“The Philippine government can follow Cuba’s example of resisting privatization and establishing an integrated national health system that is strongly public and shouldered by government through our taxes.”
By ANNE MARXZE D. UMIL
MANILA — For the first 100 days of President Rodrigo Roa Duterte, no significant change was seen by the progressives in the health sector.
Robert Mendoza, national president of the Alliance of Health Workers, said the Department of Health has been implementing the same old policies, such as corporatization of public hospitals and devolution of health services.
For one, the Duterte administration is still pushing through with the controversial closure of the Dr. Jose Fabella Maternity Hospital, which began during the administration of President Benigno Aquino III.
Even before assuming her post, Health Secretary Paulyn Jean Rosell-Ubial announced that government hospitals will be corporatized.
What is worse is the huge budget cut for Maintenance and Other Operating Expenses (MOOE) of government hospitals for 2017. From this year’s P74 billion ($1.53 billion), the proposed MOOE in 2017 is P38 billion ($787 million).
The AHW said the health department tried to slash at least P1.5 billion ($31 million) from 70 DOH-retained hospitals, to bring their budget from P5.2 billion ($107 million) this year down to P3.6 billion in 2017. This was, however, opposed by the Makabayan bloc, and the P1.5 billion cut was restored after second reading of the General Appropriations Act in Congress.
Health groups remain vigilant. “We have to watch closely so that it will not be cut again until the General Appropriation Act of 2017 is passed by the end of the year,” Mendoza told Bulatlat in a phone interview.
Lower MOOE forces public hospitals to generate income
The MOOE for government hospitals under the national budget is allotted to medicines, supplies and utilities, such as electricity and water. Mendoza said insufficient budget for the MOOE would force public hospitals to increase the cost of laboratory procedures and other hospital services.
“The budget reduction would also mean more out-of- pocket expenses for the people, because the hospitals are in a bind to collect fees and enforce other income-generating schemes to sustain operations,” Mendoza said.
One such case is that of the Philippine Orthopedic Center, whose MOOE will be reduced to P85 million ($1.76 million) in 2017 from the current P153 million ($3.16 million). The POC is a specialty hospital for Musculo-Skeletal Injuries and Diseases and the Premiere Rehabilitation Medicine Center in the Philippines.
Sean Herbert Velchez, National Orthopedic Hospital Workers Union-Alliance of Health Workers president said their hospital could not afford any budget cut. The POC, he said, has been suffering from neglect and abandonment for many years resulting in dilapidated buildings and lack of facilities. The POC was also the first government hospital under President Aquino to be modernized under the Public-Private Partnership program. The planned modernization was foiled due to the strong resistance of the people and employees. The hospital has been able to cater to thousands of patients free of charge even with the minimal budget allotted to them every year.
The Fabella Hospital will get a smaller MOOE, from P93 million ($1.92 million) this year to P53 million ($1.10 million).
Barangay Health Stations will have it worse, with zero budget in 2017, noted Health Alliance for Democracy (HEAD) secretary general Dr. Joseph Carabeo, who has been a public health official and a staunch advocate of primary health care.
“Imagine the indigenous people: even if they receive the government’s much flaunted Philhealth coverage, they cannot use their card for basic check-ups or primary care services, let alone travel to the distant, cash-strapped, ill-maintained district or provincial hospitals,” Carabeo said.
Special provision on hospital income
The AHW noted the special provision no. 2 in the 2017 national budget that says: “All income generated from the operation of hospitals and institutions under DOH shall be used to augment the hospitals’ MOOE and capital outlay requirements, including payment of Philhealth premium under Point of Care Program.”
“This clearly indicates that the budget of hospitals have been cut because the national government mandates them to generate income from patients rather than ensure provision of free medicines and services,” said Mendoza.
He added that Philhealth, as a government corporation has been generating income and profits through premium payments. As such, he said hospitals have no obligation to subsidize Philhealth premium and the law does not mandate them to do so.
The AHW also noted the budget allocation of Philhealth which is P50 billion ($1.03 billion) for 2017, add to that the P7 million ($144,759) budget of the DOH, which is allotted for the PhilHealth’s Payapa at Masaganang Pamayanan programs in conflict-affected areas.
Mendoza said many more poor patients would benefit if the Philhealth budget will be allotted directly to government hospitals, especially in the provinces and far-flung areas.
“This way, all patients can have access to health care regardless if they are PhilHealth members or not and whatever their illnesses are,” said Mendoza.
‘Unfilled plantilla positions remain’
The number of health professionals and employees would remain, said the AHW, as vacant plantilla positions remain unfilled. There are 63,281 authorized positions in the DOH but only 40,376 have been filled.
Mendoza said health workers would remain overworked if some positions remain vacant. Data by the AHW showed that nurse to patient ratio is 1:60 up to 80, contrary to the DOH-prescribed 1: 12 nurse to patient ratio.
This would mean nurses working double-shifts while attending to several patients. The group Filipino Nurses United identified this situation as contributing factor to the hardship of nurses, making them stressed and grumpy as what Negros Oriental Rep. Arnulfo Teves pointed out in one of the budget hearings. Nurses’ salaries also remain lower than their proposed P25,000 ($517) a month.
“Allotting budget for unfilled positions and creating more plantilla positions of doctors, nurses and midwives would deliver ideal and more responsive health worker to patient/population ratio,” said Mendoza.
Secretary Ubial contradicting President Duterte
For the administration’s first 100 days, Carabeo said, there is a glaring contradiction between Ubial and Duterte’s wish for free healthcare for the Filipino people, especially the poor.
Although Ubial was sent to Cuba to observe the best practices of health care system in the country, he said the secretary seemed to have failed to understand the Cuban healthcare system.
“There has been no change in the health policy direction of the DOH. The ‘Ubial’ Health Agenda is a mere rehash of the Aquino Health Agenda and the other Health Sector Reform Agenda of previous administrations that miserably failed to guarantee health for all,” said Carabeo.
“The IMF-WB, WTO-APEC-WHO neoliberal agenda of budget cuts, fiscal autonomy, corporatization and privatization of public hospitals and an insurance-led healthcare system remain to be their mantra,” he added.
The health groups stressed the need for government to look into the DOH policy direction and programs. Carabeo also urged Duterte to exercise his political will to “make the Filipino people’s common wish of a free, comprehensive and progressive health care for the people come true.”
“The Philippine government can follow Cuba’s example of resisting privatization and establishing an integrated national health system that is strongly public and shouldered by government through our taxes,” Carabeo said.