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Journal of Alzheimer’s Disease 97 (2024) 1533–1543
DOI 10.3233/JAD-230845
IOS Press
1533
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
aDepartment of Neurosciences, Division of Adult Neurology, College of Medicine and Philippine General
Hospital, University of the Philippines Manila, Manila, Philippines
bDepartment of Internal Medicine, Section of Adult Neurology, Cardinal Santos Medical Center, San Juan City,
Philippines
cDepartment of Neurology, Institute of Neurological Sciences, The Medical City, Pasig City, Philippines
dDepartment of Clinical Neurosciences, Section of Neurology,University of the East Ramon Magsaysay Memorial
Medical Center, Quezon City, Philippines
eInstitute 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
1These authors contributed equally to this work.
∗Correspondence to: Veeda Michelle M. Anlacan, MD, Divi-
sion of Adult Neurology, Department of Neurosciences, College
of Medicine and Philippine General Hospital, University of the
Philippines Manila, Manila, Philippines. Tel.: +639189197143;
E-mail: vmanlacan@up.edu.ph; ORCID ID: 0000-0002-1241-
8805.
INTRODUCTION
Dementia is a neurocognitive disorder present-
ing with deterioration in cognitive function beyond
what is expected from the consequences of biologi-
cal aging, significantly interfering with activities of
daily living and social autonomy [1]. Approximately
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
Philippines [2]. Filipinos aged 60 and older com-
prised 7.5% of the total Philippine population as of
2020 [3], and this proportion is expected to increase
to 12.8% by 2035 [4].
The Philippines is an archipelago with 7,641
islands subdivided into 17 administrative regions,
81 provinces, 145 cities, 1,489 municipalities, and
42,044 barangays, each with their own local govern-
ing bodies [5, 6]. With the enactment of the Local
Government Code of 1991 or Republic Act (RA)
7160, the autonomy and responsibility of provid-
ing basic health services have been transferred to
the local government units [5, 7]. While this devo-
lution was implemented to encourage self-reliance
and ensure efficiency in the allocation and distribu-
tion of resources, difficulties in coordination between
national and local governments, poor health prioriti-
zation, lack of facilities and skilled health workers,
and poorly functioning referral systems have led to a
fragmented system delivering inadequate services to
vulnerable groups such as older adult Filipinos [5, 7].
Earlier scoping reviews have explored the status
and challenges in the care of people with various
neurological disorders such as bacterial meningi-
tis, autoimmune encephalitis, brain tumors, epilepsy,
multiple sclerosis, and Parkinson’s disease in the
Philippines [8–13], but comprehensive local data on
dementia remains lacking. This scoping review aimed
to give an overview of dementia care in the Philip-
pines and to identify challenges and gaps in the
provision of dementia care in terms of local epi-
demiology, research, financial coverage, diagnostics,
pharmacotherapy, manpower, and caregiver support.
METHODS
Protocol
Our study adhered to the Preferred Reporting Items
for Systematic reviews and Meta-analysis (PRISMA)
extension for scoping reviews [14]. This article does
not contain any studies involving human or animal
participants performed by any of the authors.
Eligibility criteria
We considered published systematic reviews,
review articles, cohort studies, conference pro-
ceedings, clinical practice guidelines, and local
government data on the local epidemiology, research
output, health financing, diagnostics, pharmacother-
apy, manpower availability, and caregiver training for
dementia in the Philippines. Case reports, abstracts
only, and animal and plant studies were excluded.
Articles not in English or Filipino were excluded.
Only human studies set in the Philippines were
included, with studies on Filipinos or healthcare
workers living abroad excluded. No restrictions were
set in terms of the date of publication.
Information sources
We searched international databases including
PubMed, Scopus, EMBASE, EBSCO, Web of Sci-
ence, and ClinicalTrials.gov. We also searched local
medical databases such as the Health Research
and Development Information Network (HERDIN)
and Philippine E-Journals for relevant studies.
We accessed pertinent and available literature
via official websites of international organizations
(i.e., World Health Organization, World Bank),
government and non-government agencies [i.e.,
Philippine Department of Health (DOH), Philippine
Health Insurance Corporation (PhilHealth), Philip-
pine Statistics Authority (PSA), National Institutes
of Health-Institute of Aging, and local professional
organizations (i.e., Philippine Neurological Associ-
ation (PNA), Alzheimer’s Disease Association of
the Philippines (ADAP), Dementia Society of the
Philippines (DSP), Philippine College of Geriatric
Medicine (PCGM), and the Philippine Society of
Geriatrics and Gerontology (PSGG)]. Data on the
cost of diagnostics and medications were identi-
fied through relevant laboratories and institutions via
website and phone queries. Due to paucity of data on
some categories, grey literature was explored through
links and secondary searches.
Search and selection of sources
We conducted a scoping review of the available
literature from the earliest indexed record until June
2022 using “(dementia OR Alzheimer∗OR vascular
dementia OR Lewy body disease OR frontotempo-
ral dementia) AND Philippines” as our search string.
Duplicates were excluded. Authors PDL, AAS, and
VMA separately screened all titles and abstracts
based on the eligibility criteria; author RDJ was con-
sulted for disagreements. We then retrieved the full
text of eligible articles for data extraction.
We also searched the websites of international
and local organizations as previously mentioned
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-
atrist, geriatrician, caregiver,” “dementia,” AND
“Philippines.”
RESULTS
The search of studies
The search yielded a total of 438 articles (see
Fig. 1). We then screened 321 articles after duplicates
were removed. A total of 97 full-text articles were
assessed for eligibility, out of which we excluded 22
articles which did not have data on the Philippines,
and which focused on delirium, test construction, and
validation for their main topic. Thus, a total of 75 arti-
cles were included for synthesis. Of the 75 articles,
10 focused on epidemiology, 3 on research, 23 on
health service delivery and financing, 5 on diagnos-
tics, 18 on management, 8 on manpower resources, 8
on caregiver support.
The local epidemiology of dementia
As of 2015, the prevalence of dementia in the
Philippines was 10.6% for those 60 years and over,
with an age-standardized prevalence of 14.2%, equat-
ing to an estimated 726,864 people living with
dementia [15]. As of 2021, the estimated dementia
incidence in the Philippines was at 16 per 1,000, with
an estimated increase in dementia cases to 1,474,588
by 2030, 1,972,067 by 2040, and 2,529,436 by 2050
[16]. The most common subtype of dementia was
AD (85.5%), followed by vascular dementia (11.7%),
and other dementias (2.7%). Increasing age was asso-
ciated with an increased risk for dementia, while
educational attainment was associated with a reduced
risk. Sex and civil status were not associated with
dementia risk [15]. The mean total disease duration
was 3.84 years, with an estimated disability-adjusted
life years of 2,876 years per 100,000 persons [16]. In
order to address the lack of updated data on dementia
incidence and prevalence, the PNA is in the process
of creating a multi-center, prospective database on
Filipinos diagnosed with cognitive impairment and
dementia, targeted to be completed by 2024 [17].
Dementia research in the Philippines
Dementia research and innovation has been identi-
fied as an action area in the WHO’s global action plan
on the public health response to dementia for 2017-
2025, with the global target of doubling the output of
global research between 2017 and 2025 [2]. Research
productivity in the field of dementia has been noted
to be growing rapidly over the recent years; however,
research output on dementia in the Philippines has
remained low. In a previously conducted systematic
search of published articles on dementia in South-
east Asia by Sy, et al. (2020), only 11 out of 1,006
(1.1%) publications were from the Philippines, com-
prising only 8 of the 687 (1.2%) publications found
in journals with impact factor [18]. This signifies the
need for adequate resources and government support
in order to advance dementia research in the country.
Financial coverage of costs
The Philippines’ current health expenditure (CHE)
has increased by 12.6%, from USD 14.34 billion in
2019 to USD 16.14 billion in 2020. Its total health
expenditure (THE), considering the health capital for-
mation expenditure, has also increased by 10.4%,
from USD 16.39 billion in 2019 to USD 18.02 billion
in 2020; now accounting for 5.6% of the coun-
try’s gross domestic product (GDP). Consequently,
per capita health spending has also increased by
10.7%, from USD 133.74 in 2019 to USD 148.04 in
2020. However, despite these improvements in health
financing, the Philippines still only ranks 6th out of 11
countries in Southeast Asia, with its THE per capita
equating to only 5.4% of that of Singapore [19]. Over
the past decades, out-of-pocket spending has been the
leading source of health expenditure in the country.
In 2020, government schemes and compulsory con-
tributory health care financing schemes contributed
the largest percentage to health expenditure (45.7%),
but household out-of-pocket payments still came in
at a close second place (44.7%) [20]. As per the latest
PSA data, the average annual family income is USD
5,640 (USD 1.00 = PhP 55.5 as of May 1, 2023), with
an average annual family expenditure of USD 4,306,
of which only 2.7% is being allocated for health [21].
In order to provide some financial risk protec-
tion, PhilHealth was established through the National
Health Insurance Act of 1995, with the goals of
providing health insurance coverage and ensur-
ing affordable, acceptable, available, and accessible
healthcare services for all Filipinos [22]. Through
RA 10645, all senior citizens are automatically cov-
ered by the National Health Insurance Program [23].
Some of the common causes for hospital admissions
in older adults, including pneumonia, osteoporosis,
osteoarthritis, and dementia are covered by Phil-
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
coverage (92%), benefit utilization is low, likely due
to poor awareness of members and maldistribution
of health services and facilities [5, 6]. Social insur-
ance programs such as the Social Security System
for the private sector and the Government Service
Insurance System for the public sector also aim to
provide financial protection for their members, but
they remain poorly utilized. Based on the 2014 Con-
sumer Finance Survey, only 1 in every 4 economically
dominant household members aged 60 and above
were covered by social security, with 1 in every 4 pen-
sioners receiving a monthly pension of below USD
36, and 3 in every 5 pensioners receiving a monthly
pension of below USD 90 [25]. Another means of
alleviating financial burden on older adults was the
passage and implementation of the Senior Citizens
Act (RA 7432), further amended by the Expanded
Senior Citizens Act of 2003 (RA 9257) and 2010 (RA
9994). Through these legislations, older adults are
now entitled to a twenty percent discount and exemp-
tion from the value-added tax (VAT) in the purchase
of medicines, vaccines, medical and dental services,
and diagnostic and laboratory fees in all private facil-
ities, as well as free medical and dental services,
and diagnostic and laboratory fees in all government
facilities [26]. In 2017, the DOH has issued policy
guidelines on the standards of care for older persons
in the acute and sub-acute care, rehabilitation facility,
continuing care retirement community and long-term
care settings; enumerating guidelines on the creation
of safe and secure environments and strengthening
collaborative effort among various stakeholders [27].
Lastly, the National Commission of Senior Citizens
Act (RA 11350) was also created in 2019 to ensure
the full implementation of government laws, poli-
cies, and programs on senior citizens, as well as
to formulate policies geared towards the promotion
and protection of the rights and well-being of senior
citizens [28]. This legislation, however, effectively
misses out on the population of young-onset demen-
tia and also does not provide additional benefits to
older adults living with dementia who require higher
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
Initial assessment of dementia heavily relies on the
patient’s clinical history, with emphasis on the cog-
nitive, behavioral, and psychological symptoms, and
the impact of these symptoms on the patient’s daily
activities. A complete physical examination, includ-
ing a neurologic examination, should be performed to
exclude possible visual and auditory problems and to
check for focal neurologic deficits. Several cognitive
assessment tools in the form of validated question-
naires are available to evaluate the patient’s cognition,
mood, behavior, and functional performance. Labora-
tory tests and neuroimaging studies are also necessary
to rule out reversible (i.e., toxic, metabolic, infec-
tious) causes of cognitive decline (see Table 1) [29].
Diagnostic tests are primarily funded out-of-
pocket, as PhilHealth only covers in-hospital
admissions and coverage is based on predetermined
case rates (see Table 2). Dementia has a case rate
of USD 180, with USD 54 as professional fee and
USD 126 as hospital fee. Given the nature of the
disease, most people with dementia are seen in out-
patient clinics. Consultation fees with neurologists in
private clinics typically range from USD 15 to USD
45, while consultation fees with dementia specialists
in memory clinics typically range from USD 36 to
USD 90 [30, 31]. These are not yet covered by Phil-
Health and may only be partially covered by private
health maintenance organizations or insurance.
Challenges in the treatment of dementia
Management of dementia involves both pharma-
cologic and non-pharmacologic treatment strategies.
Medications used in the treatment of dementia
include acetylcholinesterase inhibitors (donepezil,
galantamine, and rivastigmine) and N-methyl-D-
aspartate antagonist (memantine). Galantamine is no
longer available in the Philippines as of May 1,
2023. Comparing the cost, availability, and afford-
ability of these AD drugs among 21 countries across
6 continents, these drugs have been noted to be
more expensive in LMIC compared to high-income
countries. In addition, most high-income countries
subsidize the cost of these medications through health
insurance, while patients spend for these medications
from their own pockets in LMICs [32].
The Philippine government’s response to the inac-
cessibility of essential medications over the past years
was the legislation of the Generics Act of 1988,
and consequently, the development of the Philippine
National Formulary (PNF). The PNF contains the list
of essential medicines that can be procured by the
government and serves as the basis for PhilHealth
reimbursement for public and private health facilities.
However, only donepezil (5 mg and 10 mg tablets)
and rivastigmine (1.5 mg, 3 mg, and 6 mg capsules)
are included in the PNF [33]. Noticeably absent on
the PNF are higher doses of donepezil (23 mg tablet),
rivastigmine (4.6 mg/24 h patch 5, 9.5 mg/24 h patch
10, 13.3 mg/24 h patch 15), and memantine 20 mg
tablet. The Drug Price Reference Index (DPRI) enu-
merates the ceiling prices of essential medicines for
government bidding and procurement. The recom-
mended cost of the following drugs as per the DPRI
are USD 0.30 for donepezil 5 mg tablet, USD 0.28 for
donepezil 10 mg tablet, and USD 0.77 for meman-
tine 10 mg tablet [34]. However, locally available
memantine 10 mg costs USD 0.41–2.54, memantine
20 mg costs USD 4.54, donepezil 5 mg costs USD
0.45–2.03, donepezil 10 mg costs USD 0.68–2.64,
and donepezil 23 mg costs USD 2.57 (see Table 3).
The wide price range is accounted for by the unavail-
ability of generic versions for memantine 20 mg and
donepezil 23 mg. As of June 2022, the minimum
wage is USD 10 per day, with the average Filipino
family spending 42.6% on food, 12.2% on house
rental, 8.2% on utilities, 6.61% on transportation, and
only 2.7% on healthcare [21, 35].
In addition to laboratory tests, neuroimaging stud-
ies, and medications, other direct medical costs
include consultation and hospitalization fees, and
caregiver salaries. Direct non-medical costs include
nursing home fees, transportation costs to healthcare
providers, and costs of home safety modifications.
Lastly, indirect costs include the potential earn-
ing capacity of unpaid caregivers. In a Filipino
community-based study done in 2016, the median
direct medical cost was computed at USD 237.40,
while direct non-medical cost was at USD 6.57, with
the total median indirect cost at USD 229.03. Adding
up the annual indirect costs due to unpaid caregiving,
the median direct cost was USD 3,650, making the
overall total annual per capita cost at USD 3,916.47
[16].
Manpower density
Although the Philippines can educate and develop
numerous healthcare professionals, a significant
number is lost due to migration to higher income
countries. In a 2017 study, the desire to migrate in
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
midwives, contributing to the gap in the available
manpower especially in rural areas [37]. From 1990
to 2017, a total of 350,361 healthcare professionals
have left the country: 95% of which are nurses, 3% are
doctors, and 2% are midwives [38]. To stem the tide
of migration and ensure a steady supply of doctors,
the University of the Philippines College of Medicine
started requiring their graduates in 2011 to sign con-
tracts of return service, which entails residing and
working in the Philippines for the next 5 years after
graduation [39].
At the emergence of dementia symptoms, people
and caregivers often turn to their primary care physi-
cian for a diagnosis. However, in a local study done in
2000, 64% of primary care physicians expressed their
doubt in their ability to diagnose dementia clinically
and 92% will opt to refer their patients to specialists
such as neurologists, psychiatrists and geriatricians
for diagnosis and treatment [40]. There are 664 active
fellows of the Philippine Neurological Association,
nearly half practice in the National Capital Region
(NCR), and a nationwide a ratio of 1 neurologist per
164,156 Filipinos. There are only eleven dementia
specialists in the country, and all but one practice in
NCR. There are twelve accredited training institu-
tions for Adult Neurology in the Philippines, nine of
which are in NCR. Fellowship training in dementia is
offered in only three institutions in NCR [41]. There
are only ten memory clinic sites in the country mostly
staffed by neurologists, with a few clinics under geri-
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:
University of Santo Tomas Hospital (private) and the
Philippine General Hospital (government). The only
DOH-funded hospital with a memory center is the
National Center for Mental Health; all other mem-
ory clinics are in private hospitals [42]. There are
only 591 psychiatrists and 140 geriatricians in the
country, with a ratio of 1: 184,433 and 1 : 778,571
respectively (Table 4) [43, 44]. Lastly, there are 133
psychologists (0.1 : 100,000), 516 psychiatric nurses
(0.5 : 100,000), and 1,241 mental health social work-
ers (1.2 : 100,000) in the Philippines [45]. These data
highlight the lack of healthcare professionals trained
in providing care for persons with dementia.
Caregiver training and support
Rooted in the Filipino concept of utang na loob
(debt of gratitude) and giving back to one’s parents,
co-residence with family members remains to be the
most common living arrangement for older Filipinos.
The primary caregiver is often a female family mem-
ber, who is either the patient’s spouse or daughter
[46]. However, the majority of caregivers taking care
of older adult Filipinos have never received formal
training on dementia care [47]. At present, govern-
ment organizations and specialty medical societies
conduct caregiver training programs for both family
caregivers and rural health workers on basic dementia
care. The Philippine Technical Education and Skills
Development Authority offers a caregiving training
program which includes provision of care and sup-
port to older adults as one of its core competencies;
however, there are no specific modules on caring for
people with dementia [48]. In 2018, the WHO has
created a dementia toolkit for community workers
in low-and middle-income countries which aims to
assist community workers in identifying people at
risk for dementia, providing support to people with
dementia and their families, and engaging local com-
munities in dementia-related activities [49].
DISCUSSION
The Philippines has an aging population, with
a high dementia prevalence projected to be twice
the crude estimated prevalence for the entire South-
east Asia in 2015 [50]. Despite the total number of
older persons being large in absolute numbers, the
relative numbers remain small, hence they do not
receive much attention from government agencies.
With projections for these numbers to increase in
the next thirty years, the discrepancy in terms of the
amount of attention older Filipinos receive also con-
tinues to widen. Local research on dementia remains
limited, potentially due to paucity of financial and
human resources and institutional support. However,
the increase in research productivity on dementia
in recent years within the region, has encouraged
researchers in the country to contribute to local data
which could be useful in the development of a more
culturally appropriate plan of care [18]. And although
the national government has enacted laws and poli-
cies which aim to protect and improve the quality of
life of older adults, the devolution of management to
local government units who do not imbibe the same
priorities results in fragmented care.
Cost is one of the major barriers preventing Fil-
ipino persons with dementia from getting high quality
of care. Despite increasing health expenditures by
the government, the Philippines still lags behind its
neighboring countries in Southeast Asia in terms of
THE per capita; ranking at 6th place behind Singa-
pore, Brunei, Malaysia, Thailand, and Vietnam. The
Philippines’ THE equates to only 5.4% of that of
Singapore and is only twice that of Myanmar [51].
Efforts by the national government to provide finan-
cial risk protection in the form of social insurance
programs are inadequate to cover both direct and indi-
rect expenses from the diagnosis of dementia up to
long-term home care. The national health insurance
is poorly utilized, and at best, only partially covers
in-patient admissions, while social insurance in the
form of monthly pensions is barely enough to shoul-
der the cost of dementia medications. This forces
persons with dementia and their families to rely on
out-of-pocket payments to shoulder their expenses;
a formidable challenge when the minimum wage is
USD 10 per day and may even be less, depending on
the region of residence [35].
This study further emphasizes the disparity
between the availability, accessibility, and affordabil-
ity of diagnostics and therapeutics between public
and private health systems. Laboratory and neu-
roimaging tests typically cost 2–10 times more in
private compared to that of government facilities that
offer full coverage. More sophisticated tests such as
serum amyloid and cranial amyloid positron emission
topography scans are only available in private institu-
tions. Consultation fees with private neurologists and
dementia specialists roughly cost 2–6 times the mini-
mum wage. In terms of treatment, not all medications
for dementia are included in the national formulary,
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
the DPRI. The costs of dementia care present an eco-
nomic burden per patient of roughly USD 3,916.47
annually, which is over half of the average family
annual income in the Philippines [16].
In terms of manpower, there is a low ratio of spe-
cialists to the general population. There are only 0.05
neurologists, 0.04 psychiatrists, and 0.01 geriatri-
cians for every 10,000 population, with more than
half practicing in the NCR, and the rest unevenly
distributed into the 16 other regions. This is half
the ideal doctor-to-patient ratio prescribed by WHO,
although there is no set specialist-to-population tar-
get ratio. Nursing homes remain underutilized due
to the stigma attached to institutionalizing relatives
into these homes, erroneously equating it to aban-
donment and lack of debt of gratitude. Consequently,
most older persons are left under the care of untrained
caregivers who are left with the responsibility of pro-
viding long-term care.
As of 2022, Singapore is the only country in
Southeast Asia with a funded National Dementia
Strategy ensuring that programs and other improve-
ments regarding dementia care are implemented [52]
Currently, dementia is only mentioned as one of the
outputs and key indicators in the 2019–2023 Philip-
pines’ Mental Health Strategic Plans, with efforts
to integrate a dementia plan in the succeeding plan
for 2024–2028 [53, 54]. With the lack of a national
dementia plan and limited implementation of the
healthy and productive aging program [55], non-
government organizations have tried to fill the gaps
by embarking on numerous programs in accordance
with the WHO global action plan on dementia [2].
These programs range from yearly dementia aware-
ness campaigns culminating in World Alzheimer’s
Month every September, lay fora, prevention and risk
reduction infographics and materials, requests for
further government subsidy and insurance coverage,
running support groups for families caring for persons
with dementia, ensuring availability of free dementia
screening tools, and translating the WHO iSupport
Manual for Dementia for free download [56–58]. In
addition, these organizations leverage their network
and resources to liaise the academe, clinicians, fam-
ilies, and persons living with dementia to relevant
clinical trials that may benefit them. These organiza-
tions like the ADAP, DSP, PCGM, and PSGG to name
a few, also constitute the stakeholders who participate
in consultative workshops initiated by the govern-
ment for programs or laws relevant to providing care
for persons with dementia.
Despite the extensive search done using interna-
tional and local databases as well as gray literature,
this review may have missed relevant published and
unpublished literature. Other relevant articles pub-
lished in the non-English or non-Filipino language
may also have been missed. Lastly, given the intrin-
sic nature of scoping reviews, the lack of critical
appraisal of included studies can also be a potential
source of bias.
Conclusion and future perspectives
This scoping review explores the current status
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
earlier reviews on the status of various neurological
disorders in the country. A multi-pronged approach
on enhancing research on nationwide dementia epi-
demiology, improving government financial support
spanning the different levels of dementia care,
improving access to dementia diagnostics and medi-
cations as well as increasing the number of dedicated
manpower for dementia would be important in fill-
ing the gaps in dementia care in the Philippines.
Acknowledging these gaps and challenges is a good
initial step in developing plans and health policies to
improve the quality of life of Filipinos with demen-
tia but eventually, a national dementia plan will be
necessary for systematic and cost effective delivery
of care.
ACKNOWLEDGMENTS
The authors have no acknowledgements to report.
FUNDING
The authors have no funding to report.
CONFLICT OF INTEREST
The authors have no conflict of interest to report.
DATA AVAILABILITY
The data supporting the findings of this study are
available within the article.
REFERENCES
[1] World Health Organization (2020) Dementia. https://www.
who.int/news-room/fact-sheets/detail/dementia, Last
updated March 15, 2023, Accessed on September 6, 2023.
[2] World Health Organization (2017) Global action plan on the
public health response to dementia 2017-2025.
[3] National QuickStat for 2022, https://psa.gov.ph/statistics/
quickstat/national, Last updated 2022, Accessed on August
23, 2022.
[4] Abalos JB (2020) Older persons in the Philippines: A demo-
graphic, socioeconomic and health profile. Ageing Int 45,
230–254.
[5] Dayrit M, Lagrada L, Picazo O, Pons M, Villaverde M
(2018) The Philippines health system review. In Health Sys-
tems in Transition,Patcharanarumol W, Tangcharoensathien
V, eds. WHO Press, Geneva, p. 1–316.
[6] Department of Health (2017) National Objectives for Health
Philippines 2017–2022.
[7] Alliance for Improving Health Outcomes. The Philip-
pine Health System at a glance, https://www.aiho.
org.ph/2017/05/08/philippine-health-system/. Last updated
2017, Accessed on August 2, 2022.
[8] Ocampo FF,Espiritu AI, Jamora RDG (2022) Current status
and challenges in the care of patients with bacterial menin-
gitis in the Philippines: A scoping review. Trop Med Int
Health 27, 38–48.
[9] Pagaling GT, Turalde CWR, Jamora RDG (2022) Autoim-
mune encephalitis in the Philippines: A scoping review on
the treatment gaps, challenges, and current state of care.
Front Neurol 13, 788309.
[10] Mondia MWL, Espiritu AI, Batara JMF, Jamora RDG
(2021) Neuro-oncology in the Philippines: A scoping review
on the state of medical practice, deterrents to care and ther-
apeutic gaps. Ecancermedicalscience 15, 1238.
[11] Moalong KMC, Espiritu AI, Fernandez MLL, Jamora RDG
(2021) Treatment gaps and challenges in epilepsy care in
the Philippines. Epilepsy Behav 115, 107491.
[12] Ignacio KHD, Espiritu AI, Jamora RDG (2020) The
current status and challenges in multiple sclerosis man-
agement in the Philippines. Mult Scler Relat Disord 46,
102510.
[13] Jamora RDG, Miyasaki JM (2017) Treatment gaps in
Parkinson’s disease care in the Philippines. Neurodegener
Dis Manag 7, 245-251.
[14] Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun
H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L,
Hempel S, Akl EA, Chang C, McGowan J, Stewart L,
Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin
S, Godfrey CM, MacDonald MT, Langlois E V., Soares-
Weiser K, Moriarty J, Clifford T, Tunc¸alp ¨
O, Straus SE
(2018) PRISMA extension for scoping reviews (PRISMA-
ScR): Checklist and explanation. Ann Intern Med 169,
467-473.
[15] Dominguez J, Fe De Guzman M, Reandelar M, Thi Phung
TK (2018) Prevalence of dementia and associated risk
factors: A population-based study in the Philippines. J
Alzheimers Dis 63, 1065-1073.
[16] Dominguez J, Jiloca L, Fowler KC, De Guzman MF,
Dominguez-Awao JK, Natividad B, Domingo J, Dominguez
JD, Reandelar M, Ligsay A, Yu JR, Aichele S, Phung TKT
(2021) Dementia incidence, burden and cost of care: A
Filipino community-based study. Front Public Health 9,
628700.
[17] The Philippine Neurological Association One Database
-Dementia (PNA1DB-Dem), https://clinicaltrials.gov/
study/NCT05484960, Last updated August 2, 2022,
Accessed on August 10, 2023.
[18] Sy MCC, Espiritu AI, Sy MSC, Jamora RDG, Anlacan
VMM (2020) Dementia research productivity and associ-
ations with socioeconomic factors and burden of disease in
Southeast Asia. J Alzheimers Dis 76, 1151-1160.
[19] Total health expenditure per capita in Southeast Asia 2019
(in U.S. dollars), by country, Last updated March 3, 2022,
Accessed on August 2, 2022.
[20] Philippine Statistics Authority (2021) Health Spending
Registered 12.6 Percent Growth, Share of Health to
Economy Went Up to 5.6 Percent in 2020. https://www.
psa.gov.ph/content/health-spending-registered-126-perce
nt-growth-share-health-economy-went-56-percent-2020
[21] Philippine Statistics Authority (2018) 2018 Fam-
ily Income and Expenditure Survey. https://psada.
psa.gov.ph/catalog/FIES/about. Accessed September 6,
2022.
[22] Philippine Health Insurance Corporation (2014)
Agency’s mandate and functions, https://www.philhealth.
gov.ph/about us/mandate.php. Last updated 2014,
Accessed on September 6, 2022.
1542 V.M.M. Anlacan et al. / Challenges in Dementia Care in the Philippines
[23] The LAWPHiL Project (2014) Republic Act No. 10645,
https://lawphil.net/statutes/repacts/ra2014/ra 10645 2014.
html. Last updated November 5, 2014, Accessed September
6, 2022.
[24] Philippine Health Insurance Corporation (2017)
List of Medical Case Rates. https://www.
philhealth.gov.ph/circulars/2017/annexes/0019/AnnexA-
MedicalCaseRates.pdf. Last updated February 2017,
Accessed May 1, 2023.
[25] Mina CD, Cacnio FCQ (2019) Are Filipino senior
citizens financially protected?: Evidence from Con-
sumer Finance Survey. https://www.isi-next.org/abstracts/
submission/793/view/. Last updated 2022, Accessed
September 6, 2022.
[26] Fourteenth Congress of the Republic of the Philip-
pines (2003) Senate S.B. No. 2154. https://legacy.
senate.gov.ph/lis/bill res.aspx?congress=14&q=SBN-
2154. Accessed September 6, 2022.
[27] Department of Health (2017) Policy Guidelines on the Stan-
dards of Care for Older Persons in All Healthcare Settings,
https://extranet.who.int/mindbank/item/7178. Last updated
January 30, 2017, Accessed September 6, 2022.
[28] Official Gazette (2018) Republic Act No. 11350.
https://www.officialgazette.gov.ph/2019/07/25/republic-
act-no-11350/. Last updated July 25, 2019, Accessed
September 6, 2022.
[29] Pink J, O’Brien J, Robinson L, Longson D (2018) Demen-
tia: Assessment, management and support: Summary of
updated NICE guidance. BMJ (Online) 361, k2438.
[30] Philippine General Hospital Radish (Computerized Reg-
istry of Admissions and Discharges), http://172.16.
187.118/radish, Last updated April 2023, Accessed on May
1, 2023.
[31] St. Luke’s Medical Center, https://www.stlukes.com.ph,
Last updated April 2023, Accessed on May 1,
2023.
[32] Suh G-H, Wimo A, Gauthier S, O’Connor D, Ikeda M,
Homma A, Dominguez J, Yang B-M (2009) International
price comparisons of Alzheimer’s drugs: A way to close the
affordability gap. Int Psychogeriatr 21, 1116-1126.
[33] The Philippine National Formulary, https://
pharma.doh.gov.ph/the-philippine-national-formulary,
Last updated 2019, Accessed on September 6, 2022.
[34] Drug Price Reference Index (10th edition),
https://dpri.doh.gov.ph, Last updated August 23,
2022, Accessed on September 6, 2022.
[35] Department of Labor and Employment National Wages and
Productivity Commission (2022) National Capital Region,
https://nwpc.dole.gov.ph/regionandwages/national-capital-
region, Last updated 2022, Accessed on September 6,
2022.
[36] Mercury Drug Corporation, https://www.mercury
drug.com, Last updated 2023, Accessed on May 1, 2023.
[37] Castro-Palaganas E, Spitzer DL, Kabamalan MMM,
Sanchez MC, Caricativo R, Runnels V, Labont´
e R, Murphy
GT, Bourgeault IL (2017) An examination of the causes,
consequences, and policy responses to the migration of
highly trained health personnel from the Philippines: The
high cost of living/leaving – a mixed method study. Hum
Resour Health 15, 1-14.
[38] Robredo JP, Ong B, Eala MA, Naguit RJ (2022) Out-
migration and unequal distribution of Filipino physicians
and nurses: An urgent call for investment in health human
resource and systemic reform. Lancet Reg Health West Pac
25, 100512.
[39] University of the Philippines Manila College of Medicine
(2022) Return Service Obligation Program & Regionaliza-
tion Program. https://cm.upm.edu.ph/p/unified-handbook-
rsop-rp/. Last updated 2022, Accessed on February 19,
2023.
[40] Capino P, Ramos Jr. M, Gatchalian E (2000) Beliefs and
attitudes of general practitioners on Alzheimer’s disease
dementia. Philipp J Intern Med 38, 183-187.
[41] Philippine Neurological Association (2022) PNA Fellows,
https://www.philippineneurologicalassociation.com/pna-
fellows, Last updated 2022, Accessed on September 6,
2022.
[42] Dementia Society Philippines (2021) Memory Clinic Sites,
https://www.dementia.org.ph/memory-clinic-sites, Last
updated 2021, Accessed on September 6, 2022.
[43] Philippine Psychiatric Association (2022) Philip-
pine Psychiatric Association: Search a Psychiatrist,
https://philippinepsychiatricassociation.org/psychiatrist,
Last updated 2023, Accessed on October 8, 2023.
[44] Senate of the Philippines, 19th Congress (2019) Angara: PH
needs more medical students to specialize in treating elderly,
https://legacy.senate.gov.ph/press release/2019/0505
angara1.asp, Last updated 2019, Accessed on October 8,
2023.
[45] World Health Organization, Department of Health (2020)
Philippines WHO Special Initiative for Mental Health Sit-
uational Assessment, Last updated March 2020, Accessed
on February 19, 2023.
[46] Cruz GT, Cruz CJP, Saito Y, eds. (2019) Ageing and Health
in the Philippines, Economic Research Institute for ASEAN
and East Asia (ERIA), Jakarta.
[47] Dela Vega SF, Cordero CP, Palapar LA, Garcia AP, Agapito
JD (2018) Mixed-methods research revealed the need for
dementia services and Human Resource Master Plan in an
aging Philippines. J Clin Epidemiol 102, 115-122.
[48] Technical Education and Skills Development Authority
(2020) Training Regulations CaregivingNC II, Last updated
2020, Accessed on September 6, 2022.
[49] World Health Organization Regional Office for the Western
Pacific (2018) Dementia Toolkit for Community Workers in
Low- and Middle-Income Countries: Guide for community-
based management and care of people with dementia,
World Health Organization Regional Office for the Western
Pacific, Manila.
[50] Prince MJ, Wimo A, Guerchet MM, Ali GC, Wu Y-T, Prina
M (2015) WorldAlzheimer Report 2015. The Global Impact
of Dementia: An analysis of prevalence, incidence, cost and
trends. Alzheimer’s Disease International, London.
[51] TheGlobalEconomy.com (2020) Health spending per
capita in South East Asia, https://www.theglobale
conomy.com/rankings/health spending per
capita/South-East-Asia, Last updated 2020, Accessed on
May 28, 2023.
[52] World Health Organization (2023) Global Dementia
Observatory – Dementia Plan, https://www.who.int/
data/gho/data/themes/global-dementia-observatory-gdo,
Last updated 2023, Accessed on May 28, 2023.
[53] Philippine Council for Mental Health (2019) Mental Health
Strategic Plan, World Health Organization Philippines,
Manila.
[54] Electronic Freedom of Information – Request for National
Dementia Plan of the Philippines #DOH-454113927358,
https://www.foi.gov.ph/requests, Last updated May 4, 2023,
Accessed on October 11, 2023
V.M.M. Anlacan et al. / Challenges in Dementia Care in the Philippines 1543
[55] Department of Health (2023) Healthy and Productive
Ageing Program, https://doh.gov.ph/health-programs/
healthy-and-productive-ageing-program, Last updated
2023, Accessed on May 28, 2023.
[56] Alzheimer’s Disease International (2022) World
Alzheimer’s Month, https://www.alzint.org/get-involved/
world-alzheimers-month, Last updated 2023, Accessed on
May 28, 2023.
[57] Dementia Society of the Philippines (2019) Dementia
Screening Tools, https://www.dementia.org.ph/dementia-
screening-tools, Last updated 2019, Accessed on May 28,
2023.
[58] Alzheimer’s Disease Association of the Philippines (2022)
iSupport Para Sa Dementia: Pagsasanay at gabay para sa
mga tagapag-alaga ng taong may dementia, Alzheimer’s
Disease Association of the Philippines, Manila.
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