Exploring the Role of Social Networks in Facilitating Health Service Access Among Low-Income Women in the Philippines: A Qualitative Study

Abstract

Despite efforts to implement universal health care coverage (UHC) in the Philippines, income poor households continue to face barriers to health care access and use. In light of recent UHC legislation, the aim of this study was to explore how gender and social networks shape health care access and use among women experiencing poverty in Negros Occidental, Philippines. Semi-structured interviews were conducted with women (n = 35) and health care providers (n = 15). Descriptive statistical analyses were performed to report demographic information. Interview data were analyzed thematically using a hybrid deductive-inductive approach and guided by the Patient-Centred Access to Health Care framework. Women’s decisions regarding health care access were influenced by their perceptions of illness severity, their trust in health care facilities, and their available financial resources. Experiences of health care use were shaped by interactions with health professionals, resource availability at facilities, health care costs, and health insurance acquisition. Women drew upon social networks throughout their lifespan for social and financial support to facilitate healthcare access and use. These findings indicate that social networks may be an important complement to formal supports (eg, UHC) in improving access to health care for women experiencing poverty in the Philippines.

Dramatic increases in knowledge, attitudes and practices of COVID-19 observed among low-income households in the Philippines: A repeated cross-sectional study in 2020

“…Concerns about visiting places with increased risk of disease transmission or mistrust surrounding infection prevention and control protocols may have decreased intentions to access and use public hospitals. Given the severely reduced income due to COVID-19 movement restrictions, many individuals experiencing extreme poverty would also not have been able to afford travel expenses to the health facility or any out-of-pocket expenses not covered by the national health insurance program [ 29 ]. The social costs of seeking care would have also had to be taken into consideration, including experiencing socioeconomic status discrimination at public health care facilities [ 29 ] or exclusion from their community due to the stigma associated with contracting the virus [ 30 ].…”

“…Given the severely reduced income due to COVID-19 movement restrictions, many individuals experiencing extreme poverty would also not have been able to afford travel expenses to the health facility or any out-of-pocket expenses not covered by the national health insurance program [ 29 ]. The social costs of seeking care would have also had to be taken into consideration, including experiencing socioeconomic status discrimination at public health care facilities [ 29 ] or exclusion from their community due to the stigma associated with contracting the virus [ 30 ]. Health systems worldwide, even those that were thought to be prepared [ 31 , 32 ], have come under pressure as a result of COVID-19, so it is perhaps unsurprising that existing patterns of exclusion remained unchanged.…”

Navigating fear and care: The lived experiences of community-based health actors in the Philippines during the COVID-19 pandemic

“…This study was part of a broader qualitative project investigating how a mid-size NGO in the Philippines has worked with staff to continue their community-based poverty alleviation work during the COVID-19 pandemic. International Care Ministries (ICM) is an NGO that aims to support ultra-poor households in the Philippines through providing community-level health education, experiential learning opportunities, and resource provision ( Luu et al, 2022 ). ICM operates programs across twelve regional bases in the Visayas and Mindanao islands and employs approximately 500 fulltime staff at various levels of work and management ( see Appendix A for a summary of ICM's organizational structure and associated staff roles ).…”

Extending health systems resilience into communities: a qualitative study with community-based actors providing health services during the COVID-19 pandemic in the Philippines

“…International Care Ministries (ICM) is an NGO based in the Philippines that operates programs focused on poverty alleviation with individuals and households experiencing ultra-poverty (defined by ICM as those living on less than 0.50 USD or 22 Philippine pesos per person per day) [ 20 , 21 ]. ICM's core program is called Transform, which is a 15-week program that provides weekly health and livelihood education sessions for approximately 30 individuals per community.…”