Health Policy ; Health ; Policy

OBJECTIVES

PhilHealth’s present health benefit scheme is largely centered on in-patient services. This inadvertently incentivizes hospital admissions for increased access to benefit coverage. To address this problem, this study proposes a costing method to comprehensively finance outpatient care. The objective of this paper is to estimate an annual primary care benefit package (PCBP) cost based on experience analysis (actual benefit usage) on the first year of implementation at an urban pilot site.

A cost analysis was conducted to assess a disease-agnostic primary care benefit package for an urban outpatient government facility over the first year of implementation. Costing information was gathered through staff interviews, accounting documents, and usage data from the electronic health records system available on-site.

The annual primary care cost was defined as the estimated financial coverage for eligible employees and their eligible dependents (n=15,051). The annual utilization rate for consultations was reported at 51%. Of patients who consulted, approximately 38% accessed free available diagnostic procedures and 48% availed of free available medicines. Based on these usage rates, the annual primary care cost for the first year was computed at PhP 403.22 per capita.

Our study shows that on the first year of coverage in a government run urban outpatient facility, an allocation of PhP 403.22 per capita can allow coverage for a disease-agnostic package (comprehensive); this amount excludes out-of-pocket expenses incurred by the target population of this study. This amount is feasible only when coopted with opportunistic registration, reduction of untargeted check-ups, prior contextual community engagement, and streamlining of patient-transactions through an electronic health record (EHR).

BACKGROUND AND OBJECTIVES

The COVID-19 pandemic has brought additional strain to health workers in the Philippines, leading to a significant proportion of them leaving the workforce. The purpose of this study is to explore the impact of the pandemic on health workers, the support that they received and associated challenges; and identify relevant policies for better workplace conditions.

An environmental scanning method was utilized. Particularly, a literature review and policy scan that were validated through key informant interviews with administrators and frontline health workers from selected urban and rural sites in the three main islands in the Philippines. These were framed into a background note to springboard the discussions during a national policy dialogue participated by representatives from key government organizations, professional organizations of physicians, nurses, and midwives, professional regulatory bodies, hospital administrators, frontline health workers, and donor agencies in the Philippines.

Deaths, burn-out, mental health problems, lack of personal protective equipment and poor allocation of vaccines were reported in the early phases of the pandemic. Support varied across settings but included additional allowance, free meals, accomodation, transportation, training and psychosocial services. Furthermore, pre-pandemic issues such as as low salaries and heavy workload continue to be the main reasons for leaving the workforce or the country. The proposed solutions are as follows: (1) creating policies and strategies for appropriate production, recruitment, and retention of human resources for health; (2) allocating regular permanent positions for both the education and health sector; (3) augmenting and continuation of deployment programs; (3) expanding roles of nurses to push for advanced practice nursing; (4) providing fair compensation along with risk allowances, non-financial incentives, and expanded benefits; (5) supporting mental health wellness by providing an appropriate work-rest balance and safe work environment; (6) providing opportunities for professional development and scholarships with accompanying return-service agreement; and (7) strengthening the reintegration programs for returning overseas health workers.

The pandemic has affected the well-being of health workers and disparities in support were reported due to longstanding workplace issues and policy implementation gaps. Stakeholder commitments require sustained monitoring while policies that are in place and yet to be developed demand stronger support from the government, members of Congress, the private sector, and other key decision-makers.

BACKGROUND AND OBJECTIVE

Public health nurses (PHNs) perform more than the provision of direct care to clients. They are also expected to perform roles as leaders, managers, and collaborators in different settings, especially in areas where there are no physicians. Their continuous professional development must be facilitated to empower them to lead the delivery of health programs and services in pursuit of universal healthcare. This study aims to determine the perceived competencies of public health nurses and describe their training needs.

A descriptive, cross-sectional study was utilized, where an online survey was administered to PHNs across the Philippines to determine their self-perceived competencies and training needs based on the eight domains of core competencies of public health professionals. Descriptive statistics was used to summarize the data.

A total of 330 PHNs answered the survey. The results showed that at baseline, PHNs perceived themselves to be competent (from most to least) in the following: communication, analytical/assessment, community dimensions of practice, policy development/ program planning, leadership and systems thinking, cultural competency skills, public health science, and financial planning and management. In terms of training needs, the enablers mentioned include a supportive work environment that can provide a work schedule that is inclusive of time for professional development and work-life balance; a learning environment where colleagues and supervisors support the need for training and innovation; strong internet connection; and enough equipment to participate and submit deliverables for courses taken.

Filipino public health nurses perceived themselves to be competent in the areas of communication and community practice, but less competent in public health science, and financial planning and management. Future capacity-building programs must be designed to meet this demand. Furthermore, to make training programs truly responsive to the needs of nurses, steps must be taken to promote capacity-building enablers.

BACKGROUND

Family and Community Medicine is a medical specialty that plays a crucial role in the healthcare system and will be in the best capacity to provide primary care services, coordinate referrals to specialists when needed, and promote continuity of care across different healthcare settings in the implementation of the Universal Health Care Law. These are policy recommendations on how family and community medicine can play a significant role in the successful implementation of the UHC.

Recommendation #1. The undergraduate curriculum in Family and Community Medicine must be competency based.

Recommendation #2. The competency outcome of Family and Community Medicine undergraduate curriculum must be aligned with the need of the Philippine health system in the context of Universal Health Care reform.

Recommendation #3. The process of delivery of Family and Community Medicine undergraduate curriculum must adopt to new technology and teaching innovation.

Recommendation #4. Family and Community Medicine must develop strategies to make it as career choice.

Recommendation #5. Family and Community Medicine must develop and implement an effective and sustainable faculty development program.

Recommendation #6. Family and Community Medicine must be socially accountable to the community it serves.

Recommendation #7. Family and Community Medicine must be one of the major core competencies of a licensed physician ready to practice as primary care provider in the UHC.

Recommendation #8. Early placement for Family and Community Medicine practice must be available for newly licensed physicians.

Recommendation #9. Family and Community Medicine practitioners must be provided with continuing professional education and training to provide quality patient care.

Recommendation #10. Family and Community Medicine postgraduate education and training must adopt to new technology and training innovation.

Recommendation #11. Family and Community Medicine postgraduate training should cover urban and rural community health service.

Recommendation #12. Family and Community Medicine continuing professional education and training programs must meet the prescribed standards.

Recommendation #13. Regulation of Family and Community Medicine practice must be a public-private partnership.

Introduction: Access to appropriate and timely care underpins the Republic Act 9707 or the Universal Newborn Hearing Screening and Intervention Act of 2009. However, less than 10% of babies born every year have been screened for hearing loss. The Hearing for Life (HeLe) research program aims to increase the rate of newborn hearing screening (NHS) nationwide through the development and deployment of novel digital health or eHealth technologies in government rural primary care health centers (PCHC). The HeLe is also built on the global call for increased and systematic use of eHealth to strengthen health systems. Effectiveness of eHealth innovations requires acknowledgment of the product’s life cycle; one consideration is organizational readiness at this development stage of the HeLe. Objective: This study assessed readiness of the eight PCHC selected to use the HeLe technologies. Methods: This research utilized the Khoja-Durrani-Scott (KDS) eHealth evaluation tool to assess the PCHC’s readiness level prior to the implementation of HeLe. The KDS tool was distributed through a self-administered survey; data was analyzed using descriptive statistics. Readiness is measured in terms of seven dimensions or outcomes resulting from the use of the HeLe technologies. Results: The study revealed that the eight PCHC were most to least ready, in decreasing order, in the following areas: Ethical, Health, Technology, Social & Cultural, Readiness & Change Management, as well as Economic, and Policy outcomes. The study affirms the PCHCs’ value for equity in health care, i.e., providing accessible NHS services in the community setting closest to where the families and their newborns are. Likewise, results confirm the PCHC staff’s preparedness for another set of innovations, through agreement with statements on Technology, Social & Cultural as well as Readiness & Change Management parameters. Conclusions The results informed the training and technical support strategies to be implemented by the HeLe program proponents. However, even in this early development phase of the HeLe technologies, the PCHC are already concerned with how to sustain NHS services after the research. Fully aware that the HeLe ICT tools need to be maintained and upgraded, the PCHC views that economic and policy support should also be in place to ensure continuous delivery of the ICT-enabled NHS services. While results are illustrative, usefulness is limited by the small sample size and character of the study sites. Nevertheless, social dimensions still have to be carefully considered as innovative NHS tools are introduced to primary care health workers nationwide. Researchers have to be deliberate in working with broader health systems and policy advocacy efforts to allow novel NHS technologies to be smoothly introduced at the community level and frontlines of care.
Telemedicine ; Health ; Technology ; Change Management ; Policy ; Ethics ; Primary Health Care

The standardized training for public health physicians plays an important role in exploring the cultivation public health professionals and strengthening the construction of public health service providers. In 2018, the National Health Commission of China launched a pilot program of standardized training for public health physicians in 10 provinces. This paper clarifies the definition of the standardized training for public health physicians, systematically analyzes the status quo of the training in China and other countries, articulates the design and progress of the training in the perspective of Centers for Disease Control and Prevention, and makes some suggestions for the priorities of the pilot training program, so as to provide reference and basis for the better development of the standardized training for public health physicians in China in the future.
China ; Humans ; Physicians ; Pilot Projects ; Policy ; Public Health

On May 20, 2022, World Health Organization (WHO) Position Paper on Understanding the Behavioural and Social Drivers of Vaccine Uptake (BeSD) was published. This review introduced the BeSD toolkit, interventions to increase vaccine uptake, and offered WHO's position and recommendation. Based on immunization practice, this position paper had some implications for improving the vaccination coverage in China: (1) To promote the BeSD toolkit localization; (2) To integrate the measurement and monitoring of BeSD into multisectoral routine efforts; (3) To enhance the diversity and professionalization of immunization practitioners; (4) To design and carry out implementation research scientifically.
Humans ; Immunization Programs ; Immunization Schedule ; Health Policy ; World Health Organization ; Vaccination ; Vaccines

Objective: To investigate the current situation of influenza vaccination, vaccination willingness, recommended behavior and influencing factors of health care workers (HCWs) under the policy of free vaccination. Methods: A cross-sectional survey was conducted among 3 167 medical staff from 8 hospitals in Nanshan district of Shenzhen city based on a web-based questionnaire platform. The logistic regression was used to analyze the data. Results: The influenza vaccination rate in HCWs was 23.97%, and the recommendation rate was 25.69% from 2019 to 2020. Staff with high professional titles, high academic qualifications, and positive awareness about influenza vaccine had a higher vaccination rate. The main reasons for not recommending influenza vaccine were the fear of patients' misunderstanding of commercial benefits, fear of possible disputes caused by recommended vaccination, lack of national or institutional requirements for recommended influenza vaccine, and fear of adverse reactions of influenza vaccines. Conclusion: Under the free policy, the influenza vaccination rate and recommendation rate of HCWs in Nanshan district of Shenzhen city are relatively low. Strengthening health education on influenza and related knowledge, publicizing the policy of free influenza vaccination, providing convenient vaccination services and promoting the construction of relevant policies and regulations are the key to improve the influenza vaccination rate and recommendation rate among HCWs.
Humans ; Influenza Vaccines ; Influenza, Human/prevention & control* ; Vaccination Coverage ; Cross-Sectional Studies ; Attitude of Health Personnel ; Vaccination ; Health Personnel ; Surveys and Questionnaires ; Policy

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.