Function-based rehabilitation model: An initial step towards universal health coverage

Objective@#As part of the thrust towards Universal Health Care, the Philippines has enhanced health insurance coverage for rehabilitation with recent introductions of benefits for disabilities in children, prostheses, and orthoses. The project aimed to develop a functionality-based framework to guide comprehensive benefits for rehabilitation services for adult Filipinos. @*Methods@#Scoping review was conducted to identify common rehabilitation conditions, frameworks for clinical assessment, and essential services for rehabilitation. Key informant interviews and focus group discussions were conducted with targeted rehabilitation service providers and experts to validate the information collected. A unified pathway of care and essential services for the provision of rehabilitation medicine services was developed through triangulation. The study was conducted from October 2018 to September 2019, with activities done in Metro Manila. @*Results@#The results summarized treatment pathways for four major disease categories: neurologic, musculoskeletal, chronic pain, and activities of daily living/ cardiopulmonary. Impairments were identified reflecting the principles from the International Classification of Function. Disabilities were categorized based on function: mobility, self-care, cognitive-behavioral, and communication. A unified care pathway was developed to harmonize rehabilitation assessment, management, and care. A framework to simplify financial coverage was likewise provided. The extent of management (e.g., duration of therapy) depends on the severity of the disability classified as mild, moderate, or severe. Based on this classification, essential management modalities included physiatry interventions, medications, and rehabilitation sessions, supported by outcomes evaluation.@*Conclusion@#A framework is proposed to guide the design and implementation of benefits and health insurance coverage. Awareness and application of this approach among rehabilitation practitioners and health facilities are essential steps for successful uptake and implementation of the upcoming expansion in PhilHealth coverage.

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.

Operationalizing the development of the National Unified Health Research Agenda 2017-2022

Introduction@#The National Unified Health Research Agenda is a major document whose creation by the Philippine National Health Research Systems is mandated by Philippine Law. Multiple frameworks, methods, and approaches for the development of a health research agenda exists. Available literature on research priority setting have mostly focused on its methods, results, or implementation. There are limited studies on the operations management of conducting a national health research priority-setting exercise.@*Objectives@#This paper aims to describe the operational components utilized to develop the NUHRA 2017-2022 and provide lessons learned for future research priority setting endeavors. @*Methods@#This paper identified and categorized the operational components to develop the NUHRA 2017-2022 using the Enabler Criterion of the European Foundation for Quality Management’s (EFQM) Excellence Model.@*Results@#Operationalizing the development of a national health research agenda requires the harmonization of multiple components. Having region-based staff involved in the production of a regional situational analysis improved its context and accuracy. The workload for each cluster team must be considered and anticipated by the management. Stakeholder engagement requires political, diplomatic, advocacy, marketing, management, and technical skills. The process requires building relationships with various institutions. In a largescale project, management processes must be in place to effectively track and monitor its progress.@*Conclusion@#Operations and management are usually a neglected area in research and development projects. In a bottoms-up research priority-setting approach, iteration and flexibility is needed which requires a lot of management skills and insight. Duration of the project, planning, resources available, and quality of outputs have a strong interconnected relationship.

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>

Applying knowledge management in generating and using evidence in health research priority setting (HRPS)

@#<p><strong>BACKGROUND:</strong> Current international recommendations in generating and using evidence in Health Research Priority Setting (HRPS) include the use of systematic reviews, and systematic or scientific situational analysis. In the Philippines, the Philippine National Health Research System's (PNHRS) National Guidelines for Health Research Prioritization recommends the use of either a Combined Approach Matrix (CAM) or situational analysis in generating and using evidence for HRPS. At present, there is a lack of a gold standard in generating and utilizing evidence in HRPS.</p><p><strong>OBJECTIVE: </strong>The primary objective of this paper is to document a practical yet alternative/innovative approach on how evidence was generated and utilized in the process of HRPS as observed in the development of the National Unified Health Research Agenda (NUHRA) in the Philippines. Specifically, it identifies the types of knowledge products produced and their role in the process of health research agenda setting; how evidence was used and managed in the course of NUHRA development; and, the lessons learned from the experience.</p><p><strong>METHODS:</strong> This case study is descriptive of the experience of generating and utilizing evidence for HRPS in the Philippines. The study utilized primary and secondary data. Knowledge Management (KM) was used as a lens to describe the process of generating and managing information for the NUHRA. Document analysis was used in comparing and aligning data with the integrated KM framework.</p><p><strong>RESULTS:</strong> Pre-selected data were captured and created; shared and disseminated; and subsequently acquired and applied voluntarily by stakeholders during the process of HRPS. Relevant data was presented into various information products designed with a specific stakeholder in mind. Technical papers were developed to cater to national level stakeholders and focused on broad, nationally-relevant issues. Regional situational analysis reports focused on regional and local data and were designed for regional stakeholders to use during the development of Regional Unified Health Research Agenda (RUHRA). Infographics were developed to present the findings of the technical papers creatively and concisely and the NUHRA methodology and were presented to both national and regional stakeholders. The RUHRAs and the NUHRA were the outputs of the health research prioritization activities and will be made available through local and national channels of the PNHRS.</p><p><strong>RECOMMENDATIONS:</strong> Opportunities for formalization and institutionalization of knowledge management for generating and using evidence in HRPS may be explored to address health information fragmentation across the health research system.</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>

Enabling greater private sector participation in health research in the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study reviewed the current health research and development environment in the Philippines with respect to the engagement between the public and private sectors. The overall objective was to identify the role of the private sector in health research and identify barriers and opportunities for successful public-private health research partnerships.</p><p style="text-align: justify;"><strong>METHODS:</strong>  Key informant interviews were conducted using a semi-structured interview tool. Secondary data such as annual reports and project funding documents from the Philippine Council for Health Research and Development were also analyzed.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The roles of the private sector when engaging with the public sector for research and development were identified as generators, funders, and adopters of research. Information gathered showed that there were several institutional and practice barriers to the successful collaboration of the public and private sectors, however there were also lessons learned from the successes of cases such as the Axis-Knee System, Sambong, and Lagundi technologies.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The collaboration and partnership of the public and private sectors can be mutually beneficial. Government initiative to increase the ease of collaboration with the private sector in health research was found to be a necessary step to stimulate a productive health research environment.</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>

Operationalizing the development of the National Unified Health Research Agenda 2017-2022

INTRODUCTION: The National Unified Health Research Agenda is a major document whose creation by the Philippine National Health Research Systems is mandated by Philippine Law. Multiple frameworks, methods, and approaches for the development of a health research agenda exists. Available literature on research priority setting have mostly focused on its methods, results, or implementation. There are limited studies on the operations management of conducting a national health research priority-setting exercise.OBJECTIVES: This paper aims to describe the operational components utilized to develop the NUHRA 2017-2022 and provide lessons learned for future research priority setting endeavors.METHODS: This paper identified and categorized the operational components to develop the NUHRA 2017-2022 using the Enabler Criterion of the European Foundation for Quality Management's (EFQM) Excellence Model.RESULTS: Operationalizing the development of a national health research agenda requires the harmonization of multiple components. Having region-based staff involved in the production of a regional situational analysis improved its context and accuracy. The workload for each cluster team must be considered and anticipated by the management. Stakeholder engagement requires political, diplomatic, advocacy, marketing, management, and technical skills. The process requires building relationships with various institutions. In a largescale project, management processes must be in place to effectively track and monitor its progress.CONCLUSION: Operations and management are usually a neglected area in research and development projects. In a bottoms-up research priority-setting approach, iteration and flexibility is needed which requires a lot of management skills and insight. Duration of the project, planning, resources available, and quality of outputs have a strong interconnected relationship.