FIRST PERSON - Alex Magno (The Philippine Star) - May 14, 2020 - 12:00am

This point is hardly a matter of debate: when the pandemic struck, our health system was woefully unprepared.

Without a functioning grassroots health system, the main hospitals became the frontline in meeting the surge in infections. Without a stockpile of protective gear for health workers, we suffered a high proportion of casualties among medical personnel.

Our ICU bed capacity nationwide was way below international standards. Our entire hospital capacity was woefully short. In the beginning, the Research Institute for Tropical Medicine (RITM) was the only functioning facility for molecular testing. A huge backlog formed, with many patients dying before a reliable diagnosis was released.

When the enhanced community quarantine was ordered, we had only 2,000 test kits for COVID-19. This aspect is, of course, understandable. The test kits could be developed only after the genetic sequence of this new virus was identified.

We scrambled. When all public transportation was banned, someone forgot that nurses and doctors had to make their way to the hospitals. When localities were locked down, the barangay personnel had no training to trace and isolate infected persons.

Meanwhile, our neighbors, with more robust public health systems, responded more effectively. Vietnam immediately set up 100 laboratories to process tests. This country is the gold standard as far as effective response to an epidemic is concerned. They had just over 200 cases and no fatality.

Taiwan and South Korea likewise responded admirably. They quickly deployed tests and isolated infected persons.

Wuhan, once the epicenter of the pandemic, had no cases reported for a month. When six infected persons were found the other day, Chinese health authorities decided to test all 11 million residents of this city over the next ten days.

Talk about a robust response. In our case, after two months, we are still struggling to make 30,000 tests per day.

To be fair, we did scramble to set up large isolation facilities with the help of private corporations and a large religious sect. In addition, the presidential yacht and two passenger ships belonging to Udenna Corp. have been refitted to serve as isolation units. There has been no clear information about the rate of utilization of all these facilities.

Surely we need a large army of health workers to man the expanded isolation and treatment facilities. The armed forces increased its recruitment of health workers to its ranks. A controversial ban was imposed on health workers leaving the country to take up better paying jobs abroad.

It has been very difficult to overcome the structural weakness of a poor public health care system. Surely, in the next few years, rebuilding that system should rank among our priorities. This is certainly nor the first and surely will not be the last instance we will have to respond to rapidly disseminating epidemics.


Russia is now second only to the US in the number of COVID-19 cases recorded. That is a dubious distinction.

Over the past ten days, Russia posted over 10,000 cases each day. A high mortality rate is expected to follow. Vladimir Putin’s job approval rating is plunging as fast as the infection rate is rising.

The most compelling explanation offered for this looming health calamity in Russia is the poor public health care system maintained by an unaccountable government. While there are a number of bright new hospitals in the major cities, public health care is virtually nonexistent in the rural areas.

Fortunately, in our case, the lockdowns effectively contained the bulk of infections in the Metro Manila region. If the lockdown was less decisive, our infection numbers might have rivaled Russia’s.

Our grassroots health system was not as miserable many years back. I grew up in a town that had a well-equipped health center where we went for vaccination and for medical consultations.  Save for extreme emergencies, no one really needed to go to a hospital.

Most likely as a consequence of the cholera, typhoid and polio epidemics we experienced a century ago, we had a functioning municipal health care system. The town’s chief sanitary officer was often held in higher esteem than the elected officials. His word was law.

Somehow, this grassroots health system built in the aftermath of horrible epidemics was allowed to deteriorate. When we had to go into austerity mode because of the debt crisis, public services in general and health services in particular suffered. This brought us to the state of vulnerability this latest epidemic found us in.

Corruption, of course, is another reason. Driven by idealism, a young doctor chose to serve in a remote northern province. Recently, the local dynasts asked her to sign blank procurement forms. The young doctor is now considering serving out her internship in a regular city hospital.

When this current health crisis is finally over, we should take a long and hard look at how our health system has been configured (possible disfigured). Having strong state-of-the-art hospitals is good. But we must rapidly rebuild our grassroots health care system if we want to be more responsive to future disease outbreaks.

A strong municipal health care system will be more accessible to greater number. It will necessarily be oriented toward preventive medicine and manned by true professionals. In the event of an epidemic, the municipal health care system will be our real front line.

Since we will likely have to do testing, tracing and isolating, the next few months should be an ideal time to rebuild our grassroots health system. Fighting COVID-19 will push us to reconfigure our health system.

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