DEMAND AND SUPPLY - Boo Chanco (The Philippine Star) - August 5, 2019 - 12:00am

If health is wealth, we are a poor country indeed. When President Duterte stopped the operations of PCSO, the top worry of people is the loss of PCSO’s monetary assistance to cover health care needs.

Making sure that our people are healthy enough to contribute to economic growth has not been a major concern of past and present administrations.

While health care is used as a justification for raising sin taxes, government doesn’t have an adequate plan to take care of our health needs. Just visit the emergency rooms of PGH and other government hospitals and you will see the sad state of our public health system.

Now we have a dengue epidemic that has not elicited a credible response from our health authorities. We are still deep in partisan political debate about a dengue vaccine that had apparently been deployed carelessly by the previous administration.

The problem is, Dengvaxia is apparently the only game in town. Doctors are faced with an ethical dilemma that comes face-to-face with a raging epidemic.   

A UP professor and former health undersecretary tweeted: “The case fatality rate of dengue fever in the Philippines is 0.44 percent  – DOH. Or if you get dengue, 99.56 percent will get better and recover. Sige, mapaturok ka ng Dengvaxia, your uncertainty increases! Pwede ba, maglinis na lang tayo ng lahat ng breeding sites ng mga lamok!”

Here is how the New England Journal of Medicine puts it:

 “…consider a vaccine for a common and sometimes deadly virus. Assume that the vaccine’s public health benefit is clear: if given to one million children over nine years of age, it can probably prevent some 11,000 hospitalizations and 2,500 severe cases of disease.

“But what if, in achieving this population benefit, the vaccine also caused 1,000 hospitalizations and 500 severe cases of disease in children who would not otherwise have fallen ill? Would you initiate a widespread vaccination program in a disease-endemic region?”

“The utilitarian calculus remains clear,” the NEJM says: “in endemic regions, vaccinating children over age nine reduces the rate of severe infection and hospitalization by 80 percent. It’s the moral calculus that still feels untenable.”

I get it that Dengvaxia is not going to do anything about the current epidemic. And there is no dependable means of determining who had prior infection, a crucial life and death step before using the vaccine.

This is what the DOH should be explaining today. But the health secretary is too busy defending himself and his family over conflict of interest charges. One might say DOH is on autopilot and it is not doing well.

Cases in point: That P154 billion scam at PhilHealth is a lot to explain. At the very least, management incompetence and at worse complicity in corruption.

Then there is the COA revelation that P18 billion worth of drugs are rotting away in DOH warehouses and are about to expire or already expired. Again, that shows lack of management competence.

Then there is this report that in 2018, the government spent only P1.58 billion to purchase medicines. That represented only 11.3 percent of its total budget for drugs and treatment, including vaccines… Prior to 2017, the government was able to disburse more than 80 percent of its medicine funds every year.

The same report indicates that “the proportion of children with required vaccinations – or those ‘fully immunized’— dropped to 66.2 percent from as high as 85.6 percent eight years ago.”

Actually, DOH must up its game to achieve the objective of Universal Health Care to make subsidized drugs available to all Filipinos, not just the poor. More diseases will also be covered, increasing from the current seven common ailments, including diabetes, where subsidized treatment is given.

Even less discussed is how to protect the quality of healthcare being given nationwide. A good indicator of some loss of faith in local healthcare, even in top tertiary hospitals, is the increasing number of those who go to Singapore or Hong Kong for annual check-ups.

Because I come from a family of doctors and my late father was professor to several generations of doctors, I have faith in the ability of local doctors to deliver quality healthcare. But still, there are enough scare stories told in quiet private parties about experiences in the ER of some top hospitals that make me wonder.

Emergency or urgent care even in the very top Philippine hospitals is inconsistent. It is time and day-related due to an archaic on-call system.

One good lesson learned, one doctor said, is not to have an emergency after office hours, on holidays and weekends. The good consultants who can save your life are off.

The protocols in urgent care are pretty standard globally, one retired doctor and a student of my father told me. “But in reality - linkage between protocols and victims IS hardly ever successful. Reason - the practice and the economics are essentially stuck in the healthcare of the ‘60s.

“It would seem to me that heart attacks and strokes constitute a very high percentage of extreme and sudden health distress conditions. Do a research - how many hospitals have in stock – ready to use – tPA – or even streptokinase in Metro Manila or Cebu, standard meds in urgent care. Boracay or Tagaytay?

“If injected within two to four hours and for the correct condition, lives could be saved. If neither is available, we will be nowhere.

“In strokes, bleeding in compartment A may indicate an immediate decompression; the same in compartment B will kill the patient. Differentiation is done by CT. But if we do not have a senior imageologist to make the call, then again, we would be nowhere.”

The health secretary must lead in assuring the quality of health services we get. Or maybe, we need a management expert to run the DOH day-to-day and the health secretary handling the tough issues only a doctor can understand.

Boo Chanco’s e-mail address is bchanco@gmail.com. Follow him on Twitter @boochanco

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