In reducing maternal mortality, for instance, “the Philippines lags behind many countries in similar socio-economic conditions,” said WHO representative Dr. Soe Nyunt-U during a conference on health financing in Davao City in February.
He said the Philippines is facing problems in the health sector similar to those of its Asia-Pacific neighbors. The government’s chronic under-funding of health services leads to higher out-of-pocket spending by families. Compounding the problem in the Philippines is the fragmentation of health services among different levels of local governments, brought about by devolution (See related story, “Where do the sick go?”).
Statistics show that the Philippines is not likely to achieve the Millenium Development Goals, according to the National Statistics and Coordination Board. “MDG data of the NSCB show that we have low probability of achieving the targets on Indicator 4.3 (proportion of 1-year old children immunized against measles) and Indicator 5.1 (maternal mortality ratio),” said Dr. Romulo A. Virola, secretary-general of NSCB.
Except for Region IV-A (Southern Luzon), all regions, including Metro Manila, have “low probability of achieving the target,” he said.
For the maternal mortality target, Virola noted that only the National Capital Region, Southern Tagalog, and Central Luzon have ratios lower than the national rate. Additional investments in health, therefore, “are badly needed.”
Many LGUs, however, do not seem to prioritize health spending, because “health is not a big political issue,” said Dr. Alvin Caballes, a health economist specializing in local health systems and hospitals.
Although quarterly surveys of Pulse Asia over the years have shown that health has always been among the top five concerns of Filipinos, “no one is demanding health services of local governments,” Caballes said. If ever they did, “it would seem that people are not too concerned about quality—at least to the degree that they will complain about the lack of it or make such deficiencies election issues.”
In an attempt to help LGUs address the funding problems in health services, the government adopted the Health Sector Reform Agenda in 1999. The HSRA allows public hospitals to raise revenues on their own, thus prompting these hospitals to either charge fees for otherwise free services and medicines. It also lets public hospitals accommodate private providers into their operations.
The devolution and the HSRA had stimulated some LGUs to be “more innovative by partnering with the private sector or non-government organizations, or integrating health objectives into long-term plans,” for example, according to a 2010 study called “From Devolution to Consolidation: Local health system’s arrangement and facility-based deliveries in the Philippines,” by economists Joseph Capuno and Marian Panganiban. Some LGUs, their study said, are able to maximize “existing systems,” such as availing of Philhealth services and foreign donations to address specific health problems.
But “Notwithstanding the proliferation of innovations in local public services, the impact of devolution on health outcomes and outputs remains ambiguous at best,” Capuno and Panganiban concluded in their study.
One factor in the ambiguity is that the amount of public money spent on the health services does not necessarily indicate quality coverage.
For instance, say public health specialists, politicians embark on high-impact but unsustainable projects meant primarily for public relations purposes. These include one-time medical missions in vote-rich areas, and the distribution of Philhealth cards or medicines during election seasons.
Clearly, much of the reduced government’s spending has flowed more to hospital and personal health care, perhaps because people always go to politicians for assistance in emergency cases. Of the national and local government’s total health spending of P61.5 billion in 2007 (the latest health accounts data available), P27 billion went to such highly politicized but personal health care services.
In contrast, the national and local government spent a total of P20 billion on public health care, or services with benefits accruing to entire communities, such as immunization and disease control.
At times, these quick-fix programs meant for the poor even breed other problems in health service delivery. The Pantawid Pamilyang Pilipino Program (4Ps) of the social welfare department is an example. It provides cash grants to extremely poor households on the condition that they would use the money to improve their health and nutrition, among other things. It didn’t consider, however, that with more families now required to go to government clinics and hospitals, there may not be enough doctors and other health professionals to attend to them (see related story, “Not enough doctors, and nurses, in”).
In the end, the more desirable approach to the problem would be for the government, national or local, to invest in empowering families economically so they can afford to live in healthier conditions. This is according to the non-government organization Council for Health Development, which implements community-based health projects in many parts of the Philippines.
Dr. Eleanor Jara, CHD executive director, believes that “improvements in the health sector only account for about 20% of the improvement in health status [of citizens], while improvements in the social conditions account for the larger 80%.”
She explains: “You cannot solve the health problems by health programs alone. Our mothers, babies, and people will only be really healthy if they earn enough from agriculture and from a genuine industry…. If you live in the slum or in rural areas with insufficient potable water and sanitation, your health is not assured. Treatments at health clinics, no matter how free, are only palliatives at best.”
(This article was produced under the Maggie de Pano Fund for Investigative Reporting on Health. The Fund, which is managed by Newsbreak, is funded through a grant from Macare Medicals Inc.)