Addressing primary care inequities in underserved areas of the Philippines: A review

@#Background. Inequities in health care exist in the Philippines due to various modifiable and non-modifiable determinants. Through the years, different interventions were undertaken by the government and various stakeholders to address these inequities in primary care. However, inequities still continue to persist. The enactment of the Universal Health Care (UHC) Act aims to ensure that every Filipino will have equitable access to comprehensive and quality health care services by strengthening primary care. As a step towards UHC, the government endeavors to guarantee equity by prioritizing assistance and support to underserved areas in the country. This paper aims to review different interventions to promote equity in the underserved areas that could aid in needs assessment. @*Methods@#A search through PUBMED and Google Scholar was conducted using the keywords, “inequity,” “primary care” and “Philippines.” The search yielded more than 10,000 articles which were further filtered to publication date, relevance to the topic, and credibility of source. A total of 58 full-text records were included in the review. @*Results and Discussion@#In the Philippines, inequities in primary care exist in the context of health programs, facilities, human health resources, finances, and training. These were recognized by various stakeholders, from government and private sector, and nongovernment organizations, taking actions to address inequities, applying different strategies and approaches but with a shared goal of improving primary care. On another end, social accountability must also be instilled among Filipinos to address identified social and behavioral barriers in seeking primary care. With political commitment, improvement in primary care towards health equity can be achieved.@*Conclusion and Recommendation@#To address inequities in primary care, there is a need to ensure adequate human resources for health, facilities, supplies such as medications, vaccination, clean water, and sources of funds. Moreover, regular conduct of training on healthcare services and delivery are needed. These will capacitate health workers and government leaders with continuous advancement in knowledge and skills, to be effective providers of primary care. Institutionalizing advocacy in equity through policies in healthcare provision would help realize the aims of the Universal Health Care Act.

Profiling “Voluntary Surrenderers” of Oplan Tokhang in Marikina City, Philippines: An emic view

@#<p><strong>Background:</strong> This study was undertaken in response to the lack of contextualized and grounded description of surrendered drug offenders (e.g voluntary surrrenderers) provided to the media and to the public by the law enforcement agencies on the Oplan TokHang campaign of the Duterte administration.</p><p><strong>Objective:</strong> This paper sought to provide a profile of “voluntary surrenderers†of Oplan TokHang in 4 selected barangays in Marikina City. Specifically, it aimed to describe their socio-demographic characteristics, drug use behaviors, underlying reasons for initial and continued drug use, severity of use, and the nature and reasons behind their participation to the Oplan TokHang campaign, respectively.</p><p><strong>Methodology:</strong> A total of 56 participants were surveyed and descriptive statistics was used in the presentation and analysis of data. These were triangulated by direct observation, local studies and international studies, data from national agencies and news reports.</p><p><strong>Results:</strong> Most of the voluntary surrenderers in the study were drug users rather than user-pushers and were predominantly single, male, high school educated and were observed to be in their most productive years yet unemployed. They abused shabu and marijuana and started to take drug in their mid-adolescent years. Although users for 1 to 2 years, more than majority of them were mild users, taking drugs on a weekly basis that were sourced from their friends and from drug pushers. Exposed to drug- using friends and relatives, most were initiated to drugs because of peer influence, personal and family problems. They continued to use drugs because<br />they were not able to resolve these personal and social relations issues. Being jobless, most sustained their drugtaking behavior by committing petty crimes such as selling household goods, drug-pushing and theft. Afraid to be killed and wanting to be rehabilitated, they participated in the TokHang campaign for safety and for self-change.</p><p><strong>Conclusion:</strong> Voluntary surrenderers in the study were not as violent and dangerous as generally reported by media and by law enforcers. As mild users, they were not those types that were considered as “beyond redemption†but were rather capable of self-change. These primary data were reflective of national reports that 90 percent of surrenderers were mild users. Policy-wise, the study suggests that government should, through the Oplan TokHang campaign, shift more focus in providing community-based treatment and rehabilitation program that is responsive, sustainable, protective, and rights-respecting of voluntary surrenderers.</p>

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>

Sexual exploitation and abuse of children online in the Philippines: A review of online news and articles

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Advances in information and communication technologies facilitate opportunities for sexual exploitation and abuse of children online (SEACO). Despite the presence of laws against child pornography, trafficking, and cybercrime, the Philippines has become known as a key hub of the billion-dollar global child cybersex industry.</p><p style="text-align: justify;"><b>OBJECTIVE:</b> The objective of this study was to provide insight on SEACO in the Philippines.</p><p style="text-align: justify;"><strong>METHODS:</strong> The methodology consisted of a review of readily available news articles and reports. The search term "Philippines cybersex" was used in Advanced Search in Google News (https://news.google.com.ph) for English language reports from 1995 to 2015 to describe the geographic distribution of media reported cases of SEACO, the profile of victims and offenders, and how offenders and victims became involved in SEACO.</p><p style="text-align: justify;"><b>RESULTS:</b> The review found 55 reports and articles from 2011 to 2015. Cases were reported from 9 regions in the country with victims ranging from 18 months to 17 years in age. Three types of SEACO were identified: live streaming of child sexual abuse, child sexual abuse material (child pornography), and sextortion using minors.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Cases of SEACO were found to be present throughout the country. National policies and preventive measures are needed to stem this crime.</p>

University of the Philippines Manila position statement on the Department of Health's proposed condom access program in public high schools

@#<p style="text-align: justify;">Consequently, abstinence only programs may not be enough to lower the risk of sexually transmitted illnesses (STIs), such as the Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome (HIV AIDS). Paradoxically, in another study, it was shown that the more strongly abstinence was emphasized by the law, the higher the average teenage pregnancy and birth rates were.2 In fact, the same study concluded that while abstinence-only programs were not successful, areas that taught comprehensive sex and/or HIV education and covered abstinence along with contraception and condom access tended to be more successful, and had the lowest teen pregnancy rates. (see full-text for continuation)</p>

Profiling "voluntary surrenders" of Oplan Tokhang in Marikina City, Philippines: An emic view

BACKGROUND: This study was undertaken in response to the lack of contextualized and grounded description of surrendered drug offenders (e.g voluntary surrenderers) provided to the media and to the public by the law enforcement agencies on the Oplan TokGang campaign of the Duterte administration.OBJECTIVE: This paper sought to provide a profile of "voluntary surrenderers" of Oplan TokHang in four selected barangays in Marikina City. Specifically, it aimed to describe their socio-demographic characteristics, drug use behaviors, underlying reasons for initial and continued drug use, severity of use, and the nature and reasons behind their participation in the Oplan TokHhang campaign, respectively.METHODOLOGY: A total of 56 participants was surveyed and descriptive statistics was used in the presentation and analysis of data. These were triangulated by direct observation, local studies and international studies, data from national agencies, and news reports.RESULTS: Most of the voluntary surrenderers in the study were drug users rather than user-pushers and were predominantly single, male, high school educated, and were observed to be in their most productive years, yet, unemployed. They abused methamphetamine (shabu) and marijuana and started to take drug in their mid-adolescent years. Although users for one to two years, more than the majority of them were mild users, taking drugs on a weekly basis that were sourced from their friends and from drug pushers. Exposed to drug-using friends and relatives, most were initiated to drugs because of peer influence, personal and family problems. They continued to use drugs because they were not able to resolve these personal and social relations issues. Being jobless, most sustained their drug-taking behavior by committing petty crimes, such as selling household goods, drug-pushing, and theft. Afraid to be killed and wanting to be rehabilitated, they participated in the TokHang campaign for safety and for self-change.CONCLUSION: Voluntary surrenderers in the study were not as violent and dangerous as generally reported by media and law enforcers. As mild users, they were not those types that were considered as "beyond redemption" but were rather capable of self-change. These primary data were reflective of national reports that 90 percent of surrenderers were mild users. Policy-wise, the study suggests that government should, through the Oplan TokHang campaign, shift more focus in providing community-based treatment and rehabilitation program that is responsive, sustainable, protective, and rights-respecting of voluntary surrenderers.