Rewarded for being poor

People will act poor if they know they’ll get paid for it.

That may sound as a harsh generalization to some but anyone who watched the million strong crowd of people lining up to get free medical service and groceries in the City of Manila this week would have a hard time arguing otherwise. The truth of the matter is that “poverty” or “poor” has become an ugly standard even in terms of government policy and public management.

While it is good to care and address the needs of the poor, it is disturbing to realize that in many instances we see poor quality government services because many people in government conclude that the “poor” don’t pay, the poor don’t complain, and the poor will take anything they can get as long as it is free. To complete this vicious and shameful circle, many people simply resign themselves to act poor, think poor and talk poor because they get something free for it.

‘This is one big lie’  

What the poor people in our society are supposed to be getting are not freebies but good service, because “WE” the taxpayers paid and funded all of that. It is not free. It is paid for! Just because a government office or facility services mostly poor people does not mean, and is no excuse for their offices or facilities to look squalid or dirty as if conforming to the “poor” living conditions of their “poor” clients or customers. Just because poor people don’t speak with the confidence and eloquence of educated “civilized’ individuals, this does not mean that front line government employees have license to be rude or speak like gutter rats because the poor are unschooled or “walang pinag aralan.”

That reawakening to better quality and “equal” service was just one of many “take home” messages that participants gained last Wednesday during “Universal Health Care Forum II” sponsored by PhilHealth, Novartis Healthcare Philippines and the Ateneo de Manila School of Medicine and Public Health. The forum was organized to address public health issues “in pursuit of Access, Quality, and Financial protection” for managers and beneficiaries of public healthcare specifically under PhilHealth. Divided into three main sessions, the panelists and participants discussed: Increasing access to PhilHealth benefits — Ensuring Financial protection — Safeguarding Quality Care.

The good news is that the road to affordable public healthcare in the Philippines continues to expand its coverage, much of the needed legislation, policies, and logistics are in place. To top it all, public healthcare managers have been very proactive in raising standards for accreditation of hospitals and physicians and working towards a “zero billing” world for Filipinos who enter public hospitals all over the country. PhilHealth has also gone tough on service providers who violate policies by suspending, removing accreditation as well as stiff fines on hospitals, clinics and doctors found guilty of violations.

The bad news is that all of these efforts are not being maximized simply because of traditional mindset and behavior. For instance, coverage has not reached ideal numbers simply because a number of local officials have other priorities, don’t want to spend part of their IRA for coverage and do not appreciate the long term value of public healthcare and insurance, while others are simply too lazy to do the necessary paper work or to enroll people in far flung barangays that require sending out social workers or healthcare personnel to gather data. I’m not familiar with the PhilHealth law but again the failure to enroll your constituents should be punishable by removal from office whether elected or otherwise, or else public officials will feel no dire need to comply. If there is a law, cases should immediately be filed.

While listening in  the earlier forums, one comment that placed everything in perspective was the statement of Dr. Jaime Alip who pointed out that most of the government healthcare facilities such as hospitals and clinics are often located in urbanized areas which are often too far, too expensive to reach, for the many poor people who need healthcare the most. Considering the rising and often unaffordable cost of real estate in many urbanized settings, one would think that building clinics outside towns and cities would be fair and equitable since property values would be lower and urban residents often have the money and the means to travel while the poor don’t.

In a time when we have more and more mobile food stalls, mobile advertising trucks etc. how difficult is it to set up mobile clinics which will always be cheaper and effective than fixed assets.  We can even give a new definition to the term “riding in tandem” by mobilizing doctors on motorcycles. Strangely enough, the politicians who have no qualms “busing” or making “hakot” voters during elections suddenly forget how effective it is to provide buses or trucks that can ferry or transport would be patients at least twice a week to town or city centers for much needed medical care. Some “poor” people actually are willing to pay bus fare to seek needed medical attention, but in many places there are no regular transportation services!

In spite of it all, the most positive news has to be the fact that many public hospitals that were once considered “dumps” or  “lay-in / die-in” clinics have risen to the challenge of renovation physically and operationally to the point of being ISO certified. Just five minutes away from where I live is the Rizal provincial hospital along Shaw/Pasig Boulevard that used to be so cramped, run down and old. But after a change of administration and general renovation, the hospital has become ISO certified and has attracted some of my doctor friends to relocate their clinics that used to be in the top 3 private hospitals in Metro Manila.

Quality public health care, excellent public facilities and professionals are not just goals, they are today’s reality. It can be done. It is being done.

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