CHAPTER I

THE PROBLEM AND ITS BACKGROUND

Rationale

The Department of Health’s 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 do’s and don’ts 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.

1
 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 midwife’s 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 women’s 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.

2
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:

3
 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.

4
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.

5
 DEPENDENT VARIABLES

INDEPENDENT VARIABLES Level of Effectiveness

Rendering of primary health care 1 – not effective

services 2 – moderate effective
3 – effective
4 – very effective

Correlative Variables
 Age
 Civil status
 Length of residency
 Length of service as midwife
 Trainings/seminar attended

CHAPTER II: REVIEW OF RELATED LITERATURE

Today’s 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

6
system—one 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 do’s and don’ts 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

7
postpartum period, to conduct births on the midwife’s 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 women’s 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 prescribed
course 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

8
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 women’s 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 don’t just attend births—they offer many types of gynecologic care.

Midwives can:

 Perform gynecological exams

 Help with preconception planning
 Provide prenatal care
 Assist during labor and delivery
 Offer guidance with breastfeeding and other newborn care issues
 Help women who are going through menopause

Midwives have a different philosophy than doctors—they 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.

9
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

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

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

10
  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.
 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
physician’s 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 according
to 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 what’s 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 participant’s 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.

11
 Involves people in decision making.
Accepts need for joint planning and decision relative to health care in particular situation;
not resistant to change.
10. Sense of humor
Knows how to place a touch of humor to keep audience alive.
11. Change agent
Involves participants actively in assuming the responsibility for his own learning.
12. Coordinator
Brings into consonance of harmony the community’s health care activities.
13. Objective
Unbiased and fair in decision making.
14. Flexible
Able to cope in different situations.

These traits and qualities that should be possess by health workers could help them perform better
and more effectively in their functions in the community. (http://nursingcrib.com/traits-and-qualities-of-a-
health-worker).

Primary Health Care

Primary Health Care characterized by partnership and empowerment of the people shall
permeate as the core strategy in the effective provision of essential health services that are community
based, accessible, acceptable and sustainable, at a cost, which the community and the government can
afford. It is a strategy, which focuses responsibility of health on the individual, his family and the
community. It includes the full participation and active involvement of the community towards the
development of self-reliant people, capable of achieving an acceptable level of health and well being. It
also recognizes the inter relationships between health and the overall political, socio-cultural and
economic development of society (Reyala,2000).

Elements of Primary Health Care

The elements of primary health care are the following: environmental sanitation; control of
communicable diseases; immunization; health education; maternal and child health and family planning;
adequate food and proper nutrition; provision of medical care and emergency treatment; treatment of
locally endemic diseases; and provision of essential drugs (Reyala,2000).

Strategies of primary Health Care

12
 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 categories
are 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).

13
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 into
the 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.

14
 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/

15
 CHAPTER III
METHODS AND PROCEDURE

Research Design
This research made use of descriptive comparative-correlational design. It is non-experimental in
nature because it did not involve manipulation of an independent variable or control rather; its focus is to
describe and to measure the independent and dependent variables. It is correlation because it intended to
show the profile of the midwives respondents and how their selected profiles affect their level of
effectiveness in rendering primary health care services. It also tried to describe and compare the
perception of the two groups regarding the effectiveness of the midwives in carrying out their primary
functions in the community.
Research Locale
The study was conducted to 10, 5 urban and 5 rural, selected barangay of Bambang Nueva
Vizcaya.. The 5 urban barangays are the following: Banggot, Buag, Homstead, Calaocan, and Macate.
The 5 rural barangays are the following: San Antonio North, San Antonio South, Almaguer North,
Almaguer South and Sto. Domingo. The selected barangay were very accessible for the researchers
because of the availability of transportation.
Respondents of the Study
The subject of the research was the midwives of Bambang Nueva Vizcaya. The respondents were
the midwives and the community people residing in the same Barangays.
Data Gathering Tool
A survey questionnaire was used to gather data essential to the study. The said tool was used
because it can be applied to many populations and it can focus on wide range of topics.
The questionnaire consisted of three -pages wherein the functions of midwives were identified
and were translated to tagalong to be easily understood by the community respondents and were asked to
check their answers on the space provided as to how they perceive the performance of midwives in
rendering primary health care services. Rating scale was provided as very effective (4), effective (3),
moderately effective (2) and not effective (1). The same questionnaire was given to all respondents from
both groups.
Another questionnaires were given to the midwives to elicit information about their personal
profile such as their age, civil status, educational attainment, monthly income, duration of their services as
midwives, length of residency in their barangay and the number of seminars and trainings they have
attended.

16
 Survey questionnaires that were administered face to face were used to obtain information
regarding the topic undertaken.

Validity and Reliability of the Data Gathering Tool

Prior to the conduct of the study, the researchers devised a survey questionnaire containing
questions that were based on the problems identified. The functions of the midwives were based on their
job description. Once it was finalized, it was shown to our research adviser and validated by our
community clinical instructors and was shown to the research center for further evaluation. They were
asked if all items were clear, objective, relevant to the research problem and were adequate enough to
collect the desired data. The questioned items were revised for more clarity.
The questions to the respondents in the community were all translated to tagalong to facilitate
easier understanding of what were being asked and the questions to the midwife are written in English.

Data Gathering Procedure

Before the conduct of the study, the researchers devised a questionnaire to gather data relevant to
the study. The questionnaires were shown to the researchers’ respective adviser and to the research center
for approval and validation. The questionnaires were then reproduced according to the number of
respondents. Prior to actual conduct of research, the researchers coordinated with the community leaders
to seek permission to float questionnaires to the chosen respondents. Once permitted to conduct the study,
the validated questionnaires were then floated with supervision and guidance and were retrieved on the
same day.
Flowchart of Data Gathering Procedure

Devise of Approval and validation of Reproduction of

questionnaires questionnaires questionnaires

Retrieval of Floating of Permission to float

questionnaires questionnaires questionnaires

17
Treatment of Data

The perceived levels of effectiveness of midwife in rendering primary health care were classified
into the following:

Table 1

Enrollment in local colleges, 2005

Weighted Mean Quantitative Description Qualitative Description

3.50-4.00 4 Very Effective

2.50-3.49 3 Effective

1.50-2.49 2 Moderately Effective

1.00-1.49 1 Not Effective

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.

CHAPTER IV

PRESENTATION, ANALYSIS AND INTERPRETATION OF FINDINGS

18
 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 to
age. 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 56-60
which 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 correlation
between the result and their level of effectiveness as midwives.

Table 4. Frequency and Percent Distribution of Midwives According to Length of

Service as Midwives

19
 Years of Service Frequency Percent
< 15 2 18.18
15-20 4 36.36
21-25 3 27.27
26-30 1 9.09
31-35 1 9.09

Table 4 shows the frequency and percent distribution of midwives according to the length of
service . most of the midwives has serve for 15- 20 years with a percentage of 36.36%. one
midwife has serve for service for 31-35 years. Two midwives has serve for less that 15 years.

Effectiveness of the Midwives

Evaluated by Residents

Table 5. Level of Effectiveness on Midwives as Evaluated by the Community Residents as

coordinator of service

Std. Description of
A. Coordinator of Service N Mean Deviation Mean

1. Participates in determining health

needs of individual, families, and 200 3.41 .666 Effective
the community.
2. Assists in planning and organizing
the Clinic in his/ her Barangay
200 3.36 .650 Effective
health station.

3. Prepares monthly schedule of

activities in coordination with the
Physician, Nurse, Sanitary 200 3.42 .652 Effective
Inspector, and other Health
workers.
Total 200 3.3950 .57306 Effective

Valid N (listwise)
200

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

20
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

Std. Description
N Mean Deviation

4. Gives direct care to normal child

bearing women during pregnancy 200 3.55 .648
until the end of puerperium as well Very Effective
as to the normal newborn infants.
5. Gives tetanus toxoid
immunization. 200 3.57 .676
Very Effective

6. Refers to the Physician and/or Effective

Nurse and appropriate agencies
pregnant and post- partum women 200 3.34 .704
and newborn infants with
suspected abnormalities and
problem.
7. Registers births and do prenatal 200 2.71 .990 Effective
care.
8. Promotes breastfeeding. 200 3.45 .768 Effective

9. Conducts. operation timbang 200 3.25 .843 Effective

10. Gives food supplementation to 2nd Effective

and 3rd degree malnourished 200 2.95 1.055
children.
Total 200 3.2586 .50236 Effective

Valid N (listwise) 200

Table 6 shows the effectiveness of midwives in rendering primary health care as evaluated by the
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.

21
Table 7. Level of Effectiveness on Midwives as Evaluated by the Community Residents as
Health Care Provider

Std.
Heath Care Provider N Mean Deviation

11. Obtaining clinical history 200 2.92 .915 Effective

12. Performing simple routine physical Moderately

and lab exam 200 2.37 .953
Effective

13. Administering emergency and Effective

therapeutic measures based in the 200 2.98 .935
standing orders
Total 200 2.7567 .72578 Effective

Valid N (listwise) 200

Table 7 shows the effectiveness of midwives in rendering primary health care as evaluated by the
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

Std.
As a Health Monitor N Mean Deviation

14. Conducts home visit , case Effective

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

Valid N (listwise) 200

22
Table 8 shows the effectiveness of midwives in rendering primary health care as evaluated by the
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

Std.
As a Community Organizer N Mean Deviation

15. Identifies individuals and groups in Effective

the community who can participate 200 3.15 .811
in the delivery of health care.
16. Organizes individuals and groups Effective
to support activities in relation to 200 3.11 .831
the delivery of health services
within the catchment area.
17. Facilitates community health Effective
200 3.06 .849
development projects

Total 200 3.1050 .66295 Effective

Valid N (listwise) 200

Table 9 shows the effectiveness of midwives in rendering primary health care as evaluated by the
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.

Table 10 Level of Effectiveness on Midwives as Evaluated by the Community Residents as

an Educator

Std.
As an Educator N Mean Deviation

18. Conducts individual and group 200 2.41 .967 Moderately

teaching utilizing information Effective
education communication

23
 materials.
19. Requests and distributes Effective
information education
communication or IEC materials to
other government and non 200 2.35 .990
government units like schools,
civic and church organizations
within the catchment area.
Total Moderately
200 2.3750 .91573
Effective

Valid N (listwise) 200

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 can’t appreciate
much the effort of the midwives in educating them.

Table 11 Level of Effectiveness on Midwives as Evaluated by the Community Residents as

Supervisor/ Manager

Std.
As a Manager/ Supervisor N Mean Deviation

20. Guides volunteer health workers Effective

and or trainees assigned to 200 3.30 .819
barangay health station.
21. Accomplishes required records and 200 3.33 .744 Effective
forms for activities undertaken.
22. Prepares and submits reports of Effective
activities and needs for supplies 200 3.39 .714
and other logistic requirements of
the barangay health workers.
Total 200 3.3383 .64059 Effective

Valid N (listwise) 200

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

24
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

Std. Description
Role of Midwives N Mean Deviation

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. Educator Moderately
200 2.3750 .91573
Effective

G. Supervisor/ Manager 200 3.3383 .64059 Effective

Overall 200 3.0305 .40135 Effective

Valid N (listwise) 200

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
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

Std.
N Mean Deviation

1. Gives direct care to normal child 11 3.91 .302 Very Effective

25
 bearing women during pregnancy
until the end of puerperium as well
as to the normal newborn infants.
2. Gives tetanus toxoid 11 4.00 .000 Very Effective
immunization.
3. Refers to the Physician and/or Very Effective
Nurse and appropriate agencies
pregnant and post- partum women 11 3.82 .405
and newborn infants with
suspected abnormalities and
problem.
4. Registers births and do prenatal 11 3.82 .603 Very Effective
care.
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 Very Effective

and 3rd degree malnourished 11 3.73 .647
children.
Total 11 3.8571 .25555 Very Effective

Valid N (listwise) 11

Health Care Provider Std.

N Mean
Deviation

1. Obtaining clinical history 11 3.82 .405 Very Effective

2. Performing simple routine physical 11 3.73 .467 Very Effective

and lab exam
3. Administering emergency and Very Effective
therapeutic measures based in the 11 3.82 .405
standing orders
Total 11 3.7879 .37335 Very Effective

Valid N (listwise) 11

Health Monitor Std.

N Mean
Deviation

1. Conducts home visit , case Very Effective

findings on TB, AIDS, malaria, 11 3.8182 .40452
Dengue,etc.

Valid N (listwise) 11

26
 Community Organizer Std.
N Mean
Deviation

1. Identifies individuals and groups in Very Effective

the community who can participate 11 3.91 .302
in the delivery of health care.
2. Organizes individuals and groups Very Effective
to support activities in relation to 11 3.91 .302
the delivery of health services
within the catchment area.
3. Facilitates community health 11 4.00 .000 Very Effective
development projects
Total 11 3.9394 .13484 Very Effective

Valid N (listwise) 11

Educator Std.
N Mean
Deviation

1. Conducts individual and group Very Effective

teaching utilizing information 11 3.73 .647
education communication
materials.
2. Requests and distributes Very Effective
information education
communication or IEC materials to
other government and non 11 3.73 .647
government units like schools,
civic and church organizations
within the catchment area.
Total 11 3.7273 .64667 Very Effective

Valid N (listwise) 11

Supervisor/ Manager Std.

N Mean
Deviation

1. Guides volunteer health workers Very Effective

and or trainees assigned to 11 4.00 .000
barangay health station.
2. Accomplishes required records and 11 4.00 .000 Very Effective
forms for activities undertaken.
3. Prepares and submits reports of Very Effective
activities and needs for supplies 11 3.91 .302
and other logistic requirements of
the barangay health workers.
Total 11 3.9697 .10050 Very Effective

27
 Valid N (listwise) 11

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

Mean Description
Category N Mean Differen t df sig
ce

A. Coordinator of Residents 200 3.3950 - Effective

20
Health -.45348 2.59 .010
Midwives 11 3.8485 9 Very Effective
9

B. Residents 200 3.2586 - Effective

20
-.59857 3.91 .000
Midwives 11 3.8571 9 Very Effective
8

C. Health Care Residents 200 2.7567 - Effective

Provider 20
Midwives -1.03121 4.67 .000 Very Effective
11 3.7879 9
1

D. Health Monitor Residents 200 2.9850 - Effective

20
-.83318 3.03 .003
Midwives 11 3.8182 9 Very Effective
2

E. Community Residents 200 3.1050 - Effective

Organizer 20
Midwives -.83439 4.16 .000 Very Effective
11 3.9394 9
1

F. Educator Residents 200 2.3750 -1.35227 - 20 .000 Moderately

28
 4.82 Effective
9
Midwives 11 3.7273 7 Very Effective

G. Supervisor/ Residents 200 3.3383 - Effective

Manager 20
Midwives -.63136 3.25 .001 Very Effective
11 3.9697 9
9

Overall Residents 200 3.0305 - Effective

20
-.81921 6.71 .000
Midwives 11 3.8497 9 Very Effective
0

Table shows the comparison of midwives’ and community residents’ evaluation. It can be seen
that the midwives evaluated themselves as very effective in rendering their functions as
coordinator of health, health monitor agent, community organizer, educator and as a supervisor/
manager. On the other hand the community residents evaluated them to be effective in their
conduct of functions stated above. There is a difference between the evaluation from the two
respondents. The significant difference between the perception of the two respondents implies
that efforts of the midwives which for them is very effective are perceived by the community
residents as effective. This implies that midwives need more practice and trainings i the conduct
of their duty to satisfy the perception of residents as to being very effective. The research serves
as a reflection for the midwives to improve and to have a better performance although there
could be factors that lead them not to meet the expectations of the community residents.

Midwives

Correlations

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

29
 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).

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
doesn’t also poses an effect on the effectiveness.

30