Crisis in health care

DEMAND AND SUPPLY - Boo Chanco - The Philippine Star

A developing country like ours must invest as heavily in human resources as in infrastructure. Both are essential to economic growth.

As we allow our politicians to lavishly allocate funds to satisfy their greed, investments in education and health care suffer. If this goes on, there will be a bleak future for the next generations.

Health care and the development of our economy are more closely intertwined than we think. When people are unable to get good health care, their ability to contribute to national growth diminishes. According to the UNDP, eight out of 10 Filipinos never had a physical or medical check up in their lives.

Health is as important as education and even more important than national defense. People who are not healthy cannot be competitive in the world today.

Unfortunately, our political leaders fool the people with things like PhilHealth and Universal Health Care. Both promise adequate healthcare, but fail to deliver.

So, it is not surprising to learn from the health secretary that Universal Health Care lacks around P74 billion in funds for its implementation next year. Binobola lang pala tayo about UHC.

UHC’s implementing rules aim to strengthen lower-level facilities like barangay and district health centers so patients need not go to already crammed hospitals, Secretary Duque told dzMM. But public health centers are incapable of delivering on the promise.

Secretary Duque said due to the funding deficit, the UHC pilot areas will be reduced to 10 in Mindanao, eight in Visayas, 13 in Luzon and two in Metro Manila.

Under the UHC Law, all Filipinos are automatic members of PhilHealth and eligible for no-balance billing once admitted to basic or ward accommodations in hospitals.

“Walang isang municipality, lungsod o lalawigan sa ating bansa na makakatupad na sa pangako ng Universal Health Care. Hindi niya kaya mag-isa,” Health Dir. Eric Tayag told ABS-CBN News.

According to Dr Tayag, all health centers in the country still need to improve leadership and governance, health financing, health information, availability of medicines, vaccines, technology, human resource and delivery of services.

Health centers have needs as basic as clean toilets, Dr. Clemencia Bondoc, national president of the Association of Municipal Health Officers, said in an interview with ABS-CBN News.

About 30 percent of health care facilities in the Philippines do not have clean toilets, according to a study jointly produced by two UN agencies.

Twenty-three percent of health care facilities in the country have dirty toilets, while another four percent have no toilets at all, according to a report of the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) Joint Monitoring Program.

“Health care facilities won’t be able to provide quality care to people, if there is no safe water, toilet or hand washing facility,“ said WHO representative in the Philippines Dr. Gundo Weiler.

This lack of support from the national government in terms of basic facilities discourages doctors to choose a public health practice, Dr Bondoc said. Those who try get very frustrated and leave.

We have a health crisis as it is. There is a renewed outbreak of infectious diseases. Deaths due to dengue are at record high. Polio has resurrected 19 years after the country was declared polio-free. Underfunded hospitals are understaffed and existing staff are overworked and underpaid.

The Supreme Court recently ruled that the minimum base pay of entry-level nurses should not be lower than Salary Grade 15, although it also said it is up to Congress to provide for funding. Salary Grade 15 is equivalent to not less than P30,000.

There are 7,193 authorized Nurse 1 positions in government, which will entail an additional P1 billion to implement the RA 9173 starting 2020. The budget measure passed by the House does not provide the resources needed to implement the Supreme Court ruling.

Instead, Maristela Abenojar, president of the Filipino Nurses United, said that nurses are victims of contractualization, especially in government hospitals. That’s why so many of them leave the country or work in call centers.

A study done by the Philippine Nurses Association in 2017, Abenojar said, shows that the majority of registered nurses are either abroad (around 150,000) or working in other industries, such as call centers (roughly 30,000).

Overall, the country’s health care worker-to-population ratio is less than half the standard of the World Health Organization (WHO), at 45 health workers for every 10,000 persons. Our ratio is at only 19 per 10,000.

“There is no shortage of nurses. There is only a need to improve their working conditions,” Abenojar said. The realities in the health sector, according to Abenojar, should make the government rethink its priorities because the situation is nothing short of a crisis.

Nurses working in private hospitals are similarly abused. Indeed, some are even made to pay for the privilege of being overworked. They need to show work experience in a hospital to be able to work abroad.

PGH, the country’s largest and best public hospital suffered budget cuts. Ironically, even a 2020 budget without cuts would still be way off the P10 billion PGH needs to “render quality health care for all its patients.”

PGH’s operating requirement is currently at P5 billion, but its budget for 2019 is only at P3.2 billion. For 2020, the budget department only programmed P2.8 billion for the country’s premier tertiary hospital. In the general appropriation bill sent to the Senate, the House of Representatives added only P200 million for the PGH.

A P10-billion budget would allow the PGH to hire more nurses, health workers, provide free medicines for indigent patients, purchase respirators and other life-saving medical equipment.

I realize it is also not just about budgets. DOH also has problems utilizing its meager budget. COA discovered medicines rotting in DOH bodegas undistributed to health centers where these are needed.

Inadequate budget and lousy management are at the core of the current health crisis. These must be addressed urgently for our people’s sake.

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

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