LGUs and health care

In the face of the national government’s failure to have an adequate coronavirus disease 2019 or COVID-19 response, a number of Local Government Units (LGUs) have stepped up to fill the yawning gap. This is perhaps how we should manage the public health care system… at the LGU level.

Marikina Mayor Marcy Teodoro persisted in building his own testing center despite early resistance from the Department of Health (DOH). Valenzuela Mayor Rex Gatchalian teamed up with Medical City and so did Pasig Mayor Vico Sotto to process the same tests.

Baguio’s Mayor Benjie Magalong pretty much kept his city COVID free and operated almost as if he assumed there was no DOH to help.  According to Dr. Tony Leachon, Magalong is innovative, including the use of artificial intelligence and satellite maps for contact tracings.

Down south, Iloilo Mayor Jerry Trenas also did well in managing the epidemic in his city. He practically assumed he was on his own with little or no DOH help.

City governments like those in Pasig, Quezon City and Manila have built overflow hospital facilities at the height of the crisis. No one waited for DOH.

LGUs in other areas of the country are apparently doing what they can as well. They have enforced border lockdowns to protect their residents from infection.

It was only when the national government forced them to accept Balik Probinsya participants, who were not adequately tested, did infection start to rise. Richard Gomez, as Ormoc City mayor, kept his city COVID-free until Balik Probinsya was carelessly implemented.

Overall, LGUs proved to be a bright spot in our government’s response to the epidemic. The DOH had not always been supportive of their efforts, but they persisted as they should.

Perhaps this is how it should be. Indeed, health care was devolved to LGUs in our Local Government Code. But for the longest time, only the responsibility was devolved. A large part of the DOH budget should have come with it.

In his talk before the economists in the Foundation for Economic Freedom, Dr. Manuel Dayrit, former health secretary and former dean of the Ateneo School of Medicine and Public Health, pointed out the continuing role of LGUs in managing the ongoing epidemic.

Forget the reluctance of DOH to do the required testing and tracing. Dr. Dayrit placed that responsibility on LGUs. He specifically mentioned the need to do repeated seroprevalence surveys to track infection in the population and give an idea of where we are in this war against COVID.

Also moving forward, it will be the LGUs at the forefront of enforcing social distancing rules, wearing masks and monitoring health conditions specially in densely populated communities. This emergency will most likely occupy their attention even beyond 2022.

With the Supreme Court ruling on the sharing of taxes collected by the national government, LGUs will have more resources to use in this battle with the virus. LGU officials will just have to up their game.

LGUs are in the best position to provide basic health services to the people. Congress should give them budgets to set up health centers to cover every Filipino.

I remember having a conversation with former Cebu City mayor Tommy Osmeña about how he monitors the health condition of his constituents. He wrote about it in a recent letter to Cebu Daily News.

Tommy set up a network of volunteers in 80 barangays to serve as a daily contact to each resident and report anyone who doesn’t feel well. It is a rapid reporting system that works better than a P240 million command center. If it had not been dismantled, it could have also monitored fair and proper food distribution during COVID.

For this network, Tommy hired jobless people for P100/day to deliver maintenance medicines to 50 patients house to house. (Computes to only P2/patient/day).

The volunteer would remind the patient to take his medicine as he gives it. If the patient doesn’t feel well, he must report to the volunteer, who in turn, will report to the health center.

Another trained volunteer would then arrive and take the blood pressure and other vital signs. He reports this to the health center. The health center doctor may adjust or alter the medication.

If there is no improvement, a barangay nurse will extract a blood sample that will be sent to a laboratory which won the bidding for 5,000 prepaid blood analysis. So there’s automatic processing. The lab will text the doctor the results the same day.

Tommy explains that many patients end up at an emergency ward because the patient was not diligent in taking his daily medication. The city government spends up to P30,000 for hospital costs.

The patient typically waits two to three days before seeking medical attention. This is not good especially now, in time of COVID, Tommy observed.

Tommy claims that “by the end of my term, 40,000 residents were already receiving their daily maintenance through 800 volunteers receiving P100.00/day.”

But the new city administration scratched what Tommy calls “the only system of daily house-to-house distribution of medication in all the 7,000 islands and in all of ASIA.  Ask your friends in Japan and Korea if they do this. (They do) Not even (do this) in the US or Europe.”

You may or may not like Tommy, and I have no first hand knowledge how his system worked, but I like the innovative thinking that went into it. This is precisely the kind of out-of-the-box thinking that good LGU officials can come up with.

Something like this is what we seem to be getting from Pasig’s Vico Sotto, Valenzuela’s Rex Gatchalian, Marikina’s Marcy Teodoro and Manila’s Isko Moreno. If more mayors, and even governors (like Joey Salceda in his time), think this way, shortcomings of national agencies like the DOH can be mitigated.

Does this mean federalism is the way to go? Not sure. A few good LGU officials do not mean a federal government system will work. Let us have more examples rise from city halls and provincial capitols nationwide.

But there could be hope with more good mayors showing good governance.

Boo Chanco’s e-mail address is [email protected]. Follow him on Twitter @boochanco