From a drop of doubt to making ripples

Coming into to my 20’s, I didn’t see the need for health insurance. I was young, healthy, not very sickly and averse to risk. I was well aware that insurance was not really for people like me. The health benefits are just the perks of my premium going into the communal pool. Insurance was created to help the majority, especially those for whom healthcare was a luxury. Little did I know I would soon be diving deep into the ideas and challenges of health insurance.

At the time, I was only a few months as a licensed physician locally and abroad, one year since graduating with a MD-MBA degree and scarcely involved in public health after nine years of training. Throughout that time, I wondered when I would be able to practically live up to the “public health” part of my education.

As fate would have it, I saw an ad for a research position in a private health research company. EpiMetrics, Inc. was making waves in the public health industry, and its president, Dr. John Q. Wong was my advisor and mentor to many generations besides myself. He would set many on noble paths and many have since been doing great things for public health. My entry into public health could not be better. The Philippines was shifting to universal health care, a movement that was going to be turned into law in the coming year (2020).

“Do or not do, there is no try- Yoda”

I applied for the position of a researcher but was instead offered a project manager role. There were a few projects to choose from but I landed on a capacity building program. It was a challenge to myself to educate and give back. Likewise, it was a challenge to be in a position of leadership. The task was to train a select group of officers of the Philippine Health Insurance Corporation (Philhealth) to do implementation research to produce policy reform.

I was nervous because I realized I was pioneering. It was my first time getting involved in this kind of project. I made up my mind to exceed expectations and likewise decided that if I was ever to fall short, I would keep striving. “You have the capability to rise, Joey. You can run this project impeccably. Even if you don’t get how, just keep going, it’ll become clear.” This is the pep talk that I’d give myself. There was a lot of work towards accepting the situation as it was and pressing myself to improve. Luckily, I had the help of my colleagues at EpiMetrics.

With our partners, we designed the project for 38 participants, with 18 regions represented, meeting in 5 cities with 5 modules running 3-5 days each within the span of 5 months. The project’s aim was to train researchers who would then use the data to implement better policy. PhilHealth wanted to be in line with transitioning to universal health care (UHC) through being grounded in data. The project culminated in an implementation research training manual, 38 proficient implementation researchers and 5 fully executed, defended and actionable theses that became bases for policy reform.

“By Failing to prepare, you are preparing to fail.” – Benjamin Franklin

We spent the first month carefully ironing out the details of how to best serve our clients. We built the program through a client-centered approach, starting with a needs assessment. Our preliminary plan was simplified already but considering the responses, we had to rethink and redesign. We really only knew we were successful after the first few modules. Participant engagement and output quality kept getting better and better than we expected. Can you guess what we did right?

Part of training seasoned professionals is allowing each experience to enrich what is being taught. It was vital to get everyone comfortable enough to share with the group. Though it was an unusual exercise with colleagues, we asked group members to give forced rankings, and comment on each other’s good and bad traits. Afterward, we summarized the comments to the person, in front of everyone. With delicate matters like this, it is important to highlight the strengths without discounting the weaknesses. We outdid ourselves by drawing connections between how one person’s weakness can complement another’s strength, or even make another’s weakness look strong. For example, a strong leadership initiative could easily unite and steer, but it could also be overpowering. So then a less serious joker is now vital to gently nudge the overpowering leader down. After this exercise, we were able to thoroughly break the ice and easily commit to roles. Confident personalities, daring leadership and the serious commitment to the improvement of public health became apparent, and was recognized and shared.

As the modules ran, the planning team was adamant to cultivate constant improvement. Feedback was collected for each session, lecturer, day, module, and travel experience. Responses were important to gauge how well operations were planned and executed. Learning experiences were journalled after each day. This gave the participants time to consolidate what was taught and told the team how effective they were, while identifying what needed remedial. The planning team themselves set aside time at the end of each day to ask what went well, what didn’t and how we could improve. All the information was used to rework succeeding sessions and kept the program dynamic. Letting the participants know that we listened improved our relationship with them.

Of all of the methods, the dedicated one-on-one time was most effective in ensuring the participants grasp the concepts well. Each session had two parts, the lecture and active application. Once the lecture had concluded, the instructors would go around, address problems and guide the individual groups through worksheets. At this time, participants could ask for clarifications, groups could make better informed decisions and ultimately produced a better paper. It was important to get things right because the output from each module would contribute to the final research paper. As the day concluded, there was also time for participants to ask for remedials or counsel. The team made sure everyone was following along together. Taking the time to ensure everyone understood the lessons helped participants in accomplishing assigned work, even during the inter-module breaks.

“You may have to fight a battle more than once to win it.”― Margaret Thatcher

There were numerous challenges. To name a few poignant ones, our team had to face getting those unfamiliar with technology to love online integration and productivity tools. We worked to safely proceed with the modules despite seismic and hydro-meteorological hazards, or in other words, earthquakes and storms. The team also dealt with calibrating session intensity so they were manageable for those with full time jobs. We grappled with allowing extensions while adhering to the schedule, and adjusting to participants failing to attend due to sickness or sudden job reassignment. Every time we proceeded, we were met with more challenges. But I knew that we had to keep going.

I think the greatest challenge in this project was already knowing the many health system problems, and still being hopeful that we were going to significantly change it. Still, everyone knew there was no room for failure. The UHC bill was going to be signed into a law, everyone had a role in leading research in their districts, and everyone would report their findings in a national research forum that was already set. There was no stopping the train, so we kept moving too.

Though this project may just be a drop in the ocean, we all knew and agreed to take up the challenge because we wanted to make a difference in public health. This project was envisioned to be recurring within PhilHealth. Our participants will be the resource people to continue training and leading research for the next set of leaders.

In macro, it was a tall order to help the country transition to universal health care, as well as to make implementation researchers out of managers. But as they say, “every journey starts with a single step”. Change takes time, and we don’t expect to fix everything overnight. We must only persist.