Celso Pagatpatan, Jr. | Ateneo de Manila University (original) (raw)

Papers by Celso Pagatpatan, Jr.

The Lancet Regional Health - Western Pacific

Background Our study aimed to explore the experiences of stakeholders from local government units... more Background Our study aimed to explore the experiences of stakeholders from local government units, health facilities and higher education institutions on the delivery of non-COVID-19 health services after the initial wave of the pandemic. Methods Twenty-nine public health workers, thirteen university staff, and four hospital administrators in the Philippines participated. Using a descriptive phenomenological approach, we analysed transcripts from six focus group discussions conducted online between March and June 2021. Findings The COVID-19 pandemic made the routine health programs inaccessible due to hesitancy among patients to visit health facilities, a shift in public health priorities, and lack of students to augment the existing workforce. Public health workers reported stress and mental health exhaustion. Apart from fear of infection during service provision, public health workers and university staff experienced work overload, pressure to learn new technology, and webinar fatigue. Mental health problems have surfaced as health workers and young people have become more affected while support services remain insufficient. Public health workers have reported actions to maintain service delivery in the new normal such as use of telehealth and social media. However, issues on workforce wellbeing and digital equity posed adaptation challenges. Participants suggested partnership with higher education institutions as pivotal to position local health systems towards recovery. Interpretation The rapid change in the service landscape highlights the importance of sustainable partnerships, effective workforce management, equitable digital innovations, and promoting mental wellbeing to preserve community, school, and occupational health and rebuild resilient local health systems in low-resourced areas.

© 2020 Philippine Nurses Association. All rights reserved. Background. In ensuring access to mate... more © 2020 Philippine Nurses Association. All rights reserved. Background. In ensuring access to maternal health services, various strategies toward safer health practices and improved health service delivery are important ingredients to eliminate avoidable maternal deaths. A recent household survey showed that access to antenatal care (ANC) (89%) and facility-based delivery (FBD) (82.4%) in the Eastern Visayas region is significantly high, despite the extensive damage to over 500 health facilities caused by Typhoon Haiyan in November 2013. Postpartum care (PPC), however, was relatively low (37.4%). As these findings needed further elaboration, a qualitative study using focus groups was conducted. Method. The focus groups method was utilized to elicit responses from the mothers, BHWs, and midwives to explain what contributed to the high ANC visits, high FBD, and low PPC. Sixteen focus groups were conducted in the local dialect (Waray and Cebuano), and all discussions were audio recorded. Focus groups data were transcribed and subsequently translated to English text, then reviewed and validated by socio-linguistic academics from the region. Other data sources included debriefing session reports and expanded field notes. Nvivo 10 software was used in the coding process and data management. The data analysis referred to the principles of thematic analysis. Results. The findings showed that incentives in the form of free maternal services and cash grants drive mothers to go to the health facility for antenatal care and facility-based deliveries. The free services were provided by PhilHealth (the country\u27s social health insurance), while cash grants were awarded through the government\u27s conditional cash transfer program and other community partners. Mothers were provided with some financial risk protection through these financial incentives. The disincentives came in the form of local ordinances, which prohibited home births. Penalties included fines for both mother and birth attendant when the mother was found to deliver outside the health facility. The unintended stigma, shame, and fear that developed in response to these ordinances also deterred home births. The significantly low use of PPC services in the health facility was attributed to the lack of advices given to mothers regarding the need for followup care after delivery. It is also noted that there are no incentives for PPC, which may contribute to its low rates. The role of the community health workers and midwives were to inform and educate the mothers on these incentives and disincentives. However, these incentives and disincentives are extrinsic motivators and are deemed insufficient to provide long-term impact. Conclusion and Recommendations. The implementation of the incentives and disincentives in Eastern Visayas has increased rates of ANC and FBD. The presence of these in the current environment has initially facilitated behavior change, shifting home births to facility births. However, we argue that financial incentives, with a lack of intrinsic motivation, may be insufficient to sustain long-term impact. Disincentives, in the form of local ordinances, forced mothers instead to seek care in facilities. Such an approach may eventually become less effective over time. Incentives and disincentives are both demand-side factors, and to sustain change, concurrent improvements in the supply end need to be implemented. The capacity of facilities to absorb the increased demand should be in place to provide positive experiences for mothers in the health facilities

The Philippine journal of nursing, 2011

Philippine Journal of Health Research and Development, 2021

Background: The effects of community immersion programs and other forms of community-based medica... more Background: The effects of community immersion programs and other forms of community-based medical education on students have been highlighted in the literature. However, the driving factors that generate these outcomes are not emphasized by many authors. Objective: This study aimed to identify and explain the important contextual factors and mechanisms considered as driving factors of the outcomes of community immersion programs.

Methodology: An exploratory qualitative inquiry that employed focus group discussions, in-depth interviews, and reflection papers was utilized. The realist approach provided the structure in eliciting and analyzing medical students’ perspectives on the driving factors of the program outcomes of community immersion. Data were analyzed through thematic analysis.

Results: The outcomes generated by the community immersion program are consistent with the literature as well as relevant to the course and social outcomes as identified by De La Salle Medical and Health Sciences Institute. Uncovered major driving factors for these program outcomes include: “perceiving things from a different perspective”, and “positive attitude towards community health”. Various contextual factors that trigger these driving factors were further unpacked that provide a backdrop to the community immersion program

Conclusion: Factors that bring about the program outcomes of community immersion are evident in the experiences of medical students. Focusing on these factors may allow community preceptors and administrators to have clearer perspectives on the factors to focus on in teaching community medicine through community immersion. It is recommended that preceptors and administrators consider and nurture these factors during community immersion to be effective in teaching medical students in the community setting and in the provision of primary health services to communities.

Philippione Journal for Health Research and Development, 2020

Medical educators are restricted by the current pandemic in teaching community medicine. Although... more Medical educators are restricted by the current pandemic in teaching community medicine. Although medical schools suspended the exposure of their students to real community settings, many community medicine educators advocate that learning in community medicine could be sustained during the pandemic as initially experienced in several medical schools in the Philippines. To maximize learning, it is essential to highlight interactivity as an important process in students' learning in whatever mode of delivery. This commentary focuses on the various forms of interactivities in teaching community medicine: student-to-student, student-to-community, and student-to-teacher. It is suggested that the interactivity between the student and the teacher should be emphasized to address the potential limitations of the other forms.

Forum 2015 Abstracts

Background This research sought to understand and explain the factors that generate the effective... more Background This research sought to understand and explain the factors that generate the effectiveness of public participation in health policy. Researchers consider the role of the contextual factors as well as the participation process, especially participation techniques, to influence significantly the effectiveness of public participation. Although these are important factors to consider, these do not sufficiently explain what works, when and why.

Australian journal of primary health, Jan 23, 2017

Although researchers argue for the importance of involving the public in developing health policy... more Although researchers argue for the importance of involving the public in developing health policy, there has been little focus on central research questions - such as what techniques of public participation work, in what circumstances, and why. This paper presents a realist synthesis which identifies and explains the underlying mechanisms and specific contextual factors that lead to effective public participation in health policy and planning. Peer-reviewed, English language literature was searched, which resulted in 77 articles for review and synthesis. This synthesis uncovered the underlying mechanism of 'political commitment' that generates public participation effectiveness. The other three possible underlying mechanisms, namely: 'partnership synergy', 'inclusiveness' and 'deliberativeness', were found to potentially provide further explanation on public participation effectiveness for health policy and planning. The findings of this review provid...

Philippine Journal of Nursing, 2020

Background. In ensuring access to maternal health services, various strategies toward safer healt... more Background. In ensuring access to maternal health services, various strategies toward safer health practices and improved health service delivery are important ingredients to eliminate avoidable maternal deaths. A recent household survey showed that access to antenatal care (ANC) (89%) and facility-based delivery (FBD) (82.4%) in the Eastern Visayas region is significantly high, despite the extensive damage to over 500 health facilities caused by Typhoon Haiyan in November 2013. Postpartum care (PPC), however, was relatively low (37.4%). As these findings needed further elaboration, a qualitative study using focus groups was conducted.

Systematic search of literature is an important skill for researchers to help achieve a comprehen... more Systematic search of literature is an important skill for researchers to help achieve a comprehensive understanding of the topic of interest. Likewise, clinicians need this skill for them to be updated on the recent evidence in providing relevant health care interventions to their patients. However, many health professionals and health science students rely on the use of limited search engines and few databases without systematically performing search and retrieval of relevant studies. This practice commonly yields inadequate references for a research project or clinical decision-making resulting to an incomplete understanding of the topic at hand. This paper aims to provide an introductory guide for researchers as well as clinicians on the step-by-step process of systematic literature search. It also provides information on the available open-access directories and databases as additional or alternative sources of evidence especially in low-resource institutions. However, careful guidelines must be considered in using open-access sources to maintain the quality of research projects and clinical decisions.

Background: This research sought to understand and explain the factors that generate the effectiv... more Background: This research sought to understand and explain
the factors that generate the effectiveness of public participation in health policy. Researchers consider the role of the contextual factors as well as the participation process, especially participation techniques, to influence significantly the effectiveness of public participation. Although these are important factors to consider, these do not sufficiently explain what works, when and why.

Objectives: This investigation aimed to: (1) explain the causes
of participation effectiveness and ineffectiveness, (2) understand the significance of context in achieving participation effectiveness, (3) understand the evidence of participation effectiveness.

It ultimately aimed to contribute to the design of effective
public participation practice in the Philippine health sector and
elsewhere.

Methods: This study was conducted in two phases. The first
phase was a realist synthesis of existing literature on public participation, which included the analysis of 83 journal articles.
The result of this phase was a set of mechanisms and the
context within which they worked, which have been shown in
the literature to promote effective public participation. The
second phase included 32 realist interviews of Philippine government leaders and health practitioners to understand which mechanisms from the realist synthesis were occurring or not present in the Philippine context and why. The synthesis of the two phases developed a refined explanation of the causes of participation effectiveness.

Result: Five key mechanisms were found in both the realist
synthesis and the interviews in the Philippines that generate
participation effectiveness: political will, partnership synergy,
participative voice, inclusiveness and legitimacy. Political expediency and power-over were found to potentially block the effectiveness of public participation. A significant implication of these mechanisms relates to the crucial role of the discretionary power of public officials in aiming for an effective public participation practice. This study also highlighted the need for active populations as well as a diversity of perspectives as important contexts for these mechanisms to operate.

Conclusion: This study has highlighted that participation effectiveness in the Philippine health sector and elsewhere is caused by several key underlying mechanisms and the understanding of the significant contextual factors that influence the operation of these underlying mechanisms allows us to determine the appropriate interventions (including the participation techniques) that contribute to the generation of participation effectiveness. In a practical sense, this study has shown that understanding the interactions of the context, mechanism, and outcome can provide a direction for planners and practitioners in the design of an effective participation exercise. It clarified in what circumstances a particular participation intervention or strategy could be effective or ineffective by the activation of a particular mechanism.

Focus group (FG) as a method of research is becoming popular in nursing. However, limited practic... more Focus group (FG) as a method of research is becoming
popular in nursing. However, limited practical examples
on the processes and skills required for its
implementation in the Philippines to address the
complexity of this method may prevent novice nurses to
pursue more FG-based researches. For nurses and other
health researchers who intend to use the FG, facilitation
and note taking in FG discussions as well as transcribing
and translating are important skills to master. Ways to
enhance the quality of data should also be devised to
improve trustworthiness of findings such as pre-testing of
tools, conduct of debriefing sessions and, validation of
translations and other data sources. Through appropriate
methodological processes and examples, FG research is
valuable in exploring and understanding nursing and
health-related issues. This article showcases the
experience of nine novice Philippine nurse researchers in
their aim to achieve high quality FG study on access to
maternal health services conducted in the Eastern Visayas
region of the Philippines

The interpretation of access has been a subject of debate in health care as well as a major conce... more The interpretation of access has been a subject of debate in health care as well as a major concern in health policy formulation especially in the area of health care reform. Access to health care studies had focused mainly on limited elements of geographic access and financial access, and many used health care utilization as proxy of access. Scarce studies had examined access per se. This review aims to examine the concept of access within health care financing through a conceptual framework that views access as empowerment and a multidimensional concept of affordability, availability and acceptability resulting from the interaction of health system and the client. Review of 40 original and review articles on access to health care within health care financing was conducted. The review reveals that most studies agree on both financial and non-financial factors affecting access within health care financing but showed a wide non-recognition of the interaction of affordability, acceptability and availability dimensions that determines access. Some evidence of empowerment, resulting from this interaction were reported but an elaboration of its relation to community participation is suggested. Recognition of the multi-dimensional concept and its interaction is suggested as basis of conceptualization of access that inform health policy change for better health care access.

Drafts by Celso Pagatpatan, Jr.

This study investigated the social health insurance (SHI) scheme in the Philippines in terms of e... more This study investigated the social health insurance (SHI) scheme in the Philippines in terms of equity and access. A review of policy documents of PhilHealth, a SHI institution in the Philippines, was conducted using a framework that views access as empowerment and as a multi-dimensional concept arising from the interaction of the clients and health system. This review showed that PhilHealth recognizes the multi-dimensionality of access as it strives for financial risk protection and quality of health care. Social solidarity as an inherent principle in SHI indicates community spirit but does not necessarily imply empowerment. PhilHealth policies that use the SHI scheme confirm a supply-side and provider-focus in health financing. It is recommended that the demand-side factors of access should emphasize not only the enhancement of purchasing power but also the freedom to use health services, as improving people’s willingness and capabilities are essential preconditions for the utilization of health care.