Results of the mid-term evaluation of the Family Planning Program in the Philippines done in February 1993 pointed to the need for a more thorough analysis of the consumption of the family planning supplies and equipment, and the mechanisms for their distribution from the national to the barangay levels.
This operations research sought to clarify the issues recognized in the mid-term evaluation as well as determine immediate concerns of the family planning program in terms of consumption rate of supply and equipment, mechanisms for distribution, and problems in distribution and procurement.
The study that SDRC undertook for HAMIS focused on the awardees' organizational set-up and management of health care delivery systems, community involvement, factors that contribute to the sustainability of the project, project's experiences with the HAMIS contest, and its utilization and management of the HAMIS award money. It utilized the case study method which used two data-gathering techniques: Review of existing project documents, and key informant interview.
The 10 HAMIS awardees who were the subjects of this study were selected on the basis of three main categories: a) community-based health projects managed by non-government organizations to serve the urban poor; b) projects advocating herbal cure as an alternative strategy; and c) innovative special health concern. The subjects were composed of four silver awardees, four bronze awardees, and two recognition awardees.
Results:
Among the findings of the study are:
a)Two factors perceived to be contributory to the projects' sustainability were the people's support for the project and the dedication and commitment of the project staff, community leaders and supporters. Both factors were also regarded as the strengths of the projects.
b)The major problem encountered by the projects was insufficient funding for activities which resulted in shortage of medical supplies and manpower. To address the problem, the projects solicited or raised funds, or initiated self-help projects among their beneficiaries.
c)Funding for the projects' activities came from multiple sources: External subsidies or grants; and activities initiated by project such as food sale, raffle draw and popularity contests.
d)Major forms of health intervention conducted by the projects can be classified into five types: 1) provision of medical services (consultations, child immunizations, prenatal and postnatal care, referrals and emergency assistance) and medicines; 2) nutrition rehabilitation (child feeding programs, cooking demonstration classes for mothers); 3) health information and education; 4) promotion and production of herbal medication; and 5) tuberculosis control.
e)In terms of management, the organizational set-up of the projects followed the traditional mode with decision-making made largely by top management and executed by the staff and volunteers; planning was done whenever necessary and a system of monitoring and evaluating of project activities was evident.
f)The award money was used to finance project activities.
g)The beneficiaries were involved as participants in fund-raising projects and as donors of voluntary contributions and services. In some projects, the beneficiaries assisted the staff in coordinating and manning small center projects, disseminating health information, and training or educating mothers on health-related matters.
The HAMIS project awardees used a blend of health and non-health related programs and services for improving their clienteles' health welfare. Some innovative concepts of health care service delivery were: Balik-lusog, Ating Botika through Paluwagan sa Botika, and the Community Health Care program, the emerging medical system, and the health education broadcasting. It was also found that the awardees chose projects which addressed the needs of their poor clients, used volunteerism to augment limited resources, and generated program funds from a multiplicity of sources. Provision of livelihood sources was also a popular undertaking of the projects. This included capital lending through loans of credit, skills training and development, income-generating projects, swine dispersal and job placement.
The HAMIS awardees suggested that the contest be continued. They also proposed that only competent evaluators be allowed to screen the contestants, and that content criteria and mechanics be clearly stated.
Findings from the case studies suggest the following implications concerning health care management: a) the development of economic programs as an integral component of health programs among the poor; b) the need for involvement, training and motivation of a greater number of community health workers in delivering primary health care services to broaden area coverage; c) the necessity of undertaking and strengthening community organizing efforts geared toward the formation not only of various economic but also health cooperatives; and d) the allocation of resources for subsidizing more preventive services including family planning.
