From 2016 to 2019 alone, the public health program’s total budget allocation has been reduced significantly, varying from 15-percent to 28-percent cut. For one, the budget for Research Institute for Tropical Medicine, the lead public hospital in the government’s effort to address the looming outbreak, has been slashed from P263 million in 2019 to P115 million in 2020.
By JANESS ANN J. ELLAO
MANILA – Despite the country’s experiences of health crises in the past, the Philippine government appears to be ill-prepared in dealing with COVID-19.
Filipinos were left with more questions than answers as President Rodrigo Duterte, in his press briefing last night, tapped state security forces to combat COVID-19 in the guise of community quarantine without offering concrete medical solutions.
This has left the likes of retired health worker from the Research Institute for Tropical Medicine, Edgardo Damicog in disbelief. He asked, “why have we not learned anything from the past?”
Critics trace this ineptness to both massive budget cuts and long-standing impacts of the devolution of the public health system.
The Philippines, as of this writing, has 52 confirmed cases.
President Duterte said the government bureaucracy will take its cue from the health department. However, police and military forces will be deployed in Metro Manila to purportedly maintain order, clarifying several times during the briefing that this is not martial law.
And so, despite the repeated assurance that the government is prepared to tackle COVID-19 head on should an outbreak take place, the steps that they are taking is quite telling that the situation proves otherwise.
Recalling the reported transfer of a then suspected COVID-19 patient from Dumaguete to Manila, Damicog said it is telling of how regional public health care system is not equipped to deal with the virus.
“This is definitely a result of years of neglect, lack of budget, of being kowtowed by neoliberal policies, and the continuing commercialization of public health care,” Damicog said in a protest action in Mendiola last month.
Budget cuts, disease surveillance
The WHO noted that the Philippine public health system has a network of epidemiology and surveillance units from the central office down to the city levels.
Critics said this could have been tapped for contact tracing during the onset of the virus in the country as these played a “leading role in the surveillance and control of emerging infections such as Middle East respiratory syndrome (MERS) coronavirus, Ebola and severe acute respiratory syndrome,” per WHO.
In its earlier report, the WHO said that in compliance to their 2005 health regulations, the Philippines should have developed its system of health surveillance for emerging and re-emerging diseases of domestic and global importance.
The Philippines has also issued other administrative orders on various health-related crises, which the present government can draw lessons from, such as in containing zooneses and anti-microbial resistance.
However, from 2016 to 2019 alone, the public health program’s total budget allocation has been reduced significantly, varying from 15-percent to 28-percent cut.
For one, the budget for Research Institute for Tropical Medicine, the lead public hospital in the government’s effort to address the looming outbreak, has been slashed from P263 million in 2019 to P115 million in 2020.
Damicog, too, recalled that the RITM suffered the worst budget cut in 2017, which was about a 57-percent decrease.
“This is the same agency that Duque referred to as ‘incompetent.,” Dr. Josh San Pedro, co-convenor of the Coalition for People’s Right to Health, said in a briefing before members of the progressive community last month.
No lessons from the past?
Damicog recalled his days when he served in the frontline of a government hospital as they confronted the then Severe Acute Respiratory Syndrome (SARS) back in 2003. Though they were short of information on the epidemic, Damicog and his colleagues, he said, had a job they needed to do.
During the SARS outbreak, the Philippines recorded a chain of transmission linked to one single imported case that resulted in two deaths. As a response, then President Gloria Macapagal Arroyo issued Executive Order No. 201, which defined the powers and responsibilities of government agencies to address SARS. This acknowledged that the Philippines is in “danger” of being affected “unless bold, preemptive, active and immediate steps are taken.”
The health secretary was then designated as “crisis manager” until such time that he would declare that SARS was no longer a threat to public health. As crisis manager, the health secretary was expected to lead prevention of its spread, and public education. The department, too, was tasked to create “an efficient triage system” and “continuous contact tracing” for effective quarantine and proper isolation procedures in addressing SARS.
The health secretary, too, was empowered to call on all government agencies for assistance, including both civilian and military offices. The executive order essentially tapped the entire executive bureaucracy to address SARS.
To do all these, a P1-billion fund was allocated from the Philippine Charity Sweepstakes Office to cover the financial requirements of Arroyo’s executive order.
Despite the declaration of public health emergency, Duterte has not allocated additional funds to combat the corona virus.
Fragmented public health system
No less than the WHO itself, in a statement issued on Jan. 30, found it unimaginable of the damage this virus can bring to a country with a “weaker health system.” Health Secretary Francisco Duque was quick to react that the Philippines, despite the repeated criticisms of its deteriorating public health system, is not among those referred to by the WHO as it is a “middle-income country.”
San Pedro, however, said that being a middle-income country will not necessarily translate to better health system. The country has a doctor to patient ratio of 1:33,000, a far cry from Cuba’s 1:700.
In 2016, then Health Secretary Paulyn Ubial said the country is short of 15,000 doctors to adequately meet the needs of Filipinos each year.
A 2005 Bulatlat report noted that since the mid-1980s, the health budget has never gone beyond four percent of the total national appropriations. Budget for hospitals, whose upkeeps are now managed by local government units, have also gone down even more when the devolution of public health system began in 1992.
The devolution of the country’s public health care is but another neoliberal dictates of the US government.
In the early 2000s, various US-funded programs such as the Health Sector Reform Technical Assistance Project pushed for supposedly improving public health programs, which recommended, among others, fiscal autonomy for government hospitals.
Plight of health workers
Damucog said that despite lessons that we can draw from the past, many Filipinos cannot find the heart to remain calm.
“How can we remain calm,” he said, “when we are always left in the dark?”
As it stands, San Pedro said that health workers are at risk of the communicable disease.
In China, at least 1,716 health workers were infected and seven dead. Meanwhile, in the Philippines, San Pedro said health workers may be more vulnerable due to massive budget cuts.
“I can still remember how anxious and scared we were. Health workers sent to the frontlines nonetheless, despite having little information on the then looming disease, especially its mode of transmission,” said Damicog, who was among those who assisted in the autopsy of 46-year-old Adela Catalon, the country’s second SARS case and also its first death.
RITM’s current union president Romeo Garcia recalled the discrimination that he and his family had to go through during the SARS days – his neighbors and relatives want nothing to do with them as they may be carriers or even afflicted by the virus.
In then addressing SARS, Philhealth was tasked to develop an insurance package for public health workers that will defray the hospitalization cost should they develop SARS in the course of their job. In his recent press briefings, Duterte was silent on the needs and welfare of health workers.
Damicog said the necessary quarantine for health workers exposed to COVID-19 patients may lead to more understaffing.
In a statement, the Coalition for People’s Right to Health decried the 10-billion budget cut for health and the increased intelligence funds.
“In this time of a health crisis, the government should realign funds from the aforementioned to undebatably more important and relevant programs that directly impact people’s lives such as health,” the group said. (With reports from Marlo Madrigal /