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

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

Objectives: Despite the public-health significance of both malnutrition and crises, little has been done to explore the convergence of the two domains and develop ways to improve policies and practices, especially in rural communities. This article remedies that knowledge gap by focusing on nutrition-related changes, responses, and practices during crisis situations in Siargao Island, Philippines, using the COVID-19 pandemic as a backdrop. Methods: Forty-six (46) semi-structured interviews were conducted among parents, caregivers, local health workers, and local officials of Del Carmen, Siargao Island. Principles of thematic analysis were applied to data analysis using NVivo 12. Afterwards, the preliminary data were presented in a virtual validation session with the local community and stakeholders. Results: Despite the high prevalence of malnutrition amid a backdrop of economic and nutritional difficulties, the community members generally viewed their children as healthy. Rice remained (disproportionately) central to people’s diets; possible alternatives like root crops were considered emergency foods only and not culturally acceptable as staples, in spite of their cheap and ubiquitous nature. Lastly, the economic and financial repercussions of the COVID-19 pandemic have also negatively affected the community members’ overall nutrition and food sources. Conclusion More efforts should be directed toward encouraging the consumption of root vegetables and fruits as rice alternatives in everyday diet—a costeffective strategy that would also promote dietary diversification. More importantly, nutrition responses should consider local food systems in terms of specific local economies and geographies, while health promotion efforts should engage with local notions of ‘health’ and ‘nutrition’ and encourage community participation in (re)designing policy interventions.
Nutrition ; public health ; rice ; COVID-19