sputum AFB positive to sputum AFB negative. Indigenous health workers from communities of TB patients were trained to identify the TB patients, educate the community and the patient's fatuity about TB, to do sputum smear and to closely supervise the intake of anti-TB meds in the homes of the patients, When TB treatment is center-based and managed by health professionals, there is very low conversion rate, poor compliance and inadequate knowledge of the illness. In fact, because of the inappropriate approach to TB control, TB resistance is now a problem in the country. Another big wave created by people participation is achievement of a wider coverage. More individuals and more communities are reached relatively inexpensively because of the primary health care approach. Dr. Mita Pardo de Tavera, 76 y.o.. the current President of the Philippine Cancer Society, a nationalist Filipina with Spanish and patriotic roots, who put forward the domiciliary approach to TB Control when her doctor colleagues thought it was a crazy idea but she implemented it just the same and achieved a 97% conversion rate from sputum AFB positive patients to sputum AFB negative patients (the highest recorded so far in the history of Tuberculosis control in the Philippines), who has always been concerned about the small area of coverage in the pioneering efforts of the Hospice Home Care Program of the Philippine Cancer Society, has proposed the idea of exploring a primary health care approach to hospice/palliative care mainly to achieve a wider coverage and to include it and cancer care with the other primary care issues in a community health education program curriculum.
Principles and Strategies employed by Primary Health Care as applied to Hospice Care:
PRINCIPLES
1. Accessibility, Availability and Acceptability of Health Services
STRATEGIES
Health services delivered where the people are;
Use of indigenous/resident volunteer health worker as health care providers
Use of indigenous treatment modalities
The emphasis on home care in hospice care answers above principle. What needs to be explored now is to decide how much of the skills in hospice care can be realistically taught to informally educated community hospice workers. In the Philippines, primary health care approach has enabled indigenous health workers to inject Streptomycin and do sputum smears in Community-based programs. In the care of the care of the chronically and terminally-ill, a lot of intrinsic talent, care and dedication has been found among neighbors and extended family members of the patients. A treasure of indigenous and psychosocial and spiritual approaches naturally sprout at a time when the patient and his family need them most. Some indigenous treatment modalities like the use of "ikmo" leaves that helps dry up malignant breast ulcers, and the intake of a solution from boiled tree barks to relieve constipation among others have been discovered. Unearthing these indigenous practices that help and adding them on to extrinsic earing maneuvers that the hospice movement has discovered and re-discovered would result in a more acceptable and cost-effective means of delivering hospice care.
2. Provision of quality, basic and essential health services
Training design and curriculum based on community needs and priorities, task analysis of community health workers (CHW) and competency based
* Attitudes, knowledge and skills developed are on caring of hospice patients
Regular monitoring and periodic evaluation of CHW performance by the community and hospice staff
The development of the training design and curriculum based on community needs and priorities is a revelation. In a dialogue with a non-government organization doing primary health care to explore the possibility of integrating hospice care into the training program and services, it was discovered that before exploring the
