Room for improvement

THEY say the biggest room in the world is the room for improvement. No matter how successful any undertaking is, there will always be areas where enhancements, readjustments, and further improvement can be achieved.

We can say the same thing with regards our health care delivery in the country.

Earlier this month, the Pharmaceutical and Healthcare Association of the Philippines (PHAP)—composed of the country’s leading multinational drug and medical device companies— organized a whole-day colloquium to revisit the gains of the Aquino Health Agenda (AHA) in the last six years and discuss what else need to be done to build on it—which President-elect Rody Duterte’s incoming administration could perhaps consider.

There can be no denying that much gains have been achieved in the last six years towards universal health care or Kalusugang Pangkalahatan; yet, health inequity is still a pervasive problem that the next administration needs to address urgently.

The AHA aimed to bridge the healthcare gaps, wherein a good percentage of the population, particularly those residing in remote areas of the country, have not even seen the shadow of a government physician, and have nowhere to go to for their healthcare needs.

“After five years, the Aquino administration has a mixed bag of results to show for its efforts,” says former Health Secretary Esperanza Cabral, who was one of the speakers in the forum.

It is to PhilHealth’s credit that its coverage has reached 92 percent of the total population; and the support value of the insurance on the actual medical expense has improved to 56 percent. However, Dr. Cabral suggests that health officials also look at it from a cost-effectiveness perspective, to make sure that the health budget is well spent to get optimal results for the people who need PhilHealth’s benefits most.

“The government allots billions of pesos (36.7 billion pesos in 2015) to pay the premiums of the poor, but their utilization rate, though rising, is nowhere what it should be to make the expenditure worth it,” says Dr. Cabral.

It seems ironic indeed that a national health care insurance aimed to benefit the marginalized sectors of the country, are being used more by the “well-to-do” or “can-afford” sectors. Statistics would show that the “can-afford” are the greatest users of the national health insurance program, and the greatest claimants are the modern and expensive hospitals where the middle class and upper class go to.

“In effect, the government is paying for the health care of the rich by subsidizing the health insurance premiums of the poor,” explains Dr. Cabral.

PhilHealth coverage and improvement of health facilities must run in parallel, as it’s meaningless to increase the number of enrolled card-bearing members but with not enough health facilities and medical personnel to serve them.

The Department of Health’s Health Facility Enhancement Program (HFEP) must really work double time to ensure that all government health facilities are operational, and adequately equipped with the necessary manpower, instruments and supplies. This should be a prime short- and continuing long-term goal of the incoming administration.

In terms of priority, the rural health centers including the sub-clinics at the barangay level should be enhanced first, rendered fully operational and adequately manned, preferably by dedicated primary health care physicians; or if this is not possible, by trained paramedical personnel.

Primary health care renders basic preventive and curative care services such as maternal and child health services, family planning, health education, proper food and nutrition, immunisation, healthy lifestyle counseling, and other ways to prevent common diseases.

Health-wise, a strong primary health care is the hallmark of a truly meaningful and inclusive enhancement of health care which can be readily felt by the poorest-of-the-poor segment of the population. And it’s high time our country’s economic gains translate to an inclusive enhancement of the average Juan and Juana’s lives, especially when it comes to health care.

Vital Signs Issue 87 Vol. 4, May 1-31 2016