Maternal and Child Health Handbook and the Indigenous Mothers and Children in the Philippines:

Transcription

1 Maternal and Child Health Handbook and the Indigenous Mothers and Children in the Philippines: The Case of Tagbanua Mothers and Children of Coron Island, Palawan Calvin de los Reyes, PhD College of Arts and Sciences University of the Philippines - Visayas (c.delosreyes.phd@gmail.com)

2 MCH Handbook One effective public health measure used to aid in meeting the continuum of care approach is the Maternal and Child Health (MCH) Handbook. It is defined as a book that contains essential information, kept by the family, to promote and maintain the health of mothers and children (International Committee on MCH Handbook, 2009). It functions as a health education material which contributes to the mother s knowledge and as a comprehensive health record book which integrates health records.

3 MCH Handbook and Primary Health Care Address MCH problems by providing promotive, preventive, curative and rehabilitative services for mothers in the communities Participation of people individually and collectively in the planning, implementation and evaluation of their health care Health in the hands of the people

4 MCH Handbook in the Philippines Booklet ni Nanay at Baby The MCH Handbook is nationally initiated and decentralized to the local government units. Design was by the central office of the Department of Health, with reprinting as a responsibility of the local government unit. The handbook is useful from pregnancy until the child reaches the age of five. 63-pages, mostly in black and white. Currently being updated by the Department of Health

5 Challenges of MCH Handbook Program Availability of MCH Programs Slow expansion (2013) Sustainability of reproduction, limited copies Fragmented local health system Exodus of health professionals Lack of research Language barrier (Filipino, English) Technical terminologies and usage HOW ABOUT THE INDIGENOUS POPULATIONS???

6 Indigenous Peoples in the Philippines Known as cultural minorities, or tribal Filipinos, lumped in the generic term indigenous cultural communities or the more politically correct term indigenous people of the Philippines. Refer to a group of people or homogenous societies, who have continuously lived as organized community on communally bounded and defined territory, under claims of ownership since time immemorial; occupied, possessed and utilized such territories, sharing common bonds of language, customs, traditions and other distinctive cultural traits.

7 Indigenous Peoples in the Philippines ETHNOGRAPHIC REGIONS CAR and Region I Region II Region III and Rest of Luzon Island Group Southern and Eastern Mindanao Central Mindanao Northern and Western Mindanao 7.7 M HAS. (25.84%) 110 ETHNOLINGUISTIC GROUPS 14,184,645 IP POPULATION (16%) (Source: National Commission on Indigenous Peoples Philippines)

8 Issues on IP Health Geographic loca-on Socio- economic status Inadequate services Tradi-onal beliefs POOR IP MCH Inaccessibility to health care (access) Many IP families can not afford the high costs of health care services including hospitalization, medicines and consultations No disaggregated data about IPs in terms of relevant indicators, and dearth of data and information on indigenous health knowledge and practices and traditional medicine Lack of IP-specific health interventions Appreciation of the holistic nature of indigenous knowledge on health is often compartmentalized or lacking There is an assumed high incidence of preventable and communicable diseases as well as malnutrition and infant mortality in indigenous communities

9 Tagbanua of Coron Island, Palawan TAGA meaning people from and BANUA meaning countryside. Most widely distributed IP in Palawan province. They live in small groups, with livelihood as fishing.

10 Tagbanua of Coron Island, Palawan Coron Island in Palawan is the habitat of the Tagbanua Indigenous Group

11 Baseline Tagbanua mothers at HIGH RISK before introduction: Pregnancy There is also one mother who experienced pregnancy 11 times. Twenty-seven (54%) have been pregnant four times or more. The mean number of experienced pregnancy for all the mothers surveyed is 4 (±2.21). Abortion/Stillbirths Seven mothers or 14% have at least one abortion. Nine mothers who experienced stillbirths, 7 or 14% experienced it once, while 2 or 4% have experienced it twice. Offsprings Sixteen (32%) surveyed have more than four children. The mean number of living children for all the mothers surveyed is 3.28 (±2.12). None of the Tagbanua children completed the prescribed immunization schedule!

12 MCH Handbook and IP Mothers and Children Sustainable indigenous-specific health interventions? Effect of the MCH Handbook on the Knowledge and Behavior of Tagbanua mothers in Coron Island, Palawan, Philippines: Five Years After To determine the effect of utilizing MCH handbook on the knowledge and behavior on MCH of Tagbanua mothers in Coron Island, Palawan five years after the introduction of the handbook (2008 to 2013)

13 Development of the MCH Handbook Development of the MCH Handbook: A one-day workshop was conducted among: (1) municipal health officer, (2) local midwives, (2) barangay/community health workers, (2) Tagbanua mothers, and (2) NGO-representatives. This was conducted to discuss the current status of MCH, existing health recording system/health education tools and the development of the Tagbanua MCH handbook. Constant community consultation (among Tagbanua mothers and local midwives) in developing the contents.

14 Development of the MCH Handbook Contents of the Tagbanua MCH Handbook: The members of the core group developed and finalized the contents of the Tagbanua MCH handbook. Antenatal Care Card Immunization Card Growth Card Existing Health Information Materials Additional Information 34-paged in black and white

15 Gabay ng Ina at Sanggol, 2007 Basic information on Maternal and Child Care

16 Gabay ng Ina at Sanggol, 2007

17 Gabay ng Ina at Sanggol, 2007 Additional information on diarrheal diseases, tuberculosis, malaria and filariasis.

18 Distribution of the MCH Handbook MCH Handbook Program: The Tagbanua MCH handbook was distributed among mothers during a mothers class.

19 Phase II: Distribution of the MCH Handbook MCH Handbook Program: The Tagbanua MCH handbook was distributed among mothers during a EPI program in the island.

20 Assessment of the MCH Handbook (5 years after) Interview Survey: 2008 (at baseline) Tagbanua mothers of reproductive age, who are pregnant and or with children ages 5 and below (n=50) 2013 (five years after) Tagbanua mothers of reproductive age, who are pregnant and or with children ages 5 and below (n=67).

21 Knowledge First prenatal consultation should be done during the first trimester of pregnancy Pregnant woman should consult a healthcare provider more than three times during the duration of her pregnancy Changes on Knowledge on Maternal Health Baseline 2008 (n=50) Postevaluation 2013 (n=67) p-value No. % No. % < < Risk factors during pregnancy Pregnant woman needs tetanus toxoid immunizations Additional iron sources are needed during < pregnancy Mothers should consume more food during her pregnancy Appropriate birth attendants are the health < personnel Knowledge on post-natal care

22 Phase III: Assessment of the MCH Handbook (5 years after) Baseline and Follow-up Changes on Knowledge on Child Health (n=50) Knowledge Baseline 2008 (n=50) Postevaluation 2013 (n=67) p-value No. % No. % Mothers know that exclusive breastfeeding < should be 6 months Importance of the regular monthly weighing of < the youngest child Importance of vaccines Importance of Vitamin A supplementation <0.0001

23 Phase III: Assessment of the MCH Handbook (5 years after) Changes on Behavior on Maternal and Child Care Practice Baseline 2008 (n=50) Postevaluation 2013 (n=67) p-value No. % No. % Had prenatal consultation during her last pregnancy Mothers had their first prenatal consultation during the first trimester Mothers had at least two TT immunizations Health personnel were the birth attendant Mother uses a family planning method Mothers exclusively breastfed for 6 months < Complete vaccines were given < Monthly weighing of the child <0.0001

24 MCH Handbook and IP Mothers and Children Applying the Tagbanua MCH Handbook Experience The MCH Handbook development presented the significance of indigenous people s participation in creating a public health measure. In planning, designing or developing of any health interventions directed among indigenous communities, it is of great value to maintain community participation. In assessing the influence on the Tagbanua mothers maternal and child health knowledge after the introduction of the handbook the results showed significantly improved knowledge of mothers from baseline to follow-up Improving health among IP will mean mainstreaming their rights into the local policies, as well as devising some specially-adapted programs to overcome the numerous barriers they face. Ensure that health services are extended to the more remote geographical areas and are culturally sensitive.

25 IP Mothers and Children s Health BETTER IP MCH 1. Adap-ng to the needs of the IP 2. Valuing IP rights 3. Accessible healthcare

26 Typhoon Haiyan/ Yolanda

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28 Tagbanua boy and his own MCH Handbook after Yolanda All households were victims of Typhoon Yolanda. 2/3 of Tagbanua mothers kept their MCH Handbook with them. Disaster preparedness and response the MCH Handbook Program.

29 Maraming salamat po!

30 Tagbanua mother and her own recording plank A Tagbanua mother showing her own recording system of her children s birthdays (2006)

31 Tagbanua mother and her own recording plank An irregularly shaped plank served as a recording system of a Tagbanua mother s children s birthdays (April 2007)

32 Tagbanua mother and her own recording plank An irregularly shaped plank and a part of the wall served as a recording system of a Tagbanua mother s children s birthdays (April 2007)

33 Tagbanua mother and her own recording plank A Tagbanua mother showing her OWN recording system, the MCH Handbook (September 2007)