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Regional Unified Health Research Agenda for Region 8

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 I. BACKGROUND 

The Philippine National Health Research System (PNHRS) periodically constructs the National Unified Health Research Agenda (NUHRA) to guide health research to address health system needs, ensuring that optimal benefit is gained from national and international investments. At the regional level, regional health research consortiums develop regional health research agenda to align of health research activities in the region, ensuring that health research activities are conducted to respond to regional health research needs. The degree with which the design of the NUHRA influences the RUHRAs, and vice versa, has been shifting throughout the preceding agenda; nonetheless, the strong links between the national and regional research priorities remain the same.

In recognition of the diverse and specific health needs of each region, Regional Unified Health Research Agenda (RUHRA) are developed along with the NUHRA. The RUHRA is designed by each region reflecting the regional needs and health research priorities. As part of the development of the RUHRA, a regional consultation is conducted to serve as a venue for key regional stakeholders to provide their inputs.

Regional Context

Eastern Visayas (Region VIII) is located in the east central area of the Philippines facing the Pacific Ocean. It is the fourth largest region in the Philippines with a total land area of 21,431.9 square kilometers (Department of Health - Region 8, n.d.). It is composed of three main islands (Samar, Leyte, and Biliran) and six provinces, one independent city, and one highly urbanized city (Biliran, Leyte, Northern Samar, Eastern Samar, Samar, Southern Leyte, Ormoc and Tacloban).

Region VIII has a total project population of 4,375,474 with a growth rate of 1.25% in 2015 (Department of Health - Region 8, n.d.). It also has a projected life expectancy of 71.7 for women and 66.8 for men in the period of 2010-2015. From 2011 to 2015, there was a 5.13% increase in the population, a decrease of 6.30% in crude birth rate, and a 6.56% increase in the crude death rate (Department of Health - Region 8, n.d.). In 2013, the estimated population of Eastern Visayas was 4,267,703. Biliran has the lowest estimated population with 169,111 while Leyte has the highest population at 1,414,512. In 2012, PSA recorded a poverty incidence of 37.40% for the region (Philippine Statistics Authority, n.d.). Latest report on poverty incidence showed an upward trend on the region’s number of poor population. From 45.4 percent in the first quarter of 2012, it grew to 47.3 in the first quarter of 2015. During the same period, subsistence incidence among population, a measure of extreme poverty, likewise increased from 23.0 percent to 26.1 percent.

Eastern Visayas has a total land area of 2,325,395 hectares with 723,048 hectares of agricultural land (Philippine Statistics Authority, n.d.). The region contributed 2.25% to the country’s GDP, with the agriculture, hunting, forestry, and fishing sector accounting for 20% of the regional economy. Palay and coconut, the leading commodities in the region, accounted for 42.82% contribution to agricultural production for 2013 (Philippine Statistics Authority, n.d.). In terms of employment, the region recorded 1,832,000 persons employed in 2013, with 807,000 persons under the agricultural sector. Furthermore, of the 807,000 working in the agricultural sector, 639,000 are male, while 168,000 are female. Employment under the agricultural sector is responsible for 44.05% of the persons employed in the region.

Recent Health Researches Completed

A total of 27 researches were identified which were conducted from 2010-2016. Out of the 27 researches, 22 can be classified under health research related impacts, three under service impact and two are under societal impact. Research areas covered by the studies include prevalence and incidence studies, mental health, communicable diseases, non-communicable diseases, nutrition, water, sanitation, and hygiene, mental health, quality of care, health emergencies and disasters, health service delivery and utilization, human resources, and studies on knowledge, attitude, and practices.

Regional Stakeholders for Health

The Regional Health Research and Development Consortia VIII was initially organized in 1983 by DOST Region VIII and DOH Region VIII, but remained inactive for a few years because of administrative problems (Regional Health Research and Development Consortia Region VIII, n.d.). The consortium was revitalized in 1994 becoming active in conducting researches and capacity building activities since then. Moreover, the name of the consortium was changed to Eastern Visayas Health Research and Development Consortium. The consortium stands as the structure through which PCHRDs Institution Development Programs were implemented and functions as the mechanism that encourages and promotes health research activities in Eastern Visayas.  

Currently, the consortium is composed of academic institutions, government agencies, professional organizations, and hospitals. To deal with several concerns, five committees were organized by the consortia – Executive committee, Research Management committee, Ethics Review committee, Resource Management committee, and Research Information committee. In order to give equal focus on selected research areas, four subcommittees were created according to the research priorities – infectious diseases, lifestyle diseases, environment health and, traditional and alternative medicine. 

The executive committee is chaired by Dr. Minerva Molon of DOH RO VIII, with Engr. Edgardo Esperancilla of DOST RO VIII as the co-chair. Together with the chair and the co-chair are the heads of NEDA, SSCHS, UPM-SHS, VSU, and CHED as members of the executive committee.

Regional Health Situation

According to the data from the DOH Regional Office VIII, Acute Upper Respiratory Tract Infections account for more than half of all the causes of morbidity in the region. This is followed by Hypertensive Cardiovascular Disease with 13%, Pneumonia with 9%, and Pulmonary Disorders at 8%. In terms of the top causes of mortality, Hypertensive Cardiovascular Disease has leads the list causing 23% of mortality, to be followed closely by Pneumonia with 21%. The third in the list is Trauma/Injuries and Accident accounting for 13%.

Based on the 2013 NDHS, in terms of place of delivery, 61.6% of births in Eastern Visayas in 2013 were delivered in a health facility while 38.4% were delivered at home (PSA, 2013). Under the same report, it was found that 18.4% of women who gave birth in Western Visayas had no postnatal checkup. Overall, about 76.7% of births had a postnatal checkup in the first two days after birth. In terms of family planning, 61.7% of married women uses any method of contraception with 37% using any modern method, while 24.8% uses any traditional method (Philippine Statistics Authority, 2013).

Results of SWOT analysis

II. METHODOLOGY

An initial meeting was conducted in the first week of March between the cluster lead for Visayas, the regional coordinator for region 8, and key stakeholders from the EVHRDC to discuss the conceptualization and project brief of the NUHRA 2017-2022. After the discussions, EVHRDC was invited to attend the cluster orientation for the entire Visayas cluster to present the project flow and key activities involved in the development of the NUHRA.

The cluster orientation was conducted on March 14, 2017 at Golden Prince Hotel in Cebu City which was attended by representatives from the EVHRDC. During the orientation, there was a discussion regarding the process of RUHRA and NUHRA development, the development of a regional situationer, and preparation for the regional consultation. Before the conclusion of the orientation, representatives from the different regions provided their tentative schedule for the regional consultation.

The regional consultation for Region 8 was held last May 4 and 5, at Hotel Rodolfo, Tacloban City. The participants who were invited for the consultation were based on a stakeholder mapping conducted by the regional consortium ensuring that the different key agencies and sectors are represented. A total of 27 participants attended the regional consultation composed of representatives from government agencies (20 participants), academe (6 participants) and private sector (1 participants). While not all agencies invited sent representatives, we can conclude that the consultation had a good turnout of participants considering that the major government offices and academic institutions are represented. It is also important to note that majority of the major government agencies were able to attend the consultation (NEDA, DOH, DOST). The regional director and assistant regional director of DOST and DOH also attended the consultation. The attendance of the government agencies and their presentations on their regional priorities helped the participants align the health research agenda of the region to other related regional priorities contributing to a multi-sectoral approach.

The morning activities comprised of the presentation of the regional agenda of DOH and PIHTAC. Immediately after the lunch, the technical papers and the highlights of the regional situationer were presented. For the brainstorming session, the participants were divided into three groups randomly to distribute the representatives of institutions evenly among the three groups. The participants were then asked to discuss within their groups possible regional research areas that they think should be included in the RUHRA. A suggested matrix for brainstorming was presented to the participants to guide them in the process. Each group was tasked to assign a leader and a rapporteur for the presentation of the group outputs.

After the brainstorming session, each group presented the group outputs, which concluded the activities for the first day. The AIHO project team, composed of the Cluster lead, Regional Coordinator, Cluster Research Assistant, and a representative from the AIHO Core team clustered the topics together for the recapitulation and validation on the second day. To ensure transparency of the process, the AIHO project team presented the three-step procedure of how the clustering was conducted. The first step focused on developing a single matrix containing the outputs of the three groups. This was followed by grouping the research topics according to main categories. For this step, similar topics were grouped together without deleting any topic. For the third step, research topics and sub-topics which were similar were combined into one to avoid redundancies. Topics that are vague or needs further explanation were clarified during the validation activity.

During the recapitulation and validation activity, the list of proposed agenda were discussed again by the group. Once the participants agree with the final list of proposed agenda, a criteria for the prioritization activity was developed. The final criteria set by the group are: Public health impact (35%), Ethical acceptability (20%), Feasibility (30%), and Collaboration (15%). The set criteria were printed together with the list of topics for the prioritization activity. During this discussion, several participants suggested to simply rank the research topics from 1-22 and to just average the ranking of the group to develop the final priority list of the region. The other participants agreed with this suggestion thus, shifting the method of prioritization from scoring based on criteria to ranking of research topics.   

After the presentation of the results of the prioritization exercise, the participants were asked if they have other concerns or issues regarding the results. One participant commented that some priority areas of their region, such as nutrition, were not reflected at the top research priorities. One reason for this is that the results of the prioritization activity is limited only to the participants who attended the regional consultation. As a next step, the consortium will present the research priorities to the other members of the consortium and other regional stakeholders in their June conference. Aside from this concern, the participants expressed concurrence with the list of priority researches of the region.

III. STANDARD MATRIX FOR RESEARCH PRIORITY AREAS/TOPICS

Priority Area 1: Service Delivery

Rationale: To address the issues on the effectiveness of service delivery networks, referral system, and health services.

Sub Topics:

1. Rehabilitative/Palliative care
2. Effectiveness of Referral System

Priority Area 2: Communicable Disease

Rationale: To conduct researches on the epidemiological status and health seeking behaviors on communicable diseases

Sub Topics:

1. Tuberculosis and other respiratory tract infections
   1. Prevalence of TB among children
   2. Causes of rise of MDR TB
2. Diarrheal Disease Management and Control
   1. Community and household attitudes and practices towards preventing Diarrhea
3. Dengue Vector Control
   1. Bioassay and Insecticide-Resistance
4. HIV-AIDS
   1. Sexual Health of Men having sex with men
   2. Social Stigma
5. Schistosomiasis
   1. Assessment/ Utilization of Research Conducted
6. Capillariasis
   1. Prevalence and incidence in Region 8

Priority Area 3: Maternal and Child Health

Rationale: To conduct researches on health seeking behavior, effectiveness of local interventions, and epidemiology of maternal and child health.

Sub Topics:

1. Child
   1. Child Development of Antibodies from Immunizable Vaccines
   2. Eye Health
   3. Attitude of Filipinos on vaccination
   4. Incidence of congenital anomalies
2. Maternal Health
   1. Effectiveness of halfway house in GIDA areas
   2. Effectiveness of BeMONC Training on MMR
   3. Lifestyle and Pregnancy

Priority Area 4:  Health Technology Development

Rationale: To conduct research work on the development of new diagnostic devices, drugs, and utilization of other health technologies.

Sub Topics:

1. Functional foods
2. Drug discovery
   1. Molecular Analysis for Drug Discovery
   2. Drug Discovery for Cancer
3. Hospital Equipment and Biomedical Devices
   1. Diagnostics
4. ICT in heath
   1. GIS - Based mapping for outbreak monitoring and surveillance

Priority Area 5: Health Care Financing

Rationale: To assess the impact of health financing programs in the region and identify policy gaps.

Sub Topics:

1. PhilHealth services/costs
2. Medical Assistance Fund Utilization

Priority Area 6: Health Governance

Rationale: To address issues on the governance system and assess local health programs in the region.

Sub Topics:

1. Impact assessment of health related policies and programs
2. Impact of 4Ps to health outcome indicators
3. Inter Local Health Zone
   1. Effectiveness of Implementation Process applied by DMOs on Local Health Systems Development on Inter-local Health Zones

Priority Area 7: Health Knowledge Management

Rationale: To assess the local information management system and develop new mechanisms for a better information management system.

Sub Topics:

1. Assessment of Health related indicators in existing community based management information system
2. Surveillance of reported infectious and non-infectious diseases

Priority Area 8: Environmental health

Rationale: To address environmental health and sanitation issues in the region.

Sub Topics:

1. WASH Implementation Assessment (Impact for Policy Development)
2. Waste Disposal and management of Region VIII
3. Water quality and potability in Region VIII

Priority Area 9: Lifestyle diseases

Rationale: To address gaps in non-communicable diseases in the region

Sub Topics:

1. Genito-urinary diseases (kidney and urinary problem
2. Genito-urinary diseases among children
   1. Chips Consumption As a Risk Factor For UTI Among School Children in Tacloban City
3. Prevalence of gout among fisherfolks in Tacloban City

Priority Area 10: Disaster Risk Reduction and Management and Climate Change Adaptation

Rationale: To conduct researches addressing the health effects of disasters and climate change

Sub Topics:

1. Effects/risk of climate change to all ages
2. Assessment of climate change adaptation strategies
3. Nutrition in Emergencies
4. Hospital Capacity Assessment on Health Emergency Management

Priority Area 11: Reproductive Health and Family Planning

Rationale: To address knowledge gaps on reproductive health practices and health seeking behaviors in the region

Sub Topics:

1. Family Planning
   1. Factors Affecting Acceptability of Family Planning Method
2. Adolescent Sexual Reproductive Health
   1. Increase incidence of HIV among young people in Region VIII
3. Human sexuality education
   1. Assessment on the implementation of human sexuality education

Priority Area 12: Nutrition

Rationale: To conduct researches on nutrition-related health problems in the region

Sub Topics:

1. Obesity in children (practices and attitude)
2. Malnutrition and other nutrition-related health problems
3. Factors Affecting High incidence of hyperthyroidism

Priority Area 13: Mental Health Problems

Rationale: To address knowledge gaps in the epidemiologic pattern, service delivery and rehabilitation of mental health

Sub Topics:

1. Depression and suicide
   1. Incidence and Factors of Depression in Adolescents
2. Post-traumatic Disorders
3. Mental retardation, children with special needs
4. Mental Health in Workplace (Harassment, Bullying)
5. Health effects of computer games addiction

Priority Area 14: Health Infrastructure

Rationale: To explore health infrastructure needs and factors affecting implementation of health infrastructure projects in the region

Sub Topic: Factors Associated with Slow Implementation of HFEP projects in LGUs       

Priority Area 15: Traditional and Alternative Health Medicine

Rationale: To conduct researches focusing on the traditional and alternative medicine that has the potential to be applied to lifestyle and other diseases.

Sub Topics:

1. Clinical Researches on homeopathy
2. Clinical Researches on Acupuncture for pain, substance addiction
3. Clinical Researches on naturopathy, Ayurveda and anthroposcopic medicine
4. Adjunctive treatment for cancer, diabetes, COPD and CVD

Priority Area 16: Health Promotion

Rationale: To address knowledge gap on health promotion and education in the community

Sub Topics: Effectiveness of IEC materials in health promotion

Priority Area 17: Health Regulation

Sub Topics: To evaluate the implementation of regulatory policies and assess the compliance of regional stakeholders to regulations.

1. Compliance to Hospital Standards
2. Food and Drug Administration
   1. Study on the Use of Rate of Selected Antibiotics in Tacloban City
   2. Presence of Pharmacist in Licensed drug establishments
   3. Practice of Medication Counselling Skills
   4. Dispensing of Antibiotics without prescription
   5. Adverse Drug Reporting by Health Practitioner

Priority Area 18: Drug and substance abuse

Rationale: To conduct researches on epidemiological data and address knowledge gaps on drug and substance abuse in region 8.

Sub Topics:

1. Drug Surrenders Quality of Life
2. Perceptions on Drug Abuse and Trafficking
3. Prevalence of Drug Abuse Among Different Age Groups in the region

Priority Area 19: Gender and Development

Rationale: To address health related issues on gender and development

Sub Topics:

1. Gender and development issues and policies on Health and health-related practices
2. Violence against Men, Women, LGBT, and Children

Priority Area 20: Geriatrics

Rationale: To collect baseline data on the aging population in the region and assess current health services for the elderly

Sub Topics:

1. Prevalence and incidence studies on diseases of the elderly
   1. Accidents/trauma
   2. Dementia
2. Longevity of Life for the aged
3. Healthy aging programs
4. Quality of life for the elders
5. Palliative (hospice) care
6. Home health care

Priority Area 21: Disability

Rationale: To address knowledge gaps on disability and implementation of health services

Sub Topic: Stroke (Quality of Life Post Stroke Patient/ Recovery vis–a-vis compliance)

IV. IMPLEMENTATION PLAN

Considering that not all regional stakeholders were able to attend the consultation, one of the key activities that the participants plan to do is to disseminate the priority research agenda to other stakeholders. Additional consultative meetings will also be conducted to ensure that inputs from other stakeholders are considered. This will be followed by a presentation to the RDC for integration to regional priorities and assignment of appropriate tasks to the EVRHDC committees. After which, an RDC resolution shall be issued emphasizing the adoption of the RUHRA.

To ensure that the RUHRA is monitored, M & E indicators will be identified by the regional stakeholders. Yearly visiting of the RUHRA will also be conducted to ensure that topics relevant to the needs of the region is included in the agenda. The RUHRA shall be posted in the EVRCHD website and social media accounts and the RUHRA shall be echoed in trainings to ensure dissemination.

ANNEX A. Stakeholders present during regional consultation

ANNEX B. Brainstorming Session Matrix

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