Objectives. Within the last two decades, studies worldwide have documented catastrophic health spending and out-of-pocket expenditure in low- and middle-income countries like the Philippines. This study sought to unpack patients and their families' lived experiences in dealing with such financial challenges.

Methods. This paper stems from a multi-sited qualitative project in the Philippines involving FGDs that sought to elicit people's long-term health goals and the barriers they encounter in attaining good health. Focusing on the domain of health financing, we used principles of grounded theory to analyze how low and middle-income Filipinos pay for their health needs.

Results. For many Filipinos, health financing often necessitates various actors' participation and entails predictable and unforeseen complications throughout the illness trajectory. We describe the lived realities of health financing through four domains: 'pagtitiis' (enduring the illness), 'pangungutang' (borrowing the money), 'pagmamakaawa'  (soliciting help from the government and non-government channels), and PhilHealth--the State-owned national insurance agency--whose (non-)role figures prominently in catastrophic expenditure.

Conclusion. Our paper illustrates how illness not only leads to catastrophic expenditure; expenditure-related challenges conversely account for poorer health outcomes. By exploring the health system through qualitative means, we identify specific points of intervention that resonate across LMICs (low and middle-income countries) worldwide, such as addressing predatory loan practices and 'hidden' costs; improving public health communications; expanding government insurance benefits; and bolstering health literacy to include health financial literacy in the school and community settings.

Healthcare Financing ; Health Policy ; Health Expenditures ; Insurance, Health

Incivility creates an environment of hostility among healthcare providers in the workplace, and undermines a culture of patient safety. Although this phenomenon is pervasive in the profession, nurses tolerate or ignore its occurrence due to inadequate knowledge, fear and lack of institutional policies. There are no empirical studies in the local context which explore incivility among nurses in the hospital setting. This study examined the sources and forms of incivility among nurses working in a hospital according to nurse-related variables. A descriptive, cross-sectional design was utilized. Respondents were asked to answer Nurse's Profile and Nursing Incivility Scale. A stratified random sampling was used. A sample of 280 nurses from different clinical nursing units in a national tertiary hospital completed the questionnaire. Incivility outcome was analyzed using One-way Analysis of Variance (ANOVA) according to nurse-related variables such as nursing designation, practice setting, type of clinical nursing unit and length of hospital work experience. Post-hoc analysis was performed using Tukey's Honestly Significant Difference. Data were collected from September to October 2017.

Majority of the participants are female (78 %) and single (50 %) with an average age of 36 years old (SD= 9.96, range 21-62). They are employed in the hospital for an average of 9 years (SD = 8.82). Most of the sample works in general clinical nursing units (68 %) in a service/ charity setting (57 %). More than half of the respondents are staff nurses (67%) who provide direct care (Nurse I/II) followed by charge nurses (Nurse III) (19%) and head and chief nurses (IV/VI) (13%). Significant in civil interactions were reported between nurses and their colleagues at work, physicians and patients and their families according to the nursing designation, practice setting, type of clinical nursing unit and length of work experience. The moderately in civil interactions were exhibited in the forms of inconsistent behaviors, hostile climate and displaced frustrations. Nurse-related variables have significant impact on in civil interactions in the hospital setting. Understanding the sources and forms of incivility is of paramount importance in mitigating its impact on healthcare delivery and patient outcomes, and developing relevant policies and interventions that protect the welfare of nursing workforce.

Human ; Male ; Female ; Adult (a Person 19-44 Years Of Age) ; Interprofessional Relations ; Incivility

OBJECTIVES

While the chronically overburdened state of public school teachers in the Philippines is well-established, little is known about how they specifically provide ‘care’ and attend to their students’ health in the workplace. This article addresses that knowledge gap by illustrating the many forms of ‘health work’ undertaken by public school teachers on a daily basis, and analyzing the concrete challenges they face in doing such work. In so doing, this article provides a qualitative construction of school teachers as ‘health workers’ in the country.

METHODS

This article draws from two focus group discussions conducted in Southern Luzon and Eastern Visayas between November 2018 to May 2019, as part of a multi-sited study on the health-related challenges faced by lowand middle-income Filipinos. A total of 19 teachers participated in those two discussions. We used the principles of thematic analysis to code and analyze the discussion transcripts.

RESULTS

Teachers regularly fulfill various tasks that can be considered health work, including measuring students’ anthropometrics; supervising and administering government programs like deworming, feeding programs, and vaccinations; providing first-aid and various forms of immediate medical attention; addressing students’ mental and psychological health concerns; and working with students’ families in ways that resemble social work. However, the study participants largely considered themselves unqualified to do health work, often sacrificed their own personal health and interpersonal relationships to take on the additional burden of health work, and felt they received insufficient institutional support.

CONCLUSION

Doing health work not only takes away from actual teaching time, but also comes at the expense of teachers’ own health. Hiring the appropriate personnel to conduct health work and improving legal safeguards are possible solutions to ameliorating the present working conditions of teachers. Yet, the larger and more long-term conversation demands the prioritiziation of teachers’ well-being and overall quality of life, and recognizing the cruciality of a healthy work-life balance for them. Future studies should involve more diverse geographic sites and teacher populations, and utilize more focused forms of analysis (e.g., comparative, policy-driven).

Human ; School Teachers ; Healthcare Workers ; Health Personnel ; Philippines