Project Title: Defining The Social Value Principles Relevant to the Philippines in Informing Coverage Decisions
Funding Agency: World Health Organization-Philippines in cooperation with Department of Health
Duration: 5 months Role: Principal Investigator
Project Abstract:
A longstanding issue in Value Assessment Frameworks on Health Technology Assessment (HTA) agencies is its inability to address the widening gap in the Knowledge, Attitude and Practice (KAP) of varying stakeholders. This is primarily due to the template analysis that most of these frameworks employ that is subscribing to the “substantive criteria” which is plagued by issues on ownership and inclusiveness of the criteria: “are the criteria governing the KAP of the industry parallel to those of the patients?” As various stakeholders have differing experiences of the health system that they belong in, HTA agencies implement a “cost-effective” framework in drafting policies and implementing rules and regulations (IRR). This naturally poses multi-layered problems which range from underserved patients, overworked clinicians, to pharmaceutical economic bubble. The shift in framework in understanding this phenomenon is now not only a demand within the academe but has become an urgent need for countries with widening gap in the delivery of health services and products.
Localizing the understanding on health systems allows for a more relevant approach to the users and practitioners within that ecosystem. Kleinman (1981) has discussed the importance of ensuring that the evaluations of issues related to health be culturally specific. It is for this reason that he has developed the framework of Cultural Epidemiology which situates diseases within the cultural realities of the patients, the carers, the health professional, and the specific society. He argued that the failure of most health researches is in its predisposition to use standardized tests in establishing the case. By localizing the framework through a Cultural Epidemiology approach, the health issue will be understood in-depth and the responses to it which may involve policies, modules, or actual health interventions will be of higher relevance to the lived experiences of the clients (Yang et al., 2014; Kleinman & Hall-Clifford, 2009). Baltussen & Van Der Wilt (2017) argued the same stating that “HTA presently employ value assessment frameworks that are ill fitted to capture the range and diversity of stakeholder values and thereby risk compromising the legitimacy of their recommendations”. Various anthropologists and other social scientists have subscribed to this orientation as they studied tuberculosis (Sima, Belachew, Bjune, & Abebe, 2019), mental illness (Yang et al., 2014), disability (Kuppers 2011), organ trafficking (Campion-Vincent, Campion-Vincent, & Scheper-Hughes, 2001), and HIV-AIDS (Farmer, 2009). In my own practice of social health, I have utilized this framework to understand malnutrition among older adults (Alejandria-Gonzalez, 2018) and pediatric tuberculosis (Alejandria et. al., In Press).
Through this orientation, this study will map and situate the pervading social values of key sectors with regard to funding allocation decisions on health coverage with respect to the implementation of the health technology assessment (HTA). Apart from a multi-sectoral approach to the understanding of the social values on health coverage, a multi-regional approach becomes a cornerstone of this work. Of further interest is the assertion that there is no grand narrative that could singularly encapsulate the Filipino social values given the regional variation in experiences which have ultimately shaped their social worlds. It is for this reason that person in one region will perceive and experience a particular policy differently than his/her counterpart from another region. This design responds to the stipulated objective in the TOR which requires the study of “social values relevant to within the context of the same jurisdiction”.
Fieldwork Photos in Cebu City
Fieldwork in Davao City
Fieldwork in Baguio
Fieldwork in Manila
Maria Carinnes P. Alejandria 
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