We sincerely thank you for your continued warm support and interest in our organization's activities.
NGO Reaching Zero-Dose Children conducted field research on vaccination in Pampanga Province and the surrounding area of Angeles City in the Philippines. From Week 1 to Week 3, we visited three areas—Masantol, Macabebe, and Sapangbato—and carried out household-based quantitative surveys and interviews with the support of local residents, caregivers, Community Health Workers (CHWs), Barangay officials, and local medical students.
Through this research, we aimed to understand the factors that may delay vaccination from multiple perspectives, including local living conditions, geographic access, the flow of information, and trust in health services.
Week 1: Beginning the Research in Masantol
Week 1 began with fieldwork in Masantol. Before starting data collection, we first visited the mayor to introduce our organization’s activities and explain the purpose of the study.
The mayor warmly welcomed our work and expressed strong support for the significance of our activities. He also shared that, in order to achieve the municipality’s current goal of 95% vaccination coverage, it is important to carefully listen to why some people remain unvaccinated and to share those findings with the community. We later had the opportunity to meet with the vice mayor, who also offered words of encouragement before we returned to the community.
At the time, a typhoon was approaching and the rain continued for some time. We therefore stayed at the Barangay office and spoke with local health workers. The CHWs shared their perspectives on how community members think about vaccines and the challenges they face in promoting vaccination through their daily work.
In the afternoon, we finally began data collection and visited nine households on the first day. All of the households we visited kindly agreed to participate in the study. That evening, we also visited another Barangay Captain, who kindly approved our data collection activities for the following day and beyond.
From the second day onward, with the support of local medical students, we continued quantitative surveys across multiple Barangays. In parallel, we also conducted interviews with caregivers and CHWs to deepen our understanding of the community-specific challenges surrounding vaccination. In Masantol, we learned about the living conditions in flood-affected areas and saw how local government officials, CHWs, and residents work together to sustain health activities in the community.
Week 2: Research in Macabebe
In Week 2, we conducted research in Macabebe, located about 30 minutes inland by car from Masantol, the Week 1 field site. Macabebe is relatively close to larger towns such as San Fernando and Apalit, and the area has fast-food restaurants and supermarkets.
Compared with the communities we visited in Week 1, Macabebe appeared more urbanized, and people seemed to live more individual-centered lives. Although the effects of flooding remained, we saw fewer buildings buried in mud and fewer makeshift houses made of tin sheets or plywood, which had been more common in the Week 1 areas. Overall, it gave the impression that daily life had been relatively maintained.
From Week 2, five first-year medical students from Mapúa University in Manila newly joined the research team. Unlike the students who had participated in Week 1, they had limited prior experience in clinical or field settings, and they seemed a little nervous on the first day. However, they quickly became familiar with the research process and then took the initiative in communicating with residents and collecting data, allowing the fieldwork to proceed smoothly.
The Monday of Week 2 was also the first day of school after summer vacation. Unlike the previous week, children went to school in the morning, came home at lunchtime, returned to school again, and then came home in the evening. Adults worked around this daily rhythm and accompanied their children to and from school.
Despite their own daily responsibilities, caregivers kindly made time for our quantitative surveys and interviews. CHWs also provided dedicated support, which allowed us to reach our target sample size smoothly.
On the final day of Week 2, we also visited a settlement called Sapang Kawayan within Masantol. Sapang Kawayan has been surrounded by floodwater for several years and has become almost like an “island.” This settlement, with a population of approximately 5,000 people, has an elementary school, junior high school, and high school. While daily supplies are transported by boat, the community appeared to function as a largely self-sustaining society.
Children were energetically playing basketball and greeted us, despite our sudden visit, with warm smiles. In this area, Tagalog—not Kapampangan, which is widely spoken in Pampanga Province—is used as the everyday language. This gave us an opportunity to observe cultural differences between Sapang Kawayan and other parts of Masantol.
Week 3: Research in Sapangbato
In Week 3, we conducted research in Sapangbato, Angeles City. The areas we visited during the previous two weeks, Masantol and Macabebe, were flood-prone areas located near the sea. Sapangbato, however, is a very different, mountainous area.
Sapangbato is geographically close to Clark, one of the Philippines’ major economic zones. At first glance, the area may appear urbanized and modern. However, when we visited in person, we were struck by the fact that Clark is surrounded by walls, and that living conditions differ greatly between the inside and outside of those walls.
In this community, located just outside Clark, houses are densely clustered along steep mountain slopes and limited flat land. People’s means of transportation are mainly limited to walking or taking tricycles. Except in limited cases, such as when people go out to sell goods, many residents seemed to complete much of their daily life within the settlement.
We felt that these geographic constraints also influence residents’ health-seeking behavior. In some areas, people must travel several kilometers along mountain roads to reach the health center where CHWs work and where health programs, including vaccination, are implemented. Some residents shared that these access barriers limit vaccination behavior.
In addition, because internet access is limited in this area, we observed unique characteristics in how information spreads and how trust is formed. In interviews with caregivers, some described the influence of social norms within the community, especially injunctive norms such as “what people around them think” and “who is recommending what.”
Furthermore, the research suggested that trust in CHWs, local government, and people from outside the community who are involved in vaccination may vary within the community. For example, residents may respond differently to people who come from outside the community carrying vaccines depending on whether they are accompanied by CHWs.
At the same time, both adults and children in the community were extremely kind and welcoming to us as visitors. I believe this was largely because we visited the community together with CHWs, carefully explained the purpose and background of the research to community leaders and individual residents, clarified that our study was observational rather than an intervention study, and because local medical students built rapport in Tagalog with great care. Above all, it was also thanks to the warmth and generosity of each resident who kindly supported our work.
What We Learned Across the Three Weeks
Through the fieldwork from Week 1 to Week 3, we learned again that the challenges surrounding vaccination cannot be explained simply by whether people have information or not.
In Masantol, local government officials and CHWs supported health activities in close collaboration with residents amid flood-affected living conditions. In Macabebe, a more urbanized area, caregivers participated in the research while balancing the daily rhythms of school, work, and family life. In Sapangbato, we observed how mountainous terrain, limited transportation options, and restricted internet access may affect access to vaccination and the way information is shared.
Across all three areas, CHWs and Barangay officials played an extremely important role and were essential in building trust with residents. Through our collaboration with local medical students, we also strongly recognized the importance of explaining the research carefully in local languages and conducting fieldwork with respect for residents’ daily lives.
Improving access to vaccination requires more than simply providing services. It is essential to understand geographic conditions, living environments, social norms, information environments, and local relationships of trust. These three weeks of field research gave us an important opportunity to reflect on the importance of engaging with each community’s specific context when considering approaches to zero-dose children and unvaccinated populations.
We sincerely thank all of the community members, CHWs, Barangay officials, local medical students, and everyone else who supported and cooperated with this research.
