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CHAPTER I

THE PROBLEM AND ITS BACKGROUND

Rationale

The Department of Healths ultimate vision and mission is the health for all Filipinos by ensuring

accessibility and quality of the health care to improve the quality of life for all Filipinos especially the

poor. This is a consonance to the right of every individual to realize his birthright of health and longevity

(Reyala et al, 2000).

At the municipal level the health development structure include personnel who are graduates of

an accredited school of their respective professions, passed the board examination and probably secured

their license to practice and perform their respective tasks considering the dos and donts or laws

covered by their profession. This Health Care Providers are intended to bridge the gap between DOH

services and communities. It is important to remember that this bridge spans not only different beliefs and

experiences but also different social organizations (Kahssay, 1998).

Our Health Care Providers include medical practitioners, Public health nurses, sanitary

inspectors, and the midwives. The said practitioners which are one who are also accountable in guiding

the community about managing their health regardless of culture, is thought to play an important role in

uplifting the health care delivery system for the people in the community. They reflect on the needs of the

people and help them to look after its health.

There may be variation of the tasks of the Health care Personnel, but in general, they serve as

planners, managers or supervisors, coordinator of services, health educators, and detect deviation from

health of individuals, families, and groups of the community through contact or visit with them.

Furthermore, they also motivates changes in health behavior of individuals, family, groups, and

community including lifestyle in order to promote and maintain health, and serve as a good example or

model of healthful living to the public community.

There are two levels of Primary Health Care workers that have been identified. First is the Village

or Barangay Health Workers (V/BHWs) which refers to the trained community health workers or health

auxiliary volunteer or a traditional birth attendant or healer. The other one are the intermediate level

health workers which composed of general medical practitioners or their assistants, Public Health Nurse,

Rural sanitary Inspectors and the Midwives (Reyala et al, 2000) who will be the focus of this study.


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Midwives refer to people who, having been regularly admitted to a midwifery educational

program that is duly recognized in the country in which it is located, has successfully completed the

prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered

and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a

formal university or a combination.

The Midwife is recognized as a responsible and accountable professional who works in

partnership with women to give the necessary support, care and advice during pregnancy, labor until

postpartum period, to conduct births on the midwifes own responsibility and to provide care for the

infant. This care includes preventive measures, promotion of normal birth, the detection of complications

in mother and child and accessing of medical or other appropriate assistance and the carrying out of

emergency measures.

The Midwives have an important task in health counseling and education, not only for woman,

but also within the family and community. This work should involve antenatal education and preparation

for parenthood and may extend to womens health, sexual or reproductive health and childcare.

The midwife is also considered as the front liners of the health care team. They are the one who

are in contact with the people in the community where in they assessing needs and problems to be

addressed to the right agencies of the government who can help them regarding their concerns. Based on

their job description, they are the one who gives care to the whole community because they renders direct

care to the normal pregnant women during pregnancy until the end of puerperium as well as to normal

labor infant.

The quality of services received by the community people also greatly depends on the effectiveness of the

midwives in rendering them. The researchers are concerned whether the people of selected Barangay of

Bambang Nueva Vizcaya are really acquiring the services they deserve to receive from midwives and so

this research of the effectiveness of midwives in delivering primary health care services will be

conducted.


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Statement of the Problem

This study aims to assess the level of effectiveness of midwives in selected barangays of

Bambang, Nueva Vizcaya in delivering primary health services.

Specifically, this study aim to answer the following:

1. What is the profile of midwives of selected barangays of Bambang, Nueva Vizcaya in terms of

the following?

a. Age

b. Civil status

c. Monthly income

d. Length of residency

e. Length of service as midwives

f. Trainings/seminars attended

2. What is the level of effectiveness of midwives in rendering primary health care services to the

community people as evaluated by?

A. The community residents

B. The midwives

3. Is there a significant relationship between the midwives perception of the level of effectiveness in

delivering primary health care services and their selected profile variables?

a. Age

b. Civil status

c. Length of residency

d. Length of service as midwives

e. Trainings/seminars attended

4. Is there a significant difference in the evaluation of midwives and the evaluation of the

community residents in terms of effectiveness of the former in delivering primary health care

services?

Statement of Hypotheses

1. There is no significant relationship between the midwives perception on the level of

effectiveness in delivering primary health care services and their selected profile variables:


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2. There is no significant difference in the evaluation of midwives and the evaluation of the

community residents in terms of effectiveness of the former in delivering primary health care

services?

Significance of the Study

The result of this study, assessing the level of effectiveness of midwives in ten selected barangays

in Bambang, Nueva Vizcaya in rendering primary health care services will benefit the following:

a. The Municipal and Local Health Board: Through this study, the Municipal and Local Health Board

will be able to determine which among the profiles studied positively affects the level of effectiveness of

the midwives in rendering primary health care services to the community. This would help them evaluate

and screen out all volunteers? Who among them would be the most qualified and most capable to function

more effectively.

b. The DOH Health Manpower Development and Training Service (HMDTS): The HMDTS which is

the lead DOH office responsible for the development, coordinating and monitoring of midwives would be

able to determine which training courses are need to improve the level of effectiveness of the midwives in

their functioning especially in areas wherein their evaluation is not effective or moderately effective.

c. Community people: The result of this study will be of value to community people because should

their be positive actions with regards to inadequacy of midwives in performing their functions. It would

somehow guarantee them to acquire the quality of services they deserve to receive from health workers,

particularly from the midwives.

d. Future researchers: This research may become a spring board for the conceptualization of other

related research studies.

Scope and Delimitation

This research mainly focuses on the level of effectiveness of midwives in selected barangays of

Bambang, Nueva Vizcaya in delivering primary health services. The 5 urban barangays are the following:

Banggot, Buag, Homstead, Calaocan, and Makati. The 5 rural barangays are the following: Salinas, Barat,

San Antonio, Aliaga and Almaguer South The respondents are the residents of the said barangays.

There is no attempt to study and include the reasons to the level of effectiveness of midwives in

selected barangays of Bambang, Nueva Vizcaya in delivering primary health services. It is limited during

sy 2009-2010.


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Definition of Terms

Midwives - are autonomous practitioners who are specialists in low-risk pregnancy, childbirth, and the

postpartum stage. They generally strive to help women to have a healthy pregnancy and natural birth

experience. Midwives are trained to recognize and deal with deviations from the norm. Obstetricians, in

contrast, are specialists in illness related to childbearing and in surgery. The two professions can be

complementary, but often are at odds because obstetricians are taught to actively manage labor, while

midwives are taught not to intervene unless necessary.

Primary Health Care - as defined by the World Health Organization, is essential health care made

universally accessible to individuals and families in the community by means acceptable to them, through

their full participation and at a cost that the community and country can afford at every stage. Its goal is

health for all Filipinos and health in the hands of the people by the year 2020 and its mission is to

strengthen the health care system by increasing opportunities and supporting the conditions wherein

people will manage their own health care.

Community Organizing Participatory Research - is a collective, participatory, transformative,

liberative, sustained and systematic process of building people's organizations by mobilizing and

enhancing the capabilities and resources of the people for the resolution of their issues and concerns

towards affecting change in their existing oppressive and exploitative conditions (1994 National Rural

Conference). It is continuous and sustained process of educating the people to understand and develop

their critical awareness of their existing condition, working with the people collectively and efficiently

on their immediate and long-term problems, and mobilizing the people to develop their capability and

readiness to respond and take action on their immediate needs towards solving their long-term problems

(CO: A Manual of experience, PCPD).

Conceptual Framework

The effectiveness of midwives in rendering primary health care services depends upon their age,

civil status, monthly income, length of service as midwives and number of trainings or seminars attended.


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CHAPTER II: REVIEW OF RELATED LITERATURE

Todays health care consumers have greater knowledge about their health than in previous years

and they are increasingly influencing health care delivery. The trend is toward an integrated health care

INDEPENDENT VARIABLES

Rendering of primary health care

services

DEPENDENT VARIABLES

Level of Effectiveness

1 not effective

2 moderate effective3 effective

4 very effective

Correlative Variables

y Agey Civil status

y Length of residency

y Length of service as

midwife

y Trainings/seminar

attended


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systemone that is community based. The shift from institutional to community based care brings

changes in the roles and responsibilities of health care providers (Kozier, 2004).

At the municipal level the health development structure include personnel who are graduates of

an accredited school of their respective professions, passed the board examination and probably secured

their license to practice and perform their respective tasks considering the dos and donts or laws

covered by their profession. This Health Care Providers are intended to bridge the gap between DOH

services and communities. It is important to remember that this bridge spans not only different beliefs and

experiences but also different social organizations (Kahssay, 1998).

Our Health Care Providers include medical practitioners, Public health nurses, sanitary

inspectors, and the midwives. The said practitioners which are one who are also accountable in guiding

the community about managing their health regardless of culture, is thought to play an important role in

uplifting the health care delivery system for the people in the community. They reflect on the needs of the

people and help them to look after its health.

There may be variation of the tasks of the Health care Personnel, but in general, they serve as

planners, managers or supervisors, coordinator of services, health educators, and detects deviation from

health of individuals, families, and groups of the community through contact or visit with them.

Furthermore, they also motivates changes in health behavior of individuals, family, groups, and

community including lifestyle in order to promote and maintain health, and serve as a good example or

model of healthful living to the public community.

There are two levels of Primary Health Care workers that have been identified. First is the Village

or Barangay Health Workers (V/BHWs) which refers to the trained community health workers or health

auxiliary volunteer or a traditional birth attendant or healer. The other one are the intermediate level

health workers which composed of general medical practitioners or their assistants, Public Health Nurse,

Rural sanitary Inspectors and the Midwives (Reyala et al, 2000) who will be the focus of this study.

Midwives refer to people who, having been regularly admitted to a midwifery educational

program that is duly recognized in the country in which it is located, has successfully completed the

prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered

and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a

formal university or a combination.

The Midwife is recognized as a responsible and accountable professional who works in

partnership with women to give the necessary support, care and advice during pregnancy, labor until


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postpartum period, to conduct births on the midwifes own responsibility and to provide care for the

infant. This care includes preventive measures, promotion of normal birth, the detection of complications

in mother and child and accessing of medical or other appropriate assistance and the carrying out of

emergency measures.

The Midwives have an important task in health counseling and education, not only for woman,

but also within the family and community. This work should involve antenatal education and preparation

for parenthood and may extend to womens health, sexual or reproductive health and childcare.

The quality of services received by the community people also greatly depends on the

effectiveness of the midwives in rendering them. The researchers are concerned whether the people of

selected Barangay of Bambang Nueva Vizcaya are really acquiring the services they deserve to receive

from midwives and so this research of the effectiveness of midwives in delivering primary health care

services will be conducted.

The Midwives

Midwifery is a health care profession in which providers give prenatal care to expecting mothers,

attend the birth of the infant, and provide postpartum care to the mother and her infant. A practitioner of

midwifery is known as a midwife, a term used in reference to both women and men. In the United States,

nurse-midwives are advance practice nurses (nurse practitioners). In addition to giving care to women in

connection with pregnancy and birth, they also provide primary care to women, well-women care

(gynecological annual exams), family planning, and menopause care.

Midwives refer women to obstetricians when a pregnant woman requires care beyond the

midwives area of expertise. In many jurisdictions, these professions work together to provide care to

childbearing women. In others, only the midwife is available to provide care. Midwives are trained to

handle certain situations that are considered abnormal, including breech births and posterior position,

using non invasive techniques. (http://en.wikepedia.org/wiki/midwifery).

A midwife as a person who, having been regularly admitted to a midwifery educational program

that is duly recognized in the country in which it is located, has successfully completed the prescribedcourse of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally

licensed to midwifery. The educational program may be an apprenticeship, a formal university program,

or a combination. The midwife is recognized as a responsible and accountable professional who works in

partnership with women to give the necessary support, care and advice during pregnancy, labor and the

postpartum period, to conducts births on the midwives own responsibility and to provide care for the


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infant. This care includes preventive measures, the promotion of formal birth, the detection of

complications in mother and child, accessing of medical or other appropriate assistance and the carrying

out of emergency measures. The midwife has an important task in health counseling an education, not

only for the woman, but also within the family and community. This work should involve antenatal

education and preparation for parenthood and may extend to womens health, sexual or reproductive

health and childcare. A midwife may practice in any setting including in the home, the community,

hospitals, clinics or health units. (International Confederation of Midwives).

Midwifery. The word brings to mind a pregnant women in a softly lit room, laboring with intent,

touched and tended by gentle women who are experienced and wise in the ways of labor and birth. One

role of midwives is to protect the sanctity of birth and to honor and cherish women both as they strive to

bring forth new life and throughout their lives.

(http://www.midwiferytoday.com/articles/MidwiferyLegacy.asp)

Functions of Midwife

The main function of a midwife is to provide support and care to women during labor and

delivery. However, midwives today dont just attend birthsthey offer many types of gynecologic care.

Midwives can:

y Perform gynecological exams

y Help with preconception planning

y Provide prenatal care

y Assist during labor and delivery

y Offer guidance with breastfeeding and other newborn care issues

y Help women who are going through menopause

Midwives have a different philosophy than doctorsthey want the women they work with to

make their own decisions about the birthing experience. Women have reported that they are more

satisfied about their ability to make decisions when they are assisted by a midwife a opposed to

an obstetrician. Although midwives are trained to provide medical assistance when necessary,

they prefer to avoid interventions, such as forceps and C-sections delivery.

EXAMINATION AND REGISTRATION OF MIDWIVES

Section 11. Examination required- all applicants for registration to the practice of midwifery in the

Philippines shall be required to undergo an examination as required for in this Act.


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Section 12. Scope for Examinations- the scope of examinations for the practice of midwifery shall consist

of the following:

(a) Infant care and feeding; Chan Robles virtual law library

(b) Obstetrical anatomy and physiology

(c) Principles of bacteriology as applied to midwifery practice

(d) Obstetrics; Chan Robles

(e) Midwifery procedures

(f) Domiciliary midwifery

(g) Community hygiene and first aid

(h) Nutrition

(i) Ethics of midwifery practice

(j) Primary health care

(k) Professional growth and development

(l) Family planning and

(m) Other subject within the Board may deem necessary for addition or inclusion

from time to time.

Section 13. Prerequisite and qualifications of applicants for examination- in order to be admitted to the

midwifery examinations, an applicant shall, at the time of filing of his/her application thereof, establish to

the satisfaction to the board that he/she:

(a) Is in good health and good moral character, and Chan Robles virtual law library

(b) Isa graduate of midwifery in a government recognized and duly accredited

institution.

At the time of the issuance of a certificate of registration, the applicant shall be a citizen of the

Philippines and at least eighteen years of age. (www.chanrobles.com/republicactno7392.htm )

Difference Between Midwives and Physicians

y SKILLS: Physicians receive an MD while midwife training is comparable to a nursing

background. Only physicians can perform surgery such as cesarean delivery.


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y FINANCIAL INCENTIVES: Physicians have a financial incentive to recommend

cesareans since they will reap the financial rewards of performing the surgery. Since

midwives do not receive any compensation from surgery, they may be more likely to

look out for the best interest of the patient.

y ATTITUDE TOWARD CHILDBIRTH: The midwifery model of care views birth as a

natural process and gives the mother more input toward shaping the birth experience. The

physicians medial approach ..highlights the risk of childbirth, viewing the event as

inherently medical, even pathological, requiring hospital admission and technological

intervention. (http//healthcare-economist.com)

Traits and Qualities of a Midwives

1. Efficient

Plans with the people, organizes, conducts, directs health education activities accordingto the needs of the community.

Knowledgeable about everything relevant to his practice; has the necessary skills

expected of him/her.

2. Good listener

Hear what being said and whats behind the words.

Always available for the participant to voice out their sentiments and needs.

3. Keen observer

Keep an eye on the proceedings, process and participants behavior.4. Systematic

Knows how to put in sequence or logical order the parts of the session.

5. Creative/Resourceful

Uses available resources.

6. Analytical/critical thinker

Decides on what has been analyzed.

7. Tactful

Brings about issues in smooth subtle manner.Does not embarrass but gives constructive criticism.

8. Knowledgeable

Able to impart relevant, updated and sufficient input.

9. Open

Invites ideas, suggestions, and criticism.


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To achieve the goal of Primary Health Care which is health for all Filipinos and health in the

hands of the people by the year 2020, the following strategies were set: reorientation and reorganization

of the national health Care system with the establishment of functional support mechanism in support

of the mandate of devolution under the Local Government Code of 1991; effective preparation and

enabling process for health action at all levels; mobilization of the people to know their communities

and identifying their basic health needs with the end in view of providing appropriate solutions leading

to self-reliance and self determination; development and utilization of appropriate technology focusing

on local indigenous resources available in and acceptable by the community; organization of the

communities arising from their expressed needs which they have to decide to address and that this is

continually evolving in pursuit of their own development ; increase opportunities for community

participation in local level planning, management, monitoring and evaluation within the context of

regional and national objectives; development of intra-sectoral linkages with other government and

private agencies so that programs of the health sectoral is closely linked with those of other socio-

economic sectors at the national, intermediate and community levels; emphasizing partnership so that the

health workers and the community leaders/members view each other as a partners rather than merely

providers and receiver of health care respectively. The frame work for meeting the goal of primary health

care is organizational strategy, which calls for active and continuing partnership among the communities,

private and government agencies in health development ( Reyala, 2000).

Using a Team Work Approach

Different categories of health personnel must learn to work together, since the different categoriesare trained separately; they are not always prepared to work effectively in health care teams. To do so,

health workers need training in working with each other care providers. The teamwork approach will lay

the foundation for increase solidarity and respect among health care workers. They will realize that they

are interdependent but they share responsibilities and need to act frequently.

At district and community levels, inter-sectoral coordination is an important pillar of primary

health care. Given the multiple causes of health and disease, the team concept must be expanded even

beyond health care workers. To enhance the understanding of development and to strengthen preventive

and promotive activities , community teams should include workers from sectors such as agriculture,

water supply and education.

Primary health care services exist to improve the health of individuals and communication;

participation of these individuals and communities in their own health care is essential in improving

health outcomes (Kahssay,1998).


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Community Organizing Participatory Research (COPAR)

COPAR is an important tool for community development and people empowerment as this helps

the community workers to generate community participation in development activities. It prepares

people/clients to eventually take over the management of a development program s in the future. It also

maximizes community participation and involvement; community resources are mobilized for community

services.

COPAR is based on the principles that people, especially the most oppressed, exploited and

deprived sectors are open to change, have the capacity to change and are able to bring about change. It

should be based on the interest of the poorest sectors of society and should lead to a self-reliant

community and society.

It involves a progressive cycle of action-reflection action which begins with small, local and

concrete issues identified by the people and the evaluation and the reflection of and on the action taken by

them. It places emphasis on learning that emerges from concrete action and which enriches succeeding

action. It is participatory and mass-based because it is primarily directed towards and biased in favor of

the poor, the powerless and oppressed. It is also group-centered and not leader-oriented. Leaders are

identified, emerge and are tested through action rather than appointed or selected by some external force

or entity (http://nursingcrib.com/community-organizing -participatory-researh-copar/).

The COPAR process has four phases. First is the pre-entry phase which is the initial phase of the

organizing process where the community/organizer looks for the communities to serve/help. It is

considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it.

Activities include designing a plan for community development including all its activities and strategies

for care development, designing criteria for the selection of site and actually selecting the site for

community care.

The second phase is the entry phase sometimes called the social preparation phase as to the

activities done here includes the sensitization of the people on the critical events in their life, innovating

them to share their dreams and ideas on how to manage their concerns and eventually mobilizing them to

take collective action on these. This phase signals the actual entry of the community work/organizer intothe community. She /He must be guided by the following guidelines however.

1. Recognizes the role of authorities by paying them visits to inform them of their presence and

activities.

2. The appearance, speech, behavior and lifestyle should be in keeping with those of the community

residents without disregard or their being role models.


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3. Avoid raising the consciousness of the community residents; adopt a low-key profile.

The third phase is the organization building phase which entails the formation of more formal

structures and the inclusion of more formal procedures of planning, implementation and evaluating

community-wide activities. It is at this phase where the organized leaders or groups are being given

training (formal, informal, OJT) to develop their skills and in managing their own concerns/programs.

The fourth phase is the sustenance and strengthening phase which occurs when the community

organization has already been established and the community members are already actively participating

in community-wide undertakings. At this point, the different communities setup in the organization

building phase are already expected to be functioning by way of planning, implementing and evaluating

their own programs with the overall guidance from the community wide organization. Strategies used

may include education and training; networking and linkaging; conduct of mobilization on health and

development concerns; implementing of livelihood projects; and developing secondary leaders(http://nursingcrib.com/phases-of-the-copar-process/


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Treatment of Data

The perceived levels of effectiveness of midwife in rendering primary health care were classified

into the following:

Table 1

Enrollment inlocalcolleges,2005

Weighted Mean Quantitative Description Qualitative Description

3.50-4.00 4 VeryEffective

2.50-3.49 3 Effective

1.50-2.49 2 ModeratelyEffective

1.00-1.49 1 NotEffective

Statistical Tool

The t-test and ANOVA with LSD will be used to compare level of effectiveness of midwife in

delivering primary health care services and their selected profile variables. Significant level is set at 0.05.


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CHAPTER IV

PRESENTATION, ANALYSIS AND INTERPRETATION OF FINDINGS

Table 2. Frequency and Percent Distribution of the Midwives According to Age

Age Group Frequency Percentage

36- 40 1 9.09%

41- 45 3 27.27%46- 50 2 18.18%

51- 55 4 36.36%56- 60 1 9.09%

Total 11 100%

Table 2 shows the frequency and percent distribution of the Midwives according toage. It can be seen that most of the midwives are from ages 51 -55. It can also be

noted that only 2 midwives belongs to the extreme age range of 36-40 and 56-60which means that only few midwives are very young and very old, most midwives

are in late adulthood stage.

Table 3. Frequency and Percent Distribution of the Midwives According to Civil

Status

Civil Status Frequency Percentage

Single 0 0%Married 11 100%

Widow 0 0%

Separated 0 0%

Total 11 100%

Table 3 shows that all of the respondent midwives are married. This implies that a great number

of midwives divide their time and responsibility in dealing with their families and in dealing with

their job as health workers. Their responsibility as married person could pose a bearing in their

effectiveness as midwives. The result, however, needs to be tested if there is a correlationbetween the result and their level of effectiveness as midwives.


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Table 5 shows the effectiveness of midwives in rendering primary health care as evaluated by the

community residents in the area of functioning as a coordinator of health services. It can be seen

that the community residents evaluated the midwives as effective in the role as a coordinator of

health. In their role as coordinator of service, they are effective in participating in determining

health needs of individual, families, and the community; assisting in planning and organizing the

Clinic in his/ her Barangay health station; preparing monthly schedule of activities in

coordination with the Physician, Nurse, Sanitary Inspector, and other Health.

Table 6. Level of Effectiveness on Midwives as Evaluated by the Community Residents as

N Mean

Std.

Deviation

Description

4. Gives direct care to normal childbearing women during pregnancyuntil the end of puerperium as well

as to the normal newborn infants.

200 3.55 .648Very Effective

5. Gives tetanus toxoidimmunization. 200 3.57 .676

Very Effective

6. Refers to the Physician and/orNurse and appropriate agencies

pregnant and postpartum womenand newborn infants with

suspected abnormalities andproblem.

200 3.34 .704

Effective

7. Registers births and do prenatalcare.

200 2.71 .990 Effective

8. Promotes breastfeeding. 200 3.45 .768 Effective

9. Conducts. operation timbang 200 3.25 .843 Effective

10.Gives food supplementation to 2ndand 3

rddegree malnourished

children.

200 2.95 1.055Effective

Total 200 3.2586 .50236 Effective

Valid N (listwise) 200


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community residents in the area of functioning as a. all of the functions related to their role as is

evaluated as effective meaning they do this job often.

Table 7. Level of Effectiveness on Midwives as Evaluated by the Community Residents asHealth Care Provider

Heath Care Provider N Mean

Std.

Deviation

11.Obtaining clinical history 200 2.92 .915 Effective

12.Performing simple routine physicaland lab exam

200 2.37 .953Moderately

Effective

13.Administering emergency andtherapeutic measures based in thestanding orders

200 2.98 .935 Effective




community residents in the area of functioning as a heath care provider. Based from the table the

midwives are effective in obtaining clinical history and administering emergency and therapeutic

measures based in the standing orders while they are moderately effective in performing simple

routine physical and lab exam. This implies that some instruments for simple laboratory

examinations are lacking in the community therefore the midwives neither can nor perform this

task at the most effective level. Overall evaluation on this area shows that they are effective as

health care provider.

Table 8. Level of Effectiveness on Midwives as Evaluated by the Community Residents as

Health Monitor Agent

As a Health Monitor N Mean

Std.

Deviation

14.Conducts home visit , case findings

on TB, AIDS, malaria, Dengue,etc.200 2.9850 .90491

Effective


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community residents in the area of functioning as health monitor agent. As a health monitor

agent the residents evaluated the midwives as effective in their conduct of duty such as

conducting home visit , case findings on TB, AIDS, malaria, and dengue.

Table 9 Level of Effectiveness on Midwives as Evaluated by the Community Residents as

Community Organizer

As a Community Organizer N Mean

Std.

Deviation

15.Identifies individuals and groups inthe community who can participatein the delivery of health care.

200 3.15 .811Effective

16.Organizes individuals and groupsto support activities in relation tothe delivery of health services

within the catchment area.

200 3.11 .831

Effective

17.Facilitates community health

development projects200 3.06 .849

Effective




community residents in the area of functioning as a community organizer. In their function as a

community organizer, they are effective in identifying individuals and groups in the community

who can participate in the delivery of health care, organizing individuals and groups to support

activities in relation to the delivery of health services within the catchment area, and facilitating

community health development projects.


an Educator


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As an Educator N Mean

Std.

Deviation

18.Conducts individual and groupteaching utilizing information

education communicationmaterials.

200 2.41 .967

Moderately

Effective

19.Requests and distributesinformation educationcommunication or IEC materials to

other government and nongovernment units like schools,

civic and church organizationswithin the catchment area.

200 2.35 .990

Effective

Total200 2.3750 .91573

Moderately

Effective


Table 10 shows the effectiveness of midwives in rendering primary health care as evaluated by

the community residents in the area of functioning as an educator. In the overall evaluation as an

educator, they are moderately effective. This implies that community residents cant appreciate

much the effort of the midwives in educating them.


Supervisor/ Manager

As a Manager/ Supervisor N Mean

Std.

Deviation

20.Guides volunteer health workersand or trainees assigned tobarangay health station.

200 3.30 .819Effective

21.Accomplishes required records and

forms for activities undertaken.

200 3.33 .744 Effective

22.Prepares and submits reports ofactivities and needs for supplies

and other logistic requirements ofthe barangay health workers.

200 3.39 .714

Effective



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Table 11 shows the effectiveness of midwives in rendering primary health care as evaluated by

the community residents in the area of functioning as a manger/ supervisor. As a manager/

supervisor they are effective in guiding volunteer health workers and or trainees assigned to

barangay health station, Accomplishing required records and forms for activities undertaken,

Preparing and submitting reports of activities and needs for supplies and other logistic

requirements of the barangay health workers. In general as a manager/ supervisor, they are

effective as evaluated by the residents.

Table 12 Effectiveness of Midwives in seven areas of functioning

Role of Midwives N Mean

Std.

Deviation

Description

A. Coordinator of Health 200 3.3950 .57306 Effective

B. 200 3.2586 .50236 Effective

C. Health Care Provider 200 2.7567 .72578 Effective

D. Health Monitor 200 2.9850 .90491 Effective

E. Community Organizer 200 3.1050 .66295 Effective

F. Educator200 2.3750 .91573

Moderately

Effective

G. Supervisor/ Manager 200 3.3383 .64059 Effective

Overall 200 3.0305 .40135 Effective


Table 12 shows the overall level of effectiveness of midwives in the seven areas of functioning

as a coordinator of health, health care provider, health monitor agent, community organizer, an

educator, and as a manager/ supervisor. The result shows that the community residents evaluated

their midwives as effective in overall. They are effective in performing functions as a


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coordinator of health, health care provider, health monitor agent, community organizer, and as a

manager/ supervisor while they are moderately effective as an educator.

Table 13. Effectiveness of Midwives as evaluated by the midwives themselves

N Mean

Std.

Deviation

1. Gives direct care to normal childbearing women during pregnancyuntil the end of puerperium as wellas to the normal newborn infants.

11 3.91 .302

Very Effective

2. Gives tetanus toxoidimmunization.

11 4.00 .000 Very Effective

3. Refers to the Physician and/orNurse and appropriate agenciespregnant and postpartum women

and newborn infants withsuspected abnormalities and

problem.

11 3.82 .405

Very Effective

4. Registers births and do prenatalcare.


5. Promotes breastfeeding. 11 3.91 .302 Very Effective

6. Conducts. operation timbang 11 3.82 .405 Very Effective

7. Gives food supplementation to 2nd

and 3rd degree malnourishedchildren.

11 3.73 .647

Very Effective

Total 11 3.8571 .25555 Very Effective


Health Care Provider N Mean

Std.

Deviation

1. Obtaining clinical history 11 3.82 .405 Very Effective

2. Performing simple routine physicaland lab exam


3. Administering emergency andtherapeutic measures based in thestanding orders




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Health Monitor N Mean

Std.

Deviation

1. Conducts home visit , case findingson TB, AIDS, malaria, Dengue,etc.



Community Organizer N Mean

Std.

Deviation

1. Identifies individuals and groups inthe community who can participate

in the delivery of health care.


2. Organizes individuals and groupsto support activities in relation tothe delivery of health services

within the catchment area.


3. Facilitates community healthdevelopment projects




Educator N Mean

Std.

Deviation

1. Conducts individual and groupteaching utilizing informationeducation communication

materials.

11 3.73 .647

Very Effective

2. Requests and distributesinformation educationcommunication or IEC materials to

other government and nongovernment units like schools,

civic and church organizationswithin the catchment area.

11 3.73 .647

Very Effective



Supervisor/ Manager N Mean Std.


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Deviation

1. Guides volunteer health workersand or trainees assigned to

barangay health station.


2. Accomplishes required records andforms for activities undertaken. 11 4.00 .000 Very Effective

3. Prepares and submits reports ofactivities and needs for supplies

and other logistic requirements ofthe barangay health workers.

11 3.91 .302

Very Effective



Table 13 shows the effectiveness of midwives in the seven areas of functioning; as coordinator

of health services, community organizer, health care provider, health monitor, health educator,

and supervisor/ manager, as evaluated by the midwives themselves. The table reveals that the

midwives evaluated their performance as very effective in all aspect of functioning. This will

possibly imply that they do most of the job related to their role as midwives which satisfy their

definition of very effective. The self-evaluation reveals that midwives are satisfied in their

performance and that they evaluated themselves as very effective. This could also possibly mean

that they uplift they effectiveness though more researches should be done to prove it so.

Evaluation of Residents vs. Evaluation of the Midwives

Table 14. Comparison of Midwives and Community Residents Evaluation

Category N Mean

Mean

Differen

ce

t df sig

Description

A. Coordinator of

Health

Residents 200 3.3950

-.45348

-

2.599

20

9 .010

Effective

Midwives 11 3.8485 Very Effective

B. Residents 200 3.2586

-.59857

-

3.91

8

20

9.000

Effective

Midwives 11 3.8571 Very Effective


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Table 15. Relationship between Midwives Effectiveness and their Profile Variables

Age LS Trainings HT

A Pearson Correlation .031 .359 -.045 -.424

Sig. (2-tailed) .928 .279 .895 .193

N 11 11 11 11

B Pearson Correlation .169 .226 .241 -.127

Sig. (2-tailed) .619 .503 .476 .709

N 11 11 11 11

C Pearson Correlation -.035 .199 .113 -.330

Sig. (2-tailed) .919 .557 .740 .322

N 11 11 11 11

D Pearson Correlation -.089 .153 .163 -.453

Sig. (2-tailed) .794 .654 .633 .162

N 11 11 11 11

E Pearson Correlation .225 .081 .290 .240

Sig. (2-tailed) .505 .812 .386 .477

N 11 11 11 11

F Pearson Correlation -.269 -.360 .366 .022

Sig. (2-tailed) .425 .277 .269 .948

N 11 11 11 11

G Pearson Correlation .178 .078 .052 .306

Sig. (2-tailed) .601 .819 .879 .360

N 11 11 11 11

Overall Pearson Correlation -.084 .064 .302 -.272

Sig. (2-tailed) .806 .853 .367 .419

N 11 11 11 11

** Correlation is significant at the 0.01 level (2-tailed).* Correlation is significant at the 0.05 level (2-tailed).


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Table 15 shows the relationship between midwives effectiveness and their selected profile

variable. It can be derive from the table that age, length of service and trainings attended have no

significant relationship on the effectiveness of the midwives in delivering health care. This

implies that neither older midwife nor younger midwife performs better. Length of service

doesnt also poses an effect on the effectiveness.

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