Indigenous Peoples Plan

Medical Health Support Project (Building Medical Facility for the Indigenous People’s Protection)

October 29, 2020

I. Rationale of the Study

Indigenous people are distinct social and cultural groups that share collective ancestral ties to the
lands and natural resources where they live, occupy or from which they have been displaced (World
Bank, 2020). Their identities, cultures, livelihoods, as well as their physical and spiritual well-being are
inextricably linked to the land and natural resources on which they depend on.

According to the World Bank Organization, there are approximately 476 million Indigenous Peoples
worldwide in over 90 countries. Although they make up over 6 percent of the global population, they
account for about 15 percent of the extreme poor. IPs have experienced profound disruption, including
epidemics, forced relocation, cultural colonization and genocide over the past few centuries. This legacy
of inequality and exclusion has made indigenous communities more vulnerable to the impacts of climate
change and natural hazards, including to disease outbreaks such as Covid-19. Vulnerabilities to the
pandemic are exacerbated with the lack of access to national health, water and sanitation systems, and
mobility restrictions that have greatly impacted their livelihoods, food insecurity and well-being.

The evolution of indigenous primary health care services arose from mainstream health services
being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often
being excluded and marginalized from mainstream health services (Globalization and Health, 2018)

According to a research and data that Assisi Development Foundation (ADF), out of the 25 million
Filipinos recorded to be living a lifestyle considered poor, 1.5 million of these are considered to be at
extreme poverty. This number had recently increased to 1.7 million. According to Benjamin Abadiano
(president of the ADF), One of the things that the government before had trouble addressing was the
increasing rate of child mortality. Research was done and found out that around 1.7 million Filipinos are
considered extremely poor and a big chunk of it are IPs.

Consider the fact that most of the Culturally-indigenous peoples are far away to towns or cities and
only few of them had clinic or medical facilities in their places, the other IPs still need to travel a
kilometers away just to go to hospitals or clinics to have a medical care.

One of the group of IPs who somehow have experienced these kind of situation are the Aeta
Magbukún of Bataan in Luzon, municipality of Mariveles located at the southern tip of Bataan Peninsula.
They are the Philippines remain one of the least known and documented Indigenous tribes. They retain
primarily subsistence hunter-gathering strategies to supply their basic needs. According to the study of
the Singapore Journal of Tropical Geography (2013), the Aeta continue to endure dispossession, poverty
and political discrimination through decades of protracted land rights processes.
 Through the continued encroachment of non-Indigenous populations, the Aeta Magbukún persist at
a critical level. Finding it increasingly difficult to sustain their traditional livelihoods, they must engage in
informal commerce to procure sufficient food throughout the year (Journal of Anthropology, 2013)

Part of the solution has been to establish IPs (Aeta Magbukún) a specific primary health care
services such as medical and dental health check-up.

This indigenous peoples plan aims to give a free check-ups and medical services for the Aeta Tribe of
Bataan in Luzon and as well as to give a new knowledge to the Aeta Tribe on how will they take good
care of their health through seminars and/or sessions. Also to comply a support alliance to the
Philippine Indigenous Peoples Rights Act (1997) and the World Bank’s OP/BP 4.10 enable to establish
the proposed project in benefits for the Aeta Tribe of Bataan in Luzon.

A. Policy Context
The project will adopt the definition of indigenous peoples under the Philippines’
Indigenous People’s Act (Republic Act No. 8371) which states that IPs are: “a group of
people or homogenous societies identified by self-ascription and ascription by other,
who have continuously lived as organized community on communally bounded and
defined territory, and who have, under claims of ownership since time immemorial,
occupied, possessed customs, traditional and other distinctive cultural traits, or who
have, through resistance to political, social and cultural inroads of colonization, non-
indigenous religions and culture, became historically differentiated from the majority of
Filipinos”. ICCs/IPs shall likewise include peoples who are regarded as indigenous on
account of their decent from the populations which inhabited the country, at the time
of conquest or colonization, or at the time of inroads of non-indigenous religions and
cultures, or the establishment of present boundaries, who retain some or all of their
own social, economic, cultural and political institutions, (Section 3, Article III).

Further, the Project shall contribute to the promotion of the various rights of indigenous
people in the Philippines as provided for in the IPRA. Specifically, Section 25 of Chapter
IV of IPRA guarantees the access of IPs to basic services, including health. Moreover, the
project shall be implemented in a manner that promotes the important rights of IPs to
self-governance and empowerment (Chapter IV) and cultural integrity (Chapter VI).

The World Bank’s Indigenous Peoples policy (OP/BP 4.10) contributes to the Bank’s
mission of poverty reduction and sustainable development by ensuring that the
development process fully respects the dignity, human rights, economies, and cultures
of Indigenous Peoples. For all the projects that are proposed for Bank financing and
affect Indigenous Peoples, the Bank requires the borrower to engage in a process of
free, prior, and informed consultation. The Bank provides project financing only where
 free, prior, and informed consultation results in broad community support to the project
by the affected Indigenous Peoples. Such Bank-financed projects include REPUBLIC ACT
NO. 8371, the Indigenous Peoples Rights Act of 1997: an act to recognize, protect and
promote the rights of indigenous cultural communities/indigenous people, creating a
national commission of indigenous people, establishing implementing mechanisms,
appropriating funds therefore, and for other purposes, Chapter II, Section 3 (h).

B. Indigenous Peoples in the Philippines and their Health Situation

Data from the National Commission on Indigenous People show that there were about
12 million indigenous peoples in the Philippines. The majority (61%) of the IP are in
Mindanao while 33% reside in Luzon. The remainder 6% are scattered among the
Visayan Islands. Historically, the IP communities resisted assimilation thus, they have
been driven to remote rural areas with no or inadequate access to basic services such as
health. Thus, most IP’s are among the indigent sectors in the country. A large body of
research exists in the country on the health of indigents as well as the problems of faced
by indigent families in accessing health care. Health outcomes among indigent families
in the Philippines are significantly worse than among non-indigent families.

Access problems relate to: (1) distance to health facilities/services, (2) lack of medicines,
drugs in facilities, (3) lack of medical/health facilities. Given that IPs are included in the
indigent population, these problems are equally relevant for this group. In addition, IPs
face various cultural, social barriers, although the extent of these barriers vis- ȧ-vis
implementation of universal health care are not well documented. Consultations with
non-governmental organizations indicate that many of these barriers may be related to
potential discrimination faced by IPs when they visit health facilities. Moreover, IPs
practice indigenous medicine, and these practices need to be integrated to the extent
possible to make health services more accessible to IPs. Use of traditional midwives
(hilots) is also critical.

There instances when basic health services reach the IP communities. However, detailed
information on the specific health situation as well as resources of the IPs, including
their indigenous health practices, beliefs and health seeking behavior is limited.
Anecdotal stories tell of IPs’ apprehension in having their children immunized.
Consultation with the National Commission on Indigenous Peoples (NCIP) reveals that
some IPs do not even want to go to hospitals and prefer to deliver their babies at home,
as well. Home deliveries have been said to account for high maternal and neonatal
deaths among IPs.
C. Health Policies and Programs for IPs
Health is a priority of the State especially for disadvantaged population, which includes
indigenous peoples. In 1987 Constitution of the Philippines mandates the protection and
promotion of the right to health of the people and instills health consciousness among
them. This state policy is operationalized through Kalusugan Pangkalahatan (KP), a
focused approach to health reform implementation ensuring that all Filipinos receive
the benefits of health reform, which shall be measured by the progress made in
prioritizing the poor and the marginalized, such as indigenous population, older persons,
differently-abled persons, internally-displaced population (Administrative Order No.
2010-0036 “Achieving Universal Health Care for All Filipinos”).

As early as 2004, the Department of Health has issued a policy on geographically

isolated and disadvantaged areas (GIDAs), a local health systems development strategy
for far-flung areas and marginalized populations, such as islands, mountain areas,
conflict-affected areas, and IPs to achieve equity in health and improve access to health
resources and services. The GIDA implementation provides for regular consultations
with IPs at the local level. Recently, DOH directed significant fund allocation for the
development of GIDAs, and systems-wide interventions to increase and extend coverage
of health service provision through Department Memorandum No. 2011-0239
“Prioritization of GIDAs in Province-wide Annual Operations Plan (AOP) to support KP
Execution Plan. Specific interventions for IP as identified in province-wide annual
operational plans have previously included:
 MCH- birthing facility at community level- CEMOC/BEMOC to improve access to
FBD by IPs ; upgrading of FBD priority on GIDA areas
 IP health workers- scholarship for IP midwives;
 Program materials/IEC materials- community-health workers’ manual which is
illustrated and localized.

An operational Manual for Community Volunteer Health Workers (CVHWS) has long
been in use in the country to guide volunteer health workers in delivering appropriate
and responsive health services to communities. The Manual provides guidelines, as well
as illustration on various health care work and services for all members of the
community.