NIHR HPSR-RL: Tulong, Ugnayan ng Lingap At gabaY (TULAY): Co-designing Philippines' Community Physical Rehabilitation Rehabilitation is care that can help people get back, keep, or improve functions that are needed for daily life. These may be physical, mental, and/or cognitive (thinking and learning) and is help is almost always needed following stroke or other physical illnesses. Unlike in the UK, where there are very effective recovery programmes, in the Philippines, these services are almost non-existent. We intend to design, with the help of patients, carers and health workers, a programme of activities to help people manage their recovery from physical illness, such as stroke, themselves. We are doing this because the evidence from research strongly supports this type of help, which will be given by trained municipal and barangay (village) health workers, alongside family carers, who work in the island areas of the Philippines, away from towns and cities.
The joint team of researchers and health professionals from the UK and Philippines will work together with stroke survivors and families to develop recovery care delivered within the community setting. This programme is intended to be adapted for other physical conditions in the Philippines and other low to middle income countries. To do this we will use a mixture of approaches to find out about current services, what people want before designing a programme, jointly with patients, carers and health workers, that meets local needs. We will train local health workers and village people to help to deliver it. The University of Plymouth, in the UK, and De La Salle University, in the Philippines are leading this project, having spent time meeting with policy makers, clinicians, and patient/carer groups, as well as the Philippine Academy of Rehabilitation Medicine (PARM) and national therapy organisations to involve them in this work.
The project will start in October 2022 and continue until 2026, when we hope to have this model approved as part of the Philippines’ Universal Healthcare Scheme, to help others to manage themselves after physical illness. This work will help the health system to improve patient and family health, using a sustainable model that reflects the diversity and culture of the Philippines. To work together with stroke survivors and families to develop a programme of activities to help people manage their recovery from physical illness, such as stroke, themselves. This will be delivered within rural community settings, by trained local health workers and village people.
To do this we will:
1. Record current services, key people and organisations involved in the delivery of care following stroke and other physical illnesses at national, regional and local (village) levels. We want to find out about what current care following stroke is provided, with a focus on community delivery of care (not in towns and cities). We will also review the evidence about community-based rehabilitation in low to middle income countries. The outcome will be a report that includes initial recommendations that can be shared more widely in the Philippines and form the basis for discussions in the regions where the self-management programme will be developed, so we can make sure the new programme fits with what is currently available.
2. Find out what Filipinos want, by talking to stroke patients, carers and health professionals in the Philippines about their needs and experiences following stroke. The outcome will be a summary of needs that will be used in the co-design stage of the project.
3. Co-design a programme that meets their local needs of people following stroke. To do this we will work with around 3-6 stroke survivors per village (barangay) in three main regions of the Philippines. We will aim to train at least 60 barangay (village) workers across the three regions. The outcome of this work will be a report detailing the development of the self-management programme for stroke rehabilitation in community settings for delivery at local level, and a ‘teach the teachers’ toolkit/package of support for wider use.
4. Seek feedback to find out what worked well, what needed changing when we move to a new region of the Philippines and gather basic information about the costs of delivering the programme. To do this we will seek information from key people from the three regions who have already been involved in the research, including stroke survivors, carers, health workers and other officials. The outcome will be a report that describes the implementation and evaluation of the programme, which can be used by policymakers in the Philippines and other similar countries as well as a report that simply describes the costs of delivering the recovery support programme.