Sidestory: Helping the Birth Attendants

Last July 2009, I happened to come across the Asian Development Bank (Southeast Asia Department) and read about their Enhancing Midwives' Entrepreneurial and Financial Literacy (Credit for Better Health Care Project). I was not sure how this support system would work but I emailed the project coordinator nonetheless and inquired about the project. As far as I understood it, it is about helping midwives on how to start their livelihood. Since it is a Credit for Better Health care project, I was thinking that maybe some loan for capital investment is involved here. I have always wanted to put up a cooperative for my midwives or even my barangay health workers or traditional birth attendants (hilots), especially the latter. My email was something like this:

"Vincent De Wit
ADB Officer
I am Dr. Bien Eli Nillos, Municipal Health Officer of the Municipality of
Candoni, Negros Occidental, employed by the National Government under the
Department of Health's Doctors to the Barrios program. My area of
assignment is a 4th class municipality in the province of Negros
Occidental, with a population of 27,000, divided into 9 barangays. It is
landlocked and accessible by road, 40 kilometers away from Kabankalan City
and 130 kilometers away from Bacolod City which is the capital of the
province.
Part of my personal mission as a DTTB is to uplift health outcomes of my
area, particularly those answering the Millenium Development Goals such as
reduction of maternal mortality rate and infant mortality rate.
Before my deployment, Candoni has a high maternal mortality rate with
around 7 per 1,000 livebirths in 2007, and the trend was increasing. This
was due to the fact that the municipality has a low facility-based rate of
deliveries and low rate of deliveries attended by skilled-health workers.
Infant mortality in 2007 was also high at around 25 per 1,000 livebirths.
Through strict implementation of the facility-based delivery and upgrading
our facilities, we were able to reverse the situation. We were able to
increase our facility based deliveries from 23% in 2007 to 70% in 2008. We
were able to reduce slightly our infant mortality rate to 21% and thereby
halt the increasing trend in infant mortality. Successfully, we were able
to reduce our maternal mortality rate to 0% in 2008.
With these successes, we were able to provide better health care to our
mothers and their children. Unfortunately, we are still a long way to go.
What keeps us from moving forward is the lack of support for manpower.
Our municipality's budget is dependent on Internal Revenue Allotment. It
cannot afford to provide enough compensation for its health care workers.
Presently, there are 9 barangay midwives, 2 nurses, 1 midwife
microscopist, 1 rural sanitary inspector and 5 midwives and 2 nurses
assigned in the Night emergency clinic and lying in center. Those assigned
in the NEC and lying in are job orders. The municipality has yet to
provide the Magna Carta benefits in full.
It is my desire to provide my health care workers the compensation that
they so deserve. We are looking for external sources of funds, enough to
provide for their families left at home while they take care of other
families. We are thinking of starting a cooperative that may either sell
family planning commodities or provide livelihood opportunities to
children of the midwives who are out-of-school or their unemployed
husbands. The problem is how to begin.
When I found out about your grant on Enhancing Midwives' Entrepreneurial
and Financial Literacy (Credit for Better Health Care Project), I thought
of inquiring your organization as to how this support works. The objective
is to request any assistance from your organization that would help us
start our small project that would even involve later our barangay health
workers and trained traditional birth attendants who have lost their
source of income due to the implementation of facility-based deliveries.
I am very much hopeful that your organization can help us..
Should you wish to contact me for whatever purpose, please contact me at
********** (mobile), (63-034) ********* (home) or (63-034) ********
(office).
Thank you very much and I hope your organization can provide us with some
assistance.
Sincerely,
Bien Eli Nillos, MD
MHO-OIC
Municipality of Candoni, Negros Occidental"

Today while checking my emails, I was able to receive two emails from them, both with positive results.

"Dear Dr Bien Eli Nillos,

Thank you for your email and for your interest in the proposed subproject
on Enhancing Midwives' Entrepreneurial and Financial Literacy under the
Credit for Better Health Care Project.

I will forward this email to our executing agency overseeing the
implementation of this project.

Kind regards,
Emiko Masaki
Southeast Asia Department
Asian Development Bank"

Ms Emiko Masaki must have immediately forwarded the email because the executing agency overseeing the implementation of the project emailed me immediately (actually copy furnished me the email in response to Ms. Emiko's email)

"Hi, Ms. Emi,

This is a challenging case of health workers wanting to organize a health
cooperative to expand health services in the municipality, and increase
income of health workers organized as such.

We will contact the good doctor and assess realistic options to support
them. Dr. Nillios can call me as well thru mobile ********** or office
numbers ******** loc. 2332 or ********. Medical Missions composed of 21
hospitals nationwide is organized as a cooperative.

Thank you.
Nonoy"

I am definitely going to pursue this shelved project and if it will push through this will be my answer to the question jokingly asked by my health staff in relation to my Buntis Baby Bag Project: "Doc, paano ya kami nga nagapabata? May bag man kami nga pagabatunon?(Doctor, what about us birth attendants? Do we also get a bag?"

Again, prayers and support are much needed.