Rural Philippines Research Articles

Emotional Earmarking: Insights into Remittances and Emotions from a Mixed Methods Study of Migrant Households in Rural Philippines

Overseas remittances improve the economic conditions and influence the financial behaviors of international migrants’ families that remain in the country of origin. Remittances affect family relationships in the hometown and across transnational borders, but migration research has not yet analyzed these family dynamics through the lens of household finance. Recent studies address the remittance–emotion nexus partially and statically rather than holistically and dynamically, delivering an insufficient understanding of complex and evolving links mediated by the sending, using, and investing of remittances. Built on an existing family financial socialization model, and using mixed methods for case studies in two rural municipalities of the Philippines, this study sets out to determine how emotions come into play as families strive to use remittances productively. A central finding is that migrant households employ what we call emotional earmarking to bring about economic benefits along with concurrent emotional benefits to family relationships. This emotional earmarking can help families (as well as migration and development stakeholders) in the productive use of remittances and the maintenance of family connections despite the physical absence of migrant members.

Boys’ Underperformance, Teacher Scoring Bias and Unbalanced Teacher Market in Rural Philippines

This study exploits a natural experimental setting in rural Philippines to investigate the reversed gender disparity in education. We compare two rating systems implemented in the Philippines, observing that boys’ underperformance persists in evaluations by teachers who know the examinees. Conversely, this bias is not evident in external assessments where the examinees’ attributes are concealed from evaluators. Our empirical analyses identify two underlying channels. The first is the disparity rooted in a stereotype against male students. The second is teacher-rated scores capturing a broader range of diligence aspects, such as attendance, where male students are likely to underperform. This bias is also amplified by the likelihood of student–teacher gender (mis)match, reflecting teacher labour-market conditions in developing countries. This study has limitations due to the relatively small sample to generalise and determine which mechanism prevails over the other. Nonetheless, we emphasise that gender disparity is driven by stereotypes (i.e. being male or diligent towards a specific gender) of one gender over the other.

Adherence to Clinical Practice Guidelines on the Management of Acute Infectious Gastroenteritis in Children as a Measure of Quality of Care Delivered by a Primary Care Facility in Rural Philippines: A Descriptive Retrospective Study.

This study aimed to describe the pattern of prescription and laboratory use in the management of infectious acute gastroenteritis (AGE) in children seen in a rural service delivery network (SDN) and to determine their adherence to the 2019 Clinical Practice Guidelines on the Management of Acute Infectious Diarrhea in Children and Adults from the Department of Health (DOH). A descriptive retrospective study was done using the electronic medical records (EMR) of patients less than 19 years old seen by the rural SDN from April 2019-2021 and diagnosed with infectious AGE. Data were extracted on diagnostic and therapeutic management. Adherence to strong CPG recommendations focusing on rehydration, zinc supplementation, rational laboratory use, and antibiotic prescription was chosen as indicator of quality of care. Adherence of less than 70% was defined as low. There were 227 infectious AGE cases, with 72% diagnosed under non-specific infectious AGE. Fifty two percent (52%) were prescribed with low-osmolarity oral rehydration solutions (ORS), while 74% were given zinc. Stool analysis was done in 25% of cases while CBC was done in 20%. Top antibiotics given were metronidazole at 44% and cotrimoxazole at 33%. There was low adherence to prescribing low-osmolarity ORS for rehydration (52%) and to deferring routine antibiotic prescription for non-specific infectious AGE cases (24%). Adherence to deferring routine stool analysis and CBC were relatively high at 73% and 70%, respectively while adherence to antibiotic use for indicated cases was high at 95%. Frequency of diagnostics ordered were low resulting to high adherence rates to recommendations concerning judicious laboratory use. Prescription frequency of appropriate antibiotics and interventions for AGE were low, leading to low adherence rates to recommendations concerning rational antibiotic use and prescription of cornerstone therapies for infectious AGE.

Patient Perspectives on Utilizing a Mobile Medical Clinic in Rural Philippine Communities

The purpose of the ABC’s for Global Health Medical Mobile Clinic (ABC-MMC) is to (1) provide primary health care services and (2) prevent and manage hypertension and type 2 diabetes in underserved rural villages (barangays) in Pampanga Province, Philippines. The aims of this study were: (1) to evaluate patient perceptions regarding ABC-MMC’s health care services; and (2) understand the barriers to and facilitators for patient engagement in ABC-MMC. This was an exploratory qualitative study conducted in November 2021 using open-ended, semi-structured focus group interviews. Participants enrolled in ABC-MMC were recruited from six of the 18 barangays served by ABC-MMC. Community health workers (CHWs) recruited from each barangay were instructed on how to facilitate focus groups. Focus group interviews were digitally recorded and open coding methods were used to analyze the resulting data. Six focus groups were conducted with N=57 adult Filipino participants (28.1% male, 71.9% female). Overall, mean age was 61 years. A majority had hypertension (84.2%), while 42.1% had type 2 diabetes. Mean duration for patient-enrollment in ABC-MMC was 2.3 years. Four major focus group themes emerged: (1) barriers for access to healthcare, (2) facilitators for accessing healthcare, (3) positive perceptions towards ABC-MMC, and (4) limited health literacy. As far as authors know, ABC-MMC is the first mobile primary healthcare program emphasizing continuity of care in low-income rural Philippine barangays that (1) addresses the lack of healthcare services, and (2) focuses on chronic disease prevention and management. This study found that the ABC-MMC was well-received by rural Filipino communities. Moreover, barriers and facilitators were identified to inform how best to promote engagement in ABC-MMC services and improve health outcomes in low-income underserved rural Philippine barangays.

Incorporating Praxis into Community Engagement- Self Monitoring: A Case Study on Applied Social Innovation in Rural Philippines

Incorporating Praxis into Community Engagement- Self Monitoring: A Case Study on Applied Social Innovation in Rural Philippines

Quantitative evaluation of water, sanitation, and hygiene measures on COVID-19 pandemic peak reduction in the Philippines

New cases of coronavirus disease 2019 (COVID-19) are continually being recorded worldwide, despite global efforts in implementing non-pharmaceutical interventions and establishing vaccination programs. This trend highlights the need to identify the factors associated with the continued spread of COVID-19. The World Health Organization recommends hand washing as a cost-effective intervention for preventing COVID-19, indicating that water, sanitation, and hygiene (WaSH) are central to the prevention of the disease. However, low- and middle-income countries lack adequate access to WaSH, which increases the risk of contracting COVID-19. The aim of this study was to identify the WaSH factors associated with the incidence of COVID-19 and quantitatively estimate the effects of improvements in WaSH on reducing the incidence of COVID-19 during the peak of the pandemic. Lasso regression and extreme gradient boosting models were used to identify the WaSH factors. Distinct estimation models were developed to assess the effect of WaSH in rural regions under two assumptions: increasing regional basic sanitation coverage up to 25 % and 50%. The reduction in the incidence of COVID-19 during the peak of the pandemic was calculated for each rural region. The results of the analyses indicated that basic sanitation is important for reducing the incidence of COVID-19 in rural regions compared to urban regions in the Philippines. In addition, the results suggested that increasing basic sanitation coverage could reduce the incidence of COVID-19 by 2–66 %, alleviating the burden on healthcare facilities. This study indicates that improved basic sanitation infrastructure are needed in rural Philippines. The results of this study emphasise the significance of WaSH as an indicator of COVID-19 incidence, highlighting the need for its enhancement to enable the achievement of sustainable disease prevention and pandemic preparedness goals.

Integrated Primary Healthcare Delivery of Hypertension and Diabetes Services: A Task Analysis of Nurses and Doctors in Rural Philippines

Integrated Primary Healthcare Delivery of Hypertension and Diabetes Services: A Task Analysis of Nurses and Doctors in Rural Philippines

Social service delivery for senior citizens in rural Philippines and secrets to longevity of Apo Whang-od

Access to social services such as healthcare, transportation, and financial support can be limited, leaving many elderly individuals vulnerable to poverty and social exclusion. This paper examined the recent elderly demographics, status of social service delivery, the roles of traditional and cultural practices, and specific challenges faced by older persons in rural areas, using the case of Apo Whang-od and her community, Buscalan that is in the municipality of Tinglayan, Province of Kalinga, Philippines. Using a mixed methods approach, this paper revealed that almost 11% of Tinglayan’s population is elderly, mostly indigenous people with a relatively low literacy rate, and low-income earners who are engaged mostly in subsistence farming and small-scale traditional craft making. Also, there are substantial government programs and services offered by existing laws; however, access to these is challenged by limited access to education and healthcare services, with long travel distances and a lack of transportation being major barriers. Financial difficulties were also observed, with no or few having access to social security benefits and reasonable amounts of pensions. The challenges can also be attributed to an unfavorable geographical location, conflicts with neighboring tribes, limited local government funds, lack of knowledge, and inadequate social service centers within the locality. Tinglayan’s cultural values were also found to play a pivotal role in supplementing the scarce social services by fostering a supportive atmosphere for the elderly. Analysing Apo-Whag-od's longevity, it was revealed that she lived a longer life because she ate organic and locally sourced food, slept well, laughed a lot, engaged in regular physical activity, nurtured her spiritual well-being, built strong relationships with her family and community, and kept a positive outlook. In conclusion, social demographics shows that elderlies in rural areas are disadvantaged, which calls for more efficient and effective access, delivery, and availability of social services. Moreover, policymakers are enjoined to accelerate social infrastructures, expand social protection programs, and support intergenerational solidarity and resilience and cultural preservation. Lastly, Apo Whang-od’s legacy lives on. Her popularity not only gained revitalization of the Kalinga tattoo culture, but it also inspired people to follow her steps to longer and happier way of life.

Sharing norm, household efficiency and female demand for agency in the Philippines

Households in the Philippines are characterized by durable unions and a relatively high status of women who are entrusted with the management of household finances. In this setting conducive to cooperation, we expect households to be less inefficient than in other contexts and women to be more inclined to contribute to household income than men. We run experimental games with couples in the rural Philippines i) to test the existence of a sharing rule favouring women; ii) to measure the degree of overall household efficiency and iii) to trace the latter to gender specific behaviors.We first find the prevalence of a strong sharing norm whereby women secure about two thirds of the total couple payoffs, in line with their prominent role in the family. However, couples, and in particular women, incur large efficiency losses of about half of the potential gains offered by the games. We interpret this finding as revealing a strong, latent demand for agency by women who express a strong preference for own money over (larger) transfers from their husband as the latter involve an implicit control over their use. These findings challenge a naive view of female empowerment that solely focuses on the nominal control over household resources.

Pilot Implementation of a Computer-based Training Course on Newborn Hearing Screening and Teleaudiology among Primary Healthcare Providers in Low Resource Settings.

Newborn hearing screening (NHS) in the Philippines has been mandated by law since 2009. However, lack of awareness and knowledge about NHS remains a challenge, especially among healthcare providers. This paper describes the pilot implementation of a computer-based training (CBT) course on NHS and teleaudiology among primary healthcare providers (PHCPs) in rural Philippines. A four-module web-based training course on newborn hearing screening and teleaudiology in an online learning management system (LMS) was field-tested among PHCPs from eight rural communities in the Philippines. Participants were given four weeks to complete the course. Forty-two PHCPs participated in the CBT. Thirty-four (81%) completed the whole course (mean attrition rate of 4.8% per module) at a mean duration of 10.2 days. Baseline data shows that participants had no NHS training, although the majority (83%) had information and communications technology (ICT) training. Comparison of pre- and post-test mean scores showed a 24.0% (p<0.001) significant increase in the post-test in all four modules. Passing rates (i.e., score ≥70%) from pre- to post-test increased by 54.6% (range: 38-80% increase). Usability of the CBT was rated high with a mean score of 4.32 out of 5 (range: 4.13 to 4.47), covering all eight parameters. Participants expressed general satisfaction and a positive attitude on CBT to improve knowledge on NHS and teleaudiology. Even in low resource settings where gaps in ICT infrastructure exist, eLearning can be used as an alternative approach to increase awareness and support training of healthcare providers on newborn hearing screening.

Pro-poor change in the aftermath of disasters – Exploring possibilities at the intersection of disaster politics and land rights issues in Central Philippines

This article demonstrates how natural disasters can rearrange arenas of contestation over land use, ownership and titling. It analyses how state agents, organized civil society, communities and powerful business groups in three cases in rural Philippines dealt with the challenges and opportunities for agrarian reform after being hit by typhoon Haiyan in 2013. Understanding this connection between agrarian reform and disasters will become increasingly important to address the vulnerabilities of the marginalized in the context of climate change and related rise in disasters. An actor-oriented perspective and a case study method was used to unravel how specific communities engage with processes of agrarian reform after a disaster and how a crisis can change dynamics between actors from above and below in agrarian reform processes. This is needed since the people’s perspective on these processes is often missing and knowledge on the everyday experiences of social change is limited. The cases show that disasters are a window of opportunity to reverse or accelerate complicated agrarian reform processes: by restructuring dynamics between actors from below and above in existing, sometimes stagnated agrarian reform processes, by revealing political dynamics that were invisible before or by creating new possibilities to mobilize actors from above and below to claim access to land.

Factors affecting the University Students’ Mental Health during the 2020 COVID-19 outbreak

Fear and worry, especially in rural Philippines, harmed youths' mental health during the COVID-19 pandemic. There were 722 Isabela State University students surveyed for mental health. An online descriptive survey described their characteristics, stressors, coping techniques, and epidemic-related mental health hurdles. Depression and anxiety were assessed with the Patient Health Questionnaire -9 and Gender Anxiety Disorder-7. Most 19-20-year-old students reported mild depression and anxiety, with females more affected than males. Financial issues prevented mental health care, affecting academic performance. Other stressors were COVID-19 symptoms, lack of counseling, and social isolation. Exercise, diet, and creativity were also coping techniques. These facts demonstrate that COVID-19's isolation and economic, educational, and mental effects are interrelated. Increased counseling services, telehealth training, seminars, interventions, academic assistance, and mental health technology can help bridge the gap between students, parents, and institutions. Future studies will provide specific therapies for the most affected groups.

Life has become more colourful: the social and economic outcomes of community-led sanitation initiatives in the rural Philippines

Abstract This article considers the impact of improved sanitation beyond physical well-being. Based on the experiences of women from three community-based organisations (CBOs) in the rural Philippines, this article expands on documented non-health related outcomes of health, safety and security, cleaner surroundings, and ownership, to also include those linked to household income, livelihood, and CBOs. Drawing from the participatory and qualitative methods of Photovoice and Most Significant Change, semi-structured interviews and individual photo conversations were conducted among 13 CBO leaders and 50 sanitation project participants, respectively. Findings suggest that CBOs enable improved sanitation, and such improvements include a personal and communal change in the form of reformed sanitation and hygiene practices, enhanced independence, privacy, and security, and improved ability to reclaim spaces for personal and public use, cultivation, and economic stimulation. Findings also underscore the idea that people may be more likely to adopt and sustain improved sanitation efforts if they are made aware of the additional non-physical health advantages of doing so.

Identities and Roles of Gay and Bisexual Teachers in Rural Philippines

This study utilized a descriptive exploratory approach to explore the identities and roles of gay and bisexual teachers in their workplace. The ten informants were purposively chosen. Interviews, focus group discussions, and direct and participant observation were the data-gathering procedures employed in the study. To dig deeper into their identities and roles, thematic analysis was used. The study revealed that the profile of gay and bisexual teachers varied from one another. Further, the informants identify with their preferred gender identities and characterize their roles and duties as teachers who are committed, competent, creative, and compliant. Training and seminars on gender mainstreaming issues may be strengthened to foster gender-responsive schools toward safe and inclusive spaces for LGBT teachers.

Perks of Pivoting: Key Learnings from Data Collection Amid COVID-19 Regulations

Abstract Sanitation interventions are bountiful, yet concerns prevail regarding their impact and sustainability. Community-led initiatives, such as those facilitated by Outreach Philippines, Incorporated (OPI), prove to ease such concerns. The research team conducted a qualitative study to understand the role of OPI’s sanitation activities and their impact on three communities in the rural Philippines. Due to COVID-19 restrictions, the team adapted their data collection strategy by employing Most Significant Change and Photovoice methodologies. The breadth of data collected underscores the vitality that multimedia brings to data collection. Significantly, the pivoting necessary to conduct the study was made possible by OPI staff and community leaders who played integral roles in developing and carrying out the research. The findings point to the advantages of using multiple qualitative methods, the necessity to do so during COVID-19, and community members’ ability to bolster study success.

Turnaround Time of Consults in a Primary Care System in Rural Philippines: A Descriptive Retrospective Cohort Study.

Turnaround time is an integral component of primary healthcare and is a key performance indicator of healthcare delivery. It is defined as the time patients spend during a healthcare facility visit. In this study, turnaround time is defined as the time elapsed from registration to the end of consultation. This study aimed to determine the turnaround time of consults in the primary care system in a rural site in the Philippines, and compare turnaround time during the pre-pandemic and COVID-19 pandemic periods. This is a retrospective cohort study of patients seen at the primary care facility under the Philippine Primary Care Studies (PPCS) rural site from April 2019 to March 2021. Patients included in this study were chosen through random sampling. Electronic medical records (EMR) of these patients were reviewed. Turnaround time was computed electronically from time of registration to end of consultation. Descriptive statistics was used to summarize data and report turnaround time. The turnaround time before and during the pandemic was compared using an independent sample t-test (if normally distributed) or Mann Whitney U test (if not normally distributed). A p-value of <0.05 was considered statistically significant. A random sample of 342 patients out of the total 45,501 patient consults seen at the rural primary healthcare facility from April 2019 to March 2021 were included in this study. The median turnaround time was 29.0 minutes (interquartile range [IQR] 68.3), with range of 0.9 to 437.2 minutes. During the pre-pandemic period, the median turnaround time of consults is 29.3 minutes (IQR 70.4) which is 1.8 minutes longer than the pandemic period which showed median turnaround time of 27.5 minutes (IQR 72.7). The difference between the two time periods was not statistically significant (P = 0.39). The study showed that the median turnaround time of medical consults was 29.0 minutes, which was shorter by 80 minutes compared to other published Philippine studies. The turnaround time did not differ significantly in the pandemic and pre-pandemic period, despite new policies and systems that were implemented during the pandemic.

Implementing a mHealth-Based Patient and Nurse Educational Program to Reduce Wound Infection in Rural Philippines.

Background:Surgical site infection (SSI) is a prevalent but preventable complication in low-and-middle income countries (LMIC), with reported incidence varying from 8–30%. In 2018, the MEDIPINAS surgical mission to the Philippines observed a 28.8% rate of SSI despite adherence to WHO intraoperative protocols.The objective of this study was to introduce an educational program for wound care and early identification of wound infection. This program included provision of wound care materials and systematic protocol to ensure adequate and effective follow-up. Barriers to SSI prophylaxis in the Philippines include limited resources in regional hospitals and isolation of patients living in rural areas. The MEDIPINAS mission utilized mobile health software to connect with regional providers and to reinforce the wound care educational program introduced at discharge.Methods:The 2019 MEDIPINAS mission returned to the Philippines and operated on 187 patients in San Antonio de Padua Diocesan Hospital and Santa Maria Josefa Hospital. Before discharge, patients were individually consulted about maintaining the cleanliness of their surgical wound. Each patient was discharged with a wound care infographic and a kit to change dressings. In collaboration with regional care providers, we utilized a secure mobile health software to monitor wound healing 7 and 30 days following the operation.Results:Between the 2018 and 2019 surgical missions, we observed a decrease in SSI from 28.8% to 9.7%. Fourteen patients (7.5%) were lost to follow-up. Postoperative infection was diagnosed using photos provided by hospital-based nurses. Individuals with infections were treated with antibiotics and all but two SSI resolved after 30 days.Conclusions:Patient education, discharge with basic sanitary resources, and development of a mobile health-based follow-up infrastructure may contribute to significant reductions in SSI in LMICs. A limitation to implementation of such a program was integration of the mobile health software into the practice of local healthcare providers.

Striving to publish in international journals: A case study of a small university in rural Philippines

ABSTRACT This article analyzes a recent Peace Corps Response project led jointly by a Filipino scholar and a U.S. scholar at a rural university in the Philippines with the goal of coaching faculty who seek to make it in the world of international scholarly research and publishing. The article first highlights ten major challenges including lack of internet, university bureaucracy, limited time, lack of training, clashing incentives, and lack of knowledge about professional opportunities. Ideas for leveling the playing field for scholars around the world are presented, including: Increased internet access, open access to the scholarly literature, streamlined university processes, more in-country research funding opportunities, individualized research consultations, group seminars offered by national and international professional organizations, enhanced graduate education on research process and methods, grant and fellowship opportunities that reach beyond elite institutions, funds to attend international conferences, and additional scholarly networking opportunities.

“To be one with others”: exploring the development of community leadership in the Rural Philippines

ABSTRACT Local leadership is increasingly recognised as essential to community-led development interventions. This exploratory qualitative study considers how such community leadership develops within rural Filipino communities. Informed by current definitions of community leadership, Leadership-as-Practice literature, and nine individuals’ experiences, emerging themes denote practices of capacity development, personal change, and relationship building as most significant to community leadership development. These practices happen within the context of collective action, and activities related to the identification and critical analysis of shared challenges; accessing resources communities need to address their identified challenges; management of locally owned projects; and structuring of local groups into formal organisations.

A community-based survey to assess risk for one health challenges in rural Philippines using a mobile application

BackgroundRecent emerging and re-emerging diseases in animals and humans show the vulnerability of humans, animals, and crops to disease outbreaks and the large potential impact on health, food security, and economies worldwide. A technology-enabled One Health (OH) surveillance program offers an opportunity for early detection and response as well as prevention of disease outbreaks in resource-limited settings. As an initial step toward developing the surveillance program, we aimed to identify at-risk groups of households for potential shared health challenges at the human-animal-environmental interface in a rural community of the Philippines.MethodsA cross-sectional household survey was conducted in the municipality of Los Baños in proximity (63 kilometers south) to Metro Manila by enumerators living in the same community. Twenty-four enumerators conducted household interviews asking a) household characteristics including ownership of animals and crops; b) awareness, beliefs and knowledge about OH; c) family-level health practices related to sanitation, hygiene, and food safety; and d) risk factors for potential OH issues. All data collection and transferring process were streamlined using a mobile application.ResultsOf 6,055 participating households, 68% reported having one or more of gardens, farms, and animals for various reasons. While only 2% of the households have heard about OH, 97% believed they can get disease from animals, plants or the environment. A latent class analysis with nine risk factors for potential OH issues suggested that 46% of the households were at moderate to high risk for exposure to zoonotic pathogens and environmental contaminants.ConclusionOur findings indicate that there are unaddressed threats to human, animal, and plant health. Given the importance of the interconnections between the health of humans, animals, and plants, further evaluations of the at-risk households would be necessary to mitigate potential shared health threats in the community. Further, our study demonstrates that mHealth technology can provide an opportunity to systematically assess potential one health problems in the rural communities with limited internet connection.