The health sector was not spared from the crisis that envelops the country.  Health as a fundamental requisite for development is continuously being neglected by a government keen only in seeking profit. Health workers continue to suffer from the lack in government budget resulting from the flawed privatization and market-driven policies of the Arroyo government, and made worse by corruption. The few idealistic and patriotic health workers and professionals who have decided not to leave had to work amid the crumbling public health system.      

BY PHILIP PARAAN
Contributed to Bulatlat 

NO TO INTEGRATION: Doctors and other health workers rally in front of the Philippine Heart Center in protest against the integration of government hospitals for medical tourism. The Philippine Heart Center is one of the government hospitals targeted for integration. PHOTO COURTESY OF COUNCIL FOR HEALTH AND DEVELOPMENT

The year 2006 was tumultuous for the country - politically and economically.  The health sector was not spared from the crisis.  Health as a fundamental requisite for development is continuously being neglected by a government keen only in seeking profit. Health workers continue to suffer from the lack in government budget resulting from the flawed privatization and market-driven policies of the Arroyo government, and made worse by corruption. Having to endure low wages and unbearable working conditions, more and more health professionals leave the country in search of gainful employment abroad.  

The few idealistic and patriotic health workers and professionals who have decided not to leave had to work amid the crumbling public health system.      

Health hazards 

Administrative Order no. 2006-0011 issued May 16 and effective July 1, 2006 was meant to provide for a standardized hazard pay of P 4,989.7 ($101.83 at an exchange rate of $1=P49) per month. But the hazard pay did not benefit all health workers. This is merely a repetition of an earlier order that benefited only a few in the health department. Only Department of Health (DoH) officials and employees within Salary Grades 20 and up or those in the top management, would again benefit from it. While those severely affected by the crisis, those within Salary Grades 9 and below or the rank and file employees did not have any increase in their pay or their benefits.

Although health workers, well understand that health hazards do not distinguish between salary grades, those in the frontlines namely, doctors, nurses, midwives and attendants who are most exposed would not benefit from the proposed increase. Emma Manuel, president of the Alliance of Health Workers (AHW), an alliance of unions and associations of health workers, said, “Hindi  dapat dependent ang hazard pay sa salary grade, di mo naman alam kung sino ang unang dadapuan ng bacteria.” (The hazard pay should not be dependent on the salary grade since you could not predict who would be the first to be infected by bacteria.)  

But the most vulnerable to infections are the rank and file who are directly involved in patient care and other services. They work more than eight hours and usually takes care of 60-80 patients per shift. 

Health workers protested against the discriminatory order prompting the DoH to consider a resolution fixing the hazard pay of all health workers.  The resolution is being studied by the National Health Workers Management Consultative Council under Health Undersecretary Nemesio Gako.  

Their long fought battle for unpaid hazard pay dates back since the term of former Health Secretary Manuel Dayrit, and with its earlier precedents of a series of contradicting administrative orders. Administrative Order no.17, dated February 10, 2003, ordered an increase in the hazard pay of Salary Grade 20 from five percent of basic pay to 25 percent, using Salary Grade 19 as benchmark. Salary Grade 20 and above employees have been enjoying this benefit from 2003 to present, without the knowledge of rank and file employees.  

Later that year, health workers, through their protests, managed to lobby for a hazard pay increase for all. Under AO 125, dated December 15, 2003, Salary Grade 1 employees were granted hazard pay amounting to 43 percent of their basic pay while those in Salary Grade 20 were suppose to receive hazard pay equal to 24 percent of their basic pay. This proposal would have been favorable according to AHW because of its proximity to the provisions set by the RA 7305 or Magna Carta for Health Workers.  But it was never implemented.  

The AHW is demanding for a uniform rate for hazard pay, which is 25 percent of basic pay with Salary Grade 19 as benchmark. Only the Philippine General Hospital implemented a uniform hazard pay citing an implementing guideline of RA 7305 issued by then Health Secretary Juan Flavier.

.In a dialogue last Oct.2, 2006 between the DoH and officers of various hospital unions under AHW,  Health Secretary Francisco Duque claimed that he was unaware of previous administrative orders regarding hazard pay, which were never implemented.  Duque said that he was amenable to the proposal for a hazard pay increase. But nothing has come out of it yet.  

Reversing the gains of concerted action 

Instead of addressing the legitimate demands of the government service sector, the Arroyo government introduced the Government Compensation and Classification Act of 2006 (GCCA). The bill which is pending in Congress is being proposed jointly by the Civil Service Commission (CSC) and the Department of Budget and Management (DBM).  Under the GCCA, Salary Grades 1-5 will get a minimal increase even if their basic salaries are still below poverty line. The basic pay of Salary Grade 1 amounts to only P 5, 082 ($103.71). 

Worse, the bill gives both the DBM and Civil Service Commission vast powers including the authority to repeal or take back economic benefits given to government employees.  This would reverse the gains achieved by government employees through concerted action such as Republic Act 7305 or the Magna Carta for Health Workers of 1992, the Magna Carta for Teachers, among others. Health workers also believe that the GCCA would be used by both agencies to implement mass lay-offs in the government sector.

Medical tourism = streamlining 

The Arroyo government is aggressively pushing for its medical tourism program. Medical tourism is being promoted by the government purportedly to improve the quality of health services and to encourage health professionals and workers to stay in the country. But one of the government’s first projects under this program is the integration of the five major specialty hospitals—National Kidney and Transplant Institute, Philippine Children’s Medical Center, Lung Center of the Philippines, Philippine Heart Center, and the East Avenue Medical Center.  This, health workers said, would lead to duplication of jobs in hospital services such as pharmacy and dietary leading to retrenchments.  A joint Board of Directors would also be created with vast powers, including the authority to reduce the allocation of charity patients.  (LINK sa previous articles regarding these) 

The AHW also believes that medical tourism would not lead to an increase in the salaries of health professionals and workers as revenues would be directed towards infrastructure development and acquisition of state of the art medical technology. Last year, the government claimed that the medical tourism industry earned P 125 million ($2,551,020) and doctors were asked to charge higher user fees. But health workers and professionals have yet to receive any increase in salaries disproving government claims that the program would also benefit them.  

In a statement in the Philippine Daily Inquirer, Secretary Francisco Duque suggested a review of legal impediments in the constitution that prevents the entry of Indian physicians in the country. Some 400 applied for medical residency last year but were denied.  

“We could soon expect a lot of Chinese and Indian doctors, whose rate are said to be cheaper than ours, working in the country leading to streamlining in our hospitals and displacing Filipino health professionals.  These countries would also be sending nurses to ASEAN countries soon,” said Jossel Ebesate, chief nurse of the UP-PGH and President of the ALL-UP Workers Union. 

Ebesate added that this move to liberalize the entry of foreign health professionals and workers are in line with the rules of “reprocity” under the General Agreement on Tariffs and Trade( GATT) which the national government  adheres to. This could only mean displacement and further neglect for our own health workers. 

Plugging an unstoppable leak  

The year 2006 was the most controversial for the nursing sector with the much-publicized leakage in the nursing licensure examinations. Although progressive health organizations believe that the problem of leakage in the nursing licensure examinations has been going on for years, the June 2006 leakage generated the most controversy.  It has placed the future of 42, 000 examinees under question. 

Moreover, the AHW said the controversy regarding the leakage exposed the commercial orientation of nursing education in the country.   

There was a long stand off between those who proposed that examinees retake the licensure exams and those who refused.  The issue was aggravated by confusing statistics produced by the Professional Regulations Commission regarding passing scores with or without considering the controversial sections of the tests.  The Arroyo government added to the confusion by flip-flopping in its position regarding the call for a retake of the examinations.   

After the Court of Appeals (CA) ruled on a selective retake of Test 3 and 5 of the June nursing board exams, it has been back to business as usual.  The government has remained mum on the fate of those who were identified as accountable.   None of those found liable by the National Bureau of Investigation, including Board of Nursing Commissioners Virginia Madeja and Anesia Dionisio, former Philippine Nursing Association President George Cordero, and operators of Inress review centers, had their day in court.   

Immediately after, the CA ruling President Gloria Macapagal-Arroyo met with representatives of the U.S. National Council of Sate Boards to resume discussions on the prospects of establishing a NCLEX-RN (National Council Licensure Examination-Registered Nurse) testing center in the Philippines. Recently, two major employment programs recently signed by the Arroyo government under the Japan-Philippines Economic Partnership Agreement and the ASEAN Mutual Recognition Agreement were designed to facilitate the entry and practice of Filipino nurses in Japan and ASEAN countries.  

Heal and struggle 

The Philippines is reputed to be the biggest exporter of nurses and second biggest exporter of doctors.  The country’s health professionals are known as caring and efficient.  But those who remained to care for the country’s ailing population are themselves neglected.  They continue to work within a crumbling health system made worse by a decreasing health budget.  The threat of streamlining and retrenchment hovers over their heads.  They constantly face the challenge of being understaffed, overworked and underpaid.  Laws and policies that worsen their living and working conditions are being passed. 

But they are determined to push forward in their struggle for just wages and benefits, including a P3, 000 ($61.22) across the board increase; for job security; and for their democratic rights. They believe that their healing starts with their participation in the struggle. Bulatlat