State of Philippine Health by Dr. Alberto Romualdez

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  • 1. By Dr. Alberto Romualdez Dean, Graduate School of Health Sciences Pamantasan ng Lungsod ng Maynila
  • 2. Equity in health
    • fair, just, and equal access to health care by all Filipinos.
    • Constitutional guarantee: Article II Section 15 – “The State shall protect and promote the right to health of the people and instil health consciousness among them.”
  • 3. Overall health status – Lower than Thailand, Malaysia, Japan and Korea
    • The 70 years average life expectancy at birth is more than 15 years shorter than those of developed countries.
    • The infant mortality rate of about 35 per thousand live births translates into 80,000 Filipino babies dying of preventable causes each year
    • Maternal mortality ratio that has remained well above 150 per 100,000 live births – meaning more than 3,000 Filipinas dying unnecessarily every year.
  • 4. Status of Health Equity in the Philippines Indicator High Income / urban areas Low Income / Rural areas Life Expectancy at Birth >80 <60 Infant Mortality Rate <10 >90 Maternal Mortality Ratio <15 >150
  • 5. Inequity in Health Outcomes
    • Average Fertility Rate by Income Quintiles
    Income Group Average Fertility Rate (Desired) A 2.0 (1.9) B 2.4 C 3.7 D 4.7 E 5.6 (3.1)
  • 6. Factors Promoting Health Inequity
    • Organization of Health Services
    • Cost of medicines and other health supplies
    • Distribution of human resources
    • Health Care Financing
  • 7. Organization of Health Services
    • Public- Private Sector imbalance
      • Highly resourced private sector servicing 20-30 % of population
      • Health promotion/Disease prevention lag behind Curative Service provision
    • Fragmentation of Services
      • Overspecialization of curative services
      • Devolution of health services - national and local
      • Weak regulatory mechanisms
  • 8. Result: Inequitable Access to Health Services
    • Less than 50% of poor women get vitamin supplements compared to 80% of high income women
    • 2% of lowest quintile women and 20% of highest quintile have caesarean sections
    • Less than 50% of children from lowest quintile homes compared to 80% from highest quintile are immunized
    • Each year, less than 5% of the estimated 3000 new Filipino end-stage renal disease cases can have kidney transplants
  • 9. Cost of medicines and other health supplies
    • The prices of medicines in the Philippines are among the highest in the world – higher than Europe and America and most of Asia and certainly too high in relation to household incomes of most Filipinos. Given the high prices, most medicines are beyond the paying capacity of most Filipinos.
  • 10. Number of day’s wages needed to purchase a 30 days treatment with Ranitidine
    • - Philippines, 30 days
    • - Sri Lanka, 10 days
    • - Brazil, 10 days
    • - South Africa, 5 days
  • 11. Average 4-week Medicine Expenditures within Household Expenditure Quintiles Source: WHO, World Health Survey, 2002 $88 $153 Result: Poor families cannot afford to pay for medicines
  • 12.
    • It is estimated that 70% of all health workers are employed in a private health sector that serves only the 30% of the population that can afford to pay for their health care.
    • Private clinical practice in lucrative urban areas is preferred by most doctors and even midwives. For nurses, teaching in nursing schools is significantly more rewarding than providing nursing care.
    • The fact that the market for expensive services is limited to the rich few partly explains the on-going exodus of health professionals at all levels.
    Maldistribution of human resources
  • 13. Dysfunctional Health Workforce Structure
    • The output of a workforce production system that is de-linked from the actual needs of the Philippine system are health providers for whom service is a lower priority than personal professional advancement. They are ill-prepared for dealing with health problems in the Philippine setting.
    • Market orientation has influenced all the programs for health workforce production. In medicine, the number of schools, the curriculum, and even the type of faculty is determined by a philosophy of “what the market will bear”. The medical professions as well as the other health professions are self-centered and protective of professional privileges, status and opportunities.
  • 14. Health Care Financing
    • Total Health Expenditure (2005) PHP 200 billion
    • % of GNP < 3 %
    • % of GNP per WHO > 5 %
  • 15.  
  • 16. NHA2004: Sources of Funds
    • Government (local & national) 30.3%
    • Social Health Insurance 9.5%
    • Private Shared Risk 12.5%
    • Out of Pocket 47.7%
  • 17. Only those with money (i.e., the rich) can fully pay for out of pocket payments and often they have generous health insurance The near-poor and the lower middle classes can become impoverished to meet out of pocket payments for health care. The very poor don’t even have pockets
  • 18. Recommendation: Aim for Universal Health Care
    • Increase in level and coordination of government spending by national government (including DOH and PHIL Health as well as other sources such as PAGCOR, PCSO) and local government to reduce out of pocket spending to <30%
    • Restructure HRH production of government institutions to target government and other service oriented organizations and to emphasize service over self-interest
    • Strengthen regulation of private sector to include, where appropriate and necessary, cost containment measures and taxation of non-essential services
  • 19. Restructuring HRH production and Deployment – UP Manila
    • Return service requirement to be extended to all units and all training programs – including PGH
    • “ Consecrate one generation” of graduates to service in government and/or underserved communities or areas
    • Review private practice aspirations