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Chapter 5

restless_river — Fri, 15 Feb 2008 04:40:52 CST

Chapter 5 Leading Minds: Managing Myths, Memories, and Meanings

When the leader arrives, people are full of panic, uncertain what to do and defeatist about the future. When the authentic leader has spoken, they have been given back their courage. --William Rees-Mogg

From beginning to end, the rituals of our lives shape each hour, day, and year. Everyone leads a ritualized life. Rituals are repeated patterns of meaningful acts. If you are mindful of your actions, you will see the ritual patterns. If you see the patterns, you may understand them. If you understand them, you may enrich them. In this way, the habits of a lifetime become sacred. -- Robert Fulghum

In the play Miss Saigon, Leah Salonga in her character Kim, sings a song entitled “Movie in My Mind”. Through this song, Kim imagines and describes the life she hopes to live out. At the start, she sings out as an innocent village lass singing about the love she hopes to have. It starts out as a hopeful, innocent song. As the plot of the play moves forward, the “movie” unfolds in Kim’s mind and in Kim’s reality. Kim falls in love with an American soldier, marries him, gets separated from him by the war, and then bears his child whom she has to raise alone. Kim’s reality takes a tragic turn, but in the song, and in the movie in Kim’s mind, even sadness has meaning. Kim continues to sing Movie in My Mind plaintively into the darkness, as if trying to conquer tragedy with hope, imagination, and song.

Movies in Our Minds

Everybody sees life as a movie that unfolds right before his or her eyes. A young girl plays a princess or a pilot or a nurse; a young boy plays a conqueror of some island unbeknownst to the rest of the world. A farmer dreams of the day his children finish school and work in the big city. The market vendor envisions her daughter working abroad and sending over dollars, chocolates, and tuition for the younger siblings. We play this movie in our minds over and over again. We try to influence the outcome of this movie through our actions. These are our private movies, and we put private meanings to it.

The movies in our mind create our inner tensions and conflicts, our secret triumphs and tears, our personal values and dreams. If our actions are not enough, we go further by influencing the other actors in the movie, the script, the setting, and the relationships so that the movie unfolds the story as our hearts desire. In interacting with others, we too, become part of their our movies. Our movies become intertwined. People also share their dreams with others. And when they do, these movies break free from private seclusion of the minds and bear themselves out publicly. These become public movies – the stories, experiences, motivations, and meanings that guide a people.

Collective Consciousness: I Need We to be Fully I

The Zulus of Africa have a word for it—ubuntu (short for unmunta ngumuntu, nagabuntu)1 which means “I need we to be fully I.” The natives of Sagada, Mountain Province, manifest collective consciousness in a different way. Every ten years, they celebrate the Dangtey, a community ritual of prayer, gratitude, and offering done to ensure a bountiful harvest. The revolts in EDSA are a long-playing 3-part public movie—the first was a collective dream to oust a dictator, the second to impeach an erring president, and the third to try to redeem the impeached. In each of the three parts, Filipinos marched to the streets acting out the movies in their individual minds, as they pushed forward the public movie. As actors in this collective movie, they co-authored Philippine history.

Collective Consciousness and Channels of Governance

Governance is a key element in these "public movies". Among the social sciences, “public movies” fall within the realms of organizational psychology, behavioral psychology, social anthropology, cultural anthropology, community organizing, institutional economics, political science, and political sociology – the realms of the individual and collective consciousness. As discussed in the previous chapter, the public script is often written by the leaders in government. Citizens, knowingly or unknowingly, become spectators or actors in the movie. The interesting thing about the cases in governance studied here is that the movies are seldom simple stories to be interpreted literally. Instead, they are complex movies, rich with metaphors and symbolisms, paradoxes and dilemmas. They are stories with multiple meanings, filled with characters selflessly pursuing their noble longings.

Governance, in these cases can be thought of as occurring in the minds of the governors and the governed, in multiple channels. As on TV, the multiple channels are there for people to tune in to. Not all the viewers tune in to all the channels though. Some channels are more popular and some channels are seldom tuned into or understood. Waiting sheds, basketball courts, and free clinics can be viewed in the governance Channel 1. This is the most popular channel and seemingly most mayors and citizens are tuned into this channel. In this channel, the LGU interacts with citizens who are treated as passive clients, beneficiaries, or constituents. The LGU manages resources and outputs in order to deliver goods and services to the citizens. Performance is measured in kilometers of roads constructed, doctor-patient ratios, number of trees planted, and per capita incomes.

The logic in Channel 1 is that if the mayor installs a lot of highly tangible, high visibility projects, the citizens will remember him and vote for him come election time. Channel 2 focuses on the citizens as partners and co-creators of the municipality. Marikina’s Disiplina Sa Banketa, with it’s new ordinances, self-policing mechanisms, and painted sidewalks focus on getting citizen’s to give up the culture of chaotic sidewalks in exchange for order. Surigao’s Federated Women’s Club and its strong participation in LGU affairs through the implementation of self-help projects can also be viewed through this channel. Themes in this channel include consensus-building, multi-sectoral participation, political empowerment, policy-making, and establishing order in society. Fewer viewers watch this channel but this channel seems to be popular among NGOs, sociologists, and political scientists. Growth and maturation of the individual, community, and organization are key themes in Channel 3.

The quest for self-fulfillment (or self-actualization as described by Maslow) is a central theme in this channel. There is a recognition that each citizen is a traveler, going about each day trying to make meaning in his or her life. Each citizen yearns for fullness of life, and this fullness of life is not measured through per capita income; but by challenges faced, lessons learned, and meanings made. This is often thought of as the realm of development psychologists and psychoanalysts. When projects last for years, or when they take on multiple dimensions, or when the programs take on a life of their own (as described in Quadrant 4 in the previous chapter), then it is possible that the individuals behind these programs find and are motivated by deeper meanings they see in participating in the programs.

The Federated Women’s Club of Surigao, with its beginnings way back in 1976, and with it’s current membership of 7,200 members and multiple projects, is likely to have a few hundred to a few thousand members who are so deeply involved in it’s programs that it has become a way of life for them. Poetry and song, as shown in below written by a Barangay Health Worker of Bustos, can also be thought of as an indicator that the writer is deeply moved by their involvement in the LGU programs. Then there are tears which can also be thought of as an indicator of deep emotional involvement. Aling Deling of the Alay Paglingap Program of the Provincial Government of Bulacan, wept as she recalled how she used to wear her duster all day and comb her hair only once in the morning when she was but a socially isolated housewife in her barrio.

When she became a Barangay health Worker (BHW), she was liberated from her social isolation and took on more responsibilities in the community, eventually getting elected as barangay kagawad. One particularly touching episode came during a cataract surgery project at the provincial capitol. She referred a neighbor who had been blind due to cataract for years. With Aling Deling's assistance, her neighbor went thought the free surgery and came home with her sight restored. With teary eyes, Aling deling shared how that neighbor would embrace her out of gratitude whenever they would meet in the streets.

Spiritual growth and well-being of the individuals and community are central in Channel 4. This is usually the realm of priests, pastors, and babailans. El Shaddai, Couples for Christ, and other spiritual programs operate and communicate in this channel. The forest-cemetery program of San Carlos clearly operates at this level (among other levels), creating a forest sanctuary so that the citizens can commune with nature as they remember their dead. The BHW song of Bustos mentions Bathala, showing that somehow, a higher being is woven into their consciousness as BHWs and as individuals. Besides poetry, song, and tears that are indicators in Channel 3, other indicators include rituals, symbols, and prayers. Filipinos being a religious people, it is possible that Channel 4 has more viewers than Channel 3.

Socio-Emotional Health and the Inner Lives of Citizens

Why manage meanings? In developmental psychology, the concept of socio-emotional health pertains to the sense of inner wellness that individuals experience. The cases showed over and over again that LGU programs, when properly conducted by reasponsible and committed leadership, can enrich the lives of its citizens not just economically but also socially, emotionally, and spiritually through the different channels of governance. When funds are scarce and capacities limited, then this is an excellent way of improving the qualities of the inner lives of the citizens. As Professor Noel Tichy of the University of Michigan puts it: “it is a leader’s task to bring people on a journey into an uncertain and chaotic future—everyday. The best way to get people to venture into unknown terrain is to make it desirable by taking them there in their imagination.”

Hanapbuhay and Multi-Channel Leadership

The LCE or the public health leader can address social, emotional, and spiritual want by creating venues for growth. They merely have to participate in the weaving of dreams, provoke discernment and reflection, and engage the citizenry in the acting out of their individual and shared movies. This way, a training of BHWs is not just a transfer of knowledge and skills in health. The training is also a way of bringing the women out of their social isolation, getting them to take on new roles in the community, allowing them to meet new friends and ideas. It enriches their lives by providing them with new challenges, allowing them to relate with neighbors as care-givers. In the story of their lives, their role as BHWs phase could be the venue for them to achieve growth and self-fulfillment. LCE’s have only three years per term within which they are supposed to touch their lives of their constituents (enough to get elected in the following elections). During that period, few programs can radically improve the incomes of the citizens. Most will not, at least in three years. Through multi-channel leadership, the LGUs programs can touch the lives of the citizens in other ways though. After all, Filipinos refer to making a living as hanapbuhay, not hanappera. Multi-channel governance helps the citizens find that fullness of lives. Instruments for Managing Meanings

How can leaders evoke common meanings? Or how can leaders manage an existing meaning so that it becomes a rallying point for action? A review of the cases as well as other cases from history yield the following mechanisms. They range from the evocative to the prescriptive.
Evoking Memories and Emotions. Leaders can refer to memories of common pasts--e.g. Katipunan, Jose Rizal, Flor Contemplacion—to collectivize people’s thoughts and actions. EDSA 1,2, and 3 could be thought of as driven by memories and emotions. Former Philippine Ramos dubbed the Overseas Contract Workers as “Bagong Bayani”, reminding the public of the heroic effort the OCWs exert as they earn dollars to support their families back home.
Normative rhetoric/speeches. After the Americans left the bases, then Olongapo Mayor Dick Gordon rallied volunteers to maintain Subic. He got them to maintain the cleanliness and security of the Subic Base facilities without pay. Through rhetoric and speeches, he exhorted them to action.

Rituals. Public rituals help the citizens become mindful of certain themes in their inner lives that are woven into the collective consciousness. Acting out the rituals help renew their belief in certain values and relationships. The monthly dancing sessions in Bustos can be thought of as rituals celebrating health, life and togetherness. The building of kiosks using only volunteer labor in Balilihan is also a ritual, a rite-of-passage of sorts, that allowed the citizens to discover and unleash the latent power of solidarity and cooperation that they had among them.

Stories and drama. Marikina citizens would never forget the drama behind Mayor Bayani Fernando sledge hammering an airconditioner before city officials. The aircon unit was confiscated from the office of a wealthy businessman in Marikina when it was protruding from the building’s wall into the city’s sidewalk in violation of the some city ordinances.
To send the message across to the citizenry that the city meant to enforce its ordinances, the airconditioner was smashed during a Monday morning flag ceremony in front of the City Hall employees.

Down south, Mayor Jess Robredo of Naga City was seen early in the morning as among the first on the city streets sweeping debris after a powerful typhoon.
Stories like these travel far and wide and stay long in the memories of the citizens. When certain stories stay in the minds of citizens, they serve as reference for behavior. Structures and Symbols. Physical structures symbolize meaning in a stronger and more permanent way. The Purok Kiosks of Balilihan (case __ below) not only served as a venue for purok meetings. The Kiosks were symbols of the capacity of the community for collective action, serving to remind them that they could achieve significant gains through cooperation. Like symbols, structures communicate meanings. The red colored sidewalks of Marikina City reminded the citizens of the new order that the City hoped to create.

Rules and Relationships. Rules and ordinances communicate the values, relationships, and behaviors that the municipality or city upholds. Ordinances complemented the red sidewalks in Marikina in communicating the desired behavior on the streets. Policemen enforced these behaviors.

Information, education, and communication. Leaders can create and manage meanings through comprehensive education, training, and information campaigns. The advertising industry is one big industry that focuses on getting the public to behave in a certain way (that is to buy the advertised product), through messages delivered via the different mass media.

The Meanings Axis The management of meanings can therefore be thought of as the LGU’s contributing to the cognitive, emotional, and spiritual experiences of individuals and communities. LGU interventions can be located on the Meanings Axis, with the temporal, Channel 1, waiting shed-type interventions on the right side; and the transcendent, Channel 4, forest-cemetery-type interventions on the left side. Of course, since a project can be perceived in multiple channels, various project components may be located on multiple points in the Meanings Axis.

Channel 4 3 2 1 Cognitive (forest-cemetery) Temporal (waiting-shed)
In municipalities we cited where leaders managed the meanings, we see that citizens themselves “enforce” the new value-driven behaviors among each other. If all citizens appreciate the meaning of a clean and healthy environment, or of harmony in the community, we could imagine how much this reduces enforcement costs. We would need less money for garbage trucks, pay garbage collectors; or fewer policemen to enforce laws, settle local disputes and even avert crime. The cases showed that effective public health leaders do not merely provide health services. Public Health Leaders create inroads into the consciousness of their constituents, awakening their imagination, and encouraging them to write and collectively act out the shared movies in their minds. As in the movie, a fine script will not come alive in film unless the actors internalize it. Our actors are now ready for a take. It’s time to spring into… Lights, Camera, Action!

Case 6 Awakening the Sleeping Giant: Citizens Mobilization and the Balilihan Countryside Action Program

Aling Maria smiled as she related the various undertakings of Purok Talong, her purok in the town of Balilihan, Bohol. A retired teacher, Aling Maria emerged as one of the more active members of her “purok,” a small group of around a dozen households living adjacent to each other. Like other puroks in Balilihan, Aling Maria’s purok named their group after a vegetable (eggplant).

She showed the ledger of their finances, reflecting P15,000 worth in purok funds earned from income generating projects such as rice-reselling within the purok, ornamental plant-growing, and regular contributions from purok members. Taking out another well-kept notebook, Aling Maria showed minutes of Purok Talong meetings held over the years. Agenda, discussions, motions, and decisions were all well-documented.

The present Balilihan was a far cry from the rebel-infested town it was in the 1980’s. In the past, armed communist rebels even raided the municipal hall in broad daylight. Balilihan then had the highest rate of insurgency-related deaths in the entire province.

But in the 1990s, a strong partnership between the local government and the communities resulted in a flourishing civil society through the purok system, and a major improvement in the peace and order situation. The citizenry became active partners in development, and took more control over their own lives.

A rural purok initiative for community-based Primary Health Care (PHC) program began in Balilihan in 1983. Dr. Jude O. Doblas, the municipal health officer, ,tried setting up purok organizations from 1983 up to 1988. When Mayor Edgardo Chatto assumed office in 1988, he learned that the program has made little progress apart from the construction of purok kiosks and training of barangay health workers. Dr. Doblas got little support from other government agencies because of the compartmentalized view that health programs were the sole concern of the health sector, ,and that there was no need for cooperation and coordination with other development efforts.

Seeing the purok approach as a viable vehicle for community mobilization, Mayor Chatto and Dr. Doblas expanded the purok concept to involve other sectors serving the municipality. This brought about the collaboration of the local government, the rural health unit (RHU), and the agencies (private and public) tasked to deliver the basic services to the community. This initiative was named the Balilihan Countryside Action Program (CAP).

Community Organization Phase

Armed with new skills and attitudes, the municipal and barangay machinery was ready to engage the community as partners in development. CAP was launched with its purok system giving spirit to empowerment through community organizing, mobilization, and human resource development.

Once the puroks experienced initial successes such as the construction of their kiosks and the maintenance of a small vegetable/herbal garden, many of them took on a life of their own. out of their own initiative, they started all sorts of projects, often with little or no support from the municipal government. As a result, there emerged 186 puroks with 1,302 sectoral volunteers, acting as semi-autonomous extensions of government.

The purok system has become a way of life. Residents frequently spend their free time in the purok kiosks. Prayer groups are organized around the purok organizations. Household kitchens are somehow linked together as they drew their rice supplies from the same of rice collectively brought and stored in the kiosk kitchen. During elections, a candidate’s performance in his or her respective purok became an important criterion for voters. Many new barangay leaders emerged from the ranks of the purok volunteers.

Case 7BHW Theme Song (Composed by and for Volunteer Barangay Health Workers of Bustos Bulacan)

BHW pangalan mo’y dakila / Nasa yo ang biyaya ng lupa / Lupa, langit tumawag kay Bathala Di ka lilimuting hanggang sa mamayapa.
Kami ang babae (ang babaeng sexing-sexy) (mga health workers Kami’y naririto upang tumulong sa inyo./ Maging sa paggawa, sa pagtulong sama sama / Kung kaya’t nabansagang, nabansagang BHW.
Ay-ay-ay-ay zero waste ugaliin Upang paligid ay luminis din Basura ay dapat sinupin. /
Mga basyong bote at lata ipunin upang maging pera / Upang makatulong sa mga batang namimili ng garapa.
Kinikilo papel at dyaryo, pambalot sa kahit ano. Tipunin natin ito, huwag ikalat saan mang dako.
Maga dumi ilagay sa lata, pagbukud-bukurin sa tuwina. / Pampataba sa lupa, upang halaman lumago at gumanda.
BHW your name is great you hold the blessing of the earth the earth and the sky called to God /will not forget you till you die. ) / we are the women (sexy, sexy women) (we are the health workers) we are here to help you. in deed we help each other together / that’s why we are called Barangay Health Workers

ay-ay-ay-ay practice zero waste management / to clean the environment, too don’t trash too much
put together empty bottles and can to make money, /and to help the kids who collect and buy them

/ scrap papers and old newspapers reach kilos, they can be used to wrap anything / let’s save them, and don’t scatter them anywhere.

place the wastes in cans, and every time segregate them they are good fertilizers for the soil, so our plants can grow and be beautiful.

/

1 Translated by Carl G. Jung

 not her real name

Chapter 4

restless_river — Fri, 15 Feb 2008 03:54:40 CST

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.

Social Organization	Case citation	Indicator of function of group
Households putting out garbage at the same time	Olongapo	Garbage collection level, spillage, compliance rate
Individuals donating blood to increase reserve blood pool	Davao	Blood reserve levels
Individuals paying premium for health insurance	Guimaras	Premiums, positive cash flow of project
BHWs and friends getting together to dance once a month	Bustos	Uniforms, choreography
Filipinos abroad getting together to support a project in their home province	Sebaste	Funds generated
Care-givers attending class for caring for differently-abled	Alimudian	Attendance in classes
Purok committees planning purok development	Balilihan, Bohol	Purok kiosks, minutes of meetings, budget of purok
Confederation of health councilors	San Miguel, Bohol; Surigao	Minutes of meetings
Joint venture of municipality with private operator of X-ray machine	San Miguel, Bohol	Minutes of meetings, dividends from operations

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.

Chapter 3

restless_river — Fri, 15 Feb 2008 03:04:28 CST

Chapter 3 Paradigm Pioneers
I have a dream... -Martin Luther King
All leadership takes place through the communication of ideas to the minds of others. –Charles Cooley

A forest-cemetery,that’s new.(actually not a novel idea but new for Philippines?) Mayor X of San Carlos City shared how pieces of the concept came together in his mind. First, he read about the 5-day war in Israel that resulted in some 5,000 casualties. In remembrance of those who died, a forest was planted. Second, he noted how Filipinos no longer cherished the forests and trees. Trees were cut and forests leveled because trees were merely objects to be converted into saleable lumber. That’s why there were denuded hills in San Carlos City. The third recognition was that Filipinos revered their departed family members, traveling from across the islands to visit their tombs on All Saint’s Day. Fourth, the city’s cemetery was getting congested. In the long run, the city could not be expanding acres for the dead as that that would deprive the living of the precious land. Thus, the concept of the first forest-cemetery in the Philippines was crystallized in his mind. A memorial forest would be planted and the remains of the dead would be transferred, after 5 years in the cemetery, to the foot of a specific tree. The family could then visit the tree to remember their loved ones. The forest has become sacred ground, as such no logger would dare cut down those trees. The city cemetery no longer needed to be expanded. Instead, the forest would become dense as the number of memorial trees increased when the departed citizens were moved to their final resting place of shady greens.

Leaders Make Things Happen Everybody has bright ideas about what government should be doing. Radio commentators, newspaper columnists, TV journalists, NGOs and even the beer-drinking bunch next door all have their bright ideas about how the town, city, or nation should be run. Unfortunately, not all of them have the opportunity to turn their ideas into reality. Unless they take things upon themselves and become entrepreneurs or decide to run for office, they remain fence-sitters, watching as others make things happen.
The Leader as Innovator or Early Adoptor Change happens first in the minds of the inventors and innovators. In the LGU, this may be the mayor or governor herself. Marikina City’s Mayor Bayani Fernando, asked what drives him to innovate, cites the “inventor’s high” as a major motivator. He gets a real kick by conceptualizing programs, implementing them, and seeing them succeed. (insert a summary of Marikina’s award winning program under Bayani Fernando.) Sometimes, the idea comes from somebody close to the mayor. The mayor’s role, in this case is to recognize the good idea s and move them forward into implementation. In many cases studied here, the innovations were conceived by the Municipal Health Officers and championed by the Mayors. There are describes five types of individuals within organizations according to the way they accept new ideas.1 These are:

Innovators – these are the dreamers who hatch new ideas.
Early adopters – these individuals recognize a good idea when they see one. Their ideas are respected within the organization. Though the ideas are not theirs, they try to convince others to accept it.
Middle adopters – accounting for the majority of the organization, they respond to the opinions of others. They are reasonable in their analysis of an idea but are inclined to maintain status quo.
Late adopters – these individuals are the last group to accept an idea and will often speak out against the proposed changes. They will usually adopt an idea only if the majority demonstrates support.
Laggards – these individuals are committed to the status quo and the past. They are always against change.

From Insight to Action Once the mayor decides that an idea is worth trying, she now works it through the bureaucratic structures so that it can be implemented. The following seven steps can be thought of as processes for injecting new ideas into the bureaucracy. Similar processes occur as the idea is presented to the citizenry.2

Step 1	Innovation. The innovator dreams up a new approach to current problems. He presents it to the Mayor.
Step 2	Information. The Mayor rounds up a technical working group to put together a program concept paper. The concept paper is then circulated. Initially, the new concept is not embraced. The new idea meets apathy, tradition, and prejudice. People resist change and point out the problems of the new concept. They try to prove how the status quo is better.
Step 3	Individual Change. The early adopters (often members of the initial technical working group) begin to see the strengths of the proposed concept and embrace the idea. Personal convictions replace complacency.
Step 4	Organizational Change. The early adopters are able to persuade more individuals (inside the bureaucracy and partners from the private sector or civil society) to support the program. Less defensiveness and more openness can be observed. Operational issues of the program are hammered out.
Step 5	Awkward Application. The program is implemented and early successes and failures are experienced. The learning process is rapid. Some assumptions are validated.
Step 6	Integration. Awkwardness begins to decrease. Efficiency and effectiveness increases. As new successes occur, more support from the middle adopters and late adopters is generated.
Step 7	Cultural Evolution. After repeated cycles of program implementation, the new scheme becomes the norm, the status quo, part of the culture – until the next wave of innovation.

Heading
Steps 1 to 6 are the common steps of in program implementation. This sequence works well in government programs where government provides the services and the citizens are passive spectators or clients. Such is the case in government-run a free clinic, day care center, or waiting shed construction. It’s different for programs where the citizens play an active role in implementation. In such cases, the citizens are not passive clients or beneficiaries of a program, they are themselves the actors. Marikina’s Pulitika Sa Bangketa (Case No.3), would have failed if the citizens refused to follow the rules. Of course, non-compliant citizens would have been fined or arrested, but widespread compliance made the program succeed. Widespread rejection of the ordinances would have resulted in the continuous chaos in the streets, as in many other areas in Metro Manila. In it’s traffic and parking management component Marikina’s Towards Hassle-Free Roadways mobilized the citizens not only to comply but also recruited them to enforce the ordinances through it’s self-policing mechanisms. LGUs as Supporting Actor In the entertainment industry, Sharon Cuneta, the Megastar and Vilma Santos, the Star for All Seasons have played a plethora of leading roles in their films. Through their powerful dramatic acting and sheer audience-drawing power that their movies became box office hits. Exemplary LGU programs, on the other hand, often do not intend for the LGU to be the Megastar. In programs where LGU resources are limited, when the problems addressed are complex and multi-dimensional, government has to recruit the citizenry for some audience participation. In such cases, the government is no longer the lead actor, or bida, but instead relegates itself to acting out supporting roles, allowing the private sector or citizenry to take the lead. Such an approach requires the government to take on a lot of new roles. Likening these roles to those in the entertainment industry, we can better understand what excellent LGUs do.

Example	Role	Tasks
Jess Abrera	social analyst/ critic	segmentize, understand publics, identify needs, wants, and motivations
Pete Lacaba	Scriptwriter	conceptualize plot, write script, strategize
German Moreno	talent scout and manager	identify and nurture talents, identify lead and supporting actors
Mother Lily	Producer	negotiate, contract actors, support crew, find investors
Marilou Diaz-Abaya	Director	Director, orchestrator, coach
Panchito	Supporting Actor/ Extra	Helps lead actor act out his role as extra, spices up the movie with antics and bit roles
Nestor Torre	Film Critic	evaluate, review, rate

adapted from Limlingan
In this scheme of things, an idea starts with a keen eye for the needs of the different sub-groups in society. It starts with a social analyst and critic studying, seeing and being disturbed by the realities around them. Like the social analyst and cartoonist Jess Abrera who comes up caricatures of Filipino life and culture in Pinoy Nga! published weekly in the Sunday Inquirer, the public health leader has to have a keen eye for details, and discern emerging realities and problems, and describe them to the rest of society so that they can be acted upon. Next, the public health leaders has to be a scriptwriter like Pete Lacaba. He understands and lays down the setting, conceptualizes a plot, and imagines the cast of characters and the roles they play in order for the story to unfold. The public health manager then has to be like German Moreno, the talent scout and manager. The talent scouts looks around for potential actors and recruits them for the movie. As a talent manager, he prepares a series of contracts so that the newfound talent hones his skills and grows into a powerful actor over time. A producer like “Mother” Lily Monteverde to assemble the production team to make the movie. She brings in investors, the technical staff (cameramen, lights men, and editors), director, and actors together. She orchestrates the ensemble of resources, manpower, and ideas together to turn the script into a movie With all the requirements in place, the public health leader then sets the stage, brings out the script and calls the people to action like director Marilou Diaz-Abaya. As director she ensures that the actors interpret their roles correctly and that the relationships between the characters develop as planned. The LGU or public health leader often also has to be an actor in the movie. Like Panchito (who was for decades Dolphy’s supporting actor), the supporting actor may play a significant role in bringing out the character of the lead actor and pushing the plot forward. If the actor plays a bit role, then he’s there to spice up the movie and provide a little support here and there. Finally, after the change happens or after the program is accomplished; the public health leader, like film critic Nestor Torre, evaluates the program for its strengths and weaknesses, its successes and failures. Public health leaders, therefore, have to be all these people rolled into one. There are some models in the entertainment industry who take on multiple roles. Jaime Fabregas not only tickles our bones with his comic and sometimes dramatic stints but also impresses us with his musical score. Cesar Montano has his hand on the script and musical score of his films, and even makes his tandem director, Marilou Diaz-Abaya, listen to how he thinks the act is to be staged. Action star Ronnie Rickets has produced (he owns a film production company) directed and wrote many of his films as well.
The Dancers Become the Dance The curious thing about treating the citizens as actors in the story is that sometimes, they take over the entire production. In the Bustos Jogger’s Club monthly dance get-togethers, it was the community’s event and Mayor Arnel Mendoza merely dropped by to say a few words and touch base with the participants. The various barangay “jogger’s clubs” financed the purchase of their own uniforms, and paid for their own merienda. At some point, the municipal bureaucracy had little or nothing to do with the perpetuation of the jogger’s club program. After some time in Marikina City, the citizens imbibed the behavior of discipline in the sidewalks. At some point, Disiplina sa Banketa was no longer a program to be implemented, but a sub-culture of the citizens of Marikina. Cultural evolution occurred. The dancers became the dance.
Transformative Leadership The roles of the public health leader, therefore, are multiple, and they shift over time as the health program unfolds. Table 4 below how the relationship between LGUs and it’s citizenry evolved in the course of the programs described in the cases. Table 4: The Empowerment Loop

	Partners passive	Partners active
LGU active	2 Early LGU-driven Well-defined program design Simple structures	3 participatory partner-strengthening LGU and partners as Co-equals
LGU passive	1 Stagnant, inaction	4 People-driven and LGU supported Diversification Differentiation Increased complexity LGU takes a back seat Evolution to a learning community

An LGU starts out in Quadrant 1 where the problem is not actively being addressed. Once a problem is recognized and a solution is to be tried out, the LGU moves to Quadrant 2. During the start-up of the program, the LGU is the main driver and the program moves along from Stages 1 to 5 (from innovation to awkward application) occurs in this quadrant. Leadership and decision-making is concentrated in the public health leader and the program goes more or less as designed. If the LGU and the public health leaders are willing to share power with the citizenry, the program moves to Quadrant 3 where the partners take a more active role in program in implementation. This quadrant roughly corresponds to Stages 2 to 6 (information to integration) as the partner organizations or the citizenry begin taking on the processes of the program. Some authority and responsibility, and therefore political power, is delegated to the partners. The partners become strengthened by the growing operational and political control over the program. The partners become increasingly autonomous, along with an increasing sense of ownership over the program. Takeover occurs in Quadrant 4, when the partners assume accountability for the program (stages 6-7, integration to cultural evolution). At this point, the LGU leaves the driver’s seat and allows the partners to drive the program. In a sense, the program takes on a life of its own and it become increasingly difficult to attribute the further outcomes of the program solely to the LGU. The program becomes woven into the partner organization’s operations or into the citizen’s culture. After 20 years of implementation, the Surigao Federated Women’s Club (Case 5), is clearly in Quadrant 4. By the time the case was written, the organization was already involved in a gamut of health programs, from family planning, to youth programs, to a health information program through local radio.
The Leadership Axis discusses various strategies for change management based on the management sciences. The Leadership Axis arranges managerial phenomena from micro-management on the left to strategic management on the right. It also orients the different change management strategies from evolutionary change on the left to programmed change on the right (see Case 4).
The Leadership Axis To help get a better handle on the concepts presented in this chapter, they are chunked up in the leadership axis (See Fig.1). In terms of management style, intuitive management is placed on the left and strategic/goal-oriented management is placed on the right. Leaders with formal management training or corporate experience are likely to be seen to the right. In terms of change management style, the goal-oriented. Leader-driven. programmed change is located to the right. Towards the left is the more process-oriented, participatory, and less controllable evolutionary and participatory change.
Figure 1: The Leadership Axis

intuitive mgt. - operations mgt. - organization mgt. - strategic mgt. disorder - evolutionary change - emergent change - programmed change people-driven/bottom up- participatory mgt. -leader-driven/top-down

Because of Marikina Mayor Bayani’s corporate background, his management style is highly goal-driven and based on strategic plans. The leadership style which is described as leader-driven, with programmed change based on strategic plan is plotted in the right side of the axis. His projects can be located mostly in Quadrants 2 and 3. (Marikina City is a Hall of Famer in the annual Galing Pook awards. Among the programs that bagged awards for Marikina City were Squatter-free Marikina; Barangay Talyer, Disiplina sa Bangketa and the Save the Marikina River.) Bustos, Bulacan Mayor Mendoza and his doctor-wife, are physicians by training but their highly innovative, process-oriented, people-oriented leadership style more than made up for that slack. At the start of Mayor Mendoza’s term in 1988, he had no strategic plans. His programs were driven primarily by good intentions. The husband-wife team’s leadership style could be located in the left side of the Axis because their efforts resulted in a highly participatory evolutionary change. We must note that the results here are no less effective than the right side type.
Conrado de Quiros describes this all succinctly. He wrote:
We need an ordinary mortal who rises to the extraordinariness by the heroic nature of her vision, by the epic nature of her quest, by the monumental scale of her dedication to it. We need someone who is humble enough to hear the voice of the people and is proud enough to bend the world to their will. We need someone who can push people to transcend themselves, and, doing thus, pull them to reach for things beyond their grasp. We need, in sum, a leader.

Case 4 Marikina City’s Politika sa Bangketa
Anarchy in the sidewalk of Marikina flourished through years of neglect and indifference. There was a call for change with the coming in of a new local chief executive. The battle cry was the need for discipline. " A man may be king in his domain, but once he sets foot on the sidewalk he has to bear in mind that he is bound by the rules of society and has to live by them." Appropriate ordinances, which prohibited the use of sidewalks for other purposes, were passed. Initially, the city disseminated to all households a pamphlet on "Disiplina sa Bangketa" (Discipline in the Sidewalk) outlining the rules and regulations to guide people's behavior in the sidewalk. The city paved around twelve kilometers of its sidewalk with red colored demarcation line to impress upon the public the value of conforming to the rules and mores of society to achieve physical and social order. Its operation was guided by the dictum of checking the smallest infringement in the law with the objective of eventful ease in reducing petty and bigger crimes on account of the citizen's obedience to simple rules and regulations.
The city government succeeded in liberating 90 percent of its sidewalk from any form of encroachment or obstructions. Trees were planted along the sidewalk and in other parts of the city in support of its program called " Puno Kahit Saan ( Trees Everywhere) to convert the whole city into a nursery of trees. Everyone was encouraged to plant trees everywhere with guarantee from the city government to remove and transfer the trees anytime for free. The city acquired a tree mover for balling out and transferring trees. In 1997, around 85,000 trees had been planted. The tree planting is consistently being pursued to attain its goal of having 1,000 to 1,500 trees planted per capita. Added to these accomplishments was the implementation of another program " Towards a Hassle Free Roadways" which strictly enforced the traffic and parking ordinances through self-policing policy. To support the program, a five-hectare parking area was built; street and traffic signs were upgraded; new access roads were opened to decongest main thoroughfares, among others. As a result, Marikina has some of the safest and most convenient sidewalks and roads in Metro Manila today.

Case 4 Federated Women’s Club in Surigao
Surigao City is known to award-giving national and international bodies through its primary health care program initiated and implemented through women's clubs. In 1976 Mrs. Zenaida Arana, a midwife of the City Health Office assigned to two barangays, began organizing mothers at the purok level and training them in nutrition, responsible parenthood, and sanitation so they could assist in the delivery of PHC services.
Barangay Health Workers (BHWs) assisted Mrs. Arana in her pioneering tasks. By the 1980's mothers clubs had become very visible in the city. Because of their success, local politicians took advantage of them and converted them into their private organization. This confused the members, and the organization died within one year. It took Mrs. Arana two years of hard work in 1985 and 1986 to form another set of ten mother's clubs.
LOCAL GOVERNMENT SUPPORT
In 1988 the new City Health Officer gave recognition to Mrs. Arana's efforts and assigned her as overall coordinator of the primary health care programme for all 54 barangays of the city. Because of that support Mrs. Arana was able to organize a functional PHC Women's Club in all the barangays. In 1991 the groups formed a federation. In 1992 it became the Surigao City Primary Health Care Federated Women's Club, Inc., and since then has been instrumental in propagating the PHC strategy.
FAMILY PARTICIPATION The women involved their husbands in primary health care activities. The men got into the program by organizing the BESIG (Barangay Environmental Sanitation and Implementing Group). The PHC Youth composed of 12-21 year-old family members and the Mini-Youth (from 7-12 years old) were subsequently organized by Mrs. Arana. By 1990 BESIG had become an indispensable partner of the PHC women's clubs. TRAINING AND AWARENESS
The PHC activities involve immunization, family planning, nutrition, implementation of the national tuberculosis programme, and control of the diarrheal projects. Believing in the capacity of mothers to implement PHC, the programme put emphasis on training women in leadership, community development, and management. PHC also runs a weekly radio programme to promote health awareness and serve as a communications facility among the members. ORGANIZATION
The federation is organized like a pyramid, with the 7,200 members of 180 chapters at the base. The chapters are grouped into seven districts composed of five to 12 contiguous barangays. Each level of organization has its own set of officers, including its representative to the next higher level. The PHC structure involves the City Mayor and Vice-Mayor as PHC Committee chair and co-chair, respectively. Mrs. Arana remains as PHC Coordinator and adviser.

FINANCING The PHC gets financial support from the development fund (20% of the City's IRA). The City budget also funds its health projects. However, the organization is essentially self-supporting. The annual membership fee is P10.00 (ten pesos). Each member also contributes P60.00 a year for funeral assistance to members. The organization also raises funds from special projects and accepts donations from external sources; cash awards from HAMIS (Health and Management Information System) in 1991 and 1994 went into the financing of PHC activities.
MEASURING SUCCESS
Infant mortality in Surigao City was a high 76.6% in 1981 and 69% in 1984. After PHC became active it was drastically reduced to 29.5%. By 1996 it was only 19.1%. Maternal mortality rate also went down from 1.9% in 1975 to .5% in 1996. In the years PHC was inactive, both infant and maternal mortality rates were high.
Nutrition rates for pre-school children have also improved. In 1980 there were only 38.1% of children who had normal weights. Although the figures fluctuated, the rates were lowest when PHC was inactive. In the last few years of PHC's re-emergence the rate of children with normal weights had been high--- 54.7% in 1992, 59.19% in 1993, 61.02% in 1995, and 62.54% in 1996. The establishment of BESIG in 1990 has increased household access to sanitary toilets (Table 8). Conversely, households without access to sanitary toilets decreased at a rate of 31% in 1990-96.
These figures show the impact of the PHC Women's Club in the lives of Surigao City residents.

1 Winifield Arn, Growth Report No.5., Ten Steps for Church Growth (New York: Harper & For, 1977). As summarized by John Maxwell, p.64.

2 Adopted from Maxwell, p.65, Developing the Leader Within You