PROVINCIAL HEALTH

STRATEGIC PLAN
2006-2010

PROVINCIAL HEALTH OFFICE

Compostela Valley
Philippines

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 TABLE OF CONTENTS

Introduction 1
Executive Summary 2
Chapter 1 Provincial Profile 3
Demographic Profile 4
Chapter 2 Health Status 5
CBR & CDR
MMR & IMR
Leading Cause of Mortality
Leading Cause of Morbidity
Leading Cause of Infant Mortality
Leading Cause of Maternal Mortality
Chapter 3 Health Resources 8
Chapter 4 Tabular Summary of Priority Health Programs 11
Safe Motherhood
Natality
Family Planning
Expanded Program of Immunization
National Tuberculosis Program
Nutrition & Rehabilitation Program
Environmental & Sanitation Program
Rabies Control Program
Filariasis Control Program
Dengue Control Program
Chapter 5 Summary of Current Situations & Identified Problems 19
Opportunities & Threats
Causes of Mortality
Causes of Morbidity
Other Emerging Concerns on Health
Prioritization of Health Problems
Strengths & Weaknesses
Operational Performance Problems
Chapter 6 Summary Statement of Priority Problems 29
Major Goals
Chapter 7 Objectives & Target Setting 30
APPENDICES 33
Annual Operation Plan 2006

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 ABBREVIATIONS

Accomp. - Accomplishment
AMHOC - Association of Municipal Health Officers in Compostela Valley
AO - Administrative Order / Administrative Officer
ARI - Acute Respiratory Infection
AURI - Acute Upper Respiratory Infections
BFAD - Bureau of Food and Drugs
BHS - Barangay Health Station
BHW - Barangay Health Worker
Bldg. - Bldg.
BnB - Botika ng Barangay
BNS - Barangay Nutrition Scholar
Brgys. - Barangays
CARI - Control of Acute Respiratory Infection
CBR - Crude Birth Rate
CDD - Control of Diarrheal Diseases
CDR - Crude Death Rate
CHD - Center for Health Development
COH - Chied of Hospital
Comm. - Community
Comval - Compostela Valley
CPR - Contraceptive Prevalence Rate
CVD - Cardiovascular Disease
DMPA - Dimethyloxy Progesterone Acetate
DOH Reps. - Department of Health Representatives
DOH - Department of Health
DOTS - Directly Observed Treatment Short Course
DRH - Davao Regional Hospital
Dse./dses. - Disease / diseases
EO - Executive Order
EPI - Expanded Program of Immunization
FIC - Fully Immunized Children
FIM - Fully Immunized Mother
FP - Family Planning
GA - Government Agency
Gen. - General
GO - Government Offices
Gov’t - Government

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Hosp./hosps. - Hospital / hospitals
HPN - Hypertension
IEC - Information Education Campaign
ILHZ - Inter-Local Health Zone
IMCI - Integrated Management on Childhood Illnesses
IMR - Infant Mortality Rate
IUD - Intauterine Device
Lab. - Laboratory
LB - Livebirth
LCE - Local Chief Executive
LCR - Local Civil Registrar
LGU - Local Government Unit
LHB - Local Health Board
LMH - Laak Municipal Hospital
MCH - Maternal and Child Health
MD - Medical Doctor
MDH - Montevista District Hopsital
Med. Tech. - Medical Technologist
Med. - Medical
Mgt. - Management
MHC - Main Health Center
MHO - Municipal Health Officer
MMH - Maragusan Municipal Hospital
MMR - Maternal Mortality Rate
MOA - Memorandum of Agreement
MOOE - Maintenance and Other Operating Expenses
Mun. - Municipality
Nat’l - National
NB - Newborn
NFP - Natural Family Planning
NGO - Non Government Office
NHIP - National Health Insurance Program
NSO - National Statistics Office
NSV - Non Scalpel Vasectomy
NSVD - Normal Spontaneous Vaginal Delivery
NTP-DOTS - National Tuberculosis Program
OB-Gyne - Obstetrics-Gynecology
OR / DR - Operating Room / Delivery Room
PAB - Protected At Birth

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PDH - Pantukan District Hospital
PGO - Provincial Government Office
PHC - Primary Health Care
PHIC - Philippine Health Insurance Corporation
PHN - Public Health Nurse
PHO - Provincial Health Office
PHTL - Provincial Health Team Leader
PIR - Program Implemenation Review
PMC - Pre Marriage Counselling
PNV - Pre-natal Visits
Pob. - Poblacion
Pop. - Population
PP - Post Partum
Prov. / Prov’l. - Province / Provincial
PSI - Provincial Sanitary Inspector
Pts. - Patients
RA - Republic Act
Rehab. - Rehabilitation
RHIS - Regional Health Information System
RHM - Rural Health Midwife
RHU - Rural Health Unit
RSI - Rural Sanitary Inspector
Schisto.- Schistosomiasis
SP - Sangguniang Panlalawigan
SS - Sentrong Sigla
STD - Sexually Transmitted Diseases
SVI - Systemic Viral Infection
TB - Tuberculosis
Tx - Treatment
UTI - Urinary Tract Infection
VAC - Vitamin A Capsule
Yrs. - Years

INTRODUCTION

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The Strategic Provincial Health Plan 2006-2010 is a presentation of relevant
accomplishments and major issues on different programs of the Provincial Health Office. It
also provides vital information on the current health status and performance of the province
through comparative trend on health statistics, demography and the affected age-grouping
population of disease summary, SWOT analysis from the consolidated updates coming from
the 11 Rural health units, 4 government hospitals of the province - Montevista District
Hospital, Pantukan District Hospital, Maragusan Municipal Hospital and Laak Municipal
Hospital.

On this plan, attached is the Annual Operational Plan of the Province. This is to elaborate
the various setbacks and problems in health with its suggested strategies and activities to
be undertaken, targets to be pursued, facilities to be improved and possible resources to be
adhered.

This plan can also be used as a reference in the decision-making, policy-making and
development health planning processes. It is hoped that through this integrated planning
system, the local government units, government agencies, non-government offices and
other private health sectors will be guided in identifying health problems associated with risk
behaviors of people leading to a particular disease, the emerging concerns and the technical
and financial needs to address such problems. It also allows LGUs to plan health services
with their own needs and priorities, encourage research and studies on the incidence of the
disease in their locality and deal with the operational and management problems and issues,
provide quality assurance indicators of a health facility, introduces a logical process for
health service requirements which is useful in advocating and promoting the need for health
resources to funding organizations.

With this strategic presentation, it is hoped that the national government would take into
consideration that Compostela Valley province is indeed a jewel in Mindanao given all the
possibilities and opportunities to meet all its health needs and resources to achieve its
health priorities and problems.

EXECUTIVE SUMMARY

The Province of Compostela Valley – the golden frontier of the south through its 8 th year of
existence has fully blossomed and continues to shine anchored by the provincial governance
initiating economic development. Amidst the adversities, it has surmounted the odds and
risen above the challenges of the times. In each year, it continued to move on to strengthen
its advantages and confront threats and weaknesses so that the unity, peace and progress
banners through its existence will be sustained. It overcame challenges despite its limited
resources and in spite of the difficult macroeconomic realities that challenged the efficacy of
governance across our country.

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Despite the year’s early start of political bickering and clashes that only beget policy
impasse and unnecessary delays in the turning of the wheels of provincial governance, the
Caballero administration has accomplished and moved things for the betterment of
Comvaleños more specifically in the health sector.

This Strategic Provincial Health Plan 2006-2010 was developed to continually guide and
supervise the pathway of all the Health Sector Areas with the application of the new
components of the Fourmula 1 strategies: Health Financing, Health Regulation,
Service Delivery and Good governance. Planning is one essential tool for effective
management that could eventually improve the delivery of health services to the people of
this province. It is hoped that the national government as well as the local government
units, private agencies and other stakeholders in health will be encouraged to participate
more to generate initiative and more creative efforts that could increase resources of health.

With the strong support of the Governor, Honorable Jose R. Caballero, Sangguniang
Panlalawigan team, other LCE’s, LGU’s, MHO’s, COH, NGO’s, GA’s, private sectors, PHO and
with the infinite provision and assistance of DOH, together hand in hand will enjoin for the
one true aim to enhance all the health areas of concern for the betterment Compostela
Valley Province.

VISION: A healthy & productive citizenry working together for a

better quality of life.

MISSION: Ensure genuine commitment & dedicated involvement,

partnership & collaboration among the people, health
workers, LGUs & health care providers in the quest for
a
better quality health for the people of Compostela
Valley.

Chapter 1 - PROVINCIAL PROFILE

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Compostela Valley, the 78th province in the country, was created into a separate and district province from
Davao del Norte by virtue of Republic Act No. 8470, signed by Pres. Fidel V. Ramos on January 30, 1998.
On March 7, 1998 the law was ratified through a plebiscite in the 22 mun. of the mother province.

Honorable Jose R. Caballero, the former Vice-governor of Davao del Norte, is the first elected governor of
Compostela Valley. He assumed office on July 1, 1998. He envisions Compostela Valley as a dynamic
community where citizenry will achieve a better quality of life and live under the regime of a peaceful and
balanced ecology within the context of equitable development, with the mission to provide open and
accessible government and to deliver basic services so everyone can enjoy a better quality of life.

Location: Located at southeastern part of Topography: Flat, rolling, hilly & mountain
Mindanao Island & north-central part
of Region XI. It is bounded by Agusan
del Sur on the north, Davao Oriental
on the east & south, Island Garden LUZON
City of Samal on the southwest & Compostela
Davao del Norte on the west & Valley Province

northwestern part.
Capital: Nabunturan
VISAYAS
No. of district: 2
No. of municipalities: 11
No. of barangays: 235
Total land area: 4,666.93 sq.km. MINDANAO
Mother Tongue: Cebuano / Visaya
Income class: FIRST
Climate: Generally tropical with no marked rainy or dry season
Economic resources: Agriculture, fishing, mining & quarrying, trade
Major crops: Rice, corn
Industrial crops: Coconut, coffee, abaca and rubber
Fruit crops: Banana, mango, pineapple, durian, calamansi, mandarin and lanzones

DEMOGRAPHIC PROFILE

Population: 580,244 (NSO 2000)

THE 11 MUN. OF COMPOSTELA VALLEY
Population density: 124
Average household size: 4.64 Laak Monkayo

No. of Indigenous people: 62,187 (NCIP-Comval 2000)

Economic dependency rate: 78.9% Montevista Compostela

Employment rate: 91.70 (NSO 2001)

Nabunturan
Literacy rate: 88.64 Maragusan
Mawab

Maco
New Bataan
Mabini

Pantukan

Table 1. PROJECTED POPULATION 2005

Compostela Valley

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 NO. OF
MUNICIPALITY POPULATION GROWTH RATE (%)
HOUSEHOLDS

Compostela 69,472 12,151 2.47

Laak 69,862 11,904 3.31
Mabini 34,875 6,524 1.76
Maco 72,825 13,090 2.31
Maragusan 51,972 8,762 2.56
Mawab 34,345 6,694 1.49
Monkayo 113,749 20,238 5.61
Montevista 34,623 6,570 0.87
Nabunturan 64,909 12,930 1.46
New Bataan 41,790 8,592 -0.39
Pantukan 67,463 13,311 1.83

COMVAL PROVINCE 655,885 120,766 2.38

Source: DOH-Davao Region Population Projection based on NSO 2000 of Population & Housing

The total population provincewide is 655,885 with the annual growth rate of 2.38% based from the
updated Population Projection Records disseminated by the National Statistics Office 2005. Monkayo has
the greatest number of population with 5.61% growth rate and with the biggest share number of
households with 20,238. This is attributed to the influx of migrants coming from neighboring
municipalities, cities and provinces when gold was discovered in Mt. Diwata popularly called as Diwalwal
in the late 1980s. But with presence of the newly established mining zone in the District 2 area it is
expected to have an invasion of migration among Mabini, Maco and Mawab municipalities. On the other
hand, Mawab has the least population with 34,345 dwellers but according to survey, Mabini got the
smallest number of household population with only 6,524.

Chapter 2 - HEALTH STATUS

Figure 2-1. CRUDE BIRTH RATE AND CRUDE DEATH RATE

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In the 8-year comparative trend of Crude Birth and Crude Death Rate, Year 2004 has the highest CBR
with 22.64% and Year 2002 has the least with 17.36% per 1,000 population. While in CDR, year 2005
has the most number of death occurred with 4.29% and year 1998 has the least number of recorded
death with 3.20% per 1,000 population. It is the initiative of PHO to conduct active retrieval of death
masterlisting starting Year 2002 covering all Local Civil Registrar’s Office provincewide including Tagum
and Davao City and all major hospitals undocumented and unrecorded Davaowide to achieve the true
picture of Leading Cause of Death in the Province. Indeed, there has been an elevation on the
movement of the trend starting the Year 2002 as shown in the figure above.

Figure 2-1. MATERNAL MORTALITY RATE AND INFANT MORTALITY RATE

The MMR 2005 has increased by 30% from 2004 with the rate of 100,000 livebirth but apparently MMR in
2002 has a sudden rise with 237%, while the Infant Mortality Rate maintained with 16% with a rate of
1,000 livebirth. Strong intensification of advocacy has been conducted to every barangay on Safe
Motherhood to achieve quality Maternal Care and Child Care.

Figure 2-3. LEADING CAUSE OF MORTALITY

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The cases of all forms of accidents with the rate of 57 per 100,000 population are very alarming. During
the consolidation of this report almost all municipalities has a consistent no. 1 cause of death and
Accidents mostly by Assault cases by Stab and Gunshot incidents emerged to be the top source followed
by all forms of Vehicular accidents. It is also a worrying scenario that Diabetes Mellitus with the rate of 8
per 100,000 population came into view among the leading cause of Mortality of this province. Evidently,
unhealthy lifestyle is the main component on the causes of death mentioned above because eight of the
disease problems pertain to the harmful and injurious habits and ways of living.

Figure 2-4. LEADING CAUSE OF MORBIDITY

Acute upper respiratory infection continues to be always the no. 1 cause of illnesses of this province, with
the rate of 1,124 per 100,000 population and AURI pertains to a common cold, laryngitis, acute
pharyngitis, rhinitis, sinusitis and tonsillitis whilst Tuberculosis is keep on going down on to its 11th
position with the rate of 175 per 100,000. This must be attributed to the strong advocacy of the National
Tuberculosis Program.
Figure 2-5. LEADING CAUSE OF INFANT MORTALITY

Pneumonia has always been the No. 1 cause of death in the Infant Stage (below 1 yr. old) with 38% per
10,000 livebirth but with the intensive implementation of the IMCI program it is expected to drop next year,

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and the least was the Neonatal tetanus case of which there are still mothers who continues to seek the
help of untrained hilots to handle the delivery mainly because of the easy accessibility specially in the far
flung areas.

Figure 2-6. LEADING CAUSE OF MATERNAL MORTALITY

Post-partum hemorrhage emerged as the no. 1 cause of maternal death in the year 2005 and also in
previous years with 70% per 100,000 livebirth and maternal sepsis and Abortion shared the last ranking
with only 14% per 100,000 livebirth. Delayed referral of hilots handling delivery to higher facility can
eventually cause the prevalence of mother to have further complications and in the long run can lead to
death. But with the current strong campaign and close monitoring of all pregnant women on the quality
pre-natal and quality portpartum care on Safe Motherhood it is hoped maternal deaths in Comval will be
lowered.

Chapter 3 - HEALTH RESOURCES

Table 3-1. NUMBER OF HEALTH PERSONNEL AND STATUS OF EMPLOYMENT, 2005

FACILITY REGULAR CASUAL JOB ORDER TOTAL

Provincial
33 5 1 39
Health Office
Montevista District
28 11 6 45
Hospital
Pantukan District
26 5 3 34
Hospital
Maragusan
15 10 1 26
Municipal Hospital
Laak Municipal
19 4 0 23
Hospital
TOTAL 121 35 11 167

Under the umbrella of the Provincial Health Office management, there are a total of 167 employees in the
health workforce, 121 have the regular item status, 35 are casuals and 11 are Job-orders. All in all there

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are 128 health workers who are hospital staff caregivers serving Comvalwide but apparently it is soon
expected to have a great turn-over of health personnel exodus lined-up because of the better life and
financial compensation offered abroad.

Table 3-2. NUMBER OF HOSPITAL HEALTH PERSONNEL, 2005

PARTICULARS MDH PDH MMH LMH

Service capability Secondary Primary Infirmary Primary

Bed capacity 25 25 10 10
Occupancy rate 96% 55% 111% 62%
Actual implementation 50 25 13 10
Doctors 6 3 2 3
Nurses 6 3 4 3
Midwife / Attendant 10 11 4 3
Med. Technologist 1 1 2 1
Dentist 1 1 - -
Admin. Support 17 13 12 12
Pharmacist 2 1 1 1
Radio technician 2 1 - -
Nutritionist - - 1 -

MDH has the Secondary service capability in terms of health competent service provider. The Prov’l.
gov’t. has allocated funds for the big transformation of MDH into a Provincial Hospital purposely for the
benefit of every Comvaleños easy-access of hospital assistance during health crisis. Nearby residents
like those coming from Monkayo, Compostela, New Bataan, Maragusan and Nabunturan would be an
advantage for them to reach the healthy facility because of proximity of location.

Table 3-3. NUMBER AND RATIO TO POPULATION OF MHC AND BHS BY MUNICIPALITY, 2006
BARANGAY HEALTH
PROJECTED MAIN HEALTH CENTER
NO. OF STATION (w/ own bldg.)
MUNICIPALITY POPULATION
BRGYS. RATIO TO RATIO TO
2005 NO. NO.
POP. POP.
Compostela 69,472 16 1 1:69,472 15 1:4,631
Laak 69,862 40 1 1:69,862 24 1:2,911
Mabini 34,875 11 1 1:34,875 10 1:3,488
Maco 72,825 37 1 1:72,825 15 1:4,855
Maragusan 51,972 24 1 1:51,972 21 1:2,475
Mawab 34,345 11 1 1:34,345 9 1:3,816
Monkayo 113,749 21 1 1:113,749 18 1:6,319
Montevista 34,623 20 1 1:34,623 11 1:3,148
Nabunturan 64,909 28 1 1:64,909 20 1:3,245
New Bataan 41,790 14 1 1:41,790 12 1:3,483
Pantukan 67,463 13 1 1:67,463 12 1:5,622
COMPOSTELA
655,885 235 11 1:59,626 167 1:3,927
VALLEY
Source: DOH-Reps & PHTL Comval

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Using the projected population there are 655,885 people living in ComVal and there are 235 barangays
with only 11 main health centers mostly located in the poblacion area. Monkayo has always been the
biggest coverage of ratio and proportion with 1:6,319 and Maragusan has the smallest unit with 1:2,475.
With the presence of BHS provincewide, delivery of health services are continuously administered and
conducted with the supervision of the DOH and its component health programs through PHO and DOH-
reps as partners for constantly providing health advocacies and monitoring the province health status.

Table 3-4. FIELD HEALTH FACILITIES, 2006

FOOD
HEALTH FACILITY
DENTAL DRUG BOTIKA NG ESTABLISHMENT
MUNICIPALITY
GOV’T PRIVATE CLINICS STORES BARANGAY
w/o LTO w/ LTO
HOSP. CLINICS
Compostela - 3 4 13 4 38 10
Laak 1 - - 3 20 25 2
Mabini - - - 1 7 17 1
Maco - 4 1 5 - 33 6
Maragusan 1 1 1 7 7 45 9
Mawab - 3 2 3 - 40 7
Monkayo - 4 2 5 8 16 8
Montevista 1 1 1 6 6 18 4
Nabunturan - 7 6 10 9 35 9
New Bataan - 1 - 2 8 24 4
Pantukan 1 2 1 8 6 10 3
COMPOSTELA
4 26 18 63 75 301 63
VALLEY
Source: DOH-Reps, PHTL, FDRO Comval
Immense intensification campaign for license to operate on different facility establishments are closely
monitored by health authorities and provincial officials. For Comval, there are 26 existing private clinics,
18 Dental clinics, 66 drugstores and 60 food establishment registered according to DOH-BFAD records.

Table 3-5. NUMBER OF SELECTED HEALTH MANPOWER IN MAIN HEALTH CENTERS, 2006
DOC DEN NUR MID MED NUTRI DENTL LAB AD
MUN. SI BHW BNS
TORS TISTS SES WVS TCHS TNIST AIDE AIDE MIN
Compostela 1 1 2 12 2 1 - 1 334 26 - 2
Laak 1 1 1 23 1 2 - 1 292 51 - 3
Mabini 1 - 1 9 1 1 - - 97 16 1 3
Maco 1 1 4 12 2 1 1 1 211 37 - 4
Maragusan 1 1 1 20 1 1 - 1 216 27 - 1
Mawab 1 1 1 6 1 2 - 1 151 19 - 1
Monkayo 2 1 3 25 4 2 - 233 24 - 8
Montevista 1 1 1 7 1 1 - - 185 21 - -
Nabunturan 1 1 2 14 1 2 1 1 187 30 1 1
NewBataan 2 1 2 17 1 1 1 104 30 1 1
Pantukan 1 1 1 13 1 2 1 174 32 1 1
PHO 3 2 4 2 3 2 2 1 - - - 16
TOTAL 16 12 23 160 19 18 4 9 2,184 313 4 41
Source: DOH-Reps, PHTL Comval

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Health workers in health centers have a great impact for the service delivery in the community. In
Comval, there are only 16 doctors, 12 dentists, 23 nurses 160 midwives, 19 med. techs. and 19 sanitary
inspectors who are health performers in every area provincewide. But despite of the shortages &
insufficiencies, Comval health staff are committed and hardworking and in fact performing multi-tasking
for the provision of health assistance and service delivery in the province.

Table 3-6. FUNDS FOR HEALTH IN THE PROVINCIAL HEALTH OFFICE, 2005

FACILITY YEAR PS MOOE CO TOTAL

2005 9,488,592.98 12,582,355.00 2,500,000.00 24,570,947.98
Provincial Health
2004 10,271,105.00 14,789,600.00 340,000.00 25,400,705.00
Office
2003 10,189,847.00 13,789,600.00 - 23,979,447.00
2005 6,735,769.72 4,800,000.00 50,000.00 11,585,769.72
Montevista District
2004 6,677,992.00 5,000,000.00 - 11,677,992.00
Hospital
2003 6,630,621.00 4,609,075.00 - 11,239,696.00
2005 6,340,521.00 3,859,783.82 40,000.00 10,240,304.82
Pantukan District
2004 6,273,825.00 3,500,000.00 - 9,773,825.00
Hospital
2003 6,226,116.00 3,152,500.00 - 9,378,616.00
2005 4,012,660.72 2,694,020.00 54,000.00 6,760,680.76
Maragusan
2004 3,886,901.00 2,000,000.00 - 5,886,901.00
Municipal Hospital
2003 3,871,113.00 5,248,913.00 - 9,120,026.00
2005 3,850,219.92 2,735,907.00 - 6,586,126.92
Laak Municipal
2004 3,874,075.00 2,000,000.00 - 5,874,075.00
Hospital
2003 3,869,676.00 1,407,450.00 - 5,277,126.00
The 3-year comparative budget for PHO, MDH and PDH has been very tight and in fact there has been a
slight decrease for the total amount in 2005 comparing to 2004, while MMH and LMH continuously having
an increase each respective year. Despite of the constricted budget given, health operation still continue
to function well using all the initiative resources so as not to hamper the health undertakings.
Chapter 4 - TABULAR SUMMARY OF PRIORITY HEALTH PROGRAMS

SAFE MOTHERHOOD

These are the province accomplishments on the Maternal Care program reflecting both the pre-natal and
post partum status per municipality with its corresponding target in each health indicator.

Table 4.1 MATERNAL HEALTH – PRENATAL CARE, 2005

PRENATAL CARE
% % %
% %
% Prevalence Women Women
MUNICIPALITY Pregnant of Fully % Quality
Pregnant of Anemia del. w/ 5 del. w/
w/ 1st PNV Immunized Prenatal
women w/ among PNV hgb det.
during 1st Pregnant Care
1st PNV pregnant during during
tri women
women preg. preg.
NATIONAL
80% 80% 80% 38% 80% 80% 80%
TARGET
Compostela 73.4 33.2 87.1 32.2 0.3 3.0 34.9
Laak 65.6 47.9 77.8 24.0 1.8 24.7 72.2
Mabini 60.5 43.3 56.3 12.2 0.3 24.4 71.9

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Maco 68.5 54.6 73.6 22.4 2.0 9.2 67.2
Maragusan 69.9 46.6 81.2 21.4 9.3 15.6 63.5
Mawab 58.3 45.4 40.7 31.8 2.3 4.9 47.6
Monkayo 53.8 50.8 53.1 22.3 31.0 34.1 82.5
Montevista 88.1 44.3 88.7 33.8 0.7 12.6 46.1
Nabunturan 72.9 81.3 78.3 19.8 57.6 60.2 78.0
New Bataan 73.5 72.5 80.3 21.3 36.2 45.5 73.4
Pantukan 70.6 37.9 78.9 49.9 6.6 14.1 55.4
COMPOSTELA
67.1 50.8 72.1 26.9 14.0 22.4 63.4
VALLEY

Table 4.2 MATERNAL HEALTH – POSTPARTUM CARE, 2005

POSTPARTUM CARE
% %
% % % %
Women % Women w/
MUNICIPALITY Women Women Quality Birth
del. Women del. PP clinic
del. del. w/ 3 Post delivered
received w/ at least 1 visit 4-6
initiated PP home Partum in health
complete PP visit wks. after
BF visits Care facilities
iron delivery
NATIONAL
80% 90% 80% 100% 80% 80% 70%
TARGET
Compostela 0.3 92.6 35.0 53.1 25.0 8.8 23.4
Laak 3.7 71.7 71.6 91.2 58.8 60.6 10.3
Mabini 25.2 92.1 51.5 67.0 55.9 39.7 23.4
Maco 3.8 91.2 64.7 58.0 21.5 11.0 28.4
Maragusan 12.7 91.1 71.7 74.6 61.8 53.2 29.4
Mawab 3.9 88.1 28.2 75.7 18.2 10.2 19.2
Monkayo 38.3 91.7 77.1 78.3 65.7 68.3 22.9
Montevista 1.9 89.8 66.1 48.6 28.6 21.7 17.4
Nabunturan 62.5 93.9 87.3 95.3 82.0 84.1 27.3
New Bataan 38.3 91.8 84.8 86.6 81.2 76.3 15.4
Pantukan 11.2 90.4 77.5 80.0 55.1 49.2 20.7
COMPOSTELA
18.2 89.4 66.9 62.8 50.9 45.9 22.0
VALLEY

NATALITY REPORT

The pie diagram shows the province’ overall Figure 4-2. PLACE OF BIRTH, 2005
attainment for the outcome of pregnancy under the Figure 4-1. OUTCOME OF PREGNANCY, 2005
Natality program. The largest pie share belongs to
the livebirth outcome with 88%, late registration
has 9%, stillbirth with 2% and abortion with 1%.
These accomplishments were taken from the
regional health information system booklets from
the rural health centers.

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 Under the place of birth indicator, people of
Compostela Valley mostly resort to home
deliveries with 72%, hospital deliveries got only
22% and no information has 6%. But under the
new thrusts of the DOH enforcing the Fourmula
1 strategies, massive advocacy intensification
will be made to bring mothers into safe and
aseptic technique of delivery under the health
facility management to bring out quality care of
safe motherhood and avoid further complications
and infections of both mother and the baby.

Figure 4-3. % ATTENDANCE AT BIRTH, 2005

Home deliveries are usually attended by hilots.
Hilots are those persons who are conducting the
traditional way of deliveries performed usually at
home. 45% were the trained performers under
the supervision of a medical personnel and 8%
were the untrained ones. But under the new
thrusts of DOH, total eradication of hilots will be
made because of the high incidence of Maternal
and Perinatal Death most specifically in
Compostela Valley.

FAMILY PLANNING

Figure 4.4 FAMILY PLANNING BY METHOD, 2005

Compostela Valley has a total population of 654,974 of the revised National Statistic Office Records for
the 2005 Population Projection. Of these, 12.33% or 80,726 are married couples of reproductive age.

17
80% of the current users indulged in the Modern methods which include those who are users of pills, IUD,
condom and DMPA. Permanent method such as the bilateral tubal ligation for women and vasectomy for
men comprises the 14% and the Natural method users like LAM, SDM and NFP are 6%.

Figure 4.5 CONTRACEPTIVE PRELAVANCE RATE PER MUNICIPALITY, 2005

For the Contraceptive Prevalence Rate, Nabunturan municipality got the highest rate seconded by Maco
and Monkayo respectively with 69% and the least accomplishment rate is 47% were garnered by Mawab
and Montevista. Fortunately 7 municipalities out of 11 have achieved the regional target which is 54%.
The over-all accomplishment of the province is 61% CPR. This must be attributed to the strong campaign
under the MSH-LEAD project of DOH.

EXPANDED PROGRAM OF IMMUNIZATION

Figure 4.6 FULLY IMMUNIZED CHILDREN, 2005

For this program, the national target to be attained is 95% based on the 3% DOH standard target
population of children. Unfortunately the province wasn’t able to reach the object goal. Montevista
almost reached its target with 90% while Monkayo got the lowest with 66%. Health frontliners were in fact

18
complaining for the unachievable target and projected number of children in their vicinity, and were
constantly monitoring every pregnant women and children to obtain such target in the EPI program.

Figure 4.7 PROTECTED AT BIRTH, 2005

Three municipalities were able to achieve the PAB standard target which is 80% and these are
Compostela, Montevista and Pantukan. Three municipalities also got the very low benchmark
performance on children’s protection at birth and these are Mabini, Monkayo and Mawab. The over-all
accomplishment of the province is 68%.

NATIONAL TUBERCULOSIS PROGRAM

The graphs below are the NTP accomplishment for 2005. Yearly accomplishments of cure rates, case
detection rates updates shown. Also displayed were the comparative 2000-2005 TB cases treatment
statuses of the province and the CR, CDR condition per municipality.

Figure 4.8 CURE RATE Figure 4.9 CASE DETECTION RATE

19
 Figure 4.10 TB CASES - TREATMENT STATUS, 2000-2005

Figure 4.11 CASE DETECTION RATE & CURE RATES OF NEW SMEAR (+) TB CASES, 2005

NUTRITION AND REHABILITATION PROGRAM

The virtual elimination of Vitamin A and Iodine Deficiency Disorder is a priority thrust of the Department of
Health. Strategies towards the attainment of this goal include universal Vitamin A supplementation and
the iodization of salt. Hereunder are the Vitamin A supplementation accomplishment per municipality,
with Montevista attained the highest mark of 93% and Monkayo has the lowest attainment with 70%. The
entire province has only 82% accomplishment.

Figure 4-12 VITAMIN A SUPPLEMENTATION ACCOMPLISHMENT, 2005

20
 Figure 4-12 PREVALENCE OF MALNUTRITION, 2005

The province of Compostela Valley is being awarded for its 2 consecutive terms of Nutrition awardee for
the good governance implementation of the provincial government of Nutrition program. One of the
criteria it has being considered is the low incidence of malnutrition. On this data above it has been clearly
stated that Compostela has the most numbered malnutrition cases provincwide seconded by Laak and
Montevista. While Nabunturan, Mawab and Mabini has the least number cases of malnutrition incidence.

ENVIRONMENTAL HEALTH SANITATION PROGRAM

One of primary concentration of the provincial government is the stipulation of clean and safe
environment to the constituents of this province. One of the major provisions is the development of safe,
clean toilet thru distribution of toilet bowls plus one sack of cement to far flung communities provincewide.
Another provision is to supply safe water to all; water is a vital natural resource. An adequate and potable
water supply is essential for daily life function, such as drinking, food preparation, personal hygiene and
sanitation. Hereunder are the consolidated number of toilet bowls distributed per municipality and the 3-
year comparative provincial accomplishment of toilet and water facilities.

Table 4-3 NO. OF TOILET BOWLS GIVEN PER MUNICIPALITY

MUNICIPALITY 2000 - 2004 2005
TOTAL NO. OF TOILET BOWLS DISPENSED TO MUNICIPALITIES
Compostela 315 155
Laak 348 198
Mabini 368 27
Maco 568 233
Maragusan 385 -
Mawab 304 25
Monkayo 941 157
Montevista 360 -

21
Nabunturan 333 77
New Bataan 329 77
Pantukan 518 212
TOTAL 4,769 1,161

Figure 4-13 HOUSEHOLDS USING SANITARY TOILETS & ACCESS TO SAFE WATER SUPPLY
Compostela Valley Province
2003 - 2005

RABIES CONTROL PROGRAM

The Provincial government has allocated budget

for the rabies vaccine and all rabies cases in the
Figure 4.14 RABIES CASES, 2000-2005
province were given immediate treatment through
injecting anti-rabies medication from Rabies
satellite centers. Three rabies satellite centers
were created and these are the Montevista District
Hospital, Pantukan District Hospital and
Maragusan Municipal Hospitals. The diagram
reveals the 3-year provincial rabies status of
morbidity and mortality provincewide.

FILARIASIS CONTROL PROGRAM

Although Filariasis is not a killer disease, it is
considered the second leading cause of
permanent, long term disability among infectious
diseases. World Health Organization has
defined it as one of the eradicable diseases and
has called for its global elimination. The
diagram shows the 3-year provincial Mass Drug
administration coverage accomplishment.

22
Figure 4-15 MDA COVERAGE, 2003-2005

DENGUE CONTROL PROGRAM

During the first quarter of the year Dengue cases

were all over in the hospitals most particularly in
the major hospitals in Tagum City. The Provincial
health office conducted massive campaign against Figure 4-15 DENGUE CASES, 1999-2005
the prevention aspect of the dengue disease. As
of 2005, there was a gradual decrease of dengue
cases from year 2004, all these cases were
clinically diagnosed through obtaining the
laboratory results of the patient. Numerous
dengue activities were undertaken to control the
rapid spread of the incidence and environmental
sanitation is the most effective way in controlling
the mosquito killer.

Chapter 5 – SUMMARY OF CURRENT SITUATION & IDENTIFIED PROBLEMS

The table below illustrates the province consolidated summary of major issues, concerns and problems
on the external environment showcasing the opportunities and threats with regards to the peripheral
aspect perceived that has a great impact on the province current situation.

Table 5-1. EXTERNAL ENVIRONMENT – MAJOR ISSUES, CONCERNS AND PROBLEMS

Provincial Health Office, Compostela Valley
EXTERNAL
OPPORTUNITIES THREATS
FACTORS
-Strong support for implementation of
-No continuity if admin. changes.
necessary legislation to support health
-Short period between elections
initiatives.
LGU / LCE affecting support.
-Presence of AMHOC to foster close ties
-Political differences.
with other municipalities.
-Inadequate & limited health budget
-Magna Carta implementation.

23
 -Provision of trainings & seminars to the
health sector.
-Technical assistance & logistics.
-Financial support for capability building.
DOH
-Financial support for gov’t. hosps &
RHUs unmet needs in structures &
equipments repairs.
-Regular validation of RHIS & other reports
-Inclusion in the list of priority mun. & brgys
Other GA, NGO’s & for various health related gov’t programs.
Private sector -Presence of private clinics & dental
practitioners in the community.
People’s origin; -Presence of private & gov’t donors willing
community to provide health support.
-Rich water supply from rainfall / springs.
Geography -Easy access to services in areas with
transportation facilities.
Plantations, mining -Employment opportunity.
access -Increased workforce / income.
Migration (influx
from other -Increased workforce / income.
province)
CAUSES OF MORTALITY
-Implementation of EO 366.
-Possible reduction of health
workforce due to decreasing Nat’l
Budget.
-Overburdened health service
providers due to increase needs.
-Increase social problems.
-Insurgency.
-Inability of patient’s to pay cost of
health care.
-Unproductive land (mountainous &
rocky).
-Inaccessibility to health service
facility due to terrain.
-Accidents.
-Chemical hazard & envi’l pollution.
-Exposure to mercury.
-Rising cases of STD.
-Denudation of forest & illegal
logging for flash floods &
landslides during rainy season.
-Rising cases of prostitution.
-Pollution causes high cases of ARI
& skin dses.
-Possible dse carriers.
-Increase number of clients &
patient’s need.
-Peace & order is affected.
-Scarcity of medical health staff.

Hereunder is the 2005 leading cause of death in Compostela Valley reflecting its total no. of cases,
contributing factors, areas of municipalities affected with precipitating cause and age-group distribution.

Table 5-2. TOP 10 LEADING CAUSE OF MORTALITY, 2005

Provincial Health Office, Compostela Valley
MAGNITUDE OF THE PROBLEM
AFFECTED
TOTAL AFFECTED POPULATION
CAUSES OF CONTRIBUTING AREAS
NO. OF
DEATH FACTORS SEX
CASES AGE
MUN. No.=% No.=% MALE FEMALE
GROUP
No.=% No.=%
-Presence of
Mining Industry. MONK 84=22% Mid.adult: 53=63% 48=91% 5=9%
1) Accidents,
375 -Political differnces COMP 48=13% 25-49 25=52% 21=84% 4=16%
all forms
-Insurgency. NAB 47=13% yrs. old 22=47% 18=82% 4=18%
-Poverty.
2) CVD 321 -Unhealthy lifestyle. MONK 60=19% Late adult 39=65% 16=41% 23=59%

24
 -Delayed referrals
(Cerebrovas- NWBT 44=14% 55-85 33=75% 19=56% 14=44%
& consultations.
cular dses) MACO 34=11% yrs. old 12=35% 9=75% 3=25%
-Advocacy problem.
-Poverty.
MONK 61=24% Late adult 43=70% 22=51% 21=49%
3) Pneum- -Poor nutrition.
258 MACO 60=23% 60-85 47=78% 26=55% 21=45%
onia -Inadequate meds.
NAB 37=14% yrs. old 25=66% 8=32% 17=68%
-Overcrowding.
-Unhealthy lifestyle. COMP 42=18% Mid.adult 19=45% 9=47% 10=53%
4) Cancer,
231 -Poor health NAB 35=15% 20-49 16=46% 6=38% 10=62%
all forms
seeking -behavior. MACO 27=12% yrs. old 9=33% 7=78% 2=22%
-Poor compliance
COMP 29=16% Late adult 19=66% 13=68% 6=32%
5) TB (Pul. w/ prog. protocols
185 NAB 27=15% 60-85 16=59% 13=81% 3=19%
Tuberculosis) -Overcrowding.
MONK 26=14% yrs. old 10=38% 7=70% 3=30%
-Social stigma.
-Unhealthy lifestyle.
-Lack of knowledge
6) HPN on proper nutrition. COMP 45=25% Late adult 39=87% 25=64% 14=36%
(Hyper- 181 -Unavailability of NAB 40=22% 50-85 36=90% 19=53% 17=47%
tension) services for MONK 21=12% yrs. old 8=86% 10=56% 8=44%
complicated cases
in the community.
-Unhealthy lifestyle,
7) Other smoking, alcohol, NWBT 15=8% Late adult 12=80% 6=50% 6=50%
forms of 179 lack of physical COMP 9=5% 50-85 7=78% 3=43% 4=57%
heart dses activity, high MACO 9=5% yrs. old 2=22% 2=100% 0=0
cholesterol diet
-Unhealthy lifestyle.
Late adult
8) Renal -Lack of diet promo MONK 18=18% 9=50% 8=89% 1=11%
98 65-85
failure tion on kidney dses MACO 12=12% 6=50% 2=33% 4=67%
yrs. old
-Advocacy problem.
-Accessibility of
9) Birth
trained & untrained PANT 14=16% 14=100% 9=64% 5=36%
asphyxia / Neonatal
87 hilots. NAB 11=13% 11=100% 5=45% 6=55%
Intrauterine stage
-Poor quality pre- MAB 10=11% 10=100% 4=40% 6=60%
hypoxia
natalcare.
-Untrained new
10) Chronic MACO 16=21% Late adult 13=81% 9=69% 4=31%
staff on CARI,IMCI
lower resp. 77 MAB 9=12% 50-85 9=100% 8=89% 1=11%
-Pollution.
dses NAB 9=12% yrs. old 8=89% 5=63% 3=37%
-Smoking.
CAUSES OF MORBIDITY

Hereunder, 2005 leading cause of illnesses in Compostela Valley reflecting total number of cases,
contributing factors, areas of municipalities affected, precipitating cause and its age-group distribution.

Table 5-3. TOP 10 LEADING CAUSE OF MORBIDITY, 2005

Provincial Health Office, Compostela Valley
MAGNITUDE OF THE PROBLEM
AFFECTED
TOTAL AFFECTED POPULATION
CAUSES OF CONTRIBUTING AREAS
NO. OF
ILLNESSES FACTORS SEX
CASES AGE
MUN. No.=% No.=% MALE FEMALE
GROUP
No.=% No.=%
1) AURI 7,360 -Sudden change of MONK 3870=53% 15-49 1165=30% 516=44% 649=56%
(Acute weather condition. MACO 1316=18% 5-14 395=48% 189=48% 206=52%
upper -Pollution.
respiratory -Poor housing facility.
infection) -Overcrowding

25
 -Poor nutrition
-Lack of safety
2) Accidents
measures
all forms
5,064 -Lack of capability MONK 1633=32% 15-49 883=54% 604=68% 279=32%
of
to attend to trauma
injuries cases.
-Poor nutrition.
3)Pneum- -Inadequate meds. NAB 457=16% Under 1 145=32% 88=61% 57=39%
2,870
onia -Untrained new staff MONK 436=15% 1-4 163=37% 80=49% 83=51%
on CARI & IMCI.
-No sanitary toilet.
-Poor personal
4) Int. MACO 988=49% 297=30% 189=64% 108=36%
2,026 hygiene 15-49
Parasitism MONK 653=32% 205=31% 143=70% 62=30%
-Unhygienic food
preparation.
5) UTI -Unhealthy lifestyle.
(Urinary -Eating of food w/ MONK 447=23% 318=71% 59=19% 259=81%
1,917 15-49
tract high preservatives & MONT 391=20% 235=60% 93=40% 142=60%
infection) salt content.
-Unsafe water supply
-Improper disposal
6) Diarrhea MACO 362=19% 5-14 110=30% 53=48% 57=52%
of garbage & human
& gastro- 1,871 PANT 336=18% under 1 125=37% 91=73% 34=27%
waste.
enteritis MONK 305=16% 1-4 98=32% 58=59% 40=41%
-Unhygienic food
preparation.
-Poor nutrition.
-Increase cases of
7) Anemia 1,422 MONK 797=56% 15-49 432=54% 72=17% 360=83%
STH & other
parasitoses.
-Unhealthy lifestyle.
-Lack of knowledge
8) HPN
1,329 on proper nutrition. MONT 405=30% 50-64 333=82% 142=43% 191=57%
(Hypertension)
-Delayed referrals &
consultations.
-Poor health seeking
9) Sepsis / behavior. COMP 224=18% 108=48% 38=35% 70=65%
1,273 15-49
Septicemia -Delayed referral to MACO 205=16% 92=45% 30=33% 62=67%
health facility.
10) CVD -Unhealthy lifestyle.
(Cerebrovas- 1,179 -Poor advocacy MACO 647=64% 50-64 321=50% 164=51% 157=49%
lar dses) intensification.

OTHER EMERGING CONCERNS ON HEALTH

The table shown below is the status of the province emerging concern on other health and health-related
problems. This is to facilitate the assessment of the contributing factors and magnitude of the identified
occurrences and rising matters in the most affected areas and population groups.

Table 5-4. OTHER HEALTH & HEALTH-RELATED PROBLEMS / EMERGING CONCERNS, 2005
Provincial Health Office, Compostela Valley
MAGNITUDE OF THE PROBLEM
EMERGING AFFECTED POPULATION
CONTRIBUTING FACTORS AFFECTED
CONCERNS AGE SEX
AREAS
GROUP MALE FEMALE
1) Diabetes -Unhealthy lifestyle. ALL Adult: No sex preferences.
mellitus -Too much intake of sweets. MUNICIPALITIES 25-50 All sex status are involved.
-Sedentary activity / Obesity. yrs. old

26
 -Poor health seeking behavior.
-Poor quality prenatal care.
-High risk pregnancies. Women of
2) Maternal ALL 15-49
-Home deliveries. reproductive
mortality MUNICIPALITIES yrs. old.
-Delayed referral to hosp facilities age
-Maternal hypertension.
-Poor quality prenatal care.
3) Pregnancy -Accessibility of untrained & trained Women of
ALL 15-49
w/ abortive hilot reproductive
MUNICIPALITIES yrs. old.
outcome -Unwanted pregnancy. age
-Teenage premarital sex.
-Poor environmental sanitation.
MACO School
4) Dengue -Storage of uncovered water No sex preferences.
NAB. children
fever container in the vicinity. All sex status are involved
COMP. (mostly)
-Delayed referral to hosp facility.
-Home deliveries w/o aseptic
5) Perinatal /
technique ALL No sex preferences.
Infant Under 1
-Congenital malformations. MUNICIPALITIES All sex status are involved
deaths
-Accidents.
-Lack of intensification on
implementing pet ownership
ALL ALL No sex preferences.
6) Rabies ordinance.
MUNICIPALITIES AGES All sex status are involved.
-Inadequate rabies vaccine
availability.
7) Schistoso- -Improper human waste disposal ALL
miasis / -Eating of raw & half cook fish / MUNICIPALITIES 15-49 No sex preferences.
Heterophy- food. except of Comval yrs. old All sex status are involved.
Diasis -Unhygienic food preparation. Mabini
-Poverty. Men &
8) Prostitution -High level of migration. ALL 15-49 women of
/ STD cases -Unsafe sexual activity. MUNICIPALITIES yrs. old reproductive
-Social stigma. age.
-Unhealthy lifestyle. 25% of
75% of men women
-Excessive intake of alcohol. Adult
9) Alcohol ALL engages to also
-Depression. 25-50
liver dses MUNICIPALITIES heavy participates
-Family problem. yrs. old
drinking to
-Unemployment. alcoholism.
-Peer, group & social pressure.
10) Drug -Family problem. ALL ALL No sex preferences.
addiction -Curiosity, ignorance & alienation. MUNICIPALITIES AGES All sex status are involved.
-Parental negligence.

PRIORITIZATION OF HEALTH PROBLEMS

The table shown below is the tabulated and consolidated health problems priority in the province. All the
enumerated health threats below were considered to be among the top 5 health menace to every
municipality. Each column correspond a percentage of which it is being rank according to the indicated
criteria: urgency, magnitude, availability of technology to solve the problem, implication of inaction, cost
effectiveness.

Table 5-5. PRIORITIZATION OF HEALTH PROBLEMS

Provincial Health Office, Compostela Valley

27
 AVAILABILITY
OF IMPLICA- COST
UR- MAGNI- TOTAL
HEALTH TECHNOLOGY TIONS OF EFFEC-
GENCY TUDE TO SOLVE POINTS RANK
PROBLEMS INACTION TIVENESS
PROBLEM
(%) (%) (%) (%) (%) (%)
ARI dses. 20 20 20 20 20 100 1
Tuberculosis 20 20 15 20 20 95 2
Maternal death 20 15 15 20 20 90 3
Cerebrovascular
20 15 15 20 15 85 4
dses
Hypertension 20 15 15 20 10 80 5
Diabetes 20 10 20 10 15 75 6
Dengue fever 20 5 5 20 10 60 7
Cancer, all forms 10 18 10 10 8 56 8
Schistosomiasis
15 10 10 10 10 55 9
& other STH
Accidents, all
15 8 8 10 8 49 10
forms

Legend: TOTAL POINTS:

HIGH = 76 to 100%
MEDIUM = 50 to 75%
LOW = below 50%

HEALTH PROBLEMS – STRENGTHS AND WEAKNESSES IN ADDRESSING THEM

The table below reveals the summary of the prioritized health setback which has the utmost occurrences
affecting the health condition of the province with its corresponding strengths and weaknesses.

Table 5-6. HEALTH PROBLEMS - STRENGTHS AND WEAKNESSES

Provincial Health Office, Compostela Valley
PRIORITIZED
HEALTH STRENGTHS WEAKNESSES
PROBLEMS
1) ARI dses. -RHU staff are trained in IMCI programs. -New staff are not trained on ARI cases

28
 -RHUs have nebulizers & other equipments
-Strong advocacy to reinforce the counting
of Respiratory Rate to those with ARI.
-Augmentation of drugs, meds & other
logistics from PHO & DOH.
-RHU staff are trained in DOTS program.
-All med. techs are trained in TB-DOTS for
case finding & case holding.
-BHW are active as treatment partners in
management protocols.
2) Pulmonary
-Regular supply of drugs & meds.
tuberculosis
-Presence of lab. equipment & facilities.
-Augmentation of drugs & meds & other
logistics from DOH & PHO.
-Conducts monthly monitoring, slide validation
-With budget for TB program implementation.
-All RHU personnel specially midwives
were tasked to monitor all pregnant
women to their community or station.
-PHO active retrieval of death records in
3) Maternal death the hospital & local civil registrars.
-Conduct maternal death orientation.
-DOH reps monthly & regular validation of
RHIS & target client lists.
-MSH & LEAD commodities.
4) Cerebrovascular -Provincial & government offices conduct
dses stress management & other sports activities.
-Availability of equipment for BP screening.
5) Hypertension
-RHU conducts regular HATAW activities.
-Non gov’t agencies & private sectors
6) Diabetes
conducts diabetes screening to RHUs.
mellitus
-With available IEC materials.
7) Dengue fever -Conduct massive campaign on dengue
awareness to private agencies, GOs & NGOs
-Creation of dengue brigade to schools &
communities.
management.
-Poor implementation of IMCI program.
-Creates social stigma among patients.
-Children are exposed to their family
and friends with active infection.
-Poor compliance on treatment
protocols.
-Poor quality prenatal check-up.
-High risk pregnancies.
-Accessible trained & untrained hilots.
-Unsafe abortion.
-Home deliveries w/ no aseptic techniques
-Delayed referral of hilots handling delivery
-Late referrals aggravated by lack of
medical mgt & poor access to hosp.
-Lack of emergency obstetric care.
-Lack of info & means to recognize &
manage complications in difficult labor
pregnancies.
-Health staff are not trained for BEmOC.
-MSH & LEAD project has terminated.
-No provincial maternal death review.
-Unhealthy lifestyle.
-Inadequate supply of drugs & meds.
-Delayed referral to hospital facility.
-Poor patient’s health seeking behavior.
-No provincial program implementation.
-Unhealthy lifestyle & obesity.
-Inadequate supply of antihypertensive
drugs & meds.
-Poor compliance on meds maintenance.
-No provincial program implementation.
-Patient resort to unhealthy lifestyle.
-Sedentary activities & obesity.
-Poor compliance on management of
meds as maintenance.
-Inadequate supply of drugs & meds.
-Lack of advocacy intensification.
-Can be acquired thru parental inheritance
-No provincial program implementation.
-Poor environmental sanitation.
-Delayed referral to hospital facility.
-Affected families are usually those not
active in voluntary blood donation.
29
 -Conduct dengue symposia to elem., hi-
school students & communities.
-PHO conduct case finding mgt & vector
control among households.
-PHO mobilized the creation of Dengue
task force to every brgy.
-PHO has its own manpower to facilitate
blood processing assigned in DRH.
-Regular data gathering to all dengue
cases in the major hospitals.
-Unhealthy lifestyle.
-Conduct regular pap smear & breast self -Unavailability of financial resources for
8) Cancer, all exam activities during outreach & other treatment & chemotherapy.
forms provincial initiated programs. -Can be acquired thru parental lineage
-With available IEC materials. inheritance.
-No provincial program implementation.
-Presence of DOH & PHO itinerant team &
sanitary inspectors for monitoring of
Schisto & other STH parasitoses.
-Conduct case finding & mass treatment if
found positive on Schisto.
9) Schistosomiasis -Conduct health education & ocular house-
& other STH hold survey to communities for their water
-Poor environmental & personal hygiene
parasitoses / sources & toilet facilities.
-Unhygienic food preparation.
Intestinal -Creation of schisto team at mun. level.
Parasitism -PGO and PEO conducted channeling,
deepening, desilting of snail colonies, &
vegetation clearing.
-Augmentation of meds from DOH & other
logistics from PHO.
-Presence of lab equipments & facilities.
-Improvement of Comval main roads is now -Insurgency.
on going through a foreign project. -Geographic location.
-Improvement of Comval brgy. roads from -Lack of precautionary & safety measures.
10) Accidents, all
the prov. gov’t. -Unavailability of resources to performs
forms
-Provision & construction of bridges & emergency cases in the health facility.
lighting facilities to brgys from prov’l. gov’t. -Rampant assault cases due to
-Police visibility. influence of alcohol & prohibited drugs.

OPERATIONAL PERFORMANCE PROBLEMS

The data below shows the consolidated operational implementation of the health office set-up. For each
identified problem a column for the strengths and weaknesses are enumerated using the 7 M’s. Each
area of concern tackles on the existing assets or resources available addressing them to be as the
strength category. While all internal deficiencies that hamper the functioning level of the province are
referred to as the weakness category.

Table 5-7. STRENGTHS AND WEAKNESSES

Provincial Health Office, Compostela Valley

30
OPERATIONAL
PERFORMANCE STRENGTHS
PROBLEM
-Enrollment of more clients to Indigency prog.
from congress to brgy. level.
-With RHU budget for med. assistance / LGU
-With available disaster & crisis intervention
for prov. & mun. level.
-With prov. & cong. med. assistance funds
for monthly bill-out sys. in DRH pts.
-Nabunturan & New Bataan implement cost
recovery scheme.
-MDH, PDH, MMH & LMH: increase collection
MONEY & revenues for 3 terms.
-PHO, MDH, PDH, MMH & LMH: funds can
be provided thru supplemental budget.
-MDH: trust fund available but for MOOE.
-MMH: LGU Maragusan have subsidized pts
in procurement of needed meds.
-MMH: LGU Maragusan have subsidized
fuel for ambulance to patients for referrals.
-MMH: Maragusan board members extends
financial help to hosp in special occasion.
-The Governor major goal zero backlog of his
priority projects in infrastructure, agriculture
& health sector.
-Strong linkages to health stakeholders, GOs,
NGOs & other private agencies.
-Well organized Peacekeeper’s, Women’s
BHW, SrCitizen, Youth & Handicapped org.
-Presence of Lamdag Panginabuhi project
w/c provides livelihood sources to farmers,
MANAGEMENT indigents & far flung communities.
-Prov. initiated activities - med, surgical,
dental, lab & nut. outreach to brgys.
-Adopt a malnourished child per office.
-BHW benefits from prov gov’t.
-Coordination with Dep-Ed on nephrology,
dental & lab services.
-Nab. RHU is TB-DOTS center certified.
-MDH, PDH, MMH & LMH: PHIC accredited
-LMH: 2-way referral system in place.
WEAKNESSES
-Minimal increase of health budget.
-Delayed processing of fund utilization
reports.
-Inadequate funds for travel, meds,
supplies & logistics.
-Inadequate funds for capability building
& trainings.
-Dole-out mentality has been tolerated.
-Unfunded position at PHO, hosp & RHU
-Inadequate funds on PHIC enrollment.
-PHO, MDH, PDH, MMH & LMH: lack of
funds for hosp. equipments, computers,
purchases & repairs.
-PHO, MDH PDH, MMH & LMH: needs
add’l funds for ambulance repair &
maintenance.
-MDH, PDH, MMH & LMH: over-utilized
budget of due to 100% occupancy rate.
-MDH, PDH, MMH & LMH: no funds for
structure set-up for PHIC requirement.
-Inadequate logistical support for hosp.
programs & projects.
-Poor document processing & needs
liason intervention.
-Delayed procurement processing.
-Program / policies & guidelines not
strictly practiced & observed.
-Magna Carta partially implemented.
-Poor referral system.
-Inactive LHB.
-No INTER LOCAL HEALTH ZONE.
-Political differences of elected govt
officials
31
 -All health staff are resourceful, committed,
hardworking & good mobilizer.
-Availability of health workers in all BHS.
-Majority of RHU health personnel were
trained in IMCI, CARI-CDD, NTP-DOTS,
FP, EPI, NTP & Nutrition programs.
-Well supportive BHW treatment partners.
-DOH & PHO facilitates trainings &
MANPOWER seminars among health workers.
-Presence of hosp. private practitioner.
-Presence of DOH reps in all RHUs.
-Presence of community organizer for
Malaria program.
-MDH: have 4 specialized MD’s.
-LMH: with available Pathologist.
-PHIC accreditation to 3 RHUs & 4 hosp.
-Construction & renovation of hosp, rhu &
bhs structures from different donor agency
-Assistance from outside sources for
upgrading facility in hosp & BHS.
-All RHU are SS certified Phase 1 Level 1 &
8 are certified Phase 2 Level 1.
-MDH: with approved allocations from Natn’l
Office to fully equipped & meet standards
as prov. hosp.
MANSION -MDH: Philhealth accredited Secondary hosp.
with a functional OR.
-MDH: with on-going expansion &
construction of a 2-storey building.
-MDH & MMH: with available semi-private
rooms for paying clients.
-PDH: with available standard space
Pharmacy building area.
-PDH: functional laboratory.
-MMH: available spacious surgical room.
-MMH: spacious & comfortable workplace.
-25% of brgys. has multicab in District 1.
-With new vehicles for PHO & hosps.
-Existence of computers to RHUs & hosps.
-Medical record database available at DOH.
-Presence of HMS to repair equipments.
MACHINES -PHO: available mobile hosp on wheels.
-PHO: with cold chain room for vaccines
-MDH, MMH & LMH: 1 functional computer.
-MDH: with available spectrophotometer
but tie up with a private company.
-MMH: has brand new model X-ray.
-Multiple tasking of health personnel.
-PHO, MDH, PDH, MMH & LMH: with
unfilled-up positions still available.
-MDH, PDH, MMH & LMH: inadequate
staff (MD, RN, RM, Admin.)
-MDH, PDH, MMH & LMH:staff have low
access in trainings for capability building
-MDH & MMH: hosp staff will soon leave
-MDH: COH have resigned, COH of
PDH was temporarily assigned.
-PDH: Asst. PHO was assigned as COH.
-PDH:no medtech during night &holidays
-PDH: staff are not computer literate.
-PDH: no Pharmacy Aide
-MMH: factionalism among employees.
-MMH: no Cashier & Liason officer.
-Dilapidated structures in hosp & RHUs
-No staff house for employees in hosp.
-MDH, PDH, MMH & LMH: building is
dilapidated & needs renovations, repairs
form roof to floor & other room stations.
-MDH, PDH, MMH & LMH: needs upgrade
for lab facilities.
-MDH: non-renewal of Philhealth.
-PDH: Pharmacy is not visible to clients.
-PDH: limited space for work & ward.
-PDH: has no room for storage of
Pharmaceutical products & supplies.
-PDH: leaking roofs in lab area.
-PDH: has hospital land conflict.
-MMH: comfort room is clogging.
-MMH: worn-out paint hosp. facilties.
-MMH: incomplete fencing on premises.
-MMH: deed of donation docs unlocated.
-MMH: certificate property title is vague.
-MMH: Philhealth license may be
suspended due to poor amenities.
-MDH, PDH, MMH& LMH: previous
ambulance is dilapidated & unreliable.
-MDH, PDH, MMH, LMH: med. equipmnts
are worn-out & inaccurate.
-MDH, PDH & LMH: needs add’l computer
-MDH & MMH: 2 computer not function
-MDH: no cart meds cabinets.
-PDH: no available bloodchem for exam
-PDH: electrical fluctuations often occurs
-PDH: no spectrophotometer.
-PDH: no storage for wastes & products.
-PDH: aging ward beds.
-PDH: no OR lights & DR anes. machine
-MMH: no consumable materials for Xray
-LMH: non-functioning gen-set.
-LMH: no X-ray machine & transformer
-LMH: no aircon for ER, OR & DR.
-LMH: needs another microscope.
32
 -Inadequate logistics for materials,
-With existing IEC materials, charts,
drugs, meds & other supplies.
manuals to some health programs.
-Delayed updating of records & reports.
-Regular supplies of meds, drugs, office
-Unavailability of hosp info sys database.
supplies, reagents & other logistics
-MDH: circuitous procurement process
assistance from DOH & PHO.
MATERIALS -On-line database procurement will be
thus delay acquisition of hosp needs.
-MDH: unsatisfactory performance of
established next year.
hosp due to inadequate facilities lead to
-MDH: tight control of procurement process
loss of lives & negative hosp image.
& safety net observed.
-PDH: delay updating of logistics, data,
-MDH: w/ sub-allotment per COA circular.
hospital & record keeping.
-Improper & abusive sending of text
messages.
-Existing means of communication, radio-
-MMH & LMH: no 2-way radio base.
base, cell phones, cellists.
MESSAGES -Presence of AM/FM stations reach brgys,
-Not all can buy cellphones & load.
-Comm. from PHO is sometimes delay
-MMH & LMH: w. handheld radio comm. sys
in spite of communication lines.
-MMH: with unlicensed hand-held radio.

33
 Chapter 6 - SUMMARY STATEMENT OF PRIORITY PROBLEMS

Table 6-1. SUMMARY STATEMENTS OF PRIORITY PROBLEMS

Provincial Health Office, Compostela Valley
A. HEALTH / DISEASE PROBLEMS
1. High prevalence of communicable diseases.
 Acute respiratory infection and pneumonia
 Tuberculosis
 Malaria and other vector borne disease such as dengue fever and filariasis
 Schistosomiasis and other parasitoses such as heterophyidiasis and capillariasis.
2. Increasing prevalence of lifestyle / non communicable disease.
 Cardiovascular diseases
 Hypertension
 Diabetes mellitus
 Cancer
 Maternal mortality
3. Increasing incidence of accidents / injuries.
 Wounds
 Assaults
 Vehicular accidents
B. INSTITUTIONAL OR OPERATIONAL PROBLEMS
1. Human resources do not meet required population ratio, health workers are performing
multi-tasking.
2. Limited health budget.
3. Inadequate medicines and hospital commodities and equipment.
4. Present procurement system increase likelihood of delay in the availability of meds and
other supplies.
C. CLIENT-BASED PROBLEMS
1. Poor health seeking behavior.
2. Unhealthy lifestyle.
3. Poor compliance to treatment.
4. Dole-out mentality.

Table 6.7 MAJOR GOALS

Provincial Health Office, Compostela Valley

1. Reduce incidence of communicable, non-communicable dses & other emerging dse

problems.

2. Increase enrollment of Philhealth Indigency program.

3. Assure quality health facilities, reinforcement of health regulations and access to

affordable quality meds.

4. Improve the management support system for health system performance.

34
 Chapter 7 - OBJECTIVES AND TARGET SETTING

FOURMULA 1 Component No. 1: HEALTH SERVICE DELIVERY

GOAL # 1. REDUCE PREVALENCE OF COMMUNICABLE DISEASES

BASELINE
YEAR YEAR YEAR YEAR YEAR OUTPUT
OBJECTIVE DATA
2006 2007 2008 2009 2010 INDICATOR
2005
G 1.1 TUBERCULOSIS
To increase CDR from
Increased case
89% in 2005 to 90% in 89% 90% 90% 90% 90% 90%
detection rate.
2010.
To increase CR from 85% Increased cure
85% 86% 87% 88% 89% 90%
in 2005 to 90% in 2010. rate.

BASELINE
YEAR YEAR YEAR YEAR YEAR OUTPUT
OBJECTIVE DATA
2006 2007 2008 2009 2010 INDICATOR
2005
G.1.2 MOSQUITO Borne : MALARIA, FILARIA and DENGUE
To reduce morbidity of
Malaria from 1.92/100,000 Decreased
1.92% 1.8% 1.6% 1.4% 1.2% 1.0%
pop. in 2005 to 1.0% in malaria morbidity.
2010.
To increase mass tx
Increased mass
coverage for Filariasis from
81% 84% 86% 88% 90% 90% treatment
81% in 2005 to 90% in
coverage.
2010.
To decrease mortality rate
Decreased case
of Dengue from 6.52% in 6.52% 5.0% 4.0% 3.0% 2.0% >1%
fatality rate.
2005 to >1%in 2010.

BASELINE
YEAR YEAR YEAR YEAR YEAR OUTPUT
OBJECTIVE DATA
2006 2007 2008 2009 2010 INDICATOR
2005
G.1.3 SCHISTOSOMIASIS
To reduce prevalence rate of
Decreased
Schistosomiasis in 10
1.88% 1.75% 1.60% 1.5% 1.55 1.0% occurrence
endemic mun. from 1.88% in
rate of schisto.
2005 to 1% in 2010.
To increase case finding from Increased case
the pop at risk from 78% in 78% 80% 81% 82% 83% 85% finding of
2005 to 85% in 2010. schisto.

BASELINE
YEAR YEAR YEAR YEAR YEAR OUTPUT
OBJECTIVE DATA
2006 2007 2008 2009 2010 INDICATOR
2005
G.1.4 DOG BITES AND RABIES
85 75 65 50 50
To reduce cases of dog
95 cases cases cases cases cases cases Decreased cases of
bites & maintain zero
dog bites & no
case of rabies from
0 rabies 0 0 0 0 0 death from rabies.
2005-2010.
rabies rabies rabies rabies rabies

35
GOAL # 1.2. TO REDUCE AND PREVENT NON-COMMUNICABLE DISEASES

BASELINE
YEAR YEAR YEAR YEAR YEAR OUTPUT
OBJECTIVE DATA
2006 2007 2008 2009 2010 INDICATOR
2005
G.2.1 REPRODUCTIVE HEALTH
To reduce incidence of 182/ 170/ 160/ 140/ 120/ 100/
Decreased maternal
MMR from 182/100,000 100T 100T 100T 100T 100T 100T
mortality rate.
LB to 120/100,000 LB. LB LB LB LB LB LB
To increase CPR from Increased
61% in 2005 to 65% in 61% 62% 63% 64% 65% 65% contraceptive
2010. prevalence rate.
To increase % of
Increased % of
pregnant w/ quality
14% 30% 50% 60% 70% 80% pregnant w/ quality
prenatal care from 14%
prenatal care.
in 2005 to 80% in 2010.
To increase % of mothers Increased % of
w/ quality PP care from mothers & received
46% 50% 55% 60% 70% 80%
45.9% in 2005 to 80% in quality postpartum
2010. care.
To increase % of FIM
Increased % fully
from 72% in 2005 to 80% 72% 73% 74% 75% 76% 80%
immunized mothers.
in 2010.

BASELINE
YEAR YEAR YEAR YEAR YEAR OUTPUT
OBJECTIVE DATA
2006 2007 2008 2009 2010 INDICATOR
2005
G.2.2 TO REDUCE AND PREVENT CHILDHOOD ILLNESSES
To increase % of Increased % of
FIC from 79% in fully
79% 82% 85% 86% 90% 95%
2005 to 90% in immunized
2010. children.
To reduce IMR
Decreased
from 15/1,000 LB 13/1,000 11/1,000 9/1,000 7/1,000 5/1,000
15/1,000 LB infant mortality
in 2005 to 5/1,000 LB LB LB LB LB
rate.
LB in 2010.
To reduce PMR
Reduced
from 20/1,000 LB
18/1,000 16/1,000 14/1,000 12/1,000 10/1,000 perinatal
in 2005 to 20/1,000 LB
LB LB LB LB LB mortality
10/1,000 LB in
rate.
2010.
To decrease
prevalence of Decreased
malnutrition from 14.7% 11% 10% 10% 10% 10% occurrences of
14.7% in 2005 to malnutrition.
10% in 2010.

FOURMULA 1 Component No. 2: HEALTH FINANCING

BASELINE
YEAR YEAR YEAR YEAR YEAR OUTPUT
OBJECTIVE DATA
2006 2007 2008 2009 2010 INDICATOR
2005
GOAL # 2. TO INCREASE ENROLLMENT OF PHILHEALTH INDIGENCY PROGRAM.
To increase PHIC enrollment
plus plus plus plus plus Increased
from 20,000 enrollees in 2005
20,000 10,000 15,000 20,000 25,000 30,000 PHIC enrollee.
to 50,000 in 2010.

36
 FOURMULA 1 Component No. 3: HEALTH REGULATION

BASELINE
YEAR YEAR YEAR YEAR YEAR OUTPUT
OBJECTIVE DATA
2006 2007 2008 2009 2010 INDICATOR
2005
GOAL # 3. TO ASSURE QUALITY HEALTH FACILITIES, ENFORCEMENT OF HEALTH
REGULATIONS & ACCESS TO AFFORDABLE QUALITY MEDS.
To upgrade RHUs as 100% of RHUs are
8 9 11 11 11 11
Sentrong Sigla phase 2 level phase 2 & level 1
RHUs RHUs RHUs RHUs RHUs RHUs
1 from 8 in 2005 to 11 in 2010. accredited.
To upgrade RHU to SS Phase 100% of the RHUs
0 2 3 4 2 11
2 level 2 from 0 in 2005 to 11 are phase 2 level 2
RHUs RHUs RHUs RHUs RHUs RHUs
in 2010. accredited.
To increase Botika ng
Barangay establishments 70 100 125 150 200 Increased BnB
45 BnB
from 45 Bnb in 2005 to 200 Bnb Bnb Bnb Bnb Bnb establishments.
Bnb in 2010.

FOURMULA 1 Component No. 4: GOOD GOVERNANCE

BASELINE
YEAR YEAR YEAR YEAR YEAR OUTPUT
OBJECTIVE DATA
2006 2007 2008 2009 2010 INDICATOR
2005
GOAL # 4. IMPROVE THE MANAGEMENT SUPPORT SYSTEM FOR HEALTH SYSTEM
PERFORMANCE.
To create Inter-local
Inter-local health
health zone from 0 in 0 0 1 1 2 2
zones functioning.
2005 to 2 in 2010.
To activate local
Monthly meeting
health board by Once a
once Quarterly Monthly Monthly Monthly instituted &
having a meeting year
organized.
every month.
To provide 100%
10% 15%
Magna Carta privilege 25% full Full Full Full Full implementation
partial partial
to all health workers.

G.2.3 HOSPITAL REFORMS

OBJECTIVE MDH PDH LMH MMH Remarks
Manpower Filled-up all
To increase Fill up vacant Fill up vacant Fill up vacant
answers the need plantilla
manpower. positions. positions. positions.
of a prov’l hosp. positions.
To allocate amt. Needs 2M for 1M for Dilapadated
1M for 1M for
for hospital renovation of renovation. structures
renovation. renovation.
renovation. phase 1 bldg. renovated.
To procure
To procure To procure To procure X- To procure new Equipments
additional
Ultrasound. Ultrasound. ray machine. ECG machine. procured.
equipment.

APPENDIX

37
 SUMMARY OF OVER-ALL HEALTH INITIATIVE OF THE PROVINCE

Year 2005 was a very tough and taxing year in the Provincial Health Office. From the first quarter up to
the last quarter tons of works were already pushed to the limit to all health workers. But the unending
support of the Provincial Government and the headship of our compassionate Governor JOSE R.
CABALLERO brought the realization of the PHO Magna Carta and additional grant to our benefits. Thus,
we thank the Honorable Governor for all the provision and sustenance to our needs. We continue to
improve the conveyance of our health services far and wide to all Comvaleños.

HE
HEALTH SECTOR
The provision & realizationHEALTH
of Magna CartaSECTOR
to all health workers in the province.
The provision
Philhealth & realization
insurance expansion of Magna
coverage Carta
whichto all health
entails workers membership
automatic in the province.
given
to Philhealth
all Seniorinsurance
Citizens, expansion coverage which
Prov’l Peacekeepers, entails Health
Barangay automatic membership
Workers, given
Barangay
to all Workers
Health Senior Citizens, Prov’l Peacekeepers,
& Physically Disabled individuals Barangayplus Health Workers,
additional budgetBarangay
was
Health Workers & Physically Disabled individuals plus additional budget was
allocated.
Theallocated.
Blood Processing fee for Blood Sufficiency Program has increased covering the
11The Blood Processing fee for Blood Sufficiency Program has increased covering the
municipalities.
11 municipalities.
Regular outreaches to far flung barangays despite of the limited resources but
Regular alloutreaches
maximize to fartheflung
efforts to serve barangays
deprived despite of the limited resources but
communities.
A maximize all efforts
total of 1,161 to bowls
toilet serve the plusdeprived
1 sackcommunities.
of cement given & distributed to all
A total of 1,161 toilet bowls plus 1 sack of cement given & distributed to all
municipalities.
municipalities.
Adopt a malnourished child per office in coordination of the Nutrition Council &
Adopt ahas
Comval malnourished
received 2 child per officeawards
successive in coordination of the implementation
for the good Nutrition Council& &
Comval has
decreasing casesreceived 2 successive
of malnutrition awards for the good implementation &
in the province.
decreasing
Comval’s casestoofpoverty
answer malnutrition
or food in the province. has narrowed down due to the
insufficiency
Comval’s
prov’l answer toof poverty
gov’t dispersal marine, or food insufficiency
agricultural resourceshas narrowed
& other sources down due to the
of livelihood
to prov’l gov’t
indigent dispersal
families of marine, agricultural resources & other sources of livelihood
& communities.
to indigent
Purchased families
new & communities.
ambulance each for the 4 gov’t hosp.
Purchased new
Rehabilitation ambulancedistrict
of Montevista each hospital
for the 4 togov’t
be ahosp.
Provincial Hospital.
Rehabilitation
Activation of theofEyeMontevista district hospital
Care Program & Diabetic to beClub
a Provincial
which hasHospital.
been inactive for
Activation
many years..of the Eye Care Program & Diabetic Club which has been inactive for
many
Fully years.. Women empowerment & has caused the inclusion of R.A. 9262
supported
Fully supported
Violence against womenWomen empowerment
& children & has
Act in 2005 caused
ratified the inclusion
mandates throughofthe R.A.
BLEW9262
Violence Legal
(Barangay against women &onchildren
Education Wheels) Act in 2005 ratified mandates through the BLEW
program.
(Barangay Legal Education on Wheels) program.

38
Prepared:

ROSE CHERYL P. REYNES-EYAS JOCELYN B. ACA, M.D.

Statistician I Medical Officer V–Planning Division Head

Noted:

RENATO B. BASAÑES, M.D.

Provincial Health Officer

Approved:

Hon. JOSE R. CABALLERO

Governor

39