Wanted: Doctors for Palawan’s islands

Chi Laigo Vallido
Wanted: Doctors for Palawan’s islands

Frank Cimatu

Of the 7,100 islands in the Philippines, 1,700 are in Palawan. The province has many geographically-isolated areas that health workers are unable to reach.

PUERTO PRINCESA CITY, Philippines – The laughter of women and mothers with their children and babies in tow filled the gymnasium of Barangay Alimanguan in San Vicente – a small town of about 34,000 residents in the province of Palawan, and a good 4-hour drive from the capital city Puerto Princesa.

The topic that brought the house down? Myths and misconceptions on various methods of family planning, both natural and artificial. Dr Ronaldo “Jingle” Santos, an obstetrician-gynecologist from the FEU-Nicanor Reyes Memorial Medical Center and Jose Reyes Memorial Hospital, was answering questions as well on reproductive health.

“Ngayon lang yata may pumuntang doktor sa amin para magturo ng family planning,”  barangay chairperson Elena Tan said. (I think this is the first time that a doctor has come to our place to teach family planning).

Amid the laughter, however, a 23-year-old woman sat quietly in a corner. She waited until the community seminar was finished so that she could talk to Dr Santos privately. Almost a month after her miscarriage, she was still experiencing bleeding, she said.  

Dr Santos wanted to examine her, but the health center just across the street from the gymnasium was closed on a Saturday and the midwife who lives in Puerto Princesa had gone home for the weekend. The nearest hospital was 3 hours away. 

So they used the desks at the barangay hall to form a makeshift bed. The clean curtains were used as beddings. During examination, Dr Santos discovered there was a small cyst in the young woman’s uterus.

Not enough doctors

The Department of Health (DOH) admits that the country suffers from a shortage of physicians. The ideal doctor-to-patient ratio is 1:1,000. To achieve this, DOH says that the country needs an additional 30,000 doctors. 

DOH says that the shortage of doctors is more pronounced in remote areas, where one doctor could be serving 33,000 people. The presence of specialist doctors – cardiologists, ob-gyne, pediatricians, oncologists, for example – is a different need altogether.

Maternal mortality – or the number of mothers dying due to pregnancy and child birth complications – remains high with 14-15 mothers dying every day. Palawan has among the highest maternal mortality rates in the country. Of the 7,100 islands in the Philippines, 1,700 are in Palawan. This means that the province has many geographically isolated areas that contribute to the poor reproductive health status of residents.

There are 20 obstetrician-gynecologists in Palawan, but only 5 are government staff or serve in public health institutions or hospitals. Majority of specialists are based in the provincial capital of Puerto Princesa. 

Maldistribution of health workers 

GUEST SPECIALIST. Obstetrician-gynecologist Dr Ronaldo Santos answers questions on reproductive health from mothers in San Vicente, Palawan. The town has only two doctors from the Municipal Health Office for its 34,000 residents. Photo by Chi Vallido/Rappler

There is a shortage of health workers overall and not just physicians. Aside from shortage, there is an inequitable distribution of health workers across the regions. Data from the DOH and the National Statistical Coordinating Board (NSCB) show that the National Capital Region (NCR), Region IV-A (Calabarzon), and Region III (Central Luzon) enjoy the highest concentration of government health professionals. 

According to DOH data for 2008 and 2009, 22% of all public health physicians are in NCR, while 2.8% are in Region IV-B or Mimaropa, where Palawan is. Next to the Autonomous Region in Muslim Mindanap, Mimaropa has the least number of public health professionals, with 3% of all government midwives and nurses working in the region. 

San Vicente, Palawan, has two doctors from the Municipal Health Office for their 34,000 residents. But San Vicente is luckier than many municipalities of the province since the local government invested in new equipment and improved their Rural Health Unit to be capable of addressing Basic Emergency Obstetric and Neonatal Care. They also have a standby vehicle to transport patients to Puerto Princesa for complicated medical procedures. 

Dr Mary Ann Navarro, officer in charge of the Provincial Health Office, says that there are many remote and isolated areas in Palawan that take hours to reach and are accessible only by foot.

Rural health units and health centers across the country are faced with many reproductive health-related cases. These include pre- and post-natal care, child deliveries, infant child and nutrition (including vaccination), treatment of sexually transmitted infection, childbirth complications, and family planning.  

The challenge of devolution

Under the devolved set-up of government, local government units (LGUs) are faced with the challenge to provide basic services to the people, and this means hiring the appropriate number of health workers to serve their constituency. 

But not all LGUs are able to hire enough health workers due to their low internal revenue allocation. Apparently, the funds are not enough for some even if LGUs are mandated to spend at least 30% of their IRA on public health care.  

A huge window of hope to improve the health system and services is the Responsible Parenthood and Reproductive Health Law (RPRH Law), which was upheld as constitutional by the Supreme Court (SC) in April 2014.

Under the law, the DOH is mandated to assist LGUs in improving their RH services, including support for the provision of family planning commodities, mobile health clinics which is useful for hard to reach areas, facilities enhancements and health worker complement among others.  

But the new law is still at its birthing stage and experiencing complications in implementation. Most recently, the SC issued a temporary restraining order on the provision of implants, a family planning method that gives women up to 3 years of protection from pregnancy and is safe for breastfeeding mothers. 

Many LGU heads are also resisting the new law. Sorsogon City Mayor Sally Lee, for example, issued an executive order declaring her city as pro-life. The effect of the EO on the delivery of RH services is yet to be determined by the DOH. 

With the national elections just around the corner, the new administration will inherit the current state of health of the country. While the Aquino government has increased the budget for health by 5 times from the previous administration, many health indicators still show that the next administration should do better.

For starters, the next government should look into the health service human resources of the country. – Rappler.com 

Chi Laigo Vallido is an independent filmmaker and an advocacy specialist of the Forum for Family Planning and Development, a non-governmental organization based in Quezon City.


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