Assessing health system and service delivery capacity in responding to changing disease patterns in the Philippines: an analysis using national health information system longitudinal data.

backgroundThe Philippines is experiencing an escalating prevalence of noncommunicable diseases (NCDs). As a country with aspirations of achieving universal health coverage, it is imperative to undertake evidence-based health planning to align health service coverage and health resources with the requisite NCD-related health services in each region. This study aimed to address the following questions: (1) in light of the mounting burden of NCDs, to what extent do the health systems and service delivery capacity align with the local health service needs? (2) Which regions require greater attention? and (3) Which aspects of health system strengthening should be prioritized in these regions?

methodsUsing regional, provincial, and municipal data from the Field Health Services Information System (FHSIS) Annual Report, the Philippine Statistical Yearbook, and the Philippine Health Statistics, we constructed the Noncommunicable Diseases-Health Care Need Index (NCD-HCNI) and health system and service delivery index (HSSDI) in each region. To ascertain the overall trend of these indicators across regions, we employed the average annual percent change (AAPC) for the longitudinal data of these indicators for the period 2010 to 2022 in calculating the health system development index (HSDI). The sub-indexes (for NCD-HCNI: health status index/risk factor index; for HSSDI: health service coverage index/health units index/health workforce index; for HSDI: health service coverage development index/health workforce development index) were employed to identify priority regions. Regression models and correlation analyses were used to ascertain the compatibility between the capacity of the health system and service delivery and the NCD-related health care need at the regional level.

findingsThe NCD-HCNI was higher in the Davao Region (64.34), Calabarzon (61.61), National Capital Region (59.80), BARMM (49.39), and Northern Mindanao (46.11), while the HSSDI for National Capital Region (25.25) and Northern Mindanao (26.24) were comparatively lower. The HSDI was lower in the National Capital Region (31.41), Davao Region (51.38), and BARMM (65.00). A negative correlation was observed between HSSDI and NCD-HCNI at both regional (β = -0.45, p < 0.05) and provincial levels (β = -0.17, p < 0.05), indicating that there is an inverse relationship between the availability of health resources and the need for NCD-related health services in the Philippines. A positive correlation was noted between HSSDI and HSDI at the provincial and municipal levels (β = 0.20, p < 0.05), indicating that regions with low availability of health resources also exhibit health system development gaps. Specifically, the health workforce index demonstrated a negative correlation with the health status index (r = -0.29, p < 0.01), the proportion of adults aged 20 years and above with hypertension (r = -0.30, p < 0.01), and the proportion of adults aged 20 years and above with diabetes (r = -0.21, p < 0.01).

interpretationThe Philippines needs to allocate health resources more granularly according to regional health needs and health system development to more effectively prevent, treat and manage NCDs. The regions of Luzon (particularly the National Capital Region and Calabarzon) and Mindanao (including the Davao Region, BARMM, and Northern Mindanao) have been identified as priority areas with high needs for NCD-related health care services and low health care service delivery capacity. The health workforce is a crucial area for improvement, and the Philippine government should prioritize the training and development of human resources for health to address the growing threat of NCDs.