Chapter III My Work

1
Chapter III
Health Situationer

This chapter presents the health situation of the province of Northern Samar. It
articulates data on natality, mortality and morbidity, family planning, malnutrition, health
practices and best practices, diseases and causes, dental health program, health facilities,
services and personnel, financing and expenditures as well as gaps and deficiencies in
services/programs delivery.
Health Status
Natality

Figure 1 below presents the Crude Birth Rate (CBR) per 100,000 population data of
the twenty four (24) municipalities of Northern Samar. The entries are sex disaggregated
and geographically presented.
The 1st District is composed of thirteen (13) municipalities where the highest
recorded CBR is at 2,872 in the Municipality of Allen; and the lowest CBR is at 1,537 in the
island town of San Antonio. On cumulative average, the districts CBR is recorded at 1,797
or 17.99% per 100,000 population. This CBR is estimated to be at 1.12% of 100,000
population per municipality and 7.29% of the districts total population.
On the other hand, the data for the eleven (11) municipalities comprising the 2nd
District is as follows: 1,294 is the cumulative average CBR per 100,000 population. The
highest rate is at 2,123 in the Municipality of Pambujan; and the lowest is at 1,150 in
2

Lapinig. The districts cumulative average CBR is at 14.32% per 100,000 Population or 1.5%
per municipality.
On the whole, the grand average CBR or the 1
st
District is at 13.80 per 100,000
population and that of the 2
nd
District is at 1.69 per 100,000 population. Roughly, it is 15.49
per 100,000 population CBR for the Province of Northern Samar.
Municipality Total Popu-
lation
Crude Birth Rate Rate/ 100,000
Population Male Female

1st District
Allen 27,187 378 403 2.87
Biri 10,759 135 135 2.51
Bobon 22,168 280 306 2.6
Capul 13,961 141 130 1.94
Catarman 90,641 898 882 1.95
Lavezares 33,505 269 229 1.49
Lope de Vega 14,680 117 110 1.54
Rosario 10,930 75 102 1.61
San Antonio 9,952 83 70 154
San Jose 17,992 249 245 2.74
San Isidro 28,726 283 305 2.05
San Vicente 7,249 91 85 2.42
Victoria 14,966 153 108 1.74
Districts Average 13.80
2nd District
Catubig 35,452 330 325 1.85
Gamay 28,523 230 240 1.64
Laoang 75,265 648 534 1.57
Lapinig 14,493 114 99 1.50
Las Navas 41,031 214 258 1.15
Mapanas 15,732 113 115 1.45
Mondragon 37,747 469 432 2.39
Palapag 43,847 389 366 1.72
Pambujan 34,993 378 365 2.12
San Roque 26,581 286 255 2.0
Silvino Lobos 17,425 119 97 1.26
Districts Average 1.69
Provincial Average 15.49
Fig. 1 Crude Birth Rate/ 100,000 Population Northern Samar
(Source: PHO Accomplishment Report 2012)
3

Data on deliveries by birth attendance is presented in Figure 2. Deliveries attended
by professional health workers doctors, nurses and midwives totaled to 7,665 or 61.6% of
the deliveries in 2012.
The traditional birth attendants and untrained hilots deliveries were 4,984 or
39.4%. The data apparently indicate that there was decline of deliveries by traditional birth
attendants as compared with those of some years back due to upgraded Rural Health Units
as BeMoNC activity. Services of the TBAs are secured due to distant and hard to reach
locations.

Figure 2. Deliveries by Birth Attendance
Accomplishment Report 2012

Figure 3 shows a record of 7,301 or 58% live births which were home deliveries;
2710 or 21% hospital deliveries and 2650 or 20% were delivered at the Rural Health Unit
with Basic Emergency Manage Obstetric Neonatal Care Facilities (BeMonC) and 1.3 others.
While most are home deliveries, it is to be noted that deliveries at both hospital and RHUs
4

are increasing. There remains however, to be a need to further undertake massive
campaigns about maternal deliveries. This is geared towards changing a particular health
seeking behavior especially for expectant mothers.
In addition, the data explicitly tells the need or local government units (LGUs) and
the health sector to converge and collaborate for the enrolment of the two poorest quintiles
to the PhilHealth Program at No Billing level.

Figure 3. Maternal Deliveries by Place
Source: PHO- Accomplishment Report 2012

Infant Mortality

Figure 4, articulates the data on infant mortality. Highlights include deaths at 74 for the 1
st

District over the 5-year average and 43 for CY 2012. This implies a rather high infant mortality data.
Data for the 2
nd
District reveal that there are 53 infant mortality on a 5-year average data
and 74 for the CY 2012; and total deaths is at 108 for the 5-year average and 117 for CY 2012; and
highest deaths has been recorded to be those from Catubig at 15 and 40, respectively.
5

At a rate of 1,000 live births, the data reveals that for the 1
st
District the rate is 11.16 and
7.56 for the 5-year average and CY 2012 respectively.
The infant mortality picture at the 2
nd
District includes a recorded death of 13 in Palapag. Its
5-year average rate is 10.09 and 14.31 at CY 2012.
The provinces infant mortality rate is at 10.62 on a 5-year average and 10.93 for CY 2012.
These data necessarily suggest for the need to intensify child health programs
implementation. At the grassroots level, breast feeding, nutrition services and the like
services may be given immediate focus. The 4Ps families and their children 14 years old
and below provide a potent avenue for health workers to converge with the DSWD. The
Family Development Sessions (FDS) can be best utilized to re-educate the mothers at the
grassroots level.
Most importantly however, attention should be given to the infant mortality rate at
the provincial level; taking particular notice over the wide disparity between the 5-year
average and the CY 2012. The figure rings the alarm
. This may not only suggest an adequate health seeking behavior but may also strongly
forward an institutional evaluation of how programs intended for such clientele are taking
ground. An intelligent looking back may well address the situation.

6

Infant Mortality 2012
Per 1000 Live births
5- Year Average
Municipalities 5-Year Average CY 2012
1
st
District Number Rate Number Rate
Allen 5 6 4 5.10
Biri 0 0 0 0.00
Bobon 7 12 10 17.6
Capul 9 33 11 40.5
Catarman 9 5 6 3.37
Lavezares 7 14 6 12
Lope de Vega 5 22 0 0
Rosario 1 6 0 0
San Antonio 2 13 0 0
San Jose 5 10 6 12.15
San Isidro 4 7 0 0
San Vicente 1 6 0 0
Victoria 0 0 0 0
Total 74 43
Average 11.16 7.56
2
nd
District
Gamay 4 9 2 4.26
Laoang 6 5 0 0
Lapinig 4 19 4 18.7
Las Navas 0 0 0 0
Catubig 15 23 40 61
Mapanas 3 13 2 13.16
Mondragon 3 3 3 3.33
Palapag 7 9 13 17.22
Pambujan 4 5 3 4.04
San Roque 3 6 1 7.94
Silvino Lobos 4 19 6 27.78
Total 53 74
Grand Total 108 117
Average 10.09 14.31
Grand Average 10.62 10.93

7

Maternal Mortality
Figure 5 shows the trend of Maternal Mortality Rate (MMR ) in Northern Samar from
2008 to 2012. Over the five year spread MMR increased doubling its record from 150 to
300. This may be attributed to active maternal birth reporting and tracking; which suffices
to say that with up to date MMR reporting and tracking better interventions may be
resorted to and therefoer attend to the maternal mortality situation of the province.
The data suggest of a service delivery at the grassroots level. This would entail more
health workers at the front line doing what they do best community organizing,
mobilization and social marketing. Tracking and reporting should include 4Ps partners since
health services form part of the condition for compliance. While, it may be true that there
are mothers with poor health seeking behavior which in effect causes delay in decision
making this remains to be a real and material point for consideration. Meanwhile,
BeMonc trainees and trainings should continue.
Maternal Mortality Rate/ 100,000 Live Births.
8

Figure 5. Maternal Mortality Rate
Source : PHO- Accomplishment Report 2012

0
50
100
150
200
250
300
350
2008 2009 2010 2011 2012
9

Maternal Mortality Rate by Municipality

Figure 6 details the information on maternal mortality on a per municipality basis for
CY 2012.
For the 1
st
District of Samar, the highest total live births recorded are from
Catarman. The highest live birth recorded was 1,780 in Catarman at a rate of
1.69/1.69MMR/100,000 live births; meanwhile the data for the 2
nd
District is topped by
Laoang with a total live birth of 1,182 at 0 MMR. At the provincial level, total live births
recorded were at 12,724 at 30.8 MMR/100,000.
Maternal Mortality Rate /100,000
Total Live
birth
FHSIS Hospital Total Rate
1
st
District
1. Allen 781 0 0 0 0
2. Biri 280 1 1 2 714
3. Bobon 586 1 1 2 341
4. Capul 271 0 0 0 0
5. Catarman 1,780 1 2 3 169
6. Lavezares 498 0 0 0 0
7. Lope De Vega 227 2 1 3 1321
8. Rosario 177 0 1 1 564
9. San Antonio 153 0 0 0 0
10. San Jose 494 2 1 3 607
11. San Isidro 588 0 0 0 0
12. San Vicente 174 0 0 0 0
13. Victoria 261 0 2 2 766
Total 6270 7 9 16 344.96
2
nd
District
14. Gamay 470 0 0 0 0
15. Laoang 1182 0 0 0 0
16. Mapanas 228 0 1 1 438
17. Catubig 655 2 4 6 916
18. Mondragon 901 1 1 2 222
19. Palapag 833 0 1 1 120
20. Pambujan 743 2 2 4 538
21. Lapinig 213 0 0 0 0
10

22. Las Navas 472 0 0 0 0
23. San Roque 541 0 4 4 739
24. Silvino
Lobos
216 2 1 3 1388
Total 6454 7 14 21 396.45
Grand Total 12724 14 23 37 308
Figure 6. Maternal Mortality Rate per Municipality
Source: PHO Accomplishment Report 2012

Morbidity

Figure 7, As shown in the succeeding table, Upper Respiratory Tract Infection has
topped the causes of morbidity followed by pneumonia, diarrhea, bronchitis, hypertension,
wounds all types. However UTI, Influenza & Tb Respiratory although present for the past 5
year average this year 2012 they are not listed for the ten leading causes of Morbidity.
Most of this are due to poor health sanitation facilities and practices. This plan has
intervention projects especially to far flung communities.

Causes of Morbidity 5-Year Average CY 2012
Number Rate Number Rate
1. Acute Upper
respiratory Infection
9,360 1463 10317 1613
2. Pneumonia 3,152 492 8926 1395
3. Acute Gastro-
Entiritis (Diarrhea)
2,529 395 15705 2456

4. Hypertension 2,404 376 1936 302
5. Asthma 1,109 173 1417 221

6. Acute Bronchitis 924 144 2096 327
7. Wounds all types 893 139 942 147
8. Cough 845 132 5800 907
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9. Dermatitis 787 123 1059 165
10. Abscess 675 105 675 105
Figure 7. Leading Causes of Morbidity per 100,000 Population

Causes of Mortality As shown below Heart disease and Diabetes Mellitus lead the top ten
causes of mortality. This means that Healthy Lifestyle diseases are emergency and
surpassing the communicable disease which is prevalent over the years. Included in this plan
is the intensive intensification of the prevention and control of such disease.

Ten Leading Causes of Mortality per 100,000 Population
Cause o Mortality 5-Year Average CY 2012
Number Rate Number Rate

1. Heart Disease 187 29 177 27
2. Diabetes Mellitus 184 29 119 19
3. Hypertension 137 22 316 49

4. Pneumonia 134 21 372 58
5. Acute Renal Failure 127 20 - -

6. Drowning 124 19 - -
7. CVA 115 18 97 15
8. PTB 110 17 77 12
9. Septecemia 107 17 70 11
12

10. Diarrhea (AGE) 106 17 95 15

Prevalence of Malnutrition
Figure. Below shows that prevalence of Malnutrition are diminishing from year 2008
up to 2012. From 28.00 prevalence it decline to 16.1 on 2012.
Prevalence Rate

0
5
10
15
20
25
30
2008 2009 2010 2011 2012
13

Municipalities of 1st district and then prevalence Rate of 2011 & 2012

Municipalities of 2nd District and then prevalence Rate of 2011 & 2012
9.4
17.8
10.6
11
20.2
21
21.4
23
18.7
11.9
19
18
12
10.4
0
5
10
15
20
25
30
14

Family Planning
The figure below shows the utilization of the family planning methods commonly practiced
in the province of Northern Samar. The figure reveals that out of 7,632 current users of
family planning 3,808 or 42% use natural method. The permanent method is only 7%. Very
few are using permanent method of family planning for the fact that the province is a pro-
life advocate especially our former Governor.

Fig. Utilization of family planning methods

0
5
10
15
20
25
30
19.5
15
15.3
14.1
27
17.5
16
15.1
18.6
30
15


National Tuberculosis Program
For decades already, Tuberculosis is still a burden disease in Northern Samar. Province-wide
there were enornous private individuals that can identify significant number of patients with
symptoms of Tuberculosis but has no capacity to manage them through Directly Observed
Treatment Short-Course ( DOTS) therapy.
The Department of Health (DOH) implemented the program in the province
with National targets of 85% Case Detection Rate and 90% Cure Rate the Accomplishment of
the Province for CDR is 68% and CR is 72%. As the CY 2012 TB ranked 8 to 10 leading causes
of Mortality. There are 1.001 all forms of Tb cases and 496 New smear positive Tb cases.
49, 50%
42, 43%
7, 7%
Family planning Methods
Artificial
Nutural
Permanent
16

This means that the Sizeable numbers of new smear positive cases are potential sources of
infection from Tb considering that if left untreated each case can reflect 10 more persons in
a year time.

Endemic Diseases
A. An additional share of disease burden from endemic diseases such as
Schistosomiasis, Dengue and Malaria by 2012 Northern Samar is declared
Filaria free province. Schistosomiasis is considered endemic to the province
and the highest schisto prevalence at 68%. Both parasitic diseases employ
mass treatment strategy providing force medicines. However the side effect to
mass treatment being experienced by individuals taking the medicines
contributed to low compliance to the program.
17

Leprosy has ceased to be a major health public problem. Its prevalence has gone
down to less than 12 per 100,000 populations, Northern Samar has 14 municipalities
endemic for malaria but was declared malaria free since 1997.
B. Implementation of the filaria program is being undertaken by the Province
with assistance of DOH CHD region VIII which started two years ago. 58% of
the population were covered by mass treatment for filariasis.
On Rabis prevention from jan to december 2012 a total of 1,783 dogs and cat bites patients
were evaluated. The animal bite victimfor thus year declined by 16%. It is maybe due to
massive campaign on the Animal Bite Treatment and management and rabies awareness
that it kills 100% if not treated but 100% preventive if seek early consultation and given post
exposure prophylaxis.
Best Practices PHO ( Provincial Health Office )
Conduct Health Education and Animal Bite Management during vaccination schedule
to the victim and guardian at ABC
Encourage patients to complete post exposure prophylaxis and report if
the biting animal died during treatment.

84, 84%
16, 16%
Percentage of Biting Animal
Dog
Cat
18

Life Style Related Diseases
Although there are many programs on the prevention of LifeStyle Related Diseases, many of
these are losing steam in terms of sustained advocacy promotion both from the National
and Local Goverments. A classic example is Anti-smoking program supported by the passage
of anti-smoking law, reinforced by corresponding ordinance at the local level. And yet
enforcement remains dismally weak. The phenomenal predominance of lifestyle diseases in
the morbidity and mortalitystatistics is indicative of the need for more vigorous
information,education campaign agaisnt lifetyle diseases, through healty life style practices.

Household Access to Safe Drinking Water
The provinced has 100,799 households out of this only 68% had access to
safe dringking water while the 32% do not have access to safe dringking water.
Consequently diarrhea diseases have prevalent occurences in the province
especially at the Flung Barangays with level 1 water source.

19

Household with Sanitary Toilet Facilities
Figure below shows the provinces number of households with and without sanitary toilets
of the 100,799 total HHs of the provinc 65,364 or 65% have sanitary toilet and 35,435 or
35% have no sanitary toilets. Majority of the HHs residing in the rural areas have no sanitary
toilets. Silvino lobos being the rural & hard to reach municipality has the greatest number
74% of the HHs that has no toilet. This situation aggravates the provincesever present
problem or poor environmental sanitation

Fig: Household with and without Sanitary Toilet

68, 68%
32, 32%
Safe Drinking Water
with access68
without access
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Dental Health Programs
There is need to support Dental Health Program. There is a need to augment the 6 Public
health Dentist of the province. Of the 24 municipalities oly 5 have plantella positions for
municipal dentist Support to Dental Health Program is extremely wanting.
A sizeable proportion of the population specially school children have been served
through DOH and Provinces dental program, In 2012 97% pregnant womens provided with
Basic Oral Health care which was given priority the school children with 37% given BOHC
and only 10% are orally fit children 12-71 months

Health Delivery System
65, 65%
35, 35%
Household with and without Sanitary Toilet
With sanitary toilet
Without Sanitary Toilet
21

The Province of Northern Samar adopts the dual health system consisting of a public
sector and a private sector. The former is basically under the supervision of the Provincial
Health Office headed by a Provincial Health Officer who supervices all Health Units (RHU) in
every municipalities. Municipal Health Officer man and operates the RHU with the
assistance of nurses and midwives, They are also assisted by the Barangays Health Workers
(BHW).

Health Facilities
There ar 12 Public and Private Hospitals operating in the province providing for a total of
400 beds, 9 of which are being operated, managed and maintained by the Provincial
Goverment of Northern Samar (PGNS) providing 350 beds while the remaining 3 are private
hospitals operating as infirmaries and one New Hospital the Catarman Doctors Hospital
operating a Secondary Hospital? With a combined total bed capacity of 45 beds of these
Hospitals operated by PgnS only Northern Samar Provincial Hospital and Allen District
Hospital are able to maintain theirprevious Secondary Standards. The remaining seven
District Hospitals of San Vicente, San Antonio, Gamay, Capul, Catubig, Biri, and G.B Tan are
operating as primary. San Antonio, Capul, Biri and San Vicente can be labeled as infirmary
similar to that of a municipal hospital as these hospital are situated in an island.
Deficiencies of the Hospitals are mainly referable to man power, Infrastrusture and
equipments. Full time physicians with permanent status mans the (19) of the 24 rural Health
Units (RHUs) of the province. However of these 24 RHU 5 (RHUs) of San Roque, Mapanas,
22

Biri, Laoang, and Silvino are manned with Doctors to the Barrio physicians (DTTBs) although
all of these have plantilla positions for MHO
Almost all 24 RHUs are 100% upgraded as birthing facilities to develop lying in capabalities
to become Become Basic Emergency Obstetric Neonetal Care (BEmONC) health facilties. Out
of 24 only San Vicente RHU and RHU Silvino are not yet 100% complted, In Catarman the
capital town a new Rural Health Unit way able to cope-up the ever increasing population of
90,549.
Health Personnel
Goverment health personnel both the Provincial and Municipal Govt totaled to 534. All the
24 municipalities have physicians. The municipalities of Laoang with 2 rural health
physicians one is DTTB (doctors to the barrios) and the other is hired by the Local
Goverment. The 24 municipalities had 34 physicians, 150 RHU, 18 midtechnologist,24
medical doctors,.
The Provincial Goverment hired 37 midical doctors, are assigned in the provincial Health
office while the remaining 34 are working in the provincial Hospitals as residents,
consultants and contractual, The others mans the 8 district Hospital. There are 15 dentist 12
Midtechnologist, 11 pharmacist, 178 nurses and 21 Provincial Sanitary Inspectors.

23

UTILIZATION OF HOSPITAL SERVICES

Facility
%
Occupancy
Bed Days
Utilized
Expenditure
Ave. Cost
per
patient/Day
1. Northern
Samar
Provincial
Hospital

126.63%

126.63

11,987,876.00

P772.11
2. Allen
District
Hospital

49.35%

24,67

3,374,370.00

P46.33
3. BIRI
District
Hospital

27.94%

6.98

1,333,845.00

P86.97
4. San
Antonio
District 1
Hospital

10.91%

2.72

1,034,200.00

P75.00
5. Capul
District
Hospital

9.11%

2.27

864,400.00

P79.99
6. San
Vicente
District
Hospital

-

-

-

-

7. GB- TAN
Memorial
District
Hospital

41.98%

20.49

2,626,051.00

I88. Catubig
District
Hospital

44.27%

11.06

P8,232,295.03

P115.38
9. Gamay
District y
Hospital

27.17%

6.79

8,279,681.73

P312.57
24

Profile of Northern Samar Goverment & Private Hospitals
Hospital Types No. of Beds Category Operating as
1.Northern Samar
Provincial Hospital
(NSPH)
G 100 Secondary Secondary
2. Our Lady of Peace
Hospital
P 15 Infirmary Infirmary
3. Leoncio Uy Hospital
P 10 Infirmary Infirmary
4. Catarman Doctors
Hospital
P 25 Secondary secondary
5. BIRI District Hospital
G 25 Primary Primary
6. Allen District
Hospital
G 50 Primary Secondary
7. San Antonio District
Hospital
8. Capul District
Hospital
9. San Vicente District
Hospital
10. GB-TAN Memorial
Hospital G 50 Primary Primary
11. Catubig District
Hospital
12. Gamay District
Hospital

25

Health Financing
Being classified a one of the poorist province the provincial government of Northern Samar
is 92% dependent on its internal province allotment (IRA) and this gratly hinders the
improvemnt of basic services of the province particularly healthcare.
Provincial Expenditures
In 2012 the total budget of the province of Northern Samar was Php 722,095,879. of this
total budget 66.5% where utilized for personal cost. Only 29.8% is allocated for public
health while all the rest are allocated for hospital operations. At the municipal level only 6%
to 19% of municipal budgets are earmarked for public health.
Provincial Expenditure for 2011 and 2012
PGNS Expenditure 2011 2012
PHO Personal services
Mooe
17,656,995.59
1,408,568.59
18,907,476.00
1,965,000
NSPH Personal services
Mooe
37,897,744.74
10,064,481.76
43,019,808.00
11,987,876.00
GB Tan DH Personal services
Mooe
15,108,500.58
1,974,160.10
17,445,150.00
2,626,051.00
Allen DH Personal services
Mooe
17,530,714.87
2,828,160.13
18,963,758.00
3,374,370.00
Biri DH Personal services
Mooe
9,431,634.00
1,180,389.65.00
9,981,219.00
1,333,845..00
Capul DH Personal services
Mooe
7,408,286,00
827,669.16
8,616,644,00
864,400,00
Catubig DH Personal services
Mooe
9,963,401,72
1,588,481,32
11,390,713,00
1,815,000,00
Gamay DH Personal services
Mooe
7,518,991,43
856,738,80,00
8,472,982,00
1,360,740,00
San Antonio DH Personal services
Mooe
9,895,786,03
685,044,06
11,742,867,00
1,034,200.00
San Vicente DH Personal services 4,051,474,08 5,202,,131,00
26

TOTAL
PS and MOOE 158,218,087.55 339,111,902.55

GAPS AND DEFICIENCIES
Deficiencies in terms of physical structure manpower and equipment have decreased due to
Department of Health augmentation in relation to its KP ( Universal Health Care Program ).
The ( HFEP ) Health Facility Enhancement Program for the 24 Rural Health Unit as BemonC
and 9 disctrict hospitals was upgraded in physical structure and equipment still the high cost
ofmaintaining so many Hospitals is stretching resources of the province to the limit and
spreading thinly whatever fund is available.
The presence of local and foreign donors like UNICEF, PLAN philippines and DOH
hasa ensured the implementation of public health program especially maternal and Child
Health Programs. HIV-AIDS and TB However thre is still the used to strengthen and intensify
program operations and management institute strategies to further enhance their
implementation and disease elimination efforts.
Problem are noted i programs not covered by donors or partners particularly
environmental sanitation and Dental Health Program. The Reproductive Health Responsible
Parenthood Program was influenced by our former Governor for his prolife stances at the
provinced level only 61% of households have access to saitary toilets which is much lower in
somemunicipalities. While access to safe drinking water is 68% those are level 1 and level 2
water facilities. Some water facilities are built near toilets and care less than 65m deep.
More efficient monitoring by sanitary inspectors and enforcement of sanitation could have
27

made difference. There is no wonder that outbreaks of diarrhea and typhoid fever occurs
more often in the province.
1. HEALTH FINANCING
A.Financial risk protection
I. Philhealth enrolment and utilization
1. Low PHIC utilization
2. Non sponsorship of 2nd poorest quintile
II.LGU Investment for Health
1.Low revenue-enhancement and resource mobilization schemes to all devolved
Health facilities and Inter-local Health Zones .
2. Low percent of budget allocated to health
3. Low percent of MOOE allocated to health.
2. SERVICE DELIVERY
2.1 DISEASE FREE ZONE INITIATIVE
I. filariasis Elimination
Low percentage of mass treatment coverage of target population in endemic areas.
Non compliance of target recipients to mass treatment.
II.Schistosomiasis Elimination
Low percentage of mass treatment coverage of target population in endemic areas
Poor environmental sanitation.
III. Rabies Elimination Program
Inadequate human anti- rabies vaccine
Poor Implementation on ordinance on responsible pet ownership.
No LGU counterpart in human anti-rabies vaccine.
IV. Leprosy Program
Low detection of leprosy cases.

28

2.2 INTENSIFIED DISEASE PREVENTION AND CONTROL
I. TB Prevention and Control
Low detection rate
Low cure rate
II. HIV /AIDS and STI Prevention and control
Inactive provincial and municipal HIV-AIDS council
Lack of program directed towards education and counseling conducted among
Commercial sex workers (csw)
III. Emerging/Reemerging Infection Control Services
(SARS, MENINGOCOCCEMIA,AVIAN FLU)
Lack of capability to diagnose emerging case.
Inadequate information campaign
No preparedness plan for emerging and reemerging cases.
IV. Dengue Prevention and Control
Poor Environmental sanitation(behavioral practices)
Poor monitoring house index and breautex index
2.3 IMPROVEMENT OF MNCHN OUTCOME
C. Attainment of MDG # 4
I.Child Health Program
1.Low FIC coverage
2.Inadequate vaccines
3. High prevalence of malnutrition
4.Lack of essential IMCI drugs in health facilities
5. Inadequate newborn screening filter cards
6. Low percentage of orally fit children
7.Poor behavioral practices of complimentary feeding program
29

C. attainment of MDG # 5
II.Maternal Health Program
1. low percentage of facility based deliveries
2. Low contraceptive prevalence rate
3. Low percentage of tetanus toxoid immunization coverage and provision of
Iron to mothers.
4. Low deliveries attended by skilled birth attendant
5. Inadequate EmONC, BEmONC, CEmONC drugs and medicines.
2.4 Healthy Lifestyle and Management of Health Risks
I. Control of Degenerative Disease
1.Poor hospital and public health integration in promoting healthy lifestyle.
2. Non functional Health and wellness Clinic and Smoking Cessation Clinic
3. Lack of trained personnel in promoting healthy lifestyle.
II. Oral Health Care
1. Poor advocacy and Health promotion
2. Lack of Dental Equipment
3. Lack of Dentist at RHU
III. Water and Sanitation Program
1.Low access to safe drinking water.
2. Low access to sanitary toilet facilities
3. Poor behavioral practices on environmental sanitation.
4. Weak political will to enforce follow ordinances on solid waste
management.

30

2.5 Surveillance and Epidemic Management System
I. Disease Surveillance
1. No municipal epidemiology surviellance unit and trained staff
2. No proper training in epidemiology surveillance nurses in hospital.
3. Poor reporting of cases of RHU and hospital.
4.Poor coordination during outbreak.
2.6 Disaster Preparednes and Response system
I. Health Emergency Management Service.
1.Poor program implementation at LGU level.
2.Lack of necessary supplies and equipment to respond emergency situation.
3. Poor functioning provincial disaster coordinating council.
4. Poor hospital emergency preparedness plan.
2.7 Health Facilities Development Program
1. 3 remaining RHUs are not Bemonc facilities.
(Allen,Silvino Lobos and Mapanas)
2. NSPH remained level 1
3. District hospitals downgraded as infirmary.
4. No PHO/PHTO building and training center.
5. Lack of infrastructure and equipment in Barangay Health Station (BHS)
6. Lack of hospital medical and dental equipment.
7. No sputum TB DOTS facilities.
8. No NTP Office
9. No External Quality Assurance Center.
10. No malnutrition ward in NSPH and district hospitals.
11. No HEMS OPCEN
12. Lack of Health and Nutrition Posts
31

13. No NSPH Bloodbank
REGULATION
1. Poor hospital drug management
2. Low Philhealth accreditation TB-DOTS ( 10 out 24)
3. Some health ordinances are not implemented.
GOVERNANCE
1. Non functional Inter Local Health Zones (ILHZs)
2. Non- fully functional hospital therapeutic committe
3. Not- fully functional Referral system
4. No Inter Zonal Blood Council
5. Non functional Local Health Board
HEALTH HUMAN RESOURCE
1. Lack of physician for RHUs with high population
2. Lack of PHN for RHUs with high population
3. Lack of medical technologist in RHU for TB DOTS
4. Lack of dentist in RHUs
5. No plantilla position for data encoder in RHUs
6. No health statistician in provincial level
7. Lack of physician in district hospitals.
Health Information System
1. Few RHUs with intrnet connection to support EFHSIS report.
2. No IT equipment in BHS
3. No IT training for BHS personnel 4. Late FHSIS reporting

32

VISION:
A Healthy Norte Samarenos by the year 2016 and beyond

MISSION:
To provide guaranteed, accesible, sustainable and quality health services, for all,
especially the indigents, with fully supportive LCEs in partnership with othr agencies, run by
competent and compassionate health workers through acquired technologies to an empowered
community.

GOAL:
To provide access to sustainable, quality and affordable health care services
giving priority to the marginalized and vulnerable sectors of society.

Stratgic Thrusts/ Instruments
1.Health financing
A. Increase in PhilHealth Enrolment and utilization
I. Increase in PhilHealth Enrolment and Utilization
1. Maintain 100% Universal Philhealth coverage
2. Intensify health promotion on PHIC benefits and processes to increase utilization
3. Facilitate annual renewal of enrollees
II. Increase in LGU Investment for Health
1. Increase percent of budget allocated to health
33

2. Increase percent of MOOE to total health budget.
3. Strengthen hospital drug management .
4. Enhanace water analysis laboratory from bactriological to physical and chemical analysis for
revenue generation.
5. Strengthen of Revolving Fund Management.

Service Delivery
I. Filariasis Elimination
Objective:
1. Increase Mass Drug Administration (MDA) coverage from 58% to 85% by the end of 2016
2. Reduce micro filarial rate from 3.2 % to less than 1% by 2016
Key Interventions:
1. Conduct mass treatment
2. Provision of DEC tablets
3. Provision of adverse reaction drugs
4. Provision of disability kits
5. Boarder Operations
Support Interventions:
1. Disability management training
2. Training on NBE and ICT

II. Schistosomiasis Elimination
Objective: Increase mass treatment coverage from 49% to 85% by the end of 2016
Key Interventions:
34

1. Conduct mass treatment to endemic municipalities
2. Provision of PRAZIQUANTEL tablets
3. Provision of side reaction drugs
4. Provision of Schisto kits
1. Production of IEF materials
2. Establishment referral system/ linkages to private health facilities
3. Networking with partner agencies and NGOs
4. Training on Shisto case management
5. Training on malacological survey
6. Refresher course on quality control for micropist

III. Rabies Elimination Program
Objectives:
1 .zero human rabies case to all animal bite victims
2. Post- exposure Prophylaxis to all animal bite victims
Key Interventions:
1. Provision of post-exposure prophylaxis
2. Provision of rabies vaccines
3. Advocacy for responsible pet ownership.
1. training on animal bite management
2. Conduct program implementation review
3. Rabies awareness month and worl rabies day celeration

35

DISEASE FREE ZONE INITIATIVE
IV. Leprosy program
Objective: Decrease prevalence rate to less than 2% per 20,000 population by 2016
Key Interventions:
1. Leprosy case finding
2. Leprosy case management
3. Provision of drugs and medicines
Support Intervention:
1. Monitoring
2. Recording and reporting
3. Leprosy awareness activity
4. Capability building on leprosy case

I. TB Prevention and Control
Objectives: 1. Increase detection rate from 65% to 85% by the end of 2016
2. Increase cure rate from 59% to 90% by the end of 2016
Key Intervention:
1. Case detection
2. Case holding
3. Provision of anti- TB drugs
4. Oranize Kusgod baga/ treatment partner task force at Barangay level
1. Monitoring, supervision and evaluation
2. Lung month and world TB day celebration
3. Training on programmatic management of drugs resistance Tuberculosis
36

4. RSS training for midwives and BHW
C. Attainment of MDG#6
II. HIV/AIDS Prevention and Control
Objectives: To reduce HIV/ AIDS by 5% from 6,198/ 100,000 pop. to 5,888/100,000 by the end of
2016
Key Interventions:
1. Strengtheningof HIV/AIDS council
2. Orientation and Advacacy on HIV/ AIDS
3. Case management
4. Conduct social hygience clinic
1. Capability building
2. Provision of Drugs

III. Emerging/Reemerging Infection Control Services
(SARS, MENINGOCOCCEMIA,AVIAN FLU)
Objectives: Increase case detection, improve contact tracing,implement quarantine policies for all
cases of emerging an reemerging infections.
Key Interventions:
1. Formulation of emerging and reemerging disease preparedness plan.
2. Identification of isolation ward in the hospital
3. Contact tracing of suspected cases
4.Treatment service
1. Conduct information dissemination and distribution of IEC materials for immediate public
information

37

IV. Dengue Prevention and Control
Objective: Reduce Dengue case fatality from .08% to .05% by 2016
Key Intervention:
1. Environmental sanitation and vector control
2. Triaging of cases
3. Reactivation of BHERT (Barangay Health Emergency and Response Team)
4. Advocacy
1. Procurement of laboratory supplies and reagents
2. Dengue awareness month and dengue ASEAN day celebration
3. Strengthen referral system to other health facilities for further treatment if necessary and
adequate supply of blood platelets.
4. Training on Integrated vector borne disease management
5. Capability building on epidemiology surveillance
6. Provision of surveilance communication equipment
A. Child Health Program
Objectives:
1. Increase FIC coverage from 47% to 95% by 2016
2. Reduce under-five mortality from 9.5/1,000 lb to 5/1,000 lb by 2016
3. Reduce infant mortality rate from 9.3/1,000 lb to 7/1,000 lb by 2016
4. Reduce prevalence rate of malnutrition from 16% to 10% by 2016
5. Reduce Neonatal mortality rate from 9.4% to 6% by 2016
Key Interventions:
1. Expanded program on immunization
38

2. Establishment of breastfeeding room
3. Setting-up of breastfeeding support group
4. IMCI
5. IYCF
6. Essential Intrapartum and newborn Care
7. Complimentary feeding

C. Attainment of MDG #4
A. Child Health Program
1. Vitamin A and Iron supplementation
2. Operation Timbang and follow-up weighing
3. Conduct deworming activities
4. Procurement of Newborn screening kits
5. Procurement of EINC drugs
6. Procurement of Under-five drugs.

A. 1. Nutrition Services
Objective: Reduce prevalence rate of malnutrition from 16% to 10% by the end of 2016
Key Interventions:
1. Supplementary feeding
2. Garantisadong Pambata
3. Micronutrient supplementation
4. Operation Timbang
39

5. Pabasa ng Barangay
6. Follow-up OPT for malnourished children
7. Linkages to other agencies
1. Provision of supplies for health Nutrition Posts
2. Construction of malnutrition ward
3. Creation/Establishment of Health Nutrition Posts

A.2. Expanded Program on Immunization.
Objective: To increase percentage of fully immunized children from 47% to 95% by the end of
2016
Key Interventions:
1. Outreach activities
2. Continued EPI/Reb activities activities
3. EPI/REB monitoring child survival program
5. Organization of community health teams
1. Rehabilization and maintenance of cold chain facilities
2. Provision of generators

A.3. Integrated Management of Childhood Illnessess
Objective: To reduce under-five mortality from 9.5/1,000 LB to 5/1,000 LB by the end of 2016
40

Key Interventions:
1. Under-five Death Review
2. Newborn Screening
3. Immunization
4. Breastfeeding and complimentary feeding
5. Micronutrient supplementation and deworming
2. Provision of Essetial Newborn care package
3. Support drugs and medicines

A.4. Breatfeeding Program
Objective: to sustain/increase the 90% rate of infats exclusively breastfeed up to 6 onths to 95% by
2016
Key Interventions:
1. Quarterly monitoring of MBFHI sustainability
2. Advocacy and promotion
3. Lactation management training BEmONC and CEmONC level

B. Maternal Health Program
Objectives:
1. Reduce maternal mortality ratio from 304/100,000 to 52/100,000 by 2016
2. Increase facility based delivery from 41% to 90% by 2016
41

3. Increase skilled health professional from 62% to 90% by 2016
4. Increase antenatal care from 69% to 80% by 2016
5. Increase contraceptive prevalence rate from 11.36% to 60% by 2016

Key Intervention
1. Creation/Integration of mnchn/fp/ahp in hospitals and RHUS
2. Strengthening of Mother baby friendly hospital initiative
3. Institutionalization of MNDR
4. Program Implementation Review
5. Establishment of AYHR friendly clinic in hospitals and RHUs
6. Strengthening IECM
7. Retooling of CHT-KP
8. Strengthening of referral system
9. Continueing quality improvement system
10. Establishment of halfway house

C.Attainment of MDG#5
1.Capability building
2. Procurement of Mother and Child book
3. Advocacy meeting among identified Service Delivery Network (SDN) private and public

42

B.1. Contraceptive Self Reliance
Objective: To increase Contraceptive prevalence rate from 10.44% to 65% by the end of 2016

Key Interventions:
1. Conduct pre-marriage counselling
2. conduct Parents supplies and medicines for reproductive health
4. Provision of contraceptive commodities
5. Capacity building

C. Attaiment of MDG#5
B.2. BEMONC/ CEMONC Facilities
Objectives: To increase facility Based Deliveries from 44% to 90% by the end of 2016
Key Interventions:
1. Upgrading of RHUs/Birthing facility (BEmONC) (Silvino Lobos,Allen,Mapanas)
2. Construction of Barangay Health Stations
3. Equipping health facilities (RHUs and BHS)
1 Policy formulation on facility based delivery
2. Enhance referral system to include transportation and communication and voluntary blood
donation.
3. Ogranization of community support group
4. Deployment of CHT for pregrancy tracking

43

2.4 HEALTHY LIFESTYLE AND MANAGEMENT OF HEALTH RISK
1. Control of Degenerative Disease
Objective : To intensify advocacy campaign for healthy lifestyle
Key Interventions:
1. Integration of hospitals and public health in promoting healthy lifestyle
2. Activate Health and Wellness Clinic in all hospitals and RHUs.
3. Avtivate Smoking Cessation Clinic in District hospitals and RHUs
4. Ogranization of HL coordinators at the hospital and RHU level
5. Provision of physical fitness equipment in recreation area/park
6. Provision of supplies and equipment
7. Advocacy and health promotion on health lifestyle
8. Drugs for control of degenerative diseases

II. Oral Health Care
Objective:
1. Reduction of dental caries from 56% to 85% by 2016
2. Reduction of periodontal disease from 40% to 60% by 2016
Key Intervention:
1. Institutionalization of Orally fit children campaign
2. Health promotion and advocacy
1. Provision of dental equipment and supplies

44

III.Water and Sanitation Program
Objective:
1. To increase number of Household with access to safe drinking water from 68% to 95% by 2016
Key Intervention:
1. Construcking of Level II water sources
2. Inspection of all water system
3. Water sampling and disinfection

1. Refresher course for sanitation inspectors on water sampling and disinfection
2. Provision of motorcycle to sanitation inspectors for program monitoring
3. Operationalization of water analysis laboratory
4. Upgrading of water analysis laboratory from bacteriological analysis to physical and chemical
analysis
5. Promotion of household water chlorination
6. Inspection/ monitoring of water refilling stations as to compliance of DOH requirements.

Objective:
45

1. To increase number of Household with sanitary toilet facilities from 61% to 95% by 2016
Key Interventions:
1. Inspection public toilet facilities
2. Campaign and provision of technical assistance proper construction of toilet

1. refresher course for sanitation inspectors in sanitary toilet construction
2. Strengthen Zero Open Defecation campaign
3. Search for Barangay with best sanitation practices
4. Enforcement of Sanitation Code of the phils.

IV. National Voluntary Blood Services Program
Objective:
1. To increase voluntary blood donors from 45% to 85% by 2016
2. To prevent the transmission of blood transmissible diseases (HIV, Hepa B, Hepa C,Syphillis and
Malaria)
Key Interventions:
1. Mass blood donation activity
2. Ogranization of Inter- local council
3. Advocacy and health promotion on blood donation
4. Establishment of Licensed Blood bank
1. Provision of blood screening kits and laboratory supplies and equipment
2. Provision of donors incentives and awards.
3. Construction of blood bank building.

46

2.5 SURVEILLANCE AND EPIDEMIC MANAGEMENT SYSTEM
I. Disease Surveillance
Object: Reduce morbidity and mortality through an institutionalized functional integrated disease
surveillance system
Key Interventions:
1. Improved communicating facilities in all RHUs and hospitals
2. Updated reporting of notifiable disease in all health facilities
3. Improve referral system in all health facilities
4. Establishment of PESU and MESU.
1. Training on basic Epidemiology
2. Management training on prevention and control of emerging and reemerging diseases
3. Outbreak management
4. Purchase of laboratory reagents

2.6 DISASTER PREPAREDNESS AND RESPONSE SYSTEM
1. Health Emergency Management System
Objective: Reduce morbidity and mortality during emergency and disaster
Key Interventions:
1. Reactivation of HEMS Cluster
2. Institutionalization of HEMS
3. Provision of supplies and equip ment to respond emergency situation.
4. Capability building to health personnel to respond emergency situation.
5. Establishment of OPCEN

47

2.7 HEALTH FACILItiES AND DEVELOPMENT PROGRAM
B. Improved acces to quality hospitals and health care facilities
I. Rationalization of Local Health Facilities
1. Upgrading of District hospitals from infirmary to level 1
2. Construction of new NSPH with blood bank building
3. Upgrading of 3 remaining RHUs to Bemonc facility (allen, Silvino Lobos and Mapanas)
4. Construction and equipping BHS
5. Upgrading of hospital medical and dental equipment
6. Construction of PHO/PHTO building and training center with HEMS OPCEN
7 Construction of NTP warehouse
8. Provision of malnutrition ward in all hospitals

HEALTH REGULATION
KEY INTERVENTIONS:
1. Sustain Philhealth in PCB, MCP and increase TB-DOTS accreditation.
2. Institutionalize revenue-enhancement and resource mobilization schemes to all devolved health
facilities and Inter-Local Health Zones
3. Implementation/Enforceent of national health laws and health regulatory policies and compliance
4. Implementation of facility based standards as required by DOH and philhealth.
5. Enforcement of national laws to provencial and municipal level
6. Enforcement of national laws to provincial and municipal level
7. Creation of local health regulatory policy for implementtion at the ILHZs Bids and Awards
Committee (BAC) and referral system

48

GOVERNANCE
OBJECTIVE:
1. Improve health system at ptovincial Inter-local Health Zones,municipal and GIDA sites.
Key Interventions:
1. Revitalization of governance structures for local health board at provincial and local level
2. Enhance inter LGU cooperation through ILHZ.
3. Strengthen referral system to include private sectors
4. Institutionalize integrated planning (PIPH, AOPs/ AIPs) health information system,monitoring and
evaluation.
5. Enhancement health financing in the province
6. Enhance Public-Private Partnership (PPP)
1. Ensure allocation of LGUs for ILHZ CHTF
2. Strengthen reporting system
3. Health facility enhancement to facilities referral system
4. Policy formulation for income retention for health facilities
5. Development of Provincial and Municipal Inter Local Drug procurement and management system.

HEALTH INFORMATION SYSTEM
OBJECTIVES: Ensure, Accurate,reliable and timely information for both public health programs and
clinical services are availanbe to constituents and decision makers
Key Interventions:
1. Hospital information system
2. Electronic Field Health Service Information System Training to RHUs Data Encoder
3. Clinic Information system training to RHU and BHS Data Encoder
4. Procurement of computer/Laptop for provincial Health Program Coordinators for database
5. Computer set to all BHS
49

6. Internet connection in RHUs/BHS
HEALTH HUMAN RESOURCE
OBJECTIVE: Strengthening the local health human resource management system in the
provinceq\
Key Interventions:
1. Additional physician for RHUs with high population
2. Additional PHN for RHUs with high population
3. Hiring of Medical technologist in RHU for TB Dots accreditation
4. Hiring of Dentist in RHU
5. Designate surveillance nursees in district hospitals
6. Plantilla position for data encoder in RHUs
7. Plantilla position for health statistician in provincial level
8. Additional Medical technologist in blood bank
9. Additional physician in district hospitals

50

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