lost in the milieu: a study on the nature of neglect of

Lost in The Milieu | 1

LOST IN THE MILIEU:

A Study on the Nature of Neglect of the Local Government on the Cases of

Neglected Tropical Diseases (NTDs) in Juban, Sorsogon

Christine Joy F. Angat

ABSTRACT

This study is a descriptive, cross-sectional research on the nature of neglect of the

local government of Juban, Sorsogon on the cases of neglected tropical diseases

(NTDs). NTDs are a subset of infectious diseases which affects the poorest

population and are neglected due to their marginalization in health priority vis-à-

vis the focus given to HIV/AIDS, tuberculosis and malaria. Using the political

economy of health framework, the research aims to know the forms of neglect and

the perception and experiences of the residents of Juban in dealing with the NTDs.

Data used in the research were gathered through key interviews, survey and

secondary data. The results yielded in the study showed that the government had

concentrated on curing the disease rather than incorporating control and prevention

measures. The people perceived the said neglect from moderate to strong neglect.

The prevalence of the disease was found to have a strong link to development and

poverty. The study concluded that the lack of infrastructure and manpower, in

addition to the lack of access of the residents to information and treatments, is one

of the many factors why these diseases are coined to be neglected, furthermore re-

emerging. Health and illness is not just in the biomedical lens, but also lies in the

social realities experienced by the people. Addressing the illness through cure is

not enough; prevention and care is also warranted.

.Keywords: Neglected Tropical Diseases; NTD; Local Government; poverty; Juban, Sorsogon;

Politics of Health

Introduction

Health and diseases will never be isolated from the plights of the society. According to

Castillo (2004), health and illness are, in nature, both social and biological (p.1). These two

concepts will always be connected to the societal and political impressions such as poverty,

inequality, policy formulation, project implementation, governance, and globalization. Thus,

understanding them in both social and biomedical lens open wider opportunities for scrutinizing

the various factors in their dynamics and complexity.


The emergence of the so-called neglected tropical diseases (NTDs) as a health priority in

the global and local scale posed a societal problem yet to be addressed. The NTDs, which was

first recognized as part of the “other diseases” in the Millennium Development Goals (MDGs), is

a list of tropical infections that were “neglected” by the national governments and global health

institutions despite their significant health and socioeconomic effects. According to Hotez

(2008), the flurry of global health advocacy and resource mobilization to satisfy MDG Goal 4

(reduce mortality rates), Goal 5 (improve maternal health) and Goal 6 (combat HIV/AIDS,

malaria and other diseases) largely bypassed the “other diseases” component of the MDGs (p.3).

Globally, the World Health Organization (WHO) stated that there are 17 ailments

declared to be neglected, namely dengue, rabies, trachoma, buruli ulcer, endemic

treponematoses, leprosy, chagas disease, human African trypanosomiasis (sleeping sickness),

leishmaniases, teaniasis/cysticercosis, dracunculiasis (guianea-worm disease), echinococcosis,

foodborne trematodiases, lymphatic filariasis, onchocerciasis (river blindness), schistosomiasis,

and soil-transmitted helminthiases (World Health Organization, 2010: p. iv).

However, due to differences in geography among, as well as funding in, states, not all of

these diseases may be considered neglected in a particular country. In the Philippines, only six

are considered to be neglected, namely schistosomiasis, leprosy, filariasis, rabies, soil-

transmitted helminthiases, and food and water-borne diseases (Department of Health, 2013;

Samaniego, 2012). Dengue is not considered neglected due to the prioritization it receives while

the remaining diseases that were considered globally endemic do not exist in the country.

In the Philippines, the province of Sorsogon is considered as one of the poorest provinces

in the country and is a converging point of NTDs, with four overlapping diseases (Department of

Health, 2013). Consequently, data culled from the the Provincial Planning and Development

Office and Provincial Health Office states that NTDs such as schistosomiasis, soil-transmitted

helminths, filariasis and intestinal helminths prevail in Juban and Irosin, two municipalities

where the Cadac-an river flows.

Given the name “Neglected Tropical Diseases” and the remark that these diseases do not

receive considerable attention, the study on the efficacy of the local government in light with the

NTDs is worth noting. While the NTDs may not come as the most lethal of all the diseases, their

presence and morbidity warrants attention. Hence, we ask, what is the current nature of neglect

exhibited by the local government on the cases of Neglected Tropical Diseases in Juban,

Sorsogon? This study investigates the nature of neglect, as well as the community’s perception

and experiences on such neglect. The success of this study would benefit health and social

science researchers and the community itself. The research study would also help students who

will conduct studies on health social science research and public administration.


Framework and Methodology

The study of neglected tropical diseases should not be confined in the laboratory. Rather,

it should also look into the role of the government and other institutions that are considered

stakeholders in the said discourse. The politics of health looks into the struggle of the people, as

well as the dynamics of their interaction with the government and society as a whole.

Using the Political Economy of Health framework, the aspects of community life

neglected by the local government in the context of NTDs can be investigated. The Political

Economy of Health theoretical framework “provides a valuable context in which to consider the

economic and political determinants of health” (Stephens, 2007: p.9). In the definition of

political economy provided by Minkler et.al, he combines the political, economic, and social

context to determine how and health and illness are defined, treated, and managed (as cited in

Stephens, 2007: p.10; Morgan, 1987: p.132). Factors such as gender, class, and education are

scrutinized to impact the illness’ morbidity to social life, as well as examine how these factors

affect the illness as well.

The research is under the assumption that it is the duty of the government to provide for

and respond to the needs of its citizens. With the phenomena of Neglected Tropical Diseases

endemic in the municipality, it is up to the local government, with the help of other institutions,

to act on such. However, neglect starts when the local government fails to uphold its mandate of

providing the healthcare that the NTD patients need.


Figure 1. Paradigm of the Study.

The research is in a descriptive, cross sectional design in Juban, Sorsogon where the data

were gathered using Key Expert Interviews (KEI) from the bureaucracy and research field, Key

Informant Interviews (KII) from the local government and non-governmental organizations

(NGOs) on health, survey, and narratives. The key expert interviewees are Dr. Mario Jiz from

the Research Institute for Tropical Medicine (RITM), Ms. Paolo Camille Baladjay of the World

Health Organization (WHO), and Ms. Liezl Fernandez of Department of Health. Meanwhile, key

informant interviews were Mr. Teodoro Manduriao and Ms. Lilian Aninipot of Sorsogon’s

Provincial Health Office (PHO), Dr. Genevie Reyes of Health Alliance for Democracy (HEAD),

and Katarina Ann Riversa of Community Health and Development (CHD).

Meanwhile, the survey was administered in three identified barangays in the municipality

of Juban, namely, Brgy. Guruyan, Brgy. Buraburan, and Brgy. Bacolod. Using the Lynch

formula at 90 percent reliability, a total of 172 respondents participated in the survey. The survey

was done through systematic random sampling using a geospatial map.

Secondary bibliographical data were gathered from the published and released researches

of the Department of Health, World Health Organization, National Institute for Health,

BioMedCentral, United Nations, and other research firms. Likewise, secondary data were also

obtained from the Department of Health, Department of Budget and Management, National


Statistics Coordination Board, and the local government units of the province and municipality

being studied.

Results and Discussion

Contextualizing the Neglect

It is a recognized function of the government, as part of its mandate, to provide for its

citizens. The needs of the citizens are not just material endowments but their rights as human

beings and as citizens of the state. This mandate has been realized in several local and international

declarations and conferences, such as the 1978 Alma Ata Declaration and the 1987 Philippine

Constitution.

Various literature had proven that the Neglected Tropical Diseases is a fairly new group

of illnesses coined to generalize the “other diseases” component bypassed due to the

prioritization of the big three (HIV/AIDS, Malaria, and Tuberculosis), as reflected in the Goal 6

of the Millenium Development Goals. Likewise, the general explanation for the use of the term

“neglect” is because the said diseases are not prioritized in health programs and are recipients of

low budget. However, there is power in words and meanings. While the term “neglect” may

illustrate why it is neglected, it also puts forward the advocacy of catching attention. According

to the interviewed representative of the World Health Organization (WHO) Philippine office, the

term “neglected tropical diseases” connotes that these diseases are not simply overlooked, but

that they warrant attention:

“And, I think, based on the forum kasi, noong nagkaroon sila ng press conference,

may isang nagsabi doon na kaya siya ti-nerm as neglected tropical diseases is to

gather attention. Bakit siya neglected? Kasi available naman yung treatment and

tools, pero bakit hindi pinapansin ng communities? Something like that. So,

treatable siya pero hindi siya napapansin kaya tinatawag siya na neglected (And,

I think, based on the forum, when they held a press conference, someone said that

these diseases were termed as neglected tropical diseases in order to catch attention.

Why are they neglected? Because the treatment is available, however the

communities ignore them. They are treatable, but for some reason, they do not

receive attention).”

This was supported by Kariuki (2011) when he wrote, “The choice of the word ‘neglect’

is pointed and loaded, forcing us to reflect on our social obligation. Inherent in this campaign

strategy is an appeal for the recognition of human suffering and the need for social justice.”


In this sense, Kariuki posits that the use of the said term transcends soliciting attention and

cure, but it also puts forward the population, the people affected by the diseases. More than a

priority in the public health agenda, NTDs is also a social phenomenon as it is about the people

who are silently suffering, are disregarded and overlooked by the society and the government, and

who are marginalized and disempowered. According to Feasey (2010), instead of characterizing

the NTDs as tropical diseases, they should be regarded as the diseases of the “bottom billion”–the

poorest one-sixth of the world’s population.

The Issue of Education, Access, and Diagnostics

The national government and the local government of Juban had recognized the NTD

phenomenon and had launched programs to control and eliminate such diseases, from detecting

the diseases up to curing them. For instance, for the elimination leprosy, the government programs

of the local government include case finding, contact tracing, and Kilatis Kutis; in rabies

elimination, programs include strict reinforcement or ordinances, regular dog vaccination

campaign, and provision of pre- and post- exposure; filarial elimination services include door to

door and foxed site mass drug administration, rapid assessment coverage, tapping of donors for

surgical intervention, home based morbidity control, and entomology; schistosomiasis control,

case finding and treatment, malacological studies, conversion of identifies vector breeding areas,

provision of potable water supply, provision of toilet facilities, and mass drug asministration; and

soil transmitted helminths is garantisadong pambata (Municipal Health Office, 2010).

However, judging from the list of programs of the Municipal Health Office (MHO), there

is lack of education and information drives to further learn the epidemiology of the disease. This

is also reflected in the results of the survey, where almost half of the respondents stated that there

were no information dissemination campaigns about the NTDs.

Figure 2. Perception of the Residents on the Health Promotion in Juban, Sorsogon


However, according to the LGU, they have constantly distributed materials such as flyers

and comics so the residents can learn about the said diseases. They blame the residents for their

non-compliance despite the information handed to them. Another set of questions in the survey

also showed that majority of the respondents are familiar on the diseases included in the NTDs.

Table 2. Familiarity on the NTDs among the Respondents

Know Quite

Familiar

Not Familiar Total

Schistosomiasis (Schisto) 160 10 2 172

Leprosy (Ketong) 65 76 31 172

Filariasis (Buyong) 81 71 20 172

Rabies 110 53 9 172

STH (Aluluntian) 107 56 9 172

Food and Waterborne

Diseases (bulati)

84 57 31 172

The contradiction between the response of the LGU and the observations of the secondary

data and the results of the survey posits three implications. First, while the LGU may have

information dissemination materials, it does not reach the periphery where the NTD infestation is

high. Second, since the respondents were not really fluent and adequately literate, as implied in

10

9

15

0

13

9

80

63

22

33

92

D IS TRIBUTIO N O F V ITA MINS

A CTIV ENESS OF HEA LTH CENTER

A D EQUA TE NUMBER OF BHWS

PRESENCE OF INFORMA TION

D RIV ES

Yes No


their educational attainment where majority were a considerable number did not finish their

elementary education, mere distribution of materials may be a problem. If the government will not

ensure that these people understands the information being fed to them, then the effort may be

futile. Lastly, they may seem familiar on the disease due to the personal contact they establish with

the health personnel during mass drug administrations, however, the knowledge they acquire is

only limited on the name of the disease and what to do to cure them. Information on where are

they acquired or how to prevent getting such illnesses were not thoroughly discussed. As one

resident recounts, “Basta sinabi na ganito yung sakit ko, di na sinabi kung saan nakuha [They just

said this was my illness. They did not specify where I got it] (Personal Interview, 2013).”

The problem of lack of education and information on diseases has long been recognized as

a hindrance in eliminating the NTDs. In a study done by Nida Aleonar on the evaluation of the

economic impact of schistosomiasis, she found that many rural areas still follow their old beliefs

and customs. The failure of health teams to educate the residents on the medical science and

sanitation practices reinforces the prevalence of the said disease (p.64). Another study done by

Bernardo had concluded that education is an important socioeconomic determinant of NTDs.

Dr. Genevie Reyes of HEAD also emphasized the importance of education in attaining

health. According to her, as long as residents are unable to study and acquire skills to improve

their life, they will never get out of the poverty trap and contribute to the Philippine society, thus

being detrimental to the health of the individual and the community.

Consequently, the issue of “core-periphery” relations is not just confined in the issue of

health education. More importantly, the issue of access to medicine, health programs and health

prioritization is put in question.

The residents stated that medicines and cure are available for cases of neglected tropical

diseases. However, there is also the issue of whether or not the residents were able to avail or

access the medicine, and whether or not the medicine is enough to combat the disease.

Table 3. Perception on the Adequacy of Medicine to Eliminate the NTDs

Frequency Percent

Was able to avail Adequate 97 56.4

Inadequate 62 36.0

Was not able to avail 13 7.6

172 100.0

The only time that people from communities see their health worker is during the one day

mass drug administration, where the DOH had scheduled their treatment (Dr. Mario Jiz, personal


interview, 2013). The health personnel, usually the midwives and the nurses, stay at the barangay

hall to administer the mass treatment. The problem with this setup is the residents who are in the

periphery have no access to these free medicines, if they are even informed at all. As you go farther

from the capital or the core, the access further weakens.

The issue of access and availability is what makes community health much worse, Dr.

Reyes and Katarina Riversa cited. Most rural communities are deficient or lacking of health

stations, pharmacies, health facilities, and health personnel. It takes time for residents to recover

from simple illnesses, and hunger is a dilemma especially during disasters. The issue of distance

and transportation also impose a considerable hindrance in health delivery.

Riversa cites that there are areas in the Philippines were seven out of ten Filipinos die

without even seeing a doctor their entire lives. The lack of facilities where people are supposed

to go to contributes to the emergence of preventable and cureable diseases such as tuberculosis

and diarrhea that causes morbidity and mortality even at this digital age.

Conversely, Dr. Jiz further asserts that medicine or cure, without intervention, is not

enough to eliminate a disease. This is related to the issue of vulnerability which will be discussed

in the following sections.

In addition, while programs on the diagnosis of the diseases are evident in the goals and

projects of the MHO, key expert and key informant interviewees have argued that the strategies

and indicators being used is quite problematic. Teodoro Manduriao of the local government had

stated that through the years, the technique in diagnosis had been shifting, as mandated by the

institutions such as the WHO and the DOH.

“Nagsimula sila sa population, genpop, tinarget namin yung 85% na genpop,

tapos after that, after mga ilang years, bago naman. Tinira naman yung ano,

yung ano, sa school, grade 1 to grade 6. Tapos after many years naman,

nakita siguro nila, nagbago na naman. Pinatatarget naman na samin, yung

grade 3 na lang. Every school, endemic barangays, grade 3. (We started with

[targeting] the general population, then it changed to 85% of the population,

then, after several years, it changed again. We targeted school children, from

Grade 1 to 6. After many years, they may have observed something, they

changed again. This time, we only target Grade 3 students. Every school in

every endemic barangays, Grade 3).”

According to Dr. Mario Jiz of the RITM, the continuous shift of the targeted cohort to

detect the disease undermines the true measure of the disease’s incidence and prevalence. While

getting a sample prevalence is cost-defective, the data is only a “gross underestimation” of the true

illness situation in the community. Given that prevalence is the indicator of the DOH in evaluating


whether a disease is eliminated, getting only a sample prevalence may give a skewed measure of

success and may result to misaligned strategies and priorities.

The shift in diagnostics also affects the compliance of the people in the health programs

being delivered by the local government. The mass drug administration with limited diagnostics

receives varying degrees of amenability among the residents. While one resident states that

drinking the medicine is equivalent to resistance from filariasis or schistosomiasis, another resident

states, “Hindi po ako umiinom. Bakit naman ako iinom eh hindi ko naman alam kung may sakit

ako? (I do not drink [the medicine]. Why will I take it if I do not know whether I am infected or

not?”

This attitude, as Dr. Jiz notes, is a display of how people get tired of the NTDs which

continue to re-emerge and prevail. “What we’d notice is that napapagod na din yung mga tao. Kasi

every year babalik ka din, mamimigay ka din ng gamot, eh mass treatment siya eh, hindi nila alam

kung infected sila o hindi. So parang sa kanila, “Pagod na ako. Hindi ko alam kung infected ako

or hindi, bakit ako iinom ng gamot? (What we’d notice is that people get tired. Every year, you

will come back and distribute medicines because it is a mass treatment, yet they do not know

whether they are sick or not. So they think, ‘I’m getting tired of it. I do not know if I’m infected

or not, so why should I [take the medicine]?”

While the issue of compliance is a discourse in public health, the issue of partnership and

empowerment is political. What is evident is that the misconstrued and misguided indicators of

development, often patterned after international standards or unfitting parameters, affects the

quality of healthcare delivered in the local setting. As Dr. Reyes suggests, patients are not

identified correctly and indicators of success are skewed. Patients lack voice and silently suffer.

For instance, the NTDs soil transmitted helminths and food and waterborne diseases or intestinal

parasitism is not only an issue of deworming, but also an issue of whether the mother has a

footwear, the community has clean water and the family eats nutritional foods.

Proximity, Vulnerability, and Exclusion

Given that NTDs are considered as the “diseases of the poor”, the control and elimination

of such diseases is ultimately linked to development. A number of literature, as well as the opinions

of the various key experts, had attributed the thriving of the disease to the absence of infrastructures

such as roads, bridges, and reservoirs, and the lack of access to clean water and reliable sanitation.

In the data provided by the local government, as of 2012, the municipality of Juban has

only one rural health unit (RHU), nine health centers, and one dental unit. Likewise, data from the

year 2010 stated that the whole municipality has only 124 barangay health workers (BHWs).

In terms of water access, as of 2012, 4,421 out of 5, 689 households or 77.62 percent have

access to clean and safe water. Meanwhile, almost one-fourth of the households, or 22.38 percent,


does not access such necessity. Likewise, 2, 182 of the households enjoy Level II water source, or

a communal piped water, while 1, 116 have a Level III water source or a private water system.

Nonetheless, 786 households get their water from springs or rivers.

Consequently, as of 2010, 3, 788 out of the 5, 154 households or 73 percent possess a

sanitary toilet, while 1, 366 or 27 percent don’t.

In the municipality of Juban, majority of the respondents earn at around PhP 101 – 200 a

day. Such meagre income should provide for food, water, and allowance of a family of 6, in

average, the whole day.

According to Bergquist and Whittaker (2012), the most common denominator of patients

and countries infected with NTDs is poverty. Poverty makes people proximate and vulnerable to

greater risks of infection which excludes them in community life (Bergquist and Whittaker,

2012: p.1). Bergquist and Whittaker further writes:

“The common denominator for being at risk for neglected tropical diseases (NTDs)

is poverty, a condition that makes people vulnerable to them due to environmental

risks as well as social vulnerabilities varying from gender bias to substance abuse

or harmful feeding habits. These vulnerabilities sustain the problem as they are

widespread and the forces upholding them are as much shaped by the economy and

society as by the environment. They are in truth neglected people’s neglected

diseases since they, beyond their direct impact on health, feed the vicious cycle of

poverty and disease that leaves children unable to go to school and adults incabable

of working or fully participating in community life. (p.1)”


Figure 3. The Vicious Cycle of Poverty and Disease. Bergquist and Whittaker (2012: p.2)

The disregard for the socioeconomic determinants heighten people’s vulnerability to ill

health. Since communities and groups most affected by NTDs are people in poverty-stricken

areas, the neglect on political, economic, and social determinants trap the people in a continuous

cycle of poverty.

According to one resident, people are so used of being infected with schistosomiasis, STH,

and intestinal helminths that they no longer mind, as long as there are medicines that will cure

them in the end of the day. “Nasanay na. Andiyan na yan, eh. Matagal na. Nagagamot naman.

Okay na. (We’re used to it. It’s been there for a long time. It can be cured, so it’s fine.),” he says.

A study done on the cases of schistosomiasis in Masiit, Irosin, Sorsogon had yielded to

same sentiments. The study found that while residents are aware that contact to infected water as

the main cause of the disease, they cannot do anything about it since their livelihood depended on

rice farming and water contact is inevitable. Women do laundry in the canals or rivers rather than

in the water from deep or shallow well (p.76)


In reality, people do not have a choice. They cannot get out of the cycle that had trapped

them because the factors which determine the emergence and prevalence of the disease is so

inculcated in their lives. In a macro-level, no sanitary toilets and clean water to access, and no

cemented roads and bridges to walk on. In a micro-level, there are limited information for them to

learn from and no stable livelihood and adequate income to support their health and nutritional

needs.

The kind of development the community has is reflected on and reflective of the kind of

lifestyle the people has. And when that lifestyle creates risk, the people and community is

becoming more proximate and vulnerable to infection. As Castillo suggests, “Ill health is rooted

in malnutrition, ignorance, disempowerment and marginalization (p.8).”

This proximity of and vulnerability to illness also reinforces exclusion in the society. Apart

from the stigma and discrimination that patients with NTDs receive, patients with NTDs are being

pushed out of the core in the society. The prioritization of other health services already

discriminates NTD in the public agenda. But at the local setting, the failure of the government to

ensure that everyone will have access to health services only furthers the exclusion and

disenfranchisement the people experience within the NTD phenomena.

Generally, health and development, may it be in the community or in the individual’s life,

is something that cannot be separated. Riversa and Dr. Reyes affirms this by saying that the

development of a nation is linked to the health of its population, and the health of the population

should be in line with the country’s development. If the population is healthy, the economy will

follow since the people can work, can study, and can be productive.

Furthermore, the health of an individual is linked to the society’s distribution of resources

and rendering of social justice. In line with this, Riversa claims that the Philippines should have a

free, progressive, and comprehensive healthcare—free because health is an inalienable right that

should be attained, progressive because health should be accessed by all, and comprehensive,

because health is not just about cure since it is also about education and prevention.

Role of the Local Government and the Importance of Partnership

It is the primary role of the local government, through its partnership with the national

government and the civil society, to serve its populace. In essence, local governments have two

roles: the administration of services and the representation of the people’s wishes (Report of the

Commissioner on the Future of Local Governance).

Local governments had been instituted as a platform for liberty, equality, and welfare. As

Maass (cited in Tapales, 2003) writes, “On the governmental and individual level, local

government promotes liberty by ‘providing additional and more readily available points of access,

pressure and control’; it promotes equality by providing for widespread participation and fostering,


on the part of the government, ‘responsiveness and flexibility’; it provides welfare or service in

terms of assuring ‘that demands will be heard and that needs will be served’ (p.314).

According to the DOH, the success of their programs on NTDs lies in the hands of the

LGUs. However, the receptiveness and ownership of the LGUs of the programs is one of the

national challenges that was identified in a recent stakeholder forum on neglected tropical

diseases. According to them:

“Hindi magiging successful ang program kung hindi dahil sa mga local

governments. Sa tingin ko maganda iyong acceptance ng ibang mga probinsya

kaya sila nadeclare na filaria free, ganun. Kasi sila iyon eh. Ang DOH lang ang

nagbibigay ng guidance, information. Pero sila pa rin talaga iyong kikilos. Iyong

willingness nila to combat these diseases, siguro ito ang kailangan. May mga best

performing provinces tayo and meron din tayong worst performing provinces. So

ang problem talaga ay iyong local government ownership. (Our programs will not

be successful if not for the local government. I think there are provinces who

exhibited a good acceptance of the programs, that’s why they were declared filarial

free and such. It will always be the local government. The DOH is just here to give

guidance, information, but the action will be up to them. Their willingness to

combat the diseases is really needed. There are best performing provinces and there

are also worst performing provinces. The real problem is the local government

ownership.)”

As of today, however, given the devolved framework of the local government, the DOH

satellite office in the municipality of Juban and province of Sorsogon would soon be dissolved,

and the schistosomiasis and other neglected tropical diseases program would be absorbed

transformed to the local government.

While this transfer program may mean grassroots training and a closer partnership with the

communities, the local government, according to Manduriao, sees this as an additional burden to

them. According to him:

“Hindi. Hindi din. Iyon pa ang isang mahirap. Napakahirap i-transfer ng

ano namin kasi iyong mga tao hinid receptive noong program. Ayaw nila noong

program kasi burden din iyon sa kanila, kasi marami na silang hinahawakan: may

TB, may ano, may mga malaria. Lahat naman ng program, binigay na sa kanila,

kaya hirap na hirap yung ano. Medyo naiintindihan ko rin, hirap na hirap iyong

kalooban ng mga local government. Lahat ng neglected tropical diseases [control

programs], ibibigay na sa local government. (No. This is what makes it difficult. It

is hard to transfer the program to people who are not receptive of it. They don’t

want the program because it would be a burden for them since they are already

managing other programs such as the TB and the malaria. All of the programs were

given to them that is why they are having a hard time. I do understand them, though.

All of the neglected tropical diseases [control programs] will be given to the local

government.)”


Riversa and Dr. Reyes believes that there is a neglect on the part of the national

government in terms of health prioritization. Likewise can be said on the part of the local

government. The advent of devolution gives considerable freedom to local governments on

which projects and programs to prioritize and implement. The DOH may design programs and

formulate guidelines, but the choice is in the hands of the LGUs. In effect, the local government,

rather than financing provincial hospitals and barangay health stations, chooses hard projects

such as infrastructures and commercial programs where names can be plastered, such as roads,

markets, and waiting sheds.

According to Dr. Jiz, there is a variability on the kind of ownership and performance that

local government exhibits. There are factors such as type of governance, priority, and even

personal politics that comes into play on the health policy development and implementation in

the local setting.

Likewise, the NTD phenomena is not just a concern of the DOH. It is also a discourse of

the Department of Agriculture (DA), Deprtment of Social Welfare and Development (DSWD),

Department of Local and Internal Governance (DILG), and several other institutions. According

to Dr Jiz, the elimination of the NTDs is dependent on the interventions done by the involved

offices. A holistic approach, wherein the partnership between and among animal reservoir, the

local government and governance, and people’s behaviour should be built in order to prevent the

emergence and combat the prevalence of the NTDs. “Yes, meron na tayong mass treatment,

nakokontrol na natin yung severe morbidity and mortality, pero the infection per se. Hangga’t

hindi natin nagagawan ng new and innovative intervention strategies, hindi mawawala yung

sakit ng community. Everyday ay paulit-ulit sila maiinfect. And ang gusto nating mangyari yung

yearly infection. (Yes, we have the mass treatment. We are able to control the severe morbidity

and mortality, but the infection per se, As long as we do not create new and innovative

intervention strategies, the illness will not go away. Infection will repeat every day, and what we

want is [to eliminate] the yearly infection).”

Noneteless, the issue of health is not just limited to the issue of healthcare budget or the

issue of privatized hospitals or the issue of underpaid health workers. The problem is that the

Philippine government views health as the sole responsibility of the DOH, alienating the

Department of Interior and Local Government (DILG), Department of Labor and Employment

(DOLE), Department of Public Works and Highways (DPWH) and other institutions of their

responsibility. However, according to Dr. Reyes, the discourse on health includes a multitude of

issues, such as the land reform of the famers, the low wages of the labor sector, destruction of the

environment, educational access of the youth, and the problems of the other sectors of the

society. What links health to the society is the issue of sustainability, of whether the society and

the individual is capable of sustaining the people’s health. If people are not empowered, not


matter how many prescriptions are issued or medicines are administered, the health of the people

will remain in vain.

Conclusion

As seen, the government of Juban, Sorsogon somehow failed to uphold its mandate of

serving its constituents in line with the neglected tropical diseases. The interview, survey and

narratives had illustrated that there was a neglect on aspects of health education, access and

diagnostics in dealing with the NTDs. Same way, the lack of infrastructures and manpower, and

the backward and stagnant state of development in the municipality, reinforces the re-emergence

and prevalence of the NTDs.

The perception of the community, when it comes to the neglected tropical diseases in the

community, namely schistosomiasis, soil-transmitted helminths, intestinal helminths, and

filariasis, varies. While they are knowledgeable on these disease, there are common

misconceptions which affect their attitude and compliance toward these illnesses. According to the

community, the manifestation of neglect by the local government is grave.

The devolution of health services is found to be also an important facet of why there is a

neglect. The local government has too much in its hand to be able to handle the NTDs. However,

as an old adage says, “Prevention is better than cure.” To be able to wholly eliminate the NTDs,

hands-on government intervention is needed. The fight against NTDs are no longer boxed in the

administration of drugs, but in the incorporation of health education and health infrastractures.

Furthermore, the job to eliminate NTDs are not just in the hands of the Department of Health and

the Municipal Health Office. Close coordination in the bureaucracy, such as in the Department of

Public Works and Highways (DPWH), Department of Agriculture (DA), and Department of Social

Welfare and Development (DSWD), as well as the partnership of the national administration, local

government, and the integration of the community, is needed.

Following the theory of the political economy of health, it can be said that the local

government had failed to look beyond the control and cure of the diseases. The political and socio-

economic determinants if health, such as education, income, occupation, social justice, living

conditions were not satisfied, thus becoming a manifestation of neglect on the part of the local

government. Much importance had been given on curing the disease to be able to meet the

standards set by the national and international parameters, yet this became a failure of being one

with the community, of sharing their plights and experiences and addressing their issues while

learning from them.

Lu (2005) had stated that “Health is not only a medical construct but also a social construct

that embodies both the ‘lived experience’ and ‘lived relations’”(p.175). To be able to address the


needs of the community is to be able to hear their experiences and learn their perceptions. Rather

than focusing on a macro-level, the micro-politics of it all—their location, their struggle, their

engagement. As much as it is related to the development of the community and the nation, the

wider sense of development is also related to the development of the individual, and his experience

of health and illness.

While there is a neglect on the part of the local government, there is always a finger pointed

to the people. Are the people to be blamed for being ill?

The proximity to illness and the vulnerability and exclusion it creates does not come from

the people, but from the society whose policies and institutions had created a cycle that had trapped

the people. If we consider the fact that these people are misinformed, disempowered, unheard, and

marginalized, one will understand that it was not their fault. As Castillo (2006) states,

“Responsibility presupposes capability or power. For governments, to put the onus on

disempowered people is to actually shirk responsibility. It is government which has the resources,

authority, and capabilities. According to Michael Tan, ‘we create risky societies and blame people

when they get sick.’ (p.7-8).”

Likewise, it is not enough to feed them food or to give them medicine. The elimination of

the NTDs and other diseases, as well as ensuring the health of the people and the nation, comes

from empowerment and sustainability. “’Health’ should be defined in its widest sense to mean not

just the absence of physical and physiological diseases, but also feelings of well-being, happiness,

and satisfaction. Indeed, it is about obtaining a ‘good quality of life’ and a means of

‘empowerment’ (Lu, 2005: p.179).”


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