Scaling up primary health care in the Philippines: Lessons from a systematic review of experiences of community-based health programs

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> In view of renewed interest in primary health care (PHC) as a framework for health system development, there is a need to revisit how successful community health programs implemented the PHC approach, and what factors should be considered to scale up its implementation in order to sustainably attain ideal community health outcomes in the Philippines.</p><p style="text-align: justify;"><strong>OBJECTIVE AND METHODOLOGY:</strong> Using the 2008 World Health Report PHC reform categories as analytical framework, this systematic review aimed to glean lessons from experiences in implementing PHC that may help improve the functioning of the current decentralized community-level health system in the country, by analyzing gathered evidence on how primary health care evolved in the country and how community health programs in the Philippines were shaped by the PHC approach.</p><p style="text-align: justify;"><b>RESULTS:</b> Nineteen (19) articles were gathered, 15 of which documented service delivery reforms, two (2) on universal coverage reforms, three (3) on leadership reform, and one (1) on public policy. The literature described how successful PHC efforts centered on community participation and empowerment, thus pinpointing how community empowerment still needs to be included in national public health thrusts, amid the current emphasis on performance indicators to evaluate the success of health programs.</p><p style="text-align: justify;"><strong>CONCLUSION AND RECOMMENDATIONS:</strong> The studies included in the review emphasize the need for national level public health interventions to be targeted to community health and social determinants of health as well as individual health. Metrics for community empowerment should be developed and implemented by government towards sustainable health and development, while ensuring scientific validity of community health interventions.</p>

Community-managed health programs for better health outcomes: Preliminary results of a community participatory research in Murcia and Isabel, Negros Occidental, Philippines

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Community-managed health programs (CMHPs) were designed to promote community self-determination in addressing health needs, but there is a need to evaluate how CMHPs can lead to better outcomes while accommodating changes in the national health system, which requires analysis of current CMHP interventions, institutional and community readiness, and points of interface with other health facilities.</p><p style="text-align: justify;"><strong>OBJECTIVE AND METHODS:</strong> This preliminary study aimed to guide an eventual effort to develop a framework to ensure CMHPs sustainably improve health outcomes. A preliminary analysis of results from a community participatory research was done in which baseline health characteristics, related social determinants, level of involvement of CMHPs with the local government health system, and quality of life were documented through surveys, focus group discussions and key informant interviews, both in a community with an established CMHP (Murcia, Negros Occidental, Philippines), and a control area without a similar NGO sector (Isabela, Negros Occidental).</p><p style="text-align: justify;"><strong>RESULTS:</strong> There was higher NGO and local government involvement among respondents in Murcia, use of traditional medicine, and sense of awareness of the need to improve the water quality in Murcia, with noted persistence of sanitation concerns, pinpointing the need to assess community participation and the efficiency of CMHPs.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Further study is needed in measuring community participation while considering its underlying cultural and socioeconomic contexts, in order to facilitate planning and implementation of strategies that intend to address community-recognized health needs while sustainably improving health outcomes.</p>

Catalyzing development of best practice guidelines for community-managed health programs: Case study of a community-academic partnership

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> There is a need to standardize community health practices, while still adhering to principles of community involvement, to ensure social acceptability and equitable access to health services. A set of Best practice guidelines (BPGs) were thus developed through a community-academic partnership (CAP) between the Integrative Medicine for Alternative Healthcare Systems Philippines, Inc. and its affiliated community-managed health programs (CMHPs), the University of the Philippines, and Bicol University.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to report the process and insights gained from the crafting of the BPGs.</p><p style="text-align: justify;"><strong>METHODS:</strong> The BPGs were developed using a community-based participatory research approach and focused on top ten (10) diseases based on local prevalence and experiences of its CMHPs.</p><p style="text-align: justify;"><strong>RESULTS:</strong> BPGs were developed for eight (8) communicable diseases (common cold/cough, influenza, measles, pulmonary tuberculosis, acute gastroenteritis, amebiasis, scabies, and intestinal parasitism); and two (2) noncommunicable diseases (diabetes and hypertension), which also provided information on signs and symptoms, initial referral criteria, management, and, where appropriate, specific use of medicinal plants, acupressure, and traditional massage. Emerging issues from this project include how community involvement led to the development of BPGs, the need to update its content, its potential application as a model for costing public health interventions, its anticipated benefits to health workers, the state of local health service delivery, and how the project epitomizes the ideal concept of community-academic partnerships.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> As a CAP project, this process holds promise as a catalyst for stakeholder engagement and health service delivery improvement. Further studies are necessary to map out other potential challenges and success factors, especially the socio-cultural, political, and health impact of CAPs.</p>

Establishing a blueprint for nature-based products development and conservation for the Philippines

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Many of the leading causes of mortality and morbidity in the Philippines are controllable with nature-based products, either as agents of intervention, or prevention, as nutritional supplements or for the control of side-effects of medications. The different R&D programs on nature-based products in the Philippines are usually conducted in isolation, or through silos. These often lead to products that are shortsighted, duplicate products, or products with minimal innovation, not readily applicable to population and environmental sustainability.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to draft an internationally benchmarked and integrated blueprint for a population health and environmental health-led nature-based product development and conservation for the Philippines.</p><p style="text-align: justify;"><strong>METHODS:</strong> The methodology consisted of a review of literature; regional educational visits; and a series of consultative meetings with stakeholders.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The study resulted in a stakeholder-validated blueprint that assigns the Philippine Institute of Traditional and Alternative Health Care (PITAHC) to lead the way for Filipinos to produce more nature-based products that are of international quality and attuned with local health needs. The blueprint has identified "9 Optimizations" in the realization of this aspiration, including an expanded role for PITAHC, a national database, an ethical researchers list, and to produce at least five commercial products and 20 intellectual property rights within 5 years with an estimated total investment of approximately PhP 816 M.</p>

Ethnomedicinal uses of tawatawa (Euphorbia hirta Linn.) in selected communities in the Philippines: A non-invasive ethnographic survey using pictures for plant identification

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> There is a growing interest in the use of Euphorbia hirta Linn. as herbal remedy for dengue, supposedly based on folkloric practice. However, there has been no ethnobotanical documentation of such use in the Philippines. Because of this, the medical community cautions the public against the sole use of E. hirta in treating dengue.</p><p style="text-align: justify;"><b>OBJECTIVE:</b> To describe the ethnomedicinal uses of Euphorbia hirta Linn. In selected communities in the Philippines. Specific Objectives. (1) To identify the vernacular names of the plant; (2) to identify the earliest known use of the plant against dengue infection and for other indications; (3) to document the methods of preparation and administration, side effects, and contraindications of use.</p><p style="text-align: justify;"><strong>METHODS:</strong> Cross-sectional descriptive design using the snowball sampling of interviewer-guided key informants for the ethnobotanical interview.</p><p style="text-align: justify;"><strong>LIMITATIONS:</strong> The results of this study may be limited by its convenient sampling design and the use of plant pictures with different magnifications.</p><p style="text-align: justify;"><strong>RESULTS AND CONCLUSION:</strong> Majority of the respondents were female (93%), 41-60 years old (39%), had high school education (43%), and resided in Quezon City (31%). The plant is locally known as tawatawa, butobutonesan, malagatas, and mangagaw. It has been used to treat fever in the Philippines as early as 1948. Its use as a treatment for dengue started only in the 1980s. The plant is either squeezed, crushed, or boiled, and is administered topically or orally. The only reported side-effect is increased urinary frequency.</p><p style="text-align: justify;"><b>RECOMMENDATIONS:</b> It is recommended that more comprehensive and large scale studies be conducted, including (1) identification of folkloric uses of E. hirta for the treatment of other diseases; (2) determination of different concentrations of extract (crude or semicrude) using the various reported preparations for optimal outcomes for the different reported medicinal uses.</p>