BACKGROUND AND OBJECTIVE

Barangay Health Workers (BHW) are a crucial part of the local health system. Health services at the barangay level are heavily dependent on BHWs. However, despite their significant role in the local health system, support has been minimal and not commensurate with their contributions. The study aimed to identify the perceived external and internal factors that affect the performance of BHWs.

The study identified the BHW-perceived external and internal factors affecting performance, through mixed quantitative and qualitative methods. A self-administered questionnaire with a 4-point Likert scale that will assess the factors was given to 561 BHWs from five different upland municipalities of Cavite. A focus group discussion using open-ended questions was conducted to gain an in-depth understanding of their experiences. Emerging themes were reported into narratives.

BHWs maintained a strong level of participation at required health activities, but more than half were often late, owing to their volunteer status and external responsibilities. They were perceived to have a high sense of duty reflected by punctual submission of reports and confidence in delivering health services. Job satisfaction emerged as a substantial motivator while burnout was not a significant demotivator. Leadership and support from local government and health program management were perceived positively by most BHWs. Service delivery confidence was high among BHWs as reflected in their capability to provide expected services. BHWs perceived that challenges were present in terms of the adequacy of medicines and supplies, and on data transmission, although half were generally satisfied with the organization of health records. Human resources were perceived to be sufficient. Financial aspects showed that while most BHWs do not contribute personally to patient care, a significant minority shell out resources for patients, reflecting financial strains within the health system. The study also revealed the varying motivations for volunteering, including community service, staff shortages, knowledge acquisition, and additional income.

External and internal factors affect the performance of BHWs at the local level. These were related to current health systems, political climate, personal household duties, and financial status. Despite facing these challenges, the BHWs showed commendable involvement in local health programs. BHWs remained motivated through training opportunities and positive community feedback but were hindered by a lack of health science knowledge and the need for supplementary income.

The Supreme Court decision on the Mandanas-Garcia petition regarding the internal revenue allocation given to local government units is a significant ruling in strengthening the concept of decentralized governance and delivery of services. While the ruling grants local government greater resources and financial support, the immediate implication is the full devolution of services defined in the Local Government Code, including health services. The urgent concern is how much the Mandanas Ruling will affect local health systems. This paper presents some existing and foreseeable issues surrounding the implementation of the Mandanas Ruling in relation to the current devolved healthcare system. In particular, challenges in implementing the ruling in relation to health devolution, the local health system process, and the Universal Health Care Act are discussed. Some concrete action points for addressing these issues are also posited for policy-makers and implementors to consider in order to ensure not just the smooth and efficient implementation of the ruling but also the continuity of care for Filipinos.

OBJECTIVE: This study examined the clinical characteristics of suicide attempters who exposed their suicidal intension to suggest an active intervention strategy for suicide prevention based on the regional emergency medical service system. METHODS: A prospective database of suicide attempters who visited the emergency department of Chungbuk National University Hospital between October 2013 and December 2017 was used. All of the adult patients who provided consent for the initial assessment for suicidal attempters were eligible, excluding cases with unknown exposure of suicidal intension. The primary and secondary endpoints were the risk factors affecting exposure to the suicidal intension and characteristics of the exposure group. The adjusted odds ratios (AORs) of exposure to suicidal attempts after adjusting for potential confounders was calculated. RESULTS: Of a total 1,035 suicidal attempters enrolled, 332 (32.1%) were included in the exposure group. The exposure group was more likely to have an educational level above high school and no religion, and have suicidal characteristics at night time (18:00–08:00), under the influence of alcohol, suicidal plan before 1 week, and suicidal method involving asphyxia (P<0.05). The exposure group was more likely to have no guardian (AORs, 1.46; 95% confidence interval [CI], 1.00–2.12), use methods involving asphyxia (AORs, 2.07; 95% CI, 1.46–2.91), and attempt suicide at night (18:00 to 08:00) (AORs, 1.38; 95% CI, 1.05–1.83) compared to the no exposure group. CONCLUSION: Models need to be established, where regional mental health welfare center, local government, fire headquarter, and tele-communication companies can participate in the implementation of an active intervention strategy.
Adult ; Asphyxia ; Chungcheongbuk-do ; Emergency Medical Services ; Emergency Service, Hospital ; Fires ; Humans ; Local Government ; Mental Health ; Methods ; Odds Ratio ; Prospective Studies ; Risk Factors ; Suicidal Ideation ; Suicide ; Suicide, Attempted

OBJECTIVES: In this study an enterprise architecture (EA) was developed for a health referral information system (HRIS) for individual healthcare in Indonesia with reference to the Open Group Architecture Framework (TOGAF) 9.1. The HRIS includes patient referrals for vertical and horizontal references (internal and external), specimen referrals, and health personnel referrals. METHODS: This research was a qualitative study that used the interview and observation method of the Primary Health Care Information System (SIMPUS) application developed by the Agency for Assessment and Application of Technology (BPPT). The interviews were conducted at South Tangerang City Government Health Office with five resource persons who were responsible for conducting health referral processes. RESULTS: The EA of the HRIS includes the principles of architecture, business, application, data, and technology architecture. Twelve principles, four referral processes, and three application reference modules and centralized applications comprise the architecture of the HRIS. The HRIS is a centralized integrated application that uses application program interface (API) to integrate with SIMPUS. CONCLUSIONS: The proposed architecture was developed in an integrated and comprehensive manner for the individual healthcare referral process, which can be implemented by regulators and healthcare facilities. This architecture can also help regulators and healthcare facilities to standardize and integrate health referral data and related processes.
Commerce ; Delivery of Health Care ; Health Information Systems ; Health Personnel ; Humans ; Indonesia* ; Information Systems ; Local Government ; Methods ; Primary Health Care ; Referral and Consultation*

OBJECTIVES: This study examined the nutrition teachers' and parents' recognition of environmentally-friendly agricultural products (EAPs) used in school foodservice. METHODS: A questionnaire survey was given to 128 school foodservice nutrition teachers in Seongnam and 189 parents from Oct. 16 to Oct. 31, 2018 at Seongnam in Gyeonggi province. The survey included information on the recognition, satisfaction, and improvement of EAPs, and the results of the two groups were compared. RESULTS: A comparison of the recognition of EAPs showed that nutrition teachers knew more about the EAPs and local government support in school foodservice than the parents. On the other hand, the parents were more aware than the nutrition teachers in that children have a higher affinity for EAPs than for general agricultural products in the school foodservice. A comparison of the level of satisfaction with the EAPs by nutrition teachers and parents revealed the nutrition teachers to be significantly more satisfied than parents in terms of the color, taste and nutrition of EAPs. Among the items that should be provided with EAPs, more than 50% of each group of nutrition teachers and parents answered that vegetables must be provided first. Some 70.9% of nutrition teachers and 84.5% of parents were aware of the certification standards of EAPs. The nutrition teachers had showed a slightly higher score than the parents in the certification system (3.51 vs. 3.25). In terms of improving the EAPs, 36.2% of nutrition teachers answered a reasonable price preferentially, whereas 56.4% of parents answered maintaining quality. In the expected effects of using EAPs, 57.9% of nutrition teachers answered an improvement of parents' satisfaction on the school foodservice. On the other hand, 38.0% of parents answered an improvement of children' satisfaction on school foodservice. CONCLUSIONS: Nutrition teachers and parents need to be educated on the certification systems that would enhance the trust in EAPs.
Certification ; Child ; Gyeonggi-do ; Hand ; Humans ; Local Government ; Parents ; Vegetables

The biological profile of a person is crucial in the forensic anthropology casework; and sexual dimorphism of the index and ring fingers makes them a vital tool for sex prediction. This study was undertaken to predict the sex of an individual from the index and ring finger lengths, and index-ring finger length ratio in the Ukwuani of Nigeria. It was a cross-sectional study involving all the indigenous Ukwuani secondary school students and members of staff within Ukwuani local government area that utilized 200 male and 200 female adolescents and 68 male and 83 female adults based on the systematic random sampling technique. The index and ring finger lengths were measured and the index:ring finger ratio calculated. Data were analyzed using SPSS statistics version 23.0. P<0.05 was considered statistically significant. Statistics used were mean, standard deviation, t test, Pearson's correlation, and discriminant function analysis. Males showed statistically longer absolute finger lengths than females. The left index:ring finger ratio in adolescents was significantly greater in females than males, but the others were not. There were significant paired sample correlations in both age groups. There was no significant correlation between age and finger lengths, and ratios. The overall accuracy of the discriminant functions was higher and better for the finger lengths than for the finger ratios that were moderate. This study showed that the index and ring finger lengths can be used as tools to predict the sex of an individual using the discriminant function analysis in a medico-legal situation.
Adolescent ; Adult ; Cross-Sectional Studies ; Discriminant Analysis ; Female ; Fingers ; Forensic Anthropology ; Humans ; Local Government ; Male ; Nigeria ; Sexism

This study investigated the social outcomes of the Environmental Health Studies of National Industrial Complex (EHSNIC), which have been conducted by the National Institute of Environmental Research (NIER) in eight National Industrial Complex Areas (NICAs) since 2003. Eighteen sessions of focus-group interviews with 85 people were conducted from October 2016 to January 2017. Interviewees were stakeholders from eight NICAs and included resident representatives, environmental nongovernment organizations, local government officials, and environmental health and safety officers from companies. Interview results were divided into six categories: EHSNIC awareness, EHSNIC outcomes, EHSNIC limitations, EHSNIC continuation, EHSNIC improvement directions, and EHSNIC results use. They were then further indexed into 23 divisions. EHSNIC awareness varied across stakeholders. A major EHSNIC outcome is that a continued result database was established, which was used as a reference for environmental improvements. EHSNIC limitations included no proper healthcare actions taken during the EHSNIC study period, a lack of EHSNIC results disclosure, a failure to reflect local specificity, and a lack of validity in the results. Regarding EHSNIC continuation, all stakeholders said EHSNIC should be conducted continuously. EHSNIC improvement directions included conducting studies tailored to each NICA, identifying correlations between pollutant exposure and disease, increasing the sample size, and performing repeated studies. Regarding EHSNIC results use, respondents wanted to use the results as a reference to relocate residents, ensure distance between NICAs and residential areas, provide healthcare support, develop local government policies, and implement firms’ environmental controls. Since EHSNIC aims to identify the health effects of NICAs on residents and take appropriate actions, it should be continued in the future. Even during the study period, it is important to take steps to preventively protect residents’ health. EHSNIC also needs to reflect each NICA’s characteristics and conduct reliable research based on stakeholder participation and communication.
Delivery of Health Care ; Disclosure ; Environmental Health ; Local Government ; Qualitative Research ; Sample Size ; Sensitivity and Specificity ; Surveys and Questionnaires

BACKGROUND: This study aimed to investigate resilience as a protective factor for depressive mood and anxiety among Korean employees. METHODS: Participants were employees of eight private and local government organizations in Korea, aged 19 to 65 years. A self-report questionnaire that included items on resilience, job stress, levels of depression and anxiety, and socio-demographic factors, was administered to 1,079 Korean employees, with 1,076 valid responses. We performed hierarchical linear regression analyses with the levels of depression and anxiety scores as dependent variables. RESULTS: Being women and having a high level of job stress were associated with greater depressive mood and anxiety. In contrast, resilience was negatively related to depressive mood and anxiety, after adjusting for demographic variables and the level of job stress. Among the five factors for resilience, “support” and “hardiness” were protective factors for depressive mood and anxiety after adjusting for demographic variables and the level of job stress. CONCLUSION: Based on the results of the current study, we suggest that focusing on the resilience of employees, especially on “support” and “hardiness,” factors as well as developing and engaging in interventions that increase resilience in the workplace, can protect against depressive mood and anxiety, especially for those with high levels of job stress.
Anxiety ; Depression ; Female ; Humans ; Korea ; Linear Models ; Local Government ; Occupational Health ; Protective Factors ; Resilience, Psychological

PURPOSE: With the increase of going out to eat, reducing the sodium in restaurant foods has a crucial impact on reducing sodium intake. This study aimed to assess the current status and perceptions of restaurant staffs related to reducing sodium use in restaurants. METHODS: Restaurant managers and chefs (n = 312) in Seongnam area completed a questionnaire on the current status related to sodium use, the barriers to practice for reducing sodium use, support needs, and the practicability of methods for reducing sodium use in restaurants. RESULTS: The percentage of restaurants in the preaction stage (including the precontemplation, contemplation, and preparation stages) for reducing sodium use was 79.7%. Logistic regression analysis showed that measuring salinity while cooking was associated with measuring seasoning (OR, 4.761; 95% CI, 2.325 ~ 9.751), action/maintenance stages of behavior change (OR, 2.829; 95% CI, 1.449 ~ 5.525) and providing salinity information of restaurant foods (OR, 6.314; 95% CI, 2.964 ~ 13.45). Maintaining taste and hindering the cooking process were the main barriers to reduce sodium use. The total practicability of actions for reducing sodium was higher in staffs who worked in restaurants that measured seasoning and salinity while cooking (p < 0.05 and p < 0.01, respectively). The hardest item to practice was ‘purchase foods after comparing sodium content in the nutrition labeling’. ‘Avoid serving salt-fermented foods as side dishes’, ‘serve small portions of kimchi and less salty kimchi’, and ‘put up promotional materials for reducing sodium intake’ were selected as easy items to perform. The majority (82%) was willing to reduce sodium in restaurant foods under the support of local government and they desired the promotion of participating restaurants and education on cooking skills to reduce sodium. CONCLUSION: Measuring seasoning and salinity while cooking is a meaningful practice that is associated with stages of behavior change and the practicability of actions for reducing sodium. It is necessary to provide support and education with a gradual approach to staffs for reducing sodium in restaurant foods.
Cooking ; Education ; Gyeonggi-do ; Korea ; Local Government ; Logistic Models ; Restaurants ; Salinity ; Seasons ; Sodium

This study investigated the social outcomes of the Environmental Health Studies of National Industrial Complex (EHSNIC), which have been conducted by the National Institute of Environmental Research (NIER) in eight National Industrial Complex Areas (NICAs) since 2003. Eighteen sessions of focus-group interviews with 85 people were conducted from October 2016 to January 2017. Interviewees were stakeholders from eight NICAs and included resident representatives, environmental nongovernment organizations, local government officials, and environmental health and safety officers from companies. Interview results were divided into six categories: EHSNIC awareness, EHSNIC outcomes, EHSNIC limitations, EHSNIC continuation, EHSNIC improvement directions, and EHSNIC results use. They were then further indexed into 23 divisions. EHSNIC awareness varied across stakeholders. A major EHSNIC outcome is that a continued result database was established, which was used as a reference for environmental improvements. EHSNIC limitations included no proper healthcare actions taken during the EHSNIC study period, a lack of EHSNIC results disclosure, a failure to reflect local specificity, and a lack of validity in the results. Regarding EHSNIC continuation, all stakeholders said EHSNIC should be conducted continuously. EHSNIC improvement directions included conducting studies tailored to each NICA, identifying correlations between pollutant exposure and disease, increasing the sample size, and performing repeated studies. Regarding EHSNIC results use, respondents wanted to use the results as a reference to relocate residents, ensure distance between NICAs and residential areas, provide healthcare support, develop local government policies, and implement firms’ environmental controls. Since EHSNIC aims to identify the health effects of NICAs on residents and take appropriate actions, it should be continued in the future. Even during the study period, it is important to take steps to preventively protect residents’ health. EHSNIC also needs to reflect each NICA’s characteristics and conduct reliable research based on stakeholder participation and communication.
Delivery of Health Care ; Disclosure ; Environmental Health ; Local Government ; Qualitative Research ; Sample Size ; Sensitivity and Specificity ; Surveys and Questionnaires