Linking Community-Based Participatory Research with Revitalized Primary Health Care in the Philippines

1. Linking Community-Based Participatory Research with Revitalized Primary Health Care in the Philippines Barbara C. Pence, PhD, CCRP Professor of Pathology, School of Medicine M. Christina Esperat, RN, PhD, FAAN Professor and Associate Dean for Clinical Services and Community Engagement, Perry School of Nursing

6. In 1898, during the Spanish-American War, Filipinos established the basic flag in use today; it was officially adopted in 1936. The white triangle is for liberty. The golden sun and stars are for the three main areas of the Philippines: the Visayan Islands, Luzon, and Mindanao. The red color is for courage and the blue color is for sacrifice.

7. Philippines Demographics & Politics • Population (2007 census) = 88,574,614 • Population is young: 0-14 yr = 33.8%, >65 yr = 4.4% • Life expectancy: Male = 64 yr; F = 70 yr • PH is a democratic and republican state with three branches of govt. • 1991: devolution giving responsibility for basic services, including health, to local govt units (LGU) • LGUs include provinces, cities, municipalities, barangays

8. Philippines Health Trends • Communicable diseases: ASMR (2004 data): 285/100,000 • Non-communicable diseases: ASMR (2004 data): 620/100,000 • Health workforce, MDs: 12/10,000 • Health workforce, RNs and midwives: 61/100,000 Major responsibility for revitalization of PHC will fall on nurses and other such as CHW.

9. Figure 1.The PHC reforms necessary to refocus health systems toward health for all • Universal coverage reforms to improve health equity • Service delivery reforms to make health-systems people-centered • Public policy reforms to promote and protect the health of communities • Leadership reforms to make health authorities more reliable WHO Health Report, 2008. Primary Health Care: Now More Than Ever, WHO, Geneva.

10. What is CBPR? • “Research” is a loaded word in many underserved communities, associated with expectations of being examined or exploited. • CBPR is defined as “a collaborative approach to public health research that involves community members, organization representatives and researchers as equal participants in all phases of the research process”. • CBPR is especially useful in addressing health disparities and chronic disease management. • CBPR is used in making communities healthier.

11. CBPR Definition B. Israel et al. (1998) provide key principles of CBPR: • “Recognizes community as a unit of identity; • Builds on strengths and resources within the community; • Facilitates collaborative, equitable involvement of all partners in all phases of the research; • Integrates knowledge and action for mutual benefit of all partners;

12. CBPR, continued • Promotes a co-learning and empowering process that attends to social inequalities; • Involves a cyclical and iterative process; • Addresses health from both positive and ecological perspectives; • Disseminates findings and knowledge gained to all partners; and • Involves a long-term commitment by all partners.” Israel et al., Review of community-based research: assessing partnership approaches to improve public health. Ann Rev Pub Health 19, 173, 1998.

13. Fogarty NCD-LIFESPAN Grant “Chronic, Non-Communicable Diseases and Disorders Across the Lifespan: Fogarty International Research Training Award (NCD – LIFESPAN)” (D43) Amount: up to $250,000 (total cost) per year up to 5 years

14. THE VISION • We will need to develop a research agenda that: • Connects PHC with Community-Based Participatory Research (CBPR) methodologies; • Define the research priorities for graduate study in the above areas, to focus on NCDs; • Documents the process as we develop PHC and its associated research focus in chronic disease prevention and management, and • Create a model to replicate in other LMIC of SE Asia and then globally.

15. Partners LMIC: Silliman University, Dumaguete • University of the Philippines, Manila • WHO Collaborating Center, Western Pacific Region Office • Philippines Nurses Association and PRC • Philippines DOH HIC: Texas Tech University Health Sciences Center Schools of Nursing and Medicine

16. NCD-LIFESPAN Training Program Objectives • To strengthen the capacity of LMIC institutions to conduct NCD research; • To support multidisciplinary research training in basic through translation and implementation research science to address NCDs; • To develop a cadre of research experts • To support training-related research (degree-related or mentored research projects) • To strengthen the research and research training capacity required for success by building on existing programs in the LMIC, and

17. Objectives, cont’d. • To integrate with other efforts to strengthen core research support capabilities needed to manage and research training grants at the LMIC institution, including expertise in ethics and compliance issues, protection for human subjects, animal welfare, fiscal management, budgeting, program and grants administration, grant and report writing, preparation of scientific manuscripts, information technologies, technology transfer and management of intellectual property, data management, and Internet connectivity.

18. Disease Focus on NCD such as Obesity, HTN, DM) and Breast Ca • Obesity and its consequences of HTN and DM, is rising in the Philippines as in the rest of the world (WHO data) • Major consequences of obesity are HTN and diabetes • Breast cancer is underdiagnosed and undertreated resulting in a high mortality compared to the US, and the highest incidence in Asia

20. NCD-LIFESPAN Grant Timeline • Meetings in Dumaguete and Manila: August 18-20 and 24, 2010 • Submit Letter of Intent to NIH due: October 2, 2010 • Application receipt date (electronic submission thru Grants.gov) November 2, 2010 • Must be processed through TTUHSC Office of Sponsored Programs 5 days prior to mailing application: October 22, 2010.