Assessing Philippine Health Care Coverage Gaps: An Assessment of Accessibility of Public Health Programs in Selected Barangay in Imus, Cavite, Philippines

Anthony R. Marin^*, Angela Christine Hular, Mauriesse M. Olarte,

Eliah Trexie V. Sison

Department of Pharmacy, St. Dominic College of Asia, Emilio Aguinaldo Highway,

Bacoor City, Cavite, Philippines

Correspondence: amarin@sdca.edu.ph.

DOI: https://doi.org/10.71431/IJRPAS.2026.5701     

INTRODUCTION

Public health is a system comprising different healthcare teams that collectively work to improve and maintain the health of communities and nations. The Philippines conducts various medical missions and programs that align with the DOH's public health initiatives. However, there is still a rampant increase in percentages of Filipinos being sick, even dying, because of the inaccessibility of the programs. It is intriguing to understand the factors affecting program accessibility, despite the government offering numerous initiatives. According to Cordero, D. (2022), significant changes were made to the health sector in 2019 when President Rodrigo Duterte signed the Universal Health Care Bill into law. The UHC Law's expansion of population, service, and financial coverage through a number of health system amendments is one of its most notable aspects. Alongside this is a planned paradigm shift toward primary care, which serves as the focal point of all UHC-related health reforms. According to Banogon, Meljun, et. al. (2023), financial deficits, referral issues, gaps in primary care, and other health-related difficulties hamper the sustainability and efficiency of LGU healthcare systems. These challenges have a profound impact on the healthcare system's overall performance, leading to suboptimal healthcare outcomes and restricted access to high-quality care. However, recent healthcare reform measures in the Philippines have focused on ensuring equal access to high-quality, affordable healthcare services, including risk management for patients and hospitals. Despite various government programs aimed at improving the effectiveness of the local health system, providing healthcare at the regional level remains a challenge. According to Flaminiano, C.J., (2022), universal access to healthcare services is crucial for promoting population health. Healthcare access is an intricate procedure. In terms of accessibility, urban areas generally benefit from better health infrastructure, including a higher concentration of hospitals, specialty clinics, and health professionals. This study aims to address the knowledge gap regarding the accessibility and affordability of programs established by the local government. It also seeks to understand why residents cannot participate in these programs and whether the residents' location influences their participation. Finally, it aims to identify the most and least accessed programs in each barangay.

MATERIALS AND METHODS

Research Methodology

To gather information and data to determine whether residents of Imus, Cavite have accessed, completed, or are aware of the City Government’s public health programs. This study used the descriptive approach to also help the researchers understand the reason of the residents for not participating in the activities.

Research Design

A descriptive research approach was employed in this study to gather information about the current state of the phenomenon to describe “what exists” regarding the situational variables or conditions, as descriptive research involves collecting data without altering the environment. The methods was selected because it best aligns with the study’s goal of assessing the public health services in the communities of Imus, Cavite, while maintaining the environment.

Participants of the Study

Convenience sampling will be used by the researchers to select respondents, allowing all residents of the two (2) barangays who received primary healthcare services at rural health facilities to participate in the investigation throughout the data collection period. The sample population for Barangay Malagasang 1-G and Buhay na Tubig will be 382 and 191 respondents, respectively. The sample population was estimated using a sample size calculator.

The sample size strategy provided this study's three hundred and eighty-two (382) respondents with a 95% confidence level and a 5% margin of error.

Research Instrument

This study will use one (1) closed-ended questionnaire comprising thirty-eight (38) questions. The questionnaire was adapted from a study; permission was obtained from the study's author via email. The content of the questions is based on data from the DOH national program to assess if the participants had participated in or accessed the national program through the public health system.

The instrument is divided into two different parts. The first component collected respondents' demographic information, while the subsequent segment assessed their evaluations of public health services. The questionnaire contained a confidentiality clause.

Data Collection

To move forward with the study, the researchers had the questionnaires checked and approved by their thesis adviser and a psychometrician. The researchers attached a sample questionnaire. Upon approval, the researchers will conduct online surveys via Google Forms.

Before the respondents answer the questionnaires, the questions and the purpose of the study will be explained. The respondents will be given ample time to respond, ensuring they provide a complete understanding. The data collected from the questionnaires will be tabulated and statistically analyzed.

Data Analysis

Three basic formulas were used to guide the data analysis to determine the current accessibility of public health programs promoted within the City of Imus, Cavite.

Mean. The mean represents the central tendency of the data and is commonly used in health and social science research. It I the arithmetic average of a dataset, calculated by summing all values and dividing but the numbers of items to summarize numerical information (Frankfort-Nachmias & Nachmias, 2015).

Frequency. According to Gravetter & Wallnau (2017), frequency can help identify common health issues or conditions in a population as it refers to the number of times a particular value or category occurs in a dataset. It is a basic concept in descriptive statistics that summarizes and organizes data.

Percentage. A percentage expresses a part of a whole as a fraction of 100. It is a useful tool for comparing proportions and is widely used in reporting public health statistics to make data easier to interpret (Babbie, 2020).

ANOVA Test. A statistical technique called analysis of variance, or ANOVA, compares the means of three or more groups to see if there are any differences between them that are statistically significant (Muhammad Hassan, 2024).

RESULT AND DISCUSSION

Table 1. Demographic profile of the participants

The respondents' ages were split into two groups: 18-25 years old and 25 years old and above. The data showed that most respondents were between 18 and 25 (67%). The remaining 33% were 25 years old and above. It showed that 18 to 25-year-olds participated more actively in our survey.

Barangay   

The respondents were asked about their barangay location to get the data needed for the study.

Table 1.2. Demographic profile of the participants

Table 1.2 shows the barangay where the respondents live. In Malagasang 1-G, the researchers gathered one hundred ninety-one (191) respondents, the same as Buhay na Tubig, with one hundred ninety-one (191) respondents. The total number of respondents is three hundred and eighty-two (382), reaching the target sample size.

Summary of Personal Demographic Data

Section A revealed the respondents' age bracket and their barangay. Most of the respondents were 18-25 years old, with 256 (67%) responses, and the goal of 382 respondents from Malagasang 1-G and Buhay na Tubig was met.

1. SOP #1: Residents of the two (2) barangays that participated in the public health programs of the

    City of Imus.

2. SOP #2: Most accessible and least accessible public health programs in the City of Imus

Table 2. Questions answerable with “Already participated”, “Not yet accessed”, and “Not accessible”

Table 2 shows the ranking from least to most accessible public health programs conducted by the City of Imus, Cavite. This table illustrates the study’s primary goal by clearly identifying which programs need more promotion and which are being enjoyed by residents of Imus.

The programs with the highest rate of accessibility are the Tuberculosis treatment provision and health education promotion, with a total of two hundred and eighty-nine (289) respondents reporting that they have accessed and participated in local efforts to distribute treatment measures and advertise good health practices to residents of the target barangays.

The second most accessible program is the Dengue prevention and control program, with a frequency of two hundred and eighty-seven (287). The existing data lies in contrast with the results gathered from this research. In studies by Gregorio (2024) and Herbuela (2019), it was reported that despite widespread dengue prevention activities, a significant percentage of the population was still unable to participate due to poor knowledge and attitudes towards good health practices and the drive to join said programs. In addition, the programs are focused on prevention and health education, making it easier to facilitate and offer to residents and to cater to several people without incurring significant financial outlay than service-oriented projects.

On the other hand, the least accessible programs for the residents in  Imus are also included in this study. Table 2 shows that the three programs with the least accessibility are Natural Family Planning at the 29th rank with a frequency of one hundred and twenty-seven (127), followed by Provision of Adequate Care in the 30th rank with a frequency of one hundred twenty-four (124), Premarital Counseling with the frequency

of one hundred and six (106) ranking 31st and second to the last, and Food Sanitation on the 32nd/last in rank with a frequency of one hundred (100). This data shows that among the thirty-two (32) programs identified by the study, family planning and nutrition are at the bottom in terms of accessibility and residents' concern. This is reflected in the Cavite Ecological Profile (2020), which shows Imus as one of the cities within the municipality of Cavite with a population increase greater than 10% over the last 4 years. There are barriers to achieving impactful family health programs focused on family planning and premarital counseling, according to Trisolini et al. (2023); factors such as religious beliefs, "hiyang" mindset, and limited access to new contraceptive and counseling options limit people's engagement with such public efforts.

1. SOP #3: Common reasons residents are unable to participate in the programs.
2. SOP #4: If the location of the residents matter when accessing the programs held by the local government.

Table 3. Reasons for not participating

Table 3 displays the main reasons for accessibility issues within the selected barangays in Imus Cavite. In Malagasang 1-G, the most common reason is "Too Pricey," with a frequency of fifty-nine (59) and a percentage of thirty-one (31%). It is followed by "I/We don't need it," which has a frequency of fifty-one (51) and a percentage of twenty-six point seven (26.7%). Conversely, the least likely reasons for inaccessibility to public health programs are "too crowded" and "I was not aware about it," both with a frequency of ten (10) and a percentage of five point two (5.2%). Additionally, "The sites are too far" has a frequency of eight (8) and a percentage of four point two (4.2%). This indicates that even when residents are aware of the programs and live near the event locations, many choose not to participate in the City's programs. This may be due to the perception that the programs are not free, and residents are concerned about financial constraints.

In Buhay na Tubig, most respondents voted "I was not aware of it," with a frequency of 65 and a percentage of (34%). The second highest is "I don't know how to go," with a frequency of 36 and a percentage of (18.8%), almost tying with "The sites are too far," with 35 respondents and a percentage of (18.3%). This shows that most of the programs held and announced were not attended by the residents because of a lack of information provided to them or promotion for the upcoming programs.

The data collected from this section of the study agrees with the existing body of knowledge. On the overcrowding and logistical issues in Malagasang 1-G, the data shows that while overcrowding was not a significant concern for most respondents, it was still a factor for a small percentage (5.2%) of the residents. This is supported by Thompson et. al. (2017), who noted that overcrowding of spaces and long wait times before the actual event at public health programs can deter people from participating. Even if a program is free, if individuals expect a long wait or perceive the service as inefficient, they may choose not to attend. Additionally, the sensationalism of events that puts spotlight on the government officials and projects and highlighting the scarcity of people might also be a deterrent to people’s attendance. Ensuring that programs are well organized, participant focused, with manageable participant numbers and efficient service delivery, can help reduce this barrier. In addition, the data from the Imus, Cavite indicates that ‘too pricey’ is the most frequent reason for not participating in public health programs, with 31% of respondents indicating financial constraints. This finding is consistent with the research by peters et. al. (n.d), who discussed how indirect costs, such as high rates of transportation or the opportunity cost of missing work in exchange of attending the said

events or projects, can discourage people from attending even free programs. Many individuals may be deterred by the associated costs of accessing these services, which can be a significant burden, particularly for lower-income communities. This suggests that while the programs are free and entail great benefits for the residents, the financial strain on residents still plays a pivotal role in their decision to opt out.

The interpretation of the data reveals key hindrances to accessibility for public health programs in two barangays of Imus, Cavite Malagasang 1-G and Buhay na Tubig. In Malagasang 1-G, the most significant barrier respondents identified is the program, cost, with 31% of the respondents stating that the programs are ‘too pricey’. This primary factor preventing participation, even though the programs are nearby and people may be aware of them. A substantial number (26.7%) also mentioned that they did not feel the need for the programs, indicating that there may be a disconnect between the residents’ needs and services offered and formulated by the LGU. On the other hand, other barriers such as overcrowding (5.2%) and lack of awareness regarding the program, (5.2%) were much less significant, showing that logistical issues or unawareness are not the leading cause of inaccessibility in this area. The low participation may therefore reflect concerns about the affordability of the services with regards to its accessibility, rather than a lack of awareness or physical barriers to attending.

In Buhay na Tubig, the lack of awareness was more apparent as the data shows, with 34% of respondents indicating they were unaware of the programs. This indicates that information dissemination is a significant challenge in this area. Additionally, 18.8% of residents reported not knowing how to reach the event locations, and 18.3% found the venues too distant from their residences. These factors suggest that the core issue in Buhay na Tubig is the insufficient promotion of the events and communication lapses about the programs and its specifics, leading to a lack of awareness and, potentially, a lack of interest in participating from the side of the residents.

In summary, financial constraints are the primary obstacle in Malagasang 1-G, while the lack of information and inadequate communication are the most significant barriers in Buhay na Tubig. Both barangays face unique challenges that could still be focused on to improve participation of residents of both barangays in public health programs.

CONCLUSION

In conclusion, the study highlights key barriers to accessibility and participation in public health programs in the City of Imus, Cavite, especially within the barangays of Malagasang 1-G and Buhay na Tubig. The data indicate that financial constraints are the main reason residents in Malagasang 1-G do not join the available programs, with 31% of respondents citing cost as a major obstacle, despite the programs' proximity and awareness. On the other hand, the main challenge in Buhay na Tubig seems to be a lack of awareness, with 34% of respondents saying they were unaware of the programs. Additionally, logistical issues, such as not knowing how to access the events or their locations, further lowered participation in this area.

These findings highlight the need for targeted efforts to overcome the obstacles each barangay encounters. For Malagasang 1-G, reducing the financial burden through more affordable or subsidized services could encourage higher participation. In Buhay na Tubig, strengthening the promotion and communication of public health programs is essential to ensure residents stay informed and involved. By tackling these barriers, the City of Imus can improve the reach and effectiveness of its public health initiatives, allowing more residents to access these vital services.

CONFLICT OF INTEREST

Author(s) shall declare the conflict of interest before submission of manuscript for publication. The conflict of interest as mentioned in manuscript before references section. Please note that all articles submitted to the journal will be evaluated by turnitin for plagiarism.

ACKNOWLEDGEMENT

The kind support and help of several people has made this study a reality. The researchers would want to express their heartfelt appreciation. For the ongoing gift of life, wisdom, health, wealth, and hope, researchers are grateful to the Almighty God, the Divine Creator. This accomplishment would not have been possible without His unending grace, wisdom, and fortitude. The researchers also want to express their deepest gratitude to their family for the understanding of the circumstances and for the words of encouragement that helped the researchers to complete this research study. To their friends who were standing as their foundation while going through tough situations and their continuous show of help and support. Gratitude and appreciation also go to colleagues and people who have willingly helped out with their abilities.The researchers would also like to express their gratitude to their Program Chair and Thesis Adviser, Prof. Anthony R. Marin for his outstanding support, invaluable guidance, and supervision. This is the outcome of his thoughtful and generous attitude.The researchers also would like to acknowledge Dr. Joel G. Matamis, the School Dean, and other professors from the School of Medical Laboratory Sciences for their assistance at the International Mobility Program in Vietnam during the presentation of this study.To the Psychometrician, Ms. Bhea Patrisha Beladas, for allocating her time to provide review and recommendation to our questionnaires.

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