Chapter 11

Health, by itself, is a source of satisfaction. It enables individuals to undertake activities that enhance their current and future income. Spending for health is, therefore, an investment in human capital. Relatively prosperous individuals are able to spend for health and as a result tend to be more productive. The poor, lacking in income and with no access to credit, forego investments in health and get trapped in poverty.

The government aims to break the vicious cycle of poverty and thus widen access to health and medical care. To succeed, it supports further empowerment of LGUs to enable them to undertake devolved basic health services effectively. When public health programs of a particular LGU involve benefits that extend beyond its jurisdiction, the national government will guard against underinvestments by providing financial support either in the form of grant or a matching grant.

As a safety net, the national government exerts regulatory powers in health and medical care. Setting quality standards for pharmaceutical drugs is an example. Drug companies that violate competition policies risk being sanctioned. This is done at the national rather than the local level since the national government has a better capacity to get the relevant information about pricing practices of multinational drug companies.

In the area of hospital regulation, the Department of Health (DOH) will continue to operate tertiary hospitals both for training purposes and as a form of safety net. The benefits from medical training are extensive and private individuals are liable to restrict investments in training if they are not compensated for the extra benefits they create. The national government steps in and takes responsibility for training hospitals to ensure uniform standards of quality.

The government is committed to the strengthening of National Health Insurance Program (NHIP), the health insurance program of the government. The program will ensure that 500,000 indigent families each year are added to its list of eligible beneficiaries.

At this stage, demographic factors hamper the ability of the government to supplement household investments in health. Given the still rapid growth of the population, it is difficult to maintain a constant increase in public expenditures in health. It is, therefore, vital to slow down the population growth rate. A good starting point is to address the unmet need for family planning services and to inculcate responsible parenthood, particularly among the poor whose family size exceeds desired number.

Health and Nutrition

In recent years, major improvements were observed in various health, nutrition and population indicators. But issues remain to be addressed in the medium term. Infectious diseases persist at high rates along with chronic and degenerative diseases which have become prevalent. Large variations in health status persist across population groups, income classes and geographic areas, paralleled by inequities in access to health facilities or providers and services, the high cost of drugs, and the limited coverage of social health insurance. Meanwhile, drug addiction is still a major concern (Table 11.1).

Low quality, absence or limited access to health services and inadequate health care financing characterize health service delivery and health standards and regulations. Inefficient hospital systems, ineffective mechanisms for public health programs, and uneven distribution of health workers contribute to poor delivery of health services. Health institutions also lack the capacity to enforce health standards and regulations. Consequently, overpriced and low quality drugs and medicines flood the market.

To address these concerns, the Health Sector Reform Agenda (HSRA) was institutionalized in 2000. It aims to improve health financing, health regulation, hospital systems, local health systems, and public health programs.

The health care system still faces ineffective health service implementation resulting from the transfer of responsibility of health care to LGUs without adequate institutional preparations.

In the nutrition sector, several institutional developments such as the enactment of the Food Fortification Act and updating of the national nutrition agenda were undertaken. Several programs were implemented in line with food fortification, early childcare and development, and massive nutrition education campaign focusing on the Nutritional Guidelines for Filipinos. Likewise, changes were adopted in the Medium-Term Philippine Plan of Action on Nutrition (MTPPAN), the country’s roadmap for achieving nutritional adequacy for all. These changes include revising credit assistance for livelihood as a nutrition impact program, and the separation of the micronutrient supplementation and food fortification into two impact programs to more accurately reflect their equally important roles in improving the nutritional status of the Filipinos.

The following challenges for the subsector remain: (a) increased occurrence of underweight and wasting among children, particularly among the one- to two-year-old preschoolers, and among the nine- to ten-year-old schoolchildren; (b) vulnerability of zero- to five-year-old children, particularly boys, to stunting and wasting; (c) high iron deficiency anemia across all population groups, especially among infants, and pregnant and lactating women; (d) Vitamin A deficiency among pregnant and lactating women; and (e) high prevalence rates of overweight and chronic energy deficiency among adult females (20 years old and above) and older persons (60 years old and above) (Table 11.1).

The country has not met the goal of universal salt iodization set in 2000. From 1996 to 1998, only 2.6 percent of the annual requirement of Filipinos for iodized salt was met. To attain this goal, there is a need to prioritize the nutritional requirements especially of children, and pregnant and lactating women. Government should improve the implementation of the Act Promoting Salt Iodization Nationwide (ASIN Law).

Population and Development

Based on the results of the 2000 census, the country’s population increased by an average of 2.36 percent from 1995 to 2000, higher than the average growth of 2.32 percent from 1990 to 1995. Relative to the other ASEAN countries, this growth rate is very high given that Thailand and Indonesia have reduced their population growth rates to 0.9 percent and 1.5 percent, respectively, since the early 1990s.

These efforts notwithstanding, several issues have not been addressed. The gap between desired and actual family size, for example, remains formidable. In 1998, actual family size was 3.7 children while the desired family size per woman was 2.7 children. Contraceptive use is low at 28.2 percent for the modern method. Moreover, unmet needs remain high at 19 percent (about three million women). Meanwhile, male participation in fertility management, childcare, and household activities can still be improved. Other issues are the increasing incidence of teenage pregnancy and the lack of a sustainable operating mechanism for RH/FP.

Financing Health Services

Total health expenditure increased by P12.64 billion from 1998 to 1999. All three broad sources, namely: government, social insurance and private sources, contributed to the increase, with the private sources accounting for the bulk (P6.87 billion). Government contributed P4.08 billion while social insurance registered a P1.69 billion increase (Table 11.2).

Targets

A slow but steady decline in crude death rate is expected, from 6.3 per 1,000 population in 1998 to 5.7 per 1,000 population in 2004. Maternal mortality or deaths of women during pregnancy or at childbirth is expected to decline from 0.6 per 1,000 live births in 1998 to 0.4 per 1,000 live births by 2004. Infant mortality rate (IMR) per 1,000 live births is also expected to decline by 2004 to 35.0 per 1,000 live births from 48.9 per 1,000 livebirths in 1998. The average life expectancy is expected to improve from the 67.4 years as of 1998 to 70.1 years by 2004, with females and males projected to have a life expectancy of 72.8 and 67.53 years, respectively (Table 11.3). The longer life expectancy implies a higher proportion of the elderly in the general population.

In nutrition, the prevalence of underweight children and the deficiencies in Vitamin A, iron and iodine among priority affected age groups are targeted to decline by 2004 to levels or closer to levels no longer considered by the World Health Organization (WHO) as a problem of public health significance.

Strategies

The assessment of the general health status of Filipinos points to several basic strategies to improve health conditions.

Management capacities for public health programs will be strengthened as it will, among others, contribute to the successful implementation of these programs particularly their ability to absorb funds. Specifically, new skills and approaches in implementing national programs through autonomous local health systems will be developed and adopted.

Moreover, resources will be mobilized to: (a) implement priority public health programs; (b) promote a healthy lifestyle and better health practices and behavior; (c) increase access to safe water and sanitary toilet facilities; (d) increase safe practice in disposing infectious and hazardous waste in hospitals; (e) ensure that all food establishments comply with the minimum sanitation standards; (f) address emerging health problems such as chronic and degenerative diseases, STD/HIV-AIDS, and environmental and work- related health risks; (g) promote mental health, upgrade mental health facilities, and enhance competencies of mental health workers; and (h) expand traditional targets to respond to the changing demographic and health trends notably the rise in the numbers of the elderly and the shift of the disease burden toward degenerative diseases.

Functional local health systems — such as district health systems, hospital networking system, patient referral system — will be developed within the purview of the Local Government Code to better carry out public health programs and services. Likewise, a better mechanism for providing resources to LGUs will be set up. The private sector will also be tapped to adequately address the health delivery system backlog.

Hospitals will improve their service capabilities from the first referral facility at the district level up to tertiary care facilities at the national level. Some facilities will be developed into regional and subspecialty centers.

The benefits and the coverage of the NHIP will be expanded through the LGUs and through community participation. Aggressive enrolment under the NHIP will be pursued to meet the target of universal coverage by 2010. The coverage of the NHIP enrolment will expand to include 500,000 indigent families in urban poor areas of Metro Manila and other cities by June 2004. Insurance premiums will also be made income-contingent. The NHIP has three major components namely: (a) the regular hospitalization program (in-patient) and out-patient benefits; (b) special out-patient benefits administered and delivered by LGUs through the health centers, and (c) the "Medicare Para sa Masa" program (indigent program).

The regulations involving health facilities will be strengthened through the government’s licensing mandates and the national health insurance accreditation and benefit payments. Licensing and regulation of health products and devices like drugs, cosmetics and medical equipment will be improved. Quality and affordability of essential drugs and medicines will be prioritized, specifically by reducing the price of essential and frequently used drugs by 50 percent in a year’s time, particularly for life threatening conditions and chronic debilitating conditions. A mechanism to assess and regulate technological innovations and activities that affect health will also be institutionalized and strengthened.

The welfare of frontline health workers and other health professionals will be improved through training and institutions development.

In support of health strategies, the Health Sector Reform Implementation Act which provides incentives to DOH programs in the areas of health care financing, hospitals systems, local health systems, public health system and health regulations will be adopted.

In addition, a bill on hospital corporatization will be supported to convert fiscally and technically viable national government hospitals into corporate entities. This proposal promotes autonomy and assures provision of quality services, and allows the utilization of additional resources for preventive public health programs.

The proposed "Accelerated Nutrition Improvement Act" will be pushed to strengthen the national nutrition program. The measure requires the provision of correct nutrition information on the labels of food products. This will be pursued simultaneously with the Implementing Rules and Regulations (IRR) of the Consumer Act of the Philippines.

Advocacy and other information, education and communication (IEC) activities on population and development (POPDEV) integration will be conducted such as information sessions for local government officials, and capability-building initiatives for provinces/cities, among others. Moreover, POPDEV concerns will be integrated in local development and investment plans.

Relative to this, the new population policy will be pushed in Congress and ensure its successful implementation. The policy amends PD 79 by incorporating the 1987 Constitutional provision, which gives couples the responsibility to decide on the number of children to have to meet the demands of responsible parenthood, and adopting the Philippine Population Management Program’s (PPMP) Responsible Parenthood and Sustainable Development framework. It incorporates the Philippine commitments to the International Conference on Population and Development. Likewise, it gives the Commission on Population (POPCOM) the mandate to oversee the implementation of the restated population policy.

The availability and accessibility of quality information and reproductive health services needed to make informed choices will be ensured. The responsibility of couples to decide on the number of children in accordance with religious beliefs and the demands of responsible parenthood will continue to be recognized.

Successful innovative approaches such as Teen Centers, Counseling on Air, and Peer Counseling will be institutionalized to provide the youth with age-appropriate information on reproductive health and responsible sexual behavior during childhood, adolescence, and adulthood. An adolescent reproductive health (ARH) database will also be established.

With the donor resources likely to be reduced in the future, alternative methods for program financing will be developed. These may include allocation in the national budget of funds for responsible parenthood and RH programs; organizing government agencies and NGOs for the preparation of the population investment plan; and mobilizing resources from private commercial sector, NGOs and LGUs for the three component programs of the PPMP, namely: RH and FP, adolescent health and youth development, and POPDEV integration.

Gender equality will be pursued through women’s empowerment. Gender awareness will be raised through training and orientation, with emphasis on the linkage of gender to population and development issues. Women’s organizations that conduct population and development activities will be tapped for this purpose.

Advocacy to national and local officials will be intensified to enhance understanding and consciousness on the impact of population on human settlements. Moreover, information and technical assistance will be provided to LGUs in planning and managing urban settlements.

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