?
(How long have you lived in the current barangay? )
1) Less than 6 month
3) 1 to less than 3 years
2) 6 month to less than 1 year 4) 3 to less than 6 years
A12 Asa dapit ang imong lugar nga ginapuy-an?
(How do you describe the area where you live?)
1) Within downtown (or commercial area)
2) Near downtown (or commercial area)
5) 6 years or more
3) Mountain area
4) Island
5) Others: specify
Visaya
A13 Unsa kasagaran ang imong masakyan gikan sa imong balay padulong sa __________________(ngalan sa iyahang
health center)?
What is your usual means of transportation from your house to ________________________(name of her health
center)?
*Multiple answers. Please use the name of RHU/BHS where she used the service when asking the respondent.
Travel
Means of transportation time (in
minutes)
Is there a regular
trip?
1. By walking
2. Motorcycle
(Habal-habal)
Yes
No
3. Tricycle
Yes
No
4. Jeepney
Yes
No
5. Multicab
Yes
No
Yes
No
6. Other: (specify)
A14 Unsa ka dako ang imong problema alang sa masakyan padulong sa health center?
(How much problem do you have with your transportation in going to the health center?)
1) Not a problem
3) Big problem
2) Somewhat problem
A15 Naglisod ba ka sa pag-adto sa health center alang sa imong regular nga prenatal check-up o check-up human sa pangan
(Do you have a difficulty in going to health center for regular prenatal or postpartum check-up?)
1) Yes
2) No
Proceed to B1
A16 Unsay mga nangunguna nga rason sa imong pagkalisod?
(What are the main reasons of your difficulty?)
1) Cost of Transportation
4) Travel Distance
2) Cost of health service
5) Household work
3) Family's disagreement
6) Outside work/job
HC
9) Other: specify below
Proceed to B3
Visaya
B2 Kaila ba ka sa mga tawo nga nagahatag og serbisyo sa panglawas alang sa mga inahan ug sa mga bag-ong natawo sa
imong komunidad?
(Do you know the person who is providing maternal and newborn services in your community?)
1) Yes
2) No
End of survey, please thank the respondent
B3 Kinsa ni nga tawo o mga tawo nga nagahatag niini nga mga serbisyo?
(Who are the person/people who provide such services?)
*Multiple answers. Please read the following to the respondent.
1) Barangay Health Worker (BHW)
4) Barangay Nutrition Scholars (BNS)
2) BSPO
5) Parent's leader
6) Others: specify
3) Day Care Worker
B4 Kabalo ba ka sa ngalan sa CHT/BHW/BNS/BSPO nga nadestino sa inyong komunidad?
(Do you know the name of your CHT/BHW/BNS/BSPO who is assigned in your community?)
* Please confirm the name of CHT at the office after interviews, and mark "confirmed". The respondent may
give a nickname instead of the actual name. If so, please record as it is.
1) Yes : please tell me the name of CHT
2) No
B5 Unsa nga mga klase og serbisyo ang ginahatag ni ________________(ngalan sa CHT nga gitubag sa taas) sa imo?
Palihug sa pag grado gikan sa 4 hangtod sa 1 alang sa katagbawan sa serbisyo nga gihatag kanimo. 4 isip pinaka
katagbawan.
(What kind of services does _______________(name of CHT answered the above) provide you?)
What is your satisfaction of each service you mentioned?
* Multiple answers. Please do not give any answer key to the respondent, but "Probe" (E.g. "What else?") .
Services
Very
Somewhat
Not
Dissatisfied
satisfied satisfied satisfied
(1)
(4)
(3)
(2)
3. Health Education/Advise
(
)
8. Other: Please specify
(
)
B6 (Only for those who answered "Home Visit" in the above question in B5.)
Pila ka higayon nga ang CHT nagbisita kanimo?
(How many times did CHT visit you?)
Time Period
N/A
(0)
Visaya
B7 Unsa kadugay kasagaran si _______________________(ngalan sa CHT) mogahin og panahon uban kanimo matag
bisita?
(How long does ___________________(name of CHT) usually spend time with you per visit? (Average time))
minutes
B8 (Only for those who answered "Health Education/advise" in the question B5.)
Katong miduaw si ______________________(ngalan sa CHT), unsa nga mga impormasyon ang gihatag sa CHT kanim
(When _________________________(name of CHT) visited you, what kind of information did CHT give you?
Multiple Answers)
B9 Gitagaan ba ka og Mother and Child Book alang sa imong ulahi nga pagmabdos? Kon wala, unsa ang rason?
(Were you given a Mother and Child Book for your last pregnancy? If no, what was the reason?)
*(Interviewer) Please show the MC book to the Client.
1) Yes
Proceed to next question
2) No
Specify reason and proceed to B16
Reason:
B10 Anaa lang ba gihapon ang Mother and Child Book gikan sa imong ulahi nga pagmabdos? Kon wala, ngano?
(Do you still have a Mother and Child book for your last pregnancy? If no, why?)
1) Yes
2) No
Specify reason and proceed to B12
Reason:
B11 (Ask the respondent to show you her MC book & check the status of the following pages)
Pages
Properly filled-out?
1
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Remark
Visaya
B13 Unsa ang rason sa imong gitubag sa taas?
What is the reason of your answer above?
Good (3)
Fair (2)
Poor (1)
B18 Kinsa og unsa ang imong mga tinubdan sa impormasyon bahin sa pag-atiman sa panglawas sa inahan ug bata?
Who or what are your sources of information about maternal and child health care? *Multiple answers.
1) Family/relatives
5) RHU/BHS/DHC staff
2) Friends
6) MC book
3) CHT members
7) Others
4) Mass media/magazine
Specify:
Specify:
8) No information/ Did not know
Visaya
B19 Sa imong opinyon, unsa ka impluwensiya ang mga mosunod sa imong desisyon sa pagpangita og serbisyo sa
panglawas alang sa inahan ug bata sa usa ka pasilidad? Palihug sa pag grado gikan sa 1 hangtod 4, 4 mao ang pinaka
kusog ang impluwensya
(In your opinion, how influential are the following in your decision of seeking Maternal Child Care Services at health
facility? Please answer on the scale of 1 to 4, 4 being the most influential.)
Item
Very
influential
(4)
Influential
Not
influential
(1)
N/A
(3)
Slightly
influential
(2)
(0)
Husband
Parents
Community's opinion
CHT:(Name:
Midwife
Nurse
Doctor
Ordinance
Other: Specify
B20 Nakapahimulos ba ka sa mosunod nga mga serbisyo alang sa inyong ulahi nga pagmabdos? Kon oo, kinsa ang
nagimpluwensiya kanimo sa pagpahimulos niini nga mga serbisyo? Kon walay, unsa ang mga rason?
(Have you availed of the following services for your last pregnancy? If yes, who influenced you to avail of these
services? If no, what is/are your reason/s?)
Services
Yes, I
availed
Who influenced?
No, I didn't
avail
3. Facility based
Delivery (FBD)
4. Post-partum Care
(PNC)
5. Immunization
6. Family Planning
Visaya
C. Suggestions and Comments for improvement
C1 Palihug sa paghatag bisan unsa nga maayo og dili maayo nga kasinatian nga imong nasinati sa CHT.
(Please share any good or bad experiences you had with your CHT.)
C2 Palihug sa paghatag sa imong mga ideya sa kung unsang paagi mapalambo ang serbisyo sa CHT alang sa mga inahan
ug sa mga bata?
(Please share your ideas on how CHT can improve their service for mothers and babies?)
Waray
Contact # (Mobile)
ID No
Starting Time
Ending Time
RHU
A. Background Information
A1 (Gender)
1) Female
2) Male
3) Married (Legal)
4) Separated
5) Widow
4) College
6) Post graduate
2) Elementary School
5) Vocational School
3) High School
(Pls specify: Grad, 1, 2, 3, 4)
A5 May ada ka ba gin kakaputan nga posisyon? Ano ka na kaiha dida hiton nga posisyon?
(How long have you been working as CHT member?) *If CHT answered in years, convert it to number of months
months
Waray
A7 Paano ka naging usa nga miyembro han CHT?
)
)
3) Self-volunteered
4) Other :Please specify
A8 Pira ka oras ha usa ka semana ka nagtratrabaho komo CHT?
(Do you have work aside CHT? Are you paid for work?)
1) Yes, I have paid work (Specify the kind of work:
A11 Pira it kasagaran nga kita hit imo pamilya kada bulan?
5) 10,000 to 14,999.00
6) 15,000.00 and above
Waray
A14 Puydi mo ba maisumat ha akon an mga ngaran han mga cluster/purok/sitio nga imo gin kakaptan?
No
No. of HH
Remark if any
Total
A15 Ano it imo sinasakyan tikang ha iyo balay ngadto ha pinakaharayo nga panimalay/pamilya nga imo gin kakaptan?
(What is your means of transportation from your house to your furthest household/family?)
*Multiple answers
Means of transportation
Travel
time (in
minutes)
Is there a regular
trip?
Cost for
How regular/frequent is the trip per
transportation
day?
(e.g., every 10 minutes, every hour etc.)
(one way)
1. By walking
2. Motorcycle
(Habal-habal)
Yes No
3. Tricycle
Yes No
4. Jeepney
Yes No
5. Multicab
Yes No
6. Other: (specify)
Yes No
Waray
A16 Ano it imo sinasakyan tikang ha imo balay tikadto ha iyo barangay health center?
(What is your means of transportation from your house to your assigned barangay health center?)
*Multiple answers
Travel
Means of transportation time (in
minutes)
Is there a regular
trip?
Cost for
How regular/frequent is the trip per
transportation
day?
(e.g., every 10 minutes, every hour etc.)
(one way)
1. By walking
2. Motorcycle
(Habal-habal)
Yes No
3. Tricycle
Yes No
4. Jeepney
Yes No
5. Multicab
Yes No
6. Other: (specify)
Yes No
A17 May ada ka ba travel allowance nga gin hatag han LGU o Barangay?
Waray
B3 Ha imo opinyon, ano ka importante it paggamit hini nga masunod nga mga butang para mabuligan it imo cliyente
nga makatagamtam hit iya kinahanglanon nga serbisyo panlawas? Alayon pag grado tikang ha 1 ngada ha 4. 4
komo pinaka importante.
(In your opinion, how important is it to use following items to help your client to avail necessary health service?
Please answer on the scale of 1 to 4. 4 being the most important.)
* Please mark only one answer and ask the respondent for reason of her/his answer. "Not Applicable or N/A"
for non-use of the item. If the answer is either: " Very Important "or " Not Important" , please ask for the
reason.
ITEM
1 Pregnancy Tracking Form
Very
Important Somewhat
Not
Important
Important Important
(4)
(3)
(2)
(1)
N/A
(0)
Reason
3 CHT Monthly Report
4 MC Book
Reason
5 Reference Guide for MC book
Reason
6 Health Use Plan
Reason
Reason
Reason
B4 Na atender ka ba hit CHT meeting ha Barangay Health Center/station?
(Do you have difficulty in the following activities? If yes, what is the reason?)
Yes (1)
No (0)
Activity
1) Pagkilala hin temprano kun burod it usa nga babaye. (Identifying women in the
early stage of pregnancy.)
Reason:
3) Pagkumbinsir han burod nga manganak ha usa nga health facility. (Convincing
pregnant women for facility-based delivery)
Reason:
Waray
B6 Ano ka kusog it imo pagtapod ha imo kalugaringon hibaro ngan kapasidad ha paghatag hin edukasyon
(In your opinion, how do you consider your workload as a CHT member? )
Too much (4)
C. Support System
C1 Paano mo gragraduhan an suporta nga tikang han masunod nga mga tawo ngadto han imo trabaho? Ano an mga
rason? Alayon paghatag hin grado tikang 1 ngada 4. 4 amo it kuntento hin duro.
(How do you rate the support from the following people to your work? And, what are the reasons? Please answer
on the scale of 1 to 4. 4 being the most satisfied.)
* Please mark only one answer and ask the respondent for reason of her/his answer.
IF THE ANSWER IS EITHER: " Very Satisfied" or " Very Dissatisfied" , PLEASE ASK FOR THE
REASON.
Very
satisfied
(4)
Satisfied
(3)
Not
satisfied
(2)
Very
dissatisfied (1)
1 LGUs/Mayor
Reason
2 MHO/MO
Reason
3 PHN
Reason
4 Midwife
Reason
5 NDP
Reason
6 Barangay Captains
Reason
7 Community members in catchment area
Reason
8 Other: Specify
ITEM
Reason
C2 Nakakakarawat ka ba hin bisan ano nga insentibo o honorarium?
Waray
C3 Kun oo, ano nga klase hin mga insentibo/honorarium it imo nakakarawat tikang ha mga masunod?
(If yes, what type of incentives/honorarium do you receive from the following?)
Source of Incentive/
Honorarium
*Multiple Answers
Type of Incentive/Honorarium Received
(Check relevant box and specify amount/material, if applicable)
PhilHealth
Transportation
Allowance
In-Kind
1. DOH
Php______/___
Php______/___
2. PhilHealth
Php______/___
Php______/___
3. Barangay
LGU
Php______/___
Php______/___
4. Municipal
LGU/RHU
Php______/___
Php______/___
5. Provincial
LGU
Php______/___
Php______/___
Php______/___
Php______/___
6. Others:
Specify
Others
Agree
(3)
Disagree
(2)
Strongly
disagree
(1)
N/A
1 Doctor
Reason
2 Nurse
Reason
3 Midwife
Reason
4 Client/Mothers
Reason
5 Community
Reason
6 Barangay Officials
Reason
7 Municipal/City Officials
ITEM
Reason
Waray
D2 Ha imo pagbati mayda ka ba sadang nga "resources" para suportahan it imo kliyente. Alayon pag grado tikang ha 1
=> Go to D4
D4 Ano nga mga impluwensiya an nakakaapekto hit imo trabaho komo usa ka miyembro hit CHT?
(What are the factors affecting your performance as a CHT member?) *Multiple answers
1) Lack of Training
5) Availability of Logistics
2) Availability of Monetary Incentives
6) Supervision by health workers
3) Attitude of community/client
7) Other: please specify
4) Availability of IEC materials
D5 *For those who answered (2), (4), (5), or (7):
May panahon ba nga nakagasto ka hit imo kalugaringon nga kuwarta para ha trabaho kabahin ha CHT?
Have you ever shouldered any of the following expenses related to CHT work with your own money? *Multiple
answers)
1) Transportation cost to attend or report to health center
2) Transportation cost for home visits
3) Transportation cost for accompanying client going to health center
4) Transportation cost (Other: specify_____________)
5) Communication cost (texts or phone calls)
6) Purchase of Logistics (photocopy of reporting forms, stationary)
7) Other: Please specify
8. ) No
D6 Ano it sadang pa buhaton para makahatag ka hin mas mauruupay nga serbisyo ha imo kliyente?
(What improvement, if any, could be made to enable you to provide better services to your client?)
*Multiple answers
1) Training
4) Provision of other Logistics
2) Monetary Incentives
5) Supervision by health workers
3) Provision of IEC materials
6) Other: please specify
D7 Ano it nagpapadasig ha imo pagtrabaho komo usa nga miyembro hit CHT?
6) Recognition by community
3) Means of income => Go to D8
7) Other: please specify
4) Benefits availment
Waray
D8 *For those who answered "(3) Means of Income" in D7
D11 Ha imo opinyon, ano an tulo nga mga kaulangan o kakurian komo usa ka miyembro hit CHT?
(In your opinion, what are the three challenges or difficulties as a CHT member?)
D12 Ha imo opinyon, ano an pinaka importante nga butang para maging malinampuson an imo trabaho komo CHT?
(In your opinion, what is the most important thing that would make your work as CHT successful?)
2015/6 (D/M)
Cebuano
Contact # (Mobile)
ID No
Starting Time
Ending Time
RHU
A. Background Information
A1 (Gender)
1) Female
2) Male
A3 Minyo na ka?
3) Married (Legal)
4) Separated
5) Widow
4) College
6) Post graduate
2) Elementary School
5) Vocational School
3) High School
(Pls specify: Grad, 1, 2, 3, 4)
A5 Naa kay katungdanan nga gihuptan sa barangay? Unsa ka dugay na ka sa inani nga posisyon?
(How long have you been working as CHT member?) *If CHT answered in years, convert it to number of months
months
Cebuano
A7 Sa unsa nga paagi ka nahimong miyembro sa CHT?
)
)
3) Self-volunteered
4) Other :Please specify
A8 Diha sa imong hunahuna, pila ka kaha ka oras sa usa ka semana nagatrabaho isip usa ka miyembro sa CHT?
(Do you have work aside CHT? Are you paid for work?)
1) Yes, I have paid work (Specify the kind of work:
A11 Pila ang tibuok nga halin sa imong pamilya sa usa ka buwan?
5) 10,000 to 14,999.00
6) 15,000.00 and above
Name of clusters/purok/sitios
No. of HH
Remark if any
Cebuano
Total
A15 Unsa ang imong ginasakyan gikan sa imong balay padulong sa imong pinakalayo nga sakop nga
panimalay/pamilya?
(What is your means of transportation from your house to your furthest household/family?)
*Multiple answers
Travel
Means of transportation time (in
minutes)
Is there a regular
trip?
Cost for
How regular/frequent is the trip per
transportation
day?
(e.g., every 10 minutes, every hour etc.)
(one way)
1. By walking
2. Motorcycle
(Habal-habal)
Yes No
3. Tricycle
Yes No
4. Jeepney
Yes No
5. Multicab
Yes No
6. Other: (specify)
Yes No
A16 Unsa ang imong ginasakyan gikan sa imong balay padulong sa imong sakop nga health center?
(What is your means of transportation from your house to your assigned barangay health center?)
*Multiple answers
Means of transportation
Travel
time (in
minutes)
Is there a regular
trip?
Cost for
How regular/frequent is the trip per
transportation
day?
(e.g., every 10 minutes, every hour etc.)
(one way)
1. By walking
2. Motorcycle
(Habal-habal)
Yes No
3. Tricycle
Yes No
4. Jeepney
Yes No
5. Multicab
Yes No
6. Other: (specify)
Yes No
Cebuano
A17 Naa ba gihatag kanimo nga kwarta gikan sa LGU o Barangay aron gamiton sa pagpliti og sakyanan?
kliyente ug makakuha sa gikinahanglan nga pag-alagad sa panglawas? Palihug sa paghatag og grado gikan sa 1
hangtod sa 4. 4 mao ang importante kaayo.
(In your opinion, how important is it to use following items to help your client to avail necessary health service?
Please answer on the scale of 1 to 4. 4 being the most important.)
* Please mark only one answer and ask the respondent for reason of her/his answer. "Not Applicable or N/A"
for non-use of the item. If the answer is either: " Very Important "or " Not Important" , please ask for the
reason.
ITEM
Very
Important Somewhat
Not
Important
Important Important
(4)
(3)
(2)
(1)
N/A
(0)
Reason
3 CHT Monthly Report
4 MC Book
Reason
5 Reference Guide for MC book
Reason
6 Health Use Plan
Reason
Reason
Cebuano
B4 Motambong ba ka ug mga miting sa CHT diha sa sentro?
(Do you have difficulty in the following activities? If yes, what is the reason?)
Yes (1)
No (0)
Activity
1) Pag-ila og sayo sa mga babaye nga mabdos. (Identifying women in the early
stage of pregnancy.)
Reason:
B6 Unsa ka dako ang imong pagsalig sa imong hibalo ug kahanas sa paghatag og edukasyon sa panglawas
sa imong kliyente?
(How confident are you with your knowledge and skills to give health education to the client?)
Very confident (3)
Confident (2)
Not confident (1)
B7 Sa imong opinyon, unsa ka daghan ang imong trabaho isip usa ka miyembro sa CHT?
(In your opinion, how do you consider your workload as a CHT member? )
Too much (4)
Cebuano
C. Support System
C1 Unsaon man nimo ang pag grado sa suporta nga gikan sa mga tawo diha sa imong trabaho? Ug, unsa ang mga
rason? Palihug sa paghatag og grado gikan 1 hangtod 4. 4 mao ang labi nga kontento.
(How do you rate the support from the following people to your work? And, what are the reasons? Please answer
on the scale of 1 to 4. 4 being the most satisfied.)
* Please mark only one answer and ask the respondent for reason of her/his answer.
IF THE ANSWER IS EITHER: " Very Satisfied" or " Very Dissatisfied" , PLEASE ASK FOR THE REASON.
Very
satisfied
(4)
Satisfied
(3)
Reason
4 Midwife
Reason
5 NDP
Reason
6 Barangay Captains
Reason
7 Community members in catchment area
Reason
8 Other: Specify
ITEM
1 LGUs/Mayor
Reason
2 MHO/MO
Reason
3 PHN
Not
Very dissatisfied
satisfied
(1)
(2)
Reason
C2 Nakadawat ba ka og insentibo o honorarium?
Cebuano
C3 Kon oo, unsa nga mga insentibo o honorarium ang imong nadawat gikan sa mosunod?
(If yes, what type of incentives/honorarium do you receive from the following?)
*Multiple Answers
Type of Incentive/Honorarium Received
(Check relevant box and specify amount/material, if applicable)
Source of Incentive/
Honorarium
Transportation
Allowance
Monetary
PhilHealth
Enrollment
1. DOH
Php______/___
Php______/___
2. PhilHealth
Php______/___
Php______/___
In-Kind
3. Barangay
LGU
Php______/___
Php______/___
4. Municipal
LGU/RHU
Php______/___
Php______/___
5. Provincial
LGU
Php______/___
Php______/___
Php______/___
Php______/___
6. Others:
Specify
Others
Agree
(3)
Disagree
(2)
Strongly
disagree
(1)
N/A
1 Doctor
Reason
2 Nurse
Reason
3 Midwife
Reason
4 Client/Mothers
Reason
5 Community
Reason
6 Barangay Officials
Reason
7 Municipal/City Officials
ITEM
Reason
Cebuano
D2 Imo bang gibati nga ikaw adunay igo nga hinabang sa pagsuporta sa imong kliyente? Palihug sa paghatag og grado
Move to D4
D3 Kon ang imong tubag sa taas "Disagree" o "Strongly Disagree", unsa pa nga mga klase og hinabang ang imong
D4 Unsa ang mga impluwensiya nga makaapekto sa imong trabaho isip usa ka miyembro sa CHT?
(What are the factors affecting your performance as a CHT member?) *Multiple answers
1) Lack of Training
5) Availability of Logistics
2) Availability of Monetary Incentives
6) Supervision by health workers
3) Attitude of community/client
7) Other: please specify
4) Availability of IEC materials
D5 *Please ask for those who answered (2),( 4), (5), or (7):
Adunay panahon ba nga gigamit nimo ang imong kaugalingon kwarta sa imong trabaho sa CHT?
(Have you ever shouldered any of the following expenses related to CHT work with your own money?) *Multiple
answers
1) Transportation cost to attend or report to health center
2) Transportation cost for home visits
3) Transportation cost for accompanying client going to health center
4) Transportation cost (Other: specify_____________)
5) Communication cost (texts or phone calls)
6) Purchase of Logistics (photocopy of reporting forms, stationary)
7) Other: Please specify
8. ) No
D6 Unsang kalamboan ang puwede mahimo aron makahatag ka og oras og mas maayo nga serbisyo sa imong kliyente?
(What improvement, if any, could be made to enable you to provide better services to your client?)
*Multiple answers
1) Training
4) Provision of other Logistics
2) Monetary Incentives
5) Supervision by health workers
3) Provision of IEC materials
6) Other: please specify
D7 Unsa nga mga butang ang modasig kanimo sa imong trabaho isip usa ka CHT?
Cebuano
D8 *Only for those who answered "(3) Means of Income" in D7:
Mopadayon ba ka sa imong trabaho isip usa ka CHT bisag wala na ka madawat nga insentibo sa DOH?
(Will you continue your work even after the termination of incentives by DOH?)
1) Yes
2) No
D9 Sa imong hunahuna, makahimo ba og kaibahan ang imong trabaho sa kaayuhan sa panglawas sa mga inahan ug
D11 Sa imong opinyon, unsa ang tulo nga mga kalisdanan isip usa ka miyembro sa CHT?
(In your opinion, what are the three challenges or difficulties as a CHT member?)
D12 Sa imong opinyon, unsa nga butang ang labing importante aron ang imong trabaho malampuson?
(In your opinion, what is the most important thing that would make your work as CHT successful?)
2015/6 (D/M)
69
5
74
93.2%
6.8%
100.0%
45.8911.30
(22------64)
(3) Position
Rural Health Midwife
PHN
MHO/MO
Total
57
8
9
74
77.0%
10.8%
12.2%
100.0%
87.8%
12.2%
100.0%
(6) Perceived difficulty in attaining the coverage of PNV4 in the target client (N=65)
Yes
43
66.2%
No
21
32.3%
No answer
1
1.5%
Total
65
100%
(7) Reasons for difficulties (Multiple answers) (N=43)
Hesitation or Denial of the Pregnant Woman (due to unwanted/teenage
pregnancy/multigravida)
Negative attitude of the Pregnant Woman (Not cooperative or Hard headed)
Large population in the area
Transient Clients
Geographical problem in accessing to health facility
Delayed report submission by CHT volunteers
23
Total
9
4
4
3
1
44
11
Conducting regular monitoring, and counseling and health teaching to the client
3
1
1
22
Total
(7) Areas/health services in which CHT program contributed in improving (Multiple answers)
MNCHN related service delivery
EPI Program
Nutrition Program
Family Planning Program
Operation Timbang (weighning)
Communicable Disease
TB-DOTs program
Communicable Disease Program (General)
Other Health Program or related activity
Health education
Patient's tracking and follow-ups
Home visits to the client
Environmental and Sanitation Program
All DOH programs
Outpatient service
Facility maintenance
KP program
Barangay
Barangay Survey For Women
Family development session/orientation at barangay
Identification of Hilots
4P's program
Medical mission
Blood-letting activity
Others
Opportunity to have logistics (e.g., MC book/forms)
Opportunity to provide incentives to the volunteer
(N=61)
28
12
10
5
1
13
9
4
27
9
8
3
2
2
1
1
1
7
2
1
1
1
1
1
3
2
1
(8) Importance of the specified activity in contributing to the improvement of MNCHN service
1) Pregnancy Tracking of the Client
Strongly agree
Agree
Disagree
Strongly disagree
Not sure
Total
51
22
1
0
0
74
68.9%
29.7%
1.4%
0.0%
0.0%
100.0%
44
26
3
1
74
59.5%
35.1%
4.1%
1.4%
100.0%
2
1
1
4
45
26
3
0
74
60.8%
35.1%
4.1%
0.0%
100.0%
45
28
1
0
74
60.8%
37.8%
1.4%
0.0%
100.0%
51
18
4
0
1
74
68.9%
24.3%
5.4%
0.0%
1.4%
100.0%
1
1
1
3
5) Health Education
Strongly agree
Agree
Disagree
Strongly disagree
Not sure
Total
42
29
2
0
73
1
1
2
4
57.5%
39.7%
2.7%
0.0%
100.0%
1
1
2
49
22
2
0
1
74
66.2%
29.7%
2.7%
0.0%
1.4%
100.0%
50
18
2
1
3
74
67.6%
24.3%
2.7%
1.4%
4.1%
100.0%
1
1
2
35
26
3
0
8
72
1
1
1
3
48.6%
36.1%
4.2%
0.0%
11.1%
100.0%
1
2
3
58
15
0
0
73
79.5%
20.5%
0.0%
0.0%
100.0%
52
21
0
0
73
71.2%
28.8%
0.0%
0.0%
100.0%
48
22
1
0
71
67.6%
31.0%
1.4%
0.0%
100.0%
34
28
0
0
10
72
47.2%
39.4%
0.0%
0.0%
14.1%
100.7%
63
10
1
0
74
85.1%
13.5%
1.4%
0.0%
100.0%
8) MC Book
Very useful
Useful
Slightly useful
Not useful
Total
Reasons for slightly useful/not useful (N=1)
Time-consuming and repetitive questions
Total
9) CHT reference guide (SMACHS-EV Project)
Very useful
Useful
Slightly useful
Not useful
Not applicable
Total
42
25
0
1
3
71
56.8%
33.8%
0.0%
1.4%
4.1%
95.9%
Total
1
1
1
1
4
1
1
(3) Opinion on the required task of CHT volunteers in relation to their capacity
11
15.1%
Easy
Appropriate
37
50.7%
Slightly difficult
18
24.7%
Difficult
7
9.6%
Total
73
100.0%
*Of the 74, 1 respondent has no answer
19
15
9
4
3
3
2
2
2
2
2
1
1
1
66
28.8%
22.7%
13.6%
6.1%
4.5%
4.5%
3.0%
3.0%
3.0%
3.0%
3.0%
1.5%
1.5%
1.5%
100.0%
61
12
73
83.6%
16.4%
100.0%
44
25.0%
45
45
25.6%
25.6%
39
22.2%
Content of MC book
Interpersonal/communication skills
Total
2
1
176
1.1%
0.6%
100.0%
10.1%
89.9%
100.0%
2
2
4
1
1
17
57
74
23.0%
77.0%
100.0%
Total
4
2
1
1
1
1
10
39.2%
20.3%
21.6%
10.8%
8.1%
100.0%
97.3%
2.7%
100.0%
42
26
2
2
72
Total
Reasons for not continuing CHT program (N=2)
Pregnant women visits health facility without efforts from CHT volunteers
The CHT volunteers are not helpful in providing better health services especially in tracking
the client
Total
1
1
2
(13) The most challenging activity in the implementation of the CHT program at health facility
19
29.2%
10
15.4%
13.8%
9.2%
7.7%
7.7%
6.2%
4.6%
3.1%
1.5%
1.5%
65
100.0%
Total
(14) Reasons for difficulties
1) Motivating CHT volunteers to continue their work
Lack of logistics or incentives
Political influence on CHT volunteers
Lack of cooperation
Dicrepancy of benefits among CHT volunteers
Conflict with other schedules (e.g., seminar and report submission/meeting)
Distance to health center
10
4
4
1
1
1
Total
21
Total
3
2
1
1
1
8
Total
3
2
2
1
1
9
Total
3
1
1
1
6
61
33
26
21
20
15
11
9
4
3
3
2
2
2
1
1
214
3
3
2
2
1
1
12
28.5%
15.4%
12.1%
9.8%
9.3%
7.0%
5.1%
4.2%
1.9%
1.4%
1.4%
0.9%
0.9%
0.9%
0.5%
0.5%
100.0%
(N)
39
32
8
7
6
Disadvantages
None
CHT volunteers are not active
Delayed or lack of incentives to CHT volunteers
Additional workload for health personnel/health volunteers
Problmens with politics (e.g., selection of health volunteers)
Clients dont favor their work (e.g., being tracked/going to health center)
Lack of forms
No answer
(N)
50
8
7
5
3
2
1
1
10
6
1
1
1
1
1
20
15
13
12
11
6
3
3
2
2
1
1
1
1
52
23
14
8
7
5
2
1
1
1
1
1
1
1
*None: 7 respondents
7. Innovative activities being implemented for strengthen performance of the CHT program at health facility
(Multiple answers)
Conduct of recognition or awarding of CHT volunteers for accomplishment (including
17
certificate)
Conduct of monthly meetings with CHT volunteers
8
Conduct of activity to establish team work (including recreation program)
7
Provision of incentives to CHT volunteers based on their accomplishment (through PhilHealth6
MCIP or other sources)
Conduct of refresher training/knowledge enhancement/OJT activity for CHT volunteers
5
Provision of travel fare/logistics/food to CHT volunteers
3
Conduct of monthly peer-reviews among CHT volunteers
2
Conduct seminars or health education activity by RHU/DHC personnels to the client
2
Provision of breast feeding kits for mothers
2
Ordinance on FBD
2
Revision of forms
2
Enlistment of Women on reproductive age
2
Attend training of BEmONC
1
Coordination with barangays to allocate funds for CHT volunteers
1
Utilization of CHT database
1
Banco de Nueve: Introduction of good practices from CAR region
1
Positive attitude towards the client
1
Flexible schedule for prenatal check-ups (e.g., night time opening for prenatal)
1
Sharing words of wisdom
1
Not applicable
1
*None: 20 respondents
11
27.236.17
(18------46)
4
63
28
3
1
99
4.0%
63.6%
28.3%
3.0%
1.0%
100%
8.752.7
(1------14)
2.941.85
(1------10)
(5) Occupation
Housewife (full-time)
Food Vendor
Farmer
Sugercane Laborer
Sari-Sari Store Owner
Sales Lady
Contractual Worker
Unknown (paid)
Unknown (unpaid)
Total
87
3
2
1
1
1
1
2
1
99
87.9%
3.0%
2.0%
1.0%
1.0%
1.0%
1.0%
2.0%
1.0%
100%
10
45
30
7
4
3
99
10.1%
45.5%
30.3%
7.1%
4.0%
3.0%
100%
29
23
16
31
99
29.3%
23.2%
16.2%
31.3%
100.0%
28
71
99
28.3%
71.7%
100.0%
48
41
1
6
2
1
99
48.5%
41.4%
1.0%
6.1%
2.0%
1.0%
100.0%
13
51
16
5
14
99
13.1%
51.5%
16.2%
5.1%
14.1%
100.0%
0
3
10
17
69
99
0.0%
3.0%
10.1%
17.2%
69.7%
100.0%
84.8%
12.1%
3.0%
100.0%
(13) Difficulty in going to the health center for regular prenatal/postpartum check-up
Yes
11
11.1%
No
88
88.9%
Total
99
100.0%
*All "Yes" come from the respondents from Leyte
(14) Reasons for the difficulty in going to health center for prenatal/postnatal check-ups
(Multiple answers) (N=11)
Cost of Transportation
3
Household Work
2
Family's disagreement
1
Due to her job/work
1
Bad Weather
2
No answer
2
Total
11
31
23
17
15
7
2
2
1
1
99
31.3%
23.2%
17.2%
15.2%
7.1%
2.0%
2.0%
1.0%
1.0%
100.0%
minutes
80.4%
13.4%
3.1%
2.1%
0.0%
1.0%
100.0%
(18) Cost of Transportation (one way) among those who use public/pvt transportation
(mean )
11.128.16
pesos
(range)
(5------50)
63.6%
36.4%
100.0%
(2) Knowledge on the person with the position who provides maternal & child health service in the
community (Multiple answers)
BHW
95
48.5%
Midwife/Nurse/Doctor
25
12.8%
BNS
21
10.7%
Day Care Worker
19
9.7%
Parent Leaders
16
8.2%
Barangay Service Point Officer
12
6.1%
Barangay Kagawad
3
1.5%
CHT volunteers
2
1.0%
Medical mission
1
0.5%
NPS*
1
0.5%
Dont' know the specific position
1
0.5%
Total
196
100.0%
*Possibly "Nurse Deployment Program (NDP)"
1.8%
0.5%
0.3%
0.3%
0.3%
100.0%
69.1%
23.7%
1.0%
0.0%
6.2%
100.0%
63.8%
27.5%
2.5%
0.0%
6.3%
100.0%
64.9%
23.0%
1.4%
0.0%
10.8%
100.0%
48
17
1
0
8
74
24.3%
20.1%
18.5%
16.8%
7.5%
6.8%
3.0%
18
10
1
0
1
30
60.0%
33.3%
3.3%
0.0%
3.3%
100.0%
77.8%
14.8%
3.7%
0.0%
3.7%
100.0%
(10) Number of home visits by CHT volunteers from prenatal period until delivery (N=95) (1)
(mean )
7.47 28.39
times
(range)
(1------280)
(median)
4
*Of the 97, 2 respondents did not answer
(11) Breakdown of number of home visits by CHT volunteers from prenatal period until delivery (2)
1-2 times
10
10.5%
3 times
23
24.2%
4 times
35
36.8%
5-10 times
24
25.3%
11-20 times
2
2.1%
More than 21 times*
1
1.1%
Total
95
100.0%
* 280 times
(12) Number of home visits by CHT volunteers after delivery until 42 days (N=78) (1)
(mean )
3.85 5.23
times
(range)
(1------42)
(median)
3
*Of the 80, 2 respondents did not answer
(13) Breakdown of the number of home visits by CHT volunteers after delivery until 42 days (2)
1-2 times
35
44.9%
3-4 times
30
38.5%
5-10 times
11
14.1%
11-25 times
1
1.3%
More than 26 times*
1
1.3%
Total
78
100.0%
*42 times
(14) Average time CHT volunteers spend every home visit (N=93) (1)
(mean )
42.44 44.42
minutes
(range)
(2------240)
(median)
30
*Of the 97, 3 respondents did not answer, and 1 respondent was not applicable
(15) Breakdown of the average time CHT volunteers spend every home visit (2)
5 minutes or less
12
12.9%
10-15 minutes
13
14.0%
20-25 minutes
6
6.5%
30 minutes
30
32.3%
40-50 minutes
2
2.2%
60 minutes
21
22.6%
80 minutes or more
9
9.7%
Total
93
100.0%
5
(16) Type of information given by CHT volunteers during health education (Multiple answers)
Importance of prenatal visit
55
Immunizaion
52
Baby care routine
50
Warning signs during pregnancy
45
Importance of facility-based delivery
41
Importance of post-partum visit
35
Birth & emergency plan
35
Family planning
30
Nutrition
4
Exclusive Breastfeeding
2
Referral to HC for a baby
1
Total
350
3. MC Book and CHT work
(1) Mother and Child Book was given during last pregnancy
Yes
98
No
1
Total
99
99.0%
1.0%
100.0%
Reason for "No": The client was transferred in (from Manila), and had a home based mother's record instead of
MC book (Leyte).
(2) Availability of Mother and Child Book after delivery (as of now) (N=98)
Yes
97
99.0%
No
0
0.0%
No answer
1
1.0%
Total
98
100.0%
(3) Status of Recording on MC book (if properly filled-out on the important records) (N=90)
*Of the 97 respondents, 7 did not bring their MC book during the assessment
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
83
7
70
20
85
5
40
50
46
44
92.2%
7.8%
77.8%
22.2%
94.4%
5.6%
44.4%
55.6%
51.1%
48.9%
81
13
4
0
98
Total
82.7%
13.3%
4.1%
0.0%
100.0%
81
13
17
1
112
2
1
1
4
(7) Whether CHT volunteers discussed the content of MC book during home visits (N=98)
Yes
77
78.6%
No
21
21.4%
Total
98
100.0%
(8) Client's Satisfaction of CHT volunteers discussing the content of MC Book during home visits (N=77)
Very good
Good
Fair
Poor
No answer
43
29
3
1
1
77
Total
55.8%
37.7%
3.9%
1.3%
1.3%
100.0%
65.7%
28.3%
3.0%
2.0%
1.0%
100.0%
30
26
20
16
12
2
106
Total
2
3
1
6
4. Source of information and decision making on maternal and child health care
(1) Source of information about MCH care (Multiple answers)
CHT members
81
23.5%
Family/relatives
79
22.9%
Health Personnel (RHU/DHC/BHS)
69
20.0%
MC book
58
16.8%
Friends
30
8.7%
Mass media/Magazine
18
5.2%
Health Personnel at Private Clinic
5
1.4%
Neighbors/Other mothers
3
0.9%
Personal experience
2
0.6%
Total
345
100.0%
(2) People who influenced the decision to seek maternal and child care services at health center
Score: 1 (not influential)------4 (very influential)
Category
(mean )
(range)
Midwife
3.74 0.50
1---------4
Parents
3.64 0.74
1---------4
Doctor
3.64 0.66
1---------4
Husband
3.62 0.73
1---------4
Nurse
3.55 0.65
1---------4
CHT volunteer
3.48 0.82
1---------4
Ordinance
3.46 0.89
1---------4
Community's opinion
2.88 0.92
1---------4
Others: Religion (1), NDP (1)
(3) Availment of health services: Prenatal Care during 1st Trimester
Yes
82
No
17
Total
99
N
98
95
97
94
96
97
87
98
82.8%
17.2%
100.0%
(4) Personnel who influenced for availing the service (Multiple answers) (N=82)
CHT volunteers
52
54.2%
Midwife/RHU staff
16
16.7%
Own decision
12
12.5%
Mother/Parent
8
8.3%
Husband
5
5.2%
Friend
1
1.0%
Health Worker (aside from DHC/RHU)
1
1.0%
Neighbor
1
1.0%
Total
96
100.0%
(5) Reasons for not availing the service (Multiple answers) (N=4)
Not aware of being pregnant/irregular
7
menstration
Out of town
4
Unnecessary
2
Delay in accessing the service
2
Schooling/Working (unplanned pregnancy)
2
Total
17
41.2%
23.5%
11.8%
11.8%
11.8%
100.0%
(6) Availment of health services: Prenatal Care during 2nd and 3rd Trimester
Yes
97
98.0%
No
2
2.0%
Total
99
100.0%
(7) Personnel who influenced for availing the service (Multiple answers) (N=97)
CHT volunteers
70
57.4%
Midwife/RHU/DHC staff
25
20.5%
Own decision
11
9.0%
Mother/Parent/Family Members (aside from
11
9.0%
husband)
Husband
3
2.5%
Friend
2
1.6%
Total
122
100.0%
(8) Reason for not availing the service (N=2)
Out of town
Total
2
2
98.0%
2.0%
100.0%
(10) Personnel who influenced for availing the service (Multiple answers) (N=97)
Midwife/RHU/DHC staff
46
38.7%
CHT volunteers
43
36.1%
Mother/Parent/Family Members (aside from
13
10.9%
husband)
Own decision
12
10.1%
4
3.4%
Husband
Community
1
0.8%
Friend
0
0.0%
Total
119
100.0%
(11) Reason for not availing the service (N=2)
Delivery room was not available due to
repair
Unknown
1
2
Total
(12) Availment of health services: Post-partum Care
Yes
No
No answer
Total
89
9
1
99
89.9%
9.1%
1.0%
100.0%
(13) Personnel who influenced for availing the service (Multiple answers) (N=89)
Midwife/RHU/DHC staff
43
46.2%
CHT volunteers
29
31.2%
Health Worker (aside from DHC/RHU)
7
7.5%
Own decision
5
5.4%
Mother/Parent/Family Members (aside from
4
4.3%
husband)
Husband
3
3.2%
Friend
1
1.1%
Unknown
1
1.1%
Total
93
100.0%
(14) Reasons for not availing the service (N=9)
Unnecessary
33.3%
33.3%
No time to visit
22.2%
11.1%
Total
100.0%
97
2
99
98.0%
2.0%
100.0%
(16) Personnel who influenced for availing the service (Multiple answers) (N=97)
CHT volunteers
61
52.6%
Midwife/RHU/DHC staff
41
35.3%
Own decision
6
5.2%
Mother/Parent/Family Members (aside from
4
3.4%
husband)
Neighbor
1
0.9%
Unknown
1
0.9%
Health Worker (aside from DHC/RHU)
1
0.9%
Husband
1
0.9%
Total
116
100.0%
(17) Reason for not availing the service (N=2)
Dont have any schedule
Total
2
2
64
35
99
10
64.6%
35.4%
100.0%
(19) Personnel who influenced for availing the service (Multiple answers) (N=64)
CHT volunteers
33
45.2%
Midwife/RHU/DHC staff
28
38.4%
Own decision
5
6.8%
Husband
3
4.1%
Unknown
2
2.7%
Mother/Parent/Family Members (aside from
1
1.4%
husband)
Health Worker (aside from DHC/RHU)
1
1.4%
Total
73
100.0%
(20) Reasons for not availing the service (Multiple answers) (N=35)
17
Not allowed
13
Not right timing (berastfeeding/no6
No schedule
3
Unnecessary
3
Unknown
2
Fear (e.g. side effect)
2
No information on importance or necessity
2
Undecided/confused
1
Busy doing house work
Total
49
34.7%
26.5%
12.2%
6.1%
6.1%
4.1%
4.1%
4.1%
2.0%
100.0%
91.1%
8.9%
100.0%
72
7
79
Positive comments:
Accomodating & giving special assistance to the mothers
Reminding the client about shedules of check-ups & immunization
Providing advices/health educations to the mothers
No bad experiences, compliment
(N)
30
20
20
4
Negative comments:
CHT not being active (no home visits/follow-up)
CHT being forgetful (e.g., information on schedule of prenatal service)
CHT not having enough knowledge/information to give health advice
CHT having negative attitude (e.g., favoritism over the client)
(N)
3
2
2
1
11
(N)
27
14
9
5
4
3
2
2
1
1
1
38
2
40
Total
(2) Age
(mean )
(range)
95.0%
5.0%
100.0%
47.2313.48
(22------65)
7
5
10
9
9
40
17.5%
12.5%
25.0%
22.5%
22.5%
100.0%
2
2
28
0
8
40
5.0%
5.0%
70.0%
0.0%
20.0%
100.0%
9.08 3.12
(2------14)
1
8
20
11
40
2.5%
20.0%
50.0%
27.5%
100.0%
Total
1
29
0
9
1
40
2.5%
72.5%
0.0%
22.5%
2.5%
100.0%
12
4
24
40
30.0%
10.0%
60.0%
100.0%
(7) Position
None
BHW
BSPO
BNS
Parent Leader
6
1
5
12
50.0%
8.3%
41.7%
100.0%
7
2
15
3
1
6
1
4
39
17.9%
5.1%
38.5%
7.7%
2.6%
15.4%
2.6%
10.3%
100.0%
Total
3
25
11
1
0
0
40
7.5%
62.5%
27.5%
2.5%
0.0%
0.0%
1
Total
17
1
11
11
40
42.5%
2.5%
27.5%
27.5%
100.0%
Total
10
30
40
25.0%
75.0%
100.0%
3.4 1.4
(0.1------5)
years
2
3
7
5
16
6
39
5.1%
7.7%
17.9%
12.8%
41.0%
15.4%
100.0%
8
5
22
4
39
20.5%
12.8%
56.4%
10.3%
89.7%
6
3
1
1
2
13
46.2%
23.1%
7.7%
7.7%
15.4%
100.0%
9.42 7.91
(0.5------30)
99.62 58.79
(32------250)
hours/week
HHs
0
8
14
9
6
37
0.0%
21.6%
37.8%
24.3%
16.2%
100.0%
29
6
1
1
1
1
1
40
72.5%
15.0%
2.5%
2.5%
2.5%
2.5%
2.5%
100.0%
32.50 34.83
(5------180)
minutes
(23) Breakdown of travel time from house to the furthest catchment (2)
0-15 minutes
16-30 minutes
31-45 minutes
46-60 minutes
61-90 minutes
More than 90 minutes
Total
17
11
3
4
1
2
38
44.7%
28.9%
7.9%
10.5%
2.6%
5.3%
100.0%
(24) Cost of transportation (one way) among those who use public/private transportation (N=11)
(mean )
15 10.54
pesos
(range)
(0------30)
*1 respondent (Group A) has no answer
(26) Travel time from house to the assigned barangay health center (1)
(mean )
(range)
26
9
1
0
0
1
1
1
1
40
65.0%
22.5%
2.5%
0.0%
0.0%
2.5%
2.5%
2.5%
2.5%
100.0%
13.34 12.63
(1------60)
minutes
(27) Breakdown of travel time from house to the assigned barangay health center (2)
0-15 minutes
30
16-30 minutes
5
31-45 minutes
2
46-60 minutes
1
61-90 minutes
0
More than 90 minutes
0
Total
38
78.9%
13.2%
5.3%
2.6%
0.0%
0.0%
100.0%
(28) Cost of transportation (one way) among those who use public/private transportation (N=13)
(mean )
12.507.82
pesos
(range)
(5------30)
39
1
40
97.5%
2.5%
100.0%
38
32
21
10
14
33
39
28
25
5
3
2
250
15.2%
12.8%
8.4%
4.0%
5.6%
13.2%
15.6%
11.2%
10.0%
2.0%
1.2%
0.8%
100.0%
(3) Perceived importance of the tools to promote utilization of health service by the client
1) Pregnancy Tracking Form
Very important
35
Important
4
Somewhat important
0
Not important
0
0
Not applicable
Total
39
89.7%
10.3%
0.0%
0.0%
0.0%
100.0%
20
6
1
34
4
0
0
1
39
87.2%
10.3%
0.0%
0.0%
2.6%
100.0%
28
6
2
30
7
0
0
1
38
Total
78.9%
18.4%
0.0%
0.0%
2.6%
100.0%
20
4) MC book
Very important
Important
Somewhat important
Not important
Not applicable
32
6
0
0
0
38
Total
84.2%
15.8%
0.0%
0.0%
0.0%
100.0%
9
14
9
3
25
9
0
0
4
38
Total
65.8%
23.7%
0.0%
0.0%
10.5%
100.0%
6
6
2
26
12
0
0
1
39
Total
66.7%
30.8%
0.0%
0.0%
2.6%
100.0%
8
7
9
39
0
39
100.0%
0.0%
100.0%
1
26
7
2
2
1
39
2.6%
66.7%
17.9%
5.1%
5.1%
2.6%
100.0%
(6) Difficulty in conducting the activity: Identifying the pregnant women in the early stage of pregnancy
Yes
14
35.0%
No
26
65.0%
Total
40
100.0%
10
1
1
2
14
1
0
1
(7) Difficulty in conducting the activity: Convincing the client for prenatal check-ups
Yes
9
No
31
Total
40
Reasons for difficulty (Multiple answers)
The client is not cooperative
Health condition of the client
Weather
Shyness/denial of the client
Lack of money
N/A
Total
22.5%
77.5%
100.0%
3
1
1
2
1
2
10
*No reason was provided for non difficulty of convincing the client for prenatal check-ups
(8) Difficulty in conducting the activity: Convincing the pregnant women for Facility-Based Delivery
Yes
6
15.0%
No
34
40
Total
Reasons for difficulty
Depending on the decision of the client
Hard headed clients regarding the importance
The client prefer private clinic for delivery
N/A
Total
1
3
1
1
6
Total
85.0%
100.0%
(9) Difficulty in conducting the activity: Convincing the postpartum women for postnatal check-ups
Yes
6
15.0%
No
34
85.0%
Total
40
100.0%
Reasons for difficulty
Hard headed clients regarding the importance
Financial problem of the client (e.g., transportation)
Total
2
1
3
*3 respondents (Group B) did not specify the reason or not applicable answer.
(10) Confidence with the knowledge and skills to give health education to the client
Very confident
24
Confident
16
Not confident
0
Total
40
(11) Workload
Too much
A little too much
Just enough
Not enough
60.0%
40.0%
0.0%
100.0%
15
12
13
0
40
37.5%
30.0%
32.5%
0.0%
100.0%
13
20
3
4
40
32.5%
50.0%
7.5%
10.0%
100.0%
4
1
1
1
7
8
3
2
0
13
21
16
1
1
39
Total
53.8%
41.0%
2.6%
2.6%
100.0%
1
1
2
9
8
3
1
21
27
11
1
0
39
69.2%
28.2%
2.6%
0.0%
100.0%
1
1
31
8
0
0
39
79.5%
20.5%
0.0%
0.0%
100.0%
24
14
1
0
39
61.5%
35.9%
2.6%
0.0%
100.0%
20
13
5
2
40
50.0%
32.5%
12.5%
5.0%
100.0%
4
1
2
7
21
17
1
0
39
53.8%
43.6%
2.6%
0.0%
100.0%
1
1
*Client mentioned "dissatisfied" on JICA incentive while JICA does not provide any incentives (aside logistics) to CHT volunteers
39
1
40
97.5%
2.5%
100.0%
31
9
40
77.5%
22.5%
100.0%
30
1
0
2
33
90.9%
3.0%
0.0%
6.1%
100.0%
28
12
40
70.0%
30.0%
100.0%
92.9%
3.6%
3.6%
0.0%
100.0%
72.5%
27.5%
100.0%
29
11
40
415.8
(50----900)
1
2
2
1
1
8
15
15
15
10
57.1%
42.9%
1
per time
18
22
40
45.0%
55.0%
100.0%
94.7%
0.0%
0.0%
0.0%
5.3%
100.0%
28
12
0
0
0
40
4
6
3
12
1
1
12
39
29
11
0
0
0
40
1
5
18
11
43
31
9
0
0
0
40
11
70.0%
30.0%
0.0%
0.0%
0.0%
100.0%
72.5%
27.5%
0.0%
0.0%
0.0%
100.0%
77.5%
22.5%
0.0%
0.0%
0.0%
100.0%
18
7
1
2
1
4
1
9
43
22
15
3
0
0
40
Total
Reasons for strongly agree/agree (Multiple answers)
Supportive and cooperative with CHT volunteers
Learn and follow advices of CHT volunteers
Seek advice and support from CHT volunteers
Sometime not cooperative
They need to be reminded by CHT volunteers
Appreciate CHT volunteer's work
No answer
Total
14
9
2
2
0
2
13
42
1
2
3
14
3
1
2
17
37
1
1
2
12
55.0%
37.5%
7.5%
0.0%
0.0%
100.0%
50.0%
45.0%
5.0%
0.0%
0.0%
100.0%
(6) Perceived recognition of the importance of their work by others: Barangay officials
Strongly agree
22
Agree
13
Disagree
3
Strongly disagree
1
Not applicable
0
Total
39
56.4%
33.3%
7.7%
2.6%
0.0%
100.0%
15
1
3
2
1
2
13
37
1
1
2
4
(7) Perceived recognition of the importance of their work by others: Municipal/City officials
Strongly agree
9
Agree
24
Disagree
3
Strongly disagree
2
Not applicable
2
Total
40
Reasons for strongly agree/agree (Multiple answers)
Supportive and cooperative on the needs of CHT volunteers
Supportive financially
Acknowledge the work of CHT volunteers
Monitor CHT volunteers' work
Not always supportive
No answer
Total
6
2
2
1
1
21
33
2
3
5
16
22
2
0
40
1
1
2
13
22.5%
60.0%
7.5%
5.0%
5.0%
100.0%
40.0%
55.0%
5.0%
0.0%
100.0%
13
13
11
12
7
5
1
9
0
6
1
1
1
80
16.3%
16.3%
13.8%
15.0%
8.8%
6.3%
1.3%
11.3%
0.0%
7.5%
1.3%
1.3%
1.3%
100.0%
(10) Experiences spending out of pocket money on work related to CHT activities (N=35)
Yes
33
No
1
Total
34
97.1%
2.9%
1
29
12
22
4
9
13
3
4
1
97
29.9%
12.4%
22.7%
4.1%
9.3%
13.4%
3.1%
4.1%
1.0%
100.0%
(12) Suggested improvement for better performance by CHT volunteers (Multiple answers)
30
Training
15
Provision of monetary incentives
9
Provision of IEC materials
6
Provision of other logistics
13
Supervision by health workers
5
Health education
Availability of medicines
1
Exact time to the client
2
Good health condition
1
Increased number of CHT volunteers
1
Total
82
36.6%
18.3%
11.0%
7.3%
15.9%
6.1%
1.2%
2.4%
1.2%
1.2%
100.0%
37.2%
28.7%
6.4%
7.4%
2.1%
13.8%
2.1%
2.1%
100.0%
14
35
27
6
7
2
13
2
2
94
(14) Willingness to continue CHT work after the termination of incentives by the DOH
3
Yes
1
No
2
Unknown
Total
6
50.0%
16.7%
33.3%
100.0%
(15) Opinion on whether CHT work can make a difference in the health of mothers and baby
40
Yes
0
No
Total
40
100.0%
0.0%
100.0%
15
5. Good practices/innovative methods used to promote work of CHT volunteers (Multiple answers) (N=40)
Maintaining positive/approachable attitude to the work and the client
Unity among the CHT volunteers to work as a team
Sharing ideas and cooperative with others
Consulting mothers (especially after they gave a birth)
Patience
Convincing power to the client
Consulting client's husband
Be punctual on time/Good time management skills
Providing quality service
Provide additional service to the client (e.g., massage or BP check-up)
Willingness to learn more
None
Not applicable
TOTAL
6. Challenges or difficultes experienced by CHT volunteers (Multiple answers) (N=40)
Prioritizing CHT tasks due to financial difficulty or other responsibility to engage in work
Lack of tools or logistics (e.g., forms, stationery)
Weather condition (e.g., rain)
Lack of incentives
Lack of cooperation by the client/community
Inadequacy of the skill or knowledge to perform required CHT task
Lack of transportation or allowance for transportation/distance to the catchment/health center
Health condition
Lack of assistance/supervision by the midwife/NDP
Workload
Changes in rules or policy every year
Safety in the catchment area (e.g., dog)
None
TOTAL
8
8
8
5
3
2
1
1
1
1
1
1
5
45
6
1
10
2
15
8
10
5
1
1
1
1
3
64
7. The most important matters to make CHT work successful (Multiple answers) (N=40)
Giving full support to the client and family/commitment on serving for the community
Performing required task such as tracking, home visiting and report submission
Team work/cooperation with others
Financial support
Patience
Equipped with necessary materials/logistics
Good health condition
Proper training
Supervision on CHT's task
Man power to serve the community
TOTAL
17
13
3
1
9
3
4
2
1
1
54
59
1
60
(2) Age
(mean )
(range)
98.3%
1.7%
100.0%
479.32
(26------66)
3
16
21
16
4
60
5.0%
26.7%
35.0%
26.7%
6.7%
100.0%
Total
3
3
49
1
4
60
5.0%
5.0%
81.7%
1.7%
6.7%
100.0%
9.33 2.45
(3------14)
1
8
38
13
60
1.7%
13.3%
63.3%
21.7%
100.0%
Total
8
34
1
5
1
1
3
1
1
1
2
1
1
60
13.3%
56.7%
1.7%
8.3%
1.7%
1.7%
5.0%
1.7%
1.7%
1.7%
3.3%
1.7%
1.7%
91.7%
25
6
29
60
41.7%
10.0%
48.3%
100.0%
(7) Position
None
BHW
BSPO
BNS
Parent Leader
Barangay Kagawad
BHW/BNS
BHW/BNS/Kagawad
BHW/BNS/Day Care Worker
BHW/BSPO
BHW/Kagawad
BHW/Parent Leader
Daycare Worker
14
2
2
2
1
1
2
1
25
56.0%
8.0%
8.0%
8.0%
4.0%
4.0%
8.0%
4.0%
100.0%
18
9
18
2
5
3
1
1
57
31.6%
15.8%
31.6%
3.5%
8.8%
5.3%
1.8%
1.8%
100.0%
3
40
11
2
2
2
60
5.0%
66.7%
18.3%
3.3%
3.3%
3.3%
1
Total
20
9
17
14
60
33.3%
15.0%
28.3%
23.3%
100.0%
Total
26
33
59
44.1%
55.9%
100.0%
Total
(10) Main Source of Income
Family's income (e.g., husband/children)
Sari-Sari Store
Farming/gardening/shell gathering
Labor/house keeper
Food vendors/dress making
Own business
Botika ng barangay
BHW
Total
*2 respondents in Group A and 1 respondent in Group B have no answer.
3.7 1.3
(0.2------6)
5
0
6
7
29
13
60
years
8.3%
0.0%
10.0%
11.7%
48.3%
21.7%
100.0%
28
26
6
60
46.7%
43.3%
10.0%
100.0%
20
23
4
1
3
3
54
37.0%
42.6%
7.4%
1.9%
5.6%
5.6%
100.0%
7.215.09
(1------30)
65.27 44.94
(21------200)
hours/week
HHs
0
33
17
6
4
60
0.0%
55.0%
28.3%
10.0%
6.7%
100.0%
49
1
2
0
0
2
5
1
60
81.7%
1.7%
3.3%
0.0%
0.0%
3.3%
8.3%
1.7%
100.0%
19.3815.42
(1------65)
minutes
*3 respondents (Group B) have no answer and 1 respondent's answer (Group B) not applicable
(23) Breakdown of travel time from house to the furthest catchment (2)
0-15 minutes
16-30 minutes
31-45 minutes
46-60 minutes
61-90 minutes
Total
30
20
3
2
1
56
(24) Cost of Transportation (one way) among those who use public/private transportation
(mean )
17.7322.29
(range)
(0------70)
53.6%
35.7%
5.4%
3.6%
1.8%
100.0%
pesos
34
15
2
0
0
3
4
1
1
60
17.6317.68
(1------90)
56.7%
25.0%
3.3%
0.0%
0.0%
5.0%
6.7%
1.7%
1.7%
100.0%
minutes
(27) Breakdown of travel time from house to the assigned barangay health center (2)
0-15 minutes
36
16-30 minutes
14
31-45 minutes
2
46-60 minutes
4
61-90 minutes
1
Total
57
63.2%
24.6%
3.5%
7.0%
1.8%
100.0%
(28) Cost of Transportation (one way) among those who use public/private transportation (N=25)
(mean )
20.7238.35
pesos
(range)
(5------200)
59
1
60
98.3%
1.7%
100.0%
56
46
23
16
23
43
51
18
23
7
5
1
1
313
17.9%
14.7%
7.3%
5.1%
7.3%
13.7%
16.3%
5.8%
7.3%
2.2%
1.6%
0.3%
0.3%
100.0%
(3) Perceived importance of the tools to promote utilization of health service by the client
1) Pregnancy Tracking Form
Very important
49
Important
10
Somewhat important
1
Not important
0
0
Not applicable
Total
60
81.7%
16.7%
1.7%
0.0%
0.0%
100.0%
*The most common reason for importance is that it is the tool for CHT volunteers to monitor the client throughout the course of her
pregnancy.
41
19
0
0
0
60
68.3%
31.7%
0.0%
0.0%
0.0%
100.0%
31
27
1
0
0
59
52.5%
45.8%
1.7%
0.0%
0.0%
100.0%
4) MC book
Very important
Important
Somewhat important
Not important
Not applicable
47
12
0
0
0
59
Total
79.7%
20.3%
0.0%
0.0%
0.0%
100.0%
25
19
1
0
13
58
43.1%
32.8%
1.7%
0.0%
22.4%
100.0%
15
19
4
0
21
59
25.4%
32.2%
6.8%
0.0%
35.6%
100.0%
58
1
59
98.3%
1.7%
100.0%
51
7
58
87.9%
12.1%
100.0%
(6) Difficulty in conducting the activity: Identifying the pregnant women in the early stage of pregnancy
Yes
15
25.0%
No
45
75.0%
Total
60
100.0%
Reasons for difficulty
The pregnant women hide or deny her pregnancy
Some clients can not be identified by appearance
Lack of technical skills to identify the pregnant woman
No answer
Total
11
1
2
1
15
6
3
9
(7) Difficulty in conducting the activity: Convincing the client for prenatal-checkup
Yes
6
No
54
Total
60
Reasons for difficulty
The client is not cooperative
The client is just being lazy
Lack of money for transportation
Total
4
1
1
6
3
3
6
10.0%
90.0%
100.0%
(8) Difficulty in conducting the activity: Convincing the pregnant women for Facility-Based Delivery
Yes
8
No
Total
13.3%
52
86.7%
60
100.0%
5
3
8
3
1
1
1
6
(9) Difficulty in conducting the activity: Convincing the postpartum women for postnatal check-ups
Yes
3
No
56
Total
59
5.1%
94.9%
100.0%
3
3
4
1
1
6
(10) Confidence with the knowledge and skills to give health education to the client
Very confident
28
Confident
32
Not confident
0
Total
60
(11) Workload
Too much
A little too much
Just enough
Not enough
46.7%
53.3%
0.0%
100.0%
5
21
32
2
60
8.3%
35.0%
53.3%
3.3%
100.0%
15
34
9
2
60
25.0%
56.7%
15.0%
3.3%
100.0%
1
2
3
5
11
19
37
4
0
60
1
3
4
17
39
1
1
58
Total
31.7%
61.7%
6.7%
0.0%
100.0%
29.3%
67.2%
1.7%
1.7%
100.0%
26
31
0
0
57
45.6%
54.4%
0.0%
0.0%
100.0%
16
39
3
0
58
27.6%
67.2%
5.2%
0.0%
100.0%
14
36
4
1
55
25.5%
65.5%
7.3%
1.8%
100.0%
2
3
5
8
48
2
0
58
13.8%
82.8%
3.4%
0.0%
100.0%
2
2
2
0
6
53
7
60
88.3%
11.7%
100.0%
30
30
60
50.0%
50.0%
100.0%
29
2
1
3
0
35
82.9%
5.7%
2.9%
8.6%
0.0%
100.0%
*According to the DOH RO8, no PhilHealth enrollement or transportation allowance were given to the CHT volunteer
1,643.3
(1,000----3,000)
*According to the DOH RO8, only Php 250/month has been released to CHT volunteers
9
51
60
15.0%
85.0%
100.0%
46.7%
33.3%
0.0%
13.3%
6.7%
100.0%
1
3
1
1
1
7
46
14
60
596.2
(200----1,500)
76.7%
23.3%
100.0%
61.9%
1.6%
33.3%
3.2%
0.0%
1
169.4
(50----300)
9
16
5
21
1
1
5
55
60
2
2
4
1
1
3
57
60
per time
respondents
8.3%
91.7%
100.0%
57.1%
14.3%
0.0%
14.3%
14.3%
1
5.0%
95.0%
100.0%
50.0%
0.0%
25.0%
25.0%
0.0%
1
*According to PHO, no monetary or transportation allowance were given to CHT volunteers; they are likely done by Municipal LGUs
1
1
2
10
0
60
60
0.0%
100.0%
100.0%
29
28
3
0
0
60
48.3%
46.7%
5.0%
0.0%
0.0%
100.0%
9
6
12
4
4
1
1
22
59
1
1
1
3
17
37
3
0
3
60
2
1
3
2
34
54
1
1
1
3
11
28.3%
61.7%
5.0%
0.0%
5.0%
100.0%
3
9
29
31
0
0
0
60
Total
Reasons for strongly agree/agree
Guideing, coaching and mentoring CHT volunteers on
knowledge/skills
Give assistance or support to CHT volunteers (e.g., regular visit to
barangay)
Aknowldge the work of CHT volunteers
Provide necessity (e.g., materials, advice)
Dedicated/patient
Counterpart of CHT volunteers
Coordinate the work with CHT volunteers
Treat CHT volunteers well
Follow-up on CHT volunteers if any problem
Never had a problem
No answer
Total
48.3%
51.7%
0.0%
0.0%
0.0%
100.0%
15
8
3
3
3
1
1
1
1
1
26
63
33.9%
55.9%
10.2%
0.0%
0.0%
100.0%
13
5
2
1
1
4
28
54
1
5
6
19.0%
75.9%
5.2%
0.0%
0.0%
100.0%
12
7
2
2
2
1
2
2
37
55
1
2
3
(6) Perceived recognition of the importance of their work by others: Barangay officials
Strongly agree
13
Agree
39
Disagree
3
Strongly disagree
4
Not applicable
0
Total
59
22.0%
66.1%
5.1%
6.8%
0.0%
100.0%
1
2
1
2
36
52
1
1
1
1
3
7
7
3
(7) Perceived recognition of the importance of their work by others: Municipal/City officials
Strongly agree
4
6.8%
Agree
39
66.1%
Disagree
15
25.4%
Strongly disagree
0.0%
Not applicable
Total
1.7%
59
100.0%
13
2
1
2
1
1
1
35
43
3
3
9
15
4
45
10
1
60
5
6
2
1
1
1
2
18
6.7%
75.0%
16.7%
1.7%
100.0%
16.4%
19.5%
25.8%
10.2%
12.5%
4.7%
2.3%
3.1%
0.8%
2.3%
0.8%
0.8%
0.8%
100.0%
(10) Experiences spending out of pocket money on work related to CHT activities (N=37)
Yes
35
No
1
Total
36
97.2%
2.8%
1
14
(11) Types of out of pocket money being spent (Multiple answers) (N=35)
Transportation cost to attend/report to health center
Transportation cost for home visits
Transportation cost to accompany/refer the client
Communication costs (texts/calls)
Purchase of logistics (forms/umbrella etc)
Purchase of medicines for the patient
Contribution for lunch/snack/Christmas party
Total
28
5
24
6
23
1
3
90
(12) Suggested improvement for better performance by CHT volunteers (Multiple answers)
44
Training
25
Provision of monetary incentives
19
Provision of IEC materials
23
Provision of other logistics*
16
Supervision by health workers
1
Support from the client
1
More counseling to the client
2
Regular employees and increased number of CHT volunteers
1
Good relationship with co-CHT volunteers and the client
1
Attitude of CHT volunteers (focus/attention to the task)
Total
133
31.1%
5.6%
26.7%
6.7%
25.6%
1.1%
3.3%
100.0%
33.1%
18.8%
14.3%
17.3%
12.0%
0.8%
0.8%
1.5%
0.8%
0.8%
100.0%
*Other logistics: medical equipment at barangay level, logistics for rainy season
42.2%
27.5%
6.4%
4.6%
1.8%
8.3%
4.6%
2.8%
0.9%
0.9%
100.0%
(14) Willingness to continue CHT work after the termination of incentives by the DOH (N=7)
7
Yes
0
No
Total
7
100.0%
0.0%
100.0%
(15) Opinion on whether CHT work can make a difference in the health of mothers and baby
58
Yes
2
No
Total
60
96.7%
3.3%
100.0%
15
5. Good practices/innovative methods used to promote work of CHT volunteers (Multiple answers) (N=60)
Maintaining positive/approachable attitude to the work and the client
Unity among the CHT volunteers to work as a team
Sharing ideas and cooperative with others
Convincing power to the client
Consulting mothers (especially after they gave a birth)
Be punctual on time/Good time management skills
Establish the network of friends to identify the client
Providing quality service
Provide additional service to the client (e.g., massage or BP check-up)
Duty at health centers
None
Not applicable
TOTAL
15
9
5
5
3
3
2
1
1
1
11
6
62
23
16
9
9
18
12
8
4
1
2
3
4
109
7. The most important matters to make CHT work successful (Multiple answers) (N=60)
Giving full support to the client and family/commitment on serving for the community
Performing required task such as tracking, home visiting and report submission
Team work/cooperation with others
Financial support
Patience
Equipped with necessary materials/logistics
Good health condition
Proper training
None
TOTAL
25
15
8
5
2
3
2
2
1
63