Journal of Asia Pacific Studies ( 2013) Volume 3 No 1, 86-109

________________________________________
Information Delivery in the Provision of
Barangay Health Services in Barangay Dawis,
Digos City, Philippines

Dennis John F. Sumaylo, AB, MDC, Assistant Professor 1, Department

of Humanities, College of Humanities and Social Sciences, University of
the Philippines Mindanao, Davao City, Philippines

Abstract: The main focus of this paper is to narrate, describe, and

evaluate the information delivery in the provision of Barangay Health
Services by observing the practices of the Barangay Health Workers
(BHWs) at the Barangay Health Center in Barangay Dawis, Digos City,
Philippines as a case in point.

Two phases of data gathering were employed in this study. Phase 1

gathered information through interview from 14 BHWs regarding the
various external communication tools they used in delivering information
on various health care programs. In Phase 2, BHWs were evaluated on
how they deliver information as perceived by their clients/patients.
Variables considered in this phase are taken from the Interpersonal
Communication and Counseling Manual of the Department of Health and
HealthPRO. A total of 280 clients/patients were asked to evaluate the
BHWs.

The study revealed the following findings.

Face-to-face interaction is the main method of delivering information

in Barangay Dawis. The 14 BHWs were evaluated using three core
criteria from two fields of communication: speech communication and
health communication as reflected in the manual used by the Department
of Health. Overall, the BHWs were rated good to excellent in all criteria.
BHWs also use other forms of communicating and persuading
clients/patients not necessarily part of the Interpersonal Communication
and Counseling Manual. The use of fear to persuade was even employed
by the BHWs. Also, when speed is a priority, BHWs utilize technology, in
particular text messaging (SMS), in delivering information.

86
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

Furthermore, the top-down flow of information affects the delivery of

health intervention programs. Aside from possible communication
breakdown due to communication noise, this can also be attributed to the
lack of and/or inappropriateness of external communication tools. These
tools include the BHWs as a medium of communication aside from flyers,
leaflets, brochures, and fact sheets distributed to the various Barangay
Health Centers in the City.

Another breakdown lies in the Interpersonal Communication and

Counseling Manual of the Department of Health due to its faulty
assumptions and the lack of focus on Health Communication as
transactional in nature. The manual also failed to consider possible issues
on disclosure in the whole communication process.

Training on the proper use of metaphors, analogies, and its relation to

folk beliefs were not present in the same manual. It is evident that in the
Philippines, specially in the Barrios, health care providers tend to use
metaphors and analogies in disseminating information on health care
intervention programs. Communication breakdown occurs in this level as
well.

Lastly, this paper also explored the need to go beyond traditional

communication channels and go for technology-mediated communication.
The rules and resources within the context of Adaptive Structuration
Theory of Marshall Scott Poole looked at the process of documenting how
the BHWs negotiate communication to successfully disseminate
information on health care intervention programs of the Department of
Health properly.

This case study therefore provides an actual observation data of how

the BHWs in Dawis, Digos City, Philippines use the traditional
communication tools and supplement it with their own way of explaining
health care messages according to their way of understanding it.

1. Introduction

The creation and implementation of the Health

Intervention Programs of the Department of Health (DOH) in
the Philippines goes through a lengthy process. As explained
by Mary Divene C. Hilario, RN, MPH, the officer in charge of
the Health Advocacy and Promotion Unit of the Department
of Health Region XI, the Central Office of DOH, specifically

87
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

the National Center for Health Promotion, calls for a

collaborative national workshop involving representatives
from the Center for Health Development Regional Offices and
consultants. The Central Office usually presents a prototype
of a health intervention program including communication
materials and training modules.

The consultative and collaborative national workshop

aims to further enhance the prototype that might work for
each region. Usually, the prototype is in Filipino or in
English and later on adapted into various local languages.
The prototype in this level is already pre-tested and is
considered effective. Sometimes, the National Center for
Health Promotion reproduces promotion collaterals
(calendars, posters, etc.) by bulk and these are sent out to
various regions as is.

Once translated and reproduced, these materials are now

distributed to various provincial health offices. For Region
XI, it covers 4 provinces (Davao del Sur, Davao del Norte,
Davao Oriental, and Compostela Valley Province) and 1 city
(Davao City). The provincial health offices then distribute
these materials to their respective municipalities and
component cities. The distribution of materials and training
of health care providers are now passed on to the barangay
level – the barangay health centers, through the city health
offices and municipal health offices.

The Barangay Health Centers play a crucial role in the

delivery of health services in the Philippines. Health
intervention programs designed by experts in the
Department of Health are implemented in the grassroots
level by Barangay Health Workers (BHWs). These BHWs are
volunteers trained as frontline health service providers (HSP)
of the government. Each BHW trained in basic interpersonal
communication and counseling, is assigned to a particular
area in the barangay in order to gather data by asking
questions and listening effectively for them to correctly
assess/diagnose the health concerns of patients/clients.
Each BHW is also trained to discuss medically correct health
information in the dialect or in a simple language that is
easy to understand. (Handout to IPC/C Manual for HSP)

88
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

In the interview with Hilario, each participant from the

regional offices in the national workshop is trained how to
implement the health intervention program. The central
office then expects the regional offices to conduct the same
training in their respective regions, in particular, the
provincial health offices. The provincial health offices then
train the city health offices and the municipal health offices
through the midwives assigned in each barangay.

Furthermore, Hilario mentioned that each region,

province, municipality, city and even barangay level can
create their own tools and ways to implement the various
health intervention programs as long as it still follows the
prescribe content. She even mentioned that it does not need
any approval coming from the city health office nor the
regional office.

Given these two structures that tends to compliment each

other, it is appropriate to document how far a BHW follows
and deviates from the prescribe format of implementing
various health prevention programs of the Department of
Health.

2. Methodology
This research documents and assesses the effectiveness
of face-to-face interaction as external communication tool
used by BHWs in implementing health intervention
programs of the Department of Health using survey and
interview as data-gathering tools.

There are two sets of respondents in this study. The first

set of respondents are all Barangay Health Workers of
Barangay Dawis, Digos City because they are the frontliners
in implementing health intervention programs directed
towards the immediate community. The data derived from
the Barangay Health Workers include their opinions,
impressions, and personal judgments on the traditional
communication tools. The data likewise include the
respondents’ other methods of delivering these health
intervention programs since the traditional communication

89
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

tools intended for the BHWs patients/clients are posters,

leaflets, and face-to-face interactions. This study
documented the methods of delivering health intervention
programs adapting the survey questionnaire from WK
Kellogg Foundation designed to document and assess the
public relations communication tools of an organization
(http://ola.wkkf.org/toolkit/assess/, accessed June 2008).

Each respondent is asked to identify and rate the

communication tools directed towards their patient/client on
a 5-point scaling system with 1 as the lowest and 5 as the
highest. The ratings of each respondent are based primarily
on their perception of how useful the communication tool/s
is/are in delivering health care services. The qualitative data
derived herein are from interviews of the respondents.

A total of 14 BHWs were surveyed and interviewed taking

into consideration the whole population of BHWs in the area
of study.

On the other hand, the second set of respondents

comprises the clients/patients. The method of evaluation is
adapted from Paulette Dale and James Wolf’s Speech
Communication Made Simple: A Multicultural Perspective
Second Edition (2000) published by Addison Wesley
Longman, Inc. The BHWs were evaluated on their
Interpersonal Communication and Counseling Skills as
perceived by the clients/patients. The criteria used is based
on the Department of Health’s Interpersonal Communication
and Counseling Manual for Health Service Providers since
the Center for Health Development Regional Office uses this
manual to train BHWs in communicating with their
patients/clients. Random sampling was employed and a total
of 280 households were surveyed out of 899 households
roughly comprising 31% of the total number of population.

All quantitative data from both sets of respondents were

organized according to ordinal scaling and further subjected
to computation for mean, frequency, and percentage.

Furthermore, this study is further delimited to the

following:

90
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

• Significant others are not included in the

elements observed because this study focuses on the
health care provider and client
transaction/interaction. The significant others of the
patient/client, may it be parents, husband/wife,
children, may greatly affect the transaction/interaction
between the health care provider and the
patient/client.
• Other non-verbal communication cues such as
haptics, chronemics and proxemics are not
considered.
• In terms of context/setting, only the house of
the client and the Barangay are considered.
• The ratings/evaluations/assessments indicated
in this study are non-parametric since all judgments
presented herein are in the form of qualitative
responses and are mostly based on the respondents’
perceptions and self-judgments.
• Therefore, this study is limited in documenting
the communication flow in delivering health care
services and how the tools used in delivering these
services are effective as perceived by the BHWs as
frontliners of the DOH.

3. Results of the Study

Area of Study

Barangay Dawis is called Lawis by the IP (Indigenous

People) group Calagan which means a body of water that has
no outlet. It has a total land area of 175 hectares divided
into residential and commercial lots. The Barangay is divided
into nine puroks with 899 households each. As of 2007, the
total population of the Barangay is 3,884.

The first inhabitants of the Barangay are the Calagans

but Dawis, as it progressed into a commercial area with
beach resorts and apartelles as major businesses, became a
melting pot of several other local cultures which resulted to
its having several dialects (B’laan, Tagakaulo, Bagobo,
Muslim, Cebuano, Bol-anon, etc ) spoken in the area.

91
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

In terms of budget, the barangay has an IRA of Php

1,109,784.00. It also receives Php 1,000,000.00 as aid from
the City Mayor. A total of Php 100,000.00 also comes from
the Real Property Tax and other Miscellaneous Income
(Community Tax Certificate, Barangay Clearance etc.).

Currently, the barangay has 899 households divided into

nine puroks. Each purok has several households as follows:

INSERT Table 1: Number of Household per Purok in Barangay Dawis,

Digos City

A total of fourteen (14) barangay health workers service

the total number of households. These Fourteen BHWs were
assigned to the following areas/purok as follows:
INSERT Table 2: Number of BHWs per Area Ratio

Also, the following schedule is implemented by the

Barangay Health Center.
INSERT Table 3: Weekly Schedule of the Barangay Health Center in
Dawis, Digos City

Other programs include, a once-a-month weighing

activity held for children 0 – 23 months old and a bi-annual
weighing activity for 0 – 71 months old children. Other
services include giving of Vitamin A twice a year, free anti-
rabies injection once a year, giving of medicine for philariasis
once a year, ligation twice a year and several medical
missions either headed by the City Health Office or the
Provincial Health Office.

Each BHW informs her/his clients/patients about the

schedule during their house-to-house visit. Each
client/patient is informed and educated about the
importance of these consultations at these schedules since
information dissemination and health education is done
during these days at the Barangay Health Center. If the
client/patient is not able to go to the barangay health center,
the BHWs bring with them the medicines and distribute
these house-to-house.

92
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

Also, clients/patients are informed about the various

programs and schedules once they visit the Barangay Health
Center.

Aside from being frontliners for Health Intervention

Programs of the DOH, BHWs are also expected to do
environmental scanning of their assigned area using the
Community Based Information Sheet provided by the City
Health Office. Each of them is also trained to perform this
task.

Given this scenario, face-to-face interaction is the main

method of BHWs in delivering information to their respective
patient/client.

This study also assesses the external communication

tools used by the Barangay Health Center in fulfilling its
mandate that is to act as frontliners in providing health care
services to and monitoring of the client/patient of the
Barangay Health Centre or simply the residents of the
Barangay. External communication tools are communication
tools directed towards the clients/patients. These are
posters, streamers, leaflets, one-on-interaction, direct mail,
website, and more, produced by either the DOH Central
Office or the City Health Office.

The Barangay Health Centre, working directly under the

supervision of the City Health Office that is also under the
Department of Health, offers services like monitoring,
vaccination, pre-natal check-up, medicine disbursement,
and referral to doctors.
INSERT Table 4: External Communication Tools used in Dawis, Digos
City

For the BHWs to implement these programs, external

communication tools are utilized. These include flyers,
leaflets, posters, brochures, fact sheets, PSAs, and Face-to-
Face Interactions. Posters are least used because the
Barangay Health Workers do not bring these posters as they
visit households in their area. One major reason is lack of
copies. Even if the BHWs are trained in using printed IEC
materials in spreading medically correct information, the

93
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

lack of materials is the main problem. With this, face-to-face

interaction is the most commonly used method in dealing
with the external public.

Among the external communication tools enumerated,

only two external communication tools are identified as the
most effective tools in relaying information to the external
public – PSAs and Face-to-Face interactions.

Hilario also mentioned that each unit, may it be province,

municipality, city, or barangay, is allowed to come up with
communication tools to implement various health
intervention programs without the approval of the regional
office nor the city health office as long as each barangay
health center follows the prescribe content and format of the
central office. In Dawis, they do not produce/design their
own communication tools so they intend to rely on the tools
in which they have full control of – face-to-face interaction.

Since face-to-face interaction is considered most effective,

it means that all useful information intended for the
client/patient is handed down through small group
discussions and one-on-one interactions making the
Barangay Health Workers the responsible authorities in
producing their own external communication tool. Another
tool widely used by the BHWs is text messaging.

The Barangay Health Workers were also asked to identify

the external communication tools they consider as important
and if they need more skills in producing these tools.

These include public service announcements, community

meetings, one-on-one interaction, and designing/writing
semi-annual/annual reports. The rest of the popular
communication tools like campaigns in print and new media
were considered less important.

It should also be noted that although the semi-

annual/annual report is classified for both internal and
external publics in the field of public relations, the
respondents perceive this as an internal communication tool
only.

94
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

This study also aims to know if the currently used

external communication tool is effective in relaying
information. This way, the authority concerned will develop a
method of improving the identified tool for patient/client.
There is emphasis in external communication tools because
the nature of the organization is service-centered.

The evaluated external communication tool is face-to-face

interaction since it was identified as the most commonly
used tool. This means that the Barangay Health Workers
were evaluated as a medium of communication. They were
evaluated using three core criteria in the context of speech
and health communication. Under health communication,
four health care variables are examined. These are empathy,
trust, self-disclosure, and confirmation. On the other hand
speech communication evaluates the delivery, content, and
handling of message.
INSERT Table 5: Over-all Evaluation of BHWs as Medium of
Communication

Table 5 shows that the over-all evaluation of the

Barangay Health Workers as a medium of communication is
Good. It means that face-to-face interaction is a good tool in
delivering information to the clients/patients. The Barangay
Health Workers are able to persuade the clients/patients to
go to the Barangay Health Centre to avail of the programs
and services that they offer. It also means that the Barangay
Health Workers have enough knowledge on the subject
matter. Furthermore, the external public communicates
openly with the Barangay Health Workers because they are
trustworthy. In terms of delivery, the Barangay Health
Workers are good speakers based on the high average results
in the different variables under delivery.

For individual analysis, each Barangay Health Worker

was given an assigned number according to their
questionnaire.
1 - Esterlita Candia
2 - Shirly Aballe
3 - Corazon Alcala
4 - Emma Navaja
5 - Linda Capuso

95
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

6 - Cerila Empic
7 - Nelda Francisco
8 - Ma. Concepcion Hyde Luang
9 - Norma Bolon
10 - Leonila Gelves
11 - Julita Labor
12 - Luzvisminda Llagas
13 - Feliciana Navaja
14 - Nerry Bocoya

INSERT Table 6: Individual Analysis of Respondents in Delivery,

Health Care Variables, and Content

4. Discussion
The flow of communication in the grass root
implementation of health intervention programs is discussed
under three subheadings: The Flow of Information,
Supplementary Communication Tools, and Transactional
Communication Model and Issues on Disclosure.

The Flow of Information

As described, the Barangay Health Center works under

the supervision of the City Health Office. All communication
materials for clients/patients are from this agency making
the flow of information top-down flow.

On the other hand, the top-down flow of information

affects the delivery of health intervention programs. Aside
from possible communication breakdown due to noise, this
can also be attributed to the lack of external communication
tools like flyers, leaflets, brochures, and fact sheets
distributed to the various Barangay Health Centers in the
City and the lack of capacity for each center to produce its
own materials. That is the reason why Barangay Health
Workers rely on face-to-face interaction only, supported with
printed communication materials of which they are also
trained in using. These printed materials come from the
Department of Health Central Office and are given to the City
Health Office through several channels. Since most ofthe
materials follow a generic content, these may not help in the

96
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

process of implementing various health intervention

programs. The communication tools used by the Barangay
Health Workers should be tailor fitted to the needs of each
Barangay.

Hilario also said that there are instances that the regional
office translates a material from the central office to Bisaya
but this action also depends on the capacity of the region,
the municipality, and the city to reproduce this material that
can be perused by all barangays. She even mentioned that
sometimes the Center for Health Development Regional
Office produces just one copy of a translated material that is
used, not in the barangay lectures, but in schools.

Furthermore, since the top-down flow of information

affects the delivery of health intervention programs, it can
also affect the delivery of such program at the barangay level
because all kinds of information coming from the City Health
Office are handed down to the midwife assigned in the
Barangay. The midwife then passes the information to the
Barangay Health Workers. Since the BHWs rely on face-to-
face interaction, they only pass on what is handed down to
them by the midwife. This flow of information is affected if
the information coming from the City Health Office is not
properly passed on to the midwife. This indicates that the
top-down flow of information affects the effectiveness of the
external communication tools identified in this study.

Health Care Variables (empathy, trust, self-disclosure,

confirmation, and control) are also affected by face-to-face
interaction. All Barangay Health Workers are residents of
Barangay Dawis and each of them is assigned in a specific
area. It is not a pre-requisite that if they serve the purokthey
live in. Instead, each purok is assessed in terms of its health
care needs.

Since Barangay Dawis is a small barangay with 899

households, it is not impossible to know everyone in the
area. If a Barangay Health Worker is assigned in an area
where she is known, empathy, trust, and self-disclosure can
easily be achieved. Confirmation and control are established
after the three health care variables are present.

97
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

Furthermore, familiarity of the residents with the Barangay

Health Worker is important in building the HSP-
client/patient relationship.

It is good to note that the BHWs, due to lack of printed

communication materials, also rely on text messaging as
alternative communication tool to disseminate information
on various health intervention programs. Given the fact that
there are a few printed materials available for dessimination
and since most of them are not trained to produce their own
communication materials, barangay health workers devised
a way for them to communicate with each other to keep
them posted of the activities of the barangay and of the
clients/patients in their assigned area of responsibility.

There are several reasons why members of an

organization find various ways to communicate with their
publics. According to Marshall Scott Poole’s Adaptive
Structuration Theory, “members in groups are creating the
group as they act within it.” This shows that if there were
gaps within the process of fulfilling the mandate of the
Barangay Health Centre, BHWs would look for solutions, not
necessarily mandated by their superior, to fill the gaps in the
communication process. They continuously monitor their
areas by all means necessary.

This would further lead to the use of rules and resources

within the context of Adaptive Structuration Theory. Rules
are defined as “propositions that indicate how something
ought to be done or what is good or bad.” (Griffin, 2006) The
basic trainings BHWs get from the City Health Office on how
to handle clients/patients are considered rules in this
context. These are sets of theories and how-to-instructions
in order for them to reach their goal – to provide medical
intervention. Resources, on the other hand, are “materials,
possessions or attributes that can be used to influence or
control the actions of the group or its members.” (Griffin,
2006.) Relationships and expertise on the subject matter,
two of the variables the BHWs are evaluated upon, are
considered resources. Since they could not bring printed
materials during their home visits due to lack of copies and
costly production of their own communication tools, they

98
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

need to improvise. This improvisation – the use ofan

alternative communication tool, is based on their
relationship with the people in their assigned area. Since
they received trainings from the City Health Office, they are
considered the person-in-authority when it comes to health
concerns making them sort of “experts” in medical
intervention. This also proves Poole’s claim as cited in Griffin
(2006) that “group structures can constrain members from
acting freely” making improvisation inevitable. The lack of
training in business communication and the inductive
method of processing group interactions resulted to
improvisation in the part of the BHW.

There are several reasons why they need to go beyond

traditional communication channels and go for technology-
mediated communication. To address the needs of their
external publics, BHWs identified the following needs:

Training in culturally-rooted face-to-face

interaction;

Training in public speaking;

Training in Environmental Scanning;

Training in processing group interactions;

Training in Message Development; and

Training in Event Planning.

With these needs identified, it is clear that there are a lot

of things to be done for the BHWs to be well equipped with
knowledge and skills in the field. But to provide all these
trainings to all BHWs would be expensive. There is also a
need to factor-in the fact that being a BHW is voluntary and
in Dawis, the BHWs are sometimes co-terminus with a
government official. They can only keep their post for at most
3 years. Given this fast turnover of volunteers, it would be
very expensive to repeat the same training every 3 years.

Since not everyone has the skill to design communication

tools intended for their clients/patients, they resort to the

99
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

simplest and fastest way to communicate with each other –

text messaging.

Supplementary Communication Tools

All BHWs rely on text messaging to inform their

clients/patients in their respective areas of responsibility
about the various health intervention programs of the
Barangay Health Center.

According to Nelda Francisco, one of the BHW

respondents, text messaging makes their work easier and it
makes transmitting information faster. Linda Capuso also
points out that the only problem they encounter with this
tool is lack of prepaid credit. But with the unlimited text and
call promo of telecom companies, this tool will be less
expensive compared to printing posters and the use of other
traditional media. Other than that, face-to-face interaction is
still the medium used in delivering information and
instruction to the clients/patients of their assigned area.

It is also good to note that the BHWs get the cell phone
number of a representative from each household. This way,
it will be easy for the BHWs to inform the residents of their
assigned area of any activity of the barangay health centre
reducing the physical cost of the BHW.
The health care providers also acknowledge the fact that
posters are not enough to communicate health messages.
When speed is priority, BHWs resort to technology.

Transactional Communication Process and Issues on

Disclosure

In accordance to the goal of the Department of Health to

adopt Behavior Change Communication (BCC) as one of its
main approaches in addressing a particular health issue, the
IPC/C Manual highlights the need for a transactional form of
communication – a give-and-take scenario. Although it is
evident in the result of the study that this has always been
the objective, it is only recently that “the government tried to
adopt a more systematic and more deliberate approach to
equip health service providers facilitate and support behavior

100
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

change in their patients/clients.” (Handout to IPC/C Manual

for HSP)

INSERT Image 1: Transactional Model of Communication

It is deemed important that the health care providers be

trained in alternative ways of delivering health intervention
programs to their clients/patients. However, there is a
problem in terms of level of disclosure of client/patient to
BHW.

The reason why people do not disclose is the same reason

why BHWs are/should be residents of the barangay they
serve. If clients/patients have difficulty disclosing to their
doctors, how much more to a BHW who is no stranger to
them?

As Parrott said, disclosing, and even simply talking about

health, “defines our self.” It builds an identity and somehow
“connects to our self-concept.” These “identities form not just
around our health status but also around those who work in
health care and places where care is given.” (Parrott, 2009)

For instance, the family planning program, which involves

selling of contraceptives like pills and the dissemination of
information about various family planning methods through
lectures in the barangay health centers and house visits,
may have helped educate couples. But there are some who
ends up getting pregnant despite educating them about
family planning methods. These women, who diligently
attend the lectures, would not easily disclose to the BHW of
their pregnancy for fear of judgment which will end up to an
untimely announcement of their pregnancy through
grapevine dissemination.

This scenario happened to Nelda Francisco. As BHW, her

task also includes monitoring of those couples identified to
have used a method of family planning. If this couple would
not inform the BHW, one problem of non-disclosure would
be exclusion to some health care services of the barangay
health center intended for pregnant women just because
nobody knew.

101
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

There are two possible focal points where communication

breakdown are seen: 1) the IPC/C Training Manual; and 2)
promoting (mis)understanding in communicating about
health concerns.

The IPC/C Training Manual

According to Hilario, the IPC/C Training for HSPs is

generic in nature. She also said that each health care
program training include how to effectively communicate
with clients/patients. The primary concern is to deliver a
correct health care education program. The manual also
works on the assumption that since a BHW is a resident of
the barangay, clients/patients would easily disclose to them.

Emma Navaja also mentioned that they were trained both

in verbal and non-verbal communication which includes eye
contact, facial expressions and gestures, and even
highlighting physical appearance.

In fact, after carefully studying the manual, it provides a

complete guide on how to conduct oneself as a BHW. The
only setback in the manual is downplaying health
communication as transactional communication. It focused
only on the sender of the message adhering to a linear type
of communication. This in turn results to BHWs devising
ways to get accurate responses from their clients/patients.
There should be a part in the manual that trains the BHWs
in understanding their clients/patients.

Tomas Andres (1988) said that to be a community

trainer/facilitator/leader, one should go beyond information
giving and data gathering. It should also include problem-
identification and analysis, as well as interaction with the
community.

With the current IPC/C Manual, it only educates BHWs

around information giving and data gathering. Therefore,
problem-identification and analysis, and identifying
solutions only revolve around information giving and data
gathering.

102
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

In fact, text messaging as a solution to information giving

and sometimes data gathering is not part of the manual even
if DOH-Central Office is aware of this. It is the initiative of
BHWs to use this method for them to fulfill their duties and
responsibilities.

As an additional tool to the traditional print and face-to-

face interaction, there is now a need to develop a training on
crafting brief messages like text messaging.

In the context of compliance, BHWs use reward and

punishment system to elicit action from their
clients/patients. As Nelda Franscisco puts it, “usahay
hadlukon namo sila para lang muadto sa center.” (Trans.
Sometimes we scare them just so they visit the (Barangay
Health) Center.)

Scaring them means not including them in the future

programs of the Barangay Health Center. This strategy is
definitely not in the IPC/C Manual and even Business
Communication Manuals. In business communication, the
“YOU” attitude should be observed in crafting messages.
(Bovee, 2010)

It is then evident that BHWs suffer from emotional labor

since their roles often change in the community. At on point
they are concerned and caring HSPs, on the other, they are
strict headmistresses imposing rules and giving
punishments to those who disobey. Although most often they
follow the IPC/C standards in dealing with client/patient,
sometimes they deviate from the SOP and instead use
reward and punishment system.

The closest the manual can provide to understanding

client/patient is defining what motivation is and identifying
the barriers to behavioral improvements. Aside from role-
playing during the training as an application of the various
phrases to “motivate” client/patient, BHWs have no other
trainings in motivating adults.

Andres (1988) discussed a method of understanding the

Filipino community. The BHWs should be trained in

103
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

understanding the Filipino, his sources of values and his

role and understanding of development. Afterwhich, a more
specific method of motivating should be designed by the
DOH Central Office patterned after the Adult Learning Cycle
as discussed by Ortigas (2008) in Group Process and the
Inductive Method.

Promoting (Mis)Understanding in Communicating about

Health Concerns (Parrott, 2009)

This aspect of communicating health concerns is coined

by Parrott (2009) to explain another area of possible
communication breakdown.

According to Parrott (2009), “our ability to understand

sumptoms, give informed consent, and make informed
decisions about health come from communicating about
health.” There is communication breakdown if the HSP and
the client/patient do not understand each other specially if
the HSP uses medical jargons.

Doctors usually rely on metaphors and analogies in

explaining health issues to clients/patients. Juan Flavier
(2002) even documented the various metaphors and
analogies he used in educating rural folks on family
planning.

The communication breakdown happens when the

metaphor and/or analogy does not work. Oftentimes, an
analogy and/or metaphor only works if there is enough
common field of experience between sender and receiver of
the message as illustrated in the transactional model of
communication.

Sometimes, folk beliefs interfere with new medicine. With

Barangay Dawis, this should also be taken into
consideration since the barangay has become a melting pot
of various cultures and traditions and beliefs. This is true
with other barangays in the country. Health communication
is not just transactional it becomes intercultural as well.

104
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

Geist-Martin, Ray, and Shart as cited in Angelelli and

Geist-Martin (2005) clearly emphasized that “the differences
in health care beliefs and practices of persons seeking and
providing health care can lead to problems in
communication with one another.”

5. Implications

The changing health communication landscape tells us

that with the improvement of technology, newer and better
tools are used to relay information to elicit action. As cited in
Speaking of Health: Assessing Health Communication for
Diverse Population published by the Institute of Medicine of
the National Academies (2002), various “innovative uses of
current technologies”now includes Tailored Print
Communication, Telephone Delivery Interventions, and
Interactive Health Communication.

These forms of communication also change with the

constant improvement of the medium itself i.e. smartphones.
However, despite improvements in the way we communicate,
face-to-face interactions between HSPs and clients/patients
us still necessary.

Also, various efforts to use other communication tools in

delivering health care services have been documented as well
– the Leprosy Intervention Project in Nepal, HIV/STDs
Intervention in Vanuatu, and Health Information Drive in
Nigeria – all uses Theater in delivering health care
information. The debate now situates on the issue on which
communication tool best transmit information and elicit
action from the clients. (Dagron, 2001)

Moreover, several studies conducted already proved that

the traditional communication tools – posters, flyers, etc.,
are not always enough in transmitting information and
eliciting action. Combining these media alternatives with the
traditional communication medium will help in information
dissemination and health education activities of the
barangay health centers in the country.

105
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

Also, knowledge of folk healing practices is important in

designing a targeted communication tool for health
education. (Geist, 2000) This way, the provider will be able to
communicate to their clientele with empathy, sensitivity, and
open-mindedness.

If these elements in face-to-face communication are

perfected, patients will be more open to the various health
intervention programs provided by the barangay health
workers.

Overall, text messaging is best used to inform and

instruct compared to other traditional tools used to
communicate within the describe communication scenario.
But despite the use of a fast and convenient way to inform
and instruct, problems are still encountered.
Clients/Patients and even Barangay Health Workers still
consider the information less formal which makes it easy for
them not to act on it. A good example would be coming in
late for a meeting of BHWs just because they were informed
via text message.

However, the informality of text messaging perceived by

the clients/patientsmay not always apply because the BHWs
also use face-to-face interaction to reinforce text messaging
as text messaging reinforce face-to-face interaction. Yet
heads of families, wives, and children have their own
personal reasons not to attend regular check-ups and
vaccinations done in the health centre. They may have
received a text message from their assigned BHW yet it is up
to them to act on the information.

This will bring into focus the issues of stability and

change of the alternative media used. There is now the
question of how stable and reliable text messaging and face-
to-face interaction are as communication tools. There is also
a need to accept the inevitable change that someday, text
messaging, and perhaps face-to-face interaction, will be
replaced with another tool that will make information
dissemination easier, faster, and more convenient for both
parties involved in the communication process.

106
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

The BHWs can be trained in IPC/C but it is still up to the

BHW to come up with a mix of strategic communication
interventions to make the health intervention programs of
the government more accessible. May it be the use of
technology like smartphones or using reward and
punishment as strategy to mobilize the community, the
BHWs ultimate goal is to deliver these health intervention
programs to the people they serve.

Afterall, in health communication, the ultimate goal is

behavioral impact. For someone to act on something, that
person needs the following: correct information, education,
persuasion, community involvement, advocacies, mobilized
society, and a committed government, all applied to health
behaviors. (Handout to IPC/C Manual for HSP)

Bibliography:
Books

Andres, Tomas Quintin D. (1988). Community Development:

A Manual. New Day Publishers, Quezon City, Philippines.
Angelelli, Claudia V. and Patricia Geist-Martin. (2005).
“Enhancing Culturally Competent Health
Communication: Constructing Understanding Between
Providers and Culturally Diverse Patients.” Pp271-283.
In: Ray, Eileen Berlin. Health Communication in Practice:
A Case Study Approach. Lawrence Erlbaum Associates,
Inc., New Jersey.
Apker, Julie. (2005). “Role Negotiation, Stress and Burnout: A
Day in the Life of Supernurse.” Pp245-260. In: Ray, Eileen
Berlin. Health Communication in Practice: A Case Study
Approach. Lawrence Erlbaum Associates, Inc., New
Jersey.
Barangay Primer. Republic of the Philippines.
Baskin, Otis, Aronoff, Craig, and Dan Lattimore. (1997).
Public Relations: The Profession and the Practice. Brown &
Benchmark Publishers, Dubuque, IA.
City Primer. Republic of the Philippines.

107
Information Delivery in the Provision of Barangay Health Services in Barangay
Dawis, Digos City, Philippines

Dale, Paulette and James Wolf (2000). Speech

Communication Made Simple: A Multicultural Perspective
(2nd ed.) Addison Wesley Longman, Inc.
Dagron, Alfonso Gumucio. (2001) Making Waves: Stories of
Participatory Communication for Social Change. The
Rockefeller Foundation, New York.
Flavier, Juan M. (1974). My Friends in the Barrios. New Day
Publishers, Quezon City, Philippines.
Geist, Patricia. (2000). “Communicating Health and
Understanding in the Borderlines of Co-Cultures.”
Pp341-354. In: A. Samovar and R.E. Porter.
Intercultural Communication: A Reader.
Wadsworth Publishing Company, Belmont, CA.
Griffin, Em. (2006). A First Look at Communication Theory
(6th ed.). McGraw Hill, Boston, MA.
Lesley, Philip. (1998). Lesley’s Handbook of Public Relations
and Communications. NTC Business Books.
Littlejohn, Stephen W., & Karen A. Foss. (2005). Theories of
human communication (8th ed.). Thomson Wadsworth.
Local Government Code of 1991. Republic of the Philippines.
National Academy of Sciences. (2002). “New Communication
Applications and Technologies and Diverse Populations.”
Pp179-223. In: Institute of Medicine of the National
Academies. Speaking of Health: Assessing Health
Communication Strategies for Diverse Populations. The
National Academies Press, Washington, DC.
________________________. (2002). “Health Communication
Campaigns Exemplar.” Pp76-126. In: Institute of Medicine
of the National Academies. Speaking of Health: Assessing
Health Communication Strategies for Diverse
Populations. The National Academies Press, Washington,
DC.
Ortigas, Carmela D. (2008). Group Process and the Inductive
Method: Theory and Practice in the Philippines. Third
Edition. Ateneo de Manila University Press, Quezon City,
Philippines.
Parrott, Roxanne. (2009). Talking About Health: Why
Communication Matters. Wiley – Blackwell, UK.
Manuals
Department of Health and HealthPRO. (2012) Interpersonal
Communication and Counselling Manual for Health
Service Providers.

108
 Dennis John F. Sumaylo, AB, MDC, University of the Philippines Mindanao,
Davao City, Philippines

Online Sources

McNamara, Carter. (2007) Thinking About Organizations as

Systems. Retrieved June 22, 2008.
_______________. (2007) Basic Definition of Organization.
Retrieved June 22, 2008.
_______________. Communications Toolkit. Retrieved June 13,
2008. [On-line] Available from:
http://ola.wkkf.org/toolkit/assess/.

109