University of the Philippines Manila National Institutes of Health Policy Landscape on HEALTH HUMAN RESOURCE FOR AN AGING PHILIPPINES Shelley F. de la Vega, M.D., MSc Professor, College of Medicine Director, Institute on Aging NIH
In the Philippines, the population 60 years and over has grown at a very rapid rate increasing from 3.2 million in 1990 to 4.6 million in 2000 and 7 million in 2014. (NSO and UP Population Institute) de la Vega 2015
Percent Share of Senior Citizens to Total Population: 1980, 1990, 1995, 2000, 2007, 2010, 2011, 2016, 2017 and 2040 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1980 1990 1995 2000 2007 2010 2011 2016 2017 2040 Source: World Population Prospects: The 2010 Revisions, UN Population Division, Census of Population (and Housing) and Census of Population of the National Statistics Office (NSO) and National Statistics Coordination Board (NSCB) Technical Staff special computations using the Population Projections of NSO
Health Human Resource Health human resource (HHR) is defined by the World Health Organization as people whose job it is to protect and improve the health of their communities.
Usual Care of the Older Patient Multiple Health Providers Patient Complex Poor communication between providers Expensive Self management de la Vega 2015
The CGA A multidisciplinary evaluation in which the multiple problems of older persons are uncovered, described, and explained, if possible, and in which the resources and strengths of the person are catalogued, need for services assessed, and a coordinated care plan developed to focus interventions on the person s problem Solomon D, Brown AS, Brummel-Smith K, et al. National Institutes of Health Consensus Development Conference statement: geriatric assessment methods for clinical decision-making. J Am Geriatr Soc 1988;36:342 7.s de la Vega 2015
Why is Geriatrics and CGA Important? FOCUS: Quality of Life Offers opportunities for health promotion and disease prevention Allows screening for geriatric syndromes that are responsive to geriatric management Identifies critical areas of psycho-social health Identifies gaps in health education Improves doctor-patient-family interaction de la Vega 2015
Physicians Geriatrician Generalists Specialists Screening CGA Team Evaluation Nurses Nutritionists Dentists Allied Professionals Social Workers Psychologists Spiritual Advisers Follow up and Reassessment Patient and Family Counseling Third Party Payers Legal Counsel Community de la Vega 2015
Government Mandates Republic Acts 9257 and 9994 state that all government facilities should have a geriatric ward Philippine Plan of Action for Senior Citizens (PPASC 2006-2010) is Expand coverage/improve accessibility and affordability of social & health care to majority of indigent Senior Citizens. Calls to institutionalize geriatric courses/subjects in the curriculum of medical, nursing, allied professions, and caregiving schools.
Geriatric Education: Philippines 2007 Five major medical schools offer a special geriatric content in their curriculum. University of the Philippines University of St. Tomas St. Luke s Medical School Cebu Doctor s Institute Ateneo School of Medicine
Status of Geriatric Education in Philippine Medical Schools (Dela Vega S, Mojica A, and Agapito JD 2010) Funded by NIH A cross sectional study of twenty-five out of thirty-five (68.6) qualified Philippine Medical Schools revealed that most medical schools do have Geriatrics as part of a required course and many enjoy institutional support for developing said course.
Status of Geriatric Education in Philippine Medical Schools (Dela Vega S, Mojica A, and Agapito JD 2010) 99 graduating medical students believe they are prepared to take care of the elderly in outpatient clinics and hospitals, only 61% of their teachers think that they possess the necessary KAP (knowledge, attitude and practice) for such a job.
Status of Geriatric Education in Philippine Medical Schools (Dela Vega S, Mojica A, and Agapito JD 2010) Contributors to the perceived lack in KAP of fresh graduates: crowded medical course schedule and the lack of a curricular map of subjects that teach them how to take care of the elderly. Medical students learn the basics during the first three years of med school but may not possess the skills in the final clinical years called internship.
Status of Geriatric Education in Philippine Medical Schools (Dela Vega S, Mojica A, and Agapito JD 2010) The lack of clinical teachers and researchers were also identified as obstacles to the development of a good Geriatric program. Similar researches on Geriatric Curricular studies have since been undertaken in Nursing and Allied Medical Schools.
Round Table Discussions (RTD) on Health Human Resource for an Aging Philippines Funded by the NIH, February 2013 First RTD : Current Situation and Needs Assessment Filipino professionals representing government, academic, technological and professional institutions and organizations, actively participated.
Round Table Discussions (RTD) on Health Human Resource for an Aging Philippines How can we improve current HHR for an aging Philippines?. Second RTD: Policy recommendations were drafted on HHR major themes: training, deployment, teamwork, and funding. These recommendations were presented during the Annual Conference of the National Institutes of Health.
Excerpts from the 2013 Multisectoral RECOMMENDATIONS on HHR for an Aging Philippines To create a common core competency for all disciplines related to health and care of the senior citizens. To align the Knowledge, Skills and Attitudes with the upcoming CHED curriculum for Health related courses. To amend the list of subjects by including geriatrics in the attainment of Doctor in Medicine and to include Geriatric Care Questions in Licensure Examinations for Health Professionals.
Excerpts from the 2013 Multisectoral RECOMMENDATIONS on HHR for an Aging Philippines To collaborate with the Department of Education so that the curriculum for elementary and high school levels would focus on human development so as to inculcate respect and love for the elderly among our youth. To bring/conduct training on geriatric care to where these health professionals are, by collaborating with Local Government Units and utilizing Public Private Partnerships whenever possible to fund these trainings.
Excerpts from the 2013 Multisectoral RECOMMENDATIONS on HHR for an Aging Philippines To push for strict implementation of the provision of Geriatric Ward in government hospitals and other institutions to generate employment for health professionals.
Status of Dementia Care Services and Workforce in the Philippines (DelaVega S, Cordero C, and Palapar L, 2014) Funded by the Department of Health Twenty six (26) of four institutional settings were purposively sampled in Luzon, Visayas and Mindanao. These were 1) government tertiary hospitals; 2) private tertiary hospitals; 3) government operated institutions (homes for the aged); and 4) privately-operated nursing homes. Qualitative methods were 54 Key Informant Interviews (KIIs), 4 Focus Group Discussions (FGDs), and a survey of 167 health workers.
Status of Dementia Care Services and Workforce in the Philippines (DelaVega S, Cordero C, and Palapar L, 2014) Results: Only private facilities had specific services for dementia (1private hospital and 1 private nursing home). Only 3 out of the 15 government facilities offered a Comprehensive Geriatric Assessment. Only 3 out of 5 government homes for the aged had physicians, and none of them were geriatric specialists
Status of Dementia Care Services and Workforce in the Philippines (DelaVega S, Cordero C, and Palapar L, 2014) With regards to workforce: Only 4 of the 26 facilities had an occupational therapist. Physical therapists were available in most facilities, but most were outsourced. Workforce knowledge on the definition and diagnosis of dementia was very poor at 27%
Status of Dementia Care Services and Workforce in the Philippines (DelaVega S, Cordero C, and Palapar L, 2014) Majority of the workforce (73 of 167) did not have training in dementia care. Perception on the quality of dementia care
Policy Recommendations on Dementia Care Workforce Create a Health Human Resource Masterplan for Care of Patients with Dementia, in coordination with Mental Health and Aging programs. (DOH, DSWD, CHED, Academe, TESDA, Professional groups, LGU). Provide plantilla positions for healthworkers who care for patients with dementia, especially geriatricians, occupational and physical therapists. Include care for patients with dementia in the curriculum and training programs for health, caregiving and social work.
Policy Developments As a result of these researches and many policy discussions with stakeholders, numerous improvements have taken place.
Policy Developments Standards 2012 (PRC BON NNCCS 2012) now includes nursing care of the older person. Gerontology will be considered now as one major subject in the ongoing revision of the Bachelor of Science in Nursing curriculum towards outcome based education (OBE).
Policy Developments 2012 Policy Recommendation on Geriatric Medicine in the Curriculum of Medical Schools Tripartite project describing essential geriatric competencies of a graduating medical student Philippine College of Geriatric Medicine, Department of Health Policy Development Bureau and Institute on Aging NIH 2013 The Association of Philippine Medical Colleges has agreed to include Gerontology and Geriatrics in their curriculum
de la Vega 2015
Policy Developments 2014 The Department of Health has launched a Task force for Geriatric Nursing and has recently approved the Policy for Health and Wellness for Older Persons and agreed to adopt these recommendations. 2015 A Geriatrician was hired to attend to a tertiary Government hospital caring for persons with mental diabilities
Policy Developments 2015 The IA NIH with the Philippine College of Geriatric Medicine recently standardized the Comprehensive Geriatric Screening Tool and will have a training program 2015 The DOH formed a Technical Working Group on the Health and Wellness of Senior Citizens and plans to train its workforce
Training of Social Workers DSWD
Capiz-Panay Training Outreach
Meeting the Governor of Capiz
Future Challenges ASEAN Integration of Professional Health workers Need to shift to outcome-based curriculum Standardized content of specialty training Common certification process/professionalization Equity: wage? Distribution?
Institute on Aging NIH Philippines VISION The Filipino elderly enjoying a healthy body, mind and spirit, being treated with dignity, and valued as a productive member of society, in a dynamic process unique to himself, and beginning a life of unlimited possibilities.