American Academy of Pediatrics Promotes Child Health in the Philippines

The Bagong Barangay Program – "The New Village Program" – was one of four initial International Community Access to Child Health (I-CATCH) projects funded in the first year of these grants, from 2006 to 2009. The I-CATCH grants program, founded by the American Academy of Pediatrics’ Section on International Child Health, gives seed funding to pediatricians living and working in resource-limited countries to improve access to child health and encourage partnership with local community resources, state and national ministries of health, and nongovernmental agencies. As of fall 2011, I-CATCH will have funded 29 projects in 20 countries around the world. The 2012-2015 I-CATCH funding cycle is now open for applications, which are due Aug. 1, 2011, and can be accessed at the I-CATCH website.

The Bagong Barangay Program is a community-based system for family-centered care of at-risk mothers and infants in a low-income urban community of 35,500 in Manila. At the start of the program, prenatal care was limited and poorly coordinated; high-risk pregnancies were undetected; and there was a lack of communication between the place of birth, the primary care provider, specialty clinics, and support services. The overall plan was to train community health workers to identify high-risk pregnancies and high-risk newborns, refer when necessary, enroll every child in a medical home, and institute a tracking system that would include home visits and ensure continual care.

A community needs assessment identified existing resources and gaps in delivery of services, and partnerships were established with community-based health care providers that included the department of obstetrics and gynecology at the Philippine General Hospital, the Manila Health Department, and other lying-in centers and hospitals.

It was not difficult to conduct the community needs assessment because there were previous opportunities to work in an adjacent area, which provided an existing network for the community partners and our medical team. The political scenario – a general and local election meant changes of government officials – delayed project implementation, although meetings were still conducted even prior to the actual community immersion. A more extensive discussion, however, went into the working definition what "high risk" meant for the community and the hospital teams.

More problems were encountered in coordinating services within the hospital once a referral for admission of a high-risk mother was made, because of constraints such as availability of beds, closure of the nursery for infection control, and other political complexities of the public hospital system. The Bagong Barangay community, on the other hand, was more flexible. It easily adapted to the medical team’s recommendations, and showed a lot of enthusiasm and support despite these challenges.

Problems encountered in identifying, referring, and tracking high-risk pregnant mothers and newborns, and then providing a medical home for every high-risk infant in the community, included the "transient" nature of some of the families, which made tracking difficult. There also were concerns about changes of "family names for identification," which further added to the confusion and delay. The actual evaluation of the high-risk newborns in the hospital setting was another problem, because the babies had to be transported to the high-risk clinics every month. These and other related issues, such as having the mother or family present during the assessments, made the implementation of the medical home by far the biggest challenge. A limited understanding of the medical home concept, the lack of resources, and inadequate networking of services were recurrent issues.

As of August 2010, of the 1,012 pregnancies in the community, we had 885 deliveries; 58 were high-risk neonates, with 49 (15%) from "high risk" pregnancies (n = 319) and 9 (1.5%) from normal pregnancies (n = 566). Of the 49, 21 (43%) underwent a full developmental assessment, with 8 (38%) having global developmental delay and 1 (5%) having specific delays. The other 28 (57%) high-risk neonates have yet to be fully assessed. Teenage pregnancies accounted for an alarming 29% of all deliveries.

To a great extent, initial difficulties were addressed with a lot of persistence and some basic strategies. There was a need to deal with the "red tape" in the hospital, so a simple compromise was reached regarding the number of high-risk pregnancies admitted. Reorientation seminars were conducted for the departments of obstetrics and gynecology and pediatrics, and posters were placed in the hospital to remind both the doctors and families regarding this project. Babies were seen in the community for evaluation instead of being brought to the high-risk clinic at the hospital. Accessibility and continuity of care, two key elements of the medical home, were implemented.