May 10, 2016

Make Health a Priority

Now that the election is over and the Filipino people have already made a decision for a meaningful change, we, the Medical Action Group, a health and human rights non-governmental organization, call on everyone especially the new administration to make health a priority if elected to office and all the voters to consider health as the defining factor for rebuilding our nation
We urge the new administration to commit itself and demonstrate its political will to ensure the availability and accessibility of quality and affordable health care for each and every Filipino.

Health is fundamental to our personal well-being and ability to become productive members of society. The 1987 Constitution and several international human rights instruments explicitly recognize health as a human right as they provide obligations to the State to protect and promote the right to health of the people and instill health consciousness among them. Universal health care is supposed to provide for the protection and promotion of the right to health and the adoption of an integrated and comprehensive approach to health development. This should mean that no one should be denied of adequate health care not even those without the means to pay.
However, inequity in health care remains a pervasive problem in the country. Those who have less in life are usually those who are having difficulties confronting health situation. This is because many poor households especially in far-flung provinces, mountainous regions and conflict areas still do not have access to basic health care services. This is in spite revenue increase generated by the sin tax reform law that allows the government to provide healthcare to an additional 14 million families. More spending on health should have been made to give the poor and the sick the equal chances of getting access to quality health care.

The incremental increase in population coverage of PhilHealth in the recent years has done little as out-of-pocket payment continuously increases due to limited health packages for the inpatient hospital care and outpatient care, inadequate PhilHealth-accredited facilities and the lack of information on claim procedures. This only shows a wide disparity between the rich and the poor in terms of utilizing PhilHealth benefits.
We urge the next administration not only to increase funding for health care to the level of the World Health Organization’s recommendation of 5% of the Gross Domestic Product to finance the expansion the PhilHealth out-patient care benefits but also to ensure that they are equally appropriated and made available in all barangays especially in rural and remote areas of the country.

Drug is the main cost-driver of health spending, which accounted for almost two-thirds of the total out of the pocket payment, and as much as three-quarters among the poor. This is in spite of the enactment of Republic Act 9502 or the “Universally Accessible Cheaper and Quality Medicines Act” of 2008 and the Republic Act 9711 or the “Food and Drug Administration Act” of 2009.  This is due to the continuing dominance of some drug companies in the manufacture and distribution of drugs, lack of awareness on the part of households regarding generics, and the drug promotion incentives given to prescribing doctors by the pharmaceutical industries.

We urge the next administration to review the regulation of the drug industry in order to ensure that pharmaceutical industries comply with international drug regulation standards and make medicine affordable. The government should also consider removing Value Added Tax (VAT) on medicine and expanding the coverage of the government’s cap on drug prices to lower the cost of drugs.

Inequity in health care is even widened by decentralization. Since the devolution, the local government units (LGUs) have provided primary and secondary levels of health care through their local health facilities. However, there are inequities in the distribution of such health facilities and human resources, as most facilities and health personnel are concentrated in the National Capital Region (NCR) and other urban areas, while poor provinces especially in Mindanao have the least.

We urge the next administration to ensure that health care resources and services must be distributed and accessible according to people’s needs. It should provide adequate support and assistance to LGUs to invest in tertiary health care by establishing comprehensive programs for health care (from primary to tertiary), improving public access, ensuring presence of health care providers, improved referral system and make emergency medical care system (EMS) or pre-hospital care available.

Inequity in health care is compounded by the continuing shortage of health professionals in government service. Health professionals account for a large share of total Filipino migrants every year, while those who are left enticed to serve in private practice. The human resource density of doctors in the government is 1 to 1,000 patients, but the actual average is 3 doctors per 10,000 patients. In the private sector, on the other hand, there are three times a number of doctors. Many of them are even working in contractual basis. The inequity in health workforce leads to increased workload in health facilities and the hiring of many new graduates that create challenges in ensuring quality care for patients. It no wondering why more than 30 percent of our countrymen die without seeing a health professional.

We urge the next administration to strictly enforce the Magna Carta of Health Workers to ensure that all health professionals receive just compensation and to substantially improve human resource development and recruitment, training  and  retention  of  the  health  workforce,  especially  in  rural areas.
We agree on the World Bank’s assessment in May 2015 that “achieving universal health care is not just about improving health services, but achieving “a situation where all people who need health services (prevention, promotion, treatment, rehabilitation, and palliative) receive them without undue financial hardship”.

Those who have less in life should be given more protection by the law. Failure to do so constitutes a violation of the basic human right.  But reality shows otherwise.

Not only that access to health care services is limited and even non-existent especially during in areas under emergency situation, it is most often teeming with violations of the patients’ rights such the non-observance of no deposit policy and the hospital detention.

Victims of human rights violations specifically torture are often deprived of their basic right to have immediate health care particularly the provision of medical and psychological examinations during custodial investigation. Despite the enactment of the Republic Act 9745 or the Anti- Torture Law in 2009, torture and ill treatment continue unabated with only one successful conviction. Medical and psychological examination of victim using the Istanbul Protocol or the United Nations Standards for the Effective Investigation and Documentation of Torture and Ill-Treatment has yet to be institutionalized in hospital procedures which could have been a major step for torture prevention and establishing accountability. Rehabilitation is considered as an important prerequisite for the pursuit of justice and for establishing preventive measures. But despite the crafting and approval of a  comprehensive rehabilitation program by an interagency cooperation headed by the Commission on Human Rights (CHR), rehabilitation remains very elusive for torture survivors and their families as no lead agency for its implementation, the absence of a detailed programs and procedures, from and the provisions of a separate budget allocation.

While the primary concern of health care is prevention and treatment, healing can’t be complete without justice.

We urge the next administration to fully implement human rights laws particularly the absolute prohibition of torture and should hold accountable those responsible for violations of human rights including the right to health.

Indeed, a healthy citizenry makes for a healthy nation. But we know that the road toward this goal is not that easy. Determining the most effective strategy and allocation of resources to address health issues is a really challenge, but it is a big step forward. This is where he or she should make a stand for. This statement is not meant to provide an endorsement to anyone but a challenge the executive capacity of our national leader.

The next Philippine President can make a big difference not only in creating a more responsive health care system but guaranteeing health as a basic human right of every Filipino.

Only then that change will truly come.