Hospitals,

Morbidity and Mortality in the Philippines

Hannah M. Pellejo, PTRP

At present, there are 1,465 hospitals registered under the National Health Facility Reg-
istry, 997 from the private sector and 468 from the public sector. The distribution of the
hospitals are largely clustered in areas surrounding NCR, Regions IV-A and III with the
distant regions having the least number of hospitals (CAR, ARMM, Region XIII).
The hospitals are largely of the private sector, composing more than 2/3 (68.05%) of the
total number (Figure 1). This sector hires more than 70% of the healthcare providers but
only caters to around 30% of the population (World Health Organization, 2011). They are
likewise not integrated into the health information systems of the Department of Health,
making communication and service delivery difficult in the country. Considering that only
a minority is treated in the private hospitals, the limited number of public hospitals cater to
most of the population, resulting to congestion. Overall, this has resulted to inequity of
health services between the private and public sector.

Figure 1: Total Hospitals in the Philippines for the Government and Private Sectors.

In 1965, the “Hospital Licensure Act” has been passed, requiring all hospitals to be
licensed to be able to operate. Section 4 of this act states that “No hospital shall operate or
be opened to the public unless it shall be been registered and a license for its operation obtained from
the licensing agency provided in this Act”. Despite this, many hospitals have continuously
violated the law by operating without a license, mostly from the private sector (Figure 2).
This indicates uncontrolled medical activities and unguaranteed quality of service. NCR
and Region IV-A have the highest number of unlicensed hospitals at 41 and 37,
respectively. However for areas like Region XIII (Caraga Region)—where health facilities
are scarce—although 15 hospitals are unlicensed, it becomes a dilemma whether to close
these institutions as it will decrease the health providers to that location. It may even be
unethical to some extent. For the urban areas, the continuous operations of unlicensed
hospitals may not have other better explanations except the poor implementation of the law
and possibly, some corruption in the ranks of the government.
 Figure 2: Total Government and Private Hospitals in the Philippines, Licensed and Unlicensed.

In terms of regional distribution, urbanized areas have the largest number of hospitals
(Figure 3). Region IV-A has the highest count at 257 (17.8%) hospitals, followed by NCR at
204 (14.1%) and Region III at 193 (13.4%). Region IV-A is the second most populated region
in the country and has undergone rapid urbanization. This region along with Region III are
readily accessible from NCR via land travel. Many of the people working in NCR are living
in these two regions and have relatively better economic capacity for healthcare than those
in the other far-flung regions. Hence, investors may have decided to build institutions in
these areas given the economic capability of the population and the dense number of people
they can cater to. The overcrowding due to urbanization has also resulted to unhealthy
lifestyles and pollution, making the population more prone to sickness that will need medical
attention.
The level of care that the hospitals also provide are mostly basic. Majority of the
hospitals in the Philippines are only Level I (66.5%), followed by Level II (24.6%) and Level
III (8.8%). There are no Level IV hospitals in the country as of the present. The services
offered per level are as follows (WHO, 2011):
Level 1 hospitals: emergency care and treatment, general administrative and ancillary
services, primary care for prevalent diseases, clinical services (general medicine, paediatrics,
obstetrics, non-surgical gynaecology and minor surgery)
Level 2 hospitals: non-departmentalized, cater to patients who require intermediate,
moderate and partial supervised care by nurses for 24 hours or longer. Same with Level 1
hospitals with the addition of surgery and anesthesia, pharmacy, first level radiology and
secondary clinical laboratory.
Level 3 hospitals: organized into clinical departments and offer intensive care, clinical
services in primary care and specialty clinical care.
Level 4 hospitals: render clinical care and management, specialized and sub-specialized
forms of treatment, surgical procedures and intensive care, have at least one accredited
residency training programme for physicians.
The limited services provided by the majority of the hospitals result to overcrowding in
specialty institutions and a possible compromise of the quality of care. Of the 98 hospitals
that offer Level 3 services, 47 of these are found within the NCR. The lack of distribution of
specialty hospitals in other regions has resulted to people from far-flung provinces to travel
to NCR to access the services or to avoid seeking treatment altogether, resulting to poor
 Figure 3: Percent Distribution of Hospitals in the Philippines per Region.

health outcomes.
Morbidity and Mortality
The Field Health Service Information System (FHSIS) has reported in 2016 that the
leading causes of disease are largely communicable (Table 1). This is because they can
spread easily among neighboring houses. The rate of survival is higher and one person
acquire the condition more than once, giving it a higher count.
However for mortality, leading causes are mostly non-communicable diseases (NCDs)
(Table 2). They do not manifest with problems initially, hence people may not consult with
a healthcare provider during this period. Once they have been diagnosed, follow-up may
also be difficult given that these conditions need multiple interventions. The common
Filipino may avoid consultation altogether to save on funds. Only when these diseases have
progressed to its late stages will the person seek medical treatment. The trend seen with
regard to the type of NCD can also be attributed to the Filipino’s tendency for salty and
fatty diets and lack of exercise.

Figure 4: Percent Distribution of the Different Hospital Levels in the Philippines.

 Table 1: Leading Causes of Morbidity in the Philippines (2016).

Disease Number of Rate per 100,000

Cases population
1. Acute Respiratory Infection 3,080,343 2,970.12
2. Hypertension 886,203 854.49
3. ALTRI and Pneumonia 786,085 757.96
4. Urinary Tract Infection 288,588 278.26
5. Influenza 216,074 208.34
6. Bronchitis 200,176 193.01
7. Acute Watery Diarrhea 139,770 134.77
8. TB Respiratory 87,422 84.29
9. Acute Bloody Diarrhea 57,647 55.58
10. Dengue Fever 56,487 54.47

Lack of financial resources may also be the cause of persistent respiratory

infectious diseases that result to death. Although avoidable, the lack of follow-up due
to financial constraints and poor education and awareness of the condition, and the
emergence of drug- resistant microorganisms all have debilitating results. Stroke is
one of the major cause of mortality in cerebrovascular diseases. Hearing impairments
due to localized diseases of the ear account for very little of the cases for mortality.

Table 2: Leading Causes of Mortality in the Philippines (2016).

Disease Number of Rate per 100,000

Cases population
Ischaemic heart diseases 74,134 12.70
Neoplasms 60,470 10.40
Pneumonia 57,809 9.90
Cerebrovascular diseases 56,938 9.80
Hypertensive diseases 33,452 5.70
Diabetes Mellitus 33,295 5.70
Other heart diseases 28,641 4.90
Respiratory tuberculosis 24,462 4.20
Chronic lower respiratory infections 24,365 4.20
Remainder of diseases of the 19,759 3.40
genitourinary
system
**Diseases of the ear and mastoid process 35 0.00
(2014)
References

An Act Requiring the Licensure of All Hospitals in the Philippines and Authoring the
Bureau of Medical Services to Serve as the Licencing Agency, Pub. L. No.
Republic Act No. 4226 (1965).
Deaths in the Philippines, 2016 | Philippine Statistics Authority. (2018). Retrieved
January 27, 2019, from https://psa.gov.ph/content/deaths-philippines-
2016?fbclid=IwAR0v7kPa9HgCR0mfOuKODu8t39E4vEqX
oBpR2YKCQ4WS7a47tPmf-A0I37s
FHSIS. (2016). Field Health Service Information System 2016 Annual Report.
Retrieved from https://www.doh.gov.ph/sites/default/files/publications
/FHSIS2016.pdf
National Health Facility Registry v2.0. (n.d.). Retrieved January 27, 2019, from
https://nhfr.doh.gov.ph/ rfacilities2srch.php
The Philippines health system review. (2011). Manila, Philippines: World Health
Organization, Western Pacific Region.