Caraga Region
Vision :
Champion in Accelerating Reforms for the Attainment of a
Guaranteed and Accessible Healthcare Services
Mission :
Committed to provide a responsive and sustainable quality
healthcare services especially to the marginalized
sector in partnership with all stakeholders
Thrusts : - Better Health Outcome
- More Responsive Health System
- Equitable Health Care Financing
Values :
- Compassionate
- Accountable
- Responsive
- Achiever
- Grounded/God-fearing
- Available/Accessible
In 2010, the implementation of all public health programs in
Caraga Region which the Center for Health Development (CHD-
Caraga) spearheads is in accordance with the Aquino Health
Agenda (AHA) which is geared towards Achieving Universal
Health Care (UHC) for all Filipinos, this in compliance to AO 2010-0036.
This Administrative Order states that AHA is launched to improve, streamline
and scale up reform interventions espoused in the Health Sector Reform Agenda
(HSRA) and implemented under F1. This is a deliberate focus on the poor to ensure
that as the implementation of health reforms moves forward, nobody is left behind.
UHC therefore is an approach that aims to address inequities in health outcomes by
ensuring that all Filipinos, especially those belonging to the lowest two income
quintiles have equitable access to quality health care.
To successfully implement the AHA, the following components are required:
enlightened leadership and good governance practices; accurate and timely
information and feedback on performance; financing that lessens the impact of
expenditures especially among the poorest and the marginalized sector;
competent workforce; accessible and effective medical products and
technologies; and appropriately delivered essential services. The above items are
aptly labeled as the following instruments: 1. Service Delivery, 2.Health Financing,
3.Governance for Health, 4.Policy Standards and Regulations, 5.Health Human
Resource and 6.Health Information System.
All these are hoped to realize the PNoy’s administration Goals for Health:
Better Health Outcomes, Responsive Health System, Equitable Health
Financing through the employment of the following strategic thrusts: Achieving
MDG-MAX, Improving access to quality health facilities and Financial
Risk Protection.
Highlights of our 2010 Annual Accomplishments are being presented in this
document with the desire to give our partners from various agencies in the
government and private sectors a clearer picture on our accomplishments that
contribute to the present health status of the Caraganons.
Introduction
1. Vital Health Indices for 2010
A. Population, Land Area and
Population Density
The National Statistics Office has estimated
the population of Caraga Region in 2010 to
reach 2,549,400 with a male to female ratio of
51:49 with a pyramidal distribution that is more
than 50% of the population belong to 25 years
old below, and as the age group advances,
the population in both sexes decreases almost
equally. However, it can be noted that the
upper age groups have more females than
males as there are more males dying earlier
than females – thus the ratio is reversed. This
phenomenon can be observed readily,
starting age 50 and over.
Caraga Region has a total land area of
18,846.97 km2 which is equivalent to 6.28% to
the total land area of the entire Philippines and
18.48% to the total land area of Mindanao. In
2010, the number of barangays has already
reached to 1,334. With this land area and
population, the population density is computed
at 136 persons per square kilometer.
The Province of Agusan del Sur has 27% of
the population or 704,100 that are unevenly
distributed in 314 barangays under 13
municipalities and 1 component city, the newly
created city of Bayugan. The province has the
largest area in the region that comprise 47.57%
or 8,965.50 square kilometer and a population
density of 79 per km2 which shows that this
province is still sparsely populated. The
municipality of Prosperidad has the largest
population of 92,034 while La Paz has the
smallest with only 26,175.
The Province of Surigao del Sur has 597,400 or 24% of the population. 115,995 of it, is in the
component city of Bislig and this is equivalent to 5% of the population of the entire region. This
province has 333 barangays, of which, 24 are in Bislig City. Tandag is newly created
component city for this province and has a population of 55,486. Among municipalities,
Hinatuan has the largest population which is estimated to be at 40,138 while the municipality
of Bayabas has the smallest population of 9,524 only. Surigao del Sur with Bislig City have a
total land area of 4,552.16 square kilometer or 24.15% of the regional area, thus a population
density of 106 persons per square kilometer is computed.
The Province of Agusan del Norte has an estimated population of 334,331 or 14% of the
regional population and is distributed in 166 barangays that are scattered in 10 municipalities
and a city. A population density of 167 persons per square kilometer is computed for a total
land area of 2,064 square kilometers. The City of Cabadbaran has a population of 65,927 and
is the newly created component city of this province. Among municipalities, Buenavista has a
population of 64,212, the highest while Kitcharao has 16,334, the lowest in this province.
Surigao del Norte Province has only 10.7% of the regional area or 2,017.10 square
kilometers. It is composed of 20 municipalities and 1 component city, the City of Surigao and
335 barangays. The estimated population in 2010 of the entire province is 459,929 or 18% of the
region’s population and 31% (143,285) of which is in the city. The population density is
computed at 155 persons per square kilometer. Among municipalities, Mainit has most
population (27,307) while Burgos has the least with only 3,729.
The Province of Dinagat Islands is composed of 7 municipalities and 100 barangays and
has a total population of 129,771 or 5% of the region’s population which are distributed in a
total land area of 721.92 square kilometers or 3.83% of the regional land area. A population
density ratio of 178 persons per square kilometer is computed. Among municipalities, Basilisa
has the most populated area with 34,412 while Tubajon has the least with only 8,397.
The City of Butuan has an estimated population of 318,869 or 12% of the region’s population
distributed in 86 barangays covering a total land area of 526.29 square kilometers which is
equivalent to 2.79% of the region’s total land area. With this land area and population, a
density of 606 persons per square kilometer is computed which is typical for a highly urbanized
city. A considerable percentage of population in this city comes from the nearby provinces
within and outside the region for various reasons like seeking for jobs, schooling, & etc. Most of
these transient individuals live in slum areas, leading to congestion and overcrowding, a factor
to consider in the spread of some infectious diseases like measles and others.
Trend of Contraceptive Prevalence Rate
Caraga Region
2003 - 2010
54
44
3943
41
45
38
47.36
0
10
20
30
40
50
60
2003 2004 2005 2006 2007 2008 2009 2010
B. Crude Birth Rate & Live Births
The 10-year trend of Crude Birth Rate (CBR)
differs from area to area. Among provinces in
Caraga Region in 2010, the province of Agusan
del Norte has registered the highest CBR
(23.52/1000 pop) while the Province of Dinagat
Islands has registered the lowest, 16.13/1000 pop.
Among cities, Butuan City has the highest with
25.08/1000 pop. while Bislig City registered the
lowest with 17.10/1000 pop. However, the
regional average shows an increasing trend for
the past 5 years and in 2010, CBR is at 21.12/1000
pop. – the highest in ten years. This means that in
a community of 1000 population, one can find at
least 21 newborns in 2010.
This increasing trend can be attributed to the
increasing number of newborns each year due
to increasing number of women of reproductive
age (15–49 years old) having unmet needs for
family planning. Though the contraceptive
prevalence rate (CPR) has increased
considerably in 2010 yet, it seems that the effort
needs to be intensified to minimize to the very
least number of WRA with FP unmet needs, so
that unwanted and unplanned pregnancies can
be prevented.
C. Crude Death Rate & Distribution of
Deaths
Caraga Region has registered a total of 8,149
deaths in 2010. 59.7% (4,868) of which are men
and 40.3% (3,281) are women. With this year’s
population, a Crude Death Rate (CDR) of
3.20/1000 population is computed. That is, for a
population of 1000, at least 3 persons died that
year.
Among the 5 provinces, the Province of
Surigao del Sur registered the most deaths while
the Province of Dinagat Islands registered the
least with 1,666 or 20.4% and 326 or 4.0% of the
total deaths respectively. Among cities, Surigao
City registered the most number of deaths, 796 or
9.8% while Bislig City with the least of 425 or 5.2% of
the total deaths in the region. Butuan City with
level 3 private and government hospitals
registered 704 or 8.6%.
The Ten-Year Trend of Crude Death Rates in
Caraga is very irregular. After it plunged down to
3.3 per 1000 pop in 2007, it increased in the next
succeeding 2 years and reached its highest of 3.8
per 1000 pop in 2009. In 2010, it plunged down
back to 3.2 per 1000 pop, still not a very
significant development considering that out of
1000 individuals, at least 3 died in that year.
The Province of Surigao del Norte along with its
component city of Surigao have a total death of
1,170. In these areas CDRs are consistently higher
than the other areas for the past 5 years (2006 –
2010), that is, yearly death in the province of
Surigao del Norte is at least 4 while in Surigao City,
at least 6 per 1000 persons.
Agusan del Sur due to its big population,
consistently has the lowest CDR for the past 5
years though the number of deaths is high.
D. Leading Causes of Morbidity and
Mortality
Morbidity. In Caraga Region, the respiratory
diseases like upper respiratory tract infection
and bronchitis have been consistently the first
leading cause of morbidity among Caragans.
Mostly of the affected belong to the younger
age groups specifically children below 15 years
old. Its trend since 2004 is increasing and at
present its rate is registered at 6,466 per 100,000
population.
Pneumonias and diarrheas are on the
decreasing trend. These 2 infectious diseases
were at the top 6 and 3 respectively in 2004 –
2008 but in 2009, diarrhea dropped to no. 5 and
pneumonia to no. 7 and finally in 2010, these
duo rank 9 and 10 respectively. All other
diseases like Cardiovascular, Dental Problems,
Skin Diseases, Accidents/wounds/injuries in all
forms, Parasitism, Genito-Urinary and Influenza
are increasing considerably in 2010.
Mortality. In 2009 – 2010 the following
diseases are observed to be on increasing
trend: all types of Cancer, Bleeding Peptic Ulcer
and Multiorgan Failure. Pneumonias and
Tuberculosis (all forms) are the only 2 infectious
diseases that remain in the top 10 but with
decreasing trend in the past 2 years.
Hypertensive Cardiovascular Diseases along
with Diabetes and Renal Diseases which are
lifestyle related diseases, had significant
decrease but the former has been consistently
ranked number 1 in the past 10 years while the 2
latter diseases had dropped from the rank by 1
level and its trend is very hard to predict due to
absence of good reporting and limited
capabilities of most government hospitals
especially the lower level facilities to do proper
diagnosis and management of these diseases.
Liver and Gallbladder Diseases along with all
forms of Accidents/Wounds/Injuries remained
on the same rate.
In most all of the lifestyle related diseases,
cases are getting younger particularly HCVD
and Cancer.
These leading causes of mortality and
morbidity in Caraga are consistent with the
national situation.
E. Infant Mortality: Trend & Distribution
In Caraga Region, the MDG target for infant
mortality reduction is highly attainable by 2015. By
that year, the target which is 5.8/1000 LB (very
much lower compared to the national target of
19/1000 LB) can be attained especially if the
efforts that resulted to the present outcome of
6.24/1000 LB IMR be sustained and strategies be
intensified to further bring down the rate even
lower than the target. This present rate tells us that
336 infants died in 2010 out of 53,839 live births.
The number of infant deaths stays below 400 since
2007.
A lot of strategies have already been
implemented and local governments are doing
their best to sustain these efforts in order to realize
the goal.
Though the Ten-Year Trend of Infant Mortality
Rates is somewhat erratic yet, a general
downward trend can readily be appreciated –
that is, from 11.5/1000 LB in 2001, it gradually
dropped to 6.24/1000 LB in 2010.
The Province of Agusan del Sur registered the
most infant deaths in 2010 with 140 and is
equivalent to 42% of the total infant deaths in the
region and consequently has the highest IMR
while the Province of Dinagat Islands got 10 or 3%
but the IMR of 4.78 per 1000 livebirths is higher
than Agusan del Norte which has only 2.10 per
1000 livebirths.
Among cities, Butuan City registered the most
infant deaths with 37 or 11% of the regional total
infant deaths but the IMR of 4.63 per 1000 live
births is low due to high live births while Surigao
City has 30 or 9% of the regional total infant
deaths and has the highest IMR of 11.63 per 1000
live births.
The availability and quality health care
services in the area greatly influence the
decrease or increase of these rates, not to
mention live births as denominators.
Strategies To Reduce Infant Mortality.
To ensure realization of MDG target for reduction of
Infant Mortality in Caraga Region, strategies like
intensification of promotion and advocacy for
expectant mothers to deliver only in the health
facilities like hospitals and birthing homes is
encouraged where attendance of health
professionals who are skilled in attending birth
ensure safe delivery and deal with postpartum
blues.
These intensification efforts through the years
resulted to the constant decline of home delivery
rate and increase of the deliveries in health
facilities. In 2010 in Caraga Region, almost 60% of
deliveries occurred in the health facilities, mostly of
which were in the hospitals, while home delivery
rate dropped from almost 50% to only 40% - a
remarkable development.
Since 2005 the rate of deliveries attended by skilled
birth attendants who only include doctors, nurses
and midwives steadily increases. That in 2010, the
rate is nearly 80% (attended by these health
professionals) versus 20% (attended by traditional
birth attendants or TBAs.
These developments can be attributed to the
heightened awareness among community people
brought about by the intensive efforts rendered by
frontline workers in the rural health units specially
midwives with their partners, the Barangay Health
Workers.
The Expanded Program on Immunization (EPI) also
intensifies promotion and advocacy in order to
increase rate of fully immunized children (FIC)
before reaching one year old. This program aims to
protect infants against the immunizable diseases.
In 2010, FIC reaches 88% out of the targeted 2.7%
of the target population. This is considerably lower
than the national target. The main reason
according to the frontline workers is the over
estimation of population projection.
F. Under Five Children Mortality: Trend &
Distribution
Under five population is estimated to be at
17.82% or 454,303 individuals out of more than 2.5
million population in Caraga Region with a sex
ratio of 107.4, that is, for every 100 females there
are 107 males. Under 1 year of age only comprise
2.7% of these population.
Under five children mortality reduction target
under MDG has already been attained in Caraga
Region considering its present rate at 8.19 versus
2015 target at 8.7 per 1000 live births which is a lot
lower compared to the national MDG target of
26.7/1000 LB. However, provinces and cities have
rates that are much higher than the regional
average and even higher than that of the 2015
target. Efforts therefore should be intensified and
sustained by area so that this present rate can still
be further reduced.
Of the total under five mortality, 76% or 336 are
infants who have not reached their first birthday
yet. And only 24% or 105 infants of ages more
than one year but not over 5 years old died.
Among cities, Surigao City has the highest with
17.83 per 1000 live births while Bislig City has the
least with only 5.55 per 1000 live births. For the
provinces, Agusan del Sur has the highest with
10.94 per 1000 live births or a total of 172 deaths
which is equivalent to 39% of the total under five
deaths regionwide, while Agusan del Norte has
6.30 per 1000 live births or 51 deaths or 12% versus
the total under five deaths.
A lot of factors contribute to the decrease or
increase of under five mortality. In areas where it
is increasing, the most common is the non
availability of quality basic and advance health
care services and the opposite is true in areas
where it is decreasing.
G. Leading Causes of Infant Mortality and Morbidity
Mortality. Since 2004 the ten leading causes of infant mortality have not changed a lot. Most of these
are filth-related diseases. Among them are pneumonia with death rate that is steadily decreasing along
with sepsis and meningitis. These steady decrease can be attributed to heightened awareness among
parents and caregivers on the necessity of seeking immediate healthcare and treatment.
Diarrheas and malnutrition are having irregular trends. Tetanus persists to stay despite increasing rate of
CPAB (Child Protected at Birth).
Among other causes, congenital anomalies, and accidents are having irregular trends. Increasing are
pre/post maturity, respiratory distress syndrome (RDS) and sudden infant death (SID). This trend
irregularities only shows that preventive measures need to be intensified and sustained.
Morbidity. URTI/ARI with bronchitis/bronchiolitis are increasing along with skin diseases and
accidents/injuries while pneumonias, influenza, malnutrition and abdominal disorders and anemia are
having irregular trends. Genito-urinary diseases remains at the alarming level.
Morbidity reporting has been a problem in the region. Most of the consolidated reports received from
the Provincial Health Offices and City Health Offices do not include reports from the hospitals. With that,
there is a very high possibility that rates reflected on the table are actually lower than what occur in the
communities.
H. Leading Causes of Under Five Children Mortality and Morbidity
Mortality. Through the years the leading causes of mortality among under five years old children have no
remarkable changes. Pneumonia, congenital anomalies, accidents, malnutrition and meningitis have
irregular trends since 2004. Sepsis, pre/post maturity, RDS are increasing. Diarrhea is decreasing
remarkably while meningitis is slightly.
Cancer cases among children in this age group has likewise an irregular trend since 2004, and due to
non availability of appropriate diagnostic capability in the region particularly in government hospitals, it is
highly probable that there are a lot of undiagnosed cases not reported.
Morbidity. All leading causes of morbidity among under five children are steadily increasing in a very
alarming level since 2004 except for pneumonia, diarrhea and malnutrition. The decrease of the latter
group of diseases can be attributed to the increasing level of awareness of the population on the
importance of sanitation in preventing these filth-related diseases as well as the importance of seeking for
early treatment. Distribution of these leading causes of morbidity in the provinces and cities does not vary
in magnitude, that is, what is true in one province or city is also true in others.
The strategy implemented nationwide to control and prevent these diseases among children in the under
five age group has been universal, to include intensification of health education in all communities with
local health personnel as the main health education provider to their respective constituents. The Center
for Health Development in Caraga Region has been conducting trainings for these local health
personnel to enable them to effectively educate the people in the community.
In Caraga Region, the
possibility to realize the
target for Maternal Mortality
is very low unless efforts be
doubled along with
commitment and
concentration to achieve
the target which is
52/100,000 live births.
I. Maternal Mortality: Ratio, Distribution
and Leading Causes
For the past 10 years, Caraga Region is one of
the regions nationwide with the highest
maternal mortality ratio with an average of at
least 1 maternal death for every 1000 live births
during pregnancy, delivery or postpartum.
From 2008 to 2010 the province of Dinagat
Islands registered the highest maternal mortality
ratio (MMR) followed by Surigao del Sur.
However, MMR trend of the latter remarkably
decreased from 2.58 in 2008 to 1.05 in 2010 per
1000 live births while that of the former
alarmingly increased from only 1.54 in 2008 to
3.34 in 2010 per 1000 live births.
Agusan del Norte and Surigao del Norte
provinces have irregular MMR in the same
period. The former has MMR that decreased in
2009 and increased in 2010 while the latter has
MMR that increased in 2009 and decreased in
2010.
All cities have MMR trend that is decreasing
remarkably in the past 3 years. Butuan City from
1.59 in 2008 to 1.25 per 1000 live births in 2010 or
21% decreased in 3 years. Surigao City’s
percentage decrease has reached 65% or from
1.10 in 2008 to 0.39 per 1000 live births in 2010.
The City of Bislig boasts its highest performance
of 100%, that is 0 maternal death in 2010 from a
high rate of 2.65 per 1000 live births in 2008.
Generally, the trend of maternal mortality ratio
is very erratic. It is very hard to make a
conclusion on whether or not the efforts in the
past had been of any effect. LGUs at various
levels have to double their efforts so that the
targeted maternal mortality reduction can be
realized.
In 2010, the province of Agusan del Sur has registered 13 maternal deaths, the highest among the
provinces. With a total registered livebirths of 15,716 this would mean that there can be 1 pregnant
woman who died for every 1000 live births. Agusan del Norte comes next with 12 maternal deaths
and with 8,097 live births, the maternal mortality ratio can be estimated at 1.48 which means that
there can be 1 to 2 maternal deaths for every 1000 live births which is higher compared to Agusan
del Sur.
Surigao del Norte has 11 maternal deaths and since the number of live births is only 5,840 the
maternal mortality ratio is estimated to be at 1.88 which means that there can be 2 pregnant
mothers who died for every 1000 live births during pregnancy, during delivery or even up to 42 days
postpartum. Surigao del Sur province has registered 10 maternal deaths and with 9,533 livebirths,
the MMR is computed at 1.05 which means that for every 1000 live births at least 1 pregnant mother
dies.
The Province of Dinagat Islands has only 7 maternal deaths, the least number of maternal deaths
among the provinces, however, due to only 2,093 livebirths, the MMR is computed at 3.34 which
means that for every 1000 live births, 3 to 4 maternal deaths occurred.
Among cities, Butuan City has registered 10 maternal deaths and with 7,997 livebirths, MMR is
computed at 1.25 or 1 to 2 maternal deaths occurred for every 1000 livebirths. Surigao City has only
1 and Bislig City has none.
Causes of maternal deaths are mostly due to postpartum hemorrhage precipitated by specific
causes like retained placenta and others. Eclampsia, septicemia and amniotic fluid embolism are
some of the common causes. Nothing in the list is not preventable. If only appropriate measures are
timely implemented, these maternal deaths can surely be prevented.
J. Public Health & Manpower
Public Health Facilities - Caraga Region has a total of 80 Rural Health Units (RHUs) and Main Health
Centers (MHC) and 654 Barangay Health Stations (BHS). Each municipality has at least 1 RHU.
Municipalities with 5 or 6 barangays and a population of less than 10,000 like Burgos & San Benito in
Siargao Island in the province of Surigao del Norte and in some other provinces have only 2 BHSs each.
Bigger municipalities with more than 30 barangays like Esperanza and Prosperidad in Agusan del Sur
have have 14 BHSs each respectively and Bayugan City has 18 BHSs. In Caraga Region, the average
number of barangays per BHS is not less than 2.
Among provinces, Surigao del Sur has the most number of BHSs with 198 distributed in 17 municipalities
and the new city of Tandag. This means that out of 285 barangays in the said province, most of the
BHSs have only 1 catchment barangay and some have 2. Surigao del Norte, has 69 distributed in 20
municipalities. Since there are 281 barangays in this province, each BHS has at least 4 catchment
barangays. In the province of Agusan del Sur, each BHS has 2 to 3 catchment barangays while in the
Province of Dinagat Islands, the ratio is higher at 3 or more barangays per BHS.
Butuan City has 29 BHSs dispersed in 86 barangays and managed by the personnel in 3 MHCs. Surigao
City has 4 MHCs and 21 BHSs distributed in 54 barangays. This means that some BHSs serve at least 3
catchment barangays while others have 2. The small city of Bislig with only 24 barangays has 3 MHCs
and 38 BHSs. This means that in some barangays there are 2 BHSs serving the population.
Each BHS is managed by 1 midwife only and is supervised by the Public Health Nurse in the RHU. The
presence of Barangay Health Workers and other volunteers boost the midwife’s performance.
In some areas where catchment barangays are limited to 2, yet, the distance and the terrain, poverty,
poor attitude of the health personnel and health being given less priority by the LGU officials are some
factors that made health services somewhat inaccessible. Poor health awareness and poor health
seeking behavior of the people especially in far flung areas aggravate the health problems.
Manpower – Health manpower in Caraga Region
has been a problem in as much as there are
areas that do not meet the required standard
ratio to population, hence not being able to
meet the health needs with high quality health
services. For an estimated population of
2,549,400 in 2010, the region requires a total
of 128 public health doctors and 128
public health nurses to meet the standard
of 1:20,000 for both public health workers.
However, the region has only 84 municipal health
officers and 124 PHNs. On the average, the
region’s ratio for public health physician to
population is 1:31,062 which is very high
compared to the national standard. And for the
nurses, the ratio is 1:20,560 and is a little bit over
than the standard.
Among provinces, Agusan del Sur has the highest
ratio of 1:50,293 for public health doctors while
Surigao del Norte has the lowest with 1:14,166; a
somewhat ideal ratio. Among cities, Butuan City
has the highest of 1:79,717 while Surigao City has
1:23,881 – slightly higher than the standard.
For Public Health Dentist, the standard ratio is
1:50,000 population. Caraga Region has attained
this ratio on the average at 1: 42,490. This means
that in the region, we have more than enough
PHDs. However, looking at the individual provinces
and cities, Agusan del Sur has a problem with a
ratio slightly higher than the standard – 1:58,675. In
Surigao City, the problem of lack of PHDs is worse
with the ratio of 1:71,642 while it is much worst in
Butuan City with a ratio of 1:106,290. The good
thing with these 2 cities is that there are hundreds
of dentists who are in private practice. The main
problem therefore in these areas why there are a
lot of people suffering from oral health problems is
poverty and their poor health seeking behavior.
For Rural Health Midwives (RHM), the region
requires only 510 in 2010 to meet the standard ratio
of 1:5000. But a total of 613 RHMs are available so
that the regional ratio is only 4,169 and is lower
than the standard. However, the 2 cities of Butuan
and Surigao do not meet this standard.
Nutritionists, medtechs, etc. who are equally
important for the provision of effective and quality
health services are likewise lacking, hence,
implementation of health programs are greatly
affected.
Most of the Local Government Units have
manpower issues that most of them resort to
contract job orders to temporarily meet manpower
shortages.
K. Environmental Health Sanitation
Program
Environmental sanitation is an important
component of a healthy environment. This factor
greatly influences the attainment of health goals and
it is the physical indicator that readily tells the general
health status of the community.
Water is an indispensable resource and the want
of it extinguishes mankind. However, it can also be a
worst vehicle of disease transmission like cholera and
many others. With that, it is important that households
in the community should be assured of a safe water
source.
In 2010, Caraga Region has registered an average
of 87% of households with access to safe water
supply. Agusan del Norte has 96.8%, the highest
among the provinces of which 41% is level 1 while
Surigao del Norte has the lowest at 79.5% with only
2% level 1. Among cities, Surigao City has the highest
with 94.2% of which more than 55% level 3 and 35.5%
level 2. While the city of Butuan has only 87.9%
despite being the highly urbanized city, it has only
67.7% level 3 and still 18.3% level 1. Most of the
households in Bislig City enjoyed level 3 water supply
which is 65.8% out of 91.7% households with access to
safe water supply. With this non attainment of 100%
of households with access to safe water supply,
persistent cases of diarrhea and other filth – related
diseases can be expected.
Of equal importance is the availability of
sanitation facilities, among them are: sanitary toilet
and other basic sanitation facilities like blind
drainage, etc. within the households. Caraga Region
has only 83.5% of households with sanitary toilet,
56.6% with satisfactory disposal of solid waste
practices and 53.8% with complete basic sanitation
facilities. Both, Agusan del Norte and Butuan City
ranked at the top among provinces and cities in the
region except for sanitary toilet in which Bislig City got
the highest with 99.4%.
CHD – Caraga 2010 Accomplishment Highlights
1. Service Delivery
A. Hospital
With issue on quality of
hospital services getting
poorer nationwide, the
CHD – Caraga conducted
the Hospital Sector
Reforms Forum in Bislig
City on January 25 – 27,
2010. The very objective of
which is for the
participants to know the
latest on the
enhancement of the
quality of hospital services
and apply them in their
respective facilities to reduce hospital – acquired infections and mortality. This was
attended by the Chiefs of Hospitals, Chief Nurses and Administrative Officers from
government and private hospitals. The resource persons invited include the former
Undersecretary of Health Margarita Galon who talked on
Improvement of the Quality of Hospital Services.
Another activity conducted was the Training on Infection Control
in Health Facilities on June 7 – 9, 2010 at the Almont Hotel’s Inland
Resort, Butuan City. Chief Nurses, Nurse Supervisors, Medical
Technologists and some Administrative Officers from all
government hospitals in Caraga Region attended this said
training and each were required to return demo on the various
procedures on infection control from donning personal
protective equipment (PPE), hand washing and nasopharyngeal
swabbing and were expected to conduct the same training to their co-
employees in the health facilities where they come from.
Hospital
In 2010, Caraga Region has a total of 59
hospitals, 35 of which are operated by the
government which includes the 2 retained
hospitals, the Caraga Regional Hospital (CRH)
in Surigao City and Adela Serra Ty Memorial
Hospital (ASTMMC) in Tandag and the 24
hospitals are operated by private individuals.
Bed to Population Ratio. In order to meet the
standard hospital bed to population ratio
which is 1000 population per hospital bed,
Caraga Region needs a total of 2,550 beds.
However, with the present total beds which is
1,732, the bed to population ratio is computed
at 1:1,471 which is higher.
Surigao del Norte has the most number of
government hospitals (9) with a total bed capacity
of 170. The retained hospital and the 3 private
hospitals in Surigao City have a total of 265 beds.
With this number of hospital beds, bed to
population ratio can be computed at 1:1,833
population for the province while 1:541 population
for Surigao City.
Agusan del Sur has a total of 12 hospitals, 6
government and 6 private with a total of 255 beds.
A ratio of 1:2,761 is computed. This ratio is more
than 200 times higher than the standard and is
further aggravated by poverty and geographical
factors which includes terrain where transportation is
seldom, if not, impassable. The same problem is
shared by the Province of Dinagat Islands and
Surigao del Sur.
The cities of Butuan and Bislig have no problem
regarding this issue on bed to population ratio.
Poverty, high risk practices and poor health-seeking
behavior of the community people are among the
main concerns affecting health of the people.
Accreditation. PHIC accreditation helps ensure
delivery of quality health services in addition to the
many benefits that it offers not only to the health
facilities but the clients as well. PhilHealth benefits
include hospital expenses reimbursements and
many others.
In 2010, not all health facilities are accredited
with PHIC despite advocacy efforts for them to
comply with the requirements. Out of 59 DOH
licensed hospitals, only 46 are accredited and out
of 80 RHUs only 65 are accredited.
Birthing homes and TBDOTS Centers are likewise
being accredited by PHIC, the purpose of which is
to help patients solve their financial problems that
made them hesitate to seek health care. The
benefit packages are to be given to the health
facilities to replenish resources used in providing
care. These benefits can only be enjoyed by the
patients in PHIC accredited facilities.
Bed Occupancy Rate (BOR). Regional average of
Bed Occupancy Rate (BOR) in Caraga in 2010 is
74.6% which is slightly lower than the national
standard of 85%. Only hospitals in the provinces of
Agusan del Sur and Surigao del Sur had reached 80%
or more in the past 2 years while others had as low as
50% especially in the Province of Dinagat Islands.
Even in the provinces where BOR is higher, one can
still find few hospitals with BOR that is even lower than
30%. Reasons for this very low occupancy rate is the
non availability of doctors and or medicines so that
the most that a hospital can do is to refer the patients
to nearby hospitals. This experience is at its worst
scenario in the early phase of devolution of health
services to the local government.
Average Length of Stay (ALOS). In most hospitals if not
all, the average length of stay of patients is 3 days.
This figure only tells that most of the cases catered by
these government hospitals are minor ones which
usually are infectious diseases and can be
discharged after 3 days if management is effective.
This rate is within the Philippine standard and is an
indicator of quality and effective care.
Admission to Consultation Ratio. One of the many
ways to consider in the effective and efficient
utilization of hospital services is the thorough
screening of patients and that only those that require
admission will be admitted, thus resources can be
maximized and only those that really need it can be
benefited.
The trend of admission to consultation ratio from
2006 to 2010 is increasing significantly except in the
hospitals in the Province of Dinagat Islands where it
remains lower than 1:5. However, the ratio in 2010
that is 1:8 is still lower than the standard of 1:10. Lower
ratio is usually experienced in most primary hospitals
throughout Caraga.
The factor to consider may include poor health –
seeking behavior of the people who never come to
the hospital until the condition worsens, hence no
other choice but admission.
Laboratory Utilization Rate. Laboratory performance
correlates with the quality of care since doctor’s
appropriate diagnosis is being supported by the
results of the laboratory procedures he or she ordered
on a patient. When properly utilized, laboratory can
be a very good source of income for the hospital to
recover expenses.
In 2010, the average laboratory utilization rate of all
public hospitals in the region is below 300%. The
province of Surigao del Sur has the highest with 450%
followed by Agusan del Sur with 400%. One of the
main reasons for the very low laboratory utilization
rate is the non availability of reagents and or
equipment in most primary hospitals especially in the
province of Dinagat Islands. On the other hand, too
high laboratory utilization could mean indiscretion of
the physicians who order laboratory procedures even
if, it is not necessary or needed which may cause a lot
of additional expenses to the patients.
Charity Patients. Government hospitals are designed
to cater the poorest of the poor, so that it is expected
that a higher percentage of clients belong to this
group. This means that these patients do not have to
pay any amount upon discharge.
In Caraga, the percentage of charity patients is 78%
in 2010 and is within the national standard. The higher
the figure shows that poverty rate of the population is
also very high. One factor to consider for this
accomplishment is the presence of trained hospital
social workers that diligently classify patients
according to their capability to pay.
Gross and Net Death Rates. These are important data
to be used in evaluating quality of hospital care. Most
of the government hospitals in Caraga Region have
gross death rate and net death rate that are within
the acceptable level. NDR acceptable level is 4%
and most of the hospitals have only 1.2% which is a lot
lower than what is acceptable. Factors may include
immediate referral of severe and dying cases to
private hospitals with higher capability of care.
B. Public Health
B.1. Regional Health Emergency
Management Staff (RHEMS)
RHEMS Caraga had accomplished a lot in 2010:
For Health Policy and Program Development
the following were the activities:
a. Consultative Workshop was conducted
for Province/City Local
Coordination/Clustering. This was attended by the PHOs, CHOs, MHOs, PHTLs. DOH
Representatives and some LGU Officials in charge of emergency management in the
locality. b. Regional Level Consultative Meetings on Cluster Approach involving Regional Offices,
Butuan City Health Sanitation Office & other private sectors (e.g., water district).
c. Formulation of CHD Interim Guidelines on HEMS applicable for the activation of
Operation Center during
emergencies/disasters. d. Update/Orientation Meeting
on Health Emergency
Response Operation for CHD
Staff For the Capability
Building the following
activities were accomplished:
a. Basic Life Support Training – a total of 10 batches
were conducted, 6 of which were funded by
LGUs and other stakeholders while 4 batches
were funded by the CHD.
b. EMR – B Mindanao Facilitators Meeting Last
May 4, 2010
c. Hosted the Mindanao-Wide Basic Life
Support Training of Trainers (BLS-TOT) on
August 29 – Sept. 3, 2010. A total of 51
responders attended the said training,
31 of which from various CHDs
and Retained Hospitals in
Mindanao regions.
B.2. Regional Epidemiology and
Surveillance (RESU) unit major
accomplishments for the year 2010 include:
a. Basic Computer and Epidemiology Information
System (Epi Info) Training for Surveillance Officers and
DOH Representatives on July 21-23, 2010 at the
Almont Inland Hotel and Luciana Convention, Butuan
City. This training was conducted in response to the
needs of the local epidemiology and surveillance unit as
well as the DOH representatives to enhance their skills for computer use as a requirement for
the effective utilization of Epi Info in their respective areas of assignment. With the thrust of
the PIDSR system to improve efficiency of disease notification and response, computer
processing of surveillance data is essential and the people who will manage the data need
to be trained.
b. Rapid Assessment Survey on HIV Vulnerability in Bislig City, General Luna, Bayugan and Tandag
all in Caraga Region and ran from March to June, 2010. Prior to the actual survey, a
Rapid Assessment Team was organized and trained, for them to
become very effective and efficient in
data gathering and in helping those
vulnerable that they would meet in
the process.
c. Epidemiology and Outbreak
Response Training was
conducted on June 29 –July 1,
2011 at the Almont Hotel’s Inland Resort in
Butuan City. The training was designed to capacitate
multidisciplinary team in responding to outbreak
particularly on Emerging and Re-Emerging diseases.
Basic epidemiological investigation skills and
outbreak response are necessary to ensure that
Local Epidemiology and Surveillance Unit Staff are well
prepared to respond. Program Managers
handling Expanded Program of Immunization
and Doctors, Nurses, and Sanitary Engineers
from Provincial and Municipal Epidemiology
and Surveillance Unit regionwide were trained
on the technical information and skills in conducting
epidemiologic investigation and response.
d. Regionwide Orientation on AH1N1 Vaccination and Deployment of
Vaccinators was conducted on March 22 – 23, 2010 to answer all questions and allay fears
regarding the new vaccine for AH1N1. Regionwide vaccination then followed. Health
workers and other front liners (susceptible and vulnerable) were to be vaccinated first and
personnel of other agencies and schools would follow. Team of vaccinators from CHD and
LGUs were dispatched. AH1N1 vaccination was done even during PhilHealth Sabado.
B.3. Family Health Cluster
The Family Health Cluster conducted
several activities like training,
orientation workshops, seminars, etc.
in 2010. All of these activities were
designed to enable the participants who are
front line health workers to do what should
be done to realize the various MDG
targets like reduction of maternal,
infant and child mortality by improving
the quality of health services provided
in the communities.
a. In the month of March, a Conference
on Newborn Screening was done. NBS policies
among others was the topics discussed in this
activity. Municipal Health Officers and
Nurses from various RHUs attended in
this conference along with some
doctors and nurses from private health
facilities in Caraga Region.
b. Another activity conducted was the
Oral Health Program Consultative
Workshop which was attended by rural
health dentists and some dentists who are in
the private practice. One important issue that was raised was on the lack of dentists in
some municipalities.
c. Buntis Kit Distribution was done in the Municipality of Del Carmen,
Siragao Island, Surigao del Norte. More than a hundred
pregnant women gladly received the kits each
contain very important items that will be
necessary in maintaining personal hygiene and
baby care. The objective of the activity is to
emphasize to the father and mother, the
importance of taking care of pregnancy to
avoid complications and possible death of
the baby and or the mother.
No woman
should die
while giving
birth!
d. To address the problem on high maternal mortality in
the region, CHD Caraga intensifies all efforts to realize
the MDG target by 2015. One of these endeavors is
to establish and equip health facilities to be
able to handle normal deliveries in the
communities. In 2010, one of these facilities is
the Basic Emergency Obstetric and
Newborn Care (BEmONC) Facility in
Tandag which was turned over to the
LGU in April, 2010 and this was
witnessed by Asec Nemesio
Gako and Director Mylene
Beltran from the DOH Central
Office.
e. Maternal Death Review for Caraga Region was conducted on April 22 – 23, 2010 at
the Luciana Convention Center, Butuan City. The activity was aimed at
knowing issues and reasons behind each death, drawing lessons from
said tragedy and formulating action plans to ultimately accelerate
reduction, if not zeroing out maternal death in the region.
A total of 100 participants who were mostly Municipal
Health Officers, Chief of Government Hospitals,
Public Health Nurses, Rural Health Midwives and
representatives of private hospitals of the cities and
provinces of the region.
Each province and city presented their respective cases
highlighting issues and events surrounding each death. Best
practices relative to the effective and efficient dealing with
factors/issues and concerns that may have an influence to the
occurrence of maternal mortality that were implemented in some
areas were also presented. Other areas were encouraged to
replicate such to enable them to successfully curtail preventable
causes of maternal mortality.
Representatives from foreign donors operating within the region
such as HealthGov, HPDP, EC and UNFPA assisted the CHD in
providing inputs and
technical assistance
during the whole
process.
f. The Safe Motherhood Week
Celebration was conducted in May 4,
2010. The Honorable Secretary Esperanza
Cabral and Usec. David
Lozada graced this
occasion and inspired all
participants especially the
pregnant mothers in
attendance.
Both Health Secretary
Cabral and Usec. Lozada
stressed the importance of
health of the woman
before, during and after
pregnancy to be able to
give birth and provide
appropriate care to a
healthy baby and her
family.
Moreover,
all means
should be
employed to
realize 100% Facility – based delivery
attended by highly skilled and
competent birth attendants in all
areas to realize the MDG Target for
Maternal, Infant and Child
Mortality reduction.
More than 500 individuals from
various offices both government
and private were in attendance. Each
pregnant in the audience received a
buntis kit.
g. During this occasion the Essential Newborn
Care Protocol and Postpartum Contraception
was simultaneously launched at the provincial
level on May 4, 2010 at the Gateway Hotel,
Surigao City in Surigao del Norte. A total of 229
Municipal Health Officers, Public Health Nurses,
Rural Health Midwives and Barangay Health Workers
and Local Government Officials from different
municipalities/RHUs and health personnel from
government and private hospitals and clinics, DOH
Representatives and representatives from DepEd,
CNAO, PNAO and some NGOs attended the said
activities. The participation of 79 expectant
mothers from various municipalities, the
messages and the presence of Usec Dave
Lozada, Dr. Rosalie Paje of NCDPC, Director LP
Gorgolon with ARD Cassion, Dr. Jacqueline Kitong
Head of UNFPA highlighted the event.
Usec Dave Lozada emphasized on the importance of
the following: a.) continuum of health care for both
mother and child, b.) to correct misconceptions on
the previous common practices for newborns and
c.) the basic guidelines in formulating effective
strategic plans.
The 1 – day launching ended with the signing of
the Declaration of Commitment to the MNCHN
Strategy with no other than Usec. Dave Lozada
leading the group. Buntis Kits were also distributed to
the pregnant women.
Usec. Dave Lozada signed the Declaration of
Commitment to the MNCHN Strategy
Usec. Dave Lozada with RD LP Gorgolon
distributed Buntis Kits to the Pregnant Mothers
Dr. Grace Lim, the MNCHN Coordinator
Malnutrition rate
among preschoolers
decreased by 31.6% or
from 18.52 in 2006 to
12.67% in 2010 in
Caraga Region.
h. Nutrition Program conducted the Annual
Nutrition Assessment on the first quarter of
2010. This year’s assessment used the New
WHO Child Growth Standards (GCS) as
mandated. The purpose of assessment is to
locate and identify the malnourished children,
recognize the potential nutrition problems and
needs of a specific population group and to plan for
course of action to reduce malnutrition and improve the
nutritional status of children particularly the preschoolers.
Prior to the conduct of this annual assessment, a three- day training was conducted last
Sept. 7-9,2010 at Butuan City to improve the
capability and skills of nutrition
workers particularly the
Nutritionist-Dietitians at
the PHOs/CHOs,
Nutrition Action Officers
and District Nutrition
Program Coordinators
to enable them to
conduct the activity
effectively, efficiently and
accurately.
Measuring the height through the use of microtoise
Measuring the height using Height board
Measuring the infant using infantometer
Interviewing mother using the new ECCD card
i. Expanded Program on Immunization
(EPI) conducted the following activities:
1. Several batches of Orientation and
Consultative Workshop on the New
EPI Vaccine and AEFI. Participants
were MHOs, PHNs, and RHMs,
Hospital Nurses from Government
and Private Hospitals all over
Caraga.
2. Developed, reproduced and
distributed IEC Materials to
government and private facilities.
These IEC Materials include: EPI
Monitoring Chart, Tarpaulin for EPI Vaccine Preventable Diseases, Modules for
AEFI Training and EPI Diseases, EPI T-shirts for the Health Personnel and for FIC
Children, Umbrella w/ EPI Logo, Growth Monitoring Chart.
3. Facilitated the distribution of vaccines, needles and syringes, hub cutters, safety
boxes, refrigerators, cameras and calculators to
various recipient health facilities all over the
region.
4. Conducted Rapid Coverage Assessment
(RCA) to look for missed children in a total of
23 barangays in the following areas:
a. Bislig City - 5
b. Bayugan City - 7
c. Butuan City - 5
d. Agusan Norte - 6
5. Provided technical assistance/monitored
priority areas to ensure proper implementation
of designed activities and to address issues
and concerns relative to EPI that surfaced.
B.4. Non Communicable Diseases Cluster
a. In response to the request of the
Department of Tourism, the CHD
provided a Medical Team to
ensure that health needs of the
participants of the 3rd Siargao
International Game Fishing
Competition are met. Director
Leonita P. Gorgolon herself
spearheaded the team.
The said event was done
in April, 2010.
b. The Environmental Health and Sanitation Program launched the Floating Sanitary
Toilet in Del Carmen, Siargao Island, Surigao del Norte. This is the
second municipality in Caraga where this project is
launched. The first one was in Talacogon, Agusan
del Sur in 2009.
This approach hopes to address the sanitation
problem in the region. In 2009, less than 80% of the
total households in Caraga have sanitary toilet
facilities. With that, correspondingly, diarrhea,
pneumonia, dengue, parasitism and other
filth related diseases still abound.
It is also hoped that many local
government units will replicate the
project in their respective municipalities
to solve their communities’ sanitation
problems.
This launching was attended by several
heads of offices both government
and NGOs in the region.
c. The National Voluntary Blood Services
Program conducted the following activities in
2010:
1. Some CHD Personnel headed by Director LP
Gorgolon attended the World Donor
Day in Bacolod City.
2. Assessment of Blood Service
Facilities in consonance with the
Administrative Order 2008 – 0008,
in anticipation of establishing a
Regional Blood Center or possible extension of flexibility
function of other Blood Banks. The checklist for NVBSP Blood Facilities
was used in this assessment.
Flexibility is given to CRH, ADN Blood Center, D.O. Plaza Memorial Hospital Blood Bank, and
ASTMMC Blood Bank to function as Blood Centers.
3. Regular Community Blood Donation Campaign
conducted by the various blood mobile teams:
Caraga Regional Hospital Mobile Blood Team,
Agusan BCU Team, Adela Serra Ty Mobile Blood
Team and the Agusan del Sur PBCC Mobile
Blood Team. With their combined
accomplishments, 4,607 donors were gathered.
4. Regional Blood Showcase is an annual event
honoring blood donors who in one way or another have
contributed in saving lives. Bloodletting highlighted this
year’s event and graced by LGU Champions.
5. Consultative Meeting with Key Stakeholders is regularly
conducted to track performance to ensure availability of safe
blood at all times.
709 BnB Outlets out of
1,310 Barangays or 1
BnB Outlet : 2
Barangays in Caraga
Region in 2010.
d. Botika ng Barangay (BnB) conducted
the following activities:
1. Several batches of BnB Training for Operators
and Barangay officials were conducted in
fulfillment of the requirement for the
operationalization of Botika ng Barangay. These
trainings were conducted in the months of April,
May, October and November in 2010. The very
objective of which is to equip BnB Operators with
knowledge and skills on how to successfully operate a
botika in their respective barangays.
2. Consultative Meetings conducted were LGU initiated to assess BnB Operations and to
address relative issues and concerns. Several Consultative Meetings were done during the
months of November and December in various provinces and municipalities and all were
focused on sustainability issues.
3. Awarding and Recognition of the Best Performing LGU – BnB was done in December to
encourage LGU Operators to improve performance.
e. Launching of Healthy City during World Health Day Celebration on April 7,
2010. “Year of the Urban Health - 1000 Cities, 1000 Lives” was this year’s theme.
In Caraga Region, launching activities
were simultaneously done in
cities of Butuan and
Cabadbaran in
Agusan del Norte,
Surigao City in
Surigao del
Norte, Bayugan
City in Agusan
del Sur, the cities
of Bislig and
Tandag in Surigao
del Sur. Programs
were held in Public
Plazas and basic health
services were provided.
Hundreds of people
attended the said event availed the various health services like BP taking, FBS,
immunizations, vitamin supplementation for Garantisadong Pambata, & etc., which was
provided by the City Health Offices with the assistance of the CHD – Caraga Field Health
Personnel.
In each city, the Local Chief Executives headed the conduct of activities. Hotels and
eating places that met the DOH standards were recognized and awarded with Quality
Seals.
In Butuan City, ARD Cesar C. Cassion emphasized in his message the importance of a
healthy environment and healthy lifestyle for quality living and quality life years span of
individuals.
The honorable Butuan City Mayor, Democrito “Boy Daku” Plaza gave a very inspiring
message enjoining all LGU Officials, Butuanons and everyone living in the city to be
responsible citizens for a better Butuan City, a conducive place to live for healthy living.
f. To promote health, unity and commitment to work, the Non-Communicable Cluster
initiated the conduct of a 2 – day Family Day. Every
employee with the Director herself joined the fun –
filled activities which include group
dynamics, swimming, etc.
The Director and the
Assistant Regional
Director emphasized
the importance of this
activity to be
conducted at least once
a year so that each
employee can be
unloaded with so
much
work–related
stress to sustain
higher degree
of productivity.
g. Promotion of HEALTHY LIFESTYLE is
intensified in Caraga Region thru the following
activities:
Lay Forum on Cardiovascular Diseases
Prevention and Control on February 26, 2010
in Luciana Convention, Butuan City.
Participants to this activity were Barangay
Captains and BHWs of Butuan City.
Orientation on Smoking, Physical Exercise, Healthy
Diet, Cancer Prevention were strongly promoted in 9
Pilot Barangays of Butuan City with the assistance
of the Pangkalambuan, Inc. from January to
March, 2010.
Facilitated Hataw in the different National and
Local Agencies region wide. In the provinces, DOH
Representatives headed the activity in their respective
municipalities
Responded to invitations from agencies, colleges
and universities to conduct seminars, symposia
on Non Communicable Diseases throughout
the year.
Tapping Trimedia thru Press Conferences to
intensify promotion and advocacy to reach all
sectors of society.
All these are aimed to reduce the
incidence rates of lifestyle –
related diseases such as
Hypertensive Cardiovascular
Diseases, Cancer all types, Diabetes,
Renal Diseases, etc.
Nursing Students during symposium
on Healthy Lifestyle
Ms. Delma O. Legaspi, the Nurse
Coordinator of Healthy Lifestyle Program
on Healthy Lifestyle
Seminars/symposium on Healthy
Lifestyle in various agencies in Caraga
Seminar/Symposium on Healthy
Lifestyle with High School Students
Seminar/Symposium on Healthy
Lifestyle with Brgy. Officials
Teaching HATAW to the partipants during
Seminar/Symposium on Healthy Lifestyle
550 clients with
various eye
problems were
benefited
h. Vision 2020 Philippines : The Right to Sight of the
Visual Health Program in 2010 conducted several
activities geared toward helping people with visual
problems to eliminate avoidable blindness by the year 2020
thru multisectoral partnership approaches:
Conducted Eye Screening to the different schools in coordination
with the NGOs
Basic Eye Care Trainings to the Volunteers
Cataract,Ptyrigium and Squint Operations
Advocacy on the prevention of the different eye diseases
Advocacy, Eye Screening, trainings and cataract surgeries are
the collective, regular endeavor of the different Local
Government Units, Private & Government Ophthalmologists, Celsius
Pharmaceuticals, Cataract Foundations, Loving Presence
Foundations, Chief of Hospitals of District and Retained
Hospitals, RHU Staff, Dep-Ed and CHD-Caraga.
Beneficiaries of these activities are mostly indigents
from all over Caraga Region. A total of 550 clients
were successfully operated on and are now living a
normal life again. To benefit more indigents with vision
problems, the CHD – Caraga strengthened
coordination and collaboration with other stakeholders.
Cataract Screening
Squint Screening
During the Training on Basic Eye Care
Post Cataract Op pose of some beneficiaries Lucky Boy to benefit the free
operation for squints
i. RENAL DISEASE CONTROL PROGRAM
(ReDCoP) with the objective to reduce
morbidity and mortality due to renal diseases
thru increasing the level of awareness of the
health personnel, community and partner
agencies on the prevention and control of
common kidney diseases, conducted the following
activities in 2010:
Consultative Meeting Workshop/Status Reporting
on Kidney Diseases Prevention Program
Implementation with the various stakeholders.
Lay Forum on the Prevention of Kidney Diseases
participated by Barangay Captains, BHWs, Health
Workers, Students, Pupils & Municipal Employees on
June 29, 2010 in General Luna, Surigao del Norte
Symposium on the Prevention of Kidney Diseases
among Nursing and Midwifery Students on June
15, 2010 in Butuan City
Attended ReDCoP Launching in Buenavista-
SPED on June 26, 2010
Kidney Month Celebration in June which was
highlighted by a Press Conference
To be successful in all of these endeavors, strong
collaboration with DepEd, LGUs, NGAs, NGOs and communities
has been maintained and enhanced. Distribution of IEC materials to the different health
facilities and partner agencies and to individuals was also done. To ensure data quality, a
continuous data validation
check has been on-going
throughout the year.
ReDCop Launching at
Buenvista, Agusan del Norte
The Coordnators from the CHD and PHO
during the Team’s monitoring of the
program
Smoking is strictly
banned in the
premises of all
DOH offices and
Hospitals.
j. Anti - Smoking Program conducted the
following activities:
DOH RED ORCHID Validation in CHD & CHO-
Surigao City on February 17-20, 2010
Attended Launching of Tobacco Legislation in
Veruela on May 20, 2010
MPOWER Training on June 16 -18, 2010
Launching of 100% Smoke Free Environment
Conducted Orientation on Anti-Smoking
among High School Students in Las Nieves, RTR
in Agusan del Norte and Tandag in Surigao
del Sur on July 2,6 & 8, 2010 and in St. Paul
University of Surigao City.
Because smoking severely impacts public health
by affecting not only the smokers but non
smokers who are exposed to second hand
smoke as well, efforts toward 100% smoke
free environment is being intensified.
Smoking is now ban in all DOH Offices and
hospitals and attached agencies in Caraga
Region. Local Government Units are likewise
enjoined to do the same.
Strong collaboration with partner agencies is therefore
indispensable for the realization of the dream to have a
100% Smoke – Free Environment. Validation of reports
and regular monitoring and evaluation of the
implementation of non-smoking ordinances are
likewise intensified.
During the Launching of the 100% Smoke – Free
Environment
During the validation of Red Orchid
Award in the CHOs
During the Anti-smoking Orientation in Schools
k. Community – Based Rehabilitation
Program (CBRP) is a program that takes
charge of the interests of the persons with
disability. To make endeavors more
meaningful and beneficial for the target clients,
the program conducted several activities in 2010, to wit:
Attendance to Regional Committee on Disability Affairs, Quarterly at Regional
DSWD Office
Training of CBR in Jabonga ( Aug. 23-25, 2010) & San Francisco (December 3-5,
2010 and among RHU Staff and BHWs in coordination with Loving Presence, Inc.
Celebration of National Disability Prevention &
Rehabilitation Week. This activity was highlighted with
a mass, motorcade and orientation on the
prevention of disabilities.
Conducted 4 batches of Training of National
Electronic Injury Surveillance & PWD Registry System (4
Batches)
Facilitated CBR Congress in San Francisco,
Agusan del Sur.
Conducted Ear Care Skills Training among PHNs,
RHMs and BHWs in Agusan del Sur
In each of these activities, the rights and privileges of PWDs as
mandated in the Act Amending RA No. 7277 were
discussed as well as the guidelines in the issuance of
their identification card and the National Electronic
Injury Surveillance System (NEISS) and PWD Registry.
Institutionalization of the Community – Based
Rehabilitation Program in the Local Government Units
is very important for the PWDs to have a solid support in
all areas.
During the Celebration of the NPDR Week
Deaf Mute Children during the NDPR Week
During the Ear Care
Skills Training
l. Elderly Program conducted the following
activities that benefited the elderly population in
Caraga Region:
Orientation on
the IRR of RA No. 9994 ”Expanded Senior Citizens
Act of 2010” in Balanghai on Nov. 23, 2010.
Chief of Hospitals, Chief Nurses were among
the participants.
This is an act granting additional benefits and privileges to
Senior Citizens. Included in the benefits is the 20% discount
and VAT exemption in medicines, essential medical supplies,
hospitalization, transportation, hotels, restaurants, recreational
centers, places of leisure and funeral services.
Senior Citizen Forum in Butuan City on
September 15, 2010. Hundreds of Senior Citizens
attended the forum and most of them
expressed gratification of knowing their rights
and privileges which were lengthily discussed.
Attendance to the Training
on Capacitating
OSCA
Heads
on How
to
Handle
Complaints.
Attendance to the Quarterly
Regional Coordinating & Monitoring Board (RCMB) Meeting.
m. Organized Non – Communicable Disease Coalition in various areas of the
region. The Goal of these organizations whose membership is multi-sectoral is to work
together toward primary prevention of chronic non communicable diseases by
initially addressing the shared risk factors of tobacco use, physical inactivity and
unhealthy nutrition.
RCB Meeting
Senior Citizen Forum
NCD Coalition during the organization and orientation
B.5. Infectious Diseases Cluster
a. The National Rabies Prevention and
Control Program conducted 2 batches of
Orientation and Advocacy. Participants of these
activities were Medical Officers and School Nurses and
Dentists from the Department of Education of the Division
Offices in Surigao City and Surigao del Norte, Province of Dinagat Islands during the first
batch and in Bislig City and Surigao del Sur on the second batch.
The main objective of these activities was to raise
awareness of the participants on the reality of the
possibility to eliminate Human Rabies as a public
health problem in Caraga Region thru the unified
efforts of all health sectors.
Also this program conducted the Regional
Consultative Meeting on to address
problems/issues and concerns resulting to the less
meaningful success of the program in eliminating rabies in the region.
There were 52 participants who were Provincial/City Rabies
Prevention and Control Program Coordinators and Animal Bite
Center Managers from all over the region. In this activity, it
was emphasized that only competent staff should manage
the Animal Bite Treatment Centers in order to provide the
appropriate services effectively and efficiently.
b. National Filariasis Elimination Program - after having
received authority from the World Health Organization and the
Department of Health declared the
provinces of Agusan del Sur and Dinagat
Islands, a Filaria – free after 7 rounds of mass
drug administration and after thorough
evaluation of the reported disease prevalence
rate of less than 1 per 1000 population. This
declaration is a proof that Caraganons can
achieve the goal of eliminating the disease in
the region.
Country’s
First TB DOTS
Center in Jail
is in Butuan
City
c. The National Tuberculosis Program
(NTP) conducted the following activities in 2010:
1. Launching the BJMP – Butuan City TB DOTS
Center on March 30, 2010 at the BJMP Compound,
Libertad, Butuan City. This is the first of its kind in
the Philippines. This endeavor aims to provide the
healthcare needs of particularly the inmates who
suffer tuberculosis, to treat and to prevent other
inmates from getting infected with this disease.
2. Construction of the National
Tuberculosis Reference Laboratory in
Caraga Regional Hospital
Compound, Surigao City. The
ground breaking ceremony was
done on April 23, 2011. The very objective for the
establishment of this TB Reference Laboratory is to strengthen
the capacity of the laboratories around to respond to threats
like multi-drug resistant TB.
3. Launching of TB DOTS Center in DepEd Surigao del Norte
Division in Surigao City on May 4, 2011. With this, the Department of
Education can participate in the implementation of TB prevention and control activities like
case finding by direct sputum microscopy and TB cases treatment using the Directly
Observed Treatment Shortcourse Chemotherapy (DOTS) to DepEd employees, dependents
and their students.
4. Facilitated the PhilHealth Certification of TB-DOTS Centers in Caraga Region to
ensure that all these TB – DOTS Centers meet at least the specified standards to spell out
their capability of providing safe and effective DOTS services to all TB patients. TB-DOTS
Centers that are PhilHealth Certified can enjoy the TB Health Package. This package can
lighten the economic burden of the patient and the facility because it offers PhP4,000.00 for
every PhilHealth Cardholder TB patient diagnosed and treated in the same facility.
As of December 31, 2011, Caraga Region has already 26 TB-DOTS PhilHealth
Accredited Centers distributed as follows:
Agusan del Norte and Butuan City - 8 (But1 DOTS – private)
Agusan del Sur - 6 (NBMH – private )
Surigao del Norte and Surigao City - 6
Surigao del Sur and Bislig City - 6
d. National Leprosy Prevention and
Control Program conducted 4 batches of
Orientation/ Training on Basic Leprosy
Management. These activities were
attended by the PHNs and RHMs from the
Rural Health Units and Main Health Centers as
well as City Health Offices and Provincial
Health Offices all over Caraga. The 1st batch on
February 23 -24, the 2nd on June 15 – 16, the 3rd on
October 26 – 28 and the 4th batch on October 28 - 29, 2010.
The main objective of this training is to enhance the
knowledge and skills of health workers in the
detection and management of leprosy. Moreover,
same health personnel are expected to
effectively raise awareness of the people in their
respective communities by providing right and
appropriate information about the disease in
order to encourage cases who are in hiding to
come to the open to avail of the free services
intended for them by the program.
To address issues and concerns relative to program
operation the Regional Consultative and Planning
Workshop and Updates on National Leprosy Control
Program was conducted on February 25 – 26,
2010. All 11 Provincial/ City Leprosy Medical and
Nurse Coordinators, 4 Nursing Attendants and the
CHD Program Managers attended the said
workshop.
e. Malaria Control Program conducted the following activities in 2010:
1. Training on Malaria Entomology and Vector Control for Vector Borne
Diseases. This training was attended by the Provincial and City
Malaria Control Coordinators. The focus of the activity was the
identification of different species of mosquitoes
that are vectors of various diseases.
2. Regional Malaria Implementation
Coordination Team Meeting attended by
the PHOs, CHOs, CHD personnel to include PHT Leaders and
DOH Representatives and some Local Chief Executives. One
of the issues and concerns raised was on the microscopy quality
assurance.
3. Program Orientation/Training on the Revised Policy
and Guidelines on the Diagnosis and Treatment for
Malaria. Participants were MHOs, PHNs, RHMs from malaria
endemic municipalities with the provincial
and city Malaria Control Program
Coordinators.
4. Organization of the Local Infectious Diseases
Alliance at the Regional Level
Towards Elimination of
Malaria. Participants were
Chieftains (Datu), ABC President/
Barangay Captains, City/ Provincial Coordinators of
Malaria, Rabies and Leprosy.
5. Basic
Entomology
Training in
Tandag on July,
2010.
Tribal Sector Officers of the Alliance of
Infectious Diseases in collaboration
with the National Commission on
Indigenous Peoples.
Participants during the Organization of the Local Infectious Diseases Alliance
Dr. C.D. Yu gives lecture and Mr. J. Basadre peeping the microscope during the training
Ingat Lagi!
Persistent
and Correct
used of
Condoms Prayer for
those who died of
AIDS
Part of the big crowd who participated in the World Aids Day
f. HIV/AIDS Prevention and Control
Program conducted the World AIDS
Day on December 1st , 2010 with the theme
“Act Aware” that calls everyone to act so that
this disease can be prevented and controlled
and be aware of the
possibilities of
getting infected with the disease and
put that awareness into action
by practicing safe sex.
The event was highlighted with a
courageous PLHIV shared her
experiences so that the public may
know that an “ounce of prevention saves one from millions of
miseries”. Hundreds of people
participated the 1 – day event which started
with a motorcade and ended with a
prayer for those who died of AIDS and
those who suffered of stigma and
discrimination. And releasing
of balloons to be open with
hope that the community will
be ready to accept PLHIV without
prejudice.
Men and women in Uniform
join the WAD celebration
B. 6. Health Human Resource
The Health Human Resource Unit conducted the
Orientation/Training on the Installation
and Institutionalization of Human
Resource for Health Management
and Development Systems
(HRHMDS) on December 1-3, 2010 at
Balanghai Hotel, Butuan City
This training was participated by Human
Resource Management Officers (HRMOs)
and Administrative Officers of Provincial
Health Offices, selected government
hospitals and city health offices.
Four (4) HHRDB Staff provided technical
assistance during the training and they were
Ms. Grace Fernando, Ms. Gwyn Grace Marantan,
Ms. Janette Cruz and Ms. Grace Obedoza
This activity is conducted to advocate the
proper implementation of these systems
especially the processes, tools and
concepts to all stakeholders.
The participants with the resource
persons from the HHRDB
The participants during the workshop
Another activity conducted by the Health Human Resource Unit was the Culmination of
2nd Batch of Project NARS.
A total of 535 nurses under the 2nd Batch of Project NARS were fielded in various
municipalities in 5 provinces and 6 cities in the region to augment health manpower so that
healthcare needs of the people especially the poor in the communities can be provided.
These nurses were assigned 6 months in the hospital and 6 months in the community.
Directors of DOLE and various RLAs attended the culmination activity and each
congratulated the nurses for having done a good job that contributed meaning to the lives
of the community people.
Dr. Lester P. Tan from HPDPB discussing the Universal Health Care during the conduct of 2011-2016 Strategic Planning last October 20-22, 2010
ARD Cesar Cassion and Engr. Meriedeth O. Pagaran, the Planning Officer discussing with the Resource Speakers from Central Office (Ms. Nieto and Dr. Bautista)
B.7. Governance
3.1. Planning Unit conducted
the following activities:
a. PREPARATION OF 2011 - 2016
STRATEGIC PLAN on October 20-22,
2010 at the Amontay Beach Resort in
Nasipit Agusan del Norte.
In line with the thrusts of the Health Sector; with
the full implementation of the Fourmula One for
Health, Medium Term Philippine Development Plan, the Millennium Development Goals and
the attainment of the National objectives for Health, the Center for Health Development -
Caraga is now on its final preparation for a more comprehensive and realistic 2011-2016
Strategic plan. This will serve as the manuscript stipulating priority activities of the health
system for 2011-2016 programs and projects implementation
CHD shall develop a complete and technically sound strategic plan. The Strategic Plan
reflects the sector approach to health development over a six-year period. This rolling plan
allows the region to adjust and update activities and refine their cost estimates in the plan
as the need arises.
There were several workshops for the development of 2011 - 1016 Strategic Plan of CHD
facilitated by Central Office staff from Health Policy Development Planning Bureau. The
activity was participated by Technical Staff of the Provinces and Butuan City, CHD Staff and
ManCom led by RD LP Gorgolon.
Part of the crowd during the Service Level Agreement attended by the Provincial Health Officers and Butuan City Health Officer
Dir. LP Gorgolon addresses the participants during the Service Level Agreement.
b. ASSESSMENT ON SERVICE LEVEL AGREEMENT 2008 vs 2009 FOR ALL
PROVINCES AND BUTUAN CITY on January 19 - 20, 2010 at the Luciana Convention
Center, Butuan City
With the full implementation of the PIPH/CIPH it
is understood that CHD shall provide
technical assistance and conduct periodic
assessments based on the performance on
the implementation. It is high time to assess
the targets stipulated in the Service Level
Agreement and in order for the region to
provide recommendations to the
provinces/city
and direct
them
towards
the
development of a complete and technically
sound plan and activities.
The 2008 and 2009 Service Level Agreement
were presented. Comments and
recommendations as well as Health issues and
concerns were discussed during the open forum. It was
a well participated activity wherein Provincial Health
Officers II and Technical Staff of all five provinces and
Butuan City were present. All the Management Committee
of CHD, Provincial Health Team Leaders and CHD staff
were also in full force.
c. CHD CY – 2010 WORK AND FINANCIAL PLAN AND AGENCY PERFORMANCE
REVIEW on February 3-5, 2010 at Almont Beach Resort, Surigao City
Center for Health Development has been providing technical assistance to partners
especially to the Local Government Units and conducted periodic assessments of
performance based on the implementation of plan in all programs and projects. It is high
time to assess the Performance of the Agency itself for us to adopt some strategies,
activities and innovations in order for the region to provide recommendations to the
provinces/city. Furthermore, we need to know where we are now in terms of
accomplishing our goals and objectives geared towards the attainment of the DOH thrusts.
d. Kumustahan sa Inter-Local
Health Zone Cum GIDA
Launching on October 28-29, 2010
at Almont Inland Resort, Butuan City
The functionality of
Inter-Local Health
Zones stems that
no single LGU can
adequately meet all public and clinical health needs of its
constituents without cooperating with other LGUs. Inter-LGU
cooperation was the vehicle in addressing public health
threats and dangers which compels them to coordinate.
Moreover, the conduct of zonal conferences has become
a venue for the sharing of best practices on local health
systems of participating LGUs which widened the
perspective of local leaders into developing strategies
to address the existing health conditions of their
respective locality based on the insights derived from
the presentation of existing models of local health
system of other LGUs.
There are initiatives done by the different ILHZs and GIDA
areas. These initiatives are worth-emulating to be shared during the
LGU to LGU meetings thus this consultative meeting is
conducted.
A total of 214 participants were able to register and take
part in the 2 –day activity. The participants were composed
of the Inter-Local Health Zone( ILHZ) Board Members and
the Technical Management Committee of the five (5)
Provinces and one (1 ) City of Caraga Region as well as CHD
Staff including PHTL and DOH Representatives.
The Regional Director of CHD-Caraga, Dr. Leonita P. Gorgolon
welcomed the participants and presentation of Best Practices
and Rationalization Options for Agusan Norte, Agusan Sur,
Surigao Norte, Surigao Sur, Province of
Dinagat Islands and Butuan City
followed. There was Launching of
of GIDA and Ceremonial
Signing of the Memorandum of
Agreement.
Dir. LP Gorgolon welcomes the participants
Registration at the secretariat
Dr. Lilibeth David with some participants in the best booth as background
Part of the participants Dr. R de los Reyes, PHO IIof
SDS receives recognition
award Dr. My Beltran, GIDA Coord.
99% Generic Rx
Compliance in
Caraga Region
B. 8.Regulations, Licensing & Enforcement
A. Food and Drug
Authority of CHD Caraga
conducted the following activities:
1. Five (5) batches of Licensing Seminar for Food
Processors and Manufacturers with a total of 167
participants coming from the municipalities all
over Caraga Region.
This seminar was designed to orient/reorient food
processing and manufacturing plant owners of
the importance of strict compliance to licensing
requirements especially on good manufacturing
practices.
2. Another activity conducted was the Introductory
Course on Pharmacovigilance last August 31, 2010
at Luciana Inn, Butuan City. The topics discussed
were on Medication Errors, Clinical Drug
Interactions and Drug Counterfeiting and were
able to invite the interest of the Hospital Pharmacists from both government and private
hospitals. Moreover, they were made cognizant of the Need for Pharmacovigilance
through competent Adverse Drug Reaction/ Adverse Drug Event monitoring, evaluation
and reporting.
Former Usec Margarita Galon during the OSS Seminar
Joy Metrillo, discussed on the Statistics in Chemistry and Interpretation of the
EQAS-CC
B. Health Facilities Licensing Unit of the
Regulatory, Licensing and Enforcement Division of
CHD Caraga conducted the Orientation Seminar
on Hospital Management/Policies/Updates on
OSS Licensing Requirements on July 8-9, 2010 at
Almont Inland Resort, Butuan City. The 150
participants were Chiefs of Hospitals and
Administrative Officers and Chief Nurses from 35
Government Hospitals and 24 Private Hospitals in the
Region.
The seminar hopes to raise the level of awareness among
various stakeholders management/policies/standards that
will help in their successful hospital operation.
Another activity conducted was the Seminar
Workshop on Preparation of the Laboratory Quality Manual
Based on A.O. 2007-0027 and Basic Quality
Control Procedures in Clinical Chemistry on June 22-24,
2010 at Almont Hotel’s Inland Resort, Butuan City.
The workshop was conducted to help operators of Clinical
Laboratories comply the licensing
requirements for initial and renewal of
License to Operate at the One-Stop Shop
facility of the CHD and to improve quality
laboratory results and maintain a high
standard of practice ensuring the accuracy
and precision of laboratory
examinations in order to
safeguard public health and
safety.
The invited speakers were from the
Lung Center of the Philippines, the
National Reference Laboratory for Anatomical Pathology and
Biochemistry, namely: Dr. Gloria Lim-Tan, pathologist with the
three Medical Technologists and one from the Bureau of Health Facilities and Services,
Manila. Topics discussed were on the standards on records and communication. Seventy
seven (77) Medical Technologists from the government and private hospitals, institutional
based and free standing clinical laboratories attended the said workshop.
Dr. Gloria Lim Tan discussed on the Preparation of Quality Manual, Quality Standards in Clinical Laboratory, Quality Assurance in Clinical Lab.
Batch of SDN & PDI Participants of the eFHSIS Users Training with the FHSIS Coordinator Mr. Paul Ofiasa
Mr. Daryl Estrella coaching
participant s of eEDPMS
B. 9.Health Information System (HIS) The Health Information System (HIS) of the
CHD Caraga maintains several information
systems which are mostly in electronic form.
Each has a point person/coordinator to man
the specified system. All of these are designed
to meet the health
information needs for
development of all sectors.
a. Field Health Service
Information System the official health
information system of the
Department of Health
conducted 5 batches of
Electronic FHSIS Users’ Training
from August to November, 2010
at the Holy Child Colleges of Butuan in Butuan City. A
total of 250 participants actively learned the software
and all of them especially PHNs expressed their delight to
have this electronic system at last.
It is hoped that with this electronic system, the issue on delayed and
inaccurate reporting can be addressed so that the need for quality
and highly reliable data can be met.
b. Ten (10) batches of Hands – On Training/Refresher
Course on Electronic Essential Drug Price
Monitoring System (eEDPMS) were conducted last
November and December, 2010. 98% of the invited
participants from drug
establishments and outlets
successfully completed the
training on the computer-
based price monitoring system of
essential drug prices and
inventories.
Mr. Jayson Villahermosa with FDRO Nora Gaballo coaching participants of eEDPMS
L-R: AVP JY Sychua, Hon. Mayor DB Corvera, Usec.
Mario Villaverde, Dir. LP Gorgolon and Dr. L. David in
Cabadbaran City
B.10. Health Care Financing
The Program on Health Care Financing
conducted several activities that were all
geared toward achievement of goals:
a. PhilHealth Sabado/Nationwide
PhilHealth Registration Day
was conducted throughout
the region in fulfillment of
PNoy’s Universal Health
Care (UHC) health agenda.
The Regional and Provincial Core Team composed of DepEd,
PHIC, DSWD, DILG, PIA, NSO and Provincial Health Offices made
this activity highly successful. Each agency has its own area of
responsibility. A series of advocacy and consultation meetings were
done by this team and is a factor that contributed to the success of
PhilHealth Sabado.
Preparations included the establishment of registration Kiosks which
were mostly provided with computers with online connection to the
internet. Online kiosks can receive payments from IPP and offsite
kiosks (those without online internet connection) have activities
limited to advocacy and distribution of PHIC Cards. PHIC verified the
list of indigents thru the National Households Targeting System (NHTS)
which the DSWD provided.
Most of the LGUs provided meals, snacks and transportation for their
constituents while the DOH CHD Provided meals, snacks and
T-shirts to the core team members and working force and IEC
materials to LGUs.
b. Training on PhilHealth
Bench Book Standards
for Out Patient Services
for LGU Implementers
and Roll Out Training for
Technical Assistance on
PhilHealth Bench Book
for Out Patient Services (PBSOS) were conducted to
help facilities and members to benefit the most out of
PhilHealth. Chief of Hospitals, Chief Nurses, Hospital Administrators, MHOs and PHNs from all
over the region attended these activities and most exclaimed that implementation of this
benchbook will surely address the present problems.
Mr. Daryl Estrella and Mr. Jayson Villahermosa
with FDRO Nora Gaballo coaching
participants of the eEDPMS Training
The marked difference in total livebirths and total deliveries is due to the inclusion of deliveries with
stillbirth outcome as reported by Surigao del Sur and Butuan City. The data on deliveries from these
areas were the ones submitted to DILG for the LGU Scorecard 2010.
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