# Situation: A public health nurse at a Rural Health Unit (RHU) runs the postpartum and family planning clinic. She supervises the rural health midwives, who in turn work with the barangay health workers (BHWs). The nurse plans next week's postpartum services. Which task should she assign to a barangay health worker (BHW)?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A public health nurse at a Rural Health Unit (RHU) runs the postpartum and family planning clinic. She supervises the rural health midwives, who in turn work with the barangay health workers (BHWs).

The nurse plans next week's postpartum services. Which task should she assign to a barangay health worker (BHW)?

## 보기

1. Screening mothers for medical eligibility before they start a method
2. Visiting new mothers at home to remind them of their postpartum check-up **✔ 정답**
3. Checking the fundal height and lochia of mothers during home visits
4. Giving the injectable contraceptive to mothers who have chosen that method

**정답: 2**

## 해설

Barangay health workers are volunteers who support primary health care through home visits, health reminders, household records, and referral; they do not perform clinical nursing or midwifery acts. Reminding mothers of their follow-up visits fits this role, while injections, postpartum physical assessment, and eligibility screening need a licensed nurse or midwife.

## 심화 해설

Role Delineation in the Philippine Primary Health Care Team

The key to this item is recognizing that the barangay health worker (BHW) operates as a trained community volunteer, not as a licensed health professional. The Philippine primary health care system is deliberately tiered: the public health nurse supervises, the rural health midwife performs clinical midwifery acts, and the BHW extends the reach of the health center into the household through health promotion, case finding, reminders, and referral. A BHW may remind, observe, record, and refer—but may not assess, screen, inject, or otherwise perform acts reserved for a licensed nurse or midwife.

Task delegation in this context follows the principle of assigning each task to the least specialized worker who can perform it safely and legally. Home visits to remind mothers of a scheduled postpartum check-up fall squarely within the BHW role because they require no clinical judgment, no physical examination, and no medication administration. The visit is a supportive, educational, and logistical intervention: the BHW reinforces the importance of the follow-up visit, helps the mother remember the date and time, and can identify barriers such as transportation or childcare that may prevent attendance.

Watch out! The BHW role is often confused with that of the midwife because both conduct home visits. The difference is what happens during the visit. A BHW visit is for health education, reminder, and referral; a midwife visit includes clinical assessment and intervention.

The three incorrect options all require a licensed professional:

| Option | Task | Why it exceeds the BHW role |
| --- | --- | --- |
| 1 | Screening mothers for medical eligibility before starting a family planning method | Medical eligibility screening requires knowledge of contraindications, drug interactions, and medical history interpretation—a clinical judgment reserved for a nurse or midwife using tools such as the WHO Medical Eligibility Criteria. |
| 3 | Checking fundal height and lochia during home visits | Fundal height measurement and lochia assessment are components of the postpartum physical examination. They require palpation skills, recognition of abnormal findings such as subinvolution or infected lochia, and the authority to act on those findings. |
| 4 | Giving the injectable contraceptive | Administering an intramuscular injection such as depot medroxyprogesterone acetate (DMPA) is a medication administration act. In the Philippine setting, this is performed by a nurse or midwife under protocol, not by a volunteer BHW. |

Evidence from Philippine Community Health Studies

Qualitative research on postpartum services in the Philippines confirms that BHWs are positioned as community-level extenders of the formal health system, not as substitutes for clinical providers. The focus group study in Muntinlupa City documented that maternal health service delivery faces a shortage of medical professionals and that BHWs are expected to help bridge access gaps—but their documented activities center on community mobilization, home visiting, and linkage to facility-based care rather than on clinical procedures [1]. This supports the delegation of reminder visits to BHWs while keeping clinical tasks with licensed personnel.

The quasi-experimental evaluation of the timed and targeted care for families (ttCF) program in Eastern Visayas provides direct evidence of what trained BHWs can safely and effectively do during home visits. In that program, BHWs conducted 12 scheduled home visits from pregnancy through the first 1,000 days of life, delivering structured counselling on maternal and child nutrition and mental health [2][3]. The intervention content was educational and supportive—timed counselling messages, reinforcement of healthy practices, and encouragement to use health services—not clinical assessment or treatment. This is precisely the category of task represented by reminding a mother of her postpartum check-up.

The cross-sectional study of postpartum health care service utilization adds an important contextual point: approximately two-thirds of all maternal deaths in the Philippines occur during the postpartum period, and access to postpartum care remains a challenge [4]. Key point! This high-risk window is exactly why BHW home visits for reminders and follow-up are valuable. The BHW helps close the gap between facility-based services and the mother who may not return for her scheduled check-up—not by providing the clinical care, but by ensuring the mother reaches the person who can.

Clinical and Legal Reasoning for the Licensure Examination

The question tests delegation and scope of practice, which are high-yield concepts for both the PNLE and NCLEX-RN. The reasoning sequence is as follows:

First, identify the nature of each task. Is it clinical (requiring assessment, judgment, or invasive procedure) or supportive (requiring communication, education, or logistics)?

Second, match the task to the legal scope of the worker. In the Philippine setting, the Philippine Nursing Act and midwifery regulations define what nurses and midwives may do. BHWs, as volunteers, have no independent clinical scope; their authority derives from what the supervising nurse or midwife assigns within the boundaries of non-clinical support.

Third, apply the principle of right task, right person, right supervision. A reminder visit is the right task for a BHW because it is non-invasive, does not require clinical interpretation, and can be supervised through simple reporting. Fundal height measurement, lochia assessment, eligibility screening, and injection administration all fail at least one of these criteria.

The correct answer is therefore option 2: visiting new mothers at home to remind them of their postpartum check-up. This task aligns with the documented BHW role in Philippine community health programs [1][2][3], addresses the documented gap in postpartum service utilization [4], and respects the legal boundary between volunteer health workers and licensed professionals.References (research sources)

- [1]Understanding Postpartum Healthcare Services and Exploring the Challenges and Motivations of Maternal Health Service Providers in the Philippines: a Qualitative Study.Research articleYamashita T, Suplido SA, Llave C, Tuliao MT, Tanaka Y, Matsuo H (2015) · DOI: 10.2149/tmh.2014-40

- [2]Impact of home-visit counselling on maternal and child health and nutrition by Barangay health workers: a quasi-experimental study from Eastern Visayas, Philippines.Research articleKang Y, Choi A, Kim H, Edward A, Ji H, Jeon J. (2025) · DOI: 10.7189/jogh.15.04276

- [3]Evaluation planning for the timed and targeted care for families program in Eastern Visayas, Philippines.Research articleKang Y, Provido SM, Kim H, Kim HS, Ji H, Jeon J. (2025) · DOI: 10.3389/fpubh.2025.1594388

- [4]A cross-sectional analytic study of postpartum health care service utilization in the Philippines.Research articleYamashita T, Suplido SA, Ladines-Llave C, Tanaka Y, Senba N, Matsuo H (2014) · DOI: 10.1371/journal.pone.0085627

## 임상 시나리오

Delegation to Barangay Health Workers in Postpartum CareSafe task assignment in the Philippine primary health care team
The BHW is a trained community volunteer whose role is limited to health promotion, reminders, and referral. They do not perform clinical acts requiring licensure.

Appropriate tasks include home visits to remind mothers of their postpartum check-up schedule, reinforcing its importance, and identifying barriers like transportation or childcare.

CautionNever assign screening for medical eligibility, fundal height or lochia assessment, or injectable contraceptive administration to a BHW. These require the clinical judgment and legal scope of a licensed nurse or midwife.

## 핵심 개념

- **Barangay Health Worker (BHW)** — A trained community volunteer in the Philippine primary health care system who conducts home visits, health education, reminders, and referrals, but does not perform clinical acts.
- **Role Delineation** — The clear definition and separation of tasks and responsibilities among different levels of health workers (nurse, midwife, BHW) based on licensure and training.
- **Rural Health Midwife (RHM)** — A licensed health professional who performs clinical midwifery acts, including assessment and some medication administration, under the supervision of a nurse.
- **Postpartum Check-up** — A scheduled follow-up visit for a mother after childbirth to assess recovery and provide family planning services.
- **Referral** — The act of directing a client to a higher level of care or a more qualified health professional when needs exceed one's scope of practice.

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