Cultural Sensitivity and Competency Training Manual: Revision Date: July 30, 2020

Revision Date: July 30, 2020
Cultural Sensitivity and Competency

Training Manual
Bureau of Local Health Systems Development
Department of Health
Manila, Philippines
2019
1
Table of Contents
Acronyms 3
Introduction 4
Background 4
What is the Training Manual About? 5
Who are the Users of this Training Manual? 5
Structure of the Manual 5
Pre-training Preparations 6
Training Methodologies 6
Training Proper 7
Session 1 – Culture Sensitivity in Health Care: Setting the Objectives and Expectations 8
Module 1 – Introduction to Cultural Awareness, Sensitivity and Competency 11
Session 2 – Cultural Sensitivity in Health Care: Definitions and Concepts 12
Session 3 – Indigenous Peoples and Indigenous Cultural Communities: Laws and Policies 15
Session 4 – Indigenous Peoples and Indigenous Cultural Communities: Workshop 19
Session 5 – Understanding Culture: Basic Concepts 29
Session 6 – Understanding Culture: Preservation vs. Change 34
Module 2 – Developing Skills on Culture Sensitivity and Competency 37
Session 7 – Assessing One’s Self 38
Session 8 – Starting the Road to Culture Sensitivity 41
Session 9 – I-LEARN Model for Culture Sensitive Health Care 45
Session 10 – Applying the I-LEARN Model: Role Plays 48
Session 11 – From Culture Sensitivity to Culture Competency 52
Module 3 - Cultural Sensitivity and Competency at Organizational Level 56
Session 12 – Organizational Cultural Sensitivity and Competency 57
Session 13 – Organizational Sensitivity and Competency: Operational Planning Workshop 61
Session 14 – Development of Evaluation and Monitoring Framework 65
Session 15 – Summary, Declarations and Closing 70
References 71
Annexes 72
2
Acronyms
AD Ancestral Domain
AO Administrative Order
DILG Department of Interior and Local Government
DOH Department of Health
GIDA Geographically Isolated and Disadvantaged Areas
IAC Inter-Agency Committees
ICCs/IPs Indigenous Cultural Communities/Indigenous Peoples
IKSP Indigenous Knowledge Systems and Practices
IPRA Indigenous Peoples Rights Act
JMC Joint Memorandum Circular
LGU Local Government Unit
MHO Municipal Health Office
MIAC Municipal Inter-Agency Committee
NCIP National Commission on Indigenous Peoples
NIAC National Inter-Agency Committee
NSP National Strategic Plan
PHO Provincial Health Office
PIAC Provincial Inter-Agency Committee
RHU Rural Health Unit
RIAC Regional Inter-Agency Committee
SLE Structured Learning Experience
TAMA Traditional and Alternative Medicine Act
UHC/KP Universal Health Care/ Kalusugang Pangkalahatan
UNDRIP United Nations Declaration on the Rights of Indigenous Peoples
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Introduction
Background
The Department of Health (DOH), the National Commission on Indigenous Peoples (NCIP) and
the Department of Interior and Local Government developed the Joint Memorandum Circular (JMC) no.
2013-01 (DOH-NCIP-DILG JMC no. 2013-01) entitled “Guidelines on the Delivery of Basic Health Services
for Indigenous Cultural Communities/Indigenous Peoples. This JMC aims to set the guidelines that will
address the access, utilization, coverage and equity issues in the provision of health care services to
indigenous cultural communities/indigenous peoples (ICCs/IPs) to achieve better health outcomes.
Cultural sensitivity and competence is a vital part in the implementation of this JMC for health services
to be responsive to the needs of ICCs/IPs and make it acceptable, utilized and fully participated by the
communities. A culture sensitivity orientation has been done in the past but only at the national level
and regional level. This training manual was designed to address the need to roll-out this training to the
frontline health workers.
The primary purpose of any training is to improve self-awareness, knowledge and skills to
become culturally sensitive and competent in providing health service to patients, families and
community. But becoming culturally competent may be a long process. Some health workers might
object on the grounds that everyone should be treated equally, thus ignoring cultural sensitivity. Others
will not participate in training activities aimed at promoting cultural sensitivity and competence or if
they do, they may feel forced to learn about it. For cultural sensitivity and competency to be sustained,
organizational support is necessary. This may be in the form of ensuring adequate resources to apply the
knowledge and skills, rewards and incentive mechanisms manifested in organizational policies.
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For this training to be effective, we make the following assumptions.
● The responsibility of providing culture sensitive service has been on the individual health care
provider. However, this will not be sustainable if the individual health care provider is not
supported by the organization. Thus, understanding of culture is important at all levels. An
understanding of culture is necessary to appreciate the diversity of health care facility’s patients
and clients and treat them effectively.
● Incorporating cultural sensitivity and competence into the treatment strategy improves clinical
decision making, expand alternative options for treatment and make patients and clients more
likely to accept treatment. Being culturally responsive therefore gives pride to the health worker
and the whole health organization.
● Achieving cultural sensitivity and competence requires the involvement of multiple stakeholders
in the development and implementation of culturally responsive services and programs from
the frontline health workers to the health managers i.e. whole health organization.
What is the Training Manual About?
Cultural sensitivity is being aware about the cultural differences and similarities between people
without judging them to be right or wrong. Cultural competence on the other hand is having a set of
congruent behaviors, attitudes, and policies that come together in a health worker, agency or health
system to work effectively in cross-cultural situations. Culture sensitivity and cultural competency
training is an effective intervention that enables healthcare providers to give health care or service that
increases satisfaction of patients from cultural or minority groups. This training manual was developed
for this kind of training for health personnel working in the health care system. The learning objectives
of this training manual is to improve self-awareness and knowledge about culture that will motivate
health workers to explore personal perspectives and multiple worldviews, understand and embrace
culturally sensitive health service. Ultimately, it is also the objective of this training to make the health
workers and managers and the organization to which they belong to be culturally competent as well.
Who are the Users of this Training Manual?
The target users of this training manual are the trainers and managers in health systems and
health services development. These trainers and managers can be from all government agencies
planning to provide culturally sensitive health programs and services. The target participants of the
training are the health care providers and managers involved in the design and implementation of
health service delivery.
Structure of the Manual
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The training manual is divided into three self-contained modules, each with different level of
training objectives i.e. improving level of knowledge and awareness, improving level of skills on culture
sensitivity and finally developing and institutionally adopting cultural competency at organizational
level. The individual modules may also be applicable to different groups of professionals working in
health care system from program managers to frontline health service providers. It can also be used
depending on the participants’ needs i.e. knowledge and awareness or skills development or
organizational improvement. Each module is composed of several sessions which has its own learning
objectives that is incremental from the previous one. The session has description on how it should be
conducted, the number of hours, instruction to facilitators and background information for facilitators. It
also has its respective slide deck with notes for presentation.
This training manual has two sections i.e. facilitators manual in MS Word file and the slide deck
in MS Powerpoint file which can be printed as participants’ handout. The participants handout should
include the schedule, training objectives and the printed slide presentations with space for notes. The
facilitators’ manual includes the schedule, session objectives and instructions, background information
and the slide presentations with notes and key points/take-away messages in every session.
Pre-training Preparations
It is recommended that BLHSD and the regional representatives plot the schedule of training on
an annual basis. The training module and the annual schedule are also recommended to be submitted to
Professional Regulation Commission (PRC) for accreditation. This will provide Continuing Professional
Development units/points to the trainers, facilitators and participants. It will also entice the prospective
trainees to avail of the training. The tentative schedule can be disseminated to the RHUs, and hospitals
so the prospective participants can also plan for their attendance. The training coordinators, usually
coming from the RIAC can accept advance registration so they can estimate the number of participants
on the schedule training.
At least two months prior to the scheduled training, the training coordinators should meet for
general agreements and arrangement. They should decide on the exact dates and reserve the venue for
the training. Request for funding source must be done by the responsible person/agency. They should
also decide on the assignment of facilitators per session and also assign a point person who will prepare
the necessary materials (i.e. office supplies, post-it notes, regional maps etc.) for the training. The
training coordinators should also assign the point person who will send the official letter invitations
(DPO). The letter of invitation shall include the materials/documents to be brought by the participants
i.e. laptops, existing plans (i.e. LIPH, ADSDPP, ADIPH and AIP), FHSIS annual report at barangay level and
other relevant data concerning their IP communities. Facilitators should bring some materials that can
help in the discussion or planning i.e. ADSDPP and ADIPH can be brought by NCIP facilitators, regional
plans by the DOH etc. Regional health program coordinators of DOH and other related agencies may
also be invited either as participants or resource persons.
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Training Methodologies
The training methodologies include lectures with slide presentations, interactive session, group
exercises and role plays. Slide presentations and interactive sessions will mostly be used during module
one. The slide deck has vacant spaces and slides allocated for localization. In module 2, role-play with
different given scenarios will be utilized. In module 3, group work exercises will be used. It is strongly
recommended that the facilitators follow the pre- and post-session instructions to ensure fluent
transition from one session to another. Based on the pilot testing of this training, adhering to these
methodologies addressed the issues and concerns of the participants.
Training Proper
During the first day of training or a day before, the facilitators are recommended to visit the
training venue and make sure it has the necessary set-up and equipment needed for the training. There
must be space/area for group activities, whiteboard for posting, areas for posting of maps and space for
the role play. The sitting arrangement should allow for interactions between the participants and
facilitators and the among participants themselves.
During the first day, it is recommended to start on time. Start with culturally appropriate prayer
followed by the Philippine national anthem. Then introduce the person who will give the brief welcome.
After the brief welcome address, proceed immediately to session 1.
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Session 1 – Culture Sensitivity in Health Care: Setting the Objectives and Expectations
Session Objectives
● To introduce the cultural sensitivity and cultural competency training program;
● To introduce briefly the participants and their role in their health facility (prior experience in
serving IPs may be helpful);
● To orient the participants to the specific objectives and activities of each module in the training
program; and
● To elicit expectations of the participants that might be relevant to the achievement of the
overall objectives of the training program.
Description
● Slide presentation for 5 minutes
● Brief introduction of participants
● Ideas generation with meta-cards for 10 minutes

o Participants will write in the meta-cards their own personal expectations related to the
overall objectives of the training
● Processing and discussion for 30 minutes
Preparation and Planning
● Equipment and materials needed:

o Equipment needed are LCD projector and laptop
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o Materials needed are flipcharts, meta-cards (stick-on), black markers (Pentel Pen),
masking tapes
● Facilitator’s tasks:
o Review the slide deck and background information;
o Ask the participants to briefly introduce themselves one-by-one, their role in their
health facility and prior experience in working with IPs;
o Brief slide presentation;
▪ Review the proposed agenda and objectives of the training program with the
participants;
▪ Review the contents and structure of the training program with the participants;
and
▪ Explain that before leaving this training, together we will plan on how we can
strengthen and put into practice the skills learned here.
o Provide instructions for the subsequent activity which is to write in the meta-cards their
own personal expectations for 10 minutes.
▪ At the start of the session of the session, ask the participants to introduce
themselves, their work tasks and previous experience in working with
indigenous peoples.
▪ Ask the participants to post their expectations in the whiteboard or flipchart in
front.
▪ Discuss and process each expectation for 30 minutes and summarize; and
▪ Tips for processing:
● Some participants will share problems with previous experience in

working with the IPs i.e. geographic distance, lack of fund for travel, lack
of segregated data etc. The facilitator can park those issues for future
discussion, otherwise the discussion is going to be long and may lose
time for the essential part of the training i.e. culture-sensitivity
knowledge and skills development.
● These problems are not covered by his training module and may have to
be addressed in some other meetings. If participants insist because they
are relevant to working in the field, just tell them to first focus on
knowledge and skills development and these issues can be tackled
during the planning on the 3rd day.
● Always be concerned about time management.
o Provide brief instruction for the next activity.
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Background Information for the Facilitator
Cultural sensitivity is an attitude of health care provider that enables effective work in cross-
cultural situations. It is a vital ingredient to ensure an appropriate and effective implementation of the
JMC. It is a fundamental aspect of capacity-building for a health system that is more responsive to the
intricacies of working in areas of Indigenous Cultural Communities and Indigenous Peoples (ICCs/IPs), as
well as in Geographically Isolated Disadvantaged Areas (GIDAs). Thus, it is desirable that health workers
be in the forefront of inculcating cultural sensitivity and competence.
To inculcate cultural sensitivity and competence among health workers requires that they are
able to view perspective “outside the box” and to go beyond the comfort zone in ways of thinking. The
activities or methods are designed to allow the facilitator to take off from the existing paradigms held by
participants, sometimes to the point of taking them off from their comfort zones, but in an atmosphere
that is non-threatening and non-confrontational. The overall methodology is to guide participants in
analyzing what culture is, as a basic step in an inductive approach to shaping the construct of a health
system that is responsive to the situation and needs of IPs as a vulnerable sector.
Presentation Content
● Slide 1 – Culture-sensitivity and competence in health care: opening session
● Slide 2 – Session 1 Culture sensitivity in health care: setting the objectives
● Slide 3 – Session objectives
● Slide 4 – Instructions for session 1
● Slide 5 – Thank you
● Slide 6 – Culture-sensitivity and competence in health care
● Slide 7 – Background
● Slide 8 – Purpose of education and training
● Slide 9 – Assumptions for this training to be effective
● Slide 10 – What is the training manual about
● Slide 11 – Who are the users and target of the training
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● Slide 12 – Structure of the training manual
● Slide 13 – Objectives of module 1
● Slide 16 – Thank you slide (clarification)
● Slide 17 – Title slide module 1
● Slide 19 – Sessions of module 1
Module 1 – Introduction to Cultural Awareness, Sensitivity and

Competency
Objectives of the Module
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By the end of this module, participants should be able to:
● Rearticulate information about indigenous peoples and indigenous cultural communities in the
Philippines;
● Rearticulate cultural ideas and constructs;
● Describe how contextual and structural factors of health services impact health outcomes for
indigenous peoples and indigenous cultural communities; and
● Rearticulate personal ideas and beliefs on culture, culture sensitivity and cultural competency.
Sessions
● Session 2 – Cultural Sensitivity in Health Care: Definitions and Concepts
● Session 3 – Indigenous Peoples and Indigenous Cultural Communities: Laws and Policies
● Session 4 – Indigenous Peoples and Indigenous Cultural Communities: Workshop
● Session 5 – Understanding Culture: Basic Concepts
● Session 6 – Understanding Culture: Preservation vs. Change
Facilitators Meeting
● Prior to the conduct of the module, the facilitators are encouraged to hold a facilitators’
meeting
● Make sure there is an assigned facilitator for each session
● Each facilitator should review the session and make sure the equipment and materials needed
for the session is available
● Examine the venue and make sure that it is adequate for the sessions i.e. sound system, slide
projection, workshops and structured learning exercises
● Identify an overall coordinator, time-keeper and moderator/referee
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Session 2 – Cultural Sensitivity in Health Care: Definitions and Concepts
Session Objectives
● To introduce the concepts of culture, cultural sensitivity and cultural competency;
● To discuss the importance of cultural sensitivity and competency training; and
● To discuss what has been done, the challenges and the next steps.
Description
● Open forum for 15 minutes
● Equipment and materials needed:

o LCD projector and laptop
● Facilitator’s tasks:
o Review the slide deck and background information
o Slide presentation
▪ Emphasis on definition of cultural sensitivity and competency, disparity on
health service delivery and health outcome.
▪ Discuss importance of cultural sensitivity and competence training.
▪ Facilitate an interactive session with the participants.
▪ Elicit clarifications and questions after the set of slides on definitions, slides on
health disparity due to cultural differences and the slides on the policies on
cultural sensitivity.
o Summarize the learning points.
▪ Cultural competence is the behavior, attitudes and policies to work in cross-
cultural situation.
▪ Differences may occur because of our differences in our worldview
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▪ Respect for one’s world view is necessary at individual, organizational and
program level.
▪ If there is no culture-sensitivity, there might be health disparity.
o Provide instructions for the subsequent activity.
Cultural competence is a set of congruent behaviors, attitudes, and policies that come together
in a system, agency, or among professionals that enables effective work in cross-cultural situations.
“Culture” refers to integrated patterns of human behavior that include the language, thoughts,
communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social
groups. “Competence” implies having the capacity to function effectively as an individual and an
organization within the context of the cultural beliefs, behaviors, and needs presented by consumers
and their communities.
To provide culturally responsive treatment services, health workers and other clinical staff, and
organizations need to become aware of their own attitudes, beliefs, biases, and assumptions about
others. Care providers need to invest in gaining cultural knowledge of the populations that they serve
and obtaining specific cultural knowledge as it relates to help-seeking, treatment, and recovery. Cultural
competence requires an understanding of the client's worldview and the interactions between that
worldview and the cultural identities of the counselor and the client in the therapeutic process.
Culturally responsive practice reminds health workers that a client's worldview shapes his or her
perspectives, beliefs, and behaviors surrounding illness and health, seeking help, treatment
engagement, counseling expectations, communication, among others.
Cultural sensitivity includes addressing the client individually rather than applying general
treatment approaches based on assumptions and biases. It also can counteract a potentially omnipotent
stance on the part of health workers that they know what clients need more than the clients themselves
do. Cultural competence highlights the need for health care providers to take time to build a
relationship with each of their clients, to understand their clients, and to assess for and access services
that will meet each client's individual needs. Cultural sensitivity and competence must be at all levels of
treatment services: the individual staff member level, the clinical and programmatic level, and the
organizational and administrative level. Interventions need to occur at each of these levels to endorse
and provide culturally responsive treatment services.
Why is cultural sensitivity and competence important?
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● It provides clients with more opportunities to access services that reflect a cultural perspective
on and alternative, culturally congruent approaches to their presenting problems.
● It will likely provide a greater sense of safety from the client's perspective, supporting the belief
that culture is essential to healing.
● it increases the likelihood of the health facility’s acceptability to its clients and eventually
sustainability.
Health disparities are “differences in the incidence, prevalence, morbidity, and burden of
diseases and other adverse health conditions that exist among specific population groups.” A health
disparity is a particular type of health difference closely linked with social, economic, and/or
environmental disadvantage. Health disparities adversely affect groups of people who have
systematically experienced greater obstacles to health based on their racial or ethnic group; religion;
socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual or
gender orientation; geographic location; or other characteristics historically tied to discrimination or
exclusion. Multiple causes for these disparities, including historical inequalities that have influenced the
healthcare system, persistent racial and ethnic discrimination, and distrust of the healthcare system
among certain ethnic and racial groups. However, the most persistent and prominent cause appears to
be disparities in cultural and socioeconomic status. Culture therefore becomes a social determinant of
health.
“Social determinants of health are conditions in the environments in which people are born,
live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-
life outcomes and risks.” Social determinants include access to educational, economic, and vocational
training; job opportunities; transportation; healthcare services; emerging healthcare technologies;
availability of community-based resources, basic resources to meet daily living needs and social support;
exposure to crime; social disorder; community and concentrated poverty; and residential segregation.
● Slide 1 – Title slide for session 2
● Slide 2 - Objectives of session
● Slide 3 - Definitions of cultural competence
● Slide 4 – Cultural awareness: self and client
● Slide 5 – Worldview
● Slide 6 – Culturally sensitive approach
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● Slide 7 – Cultural sensitivity in levels of care
● Slide 8 – Why is cultural sensitivity important
● Slide 9 – Health disparity
● Slide 10 – Culture as cause of health disparity
● Slide 11 – Culture as social determinant of health
● Slide 12 – Evidence of health disparity
● Slide 13 – Evidence of health disparity
● Slide 14 – Causes of health disparity
● Slide 14 – Culture sensitivity minimize disparity
● Slide 15 – Cultural sensitivity in the JMC
● Slide 16 – Prior cultural sensitivity training (localize)
● Slide 17 – Challenges (localize)
● Slide 18 – Next steps (localize)
● Slide 19 – Thank you slide
Session 3 – Indigenous Peoples and Indigenous Cultural Communities: Laws and Policies
Session Objectives
● Introduce the laws and policies that pertains to indigenous peoples and indigenous cultural
communities in the Philippines
● Discuss the specifics of these policies and how they are related to cultural sensitivity and cultural
competency
● Discuss the extent of the implementation of these policies
Description
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● Task of support staff

● Facilitator’s tasks
▪ Ask the participants if they are familiar with the laws and policies national or
international) related to IP health.
▪ Once a law or policy is mentioned, expound it further in the slide presentation.
▪ Emphasize that these laws and policies are guaranteed in our constitution. Begin
from higher laws to the JMC.
▪ Emphasize that with the existence of these mandates, the government has a
legal obligation to uphold the rights of the indigenous peoples including their
right to health services.
o Facilitate an interactive session with the participants
▪ Ask the participants for clarifications and questions
▪ Summarize the learning points
● The rights of indigenous peoples to their own cultural views and beliefs
are protected in international and local laws
● Government agencies like the DILG, DOH and NCIP has also developed
policies to consider these cultural beliefs in the delivery of their services
● However, there are some issues we need to address at the local level
o Provide instructions for the next activity.
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As stated in the constitution, IPs, because of their distinct culture, are given “special mentions”
in various laws. IP rights are recognized through national and international laws and declarations.
Philippine 1987 Constitution. Our current constitution provides for the State’s recognition and
promotion of the rights of indigenous cultural communities. It mentions in Article XIV, Section 17 that
the State shall recognize, respect, and protect the rights of indigenous cultural communities to preserve
and develop their cultures, traditions, and institutions. It shall consider these rights in the formulation of
national plans and policies. In addition, the constitution also stipulates the following:
● Article II, Section 15. The State shall protect and promote the right to health of the people and
instill health consciousness among them.
● Article II, Section 16. The State shall protect and advance the right of the people to a balanced
and healthful ecology in accord with the rhythm and harmony of nature.
Indigenous Peoples Rights Act (IPRA), Republic Act 8371, 1997 - An act that recognizes, protects
and promotes the rights of indigenous cultural communities/indigenous people, IPRA guarantees the
access of indigenous peoples to basic services, including health. It further states that interventions
towards the health development of IPs shall be implemented in a manner that promotes the important
rights of IPs to ancestral domain, self-governance and empowerment, social justice and human rights,
and cultural integrity.
United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) 2007 - Recognizes the
urgent need to respect and promote the rights of indigenous peoples, including their ‘freedom to
maintain and develop their traditional medicines and health practice. This includes keeping and
protecting their medicinal plants, animals and mineral. They must also be able to enjoy the highest
attainable standard of physical and mental health care. Government must take necessary steps to
ensure that this right is fulfilled.
The Local Government Code of 1991 - The LGUs assume primary responsibility over the delivery
of health services and the provision of health facilities. The DOH in coordination with LGUs, designed
mechanisms for a comprehensive approach to health care delivery. Section 16: General welfare - within
their respective territorial jurisdictions, local government units shall ensure and support, among other
things, the preservation and enrichment of culture, promote health and safety.
The Universal Health Care Act (RA 11223) has in its declaration of principles (Section 2d) that it
should establish a people-oriented approach for the delivery of health services that is centered on
people’s needs and well-being, and cognizant of the differences in culture, values and beliefs. Further it
emphasizes to foster a whole-of-system, whole-of-government and whole-of-society approach in the
development, implementation, monitoring and evaluation of health policies, programs and plans. With
these principles, it is given that health service delivery must be culture-sensitive and health programs
must be design in a participatory approach. Since there is a DILG circular (2010-119) on the mandatory
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representation of indigenous cultural communities to local policy or legislative making body, national
programs can be designed to be modified at local level and address local health service based on cultural
preferences.
Policies related to Indigenous Peoples Health Carely the disadvantaged groups, have equitable access to
affordable health care.
● Administrative Order No. 2020-0023 “ Guidelines on Identifying Geographically-Isolated and

Disadvantaged Areas and Strengthening their Health Systems” provides guidelines on the
identification and recommendation of strategies in the strengthening GIDA health systems in
remote and marginalized communities, which are characterized by poor geography hindering
access to health services, high poverty incidence, and health performance disparities, among
others. As a result, a policy framework was defined now referred to as the IP Health Policy or
the JMC.
DOH-NCIP-DILG Joint Memorandum Circular No. 2013-01, Guidelines on the Delivery of Essential
Health Packages for Indigenous Peoples and the National Strategic Plan ensure the provision of quality
health care services and support the implementation of the local health systems reform in remote,
isolated and disadvantaged communities. It gives priority focus on the health care needs of marginalized
and vulnerable groups who are greatly denied of socio-economic opportunities and development. It
provides directions for:
● Making basic health services available and culture-sensitive,
● Providing equitable distribution of needed health resources,
● Ensuring non-discrimination of ICCs/IPs in the delivery of health services,
● Managing geographical, financial and socio–cultural barriers so that IPs can access basic health
services; and,
● Strengthening recognition, promotion, and respect of safe and beneficial traditional health
practices.
Formalize the partnership/collaboration among NCIP, DOH, and DILG. DOH has the expertise to
bring effective health service programs, DILG provide supervision and monitoring of programs by LGUs
and NCIP has the mandate to promote and ensure a more culture-sensitive delivery system. Thus,
collaboration of the three agencies is vital in the pursuit of better health service delivery and health
outcomes for the IPs. A strategic plan for the implementation of the JMC was formulated and signed in
November 2014. As defined in the plan, there will be a 3-tiered structure – Inter-Agency Committees on
IP Health at National (NIAC), Regional (RIAC), and Provincial (PIAC) levels.
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Most health programs of the DOH being implemented at the LGU level are already following
evidence-based standards for quality care. However, its acceptability to IP communities varies because
of differences in cultural and traditional perceptions and practices. Culture-sensitivity is one aspect of
health service that can promote its utilization. There is, therefore, a big challenge for the different
programs of the DOH in partnership with the LGUs to include elements of culture-sensitivity into its
program guidelines and standards. At its current format, these programs are already evidence-based
and proven to be effective. However, its design is at the national level and there is an opportunity for
localization at the LGUs and community level. This is emphasized in the JMC Strategic Plan.
● Slide 1 – Title slide of the session
● Slide 2 – Objectives of the session
● Slide 3 – International declarations on IPs
● Slide 4 – Constitutional declaration
● Slide 5 – Indigenous Peoples Rights Act
● Slide 6 – Indigenous Peoples Rights Act
● Slide 7 – Local Government Code
● Slide 8 – Local Government Code
● Slide 9 – Universal Health Care Act
● Slide 10 – Kalusugan Pangkalahatan
● Slide 11 – DILG circular on IPMR
● Slide 12 – Establishment of GIDA
● Slide 13 – DOH-NCIP-DILG JMC
● Slide 14 – DOH-NCIP-DILG JMC
● Slide 15 – JMC Strategic Plan on culture-sensitivity
● Slide 16 – Other laws and local ordinances
● Slide 17 – What has been done to implement these policies
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● Slide 18 – Challenges
● Slide 19 – Next steps
Session 4 – Indigenous Peoples and Indigenous Cultural Communities: Workshop
Session Objectives
● To orient the participants on the geographic location of the indigenous peoples and indigenous
cultural communities in the Philippines; and
● To describe brief information about the culture of these indigenous cultural communities.
Description
● Slide presentation of instruction for 5 minutes
● Group work 30 minutes: Identifying indigenous peoples and indigenous cultural communities
and their practices
o Divide the group in groups of 6 or a maximum of 4 groups
o Give each group the same set of meta-cards printed with name of IP groups or their
social or cultural description
o After reviewing the meta-cards, ask each member of the group to place the meta-cards
given to them in their proper places in the map
● Open forum and processing for 15 minutes
● Equipment and materials needed
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o LCD projector and laptop
o Materials needed are meta-cards (stick-on) with printed information about the
indigenous peoples and indigenous cultural communities, black markers (Pentel Pen),
masking tapes, Philippine map
o Slide presentation for instructions.
o Ask the participants how familiar they are with the different indigenous groups in the
Philippines and to cite the different tribes they are aware of.
o Ask them to go through the meta-cards and instruct them to post them in the map
where the IP/ICC resides. Facilitate the small group workshop.
o When the small groups are done with the posting in their maps, present the slide
presentation on the location and characteristics of IPs in the region.
o Check answers and give brief description of that particular IP group.
o Summarize the learning points.
Indigenous Peoples in the Philippines are described as:
● belonging to a community, whose members’ life ways are different from mainstream population
● members share a common language
● living in a defined territory (ancestral domain)
● marginalized because of their resistance to assimilation by colonization and continue to be

marginalized by the mainstream
Using the term “indigenous peoples” is a recognition requires political will. The historical
circumstances that led to their formation and their current vulnerabilities as a result of their separation
from the mainstream must be recognized. The term “Indigenous Peoples” is not automatically
synonymous with:
Ethnicity – sense of belonging to a group of people based on consanguineal relations, culture, language,
religion, or other factors
Ethnic group – group of people whose members have common cultural practices distinct from other
groups
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Ethnolinguistic group – group of people speaking the same language based on which they have common
cultural practices
Cultural community – group of people whose members practice the same culture or way of life
Ethnic group/ cultural community - They are practically the same, though cultural community tends to
be a more general term
Remember that IP groups are also ethnolinguistic groups and cultural communities but an
ethnolinguistic group or cultural community is not necessarily an IP group. Concepts to remember when
working with IPs:
● Ancestral domain. Not just hectarage, but the totality of the area including geographical
features, which generally have cultural significance. IPs see themselves not as owners, but as
stewards.
● Ritual. A manifestation of their world view which may be different from the mainstream or
majority. Sometimes not easily understood or accepted by mainstream or majority society.
● Consensus-building. Opinion or decision reached by a group as a whole. Usual way of decision-
making in IP communities: places importance on harmony within the community; as opposed to
voting. May be twisted to show preference for the decisions of certain individuals (e.g. leaders)
or sectors (e.g. men)
● Deference to Authority. Traditionally, leaders and elders are held to make decisions taking into
consideration the welfare of the whole community; thus great trust of community members
toward them. In the interest of community harmony, open confrontation is avoided especially
against figures of authority. May be twisted to become blind trust.
IP count ranges from 12 million to 15 million according to NCIP. Ethnicity variable included in
2010 census but results disputed – too low according to NCIP. Last total count of IPs before 2010 was in
1916. Lack of clarity of numbers renders them invisible in policy and planning. Approximately 7.5 million
hectares of ancestral domain.
● Level of Education. Except for Cordillera, other IPs generally have low educational attainment.
Mainstream education not culturally appropriate. DepEd has come up with Framework for IP
Education.
● Language. difference between language and dialect (variation of a language) There is difference
between referring to the indigenous group’s language and the lingua franca (what is generally
spoken in an area, not necessarily the indigenous language. Not all IP communities familiar with
the lingua franca of the mainstream society. Related to low level of educational attainment; but
also to different world view Information dissemination may not always be culturally appropriate.
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● Names. Note taboos in relation to names that cannot be mentioned by certain people, e.g.,
among the Aeta of Zambales one cannot mention the spouse’s name. Some names are
according to pronunciation in the area rather than how a name is commonly spelled e.g.,
“Ruben” in Luzon is sometimes spelled “Robin” in Mindanao. Names may change, for instance
when a leader has a change in hierarchy.
● Discrimination. Frequently internalized – low esteem, lack of confidence including in decision-
making. Stems from lack of understanding of indigenous peoples and their situation, lack of
appreciation for cultural diversity and negative cultural attitude (not open-minded enough).
IPs comprise 13% of the total population. This figure, however, varies among different agencies,
as to date, there is still no reliable data in terms of national aggregation on IP database. They can be
generally grouped as follows:
● Cordillera – Mountain range found at the centre of northern Luzon
● Caraballo – Mountain range connecting the Cordillera and the Sierra Madre
● Mangyan – Island of Mindoro
● Palawan – Island of Palawan
● Bukidnon – Island of Panay
● Negrito/Ayta – Hunting and gathering groups found throughout the archipelago
● Lumad – Throughout Mindanao.
Indigenous Peoples Information for the Mapping Exercise
(Edit and print post it meta-cards the following bits and pieces of information. Remove the information
on locality and geographic residence. It is still included in the text as facilitators’ background
information.)
CAR or Cordillera Administrative Region is composed of six provinces and one chartered city.
(Abra, Apayao, Benguet, Ifugao, Kalinga, Mountain Province and highly urbanized Baguio City ). CAR is
the home of many ICCs/IPs collectively known as the Igorots. They speak several dialects but have lingua
franca. Majority are formally educated. Land is viewed by the ICCs/IPs of CAR as life itself, the source of
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their livelihood. It is indispensable in the sustenance of life. The nurturing and protection of the land
and its environment are the shared responsibilities of the IPs therein.
● Kankanaey, Ibaloi, Kalanguya, Karao and Iowak/Iwak of Benguet

o Council of Elders (COELS): Pangamaen.
o Rituals: TAEDEW- performed when birthing is difficult. One chicken is sacrificed to drive
away the envious spirits
o Health and belief system: Majority patronize conventional health system but maintains
their indigenous ways of healing like the “hilot” and use of herbal medicines
● Kalinga
o The Kalingas generally occupy the Kalinga Province.
o Sociopolitical /leadership system: They have peace council called BODONG/PANGAT
● Itneg/Tingguian, Adasen, Banac, Masadiit, Maeng, Mabaca, Inlaud and others of Abra
o Sociopolitical/ leadership system: Council of Elders and wise leaders known as AMAM-A,
LALLAKAY and MANAKEM or MANAKOM.
o The manakem/manakom means a person with wisdom to include women elders/leaders
for membership in their IPS and their democratic system of self-governance.
o The Maeng IP community has their Dap-ay, a physical structure and a center of self-
governance. The leadership of the dap-ay is composed of the AMAM-A and the ININ-A,
men and women elders.
● Isnag of Apayao
o Their sociopolitical system is led by the PANGLAKAYEN or COUNCIL OF ELDERS.
o Pangat is the leader of elders. The Pangat must be obeyed and followed by the
community. He has the virtue and power to appoint his elders in the papangat.
Papangat are the advisers of the elders.
● Tuwali, Ayangan, Kalanguya and other Ifugao live in Ifugao, Ibalois, Kankanaeys, Kalanguyas, IP
migrants of Baguio City
o Ibalois are the original settlers of Loakan, Pinsao, Asin, Irisan, Bakakeng, Happy Hallow ,
Mines View , etc. of Baguiio City and speak Ibaloy.
o All of them have Council of Elders/Pangamaen/Barangay Lupon.
o Means of living usually farming, cut- flower production, handicraft, local
entrepreneurship & local employment.
o Most of them attend formal education and view of land is the same with the rest of
Cordillerans.
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Region 1 : Bago, Kankanaey and Ibaloi inhabit 7 towns of La Union ; Bago, Kankanaey and Tingguian in 9
towns of Ilocos Sur; Isnag/Itneg, Kankanaey, Apayao/Yapayao in 10 towns of Ilocos Norte; Kankanaey,
Ibaloi, Bago, Aberling in some Pangasinan towns. All in Region 1 or the Ilocos Region. ICCs/IPs in region 1
call their leaders “panglakayen”, speak several dialects and most of them engage in farming, fishing and
soft-broom making. They value their clan or “Puli”. When it comes to education, they send their children
to formal education or mainstream education. They practice the following:
● La Union : “PAN-IYAMAN” – a thanksgiving ritual performed by an elder using 5 chicken.
● Ilocos Sur/Ilocos Norte/Pangasinan:

o “ÁN-ANAWANG”
o “MAKMAKSIL” – performed when birth is difficult or painful
o “DAWDAWAK” – performed before the actual live birth to alleviate pain
Region 2: Agta/ Dumagat, Ibanag, Gaddang, Yogad, Itawis, Calinga, Isinai, Bugkalot, Kalanguya, Iwak,
Ayangan, Ibaloi, Kankanaey and others of the Cagayan Valley
● Isinay/Isinai are found in Aritao, Bambang & Dupax del Sur of Nueva Vizcaya.
o They speak Isinay/Isinai although many are already using Tagalog, Ilocano and English
o The highest decision making body of the Isinai Political Structure is the ‘’UjmusiLallahay”
(Council of Elders ). This is composed of Lallahay/Aamma that emerges in every “bona”
(Clan) usually the eldest son of a clan (now consider woman). This body will choose
among themselves a chairman and the body will decide all matters involving the welfare
& wellbeing of the Isinai ICC including the power to “toddoh’’(appoint) the’’Pangiyu
(President) from among themselves and other positions in the socio-political leadership
structure. The Pangiyu(President) is the Chief Executive of the Isinay Political structure.
o “dotaj”änd “ohbu/tagnawa’ is a usual practice to help ease and support one another in
times of needs
o “bonaj” (clan ) wherein the Isinais form association in order to preserve the closeness of
familes including clans.
o Isinai “albularyo” – medicine man or traditional healer prescribed numerous herbal
medicines and performed praying, spitting, rubbing, plastering and murmuring to cure
specific diseases or sicknesses of people however with the advent of modern medicine,
they are vanishing
● Kalanguya of Ambaguio, Sta Fe, Kayapa, portion of Aritao, Nueva Vizcaya has 4 major distinctive
classifications
o NIHNIH OR KAL-ING- dialect commonly used in Ambaguio
o KIB-AL-dialect known to be a combination of Ibaloi and Kalanguya spoken in Sta Fe
(Kallahan) and Kayapa.
o Sociopolitical/Leadership System: NANGKAAMA/Aamed -They are the persons in
authority in the kalanguya society.They are well respected and their help and advice is
26
always sought in community affairs. The ascendance to the elder status does not require
any election nor is received through inheritance. It is earned status through community
recognition of one’s ability to accomplish reconciliation. This leadership quality is
pronounced in the Tongtongan (conference) where all sorts of crimes and offenses are
settled through the counsel of elders.
● Ayangan of Villaverde, Communal Solano, Portion of Cabua-an, Bayombong, Nueva Vizcaya

o Language: Ijadjang/ Ijadjangan
o Sociopolitical/Leadership System : O-ommod-(council of elders/leaders)- The highest
body that ultimately confirms any policy, guidelines, rules and procedures, plans and
programs of the organization, a group represented by the women, the men, and youth
sector constituting a council of elders/leader
o Kinship: The Ijadjang maintain and recognize kinship during occasion wherein relatives
are called during baptism, engagement (FONONG). The system of meat sharing is an
indication of how kinship is valued. They call this division and sharing of meat (FOGWA).
Region 3: Aeta of Pampanga speaks Mag-indi
● Sociopolitical/Leadership System: Amamugis-highly respected elder in the community. They

practice Dowry system.
● Means of living/Economy: Farming (rainy season), Fishing, Charcoal making, Handicraft
Bamboo/Cogon (summer)
● Education: Formal (NCIP and Prov Gov’t scholarships) and/or non-formal education (NFA-ALS)
● Land for them is life.
● Belief System: Apu na Malyari – God Creator
● Healing System : Herbal medicines, Herbal System – if not cured, they go to RHU or nearest
hospital
● Mag-aanito – Traditional hilot system
Region 4: Aeta of Southern Quezon (R4) speaks Tagalog and their practices almost the same with the
Dumagat
● Dumagat / Remontado of Quezon and Rizal Province speak Dumagat /Hatang Kaye
o Sociopolitical/Leadership System:
o PAPU – eldest in the community
o RAPU – 2nd o pangalawa sa matanda
o AMBA – elders na lalaki
o INDA – elders na babae
27
o Tribal councils and Tribal elders and IPMR
o Means of living/Economy: Kaingin System, or shifting cultivators, laboring, forest
products gatherer, hunting, fishing, trader
o They believe that land is life
o They believe to “MAKIDIAPAT”-God Almighty
o Practice Herbal Medicine
o Practice Hilot system and believe in traditional healers
o They believe in the existence of evil spirits like “Engkanto”, “Dwende”, “Tigbalang”,
“Nuno sa punso” at “espiritung di nakikita”.
o They practice rituals as form of healing – (Suob) – buga-using
● Mangyans of the island of Mindoro

o Mangyan is the generic name for the eight indigenous ethnic groups found in Mindoro,
each with its own tribal name, language, and customs.
o The ethnic groups from north to south of the island are: Iraya, Alangan, Tadyawan,
Tawbuid (called Batangan by lowlanders on the west of the island), Buhid and Hanunoo.
o They are mainly subsitence agriculturists, planting a variety of crops and rice.
o Mangyan communities are economically poor as well as their health status. Their low
access to quality health services is probably the main reason for this. Aside from their
financial incapacity and geographic distance, cultural differences raise barriers to
accessing health facilities.
o Mangyans have different health concepts and different ways of describing illness.
Untrained traditional birth attendants are preferred over midwives, nurses, and doctors
because they rarely touch body parts. At times, the husband attends to the delivery of
their wives. Bamboo sticks are used for cutting the cord of their babies. The Mangyans
do not seek prenatal and postnatal care from health workers or trained birth
attendants. Most of them do not register birth and death of their babies. Thus, their
health status cannot be seen from regular reports and health problems are not
recognized early. They also have different expectations from a consultation and the
mode of treatment.
o They speak Filipino as a second language unlike the health workers who use Filipino as
their main language. These result into communication gap leading to missed
expectations and failed health service provision.
o Another reason for the poor health status of Mangyans, is the lack of health facilities to
provide maternal and neonatal health services to the Mangyan communities. If they are
available for the rural/mountainside areas, health services are delivered by religious
missionaries and civic groups that do not have the formal reporting system and
structured maternal and neonatal health services as seen in rural health units (RHU).
Region 5: Kabihug (Albay, Sorsogon, Cam Sur, Cam Norte, Catanduanes)
● Kabihug of Camarines Norte (7 municipalities out of 12) speak Mamanede and Tagalog
28
o Sociopolitical /leadership system: Election base on seniority. They have their Elders and
IPMR
o Means of living/Economy: Farming, Mining, Laborer, Fishing, Hunting and Handicraft
o They practice communal sharing, they have extended family household
o Education: Adapted mainstream education, formal education and ALS
o They see themselves as tenant to the land and consider land as the source of life.
o Practices/Rituals: Traditional medicines : although adapted modern health system. They
still do traditional health practices like the “Harop”- drive away evil spirit.
Bukidnon of Region 6/7/8
● Bukidnon
o Language: Kinaray a, Ilonggo, Cebuano, Bisaya
o Sociopolitical/ leadership system: Magurang or elders
o Traditionally, San Agustin is lead by elders who are respected persons, having possessed
of knowledge, wisdom, or special abilities. Of political importance is, the parangkuton
(advisor) who gives advice, and the husay/manoghusay (arbiter) who settles conflicts. A
parangkuton may likewise be the husay/manoghusay.
o At present, however, San Agustin is a community where customary law system co-exists
with the local government system introduced from the lowland. Thus, the community
has an informal leader in a Tribal Chieftain who is respected for being the most
informed of the history and indigenous knowledge of the community. Meanwhile, the
community is also a barangay, with usual set of elective and appointive barangay
leaders as provided by the Local Government Code.
o Healing System : The babaylan or surhano is consulted for illnesses or performs rituals
because of their special abilities in folk medicine, particularly herbal medication, and
supposed ability to commune with the spirits.
o Means of living/Economy
o Farming and livestock raising (23%), household workers, sugarcane workers, or daily
wage laborers (16%), employed (4%), while two percent (2%) earn their income as
barangay officials. The rest are unemployed who engage in hunting, fishing, gathering of
root crops, batwan (fruit of a wild tree used as a condiment) and other edible fruits, and
forest products like uway (rattan).
o Kinship : The “puró” kinship, as in all ethnic groups, belongs to what anthropologists call
the generational-bilateral, i.e., the overall framework of kinship referents is organized
on the principle of generation, with each generation clearly defined and differentiated
by a distinct set of referential and vocative terms. The tracing of relationships at any
point of reference involves bilateral reckoning of the kin of both the father and the
mother. The lineal relatives are set off from collateral relatives in every generation
Lumads of Mindanao – Though generally called lumad, IPs in Mindanao have distinctive features
differentiating them from each other.
29
● Subanen
o They call their leader as Timuay. He is believed to be blessed by the Gods and must have
this characteristic in lineage.
o Their rituals include:
▪ banghal dalangan – ritual by the pregnant mother two days before giving birth
▪ gësëg – ritual three days after giving birth for the father and his child
▪ panagay – ritual performed when a child goes out from the house
▪ khanu bata – giving name to the child
▪ khanu gutong – ritual for the child to survive even without its parents
▪ buklog blaan – ritual performed as promised to the spirits after a sick child is
healed
● Matigsalug-Manobo
o Health and belief system – Having a good health greatly depends on how well one
relates to the spirits. Ailments are inflicted when people trespass the spirits. If one gets
sick, the tumanuren or the traditional medicine man uses his power and talk to the
spirits to cure the sick person. He also has a wide knowledge on plants, where to find
them and how to use them as cure.
o View of land – Lands for the Matigsalug are not properties to own. They see themselves
as stewards. It is a sign of respect to the spirits whom they consider as the rightful
owners.
● Dibabawon and Mangguangan

o Etymology: “Dibabaw” means upland or mountain. The Dibabawon come from the
bigger Agusan Manobo group. “Guangan”, on the other hand, means forest.
o Territory – Dibabawon and Mangguangan lived in the forests of Saug and Agusan. Being
in adjacent territories, they share similarities in language, religious belief and genealogy.
Inter-marriage has been very frequent between both tribes.
● Arumanen-Manobo
o Kinship: The Manobo recognize their lineage to both their mother and father’s families
o Subsistence: farming (pengengawid), fishing in streams and rivers (penginseda) and
hunting (penubok)
● Banwaon
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o Environment: Dependent on the forest’s natural resources for survival. Forest fruits,
vegetables and wild animals have been the traditional diet of the group
o Leadership: Several Datu have established leadership in small communities. Such self-
governance structure existed before the coming of the Spaniards. In this system, there
are clearly defined roles and responsibilities for the leaders and community members
and between gender
● Slide 1 – Title of the session
● Slide 4 – Indigenous peoples
● Slide 5 – Indigenous peoples not synonymous with
● Slide 6 – Concepts to remember
● Slide 7 – Who are the ICCs and IPs (RA 8371)
● Slide 8 – Who are the ICCs and IPs (RA 8371)
● Slide 9 – Where are the indigenous peoples
● Slide 10 – Instructions
● Slide 11 – Processing of group map
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Session 5 – Understanding Culture: Basic Concepts
Session Objectives
● Introduce the conceptual definitions related to culture and how it is developed.
● Make participants realize that culture is a matter of personal identity that people values and
that change while possible will not be easy if forced.
Description
● Interactive session and small group learning exercise for 30 minutes

32
▪ Explain that cultural factors have significant effects on how a particular group
behave, relate or perceive in a certain society. It is also part of the totality of a
certain culture.
▪ Culture, therefore, is generally defined as the totality of the way of life of a
group of people.
▪ There are distinct elements in the culture that makes it ideal depending on
whose perspective on how we view it.
▪ Culture is dynamic, it can change through several processes
▪ Structured learning exercise (charades)
● Divide the participants into 2 groups
● Give the cultural concept to one member of the first group and ask that
member to act out (or draw) the word and the other group members
guess the word in one minute
● Give each group alternating turn to play with different cultural concept
to act out and guess each time.
▪ Words to be printed and act out (or draw) for the charades can be: PERSONAL
PERSPECTIVE, BELIEF SYSTEM, CULTURAL ARTS, HEALING SYSTEM, LANGUAGE,
DYNAMIC
Culture refers to the knowledge, experience, beliefs, values, attitudes, meanings of concepts and
notions of the world and possessions acquired by a group of people in the course of generations through
individual and group initiative. Culture is defined by a community or society. It structures the way
people view the world. It involves the set of beliefs, norms, and values concerning the nature of
relationships, the way people live their lives, and the way people organize their environments. Culture is
a complex and rich concept.
33
From a personal perspective, culture is a personal identity that describes an individual's
affiliation or identification with a group or groups. Cultural identity arises through the interaction of
individuals and culture(s) over the life cycle. Understanding it requires a willingness to examine and
grasp its many elements and to comprehend how they come together.
Elements generally agreed to constitute a culture are the following:
● A common heritage and history that is passed from one generation to the next.
● Shared values, beliefs, customs, behaviors, traditions, institutions, arts, folklore, and lifestyle.
● Similar relationship and socialization patterns.
● A common pattern or style of communication or language.
● Geographic location of residence (e.g., country; community; urban, suburban, or rural location).
● Patterns of dress and diet.
In every culture, we find distinctive elements:
● Belief system – concepts, assumptions, convictions that are held as true in a certain group
(includes religion, spirituality, values). An IP group in Bukidnon sees their culture as the
manifestation of their relationship with the Divine. Their healing system is influenced by this
relationship. Driving away the bad spirits will restore their relationship with the Divine. This
system is a manifestation of the omnipotence of the Divine.
● Material culture –This includes the things we make, eat, those that are visible and we can touch.
These reflects our beliefs about the world and are held very significant to every IP community.
For instance is the Subanen bandi or jars. Bandi, a storage for their traditional wine called gasi,
drank during rituals, are used as bëlayan or brideprice for marriage.
● Arts/aesthetics – Includes visuals, performances and other avenues showing ones perception of
beauty. IPs have their distinct ways of showing their artistry such as traditional wear and
accessories, handicrafts, or music, dances, chants, among others.
● Economy (subsistence pattern) – How the society uses their limited resources to satisfy their
wants and needs. In traditional IP communities, they produce most of what they need to survive
through cultivation, hunting, gathering, fishing, among others.
● Socio-political system – Refers to organizational and cultural leadership systems, institutions,
relationships and processes for decision-making and participation accepted by ICCs/IPs. IP
34
groups in Mindanao would have a timuay or datu as a figure of power and guided by their
customary laws.
● Kinship pattern – How people organize themselves into social relationships. This can be
relationships by blood (consanguinity) and through marriage (affinity).
● Education – A form of learning, may be formal or informal, by which the knowledge, skills, and
habits are transferred to the next generation. Transfer of knowledge is also done through
learning by doing.
● Healing system (health) – Traditional beliefs and practices on health exists in every IP group. The
Subanen would have a “panday-tiyan”, a Subanen term for their traditional birth attendant, to
care for a pregnant woman and assist her during childbirth.
● Language – Body of words and the systems for their use common to a people who are of the
same community or nation, same geographic area, or the same cultural tradition.
● Environment –Includes the geographical setting, settlement pattern and natural resources. We
frequently hear IPs say, “Land is life”. Forests for them are considered their marketplace,
pharmacy, and the domain of the spirits.
Features of culture
● Culture is learned – No one is born knowing about one’s culture. Learning can be formal (a
formal educational system) and informal (experiences). Health practices and beliefs are
therefore learned.
o Enculturation - culture is learned and transmitted across generations
o Diffusion - borrowing cultures either directly or through intermediaries
o Acculturation - cultural changes that develop as a result of continuous firsthand contact
between cultures
● Culture is shared - The beliefs and practices are held by majority of the groups’ members. A
group of people sharing a culture will have shared beliefs and practices about health.
● Culture is integrated – If you change one aspect of culture, you (usually unwittingly) change
another aspect. Various cultural elements are related to each other.
How we view one’s own culture vis-à-vis the culture of others affects how we understand
ourselves and others, and therefore how we interact within a culture and with other cultures. It also
influences how one shapes and implements laws, policies, programs, projects and activities.
● Ethnocentrism – The beliefs and practices of one’s culture are correct, superior and valid, and
those of other cultures are false, inferior and invalid. Health workers promoting the building of
toilets are baffled by community resistance to this. Many rural and indigenous communities
35
resist the building of toilets because they believe it leads to keeping “dirty material”
permanently near their homes. This is okay in communities where houses are far apart,
environment is still clean, there is a lot of sun and fresh air. But it is no longer okay in more
densely populated communities. Development workers promoting the planting of herbal
gardens by women for both health and economic benefits are baffled by the community
women’s resistance. It is only later that they realize that the community believes that growing
these herbal plants in one place, near their homes, is like inviting the spirits of the illness the
plants are expected to cure to come to their homes.
● Colonial mentality – The beliefs and practices of other cultures, especially those of the
colonizers, are more valuable than those of one’s own, especially indigenous culture. People
who automatically trust that the quality of more routine surgical procedures abroad is better
than locally done. The member of an indigenous community develops an automatic preference
for the medical doctor than for the traditional healer.
● Noble savage – Indigenous peoples and their culture may be “primitive” or “simple”, but they
have noble hearts and souls. Romantic view of indigenous peoples. Tends to see them as
museum pieces, change by them toward more contemporary beliefs and behaviors is not
considered desirable.
● Cultural relativism – Each culture should be viewed within its own context and not judged in
comparison with other cultures. Emphasis on documenting and understanding a variety of
cultures, especially those in danger of “disappearing”. Should not be a reason to withhold
assessments of what is right or wrong.
Culture is symbolic. Each culture has sets of symbols understood by most members of that
culture. Language is highly symbolic. Language is one of the best medium for carrying on the culture of a
group of people. Symbols are learned. Therefore, there are no universal symbols. We have to be careful
that the symbols we use is understandable to others. For example, the colors associated with grief after
someone has died vary from culture to culture.
There are ideal and actual patterns of beliefs and behaviors. When asked about a cultural belief
or practice, is the respondent sharing what is the ideal or what is the actual? In the first place, what do
you want to know? The ideal (useful for capturing the total body of knowledge on health beliefs and
practices) or the actual (useful to generate information in preparation of materials for behavioral
change.
Cultural identities are not static factors that simply mediate individual identity; they are
dynamic, change via interactive developmental processes that influence one's willingness to
acknowledge the effects of ethnicity and culture and to act against disparity across relationships,
situations, and environments. Even the most traditional culture today is not exactly the same as it was
36
100 years ago. Change however can be maladaptive if forced. An adaptive cultural change is more
beneficial and sustainable.
● Slide 1 – Title slide
● Slide 2 – Objectives of the session
● Slide 3 – Definition of culture
● Slide 4 – Culture from personal perspective
● Slide 5 – Elements that constitute culture
● Slide 6 – Distinct Elements
● Slide 11 – Features of culture
● Slide 12 – Features of culture
● Slide 13 – How we view one’s culture
● Slide 17 – Culture is dynamic
● Slide 18 – Structured learning exercise (charades)
37
Session 6 – Understanding Culture: Preservation vs. Change
Session Objectives
● To enhance the participants understanding of culture after the previous session; and
● To discuss opportunities for change.
Description
● Interactive session or small group learning exercise for 30 minutes

▪ Explain that culture is dynamic and change happen in a natural way.
38
▪ Present a couple of slides and ask the participants if they are ideal or not. Note
the differences in answers. There is no need to resolve for a common or the
right answer.
▪ The challenge is to develop health programs that will promote change in both
the provider and client a natural way.
▪ The approach may be through the family, geographic and gender influence.
▪ Structured learning exercise (scrambled phrases quiz)
● Divide the participants into 3 groups
● Print the scrambled word of the different cultural concepts and show to
the group
● The first group who guessed the word will have the chance to explain
the concept
● If the explanation is correct, give one point for the group
● The group that gets the highest number of points wins and may be given
a group prize.
● The phrases that can be scrambled are: CULTURE CHANGE, DESIRABLE
ASPECTS OF CULTURE, INDIVIDUAL CHANGE, HEALTH BELIEFS, FAMILIES
AS AGENTS OF CHANGE, CONSTRAINTS TO PROMOTE CHANGE
There are aspects of one’s culture that are desirable. The members of that culture must have
the desire to maintain these cultural beliefs and practices. We respect the right of members of a cultural
group to maintain their cultural integrity. However as discussed in the previous session, cultural
identities are not static; they develop and change across stages of the life cycle. People reevaluate their
cultural identities and sometimes resist, rebel, or reformulate them over time.
There are many forces at work that pressure a person to alter his or her cultural identity to
conform to the mainstream culture's concept of a “proper” identity. When this change is forced, people
may feel conflicted about their identities – wanting to fit in with the mainstream culture while also
39
wanting to retain the values of their culture of origin. This is very evident in health service delivery.
When the health service is against cultural beliefs and practices, there is a possibility that it will not be
utilized even if access is made easy.
If cultures change, then people have the capacity to change. As health workers, we advocate for
change that would make peoples’ lives better. To do this, we must understand how culture is changed
and how one perceives and utilize the health service. In general, cultural groups differ in how they
define and determine health and illness; who is able to diagnosis and treat an illness; their beliefs about
the causes of illness; and their remedies (including the use of Western medicines), treatments, and
healing practices for illness. Many cultural groups hold views that differ significantly from those of
Western medical practice and thus can affect treatment. But health standards, beliefs and practices
have been changing over time in both mainstream and indigenous groups.
Families are important in all cultural groups. Concepts of culture and attitudes are initially
formed in the family and family ties, the family's inclusiveness, how hierarchical the family is, and how
family roles and behaviors are defined by culture as well. Even in cultural groups with carefully defined
roles and rules for family members, family dynamics may change as the result of internal or external
forces. The process of utilizing a health service, for instance, can significantly affect family roles and
dynamics among families. There are complex rules about which members of the family can make
decisions about utilization of health care across cultural groups. If utilization is forced this might cause
the dissolution of longstanding cultural hierarchies and traditions within the family and resulting in
conflict between spouses or different generations of the family.
Geographical factors can also have a significant effect on a client's culture. For example, clients
coming from a rural area – even if they come from different ethnicities – can have a great deal in
common, whereas individuals from the same ethnicity who were raised in different geographic locales
can have very different experiences and attitudes. Similarly, gender roles can vary across cultures.
Diverse cultural groups have different understandings of the proper roles, attitudes, and behaviors for
men and women.
In the past we design health service with formal and informal constraints.
● Formal: local laws, policies, guidelines. The sanctions for disobeying them are generally clear.
● Informal: peer pressure, shame, desire not to help in the future if conditions are not met.
The challenge is in conceptualizing and implementing health policies, programs, projects and
activities that are flexible to change. Culture is always changing, and we are part of changing it.
40
Recognizing our cultural attitudes and the different types helps us become more conscious of how we
are changing culture in our daily lives.
● Slide 3 – Desirable aspect of culture
● Slide 4 – Desirable or not
● Slide 8 – Changing cultural identity
● Slide 9 – Individual change and culture change
● Slide 10 – Cultural groups differ in their health beliefs
● Slide 11 – Families as agents of change
● Slide 12 – Geography and gender
● Slide 13 – Constraints to promote change
● Slide 14 – Two-way change
● Slide 15 – Structured learning exercise (scrambled phrases)
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Module 2 – Developing Skills on Culture Sensitivity and Competency
By the end of this module, participants will be able to:
● Rearticulate culture sensitivity and evaluate one’s capacity to be culture sensitive
● Identify how culture sensitivity can be applied at the micro level in one-on-one or small group
interactions
● Describe how contextual and structural factors of health service delivery impact health
outcomes for indigenous peoples and indigenous cultural communities
● Learn “debiasing” techniques to either unlearn or better manage implicit biases that may affect
decision-making on behalf of indigenous peoples and indigenous cultural communities
Sessions
● Session 7 – Assessing One’s Self
● Session 8 – Starting the Road to Culture Sensitivity
● Session 9 – I-LEARN Model for Culturally Sensitive Health Care
● Session 10 – Applying the I-LEARN Model: Role Plays
● Session 11 – From Culture Sensitivity to Culture Competency
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Session 7 – Assessing One’s Self
Session Objectives
● At the end of the session, the participants shall be able make a self-assessment of their current
culture sensitivity orientation
Description
● Self-assessment for 40 minutes

o Printed copies for each participants the self-assessment questionnaire
o The facilitator should also try to answer the self-assessment questionnaire prior to the
session.
▪ Emphasize that each participant has their own cultural identify that they should
be aware of.
▪ Ask about beliefs they learned since childhood that they may have learned from
their parents and peers.
▪ During their time as a health worker, ask what cultural beliefs they have learned
from their patients or clients.
▪ Then ask them to respond to the self-assessment questionnaire and score their
cultural orientation and sensitivity.
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▪ Ask the participants for clarifications and questions. The self-assessment score
only signifies the level of awareness. Less than 10 means low, 10-20 is middle
and above 20 can be considered high awareness. Emphasize that the current
score can be improved hopefully after this training module.
▪ Summarize the learning points.
o Provide instructions for the subsequent activity
Health workers who are aware of their own cultural backgrounds are more likely to
acknowledge and explore how culture affects their client–counselor relationships. Without cultural
awareness, they may provide care that ignores or does not address obvious issues that specifically relate
to culture. Lack of awareness can discount the importance of how health workers' cultural backgrounds
– including beliefs, values, and attitudes—influence their initial and diagnostic and treatment plan for
patients and clients. Without cultural awareness, health workers can unwittingly use their own cultural
experiences as a template to prejudge and assess client experiences and clinical presentations.
A key step in attaining cultural competence is for health workers to become aware of their own
cultural identities. Although the constructs of these identities are complex and difficult to define briefly,
what follows is an overview. Racial identity “refers to a sense of group or collective identity based on
one's perception that he or she shares a common heritage with a particular racial group”. Ethnic and
cultural identity is “often the frame in which individuals identify consciously or unconsciously with those
with whom they feel a common bond because of similar traditions, behaviors, values, and beliefs”. In
working to attain cultural competence, health workers must explore their own racial and cultural
heritages and identities to gain a deeper understanding of personal development.
● Slide 3 – Why self-awareness
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● Slide 4 – Why self-awareness
● Slide 5 – Cultural belief learned from childhood
● Slide 6 – Cultural beliefs learned at work
● Slide 7 – Instructions for self-assessment
Cultural Competency Awareness Self-assessment
Awareness Never Sometimes Often Always
Value Diversity
I view differences in beliefs and perception

as a positive thing.
Know myself
I am aware of my own ethnic and cultural

identity.
Share my culture
I am aware that in order to learn more about
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others I need to tell them my own culture.
Be aware of areas of discomfort
I am aware if I have discomfort when I

encounter people with different religion,
language, ethnicity and culture.
Check my assumptions
I control my own views and assumptions

about people of cultures different from my
own.
Challenge my stereotypes
I correct or reduce my stereotype views

about others as they may cause harm.
Reflect on how my culture affect my
judgement
I think and reflect on my cultural perspective

as they influence my judgement.
Accept ambiguity
I accept that in cross cultural situations there
can be uncertainty about what is

appropriate.
Be curious
I make effort to learn about differences and

create partnership with people of different
culture.
Aware of my privilege as health worker
If am aware that being a health worker, I will

be perceived as a person with privilege
higher authority.
*Scoring: 0-Never, 1-Sometimes, 2-Often, 3-Always
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Session 8 – Starting the Road to Culture Sensitivity
Session Objectives
● At the end of the session, the participants should be able to understand the necessary
behavioral change towards culture sensitivity
Description
● Task of support staff

▪ Emphasize and review the definition and concepts of cultural sensitivity and
competency.
▪ Explain that it requires behavior change from both the health care worker and
the patient or client.
▪ Emphasize the initial behavior change necessary for the health worker i.e.
RESPECT.
▪ Show the spectrum of cultural sensitivity to competency and ask the
participants where in the spectrum they feel situated and ask why.
▪ Ask, what are the instances in the past to support their answer.
o Facilitate an interactive session or small group learning exercise with the participants
▪ If the process chosen is interactive session, present a couple of slides with
beliefs and practices and ask the participants if they are ideal or not. Note the
differences in answers.
▪ There is no need to resolve for a common or the right answer.
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Becoming culturally sensitive and competent starts with awareness, followed by skills
development and eventually application of the skills. Cultural sensitivity and competence is the ability to
recognize the importance of culture in the provision of health services. Health workers need to be aware
and accept that people from other cultural groups do not necessarily share the same beliefs and
practices. Cultural sensitivity is recognizing that each of us has some ethnocentric views that are
provided by our culture.
Health workers with a strong belief in scientific and evidence-based treatment methods can find
it hard to relate to clients who prefer traditional healing methods. Similarly, those with strong trust in
traditional healers and culturally accepted methods can fail to understand clients who seek scientific
explanations. To become culturally competent, counselors should begin by exploring their own cultural
heritage and identifying how it shapes their perceptions of normality and abnormality in the health care
process.
The term “worldview” refers to a set of assumptions that guide how one sees, thinks about,
experiences, and interprets their experience. During childhood, worldview development is facilitated by
significant parents and family members and eventually life experiences that influence one’s values,
attitudes, beliefs, and behaviors. It’s like a pair of glasses with lenses colored by one’s experiences.
Health workers has their own lens. Their own experiences, histories of prejudice, cultural stereotyping,
and discrimination. They should be aware that they have their own lens. Indigenous peoples also have
their own experiences and worldview. Their own lens that may be different from the health worker.
Cultural sensitivity and competency start by recognizing and accepting this.
However, the power relationship between a health worker and the client may make these
differences in worldview be difficult to be accepted by both care provider and client. Health workers
need to understand the impact of their role and status within the client–provider relationship. Client
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perceptions of health care provider's influence, power, and control vary. In some they can be seen as all-
knowing professionals, but in others, they can be viewed as representatives of an unjust health system.
A key element of ethical care is practicing within the limits of one's competence. Health workers
must engage in self-exploration, critical thinking, and clinical supervision to understand their clinical
abilities and limitations regarding the services that they are able to provide, the populations that they
can serve, and the treatment issues that they have sufficient training to address. Cultural sensitivity and
competence require an ability to assess accurately one's clinical and cultural limitations, skills, and
expertise. Health workers risk providing services beyond their expertise if they lack awareness and
knowledge of the influence of cultural groups on client–provider relationships, clinical presentation, and
the treatment process or if they minimize, ignore, or avoid viewing treatment in a cultural context.
There are some principles that need to be considered by a health worker in providing culturally sensitive
health service. RESPECT.
● Respect—Understand how respect is shown within given cultural groups. Counselors

demonstrate this attitude through verbal and nonverbal communications.
● Explanatory model—Devote time in treatment to understanding how clients perceive their
presenting problems. What are their views about their own substance abuse or mental
symptoms? How do they explain the origin of current problems? How similar or different is the
counselor's perspective?
● Sociocultural context—Recognize how class, race, ethnicity, gender, education, socioeconomic
status, sexual and gender orientation, community, family, gender roles, and so forth affect care.
● Power—Acknowledge the power differential between clients and health workers.
● Empathy—Express, verbally and nonverbally, the significance of each client's concerns so that
he or she feels understood by the health worker.
● Concerns and fears—Elicit clients' concerns and apprehensions regarding help-seeking behavior
and initiation of treatment.
● Therapeutic alliance/Trust—Commit to behaviors that enhance the therapeutic relationship;
recognize that trust is not inherent but must be earned by health workers.
Becoming culturally competent is an ongoing process—one that requires introspection,

awareness, knowledge, and skill development. Health workers need to develop a positive attitude
toward learning about multiple cultural groups; in essence, they should commit to cultural
competence and the process of growth. This commitment is evidenced via investment in ongoing
learning and the pursuit of culturally congruent skills.
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Figure 1 Spectrum from Cultural sensitivity to cultural competence
● Slide 3 – Awareness, skills development and application
● Slide 4 – Awareness vs acceptance
● Slide 5 – Worldview
● Slide 6 – Whose lens then? The power relationship
● Slide 7 – Insensitive and unjust health system
● Slide 8 – What are the positive strategies
● Slide 9 – Ethical practice and cultural sensitivity
● Slide 10 – RESPECT
● Slide 11 – RESPECT
● Slide 12 – Cultural sensitivity and competence is an ongoing process
● Slide 13 – Spectrum of cultural sensitivity and competence
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Session 9 – I-LEARN Model for Culture Sensitive Health Care
Session Objectives
● To introduce the participants to I-LEARN model of providing culturally sensitive health service;
and
● To demonstrate how I-LEARN is practiced
Description
● Role play demonstration for 30 minutes
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▪ Explain the concept of I-LEARN
▪ Emphasize that the challenge is to develop behavioral change in both the health
care worker and the patient or client in a mutually acceptable manner.
▪ Present a couple of slides as examples and conduct a brief role play
● Ask the participant to practice I-LEARN with the participant as the health
worker and the facilitator as the client.
● Present the scenario and during the role play, guide the health worker
to adopt the step-by-step process of I-LEARN
● Processing
o Sharing by observer
o Ask feeling of health worker
o After a brief role play, facilitate an interactive session with the participants
● Cultural sensitivity skills can be developed by practicing I-LEARN
● The skill cannot be perfected right away but through constant

application and practice at work
Health workers should learn how culture interacts with health beliefs and other behavioral health
issues. They can access literature and training that address cultural contexts and meanings of health
problems, behavioral and emotional reactions, help-seeking behavior, and treatment. To promote
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culturally responsive services, health workers need to acquire cultural knowledge regarding concepts of
health, illness, and healing.
Advise to health care providers:
● Health workers should educate themselves as much as possible regarding the patterns of
communicating in the client's cultural or ethnic population while also being aware of his/her
own communication style.
o Understand the client's verbal and nonverbal ways of communicating. Styles of
communication and nonverbal methods of communication are important aspects of
cultural groups.
o Listen to storytelling carefully, as it can be a way of communicating with the health
worker.
● Make allowance for variations in health beliefs. Cultural groups have different expectations and
norms of propriety concerning how close people can be while they communicate and how
personal communications can be depending on the type of relationship (e.g., peers versus
elders).
● Health workers should frame clinical issues with culturally appropriate references. For example,
in cultural groups that value the community or family as much as the individual, it is helpful to
address illness in light of its consequences to family or the community.
● Health workers must take care with suggesting simple solutions to complex problems. It is often
better to acknowledge the intricacies of the client's cultural context and circumstances.
I-LEARN
● Inquire about the reason for consultation or the encounter. Make sure to start with opening
greetings. Use open ended questions.
● Listen to each patient or client about the health issue and ask interpretation from his or her
cultural perspective. Avoid interrupting or posing questions before the client finishes talking;
instead, find creative ways to redirect dialog (or explain session limitations if time is short). Take
time to learn the client's perception of his or her problems, concerns about presenting problems
and treatment, and preferences for treatment and healing practices.
● Explain your perception or diagnosis of the problem i.e. from your own lens. But remember that
the client's needs come before your set own perceptions.
● Acknowledge client’s perceptions and concerns and discuss the probable differences between
you and your clients. Take time to understand each client's explanatory model of illness and
health. Recognize, when appropriate, the client's healing beliefs and practices and explore ways
to incorporate these into the treatment plan.
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● Recommend a course of action through collaboration with the client. The client must know the
importance of his or her participation in the treatment planning process. With client assistance,
client beliefs and traditions can serve as a framework for healing in treatment. However, not all
clients have the same expectations of treatment involvement; some see the health worker as
the expert, desire a directive approach, and have little desire to participate in developing the
treatment plan themselves.
● Negotiate an acceptable treatment plan that weaves the client's cultural norms and lifeways
into treatment goals, objectives, and steps. Once the treatment plan and modality are
established and implemented, encourage regular dialog to gain feedback and assess patient’s
satisfaction. Respecting the client's culture and encouraging communication throughout the
process increases client willing to engage in treatment and to adhere to the treatment plan and
continuing care recommendations.
Culturally responsive treatment planning is achieved through active listening and should
consider client values, beliefs, and expectations. Client health beliefs and treatment preferences should
be incorporated in addressing specific presenting problems. Some people seek help for direct medical
intervention while others prefer treatment programs that use principles and approaches specific to their
cultures.
● Slide 3 – Culture affects health beliefs and practices
● Slide 4 – Advice to health workers
● Slide 5 – Advice to health workers
● Slide 6 – I-LEARN
● Slide 12 – Culturally responsive treatment plan
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● Slide 13 – Brief role play
● Slide 14 – Scenario
● Slide 15 – Points for discussion
Session 10 – Applying the I-LEARN Model: Role Plays
Session Objectives
● To develop and demonstrate the skill for a culture sensitive and competent care for patients and
clients; and
● To give observation and feedback on the application of I-LEARN in a role play.
Description
● Role play for 3 scenarios at 15 minutes each scenario for a total of 45 minutes
● Open forum and processing for each scenario for 15 minutes for a total of 45 minutes

o Printed copies for each participants the individual role they are supposed to play
o There is also a need for a big room where each small group can stay, conduct the role
play without disturbing the other group. All small groups must be ready to gather in a
plenary session after each role play.
o Review the slide deck and scenarios
o Slide presentation on the instructions to the activity
o Divide the participants into groups of three (3’s).
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o They will each be given a handout with a scenario and instructions on the role they will
be playing i.e. health worker, patient or client and observer.
o Allow the role play for 15 minutes then process the role play by asking the observers’
evaluation for 15 minutes.
o Make sure the processing is at plenary session where everyone can share their
experience with the other small groups.
o Give another set of handouts with the second scenario and instructions on the role they
will be playing i.e. health worker, patient or client and observer. Rotate the roles within
the group.
o Similarly, allow the role play for 15 minutes then process the role play by asking the
observers’ evaluation for 15 minutes.
o Lastly, give another set of handouts with the third scenario and instructions on the role
they will be playing i.e. health worker, patient or client and observer. Rotate the roles
within the group. Make sure each became the health worker, patient or client and
observer.
o Similarly, allow the role play for 15 minutes then process the role play by asking the
observers’ evaluation for 15 minutes.
● After all the role plays and if there is more time, facilitate an interactive session with all the
participants.
o Ask the participants for clarifications and questions
o Summarize the learning points
● Provide instructions for the subsequent activity
The following scenarios are sample scenarios and can be modified by the facilitators to adopt to
local area. When revising, just make sure that the scenario present cultural differences that can
demonstrate learning of the skills of I-LEARN.
Scenario 1
● Health worker – You’re a midwife in the RHU. You were accompanied by a BHW to a home of an
IP who is pregnant for the second time and having vomiting and frequent dizziness. She refuses
to go to the health center because she believes her symptoms are “normal” for a pregnant
woman. She also felt this when she was pregnant with her first child. Your task is to convince her
56
to consult the health center for laboratory tests and other evaluation as what she has may be
symptoms and signs of high-risk pregnancy.
● Patient – you’re a pregnant woman in your second pregnancy. You’re having vomiting and
frequent dizziness. You don’t want to go to the health center because it is a 2 kilometer walk
and no one will be left to your child (boy) who is just 2 years old. Since you also felt these
symptoms during your first pregnancy, you believe that these symptoms are “normal” for a
pregnant woman.
● Observer – observe the interaction process. Use the I-LEARN checklist if the health worker
applied the principles.
o Inquire – the health worker allowed the patient to explain her condition freely with no
interruption
o Listen – the health worker paid attention and took notes of the discussion
o Explain – the health worker explained to the patient the what she thinks is the problem
o Accept – the health worker accepted the patient’s own beliefs about her condition
o Recommend – the health worker recommended several options to the patients
o Negotiate – the chosen option was a result of fair negotiation
Scenario 2
● Health worker – you’re a doctor in a PHIC accredited birthing facility attending to a pregnant
woman who is in labor room. The cervical dilatation is now 8 cm and 90% effaced. You want to
transfer the pregnant patient to the delivery room. The husband wants to join his wife in the
delivery room. But you’re worried because the PHIC accreditation standard is very strict with
regards to infection control.
● Client – you’re the husband of a pregnant IP who is now about to deliver. Your wife is now
crying in pain and will be transferred to the delivery room. You swore to your wife and to his
father that you will be with her during this first pregnancy until she delivered the child.
Unfortunately, the doctor will not allow you to be inside the delivery room. Because it is in your
culture to honor an oath, you have to insist to be with your wife in the delivery room.
interruption
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Scenario 3
● Health worker – you’re a nurse in the birthing clinic who just assisted in the delivery of an IP
woman to a healthy baby boy. The father like to take the placenta home with them. You’re
hesitant to give it because the licensing standard of DOH insisted on a placenta pit for disposal
of placenta.
● Patient – you’re the father of a just recently delivered baby boy (first son) by your wife. It is in
your culture to bury the placenta under your stairs at home because you believe that the boy
even when he grow up to become a man and have his own family, he will always find a way to
visit your home because his placenta is buried under your stairs. Unfortunately, the nurse of the
health center refuse.
interruption
● Presentation Content
o Slide 1 – Title slide
o Slide 2 – Session objectives
o Slide 3 – Instruction for 1st 30 min
o Slide 4 – Instructions for 2nd 30 minutes
o Slide 5 – Instructions for 3rd 30 minutes
o Slide 7 – Thank you slide
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Session 11 – From Culture Sensitivity to Culture Competency
Session Objectives
● After gaining the skills, the participants should realize the next steps to take towards cultural
sensitivity and competency; and
● The participants must realize that attitude change does not happen overnight but in stages
across time.
Description
59

▪ Explain that after gaining knowledge and skills about cultural sensitivity and
competency, attitude change is necessary.
▪ Attitude change happen in stages and across time.
▪ Summarize the learning points and if there is more time, ask the participants
what they can do when they go back to their health facility.
Cultural competence begins with awareness and knowledge. Health workers and managers
should be aware of and responsive to how culture shapes attitudes and beliefs. This understanding will
broaden when the knowledge and skills they learned is applied in actual experience with the cultural
groups of their client population. This will enable them to better understand client issues and interact
with clients in culturally specific and appropriate ways.
In the implementation of cultural sensitivity and competence, the patients and clients will also
be exposed to educational and clinical experience contrary to their own culture. They will also realize
that they also have their own biases, which can affect their perspectives and subsequent relationships
with health workers as well as other community members. Cultural sensitivity and competence promote
relationships based upon understanding and knowledge of how one's own cultural beliefs and values. It
involves being able to identify, learn from, and incorporate these into the health care process. Cultural
competence should be an integral part of personal competence. This will need an ongoing commitment
to openness and learning, taking time and taking risks, sitting with uncertainty and discomfort, and not
having quick solutions or easy answers.
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Culturally responsive service makes both the health worker and patients/clients not only to
embrace their own cultural and life experiences, but to acknowledge and respect the experiences,
perspectives, and diversity of others. Cultural sensitivity and competency involve behavioral change in
both the health worker and patients. This change happens in stages.
● Precontemplation. The individual does not see a need to change. For example, a health worker
trained with the scientific methods does not see any need to alter his or his method of caring for
patients.
● Contemplation. The person becomes aware of a problem but is ambivalent about the course of
action. For instance, a health worker recognizes that patients are not consulting his/her center
and is already affecting his/her performance in reaching the immunization targets but remains
ambivalent on how he/she may do this.
● Preparation. The individual has determined that the consequences of his or her behavior are too
great and that change is necessary. Preparation includes small steps toward making specific
changes. The health worker may still do what he/she has been doing but may already have
altered or changed some behavior towards patients or clients.
● Action. The individual has a specific plan for change and begins to pursue it. In relation to
cultural sensitivity, the health worker may attend cultural competence training and strat
applying what he or she learned from the training.
● Maintenance. The person continues to engage in behaviors that support his or her decision. For
example, when the health worker realized that with cultural sensitivity, he/she has more IPs
consulting for immunization and he/she is now exceeding her performance targets, he/she
might want to maintain applying that skills to maintain the performance.
Cultural competency is a form of social intelligence with four components:
● Awareness - the ability to recognize one’s own reactions to people who are different, as well as
understanding the implications of these reactions for effective interaction with others.
● Attitude – one’s values and beliefs about differences among individuals or groups.
● Knowledge – one’s understanding of the facts about individual or groups.
● Skills – tools and processes used to communicate and interact with diverse individuals or groups.
Top ten cultural competency skills
● A willingness to learn about one’s own prejudices and biases.
● A willingness to identify and overcome personal biases to the extent possible.
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● An ability to work toward equal status relationships with people who are or appear different
from oneself.
● An ability to accept responsibility for the harm that one’s intentional or unintentional actions
may cause for people who are different or who are perceived to be different from oneself.
● An ability to use language in a manner that promotes equal status interactions.
● An ability to question personal assumptions about the skills and competencies of people who
are different or who are perceived to be different from oneself.
● An ability to tolerate the ambiguity of not knowing what one expects or what to do in
intercultural interaction.
● A desire to learn as much as possible about how one’s own culture is different or similar to other
groups or individuals, and how this knowledge can contribute to a particular way of viewing
oneself and others.
● An ability to take risks in efforts to communicate with people from other cultures.
● An ability to learn from mistakes made in communications with persons or groups of other
cultures.
Steps to cultural competency
● The recognition and acceptance that all cultures have a profound influence in our lives.
● The personal awareness that oppression is pervasive in our society. It is a part of our collective
history and does affects our relations and interactions with each other.
● The acceptance that there are cultural differences that all need to learn to respect, even though
there may be aspects that are not always understood.
● Having the humility to accept that we do not know everything about other cultures, and never
will.
● Therefore, one needs to continually strive to learn what we need to know about the groups that
are interacted with.
● A willingness to pursue information and knowledge about other groups via methods that are
available.
When unable or complete the steps listed above, health workers need some courage and
humility to identify and confront any personal resistance, anger and especially fears that may in
interfere with one’s ability to acknowledge, respect or effectively interact with other individuals or
groups.
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Always remember that cultural competency is a life-long process
● Recognize that cultural sensitivity and competency training is necessary, but not solely sufficient
to accomplish cultural competency.
● Recognize the goal of cultural competence training to continually strive to reach a progressively
higher state of competence, but the learning and the application of knowledge and skills
obtained during training and experiences is a lifelong process.
● Slide 2 – Session 11 objectives
● Slide 3 – Cultural competence begins with awareness
● Slide 4 – Cultural competence for patients
● Slide 5 – Cultural competence for health workers
● Slide 6 – Cultural competence as personal competence
● Slide 7 – Stages of change
● Slide 8 – Stages of change
● Slide 9 – Stages of change diagram
● Slide 10 – Four components of cultural competency
● Slide 11 – Ten cultural competency skills
● Slide 12 – Ten cultural competency skills
● Slide 13 – Steps to cultural competency
● Slide 14 – Cultural competency is a life-long process
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Module 3 - Cultural Sensitivity and Competency at Organizational Level
By the end of this module, participants will be able to:
● Identify how cultural competence can be applied at macro level to build culturally competent
organizations, programs and policies; and
● Develop an organizational plan, evaluation and monitoring system for the development and
implementation of culturally sensitive and competent service.
Sessions
● Session 12 – Organizational Cultural Sensitivity and Competency
● Session 13 – Organizational Sensitivity and Competency: Operational Planning Workshop
● Session 14 – Development of Evaluation and Monitoring Framework
● Session 15 – Summary, Declarations and Closing
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Session 12 – Organizational Cultural Sensitivity and Competency
Session Objectives
● The participants should realize that cultural sensitivity and competency to be sustainable should
have organization support; and
● To identify the different strategies and activities that the organization can do to implement and
sustain cultural sensitivity and competency in the whole organization.
Description

65
▪ Explain that after the individual health workers gained knowledge and skills
about cultural sensitivity and competency, organizational support is necessary.
▪ Organizational structures and policies must be developed and implemented.
▪ Summarize the learning points.

The responsibility for developing culturally responsive services has historically fallen on
individual health worker. But they are a part of a larger organization or system. Cultural competence
among health workers is only as effective as their organization’s commitment to and support of cultural
sensitivity and competence. Health workers are unlikely to affect organizational change to the same
degree as the organization's overall managers can. Hence, culturally responsive treatment cannot be
sustained without an organization's commitment and support. In fact, if the organization is not
supportive it can prevent patients and clients from receiving culturally responsive services or treatment
opportunities.
At the organizational level, cultural competence or responsiveness refers to a set of congruent

behaviors, attitudes, and policies that enable a system, agency, or group of professionals to work
effectively in multicultural environments. Organizational cultural responsiveness is a dynamic, ongoing
process; it is not something that is achieved once and is then complete. Organizational structures and
components change. The importance and benefit of cultural competence does not end with changes in
organizational policies and procedures, increases in program accessibility and tailored treatment
services, or enhancement of staff training.
To maximize its effectiveness in working with diverse groups, the organization must first view
cultural diversity as an asset. It must ensure that its process of developing cultural sensitivity and
competence is supported by the organization's leadership. There must be a mandate and commitment
to provide resources to undertake major organizational change.
Organizational change needs organizational planning. At the start a senior member of the
organization may be assigned to develop the process of planning, evaluating and implementing
66
culturally responsive administrative and clinical services. By appointing a senior member, the
organization ensures that the person can provide oversight and direction. He/she must be empowered
to influence, formulate, implement, and enforce cultural sensitivity and competence initiatives on all
levels and throughout every unit of the organization.
Before planning, the organization should first determine how the patients, clients and
community it serve can support the achievement of the its cultural responsiveness. Organizations can
sometimes have the best intentions of creating culturally responsive services but miss the mark by
planning for themselves and operating in a vacuum. This approach can appear straightforward and less
time consuming. But administrators cannot always assume that they inherently know what is best for
the program, clients, staff, and community. Otherwise, services may be poorly matched to clients and
underused by the community. Instead, organizations and the services that they provide need to be
congruent with the specific populations being served. Thus, clients and the community should have an
opportunity to provide input on how services are delivered and the types of services that are needed.
Culturally responsive organizational statements cannot provide a tangible framework unless supported
by community, referral, and client demographics; a needs assessment; and an implementation plan.
Mechanisms for community involvement, beginning with the development of a community participation
strategy in relevant treatment activities or in support of treatment services (e.g. barangay health
workers).
Lastly, developing culturally responsive organizational policies includes hiring and promotional
practices that support staff diversity at all levels of the organization. Increasing diversity does not
guarantee culturally responsive practices, but it is more likely that doing so will lead to broader, varied
treatment services to meet client and community needs. Organizations are less able to ignore the roles
of ethnicity and culture in the delivery of behavioral health services if staff composition at each level of
the organization reflects this diversity.
Parts of cultural competency plan
● A narrative introduction that covers community demographics and history, organizational self-
assessment and other evaluation tools, the rationale for providing culturally responsive services,
and the organization's strengths and needs for improvement in providing services that are
responsive to client cultural groups; a brief overview of current priorities, goals, and tasks to
help the organization develop and improve culturally responsive clinical services and
administrative practices is also advisable.
● The organization's mission, vision, and value statements are vitally important in creating a
conceptual framework that promotes culturally responsive behavioral health services. Agencies
should examine how these statements are developed
● Strategies for recruiting, hiring, retaining, and promoting qualified diverse staff.
● Resources and policies to support language services and culturally responsive services.
67
● Methods to enhance professional development (e.g., staff education and training, peer
consultation, clinical supervision) in culturally responsive treatment services.
● Approaches to amending facility design and operations to present a culturally congruent
atmosphere.
● Identification of and recommendations for culturally and linguistically appropriate program
materials.
● Programmatic strategies to incorporate culturally congruent clinical and ancillary treatment
services.
● Fiscal planning for funding and human resources needed for priority activities
● (e.g., training, program development, organizational infrastructure).
● Guidelines for implementation that describe roles, responsibilities, timeframes, and specific
activities for each step.
Preparations that might help when developing a cultural sensitivity and competence plan.
● Develop a thorough knowledge and understanding of the social, cultural, and historical
experiences of the community of people your agency is serving.
● Identify and clearly articulate an understanding of the ethnic, cultural, linguistic, and social
groups in the area your agency serves.
● Document, track, and evaluate/assess the reasons why clients are not accepted for services.
● Know the demographics of clients within the program and their rates of program completion.
● Keep profiles of clients who do not complete services.
● Design steps for your agency to take to remove identified barriers that keep clients from using
your agency's services.
● Establish steps your agency will implement or sustain to create a consumer-friendly
environment that reflects and respects the diversity of the clients that use your services.
● Establish internal criteria the agency will use to measure the impact of the services and
programs that it offers.
68
● Slide 2 – Session 12 objectives
● Slide 3 – Health workers and the system
● Slide 4 – Organizational cultural competence
● Slide 5 – Why is it important
● Slide 6 – What organizations must do
● Slide 7 – Organizational change and planning
● Slide 8 – Community involvement in planning
● Slide 9 – Organizational staff diversity
● Slide 10 – Parts of cultural competency plan
● Slide 11 – Parts of cultural competency plan
● Slide 12 – Preparations before planning
● Slide 13 – Preparations before planning
69
Session 13 – Organizational Sensitivity and Competency: Operational Planning
Workshop
Session Objectives
● The participants should be able to develop an organizational plan to implement and sustain
cultural sensitivity and competency at the individual and organizational level
o At the individual level, the participant should plan on how they can apply the learnings
in this workshop when they go back to their work.
o At the organizational level, MHO and PHO participants can plan how they can apply the
learnings in this workshop at the RHU or PHO level.
Description
● Slide presentation for instructions
● Planning workshop for 60 minutes
● Presentation and interactive session for 30 minutes

o Digital copy of template for organizational plan
o Brief slide presentation for instructions
o Facilitate presentation for each group
● Facilitate an interactive session with the participants during presentations
o Ask the participants for clarifications and questions
o Summarize the learning points
● Provide instructions for the subsequent activity.
70
A strategic plan discussed in the previous topic is developed by the organization that defines the
vision, goals and objectives for the cultural sensitivity and competency service. It is usually long-term i.e.
5-10 years. Operational plan on the other hand is managerial and shorter term. It deals with day-to-day
implementation and often has a one-year time horizon. It provides a framework for activities based on
the strategic plan. The operational planning process has the potential to greatly assist stakeholders in
gaining a better understanding of the target population and its needs, as well as stakeholders’ own
capabilities and limitations in implementation.
Ideally, all of those who are responsible for the activity will be involved in operational planning,
either directly or through having their interests represented by someone involved in the formal planning
process. Key stakeholders are the national, regional and local government units, health service providers
and the community they serve.
The following steps are necessary for sound operational planning:
● Conduct situational analysis (where are we now?), including identification of stakeholders (who
is involved?);
● Set strategic priorities from the strategic plan;
● Define the activities in the operational plan (what are we going to do?), including the
operational budget;
● Implementation of planned activities (how are we going to do it?);
● Monitoring and evaluation of the operational plan (what have we accomplished so far?);
● Invite program managers during planning presentation
71
Indigenous Peoples Health
Operational Plan Template
Name of CHD: ____________________________________
Name of IP Health Coordinator: ______________________
Operational Plan
Individual Level
Target Responsible Resources Amoun Source

Activity Timeframe Remarks
Output Person Needed t of Funds
Organizational Level
Activity Target Timeframe Responsible Resources Amoun Source Remarks
72
Prepared By: Noted By:
_________________________ _____________________________
Name of IP Health Worker Name of Supervisor
Date: Date:
Sample Operational Plan Template
Operational Plan
Individual Level

Apply I-LEARN Once a Weekly Midwife Pre-natal

during pre- week facility
natal
consultation
73
Organizational Level

Policy to 1 6 months MHO RHU

prioritize IPs in
consultation
● Slide 3 – Strategic plan vs. operational plan
● Slide 4 – Steps in doing operational plan
● Slide 5 – Planning template
● Slide 6 – Reporting and processing
74
Session 14 – Development of Evaluation and Monitoring Framework
Session Objectives
● To develop an organizational evaluation and monitoring plan for the implementation and
sustainability of cultural sensitivity and competent services
Description
● Planning workshop for 60 minutes
● Presentation and interactive session for 30 minutes

o Digital copy of template for evaluation and monitoring framework and sample copy of
patient or client satisfaction survey.
o Brief slide presentation for instructions
o Facilitate presentation for each group
o Facilitate an interactive session with the participants during presentations
▪ Summarize the learning points and if there is more time, ask the participants
what they can do when they go back to their health facility.
Monitoring ensures interventions are implemented as planned, identifies specific problems as

they arise, and allows continuous feedback. Monitoring primary health care interventions means using
participatory approach to methodically ensure that activities are carried out according as to achieve
objectives of the intervention. Implementers use information generated to make necessary changes for
greater effectiveness and efficiency.
Steps in developing monitoring and evaluation plan
75
● Start with constituting monitoring teams, carefully selected based on agreed criteria to ensure
competence. Ensure the team is include women, men, and when necessary youths depending
on what is being monitored.
● Establish clear objectives and indicators to facilitate monitoring. Those involved in implementing
the activities must understand objectives, indicators, expected outputs, outcomes. These should
be converted to monitoring indicators.
● The team develops monitoring plan guided by established indicators. The plan should include
what, who, how and when to gather the data that reflect the accomplishment of indicators.
● Develop structured, consistent, user-friendly tools are necessary for collecting relevant,
accurate, and timely data.
● The team monitors and submits report.
What should be monitored and evaluated, operational definition and examples
● Assess progress of the implementation of the operational plan itself. Identify achievement
against planned activities, identify gaps, and their causes. Actions are then taken to keep the
process, and activities on course.
o Example can be performance or non-performance of planned activities.
● Assess efficiency of the implementation of activities against the timeframe and the budget made
available and utilized.
o Example can be monitoring the performance of scheduled and planned activities either
in shorter period of time or lesser cost than budgeted.
● Assess effectiveness to determine immediate outputs and outcomes of the activities. For
training activities, assess the knowledge and skills gained by the participants.
o Examples and recommended are the regularly collected program indicators like
immunization rates, pre-natal check-ups and facility-based deliveries in IP communities
may also be considered. It may also be assessed in terms of satisfaction or
dissatisfaction expressed by the patients and clients.
● Assess impact after implementation to understand overall outcome of cultural sensitivity and
competency intervention on the health and social well-being of the patients and clients.
o This can be in the form of maternal and infant mortality, mortality due to communicable
and non-communicable diseases in IP communities.
● Assess sustainability to determine continuity of intervention.
o This may be done years after the implementation of the strategic and operational plans.
76
Indigenous Peoples Health
Monitoring and Evaluation Framework
Indicators Definition Target Means of Frequency Responsible

Verification
Progress
Efficiency
Effectiveness
Impact
_________________________ _____________________________
Name of IP Health Coordinator Name of Cluster Head
77
Sample Monitoring and Evaluation Framework
Indicators Definition Target Means of Frequenc Responsible

Verification y
Progress Number of Use of 5 TCL Monthly Midwife

I-LEARN ILEARN in
application maternal
care
Number of Conduct 1 Attendance, Semi- Midwife/

cultural orientation report annual Nurse
sensitivity of other documentation
orientation health s
facility staff
Efficiency Timeliness Number of 50% Attendance, Semi- Midwife/

of activities report annual Nurse
activities conducted documentation
on s
time/Numbe
r of
scheduled
78
activities
Effectivenes Increase in Percent 5% TCL, RHU Monthly Midwife/

s number of increase of Quarterl registry Nurse
IP IP y
consulting consultation
health
facility
Satisfactio Average 80% Forms, report Monthly Midwife/

n rate satisfaction Nurse
rate from IP
clients
Impact Decrease Percent Any Forms, report Monthly Midwife/

maternal decrease in decrease Nurse
mortality maternal
mortality
_________________________ _____________________________
Name of IP Health Coordinator Name of Cluster Head
Date: Date:
● Slide 3 – Monitoring and evaluation
● Slide 4 – Steps in developing monitoring and evaluation plan
● Slide 5 – What should be monitored
● Slide 6 – Evaluation and monitoring template
● Slide 7 – Reporting and processing
79
Session 15 – Summary, Declarations and Closing
Session Objectives
● To summarize the events of the past three days of training, significant learning and challenges
● To encourage the participants to apply what they have learned when they go back to work and
their organization
Description
80
● Slide presentation for summary and conclusion
● Closing remarks by key persons

o Brief slide presentation for conclusion summary
o Declaration of commitment
▪ Get an IP container motif like “banga”
▪ Ask everyone to write their commitment to cultural sensitivity and competency

health service in a post-it note.
▪ Then as the participant to declare their commitment to the group and place it in
the “banga”.
▪ The “banga” will be the symbol of cultural competency to be kept by BLHSD.
o Introduce key persons to provide closing remarks
o Bid farewell to everyone
● Slide 3 – Summary
● Slide 4 – Declaration of commitment
● Slide 5 – Closing remarks
81
References
1. Department of Health and each District Health Authority in Nova Scotia. A Cultural Competence
Guide for Primary Health Care Professionals in Nova Scotia. Health Canada’s Primary Health Care
Transition Fund, 2005.
2. Reese G. Cultural Competency and Community Development Resources. National Center for
Cultural Competence. http://gucchd.georgetown.edu/topics/cultural_linguistic_competence/
index.html.
3. Substance Abuse and Mental Health Services Administration. Improving Cultural Competence.
Treatment Improvement Protocol (TIP) Series No. 59. HHS Publication No. (SMA) 14-4849.
Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
Annexes
Pre-test and post-test question
82
1. The DOH, NCIP and DILG developed the Joint Memorandum Circular (JMC) no. 2013-01 (DOH-
NCIP-DILG JMC no. 2013-01) to:
a. Set the guidelines that will address the access, utilization, coverage and equity issues
b. Cultural sensitivity and competence are separate and not essential in this JMC
c. There is no need to make IPs utilize health service if they don’t like it.
d. All of the above are correct.
e. None of the above are correct.
2. The following statements are true about cultural sensitivity.

a. An attitude of health worker to work effectively in cross-cultural environment.
b. It is part of the Joint Memorandum Circular of DOH, NCIP and DILG
c. It is a fundamental capacity development program for health workers.
d. All of the above
e. None of the above
3. Cultural competence is defined as:

a. Obtained by participants in a certificate course given by DOH and NCIP for health
workers.
b. A set of congruent behaviors, attitudes, and policies that come to enables effective work
in cross-cultural situations.
c. Capacity of health worker to perform rituals, prescribe herbal medicines and recite
prayers for healing of disease.
d. All of the above
4. Cultural sensitivity is about

a. Addressing the client individually
b. Applying general treatment approaches
c. Making on assumptions on cultural beliefs
d. All of the above
5. Cultural competence highlights the need for health care providers to

a. Take time to build a relationship with each of their clients
b. Understand their clients
c. Assess services that will meet each client's individual needs
d. All of the above
6. Cultural sensitivity and competence must be at what level of treatment services?

a. Individual staff member level
b. Clinical or hospital level
c. Programmatic and organization level
83
d. All of the above
7. RESPECT includes the following concepts:

a. Recognize patients from their sociocultural context
b. Power between health worker and patients is equal
c. Patients are not fearful of their doctors
d. All of the above
8. To be culture sensitive, health workers should:

a. Learn how their patients’ language
b. Avoid listening to story telling
c. Understand verbal and non-verbal ways of communicating
d. All of the above
9. Health workers are also advised to do the following:

a. Make allowance for variation in health beliefs
b. Frame clinical issues with cultural references
c. Be careful in suggesting simple solution to complex problem
d. All of the above
10. I-LEARN stands for

a. I - ____________________
b. L - ____________________
c. E - ____________________
d. A - ____________________
e. R - ____________________
f. N - ____________________
84

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Cultural Sensitivity and Competency

Bureau of Local Health Systems Development

DILG Department of Interior and Local Government

DOH Department of Health

GIDA Geographically Isolated and Disadvantaged Areas

IAC Inter-Agency Committees

ICCs/IPs Indigenous Cultural Communities/Indigenous Peoples

IKSP Indigenous Knowledge Systems and Practices

IPRA Indigenous Peoples Rights Act

JMC Joint Memorandum Circular

LGU Local Government Unit

MHO Municipal Health Office

MIAC Municipal Inter-Agency Committee

NCIP National Commission on Indigenous Peoples

NIAC National Inter-Agency Committee

NSP National Strategic Plan

PHO Provincial Health Office

PIAC Provincial Inter-Agency Committee

RHU Rural Health Unit

RIAC Regional Inter-Agency Committee

SLE Structured Learning Experience

TAMA Traditional and Alternative Medicine Act

UHC/KP Universal Health Care/ Kalusugang Pangkalahatan

UNDRIP United Nations Declaration on the Rights of Indigenous Peoples

What is the Training Manual About?

Who are the Users of this Training Manual?

Structure of the Manual

● To introduce the cultural sensitivity and cultural competency training program;

● Slide presentation for 5 minutes

● Brief introduction of participants

● Ideas generation with meta-cards for 10 minutes

Preparation and Planning

● Equipment and materials needed:

▪ Tips for processing:

● Some participants will share problems with previous experience in

● Slide 1 – Culture-sensitivity and competence in health care: opening session

● Slide 2 – Session 1 Culture sensitivity in health care: setting the objectives

● Slide 3 – Session objectives

● Slide 4 – Instructions for session 1

● Slide 5 – Thank you

● Slide 6 – Culture-sensitivity and competence in health care

● Slide 8 – Purpose of education and training

● Slide 9 – Assumptions for this training to be effective

● Slide 10 – What is the training manual about

● Slide 11 – Who are the users and target of the training

● Slide 13 – Objectives of module 1

● Slide 14 – Objectives of module 2

● Slide 15 – Objectives of module 3

● Slide 16 – Thank you slide (clarification)

● Slide 17 – Title slide module 1

● Slide 18 – Objectives of module 1

● Slide 19 – Sessions of module 1

● Slide 20 – Thank you

Module 1 – Introduction to Cultural Awareness, Sensitivity and

Objectives of the Module

● Session 2 – Cultural Sensitivity in Health Care: Definitions and Concepts