Technical Writer for Political Economy Analysis

  • Contract
  • Philippines
  • TBD USD / Year
  • Salary: TBD

The Asia Foundation

Terms of Reference

Political Economy Analysis of the Philippine Healthcare System

Background of the Study

Despite gradual improvements, the Philippine healthcare system continues to produce poorer than expected health outcomes, compared to neighboring countries in the ASEAN region[1]. Among others, the Philippines is challenged by high rates of maternal and neonatal mortality and tuberculosis (TB). Deep inequities in outcomes also persist between urban and rural areas, across regions, populations and income groups.

Longstanding issues in the Philippine healthcare sector have been identified. [2]Among others, a fragmented public health care system, a focus on tertiary (rather than primary) care by the public sector, a dearth of public health care workers, insufficient funding of public health services, on the supply side, and poor health seeking behavior on the demand side. [3] Consequently, important legislation have been passed , for instance the Sin Tax Law of 2012 and other sin tax reforms and the Universal Health Care Law of 2019. The former has raised revenue for public health, while lowering the incidence of tobacco smoking at the same time. The latter aims to address the fragmented healthcare system by integrating local health systems into coordinated service delivery networks.

It is too early to tell whether or to what extent the UHC will address identified issues. However, it is not too early to take stock of health care system developments since the UHC, particularly given the limitations and weaknesses of the system demonstrated during the pandemic. A stocktaking would include an assessment of the early plans for the UHC (and what these signal about UHCs feasibility or coherence) as well as other relevant/significant developments, such as the Mandanas ruling.

Using a Political Economy Analysis (PEA) Framework, this paper seeks to provide insight about the central question of why the Philippine healthcare system has produced poorer than expected health outcomes. A Political Economy Analysis focuses on the incentives, relationships, and distribution and contestation of power among different groups, individuals, and organizations to explain certain outcomes and what might be done to improve them. The Philippine healthcare system is comprised of stakeholders often with competing interests, but all embedded within institutions, both formal and informal, and other components of the political process. A PEA approach could help to identify policy gaps and opportunities for reform, enriching or refining the menu of options gathered from other analyses.

Objectives

The main objective of this paper is to use a Political Economy Analysis framework to explain why the Philippines’ healthcare system has produced (and is likely to produce) poorer than expected health outcomes. It is a sector level analysis of the healthcare system which includes a discussion of the structures and processes, formal rules and informal norms, and key stakeholders or actors that comprise this system

Deliverable

The researcher will form part of a team reporting under the Coalitions for Change Program of the Asia Foundation Philippines. The team will be tasked to produce a Political Economy Analysis of the Philippine Healthcare System. The research is envisioned to include, among others, the components described in the attached draft outline.

Outputs and Timeline

The research team shall produce a Political Economy Analysis Report with key outputs and timeline of activities listed below

Phase 1 (April 1 – June 30, 2023)

  • Report outline finalized
  • RTD with key informants conducted
  • Expanded (annotated) outline/Inception report produced (May 15)
  • Part 1 and 2 completed (June 30)

Phase 2 (July 1 – August 15, 2023)

  • Part III completed (preliminary draft of Parts I, II, and III by July 15 )
  • RTD with key informants (3rd week of July)

Phase 3 (August 16, 2023 – November 15, 2023)

  • Parts IV and V completed (preliminary draft by October 15)
  • Integrated first draft of report

Phase 4 (November 16, 2023 – January 30, 2024, period of revisions)

  • RTD with key informants (end-November; mid-January)
  • Final report completed, including options for reform.

Team Composition

A research advisor, a technical writer, and a research associate are sought to complete the project research team under the direction of the Coalitions for Change Economic reform team

Research Advisor

Tasks:

  • Supervise writing tasks based on the working outline attached and in accordance with the project timeline
  • Provide feedback and edits as necessary on working drafts produced by writers
  • Convene and facilitate roundtable discussions for data analysis in coordination with CfC program team
  • Advise on strategic project direction including, changes in research coverage, and adjustments to timeline
  • Attend alignment meetings with the PEA team on a weekly or biweekly basis as necessary based on the activities due in the project timeline
  • In coordination with CfC program team provide status updates and respond to questions on technical material covered as raised by TAF management or counterparts from the Department of Foreign Affairs and Trade
  • Conduct revisions together with PEA writers after external program review of the working paper draft

Qualifications:

  • At least 10 years research experience in economic policy or political economy research. Degree in economics, political science, public health and other related fields. Graduate degree is a plus
  • Experience in supervising research projects with donor funding
  • Strong research writing and presentation skills with experience in both qualitative and quantitative research methods
  • Strong interview and communication skills, especially with external stakeholders and other key informants
  • Understanding of Philippine healthcare system and policy landscape including current events and political developments
  • Experience working with international development / donor organizations for research projects / reports is a plus

Technical Researcher / Writer

Tasks:

  • In coordination with research team and with the lead writer, produce annotated outline / inception report
  • In coordination with research team and with the lead writer, produce written paper drafts based on prescribed outline
  • Participate in roundtable discussions for data analysis
  • Attend alignment meetings with the PEA team on a weekly or biweekly basis as necessary based on the activities due in the project timeline
  • Conduct revisions and address comments after program review of the working paper draft
  • Conduct revisions together with PEA writers after TAF and DFAT review of the working paper

Qualifications:

  • At least 5 years research experience in economic policy or political economy research. Degree in economics, political science, public health and other related fields. Graduate degree is a plus
  • Strong research writing and presentation skills with experience in both qualitative and quantitative research methods
  • Strong interview and communication skills, especially with external stakeholders and other key informants
  • Understanding of Philippine healthcare system and policy landscape including current events and political developments
  • Experience working with international development / donor organizations for research projects / reports is a plus

Research Associate

Tasks

  • Assist writing team with additional background research for written drafts
  • Assist in referencing, footnotes, and citation
  • Participate in roundtable discussions for data analysis
  • Attend alignment meetings with the PEA team on a weekly or biweekly basis as necessary based on the activities due in the project timeline
  • Conduct revisions and address comments after program review of the working paper draft
  • Conduct revisions together with PEA writers after TAF and DFAT review of the working paper

Qualifications:

  • Degree in economics, political science, health sciences, public management, development studies, and other related disciplines. Fresh graduates are welcome to apply
  • Adequate experience and knowledge on referencing, citations and synthesis of secondary materials
  • Effective project coordination including arranging logistics for meetings, roundtables, and internal systems for file management
  • Proficient in MS Word, Excel, Powerpoint, Google Drive

Contract Period:

The initial contract period is from April 1, 2023 – June 30, 2023 (covering Phases 1 in the timeline), with a possibility of extension until January 30, 2024, covering Phases 2, 3, 4.

**A Political Economy Analysis of the Philippine Health Care System

Working Outline**

Executive Summary

  1. Introduction

The problems in Philippine health care:

There have been some improvements in health outcomes

But health outcomes for Filipino citizens does not compare well to similarly situated middle-income countries.

Many Filipinos continue to die or suffer from illnesses that have well-proven, cost-effective interventions, such tuberculosis, HIV and dengue, or diseases affecting mothers and children. The Philippines is challenged by high rates of maternal and neonatal mortality and tuberculosis (TB). Deep inequities persist between urban and rural areas and among regions, rich and the poor, and different population groups.

From Problems Plaguing the Philippines’ Medical Care

    1. Majority of Filipino people lack access to basic healthcare.
    2. There are not enough healthcare workers in the country.
    3. The healthcare industry has not embraced digitalization.
    4. Provincial hospitals have limited access to medical supplies.

Research question:

Why does the Philippine health care system produce poorer than expected outcomes?

The framework:

This paper uses a political economy analysis framework to answer this question. A PEA framework focuses on the incentives, relationships, and distribution and contestation of power among different groups, individuals, and organizations to explain current outcomes and what might be done to improve outcomes.

  1. This section briefly describes the foundational factors of the Philippines and the health care system. These are deeply embedded, longer-term national and sub-national socio-economic and power structures that shape the nature and quality of the country and the health care sector and why it works or looks the way it does.

    1. Foundational factors of the health care system
      1. Nurses, doctors as Overseas Contract Workers or Migrants
      2. Focus on tertiary instead of primary care
      3. The Philippines’ healthcare system relies heavily on private providers. Most hospitals – almost 60% – are also privately owned.
      4. Only 30 percent of health professionals employed by the government address the health needs of the majority. Healthcare in the Philippines suffers because the remaining 70 percent of health professionals work in the more expensive privately run sectors. 10 Facts About Healthcare in the Philippines
      5. Separate coverage and organization of private service delivery networks and public service delivery networks
      6. Financing mandates and schemes for public health compared to other public goods
    1. Foundation factors for Philippines
      1. Weak State, Persistent Elites
      2. Hyper powerful President (vs. legislature)
      3. Elections but dynasties
      4. Bureaucracy
      5. Weak provincial (vs central and municipal)
      6. Corruption and rent-seeking
  2. This section maps out the institutional and governance arrangements and capacities. It identifies the relevant institutions – the formal and informal rules of the game. Importantly, it identifies (or reviews) the rationale/motivation for these institutions and the degree to which “outcomes” have been obtained.

  3. Local Government Code 1991 (Republic Act No. 7160)

    • Objective
    • Key provisions
    • Key health-care provisions
    • IRA and its implementation (pre-Mandanas)
  4. National Health Insurance Act of 1995 (Republic Act No. 7875) that created Philippine Health Insurance Corporation (PhilHealth)

    • Objectives
    • Key provisions
    • Key organizations
  5. Sin-tax and other prescribed sources of funding for health care

    • Pre-sin tax
    • 2012 – Sin tax reform law Republic Act 10351
    • 2017
    • 2019 – vape and heated tobacco
    • 2020
    • Current funding picture
  6. Universal Health Care Act of 2019 (Republic Act No. 11223)

    • Objectives
    • Key provisions
      • Individual and Population-based
      • Integration
    • Key organizations
      • Department of Health
      • Provincial, Municipal, City, Barangay
      • Private hospitals
      • Health Management Organizations
  7. Private sector institutions (e.g. medical associations, nursing schools, etc.)

  8. Mandanas decision

  9. This section drills down to the political economy drivers. It tries to understand and explain why are things the way they are. Why are policies or institutional arrangements not being improved? What are the underlying drivers—stakeholders, rent/rent distribution, historical legacies, path dependency, history etc. —that explain why things are as they are.

We will take into consideration current events and circumstances influence the objectives and behavior of key actors /stakeholders, and how they respond to opportunities for, or impediments to change.

  1. This final section summarizes the findings and proposes recommendations how things might be improved.
    1. Key findings
    1. Recommendations

[1] Panelo et al. 2016. The Challenge of Reaching the Poor with a Continuum of Care: http://www.upecon.org.ph/wp-content/uploads/2018/03/HSR_061818.pdf

[2] Panelo et al (2016), [CITE THE OTHERS]_______________________

[3] Problems Plaguing the Philippines’ Medical Care (medhyve.com)

How to apply

For more details on these opportunities, access the Terms of Reference here: https://tinyurl.com/TAFPHConsultancyOpportunities

APPLICATION GUIDELINES: Interested applicants should send in their The Asia Foundation Application Form (https://tinyurl.com/TAFAppForm2022), EBD Form (https://tinyurl.com/EBDForm), and sample portfolio (if any) to [email protected] before the indicated deadline. Kindly follow the instructions for the subject heading.

To keep updated with project-based and consultancy-based career opportunities at The Asia Foundation, you may check out our regularly updated Job Bulletin here: https://bit.ly/TAFPHJobBulletin


Deadline: 24 Mar 2023