Philippines:THE PEOPLE’S HEALTH

SITUATION

&

THE POLICY OF PRIVATIZATION

Face of Poverty 69 million Filipinos (11.1 million Families)

(80% of population) struggle to survive on P96 (US$2) or less a day

(Ibon Databank 2007)

Face of Poverty Unemployment rate

for the first two years of Aquino averages 26.8%, the highest compared to : (19.6% Arroyo, 9.2% Estrada, 10.3% Ramos)

(SWS survey, First quarter 2012; Padilla, 2012)

7 out of every 10 farmers do not own the land they till

Agriculture remains backward

Agrarian laws have re-concentrated lands back to landlords (Kilusang Magbubukid ng Pilipinas, 2011)

Face of Poverty

Wages are not enough to

sustain a decent life.

Prices of basic goods are rising faster than wages.

200 2011 2012

Daily Cost of Living

509 910 993

Minimum Wage

240 402 426

Difference 269 508 567

Increasing Prices of Commodities

In pesos Before Now

DIESEL (per liter)

34.25 45.70

LPG (per tank) 614 721

MERALCO (per kWh)

1.49 1.64

NAPOCOR (per kWh)

4.34 4.67

MAYNILAD (per cu.m.)

33.42 40.80

SLEX (PUVs) 43 172

NFA rice (per kilo)

25 27

Kuha ni Jonjon Vicencio

Hunger at an all-time high (23.8% March 2012) highest according to SWS survey and as compared to Erap (10%) and Arroyo (14%)

(Padilla, 201)

For every 100 families (30% of the poorest) 60 have no homes

48 have no electricity

40 cannot send their children to school

35 have no potable water

20 have child laborers

(IBON Databank, 2007))

The Face of Poverty

Kuha ni Marriane Bermudez

HOUSING NEEDS

2001-2004: 3.6M families

2005-2010: 3.75M families

Only 822,823 houses built from 2001-2009

(BAYAN-NCR, 2012)

Around 16,000 out of 20,000 families

- the estimated number of urban poor families in NCR who lost their homes under Aquino

Kuha ni Marriane Bermudez

The Face of Economic Crisis

Past deployments:

Arroyo -1 milyon

Erap - 0.84 milyon

Ramos - 0.69 milyon

Cory - 0.47 milyon

1.4 Million Filipinos OCFWs during Aquinos term with billions in remittances (highest!)

Perpetual Crisis

Aquino boasts of a 6.4% development but is actually pushed by:

OFCWs remittances

service sector (call centers)

export of light industry products

loans

Solutions or Illusions?

Pantawid Pamilya (CCT)

Pantawid Pasada (fuel subsidy

Pantawid trabaho (Community-Based Employment Program)

Is just a token gesture to cover up the crisis –taken as loan from ADB and World Bank $805million

talakayanatkalusugan.com

State of Health as a Reflection of

the Nations Situation

A Filipino getting sick is pushed into a CRISIS EVENT and LOOKS UP TO GOVERNMENT FOR MUCH NEEDED HEALTH SERVICES

Health is a rightguaranteed by our Constitution.

enshrined in the WHO Constitution

and in various UN instrumentalities.

6

80,000

out of 10 Filipinos

who die are

without medical

attention.

Filipino babies die of

PREVENTABLE

causes ANNUALLY

(Romualdez, 2011)

Low income, rural areas

Life expectancy at birth < 60

Infant mortality rate> 90

Maternal mortality ratio>220

health disparities

High income, urban areas

Life expectancy at birth > 80

Infant mortality rate< 10

Maternal mortality ratio

< 15

Worsening inequities require us to revisit government policy

Health Policy in the Philippines

HEALTH SECTOR REFORM AGENDA, 1998-2004

• Health Financing• Health Regulation• Public Health

Programs• Public Hospitals• Local Health

Systems

Fourmula One (F1) for Health, 2004-2010

• Health Financing• Health Regulation• Health Service

Delivery• Good Governance

in Health

Universal Health Care, 2011-2016

• Health Financing• Policy, Standards,

Regulation• Service Delivery• Governance for

Health• Human Resources

for Health• Health Information

WHO Policies & Programs

1948

WHO

constitu-

tion

Health –

complete

state of

well being

Prominence

of Bio-

Medical

Model

approach to

health

Smallpox TB

Malaria

Alma Ata

Health for

All

Comp

PHC

WHO turns back

on C-PHC

S-PHC

GOBI

1990s

HSRA

Privatization

User fees

Devolution

(1990)

1980s

Neo Liberal

Policies

SAPs

2000

MDGs

PPP

(2010)

Post War:

Welfare states

Postcolon-ial health systems

Disease Palaces

1950 – 60s

Discovery of

Drugs –

antibiotics

Rise of

Pharma-

ceutical

industry

1970s

China’s

Barefoot

MDs

Rise of

CBHPs

Uneasiness

of some with

Comprehen-

sive PHC

Share of health expenditure per

GDP

0

0.5

1

1.5

2

2.5

3

3.5

4

Percen

t

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Year

Total health expenditure = P234.3 B or 3.2 percent of GDP

Source: Philippine National Health Accounts

Distribution of Health

Expenditure by Source of Funds

Source: Philippine National Health Account, 2007

Total health expenditure is P234.3 B (3.2 percent of GDP)

Share of Total Health Expenditure

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

1994 1996 1998 2000 2002 2004 2006 2008

% s

ha

re in

TH

E

Government

Out-of-pocket

Philhealth

National Health Accounts, NSCB

23.7%

7.2%

57.9%

…but 70% of Filipinos have no access to essential drugs. Monopolized (expensive)

There are more than 16,000 registered medicine in the country…

(WHO World Medicines Situation, 2004)

ACCESS TO ESSENTIAL DRUGSOf the total 41,000 villages, there are only around 17,000 which have government established health stations that are often ill equipped with facilities, medicines and staff.

HEALTH HUMAN RESOURCES

Health personnel

for EXPORT

Output of a flawed system

WHERE ARE THEY?

Most affluent regions (NCR , III, IV-A) has the highest numbers of health professionals40% doctors , 34.9% nurses, and 26.7% midwives

70% of ALL health workers are employed in the private sector serving 30% of the population

85% of all employed Filipino nurses are working abroad

“Oversupply” of nurses: 400,000; Number of doctors added in 2008: 1,500

(Aiken et al., 2003; Domingo, 2011)

“An estimated 85% of employed Filipino nurses (more than 150,000) are working internationally.” (Aiken et al 2004)

HEAD estimates: Filipino nurses working abroad have accounted for at least 30% of OFW remittances since 2004 (approx. US $3.24B in 2004)

Doctor to patient (population) ratio:

Cuba 1:225

USA 1:450

Ideal (WHO) 1:600

Senate (2005) 1:28,000

HEAD 1:26,000

Sec Duque (Oct 2007) 1:28,000

Health Personnel and Public Health Services

under fire

Community health workers (CHWs) have been prevented from performing their duties, barred from their areas of work, or included in the military’s “order of battle”

In many provinces and cities, health work and services has been denied because of military harassment of health workers and volunteers.

2009: 2 doctors were shot

2010: 43 health workers were illegally arrested, detained and tortured by the AFP

2011: HARASSMENT OF CHESTCORE STAFF

July 3, 2012: WILHELM GEERTMAN, EXECUTIVE DIRECTOR OF ALAYBAYAN WAS SHOT DEAD

GOVERNMENT’S RESPONSE: Public-Private Partnerships

PRIVATIZATION is the biggest threat to the

lives and well-being of

Filipinos todayMula sa balita.ph

Definition

Privatization of basic services is an abdication of responsibility by all levels of government, and the surrender to national and international corporations and private providers that do not recognize social responsibility or accountability to people and communities.

People’s Health Assembly 3July 2012 Cape TownSouth Africa

Forms of privatization:Complete take-over by a business enterprise

Privatization of operations/maintenance – outsourcing: Dietary,

janitorial, Himex at JRRMMC, sub contracting e.g. security

Outright sale – NCMH affected by sale of Welfareville

Public-Private Partnership – POC, RITM, SLH, RMC

Conversion of public hospitals into corporations – corporatization

of 26 public hospitals

Integration/ merging of public hospitals – GOCC hospitals: PHC, LCP, NKTI, PCMC, East Avenue Medical Center

Investor- driven conversion from a specialty hospital into research and training – Fabella

Private entity within a public hospital – FMAB at UP-PGH

Effects of privatization

• Health becomes a commodity only the rich can buy

• Inequitable access to health facilities, goods and services

• Increasing out-of-pocket share of patients reaching as much as 50% of total health expenditures

• Prevalence of user fees/fees for service in public hospitals to make up for budget cuts in government subsidy

• Surge of medical tourism marginalizing the majority poor Filipinos further

WORSENING POVERTY AND ILL HEALTH: A Result of Policy supposedly for

development?

1980s: Structural Adjustment Programs of IMF-WB

1990s: Globalization and the World Trade Organization

Deregulation, Liberalization and Privatization

BUT PUT THE COUNTRY AND ITS PEOPLE HEAVILY INDEBTED TO INTERNATIONAL FINANCIAL INSTITUTIONS;• As of JUNE 2012, the country’s foreign and domestic debt has reached P5.1Trillion ((with foreign debt at P2.05 Trillion)• Each Filipino owes P51,675

…in order to pay our debts

60.4 Billion pesos per month to pay our debt

Represent 53% of total government spending (Jul 2010 – Mar 2011)

Comprised 8.5% of the country’s GDP since 1986 to present

CUT DOWN ON GOVERNMENT SPENDING

Mula sa mylot.com

MAY 2012: national government debit is at P5.15T; By year-end, this will reach 5.52 Trillion

MAY 2012: national government debit is at P5.15T; By year-end, this will reach 5.52 Trillion

The real Bosses of Aquino

Partial list of the biggest families/groups with businesses in infrastructure and PPP

Groups/Family Business

COJUANGCO Electricity, airport

AYALA Water, telecomm

PANGILINANElectricity, water, MRT, toll, health, telecomm, mining

LOPEZ Electricity, toll

HENRY SY Electricity

ABOITIZ Electricity

CONSUNJI Electricity, water

RAZON Port

Mula sa The Philippine Star

The interconnections of the health system with other major social systems (economic, political and cultural) were quickly recognized by the program workers.

REFERENCES

World Health Organization and UNICEF. The Declaration of Primary Health Care. Alma Ata, 1978

Romualdez, A Jr. Universal Health Care: From Advocacy to Policy. February 2012

Caguiat, J. Community-Based Health Programs (CBHPs): Lessons. November 2005

de la Paz, EP. Health Restructuring through Liberation Movements. July 2011

Nisperos, GA. Philippine Health Situation Under Aquino: A Brief Overview. January 2012

Paterno, RP. How Do We Finance Universal Health Care. May 2012

Community Medicine Development Foundation, Inc. The Philippine Health Situation. August 2011

Bergstrom, S. From population control to sexual and reproductive health and rights (SRHR). June 2010

Galvez-Tan, JZ. The Health Human Resource Development in the Philippines: 2009 Situationer. April 2010

Padilla, A. Economic growth not creating jobs, excluding the poor. May 2012

Pictures from Dr. Geohari Hamoy (COMMED), Dr. Reginald Pamugas (HAHR), Bullit Marquez (AP)