PEARL S. BUCK 
INTERNATIONAL
PARTNERS FOR HEALTH
CHILD SURVIVAL PROJECT CSXIII
FY2000 - FY2003
FAO-0097-00041-00
In Ormoc and Merida, Leyte Province,
Eastern Visayas, Philippines
Final Evaluation Report, July 2003
Written by Joan M. Jennings, MPH
Edited by Hannah M. Gilk, MPH
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation June-July 2003
TABLE OF CONTENTS PAGES
A. SUMMARY
A1. OVERVIEW
A2. KEY FINDINGS
1-4
1
2
B. ASSESSMENT OF RESULTS AND IMPACT OF PROJECT
B1. SUMMARY CHART OF QUANTITATIVE RESULTS
B2. RESULTS: TECHNICAL APPROACH
B2a. Project Overview
B2b. Progress by Intervention Area
B2b1. Nutrition and Breastfeeding Promotion Intervention
B2b2. Maternal Care Intervention
B2b3. Child Spacing Intervention
B2b4. Lessons Learned
B2b5. Constraints
B2c. New Approaches and Operations Research
B2c1. The Hearth Model
B2c2. Bio-Intensive Gardening (BIG)
B3. CROSS-CUTTING APPROACHES
B3a. Community Mobilization
B3b. Communication for Behavior Change
B3c. Capacity Building Approach
B3c1. Strengthening the PVO Organization
B3c2. Strengthening the Local Partner Organizations
B3c3. Health Facilities Strengthening
B3c4. Health Worker Performance
B3d. Sustainability Strategy
4-24
4
6
6
7
7
11
13
13
14
14
14
15
16
16
17
18
20
21
22
22
24
C. PROGRAM MANAGEMENT
C1. PLANNING
C2. STAFF TRAINING
C3. SUPERVISION OF PROJECT STAFF
C4. HUMAN RESOURCES AND MANAGEMENT
C5. FINANCIAL MANAGEMENT
C6. LOGISTICS
C7. INFORMATION MANAGEMENT
C8. TECHNICAL AND ADMINISTRATIVE SUPPORT
C9. MANAGEMENT LESSONS LEARNED
26
26
26
26
27
27
28
28
28
29
D. OTHER ISSUES
E. CONCLUSIONS AND RECOMMENDATIONS
F. RESULTS HIGHLIGHT
29
29
30
ANNEXES
Annex A Final Evaluation Participants
Annex B Assessment Methodology
Annex C Persons interviewed and contacted
ACRONYMS
BCLP Basic Child Learning Package
BEOP Barangay Emergency Obstetrical Plan
BHC Barangay Health Committee
BHS Barangay Health Station
BHW Barangay Health Worker
BIG Bio-Intensive Gardening
BNS Barangay Nutrition Scholar
CS Child Survival
CSTS Child Survival Technical Support
DIP Detailed Implementation Plan
EBF Exclusive Breastfeeding
EPI Expanded Program on Immunization
FE Final Evaluation
FGD Focus Group Discussion
FHSIS Field Health Surveillance Information System
FP Family Planning
GM Growth Monitoring
HBMR Home Based Maternal Record
HNP Health and Nutrition Post
IECM Information Education Communication Motivation
IMCI Integrated Management of Childhood Illness
KAP Knowledge Attitude Practice
KPC Knowledge Practice Coverage
LGU Local Government Unit
LQAS Lot Quality Assurance Sampling
M&E Monitoring and Evaluation
MOH Ministry of Health
MSG Mother Support Group
NGO Non-Governmental Organization
PDI Positive Deviance Inquiry
PHDB Purok Health Data Board
PHN Public Health Nurse
PHO Public Health Officer
PSBI Pearl S. Buck International
RHM Rural Health Midwife
SEATS Family Planning Service Expansion and Technical Support
TA Technical Assistance
TBA Traditional Birth Attendant
TT Tetanus Toxoid
USAID United States Agency for International Development
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
1
Saying in the Philippines Region VIII, Eastern Visayas:
"The crisis of today can be laughed at tomorrow, once it is solved."
A. SUMMARY
A1. OVERVIEW
Pearl S. Buck International (PSBI) implemented a 2 year Child Survival entry planning grant from 
October 1997 to September 1999 in the Ormoc and Merida health units of Leyte Island Provincial 
Health Office, Eastern Visayas, the Philippines. This period was spent networking and coordinating 
with MOH and local government to build capacities for implementing essential child survival 
services and for monitoring and evaluating (M&E) activities. The entry period culminated in 
participatory development of a Detailed Implementation Plan for future planned activities.
In October 1999, a 4 year Child Survival Grant (CSXIII) was awarded to PSBI, for implementation 
until September 30, 2003. Review of the Detailed Implementation Plan produced suggestions that 
contributed to a revised DIP. These revisions were made to better focus activities; both in terms of 
the number of interventions and in terms of geographic coverage, and improvements were suggested 
for M&E plans.
This is the report of the final evaluation of the Partners for Health Child Survival Project. 
The project goal was "to improve the health and nutritional status of children and women through the 
strengthened capacities of families, communities, Local Government Units (LGU) and Non￾Governmental Organizations (NGO) to manage community health programs."1
 The project focused 
on three technical intervention areas:
ß Nutrition and Breastfeeding Promotion (40%)
ß Maternal Care (30%)
ß Child Spacing (30%)
Note that a chart of detailed objectives and targets can be found in section B1.
The project location focused on 48 rural communities (barangays) of the Ormoc and Merida health 
unit areas of Leyte Island (38 in Ormoc and 10 in Merida). Project beneficiaries were 21,867 
children 0 to 59 months of age, along with 12,617 women of childbearing age. Partners included 
MOH personnel, local government unit personnel and, originally, 3 local NGOs; however, the local 
NGOs gradually opted out of participating, primarily due to changes in their own geographic or 
technical area of emphasis. Participation by MOH and LGU partners was as strong as or stronger 
than expected during the life-of-the-project.
The project's approach was to build capacity at the household, community, local government, local 
health unit and health management levels. Extensive meetings with MOH and LGU personnel were 
held during the 2-year entry grant period and within the first year of this project, to update and refresh 
MOH staff capacity for implementing key child survival and maternal care interventions. Local 
Government Units in Ormoc and Merida, with health care responsibility under the on-going 
 
1
 PSBI Detailed Implementation Plan for Partners for Health Child Survival Project, June 1999.
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
2
devolved strategy for maternal and child health outreach, were active project partners involved in all 
activities, including participation in workshops on technical topics and topics such as social 
mobilization. In addition, the project provided training in leadership and health action planning for 
Community (Barangay) Councils, to strengthen their capacities in support of community health 
actions.
The project provided technical training and equipment support for existing community health 
volunteers, including approximately 95 Barangay Health Workers (BHW), 35 Barangay Nutrition 
Scholars (BNS) and 60 Traditional Birth Attendants (TBA). They were trained in the recommended 
health practices and messages for nutrition and breastfeeding, maternal care, and child spacing. They 
also received training on the formation of Mothers Support Groups, for community group health 
education through the Basic Child Learning Package, and in health action planning with community 
BarangayCouncils. All community health volunteers were provided with 3 sets of behavior change 
communication materials and flipcharts: Healthy Baby, Healthy Mother and Healthy Family. The 
project also conducted a contest for Healthy Baby, Healthy Mother and Health Family in Years 1 to 
3, with photos of winners used to create calendars, with a health message for each month, that were 
distributed to all participating families. In 5 communities each, BHWs received additional training 
for new approaches for recuperation of malnourished children (the Hearth model) or for promotion of 
bio-intensive gardening (BIG).
Basic equipment for maternal and child health care was also provided to the Barangay Health 
Stations (BHS) that provide coverage for target communities and MOH referral units. This included 
50 obstetric exam tables, 44 standing scales, 150 sphygmomanometers and stethoscopes, 30 
gooseneck lamp and Salter hanging scales (132, including those provided to community health 
volunteers). Communities distant to BHS were encouraged to construct simple Weighing Posts with 
local materials and BHWs in 36 such communities were provided with child hanging scales to use in 
conducting regular growth monitoring. In a few instances, these Weighing Posts were expanded and 
converted into outreach clinics, or Health and Nutrition Posts, for use by visiting Rural Health 
Midwives based at BHS distant to these communities. The project also translated Child Health Cards 
and Home Based Maternal Records from English into the local language and distributed 1,500 of 
each.
This final evaluation report is based upon quantitative results from a participatory LQAS survey of 
mothers’ knowledge and practices, along with a client satisfaction survey of the quality of care 
provided by Rural Health Midwives and community health volunteers (including TBAs) carried out 
by the project in May 2003, along with qualitative results from participatory field evaluation 
activities (focus group discussions and interviews of key informants) led by the author of this report 
and a local consultant in two teams of MOH and LGU local and provincial-level representatives.2
 
Results were analyzed in a participatory manner and key findings were presented to project partners. 
Further description of final evaluation methodology can be found in Annex A, B, and C.
A2. KEY FINDINGS
 
2
 Final Evaluation Team Leader Joan M. Jennings, MPH; Assistant Leader, Susan Balingit, M.D.
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
3
Of the project's eleven objectives that were assessed at baseline and final evaluation by LQAS 
and review of project monitoring information, two-thirds of these showed significant 
improvement. Among the 7 objectives showing improvement, 3 did not quite meet the target 
while 4 exceeded the targets established in the DIP. 
The technical interventions of maternal care and child spacing achieved very successful 
results. The percentage of women with children under 24 months of age, with at least 3 
documented prenatal care visits during their last pregnancy increased from 48% to 93.2% (+
4.8). Among the same sample group, women who had received at least 2 or more tetanus toxoid 
vaccinations increased from 58% to 98.5% (+ 1.8). Among women of reproductive age, the 
percentage using modern contraceptive methods increased from 25% to 66.6% (+ 7.0).
Qualitative results from final evaluation focus group discussions (FGD) were triangulated with 
quantitative LQAS results. There was concordance that mothers that were interviewed showed
the broadest and most comprehensive knowledge of recommended practices for maternal care 
and/or child spacing, compared to all technical intervention areas. Barangay Council members, 
mothers and fathers all specifically noted the inclusion of men in health education activities on 
child spacing as a key strength of the project.
LQAS found that the percentage of women who were delivered by a TBA and received quality 
post-partum care from that TBA increased from 57% to 81.8% (+ 6.5). The quality of this post￾partum advice, however, was found in FGD to be close to but not quite adequate. Conversely, 
there was no change in the percentage of women delivered by an MOH or project -trained TBA, 
among all women delivered by a TBA (90% to 84.6% + 6.2). However, FGD results 
demonstrated that the quality of care had improved tremendously, with sterile technique used in 
100% of recent deliveries. As roughly 40% of mothers in FGD had a delivery attended by a
TBA, this underscores the continued importance of technical training for TBAs.
Objectives for promotion of breastfeeding showed a mix of positive improvement (continued 
breastfeeding increased from 46% to 66.0% + 6.2; early initiation of breastfeeding, although not 
a project objective, was found to increase from 80.5% to 97.5% + 3.6) and no change (exclusive 
breastfeeding for six months, 50% to 40.4% + 4.3). Qualitative results from FGD also concurred 
with these results. Mothers cited increased knowledge of the benefits of colostrum as enabling 
them to continue and promote this traditional practice to new mothers. Positive changes in other 
traditional beliefs that could restrict the continuation of breastfeeding were also noted, along with 
increased knowledge of multiple positions for breastfeeding. Confusion still exists regarding the 
appropriate age to maintain exclusive breastfeeding, as the official MOH message and the project 
indicator changed from 4 months to 6 months during the life-of-the-project.
The two objectives for child complementary feeding revealed the poorest quantiative results. 
The percentage of children age 6 to 9 months provided with continued breastfeeding and 
introduction of solid foods showed no change (31.5% to 37.9% + 4.0). The percentage of 
mothers giving at least one food high in Vitamin A or iron to children 6 to 24 months of age 
appeared to decrease, from 85% to 45.7%. However, results from FGD were the opposite of 
quantitative results. It is considered likely that a concern expressed by supervisors of the LQAS 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
4
may have affected quantitative results -- that surveyors were not sufficiently patient for mothers 
to give multiple answers during 24 hour diet recall. 
In FGD, mothers repeatedly mentioned the benefits of giving children age 6 months or older 
"adult food". They noted the importance of adding an available source of protein, such as 
shredded dried fish, to the staple weaning food of porridge. The benefits of including local 
vegetables high in Vitamin A and/or iron also in the porridge were expressed by almost all 
mothers interviewed. Mothers’ knowledge was weaker on the importance of including sources 
of concentrated calories in the weaning diet and/or of multiple cheap options for protein sources. 
However, FGD and field visits during final evaluation found mothers’ interest in and understanding 
of growth monitoring to be a key project achievement and may be partially attributed to community 
construction of 36 Weighing Posts, which are manned by BHWs or BNSs, and provide an extension 
of community services. These posts were promoted by the project through cross-visits to other sites 
in the Philippines. In addition, the project introduced the Hearth model for community-based 
recuperation of malnourished children in 5 communities. Evaluation found this approach to have also 
contributed to a new level of knowledge by mothers regarding child growth; however, final 
evaluation findings were similar to those of a special operations research conducted in June 2002 --
that the education component is weak and not completely based on the Hearth model of analysis of 
positive deviance. In response to this finding, the person providing HQ technical backstopping to the 
project decided to prolong her stay beyond participation in final evaluation activities, in order to 
support a refresher training for project partners in the Hearth model.
Results from Client Satisfaction Surveys also conducted at final evaluation were very positive, 
showing a good level of quality care and client satisfaction with care provided by MOH Rural Health 
Midwives, Barangay Health Workers, and Traditional Birth Attendants. The only weak aspect was 
revealed to be trust in the confidentiality of interactions. Assessment of BHW, BNS and TBA 
technical knowledge of key child survival and maternal care messages conducted in focus groups 
during final evaluation qualitative activities found a strong level of technical knowledge in all 
intervention areas.
It should be noted that project MOH partners were active and enthusiastic participants in the final 
evaluation process, conducting focus group discussions with Barangay Council and/or mothers group 
members during community visits. Two days were spent in participatory analysis of FGD results, 
and the key findings of final evaluation were presented in a workshop at the conclusion, with 
attendance by all key MOH and LGU partners in positions of authority and staff management. The 
overall level of capacity-building for project partners is seen as another key achievement of this 
project, especially in the area of monitoring and evaluation techniques.
B. ASSESSMENT OF RESULTS AND IMPACT OF PROJECT
The following results are based upon the project objectives and indicators submitted with the revised 
Detailed Implementation Plan in June 1999. It should be noted that a revision of the DIP was 
requested partly in order to strengthen the monitoring and evaluation component of the proposed 
project. The project has invested considerable efforts in capacity-building for M&E activities. 
Throughout the life-of-the-project there has been continuous improvement in the use of evaluation 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
5
methods, from KPC cluster sampling to Lot Quality Assurance Sampling techniques, and in the 
reformulation of objectives and definition of the criteria for calculating these objectives. Differences 
in criteria used for indicator calculation are explained in the "Comments" section of the Summary 
Chart of Results. As much as possible, final evaluation results were either calculated identically as 
baseline indicators, or, in many cases, even stricter and more appropriate definitions of criteria were 
used. 
B1. SUMMARY CHART OF QUANTITATIVE RESULTS
Table No.1
Project Objectives Baseline FE Comments
Nutrition and Breastfeeding Promotion (40%)
1. Increase from 50% to 70% the 
percentage of children <24 mos. 
who were exclusively breastfed 
until 6 mos.
50% 40.4%
+ 4.3
NO CHANGE: Baseline was 
calculated as present practice among 
mothers of children 0 to 4 mos. of 
age; FE came from retrospective 
question for children 6 to 24 mos. as 
LQAS contained few mothers with 
children <6 mos. of age.
2. Decrease from 31% to 10% the 
percentage of mothers initiating 
solid foods to children <6 months 
of age.
31% n/a NOT ASSESSED: determined to be 
inappropriate in its focus on only 
solid food, not including liquids. 
3. Increase from 46% to 70% the 
percentage of children who are 
continuously breastfed (age 20 to 
23 mos.).
46% 66.0%
+ 6.2
IMPROVEMENT: FE numerator 
includes children age 18 to 23 mos. 
to achieve sufficient sample size.
(n/a) Percentage of mothers 
Immediately breastfeeding at 
childbirth (colostrum).
80.5% 97.5%
+ 3.6
IMPROVEMENT: Not included as 
project objective but assessed at 
baseline and FE.
Project Objectives Baseline FE Comments
4. Increase from 22% to 60% the 
percentage of children age 6 to 24 
mos. provided with appropriate 
complementary feeding. 3
31.5% 37.9%
+ 4.0
NO CHANGE: Criteria for baseline 
and FE includes:
ß continued breastfeeding
ß introduction of any solid food
Numerator includes children age 6 to 
9 mos. of age.
5. Increase from 85% to 95% the 
percentage of mothers with 
children <5 years old who gave 
85% 45.7% DECREASE. Criteria includes 
consumption of any food high in 
Vitamin A or iron among children 
 
3
 Note that objective would be better written as "the percentage of children age 6 to 9 months with 
continued breastfeeding and consumption of solid food". Note also that Baseline value had been 
reported as 22%, but this incorrectly included only children age 6 mos. within the numerator, while KPC 
survey recommendations are for age 6 to 9 months (KPC+ 2000).
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
6
children at least 2 Vitamin A / 
iron rich foods.4
age 6 to 24 mos. (Questions exist as 
to surveyor technique.)
6. Increase from 0 to 48 (100%) 
the number of communities with 
established and functional 
weighing posts.
0 32
(66.7%)
IMPROVEMENT: Criteria includes 
regular growth monitoring activities 
by community health volunteers; 
source is project monitoring data.
Project Objectives Baseline FE Comments
Promotion of Appropriate Maternal Care Practices
7. Increase from 48% to 70% the 
percentage of women who have at 
least three prenatal care visits. 
48% 93.2%
+4.8
TARGET EXCEEDED: Criteria for 
baseline included only 2 or more 
documented PNC visits, while FE 
criteria is 3 or more.
8. Increase from 58% to 75% the 
percentage of women who 
received at least 2 Tet.Tox.
58% 98.5%
+1.8
TARGET EXCEEDED: Includes 
only documented vaccination among 
those with health cards.
9. Increase from 90% to 95% the 
percentage of deliveries attended 
by a trained TBA.
90% 84.6%
+6.2
NO CHANGE: Denominator is total 
number deliveries attended by any 
TBA, trained or untrained.
10. Increase from 57% to 75% 
the percentage of women who 
receive quality post-partum care 
from a trained TBA.
57% 81.8%
+6.5
TARGET EXCEEDED: 
Denominator includes only births 
attended by trained or untrained 
TBAs. Criteria for defining 
"quality" were not included in 
survey questions baseline or FE.
11. Increase from 0 to 48 the # of 
communities with an Emergency
Obstetrical Plan.
0 47 IMPROVEMENT: Information 
from project monitoring system.
 
4
 Note that objective would be better written as "children 6 to 24 mos. of age given any food source high 
in Vitamin A or iron."
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
7
Of the project's eleven objectives that were assessed at baseline and final evaluation, two-thirds 
of these showed significant improvement. Among the 7 objectives showing improvement, 3 did 
not quite meet the target while 4 exceeded the targets established in the DIP. The most 
successful results were achieved in the technical interventions for maternal care and child 
spacing. Objectives for promotion of breastfeeding showed a mix of positive improvement 
(continued breastfeeding; early initiation of breastfeeding) and no change (exclusive 
breastfeeding). The two objectives for child complementary feeding revealed the poorest 
results (and may reflect a weakness in survey technique rather than actual results; see section 
B2b for more information).
B2. RESULTS: TECHNICAL APPROACH
B2a. PROJECT OVERVIEW
Pearl S. Buck International (PSBI) implemented a 2 year Child Survival entry planning grant
from October 1997 to September 1999 in the Ormoc and Merida health units of Leyte Island 
Provincial Health Office, Eastern Visayas, the Philippines. This period was spent networking 
and coordinating with MOH and local government to build capacities for implementing essential 
child survival services and monitoring and evaluating activities. 
In October 1999, a 4 year Child Survival Grant was awarded to PSBI, for implementation until 
September 29, 2003. A revised Detailed Implementation Plan was submitted in June of 1999. 
Revisions were made to better focus activities, both in terms of the number of interventions and 
in terms of geographic coverage.
The project goal was "to improve the health and nutritional status of children and women through the 
strengthened capacities of families, communities, Local Government Units (LGU) and Non￾Governmental Organizations (NGO) to manage community health programs."5
 The project focused 
on three technical intervention areas:
 
5
 PSBI Detailed Implementation Plan for Partners for Health Child Survival Project, June 1999.
Project Objectives Baseline FE Comments
Promotion of Child Spacing
12. Increase from 25% to 50% 
the percentage of women using 
modern contraceptive methods.
25% 66.6%
+ 7.0
TARGET EXCEEDED: Criteria 
include only modern methods such 
as condoms, pills, injection, IUD or 
sterilization.
13. Increase from 0 to 48 the 
number of Barangay Health 
Stations providing quality family 
planning service.
0 n/a NOT ASSESSED: Project 
complemented efforts of MOH and 
other projects to improve access to 
quality FP services. Health facilities 
were not assessed by this project.
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
8
ß Nutrition and Breastfeeding Promotion (40%)
ß Maternal Care (30%)
ß Child Spacing (30%)
The project location focused on 48 rural communities (baranagays) of the Ormoc and Merida health 
unit areas of Leyte Island (38 in Ormoc and 10 in Merida). Project beneficiaries were 21,867 
children 0 to 59 months of age, along with 12,617 women of childbearing age. Partners included 
MOH personnel, local government unit personnel (LGU) and, originally, 3 local NGOs; however, the 
local NGOs gradually opted out of participating, primarily due to changes in their own geographic or 
technical area of emphasis. Participation by MOH and LGU partners was as strong as or stronger 
than expected during the life-of-the-project.
The project's approach was to build capacity at the household, community, local government, local 
health unit and health management levels. Extensive meetings with MOH personnel were held 
during the 2-year entry grant period and within the first year of this project, to update and refresh 
MOH staff orientation and capacity for implementing key child survival and maternal care 
interventions. 
Local Government Units in Ormoc and Merida, with health care responsibility under the on-going 
devolved strategy for maternal and child health outreach, were active project partners involved in all 
activities, including participation in workshops on technical topics and topics such as social 
mobilization. In addition, the project provided training in leadership and health action planning for 
Community (Barangay) Councils, to strengthen their capacities in support of community health 
actions.
The project provided technical training and equipment support for existing community health 
volunteers, including approximately 95 Barangay Health Workers (BHW), 35 Barangay Nutrition 
Scholars (BNS) and 60 Traditional Birth Attendants (TBA). They were trained in the recommended 
health practices and messages for nutrition and breastfeeding, maternal care, and child spacing. They 
also received training on the formation of Mothers Support Groups, for community group health 
education through the Basic Child Learning Package, and in health action planning with community 
BarangayCouncils. All community health volunteers were provided with 3 sets of behavior change 
communication materials and flipcharts: Healthy Baby, Healthy Mother and Healthy Family. The 
project also conducted a contest for Healthy Baby, Healthy Mother and Healthy Family in Years 1 to 
3, with photos of winners used to create calendars, with a health message for each month, that were 
distributed to all participating families.
Basic equipment for maternal and child health care was also provided to the Barangay Health 
Stations (BHS) that provide coverage for target communities and MOH referral units. This included 
50 obstetric exam tables, 44 standing scales, 150 sphygmomanometers and stethoscopes, 30 
gooseneck lamp and Salter hanging scales (132, including those provided to community health 
volunteers). Communities distant to BHS were encouraged to construct simple Weighing Posts with 
local materials and BHWs in 36 such communities were provided with child hanging scales to use in 
conducting regular growth monitoring. In a few instances, these Weighing Posts were expanded and 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
9
converted into outreach clinics, or Health and Nutrition Posts, for use by visiting Rural Health 
Midwives based at BHS distant to these communities. The project also translated Child Health Cards 
and Home Based Maternal Records from English into the local language and distributed 1,500 of 
each. 
B2b. PROGRESS BY INTERVENTION AREA
B2b1. NUTRITION AND BREASTFEEDING PROMOTION INTERVENTION
In summary of the quantitative results presented in section B1: LQAS results did not show 
improvement in the indicator of exclusive breastfeeding. This concurs with results from the 
qualitative final survey. It may be partly due to confusion that remains as the official MOH 
message , as did the project indicator, from 4 mos. to 6 mos. during the first few years of the 
project. 
The project did not quite meet the target (66%) for continued breastfeeding, but significant 
improvement was found since baseline, with positive practice increasing by 20 percentage 
points. This is an important accomplishment, considering that large national studies have shown 
the median length of breastfeeding to be 13 months.6
 
Early initiation of breastfeeding (colostrum) was not included as a project objective as it was 
among the more positive findings at baseline (80%); however, it was assessed at final evaluation 
and revealed statistically significant improvement (97.5%). 
As seen in Text Box No.1, results from focus group discussions with mothers supported 
quantitative LQAS results, with a strong emphasis by mothers on the importance of colostrum 
and multiple comments supporting new techniques that enable a mother to continue 
breastfeeding. 
Text Box No.17
Open-ended question: What changes in breastfeeding practices 
have occurred due to the project?
ß New knowledge to continue support for a traditional practice -- that colostrum has 
antibodies that protect against childhood diseases.
ß New knowledge on a variety of positions for breastfeeding.
ß Rejection of traditional beliefs that breastmilk can become "old".
ß New knowledge about expressing breastmilk, to be given by spoon.
ß New knowledge on hygiene of cleaning nipples with warm water.
 
6
 National Demographic Health Survey, 1998.
7
 Note that in the Text Boxes, only those comments that were made "frequently" or "very frequently" in 
final evaluation focus group discussions are presented.
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
10
Mothers stated that early initiation of breastfeeding is a traditional practice (although it should be 
noted that the percentage increased from 80.5% to 97.5%) but were enthusiastic that their new 
knowledge of the detailed benefits of colostrum justified the validity of this practice and enabled 
them to feel capable of promoting it to new mothers. They stated that Mothers Support 
Groups, organized by a BHW or BNS leader, were an effective strategy for disseminating 
information on the benefits of breastfeeding. However, final evaluation did note that these 
groups appeared to be more general "community health education mothers groups" rather than 
groups that achieve all of the objectives for mutual support as outlined in the MSG model 
promoted by La Leche League and others.
There was also frequent mention of a traditional belief that a mother must express breastmilk and 
throw it away, if she had left the home without the child for a few hours, as the breastmilk would 
become "old". This practice could decrease a mother's ability to continue breastfeeding. 
Mothers were also enthusiastic about their new knowledge that breastmilk could be expressed 
and given to a child by spoon. Most stated that the breastmilk would be fine at room temperature 
for about "8 hours to a day". A common obstacle to continued breastfeeding up to age 24 
months is the need for many mothers to engage in temporary work, such as selling things at 
market. Expressing breastmilk for use during a mother's short-term absence can greatly assist in 
prolonging the period of 
continued breastfeeding. Mothers were also enthusiastic about their new knowledge of a variety 
of positions for breastfeeding, although they did not correlate this with a decrease in nipple 
problems or other factors.
Among the messages for breastfeeding promotion that could benefit from further strengthening 
are promotion of exclusive breastfeeding and education on the management of breastfeeding 
problems. In focus group discussions, mothers were clearly confused as to whether exclusive 
breastfeeding should be continued until 4 months of age or 6 months of age. Many mentioned
introducing soups at 4 months. Several of the younger mothers noted strong influences from in￾laws to introduce cereal-based commercial formulas at an early age and a few confidently 
recommended practices that are discouraged, such as giving liquid vitamins to babies before 6 
months of age. A few mothers mentioned problems that prevented their breastfeeding, such as 
inverted nipples, without any of the other mothers commenting on ways to prevent or manage 
such problems.
Final evaluation LQAS did not show improvement in child complementary feeding 
(introduction of solids and continued breastfeeding among children age 6 to 9 months); however, 
final evaluation qualitative results were at odds with these quantitative results. Focus group 
discussions with mothers of children age 6 to 24 months consistently revealed increased 
knowledge and report of improved practices in diversifying the diet of children and no 
resistance to the recommended practice of introducing solid foods at 6 months of age was 
detected. (See Text Box No.2 for more information.) 
Final evaluation LQAS also oddly revealed a reduction in the percentage of mothers giving 
children foods high in Vitamin A or iron. This result is also completely contrary to results from 
focus group discussions with mothers (Text Box No.2). It may unfortunately reflect a concern 
expressed by final evaluation LQAS supervisors -- that interviewers were not giving mothers 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
11
sufficient time for multiple answers during the 24 hour diet recall section of the questionnaire. 
This is considered to be the likely explanation as values were found to be lower at final 
evaluation for ALL food categories, yet there has been no dramatic change in household 
livelihood security during the life of the project.
Text Box No.2
Open ended question: What changes in child feeding practices 
have occurred due to the project?
ß New knowledge on the importance of a balanced diet.
ß New knowledge of the value of available vegetables as sources of vitamins.
ß New knowledge on the importance of feeding a child 5 times a day.
ß New knowledge that small children can "eat adult foods".
ß Strengthened knowledge on the importance of healthy snack foods.
ß Better knowledge on improved hygiene during food preparation.
ß Decreased traditional beliefs that consumption of fruit is harmful for small children.
Results from final evaluation focus group discussions on complementary feeding were consistent 
among all 10 communities visited. Responses to open-ended questions repeatedly emphasized 
that the communication and discussion of recommended complementary feeding practices had 
been a strong element of the project, and that mothers had now internalized these messages. 
FGD results revealed that mothers understand most of the key messages of the Philippines 
Nutrition Council for a balanced diet: "Rice plus Go, Grow, Glow foods ". Almost all mothers 
noted the need to have a variety of locally
available sources of complex carbohydrates in the diet, most frequently mentioning cassava and 
noodles and occasionally taro and/or bread. Most mothers mentioned the importance of 
including small amounts of shredded fish in the staple weaning diet of porridge; a few also 
mentioned eggs or meat. All mothers noted the importance of including locally available 
vegetables high in Vitamin A and iron, chopped up into the weaning porridge. In FGD, both 
older and younger mothers noted that 
they had come to agree that the 
traditional belief that fruits were 
harmful to small children was 
inappropriate. The words mothers 
used in FGD to describe their 
opinions reflected a commitment to 
recommended practices, rather than a 
"parroting" of nutrition messages.
There were two areas of 
complementary feeding knowledge found to be weak: other cheaper options for sources of 
vegetable protein, such as beans or nuts; and the importance of fats and oils as sources of 
concentrated calories among the "Go" foods. In addition, mothers in FGD did not specifically 
mention active feeding practices, nor the importance of a child having his own separate bowl of 
food.
"We have learned that you must try a variety of 
foods mixed into the porridge, until you figure out 
which the child prefers. But you must not give up 
trying to give this food again, as children's tastes 
will change day by day and it is important they learn 
to eat all vegetables. Children should eat the same 
foods as adults, but mothers must make sure the 
foods are soft and chopped up so the child can 
swallow them.
Comment by mother in Tubod, Merida
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
12
The project supported the promotion of Vitamin A supplementation for children through 
community volunteer trainings. In FGD, mothers demonstrated awareness of the importance of 
Vitamin A supplementation for children and specifically cited its importance for vision. The 
percentage of children receiving supplements was not assessed at final evaluation, as it was not 
one of the key project indicators. In interviews with MOH staff, they noted that supplies of 
Vitamin A are usually sufficient; however, MOH staff also noted frequent changes in health 
policy that determines the selection of sub-regional areas for increased emphasis in micronutrient 
campaigns and subsequent receipt of supplies.
Although the project did not meet its 
target (67% of 100%, or 32 of 48 
communities) for establishing 
Weighing Posts, a new approach for 
this area, focus group discussions 
and field visits revealed a fairly good 
quality of service available in these posts. The Weighing Posts were built by community 
BarangayCouncils with community participation. The posts are managed by community health 
volunteers, with occasional supervisory visits by local health personnel. Most of the weighing 
posts are small single rooms constructed of locally available materials. A few, over time, were 
expanded and converted into outreach clinics, or Health and Nutrition Posts, for use by visiting 
Rural Health Midwives based at health units distant to these communities. The promotion of 
regular growth monitoring through Weighing Posts is an important strategy when trying to 
reduce child malnutrition8
, as mothers must pay close attention to a child's weight for immediate 
and additional action at the point at which growth faltering occurs.
Mothers interviewed stated that BHW and/or BNS not only discuss growth monitoring results 
with them, but also have taught them how to chart their child's growth; they are able to describe a 
correct understanding of the chart and of growth trends and tendencies. Mothers' interest in and 
comprehension of growth monitoring activities was determined by final evaluation to be an 
important project accomplishment.
B2b2. MATERNAL CARE INTERVENTION
The project exceeded targets for both prenatal care indicators (99% with >TT2; 93% with 3 
or more PNC visits); this is indicative of the high degree of collaboration between the project and 
its key partner, MOH personnel, in coordination with community health volunteers. These are 
very important achievements for maternal health, especially as national statistics had shown TT2 
levels to be decreasing between 1993 and 1998, from 42% to 38%9
. 
These project achievements also reflect the importance of a Home Based Maternal Record, in 
order to better evaluate these indicators. Few mothers possessed a HBMR at baseline. The 
 
8DOH data for Ormoc in 1998: 28% mild malnutrition, 7% moderate, <1% severe; weight-for-age. 
9
 DIP 1999.
"Even if my child is below the curved line printed on 
the growth chart, the most important thing is that the 
line showing her weight each month is going up. I 
can also continue to give her extra food so that she 
can get closer and closer to the curve."
Comment by mother in Santo Niño, Ormoc
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
13
project provided not only for the distribution of HBMR, but also had these translated into the 
local dialect to promote better knowledge of maternal health care recommendations. More than 
70% of mothers were found to have HBMR in the final evaluation LQAS, while only a 
negligible number had these at baseline.
Results from focus group discussions with mothers concurred with quantitative results, finding 
the greatest positive change in knowledge to be in the technical intervention area of maternal 
health care (Text Box No.3). The greatest number of mothers expressed the most comprehensive 
knowledge of recommended prenatal care practices, among all of the technical intervention 
topics. 
Text Box No.3
Open-ended question: Why is prenatal care important? 
Frequency of comment Comment
ß Very frequent
ß Very frequent
ß Very frequent
ß Moderate frequency
ß Moderate frequency
ß Check weight
ß Check status of the fetus, including position
ß Receive tetanus toxoid vaccination
ß Check blood pressure
ß Get iron tablets
Mothers described confidence in and comfortableness with Rural Health Midwives at the local 
health unit, and a close relationship between RHM, TBAs and pregnant women. Final 
evaluation with Client Satisfaction Surveys of prenatal care by Rural Health Midwives also 
found very positive results, with good quality of care and a high level of client satisfaction (see 
section B3c4, Health Worker Performance, for more information).
Among TBAs attending childbirth, the percentage of these found to be MOH-trained TBAs 
remained similarly high between baseline and final evaluation (85-90%). However, results from 
qualitative focus group discussions found the use of appropriate practices during childbirth 
by TBAs, as reported by mothers with a TBA attended birth, to be of excellent quality in all 
cases (Text Box No.4). When mothers were questioned about TBA practices during childbirth, 
sterile techniques had been used during every childbirth attended. 
Text Box No.4
Open-ended question: (for those attended by TBA) 
What techniques were used by the TBA to protect your health 
and the baby's during childbirth? 
Frequency of comment Comment
ß Mentioned by all
ß Mentioned by all
ß Very frequent
ß Sterilize equipment
ß Wash hands or use gloves
ß Cut cord with sterilized scissors, use betadine
ß Place clean plastic sheet under lower body
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
14
ß Very frequent
ß Moderate frequency
ß Wash perineal area with warm water
At 82%, the project exceeded its target for post-partum care by trained TBAs. All mothers 
whose childbirth had been attended by a TBA had also been visited by the TBA during the post￾partum period, even though this was not a traditional practice previous to the project. Qualitative 
results (Text Box. No.5) show post-partum care to have improved in quality, though room for 
improvement remains. 
Text Box No.5
Open-ended question: (for those visited post-partum by TBA) 
What advice was given post-partum?
Frequency of comment Comment
ß Very frequent
ß Moderate frequency
ß Moderate frequency
ß Importance of breastfeeding
ß Visit health unit for Vitamin A capsule
ß Visit health unit for iron tablets
Post-partum counseling topics found to show positive results were on the importance of 
breastfeeding and the need for the mother to visit the health unit to receive Vitamin A and iron 
tablets. However, the overall quality of counseling remains weak, similar to that found at 
midterm evaluation. Counseling topics that could be strengthened include some of the most 
important elements of post-partum care, such as signs of infection for mother or baby, the 
importance of immunization for the newborn and discussion of child spacing. It should be noted 
that in final evaluation FGD with TBAs for assessment of their level of technical knowledge, all 
recommended post-partum counseling messages were mentioned by TBAs; however, FGD with 
mothers revealed the above results.
The project supported the promotion of MOH messages for iron supplementation during 
pregnancy and receipt of Vitamin A supplement post-partum. As MOH supplies of ferrous 
sulfate were inadequate, the project utilized private matching funds for the purchase of this 
micronutrient several years during the life-of-the project. Receipt of micronutrients by women 
of childbearing age was not assessed in LQAS at final evaluation. However, in FGD and 
interviews with MOH staff, supplies were said to be adequate due to the project's support.
The project came very close to meeting its target for community emergency obstetric plans. It 
should be noted that community leaders interviewed during qualitative fieldwork noted the 
infrequent need for such a plan to be a hindrance in motivating community involvement and 
therefore modified it to an emergency transportation plan for any community health problem.
B2b3. CHILD SPACING INTERVENTION
The project exceeded its target for use of modern contraceptive methods. This is indicative of 
the potential of collaborative efforts between more than one NGO and the local MOH partner. 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
15
The local MOH has been promoting child spacing and family planning techniques for many 
years previous to the project. In addition, another NGO (Marie Stoppes) provides support, 
especially for voluntary surgical sterilization. 
The PSBI project focused on complementary activities by providing support and equipment for 
the training of Rural Health Midwives in the technique of IUD insertion. In addition, the strong 
focus of the PSBI project on community mobilization also provided complementary activities for 
message dissemination and discussion for behavior change (Text Box No.6). Although an 
increased involvement of husbands and other male community members in maternal and child 
health care community activities was mentioned several times during final evaluation focus 
group discussions, it was most strongly noted during discussion of the topic of child spacing. 
Women, men and local government councils interviewed stated that this was one of the 
strengths of the PSBI project. 
Text Box No.6
Open-ended question: In regards to child spacing, 
what changes have occurred due to the project? 
ß increased access to a greater variety of methods
ß community members better-informed on types of methods
ß more involvement of husbands in community activities and personal discussions
B2b4. LESSONS LEARNED
ß Collaboration with MOH partners: Project management staff learned several important 
lessons related to partnership with other actors. First and foremost, the strong participation of 
local MOH personnel throughout the life-of-the-project validated the project's early emphasis in 
participatory planning with MOH partners and the focus on capacity-building in all project areas 
of activities. 
ß Partnership with other agencies: Although partnership with local NGOs initiated with 
exploratory discussions and participatory planning, over time it became apparent that the 
partnerships were not functional. A more structured process to detail and compare partners 
goals, objectives, key strategies and expectations would be recommended for any future PSBI 
activities. Some difficulties, however, were most likely inevitable as a few of the partners 
altered their technical or geographic area of focus during the life-of-the-project.
ß Value of technical assistance from experienced providers: PSBI sought input from NGOs 
with experience in child survival projects throughout the life-of-the-project and staff note the 
benefit this provided in strengthening capacities.
B2b5. CONSTRAINTS
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
16
ß Constraints at the Community Level: An important potential constraint mentioned by 
multiple project participants and partners during qualitative final evaluation fieldwork was that 
some of the mothers with the highest needs for health and nutrition education do not have much 
time available for these community activities as they must work outside the community. In most 
cases, this was addressed by the community health volunteers' willingness to hold activities on 
Saturdays, with compensatory time permitted for PSBI field staff. In addition, communities have 
multiple health volunteers and these volunteers also conduct home visits in the evening or on 
weekends.
Another potential constraint mentioned by project staff and partners during final evaluation 
interviews was a concern that re-elections of BarangayCouncil members would negatively 
impact the work of community health volunteers. However, final evaluation found this potential 
constraint to have had minimal to no effect to-date on community health activities. Many BHWs 
were asked about the length of time they had been active and most had extensive years of service 
that had continued during multiple changes in Council structures. Although they agreed that this 
potential constraint exists, they stated that truly active community health volunteers are valued 
by the community.
ß Constraints at the Institutional Level: Review of project Annual Reports found that project 
partners consistently mentioned budget constraints as an impediment to increasing or modifying 
supervisory activities.
B2c. NEW APPROACHES AND OPERATIONS RESEARCH
B2c1. THE HEARTH MODEL
In support of local response to child malnutrition, PSBI decided to undertake the Hearth model 
of community-based recuperative activities for malnourished children in 1 pilot barangay in 
September 2000. The Hearth model is based on the identification of child health care and 
feeding practices among "positive deviants", or well-nourished children, discovered within 
families of similar economic status within a community. An international consultant with 
experience in this model assisted in the design of the pilot intervention and accompanied project 
staff through the key steps for implementation, including inquiry into positive deviance, analysis 
of these results and determination of menus based on these results. The intervention was 
expanded to an additional 4 communities in 2001.
Operations research was conducted in June 2002, led by the HQ technical support staff member. 
The operations research activities were participatory with project partners, as another strategy for 
capacity-building. The key findings of this operations research were that, although the 
appropriate tools were available and the initial steps were followed in establishing the Hearth 
intervention, the education component was quite weak. An unexpected success, however, was in 
forging stronger bonds between mothers for community health action.
During qualitative final evaluation visits to two of the communities that implemented Hearth, 
results similar to those found during operations research were again encountered. Participants 
did not fully understand some of the key elements of the model, such as that the promoted 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
17
actions were those of local mothers in similar economic situations. The feeding 
recommendations also had not clearly been based upon the findings of the inquiry into practices 
of mothers with children that were positive deviants for nutritional status.
However, mothers that had participated revealed a good level of knowledge about growth 
monitoring, along with understanding of the growth monitoring graph on the Child Health Card. 
Increased concern and focus on their child's nutritional status and eating behaviors had clearly 
been motivated through participation in Hearth. 
Participant mothers interviewed also stated their children were no longer malnourished, although 
this could not be verified as their children were not present. Many participant mothers continued 
meeting, cooking together and feeding their children on a regular basis for almost a year after the 
initial 12 week cycle of activities. However, BHWs, BNSs, and mothers did not demonstrate a 
capacity to repeat the Hearth cycle of activities on their own. It was decided during final 
evaluation that the project would have one last refresher training for MOH partners on the Hearth 
model, and that the PSBI headquarters staff that provides technical backstopping (and was 
present for participation in final evaluation) would remain two weeks longer to provide technical 
support during the training.
B2c2. BIO-INTENSIVE GARDENING (BIG)
The initial focus of the bio-intensive gardening activities was to promote backyard food 
production, especially of locally available vegetables and fruits rich in Vitamin A and iron, 
through methods based on the use of organic fertilizer and natural insecticides and planting in 
sacks or other small containers that make up locally available refuse. Training from the 
Department of Agriculture specialists was provided in four pilot communities. These trainers 
were unavailable for future trainings, as they were busy in other areas of the country. Project 
staff assisted interested BarangayCouncils, BHWs or BNSs to replicate these activities in their 
communities. 
Over the life of the project, the bio-intensive gardening activity morphed into community interest 
in several different types of gardening activities: individual backyard gardens, communal 
gardens, and model community gardens managed by the Barangay Council and community 
health volunteers. Almost all of the communities participating in the Child Survival project had 
initiated some type of new gardening activity by Year 4 of the project.
During final evaluation fieldwork visits to 10 communities with any type of gardening activity, it 
was found that the most sustained model was that of community gardens (except for a few 
individual backyard gardens). However, all models were found to have strongly promoted the 
value and benefit of local fruits and vegetables. 
The BIG model did not focus very heavily on vegetable sources of protein, such as beans, and 
based on garden size observed, it is doubtful that the gardens were providing significant amounts 
of fruits or vegetables for family consumption. However, produce from these gardens was 
reported to be used in diversifying the diet of small children, whenever available. In a few 
instances, fathers that were interviewed noted that they were able to sell small amounts of 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
18
produce and purchase other foods for the family with the income, primarily animal sources of 
complete protein.
Many of the model gardens were also promoting local herbs used for medicinal purposes. All 
were known and still in common use among community members; evaluation consultants saw no 
potential harm in any of the herbal medicine promoted.
B3. CROSS-CUTTING APPROACHES
B3a. COMMUNITY MOBILIZATION
The project strategy for community mobilization was:
a) To increase the capacities of community health volunteers to provide maternal-child health 
education and promotion within a context in favor of behavioral change, while
b) Also strengthening collaboration and mutual support between health personnel, community 
health volunteers and community BarangayCouncils for community health actions.
More information on the capacity of community health volunteers to provide maternal-child 
health education and promotion can be found below, in section B3b, Communication for 
Behavior Change.
In terms of coordination with committees and community members, partners received technical 
training on community organization, advocacy and social mobilization. BHWs and Barangay
Council members were trained in the development of health action plans. In addition, one round 
of leadership training for BarangayCouncil members was conducted in Year 3 of the project. 
Another round is scheduled to take place during the final months of the life-of-the-project.
Final evaluation found the project approach for building the capacity of community health 
volunteers for the dissemination of maternal-child health messages to be a very effective 
approach. (See section B3b, Communication for Behavior Change, for more information.)
The approach for community mobilization through Barangay Council Health Committees was 
found to be either fairly effective in those communities with Health Committees, or ineffective 
due to the non-existence of Health Committees. Among the 10 communities visited during final 
evaluation field visits, the 5 BarangayCouncils that had active Health Committees described a 
good degree of coordination with and support for community volunteer activities and community 
health actions. This result concurs with that noted in the project's Year 3 Annual Report, in 
which approximately half of Barangay Councils are noted to be actively supporting health 
activities through Health Committees. 
During focus group discussion with Council members in those communities with active Health 
Committees, frequently mentioned comments in regards to a description of this coordination 
included:
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
19
ß The Council monitors project activities through BHW reports to the Council. 
ß The Council allocates funds, such as for transportation to trainings, in support of community 
health volunteer activities
ß The Council organized community support for construction of Weighing Posts.
ß The Council and BHWs address community health problems jointly.
ß The Council informs community members of health education activities and meetings.
ß The Council holds community meetings to discuss health problems and report on progress 
in addressing such problems.
It should be noted that BarangayCouncils coordinated support for the achievement of the 
construction of 32 Weighing Posts in the project's 48 target communities. The fact that 
Barangay Councils receive allocations from Local Government Units strengthens the likelihood 
that actions will be sustained among those Health Committees actively collaborating with 
community health volunteers at present.
The establishment of Purok Health Data Boards was a key mechanism for promoting 
community health action. PHDBs were organized by the BarangayCouncil members and 
community health volunteers and had project support. 
The use of a Purok Health Data Board (PHDB) builds upon an existing practice of having a 
community level map of key landmarks, resources and geographic boundaries posted in a central 
location. The PHDB is a map of a smaller section of a community (the Purok) and is color￾coded to reflect each household's health status in terms of appropriate water and sanitation 
practices, existence of bio-intensive garden, etc. During final evaluation field visits to 
communities, the PHDB was found to exist in at least one or more Purok in 7 of the 10 
communities visited. In FGD with the BarangayCouncils with active Health Committees, 
frequently mentioned comments on the usefulness of the PHDB included the following: 
ß Enables the community and the Council to see the health situation of the community
ß Enables the Council to monitor status by color-coding
ß Functions as a basis for decision-making by the Council
ß Aids decisions by the Council for budget allocations
ß Creates social pressure to comply with good health practices
ß Helps the community know of health dangers
It was also noted by one Barangay Council that the PHDB also functions as a guide for visitors --
especially visits by other organizations with potential resources for community projects. 
Barangay Council members interviewed during final evaluation expressed a willingness to 
sustain the PHDB through regular up-dates to the information. However, MOH personnel 
interviewed expressed doubt that the PHDB would be updated without project impetus.
Among the BarangayCouncils with active Health Committees, final evaluation FGD 
encountered multiple positive impacts and effects attributed to the project, including:
ß More regularity in health service availability
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
20
ß Less sickness in the community
ß Better information on child spacing options
ß More participation by men (husbands) in community health activities
ß Less or no malnutrition among children
ß Better relations among the community members
ß Increased community mobilization for health actions
ß Better availability of equipment for community health activities
See section B3d, Sustainability Strategy, for further discussion. 
B3b. COMMUNICATION FOR BEHAVIOR CHANGE
The project promoted "communication for behavior change" at the institutional and community 
level -- by providing training on communication for behavior change to all partners, by 
organizing participatory training based on adult learning methods for all project partners, and by 
providing Information, Education, Communication and Motivation (IECM) materials to all 
community health volunteers and Barangay Health Stations.
On a large scale, the project initially stimulated community interest in child health by having a 
Healthy Baby contest. A set of 12 winners were chosen on the basis of the number of 
recommended child health care practices followed by the mother. Winners received small 
prizes. Photos of these children, along with a key health message, were then incorporated into 
calendars distributed to all participating families in the project coverage area. This activity was 
so successful that it was adapted as a Healthy Mother Contest (Year 2) and a Healthy Family 
contest (Year 3).10 Final evaluation found project partners and community members to have had 
a very positive experience with this approach. Mothers clearly felt that "winners" were from 
their peer group, and that anyone could be a winner if they learned and implemented all of the 
recommended health care practices. MOH partners were concerned that they may not be able to 
continue to provide prizes, as they are legally prohibited from soliciting small businesses; 
however, in spite of this constraint, they were optimistic that they will find a solution and be able 
to sustain this activity that is so clearly valued by families.
On the level of one-to-one or small group counseling, the BHWs were provided with an IECM 
kit on each of 3 topics: Healthy Baby, Healthy Mother, and Healthy Family. A series of half￾page size flipcharts were packaged as a set enclosed in a carrying case. The case converts into a 
tripod-like support for the flipcharts. The flipcharts are colorful, with appropriate drawings and 
messages in the local language. Messages provide some additional technical information for 
greater depth of understanding of recommended behaviors, along with comments to stimulate 
discussion of constraints to behavior change. For larger group education activities at the 
Barangay Health Stations, the BHS were provided with large cloth flipchart versions of the 
IECM kit materials.
 
10 Year 4 was initially going to be "Healthy Community", but, being the final year of the project, it become 
a recognition of the efforts of all project partners. 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
21
Final evaluation shows the project approach to communication for behavior change to have 
been an essential element contributing to all of the project's accomplishments. Repeatedly in 
focus group discussions (FGD), mothers would mention that "now we know why" a 
recommended practice is important. Mothers clearly felt that BHWs and BNSs communicated
useful technical information to them, while Mothers Support Groups and Basic Child Learning 
Groups offered a forum for discussing constraints. Another frequent comment in FGD was that 
"now we have the knowledge to challenge some of the practices recommended by our mothers or 
in-laws". In final evaluation LQAS results, 81% of mothers sampled stated they had acquired 
information through the health network of project participants, while 63% also cited project 
posters and/or calendars as a source of health information. 
The high level of internalization by BHWs, BNSs, mothers and fathers of recommended child 
survival practices detected during final evaluation field visits supports the perception that 
positive behavior change will be sustained even after the project ends. The confidence level of 
BHWs and BNSs and their familiarity in using the IECM materials, along with the sturdy 
construction of the materials, makes it likely that community health education activities will also 
be sustained.
B3c. CAPACITY BUILDING APPROACH
The project included measurable objectives for capacity-building in the DIP. However, early 
on project staff determined that this was overly ambitious. At baseline the project focused their 
efforts on ensuring the quality of several important monitoring and evaluation elements: the KPC 
Survey, (self) Institutional Assessment, and an Equipment and Supplies Assessment. For 
monitoring purposes, the project regularly conducted participatory Lot Quality Assurance 
Sampling. At final evaluation, LQAS and a set of 4 Client Satisfaction Surveys comprised the 
quantitative inputs to final evaluation. 
Qualitative information from final evaluation focus group discussions revealed good results 
for almost all of the capacity-building objectives presented in the DIP. Each objective is 
presented below, with comments from field visits and a note on other sections of this report with 
additional relevant information. 
No.1: Increase community participation in community health assessment, planning, 
implementation, monitoring and evaluation, from 0 to 50% of families.
No.2: Increase knowledge and skills of 168 BarangayCouncil members, 50 BHWs, 35 
BNSs and 20 TBAs in community health assessment and designing community health 
programs.
The project did not achieve the target of having 50% of families participate regularly in 
community organization for health. However, through use of the Purok Health Data Board as a 
tool of BarangayCouncils and Health Committees, almost every family obtained some level of 
knowledge regarding the health status of their community and awareness of community health 
action plans. Additional information on the PHDB can be found in section B3a, Community 
Mobilization.
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
22
In regards to the second objective, the project was successful in building the capacity of 
Barangay Council members, BHWs, BNSs and TBAs. The numbers of BHWs and TBAs trained 
were higher than expected, due to improved assessment and identification of community health 
volunteers during project implementation. Approximately 100 Barangay Council members have
been trained to-date (more than 1 per community); another training was planned to occur during 
the final months of project implementation.
No.3: Increase from the current level to 25% the health resources of 10 communities.
This objective was not assessed during final evaluation. The project's Annual Report for Year 3 
notes: "34 (of 48) barangays had budgetary allocation on health but did not meet the goal of 25% 
due to low Internal Revenue Allotment provided by the LGU." Per informal discussions with 
project partners during final evaluation, it is not expected that results for Year 4 were different 
than that reported for Year 3.
No.4: Increase from 0 to 48 the number of communities with functional health 
committees.
Of the 10 communities visited during final evaluation qualitative investigation, half had active 
Health Committees. This concurs with information from the Annual Report for Year 3, in which 
half of Councils in project communities had active Health Committees. Additional information 
can be found in section B3a, Community Mobilization. 
No.5: Increase the capacity of three NGO partners in managing high quality and 
sustainable child survival programs.
The capacity of the NGO partners was not assessed at final evaluation as they were no longer 
actively participating in the project due to changes in their area of technical or geographic focus.
No.6: Increase the technical skills of city and municipal health personnel and Barangay
Health Workers in three interventions in terms of quality of care, efficiency and 
effectiveness, conduct of behavioral change communication, records keeping, analysis and 
utilization, and reaching out to missed opportunities.
Qualitative final evaluation found this objective to reflect one of the key accomplish-ments of the 
program. The positive results found in the Client Satisfaction Surveys at final evaluation, 
presented below in section B3c4 - Health Worker Performance - further support the qualitative 
finding.
B3c1. STRENGTHENING THE PVO ORGANIZATION
As this Child Survival project built upon an entry-level grant, PSBI continuously invested in 
building capacity of both local staff and partners. The technical support person from PSBI 
headquarters visited the project at least twice a year, and three times yearly at baseline, 
midterm and final in order to also participate in project evaluation activities. In fact, upon 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
23
presentation of the key findings of this final evaluation, the technical support person changed her 
plans in order to remain an additional 2 weeks to assist in a refresher training course on the 
Hearth model, to ensure transfer of capacities to local partners before the end of the project.
The technical support person from HQ also regularly participated in Child Survival activities, 
such as CORE Group meetings, researched materials available through such agencies as CSTS, 
and networked with those NGOs implementing new tools or approaches in child survival 
interventions. During the final evaluation interview, local project management staff notes that a 
continuous stream of information, tools and linkage with technical assistance was provided to 
field staff from PSBI headquarters.
The project received technical assistance from a regional resource staff member of World 
Vision for implementation and data analysis of the baseline KPC survey. Helen Keller 
International also provided assistance in developing project indicators and input into monitoring 
plans. Experienced international consultants assisted in the development of the DIP (for which 
CSTS covered the expenses), and in launching the Hearth nutrition model. 
Health Futures International, a local NGO led by a former Under-Secretary of Health for the 
Philippines, provided technical assistance in developing and field-testing the Information, 
Education, Communication and Motivation (IECM) materials for community health volunteers. 
(See section B3b, Communication for Behavior Change.) Arugaan Inc., a member of the World 
Association for Breastfeeding, provided technical assistance in establishing Mothers Support 
Groups and in providing refresher training to MOH staff and community health volunteers on 
key messages in the promotion of breastfeeding. They also conducted follow-up visits and 
refresher training at the community level. Helen Keller International provided technical 
assistance in micronutrient initiatives and a Basic Child Learning Package for community 
groups. 
PSBI not only networked in order to build their capacity for child survival project 
implementation, but also in order to share their experiences with other groups. PSBI 
Philippines sponsored a Child Survival conference among NGOs with child survival programs in 
the region. This included participation by World Vision, Catholic Relief Services, and Helen 
Keller International, among others. Participants at the conference also visited PSBI child 
survival activities in the field. A PSBI project staff member participated in a final evaluation of 
a World Vision child survival project, while CRS participated in the midterm evaluation of this 
PSBI project. PSBI staff also trained CRS to implement Hearth.
B3c2. STRENGTHENING THE LOCAL PARTNER ORGANIZATIONS
The project formed an Advisory Board, composed of Ormoc and Merida health management 
personnel, Local Government Unit leaders, representatives from Ormoc and Merida of the 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
24
Barangay Health Worker Federation and members of partnering NGOs11
. Technical Working 
Groups were also formed among these participants or others assigned, such as from the MOH 
provincial level. 
Per final evaluation interview with AdBoard representatives, and separately with project 
personnel, this strategy was described as having been highly effective for implementing the 
project in a participatory manner. MOH personnel especially noted that this ensured that all 
activities fit into their strategic plans and promoted the transfer of capacities. As an example, 
they cited participation in the design of IECM materials. 
BHW Federation representatives noted that participation in the AdBoard enabled them to 
disseminate information on the project to their members and thereby promote community 
support for the project. They also mentioned that project staff and AdBoard members had 
supported them in lobbying before Local Government bodies in favor of the stipend that is 
assigned for BHWs and allocated from funds that are provided to BarangayCouncils by the 
LGU.
The project heavily invested in technical training for MOH personnel, especially in the entry￾level period and in the first year of this project. (See information on Institutional Assessment in 
section B3c3.) In final evaluation interviews with MOH personnel from Ormoc and Merida 
health units and Provincial Health representatives, this was reported to have been a key element 
for building capacity for community-based child survival actions. 
There was also a strong focus on the provision of training on monitoring and evaluation 
techniques, such as: KPC survey; Participatory Rural Assessment; and Lot Quality Assurance 
Sampling. Project partners were able to put their new knowledge into action with practical field 
experience through their participation in all project monitoring and evaluation activities. A key 
finding of the final evaluation is the strong level of participation by MOH partners in project 
monitoring and evaluation activities.
In addition to training on technical topics, MOH partners also received training on community 
organization, advocacy and social mobilization techniques. The final evaluation found that 
partner capacity for community mobilization appeared to have been strengthened by a 
broadening of expectations for health action by community members. 
Project partners, including MOH staff and community health volunteers, also noted in final 
evaluation interviews the benefit of cross-visits to other child survival sites in the Philippines. 
This enabled them to learn from other approaches, such as Weighing Posts, in action and 
replicate these activities. The Provincial Health Officer (PHO) of Leyte also attended, with the 
PSBI CS Project Manager, a SEATS-sponsored workshop in Bangladesh on the integration of 
reproductive health activities into maternal-child health programs. Not only did the PHO find 
this beneficial, but other MOH staff also noted the feedback from this visit as useful.
 
11 Note that each of the local NGOs partners (Rural Development Institute, the Action for Development 
Foundation, and the Philippine National Red Cross Ormoc Chapter) dropped out of participating in the 
AdBoard at the time when each decided to no longer partner in the project, due to changes in their 
technical or geographic focus. No final evaluation interviews were conducted with these NGOs.
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
25
Although the MOH had a history of working with BHWs, BNSs and TBAs, the on-going 
devolution strategy has meant that there is little or no money assigned for refresher training for 
community health volunteers. Support from this project enabled all community health 
volunteers to be brought up-to-date with the most recent recommendations for appropriate 
maternal-child health practices and to receive technical training in new approaches, such as the 
Hearth model.
See key findings from client satisfaction surveys below, in section 3C4 - Health Worker 
Performance - for information on community health volunteer performance. See section B3a -
Community Mobilization - for more information on capacity-building activities with local 
community partners, the BarangayCouncils and Health Committees.
B3c3. HEALTH FACILITIES STRENGTHENING
In Year 1 of the project, MOH and LGU partners, along with PSBI staff, received training in 
Institutional Assessment, including elements of the technique for Appreciative Inquiry. MOH 
and LGU partners then conducted self-assessments, with assistance from PSBI staff. Results 
from these assessments were used to develop Institutional Development Plans. Plans for training 
of MOH staff concurred with plans in the project project and were primarily implemented as 
intended in the work plan of the DIP.
Per review of the project's Annual Reports and discussion with project management, formal 
project plans for strengthening the supervision systems of the MOH and relevant LGU partners 
never quite solidified. In Year 2, Helen Keller International was brought in to provide 
recommendations on improving monitoring systems, but these were ultimately determined by 
project partners to be too cumbersome. Later, the project’s HIS coordinator convened an M&E 
task force, which provided recommendations on improving systems and adapted existing 
supervision tools. However, this task orce did not remain extremely active. Project partners 
repeatedly noted budgetary constraint, with little or no financial support for supervision 
activities.
Project support for provision of basic equipment and supplies was based upon an Equipment
and Supplies Assessment conducted in 1999. Major findings of this assessment were that 
vaccine and contraceptive supplies were adequate while micronutrient supplements were not. 
Some CS grant matching funds were used to provide a limited supply of ferrous sulfate 
(approximately 1,000 small bottles). A limited amount of equipment was provided to Barangay 
Health Stations, primarily standing scales for monitoring maternal weight gain during pregnancy, 
and replacement blood pressure cuffs, stethoscopes and exam tables. Hanging scales for child 
weighing were provided to BHS and to those communities that had established Weighing Posts.
More than 60 Traditional Birth Attendants were provided the Unicef -established standard TBA 
Kit. Blood pressure cuffs and stethoscopes were provided to those BHWs and TBAs that 
demonstrated capacity to use these instruments correctly. All community health volunteers 
(BHW, BNS, and TBA) were provided with IECM Kits for community education. (See section 
Bcb, Communication for Behavior Change.) 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
26
B3c4. HEALTH WORKER PERFORMANCE
As another input into final evaluation activities, client satisfaction surveys were conducted with 
at least 30 respondents in each of the two project MOH areas in each of four different topic 
areas: prenatal care, family planning counseling, growth monitoring, and care by Traditional 
Birth Attendants. Results of client satisfaction survey for prenatal care and/or family planning 
counseling, as provided by MOH-salaried Rural Health Midwives, demonstrated positive results 
regarding the quality of care as perceived by clients. Highlights from these surveys include the 
following:
Prenatal Care (by Rural Health Midwives)
ß 84-89% of providers ask if client is having any problems12
ß 87-92% of clients feel provider gives the right amount of information to client
ß 95-98% of clients feel comfortable asking questions
ß 96-100% of providers discuss family planning
ß 98-100% had visual privacy during exam
ß 42-54% waited less than 15 minutes to be seen
ß ~100% state provider treated them "well" (~75%) or "very well" (~25%)
Family Planning Counseling (by Rural Health Midwives)
ß 73-87% asked if client was having any problems with method
ß 60-100% were satisfied with the advice given by the provider
ß 88-98% explained how to use the method effectively
ß 89-90% gave instructions on when to return
ß 60-86% waited less than 15 minutes to be seen
ß 94-96% received the method of their choice
ß 60% of providers encouraged simultaneous use of condoms
ß ~100% stated that provider treated them "well" (~85%) or "very well" (~15%)
The area in which results were less than desired was in regards to auditory privacy during 
prenatal exam or family planning counseling (48-60%) and belief that the provider would treat 
information as confidential (42-67%). 
Results of client satisfaction with child growth monitoring by Barangay Health Workers or 
Barangay Nutrition Scholars, assisting health personnel at local health units, was found to be 
equally positive. Highlights include:
Child Growth Monitoring (by community health volunteers)
ß 84-90% asked if child was ill or had other problems
ß 87-100% feel comfortable asking questions
 
12 Note that results were tabulated separately for the two health areas of Ormoc and Merida, for MOH 
management purposes.
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
27
ß 100% were informed of child's weight
ß 71-90% received an explanation of what child's weight means
ß 87-95% were instructed when to return
ß 92-100% received counseling on breastfeeding and/or complementary feeding
ß 100% stated that provider treated them "well" (~75%) or "very well" (~25%)
The weakest result was the above-noted 71% for explanation of what the child's weight means. 
Results of the client satisfaction survey of TBA care provision were also positive. Highlights 
include:
TBA Maternal Care
ß 70-87% ask if client is having any problems
ß 90% feel comfortable asking questions during session
ß 70-90% received information on family planning
ß ~100% stated provider treated them "well" (~75%) or "very well" (~25%)
However, it is important to note that only 17% felt that the TBA provided sufficient information 
to the client (as compared to 87-92% for prenatal care visits with Rural Health Midwives) and 
less than 15% cited "better quality of care" as a reason for choosing TBA care. The most 
frequently cited reason was "closer to home" and/or "conducts home visit" (48-53%).
Client satisfaction with the level of confidentiality provided by a TBA was similarly low as that 
for Rural Health Midwives, at 47-67%. Results for auditory privacy were equally low (52-66%), 
most likely due to the fact that the visits are conducted in the home.
Until all pregnant women have easy access to institutional health services for childbirth, it will 
continue to be important to strengthen the quality of care provided by Traditional Birth 
Attendants. These positive results from client satisfaction survey, in conjunction with the
overwhelmingly positive results for safe childbirth techniques by TBAs as found during focus 
group discussion, reveal the value of the project's investment in TBA training and involvement in 
community mobilization for maternal-child health care.
B3d. SUSTAINABILITY STRATEGY
During the project design phase and preparation of the Detailed Implementation Plan, project
partners were active participants in developing a sustainability plan. The DIP noted three levels 
of actions to achieve sustainability:
ß financial support for community health activities
ß skills transfer to partners
ß behavior change
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
28
The project objectives for capacity-building, section B3c, are directly related to the first two 
levels of sustainability. The third, behavior change, was addressed through the key objectives 
and indicators in the project monitoring and evaluation plan for technical interventions (see 
section B1). In addition, the sustainability plan included two additional objectives:
ß Trained community health volunteers continue to render service of high quality.
ß Advocates and support groups for project technical intervention areas (nutrition and 
breastfeeding, maternal health and child spacing) are organized in all communities.
During the final evaluation, individual focus group discussions were conducted in a central 
location with participation by each of the three different types of community health volunteers: 
Barangay Health Workers, Barangay Nutrition Scholars, and Traditional Birth Attendants. They 
were asked not only open-ended questions as to the effects of the project and level of 
coordination and support from non-PSBI partners, but also their knowledge of the key messages 
for technical interventions was assessed as a group. The results of two FGD with a total of 25 
BHWs can be seen in Text Box No.7:
Text Box No.7
FGD Assessment of Technical Knowledge of BHWs
Excellent Good Weak
ß General messages for child 
health
ß Recommended 
breastfeeding practices
ß Advantages of appropriate 
breastfeeding practices
ß Importance of regular
growth monitoring
ß Methods of child spacing
(CS)
ß Key benefits of CS
ß Recommended 
complementary feeding 
practices
ß Key risk factors during 
pregnancy
ß Recommended prenatal 
care practices 
ß Importance of post-partum 
visit and recommended 
counseling topics
As can be seen, the level of technical knowledge among BHWs was very high in the topics of 
general child health, breastfeeding, growth monitoring and child spacing. The level of technical 
knowledge was good in the topic of recommended complementary feeding practices, although 
some additional training could be useful. Last of all, BHW knowledge in the area of maternal 
health was weak (i.e. only half of BHWs could easily recall only half of the key practices). In 
final evaluation activities to analyze results with partners, it was noted by MOH staff that 
recommended prenatal and post-natal health practices is not a topic that is emphasized in BHW 
training.
The key area of technical knowledge assessed for Barangay Nutrition Scholars was their 
knowledge of child health messages and correct growth monitoring technique. Their level of 
knowledge of the key recommended messages for nutrition and breastfeeding and the importance 
of growth monitoring was similar to that found for BHWs. Their knowledge of the key steps 
involved in growth monitoring was excellent, from hanging the scale at eye level and calibrating, 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
29
to determining if the child is growing properly and giving nutrition counseling to the mother. 
BNS did admit that the removal of all of a child's clothing is not culturally accepted in their 
communities. They emphasized that they were careful to remove as much clothing as possible 
and especially replace any wet cloth or diaper.
The results of two FGD with a total of 17 Traditional Birth Attendants (Text Box No.8) were 
considered to be satisfactory for achieving sustainability of the strategies for the promotion of 
behavior change by women in their communities. Although the area of post-partum counseling 
is weak, it must be remembered that the total amount of information a new mother receives will 
be combined with that provided through post-partum referral to the local health unit (see positive 
results noted for client satisfaction with care by MOH staff at BHS -- Rural Health Midwives --
in section B3c4).
Text Box No.8
FGD Assessment of Technical Knowledge of TBAs
Excellent Good Weak
ß Recommended prenatal 
care practices
ß Risk factors during 
pregnancy
ß Key practices for safe and 
clean childbirth
ß Recommendations for 
mothers health during 
post-partum visits
ß Recommendations for 
child health during post￾partum visits
Although final evaluation did not verify project monitoring results showing all 48 target 
communities to have active Mothers Support Groups and/or Behavior Child Learning Groups, in 
all 10 communities visited during final evaluation field visits, self-confident and knowledgeable 
mothers and fathers that had been active participants in these groups were encountered in FGD. 
The key constraint to sustainability of project activities is likely to be the limited MOH budget 
for community health volunteer refresher training and supervisory visits.
C. PROGRAM MANAGEMENT
C1. PLANNING
The project conducted a series of participatory baseline assessments (including KPC Survey 
and Participatory Rapid Appraisal) and planning workshops based on these assessment results to 
jointly develop a Detailed Implementation Plan. Multiple representatives participated from all 
project partners groups. In final evaluation interviews with project staff and MOH and LGU 
partners, this was reported as being a key strategy for facilitating project implementation while 
building capacity for long-term sustainability of project activities.
Per final evaluation results, the DIP work plan appears to have been a bit ambitious, but the key 
elements of progress as planned for all technical intervention areas were achieved. (See section 
C3, Supervision, and C7, Information Management, for more information.) The project 
developed annual work plans and reviewed results based upon these plans. Project management 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
30
staff demonstrated flexibility in addressing any obstacles encountered during implementation 
while remaining within the goals, objectives and budget as proposed in the DIP.
C2. STAFF TRAINING
The project devoted considerable resources to organizing training and orientation activities 
for project partners. Consultants or the HQ backstop led these workshops and project field staff 
also participated in these activities as students, improving their capacities along with partners. In 
final evaluation interviews with project staff, they cited increased knowledge of the key 
messages and recommended behaviors for technical interventions, noting that their previous 
education and work experience had primarily been on community organization. MOH partners 
interviewed cited new knowledge in evaluation processes, including the KPC Survey and LQAS 
techniques. The project training plan and level of resources dedicated appears to have been 
appropriate to transfer capacities to project partners while providing skilled assistance by project 
staff throughout the life-of-the-project. (More information can be found in section B3c, Capacity 
Building Approach.)
C3. SUPERVISION OF PROJECT STAFF
In final evaluation interviews, project staff reported regular visits to the field office by 
management staff, from both the central office for PSBI in the Philippines and from PSBI 
headquarters. These supervision visits included review of project systems and reports, meetings 
with project partners, and field visits to communities. PSBI Philippines central office staff 
and/or PSBI HQ staff participated in all key project activities, such as project planning, initiation 
of new approaches, key workshops, and midterm and final evaluation.
Per review of project Annual Reports, the DIP appears to have been a bit ambitious in plans for 
making institutional changes to strengthen local MOH systems for supervision of community 
outreach. The key obstacle was a lack of funds to support visits to communities by health unit 
supervisors, as noted by MOH partners. However, per final evaluation interview, project staff 
felt MOH capacity for supportive supervision of community health activities was achieved 
through the process of accompaniment by PSBI field staff in all activities. In final evaluation 
interviews with MOH partners, achievements in the area of supervision systems were not 
specifically noted or recognized by partners.
C4. HUMAN RESOURCES AND MANAGEMENT
Pearl S. Buck International country offices have previously existing systems, policies and 
procedures for human resource management and program operations. Per final evaluation 
interview with project staff, no constraint in this area was noted.
Staff morale and working relationship appeared satisfactory, and no problems in this area 
were encountered. Staff turnover, however, had been high. By Year 4, the project had a new 
HIS Coordinator, no longer had a Coordinator for Training nor a Coordinator for Community 
Health Development, and the two field staff (Community Health Development Officers) were 
both new. These new staff, when interviewed during final evaluation, reported having received 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
31
sufficient orientation to support on-going project processes and activities; however, a lack of 
organizational memory was encountered during the final evaluation process. Documentation of 
previous processes and activities was good, but new staff did not seem thoroughly familiar with 
the content of project documentation. The Country Office supervisor and Project Manager stated 
they had considered youth and a desire to grow professionally as criteria for hiring field staff that 
would be motivated and enthusiastic about community development and health improvement. 
They consider staff turnover to have been due to a typical pattern in the Philippines of young 
professionals encountering new opportunities (all staff had left for new education or work 
opportunities). They did not feel this level of staff turnover had hindered project 
implementation, but rather felt it had increased the transfer of capacity to project partners. There 
had also been turnover of the HQ backstop in the early years of the project
No formal plans for assisting staff in finding new jobs were encountered at final evaluation. 
However, staff has informally supported each other by networking and sharing contacts and 
information on future opportunities.
C5. FINANCIAL MANAGEMENT
PSBI follows approved accounting procedures and standards, as mandated by the Child 
Survival Grant Program. The field office is responsible for basic documentation and accounting 
of project expenditures and for submission of regular financial reports to the Country Office. 
These financial reports are reviewed at the Country Office level, before being forwarded to PSBI 
headquarters. At PSBI HQ, a final review is conducted.
The project appears to have budgeted adequate resources and to have essentially remained 
within the budget as planned. The project anticipated the potential for approximately US$50,000 
in unspent funds and explored the possibilities for a no-cost extension. This was determined by 
PSBI HQ to be an inefficient use of resources, and the project has since planned for the 
disbursement of these funds during the final quarter of project implementation. Plans for the use 
of these funds include increasing the number of partner training workshops planned for the final 
quarter, increasing project activities for documentation of processes and experiences, and 
supporting partners with the purchase of a limited amount of essential equipment. During final 
evaluation, it was recommended that the project replace those child weighing scales provided to 
community health volunteers that were not the recommended brand (Salter) and were damaged 
at present. It was suggested these might be available through the Unicef office in Manila.
C6. LOGISTICS
Project management at the field level did not report any obstacles to project implementation 
based upon logistics. The level of resources dedicated to logistics appears adequate and 
extremely cost-efficient. For example, the project has no assigned vehicles, but rather all staff 
rely upon public transportation. Field staff interviewed during final evaluation state that there is 
sufficient and multiple public transportation options available for visiting any project community 
and returning within the same day. This was confirmed by observation during final evaluation 
field visits.
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
32
C7. INFORMATION MANAGEMENT
One of the key positive results found at final evaluation is the level of effort the project 
invested in developing partner capacity for using recognized evaluation techniques, including 
the KPC Survey at baseline and Lot Quality Assurance Sampling annually, and basing 
decisions upon assessment results. Several people in key positions within each of the partner 
units participated in every step of project evaluation activities, including analysis and discussion 
of key findings. This was documented in baseline, midterm and annual evaluation reports, and 
observed first-hand during final evaluation. Between 8 and 10 personnel from MOH 
management and supervision at the area and provincial level not only participated in conducting 
focus group discussions during daily visits to 10 communities, but also participated in two full￾day sessions to tabulate and analyze results of qualitative final evaluation.
Beyond the project and partners, project management staff have been active participants in a 
collaborative group of PVOs with child survival projects in the Philippines. They have shared 
evaluation results and also invited and received participation by other PVO staff in project 
evaluation activities.
At the community level, development and analysis of the Purok Health Data Board was the 
key health information management strategy utilized by the project. Final evaluation found the 
effectiveness of this strategy to vary from strong to weak, depending on each community's 
individual idiosyncrasies (see section B3a, Community Mobilization, for more information). In 
communities with good use of this technique, community council leaders specifically cited this 
information as a basis for council allocation of resources on an annual basis.
At one point, the project intended to invest significant effort into adapting and improving the 
MOH computerized Field Health Surveillance Information System (FHSIS). Several 
computers were provided, technical assistance was obtained, and potential modifications were 
discussed. However, in the end, agreement among all partners and the project could not be 
achieved. The productive outcome of this activity was that the local coordinators of the FHSIS 
system did agree to and provide the project with annual information disaggregated at the 
community level.
The project provided for the translation of a Child Health Card and Home Based Maternal 
Record into the local language, along with replication and distribution of the cards (1,500 each) 
within the project area.
C8. TECHNICAL AND ADMINISTRATIVE SUPPORT
Final evaluation interviews with project management and field staff revealed a more than 
adequate degree of timely and appropriate technical assistance and administrative support. 
(See section B3c1, Strengthening the PVO Organization, for more information.) In a few 
instances, significant modifications were made to the technical assistance received. For 
example, the training plan for Mothers Support Groups developed by Arugaan, Inc., was altered 
to reduce and concentrate the focus on breastfeeding topics. In another instance, a plan for 
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
33
modifying MOH monitoring and supervision systems developed with the assistance of Helen 
Keller International was also altered by project partners. This effort might have been better 
invested in more pre-planning and collaboration between technical assistance providers and the 
project and partners.
Per final evaluation interview, project staff would have requested, upon looking back at the early 
development of the project plan, assistance in a few areas. They would have benefited from an 
experienced international consultant on the entire process of determining project objectives 
and defining criteria for calculating the indicators of success in meeting such objectives. 
Assistance on designing survey questionnaires and tabulating these results indicators would also 
have been useful. 
C9. MANAGEMENT LESSONS LEARNED
Project management did not report any lessons learned in this area; however, it is suggested that 
more analysis be given to criteria for hiring field staff for any future projects. Back-up plans to 
ensure the transfer of organizational memory to new staff could be developed, if high turnover is 
considered to be unavoidable in order to attain the level of technical skill and individual 
enthusiasm appropriate for a community development project.
D. OTHER ISSUES
No other issues were identified by the final evaluation team.
E. CONCLUSIONS AND RECOMMENDATIONS
Final evaluation shows the project to have achieved excellent to satisfactory results in the 
technical intervention areas of nutrition and breastfeeding promotion, maternal health care and 
child spacing. A key accomplishment has been the transfer of capacity to project partners at all 
levels. Among new approaches of the project, the establishment of Weighing Posts in 
communities distant to health units appears to have been the most successful. 
Project MOH partners were active participants in the final evaluation process, not only 
conducting focus group discussions but also analyzing results. MOH and LGU representatives 
and key staff attended a presentation of final evaluation findings, and recommendations 
regarding a few specific technical message areas that could benefit from further strengthening 
were shared.
In conclusion in regards to project management, overall systems and procedures appear more 
than adequate. The only recommendation for PSBI to consider internally when developing 
future maternal-child health projects would be in relation to the criteria for selection of field staff 
and backup plans for staff turnover. It is also possible that additional HQ support or review of 
procurement plans for key equipment would avoid the purchase of non-recommended brands of 
such items as child weighing scales.
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
34
Although it is difficult to tell if any different procedure would have given different results in 
terms of partnering with local NGOs, it might be useful for PSBI to promote the use of available 
tools for analyzing concordance between potential NGO partners in detail.
Pearl S. Buck International Partners for Health Child Survival Project
CSXIII FY2000 - 2003; Final Evaluation July 2003
35
F. RESULTS HIGHLIGHT13
In the Ormoc and Merida area of Leyte Island in the Philippines, the Partners for Health Child 
Survival project implemented by Pearl S. Buck International found that at least 40% of 
childbirths are attended by Traditional Birth Attendants (TBA). This is not due to a lack of 
confidence in the formal health care system. Client satisfaction surveys at final evaluation found 
more than 90% of respondents to rate the level of maternal health care provided by Rural Health 
Midwives as "good" or "excellent". The main reason given by respondents for preferring a TBA 
to attend the birth of their child was "closeness to home". Although there are fairly extensive 
road systems and available public transportation in this region, it is understandable that a woman 
in labor might hesitate to spend an hour on a very bumpy dirt road, in order to reach accessible 
services.
In discussion of baseline survey results and analysis of the causes of maternal mortality in the 
region, which is at least 180 per 100,000 births or higher (due to under-reporting), the PSBI 
project partners decided that support for MOH training, refresher trainings and equipment kits
for local TBAs would be one of the key project activities. In final evaluation focus group 
interviews in 8 diversely located communities with over 25 mothers whose recent childbirth had 
been attended by TBAs, every single mother interviewed stated that the TBA attending their 
birth had used all of the key techniques for preventing infection during childbirth. These 
include sterilizing instruments, washing hands with special attention to clipping and cleaning 
fingernails, and use of sterile instruments to cut the umbilical cord. 
This level of achievement (100%!) exceeded project expectations. This result, in combination 
with other very positive results for maternal health care found at final evaluation (including an 
increase in the percentage of recently pregnant women with at least two or more recorded 
vaccinations with tetanus toxoid, from 58% to 98.5%), has contributed to the project goal to 
reduce maternal mortality for the 12,617 women of childbearing age in the project target area -- a 
benefit also for their 21,867 small children ages 0 to 59 months.
 
13 Note that this is submitted in the final report as a separate tear-away page.
Annex A
Participants in Final Evaluation
Pearl S. Buck International Child Survival Project FY2000-2003, Philippines
A. Consultants:
ß Joan M. Jennings, MPH; Team Leader
ß Susan Balingit, MD; Assistant Team Leader
B. Pearl S. Buck International Headquarters:
ß Hannah Gilk, MPH; Health Programming Specialist
C. Project Partners:
Region VIII, Department of Health, Center for Health Development
ß Ms. C. Singco, Nurse Coordinator for Breastfeeding
ß Ms. F. Modesto, Nurse Coordinator for Family Planning and E.P.I.
ß Dr. N. Navales, DOH representative assigned to Ormoc City Health Office
ß Dr. C. Sabulao, Coordinator for Maternal and Child Health
Leyte Provincial Health Office
ß Ms. G. Pijo, Nurse Coordinator for Family Planning and E.P.I.
ß Ms. V. Fernandez, Nurse Coordinator for Women's Health and Safe Motherhood
ß Ms. C. Panao, Coordinator for Nutrition
Ormoc City Health Office
ß Dr. R. Marson, MPH, City Health Officer II
ß Dr. V. Espina, MPH, City Health Officer I
ß Dr. M. Lampong, Medical Officer III
ß Ms. N. Adolfo, Nurse Supervisor and EPI Coordinator
ß Ms. E. Romero, Nurse Coordinator for Family Planning
ß Ms. L. Calipayan, Nurse Coordinator for Barangay Health Workers and TBAs
ß Ms. R. Nastor, Coordinator for Nutrition
Merida Rural Health Unit
ß Dr. J. Solana, Municipal Health Officer
ß Ms. D. Panares, Nurse Supervisor
ß Ms. T. Sosmena, Rural Health Midwife
Local Government Unit
ß Dr. R. Omega, City Councilor of Ormoc
ß Ms. D. Corbo, City Planning and Development Office
ß Ms. N. Cubilla, Municipal Nutrition Action Officer
Community Partners
ß Ms. R. Caraca, President of the BHW Federation of Ormoc City
ß Ms. A. Lubaton, President of the BHW Federation of Merida Municipality
i
Annex B
Final Evaluation Methodology
Pearl S. Buck International Child Survival Project FY2000-2003, Philippines
A. Activities conducted by project staff and partners from May to June 2003
1. 3 LQAS surveys in 4 lots of 24 mothers each (total = 96):
ß Breastfeeding and Nutrition
ß Maternal Care
ß Child Spacing
2. 3 Client Satisfaction Surveys with an average of 100 mothers in each of two MOH health 
geographic units:
ß Quality of care for Family Planning provided by Rural Health Midwives
ß Quality of care for Growth Monitoring by Barangay Health Workers
ß Quality of care for Maternal Health provided by Traditional Birth Attendants
B. Activities conducted by final evaluation team, June 30 to July 11, 2003
1. Focus group discussion in 10 communities:
ß With 6 mothers participating in project activities
ß With 6 fathers participating in project activities
ß With 3 to 5 members of community local government
C. Activities conducted by final evaluation consultants, June-July, 2003
1. Review of project documents:
ß Project Detailed Implementation Plan
ß Project Annual Reports
ß Midterm Evaluation Report
ß Operations Research on the Hearth Model
2. Review of LQAS and Client Satisfaction Survey results
3. Review of project BCC materials:
ß Healthy Baby and Healthy Mother Calendars
ß Community health volunteer kits: Healthy Baby, Healthy Mother, Healthy Family
ß Flipcharts provided to health units: Healthy Baby, Healthy Mother, Healthy Family
4. Focus group discussions with community health volunteers in two groups each:
ß 33 Barangay Health Workers from 25 communities
ß 17 Traditional Birth Attendants from 15 communities
ß 14 Barangay Nutrition Scholars from 14 communities
5. Interviews with key informants (see Annex C)
ii
Final Evaluation Focus Group Discussion Guides
NUTRITION: BREASTFEEDING AND COMPLEMENTARY FEEDING
Date: __________________________ Community: _____________________
No. Participants: ______ Project role: ________________________________
(Females ______ Males ________) ________________________________
Materials: Toy baby doll; Poster of Child about 1 year old; tape or tacks for poster.
Introduction: The ............local name...........project is ending and this evaluation hopes to find 
out what elements of the project have been most useful for community members, providing 
benefits for the health and nutrition status of women and small children.
Participatory Techniques: Conduct icebreaker for participant introductions.
Assessment of Knowledge, Attitudes and Practices of BREASTFEEDING: 
Moderator: Use a toy doll to stimulate participation, by passing the Doll from mother to mother. 
Explain that you would like 3 mothers to participate and ask for or select volunteers. Explain 
that you will tell each mother what age her child is, and then she should tell the group:
ß what the child's name is
ß when she began to breastfeed this child and whether she continues 
ß why she (does or doesn't) breastfeed the child
ß what other foods or drinks she gives to this child
ß why or why not she gives other foods or drinks to this child
MOTHER #1: (...........NAME........) AGE OF CHILD = 4 MONTHS 
When began BF: ______________ Continues? Yes____ or No _____
Why or not BF: _______________________________________________________
Other liquids or foods: _________________________________________________
Why other foods: _____________________________________________________
MOTHER #2: AGE OF CHILD = 6 MONTHS
iii
When began BF: ______________ Continues? Yes____ or No _____
Benefit of BF: _______________________________________________________
Other liquids or foods: ________________________________________________
Benefit liquids or foods: _______________________________________________
MOTHER #3: AGE OF CHILD = ABOUT 18 MONTHS, OR 1-1/2 YEARS 
OLD
When began BF: ______________ Continues? Yes____ or No _____
Benefit of BF: _______________________________________________________
Other liquids or foods: ________________________________________________
Benefit liquids or foods: _______________________________________________
Assessment of KAP of COMPLEMENTARY FEEDING: 
Moderator: Display a poster with a picture of a child approximately 1 year old. Ask the 
following questions and uses methods to promote participation by many mothers. 
Repeat each question for TWO DIFFERENT MOTHERS. 
1. WHAT FOODS WOULD YOU GIVE THIS CHILD FOR BREAKFAST? 
WHY?
a. FOOD: _____________________ WHY: _________________________
FOOD: _____________________ WHY: _________________________
FOOD: _____________________ WHY: _________________________
b. FOOD: _____________________ WHY: _________________________
FOOD: _____________________ WHY: _________________________
FOOD: _____________________ WHY: _________________________
iv
2. HOW MANY TIMES EACH DAY WOULD YOU FEED THIS CHILD? 
WHY?
a. # TIMES: _______ WHY: __________________________
b. # TIMES: _______ WHY: __________________________
3. WHAT WOULD YOU GIVE THIS CHILD BETWEEN MEALS 
(SNACKS)? WHY?
a. FOOD: _____________________ WHY: _________________________
FOOD: _____________________ WHY: _________________________
b. FOOD: _____________________ WHY: _________________________
FOOD: _____________________ WHY: _________________________
Discussion of NEW KAP: Focus Group discussion, open to all participants. Moderator asks the 
following questions:
ß Since this project started, have there been any changes in the typical BREASTFEEDING 
practices of mothers in ..........name of barangay...........?
NOTE CHANGES MENTIONED BY MOTHERS:
1. __________________________________________________________________
2. __________________________________________________________________
3. __________________________________________________________________
4. __________________________________________________________________
ß Since this project started, have there been any change in the typical COMPLEMENTARY 
FEEDING practices of mothers in .......name of barangay......?
5. __________________________________________________________________
v
6. __________________________________________________________________
7. __________________________________________________________________
8. __________________________________________________________________
ß What influenced these changes to occur? (Look for influence of BHW, local health staff, 
radio or other media campaigns, Mothers Support Groups.)
How did (?) influence practices? (For example, was trust in the message established? How? Did 
discussion promote messages? By groups? Family? Other?
What was the opinion of “others of influence", such as husbands, mothers-in-law, etc.?
Influence: _________________ How: ______________________________
Influence: _________________ How: ______________________________
Influence: _________________ How: ______________________________
Impact and Sustainability: Use of the DEBATE technique. Moderator divides the group in half 
and assigns one group to the POSITIVE side and one to the NEGATIVE side. They are asked to 
debate, in turns, the following question. KEEP TRACK OF TIME and limit debate to FIVE 
MINUTES.
QUESTION: When the project ends, will the positive changes that have occurred in CHILD 
FEEDING PRACTICES for the health of mothers and children in your community continue on? 
How and why?
YES NO
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
CONCLUSION: Moderator explains that the Focus Group session is about to close with two 
final questions.
1. In your opinion, what has been the BEST or MOST IMPORTANT part of the project?
vi
2. Are there any other comments?
THANK THE PARTICIPANTS
AND ANSWER ANY FINAL QUESTIONS.
vii
MATERNAL CARE AND CHILD SPACING
Date: __________________________ Community: _____________________
No. Participants: ______ Project role: ________________________________
(Females ______ Males ________) ________________________________
Introduction: The ............local name...........project is ending and this evaluation hopes to find 
out what elements of the project have been most useful for community members, providing 
benefits for the health and nutrition status of women and small children.
Participatory Techniques: Conduct icebreaker for participant introductions.
Assessment of KAP of ANTE-NATAL CARE: 
1. Why do pregnant mothers go to Rural Health Midwife for Ante-Natal Care (also include 
question on Tetanus Toxoid if not mentioned)?
2. Why not?
POST-NATAL CARE
WHY ANTE-NATAL CARE? WHY NOT?
1.________________________________
2.________________________________
3.________________________________
4._________________________________
1.________________________________
2.________________________________
3.________________________________
4._________________________________
Assessment of KAP of CHILDBIRTH AND POST-NATAL CARE: 
TECHNIQUE:
TWO QUESTIONS to whole focus group
TECHNIQUE: 
GUIDED STORY TECHNIQUE to discuss recent CHILDBIRTH and 
POST-NATAL CARE in the family.
Ask for 3 people to participate and guide them with the following questions
viii
Experience Number 1:
Age of mother: ________ Number of pregnancies: ______
Age of youngest child: _______ Attended by TBA alone or with RHM? ________
ß What did TBA do to make sure there was good HYGIENE during childbirth?
_____________________________________________________________________
_____________________________________________________________________
ß Did anyone give you advice about what to do within a month to six week after childbirth 
(POST-PARTUM) for:
ß Good health for MOTHER?
ß Good health for BABY?
HEALTH FOR MOTHER HEALTH FOR BABY
1._________________________________
2._________________________________
3._________________________________
4._________________________________
1._________________________________
2._________________________________
3._________________________________
4._________________________________
ß Did you follow advice? Why or why not?
_____________________________________________________________________
_____________________________________________________________________
Experience Number 2:
Age of mother: ________ Number of pregnancies: ______
Age of youngest child: _______ Attended by TBA alone or with RHM? ________
ß What did TBA do to make sure there was good HYGIENE during childbirth?
_____________________________________________________________________
ix
_____________________________________________________________________
ß Did anyone give you advice about what to do within a month to six weeks after childbirth 
(POST-PARTUM) for:
ß Good health for MOTHER
ß Good health for BABY
HEALTH FOR MOTHER HEALTH FOR BABY
1._________________________________
2._________________________________
3._________________________________
4._________________________________
1._________________________________
2._________________________________
3._________________________________
4._________________________________
ß Did you follow advice? Why or why not?
_____________________________________________________________________
Experience Number 3:
Age of mother: ________ Number of pregnancies: ______
Age of youngest child: _______ Attended by TBA alone or with RHM? ________
ß What did TBA do to make sure there was good HYGIENE during childbirth?
_____________________________________________________________________
_____________________________________________________________________
ß Did anyone give advice POST-PARTUM for good health for:
HEALTH FOR MOTHER HEALTH FOR BABY
1._________________________________
2._________________________________
3._________________________________
4._________________________________
1._________________________________
2._________________________________
3._________________________________
4._________________________________
ß Did you follow advice? Why or why not?
_____________________________________________________________________
x
Assessment of KAP of CHILD SPACING: 
THE BENEFITS OF CHILD SPACING
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
Discussion of NEW KAP: Focus Group discussion, open to all participants. 
ß Since this project started, have there been any changes in the typical ANTENATAL, OR 
CHILDBIRTH OR POST NATAL practices of mothers in ..........name of barangay...........?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
ß WHO influenced these changes to occur? HOW? (Look for influence of BHW, local health 
staff, radio or other media campaigns, Mothers Support Groups.)
Influence: _________________ How: ______________________________
Influence: _________________ How: ______________________________
ß Since this project started, have there been any changes in the typical CHILD SPACING
practices of mothers in .......name of barangay......?
____________________________________________________________________
____________________________________________________________________
TECHNIQUE:
Uses of the HOT POTATO TECHNIQUE until ALL participants 
have given at least one comment on:
xi
____________________________________________________________________
ß What influenced these changes to occur? (Look for influence of BHW, local health staff, 
radio or other media campaigns, Mothers Support Groups.)
ß How did (?) influence practices? (For example, was trust in the message established? How? 
Did discussion promote messages? by groups? Family? Other? What was the opinion of 
“others of influence", such as husbands, mothers-in-law, etc.?
Influence: _________________ How: ______________________________
Influence: _________________ How: ______________________________
Influence: _________________ How: ______________________________
SUSTAINABILITY: 
QUESTION: When the project ends, HOW will the positive changes that have occurred in 
MATERNAL CARE AND CHILD SPACING PRACTICES for the health of mothers and 
children in your community continue on? 
1. __________________________________________________________________
2. __________________________________________________________________
3. __________________________________________________________________
4. __________________________________________________________________
CONCLUSION: Moderator explains that the Focus Group session is about to close with two 
final questions.
1. In your opinion, what has been the BEST or MOST IMPORTANT part of the project?
2. Are there any other comments?
THANK THE PARTICIPANTS 
FOCUS GROUP QUESTION:
Ask ONE QUESTION to the whole focus group.
xii
AND ANSWER ANY FINAL QUESTIONS.
xiii
BARANGAY HEALTH WORKERS FOCUS GROUP
Date: _____________ Facilitator:________________ (circle) Merida or Ormoc 
TOTAL PARTICIPANTS: _____ BHW (Female _____ Male _____ )
Barangays Represented: ______________________________________________
GENERAL
1. Who have you received training from? How many times? When? What were the topics?
(WHO, # TIMES, WHEN, TOPICS)
2. Do you feel you have received sufficient training to provide care to your community or do 
you need more training? 
3. What was good about the training you received?
4. What could be improved about the training you received?
5. Please describe your responsibilities as a (Barangay Health Worker, TBA, other):
6. Do you have all the supplies and materials you need to fulfill your responsibilities? What do 
you have? Where do supplies come from? What is missing?
7. What is the attitude of people in your community towards what you do and the good health 
practices you promote? Do they support you? Is your work difficult or easy?
Technical Information
1. What messages do you promote for good health in general for children <2 years old?
q Complete immunization
q Good hygiene
q Breastfeeding
q Good nutrition (Vitamin A and iron)
q Growth monitoring
q Complementary feeding
q Other: (note)____________________________
2. What are the recommended practices for breastfeeding?
q Immediately after birth (colostrum)
q Exclusive until 6 months of age
q Continued until 24 months of age
q Frequent breastfeeding throughout the day
q On demand breastfeeding
xiv
3. What are the advantages of appropriate breastfeeding for mothers and children? 
q Natural immunity for baby
q "Breast is best", contains best nutrients for growth
q Immediate breastfeeding helps to expel the placenta
q Exclusive breastfeeding until 6 months old reduces illness from contamination
q Other: (note)____________________________
4. What feeding practices are recommended after a child is 6 months old?
q Always give breast-milk 
q Frequent feedings 3-5 times/day
q Child has own bowl
q Good hygiene in food preparation
q Give foods rich in vitamins and micronutrients (Go, Grow, Glow) (EXAMPLES)
ß Food:______________________ Nutrient: _____________
ß Food:______________________ Nutrient: _____________
ß Food:______________________ Nutrient: _____________
5. What is the importance of regular weighing and monitoring of a child's growth?
q Identify any problems in growth early
q Opportunity to give nutrition advice to mothers
q Can detect a child with illness and refer for treatment
q Other (note): ______________________________
6. What are the key risk factors for a pregnant woman?
q Age (younger than 20, older than 40)
q Less than 2 years since last childbirth
q Greater than ______ total number of childbirths
q Headache
q Dizziness or short of breath
q Unusual bleeding
q Pale in color (inner eyelid)
q Swollen feet or hands
q Fever 
7. What prenatal care practices are recommended for pregnant women?
q Immunization with at least two doses of Tetanus Toxoid
q At least 3 prenatal care visits (or 1 per trimester)
q Good nutrition
q Taking iron and folic acid supplements as recommended
q Decreased work load in the final months of pregnancy
xv
8. What methods of family planning are available for spacing the birth of children, and where 
can you get these?
q Abstinence or rhythm method
q Standard Days Method (SDM)
q Lactational amenorrhea method (LAM)
q Condoms
q Pill
q Injections (depoprovera)
q IUD
q Tubal ligation
q Other (note): _________________
9. Why should a mother and baby have an exam during the month after childbirth?
q Check mother for infection
q Check that mother has no problems breastfeeding
q Give baby first immunization
q Check health and growth of baby
q Other (note): ________________________________________
10. What are the key benefits of spacing childbirth?
q Better health for the mother
q Better health for the baby
q Less chance of low birth weight of baby
q Easier economic situation for family
q Other (note): ________________________
Sustainability
1. What is your link with the Barangay Health Station/Center? How often do you have 
meetings? When was the last time health personnel supervised your work within your 
community? Do you feel you are supported by the health office? 
2. Do you receive any support or collaboration from other groups (community or Local 
Government Unit, etc.)? Who? How?
3. When this project finished, will the activities of the BHWs continue? Why or how?
4. When this project finishes, what will be the difficulties to continue your work? 
5. In your opinion, what was the best part of the project?
6. In your opinion, what part of the project could have used more emphasis?
7. Do you have any final suggestions for the project or for the project partners? 
xvi
BARANGAY Nutrition Scholars FOCUS GROUP
Date: _____________ Facilitator: ________________ (circle) Merida or Ormoc 
TOTAL PARTICIPANTS: _____ BHW (Female _____ Male _____)
Barangays Represented: ______________________________________________
GENERAL
1. Who have you received training from? How many times? When? What were the topics? 
(WHO, # TIMES, WHEN, TOPICS)
2. Do you feel you have received sufficient training to provide care to your community or do 
you need more training? 
3. What was good about the training you received?
4. What could be improved about the training you received?
5. Please describe your responsibilities as a Barangay Nutrition Scholar.
6. Do you have all the supplies and materials you need to fulfill your responsibilities? What do
you have? Where do supplies come from? What is missing?
7. What is the attitude of people in your community towards what you do and the good health 
practices you promote? Do they support you? Is your work difficult or easy?
Technical Information
1. What messages do you promote for good health in general for children <2 years old?
q Complete immunization
q Good hygiene
q Breastfeeding
q Good nutrition (Vitamin A and iron)
q Growth monitoring
q Complementary feeding
q Other: (note)____________________________
2. What are the recommended practices for breastfeeding?
q Immediately after birth (colostrum)
q Exclusive until 6 months of age
q Continued until 24 months of age
q Frequent breastfeeding throughout the day
xvii
q On demand breastfeeding
3. What are the advantages of appropriate breastfeeding for mothers and children? 
q Natural immunity for baby
q "Breast is best", contains best nutrients for growth
q Immediate breastfeeding helps to expel the placenta
q Exclusive breastfeeding until 6 months old reduces illness from contamination
q Other: (note)____________________________
4. What feeding practices are recommended after a child is 6 months old?
q Always give breastmilk 
q Frequent feedings 3-5 times/day
q Child has own bowl
q Good hygiene in food preparation
q Give foods rich in vitamins and micronutrients (Go, Grow, Glow) (EXAMPLES)
ß Food:______________________ Nutrient: _____________
ß Food:______________________ Nutrient: _____________
ß Food:______________________ Nutrient: _____________
5. What is the importance of regular weighing and monitoring of a child's growth?
q Identify any problems in growth early
q Opportunity to give nutrition advice to mothers
q Can detect a child with illness and refer for treatment
q Other (note): ______________________________
6. What are the steps in weighing a child correctly?
q Scale should hang at eye level
q Calibrate the scale to "ZERO"
q Find out the birth date and determine the 
child's age
q Use a "sling" for babies and hanging pants 
for children
q Make sure the child is secure when hanging 
the child on the scale
q Wait until the needle on the scale stops 
moving
q Record the weight to the nearest "tenth".
q Mark the child's weight on a graph
q Determine if the child is growing properly 
and inform the mother
q Give nutrition counseling to mother
q Other answers? ____________________________
_____________________________________________
xviii
8. How do you plot the child's weight on the graph?
9. Why do some children not grow properly?
10. What can a family that is poor do to feed their child properly?
Sustainability
1. What is your link with the Barangay Health Station/Center? How often do you have 
meetings? When was the last time health personnel supervised your work within your 
community? Do you feel you are supported by the health office? 
2. Do you receive any support or collaboration from other groups (community or Local 
Government Unit, etc.)? Who? How?
3. When this project finished, will the activities of the BNSs continue? Why or how?
4. When this project finishes, what will be the difficulties to continue your work? 
5. In your opinion, what was the best part of the project?
6. In your opinion, what part of the project could have used more emphasis?
7. Do you have any final suggestions for the project or for the project partners? 
xix
BARANGAY Traditional Birth Attendant FOCUS GROUP
Date: _____________ Facilitator: ________________ (circle) Merida or Ormoc 
TOTAL PARTICIPANTS: _____ BHW (Female _____ Male _____ )
Barangays Represented: ______________________________________________
____________________________________________________________________
1. Who have you received training from? How many times? When? What were the topics?
WHO: # TIMES:
WHEN: TOPICS:
2. Do you feel you have received sufficient training to provide care to your community or do 
you need more training? 
3. What was good about the training you received?
4. What could be improved about the training you received?
5. Do you have all the supplies and materials you need to fulfill your responsibilities? What do 
you have? Where do your supplies come from? What do you do when you need more 
supplies?
6. What is the attitude of mothers and their families to the good health practices you promote? 
Do they agree with you and follow your advice? Is your work difficult or easy?
Technical Information
1. What messages do you promote for mothers during their pregnancy? 
2. What are some of the danger signs that a pregnancy is HIGH RISK?
3. What do you do when you attend a child birth to protect the health of the mother and baby?
xx
4. Why should a mother and baby have an exam within 4 to 6 weeks after childbirth? What do 
you check for during that visit?
5. What good practices do you suggest to mothers for the health of their newborn baby?
6. Why should mothers visit the health clinic within a month after the birth of their child? 
Sustainability
1. How do you coordinate and work with the Rural Health Midwife at the Barangay Health 
Station/Center? 
2. Do you feel you are supported by the Rural Health Midwife and the City or Municipal health 
office? 
3. Do you feel welcome to stay with a mother during a prenatal exam at the health center? Are 
you welcome to stay with a mother during childbirth at the local hospital? Do you feel you 
are treated as part of the "health team" that is attending to the mother?
4. When this project is gone, will that have an effect on any of your work as a TBA? Why or 
why not? How?
5. In your opinion, what was the best part of the project?
6. In your opinion, what part of the project could have used more emphasis?
7. Do you have any final suggestions for the project or for the project partners? 
xxi
BARANGAY HEALTH COMMITTEE OR COUNCIL
Date: _____________ Facilitator: _________________________________________
TOTAL PARTICIPANTS: _____ (MALE ____ FEMALE ______)
 
1. Please describe the responsibilities of your (committee or council) for the health of women 
and children:
2. What do you think are the GOALS of this project and do you agree with these? How does the 
project help your community?
3. What does your COMMITTEE or COUNCIL do to support the project?
4. How do the HEALTH WORKERS (BHW, TBA, BNS, etc.) coordinate with the committee or 
council? Does this coordination work well or could it be improved?
5. Does your community have a PUROK HEALTH DATA BOARD? If yes, how does this help 
the community?
6. What positive changes do you think the project has achieved for the health of MOTHERS and 
CHILDREN in the Barangay? (How and why?)
7. What is the attitude of the community in general (NOT the BHW, etc.) to the goals of this 
project and the work of your committee/council to improve health?
8. What is the link between the community and other HEALTH care providers? 
9. When this project finished, will the activities to improve the health of mothers and children 
continue without the project support? Why or why not? How? 
10. In your opinion, what was the best part of the project?
11. In your opinion, what part of the project could have used more emphasis?
12. Do you have any final suggestions for the project or for the project partners? 
Annex C
List of Persons Interviewed
Pearl S. Buck International Child Survival Project FY2000-2003, Philippines
Focus Group Discussions with Project Partners as Key Informants:
AdBoard Representatives
ß Dr. R. Marson, MPH, City Health Officer II
ß Ms. G. Pijo, Nurse Coordinator for Family Planning and E.P.I.
ß Ms. D. Corbo, City Planning and Development Office
ß Ms. R. Caraca, President of the BHW Federation of Ormoc City
ß Ms. A. Lubaton, President of the BHW Federation of Merida Municipality
Ormoc City Health Office
ß Ms. N. Adolfo, Nurse Supervisor and EPI Coordinator
ß Ms. E. Romero, Nurse Coordinator for Family Planning
ß Ms. L. Calipayan, Nurse Coordinator for Barangay Health Workers and TBAs
ß Ms. R. Nastor, Coordinator for Nutrition
ß Dr. N. Navales, DOH medical representative assigned to Ormoc City Health Office
Merida Rural Health Unit
ß Dr. J. Solana, Municipal Health Officer
ß Ms. D. Panares, Nurse Supervisor
ß Ms. T. Sosmena, Rural Health Midwife