Nutrition in times of crisis: A qualitative study in Siargao Island, Philippines, during the COVID-19 pandemic

Objectives@#Despite the public-health significance of both malnutrition and crises, little has been done to explore the convergence of the two domains and develop ways to improve policies and practices, especially in rural communities. This article remedies that knowledge gap by focusing on nutrition-related changes, responses, and practices during crisis situations in Siargao Island, Philippines, using the COVID-19 pandemic as a backdrop.@*Methods@#Forty-six (46) semi-structured interviews were conducted among parents, caregivers, local health workers, and local officials of Del Carmen, Siargao Island. Principles of thematic analysis were applied to data analysis using NVivo 12. Afterwards, the preliminary data were presented in a virtual validation session with the local community and stakeholders.@*Results@#Despite the high prevalence of malnutrition amid a backdrop of economic and nutritional difficulties, the community members generally viewed their children as healthy. Rice remained (disproportionately) central to people’s diets; possible alternatives like root crops were considered emergency foods only and not culturally acceptable as staples, in spite of their cheap and ubiquitous nature. Lastly, the economic and financial repercussions of the COVID-19 pandemic have also negatively affected the community members’ overall nutrition and food sources.@*Conclusion@#More efforts should be directed toward encouraging the consumption of root vegetables and fruits as rice alternatives in everyday diet—a costeffective strategy that would also promote dietary diversification. More importantly, nutrition responses should consider local food systems in terms of specific local economies and geographies, while health promotion efforts should engage with local notions of ‘health’ and ‘nutrition’ and encourage community participation in (re)designing policy interventions.

The lived realities of health financing: A qualitative exploration of catastrophic health expenditure in the Philippines

@#<p style="text-align: justify;"><strong>Objectives.</strong> Within the last two decades, studies worldwide have documented catastrophic health spending and out-of-pocket expenditure in low- and middle-income countries like the Philippines. This study sought to unpack patients and their families' lived experiences in dealing with such financial challenges.</p><p style="text-align: justify;"><strong>Methods.</strong> This paper stems from a multi-sited qualitative project in the Philippines involving FGDs that sought to elicit people's long-term health goals and the barriers they encounter in attaining good health. Focusing on the domain of health financing, we used principles of grounded theory to analyze how low and middle-income Filipinos pay for their health needs.</p><p style="text-align: justify;"><strong>Results.</strong> For many Filipinos, health financing often necessitates various actors' participation and entails predictable and unforeseen complications throughout the illness trajectory. We describe the lived realities of health financing through four domains: 'pagtitiis' (enduring the illness), 'pangungutang' (borrowing the money), 'pagmamakaawa'  (soliciting help from the government and non-government channels), and PhilHealth--the State-owned national insurance agency--whose (non-)role figures prominently in catastrophic expenditure.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Our paper illustrates how illness not only leads to catastrophic expenditure; expenditure-related challenges conversely account for poorer health outcomes. By exploring the health system through qualitative means, we identify specific points of intervention that resonate across LMICs (low and middle-income countries) worldwide, such as addressing predatory loan practices and 'hidden' costs; improving public health communications; expanding government insurance benefits; and bolstering health literacy to include health financial literacy in the school and community settings.</p>

“It’s as if I’m the one suffering”: Narratives of parents of children with disability in the Philippines

@#<p style="text-align: justify;"><strong>Background.</strong> Children comprise a significant proportion of persons with disabilities (PWDs) in the Philippines, and represent a major public health challenge. One under-explored topic is the "lived experiences" of their parents and guardians as well as the roles they play in caring for their children. This qualitative study responds to this research gap by eliciting and foregrounding their experiences and narratives.</p><p style="text-align: justify;"><strong>Methods.</strong> Six focus group discussions (FGDs) were conducted among parents of children with disabilities (CWDs) in Davao City and Tagum City. These were complemented by 12 key informant interviews among healthcare providers in both cities.</p><p style="text-align: justify;"><strong>Results.</strong> For many parents, coming to terms with a disability is a difficult and lengthy process, but one that ends with a measure of relief and eventual adaptation. Living with disability, meanwhile, is fraught with medical, financial, educational, and social challenges. A positive religious outlook allows them to make sense of disability, helping them to overcome these challenges. Support groups and the health care system are likewise crucial factors towards family resilience.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Our findings show that the experience of disability is shared among family members, particularly, the parents of CWDs; thus, underscoring the need for a family-centered approach in policies, clinical care, and communications efforts involving children with disability in the Philippines.</p>