i LEVEL OF SATISFACTION OF HEALTH CARE SERVICES AND MANAGEMENT OF THE HEALTH CARE TEAM AS ASSESSED BY THE RESIDENTS AND

HEALTH CARE WORKERS OF BARANGAY ZAPOTE LAS PINAS CITY: BASIS FOR A PROPOSED ENHANCEMENT PROGRAM

A Thesis presented to The Faculty of the Graduate School University of Perpetual Help System DALTA Alabang Zapote Road, Pamplona Las Pinas City

In Partial Fulfillment of the Requirements of the Degree Masters of Arts in Nursing Major in Nursing Administration

By: Gennieve Siy Pabayos, RN October 2012

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APPROVAL SHEET This graduate thesis entitled: LEVEL OF SATISFACTION OF HEALTH CARE SERVICES AND MANAGEMENT OF THE HEALTH CARE TEAM AS ASSESSED BY THE RESIDENTS AND HEALTH CARE WORKERS OF BARANGAY ZAPOTE, LAS PINAS CITY: BASIS FOR A PROPOSED ENHANCEMENT PROGRAM. prepared by Gennieve S. Pabayos, RN, in partial fulfillment of the requirements for the degree of Master of Arts in Nursing Major in Nursing Administration has been examined and recommended for the acceptance and approval for oral defense.

HAZEL N. VILLAGRACIA, RN, MAN, Ed D Thesis Adviser

ORAL EXAMINATION COMMITTEE Approved by the Oral Examination Committee with a grade of
_____________

YOLANDA T. CANARIA, RN, Ph.D. Member

ENJOLA KAYE S. ELMA, RN, Ph.D. Member

NAOMI M. DE ARO, RN, Ph.D. Chairman

Accepted in partial fulfillment of the requirements for the degree of the Master of Arts in Nursing, Major in Nursing Administration

ATTY. IRINEO F. MARTINEZ JR. PhD Dean, Graduate School

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ACKNOWLEDGMENT

During the course of the thesis work, many individuals have been a part of this thesis, contributing both their time and support to help make the project possible. The researcher would like to acknowledge the help of the following.... THE ALMIGHTY GOD who has given me an opportunity to finish everything, for without His help, there would not be wisdom, strength and knowledge needed to be successful. ATTY. IRINEO F. MARTINEZ, Dean and Professor of the Graduate School of Education, University of Perpetual Help System DALTA Las Pias, who encouraged researchers to continue to enrol and finish the Master of Arts in Nursing Administration DR. HAZEL N. VILLAGRACIA, RN, MAN, the research adviser for her patience and untiring support, throughout the preparation of this paper, giving insights, correcting errors and the meetings that were always very enriching. DR. NAOMI M. DE ARO, RN, one of the members of the panel in the colloquium and chairman in the final defense panel, her appreciation for wonderful insights into the research study and in providing the proper research direction.

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DR. YOLANDA T. CANARIA, RN, MAN, one of the members of the colloquium and final defense panels for her support and guidance all throughout this paper. DR. ERIC A. OLIVAREZ, the panel chairman during the colloquium for his insights and further enhancement of the work. DR. ENJOLA KAYE S. ELMA, RN, MAN, one of the members of the panel in the final defense who also validated the instrument, for her useful suggestions. DEAN MA. IMELDA O. JAVIER, RN, MAN, Dean, College of Nursing, University of Perpetual Help System DALTA Las Pias, for her relentless encouragement to continue to finish with the program. DEAN FRANCISCO B. SOSA JR., RN, MAN, who validated the questionnaire, for his insights in the proper alignment of the tool, along with the identified sub problems. MRS. ROSARIO A. BROQUEZA, RN, RM, MPH, one of the

validators of the questionnaire, for her insights in the different programs and services offered in the health center. MAYOR VERGEL NENE A. AGUILAR for allowing the researcher to conduct the research in her locale.

BARANGAY CAPTAIN LEOBY L. FABIAN for his permission to allow the conduct of this research and his insights on the outlook of the residents. BARANAGAY CAPTAIN BIENVENIDO DE LARA MATEO JR. for allowing the research and taking the time to endorse to the person responsible. MR. HENRY O. DELA CRUZ for his role in the approval of this research without you this paper would not push through. DR. FLORENCIA C. MARFIL, Dean of Education, University of Perpetual Help System DALTA Las Pias for inputs in the subject. DR. NIEVES M. MEDINA, former Dean of the Graduate School of Education, University of Perpetual Help System DALTA Las Pias, without her guidance, encouragement, and support. THE HEALTH WORKERS OF BARANGAY PAMPLONA1 LAS PINAS CITY, for their honest responses in the completion of this research. THE HEALTH WORKERS OF BARANGAY ZAPOTE LAS PINAS CITY, for their patience and understanding in answering questions about this research.

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THE RESIDENTS OF BARANGAY ZAPOTE, LAS PINAS CITY, for their biggest and most important role in this research her heartfelt thanks. THE RESPONDENTS OF BARANGAY PAMPLONA 1 LAS PIAS CITY, for their insights and honest feedbacks. MR. EDGAR B. AZABAN for his help in the translation of the instrument into the Filipino language. DORIS O. DAVA, RN, CHERYL JOY O. MACASPAC, RN AND NINA MARIE A. VILLA, RN, the researchers colleagues in research writing, for their relentless support, endless communication and enthusiasm to finish this paper. DINA AND JANET SANTOS for their guidance given to the community people during the research data gathering JENNYLOU I. MARMOL, RN MEGUMI O. HAMOR, RN, DARLENE A. RONAS, for the continuing support and encouragement. CONEY ROSE E. MAGOS, RN for being there all throughout. Her parents Ernesto and Lingling Pabayos, her siblings Gemmielene, Guinevere and Gene Geofrey, and other family members of the researcher who played a big part in molding the researcher. The familys support is truly an inspiration. GSP

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ABSTRACT

Name of the Institution Address Title

University of Perpetual Help System DALTA Alabang-Zapote Road, Las Pias City Level of Satisfaction of Health Care Services and Management of the Health Care Team As Assessed by the Residents and Health Care Workers of Barangay Zapote, Las Pinas City: Basis for a Proposed Enhancement Program

Author Degree Major Date of Completion

Gennieve Siy Pabayos Master of Arts in Nursing Nursing Educational Management October 2012

STATEMENT OF THE PROBLEM: This study aimed to ascertain the respondents (Basa and Santos residents and the health workers) level of satisfaction with the health care services of the health center of Barangay Zapote, Las Pinas City Specifically this study sought to answer the following:

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1. What is the profile of the respondents of Barangay Zapote, Las Pinas City in terms of the following: 1.1 age; 1.2 civil status; 1.3 family income level for the residents; and 1.4 length of service for the health workers? 2. What is the level of satisfaction of the respondents of Barangay, Zapote Las Pias City in terms of the following health care services: 2.1 maternal check up; 2.2 immunization services; 2.3 family planning services; and 2.4 sanitation services? 3. What is the level of job satisfaction of the health care workers in terms of Motivation variables: 3.1 achievement; 3.2 recognition; 3.3 work itself; 3.4 responsibility; and 3.5 advancement?

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4. What is the level of job satisfaction of the health care workers in terms of Hygiene variables: 4.1 pay and benefits (salary); 4.2 company policy and administration; 4.3relationship relationships); 4.4 supervision; and 4.5 working conditions? 5. Are there significant differences in the respondents levels of satisfaction on the different health care services offered when grouped according to their profile variables? 6. Are there significant differences in the evaluations of the residents and the health workers on the health care services? 7. Based on the results of the study, what enhancement program can be proposed to improve the health care services and management of the health care team? with co-workers (interpersonal

HYPOTHESES: Ho1: There are no significant differences between the residents and health care workers levels of satisfaction on the health care services when grouped according to their profile variables.

Ho2: There are no significant differences in the evaluations of the residents and the health workers on the health care services.

METHODOLOGY: The researcher used a descriptive design to represent the findings. Non-probability sampling method was used in the qualification of the respondents, where the purposive sampling method was used in the choosing of the qualified respondents from the list available in the health center. Quota sampling was used in the narrowing down of the total number of population to 30% of the respondents who went to the Santos Health Center and Basa Health Center, then convenience sampling was applied to the members of the population based on their relative ease of access. The following were used in the gathering of data: pilot study of the validated instrument at Pamplona 1, Las Pinas Center with a total of 10 residents and 10 health workers in which convenience sampling was done in the gathering of the data for the residents and health workers. The criteria for the residents as respondents are as follows: (1) at least one year residence at Barangay Zapote - Las Pinas City; (2) residents who regularly visit and avail of the services of the health center namely:

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maternal check-up, immunization services, family planning services and sanitation services ; (3) must be 17 years old and above. The researcher had an overall 115 respondents in which 69 came from the Santos Health Center and 46 came from the Basa Health Center. The reseacher used a convenience non probability sampling. The health care workers, the second group of participants were those under the following category (1) They are employed in the Barangay Zapote Health Center Santos and Basa, Las Pinas City; (2) Working full time as health workers in Barangay Zapote Health Center, Las Pinas City. Only 11 of the health workers had duty schedules The Pearson r correlation was used in determining the validity of the instrument with a correlation of r = 0.897 wherein the value gained was more than the critical value of r = 0.997. Testing the reliability of the instrument, a pilot study was conducted and the set of data gathered was analyzed using the Split-Half Method for reliability coefficient with the application of Pearson Product Moment Coefficient of Correlation. Based on the data obtained from odd-even items, the computed r-value of 1.025 being higher than the critical r-value of 0.987 at five percent level of significance, revealed a significantly high reliability of the instrument.

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The study was done using a frequency and percentage distribution for the profiles, simple and weighted mean using the Microsoft excel was used to determine the mean of the answers of respondents. Correlation analysis using the t-test and Analysis of Variance was used in the determinants of the (1). significant level of satisfaction of the residents on the different services when grouped according to their profile variables. (2). Significant level of satisfaction on the services by the residents and health care workers

FINDINGS: The following are the findings of the study discussed according to the order of the research problems stated in the first chapter.

1. 1 As to the profile of the residents of Barangay Zapote (Santos and Basa residents) Las Pinas City in terms of the following: A total number of 115 respondents were gathered for the purpose of this research to which 69 of the respondents were from those who visit Santos Health Center and 46 respondents from Basa Health Center. When grouped according to age, it was found out that mothers belonging to age group 26 to 30 years old are the most frequent visitors of the health center while those aged from 41 and above are the ones

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who least likely visit the health center. Most of the 2nd time mothers belong within the age bracket of 22 which is considered to be the most common age in the Philippines where they start to build their own families. Usually females in their late 30's already have 4 children and sometimes this prompted them to stop the idea of having another child. Live-in couples, on the other hand, have the highest number compared to the married group while those who are single, widowed or separated have the least number. Evidently, more and more couples are opting not to get married. Meanwhile, families with an income level of 5001 to 10,000 per month are those who frequently visit the health center while those who have an income level of more than 15,001 per month are the ones who least likely visit the health center.

1.2 As to the profile of the health workers of Barangay Zapote Las Pinas City in terms of the following: As to age profile of health workers, most of them are already 50 years old and above while the other age group are equally distributed into the different age group. Apparently, most of the health workers in the Santos health center are nearing their age of retirement while those from the Basa have different ranges.

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In terms of civil status, more than half of the health workers are married rather than single. Data showed that married workers dominate the population. This sets a good example to the society in terms of morality per se. For the length of service, most of the health workers have already been working more than 21 years in the health center. Mastery of the work and the benefit of experience can be seen from these data. On the other hand, resistance to change can also be a drawback looking at this profile.

2.1 As to the level of satisfaction of the residents of Barangay, Zapote (Santos and Basa) Las Pias City in terms of the following health care services: On the maternal check up service that the health center conducts, both Santos and Basa respondents have come up with very satisfied findings. For some of the criteria such as the promoting of Vitamin A supplementation after giving birth, both centers have gathered excellently satisfied feedbacks while rendering of dental services for pregnant mothers has the lowest mean score. Since the best result for the category should be excellently satisfied, the service still has room for improvement.

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Regarding the immunization services, both respondents of Santos and Basa have come up with an excellently satisfied result. For this category, this means that the health workers should continue in providing appropriate services to the respondents. In terms of family planning services, a very satisfied score was earned. Majority of the respondents stated that most of the health

workers have been openly honest in disclosing information about the different types of family planning methods, as well as, services although some respondents admitted that these workers seldom demonstrate the methods on how to use this type of services. With the said feedback, it is necessary to implement improvement measures regarding this service. As to the sanitation services, Santos respondents have come up with an excellently satisfied result while Basa respondents ended with a very satisfied score. It is evident that Basa respondents are still

expecting for much better health services to suit their level of satisfaction.

2.2 The level of satisfaction of the health workers in terms of the following health care services: In terms of maternal check-up seen from the point of view of the health workers a very satisfied result was given. Based on the self-

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assessment of the health workers, it is evident that they are still expecting for better quality of the delivery of the said services based on the criteria set to come up with an excellently satisfied result. As to the immunization services, from the health workers point of view, a room for augmentation can still be invoked as the score only resulted in a very satisfied result. When it comes to family planning services, from the health workers outlook, a very satisfied result was given. Further improvement is still expected in this area. With the sanitation services, although a very satisfied score was given, there are still some areas in this aspect that need to be improved in order to satisfy excellently the level of needs of the respondents.

3. The level of job satisfaction of the health care workers in terms of Motivation variables: Regarding the level of job satisfaction in terms of the motivation variables of achievement, very satisfied results were given. While most of the health workers were already very satisfied with their

achievements, it is also considered that an achievement motive is an impulse to master challenges and reach the standard of excellence. Both personality and situational factors influence achievement motivation

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As to the level of job satisfaction in terms of the motivation variable of recognition, a very satisfied feedback was also given. It is clear that recognition is considered to be a very influential factor to an individual towards motivating the person for a better output. The level of job satisfaction of the health workers in terms of the motivation variable of work itself resulted in a very satisfied result. The source of motivation may differ from person to person. In the work

environment, many believe that the level of satisfaction at work is a strong motivator. It is true that people change throughout their lives. A person who once was motivated by change may not enjoy it anymore. Whereas, the person who loves a routine work may want to experience change to get something different in his/her lives, or just to see if he/she is good at something else than what he/she has been doing for many years. When it comes to the level of job satisfaction in terms of motivation variable of responsibility, also a very satisfied result was given for this category. People are motivated when their responsibilities are meaningful and engage their abilities and values and it is also most meaningful when it fits a person's values. A motivated person knows his/her responsibilities and this helps him/her to give value in performing his/her job well.

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The level of job satisfaction for the motivation variable of advancement resulted in a very satisfied outcome. Advancement opportunities are central to strong job performance. With additional

skills, a workers diverse expertise might create an impact to increase his/her value particularly to their employers.

4. The level of job satisfaction of the health care workers in terms of Hygiene variables: As to the level of job satisfaction of the health workers according to the hygiene variable of pay and benefits (Salary), only satisfied outcome was given. Though negotiating a salary raise may not be

easy, there are some strategic ways that can help these workers such as a letter of request to the people/office concerned stating the purpose of their request for a possible salary increase. The level of job satisfaction of the health workers according to the hygiene variable of company policy and administration is very satisfied. Although, the city health office already has a good policy and administration from the workers point of view, company policy should be reviewed and updated occasionally. In terms of the level of job satisfaction of the health workers in the hygiene variable pertaining to relationship with co-workers (interpersonal

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relationships), a very satisfied result was given.

Interpersonal

relationship refers to a strong association among individuals working together in the same organization. Employees working together ought to share a special bond for them to deliver their level best. It is essential for individuals to be honest with each other for a healthy interpersonal relationship and eventually positive atmosphere at the workplace. Meanwhile, the level of job satisfaction of the health workers in terms of the hygiene variable of supervision has resulted to a very satisfied outcome. The results demonstrated that workers satisfied with the quality and style of supervision evidenced greater overall job satisfaction. Workers were generally more satisfied with their jobs when they were more satisfied with their supervision and liked their supervision better when it matches their preferred style. On the other hand, as to the level of job satisfaction of the health workers in terms of hygiene variable of working conditions, only a satisfied result was given. Workplace environments greatly influence employee satisfaction, which in turn directly affects employee turnover rates. Knowing how to use a positive work environment to increase employee satisfaction and reduce turnover is a key to developing a highperforming workforce.

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5. Significant differences in respondents levels of satisfaction on the different health care services offered when grouped according to their profile variables: Upon reviewing the data presented according to the profile of age, with critical values of 2.361 and 2.449 for the Santos and Basa respondents respectively, results showed that the outcomes are below the critical value. This means based on the profile of age and the

different services, findings are not significant for both Santos and Basa respondents. Apparently regardless of age, findings were not different. Moreover on the civil status as a profile criterion, based on the critical values of 3.136 for the Santos respondents and 3.214 for the Basa respondents, the findings are not significant as the status did not change in terms of the different health services offered. On the family income level, with critical value of 3.077 for the Santos respondents and 2.827 for the Basa respondents, evidently, there are no significant differences as to the findings coming from the Santos residents as to the health services, however, there are significant differences as to the findings in terms of immunization and family planning services in relation to the income level of the family.

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6. Significant differences in the evaluations of the residents and the health workers on the health care services The following data showed that a critical value level with significance level of 5% from Santos respondents and the health workers is 1.991. Looking at the different services presented, the mean level for the residents is higher than those of the health workers. This means that in terms of service satisfaction, residents are more satisfied in receiving the services than the health workers who give the said services. On the other hand, Basa residents came up with a 5% critical level of significance while the health workers only earned 2.004. Evidently, maternal services earned a high score from the health workers point-of-view while the rest of the services such as immunization, family planning and sanitation services earned a high score from the residents.

CONCLUSION: The following are the conclusions drawn on the basis of the findings of the study: 1.1 As to the profile of the residents of Barangay Zapote (Santos and Basa residents) Las Pinas City in terms of the following:

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For some of the most vulnerable members of society, finding quality care at an affordable price can be difficult if not impossible. Whether uninsured, in a low paying job, or in a rural community, many people wind up forgoing care at the expense of their own health. Looking at the profile of Barangay Zapote (Santos and Basa) respondents, regardless of what age group, civil status or income level they have, health remains to be a very important matter for all. This means that respondents specially coming from those low income level family, tend to sought services from the community health centers in their respective areas.

1.2 The profile of the health workers of Barangay Zapote Las Pinas City in terms of the following: Most of the health workers in this health center are 50 years old and above, nearing their retiring age. Meanwhile in the civil status category, more than half of the health workers are married. Morever as to the length of service, most of the health workers have been in the service for more than 21 years.

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2.1 As to the level of satisfaction of the residents of Barangay, Zapote (Santos and Basa residents) Las Pias City in terms of the following health care services: In summary as to the different levels of satisfaction of the residents of Barangay Zapote (Santos and Basa) in the different health care services: the maternal services obtained a very satisfied result; immunization services had an excellently satisfied result while both family planning and sanitation services obtained very satisfied scores. Client satisfaction is the level of satisfaction that clients experience after having used a service. It therefore reflects the gap between the expected service and the experience of the service, from the client's point of view. Measuring client or patient satisfaction has become an integral part of hospital/clinic management strategies across the country. Asking

patients what they think about the care and treatment they have received is an important step towards improving the quality of care, and ensure that local health services are meeting patients' needs.

2.2 The level of satisfaction of the health workers in terms of the following health care services: On the maternal check-up service seen from the point of view of the health workers resulted to a very satisfied feedback. In terms of

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immunization services, family planning and sanitation services, very satisfied scores were also given. Taken collectively, the health workers are all very much satisfied in terms of the different health services mentioned above.

3. The level of job satisfaction of the health care workers in terms of motivation variables: The level of job satisfaction of the health care workers in terms of the motivation variables of achievement, recognition, work, responsibility and advancement all resulted with very satisfied outcomes. Based on the findings, health workers are very satisfied in terms of the different motivation variables used. Evidently, highly motivated individuals can often overcome different obstacles related to their jobs.

4. The level of job satisfaction of the health care workers in terms of hygiene variables: As to the level of job satisfaction of the health workers according to the hygiene variable of pay and benefits (Salary) and working conditions, majority were only satisfied on the salary that they have been receiving as well as to their present working environment. Meanwhile according to the hygiene variable of company policy and administration,

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relationship with co-workers and supervision, very satisfied results were obtained. Apparently, results showed that most employees are not satisfied with their salary. While salary is clearly important to the majority of

people it is very encouraging to see that job satisfaction is deemed to be even more influential. On the other hand, workplace environments greatly influence employee satisfaction, which in turn directly affects employee turnover rates. Knowing how to use a positive work environment to increase employee satisfaction and reduce turnover is a key to developing a high-performing workforce.

5. A significant difference in respondents level of satisfaction on the different health care services offered when grouped according to the profile variables: A slight difference was noted in the respondents level of satisfaction in terms of different health care services when grouped according to the profile variable except for the immunization service and family planning service when it comes to the family income level category.

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6. Significant differences in the evaluations of the residents and the health workers on health care services: No significant differences were noted in the evaluation of the residents and health workers on different health care services both from the part of Santos respondents and health workers. Hence, a higher difference in terms of level of satisfaction of the residents were evident. On the other hand for the maternal services, a higher difference was noted from the health workers perceptions while the rest of the services such as immunization, family planning and sanitation presented a higher difference from the respondents point-of-view.

RECOMMENDATIONS:

Community health centers are beneficial because they service less-fortunate residents of the city. With rising unemployment and health care costs, these residents need affordable, high-quality care. With the increase of the working poor in the country, low-income families struggle to stay on a budget and pay bills. In many cases, their jobs don't offer health insurance, so the community health clinic provides affordable care to them. Although community health centers are available in every

barangay, some of the services including facilities should be updated from time to time for better quality of health services. Enhancement

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program is strongly recommended to further address and adequately meet the needs of their clients.

xxviii TABLE OF CONTENTS

PAGE TITLE PAGE APPROVAL SHEET ACKNOWLEDGMENT ABSTRACT TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES i ii iii vii xxviii xxxii xxxv

CHAPTER 1 THE PROBLEM AND ITS BACKGROUND Introduction Theoretical Framework Conceptual Framework / Paradigm Statement of the Problem Hypothesis Scope and Limitation of the Study Significance of the Study Definition of Terms 1 4 5 7 9 9 10 12

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REVIEW OF RELATED LITERATURE Related Literature Foreign Literature Abraham Maslows Hierarchy of Needs Structured Dependency Theory Herberz theory on Motivation Disengagement Theory Local Literature Foreign Studies Local Studies Synthesis 17 17 21 22 23 25 25 32 34 41

METHODOLOGY Research Design Population and Sampling Pilot Study Actual Study Research Instrument Validation of Instrument Data-Gathering Procedure Statistical Treatment of Data 44 45 46 47 48 49 51 52

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PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS Summary Findings Conclusions Recommendations

51

131 136 145 150 152

REFERENCES APPENDICES A Conforme Letter from the Validator for the Questionnaire Letter to the City Health Office for Approval of Research Approved Letter from the City Health Office to Conduct Research in the Specific Health Center Approved Letter from the Pamplona 1 Las Pinas City Barangay Captain to Conduct an Interview Approved Letter from the Zapote Las Pinas City Barangay Captain to Conduct an Interview The Questionnaire for the Residents Barangay Zapote, Las Pinas City of

156

159

160

161

162

163

Filipino Translation of the Validated Questionnaire to be Used for the Residents of Barangay Zapote Las Pinas City The Questionnaire for Validation for the Health

168

173

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Workers of Barangay Zapote Las Pinas City I Data Gathering Procedure for the Enhancement Program Statistical Treatment of Profile of the Respondents Santos Residents and Health Workers Statistical Treatment of Profile of the Respondents Basa Residents and Health Workers Summarized Answer of the Santos Resident Mean Answer of the Santos Resident Age Analysis Mean Answer of the Basa Resident Age Analysis Statistical Treatment of the Mean of Santos Residents and Civil Status Statistical Treatment of the Mean Santos Residents and Family Income Level Statistical Treatment of the Mean of Basa Residents and Family Income Level Health Teaching Information for Pregnant Client Sample Family Planning Form Assessment Certification of Editing Certification of Statistical Treatment 179

180

182

L M

184 186

188

190

192

194

R S T U

196 199 200 201 202

CURRICULUM VITAE

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LIST OF TABLES Table 1 Total Number of Qualified People Who Visit the Health Center as of January 2011 Criteria Used to Assess the Satisfaction of the Respondents Level of Page 48

50

Profile of the Residents of Barangay Zapote Las Pias City Categorized under Santos and Basa Residents according to Age, Civil Status and Family Income Level Profile of the Health Workers of Barangay Zapote, Las Pias City Categorized Under Age, Civil Status and Length of Service Mean Distribution of the Residents of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Maternal Check-up services Mean Distribution of the Residents of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Immunization services Mean Distribution of the Residents of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Family Planning services Mean Distribution of the Residents of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Sanitation Services Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Maternal Services

57

62

65

68

70

73

75

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10

Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Immunization Services Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Family Planning Services Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Sanitation Services Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of Motivation Variables Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of Hygiene Variables Significant difference in the respondents level of satisfaction on the different health care services offered when grouped according to Age Significant difference in the residents level of satisfaction on the different health care services offered when grouped according to civil status Significant difference in the respondents level of satisfaction on the different health care services offered when grouped according to Family Income Level Mean Level of Satisfaction Signifying Differences in the Evaluations of the residents and the health workers on the health care services from the Santos Residents

78

11

80

12

83

13

85

14

90

15

94

16

97

17

100

18

103

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19

Mean Level of Satisfaction Signifying Differences in the Evaluations of the residents and the health workers on the health care services from the Basa Residents

105

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LIST OF FIGURES Page 1 Conceptual Paradigm showing the level of satisfaction with the health care services of the health center of Barangay Zapote Las Pinas City 4

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Chapter 1 THE PROBLEM AND ITS BACKGROUND

Introduction Health centers provide primary care to specific populations and are staffed by nurse practitioners and community health nurses. Although nurses are the primary care providers to clients visiting the center, a physicians consultation is also available as needed. (Kozier, 2008) Community health centers on the other hand, offer a variety of health services such as pre-natal check-up, assessment of geriatric, adult and pediatric patients, free immunizations, and referrals to other health facilities. The Local Government Code of the Philippines declares that local government units shall be given more powers, authorities,

responsibilities, and resources. More so, the process of decentralization shall proceed from the national government to the local government units. The Code shall apply to all provinces, cities, municipalities, barangays, and other political subdivisions as may be created by law, and, to the extent herein provided, to officials, offices, or agencies of the national government. (R.A 7160)

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Public health nursing is a special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total program for the promotion of health, improvement of conditions on the social and physical environment and rehabilitation of illness and disability. (World Health Organization) Community health nursing is a unique blend of nursing and public health practice woven into human service properly developed and applied which created a tremendous impact on human well-being. Its responsibilities extend to the care and supervision of individuals and families in their homes, in places of work, in schools, and clinics. Community Health Nursing responds to the health needs of its clients. The different levels of clientele in community health nursing comprises of- The individual, family, population group and community. (Maglaya, 2008) The ultimate goal of community health services is to raise the level of the citizenry. The goal of community health nursing on the other hand, is to help communities and families to cope with the discontinuities in health and threats to maximize their potential for a high level of wellness, as well as, to promote a reciprocally supportive relationship between people and their physical and social environment. (Reyala et. al., 2005)

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Even before the researcher became a health worker, community volunteer work has already been her passion. The parents involvement to various community outreach programs somehow influenced the researcher and the researcher's siblings passion in the field of community work. The family have been very much involved specially in the care of health and welfare of the residents of Barangay Zapote Las Pinas City. In relation to this, she envisions that there can still be a venue for improvement in the current setting of the community health and the health status of the community members. Taking into consideration, the researcher's willingness and perseverance she ventured on this to pinpoint study areas that need to have further improvement in terms of services. The researcher also

considers this opportunity as her venue to exercise her role as a community health nurse. It is therefore the intention of the researcher to delve into the respondents (Basa and Santos residents' and the health workers) levels of satisfaction with the health care services provided by the health center in Barangay Zapote, Las Pinas City.

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Theoretical Framework Supporting good performance, health care workers need clear job expectations, up-to-date knowledge and skills, adequate equipment and supplies and other aspects that give motivation. Workers need

motivation, especially when some of the other factors that support good performance are lacking. Raising the level of motivation increases

profitability through greater activity and commitment of each worker. (Herbergz Motivator Hygiene Factors, 1987). The Dual Structure theory or Two Factor Theory of job satisfaction was derived from the concept that there were two influences that affect how people felt about their job. Satisfiers describe a person's relationship with what she or he does, many related to the tasks being performed. Dissatisfiers, on the other hand, have to do with a person's relationship to the context or environment in which she or he performs the job. The satisfiers relate to what a person does while the dissatisfiers relate to the situation in which the person does what he or she does. The Herbergz Motivator Hygiene factor was used in the assessment of the job satisfaction of the health workers relevant to their job and the management of their work. This theory serves as a basis for the enhancement program to be developed by the health workers as it affects directly job satisfactory levels.

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Input Process Output Conceptual Paradigm

Input Profile Variables of Residents - Age - Civil Status - Income Level for the residents - Length of Service for the health workers Job Satisfaction of the Health Care workers: - Motivator Variables Achievement Recognition Work Itself Responsibility Advancement - Hygiene Variables Pay and Benefits (Salary) Company Policy and Administration Relationships with coworkers (interpersonal) Supervision Working Conditions Process Determination of the Satisfactory Level Health Care Services and Management in terms of - Maternal Check up services - Immunizatio n Services - Family Planning Services - Sanitation Services Output An Enhance ment Program for of Barangay Zapote Las Pinas City

Feedback
Figure 1 Paradigm showing the respondents (Basa and Santos residents' and the health workers) level of satisfaction with the health care services provided by the health center in Barangay Zapote, Las Pinas City.

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Herzberg's findings revealed that certain characteristics of a job are consistently related to job satisfaction, while different factors are associated with job dissatisfaction. In relation to this, figure 1 presents the paradigm of the study where it is anchored in the theory of Herzberg. The researcher intends to pursue the determination of the respondents (Basa and Santos residents and the health care workers) level of satisfaction with the health care services provided by the health center in Barangay Zapote, Las Pias City as the major variables of the study. Clients of Barangay Zapote Las Pinas City Health Center are categorized in terms of Age, Gender, Civil status, and Family income level and the factors that can alter the motivation factor of the health care workers in terms of motivator factors according to Achievement, Recognition, Work itself, Responsibility, and Advancement; the Hygiene factors of Pay and Benefits (Salary), Company Policy and

Administration, Relationship with co-workers (Interpersonal Relations), Supervision, and Working Conditions. After undergoing the different services offered by the health center and answering the questionnaires provided, the researcher will be able to evaluate client s and health care workers satisfaction. The cooperation and truthfulness of the

respondents in answering the questionnaires will serve as the basis for an enhancement program for these community services.

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Statement of the Problem This study aimed to ascertain the respondents (Basa and Santos residents' and the health workers) level of satisfaction with the health care services provided by the health center in Barangay Zapote, Las Pinas City This study aims to propose an enhancement program.

Specifically this study sought to answer the following: 1. What is the profile of the respondents of Barangay Zapote Las Pinas City in terms of the following: 1.1 age; 1.2 civil status; 1.3 family income level for the residents; and 1.4 length of service for the health workers? 2. What is the level of satisfaction of the respondents of Barangay, Zapote Las Pias City in terms of the following health care services: 2.1 maternal check up; 2.2 immunization services; 2.3 family planning services; and 2.4 sanitation services?

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3. What is the level of job satisfaction of the health care workers in terms of Motivation variables: 3.1 achievement; 3.2 recognition; 3.3 work itself; 3.4 responsibility; and 3.5 advancement? 4. What is the level of job satisfaction of the health care workers in terms of Hygiene variables: 4.1 pay and benefits (Salary); 4.2 company policy and administration; 4.3relationship relationships); 4.4 supervision; and 4.5 working conditions? 5. Are there significant differences in the respondents level of satisfaction on the different health care services offered when grouped according to the profile variables ? 6. Are there significant differences in the evaluation of the residents and the health workers on the health care services? with co-workers (interpersonal

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7. Based on the results of the study, what enhancement program can be proposed to improve the health care services and management of the health care team?

Hypothesis Ho1: There are no significant differences between the residents and health care workers level of satisfaction in terms of health care services when grouped according to the variables. Ho2: There are no significant differences in the evaluation of the residents and health workers on the health care services.

Scope and Limitation of the Study The scope of the study focuses on the level of satisfaction of the residents with the health care services rendered in Barangay Zapote Las Pinas City Health Center: Santos Health Center; which serves the City residents who visit the Health Center (Santos or Basa) for maternal checkups, immunization services, family planning services, and

sanitation services, at the same time, assessment of job satisfaction of the health care workers working in Barangay Zapote (Santos and Basa) Las Pinas City in terms of motivation and hygiene variables. Due to limited time available in conducting the study, only the factors that were

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considered relevant were given emphasis. With the above mentioned scope and limitations, the researcher does not claim to be in the position to make broad generalizations and general conclusions regarding the clients satisfaction.

Significance of the Study This study would be beneficial to the following: Residents of Barangay Zapote Las Pinas City. Clients satisfaction measures the extent to which a clients expectations for meeting good service are met. A proper measure of satisfaction includes a separate assessment of both client expectations and the quality of service provided. This study helps the client to express their feelings

and concerns regarding the health services that they have been receiving. Health Workers of Barangay Zapote Las Pinas City. Health workers are considered to be one of the most important components who have been selected by the community to assist them with their health needs. The result of this study can further help them express their concerns regarding their jobs and their perceptions regarding the different services that they have been rendering to community people. This further gives them an opportunity to develop programs for more

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improved community health services. In light of this study, this will also help them realize the value of their profession as a human component in the healthcare delivery system who are always prepared to reach out to those in need and fill the void of human caring created by clinical environments. Zapote, Las Pinas Health Center. As a venue of different health services, this study can help the respondents to air their concerns and suggestions as to their level of satisfaction with regards to the services that they have been receiving from this institution. The Local Government Units. As one of the primary health care providers, the results of this study may help increase their efforts in strengthening further health management systems, provide more financial assistance and provide assistance in improving health service provider performance. For Future Researchers. The study would benefit and help the future researchers. This may also serve as their motivation and may somehow pave the way for student nurses and registered nurses to aspire more and become more innovative in their own capacity.

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Definition of Terms For a clearer understanding of the study, the following terms are operationally defined. Respondent refers to the one who responds to the questions being asked or given. Age refers to the profile of the respondents categorized by group according to how many years old the respondents are. Civil status refers to the marital status of the residents and health workers, whether the respondents are single, married, widow or live in. Family income level refers to the amount of financial gain that the family receives each month. Ranges of salary per month are as follows: less than 5,000; 5001 to 10,000; 10,001 to 15,000; 15,001 and above. Length of Service refers to the number of years that the health care workers have been working in the health center for their individual profession. The range for the length of service is less than 10 years; 11 to 20 years; 21 to 30 years; 31 years and above. Basa and Santos Residents refer to the respondents of the

study availing of the health services of the health center.

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Health care services. refers to the following: Maternal Check-up services pertain to the services given to pregnant women which include physical examination, tetanus toxoid immunization. Immunization Services pertain to the basic health services for infants and children which includes Bacillus Calmette Guerin (BCG) vaccine, Diptheria Pertussis Tetanus (DPT) vaccine, Oral Polio Vaccine (OPV), Hepatitis B, Anti Measles vaccine etc. Family Planning Services are the services provided for couples to maintain proper birth spacing of their family. Sanitation Services refer to health care services rendered to prevent deleterious effect on the communitys health, well being and survival. Health Care Workers are the personnel in the Barangay Zapote Las Pinas City which comprises of a doctor, a dentist, nurses, midwives, and a barangay health nutritionist. Health Center refers to a place where people seek primary health service like maternal check up, Immunization services, family planning service, and sanitation services.

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Job satisfaction refers to the personal gauge of a worker in his or her duty, compensation and administration of the workers by the organization. Motivator Variables: Achievement is the attained level of position of health workers, their feedback and the level of being challenged in their jobs. Recognition refers to acknowledgement of worth in terms identifying the accomplishments, the timely and meaningful inputs through a formal program of work of health workers. Work itself pertains to the meaningfulness of a job to a health worker; that his/her job is important so that the health worker can work efficiently. Responsibility refers to giving of duty and task to a particular health worker. Advancement refers to the level of promotion in the

organization and personal growth in this line of work for the health workers.

Hygiene variables: Pay and benefits (Salary) pertain to compensation received by health workers in the form of monetary and non-monetary rewards Company policy and administration pertain to the rules and regulations being followed by the health workers, the process of implementing and following of the policy by the health workers in the health center. Relationship with co-workers (interpersonal

relationships) refers to Interaction of health workers with other health workers. Supervision refers to the act of overseeing the work and services of the health workers; their trust in their immediate head with the feedback and constructive criticism in a timely manner. Working conditions are the environmental conditions encountered by the health workers. Enhancement program refers to the program focusing on the job satisfaction of health care workers as to different services such as maternal check-ups, immunizations, family planning seminars, dental services and sanitation services.

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Level of Satisfaction refers to the fulfillment of a need or want. In which for the purpose of this research would be labeled the following : 4.51 5.00 Excellently Satisfied; 3.51 4.50 Very Satisfied;

2.51 3.50 Satisfied; 1.51 2.50; Dissatisfied and 1.00 1.50 Very Dissatisfied.

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Chapter 2 REVIEW OF RELATED LITERATURE AND STUDIES

Many theories have been proposed to explain what motivates human behavior. Although the literature covers a wide variety of such theories and facts, this review will focus on the comparison between excerpts from foreign and local literature which focus on different aspects of health care services such as maternal and child care, immunization, family planning and sanitation services. Also included in this study are different motivation factors that influence level of satisfaction between the client and the health workers related to different aspects of health services. The researcher reviewed several studies

conducted by different authors which served as significant details and provided the researcher insights and views on the constituents of the study. The related information and details are in one way or the other related in some aspects to the present attempt which added more relevance and depth to the research study.

Foreign Literature Competent practice is a major legal safeguard for nurses. Nurses need to provide care that is within the legal boundaries of their practice and within the boundaries of agency policies and procedures. Nurses

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therefore, must be familiar with their various job descriptions. (Kozier, 8th edition) Government agencies are established at the local state and federal levels to provide public health services. Health agencies at the state, county or city level vary according to the needs of the area. State health organizations are responsible for assisting the local health department. In some remote areas, state departments also provide direct services to the people. (Davis, Fredrickson, 2004) United States law requires that immunization providers use Centers for Disease Control Vaccine Information Statements (VISs) and inform parents about vaccine risks and benefits prior to every childhood immunization. A recent national survey found that public health clinics (PHCs) reported high compliance with this law. Vaccination is credited today as the most effective means of infectious disease prevention. An example of a successful immunization program is in Clark County, Nevada. This program has made all the child and adult vaccines available in the health district setting. According to the Southern Nevada Health District (SNHD) disease statistics for the 4Q 2010, the prevalence for vaccine-preventable diseases such as Hepatitis A and B, influenza, measles, and mumps were significantly lower than the aggregate quarterly rate from 2005 up to 2009. There were also zero

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incidence for diphtheria, polio, rubella, and tetanus since 4Q 2008. According to the 2009 SNHD Report to the Community, the district scored a 90% compliance rating on adolescent immunization booster dose for DTaP and a 10% improvement rate in terms of child vaccination. Moreover, more than 60,000 hepatitis A vaccines and 14,000 TB skin tests have been administered to people requiring a health card. Also, more than 23,000 hepatitis B and HBIG birth doses were provided to birthing centers in the district. (Brite,S., 2011) Cross, Sharon in 2006 described the development and initial testing of an instrument to measure population-based public health nursing competencies. Although multiple lists of public health

competencies exist, literature review did not elicit a valid instrument that could measure changes in public health nursing competency over time Mobilizing for action through planning and partnership is the most recent planning tool used in public health practice which is built upon a long history of planning by local public health agencies. Planning by local public health agencies has evolved over a half century from the earliest problem/program focused planning through more comprehensive

approaches like the planned approach to community health and the assessment protocol for excellence in public health. (Lenihan, 2005)

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Government agencies are established at the local state, and federal levels to provide public health services. Health agencies at the state, county or city level vary according to the needs of the area. Their funds, generally from taxes are administered by elected or appointed officials. Local health departments have responsibility for developing programs to meet the health needs of the people, providing the necessary nursing and other staff and facilities to carry out these programs. (Kozier et.al., 2008) In programs for older persons, the UN general assembly adopted Resolution 46 on December 16, 1991; the UN principles for older persons to add life to years that have been added to life. The Principles call for action in many areas, among them: Independence: Older persons should have access to food, water, shelter, clothing, health care, work and other income-generating opportunities, education, training, and a life in safe environments. Participation: Older persons should remain integrated into community life and participate actively in the formulation of policies affecting their wellbeing. : Older persons should have access to social and legal services and to health care so that they can maintain an optimum level of physical, mental and emotional well-being. This should include full respect for dignity, beliefs, needs and privacy. Self-fulfillment: Older persons should have access to educational, cultural, spiritual and

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recreational resources and be able to develop their full potentials. Dignity: Older persons should be able to live in dignity and security, be free of exploitation and physical or mental and be treated fairly regardless of age, gender and racial or ethnic background. (United Nations, 2004). Abraham Maslows Hierarchy of Needs The Hierarchy of Needs, is a pyramid depicting the levels of human needs, psychological and physical. When a human being ascends the steps of the pyramid he reaches self-actualization. At the bottom of the pyramid are the Basic needs or Physiological needs of a human being, food and water and sex. The next level is Safety Needs: Security, Order, and Stability. These two steps are important to the physical survival of the person. Once individuals have basic nutrition, shelter and safety, they attempt to accomplish more. The third level of need is Love and Belonging, which are psychological needs; when individuals have taken care of themselves physically, they are ready to share themselves with others. The fourth level is achieved when individuals feel comfortable with what they have accomplished. This is the Esteem level, the level of success and status (from self and others). The top of the pyramid, Need for Self -actualization, occurs when individuals reach a state of harmony and understanding. The Developing

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Person through the Life Span, (1983) pg. 44 He realized that all the individuals he studied had similar personality traits. All were "reality centered", able to differentiate what was fraudulent from what was genuine. They were also "problem centered", meaning that they treated lifes difficulties as problems that demanded solutions. These individuals also were comfortable being alone and had healthy personal relationships. They had only a few close friends and family rather than a large number of shallow relationships. Maslow stated in his book, It is as if Freud supplied us the sick half of psychology and we must now fill it out with the healthy half. (Toward a psychology of being, 1968) There are two faces of human naturethe sick and the healthyso there should be two faces of psychology. (Tohenn, 2005)

Structured Dependency theory (Townsend, 1979) The theory focuses primarily on the role of financial resources in conditioning the experience of older people and asserts that society has created the negative position occupied by some elderly people by compelling them to depend upon the state for pensions and benefits. This position has been adopted by others (Walker, 1981) who think that retirement, low pensions, institutional care and passive forms of community care have effectively created the dependency of a group of elderly people. (Walker, 1993) It was recognize in later work that the

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degree of dependence of the individual in terms of pensions and savings is related to their occupational status during their working life. Herzbergs theory on motivation (1987) Individuals often have problems consistently articulating what they want from a job. Therefore, employers have ignored what individuals say that they want, instead telling employees what they want, based on what managers believe most people want under the circumstances. Frequently, these decisions have been based on Maslow's needs hierarchy, including the factor of prepotency. As a person advances through an organization, his employer supplies or provides opportunities to satisfy needs higher on Maslow's pyramid. According to Bellott and Tutor in 1990, the problems with Herzberg's work are that it occurred in 1959- too long ago to be pertinent-and did not cover teachers. They cite earlier research by Tutor (1986) with Tennessee Career Ladder Program as a means of overcoming both those problems. TCLP has three levels, the largest and beginning one of which (Level I) has 30,000 members. Bellott and Tutor believe that the data from the study clearly indicate that the Level I participants were as influenced by motivation factors as by hygiene factors contrary to Herzberg's theory on motivation.

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According to Spencer (2008), a good employee benefits administration, builds relationships, cultivates trust. A benefits

administrator does far more than just sell the benefits package. He works with people from the very beginning to establish their needs. Then he works to customize a solution to meet their needs, utilizing the best advantages in the market to their advantage. Benefits administrators then take it upon themselves to work as liaisons between the company and their employees, explaining the plan in detail. Importance of interpersonal relations at work: 1. will help one develop a mutual understanding with other employees and the management; 2. will help in better teamwork, which will be guided by better understanding among the employees. Good relations among the employees at the workplace will lead to better productivity and less conflicts and issues to handle; 3. provides a good environment for the employees to work in. Employees will feel like getting to work and attaining goals in such an environment. Better understandings among the employees will also reduce the conflicts between them; 4. Will create an environment which will be welcoming and which will boost the morale of the employees and will inspire them to deliver quality work. (Rampur, 2010)

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Disengagement theory (Cumming and Henry1950's) This theory connects with issues of health by pointing to the older persons gradual but inevitable withdrawal from their social context in preparation for the ultimate disengagement from society, that of death. Retirement from work is thought to mark the beginning of disengagement from society and leads to social isolation, illness and a decline in happiness.

Local Literature The Magna Carta for Women of 2009 contains the following provisions in Section 17 and 19: 1. Prenatal and postnatal care; 2. Information regarding all types of family planning methods; 3. Access to family planning methods as long as they are ethically and medically safe; 4. Sex education; 5. Obstetric and gynecological care regarding pregnancy complications and the prevention of sexually transmitted diseases; 6. Spouses have the right to decide to space their children. The Implementing Rules and Regulations of the Magna Carta directs the Commission on Women under the Office of the President to oversee that the provisions are implemented by the Department of Health, the Department of Local Governments, the Commission of Human Rights, the Department of Education, Department of Social Welfare, Department of Labor, the Commission on High Education. In

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the IRR, it also states that in order for the law to be successful, the government should tie up with all LGUs so that midwives, doctors, birthing facilities should be put in place to take care of the health needs of all to ensure that minimized maternal and child deaths. Using data from the 2008 National Demographic and Health Survey, Lagman stated that "Twenty-two percent of married Filipino women have unmet needs for family planning services, an increase by more than one-third since the 2003 National Demographic and Housing Survey." "Our women are having more children than they desire, as seen in the gap between desired fertility (2.5 children) and actual fertility (3.5 children), implying a significant unmet need for reproductive health services," The Bill provides that "The State shall assist couples, parents and individuals to achieve their desired family size within the context of responsible parenthood for sustainable development and encourage them to have two children as the ideal family size. Basing itself on demographic surveys, Likhaan, a non-government organization for women's health, stated that the most common reasons why women with unmet need in the Philippines do not practice contraception are health concerns about contraceptive methods, including a fear of side effects. 44% reported these reasons in 2008. The second largest category of reasons is that many believe they are unlikely to become pregnant

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41% in 2008. Their specific reasons include having sex infrequently, experiencing lactational amenorrhea (temporary infertility while nursing) and being less fecund than normal. Writing against the bill, Bernardo Villegas wrote about the Myth of Unmet Family Planning Needs, citing development economist Lant Pritchett who said that the term "unmet need" is an elitist construct, an imposition of a need on the poor, disrespectful of their real preferences. Pritchett said that it is "based on a discrepancy identified by the analyst through the comparison of responses to items in separate blocks of the questionnaire" and is "an inference on the part of the researcher, not a condition reported by the respondents themselves." Pritchett argued this term is applied to women who are not sexually active, are those whose husbands are absent, etc., thus bloating the numbers to favor the pharmaceutical companies and those with a population control agenda. Villegas stressed: "Because [the poor] have been deprived of the infrastructures they need, such as farmto-market roads, irrigation systems, post-harvest facilities and other support services that the State neglected to provide them, the only economic resources they have are their children." He also challenged that he is willing to bet that if the government will provide cash money to the poor to buy condoms, the poor will use the cash for food and basic needs, thus exploding the myth

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Concepts basic to nursing are used in working with the clients. One of these concepts is: primary focus of community health nursing is promotion; it is extended to benefit not only the individual but the whole family and community. Nurses are generalists in terms of their practice through lifes continuum. (Reyala et.al, 2005) Health problems that are beyond the capability of Primary Health Care (PHC) units and beyond the competence of PHC workers are referred to an intermediate health facility, usually a Rural Health Unit located in the town or poblacion. The team includes physician, dentist, public health nurse, midwife, sanitarian and other health workers. Health workers employed in all hospitals, sanitaria, health infirmaries, health centers, rural health units, barangay health stations, clinics and other health related establishments owned and operated by the government shall include medical, allied health professionals, administrative and support personnel. (Section 3 Republic Act No. 7305 The Magna Carta of Public Health Workers) The DOH recommends that all pregnant women have at least four antenatal visits during each pregnancy. It further recommends that the first antenatal checkup should occur in the first trimester of the pregnancy to detect complications early. It is also essential that women have iron or folate supplementation to prevent anemia. Delivery itself should be conducted in health facilities or birthing

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centers with a skilled professional birth attendant. The Expanded Program on Immunization, another pillar health program of the DOH, aims to protect children against preventable diseases such as tuberculosis, polio, diphtheria, pertussis, tetanus, and measles. A child is considered to have complete immunization when he/she has received three dosages of diphtheria, pertussis, tetanus (DPT) vaccine and oral polio vaccine, as well as, one dose each of measles and Bacillus Calmette-Guerin (BCG) vaccines. This program brought about

improvements in the prevention and control of vaccine preventable diseases among infants and children in the past but the vulnerability of the nonimmunized population increases with a drop in the proportion of fully-immunized children from 90% in 1997 to 69.8% in 2003. (Reyala et. al., 2005). Protection and advancement are the rights of the people to a balanced and healthful ecology in accord with the rhythm and harmony of nature. Promoting and protecting the global environment will attain sustainable development while recognizing the primary responsibility of local government units to deal with environmental problems.

Recognizing that the responsibility of cleaning the habitat and environment is primarily area-based, while recognizing that a clean and

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healthy environment is for the good of all and should therefore be the concern of all. (Republic Act 8749). The Environmental Health Services (EHS) of the Department of Health is responsible for the promotion of healthy environmental conditions and prevention of environment related diseases through appropriate sanitation strategies. Through EHS the Department of Health (DOH) has authority to act on all in environment and health including the comprehensive Sanitation Code of the Philippines, (PD 856). The Reproductive Health (RH) Bill promotes information on and access to both natural and modern family planning methods, which are medically safe and legally permissible. It assures an enabling environment where women and couples have the freedom of informed choice on the mode of family planning they want to adopt based on their needs, personal convictions and religious beliefs. The bill does not have any bias for or against either natural or modern family planning. Both modes are contraceptive methods. Their common purpose is to prevent unwanted pregnancies. The bill will promote sustainable human development. The UN stated in 2002 that family planning and reproductive health are essential to reducing poverty. The Unicef also asserts that family planning could bring more benefits to more people at less cost than any other single technology now available to the human

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race, (Reproductive Health bill by Lagman, Edcel, 2009) Reproductive Health Care refers to the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. This implies that people are able to have a satisfying and safe sex life, that they have the capability to reproduce and the freedom to decide if, when and how often to do so, provided that these are not against the law. This further implies that women and men attain equal relationships in matters related to sexual relations and reproduction. According to Rogan and Olvea (2005) Ideally, prenatal care functions to identify and monitor women at risk of future complications, to detect and treat pre-existing and concurrent illnesses of pregnancy, to provide preventive care and information to women and their families, and to establish a relationship between providers and women early in pregnancy. Prenatal care services are part of primary health care services or pregnant women which include regular medical checkups, medical advice regarding health, hygiene, nutrition, etc. related to pregnancy and child bearing. Pregnant women who were registered for prenatal care and who visit on a regular basis usually receive iron and folic acid tablets and they are vaccinated against tetanus.

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Foreign Studies Studies have shown that investments in public health workforce development are based on the assumption that capacity and competencies are linked with the effectiveness and efficiency of providing essential public health services. However, evidence of the effects of workforce quantity or quality on the performance of core public health functions is limited, Ogolia (2007) Bernal, Shellman and Reid (2004) said that University and community partnerships are being created to increase community-based educational experiences for nursing students and to assist agencies in facing ever-decreasing resources to pay for health services for clients. Many challenges often burden these partnerships, leading to a less than satisfying experience for all those involved. Results of the study underscores that client satisfaction is determined by the cultural background of the people. It shows the dilemma that, though optimally, care should be capable of meeting both medical and psychosocial needs, in reality care, that meets all medical needs may fail to meet the clients emotional or social needs. Advanced practice nurses and nurse researchers with experience in clinical settings may encounter challenges in the initial development and implementation of community-based projects. Participatory action research methodology, a user-friendly framework for community-based

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research activities, provides a way for researchers and community members to work together to define a problem, take action, and evaluate their work Suggestions for initial steps and the planning and review cycles are presented, along with examples from the literature. (Kelly, 2005) In a research study, 289 of the eligible public health nurses in five California counties, returned survey questionnaires regarding their demographics, employment, education and scope of practice. Nurses were asked how frequently they performed specific interventions aimed at the individual-family, the community and the health care system. Over all, the public health nurses regularly performed interventions aimed at the individual-family. The most often performed intervention was case management of individuals/families. Few nurses reported frequently performing interventions at the community. The researcher concluded that the public health nurses were not really fulfilling their role since the focus of public health nursing is not on providing direct care to individuals on community settings but rather on promoting the health of populations. (Grumbach, Miller, Mertz, Finocchio, 2004) Conversely, care that meets psychosocial needs may leave the clients medically at risk. It seems important that developing countries promoting client-oriented health services should carry out more in-depth

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research on the determinants of client satisfaction in the respective culture. (Aldana, Piechulek, Al-sabir, 2001).

Local Studies
In Metro Manila (MM), where government health centers and hospitals are arguably better financed, the distortion in the ability to meet all obligations mandated under the Magna Carta law is very telling. Based on the total figures gathered from the Statement of Allotments, Obligations and Balances (SAOB) of MM specialty hospitals, it appears that only 11 percent of the obligated hazard pay and 92 percent of obligated subsistence and laundry allowances were covered by appropriations in 2007. On the whole, the budget may have only covered 65 percent of the implemented Magna Carta benefits while the rest of the funding requirements were sourced through savings. In a case study done by Demetrio Imperial Jr. in 2010.The training of facilitators in participatory planning for officials and staff of LGUs of the province of Nueva Ecija, Philippines was undertaken by the International Institute of Rural Reconstruction (IIRR) and the Central Luzon State University. The project started in August 1996 and completed in June 1997 with the end goal of broadening the technical knowledge and facilitation skills of municipal and village planners. Anchored on the dialogue-oriented, people-centred planning approach, the project was pilot-tested in three municipalities and three villages in each municipality. It was designed for the heads and junior staff of the different line agencies, the municipal and village council members and other sectorial leaders based in the pilot village. It was expected that after the nine-

lxx month "action-training" program, said participants would then be able to: 1) identify the value of a participatory planning process in their work; 2) demonstrate skills in facilitating a participatory planning process; 3) facilitate the formulation of a village development plan; and 4) replicate the planning process in the other villages of their respective municipalities. To facilitate the project process, workable and appropriate 'alternative' yet complimentary mechanisms to the legal government authorities were established. These included: 1) the Municipal Planning Task Force (MPTF) led by the Municipal Planning and Development Coordinator who works closely with the heads and junior staff of other line agencies in the municipality and 2) the Village Planning Team (VPT) led by the Village Captain and his Council members, the Village Development Council and other sectors/organizational leaders in the village. The legitimization of both the MPTF and VPT provided participants with authority and the impetus to undertake village planning and budgeting with the agreement that their proposed development plans and budget would then be submitted and approved by the village government officials.

Mandating health centers and hospitals to provide Magna Carta benefits without giving them the appropriate budget and restricting them on the uses of funds might push the hospitals to resort to gaming such as report manipulation or deliberate understaffing to generate savings for benefit payments to the existing staff. Since the law is already enacted, though, and it has long been recognized that health workers are undercompensated, Magna Carta benefits should indeed be paid but

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through other means that would not affect the ability of the government to provide quality and affordable health care. Given that the national government budget cannot afford to pay for these benefits, a possible source is the professional fee reimbursement from PhilHealth. Currently, these are used by some hospitals to provide honoraria to their workers; in other hospitals, however, it is not clear where these funds are spent for. As opposed to the current practice of funding the benefits from personal services, savings, an option worth exploring is earmarking these PhilHealth professional fee reimbursements for Magna Carta benefits. This will also provide an incentive for health workers and hospital workers to encourage patients to enroll in PhilHealth. (Lavado, 2010)
Under RA 7305, public health workers are entitled to a host of benefits, including subsistence allowance, laundry allowance, longevity pay, hazard pay, and higher salary grade upon retirement, among others. Since its passage in 1992, however, successive governments have failed to fully provide for the payment of all the benefits prescribed in the law in the public hospitals budget. Only the subsistence and laundry allowances are provided and only partially, for subsistence allowance. Of the PHP 1,500 under the Implementing Rules and Regulations (IRR) of the Magna Carta, only PHP 900 per month was funded from the General Appropriations Act (GAA) while the balance of PHP 600 per month was sourced from hospital savings; for laundry allowance, only

lxxii PHP 125 per month was funded from the GAA while the balance was sourced from savings. Hazard allowances were also budgeted but only for x-ray technicians. The rest of the benefits prescribed in the Magna Carta were not funded at all. Since the Magna Carta law was vague in specifying the sources of funds for payment of all the benefits, there is no real accountability on who should fund it. For instance, the law stated that payment must be based on LGU capacity, yet the PIDS study on local services delivery had shown that there is no real logic to the compliance by local government units (LGUs) on the payment of Magna Carta benefits. Differences in the LGUs capacity to pay have resulted in differences in benefits received by health workers, even among those of equal ranks. These differences in pay and benefits have an adverse effect of sowing discontent rather than empowerment of health workers.

In another study, majority of pregnant women in the provinces of Western Samar, Surigao del Sur and Sorsogon still prefer to give birth at home instead of delivering their babies in a lying-in clinic or private hospital in their area, according to a recent study sponsored by the Department of Health. The baseline survey, which was conducted from June 2007 to March 2009, showed that up to 75 percent or three out of four babies in parts of the three provinces are delivered at home. Less than three percent of deliveries in the three provinces were in private hospitals or private clinics. Twenty-two percent of deliveries in Western

lxxiii

Samar, 19 percent of deliveries in Surigao del Sur and 38 percent of deliveries in Sorsogon were done in government hospitals. The survey interviewed 1,200 women and 350 health care providers including doctors, midwives and traditional birth attendants in the three provinces. It was conducted by the University of the Philippines Center for Economic Policy Research for the DOH Women's Health and Safe Motherhood Project. The survey showed that traditional birth attendants or hilots attended to about a third of deliveries in Western Samar, 20 percent of deliveries in Sorsogon and 43 percent of deliveries in Surigao del Sur. In Sorsogon, 20 percent of pregnant women were attended to by physicians compared to 18 percent in Surigao del Sur and 15 percent in Western Samar. On the other hand, nurses attended to 18 percent of pregnancies in Surigao del Sur, 11 percent in Sorsogon and nine percent in Western Samar. (Recidoro, 2008) Corruption in the Philippines is undermining its delivery of health services, reducing its child immunization rate by 10 to 20 percent, and increasing the waiting time in public health clinics by 30 percent, a study says. The group ranked the Philippines as the ninth most corrupt country in the world last year worse than in 2004 when it ranked 11th. Corruption in the Philippines health sector reduces the chances of children completing their vaccination by four times, the report says.

lxxiv

Corruption affects all health systems, but its effects are disproportionate upon the poor who cannot afford private sector alternatives and for whom the fees charged represent a large proportion of their family budget. According to the study, the Philippines is an ideal place to study the impact of corruption on service delivery, especially because it has devolved both political authority and administrative control of many health and education services to local government units. (Mencias, 2006) In one of the studies, ninety-four percent of women who had at least one birth in the five years preceding the survey received prenatal care from a doctor, nurse, or midwife for their most recent birth. The use of professional assistance during delivery is generally low for the Philippines. Only sixty percent of women who delivered in the last five years preceding the survey were assisted by a health professional for their most recent pregnancy, while seventy percent of women received postnatal care. Utilization of maternal care is lowest in the Autonomous Region of Muslim Mindanao (ARMM) with only eighty-five percent for prenatal care, twenty-one percent received professional delivery assistance and forty-eight percent obtained postnatal care. Meanwhile, the National Capital Region (NCR) accounts for the highest percentage of maternal health utilization with ninety-seven percent for both prenatal

lxxv

and delivery care and seventy-six percent for postnatal services. Ninetysix percent of women from the urban areas received professional prenatal care while seventy-nine percent were assisted by professionals during childbirth and sixty-two percent obtained postnatal care. On the other hand, the rural counterparts have the following percentages in terms of maternal health usage, ninety-three percent for prenatal care, fifty-six percent for assistance in delivery and half of the women had postnatal care. The use of prenatal care is highest for the age group 3034 years old with ninety-five percent while it is lowest at 15-19 years of age with only eighty-seven percent. In terms of delivery care, a little difference in the percentage was obtained. Also, there is little difference in utilization of postnatal care by age. Womens education is highly

associated with use of maternal care in the Philippines. As the degree of education increases, maternal health care utilization also increases. Ninety-eight percent of women with college degrees received prenatal care compared with ninety-five percent of women with secondary education and eighty-eight percent with primary education. A similar

pattern is seen for delivery care and postnatal care. The work status of the mother yields no significant impact on the utilization of maternal health care since the results show parallelism. Meanwhile, mothers with one live birth are more likely to use maternal health services for first

lxxvi

births than for second and higher order births. Utilization of maternal health services is generally lower among mothers of birth order five and higher. (Rogan, S and Olvea, M.V., 2005)

SYNTHESIS Disease prevention is the key to public health. It is always better to prevent a disease than to treat it. Vaccines prevent diseases according both to the program in Clark Country Nevada done by the Sourthern Nevada Health District (SNHD) and the Department of Health (DOH) in the Philippines, in these studies, the people who receive them are protected and also help protect those who come into contact with unvaccinated individuals. Vaccines help prevent infectious diseases and save lives. Looking into foreign and local literature, vaccination is very

important for newborns and children. In the Philippine setting, the local health units are responsible in disseminating the proper information to the parents about the risks and benefits of every immunization. In the United States the Center for Disease Control (CDC) is the one responsible for the information while in the Philippines, the Department of Health (DOH). According to the studies done by these agencies vaccination is one of the most effective means of preventing infectious diseases. Aside from immunization, family planning and care for pregnant women are some of the critical responsibilities that the health

lxxvii

care workers should do according to the studies by Cross, Sharon in 2006 while in the Philippine setting Lenihan in 2005 has expressed problem and program focus planning in community health and assessment protocol. Individuals, on the other hand have different needs and needs are physiological or psychological deficiencies that arouse behavior. These vary over time and place, as that it can be strong or weak and influenced by environmental factors. workplace motivation Needs theories are the basis of most theories. The work of well-known

theorists/psychologists like Maslow, Herzberg, Townsend, Cumming and Henry is closely associated with human needs and motivations and helps to create better living and working conditions.

lxxviii

Chapter 3 METHODOLOGY

The purpose of this chapter is to present the philosophical assumptions underpinning this research, as well as, to introduce the research strategy and the empirical techniques applied. Discussed in sufficient detail under methodology are: research design, sampling design, instrumentation; validation of instrument; data gathering procedure and statistical treatment of data.

Research Design

A research design is a structural plan and strategy of investigation visualized to obtain answers to the research problems and questions

lxxix

formulated. It ensures the attainment of the objectives, the formulation of valid conclusions and impact in a field of specialization. (NazarenoMartinez, 2002). More so, it is a course of action or plan that is followed in order to solve a problem in a research which consist of strategies and procedures that will arrive at valid and reliable answers. In this study, the researcher used descriptive research method which was conducted through observations, interviews and questionnaires. A descriptive research method was used because it was similar to other studies related to the objectives presented in this research. It allows the assessment and observation of the data that establish the nature and occurrence of existing circumstances, practices or descriptions of objects, processes and persons subject to the method used. The study describes the level of satisfaction of the respondents: the Barangay Zapote Las Pias residents and the health workers of Barangay Zapote Las Pias in the health care services conducted in the health center.

Population and Sampling

A population, in research and statistics, is defined by Burt, Barber and Rigby (2009) as the total set of elements (objects, persons, regions, neighborhoods, etc.) under examination in a particular study. These

lxxx

elements possess specified characteristics of interest in the study. On the other hand, sampling is defined by LoBiondo-Woods and Haber (2006) as the process of selecting representative units of a population for study in a research investigation. Sampling involves a procedural determination of the number of elements drawn from the population called the sample size. The most important reason for using sampling is economic to reduce the cost of collecting data. Other reasons for sampling which are applicable to the present study include: processing speed, accuracy, and accessibility (LoBiondo-Woods and Haber, 2006; Black, 2010). Non-probability sampling method was used in the qualification of the respondents. Purposive sampling method was used in choosing of the qualified respondents from the list available in the health center. Quota sampling was also used in narrowing down the total number of population to which 30% of the respondents came from respondents who have availed services from Santos and Basa health center. Convenience sampling on the other hand, was applied to the members of the population based on their relative ease of access.

Respondents of the study Pilot Study

lxxxi

The instrument was first pre-tested in another community, the Pamplona 1, Las Pias City health center and residents in particular. Ten qualified respondents (residents of Pamplona 1, Las Pinas City) were taken for pilot testing where convenience sampling method has been used. More so, 10 qualified health workers were also taken for pilot testing before conducting the study on the actual respondents of Barangay Zapote Las Pias City. This was done in order to test the validity of the research instrument before the actual study. The Split Half Method for reliability Coefficient using Pearson Product Moment Coefficient of Correlation r = 0.539 was the basis for this. In testing the reliability of the instrument, a pilot study was conducted and the set of data gathered were analyzed using the SplitHalf Method for reliability coefficient with the application of Pearson Product Moment Coefficient of Correlation. Based on the data obtained from odd-even items, the computed r-value of 0.539 being higher than the critical r-value of 0.514 at five percent level of significance, revealed a high reliability of the instrument.

Actual Study

lxxxii

Participants of the research study were residents of Barangay Zapote - Las Pinas City who avail of the health services at the Santos and Basa Health Center for maternal check ups; immunizations; and family planning and sanitation services. Criteria to become a participant are: (1) at least one year residence at Barangay Zapote - Las Pinas City; (2) residents who regularly visit and have availed of the services of the health center namely: Maternal check-ups, immunization services, family planning services and sanitation services ; (3) must be 17 years old and above. The researcher had an overall 115 respondents of which 69 came from Santos Health Center and 46 from Basa Health Center. The researcher used a convenience non probability sampling where the samples most available were chosen. The second group of participants were the health care workers who were classified under the following categories (1) They are employed in the Barangay Zapote Health Center Santos and Basa, Las Pinas City; (2) Working full time as health workers in Barangay Zapote Health Center, Las Pinas City. All in all the total number of health workers qualified for the two health centers were 11 some of whom sometimes worked for both health centers. Table 1 Total Number of Qualified People Who Visit the Health Center as of January 2011

lxxxiii Total Number of Qualified Respondents Santos health center 205 138 343 Sample population 69 46 115

Basa health center Total

Research Instruments A research instrument is a tool or means by which data or information is collected for a study (Kumar, 2005). The construction of a research instrument is regarded as the first practical step in conducting a research study. Research instruments are created to serve the needs of the data gathering procedure and to perform a systematic approach for collecting and analyzing the data. For this research study, the researcher used questionnaires to obtain answers from the respondents. The questionnaire is composed of two parts. The first part consists of the respondents demographic profile such as gender, age, civil status and family income level. The second part questions were about the health care services that the health center offers and the options on how the respondents can rate the different health care services provided to them. The researcher used the Likert Scale to determine the clients level of satisfaction. The researcher used a questionnaire adopted from Frederick Herzberg composed by Syptak, and Marsland, M.D. and Ulmer Ph.D. The first part is a self-made

lxxxiv

questionnaire used for respondents: the residents and the health workers. The first questionnaire assesses the level of satisfaction of the residents and health workers towards the different health care services conducted in the health center. Another set of questionnaire which was adopted and modified from Syptak and Marsland M.S. and Ulmer Ph.D. studies was used in the assessment of the satisfaction level of the health workers towards the management. Modifications were made to make it relevant to the study.

Validation of Instrument The questionnaire was validated by people specializing in the Community Health Nursing Field. Suggestions, comments and

corrections were incorporated in the instrument before being pilot tested in Pamplona 1, Las Pias City Health Center and residents of the community before being implemented in Barangay, Zapote Las Pinas City. A total number of 10 qualified respondents both from the residents and the health workers, were selected by convenience sampling in the health center. The following criteria used were the level of satisfaction of the respondents:

lxxxv

Table 2 Criteria Used to Assess the Level of Satisfaction of the Respondents

Weighted Mean 4.51 5.00 3.51 4.50 2.51 3.50 1.51 2.50 1.00 1.50 Descriptive Interpretation Excellently Satisfied Very Satisfied Satisfied Dissatisfied Very Dissatisfied Interpretation

Excellently satisfied with the services provided Very satisfied with the services provided Satisfied with the services provided Dissatisfied with the services provided Very dissatisfied with the services provided

Data Gathering Procedure The data gathering procedure is graphically presented in appendix I by way of a flowchart. 1. Approval was obtained on January 18, 2012 from the City Health Office of Las Pinas City to conduct and distribute the instrument to the health workers in the health center. 2. Approval was also obtained on January 18, 2012 from the Barangay Captain of the Pilot Study and Actual Study Areas to interview the residents. 3. On January 20, 2012, the researcher asked the permission of the health center personnel to peruse the qualified client list. Indicating the name and address each respondent.

lxxxvi

4.

During the pilot study in Pamplona 1, at Las Pias City health center on January 20, 2012, the residents were interviewed by the researcher with the validated instrument.

5.

After the interview and collation of the data. It was given to the statistician for the validity of the answers of the pilot study.

6.

On the part of the health workers in Pamplona 1, Las Pias City health center, the research instrument was distributed to be answered and collected by January 26, 2012.

7.

The researcher asked the permission of the Zapote, Las Pias City (Santos and Basa) health center to review the qualified client list. From the list, selected and qualified respondents were identified

8.

Once the instrument passed the validity test by the statistician, actual interview of the residents were conducted where the researcher started to search for qualified respondents.

9.

Conduction of the interview from the respondents was done on January 30, 2012 up to February 10, 2012. The return of the questionnaire from the health workers was completed on February 16, 2012.

10.

After gathering the adequate number of the population sample of the resident through convenience sampling method among the

lxxxvii

qualified residents from Santos and Basa health center list and collection of the instrument from the health workers, data were collated and submitted to statistical treatment.

Statistical Treatment of Data Frequency and percentage distribution A frequency distribution presents a summary of data showing the number or frequency of items in each of several non-overlapping classes, whereas, a percentage distribution exhibits the percentage of observations in each of the non-overlapping categories, such that the percentages for all categories sum up to a hundred percent (Anderson, et al., 2009; Dodge, 2006). Frequency and percentage distribution were used in summarizing the profile of the residents categorized under the following: age, civil status, and family income. Profile of the health workers was categorized under the following: age, civil status and length of service. Thus: F %= N x 100 Where: % means percentage, F means frequency of occurrence of each response, N means the total number of respondents and the quotient multiplied by 100.

Simple and Weighted Mean

lxxxviii

Simple mean also known as arithmetic mean or average, refers to the sum of the observations divided by the number of observations. In analyzing the date in determining the level of job satisfaction of the health care workers in terms of Motivation variables: achievement; recognition; work itself; responsibility; advancement and Level of Job satisfaction of the health care workers in terms of Hygiene variables: pay and benefits (Salary); company policy and administration; relationship with co-workers (interpersonal relationships); supervision; working conditions. 3. Level of satisfaction of the respondents in terms of the following health care services: maternal check up; immunization

services; family planning services; sanitation services. 4. the significant difference in respondents level of satisfaction on the different health care services offered when grouped according to the profile variables of: maternal check up; immunization services; family planning services; sanitation services. The weighted mean was used in order to translate the total number of respondents for every question into averages which feel under the level with corresponding verbal descriptions. The general formula for weighted mean is: TWF WM = N

lxxxix

Where: WM means weighted average TWF means total weighted frequency N means the total number of respondents WM = VS (5) + S (4) + N(3) + NI (2) + P (1) N

Correlation analysis T Test The statistics t-test answers a question to determine a p-value that indicates how likely it could have gotten these results by chance. By convention, if there is less than 5% chance of getting the observed differences, it rejects the null hypothesis because it has found a statistically significant difference between the two groups. The unpaired, or "independent samples" t-test is used when two separate sets of samples are obtained, one from each of the two populations being compared. This was used in getting the (1). significant level of satisfaction of the residents on the different services when grouped according to the profile variables. (2). Significant level of satisfaction on the services by the residents and health care workers.

Analysis of Variance (ANOVA) Test The purpose of an ANOVA is to test whether the means for two or more groups are taken from the same sampling distribution.

xc

(Hinkelmann and Kempthorne 2008). This is used to make sure that the t-test is accurate. This was used in getting the (1). significant level of satisfaction of the residents on the different services when grouped according to the profile variables. (2). significant level of satisfaction on the services by the residents and health care workers.

Chapter 4 PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter presents the findings of the study based on the content analysis of the data collected and their corresponding interpretations. Results and discussions were organized in terms of the sequence of the research problems stated in the previous chapter.

Problem 1. Profile of the respondents (Santos and Basa residents and health workers) of Barangay Zapote Las Pinas City:

xci

Table 3 Profile of the Residents of Barangay Zapote Las Pias City Categorized under Santos and Basa Residents according to Age, Civil Status and Family Income Level
Age Less 20 21 25 26 30 31 35 36 40 41 and above Total Than 8 11 22 13 9 6 69 12 16 32 19 13 9 100.00 4 7 14 8 9 4 46 9 15 30 17 20 9 100.00 Santos residents Frequency Percentage Basa residents Frequency Percentage Overall Frequency Percentage

12 18 36 21 18 10 115

10 16 31 18 16 9 100.00

xcii

Overall Santos residents Civil status Married Live- in Single/ Widowed / Separated Total Frequency 31 36 Percentage 45 52 Basa residents Frequency 14 30 Percentage 30 65 Frequency 45 66 Percentage 39 58

2 69

3 100.00

2 46

4 100.00

4 115

3 100.00

Family income less than 5,000 per month 5,001 10,000 per month 10,001 15,000 per month 15,001 and above per month Total

Santos residents Frequency Percentage

Basa residents Frequency Percentage

Overall Frequency Percentage

17

25

19

41

36

31

34

49

19

41

53

46

13

19

11

18

16

5 69

7 100.00

3 46

7 100.00

8 115

7 100

Table 3 represents the profile of residents as respondents in Barangay Zapote Las Pinas City which is categorized under Santos and Basa Health Center. Looking at the table on the profile according to age, the highest number of respondents who visit the health center are those belonging from 26 to 30 years old category which has the percentage of 31 out 100. On the other hand, least number who visit the center are those belonging from 41 years old and above which has a percentage of 9.

xciii

In terms of the civil status of the respondents, the highest percentage for both Santos and Basa Residents falls under the Live-in category which earned a percentage of 58% out of 100. While Single, Widowed and Separated individuals are grouped into one which earned the lowest number of respondents of 3% out of 100%. As to the family income level, the highest number of family that visits the health center belonged from those family with an income level of 5,001 to 10,000 per month as represented by 46% out of 100% while those who seldom visit the health center come from the family with an income level of 15,001 and above per month as represented by the 7% out of 100%. Overall, majority of the respondents fall under the category of 21 to 40 years of age. Mong Palatino (2007) explained that the Philippines is in the 14th most populous country in the world and third in the Southeast Asian region. Young dependents aging 1-18, comprise 34 percent of the population, individuals aging 20-40 years received a 62 percent rating that belongs to the working-age group and 4 percent are categorized as elderly dependents. Scholars have estimated that the large youth population will continue until the year 2040, but the workingage population and the number of senior citizens will increase much faster. According to Erikson (1950) the age from 25 to 40 is the time where generativity starts concerning more on producing the next

xciv

generation, creating a comfortable home and achieve mature, civic and social responsibility. Moreover, the importance of marriage versus live-in or cohabitation per se is that couples who are married are more financially secured, have more emotional support available, and have social and legal recognition (Walsh, 2010). Recent studies showed that adults who live together but do not marry are similar to singles than to married couples in terms of physical health and disability, emotional wellbeing and mental health, as well as, assets and earnings. Their children more closely resemble the children of single people than the children of married people. Children who live with their own two married parents enjoy better physical health, than children in other family forms. (Roberts, 2011). This is also true according to the National Statistical Coordination Board: Official Poverty Statistics, presented by Dr. Romulo A. Virola, Secretary General last February 8, 2011. In 2009, a family of five in Metro Manila needed Php 8,251 per month to be kept out of poverty. Seemingly, the Econ Stats Beta the Economy Watch as of February 24, 2012, presents that for the year 2011, the Philippines has a 5.14% inflation rate at the end of the year. This signifies that most of the respondents who avail of the services of the health center are those with limited income. The face of poverty in the Philippines is manifested in

xcv

chronic deprivation in many rural and urban areas and the ubiquitous presence of pockets of slums in urban areas; many others experience transient poverty, not persistently poor, but highly vulnerable even in the best of time. (Juarez, 2005). Most mothers who visited the health center are between those ages 20 to 40 years old. This are considered to be the stage in which they are just starting their own family hence, the ones that usually avail of the services of the health center are mostly second time mothers. Mostly first time mothers or those who have just started having a family are the ones who sought medical advices from more knowledgeable persons such as doctors, nurses or midwives. The study shows that

married and live-in respondents visit the health center and avail of its health care services more often than the single respondents. This implies that couples with children are the ones who visit the health center mostly rather than those who are not married specially those who do not have any children. It is evident that married couples are the ones who visit the health center most of the time due to their shared responsibility over the health of their family. Altogether, more than half of the

respondents both for the Santos and Basa respondents fall below the poverty line. Availing of services in the health center is a means of lessening the burden of peoples needs in the community. Consultation

xcvi

with doctors like pediatrician, obstetrician and family medicine is more expensive and could cost around 300 and up per visit, whereas visits to the health center would be more practical and least expensive since assessments are done first by midwives, nurses and doctors who are general practitioners and most of the time it is free of charge. This can be advantageous to the family as those who often visit the health center have limited means of income as presented in Table 5. Health center services like initial consultation, immunization and some vaccine, pre-natal check-ups, family planning consultations are free and can be availed of during clinic hours which is usually from 8 am to 5 pm Mondays to Fridays except on holidays. The health center has clinic schedule: Monday and Friday mornings are for consultation, Monday, Tuesday, Thursday and Friday afternoons are consultations for clients with tuberculosis. Tuesday and Thursday mornings are for

pregnant clients or pre-natal check-ups. Wednesday mornings are for immunization and Wednesday afternoons are for family planning consultation.

Table 4 Profile of the Health Workers of Barangay Zapote, Las Pias City Categorized Under Age, Civil Status and Length of Service
Age Less Than 30 Frequency 2 Percentage 18

xcvii 31 40 41 50 50 above Total 2 2 5 11 18 18 45 100.00

Civil status Married Single/ Widowed Separated Total

Frequency 9 / 2 69

Percentage 82 18 100.00

Length of service Less Than 10 11- 20 years More than 21 years Total

Frequency 4 2 5 11

Percentage 36 18 46 100.00

Table 4 represents the profile of health workers from barangay Zapote, Las Pias City grouped according to age. The highest number of health workers age 50 years old and above represent 45% out of 100%. The other age groups of less than 30 years old; 31 to 40 years old and 41 to 50 years old have 18% respectively. In the data presented, 82% out of 100% of the health care workers are married while others are single, separated or widowed health workers who are represented by 18%. For the length of service, represented by the longest term in service are those who have served for more than 21 years with 46% out 100% while those who served the least from 11 to 20 years, earned 18% out of 100%.

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Mein, G. et. al. (1998) described how the Disengagement theory begins with retirement from work leading to social isolation, illness and a decline in happiness. The researcher found most people explained how they missed their colleagues at work but generally did not admit to feeling isolated. The Structured Dependency theory by Townsend, focuses primarily on the role of financial resources in conditioning the experience of older people. The theory of Abraham Maslows self actualization also states that the more the person has self-actualized he can have many peak experiences throughout a day while others have those experiences less frequently. The Hierarchy of Needs, is a pyramid depicting the levels of human needs, psychological and physical. When a human being ascends the steps of the pyramid he reaches selfactualization. Relative to the age of the health workers, majority are more on the middle adult age group going to retirement. Most of the health workers have more than 20 years of experience in the health care service and most are matured and established already in their field of work.

Problem 2. The level of satisfaction of the respondents (Santos and Basa residents and health workers) of Barangay, Zapote Las Pias City in terms of the following health care services:

xcix

Table 5

Mean Distribution of the Residents of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Maternal Check-up services:
Maternal check-up As a resident in Barangay Zapote, Las Pias City, the health workers provides the following services 1.providing proper physical examination of the pregnant mother by the health workers. 2. giving of tetanus toxoid immunization by the health workers. 3. informing of pregnancy complications like Risk and Danger signs of pregnancy by the health workers 4. coordinating referral of health workers, to health facilities like public hospitals; public or private diagnostic center 5. Ensuring confidentiality of examination results discussed by the health workers 6. rendering of dental services for pregnant mother 7. administering advice on proper hygiene for the female reproductive system by health workers 8. giving health education on nutrition (balanced diet) by health workers 9. promoting the use of iodized salt in the diet to prevent thyroid problems by the health workers 10. encouraging the client to return after giving birth to avail of the vitamin A supplementation program by the health workers Overall Mean Santos residents Basa residents Mean Mean Description Excellently Satisfied Excellently Satisfied Mean Description Very Satisfied Excellently Satisfied Very Satisfied Excellently Satisfied Overall Description

4.59

3.98

4.35

4.64

4.52

4.59

4.55

Excellently Satisfied

4.02

Very Satisfied

4.34

Very Satisfied

4.57

Excellently Satisfied Very Satisfied Very Satisfied

4.30

Very Satisfied Very Satisfied Satisfied

4.46

Very Satisfied Very Satisfied Very Satisfied

4.33 3.94

4.00 3.17

4.20 3.63

4.12

Very Satisfied Excellently Satisfied

3.59

Very Satisfied Very Satisfied

3.90

Very Satisfied Excellently Satisfied

4.74

4.37

4.59

4.52

Excellently Satisfied

4.17

Very Satisfied

4.38

Very Satisfied

4.75 4.48

Excellently Satisfied Very Satisfied

4.72 4.08

Excellently Satisfied Very Satisfied

4.74 4.32

Excellently Satisfied Very Satisfied

Legend: 4.51 5.00 Excellently Satisfied 3.51 4.50 Very Satisfied 2.51 3.50 Satisfied

1.51 2.50 Dissatisfied 1.00 1.50 Very Dissatisfied

Table 5 represents the mean distribution of the answers from the respondents of Santos and Basa residents with regards to the maternal

ci

check-up services. The highest criterion goes to immunization of tetanus toxoid to pregnant clients by the health workers which earned a mean of 4.59 which is equivalent to excellently satisfied; and the lowest mean of 3.63 which is equivalent to very satisfied result was given to the dental services rendered for pregnant mothers. Overall the maternal check-up represents 4.48 for Santos health center and 4.08 for Basa health center which both earned a very satisfied result. The nurse-midwife, as an individual educated in the discipline of nursing and midwifery has played an important role in assisting women with pregnancy and child bearing. Either independently or in association with an obstetrician, the nurse-midwife can assume full responsibility for the care and management of women with complicated pregnancies. (Pillitteri, 2002). Postnatal care includes advice regarding nutrition, breastfeeding, receiving free medicine, tonic, other vitamins, food supplements, etc. Treatment of complications that might have occurred during delivery requires attention of trained professionals. (Rogan, S and Olvea, M.A. 2005). According to the Center for Disease Control, during pregnancy, teeth and gums are even more sensitive to bacteria than at other times during a woman's life. In addition, pregnant women are more likely to develop dental complications; these need to be dealt with promptly.

cii

Neonatorium tetanus can be prevented with the promotion of the immunization of pregnant mothers, which is transmitted through passive immunity. The unhealed stump of the newborn especially if used with unsterilized instrument in cutting the cord can be the cause of the transmission of the bacteria clostridium tetani. Mothers now are more aware of the importance of being immunized to prevent the occurrence of this disease for their infants. Also the health workers are more into emphasizing the importance of this vaccine especially during the time that the mothers go to the health center for their check-ups following up if they have missed the next dose. On the other hand, since both Santos and Basa health centers has only one dentist on duty and the dentist is more likely to address the needs of other community members who need the service specifically removal of the teeth, addressing the needs of the pregnant client is down below the priority in assessment of oral health hygiene, although the need can be addressed by other health care members like the nurse or the midwife on duty.

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Table 6 Mean Distribution of the Residents of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Immunization Services
Immunization services As a resident in Barangay Zapote, Las Pias City, the health workers provide the following services 1 accommodating assessment of the immunization program 2. implementing the proper procedure of the immunization program. 3. ensuring understanding by the residents of the Health teachings about the risks and benefits of immunization. 4. rendering health teaching about when the child is qualified to be given immunization or not. 5. providing referrals to other health care facilities in cases of a side effect of the immunization 6. ensuring completeness of immunizations offered 7. replenishing adequate supplies for immunization Santos residents Basa residents Overall

Mean

Description Excellently Satisfied Excellently Satisfied

Mean

Description Excellently Satisfied Excellently Satisfied

Mean 4.64 4.62

Description Excellently Satisfied Excellently Satisfied

4.72

4.52

4.65

4.57

4.52

Excellently Satisfied

4.65

Excellently Satisfied

4.57

Excellently Satisfied Excellently Satisfied Very Satisfied Excellently Satisfied Excellently Satisfied Excellently Satisfied

4.70

Excellently Satisfied

4.54

Excellently Satisfied

4.63

4.55

Excellently Satisfied Excellently Satisfied Excellently Satisfied

4.35

Very Satisfied Excellently Satisfied Excellently Satisfied

4.47 4.90 4.80

4.88

4.93

4.83

4.76

Excellently Overall Mean 4.69 Satisfied Legend: 4.51 5.00 Excellently Satisfied 3.51 4.50 Very Satisfied 2.51 3.50 Satisfied

Excellently 4.66 4.62 Satisfied 1.51 2.50 Dissatisfied 1.00 1.50 Very Dissatisfied

Table 6 represents the mean distribution for immunization services for the childrens vaccination. The highest mean, ensuring completeness of immunizations offered by the health workers is given an overall mean of 4.90 which is excellently satisfied while providing

civ

referrals by the health workers to other health care facilities in case of side effect of the immunization resulted to an overall mean of 4.47 which is very satisfied. Overall, the mean score for immunization services is 4.66 which is excellently satisfied. According to the expanded program on immunization (EPI) in the Philippines, the standard routine immunization schedule for the infants is to protect against the seven vaccine preventable diseases in the country before the childs first birthday (Reyala et. al., 2008). The following are the vaccines that the health center should give: bacillus calmette-guerin; diphtheria pertussis tetanus; oral polio vaccine; hepatitis B vaccine and the anti-measles vaccine. The Philippine Health Insurance Corporation (PHIC) shall include the basic immunization services in its benefit package when actuarial studies have determined its financial feasibility. The immunization services given in the health center are usually provided by the local government where it was supplied by the World Helath Organization (WHO). The health workers are very much effective in the dissemination of the information on the importance of vaccines for the infants and on the part of the mothers, they really take note of the importance and schedule of the next visit of the infants for the immunization.

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Table 7 Mean Distribution of the Residents of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Family Planning services
Family services planning
Santos residents Basa residents Overall

As a resident in Barangay Zapote, Las Pias City, the health workers provide the following services 1. giving of counseling for family planning acceptance 2. disclosing the health benefits and risks of the different types of family planning program 3 informing the residents about different types of family planning techniques 4. providing actual demonstrations on insertion, use or calculation of family planning device/s, equipment or charts if needed. 5 furnishing complete details on the different options for family planning programs. 6 doing follow through of the family planning acceptors or defaulters Overall Mean
Legend:

Description Mean Description Excellently Satisfied Mean Description Very Satisfied Mean Excellently Satisfied

4.59

4.43

4.53

4.61

Excellently Satisfied

4.46

Very Satisfied

4.55

Excellently Satisfied

4.54

Excellently Satisfied

4.33

Very Satisfied

4.45

Very Satisfied

4.35

Very Satisfied

4.24

Very Satisfied

4.30

Very Satisfied

4.48

Very Satisfied

4.24

Very Satisfied

4.38

Very Satisfied

4.41 4.50

Very Satisfied Very Satisfied

3.98 4.28

Very Satisfied Very Satisfied

4.23 4.41

Very Satisfied Very Satisfied

4.51 5.00 Excellently Satisfied 3.51 4.50 Very Satisfied 2.51 3.50 Satisfied

1.51 2.50 Dissatisfied 1.00 1.50 Very Dissatisfied

Table 7 describes the mean distribution for family planning services with the following results: For the highest mean, the disclosing

cvi

the health benefits and risks of the different types of family planning program by the health workers, earned a 4.55 mean given by the residents which resulted to an excellently satisfied outcome, while doing a follow through of the family planning acceptors or defaulters by the health workers, the overall mean is 4.23 which only fell to a very satisfied result. Overall the mean for the Family Planning Services was given a score of 4.41 which is equivalent to a very satisfied outcome. An estimated 350 million couples worldwide lack access to effective and affordable family planning. Family planning does more than help couples limit their family size: It safeguards individual health and rights, preserves natural resources, and can improve the economic outlook for families and communities. Family planning also saves lives; up to one third of all maternal deaths and illnesses could be prevented if women had access to contraceptives. The need for quality family planning services is all the more urgent today because more than 1 billion young people aged 15-24 are entering their reproductive years, guaranteeing an enormous surge in population growth through 2050. Eighty percent of these young people live in the developing world (Esguerra, 2008). According to the 2006 Family Planning Survey, only 50.6 per cent of women used family planning methods unchanged in the past six

cvii

years. In the Philippines, more than 80 per cent of the population is Catholic, and only natural family planning methods are sanctioned by the Church. Today, a lot of sexually active couples whether married or not; Catholic or not, have opted to avail of family planning services given by the local government and health center facilities. According to some of the residents who have been interviewed by the researcher, with the prices of commodities today, it is hard for a family with a small income to sustain the needs of the children in terms of food, clothing, shelter, and education. Even if the Catholic church sanctions the use of natural family planning methods only for the practical side, it is hard for a couple to control, so most of them would be using the artificial family planning methods in order to help prevent the unplanned addition to the family.

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Table 8 Mean Distribution of the Residents of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Sanitation Services
Basa residents Overall

SanitationServices As a resident in Barangay Zapote, Las Pias City, the health workers provide the following services 1. giving information about the campaign on health hazards 2. providing information on environmental hazards 3. assuring policy and sanitation programs are implemented. 4. furnishing program on health risks minimization 5. ensuring the cleanliness of the environment 6. conducting programs to make the environment clean. 7. cooperating with the city government mandate of using ecofriendly materials (i.e.: paper bags, reusable materials) Overall Mean

Santos residents

Mean

Descrip tion Very Satisfied Very Satisfied Excellently Satisfied Excellently Satisfied Excellently Satisfied Excellently Satisfied

Mean

Descrip tion Excellently Satisfied Excellently Satisfied Very Satisfied Excellently Satisfied Very Satisfied Very Satisfied

Mean

Description Excellently Satisfied Excellently Satisfied Excellently Satisfied Excellently Satisfied

4.45

4.61

4.51

4.49

4.52

4.50

4.55

4.41

4.50

4.71

4.54

4.64

4.55

4.24

4.43

Very Satisfied Excellently Satisfied

4.61

4.46

4.55

4.41 4.54

Very Satisfied Excellently Satisfied

4.24 4.43

Very Satisfied Very Satisfied

4.34 4.50

Very Satisfied Excellently Satisfied

Legend: 4.51 5.00 Excellently Satisfied 3.51 4.50 Very Satisfied 2.51 3.50 Satisfied

1.51 2.50 Dissatisfied 1.00 1.50 Very Dissatisfied

Table 8 describes the mean distribution for the sanitation services of the respondents on the following: the highest score was on furnishing programs on health risks minimization by the health workers, a mean of 4.64 score was given which is excellently satisfied while the lowest mean

cix

goes to the category of cooperation of the health workers with the city government which mandates the use of eco-friendly materials (i.e.: paper bags, reusable materials) was given a score of 4.34 which is very satisfied. Overall, the mean score given by the residents with regards to sanitation services is 4.50 which is equivalent to excellently satisfied. The World Bank said poor sanitation in the Philippines costs the government P77.8 billion a year. In its study Economic Impacts of Sanitation in the Philippines, the World Bank said poor sanitation also causes 31 premature deaths a day and reduces income from fishery, tourism and other sectors. The study aimed to heighten public awareness on the national economic impacts of poor sanitation and call on lawmakers, economists, investors and media to help solve the problem. (Amojelar,D. 2009) The accessibility of the media: newspaper, radio, television, internet has been a big impact on the awareness of the people in the community. Being responsible for the environment has also been recently a part of the moral and social responsibility of the community people. The community people are aware that there are programs being implemented in the community regarding health risks minimization but the community people voiced out that they seldom see the health

cx

workers participate with each other regarding the programs that are being implemented.

Table 9 Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Maternal Services
As a health worker, I am giving the following services. 1. providing proper physical examination of the pregnant mothers 2. giving of tetanus toxoid immunization 3. Informing mothers of pregnancy complications like Risks and Danger signs of pregnancy 4. coordinating referrals of health workers, to health facilities like public hospitals; public or private diagnostic centers 5. Ensuring confidentiality of examination results 6. rendering dental services for pregnant mothers 7. administering advice on proper hygiene for the female reproductive system 8. giving health education on nutrition (balanced diet) 9. promoting the use of iodized salt in the diet to prevent thyroid problems 10. encouraging the client to return after giving birth to avail of the vitamin A supplementation program

Mean 4.27 4.55

Description Very Satisfied Excellently Satisfied

4.45

Very Satisfied

4.45 4.64 4.09

Very Satisfied Excellently Satisfied Very Satisfied

4.36 4.36 4.09

Very Satisfied Very Satisfied Very Satisfied Excellently Satisfied

4.55

Overall Mean
Legend: 4.51 5.00 Excellently Satisfied 3.51 4.50 Very Satisfied 2.51 3.50 Satisfied

4.38

Very Satisfied

1.51 2.50 Dissatisfied 1.00 1.50 Very Dissatisfied

cxi

Table 9 represents the mean distribution of the answer of the respondents from the health workers with regard to the maternal checkup services that the health center provides. Under the following criteria which scored the highest is: ensuring the confidentiality of the examination results discussed by the health workers which were answered by the health workers that earned a 4.64 mean equivalent to excellently satisfied; while the lowest score fell to the rendering of dental services for pregnant mothers which was answered collectively and promoting the use of iodized salt in the diet to prevent thyroid problems by the health workers obtained a score of 4.09 which is equivalent to very satisfied. Overall the maternal check-up obtained a mean score of 4.38 coming from the health care workers which is also equivalent to very satisfied outcome. According to a study by Alderman in 2010, fortification of salt with the potassium iodate or potassium iodide protect against iodine deficiency disorders and improve the cardiovascular health outcomes while one of the studies about the check-up of the teeth during prenatal period has a significance impact on the health of the mother. (American Dental Association, 2010). During this time the assessment of the teeth may describe that the mother may lack certain nutrients such as Vitamin C needed by the developing fetus.

cxii

The health workers are very confident regarding the reading of the examinations and diagnostic examination results received. The health workers are very confident in discussing the data and examinations mostly because most of them have been in the health center services for more than 20 years. Experience is the best teacher is an old clich because learning by ones own experiences is long lasting and provides better learning. Most of all, learning by ones own experiences help people to become more mature and ready to tackle difficulties of life. It is also possible that these workers already encountered different or similar cases from their long interaction with different clients.

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Table 10 Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Immunization Services
As a health worker, I am giving the following services. 1 accommodating assessment of the immunization program 2. implementing the proper procedure of the immunization program 3. ensuring understanding by the residents of the Health teachings about the risks and benefits of immunization 4. rendering health teaching about when the child is qualified to be given immunization or not 5. providing referrals by the health workers to other health care facilities in cases of a side effect of the immunization by the health workers 6. ensuring completeness of immunizations offered 7. replenishing of adequate supplies for immunization

Mean 4.55 4.45

Description Excellently Satisfied Very Satisfied

4.36 4.36

Very Satisfied Very Satisfied

4.18 4.45 4.09

Very Satisfied Very Satisfied Very Satisfied

Overall Mean
Legend: 4.51 5.00 Excellently Satisfied 3.51 4.50 Very Satisfied 2.51 3.50 Satisfied

4.35

Very Satisfied

1.51 2.50 Dissatisfied 1.00 1.50 Very Dissatisfied

Table 10 represents the mean distribution for immunization services for the childrens vaccinations. It was represented by the following questions with the highest mean score for the category accommodating assessment of the immunization program with a mean of 4.55 which is equivalent to excellently satisfied; while replenishing of adequate supplies for immunization obtained a mean of 4.09 which is very satisfied. Meanwhile, the overall mean score of the health care workers for the immunization services is 4.35 which resulted to a very satisfied feedback.

cxiv

Vaccines offer a safe and effective protection from infectious diseases. Different vaccines are recommended depending on a persons age, occupation and travel plans. It is especially important for parents, and other caregivers to be health workers, aware of the vaccines that are recommended for infants, children, adolescents and adults of all ages and seniors which is a step in the right direction, but making sure they receive these immunizations critical to protecting them and the communities from disease. (Daily, 2011) The data from the point of view of the health workers represent that health workers strive to assess the clients, specifically the infants before giving immunization to them. Assessment is a very important part before giving vaccines to infants as infants usually cannot express in articulate language what they feel when being vaccinated. Meanwhile, awareness and the importance of having an experienced clinical eye is encouraged for the health worker in order to render safe and effective care. On the other hand, the health worker feels that there is inadequacy of the supplies given to the health center such as syringe, needles, vaccines, cotton balls and alcohol.

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Table 11 Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of the Family Planning Services
As a health worker, I am giving the following services. 1. giving of counseling for family planning acceptance 2. disclosing about the health benefits and risks of the different types of family planning programs 3 informing about different types of family planning techniques 4. providing actual demonstrations on insertion, use or calculation of family planning device/s, equipment or charts 5 furnishing complete details on the different options for family planning programs. 6 doing follow through of the family planning acceptors or defaulters

Mean 4.36

Description Very Satisfied

4.18 4.27

Very Satisfied Very Satisfied

4.09

Very Satisfied

4.27 4.18

Very Satisfied Very Satisfied

Overall Mean
Legend: 4.51 5.00 Excellently Satisfied 3.51 4.50 Very Satisfied 2.51 3.50 Satisfied

4.23

Very Satisfied

1.51 2.50 Dissatisfied 1.00 1.50 Very Dissatisfied

Table 11 describes the mean distribution for family planning services with the following results: For the highest mean score, giving of counseling by the health workers for family planning acceptance was given a score of 4.36 which is very satisfied; while providing actual demonstration on insertion, use or calculation of family planning device/s, equipment or charts by the health workers if needed was given a mean 4.09 which is also very satisfied. Overall, the mean for the Family Planning Services was given a score of 4.23 by health workers which falls under the very satisfied category.

cxvi

One of the main concerns of the proponents for the proposal of the family planning is that there is a perceived lack of access to family planning devices such as contraceptives and sterilization. On the other hand, a proposed law says that: "Access to contraceptives is free and unrestricted" and that the proposed law is pushing an open door. They say that these family planning items are available to the citizens and many local government units and Non governmental organizations (NGO)s provide these for free. Congressman Teddyboy Locsin, also a Business Mirror editor argued, that the poor can afford condoms since they can pay for other items such as cellphone load. The Philippine government is not a welfare state, and taxpayers are not bound to provide for all the wants and desires of its citizenry, including their vanity needs, promiscuous actions and needs artificially created by elitists, imperialists and eugenicist forces; nor should taxpayers pay for drugs that are objectively dangerous (carcinogenic) and immoral. The Philippines should give priority to providing access to medicines that treat real diseases. Although The UP School of Economics argues, that the lack of access especially for poor people, because contraceptive use is extremely low among them and "Among the poorest families, 22% of married women of reproductive age express a desire to avoid pregnancies but are still not using any family planning method." They say

cxvii

that lack of access leads to a number of serious problems which demand attention: (1) "too many and too closely-spaced children raises the risk of illness and premature deaths (for mother and child alike)," (2) "the health risks associated with mistimed and unwanted pregnancies are higher for adolescent mothers, as they are more likely to have complications during labor," (3) women who have mistimed pregnancies are "constrained to rely more on public education and health services and other publicly provided goods and services," further complicating limited public resources, (4) families are not able to achieve their desired family size. Thus the UP economists "strongly and unequivocally support" the thrust of the bill to enable "couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to carry out their decisions. Proponents argue that government-funded access is the key to break the inter-generational poverty that many people are trapped in. On the part of the health worker, it correlates with the assessment of the residents regarding the family planning services given in the community. According to the residents, giving of information on the part of the health worker about the different family planning methods have been performed, although what the health workers lack is the time to give the actual demonstration of each available family planning

cxviii

technique and method.

Hence the information dissemination and

information lacks weight for the program.

Table 12 Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms the Sanitation Services
As a health worker, I am giving the following services. 1. giving information about the campaign on health hazards 2. providing information on environmental hazards 3. assuring policy and sanitation programs are implemented 4. furnishing program on health risk minimization 5. ensuring the cleanliness of the environment 6. conducting programs to make the environment clean. 7. cooperating with the city government mandate of using eco-friendly materials (i.e.: paper bags, reusable materials) Overall Mean
Legend: 4.51 5.00 Excellently Satisfied 3.51 4.50 Very Satisfied 2.51 3.50 Satisfied

Mean 4.36 4.09 4.18 4.18 4.36 4.27

Description Very Satisfied Very Satisfied Very Satisfied Very Satisfied Very Satisfied Very Satisfied Very Satisfied Very Satisfied

4.00 4.21

1.51 2.50 Dissatisfied 1.00 1.50 Very Dissatisfied

Table 12 describes the mean distribution for the sanitation services of the respondents on the following: The highest mean scores were given to the categories giving information about the campaign on health hazards and ensuring the cleanliness of the environment both with mean scores of 4.36 which mean very satisfied; while the lowest mean were given to cooperation of the health workers with the city

cxix

government mandate in using eco-friendly materials (i.e.: paper bags, reusable materials) with a mean of 4.00 which also means to a very satisfied result. Overall, the mean for sanitation services is equivalent to 4.21 which is very satisfied. According to Khosla, R et. al. (2005), It has been estimated that 1.7 million deaths each year, or 3.1 percent of all deaths are attributable to inadequate access to water, sanitation and hygiene. The urgency for sanitation in the urban environment stems from the fact that the urban poor live in crowded slums and informal settlements where sanitation facilities are particularly important for children's health and personal dignity. Demand for sanitation services has remained low, as livelihood priorities have been more pressing. Data implied that adequate sanitation, together with good hygiene is fundamental to good health and to social and economic development. The locality is making its own effort to provide residents in Zapote, Las Pinas city adequate knowledge about health sanitation. Health workers of the said municipality admitted that they are trying their best to actively promote and implement programs mandated by the government regarding health promotion and health risk minimization. Hence, the use of environmental friendly materials does not relate much in this study since this category obtained the lowest score among those given.

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Problem 3. Level of job satisfaction of the health care workers in terms of Motivation variables: Table 13 Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of Motivation Variable
Motivation: achievement 1. providing health care workers clear, achievable goals and standards for their positions 2. presenting the health care workers with regular, timely feedback on how they are doing 3. ensuring the health care workers are adequately challenged in their jobs Overall Mean Motivation: recognition 1. identifying individuals for their major accomplishments for the job by the city health office. 2. acknowledging the health workers inputs by the city health office in a timely, and meaningful way 3. noticing staff members achievement on the job done by the city health office through a formal program (like health care workers of the month) Overall Mean Motivation: work itself 1. recognizing health worker whose work is meaningful. 2. acknowledging that health care workers work is important 3. procuring processes to make health care workers more efficient Overall Mean Motivation: responsibility 1. perceiving from Health care workers that they can be dependable upon their work. 2. providing Health care workers with sufficient freedom and authority in decision making 3. presenting health care workers for opportunities of adding to their responsibilities (not simply adding more tasks). Overall Mean Motivation: advancement 1. rewarding the health workers for their performance by the city health office 2. promoting people by the city health office. 3. providing health workers with continuing education and personal growth Overall Mean
Legend: 4.51 5.00 Excellently Satisfied 3.51 4.50 Very Satisfied 2.51 3.50 Satisfied

Mean 4.18 4.00 4.00 4.06 Mean 3.91 4.00

Description Very Satisfied Very Satisfied Very Satisfied Very Satisfied Description Very Satisfied Very Satisfied

3.73 3.88 Mean 4.27 4.45 4.27 4.33 Mean 4.18 4.09 4.09 4.12 Mean 3.73 3.73 4.18 3.88

Very Satisfied Very Satisfied Description Very Satisfied Very Satisfied Very Satisfied Very Satisfied Description Very Satisfied Very Satisfied Very Satisfied Very Satisfied Description Very Satisfied Very Satisfied Very Satisfied Very Satisfied

1.51 2.50 Dissatisfied 1.00 1.50 Very Dissatisfied

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Table 13 represents the mean distribution on the health workers level of satisfaction in terms of motivation variables with achievement as the first category, with items providing health care workers clear, achievable goals and standards for their positions which obtained the highest mean of 4.18 equivalent to very satisfied while presenting the health care workers with regular, timely feedback on how they are doing and ensuring that health care workers are adequately challenged in their jobs were both given mean scores of 4.00 which are also very satisfied but obtained the lowest point for motivation variable on achievement. In the second motivation variable of recognition, the highest score went to acknowledgment of the health workers input by the city health office in a timely, and meaningful way with a mean of 4.00 which is equivalent to very satisfied; while noticing of staff members achievement on the job done by the city health office through a formal program (like health care workers of the month) was given a mean of 3.73 which also resulted to a very satisfied outcome. For the third motivation variable, work itself: The highest scores went to acknowledgment that health care workers job is important with a mean of 4.45 which is very satisfied, while the lowest score was given to recognizing of health workers that their work is meaningful given a mean of 4.27 which is also very satisfied. As to the fourth motivation variable of responsibility, the highest is perceiving from

cxxii

health care workers as to dependability on their work with a mean of 4.18 which is very satisfied; while the lowest went to providing health care workers with sufficient freedom and authority in decision making and presenting health care workers for opportunities of adding to their responsibilities (not simply adding more tasks) obtained a mean of 4.09 which is also very satisfied. Meanwhile, the fifth motivation variable on advancement has the highest mean gathered in terms of providing health workers continuing education and personal growth with 4.18 which is equivalent to very satisfied; while rewarding of the health workers for their performance by the city health office and promoting of people by the city health office both were given mean scores of 3.73 which are also very satisfied. Summing it up, the overall mean score for the level of satisfaction for the motivation variable: first is achievement with 4.06 mean which is very satisfied followed by the second variable recognition with 3.88 which are very satisfied. The third motivation variable work itself has a mean score of 4.33 which is very satisfied followed by the fourth motivation variable responsibility with a mean of 4.12 which is very satisfied. Lastly, the fifth motivation variable on advancement obtained an overall mean score of 3.88 which is also very satisfied.

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According to Semplici 2011, the goal is to pursue 'the highest attainable standard of health' as a fundamental human right, that should as such be guaranteed to every human being. While to McLelland (2009), the characteristics of people with high achievement motivation are the following: 1. want to have success; 2. require constant feedback; 3. avoid low risk and high risk jobs; 4. undertake medium risk; 5. selfmotivated, self-directed, set challenging but realistic goals; 6. prefer working alone or with high achievers; 7. goal is accomplishment or challenge itself; 8. assume personal responsibility for problem solving; 9. sequence tasks in relation to goals; 10. prioritize tasks to attain goals; 11. evaluate by monitoring results and establishing check points nontraditional Independent at earlier age. Thronicroft and Tansella (2005) showed that outcomes data rated by service users in some cases are more important than those rated by staff. The reduction in patient-rated unmet needs in the social domain was the strongest predictor of an increase in subjective quality of life. The importance of including service user preferences within the content of the research questions is exemplified by the results of a recent study that showed that joint crisis plans can significantly reduce the use of compulsory admission during crises. Consistent with the delivery of world-class care and patient experiences starts with creating consistent

cxxiv

and world-class employee and caregiver experiences. Timely, specific, personalized and sincere recognition in the workplace will help support any healthcare organizations focus on the patient and exceptional patient care. (Psichogois, 2012) Over and again, workers who feel motivated to work are likely to be persistent, creative and productive, turning out high quality work that they willingly undertake but the reality is that every employee has different ways to become motivated. Employers need to get to know their employees very well and use different tactics to motivate each of them based on their personal wants and needs. Data showed in this study that these workers admitted that they have given their best in their jobs in order to provide quality of care to the people in the community.

Problem 4. Level of job satisfaction of the health care workers in terms of Hygiene variables:

cxxv

Table 14 Mean Distribution of the Health Workers of Barangay Zapote Las Pinas City Level of Satisfaction in terms of Hygiene Variable
Hygiene: salary 1. receiving of pay is adequate for needs 2. perceiving of other benefits aside from salary is enough 3. providing of clear policies related to salaries, raises and bonuses are given. Overall Mean Hygiene: company policy & administration 1. equipping the health center with policy manual by the city health office 2. implementing of the policies is fair. 3. following of the policy is done by the health care workers. Overall Mean Hygiene: interpersonal relationship 1.giving of opportunity to socialize during workdays 2. having a sense of camaraderie and teamwork among health workers. 3. dealing with the disruptive individual is done by the supervisor. Overall Mean Hygiene: supervision 1. acknowledging that the health workers could trust their supervisor 2. using positive feedback for health care workers 3. giving of evaluation is in a timely manner and fair method Overall Mean Hygiene: working conditions 1. supplying the health center with adequate equipment ( computers, machines, calculator, oxygen, dental chair, etc.) that work properly. 2. Providing a clean and up to date facility. 3. Furnishing the health center with comfortable conditions: (adequate ventilation and lighting). Overall Mean
Legend: 4.51 5.00 Excellently Satisfied 3.51 4.50 Very Satisfied 2.51 3.50 Satisfied

Mean 2.91 2.64 3.00 2.85 Mean 4.18 4.18 4.09 4.15 Mean 3.64 4.09 3.82 3.85 Mean 4.36 4.18 4.09 4.21 Mean

Description Satisfied Satisfied Satisfied Satisfied Description Very Satisfied Very Satisfied Very Satisfied Very Satisfied Description Very Satisfied Very Satisfied Very Satisfied Very Satisfied Description Very Satisfied Very Satisfied Very Satisfied Very Satisfied Description

3.27 3.55 3.27 3.36

Satisfied Very Satisfied Satisfied Satisfied

1.51 2.50 Dissatisfied 1.00 1.50 Very Dissatisfied

cxxvi

For the mean distribution of the level of satisfaction of the health workers in terms of hygiene variables, the first variable is pay and benefits or salary. The highest for this category is providing of clear policies related to salaries, raises and bonuses. This category was given a mean of 3.00 which is equivalent to satisfied. The lowest went to perceiving of other benefits aside from salary with a mean of 2.64 which earned a satisfied result. The second variable pertains to the company policy and administration to which the highest mean score of 4.18 with a very satisfied rate went to equipping the health center with policy manual by the city health office and implementation of policies. The lowest is following of the policy done by the health care workers with a mean of 4.09 equivalent to a very satisfied rate. Interpersonal relationship as the third variable the highest mean score of 4.09 with a very satisfied result went to the category of camaraderie and teamwork among health workers. The lowest mean of 3.82 with also a very satisfied result fell under dealing with disruptive individuals by the supervisor. The fourth variable deals with supervision to which the highest mean score of 4.36 and a very satisfied result was given to the acknowledgment of trust by the health workers to their supervisors. The fifth and last variable

pertains to working conditions which earned the highest mean of 3.55 in terms of providing a clean and up-to-date facility with a very satisfied

cxxvii

result. Meanwhile, in terms of supplying with adequate health center equipment (computers, machines, calculators, oxygen, dental chair, etc.) that work properly and furnishing the health center with comfortable conditions: (adequate ventilation and lighting) both earned mean scores of 3.27 and a satisfied result. Overall the mean score for the pay and benefits or salary of the health workers was given a 2.85 mean with a satisfied outcome. Summing it up, the overall mean for the company policy and administration is 4.15 with a very satisfied result while the mean score for the hygiene variable in terms of interpersonal relationship was given a mean of 3.85 with a very satisfied outcome. On the other hand, the overall mean for hygiene variable in terms of supervision was given 4.21 and a very satisfied outcome while the overall mean for the hygiene variable with working conditions earned a satisfied score of 3.36. It is evident that a good employee benefits the administration, builds relationships and cultivates trust (Spencer 2008). Generous benefit packages (especially those with an emphasis on health insurance and retirement savings) tend to attract employees who are looking for long-term, stable positions. The importance of building a team of quality employees is not lost on employers - even those currently financially stretched by market conditions. (Keimig, 2011). The objective of policies

cxxviii

and procedures is to document an organizations policy for operation s and the procedures necessary to fulfill that policy. Policies and

Procedures also help to create an internal control framework. (Widzinski, 2009). Proper communication, understanding and mutual efforts are the binding base of any relationship to sustain and grow, and same is the case with the interpersonal relationships among the employees in a workplace (Rampur, 2010). Also in one of the studies done by Westerman and Simmons (2007) the primary contribution of this research was the examination of the unique variance contributed by personality and work environment preferences in determining employee performance. The results of this study indicated that personality, work environment, and employee outcomes are interrelated. The significance of employee goal-orientation preferences in fully mediating the relationship between personality and workplace outcomes provides further evidence to support the contention that the relationship between personality and performance may not be bivariate, and that intervening variables play substantial roles. Data implied that health workers are dissatisfied by the compensation that they are presently receiving as it has the lowest satisfier rating given compared to the supervision that they received. Adequate worker compensation should be considered in order for the

cxxix

workers to achieve a high level of satisfaction towards their work. A well thoughtout and fair compensation system aligned with success in fulfilling the designated goals is the basis of social peace in the company or organization and will definitely motivate workers to deliver the required performance.

Problem

5.

Significant

difference

in

respondents

level

of

satisfaction on the different health care services offered when grouped according to the profile variables of: Table 15 Significant differences in the respondents level of satisfaction on the different health care services offered when grouped according to Age
Fcompu ted value*

SERV ICES Maternal check-up Services Immunizatio n Services Family planning Services Sanitation Services

Less Tha n 20

21 25

2630

31 35

3540

41 abo ve

4.23

4.41

4.22

4.20

4.48

4.59

0.877

4.61

4.87

4.53

4.69

4.68

4.76

1.159

4.28

4.68

4.36

4.38

4.16

4.78

0.934

4.27

4.63

4.40

4.52

4.44

4.90

1.161

Result Not Signific ant Not Signific ant Not Signific ant Not Signific ant

Decisio n Ho; not rejected Ho; not rejected Ho; not rejected Ho; not rejected

*F-critical value (5% level of significance, 5 & 109 df) = 2.298

Table 15 represents significant differences in the residents level of satisfaction on different health care services offered in the health

cxxx

center grouped according to age. At a glance, for the maternal check-up the highest score with a mean of 4.59 comes from 41 and above while the lowest comes from 26 to 30 age group with a mean of 4.22. In the immunization services, 21 to 25 years old age group has the highest mean with a score of 4.87 while the lowest score mean of 4.53 came from 26 to 30 years old age group. In terms of family planning services the age group of more than 41 years old earned the highest mean of 4.78 while the lowest was from the 36 to 40 age group with a mean of 4.16. As to sanitation services, 41 and above group has the highest mean with 4.90 while those who are less than 20 years old earned the lowest mean score of 4.27. Taken collectively, according to the f- computed critical value of 2.298 with a 5% level of significance from the residents when grouped according to age, the highest is from the sanitation services with a value of 1.161 while the lowest is from the maternal services which is 0.877. Evidently the significance of this table showed that the services are not suggestive and the decision is not side-tracked for all of the services offered in the community. Studies consistently show that community health centers provide care that improves health outcomes of their patients. The patients of these centers are also more likely to identify a usual source of care, and

cxxxi

report having better relationships with their health care providers. This focus on primary care and the provision of additional supportive services are among the reasons that care delivered by community health centers is less expensive and ultimately saves money for the broader health care system. Studies estimate that the provision of care in community health centers ultimately saves the U.S. health care system between $9.9 billion and $24 billion annually by eliminating unnecessary emergency room visits and other hospital-based care, (Whelan, 2010) In terms of urbanity, women in urban areas are 0.88 times more likely to avail of prenatal care services than their rural counterparts. Regarding parity, the study revealed that there is little difference in the likelihood of use of prenatal services among women. The odds of having prenatal care decreases as the number of children increases. On the other hand, women who are 15 to 19 years old are twice as likely to access maternal care as the 45-49 year old women, (Rogan, S and Olvea, M.V. 2005) Subsequent data show that those more than 41 years old mothers-to-be give emphasis on the prenatal program given by the health center. Moreover, those within the 26 to 30 years old age group tend to indicate lower frequency in visiting the health center for the prenatal care. Immunization is very much emphasized for the 21 to 30

cxxxii

year old mother while family planning is very much asserted on the 36 years old and above. Sanitation services on the other hand tend to be regarded as opposite views from the youngest and oldest age-groups. Therefore, it is more apparent that those belonging to a higher agegroup ranging from 36 years old and above are more concerned about their health status as evidenced by their frequent consultations with the health center personnel compared to the younger ones.

Table 16 Significant difference in the residents level of satisfaction on the different health care services offered when grouped according to civil status
Fcomputed Interpreta value* tion Not Significant Not Significant Not Significant Not Significant

Services Maternal check-up Services Immunization Services Family planning Services Sanitation Services

LI

SWS

Decision Ho; not rejected Ho; not rejected Ho; not rejected Ho; not rejected

4.34 4.29 4.59 4.72

4.90 4.71

1.126 0.899

4.31 4.47 4.43 4.54

5.00 5.00

0.948 1.049

*F-critical value (5% level of significance, 2 & 112 df) = 3.077 Legend: M Married LI Live-in SWS Single/ Widowed/ Separated

Table 16 represents the significant difference in Santos and Basa residents level of satisfaction on the different health care services offered when grouped according to Civil Status.

cxxxiii

As shown above, maternal services earned the highest among the group with a mean score of 4.90 particularly belonging from the single group; followed by the married ones with a mean of 4.34 and lowest is from the live-in group with a mean of 4.29. As to immunization services, a highest mean of 4.72 came from the live-in group; followed by the single group with a mean of 4.71 and lowest from the married group with a mean of 4.59. The family planning services were highest among the single group with a mean of 5; followed by the live-in group with a mean of 4.47 and lowest among the married group with a mean of 4.31. Meanwhile, the sanitation services was given a perfect mean of 5.00 by the single group followed by the live-in with a mean of 4.54 and lastly by the married group with 4.43 mean. The f-computed critical value with 5% level of significances 3.077 for the mean of the residents based on the profile of civil status. The highest for the computed value is on the maternal services with 1.126; followed by sanitation services with a value of 1.049; and third is on family services with a value of 0.948 while the lowest is from the immunization services with a value of 0.899. It is apparent that the

higher the value for the f-computed critical value the closer it is to percentage error.

cxxxiv

An evidence was presented by Case and Paxson in 2011, that changes in self-assessed health are related to future changes in employment grade and that changes in employment grade are not related to changes in future health. The findings are consistent with the hypothesis that strong correlation between health and employment grade reects the effects of health on success in the workplace. The results stand in stark contrast to other studies based on Whitehall II, which downplayed the role of health selection in employment. It should be noted that this finding, although striking, is based on only one measure of health self assessed health status. Although self-assessed health status is highly predictive of future mortality and is strongly correlated with a range of health conditions, different results, it is obtained using different measures of health. In the future, it would be useful to examine whether similar results will be obtained when different measures of health, such as cardiovascular disease or depression, are used in place of self-assessed health. This table is used to gauge the answers of the respondents grouped according to the variable thus, this table shows no significance and the value is not rejected.

cxxxv

Table 17 Significant Differences in the Respondents Level of Satisfaction on the Different Health Care Services Offered when Grouped according to Family Income Level
5,00110 / mo. > 15/ mo

SERV ICES Maternal check-up Services Immunizat ion Services Family planning Services Sanitation Services

< 5/mo

10,001 15/ mo.

Fcomputed value*

4.31

4.42

4.14

4.08

1.105

4.60

4.74

4.68

4.39

1.235

Interpre tation Not Significa nt Not Significa nt Significa nt Not Significa nt

Decision Ho; not rejected Ho; not rejected Ho; rejected Ho; not rejected

4.30

4.67

4.12

3.81

3.402

4.55

4.53

4.34

4.39

0.426

*F-critical value (5% level of significance, 3 & 111 df) = 3.077

Table 17 represents the significant differences in the residents level of satisfaction on the different health care services offered when grouped according to the family income level. In the maternal services, the highest among the group is from those that have an income of more than 5,001 to 10,000 monthly with a mean of 4.42; second among the highest is from the respondents with an income level of less than 5,000 monthly with a mean of 4.31; third are those with family income of 10,001 to 15,000 with a mean of 4.14. The lowest mean value of 4.08 comes from respondents with a family income level of more than 15,000 monthly

cxxxvi

As to immunization services, the families with an income level of 5,001 to 10,000 earned the highest mean of 4.74; second to the highest is from families with income level of 10,001 to 15,000 with a mean of 4.68; third to the highest is from families with income level of less than 5,000 monthly with a mean of 4.60. The lowest mean of 4.39 came from the families with income level of more than 15,000 per month. In the family planning services the highest mean were given by the respondents with family monthly income level of 5,001 to 10,000 with a mean of 4.67; followed by those with family monthly income less than 5,000 per month with a mean of 4.30; third is from those with monthly income of 10,001 to 15,000 with a mean of 4.12. The lowest mean given was 3.81 from respondents with family income level of more than 15,000 monthly. In terms of sanitation services, the highest mean was given by the families with monthly income level of less than 5,000 with a mean of 4.55; secondly with a mean score of 4.53 from the families with income level of 5,001 to 10,000 monthly and third from the families with income level of more than 15,000 monthly with a mean of 4.39. The lowest was from the families with income of 10,001 to 15,000 with 4.34 mean. The f-computed critical value with 5% level of significance of 3.077 from Santos residents based on the profile of family income level

cxxxvii

status: the highest for the computed value is from the family planning services with 3.402; followed by immunization services with a value of 1.235; third is from maternal services with a value of 1.105; while the lowest is from sanitation services with a value of 0.426. Once again it is apparent that the higher the value for the f-computed critical value the closer it is to percentage error. According to Clay, R. (2001) Epidemiological studies have confirmed the relationship between income, education and occupation on the one hand and health outcomes on the other. The lower the socioeconomic status, the greater the risk of both physical and psychological health problems. Another aspect seen was: "As you move up the socioeconomic status hierarchy, your health prospects continue to improve," says psychologist Norman B. Anderson, PhD, a professor of health and social behavior at Harvard University's School of Public Health (2002). The relevance of this table is to gauge the answers of the respondents grouped according to variables. Once again, this table

shows no significance and the values are not rejected. However, based on the results above, it is evident that those families who have higher income levels avail most of the services in the community, therefore, there is also a tendency for these families to be less satisfied with the

cxxxviii

services being given to them.

More so, it can be said that the family

planning services is the only one that has significant difference among all the programs that have been presented.

Problem 6. Significant differences in the evaluations of the residents and health workers on health care services. Table 18 Mean Level of Satisfaction Signifying Differences in the Evaluations of the residents and the health workers on the health care services from the Santos Residents
MEAN LEVEL OF SATISFACTION Computed SANTOS HEALTH RESIDENTS WORKERS t-value* 4.48 4.69 4.50 4.54 4.38 4.35 4.23 4.21 0.518 1.961 0.999 1.579

Interpreatation Significant Not Significant Not Significant Not Significant Not Significant Decision Ho; not rejected Ho; not rejected Ho; not rejected Ho; not rejected

HEALTH CARE SERVICES MATERNAL CHECK-UP IMMUNIZATION FAMILY PLANNING SANITATION

*t-critical value (5% level of significance, 78 df) = 1.991

Table 18 presents the results of the t-test in comparing the mean satisfaction ratings of the residents and the health workers regarding health care services, namely: maternity check-up services, immunization services, family planning services, and sanitation services. Data analysis is shown in Appendix J The mean satisfaction for the Santos residents for maternal check-up services is 4.48 while for the health workers is 4.38. The

cxxxix

immunization services gathered 4.69 for the Santos residents while 4.358 for the health workers. In terms of family planning services the mean level of satisfaction for the Santos residents is 4.50 while 4.23 for the health workers; and for the sanitation services the Santos residents have 4.54 while 4.21 for the health workers. The measurement of patient perceptions provides a valuable dimension of insight into the process by which the quality of health care services is evaluated. In order to identify and correct service quality problems quickly, managers need to understand patients perceptions of the quality of services actually delivered. The present results have shown, however, that managers have quite different perceptions of the services provided in their health centers from that of the patients. In particular, they are over-estimating the perceived quality of almost all the service quality attributes that were studied. In one of the studies in 2010 by Miranda, F. et.al, the findings show they have implications for managing primary health care centers. In particular, the perceived quality of a health care center depends mainly on dimensions that are closely linked to the health personnel who are in touch with the patients, as well as, to certain measures of efficiencythe ease of making an appointment, level of bureaucracy, waiting times before entering the consulting room, speed of

cxl

complementary tests, complaints resolution, time to focus on each patient, and the timetable of the health center. The t-test resulted to a negative computed t-value in the maternity check-up services; immunization services; family planning services and sanitation services all of which indicate that the residents had a lower mean satisfaction rating than the health workers. Analysis revealed that the differences in the mean ratings in all the services were found not significant since the computed t-values did not exceed the critical t-value of 1.991 at five percent level of significance. Hence, the null hypothesis that there are no significant difference in the evaluations of the residents and the health workers is not rejected.

Table 19 Mean Level of Satisfaction Signifying Differences in the Evaluations of the Residents and the Health Workers on Health Care Services from Basa Residents
MEAN LEVEL OF SATISFACTION BASA HEALTH RESIDENTS WORKERS 4.08 4.62 4.28 4.43 4.38 4.35 4.23 4.21 tcomputed value* -1.284 1.542 0.116 0.830 Interpretation Not Significant Not Significant Not Significant Not Significant Decision Ho; not rejected Ho; not rejected Ho; not rejected Ho; not rejected

HEALTH CARE SERVICES MATERNAL CHECK-UP IMMUNIZATION FAMILY PLANNING SANITATION

*t-critical value (5% level of significance, 55 df) = 2.004

cxli

Table 19 presents the results of the t-test in comparing the mean satisfaction ratings of the residents and the health workers regarding health care services, namely: maternity check-up services, immunization services, family planning services, and sanitation services. Data analysis is shown in Appendix K The mean satisfaction for the Basa residents in terms of maternal check-up services is 4.08 while for the health workers is 4.38; the immunization services gathered 4.62 for the residents while 4.35 for the health workers. Meanwhile in the family planning services, the mean level of satisfaction for the residents is 4.28 while 4.23 for the health workers; and for the sanitation services the residents have 4.43 while 4.21 for the health workers. In one study globally, it was concluded that the relationship

between human resources management and health care is extremely complex, particularly when examined from a global perspective. The research and analysis indicated that several key questions must be addressed and that human resources management can and must play an essential role in health care sector reform. The t-test resulted to a negative computed t-value in the services, had a higher mean satisfaction rating while maternal check-up obtained a lower score. This indicated that the residents had lower mean

cxlii

satisfaction rating than the health workers for immunization services; family planning services and sanitation services while Basa residents had a higher service expectation than what the health workers perceived they are delivering. Analysis revealed that the differences in the mean ratings in all the services were found not significant since the computed t-values did not exceed the critical t-value of 1.991 at 5% level of significance. Null hypothesis revealed that there are no significant difference in the evaluations of the residents and the health workers hence it is not rejected.

Problem 7. Proposed Enhancement program to improve the health care services and management of the health care team.

I. Introduction Health is an invaluable part of a human being's life. Without it, people can become uninspired, de-motivated, and unable to thrive for success and with all of these to consider, some individuals visit their doctors regularly to make sure they are in tiptop shape. Likewise, there are those who purchase insurance coverage so they can receive the best healthcare should there be a need in the future. However, people with low incomes, particularly those who live in poverty, face particular challenges in maintaining their health. They are more likely than those

cxliii

with higher incomes to become ill, and to die at younger ages. They are also more likely to live in poor environmental situations with limited health care resources and factors that can compromise health status and access to care. Health is not one of the benefits of sustainable

development: it is a prerequisite. Providing for the future of coming generations can only be achieved by strengthening the resilience of present generations. Vulnerability to disease is one of the most formidable obstacles faced by populations trying to escape the cycle of poverty and resource depletion. Access to a safe water supply and to proper sanitation facilities has proved to be the single most important factor in promoting health and combatting disease among the community. Disease prevention is the key to public health. It is always better to prevent a disease than to treat it. Vaccines prevent disease in the people who receive them and protect those who come into contact with unvaccinated individuals. Vaccines also help prevent infectious diseases and save lives. On the other hand, the risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception (before pregnancy) and inter conception (between pregnancies) care. Moreover, healthy birth

outcomes and early identification and treatment of health conditions among infants can prevent death or disability and enable children to

cxliv

reach their full potential. Family planning on the other hand according to the WHO (World Health Organizations) allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. A womans ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy.

Public programs play a vital role in helping to reduce disparities in health by income by supporting health initiatives targeted at those with low incomes and maintaining a safety net of health and social services for the poor. In the Philippines, Barangay Health Center usually

provides first aid, maternal and child health care, diagnosis of social diseases, and other basic health services to all the members of the community it is serving. It is usually the first point of contact between residents of the community and other health care facility levels and is commonly staffed by doctors, public health nurses, nutritionists, medical technicians, rural health midwives and barangay health workers. Barangay Health Workers (BHW) are the front liners in primary health care services in any Philippine locality. They are often volunteers in community health centers that operate under the guidance of the Local Health Board (LHB) in accordance with the guidelines of the Department

cxlv

of Health (DOH).

Health services such as maternal health,

immunization, family planning and sanitation were only amongst the few services offered by these health centers. However, people from such communities are adamant to have their consultation done in their nearest barangay health centers due to low quality of services. In relation to this, health worker motivation can potentially affect the provision of health services as well. Low morale among the workforce can undermine the quality of service provision and drive workers away from the profession. The quality of the health services, their efficacy, efficiency, accessibility and viability depend on the performance of those who deliver them. Motivation factors plays an important role on this because motivation factors are known to intensively affect whether or not individuals are satisfied with their jobs. Variables such as achievement, recognition, work itself, responsibility and advancement were some of the motivation factors used in this enhancement program.

Many factors influence health and well-being in a community, and many entities and individuals in the community have a role to play in responding to community health needs. The health of a community is a shared responsibility of all its members. Although the roles of many community members are not within the traditional domain of ''health

cxlvi

activities," each has an effect on and a stake in community's health, (Patrick and Wickizer, 1995).

In developing a health improvement program, every community will have to consider its own particular circumstances, including factors such as health concerns, resources and capacities, social and political perspectives, and competing needs. The committee cannot prescribe what actions a community should take to address its health concerns or who should be responsible for what, but it does believe that communities need to address these issues and that a systematic approach to health improvement should be implemented.

II. Rationale The purpose of this program is to assess and evaluate the effects of motivation factors to the healthcare workers in terms of rendering different health services to clients in the community as well as clients satisfaction to the services being rendered to them. Identifying the distinct conditions that affect health worker satisfaction and motivation in each sector can provide a basis for considering enhanced policies and management approaches to improve work conditions that are different in each setting. Also, the purpose of this enhancement programs are

focused around skill enhancement that combines the best practices

cxlvii

from education, psychology, social work, career counseling, technology training.

and

Skill enhancement or training typically uses a

combination of cognitive and behavior problem solving approaches, both of which are used to strengthen a person's positive skill development.

III. Scope The provision of health services in community setting and the level of satisfaction of clients is a real challenge. More so, health

workers motivation affects the provision of this health services as well. Government, health services and professionals are already investing significantly in the enhancement of community health services. This enhancement program is provided for individuals, families and health workers of Barangay Basa and Santos in Zapote, Las Pinas City. The purpose was to share common concerns and difficulties about the implementation of health services in their locality and to consider ways in which local partnerships could be strengthened. It was hoped that with this programs, progress could be made in developing a framework for the role and position of health advancement within local government using different strategies such as trainings, seminars, workshops, continuing education and other programs and activities.

cxlviii

IV. Definition of Terms Achievement pertains to an accomplishment. Baranagay Health Center pertains to community-based and

patient-directed organization. Its goal is to provide first aid, maternal and child health care, diagnosis of social diseases, and other basic health services to all the members of the community it is serving. Barangay Health Worker pertains to a category of health care providers in the Philippines. They undergo a basic training program under an accredited government or non-government organization, and render primary care services in the community. Birth Spacing refers to the time interval from one child's birth date until the next child's birth date. Family Planning pertains to the planning of when to have children and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, preconception counseling and

management and infertility management. Fertility refers to the natural human capability of producing offspring.

cxlix

Immunization refers to the process by which an individual's immune system becomes fortified against an agent. Morbidity Rate refers to the number of individuals in poor health during a given time period or the number of newly appearing cases of the disease per unit of time. Mortality Rate refers to the number of deaths (in general, or due to a specific cause) in a population, scaled to the size of that population, per unit of time. Mortality rate is typically expressed in units of deaths per 1000 individuals per year; thus, a mortality rate of 9.5 (out of 1000) in a population of 1,000 would mean 9.5 deaths per year in that entire population, or 0.95% out of the total. Motivation refers to the psychological feature that arouses an organism to action toward a desired goal and elicits, controls, and sustains certain goal directed behaviors. Postnatal refers to the period beginning immediately after the birth of a child and extending for about six weeks Prenatal Care refers to the regular medical and nursing care recommended for women during pregnancy. Prenatal care is a type of preventive care with the goal of providing regular checkups that allow doctors or midwives to treat and prevent potential

cl

health problems throughout the course of the pregnancy while promoting healthy lifestyles that benefit both mother and child . Recognition pertains to acknowledgment Responsibility pertains to a duty or obligation to satisfactorily perform or complete a task (assigned by someone, or created by one's own promise or circumstances Sanitation refers to the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Vaccine refers to a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins Work pertains to the entire scope of a project encompassing all people, equipment, material and other goods and services required to fulfill the contractor's obligations under a contract.

V. Table