Previous and active tuberculosis increases risk of death and prolongs recovery in patients with COVID-19

Background: There is a growing literature on the association of SARS-CoV-2 and other chronic conditions, such as noncommunicable diseases. However, little is known about the impact of coinfection with tuberculosis. We aimed to compare the risk of death and recovery, as well as time-to-death and time-to-recovery, in COVID-19 patients with and without tuberculosis. Methods: We created a 4:1 propensity score matched sample of COVID-19 patients without and with tuberculosis, using COVID-19 surveillance data in the Philippines. We conducted a longitudinal cohort analysis of matched COVID-19 patients as of May 17, 2020, following them until June 15, 2020. The primary analysis estimated the risk ratios of death and recovery in patients with and without tuberculosis. Kaplan–Meier curves described time-to-death and time-to-recovery stratified by tuberculosis status, and differences in survival were assessed using the Wilcoxon test. Results: The risk of death in COVID-19 patients with tuberculosis was 2.17 times higher than in those without (95% CI: 1.40-3.37). The risk of recovery in COVID-19 patients with tuberculosis was 25% lower than in those without (RR ¼ 0.75,05% CI 0.63-0.91). Similarly, time-to-death was significantly shorter (p ¼ .0031) and time-to-recovery significantly longer in patients with tuberculosis (p ¼ .0046). Conclusions: Our findings show that coinfection with tuberculosis increased morbidity and mortality in COVID-19 patients. Our findings highlight the need to prioritize routine and testing services for tuberculosis, although health systems are disrupted by the heavy burden of the SARS-CoV-2 pandemic

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

Epidemiological profile and transmission dynamics of COVID-19 in the Philippines

The Philippines confirmed local transmission of COVID-19 on 7 March 2020. We described the characteristics and epidemiological time-to-event distributions for laboratory-confirmed cases in the Philippines recorded up to 29 April 2020 and followed until 22 May 2020. The median age of 8212 cases was 46 years (IQR 32–61), with 46.2% being female and 68.8% living in the National Capital Region. Health care workers represented 24.7% of all detected infections. Mean length of hospitalisation for those who were discharged or died were 16.00 days (95% CI 15.48–16.54) and 7.27 days (95% CI 6.59–8.24). Mean duration of illness was 26.66 days (95% CI 26.06–27.28) and 12.61 days (95% CI 11.88–13.37) for those who recovered or died. Mean serial interval was 6.90 days (95% CI 5.81–8.41). Epidemic doubling time prior to the enhanced community quarantine (ECQ; 11 February and 19 March) was 4.86 days (95% CI 4.67–5.07) and the reproductive number was 2.41 (95% CI 2.33–2.48). During the ECQ (20 March to 9 April), doubling time was 12.97 days (95% CI 12.57–13.39) and the reproductive number was 0.89 (95% CI 0.78–1.02)

Soil-Transmitted Helminthiasis and Schistosomiasis in Children of Poor Families in Leyte, Philippines: Lessons for Disease Prevention and Control

Objective Neglected tropical diseases (NTDs) continue to be a public health problem in the Philippines. We assessed the association of soil-transmitted helminthiasis (STH) and schistosomiasis with selected health-related and socioeconomic variables in four villages in Leyte, Philippines. Methods Stool specimens from 418 adults and 533 of their children from 209 families were examined through the Kato-Katz technique. Results STH and schistosomiasis were present in 64.6% and 12.5%, respectively, of study participants. Analysis through the generalized linear mixed model revealed a number of associations between infection in parents and their children. Findings indicate that years of disease prevention and control efforts in these areas have been unable to bring down prevalence in children and their parents. Eliminating NTDs as public health problems will require a systems thinking approach beyond implementation of vertical control programs alone

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

Cocreation in Health Workforce Planning to Shape the Future of the Health Care System in the Philippines.

Background: The Philippines passed landmark legislation in 2019 on universal health coverage, including reforms in the development of its health workforce, an essential building block of responsive health care systems. Health Workforce Planning Cocreation Process: We based our planning process on a model of cocreation defined as sharing power and decision making to solve problems collaboratively and build consensus around action. Through cocreation with policy makers, researchers, and other stakeholders, we performed projection studies on 10 selected health professions and estimated the need for primary care at national and subnational levels, which was the most extensive health workforce projection carried out by the Philippine Department of Health to date. We determined health workforce requirements based on target densities recommended by the World Health Organization and a health needs approach that considered epidemiological and sociodemographic factors. In consultation with stakeholders, we interpreted our analysis to guide recommendations to address issues related to health workforce quantity, skill mix, and distribution. These included a broad range of proposals, including task shifting, expanding scholarships and deployment, reforming health professionals’ education, and pursuing a whole-of-society approach, which together informed the National Human Resources for Health Master Plan. Conclusions: Our cocreation model offers lessons for policy makers, program managers, and researchers in low- and middle-income countries who deal with health workforce challenges. Cocreation led to relationship building between policy makers and researchers who jointly performed the research and identified solutions through open communication and agile coordination. To shape future health care systems that are responsive both during normal times and during crises, cocreation would be essential for evidence-informed policy development and policy-relevant research

Cocreation in Health Workforce Planning to Shape the Future of the Health Care System in the Philippines

Background The Philippines passed landmark legislation in 2019 on universal health coverage, including reforms in the development of its health workforce, an essential building block of responsive health care systems. Health Workforce Planning Cocreation Process We based our planning process on a model of cocreation defined as sharing power and decision making to solve problems collaboratively and build consensus around action. Through cocreation with policy makers, researchers, and other stakeholders, we performed projection studies on 10 selected health professions and estimated the need for primary care at national and subnational levels, which was the most extensive health workforce projection carried out by the Philippine Department of Health to date. We determined health workforce requirements based on target densities recommended by the World Health Organization and a health needs approach that considered epidemiological and sociodemographic factors. In consultation with stakeholders, we interpreted our analysis to guide recommendations to address issues related to health workforce quantity, skill mix, and distribution. These included a broad range of proposals, including task shifting, expanding scholarships and deployment, reforming health professionals’ education, and pursuing a whole-of-society approach, which together informed the National Human Resources for Health Master Plan. Conclusions Our cocreation model offers lessons for policy makers, program managers, and researchers in low- and middle-income countries who deal with health workforce challenges. Cocreation led to relationship building between policy makers and researchers who jointly performed the research and identified solutions through open communication and agile coordination. To shape future health care systems that are responsive both during normal times and during crises, cocreation would be essential for evidence-informed policy development and policy-relevant research

Too early, too late: Timeliness of child vaccination in the Philippines

The Philippine Expanded Program for Immunization has focused primarily on immunization coverage as their metric for performance. However, an equally important indicator of effective vaccine delivery remains unmeasured - the timeliness of administration. National Expanded Programs on Immunization should aim for both high immunization coverage levels and timely administration of vaccines - not early, not late. In this paper, we estimated the coverage and timeliness of routine childhood vaccination in the Philippines from 1993 to 2017 using six rounds of the National Demographic Health Survey. The major findings of the study are: (a) coverage for routine childhood vaccination fluctuated over the last 25 years, a trend not usually observed in most other countries like those in ASEAN. In 2014, the basic vaccination coverage in the Philippines dipped to 65%, the lowest level since 1990; (b) the provision of routine childhood vaccination is predominantly public; about 95% of vaccinated children obtained their vaccines from public facilities despite the large and increasing number of private facilities; (c) a large percentage of children, albeit vaccinated, had untimely administration. The percentage of timely administration among vaccinated children ranged from 38% to 65%. Only 10% had complete and timely basic vaccination. Overall, the Philippine EPI has shown inconsistent performance in both coverage and timeliness in the past two decades. The findings are critical inputs to a more comprehensive assessment of the EPI. It should provide insights in streamlining the delivery and financing mechanism of the EPI to rapidly expand coverage and to promote timely vaccination

An assessment of the expanded program on immunization (EPI) in the Philippines: Challenges and ways forward

The Philippine Expanded Program on Immunization (EPI) has been in existence for almost 40 years. It is one of the major programs of the Department of Health (DOH) that aims to provide Filipino children with access to safe and effective vaccines against diseases like measles, diphtheria, tetanus, and whooping cough. The Philippine EPI has achieved many milestones in this regard, including the steep decline in the country's mortality and morbidity due to vaccine-preventable disease rates. Moreover, polio and maternal and neonatal tetanus was certified as eliminated in 2000 and 2017, respectively. Despite this progress, the program has never achieved its target to fully immunize at least 95 percent of Filipino children. Coverage of basic vaccines has only hovered between 70 and 80 percent in the last 30 years. This study assesses the performance of the EPI in the Philippines. Central to this assessment is the policy question: why has the country struggled to maintain immunization coverage over the years and repeatedly failed to achieve its national immunization target? While demand factors like vaccine confidence have contributed to the weak performance of the program, the sharp decline in immunization coverage is largely a result of deep-seated supply-side systems issues related to leadership, planning, and the supply chain, which led to recurring vaccine stock-outs in the past decade

An assessment of the quality of inpatient meals and nutrition and dietetics processes in select public hospitals in the Philippines

In hospitals, nutrition care is a set of actions that allows for the identification of patient nutritional needs and the provision of care to address those needs. Optimal nutrition for inpatients has a critical role in the prevention and treatment of diseases: It helps boost the body's immune system, reduces the risk of disease and infection, and aids in the recovery from illness. In Philippine public hospitals, nutrition care is provided by the Nutrition and Dietetics Service. In this work, we give a case study on one of the hospital processes-the quality of hospital nutrition. Processes refer to the way care is delivered and whether it is aligned to evidenced-based practice or standards. We looked at whether Philippine public hospitals deliver high-quality, nutritionally appropriate meals to inpatients, adhere to the minimum meal allowance budget, and follow the minimal NDS inputs and process standards. Apart from the issue of unmet minimum meal allowance budget and nutritional content, we were able to unpack concerns related to human resources, equipment, management functions, and other NDS processes that could have an impact on the quality of nutrition care delivered. The general insight in enhancing the nutritional care offered in hospitals is to look at Nutrition and Dietetics Service as a whole, rather than just increasing the minimum meal allowance budget. The Department of Health must also guarantee that the value of high-quality nutrition care is recognized in hospitals, as it is often overlooked that it has an impact on total patient care quality