This article discuss and answers the two questions which have relevance to the Philippine situation - first, the ethics of difficult life-- and- death decisions, and secondly, new and neglected aspects of the moral responsibility of Filipino doctors for the '80's.
BIOETHICS ; COMMUNITY HEALTH WORKERS

Background: Mental Health Literacy (MHL) is considered a vital determinant of mental health and has the ability to benefit both individual and public mental health. To thoroughly measure the different aspects of mental health literacy and determine level of knowledge in the community, a MHLS-Filipino version is required. Objective: This study aimed to validate the Mental Health Literacy Scale – Filipino (MHLS-F) version among Community Health Workers in a rural and an urban health center in CaLaBaRZon. Study Design: This is a methodological study that was conducted among rural and urban health workers Patients and Methods: The guidelines provided by Beaton was used as template for the process of translation and crosscultural adaptation. The first phase involved Translation and Cross- cultural Adaptation of the Mental Health Literacy Scale from English to Filipino Version (MHLS-F). The instrument was simultaneously forward translated from English to Filipino by two independent translators from the Sentro ng Wikang Filipino. Back translations into English were done by two independent translators. The expert review committee discussed discrepancies found between the original items and the back-translated version of the questionnaire through a small group discussion and evaluated the content validity. Judgement on each item was made based on the computed i- CVI. The pre-final translated questionnaire was pre-tested on 5 rural and 5 urban community health workers with similar characteristics to the study population. Suggestions or alternative wording were documented and forwarded to Sentro ng Wikang Filipino for editing and proofreading. After synthesis of all reviews, the Mental Health Literacy Scale – Filipino Version was finalized. The final version was administered to 220 Community Health Workers from the Santa Rosa CHO and San Juan MHO. Psychometric properties on internal reliability using Cronbach’s Alpha was used as complementary procedure for determining the final structure of the instrument. Results: All six domains of MHLS were translated into Filipino without any major problems. The Final Mental Health Literacy Scale- Filipino Version has 26 items under 3 subscales. It has an acceptable content validity and satisfactory internal consistency (Cronbach’s alpha 0.730). Conclusion MHLS was successfully cross-culturally adapted into Filipino. The MHLS-F has good validity and reliability in assessing knowledge and attitude in mental health among community healthcare workers
Community Health Workers

Objectives: Community health workers (CHWs) fill in the insufficiency of health professionals in low-income countries. The CHWs’ roles include health education of their constituents whose health they likewise take care. This study aimed to describe the concept and understanding of diabetes among CHWs in the Philippines. Methods: Fifty female CHWs currently working in rural and urban areas participated in six focus group discussions with guidance from Kleinman’s eight questions. With the written informed consent of the participants, discussions were recorded and transcribed by the Research Assistant. A multi-disciplinary team manually analyzed the data. Disagreements were discussed among them and the physicians provided clinical analyses and explanations on the results. Quotations of an important point of view were also presented. Pseudonyms were utilized to uphold anonymity. Results: CHWs were aged 32 to 72 years; older participants reside in rural areas. Majority were married, housekeepers, and high school graduates. Some CHWs and their family were suffering from diabetes or dyabetis, the disease of the rich according to them. Its causes were food and lifestyle, and believed to be hereditary. Complications lead to death. Amputation was feared the most. Diabetes is incurable. Persons with diabetes should take maintenance medicines, and seek physicians’ and family’s help. Together with the patient, the family must decide on its management. Balanced diet, healthy lifestyle, maintenance medicines, food supplements, and herbal plants were perceived treatments. The internist should lower blood sugar level as well as prolong life span. Proper diet and regular check-up prevent diabetes. Conclusions CHWs’ concept and understanding of diabetes reflect some of the biomedical causes, effects, treatment, and prevention of diabetes as well as its social determinants. The efficacy and safety of herbal plants in the treatment of diabetes, however, should be further studied. Training on diabetes care should be provided to address their fears of amputation, insulin injection, and complications.
Community Health Workers ; Philippines

Background and Objective: Within a decentralized health system, barangay health workers (BHWs) are often the first point of contact for Filipinos seeking care. Despite their importance, BHWs are neglected in the health value chain. The study seeks to examine the lived experiences of BHWs, particularly their journey in navigating their roles within the community and the health system that encompasses their day-to-day realities, challenges, motivations, and the meanings they derive from their work. Methods: The study draws on seven focus group discussions (FGDs) with BHWs (n=50), residents (n=7), and local government officials and health workers (n=7) of San Miguel, Bulacan. The qualitative data collected were analyzed using thematic analysis. Results: Findings show that BHWs perform many roles, which are not limited to health and are dependent on orders from their superiors. Guidelines are vague in appointing BHWs, with personal connections valued more than technical qualifications. Their accreditation is hardly conferred any significance. There is also a lack of formal and structured training. The informality of these processes leads to an absence of quality assurance on rendered health services. The non-provision of incentives and benefits stipulated in RA 7883 also places their health and lives at risk. Furthermore, BHW’s commitment to serve is used to excuse the inadequacy of their compensation and excessive workload. Conclusion BHWs take on diverse roles, from community organizers to healthcare providers, and are confronted with significant challenges encompassing politicization, inadequate training, and insufficient compensation. The study concludes with policy recommendations to improve the conditions of the neglected BHWs, with particular attention to coordinating, capacitating, compensating, career pathing, and connecting them to the health system.
community health workers ; universal health care ; Philippines

Primary Health Care is the essential care based on practical, scientifically sound and socially acceptable method and technology made universally accessible to individuals and families in the community through their full participation and at a cost they and the community can afford to maintain in the spirit of self-reliance and self-determination. Last September, 1978 at Alma Ata, an international conference on primaiy health care was done and they declared that Health is a fundamental human right and that the attainment of the highest possible level of health is a most important world wide social goal and that the people have the right and duty to participate individually and collectively in the planning and implementation of their health care.
Primary Health Care ; Health Promotion ; Community Health Workers

Objective: The primary objective of this study was to explore the acceptability of task shifting to volunteer barangay health workers (BHWs) in the implementation of community-based Diabetes Self-Management Education (DSME) in the Philippines. Methods: This study employed a descriptive qualitative study design. Data were collected through semi-structured interviews with twelve stakeholders. The study was conducted in the urban city of Marikina which has a high prevalence of diabetes, and high death rates for diabetes and cerebrovascular disease relative to the regional and national rates. A purposive sampling technique was used in selecting participants. Results: Task shifting Diabetes Self-Management Education to BHWs is generally acceptable to the participants. Expanding the roles of BHWs should be supported by adequate training, compensation, supervision, and financial and non-financial incentives. Ensuring adequate support and resources to execute BHWs’ duties and responsibilities as volunteer health workers can promote the effective implementation of task shifting DSME in primary care. Conclusion Findings from this study provide preliminary evidence of the acceptability of task shifting to BHWs in the management of diabetes mellitus. The study highlights the importance of institutionalizing task shifting in the health system to promote acceptance and sustainability
Community Health Workers ; Diabetes Mellitus ; Primary Health Care

Objective: The primary objective of this study was to explore the acceptability of task shifting to volunteer barangay health workers (BHWs) in the implementation of community-based Diabetes Self-Management Education (DSME) in the Philippines. Methods: This study employed a descriptive qualitative study design. Data were collected through semi-structured interviews with twelve stakeholders. The study was conducted in the urban city of Marikina which has a high prevalence of diabetes, and high death rates for diabetes and cerebrovascular disease relative to the regional and national rates. A purposive sampling technique was used in selecting participants. Results: Task shifting Diabetes Self-Management Education to BHWs is generally acceptable to the participants. Expanding the roles of BHWs should be supported by adequate training, compensation, supervision, and financial and non-financial incentives. Ensuring adequate support and resources to execute BHWs’ duties and responsibilities as volunteer health workers can promote the effective implementation of task shifting DSME in primary care. Conclusion Findings from this study provide preliminary evidence of the acceptability of task shifting to BHWs in the management of diabetes mellitus. The study highlights the importance of institutionalizing task shifting in the health system to promote acceptance and sustainability.
Community Health Workers ; Diabetes Mellitus ; Primary Health Care

Objective: To determine the level of knowledge and factors affecting knowledge and satisfaction with diabetes care among persons with diabetes at urban health centre (UHC) and community health worker (CHW)-led outreach clinics (ORC) in South India. Methodology: A cross-sectional study was carried out using a structured questionnaire. One hundred patients at the UHC and 200 patients at the ORC were included. Results: Patients with DM of more than eight years, with co-morbidities and maintained on insulin had good knowledge at the UHC. At the ORC, participants who received education beyond the primary level and belonging to non - Hindu religion had higher knowledge. Patients at the ORC experienced better satisfaction in terms of waiting time for appointments, consultation, registration system and counselling. At the UHC, those who received primary education or those with lower educational attainment had better satisfaction. Overall, knowledge (p=0.03) and satisfaction (p=0.00001) of diabetes care was better at the ORC than at the UHC. Conclusions Our study found better knowledge and satisfaction with diabetes care at the ORC than at the UHC. Whether or not the difference can be attributed to CHW-based clinics in the community needs to be further elucidated.
Community Health Workers ; Primary Health Care ; Knowledge ; Personal Satisfaction

Background: As the SARS-CoV-2 virus (COVID-19) continues to affect the capacity of the health system to deliver essential nutrition and health services, many countries, especially the low- and middle-income countries, including the Philippines, are beset with addressing undernutrition and micronutrient deficiencies among children. Objective: The rapid nutrition assessment survey (RNAS) was conducted in selected areas in the Philippines to provide evidence of the effect of the COVID-19 pandemic on children's participation in the nutrition services and their mothers' knowledge level on nutrition. Methodology: The RNAS was a cross-sectional survey conducted through phone interviews in nine (9) selected areas in the Philippines. A total of 7,092 children aged 0 to 12 years were included in the survey, of which 5,239 mothers and caregivers were interviewed regarding nutrition program participation of their children, and their knowledge on nutrition. Results: A significant decline in children's participation in the Operation Timbang (OPT) Plus (83.0% vs. 51.1%), Vitamin A supplementation (65.4% vs. 54.9%), supplementary feeding (21.6% vs. 11.9%), and deworming (60.4% vs. 11.9%) was recorded during the COVID-19 pandemic based on RNAS as compared to the pre-pandemic period using the 2019 Expanded National Nutrition Survey (ENNS). The most commonly cited reasons for health service disruptions include: child did not visit health centers due to fear of infection, community health workers did not visit the child at home, and no available health workers in the facility. Stunting among children was more likely to be perceived by food insecure (19.7% vs 14.4%; p <0.001) and poor (22.1% vs 16.6%; p<0.000) mothers or caregivers than their counterpart mothers from food secure and rich households. Conclusion With prolonged limited access to health and nutrition services, children, particularly those from poor households, are at risk of hunger, malnutrition, and consequently, of not developing their full potential. Findings can guide efforts to ensure the continuity of essential health and nutrition services towards improving maternal knowledge and promotion of child health and nutrition during the COVID-19 outbreak and crisis recovery period.
COVID-19 ; Infant Nutritional Physiological Phenomena ; Community Health Workers

Objective: This study aimed to estimate the prevalence of cardiovascular risk factors and metabolic syndrome among community health workers (CHWs) in selected villages in the Philippines. It also determined the association of urbanization and socio-demographic characteristics with hypertension, diabetes mellitus and metabolic syndrome among CHWs. Methodology: A cross-sectional study was conducted among CHWs who were actively rendering service from selected communities at the time of the study. Standardized interviews were conducted and clinical measurements were collected. Results: Of the total of 457 CHWs who participated, 96% were females with a median age of 50 years. The prevalence of hypertension in this population was 32.4%. Hypertension was found to be associated with older age [adjusted odds ratio (aOR) 5.3, 95% CI: 3.2 to 8.8, p<0.001], obesity (aOR 2.4, 95% CI: 1.4 to 4.0, p=0.002) and alcohol consumption (aOR 1.7, 95% CI: 1.0 to 3.0, p<0.040). The prevalence of diabetes mellitus (DM) was 13.6%. It was found to be more prevalent among CHWs who were at least 50 years old (aOR 2.7, 95% CI: 1.4 to 5.1, p=0.002), and those who spent at least 5 hours a day in sedentary activities (aOR 3.8, 95% CI: 1.1 to 12.7, p<0.033). Borderline to high total cholesterol, low density lipoprotein cholesterol (LDL-c) and triglycerides (TG) were seen in 41%, 37% and 20%, respectively. Sixty percent had low high density lipoprotein cholesterol (LDL-c). The overall prevalence of metabolic syndrome was 52.3%. Conclusion Metabolic syndrome is prevalent among CHW participants, with obesity, hypertension and low LDL-c as the most common components present. The prevalence of cardiovascular risk factors in this population was not found to be significantly different between rural and urban areas after adjusting for other factors.
Community Health Workers ; Hypertension ; Diabetes Mellitus ; Metabolic Syndrome ; Cardiovascular Diseases