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Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines

Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines



Presentation delivered at the University of Oslo Institute of Health and Society, September 24, 2012, Oslo, Norway. For more information: ...

Presentation delivered at the University of Oslo Institute of Health and Society, September 24, 2012, Oslo, Norway. For more information: http://www.med.uio.no/helsam/english/research/news-and-events/events/guest-lectures-seminars/2012/global-governance.html

Video of the presentation here: http://www.youtube.com/watch?v=cF_JMlV12dg&list=UU3guB0vZS8vch7_mzs_5T8Q&index=1&feature=plcp



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  • Despite remaining a threat to our population’s health, deaths due to infectious diseases have actually declined. Here we see the decreasing trend of infectious and communicable disease whereas lifestyle diseases already dominate the leading causes of deaths in the country --- cardiovascular disease, Cancers, diabetes, chronic lower respiratory diseases.
  • Focus on refocusing the implementation of the National Health Insurance Program through PhilHealthParticular attention to the construction, rehabilitation and support of health facilities: LGU/regional hospitals, rural health units, barangay health stations to enhance their capacity in providing basic health services.Attainment of Millennium Development Goals 4, 5, and 6Reduction of maternal, neonatal, and infant mortalitySupport to contain/eliminate age old pubic health diseases (malaria, dengue, TB)
  • Philippines – roughly 3.3 comparable to Thailand, MalaysiaVietnam – 5% - compliant with 5% requirement of the Global Strategy for Health for All in the Year 2000China – roughly 4.5%Cuba – 6.6 %Canada – close to 9%UK – 7%US – 13%
  • When I was being interviewed by the Secretary for the position which I currently hold, he asked me what can the government do with the fact that over 30% of our countrymen die without ever seeing a doctor. Poverty is the reason for poor access to health services; The poor do not have money to finance their health needs. Government Health facilities are poorly equipped and are not adequately manned by health workers. The answer

Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines Presentation Transcript

  • Ramon Lorenzo Luis Rosa Guinto, MD Regional Coordinator for the Asia-Pacific and Founding Coordinator, Global Health Equity InitiativeInternational Federation of Medical Students’ Associations (IFMSA) Youth Commissioner, Lancet-University of Oslo Commission on Global Governance for Health
  • Outline• Global Health and the Philippines• Social Determinants of Health• The Philippine Health System• Foreign Policy and Health• Some Take-Home Lessons
  • Alma Ata, 1978The International Conference on PrimaryHealth Care calls for urgent action by allgovernments, all health and developmentworkers, and the world community to protectand promote the health of all the people ofthe world by the year 2000.
  • From Beaglehole and Bonita, 2012
  • Life expectancy at birth (men)Glasgow, Scotland (deprived suburb) 54India 61Philippines 65Korea 65Lithuania 66Poland 71Mexico 72Cuba 75US 75UK 76Glasgow, Scotland (affluent suburb) 82 (WHO World Health Report 2006; Hanlon,P.,Walsh,D. & Whyte,B.,2006)
  • Source: Dr. Ramon Paterno, University of the Philippines
  • Mortality Trend: Communicable Diseases, Malignant Neoplasms & Diseases of the Heart Rate/100,000 Population Philippines, 1953-2005 Malignant Neoplasms &Communicable Diseases Diseases of the Heart 700 100 Communicable Diseases 90 600 Malignant Neoplasms Diseases of the Heart 80 500 70 60 400 50 300 40 200 30 20 100 10 0 0 1953 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000 01 02 03 05 YearSource: Philippine Health Statistics, 2005
  • Philippine Health Situation• 6 out of 10 Filipinos who die, die without health professional attendance• 4 out of 10 families can not buy the medicine they need.• 70% of health professionals serve only 30% of the population, those who can pay.• Our latest National Health Statistics are 3 years old• Our health system is chronically underfunded• 54% of our National Health expenditure comes from out of pocket.
  • Filipino Wealth Quintiles AVERAGE HOUSEHOLD MONTHLY INCOME MiddlePoorest Poor Rich Richest Income 5,958 8,594 12,269 18,497 40,590 FOOD EXPENDITURE SHARE 40% 27% 67% 57% 49%FIES, 2009
  • Incidence of Illness and Injury by Income Quintile 100 90 80 70 60 50 40 30 55 51 45 39 20 34 10 0 Poorest Poorest Middle Rich Richest IncomeNational Demographic and Health Survey, 2008
  • Headline, Philippine Daily Inquirer, June 1, 2006.
  • Philippines: Critical DevelopmentConstraintsADB, Dec 2007 We are de-industrializing… From Ramon Paterno, 2011
  • Disasters and Climate Change • No. 6 in the Climate Change Vulnerability Index • No. 3 most vulnerable to disaster risks and natural hazards in the World Risk Index 2011, next to Vanuatu and Tonga
  • Conditional Cash Transfers
  • The Philippine ExperienceTHE PHILIPPINE HEALTHSYSTEM
  • Weaknesses of the Health System• Inappropriate & weak governance within the devolved health system• Antiquated and inadequate health information system• Ineffective regulation of health goods and services• Fragmentation of health service delivery: private vs public, curative vs public health• Dysfunctional health workforce• Unfair, unjust and inadequate health care financingFrom Ramon Paterno, 2011
  • Office of Secretary of Health Attached Agencies Regional hospital Medical Centers Regional Offices Sanitaria City Health Offices Provincial Health Offices Provincial (Chartered Cities) Hospitals Inter-local Health Zones City HealthHospitals Centers City Health Offices Municipal health District offices/ Rural hospitals Barangay (Component Cities) Health Unit Health Health Stations City Barangay Health Centers Hospitals Stations Barangay Health Stations
  • Pressing Health Issues• Universal Health Care• Reproductive Health Bill• Sin Tax Bill
  • Universal Health Care1. A roadmap towards universal health care through a refocused PhilHealth2. Particular attention to the construction, rehabilitation, and support of health facilities3. Attainment of Millennium Development Goals 4, 5, and 6
  • Inter-country Comparison Source: World Health Statistics 2010
  • Reproductive Health Bill
  • Sin Tax Bill
  • Health Workforce• Overproduction• Maldistribution• High out-migration• Nil in-migration• Low return migration Lorenzo and Dela Rosa, 2011
  • Southeast Asia: International Flows ofNurses and Doctors RNs and MDs
  • “Sixty percent of ourcountrymen who succumb tosickness die without seeing a doctor.” Department of Health-Philippines. National Objectives for Health, 2005 – 2010. DOH: Manila, 2005.
  • The Philippine ExperienceFOREIGN POLICY ANDHEALTH
  • Role in Global Health• Recipient of development aid and humanitarian assistance• Participant in the trade of health services – provider of the world’s health workforce, slow growth of medical tourism
  • Southeast Asia• Diverse political and cultural systems• Diverse health systems• Varying levels of economic development• Highly vulnerable region• Theater of FTAs
  • Association of Southeast Asian Nations• By the year 2020….. ASEAN will be Single Market and Single Production Base
  • Association of Southeast Asian Nations • Free flow of Goods • Free flow of Services • Free flow of Investment • Free flow of Capitals • Free flow of Skilled Labor
  • ASEAN Sectoral IntegrationProtocol for Healthcare
  • Trans-Pacific Partnership
  • Trans-Pacific Partnership
  • Some Take-Home Lessons• The Philippine health system faces many governance challenges internally – within the health sector and beyond.• Global forces also shape national policies – especially those related to or impacting on health.• Governments must look through a health lens as they negotiate trade agreements and forge foreign relations.• Good global and national governance will usher action on social determinants to reduce inequalities in health.
  • The Power of Medicine "Medicine… has the obligation to point out problems and to attempt their theoretical solution…The physicians are the natural attorneys of the poor…” Dr. Rudolf Virchow Father of Social Medicine
  • The Power of Young People“The youth arethe hope of the Fatherland.” Dr. Jose Rizal National Hero of the Philippines
  • Fathers of Social Medicine
  • It’s more fun in thePhilippines