Assessment of the occupational health and safety system in local health centers in Metro Manila

The environment of health care workers (HCWs) is considered as one of the most hazardous settings due to the nature of their work. In the Philippines, this continues to be overlooked in terms of programs and services on occupational health and safety (OHS). One possible reason for this is the existing information gap on OHS which limits data comparability and effective monitoring and assessment of interventions.

This study assessed the OHS system in 13 barangay health centers in a selected city using the 6 building blocks of a health system framework. Assessment was done through walk-through surveys, documents review, and key informant interview. Qualitative data from the interview were coded using NVivo while quantitative data were summarized using EpiInfo.

Results showed that there remains to be gaps in terms of improving occupational health and safety in local health centers. In terms of leadership and governance, a general policy on OHS for all local health centers was found to be lacking and in effect, an absence of health and safety committees. In terms of financing, the lack of a separate budget specific for OHS programs and services was also found to be a limitation. As a result, there was no OHS personnel identified and only one staff had valid training on OHS among all 13 health centers. There was also no established information system for OHS in place. Only 2 out of 13 health centers have Safety Inspection Reports while only three have Workplace Environment Monitoring Report.

Based on the results of the study, there is a general need for improvement in terms of the occupational health and safety system in the city where the health centers were situated. Among all the elements of the occupational health and safety system, the lack of an overarching policy on OHS resulted in the absence of health and safety committees, inadequate budget and worker specific services for OHS, lack of related trainings and workshops, and poor information and reporting system.

Key messages

Data on conditions of OHS systems in the local health center setting are limited, thus the study provides information on areas of improvement for health systems strengthening. There is a need for policies on OHS in the local health center setting to strengthen the system for improved service delivery, information management and financing for OHS.

Review of Philippine Health Laws and its Implication to HTA Institutionalization

Objective

To identify the implications of health legislations on the direction of health technology assessment (HTA) institutionalization in the Philippines.

Methods

We reviewed 15 health laws and extracted information using a preset data extraction tool. The collected data was then subjected to the KJ (Kawakita Jiro) method to group similar provisions, taking into account their respective implications to the HTA direction. Once grouped, a core concept was identified that captured the underlying provisions within the group. After which, the core concepts were tabulated and matched with the core components of HTA institutionalization to identify specific policy implication to HTA.

Results

Three major paradigms emerged that are considered important in the institutionalization of HTA. First, common among the health laws are the need for the provision or expansion of benefit packages through the Philippine Health Insurance Corporation. Aside from the benefit packages, the reviewed laws also require delivery of new health services that entail the use of specific health technologies. Lastly, as a consequence of the need for new health services, equity concerns became evident in relation to the identified health services specifically in terms of socioeconomic divide, geographical location and disease status.

Discussion and Conclusions

The three paradigms identified from the review of health laws indicate synergism and antagonism to the HTA-related policy content of the Philippines' UHC Law. Some identify the need for HTA before being funded by the government while others do not explicitly state this. Despite the health laws requiring expansion or creation of benefit packages and delivery of new health services, there is still a need to undergo HTA in order to ensure efficient use of resources. The presence of these laws should not be tantamount to exception of undergoing HTA process but rather should be taken as a guide for priority-setting of topics for assessment.

Key messages

In the process of institutionalizing HTA, existing legislations on health can help map out areas of priority for assessment. Many health policies preceded the signing of the Universal Health Care Law, thus it is important to review them to determine provisions that are synergistic or antagonistic to the content of UHC Law.

Discount Rate Determination for Economic Evaluations in HTA in the Philippines

To inform the development of a reference case for economic evaluation, we explored various approaches to determine a base case discount rate and rate options for discounting benefits and costs.

We conducted literature review and expert consultations to list approaches to determine base case discount rates, noting the advantages and disadvantages of each approach. The same methods were used to identify whether different discount rates would be applied to costs and benefits. We computed a social rate of time preference using the Ramsey formula: rc = ρ+μg, where ρ = pure rate of time preference μ= elasticity of the marginal utility of consumption and g= growth rate in per capita income. We assumed ρ = 1%, μ = 1.4% consistent with international practice, but used actual g of the Philippines of 4.5%. We compared this with the official social discount rate and with rate most commonly used internationally. These options were presented to the Philippine Health Technology Assessment Council for decisionmaking.

Based on reviewed literature, 10 out of 22 countries used a 3.0% to 3.5% discount rate while 18 countries from the same pool applied equal discount rates for both costs and outcomes. The official social discount rate (SDR) prescribed by the Philippine National Economic Development Authority is 10% for all social investments. Upon input of the values, rc was calculated at 7%, which is above the international norm but below the official rate. Four discount rate options were identified: 3%, 3.5%, 7% and 10%.

Evidence suggested using a discount rate higher than 3% to 3.5% for low-to-middle income countries. A more conservative rate based on the Ramsey formula of 7% base case discount rate was selected in performing economic evaluations. Sensitivity analysis was set between 3% and 10% to allow benchmarking with international practice and with the official SDR, respectively. Given Philippines' early HTA implementation phase, it was agreed to subject these rates to regular review.

Key messages

Setting a discount rate in economic evaluations is a crucial process for HTA institutionalization. Discount rate determination heavily relies on decision context a country considers most relevant.