Following typhoon Haiyan, health services were significantly affected, particularly in remote areas where access was already a challenge for many older people due to cost, mobility challenges and a lack of affordable health services addressing older people’s specific needs. The health services that were provided immediately after the typhoon focused on maternal and child health, with little attention given to the issues faced by older people. As a response, COSE developed its mobile health and care services approach. In the initial stages of the response to the typhoon, COSE consulted older people on their priorities, through older people’s organisations (OPOs). Health services emerged as the key issue for older people, above other sectors and services affected by the typhoon. The OPOs particularly highlighted the need for health services to be made available at the community level, closer to where older people lived. They identified significant gaps for bedridden older people who were unable to travel to access services.

Older people with vulnerabilities

Health, Social protection

Government, Civil Society Organization, Older People's Association, Academia

Older people helped to implement the project

COSE worked with Older People Organisations (OPOs) to establish an approach to deliver community level health and care services. An initial consultation meeting was held with representatives from the OPOs, the local government unit (LGU) and the office of senior citizens affairs (OSCA). The OPOs presented what had emerged through the consultation process and worked with the LGU and OSCA, alongside COSE staff to agree the best approach to take and design the interventions needed to deliver health and care services.

Through the intervention, and in the aftermath of typhoon Haiyan that brought huge loss and destruction, older people felt that a positive outcome was the increased opportunity for them to engage and more attention being given to more remote and isolated areas of the country. Following the mobile health care services project and older people’s role in them, older people reported feeling more visible, more heard and more valued. Playing a role in what they saw as a life changing and life-saving project motivated them to work hard and support each other. There was also a sense of responsibility. Older people felt responsible and accountable to each other and their frail and bedridden peers who were receiving care. Older people reported feeling that they had a renewed sense of purpose in life knowing that they were contributing to improved health services for their communities. The partnership between OPOs and LGUs in the project helped to increase understanding of the LGUs of the needs of older people. Where they had previously seen older people as passive recipients of services, they began viewing them as active contributors who needed to be involved. Most municipalities now have an OPO representative in their development councils. This structure is replicated at the barangay level.

Most members of OPOs are women. This is representative of the population structure, but also a reflection of older women’s motivation to engage. This is particularly seen in relation to health focused activities, with older women dominating. The majority of the older people trained were older women. Health and care activities are seen as ‘women’s work’, and there are cultural challenges in the provision of care. A man can be cared for by a woman, but it is not seen as appropriate for a woman to be cared for by a man. It takes a lot of time to change cultural practices and they will have to come from within the groups, as older men and women see the benefits of more of them being trained to provide care for their peers.

(1) The importance of regular monitoring data collected by members of the community: Older community health volunteers monitored whether older people were receiving services and whether they were happy with the services provided. They also monitored the health status of the older people receiving care from the nurses. If someone’s health status declined in between nurse visits the community health volunteer sent a text message to the nurse to alert them. Nurses were responsive to these messages and to the data collected. They used it to prioritise their visits, to guide referrals and to develop care plans for their patients. They were also responsible for ongoing community level identification, undertaking regular community visits to identify any older people who had become newly unwell or who needed increased support. (2) Community volunteers need a formal multi-sectors structure of support: The volunteers were supported in their role by technical support groups. These groups, formed of NGOs, academics, and LGUs, provided ongoing support to community health volunteers and the wider OPOs in their provision of services and support. Each support group had a memorandum of understanding with clear roles and responsibilities for the different actors involved. The establishment of the support groups helped increase the sustainability of the interventions. The community level health and care activities continued after the funded project in three municipalities because of this support.

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