Philippine Public Health ‘in Emergency Room’ – Health Activist

The Philippine public health sector is now “in the emergency room,” according to a health activist. Among the proofs she offers is the fact that treatable diseases are among the country’s top killers, and public hospitals now charge for most of the services they render.

BY ALEXANDER MARTIN REMOLLINO
Bulatlat

With the continuously decreasing health budget, can it be said that the Philippine public health sector is now in the emergency room? Ross Mayor, an activist who works with the non-government organization Council for Health and Development (CHD), thinks so.

Mayor was also among 400 health workers who participated in a protest motorcade by the Kilosbayan para sa Kalusugan (KbK or People’s Health Action) last Sept. 7 to call for an increase in the national health budget. The Quezon City-based CHD is part of the KbK.

The protesting health workers, after braving the heat of the afternoon sun, proceeded to the House of Representatives, attended the session, and waited patiently for hours to hear Bayan Muna (People First) Rep. Satur Ocampo deliver a privilege speech on the “deplorable condition” of the country’s public health sector.

“In the face of widespread poverty,” said the KbK in a statement distributed during the protest action, “the allocation of a measly P10.4 billion ($1.86 billion) or 1.75 percent of the 2004 budget and the proposed P10.3 billion ($1.84 billion) for 2005 amount to a grave neglect of the people’s health on the part of the Macapagal-Arroyo administration.”

Mayor deplores the fact that debt servicing and militarization rank higher in the government’s list of budgetary priorities than health. She said that most of the country’s debts did not benefit the people.

Asked for her opinion on the argument of pro-government commentators that the “terrorist” threat the country faces requires a large military budget, Mayor said:

“One example is tuberculosis. It is the primary public health threat: you don’t see it but it’s there. It kills 75 Filipinos daily. Just think how many Filipinos it kills in a year! The ‘terrorist’ threats they talk about, how many have these killed? Where is the body count for the victims of ‘terrorism’ that they are talking about?”

Some opinion writers have commented that tuberculosis has killed more Filipinos than the small bandit group Abu Sayyaf, which is included in the U.S. list of “foreign terrorist organizations.” Mayor agrees. “If I remember right we have the seventh highest number of tuberculosis deaths in the world, and second highest in the Western Pacific region,” she added.

The treatable killers

Particularly reflective of the Philippine public health sector’s situation, Mayor said in an interview with Bulatlat, is the fact that among the leading causes of death in the Philippines are diseases that could in fact be treated, provided there are sufficient funds.

Number one among them is tuberculosis, she revealed. Once tuberculosis is detected, it could be cured within six months of continuous medication. But as it is, it rarely gets detected, and if detected there are usually no available medicines in health centers: these have to be bought.

“So what happens is that usually, patients take medicines for a few months, and then they don’t complete treatment,” she adds. “Their sickness now develops a multiple drug-resistant strain – which is more difficult to treat, and at the same time is more contagious.”

Other treatable diseases that usually end up killing their victims are cholera, diarrhea, and measles, Mayor further disclosed. In other countries diarrhea and measles are no big deals, but these diseases can kill people in Third World countries like the Philippines.

Mayor also recounted the CHD’s experience medical mission to Oriental Mindoro, a province south of Manila, in 2001. A measles epidemic had struck the Mangyans, a tribe native to the island.

They were living in a remote area, and had to walk about one and a half to two hours to get to the nearest health center, Mayor recalled. And they had to traverse hills and rivers. So the children had fevers, and they had to be brought through the rivers. “By the time the people got to the health centers, many of the children had died,” she said.

Mission members talked with the local officials of Calapan, the capital city of Oriental Mindoro, and asked them to send health teams because the people were unable to go down. However, they were told that there were neither personnel nor medicines available, and that they could only afford to send dump trucks to fetch the patients.

“The provincial health officer was unable to do anything. The result, among others, was that in one tribe, out of 25 kids, only one survived,” Mayor said.

Fees

The KbK, in its statement, also noted that patients in public hospitals now also have to pay fees they didn’t have to pay before. If before 90 percent of hospital beds were reserved for indigent patients, at present ‘charity beds’ make up less than 50 percent, the statement said. “Patients even have to pay for the cotton, gauze, plaster, alcohol, needles and syringes, and even the life-saving medicines,” it said.

Mayor said that this was because public hospitals, from lack of funds, are forced to resort to revenue-raising measures to finance their operations.

The statement also noted that in a survey conducted by KbK among 553 patients of 13 public hospitals from Aug. 31 to Sept. 2, the respondents had to pay professional fees ranging from P1,000 ($17.86) to P10,000 ($178.57).

According to Mayor, doctors working in public hospitals are usually paid a monthly wage of P15,000 ($267.87), while the salaries of nurses range from P5,000 ($89.29) to P6,000 ($107.14).

“Even the doctors are hard up, though their wages are relatively higher,” Mayor points out. “If you have a family, you can’t live on P15,000 a month these days.”

Based on computations by Bulatlat’s Danilo Araña Arao, the daily cost of living for a family of six, or the average Filipino family, is P594 ($10.61). This translates to P17,820 (the equivalent of $318.21) a month. Arao based his computations on data from the National Wages and Productivity Commission.

“In some cases,” Mayor reveals, “their patients are so poor that they have to help shoulder their expenses. So if you are already underpaid and you still have to shell out money to help your patients, just imagine what you have to put up with.”

HSRA

The government, apparently feeling the pressure of mass protests since the mid-1990s against the low spending for public health, institutionalized a Health Sector Reform Agenda (HSRA) in 2000. The HSRA, states a document found on http://www.logos-net.net/ilo/150_base/en/init/phi_7.htm, “aims to improve health financing, health regulation, hospital systems, local health systems, and public health programs.”

Was the HSRA able to fulfill its avowed purpose?

Mayor doesn’t think so.

“When you do the rounds of government hospitals, you’d see the very long lines of patients, whose needs are mostly not addressed. The hospitals lack facilities, and now they have to charge fees for their services whereas before at least there were a few services they could render for free. Now you can almost no longer get free medical services.

“The HSRA merely perfumed the government’s plan to commercialize health services.” Bulatlat

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