Philippines: The people’s health in crisis

By Rep. Satur C. Ocampo
BAYAN MUNA Party-List
Privilege Speech delivered at the House of Representatives
2 October 2007

Mr. Speaker,

When I spoke to this body in September 2004, I already sounded the alarm that the provision of health services in government hospitals had reached critical levels. As we commence deliberations on the 2008 national budget tomorrow, I call the attention of this august body to a very serious concern that I have raised three years ago — and this is the dire crisis confronting our people’s health, no less.

A recent survey on the health services rendered by major government hospitals, conducted by the Kilos Bayan para sa Kalusugan, the Alliance of Health Workers, and other health organizations provides significant information about the dismal state of the country’s health care system.

The month-long survey was conducted from August 15 to September 15, 2007 among 1,005 patients in seven major government hospitals in Metro Manila that serve patients on a nationwide scope. These are the Tondo Medical Center, San Lazaro Hospital, Jose Reyes Memorial Medical Center, Quirino Memorial Medical Center, Amang Rodriguez Memorial Medical Center, East Avenue Medical Center and Philippine General Hospital (run under the Office of the President). The five specialty hospitals are the (National Kidney and Transplant Institute, Philippine Heart Center, Dr. Jose Fabella Hospital, Philippine Orthopedic Center and Lung Center of the Philippines).

Key findings of the survey show that for every 10 patients admitted to public hospitals:

■ 6 were from families who are jobless and presently unemployed

■ 3 worked as drivers, construction workers and peddlers

■ 1 was a low-income professional

■ 7 were not immediately admitted to hospitals because they either had no money, there were no available beds and no doctor was present to attend to them

■ 5 were not able to do requisite “laboratory procedure” because they had no money to pay for the service

■ 4 had to borrow money and sell property or a carabao to pay for their hospital bills

■ 7 were not members of PhilHealth

■ 9 did not receive any assistance from the hospital’s Social Welfare Assistance (SWA)

The survey pointed to a stark reality that poor patients were stripped of their self-respect as they were driven into begging and being hugely indebted because the country’s public hospitals can no longer provide for the health and medical needs of our numerous indigent countrymen and women.

Mr. Speaker, the crisis in people’s health is manifest in the following grim realities:

1. The national health budget has been shrinking.

Budget allocation for health has been consistently shrinking. Since its highest allocation of P 18.7 million in 1997, budget for health was significantly slashed to PhP11.56 B in 2007, constituting only 1.1% of the overall national budget. Roughly, this budget means the government provides for every Filipino a measly P132.90 yearly or a 36-centavo daily budget.

Although the health budget is proposed to be raised to P15.7 in 2008, this is a nomina; raise to only 1.3% of the total budget.

While allocation for health has been shrinking, budget allocation for debt servicing and military has been consistently getting the lion’s share of the national budget. Since 1996, debt servicing has eaten up 20% of the national budget. Since President Gloria Macapagal-Arroyo’s term in 2001, debt servicing allocation has shot up to 35% of the total national budget. In 2006, some P854.4 billion was allocated for debt servicing (interest and principal payment).

Meantime, budget for military spending has increased by 11% since 2001. In 2006, a total of P82.1 billion was given to the military budget (defense budget and other military spending hidden in the education (Philippine Military Academy), social services (military hospitals) and economic services (economic rehabilitation after military operations).

According to the research think tank IBON Foundation, total national government health spending of P253.00 per Filipino in 2008 will be 27.5% less than what was spent in 1997. (In fact, an additional P 8.6 billion would be needed just to return to the 1997 levels.)

Further, the supposed large overall increase in the government health sector budget from P11.56 billion in 2007 to P20.1 billion in 2008 has also seen the shrinking of the public health system. This is so because, as IBON stated, the increase in the proposed health sector budget for 2008 does not go to expanding the public health system in terms of expanding access to health or in increasing the number of doctors and nurses. The largest part is instead taken up by P1.2 billion in salary adjustments under a Miscellaneous Personnel Benefits Fund item, another P1.2 billion for family health including family planning, and P1.3 billion worth of capital outlays for a “Health Facilities Enhancement Program” likely to be accessible to those with the capacity to pay rather than to the poorest Filipinos.

One of many striking indicators of government priorities is allotting an additional P125 million in capital outlays for “Health Information Systems and Technology Development”, for a total of P130.0 million in 2008, while only a P6 million increase was granted for the implementation of the Doctors to the Barrios and Rural Health Practice Program that works with just P42.3 million.

There are cuts in the proposed budget that would effectively further hamper the efficient and affordable health services to the people:

– Cut by P10 M – Subsidy to Indigent patients: From P16.0 M (2007) to P 6 M (2008)

– Cut by P121.0 M – Operation of Special Hospitals, medical centers and institutes for disease prevention and control: From P2,700.4 M (2007) to P2,579.5 M (2008)

‧ E.g., Jose Reyes, East Avenue, Rizal, Quirino, Tondo, Fabella, Natl Children’s, Mental Health, Orthopedic, San Lazaro, Amang Rodriguez, Tropical Medicine

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– Cut by P481.6 M – Operation of Centers for Health Development-Direct service provision: From P4,173.1 M (2007) to P3,691.6 M (2008)

‧ E.g. 55 hospitals and medical center nationwide

The downward trend in the allocation for direct public services has become evident since the 1990s, making health care more and more beyond their reach of the poorest Filipinos.