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Quality assurance in health care for the urban poor.


 New initiatives to bring primary health care to the poor barangays (villages) of Manilla, the capital of the Philippines are described. Manilla had 7.7 million people in 1987, with 2 hospitals, and a health care systems based on the European model. The government per capita health expenditure was $1, while people spent 15% of their income on health care. A household survey showed that many were underserved, that respiratory and skin infections, malnutrition, gastroenteritis and intestinal parasites were common. The Manilla Health Department was reorganized into 4 major services. A new university hospital is planned. Mechanisms are being set up for private physicians to cooperate with public health agencies in 2-way referral. Barangay health Workers and Volunteers are being trained. Root causes of poor health are being attacked by providing public water, laundry and toilet facilities, drainage, skills training and feeding programs. The barangay network has promoted lay referral, child growth monitoring, immunization, collection of vital statistics and environmental sanitation.
