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.

Figure 1. Aerial view 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.

B. GEOGRAPHIC DESCRIPTION

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 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 ____for females and 39.45 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 Western Cabul-an with a population of 1697 followed by another island barangay Eastern Cabul-an with an estimated population of 1630. 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 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. 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

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

its operational guidelines. The LGU has also been strict in the imposition of the NO HOME DELIVERY rule enshrined in the new ordinance and 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 th 4 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. 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. 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. In terms of sanitation a 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. 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 6anding (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 southern part which is comprised of the Block tiendas and other dry establishments has been reconstructed and is near completion. The northern 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 . 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. Majority 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 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 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 DATE OF CONSTRUCTI ON 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 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

CANGAWA DAIT NORTE BANTUAN CANTOMOGCAD LUBANG EASTERN CABULAN PANGHAGBAN CATIGBIAN MAGKAYA CANTUBA OVERLAND LUBANG LYING-IN CRUZ BATO

yes yes no no yes 6-10PM ONLY yes yes 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. Currently there are no other government and private facilities in the municipality that provides health facilities 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 NAME OF STAFF DESIGNATION STATUS OF RATIO OF STANDARD EMPLOYMENT STAFF TO RATIO POPULATION Dr. Romeo Aparece Municipal Health Contractual 1: 32,233 1:20,000 Officer /LGU-Hired Aileen Mahusay Public Health Permanent/ 1: 32,233 1:10,000 Nurse LGU- Hired Gladives Samson Dentist Permanent/ 1: 32,233 1:20,000 PHO-Hired Lorelie Nunez Rural Health Permanent/ Midwife LGU Hired Lucena Bautista Rural Health Permanent/ Midwife LGU Hired Sansen Mar Rural Health Permanent/ Midwife LGU Hired Ninfa Nunez Rural Health Permanent/ 7: 32,233 OR 1:3,000 Midwife LGU Hired 1:4604 Rosario Anasco Rural Health Permanent/ Midwife LGU Hired Juliet Bentillo RHMPP Contractual/ DOH Hired Wima Casquejo RHMPP Contractual/ DOH Hired Joyna Dinoy RHMPP Contractual/ DOH Hired Eleonor Lugod Medical Permanent/ 1: 32,233 Technologist PHO-Hired Teodora Cleopas Nutritionist Permanent/ 1: 32,233 PHO-Hired Ferdinand Racho Sanitary Permanent/ Inspector PHO-Hired 2:32,233 1:20,000 Aracelli Tumulak Sanitary Contractual/ Inspector LGU-Hired

Frema Dacapio Artechie Diacor Mark Johnuel Duavis Joane Gucor Jeffrey Membreve Fretzel Husain Francis Marie Tumabang

RNHEALS RNHEALS RNHEALS RNHEALS RNHEALS RNHEALS RNHEALS

Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired Contractual/ DOH Hired

7:32,233

The Public Health Nurse of the Municipality is also the designated Officer-inCharge 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 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 Covered Served Lorelie Nunez 6 5,697 Lucena Bautista 6 5,330 Sansen Mar 7 4,410 Ninfa Nunez 2 (island barangays) 4,301 Rosario Anasco 4 3,508 Juliet Bentillo 4 3,666 Wima Casquejo 6 5,321

No. of Hours/ week 72 hrs/week 72 hrs/week 72 hrs/week 88 hrs/week 80 hrs/week 88 hrs/week 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 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 17.5 15 10 5 0 2009 2010 2011 4.9 RATE 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 less than 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 1.66 1.9

RATE

2011

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 RATE STILLBIRTH 4 12.64 PNEUMONIA 2 6.32 CONGENITAL HEART DEFECT 2 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. 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 7 22.11 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 7 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. TABLE 5 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 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 83.9 83.2 83.85 HOME HOSPITAL

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. 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

% AP given complete dose of iron with folic acid

% AP given TT2 Plus

% AP with at least 3 or more AP visits

0 2011 2010

10

20

30

40

50

60

2009

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

% PP with at least 2 PP visits % PP with complete iron dosage % PP with Breastfeeding % PP given Vit. A 0 2011 10 20 2010 30 2009 40 50 60 70

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. 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

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.

GRAPH 8 FAMILY PLANNING CURRENT USERS BUENAVISTA, 2009-2011

1000 900 800 700 600 500 400 300 200 100 0

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

21

28

6 12 160 CONDOM 8 152 INJECTION 406

777

826

759

MALE/FEMALE LACTATIONAL STERILIZATION AMENORRHEA

PILLS

INTRAUTERINE DEVICE

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

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.

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

15

10 NUMBER OF CASES DETECTED

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. TABLE 6 ENVIRONMENTAL INDECES MUNICIPALITY OF BUENAVISTA ENVIRONMENTAL INDEX 2009 2010 2011 Household with Sanitary Toilet 3429 4317 4736 Household Level 1 712 589 328 with Potable Level 2 2755 2409 2268 Water Supply Level 3 378 396 460 Household with Satisfactory Garbage 4212 4132 4212 Collection/disposal No. of Food Establishments 123 133 166 No. of Food Establishments with Sanitary 123 133 166 Permits No. of Food Handlers 200 238 264 No. of food Handlers with Health certificates 200 238 264 Salt Sample tested 1114 1250 96 Salt Sample found with iodine 1114 1250 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 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. TABLE 7 VACCINATION STATUS OF CHILDREN 0-12 MONTHS BUENAVISTA, 2009 TO 3RD QUARTER 2012 VACCINE 2009 2010 2011 2012 (1ST TO ANTIGEN 3RD QUARTER ONLY) BCG 649 601 669 466 DPT 1 575 546 227 503 DPT 2 544 544 263 542 DPT 3 526 488 296 543 OPV 1 576 556 683 502 OPV 2 545 549 643 535 OPV 3 536 485 593 543 HEP 1 224 247 239 281 HEP 2 492 516 82 HEP 3 452 475 148 MEASLES 575 441 596 515 MMR Not available Not available Not available 207 ROTAVIRUS 1 Not available Not available Not available 67 ROTAVIRUS 2 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.

GRAPH 12 FULLY IMMUNIZED CHILDREN BUENAVISTA, 2009-2011

80 70 60 50 40 30 20 10 0 2009 2010 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 2009 2010 2011 No.of Diarrheal Cases Number of Diarrheal Cases given ORS

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.

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 DIARRHEAL CASES DIARRHEAL CASES GIVEN ORS

II. III. IV.

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. SWOT ANALYSIS STAKEHOLDER ANALYSIS, STRATEGY FORMULATION PLANNING AND PROJECT DEVELOPMENT

MARK JOHNUEL DUAVIS, RN ARTECHIE DIACOR, RN JEFFREY MEMBREVE, RN FRETZEL HUSAIN,RN