Examining the oral health of Filipinos: Policy analysis

Background@#High prevalence of oral health problems persists across all age groups among Filipinos despite the continued endeavors of the government and professional societies. This position statement aimed to generate consensus policy recommendations to protect and promote oral health in the Philippines as an integral part of the healthcare service in light of the Universal Health Care (UHC) Act. @*Methods@#An evidence-based policy brief and presentations of dental and policy experts were used as discussion points in the roundtable discussion conducted by the UP Manila Health Policy Development Hub. Key stakeholders from various sectors were convened to generate inputs for policy actions and amendments to oral health related policies. ools.@*Results@#Thematic analysis of the discussion was organized using the WHO Building Blocks of Health Systems, which yielded practical, accessible, and population-wide interventions (2010). The following issues were highlighted: (a) health service delivery needs strong collaboration of LGUs; (b) insufficient workforce of dental professionals; (c) market availability of sufficiently fluoridated toothpaste per age group; and (d) health financing scheme on oral health services.@*Conclusion and Recommendations@#With the shift in the health system landscape brought by the UHC Act, timely and responsive inter-sectoral interventions, focusing on prevention, must be set to attain the target decrease in the prevalence of dental caries. It was also to recommend to (i) engage the academe and training institutions to increase the workforce, (ii) consider adopting international standards on sugar consumption as appropriate, and (iii) ensure sufficient funds for sustainability of oral health programs, particularly school-based caries prevention program starting in pre-schools.

Policy analysis on the mental health needs of overseas Filipino workers: Addressing gaps through evidence-based policy reform

Background@#There is an increasing number of distressed Overseas Filipino Workers (OFWs) due to adverse working conditions and unresolved post-repatriation issues. The enactment of the Republic Act 11036 (Mental Health Act) in 2018 supports the commitment of the State in promoting and protecting the mental health of every Filipino. @*Methods@#A systematic review of literature was conducted to generate evidence-based policy tools for the round table discussion conducted by the UP Manila Health Policy Development Hub, engaging all major stakeholders from all sides of the policy issue. Strengths and challenges of the current government initiatives in the phases of predeployment, deployment, repatriation, and reintegration were discussed to attain consensus policy recommendations. @*Results@#Increased migration led to a cascade of distressed OFWs and their subsequent need for trained mental health professionals. In host countries, challenges in on-site services include (i) limited psychiatry practice as prescribed by law of the host countries, (ii) reciprocity of the host country in allowing more welfare officers, and (iii) budget to support more plantilla items of Assistance to Nationals (ATN) staff. The inter-agency collaboration and legal support for all phases of migration should be holistic and set. @*Conclusions and Recommendations@#From the literature review and policy discussion, consensus recommendations included strengthening pre-deployment preparation, curbing the trafficking of minors, improving psychiatry practice through the Bilateral Labor Agreement, developing psychosocial counseling competencies among front line host country personnel, enhancing telecounselling services and exploring telemedicine, among others.

Identifying possible gaps and gray areas in the draft Universal Health Care Act implementing rules and regulations: A thematic analysis of a roundtable event on local health systems

Background@#The Universal Health Care (UHC) Act is a landmark legislation that seeks to improve provision of comprehensive health services through the integration of local health systems. The Department of Health (DOH) conducted a series of roundtable discussions to gather stakeholders' inputs and concerns to refine the initial draft of the Implementing Rules and Regulations (IRR) of UHC. @*Methods@#On April 4, 2019, the Department of Health led a roundtable discussion on the Local Health Systems sections of the UHC IRR in collaboration with University of the Philippines Manila. A total of 65 stakeholders from different sectors participated in a semi-structured roundtable event. The proceedings were audio recorded and transcribed. A thematic analysis was done using NVivo 12 software to document gaps and gray areas identified by the participants. @*Results@#Concerns of the participants revolved around the following: role of the private sector in local health systems; the integration of different municipal and other component health systems into a province-wide health system; organizational design of the health systems; pooling and utilization of the Special Health Fund (SHF). Gaps andgray areas were concentrated on the transfer of personnel and other health resources to the province-wide system, the composition of the Provincial Health Board, and the utilization and management of the SHF. @*Conclusion@#The roundtable event acquired various perspectives from stakeholders that could help the DOH identify priority action points that could be resolved at the agency level. The identified themes from the study analysis could be of value to decision makers to clarify issues, address policy gaps, and to prioritize future research directions.

Return service agreement in the context of the Universal Health Care Act: Using international and local experiences to guide application of the RSA

Background@#Philippines is in a constant struggle to address shortage and maldistribution of health professionals, affecting equity in service delivery. The government endeavors to generate adequate supply of health workforce through scholarship and training programs which have been further expanded with the enactment of the Universal Health Care (UHC) Act. This article aimed to give a background for discussion on the application of return service agreement (RSA) provisions in the light of attaining universal health care. @*Methods@#A modified systematic review of literature was conducted guided by the key issues determined by the Department of Health with focus on the extent of scholarship grants and on number of recipients. @*Results@#The Philippine government enacted policy reforms through implementing RSA in response to the progressive decline of the net flow of health professionals. However, the criticisms lie in that RSA is not a long-term solution. With the RSA provisions in the UHC Law, metrics on determining the under-produced and maldistributed professional cadre must be created. These should be responsive in addressing facility-level and health system-level gaps. @*Conclusion and Recommendation@#Paucity of current local literature impedes attaining a conclusive body of evidence, therefore, further research is needed. Operationalization of RSA should not be viewed as a singular means to solve the health workforce gaps, but as part of holistic assessment, taking into consideration epidemiological, geographical, political, and social determinants. Stakeholders must ingress in collaborative intersectoral policy actions to warrant bottom-up support. Activities related to mapping, monitoring, and incentivizing medical and health-related professionals must be established to support a system conducive for workforce retention.

Towards universal quality health care through an independent accreditation agency: A review

Background@#Guaranteeing quality of health care services is part of the objectives of Republic Act No. 11223 or the Universal Health Care (UHC) Act of 2019. In assuring that quality services are delivered by health care providers, they must be accredited to participate in the National Health Insurance Program. The UHC Act mandates the Philippine Health Insurance Corporation (PhilHealth) to recognize third party mechanisms as basis of granting incentives for health facilities that deliver services of higher quality. This review aimed to identify lessons and experiences from literature that can be adopted and contextualized in the Philippine setting, for strategic policies on strengthening the national health facility accreditation system. @*Methods@#A systematic review of literature was conducted to generate evidence-based recommendations from discussions on cross country experiences and local government initiatives towards improved accreditation system. @*Results@#By virtue of the UHC Act, a form of strategic purchasing is further institutionalized through a rating system that incentivizes health facilities that provide better services in terms of quality, efficiency, and equity. It is imperative to consider the country’s previous and current gaps and challenges in accreditation and adopt the best practices of other countries, as appropriate to Philippine's local settings. A tool is proposed in creating a national hospital accreditation system using the domains of leadership and governance, financing and sustainability, standards development, program management, and continuing quality improvement. @*Conclusion and Recommendations@#With the legitimacy of third party accreditation body mandated by the UHC Act, operationalization of the prescribed mechanisms and organizational structure must enjoin all pertinent stakeholders and be supported by sustainable funds and technical assistance by the government.

Policy analysis on financing roles for Population- and Individual-based health services in light of the Universal Health Care Act

Objectives@#The health financing scheme brought by the Universal Health Care Act has a significant change in the landscape of allocating funds for health services, as well as in the delineation of roles among the key actors. Consistent with the law, the protection from the health financial risks of Filipinos must be guaranteed. This study aimed to determine the roles of the government and other key agencies in financing population-based and individual-based health services in the Philippines. @*Methods@#A systematic review of literature was done to generate evidence for the policy brief and proposed policy alternatives. The UP Manila Health Policy Development Hub organized a roundtable discussion in collaboration with the Department of Health participated by key stakeholders from various sectors involved in the policy issue. Systematic review and insights from the discussion were analyzed to produce consensus policy recommendations. @*Results@#Given the current procurement and financing, the DOH should fund population-based services while PhilHealth, with the assistance of Health Maintenance Organizations (HMO) for premium holders, should fund individual-based services. Health programs with grey areas (i.e. with both individual- and population-based service) need further technical discussions. It is imperative to have clear-cut specific guidelines on the managerial and financial roles of the provincial health board and the scope of financing service delivery. @*Conclusion@#Delineating the roles of DOH, PhilHealth, and HMOs in financing health services is not without risks. The utilization of the special health fund at the provincial level should be carefully implemented and monitored to minimize inefficiencies and fraud.

Policy analysis on establishing criteria for population versus individual-based health services towards achieving Universal Health Care

Background@#The enactment of the Universal Health Care Act is anticipated to bring wider coverage and accessibility of quality healthcare services as stipulated in its objectives. With the integration of the healthcare system at the provincial level, determining population- and individual-based services is crucial in mapping the managerial and financial roles. Hence, this study aimed to establish the criteria for identifying population-based and individualbased health services in the Philippines. @*Methods@#A systematic review of literature was conducted to generate evidence for the policy brief and discussion points on the roundtable discussion spearheaded by the UP Manila Health Policy Development Hub in collaboration with the Department of Health. Key stakeholders of the policy issue convened to share expertise and insights in determining criteria for population- and individual-based services, intending to generate consensus policy recommendations.@*Results@#The general scope of individual-based health services stipulated in the Law are to be financed under the benefit packages of PHIC and HMOs. Meanwhile, population-based services are those that address public health issues such as health promotion and disease surveillance. Several services considered as ‘grey areas’ are those that fall in the overlap of the individual- and population-based services. These services may be examined through an outcome-based algorithm that examines fragmentation issues both in the supply and demand side of service delivery. @*Conclusion and Recommendation@#Proposed criteria in identifying individual- and population-based services include the number of recipient/s, the effectivity of service delivery and utilization, and source of funding. Health programs that are in the grey areas can be examined through an outcome-based algorithm.