Quo vadis, health?
(Conclusion)
All health officials aim for a holistic health-care delivery program for the country. As former Health Secretary Esperanza Cabral explains it: “An adequate number of health-care workers at every level of healthcare, from primary to tertiary, must be available through a service delivery network of both public and private sources to provide the appropriate service to those who need them.”
Primary healthcare (PHC) refers to the basic first level of contact between individuals and their families with the health system. The barangay and rural health centers are tasked with this. In a private setting, the general practitioners or family physicians serve as the PHC providers.
Whether in a government facility or private clinic, PHC providers are in charge of basic curative care services, maternal and child health services, family planning, health education, proper food and nutrition, immunization, healthy lifestyle counseling and other ways to prevent common diseases. Common cases seen by the PHC provider or primary physician are uncomplicated cases of hypertension, diabetes, asthma, chronic lung diseases, depression and anxiety, back pain, stomach upsets, diarrhea and arthritis.
To be truly meaningful
For universal healthcare to be truly meaningful, the government must be able to provide essential primary care to all citizens. It as an integral component of an inclusive primary health-care program. We have some distance to cover before we could achieve this.
Due to lack of manpower, trained nonmedical health workers (nurses or midwives) take the place of PHC doctors in some rural health centers in underserved areas.
Secondary health-care services are required for more serious illnesses like pneumonia, or uncontrolled hypertension and diabetes. Patients are seen in hospitals or facilities by medical specialists referred by the rural health physician or the PHC provider. For private patients, they can directly go and see medical specialists even without a referral from their primary physician.
Tertiary care requires specialized consultative healthcare, in advanced medical centers or tertiary referral hospitals such as the Philippine Heart, Kidney and Lung Centers. A more thorough medical evaluation and management of the patient are needed which the secondary medical centers are not capable of rendering.
With the advent of superspecialization and technological advances, some health experts have added a quarternary care, which can offer highly sophisticated laboratory and diagnostic evaluation plus the services of highly trained superspecialists.
All types of medical woes
Our country can take pride in having world-class medical centers and well-trained specialists and superspecialists that can handle practically all types of medical problems, even the most challenging ones. Gone are the days when well-to-do Filipino patients prefer to be brought abroad for diagnosis and treatment. However, the expansion of our primary to tertiary healthcare has not really shown an inclusive growth. A good number of our countrymen still do not have adequate access even to primary healthcare.
“At the moment there is a severe maldistribution of healthcare providers in the Philippines,” laments Dr. Cabral.
It appears our health-care problem also follows the Pareto Principle or 80-20 rule wherein Italian economist Vilfredo Pareto described in the early 1900s the unequal distribution of wealth in his country, estimating through a mathematical formula that 20 percent of the people owned 80 percent of the country’s wealth.
In our country, less than
20 percent of the doctors in the country are employed in public facilities that take care of nearly 70 to 80 percent of the health-care needs of the population. “The problem is compounded by the fact that a majority of health-care workers are stationed in urban areas and not enough serve in rural and depressed communities,” says Dr. Cabral.
Health-care workforce crisis
Health-care advocates formed the Coalition for Primary Care which has warned the government time and again that a health-care workforce crisis is plaguing the country. This causes the shortage and maldistribution of the country’s health-care workforce, which is a “prime contributor to the poor state of healthcare in the Philippines,” according to Dr. Cabral.
It’s hard to even imagine that we are lacking in financial resources so we could not address the medical and paramedical exodus due to low compensation of health-care workers, especially our young idealistic physicians who are left with no choice but to shift to private practice or leave for abroad just to provide a better future for their families.
If we can only more effectively manage our financial resources—considering that we have more than a hundred million pesos annually collected from “sin taxes” a big portion of which is supposed to go to health—then many of our healthcare woes should be eliminated.
Our Armed Forces and police force jumped in joy when President-elect Rodrigo “Rody” Duterte announced he would double their salaries immediately. We suggest he looks the other way and also consider adjusting the compensation of health workers and other government employees whose motivation and effectiveness at work can improve with a better compensation.
“Our capacity to pay for healthcare has vastly increased with a better economy and access to ‘sin tax’ revenues but this has not translated into just compensation for our health-care workers, particularly those working under hardship conditions,” says Dr. Cabral.
This is a major factor why our capacity to deliver healthcare has not kept in stride, adds Dr. Cabral.
“Priority should thus be given to augmenting and strengthening health human resources, specifically the health workers who are at the frontline of our health-care delivery networks,” she recommends.
Health-care challenge
Looking at our country’s economic scorecard in the last six years, we definitely should give the outgoing president and his administration a pat on the back. But economic progress becomes significant and meaningful only if it is inclusive, and is able to trickle down to the marginalized sectors of the population. Adequate health-care delivery for all is one concrete benchmark if a nation’s progress is truly inclusive.
Sadly though, the way it looks now, a looming paradox seems to be developing. As PhilHealth coverage in terms of card-bearing members expands, reaching closer to 100 percent, universal healthcare from a population perspective remains a nebulous mirage. In fact, it seems to retreat further into the horizon, as the expansion of the national health insurance program fails to adequately address existing inequities in healthcare. Delivery of essential health-care services with adequate facilities and manpower must increase in parallel with the expansion of PhilHealth coverage.
This is the health-care challenge for incoming President Rody and his health team.
