Implementing lessons learned from past versions of the Philippine National Unified Health Research Agenda

Background@#Considering the scope and magnitude of the National Unified Health Research Agenda (NUHRA), the implementation of the agenda requires adequate planning. Reviewing the implementation of the first and second versions of NUHRA, implemented from 2006 to 2010 and from 2011 to 2016 respectively, is thus useful in identifying potential challenges for implementing the current version.@*Objectives@#This article aimed to 1) describe strategies employed in the previous NUHRAs,2) describe uptake of the previous NUHRAs; and 3) identify lessons learned from the implementation of NUHRA 1 and 2.@*Methods@#Review of the NUHRA 1 and 2 evaluation reports and minutes of PNHRS Research Agenda Committee meeting was conducted. Interviews with PCHRD division head and staff and representatives from the academe and regional consortia were also conducted.@*Results@#A total of 96 of the 422 NUHRA 1 priorities were implemented, while 45 of the 56 NUHRA 2 priorities were implemented. While NUHRA 1 implementation was delegated to numerous agencies, dissemination was conducted primarily by PCHRD through launch events and fora. Implementation of the NUHRA 2 was delegated only to the four core agencies of the PNHRS, with each agency employing different strategies for the dissemination of the NUHRA 2.@*Conclusion@#Involvement of agencies beyond the core of PNHRS may be the better direction for implementation of the current NUHRA. Strong support and commitment of the core agencies will be key in the effective implementation of the NUHRA.

Mapping the influence of socioeconomic development plans on Philippine Health Research Agenda: A descriptive study

Background@#Understanding and addressing social determinants of health through evidence-based action is a strategy that has been advocated by the World Health Organization as part of its “Health for All” strategy in 1978 and “Health in All Policies“ framework in 2013. It has then been recommended that the research agenda-setting process should be informed by socio-economic development plans with the specific aim of gathering data on social, economic, and cultural conditions that affect health.@*Objective@#This paper reviewed the PDP 2011-2016, PDP 2017-2022, MDGs, and SDGs and identified common directions with the NUHRA 2011-2016 and 2017-2022.@*Methods@#A content analysis of the three identified priorities of the NUHRA vis-a-vis the PDP 2011-2016, the PDP 2017-2022, the MDGs, and the SDGs was done in order to identify harmonization of the priorities of the NUHRAs targets and indicators with those of the other plans and agendas. A gap analysis across all topics was done to identify links and gaps.@*Results@#The results established the common ground between health research priorities and international and national plans. Comparing the number of direct relationships between the NUHRAs, PDPs, MDGs, and SDGs, it was noted that there were more direct links between NUHRA 2017-2022, PDP 2017-2022, and the SDGs compared to NUHRA 2011-2016, PDP 2011-2016, and MDGs. The direct links were mostly found in 1) maternal, newborn and child health, 2) health systems, 3) communicable diseases, 4) water, sanitation, and hygiene, 5) environment, and 6) infrastructure development.@*Conclusion@#The NUHRAs may serve as pathways to achieve the goals stipulated in other socio-economic development plans. The relationships of these to health are complex, nonlinear and often the effects manifest after a long period of time, and as such require rigorous research.

Achieving a responsive Philippine Health Research Agenda: An analysis of research outputs and underlying factors

Introduction@#Priority setting in the context of health research is important for developing countries as it assists policymakers and researchers in effectively and efficiently targeting research topics with the greatest benefit for public health. In the local setting, the Philippine National Unified Health Research Agenda (NUHRA) was formulated to prioritize health research topics that address the health needs of the population alongside the health sector’s goal for universal health care. This paper attempts to understand the alignment of the health research outputs by the Philippine Council for Health Research and Development (PCHRD) in addressing the priority health needs of the country. @*Methods@#Review of secondary data and key informant interviews was done. Using a thematic analysis approach, we extracted secondary data from the 2006 to 2017 PCHRD Annual Reports to identify the completed PCHRD-funded health research projects. Excluded in scoping of secondary data were the zonal and other unpublished or not readily available online reports.@*Results@#Results show that most research outputs address NUHRA priorities on health technology development and on the health needs on all life stages and triple burden of diseases under the Philippine Health Agenda. However, for research outputs to improve health outcomes, efforts must first be focused on health systems strengthening and the utilization of existing research information.@*Conclusion@#Gaps and challenges in the previous NUHRAs suggest that even as researches are aligned to the agenda, they do not necessarily address the health needs of the Philippines.

Effect of personality, power, and emotion on developing the 2017-2022 Philippine health research agenda: A case study

@#<p><strong>BACKGROUND:</strong> Social dynamics, specifically personalities, power dynamics, and emotions, have been shown to influence the methods, outputs, and quality of multi-stakeholder processes, especially the development of a national health research agenda.</p><p><strong>OBJECTIVE AND METHODS:</strong> Using a case analysis approach utilizing related conceptual frameworks, the paper determined how personalities, power dynamics, and emotions affected the research priority-setting exercise, identified lessons learned, and recommended how to effectively manage these social dynamics in consultations. Data gathering methods were participant observation and process documentation, results of which were codified and analyzed.</p><p><strong>RESULTS:</strong> Dominant personalities, stakeholders with power, and stakeholders that openly expressed dissatisfaction were most likely to attempt to change the methods and final outputs of the consultation, with varying level of success. Other dominant personalities used their power constructively for a smooth flow of generating and agreeing on ideas.</p><p><strong>CONCLUSION:</strong> In this case, social dynamics was shown to heavily influence the decision-making process, thus underlining its importance in organizing multisectoral representation. Effectively managing social dynamics may thus have to consider building trust and respect between participants, mediating discussions, reaching a mutually beneficial solution, and establishing and implementing mutually agreed house rules. The significant role of facilitators in developing a climate for truly inclusive participation must also be recognized.</p>

Stakeholders in the development of the National Unified Health Research Agenda of the Philippines

@#<p><strong>OBJECTIVES:</strong> Stakeholders and stakeholder engagement in agenda setting are not well documented despite its increased recognition. This paper aimed to describe stakeholder engagement in the agenda setting. Specifically, it aimed to (1) describe the process of stakeholder engagement in the development of the NUHRA 2017-2022; (2) describe characteristics of stakeholders involved; and (3) identify lessons learned during the engagement.</p><p><strong>METHODS:</strong> Documents pertinent to the agenda setting process, which included profile of participants and feedback on the consultation process were reviewed and analyzed. Key informant interviews were also conducted among selected PCHRD officials and members of the Philippine National Health Research System - Research Agenda Committee. Stakeholder mapping was conducted prior to the engagement to identify potential stakeholders. Consultations were conducted in each region involving different stakeholders. Stakeholders in the consultation process were national government agencies, local government units, academe, public and private health facilities, and non-government organizations (NGOs).</p><p><strong>RESULTS:</strong> The stakeholder with the highest representation was the national government (n=110), while the lowest were public and private health facilities (n=14 each). Interactive discussion of stakeholders with diverse background, is the top item that went well during the consultation and should be retained in the future, and; brainstorming session and presentation were identified item that needs improvement.</p><p><strong>CONCLUSION:</strong> A diverse and well-represented set of stakeholders is important in an agenda setting to appropriately identify priorities and to improve uptake of the agenda. Stakeholder engagement, however, should not be limited to agenda setting, collaborative work must be sustained in all aspects of the research cycle.</p>

Strengthening the policy environment for health research in the Philippines: Insights from a preliminary analysis of existing policies

@#<p><strong>BACKGROUND AND OBJECTIVE:</strong> Research plays an important role in generating new knowledge that could improve health outcomes when translated into action. As such, there must exist a supportive research policy environment that facilitates the provision of necessary resources and sustainably ensures an appropriate number of skilled researchers buttressed by institutions. These, in turn, are envisioned to provide facilities, information systems, financial grants, and avenues for career development and collaboration. This study aims to analyze factors in the current policy environment that makes health research possible in the Philippines.</p><p><strong>METHODS:</strong> Qualitative exploratory design was used to characterize the Philippine health research environment. Guided by Adamchak's framework on policy environment, a content review of 39 policy documents (1991 to 2018) by the four core agencies of the Philippine National Health Research System was conducted. Seven elements of the policy environment were described.</p><p><strong>RESULTS:</strong> The policies analyzed in this study mainly addressed the legal, political, cultural, economic, and ecological elements of the policy environment. Policies that support the demographic and technological elements are lacking, in that these leave out details that are essential for capacity building and use of research output. A cross-cutting effort to resolve gaps may be necessary.</p><p><strong>CONCLUSION:</strong> Several factors continuously affect the environment in which policy is developed. There is room for improvement in terms of showcasing the government's regulatory quality and independence from political pressure. Equal attention must also be paid to human capital development, innovation partnerships, and mechanisms to improve knowledge impact, absorption, and utilization.</p>

Strengthening Science and Technology for Health Research: Perspectives from Trade, Development, and Innovation

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> It has long been observed globally that the extent to which developing countries can achieve health targets depends on their capacity to generate, harness, and apply science and technology (S&T). Beyond the health sector, S&T contributes to development by providing a solid foundation for education, infrastructure, and economic progress. The United Nations Conference on Trade and Development (UNCTAD) suggests a set of fundamental elements for an ideal S&T environment: knowledge generators, producers, infrastructures, and the policy instruments.</p><p style="text-align: justify;"><strong>OBJECTIVES AND METHODS:</strong> Through document and secondary data review guided by the UNCTAD fundamental elements, this paper aimed to 1) provide an overview of the S&T policies in the country, 2) assess the country's S&T status, 3) identify gaps and challenges, and 4) provide recommendations to strengthen the S&T environment in the country.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The country's set of policies in S&T has succeeded in attracting businesses, nurturing good governance, and applying necessary regulatory mechanisms that offers protection and incentives to innovation. While performance in Education & Research has improved, spending on research, patent applications, and journal publications lags regionally and globally. The country's university-industry collaboration has been in decline since 2015. Between 2013 to 2015, innovations strongly enabled changes in business and organizational models. Data show that the country has been devoting increasing percentage of its GDP to Gross Capital Formation. Conversely, logistics performance has been decreasing. The country's score for information and communication technology has been increasing since 2013. Since 2014, the density of newly registered business has remained stagnant.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Policies implemented through the years in the Philippines have managed to balance strengthening infrastructure capacity while increasing translation and uptake of new knowledge and technologies by enterprises. The country's S&T performance has remained largely stagnant despite the availability of human capital. The Philippines has devoted low funding to research and development, indicating the low priority that it has for S&T. This is manifested in the low research output of the country, in the form of patents and publications, that lags both regionally and globally. The availability of quality infrastructure is a requirement for efficient work of researchers and facilitates adaption of new technologies by enterprises. However, these developments must be coupled with good logistical processes to meet the demands of researchers and the industry</p>

Envisioning the Health Research System in the Philippines by 2040: A perspective inspired by Ambisyon Natin 2040

@#<p style="text-align: justify;"><strong>BACKGROUND AND OBJECTIVE:</strong> This paper aims to describe long-term visions for health research in the Philippines. Ambisyon Natin 2040, an overarching vision for a dynamic country by the year 2040, is its main inspiration as this enables innovation and sustainable development.</p><p style="text-align: justify;"><strong>METHODS:</strong> The health research profile conceptual framework developed by Tugwell et al., (2006) was utilized to structure the articulation of these visions. Review of related literature, reports, and documents and in-depth interviews with key players in health research were conducted.</p><p style="text-align: justify;"><strong>RESULTS:</strong> In view of economic and technological developments in the country, it is expected that in 2040, health research priorities shall be more trans-disciplinary and more advanced. Research on health regulation and ethics will continue to be of importance. A more enabling environment for health research is also envisioned, since majority of research funding is expected to come from government, in addition to more research-friendly laws. More innovative platforms will be utilized to disseminate research results. The increasing international exposure and impact of academic work in the Philippines is also envisaged.</p><p style="text-align: justify;"><strong>CONCLUSION AND RECOMMENDATIONS: </strong>Health research in the Philippines has been benefitted by a lot of gains and advances in the past years. Thus, to create an enabling health research system in the Philippines by 2040, focusing on innovations in health research, increased number of funding sources, and crafting of better policies on health research should be pursued. Sustaining these gains and advancing health research in our country entail collective effort from different stakeholders, both public and private.</p>

Achieving a responsive Philippine health research agenda: An analysis of research outputs and underlying factors

INTRODUCTION: Priority setting in the context of health research is important for developing countries as it assists policymakers and researchers in effectively and efficiently targeting research topics with the greatest benefit for public health. In the local setting, the Philippine National Unified Health Research Agenda (NUHRA) was formulated to prioritize health research topics that address the health needs of the population alongside the health sector's goal for universal health care. This paper attempts to understand the alignment of the health research outputs by the Philippine Council for Health Research and Development (PCHRD) in addressing the priority health needs of the country.METHODS: Review of secondary data and key informant interviews was done. Using a thematic analysis approach, we extracted secondary data from the 2006 to 2017 PCHRD Annual Reports to identify the completed PCHRD-funded health research projects. Excluded in scoping of secondary data were the zonal and other unpublished or not readily available online reports.RESULTS: Results show that most research outputs address NUHRA priorities on health technology development and on the health needs on all life stages and triple burden of diseases under the Philippine Health Agenda. However, for research outputs to improve health outcomes, efforts must first be focused on health systems strengthening and the utilization of existing research information.CONCLUSION: Gaps and challenges in the previous NUHRAs suggest that even as researches are aligned to the agenda, they do not necessarily address the health needs of the Philippines.

Implementing lessons learned from past versions of the Philippine National Unified Health Research Agenda

BACKGROUND: Considering the scope and magnitude of the National Unified Health Research Agenda (NUHRA), the implementation of the agenda requires adequate planning. Reviewing the implementation of the first and second versions of NUHRA, implemented from 2006 to 2010 and from 2011 to 2016 respectively, is thus useful in identifying potential challenges for implementing the current version. OBJECTIVES: This article aimed to 1) describe strategies employed in the previous NUHRAs,2) describe uptake of the previous NUHRAs; and 3) identify lessons learned from the implementation of NUHRA 1 and 2. METHODS: Review of the NUHRA 1 and 2 evaluation reports and minutes of PNHRS Research Agenda Committee meeting was conducted. Interviews with PCHRD division head and staff and representatives from the academe and regional consortia were also conducted. RESULTS: A total of 96 of the 422 NUHRA 1 priorities were implemented, while 45 of the 56 NUHRA 2 priorities were implemented. While NUHRA 1 implementation was delegated to numerous agencies, dissemination was conducted primarily by PCHRD through launch events and fora. Implementation of the NUHRA 2 was delegated only to the four core agencies of the PNHRS, with each agency employing different strategies for the dissemination of the NUHRA 2. CONCLUSION: Involvement of agencies beyond the core of PNHRS may be the better direction for implementation of the current NUHRA. Strong support and commitment of the core agencies will be key in the effective implementation of the NUHRA.

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>

Medical needs documented by Emergency Medical Services (EMS) responders to areas affected by Typhoon Haiyan in the Philippines: Implications on disaster response policy

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Despite existing disaster preparedness policies in the Philippines, there has not been any validated assessment of the quality of disaster medical response, which would require reliable aggregate data on patient diagnoses and management.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This mixed-methods study documented the diagnoses, triage classification and case management of patients seen by Philippine EMS groups who responded to the Typhoon Haiyan disaster in the Philippines in November and December 2013, as well as difficulties associated in gathering these data, using the Utstein-style Template for Uniform Data Reporting of Acute Medical Response in Disasters as framework.</p><p style="text-align: justify;"><strong>METHODS:</strong> Three hundred (300) individuals vetted by EMS organizations were invited to answer a survey modeled after the Utstein-style template, and submit tallies of patients seen. Out of 52 responses received, policy recommendations were subsequently generated on concerns assessed by the template using the nominal group technique.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The submitted data yielded a total of 41,202 patients with information on age, sex, and diagnosis; 19,193 with triage classification; and 27,523 with information on case management. The focus group discussion underlined the absence of a standard communication and information management system. Participants recommended establishing such a system and highlighted the role of the Department of Health - Health Emergency Management Bureau in coordinating disaster medical response efforts and information management.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This study underlines the importance of effective communication, and multisectoral coordination, to generate reliable data and thus, facilitate resource allocation for disaster medical response.</p>

Enabling factors, hindrances, and self-perceived level of preparedness of Typhoon Haiyan Emergency Medical Services (EMS) responders

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Despite the implementation of policies related to disaster risk reduction and management in the Philippines, the response after Typhoon Haiyan in November 2013 was hampered by operational challenges.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The purpose of this study was to document disaster response experiences of Typhoon Haiyan from field level emergency medical service (EMS) responders, a key component of the disaster response, specifically the enabling factors and hindrances to disaster medical response activities, including their self-perceived level of preparedness in these activities.</p><p style="text-align: justify;"><strong>METHODS:</strong> In this mixed-methods study, 52 respondents identified enabling factors and hindrances to their disaster response and their corresponding self-perceived level of preparedness. In a subsequent focus group discussion, the researchers used the nominal group technique to process the respondents' experiences.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The respondents identified factors that enabled or hindered their response activities such as coordination, stress debriefing, infrastructure, and preparedness. Furthermore, an average of 33% of the respondents said they were adequately prepared to deliver the necessary medical services during the disaster response, thus validating previous studies on preparedness and disaster response operations.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The government should critically examine its cluster approach to disaster response and consider an integrated, inclusive, and proactive approach in disaster planning.</p>

Cost of hospitalization of different types of schistosomiasis cases in endemic areas in the Philippines: Indicating the need to increase the coverage of government health insurance

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>Schistosomiasis is endemic in the Philippines. Currently, the financial and economic costs of hospitalization due to schistosomiasis have not been studied or analyzed. This will be essential to the review of health benefit package of PhilHealth for schistosomiasis.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study estimated the cost of hospitalization due to schistosomiasis and its complications in the Philippines.</p><p style="text-align: justify;"><strong>METHODS:</strong> This is a cross-sectional mixed-methods study. Nine (9) hospitals from schistosomiasis-endemic provinces were included in the study. Medical records and billing statements from year 2013 were retrieved and analyzed. Non-medical costs were calculated based on data from key informants and existing economic data in 2013.</p><p style="text-align: justify;"><strong>RESULTS:</strong> A total of 1,415 hospitalized cases were collected; 94% came from government hospitals. Fifty nine percent (59%) were classified under uncomplicated schistosomiasis. Overall hospitalization costs were PhP 8,489,524.39 (USD 200,006.70), with cases of hepatic complications having the highest costs among all types of cases. Combined nonmedical costs and productivity losses for 5,005 days of hospitalization were PhP 13,019,363.75 (USD 306,726.25).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The estimated clinical cost burden and economic losses due to schistosomiasis in selected sites in the Philippines amount to PhP 21,508,888.14 (USD 506,732.95). Significant drivers of cost were the presence of schistosomiasis sequelae or complications, co-morbidities, and increasing length of stay. Estimated productivity losses and non-medical expenses of patients due to hospitalization were found to be more burdensome than the actual hospital bills. These costs stress the need for government to provide health coverage for patients diagnosed with schistosomiasis.</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>

Describing the health service delivery network of an urban poor area and a rural poor area

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to assess the health workforce's service capacities within a health Service Delivery Network (SDN) of an urban poor and a rural poor setting.</p><p style="text-align: justify;"><b>METHODS:</b> This is a concurrent mixed-methods study implemented in Navotas and Masbate, an urban poor and a rural poor area, respectively. Health needs of the residents were assessed through records review, qualitative methods and a household survey. Health facilities in the identified SDN were assessed using the Service Availability and Readiness Assessment (SARA) tool. Training data of Human Resource for Health (HRH) were also obtained.</p><p style="text-align: justify;"><b>RESULTS:</b> SDN in the two areas are different in terms of formality where memoranda of agreement were prepared between Masbate facilities but not in Navotas. Health worker to population ratios were 12.1 per 10,000 in Navotas and 2.7 in Masbate, respectively. The primary care facilities in the two sites met the recommended level of trainings for health workers in obstetric care, immunization, childhood nutrition and tuberculosis. There was a lack of post-graduate training in non-communicable diseases in all facilities. Poverty and geography were significant factors affecting health service delivery.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> In terms of human resources, both sites have limited number of health workers and the ratios fall far below WHO guideline. Recommendations include: Primary health care staff complement should be increased in the two SDNs. HHRDB should conduct a study to settle the issue of continuing medical education requirements that are not congruent with WHO recommendations. The SDNs should include the access of medicines and commodities by poor patients in private facilities during times of stock outs. Also, during stock outs or unavailability of government health personnel, transportation should be made available via the SDN to transport poor patients to private or nongovernment facilities with the needed personnel. The DOH and HHRDB should investigate innovative strategies for telehealth services that do not require continuous electricity, nor telephone or cellphone signal.</p>