Eddie Dorotan, M.D., is the executive director of Galing Pook Foundation, which “promotes innovation, sustainability, citizen empowerment and excellence in local governance.” He is one of the contributors to a forthcoming book titled Philippine Institutions: Growth and Prosperity for All, published by Action for Economic Reforms. This was published in theJune 14, 2010 edition of the BusinessWorld, pages S1/4 to S1/5.
President Noy has a great opportunity to turn this country around.
His overwhelming mandate challenges him to translate his campaign slogan, “Kung walang corrupt, walang mahirap!” into doable programs that will be felt and appreciated by the majority of the people, especially the poor.
One very important program where President Noy can make an impact is the health of our people.
Health is a basic human right and as such every Filipino can demand basic health services from government. But health is also a responsibility of every citizen and therefore all should contribute to the well-being of all.
We are optimistic that the Aquino government will implement within the next six years a universal health care strategy. Such strategy will address the health inequality, poor basic health services, fragmentation and underspending in health care. This universal health care strategy has to put primary health care at the core.
Here are the five things that President Noy can do to move this strategy forward:
1. Expand the coverage of Social Health Insurance to all, especially the poor.
The first step and arguably the lynchpin of the strategy is to secure health insurance coverage for all. The national government can do this by enrolling all the poor (50% of the population) in the National Health Insurance Program (NHIP) of the Philippine Health Insurance Corporation (PHIC) through the Department of Health (DOH); 25% of the population (the employed sector) is currently covered by government and private agencies, and the remaining 25% should be sponsored by local governments. This would entail only about PhP10-11B/year from the National Government. Everybody then, even the poor, can demand basic preventive and curative health services from accredited government and private providers.
2. Press the DOH and PHIC to do better, together.
The DOH must exert its technical-political leadership in public health, hospital care and regulations so that the most effective, efficient and empowering health interventions are carried out nationwide.
On the other hand, the PHIC, being the biggest purchaser of health care, should craft incremental upgrading of quality benefit packages to its members and make sure these benefits (preventive and curative, including catastrophic) are delivered by accredited government and private providers across the land in the most effective and efficient manner.
Together, the DOH and PHIC, as the main players in health reforms, should partner seamlessly so that innovations and implementation are done better and faster.
3. Address fragmentation at the local level, incentivize performance.
Under the Local Government Code of 1991, the local governments are tasked with the delivery of basic health services. Mayors are in charge of basic preventive and curative health care through their Rural Health Units and the Governors of hospital care through the municipal, district and provincial hospitals. But such delineation has somehow fragmented the way health services are delivered. Pro-active performance-based mechanisms and incentives must be employed to encourage inter-LGU cooperation in health service delivery.
4. Concentrate on what matters most.
Health programs and projects, at all levels, should concentrate on what matters most: the elements of Primary Health Care(PHC). Taken together, these programs should not only improve our performance in attaining the Millennium Development Goal (MDG) targets (poverty reduction, decreased infant, child and maternal mortality, control of communicable diseases, safe water and sanitation) but also determine health status and health outcomes.
Primary Health Care elements include:
• EducationEducating the public on health lifestyles, preventing diseases, managing illnesses, where and when to get medical/health assistance is critical. Information and dissemination of health programs and projects should be popularized.
• LivelihoodProviding the poor with income-generating activities and livelihood opportunities should be a component of any comprehensive health program.
• Environmental SanitationEvery family must have access to potable water and safe sanitation facilities.
• Maternal and Child CareMothers and children should always be attended to by appropriate health personnel. Maternal and child care includes responsible parenthood, family planning, immunization and birthing facilities, among others.
• Essential DrugsEssential quality medicines should be accessible to all. Bringing down the cost of medicines is a priority; the quality and the right use of these medicines must be ensured.
• NutritionMalnutrition in this country should be minimized if not eliminated, altogether. It can be done through a tripartite partnership among government, non-government and private sectors.
• Treatment and management of Common and Chronic DiseasesMalaria, tuberculosis, schistosomiasis are still with us. We also face the onlsaught of HIV AIDS and other emerging diseases. All this must be controlled significantly. The chronic diseases of diabetes, hypertension, arthritis and the concerns of the elderly must also be addressed.
• Self-Reliance/Community InitiativesCommunity-based health initiatives have to be reinvigorated. Community health workers, parents and community organizations have to be mobilized for preventive care in the country side.
5. Invigorate the health human resource complement.Finally, the people who deliver the health services must be appreciated and be given incentives in performing their noble task of uplifting our people’s health. The benefits under the Magna Carta for Public Health Workers must be given right away.
We must also incentivize the work in the countryside and minimize brain drain and maximize brain gain.
More than two decades ago, Dr. Alran Bengzon, Health Secretary appointed by the people-power installed President Cory Aquino, remarked before a crowd of a multi-sectoral health gathering in Bicol: “Reform is about changing the way we think, we act and feel.”
Today, President Noy has that great opportunity of continuing the legacy of his mother by making a difference in the health of our people.
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