Effects of the COVID-19 Pandemic on the Implementation of NCD Care at the Primary Care Level in the Philippines: A Qualitative Inquiry.

Background and Objective: The focusing of resources to COVID-19 response hampered and disadvantaged primary care services including that for Non-Communicable Diseases (NCDs), compromising continuity of care and hence, patients' disease status. However, studies from low- and middle-income countries (LMICs) remain sparse; therefore, evidence generation on how the pandemic impacted the provision of these primary care services in LMICs will help further understand how policies can be reframed, and programs be made more efficient and effective despite similar crises. To bridge this gap, the study investigated how the pandemic affected the implementation of NCD care at the primary care level in the Philippines. Methods: Thirty-one online focus group discussions via Zoom Meetings were conducted among 113 consenting physicians, nurses, midwives, and community health workers from various facilities - community health centers and stations, free-standing clinics, infirmaries, and level 1 hospitals - located within two provinces in the Philippines. All interviews were video-recorded upon participants' consent and transcribed verbatim. Inductive thematic analysis was employed through NViVo 12® to generate themes, identify categories, and describe codes. Results: The impact of COVID-19 on NCD care at the primary care level revolved around heightened impediments to service delivery, alongside worsening of pre-existing challenges experienced by the healthcare workforce; subsequently compelling the public to resort to unhealthy practices. These detriments to the primary healthcare system involved resource constraints, discontinued programs, referral difficulties, infection, overburden among workers, and interrupted training activities. Citizens were also observed to adopt poor healthcare seeking behavior, thereby discontinuing treatment regimen. Conclusion: Healthcare workers asserted that disadvantages caused by the pandemic in their NCD services at the primary care level possibly threaten patients' health status. Besides the necessity to address such detriments, this also emphasizes the need for quantitative studies that will aid in drawing inferences and evaluating the effect of health crises like the pandemic on such services to bridge gaps in improving quality of care.

Evolving academic and research partnerships in global health: a capacity-building partnership to assess primary healthcare in the Philippines.

Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. In this paper, we offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions. The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary healthcare in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior healthcare experience. We describe here the progression of the partnership between these institutions to carry out the project and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health.

An evaluation of the Medical Pool Placement and Utilization Program (MedPool PUP) of the Philippine Department of Health

OBJECTIVE: This study evaluates the effectiveness of the Medical Pool Placement and Utilization Program (MedPool PUP) of the Philippine Department of Health whose purpose is to augment the medical resource requirements of public hospitals.  METHOD: Mix method was used to gather data through a questionnaire survey sent by fax, email or postal mail. Beneficiary hospitals were selected and key informant interviews done to both the executive officers and the deployed medical pool physicians to further gain insights on the results of the survey.  RESULTS: A total of 75 public hospitals were beneficiaries of the MedPool PUP covering all hospital categories- Level 1, Level 2, Level 3 and Level 4 hospitals. Fifty-one hospitals responded to the survey. Justifications for requesting deployment include: a) need for additional physicians (43%), b) need for a medical specialist of a given clinical specialty (23%), c) need for accredited specialists to maintain a residency training accreditation (23%), d) need for substitute doctors while their regular doctors undergo training (8%) and e) need for a trainer of a specific medical specialty (2%). Almost all deployed doctors have finished a residency training program belonging to a medical specialty. Although the work descriptions covering the deployment of the MedPool doctors are focused on providing medical care to the patients, the contributions to the achievements of the hospitals s by the MedPool doctors go beyond these. They are also involved in medical training of other doctors, many are also given additional assignments in clinical administration and researches. Some also get involved in outreach services. Many exceptional contributions to the hospitals were given by the deployed doctors. In 12 out of 16 (75%) hospitals visited, the doctors deployed were able to introduce new clinical services such as heart surgery, ophthalmology, renal transplant, hepato-biliary surgery, automation of clinical laboratory procedures, among others. This is the primary basis for this study to conclude that the MedPool PUP is effective. CONCLUSION: The effectiveness of the MedPool PUP has been shown to go beyond augmenting the medical staffs of public hospitals in providing services. The doctors it deployed have contributed significantly in improving the clinical services by introducing new specialty services and enhancing existing ones. It is recommended that MedPool PUP be continued and strengthened to fill the needs of public hospitals based on a system of priorities. 

Health human resource needs of government hospitals in the Philippines

OBJECTIVE: To describe the health human resource needs of government hospitals in the Philippines.METHODS: All 733 licensed government hospitals were included in a survey except 75 of them which the Department of Health have been deploying medical specialists and medical officers to augment the needs of these 75 hospitals.RESULTS: A total of 96 government hospitals responded to the self-administered survey questionnaire sent to them. Analysis showed 20% to 29% among the level 2, level 3 and level 4 hospital responders have their Chief of Hospitals still without a master's education degree as required by the Department of Health. Fifty-nine percent (59%) of all hospitals do not have nearby medical educational institutions while 28% of them do not have nearby nursing educational institutions.The greatest need, however, is in the adequacy of the number of doctors and nurses. The minimum required number of doctors and nurses has not been met based on the staffing pattern standards set by the Department of Health for the different hospital categories and by the required 40 work hours per week set for civil servants.CONCLUSION: The decline in the adequate number of health human resources noted to start when local public hospitals were devolved from the national government to the local government units in 1991. With this inadequacy, one cannot expect these public hospitals to provide even fair quality of hospital care; thus, the need for the national government to intervene.

Significant predictors of underutilization of inpatient benefits among PhilHealth members in selected barangays in Manila

BACKGROUND: Underutilization of PhilHealth benefits undermines the effective distribution of public resources. To formulate effective strategies, the factors affecting the utilization of members must be studied. OBJECTIVES: To (1) assess the rate of underutilization of inpatient benefits and (2) determine the association of chosen factors with PhilHealth underutilization of selected member groups in three barangays in Manila. METHODS: The study was done in selected Barangays in Manila. Using the Expanded Program on Immunization (EPI) method of sampling, a sample size of 147 households were obtained and interviewed  for the study. An interview guide was used to gather the data needed for analysis. Chi-square test was then used to determine existing associations between underutilization and the chosen factors. RESULTS AND CONCLUSION: The chi-square test of association revealed that gender (p-value=0.034), income (p-value=0.026), and type of membership (p-value=0.027) are significantly associated with underutilization. Females and paying members were found to be more frequent users. Gap between the utilization and underutilization rates was found to be greatest in the lowest income groups. 'Lack of knowledge on filing claims' (p-value