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CHAPTER I
Introduction
is the primary idea of extensive meaning of human capabilities that indicates the true
Respectively, a vast number of studies confirm that there is a very strong relationship
between health and economic growth (Mayer, 2014). Thus, healthcare is undoubtedly
essential for every people in maintaining health status and promoting human
development.
Access to healthcare is important especially for women for they are vulnerable
and more prone to suffer from illnesses. Data reveals that maternal mortality rate
remains surprisingly high. According to World Health Organization (WHO) 135 million
women give birth per year, an estimated 20 million of them suffer from pregnancy
related illness, and about 303,000 women die while giving birth every day. With regards
to nutrition, it is said that girls aged 15-19, more than 1/3 of them are vulnerable to
anemia because of poor iron diets and monthly menstruation period which leads to
Similarly, healthcare access is also significant for children because their physical
infectious illness. Hence, healthy growth and development of the children are
unarguably, should be the basic concern of the society. According to WHO (2017)
malnourished children are more likely to have weak immune system resulting to a
greater chance of getting sick like pneumonia, diarrhea, and malaria or in severe cases,
said that in 2016, 5.6 million under age five suffer from death and 83 % of deaths are
childbirth every day. Around 4,500 die every year due to excessive bleeding,
and abortion. Additionally, infant mortality remains unchanged with 35 deaths per 1000
birth. It is also believed that a huge number of Filipino children are undernourished.
Around 3.6 million 0-59 months old are underweight and 4 Million are stunted. In fact,
Philippines is included among 68 countries that causes the 97% of maternal, neonatal
and child health deaths globally (United Nation Children’s Fund, 2017).
Health challenges among women and children indicate the deprivation of proper
nutrition, water, sanitation facilities, shelter and access to healthcare. Poverty, distance
and unavailability of services are factors that hinder them from seeking healthcare.
Disadvantaged people like poor, women and children, rural dwellers, and indigenous
health systems. In particular, lack of access and inadequacy of basic health services is
one of its major challenges that often directs to health consequences that are worse
than those in other impoverished areas of the Philippines (Bam, 2014). Poor coastal
communities often translate into poor access to health services because of its remote
location (World Wide Fund, 2012). These communities are too small and isolated to
support their needs of health services that’s why residents are required to go to urban
to WHO (2017), 400 million people are unable to access the needed health services.
Considering the importance of health among women and children, and the health
challenges that still remains unsolved specifically in coastal areas, healthcare systems
must be then organized, regulated properly and be able to access. That is why, this
study focuses on accessibility of healthcare among poor women and their children in
Paombong. The researchers choose this topic because health has a crucial and critical
have a better understanding and expand their knowledge about the contribution of
health to society and its perceived barriers in accessing healthcare. The barrier that will
be analysed will served as an eye opener that geographical and affordability alone, are
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not enough to tell if healthcare is accessible or not. The results will be used in improving
The general problem of the study is: How may accessibility to health care among
described?
1. What are the existing healthcare programs of the government in the coastal
communities?
2. How may accessibility to heath care among poor women and their children be
measured in terms of :
2.2 availability;
2.3 affordability
2.5 acceptability?
experience of participants?
accessibility?
accessible particularly for poor women and children. Also, families who live in coastal
areas have difficulties with regards to their geographical location, for it hinders them
The study will provide empirical evidence concerning the current status of
healthcare access in Paombong. In addition, the study will also explain the barriers that
prevent the residents in accessing health. The knowledge obtained from the study will
be useful as a starting point for projects that aim to improve accessibility of healthcare.
information to the DOH Officials about the occurring interventions to healthcare access,
use and cost. Additionally, it will help them to discover the major types of illness that is
present on the area and what are the common causes of death in the coastal
communities of Paombong. The DOH will be aware on what kinds of medicine and
medical equipment are mostly needed so that they can provide it.
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Municipality of Paombong. The study will help the officials for further
Residents of Coastal Communities. The study will help the residents of coastal
areas to improve their access to healthcare because this paper can guide policy makers
to refine their healthcare system which will be beneficial for the dwellers. This can also
help people in coastal communities to become aware about their right to health.
knowledge on development economics because the findings of the study can be used in
(HDI) since health is one of the key factor and important indicator for development.
Future Researchers. The study will provide empirical evidence and will serve as
a reference to future researchers that have the same topic. They can also use the
Binakod and Sta. Cruz. The accessibility of healthcare will be measured in terms of: (a)
geographic accessibility, (b) availability, (c) affordability, (d) acceptability; and (e)
accommodation.
There will be a total of one hundred twenty-eight (128) participants. The 90 poor
women and children will be picked through stratified sampling approach, while the other
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28 will be chosen through purposive sampling with the criteria based on the
researchers. The study will be limited to women and their children living within the three
(3) barangays. Additionally, women and their children living outside the barangays are
excluded in the study. Survey questionnaire, focus group discussion guide, key
informant interview guide and secondary data are the instruments that will be used in
the study.
CHAPTER II
This chapter presents the relevant theories, related literature and conceptual
framework which researchers have pursued to shed light on the topic under study.
Relevant Theories
Thomas in 1981. The theory defined access as the degree of fit between the patient and
the healthcare system. Access has independent yet interconnected dimensions that
attitude to accept the service and the provider’s attitude towards the personal
resources are organized to accept and meet the patients’ needs. The theory also states
that access is the center of these dimensions which cannot be isolated from it.
in coastal communities. The 5 A’s of access will be used to identify and to measure the
existing issues encountered by poor women and their children in terms of accessing
healthcare.
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Related Literature
This section provides the reviews of related literature which will give a clear
health system from WHO constitution of 1948, stating that health is an essential human
right, and from the Health for all agenda prepared by Alma Ata declaration in 1978. This
means that the entire people and community receive quality health services while also
assuring the affordability of health services. The given definition mirrors its three related
objectives particularly equity in excellent health services that is enough to improve the
health of the users and the security of people against financial risk of obtaining health
services. It also includes all component of health system like health delivery system,
Tracking progress toward UHC focus on two things: the portion of the population
that can access the indispensable quality health services and the portion of the
population that pay a huge amount of family income on health. WHO, together with the
World Bank, has developed the framework to monitor the progress of UHC by tracing
both categories. Moving toward UHC demands strengthening health systems and
should be available and accessible for every Filipino. It aims to guarantee that Filipinos
shall be able to afford and acquire quality health benefits. This includes supplying
sufficient resources such as health facilities, health professionals and health financing.
To achieve UHC in the Philippines, there are 3 goals to be pursued namely: Financial
risk problem, improved access to quality hospitals and healthcare facilities and
The WHO (2017) defines the primary health care as necessary healthcare
to them, by their full participation and in the cost that the public can afford. In addition,
patients, diagnosis and treatment of acute and chronic illness. In Philippines primary
the local government code 1991 for the LGUs to be the main providers of this primary
healthcare. Each municipality has the Barangay Health Centers (BHCs) and Rural
Health Units (RHUs) to accommodate patients that need it. BHCs workers are Barangay
Health Workers, Volunteer Community Health Workers, and Midwives while in RHU
Sanitary Inspectors and Volunteer Health Workers. These people are the one that
deliver the primary care in the public (Romualdez et al., 2017). In rural health units
available healthcare are sub centers, chest clinics, malaria eradication units, and
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Schitomiasis central units operated by DOH. Also, there are puericulture centers,
tuberculosis clinics and hospitals. The Philippine Medicare operates the community
hospitals and health centers that give primary healthcare (Williams & Tungpalan, 2017).
Inpatient Care
The inpatient care is the medical treatment that is given in a hospital or other
health facility that requires overnight stay for health observations (Santiago, 2017). The
patients of this care are afflicted by the illness or disease that threatens their health and
requires highly technical and specialized knowledge of the facilities and personnel to
treat effectively (Williams & Tungpalan, 2017). This type of care can be reimbursed to
Inpatient Benefits of the Philhealth includes the deduction on the member’s total bill in
all case rates and it covers the professional fees of the physician prior to discharge
(PhilHealth, 2017).
Outpatient Care
care that the patients don’t need to stay overnight in the hospital or any medical facility.
Outpatient care can be delivered in a medical offices, hospitals and clinics. This care
involves routine service like check-ups or visiting to clinics (Santiago, 2017). PhilHealth
also provides benefits for the outpatients. First is the day surgery – the surgical
procedures that is major or minor operations which patients can discharge safely within
the same day for post-operative care. The case rates shall be deducted in member’s
total bill including the hospital and professional fee charges. Second, for those who
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undergo in Radiotheraphy, it includes the radiation treatment delivery using cobalt and
Linear accelerator. Multiple sessions can be filed by one (1) form and has a 45 days
benefit limit. The third one is Hemodialysis, can cover the inpatient and outpatients
involving emergency dialysis procedures and has 90 days benefit limit. The last one
blood transfusion, it covers outpatient blood transfusion and the Drugs & medicine, X-
ray, Laboratory test, operating room and others. One-day transfusion of blood
regardless to number of bags is equivalent to one session and has 45 days limit
(PhilHealth, 2017).
Emergency Service
unscheduled medical condition (ACEP, 2016). The emergency care in the Philippines is
governed by Republic Act No. 344. This is an act of penalizing the refusal of hospitals
cases. This is an Act of prohibiting the medical facilities to require deposits or advance
payments for the admission or treatment of the patients in hospitals and medical clinics
Long-Term Care
A long-term care refers to continuous medical and social service that support the
needs of those persons with disability or even the elderly (McCall, 2015). The Act of
2010 granted that all senior citizens has a direct discount in all pharmaceutical
covers the goods and services from hospital pharmacies, medical and optical clinics.
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PhilHealth members may benefit from lifetime coverage (Romualdez et al., 2017).
Social Security System (2017), also gives their senior citizen pensioners financial
assistance that may help for their health expenses. Department of Social Welfare and
Development (2017) also has a haven offered for the elderly and also gives social
pension program for indigent senior citizens (SPISC). Furthermore, there is the national
program for Persons with Disabilities’(PWDs) health by the DOH was based on the Act
of providing self-reliance and rehabilitation for person with disability also known as the
Mental Care is a service devoted for treating mental illness, and improving the
mental health of people with mental disorders or problems (Collins dictionary, 2017).
The National Center for Mental Health (NCMH) is committed to deliver preventive,
curative and rehabilitative mental health services. NCMH services are hospital services
like general adult psychiatry, child & adolescent psychiatry, forensic psychiatry and
general medicine & surgery for out-patients such as emergency psychiatry, acute crisis
psychiatry. Last the Anicillary Service, which are the Clinical and Anatomic Laboratory,
psychological services and occupational and physical therapy (NCMH Gov, 2017).
Palliative Care
The Palliative care is an approach that aims to improve the quality of life on both
patient and the family facing the problem in connect with the life-threatening illness,
through prevention and relief from suffering by means of early identification and treating
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the pain and other physical or psychological (DOH, 2015). On year 2015, DOH released
an administrative order about National Policy on Palliative and Hospice Care in the
Philippines. This order aims to set an overall policy to identify the roles and functions of
DOH when it comes to the provision of palliative and hospice care in all Health
Facilities, communities and home-based levels. This includes the primary level facilities
like RHUs shall provide palliative and hospice care through community home-based
care approach. Secondary and Tertiary Health Facilities such as Hospitals and Clinics
shall give consultation services, Inpatient palliative care units and shall provide access
to support service from health professionals. DOH and the local government units
should ensure the funding, generation and mobilization of resource to sustain palliative
Dental Care
This Dental Care is the maintenance of Healthy teeth pertaining to oral hygiene
services such as oral prophylaxis, gum treatment, tooth restoration, cosmetic dentistry
and root canal treatment. Oral surgery such as, tooth extraction, odontectomy,
which are the brackets and retainers. Through dental examination determines the the
DOH is the Philippines' central health agency. It manages the inclusive technical
authority of health. "Basically, DOH as three major roles in the health sector: (1)
leadership in health; (2) enabler and capacity builder; and (3) administrator of specific
health services" (p.1) It’s mandate is to formulate national plans, technical standard and
rules or instructions on health. The agency is also accountable for assuring access to
basic public health services to all Filipinos. Dr. Francisco Duque III, MSc is the current
In 2008, DOH started its program on Neonatal, and Child and Nutrition Strategy
(MNCHN) and Universally Accessible Cheaper and Quality Medicines Act of 2008. This
year DOH intensifies its program on access to safe drinking water (GOVPH, 2017).
PHILHEALTH
PhilHealth administer the National Health Insurance program that covers the Inpatient
hospital care, room, board, service of health professionals, diagnostics, laboratory, and
other medical services. The use of medical or surgical equipment and facilities. Also,
the drugs, biomedicine and inpatient educational package. For out-patients, the
prescription of drugs and other biologicals, and the service of health professionals. The
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Corporation collects, deposits, invest, administer and disburse the National Health
achieve the desired number, spacing and timing of children. They provide different kinds
Development Integration and Gender and Development. The said programs are made
(POPCOM, 2017)
Accessibility to Healthcare
Geographic Accessibility
Health And Place Initiative also known as HAPI (2014) defined geographic
access to healthcare as the time when patients can physically access the services in
the health centers from their community. In the article of HAPI (2014), greater distances
and travel times are considered barriers in using health services. Rural areas and
remote island areas especially have less geographic access to healthcare services in
terms of long distances and/or travel time to care and less service are available.
According to Kumar, Dansereau & Murray (2014), distance and travel time are
one of the barriers in access to health care in India. Places that are way too far from
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health care provider have big impact in utilization of healthcare and outcome in health.
Some families in India are forced to travel longer just to have proper medication.
Household, on some cases doesn’t have the means to acquire healthy life because they
often lack resources for transportation and travel time takes too long. As a result,
article, some Indian families are unable to acquire proper health service because they
are far away from health facilities. Geographic access is more important than socio-
economic factors especially in rural and remote areas with scarce health services.
mothers who are about to give birth and experienced difficulties in terms of geographic
access in rural health facilities. People who need to go to the health facilities must look
for a boat first in order to transport pregnant women to the nearest health facilities and
travel for about an hour. Distance and lack of transport to the nearest health center is a
huge challenge for people in the community of Solomon Islands. According to one of the
official in Solomon island, some mothers chose not to visit health center when they are
sick even their children, as it is far and expensive to hire a boat and travel for an hour or
In the Philippines, people who live in rural remote areas are isolated by
distance, terrain and poverty from healthcare access. Lack of basic infrastructure
(bridges and roads) and access to transport services makes it difficult for poor people to
access health centers. There is clear indication that rural isolation is associated with
poor health status. Access to health care in rural and remote island, transport
infrastructure and means of transport are crucial to overcoming the decision to seek
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medical services, the travel time to reach care and the treatment within the healthcare
system are all depend on access to transport. Where people are far from health centers,
Availability
Chen, Yin, & Xie (2015) found out that one of the problems in healthcare is the
unequal distributions of healthcare resources in rural and urban areas due to the fact
that rural areas have a much poorer economic condition, lack of government
investments, and low resident’s payment capability. According to Titus, Adebisola, and
Adeniji (2014), accessibility of household to medical facilities are very low because of
the inadequate and unequal distributions of public health facilities. There are also
disparities between patients and health personnel because of the inadequate supply of
health workers.
Filipinos are also experiencing urban and rural disparities in terms of public
health services. Public health services are very poor in the country whereas, there’s
only one (1) hospital bed available per 1000 people and only one (1) doctor, three (3)
nurses, and seven (7) mid-wives available for 100,000 people. Even though nursing has
the highest amounts of graduates, the country is still experiencing shortage in public
health workers due to a massive amount of export in other countries (Gijsel, 2016).
Affordability
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income being sufficient enough to pay for healthcare cost. There are plenty of people
who are unable to obtain medical care because it is expensive (Glynn, MacKenzie &
Fitzgerald, 2016). Low income is one of the factors that contribute in having poor health.
Often, people who have low income or living in poverty cannot afford checkups and
medications that’s why most of the time they are the ones who have illness and
disease. Those people who experience an abrupt decline in health frequently become
poorer after losing their job. Furthermore, people with illness often experience difficulty
in accessing health care because there are only few health care providers nearby and
In the Philippines, health care costs are becoming quite expensive. Many
Filipinos living in poverty are wondering whether they can afford hospitalizations and
medicines with their income alone. Usually, the answer is no. With the high cost of
health care, they cannot afford it without the use of health insurance. A treatable illness
can be a catastrophe for poor Filipinos who have low income and do not have insurance
because they might be financially ruined or bankrupt. Some might think that this is an
exaggeration but it is the truth because even if it is a treatable illness, costs like hospital,
surgery, medicines and doctor’s fee should be taken in consideration, these costs are
Acceptability
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need, desires, expectations, beliefs, values and levels of independence on the people
around you. The cultural and religious beliefs affect the delivery and acceptance of
cultures, women are not allowed to see and be examined by the male health workers.
Additionally, there is some inappropriate behaviour the health care providers some
humiliate and abuse health consumers. Dr. Tello stated that most physicians are not
explicitly racist yet they are under the racist system. Furthermore, poor patients are
more likely to cure themselves naturally before seeing the doctors. Accepting treatment
satisfaction of consumers in the services bases on how they trust their provider (Tello,
2014).
The cultural division exists between the patient and health professionals
(Winkelman, 2009). Philippines have approximately 175 ethno linguistic groups with
different cultural identity and health practices. Filipino culture is a mixture of indigenous
as well as imported and borrowed element this case affects the acceptability of the
Filipinos when it comes to healthcare. Filipinos tend to cure themselves first through
their traditional or cultural beliefs. As they continue to follow their beliefs relying through
natural and traditional way of curing them these prohibits them in consulting the
physicians. These presumptions sometimes tend to cause more diseases. For example
the namamaligno or Sumpa supernatural belief of Filipino in urban areas they more
likely consult albularyo first than a physician the medication that the albularyo may give
can cause another illness for the patient. This case can be prevented if only this people
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are advised to consult physicians than relying to traditional treatment (Abad et al.,
2014).
Accommodation
service is well organized to receive clients and clients are able to use the service. This
include hours of operation, appointment system, waiting hours and the like.
In the Philippines, long lines and overcrowding are the challenges encounter
which is very evident at the six city run hospitals in Manila. The hospitals are limited to
accommodate enormous number of patients that is why Mayor Manila Joseph Estrada
increases the budget allocation to refine its Community- Health Centers (CHC)
(Alcantara, 2015).
In the case of coastal area in Australia, women who live in coastal remote
locations experienced difficulties in getting antenatal health care due to their distance
from the health facilities, cost of the healthcare and scare supply of services and
equipment. In some cases, women who are required to give birth or to consult doctors
in health facilities are forced to travel away from their community, lead to additional cost
of care, and separated temporarily from family especially to other children. Reported
neonatal death, wherein a baby dies on 28 th to 30th day after birth, are high among
women who live in rural areas and fetal death, the death of a fetus during pregnancy,
are much higher in coastal community of Australia. Women tend to suffer more because
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healthcare is not close to their homes which makes difficult for them to access
coastal and rural areas have limited access to healthcare due to availability, distance
and involved cost. One of the leading causes of disease among Filipino women is
some part in the island of Samar in Visayas, is often described as in dire situation
because of insufficient services, few doctors and nurses and have become a serious
problem particularly for poor women due to the existing issues in maternal health.
Women that reside in coastal areas in some part of Samar Island suffer from difficulties
in accessing healthcare.
Barangay Matarinao, Eastern Samar, a poor coastal village. Due to the difficulties in
accessing the healthcare facilities, midwives and doctors are the ones who travel for
hours, three times per week from Rural Health Unit in Salcedo in order to reach Brgy.
Matarinao because women and their children in the barangay cannot afford to do so.
Barangay Matarinao has reported cases of high number of malnutrition, diarrhea and
other preventable cases in children. Due to insufficient health facilities and health
personnel in the community of Matarinao village, children’s diseases are more likely to
remain untreated.
Related Studies
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accessing healthcare and coping strategies of acute illness costs. The study used
interview, focus group discussion and survey questionnaires as the method to gather
data and conduct the study. The study limits the study on acute illness costs, excluding
the chronic diseases. It concluded that most household in Koboko District, even richer
medicines the study found out that unavailability of drugs and high prices are the
medicines were not a severe problem. A large number of households sell assets or
even their food for consumption, to cope with acute illness costs.
The author made a great examination of the data through quality and quantitative
techniques that resulted to a more comprehensive finding. The author also made sure
that all details in their study are well defined. On the contrary, the authors provide a
limited information about the accessibility of medicines because the instrument used
The above study is similar to the current study in terms of the method it used in
order to collect data which is interview, focus group discussion, and survey
questionnaires. Both study also focus on coping strategy and accessibility. It was then
different in terms of setting and respondents. The relevance of his research is that it
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provides basis on accessibility and barriers obtaining healthcare that can be help the
District focused on evaluation of the healthcare access of the poor, the problems
researchers performed case study as the method and technique to gather the data from
PRU District. The data were collected from the sampling size of 200 in selected seven
rural community households. Qualitative and quantitative data were also collected from
focus group discussion and key informant interviews for chiefs, assemblymen, teachers
and youth for additional information. The study revealed that people in rural
health facilities and also financial cost. This includes unavailable health facilities, health
equipment and health personnel, poor system in transportation, long travel distance and
lack of financial means. The study concludes factors hindering access to health facilities
and services in Ghanaian context are numerous especially in rural communities ranging
The author of the study made a good evaluation of the information through
different strategies that came about to a more comprehensive finding. The study
analyzed the factors affecting the healthcare accessibility based from the result of data
collection and provides a clear assessment on the relationship to each other. However,
the researcher didn’t explain further the travel distance or geographic accessibility which
The above study was similar to the study undertaken currently by the
for the poor, challenges encountered and coping strategy of the respondents and for
techniques to be used. It was then different to the current study in terms of the setting
because researchers will emphasize on coastal area while the authors used rural
setting and other factors such as acceptability, accommodation are not present in the
Ferreira da Silva, Unger & Vázquez (2014) entitled Barriers in access to healthcare in
of central Colombia and north-eastern Brazil focus the comparison of factors that
influence the access of health care in two countries with different health systems. The
analysis was used to describe the distribution of outcome and bivariate analysis to
compare the results between two countries. The study limits its respondents to the
people residing in the study area, people who had at least one health problem or had
visited a health facility three month prior to the survey. The study found out that there is
a notable difference in the barriers in accessing health care between two countries. In
Colombia, the barriers encountered were geographical and economic barriers and the
need for authorization from insurers. Whereas in Brazil, the limited availability of health
centers, doctors and medicines are the greatest barrier which leads to longer waiting
time.
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The researchers made a well-founded study by using two countries as the setting
and comparing them. The use of quantitative method allows the study to be remade in
different areas or over time with the production of comparable findings. However, the
researchers did not elaborate the meaning of health care and the different kinds of
This study is similar to the current study in terms of using two or more setting and
the analyzation regarding the barriers that prevent the residents of central Colombia and
north-eastern Brazil in accessing health care. The study differs in terms of the
respondents and study area. The study is relevant because it serves as a basis and
postpartum health care service use in the Philippines and the challenges experienced
while accessing postpartum care. The study used survey research by the use of
questionnaire and knowledge test to gather data, and they analyzed it by using SPSS
Statistics. They limit the study to women who received postpartum checkups in
Philippine General Hospital (PGH) and women who participated in the postpartum
health education seminar conducted in Muntinlupa City Hall. The study found out that
women who delivered their child at home had a lower rate of postpartum health care
service use than those who delivered at medical facilities. The barangay health workers
may educate postpartum women regarding the health care service utilization so that
they can improve their knowledge on the utilization of health care services.
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General Hospital (PGH) and women who participated in the postpartum health
education seminar conducted in Muntinlupa City Hall. However, they did not precisely
discuss the meaning of postpartum care and what services are included in postpartum
care.
This study is similar to the current study in terms of using women as the
respondent and the country used which is Philippines. The difference is that the study is
concentrated in postpartum care and not health care as a whole. The study is relevant
The study conducted by Kosai et al. (2015) entitled Incidence and Risk Factors
behavior, incidence and mortality rates of pneumonia-like episodes, as well as the risk
the study were picked using cluster sampling and systematic random sampling. They
data and to conduct the study. According to the findings, low socioeconomic status
(SES), a history of asthma, the age of the child, a preterm birth, and travel time to the
healthcare facilities are the risk factors that affects the occurrence of pneumonia-like
episodes. During severe pneumonia-like episodes only 44% of children sought care in
health facilities, due to the fact that children with long travel time going to the hospital
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were less likely to receive healthcare. Therefore, travel time is the most important factor
The author had properly gathered and explained the relationship of risk factors to
pneumonia-like episodes, and the association between these factors and healthcare-
seeking behavior of the caregivers. However, a further study is still needed as to why
The study is relevant in our research since we want to find out what factors affect
the children on seeking care in health facilities. However, their study focuses on the
The location in our study are the ones located in remote areas while their study
Definition of Terms
healthcare refers to the ease of an individual to attain essential medical services. While
travel time, distance, and transportation cost to reach the healthcare units.
attitude of providers and clients concerning the characteristics of the services provided.
is the manner of the organization to accept patients. It includes patient’s waiting time
Coastal Area. According to FAO (2017) it is the place or area at which land and
sea interface. In this study, coastal areas meant the same. It also refers to the 3
that involves the maintenance of the whole body. In this study, healthcare meant the
Poor women. Are those who lack access to economic resources, education and
health. Poor women are paid less than men as where gender inequality at work exists.
Also, women have minimal participation in the decision making in the family (UN
Women, 2017).