Shades of ‘pork-barrel’

The Department of Health (DOH) has been lately going through the rough patch amid severe criticisms in the wake of rising cases anew of dengue-related deaths. In the aftermath of the Dengvaxia scare, the regular vaccination programs of the DOH became unpopular when many parents kept away their children from availing the government’s free immunization programs on anti-measles and other highly communicable diseases.   

Worse, it has also been affecting certain programs of the DOH, including the full implementation soon of the Universal Health Care (UHC) Act. This became apparent during the budget hearing at the House of Representatives when it was discovered that the Universal Integration Sites (UIS) Program mandated under the UHC would only include 33 provinces and independent cities next year.

Passed into law by the previous 17th Congress, President Rodrigo Duterte signed the UHC under Republic Act (RA) 11223 on Feb. 20 this year. “Health is everybody’s business. Health systems only work when everyone works together to ensure that no one is left behind,” DOH Secretary Francisco T. Duque III declared after the UHC was signed into law.

The UHC, among other things, mandated the national government, specifically the DOH, to carry out  “universal health coverage to all Filipinos whether rich or poor. This means that all people and communities can use the “promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”

Also referred to as Kalusugan Pangkalahatan (KP), the UHC Law states the “provision to every Filipino of the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public.”

At the DOH budget hearing last week, congressmen attending it blasted the DOH for supposedly failing to implement UHC nationwide. Duque and the UHC Law congressmen-authors must have been left scratching their heads where these unfounded claims were coming from.

How could this be when the implementing rules and regulations (IRR) of the UHC have yet to come out?

Had they checked first with DOH, the IRR would come out by early next month yet. Our dear legislators who caused such a ruckus could have prevented  themselves from looking foolish had they only also read first Section 41(d) of RA 11223. This provision states:?“In the first six (6) years from the enactment of this Act, the National Government shall provide technical and financial support to selected LGUs that commit to province-wide integration…”

What is this province-wide integration? It is explained in Section 19 of the UHC Act: “Integration of Local Health Systems into Province-wide and City-wide Health System. - The DOH, Department of the Interior and Local Government (DILG), PhilHealth and the LGUs shall endeavor to integrate health systems into province-wide and city-wide health systems.”

The UIS Program is meant to facilitate this integration, by helping LGUs form well-oiled health service provider networks at the local level. And no less than the law itself gives the national government six whole years to facilitate the integration of the 119 health systems of provinces and independent cities. “We cannot demand the complete integration of over 100 provincial and city health systems overnight when the law clearly provides for a realistic six-year period to accomplish this,” Duque explained.

According to Duque, the inclusion of only 33 provinces and cities in the UIS program under the UHC Law for the development of local health service provider networks is only one of the “prescribed reforms” under this entire DOH program. Under the program, every geographical area of the country is well represented under the 2020 UIS Program. Thirteen integration sites are located in Luzon, 10 in Mindanao, 8 in Visayas, and 2 in the National Capital Region. The health chief said the 2020 UIS site map represents a “fair and equitable distribution” of DOH resources for this program. 

“Though it is a critical step to address fragmentation in the health system, the UIS Program is only one of the many reforms. Let us not confuse or equate UIS with UHC,” Duque stressed. Duque added the non-selection of an area in the UIS for 2020 does not mean that UHC will not be implemented at all in a certain area next year.

Duque reassured the lawmakers the rollout of the UIS Program is nationwide in scope but progressive in approach. This despite the fact that DOH has a lot on its plate with the implementation of UHC. By next year, however, the DOH is expecting the mandatory enrollment of all Filipinos in the National Health Insurance Program (NHIP) of the Philippine Health Insurance Corporation (PHIC) to be completed.

Quite frankly, it is unreasonable for these legislators to ask DOH to accomplish something as impossible as building a nationwide network of healthcare providers in a single year, when the law itself provides six times more time to do so. If you ask me, the fact that DOH is already starting the integration work in more than one-fourth of the provinces and independent cities of the Philippines is a decent enough start for the first year.

In the first year of UHC’s implementation in 2020, the funding requirement is expected to reach P258 billion, of which total, P195 billion will be sourced from Pagcor and PCSO. The balance of P62 billion – a funding gap – will come from tax on so-called “sin” products from e-cigarette and vapes and alcoholic products now pending before the 18th Congress.

The non-inclusion of their congressional districts in the UIS gives it shades of “pork-barrel” lobbying. I hope our lawmakers will put their power of the purse to good use. By doing so, it would help ensure President Duterte’s signature social service program will not be stymied by parochial concerns of their congressional districts.