TeleMedicine

Indigenous Peoples - Community Health Workers Telemedicine Project (IP-CHWTP)

Primary Implementing Institution: Foundation of Our Lady of Peace Mission, Inc
Address: Bgy. San Dionisio, Paranaque
Telefax: 825-7653

Collaborative Institution:

National Commission on Indigenous Peoples
Department of Health
Learn.ph Foundation
University of the Philippines

A. The Health Knowledge and Skills Development Project

1. The impact of the Indigenous Peoples - Community Health Workers Telemedicine Project (IP-CHWTP) will be the development of more knowledgeable and skilled health workers from the ethnic minority groups of the Philippines. The project is consistent with the mandate of the Department of Health (DOH) and the National Commission on the Indigenous Peoples (NCIP) on health for all regardless of geographic location or cultural background. The project envision a strengthened capacity of the health education and training system pioneered by the Foundation of Our Lady of Peace Mission, Inc.(FOLPMI) together with the multisectoral partners.
2. The project will have five outputs:
(i)a national ICT consultation and training of the one hundred eighty-eight (188) IP-CHW graduates of FOLPMI together with their updates and monitoring
(ii) an IP-CHW training center equipped with information and communication technology (ICT) responsive to the remote location of the IPs
(iii)strengthened commitment of the multi sectoral partners in utilizing ICT in assisting the IPs, namely with the government agencies (DOH, NCIP), civic organizations (Tuklas Katutubo-youth tribal leaders, Community Medicine Foundation, Philippine National Red Cross), religious organization (Catholic Bishops Conference of the Philippines - Episcopal Commission on Indigenous Peoples) and academic institution (University of the Philippines-Philippines General Hospital, Learn.ph Foundation) who had previously assisted the trainings of the 6 batches of IP-CHWs
(iv) establish ten pilot sites equipped with ICT
(v) a website for the advocacy and baseline knowledge collection tool of the IP-CHW Telemedicine Project

B. Background

3.The Philippines' Indigenous Peoples Rights Act (IPRA) defines Indigenous Peoples or IPs as "a group of people or homogeneous societies identified by self-ascription and ascription by others, who have continuously lived as organized community on communally bounded and defined territory, and who have, under claims of ownership since time immemorial, occupied, possessed and utilized such territories, sharing common bonds of language, customs, traditions and other distinctive cultural traits, or who have, through resistance to political, social and cultural inroads of colonization, non indigenous religions and cultures, became historically differentiated from the majority of Filipinos." (Section 3, Article II, R8371).
4. The NCIP tries to address the lack of access to health care through outreach programs to the IPs. The NCIP Central Office has a clinic that provides free consultation and medicines. Medical and dental missions to remote IP communities have also been carried out (NCIP Accomplishment Report 2002). However, an outreach program alone will not provide a sustainable health development program for the IP communities. On the other hand, the DOH coordinate with the Barangay Health Workers (BHW), however their coverage is limited with the remote location and cultural differences of the IPs. Thus, there is a need to establish a solid base within the community, in the form of trained Community Health Workers, who will serve as health care providers and spearhead health programs in their respective communities without compromising their indigenous beliefs and traditions.
5. The FOLPMI has developed 188 community health workers from the 77 tribes of the Philippines (see annexes A & B). At present, some graduates are working as barangay health workers, nutrition scholars, NGO employees and local government consultants. Their continuing education and monitoring is important to supplement the knowledge and skills they have obtained from the 3-week intensive training. To do so, most of the monitoring were done through on-site visits, posts and phone calls which required considerable financing and time. Thus, an ICT program paralleled to this health program would cut short the time and money spent for their consults and vice versa.
6. ICT is no longer new in offering alternative assistance to the remote areas in the Asia Pacific. It has been used to leapfrog the economies of the Peoples Republic of China and South Korea through Knowledge-based economy. In the remote areas of the Solomon Islands, solar powered internet and low frequency radio were used as a means of communication.
7. The FOLPMI receive regular consults from the IP-CHW through text messages from the mobile phones. Resource speakers such as those from the National Poison Management and Control Center expressed interest in answering consults through their hot line and mobile numbers. ICT can offer a bridge to this gap between health professionals and IP-CHW.
8. Considering health as not merely a state of having no illness but a state of total well being, social and political issues are confronted as well. The foundation has been lobbying for the ancestral domains of the IP-CHWs starting from the slow process of receiving bulky document by post and sorting it through a myriad of government agencies. An ICT network of legal and government agencies can challenge this process of transacting. The use of ICT can also allow recording and documentation of the consults and traditional health practices of the IPs which can be a baseline knowledge and reference with the permission of the Indigenous Peoples..

C. Legal Framework

9. The contents of this Policy Framework are based on laws and policies of the Government of the Philippines and policies of the World Bank as follows:
a. Republic Act 8371, otherwise known as the Indigenous Peoples Rights Act or IPRA, provides that the IPs have the right to an informed and intelligent participation in the formation and implementation of any project, government or private, that will impact on their ancestral domain, and that the IPs have the right to participate in decision-making, in all matters which may affect their rights, lives and destinies.
b. IPRA Section 34 states that IPs are entitled to the recognition of the full ownership and control and protection of their cultural and intellectual rights. They shall have the right to special measures to control, develop and protect their sciences, technologies and cultural manifestations, including human and other genetic resources, seeds, including derivatives of these resources, traditional medicines and health practices, vital medical plants, animals and mineral, indigenous knowledge systems and practices, knowledge of the properties of fauna and flora, oral traditions, literature, designs, and visual and performing arts.
c. IPRA Section 46 states further that the NCIP is mandated to identify IPs with potential training in health profession and encourage and assist them to enroll in schools of medicine, nursing, physical therapy and other allied courses pertaining to the health profession.
b. World Bank Operational Directives on Indigenous Peoples (OD 4.20) requires Bank-assisted projects to ensure that interventions avoid or minimize detrimental impacts on indigenous peoples/ cultural minorities and that measures are made to maximize project benefits on IPs. It likewise requires Bank-assisted projects in areas with IPs to guarantee the informed and meaningful participation of IPs in various stages of project development and implementation. Moreover, this directive expects that IPs receive social and economic benefits that are compatible with their cultural practices and tradition.

D. Guiding Principles

10. For the project and the ICT to be culturally acceptable, guidelines are established as follows:
a. The IP-CHWTP shall ensure that the IPs are engaged in the decision-making processes in identifying, planning and implementing project interventions in areas within ancestral domain claims or areas where IPs depend for their livelihood.
b. The project must ensure that the IPs does not suffer adverse effects during and after project implementation and that they receive social and economic benefits that are compatibles with their cultural practices and tradition.
c. The Project Management Teams and its Regional counterparts must ensure at all times that the implementation of the project fosters full respect for IP's dignity, human rights and cultural uniqueness.
d. Whenever necessary, consensus of all IP members who are affected by the project must be obtained in accordance with their respective laws and practices and customary practices of consensus-building, and shall conform to Section 14 (Mandatory Activities for FPIC) of NCIP Administrative Order No. 3, series of 2002.
e. The Project Regional Implementation Teams shall ensure that project implementation will not result in damage to non-replicable cultural property. In cases where infrastructures improvement shall affect sites considered as cultural properties of the IPs. Project Implementation Teams must exert best efforts to relocate or redesign the planned renovations so that these sites can be preserved and remain intact in site.
f. Infrastructure designs must at all times be consistent with the traditional and cultural practices of the IPs in the area.

E. The Procedures

11. The IPs in the national convention shall be encouraged and given the opportunity to participate in all stages of planning, implementation and project monitoring. The IPs shall be included in the discussions, workshops and survey interviews. Efforts shall be exerted to solicit their views and suggestions in the implementation of the project. Pilot sites will be prioritized based on the following: 1.) Groups who are favorable with the ICT 2.) highly coordinated as a people's organization 3.)has established health programs. For areas unequipped with Internet transmission or IPs who are unprepared for the project, the national convention shall also be a venue for them to undergo training on being an operator of a "Botika ng Barangay" (local pharmacy) or be assimilated to the Community-based Health Program of the Community Health Development. More importantly, a federation will be organized among IP-CHW which is envisaged to be self-governing and self-reliant.
12. Building on World banks formulation of a Knowledge-Based Development, three categories of intellectual capital are applied, namely human capital, structural capital and stakeholder capital. The IP-CHW Development Program of FOLPMI has developed 188 skilled workforce for the human capital. In addition, it has established a network with multisectoral agencies (stakeholder capital) which aided in the development and monitoring of the IP-CHWs. However, the FOLPMI lacked a structural capital to convene or coordinate these human and stakeholder capital. In this regard, a national coordinating center, a structural capital, has to be setup which will extensively cater the assistance and development of the IP-CHWs. This center shall be equipped with ICT equipments that are cost-effective.
13. A memorandum of agreement will be reached by the multi sectoral partners in committing to address the consults of the IP-CHWs. These partners will be trained on IP cultural sensitivity and ICT skills. Learn.ph Foundation whose core competency is online education will provide the literacy software while UP-PGH Telehealth will provide the software and technical support for health.
14. Pilot sites will be equipped with a low memory computer with wireless Internet connection and powered by solar panels. These computers will function as ports where text messages from the mobile phones are converted to Internet messages and documents. The project shall ensure that assistance is provided to enable the IPs to participate meaningfully in the process. This may mean deployment of competent and committed staff to work in IP communities and ensure that IPs are knowledgeable and skilled in the ICT operations.
a.) The design of facilities and service delivery protocols shall be sensitive to culture and beliefs.
b.) Efforts shall be made to train IPs to serve as trainers in their respective communities
c.) IP community involvement in implementation shall be actively sought
15. Consults received through the Internet will then be forwarded to specific health professional partners who specialize on the topic relating to the consult. The answers will be processed and sent immediately to the IP-CHW. All documents processed in the Internet will be collected and sorted in the launched website which can be viewed through the Internet with the initial approval of the IPs.

F. Monitoring

16. Monitoring of project impact on IPs shall be carried out through the following:
a.) Personnel and facility-based surveys will be carried out at various stages of the project to track implementation progress and effectiveness.
b.) Special studies to provide further insight into how health outcomes have been influenced by the project will be done.

G. Sustainability

17.) Paralleled with socioeconomic assistance, this project can be a channel for transacting sales of indigenous products. Furthermore, the IP ports can be used in research or data gathering. The knowledge can be used in national policies or surveys which will be critical in decision making.

H. Impact of the Project on Indigenous Peoples

18. The activities under the project are not foreseen to impact negatively on IPs, rather, their implementation will improve the quality and relevance of skills training for IP-CHW. This would contribute to immediate measures for emergency cases and consultative means for preventive medicine. Relaying of reports for updating and monitoring would be cost effective. This will increase the likelihood of the IP-CHWs knowledge and skills to be nurtured upon their return. In addition, understanding their culture and traditional health practices will improve our understanding of disease transmission and etiology, and alternative medicines. Socioeconomic concerns such as the issuance of their land titles and sale of indigenous products may also be improved in the process. Through ICT, the most marginalized sector of the society can be placed at the forefront of health care.

COPYRIGHT @ PHILIPPINE-HEALTHNET thru Dr. Jason Abello

http://www.philippine-healthnet.blogspot.com

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Community Health Workers Training

TITLE: IMF Report: The 6th Community Health Workers Training for the Indigenous Peoples
DATE: November 5 to 25, 2007
VENUE: Our Lady of Peace Hospital and St. Andrew Cathedral

PRIMARY IMPLEMENTING INSTITUTION: Foundation of Our Lady of Peace Mission Inc


PRIMARY FUNDING INSTITUTION:
International Monetary Fund – Civic Advisory Program Group
Washington D.C

FINANCIAL GRANT: USD 6,746.00 (See Attachment E)

MULTISECTORAL PARTNERS:
National Commission on Indigenous Peoples
Department of Health
Tuklas Katutubo – A national organization of youth tribal leaders
Philippine National Red Cross
Cultural Center of the Philippines
Coca-cola Export Company
Episcopal Commission on Indigenous Peoples
Parish of St. Andrew Cathedral
Misereor - Philippines
Abbreviations
IPs – Indigenous Peoples
FOLPMI – Foundon of Our Lady of Peace Mission, Inc.
NCIP – National Commission on Indigenous Peoples
DOH – Department of Health
TK – Tuklas Katutubo
PNRC – Philippine National Red Cross
CCP – Cultural Center of the Philippines
CHWs – Community Health Workers
BHWs – Barangay Health Workers
NGO – nongoverment organization
CCF- Christian Children's Fund
ARMM – Autonomous Region in Muslim Mindanao

INTRODUCTION

The foundation of Our Lady of Peace Mission, Inc has the unique program of training community health workers from the Indigenous Peoples. The local government employs barangay health workers, these workers have minimal coverage to the remote areas inhabited by the IPs. The IPs from the different regions were gathered for a 21-day training. The training is the intensive phase (Phase I) while the on-site monitoring is Phase II. This report will focus on Phase I which was held last Novemeber 5 to 25 at the Our Lady of Peace Hospital and St. Andrew Hall of St. Andrew Canthedral.

One-hundred fifty seven (157) have graduated from the seventy-two tribes of the Philippines from the previous 5 batches of CHW training. The 6th batch trained thirty-one (31) more from the tribes of Bl'aan, Kaulo, Teduray, Kankana-ey, Manobo, Subanen, Tagakaolo, Talaandig, Yakan, Aeta, Iwak, Bantoanon, Agta, Mandaya and Kalinga. This added four more tribes from the previously unrepresented tribes namely Kalinga, Iwak, Teduray and Bantoanon. (See Attachment A)

The participants were recommended by the NCIP, graduates of the program and NGO partners in the community such as the Isabela Foundation Inc., Christian Children's Foundation, Tuklas Katutubo, Alagad sa Panglawas (Servants for Health) and Mamalo Descendant Organization (Cotabato). The particpants of the 6th CHW training were 1.)Tita Tusan (B'laan, Davao del Sur), 2.)Delma Wano (B'laan, Davao del Sur), 3.)Maricel Sakilan (B'laan, Davao del Sur), 4.) Vizminda Dela Cruz (Kaulo, Davao del Sur), 5.)Ernesto Alfonso (Te'duray, Shariff Kabunsuan), 6.)Lito Mosela (Te'duray, Shariff Kabunsuan), 7.) Emely Mardo (Kankana-ey, Infanta Pangasinan), 8.)Vicente Dag-uman (Subanen, Zamboanga del Sur), 9.)Gilda Hermoso (Manobo, Davao del Sur), 10.)Juanito Campong(Kalagan, Davao del Sur), 11.)Elizabeth Bitco (Tagakaolo,Sarangani), 12.)Lourdes Danio(Talaandig, Bukidnon), 13.)Kuring Dailun (Yakan, Basilan), 14.)Emelie Baluan(Manobo, Carmen Cotabato), 15.)Lanie Cosme(Aeta, Iba Zambales), 16.)Liway Jugatan (Aeta, Bihawo Zambales), 17.) Dario Bugtong (Iwak, Nueva Viscaya), 18.) Mylene Atanacio (Aeta, Bihawo Zambales), 19.) Margie Maaba (Bantoanon, Romblon), 20.) Veronica Domasig (Agta, Sorsogon), 21.)Julia Barrameda (Agta, Sorsogon), 22.)Ruby Dumaog (Manobo, Bukidnon), 23.) Alvin Sandag (Manobo, Bukidnon), 24.)Fe Ann Lanipao (Kalinga, Mt. Province), 25.)Shisterly Famisan (Aeta, Zambales), 26.) Daisy Capellan (Aeta, Botolan Zambales), 27.) Allan Pahanay (Manobo, Bukidnon), 28.) Susan Hugnaan (Talaandig, Davao del Sur), 29.)Jeoffrey Liguez (Mandaya, Davao Oriental), 30.)Pilar Acar (Yakan, Basilan), 31.)Virginia Ayodoc (Kankana-ey, Mt. Province). (See Attachment C)

METHODOLOGY AND OUTCOME

Implementing this progrom for 2 years with encouraging feedback from the communities, the 6th batch was pursued with improvements from the previous curriculum. The 1st phase included the CHW intensive training. It employed lectures, group discussions, demonstrations, return demonstrations, role playing and creative presentations as teaching methods (See Attachments B and D).

Health is affected by multiple factors. The IPs are keen to this as their health care is entwined with ther spiritual, cultural and social beliefs. The World Health Organization believes that health is not merely the lack of disease bu the total well being of a person. Consequently, the first week of the training was spent on and discovering the traditional health practices, cultural beliefs, rights and responsibilities of the IPs and human dignity. These topics were also intended to empower the participants. (See Attachment B)

The discussion on the biological aspect of health was strategically distributed on the three week training. The participants were very interested on topics that promoted skills development such as ventusa or moxibustion (a traditional palliative technique for muscle pains), suturing of minor wounds, child delivery, vaccination, preparation of herbal medicine, nutrition, weighing of children, first aid, emergency rescue and transfer, basic life support, history taking and physical examination. The participants were equipped with a medical kit that allowed them to do procedures on their own. They were also provided with a module that covered most of the topics. They were later assessed through an objective-structures clinical examination which is an oral and practical exam on their clinical knowledge and skills. Those with unsatisfactory performance were later tutored individually. (See Attachment D)

The second week featured the community aspect of health. It emphasized the need for prevention rather than cure and that in essence CHWs need to work with the community since prevention requires collective effort. Hence, the topics on leaderships, community diagnosis and planning were important. From these topics, the CHWs became more expressive in communicating, a skill they would need in leading and teaching. They were taught on making plans with the community and not by themselves so as to gain more support in implementing the plants. Most importantly, they were oriented to work with the local government as they have to make courtesy calls with the local officials and non-government agencies as well as they anchor in the community as a new CHW.

The third week introduced to the participants the presence of national agencies which offered assistance to the IPs. The roundtable discussion was particularly meaningful with the attendance of representatives from the NCIP (government agency), Tuklas Katutubo (Civic group), Episcopal Commission on Indigenous Peoples (Religious sector), FOLPMI (NGO), Community Medicine Foundation (NGO), and University of the Philippines Pahinungod (Academic Sector).

The participants aired the problems faced in the community and their grievances. Most of the sectors were able to offer solutions or explanations to their problems. For the unresolved cases, the participants were encouraged to put them into a letter that were later coursed through FOLPMI and sent to the concerned institutions. These unresolved concerns were about long fought rights on the ancestral domains in the ARMM Region, mining in Sorsogon, Educational Scholarship for the IPs, lack of potable water, livelihood and lack of health centers or medicines in the area. The Teduray represented by two participants expressed the lack of assistance from the ARMM local government. Tedurays who are non-muslim belong to the ARMM region. Their land has been slowly encroached by the Muslims for timber. The dignity of the ethnic minorities are often anchored on the land they are residing, cultivating and protecting, thus land grabbing is a great atrocity to their cultural identity.

In Sorsogon on the other hand, mining operations have been ongoing intoxicating the marine life and depleting the daily catch of the ethnic minority. Lack of educational grants for the IPs was also brought up since only a few institutions have been supportive. The IPs have difficulty in competing with the lowlanders in obtaining scholarships with their meager resources. As reported by some participants, there are some areas in the Philippines inhabited by the ethnic minorities that are not reached by the services of the barangay health center. Three of the above participants reported such cases. In addition, immunization programs couldn't even reach their areas. Some areas have barangay health centers but lacked the personnel such as the BHW. Some lack the facilities or medicines. After the devolution of the Department of Health, the operation of the health centers became under the local government. The decision on maintaining or improving the health centers became highly politicized.

CONCLUSION AND RECOMMENDATIONS

The 6th CHW training was generally successful. All the participants exhibited enthusiasm and satisfactory aptitude as new community health workers. Their achievement was certified by Sr. Eva Fidela Maamo, SPC, MD and by the government partners namely Dr. Carlos P. Buasen, director of the office of education, culture and health of NCIP, and Dr. Francisco T. Duque, III, the Secretary of the Department of Health. Preventive medicine was the emphasis of the whole training while equipping them as well with knowledge and skills in treating their patients. More importantly, the CHWs had workshops on leadership, community planning and networking with government and nongovernment agencies which is important in the nature of their job. The participants had a positive feedback on the duration, venue, facilities and personnel of the training. The training was both extensive and practical.

The training offered a venue for multisectoral partnership between the different tribes, government and nongovernment agencies. With the 6th batch, the FOLPMI has produced 188 graduates from the 77 tribes of the Philippines. There are 41 remaining unrepresented tribes. Thus, it is to recommended to pursue the 7th CHW training for them. In addition, it is recommended that Phase II be implemented which is the on site visit together with the updating and planning. It is important that the graduates are supported as they return to their hometown. They need to be integrated to the local health units of the barangay.
A few weeks after the training, a follow-up through the phone was done on the participants revealing 5 of them had gotten jobs and projects relating to health under the local government or community. The other participants who were BHWs continued their work. In addition, concerns on scholarship and ancestral domain were pursued. The FOLPMI has been searching for sponsors for scholarship grant while the Tedurays kept their communication as the FOLPMI became the bridge in lobbying their land rights to the NCIP.

The participants were interested in starting a Botika ng Barangay (local pharmacy) which is a program of the Department of Health. An orientation on Botika ng Barangay was done during the intesive phase. They recommended doing the training per region. Unfortunately, the personnel from the regional offices were often working on field making them elusive to communicate. Thus, it is suggested that the next CHW training should include the whole training of the Botika ng Barangay since the certificates that they will receive will be honored by the different regional offices.

COPYRIGHT @ PHILIPPINE-HEALTHNET thru Dr. Jason Abello

http://www.philippine-healthnet.blogspot.com

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Bring your Projects to the President of the Philippines

In case you need a format to get your project proposal to the president, yes the President of the Philippines, below is the format recommended by the Presidential Management Staff.

Other than making a barangay resolution to get your project funded or recognized, try to course your letter to the Chief Executive Officer of the Presidential Management Staff (PMS). The PMS is a recognized institution by the Philippine constitution which handles the assistance extended by the president.

PMS is located within the vicinity of the Malacanang Palace. I suggest you give your proposals personally to the said office and don't forget the receiving copy which is your only proof of the transaction.

It worked for us (with loads of pangungulit) since our proposal on instant nutrimeal was approved, I hope it will work for your organization as well.

The Addressee:
Her Excellency Gloria Macapagal Arroyo
President of the Republic of the Philippines
Malacanang Palace

Thru: Mr. Serge Remonde
Secretary
Presidential Management Staff

Proposal Format

I. Identifying Information

Project Title:

Project Sites:

Project Beneficiaries:

Classification of Beneficiaries

Estimated number of Beneficiaries

Project Partner: Organization, Address,Contact Persons,Telefax:

Project Duration:

Total Project Cost:

II. Project Description

Rationale

Project Description

Brief Description of Area / Site

Brief Description of the Beneficiary

Brief Description of Project Partner

III. Project Proper

1. Goal of Project

2. Objectives

3. Project Components

4. Critical Activities

IV.Organizational Chart

You can send your proposal to this address / like I've said, submit the proposal personally to this address:

Presidential Management Staff
PMS Building Arlegui Street, San Miguel
Manila NCR 1005
Local No.: 7343971 to 86

COPYRIGHT @ PHILIPPINE-HEALTHNET thru Dr. Jason Abello

http://www.philippine-healthnet.blogspot.com

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