philippines | iDSI https://www.idsihealth.org Better decisions. Better health. Mon, 09 Oct 2017 15:04:05 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.1 /wp-content/uploads/2019/04/favicon.png philippines | iDSI https://www.idsihealth.org 32 32 154166752 Towards HTA in the Philippines: iDSI welcomes passage of new Congress UHC Bill https://www.idsihealth.org/blog/towards-hta-in-the-philippines-idsi-welcomes-passage-of-new-congress-uhc-bill/ Mon, 09 Oct 2017 14:22:54 +0000 https://uat.idsihealth.org/?p=3151 September 6th 2017, the Philippines’ lower house of Congress approved the Universal Health Coverage Bill, introducing key reforms to improve population coverage, reform provider payment, and strengthen health technology assessment (HTA) implementation, among others. It has been 15 years since HTA was introduced in the Philippines through the efforts of dedicated key individuals. This development marks a crucial step towards institutionalisation of HTA, providing a legal framework for its application in priority setting and policy decision making.

Key features of the policy include the establishment of the HTA unit in the Department of Health (DOH), a description of the principles, criteria and process, as well as the composition and qualifications of the appraisal body. These provisions strengthen existing policies related to HTA, such as the Philippine National Formulary System (PNFS) in DOH and the Priority Setting Process in PhilHealth. The bill is a legislative priority of the current administration so we are hopeful that it receives substantial support from the upper house. We recognise HTA as a key tool to achieve universal health coverage in the country as per the HITAP sponsored World Health Assembly 2014 HTA Resolution, especially since service coverage remains fragmented and out-of-pocket payments are still high at 53.7% of total health expenditure (2014), despite 92% of the population having health insurance.

Global collaboration

iDSI, has provided support to the Philippines during the PNFS’ early stages. In 2011, NICE International started work with the MoH under The Rockefeller Foundation support, and in 2012, the National Center for Pharmaceutical Access and Management (NCPAM) (now called the Pharmaceutical Division in DOH) together with HITAP, conducted two policy relevant evaluations on the PCV and HPV vaccine. This project enabled NCPAM staff to visit HITAP and publish articles in international peer-reviewed journals, some articles can be viewed here and here. Two of the DOH staff are now back in Thailand pursuing a postgraduate programme in HTA at Mahidol University under iDSI scholarships.

More recently, the DOH also arranged a visiting scholarship of the HTA team lead to the Global Health and Development Group (GHD) at Imperial College London (the successor to NICE International), where they received guidance on: developing the country’s HTA roadmap, the revised process guidelines, and on economic evaluation for COPD drugs. It was also through the participation in knowledge sharing activities and international conferences that HTA was brought back on the policy agenda last year. Philippine policy makers and researchers participation in the Prince Mahidol Award Conference 2016 (co-hosted by HITAP, NICE international, and others) re-ignited the policy discussions and research on HTA and priority setting in PhilHealth and DOH.

HTA as a tool to achieve universal health coverage

Under the current bill’s whole system, society, & government approach, the vision is that the country coordinates a multisectoral approach, inclusive of all stakeholders, which looks at each component and function of the health system to realise UHC. This entails establishing a single institution that sets actionable (i.e. reimbursable) priorities for payers of healthcare. However, much capacity building is needed in terms of individual research skills, as well as sectoral capacity to manage and implement such processes. There is also a need to enhance policy makers’ understanding of what HTA is, how it is done, when and where it should be done, as HTA is not the answer to all policy questions. For example, the legislation specifies the use of HTA as an input in revising the Health Benefits Package. Another use could be in pricing discussions with manufacturers. Further, effective HTA has to accommodate existing health system features, including the interplay of different financing agents, private and public healthcare providers, and other stakeholders.

Despite these challenges, we believe that as a country, we have made significant progress towards building our national HTA institution. Last July, a HTA study group was established in the Health Research Division of the Health Policy Development and Planning Bureau in the DOH. The team has full-time researchers in charge of coordinating and implementing HTA related research activities. The DOH also just approved a revised process guideline for HTA, which expands the scope to cover all interventions (not just drugs), uses explicit decision criteria, and a multi-stakeholder process from topic selection, to assessment and appraisal. These achievements would not have been possible without international collaboration with universities, development agencies, and other HTA institutions outside the country, all of which will be featured on the bureau’s website as soon as it is up and running.

While we are still quite a way from having a NICE or HITAP counterpart in the country, the path towards institutionalisation is much clearer now that there is political support, and as we are slowly developing capacity. The DOH is set to scale-up HTA implementation by hiring more full time staff in the coming months, and investing in capacity building programmes. Collaboration with international partners such as iDSI must be fostered in order to sustain momentum. A Letter of Intent for Cooperation between the Philippine Department of Health, HITAP and the Imperial team was recently signed paving the way for further collaboration in the future.

]]> 3151 Work in the Philippines 2012 – 2014 https://www.idsihealth.org/blog/work-in-the-philippines-2012-2014/ Sun, 30 Nov 2014 16:17:45 +0000 https://uat.idsihealth.org//?p=1627 Following the award of a 2-year grant by the Rockefeller Foundation in 2012, a scoping visit to the Philippines involving HITAP and NICE International took place in December 2012 to explore possible areas of support. The visit identified a number of specific activities relating to vaccine evaluation techniques, Z-package optimisation and the processes and methods used by the Formulary Executive Committee (FEC) when making drug inclusion/exclusion decisions. Read more below about this early work on strengthening priority-setting methods and processes in the Philippines. 

 

EQ-5D workshop in Manila

November 2014

Francis Ruiz chaired a workshop on the EQ-5D tool in Manila as part of an ongoing Rockefeller funded project led by NICE International and HITAP in the Philippines. The workshop itself was led by two EuroQol experts on the instrument Professor Jan Busschbach, Director of the section Medical Psychology and Psychotherapy, Erasmus University and Chair of the Board of the EuroQol Research Foundation; and Dr. Nan Lou, Senior researcher at the National University of Singapore, Saw Swee Hock School of Public Health,  member of the Value Sets Working Group of the EuroQol Group and Chair of the Singapore Chapter of ISPOR.

Attendees at the workshop included key Philippine stakeholders in academia, PhilHealth and the Department of Health, as well as representation from the Philippine Chapter of ISPOR. At the workshop, participants learnt about the development of the three-level and five-level versions of the tool, and ongoing studies in the Philippines that have made use of the EQ-5D. The workshop concluded with outlining a proposal for initiating a study to obtain five-level value sets relevant for the Philippine context. This work will be important in the ongoing progress made in the country, supported by the NICE international and HITAP engagement, in supporting the effective use of HTA in decision making.

Filipino expert committee for clinical practice guidelines

May 2014

Francis Ruiz of NICE International, and Dr John Graham, Consultant in oncology and Director of the National Collaborating Center for Cancer which produces guidelines for NICE, attended a meeting of the Expert Committee (Chaired by Dr Jorge Ignacio) responsible for developing Philippine relevant clinical practice guidelines for early breast cancer, working with Filipino academics. Following presentations by the NICE International team that described cancer guideline developement processes and methods in England and Wales, and the role of cost-effectiveness considerations, there was a discussion among all partcipants regarding how best to develop useful guidelines in contexts where there are limited technical and other resources available for that purpose. There was a discussion on the opportunities available to adapt/adopt guidelines developed in other jurisdictions, and pragmatic approaches to take into account the budget impact of recommendations. The Philippine guidelines when developed, will have an important role in informing the content and reimbursement rate of the z-package for early breast cancer, provided by PhilHealth. The z-package programme of PhilHealth aims to provide coverage against significant, ‘catastrophic expenditure’ and also collect data on the type of care provided and the health outcomes achieved.  This is part of a broader ambition to support universal healthcare coverage

October 2013

As part of on-going technical support in health technology assessment (HTA) and evidence-based policy making in the Philippines an introductory workshop on the application of HTA in priority setting was delivered in Manila on the 29-30 October, 2013. This complements previous training activities led by colleagues from HITAP of Thailand, with their focus on vaccine evaluation and the development of Philippine-relevant cost-effectiveness analyses.

The course was led by Professor Mike Clarke of the All-Ireland Hub for Trials Methodology Research and Francis Ruiz, Senior Adviser at NICE International. Participants included members of the Formulary Executive Committee; academic partners who are or will be involved in developing local assessments to support decision making; representatives of the social insurer, Philhealth, and the Philippine Food and Drug Administration; and members of the National Center for Pharmaceutical Access and Management (NCPAM) secretariat.

Topics covered in the workshop included systematic review and critical appraisal, the use of HTA in selected countries including the UK and Thailand, economic evaluation, setting standards, and the role of financial and non-financial incentives in driving the uptake of good quality, cost-effective, practice.

Attendees considered the workshop to be a valuable introduction to HTA and priority setting, which highlighted the need for effective institutional arrangements in the Philippines to support further development of evidence-based policy making. Participants also expressed enthusiasm to further deepen their understanding of key methodological issues, particularly the application of standardised tools to assess health-related quality of life. A separate workshop on the use of EuroQol’s EQ-5D instrument in decision making is being organised for 2014.

Training workshop in Tagaytay, Philippines

September 2013

NICE International participated in a three-day training workshop in Tagaytay, Philippines. The workshop was led by Thai partners on this project, the Health Intervention and Technology Assessment Program (HITAP). HITAP are providing expert support on vaccine evaluation to representatives of the Philippine Department of Health and PhilHealth, the national health insurance program of the Philippines, among others. This work includes training and hands-on technical support in the development of localised economic models for human papillomavirus (HPV) vaccine and pneumococcal conjugated vaccine (PCV). The two vaccines were selected because they are key issues for policy makers in the Philippines, and HITAP has extensive expertise and experience in the asessment of these particular technologies.

Meeting with key figures involved in the Z-(benefit) package in the Philippines

May 2013

Francoise Cluzeau and Tommy Wilkinson met with Filipino colleagues to scope the work for refining a standardised treatment package of care for breast cancer patients. They met with representatives from the Philippine Department of Health, PhilHealth, National Center for Disease Prevention and Control, Philippine Cancer Society, National Institute for Health and oncologists and surgeons. Together they outlined activities NICE International can undertake to help build local capacity for developing/adapting clinical Guideline and Pathways as well as processes to help PhilHealth refine and implement its breast cancer Z-package.

Visit to the Philippines with colleagues from HiTAP

March 2013

Following the scoping visit NICE International (Francis Ruiz) and two representatives from HITAP (Dr Sripen Tantivess and Ms Waranya Rattanavipapong) visited Manila in March 2013. During the visit, feedback was provided on the methods and processes used by the FEC. Meetings and discussions took place with representatives from PhilHealth regarding the ongoing work on the Z-packages. The team also met with the Philippine Department of Health’s National Center for Disease Prevention and Control, and the WHO regional office (Western Pacific).

]]> 1627 Asia-Pacific Regional Capacity-Building for HTA Initiative (ARCH) https://www.idsihealth.org/blog/asia-pacific-regional-capacity-building-for-hta-initiative-arch/ Sun, 24 Aug 2014 13:46:04 +0000 https://uat.idsihealth.org//?p=1822

Final Asia-Pacific Regional Capacity-Building for HTA Conference in Singapore

The ARCH initiative for 2014 came to a close at a one-day conference attended by representatives from all the countries that participated in the initiative

November 2014

The ARCH initiative for 2014 came to a close at a one-day conference in Singapore on the 21st November. Representation from all the countries that participated in the initiative attended the conference whose guest of honour was Dr Daphne Koo from the Singaporean Ministry of Health. Dr Khoo explained her journey to HTA and policy making from her background in endocrinology and medicine, and announced her intention to work with NICE International in further developing HTA methods and processes in Singapore.

Further details of the agenda and the presentations made by country representatives who participated in the initiative can be found here: http://arch.apec.org/conference/arch-conference-2014

Francis Ruiz, NICE International provided the closing keynote speech in which he highlighted the formal definition of HTA as – in principle – supporting a range of priority setting questions including those relating to public health interventions. He discussed the technical challenges involved in taking a broad perspective on HTA, particularly the difficulty of obtaining robust RCT data for common public health interventions, and also the need (not unrelated to these technical issues) to contextualise any HTA activity within a policy framework that offers multi-stakeholder engagement and the creation of socio-political legitimacy for the use of evidence derived from HTA and similar other methods. He concluded by referring to the critical role that can be played by multi-country networks such as ARCH, HTAsiaLink and the newly created International Decision Support Initiative (iDSI) in building local technical capacity, promoting methodological development, and driving the uptake of HTA for use in policy making especially in the context of moves towards establishing universal health coverage.

2nd Asia-Pacific Regional Capacity-Building for HTA workshop in Manila

NICE International, along with colleagues, delivered a two-day workshop in Manila on HTA and research needs in relation to tobacco control.

April 2014

Francis Ruiz, NICE International, along with HITAP representatives and colleagues from the National University of Singapore delivered a two-day workshop in Manila on HTA and research needs in relation to tobacco control as part of the APEC funded ARCH initiative. Participants included researchers and policy makers from Vietnam, Lao, Cambodia, Indonesia, Thailand, Taiwan, China, Philippines and Malaysia.

The first day of the workshop involved introductory training on the standard methods and process of HTA including background on its development and its application to support policymaking. Topics covered included systematic review, costing methods, identifying and valuing relevant health outcomes, role of modelling, and exploring uncertainty in economic evaluations. The second day was focused on understanding the current situation with respect to tobacco control among participant countries and the role (if any) that HTA plays in decision-making. In addition there was a discussion on future research work as part of this initiative, with an emphasis on identifying current research and data gaps. Discussions also explored potential opportunities for collaborative research projects led by participant countries, and data sharing within the region.

A second workshop is planned for August 2014 and will include further training and support for any initiated research projects.  Research findings and other outputs from this initiative will be presented at a special conference plannedfor November in Singapore.

Launch of the Asia-Pacific Regional Capacity-Building for HTA Initiative (ARCH)

October 24-25 2013

On 24 and 25 October 2013, at the fringes of a regional WHO meeting in Manila, policy makers, researchers, academics and industry got together to discuss practical ways for building Health Technology Assessment capacity for addressing pressing problems in health policy. The meeting marked the launch of the Asia-Pacific Regional Capacity-Building for HTA Initiative (ARCH) – funded by APEC and led by the National University of Singapore, School of Public Health; the Thai Health interventions and Technologies Assessment Programme (HITAP); the Filipino Department of Health; NICE International (UK) and the University of Twente (Netherlands).

The meeting was hosted by the Filipino DoH and concentrated on the topic of HTA for tobacco control, ranging from national (e.g. WHO MPOWER) and sub-regional to individual smoker interventions. NICE International presented NICEs work in the field, including the NICE/Brunel Return On Investment tool. Professor Klim McPherson of Oxford University discussed the work of the UK Health Forum including the micro simulation models developed by the groups and applied to policy in the UK, USA, OECD, Latin America and Africa.

Over one year, with APEC funding and potential for additional funding from major sources such as the ASEAN Foundation, Rockefeller, the Thai Health Foundation, WHO country offices and private foundations, we agreed to work with researcher/NGO/policy maker teams from a number of countries, including Thailand, the Philippines, Singapore, the UK, Vietnam, the Pacific Islands, and possibly from Lao, Brunei and Malaysia, to identify and tackle important policy questions on tobacco control.

Evaluation of the benefits of national taxation policies, individual smoking cessation interventions, cross country model adaptation, burden and cost of disease trend calculation, policy vignettes and baseline data availability assessments are some of the topics put forward by the stakeholders who joined us.

The next step is to launch our website, finalise the problem shortlist and start convening the teams. We look forward to our first training and data sharing meeting to be hosted at the Prince Mahidol Award Conference in late January 2014.

This is the beginning of a journey. We hope we can collaborate across the region to raise awareness and build technical and informational capacity for tackling, in an evidence based way, the challenge of tobacco addiction.

]]> 1822 Philippines https://www.idsihealth.org/blog/philippines/ Sun, 24 Aug 2014 12:34:57 +0000 https://uat.idsihealth.org//?p=1812

Transforming Health Systems – Philippines

NICE International was awarded a 2-year grant, starting in 2013, by the Rockefeller Foundation. The focus will be on strengthening priority setting methods and processes in the Philippines.

A scoping visit to the Philippines took place in December 2012 to explore possible areas of support. The visit identified a number of specific activities relating to vaccine evaluation techniques, Z-package optimisation and the processes and methods used by the Formulary Executive Committee (FEC) when making drug inclusion/exclusion decisions.

EQ-5D workshop in Manila

November 2014

Francis Ruiz chaired a workshop on the EQ-5D tool in Manila as part of an ongoing Rockefeller funded project led by NICE International and HITAP in the Philippines. The workshop itself was led by two EuroQol experts on the instrument Professor Jan Busschbach, Director of the section Medical Psychology and Psychotherapy, Erasmus University and Chair of the Board of the EuroQol Research Foundation; and Dr. Nan Lou, Senior researcher at the National University of Singapore, Saw Swee Hock School of Public Health,  member of the Value Sets Working Group of the EuroQol Group and Chair of the Singapore Chapter of ISPOR.

Attendees at the workshop included key Philippine stakeholders in academia, PhilHealth and the Department of Health, as well as representation from the Philippine Chapter of ISPOR. At the workshop, participants learnt about the development of the three-level and five-level versions of the tool, and ongoing studies in the Philippines that have made use of the EQ-5D. The workshop concluded with outlining a proposal for initiating a study to obtain five-level value sets relevant for the Philippine context. This work will be important in the ongoing progress made in the country, supported by the NICE international and HITAP engagement, in supporting the effective use of HTA in decision making.

Filipino expert committee for clinical practice guidelines

May 2014

Francis Ruiz of NICE International, and Dr John Graham, Consultant in oncology and Director of the National Collaborating Center for Cancer which produces guidelines for NICE, attended a meeting of the Expert Committee (Chaired by Dr Jorge Ignacio) responsible for developing Philippine relevant clinical practice guidelines for early breast cancer, working with Filipino academics. Following presentations by the NICE International team that described cancer guideline developement processes and methods in England and Wales, and the role of cost-effectiveness considerations, there was a discussion among all partcipants regarding how best to develop useful guidelines in contexts where there are limited technical and other resources available for that purpose. There was a discussion on the opportunities available to adapt/adopt guidelines developed in other jurisdictions, and pragmatic approaches to take into account the budget impact of recommendations. The Philippine guidelines when developed, will have an important role in informing the content and reimbursement rate of the z-package for early breast cancer, provided by PhilHealth. The z-package programme of PhilHealth aims to provide coverage against significant, ‘catastrophic expenditure’ and also collect data on the type of care provided and the health outcomes achieved.  This is part of a broader ambition to support universal healthcare coverage

October 2013

As part of on-going technical support in health technology assessment (HTA) and evidence-based policy making in the Philippines an introductory workshop on the application of HTA in priority setting was delivered in Manila on the 29-30 October, 2013. This complements previous training activities led by colleagues from HITAP of Thailand, with their focus on vaccine evaluation and the development of Philippine-relevant cost-effectiveness analyses.

The course was led by Professor Mike Clarke of the All-Ireland Hub for Trials Methodology Research and Francis Ruiz, Senior Adviser at NICE International. Participants included members of the Formulary Executive Committee; academic partners who are or will be involved in developing local assessments to support decision making; representatives of the social insurer, Philhealth, and the Philippine Food and Drug Administration; and members of the National Center for Pharmaceutical Access and Management (NCPAM) secretariat.

Topics covered in the workshop included systematic review and critical appraisal, the use of HTA in selected countries including the UK and Thailand, economic evaluation, setting standards, and the role of financial and non-financial incentives in driving the uptake of good quality, cost-effective, practice.

Attendees considered the workshop to be a valuable introduction to HTA and priority setting, which highlighted the need for effective institutional arrangements in the Philippines to support further development of evidence-based policy making. Participants also expressed enthusiasm to further deepen their understanding of key methodological issues, particularly the application of standardised tools to assess health-related quality of life. A separate workshop on the use of EuroQol’s EQ-5D instrument in decision making is being organised for 2014.

Training workshop in Tagaytay, Philippines

September 2013

NICE International participated in a three-day training workshop in Tagaytay, Philippines. The workshop was led by Thai partners on this project, the Health Intervention and Technology Assessment Program (HITAP). HITAP are providing expert support on vaccine evaluation to representatives of the Philippine Department of Health and PhilHealth, the national health insurance program of the Philippines, among others. This work includes training and hands-on technical support in the development of localised economic models for human papillomavirus (HPV) vaccine and pneumococcal conjugated vaccine (PCV). The two vaccines were selected because they are key issues for policy makers in the Philippines, and HITAP has extensive expertise and experience in the asessment of these particular technologies.

Meeting with key figures involved in the Z-(benefit) package in the Philippines

May 2013

Francoise Cluzeau and Tommy Wilkinson met with Filipino colleagues to scope the work for refining a standardised treatment package of care for breast cancer patients. They met with representatives from the Philippine Department of Health, PhilHealth, National Center for Disease Prevention and Control, Philippine Cancer Society, National Institute for Health and oncologists and surgeons. Together they outlined activities NICE International can undertake to help build local capacity for developing/adapting clinical Guideline and Pathways as well as processes to help PhilHealth refine and implement its breast cancer Z-package.

Visit to the Philippines with colleagues from HiTAP

March 2013

Following the scoping visit NICE International (Francis Ruiz) and two representatives from HITAP (Dr Sripen Tantivess and Ms Waranya Rattanavipapong) visited Manila in March 2013. During the visit, feedback was provided on the methods and processes used by the FEC. Meetings and discussions took place with representatives from PhilHealth regarding the ongoing work on the Z-packages. The team also met with the Philippine Department of Health’s National Center for Disease Prevention and Control, and the WHO regional office (Western Pacific).

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