MUNICIPALITY OF BUENAVISTA

Bohol, Philippines

Situational Analysis and SWOT Analysis Stakeholder Analysis with Strategic Plan Case Study with Preventive Action Plan

by: DUAVIS, MARK JOHNUEL DIACOR, ARTECHIE MEMBREVE, JEFFREY HUSAIN, FRETZEL

December 2012

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MUNICIPALITY OF BUENAVISTA
Bohol, Philippines
I. SITUATIONAL ANALYSIS A. INTRODUCTION In the early days, a group of natives inhabited a coastal plain adjacent to a beautifully carved limestone cliff stretching a hundred meters long and standing like a stage overlooking the glistening sea. Natives identified their place of abode as PANGPANG, the Boholano translation for CLIFF. Spanish Roman Catholic missionaries evangelizing northwestern Bohol dropped anchor at Pangpang. The good priest standing on top floor of the cliff made a panoramic reconnaissance and saw at the horizon the silhouette of Sugbu (Cebu) Island. He envisioned the Magellan Cross at the center part of Sugbu (Cebu) Island. Facing back on the plain land, his eyes were arrested by the glory of naturethe vast stretch of cogon rippling in the sea breeze, the few jutting coconut grooves that pierced the blue sky, the yellowish limestone cliffs that majestically rose upward above the irregular shoreline, the glistening sand, the foaming blue-waters and the purple mountains of Cebu in the distant horizon. Impressed by Pangpangs natural beauty, he named the place BUENA VISTA, the Spanish phrase for Good View.

Aerial view of the Municipality of Buenavista In the early 1930s, two big barrios Buenavista Norte and Buenavista Sur occupy the southern extremity of the town Getafe. Politically, these two big barrios served as a barometer during elections for the municipality of Getafe, the mother town of Buenavista. There came a handful of people with burning desire to see the township of Buenavista. In 1960, President Carlos P. Garcia, through Executive Order No. 362, proclaimed Buenavista a municipality. Today, Buenavista holds true to its name as its environmental conditions are not only kept in good view but also developed and preserved to its full splendor.

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B. GEOGRAPHIC DESCRIPTION

Geographic Location and Topographic View of Buenavista The Municipality of Buenavista is located in the northern portion of Bohol province, approximately 83 kilometers away from Tagbilaran City. It is politically subdivided into 35 barangays, two of which are island-barangays, 9 are coastal barangays and 24 are upland barangays.

Anonang Asinan Bago Baluarte Bantuan Bato Bonotbonot Bugaong Cambuhat Cambus-oc Cangawa Cantomugcad

Cantores Cantuba Catigbian Cawag Cruz Dait Eastern Cabul-an Hunan Lapacan Norte Lapacan Sur Lubang Lusong (Plateau)

Magkaya Merryland Nueva Granada Nueva Montana Overland Panghagban Poblacion Puting Bato Rufo Hill Sweetland Western Cabul-an

The coastal barangays facing the Bohol Strait mostly consists of limestone cliffs, sandy beaches, muddy swamps and thickly-forested mangrove areas. The heavy bulk of the municipality comprising the upland barangays are mostly composed of mountainous forests and steep grassy hills that roll continually to neighboring municipalities. The municipality is bordered by the Municipality of Getafe in the north, Municipality of Inabanga in the south, Municipality of Danao in the SouthEast, the Municipality of Talibon in the Northeast and the Bohol Strait in the West. Executive Order

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No.455 defines the territorial jurisdiction of Buenavista fixing the boundary at Km.78 from Tagbilaran City to Malinao Creek, Getafe. The 9,360.88-hectare town has an agricultural area of 4,880.91 hectares, forest area of 4,018. 52 hectares, tourism area of 10.29 hectares, industrial area of 231.44 hectares and a build-up area of 487.84 hectares. C. DEMOGRAPHY In the latest census conducted by the National Statistics Office in 2007, the municipality has reached an actual population of 26,443. In 2012, the municipality has an estimated population of 32,233 growing at an annual rate of 2.64% as projected by NSO in 2000-20072. It has a total household number of 5370. The average household size is at 4.8 persons. The population density of the municipality is entried at 2.63 persons per square hectare. The big bulk of the population consists of young people within the working age. Across age brackets, there are generally more males than females in Buenavista although from ages 56-110 the ratio is inversed as there are more females than males. This signifies that women in Buenavista live longer than their men counterpart as evidenced by a life expectancy rate of 46.67 for females and 39.7 for males. On average, the life expectancy rate of the population falls on the age of 43.19. The majority of the population are concentrated in the coastal areas (Cangawa, Dait Norte, Cambuhat, Eastern and Western Cabul-an). A dense bulk of population also lives in areas where complete educational systems are established (Panghagban, Lubang, Cangawa and Cabul-an). The barangay with the biggest projected population as of 2012 is the island barangay of Eastern Cabul-an with a population of 2354 followed by another island barangay Western Cabul-an with an estimated population of 1947. The people are predominantly Roman Catholic which comprised 90-95 percent of its total population. Their faith revolves mainly around their church which is advocated to the Holy Rosary. The people celebrate its feast day on October 7 with much devotion. The feast day involves the 9-day Novena Masses and other activities which brings this town to life. D. POLITICAL DESCRIPTION The municipality of Buenavista is a fourth class municipality consisting of 35 political barangays. Hon. Mayor Ronal Lowell Tirol is the executive head of the town with Hon. Joseph Randi Torregosa as vice Mayor. Other local officials and department heads are specified below. Municipal Mayor : Hon. Ronald Lowell G. Tirol Municipal Vice Mayor : Hon. Joseph Randi C. Torregosa Sangguniang Bayan Members: 1. Hon. Jonel P. Torregosa 2. Hon. Joselito G. Mero 4|Page

3. Hon. Federico S. Pacaldo 4. Hon. Venerando G. Sotto 5. Hon. Elvira U. Celocia 6. Hon. Jourdel Mario P. Aabieza 7. Hon. Artemio C. Lopez 8. Hon. Benigno Tibon Jr. 9. Hon. Jovanni P. Gucor Mrs. Maria T. Duco, SB Secretary Mr. Apolonio Aparece, Municipal Administrator Mr. Efren Logroo, MPDC Engr. Modesta Mero, Municipal Engineer Mrs. Evangeline Suarez, Municipal Budget Officer Mr. Elmer G. Mero, Municipal Treasurer Mrs. Avelina Hagutin, Municipal Assessor Mrs. Genara B. Lerion, Municipal Accountant Mr. Editha Hubac., Local Civil Registrar Mr. Lino Divinagracia, Municipal Agriculturist Mrs. Edna Toribio, MSWD Mrs. Aileen Mahusay, PHN- OIC Rural Health Unit Mrs. Glenda Laude, DILG Dr. Lorna Torregosa, PhD, Dep ED District Supervisor For years, the political leaders of the municipality have showed recognizable support for health as evidenced by the integration of timely Health Plans in the formulated Executive-Legislative Agenda for 2010-2013. These include the provisions of: free Philhealth Membership for indigent families in the municipality amounting to 200,000 per year establishment of Birthing Centers in the island Cabul-an and Poblacion purchase, sustenance and augmentation of sufficient health supplies, medicines and equipments organization and strengthening of Health task force provision of security of tenure to trained BHWs and BNSs allocation of portions of calamity fund for health services provision of health education and inspection to households without sanitary toilet, and provision of supplemental feeding to malnourished children to pilot barangay(3 months/year) . The LGU has also coordinated with various government agencies in accomplishing health endeavors. It has currently tapped the Department of Health for a P800,000assistance in the completion of the newly constructed Birthing Center. This year, the municipality has also been endowed with a P4.5 million budget for the planned construction of a new Rural Health Unit. Other than that, the municipality was also able to establish seven new barangay health stations with the help of the Dept.of Social Welfare and Development and KALAHI-CIDSS. The LGU has also reinforced the Rural Health Units efforts in its application for Philhealth accreditation. This will enable all PhilHealth members of the municipality to avail of PhilHealth benefits. This will also create additional revenue for the LGU in its effort to shoulder the growing health needs of the population. 5|Page

1. 2. 3. 4. 5. 6. 7. 8.

Recently, the Sangguniang Bayan of the municipality has passed the new Birthing center Ordinance that legitimizes the establishment of a 24/7 Birthing Center and delineates its operational guidelines. The LGU has also been strict in the imposition of the NO HOME DELIVERY rule enshrined in the new ordinance and the imposition of penalties in violation thereof. This means that all deliveries should only be attended at health facilities by skilled birth attendants (doctors, nurses and midwives) except in other cases stipulated in the ordinance. This secures a safe delivery and lowers risks in cases of emergencies. E. ENVIRONMENTAL DESCRIPTION The municipality being a coastal area and placed in a tropical location belongs to the 4th type Philippine Climatological Condition where there is no pronounced wet and dry season. Rainfall is evenly distributed all throughout the year. It is characterized by cyclonic and monsoonal rains and sometimes thunderstorm rains. The area like any other municipalities in the province of Bohol seldom experiences typhoon surges. The most common air current are the northern east monsoon from the high pressure of Asia, the trade winds from the Pacific and the southwest monsoon from the southern hemisphere. The general directions of winds from these sources are from north to east from October to January, from east to southeast from October to January, from east to southeast from February to April and southerly from May to September. However due to some recent changes in the climate, the municipality oftentimes experiences unexpected periods of long dry days(drought) and lengthy periods of heavy rainfall. Although no major disruptions were recorded, agricultural and livelihood productions are sometimes consequently damaged by these incidences (especially rice and vegetable yield). Isolated cases of climate-related illnesses such as Respiratory infections (cough, influenza), food/water-borne diseases (e.g. diarrhea), and vector-borne disease (e.g. dengue fever) are also recorded due to these climate changes. In 2000, a major epidemic has brought severe attention in the island-barangays of Eastern and Western Cabul-an. As noted by the previous Rural Sanitary Inspector, an outbreak of over a hundred cases of diarrhea struck the island. Health efforts were given by the municipal health team with the assistance of provincial health office. In terms of sanitation, domestic waste dominates the source of solid waste generated with a volume of 12 cu. m per week. Burning is still the most practiced way of garbage disposal by half of the households in the municipality. A plurality also practice open dumping in their vicinity while around one-third have a compost pit or fence to control their garbage. Garbage collection is done once a week and only in the coastal barangays. Majority of households have exclusive water sealed flush toilet facilities. Others have a shared water sealed flush toilets while others have closed pit and open pit toilets. Three out of 10 households in Buenavista still have no toilets at all. A good majority of the households have their waste water flow from the sink to the ground. Almost half of the households collect their waste water for the use in watering plants and flushing the toilet. Water and air quality in the area remains good.

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F. SOCIO-ECONOMIC FACTORS From the economic point of view, the Municipality of Buenavista has an annual income of P 3,300,000.00 from local source and P 42,896,719.00 from the Internal Revenue Allotment making a total of P 46,196719.00 Annual Budget for CY 2009. Source of local revenue are derived from agricultural products, market collections, waterworks and other revenue sources. The socio-economic status of the majority of the population is anchored mainly on the sectors of agriculture, aquatic and livelihood industries. In the agricultural industries, 22.15% are agricultural operators (fishing included). However, as the municipality is evolving, people are hyped by the emergence of non-agricultural industries (sales, clerical, administrative, entrepreneurship, transportation and professional services). From the latest data 79.28% of the male workforce and 69.71% of its female workforce is employed. The income per capita of the municipality is extremely lower at P20,000 than the national average of 43,600 per capita. About 18.93% of he households earn about P100,001-P250,000 per annum while only 0.35% earn more than a million annually. 13.58% earn below P20,000 per year while more than half of the households earn P40,000 and below. This means that an average family of five members has only P8,000 a year or P666/month for food and other basic needs. Being an agricultural municipality, the major products it produces includes rice, corn, copra (coconut), mango, root crops and banana. As a coastal municipality, it also yields diverse marine and sea products such as fishes, mud crabs, shrimps, seashells, seaweeds and the famous river oysters. Cattle and piggery comprise the major livestock in the municipality. Livelihood also centers in production of materials such as banig (mats), saguran, baskets, hats and brooms from indigenous materials such as rattan, buri, nipa, and raffia. Production of kinugay, natok and landang (sago) are also evident in the municipality. The products are usually traded in the Buenavista Public Market especially during the designated market dayFriday. The market is situated in a one-and-a half hectare lot located at the coastal area of barangay Hunan. The original structure of concrete flooring and Nipa roofing was constructed in 1940 as one of the former Public markets of the Municipality of Getafe. Renovations were made during the establishment of the town and further during the succeeding administrations. At present, the Public Market is made up of two sections. The eastern part which is comprised of the Block tiendas and other dry establishments has been reconstructed and is near completion. The western portion located at the shoreline which is designated as the wet market for vegetables, fish and meat vendors has been temporarily demolished and closed. Construction of the new and better wet market is underway. Other alternative markets include the Dait Night Public Market which operates daily, the Lubang Public market that serves the upland barangays on Sundays and the Panghagban Public Market for nearby far-flung barangays . 7|Page

Tourism also plays a role in the socio-economic development of the municipality. Small town beaches including Cabul-an Island Beach, Pandao Island Beach, Sentenenay Beach and Tumoytumoy Beach offer visitors a relaxing and recreational atmosphere. The Internationally recognized Cambuhat River and Village Tour(CRVT), operating since 1999, has also become one of the viable and growing icons in the field of ecotourism in Bohol. As a joint undertaking of the Cambuhat Enterprises Development and Fisheries Association (CEDFA) and the Local Government Unit of Buenavista in collaboration with various agencies for funding and technical support (including CRMP/DENR, USAID, CIDA, DOST/NMCP, DA- OPA, BIPC, and FCBFI), Cambuhat river has been awarded as the cleanest river by Gawad Pangulo sa Kapaligiran. Cambuhat River shelters cultured oysters along its banks. In the field of education, the municipality enjoys the services of 19 elementary schools, 10 primary schools, four secondary schools, one college institution (Buenavista Community College) and one private preparatory school. The municipality has an overwhelming literacy rate of 97.93% while only two percent are illiterate. The large bulk of the population was not able to finish elementary. About 13.71% finished high school and only 3.36% are academic holders. With a poverty incidence of 70% as of 2005, the Department of Social welfare and Development have instituted the National Household Targeting System for Poverty Reduction (NHTS-PR) and the Pantawid Pamilya Pilipino Program (4Ps) or the Conditional Cash Transfer in the municipality. 2748 families are currently included in the NHTS-PR while 2085 families are enrolled in the Conditional Cash Transfer Scheme. Majority of the family belong to the agricultural and fisheries sectors. A huge percentage come from the island barangays of Eastern and Western Cabul-an. G. INFRASTRUCTURE AND UTILITIES Infrastructure and utilities in the municipality has optimally improved over the years. Electricity, water, communication and transportation have been made available and accessible to the needs of the population even to those who are located in the far-flung upland and island barangays. The Bohol Electric Cooperative II (BOHECO II) being the electricity distributor of the municipality has extended its electricity coverage in the inland barangays to 2487 households. Plans to extend the services to the island barangays are underway as these barangays rely on private entities for power supply. Water services are being supplied by various public and private entities in the area. One-third of the population has shared faucets (level 2) for their water connection. About one-fourth uses a shared deep well with no cover while around 10 households uses bottled or mineral water for their water needs. Very few uses deep well and faucet of their own use. The rest of the population gets water from developed & underdeveloped springs, Jetmatic, rain cisterns, rivers and streams. Telecommunication created a turn-around in the last decade. In the advent of cellular phones, internet connection, television and telephone systems, communication is 8|Page

easily accessible. Major telecommunication companies have already penetrated the municipality with their services. Opening of internet cafes have also boosted the communication access of the town. However, some far-flung areas receive poorer services in terms of signal availability. A publicly managed postal service is also operating. Transportation and transportation-related infrastructures have also progressed. The 28-kilometer National Road is completely concretized while some parts of the 20-kilometer provincial road are cemented. 32 different barangay roads connecting the 33 barangays have a total length of 42 kilometers most of which are graveled while some are still are poorly made of earth making it difficult for maneuver. A 2.59km municipal road is also present. The municipality has total road coverage of 77.63 kms. Of the fifteen bridges in the municipality, eleven are concrete, two are made of wood, one is made of steel and one is on-going construction. About one-fourth of the bridges have the capacity of 20 tons. The main transportation means that people use within the municipality is the habalhabal. There are also an abundant number of scheduled daily trips for buses, vans-for-hire (V-hire) and public utility jeepneys towards and from several destinations in the province. Provincial buses and Public Utility Jeepneys travel at an interval of 30 minutes to 1 hour while V-Hire travel at an interval of 5-30 minutes. Sea transportation has been present since the establishment of the town because of the presence of Cabul-an Island and the towns proximity to Cebu. Regular trips are usually scheduled in the morning and sometimes in the afternoon while chartered trips are available depending on the season and the number of passengers. Sea transportation is usually accomplished using motorized bancas docked at the Buenavista Port in Asinan. H. HEALTH AND NUTRITION SITUATION a. HEALTH FACILITIES The frontier and sole Health service provider in the Municipality of Buenavista is the Buenavista Rural Health Unit which boasts of its 24-hour service. The health center, located in Brgy. Poblacion is made up of three buildings. The main building provides Out-patient Medical Consultation Services, Outpatient Surgical Services, Laboratory Services and Perinatal/Delivery Services. The building also houses the offices of the Municipal Health Officer, the Rural Sanitary Inspector and the Medical Technologist. The adjacent building serves as the offices for the Public Health Nurse, Rural Health midwives and the Clinic of the Dentist. The third building is temporarily used as the ward for the postpartum mothers as well as stock room for medicines and supplies. It will be converted to a birthing center once the building will be fully functional and equipped. A fourth building will be constructed sooner to merge all the offices and the services the Rural Health Unit provides. Functional Barangay Health Stations are also serving the different barangays of the Municipality. These includes the Barangay Health Stations of Barangay Dait Norte, Cangawa, Lubang, Cantomogcad, Bantuan,Panghagban, Eastern Cabul-an, Western Cabul-an, Overland, Catigbian, Magkaya and Cantuba. Most of these BHSs 9|Page

are practically new and are built using concrete. Most of them also have access to electricity and water. These Barangay Health Stations provide basic health services such as Prenatal Services, EPI, Nutrition Services and others. The Barangay Health Stations of Dait Norte, Cangawa and Eastern Cabul-an also accommodate Delivery Services to pregnant mothers. A separate birthing center is erected in Brgy.Lubang donated by Vacine Philippines. TABLE 1 BARANGAY HEALTH STATIONS MUNICIPALITY OF BUENAVISTA
BARANGAY HEALTH STATION CANGAWA DAIT NORTE BANTUAN CANTOMOGCAD LUBANG EASTERN CABULAN PANGHAGBAN CATIGBIAN MAGKAYA CANTUBA OVERLAND LUBANG LYING-IN CRUZ BATO DATE OF CONSTRUCTION COMPLETION 2012 2003 1980s 1980s 2012 ACCESS TO
ELECTRICITY

SERVICES OFFERED

WATER Yes Yes no yes No no yes yes no no no no No no EPI, PRENATAL, DELIVERY, NUTRITION EPI, PRENATAL, DELIVERY, NUTRITION EPI, PRENATAL, NUTRITION EPI, PRENATAL, NUTRITION EPI, PRENATAL, NUTRITION EPI, PRENATAL, DELIVERY, NUTRITION EPI, PRENATAL, NUTRITION EPI, PRENATAL, NUTRITION EPI, PRENATAL, NUTRITION EPI, PRENATAL, NUTRITION EPI, PRENATAL, NUTRITION DELIVERY SERVICES Not functional yet Not functional yet

yes yes no no yes 6-10PM ONLY yes yes no yes yes yes Yes yes

2012 2012 2012 1980s 2010 2010 2012 2012

The nearest referral hospital, Francisco Dagohoy Municipal Hospital is situated 10 kms from the main Rural Health Unit. Transportation is very accessible since the referral hospital is situated near the national highway. Usually, emergency referrals are being accompanied by the RHU personnel. During emergency situations and disasters, the Municipal Disaster Risk Reduction and Management Council (MDRRMC) takes charge of the management and operations. The MDRRMC is composed of the different agencies of the LGU including the RHU Staff. The council conducts annual drills to prepare for unexpected calamities and disasters. The municipality also enjoys the 24-service of the Municipal Ambulance. The ambulance is on stand-by the Rural Health Unit and accommodates the emergency transportation needs of the people even during holidays. The LGU in coordination with the RHU has laid out specific guidelines for ambulance use.

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Currently there are no other government and private facilities in the municipality that provides health services other the Rural Health Unit although a private clinic operates in Brgy.Hunan for consultation purposes only.. b. MANPOWER The Rural health Unit staff is the prime health manpower in the municipality. It is composed of a contractual Municipal Health Officer, a Public Health Nurse, five Rural Health Midwives, 2 Rural Sanitary Inspector, a Dentist, a Dental Aide and a Medical Technologist, and a Nutritionist. The Rural Health Team also houses additional staff which includes seven RNHEALS Nurses and three RHMPP Midwives. The table below indicates the complete information of the staff, their status of employment and the ratio of population they serve. As the statistics will show there is a lack of RHU staff in the municipality. TABLE 2 RURAL HEALTH UNIT STAFF MUNICIPALITY OF BUENAVISTA DESIGNATION STATUS OF EMPLOYMENT Municipal Health Officer Public Health Nurse Dentist Rural Health Midwife Rural Health Midwife Rural Health Midwife Rural Health Midwife Rural Health Midwife RHMPP RHMPP RHMPP Medical Technologist

NAME OF STAFF

Dr. Romeo Aparece Aileen Mahusay Gladives Samson Lorelie Nunez Lucena Bautista Sansen Mar Ninfa Nunez Rosario Anasco Juliet Bentillo Wima Casquejo Joyna Dinoy Eleonor Lugod

RATIO OF STANDARD STAFF TO RATIO POPULATION Contractual /LGU1: 32,233 1:20,000 Hired Permanent/ LGU1: 32,233 1:10,000 Hired Permanent/ PHO1: 32,233 1:20,000 Hired Permanent/ LGU Hired Permanent/ LGU Hired Permanent/ LGU Hired Permanent/ LGU 7: 32,233 OR 1:3,000 Hired 1:4604 Permanent/ LGU Hired Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired Permanent/ PHO1: 32,233 Hired 11 | P a g e

Teodora Cleopas Ferdinand Racho Aracelli Tumulak Frema Dacapio Artechie Diacor Mark Johnuel Duavis Joane Gucor Jeffrey Membreve Fretzel Husain Francis Marie Tumabang

Nutritionist Sanitary Inspector Sanitary Inspector RNHEALS RNHEALS RNHEALS RNHEALS RNHEALS RNHEALS RNHEALS

Permanent/ PHOHired Permanent/ PHOHired Contractual/ LGUHired Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired

1: 32,233

2:32,233

1:20,000

7:32,233

The Public Health Nurse of the Municipality is currently the designated Officer-in-Charge of the Rural Health Unit. She takes full managerial responsibility over all matters concerning office operations, manpower and supplies/ equipments. She is also currently the Municipal Nutrition Action Officer and the TB-DOTS Program Coordinator of the municipality. The former Municipal Health Officer (MHO) who still serves the municipality three-days a week now acts as the Rural Health Consultant. Aside from providing Out-patient Consultation and Surgical Services, he also performs free clinics at upland barangays of the municipality, issues medical and medico-legal certificates and attends/testifies court hearings if summoned. Being a contractual employee of the municipality, he is relieved of the office duties required of an MHO thus transferring the managerial tasks to the PHN. Currently, the lack of a full time physician impedes the delivery of health services. The town folks can only access medical attention three days per week (Monday, Wednesday, and Friday). In times when the physician is not on duty, patients are added additional burden as they are referred to the nearest health facility 10 kilometers away from the main RHU for medical attention. The seven rural health midwives and the three RHMPP midwives being the grassroots service providers are assigned to various barangays and health zones in the municipality. Most RHMs and RHMPPs handle 4-5 barangays while some carry as much as 6-7 barangays. On Mondays and Fridays, they render duty at the main RHU. On Tuesdays, Wednesday and Thursdays they visit their health zones and 12 | P a g e

barangay health stations to conduct services such as pre and postnatal services, EPI, nutrition, home visits, community classes and the like. Apart from their regular daytime duty they also undergo PM and Night-shift duty at the main RHU to anticipate emergency deliveries. This means that they extend beyond the prescribed 40-hours-a-week work. Table 3 shows the number of barangays each RHM covers, the total population they serve and the number of hours they render services per week. TABLE 3 RURAL HEALTH MIDWIVES MUNICIPALITY OF BUENAVISTA Name of Midwife No. of Barangays Total Population No. of Hours/ Covered Served week Lorelie Nunez 6 5,697 72 hrs/week Lucena Bautista 6 5,330 72 hrs/week Sansen Mar 7 4,410 72 hrs/week Ninfa Nunez 2 (island barangays) 4,301 88 hrs/week Rosario Anasco 4 3,508 80 hrs/week Juliet Bentillo 4 3,666 88 hrs/week Wima Casquejo 6 5,321 72 hrs/week The RNHEALS nurses also add to the RHU manpower. Currently the municipality received seven nurses and one nurse/midwife. They are also assigned to various barangays of the municipality. They render duty at the RHU for 2 days (Mondays and Fridays) and do fieldwork at the remaining days. Their main responsibility is to ensure adequate health monitoring to the families belonging to the NHTS-PR list of the DWSD. They also assist the midwives in the performance of their duties such as conducting prenatal/postnatal, delivery and EPI services. Their salaries come from the Department of Health. The two Rural Sanitary Health Inspectors are responsible for implementing efficient sanitary measures to the people. They conduct sanitary inspection to food establishments, issue sanitary permits to food handlers, do salt and water testing and probe health outbreaks and epidemics if present. One of them is currently a casual employee of the municipality while the other one is an employee from the Provincial Health Office deployed in the municipality. The dentist, dental aide and medical technologist render duty at the Rural Health unit on Thursdays and Fridays. Their salaries are paid by the Provincial Health Office. The nutritionist who is also employed by the PHO renders duty usually on the first Monday of the month. In terms of trainings and competency enrichment seminars, the RHU Staff enjoys the benefit of free trainings conducted by the Department of Health and the Provincial Health Office. The LGU also willingly sponsors for the travelling allowances for these seminars. However, it can be perceived that not all RHU Staff 13 | P a g e

are trained or updated with the new trends in providing Basic life Support as well as in providing Intravenous Infusions. Taking into consideration, the distance it takes to reach another referral facility, it is but imperative that these trainings be given to these primary health care providers. c. HEALTH INDICES Vital statistics and health indices are quintessential tools in the field of Public Health as it gives a concrete picture on the current health situation of a community. Basing from the health indices provided by the Field Health Service and Information System (FHSIS) being duly complied and compiled by the Public Health Nurse, it can be noted that the health status and condition of the people of Buenavista has been fluctuating for the past three years.

GRAPH 1 INFANT MORTALITY RATE BUENAVISTA, 2009-2011

20 15 10 4.9 5 0 2009 2010 2011 RATE 17.5 17.4

From the graph presented above, it can be noted that there is a drastic increase in the infant mortality rate of the municipality since 2009 to 2011. In 2009, the infant mortality rate registered at 4. 9. The rate rose to17.5 in 2010 and maintained its position at 17.4 in 2011. This indicates that the death of children lessthan one year of age has increased in the three-year period.

GRAPH 2 MATERNAL MORTALITY RATE BUENAVISTA, 2009-2011

2 1.5 1 0.5 0 2009 0 2010 2011 1.66 1.9

RATE

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Maternal Mortality Rate also changed over the past 3 years. As seen in the graph, the municipality had a maternal death in 2009 with a rate of 1.66. It did not have a case of maternal death in 2010. However, in 2011, the rate suddenly peaked at 1.9. The increased rates signify that the risk of dying from causes related to pregnancy, childbirth and puerperium are augmented. TABLE 4 LEADING CAUSES OF FETAL AND INFANT MORTALITY BUENAVISTA 2011 CAUSE NUMBER STILLBIRTH 4 PNEUMONIA 2 CONGENITAL HEART DEFECT 2

RATE 12.64 6.32 6.32

From the assessment of the rural health team as recorded in the FHSIS in 2011, stillbirth or Intrauterine Fetal Death tops the list of the leading causes of death in the municipality with four cases and a rate of 12.64. Stillbirth is a phenomenon that happens when a child dies inside a mothers womb before it is delivered. Death due to Pneumonia and Congenital Heart Disease followed with two cases each at a rate of 6.32. TABLE 5 LEADING CAUSES OF MORTALITY BUENAVISTA, 2011 CAUSES NUMBER RATE ISCHEMIC HEART DISEASE 23 72.65 CONGESTIVE HEART FAILURE 18 56.86 HYPERTENSIVE CARDIOVASCULAR DISEASE 13 41.07 HYPERTENSIVE PARALYSIS 9 28.43 PNEUMONIA CHRONIC OBSTRUCTIVE PULMONARY DISEASE 7 7 22.11 22.11

Among the named causes of death in the municipality, Ischemic Heart Disease registers as the leading cause of mortality in the municipality with 23 cases, mostly affecting women (males- 7; females- 16). It is followed by Congestive Heart Failure with a case rate of 56.86 per 100,000 population and Hypertensive Cardiovascular Disease with 41.07. Hypertensive Paralysis falls fourth with 9 cases, followed by Pneumonia and Chronic Obstructive Pulmonary Disease with a rate of 22.11. As indicated, four out of the top six leading causes of mortality pertains to diseases affecting the cardiovascular area. These diseases are lifestyle-induced noncommunicable diseases which are highly preventable and modifiable.

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TABLE 6 LEADING CAUSES OF MORBIDITY BUENAVISTA, 2011 CAUSES NUMBER RATE UPPER RESPIRATORY INFECTIONS 1553 4905.7 (COUGH,COLD, WITH FEVER) HYPERTENSION(ELEVATED BP) 287 906.6 WOUNDS (ALL FORMS) 78 246.39 DIARRHEA (LOOSE BOWEL MOVEMENT) 78 246.39 ARTHRITIS (JOINT PAIN) 62 195.85 SKIN PROBLEMS AND INFECTIONS 21 66.34 Accounting to a rate of 4905.7 per 100,000 population and with 1553 cases, Upper Respiratory Tract Infections (usually cough and colds) outstrip the 2011 list of leading causes of morbidity in the municipality mostly affecting the ages 0-19 years old. Morbidity rates express the number of cases of a disease occurring within a particular population. It simply means the common cause of disease in Buenavista is Upper Respiratory Infections. Hypertension or Elevation in the Blood Pressure ranks second with 287 cases and a rate of 906.6. Wound (all types and forms) and diarrhea follows with a rate of 246.39 succeeded by arthritis with a rate of 195.85 and skin problems with a rate of 66.34.

GRAPH 3 LOCATION OF NORMAL DELIVERIES BUENAVISTA, 2009-2011

100 80 60 40 20 0 2009 2010 2011 13.1 15.7 16.15 HOME HOSPITAL 83.9 83.2 83.85

Home deliveries were prevalent in the last three years going at a steady percentage of 83%. Hospital deliveries, however, have inclined from 13.1% in 2009 to 15.7% in 2010 and 16.15% in 2011. Deliveries in other places like Barangay health Stations and in the Rural Health Center has increased from 0% in 2009 and 2010 to 6.25% in 2011. This may be attributed to the concerted efforts of the LGU and RHU to encourage mothers to give birth at health facilities and institutions rather than at home. This ensures that proper medical and health supervision is given and that adequate referral measures may be undertaken on emergency situations.

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The Rural Health Unit is very comfortable that more delivery services will be provided at health facilities as the implementing guidelines on the new Birthing Ordinance takes full effect in the municipality.

GRAPH 4 TYPES OF MATERNAL DELIVERIES BUENAVISTA, 2009- 2011

120 100 80 60 40 20 0 97 98.9 100 NORMAL OTHERS (CESARIAN SECTION)

3 2009

1.1 2010

0 2011

As depicted in the graph, most mothers deliver their babies via normal spontaneous vaginal delivery. In 2009, 97% are normal deliveries while only 3% are delivered by other means (e.g. cesarian section). In 2010, 98.9% delivered their babies by vagina while only 1.1% delivered by other means. In 2010, all babies were delivered through normal vaginal delivery. This data provides great implications because it signifies that more women underwent normal deliveries that lessen the health and financial burdens being introduced both to the mothers and their families.

GRAPH 5 PRENATAL SERVICES GIVEN TO ANTEPARTUM MOTHERS BUENAVISTA, 2009-2011

37 37.1 27.7 34.3 32.6 48.8 51.2 44.11 46 0 2011 2010 10 20 30 40 50 60

% AP given complete dose of iron with folic acid

% AP given TT2 Plus

% AP with at least 3 or more AP visits

2009

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The percentage of women who undertook antepartum visits or prenatal care visits has elevated to 51.2% in 2011 from 46% in 2009 and 44.11% in 2010. Antepartum visits are necessary as these ensure the well-being of the mother and the baby before delivery. The increment can be attributed to the information drive made by the RHU as well as the enrolment of majority of the mothers to the Pantawid Pamilya Pilipino Program. It can be noted that a requisite for the Conditional Cash Transfer Program of the DSWD is that pregnant women should visit their health providers for obstetric attention. The increment may also be due to the establishment of new Barangay Health Stations and the opening of their services in areas near the target population. However, there is a steep decline of pregnant women given with Tetanus Toxoid 2 plus. In 2009, the registry shows 48.8% of pregnant mothers were given Tetanus Toxoid 2 plus. It sloped down to 32.6% in 2010 and 34.3% in 2011. It may have sprung from the poor allocation of supplies of vaccines and syringes. The number of antepartum women with complete dosage of iron with folic acid has been raised from 27.7% in 2009 to 37.1% in 2010 and 37% in 2011. According to the Public Health Nurse, the increase has been cognizant since more supplies of iron supplements were given in 2010 and 2011 compared to 2009.

GRAPH 6 POSTPARTUM CARE SERVICES GIVEN TO POSTPARTUM MOTHERS BUENAVISTA, 2009-2011

5

% PP with at least 2 PP visits % PP with complete iron dosage % PP with Breastfeeding % PP given Vit. A 0 2011

49.1 44 48.9 54 39.44

58.4 57.9 57.9 60.8 60 60 70

32

10

20 2010

30 2009

40

50

Postpartum visits in the municipality have been retrenching. Like the antepartum visits, postpartum visits are necessary to ensure that the mother does not experience complication related to delivery and the circumstances after it. 58.4% of mothers underwent postpartum visits in 2009. It abated to 49.1% in 2010. Fortunately, it climbed back to 56.6% in 2011.

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Complete iron supplementation for postpartum mothers also oscillated in the last three years. From 32% in 2009, it rose to 44% in 2010 and 57.9% in 2011. The increase in iron supplies for women has enabled the statistics to rise in 2010 and 2011. Breastfeeding practices among postpartum mothers in the municipality tallied 54% in 2009. It dwindled to 48.9% in 2010. Breastfeeding rates peaked at 57.9% in 2011, the highest in three years. Breastfeeding has been promoted continually by the Health department as it provides a wide range of benefits for the mothers, the baby and the familys economic status. In 2009, 60% of postpartum mothers received their doses of Vitamin A. it lessened in 2010 cutting nearly half to 34.44%. It regained momentum in 2011 where it grew at 60.8%.

GRAPH 7 FAMILY PLANNING NEW ACCEPTORS BUENAVISTA, 2009-2011

200 180 160 140 120 100 80 60 40 20 0 185 162 143

71 32 4 1 12 14 8 3 6 2 6 43 21 20 28

2009 2010 2011

As specified in the graph, the number of family planning new acceptors in the municipality is minimal. New condom users only peaked in 2012 with 12 new users. Injectable contraceptive use only peaked in 2010. Male and female sterilization were also low as only six new acceptors were registered in 2009 and 2011. The economical Lactational Amenorrhea Method (LAM) was by far the most commonly used among new acceptors cresting at 185 new users in 2010. The usage of Oral Contraceptive Pills and Intra-uterine Device peaked in 2009 with 71 and 43 new acceptors respectively. From the data, it may be inferred that Buenavistahanonss acceptance on contraceptive use is still low. The poor statistics may be indicative of the families inability to purchase contraceptive supplies, inadequacy of free contraceptive supplies in the RHU and low awareness rate on contraceptive use. 19 | P a g e

GRAPH 8 FAMILY PLANNING CURRENT USERS BUENAVISTA, 2009-2011

1000 900 800 700 600 500 400 300 200 100 0 777 826 759

406 160 152 2009 2010 2011

The numbers of family planning current users have been steadily increasing in the past 3 years. Basing from the data above, a majority of the family planning users selects oral contraceptive pills, intra-uterine device and lactational amenorrhea as contraceptive of choice. In 2011, there was a gradual decline in the use of pills and male/female sterilization (vasectomy and bilateral tubal ligation) from 2010. However, there was a triple increase in the use of Lactational Amenorrhea which made it the greatest gainer. It may be due to the fact that Lactational amenorrhea is the most natural and the most economical among the family planning methods. Lactational Ammenorrhea uses exclusive breastfeeding for six months to avoid conception.

GRAPH 9 FAMILY PLANNING NEW ACCEPTORS AND CURRENT USERS BUENAVISTA, 2011
Current Users New Acceptors 162 6 12 160 CONDOM 8 152 INJECTION 21 28

406

777

826 PILLS

759 INTRAUTERINE DEVICE

MALE/FEMALE LACTATIONAL STERILIZATION AMENORRHEA

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Comparing the number of current users of family planning and the number of new acceptors of family planning for 2011, it can be noted that Lactational Ammenorhea still gained the highest with a 20.8% increase. It is followed by Injectable Contraception use with a 5.2% increase and Intra-uterine device use a 3.7% increase. In relation to the total MACRA (number of women of reproductive age at risk of pregnancy) which is 4673.7, the number of family planning new acceptors is still very low. Lactational Amenorrhea which has the highest number of new acceptors accounts only to 3.46% of the total MACRA. The total number of family planning acceptors is only 5.07% in relation to the total MACRA.

GRAPH 10 TUBERCULOSIS CASE DETECTION RATE AND CURE RATE BUENAVISTA, 2009-2011
80 70 60 50 40 30 20 10 0 2009 2010 2011 TUBERCULOSIS CASE DETECTION RATE TUBERCULOSIS CURE RATE 68.78 73.98 75.813

The case detection rate for Tuberculosis in the municipality has been constantly rising. In 2009, the reported case rate was 68.78. It reached 73.98 in 2010 and climaxed to 75.81 in 2011. The case detection rate measures the number of new TB cases being discovered in a given year. From the above data, it can be deduced that more tuberculosis patients were discovered and good strategic case finding practices are being initiated and employed. The tuberculosis cure rate of the municipality has been steady from 2009 to 2011, although, a minimal decrease has been noted from 48.57% in 2010 to 42.86% in 2011. The tuberculosis cure rate determines the number of TB positive cases being cured after taking the antituberculosis drugs.

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GRAPH 11 NUMBER OF TUBERCULOSIS CASES BUENAVISTA, 2012 (QUARTERLY)

15 12 10 10 NUMBER OF CASES DETECTED 14

0 1ST QUARTER 2ND QUARTER 3RD QUARTER

The number of tuberculosis cases discovered in from the 1st to the 3rd quarter of 2012 aggregates to 36 cases. 38.9% of the total number of cases was discovered in the 2nd quarter while only 10 cases (27.8%) discovered in the 3rd quarter. The remaining cases were discovered in the first quarter. TABLE 7 ENVIRONMENTAL INDECES MUNICIPALITY OF BUENAVISTA ENVIRONMENTAL INDEX 2009 Household with Sanitary Toilet 3429 Household Level 1 712 with Potable Level 2 2755 Water Supply Level 3 378 Household with Satisfactory Garbage 4212 Collection/disposal No. of Food Establishments 123 No. of Food Establishments with Sanitary 123 Permits No. of Food Handlers 200 No. of food Handlers with Health certificates 200 Salt Sample tested 1114 Salt Sample found with iodine 1114

2010 4317 589 2409 396 4132 133 133 238 238 1250 1250

2011 4736 328 2268 460 4212 166 166 264 264 96 96

There is steady rise in the number of households with sanitary toilet in the municipality with a 9.77% increase from 2010. The number of households using Level 3 water supply also rose while Level and Level 2 users gradually decreased. The number of households with satisfactory Garbage Collection/disposal declined in 22 | P a g e

2010 but returned in 2011 with 4212 households. All registered food establishments and food handlers were issued necessary health and sanitary permits across the 3 year period. Salt testing also revealed that 100% of the salt sold in the municipality contains iodine.

VACCINE ANTIGEN BCG DPT 1 DPT 2 DPT 3 OPV 1 OPV 2 OPV 3 HEP 1 HEP 2 HEP 3 MEASLES MMR ROTAVIRUS 1 ROTAVIRUS 2

TABLE 8 VACCINATION STATUS OF CHILDREN 0-12 MONTHS BUENAVISTA, 2009 TO 3RD QUARTER 2012 2009 2010 2011 2012 (1ST TO 3RD QUARTER ONLY) 649 601 669 466 575 546 227 503 544 544 263 542 526 488 296 543 576 556 683 502 545 549 643 535 536 485 593 543 224 247 239 281 492 516 82 452 475 148 575 441 596 515 Not available Not available Not available 207 Not available Not available Not available 67 Not available Not available Not available 45

The record shows that there is a steady rate of children given BCG, OPV 1, 2 & 3 and measles vaccination since 2009. However, the number of children given with DPT 1, 2 & 3 and Hep 1, 2 & 3 has steeply sloped down in 2011, cutting nearly half. A Rural Health Midwife indicated that most mothers do not return for next doses of DPT since minor side effects like fever are usually experienced after the DPT1 vaccination. Hepatitis vaccination rates are dragged down by the DPT downpour since the municipality is allocated with the new Pentavalent Vaccine in 2011 wherein DPT and Hepatitis antigens are combined in a single shot. Rotavirus and MMR vaccination rates are not indicated in 2009-2011 since the vaccines were distributed starting 2012.

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GRAPH 12 FULLY IMMUNIZED CHILDREN BUENAVISTA, 2009-2011

80 70 60 50 40 30 20 10 0

70 2009

51.3 2010

61.6 2011

The percentage of fully immunized children in Buenavista has gone down from 70% in 2009 to 51.3% in 2010. In 2011, the percentage shuttled to 61.6%. It has always been a fact that some uneducated mothers refuse to have their children vaccinated because of myths and rumors. Nevertheless, in the advent of the Pantawid Pamilya Pilipino Program, the Rural Health Department is optimistic that the percentage of Fully-Immunized children will ascend in the next years as evidenced by the 10.3% growth from 2010 to 2011.

GRAPH 13 DIARRHEAL CASES IN CHILDREN 0-59 MONTHS BUENAVISTA, 2009-2011

250 200 150 100 50 0 215 154 116 2 2009 22 2010 2011 88 Number of Diarrheal Cases given ORS No.of Diarrheal Cases

From 116 cases in 2009 to 215 cases in 2012, the increase in the annual number of diarrheal cases in the municipality is alarming. From these cases, only less than half of the cases were given Oral Rehydration Salts. Oral Rehydration Salts (ORS) are important medications as they prevent a child with diarrhea to experience dehydration. Diarrheal diseases are usually associated with poor sanitation and improper food handling.

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GRAPH 14 DIARRHEAL CASES IN CHILDREN 0-59 MONTHS BUENAVISTA, 2012 (QUARTERLY)

70 60 50 40 30 20 10 0 1ST QUARTER 2ND QUARTER 3RD QUARTER 49 41 40 44 DIARRHEAL CASES DIARRHEAL CASES GIVEN ORS 64 63

Partial 2012 data reveals that majority of this years diarrheal cases in the municipality are accounted from the months of April to September aggregating to a total of 127 cases. The total number of diarrheal cases from January to September reached 176 cases. 125 cases or 71% of the total cases received Oral Rehydration Salts. This increase has been credited to the additional ORS supplies purchase by the RHU and the LGU. According to recent data as of January 2012, the number of malnourished children in the municipality is also high with 15.87% of the population ages 0-71 months as underweight. Western Cabul-an tops the list with 38% of its children below the normal weight, followed by Putingbato with 30% and Eastern Cabul-an with 29.4%. Barangay Cantuba shows the least number of underweight children at 5.6%. This high incidence may be due to the economic status of the families in the municipality. According to the PDMS 2009 data, 18.89% of the households have food shortage while 26.71% of the households are below the food threshold. II. SWOT ANALYSIS STRENGHTS (within the Local Health Organization) Diligence, Industry and Dedication of Rural Health Personnel to Health Concerns of the municipality despite varying circumstances. Strong political support of the Local Government to Health Concerns as evidenced by formulation of new ordinances and projects for health Addition of RNHEALS and RHMPP to inadequate Health Workforce

WEAKNESSES (within the Local Health Organization) Inadequate Health Personnel Inadequate Health Facilities, equipments and supplies Inadequate health funds from both national and local level to meet health demands Barriers to communication in transporting information and updates from the national to the local level

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 Colossal Contributions coming from CHT Partners, BHWs and BNSs despite inadequate salary OPPURTUNITIES (outside the Local Health Organization) Presence of the Pantawid Pamilya Pilipino Program allowing indigents to be pro-active in health Presence of Government Organizations funding for health Infrastructure Development such as KALAHI-CIDSS and the DOH Presence of NGOs such as the Womens Organization, Path Foundation and Family Life Apostolate advocating for health Possible Philhealth Accreditation which will be beneficial in providing quality health services and additional revenue for health

THREATS (Outside the Local Health Organization) Weak Participation rate of the population in terms of health services availment and compliance Widespread poverty in the population Presence of growing ideological factions within the population(health advocates vs cultural and religious affiliations)that creates divisions and disables availment of health services Possible political disintegration and division within local officials and barangay leaders as an effect to the upcoming polls Presence of danger zone areas operated by criminal groups engaging in robbery, harassment, rape, etc. which hinders service delivery to farflung barangays

III.

STAKEHOLDER ANALYSIS, STRATEGY FORMULATION Name type of Stakeholders Kalusugan Pangkalahatan Community Health Team Partners Contribution for Health Links the clients especially indigents to the health services delivery and referral network Helps in facilitating clients for enrollment and availment of Philhealth benefits in the community level Aids in accessing of clients to quality hospitals and other health care facilities Motivates indigent clients and their households towards transforming health needs into effective health demands such as but not limited to consultation, pre-natal/postnatal services, nutrition and EPI Leads CHT Partners in bringing the government health services to the people in communities especially the categorized poor household clients. Conducts trainings to CHT Partners with regards to household profiling and monitoring of their health conditions Provides health care assistance together with the Midwife-incharge to the client communities on their Immunization schedules; Prenatal, Post natal and Family planning; Precaution 26 | P a g e

RURAL HEALTH UNIT STAFF INCLUDING RNHEALS (REGISTERED NURSES FOR HEALTH ENHANCEMENT

AND LOCAL SERVICES) AND RHMPP (RURAL HEALTH MIDWIFE PLACEMENT PROGRAM)

Treatment of TB; Sanitation and Cleanliness of environment and other DOH Program- related activities. Undergoes Trainings, Orientation and Seminars in Prevention and Control of spreading the communicable diseases of the community. Conducts Health Teachings and Precautionary Measures on Minimizing Diseases and Illnesses especially to the Infants and children clients. Provides Counseling to the client mothers in their Maternal Health and Family Planning concerns. Helps client family as a whole in promoting health lifestyle and health home practices and habits. Enforces other DOH and Health-related programs Supports the DOH programs-Kalusugan Pangkalahatan thru the Community Health Team lead by the RNHEALS and MIDWIVES Provides financial assistance on KP-CHT gatherings, trainings and seminars and outreach to the client communities. Accommodates Visiting Midwives and RNHEALS or RHU Team to their respective barangay community. Accepts Health services delivery updates and proposals at community level and includes it in their health agenda during sessions and assemblies. Supports the DOH programs-Kalusugan Pangkalahatan thru the Community Health Team lead by the RNHEALS and MIDWIVES Formulates and enacts ordinances to facilitate delivery of health services Request for health funds from various government and nongovernment organizations Assists in building projects affecting health Provides feeding programs to day care pupils Assists in cases that affects maternal and child well-being

BARANGAY COMMUNITY LEVEL OFFICIALS AND THE HEALTH COMMITTEE

LOCAL GOVERNMENT OFFICIALS

DEPARTMENT OF SOCIAL WELFARE AND DEVELOMENTBUENAVISTA BUENAVISTA WOMENS ORGANIZATION KALAHI-CIDSS (KAPIT BISIG LABAN SA KAHIRAPAN)

Provides women clients in households awareness and information on their rights and welfare. Advocates dignity of women and equal rights Provides transparent financial budget assistance in establishing barangay community projects including barangay health station facilities, source of safe and potable water and distribution pipes o household facilities, etc. Religious organization that serves pre-marriage counseling and guidance to couples for a health-morale and spirituality of families. Provides Philhealth Programs Benefits to indigent families 27 | P a g e

FAMILY LIFE APOSTOLATE MUNICIPAL

GENDER AGE DEVELOPMENT CENTER

Allocate Iron Supplements worth P30,000.00 to pregnant and postpartum mother Allocate artificial and natural family planning commodity worth P30, 000.00. Provides Seminars and Trainings for STD Prevention and Control.

PATH FOUNDATION

International Non-Government Organization that advocates family planning, proper birth spacing and contraceptive use in coastal municipalities. Trains the youth to become peer educators with emphasis on reproductive health. Allocates supplies of contraceptives to Community Based Distributors Advocates the prevention and spread of HIV/AIDS and other STIs thru provision of Key interventions including behavior change communications to increase HIV/AIDS knowledge and prevention practice and to encourage appropriate health seeking behaviors among tourism-sector workers, OFWs and members of their social networks. They also strengthen the capacity of the government health personnel and community volunteers to deliver HIV/AIDS and STI information and services to promote policies that support behavior change. STRATEGIC THRUST PLAN TO MOBILIZE STAKEHOLDERS FOR GENERAL HEALTH ADVANTAGE Deploy CHT Partners, RNHEALS and RHMPP together with RHM with regular schedule in a week to conduct survey and assessment of the households in the community with emphasis on the unattended and neglected health problems of uneducated clients and indigents. Provide systematized diagnosis and prioritization of health problems of the household and the community with adequate documentation Convene with major stakeholders such as the Government, Non-Government, Private, Religious and Civic Organizations listed above in planning for specific interventions and strategies to address prioritized health needs and problems. Provide necessary Interventions (by RHU personnel and Stakeholders if possible) using formulated plans/activities and using available funds, manpower/support services, supplies, equipments and apparatus coming from pledges of major stakeholders. Allow comments and feedback from the served population. Synthesize feedbacks and include to evaluative report. Evaluative report must consist of the feedback from the population and the evaluation from the Community Health team and Stakeholders who conducted such interventions. Add recommendations. Submit evaluative reports from the Community Health Team, RNHEALS, RHMPP, RHM and the rest of the RHU personnel(including feedback received from served population) to the Local & National Government and to the Stakeholders. Allow feedback VISUAL REPRESENTATION OF STRATEGIC PLAN Stakeholders meeting. mechanism for strategy improvement on next FOR HEALTH STAKEHOLDERS 1. First Entry Community Assessment, Diagnosis, Prioritization To be performed by Community 28 | P a g e

P O P U L A T I O N
3. Second Entry Performance of formulated strategies/activities/ interventions using available funds, services and pledges from stakeholders To be performed by Community Health Team and Stakeholders if possible

2. Stakeholders Convention/ Meeting Planning of Specific Strategies and Interventions to address assessed health needs which includes formulation of programs/activities and allocation of funds and pledges for such. Funds and pledges may vary according to Stakeholders capacity and health goals

4. Third Entry Evaluation of the interventions provided together with the retrieval of feedbacks from the population served Synthesis of the feedback together with the evaluation of the interventions into a comprehensive evaluation report with recommendations for Submission of evaluative report to stakeholders involved and to Local and National Govt To be performed by the Community Health Team

5. Provide necessary feedback and recommendations for strategy improvement Raise these improvement points on next stakeholders meeting/ convention for integration to next planning of interventions

IV.

COMMUNITY CASE STUDY AND PREVENTIVE ACTION PLAN 29 | P a g e

A. Introduction Cardiovascular diseases (CVD) have become the greatest threat to many Filipinos, including Buenavistahanons today. CVD is a general term that denotes several conditions that affects the Cardiovascular System of the body. The cardiovascular system is a quintessential system since it has the prime function of transporting blood, nutrients and oxygen to the different parts of the body. Impairment in the vital functions of the cardiovascular system impedes the quality of a persons life and the performance of his activities of daily living. B. Municipal Profile Name: Buenavista Population: 32,233 Population Density: 2.63 persons per square hectare Area: 9,360.88 hectares Municipal Classification: 4th Class municipality C. Health Statistics (2011 data) Crude Birth Rate: 19.58 Crude Death Rate: 4.42 Infant Mortality Rate: 17.4 Maternal Mortality Rate: 1.9 Life Expectancy Rate: 43.19 Male: 39.7 Female: 46.67 D. Disease of Concern/Disease on Focus: CARDIOVASCULAR DISEASES E. History of the Disease Occurence Patients with Cardiovascular Disorders come for Medical Attention all-year round. The occurrence of these cases can be traced back even on the records of the previous health care providers of the municipality. A huge number of the patients with CVDs come for medical consultation only during symptomatic stages (time when signs and symptoms of the disease appear and become pronounced). Most of the patients who are assessed usually present symptoms such as headache, blurred vision, pain in the nape and numbness on various parts of the body. On Blood Pressure Assessment, data reveals Blood Pressure above the 120/80 mmHg level.

F. Magnitude and Severity of Cases 30 | P a g e

Table 9 CARDIOVASCULAR DISEASES STATISTICS MUNICIPALITY OF BUENAVISTA, 2009-2011

DISEASE RATE/ 100,000 2011 MORTALITY CAUSES 23 CASES (M-7; F-1) 72.65 18 CASES (M-10; F-8) 13 CASES (M-5; F-8) 56.86 41.07 NUMBER OF CASES REMARKS

ISCHEMIC HEART DISEASE/ CORONARY HEART DISEASE CONGESTIVE HEART FAILURE HYPERTENSIVE CARDIOVASCULAR DISEASE HYPERTENSIVE PARALYSIS MYOCARDIAL INFARCTION CONGENITAL HEART DISEASE CEREBROVASCULAR ACCIDENT CHRONIC HEART DISEASE

HYPERTENSION ISCHEMIC HEART DISEASE/CORONARY ARTERY DISEASE CONGESTIVE HEART FAILURE HYPERTENSIVE VASCULAR DISEASE HYPERTENSIVE HEART ATTACK ARTERIOSCLEROTIC HEART DISEASE CARDIO-RESPIRATORY ARREST ACUTE MYOCARDIAL INFARCTION VALVULAR HEART DISEASE CONGENITAL HEART DISEASE

9 CASES 28.43 (M-6; F-3) 2 CASES 6.32 (M-0; F-2) 2 CASES 6.32 (M-2; F-0) 1 CASE 3.16 (M-0; F-1) 1 CASE 3.16 (M-0;F-1) 2011 MORBIDITY CAUSES 287 CASES 906.59 2010- MORTALITY CAUSES 18 CASES 57.89 (M-9;F-9) 12 CASES 38.6 (M-7; F-5) 11 CASES 35.38 (M-5;F-6) 9 CASES 28.95 (M-1;F-8) 9 CASES 28.95 (M-6;F-3) 4 CASES 12.87 (M-0;F-4) 2 CASES 6.43 (M-2;F-0) 1 CASE 3.22 (M-1;F-0) 2 CASES 6.43 (M-2;F-2) 2010- MORBIDITY CAUSES 316 CASES 1016.37 (M-127; F-189) 2009 MORTALITY CAUSES 23 CASES (M-10; F-13) 75.33

NO. 1 CAUSE OF MORTALITY2011 NO.2 CAUSE OF MORTALITY2011 NO. 3 CAUSE OF MORTALITY2011 NO.4 CAUSE OF MORTALITY 2011

NO.1 CAUSE OF INFANT MORTALITY

NO.2 CAUSE OF MORBIDITY NO. 1 CAUSE OF MORTALITY2010 NO. 3 CAUSE OF MORTALITY 2010 NO. 4 CAUSE OF MORTALITY 2010 NO. 5 CAUSE OF MORTALITY 2010 NO. 5 CAUSE OF MORTALITY 2010 NO. 8 CAUSE OF MORTALITY 2010

N0. 1 CAUSE OF INFANT MORTALITY NO. 4 CAUSE OF MORBIDITY

HYPERTENSION

ISCHEMIC HEART DISEASE/ CORONARY ARTERY DISEASE

NO. 1 CAUSE OF MORTALITY 2009

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CONGESTIVE HEART FAILURE HYPERTENSIVE HEART DISEASE MYOCARDIAL INFARCTION CONGENITAL HEART DISEASE CARDIOMEGALY HYPERTENSIVE PARALYSIS

HYPERTENSION

14 CASES 45.85 (M-8;F-6) 8 CASES 26.2 (M-5; F-3) 2 CASES 6.55 (M-2;F-0) 1 CASE 3.28 (M-1;F-0) 1 CASE 3.28 (M-0: F-1) 2 CASES 6.55 (M-1;F-1) 2009 MORBIIDTY CAUSES 97 CASES 317.7 (M-47;F50)

NO. 2 CAUSE OF MORTALITY 2009 NO. 3 CAUSE OF MORTALITY 2009 NO. 6 CAUSE OF MORTALITY 2009

NO. 6 CAUSE OF MORTALITY 2009

The aggregate cases of Cardiovascular diseases in the municipality is rapidly escalating. The alarming rates have been reflected in the number of registered mortality and morbidity cases presented on the table above. In 2011, the total mortality cases recorded in the municipality due to CVD is 69 which accounts to 49.29% of the total 140 deaths. These disease include, Coronary Artery Disease(CAD)/ Ischemic Heart Disease (IHD) with 23 cases and a rate of 72.65 per 100,000 population followed by Congestive Heart Failure with 18 cases, Hypertensive CVD with 13 cases and Hypertensive Paralysis with 9 cases. Congenital Heart Disease placed at the second rank in terms of the leading causes of Infant Mortality with 2 cases. In terms of Morbidity, hypertension ranks second with 287 cases or 13.44% of the total morbidity cases recorded in that year. In 2010, the mortality cases due to CVDs summed up to 68 cases which make up the 48.23% of total deaths in the municipality. Ischemic Heart disease still tops the list with 9 cases for men and 9 cases for women, totaling to 18 cases. Congestive Heart Failure claims the 3rd spot with 12 cases, followed by Hypertensive Vascular Disease with 11 cases. Nine people died with Arteriosclerotic Heart Disease, placing it in the number 5 spot. Congenital Heart Disease ranks number one in the leading causes of Infant Mortality in the year with two male cases. Hypertension afflicted 127 males and 189 females in 2011, placing it to the number four spot occupying 12.55% of the total morbidity cases. In 2009, the mortality rate from cardiovascular diseases tallies at 167 per 100,000 population. It occupies the 49.51% bulk of the recorded total deaths in the municipality. 32 | P a g e

Deaths due to Ischemic Heart Disease still tops the causes of death in the municipality affecting 10 males, 13 females and a total of 23 cases. It occupies 45.1%of the recorded deaths due to CVD in that year and 22.33% of the total recorded deaths from different causes. Hypertension ranks 6th in the leading causes of morbidity with 97 cases. G. Analysis on Contributing Factors of CVD Emergence in the Municipality The high rates of CVD cases in the municipality are predisposed by varying multifactorial causes. The assessment and analysis presented here are, however, unofficial and are only inferred by the researchers. The factors that may be have triggered the increase in CVD cases in the municipality are as follows. POVERTY INCIDENCE- the poverty incidence of the municipality which registers at 70% is one factor to consider. More than half of the households earn 666/month for food and other basic needs as stipulated in the Situational Analysis in the preceding pages. 18.89% of the households also have food shortage. With these, people tend to consume cheaper yet unhealthy types of foods that are economically available within the community. These include foods such as buwad (dried fish) and ginamos (anchovies). Others tend to pair rice with salt, soy sauce, edible oil, or animal fat in cases when a viand is not available. Preserved foods such as dried fish and condiments (soy sauce) contain high levels of salt which may predispose hypertension among the population. Edible oil and animal fat consumption is also dangerous since these contain high levels of cholesterol. GEOGRAPHICAL LOCATION AND FOOD SOURCES- location of the municipality being a coastal area is critical in the emergence of CVDs. Products being sold in the market are mostly aquatic products such as crabs, shrimps, prawns and lobsters which are very high in cholesterol. Salted products that are also famous in coastal areas contain high levels of sodium. EMPLOYMENT- the employment type is a crucial factor in the development of CVDs. 20.72% of men and30.29% of women are unemployed. This would mean that most of them stay at home with lesser physical activity. The rapid transformation of agricultural industries into non-agricultural work such as sales, clerical, administrative and professional also promotes lesser activity and sedentary lifestyle. Most of these jobs are also more stressful by nature. CULTURAL PRACTICES- local family practices such as siesta or after-lunch naps and consumption of alcoholic beverage (esp.tuba, 33 | P a g e

bahalina and kulafo) after eating meat may also have contributed to the CVD cases. SMOKING AND ALCOHOL CONSUMPTION- the increasing number of people who smoke and drink alcoholic beverage is always linked in the development of CVDs. REDUCTION OF PHYSICAL ACTIVITIES- the younger generations tend to omit active games and replace them with passive hobbies such as texting and internet surfing. Passive activities promote obesity and sedentary lifestyle which is leads to the development of CVDs in the future. H. Preventive, Control and Curative Management a. Preventive Management Initiated within the Municipality HATAW or Dance Exercise done regularly every Monday from 3 oclock PM to 5 oclock PM by all LGU officials Nutrition and Diet Education Programs thru PABASA sa Nutrisyon, Mother Classes and other Community Classes conducted by Rural Health Midwives Installment and Dissemination of Information Education Campaign (IEC) Materials like posters and leaflets regarding ill-effects of smoking and alcohol abuse. Promotion of sport tournaments/physical activities in town festivities and active support to other sports-related Affairs (district meets) by the LGU b. Curative and Treatment Initiated Free medical consultation with initial Blood Pressure assessment by the Rural Health Staff Provision of free antihypertensive and cardiac drugs funded by the Dept.of Health, which include generic names as: o Antihypertensives: Metoprolol, Hydrochlorothiazide, Losartan, Amlodipine o Anticholesterol: Simvastatin o Other Antihypertensives given by NGOs: Dialtezem, Hydralazine, Lisinopril I. Pathophysiological Tree Cardiovascular Disease is a general term that denotes to a number of diseases that affect the cardiovascular/circulatory system of the body. These diseases can be faced in any stages of life which includes: o At birth, Congenital Heart Disease (CHD) and vascular malformation are a possible affliction. CHDs usually arise out of genetic causes, maternal infections/diseases and maternal intake of teratogenic

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substances such as drugs and alcohol. CHDs are deformities in parts of the heart which impairs it capacity to function properly. In early childhood, the risk of Rheumatic Fever/ Rheumatic Heart Disease (RH/RHD) starts. These illnesses usually arise from frequent streptococcal throat infection (sore throat). These diseases are usually characterized by an inflammation in the endocardium(the inner lining of the heart). In early adulthood, arteriosclerotic changes in the blood vessels may set in the progress and development of hypertension or Hypertensive Vascular Disease. Hypertension (high Blood Pressure) is a persistent elevation of the arterial blood pressure equal to or above 120 mmHg systolic and equal to or above 80 diastolic. It is associated with heredity and high salt intake During the middle age, Coronary Artery Disease (CAD) or Ischemic Heart Disease (IHD) develops and leads to myocardial infarction (heart attack). Coronary Artery Disease is the narrowing of the large and medium-sized coronary arteries due to intimal plaque formation. Myocardial Infarction, on the other hand, is the destruction of the myocardial tissue in regions of the heart abruptly deprived of adequate blood supply due to reduced coronary blood flow. Among the elderly, Cerebro-Vascular Accident (CVA,Stroke) and Congestive Heart Failure are common complications of CVDs. CerebroVascular Accident happens when a blood vessel in the brain ruptures and forms blood clots into the brain tissues. Congestive Heart Failure, meanwhile, is a syndrome of pulmonary or systemic congestion due to a decreased myocardial contractility, resulting in inadequate cardiac output to meet oxygen requirements of the tissues.

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PATHOPHYSIOLOGICAL CAUSATION TREE OF CARDIOVASCULAR DISEASES

PREDISPOSING FACTORS
HIGH FAT DIET CIGARETTE SMOKING OBESITY CHRONIC STRESS FAMILY HISTORY SEDENTARY LIFESTYLE DIABETES MELLITUS HYPERTENSION HIGH CHOLESTEROL
HEREDITY HIGH SALT INTAKE

HYPERTENSION EMBOLUS HIGH CHOLESTEROL DIABETES MELLITUS

HEREDITY MATERNAL INFECTIONS MATERNAL DRUG INTAKE AND ALCOHOL CONSUMPTION

HIGH CHOLESTEROL INTAKE SEDENTARY LIFESTYLE OBESITY ORAL CONTRACEPTIVE USE SMOKING CAFFEINE ALCOHOL

FREQUENT STREPTOCOCC AL THROAT INFECTION (SORE THROAT)

ISCHEMIC HEART DISEASE AND MYOCARDIAL INFARCTION

CEREBROVASC ULAR ACCIDENT

CONGENITAL ESSENTIAL HEART HYPERTENSION DISEASE

RHEUMATI C HEART DISEASE

CARDIOVASCULAR DISEASES

GENERAL SIGNS AND SYMPTOMS CONFUSION, VISION PROBLEMS, ANGINA PECTORIS/CHEST PAIN, CYANOSIS, TACHYCARDIA/BRADYCARDIA, DIZZINESS, SYNCOPE, NAUSEA, VOMITING EDEMA AND WEIGHT GAIN, DYSPNEA, ORTHOPNEA AND RESP. DISTRESS PALPITATIONS AND HYPERTENSIONFATIGUE, DIAPHORESIS, COLD CLAMMY EXTREMITIES, APPREHENSION AND RESTLESSNESS CHANGES IN ECG TRACING, CRACKLES, DISTENTION IN NECK VEINS, HEPATOMEGALY,

ASCITES, PITTING EDEMA (ESP. IN CHF)

COMPLICATIONS LEFT VENTRICULAR HYPERTROPHY, HYPERTENSIVE CARDIOMYOPATHY, MYOCARDIAL INFARCTION, CARDIO RESPIRATORY ARREST, CEREBROVASCULAR ACCIDENT, HYPERTENSIVE ENCEPHALOPATHY, HYPERTENSIVE RETINOPATHY, HYPERTENSIVE NEPHROPATHY, PULMONARY CONGESTION

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