NEEDS ASSESSMENT OF BARANGAY HEALTH WORKERS (BHWs) IN

DELIVERING HEALTH CARE PROVISIONS IN BARANGAY DAWIS, DIGOS

CITY, PHILIPPINES
PROF. DENNIS JOHN F. SUMAYLO
Assistant Professor 1, Department of Humanities
College of Humanities and Social Sciences
University of the Philippines Mindanao

MS. MA. TERESA R. ESCANO, Instructor 7

MR. DOYLE FELIX T. ABRIO, Instructor 1
College of Humanities and Social Sciences
University of the Philippines Mindanao
ABSTRACT
It is the objective of this paper to document the needs of Barangay Health Workers in the
provision of health care program of the Department of Health in the Philippines. Furthermore, this paper
also documents the current communication tools used by the BHWs for both internal and external publics
of the Barangay Health Center to provide justifications of the needs of the BHWs in the provision of health
care programs.
Provided with the current framework of operation, the top-down model of communication is
widely implemented rendering all directives and communication are from the Department of Health
Central Office. The Central Office also provides a Manual on Interpersonal Communication and Counseling
as basis for the BHWs in implementing various health care programs. However, this method is linear in
nature and not transactional which is what health communication should be.
In the implementation of various health care programs in the barangay level in the Philippines, it
must be noted that inputs from those familiar with the locale and the people are important for a
successful communication flow. A transition from top-down to bottom-up communication is necessary in
situation where the focus of information is based on the needs of a community. This communication
system stresses the importance of empowerment of BHWs in event organization, strategic
communication planning and message development, and highlighting transactional communication in the
process.
The Barangay Health Workers (BHWs) need to come up with their own strategies in delivering
health care provisions to their clients/patients is a clear indication of this. This communication flow
provides top organization personnel with ideas/feedbacks from those working at the grass-roots level.

Keywords
Interpersonal Communication and Counseling, Health Communication, Health Promotion Methods,
Health Service Accessibility, Public Relations, Transactional Communication, and Development
Communication

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I.

INTRODUCTION

Barangay Dawis is home to people coming

from different cultures. The place was originally
inhabited by the Indigenous People called Calagan
before other settlers came. It is a coastal area
facing Davao Gulf. Its northern boundary is
Barangay Aplaya, Digos City while the southern
boundary is the Municipality of Hagonoy in Davao
del Sur. Living near a body of water is a common
trait of the Calagans in other parts of Mindanao.
Most of the residents are Catholics and the source
of livelihood is fishing. Since the area of study is a
coastal area, it is expected that there are resorts
and inns as well.

The systemic flow of communication in

the provision of health care services in the
Philippines starts with the Department of Health
(DOH) Central Office down to its Regional Offices.
From
the
Regional
Offices,
the
information/directives are passed on to the
Provincial and City Health Offices under each
region and then down to the Barangay Health
Centers (BHCs) manned by a government-paid
midwife and volunteer residents called Barangay
Health Workers (BHWs).
This system is known as top-down system
of communication. The inversion of the process
follows when information/data is submitted from
the grass-roots level of implementation of health
care provisions to the DOH Central Office. Given
this particular organizational structure and flow of
information, it is assumed that communication
breakdown may occur in any of the channels
involved.

Barangay Dawis is called Lawis by the IP

(Indigenous People) group Calagan which means a
body of water that has no outlet. It has a total land
area of 175 hectares which is divided into
residential and commercial lots. The Barangay is
divided into nine puroks with 899 households. As
of 2007, the total population of the Barangay is
3,884.
The first inhabitants of the Barangay are
the Calagans but Dawis, as it progressed into a
commercial area with beach resorts and apartelles
as major businesses, became a melting pot of
several other local cultures which resulted to its
having several dialects (Blaan, Tagakaulo, Bagobo,
Muslim, Cebuano, Bol-anon, etc) spoken in the
area.

This paper then documents the

communication tools used in this kind of
communication situation and further identifies the
needs of the implementers of health care
provisions in the grass-roots level. This involves
the volunteer residents or BHWs since most of the
data will emanate from them.
This paper also tries to present a needs
assessment base on a specific case in Barangay
Dawis, Digos City, Philippines in the form of
surveys and interviews of all fourteen BHWs in the
barangay.

Currently, the barangay has 899

households divided into nine puroks. Each purok
has several households as follows and serviced by
14 BHWs:
Purok
Number of Household
Bangus
145
Tanguigue
156
Maya-Maya
119
Talakitok
156
Bariles
32
Barongoy
47
Lapu-lapu
64
Kitong
124
Bolinao
56
Total
899
Table 1: Number of Households

Furthermore, this paper enumerates

variables that are deemed important by the BHWs
in a specific area of study. Its main purpose is to
document the needs of the implementers rather
than generalize.
II.

BARANGAY DAWIS

III. RESULTS
This paper documents the needs of
Barangay Health Workers in delivering health care
provisions from the government focusing on

Figure 1: Map of Barangay Dawis

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communication tools intended for both internal

and external publics of the Barangay Health
Center. This involves inter-agency communication
and communication within the Barangay Health
Center and communication between BHWs and
clients/patients. It is also necessary to establish
the common health problems in the area to know
if these are properly addressed by the
communication tools used.
Table
2
:
Com
mon
Disea
ses in
Baran
gay
Dawis
,
Digos
City

Disease
High
Blood
Pressure
Tuberculosis
Malnutrition
Diabetes
Skin Diseases
Dengue
Hepatitis

Frequency
13

Percentage
92.86

13
13
4
3
2
2

92.86
92.86
28.57
21.43
14.29
14.29

In the survey conducted, respondents

were asked to identify the various communication
tools used in delivering health care provisions to
clients/patients and communicate with the City
Health Office. Each respondent was allowed to
choose more than one tool to properly document
the commonly used tools in these communication
scenarios.
The commonly used communication tool
between the Barangay Health Center and the City
Health Office is monthly reports. Every month, the
Barangay Health Center, through its head, receives
monthly reports of the activities and projects of
the City Health Office. Meetings ranked second.
On the other hand, Face-to-Face
Interaction is common between Barangay Health
Center and the Barangay as Local Government
Unit. This is attributed to proxemics. The Barangay
Health Center is located at the Barangay Hall. The
office of the Barangay Captain is directly above the
Barangay Health Center, which is located at the
first floor of the building. Sending memoranda is
not necessary because the Barangay Health Center
is under the City Health Office and most of the
communication through memos is coming from
the mother organization.

Each of the 14 respondents was asked to

identify the common diseases in the Barangay.
Majority of them answered Tuberculosis and
Hypertension as the most common diseases
among the adults while Malnutrition is common
among children. This data is necessary to establish
the problems in the area and the tools used to
address these problems. The data in Table 2 is
useful in the process of understanding the
strength of the communication tools and the need
of the BHWs in crafting these tools.

It should also be noted that some of the

respondents answered text messaging as an
alternative way of sending information. They rely
on technology depending on the urgency of the
message.

Base on initial studies, the following

communication tools were used in communicating
with the City Health Office (CHO) and the
Department of Health Region 11 (DOH-RXI) and in
delivering health care services to clients/patients
in the area:
Communication
Situation
Communication
within the
Barangay Health
Center and other
Agencies
Communication
between
Clients/Patients

Meetings and face-to-face interactions

are common when communication is within the
Barangay
Health
Center.
This
means
communication situations involving the midwife
and the BHWs.

Communication Tools

Memoranda, Monthly
Reports, Semi-Annual
Reports, Annual
Reports, Face-to-Face
Interaction, Meetings
Flyers, Leaflets,
Posters, Brochures,
Fact Sheets, Public
Service
Announcements, Faceto-Face Interaction,
Text Messaging
Table 3 : Communication Tools used by BHWs with the
System of Communication

Table 4 summarizes the commonly used

tools in communicating within and outside the
Barangay Health Center.
Organization
City Health Office

Communication
Tools

Monthly Reports
Face-to-Face
Barangay (LGU)
Interaction
Face-to-Face
Barangay Health Worker
Interaction
Table 4 : Effectiveness of Handling Information Per
Organization

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Within the parameters of the systems

framework of operation, as shown in Table 5,
85.71% or 12 respondents said that the framework
of operation does not affect the delivery of the
message while 14.29% or 2 respondents said that
it is affected by the framework.

Communication and Counseling, but in other

communication tools as well.
There is only one computer in the
Assistance Needed
Event planning
Strategic
Communication
Planning
Message
Development
Audience Selection
Public Speaking
Media Relations
Materials
Development
Public Service
Announcements
Internet Outreach
Advertising

Responses
Frequency
Percentage
Yes
2
14.29
No
12
85.71
Table 5 : Effect of the Systems Framework of Operation
to the Communication Process

Despite this belief that the Framework of

Operation does not necessarily affect the
communication process, BHWs still encounter
problems, which include delays of notices in
program implementation, the inability to organize
programs and conduct their own activities, and
information lag from the City Health Office.

Modal Rank
1
2

Importance
st
1
nd
2

4
4
5
7

4
th
4
th
6
th
7

9
10

8
th
10

rd

th

th

th

Barangay and it is not owned by the Barangay

Health Center. Moreover, only eight of the BHWs
have access it. Also, the respondents answered
that they need training in using the Internet and
designing communication tools.

It is understood that there are some

projects conceptualized by the Barangay Health
Workers specifically designed for the immediate
community that could be put on hold or worst,
trashed. This is attributed to the framework of
operation wherein all activities of the Barangay
Health Center require approval from the City
Health Office. The implication of this problem is
that there is a greater possibility that in due time
and because of immediate need, the Barangay
Health Center will conduct an activity without the
approval of the City Health Office.

Table 6 : Assistance Needed

Table 6 shows the kind of assistance the

Barangay Health Workers need to improve their
delivery of health services. Event Planning ranks
first in terms of importance followed by Strategic
Communication
Planning
and
Message
Development. Event Planning involves organizing
effective events while Strategic Communications
Planning involves developing and implementing a
targeted communications blueprint for the
organization. Message Development, on the other
hand, means figuring out what to say for an
intended audience.

However, in an interview with Mary

Divene C. Hilario, RN, MPH, the officer in charge of
the Health Advocacy and Promotion Unit of the
Department of Health Region XI, she emphasized
that Barangay Health Centers can actually come up
with their own communication tools without
approval from the City Health Office nor the
Regional Office provided that it follows the DOH
Guidelines.

Event planning ranks first because most

of the time, the Barangay Health Center organizes
community meetings and consultations. These
community meetings and consultations require a
strategic communication plan and a specific
message before its implementation. The modal
ranking of the assistance needed coincides with
this model.

This particular situation is an example of a

communication breakdown.
Therefore, it is appropriate to look at the
capacity of the 14 Barangay Health Workers in
terms of designing communication tools. To them,
lack of training in designing communication tools is
a major problem followed by lack of resources.
This further emphasizes the need of the BHWs to
gain more skills not just in Interpersonal

IV. IMPLICATIONS
Given the current framework of
operation, BHWs are still equipped with the basic
knowledge in delivering health care provisions in

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their assigned areas since the City Health Office

has trained these volunteers in Interpersonal
Communication
and
Counseling
(IPC/C).
Furthermore, Hilario also emphasized the
importance of delivering correct medical
information to their clients/patients.

a response and then an adjustment or follow-up by

the person who first acted.
There is a need to go beyond statistics in
the implementation of health care programs in the
grass-roots level. Andres (1988) highlighted the
fact that trainers/facilitators/community leaders
should go beyond information dissemination and
statistics. As Hovland (2007) reiterated,
communication planners should be equipped with
planning and monitoring tools to implement
community-based projects. In fact, going beyond
information dissemination is practiced since 1947
starting with Radio Sutatenza in Colombia.
(Dagron, 2001) Hovland (2007) also highlighted to
package the message in various ways like stories
and highlight persuasion in the message rather
than pure information dissemination.

Given this, the IPC/C Manual from the

Department of Health Central Office focuses only
on factual information in delivering health care
provisions. The manuals way of monitoring is very
clinical in nature relying on statistics as sole
measurement of success in any health care
program of the government. The same set of
statistics is often used to generalize.
However, these volunteers take their
tasks beyond the statistics it can provide. They
want to be able to come up with their own
strategies in delivering health care provisions to
their clients/patients. Despite the problems
identified with this kind of framework of
operation, these volunteers still believe that it is
still a good operational framework. As Max
Webers Theory of Bureaucracy explains, the best
way to manage the complexity of an organization
compose of individuals with one aim is to come up
with three basic rules - authority, specialization,
and rules. (Littlejohn, 2008) According to this
theory, the BHWs are considered legitimate
authorities since the City Health Office formally
authorizes them. Furthermore, in this framework
of operation, people are categorized according to
what they can contribute in achieving the goal
thus creating specializations. The BHWs specializes
in the grass-root implementation of various health
care programs of the government since they are
the ones familiar with the locale and the people.
Lastly, the BHWs follow the same set of rules and
guidelines coming from the Department of Health
Central Office.

The need of the BHWs to use the Internet

is also relevant in the delivery of health care
provisions. As cited in Speaking of Health:
Assessing Health Communication for Diverse
Population (2002), health communication should
be more interactive. Face-to-face interaction is still
important but with the continuous change in the
communication landscape, alternative tools should
be developed or widely implemented. Monitoring
is also beyond statistics but rather on the
significant change that happened to the individual.
Hovland (2007) proposed several methods of
monitoring that are not included in the IPC/C
Manual. Most Significant Change (MSC) is used in
most Strategic Communications Planning. Other
monitoring tools include Outcome Mapping and
Communication for Social Change (CFSC)
Integrated Model. (Hovland, 2007)
Health Communication is Transactional
Communication and the current communication
scenario in the provision of health care services in
the Philippines is purely linear. Given this change
in the communication landscape, further trainings
for BHWs on Event Planning, Strategic
Communication
Planning
and
Message
Development are deemed important.

The simplicity of Webers Theory of

Bureaucracy is not enough to document the on
site implementation of various health care
programs. The Cybernetic Tradition of Karl Weick
as cited in Littlejohn (2008) explains the BHWs
situation in a detailed way. According to Weick as
cited an Littlejohn (2008), an interaction that
forms an organization consist of an Act, or a
statement or behavior of an individualan Interact
that involves an act followed by a responseand a
Double Interact that consists of an act followed by

V. BIBLIOGRAPHY

Andres, Tomas Quintin D. (1988). Community

Development: A Manual. New Day Publishers,
Quezon City, Philippines.

[45]

Dagron, Alfonso Gumucio. (2001) Making Waves:

Stories of Participatory Communication for Social
Change. The Rockefeller Foundation, New York.

Organisations. Overseas Development Institute.

London.

Department of Health and HealthPRO. (2012)

Interpersonal Communication and Counselling
Manual for Health Service Providers.

Institute of Medicine of the National Academies.

(2002). Speaking of Health: Assessing Health
Communication Strategies for Diverse Populations.
The National Academies Press. Washington, DC.

Hovland, Ingie. (2007) Successful Communication:

A Toolkit for Researchers and Civil Society

Littlejohn, Stephen W., & Karen A. Foss. (2008).

Theories of human communication (8th ed.).
Thomson

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