Non-communicable diseases (NCDs) and poverty create a vicious cycle whereby poverty exposes people to behavior risk factors for NCDs, and, in turn, the resulting NCs may become an important driver of poverty due to the direct and indirect costs of NCDs. NCDs are the top killers in the Philippines. It is estimated that 35 to 50 percent of NC deaths occurred before the age of 60. A significant proportion of Filipino adults continue to be exposed to the NC risks of tobacco and alcohol use, unhealthy diets and physical inactivity. This makes millions of Filipinos vulnerable in developing NCDs in the future (WPRO).
What is PhilPEN?
Adapted from the World Health Organization's Package of Essential Non-communicable (PEN) Disease Interventions, Phil PEN seeks to reduce the rates of lifestyle-related non-communicable diseases (NCDs) through early screening and timely treatment in primary care settings. The program works through different barangays, or communities, that make up the towns for each district.
What is a BHW?
A Barangay Health Worker is a community member with a LOT of influence. The BHWs provide basic primary care to community members, and implement Department of Health (DOH) programs that are delegated to them by midwives. Overall they are seen as outreach coordinators who also have health training, and because they are local community members they are highly trusted by the local population.
Where does FIMRC come in?
FIMRC is supporting the University of the Philippines scale-up the implementation of Phil PEN. In the five barangays FIMRC has partnered with (located in two districts), we work alongside BHWs in the following ways:
- Screen community members for their risk of having a cardiovascular event
- Confirm their hypertension and diabetes status
- Refer them to the rural health units as appropriate
- Develop programs to address the risk factors associated with cardiovascular disease
In Poblacion 2, the BHWs' desire to tackle physical inactivity prompted FIMRC volunteers to lead zumba sessions which sparked a conversation with community members. Now zumba is lead by a trained instructor three times a week and is open to community members throughout Bailen! The BHWs recently started a walking group to compliment the zumba classes. In Calumpang Lejos, we were able to encourage nurse Del to incorporate community members with hypertension and diabetes in the Nutrition Month activities in an effort to tackle unhealthy diets. The BHWs made a healthier version of sinagang, a popular Filipino dish, for mierenda to show community members alternate cooking methods. The local health care providers lead the way as we nudge them forward! As Phil PEN is a program of the DOH, it's expected that it will be institutionalized within the barangay health stations and rural health units to continue addressing the chronic non-communicable diseases that affect the community's life cycle.
Is there change?
In public health, change is slow, that's the nature of it. You can see change over a number of years with whole populations, but it's the individual change that is so evident to our FIMRC staff, volunteers, and the BHWs:
We accompanied Ate Ruby, a BHW of Mataas na Lupa, to visit "M". "M" had reported multiple health problems when we went to her house for a Phil PEN screening. While we had referred her to the rural health unit at that time, she had not followed through. With a blood pressure of 180/110, we asked her to go with us to the rural health unit and she agreed. "M" hadn't been to the rural health unit in three years. The nurse referred her to the hospital, which she agreed to visit that same week!
When we first met "C" while going house-to-house to conduct Phil PEN screenings, she refused to take medicine to control her high blood pressure and she stated that she would rather die than give up smoking (one of the risk factors associated with cardiovascular disease). During a barangay assembly shortly thereafter, "C" stopped me to say her high blood pressure wasn't impacting her in anyway. I asked Dr. Ants to speak with her, and he explained that high blood pressure may damage the heart, brain, kidneys, and eyes even while symptoms are not present. The next time I saw "C" was at the rural health unit, her first visit ever, picking up antihypertensive medicine, submitting herself for a blood glucose test, and reporting she was cutting back on smoking!
Video Credit: Maestro Filmworks