Tulong, Ugnayan ng Lingap At gabaY (TULAY):Co-designing Philippines' Community Physical Rehabilitation

Description

Research question: Transforming community-based physical rehabilitation services in the Philippines through co-design; is this achievable? Background: Physical rehabilitation programmes are urgently needed in the Philippines, as evidenced by the statistics for stroke. In 2014 it was estimated that about 500,000 Filipinos will be affected by stroke resulting in healthcare costs of up to $1·2 billion.[1] The age adjusted Death Rate for stroke is 130.85 per 100,000 of population; this ranks Philippines #22 in the world.[2] The Philippines' healthcare system is largely private and in 54% of the population the cost of interventions are borne by out-of-pocket payments, with limited use of services by lower and middle-income groups. Rehabilitation is central to promoting independence, meaningful life goals and economic productivity. Although stroke unit numbers have risen recently from 2 in 1999 to nearly 50 in 2021,[3] they remain inaccessible to patients who live in remote areas. No established community-based care facilities in the Philippines exist, and qualified staff to deliver rehabilitation within the Philippines are scarce. Aims: To co-design and implement a sustainable self-management community-based programme for physical rehabilitation, using stroke as the test-case, and evaluate its impact on self-management skills, patient well-being and self-efficacy. Methods: A mix of methods, to co-design and implement a bespoke self-management programme, with contextualised training resources, within 3 targeted regions, for local health workers, supported by local people with stroke acting as village heroes. Informed by the Knowledge to Action (KTA) framework, and based on the 'Bridges' training programme, co-designed self-management tools used by rehabilitation providers to support self-management will be produced. This programme has been established in the UK and elsewhere, including Estonia. Normalisation Process Theory (NPT), alongside the KTA will be used to understand implementation, sustainability, and cost-effectiveness. We will adopt a pragmatic approach, facilitating co-production, tailoring, implementation and evaluation. These frameworks will enable us to capture necessary modifications ensuring that the evidence-based self-management programme for stroke rehabilitation has a pragmatic fit with the context of wider community health delivery in the Philippines. Timelines for delivery: WP1: Management, communication and dissemination; including study set up (4 months); Q1/22 Q1/26 WP2: Clarification of Structures of Care; Q3/22 Q2/23 WP3: Quality of rehabilitation services in cities and rural settings; Q3/23 Q4/24 WP4: Co-production of TULAY stroke self-management programme; Q2/24 Q1-26 WP5: Implementation and evaluation of TULAY programme within targeted Municipalities; Q2/24 Q1/26 Anticipated impact and dissemination: Regional and national system changes in community rehabilitation services; formal adoption with ordinances approved; and stakeholders from regional and central government and the national insurance scheme (PhilHealth) working together to embed the programme into the Universal Healthcare Scheme to contribute to the 2030 Sustainable Development Goal 3. Dissemination will be via peer reviewed publications, social media, news media, a website hosted by De la Salle University (DLSU), and links to data repositories to facilitate data sharing with other LMICs.