You can’t reduce poverty without a strong public health care system

It is puzzling to us why health care, the system, and its politics, is not as prominent on the development agenda as education and agriculture.

Here is a system that by many accounts is in crisis, facing shortages in manpower and infrastructure that threaten to negate the massive additional funding it has received in the last few years. Yet the public has been quiet, the press has been quiet, the candidates have been quiet.

Why have we been talking about poverty without talking much about bringing good quality health care to the poorest in the country? The poor in the rural areas have access only to health clinics that have no doctors or nurses, no medicine to provide, and no vehicles to bring them to an equipped hospital. Even middle income families are driven into poverty if a calamitous disease were to put them in a hospital in need of a complicated procedure.

Health care is central to any poverty alleviation agenda, yet we are not talking about it nearly as much as we talk about education. What is the state of the public health care system?

There is money, but there are no doctors

It is not only doctors; it is also nurses, midwives, and other kinds of health care practitioners.

It has been said here on Rappler before:

• There are only 3.5 doctors for every 10,000 Filipinos, when there should be 15.
• About 60-70% of all medical practitioners work in urban areas, yet the majority of the poor are in rural areas.
• In areas served primarily by public doctors, there are only 3 doctors for 100,000 people!
• The shortages are also bad for nurses and midwives.
• The scale of the shortage is worse if you account for medical specialties.

According to a paper authored Dr Beverly Lorraine Ho of the Ateneo Loyola School, “there are no published data on physician specialties.” We don’t even know just how short we are on the number of cardiologists, pediatricians, pulmonologists and countless other subspecialities.

The medical professionals supply chain

If the basic data on types of doctors and where they are practicing are missing, then we can assume that these are not considered in planning for health and education. The massive shortage in medical professionals is a concern for universities, colleges, and teaching hospitals, since they should be the ones who should be graduating doctors and nurses at scale.

In the same way that the Department of Education knows exactly how many teachers it needs to fill all the shortages in schools, the Department of Health must also know exactly how many cardiologists, pediatricians, medical technicians, and hospital administrators it needs to fill the wide gap. But it knows only about doctors and health workers in the public facilities.

It is not clear why information on specialist doctors cannot be gathered, especially those in private practice. There are specialist societies that have membership lists. We need counts and we need maps so that the DOH will know where they are needed most.

With the figures in hand, the DOH, CHED, and teaching hospitals can jointly support aggressive scholarship packages for medical fields in exchange for years of service in public health. The scheme should address the urgent need for residency and fellowship positions.

There is money, but there are no hospitals

Getting the Sin Tax Law collections and giving it to the healthcare system was an exciting development. But money is only good if it is spent to maximum effect, and with an eye on efficiency.

How and where it is spent is just as important as how much is there.

The World Bank estimates a national ratio of 1.2 hospital beds per thousand Filipinos, the result of a steady decline over the past few years. (In Thailand it is 2.1, Singapore 2.7, and Malaysia 1.8.) A third, or 34%, of all hospital beds are in NCR. This means that the ratio of bed to people is much lower than 1.2 in the rest of the country. Worse, more than half of the country’s hospitals have incomplete critical care and emergency equipment. Dr Ho says that there are even no actual counts of primary care facilities because they are not required to register.

She finds it alarming that the national health system “has no national hospital plan or national health facility plan.” So while the Department knows it is short of hospitals and primary care facilities, it does not know where these are most urgently needed, what types are needed in which places, how big they should be, and how to man them with enough medical professionals.

Let’s talk about health    

It is time we put public health high up on the policy agenda, as there will be no poverty alleviation without a solid plan for fixing the health care system. It’s time to talk about health care as a system, its needs, its design, and its responsibility.

It’s time to demand of the next crop of leaders, some degree of acknowledgement that the healthcare system needs all the attention it can get. Without political commitments to fixing public health, it threatens to hold back any poverty reduction program government pursues. – Rappler.com

Clarissa C. David is a Professor at the UP College of Mass Communication and a fellow of Social Weather Stations Inc. She is also the 2015 Outstanding Young Scientist awardee for social science.

Dr Anthony Leachon is a physician, preventive health education, and health reform advocate, and immediate past president of the Philippine College of Physicians. He received a Presidential Citation for helping the government with this preventative health education advocacy through his pursuit of getting EO 595- Health Education Reform Order passed – one of his many achievements. He was the lead proponent of the civil society in the passage of the Sin Tax Law in 2012.

Stethoscope image via Shutterstock