IPs from Different Parts of the Globe: Changing Health Care Delivery System

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Rosa is a member of an IP community. Used to their traditional ways of healing, lack of financial resources, and fear of being discriminated prevents her and her family members from availing the services of the community health center. This, however, gradually changed when the Municipal Health Office in their town approached their village elders and informed them that health service access and delivery can be in their hands. They were gathered for a meeting, then invited to attend training on health and taught how to make survey forms to know the health conditions of the community, then further trainings analyzing the survey forms, and soon making their own community health program. Not long, Rosa became one of the Community Health Workers (CHWs) receiving and also sharing health services to her family and other IPs in their area. Now she’s also training other volunteers to become CHWs and is engaged in the community health financing scheme where each family contributes one peso a day for use by any of the member families in case of sickness. She feels empowered to receive and provide health services and to advocate for health for all IPs.

This is just one of the many similar stories shared at the recent international workshop on Empowerment of Peoples through Community Participation for Sustainable Local Health System: The Case of Tanay, Rizal, Philippines.

“The IP situation in Tanay maybe unique but the needs to address the health concern of the IPs is universal,” said Mayor Rafael Tanjuatco of Tanay. The International Workshop focused on the sharing of the Municipality of Tanay and other countries’ experiences on community empowerment, especially the IPs, in taking charge of and bringing health care services to the people.

Focusing on the use of alternative medicine and recognizing the values of traditional herbal plants, Governor Rebecca Ynares of Rizal Province said that “the time has never been better and the reasons never greater for giving traditional medicine its proper place in addressing the many ills of the modern and traditional societies, including the IPs. It is only when there is recognition of indigenous resources as priority areas for development that the empowerment of the IPs will be attained.”

The Workshop was organized by the Integrative Medicine for Alternative Health Care Systems (INAM) Philippines, Inc., the Asian Health Institute, and the Municipality of Tanay, Rizal, Philippines with support from the Philippine Institute of Traditional and Alternative Health Care (PITAHC), Philippine Department of Health, Philippine National Commission on Indigenous Peoples (NCIP), Bread for the World, and Shell Philippines. Participants of the Workshop included 30 community health workers, government representatives, non- government organizations, and partner organizations from Bangladesh, India, Japan, Nepal, Philippines, and Thailand. The organizations present were Bangladesh’s Development Association for Self-Reliance, Communication and Health (DASCOH), Community Group of Kodom Shohor Community Clinic, and Community Group of Gopalpur Community Clinic; India’s Center for Community Development, Government of Arunachal Pradesh, and Karuna Trust; Nepal’s Milijuli Health Cooperative and Shindhuli Integrated Development Service (SIDS); Thailand’s National Health Commission Office and Trang Hospital; Philippines’ Aloran Community Health Workers and Rural Health Unit, Barangay Health Workers Organization, Eboangan Indigenous People Tribal Association, General Nakar Health Organizers, Health and Development for All Foundation, Inc., Community Health Workers and the Municipal Health Office of New Corella, the Institute for Primary Health Care (IPHC) – Davao Medical School Foundation, Tanay Community Health Workers, Program Managers, and Rural Health Unit.

Making health service available

According to Dr. Isidro Sia of PITAHC, delivery of social services including health care services is an urgent concern among the marginalized Filipinos. However, lack of access and equity may be said to characterize the delivery of health care services. This is the case too in most developing countries.
This is where non-government organizations come in, to partner with the government in contributing to a more responsive and sustainable health care delivery system that is of good quality, available, accessible, affordable, and acceptable to the community.

“NGOs such as INAM come in not to bring programs but to learn with the community and the IPs what the health situation is and from there, train community health volunteers to establish community health programs appropriate to their needs and the resources available in their areas,” said Maria Cristina C. Paruñgao, INAM Philippines Executive Director.

She added, “the public-private partnership between Tanay Municipal Government and INAM Philippines, with the support of Asian Health Institute and Bread for the World, was effective in empowering the IPs through the Philippine Integrative Medicine (PIM) curriculum and through enhancing the local health system of Tanay.”

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From the presentations of the different countries on their health status, poverty and new threats to life such as climate change, political instability, and worsening natural calamities are a common thread among marginalized communities served. All of these further affect the health of IP communities in geographically isolated and disadvantaged areas.

The different organizations present, however, have addressed some of these challenges through community participation expressed in various ways: through direct service provision and through training of volunteer health workers in community health work, participation in decision-making process, community-initiated financing, and networking with different groups.

Several samples of health care provision to the marginalized are through Thailand’s bottom up approach in identifying the nation’s health agenda for the National Health Assembly; Nepals’s cooperatives, savings, and loans; India’s NGO-government-community partnership and focus on livelihood as a means or a prerequisite prior to addressing health; Bangladesh’s NGO running of government community clinic; and the Philippine Integrative Medicine (PIM) training IPs towards the establishment of their community-managed health programs.

Challenges and the Need for Paradigm Shift

Through years of work in bringing health care to the marginalized, challenges and threats need to be met with a corresponding change in the mindset of health professionals and development workers.

“Change in perspective is needed through projects focusing on IPs, women, PWAs, and PWDs. These also is a need to acknowledge that local health system can be built through participation and a need to redefine health as total well-being of a person or communities as a result of the interplay of political, economic, spiritual, and socio-cultural aspects,” said Sr. Dulce Velasco, INAM Philippines Vice President.

“How we see the poor should also be modified. There is a need to move away from seeing the poor as uneducated and therefore need help. If the new definition of health comes into play, it becomes evident then that health improvement is community development. It is part of the paradigm shift that needs to happen. Services need to be provided by the government but the reality is governments are unable to deliver,” pointed out Sr. Velasco.

Thus, there is a need for a constant dialogue among stakeholders.

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Mohammad Akramul Haque of Bangladesh said that the workshop and the three-day field visit/homestay in Tanay IP communities can be summarized into three words: appreciate, connect, and replicate. He explained that he appreciated that nobody hesitated to participate despite the communication difficulties. With the sharing of experiences, he felt connected with the other organizations and what they learned can be replicated in their respective areas.

Marilyn Buendicho, a community organizer from General Nakar in Quezon province, expressed gratitude for INAM, citing that for the past five years, their community faced great challenges and yet thanks to those challenges, they were able to broaden the experience of IPs. She further added that she is at her happiest when she is able to help instead of receiving assistance.

Dr. Raja Dodum from India remarked that as the head of a medical department in India, his experience the past week has humbled him and helped him find new respect for the IPs.

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The workshop concluded with the different organizations presenting what they learned from the other countries’ presentation and their action plan. With the International Workshop, CHWs, community health volunteers (CHVs), local governments, and organizations from different countries working to improve the health situation of poor communities are bringing home valuable learnings from each other. This is made possible through the sharing of practices and strategies in community participation that leads to the development of sustainable local health systems in their respective countries.