BUT THE biggest problems the barrio doctors have to tackle are the low priority local governments give to health, the trapo politics, and the corruption that is often intertwined with it.

	NOT QUITE GOING TO SEED. Danilo Guce, a retired port worker, tends a backyard garden to supplement the income his wife makes as a maid in Italy.

Labajo says local governments allocate little money for the rural health units, especially those that have been doctorless for some time. The budget for each unit could be as small as P50,000 a year. Yet the same town may have allotted P500,000 to P1 million to purchase medicines as part of the mayor's discretionary fund.

The Jipapad that greeted Balanoba had no health center at all. The RHU used to be located at a small clinic the Italian priest had put up in the town, but was closed when the clergyman had a spat with the RHU staff. Balanoba converted an old, termite-infested multipurpose building with a leaking roof into a health center.

Lariosa's RHU occupied a tiny, rundown room at the Sangguniang Kabataan building. The windows were falling off and the roof leaked. The first thing Lariosa did was to ask the mayor to repair the place while awaiting a P3-million new RHU the Japanese government had pledged to build. When Lariosa was pulled out of Tagapul-an late last year, the mayor had yet to act on his request, and Japan had not released the promised funds. "We tried to patch the roof, but Vulcaseal didn't work well," Lariosa says.

The solar-powered vaccine refrigerator at Lariosa's RHU also kept breaking down, causing the vaccines to spoil. Exasperated, Lariosa stored them in a canteen operator's fridge. "It wasn't ideal because you shouldn't be opening the ref as much as possible," he says. "But I didn't have a choice."

The barrio doctors draw their pay from the national government. They enjoy a basic monthly salary of at least P20,824, as well as representation and travel allowances. Other benefits are provided under the Magna Carta for Public Health Workers: hazard pay, laundry allowance, subsistence allowance, and even remote allowance or medico-legal allowance depending on their assignment or task. In all, Labajo estimates, a barrio doctor could gross P30.000 to P32,000 a month.

The RHU staff-nurses, midwives, dentists, barangay health workers, and sanitation inspectors-are likewise entitled to these benefits. But many local governments have not fully implemented the Magna Carta, and barrio doctors often end up fighting for their staff's benefits. In 1996, Balanoba led her RHU staff in going on a two-week sick leave to force the town treasurer to release the benefits due them.

"That's the hardest part, dealing with local government officials," says Lariosa. "They have a different perception about health. Primary health care, preventive health care is not addressed. The community's needs are not addressed."

"Politicians are really difficult to work with," agrees Labajo. "The program can be sabotaged by the mere fact that the mayor does not cooperate."

PASCUALITO CONCEPCION, an Ateneo de Zamboanga alumnus assigned to Talusan, Zamboanga Sibugay in 2002, has shown what a barrio doctor can do when the local government is health-friendly. For that he was given the Grand Distinction Award in the DOH's annual recognition of outstanding doctors to the barrio.

With help from the mayor and the town council, Concepcion transformed a dusty warehouse-like RHU into an air-conditioned health center. He got Philhealth to accredit his RHU and enrolled 500 poor families in the program in 2002 alone. The RHU's pharmacy sells paracetamol for as low as 50 centavos each.

Concepcion convinced local officials to increase the RHU's share from the development fund (from P200,000 in 2002 to P1.2 million in 2003) and even persuaded them to let it keep the Philhealth payments for the upkeep of the health center and its programs. The local government has since created more positions for the RHU and has been fully implementing the Magna Carta for Public Health Workers.

Concepcion is the envy of barrio doctors like Lariosa, who was pulled out from Tagapul-an last December after the Leaders for Health Program concluded that his mayor wasn't very concerned about health. Two other doctors in Samar were withdrawn for the same reason.

Lariosa's relationship with the mayor had been strained. The doctor objected to the removal of trained health workers and their replacement by untrained supporters of the mayor. The mayor was in turn displeased when Lariosa changed caterers for a health- training course because the food served by the first caterer caused the trainees to have diarrhea. Apparently, the former caterer was the mayor's ally.

When he arrived in Tagapul-an, Lariosa was surprised to find that the medicines for the town were being kept at the mayor's office. "When you gave a prescription to a patient not of the same political color as the mayor, he'd be told by the people at the mayor's office there was no medicine even when they were still a lot. Color coding," the doctor says.

The mayor was later persuaded to turn over all the stocks to the RHU, after being assured the people would know the medicines came from him. But months before the May 2004 elections, newly delivered medicines again wound up with the mayor. He agreed to let go of half the medicines only after Lariosa had paid him a visit.

Things came to a head when the mayor's nephew sought treatment at the RHU and found it empty. The doctor and his staff were out implementing a DOH campaign and the staff assigned to man the health center had failed to report to work. The angry mayor nailed the RHU shut. Recounts Lariosa: "The following morning I told the mayor what he did was unfair. We weren't out having fun."

Lariosa was the second barrio doctor to become a casualty of local politics in Tagapul-an. Danilo Reynes, the town's first physician after a doctorless decade, belonged to the DTTB program's first batch. He stayed there for four years, but left because incumbent officials perceived him to be allied with their political opponents.