The Rural Health Unit in the Philippines
MALCOLM J. FORD, M.D., M.P.H., and AMADEO H. CRUZ, M.D., C.P.H.
JN the couniitries of the Elast, ml-ore aiid m lore
iinterest is being(, focused oni rurial areas b-
cau11se of the rise in population, the importallce
of food piroducctioni, anid the progress of lancd
health services to rurlal inhabitants is of mlajor
sionificance aild, ill the Philippines, the gov-
erlment's lhealtlhp)iogramiilhas recently been
mniciplality ill the Repuiblic.
serv-ices to every
l'iublic lhealtlh in the 1Philippines appears to
have beeni fostered by the Franciscani friars.
In 1577, Friallr Cleiiienlte of the Order of Friars
luilova set uip a miiedical dispensary for the
in(ligenit of Manila in the l'osteria of the Fraln-
ciscan convent ini the Intramutiros, or old walle(d
city of AlsInila.
This eventually becamiie the
Sain Juian de Dios lHospital, whiclh operated at
its origyinal site for 368 years, up to the Second
AW'orld War. Followiing the creation of this in-
stitntiOll, otlher lhospitals were built in miianyv
otlher parts of the Plilippinies.
In 1690, dntring the Spanisl occuplation,the
Doml-inican Padre Juani de Pergero was instru-
menital in installinig a water system for the towin
of Sani Juan
Charles IV of Spaini senit his personal physi-
ciall, Dr. Francisco Javier de Balmnis, to MIexico,
Cenitral anid Soutlh Amiierica, aand the Plhilip-
piies, whlere lhe ariived in 1805 to introduce
At the time of this study, Dr. Ford was rural health
adviser to the United States Operations Mission
to the Philippines.
He is now chief, Special Health
Cruz serves as project director of the rural health
7, Public Health Service.
the Clentral Botard of VIaccinationI waC.S estab-
It wvas the earliest officical public lhealltl
organizationl in the Philippinies.
Spanislh Goverinment appoinited medicos titua-
1are.s,wh-lio were esseintially the provincial lhealth
officers of that day, anid, by the encd of the
Spaniislh regime, there was ani official of this type
in ev-erv province but oine.
lale,8 were Spanish.
A fumrther step in the developmienit ofp)ublic
lhealtlh was the creation- of the Superior lBoaird
of Healtlh anid Clhairity in 1888, and(l onie of the
last aclhievemnenits in lhealtlh uinder the Spaniislh
occulpationi was the taddition of a 2-year couirse
ill somle funidaiimenital medical and dential siub-
jects to the curriculllum, of the UIiiversity of
Sanito Tomiias inl 1898. Giraduates of this couirse,
chwjatnos in,inistrantes, served as male nurses
an-d sanitary inspectors.
miniisteredl to the sick in the absence of a plhysi-
Al'itlh tIme AmlleriCillOcctil)pationcanie a chanige
Plhilippine Comlimission in 1901 set uip a Bo.ard
of Health of the Philippine Islanids; aind( in the
saime year, Acts 307 tlhroug,lh 309 provided for
proviiicial anidml unllicipalboards oflhealth,witl
botlh Filipinio and ANmerican members.
Ill 1906, tlhe provincial boards of lhealtlh were
replaced by district lhealtlh officers witlh juris-
were usually coextensive witlh a province but
soin.etimles encomil)assed imiore tlhan one prv-
ince or parts of provinices.
in piblic healtlh took place in 1912 witlh the
"Fajardo Akct," wlhlich created saniitary divi-
sions, essentially geograplhic (livisions of munici -
palities within the provinces.
1 to 4 muinicipalities;
"presidenit," whlo hIad to be a duly qualifiedt
In 1876, the
AMost 7;1,nedwiPos tit-
In remuote areas, they-
eaclh was assigned
Vol. 72, No. 8, August 1957
plhysician, for supervision
Usually a sanitary inspector and occasionally
a nurse were also assigned to the sanitary
Dr. Jose Fabella, the
broughlt about the establislhment of puericul-
ture centers in 1925 for nmiaternial anid child
health car'e in local areas. They were supported
by voluintariy contributionis m-iatched by
tional funds received from the Nationial Sweep-
These puericulture centers wvere
staffed for the nmost. part by a niurse or midwife
and a woman attendanit, assisted by a l)art-time
pliysiciani. Trhe programli was largely confiined
to prenatal services concenitrCatiing oIn the de-
These ceniteirs still suffer from
inisuifficient loc-alsup,portand lack of year-round
tnder Dr. Fabella, mulnicipal miiaterniity ancd
clharity cliniics were also set up) in 1939.
operated in muniicipalities anid mutnicipal dis-
tr'icts of less tlhani 8,000 in population aind were
directe(l by eitlher a plhysician, llurse, or mid-
Salaries included a basic compensation
n(l danaccadditionial amiiouniit for (leliveries per-
sonally attenided, up to a s,pecified maximum.
Compenisation of personnel assignied to certain
lhardslhip aireas was dooubled if they were iion-
riesidents of these areas at the timie of appoinit-
In some instances, treatment of the inI-
dligenit sick in these cliniics duplicated the work
of the sanitary divisions.
the Philippine Department
Health reorganiized into butrieaus: the bureau of
lhospitals; the bureau of quaraintine; and the
bureau of health, for supervising prevenitive
health services throughout the counitry.
reorganization placed administration of city
lhealth departments at the bureau level and
p)lacedmuany specialty programs, suclh as tu-
berculosis control, liealtlh education, and nu-
trition in the division of laboratories.
municip)almaterniity anid clharity clinics were
now unider the bureau of lhospitals, and the
saniitary divisions, unider the bureau of lhealth.
At the mid-centuiry mark, many separate
local lhealth programs lhad accumulated.
president of the sanitary division was clharged
witlh duties in l)reventive medicine in addition
of health work.
first Secretary of
to medical care.
than 1 or 2 sanitary inspectors to assist him.
He was required by the act creating his office
to "provide hiimself with the necessary ap,pli-
ances and also the instrumnents for all einer-
gency cases, nmedical, surgical, and obstetricall."
He lhad an advisory relation only to the ptueri-
culture centers. There were about 400 sanitary
divisionis servinig about 1,200 muniicipalities.
The activities of all local lhealtlh Iuniits were
conifined almiiost entirely to the poblacimo
town' ceniter, leaving the outlyinig barrioiu
ruial areas relatively uniserved.
The specialty programs concenitrated oni iso-
lated plhases of the lhealtli problem, suclh as
A program-i of inmmuniza-
tioln, principally foIr sallpox, was carried out
by vacciniatingc parties, wlhiclh were mnade up
of nioniprofessionial workers whlo covered speci-
Their sclhedule called for a visit to
eaclh provinice onice in 5 years.
)eI'ViSill(r tllis gr'oupt) of activities in the pro-
vince was the district lhealtlh officer', whlose ac-
tual authlority apparently extenided onily to the
presideintsof the sanitary divisionis.
lhad general supervision of the lhealtlh of the
people of the province.
tary inspectors, nurses, anid clerks he had to
assist himii depenided on the size anid popula-
Frequently, he had no more
The number of sani-
Nurse at the El Salvador Rural Health Unit, Misa-
mis Occidental, gives prescribed medication to
Public Health Reports
rolled up his pants legs to the hip, jumped out in the
falling snow and icy water, and began digging furi-
ously, singing gaily the whole time.
a half later with the help of a cable to another car
we wound ourselves up out of the sea of mud.
the meantime my efforts to help had amounted to my
stepping off into space of the black night for a
An hour and
These paragraphs, based on overseas reports from
public health personnel with missions and field
parties of the International Cooperation Adminis-
tration, give a glimpse into health work abroad.
Most of the original material appears in an adminis-
trative publication distributted by the Public Health
Division of the ICA.
Plaque for Sulimaniyah
The new health center of Sulimaniyah in Iraq
received a silver plaque in honor of its part in the
agriculture and industry exhibition held for the
first time in that place.
village were received at the center with complete ex-
planations of the uses of this facility.
has been isolated from external influences.
economy is rural, the faith Islamic (Sunni sect), the
language Kurdish (many dialects).
also speak some Turkish, Farsi, or Arabic.
who have been to school read, write, and speak
Arabic and Kurdish and frequently have some under-
standing of English.
-M. ELIZABETH DARDEN, public health nurse ad-
viser, formerly with United States Operations
Visitors from town and
Smallpox Detection the Hard Way
On the afternoon of December 13 we received a
report of smallpox in the village of Pishvah 45 miles
southeast of Teheran in the Varamin area of Iran.
Dr. Cyrus Arasteh and I readied an investigation
team and vehicle and departed that night, in a mix-
ture of snow and drizzle.
river where we charged with our 4-wheel drive
around a bus and a large truck that were stuck side
by side blocking the "road."
the hubs and slammed against a high bank.
hardy Iranian driver, Akbar, took off his shoes,
We came to a flooded
But we mired in over
A tiny Iranian gets immunized against smallpox in
Iran's national campaign against the disease by one
of the vaccinators trained by the International Co-
operation Administration for the program.
6-foot fall into a ravine where I ended up with
muddy water over my head.
to my knee and was litter bound for the rest of the
During our investigation three cases of
smallpox were found in a family that had recently
arrived from Tabriz.
Nine thousand persons in the
area were vaccinated, and it was reported that no
more smallpox occurred.
-FRANZ ROSA, M.D., public health physician, United
States Operations Mission, Iran.
I had some damage
In a village near Shiraz, Iran, the year-long efforts
of a sanitary aide with the Public Health Cooperative
Organization to build a sanitary program reaped an
unexpected benefit. One of the villagers, who owned
a small amount of property, became so impressed
with what he had learned about sanitation and hy-
giene that he endowed the rent from one of his shops
to the village council for sanitation in the village.
-ALBERT P. KNIGHT, M.D., chief, Health Division,
United States Operations Mission, Iran
Public Health Reports