A Caring Embrace

How USAID-trained community health workers in the Philippines are improving care for Indigenous communities.

Midwife Flora Dumayo Rajah providing contraceptive counseling to Indigenous Badajo clients at their local health center. / USAID

First published May 3, 2024 by the U.S. Agency for International Development.

Midwife Flora Dumayo Rajah grew up in Barangay (village) Kapatagan, Zamboanga del Sur, in Mindanao. In her village, 70% of the population is Indigenous, including Flora.

A member of the Subanen Indigenous group, she has served her community as a frontline health worker for more than 24 years. Today, she is the manager of the Family Planning Clinic in her province.

Left to right: Midwife Flora at the entrance to the Margosatubig Regional Hospital Family Planning Clinic and providing postnatal information to a new mother inside the hospital’s OB/GYN ward. / USAID

Traditionally, Indigenous people in her village and the surrounding areas have large families to provide extra hands for farming.

Zamboanga del Sur is a geographically isolated and disadvantaged area, and, combined with regional security issues, frequent bad weather, and few physical facilities or service delivery points, outreach to its remote communities has remained low compared to other provinces.

This means that most local families are not able to access essential health services, such as contraceptive care, as well as reproductive, maternal, and child health services. On top of these challenges, Badjao, Samal, and Subanen Indigenous peoples in Flora’s province are generally reluctant to seek care from health facilities on the provinces’ mainland, fearing discrimination.

Additionally, community health workers — many of whom are volunteers — are often the only frontline providers able to serve communities in remote areas that lack access to quality care or for those facing financial barriers. As a result, many Indigenous families lack access to information about safe family planning practices.

Flora knows that primary health care, including community-based services, brings people into first contact with the health system and helps them adopt healthier behaviors.

Knowing that Flora is Indigenous herself, more Indigenous clients feel comfortable seeking her care.

“Many Indigenous people hesitate to visit a health facility. I bring primary health care services directly to the households, offering family planning information and counseling, while ensuring proper documentation,” Flora explains.

Clients say she provides culturally-respectful care and quality health services. During family planning counseling sessions, she speaks her clients’ dialects and instantly puts them at ease, especially on topics that are traditionally considered taboo and private.

Flora’s compassionate approach has earned her the genuine trust and reliance of these Indigenous women and men for their family planning and reproductive health needs.

Flora providing family planning counseling at one of the local clinics in her region. / USAID

Now that the Philippines is implementing its Universal Health Care law, community health workers are mobilizing to provide Indigenous communities with essential primary health services and connect them with specialized care at secondary health facilities, as needed.

To support this national effort and provide community health care providers with appropriate training, USAID, through ReachHealth, partnered with the Philippines Department of Health to equip Indigenous health care providers like Flora with new technical skills. These newly certified health workers can immediately put this knowledge to use and serve Indigenous families within the community, thereby improving family planning outcomes while building the primary health care system.

USAID training provided a space for community health care workers to share about and further refine their interpersonal communication and counseling skills. USAID also provided the latest technical training on dispensing contraceptive supplies, inserting of intrauterine devices (IUD) and subdermal implants, and best practices for referring of clients to hospitals for specialized fertility care.

Flora also conducts health classes for community members. / USAID

ith this training, Flora can provide more comprehensive primary health care and family planning services to local families in her region. And, as a certified trainer through the Philippines Department of Health, she will also help ensure that the next generation of health care workers can fully meet the culturally-sensitive needs of their local Indigenous communities.

Today, Flora manages the Family Planning Clinic of Margosatubig Regional Hospital in Zamboanga del Sur province. Recalling a routine day at the clinic, Flora shared an interaction she had with a Badjao mother of four.

“She hugged me and kissed me on the forehead,” Flora said. “She expressed her gratitude to me because I guided her through the intricacies of family planning. She appreciated my accommodation and support throughout the process and learned the value of spacing her pregnancies for the well-being of her family, not to mention her own health. I am grateful for the USAID training because my clients express satisfaction with the quality services I provide.”

Thanks to Flora and her fellow community health workers’ hard work, the percentage of new women and couples seeking family planning services in her province has increased by 43%.

Through these achievements, health workers like Flora are upholding primary health care systems — not only family planning, but also other routine care services, such as vaccinations — strengthening the backbone of person-centered primary health care services for Indigenous communities.

At this stage of her career, Flora finds a profound sense of worth as she extends her assistance to those in need, recognizing the greater impact she is able to make.

“It is good that I was trained by USAID, because I’ve seen improvements in my service,” shared Flora.

There has been a significant difference between my work before and now. Family planning has become closer to my heart because it allows me to help, especially poor families,” she adds. “I can be someone who they can approach, who understands them, and who can give them quality family planning service” — right in their community.

About the Authors

Radzini Oledan is the Communications Specialist of USAID/Philippines ReachHealth. Maharlika Gomez, a ReachHealth project consultant, also contributed to this report.

About the Project

Through ReachHealth (2018–2024), USAID reduces the unmet needs for family planning services, decreases the teen pregnancy rate, and improves newborn survival rates in the Philippines by supporting health officials and local governments to establish policies and programs that improve access to care. USAID focuses on disadvantaged women, adolescents, and traditional underserved populations (like Indigenous groups).

In addition, USAID’s Primary Impact effort works with the Philippines and the governments of 11 other countries around the world to expand essential services in primary health care systems, strengthen the health workforce, and leverage partnerships so that community health workers like Flora can continue effectively serving their local communities with appropriate training and resources.

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