Health Policy and Planning: The policy environment of self-care

5 November, 2022

Dear HIFA colleagues,

This new paper in Health Policy and Planning looks at the Philippines but for me raises a wider question: To what extent do governments have policies that empower individuals 'to maintain health through informed healthcare decisions, with or without the support of a health provider'. Citation, abstract and a comment from me below.

CITATION: The policy environment of self-care: A case study of the Philippines

Jaminola Leonardo ; Jana Marie Negre; Veincent Christian F Pepito; Maever L Arianna; Manuel M Dayrit

ABSTRACT: Self-care is the ability and empowerment of individuals to maintain health through informed healthcare decisions, with or without the support of a health provider. High-income countries have made advances to its conceptualization, research, and institutionalization given its reported benefits to patients, the health system, and economy. A similar undertaking in low- and middle-countries (LMICs) with already fragile health systems is warranted as highlighted by the COVID-19 pandemic. Our paper therefore aimed to describe and analyze the policy environment of self-care using the Philippines as a case study, which may have relevance to other similar countries and settings that are transitioning towards Universal Health Care (UHC) to reform and strengthen their primary care systems. We conducted 13 key informant interviews and two focus group discussions among representatives from the government, the pharmaceutical retail/ industry, community retail pharmacy, primary health physicians and health workers, an infirmary administrator, and patients and/or patient advocates. We triangulated our qualitative data with findings from our policy review. We found a total of 13 relevant policies on self-care in the Philippines recently drafted and/or implemented from 2016 to 2021 that fall under the broad categories of unifying frameworks and roadmaps, capacity building and institutional streamlining, regulations, and disease guidelines. Our case study highlights the role of the UHC Law as a driver for self-care and patient empowerment towards better health outcomes with its passage resulting in the promulgation of self-care-related policies. Our findings also suggest that changes in the local policy and built environment, and the formal educational and health systems, are needed to foster a culture of responsible self-care. There are notable exemplars in advancing self-care in the region, including Thailand, from which LMICs like the Philippines can draw lessons to make progress on institutionalizing self-care and ultimately, realizing universal health coverage and Health For All.

COMMENT (NPW): Despite information being central to the definition of self-care, the paper does not appear to address the question of whether and how governments promote improved availability and use of reliable healthcare information, although it notes that 'selfcare can be enhanced if we have strong institutions that provide information and confidence to individuals to take care of themselves'.

On 14th November I am participating in the launch of Evidence Week where I shall ask UK Members of Parliament: 'Does parliament take an interest in initiatives to improve the availability and use of reliable healthcare information for the population?' The event will be publicly live-streamed:

One area where I think the UK has excelled is in the provision of healthcare information as part of NHS services, including and especially the NHS website.

In addition to generic information, we are more aware of the importance of access to personal medical records, thanks to HIFA member Richard Fitton.

Access to personal medical records is a key part of the information a person needs to protect their own health and the health of others.

Neil Pakenham-Walsh, Global Coordinator HIFA,

Working in official relations with WHO