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CHAPTER I

THE PROBLEM AND ITS SCOPE

INTRODUCTION

Rationale of the Study

“An ounce of prevention is better than cure,” according to

Benjamin Franklin (2013). It is on the basis of the notion that there

is a need to promote awareness in the implementation of Iligtas sa

Tigdas ang Pinas Program. The popular notion has continued to

gain popularity and recognition in the health care industry.

Communicable diseases are the leading cause of illness in the

Philippines today. Most often, they afflict the most vulnerable, the

young and the elderly. They have numerous economic,

psychological, disabiling and disfiguring effects to the afflicting

individuals, families and communities.

Moreover, in this situation, the government of the Philippines

expanded the Program on Immunization (EPI) which started in

1976 and has successfully vaccinated and protected millions of

children before they reach one year old. Initiative for a well-

planned additional supplemental immunization has created disease

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reduction impact and rapid acceleration performance amidst

changes in leadership and changes in the country’s health status,

organizational structure and operational management.

Before the Expanded Program on Immunization (EPI) started

in the Philippines in 1976 up to 1997, measles belonged to the top

10 causes of morbidity in the country. Many children continue to

suffer and die from measles and its complications; hence, it is

worthy to eliminate the disease.

Measles is a highly contagious infection and a public health

problem in the Philippines. It is dangerous to very young and

under nourished children, it is very easy and rapidly transmitted

from person to person through air or direct contact. Based on

Department of Health (DOH) in the Philippines records 6,000 to

12,000 measles causes are reported yearly with 150 to 350

children under the age of 5 die annually in the year 1996 (DOH,

2014)

After the massive immunization in 1998, the measles cases

reported in 1999 decreased. The cases started to increase (DOH

report) the following year and in the succeeding years with 7,480

reported for the year 2000, 7,327 cases in 2001 and 9,586 in

2002. The number of deaths also increased: 288 reported in 2000,

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293 in 2001 and 324 in 2002. Most alarming increase in 2003 with

8, 395 cases recorded from the period from January to November

2003 as reported by the Department of Health (DOH, 2004)

Health authorities are investigating the reported emergence

of measles in four towns in Cebu province. Rennan Cimafranca,

epidemiologist of the Department of Health in Central Visayas, said

they have investigated 61 cases in Barangay Lusong in Tuburan

town last month. Cimafranca said there are 32 suspected measles

cases in Minglanilla, 15 cases in Barangay Catarman and more than

20 in Barangay Sta. Cruz in Liloan. Five cases were also reported in

Barangay Poblacion Dos, Tuburan. At least 29 blood samples have

been taken from patients from the affected areas and these will be

sent to the Research Institute for Tropical Medicine (RITM) in

Manila (Phil Star, 2012).

The researchers have the needed competencies in conducting

the research with the basic knowledge in Nursing Research and

related learning experiences which make them competent to make

the said research.

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Literature Background

The health care delivery system in the Philippines is two-fold

meaning that it is divided into two sectors: the private and the

public. In 1999, the Department of Health reported that there were

1,794 hospitals and 83,491 beds nationwide. Of these 1,794

hospitals, 648 are government owned. The other 1,148 are

privately owned. There are additional rural medical establishments

that provide doctor. The Philippine health care system has rapidly

evolved with many challenges through time. Health service

delivery was devolved to the Local Government Units (LGUs) in

1991, and for many reasons, it has not completely surmounted

the fragmentation issue. Health human resource struggles with the

problems of underemployment, scarcity and skewed distribution.

There is a strong involvement of the private sector comprising

50% of the health system but regulatory functions of the

government have yet to be fully maximized. Health facilities in the

Philippines include government hospitals, private hospitals and

primary health care facilities. Hospitals are classified based on

ownership as public or private hospitals. In the Philippines, around

40 percent of hospitals are public (Department of Health, 2009).

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Out of 721 public hospitals, 70 are managed by the DOH

while the remaining hospitals are managed by LGUs and other

national government agencies (Department of Health, 2009).

The health care model adapted from Ferlie and Shortell

(2001), the health care system is divided into four nested levels:

(1) the individual patient; (2) the care team, which includes

professional care providers, the patient, and family members; (3)

the organization that supports the development and work of care

teams by providing infrastructure and complementary resources;

and (4) the political and economic environment (e.g., regulatory,

financial, payment regimes, and markets), the conditions under

which organizations, care teams, individual patients, and individual

care providers operate (Dizon, 2006).

They begin appropriately with the individual patient, whose

needs and preferences should be the defining factors in a patient-

centered health care system. Recent changes in health care policy

reflect an emphasis on consumer-driven health care. The

availability of information, the establishment of private health care

spending accounts, and other measures reflect an increasing

expectation that patients will drive changes in the system for

improved quality, efficiency, and effectiveness. Overall, the role of

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the patient has changed from a passive recipient of care to a more

active participant in care delivery (Watson, 2014)

At the same time, the fragmented delivery system, combined

with the growing burden of chronic disease and the need for

continuous care, have all but forced many patients to assume an

active role in the design, coordination, production, and

implementation of their care, whether they want to or not.

Unfortunately, most people do not have access to the information,

tools, and other resources they need to play this new role

effectively. Considering the roles, needs, and objectives of first-

level actors, individual patientsand their interdependencies with

actors at other levels of the system, opportunities abound for using

information/ communications technologies and systems-

engineering tools to improve the overall performance of the health

care system (Watson, 2004).

A starting point for increasing the patient-centeredness of

health care delivery is changing the perspective of clinicians to

consider patients and their families as“partners and to incorporate

their values and wishes into care processes. The level of

responsibility patients and their families assume differs from

patient to patient. Some prefer to delegate some, if not most, of

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the decision making to a trusted clinician/counselor in the care

system; others want to be full partners in decision making. In

either case, however, patients need a free exchange of information

and communication with physician(s) and other members of the

care team, as well as with the organizations that provide the

supporting infrastructure for the care teams. For patients to

communicate informed needs and preferences, participate

effectively in decision making, and coordinate, or at least monitor

the coordination, of their care, they must have access to the same

information streams in patient-accessible form as their physician(s)

and care team. Information that supports evidence-based,

effective, efficient care encompasses the patient's medical record,

including real-time physiological data; the most up-to-date medical

evidence base; and orders in process concerning the patient's care.

The patient and/or his or her clinician/counselor or family member

must also have access to educational, decision-support,

information-management, and communication tools that can help

them integrate critical information from different sources.

From the patient's perspective, improving the timeliness,

convenience, effectiveness, and efficiency of care will require that

the patient be interconnected to the health care system.

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Synchronous communication between patient and physician could

improve the quality of care in a number of ways. For example,

continuous, real-time communication of a patient's physiological

data to care providers could accelerate the pace of diagnosis and

treatment, thereby reducing complications and injuries that might

result from delays. Remote (monitoring, diagnosis, and treatment

would make care much more convenient for patients, save them

time, and conceivably improve compliance with care regimes.

Communication technologies also have the potential to change the

nature of the relationship between patient and provider, making it

easier for patients to develop and maintain trusting relationships

with their clinicians.

Asynchronous communication also has the potential to

significantly improve quality of care. The easy accessibility of the

Internet and the World Wide Web should enable all but continuous

inquiries and feedback between patients and the rest of the health

care system (IOM, 2001). The World Wide Web has already

changed patients' ability to interact with the system and to self-

manage aspects of their care. One of the fastest growing uses of

the these communication technologies is as a source of medical

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information from third parties, which has made the consumer both

more informed, and, unfortunately, sometimes misinformed.

Some of the improvements just described are available today,

some are under study, and some are as much as a decade away

from realization. Thus, research is still an essential component in

transforming the current system.

The care team, the second level of the health care system,

consists of the individual physician and a group of care providers,

including health professionals, patients' family members, and

others, whose collective efforts result in the delivery of care to a

patient or population of patients. The care team is the basic

building block of a clinical microsystem, defined as “the smallest

replicable unit within an organization [or across multiple

organizations] that is replicable in the sense that it contains within

itself the necessary human, financial, and technological resources

to do its work (Quinn, 2002).

In addition to the care team, a clinical microsystem includes

a defined patient population; an information environment that

supports the work of professional and family caregivers and

patients; and support staff, equipment, and facilities (Nelson et al,

2008). Ideally, the role of the microsystem is to standardize care

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where possible, based on best current evidence; to stratify patients

based on medical need and provide the best evidence-based care

within each stratum; and to customize care to meet individual

needs for patients with complex health problems. Most health and

medical services today, however, are not delivered by groups or

teams.

The role and needs of individual physicians have undergone

changes parallel to those of individual patients. The exponential

increase in medical knowledge, the proliferation of medical

specialties, and the rising burden of providing chronic care have

radically undercut the autonomy of individual physicians and

required that they learn to work as part of care teams, either in a

single institution/organization or across institutional settings. The

slow adaptation of individual clinicians to team-based health care

has been influenced by several factors, including a lack of formal

training in teamwork techniques, a persistent culture of

professional autonomy in medicine, and the absence of tools,

infrastructure, and incentives to facilitate the change (Ferlie and

Shortell, 2001).

To participate in, let alone lead and orchestrate, the work of

a care team and maintain the trust of the patient, the physician
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must have on-demand access to critical clinical and administrative

information, as well as information-management, communication,

decision-support, and educational tools to synthesize, analyze, and

make the best use of that information. Moreover, to deliver

patient-centered care, the physician must be equipped and

educated to serve as trusted advisor, educator, and counselor, as

well as medical expert, and must know how to encourage the

patient's participation in the design and delivery of care.

At the present time, precious few care teams or clinical

microsystems are the primary agents of patient-centered clinical

care. Unwarranted variations in medical practice are common, even

for conditions and patient populations for which there are standard,

evidence-based, patient-stratified best practice protocols. Even

though many clinicians now accept the value of evidence-based

medicine and recognize that they cannot deliver evidence-based

care on their own, they are many barriers to their changing

accordingly: the guild structure of the health care professions; the

absence of training in teamwork; the strong focus on the needs of

individual patients as opposed to the needs of patient populations;

and the lack of supporting information tools and infrastructure. All

of these can, and do, prevent systems thinking by clinicians, the

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diffusion of evidence-based medicine, and the clinical microsystems

approach to care delivery. Thus, tailoring evidence-based care to

meet the needs and preferences of individual patients with complex

health problems remains an elusive goal.

For care teams to become truly patient-centered, the rules of

engagement between care teams and patients must be changed.

Like individual care providers, the care team must become more

responsive to the needs and preferences of patients and involve

them and their families in the design and implementation of care.

Care teams must provide patients with continuous, convenient,

timely access to quality care. One member of the care team must

be responsible for ensuring effective communication and

coordination between the patient and other members of the care

team (Dizon, 2006).

The third level of the health care system is the organization

that provides infrastructure and other complementary resources to

support the work and development of care teams and

microsystems. The organization is a critical lever of change in the

health care system because it can provide an overall climate and

culture for change through its various decision-making systems,

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operating systems, and human resource practices (Ferlie and

Shortell, 2001).

The organization encompasses the decision-making systems,

information systems, operating systems, and process to

coordinate the activities of multiple care teams and supporting

units and manage the allocation and flow of human, material, and

financial resources and information in support of care teams. The

organization is the business level, the level at which most

investments are made in information systems and infrastructure,

process-management systems, and systems tools. Health care

organizations face many challenges. In response to the escalating

cost of health care, government and industry, the third-party

payers for most people have shifted a growing share of the cost

burden back to care providers and patients in recent years. As a

result, hospitals and ambulatory care facilities are under great

pressure to accomplish more work with fewer people to keep

revenues ahead of rising costs (Ferlie and Shortell, 2001).

In certain respects, management of health care organizations

is not well positioned to respond to mounting cost and quality

crises. Compared to other industries, health care has evolved with

little shaping by the visible hands of management. Historically,

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most leaders of health care organizations were initially trained in

medicine or public health. Moreover, except in the relatively few

integrated, corporate provider organizations, the management of

most hospitals faces the challenge of managing clinicians, the

majority of whom function as independent agents.

Less than 40 percent of all hospital-based physicians are

employed as full-time staff by the hospitals where they practice, a

reflection of the deeply ingrained culture of professional autonomy

in medicine and the deeply held belief of care professionals that

their ultimate responsibility is to individual patients. These

circumstances have posed significant challenges to the authority of

health care management in many organizations, often creating

discord and mistrust between health care professionals and health

care management. Other challenges to management include the

hierarchical nature of the health professions and inherent

resistance to team-based care, significant regulatory and

administrative requirements and health care

payment/reimbursement regimes that provide little, if any,

incentives for health care organizations to invest in non-revenue-

generating assets, such as information/ communications

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technologies and process-management tools (Ferlie and Shortell,

2001).

To support patient-centered care delivery by well functioning

clinical care teams or microsystems, health organizations must find

ways to bridge the health care professional/ delivery system

management divide and invest in information/ communications

technologies, systems-engineering tools, and associated

knowledge. Integrated, patient-centered, team-based care requires

material, managerial, logistical, and technical support that can

cross organizational/institutional boundaries, support that is very

difficult to provide in a highly fragmented, distributed-care delivery

system.

Financial investments in information/communications

technologies and systems-engineering tools alone will not be

enough, however. These investments must be accompanied by an

organizational culture that encourages the development of care

teams working with semiautonomous agents/ physicians.

Developing a culture that emphasizes learning, teamwork, and

customer focus may be a core property that health care

organizations will need to adopt if significant progress in quality

improvement is to be made (Ferlie and Shortell, 2001).

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Finally, health care institutions must become learning

organizations that are skilled at creating, acquiring, and

transferring knowledge, and at modifying [their] behavior to reflect

new knowledge and insights (Garvin, 2003).

The fourth and final level of the health care system is the

political, economic environment, which includes regulatory,

financial, and payment regimes and entities that influence the

structure and performance of health care organizations directly

and, through them, all other levels of the system. Many actors

influence the political and economic environment for health care.

The federal government influences care through the

reimbursement practices of Medicare/ Medicaid, through regulation

of private-payer and provider organizations, and through its

support for the development and use of selected diagnostic and

therapeutic interventions. State governments, which play a major

role in the administration of Medicaid, also influence care systems.

Private-sector purchasers of health care, particularly large

corporations that contract directly with health care provider

organizations and third-party payersare also important

environment-level actors, in some cases reimbursing providers for

services not covered by the federal government (Garvin, 2003).

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The EPI (Expanded Program on Immunization) is a national

program of the Department of Health (DOH) is implemented locally

through the local government units for free. EPI is targeting to

provide maximal immunity to seven EPI diseases before the child’s

first birthday. The routine measles immunization schedule for

infants is given 9 months old as a minimum age at 1 st dose. At

least 80% of measles can be prevented by immunization at this

age (DOH, 2004).

The measles outbreak in 1996 has lead to a more aggressive

campaign against measles that launch the Philippine Measles

Elimination Campaign (PMEC) in 1998 and triggered the catch up

Vaccination of children aged 9 months to 14 years old called Ligtas

Tigdas (Safe from Measles) Campaign (LTC). This was proclaimed

and signed by then President Joseph E. Estrada.

The highest incidence of measles is reported in NCR, Region

III, V, VII, IV. In Mindanao from 2000 to 2002 period, ARMM

reported to have the highest incidence of measles followed by

Region X and Region IX. These are the regions with areas mostly

affected by internal conflicts; with the most number of families

belonging to poverty line level and indigenous community.

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(International Federation of the Red Cross – Philippine National Red

Cross Project 2004).

With the commitment of the country to Universal Child

Immunization (UCI) Goal acceleration of EPI coverage had began in

1986. The achievement of the fully immunized child (FIC)

coverage of 80% was noted one year ahead of the target data of

the Universal Child Immunization in 1990. This was attributed to

the strong political will and support from international partners,

better program management, and improvement in cold chain

facilities for better performance at all level of health facilities. The

development of the Expanded Immunization Program Manual on

operations with its clear guidelines for better planning, correct

targeting, correct immunization procedure, strategies appropriate

for better linkaging/coordination and program implementation had

contributed much for the success of the program (International

Federation of the Red Cross – Philippine National Red Cross Project

2004).

Measles is an acute highly communicable infection by fever,

rashes and symptoms referable to upper respiratory tract, the

eruption is preceded by about 2 days of coryza, during which stage

grayish pecks (Koplic Spots) may be found on the inner surface of

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the cheeks. A morbiliform rash appears on the 3 rd or 4th day

affecting face, body and extremities ending in branny

desquamation.

Death is due to complications, e.g., secondary pneumonia,

usually in children under 2 years old. Measles is severe among

malnourished children with fatality 95 – 100%. The etiologic agent

of measles is Filterable virus of measles. Source of infection are

secretion of nose and throat of an infected person. The mode of

transmission of the infection is by droplet spread or direct contact

with infected persons, or indirectlythrough articles freshly soiled

with secretions of nose and throat, in some instances, probably

airborne. Incubation period of mesls is 10 days from exposure to

appearance of fever. And about 14 daysuntil rashes (Koplic Spots)

appear (Rosario, 2005).

The Department of Health (DOH) today launched its month-

long, nationwide, door-to-door measles vaccination campaign

dubbed “Iligtas sa Tigdas and Pinas,” which is targeting about 18

million children nine months to below eight years old (DOH, 1987).

The main objective of the campaign is to reduce the number

of susceptible children that have pilled up since they last conducted

a nationwide campaign last 2004 as explained by Health Secretary

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Enrique T. Ona adding that vaccination is the best way to prevent

measles and German measles. A door-to-door Measles-Rubella

(MR) immunization campaign vaccinating all children, 9 months to

below 8 years old from April 4 to May 4, 2011.

The Philippines has committed to eliminate measles in 2012,

the target year agreed upon with the other countries in the

Western Pacific Region. Three (3) mass measles immunization

campaigns were conducted in 1998, 2004 and 2007, achieving

95% coverage in each round. In contrast, the annual coverage for

routine measles vaccination given to infants’ ages 9 – 11 months

never reached the target of at least 95%. The highest coverage

ever attained is 92% and the lowest coverage was 67% (DOH,

1987).

The lower the coverage, the faster is the accumulation of

immunized susceptible infants, resulting in measles outbreaks in

different areas of the Philippines. Laboratory confirmed measles

cases continued to be reported all over the country, which indicates

uninterrupted circulation of measles virus transmission resulting to

illness and deaths among children.

Mass measles immunization campaigns provide a second

opportunity to catch missed children but these are done every 2-3
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years interval and therefore not enough to prevent seasonal

outbreaks from occurring in areas with low immunization coverage.

The administration of a 2nd dose of measles containing vaccines on

a routine schedule will provide the second opportunity at an earlier

time and ensure the protection against measles of infants/children

who failed to be protected during the first dose.

As a response to interrupt the transmission of the measles

virus and prevent a potential large measles outbreak to occur,

there is an urgent need to conduct a measles supplemental

immunization activity this April 2011. All children ages 9 – 95

months old nationwide should be given a dose of measles-rubella

vaccine through a door-to-door vaccination campaign. Unlikes

previous campaign, a measles-free certification will be issued to

city/province meeting all the criteria of one (1) all barangays

passed the RCA with no missed child and 95% and above house

marking accuracy; (2) there are no measles cases for the next 3

months after the campaign and (3) measles surveillance indicators

have met the national standards.

“Ligtas sa Tigdas ang Batang Pinoy” is a measles

supplemental immunization activity (SIA) for the measles free

Philippines. This is a sequel to the 1998, 2004 and 2008 mass

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measles campaign. Measles-Rubella (MR) vaccines shall be

provided during the immunization activity. Strictly “Door-to-

Door” immunization strategy includes all doors of houses,

condominiums, apartments, tenements, orphanages and halfway

homes as well as nonconventional doors in the community. Non-

conventional doors include the following: informal settlements

such as families/persons living under the bridge, inside the parks,

cemeteries and opens paces; in tents, carts, abandoned buildings,

old vehicles/trains/motorboats, under the trees, in islands in the

middle of the street, etc. All business/commercial establishments

and market stall where children may rise, institutions, eligible

children of mobile and roaming families with no houses or no

permanent house shall be identifies and given immunization. All

eligible children found in the parks, playgrounds, streets, markets

and other public places shall be directed to go home to be

vaccinated.

Measles-free certification will be issued to provinces and

cities if all the following criteria are met: All barangays have

passed the Rapid Coverage Assessment (RCA) with no missed child

and > 95% house marking accuracy; and there are no measles

cases for the next 3 months after the campaign, and measles
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surveillance indicators have met the national standard wherein at

least 80% of surveillance sites should report each week on the

presence or absence of suspected measles cases. At least 80% of

the reported suspected cases should be reported within 48 hours of

rash onset (Angeles, 2005).

Moreover, at least 80% of the specimens should be taken

from initial contact until 28 days post rash onset and reach the

laboratory in a suitable state for testing. At least 80% of specimens

must be tested and the results reported black to the surveillance

until within 7d days of receipt of the specimen in the laboratory.

This certification process will be conducted at the end of the

campaign. The vaccination team with their supervisors/monitors

shall met with the Barangay Captain and other officials to discuss

the objective of the campaign and to reduce the number or pool of

children at risk of getting measles or being (Angeles,2005).

The Department of Health (DOH) last April 4, 2011 launched

its month-long, nationwide, door-to-door measles vaccination

campaign dubbed “Iligtas sa Tigdas ang Pinas,” which is targeting

about 18 million children nine months to below eight years old

(DOH,2011).
 24

The main objective of the campaign is to reduce the number

of susceptible children that have piled up since they last conducted

a nationwide campaign last 2004. Health Secretary Enrique T. Ona

explained, adding that vaccination is the best way to prevent

measles and German measles.

From April 4 to May 4, 2011, expect vaccination teams or

“Bakunadoors” to be knocking at the door to give free measles

and German measles vaccines to children aged nine months to

below eight years old. The health department advises that parents

submit eligible children for vaccination even if they have previous

measles vaccinations or if they have already suffered from

measles. Aside from vaccines, some local governments will also be

giving out free capsules of Vitamin A, which is an important

micronutrient for good eyesight, strong bones and a healthy

immune system.

From January to March 19 2013, there were 2,075 measles

cases nationwide recorded by the DOH National Epidemiology

Center. There have already been five deaths recorded. Ages of

cases ranged from eight days to 85 years old. It is alarming to

know that there are still children dying from measles even if
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measles vaccination is free and available nationwide at all health

centers.

Most of the cases came from the National Capital Region

(311), Central Luzon (198), Bicol Region (277), Calabarzon (238),

Davao Region (197), Ilocos Region (174), and Zamboanga

Peninsula (163). At the National Capital Region, most cases came

from Manila (101), Quezon City (50), and Caloocan (36).

Nationwide mass immunization campaigns such as this have

employed enjoyed a better coverage rate than regular

implementation of the Expanded Program of Immunization.

Previous measles campaigns conducted in 2004 to 2007 both

reached 95 percent coverage, a level never achieved by the regular

program. This prompted the DOH to implement the nationwide

door-to-door strategy to fight off the threat of measles.

The door-to-door campaign was made possible through the

partnership with the local government units who mobilized the

vaccination teams as well as their partners from the World Health

Organization (WHO, 2009).

Measles is a highly contagious disease which can be fatal. It

is spread by coughing and sneezing, close personal contact, or

 26

direct contact with infected nasal or throat secretions. Immunity

against measles is developed following vaccination.

Likewise, German measles, also known as rubella, is a highly

contagious mild disease characterized by flu-like symptoms

followed by a rash. Immunity against German measles is also

developed following vaccination. However, the primary danger

with rubella is the infection of pregnant women as it poses a

serious threat to the life of the unborn. It may cause miscarriages,

premature delivery and serious birth defects, including heart

problems, hearing and sight problems, cognitive impairment and

liver or spleen damage.

According to the World Health Organization (WHO), the

measles-rubella vaccine is safe, effective and inexpensive. It costs

between P500 to P15,000 to treat a child with measles, but

preventing measles through vaccination is free. Let them have

children vaccinated against measles. Let them prevent deaths due

to measles and its complications (Castillo, 2008).

The study of Bulanon et al,,(2011) dealt with the level of

vaccination compliance of mothers with children ages from birth to

three years old in Barangay Sambag I, Cebu City. In their

unpublished study, it was found out that majority of the subjects

 27

are less than 1 year old, male and received vaccinations such as

BCG1, DPT1, DPT2, DPT3, OPV1, OPV2, OPV3, HB1, HB2, HB3 and

Measles. Majority of the mothers are 20 – 20 years old, single,

housekeeper and college level. The attitude and knowledge of

mothers have a profound impact in the compliance with vaccination

and thus contributes to promotion of health. There was no

significant relationship between the profile of the mothers in terms

of age, civil status, occupation and highest educational attainment

towards their level of compliance.

The study is related to the present study since both studies

dwell on vaccination but the difference is its focus and emphasis

considering the present study deals on the awareness and the

implementation of the Iligtas sa Tigdas ang Pinas program of the

Department of Health. The study conducted by Hortelano (2007)

dealt with the effectiveness of expanded program of immunization

among the selected residents of Punta Princesa, Cebu City. In her

unpublished study, it was found out that it is moderately effective

for the reason of lack of health teachings and dissemination of

information, attitude and compliance of the selected residents.

Measures are undertaken to enhance its effectiveness to a

proposed awareness enhancement guide.

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Another study conducted by Glamora (2008) dealt with the

evaluation on the immunization program in Barangay Kamputhaw,

Cebu City as perceived by the selected families. In her

unpublished study, it was found out that the immunization program

was fair in its implementation. Measures are undertaken to

enhance its implementation through varied mediums of

dissemination of information and the involvement of the barangay

health care workers.

The study conducted by Banquisio et al ,,(2009) dealt with

the reactions and views of the selected residents on the

implementation of the Expanded Program of Immunization in

Barangay Labangon. In their unpublished study, it was found out

that most of their views are positive on the advantages of

immunization but the difference is its focus and emphasis.

The theory, literatures and studies have direct bearing to the

present undertaking as to their relatedness to make the study

more comprehensive and substantial (BAnquisio et al. 2009)

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THE PROBLEM

Statement of the Problem

This study determined the level of awareness and the level of

implementation of the Iligtas sa Tigdas ang Pinas program of the

Department of Health in Barangay Duljo, Fatima, Cebu City.

Specifically, this study sought to answer the following

questions:

1. What is the profile of the respondents in terms of:

1.1 age;

1.2 sex;

1.3 civil status;

1.4 highest educational attainment; and

1.5 average monthly income?

2. What is the level of awareness of the respondents on the

Iligtas sa Tigdas ang Pinas Program?

3. What is the level of implementation of the respondents on

the Iligtas sa Tigdas ang Pinas Program?

4. Is there a significant relationship between the:

4.1 profile and level of awareness;

4.2 profile and the level of implementation;

4.3 levels of awareness and implementation?

 30

5. What are the perceived factors that influence the

awareness of the barnagay health worker on Iligtas sa

Tigdas ang Pinas Program?

6. What are the perceived factors that influence the

implementation of the Iligtas sa Tigdas ang Pinas Program

as perceived by the barangay health workers?

Statement of the Null Hypothesis

Ho1. There is no significant relationship between the:

1.1 profile and level of awareness;

1.2 profile and the level of implementation;

1.3 levels of awareness and implementation.

Significance of the Study

The researcher believes that the study will help those

concerned in promoting the health in every child in the community.

The researcher who was also part of the program by the

Department of Health as a Volunter Nurse Vaccinator in Barangay

Duljo, Fatima can also assesses if the program was effective in the

community. The study will be of particular benefit to the following:

Client. The children of Barangay Duljo Fatima will be the

one who will benefit since they will be the one who will be given

the vaccination.
 31

Family Members. The family members in the community

will benefit from the rendered service and the programs that are

implemented. They will also be knowledgeable of the program that

is being implemented by the government.

CHN Nurses. As the primary care givers, the nurses in the

community can help improve the program and at the same time

help the community in their health status.

The Community. As the primary beneficiary of the

government in the program to eliminate measles, the community

will be benefited through their awareness and strict compliance

with the said program to promote health.

Barangay Health Workers. As the front liner in

advocating the health and wellness in the community, these people

will come to know if the program was effective in its

implementation.

Barangay Officials. As the leaders and law enforcers in the

community with wide connections in terms of politics and other

health sectors in the government, they can write or file a

recommendation regarding the result of the study. These people

can also recommend the community for any additional health

programs if necessary.
 32

Department of Health Personnel. As an agency of the

government, they are presented with the challenge in promoting

the health of every child through compliance with the program to

maintain health and get rid of diseases.

Researcher. The researcher will gain more knowledge in

the programs that the government implements in the community

and be updated of the latest status on the immunization in the

country in the area of service.

Future Researchers. To those who are planning to

engage in the similar study for those research to become a useful

literature review. Further, the researcher of these study hope that

the findings, conclusions and recommendations will provide new

learning that would serve as a guide for the future researchers.

 33

METHODOLOGY

Research Design

This study utilized the descriptive-correlational design

utilizing both quantitative and qualitative approaches. For

quantitative approach a structured survey/questionnaire on the

level of awareness and implementation of the Iligtas sa Tigdas

Program to the members and officers in Barangay Duljo, Fatima

was used. While in qualitative approach, in depth interview among

members and officers were utilized. Key informant interviews with

barangay officials was also used.

Research Environment

The research environment of the study was Barangay Duljo-

Fatima. Barangay Duljo-Fatima belongs to the South District of

Cebu composed of 36 sitios, the barangay is bounded by

Kinalumsan River in the south, Carlock Street in the north, the sea

shore in the east and Barangay Labangon in the west. Based on

the census 2000, Barangay Duljo-Fatima has a total population of

15,223. The number of families which averages to five members,

each totals to 3,221. The barangay captain is Elmer Abellana. This

is the research environment chosen as to the increasing number of

children who were not immunized with measles.

 34

Research Respondents

The research respondents were the barangay health care

workers who participated in the Iligtas sa Tigdas ang Pinas

program of the Department of Health in Barangay Duljo Fatima,

Cebu City. These people were chosen because of the inherent roles

and responsibilities in the awareness and implementation of the

program in the barangay. All officers and is residing in the

aforementioned barangay were included as respondents. Thus,

universal sampling was applied in getting the number of

respondents in the barangay. The inclusion criteria were as

follows: a) that they are residents of Barangay Duljo-Fatima; b)

that they have been residents for at least one year are willing to

participate or taken as respondents in the study; and c) and are

above 18 years old.

Research Instrument

The researcher utilized a researcher-made tool that

contained options or voices that were enumerated. The tool had

four parts. Part I was the profile of the respondents as to age,

gender, civil status, highest educational attainment and length of

service. Part 2 was the level of awareness on the measles and the

Iligtas sa Tigdas Program which was patterned according to the

 35

guidelines of the DOH. These were on case finding, case holding,

recording and reporting. While in part 3 was the implementation of

the Iligtas sa Tigdas Program in terms of functionality, parameters

related to people, structured and process are given emphasis. Part

4 for qualitative approach, unstructured questions were asked from

the selected informants especially the barangay officials through in

depth and key informant interviews were utilized. Results of the

qualitative aspects will be incorporated in the quantitative results.

Research Procedures

Data Gathering

In the gathering of data, first the researcher made a letter

addressed to the Dean, City Health. Department of Health and

Barangay Captain of Duljo, Fatima asked permission that allowed

to conduct the study. After the permission was granted, pilot-

testing was conducted to ten (10) residents. The results were

subjected to Kronbach’s alpha test for validity with a Kronbach’s

realiability of .92. The final instrument was made after the pilot

test. All findings of the validation were incorporated in the

questionnaire that enhanced and refined the study.

Then, the questionnaires were distributed to the

respondents. The researcher himself was the one who

 36

administered the questionnaire 3-5 minutes and chose the

research informants and conducted the interview of the

respondents. The interview was conducted at the houses of the

chosen research informants and the interview was conducted in the

afternoon for the convenience of the informants. There were five

(5) informants per day. It took two days to finish the interview

with the research participants. This was done so that probing

questions can be asked to validate the responses. While in

qualitative approach, the researcher asked people such as

barangay officials and other implementers. This was done

separately. It was aided with the use of field notes wherein the

answers of the informants were recorded and documented in the

field notes.

Treatment of Data

There were four statistical tools used in the study:

Simple Percentage. This was the statistical tool utilized to

determine the profile of the respondents as to age, sex, civil

status, highest educational attainment and average monthly

income.

Weighted Mean. The weighted mean was used to

determine the level of awareness on the Iligtas sa Tigdas Program

 37

and the implementation of the Iligtas sa Tigdas Program in

Barangay Duljo, Fatima.

The following were the parameter limits on the level of

awareness on the Iligtas sa Tigdas Program:

Lower Limit Upper Limit Description

3.26 4.00 Very Aware

2.51 3.25 Aware

1.76 2.50 Less Aware

1.00 1.75 Not Aware

The following were the parameter limits on the extent of

implementation of the Iligtas sa Tigdad Program:

Lower Limit Upper Limit Description

3.26 4.00 Highly Implemented

2.51 3.25 Moderately Implemented

1.76 2.50 Less Implemented

1.00 1.75 Not Implemented

Chi-square. The chi-square was used to determine whether

there is relationship between the profile and the level of awareness

and profile and the level of implementation of the Iligtas sa Tigdas

and Pinas program of the Department of Health in Barangay Duljo,

Fatima, Cebu City.

 38

Pearson-r. This was used to determine whether there is

relationship between the level of awareness and implementation of

the Iligtas sa Tigdas and Pinas program of the Department of

Health in Barangay Duljo, Fatima, Cebu City.

Thematic Content Analysis

The answers of the informants with the semi-structured

interview guide was used with the Collazi’s method on thematic

content analysis. Interview was transcribed and given analysis and

interpretations.
 39

DEFINITION OF TERMS

Terms are operationally defined as how it is used in the

study:

Iligtas sa Tigdas ng Pinas Program

The program of the government in promoting health of

children of Barangay Duljo, Fatima, Cebu. through the reduction of

measles.

Level of Awareness

This refers to the knowledge of the selected residents of

Duljo, Fatima, Cebu. with measles as a disease process.

Level of Implementation. It refers to the carrying of the

different activities in line with the program on Iligtas sa Tigdas ang

Pinas Program in Barangay Duljo, Fatima, Cebu which will be

evaluated by the residents.

Ligtas Tigdas. It is a measles supplemental immunization

activity (SIA) for a measles-free Philippines. This is a sequel to the

1998, 2004 and 2007 mass measles campaign.

Perceived Factors. It refers to the reasons or underlying

causes believed that lead to measles formation.

 40

Profile. It refers to the demographic profile of the

respondents as to age, sex, civil status, highest educational

attainment and average monthly income.

 41

Chapter 2

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

Chapter 2 gives the presentation, analysis and interpretation

of data. It answers the questions posed in the problem.

I. Profile of the Respondents

Table 1
Profile of the Respondents
n=30

Profile Frequency Percentage

(100%)
Age
19 – 25 years of age 5 16.67
26 – 35 years of age 19 63/33
36 – 55 years of age 4 13.33
56 and above 2 6.67
Sex
Male 11 36.67
Female 19 63.33
Civil Status 10 33.33
Single 12 40.00
Married 18 60.00
Highest Educational Attainment
College graduate 19 63.33
College graduate with units in Master’s 8 26.67
Degree
College graduate with Master’s Degree 3 10
Average Monthly Income
Php 5,001 – 10,000.00 8 26.67
Php 10,001 - 15,000.00 20 66.67
Php 15,001 and above 2 6.67

In terms of age profile, majority of the respondents belonged

to the age bracket of 26 – 35 years of age with responses of 29 or

63.33 percent. Then, it was followed by 19 – 25 years of age

with responses of 5 or 16.67 percent; 36 – 55 years of age with

 42

responses of 4 or 13.33 percent and 56 and above with responses

of 2 or 6.67 percent.

The findings implied that majority of the respondents

belonged to the age bracket of Middle Adulthood. According to Erik

Erickson, Middle Adulthood is the period wherein the individual is

mature, focused and service-oriented in the realization of their

dreams and goals in life (Hurlock, 2007).

As shown in the table majority of the respondents are

females with responses of 19 or 63.33 percent while 11 or 36.67

percent are males. There are more female health care workers

with the inclination of females towards care which has its roots

from Florence Nightingale, the participation of women in the

Crimean War (Woff, 2000).

Most of the respondents are married with responses of 18 or

60.00 percent while there are only 12 or 40.00 percent that are

singles. Married is entailed with responsibility and accountability

in the performance of their duties and responsibilities. It is in

connection with the age which is linked to maturity and being

focused with their tasks.

In terms of educational attainment, majority of the

respondents are college graduate with responses of 19 or 63.33

 43

percent. On the other hand, 8 or 26.67 percent are college

graduate with units in Master’s Degree and 3 or 10 percent are

College Graduate with Master’s Degree.

As to average monthly income, majority of the respondents

have an income within the range of Php 10,001 – 15,000 with

responses of 20 or 66.67 percent. Eight or 26.67 percent have an

income within the range of Php 5,001 – 10,000.00. And, lastly, 2

or 6.67 percent have an income within the range of Php 15,001

and above. The findings implied that most of the respondents

have an average income.

II. Level of Awareness of the Respondents on the Iligtas sa

Tigdas ang Pinas Program

Table 2 shows the level of awareness of the respondents on

the Iligas sa Tigdas ang Pinas Program obtained an average

weighted mean of 3.12 interpreted as Aware.

Table 2
Level of Awareness of the Respondents on the Iligtas sa
Tigdas ang Pinas Program

Statements WM Interpretation
1. Measles is a highly contagious disease caused by a virus 3.60 Very Aware
2. The first sign of measles is usually a high fever, which begins 3.07 Aware
about 10 to 12 days after exposure to the virus, and lasts four to
seven days. A runny nose, a cough, red and watery eyes, and
small white spots inside the cheeks can develop in the initial stage.
 44

A
3. After several days, a rash erupts, usually on the face and upper 3.09 Aware
neck. Over about three days, the rash spreads, eventually reaching
the hands and feet. The rash lasts for five to six days, and then
fades.
4. Severe measles is more likely among poorly nourished young 3.10 Aware
children, especially those with insufficient vitamin A, or whose
immune systems have been weakened by HIV/AIDS or other
diseases.
5. Complications are more common in children under the age of 3.04 Aware
five, or adults over the age of 20. 
6. The most serious complications include blindness, encephalitis 3.00 Aware
(an infection that causes brain swelling), severe diarrhoea and
related dehydration, ear infections, or severe respiratory infections
such as pneumonia.
7. As high as 10% of measles cases result in death among 3.09 Aware
populations with high levels of malnutrition and a lack of adequate
health care.
8. Unvaccinated young children are at highest risk of measles and 3.07 Aware
its complications, including death. Unvaccinated pregnant women
are also at risk. Any non-immune person (who has not been
vaccinated or was vaccinated but did not develop immunity) can
become infected.
9. The highly contagious virus is spread by coughing and sneezing, 3.05 Aware
close personal contact or direct contact with infected nasal or
throat secretions.
10. The virus remains active and contagious in the air or on 3.12 Aware
infected surfaces for up to two hours. It can be transmitted by an
infected person from four days prior to the onset of the rash to
four days after the rash erupts
11. Routine measles vaccination for children, combined with mass 3.00 Aware
immunization campaigns in countries with high case and death
rates, are key public health strategies to reduce global measles
deaths
Average Weighted Mean 3.12 Aware
Legend:

1.00 – 1.75 Not Aware

1.76 - 2.50 Less Aware
2.51 – 3.25 Aware
3.36 – 4.00 Very Aware

The respondents have a partial knowledge of Iligtas sa

Tigdas and Pinas Program. This is a good showing but there is a

need to enhance awareness among the respondents in order to get

rid of the communicable disease.

 45

The respondents are Very Aware of the communicable

disease: Measles is a highly contagious disease caused by a virus

(3.60). This means that the respondents have a thorough

knowledge of the program and the communicable disease.

Estimated global coverage with a first dose of vaccine increased

from 72% in 2000 to 84% in 2011. The number of countries

providing the second dose through routine services increased from

97 in 2000 to 141 in 2011. Since 2000, with support from the

Measles & Rubella Initiative, more than 1 billion children have been

reached through mass vaccination campaigns ― about 225 million

of them in 2011 (WHO, 2011).

The respondents are Aware of the program: The virus

remains active and contagious in the air or on infected surfaces for

up to two hours. It can be transmitted by an infected person from

four days prior to the onset of the rash to four days after the rash

erupts (3.12); Severe measles is more likely among poorly

nourished young children, especially those with insufficient vitamin

A, or whose immune systems have been weakened by HIV/AIDS or

other diseases (3.10); After several days, a rash erupts, usually on

the face and upper neck. Over about three days, the rash spreads,

eventually reaching the hands and feet. The rash lasts for five to
 46

six days, and then fades (3.09); The first sign of measles is usually

a high fever, which begins about 10 to 12 days after exposure to

the virus, and lasts four to seven days. A runny nose, a cough, red

and watery eyes, and small white spots inside the cheeks can

develop in the initial stage (3.08); Unvaccinated young children

are at highest risk of measles and its complications, including

death. Unvaccinated pregnant women are also at risk. Any non-

immune person (who has not been vaccinated or was vaccinated

but did not develop immunity) can become infected; (3.07); The

highly contagious virus is spread by coughing and sneezing, close

personal contact or direct contact with infected nasal or throat

secretions (3.05); Complications are more common in children

under the age of five, or adults over the age of 20 (3.04); and

Routine measles vaccination for children, combined with mass

immunization campaigns in countries with high case and death

rates, are key public health strategies to reduce global measles

deaths (3.00). The findings revealed that the respondents were

aware. It implied that the respondents have a partial knowledge of

Iligtas sa Tigdas and Pinas Program. This is a good showing but

there is a need to enhance awareness of Iligtas sa Tigdas and Pinas

 47

Program for the benefit of the people to get rid of communicable

disease.

“Ligtas sa Tigdas ang Batang Pinoy” is a measles

supplemental immunization activity (SIA) for the measles free

Philippines which is founded on April 4, 2011 by the Department f

Health. This is a sequel to the 1998, 2004 and 2008 mass

measles campaign. Measles-Rubella (MR) vaccines shall be

provided during the immunization activity. Strictly “Door-to-

Door” immunization strategy includes all doors of houses,

condominiums, apartments, tenements, orphanages and halfway

homes as well as nonconventional doors in the community. Non-

conventional doors include the following: informal settlements

such as families/persons living under the bridge, inside the parks,

cemeteries and opens paces; in tents, carts, abandoned buildings,

old vehicles/trains/motorboats, under the trees, in islands in the

middle of the street, etc. All business/commercial establishments

and market stall where children may rise, institutions, eligible

children of mobile and roaming families with no houses or no

permanent house shall be identifies and given immunization. All

eligible children found in the parks, playgrounds, streets, markets

 48

and other public places shall be directed to go home to be

vaccinated (Angela, 2005).

III. Level of Implementation of the Respondents on the

Iligtas sa Tigdas ang Pinas Program

Table 3 shows the level of implementation of the respondents

on the Iligtas sa Tigdas ang Pinas Program with an average

weighted mean of 3.09 interpreted as Implemented.

Table 3
Level of Implementation of the Respondents on the Iligtas sa Tigdas and Pinas Program

Implementation WM Interpretation
Door to Door Measles Rubella (MR) on Iligtas sa Tigdas ang Pinas 3.04 Moderately
is launched Implemented
Vaccination Teams or “Bakunadoors” knocking to give free measles 3.30 Highly
and German measles vaccine. Implemented

Monitor the disease using effective surveillance and evaluative 3.07 Moderately
programmatic efforts to ensure progress and positive impact of Implemented
vaccination activities
Achieve and maintain high vaccination coverage with two doses of 3.09 Moderately
measles and rubella containing vaccines Implemented
Develop and maintain outbreak preparedness, rapid response to 3.06 Moderately
outbreaks and the effective treatment of cases Implemented
Communicate and engage to build public confidence and demand 3.05 Moderately
for immunization Implemented
Perform the research and developmen needs to support cost- 3.08 Moderately
effective action and improve vaccination and diagnostic tools Implemented
Perform diagnostic and laboratory procedures to determine the 3.04 Moderately
presence of measles Implemented
Encourage specimen collection to test specimen whether it is 3.07 Moderately
positive for measles Implemented
Average Weighted Mean 3.09 Moderately
Implemented
Legend:
1.0 – 1.75 Not Implemented
1.76 – 2.50 Less Implemented
2.51 – 3.25 Moderately Implemented
3.26 – 4.00 Highly Implemented

The respondents implemented Iligtas sa Tigdas and Pinas

Program as to Achieve and maintain high vaccination coverage

 49

with two doses of measles and rubella containing vaccines (3.09);

Perform the research and development needs to support cost-

effective action and improve vaccination and diagnostic tools

(3.08); Encourage specimen collection to test specimen whether it

is positive for measles (3.07); Monitor the disease using effective

surveillance and evaluative programmatic efforts to ensure

progress and positive impact of vaccination activities (3.07);

Develop and maintain outbreak preparedness, rapid response to

outbreaks and the effective treatment of cases (3.06);

Communicate and engage to build public confidence and demand

for immunization (3.05); Door to Door Measles Rubella (MR) on

Iligtas sa Tigdas ang Pinas is launched (3.04); Perform diagnostic

and laboratory procedures to determine the presence of measles

(3.04).

The findings revealed that they are Moderately Implemented.

It implied that these activities were carried most of the time which

is a good showing. There is a need to enhance the

implementation of the program on Iligtas sa Tigdas and Pinas

Program.

It is supported by the study of Bulanon et al (2011) dealt

with the level of vaccination compliance of mothers with children

 50

ages from birth to three years old in Barangay Sambag I, Cebu

City. In their unpublished study, it was found out that majority of

the subjects are less than 1 year old, male and received

vaccinations such as BCG1, DPT1, DPT2, DPT3, OPV1, OPV2, OPV3,

HB1, HB2, HB3 and Measles. Majority of the mothers are 20 – 20

years old, single, housekeeper and college level. The attitude and

knowledge of mothers have a profound impact in the compliance

with vaccination and thus contributes to promotion of health.

It is where there is a need for awareness of the program for

compliance and in promoting health.

IV1. Relationship Between Profile and Level of

Awareness

Table 4.1 shows whether there is relationship between profile

and level of awareness.

Table 4.1

Relationship Between Profile and Level of Awareness

 51

Variables df Chi-square critical Decision Interpretation

value
Age and 9 20.04 16.92 Reject Significant Relationship
Awareness
Sex and 3 5.86 7.82 Accept Not Significant
Awareness
Civil Status 6 10.35 12.59 Accept Not Significant
and
Awareness
Educational 6 18.60 12.59 Reject Significant Relationship
Attainment
and
Awareness
Average 9 20.05 16.92 Reject Significant Relationship
Monthly
Income and
Awareness
* Significant at .05 level

As shown in table 4.1 whether there is significant relationship

on age and awareness of the program, it obtained a chi-square of

20.04 which is greater than the critical value of 16.92 percent

which rejected the hypothesis. The findings implied that there is

significant relationship between age and awareness of the

program. The more mature the person, the more the person the

person has the necessary knowledge. On the other hand, with less

maturity as shown by age showed little knowledge on the

communicable disease (Hurlock, 2005).

In terms of sex and awareness, it obtained a chi-square

value of 5.86 which is lower than the critical value of 7.82 which

means the acceptance of the hypothesis. The findings implied there

is no significant relationship between sex and awareness.

 52

As to civil status and awareness, it obtained chi-square of

10.35 which is lesser than the critical value of 12.59 which means

the acceptance of the hypothesis. The findings implied there is no

significant relationship between civil status and awareness of the

program.

In terms of educational attainment and awareness, it

obtained a chi-square of 18.60 which is greater than the critical

value of 12.59 which rejected the hypothesis. The findings implied

significant relationship between educational attainment and

awareness. It implied that the higher the educational attainment,

the more knowledgeable the person about the communicable

disease. On the other hand, with less educational attainment, the

less knowledgeable the person (Hunt, 2005).

In terms of average monthly income and awareness, it

obtained chi-square of 20.05 which is greater than the critical

value of 16.92 percent which rejected the hypothesis. The findings

implied significant relationship. The higher the income, the more

that the individual resort to prevention and treatment while the

lesser the income, the less the individual would resort to

prevention and treatment.

 53

The findings implied that it was on the profile of age,

educational attainment and average monthly income that have

relationship with awareness of the communicable disease or the

program.

IV. Relationship Between Profile and Level of

Implementation

Table 4.2 shows whether there is relationship between

profile and level of implementation.

Table 4.2

Relationship Between Profile and Level of Implementation

Variables df Chi-square critical Decision Interpretation

value
Age and 9 20.65 16.92 Reject Significant Relationship
Implementation
Sex and 3 4.76 7.82 Accept Not Significant
Implementation
Civil Status and 6 10.04 12.59 Accept Not Significant
Implementation
Educational 6 15.78 12.59 Reject Significant Relationship
Attainment
and
Implementation
Average 9 21.35 16.92 Reject Significant Relationship
Monthly
Income and
Implementation
* Significant at .05 level

As shown in table 4.2 whether there is relationship on age

and implementation of the program, it obtained a chi-square of

20.65 which is greater than the critical value of 16.92 percent

 54

which rejected the hypothesis. The findings implied that there is

significant relationship between age and implementation of the

program. The more mature the person, the more he would carry

activities which are important in promoting the welfare of the

people. On the other hand, with less maturity as shown by age

showed with less implementation of the program.

In terms of sex and implementation of the program, it

obtained a chi-square value of 4.76 which is lower than the critical

value of 7.82 which means the acceptance of the hypothesis. The

findings implied there is no significant relationship between sex and

implementation of the program.

As to civil status and implementation of the program, it

obtained chi-square of 10.04 which is lesser than the critical value

of 12.59 which means the acceptance of the hypothesis. The

findings implied there is no significant relationship between civil

status and implementation of the program.

In terms of educational attainment and implementation of

the program, it obtained a chi-square of 15.78 which is greater

than the critical value of 12.59 which rejected the hypothesis. The

findings implied significant relationship between educational

attainment and implementation of the program. It implied that the

 55

higher the educational attainment, the more the person implement

the program. On the other hand, with lesser educational

attainment, the more the person would fail to implement the

program.

In terms of average monthly income and implementation of

the program, it obtained chi-square of 21.35 which is greater than

the critical value of 16.92 percent which rejected the hypothesis.

The findings implied significant relationship. The higher the income

would likely implement the program. On the other hand, with less

income, the less likely the individual implement the program.

The findings implied that it was on the profile of age,

educational attainment and average monthly income that have

relationship with the implementation of the program.

IV3. Significant Relationship Between Level of Awareness

and Level of Implementation

Table 4.3 shows whether there is significant relationship

between level of awareness and level of implementation.

Table 4.3

Level of Awareness and Level of Implementation

Variables Df Pearson critical Decision Interpretation

 56

value
Level of 9 .986 .582 Reject Significant Relationship
Awareness and
Level of
Implementation

* Significant at .05 level

As shown in table 4.3, whether there is significant

relationship between level of awareness and level of

implementation, it obtained a Pearson value of .986 which is

greater than the critical value of .582 which means the rejection of

the hypothesis. The findings implied significant relat4ionship. With

more knowledge would influence the implementation of the

program. The more likely that the barangay and health care

personnel implement the program since they know the benefits and

the outcome of promoting the welfare of the community people

and getting rid of the communicable disease that would be a threat

to health (DOH, 2004).

V. PERCEIVED FACTORS THAT INFLUENCE THE AWARENESS

AND IMPLEMENTATION OF THE ILIGTAS SA TIGDAS
ANG PINAS PROGRAM AS PERCEIVED BY
THE BARANGAY HEALTH CARE WORKERS
 57

An interview was conducted with the use of the semi-

structured interview guide to determine the perceived factors that

influenced the awareness and implementation of the Iligtas sa

Tigdas Program as perceived by the barnagay health care workers.

Table 5

Perceived Factors that Influenced the Awareness and

Implementation of the Iligtas sa Tigdas
Program

Perceived Factors Multiple Responses

Awareness
Preparation Informants1 and 3
Knowledge Informants 3 and 4
Value to Health Informants 7 and 8
Implementation
Service Informants 2, 3 and 4
Promoting the welfare of the Informants 5, 6, and 7
People

Preventive Measures Informants 8 and 9

Awareness

An interview was conducted and it revealed that significant

portion of the informants were aware of the program. The themes

extracted from awareness is centered on preparation, knowledge

and value of health

 58

Preparation. One of the themes extracted from the

interview is preparation. It is important that the community people

have the needed preparations to get rid of measles considering it is

a contagious disease. The informants revealed:

Informant #2. “Ang pagpangandam kay importante kay

malikayan ang possible nga kakuyaw.” The importance of
preparedness to prevent the threats that it will bring.

Informant #3. “Maayu gyud kun naay pangandam para

malikayon ang epekto.” It is important to have the needed
preparations to prevent the effects.

The findings revealed about the importance of the needed

preparation in order to get rid of threat brought about by the

disease and it paves the way for promoting health.

Knowledge. Another theme extracted from the interview is

the need to have adequate knowledge. The importance that the

informants should have the needed knowledge in order to get rid of

the threat brought about by the disease. The informants revealed

that:

Informant #3. Gikan ito sa nosyon na naghatag ug

impluwensiya para sa kinahanglan na kaalam.” An ounce of
prevention is better than cure. It is on this notion that
emphasizes about the awareness of the disease.

Informant #4. “Ang kahumsug sa tawo mauy bahandi.

Kinahanglan sa mga tawo na matudluan para naa silay ideya ug
onsa ang mga pamaagi para malikayan ang sakit ka yang
 59

kahumsug sa tawo kay dili gyud kabayran ug sapi ug kinahanglan

tagaan gyud ug importansya.” Health is Wealth. People should be
taught so that they could have the idea on ways to prevent
communicable disease since health is priceless and is treasured.

The importance of having adequate knowledge in order to be

aware and that they would know what they are going to do if

inflicted with the disease to prevent its possible threat and

deterioration to the body.

Value to Health. Another theme extracted is the value to

health. The informants revealed that:

Informant #7. “Ang balyu gyud sa kinabuhi kay sa

kahumsug sa tawo ug dili kani kalimtan ug tagaan ug emphasis
kay importante.” The value of life through good health should not
be taken for granted but given emphasis as to its importance.

Informant #8. “Sa akung kaalam, ganahan ko na buhatun

ang mga programa para sa mga tawo para dili sila masakit kay
mau nay kuyaw sa panglawas”. With my knowledge, I want to
implement the program in order for the people to get rid of the
communicable disease which could be a threat to health.

The findings implied that significant portion of the informants

are very much aware of the importance of accumulation of

knowledge of the disease process to prevent it. It should not be

taken for granted but given emphasis.

Implementation
 60

The implementation is centered on the themes as to service,

promoting the welfare of the people and preventive measures.

Service. One of the significant themes extracted from the

interview conducted is service. The importance of service in

helping the people in promoting their health should not be taken

for granted. The informants revealed that:

Informant #2. “Sa akong propesyon, naghatag ku ug

serbisyo na wala gahunana unsa ang oras, kwarta ug akong kakugi
kay kahibalo man komaktabang samga tawo.” In this profession,
I render service regardless of time, money and effort knowing that
I can contribute something to the people.

Informant # 3. “Malipayon lang ko na nakahatag ko ug

serbisyo sa mga tawo sa akong nakat-unan ako gyud gi share sa
paghatag ug serbisyo bisan unsa pa ang iya nationality” I am just
glad to be of service to the people with my knowledge that I am
going to share to them through rendering service regardless of
races.

Informant #4. “Usa ako ka empleyado sa barangay ug

kahibalo ku unsa akong responsibilidad sa paghatag ug serbisyo”.
Being a baragay personnel, I know the commitment that I need for
service.

The findings revealed about the importance of providing

service to the people through reaching out them and emphasizing

that they are there to provide service regardless of time, money

and effort.
 61

Promoting the Welfare of the People. Significant portion

of the informants revealed about promoting the welfare of the

people as another theme. The informants revealed that:

Informant #5. “Aktibo ko sa mga programa sa gobyerno

kabahin sa pagpalambo sa kahimtang sa mga tawo” I am actively
involved in any program of the government to promote the
welfare of the community people.

Informant #6. “Daghan gyud ko nakat-unan kay aktibo man

ko sa mga programa sa gobyerno kabahin sa pagpalambo sa
kahimtang sa mga tawo sa komunidad.” I learned many things
since I am active in any program of the government that concerns
the community people.

Informant #7. “Ako gyud ipaniguro na apil gyud ko sa mga

proyekto ug programa sa gobyerno kabahin sa pagpalambo sa
kahimtang sa mga tawo.” I make sure always that I am involved
with projects and programs of the government in order that I can
contribute welfare for the people.

The findings revealed that they promote the welfare of the

people since they are duty bound and committed to the

performance of their duties and responsibilities that contribute to

the ensuring a progressive community and addressing their needs

and concerns.

Preventive Measures. Another significant the extracted on

implementation is preventive measures. It is important to

implement preventive measures to prevent further threat and

complications. The informants revealed:

 62

Informant # 8. “Nitabang ko sa gobyerno sa pagsulbad sa

problema kabahin sa pagpugong sa paglanap sa sakit para dili
masakit.” I collaborate with the government in resolving problems
especially in the transmission of communicable diseases through
the practice of prevention.

Informant #9. “Sa panahon sa akong pag serbisyo usa ka

empleyado sa barangay, ako gyud gibutang impasis sa pagpugong
sa sakita sa ma tawo para malikayan ang gasto.” In my years of
experience as a barangay personnel, I always emphasized about
preventive measures to prevent sickness to prevent expenses.

The findings revealed about the importance of preventive

measures on the basis of the notion that “An ounce of prevention is

better than cure.” It is important for them to prevent further

threats that could harm the welfare of the community people and

get rid of measles.

Chapter 3
 63

SUMMARY OF FINDINGS, CONCLUSIONS AND

RECOMMENDATIONS

Chapter 3 deals with the summary of findings, draws the

conclusions and offers the recommendations.

Summary of the Findings

The study determined the level of awareness and the level of

implementation of the Iligtas sa Tigdas ang Pinas program of the

Department of Health in Barangay Duljo, Fatima, Cebu City. The

areas of concern included the following: profile of the respondents

in terms of age, sex, civil status, highest educational attainment

and average monthly income; level of awareness of the

respondents on the Iligtas sa Tigdas ang Pinas Program; level of

implementation of the respondents on the Iligtas sa Tigdas ang

Pinas Program; determine whether there is a significant

relationship between the: profile and level of awareness; profile

and the level of implementation; and level of awareness and level

of implementation; the perceived factors that influence the

awareness and implementation of the respondents on the Iligtas

sa Tigdas Program as to respondents and barangay health

personnel; and the perceived factors that influence the

 64

implementation of the Iligtas sa Tigdas ang Pinas Program as

perceived by the respondents.

This study utilized the descriptive-correlational design

utilizing survey questionnaire.

The following are the important findings of the study: The

profile of the respondents revealed that majority of the

respondents belonged to the age bracket of 26 – 35 years of age,

females, married, college graduate and have an average monthly

income of Php 10,001 – Php 15,000.00. The level of awareness on

Iligtas sa Tigdas ang Pinas Program is Aware. The level of

implementation on Iligtas sa Tigdas ang Pinas Program is

Implemented. There is significant relationship on the: profile of

age, educational attainment and average monthly income with

level of awareness on Iligtas sa Tigdas ang Pinas Program; profile

of age, educational attainment and average monthly income with

level of implementation on Iligtas sa Tigdas ang Pinas Program;

andlevel of awareness and implementation on Iligtas sa Tigdas and

Pinas Program.

Perceived factors were centered on awareness and

implementation of the Iligtas sa Tigdas ang Pinas Program.

 65

Conclusion

From the findings, a conclusion is drawn that the level of

awareness on Iligtas sa Tigdas ang Pinas Program is Aware. The

level of implementation on Iligtas sa Tigdas ang Pinas Program is

Implemented. There is significant relationship on the profile of age,

educational attainment and average monthly income with level of

awareness on Iligtas sa Tigdas ang Pinas Program; profile of age,

educational attainment and average monthly income with level of

implementation on Iligtas sa Tigdas ang Pinas Program; and level

of awareness and implementation on Iligtas sa Tigdas and Pinas

Program.

It is supported by the theory of Imogen King’s goal

attainment theory. King’s framework shows the relationship of

operational systems (individuals), interpersonal (groups such as

nurse patients), and social systems (such as an educational

system, health care system). She selected 15 concepts from the

nursing literature (elf role, perception, communication, interaction,

transaction, growth and development, stress, time, personal space,

organization, status, power, authority and decision making as

essential knowledge for use by the nurses.

 66

Recommendations

The following recommendations are offered:

Dissemination of Information of Iligtas sa Tigdas ang Pinas

Program;Collaboration between the barangay health personnel and

the people on the prevention of contamination of measles;Resource

person should be invited to speak more about Iligtas sa Tigdas ang

Pinas Program;Reference materials should be available within the

reach on Iligtas sa Tigdas ang Pinas Program; and Compliance

with Iligtas sa Tigdas ang Pinas Program.

 67

REFERENCE

Books

Dizon, K et al (2006). Community Health Nursing. Manila: Abiva

Publishing Company.

Ferlie, B and et al (2001). Health Care Delivery System. Manila:

Manlapaz Publishing Company.

Kozier, Barbara et a (2006). Fundamentals of Nursing. Seventh

Edition. U.S.A: Addison Wesley Publishing Company.

Hurlock, Elizabeth (2007). Psychology for Modern Living.

Philadelphia: W.B. Saunders Company.

Nelson, V and et al (2008). Health Care System. Manila: Abiva

Publishing Company.

Polit, Denise and Cherry Beck (2008). Nursing Research.

U.S.A.: Addison Wesley Publishing Company.

Quinn, T (2002). Philippine Health Care Delivery System. Manila:

Phoenix Publishing Company.

Rosario, Angeles (2005). Community Health Nursing. Manila:

Phoenix Publishing Company.

Schaffer, William (2007). Medical-Surgical Nursing. 9th Edition.

Philadelphia: W.B. Saunders Company.

Watson, Jeanette (2004). Medical Surgical Nursing and its Related

Physiology. Philadelphia: W.B. Saunders Company.

Whitney, Frederick (2005). Elements of Research. New York:

McGraw- Hill Company.
 68

Unpublished Studies

Banquisio, May ann et l (2009). “Reactions and Views of the

Selected Residents on the Implementation of the Expanded
Program of Immunization in Barangay Labangon, Cebu
City.” Unpublished Study: University of the Visayas.

Bulalon, Earlian Lou (2011). “Vaccination Compliance of Children

Ages from Birth to Three Years Old in Sambag 1.
Unpublished Study: Southwestern University.

Glamora, Katherine (2008). “Evaluation on the Immunization

Program in Barangay Kamputhaw, Cebu City as Perceived by
the Selected Families.” Unpublished Study: University of
Cebu.

Hortelano, Elizabeth et al (2007). “Effectiveness of Expanded

Program of Immunization among the Selected Residents of
Punta Princesa, Cebu City.” Unpublished Study: University
of Southern Philippines.

Journals

“DOH probes alarming cases of measles in Cebu,” Phil Star. June

16, 2012.

Internet Sources

“Iligtas sa Tigdas ang Pinas Program” accesse through

www.manilatime.com, retrieved last August 15, 2012.

“Immunization Program of the Department of Health” accessed

through www.dov.gov.ph retrieved last August 14, 2012.

“DOH Launches Nationwide Iligtas sa Tigdas ang Pinas accessed

through www.gov.ph/20911/04/04
 69

APPENDICES
 70

APPENDIX A-1
TRANSMITTAL LETTER

Dr. Stella M. Ygoña M.D.

City Health Officer
CESSU
Cebu City Health Department

Dear Dr. Ygoña:

Good day!

I am a student of Southwestern University – Graduate School

taking up Master of Arts in Nursing Major in Medical-Surgical
Nursing would like to request from your good office an updated
copy of the measles cases in Cebu City from January 2003 to first
half of August 2011.

This is for the purpose of research material entitled,

“AWARENESS AND IMPLEMENTATION OF THE ILIGTAS SA TIGDAS
ANG PINAS PROGRAM IN BARANGAY DULJO, FATIMA, CEBU CITY,”
in connection with the Iligtas sa Tigdas ang Pinas Program
conducted on April 4 to May 4, 2011

Respectfully,

Chrysler Ian B Vizcayno

Noted by:

ODILON A.MAGLASANG, Ed.D.

Research Adviser
 71

Appendices A-2
TRANSMITTAL LETTER

Dr. Susana K. Madarieta

DOH Director – VII
RESU 7
Cebu City Health Department

Dear Dr. Cabugao,

Good day!

I am a student of Southwestern University – Graduate School

taking up Master of Arts in Nursing Major in Medical-Surgical
Nursing would like to request from your good office an updated
copy of the measles cases in Cebu City from January 2003 to first
half of August 2011.

This is for the purpose of research material entitled,

“AWARENESS AND IMPLEMENTATION OF THE ILIGTAS SA TIGDAS
ANG PINAS PROGRAM IN BARANGAY DULJO, FATIMA, CEBU CITY,”
in connection with the Iligtas sa Tigdas ang Pinas Program
conducted on April 4 to May 4, 2011

Respectfully,

Chrysler Ian B Vizcayno

Noted by:

ODILON A. MAGLASANG, Ed.D.

Research Adviser

ALBIM Y. CABANTINGAN, DBA

Dean
 72

Appendices A-3

Transmittal Letter

Dear Respondents,

Greetings!

I am presently conducting a research entitled, “AWARENESS

AND IMPLEMENTATION OF THE ILIGTAS SA TIGDAS AND PINAS
PROGRAM IN BARANGAY DULJO, FATIMA, CEBU CITY. In this
regard, kindly answer the following questions honestly. Your
responses will greatly contribute to the success of my study. Rest
assured these will be treated with utmost confidentiality and used
only for this study.

Thank you and God Bless.

Respectfully,

Chrysler Ian B Vizcayno

 73

Appendix B

Questionnaire

I. PROFILE:

Age: __________________

Sex:

( ) Male

( ) Female

Civil Status:

( ) Single

( ) Married

( ) Widow/Widower

Highest Educational Attainment:

( ) elementary level

( ) elementary graduate

( ) high school level

( ) high school graduate

( ) college level

( ) college graduate

( ) college graduate with units in Master’s degree

( ) college graduate with Master’s Degree

 74

( ) college graduate with units in Doctor’s degree

( ) college graduate with Doctor’s degree

( ) others, please specify: ___________________

______________________________________

Average Monthly Income:

( ) less than Php 5,000.00

( ) Php 5,001 – 10,000.00

( ) Php 10,001 – 15,000.00

( ) Php 15,001 and above

LEVEL OF AWARENESS OF THE RESPONDENTS ON THE

ILIGTAS SA TIGDAS ANG PINAS PROGRAM

On the right hand column, kindly check the extent of the

awareness of the respondents on the Iligtas sa Tigdas ang Pinas

Program.

Very Aware (4) – this means that the respondent has a

thorough knowledge of Iligtas sa Tigdas ang Pinas Program

Aware (3) – this means that the respondent has a partial

knowledge of Iligtas sa Tigdas and Pinas Program.

Less Aware (2) -- this means that the respondent has partial

knowledge of Iligtas sa Tigdas and Pinas Program.

 75

Not Aware (1) – this means that the respondent has no knowledge of Iligtas

sa Tigdas and Pinas Program.

Awareness 4 3 2 1
Measles is a highly contagious disease
caused by a virus
The first sign of measles is usually a high
fever, which begins about 10 to 12 days
after exposure to the virus, and lasts four to
seven days. A runny nose, a cough, red and
watery eyes, and small white spots inside
the cheeks can develop in the initial stage. A
After several days, a rash erupts, usually on
the face and upper neck. Over about three
days, the rash spreads, eventually reaching
the hands and feet. The rash lasts for five to
six days, and then fades.
Severe measles is more likely among poorly
nourished young children, especially those
with insufficient vitamin A, or whose immune
systems have been weakened by HIV/AIDS
or other diseases.
Complications are more common in children
under the age of five, or adults over the age
of 20. 
The most serious complications include
blindness, encephalitis (an infection that
causes brain swelling), severe diarrhoea and
related dehydration, ear infections, or severe
respiratory infections such as pneumonia.
As high as 10% of measles cases result in
death among populations with high levels of
malnutrition and a lack of adequate health
care.
Unvaccinated young children are at highest
risk of measles and its complications,
including death. Unvaccinated pregnant
women are also at risk. Any non-immune
person (who has not been vaccinated or was
vaccinated but did not develop immunity)
 76

can become infected.

The highly contagious virus is spread by
coughing and sneezing, close personal
contact or direct contact with infected nasal
or throat secretions.
The virus remains active and contagious in
the air or on infected surfaces for up to two
hours. It can be transmitted by an infected
person from four days prior to the onset of
the rash to four days after the rash erupts
Routine measles vaccination for children,
combined with mass immunization
campaigns in countries with high case and
death rates, are key public health strategies
to reduce global measles deaths
Others, please specify: ____________
________________________________

LEVEL OF IMPLEMENTATION ON THE ILIGTAS SA TIGDAS

ANG PINAS PROGRAM

On the right hand column, kindly check the extent of the

implementation of the Iligtas sa Tigdas ang Pinas Program.

Well Implemented (4) – this means the said activity is

carried throughout the way.

Implemented (3) – this means the activity is carried most of

the time.

Less Implemented (2) -- this means that the activity is

seldom carried.
 77

Not Implemented (1) – this means that the activity is not

carried at all.

Implementation 4 3 2 1
Door to Door Measles Rubella (MR) on
Iligtas sa Tigdas ang Pinas is launched
Vaccination Teams or “Bakunadoors”
knocking to give free measles and German
measles vaccine.
Monitor the disease using effective
surveillance and evaluative programmatic
efforts to ensure progress and positive
impact of vaccination activities
Achieve and maintain high vaccination
coverage with two doses of measles and
rubella containing vaccines
Develop and maintain outbreak
preparedness, rapid response to outbreaks
and the effective treatment of cases
Communicate and engage to build public
confidence and demand for immunization
Perform the research and development
needs to support cost-effective action and
improve vaccination and diagnostic tools
Perform diagnostic and laboratory
procedures to determine the presence of
measles
Encourage specimen collection to test
specimen whether it is positive for measles
Others, please specify: _______________
___________________________________
 78

Appendix C

Semi-Structured Interview Guide

1. What are the factors that influence your awareness of the

Iligtas sa Tigdas Program?

2. What are the factors that influence your implementation of

the Iligtas sa Tigdas Program?

 79

CURRICILUM VITAE

A. PERSONAL PROFILE:

NAME : Chrysler Ian Bascar Vizcayno

AGE : 25 Years Old

SEX : Male

CIVIL STATUS : Single

DATE OF BIRTH : June 24, 1988

PLACE OF BIRTH : Binondo, Manila City

PRESENT ADDRESS : 163-1 A. V. Rama Ave. Cebu City

OFFICE ADDRESS : Paseo Arcenans Estate, Banawa Cebu City

B. EDUCATIONAL ATTAINMENT

GRADUATE: Masters of Arts in Nursing

Major in Medical-Surgical Nursing
(MAN-MSN)
Graduate School of Health Science,
Management and Pedagogy
Southwestern University
Villa Aznar, Urgello St. Cebu City
2012-2013

College: Bachelor of Science in Nursing

(BSN)
College Of Nursing
University of the Visayas
Banilad, Mandaue City
2009-2010
 80

Associate in Health and Science Education

College Of Nursing
University of the Visayas
Banilad, Mandaue City
2009-2010

High School: High School Diploma

Cebu Institute of Technology-University
N. Bacalso Ave. Cebu City
2003-2004

Elementary: Elementary Diploma

H.J. Lassaline Catholic School
Windsor, Ontario Canada
2001-2002

C. PROFFESSIONAL BOARD EXAMINATION PASSED AND

ELIGIBILITY

Nursing Licensure Examination, Cebu City, Philippines

D. WORK EXPERIENCE

July 16, 2014 – Present Position: Nurse I

Company: Tuburan District Hospital
Address: Municipality of Tuburan,
Cebu

May 14-Nov. 5, 2013 Company: Convergys Corporation

Position: Customer Care
Representative
Address: Paseo Arcenas Estate,
Banawa Cebu City