Title: The policy environment of self-care: A case study of the Philippines.

ABSTRACT

Self-care is the ability and empowerment of individuals to maintain health through informed healthcare decisions, with or without the support of a health provider. High-income countries have made advances to its conceptualization, research, and institutionalization given its reported benefits to patients, the health system, and economy. A similar undertaking in low- and middle-countries (LMICs) with already fragile health systems is warranted as highlighted by the COVID-19 pandemic. Our paper therefore aimed to describe and analyze the policy environment of self-care using the Philippines as a case study, which may have relevance to other similar countries and settings that are transitioning towards Universal Health Care (UHC) to reform and strengthen their primary care systems. We conducted 13 key informant interviews and two focus group discussions among representatives from the government, the pharmaceutical retail/ industry, community retail pharmacy, primary health physicians and health workers, an infirmary administrator, and patients and/or patient advocates. We triangulated our qualitative data with findings from our policy review. We found a total of 13 relevant policies on self-care in the Philippines recently drafted and/or implemented from 2016 to 2021 that fall under the broad categories of unifying frameworks and roadmaps, capacity building and institutional streamlining, regulations, and disease guidelines. Our case study highlights the role of the UHC Law as a driver for self-care and patient empowerment towards better health outcomes with its passage resulting in the promulgation of self-care-related policies. Our findings also suggest that changes in the local policy and built environment, and the formal educational and health systems, are needed to foster a culture of responsible self-care. There are notable exemplars in advancing self-care in the region, including Thailand, from which LMICs like the Philippines can draw lessons to make progress on institutionalizing self-care and ultimately, realizing universal health coverage and Health For All.