Cost-effectiveness analysis of a physician deployment program to improve access to healthcare in rural and underserved areas in the Philippines.

OBJECTIVES: The objective of this study is to explore the cost-effectiveness of Doctor to the Barrios (DTTB), a physician deployment program in the Philippines. DESIGN: Cost-effectiveness analysis using decision tree models with a lifetime time horizon and probabilistic sensitivity analysis. SETTING: Societal and healthcare perspectives. POPULATION: Hypothetical cohort of children under 5 years in two provinces (Aklan and Nueva Ecija) and in a representative rural municipality. PARTICIPANTS: None. INTERVENTIONS: DTTB's impact on paediatric pneumonia and diarrhoea outcomes compared with a scenario without DTTB. MAIN OUTCOME MEASURES: Costs, effectiveness (in terms of lives saved and quality-adjusted life years (QALYs) gained) and incremental cost-effectiveness ratio (ICER). RESULTS: DTTB is cost-effective in the two provinces that were included in the study from societal and healthcare perspectives. Looking at a representative rural municipality, base case analysis and probabilistic sensitivity analyses suggest that DTTB has an ICER of 27 192 per QALY gained from a societal perspective. From a healthcare perspective, the base case ICER of DTTB is Philippine pesos (PHP) 71 839 per QALY gained and PHP 2 064 167 per life saved, and 10 000 Monte Carlo simulations produced similar average estimates. The cost per QALY of DTTB from a healthcare perspective is lower than the WHO recommended willingness-to-pay threshold of 100% of the country's per-capita gross domestic product. CONCLUSIONS: DTTB can be a cost-effective intervention, but its value varies by setting and the conditions of the municipality where it is implemented. By focusing on a narrow set of paediatric outcomes, this study has likely underestimated the health benefits of DTTB. Additional research is needed to understand the full extent of DTTB's impact on the health of communities in rural and remote areas. Future cost-effectiveness analysis should empirically estimate various parameters and include other health conditions in addition to pneumonia and diarrhoea in children.

Perceived occupational hazards of sanitary inspectors from two urban cities in the Philippines

OBJECTIVE: This study aimed to describe the occupational hazards perceived by sanitary inspectors (SIs) from the City of Manila (Manila) and Quezon City (QC) as they perform their administrative and technical roles. METHODS: Hazards and control measures were identified using self-administered questionnaires distributed among Sls of Manila and QC from November to December 2010. RESULTS: The most frequently perceived hazards are slips, trips and falls, and verbal assault seen consistently present among 8 out of 9 roles. Harsh climatic condition on the other hand is the hazard perceived to be the riskiest as seen consistently in 8 out of 9 roles. Of the respondents, 28% did not receive formal training in the field of sanitary inspection and 64% did not have work shifts as administrative control measures; 90% said that personal protective equipment (PPE) were not made available to them and were not used by them. CONCLUSION AND RECOMMENDATIONS: The most frequently perceived hazards encountered by SIs are slips, trips and falls, harsh climatic conditions, unwarranted complaints, and verbal assault. On the other hand, harsh climatic conditions, unwarranted complaints, and slips, trips and falls are the occupational hazards which are consistently present and perceived to pose the most risk in more than five roles. Provision of PPE and improvement in the implementation of administrative control measures is recommended. Moreover, further studies involving SIs' actual experiences, SIs from rural areas and control measures present in the workplace are suggested.