Lindquist, I.

(2014), the efficiency of healthcare facility is a relative term and has a

multiple, domain specific definitions. Efficiency translates to added value and improved

performance outcomes. Moreover, revisiting the importance of infrastructure and facility

management in the healthcare organization, it is seen as more often the forgotten

information which can play an important role in operational continuity, optimization and

continuous improvement.

Identifying barriers and enablers is useful in terms of designing implementation strategies

for health promotion in primary health care centers that are essential for innovation success.

Implementation strategies can be defined as the sets of methods, techniques and interventions

which is used to enhance the adoption and integration of evidence-based innovations into usual

care. In order to build strong implementation strategies, there is a need to identify factors that

determines the change in practice, namely, barriers and enablers of change. This also requires

learning from the experiences of all innovation agents (Martinez, C. et al., 2017).

Related Studies

As stated by Abbas, T. et al., (2011) in their research about “Analyzing the Efficiency

Differences among Basic Health Units in Sargodha District”, the efficiency in basic health

services at primary level can pave the way for destination. The study rationally demonstrated the

applicability of Data Envelopment Analysis (DEA) in health sector to identify the least and most

efficient Barangay Health Units in Sargodha District. Harmonizing the capability of DEA for

acclimating heterogeneous inputs and outputs is widely accepted and appraised by academia and

policy makers which makes it very exceptional scale of efficiency measurement. Overall, 76%

BHUs were seen as inefficient and destructing the infrastructure. The findings assented with the
communal perception that public health services delivery mechanism in developing countries is

technically inefficient. There must be a multiple cause of this high level of inefficiency in the

BHUs which should be unpacked. The Government should allocate more resources on the health

sector to curb the ruin infrastructure. Moreover, it is recommended that similar studies should be

taken at all level of health services delivery in the country.

Similarly, the study of Ablen, M. et al., (2016) entitled “Primary Health Care Delivery

Performance of Barangay Tambulilid and Barangay Boroc (Rural) of Ormoc City", that being an

urban or rural barangay is a significant element in the efficiency and effectivity of the delivery of

primary health services. Various classifications would affect the barangay’s primary health care

allocation, the capacity of health personnel and facilities, and the participation of its citizens.

Moreover, the presence of the barangay officials in primary health care service delivery also

matters, because without their support to assist the barangay health center to fulfill its duties in

accordance to the LGC, the barangay health clinic would be stagnant and too reliant to the city,

and, subsequently, will influence the performance of the barangay’s primary health care delivery.

The choice of healthcare service provider and the utilization of healthcare services is a

complex multifaceted process especially in the context of a developing nation. Andersen and

Newman as well as Kroeger mentioned age as one of the demographic variables that can

influence an individual’s decision to utilize the health care services. Past studies have empirically

tested and reported the significance of age as a determinant for health care usage. Studies done in

the developed nations (Lahana, Pappa&Niakas, (Greece) 2011; Brown et al. (USA) 2009; Jatrana

and Crampton, (New Zealand) 2009; reported that with an increase in age, the odds of utilizing

the health care services increases for an individual due to the physiological changes that happens
with the passage of time. Such changes also make an individual more vulnerable to health care

problems and therefore can lead to greater utilization of healthcare services.

In conformity with the study of Stefko, K. et al., (2018) entitled “Healthcare efficiency

Assessment using Data Envelopment Analysis in the Slovak Republic”, that in the context of the

ongoing globalization processes and pressures on the efficiency of healthcare systems in the

countries, the study focused on analyzing and evaluating the efficiency of healthcare facilities in

the various regions of Slovak Republic in order to detect significant disparities. It is shown in the

analysis that there is an indirect dependence between the values of variables overtime and the

result of the estimated efficiency in all regions. The regions which had a low value of the

variables overtime achieved a high degree of efficiency and vice versa.

As stated by Abdulraheem, I. et al., (2011) in their research about “Primary Health Care

Services in Nigeria: Critical Issues and Strategies for Enhancing the Use by the Rural

Communities”, the essence of health care to the local government is to make the management of

primary health care (PHC) services more effective and to become closer to the grassroots.

However, in view of the level of health awareness, some begins to question the extent to which

health care has been taken to the doorstep of the rural people. Such problem areas in the

implementation of PHC consist of the hindrances to the development of health like in Nigeria.

This has something to do with insufficient number of medical personnel as well as their uneven

distribution. The third development plan for Nigeria focused on the inequity in the distribution of

the medical facilities personnel. Despite the desire of the government to ensure a more equitable

distribution of resources, glaring disparities are still evident. The deterioration in government

facilities, low salaries and poor working conditions had also resulted in a mass exodus of health

professionals. It is seen that there has been too much concentration of medical personnel at the
urban to the neglect of the rural areas. Immunization outreach services are also inadequately

conducted.

As claimed by Novignon, J. (2017) in the study entitled “Improving Primary Health Care

Facility Performance in Ghana: Efficiency Analysis and Fiscal Space Limitations”, health

centers in Ghana plays an important role in every health care delivery especially in deprived

communities. They serves as the first line of service and meets the basic health care needs.

Unfortunately, these facilities are faced with inadequate resources. While health policy makers

seek to increase resources committed to primary healthcare, it is important to understand the

nature of inefficiencies that exists in these facilities. The objectives of this study are threefold

which includes to estimate the efficiency among primary health facilities (health centers), to

examine the potential fiscal space from improved efficiency and to investigate the efficiency

disparities in public and private facilities. The results show that there is a need for primary health

facility managers to improve the productivity via effective and efficient resource use. Efforts to

improve efficiency should also focus on training the health workers and improving facility

environment alongside the effective monitoring and evaluation exercises.

Based on the study of Zhang, A. et al., (2013) labeled as "Efficiency of Community

Health Service in Urban and Suburban Areas of Shanghai: Based on Production Function”,

increasing human resource investment is a key factor in increasing the community health service

output. Due to the difference of scale merit between urban and rural areas, the government or

other policy makers should also make the development policy for them accordingly. Those

community health centers in urban areas should pay more attention to the services efficiency and

service innovation.
 According to the study of P. Basinga, et al., (2011) entitled “Effect on Maternal and

Child Services in Rwanda of Payment to Primary Healthcare Providers for Performance: An

Impact Evaluation”, there is an increase in the number of institutional deliveries and in the

number of preventive care visits by children aged 23 months or younger and aged between 24

months and 59 months. There were no improvements seen in the number of women completing

four prenatal care visits or of children receiving full immunization schedules.

On the study of Pambid, R. (2015) entitled “Factors Influencing Mothers’ Utilization of

Maternal and Child Care Services”, the results shows that the profile of the mothers are usually

between the age range of 26 to 30 years old. Some of them are over and below this age range,

such as 21 to 25 years old and 31 to 35 years old. The mothers are usually in their mid-fifties

who are in their reproductive stage, optimal age of childbearing with low risk for complications

compared to those who are 40 years and above. Majority are from the rural area. The obstetrical

history of the mothers also reveals that they have an average number of three pregnancies,

deliveries and children. They usually have three to four times of prenatal checkups and very few

instances of premature deliveries and miscarriage. The mothers in the rural areas were in their

right reproductive age during their last baby birth, have low family income and are usually on the

poverty line. They are usually high school graduate and with an average of three pregnancies,

deliveries and children.

Relating to the study of Lin, Y. et. al., (2010) entitled “Maintaining Patient’s Dignity

During Clinical Care: A Qualitative Interview Study”, dignity is a significant core concept in

every nursing care and maintaining the patients’ dignity is critical to their recovery. In the

Western countries, such measures in order to maintain the dignity in patients’ care consists of

maintaining privacy of the body, providing spatial privacy, giving sufficient time, treating
patients as a whole person and allowing them to have autonomy. And that this is an under‐

studied topic in the Asian countries. Nurses’ measures to maintain dignity in patient care were

captured in five aspects such as respect, protecting privacy, emotional support, treating all

patients alike and maintaining their body image.

As claimed by Nasr, E. et al., (2015) entitled “Association between Quality of Family

Planning Services and Client’s Satisfaction Level in Maternal and Child Health Centers in Port

Said City”, the results shows the quality of family planning clinic according to the physical

structure and the availability of contraceptive methods in the clinics. It was found that health

services are completed in all family planning clinics, 70% of family planning centers hanged

family planning materials on wall and about more than three-quarters of them (80%) give family

planning material available to the clients as well as only 20% of them perform group education

to clients on child spacing/family planning. Moreover, it manifest that the family planning

practices are completed in all family planning.

On the study of MacCorquodale, D. (2017) entitled "A Study of the Effectiveness of

Family Planning Clinics in the Philippines", it shows that a study of 190 Philippine family

planning clinics revealed that certain clinic and the physician characteristics were significantly

and positively associated with clinic effectiveness. The clinics which have a high degree of

effectiveness were more likely to be staffed by physicians who wanted three or fewer children,

who relied more extensively on the use of the intrauterine device (IUD) than the physicians in

less effective clinics and who derived more satisfaction from working in family planning than

physicians in less effective clinics. It is seen that the autonomous clinics were more effective

than those integrated clinics and that clinics staffed by the physicians trained by institutions with
more experience in family planning were seen as more effective than those staffed by physicians

trained by institutions with less experience in this field.

According to the research of Gadin, R. et al., (2019) entitled “Family Planning Methods

Among Couples of a Selected Barangay in Tacloban City: Basis for Healthcare Program

Enhancement”, the demographic profile distribution of the participants includes age, religion,

education attainment, occupation, monthly income, number of children and number of years

using family planning (FP). Results shows that the bulk of the participants were within the age

ranges of 21-30 and 31-40. It can be noted that the socio-economic status of couples can be a

determinant in the application of family planning. The age, number of children, and no. of years

using family planning does not affect the couple’s level of awareness. It can rather be affected by

religion being a cultural aspect, educational attainment due to some highly technical methods

that needs deeper understanding, and occupation and monthly income as socio-economic status

of couples gave more access to the information and somehow interest on these methods.

As stated by Maglasang, P. et al., (2018) entitled “A Cross-Sectional Survey on Cold

Chain Management of Vaccines in Cebu, Philippines”, it stated that primary health centers that

stores vaccines have at least one functional refrigerator, freezer and alternative power sources.

The personnel handling the vaccines should be updated on the proper storage and transport like

the use of cold boxes and ice packs to maintain cold chain. The improvement of cold chain

management of vaccine in Cebu, Philippines was also necessary.

According to the study of Sobel et al., (2011), entitled "Implementing a National Policy

for Hepatitis B Birth Dose Vaccination in Philippines: Lessons for Improved Delivery", an

estimated seven million Filipinos are chronically infected with the hepatitis B virus (HBV).

Achieving the high birth dose coverage with hepatitis B vaccine is critical for achieving the
World Health Organization's Western Pacific Regional goal of reducing the prevalence of the

chronic HBV among children 5 years of age to <2% by 2012. Some experiences sin the

Philippines showed that actions by national, regional and health facility policy makers such as

establishing national policies, distributing detailed and specific guidelines, conducting effective

training and supervision and having hospital standing orders substantially increased the hepatitis

B vaccine birth dose coverage.

Based on the study of Kung, Y. (2014) entitled "A Quality Improvement Project to

Increase Influenza Vaccination in Healthcare Personnel at a University Health Center", it

revealed that the factors influencing vaccine uptake may be different across the practice settings.

It is important to identify the facilitators and barriers that are unique to health centers to better

plan and implement the interventions to improve the vaccination rates. Furthermore, at a time

when resources are limited, it is critical to identify the most effective strategies to maximize

outcomes.

Synthesis

The series of studies written by the local and foreign authors in this chapter discussed the

concepts and narrative details of relevant and related information to the study. The above

literature and studies are closely related and supports the current study for it helped the

researchers to identify and determine the level of efficiency and extent of implementation of the

basic health services in the selected health centers which is located in Tayabas, Quezon. As

stated, the health center really plays an important role in health care delivery in every country.

This also shows some points that the health care system undergone various changes in providing

health quality and health services in terms of the maternal checkup, immunization services and

family planning services. There are an insights of similarities with the present study included
which is about determining the significant relationship and differences for the level of efficiency

and the .extent of implementation of the basic health services. The studies of Abbas, T. et al.

(2011), Margaret Ablen and Roxanie Ranido (2016) were found related to this study as their

studies discuss the efficiency of the delivery of basic health care services. The study of

Abdulraheem, I. et al, (2011), states some critical issues in the rural communities, presented that

there has been too much concentration of medical personnel at the urban to the neglect of the

rural areas. Immunization outreach services are also inadequately conducted. The study of An

Zhang, Wen Xia and Yong Bao (2013) presented that those community health centers in urban

areas should pay more attention to the service efficiency and service innovation. The study

Kung, Y. (2014) stated that the factors influencing vaccine uptake may be different across

practice settings. From the studies reviewed, it shows that there were comparable variables that

have been considered by the different researchers. In general, these helped the researchers to

gather valuable data and ideas that guided them in their research and to assimilate and

understand the concepts of the study. Likewise, it provided significant information that helped

them in conducting the study.