december 15, 2019
Implementation of the Maternal and Child Health Nutrition Service Delivery Network for Indigenous Cultural Communities in Selected Areas in Region XII
By: Donna Isabel S. Capili, Katherine Ann V. Reyes
Participatory governance is key in people-centered health systems. The Local Government Code of 1991 intended for the devolution of health services to empower local governments design and implement health care that is responsive to the needs of the community. However, the national level agenda and standard setting for health by the Department of Health persisted. Without the enabling platform of participation and self-determination as ensured in the Indigenous Peoples Rights Act of 1997, the Philippines indigenous voice continued to be unheard. This study sought to determine what was the barriers to healthcare access among the IPs from three villages in separate municipalities in Region XII.
Discussions were held among and between groups of IPs and healthcare workers. A managed platform of dialogue made possible a shift in power differentials in the discourse that rendered primacy towards the IP perspective. Poverty, politics and geography, not cultural differences, were predominant barriers to healthcare access across these communities.
Phase 2 started in 2018 and each IP community selected four learning and development (LEAD) group members as their representatives. The LEAD together with their municipal government partners were capacitated in a people-centered participatory approach to health systems strengthening called APIL sa Lihok. APIL, in the Visayan language also spoken by the IPs in Region 12, translates to join or participate; lihok is action. APIL sa Lihok is also the project acronym for Active Participation of Indigenous Peoples In Learning for Action.
Each of the LEAD groups moved towards understanding their priority issue and mapping solutions enabled by the accommodation of local governments in a process called Contextualized Structured Learning Experience (CSLE). The CSLE comprised of co-created customized learning plans hinged on an in-depth analysis of the IPs’ issues and executed in activities, which included communication for development and writing workshops, hands-on learning and training in bureaucratic processes, and field visits that facilitated a duality in learning and reflection among the IPs and key stakeholders. The intent was to empower the IPs in addressing perceived health inequities, make government agencies more cognizant of issues that IPs face, and collaboratively determine strategies towards culturally sensitive resolution of the IPs’ identified priority issues during facilitated convergence meetings.
Co-created action plans validated in community assemblies resulted from the CSLE. Further, members of the IP communities were mobilized to join the LEADs in implementing action for change.
Political will and commitment to inclusivity and linkages between and among health system actors are needed to enable active participation among IPs and other marginalized sectors in the prioritization and design of health interventions.The APIL sa Lihok is a novel comprehensive approach towards responsive people-centered health care, however, there is need to institutionalize the process in national level policy to help its sustainability. As the Philippines takes the steps towards Universal Health Care, APIL sa Lihok finds its role to ensure that no one is left behind.