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
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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.
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Philippines Demographics &
Politics
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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
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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.
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Figure 1.The PHC reforms necessary to
refocus health systems toward health for all
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Universal coverage reforms to
improve health equity
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Service delivery reforms to
make health-systems peoplecentered
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Public policy reforms to
promote and protect the
health of communities
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Leadership reforms to make
health authorities more reliable
WHO Health Report, 2008.
Primary Health Care: Now More
Than Ever, WHO, Geneva.
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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.
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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;
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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.
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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
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THE VISION
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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.
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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
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NCD-LIFESPAN Training Program
Objectives
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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 (degreerelated or mentored research projects)
To strengthen the research and research
training capacity required for success by building
on existing programs in the LMIC, and
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Objectives, cont’d.
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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.
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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
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NCD-LIFESPAN Grant Timeline
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Meetings in Dumaguete and Manila: August 1820 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.
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