Chapters 1 To 2. Incomplete. Please Double Check
Chapters 1 To 2. Incomplete. Please Double Check
CHAPTER I
Introduction
work and thriving education is dependent on sufficient health as well (Todaro & Smith,
2012). Respectively, a vast number of studies confirms that there is a very strong
relationship between health and economic growth (Mayer, 2014). Thus, healthcare is
undoubtedly essential for every folk in maintaining health status and promoting human
development. Despite of this, however, not everyone has given a chance for an access
(Gijsel, 2016).
Access to healthcare is important especially for women for they are vulnerable
and more prone to suffer from certain illnesses. Breast and cervical cancer are the two
usual cancers that affects women. Every year cervical cancer kills half a million of
women while another half a million die because of breast cancer. This cases mostly
happens in low and middle-income countries. In line with this, gallstones, Urinary Tract
Infection (UTI), kidney disease and hypertension are some of the health problems
common for women (Stoppler & Shiel, 2017). In addition to this problem, maternal
mortality rate remains surprisingly high. According to World Health Organization (WHO)
135 million women give birth per year, an estimated 20 million of them suffer from
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pregnancy related illness, and about 303,000 women die while giving birth every day.
Poverty, distance, and unavailability of services are factors that hinder them for seeking
healthcare.
Similarly, healthcare access is also significant for children because their physical
2017). However, there are plenty of health problems they encounter. Enormous children
are dying every day because of diseases such as diarrhea, pneumonia, and measles
which can be cured or prevented (Reaves, 2017). Further, malnutrition still remains a
major issue for every child. Malnourished children are more likely to have weak immune
developing countries, 10.4 million malnourished children die. This figure tells that a vast
number of children are deprived of nutrition, water, sanitation facilities, shelter, and
According to WHO (2017), 400 million people are unable to access the needed
health services. Disadvantaged people like poor women and children, rural dwellers,
In the case of the Philippines, inequity in health status and access to healthcare
services are the challenges encountered. Only few Filipino women experience the
due to lack of financial means (Gijsel, 2016). The country also deals with inadequate
(DOH) have difficulties restoring their stocks. Available health workers in LGUs are
decresing in the last few years because health workers choose to migrate and work in
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other country. Thus, healthcare resources are under scarcity in the country where
facilities, medicines and health workers are insufficient (Cetrangolo, Mesa-lago, &
Carisma, 2013).
As such, poor coastal communities often translate into poor access to health
services because of its remote location (World Wide Fund, 2012). These communities
are too small and isolated to support their needs of health services that’s why residents
are required to go to urban health centers to access healthcare (Wakerman et. Al,
2012). Numerous coastal regions in developing nations are poorly served by health
telling whether a healthcare is accessible particularly for poor women and children on
coastal areas. The study will provide empirical evidence and comprehensive information
concerning the current status of healthcare of poor women and children access in
Paombong. In addition, the study will also explain the barriers that prevent the residents
in accessing health. The knowledge obtained from the study will be useful as a starting
The general problem of the study is: How may accessibility to health care among
described?
1. What are the existing healthcare programs of the government in the coastal
communities?
2. How may accessibility to heath care among poor women and their children be
measured in terms of :
2.2 availability;
2.3 affordability
2.5 acceptability?
experience of participants?
accessibility?
The knowledge that will be obtained from the study will be beneficial to the following
stakeholders:
Residents of Paombong. The study can be used to reveal the current status of
healthcare accessibility in Paombong to the public eye in hope to have a better access
to healthcare. Furthermore, it can raise their awareness regarding the issue addressed.
DOH Officials about the occurring interventions to healthcare access, use and cost. It
Paombong.
the measurement of the barangay`s development since health is one of the key factor
researchers that have the same topic so that they can use the findings of the study to
further strengthen the foundation of their research. It will also serve as a reference
Binakod and Sta. Cruz. The accessibility of healthcare will be measured in terms of: (a)
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geographic accessibility, (b) availability, (c) affordability, (d) acceptability; and (e)
accommodation.
There will be a total of one hundred twenty-eight (128) participants. The 90 poor
women and children will be picked through stratified sampling approach, while the 28-
key informant will be chosen through purposive sampling with the criteria based on the
researchers. The study will be limited to women and their children living within the three
(3) barangays. Their children should age 12 years and below. The women will be
chosen based on their monthly earnings below ₱9,626 per month. Additionally, women
and their children living outside the barangays are excluded in the study. Survey, focus
group discussions and key informant interviews are the instruments that will be use in
the study.
CHAPTER II
This chapter presents the relevant theories, related literature and conceptual
framework which researchers have pursued to shed light on the topic under study.
Relevant Theories
The Theory of Access was developed by Roy Penchansky and J. William Thomas in
1981. The theory defined access as the degree of fit between the patient and the healthcare
system. Access has independent yet interconnected dimensions that represent distinctive
affordability, and accommodation. It also states that access is the center of these dimensions
coastal communities. The 5 A’s of access will be used to identify and to measure the existing
issues encountered by poor women and their children in terms of accessing healthcare.
Related Literature
This section provides the reviews of related literature which will give a clear
1948, stating that health is an essential human right, and from the Health for all agenda
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prepared by Alma Ata declaration in 1978. This means that the entire people and
community receive quality health services while also assuring the affordability of health
services. The given definition mirrors its three related objectives particularly equity in
excellent health services that is enough to improve the health of the users and the
security of people against financial risk of obtaining health services. It also includes all
component of health system like health delivery system, health facilities, health
Tracking progress toward UHC focus on two things: the portion of the population
that can access the indispensable quality health services and the portion of the
population that pay a huge amount of family income on health. WHO, together with the
World Bank has developed the framework to monitor the progress of UHC by tracing
both categories. Moving toward UHC demands strengthening health systems and
should be available and accessible for every Filipino. It aims to guarantee that Filipinos
shall be able to afford and acquire quality health benefits. This includes supplying
sufficient resources such as health facilities, health professionals and health financing.
To achieve UHC in the Philippines, there are 3 goals to be pursued namely: Financial
risk problem, improved access to quality hospitals and healthcare facilities and
Dental Medicine
The dental medicine in Philippines provides dental services and maintains dental
examination and initiate dental treatment. Dental main which is the one that takes cares of
present admitted patients for dental surgical interventions. They also have an out-patient dental
section that cater the unconfined patients that also need dental care and treatment.
Prosthodontia Section, here they specialize constructions and fabrication of dental prosthesis.
This is the department that specialize dentures. Healthcare programs in the Philippines is one
way to be implemented to improve the healthcare access in the country here are agendas for
Philippine healthcare.
healthcare access in the country here are agendas for Philippine healthcare.
These will conduct annual health visits for all poor families and special populations
(NHTS, IP, PWD, Senior Citizens). Also, will develop an explicit list of primary care entitlements
that will become the basis for licensing and contracting arrangements. Transform to improve
select DOH hospitals into mega-hospitals with capabilities for multi-specialty training and
ordinances. Establish expert bodies for health promotion and surveillance and response.
Raise more revenues for health, will impose health promoting taxes, increase NHIP
premium rates, improve premium collection efficiency. Give more chance to have GSIS, MAP,
PCSO, PAGCOR and minimize overlaps with PhilHealth. Expand PhilHealth benefits to cover
outpatient diagnostics, medicines, blood and blood products aided by health technology
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assessment. Update costing of current PhilHealth case rates to ensure that it covers full cost of
care and link payment to service quality. Enhance and enforce PhilHealth contracting policies
to local and global needs. Streamline HRH compensation package to incentivize service in high-
risk or GIDA areas. Update frontline staffing complement standards from profession-based to
competency-based. Make available fully-funded scholarships for HRH hailing from GIDA areas
or IP groups. Formulate mechanisms for mandatory return of service schemes for all heath
graduates.
Mandate the use of electronic medical records in all health facilities. Make online
submission of clinical, drug dispensing, administrative and financial records a prerequisite for
systems, and support efforts to improve local civil registration and vital statistics. Automate
major business processes and invest in warehousing and business intelligence tools. Facilitate
Enforce standards, accountability and transparency & Value all clients and patients,
Publish health information that can trigger better performance and accountability. Set up
the poorest 20 million Filipinos in all health programs and support them in non-direct health
expenditures. Make all health entitlements simple, explicit and widely published to facilitate
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understanding, & generate demand. Set up participation and redress mechanisms. Reduce
turnaround time and improve transparency of processes at all DOH health facilities. Eliminate
queuing, guarantee decent accommodation and clean restrooms in all government hospitals
Harness and align the private sector in planning supply side investments. Work with
other national government agencies to address social determinants of health. Make health
impact assessment and public health management plan a prerequisite for initiating large-scale,
high-risk infrastructure projects. Collaborate with CSOs and other stakeholders on budget
ACCESSIBILITY TO HEALTHCARE
Geographic Accessibility
the time when patients can physically access the services in the health centers from
their community. In the article of HAPI (2014), people tend to find healthcare facilities
difficult to access because of the distance and travel time and much more difficult for
In the journal article of Kumar, Dansereau & Murray (2014), which focuses on the
access and distance to health facilities and stated that distance and travel time are one
of the barriers in access to health care. According to the article, places that are way too
far from health care provider have big impact in utilization of healthcare and outcome in
health. Some families in India choose to travel longer just to have proper medication.
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Households, on some cases doesn’t have the means to acquire healthy life because
they often lack resources for transportation. According to the research, geographic
access is more important than socio-economic factors especially in rural and remote
Availability
Access to health services depends on the availability of supplies, health facilities, human
Chen, Yin, and Xie (2015) found out that one of the problems in healthcare is the
unequal distributions of healthcare resources in rural and urban areas due to the fact that rural
areas have a much poorer economic condition, lack of government investments, and low
resident’s payment capability. According to Titus, Adebisola, and Adeniji (2014), accessibility of
household to medical facilities are very low because of the inadequate and unequal distributions
of public health facilities. There are also disparities between patients and health personnel
Affordability
person’s income is sufficient enough to pay for primary healthcare cost. There are
plenty of people who cannot obtain medical care because it is expensive (Glynn,
MacKenzie & Fitzgerald, 2016). In the case of America, when their country has grown,
they conducted public programs and implemented the Affordable Care Act to help poor
people obtain healthcare by the use of public health insurance. However, the
enrichment of their country does not increase their generosity proportionately towards
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poor people. Also, it does directly increase the affordability of healthcare for those
One of the goals of the government is to help poor people obtain medical care
and to make public health insurance available to the poor so that they can somehow
afford healthcare services. Their assumption is that if poor people have health
insurance, doctors and other healthcare providers will give the same and equal services
to poor people like what they do to middle class and rich people. Even though public
insurance have grown, it became clear that poor people still encounter barriers while
obtaining health care and it is beyond simply their inability to afford it. One of the
barriers is that not all healthcare providers are willing to treat people with public
Acceptability
desires, expectations, beliefs, values and levels of independence on the people around you.
The cultural and religious beliefs affect the delivery and acceptance of healthcare. Also,
barrier in accepting healthcare. In certain cultures, women is not allowed to see and be
examined by the male health workers. Additionally, there is some inappropriate behavior the
health care providers some humiliate and abuse health consumers. Dr. Tello says that most
physicians are not explicitly racist yet they are under the racist system. Furthermore, poor
patients more likely to cure themselves naturally before seeing the doctors. Accepting treatment
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to official healthcare workers sometimes tend to be second on their choices. The satisfaction of
Accommodation
service is well organized to receive clients and clients are able to use the service. This
include hours of operation, appointment system, waiting hours and the like.
Department of Health, Australia (2014), stated that women should have access
to healthcare, according to what they need and acceptable to them, as near as possible
to their community, but the available choices are different base on their location from
In the case of Australia, women who live in coastal remote area experienced
difficulties in getting antenatal health care due to their distance from the health facilities,
cost of the healthcare and scare supply of services. In some cases, women who are
required to give birth or to consult doctors in health facilities are forced to travel away
from their community, lead to additional cost of care, and separated temporarily from
family especially to other children. Reported neonatal death, wherein a baby dies on
28th to 30th day after birth, are high among women who live in rural areas and fetal
death, the death of a fetus during pregnancy, are much higher in coastal community of
Australia. Women tend to suffer more because healthcare is not close to their homes
Due to the difficulties in accessing the healthcare facilities, midwives and doctors are
the ones who travel for hours, three times per week from Rural Health Unit in Salcedo in
order to reach Brgy. Matarinao because women and their children in the barangay
cannot afford to do so. Barangay Matarinao has reported cases of high number of
Related Studies
accessing healthcare and coping strategies of acute illness costs. The study used
interview, focus group discussion and survey questionnaires as the method to gather
data and conduct the study. It concluded that most household in Koboko District seek
healthcare from public sector, even richer households. Regarding barriers in accessing
medicines the study found out that unavailability of drugs and high prices are the
medicines were not a severe problem. A large number of households sell assets or
even their food for consumption, to cope with acute illness costs.
The author made a great examination of the data through quality and quantitative
techniques that resulted to a more comprehensive finding. The author also made sure
that all details in their study is well defined. On the contrary, the authors provide a
limited information about the accessibility of medicines because the instrument used
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The above study is similar to the current study in terms of the method it used in
order to collect data which is interview, focus group discussion, and survey
questionnaires. Both study also focus on coping strategy and accessibility. It was then
for Women in Rural Samoa conducted by Paige Lynn Miller in 2012, the study states
that there are many barriers that prevent women from Rural Samoa in accessing
may lead to major health issues. All of the health issues mentioned in the study is
said that the use of mixed design will strengthen the research foundation. The
services and conducted personal interviews to one hundred one women in the Village of
Iva in Rural Samoa with ages 20 years and older. The researcher verbally verified the
data gathered with the participants after the conclusion of each interview. The findings
of this study is that the barriers preventing women in Village of Iva from accessing
affordability of the medicines and services and the transportation cost. The study shows
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that if women does not have or have minimal access to healthcare services it may lead
to low life expectancy, high maternal mortality rate, sexually transmitted disease,
obesity and diabetes. Additionally, traditional medicine, high cost of prescription drugs
and being unaware or having less knowledge in healthcare services prevents the
women in Rural Samoa from accessing the healthcare services and programs provided
The study has a good foundation based on the related literatures and studies.
The researcher has a great research techniques and methodology which shows how
reliable the study is. However, the study did not elaborate or further explain some
factors that contribute to the barriers that prevent access to healthcare. The study said
that the future researchers should focus on the infrastructure and adequacy of the
public healthcare system, further examine the pressure of the affordability constraints of
transportation, user fee and prescription drugs in a larger sample size, compare the
level of access to healthcare services between women living in urban and rural areas.
As we can see based on the recommendations of the study, there are many factors that
The study is somehow similar to researchers because the study assesses the
accessibility of healthcare for poor people in remote areas. Researchers will also apply
the same method that the study used which is mixed method and some of the
parameters in the study are quite similar to what are going to use.
District focused on evaluation of the healthcare access of the poor, the problems
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researchers performed case study as the method and technique to gather the data from
PRU District. The data were collected from the sampling size of 200 in selected seven
rural community households. Qualitative and quantitative data were also collected from
focus group discussion and key informant interviews for chiefs, assemblymen, teachers
and youth for additional information. The study revealed that people in rural
health facilities. This includes, unavailable health facilities and health equipment, poor
system in transportation, long travel distance and lack of financial means. The study
concludes factors hindering access to health facilities and services in Ghanaian context
This study analyzed the factors affecting the healthcare accessibility based from
the result of data collection and provides a clear assessment on the relationship to each
other. However, the researcher didn’t explain further the travel distance or the criteria to
The above study was similar to the study undertaken currently by the
for the poor, challenges encountered and coping strategy of the respondents. It was
then different to the current study in terms of the setting because researchers will
emphasize on coastal area while the authors used rural setting and other factors such
of Ghana.
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