MEDIUM TERM HEALTH POLICY & SYSTEMS RESEARCH AGENDA (2016-2022)
MEDIUM TERM HEALTH POLICY & SYSTEMS RESEARCH AGENDA (2016-2022)
Department of Health Health Policy Development and Planning Bureau Health Research Division
Acknowledgements The Medium Term Health Research Agenda was initiated by the Department of Health - Health Policy Development and Planning Bureau (DOH-HPDPB), together with the Philippine Council for Health Research and Development Health Systems Research Management team (PCHRD HSRM), as part of the Health Systems Research Management process as declared in Department Order 2014-0171. Grateful acknowledgement is hereby given to all the respondents from the DOH central office units, DOH attached agencies, DOH regional offices, DOH-retained hospitals, development partners, and other government sectors who made themselves available to be interviewed or those who took the time to answer the online-based questionnaires about their research and policy agendas for the medium term. Acknowledgement and gratitude is extended to the experts who participated in the focus group discussions and provided their input to this health research agenda. Recognition is also given to Alliance for Improving Health Outcomes (AIHO), Inc. for their technical assistance.
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Contents OVERVIEW Background Goals Governance of Health Policy and Systems Research Philippine National Health Research System (PNHRS) National Unified Health Research Agenda (NUHRA) Health Systems Research Management Relevant Policies for Health Policy and Systems Research Philippine Health Agenda (PHA) 2016-2022 National Objectives for Health (NOH) NEDA’s AmBisyon Natin 2040 Philippine Development Plan (PDP) 2017-2022 Sustainable Development Goals (SDGs) 2030 Philippine Global Health Agenda (GHA) Monitoring and Evaluation Framework Methods for Research Prioritization
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THE MEDIUM TERM RESEARCH AGENDA 2017-2022
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IMPLEMENTATION Framework Coordination and Management Timeframe Funding Institutional Partners Evidence to Policy Translation
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7 8 9 10 11 12 13 14
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OVERVIEW OF THE DOH MEDIUM TERM RESEARCH AGENDA
BACKGROUND Emphasis on the role of evidence in informing Philippine health policies, plans, and programs has never been stronger. Success of reform activities in many countries has demonstrated that appropriate, quality, and timely information can guide government’s decisions. Thus, the Department of Health (DOH), through its Philippine Health Agenda 2016-2022, commits to the use of evidence for decision-making. It will build on the gains of the Health Systems Research Management 2012-2016 to fully realize the vision and aspirations of the Philippine National Health Research System of a nationwide, multi-sectoral research network for health. GOALS The Medium Term Health Policy and Systems Research Agenda (MTRA) seeks to address the knowledge gaps to support the implementation of the Philippine Health Agenda 2016-2022. It has the following goals: Best health outcomes ensured for all, without socio-economic, ethnic, gender and geographic disparities; Healthcare services accessed and delivered through means that respect, value, and empower clients and patients; and All families, especially the poor, marginalized, and vulnerable, protected against the high costs of healthcare. 1
This research agenda describes broad research areas that will be prioritized for funding in the medium term (6 years). Internal and external stakeholders of DOH are encouraged to refer to this agenda when rationalizing their research investments to maximize value and minimize duplication. The annual unit-level research agenda of DOH shall also align with these broad themes of the MTRA. Additionally, these thematic research areas reflect the dynamism, richness, and crosscutting nature of health policy and systems research. Thus, this agenda encourages excellence, trust, and collaboration within the wider research community and other sectors. GOVERNANCE OF HEALTH POLICY AND SYSTEMS RESEARCH Philippine National Health Research System (PNHRS)1 The PNHRS is a network of four core agencies – DOH, Department of Science and Technology (DOST), Commission on Higher Education (CHED), and the University of the Philippines Manila National Institutes of Health (UP-NIH). Managed by the Philippine Council for Health Research and Development (PCHRD), PNHRS promotes, facilitates, and coordinates health research and development activities towards gaining wider health, economic, political, educational, scientific, and technological systems for the country. The PNHRS framework is mirrored in all regions of the country, which forms a network of research consortia that is well contextualized to the culture, resource, and needs of each region.
1 PNHRS. Pchrd.dost.gov.ph. Retrieved 30 March 2017, from http://www.pchrd.dost.gov.ph/ index.php/networks
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PNHRS IMPLEMENTING AGENCIES
DOST-PCHRD
DOH
CHED
UP-NIH
GOVERNING COUNCIL DOST Secretary, Chair; DOH Secretary, Co-chair Members: CHED (Chair), UP Manila (Chancellor), NNC (Executive Director), PCHRD (Executive Director), 5 Private Sector Representatives
SECRETARIAT PCHRD (Executive Director)
STEERING COMMITTEE PCHRD (Executive Director), DOH-HPDPB (Director), CHED-OOPRI (Director), UPMNIH (Executive Director), NEDA (Chair), Representative from PHIC, NSO, PRC, LTO, DENR-EMB, LGUs, PNHRS TWC (Chairpersons)
6 KEY AREAS OF THE PNHRS PROGRAM
RESEARCH AGENDA
ETHICS
CAPACITY BUILDING
RESEARCH UTILIZATION
RESEARCH MOBILIZATION
STRUCTURE, ORGANIZATION, MONITORING AND EVALUATION
Figure 1. The PNHRS and its agencies..
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National Unified Health Research Agenda (NUHRA)2 The NUHRA is a 5-year research agenda developed by the Research Agenda Committee (RAC) of the PNHRS that serves as the country’s template for health research topics. Although these research areas stem from the four core agencies’ research priorities, the development of the NUHRA has always been participatory, with stakeholder consultations conducted at the national and regional levels. It also aligns itself with national and international health commitments like the Millennium Development Goals and Philippine Development Plan, among others.
PNHRS
NUHRA
DOH
DOH Agenda Consultation • DOH Offices • Center for Health Development • Health Partners • Experts • Other discipline and sectors
DOST-PCHRD
National R&D Priorities Plan (NRDPP) & DOST 5-point priority program Consultation • Relevant stakeholders • Representatives from all regions in the Philippines
CHED
Natural Sciences Research Priorities + health-related priorities Consultation • Technical assistance
UP-NIH
Research Priorities Management Action Planning Workshop • Scientists • NIH-UPM management • UPM units and colleges
Figure 2. Research agencies and the NUHRA.
2 National Unified Health Research Agenda 2011-2016. (2011). Retrieved from http://www.pchrd. dost.gov.ph/phocadownload/userupload/nuhra/nuhra2011-2016_final.pdf
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Health Systems Research Management3 The DOH Department Order 2014-0171 established the Health Systems Research Management (HSRM), a program that guides the implementation and management of research studies in DOH. This was created as a response to the call for more evidence-based policies, plans, and programs of DOH and its attached agencies. The Research Reference Hub (RRH) is the arm of the HSRM that executes and monitors the policy and systems research studies under the program. It organizes and steers research efforts towards the direction of the current thrust of the health sector. Furthermore, it aims to strengthen the engagement of the Health Policy Development and Planning Bureau (HPDPB) with research proponents within and outside the health sector for capacity building and coordination for research and policy implementation.
HEALTH RESEARCH AGENDA SETTING
PROCUREMENT AND CONTRACTING
HEALTH RESEARCH DISSEMINATION AND UTILIZATION
HEALTH RESEARCH IMPLEMENTATION
Figure 3. The HSRM process. The HPDPB is tasked to oversee all activities involving the HSRM and ensure the proper implementation of each HSRM process.
3 Department of Health. (2014). DO No. 2014-0171: Guidelines on the implementation of the health researches in the DOH.
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RELEVANT POLICIES FOR HEALTH POLICY AND SYSTEMS RESEARCH The seven policies discussed below shaped the priority areas of this research agenda.
MEDIUM TERM HEALTH POLICY & SYSTEMS RESEARCH AGENDA (2016-2022)
GLOBAL HEALTH AGENDA
Figure 4. Policies and the Medium Term Research Agenda.
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MONITORING & EVALUATION FRAMEWORK (M&E)
Philippine Health Agenda (PHA) 2016-2022 (DOH Administrative Order 2016-0038)4 The Philippine Health Agenda 2016-2022 can be summed up in its rally cry of “All for Health Towards Health For All.” It envisions a healthy Philippines in 2022, where Filipinos have financial protection, better health outcomes, and a responsive health system. Through the ACHIEVE strategy, the PHA intends to reach its three guarantees: 1. Interventions for all life stages that promote health and wellness, prevent and treat disease, delay complications, facilitate rehabilitation and provide palliation; 2. Access to health interventions through functional Service Delivery Networks (SDNs); and, 3. Financial risk protection when accessing these interventions through Universal Health Insurance.
SERVICE DELIVERY NETWOR K
ALL LIFE STAGE S & TRIPLE BURDE N OF DISEASE S
UNIVERSAL HEALTH INSURANCE
Figure 5. PHA Framework
4 DOH AO No. 2016-0038. The Philippine Health Agenda. 26 October 2016
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National Objectives for Health (NOH)5 The NOH outlines the health sector strategies to reach the goals set in the PHA for the medium term. It includes indicators and targets that serve as guidance for all stakeholders towards the achievement of the objectives. Thus, research studies and programs should be aligned with the NOH to ensure that concerted effort goes towards achieving the health sector goals.
PRESENT GOALS
FINANCIAL RISK PROTECTION
RESPONSIVE HEALTH SYSTEMS
BETTER HEALTH OUTCOMES
Figure 6. Past key components of NOH and the present goals. The strategies in the previous NOH document focused on four key components. These were later carried over into the Kalusungan Pangkalahatan (KP) health reform with three health system goals directed towards the achievement of a universal healthcare for all Filipinos.
5 National Objectives for Health 2011-2016. (2012). Manila. Retrieved from http://www.doh.gov.ph/ sites/default/files/publications/noh2016.pdf
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NEDA’S AmBisyon Natin 20406 The National Economic Development Authority’s (NEDA) AmBisyon Natin 2040 is the long-term collective vision of Filipinos for themselves and the country. It is a set of goals that will guide the plans and policy directions of the next four administrations to create a better life for Filipinos and the country in the next 25 years. The government will play a pivotal role in facilitating the achievement of this AmBisyon through private and public sector action. For the health sector, this means rising to the challenge to ensure equitable quality of health and better health and wellness services for all Filipinos.
By 2040, Filipinos will feel:
MATATAG, MAGINHAWA, PANATAG SA BUHAY Filipinos will:
• Live in a prosperous, predominately middle-class society, where no one is poor. • Live a long and health life. • Be smart and innovative. • Live in a high-trust society.
Figure 7. Vision of AmBisyon Natin 2040
6 National Economic Development Authority. (2016). AmBisyon Natin 2040: a long-term vision for the Philippines. Retrieved from http://2040.neda.gov.ph/wp-content/uploads/2016/04/A-Long-Term-Vision-for-the-Philippines.pdf
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Philippine Development Plan 2017-20227 The Philippine Development Plan (PDP) 2017 - 2022 is the first of the four key medium term plans that will translate the AmBisyon Natin 2040 vision and the administration’s 0+20 point socio-economic agenda into strategies, policies, and programs. Thus, health policy and systems research and programs should align themselves with the PDP pillars and strategies to contribute towards its fulfillment.
THREE PILLARS
MALASAKIT
(Enhancing the Social Fabric)
PAGBABAGO
KAUNLARAN
(Reducing Inequality in Economic Development Opportunities)
(Increasing Potential Growth)
BEDROCK STRATEGIES Attaining justice and lasting peace
Ensuring security, public order and safety
Accelerating strategic infrastructure development
Ensuring ecological integrity and a clean and health environment
Figure 8. Three Pillars of the Philippine Development Plan 2017-2022.
7 NEDA Board approves Philippine Development Plan 2017-2022 - The National Economic and Development Authority. (2017). The National Economic and Development Authority. Retrieved 30 March 2017, from http://www.neda.gov.ph/2017/02/21/neda-board-approves-philippine-development-plan-2017-2022/ 10
Sustainable Development Goal 2030 (SDGs)8 The Sustainable Development Goals 2030 (SDGs) are composed of 17 development goals that were agreed upon by different nations around the world to end poverty, fight inequality and injustice, and confront issues involving climate change and its effects by 2030. SDG 3, Ensure healthy lives and promote well-being for all at all ages, is the main goal for health. Although, the health sector should also concern itself with the other goals as improvements in these areas will also contribute to better health.
Figure 9. United Nations Development Programme Sustainable Development Goals
8 Sustainable Development Goals (SDGs). (2017). World Health Organization. Retrieved 30 March 2017, from http://www.who.int/sdg/en/
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Philippine Global Health Agenda (GHA)9 The Philippine GHA is the country’s response to the emerging health concerns brought about by globalization. It outlines four global health thrusts that will be prioritized by the country, specifically (1) health and health-related SDGs; (2) emerging health issues and concerns, (3) governance for health; and (4) international cooperation and partnerships. The GHA also includes actions for the medium term (2022) and long term (2030), and should be used to guide measures on global health issues.
Philippine Global Health Agenda (2016-2030) ATTAINMENT OF SDG TARGETS
EMERGING HEALTH ISSUES AND CONCERNS • Trade in Health • Migrant Health • Health Security/ Regulation
• • • • •
Governance Health Financing Service Delivery Health Care Workforce Medicines, Devices and other Technology • Health Information and Information Systems
INTERNATIONAL COOPERATION AND PARTNERSHIP • Agreements and Commitments • SWAP/S DAH
Health Sector Principles SUSTAINABLE DEVELOPMENT GOALS
NATIONAL INTEREST
Financial Risk Protection Better Health Outcomes Responsiveness
National Security Economic Security Protection of Filipinos abroad
Philippine Health
Philippine Foreign
National Principles
The Constitution and the Laws of the Land
International Principles and Conventions
United Nations, World Health Organization, Sector-Wide Approaches
Figure 10. Philippine GHA Framework.
9 The Philippine Global Health Agenda 2016-2030 (Brief Version). Working Draft (2016). 12
Monitoring and Evalation Framework The research agenda will be monitored and evaluated based on the PHA monitoring & evaluation framework from Administrative Order 2017-0004.
Figure 11. PHA Monitoring and Evaluation Framework
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METHODS FOR RESEARCH PRIORITIZATION10 The research agenda was determined through the PNHRS research prioritization method. There were three parts to this process: pre-implementation, implementation, and the post-implementation. Pre-implementation 1. Identification of Conceptual Framework While the policies in the previous section were reviewed, the PHA was the main resource used for the research agenda setting. From this top-down process, a literature search was conducted to determine the principles, criteria, funding and research capacity components of the research agenda. 2. Designing engagement with stakeholders The research team identified the most appropriate methods to get feedback from stakeholders given schedule and time constraints. 3. Validation The initial output from the literature search and the engagement plan were reviewed and validated by HPDPB before it was implemented. Implementation 1. Identifying priority policy concerns (DOH Units, Regional Offices, Attached Agencies and Hospitals) Priority policy concerns were determined through a combination of document reviews, key informant interviews and an online survey. Those interviewed and surveyed represent DOH units, regional offices, attached agencies, hospitals, development partners, NGOs, and other stakeholders involved in healthy policy and systems research. 2. Assessing current/ongoing/planned research vis-Ă -vis these concerns The team assessed the research done in the past 5 years to see if it addressed the knowledge gap identified by stakeholders. They searched formal archives, published reports, and grey literature. 3. Identifying research priorities From these findings, the team determined a list of research priorities that would address the information gaps and inform policy direction in the medium term.
10 Reyes, K. (2017). Final report: technical assistance on development of medium term research agenda (2017 - 2022). Unpublished manuscript.
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Post-implementation 1. Vetting of the proposed agenda The vetting process consisted of two rounds of focus group discussions (FGDs). The first FGD was with content and subject matter experts of the PHA 3 guarantees and centered on condition-related questions. The second FGD was for experts in research implementation, where the questions focused on conducting research activities. 2. Report writing The results were presented again to HPDPB for validation and endorsement. Finally, the team that carried out this process submitted their final report to HPDPB.
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THE MEDIUM TERM RESEARCH AGENDA 2017-2022
THE MEDIUM TERM RESEARCH AGENDA 2017-2022 The Medium Term Health Research Agenda (MTRA) highlights health policy and systems research areas where evidence is most needed to realize the Philippine Health Agenda’s three guarantees. It also reflects both continuing and new areas for research. Continuing areas of research ( ) are those for which more localized and in-depth research is needed, while new areas ( ) are those for which broader research is needed as no/little evidence has been generated for the country. While research may be used in different ways, the DOH will be focusing on studies that will: Inform prioritization and resource allocation; and, Shape policy and/or program development and implementation. The MTRA adopts the Philippine Health Agenda’s three guarantees as its focus areas and further divides them into the following thematic areas: Establishing need Setting standards Identifying solutions Ensuring accountability
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Legend: Guarantee 1: All Life Stages Guarantee 2: Service Delivery Network Guarantee 3: Universal Health Insurance
Continuing areas of research New areas with little/no evidence generated for the country
Establishing Need research that describes the status quo and provides detailed characterization of issues/problems that require attention Health and Nutrition Status studies that deepen current understanding on disease burden and risk factors, including both medical and social risk factors Health Literacy and Healthy Behavior Profile studies that will facilitate better understanding of knowledge, attitudes and practices of Filipinos to inform health promotion and disease prevention strategies Health Impact Assessment broader research studies that assess the health impact of policies, plans, or projects usually of large scale development projects using quantitative, qualitative, and participatory techniques Healthcare Utilization Patterns (and Non-Utilization) and Service Coverage studies that further explore the multiple dimensions of access to health services Healthcare Supply Quantification broader research that includes enumeration and profiling of existing health facilities, drug outlets, laboratory and diagnostic facilities, and professionals Dimensions of Health Service Delivery broader research that covers: assessment on effectiveness (structure, process, outcomes); efficiency (macro, allocative, production and dynamic efficiency); equity (procedural and substantive); and resilience. Health Financing - Flow and Burden studies that enhance current understanding of sources and uses of funds, extent of efficiency, and burden on households
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Sector-wide Resource Requirement broader research that involves financial studies required to estimate resource requirements to achieve SDG and NOH targets, and feasibility of generating these from various governmental and extra-governmental resources (including private sector) Identifying Solutions research that generates and elaborates systems-based, scalable solutions
Health in All Policies broader research studies that describe and promote non-health sectorspecific solutions that reduce risk and improve health seeking behavior, which can feed into the DOH’s legislative agenda, collaboration with other national government agencies, or proposal to local government units Priority Programs broader studies that outline comprehensive and clear pathways towards addressing burden of mental health & substance abuse, HIV/ AIDS, mainstreaming sexual and reproductive health, and combatting antimicrobial resistance Increasing Access to Outpatient Drugs broader research that outlines and/or pilots solutions to increase geographic access and affordability of outpatient drugs Roles and Responsibilities under Federalism broader research studies that explore organizational and management solutions in the context of federalism Priority Populations broader studies that elucidate steps to promote inclusiveness of the health system for migrant workers, indigenous populations, and other vulnerable populations Design of Payment Mechanisms broader research studies that assess and propose improvements of provider payment mechanisms (line item budget and case rates) in terms of efficiency, effectiveness, equity, and sustainability Cost-effectiveness and Budget Impact Analysis broader research required to support resource allocations decisions through health technology assessment
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Setting Standards research that informs the development of standards that are critical in assuring healthcare quality and system efficiency Clinical Practice Guidelines broader research studies on institutionalizing a system to routinely develop and appraise locally-relevant clinical practice guidelines to inform expansion of guarantees and benefit package development Cost Accounting Systems in Health Facilities broader research on the development, implementation and analysis of cost data to inform costing of provider payment systems Private Health Insurance and Health Maintenance Organizations broader research on private health insurance markets and benefits Incentives for Health Professionals/Workers broader studies on financial and non-financial incentives for both the public and private sector as benchmarked with other health systems to inform updating of the magna carta for health workers, costing of provider payment, and medium-term expenditure planning Price Reference broader research on the development, implementation and evaluation of price reference indices for medicines, laboratory/ diagnostics and professional fees Terminologies and Disease Classification and Groupings broader studies on the development and testing of applicable procedural terminologies and disease classification and groupings to facilitate surveillance, reporting, and planning Ensuring Accountability research that provides objective assessment of program impact and design accountability mechanisms Monitoring, Evaluation, Dissemination, and Action studies that include regular, systematic, and predominately quantitative assessment of the impact of resource intensive health programs, and their subsequent dissemination to facilitate action
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IMPLEMENTATION OF THE MEDIUM TERM RESEARCH AGENDA
FRAMEWORK
The MTRA is one of the many building blocks to increase availability of high quality research and increased uptake of research evidence, leading to evidence-informed policies programs and actions that ultimately impact financial protection, health, and responsiveness outcomes. The other building blocks ensure the MTRA will be implemented at the highest possible quality.
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COORDINATION AND MANAGEMENT The HPDPB Research Division will coordinate and manage the research agenda activities including developing a research implementation plan, research dissemination, monitoring, and evaluation. In collaboration with the Bureau of International Health Cooperation, the HPDPB shall facilitate counterpart research support from development partners and other potential funders. TIMEFRAME This research agenda shall cover the medium term, years 2017 to 2022, and shall guide the annual preparation of research topics by the DOH units. FUNDING The research studies shall be funded primarily through the pooled DOH research funds coming from the various DOH offices. All other partners are encouraged to align their available funds to the MTRA. Allocation shall follow guidelines set forth in the Omnibus Guidelines for Health Research. Specifically, 80% will be allotted to research topics that fall within the areas defined in this MTRA, while the remaining 20% will be for research topics that are recognized as important but may not be within the bounds of the research areas specified in this document. INSTITUTIONAL PARTNERS The DOH shall identify, through a competitive selection process, institutional research partners who will implement the various research projects. EVIDENCE TO POLICY TRANSLATION The DOH shall facilitate the dissemination of research results through various established mechanisms. • Research outputs may be translated into policy and research briefs or other communication materials, like infographics • The National Health Research Forum for Action is a national gathering of researchers and policy makers that encourages formal and informal interactions of technical experts and potential consumers of evidence • Round Table Discussions or Brown Bag Sessions can be a means to share recent findings to a select group of possible consumers of evidence • The DOH website also has materials for the general public, where the information is derived from research studies • DOH shall also support dissemination of research findings in national and international academic fora • Other targeted and innovative opportunities shall be explored further.
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Office for Policy & Health Systems Health Policy Development & Planning Bureau Editorial Board: Usec. Lilibeth C. David, MD, MPH, MPM, CESO III Dir. Kenneth G. Ronquillo, MD, MPHM, CESO III Editorial Staff: Dr. Beverly Lorraine C. Ho, MD, MPH Dr. Gloria Nenita C. Velasco, MD, DipEpi Regina Isabel B. Abola Marie Elizabeth D. Puyat, MSc. Design and Layout: Jake Matthew C. Kho Luis Emmanuel R. De Vera