Measuring the Capacity to Combat Illicit Tobacco Trade In 160 Countries

Background Illicit trade of tobacco negatively affects countries’ tobacco control efforts. It leads to lower tobacco prices and makes tobacco products more accessible to vulnerable populations. In this study, we constructed an illicit tobacco trade index, which measures the structural and institutional capabilities of 160 countries in addressing illicit tobacco trade. We collected the most recent and best available data on general governance, tobacco control policies, and trade and customs practices. Results Singapore, New Zealand, Finland and Sweden lead countries with the most favorable illicit tobacco trade score. We observed a positive relationship between illicit tobacco trade scores and Gross National Income (GNI) per capita and a negative relationship with the share of illicit tobacco trade to total tobacco consumption. Conclusions The capability to combat illicit trade varies across countries. However, on average, low and middle-income countries (LMICs) are less capable of addressing illicit tobacco trade as suggested by the lower illicit tobacco trade index score. The lower index score in low and middle-income countries was mainly driven by low scores in tobacco control policies and trade and customs practices and conditions. Our study reinforces the importance for LMICs to adopt the WHO’s Protocol to Eliminate Illicit Tobacco Trade Products, particularly committing to treaty obligations and investing on track and trace system and other customs reforms

Trends in National-Level Governance and Implementation of the Philippines\u27 Responsible Parenthood and Reproductive Health Law from 2014 to 2020

In 2012; the Philippines passed the Responsible Parenthood and Family Planning Law; a landmark legislation billed as a multisectoral and rights-based approach to further sustainable human development. This article is part of the first comprehensive evaluation of the implementation of the law by national-level actors. This evaluation is intended to assess the progress of implementers in the conduct of mandates; roles; and responsibilities described in the law and its implementing guidelines. Interviews with key national government officials and data from official documents and literature revealed 3 major trends in governance and implementation from 2014 to 2020. First; despite being a multisectoral policy; performance was siloed within individual units of implementing agencies; with limited interagency coordination. Second; although the law explicitly called for interventions to invest in human capital and address socioeconomic disparities for sustainable human development; performance focused on biomedical and health interventions; particularly in the area of family planning. Third; national-level governance for reproductive health interventions concentrated on programmatic and operational concerns. Overall; this case in the Philippines illustrates that fragmented implementation has contributed to the slow improvement of reproductive health outcomes. This study highlights the challenges of governance and multisectoral coordination to implement multidimensional interventions in a low- and middle-income country; and it provides potential areas for political and administrative reform in reproductive health governance in the Philippines. By creating a common narrative and onboarding multiple sectors; officials can better identify and address structural determinants with holistic policy solutions to improve reproductive health outcomes

The Impact of COVID-19 on Hospital Admissions for Twelve High-Burden Diseases and Five Common Procedures in the Philippines: A National Health Insurance Database Study 2019-2020

Background The Philippines has the highest cumulative COVID-19 cases and deaths in the Western-Pacific. To explore the broader health impacts of the pandemic, we assessed the magnitude and duration of changes in hospital admissions for 12 high-burden diseases and the utilization of five common procedures by lockdown stringency, hospital level, and equity in patient access. Methods Our analysis used Philippine social health insurance data filed by 1,295 hospitals in 2019 and 2020. We calculated three descriptive statistics of percent change comparing 2020 to the same periods in 2019: (1) year-onyear, (2) same-month-prior-year, and (3) lockdown periods. Findings Disease admissions declined (-54%) while procedures increased (13%) in 2020 versus 2019. The increase in procedures was caused by hemodialysis surpassing its 2019 utilization levels in 2020 by 25%, overshadowing declines for C-section (-5%) and vaginal delivery (-18%). Comparing months in 2020 to the same months in 2019, the declines in admissions and procedures occurred at pandemic onset (March-April 2020), with some recovery starting May, but were generally not reversed by the end of 2020. Non-urgent procedures and respiratory diseases faced the largest declines in April 2020 versus April 2019 (range: -60% to -70%), followed by diseases requiring regular follow-up (-50% to -56%), then urgent conditions (-4% to -40%). During the strictest (April-May 2020) and relaxed (May-December 2020) lockdown periods compared to the same periods in 2019, the declines among the poorest (-21%, -39%) were three-times greater than in direct contributors (-7%, -12%) and two-times more in the south (-16%, -32%) than the richer north (-8%, -10%). Year-on-year admission declines across the 12 diseases and procedures (except for hemodialysis) was highest for level three hospitals. Compared to public hospitals, private hospitals had smaller year-on-year declines for procedures, because of increases in utilization in lower level private hospitals. Interpretation COVID-19’s prolonged impact on the utilization of hospital services in the Philippines suggests a looming public health crisis in countries with frail health systems. Through the periodic waves of COVID-19 and lockdowns, policymakers must employ a whole-of-health strategy considering all conditions, service delivery networks, and access for the most vulnerable. Funding Open Philanthropy

What Drives Hospitals to Expand? A Case of Private Hospitals in Palawan, Philippines

This comprehensive study aims to determine the different factors that motivate private hospitals in rural areas to expand their operation. The study was conducted in seven private hospitals in Palawan, Philippines. The study used key informant interviews to gather data on operations, finances, and other concerns affecting the viability and sustainability of the private hospitals covered. The results reveal that financing, government policies, human resources, and organizational issues, if addressed by the government, could serve as positive incentives to hospital owners and decision makers to further engage in the provision of health care services in rural areas. The results could provide useful information to policy makers in assessing the impact of existing government hospital regulations. Moreover, the study may also provide some insights on how the private sector can be harnessed to invest in health care, especially in rural and poor areas in the country

Primary Health Care and Management of Noncommunicable Diseases in the Philippines

As the Philippines adopts major reforms under the Universal Health Care Act and embarks on an integrated and primary healthcare-oriented system, it is critical to assess its readiness to manage noncommunicable diseases (NCDs), the leading disease burden in the country. This study assesses the readiness of the primary healthcare system to handle NCDs, in the context of governance, financing, service delivery, human resources, and information and communications technology. It identifies challenges in the availability, quality, and equity of the health system, which hamper the provision of comprehensive and continuous healthcare services in local communities

What Explains the Large Disparity in Child Stunting in the Philippines? A Decomposition Analysis

Objective:About a third of under-five Filipino children are stunted, with significant socio-economic inequality. This study aims to quantify factors that explain the large gap in stunting between poor and non-poor Filipino children. Design:Using the 2015 Philippine National Nutrition Survey (NNS), we conducted a linear probability model to examine the determinants of child stunting then an Oaxaca-Blinder decomposition to explain the factors contributing to the gap in stunting between poor and non-poor children. Setting:Philippines Participants:1, 881 children aged 6-23 months Results:The overall stunting prevalence was 38.5% with significant gap between poor and non-poor (45.0% vs. 32.0%). Maternal height, education, and maternal nutrition status account for 26%, 18%, and 17% of stunting inequality, respectively. These are followed by quality of prenatal care (12%), dietary diversity (12%), and iron supplementation in children (5%). Conclusions:Maternal factors account for more than 50% of the gap in child stunting in the Philippines. This signifies the critical role of maternal biological and socio-economic circumstances in improving the linear growth of children

National Multisectoral Governance Challenges of Implementing the Philippines\u27 Reproductive Health Law

In recognition of the role of reproductive health in individual and national development; the Responsible Parenthood and Reproductive Health (RPRH) Law of 2012 was passed in the Philippines after 30 years of opposition and debate. Seven years later; this article examined the cohesiveness of national multi-sectoral governance among state and non-state actors and identified challenges in coordination as part of the first comprehensive evaluation of the landmark policy. Using a qualitative intrinsic case study design and guided by the World Health Organization\u27s systems checklist for governing health equity as our theoretical perspective; we conducted 20 semi-structured interviews with national implementers from health agencies (n=11); non-health agencies (n=6) and non-state actors (n=3) that included civil society organizations (CSOs). Key themes identified through thematic analysis were supported with document reviews of policy issuances; accomplishment reports and meeting transcripts of the RPRH National Implementation Team (NIT). The study found that despite aspirations for vibrant multi-sectoral coordination; the implementation of the RPRH Law in the Philippines was incohesive. National leaders; particularly the health sector; were unable to rally non-health sector actors around RPRH nor strategically harness the power of CSOs. Local resource limitations associated with decentralization were exacerbated by paternalistic financing; coordination; and monitoring. The absence of multi-agency plans fostered a culture of siloed opportunism; without consideration to integrated implementation. This case study shows that even for neutral policies; the interest and buy-in of non-health state actors cannot be assumed. Moreover; possible conflicts in interests and perspectives between state and civil society actors must be managed. Overall; there is need for participatory policymaking and health-sector advocacy to set health equity as an intersectoral goal; involving subnational leaders in developing concrete action plans; and strengthening NIT\u27s accountability systems

Who Provides Good Quality Prenatal Care in the Philippines?

This paper attempts to illustrate the quality of prenatal care services provided by different health care providers. Section I presents the introduction and overview of the study. Section II discusses important information gathered during literature review which was organized into prenatal care and its benefits, recommended practice and discussion of quality of prenatal services. Sections III and IV present the detailed objectives and methodology adapted in the study. Section V discusses the results of the analysis. Lastly, Section V and VI present the discussions and policy recommendations. Results of the study include women who are older, poorer, and with lower educational attainment received poorer quality of prenatal care compared to women who are younger, richer, and better educated. Multiparous women also received poorer quality of prenatal care. Among the health care providers, doctors provide very good quality of prenatal care while majority of midwives and nurses provide fair quality of prenatal care. Not surprisingly, majority of the traditional birth attendants provide poor quality of prenatal care.health service delivery, reproductive health, maternal and child health, Philippines, health care providers, public health, prenatal care, prenatal attendants

Profile of Private Hospitals in the Philippines

As a recognition of the valuable role of private sector in the healthcare delivery system, this paper attempts to collate vital information on private hospitals in the Philippines. This paper looks at the different characteristics and structures of private hospitals sector with regard to geographical distribution, services, financing, human resource, and other information needed by policymakers, investors, and other interested stakeholders. To better understand the current health care delivery system in the country, other sections compare private hospitals vis-a-vis government-owned facilities.health sector, health care, health facilities, hospitals, health care reform, health care financing, health management, private sector participation, Philippines, health, health care markets, private sector, health services delivery

Assessment of the Quality of Inpatient Meals and Nutrition and Dietetics Service Processes in Select Philippine Public Hospitals

Aims The nutrition and dietetics service in Philippine public hospitals was implemented by the Department of Health in 2016 to standardise the daily allowance and nutritional content of inpatient meals. Five years later, it is timely for the Department of Health to assess the quality of inpatient meals and mandated nutrition processes in areas such as staffing, food service, and outcomes monitoring. Methods A mixed-method sequential explanatory design was employed using (1) quantitative assessment through a facility survey (n = 193 hospitals) and (2) qualitative exploration of quantitative results through 6 focus group discussions (n = 36 hospitals). Results Philippine public hospitals were unequipped with the inputs necessary to implement processes that produce high-quality meals for patients. The hospitals were unable to comply with the required minimum meal allowance (51%), nutritional content of meals (40%), and food service standards. Moreover, they had insufficient human resources and inefficient food procurement practices. Conclusions: The quality of nutrition care and inpatient meals in Philippine public hospitals, who serve mostly people on low incomes, is a neglected problem in the Philippines. Moving forward, a systems approach involving the Department of Health, its regional offices, and hospital management is necessary to equip Philippine public hospitals with the inputs and structures necessary to provide high-quality nutrition care and inpatient meals that will facilitate patient recovery and overall patient health