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FACTORS AFFECTING EFFECTIVE HEALTH INTERVENTION IN IMPLEMENTING

COMMUNITY BASED DRUG REHABILITATION PROGRAM (CBDRP) TO


KAUSWAGAN SURRENDERERS
CHAPTER 1
Introduction
Drug addiction is one of the fundamental problems in the society, which destroys millions of
lives and national resources for fighting, treatment and harms incurred by addiction1.Drug
addiction imposes biological, psychological, and social problems, and incurs profound harms
to the health of the society2.
The global problem of addiction and drug abuse causes 5 million deaths and about 42 million
new cases of AIDS each year3.
Proactive ways in addressing the ill-effects of drug use and dependence are therefore
highly essential. A need of better approaches which are evidence-based and culturally
adaptive is a must. While concerned efforts have already been instituted, much is still to
be done in achieving those goals. Community-based assessment, treatment, and care
services for drug users in the Philippines can be a cost-effective and are proven alternative
models that can be done in a caring country like ours. Based on a public health and human
rights approach, this can make services more accessible, addressing issues on stigma, fear
of social, economic, and legal consequences, and can ensure treatment compliance.
Development of model programs anchored on the principles of effective drug use and
dependence treatment would help provide quality services which are accessible and
affordable aligned with the DOH “Kalusugang Pangkalahatan” / Universal Health Care High
Impact Five (Hi-5) strategy4.

Drug abuse is followed by loss of life and property, social consequences such as economic
costs, death, suicide, heavy offenses, unsuccessful marriages and the risk of sexually
transmitted diseases such as AIDS and hepatitis5. As the findings of extensive population-
based studies on drug users show, the relatively high prevalence of drug use and changes
in the trend of drug use (using impure drugs) increases the drug-induced mortality6.
Today, addiction treatment center use conventional techniques of brief interventions such as
training programs of anger management, increasing incentive to reduce drug use, reduced
drug dependence and cognitive behavior therapy and prevention of lapse 7.
Studies show that a variety of factors affect drug use including social factors (such as the
influence of friends, acquaintances or family members, influence of media and advertisement
for drug and cigarette use, and lack of resistance to peer pressure) and interpersonal factors
(such as low self-esteem, excessive anxiety, frustration, low self-control and sensation-
seeking)8. Social and cultural factors of tendency for drugs include cultural–social domain
(including the availability of drugs and non-scientific advertisement of beauty products and
athletic supplements), family domain (presence of a drug addict in the family, parent-
adolescent relations, parental control variables), peers and friends domain, adolescent’s
personality domain, emotional functioning, and social attachment9. In a study on addicted
people, the most common causes of tendency for drug use were factors such as addicted
friends, unemployment, lack of attention to religious tendencies, economic problems, marital
discord, lack of recreational facilities, availability of drugs, failure to say no to others’
demands10.
Although studies have been conducted on the causes of tendency for drug use, all effective
factors have not been identified and further studies are needed in this area. Thus, this study
was developed to assess the impact of the health provisions as an effective factor in
implementing Community Based Drug Rehabilitation Program (CBDRP) working for the drug
use and dependence prevention, treatment and care in the Municipality of Kauswagan.

Theoretical Framework
Theoretical frameworks used to guide the development of the educational intervention
included the community organization model, in which community leadership and local
residents are mobilized for social action11, and the behavior change model, based on
Bandura’s social learning theory, which suggests that new behaviors can be induced from
exposures to powerful models and are maintained through social reinforcements.12 The
persuasive influences were considered to be community norms, village leaders, parents and
grandparents, significant others, and peers.
Figure 1 presents a theoretical model of factors influencing the initiation of drug use, including
self-efficacy and youth activities, community service, and instruction on agricultural
productivity to increase a sense of self-efficacy. Community involvement in designing and
implementing intervention strategies was designed to influence community norms (e.g.,
smoking, educational attainment, family norms, and peer pressure) that influence the
decision to take drugs.

Figure 1: Theoretical model of factors influencing the initiation of drug use.


Moral principles13, as well as pragmatic principles, were used to encourage preadolescents,
adolescents, and young adult males to avoid drugs and thereby contribute to the well-being
of both the community and themselves. Rural villages are very conservative and tend to
interpret issues as “good” or “bad” (evil). Thus, the villages elected to use these concepts in
developing their intervention messages. Social marketing principles14 were used to guide the
design of the educational messages15.

Conceptual Framework
The past decades have seen increasing concern for sub-stance use, and the United Nations
Office of Drugs and Crime (UNODC) reports that 2.3% of the world’s population abuses illicit
substances. The Philippine Drug Enforcement Agency (PDEA) also re- ported that 92%
of barangays1 in the National Capital Region are affected by illicit drug use (PDEA, 2015).
In July 2016, newly elected President of the Philippines Rodrigo Duterte declared a ‘war’
against illicit drugs dubbed ‘Operation Double Barrel’ or Oplan Tokhang 2, the campaign
involved efforts at demand reduction and supply reduction. Supply reduction involved
shutting down drug laboratories and arresting drug suppliers. Demand reduction activities
involved community officials and/or local police going to the homes of known users and
asking them to voluntarily surrender and receive treatment. 16
As of March 2017, 1.18 million illicit drug users have surrendered with an additional 44,070
arrests and 2,206 fatalities. 17 However, beyond these legal measures, the Human Rights
Watch 2017 reports that the Philippine National Police and unidentified vigilantes have
killed about 7,000 suspected drug users and pushers in what are now termed extra-judicial
killings. The staggering numbers highlight the urgent need to develop and implement
drug treatment programs. However, because drug treatments are costly and generally
inaccessible to the poor, the UNODC suggested the necessary provision of community-
based drug recovery support. 18
In the rural barangays of the Municipality of Kauswagan, Lanao del Norte, drug use and
abuse is a social and health concern. Poverty has become an increasing cause for
involvement in the illegal drug trade. Foreign drug syndicates take advantage and exploit the
poor and use promises of “easy money” to entice the people to serve as couriers and runners.
The schematic diagram below shows the variables reflected to the first box. These are
independent variables, the health intervention factors which point out the major causes of
effective Community Based Drug Rehabilitation Program (CBDRP) implementation. In the
second box is the consequence of health intervention factors, an effective Community
Based Drug Rehabilitation Program (CBDRP). This is the dependent variable. An
independent variables or combination of these factors can be the cause of effective
implementation of Community Based Drug Rehabilitation Program (CBDRP).
INDEPENDENT VARIABLES
DEPENDENT VARIABLES
 Preventive Education

 Health Promotion
Effective Health Intervention
 Screening in Community Based Drug
Rehabilitation Program
 Treatment (CBDRP)

 Rehabilitation Services

 Primary Health Services

 Basic Support

 Health Education

 Skills Training

 Livelihood Opportunities
In Communities

Schematic Diagram

Turn-over of Surrenderers to
LGU- Kauswagan thru Community Based Drug
MUNICIPAL HEALTH Rehabilitation Program
OFFICE (CBDRP)

INTERVENTION PROCESS:
1. Organization
2. Enrollment to the Program
3. Orientation of the Program
4. Implementation of the Care Programs
5. Evaluation
6. After Care
Research Objectives
Health interventions need to reach people at either their homes, schools and workplaces, or
by encouraging them to visit health facilities. Programs based in communities can reduce the
costs and barriers that impede people’s access to services. 19On the other hand, general
primary care can act as an interface between community health programs and individual
clinical care, whether ambulatory or inpatient. Hospitals are needed to reinforce community
and primary care services when specialized equipment or skills are required for particular
interventions. 20
This study will be conducted to find out the extent of how extreme is the effect of the factors
of health intervention in the Community Based Drug Rehabilitation Program (CBDRP) to the
voluntary surrenderers in the Municipality of Kauswagan, Lanao del Norte. The result of this
study is beneficial to the Person Who Used Drugs (PWUDs), to the community and other
interested individuals because this can serve as empirical data where suggestion of
minimizing drug use and pursuing the health interventions in implementing community based
drug rehabilitation program.
The study will also benefit communities to enable them to realize the great role played by the
City or Municipal Health. This enables them to guide and identify the major factors causing
effectiveness of health intervention in the CBDRP process. Then and there they would
intensify their functions to counter those causes by diversity. The researcher hoped that the
result of this study would also would also be a great help to future researchers and to all
people who are interested to know more about Community Based Drug Rehabilitation
Program (CBDRP) and the affecting factors for a successful implementation of such.
CHAPTER 2

Design
This quantitative analysis study was conducted on 32 people attending the Community
Based Drug Rehabilitation Program (CBDRP). Purposive sampling was used to select 29
men and 3 women for the study. Data were collected through personal interviews, each about
15 to 20 minutes. Then data were recorded on paper and to ensure the accuracy of
transcripts, they were reviewed by participants for several times. The health intervention
factors were recorded exactly and word for word. Then the relevant texts on the factors of
effective health intervention in CBDRP were extracted and all integrated into a single text
which formed the unit of analysis. Then the text was reviewed through dividing into each
interview as a single unit of analysis and semantic units were summarized. The summarized
semantic units were coded and multiple codes were compared with each other based on the
differences and similarities, and eventually were divided into 4 categories and 15
subcategories. Findings were reported based on the frequency of codes and developed
categories.

Respondents

The respondents of this study would be randomly selected in the three barangays of the
Municipality of Kauswagan, Lanao del Norte, which are already declared as Drug Cleared
Barangays as per the Philippine Drug Enforcement Agency (PDEA). They were chosen to
provide vital informations about the factors of health intervention affecting effective CBDRP.
These respondents were selected to generate information on these factors affecting
effectiveness of this program where they are affiliated.

The respondents of the study are those whose ages range from 15 to 50 years old who have
used drugs. Data about the respondents can be obtained from municipal health centers. The
local government has programs for the health development and recovery of these people but
still lacks factors affecting effective implementation of the program. Respondents were asked
with the following questions listed in English and was translated in Visayan dialect for better
gathering of answers from PWUDs:
1. Did the Municipal Health Office formulate policies and standards for health related to
drug abuse?
2. Is there any educational disseminations to prevent and control drug abuse and its
health-related effects conducted by the Municipal Health Office thru its workers?
3. Is there any surveillance and health information systems related to drug abuse
developed by the Municipal Health Office thru its workers?
4. Did the Municipal Health Office maintain and operate drug abuse treatment and
rehabilitation centers (outpatient/residential), detoxification units and drug testing
laboratories with modern and advanced capabilities to support local services?
5. Is there any promotions on health and well-being through public information and
provisions to the public with timely and relevant information on the risks and
hazardous effects of drug abuse?
6. Did the Municipal Health Office develop and implement strategies to achieve
appropriate expenditure patterns in health related to drug abuse as
recommended by international agencies/partners?
7. Did the Municipal Health Office develop and coordinates with regional/local
facilities or offices for health promotion, drug abuse prevention and control,
standards, regulations and technical assistance?
8. Is there any promotions and maintaining of linkages for technical collaboration made
by the Municipal Health Office?
9. Did the Municipal Health Office ensures the quality of training and human
resources development at all levels of care for drug abuse?
10. Did the Municipal Health Office oversees and ensures equity and accessibility to
health services for drug users?
11. Did the Municipal Health Office conducts research related to drug abuse prevention
and control?
12. Did the Municipal Health Office ensures the provision of sufficient resources and
logistics to attain excellence in evidence-based interventions for drug abuse and
its health-related effects?

Setting

The study was conducted in the three different barangays covered by the Municipality of
Kauswagan, Lanao del Norte. These are: Barangay Kawit Occidental, Barangay Kawit
Oriental and Barangay Tugar. These barangays were already declared as PDEA Drug
Cleared and were recently fruitful in implementing the Community Based Drug Rehabilitation
Program (CBDRP). Kauswagan, officially the Municipality of Kauswagan,
(Cebuano: Lungsod sa Kauswagan, Maranao: Monisipiyo san Kauswagan, Filipino: Bayan
ng Kauswagan), is a 5th class municipality in the province of Lanao del Norte, Philippines.
According to the 2015 census, it has a population of 26,278 people.21

This municipality was purposively chosen because of its accessibility to the researcher in
gathering data for the reason that this municipality is developing and the researcher is
concerned to those Persons Who Used Drugs (PWUDs) and those who will be tempted to
use in the future, who in the locality and are often the topics of the bystanders and
acquaintances of the respondent who are affected with the sudden twist of their life situation.

Instrument
The researcher employed a self- made questionnaire to gather data of the present study Part
I is the demographic profile of the respondents which includes their name, age, age when
they started using drugs, last school attended or work connected, educational attainment and
the economic background of the respondents. The second part of the questionnaire deals
with the health intervention factors in the Community Based Drug Rehabilitation Program
(CBDRP).

Ethical Consideration

The researcher sought permission from the Municipal Health Office and Barangay Health
Centers in Kauswagan, Lanao Del Norte, to be given pertinent data of those enlisted as Drug
Users. Inquiries from municipal and barangay officials, friends, co-nurses, neighbors and
relatives were also be considered in the possible search for respondents.

Once the researcher has identified a qualified respondent, she will personally
approached the target respondent and explain to him the study that the researcher is
presently doing. The researcher also explained to that his cooperation will be of great help
for the success of the said study.

In the analysis of the data of the study, the researcher employed the following statistical tools.

Frequency and Percentage. This was used to determine the demographic profile of the
respondents in terms of age when they started using drugs, civil status, type of school
attended and their economic background.

Average Weighted Mean. This was used to find out the extent of health intervention factors
in the Community Based Drug Rehabilitation Program (CBDRP) among the Persons Who
Used Drugs (PWUDs).

The t-test was likewise used to test the significant difference of the extent on the health
intervention factors employed in the implementation of Community Based Drug Rehabilitation
Program (CBDRP) when grouped according to age, educational attainment, civil status and
economic background of the respondents.
Step- Wise Regression Analysis was engaged to analyze which among the health
intervention factors greatly affects the effectiveness of Community Based Drug Rehabilitation
Program (CBDRP).
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