THE PHILIPPINES HEALTH AGENDA AND THE ASEAN LANDSCAPE “Towards Global Collaboration in Health”

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March 2, 2017, Bayanihan Center, Pioneer St, Pasig.

What is NIH?

The National Institutes of Health (NIH) was created on January 26, 1996 by the UP Board of Regents to strengthen the research facility of UP Manila, and serve as an institutional home of a network of researchers and research institutions (NIH, 2017 ).

         NIH was established as a national health research center by the Philippine Government during the term of President Fidel V. Ramos. The creation was made through the “Health Research and Development Act of 1998” (Republic Act 8503) on 13 February 1998. RA 9288 or “The Newborn Screening Act of 2004” was signed into law by Pres. Gloria Macapagal- Arroyo on 7 April 2004. The Institute of Human Genetics-NIH and the Newborn Screening Study Group (a coalition of many hospitals and health centers all over the country) had worked for its creation for several years (NIH, 2017 ).

         In 2007, NIH became one of the four core agencies of the Philippine National Health Research Systems (PNHRS). PNHRS is part of a global movement, initiated by the Council on Health Research for Development (COHRED) to establish national health research systems in country setting. In the same year, NIH was designated as a Training Center for Health Research Ethics and Good Clinical Practice by the World Health Organization’s Special Programme for Research and Training in Tropical Diseases (TDR), Strategic Initiative for Developing Capacity in Ethical Review (SIDCER), and Forum for Ethical Review Committees in Asia and the Western Pacific Region (FERCAP). In 2008, “The Newborn Hearing Screening Act” was passed into law. RA 9709 was made possible through the efforts of the Philippine National Ear Institute (NIH, 2017 ) .

In 2017, NIH has vision and mission to help community and Filipino. Vision is to be the country’s recognized authority in health research and development and the key source of critical health information for national development in the Philippines and Southeast Asia. And mission is to be a major resource center for health research and capacity-building using the framework “Partnership for Better Health” (NIH, Vision and Mission , 2017).

There are total 13 institutes under NIH. They are Institutes on Aging, Institute of Child Health and Human Development, Institutes of Clinical Epidemiology, Institute of Clinical Epidemiology, Institute of Health Policy and Development Studies, Institute of Herbal Medicine, Institute of Human Genetics, Philippine Eye Research institute, Institute of pharmaceutical Sciences, Institute of Molecular Biology and Biotechnology, Philippin National Ear Institute, Newborn Hearing Screening Reference Center, Newborn Screening Reference Center and Nationla Telehealth Center (NIH, Vision and Mission , 2017).

What’s New in NIH?

New issues had introduced in 19th anniversary of the National Institutes of Health, UP Manila with the theme, The Philippines Health Agenda and the ASEAN Landscape towards Global Collaboration in Health. They are

  1. Urban problem in Metro Manila is the topic which delivered by Mr. Emmanuel S. Baja, MD. He is research associate professor in Institute of Clinical Epidemiology University of the Philippines National Institutes of Health. He highlights the increase population and movements, increase extreme heat events, and increase black carbon and heavy metal levels as the effect of urbanizations and industrializations events which happening in the Metro Manila. These situations being experienced in urban Metro Manila could undoubtedly increase hospital admission, damage the ecosystem, affect work productivity and even change the health care needs of the Filipinos. Several impacts on health are expected to happen including non-communicable and communicable illness, viral disease transmissions, and vector/animal-borne, water borne and air borne diseases. He encourages multidisciplinary research approach to tackle the current diseases of rapid urbanization and industrializations in Metro Manila.
  2. Potential of Agricultural wastes of Pharmaceutical excipients as a topic presented by Dr. Erna Arollado. She said that the pharmaceutical industry is now facing numerous challenges, such as increase costs in drug development and booming patient population with unmet medical attention, resulting in increased health expenditures. To compensate for these challenges, the industry is burdened to produce pharmaceutical from raw materials outsourced at a cheaper cost. Currently, the Institutes of Pharmaceutical Sciences investigates and utilizes different agricultural waste materials and other natural products as alternatives sources of pharmaceutical excipients. This thrust will lessen the economic and environment problems posed by these wastes, and reduce the need for importations and their competitions for food. In turn, this will decrease the demand of these excipients, and possibly, the cost of pharmaceutical products in the Philippines.
  3. Diabetic retinopathy in the Philippines presented by Leo D.P. Cubillan, MD. He presented his group research in the event. Based on their research, underserved area in The Philippines (Central Luzon) still has a significant prevalence of blindness and visual impairment with majority of causes avoidable. In this setting, Rapid Assessment of Avoidable Blindness with Diabetic Retinopathy (RAAB+DB) is an effective tool for determining and potentially monitoring of implemented eye care programs that address avoidable causes of blindness.
  4. Tele-Audiology is ‘the delivery of audiology services and information via telecommunications technologies’ said James P. Marcin, MD in his presentation. Technology is used as the means to an end and tele-audiology is not a separate subspecialty. In tele-audiology, the most improving research right now is research related with mobile health. Form of mobile health are online auditory training programs, tinnitus management apps, hearing test apps and also counselling apps. Tele-audiology has estimated reduce travel savings of all the patients, decreased wait times dramatically and also potentially increase patient satisfactions. He highlighted that tele-audiology related to acutely ill and injured children especially in the evaluations, diagnoses and treatment of Newborn hearing screening. Tele-Audiology opens wider possibilities to conduct research multi-disciplinary and multi-project.
  5. Institutes of Herbal Medicines, Plans and programs for 2017 is the presentation deliver by Mrs. Cecilia C. Maramba-Lazarte, MD. She highlighted that there are many research publications that has been published under Institutes of Herbal medicines for 2017 and many to come. Institutes of Herbal Medicines will be held 1st herbal medicine summit and highlight some points, first the herbal medicines summit will be a regular event where all the stakeholders present are committed to participate and contribute for the advancement of herbal medicine research. Second, creation and development of a research directory that shall connect the herbal medicine stakeholders. Third, designate a core group that shall embody all the sectors of herbal medicine community and work to resolve problems identified. Forth, post-summit activities of the core group shall continue in order to promote and create solutions for the problems identified by the herbal medicines community and the last, creating corporate solutions only but also include people based solutions.
  6. Technology and emerging challenges in Health (TECH) by Dr. Raymond Francis Sarmiento point out the vision of bringing “e-health in empowered communities” in his department. It is National Telehealth Center (NTHC). The NTHC will continue to promote effective health information management and governance as well as provide communities with health care solutions through the appropriate use of technologies.

The ASEAN Landscape and the Triple Burden of Disease

Philippines is a lower-middle income country enjoying rapid economic growth and making significant investments in extending access to health care. Never the less the country still experiences a “triple burden” of disease which are: (i) high incidences of key communicable diseases and 13 out the 17 of the WHO recognized neglected tropical diseases remain endemic; (ii) rising rates of non-communicable diseases and high prevalence of all risk factors; and (iii) the third highest disaster prone country in the world.

Despite a 4% GDP growth annually for the past decade, 41.7% of the population still live on less than $2/day. 30% of children under-five years of age are stunted. Less than half of all babies are exclusively breast fed to 6 months. Despite major government efforts, the country is least likely to attain millennium development goals (WHO, 2015).

The country has progressed in reducing under-five mortality but significant inequities remain as seen in Mindanao in Southern Philippines where child mortality is 4 to 5 times higher than in Manila. Neonatal mortality account for 50% of all under-five deaths. The Philippines has missed the regional measles elimination and Hepatitis B control target. All regions (except the Autonomous Region of Muslim Mindanao) have now been validated for Maternal and Neonatal Tetanus elimination.

The on-going improvements in maternal services are expected to be reflected in improved mortality figures in the coming years. Teenage pregnancy rates are increasing while the age at first pregnancy is decreasing. TB incidence is decreasing but MDR-TB case finding and management is a big challenge. Although still considered to be low prevalence, the Philippines is one of 9 countries globally with increasing HIV and one of the fastest growing HIV epidemics. The past five years has seen a 587% increase in people reported as living with HIV, with one new infection occurring each hour. Good progress has been made on Malaria elimination, but sustained surveillance will be required. Medicine prices in the Philippines remain some of the highest in Asia (WHO, 2015).

Mr. Gundo Weller, MD who deliver the message highlight five points to approaches advance health in the Philippines. They are save lives, promote well-being, protect health, optimize health architecture and use platform for health. All of it will achieve the main purpose of WHO (World health organization), it is all for health towards health for all.

The Philippine health sector is a public-private mixed system, with the private sector dominating the market. The public sector plays a significant role in the provision, financing and regulation of health services. The current administration is pro-poor and pro-universal health coverage. Economic growth has made significant additional financing available to expand access to health services. The current plan, National Objectives for Health (NOH), will run to 2016, coinciding with the presidential mandate of 5 years. NOH reflects the broad priorities set out in the governmentwide Philippine Development Plan 2011-2016, which includes the Aquino Universal Health Care Agenda.

Mr. Eduardo P. Banzon, Md, Msc delivered the presentation topic related with Triple Burden of Disease and Universal Health Coverage in ASEAN Countries. He is one of the Principal Health Specialist in Asian Development Bank. He said thet ASEAN countries and especially Filipinos need to transform their health service delivery systems (Including human resources for health) from their traditional focus on addressing communicable diseases, under-nutrition and maternal mortality in to 21st century forward looking and smart health service delivery systems that are sensitive to the triple burden while simultaneously investing in climate change-mitigating, resilience building and technology adept interventions. He highlighted that country-level universal health coverage must enable the health coverage of their citizens to ‘roam ‘across and beyond the boarder of the countries.

New ideas in Research field: Some ideas to consider

Social media and Healthcare was the topic delivered by Iris Thiele Isip-Tan, MD, MSC in her session. She introduced a new way of research in health care delivered. She and her teams have been working so hard to prove that social media such as twitter, Facebook, Instagram and so on are valuable media to spread health promotion. Social media also can function as way to find out the experience in the patient related with their rare condition. She offered the idea of peer-to peer healthcare and has been developing SYMPLUR Healthcare Hashtags Project that allow exploration by either hashtag or healthcare subject matter. She and her team completed the project in pregnant woman with diabetes as the implementation of using social media (Twitter) and found that examining tweets of pregnant woman with diabetes identified issues important to them and had differing perceptions of barriers.

Understanding the young Filipino Diabetic is the topic delivered by Mrs. Elizabeth Paz-Pacheco MD, FPCP, FPSEDM. She said that the greater majority of diabetes mellitus among young Filipino is T2DM (Type 2 diabetes mellitus) characterized by insulin resistance. Cardiovascular complications also occur earlier even at a low BMI but with increased visceral adiposity, low HDL and low adiponectin levels. She introduced the ongoing research project which aims to promote the type of diabetes among young Filipinos (Aged 18-45). Characteristic and categorizations will provide clinicians with clinical clues that will provide effectives complication control.

THE TRIPLE BURDEN OF DISEASE

The triple burden disease that had discussed in the conference are communicable disease, non-communicable diseases and diseases of rapid Urbanization and Industrialization.

Communicable Disease

The Topics related with that theme are topics about vaccine-preventable diseases, immunizations program through research and HIV. Mrs. Anna Lena Lopez, Md, MPH in her presentation titled “ Supporting the National Immunization Program through research” stressed out the point that will be used for policy making and development of guidelines, assess the impact of vaccine introduction and identify possible strategies that will improve access to vaccinations.

HIV and the Philippines Epidemic is the presentation topic delivered by Mr. Edsel Maurice T. Salvana, MD. He said that HIV in the Philippines has been increasing at an alarming rate. Based on the research he and his team did, Prevalence of HIV in TB patient is 3.7% and in STI (Sexual-transmitted infection) patient is 7.7%. therefore, Filipinos should be tested early for HIV and started as soon as possible of antiretroviral if diagnosed with HIV. Finally, HIV treatment success is near 90% and closer surveillance for treatment failure and procurement of more second-line agents is needed.

Non-communicable disease

The Philippines health agenda introduces ACHIEVE as a strategy to guarantee service that provide care for all stages and address the triple burden of diseases, one of which is brought about by Non-communicable disease. It serves as a roadmap to NCD prevention and control in NCR which envision of Metro Manila free from the burden of avoidable-life-style related disease.

One of the interesting topics in non-communicable disease was the topic related with sexual abuse among urban teens delivered by Mrs. Bernadette J. Madrid, MD. She said that through the years there has been an increase in the number of abused children referred to the Child Protection Unit (CPU) of the PGH. Child sexual abuse (CSA) is the most difficult to detect. Failure to report was highest in day-care centers and schools. Based on her research, there was a significant improvement of the teachers’ knowledge, attitudes and skills in recognizing and reporting suspected cases of abuse after had received training curriculum and resource packet related to case management for the school child protection committees. The safe school for teens promotion and interventions significantly rises the awareness and reporting of cases of child sexual abuse.

Diseases of Rapid urbanization and Industrialization

Rapid urbanizations and Industrialization make effects in road traffic injury and noise problem. Road traffic injury was delivered by Adovich Rivera, MD in his presentation. Based on his research, it is estimated that there are 2,789,088 episodes and 12,336 death due to road traffic injuries in 2014. This leads to increase in health burden and lost due to injuries. The care of these case cost the Philippines PHP 1.2 B in medical cost and PHP 25.3 B in lost income. Most injuries were found to dis-appropriately affect young to middle age males. As conclusions, multisector approach to prevention is necessary to overcome those problems.

“Noise is the silent killer” by Mr. Cristopher Malorre Calaquian, MD delivered some important information about effect of noise for human. Traffic and how rapid urbanization in the Philippines especially Manila brings people in the area develop disturbance condition in their hearing function. It is better for citizen to report their self to the local public health services about their condition.

References

NIH. (2017 , March 04). Historical Highlight . Retrieved from National Institutes of Health Univeristy of the Philippines Manila: http://nih.upm.edu.ph/about-nih/historical-highlights

NIH. (2017, March 4). Vision and Mission . Retrieved from Nationl Institues of Health University of the Philippines Manila: http://nih.upm.edu.ph/

WHO. (2015, April -). County cooperation strategy at a glance in the Philippines. Retrieved from Global Health Observatory : http://apps.who.int/gho/data/node.cco

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