An Attempt to Reduce Infant and Child Mortality in Bohol, Philippines

Abstract

PIP: This discussion describes the experience of 1 local area, Bohol, Philippines, that, despite an active maternal and child health/family planning (MCH/FP) program, failed to experience a decline in mortality during the project period (1975-1979). The specific health services to be delivered were determined during the early years of the project. The project managers believed that a package of basic primary health services with an emphasis on MCH would make a measurable impact on child health and, hopefully, on mortality. It was felt that increased use of family planning, particularly on the part of high risk mothers, would also contribute to a decline in infant and child mortality. The project recruited and trained 44 new midwives and others were added later. By 1979, 100 small Primary Health Care Centers, each staffed by a midwife had been established in the project area. 50 small community drugstores were also opened. The 4 public health hospitals and 21 rural health units, 1 in each town of the project area, participated in the project. The Bohol project increased the number of health staff, supervised them, and provided logistic support. As an immediate goal, the project sought to reach all children under age 5 with basic health services. Based on census and survey data, it is probably safe to say that mortality declined in Bohol between 1970 and 1975-79, but during the project period the crude death rate for the project area showed only a slight but statistically insignificant downward trend. Even though improvements were demonstrated in health service coverage in the project area, these improvements might have worked against other trends, thus explaining the lack of a clear decline in infant and child mortality during the project period. The project collected information on trends in fertility, abortion, nutrition, breastfeeding, and general living conditions. Although the results were at times mixed, none of the 5 appeared to have had a major effect on mortality trends. Except fertility, little change was noted. Although fertility declined, it was not clear whether higher or lower risk births were being prevented. A number of plausible explanations are evaluated as to why infant and child mortality failed to show a clear decline in Bohol: health services were of inadequate quantity or quality; midwives had too many tasks; there was a lack of fit between health services and local health conditions; local health problems were intractable to current technology; resources were insufficient to provide comprehensive primary health care; the MCH program was used primarily as a vehicle for family planning; too little attention was given to curative services; MCH programs are not designed to have a demograhic impact, and the project had too short a time period to have a demographic effect on such a large population.