ResearchPDF Available

THE ROLE OF THE DOCTORS TO THE BARRIOS PROGRAM IN ADDRESSING RURAL HEALTH CARE INACCESSIBILITY IN EASTERN VISAYAS

June 2023

DOI:10.13140/RG.2.2.29438.77123

Authors:

De La Salle University

The Philippines' rural healthcare system continues to face challenges from the lack of human resources and unequal distribution of physicians. Given this, the Doctor to the Barrios (DTTB) program was created to address healthcare inaccessibility in rural areas. The study aims to evaluate the program, examine its efficacy, and identify the needs and concerns of Geographically Isolated and Disadvantaged Areas (GIDAs) in Eastern Visayas. The study used a mixed-method research design and a purposive sampling technique, wherein online close-ended survey questionnaires and semi-structured interviews were utilized to collect necessary data. Data were collected from twenty-nine (29) participants, composed of fifteen (15) DTTBs from Batch 37 (MANDALA) and sixteen (16) DTTBs from Batch 39 (SINAGTALA). As this is a mixed-method study, quantitative data were analyzed using various statistical methods, while qualitative data were examined through thematic and content analysis. The findings in the survey questionnaire highlighted that the DTTB program improves healthcare accessibility in GIDAs in Eastern Visayas and addresses their healthcare demands. Furthermore, through the interview, the shortage of medical personnel, medical tools and equipment, cost-effective vehicles, cellphone services, cell sites, and adequate funding was discovered to contribute to the prevailing healthcare inaccessibility. As these factors remain a concern in Eastern Visayas, future researchers with financial means are recommended to undergo a physical data collection procedure to witness firsthand the environmental conditions DTTBs encounter. A longer timeline for data collection is also suggested to allot time to gather responses from physicians in the GIDAs.

Content uploaded by Isaiah Anthony Thomas Barredo

Content may be subject to copyright.

University of Perpetual Help System DALTA Las Piñas

THE ROLE OF THE DOCTORS TO THE BARRIOS PROGRAM IN ADDRESSING

RURAL HEALTH CARE INACCESSIBILITY IN EASTERN VISAYAS

A Research Paper presented to the

Faculty of the Senior High School Department

In partial fulfillment of the requirements for the subject,

Inquiries, Investigations, and Immersion

Barredo, Isaiah Anthony Thomas L.

Alberto, Guia Marin D.

Damiles, Bianca M.

Digal, Alaiza Jonna J.

Diokno, John Mickael J.

Palanca, Marco Antonio P.

Sangual, AL Prince T.

12STEM3

Submitted to:

Mr. Wilfred Glenn Tirol Catud

Research Instructor/Thesis Adviser

June 2023

University of Perpetual Help System DALTA Las Piñas

APPROVAL SHEET

The research study entitled, The Role of the Doctors to the Barrios program in Addressing

Rural Health Care Inaccessibility in Eastern Visayas, prepared and submitted by Isaiah

Anthony Thomas L. Barredo, Guia Marin D. Alberto, Bianca M. Damiles, Alaiza Jonna J. Digal,

John Mickael J. Diokno, Marco Antonio P. Palanca, and AL Prince T. Sangual, in partial

fulfillment of the requirement in Inquiries, Investigations, and Immersion course has been

examined and is recommended for acceptance and approval of oral defense.

Accepted, and approved, in partial fulfillment of the requirement for

Inquiries, Investigations, and Immersion,

June V, 2023

MR. WILFRED GLENN TIROL CATUD

Thesis Adviser

MR. WILFRED GLENN TIROL CATUD

Research Learning Area Coordinator

MR. CHARLES NATHANIEL L. VALENCIA

SHS Academic Coordinator

University of Perpetual Help System DALTA Las Piñas

ACKNOWLEDGMENT

The researchers are humbled and grateful to the following individuals and institutions who

have played a vital role in the completion of my research paper. Without their unwavering support,

insightful inputs, and invaluable assistance, this study would not have been possible.

To the University of Perpetual Help System DALTA - Las Piñas, for the provision of an

exceptional academic environment that fostered our intellectual curiosity and facilitated our

pursuit of Basic Education studies. The university's facilities, resources, and dedicated faculty

members have been paramount in shaping the direction of this research.

To Dr. Julia H. Reyes, the esteemed SHS Principal and Basic Education Director, for her

unwavering support throughout our academic journey. Her unrelenting passion for education and

unwavering commitment to student success have been a constant source of inspiration.

To the Licensed Physicians from DTTB Batch 37 and 39, who participated in the survey

and interviews for this research. Their invaluable inputs, keen insights, and astute perspectives

have enriched the findings of this study.

Our sincere appreciation goes to Ms. Bayug, Mr. Buhi, and Dr. Siy for their meticulous

efforts in validating the questionnaire utilized in this research. Their expertise, dedication, and

attention to detail have ensured the validity and reliability of the data collected.

We are forever indebted to Dr. Loureli C. Siy, our esteemed assistant thesis adviser, for

her exceptional guidance, constructive feedback, and unwavering support throughout the research

process. Her outstanding insights and expertise have been instrumental in driving the success of

this study.

We extend our profound appreciation to Mr. Wilfred Glenn T. Catud, our distinguished

thesis adviser, and SHS Research Learning Area Coordinator, for his invaluable guidance,

University of Perpetual Help System DALTA Las Piñas

patience, and endless support throughout the research process. His mentorship has been a source

of motivation, and we are honored to have the opportunity to work with him.

Lastly, to our parents, we extend our heartfelt gratitude for their enduring love,

encouragement, and unflinching support throughout my academic journey. Their unwavering faith

in our abilities has been an endless source of inspiration, and we are eternally grateful for their

unwavering sacrifices and support.

University of Perpetual Help System DALTA Las Piñas

ABSTRACT

The Philippines' rural healthcare system continues to face

challenges from the lack of human resources and unequal

distribution of physicians. Given this, the Doctor to the Barrios

(DTTB) program was created to address healthcare inaccessibility

in rural areas. The study aims to evaluate the program, examine its

efficacy, and identify the needs and concerns of Geographically

Isolated and Disadvantaged Areas (GIDAs) in Eastern Visayas. The

study used a mixed-method research design and a purposive

sampling technique, wherein online close-ended survey

questionnaires and semi-structured interviews were utilized to

collect necessary data. Data were collected from twenty-nine (29)

participants, composed of fifteen (15) DTTBs from Batch 37

(MANDALA) and sixteen (16) DTTBs from Batch 39 (SINAGTALA).

As this is a mixed-method study, quantitative data were analyzed

using various statistical methods, while qualitative data were

examined through thematic and content analysis. The findings in the

survey questionnaire highlighted that the DTTB program improves

healthcare accessibility in GIDAs in Eastern Visayas and addresses

their healthcare demands. Furthermore, through the interview, the

shortage of medical personnel, medical tools and equipment, cost-

effective vehicles, cellphone services, cell sites, and adequate

funding was discovered to contribute to the prevailing healthcare

inaccessibility. As these factors remain a concern in Eastern

Visayas, future researchers with financial means are recommended

to undergo a physical data collection procedure to witness firsthand

the environmental conditions DTTBs encounter. A longer timeline

for data collection is also suggested to allot time to gather responses

from physicians in the GIDAs.

University of Perpetual Help System DALTA Las Piñas

Keywords: DTTB; Eastern Visayas; Rural Health Care; GIDA;

Rural Health Care Inaccessibility

University of Perpetual Help System DALTA Las Piñas

CHAPTER I

THE PROBLEM AND ITS SETTING

Background of the Study

The Doctors to the Barrios (DTTB) program was established by the Department of Health

(DOH) in 1993 to address the shortage of physicians practicing medicine in rural provinces and

communities in the Philippines (De Guzman, 2021). They strive to place physicians in localized

provincial areas or municipalities called "doctorless areas" to give health care services to Filipinos

that are not capable of being attained by a physician. In addition, the latest iteration of the Doctors

to The Barrios (DTTB) program is the Doctors to The Barrios-Masters in Public Health (DTTB-

MPH), which is intended to prepare physicians for the crucial impediments they will encounter as

a Rural Health Physician (RHP), Municipal Health Officer (MHO), and Health Administrators in

their assigned localities (De Guzman, 2021). Since then, there have been thirty-six (36) batches of

the Doctors to the Barrios (DTTB) program (De Guzman, 2021).

In a recent study by Manahan et al. (2021), it was deduced that due to the Philippines’

tremendous human resource shortage, there were only about seventy-thousand (70,000) physicians

for a population of one-hundred twelve million (112,000,000) individuals as of 2011, and two (2)

physicians for every ten thousand (10,000) individuals (Palmares, 2019). Despite this, the DTTB

program has enhanced communities’ health workforce through continuing medical education,

thereby educating and preparing attending physicians with pertinent public health knowledge and

skills.

Given the high population density, physicians who are a part of the DTTB program are

currently being dispatched to 4th class municipalities and 1st class municipalities such as Buwak,

Marinduque, and Pinamalayan Oriental Mindoro (Del Mundo, 2018). The DOH chose to place the

physicians in the aforementioned municipalities to fulfill their mission which is to ensure that in

every geographically isolated and disadvantaged areas (GIDA), there is at least one (1) physician

assigned (Manahan et al., 2021).

University of Perpetual Help System DALTA Las Piñas

However, when COVID-19 struck the Philippines, retention in the DTTB program

choosing to stay and work in their desired localities, and municipalities they were assigned to after

the two-year contract has been a persistent challenge. From an earlier study, Leonardia et al. (2012)

concluded that there are three (3) main factors that affects the retention of the physicians in the

DTTB program, including; 1) The crucial role of the local government units (LGUs) in every

municipality, 2) DOH support, and 3) Career advancement. Furthermore, it is essential to provide

continuous support, accommodation, and timely compensation to the physicians’ part of the DTTB

program, as well as to implement safety protocols to keep them safe when encountered with

threats, emergencies, or disasters (Manahan et al., 2021).

Although the pertinent articles mentioned provide rudimentary knowledge about the roles

and factors influencing retention in the DTTB program. The researchers of this study primarily

aim to quantify the efficacy of the DTTB program and analyze the significance of the physician-

to-patient ratio in an emergency service situation. The researchers will take advantage of purposive

sampling by choosing a sample comprising of licensed physicians from the DTTB program in

Region VIII, Eastern Visayas.

The researchers will utilize an online survey form to gather the necessary data from the

physicians indisputably; this study is intended to address the gaps, such as the medical needs and

concerns of people in Eastern Visayas. Lastly, the researchers seek to shed light on the DTTB-

MPH program by the DOH in partnership with the University of the Philippines College of

Medicine (UPCM).

University of Perpetual Help System DALTA Las Piñas

Statement of the Problem

This study revolves around the role of doctors in health care inaccessibility of GIDA in

Eastern Visayas. These will be achieved by analyzing their services, facilities, and equipment in

health centers located in their areas.

The researchers seek to answer the following questions:

1. How does the Doctors to the Barrios (DTTB) program address the health care

inaccessibility of GIDA in Eastern Visayas?

2. How does the shortage of medical personnel hamper the responsiveness of emergency

services in the area?

3. What health factors should be satisfied to improve the healthcare services system of rural

areas in Eastern Visayas?

Aim/Objectives of the Study

The aim of the study is to determine the role of the DTTB program in addressing rural

health care inaccessibility in Eastern Visayas. The researchers seeks to:

1) Evaluate the program's efficacy in terms of rural health care accessibility in Region VIII,

Eastern Visayas,

2) Examine the effects of the physician-to-patient ratio in the immediacy of medical response,

3) Identify the healthcare needs and concerns of GIDA in Eastern Visayas, and

4) Encourage individuals aspiring to be a licensed physicians to participate in the DTTB

program.

Significance of the Study

Through this study, the researchers will be equipped with sufficient knowledge regarding

the role of the DTTB program as it addresses the quality and readiness of the rural healthcare

system of Eastern Visayas. The findings of this study will redound to the benefit of the following:

University of Perpetual Help System DALTA Las Piñas

Filipinos residing in GIDAs. This study intends to educate Filipinos who reside in GIDAs

about the importance of the DTTB program in addressing the enormous difference between

its accessibility and high-quality healthcare.

Eastern Visayas LGUs. This study would urge LGUs to carefully monitor and assess the

prevailing health conditions visible in the affected isolated areas.

DOH Scholars & Graduating Medical Students (Clinical Clerk). This study will

encourage DOH scholars and graduating medical students (clinical clerks) to enroll in the DTTB

program as they continually improve their abilities and prepare for their careers as rural healthcare

providers.

Department of Health. This study will apprise the DOH regarding the repercussions of the

doctor-to-patient ratio to urge them to resolve the gap between them.

Future Researchers. Future researchers may use this study as a foundation, equipped with

much more relevant and significant information to approach the study effectively.

Scope, Delimitations, and Limitations of the Study

The main focus of the study is to determine the physician's role in the DTTB program's

inaccessibility to rural healthcare services in Eastern Visayas. The study will be conducted in the

GIDA of Eastern Visayas, Region VIII, Philippines. The researchers will only concentrate on

licensed physicians from the subsequent batches of the DTTB program, namely; Batch 37

(MANDALA), and Batch 39 (SINAGTALA); as they have first-hand knowledge of the situations

in their designated municipalities. Rural physicians assigned outside Eastern Visayas will not be

acquired as respondents. Moreover, if the licensed physician has not undergone three (3) months

of the DTTB program, he/she will not be acquired as a respondent to the study; because he/she has

not had enough exposure and experience in the said program.

University of Perpetual Help System DALTA Las Piñas

The researchers will utilize purposive sampling in choosing their respondents. In addition,

data will be gathered through an online survey that functions as the study's research instrument.

The study is limited by the COVID-19 pandemic's situation and its casualties, the distant places of

the respondents, and the researcher's travel & personal expenses. Poor internet connection of the

selected licensed physicians in answering the survey questionnaire is also a limitation.

University of Perpetual Help System DALTA Las Piñas

CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

In recent years, the Philippines has significantly improved its healthcare system. However,

as the Philippines advances in the twenty-first century, access to rural health care has become

increasingly difficult in some 1st and 4th class municipalities. In this chapter, the researchers

intend to expand their rudimentary knowledge regarding the role of the DTTB program in rural

health care inaccessibility by presenting pertinent literature & studies acquired from foreign and

local sources. The information in this chapter is relevant nowadays and is arranged seminally to

present the essential & influential ideas that contribute to the study.

Fourth-Year Medical students who are also known as Clinical Clerks are being exposed to

different aspects of the field of medicine, from clinical health to public health, in order for them to

decide on what specialty they should pursue after passing the Physician Licensure Exam (PLE).

The Philippines sees public health as a blue-collar profession, probably due to their employment

in areas without access to healthcare and the lack of payment for their service. In comparison, they

recognized community medicine (public health) as a prestigious profession abroad (Fernandes,

2017). The following are the main points Fernandes (2017) proves in an earlier article titled "Why

Community Medicine (Public Health) is the Sexiest Profession of the 21st Century" 1) The

importance and significance of pursuing public health; 2) Why it is now regarded as the Sexiest

Profession, and 3) What the government should do to preserve rural healthcare programs around

the world.

Consequently, community medicine is known by various titles, including public health,

and may be experiencing an existential issue due to regulatory authorities that have never really

understood the profession and have not delved into past textbooks and studies. Community

medicine is not solely textbook-based, as all medical students are required to read. It is a process

involving accountability, skill application, a genuine example of what it means to be human, and

the opportunity to observe the genuine nature of the human body suffering in all of its complexity.

University of Perpetual Help System DALTA Las Piñas

Dr. Fernandes once said, "But I truly believe that Community Medicine is the single most

authoritative area of medicine the world has ever experienced, if not understood." The wages that

public health professionals request are far too low. They give up prime time in their life, moments

spent conquering impediments in the field and struggles with the system. An example of a

physician's challenges is that certain organizations and institutions do not pay physicians promptly.

Significant responsibility lies in the hands of every public health physician around the

world. Public health workers must realize that they hold the future of the next generation of humans

in their hands. It is required to modernize our public health infrastructure, which will require

considerable investment. Corporate businesses must also break out from their private-centric

business models and collaborate with field organizations. Government agencies should act swiftly

on public health issues that organizations periodically raise and refrain from using the time-wasting

strategies we encounter nowadays.

The dearth of hospitals and medical personnel, particularly in rural regions, is just one of

the difficulties the Philippines suffers regarding its population's health. Four thousand five hundred

(4,500) physicians and thirty-eight thousand (38,000) nurses are produced in the Philippines,

which is roughly sufficient (Del Mundo, 2018). According to Del Mundo (2018), there are

currently 500,000 registered nurses and 130,000 doctors working in the Philippines. Despite these

figures, there are not enough physicians and nurses relative to the population, and most of them

are concentrated in urban areas, which puts rural areas at risk. Numerous lives are harmed due to

the difficulty rural residents have obtaining appropriate and prompt medical care due to the high

concentration of hospitals and medical personnel in urban regions.

The Department of Health (DOH) initially created the Doctor to The Barrios (DTTB)

program in 1993 to provide physicians to roughly two hundred (200) municipalities without

physicians at the time; however, only 50 applicants could be accepted each year. The Doctor to

The Barrios – Masters of Public Health (DTTB-MPH) is by far the latest iteration of the DTTB

program and is intended to prepare physicians for the distinct challenges they would confront as

University of Perpetual Help System DALTA Las Piñas

physicians and healthcare administrators in their assigned municipalities. The UP College of

Public Health is responsible for all this, with the Colleges of Medicine and Arts & Sciences

managing some of the courses. Physicians will graduate from DTTB and receive a Master's degree

in Public Health (MPH) after completing this program.

Since its commencement, the DTTB program has not only increased the number of health

professionals in regions but has also given participating physicians relevant training and public

health skills through continuing medical education (CME). The program changed in 2009 to reflect

the requirements and guidelines, calling for a minimum of two years of service to the designated

municipalities. Additionally, the government had broadened the program's reach to include areas

that did not have physicians. The establishment of two government scholarships, namely; (1)

Provided by the Department of Health (DOH) and (2) The Bagong Doktor Para sa Bayan provided

by the First Gentleman Foundation, enhanced the number of people enrolling in the program. By

then, each batch accepted about one hundred (100) DTTBs.

Physicians must take a Continuing Medical Education (CME) course to provide them with

the required education and training needed to be a DTTB. It entails a two (2) week series of

seminars, with one (1) week devoted to clinical matters and the other two (2) topics related to

public health. In order to deal with new logistical issues, the Development Academy of the

Philippines, a dedicated academic institution, upgraded the CME course to a formal academic track

in 2009. Thus, after completing their contract, the DTTBs could pursue a master's degree in public

management, focusing on health systems and development.

With this in mind, De Guzman (2021) was able to conclude that regardless of how many

DTTBs are deployed to a municipality, the local government and the community will inevitably

determine the future of the health systems since they are intrinsically linked to the governments

that govern them. Therefore, only local authorities and communities may work independently

toward the ultimate objective of a well-functioning and sustainable healthcare system. Ideally, we

will have physicians from and for the barrios in the future rather than doctors going to the barrios.

University of Perpetual Help System DALTA Las Piñas

Considering Allied Health courses are in high demand in the Philippines, many Filipinos

view careers in medicine as a means out of their financial distress. Students who graduated from

Allied Health courses and have a strong work ethic often pursue a Doctor of Medicine (MD)

degree. Palmares (2019) claims that the Philippines' shortage of physicians is already developing,

with only seventy-thousand (70,000) medical practitioners serving a population of one hundred

twelve million (112,000,000) individuals. Compared to those who were interested in public service

in remote areas, the number of physicians working in urban settings and abroad is significantly

higher.

However, being a practitioner of public health calls for commitment and responsibility.

Everyone cannot work as a public health professional; it is a pointless job requiring much training,

education, time and effort, patience, and strength—the experiences of Drs. Christian James

Nazareth, deployed to San Isidro, Surigao Del Norte, and Jillian Franicse Lee, currently working

in Tubajon, Dinagat Islands, were detailed in the article "Life of a Doctor in the Barrio" authored

by Bueza (2017).

In order to provide licensed physicians in Geographically Isolated and Disadvantaged

Areas (GIDA), the Department of Health (DOH) established the Doctor to the Barrios (DTTB)

Program. The Medecins Sans Frontieres program, which began in Venezuela in 1971, serves as

the program's inspiration and source. When the DTTB program was launched, it was intended to

help local governments that lacked adequate healthcare facilities. Throughout the ages, the

program played a significant role in supporting areas that deprived access to high-quality medical

care.

All attending physicians are volunteers dispersed in rural areas suffering from a doctor-to-

patient ratio. After participating in their respective communities for two (2) years, the volunteers

get a Masters's Degree in Public Management with a Major in Health and Systems Development

from the Development Academy of the Philippines. As of 2019, thirty-five (35) batches of licensed

University of Perpetual Help System DALTA Las Piñas

physicians have been sent to serve the Filipino people, and the Doctor to the Barrios (DTTB)

program now has two hundred fifteen (215) active medical practitioners.

The provision of healthcare in rural areas is a concern that several countries, including the

Philippines, are striving to address. Not all Filipino patients receive the high-quality medical care

they entail. Healthcare offered in public and private hospitals, as well as those in urban and rural

locations, differs significantly (MedHyve, 2021).

Hospitals in rural and urban areas differ considerably, with rural hospitals dealing with

much more complexities than urban hospitals. Rural hospitals are at a disadvantage because of

their location, making it extremely difficult to obtain all the medical supplies and equipment they

need.

As a result, those who reside in rural areas need access to the same quality healthcare as

those in urban areas. Furthermore, according to the government think tank Philippine Institute for

Development Studies (PIDS), nearly 75% of municipalities and cities nationwide have insufficient

medical practitioners (MedHyve, 2021). Thus, these demonstrate a significant problem concerning

rural residents' access to quality healthcare.

The Philippines' rural areas are visibly impoverished, making them highly susceptible to

access to quality healthcare. Challenges with essential amenities and services are evident in these

locations due to extreme poverty. Geographically isolated and disadvantaged areas (GIDA) is the

correct terminology to characterize these municipalities. The study focuses on these regions'

difficulties regarding health services and facilities. The Island Municipality of Jomalig, classified

as a marginalized and secluded region, served as the research location to identify these difficulties.

The region is challenging to navigate as going there necessitates a motor boat that can

require four (4) to five (5) hours, depending on the wave action. There are no paved roads,

electricity, or reliable water supply, and physicians only occasionally attend health clinics

University of Perpetual Help System DALTA Las Piñas

(Collado, 2019). To understand more about the challenges posed by the Island Municipality of

Jomalig, key informant interviews with the assigned health workers in each barangay were

performed. The key informant interviews were split into two (2) sections, the first section

consisting of open-ended questions about the current state of the community health facilities.

While the second section focuses on the WHO tracer to ascertain how fully prepared the island's

health facilities are to meet the needs of its residents in terms of health.

The data from Collado's (2019) study entitled "Challenges in Public Health Facilities and

Services: Evidence from a Geographically Isolated and Disadvantaged Area in The Philippines"

indicates challenges with personnel, services, and facilities. The island's population is affected by

these deficiencies, and the concerns will exacerbate if they are not addressed. The study identified

several options to help increase the island's capabilities, including supplying emergency boats for

each town, undertaking education programs, opening up healthcare facilities, strengthening radio

communications, and reducing dependence on quack healthcare professionals.

There are thirteen (13) barangays in the sixth-class municipality of Datu Blah Sinsuat, all

in geographically isolated and disadvantaged areas (GIDA). Individuals are at considerable risk

from inescapable difficulties, including cell phone service, electricity, transportation, and travel.

Dr. Valencia (2021) believes that places like this require numerous excellent health services. After

COVID-19, the entire healthcare system suffered a setback. The pandemic brought about several

issues that got worse in this region. The primary healthcare service emphasized in the article was

a vaccination program. Proper immunization enhances the quality of life by preventing infections

that can be fatal. However, there were issues with vaccination transportation.

Aside from the challenges with transportation, Datu Blah Sinsuat internet users are

apprehensive about relying on the health care services that the government provides. The leading

causes of people's mistrust of vaccines are misinformation, false news, and cultural views

(Valencia, 2021). The government should strive to provide accurate information and vigorous

University of Perpetual Help System DALTA Las Piñas

advocacy in light of the current challenges. People should understand that trust is powerful and

that it has the power to save lives.

In relatively low and intermediate nations, such as the Philippines, where there are only

roughly two (2) physicians per ten thousand (10,000) people, human health resources are severely

in short supply. A study titled "Factors Affecting Retention in the Philippine National Rural

Physician Deployment Program from 2012 to 2019: A Mixed Methods Study" was conducted by

Flores et al. (2021) to identify the factors and barriers affecting the retention of DTTBs in their

designated locality after their two (2) year deployments. The study used both a quantitative,

wherein all presently deployed DTTBs were surveyed, and a qualitative design, wherein interviews

with both currently deployed and former DTTBs were conducted from 2012 to 2019. The

researchers collected 102 responses to the survey, and ten (10) DTTBs took part in the interview.

The study identified five factors that affect retention in the Philippine National Rural

Physician Deployment Program, such as (1) Individual Environment, (2) Work Environment, (3)

Local Environment, (4) National Environment, and (5) International Environment.

Geographic and demographic factors, personal beliefs, well-being, friendship, family

dynamics, and perceptions of employment are the individual factors that affect DTTBs. Social

workplace circumstances, career advancement, infrastructure, and medical supplies and equipment

are work-related factors. In addition, their location, standard of living, social demands, and

technology are considered local considerations. The Universal Healthcare Act, safety, security,

and compensation are considered national environmental factors. Lastly, there is the global

environment, which includes having more opportunities in other nations.

In line with this, Leonardia et al. (2012) elaborate on the elements influencing retention in

the Philippine National Rural Physician Deployment Program. Only 10% of doctors and

pharmacists work in the Philippines' rural areas, which are residents of more than half the country's

population. This country has suffered from an imbalance in the availability of medical health

University of Perpetual Help System DALTA Las Piñas

practitioners. The study also used mixed methods, including an oral interview with former DTTBs

and a self-administered questionnaire for current DTTBs. Leonardia et al. (2021) characterized

retention as influenced by; (1) Personal origin, (2) Family and community factors, (3) Financial

considerations, (4) Career development, (5) Working and living conditions, and (6) Mandatory

service requirements.

The DTTB Program regularly places a batch of physicians in disadvantaged and perplexing

municipalities for two (2) years. The deployment initially used to occur two (2) or (3) three times

a year. As national DOH employees, the physicians are compensated well enough and given all

benefits while on this deployment. These physicians hold the position of a Municipal Health

Officer (MHO), which entails technical and managerial obligations for implementing rural

healthcare policies and programs, ensuring financial viability, managing and developing human

resources for healthcare provision, managing information, and developing and maintaining

infrastructure.

The physician can be absorbed as the MHO of the LGU after two (2) years have passed.

However, LGU personnel in low-income towns (5th and 6th class) are only eligible for a portion

of what they would typically receive from a national agency at the same salary grade, which is

about 66% to 70%. The DTTB Program needs to focus on enhancing the characteristics that drive

retention while minimizing those that inhibit it. According to Leonardia et al. (2021), the study

makes five (5) recommendations for future research, including: (1) Physician motivation to join

the DTTB Program; (2) Priority should be given to physicians who are interested in public health

or who are motivated by a desire to assist rural populations; (3) DTTB preparation needs to be

intensified; (4) DOH should always support the DTTB; and (5) DTTBs will not stay in a rural area

for an indefinite amount of time.

The Philippines, a third-world country, contends with a shortage of human resources and

an uneven distribution of physicians among various localities. Avanceña et al. (2019) explored the

cost-effectiveness of the DTTB program in the Philippines in a previous study under the title "Cost-

University of Perpetual Help System DALTA Las Piñas

effectiveness analysis of a physician deployment program to improve access to healthcare in rural

and underserved areas in the Philippines." They conducted this by employing decision tree models

with a lifetime horizon and probabilistic sensitivity analysis as their research design. Additionally,

national and local government policymakers in the Philippines and other nations interested in the

value of HRH deployment programs are the study's target audiences.

The DTTB program is one of many deployment programs the Philippine government plans

to scale up with significant resources. Nevertheless, the cost-effectiveness of these programs has

yet to be examined. According to Avanceña et al. (2021), DTTB is more cost-effective than the

alternative in lowering pneumonia- and diarrhea-related mortality in children under five (5) years

old. Since these two diseases are among the top five causes of death in young infants, pneumonia

and diarrhea were chosen as research subjects.

This cost-effectiveness analysis (CEA) complies with both the reporting requirements of

the Consolidated Health Economic Evaluation Reporting Standards and the recommendations

made by the 2nd Panel on Cost-effectiveness in Health and Medicine. In order to quantify the high-

level costs and effectiveness of implementing DTTB compared to a scenario without DTTB on

pneumonia and diarrhea outcomes, two decision tree models were independently constructed.

Subsequently, the researcher was able to decipher and compile the required data. In light

of these findings, Avanceña et al. (2021) concluded that while DTTB can be a cost-effective

intervention, its value varies depending on the environment and circumstances of the municipality

where it can be used. The health advantages of DTTB have probably been overestimated in this

study as it only looked at a small subset of pediatric outcomes. In order to thoroughly understand

the influence of DTTB on the health of rural and distant communities, extensive research is

necessary. Future cost-effectiveness analysis should experimentally assess different parameters

and consider other illnesses outside of children's pneumonia and diarrhea.

University of Perpetual Help System DALTA Las Piñas

Access to healthcare in rural areas persists to be an issue that is prevalent throughout the

world, particularly in the United States of America. The US Census Bureau estimates that 80

percent of the country's total geographical area—which includes its 50 states and ranks as the

fourth-largest nation in the world—is in rural areas. Nevertheless, only 20% of Americans live in

rural areas (Andrews, 2021).

The fact that there are minimal to no health professionals assigned to rural areas

significantly impacts the American medical industry. According to an article by the Association

of American Medical Colleges (AAMC), there are only thirty (30) healthcare specialists for every

100,000 residents in rural areas, which is concerning when compared to two hundred sixty-three

(263) healthcare specialists for every one hundred thousand (100,000) residents in urban areas

(Andrews, 2021). It simply implies that healthcare delivery to those living in rural areas is in crisis.

Barrio Adentro was a cornerstone of Bolivarian Venezuela's social medicine programs. It

was founded in 2003 by the government of former Venezuelan President Hugo Chavez to

overcome the nation's challenges with rural healthcare (Cooper & Feo, 2022). Due to Barrio

Adentro, free primary and preventive rural health services radically expanded access throughout

the country. Barrio Adentro differs significantly from the DOH's DTTB program despite having

minimal commonalities. In a recent article by Cooper & Feo (2022), entitled "The Rise and Fall

of Barrio Adentro," Barrio Adentro differed from many other government health programs because

it was rooted in underprivileged communities, depended on neighborhood activists to set up

clinics, and its physician was commended for their solidarity with underprivileged patients.

Unfortunately, every health program experiences turning points, like with Barrio Adentro.

Barrio Adentro has significantly deteriorated during its 19-year mission serving Venezuelans. The

popular clinics and holistic diagnostic centers have discontinued playing a significant aspect in

community medical care since the infrastructure in rural areas has deteriorated, the quality of rural

healthcare has fallen, and there is no longer any assistance from the government (Cooper & Feo,

University of Perpetual Help System DALTA Las Piñas

2022). On the bright side, Barrio Adentro was a successful policy that produced overall satisfaction

for all Venezuelans.

In a 2008 article titled "Barrio Adentro: A Look at The Origins of a Social Mission," Castro

claimed that given the country's tremendous poverty and dense population, access to health care

has long been a problem in Venezuela. As a result, the Libertador City Hall began seeking medical

specialists in 2003 who could attend to the medical requirements of those living in the nation's

slum areas. Given the dangerous working conditions in those places, doctors were initially hesitant

to participate in the movement; nevertheless, via its collaboration with the Cuban Medical Mission,

willing and dedicated doctors could join the medical mission.

Through implementing the Barrio Adentro Plan by several Cuban doctors working with

IDEL, Barrio Adentro, a social program aimed at providing health care to slum and rural

communities, accommodated nine million one hundred sixteen thousand one hundred twelve

(9,116,112) patient consultations and conducted four million one hundred forty-three thousand

sixty-seven (4,143,067) health education interventions in 2003. They successfully located venues

that might serve as the incoming doctors' lounge while working in the nation from the beginning

of the plan's implementation to alleviate healthcare inaccessibility. Residents of the slums were

fully supportive of the movement because it was implemented and followed, unlike prior plans

they had been promised. Cuban physicians could treat both acute and chronic conditions, conduct

several medical examinations, and treat multiple patients as the months went by.

Barrio Adentro cleared the path for the realization of the Venezuelans' right to healthcare.

Although it was intended to be a platform to promote ideas about political action and involvement,

it has collectively impacted their opinion of quality medical treatment. Despite facing challenges,

including starvation and unclear agreements, the medical mission that evolved into a national

reaction to healthcare inaccessibility was nonetheless able to address the barrio's lack of access to

competent medical treatment.

University of Perpetual Help System DALTA Las Piñas

Given the substantial number of underprivileged communities in Venezuela, health

disparities are evident. Briggs & Briggs (2011) conducted a study titled "Confronting Health

Disparities: Latin American Social Medicine." It aims to scrutinize the nature and field of one of

Venezuela's healthcare programs, Misión Barrio Adentro, to improve and ease the public's access

to healthcare services. This study wanted to investigate how their healthcare responds to various

public health situations and potential inclusive solutions to bridge the gap in medical assistance.

Two hundred sixty-eight (268), both female and male heads of household, served as the

study's respondents, and locations that were closely watched and interviewed included three (3)

capital-region neighborhoods, two (2) small cities, and two (2) rural areas. After numerous

interviews, it was discovered that the program was effective through creative and sound

interactions with key individuals, such as policymakers, healthcare professionals, and residents.

It was determined that horizontal partnerships between medical professionals and residents

in underserved communities are more effective than top-down and bottom-up techniques because

they effectively address the apparent health disparities within a particular community. As a result,

patients were less hesitant to consult doctors, which helped close the healthcare service gap.

Together with the Brazilian Health Care Reform, Latin American Social Medicine (LASM)

focused on decentralization and health as a social right in 1980. It had both private and public

subsystems. The insured are served by the private subsystem, while the public serves the

underprivileged.

On the other perspective, the Mexican government implemented a strategy of community-

based rights and resource redistribution. The Mexican government is evidence of LASM's

influence. The critical elements of the fundamental characteristics of LASM and its current

healthcare reform are provided by Laurell (2003), as well as its effect on LASM in Mexico City.

University of Perpetual Help System DALTA Las Piñas

Eventually, LASM became apparent in various nations in the late 1970s. As they increased,

it was assumed that the community would advance and the health conditions would continue to

improve. Since the assumptions were created, LASM has gone through economic miracles that

have caused a need for a fuller explanation of the processes behind health, disease, and health

policies.

Social medicine became concerned with the impact of capitalist development and the work

process on health. Social medicine was used as an analytic tool to study the role of social, political,

economic, and philosophical processes as determinants of health and disease, which became the

LASM's main focus

Humans want access to high-quality healthcare, whereas much less fortunate struggle due

to various social determinants of health. Rickshaw drivers are one of Bangladesh's most vulnerable

communities. Due to their social and economic situations, supporting themselves and acquiring

their basic needs is daunting (Banik et al., 2022). Due to this, there was limited access to healthcare,

leading to illness.

According to earlier studies, the lack of medical facilities and human resources makes it

extremely difficult for rural areas to provide high-quality healthcare services. Banik et al. (2022)

conducted in-depth interviews with members of the poor and middle classes in Bhulta to better

understand the challenges faced by rickshaw pullers. Purposive and snowball sampling was used

to choose respondents, and a Bangladeshi rickshaw puller who lives in a rural location agreed to

participate.

Subject to socioeconomic class inequalities, rickshaw drivers recognized physical and

financial barriers to receiving medical care. Physically, the time patients wait for medical care

influences how quickly they receive medical treatment. A different hurdle that led to a person's

condition deteriorating was the unreliability of diagnostic services. On the other side, paying for

medical expenditures can be challenging financially. Financial limitations are also a result of

University of Perpetual Help System DALTA Las Piñas

brokers' influence, and not having sufficient money results in a postponed appointment with a

physician.

Ninety-percent (90%) low-income countries suffer from a healthcare staff shortage which

contributes to the perception of lack of medical staff leading to increased given workload.

A study by Kovacs & Lagarde (2022) investigated the experiences faced by rural healthcare

providers due to the amount of workload and its effects on the quality of healthcare service they

provide. A survey was distributed in four disadvantaged areas of the country, specifically

Ziguinchor, Sédhiou, Tambacounda, and Kédougou. Data from nurses, midwives, and medical

providers, were gathered in health posts and health centers, which are the most common areas

providing primary care.

Medical personnel are in short supply in Senegal. It does not, however, increase the

amount of work they have. Furthermore, regardless of the doctor-to-patient ratio or the number of

administrative responsibilities, the quality of healthcare provided is unaffected as long as they have

relevant knowledge on case management and the facilities required to provide healthcare services.

Humanitarian workers need to be well-prepared now more than ever. Ripoll-Gallardo et al.

(2020), "Residents working with Médecins Sans Frontières: training and pilot evaluation," is to

define a training program created to get medical residents ready for their first field deployment

with Médecins Sans Frontières and to present the results of a pilot evaluation of its efficacy.

A three (3) month distance learning module, a one-week instructor-led coaching session,

and a field placement with MSF were all used in the study's blended learning methodology. Among

the subjects covered in the module were disaster medicine, public health, safety and security,

infectious illnesses, psychological support, communication, humanitarian law, leadership, and job-

specific skills. The first three steps of Kirkpatrick's training assessment model were employed to

gauge its effectiveness.

University of Perpetual Help System DALTA Las Piñas

Eight (8) residents took part, including one (1) resident from pediatrics, three from

anesthesia, and four (4) from emergency medicine. One (1) resident each went to Iraq,

Afghanistan, the Democratic Republic of the Congo, Pakistan, Haiti, and the MSF Mediterranean

search and rescue ship. Two residents went to Pakistan. The post-test and resident performance

scores significantly increased, and the overall course average median score was exceptional.

Synthesis

The Philippines' healthcare system is becoming progressively inaccessible, especially in

rural areas, due to health inequities. These constraints include remoteness and difficulty locating

critical medical supplies (MedHyve, 2021). Along with the region's apparent lack of healthcare

facilities, there is also a shortage of medical practitioners. The DTTB program was established in

1993 to increase the number of qualified and skilled healthcare professionals through training and

medical education (De Guzman, 2021). Furthermore, poverty adds up to the disadvantages that

these rural areas experience. In 2019, Collado stated that poverty causes challenges in basic

amenities & services and makes them susceptible to proper healthcare. Avanceña et al. (2021)

concluded that DTTB could be a cost-effective intervention, but its value varies depending on the

environment in which it is used. Similar to DTTB, "Barrio Adentro" in Venezuela has been vital

in bridging the gap in terms of providing healthcare services to those in need (Castro, 2008).

Socioeconomic class inequalities heavily affect the quality of healthcare response an individual

can receive. (Banik et al., 2022). The researchers aim to know how effectively the DTTB program

addresses the negative impacts of disadvantaged areas' lack of access to high-quality healthcare by

investigating how social medicine programs in the Philippines are performing.

University of Perpetual Help System DALTA Las Piñas

Conceptual Framework

Figure 1. The Conceptual Framework of the Study

The DOH officially launched the DTTB program in 1993 to equip geographically isolated

and disadvantaged areas with physicians (Palmares, 2019; De Guzman, 2021). The Input, Process,

Output (IPO) structure was chosen by the researchers to effectively elucidate the study's conceptual

framework and the relationships between the variables. The input includes respondents who are

licensed physicians from the subsequent batches of the DTTB program, namely Batch 37

(MANDALA), and Batch 39 (SINAGTALA). The researchers will then select their respondents

by employing purposive sampling. Given several restrictions, the researchers opted to collect the

data for the study through an online survey. Lastly, the direct contribution of the DTTB program

to the challenges of healthcare access in rural areas should be concluded.

INPUT

Profile of the respondents:

Age, Gender, assigned

municipality, and DTTB

batch name & number.

Professional experience:

year when they took the

PLE.

Application of

information from the

review of related literature

& studies

PROCESS

Purposive Sampling

 Online

Survey

OUTPUT

Determine the role of the

DTTB program to rural

healthcare inaccessibility in

Eastern Visayas.

Encourage Clinical Clerks to

undertake the DTTB program

to increase doctor-to-patient

ratio in several municipalities.

University of Perpetual Help System DALTA Las Piñas

Theoretical Framework

Figure 2. The Theoretical Framework of the Study

Shortage in human health resources has been rampant in several low-income and middle-

income countries (Avanceña, 2019). As a result, the Doctors to the Barrio program assigned

physicians to various GIDAs. It gave way for existing medical issues to be addressed, such as the

high child mortality rate caused by pneumonia and diarrhea.

University of Perpetual Help System DALTA Las Piñas

The Decision Tree Model served as the foundation for identifying and comparing the effects

of the program's existence. As DTTBs can perform their duties as soon as needed, they help ease

the problematic healthcare delivery. In areas without DTTBs, municipal health officers (MHO)

and rural health physicians (RHP) must still be hired to provide healthcare services. However,

there is a low recruitment rate as salaries for public servants are relatively low (Avanceña, 2019).

In this study, the researchers aim to produce results that will emphasize the effects of the

DTTB program in solving the existing healthcare gaps in the country. Furthermore, this table

represents the role of DTTB in alleviating and improving healthcare quality and accessibility,

narrowing the gap between healthcare quality in urban and rural areas.

Assumptions

The aforementioned related literature and studies clearly state the role of the Doctor to the

Barrios (DTTB) program on Rural Healthcare inaccessibility. The researchers assume a

considerable decrease in the doctor-to-patient ratio in most Philippine municipalities (Medhyve,

2021; Kovacs & Legarde, 2022). Retention in the Philippine National Rural Physician Deployment

Program is thus one factor that contributes to the ongoing decline in the doctor-to-patient ratio

(Flores et al., 2021; Leonardia et al., 2021).

Definition of Terms

Doctor to the Barrios program - A program established by the Department of Health in

1993 to provide quality rural healthcare to geographically isolated and disadvantaged areas

(GIDA) in the Philippines by assigning licensed physicians in several municipalities. It also serves

as the study’s individual variable.

Rural Healthcare Inaccessibility - It is the terminology utilized to describe the situation

& experience of the Filipinos residing at 1st to 4th class municipalities of Eastern Visayas. It is

referred to as the study’s dependent variable.

Eastern Visayas - It is an administrative region in the Philippines recognized as Region

VIII. Eastern Visayas is composed of three main islands and 136 municipalities that are classified

as first-class municipalities. It also serves as the study's research location.

University of Perpetual Help System DALTA Las Piñas

CHAPTER III

METHODS OF RESEARCH AND PROCEDURES

Research Design

This study entitled "The Role of the Doctors to the Barrios Program in Addressing Rural

Health Care Inaccessibility in Eastern Visayas" aims to investigate the role of the DTTB program

in addressing rural health care inaccessibility in Eastern Visayas. It will make use of a mixed

method research design, wherein both quantitative and qualitative research design will be utilized.

The research will both utilize an online survey and an online interview to gather necessary data

from the respondents. Through these, the researchers will be able to determine the effectiveness of

DTTB, the factors affecting DTTB, and the factors that should be satisfied in order to improve

rural healthcare services in Eastern Visayas. The aforementioned research design is the most

appropriate for the study since it is an efficient and convenient method for researchers to collect

more complete and comprehensive data, and it will give the researchers flexibility throughout data

collection.

Research Instrument

In this study, the researchers will identify the physician's role in the Doctor to The Barrios

(DTTB) program in addressing existing healthcare gaps in GIDAs of Eastern Visayas, Region

VIII. In this mixed-method study, the researchers will distribute online surveys and conduct one-

on-one interviews to obtain the necessary data.

Due to some constraints such as varying schedules of both parties and the distance of the

research locale itself, quantifiable data will be obtained through conducting online surveys. It will

contain close-ended questions regarding the repercussions brought by the doctor-to-patient ratio

in addressing the existing medical gaps in GIDAs in Eastern Visayas.

University of Perpetual Help System DALTA Las Piñas

On the other hand, semi-structured online interviews will be held to support and expound

on the data obtained from the online surveys, providing a more profound understanding of the

subject matter. The following are the sample interview questions:

1. Are you a licensed physician?

2. Are you one of the assigned Doctors to The Barrios (DTTB) in Eastern Visayas,

Region VIII?

3. Have you been in the program for more than 3 months?

Research Locale

The study will be conducted in Eastern Visayas, Region VIII Philippines. As the

researchers seek for respondents, assigned DTTBs from the chosen research locale have willingly

responded which became convenient for the researchers to select them as their respondents in their

study. With the responsiveness of the chosen respondents, it eased the hindrance brought by the

unavailability of respondents due to their work conditions.

Sampling Design

In gathering data, the researchers will utilize purposive sampling. This sampling allows

researchers to choose individuals knowledgeable in the field of study (Jordan, 2021). Respondents

are then narrowed down to a set of criteria, which include being (1) a DTTB in the GIDAs of

Eastern Visayas, Region VIII, (2) a part of the Doctor to the Barrios (DTTB) program from Batch

37 (MANDALA), and Batch 39 (SINAGTALA), and (3) a part of the program for more than three

(3) months. These qualifications will provide credible data as they have extensive knowledge of

the existing healthcare situation on the DTTB program given in the chosen locale.

University of Perpetual Help System DALTA Las Piñas

Data Gathering Procedure

The study being a mixed method approach allows the researchers to gather data through

survey questionnaire and interview.

The survey questionnaire will contain close-ended questions while a semi-structured online

interview will be conducted to obtain further information from the initial survey questionnaire.

The interview will approximately last for about thirty (30) minutes to forty (40) minutes at

maximum per individual. Both tools that will be utilized in sourcing data necessary for the study

have restrictions based on the given scope of the study. Google Forms and Google Meet will be

utilized to conduct both data gathering methods as these are the most accessible platforms for both

researchers and respondents.

The data needed for the study will be gathered from Batch 37 (MANDALA), and Batch 39

(SINAGTALA) of the Doctor to the Barrios Program. With them being part of the said program,

they were considered relevant to the study. Furthermore, the respondents were chosen due to their

availability and willingness to partake in the study.

Data Analysis Plan

In light with the study’s aim, the researchers utilized of descriptive statistics to completely

expound the data gathered for research question 3. This data analysis method will make a

comprehensive, yet simple explanation for the results. A bar graph will be used to illustrate the

results of the survey questionnaire.

Formula of Percentage

% = 

 𝑥 100, where;

% = Percentage

f = Frequency

n = Sample size

University of Perpetual Help System DALTA Las Piñas

The formula of percentage will be helpful to the researchers to compute for the results of

research question 3, wherein the researchers will be needing to quantify the gathered data in order

for them to have a conclusion to the said research question.

Since the study utilized a mixed method research design, the researchers will also be having

a separate data analysis part in order to analyze the gathered data from the one-on-one interview

questionnaires. After the interview has been recorded and downloaded, the researchers will

transcribe the MP4 recording into words, in order for them to have a concrete conclusion for

research questions 1 & 2.

University of Perpetual Help System DALTA Las Piñas

CHAPTER IV

ANALYSIS, INTERPRETATION, PRESENTATION OF RESULTS

This chapter will provide an in-depth analysis of the findings and discuss their implications

for the research questions. Twenty-nine (29) respondents completed the survey questionnaire, and

six (6) participants were interviewed to understand their experiences and perceptions regarding the

healthcare system in rural areas in Eastern Visayas. The researchers utilized various statistical

methods to analyze the quantitative data, while the qualitative data was analyzed through thematic

and content analysis. Thus, the findings of this chapter will serve as a basis for the

recommendations presented in the succeeding chapter.

Table 1. Respondent Profile

n # Gender Age DTTB Batch Assigned Province PLE Batch

1 F 31 Batch 39 (SINAGTALA) Northern Samar September 2021

Batch 39 (SINAGTALA)

Western Samar

October 2020

3 M 29 Batch 39 (SINAGTALA) Leyte November 2021

4 M 25 Batch 39 (SINAGTALA) Western Samar October 2021

5 F 30 Batch 39 (SINAGTALA) Southern Leyte October 2021

6 M 31 Batch 37 (MANDALA) Northern Samar October 2019

7 F 29 Batch 37 (MANDALA) Southern Leyte September 2019

8 F 31 Batch 37 (MANDALA) Western Samar September 2019

9 M 29 Batch 37 (MANDALA) Western Samar September 2019

10 F 32 Batch 37 (MANDALA) Leyte September 2019

11 F 36 Batch 37 (MANDALA) Southern Leyte September 2019

University of Perpetual Help System DALTA Las Piñas

12 F 34 Batch 37 (MANDALA) Southern Leyte September 2019

13 F 35 Batch 37 (MANDALA) Western Samar September 2016

14 F 26 Batch 39 (SINAGTALA) Leyte October 2021

15 F 33 Batch 37 (MANDALA) Leyte September 2020

16 F 37 Batch 37 (MANDALA) Eastern Samar February 2014

17 F 37 Batch 39 (SINAGTALA) Leyte March 2022

18 F 31 Batch 39 (SINAGTALA) Northern Samar September 2021

19 F 31 Batch 37 (MANDALA) Western Samar September 2018

20 F 33 Batch 37 (MANDALA) Leyte September 2019

21 F 43 Batch 37 (MANDALA) Eastern Samar March 2019

22 F 35 Batch 39 (SINAGTALA) Western Samar March 2023

23 F 28 Batch 39 (SINAGTALA) Western Samar March 2022

24 F 36 Batch 37 (MANDALA) Southern Leyte September 2020

25 F 28 Batch 39 (SINAGTALA) Leyte March 2023

26 F 27 Batch 39 (SINAGTALA) Leyte March 2022

27 M 32 Batch 39 (SINAGTALA) Leyte October 2021

28 M 30 Batch 39 (SINAGTALA) Southern Leyte September 2022

29 M 45 Batch 39 (SINAGTALA) Leyte September 2005

University of Perpetual Help System DALTA Las Piñas

Table 1 provides a comprehensive illustration of the participants and respondents involved

in the study. Most respondents were female, with twenty-one (21) female and only eight (8) male

respondents. The age of the respondents ranges from twenty-five (25) to forty-five (45) years old.

The data shows that most of the participants were part of Batch 39 (SINAGTALA), with twenty

(15) respondents, and the remaining nine (14) respondents were part of Batch 37 (MANDALA).

Furthermore, the assigned provinces for the licensed physicians were varied. The most

frequently assigned provinces were the Province of Leyte with ten (10) respondents, Western

Samar with eight (8) respondents, and Southern Leyte with six (6) respondents. The Physician

Licensure Examination (PLE) year of the respondents also varied, ranging from 2005 to 2023.

Thus, the respondent’s profile provided an excellent representation of the different DTTB batches,

assigned provinces, and Physician Licensure Exam (PLE) years.

The Doctors to the Barrios program address the health care inaccessibility in Eastern Visayas

Table 2. "The health care services in the community are accessible to all"

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 7 24.1

Disagree 14 48.3

Agree 7 24.1

Strongly Agree 1 3.4

Total 29 100

Most respondents (48.3) disagreed that the health care services in the community are

accessible to all, while 24.1% strongly disagreed. Only a small proportion of the respondents

(24.1%) agreed that the healthcare services in the community are accessible to all. It infers that

there is a perceived inaccessibility of healthcare services in the community among physicians.

University of Perpetual Help System DALTA Las Piñas

Table 2.1 “There is a high number of people in the community seeking medical attention for

their healthcare needs”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 2 6.9

Disagree 4 13.8

Agree 11 37.9

Strongly Agree 12 41.4

Total 29 100

Table 2.1 illustrates that 41.4% of the respondents strongly agree that many community

members seek medical attention for their healthcare needs. Another 37.9% of the participants

agreed with the given question, while only 13.8% disagreed and 6.9% strongly disagreed. The high

percentage of participants who responded, "strongly agree" and "agree" implies a high demand for

medical attention in the community. It indicates that more than the current health care services in

the community may be needed to meet the population's health care needs. However, the relatively

low percentage of respondents who disagreed and strongly disagreed suggests that most

respondents acknowledge the high demand for medical attention in the community.

Table 2.2 “The Doctors to the Barrios program improve access to healthcare services in

Geographically Isolated and Disadvantaged Areas in Eastern Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.4

Disagree 1 3.4

Agree 15 51.7

Strongly Agree 12 41.4

Total 29 100

University of Perpetual Help System DALTA Las Piñas

Table 2.2 presents 41.4% of the respondents strongly agree that the Doctors to the Barrios

program improves access to healthcare services in Geographically Isolated and Disadvantaged

Areas in Eastern Visayas. Meanwhile, 51.7% of the respondents agree with the statement, while

only 3.4% disagree and strongly disagree. It indicates a positive perception among the respondents

toward the program's impact on healthcare access. However, there was still a small percentage of

respondents who disagreed or strongly disagreed, suggesting that there may be some areas that

need improvement or further evaluation. Nevertheless, most respondents showed a positive view

of the program's effectiveness in addressing healthcare access in the mentioned areas.

Table 2.3 “The Doctors to the Barrios program effectively address the healthcare needs of

underserved communities in Geographically Isolated and Disadvantaged Areas in Eastern

Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.4

Disagree 1 3.4

Agree 18 62.1

Strongly Agree 9 31.0

Total 29 100

Table 2.3 presents that most respondents agreed (62.1%) and strongly agreed (31.0%) that

the DTTB program effectively addresses the healthcare needs of underserved communities in

GIDA in Eastern Visayas. It only implies that the program is positively impacting the health

outcomes of the target communities. However, it is also worth noting that a small percentage of

respondents either strongly disagreed or disagreed, indicating the need for further investigation

into areas of improvement for the program.

University of Perpetual Help System DALTA Las Piñas

Interview Answers

In Geographically Isolated and Disadvantaged Areas (GIDAs), access to healthcare is

limited due to non-strategic locations and the distance physicians travel to reach the area. Despite

the presence of the Doctors to the Barrios (DTTB) program, some municipalities still lack doctors,

nurses, and midwives. In addition, some services, such as laboratory services, are unavailable at

the primary care or municipal level, which requires patients to travel for hours to get them. The

cost of these services may also prevent patients from receiving medical care. The need for more

specialized care, such as specialists, at municipal and provincial levels hampers the immediacy of

specialty care in urgent and emergent cases, posing a significant risk. These challenges hinder the

accessibility of healthcare services in GIDAs, which the DTTB program aims to address. (DTTB

Batch 37)

The healthcare needs of the communities in Eastern Visayas are similar to those in urban

areas, such as medical consultations, minor surgeries, birthing services, and newborn screening.

However, rural residents lack access to these essential services due to their non-strategic location

and limited transportation. Health education programs need to be intensified, especially for

adolescents who face numerous cases of teenage pregnancy, as rural residents lack health

awareness which puts them at significant risk. Furthermore, transportation is a major issue in

Eastern Visayas, particularly in island towns where access to primary care is challenging. Different

isolated areas have unique transportation problems, such as the transportation of medical supplies

and emergency transportation. The DTTB program addresses these challenges by deploying

doctors to underserved communities and providing medical care, including health education and

essential medical services, to rural residents without limited access to healthcare. (DTTB Batch

37)

The DTTB program has implemented various strategies to address the issue of healthcare

inaccessibility in GIDA. One of the strategies is to provide scholarships to students willing to

become DTTBs in the future, enabling them to serve in their respective communities and address

the healthcare inaccessibility in GIDA. This initiative is a return of service program wherein the

University of Perpetual Help System DALTA Las Piñas

DTTBs must render services for a certain period in their assigned areas. This program addresses

the issue of healthcare inaccessibility in GIDA and provides opportunities for students to pursue a

career in the medical field while serving their community. (DTTB Batch 39)

The impact of the DTTB program on the healthcare system in GIDA in Eastern Visayas is

significant. One of the reasons for health issues in rural areas is the need for more awareness about

healthcare, in addition to limited access to healthcare. The employment of DTTBs in rural areas

can help address the challenges people in GIDA face. Through the DTTB program, individuals

have learned to value their health and have become more aware of health programs on a national

level, thereby improving access to healthcare in these areas. (DTTB Batch 37).

One area for improvement in the DTTB program is providing training and orientation on

administrative roles such as a Municipal Health Officer (MHO), which is essential for Rural Health

Physicians (DTTB Batch 37). This recommendation came from DTTBs who recognize the

importance of administrative work in their role (DTTB Batch 39). Additionally, addressing the

community's infrastructure needs, such as constructing roads and bridges, is necessary to improve

healthcare accessibility in GIDA. Health is not the sole factor to consider in this regard, and other

aspects, such as infrastructure, must also be given importance to address healthcare inaccessibility

in GIDA (DTTB Batch 39).

University of Perpetual Help System DALTA Las Piñas

The shortage of medical personnel hampers the responsiveness of emergency services in the

area

Table 3. “The number of medical personnel in the area is sufficient”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 9 31.0

Disagree 18 62.1

Agree 2 6.9

Strongly Agree 0 0.0

Total 29 100

Table 3 presents that most respondents (62.1%) disagree that the number of medical

personnel in the area is sufficient, with (31.0%) strongly disagreeing and (62.1%) disagreeing.

Only a tiny percentage of respondents (6.9%) agree that the number of medical personnel in the

area is sufficient, while none strongly agree. These results suggest that there needs to be more

medical personnel in the area among the respondents. There may be a shortage of medical

personnel in the area, which could affect delivering healthcare services to the community. Further

analysis and investigation are needed to explore the reasons behind the perceived insufficiency of

medical personnel in the area.

Table 3.1 “Having enough medical personnel in the area allows swift healthcare responses”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 9 31.0

Disagree 18 62.1

Agree 2 6.9

Strongly Agree 0 0.0

Total 29 100

University of Perpetual Help System DALTA Las Piñas

Table 3.1 presents that most respondents (62.1%) disagree that the number of medical

personnel in the area is sufficient, with (31.0%) strongly disagree and (62.1%) disagree. Only a

small percentage of respondents (6.9%) agree that the number of medical personnel in the area is

sufficient, while none of the respondents strongly agree. These results suggest that there is a

perceived shortage of medical personnel in the area among the respondents. There may be a

shortage of medical personnel in the area, which could affect delivering healthcare services to the

community. Further analysis and investigation are needed to explore the reasons behind the

perceived insufficiency of medical personnel in the area.

Table 3.2 “The number of medical personnel in the area is not enough for the population”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 0 0.0

Disagree 1 3.4

Agree 14 48.3

Strongly Agree 14 48.3

Total 29 100

Table 3.2 shows that most respondents (48.3%) strongly agree and agree (48.3%) that the

number of medical personnel in the area is insufficient for the population. Meanwhile, only 1 of

the respondents disagreed (3.4%), indicating a shortage of medical personnel in the area. It only

implies a need to increase the number of medical personnel in the area to adequately cater to the

population's healthcare needs. This finding is crucial in planning and implementing healthcare

programs that address the inadequacy of medical personnel in the area.

University of Perpetual Help System DALTA Las Piñas

Table 3.3 “The shortage of medical personnel affects the responsiveness of emergency

services”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.4

Disagree 0 0.0

Agree 12 41.4

Strongly Agree 16 55.2

Total 29 100

Table 3.3 shows that most respondents (55.2%) strongly agree that the medical personnel

shortage affects emergency services' responsiveness. Meanwhile, 41.4% agree, and only 3.4%

strongly disagree with the statement. The results indicate that insufficient medical personnel

impact the provision of emergency services, as perceived by the respondents. Thus, it seeks the

need for action to address the shortage of medical personnel in the area and improve emergency

response.

Interview Answers

It has been identified that various factors affect the immediacy of emergency service

response in the area. One factor affecting the emergency response rate is the lack of medical

personnel, remarkably experienced and knowledgeable doctors, nurses, and midwives. Despite the

efforts to increase human resources in the area, there still needs to be more medical personnel who

can provide the best health services to the residents. This shortage of medical personnel hinders

the immediate response of DTTBs to emergency cases per barangay in their area. (DTTB Batch

37).

Another factor affecting the emergency response rate is the shortage of medical tools and

equipment, which forces DTTBs to be innovative in treating patients effectively (DTTB Batch 37).

However, the unpaved roads also hamper the immediate response of DTTBs in emergencies. It is

University of Perpetual Help System DALTA Las Piñas

due to the difficulty of accessing patients and the healthcare center, which leads to transportation

and roadways problems (DTTB Batch 39). Delays in emergency response then led to several

casualties. (DTTB Batch 39).

DTTBs can make recommendations for improving the rural healthcare system. However, it

is essential to have a local governing body that prioritizes healthcare for these suggestions to be

taken seriously and implemented. Continuous lobbying can also help push for a better

transportation system for faster transport of patients and medical supplies. (DTTB Batch 37)

The healthcare services system of rural areas in Eastern Visayas should satisfy certain health

factors to improve.

Table 4. “Addressing the insufficient healthcare facilities and resources would enhance the

healthcare system in the rural areas of Eastern Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.4

Disagree 0 0.0

Agree 8 27.6

Strongly Agree 20 69.0

Total 29 100

Table 4 shows that most respondents (69.0%) strongly agree, 27.6% agree, and 3.4%

strongly disagree. No respondents disagreed with the statement. It infers that improving healthcare

facilities and resources would positively impact the healthcare system in rural areas of Eastern

Visayas. The result highlights the importance of addressing the current healthcare facilities and

resources shortage in rural areas to enhance the healthcare system and improve access to quality

healthcare services.

University of Perpetual Help System DALTA Las Piñas

Table 4.1 “Promoting community health education would enhance the healthcare system in

rural areas of Eastern Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.4

Disagree 0 0.0

Agree 10 34.5

Strongly Agree 18 62.1

Total 29 100

Table 4.1 shows that most respondents (62.1%) strongly agree, 34.5% agree, and 3.4%

strongly disagree. No respondents disagreed with the statement. It infers that improving healthcare

facilities and resources would positively impact the healthcare system in rural areas of Eastern

Visayas. The result highlights the importance of addressing the current healthcare facilities and

resources shortage in rural areas to enhance the healthcare system and improve access to quality

healthcare services.

Table 4.2 “Adequate funding for healthcare facilities and services would enhance the

healthcare system in rural area of Eastern Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.4

Disagree 0 0.0

Agree 8 27.6

Strongly Agree 20 69.0

Total 29 100

Table 4.2 shows that most respondents strongly agree (69.0%) that adequate funding for

healthcare facilities and services would enhance the healthcare system in rural areas. It implies

University of Perpetual Help System DALTA Las Piñas

that the lack of financing for healthcare facilities & services is a barrier to improving healthcare in

rural areas. It highlights the need for policymakers to prioritize financing for healthcare facilities

and services to improve the overall healthcare system in the rural areas of Eastern Visayas.

Table 4.3 “Addressing the scarcity of healthcare providers would enhance the healthcare

system in rural areas of Eastern Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.4

Disagree 1 3.4

Agree 8 27.6

Strongly Agree 19 65.5

Total 29 100

Table 4.3 shows that most respondents (65.5%) strongly agree that addressing the scarcity

of healthcare providers would enhance the healthcare system in rural areas. Meanwhile, 27.6% of

the respondents agree, and the remaining 6.8% strongly disagree and disagree. Thus, addressing

this issue could positively impact the healthcare system in these areas.

Table 4.4 “The availability of medical supplies would improve the healthcare system in rural

areas of Eastern Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.4

Disagree 1 3.4

Agree 8 27.6

Strongly Agree 19 65.5

Total 29 100

University of Perpetual Help System DALTA Las Piñas

Table 4.4 shows that a significant majority (65.5%) of the respondents strongly agree that

the availability of medical supplies would improve the healthcare system in rural areas of Eastern

Visayas. Additionally, 27.6% of the respondents also agreed with this statement, which further

supports the idea that the availability of medical supplies is an essential factor in enhancing

healthcare in rural areas. Notably, only 6.8% of the respondents strongly disagreed and disagreed

with the statement. It implies that ensuring the consistent supply of medical resources and

equipment in rural health facilities should be prioritized to improve the region's healthcare system.

It would require better coordination between healthcare providers and suppliers and increased

funding for healthcare facilities and services to address any supply chain issues that may arise.

Table 4.5 “Providing quality and cost-effective transportation vehicles would improve the

healthcare services of rural areas in Eastern Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.4

Disagree 0 0.0

Agree 12 41.4

Strongly Agree 16 55.2

Total 29 100

Table 4.5 shows that most respondents strongly agreed that providing quality and cost-

effective vehicles would improve healthcare services in rural areas of Eastern Visayas. However,

only one (1) respondent (3.4%) strongly disagreed with the statement. It implies a need to address

the transportation issue to enhance the delivery of healthcare services in these areas. Access to

transportation is crucial in ensuring that patients receive timely and appropriate healthcare

services, especially during emergencies.

University of Perpetual Help System DALTA Las Piñas

Table 4.6 “The development of cell phone services and cell sites would improve the healthcare

services of rural areas within Eastern Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.2

Disagree 0 0.0

Agree 15 48.4

Strongly Agree 15 48.4

Total 29 100

Table 4.6 shows that there is a moderate level of agreement that the development of cell

phone services and cell sites would improve healthcare services in rural areas within Eastern

Visayas. Only 3.2% of the respondents strongly disagreed, 48.4% agreed, while another 48.4%

strongly agreed. The availability of cell phone services and cell sites is a potential way to enhance

healthcare services in rural areas of Eastern Visayas. It may be due to the potential for improved

communication between healthcare providers and patients, as well as access to telemedicine

services. However, it is essential to note that the sample size is small and further research may be

needed to fully understand the potential impact of cell phones and cell sites on healthcare services

in rural areas.

Table 4.7 “Knowing the risks and time travel of healthcare providers and medical supplies will

improve the healthcare system in rural areas of Eastern Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 0 0.0

Disagree 1 3.4

Agree 15 51.7

Strongly Agree 13 44.8

Total 29 100

University of Perpetual Help System DALTA Las Piñas

Table 4.7 shows that most respondents strongly agree (44.8%) and agree (51.7%) that

knowing the risks and time travel of healthcare providers and medical supplies would improve the

healthcare systems in rural areas of Eastern Visayas. There were only 3.4% of the respondents who

disagreed with the statement. It only implies the perceived importance of understanding the risks

and travel time in delivering healthcare services in rural areas.

Table 4.8 “Improving the aforementioned factors will increase the emergency response rate of

healthcare systems in rural areas of Eastern Visayas”

RESPONDENTS (n = 29)

Response f %

Strongly Disagree 1 3.4

Disagree 0 0.0

Agree 8 27.6

Strongly Agree 20 69.0

Total 29 100

Table 4.8 shows that most of the respondents strongly agree (69.0%) with the statement,

followed by those who agree (27.6%) and those who strongly disagree (3.4%). It indicates that the

respondents believe that improving healthcare facilities and resources, promoting community

health education, providing adequate funding for healthcare, addressing the scarcity of healthcare

providers, ensuring the availability of medical supplies, providing quality and cost-effective

vehicles, developing cell phone services and cell sites, and knowing the risks and time travel of

healthcare providers and medical supplies are essential in improving the emergency response rate

of healthcare systems in rural areas of Eastern Visayas. Thus, there is a need for the government

and healthcare organizations to prioritize and invest in these areas to enhance the healthcare system

in the region, especially in emergencies. It also emphasizes the importance of understanding the

needs and concerns of rural communities in developing and implementing healthcare policies and

programs.

University of Perpetual Help System DALTA Las Piñas

Interview Answers

Various factors affect the healthcare services system in rural areas of Eastern Visayas.

Availability of medical supplies is scarce despite efforts to purchase them (DTTB Batch 39).

Budget approval, financing through PhilHealth, and adequate staff are recommended to increase

the availability of medical supplies (DTTB Batch 37). Moreover, transportation is hindered due to

poor road conditions and insufficient funds to rent a van (DTTB Batch 37). The DTTB

recommends improving patient transport, allocating appropriate funding, and constructing safer

roads and bridges to ensure patient and personnel safety (DTTB Batch 39). However, as a DTTB,

risks, such as insurgencies (NPA), must be considered.

Additionally, the DTTB recommends enhancing communication, collective efforts from all

institutions, and utilizing district hospitals to improve patient distribution and increase the

emergency response rate (DTTB Batch 39). Finally, first aid, water safety, & Basic Life Support

training, and earthquake drills can enhance a practitioner's knowledge, familiarity, and experience

in the field (DTTB Batch 37).

The Likert scale data revealed that a sizeable portion of respondents disagreed or strongly

disagreed with the argument that there is an adequate number of medical professionals in the region

(Del Mundo, 2018). On the other hand, most respondents agreed or strongly agreed that there are

not enough medical professionals in the area to serve the community's needs (Palmares, 2019;

MedHyve, 2021; Andrews, 2021). It draws attention to the local medical staff deficit, a severe

issue affecting how quickly emergency services can respond.

The analysis also revealed that most respondents thought that not everyone had access to

healthcare services and that few healthcare facilities and services were available. It highlights how

difficult it is to receive healthcare in remote places, which is made worse by shoddy infrastructure

and constrained transportation options (Collado, 2019). Also, the Likert scale data revealed the

significant difficulties and impediments to adequate and accessible healthcare in rural Eastern

Visayas, notably in GIDA (Avanceña et al., 2019).

University of Perpetual Help System DALTA Las Piñas

According to the survey, most responders are women, showing a gender gap in the

healthcare industry. The data also revealed that a sizable portion of respondents are from the 2019

class and have passed the Physician Licensure Examination (PLE). It could mean that younger

medical staff members are more receptive to community concerns and devoted to their work

(Fernandes, 2017). These results highlight the urgent need for politicians and healthcare providers

to solve the medical staffing crisis, upgrade the system for delivering care, and promote equity in

access (Cooper & Feo, 2022).

University of Perpetual Help System DALTA Las Piñas

CHAPTER V

SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS

Summary

As the Doctor to the Barrios (DTTB) Program continues to adhere to the shortage of

physicians in rural areas of the Philippines, the study aims to determine their role in addressing

present healthcare inaccessibility in rural areas of Eastern Visayas. Determining the efficacy of the

program, identifying the healthcare needs of Geographically Isolated Disadvantaged Areas

(GIDAs) of Eastern Visayas, and examining the immediacy of their medical response are the aims

of the research study. Different studies regarding the healthcare situation of rural areas in the

Philippines imply that various medical services are inaccessible in such places. It proves that

different healthcare problems remain evident despite implementing the Doctor to the Barrios

(DTTB) program. To completely understand their role in addressing such problems, the

researchers used purposive sampling and constructed a close-ended online survey and a set of

semi-structured online interviews. Through this, the researchers will be able to gather concise data

needed for the study. As the researchers completed the target number of respondents and

participants, the gathered data showed concise results, which enabled the researchers to analyze

the medical services situation in rural areas of Eastern Visayas. The researchers also determined

the role of the Doctor to the Barrios (DTTB) program in rural areas of Eastern Visayas.

Conclusions

All information considered; the researchers therefore conclude that the Doctor to the

Barrios (DTTB) program has made a significant difference in ameliorating the identified medical

gaps evident in the rural healthcare system of Eastern Visayas. The responses collated from both

survey-questionnaire and semi-structured interviews further vindicate the existence of the locale

rural health care inaccessibility. Inadequacy of medical supplies (DTTB Batch 39), non-strategic

location, lack of specialized care unit, budget approval, and poor transportation were among the

identified factors that contributed to the insufficient provision of health care services who are

seeking medical attention (DTTB Batch 37). Most respondents agreed that the Doctor to the

University of Perpetual Help System DALTA Las Piñas

Barrios (DTTB) program enhanced access to healthcare services and addressed the healthcare

needs of the communities in Geographically Isolated and Disadvantaged Areas (GIDAs) in Eastern

Visayas. Although the Doctor to the Barrios (DTTB) program has made collective efforts to cater

to the demand for immediate medical attention, the local government must strategize and

coordinate with them to enhance its systematic planning, budget allocation, and increased

deployment of medical staff as a holistic approach to increase the immediacy and efficacy of rural

health care systems.

Recommendations

In view of the conclusions stated, the following recommendations are hereby forwarded to

future researchers who are interested to continue or replicate the study:

1. Face-to-face data collection would immerse researchers in the environmental conditions

DTTBs experience. It will also allow immediate contact with the DTTBs as it would not

require internet service. However, there may be difficulties and risks encountered, such as:

a. Financial demands required to travel to Visayas may constraint researchers' ability to

conduct face-to-face data collection,

b. Unavailability of transportation to travel to the designated barrio, and

c. Exposure to diverse communicable diseases.

2. Given the tight schedule of the respondents, a longer duration of time for data collection is

recommended.

3. Broaden the sample to gather more diverse responses regarding the overall state of the rural

health care system in Eastern Visayas.

4. Explore GIDAs located in other regions of Visayas to compare the health care system

provided in the island group.

University of Perpetual Help System DALTA Las Piñas

REFERENCES

Andrews, L. L. (2021, April 20). Rural Healthcare Access: The providers and the challenges.

PHYSICIANS PRACTICE. https://www.physicianspractice.com/view/rural-healthcare-

access-the-providers-and-the-challenges?fbclid=IwAR3oxiDmZpxpgt-_XWr2bpzpleLR-

RMrC068sV_v_vu8vd-WIAv_WBLB3N4

Avanceña, A. L., Tejano, K. P. S., & Hutton, D. W. (2019, December). Cost-effectiveness analysis

of a physician deployment program to improve access to healthcare in rural and

underserved areas in the Philippines. BMJ Open, 9(12), e033455.

https://doi.org/10.1136/bmjopen-2019-033455

Banik, R., Pranta, M. U. R., Rahman, Q. M., Sikder, M. T., & Talha, M. T. U. S. (2022, October).

Perception regarding health and barriers to seeking healthcare services among rural

rickshaw pullers in Bangladesh: A qualitative exploration. ScienceDirect.

Briggs, C. L., & Mantini-Briggs, C. (2011). Confronting Health Disparities: Latin American Social

Medicine in Venezuela. American Public Health Association, 99(3), 549–555.

https://doi.org/10.2105/AJPH.2007.129130

Bueza, M. (2017, January 29). Life of a doctor in the barrio. RAPPLER.

https://www.rappler.com/voices/imho/159534-life-doctor-

barrio/?fbclid=IwAR0SOipAppe5H8ZfBoF2kX9zzNfNddkWv7H7-k-

Ujv7d93H7XjBsZV-3yRU

Castro, A. (2008, September 8). Barrio Adentro: A Look at the Origins of a Social Mission.

ReVista HARVARD REVIEW OF LATIN AMERICA.

https://revista.drclas.harvard.edu/barrio-adentro-a-look-at-the-origins-of-a-social-

mission/

Collado, Z. C. (2019, November 21). Challenges in public health facilities and services: evidence

from a geographically isolated and disadvantaged area in the Philippines. Journal of Global

Health Reports, 3. https://doi.org/10.29392/joghr.3.e2019059

Cooper, A., & Fescar, O. (2022, March 16). The Rise and Fall of Barrio Adentro. NACLA.

https://nacla.org/rise-fall-barrio-adentro

University of Perpetual Help System DALTA Las Piñas

De Guzman, H. J. (2021, November 3). Doctors to The Barrios, Masters of Public Health.

University of the Philippines Manila College of Medicine.

https://cm.upm.edu.ph/inspire/article/5?fbclid=IwAR1YW2O0bkeptTI8fVE7SHLdce1M

ExN438aGK1liE6bxfjs3fgNV_OdJzd4

Del Mundo, H. J. (2018, February 14). Shortage of hospitals and health workers in the Philippines.

Medical Research Information Center Global. https://www.mricg.info/single-

post/2018/02/14/shortage-of-hospitals-and-health-workers-in-the-

philippines?fbclid=IwAR0SOipAppe5H8ZfBoF2kX9zzNfNddkWv7H7-k-

Ujv7d93H7XjBsZV-3yRU

Fernandes, E. (2017, July 3). Why community medicine (public health) is the sexiest profession

of the 21st century. THE TIMES OF INDIA.

https://timesofindia.indiatimes.com/blogs/global-health-focus/why-community-medicine-

public-health-is-the-sexiest-profession-of-the-21st-century/

Flores, E. L. L., Manahan, E. M. R., Lacanilao, M. P. B., Ladaw, I. M. B. T., Mallillin, M. M. B.,

Mappatao, N. T. Q., Leonardia, J. A., & Pepito, V. C. F. (2021). Factors affecting retention

in the Philippine National Rural Physician Deployment Program from 2012 to 2019: a

mixed methods study. BMC Health Services Research, 21(1), 1–11.

https://doi.org/10.1186/s12913-021-07219-0

Kovacs, R., & Lagarde, M. (2019, January 17). Does high workload reduce the quality of

healthcare? Evidence from rural Senegal. ScienceDirect. Retrieved November 22, 2022,

from https://www.sciencedirect.com/science/article/pii/S0167629622000200

Laurell A. C. (2003). What does Latin American social medicine do when it governs? The case of

the Mexico City government. American journal of public health, 93(12), 2028–2031.

https://doi.org/10.2105/ajph.93.12.2028

Leonardia, J. A., Prytherch, H., Ronquillo, K., Nodora, R. G., & Ruppel, A. (2012, November 20).

Assessment of factors influencing retention in the Philippine National Rural Physician

Deployment Program. BMC Health Services Research, 12(1).

https://doi.org/10.1186/1472-6963-12-411

University of Perpetual Help System DALTA Las Piñas

Manahan, E. M. R., Lacanilao, M. P. B., Ladaw, I. M. B. T., Mallillin, M. M. B., Mappatao, N. T.

Q., Leonardia, J. A., & Pepito, V. C. F. (2021, January 26). Factors affecting retention in

the Doctors to the Barrios Program (Philippines) from 2012 to 2019: A Mixed Methods

Study. Research Square. https://doi.org/10.21203/rs.3.rs-152526/v1

MedHyve. (2021, August 22). The Rural Healthcare Situation in the Philippines. MedHyve.

https://news.medhyve.com/2021/08/22/the-rural-healthcare-situation-in-the-

philippines/?fbclid=IwAR2A4T7fNELtgMSF1RnB_98fmUdVgTRApSGFSg-

Xd0d4umnFcxkpM8TEX9c

Palmares, R. (2019, August 8). A Filipino Ideal Made Real: Doctors to the Barrios. ILIUM.

https://www.xiliumvirtual.com/blog/a-filipino-ideal-made-real-doctors-to-the-barrios

Ripoll-Gallardo, A., Ragazzoni, L., Mazzanti, E., Meneghetti, G., Franc, J. M., Costa, A., & della

Corte, F. (2020). Residents working with Médecins Sans Frontières: training and pilot

evaluation. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine,

28(1). https://doi.org/10.1186/s13049-020-00778-x

Valencia, J. P. A. (2021, May 24). Vaccine champions: A Doctor to the Barrio on challenges being

faced by GIDA areas: A story of a rural health doctor form Datu Blah Sinsuat,

Maguindanao. UNICEF Philippines. https://www.unicef.org/philippines/stories/vaccine-

champions-doctor-barrio-challenges-being-faced-gida-areas?fbclid=IwAR2tFfWO9B-

4B1yKy1fv9wB_Xm72UpGJ_A4WNOWe0I-MphI1HmBuqTVhkKk

ResearchGate has not been able to resolve any citations for this publication.

Does high workload reduce the quality of healthcare? Evidence from rural Senegal

Article

Full-text available

Feb 2022
J HEALTH ECON

There is a widely held perception that staff shortages in low and middle-income countries (LMICs) lead to excessive workloads, which in turn worsen the quality of healthcare. Yet there is little evidence supporting these claims. We use data from standardised patient visits in Senegal and determine the effect of workload on the quality of primary care by exploiting quasi-random variation in workload. We find that despite a lack of staff, average levels of workload are low. Even at times when workload is high, there is no evidence that provider effort or quality of care are significantly reduced. Our data indicate that providers operate below their production possibility frontier and have sufficient capacity to attend more patients without compromising quality. This contradicts the prevailing discourse that staff shortages are a key reason for poor quality primary care in LMICs and suggests that the origins likely lie elsewhere.

Factors affecting retention in the Philippine National Rural Physician Deployment Program from 2012 to 2019: a mixed methods study

Article

Full-text available

Nov 2021
BMC HEALTH SERV RES

Background To address the maldistribution of healthcare providers and the shortage of physicians in geographically isolated and disadvantaged areas of the Philippines, the Philippine National Rural Physician Deployment Program, or more commonly known as the Doctors to the Barrios (DTTB) program was established in 1993. However, as of 2011, only 18% of the DTTBs chose to stay in their assigned municipalities after their two-year deployment, termed retention. This study aims to identify the individual, local, work, national, and international factors affecting the retention of DTTBs in their assigned communities after their two-year deployment. Methods A descriptive, mixed-methods, explanatory design was used. For the quantitative part, the modified and updated Stayers Questionnaire was given to all current DTTBs present in a Continuing Medical Education session in the Development Academy of the Philippines. Descriptive statistics were then presented. For the qualitative part, individual, semi-structured key informant interviews were conducted in-person or via phone with current and alumni DTTBs from 2012 to 2019. Proceedings of the interviews were transcribed, translated, and analyzed thematically. Results 102 current DTTBs participated in the quantitative part of our study, while 10 current and former DTTBs participated in the interviews. Demographic factors and location, personal beliefs, well-being, friends and family dynamics, and perceptions about work were the individual factors identified to affect retention. Social working conditions, career development, and infrastructure, medical equipment, and supplies were among the work factors identified to affect retention. Geography, living conditions, local social needs, and technology were among the local factors identified to affect retention. Compensation, the recently signed Universal Healthcare Law, and Safety and Security were identified as national factors that could affect retention. International factors did not seem to discourage DTTBs from staying in their communities. Conclusions A host of individual, work-related, local, national, and international factors influence the DTTB’s decision to be retained in different, complex, interconnected, and dynamic ways. We also identified implementation issues in the DTTB program and suggested interventions to encourage retention.

Factors affecting retention in the Doctors to the Barrios Program (Philippines) from 2012 to 2019: A Mixed Methods Study

Preprint

Full-text available

Jan 2021

BACKGROUND: To address the maldistribution of healthcare providers and the shortage of physicians in geographically isolated and disadvantaged areas of the Philippines, the Doctors to the Barrios (DTTB) program was established in 1993. However, as of 2011, only 18% of the DTTBs chose to stay in their assigned municipalities after their two-year deployment, termed retention. This study aims to identify the individual, local, work, national, and international factors affecting the retention of DTTBs in their assigned communities after their two-year deployment. METHODS: A descriptive, mixed-methods design was used. For the quantitative part, the modified and updated Stayers Questionnaire was given to all current DTTBs present in a Continuing Medical Education session in the Development Academy of the Philippines. Descriptive statistics were then presented. For the qualitative part, individual, semi-structured key informant interviews were conducted in-person or via phone with current and alumni DTTBs from 2012 to 2019. Proceedings of the interviews were transcribed, translated, and analyzed thematically. RESULTS: 102 current DTTBs participated in the quantitative part of our study, while 10 current and former DTTBs participated in the interviews. Demographic factors and location, personal beliefs, well-being, friends and family dynamics, and perceptions about work were the individual factors identified to affect retention. Social working conditions, career development, and infrastructure, medical equipment, and supplies were among the work factors identified to affect retention. Geography, living conditions, local social needs, and technology were among the local factors identified to affect retention. Compensation, the recently signed Universal Healthcare Law, and Safety and Security were identified as national factors that could affect retention. International factors did not seem to discourage DTTBs from staying in their communities. CONCLUSIONS: A host of individual, work-related, local, national, and international factors influence the DTTB’s decision to be retained in different, complex, interconnected, and dynamic ways. We also identified implementation issues in the DTTB program and suggested interventions to encourage retention.

Residents working with Médecins Sans Frontières: training and pilot evaluation

Article

Full-text available

Dec 2020

Background: Well-prepared humanitarian workers are now more necessary than ever. Essential to the preparation process are: clearly defined learning objectives, curricula tailored to the nuances of humanitarian settings, simulation-based training, and evaluation. This manuscript describes a training program designed to prepare medical residents for their first field deployment with Médecins Sans Frontières and presents the results of a pilot assessment of its effectiveness. Methods: The training was jointly developed by the Research Center in Emergency and Disaster Medicine- CRIMEDIM of the Università del Piemonte Orientale, Novara, Italy, and the humanitarian aid organization Médecins Sans Frontières- Italy (MSF-Italy); the following topics were covered: disaster medicine, public health, safety and security, infectious diseases, psychological support, communication, humanitarian law, leadership, and job-specific skills. It used a blended-learning approach consisting of a 3-month distance learning module; 1-week instructor-led coaching; and a field placement with MSF. We assessed its effectiveness using the first three levels of Kirkpatrick's training evaluation model. Results: Eight residents took part in the evaluation. Four were residents in emergency medicine, 3 in anesthesia, and 1 in pediatrics; 3 of them were female and the median age was 31 years. Two residents were deployed in Pakistan, 1 in Afghanistan, 1 in the Democratic Republic of Congo, 1 in Iraq, 2 in Haiti and 1 on board of the MSF Mediterranean search & rescue ship. Mean deployment time was 3 months. The average median score for the overall course was 5 (excellent). There was a significant improvement in post-test multiple choice scores (p = 0.001) and in residents' overall performance scores (P = 0.000001). Conclusion: Residents were highly satisfied with the training program and their knowledge and skills improved as a result of participation. Trial registration: This study was approved by the Institutional Ethics Committee (date 24-02-2016, study code UPO.2015.4.10).

Cost-effectiveness analysis of a physician deployment program to improve access to healthcare in rural and underserved areas in the Philippines

Article

Full-text available

Dec 2019

Objectives The objective of this study is to explore the cost-effectiveness of Doctor to the Barrios (DTTB), a physician deployment program in the Philippines. Design Cost-effectiveness analysis using decision tree models with a lifetime time horizon and probabilistic sensitivity analysis. Setting Societal and healthcare perspectives. Population Hypothetical cohort of children under 5 years in two provinces (Aklan and Nueva Ecija) and in a representative rural municipality. Participants None. Interventions DTTB’s impact on paediatric pneumonia and diarrhoea outcomes compared with a scenario without DTTB. Main outcome measures Costs, effectiveness (in terms of lives saved and quality-adjusted life years (QALYs) gained) and incremental cost-effectiveness ratio (ICER). Results DTTB is cost-effective in the two provinces that were included in the study from societal and healthcare perspectives. Looking at a representative rural municipality, base case analysis and probabilistic sensitivity analyses suggest that DTTB has an ICER of 27 192 per QALY gained from a societal perspective. From a healthcare perspective, the base case ICER of DTTB is Philippine pesos (PHP) 71 839 per QALY gained and PHP 2 064 167 per life saved, and 10 000 Monte Carlo simulations produced similar average estimates. The cost per QALY of DTTB from a healthcare perspective is lower than the WHO recommended willingness-to-pay threshold of 100% of the country’s per-capita gross domestic product. Conclusions DTTB can be a cost-effective intervention, but its value varies by setting and the conditions of the municipality where it is implemented. By focusing on a narrow set of paediatric outcomes, this study has likely underestimated the health benefits of DTTB. Additional research is needed to understand the full extent of DTTB’s impact on the health of communities in rural and remote areas. Future cost-effectiveness analysis should empirically estimate various parameters and include other health conditions in addition to pneumonia and diarrhoea in children.

Perception regarding health and barriers to seeking healthcare services among rural rickshaw pullers in Bangladesh: A qualitative exploration

Article

Oct 2022

Background Understanding health in daily life can vary from person to person. The concept of health arises from the perspective of an individual's experience. People face several kinds of barriers while seeking healthcare services, where rickshaw pullers are one of the most vulnerable groups to meet their basic health needs. This study aimed to investigate Bangladeshi rural rickshaw pullers’ perception regarding health and what obstacles they face while seeking healthcare services. Methods This study followed a qualitative approach conducted in-depth interviews involving 20 rickshaw pullers in rural Bangladesh from 4th to 15th December 2020. Participants were selected through purposive and snowball sampling techniques. The verbatim transcription was performed, and the thematic analysis was done through manual coding and NVivo version 12. Results According to the study’s findings, participants’ perception regarding health were mainly based on physical, nutritional, and social points of view. The financial hardship to convey medical costs, long waiting time in receiving healthcare services, social class inequality, low trustworthiness on diagnostic services, and mastery of broker in the hospital setting were acknowledged as prevailing barriers to seeking healthcare services. Conclusion Several health perceptions existed among the rural rickshaw pullers. They faced different kinds of barriers while seeking healthcare services, and those obstacles made them hopeless and worried about getting quality healthcare services. Concerned authorities, including government and private organizations, should take effective strategies to ensure that healthcare services are available, reliable, and affordable.

Confronting Health Disparities: Latin American Social Medicine in Venezuela

Article

Feb 2009
AM J PUBLIC HEALTH

We explored the emergence and effectiveness of Venezuela's Misión Barrio Adentro, "Inside the Neighborhood Mission," a program designed to improve access to health care among underserved residents of the country, hoping to draw lessons to apply to future attempts to address acute health disparities. We conducted our study in 3 capital-region neighborhoods, 2 small cities, and 2 rural areas, combining systematic observations with interviews of 221 residents, 41 health professionals, and 28 government officials. We surveyed 177 female and 91 male heads of household. Interviews suggested that Misión Barrio Adentro emerged from creative interactions between policymakers, clinicians, community workers, and residents, adopting flexible, problem-solving strategies. In addition, data indicated that egalitarian physician-patient relationships and the direct involvement of local health committees overcame distrust and generated popular support for the program. Media and opposition antagonism complicated physicians' lives and clinical practices but heightened the program's visibility. Top-down and bottom-up efforts are less effective than "horizontal" collaborations between professionals and residents in underserved communities. Direct, local involvement can generate creative and dynamic efforts to address acute health disparities in these areas.

Rural Healthcare Access: The providers and the challenges

Apr 2021

L L Andrews

Andrews, L. L. (2021, April 20). Rural Healthcare Access: The providers and the challenges. PHYSICIANS PRACTICE. https://www.physicianspractice.com/view/rural-healthcareaccess-the-providers-and-the-challenges?fbclid=IwAR3oxiDmZpxpgt-_XWr2bpzpleLR-RMrC068sV_v_vu8vd-WIAv_WBLB3N4

Life of a doctor in the barrio

Jan 2017

M Bueza

Bueza, M. (2017, January 29). Life of a doctor in the barrio. RAPPLER. https://www.rappler.com/voices/imho/159534-life-doctorbarrio/?fbclid=IwAR0SOipAppe5H8ZfBoF2kX9zzNfNddkWv7H7-k-Ujv7d93H7XjBsZV-3yRU

Barrio Adentro: A Look at the Origins of a Social Mission

Sep 2008

A Castro

Castro, A. (2008, September 8). Barrio Adentro: A Look at the Origins of a Social Mission. https://cm.upm.edu.ph/inspire/article/5?fbclid=IwAR1YW2O0bkeptTI8fVE7SHLdce1M ExN438aGK1liE6bxfjs3fgNV_OdJzd4

THE ROLE OF THE DOCTORS TO THE BARRIOS PROGRAM IN ADDRESSING RURAL HEALTH CARE INACCESSIBILITY IN EASTERN VISAYAS

Abstract

Recommended publications

Beyond numbers: a sustainable approach to physician workforce planning in the Philippines

A Logic Model Evaluation of Barrio Adentro in Venezuela

Innovation of Remote Vital Signs Monitoring and Telemedicine Systems Using Internet of Things for Ru...

Implementation of a cluster initiative in the development of human resource potential of medical org...