Assessing Health System and Service Delivery Capacity in Responding to Changing Disease Patterns in the Philippines: An Analysis Using National Health Information System Longitudinal Data

Assessing Health System and Service Delivery Capacity in Responding to Changing Disease Patterns in the Philippines: An Analysis Using National Health Information System Longitudinal Data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessing Health System and Service Delivery Capacity in Responding to Changing Disease Patterns in the Philippines: An Analysis Using National Health Information System Longitudinal Data Yikai Feng, Roemer D. Tanghal, Beatriz Ianne Laolao, Junyi Shi, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7454742/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Jan, 2026 Read the published version in Human Resources for Health → Version 1 posted 9 You are reading this latest preprint version Abstract Background The Philippines is experiencing an escalating prevalence of non-communicable diseases (NCDs). As a country with aspirations of achieving universal health coverage, it is imperative to undertake evidence-based health planning to align health service coverage and health resources with the requisite NCD-related health services in each region. This study aimed to address the following questions: (1) In light of the mounting burden of NCDs, to what extent do the health systems and service delivery capacity align with the local health service needs? (2) Which regions require greater attention, and (3) Which aspects of health system strengthening should be prioritized in these regions? Methods Using regional, provincial, and municipal data from the Field Health Services Information System (FHSIS) Annual Report , the Philippine Statistical Yearbook , and the Philippine Health Statistics , we constructed the health care need index (HCNI) and health system and service delivery index (HSSDI) in each region. To ascertain the overall trend of these indicators across regions, we employed the average annual percent change (AAPC) for the longitudinal data of these indicators for the period 2010 to 2022 in calculating the health system development index (HSDI). The sub-indexes (for HCNI: health status index/ risk factor index; for HSSDI: health service coverage index/ health units index/ health workforce index; for HSDI: health service coverage development index/ health workforce development index) were employed to identify priority regions. Regression models and correlation analyses were used to ascertain the compatibility between the capacity of the health system and service delivery and the NCD-related health care need at the regional level. Findings The HCNI was higher in the Davao Region, Calabarzon, National Capital Region, BARMM, and Northern Mindanao (64.34/61.61/59.80/49.39/46.11), while the HSSDI for National Capital Region and Northern Mindanao were comparatively lower (25.25/26.24). The HSDI was lower in the National Capital Region, Davao Region, and BARMM (31.41/51.38/65.00). A negative correlation was observed between HSSDI and HCNI at both regional and provincial levels (β=-0.45, p < 0.05; β=-0.17, p < 0.05), indicating that there is an inverse relationship between the availability of health resources and the need for NCD-related health services in the Philippines. A positive correlation was noted between HSSDI and HSDI at the provincial and municipal levels (β = 0.20, p < 0.05), indicating that regions with low availability of health resources also exhibit health system development gaps. Specifically, the health workforce index demonstrated a negative correlation with the health status index (r=-0.29, p < 0.01), the proportion of adults aged 20 years and above with hypertension (r=-0.30, p < 0.01), and the proportion of adults aged 20 years and above with diabetes (r=-0.21, p < 0.01). Interpretation A more refined allocation of health resources is required in the Philippines in order to more effectively prevent, treat, and manage NCDs. The regions of Luzon (particularly the National Capital Region and Calabarzon) and Mindanao (including the Davao Region, BARMM, and Northern Mindanao) have been identified as priority areas with high needs for NCD-related health care services and low health care service delivery capacity. The health workforce is a crucial area for improvement, and the Philippine government should prioritize the training and development of human resources for health to address the growing threat of NCDs. Funding This study was supported by the National Science and Technology Project on Development Assistance for Technology: Developing China-ASEAN Public Health Research and Development Collaborating Center (No. KY202101004). The funders had no role in the design of the study, the collection, analyses, or interpretation of data, the writing of the manuscript, or the decision to publish the results. Philippines NCDs Needs assessment Health system development Health planning Full Text Additional Declarations No competing interests reported. Appendix Figures 1-3 and Appendix Tables 1-3 are not available with this version. Cite Share Download PDF Status: Published Journal Publication published 05 Jan, 2026 Read the published version in Human Resources for Health → Version 1 posted Editorial decision: Revision requested 07 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviews received at journal 15 Sep, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviewers invited by journal 07 Sep, 2025 Editor assigned by journal 27 Aug, 2025 Submission checks completed at journal 27 Aug, 2025 First submitted to journal 25 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7454742","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512607906,"identity":"2d171cc6-fbf3-47fb-8072-054808590b79","order_by":0,"name":"Yikai Feng","email":"","orcid":"","institution":"Peking University","correspondingAuthor":false,"prefix":"","firstName":"Yikai","middleName":"","lastName":"Feng","suffix":""},{"id":512607909,"identity":"0dfb6681-52ff-4b18-b436-303868514675","order_by":1,"name":"Roemer D. 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As a country with aspirations of achieving universal health coverage, it is imperative to undertake evidence-based health planning to align health service coverage and health resources with the requisite NCD-related health services in each region. This study aimed to address the following questions: (1) In light of the mounting burden of NCDs, to what extent do the health systems and service delivery capacity align with the local health service needs? (2) Which regions require greater attention, and (3) Which aspects of health system strengthening should be prioritized in these regions?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing regional, provincial, and municipal data from \u003cem\u003ethe Field Health Services Information System (FHSIS) Annual Report\u003c/em\u003e, \u003cem\u003ethe Philippine Statistical Yearbook\u003c/em\u003e, and \u003cem\u003ethe Philippine Health Statistics\u003c/em\u003e, we constructed the health care need index (HCNI) and health system and service delivery index (HSSDI) in each region. To ascertain the overall trend of these indicators across regions, we employed the average annual percent change (AAPC) for the longitudinal data of these indicators for the period 2010 to 2022 in calculating the health system development index (HSDI). The sub-indexes (for HCNI: health status index/ risk factor index; for HSSDI: health service coverage index/ health units index/ health workforce index; for HSDI: health service coverage development index/ health workforce development index) were employed to identify priority regions. Regression models and correlation analyses were used to ascertain the compatibility between the capacity of the health system and service delivery and the NCD-related health care need at the regional level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe HCNI was higher in the Davao Region, Calabarzon, National Capital Region, BARMM, and Northern Mindanao (64.34/61.61/59.80/49.39/46.11), while the HSSDI for National Capital Region and Northern Mindanao were comparatively lower (25.25/26.24). The HSDI was lower in the National Capital Region, Davao Region, and BARMM (31.41/51.38/65.00). A negative correlation was observed between HSSDI and HCNI at both regional and provincial levels (β=-0.45, p \u0026lt; 0.05; β=-0.17, p \u0026lt; 0.05), indicating that there is an inverse relationship between the availability of health resources and the need for NCD-related health services in the Philippines. A positive correlation was noted between HSSDI and HSDI at the provincial and municipal levels (β = 0.20, p \u0026lt; 0.05), indicating that regions with low availability of health resources also exhibit health system development gaps. Specifically, the health workforce index demonstrated a negative correlation with the health status index (r=-0.29, p \u0026lt; 0.01), the proportion of adults aged 20 years and above with hypertension (r=-0.30, p \u0026lt; 0.01), and the proportion of adults aged 20 years and above with diabetes (r=-0.21, p \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA more refined allocation of health resources is required in the Philippines in order to more effectively prevent, treat, and manage NCDs. The regions of Luzon (particularly the National Capital Region and Calabarzon) and Mindanao (including the Davao Region, BARMM, and Northern Mindanao) have been identified as priority areas with high needs for NCD-related health care services and low health care service delivery capacity. The health workforce is a crucial area for improvement, and the Philippine government should prioritize the training and development of human resources for health to address the growing threat of NCDs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e This study was supported by the National Science and Technology Project on Development Assistance for Technology: Developing China-ASEAN Public Health Research and Development Collaborating Center (No. KY202101004). The funders had no role in the design of the study, the collection, analyses, or interpretation of data, the writing of the manuscript, or the decision to publish the results.\u003c/p\u003e","manuscriptTitle":"Assessing Health System and Service Delivery Capacity in Responding to Changing Disease Patterns in the Philippines: An Analysis Using National Health Information System Longitudinal Data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-16 07:30:29","doi":"10.21203/rs.3.rs-7454742/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-07T05:36:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-07T01:13:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"329421883113107331997577444833674309526","date":"2025-09-16T16:05:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-15T17:53:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177476787241530374600244612687247265932","date":"2025-09-15T16:13:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-07T16:03:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-27T10:38:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-27T10:38:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Human Resources for Health","date":"2025-08-25T14:11:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"human-resources-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrhe","sideBox":"Learn more about [Human Resources for Health](http://human-resources-health.biomedcentral.com)","snPcode":"12960","submissionUrl":"https://submission.nature.com/new-submission/12960/3","title":"Human Resources for Health","twitterHandle":"@HRH_Journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"43cd7ee1-41cd-470c-a5ec-72c4d8f63f78","owner":[],"postedDate":"September 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:10:07+00:00","versionOfRecord":{"articleIdentity":"rs-7454742","link":"https://doi.org/10.1186/s12960-025-01041-z","journal":{"identity":"human-resources-for-health","isVorOnly":false,"title":"Human Resources for Health"},"publishedOn":"2026-01-05 15:59:06","publishedOnDateReadable":"January 5th, 2026"},"versionCreatedAt":"2025-09-16 07:30:29","video":"","vorDoi":"10.1186/s12960-025-01041-z","vorDoiUrl":"https://doi.org/10.1186/s12960-025-01041-z","workflowStages":[]},"version":"v1","identity":"rs-7454742","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7454742","identity":"rs-7454742","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}