How to kill a bill

Marilen Dañguilan

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Senator Recto’s amendments would disable two critical components of the health care delivery system, making the RH bill practically useless

Marilen J. DanguilanWhat a coup! Sen Ralph Recto was able to emaciate the RH bill, snuffing out its life. In his amendments, local government units (LGUs) and private institutions are no longer mandated to provide RH services such as family planning and emergency obstetric and newborn care. If the RH bill becomes law, it would be practically useless.  

Recto’s amendments would disable two critical components of the health care delivery system – the LGUs, i.e., the 80 provinces, 138 cities, 1,496 municipalities, and 42,026 barangays; and the private hospitals that compose about 60% of the total number of licensed hospitals in this country.

This is like installing power stations throughout the regions without setting up the transmission wires and transformers to distribute electricity to the households.

No mandates for the LGUs

Take Recto’s first amendment, the lifting of the mandate on LGUs.

Recto’s reasons are: a) he does not like mandates; he does not like the State to tell LGUs or the private sector what to do; and b) LGUs are not all that rich and many could not afford RH services.

The Senate approved this amendment, even when they know fully well that making a law and implementing it are not two separate and distinct activities; one reinforces the other. They also are aware that the success of any law’s implementation would rely, to a great extent, on those who are primarily tasked to implement it, the LGUs, in this case, in partnership with the national government.

Recto’s amendments focused on the operational aspects of the bill, unlike Sen Juan Ponce Enrile’s, that touched on philosophical, emotion-laden matters such as “the equal rights of children, youth, and the unborn” and on the centuries-old issue of when human life begins.

Recto, on the other hand, went for the kill.

He raised the nuts-and-bolts issue of costs, and implicitly the cost-effectiveness of RH services, as well as the capability of LGUs, particularly those that are struggling and impoverished, to implement the RH law. He framed these discussions within finite budgets to accommodate infuriatingly infinite mandates that impose on already overstrained LGUs. And all this, under the threat of jail terms for LGUs which do not comply.

Recto envisions a country where LGUs, even without any mandate, would ensure that each and every woman or man would be able to access RH services. But this simply is not the case.

LGUs have different priorities from the national government’s. If one takes a look at the Department of the Interior and Local Government Performance Challenge Fund, one could gauge the priorities of LGUs. Projects are mainly on infrastructure such as farm-to-market roads, irrigations systems, flood control canals and waterways, market stalls, among others. Health, particularly reproductive health, hardly emerges as one of the priorities of LGUs.

There are of course LGUs that have their own RH charters. But some, even without charters, strive to provide RH services such as Aurora, Sulu, Asipulo, Ifugao, Nueva Vizcaya, Quezon City, and Davao City. But this is not the norm; these are the outliers.

And this explains why, despite our having a high literacy rate and a relatively decent GDP growth, we have 2.2 million women whose contraceptive needs are not met and about 4,288 women who die every year from pregnancy and childbirth.

That’s why it is extremely important to mandate and legislate — particularly on services like reproductive health that national and local governments have not funded and provided.

Now, with the Senate’s approval of Recto’s amendment, the national government would be unable to effectively harness the powers of one of the most important and indispensable implementing political structures that could make a success of the RH law – the LGUs.

No mandates for private health facilities

The other amendment that Recto introduced, and which the Senate approved, is that private health facilities are not mandated to provide RH services. The reason behind this amendment is, once again, Recto’s strange aversion toward mandates.

Health facilities, private and public, are essential components of any health care delivery system. They provide health services directly to people. And private health facilities have always been a significant provider of such services in our country. In 2009, 60% of hospitals were privately owned and about 49% of patients were confined in such hospitals, according to an Asian Institute of Management study.

Like Recto’s amendment on LGUs, his amendment on private health facilities cuts out another crucial implementation arm. This limits the effectiveness and reach of the RH bill.

Despite this, all hope is not lost.

In the upcoming bicameral conference committee, our legislators can still bring the RH bill back to life by reversing Recto’s two amendments. They can mandate the LGUs and private health facilities to provide RH services. It is, after all, their duty to do so.

And just so they remember: We have a right to these services. –

(Marilen Dañguilan, medical doctor, did postgraduate studies on public policy and public administration. She was the head of the technical staff of the Senate Committee on Health in 1987 and has engaged in policymaking on health since then.)

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