corrected Setting Core Competencies

SPECIAL ARTICLE

Setting Core Competencies of Health Workers

Towards Quality Primary Care:

Proceedings of a National Consultative Workshop

Cara Lois T. Galingana,1 Regine Ynez H. De Mesa,1 Jose Rafael A. Marfori,1 Ramon Pedro Paterno,2 Mia P. Rey,3

Edna Estifania A. Co,4 Jayson T. Celeste,1 Leonila F. Dans5 and Antonio Miguel L. Dans6

1Philippine Primary Care Studies, UP Health Service, University of the Philippines, Diliman, Quezon City

2National Institutes of Health, University of the Philippines Manila

3Department of Accounting and Finance, Cesar E.A. Virata School of Business, University of the Philippines, Diliman, Quezon City

4University of the Philippines Diliman – Extension Program in Pampanga, Clark Freeport Zone, Pampanga

5Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila

6Department of Internal Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila

ABSTRACT

The National Academy of Science and Technology (NAST), in cooperation with the Philippine Primary Care Studies (PPCS), organized the Stakeholders’ Meeting on Training Objectives for Primary Care in the Philippines on February 1, 2018, at Hotel Jen, Pasay City. The stakeholder’s meeting arrived at a consensus on the objectives of primary care workshops, training the existing cadre of doctors, nurses, midwives, and BHWs in the country. Competencies built upon these training objectives will strengthen the capacity of health care workers to render patient-centered primary care services. The expected output was not intended to replace the objectives of existing professional training curricula. Instead, the consensus obtained through this meeting works to establish the framework from which future primary care training workshops can be built upon.

Key Words: primary health care, health care reforms, education, public health professional, health equity, congress

Corresponding author: Cara Lois T. Galingana UP Health Service, Laurel Avenue, University of the Philippines, Diliman, Quezon City 1101, Philippines

Email: ctgalingana@up.edu.ph

INTRODUCTION

Confronted by the triple-burden of disease, the Philippine healthcare system has struggled with the inequitable distribution of healthcare across all life stages.1 Healthcare worker shortage, administrative schisms, and health policy fragmentation have all taken to toll on the country’s health systems.2 This has resulted in poor health outcomes, with the underprivileged shouldering most of the burden.2,3 The Philippine Primary Care Studies (PPCS) works to address this crisis by proposing a gradual shift from the current fragmented approach towards a more holistic primary care system. This approach works to address a broader range of health concerns without the restrictions implicated by disease-based programs.

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

the root causes of health inequities in the country – health policy fragmentation. Dr. Jose Rafael A. Marfori cites that doctors, nurses, midwives, and barangay health workers should be trained as primary care teams that function as the patients’ entry point to the whole health system, and constant guide for any health condition.

The keynote address of the Department of Health Assistance Secretary Enrique A. Tayag states that having an effective Service Delivery Network (SDN) addresses health system fragmentation and disparities in health outcomes. This is supported by Dr. Fely Marilyn E. Lorenzo, who explains that health care systems are bound to suffer from poor quality of care, incompetent workers, and unsatisfactory patient experience without adequate training and support. Hence, reaching consensus on primary care training objectives and competencies underscores how health workers function as a team, one that is “integrated, competent, resilient, and inspired” as NAST President and academician William G. Padolina suggests.

The expected output from the stakeholder’s meeting is a framework of competencies and training objectives for primary care professional development in the Philippines. It was not intended to replace the objectives of existing professional training curricula. For this study, a consensus is defined as “a general agreement”.4 Achieving consensus in these objectives and competencies helps develop the capacity of health care workers to render primary care services effectively.

METHODS

Nearly eighty policy-makers, healthcare practitioners, and educators participated in the meeting. Participants came from the Department of Health (DOH), the National Academy of Science and Technology (NAST), University of the Philippines College of Medicine, Philippine Red Cross, DOH Family Medicine Residency Training Program, Samal, Bataan (Appendices B, C and D). To develop primary care training objectives and competencies, consensus- building through a series of lectures and a break-out session was conducted. Informed verbal consent was obtained from the participants of the workshop proceedings, and participants were made aware of the prospects of possible publication of their insights during the workshop. In this consensus, competency is defined as an ability to perform specific tasks using a set of related skills or knowledge5, whereas a training objective comprises the set of skills and knowledge required to build competency through time.5

The framework for the break-out sessions was based on the four functions of primary care and the corresponding critical players involved in fulfilling such functions. The interlocutors presented this framework during the lecture series. The definitions of each function and the roles of each player are as follows:

Four Functions of Primary Care

First contact care involves the initial assessment of a patient’s concern. This includes establishing rapport, conducting health screening, and recognizing emergency cases when necessary.6,7

Comprehensive care refers to the ability to render holistic care for a wide variety of conditions. This includes curative, preventive and promotive aspects of healthcare.7

Coordinated care involves the ability to guide patients through the Service Delivery Network (SDN), referring them to specialists and other health units, if needed.7

Continuing care entails an ability to resume direct care after a patient returns from specialized units of the service delivery network.6,8

Key Players

Barangay Health Workers (BHWs) are volunteer community members who serve as bridges between the community and the health system.9 They are the health coaches of the community, who can deliver first aid, advice household measures for common illnesses, and recommend over-the-counter drugs.9

The Midwives serve as the front-line health professionals of the health system. They manage the barangay health stations and supervise the BHWs.10

Nurses directly implement and assist doctors in the overall plan of patient care.11 They manage the Rural Health Unit (RHU) and supervise the midwives and BHWs.

Doctors are the overall leaders for patient care, the key decision-makers, administrators/managers of health programs and trainers of the health team.11,12

Following the lectures, a break-out session was conducted to gather insights on possible competencies and training objectives from participants. Groups of 15- 20 members were formed, with each group assigned to one function of primary care. Groups were then given 3 hours and 45 minutes to list down competencies and training objectives to match with each health workforce cadre. Facilitators of each group encouraged the members to share a common goal of producing quality output for primary care professional development and to commit to its implementation.

At the end of the break-out session, group outputs were presented to cluster similar ideas and to arrive at a consensus on training objectives and competencies for primary care workshops. Questions were accommodated after every group presentation. Academician Antonio Miguel L. Dans facilitated an open forum to validate the insights of participants. Once all suggestions were incorporated, and all objections were resolved, the consensus in desired training objectives and competencies were achieved. These were then thematically analyzed and synthesized in the form of the training objectives framework (Section 3). The process of arriving at a consensus in this study largely mirrors the processes documented in Moffat et al.13, Parvizi and Gehrke14, and Tong et al.15.

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

PROCEEDINGS OUTCOMES: COMPETENCIES AND TRAINING OBJECTIVES

The competencies and training objectives from the break-out session were gathered and organized in this section.

First Contact Care (Table 1)

As the first contact for any medical concern, primary care doctors, nurses, midwives, and BHWs must be effective communicators. They must learn to develop and nurture the trust of their patients.

BHW’s must be competent at distinguishing between healthy and sick individuals. They must promptly recognize emergencies and provide first aid/BLS.Training objectives must be centered on skills such as identifying signs and symptoms of common illnesses.

Midwives should be capable of diagnosing common diseases and providing first aid/BLS, and initial management for emergencies. They must be trained in taking a patient history and performing an essential physical examination, especially with regards to maternal and child care.

Nurses must be able to diagnose common diseases by performing basic history-taking and physical examination, including a nursing care plan formulation and health screening. During emergency cases, nurses should be capable of initiating treatment, such as the provision of BLS/ACLS and initial management for surgical and medical emergencies.

Primary care physicians oversee all medical and surgical emergencies and supervise initial treatment for medical or surgical conditions, especially less common cases beyond the competence of the rest of the healthcare team.

Comprehensive Care (Table 2)

BHW’s must be able to perform and teach household remedies, including integrative, complementary, and alternative medicine, and promote health through general disease prevention. BHWs are also expected to manage transport predicaments if needed.

Midwives should exhibit competency in supervising patients in the implementation of promotive, preventive, and rehabilitative services as planned by the healthcare team, especially as they pertain to maternal and child health. Also, they support the healthcare team through tracking of inventories and management of clinical records and birthing facilities.

Nurses must be able to recognize and manage mild common conditions. They must be familiar with promotive, curative, and rehabilitative aspects of patient care to assist physicians in the implementation of an overall healthcare plan.

Primary care physicians must be competent in the diagnosis and management of a broad range of health conditions. Besides, they must be capable of planning and implementing promotive, curative, and rehabilitative aspects of patient care for these conditions.

Coordinated Care (Table 3)

To assist patients and enable coordination of care, the entire primary care team (BHW’s, midwives, doctors, and nurses) must be familiar with available medicines and healthcare services, including the location of hospitals, referral centers, clinics, laboratories, and pharmacies within an SDN. Besides, they must be competent in interprofessional communication so that the entire SDN functions as an efficient one-stop-shop rather than independent units in a system. BHW’s, midwives, nurses, and doctors must be familiar with each other’s roles in the primary care system so that they refer patients to one another in an efficient, patient-centered manner.

BHW’s must play a unique role in the coordination of care by mapping out domestic resources for healthcare, such as availability of caregivers, sources of a financial report, and availability of household equipment.

Midwives and nurses also play a crucial role by managing the electronic health records at the frontline. These records will serve as a medium of communication from primary secondary to tertiary care, and back.

Primary care physicians oversee and manage the harmonious flow of work at the primary care level. They must exhibit competence in communicating effectively with the rest of the primary care team, manage the size of the team, and ensure full integration with secondary and tertiary levels of care. In addition, primary care physicians must be able to conduct comprehensive health assessments of the population and coordinate with their respective local government units to maintain a strong SDN.

Continuing Care (Table 4)

After management under higher levels of care, BHWs must be able to render long-term follow-up by continuing patient monitoring, counseling, and rehabilitation under the supervision of midwives, nurses, and doctors.

Midwives are expected to develop skills in patient health education, reaching out to patients and linking them to community support groups. They must be competent in carrying out instructions on healthcare from higher levels, especially for maternal, neonatal, and child health and nutrition.

Nurses must become competent in the management of patients after discharge, surgery, or other interventions, communicating with and carrying out instructions from primary care physicians or other specialists.

As the overall coordinators of patient care, primary care physicians must communicate effectively with specialists and get involved in healthcare plans after discharge or intervention.They must issue clear and specific instructions to nurses, midwives, and BHWs while recognizing limitations in their capacity to provide healthcare.

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

Table 1. Competencies and training objectives proposed under first contact care

Key role	Proposed competencies required	Proposed training objectives
	1. Conduct proper health screening	1a. To identify common signs and symptoms including those for emergency cases
	by distinguishing between sick and
	healthy patients

Barangay

Health

Worker

2.	Recognize emergencies and deliver first	2a.	To identify common signs and symptoms including those for emergency cases
	aid, BCLS, conduct to ER	2b.	To safely perform the necessary steps in conducting patients to the ER
		2c.	To safely conduct patients to ER
3.	Develop effective communication skills;	3a.	To communicate with patients and onlookers using appropriate verbal and
	establish rapport and patient trust		nonverbal techniques
4.	Recognize the need for next-level care	4a.	To demonstrate familiarity with the referral network system
	and coordinate referral	4b.	To refer cases to the proper level in a timely manner

	1.	Diagnose common diseases by performing	1a.	To gather basic history of patients
		basic health screening by performing proper	1b.	To conduct basic physical examination of patients
		history-taking and physical examination	1c.	To identify health risks and life-threatening conditions
		especially maternal and child care	1d.	To properly document findings
	2.	Recognize emergencies and deliver first	2a.	To safely administer basic first aid/BLS and initial management
Midwife		aid, BCLS, and initial management	2b.	To educate patients regarding health matters
	3.	Develop effective communication skills;	3a.	To establish a conducive environment for patients and primary care provider
		establish rapport and patient trust	3b.	To communicate with clients, stakeholders, and the team using appropriate
				verbal and nonverbal techniques
	4.	Recognize the need for next-level care	4a.	To demonstrate familiarity with the referral network system
		and coordinate referral	4b.	To refer cases to the proper level in a timely manner
	1.	Diagnose most diseases by performing	1a.	To utilize basic knowledge on common signs, symptoms and clinical findings
		a thorough history-taking and physical		in primary care
		examination	1b.	To gather a thorough history of the patients
			1c.	To conduct a thorough physical examination of the patients
			1d.	To accurately record all significant findings
	2.	Recognize, deliver first aid and BCLS/	2a.	To identify emergency cases for various conditions
		ACLS, and manage surgical emergencies	2b.	To demonstrate basic first aid, BLS, and ACLS procedures
		(simple cases requiring prescription drugs)
Nurse	3.	Initiate treatment for emergency cases and	3a.	To formulate emergency management plans for patients
Nurse		manage a medical condition	3b.	To advise patients, and health staff on medical plans, home remedies,
		manage a medical condition	3b.
				preventive care, and health promotion and education
	4.	Develop effective communication skills;	4a.	To communicate and listen to patients using appropriate verbal and
		establish rapport and patient trust		nonverbal techniques
			4b.	To uphold and respect patients’ right to privacy and confidentiality

5.Recognize the need for next-level care and coordinate referral

5a. To identify conditions that require referral to a specialist/service delivery network

5b. To demonstrate familiarity on the referral network system 5c. To refer cases to the proper level in a timely manner

1.		Lead overall patient care on the first	1a.	To stay well informed and updated on health, disease, and treatment
		contact		concerns relevant to the community
2.		Diagnose most diseases by performing	2a.	To utilize basic knowledge on common signs, symptoms and clinical findings
		a complete history-taking and physical		in primary care
		examination	2b.	To gather a complete history of the patients
			2c.	To conduct a complete and thorough physical examination of the patients
			2d.	To accurately record all significant findings
3.		Recognize, deliver first aid and BCLS/	3a.	To identify emergency cases in various conditions
		ACLS, and manage all medical and surgical	3b.	To demonstrate basic first aid, BLS, and ACLS procedures
		emergencies (complex cases requiring	3c.	To diagnose the patient’s new conditions and update existing conditions
Doctor		prescription drugs)
Doctor	4.	Initiate treatment for emergency cases and	4a.	To formulate management plans for patients
		manage medical conditions	4b.	To perform proper procedures for all common clinical conditions
				(for all ages)

5.Develop effective communication skills; establish rapport and patient trust

5a. To use the most appropriate verbal and non-verbal techniques when speaking and listening to patients

5b. To formulate management plans for patients

5c. To perform proper procedures for all common clinical conditions (for all ages)

5d. To advise patients and health staff on medical plans, home remedies, preventive care, and health promotion

6.Recognize the need for specialty care and coordinate referral

6a. To identify conditions that require referral to a specialist 6b. To refer the patients to the appropriate specialists

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

Table 2. Competencies and training objectives proposed under comprehensive care

Key role

Barangay

Health

Worker

Proposed competencies required		Proposed training objectives
1. Perform proper history-taking and	1a.	To identify common signs and symptoms
physical examination, including non-lab	1b.	To measure the vital signs and anthropometrics accurately
health screening	1c.	To determine the onset, severity, frequency, and other aspects of the
		common signs and symptoms
	1d.	To record the data gathered accurately
	1e. To report the findings concisely
2. Perform and teach household remedies for	2a.	To identify the appropriate home remedies based on the given situation
common conditions, including integrative,	2b.	To enumerate the steps and materials needed for common home remedies
complementary, and alternative medicine	2c.	To advise the patients about the indication and the method of using home
		remedies, complementary and alternative medicine

	3.	Counsel patients on general disease	3a.	To identify the common causes of mortality and morbidity at a given area
		prevention and health promotion
1.		Perform proper history-taking and	1a.	To identify common signs and symptoms
		physical examination, including non-lab	1b.	To measure the vital signs and anthropometrics accurately
		health screening	1c.	To determine the onset, severity, frequency, and other aspects of the
				common signs and symptoms
			1d.	To record the data gathered accurately
			1e. To report the findings concisely
2.		Perform and teach household remedies for	2a.	To identify the appropriate home remedies based on the given situation
		common conditions, including integrative,	2b.	To enumerate the steps and materials needed for common home remedies
		complementary, and alternative medicine	2c.	To advise the patients about the indication and the method of using home
				remedies, complementary and alternative medicine
3.		Counsel patients on general disease	3a.	To identify common types of patients or situations that may warrant
		prevention and health promotion		preventive or health promotive counseling
			3b.	To explain to patients and BHWs the essential points of disease prevention
Midwife				and health promotion
Midwife	4.	Implement basic individual and population	4a.	To identify health needs in maternal, neonatal, and child care that are within
		healthcare in the community, including		the scope of work of midwives
		senior citizens, persons with a disability,	4b.	To demonstrate proper maneuvers and procedures required for basic
		and AJA		maternal and child care and emergencies
			4c.	To instruct patients on basic maternal and child care

5.Coordinate Maternal and Child Health 5a. To demonstrate knowledge and skills in all aspects of basic maternal, neonatal and child care

6.Manage Barangay Health Workers

7.Track inventory

8.Map HC resources

9.Manage and use clinical records

10.Conduct interfacility referrals regarding maternal care

11.Manage birthing facilities

1. Perform proper health and physical	1a.	To identify common signs and symptoms and to interpret diagnostic
examination, including health screening		test findings
with or without labs	1b.	To measure the vital signs and anthropometrics accurately
	1c.	To determine the onset, severity, frequency, and other aspects of the
		common signs and symptoms
	1d.	To record the data gathered accurately
	1e. To report the findings concisely
2. Perform and teach household remedies for	2a.	To identify the appropriate home remedies based on the given situation
common conditions, including integrative,	2b.	To enumerate the steps and materials needed for common home remedies
complementary, and alternative medicine	2c.	To advise the patients and midwives about the indication and the method
		of using home remedies, complementary and alternative medicine

Nurse 3. Counsel patients on general disease prevention and health promotion

3a. To identify common types of patients or situations that may warrant preventive or health promotive counseling

3b. To explain to patients, BHWs, and midwives, the essential points of disease prevention and health promotion

4.	Implement basic individual and population	4a.	To identify health needs in maternal, neonatal, and child care that are within
	healthcare in the community, including		the scope of work of midwives
	senior citizens, persons with a disability	4b.	To demonstrate proper maneuvers and procedures required for basic
	and AJA		maternal and child care, and emergencies
		4c.	To instruct patients and midwives on basic maternal and child care
5.	Manage implementation of diagnostic,	5a.	To select the most appropriate diagnostic, therapeutic and preventive
	therapeutic and preventive measures for		measures for common conditions
	common conditions

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

Table 2. Competencies and training objectives proposed under comprehensive care (continued)

Key role

Doctor

Proposed competencies required		Proposed training objectives
1. Perform proper health and physical	1a.	To thoroughly assess the full range of common signs, symptoms, and
examination, including health screening		diagnostic test findings in primary care
	1b.	To accurately record all clinically significant findings for each patient
2. Perform and teach household remedies for	2a.	To demonstrate proper use of common household remedies
common conditions, including integrative,	2b.	To properly instruct patients and health workers on common home
complementary, and alternative medicine		remedies, particularly the indication, the method, and the dosing
		(EBM included)
3. Diagnose, treat, and institute preventive	3a.	To identify all health needs, both present and anticipated (Overall Risk
measures for common medical conditions		Approach; Health Screening), of patients in all age groups
using the biopsychosocial approach	3b.	To formulate diagnostic and therapeutic plans that are appropriate,
		adequate, and evidence-based
		3b-1. To explain the importance of good health, prevention of illnesses,
		treatment options, and anticipatory guidance as appropriate
		3b-2. To incorporate input and feedback from patients and health workers
		about the treatment plan
		3b-3. To apply for evidence-based medicine
	3c.	To demonstrate common clinical and surgical maneuvers and procedures in
		primary care

Table 3. Competencies and training objectives proposed under coordinated care

Key role		Proposed competencies required		Proposed training objectives
	1.	Inform patients of available	1a.	To enumerate the medications, tests, and services available within the RHU
		medications, tests, services in		and SDN, or use appropriate references to find out
		rural health units (RHU) and service	1b.	To proactively utilize methods and opportunities for educating the
		delivery networks (SDN)		community on primary care services
	2.	Develop effective communication	2a.	To select the proper communication channel, person to communicate with,
Barangay		skills when coordinating with		and information required for common situations that need coordination
Barangay		the rest of the team
Health
Health	3.	Assist patients with logistics for their	3a.	To select the proper communication channel, person to communicate with,
Worker	3.	Assist patients with logistics for their	3a.
Worker		overall health needs		and information required for common situations that need coordination
		overall health needs
			3b.	To describe the options that patients can use for accessing care, as
				appropriate for a given condition or situation
	4.	Coordinate with other levels of care	4a.	To distinguish, with reasonable judgment, if a case needs a referral to other
				primary care team members
			4b.	To refer the patient to other primary care team members as appropriate
	1.	Inform patients of available	1a.	To enumerate the medications, tests, and services available within the RHU
		medications, tests, services in		and SDN, or use appropriate references to find out
		rural health units (RHU) and service	1b.	To identify the referral centers or referral clinics, laboratories and
		delivery networks (SDN)		pharmacies in the area
			1c.	To explain the qualifications and mechanics for the enrolment and inclusion
				of patients in DOH priority programs, and PHIC benefits
			1d.	To proactively utilize methods and opportunities in educating the
				community about available health services and resources
	2.	Develop effective communication	2a.	To select the proper communication channel, person to communicate with,
		skills when coordinating with		and information required for common situations that need coordination
Midwife		the rest of the team
Midwife	3.	Assist patients with logistics for their	3a.	To relay patient options for accessing care as necessitated by their condition
	3.	Assist patients with logistics for their	3a.
		overall health needs		or situation
			3b.	To select the proper communication channel, person to communicate with,
				and information required for common situations that need coordination
	4.	Coordinate with other levels of care	4a.	To distinguish, with reasonable judgment, if a case needs a referral to other
				primary care team members
			4b.	To refer the patient to other primary care team members as appropriate

5.Use EMR

6.Supervise Barangay Health Stations and Barangay Health Workers

7.Prepare Barangay Reports

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

Table 3. Competencies and training objectives proposed under coordinated care (continued)

Key role

Proposed competencies required

Proposed training objectives

1.Inform patients of available medications, tests, services in rural health units (RHU) and service delivery networks (SDN)

1a. To enumerate the medications, tests, and services available within the RHU and SDN, or use appropriate references to find out

1b. To identify the referral centers or referral clinics, laboratories and pharmacies in the area

1c. To assist patients in understanding and availing primary care services, DOH priority programs, and PHIC benefits

1d. To direct midwives and barangay health workers in educating the community about available health services and resources

2.Develop effective communication skills when coordinating with the rest of the team

2a. To select the proper communication channel, person to communicate with, and information required for common situations that need coordination

	3. Assist patients with logistics for their	3a.	To assist patients in understanding and availing primary care services, DOH
	overall health needs		priority programs, and PHIC benefits
Nurse		3b.	To select the proper communication channel, person to communicate with,
			and information required for common situations that need coordination
		3c.	To thoroughly aid patients in accessing necessary services from other parts
			of the health system
	4. Coordinate need for other levels of care	4a.	To distinguish, with reasonable judgment, if a case needs referral to the
			doctor (or can be handled by MW or RN)
		4b.	To refer the patient to the doctor as appropriate
		4c.	To describe how conditions that need a referral to the doctor would
			usually appear

5.Supervise midwives and BHWs

6.Facilitate and conduct inter-LGU referrals provided by doctors

7.Use EMR

8.Prepare Reports

1. Inform patients of available	1a.	To enumerate the medications, tests, and services available within the RHU
medications, tests, services in		and SDN, or use appropriate references to find out
rural health units (RHU) and service	1b.	To identify the referral centers or referral clinics, laboratories and
delivery networks (SDN)		pharmacies in the area
	1c.	To assist patients in understanding and availing primary care services, DOH
		priority programs, and PHIC benefits
	1d.	To direct nurses, midwives, and barangay health workers in educating the
		community about available health services and resources

2.Develop effective communication skills when coordinating with the rest of the team

2a. To select the proper communication channel, person to communicate with, and information required for common situations that need coordination

	3.	Assist patients with logistics for their	3a.	To assist patients in understanding and availing primary care services, DOH
		overall health needs		priority programs, and PHIC benefits
			3b.	To select the proper communication channel, person to communicate with,
				and information required for common situations that need coordination
			3c.	To thoroughly aid patients in accessing necessary services from other parts
				of the health system
			3d.	To apply principles of clinical stewardship and the structure of primary care
				systems and services
4.		Coordinate need for other levels of care	4a.	To apply principles of clinical stewardship and the structure of primary care
Doctor		or admission		systems and services
			4b.	To distinguish with reasonable judgment if a case needs a referral to a
				specialist or needs hospital admission
			4c.	To refer the patient to a specialist or a hospital for admission as appropriate
			4d.	To delegate tasks within the treatment plan to the right primary care team
				member, distinguishing which are best handled by nurses, midwives, or
				barangay health workers
5.		Co-manage patients during admission	5a.	To apply principles of clinical stewardship and the structure of primary care
		and specialty referral		systems and services
			5b.	To make referrals that are truly needed, have clear goals, and are acceptable
				to patients and colleagues/partners
			5c.	To access, assess, and contribute to hospital and specialist treatment plans

6.Supervise nurses, midwives, and BHWs

7.Use EMR

8.Prepare Reports

9.Coordinate with LGU

10.Conduct specialty referrals

11.Refer for order elective admissions

12.Conduct population health assessment

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

Table 4. Competencies and training objectives proposed under continuing care

Key role

Barangay

Health

Worker

Proposed competencies required		Proposed training objectives
1. Exhibit knowledge and skills to render	1a.	To properly interpret the patient management plan for patients
counseling, monitoring or continuing care	1b.	To reach out to patients and link to community support groups for
under the supervision of the midwives,		continuing care
nurses, or doctors	1c.	To make relevant and accurate observations in the course of providing care
	1d.	To record the data gathered accurately
	1e.	To report the findings concisely to the health care team

	2.	Promote health	2a.	To conduct health education classes to patients
	1.	Exhibit knowledge and skills to render	1a.	To properly interpret patient management plan for patients
		counseling, monitoring or continuing care	1b.	To reach out to patients and link to community support groups for
		under the supervision of the nurses or		continuing care
		doctors	1c.	To make relevant and accurate observations in the course of providing care
			1d.	To record the data gathered accurately
Midwife			1e. To report the findings concisely to the health care team
Midwife	2.	Render continuing maternal, neonatal,	2a.	To conduct home visits in the community for maternal, neonatal, and child
	2.	Render continuing maternal, neonatal,	2a.
		child health and nutrition after nurse-care,		care
		specialist consult, or admission	2b.	To identify, assess, and manage various conditions that need continuing
				patient care
			2c.	To refer patients as appropriate
	3.	Promote health	3a.	To conduct health education classes to patients

1.Exhibit knowledge and skills for specific parts of care for:

a.Chronic conditions

b.Post-discharge, post-op/post- intervention patients, including postpartum and neonatal care

c.Administration of parenteral

	Nurse	medications, either in the clinic or
	Nurse	at home
		at home

1a. To properly interpret doctor’s orders and the overall management plan for patients

1b. To effectively reach out to patients, directly or through the midwife- barangay health worker network

1c. To apply community-based and clinic-based knowledge and skills for carrying out orders

1d. To make relevant and accurate observations in the course of providing care 1e. To record the data gathered accurately

1f. To report the findings concisely to the health care team

1g. To identify various conditions that require continuing patient care and to refer patients as appropriate

	2.	Partner with midwives and barangay health		2a.	To supervise midwives and barangay health workers in understanding and
		workers to maximize ongoing management			carrying out management plans, through BHS and community rounds
		of patients in the community setting
	3.	Promote health		3a.	To conduct health education classes to patients
	1.	Exhibit knowledge and skills for specific		1a.	To directly provide essential follow-up care including monitoring, wound
		parts of care for:			care, rehabilitation, early detection of complications, and liaising with
		a.	Chronic conditions		specialists
		b.	Post-discharge, post-op/post-	1b.	To identify conditions that would need further continuing care or a new
			intervention patients, including		consultation
			postpartum and neonatal care	1c.	To make relevant, accurate observations in the course of providing care and
		c.	Administration of parenteral		record / share them appropriately
			medications, either in the clinic or
			at home
Doctor	2.	Following up on specialist care		2a.	To integrate specialist advice and interventions into the patient's overall
Doctor					management plan and in the individual, family, and community context

	3.	Enhance communication and planning		3b.	To communicate the management plan through specific orders for specific
					health workers
				3a.	To effectively reach out to patients directly or through the RN/MW/BHW
					network
				3c.	To supervise RNs, MWs, and BHWs in understanding and carrying out
					management plans
				3d.	To integrate and implement the management plan from primary care team
					members and specialists
	4.	Promote health		4a.	To conduct health education classes to patients

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

CONCLUSION and RECOMMENDATIONS

With the current challenges confronted by health systems in the country, primary care providers wield a great responsibility in addressing patient needs through holistic means. Understanding patient needs in the context of their socio-economic environment will prove vital to a primary care provider’s engagement. The coordinated approach provided by primary care will help harness every facet of the healthcare network into a system that offers accessible, sufficient, and quality care.

Short primary care workshops will target the existing cadre of healthcare workers and aim to serve as a refinement of their ongoing practice of primary care. From informative and formative avenues of learning to increased inter- disciplinary communication and team-building, healthcare workers will become well-equipped to assess and adapt to the various situations they may face in the field. The roles and training objectives outlined in this consensus-building

workshop	shall play a	key role in assuring the success
of these	ventures. That	being said, future steps such as

expanding primary care learning resources, as Dr. Salvador Isidro B. Destura suggests (Appendix E), would still be necessary for strengthening service delivery networks and reducing health inequities in the Philippines.

Statement of Authorship

All authors have approved the final version submitted.

Author Disclosure

All authors declare no conflicts of interest. The authors had full access to all data in this study. Funders had no other involvement in the development of study; collection of data; and writing of the manuscript.

Funding Source

This study was supported by the University of the Philippines Emerging Interdisciplinary Research (UP- EIDR) program (grant number C07-001), the Philippine Department of Health (DOH), and the Philippine Health Insurance Corporation (PHIC).

REFERENCES

1.Romualdez AJG, dela Rosa JFE, Flavier JDA, et al. The Philippines health system review (Vol. 1). Geneva: WHO Press; 2011.

2.Frenk J, Gomez-Dantes O. The triple burden: disease in developing nations. Harvard International Review. 2011; 33(3):36-40.

3.Peabody JW, Taguiwalo MM, Robalino DA, Frenk J. Improving the Quality of Care in Developing Countries. In: Disease Control Priorities in Developing Countries: 2nd Ed. New York: Oxford University Press; 2006.

4.Oxford University Press, In: Lexico.com, definition of consensus

[Internet]. 2019 [cited 2019 Aug]. Available from: https://www. lexico.com/en/definition/consensus.

5.University of Texas, School of Public Health. Competencies and Learning Objectives [Internet]. UTHealth; 2012 [cited 2018 Jul 25]. Available from: https://sph.uth.edu/content/uploads/2012/01/ Competencies-and-Learning-Objectives.pdf.

6.Fundukian LJ.The Gale Encyclopedia of Public Health. In: Fundukian

LJ, Ed. Detroit: Gale, Cengage Learning; 2013.

7.Coulter A, Fitzpatrick R. The Patient’s Perspective Regarding Appropriate Health Care. In: Handbook of Social Studies in Health and Medicine. London: Sage Publications; 2003.

8.Salisbury C, Sampson F, Ridd M, Montgomery AA. How should continuity of care in primary health care be assessed. Br J Gen Pract. 2009 Apr; 59(561):e134-e141.

9.Fernandez DD. Barangay health workers on the sustainability of primary health care. The Trinitian Researcher. 2015; 7(1):22-39.

10.de Jonge A, de Vries R, Lagro-Janssen ALM, Malata A, Declercq E, Downe S, et al. The importance of evaluating primary midwifery care for improving the health of women and infants. Front Med (Lausanne). 2015; 2:17.

11.Elsous A, Radwan M, Mohsen S. Nurses and physicians attitudes toward nurse-physician collaboration: a survey from Gaza Strip, Palestine. Nurs Res Pract. 2017; 2017:7406278.

12.Shortell SM. Physician Involvement in Hospital Decision Making.

In: The New Health Care for Profit: Doctors and	Hospitals in
a Competitive Environment. Washington: National	Academies
Press; 1983.

13.Moffat J, Hiom S, Kumar HS, Baldwin DR. Lung cancer screening – gaining consensus on next steps – proceedings of a closed workshop in the UK. Lung Cancer. 2018 Nov; 125:121-7.

14.Parvizi J, Gehrke T. Proceedings of the second international consensus meeting on musculoskeletal infection. J Arthroplasty. 2019 Feb; 34(2):S1-S496 .

15.Tong A, Sautenet B, Poggio ED, Lentine KL, Oberbauer R, Mannon R, et al. Establishing a core outcome measure for graft health: a standardized outcomes in Nephrology-Kidney Transplantation (SONG-Tx) Consensus Workshop Report. Transplantation. 2018 Aug; 102(8):1358-66.

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

APPENDICES

Appendix A. Programme

STAKEHOLDERS’ MEETING ON TRAINING OBJECTIVES FOR PRIMARY CARE IN THE PHILIPPINES

9:00 am to 2:00 pm | 01 February 2018 | Hotel Jen, Roxas Boulevard, Pasay City

Objective: To develop consensus on the objectives of primary care training for practicing professionals and health workers in the Philippines

Expected Output: Training objectives framework for primary care professional development in the Philippines

8:30 am	Registration
9:00 am	National Anthem	(AVP)
9:05 am	Welcome Remarks	ACD. WILLIAM G. PADOLINA
		President, NAST Philippines
9:15 am	Statement of the Objectives and Expected Output of	ACD. JAIME C. MONTOYA
	the Meeting	Chair, Health Sciences Division, NAST Philippines
9:30 am	Keynote Address	ASEC. ENRIQUE A. TAYAG
(15 minutes)	Primary Care: Flagship Strategy for UHC in the Philippines	Department of Health
9:45 am	Health Workforce Development Challenges in Philippine	DR. FELY MARILYN E. LORENZO
(15 minutes)	Primary Care	Chair, Technical Committee on Nursing Education, CHED
10:00 am	Primary Care in Philippine Health Professional Education	DR. SALVADOR ISIDRO DESTURA
(15 minutes)		Dean, School of Health Sciences
		University of the Philippines Manila
10:15 am	Ongoing Research and Development in Primary Care:	DR. JOSE RAFAEL MARFORI
(15 minutes)	the PPCS Experience	Assistant Program Leader, PPCS
10:30 am	Open Forum	Moderator:
(15 minutes)	And	ACD. ANTONIO MIGUEL L. DANS
*Snacks	Proposed draft of training objectives	Member, Health Sciences Division, NAST Philippines
10:45 am	Breakout sessions	Facilitators for each health workforce cadre
(3 hours, 45 minutes) Strengthening primary care through professional development
	With working lunch
3:30 pm	Presentations	Moderator:
	Synthesis and Ways Forward	ACD. ANTONIO MIGUEL L. DANS
4:00 pm	Closing Remarks	NATIONAL SCIENTIST ERNESTO O. DOMINGO
		Member, Health Sciences Division, NAST Philippines

Prepared by Dr. Jose Rafael A. Marfori and the PPCS Team

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Appendix B. List of Participating Organizations and Organizers

Participating Organizations

Department of Health

Philippine Academy of Family Physicians

Philippine Pediatric Society

Philippine Society of General Internal Medicine

Philippine Obstetrical and Gynecological Society

Philippine Dental Association

Philippine College of Surgery

Philippine Health Insurance Corporation

Philippine Regulatory Commission

University of the Philippines Manila

University of the Philippines School of Health Sciences Association of Philippine Medical Colleges

Philippine Academic Society for Community Medicine Commission on Higher Education

Department of Education

Philippine College of Physicians

Philippine Medical Association

Philippine Ambulatory Pediatric Association

Philippine Academy of Medical Specialists

Association of Municipal Health Officers of the Philippines Philippine Federation of Private Medical Practitioners Department of Education & Culture Physicians Association

Philippine Nurses Association

Integrated Midwives Association of the Philippines

Barangay Health Workers’ Federation, Inc.

Organizer: National Academy of Science and Technology (NAST)

Co-organizer: The Philippine Primary Care Studies (PPCS)

Antonio Miguel L. Dans, MD, MSc	Program Leader, Philippine
	Primary Care Studies
Jose Rafael A. Marfori, MD, MPH	Assistant Program Leader
Nannette Sundiang, MD	Project Leader, corporate site
	(UP Health Service)
Leonila F. Dans, MD, MSc	Project Leader, rural site
	(RHU - Samal, Bataan)
Jayson Celeste	Project Leader, GIDA site
	(RHU - Bulusan, Sorsogon)
Kevin Jer V. David, MD	Municipal Health Officer,
	Bulusan, Sorsogon
Cristina Espino, MD	Municipal Health Officer,
	Samal, Bataan
Steering Committee
Ramon Pedro P. Paterno, MD MPH	Public Health
Edna Estifania A. Co, DPA	Public Administration and
	Governance
Mia P. Rey, PhD	Actuarial Science
Jesusa T. Catabui, MD	Medical service provision /
	Health facility administration
Jocelyn V. Maala, MD	PhilHealth representative
Louella Carpio, MD	DOH-HPDPB representative

Appendix C. List of Moderators and Speakers

Moderators

●Acd. Antonio Miguel L. Dans

○Program Leader, Philippine Primary Care Studies

●Dr. Jose Rafael A. Marfori

○Assistant Program Leader, Philippine Primary Care Studies

Speakers

●Acd. William G. Padolina

○President, NAST Philippines

●Acd. Jaime C. Montoya

○Chair, Health Sciences Division, NAST Philippines

●Asec. Enrique A. Tayag

○Assistant Secretary, Department of Health

●Dr. Fely Marilyn E. Lorenzo

○Chair, Technical Committee on Nursing Education, CHED

○Professor, Department of Health Policy and Administration,

UP Manila

○Founding Director, Institute of Health Policy and Development Studies, National Institutes of Health, UP Manila

○Chairperson, Health Policy Development Hub, UP Manila

●Dr. Salvador Isidro B. Destura

○Dean, School of Health Sciences, UP Manila

○Professor, College of Public Health, UP Manila

○Consultant, World Bank

●Dr. Jose Rafael A. Marfori

○Assistant Program Leader, Philippine Primary Care Studies

○Consultant, World Health Organization

○Faculty Mentor, Ateneo School of Medicine and Public Health

○Chief Medical Officer, Health & Human

○Founding President, Kyrion Medical Inc.

●Dr. Antonio Miguel L. Dans

○Program Leader, Philippine Primary Care Studies

○Member, Health Sciences Division, NAST Philippines

○Professor, College of Medicine, UP Manila

●National Scientist Ernesto O. Domingo

○Member, Health Sciences Division, NAST Philippines

○Professor Emeritus, College of Medicine, UP Manila

●Dr. Ramon Pedro P. Paterno

○Steering Committee, Public Health, Philippine Primary Care Studies

○Member, Universal Health Care Study Group, UP Manila

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

Appendix D. List of Participants

NAST Philippines	Philippine Primary Care Studies
Acd. Jaime C. Montoya	Acd. Antonio Miguel L. Dans
Acd. Remigio M. Olveda	Dr. Jose Rafael A. Marfori
National Scientist Ernesto O. Domingo	Dr. Leonila D. Dans
Ms. Guada B. Ramos-Dimaya	Dr. Ramon Pedro P. Paterno
Mr. Roberto Arat	Dr. Jesusa T. Catabui
Ms. Rishelle Escala	Dr. Mia P. Rey
Ms. Michelle Jade Nantes	Dr. Edna A. Co
Ms. Camille Santos	Ms. Rhodora N. Aquino
Ms. Cathlyn Umlas	Dr. Nanette B. Sundiang
Ms. Princess Sulit	Mr. Jayson Celeste
	Ms. Cara Lois T. Galingana

U.P. College of Medicine	Philippine College of Surgeons
Dr. Eleanor Almoro	Dr. Ma. Cheryl L. Cucueco
Dr. Josefina Isidro-Lapeña	Dr. Maria Concepcion C. Vesagas
Department of Health	Philippine Ambulatory Pediatric Association
Dr. Louella Carpio	Dr. Ma. Cecilia Alinea
Mr. Jason Nazareno	Dr. Mutya San Agustin
Ateneo School of Medicine and Public Health	Integrated Midwives Association of the Philippines Inc.
Ms. Nikki Gavino	Ms. Rosemarie Caracho
Dr. Jeremie De Guzman	Ms. Elvie Estrada
University of the East Ramon Magsaysay Memorial Medical Center	DOST Science and Technology Information Institute
Dr. Milagros B. Rabe	Mr. Reiner Zagada
Dr. Ramon Jason Javier	Mr. Jonathan Omega
	Ms. Ceajay Valerio
Family Medicine Residency Training Program (DOH)	DOST Food and Nutrition Research Institute
Dr. Leilani Nicodemus	Ms. Regina M. Pagaspas
Dr. Ava Alejandro
Dr. Zorayda Leopardo
Philippine Pediatric Society, Inc.	League of Municipalities of the Philippines
Dr. Cecilia O. Gan	Mr. Joseph Castajon
League of Vice Governors of the Philippines	National Confederation of Barangay Health Workers
Ms. Annalyn Flores	Ms. Julita B. De Jesus
Philippine League of Government and Private Midwives, Inc.	Adult Medicine-Medical Research Unit (PGH)
Ms. Cecille B. Santos	Ms. Joy Sanchez
Guests from Samal, Bataan	Philippine Red Cross
Dr. Cristina S. Espino	Dr. Lord Louis Valera
Ms. Cecilia D. Batiles	Dr. Eleanor Galvez
Ms. Elena Baluyot	Dr. Teresita Tan
Ms. Teresa Adiorida	Dr. Graciela Garayblas-Gonzaga
	Ms. Omaima Gandamra
	Ms. Euzi Valenzuela
	Dr. Eleanor Almoro
Guests from the Province of Dinagat Islands	Media
Vice Governor Benglen Ecleo	Mr. Prince Ameer
Mr. Renford Ho	Mr. Jhularab H. Sampang
Mr. Cilso Lasanglasang	Mr. Nolan Ariola (Radio Veritas)
Mr. Miguel Quinuh	Ms. Estrella Z. Gallardo (Manila News Week)
Mr. Julios A. Busano	Mr. Paul Icamina (Malaya)
Mr. Neil E. Ecleo	Mr. MJ Balaguer (diaryongtagalog.net)
Mr. Ernesto L. Igano	Mr. Michael Balaguer (diaryongtagalog.net)
Guests from South Cotabato	Ms. Melody Aguiba (Growth Publishing/Manila Bulletin)
Guests from South Cotabato	Mr. Benedicto Briones (Philippine News Agency)
Vice Governor Vicente De Jesus

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	Setting Competencies of Primary Care Health Workers: Workshop Proceedings
Appendix E. Summary of Key Points from Conference Speakers and Lecturers
Conference Speakers	Key Points
Welcome Remarks:	• Primary Care is “the cornerstone of the world’s best performing health systems.” It aims
“The Need for a Curriculum in Primary Care”	to foster a partnership with patients by having accessible healthcare in the community.
– NAST President Acd. William G. Padolina,	It is essential for a health system to be able to provide first contact, comprehensive,
delivered by Acd. Jaime C. Montoya	coordinated, and continuing care.
	• Health sector reform has become a growing national priority. The Philippine Health Agenda
	states that primary care is the key strategy towards fulfilling its three guarantees, namely
	1) covering the triple-burden disease across all life stages, 2) functional service delivery
	networks, and 3) universal health insurance.
	• The country must recognize our primary care providers’ loyalty and resourcefulness by
	“elevating their continued professional development, so they may continue to serve their
	fellow Filipinos, derive meaning from their calling, and work in concert with one another”.
	• Health care providers should function as a team that is “integrated, competent, resilient,
	and inspired”. It is therefore imperative that consensus be reached on training objectives for
	primary care.
Keynote Address:	• The Philippine flagship reform program Fourmula One Plus centers on 1) institutionalizing
“The Role of Service Delivery Networks	functional SDNs in rural areas of the country and 2) leadership of DOH in forming societal
(SDNs) in Primary Care”	coordination and collaboration with the desire of achieving the country’s development plans.
– Department of Health Assistant Secretary	• While there remains a notion that the SDNs must rely on healthcare utilities in order to
Enrique A. Tayag	provide services, they must be flexible enough to make arrangements, so that dependence
	on specific utilities will lessen.
	• For patients, first-contact is the health center. But they are not just clients of this health
	center, they are clients of the entire network.
	• SDNs aim to address fragmentation in the health system and disparities in health outcomes
	through primary care health centers. SDNs will allow mutual agreements between a barangay
	a GIDA and an apex hospital to provide assistance and support for a patient in need.
Lecture:	• Health care systems are bound to suffer from poor quality of care, incompetent health
“Health Workforce Development Challenges	care workers, and unsatisfactory patient experience without the following pillars –
in Philippine Primary Care: No Primary Care	1) sufficient numbers, 2) proper training, and 3) adequate support
Without Human Resources for Health”	• The primary care workforce demands a sufficient number of workers able to focus on specific
– Fely Marilyn E. Lorenzo, RN, MPH, DrPH	tasks. The HRH to population ratio falls short, as certain communities, some comprising
	50,000 people, have only one doctor. Health worker distribution has been heavily
	influenced by incentives resulting in 1) private to public and 2) rural to urban migration.
	• This situation is aggravated by lack of training and coordination, which prevents the primary
	care workforce from operating systematically. Inter-professional training and socialization
	ensures a focus on effective and relevant skill sets, and improves camaraderie within a
	primary care team.
	• Adequate support highly motivates the health workforce and ensures improved patient
	safety, quality of care, and patient delight. A delightful patient experience should not be
	exclusive for the private sector. However, this cannot be achieved when healthcare workers
	do not get adequate support. Key points that are likely to increase health worker retention,
	include 1) effective policies, 2) suitable working conditions, and 3) sufficient benefits.
Lecture:	• The UP Manila-School of Health Sciences implements a Step-Ladder Curriculum where
“Primary Care in Philippine Health	candidates from communities are nominated to become health professionals, regardless
Professional Education: The School of Health	of educational background. The candidates are trained in rural areas; namely the provinces
Sciences Approach”	of Baler, Leyte, and South Cotabato. The rungs of the stepladder course are composed of:

–Salvador Isidro B. Destura, RM, RN, MD, MPH 1) a Certificate of Community Health Work (Midwifery) after the 1st 2 years), 2) BS Nursing by 4th year, and 3) Doctor of Medicine by the 6th year

•The UPM-SHS trains healthcare professionals to render first contact care in rural areas. The training complements rather than copies the present program of UP College of Medicine. Manpower training in the Institute is directed toward rural practice, with the end in view of providing a program model applicable to the Philippines and other developing countries.

•In comparison to the MD graduate program recommended by CHED, the step-ladder curriculum emphasizes primary health care that is patient-centered, comprehensive, holistic and cost-effective. This allows the UPM-SHS to reduce the tendency of modern health professional education to depend on overspecialized curative care.

•UPM-SHS graduates and participants are expected to become health leaders and managers, who are able to effectively coordinate patient concerns with other health practitioners. They must be able to competently provide primary care using both conventional and complementary forms of medicine.

•The UPM-SHS approach allows it to produce dedicated and locally responsive graduates especially in remote underserved areas of the country.

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Setting Competencies of Primary Care Health Workers: Workshop Proceedings

Appendix E. Summary of Key Points from Conference Speakers and Lecturers (continued)

Conference Speakers	Key Points
Lecture:	• The goal of PPCS is to enhance PhilHealth primary care benefits and develop the
“Ongoing Research and Development in	necessary support systems for it, including information systems, governance, and health
Primary Care: The PPCS Experience”	workforce training.
– Jose Rafael A. Marfori, MD, MPH	• Health worker training in the study is framed around addressing one of the root causes of
	health inequity in the country - health policy fragmentation. PPCS proposes an alternative
	to health system reliance on multiple national programs aimed at specific diseases
	(so-called ‘vertical’ programs).
	• To achieve these goals, local health system capacities must be developed to address a wide
	range of health needs through primary care. This approach is more responsive to the triple
	burden of disease (infectious diseases, injuries, and other non-communicable diseases),
	and demands preventive, curative and rehabilitative care, coordinated across various levels
	of care.
	• Development of the capacity to render primary care will involve training of doctors, nurses,
	midwives, and barangay health workers as primary care teams that can function as patients’
	entry point to the whole health system, and their constant guide for any health condition.
	• The PPCS model leveraged the principle of risk-sharing, allotting PhP 600 per head annually
	to cover up to PhP 2,000 per individual annually in primary care expenses for consultation
	fees, diagnostic tests, or medications, regardless of diagnosis. The results from the pilot year
	at University Health Service (October 2017-September 2018) showed that 1) community
	utilization rate of the pilot primary care program rose from 8.9% to 52%; 2) there was no
	sudden increase in consultation rate, suggesting the model did not promote patient abuse
	of primary care benefits, and 3) only 2% of patients exceeded the annual allocation.
	• The system is envisioned to bridge health inequities across socioeconomic groups by
	increasing financial access to primary care services, which are more comprehensive and
	geographically accessible than tertiary care services.
Closing Remarks:	• The Philippine healthcare system is like a leper who receives prescriptions without access
“Universal Healthcare”	to proper medication. We must challenge the system to go beyond prescribing, to give
– National Scientist Ernesto O. Domingo and	necessary treatment for such a disease. At the macro level, the prescription is universal
Ramon Pedro P. Paterno, MD, MPH	health care. The heart of that system is health human resource. That is why this is a very
	important meeting.
	• Various health professional bills give rise to silos of healthcare professional practice:
	The Medical Act of 1995, the Nursing Act of 2015, and the Midwifery Act of 2016. There
	is a need for an omnibus health professional bill that would eradicate the silo approach
	to healthcare. This should define the approach of a primary care system, specifically the
	primary care services, key players, and compensation. We must look forward to the passage
	of the UHC Bill into a law, to address the chronic problem of mal distribution of health
	human resource, through further training of health care providers to function effectively in
	the primary care system.

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