Exemplary Practices: PHC - Balilihan, Bohol

BALILIHAN, BOHOL

“PUROK POWER” FOR PRIMARY HEALTH CARE Balilihan Countryside Action Program

“PUROK POWER” FOR PRIMARY HEALTH CARE Balilihan Countryside Action Program Copyright © 2004 Philippines-Canada Local Government Support Program (LGSP) The Philippines-Canada Local Government Support Program encourages the use, translation, adaptation and copying of this material for non-commercial use, with appropriate credit given to LGSP. Although reasonable care has been taken in the preparation of this book, neither the publisher and/or contributor and/or editor can accept any liability for any consequence arising from the use thereof or from any information contained herein.

Printed and bound in Manila, Philippines Published by: Philippines-Canada Local Government Support Program Unit 1507 Jollibee Plaza Emerald Ave., Pasig City 1600 Philippines Tel. Nos. (632) 637-3511 to 13 www.lgsp.org.ph This project was undertaken with the financial support of the Government of Canada provided through the Canadian International Development Agency (CIDA).

CONTENTS Summary

1

About Balilihan, Bohol’s Countryside Action Program (CAP)

3

Project History

5

Project Description

5

Project Results

7

Replicating Countryside Action Program (CAP)

8

Key Implementation Steps

8

Reference Matrix On Replicating Countryside Action Program

10

Lessons And Insights In Replicating The Project

11

Annexes

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Summary

U

nder the local governance system, puroks are sub-units of the barangay, which is the basic political unit of the government. Traditionally, however, puroks are no more than loose geographical groupings of households within the barangays, with little political or social function.

In Balilihan, Bohol, the lowly “purok” has been transformed into a powerful tool for community mobilization and action, particularly in the area of primary health care.

In 1998, then newly-elected Mayor Edgar Chatto saw the potential of harnessing puroks as a main force for the delivery of primary health care services. Mayor Chatto launched the Balilihan Countryside Action Program (CAP) with the aim of mobilizing and organizing local government, rural health units, health personnel and local residents towards the more effective delivery of basic services.

“PUROK POWER” FOR PRIMARY HEALTH CARE Balilihan Countryside Action Program Balilihan, Bohol

The program had two core strategies: 1) capacity building at the municipal and barangay levels through training, to strengthen such structures as the Municipal Development Council, the Municipal Council, the Barangay Development Council, and 2) mobilizing and organizing households into puroks or health zones that would then identify problems and needs, formulate actions and undertake programs at the purok level.

Today, a total of 186 puroks have been established in the 31 barangays of Balilihan, with 1,302 sectoral volunteers organized and acting as a semi-autonomous extensions of the local government. Some 50% of the population actively participates in purok activities, including livelihood projects, health care services, feeding programs, vegetable and herbal gardens. Various infrastructure projects have been undertaken, accessed by the puroks themselves from the national line agencies through the support of the municipal government. Most importantly, Balilihan has been able to meet 95% of its health and nutrition targets.

In 1997, the municipal government of Balilihan approved an ordinance institutionalizing the purok system in every barangay, thus ensuring its sustainability.

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Balilihan’s success has not gone unnoticed. In 1994, Balilihan won the Health and Management Information System (HAMIS) Gold Medal awarded by the Department of Health. The German Agency for Technical Cooperation (GTZ) recognized Balilihan as having the most Outstanding Health Care Management Program in.

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Bantay sa Kahusay Ug Kalinaw (BKK): Oroquieta City, Misamis Occidental

ABOUT THE PROJECT Project History: Turning Failure into Success The idea of mobilizing puroks was not new to Balilihan. The Rural Purok Initiative, a strategy of the Department of Health for rural health care was first launched in 1983. The initiative did not take off, however, mainly due to the compartmentalized view and system for delivering health care at the time and the lack of support from the national and local government. With the devolution of health services, the time became ripe for reviving the project.

The Purok system under the Baliliha’s CAP has been attracting

When Mayor Edgar Chatto assumed many visitors (e.g. healthworkers) for possible replication in their respective areas/LGUs office in 1988, he built on the beginnings of the Rural Purok Initiative and drew in other sectors to carry out a more holistic mode to development; he also gave it a new name the Countryside Action Program. One of the components of the Countryside Action program was the Primary Health Care through Purok.

The primary health care component had 4 objectives: 1. Raise health consciousness among residents 2. Organize teams of purok-level volunteers that can assist the municipal health workers in maximizing health services at the purok level 3. Encourage the design and implementation of purok-level livelihood projects 4. Mobilize human and material resources for networking with national agencies and NGOs for the implementation of community-based health programs

Project Description: Power at the Purok Level Capacity Building from the municipal to barangay level The CAP framework departed from the usual top-down approach. The Mayor begun the program by launching a series of capability-building programs. Among the first trained were the municipal government officials and employees, the members of the Municipal Development Council and local legislators. The Association of Barangay Chairs and the Barangay Development Councils as well as other barangay officials also held their own seminars on barangay administration, planning and project management.

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Residents also participated in training focused on sectoral concerns and technology transfer.

Armed with new skills and attitudes, the municipal and barangay personnel were ready to engage the municipality as partners in development. CAP was launched with its purok system, giving spirit to empowerment through community organizing, mobilization and human resource development.

Setting up the Purok Kiosks as Activity Centers The target population of CAP was the 14, 527 residents in the 31 barangays of Balilihan.

These people were mostly marginal farmers of rice, corn and other staples. Each of the 31 barangays was divided into six (6) puroks composed of 10-25 households, resulting in a total of 186 puroks of the entire municipality.

The main feature of the program that mobilized the community to participate was the construction of cluster houses or Kiosks made up of indigenous materials. The Kiosk has the features of a typical home and served as model for the members. Each Kiosk had the following: 1) Meeting / teaching area; 2) Kitchen; 3) Water sealed toilet; 4) Seed house; 5) Compost pit / pile; 6) Herbal garden; and 7) Vegetable garden.

Constructing the kiosks in every purok became the starting point for the mobilization of the community. With the kiosks constructed, they served as community centers for the conduct of meetings and health activities such as immunization drives, operation Timbang (weighing children to check for malnutrition), mass feeding, first aid treatment and training. These health activities and the presence of a structure built by their own hands, in turn made it easier for the community to move beyond health concerns to other community problems, such as livelihood and income generation and cooperative formation. The kiosks made it easier for people to congregate, and encouraged discussions on identifying problems and needs of the community and how best to address them.

Each activity center or Kiosk has installed a system whereby residents take part in monitoring their health conditions and addressing their conditions through problem-solving activities with the purok leaders. Community members of each purok have set up systems for managing and implementing activities. Among the systems put in place: • • • •

Complete record of meetings Health data boards Household profiles Organizational charts

Purok leaders also coordinate with the Barangay and municipal health workers for health campaigns, and with the barangay and municipal government for other activities. Puroks also

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Bantay sa Kahusay Ug Kalinaw (BKK): Oroquieta City, Misamis Occidental

network with national line agencies for specific projects identified by the puroks.

Project Results: A Kiosk in Every Purok, Power in Every Community 1. Meeting Health and Livelihood Needs Today, each of the 186 puroks has initiated an income-generating activity for its members. In addition, puroks Barangay officials outside Bohol Province in a visit to one of the Kiosks under Balilihan’s CAP also undertake other projects, such as vegetable and herbal gardens, compost pits, seedhouses, water-sealed toilets. As a result of the livelihood projects, a 50% increase in agricultural production was noted after 7 years of implementation.

This enabled the community to meet 95% of its health and nutrition targets. Various infrastructure projects were undertaken by provincial and national government agencies.

2. Creating a New Social Institution With its established puroks and currently 1,302 sectoral volunteers, the puroks now act as semi-autonomous extensions of the government. With these purok-level organizations, nearly 1 out of every six adult Balilihanhon is a sectoral volunteer. Each purok has an incomegenerating project to complement the municipal government and other agencies budgets.

The Purok, then, has become a new social institution. During local elections, a candidate’s performance in his/her respective purok became an important criterion for voters. It also enhanced socialization because each Kiosk became a social hall.

In the Balilihan country action program, what was initially an attempt to provide basic health services in the community itself, became a means to support and organize several community goals: • Making natural medicines available (through herbal gardens) • Better general hygiene thereby preventing and reducing the prevalence of disease • Livelihood activities so that families can increase their income and meet their basic needs • More productive and sustainable agricultural practices • Specific mechanisms to ensure peace and order in the community • Better waste management through composting initiatives

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REPLICATING THE PROJECT Due to its success, Balilihan’s purok system has been replicated at the provincial level when Mayor Chatto was elected vice-governor of Bohol. It is also being replicated by other municipalities in and outside the province.

Key Implementation Steps The following are the key implementation steps identified in implementing a similar project.

1. Conceptualize, Get LGU approval Create a Management Team that would develop a project proposal and push for the issuance of an executive order or SB Resolution for the implementation of the project.

2. Capacity Building Develop a capacity building program, in consultation with key sectors in the municipality/ city and barangay and municipal/city officials.

Among the training/capacity building that needs to be included in the program are: Table 1. Municipal and Barangay Training Municipal Level • Reorientation on MDC functions, duties and responsibilities • Human resource development • Effective local legislation • Integrated evaluation and planning

Purok/Barangay Level • Organizing of purok health zones or districts • ABC strengthening • Barangay administration (systems and procedures) • Reorganization of BDCs • Training for barangay sectoral committees (technology transfer for agriculture, health, environmental protection, infrastructure, education, livelihood) • Project planning and evaluation • Leadership training • Primary health care

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Bantay sa Kahusay Ug Kalinaw (BKK): Oroquieta City, Misamis Occidental

3. Cluster barangays as district/ health zones, assign district/health center per zone Begin the process of organizing barangays into health zones, as well as organizing puroks within each barangay.

4. Construct Purok Kiosks as a first step to mobilizing community participation Mobilize the community to participate in the start-up activity of Building a Kiosk in each Purok. This includes organizing the community around the following activities:

National line agencies like the Dept. of Education utilizing the kiosk in delivering services like non-formal education, illiteracy eradication, sanitation, etc.

• identifying strategic sites for the purok kiosk • acquiring the lot (through donation or other means) • kiosk construction 5. Mobilize and sustain community participation and project ownership This includes holding regular meetings, electing purok leaders, holding regular capacity building seminars, identifying health activities and other projects that the community would like to pursue 6. Establish monitoring and evaluation system Establish as system for monitoring and evaluation progress of the purok through annual purok and barangay evaluations.

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Implementation Step

Timeframe

1. Conceptualize, get LGU approval/Creation of the Program in the LGU 1.1 Project Proposal/Program Outline 1.2 EO Order/SB Resolution 1.3 Creation of a Management team 2. Capacity building Town level 2.1 Strengthening of the MDC for strong inter-agency cooperation(seminar/training workshop) 2.2 Human Resource Devt Training 2.3 Effective local legislation (training for developed responsive legislation) 2.4 Integrated evaluation and planning

Budget*/Resources Needed

1 month 1 day 1-3 days

1-3 days 3 days 2 days 1 day

15,000 25,000 45-47,000 5,000

District/health zone level 3. Cluster barangays as district/health zones for convenient delivery of services and coordination amongst units Assign district/ health center per zone

1 week

60,000-70,000

Barangay level - Strengthening of the ABC to enhance barangay linkages - Barangay Administration Training - Organization of Secretaries, Treasurers Federation - Establishment of Barangay offices - Reorganization of Barangay Development Council - Training of Barangay sectoral committees

1 month 1-3 days

60,000- 65,000

Purok level - Purok Chairmen,Secretaries, Treasurers & Barangay Health Workers Leadership Training - Purok Health Care Workers - Training on Primary Health Care - Training for sectoral committees

100,000 3 days 1 month 1 week 3 days per sector (total of 21 days) 3-5 days 3 days

4.Construct Purok kiosks or Activity Centers

1 month (identification to construction)

5. Mobilize and sustain community participation and project ownership

Once a month

6. Establish monitoring and evaluation system

Through annual purok an Barangay evaluations

*Note:Budget/funds are sourced from the Local funds/LGU operations budget

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50,000- 60,000

(bayanihan)

Bantay sa Kahusay Ug Kalinaw (BKK): Oroquieta City, Misamis Occidental

Lessons and Insights in Replicating the Project As Balilihan’s experience shows, the purok initiative can be a powerful tool for community mobilization and is well suited for low income communities with scarce health and other resources. The following elements need to be put in place in replicating Purok Power.

1. LGU assistance, strong leadership and commitment in capacity building of the community 2. Engaging the community and encouraging the spirit of self help and empowerment through building of purok kiosks mobilizing the community’s resources 3. Ensuring ownership and sustainability of project by helping the communities identify their needs and projects, contribute their own labor and resources, and participate in making major decisions.

4. Human resources, time and effort as the key inputs, not money.

5. Determining financial resources needed on a case to case basis by starting with minimal resources and building investment over time.

6. Using incentives to secure peoples participation such as awards for most outstanding purok with the following criteria: 7. Presence of health board – a color coded billboard using indicators that reflects the health status of the community.

8. Ensuring that the purok centers act as information centers to keep the community informed about the progress of their projects and activities.

9. Publishing gains of the puroks to keep spirit up at the community level and attract investors.

10. Enacting a local ordinance to institutionalize the program.

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ANNEXES “PUROK POWER” FOR PRIMARY HEALTH CARE COUNTRYSIDE ACTION PROGRAM Balilihan, Bohol

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Annex A: Sample Ordinance Institutionalizing the Purok System in the Balilihan Countryside Action Program: Delivery of Primary Health Care through Purok • Sample Ordinance with information on: • Vision/Mission Statement of Balilihan, Bohol • Institutionalization requirements

• Policy statement • Composition of Officers

Republic of the Philippines PROVINCE OF BOHOL MUNICIPALITY OF BALILIHAN Office of the Sanggunianag Bayan ORDINANCE NO. 97-07 AN ORDINANCE INSTITUTIONALIZING THE PUROK SYSTEM IN THE BALILIHAN COUNTRYSIDE ACTION PROGRAM IN EVERY BARANGAY WITHIN THE MUNICIPALITY (SPONSORED BY HON. AMBROSIO L. BAYUD) BE IT ENACTED by the Sangguniang Bayan of Balilihan, Bohol in session assembled that: Section 1. – This ordinance is called the “Purok System) Ordinance of the Municipality of Balilihan, Bohol.

Section 11. – Policy Statement – It is the policy of the municipality of Balilihan, Bohol to adopt the Countryside Action Program (CAP), a holistic approach to the delivery of basic services to the constituents and a feed back mechanism with man as the focus of development. CAP is implemented through the purok system in which all inhabitants shall be members of a purok.

Section 111. – Vision-Mission Statement of Balilihan CAP. Vision – a self-reliant community that has achieved a sustainable level of Physical, Social, Economic, Cultural Environmental, Moral and Spiritual Development in an Atmosphere of Peace.

Mission – to efficiently and effectively deliver the basic services with man as the focus of development through the strengthening of the Local Government Bureaucracy and Peoples Participation and Empowerment.

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Bantay sa Kahusay Ug Kalinaw (BKK): Oroquieta City, Misamis Occidental

Section 1V. – Institutionalizing of Purok in Every Barangay. The Purok serves as the smallest unit of government in the municipality. a) There shall be 6 (six) institutionalized purok in every barangay. b) The barangay officials headed by the barangay catain shall divide the barangay into six areas called puroks considering the number of households which are situated in the purok’s jurisdiction. c) All households situated within the defined area shall be registered as the members of the particular purok expect Barangay Kagawads or Sectoral Officers & their families who are assigned in another purok during their term of office. d) Each purok shall have a “kiosk” where all members of the purok hold their monthly meeting, and they are required to put up the following basic requirements: 1) Purok records and charts to include the minutes of the purok secretary, BHW’s records and purok treasurer’s records.

2) Spot map 3) Purok kitchen 4) Purok comfort room 5) Vegetable garden 6) Herbal garden 7) Compost pit/pile 8) Purok label 9) Fence Section V. – Composition of Officers. Every purok shall have the following officers: 1) 2) 3) 4)

Purok Chairman Purok Secretary Purok Treasurer Sectoral Volunteers – (7) a) Health – Volunteers Health Worker b) Peace and Order – Barangay Tanod c) Agriculture d) Education e) Livelihood and Environmental Protection f) Youth 5) Others – like the Auditor and PRO. All the purok officers, except the Purok Chairman who is the elected Barangay Kagawad assigned to the particular purok, are chosen by the purok members from among themselves.

They function as volunteers in their respective areas of concern.

Section V1. – All officers and members shall meet once a month in their purok and submit reports to the barangay captain and to the agencies concerned.

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Section V11. – Penal Clause. Any person who violates the provisions in this ordinance shall be punished by: a) Non-issuance of a purok clearance for whatever legal purpose it may serve, such as a prerequisite for the issuance of a barangay clearance. b) He is not entitled to any benefits, or privileged derived from the purok. c) Fine of One Thousand Pesos (P1,000.00).

Section V111. – Any previous ordinance whose provisions are inconsistent with the provisions in the ordinance shall be repealed or modified accordingly.

Section IX. – This ordinance shall take effect upon its approval.

APPROVED: NOVEMBER 12, 1997 A F F I R MAT IV E (SGD) ESTEBAN L. CHATTO SB Member (SGD) AMBROSIO L. BAYUD SB Member (SGD) LORENZO L. BALIONG SB Member (SGD) AGAPITO R. GEANGAN SB Member – ABC

(SGD) CONRADO M. IBARRA SB Member (SGD) LUIS S. VARQUEZ SB Member (SGD) RUPERTO H. BAQUERO SB Member (SGD) LORELIE T. CHATTO SB Member – SK NEGATIVE NONE CERTIFIED CORRECT: (SGD) SALVIO JEROME M. MADANGUIT SB Member, Presiding

ATTESTED: (SGD) EXPECTACION M. QUIRONA Clerk III Acting Secretary APPROVED: (SGD) ELADIO I. CHATTO, SR. Municipal Mayor

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Bantay sa Kahusay Ug Kalinaw (BKK): Oroquieta City, Misamis Occidental

Annex B: Sample Purok Membership Form Purok membership form with information on: • Name • Age, place of birth, status • Family members living in the area and members of the Purok This is a requirement for those availing services under the Countryside Action Program (CAP).

One has to be a bonafide member of the Purok to avail the services available in the Kiosk. (activity center).

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Annex C: Sample Purok Clearance (CAP in operation) Purok Clearance 1. A certification stating that the person applying for Purok membership is a person with good moral character and a law abiding citizen of the community.

2. This is a requirement in applying for Purok membership

Republic of the Philippines PROVINCE OF BOHOL MUNICIPALITY OF BALILIHAN Barangay Del Carmen Weste PUROK 1- TALONG

PUROK CLEARANCE

TO WHOM IT MAY CONCERN :

THIS IS TO CERTIFY that ________________________________________, a bonifide resident of Barangay Del Carmen Weste, Balilihan, Bohol and a member of PUROK 1 – TALONG of this Barangay is “cleared from all money and property accountabilities of the Purok”.

This certifies further, that he/she is a person with good moral character and a lawabiding citizen of the community.

This certification is issued to MR/MRS/MISS ____________________________ for whatever legal purpose that this may serve.

Given this __________ th day of ___________________, 200 _____ at Purok 1 – Talong, Barangay Del Carmen Weste, Balilihan, Bohol, Philippines.

RADIGUNDA H. GUMALO Purok Chairman

ATTESTED :

AGAPITO R. GEANGAN Barangay Captain

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