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Effects of the Cash Incentive Implementation of Pantawid Pamilyang Pilipino Program on Family Attendance to Health Consultations, School and Family Development Sessions in an Urban Community Setting
Pantawid Pamilyang Pilipino Programı Nakit Teşvik Uygulamasının Kent Merkezinde Yaşayan Ailelerin Sağlık Hizmetlerine, Okul Ve Aile Gelişimi Temelli Yapılan Görüşmelere Ulaşabilmesinin Etkileri
Allan Rod S. Pasuelo

Euras J Fam Med 2019;8(2):51-58. https://doi.org/10.33880/ejfm.2019080201

 

Original Research / Orijinal Araştırma


ABSTRACT

Aim: The study determined the effects of the cash incentive implementation of Pantawid Pamilyang Pilipino Program in terms of family attendance to health consultations, school and family development sessions in an urban community.

Methods: A cross-sectional study was conducted among Pantawid Pamilyang Pilipino Program Filipino families with a total sample size of 124. An assisted interview was done and the data were analyzed using Stata 14.

Results: Among 124 respondents, seventy percent were housewives, 35 finished secondary education with median income of 400 pesos ($7) daily. Out of 381 pregnancies, there were 342 and 39 pregnancies before and after implementation. All pre and post-natal check-ups attended by a physician. Childbirth were in secondary and tertiary health care facilities. Preventive health check-ups for children were reported only in 45 children aged zero to five years old. Deworming were received twice a year by 261/264 children 6-14 years old. There were 96% enrolled in school for the academic year 2018-2019 and 92% receive elementary education. Family development sessions included topics of wide variety.

Conclusion: Overall, the Pantawid Pamilyang Pilipino Program beneficiaries were compliant with conditionalities of the cash transfers. Mothers were seen and giving birth in health care facilities while children are receiving preventive medical care and education.

Keywords: preventive health services, health promotion, cash incentive plans, Pantawid Pamilyang Pilipino Program, Philippines

ÖZ

Amaç: Bu çalışma, Pantawid Pamilyang Pilipino Programı nakit teşvik uygulamasının, kent merkezinde yaşayan ailelerin sağlık hizmetlerine, okul ve aile gelişimi temelli yapılan görüşmelere ulaşabilmesinin etkilerini değerlendirmek amacıyla yapılmıştır.

Yöntem: Kesitsel tarzda planlanan çalışma, Pantawid Pamilyang Pilipino Programı dahilindeki Filipinli aileler ile gerçekleştirilmiştir. 124 katılımcı örneklemi oluşturmuştur. Görüşme sonucunda elde edilen veriler Stata 14 programı kullanılarak analiz edilmiştir.

Bulgular: Yüz yirmi dört katılımcının, %70’i ev hanımı idi. 35'i ise orta öğretimi günlük ortalama 400 peso (7 $) gelirle bitirmişti. 381 gebelik arasında, uygulama öncesi ve sonrası sırasıyla 342 ve 39 gebelik vardı. Doğum öncesi ve sonrası tüm kontroller doktorlar tarafından yapıldı. Doğum eylemi ikinci ve üçüncü basamak sağlık kuruluşlarında gerçekleştirildi. Çocuklara yönelik koruyucu sağlık kontrolleri sadece sıfır ila beş yaş arasındaki 45 çocukta yapılmıştı. 6-14 yaş arasındaki 264 çocuğun 261’inde bağırsak parazitleri için yılda iki kez tedavi uygulandı. 2018-2019 akademik yılı için %96 çocuk okula kayıtlıydı ve% 92'si ilköğretime kabul edildi. Aile gelişimi oturumları çok çeşitli konuları içeriyordu.

Sonuç: Tüm Pantawid Pamilyang Pilipino Programı faydalanıcıları nakit teşvik uygulaması şartlarına uygundu. Çocuklara koruyucu tıbbi bakım ve eğitim verilirken, anneler sağlık kuruluşlarında değerlendirilmiş ve doğum yapmışlardır.

Anahtar kelimeler: koruyucu sağlık hizmetleri, sağlık desteğinin geliştirilmesi, nakit teşvik planları, şartlı para transferi, Pantawid Pamilyang Pilipino Programı, Filipinler


Introduction

Issues on poverty led to the materialization of the two of the largest Conditional Cash Transfer (CCT) programs namely Brazil’s Bolsa Escola program (now Bolsa Familia) and Mexico’s Progresa program (now Oportunidades). The two pioneering CCT programs were replicated by other countries with two main objectives of alleviating poverty and increasing poor children’s stock of human resources to ensure beneficiary’s future wellbeing (1). The programs which target the poorest section of the population (generally among households that have schooling-age children) give financial incentives to families to temporize immediate needs of every member. 

There are about thirty countries who have developed versions of CCTs (2). Overall, CCTs appear to be achieving the program’s explicit short-term goals. Among children of beneficiaries, school participation rates have increased and are less likely to drop-out from school. Differential access to schooling due to age, gender, or minority group affiliation was addressed by the program. Utilization of preventive health services has increased, improving access of children and pregnant women to immunization, nutrient supplements, and regular health monitoring (3).

In the Philippines, Pantawid Pamilyang Pilipino Program (4Ps) was implemented in 2007, a version of CCT for poverty alleviation withsocial assistance and development as the dual objectives of the program (4-6). Social assistance is the giving of monetary support to families belonging to extremely poor category in response to immediate needs while social development is the investment of government in the health and education of poor children through different programs.  

The National Statistical Coordination Board (NSCB) has selected eligible municipalities and beneficiaries based on the characteristics set by the program. The 4Ps program has 4,353,597 active household-beneficiaries and covers 10,235,658 school children aged 0 to 18 (7). Households with income not greater than the provincial poverty line and the households with children below 14 years of age or pregnant women are also considered eligible beneficiaries. 

4Ps is now an integral part of the Philippines’ commitment to the Millennium Development Goals in order to eradicate extreme poverty/hunger, achieve universal primary education, reduce child mortality, and improve maternal health. In 2014, a reevaluation of results of the 4Ps program by Orbeta et al. (8) revealed that 4Ps encourages trial of modern family planning methods, improved mother’s access to health care of at least one antenatal checkup, and with more mothers delivered in health care facilities.

 Similarly, 4Ps provide capacity building programs thru cash incentives to encourage beneficiaries to comply with the program objectives in order to improve the health situation and educational status of members. It is an evidence-driven process of strengthening the abilities of the beneficiaries to sustainably perform core responsibilities stated in the program and to develop independence among beneficiaries. Its effects on the recipients are needed to be studied to measureif it is achieving the long term goal of breaking the intergenerational cycle of poverty (8).

The involvement of a family and community physician is significant since the objectives of the program itself revolve on the health and education of children and women empowerment at the primary level. Doctors and the local government official with first hand contact to poor communities should collaborate for the success of the program. Moreover, the results of the study can be used as basis to evaluate the program in the urban setting and gather basis for recommendations for policy making.

This study was based on a research question stated among Filipino families in an urban community setting, on the effects of the cash incentive implementation of Pantawid Pamilyang Pilipino Program (4Ps) in terms of family attendance to health consultations, school and family development sessions. The general objective was to determine the effects of the cash incentive implementation of Pantawid Pamilyang Pilipino Program in terms of family attendance to health consultations, school and family development sessions in an urban community setting.

Specifically, it was aimed to describe the socio-demographic profile of currently enrolled 4Ps beneficiaries; described the attendance of mothers to prenatal, post-natal and family development sessions as recipients of the cash incentives; described the vaccination and deworming status of children who were family recipients of cash incentives; described the enrolment and school attendance of children who are family recipients of the cash incentive program; and described the number of child birth attended by a health care personnel among families who were recipient of the cash incentive program.

Methods

Study design and Population

A cross-sectional study design was used for this study. Filipino families enrolled as 4Ps beneficiaries living in an urban poor community were chosen as the study population.

Inclusion Criteria and Exclusion Criteria

All 4Ps beneficiaries residing Barangays 100, 101, 102, 103, 104 and 105 in Magsaysay Village, a part of Tondo District in Metro Manila, National Capital Region were included in the study regardless of the time of enrollment to the program which is an urban community with 4Ps beneficiaries. Exclusion criteria include death and separation from the immediate family.

Study Plan

Using systematic sampling, the qualified respondents were determined throughthe DSWD 2017 master list of 4Ps beneficiaries living in Tondo, Manila. 

The4Ps leaders helpedthe researcher to locate the residential areas of the respondents. Aninformed consent was sought before theinterview schedule utilizing aFilipino versionof the questionnaire.

Sample Size Computation

A previous study on the 4Ps implementation showed that 78% of the beneficiaries aged 6–14 years old received deworming pills at least once a year (7). Based on this assumption that 78% of the children who went for deworming with a power of 80% and alpha risk of 5%, a total sample size of 124 was computed using EpiInfo.

Outcomes of the study

The maternal outcomes measured were the number of pre-natal care visit attended by a skilled professional in a healthcare facility; the number ofpost-natal check-up attended by a skilled professional done in a healthcare facility and the number of childbirth attended by a trained professional, manner and place of delivery and the number of Family Development Sessions attended by mothers.

For the children’s outcome, vitamin Aand ironsupplementation rates; number of health facility visit for regular weight monitoring; vaccination utilization rate and number of deworming pills administration and enrollment rates in school of children beneficiaries.

Data Processing, Analysis and Review

The collected data of the researchers were encoded using Microsoft Excel. Data analysis was done using Stata 14. Descriptive statistics such as median was used for numeric variables and frequencies was used to analyze categorical variables.

The research proposal underwent technical review by the University of the Philippines – Philippine General Hospital, Department of Family and Community Medicine Research Committee and ethical review by the University of the Philippines- Philippine General Hospital ERHO prior the start of the study.

Results

A total of 124 mothers enrolled to Pantawid Pamilyang Pilipino Program (4Ps) were includedas respondents. Seventy percent (n=87) were housewives with a median income of 400 pesos per day and only 35 out of the 124 had finished secondary education. The earliest year of enrolment was 2013,six years after the program implementation.

Out of 381 respondents, there were 342 and 39 pregnancies before and after the program implementation. All respondent reported attendance to pre and post-natal check-up (100%) and was seen primarily by a physician in both clinic encounters (Table 1). Home delivery was still observed in a mother who was a program beneficiary but most mothers had deliveries at a secondary health care facility (58.97%) and tertiary hospital (23.08%) respectively. Majority of the respondents had normal spontaneous vaginal delivery (94.87%) attended by a physician (86.62%).

 

Table 1. Attendance of mother beneficiaries of Pantawid Pamilyang Pilipino Program (4Ps) to prenatal, postnatal and number of child birth attended by a health care personnel in an urban community setting

 

Maternal Outcomes from 1999 to present of ALL Respondents

Maternal Outcomes  after 4Ps Implementation last 2011

Total Number of Pregnancies

381

39

Attendance to Prenatal Check-up

100% (381)

100% (39)

Health Care Professional attended the Prenatal Check-Up

Physician

95.80% (365 )

94.87% (37)

Midwife

3.41% (13)

5.13% (2)

Allied Health Profession (Nurses, Volunteer Health Workers)

  1. 82% (3)

-

Manner of Delivery

 

 

NSD

96.85% (369)

37 (94.87%)

CS

2.89% (11)

2 (5.13%)

Place of Delivery 

 

 

Secondary HCF

59.96% (217)

58.97% (23)

Lying In

17.06% (65)

15.38% (6)

Tertiary HCF

16.54% (63)

23.08% (9)

Home

9.45% (36)

2.56% (1)

Health Care Professional attended the Delivery

Physician

77.17% (294)

86.62% (33)

Nurse

0.52% (2)

2.56% (1)

Midwife

19.42% (74)

7.69% (3)

Volunteer Health Worker

2.89% (11)

5.13% (2)

Attendance to Postnatal Check-up

97.89% (372)

100% (39)

Health Care Professional attended the Postnatal Check-Up

Physician

98.40% (368)

94.87% (37)

Nurse

1.07% (4)

5.13% (2)

Midwife

0.27% (1)

-

Volunteer Health Worker

0.27% (1)

-

 

Out of the total 381 children, eleven percent were aged 0-5 years old (Table 2). Regular weight monitoring and Vitamin A-iron supplementation were part of the benefits of the program in which 42 children complied with weight monitoring and 43 received Vitamin A and 37 had iron supplementation. 

Furthermore, 69% or 264 out of 381 were children aged six to fourteen years old in which 261 received deworming pills twice a year. There was a higher compliance rate in vaccinations because vaccine schedules were given thru the expanded program on immunization (EPI) by the Department of Health (Table 2). 

Meanwhile, 346 of the total 366 beneficiaries in the age group of 3-18 years old were enrolled in school for the academic year 2018-2019 in which ninety-two percent are receiving elementary education.

 

Table 2. Status of children-beneficiaries of Pantawid Pamilyang Pilipino Program (4Ps) on preventive health check-ups and vaccination and enrolment to school for the academic year 2018 in an urban community setting

Children’s Outcome

Median/Count

Total Number of Children beneficiaries to 4Ps

381

Children Beneficiaries of 4Ps aged 0-5 who received Regular    

            Preventive Health Check-ups and Vaccines

11.81% (45) 

Vitamin A Supplementation

95.56% (43)

Iron Supplementation

82.22% (37)

Weight Monitoring

93.33% (42)

Immunization

BCG

100% (45)

Hepatitis B

100% (45)

DPT

95.56% (43)

Hib

93.33% (42)

Polio

97.78% (44)

PCV

86.67% (39)

Influenza

62.22% (28)

MMR

93.33% (42)

Varicella

62.22% (28)

Hepatitis A

82.22% (37)

 

Children Beneficiaries of 4Ps aged 6-14 years old

69.29% (264)

Children Beneficiaries aged 6-14 years old who were Dewormed

98.86% (261)

 

Children Beneficiaries of 4Ps aged 3-18 years old

96.06% (366)

Children Beneficiaries aged 3-18 years who enrolled in school for AY 2018-2019

95.58% (346)

Pre-school

7.43% (26)

Elementary

92.29% (323)

Junior High School

0.29% (1)

 

Discussion

Overall, the 39 4Ps program beneficiaries are compliant with conditionalities of the cash transfers. Mothers were seen and giving birth in health care facilities while children are receiving preventive medical care and education.  

4Ps program beneficiaries were mostly housewives and only had secondary education with a median daily income of 400 pesos ($7). All program beneficiaries reported attendance to pre and post-natal check-ups and were seen primarily by a physician in both clinic encounters. Child birth in secondary health care and tertiary health care facilities and regular preventive health check-ups for children-beneficiaries were reported.  Conditionalities for children such as regular weight monitoring, vitamin A, iron supplementation and vaccinations were reported to be satisfactorilycomplied. Moreover, children-beneficiaries also received deworming pills twice a year. Most children were enrolled in school for the academic year 2018-2019 in which a greater number are receiving elementary education. Furthermore, family development sessions were attended by mothers.

Interagency collaboration of the Department of Social Welfare and Development (DSWD) to the Department of Education (DepEd), Department of Health (DOH), Commission on Higher Education (CHED), The Department of Labor and Employment, The Philippine Association of State Universities and Colleges (PASUC) and PhilHealth have played an essential role in the implementation of 4Ps. Educational institutions and rural and barangay health units became the venues for providing the program services which ensured compliance of beneficiaries. The availability of the services for the beneficiaries means strengthening the preventive measures of the government against maternal morbidity and children’s malnutrition and preventable diseases. The programs will help the country achieve better health outcomes. School attendance for children would improve the literacy rate in the Philippines and will give better job opportunities to the beneficiaries. FDS could promote better understanding about the various happenings in the community thus added know-how for better life disposition.

Pantawid Pamilyang Pilipino Program is specific in fulfilling its commitment to the Millennium Development Goals such as eradicating extreme poverty and hunger, in achieving universal primary education, in promoting gender equality, in reducing child mortality, and in improving maternal health care. In this study, high rates were noted among mother-beneficiaries as to physician attended delivery in a tertiary or secondary healthcare facility which is contributory to a better maternal health outcome. In a study by Grunebaum et al. (9) last April, 2017 revealed that midwife-attended home births had the highest rate of neonatal deaths [(Relative Risk (RR): 3.6, 95% Confidence Interval (CI)] than a hospital physician births (1.7; 95%). Among midwife-assisted home births, underlying causes attributed to labor and delivery caused 39.3% (48/122) of neonatal deaths (RR: 13.4; 95% CI 9-19.9) followed by 29.5% due to congenital anomalies (RR: 2.5; 95% CI 1.8-3.6), and 12.3% due to infections (RR: 4.5; 95% CI 2.5-8.1).9Meanwhile, children-beneficiaries were also able to attend to the conditionalities set by the program which revealed high rates. In a study by Shei et al. (10) on 2014, the Bolsa Familia had increased the children-beneficiaries’ health care institution visits for preventive services. It increased the odds for growth monitoring (OR = 3.1; 95% CI 1.9-5.1), vaccinations (OR = 2.8; 95% CI 1.4-5.4), and checkups (OR = 1.6; 95% CI 0.98-2.5) for children 7 years old. A positive spillover effects on older siblings (ages 7-17) were also noted and were no longer required to meet the health conditionalities.For 4Ps beneficiaries, immunization status was reviewed and those not given with vaccines but appropriate for age during the time of enrolment were updated. However, in this study, most beneficiaries already received vaccines for 6 preventable diseases thru the Expanded Program on Immunization (EPI). The seven diseases in the EPI include tuberculosis, poliomyelitis, hepatitis B, diphtheria, tetanus, pertussis and measles. On the other hand, PCV, Hepatitis A, Varicella and influenza are new vaccines included in the EPI thus fewer children-beneficiaries were able to avail. Iron and vitamin A supplementation, deworming and weight monitoring were made available to health centers nearest the respondent’s residence. Enrolment to school is being monitored by school officials in charge. Beneficiaries were only given with an allowable number of absences otherwise the enrollment will be forfeited.

In the 2015 the 4Ps update published in the Official Gazette of the Philippine Government, reported a high compliance rate to the program conditions for the months of March and April 2015. A nationwide evaluation was done and showed that there were 95.95% for health visits of pregnant women and children aged 0-5; and 94.84% attendance in family development sessions. Furthermore, 99.91% of children aged 6-14 were dewormed; 98.99% for school attendance of children aged 6-14; 98.33% for school attendance of children in daycare aged 3-5; and 97.05% for school attendance of children aged 15-18 (7).

Limitations

The respondents of the study were limited to beneficiaries living in an urban community setting, specifically in Tondo, Manila. 

The program implementation was 2007 which is later than the implementation of other government programs especially for maternal and child health. Only 39 respondents of the study were able to avail of the complete conditionalities as 4Ps members. The study focused on the measurable outcomes based on the objectives set. 

This study does not measure the government’s commitment to Millenium Development Goals (MDGs) specifically to eradicate extreme poverty and hunger.

Recommendations

Beneficiaries to the Pantawid Pamilyang Pilipino Program in Tondo Manila are compliant to the conditionalities of the program. Hence, programs can enhance greater number of poor families to be enrolled into 4Ps.  Primary health care institutions of either government-led (Barangay health stations) or non-government and other private agencies (such as Canossa Health and Social Center Foundation in Tondo, Manila) is an essential healthcare partner of the government to reach the grass roots level. These institutions cater most of the 4Ps beneficiaries in the community. Using them as venues to do health related information and campaign drives about the 4Ps program can encourage members to religiously abide with the program conditionalities and could inform the public about the existing program. A referral system using snowball method can be implemented to recruit more families to enroll to the program. A mother beneficiary can be instructed to recruit a minimum of five families who are not yet members of the program but qualified for enrolment. Qualified families can be referred to the DSWD municipal offices for screening and initial assessment prior to enrolment. Increasing the number of families enrolled to the program means more families will be able to avail the program benefits.

The DSWD regional and municipal offices must also coordinate with each municipality’s respective local government units to conduct a house to house recruitment of qualified families to the program. A firsthand encounter with the families will allow immediate screening and initial assessment prior to enrolment.

Strengthening inter-agency collaboration between partners and to intensify efforts to address this concern could help the Philippine government achieve its commitment to the millennium development goals to eradicate extreme poverty and hunger and improve universal health care, primary education, gender equality, child and maternal health care.

Conclusion

Overall, the 4Ps program beneficiaries are compliant with conditionalities of the cash transfers. Mothers were seen and giving birth in health care facilities while children are receiving preventive medical care and education.  

Acknowledgements

The researchers would like to express their heartfelt thanks and gratitude to the following:

To Dr. Shiela Marie Laviña, Vice Chair for Research, University of the Philippines – Philippine General Hospital, Department of Family and Community Medicine for her dedication and passion to teach and guide the investigators in conducting the research study. Her selfless acts of encouragement and expertise made these all possible. To the respondents of the study, who consented to be part of this endeavor. To Dr. Emilio Q. Villanueva, who patiently helped in the data analysis and interpretation. To Mr. Tomas Bacolor and Mr. James Samson, for assisting the researchers in the data gathering and date encoding. To the faculty and staff and colleagues of the researchers from the Department of Family and Community Medicine of the University of the Philippines-Philippine General Hospital, especially to Ms. Ehla Perez for the unending support and assistance during the conduct of the study.

 

References

1. Glewwe P, Kassouf AL. The Impact of the Bolsa Escola/Familia Conditional Cash Transfer Program. Journal of Development Economics 2012;97(2):505-17. 

2. Powell-Jackson T, Mazumdar S, Mills A. Financial incentives in health: New evidence from India's Janani Suraksha Yojana. J Health Econ 2015;43:154-69. doi: 10.1016/j.jhealeco.2015.07.001

3. The World Bank [internet]. Conditional cash transfers [cited 2018 Dec 18]. Available from: http://www.worldbank.org/content/dam/Worldbank/Event/social-protection/Lindert%20-%20CCTs%20.pdf

4. Quimbo S, Capuno J, Kraft AD, Molato R, Tan CAR.Where does the money go? Assessing the expenditure and income effects of the Philippines' Conditional Cash Transfer Program. University of the Philippines School of Economics; 2015 Feb. Discussion Paper No. 2015-02.

5. Diola C [internet].8 in 10 Filipinos 'struggling, suffering' financially [cited 2018 Dec 15]. Available from: http://www.philstar.com/headlines/2015/03/25/1437430/8-10-filipinos-struggling-suffering-financially

6. Piedad Geron MA, Chua R, Songco D [internet].Attaining inclusive growth: Investing in economic development of the poor [cited 2018 Dec 10]. Available from: https://southeastasia.hss.de/fileadmin/migration/downloads/110212-Attaining-Inclusive-Growth-Seminal-Paper.pdf

7. Official Gazette of the Republic of the Philippines [internet]. Pantawid Pamilyang Pilipino Program [cited 2018 Nov 25].Available from: http://www.officialgazette.gov.ph/programs/conditional-cash-transfer/

8. Abdon A, del Mundo M, Tutor M, Valera MT, Yarcia D, Orbeta AJ [internet].Keeping children healthy and in school: evaluating the Pantawid Pamilya using regression discontinuity design, second wave impact evaluation results [cited 2018 Dec 15]. Available from: https://www.researchgate.net/publication/282605551_Keeping_children_healthy_and_in_school_Evaluating_the_Pantawid_Pamilya_Using_Regression_Discontinuity_Design_Second_Wave_Impact_Evaluation_Results

9. Grünebaum A, McCullough LB, Arabin B, Dudenhausen J, Orosz B, Chervenak FA. Underlying causes of neonatal deaths in term singleton pregnancies: home births versus hospital births in the United States. J Perinat Med 2017;45(3):349-57.

10. Shei A, Costa F, Reis MG, Ko AI. The impact of Brazil's Bolsa Família conditional cash transfer program on children's health care utilization and health outcomes. BMC Int Health Hum Rights 2014;14:10. doi: 10.1186/1472-698X-14-10.


How to cite / Atıf için: Pasuelo APS. Effects of the cash incentive implementation of Pantawid Pamilyang Pilipino Program on family attendance to health consultations, school and family development sessions in an urban community setting. Euras J Fam Med 2019;8(2):51-58. doi:10.33880/ejfm.2019080201


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