A Closer Look Into Volunteerism:
Contributions, experiences, and challenges of Barangay Health Workers in a municipality in Ilocos Norte
By Elaine Joyce C. Diaz
Article based on relevant findings of the thesis titled, “Performance of Community Health Workers during the COVID-19 Pandemic and Its Associated Factors in San Nicolas, Ilocos Norte: A Sequential Explanatory Mixed-Methods Study
When those working on the frontlines are unprotected, how do we ensure the safety of the whole? In a country with a fragmented healthcare delivery system, geographically isolated and disadvantaged areas (GIDAs) face the problem of insufficient health workers. The Philippines only relies on volunteerism when inadequate systemic support further aggravates the exodus of healthcare workers. Barangay Health Workers (BHWs) are resident non-medical volunteers trained by the municipal health unit to assist in the health programs of the barangay. Their role in the country’s health system dates back to 1978, during the Alma Ata Declaration. Years after, BHWs continue to bridge health services to the Filipino masses.
In the study, it showed that BHWs are highly capable and motivated to serve their respective communities, especially during the height of the COVID-19 pandemic as part of the Barangay Health Emergency Response Team (BHERTs). However, minimal support is provided to ensure the safety of the BHWs and their families as they must fulfill their duties amidst the lack of financial insurance, job security and protective paraphernalia .
Their strengths
In San Nicolas, Ilocos Norte, BHWs have established their name in their barangays, proving their credibility and capabilities to fulfill health-related roles and carrying a badge of local knowledge, familiarity, and intimate position in the barangay. Their relationship with communities situates them in a two-way flow of information as a receiver and a messenger. Their positionality allows them to hear the residents’ pleas and concerns regarding their overall health, which can help the Rural Health Unit (RHU) design and implement community health interventions. Likewise, BHWs work as messengers, aiding barangay residents with up-to-date news on health-related programs from the RHU.
Unlike healthcare professionals, 87 out of 134, or roughly 65% of the municipality’s BHWs are high school graduates or have at least finished a vocational course. Regardless, they have dedicated full-time effort to learning the ropes of their job through long years of service, supervision, and attending training. As the first responders during COVID-19, BHWs lighten the load for the municipal health office as they compensate for the lack of grass-roots interaction of health professionals from the RHU.
Their vulnerability
In some instances, familiarity and intimacy within the community is a double-edged sword for the BHWs — narratives showed experiences of social stigmatization, exclusion, harassment, and discrimination from residents and officials. For example, some residents labeled them as “COVID spreaders” or, at times, blatantly ignored them.
They are also often pushed to handle community rounds, reporting, and monitoring of residents in quarantine facilities despite the lack of protective gear; the BHERTS are composed of officials, tanods, and BHWs. Accounts from the study revealed cases where barangay officials were often absent; Despite being aware that they are often taken advantage of, they continue to persist because the community health will be affected if they fail to do so. BHWs shared being on-call and prepared to respond to any community needs regardless of the weather and time.
Granting the long-withstanding role of the BHWs in the country’s health system, they remain recognized as part-time health volunteers, dedicating full-time effort despite the lack of a regular salary and benefits. Republic Act 7883, or The Barangay Health Workers’ Benefits and Incentives Act of 1995, states that BHWs are entitled to receive benefits such as hazard allowances, subsistence allowance, free legal services, training, career, and education enrichment though, in reality, the benefits received are dependent on the fiscal resources available in the barangays. Instead of a salary-grade-based pay, BHWs’ in a municipality in Ilocos Norte receive a quarterly honorarium amounting to P600–1100 with a P1800 annual honorarium from the LGU– they are compensated for around P12 per day for every three months of full-time work.
Furthermore, BHWs reported a lack of benefits and material support– no provision of hazard pay despite managing those in quarantine in their communities, inconsistent and insufficient material support, lack of rapid testing and personal protective equipment (PPE), and limited training. Notably, barangay income disparities are prominent between rural and urban areas– some receive enough PPE while some do not. Despite the apparent risk that entails their everyday routine, findings show that PhilHealth insurance, previously provided, has been discontinued. BHWs must attend to hazardous work without any financial safeguard in case they get sick.
The overall scope of their work revolves around ensuring access to COVID-19 services and existing programs such as immunizations and maternal and child-health support. This list, though, is not exhaustive to reflect the difficulty of their tasks. When we expect the BHWs to sacrifice in the name of volunteerism, we force them to leave their household responsibilities and safety (i.e., working while pregnant) due to urgent cases requiring immediate attention and time.
With insufficient material support, they are often pushed to sacrifice their personal resources; nonetheless, they continue to improve their communities’ health conditions despite their spouses’ discouragement or pleas. On the side of the BHWs, they regard themselves as a public servant– not expecting high incentives but always ready to respond.
Material support is not simply their primary concern; the political nature of their appointment also threatens their role. Barangay officials hold the power to appoint or, sometimes, remove BHWs. Each election season, therefore, is a time for the BHWs to hope that the election winner will once favor them, making them vulnerable to power abuse and election promises by politicians.
Their resolutions
Discussions with the BHWs and their supervisors offered pertinent points for improving their condition, given that they have long been maximizing their resources, including coping ones. From the residents, all they hope is recognition of their efforts and more understanding instead of hurtful remarks. On the side of the government, consultative meetings must be conducted to hear the dire realities of the BHWs. Likewise, benefits must be increased and stated in their Magna Carta, municipal ordinances, and laws as safety measures, regardless of administration changes.
While the general public has been accustomed to viewing the BHWs for their contribution and sacrifices, volunteerism requires support, especially when expected to play a significant role.
It is only fitting that we do our part to protect them while they ensure our health, safety, and overall well-being. Volunteerism among health workers, when viewed in terms of financial cost, may initially be cost-effective; however, heavy reliance on volunteerism proves to be detrimental in the long run.
A disregard for the health workers’ well-being is a violation and disregard for the very essence of the goal, “Health For All.” When left with no resources to ensure their safety, BHWs rely on their faith, social distancing, and COVID-19 vaccination as protection.
The study has revealed crucial findings in a move towards an effective, efficient, and accessible public and rural health care system. And as we work together with our community frontliners, we should fill the gaps in the communities they handle, which leads us to an important question to answer: “where do we draw the line between volunteer work and unpaid labor?”
