Hello!

The Duterte administration continues to pursue neoliberal policies. Its flagship

health plan, the Philippine Health Agenda or ACHIEVE, is a sham, having failed
to address the health needs of the people and create substantial changes in the
Department of Health's (DOH) policies and programs.

Through the Philippine Health Agenda, the Duterte administration continues to

implement policies and programs like privatization/corporatization of public
hospitals, budget cut on direct health services, and fee for service.

With this, the Duterte government, like the previous administrations, abandons
its responsibility of providing health services to the people and surrenders its
obligation to private businesses, whose interest is to gain profit.

Various health groups proposed People’s Health Agenda to the Duterte

administration to make health services accessible to the Filipino people, but the
government, however, was lukewarm in its response, largely ignoring the
proposal.

The government’s inability to provide adequately for the health of its people can
be cited in the following:

Inadequate, selective and unaffordable

The TSEK AP program or free medical consultation for 20 million Filipinos did
not materialize.

Under his first year, no additional Barangay Health Stations (BHS) were put up.
Take note that at least 26,000 barangays do not have BHS, depriving thousands
of people of accessible, preventive, promotive health services. Many existing BHS
are also dilapidated, lack personnel, equipment and medicine (i.e. areas in
Western Samar). Some are occupied by military in different parts of the country.

Primary health services are also concentrated in urban centers while rural
communities have very little or no health facilities at all. There is also a lack or
absence of preventive and promotive aspects of health like immunization services
such as anti-tetanus, Hepa-B.
The DOH itself admits the government’s failure to eliminate measles.

While DOH continues its ‘No Home Birthing Policy’, many rural areas actually
have no birthing facilities, making it cumbersome for pregnant women and their
families to travel to town centers where most of the birthing facilities are
situated. Therefore, it becomes necessary for the government to send trained
midwives to expectant mothers. Due to lack of government facilities, the private
sector is encouraged to build birthing facilities for profit.

Thus, instead of reducing the maternal mortality rate (MMR), the targeted MMR
of 52:100,000 MMR in 2015, the MMR went up to 221:100,000.

Despite this situation “no home birthing policy” continues.

Hello!

The Duterte administration continues to pursue neoliberal policies. Its flagship

health plan, the Philippine Health Agenda or ACHIEVE, is a sham, having failed
to address the health needs of the people and create substantial changes in the
Department of Health's (DOH) policies and programs.

Through the Philippine Health Agenda, the Duterte administration continues to

implement policies and programs like privatization/corporatization of public
hospitals, budget cut on direct health services, and fee for service.

With this, the Duterte government, like the previous administrations, abandons
its responsibility of providing health services to the people and surrenders its
obligation to private businesses, whose interest is to gain profit.

Various health groups proposed People’s Health Agenda to the Duterte

administration to make health services accessible to the Filipino people, but the
government, however, was lukewarm in its response, largely ignoring the
proposal.

The government’s inability to provide adequately for the health of its people can
be cited in the following:

Inadequate, selective and unaffordable

The TSEK AP program or free medical consultation for 20 million Filipinos did
not materialize.
Under his first year, no additional Barangay Health Stations (BHS) were put up.
Take note that at least 26,000 barangays do not have BHS, depriving thousands
of people of accessible, preventive, promotive health services. Many existing BHS
are also dilapidated, lack personnel, equipment and medicine (i.e. areas in
Western Samar). Some are occupied by military in different parts of the country.

Primary health services are also concentrated in urban centers while rural
communities have very little or no health facilities at all. There is also a lack or
absence of preventive and promotive aspects of health like immunization services
such as anti-tetanus, Hepa-B.

The DOH itself admits the government’s failure to eliminate measles.

While DOH continues its ‘No Home Birthing Policy’, many rural areas actually
have no birthing facilities, making it cumbersome for pregnant women and their
families to travel to town centers where most of the birthing facilities are
situated. Therefore, it becomes necessary for the government to send trained
midwives to expectant mothers. Due to lack of government facilities, the private
sector is encouraged to build birthing facilities for profit.

Thus, instead of reducing the maternal mortality rate (MMR), the targeted MMR
of 52:100,000 MMR in 2015, the MMR went up to 221:100,000.

Despite this situation “no home birthing policy” continues.

WHAT CHANGE? The author likens the Duterte administration with previous administrations that have
supposedly 'abandoned its responsibility of providing health services to the people'

Privatization and corporatization of public hospitals, health facilities

The Secretary of Health declared that at least 33 of the 72 public hospitals will be
privatized to gain financial autonomy. This policy would deprive the poor of
health care services because corporations, to be financially viable, will have to
require patients to pay. Even without any legal basis, government hospitals like
Quirino Memorial Medical Center, Eastern Visayas Regional Medical Center, and
Vicente Sotto Memorial Medical Center and Corazon Locsin Montelibano
Medical Center have increased fees making medical services unaffordable for the
poor.
Aside from this, DOH also confirmed the sale of National Center for Mental
Health (NCMH)/Welfareville and its planned transfer to Rosario, Cavite. The
modernization of Philippine Orthopedic Center also lacks funding.

The budget for the maintenance and other operating expenses (MOOE) of public
hospitals remains inadequate. With this, patients will be charged of higher
hospital, laboratory, and other fees.

The plan to transfer and to eventually corporatize Dr. Jose Fabella Memorial
Hospital is expected to deprive poor patients of affordable women, maternal and
child health care. The call to improve present structures and develop facilities
with government funding continues. Although President Duterte promised to
modernize the Fabella hospital, no written policies have been made.

Budget cuts

Existing government health facilities, especially in rural areas, are dilapidated

and neglected, lacking the needed personnel, medicines, and equipment to
function and deliver services efficiently.

Secondary level of care such as district, city, or municipal hospitals lack necessary
equipment, facilities, medicines and qualified personnel. Not all municipalities
also have government hospital.

Because of these inadequacies at the primary and secondary level, patients from
far-flung areas have to go to tertiary hospitals located in urban centers for their
health needs.

This situation requires the patients and family to travel, which is way beyond the
financial capacity of the poor from remote areas.

The health budget allocated for the year 2017 is not commensurate to the needs
of Filipinos and still far from the 5% of the Gross Domestic Product standard.

Budget for maintenance and other operating expenses (MOOE) for government
hospitals and facilities remain low. The proposed budget for MOOE in the 2017
National Expenditure Program was cut by P1.5 billion ($29.54 million) from the
2016 budget. But due to combined efforts of the health sector, community
organizations, and the Makabayan bloc to push for increased health budget, the
allotment for MOOE to its 2016 level was restored in the General Appropriation
Act.
MOOE covers direct public health services including the provision of free
essential medicines and free basic services in DOH hospitals. Inadequate MOOE
budget would deprive patients especially the majority who are poor of the needed
health services.

Out-of-pocket expenses

While the budget for MOOE remains low, P53 billion ($1.043 billion) of the P102
billion (P2.09 billion) DOH budget is channeled to Philhealth.

PhilHealth is a form of user-fee that makes people pay for services. With the cap
in benefit package and lack of medicines, supplies and procedures in public
health facilities, even poor patients under No Balance Billing (NBB) are forced to
spend out of their pockets – only 4 of 10 claims were covered in the NBB.

Meaning, 6 of 10 indigent members had to cough out-of-pocket expenses to settle

their hospital bills. (READ: DOH in 2017: Focus on universal health coverage,
lowering drug prices)

Philhealth is used as a profit-making avenue for private institutions that pushe

patients to shell out out-of-pocket expenses. Philhealth is largely subsidized by
taxpayers’ money. Billions of pesos worth of subsidy – P37.5 billion ($738
million) in 2015, P43 billion ($847 million) in 2016 and P53 billion ($1.043
billion) for 2017 – were given to Philhealth. Despite this, the utilization remains
low among the lowest quintile (33%) or the poor. Even with increased subsidy for
Philhealth, out-of-pocket-expenses in health reach as high as 53% of the total
expenses.

Private health institutions and facilities get more out of Philhealth payments than
public facilities because only 35% of Philhealth-accredited facilities are
government and 65% are private.

Few government health personnel

There are 22,905 unfilled plantilla positions for health care personnel still not
filled up. Minimum of 3,000 plantilla positions for nurses are also vacant.

Aside from this, the health department failed to add plantilla positions for health
personnel even if health facilities expanded its coverage and services.

Low wages, benefits

In the past year, there were no increase in the basic salary of health personnel.
Proposed bills for government health workers – P16,000 ($315) minimum wage
for health workers, P25,000 ($492) entry level for nurses, and P65,000 ($1280)
entry level for doctors – failed to pass in the Congress.

Benefits under the Magna Carta of Public Health Workers were not regularly
given due to lack of funding. Health workers under the local government also did
not receive benefits such as hazard pay, overtime pay, and other benefits
provided by law.

Poor working conditions of health personnel continue, with many of them being
overworked. For example, first year residents of the Department of Emergency
Medicine Services (DEMS) of the Philippine General Hospital (PGH) resigned
due to poor working conditions. According to them, nurses extended up to two
and more working hours without pay.

Consequently, because of this, many health personnel choose to leave the

Philippines for better opportunites abroad.

Lack of access to safe, essential medicines

Cheaper Medicines Act did not decrease the prices of medicines and did not
dismantle drug monopoly that controls prices and distribution.

Although the Department of Social Welfare and Development (DSWD) allocated

funding for medicines under their Lingap sa Masa program, it is very difficult to
access and funds are available to few hospitals only. For example in PGH, P480
million ($9.48 million) from DSWD and additional P100 million ($1.96 million)
per month from Presidential Social Fund (PSF) are allocated for medicines.
However, these funds are not maximized by the people who need them most
because of barriers that makes access to medicines difficult, including lack of
health personnel like doctors and social workers to assess and endorse patients,
operational inefficiency and cap on the number of patients to be served, proof of
indigency and others requirements.

There is no allocation for this in the General Appropriations Act.

BUDGET FOR HEALTH. Many halth professionals and health workers claim that they are deprived of
decent wages and benefits
Contractualization persists

In PGH, there are 663 (18%) out of 3,818 personnel are contractual. In GOCCs
hospitals like Philippine Health Center, 30% of personnel are contractual
personnel.

Contractualization in hospitals comes in various forms: job order, project based,

contractual (with benefits), agency hired, and worst, “post graduate nurses’
training”, wherein nurses perform regular staff functions but have to pay a
“training fee”.

Deposit requirements

Despite a law increasing the penalty for hospitals that violate the “Anti-Hospital
Deposit” policy, hospitals still ask for deposit especially for private patients.

More malnourished children

According to Food and Nutrition Research Institute (FNRI) the number of

malnourished children has increased, and the government nutrition program is
still inadequate. DSWD feeding program is selective and provides only P15 per
child ($0.30).

In summary, the Philippine Health Agenda of the Duterte government promotes

the increasing role of the private sector, privatization/corporatization and
insurance like Philhealth to finance public health facilities with the end goal of
less or no subsidy from the government.

The government has the primary responsibility in ensuring people’s right to

health. It should provide adequate fund allotment and implement measures to
improve public health care delivery and people’s health. Taxes should be returned
to the people in the form of adequate and free social services.

Improvements in the health situation of the people could be achieved if the

government has the political will to prioritize social services and free the people
from hunger and poverty by implementing genuine agrarian reform and
nationalist industrialization.
The Department of Health (DOH) celebrates the signing of the Universal Health Care (UHC) Act into law and
congratulates all Filipinos for this accomplishment. DOH acknowledges the consistent support from legislators and
different stakeholders from civil society organizations, local government units, other national government agencies, and
international partners in pushing for the UHC Act.

“Health is everybody’s business. Health systems only work when everyone works together to ensure that no one is left
behind,” says Secretary Francisco T. Duque III.

UHC is both a vision and a commitment to the health of all Filipinos by providing the full range of high quality health
care services – from preventive to promotive, curative, rehabilitative, and palliative – at affordable cost. The signing of
the UHC Act is a remarkable achievement as it marks the beginning of a new chapter in the reform of the Philippine
health system. These include operationalizing primary health care and mainstreaming health promotion to protect
people from disease, empowering individuals and communities to maintain good health, and supporting effective
management of illness and disability. It will shift the health system’s current treatment-oriented approach towards a
more balanced approach emphasizing prevention and health promotion.

Among the significant reforms that will be implemented over time include: automatic enrollment of all Filipinos to
PhilHealth; designating PhilHealth as the national purchaser for health goods and services for individuals, such as
medicines; improvement of health facilities especially in underserved areas; responding to the gap in health workers
throughout the country; strategic engagement of the private sector; and creating and expanding new functions in DOH
to improve the delivery of health services.

“We thank the commitment of our Senators and Congresspersons to legislating for the people’s health, and the
President’s fulfillment of his promise to improve the healthcare system of the country for the benefit of all Filipinos. Let
us harness this momentum, walang iwanan at sama-sama tayo tungo sa UHC!” Secretary Duque added. The period
for drafting the law’s implementing rules and regulations immediately follows its signing with public consultations and
multi-sectoral dialogues scheduled in the coming months.

To ensure the implementation of this comprehensive and long-term reform, the Department of Health is also actively
working for higher excise taxes on both tobacco and alcohol, and seeks the support of all legislators who made UHC
possible to also advocate for and support the passage of these twin landmark health reforms of smart taxes for health.