Caraga Region

Vision :

Champion in Accelerating Reforms for the Attainment of a

Guaranteed and Accessible Healthcare Services

Mission :

Committed to provide a responsive and sustainable quality

healthcare services especially to the marginalized

sector in partnership with all stakeholders

Thrusts : - Better Health Outcome

- More Responsive Health System

- Equitable Health Care Financing

Values :

- Compassionate

- Accountable

- Responsive

- Achiever

- Grounded/God-fearing

- Available/Accessible

In 2010, the implementation of all public health programs in

Caraga Region which the Center for Health Development (CHD-

Caraga) spearheads is in accordance with the Aquino Health

Agenda (AHA) which is geared towards Achieving Universal

Health Care (UHC) for all Filipinos, this in compliance to AO 2010-0036.

This Administrative Order states that AHA is launched to improve, streamline

and scale up reform interventions espoused in the Health Sector Reform Agenda

(HSRA) and implemented under F1. This is a deliberate focus on the poor to ensure

that as the implementation of health reforms moves forward, nobody is left behind.

UHC therefore is an approach that aims to address inequities in health outcomes by

ensuring that all Filipinos, especially those belonging to the lowest two income

quintiles have equitable access to quality health care.

To successfully implement the AHA, the following components are required:

enlightened leadership and good governance practices; accurate and timely

information and feedback on performance; financing that lessens the impact of

expenditures especially among the poorest and the marginalized sector;

competent workforce; accessible and effective medical products and

technologies; and appropriately delivered essential services. The above items are

aptly labeled as the following instruments: 1. Service Delivery, 2.Health Financing,

3.Governance for Health, 4.Policy Standards and Regulations, 5.Health Human

Resource and 6.Health Information System.

All these are hoped to realize the PNoy’s administration Goals for Health:

Better Health Outcomes, Responsive Health System, Equitable Health

Financing through the employment of the following strategic thrusts: Achieving

MDG-MAX, Improving access to quality health facilities and Financial

Risk Protection.

Highlights of our 2010 Annual Accomplishments are being presented in this

document with the desire to give our partners from various agencies in the

government and private sectors a clearer picture on our accomplishments that

contribute to the present health status of the Caraganons.

Introduction

1. Vital Health Indices for 2010

A. Population, Land Area and

Population Density

The National Statistics Office has estimated

the population of Caraga Region in 2010 to

reach 2,549,400 with a male to female ratio of

51:49 with a pyramidal distribution that is more

than 50% of the population belong to 25 years

old below, and as the age group advances,

the population in both sexes decreases almost

equally. However, it can be noted that the

upper age groups have more females than

males as there are more males dying earlier

than females – thus the ratio is reversed. This

phenomenon can be observed readily,

starting age 50 and over.

Caraga Region has a total land area of

18,846.97 km2 which is equivalent to 6.28% to

the total land area of the entire Philippines and

18.48% to the total land area of Mindanao. In

2010, the number of barangays has already

reached to 1,334. With this land area and

population, the population density is computed

at 136 persons per square kilometer.

The Province of Agusan del Sur has 27% of

the population or 704,100 that are unevenly

distributed in 314 barangays under 13

municipalities and 1 component city, the newly

created city of Bayugan. The province has the

largest area in the region that comprise 47.57%

or 8,965.50 square kilometer and a population

density of 79 per km2 which shows that this

province is still sparsely populated. The

municipality of Prosperidad has the largest

population of 92,034 while La Paz has the

smallest with only 26,175.

The Province of Surigao del Sur has 597,400 or 24% of the population. 115,995 of it, is in the

component city of Bislig and this is equivalent to 5% of the population of the entire region. This

province has 333 barangays, of which, 24 are in Bislig City. Tandag is newly created

component city for this province and has a population of 55,486. Among municipalities,

Hinatuan has the largest population which is estimated to be at 40,138 while the municipality

of Bayabas has the smallest population of 9,524 only. Surigao del Sur with Bislig City have a

total land area of 4,552.16 square kilometer or 24.15% of the regional area, thus a population

density of 106 persons per square kilometer is computed.

The Province of Agusan del Norte has an estimated population of 334,331 or 14% of the

regional population and is distributed in 166 barangays that are scattered in 10 municipalities

and a city. A population density of 167 persons per square kilometer is computed for a total

land area of 2,064 square kilometers. The City of Cabadbaran has a population of 65,927 and

is the newly created component city of this province. Among municipalities, Buenavista has a

population of 64,212, the highest while Kitcharao has 16,334, the lowest in this province.

Surigao del Norte Province has only 10.7% of the regional area or 2,017.10 square

kilometers. It is composed of 20 municipalities and 1 component city, the City of Surigao and

335 barangays. The estimated population in 2010 of the entire province is 459,929 or 18% of the

region’s population and 31% (143,285) of which is in the city. The population density is

computed at 155 persons per square kilometer. Among municipalities, Mainit has most

population (27,307) while Burgos has the least with only 3,729.

The Province of Dinagat Islands is composed of 7 municipalities and 100 barangays and

has a total population of 129,771 or 5% of the region’s population which are distributed in a

total land area of 721.92 square kilometers or 3.83% of the regional land area. A population

density ratio of 178 persons per square kilometer is computed. Among municipalities, Basilisa

has the most populated area with 34,412 while Tubajon has the least with only 8,397.

The City of Butuan has an estimated population of 318,869 or 12% of the region’s population

distributed in 86 barangays covering a total land area of 526.29 square kilometers which is

equivalent to 2.79% of the region’s total land area. With this land area and population, a

density of 606 persons per square kilometer is computed which is typical for a highly urbanized

city. A considerable percentage of population in this city comes from the nearby provinces

within and outside the region for various reasons like seeking for jobs, schooling, & etc. Most of

these transient individuals live in slum areas, leading to congestion and overcrowding, a factor

to consider in the spread of some infectious diseases like measles and others.

Trend of Contraceptive Prevalence Rate

Caraga Region

2003 - 2010

54

44

3943

41

45

38

47.36

0

10

20

30

40

50

60

2003 2004 2005 2006 2007 2008 2009 2010

B. Crude Birth Rate & Live Births

The 10-year trend of Crude Birth Rate (CBR)

differs from area to area. Among provinces in

Caraga Region in 2010, the province of Agusan

del Norte has registered the highest CBR

(23.52/1000 pop) while the Province of Dinagat

Islands has registered the lowest, 16.13/1000 pop.

Among cities, Butuan City has the highest with

25.08/1000 pop. while Bislig City registered the

lowest with 17.10/1000 pop. However, the

regional average shows an increasing trend for

the past 5 years and in 2010, CBR is at 21.12/1000

pop. – the highest in ten years. This means that in

a community of 1000 population, one can find at

least 21 newborns in 2010.

This increasing trend can be attributed to the

increasing number of newborns each year due

to increasing number of women of reproductive

age (15–49 years old) having unmet needs for

family planning. Though the contraceptive

prevalence rate (CPR) has increased

considerably in 2010 yet, it seems that the effort

needs to be intensified to minimize to the very

least number of WRA with FP unmet needs, so

that unwanted and unplanned pregnancies can

be prevented.

C. Crude Death Rate & Distribution of

Deaths

Caraga Region has registered a total of 8,149

deaths in 2010. 59.7% (4,868) of which are men

and 40.3% (3,281) are women. With this year’s

population, a Crude Death Rate (CDR) of

3.20/1000 population is computed. That is, for a

population of 1000, at least 3 persons died that

year.

Among the 5 provinces, the Province of

Surigao del Sur registered the most deaths while

the Province of Dinagat Islands registered the

least with 1,666 or 20.4% and 326 or 4.0% of the

total deaths respectively. Among cities, Surigao

City registered the most number of deaths, 796 or

9.8% while Bislig City with the least of 425 or 5.2% of

the total deaths in the region. Butuan City with

level 3 private and government hospitals

registered 704 or 8.6%.

The Ten-Year Trend of Crude Death Rates in

Caraga is very irregular. After it plunged down to

3.3 per 1000 pop in 2007, it increased in the next

succeeding 2 years and reached its highest of 3.8

per 1000 pop in 2009. In 2010, it plunged down

back to 3.2 per 1000 pop, still not a very

significant development considering that out of

1000 individuals, at least 3 died in that year.

The Province of Surigao del Norte along with its

component city of Surigao have a total death of

1,170. In these areas CDRs are consistently higher

than the other areas for the past 5 years (2006 –

2010), that is, yearly death in the province of

Surigao del Norte is at least 4 while in Surigao City,

at least 6 per 1000 persons.

Agusan del Sur due to its big population,

consistently has the lowest CDR for the past 5

years though the number of deaths is high.

D. Leading Causes of Morbidity and

Mortality

Morbidity. In Caraga Region, the respiratory

diseases like upper respiratory tract infection

and bronchitis have been consistently the first

leading cause of morbidity among Caragans.

Mostly of the affected belong to the younger

age groups specifically children below 15 years

old. Its trend since 2004 is increasing and at

present its rate is registered at 6,466 per 100,000

population.

Pneumonias and diarrheas are on the

decreasing trend. These 2 infectious diseases

were at the top 6 and 3 respectively in 2004 –

2008 but in 2009, diarrhea dropped to no. 5 and

pneumonia to no. 7 and finally in 2010, these

duo rank 9 and 10 respectively. All other

diseases like Cardiovascular, Dental Problems,

Skin Diseases, Accidents/wounds/injuries in all

forms, Parasitism, Genito-Urinary and Influenza

are increasing considerably in 2010.

Mortality. In 2009 – 2010 the following

diseases are observed to be on increasing

trend: all types of Cancer, Bleeding Peptic Ulcer

and Multiorgan Failure. Pneumonias and

Tuberculosis (all forms) are the only 2 infectious

diseases that remain in the top 10 but with

decreasing trend in the past 2 years.

Hypertensive Cardiovascular Diseases along

with Diabetes and Renal Diseases which are

lifestyle related diseases, had significant

decrease but the former has been consistently

ranked number 1 in the past 10 years while the 2

latter diseases had dropped from the rank by 1

level and its trend is very hard to predict due to

absence of good reporting and limited

capabilities of most government hospitals

especially the lower level facilities to do proper

diagnosis and management of these diseases.

Liver and Gallbladder Diseases along with all

forms of Accidents/Wounds/Injuries remained

on the same rate.

In most all of the lifestyle related diseases,

cases are getting younger particularly HCVD

and Cancer.

These leading causes of mortality and

morbidity in Caraga are consistent with the

national situation.

E. Infant Mortality: Trend & Distribution

In Caraga Region, the MDG target for infant

mortality reduction is highly attainable by 2015. By

that year, the target which is 5.8/1000 LB (very

much lower compared to the national target of

19/1000 LB) can be attained especially if the

efforts that resulted to the present outcome of

6.24/1000 LB IMR be sustained and strategies be

intensified to further bring down the rate even

lower than the target. This present rate tells us that

336 infants died in 2010 out of 53,839 live births.

The number of infant deaths stays below 400 since

2007.

A lot of strategies have already been

implemented and local governments are doing

their best to sustain these efforts in order to realize

the goal.

Though the Ten-Year Trend of Infant Mortality

Rates is somewhat erratic yet, a general

downward trend can readily be appreciated –

that is, from 11.5/1000 LB in 2001, it gradually

dropped to 6.24/1000 LB in 2010.

The Province of Agusan del Sur registered the

most infant deaths in 2010 with 140 and is

equivalent to 42% of the total infant deaths in the

region and consequently has the highest IMR

while the Province of Dinagat Islands got 10 or 3%

but the IMR of 4.78 per 1000 livebirths is higher

than Agusan del Norte which has only 2.10 per

1000 livebirths.

Among cities, Butuan City registered the most

infant deaths with 37 or 11% of the regional total

infant deaths but the IMR of 4.63 per 1000 live

births is low due to high live births while Surigao

City has 30 or 9% of the regional total infant

deaths and has the highest IMR of 11.63 per 1000

live births.

The availability and quality health care

services in the area greatly influence the

decrease or increase of these rates, not to

mention live births as denominators.

Strategies To Reduce Infant Mortality.

To ensure realization of MDG target for reduction of

Infant Mortality in Caraga Region, strategies like

intensification of promotion and advocacy for

expectant mothers to deliver only in the health

facilities like hospitals and birthing homes is

encouraged where attendance of health

professionals who are skilled in attending birth

ensure safe delivery and deal with postpartum

blues.

These intensification efforts through the years

resulted to the constant decline of home delivery

rate and increase of the deliveries in health

facilities. In 2010 in Caraga Region, almost 60% of

deliveries occurred in the health facilities, mostly of

which were in the hospitals, while home delivery

rate dropped from almost 50% to only 40% - a

remarkable development.

Since 2005 the rate of deliveries attended by skilled

birth attendants who only include doctors, nurses

and midwives steadily increases. That in 2010, the

rate is nearly 80% (attended by these health

professionals) versus 20% (attended by traditional

birth attendants or TBAs.

These developments can be attributed to the

heightened awareness among community people

brought about by the intensive efforts rendered by

frontline workers in the rural health units specially

midwives with their partners, the Barangay Health

Workers.

The Expanded Program on Immunization (EPI) also

intensifies promotion and advocacy in order to

increase rate of fully immunized children (FIC)

before reaching one year old. This program aims to

protect infants against the immunizable diseases.

In 2010, FIC reaches 88% out of the targeted 2.7%

of the target population. This is considerably lower

than the national target. The main reason

according to the frontline workers is the over

estimation of population projection.

F. Under Five Children Mortality: Trend &

Distribution

Under five population is estimated to be at

17.82% or 454,303 individuals out of more than 2.5

million population in Caraga Region with a sex

ratio of 107.4, that is, for every 100 females there

are 107 males. Under 1 year of age only comprise

2.7% of these population.

Under five children mortality reduction target

under MDG has already been attained in Caraga

Region considering its present rate at 8.19 versus

2015 target at 8.7 per 1000 live births which is a lot

lower compared to the national MDG target of

26.7/1000 LB. However, provinces and cities have

rates that are much higher than the regional

average and even higher than that of the 2015

target. Efforts therefore should be intensified and

sustained by area so that this present rate can still

be further reduced.

Of the total under five mortality, 76% or 336 are

infants who have not reached their first birthday

yet. And only 24% or 105 infants of ages more

than one year but not over 5 years old died.

Among cities, Surigao City has the highest with

17.83 per 1000 live births while Bislig City has the

least with only 5.55 per 1000 live births. For the

provinces, Agusan del Sur has the highest with

10.94 per 1000 live births or a total of 172 deaths

which is equivalent to 39% of the total under five

deaths regionwide, while Agusan del Norte has

6.30 per 1000 live births or 51 deaths or 12% versus

the total under five deaths.

A lot of factors contribute to the decrease or

increase of under five mortality. In areas where it

is increasing, the most common is the non

availability of quality basic and advance health

care services and the opposite is true in areas

where it is decreasing.

G. Leading Causes of Infant Mortality and Morbidity

Mortality. Since 2004 the ten leading causes of infant mortality have not changed a lot. Most of these

are filth-related diseases. Among them are pneumonia with death rate that is steadily decreasing along

with sepsis and meningitis. These steady decrease can be attributed to heightened awareness among

parents and caregivers on the necessity of seeking immediate healthcare and treatment.

Diarrheas and malnutrition are having irregular trends. Tetanus persists to stay despite increasing rate of

CPAB (Child Protected at Birth).

Among other causes, congenital anomalies, and accidents are having irregular trends. Increasing are

pre/post maturity, respiratory distress syndrome (RDS) and sudden infant death (SID). This trend

irregularities only shows that preventive measures need to be intensified and sustained.

Morbidity. URTI/ARI with bronchitis/bronchiolitis are increasing along with skin diseases and

accidents/injuries while pneumonias, influenza, malnutrition and abdominal disorders and anemia are

having irregular trends. Genito-urinary diseases remains at the alarming level.

Morbidity reporting has been a problem in the region. Most of the consolidated reports received from

the Provincial Health Offices and City Health Offices do not include reports from the hospitals. With that,

there is a very high possibility that rates reflected on the table are actually lower than what occur in the

communities.

H. Leading Causes of Under Five Children Mortality and Morbidity

Mortality. Through the years the leading causes of mortality among under five years old children have no

remarkable changes. Pneumonia, congenital anomalies, accidents, malnutrition and meningitis have

irregular trends since 2004. Sepsis, pre/post maturity, RDS are increasing. Diarrhea is decreasing

remarkably while meningitis is slightly.

Cancer cases among children in this age group has likewise an irregular trend since 2004, and due to

non availability of appropriate diagnostic capability in the region particularly in government hospitals, it is

highly probable that there are a lot of undiagnosed cases not reported.

Morbidity. All leading causes of morbidity among under five children are steadily increasing in a very

alarming level since 2004 except for pneumonia, diarrhea and malnutrition. The decrease of the latter

group of diseases can be attributed to the increasing level of awareness of the population on the

importance of sanitation in preventing these filth-related diseases as well as the importance of seeking for

early treatment. Distribution of these leading causes of morbidity in the provinces and cities does not vary

in magnitude, that is, what is true in one province or city is also true in others.

The strategy implemented nationwide to control and prevent these diseases among children in the under

five age group has been universal, to include intensification of health education in all communities with

local health personnel as the main health education provider to their respective constituents. The Center

for Health Development in Caraga Region has been conducting trainings for these local health

personnel to enable them to effectively educate the people in the community.

In Caraga Region, the

possibility to realize the

target for Maternal Mortality

is very low unless efforts be

doubled along with

commitment and

concentration to achieve

the target which is

52/100,000 live births.

I. Maternal Mortality: Ratio, Distribution

and Leading Causes

For the past 10 years, Caraga Region is one of

the regions nationwide with the highest

maternal mortality ratio with an average of at

least 1 maternal death for every 1000 live births

during pregnancy, delivery or postpartum.

From 2008 to 2010 the province of Dinagat

Islands registered the highest maternal mortality

ratio (MMR) followed by Surigao del Sur.

However, MMR trend of the latter remarkably

decreased from 2.58 in 2008 to 1.05 in 2010 per

1000 live births while that of the former

alarmingly increased from only 1.54 in 2008 to

3.34 in 2010 per 1000 live births.

Agusan del Norte and Surigao del Norte

provinces have irregular MMR in the same

period. The former has MMR that decreased in

2009 and increased in 2010 while the latter has

MMR that increased in 2009 and decreased in

2010.

All cities have MMR trend that is decreasing

remarkably in the past 3 years. Butuan City from

1.59 in 2008 to 1.25 per 1000 live births in 2010 or

21% decreased in 3 years. Surigao City’s

percentage decrease has reached 65% or from

1.10 in 2008 to 0.39 per 1000 live births in 2010.

The City of Bislig boasts its highest performance

of 100%, that is 0 maternal death in 2010 from a

high rate of 2.65 per 1000 live births in 2008.

Generally, the trend of maternal mortality ratio

is very erratic. It is very hard to make a

conclusion on whether or not the efforts in the

past had been of any effect. LGUs at various

levels have to double their efforts so that the

targeted maternal mortality reduction can be

realized.

In 2010, the province of Agusan del Sur has registered 13 maternal deaths, the highest among the

provinces. With a total registered livebirths of 15,716 this would mean that there can be 1 pregnant

woman who died for every 1000 live births. Agusan del Norte comes next with 12 maternal deaths

and with 8,097 live births, the maternal mortality ratio can be estimated at 1.48 which means that

there can be 1 to 2 maternal deaths for every 1000 live births which is higher compared to Agusan

del Sur.

Surigao del Norte has 11 maternal deaths and since the number of live births is only 5,840 the

maternal mortality ratio is estimated to be at 1.88 which means that there can be 2 pregnant

mothers who died for every 1000 live births during pregnancy, during delivery or even up to 42 days

postpartum. Surigao del Sur province has registered 10 maternal deaths and with 9,533 livebirths,

the MMR is computed at 1.05 which means that for every 1000 live births at least 1 pregnant mother

dies.

The Province of Dinagat Islands has only 7 maternal deaths, the least number of maternal deaths

among the provinces, however, due to only 2,093 livebirths, the MMR is computed at 3.34 which

means that for every 1000 live births, 3 to 4 maternal deaths occurred.

Among cities, Butuan City has registered 10 maternal deaths and with 7,997 livebirths, MMR is

computed at 1.25 or 1 to 2 maternal deaths occurred for every 1000 livebirths. Surigao City has only

1 and Bislig City has none.

Causes of maternal deaths are mostly due to postpartum hemorrhage precipitated by specific

causes like retained placenta and others. Eclampsia, septicemia and amniotic fluid embolism are

some of the common causes. Nothing in the list is not preventable. If only appropriate measures are

timely implemented, these maternal deaths can surely be prevented.

J. Public Health & Manpower

Public Health Facilities - Caraga Region has a total of 80 Rural Health Units (RHUs) and Main Health

Centers (MHC) and 654 Barangay Health Stations (BHS). Each municipality has at least 1 RHU.

Municipalities with 5 or 6 barangays and a population of less than 10,000 like Burgos & San Benito in

Siargao Island in the province of Surigao del Norte and in some other provinces have only 2 BHSs each.

Bigger municipalities with more than 30 barangays like Esperanza and Prosperidad in Agusan del Sur

have have 14 BHSs each respectively and Bayugan City has 18 BHSs. In Caraga Region, the average

number of barangays per BHS is not less than 2.

Among provinces, Surigao del Sur has the most number of BHSs with 198 distributed in 17 municipalities

and the new city of Tandag. This means that out of 285 barangays in the said province, most of the

BHSs have only 1 catchment barangay and some have 2. Surigao del Norte, has 69 distributed in 20

municipalities. Since there are 281 barangays in this province, each BHS has at least 4 catchment

barangays. In the province of Agusan del Sur, each BHS has 2 to 3 catchment barangays while in the

Province of Dinagat Islands, the ratio is higher at 3 or more barangays per BHS.

Butuan City has 29 BHSs dispersed in 86 barangays and managed by the personnel in 3 MHCs. Surigao

City has 4 MHCs and 21 BHSs distributed in 54 barangays. This means that some BHSs serve at least 3

catchment barangays while others have 2. The small city of Bislig with only 24 barangays has 3 MHCs

and 38 BHSs. This means that in some barangays there are 2 BHSs serving the population.

Each BHS is managed by 1 midwife only and is supervised by the Public Health Nurse in the RHU. The

presence of Barangay Health Workers and other volunteers boost the midwife’s performance.

In some areas where catchment barangays are limited to 2, yet, the distance and the terrain, poverty,

poor attitude of the health personnel and health being given less priority by the LGU officials are some

factors that made health services somewhat inaccessible. Poor health awareness and poor health

seeking behavior of the people especially in far flung areas aggravate the health problems.

Manpower – Health manpower in Caraga Region

has been a problem in as much as there are

areas that do not meet the required standard

ratio to population, hence not being able to

meet the health needs with high quality health

services. For an estimated population of

2,549,400 in 2010, the region requires a total

of 128 public health doctors and 128

public health nurses to meet the standard

of 1:20,000 for both public health workers.

However, the region has only 84 municipal health

officers and 124 PHNs. On the average, the

region’s ratio for public health physician to

population is 1:31,062 which is very high

compared to the national standard. And for the

nurses, the ratio is 1:20,560 and is a little bit over

than the standard.

Among provinces, Agusan del Sur has the highest

ratio of 1:50,293 for public health doctors while

Surigao del Norte has the lowest with 1:14,166; a

somewhat ideal ratio. Among cities, Butuan City

has the highest of 1:79,717 while Surigao City has

1:23,881 – slightly higher than the standard.

For Public Health Dentist, the standard ratio is

1:50,000 population. Caraga Region has attained

this ratio on the average at 1: 42,490. This means

that in the region, we have more than enough

PHDs. However, looking at the individual provinces

and cities, Agusan del Sur has a problem with a

ratio slightly higher than the standard – 1:58,675. In

Surigao City, the problem of lack of PHDs is worse

with the ratio of 1:71,642 while it is much worst in

Butuan City with a ratio of 1:106,290. The good

thing with these 2 cities is that there are hundreds

of dentists who are in private practice. The main

problem therefore in these areas why there are a

lot of people suffering from oral health problems is

poverty and their poor health seeking behavior.

For Rural Health Midwives (RHM), the region

requires only 510 in 2010 to meet the standard ratio

of 1:5000. But a total of 613 RHMs are available so

that the regional ratio is only 4,169 and is lower

than the standard. However, the 2 cities of Butuan

and Surigao do not meet this standard.

Nutritionists, medtechs, etc. who are equally

important for the provision of effective and quality

health services are likewise lacking, hence,

implementation of health programs are greatly

affected.

Most of the Local Government Units have

manpower issues that most of them resort to

contract job orders to temporarily meet manpower

shortages.

K. Environmental Health Sanitation

Program

Environmental sanitation is an important

component of a healthy environment. This factor

greatly influences the attainment of health goals and

it is the physical indicator that readily tells the general

health status of the community.

Water is an indispensable resource and the want

of it extinguishes mankind. However, it can also be a

worst vehicle of disease transmission like cholera and

many others. With that, it is important that households

in the community should be assured of a safe water

source.

In 2010, Caraga Region has registered an average

of 87% of households with access to safe water

supply. Agusan del Norte has 96.8%, the highest

among the provinces of which 41% is level 1 while

Surigao del Norte has the lowest at 79.5% with only

2% level 1. Among cities, Surigao City has the highest

with 94.2% of which more than 55% level 3 and 35.5%

level 2. While the city of Butuan has only 87.9%

despite being the highly urbanized city, it has only

67.7% level 3 and still 18.3% level 1. Most of the

households in Bislig City enjoyed level 3 water supply

which is 65.8% out of 91.7% households with access to

safe water supply. With this non attainment of 100%

of households with access to safe water supply,

persistent cases of diarrhea and other filth – related

diseases can be expected.

Of equal importance is the availability of

sanitation facilities, among them are: sanitary toilet

and other basic sanitation facilities like blind

drainage, etc. within the households. Caraga Region

has only 83.5% of households with sanitary toilet,

56.6% with satisfactory disposal of solid waste

practices and 53.8% with complete basic sanitation

facilities. Both, Agusan del Norte and Butuan City

ranked at the top among provinces and cities in the

region except for sanitary toilet in which Bislig City got

the highest with 99.4%.

CHD – Caraga 2010 Accomplishment Highlights

1. Service Delivery

A. Hospital

With issue on quality of

hospital services getting

poorer nationwide, the

CHD – Caraga conducted

the Hospital Sector

Reforms Forum in Bislig

City on January 25 – 27,

2010. The very objective of

which is for the

participants to know the

latest on the

enhancement of the

quality of hospital services

and apply them in their

respective facilities to reduce hospital – acquired infections and mortality. This was

attended by the Chiefs of Hospitals, Chief Nurses and Administrative Officers from

government and private hospitals. The resource persons invited include the former

Undersecretary of Health Margarita Galon who talked on

Improvement of the Quality of Hospital Services.

Another activity conducted was the Training on Infection Control

in Health Facilities on June 7 – 9, 2010 at the Almont Hotel’s Inland

Resort, Butuan City. Chief Nurses, Nurse Supervisors, Medical

Technologists and some Administrative Officers from all

government hospitals in Caraga Region attended this said

training and each were required to return demo on the various

procedures on infection control from donning personal

protective equipment (PPE), hand washing and nasopharyngeal

swabbing and were expected to conduct the same training to their co-

employees in the health facilities where they come from.

Hospital

In 2010, Caraga Region has a total of 59

hospitals, 35 of which are operated by the

government which includes the 2 retained

hospitals, the Caraga Regional Hospital (CRH)

in Surigao City and Adela Serra Ty Memorial

Hospital (ASTMMC) in Tandag and the 24

hospitals are operated by private individuals.

Bed to Population Ratio. In order to meet the

standard hospital bed to population ratio

which is 1000 population per hospital bed,

Caraga Region needs a total of 2,550 beds.

However, with the present total beds which is

1,732, the bed to population ratio is computed

at 1:1,471 which is higher.

Surigao del Norte has the most number of

government hospitals (9) with a total bed capacity

of 170. The retained hospital and the 3 private

hospitals in Surigao City have a total of 265 beds.

With this number of hospital beds, bed to

population ratio can be computed at 1:1,833

population for the province while 1:541 population

for Surigao City.

Agusan del Sur has a total of 12 hospitals, 6

government and 6 private with a total of 255 beds.

A ratio of 1:2,761 is computed. This ratio is more

than 200 times higher than the standard and is

further aggravated by poverty and geographical

factors which includes terrain where transportation is

seldom, if not, impassable. The same problem is

shared by the Province of Dinagat Islands and

Surigao del Sur.

The cities of Butuan and Bislig have no problem

regarding this issue on bed to population ratio.

Poverty, high risk practices and poor health-seeking

behavior of the community people are among the

main concerns affecting health of the people.

Accreditation. PHIC accreditation helps ensure

delivery of quality health services in addition to the

many benefits that it offers not only to the health

facilities but the clients as well. PhilHealth benefits

include hospital expenses reimbursements and

many others.

In 2010, not all health facilities are accredited

with PHIC despite advocacy efforts for them to

comply with the requirements. Out of 59 DOH

licensed hospitals, only 46 are accredited and out

of 80 RHUs only 65 are accredited.

Birthing homes and TBDOTS Centers are likewise

being accredited by PHIC, the purpose of which is

to help patients solve their financial problems that

made them hesitate to seek health care. The

benefit packages are to be given to the health

facilities to replenish resources used in providing

care. These benefits can only be enjoyed by the

patients in PHIC accredited facilities.

Bed Occupancy Rate (BOR). Regional average of

Bed Occupancy Rate (BOR) in Caraga in 2010 is

74.6% which is slightly lower than the national

standard of 85%. Only hospitals in the provinces of

Agusan del Sur and Surigao del Sur had reached 80%

or more in the past 2 years while others had as low as

50% especially in the Province of Dinagat Islands.

Even in the provinces where BOR is higher, one can

still find few hospitals with BOR that is even lower than

30%. Reasons for this very low occupancy rate is the

non availability of doctors and or medicines so that

the most that a hospital can do is to refer the patients

to nearby hospitals. This experience is at its worst

scenario in the early phase of devolution of health

services to the local government.

Average Length of Stay (ALOS). In most hospitals if not

all, the average length of stay of patients is 3 days.

This figure only tells that most of the cases catered by

these government hospitals are minor ones which

usually are infectious diseases and can be

discharged after 3 days if management is effective.

This rate is within the Philippine standard and is an

indicator of quality and effective care.

Admission to Consultation Ratio. One of the many

ways to consider in the effective and efficient

utilization of hospital services is the thorough

screening of patients and that only those that require

admission will be admitted, thus resources can be

maximized and only those that really need it can be

benefited.

The trend of admission to consultation ratio from

2006 to 2010 is increasing significantly except in the

hospitals in the Province of Dinagat Islands where it

remains lower than 1:5. However, the ratio in 2010

that is 1:8 is still lower than the standard of 1:10. Lower

ratio is usually experienced in most primary hospitals

throughout Caraga.

The factor to consider may include poor health –

seeking behavior of the people who never come to

the hospital until the condition worsens, hence no

other choice but admission.

Laboratory Utilization Rate. Laboratory performance

correlates with the quality of care since doctor’s

appropriate diagnosis is being supported by the

results of the laboratory procedures he or she ordered

on a patient. When properly utilized, laboratory can

be a very good source of income for the hospital to

recover expenses.

In 2010, the average laboratory utilization rate of all

public hospitals in the region is below 300%. The

province of Surigao del Sur has the highest with 450%

followed by Agusan del Sur with 400%. One of the

main reasons for the very low laboratory utilization

rate is the non availability of reagents and or

equipment in most primary hospitals especially in the

province of Dinagat Islands. On the other hand, too

high laboratory utilization could mean indiscretion of

the physicians who order laboratory procedures even

if, it is not necessary or needed which may cause a lot

of additional expenses to the patients.

Charity Patients. Government hospitals are designed

to cater the poorest of the poor, so that it is expected

that a higher percentage of clients belong to this

group. This means that these patients do not have to

pay any amount upon discharge.

In Caraga, the percentage of charity patients is 78%

in 2010 and is within the national standard. The higher

the figure shows that poverty rate of the population is

also very high. One factor to consider for this

accomplishment is the presence of trained hospital

social workers that diligently classify patients

according to their capability to pay.

Gross and Net Death Rates. These are important data

to be used in evaluating quality of hospital care. Most

of the government hospitals in Caraga Region have

gross death rate and net death rate that are within

the acceptable level. NDR acceptable level is 4%

and most of the hospitals have only 1.2% which is a lot

lower than what is acceptable. Factors may include

immediate referral of severe and dying cases to

private hospitals with higher capability of care.

B. Public Health

B.1. Regional Health Emergency

Management Staff (RHEMS)

RHEMS Caraga had accomplished a lot in 2010:

For Health Policy and Program Development

the following were the activities:

a. Consultative Workshop was conducted

for Province/City Local

Coordination/Clustering. This was attended by the PHOs, CHOs, MHOs, PHTLs. DOH

Representatives and some LGU Officials in charge of emergency management in the

locality. b. Regional Level Consultative Meetings on Cluster Approach involving Regional Offices,

Butuan City Health Sanitation Office & other private sectors (e.g., water district).

c. Formulation of CHD Interim Guidelines on HEMS applicable for the activation of

Operation Center during

emergencies/disasters. d. Update/Orientation Meeting

on Health Emergency

Response Operation for CHD

Staff For the Capability

Building the following

activities were accomplished:

a. Basic Life Support Training – a total of 10 batches

were conducted, 6 of which were funded by

LGUs and other stakeholders while 4 batches

were funded by the CHD.

b. EMR – B Mindanao Facilitators Meeting Last

May 4, 2010

c. Hosted the Mindanao-Wide Basic Life

Support Training of Trainers (BLS-TOT) on

August 29 – Sept. 3, 2010. A total of 51

responders attended the said training,

31 of which from various CHDs

and Retained Hospitals in

Mindanao regions.

B.2. Regional Epidemiology and

Surveillance (RESU) unit major

accomplishments for the year 2010 include:

a. Basic Computer and Epidemiology Information

System (Epi Info) Training for Surveillance Officers and

DOH Representatives on July 21-23, 2010 at the

Almont Inland Hotel and Luciana Convention, Butuan

City. This training was conducted in response to the

needs of the local epidemiology and surveillance unit as

well as the DOH representatives to enhance their skills for computer use as a requirement for

the effective utilization of Epi Info in their respective areas of assignment. With the thrust of

the PIDSR system to improve efficiency of disease notification and response, computer

processing of surveillance data is essential and the people who will manage the data need

to be trained.

b. Rapid Assessment Survey on HIV Vulnerability in Bislig City, General Luna, Bayugan and Tandag

all in Caraga Region and ran from March to June, 2010. Prior to the actual survey, a

Rapid Assessment Team was organized and trained, for them to

become very effective and efficient in

data gathering and in helping those

vulnerable that they would meet in

the process.

c. Epidemiology and Outbreak

Response Training was

conducted on June 29 –July 1,

2011 at the Almont Hotel’s Inland Resort in

Butuan City. The training was designed to capacitate

multidisciplinary team in responding to outbreak

particularly on Emerging and Re-Emerging diseases.

Basic epidemiological investigation skills and

outbreak response are necessary to ensure that

Local Epidemiology and Surveillance Unit Staff are well

prepared to respond. Program Managers

handling Expanded Program of Immunization

and Doctors, Nurses, and Sanitary Engineers

from Provincial and Municipal Epidemiology

and Surveillance Unit regionwide were trained

on the technical information and skills in conducting

epidemiologic investigation and response.

d. Regionwide Orientation on AH1N1 Vaccination and Deployment of

Vaccinators was conducted on March 22 – 23, 2010 to answer all questions and allay fears

regarding the new vaccine for AH1N1. Regionwide vaccination then followed. Health

workers and other front liners (susceptible and vulnerable) were to be vaccinated first and

personnel of other agencies and schools would follow. Team of vaccinators from CHD and

LGUs were dispatched. AH1N1 vaccination was done even during PhilHealth Sabado.

B.3. Family Health Cluster

The Family Health Cluster conducted

several activities like training,

orientation workshops, seminars, etc.

in 2010. All of these activities were

designed to enable the participants who are

front line health workers to do what should

be done to realize the various MDG

targets like reduction of maternal,

infant and child mortality by improving

the quality of health services provided

in the communities.

a. In the month of March, a Conference

on Newborn Screening was done. NBS policies

among others was the topics discussed in this

activity. Municipal Health Officers and

Nurses from various RHUs attended in

this conference along with some

doctors and nurses from private health

facilities in Caraga Region.

b. Another activity conducted was the

Oral Health Program Consultative

Workshop which was attended by rural

health dentists and some dentists who are in

the private practice. One important issue that was raised was on the lack of dentists in

some municipalities.

c. Buntis Kit Distribution was done in the Municipality of Del Carmen,

Siragao Island, Surigao del Norte. More than a hundred

pregnant women gladly received the kits each

contain very important items that will be

necessary in maintaining personal hygiene and

baby care. The objective of the activity is to

emphasize to the father and mother, the

importance of taking care of pregnancy to

avoid complications and possible death of

the baby and or the mother.

No woman

should die

while giving

birth!

d. To address the problem on high maternal mortality in

the region, CHD Caraga intensifies all efforts to realize

the MDG target by 2015. One of these endeavors is

to establish and equip health facilities to be

able to handle normal deliveries in the

communities. In 2010, one of these facilities is

the Basic Emergency Obstetric and

Newborn Care (BEmONC) Facility in

Tandag which was turned over to the

LGU in April, 2010 and this was

witnessed by Asec Nemesio

Gako and Director Mylene

Beltran from the DOH Central

Office.

e. Maternal Death Review for Caraga Region was conducted on April 22 – 23, 2010 at

the Luciana Convention Center, Butuan City. The activity was aimed at

knowing issues and reasons behind each death, drawing lessons from

said tragedy and formulating action plans to ultimately accelerate

reduction, if not zeroing out maternal death in the region.

A total of 100 participants who were mostly Municipal

Health Officers, Chief of Government Hospitals,

Public Health Nurses, Rural Health Midwives and

representatives of private hospitals of the cities and

provinces of the region.

Each province and city presented their respective cases

highlighting issues and events surrounding each death. Best

practices relative to the effective and efficient dealing with

factors/issues and concerns that may have an influence to the

occurrence of maternal mortality that were implemented in some

areas were also presented. Other areas were encouraged to

replicate such to enable them to successfully curtail preventable

causes of maternal mortality.

Representatives from foreign donors operating within the region

such as HealthGov, HPDP, EC and UNFPA assisted the CHD in

providing inputs and

technical assistance

during the whole

process.

f. The Safe Motherhood Week

Celebration was conducted in May 4,

2010. The Honorable Secretary Esperanza

Cabral and Usec. David

Lozada graced this

occasion and inspired all

participants especially the

pregnant mothers in

attendance.

Both Health Secretary

Cabral and Usec. Lozada

stressed the importance of

health of the woman

before, during and after

pregnancy to be able to

give birth and provide

appropriate care to a

healthy baby and her

family.

Moreover,

all means

should be

employed to

realize 100% Facility – based delivery

attended by highly skilled and

competent birth attendants in all

areas to realize the MDG Target for

Maternal, Infant and Child

Mortality reduction.

More than 500 individuals from

various offices both government

and private were in attendance. Each

pregnant in the audience received a

buntis kit.

g. During this occasion the Essential Newborn

Care Protocol and Postpartum Contraception

was simultaneously launched at the provincial

level on May 4, 2010 at the Gateway Hotel,

Surigao City in Surigao del Norte. A total of 229

Municipal Health Officers, Public Health Nurses,

Rural Health Midwives and Barangay Health Workers

and Local Government Officials from different

municipalities/RHUs and health personnel from

government and private hospitals and clinics, DOH

Representatives and representatives from DepEd,

CNAO, PNAO and some NGOs attended the said

activities. The participation of 79 expectant

mothers from various municipalities, the

messages and the presence of Usec Dave

Lozada, Dr. Rosalie Paje of NCDPC, Director LP

Gorgolon with ARD Cassion, Dr. Jacqueline Kitong

Head of UNFPA highlighted the event.

Usec Dave Lozada emphasized on the importance of

the following: a.) continuum of health care for both

mother and child, b.) to correct misconceptions on

the previous common practices for newborns and

c.) the basic guidelines in formulating effective

strategic plans.

The 1 – day launching ended with the signing of

the Declaration of Commitment to the MNCHN

Strategy with no other than Usec. Dave Lozada

leading the group. Buntis Kits were also distributed to

the pregnant women.

Usec. Dave Lozada signed the Declaration of

Commitment to the MNCHN Strategy

Usec. Dave Lozada with RD LP Gorgolon

distributed Buntis Kits to the Pregnant Mothers

Dr. Grace Lim, the MNCHN Coordinator

Malnutrition rate

among preschoolers

decreased by 31.6% or

from 18.52 in 2006 to

12.67% in 2010 in

Caraga Region.

h. Nutrition Program conducted the Annual

Nutrition Assessment on the first quarter of

2010. This year’s assessment used the New

WHO Child Growth Standards (GCS) as

mandated. The purpose of assessment is to

locate and identify the malnourished children,

recognize the potential nutrition problems and

needs of a specific population group and to plan for

course of action to reduce malnutrition and improve the

nutritional status of children particularly the preschoolers.

Prior to the conduct of this annual assessment, a three- day training was conducted last

Sept. 7-9,2010 at Butuan City to improve the

capability and skills of nutrition

workers particularly the

Nutritionist-Dietitians at

the PHOs/CHOs,

Nutrition Action Officers

and District Nutrition

Program Coordinators

to enable them to

conduct the activity

effectively, efficiently and

accurately.

Measuring the height through the use of microtoise

Measuring the height using Height board

Measuring the infant using infantometer

Interviewing mother using the new ECCD card

i. Expanded Program on Immunization

(EPI) conducted the following activities:

1. Several batches of Orientation and

Consultative Workshop on the New

EPI Vaccine and AEFI. Participants

were MHOs, PHNs, and RHMs,

Hospital Nurses from Government

and Private Hospitals all over

Caraga.

2. Developed, reproduced and

distributed IEC Materials to

government and private facilities.

These IEC Materials include: EPI

Monitoring Chart, Tarpaulin for EPI Vaccine Preventable Diseases, Modules for

AEFI Training and EPI Diseases, EPI T-shirts for the Health Personnel and for FIC

Children, Umbrella w/ EPI Logo, Growth Monitoring Chart.

3. Facilitated the distribution of vaccines, needles and syringes, hub cutters, safety

boxes, refrigerators, cameras and calculators to

various recipient health facilities all over the

region.

4. Conducted Rapid Coverage Assessment

(RCA) to look for missed children in a total of

23 barangays in the following areas:

a. Bislig City - 5

b. Bayugan City - 7

c. Butuan City - 5

d. Agusan Norte - 6

5. Provided technical assistance/monitored

priority areas to ensure proper implementation

of designed activities and to address issues

and concerns relative to EPI that surfaced.

B.4. Non Communicable Diseases Cluster

a. In response to the request of the

Department of Tourism, the CHD

provided a Medical Team to

ensure that health needs of the

participants of the 3rd Siargao

International Game Fishing

Competition are met. Director

Leonita P. Gorgolon herself

spearheaded the team.

The said event was done

in April, 2010.

b. The Environmental Health and Sanitation Program launched the Floating Sanitary

Toilet in Del Carmen, Siargao Island, Surigao del Norte. This is the

second municipality in Caraga where this project is

launched. The first one was in Talacogon, Agusan

del Sur in 2009.

This approach hopes to address the sanitation

problem in the region. In 2009, less than 80% of the

total households in Caraga have sanitary toilet

facilities. With that, correspondingly, diarrhea,

pneumonia, dengue, parasitism and other

filth related diseases still abound.

It is also hoped that many local

government units will replicate the

project in their respective municipalities

to solve their communities’ sanitation

problems.

This launching was attended by several

heads of offices both government

and NGOs in the region.

c. The National Voluntary Blood Services

Program conducted the following activities in

2010:

1. Some CHD Personnel headed by Director LP

Gorgolon attended the World Donor

Day in Bacolod City.

2. Assessment of Blood Service

Facilities in consonance with the

Administrative Order 2008 – 0008,

in anticipation of establishing a

Regional Blood Center or possible extension of flexibility

function of other Blood Banks. The checklist for NVBSP Blood Facilities

was used in this assessment.

Flexibility is given to CRH, ADN Blood Center, D.O. Plaza Memorial Hospital Blood Bank, and

ASTMMC Blood Bank to function as Blood Centers.

3. Regular Community Blood Donation Campaign

conducted by the various blood mobile teams:

Caraga Regional Hospital Mobile Blood Team,

Agusan BCU Team, Adela Serra Ty Mobile Blood

Team and the Agusan del Sur PBCC Mobile

Blood Team. With their combined

accomplishments, 4,607 donors were gathered.

4. Regional Blood Showcase is an annual event

honoring blood donors who in one way or another have

contributed in saving lives. Bloodletting highlighted this

year’s event and graced by LGU Champions.

5. Consultative Meeting with Key Stakeholders is regularly

conducted to track performance to ensure availability of safe

blood at all times.

709 BnB Outlets out of

1,310 Barangays or 1

BnB Outlet : 2

Barangays in Caraga

Region in 2010.

d. Botika ng Barangay (BnB) conducted

the following activities:

1. Several batches of BnB Training for Operators

and Barangay officials were conducted in

fulfillment of the requirement for the

operationalization of Botika ng Barangay. These

trainings were conducted in the months of April,

May, October and November in 2010. The very

objective of which is to equip BnB Operators with

knowledge and skills on how to successfully operate a

botika in their respective barangays.

2. Consultative Meetings conducted were LGU initiated to assess BnB Operations and to

address relative issues and concerns. Several Consultative Meetings were done during the

months of November and December in various provinces and municipalities and all were

focused on sustainability issues.

3. Awarding and Recognition of the Best Performing LGU – BnB was done in December to

encourage LGU Operators to improve performance.

e. Launching of Healthy City during World Health Day Celebration on April 7,

2010. “Year of the Urban Health - 1000 Cities, 1000 Lives” was this year’s theme.

In Caraga Region, launching activities

were simultaneously done in

cities of Butuan and

Cabadbaran in

Agusan del Norte,

Surigao City in

Surigao del

Norte, Bayugan

City in Agusan

del Sur, the cities

of Bislig and

Tandag in Surigao

del Sur. Programs

were held in Public

Plazas and basic health

services were provided.

Hundreds of people

attended the said event availed the various health services like BP taking, FBS,

immunizations, vitamin supplementation for Garantisadong Pambata, & etc., which was

provided by the City Health Offices with the assistance of the CHD – Caraga Field Health

Personnel.

In each city, the Local Chief Executives headed the conduct of activities. Hotels and

eating places that met the DOH standards were recognized and awarded with Quality

Seals.

In Butuan City, ARD Cesar C. Cassion emphasized in his message the importance of a

healthy environment and healthy lifestyle for quality living and quality life years span of

individuals.

The honorable Butuan City Mayor, Democrito “Boy Daku” Plaza gave a very inspiring

message enjoining all LGU Officials, Butuanons and everyone living in the city to be

responsible citizens for a better Butuan City, a conducive place to live for healthy living.

f. To promote health, unity and commitment to work, the Non-Communicable Cluster

initiated the conduct of a 2 – day Family Day. Every

employee with the Director herself joined the fun –

filled activities which include group

dynamics, swimming, etc.

The Director and the

Assistant Regional

Director emphasized

the importance of this

activity to be

conducted at least once

a year so that each

employee can be

unloaded with so

much

work–related

stress to sustain

higher degree

of productivity.

g. Promotion of HEALTHY LIFESTYLE is

intensified in Caraga Region thru the following

activities:

Lay Forum on Cardiovascular Diseases

Prevention and Control on February 26, 2010

in Luciana Convention, Butuan City.

Participants to this activity were Barangay

Captains and BHWs of Butuan City.

Orientation on Smoking, Physical Exercise, Healthy

Diet, Cancer Prevention were strongly promoted in 9

Pilot Barangays of Butuan City with the assistance

of the Pangkalambuan, Inc. from January to

March, 2010.

Facilitated Hataw in the different National and

Local Agencies region wide. In the provinces, DOH

Representatives headed the activity in their respective

municipalities

Responded to invitations from agencies, colleges

and universities to conduct seminars, symposia

on Non Communicable Diseases throughout

the year.

Tapping Trimedia thru Press Conferences to

intensify promotion and advocacy to reach all

sectors of society.

All these are aimed to reduce the

incidence rates of lifestyle –

related diseases such as

Hypertensive Cardiovascular

Diseases, Cancer all types, Diabetes,

Renal Diseases, etc.

Nursing Students during symposium

on Healthy Lifestyle

Ms. Delma O. Legaspi, the Nurse

Coordinator of Healthy Lifestyle Program

on Healthy Lifestyle

Seminars/symposium on Healthy

Lifestyle in various agencies in Caraga

Seminar/Symposium on Healthy

Lifestyle with High School Students

Seminar/Symposium on Healthy

Lifestyle with Brgy. Officials

Teaching HATAW to the partipants during

Seminar/Symposium on Healthy Lifestyle

550 clients with

various eye

problems were

benefited

h. Vision 2020 Philippines : The Right to Sight of the

Visual Health Program in 2010 conducted several

activities geared toward helping people with visual

problems to eliminate avoidable blindness by the year 2020

thru multisectoral partnership approaches:

Conducted Eye Screening to the different schools in coordination

with the NGOs

Basic Eye Care Trainings to the Volunteers

Cataract,Ptyrigium and Squint Operations

Advocacy on the prevention of the different eye diseases

Advocacy, Eye Screening, trainings and cataract surgeries are

the collective, regular endeavor of the different Local

Government Units, Private & Government Ophthalmologists, Celsius

Pharmaceuticals, Cataract Foundations, Loving Presence

Foundations, Chief of Hospitals of District and Retained

Hospitals, RHU Staff, Dep-Ed and CHD-Caraga.

Beneficiaries of these activities are mostly indigents

from all over Caraga Region. A total of 550 clients

were successfully operated on and are now living a

normal life again. To benefit more indigents with vision

problems, the CHD – Caraga strengthened

coordination and collaboration with other stakeholders.

Cataract Screening

Squint Screening

During the Training on Basic Eye Care

Post Cataract Op pose of some beneficiaries Lucky Boy to benefit the free

operation for squints

i. RENAL DISEASE CONTROL PROGRAM

(ReDCoP) with the objective to reduce

morbidity and mortality due to renal diseases

thru increasing the level of awareness of the

health personnel, community and partner

agencies on the prevention and control of

common kidney diseases, conducted the following

activities in 2010:

Consultative Meeting Workshop/Status Reporting

on Kidney Diseases Prevention Program

Implementation with the various stakeholders.

Lay Forum on the Prevention of Kidney Diseases

participated by Barangay Captains, BHWs, Health

Workers, Students, Pupils & Municipal Employees on

June 29, 2010 in General Luna, Surigao del Norte

Symposium on the Prevention of Kidney Diseases

among Nursing and Midwifery Students on June

15, 2010 in Butuan City

Attended ReDCoP Launching in Buenavista-

SPED on June 26, 2010

Kidney Month Celebration in June which was

highlighted by a Press Conference

To be successful in all of these endeavors, strong

collaboration with DepEd, LGUs, NGAs, NGOs and communities

has been maintained and enhanced. Distribution of IEC materials to the different health

facilities and partner agencies and to individuals was also done. To ensure data quality, a

continuous data validation

check has been on-going

throughout the year.

ReDCop Launching at

Buenvista, Agusan del Norte

The Coordnators from the CHD and PHO

during the Team’s monitoring of the

program

Smoking is strictly

banned in the

premises of all

DOH offices and

Hospitals.

j. Anti - Smoking Program conducted the

following activities:

DOH RED ORCHID Validation in CHD & CHO-

Surigao City on February 17-20, 2010

Attended Launching of Tobacco Legislation in

Veruela on May 20, 2010

MPOWER Training on June 16 -18, 2010

Launching of 100% Smoke Free Environment

Conducted Orientation on Anti-Smoking

among High School Students in Las Nieves, RTR

in Agusan del Norte and Tandag in Surigao

del Sur on July 2,6 & 8, 2010 and in St. Paul

University of Surigao City.

Because smoking severely impacts public health

by affecting not only the smokers but non

smokers who are exposed to second hand

smoke as well, efforts toward 100% smoke

free environment is being intensified.

Smoking is now ban in all DOH Offices and

hospitals and attached agencies in Caraga

Region. Local Government Units are likewise

enjoined to do the same.

Strong collaboration with partner agencies is therefore

indispensable for the realization of the dream to have a

100% Smoke – Free Environment. Validation of reports

and regular monitoring and evaluation of the

implementation of non-smoking ordinances are

likewise intensified.

During the Launching of the 100% Smoke – Free

Environment

During the validation of Red Orchid

Award in the CHOs

During the Anti-smoking Orientation in Schools

k. Community – Based Rehabilitation

Program (CBRP) is a program that takes

charge of the interests of the persons with

disability. To make endeavors more

meaningful and beneficial for the target clients,

the program conducted several activities in 2010, to wit:

Attendance to Regional Committee on Disability Affairs, Quarterly at Regional

DSWD Office

Training of CBR in Jabonga ( Aug. 23-25, 2010) & San Francisco (December 3-5,

2010 and among RHU Staff and BHWs in coordination with Loving Presence, Inc.

Celebration of National Disability Prevention &

Rehabilitation Week. This activity was highlighted with

a mass, motorcade and orientation on the

prevention of disabilities.

Conducted 4 batches of Training of National

Electronic Injury Surveillance & PWD Registry System (4

Batches)

Facilitated CBR Congress in San Francisco,

Agusan del Sur.

Conducted Ear Care Skills Training among PHNs,

RHMs and BHWs in Agusan del Sur

In each of these activities, the rights and privileges of PWDs as

mandated in the Act Amending RA No. 7277 were

discussed as well as the guidelines in the issuance of

their identification card and the National Electronic

Injury Surveillance System (NEISS) and PWD Registry.

Institutionalization of the Community – Based

Rehabilitation Program in the Local Government Units

is very important for the PWDs to have a solid support in

all areas.

During the Celebration of the NPDR Week

Deaf Mute Children during the NDPR Week

During the Ear Care

Skills Training

l. Elderly Program conducted the following

activities that benefited the elderly population in

Caraga Region:

Orientation on

the IRR of RA No. 9994 ”Expanded Senior Citizens

Act of 2010” in Balanghai on Nov. 23, 2010.

Chief of Hospitals, Chief Nurses were among

the participants.

This is an act granting additional benefits and privileges to

Senior Citizens. Included in the benefits is the 20% discount

and VAT exemption in medicines, essential medical supplies,

hospitalization, transportation, hotels, restaurants, recreational

centers, places of leisure and funeral services.

Senior Citizen Forum in Butuan City on

September 15, 2010. Hundreds of Senior Citizens

attended the forum and most of them

expressed gratification of knowing their rights

and privileges which were lengthily discussed.

Attendance to the Training

on Capacitating

OSCA

Heads

on How

to

Handle

Complaints.

Attendance to the Quarterly

Regional Coordinating & Monitoring Board (RCMB) Meeting.

m. Organized Non – Communicable Disease Coalition in various areas of the

region. The Goal of these organizations whose membership is multi-sectoral is to work

together toward primary prevention of chronic non communicable diseases by

initially addressing the shared risk factors of tobacco use, physical inactivity and

unhealthy nutrition.

RCB Meeting

Senior Citizen Forum

NCD Coalition during the organization and orientation

B.5. Infectious Diseases Cluster

a. The National Rabies Prevention and

Control Program conducted 2 batches of

Orientation and Advocacy. Participants of these

activities were Medical Officers and School Nurses and

Dentists from the Department of Education of the Division

Offices in Surigao City and Surigao del Norte, Province of Dinagat Islands during the first

batch and in Bislig City and Surigao del Sur on the second batch.

The main objective of these activities was to raise

awareness of the participants on the reality of the

possibility to eliminate Human Rabies as a public

health problem in Caraga Region thru the unified

efforts of all health sectors.

Also this program conducted the Regional

Consultative Meeting on to address

problems/issues and concerns resulting to the less

meaningful success of the program in eliminating rabies in the region.

There were 52 participants who were Provincial/City Rabies

Prevention and Control Program Coordinators and Animal Bite

Center Managers from all over the region. In this activity, it

was emphasized that only competent staff should manage

the Animal Bite Treatment Centers in order to provide the

appropriate services effectively and efficiently.

b. National Filariasis Elimination Program - after having

received authority from the World Health Organization and the

Department of Health declared the

provinces of Agusan del Sur and Dinagat

Islands, a Filaria – free after 7 rounds of mass

drug administration and after thorough

evaluation of the reported disease prevalence

rate of less than 1 per 1000 population. This

declaration is a proof that Caraganons can

achieve the goal of eliminating the disease in

the region.

Country’s

First TB DOTS

Center in Jail

is in Butuan

City

c. The National Tuberculosis Program

(NTP) conducted the following activities in 2010:

1. Launching the BJMP – Butuan City TB DOTS

Center on March 30, 2010 at the BJMP Compound,

Libertad, Butuan City. This is the first of its kind in

the Philippines. This endeavor aims to provide the

healthcare needs of particularly the inmates who

suffer tuberculosis, to treat and to prevent other

inmates from getting infected with this disease.

2. Construction of the National

Tuberculosis Reference Laboratory in

Caraga Regional Hospital

Compound, Surigao City. The

ground breaking ceremony was

done on April 23, 2011. The very objective for the

establishment of this TB Reference Laboratory is to strengthen

the capacity of the laboratories around to respond to threats

like multi-drug resistant TB.

3. Launching of TB DOTS Center in DepEd Surigao del Norte

Division in Surigao City on May 4, 2011. With this, the Department of

Education can participate in the implementation of TB prevention and control activities like

case finding by direct sputum microscopy and TB cases treatment using the Directly

Observed Treatment Shortcourse Chemotherapy (DOTS) to DepEd employees, dependents

and their students.

4. Facilitated the PhilHealth Certification of TB-DOTS Centers in Caraga Region to

ensure that all these TB – DOTS Centers meet at least the specified standards to spell out

their capability of providing safe and effective DOTS services to all TB patients. TB-DOTS

Centers that are PhilHealth Certified can enjoy the TB Health Package. This package can

lighten the economic burden of the patient and the facility because it offers PhP4,000.00 for

every PhilHealth Cardholder TB patient diagnosed and treated in the same facility.

As of December 31, 2011, Caraga Region has already 26 TB-DOTS PhilHealth

Accredited Centers distributed as follows:

Agusan del Norte and Butuan City - 8 (But1 DOTS – private)

Agusan del Sur - 6 (NBMH – private )

Surigao del Norte and Surigao City - 6

Surigao del Sur and Bislig City - 6

d. National Leprosy Prevention and

Control Program conducted 4 batches of

Orientation/ Training on Basic Leprosy

Management. These activities were

attended by the PHNs and RHMs from the

Rural Health Units and Main Health Centers as

well as City Health Offices and Provincial

Health Offices all over Caraga. The 1st batch on

February 23 -24, the 2nd on June 15 – 16, the 3rd on

October 26 – 28 and the 4th batch on October 28 - 29, 2010.

The main objective of this training is to enhance the

knowledge and skills of health workers in the

detection and management of leprosy. Moreover,

same health personnel are expected to

effectively raise awareness of the people in their

respective communities by providing right and

appropriate information about the disease in

order to encourage cases who are in hiding to

come to the open to avail of the free services

intended for them by the program.

To address issues and concerns relative to program

operation the Regional Consultative and Planning

Workshop and Updates on National Leprosy Control

Program was conducted on February 25 – 26,

2010. All 11 Provincial/ City Leprosy Medical and

Nurse Coordinators, 4 Nursing Attendants and the

CHD Program Managers attended the said

workshop.

e. Malaria Control Program conducted the following activities in 2010:

1. Training on Malaria Entomology and Vector Control for Vector Borne

Diseases. This training was attended by the Provincial and City

Malaria Control Coordinators. The focus of the activity was the

identification of different species of mosquitoes

that are vectors of various diseases.

2. Regional Malaria Implementation

Coordination Team Meeting attended by

the PHOs, CHOs, CHD personnel to include PHT Leaders and

DOH Representatives and some Local Chief Executives. One

of the issues and concerns raised was on the microscopy quality

assurance.

3. Program Orientation/Training on the Revised Policy

and Guidelines on the Diagnosis and Treatment for

Malaria. Participants were MHOs, PHNs, RHMs from malaria

endemic municipalities with the provincial

and city Malaria Control Program

Coordinators.

4. Organization of the Local Infectious Diseases

Alliance at the Regional Level

Towards Elimination of

Malaria. Participants were

Chieftains (Datu), ABC President/

Barangay Captains, City/ Provincial Coordinators of

Malaria, Rabies and Leprosy.

5. Basic

Entomology

Training in

Tandag on July,

2010.

Tribal Sector Officers of the Alliance of

Infectious Diseases in collaboration

with the National Commission on

Indigenous Peoples.

Participants during the Organization of the Local Infectious Diseases Alliance

Dr. C.D. Yu gives lecture and Mr. J. Basadre peeping the microscope during the training

Ingat Lagi!

Persistent

and Correct

used of

Condoms Prayer for

those who died of

AIDS

Part of the big crowd who participated in the World Aids Day

f. HIV/AIDS Prevention and Control

Program conducted the World AIDS

Day on December 1st , 2010 with the theme

“Act Aware” that calls everyone to act so that

this disease can be prevented and controlled

and be aware of the

possibilities of

getting infected with the disease and

put that awareness into action

by practicing safe sex.

The event was highlighted with a

courageous PLHIV shared her

experiences so that the public may

know that an “ounce of prevention saves one from millions of

miseries”. Hundreds of people

participated the 1 – day event which started

with a motorcade and ended with a

prayer for those who died of AIDS and

those who suffered of stigma and

discrimination. And releasing

of balloons to be open with

hope that the community will

be ready to accept PLHIV without

prejudice.

Men and women in Uniform

join the WAD celebration

B. 6. Health Human Resource

The Health Human Resource Unit conducted the

Orientation/Training on the Installation

and Institutionalization of Human

Resource for Health Management

and Development Systems

(HRHMDS) on December 1-3, 2010 at

Balanghai Hotel, Butuan City

This training was participated by Human

Resource Management Officers (HRMOs)

and Administrative Officers of Provincial

Health Offices, selected government

hospitals and city health offices.

Four (4) HHRDB Staff provided technical

assistance during the training and they were

Ms. Grace Fernando, Ms. Gwyn Grace Marantan,

Ms. Janette Cruz and Ms. Grace Obedoza

This activity is conducted to advocate the

proper implementation of these systems

especially the processes, tools and

concepts to all stakeholders.

The participants with the resource

persons from the HHRDB

The participants during the workshop

Another activity conducted by the Health Human Resource Unit was the Culmination of

2nd Batch of Project NARS.

A total of 535 nurses under the 2nd Batch of Project NARS were fielded in various

municipalities in 5 provinces and 6 cities in the region to augment health manpower so that

healthcare needs of the people especially the poor in the communities can be provided.

These nurses were assigned 6 months in the hospital and 6 months in the community.

Directors of DOLE and various RLAs attended the culmination activity and each

congratulated the nurses for having done a good job that contributed meaning to the lives

of the community people.

Dr. Lester P. Tan from HPDPB discussing the Universal Health Care during the conduct of 2011-2016 Strategic Planning last October 20-22, 2010

ARD Cesar Cassion and Engr. Meriedeth O. Pagaran, the Planning Officer discussing with the Resource Speakers from Central Office (Ms. Nieto and Dr. Bautista)

B.7. Governance

3.1. Planning Unit conducted

the following activities:

a. PREPARATION OF 2011 - 2016

STRATEGIC PLAN on October 20-22,

2010 at the Amontay Beach Resort in

Nasipit Agusan del Norte.

In line with the thrusts of the Health Sector; with

the full implementation of the Fourmula One for

Health, Medium Term Philippine Development Plan, the Millennium Development Goals and

the attainment of the National objectives for Health, the Center for Health Development -

Caraga is now on its final preparation for a more comprehensive and realistic 2011-2016

Strategic plan. This will serve as the manuscript stipulating priority activities of the health

system for 2011-2016 programs and projects implementation

CHD shall develop a complete and technically sound strategic plan. The Strategic Plan

reflects the sector approach to health development over a six-year period. This rolling plan

allows the region to adjust and update activities and refine their cost estimates in the plan

as the need arises.

There were several workshops for the development of 2011 - 1016 Strategic Plan of CHD

facilitated by Central Office staff from Health Policy Development Planning Bureau. The

activity was participated by Technical Staff of the Provinces and Butuan City, CHD Staff and

ManCom led by RD LP Gorgolon.

Part of the crowd during the Service Level Agreement attended by the Provincial Health Officers and Butuan City Health Officer

Dir. LP Gorgolon addresses the participants during the Service Level Agreement.

b. ASSESSMENT ON SERVICE LEVEL AGREEMENT 2008 vs 2009 FOR ALL

PROVINCES AND BUTUAN CITY on January 19 - 20, 2010 at the Luciana Convention

Center, Butuan City

With the full implementation of the PIPH/CIPH it

is understood that CHD shall provide

technical assistance and conduct periodic

assessments based on the performance on

the implementation. It is high time to assess

the targets stipulated in the Service Level

Agreement and in order for the region to

provide recommendations to the

provinces/city

and direct

them

towards

the

development of a complete and technically

sound plan and activities.

The 2008 and 2009 Service Level Agreement

were presented. Comments and

recommendations as well as Health issues and

concerns were discussed during the open forum. It was

a well participated activity wherein Provincial Health

Officers II and Technical Staff of all five provinces and

Butuan City were present. All the Management Committee

of CHD, Provincial Health Team Leaders and CHD staff

were also in full force.

c. CHD CY – 2010 WORK AND FINANCIAL PLAN AND AGENCY PERFORMANCE

REVIEW on February 3-5, 2010 at Almont Beach Resort, Surigao City

Center for Health Development has been providing technical assistance to partners

especially to the Local Government Units and conducted periodic assessments of

performance based on the implementation of plan in all programs and projects. It is high

time to assess the Performance of the Agency itself for us to adopt some strategies,

activities and innovations in order for the region to provide recommendations to the

provinces/city. Furthermore, we need to know where we are now in terms of

accomplishing our goals and objectives geared towards the attainment of the DOH thrusts.

d. Kumustahan sa Inter-Local

Health Zone Cum GIDA

Launching on October 28-29, 2010

at Almont Inland Resort, Butuan City

The functionality of

Inter-Local Health

Zones stems that

no single LGU can

adequately meet all public and clinical health needs of its

constituents without cooperating with other LGUs. Inter-LGU

cooperation was the vehicle in addressing public health

threats and dangers which compels them to coordinate.

Moreover, the conduct of zonal conferences has become

a venue for the sharing of best practices on local health

systems of participating LGUs which widened the

perspective of local leaders into developing strategies

to address the existing health conditions of their

respective locality based on the insights derived from

the presentation of existing models of local health

system of other LGUs.

There are initiatives done by the different ILHZs and GIDA

areas. These initiatives are worth-emulating to be shared during the

LGU to LGU meetings thus this consultative meeting is

conducted.

A total of 214 participants were able to register and take

part in the 2 –day activity. The participants were composed

of the Inter-Local Health Zone( ILHZ) Board Members and

the Technical Management Committee of the five (5)

Provinces and one (1 ) City of Caraga Region as well as CHD

Staff including PHTL and DOH Representatives.

The Regional Director of CHD-Caraga, Dr. Leonita P. Gorgolon

welcomed the participants and presentation of Best Practices

and Rationalization Options for Agusan Norte, Agusan Sur,

Surigao Norte, Surigao Sur, Province of

Dinagat Islands and Butuan City

followed. There was Launching of

of GIDA and Ceremonial

Signing of the Memorandum of

Agreement.

Dir. LP Gorgolon welcomes the participants

Registration at the secretariat

Dr. Lilibeth David with some participants in the best booth as background

Part of the participants Dr. R de los Reyes, PHO IIof

SDS receives recognition

award Dr. My Beltran, GIDA Coord.

99% Generic Rx

Compliance in

Caraga Region

B. 8.Regulations, Licensing & Enforcement

A. Food and Drug

Authority of CHD Caraga

conducted the following activities:

1. Five (5) batches of Licensing Seminar for Food

Processors and Manufacturers with a total of 167

participants coming from the municipalities all

over Caraga Region.

This seminar was designed to orient/reorient food

processing and manufacturing plant owners of

the importance of strict compliance to licensing

requirements especially on good manufacturing

practices.

2. Another activity conducted was the Introductory

Course on Pharmacovigilance last August 31, 2010

at Luciana Inn, Butuan City. The topics discussed

were on Medication Errors, Clinical Drug

Interactions and Drug Counterfeiting and were

able to invite the interest of the Hospital Pharmacists from both government and private

hospitals. Moreover, they were made cognizant of the Need for Pharmacovigilance

through competent Adverse Drug Reaction/ Adverse Drug Event monitoring, evaluation

and reporting.

Former Usec Margarita Galon during the OSS Seminar

Joy Metrillo, discussed on the Statistics in Chemistry and Interpretation of the

EQAS-CC

B. Health Facilities Licensing Unit of the

Regulatory, Licensing and Enforcement Division of

CHD Caraga conducted the Orientation Seminar

on Hospital Management/Policies/Updates on

OSS Licensing Requirements on July 8-9, 2010 at

Almont Inland Resort, Butuan City. The 150

participants were Chiefs of Hospitals and

Administrative Officers and Chief Nurses from 35

Government Hospitals and 24 Private Hospitals in the

Region.

The seminar hopes to raise the level of awareness among

various stakeholders management/policies/standards that

will help in their successful hospital operation.

Another activity conducted was the Seminar

Workshop on Preparation of the Laboratory Quality Manual

Based on A.O. 2007-0027 and Basic Quality

Control Procedures in Clinical Chemistry on June 22-24,

2010 at Almont Hotel’s Inland Resort, Butuan City.

The workshop was conducted to help operators of Clinical

Laboratories comply the licensing

requirements for initial and renewal of

License to Operate at the One-Stop Shop

facility of the CHD and to improve quality

laboratory results and maintain a high

standard of practice ensuring the accuracy

and precision of laboratory

examinations in order to

safeguard public health and

safety.

The invited speakers were from the

Lung Center of the Philippines, the

National Reference Laboratory for Anatomical Pathology and

Biochemistry, namely: Dr. Gloria Lim-Tan, pathologist with the

three Medical Technologists and one from the Bureau of Health Facilities and Services,

Manila. Topics discussed were on the standards on records and communication. Seventy

seven (77) Medical Technologists from the government and private hospitals, institutional

based and free standing clinical laboratories attended the said workshop.

Dr. Gloria Lim Tan discussed on the Preparation of Quality Manual, Quality Standards in Clinical Laboratory, Quality Assurance in Clinical Lab.

Batch of SDN & PDI Participants of the eFHSIS Users Training with the FHSIS Coordinator Mr. Paul Ofiasa

Mr. Daryl Estrella coaching

participant s of eEDPMS

B. 9.Health Information System (HIS) The Health Information System (HIS) of the

CHD Caraga maintains several information

systems which are mostly in electronic form.

Each has a point person/coordinator to man

the specified system. All of these are designed

to meet the health

information needs for

development of all sectors.

a. Field Health Service

Information System the official health

information system of the

Department of Health

conducted 5 batches of

Electronic FHSIS Users’ Training

from August to November, 2010

at the Holy Child Colleges of Butuan in Butuan City. A

total of 250 participants actively learned the software

and all of them especially PHNs expressed their delight to

have this electronic system at last.

It is hoped that with this electronic system, the issue on delayed and

inaccurate reporting can be addressed so that the need for quality

and highly reliable data can be met.

b. Ten (10) batches of Hands – On Training/Refresher

Course on Electronic Essential Drug Price

Monitoring System (eEDPMS) were conducted last

November and December, 2010. 98% of the invited

participants from drug

establishments and outlets

successfully completed the

training on the computer-

based price monitoring system of

essential drug prices and

inventories.

Mr. Jayson Villahermosa with FDRO Nora Gaballo coaching participants of eEDPMS

L-R: AVP JY Sychua, Hon. Mayor DB Corvera, Usec.

Mario Villaverde, Dir. LP Gorgolon and Dr. L. David in

Cabadbaran City

B.10. Health Care Financing

The Program on Health Care Financing

conducted several activities that were all

geared toward achievement of goals:

a. PhilHealth Sabado/Nationwide

PhilHealth Registration Day

was conducted throughout

the region in fulfillment of

PNoy’s Universal Health

Care (UHC) health agenda.

The Regional and Provincial Core Team composed of DepEd,

PHIC, DSWD, DILG, PIA, NSO and Provincial Health Offices made

this activity highly successful. Each agency has its own area of

responsibility. A series of advocacy and consultation meetings were

done by this team and is a factor that contributed to the success of

PhilHealth Sabado.

Preparations included the establishment of registration Kiosks which

were mostly provided with computers with online connection to the

internet. Online kiosks can receive payments from IPP and offsite

kiosks (those without online internet connection) have activities

limited to advocacy and distribution of PHIC Cards. PHIC verified the

list of indigents thru the National Households Targeting System (NHTS)

which the DSWD provided.

Most of the LGUs provided meals, snacks and transportation for their

constituents while the DOH CHD Provided meals, snacks and

T-shirts to the core team members and working force and IEC

materials to LGUs.

b. Training on PhilHealth

Bench Book Standards

for Out Patient Services

for LGU Implementers

and Roll Out Training for

Technical Assistance on

PhilHealth Bench Book

for Out Patient Services (PBSOS) were conducted to

help facilities and members to benefit the most out of

PhilHealth. Chief of Hospitals, Chief Nurses, Hospital Administrators, MHOs and PHNs from all

over the region attended these activities and most exclaimed that implementation of this

benchbook will surely address the present problems.

Mr. Daryl Estrella and Mr. Jayson Villahermosa

with FDRO Nora Gaballo coaching

participants of the eEDPMS Training

The marked difference in total livebirths and total deliveries is due to the inclusion of deliveries with

stillbirth outcome as reported by Surigao del Sur and Butuan City. The data on deliveries from these

areas were the ones submitted to DILG for the LGU Scorecard 2010.