In April 1982, the Urban Child Project was approved and granted assistance by the UNICEF. The project’s life is from 1982 to 1987. The agreement was premised on the belief that total development requires the coordinated efforts of the community, government, and non-government agencies,that the needs of a child are affected by the needs of the mother to participate in income generating activities and to meet the nutritional needs of the family, and the problems that outsiders so that given the necessary and resources, they can best attend to their needs.
1. To organize inter-sectoral teams composed of Government and non-government agencies;
2. To improve the quality of the child care leading to his total development;
3. To train volunteer teachers (child trainors) for child-to-child instruction, who will train health scouts and provide assistance to livelihood activities; and
4. To increase household and community capabilities in child care and development and reduce malnutrition among the 0-4 year olds through

Methodology

Decision on the geographical area for project implementation was reached after several consultations between the City Health Office and Institute of Primary Health Care (IPHC). Selected was based on the following:
1. the area is economically depressed,
2. inadequacy of basic services – potable water sewerage, sanitation,housing , health delivery,
3. willingness of the community to participate
4. presence of a volunteer health worker preferably a katiwala

Having selected Agdao on the basis of the above criteria, orientation meeting were helod with the  local officials by the staff of Ministry of health and Institute of Primary Health Care (IPHC). The Barangay Officials (P.O), The worker who would do all the leg work and be the contact person in the community went to each purok, to hold group meeting and explain the program and to get the opinion of the people. When the people were receptive, a general meeting was held to get a consensus regarding the project.
The IPHC proposed a Primary Health Care  Program with the following components:
1. Community Capability Building to prepare the community to plan implement, and monitor its own project for urban children.
2. Child-to-child Program: Training of 9-15 years old children in the care of their pre-school siblings, in the three areas of child development (mental, physical,and psycho-social development).
3. Katiwala Service;; expansion of katiwala activities , from health service delivery to leadership of the community  activities, linking with other agencies, and training of the other volunteer health workers.
Capability Building Activities Included:
1. Focused family dialogue. These were dialogue among family members (2 to 5 oer family) facilitated by the IPHC Project Officer with the assistance of a documentor.
The interview guide including questions on:
-their aspirations for their children
-barriers/problems to meeting these aspirations
-the steps that have  been taken to minimize these barriers,
-other step they want to take , and
-who they want to work with
2. Focused community dialogue . This was the forum for presenting the results of the family dialogue. Aspirations presented included:
-to send their children to school,
-to eat three meals a day
-to increase income
Barriers to these aspirations centered on lack of income- producing opportunities.
In these dialogue, the composition of the working groups based on their socio matrix was verified and groups to be formed were identified.
3. Group formation activities and capacity-building activities: On the bases of the community dialogue,groups to be formed were given technical assistance to help them plan, implement and monitor their own projects.
4. Inter-sectoral team-building and planning workshops
In supposed of community-planned activities, representatives of the community. government services agencies, DMSF-IPHC and other non-governments agencies met to discuss the following:
-community-identified problems,
-service/resources available with each agency and within the community
-barriers to access to these service/resources,
-procedure for access to these services/resources; and
-difficulties encountered by government agencies in the provition of services to the community.
These discussions led to the preparation of action planin which specific roles were  designated to various agencies. Subsequent intarsectoral workshop were devoted to the review of project planned in previous workshops and preparation/presentation of plan for other preojects.
5. Monitoring and assistance to community-planned projects: ON the basis of the foregoing activities, the following community-planned project are being Implemented by the communities in Agdao:
Income Generating Projects            Agency Giving Assistance
or Health Related Project            to community
-Training in project selection            -IPHC, Ministry of Agriculture and Ministry of Trade
and management of micro-
business including bookkeeping
and marketing
-Production skills training            -Ministry of Agriculture and
(e.g. food processing,garment
production and dressmaking)
-Financial assistance to micro-        -IPHC
business through community
credit groups
Health and Sanitation Projects
-Sanitary toilets and health            -Ministry of Health and insti-
education regarding import-            tute of Primary Health Care
ance of sanitary toilets
-Eye check-ups and provision        -Lion’s Club
of eye glasses at low cost
-Water connetion project            -United Way, IPHC Davao City
Water District
-Immunization of children            -City Health Office
-Deworming                            -Medical and Dental Students of DMSF

-Home based growth charts            -IPHC
-Dental health education                -Dental students of DMSF and
Project, Hope of the City
Mayor’s Office

Other Project
– San Isidro Youth Group                -IPHC
recreational facilities managed
by the youth
-Puting Lupa Multi-Purpose            -no external assistance
Purok Shed
-Formation of youth organi-            -IPHC
zation in Purok Sta. Cruz
-Community Pharmacy in                -IPHC
Lana Creek

Child-to-Child Programs

In the World Countries, care of infant and toddlers is commonly delegated to older siblings because the parents and older members of the family have work outside the home or have heavier household chores to perform. In the Philippines, one often sees such children, balancing their younger brother or sister precariously on a hip or dragging him by the hand near billiard hells, bus stops, corner stores, or market places. In 1982, the IPHC Staff with the participation of the community, initiated  a Child-to Child Program in both Agdao and Baguio.

The Objectives of the Child-to-Child Program were: to train older children between 9-15 years of age to facilitate the physical, mental and spiritual/psychosocial development of their younger brother and sister (0-6 years old). During the preparatory phase, the IPHC staff familiarized themselves with the activities of these age groups in rural and urban poor communities through:
– an ocular survey of the areas,
-discussion with the mothers,
-discussions  with persons directly involved in child-focused projects namely the katiwala, Barangay Nutrition Scholar (BNS), Project Hope Teachers, Nursery Teachers and the Principal of the elementary schools,
-brief information talks with few older children’
-observation of one Project Hope Class.
Based on the insights gained from the above activities the IPHC Training Officer formulated a training design for a child-to-child Class, revised many of the IEC materials, and tested both the design and the materials in Agdao and Baguio as the pilot phase of the program. After going through the actual experience of conducting the child-to-child Class, the IPHC started a Child Trainors Training Program wherein interested target communities were asked to select volunteer child trainors were to take on the played by the IPHC Training Officer during the pilot phase so as to assure program continuity with the minimal IPHC intervention.

Selection of Child Trainors

The first group of child trainors was selected on the basis of:
-recommendation by the katiwala and local Leaders,
-willingness to attend training and conduct classes for health scouts,
-personal interview.

The first Child Trainors’ Training was carried out by the IPHC Staff with the assistance of the Early  Child Enrichment Program Staff of the University of the Philippines, Diliman (ECEP) . The training content was adapted from materials gathered by IPHC and ECEP. The bulk of the health nutrition and sanitation materials were based on the katiwala training materials

After the trainors, training some of the child trainors organized their own Child-to -Child Class in their respective communities. Each child-to-child Class had the Following course content:
1. 3-fold needs of a child
2. Value: Love
3. First aid and some home cures
4. Oral Rehydration
5. Nutrition
6. Cooking lessons
7. Behavioral characteristics of 0-6 years old children and the appropriate activities to be conducted per age group
8. Appropriate toys and songs for 0-6 years old children
9. Right values/behavior for a model health scout
10. Accident preventions
11. Basic hygiene
12. Self-evaluation: What are my values?
13. How to teach concepts of time and space to 0-6 years old children

Evaluation of Child Trainor’s  Performace

The Training Officers and the PHC Staff sensed a lack of commitment on the part of some child trainors. Although a few started holding classes in their barangay soon after the training. other could not get started, or they did start but gave up after a few sessions. There was a need for constant follow-up and remotivation and retraining. The Training Officers (T.O) in consultation with the IPHC Staff decided to adopt a better volunteer selection process and to involve the trainor candidates in baseline data gathering and in planning their own training. The second group of potential Child Trailors:
-conducted a participatory social investigation of their community about the present situation of 0-6 year old children;
-analyzed the data with the help of other trainees and the Training Officer;
-enumerated the expected tasks of the Health Scout based on the social investigation result; and
-planning the course content of a Child-to-Child Class and their trainors training

It was during these ore-training activities that the potential trainors were given ample time to understand their role and responsibilities and to express their commitment and proceed with the training, or back-out before the actual training starts. The child trainors, assisted by the katiwala or teachers invited children between the ages of 9-15 years who had sibling between the ages of 0-6 to attend the Child-to-Child Class.

At present, the content of each Child Trainors Training varies according to the data gathered through the Participatory Social Investigation conducted by the trainors and the identified needs and tasks of the Health Scouts in their respective communities. What is common in all the trainors training and the consequent Child-to-Child Class in the emphasis on:
-treatment of common health problems like fever, cough,diarrhea, malnutrition and worms,
-personal hygiene
-value formation,
-appropriate activities, song , toys, and games for 0-6 years old children
-accident prevention and first aid.
Recently, the use of home-based growth chart was introduced as a tools with which the parents and the older child can monitor the nutritional status of the younger child. Some Child-to-Child Classes included breastfeeding in their curriculum while others dealt more with  common ear infections. Hopefully ,through more flexibility, the Child-to-Child Program will be able to answer the specific needs of the children in the community.

Difficulties and Problems Encountered

The community is engaged in a constant struggle for survival. They have very little leisure time and find it difficult to attend meeting . One of the difficulties was in arriving at a  schedule that was acceptable to all;but this problem was solved by scheduling meeting to suit the member by holding smaller group meeting and supplementing these with one to one “tutorials.”After an initial acceptance  of the project, local officials were at times not supportive . They were too busy to attend meeting. Agency representatives occasionally were not committed and failed to attend meeting.

Some members have been used to dole-outs. When they realized that there was not no dole-out in this project, their interest waned. One community project failed because the member responsible malversed the fund. Agency workers were at times indifferent to the needs of the community.

The P.O stopped going to one barangay under her supervision because of the “critical” political situation. She may have to transfer her activities to another village though. She may have to transfer her activities to another village though she is still hopeful that the conditions will improve and she can return.

After their training, these volunteer Child Trainors in turn organized their own Child-to-Child Classes. In the course of monitoring  these classes, the IPHC identified areas improving the capabilities of the Child Trainors in teaching the children and also the need for constant follow-up of the Health Scouts activities at home to determine how effective they have been in promoting the total development of their younger brothers and sisters. We have  found some weaknesses in the training of the Child Trainors which accounted for the gaps in performance of the older children’s role as Health Scouts. Moreover , such gaps made us question how much of what is taught and learned in each Child-to-Child is actually applied at home.

As of June 30,1984, a total of 214 children were trained. During interviews, these children have informed IPHC Staff members that the project has enabled them to help their younger siblings. Many of them have actually used the Oral Rehydration Solution (ORS) when a member of their family gets sick.Their reports are being checked by their parents before these are submitted to the class. However, other data-gathering tools are being tested to determine the effectiveness of the program.

Conclusion
A mid-project review is scheduled for 1985. It is still too soon to say whether  the nutrition and health of the urban children have been improved by the project or not. There are indications that the communities have developed the capacity to do the unbelievable within the context of their limited resources and that they will be attempt the impossible , grasp the faintest of opportunities, and survive, even against the most difficult odds.