Journal of Alzheimer’s Disease 97 (2024) 1533–1543 1533

DOI 10.3233/JAD-230845
IOS Press

Review

Current Status and Challenges in Dementia

Care in the Philippines: A Scoping Review
Veeda Michelle M. Anlacana,b,c,1,∗ , Pamela Danielle T. Lanuzaa,1 , Anna Anjelica R. Sanchezb,d
and Roland Dominic G. Jamoraa,b,e
a Department of Neurosciences, Division of Adult Neurology, College of Medicine and Philippine General
Hospital, University of the Philippines Manila, Manila, Philippines
b Department of Internal Medicine, Section of Adult Neurology, Cardinal Santos Medical Center, San Juan City,

Philippines
c Department of Neurology, Institute of Neurological Sciences, The Medical City, Pasig City, Philippines
d Department of Clinical Neurosciences, Section of Neurology, University of the East Ramon Magsaysay Memorial

Medical Center, Quezon City, Philippines

e Institute for Neurosciences, St. Luke’s Medical Center, Quezon City and Global City, Philippines

Accepted 5 December 2023

Pre-press 25 January 2024

Abstract.
Background: Dementia prevalence is increasing in low- and middle-income countries such as the Philippines.
Objective: This study aimed to give an overview of dementia care in the Philippines and to identify gaps in terms of local
epidemiology, research, financial coverage, diagnostics, pharmacotherapy, manpower, and caregiver support.
Methods: This scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-analysis
guidelines extension for scoping reviews. Six international and two local databases, and government and non-government
websites were searched. Data published in the English or Filipino language on dementia epidemiology, research, diagnostics,
management, manpower, and training were extracted from the earliest indexed record until June 2022.
Results: The prevalence of dementia in the Philippines is high and research output on all aspects of dementia is low. Cost is a
major barrier as health care coverage is limited, with reliance mainly on out-of-pocket payments, leading to challenges in the
proper diagnosis and treatment of dementia. There is a low specialist-to-population ratio, with shortages beyond manpower
and training.
Conclusions: Gaps in dementia care include limited published local data, high healthcare costs, inadequate health financing,
and limited manpower.

Keywords: Alzheimer’s disease, dementia, health status, practice gaps

INTRODUCTION

1 These authors contributed equally to this work. Dementia is a neurocognitive disorder present-
∗ Correspondence to: Veeda Michelle M. Anlacan, MD, Divi- ing with deterioration in cognitive function beyond
sion of Adult Neurology, Department of Neurosciences, College what is expected from the consequences of biologi-
of Medicine and Philippine General Hospital, University of the
cal aging, significantly interfering with activities of
Philippines Manila, Manila, Philippines. Tel.: +639189197143;
E-mail: vmanlacan@up.edu.ph; ORCID ID: 0000-0002-1241- daily living and social autonomy [1]. Approximately
8805. 60% of people with dementia currently reside in low-

ISSN 1387-2877 © 2024 – The authors. Published by IOS Press. This is an Open Access article distributed under the terms
of the Creative Commons Attribution-NonCommercial License (CC BY-NC 4.0).
1534 V.M.M. Anlacan et al. / Challenges in Dementia Care in the Philippines

and middle-income countries (LMIC) including the apy, manpower availability, and caregiver training for
Philippines [2]. Filipinos aged 60 and older com- dementia in the Philippines. Case reports, abstracts
prised 7.5% of the total Philippine population as of only, and animal and plant studies were excluded.
2020 [3], and this proportion is expected to increase Articles not in English or Filipino were excluded.
to 12.8% by 2035 [4]. Only human studies set in the Philippines were
The Philippines is an archipelago with 7,641 included, with studies on Filipinos or healthcare
islands subdivided into 17 administrative regions, workers living abroad excluded. No restrictions were
81 provinces, 145 cities, 1,489 municipalities, and set in terms of the date of publication.
42,044 barangays, each with their own local govern-
ing bodies [5, 6]. With the enactment of the Local Information sources
Government Code of 1991 or Republic Act (RA)
7160, the autonomy and responsibility of provid- We searched international databases including
ing basic health services have been transferred to PubMed, Scopus, EMBASE, EBSCO, Web of Sci-
the local government units [5, 7]. While this devo- ence, and ClinicalTrials.gov. We also searched local
lution was implemented to encourage self-reliance medical databases such as the Health Research
and ensure efficiency in the allocation and distribu- and Development Information Network (HERDIN)
tion of resources, difficulties in coordination between and Philippine E-Journals for relevant studies.
national and local governments, poor health prioriti- We accessed pertinent and available literature
zation, lack of facilities and skilled health workers, via official websites of international organizations
and poorly functioning referral systems have led to a (i.e., World Health Organization, World Bank),
fragmented system delivering inadequate services to government and non-government agencies [i.e.,
vulnerable groups such as older adult Filipinos [5, 7]. Philippine Department of Health (DOH), Philippine
Earlier scoping reviews have explored the status Health Insurance Corporation (PhilHealth), Philip-
and challenges in the care of people with various pine Statistics Authority (PSA), National Institutes
neurological disorders such as bacterial meningi- of Health-Institute of Aging, and local professional
tis, autoimmune encephalitis, brain tumors, epilepsy, organizations (i.e., Philippine Neurological Associ-
multiple sclerosis, and Parkinson’s disease in the ation (PNA), Alzheimer’s Disease Association of
Philippines [8–13], but comprehensive local data on the Philippines (ADAP), Dementia Society of the
dementia remains lacking. This scoping review aimed Philippines (DSP), Philippine College of Geriatric
to give an overview of dementia care in the Philip- Medicine (PCGM), and the Philippine Society of
pines and to identify challenges and gaps in the Geriatrics and Gerontology (PSGG)]. Data on the
provision of dementia care in terms of local epi- cost of diagnostics and medications were identi-
demiology, research, financial coverage, diagnostics, fied through relevant laboratories and institutions via
pharmacotherapy, manpower, and caregiver support. website and phone queries. Due to paucity of data on
some categories, grey literature was explored through
METHODS links and secondary searches.

Protocol Search and selection of sources

Our study adhered to the Preferred Reporting Items We conducted a scoping review of the available
for Systematic reviews and Meta-analysis (PRISMA) literature from the earliest indexed record until June
extension for scoping reviews [14]. This article does 2022 using “(dementia OR Alzheimer∗ OR vascular
not contain any studies involving human or animal dementia OR Lewy body disease OR frontotempo-
participants performed by any of the authors. ral dementia) AND Philippines” as our search string.
Duplicates were excluded. Authors PDL, AAS, and
Eligibility criteria VMA separately screened all titles and abstracts
based on the eligibility criteria; author RDJ was con-
We considered published systematic reviews, sulted for disagreements. We then retrieved the full
review articles, cohort studies, conference pro- text of eligible articles for data extraction.
ceedings, clinical practice guidelines, and local We also searched the websites of international
government data on the local epidemiology, research and local organizations as previously mentioned
output, health financing, diagnostics, pharmacother- using the terms “incidence, prevalence, research,
 V.M.M. Anlacan et al. / Challenges in Dementia Care in the Philippines 1535

cost, laboratory, medication, neurologist, psychi- global research between 2017 and 2025 [2]. Research
atrist, geriatrician, caregiver,” “dementia,” AND productivity in the field of dementia has been noted
“Philippines.” to be growing rapidly over the recent years; however,
research output on dementia in the Philippines has
RESULTS remained low. In a previously conducted systematic
search of published articles on dementia in South-
The search of studies east Asia by Sy, et al. (2020), only 11 out of 1,006
(1.1%) publications were from the Philippines, com-
The search yielded a total of 438 articles (see prising only 8 of the 687 (1.2%) publications found
Fig. 1). We then screened 321 articles after duplicates in journals with impact factor [18]. This signifies the
were removed. A total of 97 full-text articles were need for adequate resources and government support
assessed for eligibility, out of which we excluded 22 in order to advance dementia research in the country.
articles which did not have data on the Philippines,
and which focused on delirium, test construction, and Financial coverage of costs
validation for their main topic. Thus, a total of 75 arti-
cles were included for synthesis. Of the 75 articles, The Philippines’ current health expenditure (CHE)
10 focused on epidemiology, 3 on research, 23 on has increased by 12.6%, from USD 14.34 billion in
health service delivery and financing, 5 on diagnos- 2019 to USD 16.14 billion in 2020. Its total health
tics, 18 on management, 8 on manpower resources, 8 expenditure (THE), considering the health capital for-
on caregiver support. mation expenditure, has also increased by 10.4%,
from USD 16.39 billion in 2019 to USD 18.02 billion
The local epidemiology of dementia in 2020; now accounting for 5.6% of the coun-
try’s gross domestic product (GDP). Consequently,
As of 2015, the prevalence of dementia in the per capita health spending has also increased by
Philippines was 10.6% for those 60 years and over, 10.7%, from USD 133.74 in 2019 to USD 148.04 in
with an age-standardized prevalence of 14.2%, equat- 2020. However, despite these improvements in health
ing to an estimated 726,864 people living with financing, the Philippines still only ranks 6th out of 11
dementia [15]. As of 2021, the estimated dementia countries in Southeast Asia, with its THE per capita
incidence in the Philippines was at 16 per 1,000, with equating to only 5.4% of that of Singapore [19]. Over
an estimated increase in dementia cases to 1,474,588 the past decades, out-of-pocket spending has been the
by 2030, 1,972,067 by 2040, and 2,529,436 by 2050 leading source of health expenditure in the country.
[16]. The most common subtype of dementia was In 2020, government schemes and compulsory con-
AD (85.5%), followed by vascular dementia (11.7%), tributory health care financing schemes contributed
and other dementias (2.7%). Increasing age was asso- the largest percentage to health expenditure (45.7%),
ciated with an increased risk for dementia, while but household out-of-pocket payments still came in
educational attainment was associated with a reduced at a close second place (44.7%) [20]. As per the latest
risk. Sex and civil status were not associated with PSA data, the average annual family income is USD
dementia risk [15]. The mean total disease duration 5,640 (USD 1.00 = PhP 55.5 as of May 1, 2023), with
was 3.84 years, with an estimated disability-adjusted an average annual family expenditure of USD 4,306,
life years of 2,876 years per 100,000 persons [16]. In of which only 2.7% is being allocated for health [21].
order to address the lack of updated data on dementia In order to provide some financial risk protec-
incidence and prevalence, the PNA is in the process tion, PhilHealth was established through the National
of creating a multi-center, prospective database on Health Insurance Act of 1995, with the goals of
Filipinos diagnosed with cognitive impairment and providing health insurance coverage and ensur-
dementia, targeted to be completed by 2024 [17]. ing affordable, acceptable, available, and accessible
healthcare services for all Filipinos [22]. Through
Dementia research in the Philippines RA 10645, all senior citizens are automatically cov-
ered by the National Health Insurance Program [23].
Dementia research and innovation has been identi- Some of the common causes for hospital admissions
fied as an action area in the WHO’s global action plan in older adults, including pneumonia, osteoporosis,
on the public health response to dementia for 2017- osteoarthritis, and dementia are covered by Phil-
2025, with the global target of doubling the output of Health; in particular, case rates for dementia ranged
1536 V.M.M. Anlacan et al. / Challenges in Dementia Care in the Philippines

Fig. 1. Flow diagram adapted from PRISMA extension for scoping reviews.

from USD 141-180 [24]. However, despite its high of medicines, vaccines, medical and dental services,
coverage (92%), benefit utilization is low, likely due and diagnostic and laboratory fees in all private facil-
to poor awareness of members and maldistribution ities, as well as free medical and dental services,
of health services and facilities [5, 6]. Social insur- and diagnostic and laboratory fees in all government
ance programs such as the Social Security System facilities [26]. In 2017, the DOH has issued policy
for the private sector and the Government Service guidelines on the standards of care for older persons
Insurance System for the public sector also aim to in the acute and sub-acute care, rehabilitation facility,
provide financial protection for their members, but continuing care retirement community and long-term
they remain poorly utilized. Based on the 2014 Con- care settings; enumerating guidelines on the creation
sumer Finance Survey, only 1 in every 4 economically of safe and secure environments and strengthening
dominant household members aged 60 and above collaborative effort among various stakeholders [27].
were covered by social security, with 1 in every 4 pen- Lastly, the National Commission of Senior Citizens
sioners receiving a monthly pension of below USD Act (RA 11350) was also created in 2019 to ensure
36, and 3 in every 5 pensioners receiving a monthly the full implementation of government laws, poli-
pension of below USD 90 [25]. Another means of cies, and programs on senior citizens, as well as
alleviating financial burden on older adults was the to formulate policies geared towards the promotion
passage and implementation of the Senior Citizens and protection of the rights and well-being of senior
Act (RA 7432), further amended by the Expanded citizens [28]. This legislation, however, effectively
Senior Citizens Act of 2003 (RA 9257) and 2010 (RA misses out on the population of young-onset demen-
9994). Through these legislations, older adults are tia and also does not provide additional benefits to
now entitled to a twenty percent discount and exemp- older adults living with dementia who require higher
tion from the value-added tax (VAT) in the purchase levels and costs of care.
 V.M.M. Anlacan et al. / Challenges in Dementia Care in the Philippines 1537

Challenges in the diagnosis of dementia National Formulary (PNF). The PNF contains the list
of essential medicines that can be procured by the
Initial assessment of dementia heavily relies on the government and serves as the basis for PhilHealth
patient’s clinical history, with emphasis on the cog- reimbursement for public and private health facilities.
nitive, behavioral, and psychological symptoms, and However, only donepezil (5 mg and 10 mg tablets)
the impact of these symptoms on the patient’s daily and rivastigmine (1.5 mg, 3 mg, and 6 mg capsules)
activities. A complete physical examination, includ- are included in the PNF [33]. Noticeably absent on
ing a neurologic examination, should be performed to the PNF are higher doses of donepezil (23 mg tablet),
exclude possible visual and auditory problems and to rivastigmine (4.6 mg/24 h patch 5, 9.5 mg/24 h patch
check for focal neurologic deficits. Several cognitive 10, 13.3 mg/24 h patch 15), and memantine 20 mg
assessment tools in the form of validated question- tablet. The Drug Price Reference Index (DPRI) enu-
naires are available to evaluate the patient’s cognition, merates the ceiling prices of essential medicines for
mood, behavior, and functional performance. Labora- government bidding and procurement. The recom-
tory tests and neuroimaging studies are also necessary mended cost of the following drugs as per the DPRI
to rule out reversible (i.e., toxic, metabolic, infec- are USD 0.30 for donepezil 5 mg tablet, USD 0.28 for
tious) causes of cognitive decline (see Table 1) [29]. donepezil 10 mg tablet, and USD 0.77 for meman-
Diagnostic tests are primarily funded out-of- tine 10 mg tablet [34]. However, locally available
pocket, as PhilHealth only covers in-hospital memantine 10 mg costs USD 0.41–2.54, memantine
admissions and coverage is based on predetermined 20 mg costs USD 4.54, donepezil 5 mg costs USD
case rates (see Table 2). Dementia has a case rate 0.45–2.03, donepezil 10 mg costs USD 0.68–2.64,
of USD 180, with USD 54 as professional fee and and donepezil 23 mg costs USD 2.57 (see Table 3).
USD 126 as hospital fee. Given the nature of the The wide price range is accounted for by the unavail-
disease, most people with dementia are seen in out- ability of generic versions for memantine 20 mg and
patient clinics. Consultation fees with neurologists in donepezil 23 mg. As of June 2022, the minimum
private clinics typically range from USD 15 to USD wage is USD 10 per day, with the average Filipino
45, while consultation fees with dementia specialists family spending 42.6% on food, 12.2% on house
in memory clinics typically range from USD 36 to rental, 8.2% on utilities, 6.61% on transportation, and
USD 90 [30, 31]. These are not yet covered by Phil- only 2.7% on healthcare [21, 35].
Health and may only be partially covered by private In addition to laboratory tests, neuroimaging stud-
health maintenance organizations or insurance. ies, and medications, other direct medical costs
include consultation and hospitalization fees, and
Challenges in the treatment of dementia caregiver salaries. Direct non-medical costs include
nursing home fees, transportation costs to healthcare
Management of dementia involves both pharma- providers, and costs of home safety modifications.
cologic and non-pharmacologic treatment strategies. Lastly, indirect costs include the potential earn-
Medications used in the treatment of dementia ing capacity of unpaid caregivers. In a Filipino
include acetylcholinesterase inhibitors (donepezil, community-based study done in 2016, the median
galantamine, and rivastigmine) and N-methyl-D- direct medical cost was computed at USD 237.40,
aspartate antagonist (memantine). Galantamine is no while direct non-medical cost was at USD 6.57, with
longer available in the Philippines as of May 1, the total median indirect cost at USD 229.03. Adding
2023. Comparing the cost, availability, and afford- up the annual indirect costs due to unpaid caregiving,
ability of these AD drugs among 21 countries across the median direct cost was USD 3,650, making the
6 continents, these drugs have been noted to be overall total annual per capita cost at USD 3,916.47
more expensive in LMIC compared to high-income [16].
countries. In addition, most high-income countries
subsidize the cost of these medications through health Manpower density
insurance, while patients spend for these medications
from their own pockets in LMICs [32]. Although the Philippines can educate and develop
The Philippine government’s response to the inac- numerous healthcare professionals, a significant
cessibility of essential medications over the past years number is lost due to migration to higher income
was the legislation of the Generics Act of 1988, countries. In a 2017 study, the desire to migrate in
and consequently, the development of the Philippine the next 2 years was noted in 29% of doctors, 51%
1538 V.M.M. Anlacan et al. / Challenges in Dementia Care in the Philippines

Table 1
Cost of laboratory and neuroimaging tests in government and private hospitals
Test Cost, in USD Cost, in USD Cost, in USD
(Government – (Government – Full) (Private)∗∗
Subsidized)∗
Basic work-up
Complete blood count 0–3 5 12
Basic electrolytes 0–14 30 105
Thyroid function test 0–12 21 105
Rapid plasma reagin 0–3 8 14
Serum B12 Not available Not available 117
Additional work-up
Serum amyloid Not available Not available 400
ApoE4 Not available Not available 101
Cranial CT scan plain 0–27 67 168
Cranial MRI plain 0–78 99 296
Cranial FDG PET∗∗∗ plain Not available Not available 1,100
Cranial FDG PET with contrast Not available Not available 1,255
Cranial amyloid PET Not available Not available 2,672
Electroencephalogram 0–20 49 46
∗ Diagnostic test prices from the Philippine General Hospital listed as of May 1, 2023 [30].
∗∗ Diagnostic test prices from St. Luke’s Medical Center listed as of May 1, 2023 [31]. ∗∗∗ Fully or
partially subsidized, irrespective of insurance coverage. FDG, F-fluorodeoxyglucose; PET, positron
emission tomography; CT, computed tomography; MRI, magnetic resonance imaging.

Table 2
PhilHealth case rates for dementia as of May 1, 2023
ICD 10 Description Case Rate Professional Health Care
Code (USD) Fee (USD) Institution
Fee (USD)
F01.0 Vascular dementia of acute onset 148 44 103
G30.9 + F00.9** Dementia in Alzheimer’s disease, unspecified 180 54 126
G31.8 Lewy body dementia 180 54 126
B22.0 HIV dementia 400 120 280
F01.1 Multi-infarct dementia, predominantly 141 42 98
cortical dementia
F01.8 Other vascular dementia 141 42 98
F01.9 Vascular dementia, unspecified 141 42 98
F03 Unspecified dementia, presenile dementia 141 42 98
**HIV – human immunodeficiency virus, USD – United States dollar.

of nurses, 61% of physical therapists, and 24% of doubt in their ability to diagnose dementia clinically
midwives, contributing to the gap in the available and 92% will opt to refer their patients to specialists
manpower especially in rural areas [37]. From 1990 such as neurologists, psychiatrists and geriatricians
to 2017, a total of 350,361 healthcare professionals for diagnosis and treatment [40]. There are 664 active
have left the country: 95% of which are nurses, 3% are fellows of the Philippine Neurological Association,
doctors, and 2% are midwives [38]. To stem the tide nearly half practice in the National Capital Region
of migration and ensure a steady supply of doctors, (NCR), and a nationwide a ratio of 1 neurologist per
the University of the Philippines College of Medicine 164,156 Filipinos. There are only eleven dementia
started requiring their graduates in 2011 to sign con- specialists in the country, and all but one practice in
tracts of return service, which entails residing and NCR. There are twelve accredited training institu-
working in the Philippines for the next 5 years after tions for Adult Neurology in the Philippines, nine of
graduation [39]. which are in NCR. Fellowship training in dementia is
At the emergence of dementia symptoms, people offered in only three institutions in NCR [41]. There
and caregivers often turn to their primary care physi- are only ten memory clinic sites in the country mostly
cian for a diagnosis. However, in a local study done in staffed by neurologists, with a few clinics under geri-
2000, 64% of primary care physicians expressed their atrics and wellness offering similar services. There
 V.M.M. Anlacan et al. / Challenges in Dementia Care in the Philippines 1539

are two university hospital-based memory centers: the next thirty years, the discrepancy in terms of the
University of Santo Tomas Hospital (private) and the amount of attention older Filipinos receive also con-
Philippine General Hospital (government). The only tinues to widen. Local research on dementia remains
DOH-funded hospital with a memory center is the limited, potentially due to paucity of financial and
National Center for Mental Health; all other mem- human resources and institutional support. However,
ory clinics are in private hospitals [42]. There are the increase in research productivity on dementia
only 591 psychiatrists and 140 geriatricians in the in recent years within the region, has encouraged
country, with a ratio of 1 : 184,433 and 1 : 778,571 researchers in the country to contribute to local data
respectively (Table 4) [43, 44]. Lastly, there are 133 which could be useful in the development of a more
psychologists (0.1 : 100,000), 516 psychiatric nurses culturally appropriate plan of care [18]. And although
(0.5 : 100,000), and 1,241 mental health social work- the national government has enacted laws and poli-
ers (1.2 : 100,000) in the Philippines [45]. These data cies which aim to protect and improve the quality of
highlight the lack of healthcare professionals trained life of older adults, the devolution of management to
in providing care for persons with dementia. local government units who do not imbibe the same
priorities results in fragmented care.
Caregiver training and support Cost is one of the major barriers preventing Fil-
ipino persons with dementia from getting high quality
Rooted in the Filipino concept of utang na loob of care. Despite increasing health expenditures by
(debt of gratitude) and giving back to one’s parents, the government, the Philippines still lags behind its
co-residence with family members remains to be the neighboring countries in Southeast Asia in terms of
most common living arrangement for older Filipinos. THE per capita; ranking at 6th place behind Singa-
The primary caregiver is often a female family mem- pore, Brunei, Malaysia, Thailand, and Vietnam. The
ber, who is either the patient’s spouse or daughter Philippines’ THE equates to only 5.4% of that of
[46]. However, the majority of caregivers taking care Singapore and is only twice that of Myanmar [51].
of older adult Filipinos have never received formal Efforts by the national government to provide finan-
training on dementia care [47]. At present, govern- cial risk protection in the form of social insurance
ment organizations and specialty medical societies programs are inadequate to cover both direct and indi-
conduct caregiver training programs for both family rect expenses from the diagnosis of dementia up to
caregivers and rural health workers on basic dementia long-term home care. The national health insurance
care. The Philippine Technical Education and Skills is poorly utilized, and at best, only partially covers
Development Authority offers a caregiving training in-patient admissions, while social insurance in the
program which includes provision of care and sup- form of monthly pensions is barely enough to shoul-
port to older adults as one of its core competencies; der the cost of dementia medications. This forces
however, there are no specific modules on caring for persons with dementia and their families to rely on
people with dementia [48]. In 2018, the WHO has out-of-pocket payments to shoulder their expenses;
created a dementia toolkit for community workers a formidable challenge when the minimum wage is
in low-and middle-income countries which aims to USD 10 per day and may even be less, depending on
assist community workers in identifying people at the region of residence [35].
risk for dementia, providing support to people with This study further emphasizes the disparity
dementia and their families, and engaging local com- between the availability, accessibility, and affordabil-
munities in dementia-related activities [49]. ity of diagnostics and therapeutics between public
and private health systems. Laboratory and neu-
DISCUSSION roimaging tests typically cost 2–10 times more in
private compared to that of government facilities that
The Philippines has an aging population, with offer full coverage. More sophisticated tests such as
a high dementia prevalence projected to be twice serum amyloid and cranial amyloid positron emission
the crude estimated prevalence for the entire South- topography scans are only available in private institu-
east Asia in 2015 [50]. Despite the total number of tions. Consultation fees with private neurologists and
older persons being large in absolute numbers, the dementia specialists roughly cost 2–6 times the mini-
relative numbers remain small, hence they do not mum wage. In terms of treatment, not all medications
receive much attention from government agencies. for dementia are included in the national formulary,
With projections for these numbers to increase in with most pharmacies dispensing branded medica-
1540 V.M.M. Anlacan et al. / Challenges in Dementia Care in the Philippines

Table 3
Cost of available dementia medications in the Philippines∗ as of May 1, 2023
Drug Formulation Price (USD)
Donepezil Donepezil 5 mg tab 0.45–2.03
Donepezil 10 mg tab 0.68–2.64
Donepezil 23 mg tab 2.57
Rivastigmine Rivastigmine 4.6 mg/24 h patch 5 1.95
Rivastigmine 9.5 mg/24 h patch 10 2.38
Rivastigmine 13.3 mg/24 h patch 15 2.38
Memantine Memantine 10 mg tab 0.41–2.54
Memantine 20 mg tab 4.54
∗ Drug prices from Mercury Drug Corporation listed as of May 1, 2023 [36].

Table 4
Number of neurologists, psychiatrists, and geriatricians in the Philippines∗
Regions Neurologists Psychiatrists Geriatricians Total
TOTAL 664 591 140 1,395
Ratio to Population 1 : 164,000 1 : 184,000 1 : 779,000 1 : 78,000
(109 million)
∗ According to the PNA, PPA and PCGM [41, 43, 44].

tions which cost higher than the ceiling prices noted in with the WHO global action plan on dementia [2].
the DPRI. The costs of dementia care present an eco- These programs range from yearly dementia aware-
nomic burden per patient of roughly USD 3,916.47 ness campaigns culminating in World Alzheimer’s
annually, which is over half of the average family Month every September, lay fora, prevention and risk
annual income in the Philippines [16]. reduction infographics and materials, requests for
In terms of manpower, there is a low ratio of spe- further government subsidy and insurance coverage,
cialists to the general population. There are only 0.05 running support groups for families caring for persons
neurologists, 0.04 psychiatrists, and 0.01 geriatri- with dementia, ensuring availability of free dementia
cians for every 10,000 population, with more than screening tools, and translating the WHO iSupport
half practicing in the NCR, and the rest unevenly Manual for Dementia for free download [56–58]. In
distributed into the 16 other regions. This is half addition, these organizations leverage their network
the ideal doctor-to-patient ratio prescribed by WHO, and resources to liaise the academe, clinicians, fam-
although there is no set specialist-to-population tar- ilies, and persons living with dementia to relevant
get ratio. Nursing homes remain underutilized due clinical trials that may benefit them. These organiza-
to the stigma attached to institutionalizing relatives tions like the ADAP, DSP, PCGM, and PSGG to name
into these homes, erroneously equating it to aban- a few, also constitute the stakeholders who participate
donment and lack of debt of gratitude. Consequently, in consultative workshops initiated by the govern-
most older persons are left under the care of untrained ment for programs or laws relevant to providing care
caregivers who are left with the responsibility of pro- for persons with dementia.
viding long-term care. Despite the extensive search done using interna-
As of 2022, Singapore is the only country in tional and local databases as well as gray literature,
Southeast Asia with a funded National Dementia this review may have missed relevant published and
Strategy ensuring that programs and other improve- unpublished literature. Other relevant articles pub-
ments regarding dementia care are implemented [52] lished in the non-English or non-Filipino language
Currently, dementia is only mentioned as one of the may also have been missed. Lastly, given the intrin-
outputs and key indicators in the 2019–2023 Philip- sic nature of scoping reviews, the lack of critical
pines’ Mental Health Strategic Plans, with efforts appraisal of included studies can also be a potential
to integrate a dementia plan in the succeeding plan source of bias.
for 2024–2028 [53, 54]. With the lack of a national
dementia plan and limited implementation of the Conclusion and future perspectives
healthy and productive aging program [55], non-
government organizations have tried to fill the gaps This scoping review explores the current status
by embarking on numerous programs in accordance and gaps in dementia care in the Philippines. Our
 V.M.M. Anlacan et al. / Challenges in Dementia Care in the Philippines 1541

findings have been consistent with the findings of [8] Ocampo FF, Espiritu AI, Jamora RDG (2022) Current status
earlier reviews on the status of various neurological and challenges in the care of patients with bacterial menin-
gitis in the Philippines: A scoping review. Trop Med Int
disorders in the country. A multi-pronged approach Health 27, 38–48.
on enhancing research on nationwide dementia epi- [9] Pagaling GT, Turalde CWR, Jamora RDG (2022) Autoim-
demiology, improving government financial support mune encephalitis in the Philippines: A scoping review on
spanning the different levels of dementia care, the treatment gaps, challenges, and current state of care.
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