A Humble Community in Caloocan Aspiring to practice Universal Health Coverage (UHC)

Somewhere in Caloocan City, a group of peoples organizations are aspiring and gradually building podiums in their plan to formally introduce Universal Health Care for their clients, the underprivileged people of Caloocan City and proximate barangays. The Livelihood, Education, and Rehabilitation Center of Caloocan City is gradually making Universal Health Coverage a still reality in the poor communities in the said City.

UHC Defined

Universal Health Coverage has been accepted as common development norm for all countries to promote equity among citizens. Access to health care actually is being considered as human right that has developed over the century. This became a standpoint among nations in ensuring that all citizens must have “access to key promotion, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access” (World Health Assembly Resolution 58.33).

Universal health coverage means that all people have access to the health services they need (prevention, promotion, treatment, rehabilitation and palliative care) without the risk of financial hardship when paying for them.

This would require an efficient health system that provides the entire population with access to good quality services, health workers, medicines and technologies. It also requires a financing system to protect people from financial hardship and impoverishment from health care costs. 

Access to health services ensures healthier people; while financial risk protection prevents people from being pushed into poverty. Therefore, universal health coverage is a critical component of sustainable development and poverty reduction, and a key element to reducing social inequities.

With the said principle, health care should be delivered to ALL, regardless of their social stature and economic abilities. 

Photo from World Health Organization

Guided by the above principles, Muslim Aid Philippines (MAPhil) was inspired with the initiatives of its local partners stationed at the Livelihood, Education and Rehabilitation building (LERC) in Caloocan City which, in many ways adopted the key framework of UHC and implement such health programs to local community members.

LERC’s Humble Path to Local Health Interventions

In 2006, a group of barangay health workers, local leaders, and parents of children with disabilities under organization of the Livelihood, Education and Rehabilitation Center (LERC) conducted a medical mission for the poor residents of barangay 185 in coordination with local NGOs, UERMM, the local government unit of Caloocan and Barangay 185 council. The said activity has provided free medicine and health consultations to more than 1,500 residents of Brgy. 185 of Caloocan City and that of proximate barangays.

From then on, this initiative became an annual activity of said key players in the said barangay, catering not only residents of Barangay 185, but even reaching other barangays in North Caloocan like Camarin and Amparo, and eventually reaching residents of the City of San Jose Del Monte.

Realizing the extent of health needs in their area of operations, the occupants of LERC eventually decided to establish a separate center that they envision to be a center that will take charge in “awareness raising for healthy lifestyle, prevention of disease, acquisition of cheaper medicin e; especially for the indigent residents, provision of early intervention for children diagnosed with disability, establish a referral system with health agencies and private institutions, and capacity building of the local health workers and even the parents of children with disabilities.

Through the years, LERC was able to implement various programs on health which basically are leading towards the creation of a UHC system in the community. As such, said local health facility gradually sets in place various initiatives that provides the following services;

·    Campaign drives and other activities informing and encouraging people to stay healthy and prevent illness;

·   Early detection of health conditions, in partnership with the University of East Ramon Magsaysay Medical College, etc.

· Networking and partnering with health institutions (UERMM, local health centers, Eulogio Rodriguez Hospital etc. ) to provide capacities in treating diseases;

·   Helping patients with rehabilitation

·  Capacity building of well-trained, motivated health workers to provide the services to meet patients’ needs based on the best available evidence.

·  Actions to address social determinants of health such as education, living conditions and household income which affect people’s health and their access to services.

·    Affordability – a system for financing health services so people do not suffer financial hardship when using them.

Similarly, LERC envisions to deliver medicines and technology to diagnose and treat medical problems available to the public, in collaboration with various partners of LERC. In the long run, LERC envisions to provide health services to indigent children with disabilities and residents while at the same time reducing costs to families.

The above interventions at LERC ensures the to target the Millennium Development Goals – births attended by a trained health worker, family planning, vaccinations, and prevention and treatment of diseases such as HIV, malaria and tuberculosis, considering how to address the growing problem of non-communicable diseases.

Pooling in Resources for UHC

Financial capacity for health services has been the perennial problem of parents of CWDs and other residents being catered LERC. Needless to say, the poorest populations of Caloocan City often face the highest health risks and need more health services. A single consultation with a doctor would cost around P300-P500 pesos. This would mean that a parent of an indigent patient would have to sacrifice chunk of their earnings just to mend the health needs of their child or patient. This definitely would cause financial risk on the part of the parents, who may be lured to apply for loans just to replenish their monthly budget.

This reality challenged LERC to strengthen its resources mobilization and to pool in available funding for as many as its clients are as possible. Meaning, that they have to innovate ways to acquire possible funding from within its organization and sources external to it. LERC has been consistent of its norm that health care should be delivered, especially to those in need, regardless of their ability to pay. Primarily, this strategy on reducing the reliance of impoverished LERC clients lowers the financial barriers to access and reduces the impact of health payments, allowing them to allot their meager income to some other household expenses.

Who are covered by the health interventions in LERC?

LERC works on the principle of inclusion, with a greater consideration for those who could not afford primary health care. Specifically, LERC’s main clients are the most vulnerable people in their respective communities. Aside from persons with disabilities, LERC also caters senior citizens, mothers of CWDs, and impoverished youth. In the long run, LERC’s main service would be to ensure access to health facilities, medicines and other health services to proximate barangays of Brgy. 185.

In the area of monitoring, LERC accepts the fact that it has to to track progress in providing access not just across the population of their recipients but within different groups (e.g. by income level, sex, age, place of residence, migrant status and ethnic origin). Initially, LERC was studying to employ the Android Technology for surveying and baselining and is currently looking into the technology to date. 

Measuring LERC’s health programs in relation to UHC

Sample software which LERC plans to use in thier Android survey

The primary basis of LERC’s impact is to know whether the clients (super majority of which are indigent residents of Brgy. 185 and proximate barangays) is whether they obtain primary health services that they need while being freed from too much financial obligations.

For LERC, this could be done by doing a head count on the number of inviduals who have actually acquired medical services according to their age groups. For example, LERC would like to establish a data on the number of women in fertile age groups accessing modern methods of family planning or children immunized.

Meanwhile, LERC would also like to determine how many of its recipients or partner families were placed into economic strains (especially in the case of those who applied for loans after attending a sick family member).

The main challenge for LERC is how to maintain its roster of volunteers who have the capacity to measure coverage of all of the many health interventions that LERC is providing or trying to provide. Understandably, these volunteers also have to attend to their specific jobs outside of LERC in order to provide their family needs. LERC admits that it do not have the capacity to provide remunerations to its volunteers, whilst it desperately needs the volunteers’ services.

Looking Forward

Despite the foreseen lack of resources, LERC is still committed to continue and eventually expand its services.

With its meager resources at hand, LERC sees various opportunities of funding through local solicitations, fund-raising activities, and partnerships with health service providers. It is in this strategy that LERC wishes to employ in the coming months of 2018 and beyond. Aside from furthering the capacities of its volunteers, LERC is keen on improving its health equipment and devices to serve more indigent people in their areas of operations. And while they are doing this, LERC will likewise pool in volunteer project development staff for the development of funding proposals from national and international donors who can greatly augment their very limited resources.

In the meantime, all the LERC staff and volunteers are still high in spirits as they are preparing to sustain their meager resources in preparation for the health needs of their constituents this year 2018.     

LERC occupants preparing for UHC implementation in their project areas