Describing the Health Service Delivery Network of an Urban Poor Area and a Rural Poor Area

  • Hilton Y. Lam
  • Roberto de Vera
  • Adovich S. Rivera
  • Tyrone Reden Sy
  • Kent Jason G. Cheng
  • Daryl Byte Farrales
  • Jaifred Christian F. Lopez
  • Red Thaddeus DP. Miguel
Keywords: access and quality of healthcare, Human resource for health (HRH), Service availability and readiness assessment (SARA), Service delivery network (SDN)


Objectives. This study aimed to assess the health workforce’s service capacities within a health Service Delivery Network (SDN) of an urban poor and a rural poor setting.

Methods. This is a concurrent mixed-methods study implemented in Navotas and Masbate, an urban poor and a rural poor area, respectively. Health needs of the residents were assessed through records review, qualitative methods and a household survey. Health facilities in the identified SDN were assessed using the Service Availability and Readiness Assessment (SARA) tool. Training data of Human Resource for Health (HRH) were also obtained.

Results. SDN in the two areas are different in terms of formality where memoranda of agreement were prepared between Masbate facilities but not in Navotas. Health worker to population ratios were 12.1 per 10,000 in Navotas and 2.7 in Masbate, respectively. The primary care facilities in the two sites met the recommended level of trainings for health workers in obstetric care, immunization, childhood nutrition and tuberculosis. There was a lack of post-graduate training in non-communicable diseases in all facilities. Poverty and geography were significant factors affecting health service delivery.

Conclusion. In terms of human resources, both sites have limited number of health workers and the ratios fall far below WHO guideline. Recommendations include: Primary health care staff complement should be increased in the two SDNs. HHRDB should conduct a study to settle the issue of continuing medical education requirements that are not congruent with WHO recommendations. The SDNs should include the access of medicines and commodities by poor patients in private facilities during times of stock outs. Also, during stock outs or unavailability of government health personnel, transportation should be made available via the SDN to transport poor patients to private or nongovernment facilities with the needed personnel. The DOH and HHRDB should investigate innovative strategies for telehealth services that do not require continuous electricity, nor telephone or cellphone signal.


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