Every Drop Counts: When Water Comes, Everything Changes

Water is the most basic human necessity. It is the most vital resource that affects a person’s health. At its finest, it can serve as a cure for diseases. At its worst, it causes them. These qualities therefore entail that water must be safe.

            In the Municipality of Siay, 191 cases of diarrhea were reported in 2012, of this, 129 cases came from Barangay Mirangan. Hence, diarrhea ranked 7^th in the top 10 leading causes of morbidity in Barangay Mirangan. One of the factors attributed to this is the absence of safe water supply. During the initial assessment the following reasons for the problem on lack of safe water supply are the following:

1.      Utilization of open dug wells. Sixty-three percent (63%) of the population utilize the unprotected open dug wells as a source for drinking water. According to the guidelines set by the World Health Organization “Healthy Villages”, unprotected dug wells are open to contamination and pose a potential health risk. Hence, a criterion on the ”Characteristics of low-risk water sources” which includes the following was formulated.

ü  The water source is fully enclosed or protected (capped) and no surface water can run directly into it.

ü  People do not step into the water while collecting it.

ü  Latrines are located as far away as possible from the water source and preferably not on higher ground. If there are community concerns about this, expert advice should be sought.

ü  Solid waste pits, animal excreta and other pollution sources are located as far as possible from the water source.

ü  There is no stagnant water within 5 meters of the water source.

ü  If wells are used, the collection buckets are kept clean and off the ground, or a handpump is used.

2.      Decreased number of households practicing water purification methods. The survey done last 2011, revealed that out of 292 households, 62% practice cloth filtration, 21% practice boiling and only 3% utilize chlorination.

3.      Less perceived priority project for government.  It was also noted last 2011, that there were no existing legal support and barangay ordinances regarding a viable water source.

          

           In collaboration with identified key persons from the community, the following proposed solutions were discussed in order to meet the general objective of improving the water supply from “high risk” to “low-risk” water sources based on the criteria set by the World Health Organization (WHO).

            To ensure that the water is safe, either the water supply should be protected or the water should be treated before use. Low-risk water supplies for drinking and other domestic uses can be provided to communities in many ways. Often, unprotected water sources, such as springs, traditional wells and ponds, can be improved and this may be preferable to constructing completely new supplies (WHO-Healthy Villages, 2002).

            This was the principle behind the formulation of the strategies to provide safe water. The solutions addressing the problem on lack of safe water supply were rooted in (3) three major approaches namely: Governance, Education and Improvement of Water Sources.

Governance Approach

·         Assessment of existing legal support: identification of ordinances

·         Initiation of inter-sectoral linkages: collaboration with the barangay council, municipal engineering’s office, municipal sanitary inspector, and NGO’s.

Education Approach

·         Increase awareness on water-borne diseases and its health consequences: school based teaching “Kalibanga Monster”, family development session (FDS) “Kuyaw ug Pwede Mamatay sa Kalibanga”.

·         Increase the number of households utilizing proper water purification practices: promotion of Sodium Hypochlorite (HypoSol), Solar Disinfection (SoDis) Week at Mirangan Elementary School, SoDis promotion during FDS, campaign on proper rain water harvesting.

Improvement of water sources

·         Attainment of additional funding for installation of pumps: assistance from NGO’s for financial aid and procurement of pumps, collaboration with LGU for program of works.

·         Improvement of existing water: water analysis, signing of Memorandum of Agreement, “Poso para sa Mirangan” installation of hand pumps.

            Through series of consultations and collaboration with the barangay council, Local Government Unit and Non-government Organizations, several issues were addressed; previous, existing and future plans for water development; prioritization and scope of responsibilities for each sector were discussed. Formulation of new project proposals which tackles the current status and need for a sustainable water supply were addressed as well.

Meeting with the Municipal Engineer

Meeting with Municipal Sanitary Inspector

            In line with the Governance approach which fosters political will to help improve water projects in the community, the barangay council initiated in providing funding and priority on water supply projects in their annual budget. Creation of the Mirangan Water Sanitation Association (MIRAWASA) with its legal basis was realized to provide avenue to manage and govern the existence of a water system that will ensure sustainability of water supply for its consumers in Barangay Mirangan.

MIRAWASA Board of Trustees

            People empowerment was strengthened by increasing knowledge and influencing attitude; this was the main focus of the Education approach. It was made through series of Health Education Promotion in different setting and audiences respectively.

SODIS Water Disinfection Promotion Lecture

Hyposol Water Disinfection Promotion among households of Barangay Mirangan

            Promotion of different water purification methods: Solar Disinfection (SODIS), Chlorination (HypoSol), Proper rainwater harvesting were introduced and implemented through series of health teaching during Family Development Sessions (FDS). These were attended by the majority of the residents especially mothers. In line with increasing the awareness on the prevention of water-borne disease, school based health teachings were also presented and adopted by the students and faculty of Mirangan Elementary School. Hence, ensuring safe water and eventually reducing the risk of diarrheal cases in the community.  In addition, a sustainable supply of raw material like PET bottles for SODIS and Hyposol (Chlorine Solution) was made available in local stores situated in the barangay. In effect, these interventions, yielded increase in the households practicing SoDis from 9 to 24 households, and those utilizing HypoSol from 9 to 54 households.

Households who is practicing Hyposol

Households practicing Solar Disinfection

Promotion of SODIS Week at Mirangan Elementary School

Improvement of water sources through infrastructure development, proper assessment, field surveys and planning also had a great impact in reaching its main objective of developing water sources from “high-risk” to “low-risk” based on the WHO Criteria.

Inter-sectoral linkages were upheld to mobilize the community to its full potential.  A joint effort between the different branches of the local government and several NGO’s, delivered means to provide a program of works amounting to PHP 50,000.00 worth of construction materials which paved way for the installation of seven (7) handpumps during the 4^th  quarter of 2014 and 1^st quarter of 2015. These pumps were installed in strategic locations that resulted to easy access to safe and sustainable water supply for the majority of its population that covers from 7.4% in 2012 to 89% in 2014.

Signing of the Memorandum of Agrrement on Water Projects of the Barangay Council and Local Stakeholders

Construction and Installation of Waterpumps in Purok 6B (Before and After)

Construction and Installation of Waterpumps in Purok 6A (Before and After)

Construction and Installation of Waterpumps in Purok 5 (Before and After)

Construction and Installation of Waterpumps in Purok 3B (Before and After)

Construction and Installation of Waterpumps in Purok 3A (Before and After)

Along with the institution of the MIRAWASA and its assigned personnel; routine site inspection, unit maintenance of handpumps, and warranting clean and safe water through scheduled chlorination disinfection every 3 months was upheld in Barangay Mirangan.

            Given all the results of the combined approach and effort by all sectors involved, it is rational to conclude that the interventions engaged in the achievement of the goal for this problem were all effective. The problem on lack of safe water supply in barangay Mirangan has been addressed adequately through the full involvement and passion of the community to make a Mauswagong Mirangan a reality of today.

Malnourished No More: Community-driven Strategies to Combat Malnutrition

Malnutrition continues to be a major health problem in the Philippines, which largely contribute to children’s susceptibility to diseases. Siay was also one of the municipalities with the most number of undernourished children 5 years old and below in the province of Zamboanga Sibugay, ranking 2^nd and 3^rd in the years 2011 and 2012, respectively. In one of its barangays, Barangay Mirangan, ranked 5^th among the 29 barangays with the most number of undernourished children. Almost half of the children have below normal nutritional status.

Percentage of Malnourished children over the course of 4 years

Percentage of Underweight Children

Percentage of Wasted Children

Nutritional status and the baseline data

If the weight-for-age of a child is low compared to a reference population of well nourished and healthy children, the child is classified as underweight. It is estimated that the deaths of 3.7 million children aged less than five are associated with the underweight status of the children themselves or their mothers (source: Comparative Quantification of Health Risks, 2004). Of the three growth standards, more children in Mirangan are underweight, which is mostly attributed to undernourishment – the child’s food intake does not include enough calories (energy) to meet minimum physiological needs. Thirty percent among 244 children were underweight and 12% were severely underweight in year 2011.

Stunting reflects shortness-for-age, which is an indicator of chronic malnutrition and calculated by comparing the height-for-age of a child with a reference population of well nourished and healthy children. This type of malnutrition is irreversible once the child reaches the age of 2 years old. Chronically malnourished children can lead to delayed motor development, impaired cognitive function and poor school performance. In 2011, 24% among children were stunted and 7% were severely stunted.

Wasting reflects a recent and severe process that has led to substantial weight loss, usually associated with starvation and/or disease. It is is calculated by comparing weight-for-height of a child with a reference population of well-nourished and healthy children. This form of malnutrition immediately carries the increased risk of morbidity and mortality. These children have a higher risk of dying from common diseases such as diarrhea and pneumonia than normally nourished children. In Barangay Mirangan, 17% were wasted and 11% were severely wasted.

Overall, 47% among children aged 5 years old and below were malnourished in 2011. Malnutrition is frequently part of a vicious cycle that includes poverty and disease. These three factors are interlinked in such a way that each contributes to the presence and permanence of the others (WHO). Malnutrition in children is the consequence of a range of factors, that are often related to poor food quality, insufficient food intake, and severe and repeated infectious diseases, or frequently some combinations of the three. These conditions, in turn, are closely linked to the overall standard of living and whether a population can meet its basic needs, such as access to food, housing and health care. Therefore, in order to effectively break this vicious cycle, strategies must be designed using this multi-factorial approach.

            The Team Mauswagong Mirangan 2015 formulated solutions in collaboration with the community and local agencies in order to address the problem on poor nutritional status among children under 5 years. The formulation of Sustansyang Tatak Mirangan was rooted in four (4) major approaches namely: Community Engagement and Collaboration, Education and Promotion, Growth Monitoring, and Food Security.

            Given the multi-factorial problem of malnutrition, a series of consultations and collaboration of the community was done and presented to the key persons in the barangay. A set of action plans was formulated using strategies that are appropriate for the community.    

Formulation of Sustansyang Tatak Mirangan 4-Year Health Plan

Sustansyang Tatak Mirangan 4 – Year Health Plan (March – April 2012): Evaluated and approved by the Municipal Health Officer

Sustansyang Tatak Mirangan 4 – Year Health Plan (March – April 2012): Evaluated and approved by the Provincial Nutrition Action Officer

Sustansyang Tatak Mirangan 4 – Year Health Plan (March – April 2012): Women’s Association officers identified as one of the project’s key persons

To address the lack of access to information, culturally-appropriate and socially-acceptable communication materials were developed and placed in strategic areas. Other forms of media were also used, such as broadcasting key messages on nutrition at a local radio station.

Radio guesting at Radyo Suhnan 98.7 FM with station manager, Mr. Jerry Kimos, on the importance of good nutrition.

Promotional Tools (October 2012 – February 2015): Communication materials being put up in strategic areas i.e. Sari-Sari Stores; Advocacy posters for nutrition

Health education series were also conducted to target population, namely to mothers and to schoolchildren. The different forms of education such as lectures, cooking demonstrations and role plays were used in order to effectively relay the information

Mother’s Class (2012-2014): Conducted with topics on Proper Nutrition and breastfeeding for the mothers and primary caregivers of Barangay Mirangan

Buntis Congress (Aug. 21, 2014): Discussion of nutrition in pregnancy, as well as games such as Pinoy Henyo were played by participants

Nutri-Show Part 4 (January 2015): Mrs. Mary Grace Detablan (left) conducted the cooking demonstration of: “Tortang Kangkong (Swamp Cabbage Patties) (middle).” Free samples were distributed to the attendees (right).

A certificate and cash prize was awarded to the president of the association, Mrs. Rosie Guevara

Application of Learnings (December 16, 2014): “Barangay Susta-Gulaman” served as the Mirangan Women’s Association entry during the Cooking Contest in celebration of the 58th Araw ng Siay on December 16, 2014 in its theme: “Kinaiyahan Panggaon, Sama sa Pagpangga sa Kaugalingon.” The entry won 1st place in the Dessert Category.

Performance of Gulay Fairy

Health Education on Go, Grow and Glow Foods (March 2012): Learn and play method was used wherein students were divided into teams to classify the cutout fruits and vegetables into go, grow and glow foods with a post-activity synthesis

Nutrition Month 2014 Culminating Activity (July 22, 2014): Creative performances were presented, awarding of prizes for the winners of the contests, a tiangge showcase per classroom and a salo-salo during lunch time

Promotion of Healthy Eating and Physical Activity (July 2014): Discussion of the “10 Nutritional Guidelines for Filipinos” from the National Nutrition Council (NNC) per grade level.

Poster-Making Contest (July 11, 2014): 9 participants from grades 4-6 created posters in accordance to the Nutrition Month 2014 theme: “Kalamidad Paghandaan: Gutom at Malnutrisyon Agapan”.

Quiz Bee (July 17, 2014): 31 participants from grades 4-6 wherein knowledge on nutrition topics were tested

Children’s Hour (March 2013): Educational games, lessons on nutrition and song and dance incorporating key nutrition messages done for students 5 times a week for a duration of 1 month of their summer break.

The utilization of a behavior change strategy, Trials of Improved Practice (TIPs) Methodology, was used in order to involve the mothers and caregivers in improving their feeding practices. This was done by means of home visits and counseling. Establishment of a breastfeeding station in the barangay’s local health station was also accomplished in order for the health workers to teach proper breastfeeding techniques and provide counseling to mothers. This area also provided mothers with privacy and comfort while breastfeeding their child.

Trials of Improved Practices (TIPs) Methodology on teaching mothers appropriate feeding practices for children. House to house assessment, counseling and evaluation done by BHWs and BNS on target households with 85% coverage (46 of 54 target households)

Establishment of Breastfeeding Station (January – February 2015): A breastfeeding station was created to provide privacy for mothers during breastfeeding as well as to provide an avenue for health workers to conduct counseling on breastfeeding. The room has a bed, a chair, a handwashing station and IECs on breastfeeding. Promotion of Healthy Eating and Physical Activity (July 2014): Discussion of the “10 Nutritional Guidelines for Filipinos” from the National Nutrition Council (NNC) per grade level.

Growth monitoring and updating of database is key to determine whether the strategies being implemented are effective in decreasing the malnutrition rate of the community. A nutrition data board was introduced, wherein children under 5 years old were classified according to their nutritional status and their geographical location per hamlet. This way, children can be monitored accordingly by the barangay health worker in her assigned area. The improvement of the Barangay Nutrition and provision of growth monitoring materials was also done for proper growth monitoring.

The BNS gives consultation to mothers on appropriate complementary feeding practices.

The Improvement of the Barangay Nutrition Station (BNS) (Dec. 2014 – February 2015): The BHWs utilize the weight stand and height board for proper growth monitoring

Barangay Health Worker (BHW) 3 –day Training Seminar (Dec. 2014): Lecture and Demonstration on proper anthropometric measurements, growth monitoring, record keeping and case referral done with the trainees

Database of Anthropometric Measurements (Dec. 2014 – February 2015): House-to-House height and weight measurement of children under 5 years of age conducted twice a year by the BNS and the BHWs.

Growth Monitoring Scheme – Nutrition Data Board (January – February 2015): Ms. Divine Lustria from MNAO approved the use of nutrition data board, which shows the color-coded symbols corresponding to a child’s nutritional status per hamlet. Nutrition Data Board posted at Barangay Nutrition Station. BHWs and BNS mapped per hamlet color-coded symbols corresponding to a child’s nutritional status

To ensure food security, an existing barangay ordinance on 1 backyard garden per household was strengthened by conducting house-to-house monitoring as well as health education on backyard gardening and vermicomposting. A community garden, Gulayan sa Paaralan was also created in collaboration with the identified key persons in the community.

Gulayan sa Paaralan Community Garden

Backyard Gardening Monitoring

Planting seedlings for Gulayan sa Paaralan

Some of the harvested vegetables from Gulayan sa Paaralan

Lecture on Backyard Gardening

Lecture and demonstration of vermicomposting

Mirangan Bakery

Over the course of 4 years, given the result of the combined strategic planning and efforts by all sectors involved, it is therefore rational to conclude that the interventions engaged in the achievement of the goal for this problem were all effective. The problem on poor nutritional status in Barangay Mirangan have been addressed adequately through the full involvement of the community to reach the goal of providing good nutrition for children.