OBJECTIVE: To quantify the magnitude of difference in access to selected maternal care services among Filipino women who belong to different income groups.
METHODS: Point and interval estimates of the inter-quintile difference in access to a selected maternal care services (family planning; antenatal care; facility-based delivery; skilled birth attendance; and postnatal care) were constructed using weighed coverage data from the Philippines National Demographic and Household Survey 2013.
RESULTS: There is a generally increasing trend in inter-quintile differences in coverage from the lowest to the highest income quintile group (Q1-Q4 > Q1-Q3 > Q1-Q5 > Q1-Q2 > Q2-Q5 > Q2-Q4 > Q3-Q5 > Q3-Q4 > Q2-Q4 > Q4-Q5). Differences in maternal care access between wealth groups ranged from less than 1% for antenatal care (DQ2-Q3 - 0.4% [95% Cl - 1.9% to 1.1%]) to as much as 60% for facility-based delivery (DQ1-Q5 -58.4% [95% Cl - 61.2% to -55.6%]).  Such differences persist even between the two highest quintiles (facility based delivery DQ4-Q5 - 9.7% [95% Cl - 12.5% to -6.9%]).
CONCLUSION: Gradients in access to selected maternal care services exist among Filipino women who belong to different wealth quintiles. The call for stakeholders, therefore, is to intensify efforts to narrow such gaps because, within and across communities, we affirm that no women "should die in the course of the normal process of reproduction" and no families must suffer the devastating consequences of such an occurrence. 

Human ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Demography ; Family Planning Services ; Income ; Parturition ; Philippines ; Postnatal Care ; Pregnancy ; Prenatal Care ; Residence Characteristics ; Surveys And Questionnaires ; Healthcare Disparities ; Maternal Health Services ; Maternal Death

The health systems comprises a vast pool of individuals and organizations in both the public and private sector whose concreted (or disparate) actions define the health status of Filipinos. While Filipinos today are healthier compared to the 1990s, especially with respect to the Millennium Development Goals, challenges and gaps remain. Health disparities between sociodemographic characteristics. There also still remains a gaps even if patients do know, this does not guarantee correct consequent action. Finally, ineffective governance leads to various forms of corruption that, in turn, affect health system performance. This paper offers recommendations on how youth led organizations can help address these challenges

OBJECTIVE: To describe the outcomes of implementation of a public-private mix Directly Observed Treatment Short-course (DOTS) strategy for tuberculosis (TB) prevention and control in a highly-urbanized city in the Philippines.
METHODS: Data on case-finding and case-holding activities of two facilities engaged as part of the public-private mix DOTS (PPMD) from 2006-2013 were abstracted from reports submitted to, and validated by, the city National Tuberculosis Program (NTP) coordinator. Additionality to local case-finding efforts was measured through case detection and case notification rates, while effectiveness of case-holding mechanisms was measured through determination of treatment outcomes of new smear-positive cases.
RESULTS: A total of 314 cases of tuberculosis (average of 40 cases annually) were reported by the two facilities for the period 2006 to 2013. Most of the discovered cases of TB were new cases (81%). Fifty nine percent (59%) were bacteriologically confirmed TB cases through sputum microscopy. New smear-positive cases of TB increased the local case detection rate by an average of four percentage points for the observation period. In absolute terms, this translates to an addition by private institutions of five new smear-positive cases per 100,000 population to those reported by public facilities from 2006 to 2013. Proportionately, the two private hospitals contributed an average of 5% to the total new smear-positive cases detected in the city from 2006 to 2013. In terms of treatment outcome of the cohort of smear positive patients admitted from 2006 to 2012, seven out of ten cases were cured (mean cure rate of 70%), and nearly all (90%) were successfully treated. Over the observation period, the cure rate among new smear-positive cases increased from 50% in 2006 to 86% in 2012, and was comparable to the national benchmark of 85% in 2011 and 2012. On the other hand, treatment success rates were highly variable, but have remained above the 80% mark starting 2007.
CONCLUSION: Engaging private healthcare providers to practice DOTS as the main strategy for TB prevention and control has had some modest impact on local NTP accomplishments. Current efforts need to be scaled up to include a wider range of private practitioners. A triple win situation for the patient, the private practitioner and NTP should be the end goal of all such efforts.

Human ; Aged 80 And Over ; Aged ; Middle Aged ; Benchmarking ; Public Facilities ; Sputum ; Tuberculosis ; Treatment Outcome ; Urbanization ; Hospitals, Private ; Health Personnel

OBJECTIVE: To document the the processes and outcomes of a measles-rubella supplemental immunization activity implemented in Pasay City, Philippines.
METHODS: Review of proceedings of meetings, memoranda, manuals, and reports. Interviews with field monitors, supervisors and vaccination teams, and key members of the project technical group.
RESULTS: A total of 60,685 children age 9 to >72 months were reached during the campaign, representing 75% of the estimated eligible population. On the other hand, 1,453 children were unimmunized because of [a] scheduled or documented prior immunization with a measles-containing vaccine (n = 1,154), and [b] refusal of parents due to religious or cultural reasons (n = 237). The successful completion of the measles-rubella supplemental immunization activity (MR-SIA) was grounded on appropriate timing of project implementation; a clearly identified problem; the existence of linkages between stakeholders at the national and sub-national level; strong local chief executive support; the availability of resources to support project implementation; a clear policy statement; and implementation policy guided by an organizational structure and tailored project plans.
CONCLUSION: In this paper, we have shown that the success of public health programs and projects rely not only on technical soundness of the intervention or adequate resource mobilization, but require wide grassroots support that is guided by an able leadership and clear policy.

Child ; Measles Vaccine ; Leadership ; Public Health ; Measles ; Rubella ; Rubella Vaccine ; Immunization ; Vaccination ; Parents

OBJECTIVE: This paper aims to quantify the magnitude of drowning injury related deaths among children in the Philippines, to form the evidence base for national policies for drowning prevention.

METHOD: Retrospective review and analysis of published data on child drowning injury (1963-2003) in the Philippines.

RESULTS: At least 3,000 Filipinos of all ages die annually from drowning injury (0.43% of deaths), more than a third of which (35.6%) are children under 14 years. Mortality is highest among children ages 1-4 years compared to other age groups [Mortality Rate (MR) 6.4 vs. 3.8 per 100,000]. Child drowning mortality rates have remained largely unchanged from 1963 to 2003, belying its under recognition as a public health priority. There is also a paucity of local data to adequately describe the epidemiology of child drowning in the Philippines.

CONCLUSION: In the Philippines, drowning deaths disproportionately account for 5% of deaths for 1-4 year olds. Drowning prevention could be a 'low-hanging fruit' in the quest to meet the Millenium Development Goals (MDG's) set for 2015. There is a need for better surveillance of child drowning deaths to guide policy formulation for its prevention and treatment in the Philippines.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Drowning ; Retrospective Studies ; Philippines ; Goals ; Health Priorities ; Child Mortality ; Asphyxia

CONTEXT: Evolution of the scope and context of privacy and confidentiality brought about by use of information and communications technology in healthcare.

OBJECTIVE: To review the legal, professional and ethical landscape of health information privacy in the Philippines.

METHODOLOGY: Systematic review of literature and policy frameworks.

RESULTS: Philippine laws jurisprudence recognize and protect privacy of health information as a general rule; impose upon individual practitioners and institutions the obligation to uphold such right; and may apply in both the traditional and eHealth milieu. There is no existing policy framework that addresses issues relating to [a] access to health information by non-health professionals, [b] use of health information for non-health purposes, and [c] rules relating to collection, storage and utilization of electronically-derived or -stored information. A privacy culture, on either the provider's or client's side, is also lacking in the country.

CONCLUSION: Technological developments have outpaced policy and practice. There is a need to unify the patchwork of regulations governing the privacy of health information; advocate for a privacy culture among professionals and patients alike; fortify the evidence base on patient and provider perceptions of privacy; and develop and improve standards and systems to promote health information privacy at the individual and institutional levels. 

Human ; Privacy ; Confidentiality ; Delivery Of Health Care ; Telemedicine

OBJECTIVE: To discuss the various factors contributory to maritime disaster preparedness in the Philippines, in the context of the sinking of the MV Dona Paz and formulate recommendations to address these factors.

METHOD: Review of the state of maritime preparedness in the pre-disaster setting and the post-disaster response following the sinking of the MV Dona Paz by the government and responsible agencies. A scrutiny of the state of preparedness of concerned agencies and subsequent response to the disaster was conducted with the objective of formulating recommendations which may lead to prevention and mitigate loss of lives.

RESULTS: Multiple factors accounted for the occurrence of this tragedy. These factors include an inherent risk due to the geography of shipping industry and its labor force. Economic conditions prevent both the industry and government agencies from upgrading vessels and communications equipment. Lack of enforcement of existing regulations allows vessels to sail overloaded and at times manned by less-than-qualified crew. Delayed response and deficient post-disaster medical response may have led to a disproportionately high mortality.

CONCLUSIONS: The systems inadequacies of the Philippine maritime disaster response mechanism are highlighted by the Dona Paz tragedy. Many of the factors contributing to the disproportionately high incidence of maritime disasters in the Philippines and the resulting loss of limb may be preventable. Recommendations on regulation and enforcement, disaster preparedness, search and rescue, and medical response are discussed.

Incidence ; Philippines ; Glucosamine ; Disasters ; Government Agencies ; Government ; Men ; Geography ; Employment

OBJECTIVE: To discuss the various factors contributory to the fatalities that resulted from the sinking of the MV Dona Paz.

METHODS: Review of the pre-disaster, disaster and post-disaster events surrounding the sinking of the MV Dona Paz, as well as the subsequent response by the government and responsible agencies to the disaster.

RESULTS: The Sinking of the MV Dona Paz, along with the loss of more than 4,000 precious lives, is but a footnote in the long litany of misfortunes plaguing the Philippine maritime industry. A closer look into the events and circumstances leading to this tragedy demonstrates a confluence of equipment and system inadequacy on one hand and human error and lack of preparedness on the other.

CONCLUSION: Multiple factors account for the occurence of this tragedy, along with other maritime disaster incidents dotting the long maritime history of the Philippines. A cursory analysis of these factors may lead to recommendations that can prevent similar occurrences in the future and mitigate damage to property and loss of life. The policy implications of these findings are discussed in a subsequent paper.

Philippines ; Glucosamine ; Disasters ; Government ; Policy ; Organizations

This paper aimed to provide a review of mental health stigma in the Philippines, its implications on policy and programs, and interventions on addressing the issue. Stigma towards people with mental illnesses in the Philippines is rampant; there seems to be lack of sensitivity in referencing mental health issues. Many forms of stigma affect people with mental illnesses. Stigmatizing attitudes and discriminatory behaviors are evident at home, school, workplace and healthcare settings. Stigma is a major barrier to the recovery of mentally ill persons. Increasing the awareness of the public on mental illnesses through health education and promotion is already an established intervention. Various strategies can also be done, such as integrating culture and arts, by providing incentives to companies which have mental health policies, and recognizing institutions and media agencies which promote positive portrayals of people with mental illnesses.

Human ; Mentally Ill Persons ; Mental Health ; Motivation ; Social Stigma ; Stereotyping ; Mental Disorders ; Health Education ; Attitude ; Health Policy

Traditionally, programs related to maternal health are regarded as purely a woman's domain. Nevertheless, the role of the male as the decision maker in the household gave way to the recognition of the male's role in maternal and reproductive health. This paper aimed to provide a review on male involvement strategies and their impact on maternal health based on related studies, discuss the strategies in the Philippine context and suggest interventions given the current state of the Philippine health care system. These strategies utilize the decision-making role of the male by positing itself on the reproductive, sexual and maternal health aspects encompassing important factors, such as birth spacing, first pregnancy, family planning, utilization of skilled birth attendants (SBAs), and delivery in health facilities, antenatal and postpartum care and nutrition. However, negative repercussions include stigmatization of single mothers and reinforcement of the notion of a man's control over a woman's body. Given the current state of the Philippine health care system, the suggested interventions try to veer away from it as much as possible. These include integration of the male involvement strategy into the Pantawid Pamilyang Pilipino Program (4Ps), coursing it through a public-private partnership (PPP) and non-government organizations (NGOs), involvement of educational institutions, strengthening of the health service delivery at the grassroots level, reinforcement of existing laws, and research on its institutionalization. With carefully-planned strategies that recognize existing gender norms and other sociocultural factors, male involvement in maternal health could be a possible catalyst in decreasing the Philippine maternal mortality rate (MMR).

 

Human ; Male ; Female ; Pregnancy ; Maternal Mortality ; Reproductive Health ; Birth Intervals ; Family Planning Services ; Public-private Sector Partnerships ; Stereotyping ; Maternal Health ; Mothers ; Postnatal Care ; Parturition ; Family Characteristics ; Gender Identity ; Delivery, Obstetric ; Decision Making ; Institutionalization ; Health Facilities