Older people’s self-perceptions of health and life satisfaction in the Philippines — A mixed methods application of the capability approach to monitoring and evaluating local health interventions.
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This mixed methods study was built around the implementation of HelpAge International’s global M&E tool ‘Health Outcomes Tool’ (HOT) in the Philippines. The tool measures the self-perceived health and life satisfaction of older persons in low- and middle-income countries. The research was designed to contribute to the on-going global validation process of the universalised HOT tool by evaluating its ability to quantify older Filipino people’s health capabilities in the unique socio-cultural and political-economic research context. Hence, in addition to collecting baseline health outcomes data, the research objectives were set to explain and contextualise the quantitative findings through qualitative methods. The data were collected via fieldwork over a 12-week-period in the urban Metro Manila and rural Quezon provinces of the Philippines. The sequential mixed methods study design consisted of baseline quantitative survey interviews via the HOT tool (N=309), as well as complementary qualitative applications of participatory focus group discussions (N=5) and follow-up interviews (N=16) with older persons, and key informant interviews (N=4) with a health officer of each research municipality. The deductive conceptual framework combined HelpAge International’s framework of the HOT tool, which is inspired by the WHO’s ‘healthy ageing’ policy framework, and the capabilities approach. From the freedom perspective of the capability approach, the opportunities which are definitive to the ability of the respondents to be healthy, but which are not provided for all, were found to be essentially related to the means of achieving a basis of financial security through pension or livelihood opportunities. In the absence of a universal pension system, financial security of older people is strongly inclined towards an individual’s ability to receive financial support from his/her children or other relatives; a capability which not everyone is free to choose. The tension between traditional socio-cultural expectations of filial piety and realities shaped by global processes (e.g. international migration) was found to be a great source of ambivalence for the older respondents. The findings of this study have thus implied a comprehensive socio-cultural and political-economic framework of a changing inter-generational contract. HelpAge International’s HOT tool was found to add to our understanding of older Filipinos’ health capabilities by focusing on the self-perceived functional ability of the respondents to achieve ‘beings and doings’. However, the nature and value of functionings were left for qualitative tools to discover. Hence, while the HOT tool has the ability to track the general situation and development of ‘healthy ageing’ globally through its key indicators, the findings of this study emphasise the need for complementary qualitative tool(s) to allow the full potential of country-specific learning in the M&E framework the HOT has been designed to serve, particularly in terms of local policy implications and future programme targeting.