creates a beautiful environment of cooperation, concern and actual care for the person that matters in hospice, the patient with his family. When a patient dies in peace, with no pain and with his dignity intact leaving behind a family who has been well prepared for the eventual loss and finally is able to cope with the loss, we say, hospice workers, we have done what we are supposed to do.
Community involvement in hospice/palliative care is more manifest in volunteer involvement as well as service providers' (government organiazations, non-government organizations, the religious groups, health agencies and other related groups) involvement in the delivery of hospice services, This is apparent in the history of established hospice/palliative care programs especially in developed countries which have a strong, adequate, reliable and effecient health provider - recipient relationship and a strong CONSUMER voice. The combination of established health provider - recipient relationship, effecient health care system, a strong consumer voice and the heart and the dedication to care for people who are. suffering are probably the major factors in facilitating community involvement in hospice care.
Unfortunately, developing countries do not have the complete ingredients. Caring for the terminally-ill and the dying ultimately competes with the limited resources for health. it is a given fact that hospice care is not just tender, loving care but also is competent care and therefore implies the involvement of well and almost specially-trained health professionals. As a result, specialist palliative programs have been developed for physicians as well as for nurses and in major training and research centers all over the hospice world, highly trained hospice/palliative care specialists deliver hospice/palliative care. If developed countries with hospice programs having highly trained personnel on board are able to offer the service to almost all terminally-ill and dying patients, then this would probably be the best arrangement but definitely, would require an enormous amount of resources which developing countries do not have, In the Philippines, a lot of people have the interest and the heart to do hospice work but could not do it because of very limited budget. Hospice care, especially home care services, are not reimbursible by insurance schemes. The public health system is not adequately equipped to have the time-and manpower-intensive service required of a hospice service The dominant health financing scheme in the country is still the PROVIDER <‐‐‐‐‐‐‐-> RECIPIENT or fee for service arrangement which theoretically provide high quality care but at high cost. So that by the time the patient with his family have exhausted all means of curative treatment, the finances are depleted and very little if therc is at all, is left for hospice care. A worse situation is that 70% of the population can not afford the support required of a long-standing illness like cancer. As far as job opportunity is concerned, hospice workers have yet to find good paying ones. It is in this perspective that while the hospice movement in the Philippines is trying to catch up with achieving competence by encouraging and supporting health professionals to seek further training in hospice care locally and outside of the country, it now wants to explore community involvement in hospice care which is PEOPLE PARTICIPATION, the core principle of Primary Health Care.
Primary Health Care is an approach considered to be one of the major answers to the dismal health situation among developing countries, like the Philippines especially when the Philippine government did not listen to it and even labelled primaly health care efforts as insurgency in the late 70's and early 80's. This dismal health situation was characterized as: concentration of health services and facilities in the urban areas, overdependency on imported health technologies dominated by foreign multinational companies, top to bottom decision making with very little participation of the majority, minimal support for basic health services like water and sanitation and others, emphasis on cure rather than prevention, dominance of a colonial, elitist and feudal health values. beliefs and attitudes and poor motivation of government health personnel due to low pay and poor working conditions among others. Even before the 1978 World Health Organization Alma Ata Declaration, some private practitioners have been practicing the primary health care approach as their solution to a problematic health situation.
Twenty years later, the Primary Health Care approach has gained waves in health care. The principle and strategy of people participation for example in Tuberculosis Control, as experienced by a non-government organization in small communities of Luzon in the Philippines. achieved a 97% sero-conversion rate from
