美国全球发展中心-新冠疫情对菲律宾卫生系统的影响（英文）-2021.3-25页_943kb

Summary of the Health Systems Impact of COVID-19 in the Philippines

Core Content

This paper presents a preliminary review of the indirect health system impacts of the COVID-19 pandemic in the Philippines, highlighting how mitigation strategies have affected access to and delivery of essential health services beyond the direct impact of the virus. The study is part of a broader multi-country initiative to understand the broader consequences of pandemic response measures on health systems and population health outcomes.

Main Viewpoints

1. Health System Context

• The Philippine health system is highly decentralized, with local government units (LGUs) playing a major role in health service delivery.
• The system is composed of both public and private providers, with the Department of Health (DOH) leading in governance and regulation.
• Despite efforts to advance universal health coverage (UHC) through the Universal Health Care Act (RA 11223), longstanding challenges persist, including fragmented care, uneven distribution of health facilities, and disparities in access and outcomes across geography and socioeconomic groups.

2. Impact of Lockdowns and Quarantine Measures

• Lockdowns, termed community quarantines, significantly disrupted access to non-COVID health services, especially for those requiring specialist care.
• These measures also affected the ability of health systems to maintain surveillance and record-keeping, which are critical for effective public health responses.
• Local health systems implemented gatekeeping mechanisms and telemedicine to reduce face-to-face consultations and maintain service continuity.

3. Inequities in Health System Impact

• The impact of the pandemic and its mitigation strategies varied by municipal income class and topography.
• Lower-income and rural areas were disproportionately affected due to limited resources and infrastructure.
• Disadvantaged populations such as women, children, informal workers, the poor, displaced individuals, and ethnic minorities faced greater challenges in accessing health services.

4. Indirect Health Effects

• The paper outlines potential short, medium, and long-term indirect health impacts, such as increased mortality from non-COVID diseases, delayed treatments, and reduced adherence to chronic disease management.
• These effects were attributed to disruptions in service access, funding reallocation, and changes in health-seeking behaviors.

Key Information

5. Mitigation Strategies and Their Implementation

• The Philippines adopted a whole-of-government and whole-of-society approach, with the Inter-Agency Task Force on Emerging Infectious Diseases (IATF-EID) playing a central role in policy coordination.
• The government introduced four levels of community quarantine, from the strictest Enhanced Community Quarantine (ECQ) to the least restrictive Modified General Community Quarantine (MGCQ).
• These measures were implemented based on regional assessments and recommendations from the IATF-EID, with local LGUs having some autonomy but not allowed to impose less stringent measures than those at the provincial level.

6. Data and Methodology

• The study used a combination of academic and grey literature, as well as qualitative interviews with key informants in the health system.
• The conceptual framework in Figure 2 guided the analysis, helping to identify areas of health service disruption and their potential consequences.
• Thematic analysis of interview transcripts and literature review data was used to highlight patterns and experiences of health system managers and frontline workers.

7. Results and Observations

• There was a significant reduction in access to non-COVID health services, particularly in the early stages of the pandemic.
• Women and men reported high difficulty in accessing medical supplies, hygiene products, and food.
• Health service utilization declined, with delays in treatment and increased risk of adverse health outcomes.
• The paper emphasizes the need for context-specific and tailored mitigation strategies to address both direct and indirect health impacts.

Conclusion

The study concludes that the indirect health effects of the pandemic are complex and multifaceted, influenced by pre-existing systemic inequities and the nature of mitigation measures. It underscores the importance of understanding these indirect impacts to ensure that the health system remains resilient and responsive to the needs of the most vulnerable populations. The findings also highlight the need for more comprehensive data collection and analysis to guide future policy decisions and public health responses.

Key Challenges and Limitations

• Conducting research during a pandemic presents significant challenges, including limited data availability and evolving policy environments.
• The study relies on anecdotal and secondary data, which may not capture the full scope of health system disruptions.
• The focus on the Philippines provides a snapshot of the broader implications for low- and middle-income countries (LMICs) facing similar systemic challenges.

Recommendations

• Policymakers should prioritize services that are most affected and cost-effective to mitigate the indirect health impacts of the pandemic.
• Efforts should be made to ensure that essential health services are not neglected during public health emergencies.
• Strengthening health systems to better withstand future shocks is critical for improving long-term public health outcomes.

References

• The paper draws on a variety of sources, including academic and grey literature, government reports, and qualitative interviews.
• It references data from the Oxford COVID-19 Government Response Tracker (OxCGRT), as well as reports from UN Women and the National Economic and Development Authority (NEDA).

Figures and Tables

• Figure 1: Top 10 causes of death, disability, and risk factors in the Philippines, 2017.
• Figure 2: Conceptual framework for assessing health systems impact.
• Figure 3: Cumulative and daily confirmed cases and deaths from COVID-19, alongside the Stringency Index from 13 January 2020 to 30 September 2020.
• Table 1: Summary of key community quarantine measures across different stringency levels.
• Table 2: Impact of access to healthcare services as reported in various surveys.