Duterte fails to make health a priority

More than a year in office, the Duterte administration has failed to address the inequity in healthcare in the country. The Philippines remains under severe social and economic inequalities with 26% of the population living in poverty and have limited access to healthcare services despite the promise of change by the current administration.

While the Duterte Health Agenda or ACHIEVE appeared promising, but there were no substantial changes in the health policies and programs to address the basic health needs of the people especially the marginalized and disadvantaged sectors.

The reduction of health budget from P125 billion this year to P94 billion next year, or by a huge P31 billion is not only a far cry from the 5% of the Gross Domestic Product standard but it only means a low per capita health expenditure which will generally affect the delivery of healthcare services With no additional Barangay Health Stations (BHS) that were put up, thousands of people were deprived of the promotive, preventive, and curative healthcare programs. While existing BHS which are already dilapidated and neglected, lacking the needed personnel, medicines, and equipment are no longer effectively functioning and delivering the health services needed by the communities. The primary health services are still concentrated more in urban centers while rural communities have very little or no health facilities at all.

Despite an incremental increase in PhilHealth coverage and subsidy, it has done very little to reduce the out-of-pocket payment due to limited health benefit packages, inadequate PhilHealth-accredited facilities and the lack of information on claim procedures. Thus, PhilHealth benefit utilization remains low among the lowest quintile (33%) or the poor who even under No Balance Billing (NBB) are forced to spend out of their pockets. Only the private health institutions are the one benefitting from the Philhealth payments as there are only 35% of Philhealth-accredited government health facilities compared to 65% private hospitals.

Medicine is still the main cost of personal health spending, which is accounted for almost two-thirds of the total out of the pocket payment, and a big burden among the poor. This is in spite of the enactment of Republic Act 9502 or the “Universally Accessible Cheaper and Quality Medicines Act” in 2008. The monopoly in the manufacture and distribution of drugs of big pharmaceutical industries, the lack of awareness on the part of households regarding generics, and the drug promotion incentives given to prescribing doctors are still the order of business.

The implementation of Republic Act No. 10354 or the Responsible Parenthood and Reproductive Health Act is still in limbo despite the issuance of an executive order to all concerned government units to strictly implement the law, But it is clearly not enough to push the Supreme Court to make a decision on the temporary restraining order that restricts the distribution and procurement of certain types of contraceptives which renders the law ineffective and deprives women of their right to choose.

Inequity in health care is compounded by the continuing shortage of health professionals in government service. While those who chose to serve the country received uneven salaries and benefits due to the devolution of health services. Many of them work in a very hazardous working condition. They are also most vulnerable from attack and other forms of violence with three public health doctors already killed in the span of five months. But their cases remain unresolved.

The only thing that President Duterte made true of its campaign promise is make the “war on drugs” bloody and to crash the “threat of terrorism” in the country. With more than 12,000 death of the alleged drug personalities either by legitimate police operations or by vigilante-style killings, and more than 400,000 people were displaced from their homes as a result of the military operation in Marawi City and by placing Mindanao under Martial law, the government engenders not only a security but also a public health crisis.

The justification for the killings of drug personalities now falls on the shoulder of medical and health professionals with the recent Reuters report showing that hospitals are now being used by the police to cover up the killings by taking the body of the suspects to the hospitals after the police drug operations to simply pronounce them dead on arrival. While the ongoing armed conflict has hampered the delivery of basic health services to the refugees in the different evacuation sites in many parts of Mindanao.

Today as President Duterte delivers his 2nd State of the Nation Address, we urge him to demonstrate his political will to ensure the availability, accessibility and affordability of quality health care for each and every Filipino by adopting the framework on integrated people-centered health services that put the comprehensive needs of people and communities at the center of health systems, and empowering people to have a more active role in managing their own health. With less than five years in office, he can still make it happen. But without guaranteeing the respect for the basic human rights of every Filipino including the right to health, real change is nothing but lip service.