Innovations in Health Care Delivering health services on wheels in the Philippines Why deliver health services on wheels? In many parts of the world, people are unable to access health services because of forbidden terrain and high transportation costs. In the province of Maguindanao in the Philippines, more than three-quarters of the population live in rural areas. Traveling short distances can take hours due to annual flooding, impenetrable marshes and arduous mountain waterways. Travel between barangays or villages can be difficult — some communities in the same barangay are over two hours apart.
What’s our strategy? Through its Maguindanao Tuberculosis Control Program (MTCP), CRS turned to a model previously developed by the Integrated Provincial Health Office to help provide pregnant women access health services. Called Reproductive Health on Wheels (or RH on Wheels), the project organized transport operators and encouraged them to provide their services for free or at minimal cost to pregnant women. RH on Wheels improved access to prenatal care and provided needed transportation to health facilities where women could safely deliver their babies. Adopting the RH on Wheels model, the MTCP reached out to several transport groups and tapped them to become partner advocates in TB control and prevention. The new strategy — “Microscopy on Wheels” (or MOW) — has aimed to improve access to TB laboratory services, particularly for clients experiencing symptoms of the disease and those
MOW members. Photo: CRS staff
who live in hard-to-reach areas of the province. To travel to these populations, the project has relied on motorcyles for most rural areas, tractors for flood-prone regions, and boats for the communities accessible only by water. By reaching out to all transportation operators, the MTCP has demonstrated how important these partners can be in accessing underserved areas and providing needed health services.
Roles and functions of MOW members Transport sputum specimens and smeared slides from health stations to the nearest rural health unit equipped with laboratory facilities Provide free transport to TB clients from outlying areas to the rural health unit for laboratory diagnosis and treatment
Serve as advocates of the TB program in general Disseminate information about TB services to passengers and other drivers while waiting at the transport terminal Serve as treatment partner and/or peer support group to help mitigate and cope with disasters
For more information, contact pqpublications@crs.org
MOW volunteers transporting a patient. Photo: CRS staff
Smearing sputum specimens. Photo: CRS staff
Delivering specimens. Photo: Melindi Malang
Activities The primary activity of MOW volunteers has been to transport patients and specimens, and educate the population about TB. With proper training, MOWs have been able to learn about the illness, recognize its symptoms and inform clients about the variety and location of health services. Whether waiting at a motorcyle terminal or a pier, trained volunteers have used their time to disseminate information to passengers and drivers alike.
Constraints The staff of Rural Health Units (RHU) usually reside in the areas where they serve and personally know most of the transport operators and drivers. They are able to approach and talk with them individually, yet finding time to meet the transport workers as a group was a challenge since transporters must work to make a living. To address this constraint, RHU staff visited transport workers at designated terminals, usually on market day, to meet as many of them as they could at one time. While most transport providers were willing to help their fellow residents, many felt constrained by their need to also earn a living. This conflict was the primary reason transport providers dropped out of the program. Understanding the situation, active MOWs and RHU staff encouraged the transporters to continue participating in the program as they could. The RHU staff also asked local government authorities to support MOWs through fuel allowances, but these local units have been unable to provide support on a regular basis.
Looking ahead Microscopy on Wheels has demonstrated that communities themselves can be active participants in TB control. By reaching out to members of the transport sector — a group not traditionally considered a partner in health — the program effectively engaged their support for health promotion. As a result of the MCPT’s TB-related activities, clients have received better quality care, treatment outcomes have been improved, and patients have been empowered to determine the best type of care for their family and for themselves. The community approach also raised awareness about the disease and resulted in less stigmatization. Though the MOW program ended in September 2009, this innovative project is being sustained by local health authorities and the transport sector. In October 2009, the Maguindanao Tuberculosis Control Project was awarded the International Relief and Development Project of the Year by Project Manager Today magazine.