Taking it one barangay at a time: Catarman as a model Rural Health Unit for Konsultasyong Sulit at Tama (KonSulTa)

We came together for Zuellig Family Foundation (ZFF)’s Bayang Malusog Community of Practice, uniting nine areas: Aklan, Apayao, Baguio City, Benguet, Biliran, La Union, Laguna, Northern Samar, and Quezon. Fostering collective learning to drive forward Universal Health Care (UHC) and a healthier future for all Filipinos, let us look into the story of Catarman, Northern Samar.

Introducing a new health program into a province is a challenging feat. Communities may not be welcoming of new initiatives due to past disappointments. Ms. Joanna Manalili, Head of  PhilHealth Local Health Insurance Office in Catarman, expressed the difficulties in reintroducing the Konsultasyong Sulit at Tama (KonSulTa) program to the locality, especially when previous programs had yet to prove their worth. Understanding the community’s concerns early on, Ms. Manalili made a concerted effort to engage with residents and understand their needs. Through these dialogues, key challenges were uncovered.

One-Barangay-at-a-Time Approach

When the KonSulTa program was first introduced, Rural Health Units (RHU), and even mayors, were initially resistant. “May utang pa nga kayo sa amin eh. Pinalitan niyo lang pangalan niyan,” some exclaimed, reflecting their skepticism. The resistance from the RHUs was so intense that the office devised different strategies, one of which was the one-barangay-at-a-time (OBAT) approach. Launched in January 2023 with Catarman, Samar as the pilot, the OBAT initiative aimed to intensify the program’s implementation and develop a successful model. According to Ms. Manalili, the goal was to demonstrate that “kaya ng PhilHealth, kaya ng RHU kahit marami silang ginagawa” (PhilHealth and the RHU can handle it despite their many responsibilities).

As an RHU with multiple Geographically Isolated and Disadvantaged Areas (GIDA) barangays, most patients prefer going to barangay health stations instead of traveling to the RHU. To ensure basic health services are delivered, RHU doctors, nurses and midwives conduct regular barangay visits. Barangay Health Workers and Barangay Nutrition Scholars were trained to conduct patient profiling and get vital signs of clients. RHU nurses and midwives were also trained on Integrated Management of Childhood Illness (IMCI) and the Philippine Package of Essential Non-Communicable (PhilPEN) Disease Interventions. Each barangay was equipped with materials needed for patient monitoring, and laboratory follow-ups were scheduled on patients’ birth months for easier tracking.

Leadership and Governance: The Pillars of Success

Since the launch of the initiative, Catarman has continued to excel in improving each health system building block. Dr. Blessie Norona, Medical Officer V of RHU-Catarman and President of the Association of Municipal Health Officers of the Philippines (AMHOP) Northern Samar Chapter, shared Catarman’s experience and the reasons behind its success.

Catarman’s success is exemplified in the leadership and governance of its health system. Despite not having an extensive background in health, Mayor Francisco Aurelio Rosales III supported the innovations. Together with the Local Health Board (LHB), Mayor Rosales recognized the significance of the KonSulTa program in improving their health system, as PhilHealth reimbursements comprise the majority of the funding for their health and nutrition activities. From having only P73,000 in KonSulTa benefit payments for the RHU in 2021 and 2022, the Catarman RHU received P9.4 million as the first capitation for first patient encounters in 2023. Since the OBAT initiative, Catarman received the highest FPE paid to a single local government unit in Region VIII.

What is most promising about the RHU is its well-planned allocation for the expected capitation. “Kahit ‘di pa nare-receive (capitation from PhilHealth), may plano na ‘yan kung saan mapupunta,” Dr. Blessie emphasized.

With its proven success, Catarman has positioned itself as a model RHU for the KonSulTa program. While there is still much work to be done, investing in its people and having steadfast leadership and dedication towards improving health services will continue to make Catarman a model of a people-centered health system.