Translating expert opinion to effective health governance and evidence-based decision-making for Covid-19

15 October 2020

This article originally appeared in Health Systems Governance Collaborative here

Expanding technical capacity

When Covid-19 hit the Philippines last January 2020, a lot of the science behind the disease response was still unknown. Testing was prioritized, and the Department of Health (DOH) grappled with increasing the number of capable testing laboratories and personnel, whilst balancing proper regulatory and safety standards.  At the same time DOH had to understand a wave of potentially game-changing new technologies in pandemic management and response.

As a response, DOH formally convened a Covid-19 Laboratory Expert Panel (CLEP)[1], composed of experts in fields of chemistry, biochemistry, molecular biology, pathology, medical technology, laboratory management, and public health. These individuals have strong and trusted relationships with the DOH and the Department of Science and Technology (DOST) as experts and consultants in former projects. The ad hoc panel provides evidence-based, independent, technical assessment and advice to the agency on all matters related to Covid-19 testing.

Translating expertise to decisions and actions

DOH engagement with CLEP has resulted to significant gains in policy and governance for COVID-19 testing:

• Interdisciplinary expertise complemented field experience to create a responsive strategy arc for expanded testing capacity. The CLEP hit the ground running by recommending strategies focused on (1) standardizing processes that ensure biosafety and accuracy, (2) investing in capacity-optimizing interventions such as automatic testing platforms and mobile pop-up laboratories, and (3) centralizing data management and funding to ensure efficiency and economies of scale. The diverse expertise of the panel allowed comprehensive recommendations.

Members of CLEP have been previously involved in laboratory personnel training and volunteer management. They married field experience with technical proficiency to form policy recommendations grounded in both scientific evidence and practical understanding.

• CLEP objectively reviews new technologies and crafts scientifically based recommendations to guide policy and implementation. With Covid-19 becoming a highly political issue, the DOH is pressured to make immediate decisions on a lot of challenging matters.  The private laboratory sector lobbied strongly to make use of rapid antibody tests as part of return to work clearance protocols. WHO recommended relaxing biosafety standards for GeneXpert facilities targeting poorer and resource-constrained areas. Antigen testing and pooled testing[2] are also being positioned by external stakeholders and other government partners as means to quickly scale-up testing capacity.

In the end, rapid antibody tests were still included in the expanded testing protocol, and standards for GeneXpert facilities were not relaxed. While these were not in accordance with CLEP recommendations, the engagement still resulted positively. The retained standards for GeneXpert facilities were comprehensively explained, shaping a well-rationalized policy. Technical guidance on proper use and disposal of rapid antibody tests were also provided to mitigate risks. Expert advice is currently guiding the strategic roll-out of pooled testing to fully realize its gains.

• Expertise allowed for immediate, continuous discourse on relevant innovation. Given their networks, CLEP members were able to identify two early but promising innovations for a more efficient Covid-19 testing: (1) the use of saliva as specimen for testing, and (2) onsite deactivation of collected samples. Published and unpublished literature were reviewed to guide initial recommendations. Expert discussions with other resource persons from WHO also polished ways forward.

The use of saliva as specimen and onsite deactivation of collected samples have the  potential to significant resources savings, while also safely scaling up testing capacity. The country’s national reference laboratory, the Research Institute for Tropical Medicine, is in the process of validating the applicability of these innovations in the local setting. The CLEP continues to provide technical guidance in these studies.

Continuing strategic engagements with stakeholders toward effective health governance

Deliberate and well-organized convening of external experts resulted in the swift development of evidence-based policies that offer better ammunition against the pandemic. Although individual members of CLEP work outside the DOH, regular and legitimate platforms of participation allowed strategic harnessing of their knowledge and skills. DOH has used a similar approach in the past – an ad hoc panel of health systems experts that provided technical advice in the drafting of the Implementing Rules and Regulations of the Universal Health Care Act, and more recently the law-mandated, institutionalized Health Technology Assessment Council that provides objective review of technologies for government purchasing. All of which have expanded the government’s capacity for better informed decision-making. Such strategic governance mechanisms should be continued to engage other key experts and relevant stakeholders, even beyond the pandemic. These efforts evidently allow for a more inclusive, collaborative stakeholder engagement that strengthens and facilitates units like the DOH, particularly its key function of providing stewardship over health care service delivery in a rational and efficient manner.

Written by Christian Edward Nuevo (1), Lindsay Orsolino (2), Kim Patrick Tejano (3), Maria Eufemia Yap (1), Matt Boxshall (4)

1. Strategic Purchasing for Primary Health Care (SP4PHC), ThinkWell Philippines
2. Office of the Secretary of Health, Department of Health Philippines
3. Health Regulations Team, Department of Health Philippines
4. ThinkWell United States of America

[1] through Department Personnel Order 2020 – 1348 and its amendment

[2] A means of combining samples for testing from several individuals and combining one laboratory test on the combined batch