Advancing Universal Health Coverage in the Philippines through self-care interventions

Universal Health Coverage (UHC) is a national priority of governments to provide quality healthcare services to all individuals, ensuring financial protection and equity. The progress towards UHC transition has largely been positive; however, to further advance it requires resources that low- and middle-income countries (LMICs) may struggle to meet. To reach 80% effective UHC, countries must spend around USD 1500 (adjusted for purchasing power parity) annually per capita.¹ In the Philippines, per capita health expenditure as of 2020 amounted only to around USD 430 (adjusted for purchasing power parity), highlighting the gap between the resources needed to make UHC work and the country's ability to make such investments.

To respond to such health financing gaps, the Philippines made major reforms: the passage of the Universal Health Care Law in 2019,² and the recent implementation of a benefit package that encourages primary care called “Konsultasyong Sulit at Tama” (“Konsulta”) package in 2020. As a result of past and current efforts and initiatives, the country has made modest gains in meeting global health targets set out in the Sustainable Development Goals for 2030.³ However, even with health financing schemes and patient benefit packages, catastrophic health expenditures continue to push Filipinos into poverty.^4,5

Self-care interventions are now being considered as a key strategy to achieving UHC, especially in low-resourced settings where the impacts of COVID-19 have been most felt.^6,7 Self-care empowers individuals to make health decisions for themselves and reduces unnecessary burden on the health system. It encompasses health promotion, disease prevention and control, self-medication, providing care to dependent persons, seeking care from the formal health sector if necessary, and rehabilitation.⁸ Because it is enculturated and widely accepted in its various forms,⁹ it can therefore be leveraged to accelerate UHC implementation. It is estimated that globally, self-care increases cost savings up to USD 119 billion and productivity by 40·8 billion days, and saves time spent by patients and physicians by 11 and 1·8 billion hours, respectively. Self-care also has the potential to improve quality of life from 22 million QALYs to 39 million QALYs in the future.⁹

Advances in institutionalizing self-care and providing evidence on its effectiveness have been made in developed countries, particularly in the Americas and Europe. However, lower-income countries and other regions are lagging behind.⁶ In Europe, self-care is viewed as a necessity and is promoted by national governments.⁹ The UK government requested studies on the economic impact of self-care and found that self-care interventions are cost-effective through data provided by the National Institute for Health and Care Excellence.¹⁰ In contrast, self-care is not explicitly mentioned in any recent government health policy in the Philippines. Additionally, a literature review we conducted for studies on self-care practices for acute health conditions published between 2000 and 2021 showed that only one article used ‘self-care’ per se. The other 17 studies focused on specific facets of self-care such as the use of complementary medicine and self-medication.

Regions and countries outside of the Americas and Europe, particularly LMICs, should consider implementing reforms and designing approaches to create a culture that is supportive of responsible self-care. Governments should make investments on research that provide evidence on direct and indirect costs of self-care, its perceived social value, and effectiveness on desired health outcomes. Health systems and health workers need to be involved in advocacies that promote a culture encouraging responsible self-care. Self-care is widely practiced and promoting health literacy will be critical at various levels – in basic and higher education curricula involving the whole formal education system, continued strengthening of health literacy through the health sector and civil society, improving patient counseling in community pharmacies, and involving social networks that influence healthcare decisions. Industries and workplaces, and community-based and faith-based organizations also have an influential role in self-care development. In particular, the pharmaceutical industry should continue to pursue scientific breakthroughs and scale up essential over-the-counter treatments that improve population health. Community-based and faith-based organizations, on the other hand, can effectively connect individuals to health providers and resources that allow them to make informed health decisions. Regulatory frameworks should be established that allow patients to use available self-care products safely and effectively. All these will need investments from and coordination between government and private sector actors to produce a unified approach towards self-care that advances UHC implementation and progress. In doing so, burdens on the health system, health workers, and patients are reduced. While currently an underutilized tool for UHC, self-care is at the heart of it – empowering patients to value their health and positively impact their community.

Contributors

AMLA: Conceptualization; Data curation; Formal analysis; Writing – original draft; Writing – review and editing.

VCFP: Conceptualization; Data curation; Formal analysis; Writing – review and editing.

MMD: Conceptualization; Data curation; Supervision; Writing – review and editing.

Data sharing statement

The policy and literature review findings mentioned in this paper are part of a larger project that reviewed local studies and policies on self-care, and assessed the social value and economic impact of self-care. These papers are being considered for publication elsewhere. Data are available upon reasonable request.

Declaration of interests

The authors declare receiving funding from Sanofi Consumer Healthcare to conduct research on self-care. All authors also received funding from the International Initiative for Impact Evaluation, Inc. (3ie) to propose a study on programs designed by the Philippine Health Insurance Corporation. The views expressed in this article are not necessarily those of Sanofi, 3ie, or their members.