DEMOGRAPHY AND SOCIAL PROFILE
A. Social Composition and Characteristics
1. Mother Tongue/Ethnicity
The people of Sagada, collectively called “iSagada”. Belongs to the Kankana-ey ethnolinguistic group, further classified as Applai, a group located on the western side of the province. Kankana-ey is widely spoken but with distinct variations in the different ilis in terms of diction, intonation, and accent. It is notable that most locals express themselves better in English than in Filipino.
2. Religious Affiliation
Unlike most Philippine towns, Sagada’s populace is predominantly Anglican. Other dominant religious affiliations include the Roman Catholic, Free Believers in Christ Fellowship Inc., Jehovah’s witnesses, Evangelical Protestant, Iglesia ni Cristo, Growing in Grace, Pentecostal Churches, Sapilada, and Baptist.
3. Historical and Cultural Heritage
Sagada is known for its rice terraces, the “hanging coffins”, the Sagada Mission Compound and the dap-ay. The stretches of rice terraces are traditionally farmed for substinces. The “hanging coffins” suspended on sheer cliffs is a type of burial reserved for the most distinguished or honourable leaders in the community particularly the most prominent figure in the dap-ay. The Sagada Mission Compound which is the living legacy of the Episcopal Mission Church is often visited for its historic value. The contributions of the Sagada Mission range from education, health, economic development, and social work. The St. Mary’s school continues to provide educational services through the financial and moral support of its alumni. The St. Theodore’s Hospital, which started as a dispensary, has become the primary medical center in Sagada in tandem with the government’s Rural Health Unit (RHU). The former St. Joseph’s Orphanage has been turned into lodging house for visitors. The Sagada Episcopal Church which trained many of the earliest Episcopalian bishops in the Philippines in its seminary still has the highest number of members in Sagada. As for livelihood, the Sagada Mission also taught the iSagada the arts of weaving, sewing and exporting many textile products to other Missions abroad.
In contrast to the western-influenced church, the dap-ay stands as a testament to the age-old traditions of the iSagada. It is low-roofed small building usually found at the center of an ili adjacent to open space paved with stones. Stools and back rests for elders, fashioned out of larger stones, form a ring around platform. Usually, a moyong, which is a large tree considered so sacred that no one can cut any part of it, stands on its center or side. Nowadays, though, the dap-ay hut is no longer built with pinewood and cogon but with galvanized iron and cement. The Dap-ay is the center of political, social, and religious functions in the community. It is the place of discussion for socio-economic issues, politics, values, beliefs, population concerns, the environment, opportunities, and any other topic affecting the lives of the people. It is also the center of traditional ceremonies and practices. Today, it remains the venue for making decisions, especially on land matters. Decisions are based on the rule of the majority. After a decision is made, information dissemination is the responsibility of the dumapay, or the people belonging to one dap-ay. The dap-ay is ruled by a council of male leaders known as amam-a who earned the distinction through age, wise decisions, and religious practice of all cultural traditions. But only minor or less contentious cases are discussed in the dap-ay nowadays with most cases go to the Lupong Pambarangay (village court). The dap-ay in some settlements have lost their traditional prestige as many of their elders have died out.
Other cultural practices that are no longer strictly imposed among tourists is the Obaya. Obaya is a time to rest for a day or a number of days, when people are not allowed to do their usual work in the fields nor go out of the community. Sometimes, and Obaya forbids visitors from entering the community. The extent and duration of the obaya depends on the reason for its imposition, such as the burial of a community member or a traditional ritual being performed at that time. Such rituals include the begnas, which signals the start of major event like planting or harvesting rice. Due to the pressing need to earn a living, however, the observance of obaya even among the iSagada has waned, as many people would rather work rather than take time off to take part in the ritual. In the past, most of their work revolved around the rice fields, where the dap-ay rituals were also based.
Traditional rituals during weddings and death are sometimes shortened wherein instead of performing the ritual for a week, the ama-a (council of leaders) can be requested into doing the ritual only for a period of three days. In weddings, the groom may ask permission of amam-a to do away with the rule that the newly-wed couple cannot go out the community for a couple of days, as this would affect their work. Babayas is the term for marriage ceremonies.
As for death and burial where butchering a total of 21 pigs and a number of chickens for all the rituals performed is a practice, is believed by almost a iSagada to be lessened because of economic reasons.
Unity has always been part of the iSagada culture. A customary practice that is slowly vanishing is the ob-obbo, or the cooperative effort of a group of people, which is often done during kay-kay (a time to prepare the fields for dry farming) or sama (a time to prepare the rice fields for wet farming). Ob-obbo practice extends to financial matters especially during special events like the babayas (traditional marriage ritual) and when someone dies. Supon (gift money or contribution) to the couple or to the head is a mean of investment in which the couple or the bereaved family needs to make a similar exchange in the form of money, goods, or services in the future, although not necessarily for the same occasion.
B. Population Size and Growth Rate
Based on the census data from the Philippine Statistical Authority (PSA),
the population growth rate of the municipality started to decline during the
1970’s dropping down to a growth rate of 3.09% in 1980. Primordial causes
of the decreased rate of population include the municipality’s 32 out-
migration trend due to the absence of tertiary schools as well as employment
opportunities outside the municipality for the locales of the municipality.
C. Population Distribution
Among the five (5) zones of Sagada namely Northern Zone, South
Central Zone, Eastern Zone and South Zone. The Northern Zone has the highest population with a percentage of 0.407% while the least populated zone is the Eastern Zone with 0.137%.
D. Population Density
The gross population density of the municipality is 1.22 persons per hectare (122 person per square kilometer) on the basis of 9,969.00 hectares of land as of the 2014 CBMS population. This shows a relative increase from the 2010 density of 1.13 persons per hectare (113 persons per square kilometer).
The main health facilities in Sagada are St. Theodore’s Hospital which is a private hospital, the RHU and eight Barangay Health Stations (BHSs). Most of the leading causes of consultations and some of the admitted cases were reported as manageable at the RHU and BHSs level.
The RHU has been certified for Sentrong Sigla Phase 1 only. It is also accredited for Outpatient Consultation and Diagnosis Package (OPB) and Tuberculosis Directly-Observed Treatment Shortcourse (TB-DOTS) under the Philippine Health Insurance Corporation (PhilHealth). It is equipped with the drugs, medical supplies, and equipment requirements for PhilHealth accreditation. St. Theodore’s Hospital is also accredited by the DOH and PhilHealth.
The MHO is the overall responsible health officer of the municipality. She/he is the overall manager, supervisor, trainer, and epidemiologist, medical and legal officer of the unit. She/he is ultimately responsible for all office and program activities.
1. Management: The MHO performs the whole range management functions – from planning to evaluation. She/he shall:
1.1 Make sure that the DOH program planning methodology is correctly followed by the RHU staff. This means that, among others, she/he shall make sure that the necessary data are available and are used properly; that appropriate joint meetings and adequate discussions of problems are held; and that the priorities for the municipality are in proper perspective.
1.2 Review, analyze and formally approve the consolidated annual RHU-based health plan. He/she shall also formally submit the plan to the municipal mayor if required.
1.3 Negotiate for the RHU resource requirements from appropriate bodies such as the Local Health Board or the District Health board.
1.4 Call and chair regular monthly staff planning, consultation, operations and review meetings.
1.5 Determine manpower needs and decide task assignment of RHU Staff. As much as possible, in collaboration with local government officials, other GO, and NGOs, plan special strategies to provide more efficient services.
1.6 Negotiate for staffing concerns such as additional staff items, detail or deployment of staff. Assessment of needs and requests for additional manpower shall take into consideration the hard to-reach areas.
1.7 Recruit, assess recommend new staff for hiring
1.8 Assess technical, managerial and communication skills of all RHU staff, especially the supervisory skills of the PHN.
1.9 Review and approve the proposed training plan for RHU staff, incorporating her/his training needs.
1.10 Provide on-the job training for specific needs to all RHU staff in all aspects at all possible contacts
1.11 Organize in-house courses for special topics as appropriate based on identified weaknesses and problems.
1.12 Develop, plan and implement an appropriate system of staff assessment, motivation and reward such as for instance, performance contracts.
1.13 Periodically visit, at least every 2 months and as often as the need arises, staff at the BHS level to countercheck supervisory findings and to resolve problems. Focus must be given to problematic areas brought to her/his attention by the PHN.
1.14 Provide feedback to the higher-level management regarding useful innovations developed or problems encountered at the RHU level
1.15 Review and approve tools, indicators and schedules for supervision and evaluation
1.16 Develop and enforce a system for proper management of logistics such as memorandum receipts, proper requisition and issue vouchers, stock records, at least twice a year ocular inventories, and other auditing and accounting procedures; This also includes reallocation of equipment to another BHS
1.17 Identify and tap community resources to augment resources.
2. Health Care: As the medical officer. The MHO is the technical expert in individual care of the patient. As such she/he:
2.1 Make sure that all RHU staff acquire the basic knowledge and skills required for the RHM and PHN. This will involve follow-through after formal courses, in-service training and continuing review of the clinical and patient care skills of the RHU staff, if possible at every contact with the staff
2.2 Countercheck the organization of the delivery of services, including flow of patient, proper management and referral of cases, and adherence to guidelines and standard treatment, management and referral protocols.
2.3 Translate the integration thrusts of the DOH particularly those in maternal and child care into practical steps to deliver services from the point of view of the clients, not the programs. This includes motivation of staff and testing of innovative schemes.
2.4 Attend to cases referred by the RHM and PHN in addition to new patients needing his/her care
2.5 Conduct barangay level clinics in each barangay in the municipality at least once every 3 months and as often as the need arises.
3. Epidemiology and Environmental Health: As the epidemiologist of the RHU, the MHO shall:
3.1 Learn and practice all epidemiological skills necessary to do disease surveillance and outbreak investigations.
3.2 Teach the RHU staff on the use of standard case definitions and assess staff capability to recognize the selected diseases.
3.3 Analyze weekly disease surveillance reports and immediately report outbreaks to proper authorities using standard formats.
3.4 Teach RHU staff how to properly analyze and interpret surveillance information.
3.5 Conduct epidemiological investigations on all reported outbreaks as much as possible. This includes checking the presence of signs and symptoms according to the standard case definitions and doing clinical confirmation and if available, laboratory tests of cases.
3.6 In a confirmed outbreak, institute appropriate disease control measures such as mass immunization; environmental control; or mass treatment of cases, among others.
3.7 Determine the cause of death of a person dying without medical attendance and issue the necessary death certificate.
3.8 Promote the registration of vital events such as births and deaths.
3.9 Supervise all the recording and reporting according to standard recording and reporting formats as well as the use of these information in the management of the RHU and its activities.
3.10 Exercise general supervision over the hygienic and sanitary conditions of the municipality, including private and public premises therein. In this connection, she/he shall:
· Enforce al sanitary laws and regulations applicable to his municipality and shall cause any violation to be duly prosecuted.
· Abate any nuisance endangering public health
· Identify the cause of any special disease or mortality; institute measures to eliminate these causes; and immediately report these cases to higher authorities.
· Enforce any internal quarantine regulations applicable to his/her municipality.
· Draft and recommend to the municipal council suitable ordinances or regulations for carrying into effect the powers conferred by law upon such body in respect to matters in sanitation.
4. Legal and Medico-legal: As such, the MHO shall attend to medico-legal cases, conducts autopsies and other medico-legal clinical assessments and appears in court as the medical expert when necessary.
5. Community Organization: As the head of the RHU, he/she shall formally represent the DOH in gatherings and activities in the community. He/she shall be the guiding force and inspiration for community projects. She/he shall:
5.1 Respond to requests for guidance, review and approval and attendance to community gatherings and projects.
5.2 Suggest community projects and activities and actively support these to make sure the objectives are attained. This shall include identification and allocation of resources if necessary.
6. District Support: The MHO shall perform District support functions, such as coordination and monitoring of activities and programs of the other RHUs within the District, when asked to do so.
PUBLIC HEALTH NURSE
The PHN should work closely with the MHO. Together with the MHO, she supervises RHMs and act as the immediate assistant to the MHO. If for some reason, the MHO is not available or is not able to execute her/his functions, the PHN performs the MHO’s functions as appropriate to her capabilities. Her perspective is essential in streamlining the activities of the RHMs she supervises, most especially the community health activities.
1. Management: The PHN assists the MHO in all the management functions. To do this, the PHN shall:
1.1 Provide technical assistance to RHMs in preparing their barangay-based health plans.
1.2 As much as possible, in coordination with local government officials, other GOs and NGOs, countercheck the barangay health plans and consolidate these for the municipal health plan
1.3 Assist the MHO in drafting a Municipal Health Plan incorporating RHU activities and resources needed to make sure the barangay-based health plans are accomplished
1.4 Assist the MHO in identifying needs in staffing and task assignments for RHU/BHS staff.
1.5 Recommend special strategies for organizing manpower such as mobile teams or bayanihan teams
1.6 Regularly assess the technical, management and communication skills of RHMs
1.7 Draft a 3-year training plan for all RHU staff, incorporating the training needs as discussed with RHMs and taking into consideration the training, skills and knowledge requirements for RHMs. The training plan shall include the skills desired:
· Title of specific courses available
· Methodology required like on the job practicum
· Preferred schedule, Venue for training
The 3-year plan should be updated yearly
1.8 Conduct post- training assessment for midwives
1.9 Attend supervisory skills development courses
1.10 Conduct at least once a month supervisory visits to each RHMs in their barangays according to the RHM’s capability and performance. This shall include:
· Preparation of supervisory visit schedules
· Development or adoption of supervisory checklist, indicators and tools
· Reporting of visit findings and problems
Difficulties and major or recurrent problems shall be referred to the MHO
1.11 Enter into the supervisory book kept by the RHM all her monitoring findings and recommendations and the date of next visit. This will serve as a guide for the RHMs appropriate action and reference for the next monitoring visit.
1.12 Act as overall property custodian of the RHU. This includes:
· Requisition, allocation, distribution and proper use of equipment, supplies and materials
· Training of other RHU staff on proper use of these materials
· Proper recording, reporting and accounting of these materials
· Timely referral for repair of nonfunctioning equipment.
She may be assisted by other RHU staff as designated by the MHO
1.13 Prepares and submits required reports/records. This includes:
· Review and validate reports /records of RHMs
· Consolidate BHS reports to come up with municipal reports
· Maintain adequate, accurate and complete recording and reporting
· Prepare statistical data for display and presentation during staff meetings, conference and seminar/workshops
2. Health Care: The PHN shall recognize the special midwifery skills of the RHMs and must provide, in general, the technical guidance to RHMs on the nursing aspect of care of individual patient. To do this, the PHN shall:
2.1 Provides direct nursing care to the sick/disabled in the home, clinic, school community or place of work
2.2 Aside from the nursing knowledge and skills, learn all the basic knowledge and skills
Required of RHMs
2.3 Review the management by the RHMs of a selected number of patients.
Her review shall focus on:
· Correctness of assessment of patient’s needs
· Faithfulness to procedures according to available guidelines and protocols on proper treatment and management such as, among others, proper management child with diarrhea or cough, or appropriateness and adequacy of medicines given, taking into consideration DOH policies such as national drug policy, and the policy not to use anti-diarrheal and cough medicines on children, the standard regimen of DOH, among others.
It shall therefore, be the responsibility of the PHN to know these relevant policies and communicate these to the RHMs
2.4 Develop and adapt tools that will assist RHMs in systematically delivering services in
A client-based manner. Such tools can include, among others, poster-size treatment and management charts and flow charts pasted on wall or desk-top checklists or other materials,
2.5 Propose clinic flow and management systems that will facilitate the smooth flow of
Patients; easy retrieval of patients charts and records and streamline health education activities and services.
2.6 Attend to referred cases within her capability
2.7 Assist MHO in minor surgical cases treatment at the RHU
3. Epidemiology and statistics: The PHN has an active role in disease surveillance and epidemiology of diseases in the community. She/he shall:
3.1 Propose and prepare tools for better analysis of service delivery and performance results like tables and charts of selected summative health indicators and special activities
3.2 Teach RHMs the standard case definition and use these in disease reporting
3.3 Immediately alert the MHO of any unusual increase in incidence of diseases taking into consideration selected diseases that need to be reported within 24 hours after the case is seen.
3.4 Assist MHO in outbreak investigations following proper guidelines by collating preliminary reports and filling-up case investigation forms, among others.
3.5 Assist in planning and implementing disease control measures especially mass immunizations, community assemblies, and health education classes during outbreak.
3.6 Plan and secure necessary resources needed for disease control measures. This include calculation of resources required such vaccines, needles, and syringes and other materials.
4. Community Health Organizations: The PHN has an important and active role in community health activities. She/he provides the perspective and overall direction to these community activities. The PHN shall:
4.1 Provide technical guidance to RHMs on proper identification of community health problems and strategies to solve these. She shall promote appropriate attitudes and concepts by making sure that the objectives of community participation and organization are clear to everyone and that effective methodologies to inform and mobilize communities are used.
4.2 Oversee monitoring of PHC committees, CVHW training, mothers’ class and other community activities.
4.3 Review curricula for CVHWs and other curricula or syllabi used in health education
activities. She shall make suggestions for improvement as appropriate.
4.4 Propose a municipal level health communication plan targeted at the general public or specific sectors of the community.
RURAL HEALTH MIDWIFE
The RHM is the most peripheral first level health worker in the health system. She translates health programs and plans into direct services to clients.
1. Management: In planning, budgeting and logistics management, the RHM shall:
1.1 Prepare an annual health plan for her barangays following the DOH planning methodology, as much as possible involving local Barangay officials and other community members. This includes collection of all necessary barangay level information needed in their plan; identification of problems and its causes; formulation of goals and measures; and identification of activities and resources required to accomplish these activities
1.2 In consultation with her immediate supervisor, submit a list of her training, knowledge and skills requirement for the RHM
1.3 Properly use equipment, drugs and other supplies according to standard treatment and management guidelines issued by the DOH. This function shall include proper recording and accounting of equipment, supplies and materials received, disbursed and utilized/distributed; and maintenance and referral for repair of equipment.
1.4 Properly maintain the health facilities and surroundings in her catchment area.
2. Health Care: In order to provide the best possible quality of service from a wide range of health services for individual patients, the RHM shall:
2.1 Learn all the basic knowledge and skills required of the RHM according to the standard requirements for RHMs through attendance in courses, in-service trainings and other learning opportunities.
2.2 Make a thorough assessment of the total health needs of her clients and their families, as much as possible during the first contact with the patient.
2.3 Provide the range of basic Maternal and child Health services according to her assessment of the needs of her clients and their families. These services should be provided in a continuing and comprehensive manner and with particular attention to high risk individuals and families.
Continuation of health care includes, among others:
Ø Completion of primary immunization doses so that all children are fully immunized before they reach one year old
Ø Completion of tetanus toxoid doses of pregnant women before they deliver
Ø Promotion and monitoring of growth from birth until the age of five years
Ø Regular prenatal, natal and postpartum care
Ø Promotion of responsible parenthood and family planning
Ø Early identification and management of persons with communicable and non-communicable diseases
Ø Promotion of sanitation activities
Ø Proper referral of cases beyond RHM capability
2.4 Provide primary health care services to her patients/clients and make the necessary referrals whenever the case is beyond her capability.
2.5 Conduct clinics in every barangay in her catchment area: at least once a week for barangays and once a month for the sitios.
2.6 Record all health services rendered, maintain a recording and filing system and keep a supervisory record book for her supervisors’ comments and recommendations.
3. Epidemiology and Statistics:
3.1 In disease surveillance and outbreak investigations, the RHM shall:
3.1.1 Report disease incidence using the standard case definitions.
3.1.2 Monitor a selected number of diseases by charting or graphing them on a weekly basis as they occur in her barangays.
3.1.3 Immediately alert the MHO of any unusual increase in the Disease incidence of any of the selected diseases. For some diseases like Polio, reports are needed within 24 hours after seeing the patient.
3.2 In the registration of births and deaths, the RHM shall accomplish reports according to standard routine reporting formats within a month after the birth or the death.
3.3 In program accomplishment feedback, the RHM shall regularly and accurately report service performance using the field health services information system. She shall also use information from this system in her routine management and health care functions.
4. Community Health and Organization: To promote community participation in health care, the RHM shall:
4.1 Identify community leaders and health volunteers and other GOs and NGOs.
4.2 As much as possible in coordination with other sectors, enhance the barangay health plan with community level information and diagnosis and prepare and implement a community health plan which includes:
4.2.1 Community meetings
4.2.2 Health education sessions such as mother craft and mothers’ classes, hilot classes, barangay health workers’ trainings and others.
4.2.3 Community health promotion projects such as environmental sanitation and other health activities.
4.3 Organize and monitor barangay primary health care committees and actively participate in existing community health organizations in the barangays.
4.4 Regularly follow-up and extend technical support to barangay health workers, hilots and other health volunteers within her catchment areas.
The Rural Health Medical Technologist performs routing laboratory tests, examinations and procedure utilizing the microscope, chemical reagents and other apparatus, to provide data for use in the diagnosis and treatment of diseases.
Specific Duties and Functions:
1. Performs microscopic examination of body secretions and body wastes to determine the presence or absence of pathogenic bacteria, parasites and other microorganisms.
2. Performs blood tests to determine hemoglobin content and morphology of blood, white blood cell count, differential count, groups and types blood to ascertain blood compatibility.
3. Performs chemical examination using chemical reagents on body tissue, body secretions and body excretions to provide pertinent data for diagnosis.
4. Checks accuracy and precision of laboratory test results and refers abnormal findings to the Municipal Health Officer.
5. Keeps and maintains a record of all laboratory procedures performed.
6. Prepares laboratory reports as may be required.
7. Checks availability of reagents and other materials/supplies needed in performing laboratory examinations for requisitioning purposes.
8. Assists in the training and monitoring of medical technicians and volunteers if the need arises.
9. Performs other functions as may be designated by the MHO.
10. Assists in the daily activities of the RHU.
1. Public Health Administration
a) Assists MHO in planning the program for environmental sanitation, and requesting the necessary budget and supplies to the authorities concerned.
b) Participates in planning and implementation of the total community health services, staff meetings, community meetings, conferences, trainings, etc.
c) Prepares sanitation reports and maintains proper filing system and updates sanitation records.
d) Establishes good working relationship with the different community organizations, especially the barangays and involves them in the planning and implementation of sanitation activities.
2. Environmental Sanitation
a) Water Sanitation- assists in the provision and maintenance of safe and adequate water supplies to the community
b) Excreta and sewage disposal- assists in the provision and maintenance of sanitary disposal facilities for human excrement and sewage
c) Food sanitation- assists in the provision of safe and wholesome food to consumers through proper enforcement of sanitary rules and regulations and train9ing of food operators and food handlers
d) Solid waste management- helps and promotes in the provision of sanitary storage facilities, and proper collection and disposal of solid waste either by individual, group or municipal system
e) Inspect and vermin control- assists in the elimination of breeding places and harborage, and conducts or guides organized control program
f) Public place sanitation- provide technical assistance for the provision of sanitary facilities and maintenance of the sanitary condition of public places such as schools, public buildings, parks, playgrounds, hotels, amusement and recreational center, etc.
g) Environmental protection- maintains close working relations with the environmental protection agencies such as the DENR, DAR, etc.
h) Inspection- carries out routine inspection of food establishments, hotels, sanitation facilities, etc.
i) Health education- takes the lead in the implementation of health education activities related to environmental sanitation programs.
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