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Catastrophic expenditure occurs when a household allocates more than 40% of its effective, or non-subsistence, income for health expenditures.1,2 In general, low-income households, those with older persons or persons with disabilities, and families with members requiring healthcare for chronic illnesses are more likely to experience this phenomenon. 3 In the Philippine setting, it has also been suggested that disasters create catastrophic spending situations.4 As household incomes are generally fixed, incurring unexpected, large, and/or long-term expenditures typically means either reducing allocation for other expense items (e.g., diminution of the budget for food or shelter) or sourcing funding elsewhere (e.g., incurring substantial debt to bridge the shortfall), and may lead to the impoverishment of the family, particularly for those who are living remarkably close the knife’s edge of poverty. Hence, protecting individuals and families from such financial catastrophe has become an important policy objective at the global and domestic levels.5–7 Using the 40% non-subsistence income threshold, it has been estimated that the 0.78% (95% uncertainty interval: 0.71 – 0.85) of households in the Philippines experienced catastrophic health expenditure.1 Meanwhile, using a 25% total household budget as a cut-off point – as measured for the Sustainable Development Goals – would increase the proportion to 1.41% of households.8 These figures, however, seem to underestimate the actual situation, as shown by related data from the 2018 Family Income and Expenditure Survey and the Philippine National Health Accounts 2014-2019.9,10 First, households typically spend around 75% of their income, which translates to an average annual savings of about 75,000 pesos. Second, roughly two-thirds (63%) of expenses were allocated for food, shelter, and utilities. In comparison, only 2.7% went to health expenses (or about 6,500 pesos per year for the entire household, using as reference the 239,000 pesos total annual household expenses). Third, the per capita health expenditure in 2019 was estimated at Php 6,662.20 – the bulk of which went to curative care in hospitals – nearly half (47.9%) contributed directly from out-of-pocket. In short, regularly, households allocate only a small amount for health-related expenses but are forced to spend more when presented with conditions requiring more expensive treatment. A separate analysis showed that catastrophic health expenditures were, on average, more than 60,000 pesos annually; medicines and in-patient services accounted for two-thirds of this amount.11 Given that the net household savings are not substantial, the question arises as to where the difference in funding requirement comes from. Lasco et al.’s paper in this issue provides an answer in this respect and extends our insight into how individuals and families deal with health expenditures.12 Drawing on data gathered from 30 focus group discussions participated in by 250 individuals representing different socio-demographic and stakeholder groups, their results offer a human dimension to the processes that families go through as they initially forego help-seeking, owe money, and finally request institutional assistance to finance their health need. The low incidence of catastrophic health expenditure in the country currently documented by official sources may be attributed to either of two scenarios. The optimistic scenario is that institutional assistance and subsidized healthcare in government facilities can bridge the shortfall in health financing, averting financial catastrophe for the family. Our prior research, however, has shown that such institutional assistance is almost always not sufficient to cover the deficit unless a family is resourceful enough that they can tap multiple providers or donors.13,14 The alternative is that individuals or families do not go beyond the first stage of pagtitiis, so much so that no further treatment can be offered when the individual interfaces with a healthcare provider. An additional point must be thought-out when considering catastrophic health expenditure. Health needs are fraught with uncertainty, which biases an individual’s capacity to adequately prepare, financially or otherwise, for such occurrence. Uncertainty in this sense means that there is a dimension of indeterminacy of a future health state, such as when healthcare professionals discuss the risk of a person suffering complications from a chronic illness.15 Prior research has shown that accurate risk perceptions are vital in healthcare. 16 Yet, we are well aware that the concept of risk, or chance, is a rather abstract notion that distorts our decision-making processes, especially about things that are unknown, unobserved, or not yet experienced.17 The burden, therefore, of preparing for unexpected healthcare expenditure should be shifted from the individual or household through the strengthening of existing social safety nets and reducing the out-of-pocket share in total health expenditure. This will entail additional investments by the government and the social health insurance program and will be among the challenges that the new dispensation will have to consider as we collectively rise from the ravages of the pandemic. Carl Abelardo T. Antonio, MD, MPH Department of Health Policy and Administration College of Public Health University of the Philippines Manila, Manila, Philippines REFERENCES World Health Organization. Designing Health Financing Systems to Reduce Catastrophic Health Expenditure [Internet]. Geneva: World Health Organization; 2005 [cited 2022 Jun 06]. Available from https://apps.who.int/iris/handle/10665/70005. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household Catastrophic Health Expenditure: A Multicountry Analysis. Lancet. 2003 Jul 12;362(9378):111-7. doi: 10.1016/S0140-6736(03)13861-5. Azzani M, Roslani AC, Su TT. Determinants of Household Catastrophic Health Expenditure: A Systematic Review. Malays J Med Sci. 2019 Jan;26(1):15-43. doi: 10.21315/mjms2019.26.1.3. Espallardo N, Geroy LS, Villanueva R, Gavino R, Nievera LA, Hall JL. A Snapshot of Catastrophic Post-disaster Health Expenses after Typhoon Haiyan. Western Pac Surveill Response J. 2015 Nov 6;6 Suppl 1(Suppl 1):76-81. doi: 10.5365/WPSAR.2015.6.2.HYN_017. World Health Organization. The World Health Report. Health Systems Financing: The Path to Universal Coverage [Internet]. Geneva: World Health Organization; 2010 [cited 2022 June 6]. Available from https://apps.who.int/iris/handle/10665/44371 United Nations. Transforming Our World: The 2030 Agenda for Sustainable Development [Internet]. [New York]: United Nations; 2015 [cited 2022 June 6]. Available from https://sdgs.un.org/publications/transforming-our-world-2030-agenda-sustainable-development-17981 Congress of the Philippines. Republic Act No. 11223, Universal Health Care Act [Internet]. 2019 [cited 2022 June 6]. Available from https://www.officialgazette.gov.ph/2019/02/20/republic-act-no-11223/ World Health Organization. Global Health Observatory [Internet].n.d. [cited 2022 June 6]. Available from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/population-with-household-expenditures-on-health-greater-than-25-of-total-household-expenditure-or-income-(-sdg-indicator-3-8-2)-(-) Philippine Statistics Authority. 2018 Family Income and Expenditure Survey. Volume 1. National and regional estimates [Internet]. Quezon City: Philippine Statistics Authority; 2020 [cited 2022 June 6]. Available from https://psa.gov.ph/sites/default/files/FIES%202018%20Final%20Report.pdf Philippine Statistics Authority. Philippine National Health Accounts 2014-2019 [Internet]. Quezon City: Philippine Statistics Authority; 2020 [cited 2022 June 6]. Available from https://psa.gov.ph/sites/default/files/Publication%20PNHA%202019%20signed_0.pdf Bredenkamp C, Buisman LR. Financial Protection from Health Spending in the Philippines: Policies and Progress. Health Policy Plan. 2016 Sep;31(7):919-27. doi: 10.1093/heapol/czw011. Lasco G, Yu VG, David CC. The Lived Realities of Health Financing: A Qualitative Exploration of Catastrophic Health Expenditure in the Philippines. Acta Med Philipp. 2022; 56(11):11-21. doi.org/10.47895/amp.vi0.2389. Antonio CT, Bermudez AC, Cochon KL, Garcia FB, Gueverra JP, Manalo JA, Quizon RR, Salvino RP, Benedicto EG. Stakeholder Perceptions on the Challenges of Financing Debilitating Illnesses: The Case of Colorectal Cancer and Schizophrenia in the Philippines. Phil J Health Res Dev. 2017;21(2):17-19. Guevarra JP, Antonio CT, Cochon KL, Bermudez AC, Garcia FB, Manalo JA, Pagtiilan GT, Guevarra EM, Salvino RP, Benedicto EG. Financial Assistance for Treatment of Schizophrenia in the Philippines. Acta Med Philipp. 2022;56(5):75-81. doi: 10.47895/amp.vi0.3376. Han PK, Klein WM, Arora NK. Varieties of Uncertainty in Health Care: A Conceptual Taxonomy. Med Decis Making. 2011 Nov-Dec;31(6):828-38. doi: 10.1177/0272989x11393976. Ferrer R, Klein WM. Risk Perceptions and Health Behavior. Curr Opin Psychol. 2015 Oct 1;5:85-89. doi: 10.1016/j.copsyc.2015.03.012. Enke B. What You See is All There Is. Q J Econ. 2020; 135(3): 1363-98. doi: 10.1093/qje/qjaa012.

In 2006, a seminal report from the World Health Organization1 provided an all-encompassing definition of health workers as “all people engaged in actions whose primary intent is to enhance health,” whether involved in direct service provision (e.g., physicians, nurses, midwives) or administrative/support functions (e.g., administrative professional or driver in a healthcare facility), and with or without compensation (e.g., volunteer health workers, family caregivers). Because of limitations on data availability and measurement, however, technical and academic discussions about health workers, or more formally, human resources for health (HRH), focus on those under the formal sector.2 By and large, HRH is considered a vital pillar of a functioning health system3 because the health sector is a labor-intensive industry4 that relies on a substantial number of highly skilled staff to provide services to target populations, and consequently, the attainment of national and global health targets (e.g., Sustainable Development Goals). One challenge confronting HRH management is the issue of geographical imbalance, which means that health workers are attracted to work and settle in urban more than rural areas for a variety of individual, organizational, institutional, economic, political, and cultural factors.5,6 In the Philippine context, the Department of Health (DOH) reported in 2018 that there still exists a maldistribution of HRH in the country, particularly in “hardship” posts where municipalities could not entice, nor retain, HRH.7 For example, a separate analysis of institution-based HRH data in 2017 showed that the National Capital Region had significantly more physicians, nurses, and medical technologists than the Autonomous Region of Muslim Mindanao.8 The paper by Tejero et al.9 in this issue of Acta Medica Philippina adds further evidence to the underlying reasons for the geographical imbalance of HRH in the country. Based on interviews with officials and health workers from 76 rural municipalities across the Philippines, the researchers found that, in general, while local government units attempted to implement strategies to help recruit and retain health workers in their areas, such a response has mainly been inadequate and has failed to bridge the HRH gap confronting their locality. At its core, the financial obligations tied to the recruitment and retention process appear to be a significant driver of this situation since most rural municipalities are dependent on their share of national revenues by way of the Internal Revenue Allotment (IRA), which in turn is based on population (50%), land area (25%), and equal sharing (25%).10 That is to say, rural municipalities can only commit so much financial resources in their annual budget to fund the salary of health workers, given the other equally important social and development programs that need to be implemented. Even the impact of the expected increase in IRA based on the Mandanas Doctrine promulgated by the Supreme Court in 2019 revising the computation of national revenues may be modest at best since some programs, projects, and activities previously supported by the national government will have to be assumed again by local government units.11 The devolution of health services following the promulgation of the Local Government Code of 199112 with its promise of creating a governance structure that is more responsive to the needs of communities has resulted in a paradox whereby local government units are constrained in their strategies and initiatives by, among other things, the financial resources that are available at their disposal. To this end, two important points need to be considered by local government units to address the issue of the geographical imbalance of HRH. First, augmentation of available human resources for health through national-level initiatives (e.g., DOH HRH Deployment Program 8, Medical Scholarship, and Return Service Program 13) as well as private sector support (e.g., project-specific HRH for the tuberculosis control program 14) should be maximized, but with a clear intent that, as we have argued in past publications, these be regarded as temporary measures to rectify the issue in the short- to intermediate-term.14–18 Second, and more importantly, there is a need to explore, mobilize, and maximize non-financial incentives (e.g., housing) and extrabudgetary sources (e.g., share from the feed paid by social health insurance), as more long-term tactics.1,17 Unless and until a viable fiscal environment is put in place, coupled with implementation of a comprehensive policy and framework across the phases of the working lifespan1 , the challenge of HRH maldistribution will continue to persist. Carl Abelardo T. Antonio, MD, MPH Department of Health Policy and Administration College of Public Health University of the Philippines Manila, Manila, Philippines Department of Applied Social Sciences The Hong Kong Polytechnic University, Kowloon Hong Kong SAR, China REFERENCES World Health Organization. The World Health Report 2006: Working together for health [Internet]. Geneva: World Health Organization; 2006 [cited 2022 May 4]. Available from https://apps.who.int/iris/handle/10665/43432 Al-Sawai A, Al-Shishtawy MM. Health workforce planning: an overview and suggested approach in Oman. Sultan Qaboos Univ Med J. 2015 Feb; 15(1):e27-33. World Health Organization. The World Health Report 2000. Health systems: improving performance [Internet]. Geneva: World Health Organization; 2000 [cited 2022 May 4]. Available from https://apps.who.int/iris/handle/10665/42281 Buchan J. What difference does (“good”) HRM make? Hum Resour Health. 2004 Jun 7; 2(1):6. doi: 10.1186/1478-4491-2-6. Zurn P, Dal Poz MR, Stilwell B, Adams O. Imbalance in the health workforce. Hum Resour Health. 2004 Sep 17; 2(1):13. doi: 10.1186/1478-4491-2-13. Dussault G, Franceschini MC. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health. 2006 May 27; 4:12. doi: 10.1186/1478-4491-4-12. Department of Health. National objectives for health Philippines 2017-2022 [Internet]. Manila, Philippines: Department of Health; 2018 [cited 2022 May 4]. Available from https://doh.gov.ph/sites/default/files/health_magazine/NOH-2017-2022-030619-1%281%29_0.pdf Dayrit MM, Lagrada LP, Picazo OF, Pons MC & Villaverde MC. The Philippines health system review [Internet]. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 [cited 2022 May 4]. Available from https://apps.who.int/iris/handle/10665/274579. Tejero LS, Leyva EA, Abad PB, Montorio D, Santos M. Production, recruitment, and retention of health workers in rural areas in the Philippines. Acta Med Philipp. 2022; 56(8):31-42. Congressional Policy and Budget Research Department. Facts in figures, FF2012-03 [Internet]. Quezon City: House of Representatives; 2012 [cited 2022 May 4]. Available from https://cpbrd.congress.gov.ph/images/PDF%20Attachments/Facts%20in%20Figures/03-FnF%20IRA.pdf Manasan RG. Fiscal sustainability, equity, and allocative efficiency in the light of the 2019 Supreme Court ruling on the LGUs’ share in national taxes, DP 2020-18 [Internet]. Quezon City: Philippine Institute for Development Studies; 2020 [cited 2022 May 4]. Available from https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidsdps2018.pdf Congress of the Philippines. Republic Act No. 7160, Local Government Code of 1991 [Internet]. Metro Manila: Congress of the Philippines; 1991 Oct 10 [cited 2022 May 5]. Available from https://www.officialgazette.gov.ph/downloads/1991/10oct/19911010-RA-7160-CCA.pdf Congress of the Philippines. Republic Act No. 11509, Doktor Para sa Bayan Act [Internet]. Metro Manila: Congress of the Philippines; 2020 Dec 23 [cited 2022 May 4]. Available from https://www.officialgazette.gov.ph/downloads/2020/12dec/20201223-RA-11509-RRD.pdf Antonio CT, Guevarra JP, Medina PN, Roxas EA, Cavinta LL, Manalo JA, et al. Facilitators and barriers to the implementation of selected local tuberculosis control programs in the Province of Laguna, Philippines. Philipp J Sci. 2021 Dec; 150(6A):1501-1506. Lawas ND, Faraon EA, Mabunga SY, Antonio CT, Tobias EM, Javier RS. An evaluation of the Medical Pool Placement and Utilization Program (MedPool PUP) of the Philippine Department of Health. Acta Med Philipp. 2016; 50(3):186–193. doi: 10.47895/amp.v50i3.826 Medina PN, Bardelosa DD, Lara AB, Avelino MD, Agbon AG, Cengca RM, et al. A historical perspective of mandatory service policy in the Philippines: a document analysis. Phil J Health Res Dev. 2018; 22(3):1–12. Antonio CT, Guevarra JP, Medina PN, Avelino MD, Agbon AG, Sepe DC, et al. Components of compulsory service program for health professionals in low-and middle-income countries: A scoping review. Perspect Public Health.2020;140(1):54–61. doi: 10.1177/1757913919839432. Guevarra JP, Medina PN, Avelino MD, Cengca MM, Ting ML, Agbon AG, et al. Perception of program administrators and students on the implementation of return service agreement in the Philippines. Acta Med Philipp. 2020;54(3):289–95. doi: 10.47895/amp.v54i3.1666.

Objective. To assess the competency levels of the technical staff of the Center for Health Development Calabarzon (CHD 4A) to inform the development of a human resource management plan.Methods. A cross-sectional assessment design to determine the CHD 4A technical staff's competency level was utilized. The team from the College of Public Health, University of the Philippines Manila invited all the CHD 4A technical staff to complete a self-assessment using the Learning and Development Needs Assessment Tool (LDNA) (version 3-45), rating their perceived competency and the level of importance to their functions on core and functional competencies stipulated in the Department of Health Compendium of Competency Standards. Gaps were identified by comparing perceived competency levels with a predetermined standard for each agency's salary grade or position.Results. All 67 technical staff took part in the assessment. Entry- and senior-level professionals had minimal deviations from predetermined standards, with gaps in quality service focus and teamwork for the former and planning and political savvy for the latter. In contrast, mid-career professionals had larger gaps in magnitude and number than entry and senior-level staff – the largest being on results orientation – reflective of newly-promoted staff's adjustment period. Of note, these gaps were based on the prevailing competency standards in force at the time of assessment in 2015. Findings may need to be revisited when the agency updates the core and functional competency standards.Conclusion. The participants perceived core and functional competencies as important, with the level of perceived importance increasing as the salary bracket increases. Core competency gaps were widest in integrity and quality service focus. Simultaneously, results orientation, and planning and organizing were the functional competencies that registered the widest gap and prioritized. Training needs assessments should be conducted in times of change to ensure an organization's training programs' relevance and to develop peak-level employee performance.

Objective. This paper aims to characterize existing financial assistance available to patients with schizophrenia. Specifically, we described (1) the funding mechanisms for the treatment of patients with schizophrenia; (2) the process for accessing financial assistance; and (3) the experiences of consumers of services of these support mechanisms. Methods. We employed qualitative techniques using key informant interviews (KII) and focus group discussion (FGD). Key informants were officials from institutions providing or offering financial assistance for patients with any health-related concerns, including schizophrenia. Focus group participants were support group members or caregivers of patients with schizophrenia. Purposive sampling was used to select participants for both providers and consumers of financial assistance or scheme. Topic guides for KII and FGD were used for data collection. Thematic analysis was performed on the qualitative data gathered from the informants and focus group participants. Results. Securing financial assistance for schizophrenia followed a generally similar process, whether the source is from government offices or civil society organizations, and can be grouped into three main stages: (a) pre-application, (b) application, and (c) post-application. While the process of seeking financial assistance appears to be straightforward, issues were encountered in all of the stages by both providers and recipients alike, namely: (a) Financial assistance as an augmentation to patient resources; (b) Mismatch between demand and service capability; (c) Measures of organizational effectiveness; (d) Health professionals and support groups as "bridges" / "facilitators" to financial assistance providers; (e) Financial and non-financial costs incurred by caregivers in applying for financial assistance; and (f) Recipient-provider relationship as a barrier to the feedback process. Conclusion. This study provides a glimpse of available financial and other relevant assistance to clients, including clients suffering from schizophrenia. More extensive research covering more organizations, support groups, and caregivers from different parts of the country is recommended.

Background and Objectives. Tuberculosis (TB) remains a public health problem in the Philippines despite trends indicating a decline in the burden of disease. Persons who use drugs who are confined in government-retained drug abuse treatment and rehabilitation centers (DATRCs) face an increased risk for TB because of the congestion in the facility coupled with the absence of guidelines on TB management specific to DATRCs. Thus, this study was conducted to document the current case finding and case holding practices as well as TB treatment pathway in six (6) Luzon-based, government-retained DATRCs. Methods. Key informant interviews were conducted with DATRC personnel involved in TB diagnosis and management in six selected DATRCs in Luzon, Philippines. Interviews were transcribed and coded for thematic analysis. We compared the DATRC practices with the provisions of the 2014 National TB Control Program (NTP) Manual of Procedures. Results were validated through a workshop with (a) a group of physicians and rehabilitation practitioners assigned in other DATRCs; and (b) a group of experts who have experience in managing or overseeing DATRCs in the country. Results. Two physicians and four nurses participated in the interviews. Variations in case finding and case holding practices in six DATRCs have been found. National guidelines exist for congregate settings but are more specific to jails/prisons, which are administratively and operationally different from DATRCs. Conclusion. Development of special guidelines for TB case finding and case holding in DATRCs as well as staff training on the latest NTP Manual of Procedures are recommended. However, gaps and inequities posed by the current set-up underscore the need to address health system-wide factors affecting the practice and performance of these facilities.

This paper aims to highlight some of the common areas of concern in qualitative research proposals and manuscripts, gleaned from the authors’ first-hand experience as an external referee and peer-reviewer. The purpose is to provide broad guidance to researchers who are contemplating on writing a research proposal or journal manuscript using a qualitative approach. The three issues are (1) application of the generic label “qualitative” when proponents or authors describe the study design; (2) overreliance on, and even misuse of, interviews and focus groups for data collection; and (3) misconceptions on the process of qualitative data analysis. Practice points are offered on how researchers can avoid these missteps.Research has been characterized as a quest for knowledge, and it has been proposed that both qualitative and quantitative approaches uncover different dimensions of “truth”. The predominance of a positivist ontology in health research in the Philippines and elsewhere, coupled with intense methodological training in quantitative approaches, however, has relegated qualitative research to second-class status. Improving the quality of qualitative research work by addressing some of the issues outlined in this paper is one way of moving past this situation.

Objectives. The Pharmacy DOTS Initiative (PDI) was relaunched on a larger scale in 2014 through the Innovations and Multi-Sectoral Partnerships to Achieve Control of Tuberculosis (IMPACT) project. This paper aimed to assess the PDI program through IMPACT by identifying the facilitating and hindering factors in its implementation. The identified factors are classified as to the affected stakeholders or processes. Methodology. Semi-structured interviews were conducted with the PDI Program Manager and four NTP coordinators from selected project sites. Thematic analysis was done to determine the recurring facilitating and hindering factors as identified by the key informants. Results. Facilitating factors identified include cooperation of the stakeholders, capability-building and a good referral system. The barriers to the implementation were grouped into patient-related, pharmacy-related, health center related, program-related as well as external factors. Conclusion. The referral system created through PDI facilitated the flow of referrals starting from the pharmacy. This enabled presumptive patients to have access to health facilities for TB. Hindering factors contributed to the inability of the engaged pharmacies to sustain their consistency and commitment in conducting the PDI interventions.

Background. The College of Public Health, University of the Philippines Manila (CPH-UPM) was engaged by the Center for Health Development Calabarzon (CHD 4A) to design, implement and manage the retooling of their personnel following implementation of Executive Order No. 336 on the rationalization of the Philippine government’s executive branch. Objective. To describe the training design and present outputs of the training modules designed for the CHD 4A staff. Methods. We reviewed the project documentation, which included the inception report, minutes of meetings, training modules, and post-training reports. Abstracted information was validated through internal discussion by a core group, which had representatives from the two organizations involved from project inception to close-out. Results. The design, development and implementation of the training were the product of collaborative efforts between CHD 4A and the technical team from the College of Public Health, University of the Philippines Manila. Technical staff of CHD 4A were trained in the competency areas in which gaps between the expected and perceived level of performance across all salary grades were highest: results orientation, planning and organizing, technical expertise, quality service focus, coordination and networking, and managing change. Nine training courses were implemented from May to July 2016, which was attended by 230 participants. All training modules were highly rated by participants (range: 3.60 to 3.85) based on a four-point scale, with 4 as the highest rating and 1 as the lowest. Comparison of pre- and post-tests for the modules on coordination and networking, and managing change showed a statistically significant increase in scores at the conclusion of their respective sessions. Conclusion. The design of a training program for an organization’s personnel must be tailor-fit to and answer the needs of its employees. Trainers must be willing to make dynamic changes and adapt to immediate feedback from participants. The implementing party and organization itself must both ensure thorough evaluation of the effects of the training to achieve the organization’s long-term goals.

Background and Objectives. The Philippine Department of Health (DOH) is mandated by law to, among others, develop capacities and accredit physicians and rehabilitation practitioners across the country on the assessment and management of drug dependence. This paper describes the design and presents the outputs of an advanced course on screening and assessment of drug dependence developed by DOH in partnership with the College of Public Health of the University of the Philippines Manila, Philippine College of Addiction Medicine, and the Group for Addiction Psychiatry of the Philippines. Methodology. Review, abstraction and synthesis of data from training-related documents and records for the training activities implemented in 2014. Results. The Level 2a course is a five-day program that focuses on enhancing the skills of physicians and rehabilitation practitioners on the screening and assessment of drug dependence using team-based and practical learning approaches, and builds on learnings from the basic accreditation course. A total of 36 participants from ten Drug Abuse Treatment and Rehabilitation Centers (DATRCs) in nine regions completed the pilot implementation of the course in 2014. In general, the overall participant feedback on the training was mainly favorable based on data from 47% of participants who agreed or strongly agreed to statements on the relevance and attainment of the course aims (mean rating of 1.10±0.31, 1 = Strongly agree, 5 = Strongly disagree), and the appropriateness of its content (1.24±0.43) and design (1.18±0.39). A paired-samples t-test comparing scores for 44% of participants showed that there was a highly statistically significant difference in the pre-test (54%±13%) and post-test scores (69%±10%); t(16)=6.4240, p

Objective. We aimed to provide practical guidance on the scoping review process, building on the methodologies and general steps outlined by Arksey and O’Malley, Levac et al. and The Joanna Briggs Institute. Methods. We reviewed the methodologies of three scoping studies conducted by the authors in the College of Public Health, University of the Philippines Manila between 2016 and 2017. For each project, we outlined the steps, tools utilized, good practices performed, challenges encountered, and recommendations for improving the scoping review process in relation to existing guidelines. We compared the similarities and differences across the three reviews and guidelines to come up with a list of good practices and recommendations. Results. We propose an expanded 10-step and iterative framework based on our analysis of three scoping studies: Define your research question; 2. Specify your research statement according to population, concept, and context; Prepare the necessary tools, forms, and software packages; 4. Assemble your expert panel and/or consultants; Develop your search strategy; 6. Implement the search strategy and retrieve identified studies; 7. Screen and assess studies for inclusion in the scoping review; 8. Chart the data; 9. Synthesize your results; and 10. Prepare your final report. Conclusion. Scoping reviews as a method of evidence synthesis are increasingly gaining popularity among researchers due to the scope of what can be reviewed in a relatively short amount of time. With only three scoping studies informing our proposed methodology, other issues and challenges in the conduct of a scoping review may have been missed in the expanded framework presented in this paper. We suggest future studies to apply existing scoping review methodologies, to further enhance this rapidly evolving framework in research, policy, and practice.

Objective. This paper describes the process utilized in developing a training program on data use for decision making tailored for real-time monitoring of maternal and child health indicators through Community Health Information Tracking System (rCHITS) end-users in selected areas in the Philippines. Methods. Guided by the ADDIE (Analysis, Design, Development, Implementation and Evaluation) model and the training cycle, existing records and reports lodged with the National Telehealth Center (NTHC) pertaining to rCHITS were reviewed, supplemented by interviews with the technical staff of the NTHC and discussion with healthcare workers. Training design was developed, training modules and materials were prepared, critiqued, revised and finalized. The training was implemented and evaluated using an evaluation tool designed for this specific capability-building endeavor. Results. A tailored training program on data use for decision-making was designed for rCHITS end-users in select areas in the Philippines. The process of developing the training program was guided by the ADDIE Model and the Training Cycle. Training was delivered to a total of 128 public health workers. Majority of the participants gave high evaluation on the clarity and relevance of objectives, discussion of topics, methods of delivery, and time devoted in addressing issues (range 3.5-3.8 out of highest possible score of 4). Conclusion. This paper demonstrates the utility of the ADDIE Model and the Training Cycle in developing a training program aimed at enhancing the capability of the field personnel in utilizing the data generated from rCHITS in decision-making. Training participants must also be monitored and evaluated in their workplace setting in order to determine if the concepts and principles covered during the training program are put into practice.

Background and Objectives. Tuberculosis (TB) continues to be a public health concern in the Philippines. Vulnerablepopulations in congregate settings such as drug abuse treatment and rehabilitation centers (DATRCs) have higherrisks of TB transmission and infection. With the Duterte administration’s intensified campaign against illegaldrugs, government-retained DATRCs are filled to capacity. There is an identified need to profile drug users anddependents living in DATRCs. Furthermore, national guidelines for TB management specific to this population isabsent. A study was conducted to determine the profile of admitted clients diagnosed with TB, TB prevalence,treatment outcomes and choice of TB diagnostic modalities in six (6) Luzon-based DATRCs from 2013-2015. Methods. All medical records of drug users admitted in this period were reviewed. Information on the totalpatient census was sought from DATRC heads and used to compute for prevalence. Results. A total of 347 records were obtained. Overall TB prevalence in the study sites was 7,216 per 100,000population. The typical individual diagnosed with TB in a DATRC was male, with a mean age of 35 years, with at leasthigh school education, and unemployed. Weight loss and fatigue were the most common symptoms reported. Themajority (79.83%) completed TB treatment in the DATRCs. Sputum microscopy and chest x-ray were both used forTB diagnosis in 92.80% (322) of the cases. Conclusion. The high burden of TB in Luzon-based, government-retained DATRCs is alarming and underscorethe critical need for standards and guidelines in the National Tuberculosis Control Program addressing the uniquecontext of these facilities.

Objectives. The study aimed to determine the perception of program administrators and students on the implementation of return service agreement (RSA) in the Philippines. It examined the different components of, and opportunities, and challenges in the implementation of RSA of selected institutions. Methods. Key informant interviews using a topic guide were conducted with ten program administrators and student representatives from selected institutions implementing a return service policy. Interviews were transcribed and responses in Filipino were translated to English. Open coding and focused coding were performed to identify categories and themes from the interview transcripts. Results. Addressing human resource for health (HRH) needs of the country is a common rationale behind RSA implementation among the institutions sampled for the study. A notable difference in implementation arrangements is the manner of rendering service. Majority of RSA programs require promisors to be employed in any part of the Philippines in need of health workers, while other RSA programs recruit students from rural areas in order to deploy them later on in their hometowns. There is also an apparent lack of institutionalized mechanisms for job placement for students to fulfill their return service obligations. One challenge in most institutions is the need for a formal monitoring and evaluation scheme for the policy. Conclusion. Integration of the voice of stakeholders is critical in the conceptualization, development, and implementation of RSA policies. This will ensure that issues attendant to operationalization are mitigated if not outrightly avoided.

Objectives. This scoping review aimed to support a landscape analysis to identify lessons learned about intersectoral collaborations (ISCs) by describing their existing models in the context of dengue, malaria and yellow fever. Methods. A scoping review following the methodology of Joanna Briggs Institute was performed using the following inclusion criteria: studies involving humans; studies discussing intersectoral collaborations, malaria/dengue/yellow fever, and prevention or control at any level; and studies in countries endemic for the aforementioned diseases. Studies were screened using Covidence, while data were extracted using NVivo. Results. Of the 7,535 records retrieved, 69 were included in the qualitative analysis. Most ISCs were initiated by multilateral organizations and ministries of health, and none by communities. Strategies included advocacy, health education, research, public health measures, resource mobilization, service delivery and training; mostly employed on a community level. Monitoring and evaluation were mostly formative, ongoing, and participatory. Gaps included administrative and policy barriers, resource shortages, and inadequate research and training. Conclusions. Multiple models of ISC exist in the literature. There is a need to develop a comprehensive framework for an effective and sustainable multisectoral approach for the prevention and control of VBDs ensuring adequate resources, active stakeholders, and strategies that span the entire socio-ecological spectrum.

Objective. This paper presents the experiences of, and lessons learnt from, a seven-year government-academecivil society collaboration in the development, implementation, and evaluation of a training program for Filipino physicians and rehabilitation practitioners on the management of drug dependence. Methods. Review of memoranda, records, and reports relevant to the initiation and implementation of the training activity. Where relevant, we also perused internal notes and minutes of meetings written by the authors, who are also members of the training team. Results. A tripartite collaboration between government, academe, and professional organizations developed a training program on the management of drug dependence for physicians and rehabilitation practitioners. Learnercentered approaches to education were adopted in the delivery of training content. Participation in the training is a prerequisite for government accreditation as rehabilitation professionals. A ladderized approach to the training was adapted, with participants first obtaining a broad introduction to the program, followed by in-depth focus on the assessment and management of drug dependency. This was done as a response to the perception that a single, twoweek training program is insufficient to fully capacitate physicians and rehabilitation practitioners with the requisite knowledge and skills necessary to manage persons with drug dependence. Future plans include an executive course for established practitioners, and a course on community-based management of drug dependency. Conclusion. The current perspective on drug use and dependence is transitioning from a politico-legal issue to a public health concern. Attaining the sustainable development goals in 2030 will necessitate the development of a cadre of professionals who are, among others, capable of assessing and treating persons who suffer from drug dependence. The Philippine experience may serve as a model for other countries struggling with the drug menace.

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.