Drug rehab, RH budget, Zika, and other public health newsmakers in 2016

MANILA, Philippines – Controversy ushered in 2016 for the country's public health sector, with the health secretary revealing in January that the health department lost from its 2016 budget a P1-billion allocation for contraceptives. That opening salvo seemed to have set the tone for the rest of the year.

The months that followed saw other public health issues making headlines, from the first locally-transmitted case of Zika virus in the Philippines, to the inadequacy of the country's drug rehabilitation program to address the Duterte administration's unrelenting war on drugs.

Rappler looks back at 2016's newsmakers in public health.

Advocates of the reproductive health (RH) law were aghast when they learned from then Health Secretary Janette Garin that lawmakers removed the P1-billion allocation for the purchase of family planning commodities for Filipinos.

Garin said the budget was removed at the level of the bicameral conference committee, and found out about it only after the General Appropriations Act had been signed. (READ: RH budget cut: 3 unanswered questions)

According to Senator Loren Legarda – then chair of the Senate committee on finance – they decided to reduce the budget supposedly because the Department of Health (DOH) had more than enough savings from 2015 to fund the family planning program.

Her fellow senator and staunch RH critic Vicente Sotto III said another basis for the cut was the Supreme Court's temporary restraining order (TRO) in relation to family planning commodities.

They criticized Legarda and Sotto – both members of the bicameral conference committee for the national budget – for allowing the budget cut, but Legarda maintained that "the whole budgetary process was done in the most transparent and inclusive manner." (READ: RH budget cut exposes problematic lawmaking in PH)

The budget department later issued a statement assuring the public that there are enough funds to satisfy the 2016 budgetary requirements of the RH law. Advocates then vowed to make the budget cut an issue in the 2016 election.

The TRO on implants has also been a challenge for the RH law this 2016.

The order, which has been in place since 2015, temporarily stopped the health department's distribution and sale of implants – a contraceptive that can prevent pregnancies for up to 3 years.

It also prohibited the Food and Drug Administration (FDA) from "granting any and all pending application for reproductive products and supplies, including contraceptive drugs and devices."

Since 2015, government has filed several motions asking the SC to lift the TRO. Last August, the High Court finally acted on the case, denying the plea of the Office of the Solicitor General to lift the TRO. It even ordered the FDA to find out whether certain contraceptive drugs and devices are abortifacients or not.

Not one to give up, the health department in October asked the SC again to lift the TRO, arguing that restraining the RH law could put at risk the family planning program it is implementing with local government units and civil society sectors. Other RH advocates also filed a motion asking the SC to recognize them as intervenors in the case.

What's at stake in this case is the impact of the TRO on the supply of contraceptives in the country.

Unless the SC lifts the TRO, the Commission on Population  said almost 90% of contraceptive brands will no longer be available by 2018, as their FDA certificates will expire by then. This will make the reproductive health (RH) law "ineffective," according to the PopCom.

The good news is that despite the TRO, the use of modern family planning methods in the country still increased in 2015, according to a DOH report on the implementation of the RH law. 

This year, the spotlight's on the health department's drug rehabilitation program after the Duterte administration launched its intensified campaign against illegal drugs.

Health Secretary Paulyn Ubial had said the drug problem in the Philippines can be considered a public health emergency.

But even the DOH was initially surprised with the number of drug users who surrendered to the government. Police figures showed there are already over 830,000 drug surrenderers as of December.

Based on estimates, only 1% to 2% of this number will need residential drug rehabilitation treatment, while the rest will undergo either a community-based rehabilitation program or an outpatient one.

The past months have been very busy for the health department since it is in charge of providing the right intervention for every drug surrenderer.

Aside from the newly-opened mega treatment and rehabilitation center (TRC) in Nueva Ecija – a donation from Chinese tycoon Huang Rulun – government plans to establish 3 more mega TRCs, one each in Luzon, the Visayas, and Mindanao.

The DOH's proposed 2017 budget has a P3-billion allocation for the operation of government-run TRCs.

Just months after the World Health Organization (WHO) declared the Zika situation in South America as an international health emergency, the Philippines reported in September its first confirmed local transmission of the virus – a 45-year-old woman from Iloilo City.

Since then, the health department has recorded at least 39 Zika cases in the country, and 3 of the cases are reportedly pregnant.

The mosquito-borne Zika virus is strongly suspected of causing birth defects, such as microcephaly and other brain deformities in newborns.

Since October, it has been established that Zika is endemic in the Philippines. The health department has included the prevention and detection of Zika virus in its proposed 2017 budget.

Meanwhile, the WHO announced last November 18 that the Zika virus outbreak is no longer a world public health emergency.

Much progress has been made in mainstreaming mental health in the country this year.

In July, just a week after the new administration took over, the health department announced the plan to launch a national hotline that would provide help to people with mental health concerns.

The HOPELINE Project, a 24/7 crisis support hotline for depression and suicide prevention, was officially launched in September or two months after the plan was announced to the public.

This year, too, Ubial signed an administrative order (AO) on the nationwide implementation of the health department's mental health program.

The AO details a comprehensive framework of how the mental health program will be implemented "at all levels of the health system," including barangay health stations and rural health units.

DOH is also advocating for the passage of a mental health law in the Philippines. This is especially timely in the context of the campaign against illegal drugs, since substance abuse can be damaging to a person's brain.

In fact, there are rehabilitation centers in the country that cater to patients who are "dually diagnosed" – those who deal with both substance use disorder and mental illness. (READ: Inside the brain of a drug user)

The graphic health warning law finally took effect last March, almost two years since its enactment. 

Manufacturers were then given only until November to exhaust their stocks of packs that only bore text warnings.

Now both government and tobacco control advocates expect all tobacco product packaging to have graphic health warnings placed on the lower portion of the cigarette pack, covering 50% of both front and back panels.

The implementation of the graphic health warning law comes just as the health department awaits the signature of the President on an executive order (EO) that bans smoking in all public places in the Philippines.

The draft EO also covers electronic cigarettes or e-cigarettes, and is patterned after a Davao City ordinance.

It has two key provisions: a 100% smoke-free environment, and designated smoking areas outdoors, away from the public.

The President has yet to sign the EO, although the health department has prepared its implementing rules and regulations.

Both houses of Congress have begun investigating the health department's school-based dengue immunization program, a P3.5-billion program that has so far given at least one dose of the new dengue vaccine to around 489,000 public school students (at least 9 years old) in Central Luzon, Calabarzon, and the National Capital Region.

There are criticisms the health department rushed to implement the program, using public funds that were not part of the DOH's 2016 budget to begin with.

Lawmakers have also raised questions on the timeline of events, since government started administering the vaccine to public school students in April 2016, or less than 4 months after it was cleared by the FDA in December 2015.

Some health advocates continue to question the safety and efficacy of the vaccine.

In fact, after the first Senate blue ribbon committee hearing, Senator Richard Gordon said he was convinced there was negligence on the part of the health department regarding the death of an 11-year-old boy who received the dengue vaccine.

He had congenital heart disease.

While former health secretary Garin already denied that the patient's death was related to the vaccine, Gordon still criticized the department's health workers for administering the vaccine despite being told at the time of the vaccination that the student was still recovering from illness.

Amid the controversies, Ubial still thinks the school-based dengue immunization is "a good program." She vowed to fix systems in place "so that the vaccination program is preserved."

A new bill in the House of Representatives is threatening to block the full implementation of Republic Act 10351, or the landmark Sin Tax Reform Law of 2012 passed under the Aquino administration.

On December 13, the Lower House passed on 3rd and final reading House Bill 4144, a measure that seeks to impose a two-tier excise tax structure for cigarettes. 

Under the proposed measure, a pack of cigarettes with a net retail price of P11.50 and below would be taxed P32, while cigarette packs that cost more than P11.50 would be taxed P36.

The current law mandates that a unitary tax rate of P30 be imposed on all cigarette packs – regardless of price – by 2017.

The finance department has strongly opposed HB 4144, saying it will not effectively address the woes of tobacco farmers as claimed by proponents of the bill.

Health groups have also criticized legislators who, they said, "chose to protect the interest of [the] tobacco industry."

They said the proposed bill "will kill the health and revenue gains of the sin tax law." – Rappler.com

Jee Y. Geronimo

Jee is part of Rappler's Central Desk, handling most of the world, science, and environment stories on the site. She enjoys listening to podcasts and K-pop, watching Asian dramas, and running long distances. She hopes to visit Israel someday to retrace the steps of her Savior.

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