Chapter 5 Organizational Axis

Looking back and visualizing the whole slow accumulation of inventions that has made us human beings, and finally civilized human beings, we find, salient among them, man’s developing ability to include in the conception of his own group ever more people living at greater distance: his clan, his tribe, his nation, his religion, his part of the world

--Margaret Mead

Nothing is made without men; nothing lasts without institutions.

-- Jean Monnet

Social Organizations are an integrated system of interrelated psychological groups formed to accomplish a stated objective. An organization consists of people (members), capita (resources) and idea (stated objectives and goals). Groups can be loose or tight depending on the membership, the resources, and the idea, which drives people to a range of activity. Organizations can be loose (from cooperating individuals to associations) or tight (to enterprises) See Case 4.
Today, if you want to transfer to a new house, you will have to contract a Lipat Bahay (House Transfer) truck for a price. If you had made . (Note: It's not about the timeline, its also about the strength of materials, we had wooden houses back then...we call lipat bahay now to move out the household items...the house would most often be concrete..therefore I think wrong premise?) As immortalized in the arts of Botong Francisco, the concept of bayanihan can be traced back to communal traditions where community dwellers volunteer to help a family move to a new place. The moving out process involves literally carrying the structure to its new location. Bamboo poles are formed as frame to lift the stilts from the ground and carrying the whole house across the village with the men positioned to carry the wight at the ends of each pole. This is the spirit of Bayanihan to the Tagalogs, or Pintakasi to the Visayans. Filipino community life is characteristic of collectivism—people get their acts together towards one goal. Early Filipino barangays developed into a “closed, self contained political socio-economic ecolological systems.” Village priests, village elders, and tribal leaders engage the community in setting and enforcing rules, and mobilizing village resources.These rules and norms were gradually woven into the fabric of a village’s religion, economy, agriculture, and social structures; refined and distilled through time. It seems only one “law” guided, and stemmed from, this cultural evolution --live in harmony with each other and with nature. Each autonomous barangay had its own way of regulating village life, setting norms of behavior, and dispensing justice. In pre-Hispanic Bukidnon, for example, the lakan or village elder brought together opposing parties and have them settle their disputes. Up north particularly in the Cordilleras, village elders gathered and met in the dap-ay to decide on matters of consequence to the village. In Sulu Island group, the Badjaos had their babailan or chief priestess who brought people back to health and guided families and clans on ways of maintaining harmony with the each other and with the environment. Each healing session becomes a community event which everybody witnessed. The Organizational Axis tells us of collective action, of mobilizing social resources to achieve goals. Public health managers must harness the community’s collective spirit in implementing health programs. The Organizational Axis also shows how what could start initially as a health program becomes woven into the fabrics of community living either as a culture or imbibed practice(see Cases 1, 2 and 3 below). The logic of the organizational axis is primarily based on the social sciences, particularly anthropology, sociology, and political science. Subsets of these three disciplines indicate that these sciences are indeed disciplines along the same line. Under these disciplines are specialized fields such as: social anthropology, political anthropology, social psychology, behavioral psychology, cultural anthropology, social learning, political culture, policy analysis and advocacy. Also founded on these three disciplines is community development, which includes community organizing, awareness building, community building, and community mobilization. Case 1 The Sebaste Community Clinic Rural health professionals often deplore the lopsided concentration of health facilities, skilled manpower and advanced health technology in the urban areas. With little incentive for career improvement, physicians would rather practice in the urban center than in the rural areas. Even private practitioners, clinics, and hospitals don’t find it attractive to invest in modern and expensive medical facilities in the rural areas. Most local government units lack the logistics to adequately address these limitations. This pattern had isolated a large segment of the rural poor beyond the effective and efficient reach of these modern health facilities and expertise. As a consequence, health care had become more inaccessible and financially prohibitive to the rural poor. Such is the case of the coastal town of Sebaste, one of the poorest in the province of Antique in Western Visayas. A sixth class municipality, around 70% of Sebaste’s 12, 723 residents had income below the poverty level. Aside from two other municipalities, Sebaste is farthest from the capital town of San Jose, which is 109 kms away. Typically, it had the standard rural health center, with a total workforce of nine, composed of a government physician, a public health nurse, six midwives, and a sanitary inspector. Sebaste community people were confronted with these problems: inaccessible health services (the nearest secondary hospital was twenty kilometers away), limited availability of health personnel (the center was open from 8AM to 5PM, Monday to Friday and the only doctor was not available all the time), unaffordable health services (given that 70% of residents were below poverty line), and delayed medical attention (due to poverty, residents delayed seeking medical attention resulting to illnesses becoming worse, which in turn meant more expenses). Sebaste’s Local Chief Executive could not take the scenario sitting down. Worried that she was failing to provide her people access to tertiary healthcare (a mandate to the mayor stated in the Local Government Code), Juanita dela Cruz spearheaded the transformation of the rural health unit to the fully operational Sebaste Community Clinic (SCC). To finance the construction, the local government allocated an average P617,000 for the SCC yearly from 1994 to 1995. But this was not enough. Mayor dela Cruz brought her crusade for a healthy Sebaste community to Austria and Germany, where she organized many former Sebaste residents who were working there. The Eugene Daberto Memorial Foundation (EDABEM) in Austria and the Capiznon, Ilonggo, Aklanon, Antiquenhon Association (CIAA) in Germany were borne out of these visits, and since then, had consistently sent medicines and equipment to the SCC. Later, through these NGOs, other charitable foundations in Europe donated medicines, supplies, and equipment. These donations including an ambulance when quantified would easily run to hundreds of thousands of pesos. The Countywide Development Fund of an incumbent congressman was also tapped to construct another building for the children’s ward and dental clinic of the SCC. Case 3 The Guimaras Health Insurance Who would have thought that a national project piloted in a sleepy town would survive amidst administrative tensions? In 1976, Medicare PII started as a pilot project in Guimaras, then the municipality of Nueva Valencia. Medicare PII was the national government’s second attempt at institutionalizing a health insurance system for the poor. The program survived through the years. In 1987, however, the Municipal Medicare Care Council (MMCC), the body that managed Medicare PII, was abolished by virtue of Presidential Decree 1519. Management of Medicare PII was removed from the municipality and restored to the revived Philippine Medical Care Commission (PMCC). Even without the council, Guimaras proceeded with the program. But without the usual support of the MMCC, the program weakened and was already near collapse. In 1989, then Nueva Valencia Municipal Health Officer (MHO) Dr. Tronco formally approached PMCC for assistance. In February 1990, the Department of Health (DOH) and the municipality of Nueva Valencia entered into a Memorandum of Agreement to operate the resuscitated Medicare II as their joint undertaking. Shortly after, the PMCC assigned full-time personnel to extend technical assistance to Nueva Valencia. As early as then, Dr. Tronco was already lobbying with then Board Member Catalino Nava, himself a physician, to implement the program province-wide. Dr. Tronco believed that the only way to improve the coverage of Medicare II was to widen the membership base. While Dr. Nava was receptive to the proposal, he suggested that it would have a much better chance of being implemented should Nueva Valencia become a full-fledged province, at that time, the full provincehood of Guimaras was already being worked on. After the 1992 plebiscite, Guimaras became a full-fledged province. Emily Lopez was appointed as the first governor of the newly created province. Gov. Lopez was so convinced of the program that it was one of the few she prioritized upon assuming office. For the Medicare PII to work, there was a demand for greater membership base. To reach the target group, the community volunteers were utilized to advocate for the program and recruit membership. A house-to-house campaign was done. To further augment the activity, the provincial staff conducted continuous information dissemination in the barangays. But the best marketers of the program were those who actually availed of the program’s benefits. Their testimony about how the program actually helped them, and how it unburdened them of the prohibitive cost of hospitalization, had a powerful multiplier effect in the community. Individual -family -purok –barangay-district -municipality-province Purok-communities-polity-society volunteer mobilization-community mobilization-rallies-advocacy-legislation If we are to follow Hollnsteiner’s “reading” of the social structures that saturate our local communities, then we will find out that this undermines or distorts development, which as Talcott Parsons identified is a function of the state to meet increasingly complex needs of its citizens. Development is a matter of getting people’s act together towards one goal. In most cases, that goal is prosperity, or increasing people’s capacity to meet their needs so they can have a better quality of life. Social change and development normally begins and happens at various stages. The Organizational Axis represents the various social phenomena at different levels of society, beginning with the individual level on the left (see the illustrations above), and reaching the societal level on the right. This closely approximates Zaltman’s representation of social change in a matrix. The Federated Women’s Club is an example of a tightly structured, operationally excellent organization that it becomes an enterprise. An enterprise sees end-to-end: the service delivery system has input processing unit (that involves peopleware, hardware, and software) and a measurable output. What started to be a women’s primary health care delivery unit became an enterprise of fathers and husbands, young adults, and even children. Women forged partnerships with the other members of the society and assigned areas of involvement to each, with specific activities, objectives and output. The structure and process in an enterprise sees from beginning to end of a program. Peopleware are those members engaged in the programs who make use of hardware (materials, equipment, funds, etc.) and software (trainings and seminars, awareness and capacity building activities, etc.) for a measurable output (improved nutrition rate). Hybrid structures (like the Federated Women’s Club) are effective instruments of health system development as it takes off where the state and the market fail. Hybrid organizations thrive in areas where there is state and market failure. People act together and make things happen when the state and the market can’t. This government-business-civil society configuration makes hybrid organizations effective—services are delivered to the people without much bureaucratic complexities, services are delivered to the people not to make money but to make the services affordable, and services are delivered to people by the people themselves thus becoming an act of goodwill. As their experience demonstrated, the Federated Women’s Club has cost-recovery mechanisms in place for it to propel its PHC service. Through the volunteer efforts of a pioneering midwife, the start up social capital (mothers and women volunteers, volunteer barangay health workers) sustained their initial activities. The FWC also made use of knowledge capital that is inexhaustible and can be multiplied tenfold through its awareness and capacity building seminars. Amongst themselves, the women learned and taught each other. With their increasing success the FWC was admired by local government leaders who then added to their resource—the political support given to the program, which eventually translated to financial support. As the organization progressed, the FWC leaders developed greater institutional and managerial capital through the various branch organizations managed by other members in the community. The next chapter discusses resource and recovery mechanisms fully. At this point we can say that money as the least, easily depleted resource should not be the only focus of the enterprise. Other capital harnessed through the people should greatly magnify the reach of meager funds. A leader’s role and contribution to an organization will always be recognized. But an organization solely dependent on the leader will not work effectively. When the leader ceases to act, the organization ceases to exist. The leader and the organization are not one. Even mother eagles who lead eaglets in the game called life, push their eaglets out of the nest when the right time comes. Then, thee aglets learn to fly by themselves and become involved in life’s acts—hunting for food, bringing in branches, courting. The quote that began this chapter reads: “People support what they help create.” Leaders must empower the people to lead amongst themselves so that people can sustain what programs because they have built it. Here are other ways hybrid enterprises help: Produce goods and services that private and government cannot produce due to market and state failure. Hybrid organizations deliver services which the government fails to deliver. And, as we observed in most cases, in the processes of initiating the service delivery, organizations elicit the support of government and eventually get it to act. Consciously or not, organizations become catalysts for this change as well. In the same way, hybrid organizations bring services to the people that people formerly cannot afford if sourced from the market. Hybrid organizations eventually also reel in support from the market for their activities. Reduce market/political information asymmetries (in short, the governor and the governed know about each other better). This in turn increases accountability and responsiveness of both the governor and the governed. It seems their cooperation make them each other’s keeper. Organizations become loci of power, whether political, economic, or knowledge power. This makes the power structure within the LGU more equitable. In fact, this brings greater power to the people because they are organized and make things happen for themselves. Increase absorptive capacity for new development initiatives. Whether LGU or organization-initiated, a social capital can propel development initiatives to fruition. Being highly organized, people can carry out development projects more effectively. Organizations become mini stake exchange ala stock exchange – meme jungle Contribute to discourse on area management. As active player in the community, hybrid organizations can more correctly represent the people’s genuine concerns and have these as benchmarks for the leader’s priorities. Serve as hubs in a network of responsibility and accountability. The hybrid organization holds together a network of constituents, government; private business enterprises that want to solve their own problems and make their lives better. Social Organizations Across Boundaries Localities have shared interests and so it is inevitable that social organizations at one municipality shares their hopes and fears with the social organizations at the next. For instance, it is common to two localities to work for a better health situation, and social organizations in these localities can pursue these shared interests jointly. We all belong to one larger ecosystem so what benefits one, benefits the other. What hurts one, hurts the other as well. This poses a strong reason for social organizations, municipal health offices, and even municipal governments to get together their own people internally get together. Inter-municipal relationships can draw from centrifugal forces, or the forces that pull municipalities together. Larger scale problems that hit across municipal boundaries bring municipal leaders together. Municipalities can agree with each other in sharing provincial resources for large-scale health programs, or they can collaborate to lobby for funding from the provincial board to augment to each municipal health office’s own budget. Another centrifugal force is regionalism. Collective consciousness in a region can get municipalities to act together. Party politics can also pull communities together. If two mayors happen to be under the same political banners, then it is more likely that they work together. Centripetal forces, on the other hand, pull the municipalities apart. These are also present in the municipality and can be stumbling blocks towards greater coordination. Municipal pull, or municipal leader’s tendency to deal only with smaller scale, internal interests; thwart efforts at greater collaboration. Municipal pull can be a trap especially for the poorer communities where leaders may not be as open to external coordination thinking they can’t worry about others when they are already swamped with their own problems. Partisan politics is another centripetal force. The community gets polarized in local elections such that one town’s mayor reaching out to the next town’s mayor for support will most likely be denied if they are under rival parties. Public health managers must apply the concept of mutually beneficial collective action through inter-municipality coordination. The leaders must know how to reel people across boundaries into a greater social organization. Increasing Pull Together We can generate greater centrifugal force and pull municipalities together through: Covenanting. Covenanting is entering into firm agreements. Municipalities can enter into agreements to launch health programs, share facilities, and mobilize resources. Widening Venues for Discussion. Municipalities can tap existing organizations that operate across municipalities as venue for discussion. If no such organization exists, then leaders can create one. Jaycees, Rotary Clubs, and other socio-civic groups can be platforms for bringing forward the health agenda. Resource Sharing. Municipalities can sometimes share various social, financial, and other types of resources. For instance, they can share MHOs so that if one MHO is absent, then a cooperating municipality’s MHO can fill in. It is also possible for municipalities to share ambulances, clinics, hospital facilities, and personnel so that at a larger scale, service delivery systems of primary healthcare are still functional. Municipalities can also share trainings so they can build awareness and capacity together. Smoothening Information Flow. If a dreaded diseases is detected in one town, then the town can communicate this to the next for precaution. Or if an expert visits one town to give a free lecture, then this town can invite other towns to attend. Municipalities keep smooth information flow because information is not lost when shared. Institution Building. Municipalities can also vote on or agree whom fiscal and political authority is given. As cooperating entities, they can gather together and forge an agreement on how to govern and spend money, on what projects will be launched to which town, and on how these will be funded. Summary: After the imagined future has been agreed upon, individuals –through social organizations -- become the embodiment of these new ideas. Based on the guiding ideas, these organizations produce the goods and services to address the health needs of the public. There is a technical/design dimension to the production of these goods and services, and these are discussed in next chapter.