Philippine Health Care Delivery System

THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM HEALTH CARE SYSTEM - an organized plan of health services (Miller-Keane, 1987) HEALTH CARE DELIVERY - rendering health care services to the people (WilliamsTungpalan, 1981). HEALTH CARE DELIVERY SYSTEM (Williams-Tungpalan, 1981) - the network of health facilities and personnel which carries out the task of rendering health care to the people. PHILIPPINE HEALTH CARE SYSTEM - is a complex set of organizations interacting to provide an array of health services (Dizon, 1977).

COMPONENTS OF THE HEALTH DELIVERY SYSTEM The Department of Health Mandate: The Department of Health shall be responsible for the following: formulation and development of national health policies, guidelines, standards and manual of operations for health services and programs; issuance of rules and regulations, licenses and accreditations; promulgation of national health standards, goals, priorities and indicators; development of special health programs and projects and advocacy for legislation on health policies and programs. The primary function of the Department of Health is the promotion, protection, preservation or restoration of the health of the people through the provision and delivery of health services and through the regulation and encouragement of providers of health goods and services (E.O. No. 119, Sec. 3). Vision: Health as a right. Health for All Filipinos by the year 2000 and Health in the Hands of the People by the year 2020.

Mission: The mission of the DOH, in partnership with the people to ensure equity, quality and access to health care: - by making services available - by arousing community awareness - by mobilizing resources - by promoting the means to better health LEVELS OF HEALTH CARE FACILITIES 1. PRIMARY LEVEL OF HEALTH CARE FACILITIES - are the rural health units, their sub-centers, chest clinics, malaria eradication units, and schistosomiasis control units operated by the DOH; puericulture centers operated by League of Puericulture Centers; tuberculosis clinics and hospitals of the Philippine Tuberculosis Society; private clinics, clinics operated by the Philippine Medical Association; clinics operated by large industrial firms for their employees; community hospitals and health centers operated by the Philippine Medicare Care Commission and other health facilities operated by voluntary religious and civic groups (Williams-Tungpalan, 1981). 2. SECONDARY LEVEL OF HEALTH CARE FACILITIES - are the smaller, non-departmentalized hospitals including emergency and regional hospitals. - Services offered to patients with symptomatic stages of disease, which require moderately specialized knowledge and technical resources for adequate treatment. 3. TERTIARY LEVEL OF HEALTH CARE FACILITIES - are the highly technological and sophisticated services offered by medical centers and large hospitals. These are the specialized national hospitals. - Services rendered at this level are for clients afflicted with diseases which seriously threaten their health and which require highly technical and specialized knowledge, facilities and personnel to treat effectively (Williams-Tungpalan, 1981)

FACTORS ON THE VARIOUS CATEGORIES OF HEALTH WORKERS AMONG COUNTRIES AND COMMUNITIES 1. available health manpower resources 2. local health needs and problems 3. political and financial feasibility THREE LEVELS OF PRIMARY HEALTH CARE WORKERS A. VILLAGE OR GRASSROOT HEALTH WORKERS - first contacts of the community and initial links of health care. - Provide simple curative and preventive health care measures promoting healthy environment. - Participate in activities geared towards the improvement of the socio-economic level of the community like food production program. - Community health worker, volunteers or traditional birth attendants. B. INTERMEDIATE LEVEL HEALTH WORKERS - represent the first source of professional health care - attends to health problems beyond the competence of village workers - provide support to front-line health workers in terms of supervision, training, supplies, and services. - Medical practitioners, nurses and midwives. C. FIRST LINE HOSPITAL PERSONNEL - provide back up health services for cases that require hospitalization - establish close contact with intermediate level health workers or village health workers. - Physicians with specialty, nurses, dentist, pharmacists, other health professionals.

TWO-WAY REFERRAL SYSTEM (Niace, et. al. 8th edition 1995) A two-way referral system need to be established between each level of health facility e.g. barangay health workers refer cases to the rural health team, who in turn refer more serious cases to either the district hospital, then to the provincial, regional or the whole health care system. Public P Barangay Health O Health Worker Nurse 2nd 3rd P HF HF U EA EA L Barangay RHU AC AC A Health Midwife Physician LI LI T Stations TL TL I HI HI O T T N RHS Sanitary Y Y Midwife Inspector MULTISECTORAL APPROACH TO HEALTH (NLGNI, 8th edition, 1995) The level of health of a community is largely the result of a combination of factors. Other health-related Systems (government/ private

Ways of The People (Cultural) Environment (Social, Economic, physical, Etc.

Community Health

Health Care System

Health, therefore, cannot work in isolation. Neither can one sector or discipline claim monopoly to the solution of community health problems. Health has now become a multisectoral concern. For instance, it is unrealistic to expect a malnourished child to substantially gain in weight unless the family’s poverty is alleviated…… In other words, improvement of social and economic conditions need to be attended to first or tackled hand in hand with health problems. 1. Intersectoral Linkages - Primary Health Care forms an integral part of the health system and the over-all social and economic development of the community. As such, it is necessary to unify health efforts within the health organization itself and with other sectors concerned. It implies the integration of health plans with the plan for the total community development. - Sectors most closely related to health include those concerned with: a. Agricultural b. Education c. Public works d. Local governments e. Social Welfare f. Population Control g. Private Sectors The agricultural sector can contribute much to the social and economic upliftment of the people……. Demonstration to mothers of better techniques and procedures for food preparation and preservation can preserve the nutritive value of local foods. Through joint efforts, agricultural technology that produces side effects unsafe to health (for instance, insecticide poisoning) can be minimized or prevented. The school has long been recognized as an effective venue for transmission of basic knowledge to the community. Every pupil or student can be tapped for primary health care activities such as sanitation and food production activities…..

Construction of safe water supply facilities and better roads can be jointly undertaken by the community with public works. Community organization (e.g. establishing a barangay network for health) can be worked through the local government or community structure. Likewise, better housing through social welfare agencies, promotion of responsible parenthood through family planning services and increased employment through the private sectors can be joint undertakings for health……We have to recognize that oftentimes health actions undertaken outside the health sector can have health effects much greater than those possible within it. 2. Intrasectoral Linkages - In the health sector, the acceptance of primary health care necessitates the restructuring of the health system to broaden health coverage and make health service available to all. There is now a widely accepted pyramidal organization that provides levels of services starting with primary health and progressing to specialty care. Primary health care is the hub of the health system. A PYRAMIDAL HEALTH STRUCTURE

National Health Services Regional Health Services District Health Services Rural (Local Hospital) Services

Tertiary Health Care

Secondary Health Care

Rural Health Units Barangay Health Stations

Primary Health Care

THE NATIONAL HEALTH PLAN (Niace, et. al 8th edition 1995) The National Health Plan is the blue print which is followed by the Department of Health. It defines the country’s health problems, policy thrusts, strategies and targets. POLICY THRUSTS AND STRATEGIES There are policy thrusts and strategies which are commonly important. These are: 1. Information, education, and communication programs will be implemented to raise the awareness of the public, including policy makers, program planners and decision makers; 2. An update of the legislative agenda for health, nutrition and family planning (HNFP), and stronger advocacy for pending HNFP –related legislations will be pursued; 3. Integration of efforts in the health, nutrition and family planning sector to maximize resources in the delivery of services through the establishment of coordinative mechanisms at both the national and local levels; 4. Partnership between the public and the private sectors will be strengthen and institutionalized to effectively utilize and monitor private resources for the sector; 5. Enhancement of the status and role of women as program beneficiaries and program implementers will be pursued to enable them to substantially participate in the development process.

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Related Articles: Health system Ministry of Health's mission, vision and objectives The Department of Health's vision is to be "The leader of health for all in the Philippines". Its mission is to "guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health". The goals of the health department align with the WHO health systems framework. Better health for the entire population is the primary goal. This means making the health status of the people as good as possible over the entire life cycle. The second goal is related to how the health system performs in meeting people‟s expectations and satisfaction with the services it provides. Equitable health care financing is the third goal because health and illness involves large and unexpected costs that may result in poverty for many people. The strategic thrusts to achieve the three primary health goals mentioned above are anchored in the current programme of health reforms, labelled „Fourmula One for Health‟. It is designed to undertake critical reforms with speed, precision and effective coordination, with the end goal of improving the efficiency, effectiveness and equity of the Philippine health system. Vital reforms are organized into four major implementation components: health financing; health regulation; health service delivery; and good governance in health. Implementation will focus on four general objectives: (1) health financing, the general objective of which is to secure increased, better and sustained investments in health to provide equity and improve health outcomes, especially for the poor; (2) health regulation, which aims to assure access to quality and affordable health products, devices, facilities and services, especially those commonly used by the poor; (3) health service delivery, where health interventions are aimed at improving the accessibility and availability of social and essential health care for all, particularly the poor; and (4) good governance in health, aimed at improving health systems performance at the national and local levels. Organization of health services and delivery systems With the devolution of health services to LGUs under the Local Government Code of 1991, fragmentation of services became evident. Service provision is regarded as „dual‟, consisting of both the public and private sector. The public sector has three largely independent segments or sets of providers: (1) national government providers, which include, among others, hospitals run by national government agencies (e.g., hospitals of the Department of Health and the Department of National Defense), central and regional offices of the Department of Health; (2) provincial government providers, which include provincial hospitals, provincial blood banks and the Provincial Health Office; and (3) local (municipal or city) government providers, including rural health units or RHUs, city health centres and barangay health stations or BHSs. Each BHSs is staffed by a midwife, and each RHU by a doctor, a nurse and midwives. The Department of Health's role now focuses on regulation, technical guidelines/orientation, planning, evaluation, and inspection, while the provincial

government is responsible for provincial and municipal hospitals, health centres and health posts, although funding flows do not exactly match responsibility. The municipal government-level role is not well defined and capacity is reportedly weak. With the decentralization of service delivery, local chief executives became core players in the health sector. The number of actors involved multiplied and hence the need for coordination and policy monitoring. On health financing, for instance, the Department of Health and the Central Government are no longer in control of resource allocation. The need for better coordination and a better working relationship with the local government units and other stakeholders is well recognized. Private providers are predominantly located in highly urbanized areas. The private sector consists of a wide range of privately operated facilities, such as pharmacies, physicians in solo or group practices, small hospitals and maternity centres, diagnostic centres, employer-based outpatient facilities, secondary and tertiary hospitals, traditional birth attendants and indigenous healers. Ongoing reforms in health service delivery are aimed at improving the accessibility and availability of basic and essential health care for all, particularly the poor. Public primary health facilities are perceived as being low quality, hence they are frequently bypassed. Clients are dissatisfied due to long waiting times; perceived inferior medicines and supplies; poor diagnosis, resulting in repeated visits; and the perceived lack of medical and people skills of the personnel available, especially in rural areas. The result is that secondary and tertiary facilities are inundated with patients needing primary health care. Since public primary facilities are more accessible to households and are mostly visited by the poor, improving the quality of those services particularly demanded by the poor would improve their health. Furthermore, referral mechanisms among different health facilities across local government units need to be strengthened. Pharmaceutical challenges remain due to asymmetric information, income distribution and the inadequacy of the regulatory system. This stems from various factors such as massive campaigns and lucrative incentives from multinational drug firms, prolonged patent rights cases and a lack of appropriate public understanding regarding generics. Health policy, planning and regulatory framework The Government's policy to achieve improvements in health includes a perspective on the integral value of health for any nation, the coordination of resources from all sectors, the right to access quality care, and the presence of socioeconomic fundamentals. While the Government provides the leadership and stewardship to ensure that all efforts in the health sector lead to a common goal, greater support to local health systems development and emphasis on strong management and administrative support systems at all levels of governance is critical. Better coordination between national policies and external development partner priorities would also play a major role in fostering the harmonization of resources for health. The Department of Health remains inadequate in regulating the quality of health services in the country. This is attributed to the immense gaps in health regulations caused by the lack of specific legal mandates, inadequate expertise, an inadequate

number of health regulation officers, a lack of expertise and infrastructure in specialized services and laboratory facilities, and weak health regulatory systems and processes. Health care financing The financial burden on individual families remains high. The latest (2005) national health accounts show that the most common source of funds for health in the country today is still out-of-pocket payments (around 49%). Paying for health care is an issue because of its poverty impacts. Under the current health care financing arrangements, low-income families are pushed into poverty due to payments for health care. Almost 80% of total health expenditure is spent on personal health care services. In contrast, only 11% is used for public health care services. About 10% is used for the administrative spending needed to run the entire health system. These are signs that the Philippines is not spending enough or effectively for health. Health care financing resources are spent largely on hospital-based curative services and not enough on preventive and promotive health services, and subsidies for health services are poorly targeted. The large hospitals in Metropolitan Manila and other urban areas get the biggest share of spending, while non-hospital health services face difficulties in getting adequate funding. Meanwhile, the national health insurance programme has seen only a relatively slow and cautious increase in its share of total health expenditure. Possible reasons for this include its low benefit package and the fact that coverage of the informal economy has not increased. The limited financial protection of the national health insurance programme, PhilHealth, is closely related to its benefit coverage and provider payment system. As physicians provide more services and raise prices under the current fee-forservice system, medical care expenses increase rapidly. However, PhilHealth pays only up to the rather low benefit ceiling and patients pay the rest of the expenses. At the same time, physicians‟ have the freedom to bill without fee regulation. Discussions are now ongoing to explore the feasibility of extending benefit coverage by raising the benefit ceiling. Public health facilities are funded through a mix of public subsidies, such as Philhealth reimbursements, user fees and, to a limited extent, private health insurers. At the primary care level, public subsidies and Philhealth capitation allocations are funding services for both insured and non-insured members and for both public health and personal care. At the hospital level, the mix of funding is not well understood by regulators. Moreover, several schemes may be working at the same time, depending of local priorities and management styles. Drugs are mainly purchased out-of-pocket from private for-profit retailers. The Government has recently introduced thousands of nonprofit community outlets, but their impact on access and the costs supported by patients remains to be seen. In response to these issues, the Government is finalizing its health care financing strategy to improve health care financing polices that would realistically enhance access, equity and effectiveness in resource mobilization and allocation, as well as the use of health services.

Human resources for health In 2004, there was one physician for every 880 people, one nurse for every 235, one dentist for every 1800, and one pharmacist for every 1664. However, these ratios have most likely changed, especially with the exodus of nurses in the past five years. The country is purportedly the leading exporter of nurses to the world and the second major exporter of physicians. Prevailing challenges include unmanaged immigration of Filipino health workers; a weak and inadequate human resources for health (HRH) information system; and an existing distribution imbalance, among others. Responses to HRH issues in the past have often been stopgap measures. In addition, the interventions of the agencies concerned have not always been well coordinated. In order to address such complex and multi-faceted issues, a comprehensive approach is needed. A master plan for human resources for health has been developed and implementation of activities is underway. A high-level coordinating body and multisectoral working group was established in 2006 to mobilize political commitment, donor/partner support and the funding needed to accomplish the priority activities of the master plan. Called the Human Resources for Health (HRH) Network, this group was able to successfully convene a policy forum to advocate their policy agenda, which aims to resolve issues related to production, entry and retention of health professionals, as well as their exit and re-entry. Strategic thrusts for 2005-2010 include development of HRH policies and strategies to address out-migration; sustaining incentive mechanisms for HRH distribution and complementation in underserved areas; and making education, training and skills development more appropriate to local needs. The strategies that are being undertaken include, among others, the institutionalization of the health human resource management and development system; improvement of the technical competence and relevant skills of health professionals through education and training; provision of targeted and performance-linked compensation benefits; strengthening of the coordination mechanism between the education sector, regulatory agencies and HRH users; and installation of and HRH information system. Partnerships The attainment of national health goals has significantly progressed given the welldefined, commonly-shared vision and framework for health (now called „FOURmula ONE‟). Department of Health experience has shown that better harmonization of efforts among the various stakeholders at all levels is critical. Currently, assistance for the health sector comes mainly in the form of grants, loans and technical assistance. A sectorwide development approach for health (SDAH) between government and partners is being initiated to maximize investments, minimize duplication of initiatives and generate the necessary resources for the health sector. The Department of Health is also working closely with international organizations and global initiatives to strengthen implementation of priority health programmes. Challenges to health system strengthening The publicly funded health system has been undergoing a major reform programme since 1999. At the broadest level, this has included a review of the Department of Health‟s primary functions, roles and responsibilities and the suitability of the existing

organizational structure to support these at both the strategic and service-delivery level. Introducing and pilot-testing the different concepts and strategies of heath sector reform in selected provinces has showcased some gains in health systems development. However, one of the gaps then was the absence of a comprehensive operational framework to implement the reform strategies. Thus, the FOURmula ONE framework was launched in August 2005 to set the direction and implementation arrangements for strengthening the way health care is delivered, governed, regulated and financed. FOURmula ONE is now on its third year of implementation and both the Department of Health and the LGUs are being challenged with operational issues, such as procurement. In addition, the health care delivery system has yet to address some major issues and challenges including, among others: the absence of data disaggregated at provincial/municipal level (for baseline and monitoring); the absence of a workable means of identification of the poor for targeted health interventions; the minimal involvement of the private sector in the delivery of public health programmes; the still excessive reliance on the use of high-end hospital services rather than primary care; the slow improvement in maternal mortality reduction; and population growth. Issues such as geographic inequity, where people who live in rural and isolated communities receive less and lower quality health services, and socioeconomic inequity, where the poor do not receive health services due to inaccessibility and/or unaffordability, continue to abound in the country. More specific issues like out-migration of skilled health workers, low salaries/wages and lack of incentives and poor work environments, including shortages of basic medical equipment and supplies, continue to contribute to the worsening shortage of workers in rural areas, where health needs are greatest. Hospitals, both public and private, all over the country lament the loss of senior experienced nurses and doctors. The University of the Philippines-Philippine General Hospital (UP-PGH), the largest hospital in the country, loses 300 to 500 nurses of their 2000 nurse workforce every year. Midwives, the front liners in providing health services, are also seeking jobs as caregivers in other countries in need. There is a lack of reliable, disaggregated and integrated health and health-related data, evidence and information, and inability to use health information to ensure knowledgebased policies and programmes remains a major challenge. There is also low investment in health research and development systems, as well as in information management systems. In the area of health care financing, the following challenges remain: high out-of pocket spending; inadequate government spending on health; low spending for cost-effective public health interventions; low social health insurance benefit spending; and identification of the „true‟ poor for social health insurance (sponsored programme). The high cost of drugs and medicines also remains a major challenge, as prices range from two times to as much as 30 times higher than in other neighbouring Asian countries. To date, the „Cheaper Medicines‟ Bill, which aims to effectively reduce the cost of medicines in the country, is yet to be signed by the President of the Philippines.

The devolution of health services created new challenges for the Government in overseeing that local actions are in accordance with national policies and goals. Good governance in health at the local levels, particularly in improving transparency and accountability in finance and procurement, and logistics management remains a big challenge. With FOURmula ONE, systems of accountability and transparency are being established to minimize unscrupulous behaviour, thereby ensuring efficient use of available resources for health. Source: http://www.wpro.who.int/countries/2008/phl/national_health_priorities.htm Health care beyond reach of poor, say critics By Kirsten Bernabe Philippine Daily Inquirer First Posted 05:35:00 04/13/2010 Filed Under: Health treatment, Diseases, Poverty, Government,Insurance

(11th of a series) For any Filipino family, especially among the poor, an illness striking any of its members is viewed as a catastrophe. Six of 10 Filipinos who succumb to sickness die without ever seeing a doctor, according to the University of the Philippines‟ National Health Institute. Health care is one of the most important items that should be on the agenda of whoever gets elected president in the May election, according to a group of former senior government officials who have drawn up a list of urgent concerns for the next administration to address in its first year. Unlike in the United States, where health care occupied center stage in the past presidential election and continues to be a major program of the Obama administration, very little attention is focused on the current debates on this major problem that impacts heavily on improving education and easing poverty in this country. Ailing parents can‟t support their families. Sickly and malnourished children can‟t attend schools, setting back their education, the main vehicle for social mobility especially among the poor who have no access to wealth or capital. Even among those with a regular income, like Jeremy Macalalag, 39, surviving a major ailment is nothing short of a miracle. Macalalag was diagnosed with severe kidney problem requiring dialysis, an expensive treatment that cost P3,500 a session. He had to undergo this process or would die unless he had a P1.2 million transplant operation, doctors said.

“I didn‟t know from which pocket and from what kind of hand I would get the money to save my husband‟s life,” says Macalalag‟s wife, Joanne, 38, an ultrasound technician in a hospital who earned P30,000 a month on which her family of four depended to survive. With her social network, however, she secured help from humanitarian organizations, such as the Lifeline Foundation and the Philippine Charity Sweepstakes Office, to defray the cost of the transplant. Not many in this nation of 90 million are that fortunate, especially among the more than 27 million who survive on a dollar a day, the poverty threshold defined by the World Bank. Infant mortality rates The poorest Filipinos have an infant mortality rate of 42 per 1,000 births, compared with 19 per 1,000 births among the rich, according to a concept paper presented at a UP forum on universal health care last year. “The same can be observed in maternal mortality rates. The lowest income groups are also 1.4 times more likely to be positive for tuberculosis based on X-ray exam compared to the highest income groups,” it says. Urban areas, such as the National Capital Region, have the highest number of health facilities, while the poorer regions such as the Autonomous Region in Muslim Mindanao have predominantly private facilities—far from the reach of the poor. “Despite 76 percent coverage of PhilHealth insurance, 49 percent of health spending is still out-of-pocket. Due to increasing cost of services and the lack of appropriate social protection, illness now tends to be viewed as a catastrophic event, especially for the poorest Filipino families,” the paper says. Universal health care Dr. Ramon Paterno of the UP National Health Institute says the country needs a universal health care system where “every Filipino has access to needed health care, with minimal or no co-payment.” He stresses that this isn‟t about charity. “It is prepaid by taxes and social premiums.” Paterno laments that health care financing has almost always been troublesome. “Government‟s budget for health care only amounts to less than 3 percent of the country‟s GDP (gross domestic product). This is 2 percent lower than the standard health care allocation, 5 percent, recommended by the World Health Organization,” Paterno says. “As a nation, we spend P200 billion for health care but 60 percent of this are out-of-thepocket expenditures.”

Philippine Health Insurance Corp. (PhilHealth) is a state agency attached to the Department of Health, which strives to deliver universal health care to its clients. The agency “ensures sustainable, affordable and progressive social health insurance, which endeavors to influence the delivery of accessible quality health care for all Filipinos.” Public hospitals Workers pay P100 to P750 a month for PhilHealth, but 50 percent of the monthly premium is covered by their employers. Critics say that PhilHealth is one of the better-run state corporations, accumulating assets of up to P70 billion. But they say that little of PhilHealth‟s assets are being used to finance the improvement of provincial hospitals so that they can be accredited into the system and thereby ease the shortage of medical services in the rural areas. Little tertiary health care—services provided for major ailments by such hospitals as Makati Medical Center and Medical City—is available in the provinces. Valid concern Health Secretary Esperanza Cabral acknowledges this is a valid concern. “We need to improve our activities as far as accrediting hospitals and clinics so that patients with PhilHealth cards can access them and they can be reimbursed for the services they provide so that they can have money that they can pour into other health services,” Cabral says. “The support value is only about 30 percent. At the moment, we actually say that is the only amount that we can afford. I have to take a serious look as to whether that is true and whether, if that‟s the only thing we can afford, we are putting it in the right places.” Paterno shows documentaries of the rural poor who are unable to avail themselves of medical services. “There‟s nothing I can do,” says an ailing woman profiled in the documentary. “I am just waiting to die if no one lends help,” she says, tears welling in her wrinkled eyes. Health on P1.10 a day? How does the average Filipino cope? “I do everything. I sell perfumes and I work during my days off. We also collect bottles, newspapers, boxes and the like, and sell them,” Joanne Macalalag says.

“We are in a hand-to-mouth condition. My kids are used to eating corned beef almost always. We cannot afford other extra expenses.” Based on the allocation of government‟s budget, a tax-paying Filipino spends only P1.10 a day for health care compared to P21.75 spent on debt-servicing, authorities say. Apparently, P1.10 a day isn‟t giving the Jeremy Macalalags in this country too much hope. While every Filipino is entitled to health care in the Constitution, it is regarded more as a privilege, as poverty incidence widens. “Health care in the Philippines is costly as it is mostly given for profit. Most Filipinos are poor and health care becomes least in their priorities next to food, shelter and education,” says Dr. Geneve Rivera, secretary general of Health Alliance for Democracy. She says the profit-driven nature of health care is characterized by privatization of services, including those dispensed by government facilities, as well as the western orientation of health education designed for the needs of other countries. Ill-equipped gov’t hospitals “Government hospitals are ill-equipped that a PhilHealth member will have minimal use of the membership,” Rivera says. For example, she says, few public hospitals have an ultrasound facility. Which means, you have to go to a private hospital to avail yourself of this service and pay for it. “PhilHealth also has various limitations in its coverage,” Rivera says. “But the whole concept of it does not answer the bigger problems. In these times when most Filipinos can barely afford to buy food, how can one pay for the contributions?” she says. “Government policies on health care provision have made the health care services more and more inaccessible to the people especially the underprivileged. The continued privatization of government hospitals, the low priority in allocating budget for health, and the continuing program of sending our health professionals abroad are all contributing to the worsening of the health care delivery in the country,” she says. And unfortunately, health professionals who choose to stay in the country and do community work are being targeted as enemies of the government and are being harassed, like the 43 health workers allegedly illegally arrested and detained in Camp Capinpin. The case has reached the Commission on Human Rights. Rivera says that the government should promote community health work and ensure that volunteers are safe from harassment.

“The government should work on making health and other social services equitable, those who have less should receive more,” says Rivera, one of the few doctors who immerse themselves in depressed communities and serve the poor. Alternative medicine Because of the high cost of health care, many Filipinos resort to alternative medicine. Norberto Cervales, a 32-year-old jobless father, usually brings his 16-month-old daughter to a mangtatawas, a sort of an exorcist, whenever she gets sick. Tawas is a ritual to find out supernatural causes of physical illnesses. The practitioner chants a prayer. A candle is lit and as the melted wax drops in a basin of water, an image is formed, said to be the creature responsible for the ailment. The sick then sleeps on the wax image and, voila, the ailment disappears. Cervales says he had tried to raise P300 for a doctor‟s consultation fee, but decided he couldn‟t afford it, much less the prescribed medicine. “We are asked to return again and again,” he says. “We don‟t have the money for it.” Lita Panganiban, 64, a mangtatawas, says that her patients are growing. “Even in the middle of the night, they come to my house,” she says. Faith healing Panganiban says she learned the ritual from her mother back in her Masbate hometown. “If you‟re smart, you can easily learn the prayer,” she says. Panganiban‟s services are also very much affordable. She accepts any donation the patient hands over. “I am not totally against health care alternatives, but it depends on the method,” says Dr. Imelda Ferrer. “As long as it is sanitary and does not let patients take drugs prior to doctor‟s prescription.” Ferrer also says it can get dangerous. “The illness can get worse,” she says. “With spiritual healing, I must say that it is important for a patient‟s recovery.” It‟s all about faith, when all else fails. Source: http://newsinfo.inquirer.net/inquirerheadlines/nation/view/20100413263926/Health-care-beyond-reach-of-poor-say-critics

Press Release May 27, 2009 RURAL AREAS SUFFER MOST FROM POOR HEALTH CARE SYSTEM, SAYS ANGARA

Seeks to bridge urban-rural gap through Telehealth system Senator Edgardo J. Angara today promoted a national Telehealth system in the country saying that this means access to quality health care for every Filipino, which could hopefully bridge the gap between health care in the urban and rural areas. "Two perennial problems haunt and hurt the health-care system in the Philippines: its shortage of doctors, and the concentration of health professionals in urban areas. For a country that exports doctors and nurses, the Philippines suffers from a low 1:15,000 doctor-to-population ratio, more than double the ideal 1:6,000 and a far cry from the US ratio of 1:150," said Angara who chairs the Senate Committee on Finance and authored pioneering laws such as the PhilHealth Act and the Senior Citizens' Act. He added, "Worse, majority of these doctors reside in urban areas. For instance, the disparity between the number of doctors in the National Capital Region (NCR) and in provinces, such as the Cordillera Administrative Region (CAR) and the Autonomous Region in Muslim Mindanao (ARMM), is ghastly alarming." According to a paper the Philippines presented to the Association of Southeast Asian Nations in 2005, there were 658 doctors in government hospitals in the NCR in 2002, in contrast to the 85 doctors in CAR and 69 in ARMM. Also, data from Social Watch Philippines show that in 2004, there were 197 private and public hospitals in the NCR, again a stark contrast against the 54 hospitals in CAR and 17 in ARMM. Angara told that access to health-care significantly affects the quality of life in a region's population. For instance, while the child-mortality rate in the NCR is eight per 1,000 children below five, the figure in CAR is more than double, with 20 deaths for every 1,000 children. The child-mortality rate in ARMM is worse, more than four times the NCR statistics at 33 deaths for every thousand children. Twenty-four babies die for every thousand infants born in the urban areas, while the infant-mortality rate in rural areas is higher by 50 percent: 36 babies die for every thousand live births. "There is an urgent need to increase expert health-care services in the countryside. Fortunately, advances in technology provide a means to overcome personnel and regional constraints through out-of-the-box solutions, such as the National Telehealth System," Angara added. The National Telehealth System, a project first piloted by University of the Philippines Manila in 1998, imparts clinical information and education to distant areas using

information and communications technologies (ICT). Through computers and the Internet, supplementary expert care can be delivered to far-flung provinces where health-care specialists are scarce. Angara added that in 2009 P100 million was allotted to expand the reach and scope of the National Telehealth System. Through ICT, the National Telehealth System will allow remote consultation with experts in the Philippine General Hospital regarding trauma and poison cases, and in determining and responding to epidemics. An electronic healthrecord system for poison and trauma patients shall also be developed to provide relevant information and health education to the public, and facilitate continuous learning for health professionals. "Our Constitution has recognized the right to health of every Filipino long before US President Obama said it was the right of every American during his campaign. "This means access to quality health care for every Filipino, regardless of whether he lives in the streets of Manila or at the foothills of Sierra Madre. The National Telehealth System, we hope, could bridge the gap between health care in the urban and rural areas, and make quality health care more accessible to the rural folk", said Angara. http://www.senate.gov.ph/press_release/2009/0527_angara1.asp http://www.crsprogramquality.org/storage/pubs/health/Healthinnovations-microscopy2.pdf microscopy on wheels http://www.philippinesforum.com/resources/research/files/health_ph.pdf pdf from concepts 4