Together, Primary Health Care (PHC) and resilient health systems form the cornerstone of Universal Health Coverage (UHC). They are what enable UHC to be inclusive, to ensure it leaves no one behind.
PHC is the package of essential health services — ranging from promotion and prevention to treatment, rehabilitation, and palliative care. A person receives these services across their life course, often beginning before birth and continuing through illness, injury, work, childbirth, aging, and the end of life. PHC is the frontline of a resilient health system, one which is able to prepare for, withstand the stress of, and respond to the public health consequences of disasters and emergencies.
The COVID-19 pandemic strained healthcare systems around the world, including that of the Philippines, but it also taught the global healthcare community priceless lessons.
The study “Philippines: a primary health care case study in the context of the COVID-19 pandemic” examines key aspects of PHC in the country to inform future policy and practice, incorporating lessons learned during the COVID-19 pandemic between January 2020 and July 2022. Published last August, it is part of a collection of case studies in the Western Pacific Region commissioned and overseen by the Alliance for Health Policy and Systems Research, a hosted partnership based at the World Health Organization (WHO) headquarters in Geneva, in collaboration with the WHO Regional Office for the Western Pacific (WPRO) in Manila.
The case study noted that the Philippines suffers from a triple burden of disease, from communicable diseases, noncommunicable diseases (NCDs), as well as diseases and conditions arising from rapid industrialization and urbanization. With the devolution of the country’s health system, health care management and implementation are now the responsibility of local government units (LGUs), with the Department of Health (DoH) steering national PHC directives and programs.
Although devolution has allowed LGUs to innovate around models of care to better reach marginalized communities, the case study pointed out that the country’s health system remains fragmented as exemplified by the limited referral and coordination channels among levels of governance and service delivery. The non-profit portion of the private sector helps close service delivery gaps for PHC through partnerships with nongovernmental organizations (NGOs), technical assistance from the academic community, and community-owned projects and patient groups, but these mechanisms often limit individual participation.
The case study noted that the COVID-19 pandemic exacerbated challenges to the full implementation of the Universal Health Care (UHC) Act, including a scarcity of health care workers, especially in rural areas, and variable health financing schemes resulting in increased out-of-pocket (OOP) expenditure. It recommended strengthening PHC to address health workforce and financing gaps, as well as harnessing empowered local structures.
The case study highlighted how strong local mechanisms, many of which were created during the COVID-19 pandemic, enabled PHC service delivery despite the fragmentation of the health system and limited resources. These mechanisms include ordinances for the implementation of national health programs, increased buy-in from local leaders for PHC, multisectoral collaboration for health, continual grassroots feedback from patients, and innovations around monitoring and quality assurance of service delivery.
The case study recommended PHC-oriented research which could enable further innovation at national and local levels, including to support utilization of digital technologies. For example, there may be opportunities to scale PHC innovations such as remote consultations and diversified models of care.
The COVID-19 pandemic has highlighted the need for public-private collaboration, as observed in the recently launched publication The Power of Innovation: Contributions of the Philippine Pharmaceutical Industry.
During the pandemic, public and private partnerships were crucial in developing, scaling up, and distributing important health technologies. The same collaborative mindset and practices can be applied to enable faster regulatory processes, a more efficient supply chain, and ultimately provide greater access to diagnostics, vaccines, and medicines for Filipinos.
Furthermore, public-private collaborations could be facilitated in health systems strengthening. During the pandemic, the industry closely collaborated with the government in monitoring the supply of needed medicines, and even chartered flights to make these life-saving innovations available to Filipino patients amidst global demand and strict lockdowns.
With this, health system building blocks — from logistics monitoring, efficient referral networks, healthcare funding, governance, medicines and massive information campaigns — needed to be in place at the height of the pandemic. Accelerating the rollout of UHC and pertinent laws like the Cancer Control Act would aid in strengthening local health systems so that they may better respond to the healthcare needs of Filipinos.
The innovative biopharmaceutical industry fully supports the efforts of the health department and other stakeholders in strengthening PHC in the country and fully implementing the UHC Act.
We will continue to play our indispensable role in developing and delivering health innovations to support and strengthen PHC and contribute to building resilient health systems..
Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP). PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.
