The Province of Aduas

A Hypothetical Case

Aduas is a new province created in 2004 as a result of the subdivision of the Province of Batong Puti. Due to the new situation and leadership, the health care system of the new province can be developed more ideally. The new Governor, Hon. Mario Lupitan says he will support the development of strong, quality health services in order to serve his constituents better. A medium sized province with a land area of 243,427 hectares, it has 6 municipalities and 20 barangays. The province is characterized by regularly rugged terrain and steep slopes. Only a small portion of the province can be considered flat lands, which provide the best arable land for intensive rice and corn production. Aduas has a total population of 139,455 people consisting of 27,891 households. Population density is approximately 0.57 persons per hectare. Most of the people of Aduas are of the productive age group as shown by the following age distribution: 2.52% under 1 year of age, 10.95% are 1-4 years old, 27.40% are 5-14 years old, 57.02% are 15-64 years old while only 2.11% are 65 years and over. The populations sex ratio is 10:8 while the dependency ratio is 75.36%.

Socioeconomic profile The people of Aduas primarily depends on agriculture/farming and mining; 52% of its population engage in farming, while 28% are in mining, Thirty-two (32%) of the total land area is devoted to agricultural activities, predominantly vegetable farming. Crops include corn, rice, vegetables, fruits, coffee. Other usual occupations are in transportation, communication, commerce, construction, and manufacturing industries.

The residents of Aduas consider education very important as evidenced by a high literacy rate of 94%. Only 4% of persons older than 20 years are without formal education. There are 25 public and 1 private elementary schools, 4 secondary public and 1 private secondary schools. College education is earned in the City of Cabanban, and other nearby cities and provinces. Most of the houses in the new province are single detached units and usually made of semi-concrete materials, a testimony of their socio-economic standing. Poverty threshold is set at 7.9%. Not all of the provinces residents enjoy the benefits of having electricity; only 70% of the households are connected to the ADELCO, a fledgling electric company that operates in the area. Land transportation is the main mode of travel in the province endowed with partially cemented roads. However only 12.7% of the Aduas folk have land line telephone access. Some of the households have mobile phones, which they use to communicate especially with relatives from and friends.

Environmental indices In Aduas, 10% of households have level 1 water supply, 33% have level 2 water supply, and the rest have level 3 water supply. Seventy-seven (77%) of households are with sanitary toilets while 23% have unsanitary or no toilets at all. Those without toilet facilities dispose of human wastes in open fields or in the river. The province still has no established solid waste management system, a situation that started when it was still a municipality. Garbage is disposed of mainly by open dumping and backyard burning. Majority of the households throw garbage in the river, near the highways or in the open fields. Most (70%) of the food establishments in the province have been awarded sanitary permits while 93% of food handlers are reported to be holders of health certificates.

Health Services and Statistics Aduas is fortunate to have a district hospital located within its jurisdiction whose services are shared by several municipalities. The Francisco District hospital is a 50-bed secondary hospital established in the 1980s to serve the population in this remote province. The top cause of admission is Normal Spontaneous Delivery (NSD) reported to account for 27.5% of all admissions. The other leading causes of admission are Pneumonia, Acute Gastroenteritis, Bronchial Asthma, Sepsis Neonatorum, and Cerebrovascular Accidnets. Lately however, there has been an emerging health problem that has been a cause of concern: meninggococcimia. A nearby province that has experienced full blown outbreaks has suffered economically with its annual provincial revenues reduced by at least 30 % due to less influx of tourists. Francisco District Hospital is not equipped to deal with a full blown outbreak of Meninggococcimia. There are five Rural Health Units (RHUs) mostly located in the town plaza of all the municipalities with those with RHUs. Two of the RHUs are Sentrong Sigla awardees. These two RHUs also serve as lying-in facilities. There are 5 rural health physicians, one rural health dentist, 8 rural health nurses, 18 midwives, 5 sanitary inspector, and 314 barangay health workers. One RHU is managed by a very dynamic rural health nurse. The health staff of the province conducts the annually mandated nutrition screening program. Of the 15,805 children weighed, 2% were found to be severely underweight, while 3% were moderately underweight, 92% with normal weight, and 3% were overweight. The performance of the Aduas health system can be gleaned from the following vital statistics for 2004: CBR 15.25 CDR 2.61 IMR 0 MMR 1.66

Table 1 Ten Leading causes of morbidity per 100,000 population: Aduas Province 2000-2004 2000-2003 Average 1. Bronchitis 339,405 608.8 2. Diarrhea 324,374 639.0 3. Influenza 278,156 548.0 4. Pneumonia 132,800 261.6 5. TB, all forms 118,833 234.1 6. Malaria 57,359 113.0 7. Accidents 84,637 159.1 8. Measles 41,752 82.3 9. Malignant Neoplasms 26,116 51.4 10. Diseases of the Heart 70,596 132.7 Note: Crude death rate per 100,000 population Source of Basic Data: DOH, Health Information Service 2004 586,427 522,762 44,750 205,387 153,406 121,975 96,684 62,959 24,270 70,320 1,0272.7 956.2 818.7 375.7 280.6 223.1 176.9 115.2 44.4 128.5

Table 2 Leading causes of mortality, Aduas per 100,000 population, 2000-2003 Average
No. Rate Percent of Total Death No.

2004
Rate

Percent of Total Death

1. Diseases of the Vascular System 2. Pneumonia 3. Diseases of the Heart 4. TB, all forms 5. Malignant Neoplasms 6. Diarrhea 7. Accidents 8.Avitaminosis and other nutritional deficiencies 9. Measles

23,577 45,673 32,799 28,200 16,924 13,813 8,119 6,846

46.4 90.0 64.6 55.6 33.3 27.2 16.0 13.5

7.6 14.7 10.6 9.1 5.5 4.5 2.6 2.2

27,184 52,888 36,242 31,650 18,143 11,516 10,070 7,114

49.7 96.7 66.3 57.9 33.2 21.1 18.4 13.0

8.1 15.8 10.8 9.5 5.4 3.4 3.0 2.1

7,310

14.4

2.4

8,043

14.7

10. Nephritis, Nephrotic syndrome and nephrosis

4,625

9.1

1.5

5,470

10.0

2.4 1.6

Note: Crude death rate per 100,000 population Source of Basic Data: DOH, Health Information Service