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Health Agenda for 2016 & Beyond
Health for Juan and Juana
Esperanza I. Cabral, M.D
May 4, 2016
Global Targets
1. Reduce MMR
to < 70/100,000 LB
2. End preventable
deaths of newborns
& U 5 children
3. End the epidemics
of AIDS, TB, Malaria,
& combat hepatitis,
& water-borne
diseases & other CDs
4. Reduce by 1/3
deaths from NCDs
& promote mental
health
5. Prevention &
treat substance
abuse, e.g.,
narcotics & alcohol
6. Halve traffic
accident deaths &
injuries
7. Ensure universal
SRH care, incl. FP
8. Achieve UHC, with
financial protection,
access to essential
drugs & vaccines
9. Reduce deaths &
illnesses from air,
water ,soil pollution
& contamination &
chemicals
Unfinished Agenda
New Agenda
Pervasive Agenda
Philippine Health Agenda
Within the framework of the MDGs and the SDGs, the
Philippine Health Agenda can be summed as follows:
High rates of
avertable
infectious,
child and
maternal illness
and
death
Premature death
from NCDs,
substance abuse,
including
narcotics
and alcohol
Deaths & injuries
from traffic
accidents
Universal Health
Care including
SRH & FP, with
financial risk
protection, access
to essential
medicines
& vaccines
Unfinished Agenda
New Agenda
Pervasive Agenda
Aquino Health Agenda
“from treating health as just another
area for political patronage to
recognizing the advancement and
protection of public health, which
includes responsible parenthood, as key
measures of good governance.”
Benigno Aquino III, 2010
The Aquino Health Agenda
is to ensure that Filipinos,
particularly the poor, are:
Able to use quality health services at
affordable cost
Cared for in modern health care
facilities
Prevented from falling ill through
promotive and preventive health care
Republic of the Philippines
Department of Health
DEC 16 2010
ADMINISTRATIVE ORDER NO. 2010 - 0036
SUBJECT: The Aquino Health Agenda:
Achieving Universal Health Care for All
Filipinos
l. Financial risk protection through expanded
NHIP enrolment & benefit delivery
2. Improved access to quality hospitals &
health facilities
3. Attainment of the health-related MDGs
The Aquino Health Agenda
After six years, the Aquino
administration has a mixed bag of
results to show for its efforts.
Legislation
Credit must be given to President Aquino for the passage of four
landmark laws that have the potential of improving the state of
health care in the Philippines.
The next administration must see to the speedy
and proper implementation of all these laws.
DOH Budget
2010-2016 (in Billion Php)
122.7
83.7 86.97
53.23
42.15
24.65
31.83
Sources: GAA 2010-2015; NEP 2016
Sin Tax
Revenue
Health Spending In The Philippines
• 4.4% of GDP
• ≈ PhP 580 B (2015, current prices)
Financial Risk Protection
PhilHealth coverage ~92%
Support value ~50%
Pay out – PhP 97.03 B
Government pays premiums of 15 million families
Utilization rate by the poor, rising but low
The greater insurance coverage of the
population has increased health inequity in the
country. The government is paying for the
health care of the rich by subsidizing the health
insurance premiums of the poor.
Access to quality facilities and services
Health Facilities (2015)
Actual
Standard
No.
Existing
Ratio to
Ratio to
Needed to
Population Population Achieve
Standard
RHUs
2,586 1:39,274 1:20,000
BHS
20,002 1:5,078 1:5,000
Hospital 49,000 1:1,428 1:1,000
beds
5,078
20,312
70,000
Gap
2,492
310
21,000
HFEP (2015)
75 Billion Pesos
5,000 Facilities
Distribution of Hospitals & Hospital Beds in the Philippines
Hospitals
2005
Beds
Public
Private
Level 1
Hospitals 336
465
Beds
6094
6341
Level 2
Hospitals 271
397
Beds
16237
11663
Level 3
Hospitals 26
113
Beds
2982
8784
Level 4
Hospitals 62
85
Beds
18357
16072
Total
Hospitals 695
1060
Beds
43739
43397
2007
Public Private
2012______
Public
Private
333
6516
439
5889
372
6942
390
5535
282
15175
405
11374
266
15485
428
13022
32
3881
169
13498
45
6563
209
18218
54
21569
67
14659
46
20458
68
15034
701
47241
1080
46744
728
49538
1095
51809
Access to quality facilities & services
Human Health Resource in Public Health
Actual
Standard
No.
Employed Ratio to
Ratio to
Needed
Population Population to Achieve
Standard
Doctors
Nurses
Midwives
2,983
5,596
16,948
1:34,047 1:20,000
1:18,149 1:10,000
1:5,993
1:5,000
5,078
10,156
20,312
Gap
2,095
4,560
3,328
2015 Human Health Resource
Deployment Program
Deployment
Rural Physicians (DTTB)
Nurses (NDP)
Midwives (RHMPP)
Dentists
Medical Technologists
Medical Scholarship (Pinoy MD)
Midwifery Scholarship (MSPP)
Continuing Education
Number
398
13,500
2,700
Funds (PhP)
182,885,952
3,004,938,000
488,144,402
480
1,120
147
167,201,280
249,924,168
16,512,155
100
29,845,600
47,588,400
Attainment of Health Related MDGs the measure of success
Reduce by two thirds,
Under 5 Mortality
Reduce by three quarters,
the Maternal Mortality Ratio
Reduce the incidence of
HIV/AIDS, Malaria, TB, and
other communicable diseases
Social Determinants & Building Blocks of Health
Environmental
Governance
Information
Financing
Health
Service
Providers
Products
Delivery
Better
Better
Health
Health
For All
Social Determinants of Health
“Do we not always find the diseases of the populace
traceable to defects in society?” Rudolf Virchow
Diseases and disparities in health are often products
of a “toxic combination of poor social policies and
programs, unfair economic arrangements and bad
politics,” WHO Commission on Social Determinants of Health
In the Philippines:
A Graying Population
Urbanization
Climate Change and Degraded Environments
Internal and External Migration
The Greatest Challenge:
INEQUITIES IN HEALTH CARE
• Wide disparity in health outcomes
with poor areas more likely to:
•
•
•
•
Not have access to medicines and facilities
Lack qualified medical personnel
Have higher morbidity & mortality rates
Have lower life expectancy
The Poor and Access to Health
"For unto every one
that hath, shall be
given, and he shall
have abundance:
but from him that
hath not, shall be
taken away even
that which he hath."
Matthew 25:29, King James Version.
Whither the health care system?
“Would you tell me,
please, which way
I ought to walk from here?”
“That depends a good
deal on where you want
to get to,” said the Cat.
From Alice in Wonderland by Lewis Carroll.
24
The Health Agenda:
1) The unfinished business of the MDGs
2) The emerging health issues such as the
NCDs
3) Access to quality health care regardless
of ability to pay.
4) The social, economic, and environmental
dimensions of health.
Key Actions to Address the 2016
Health Agenda
• Leadership and Governance
• Health Systems and Service Delivery
• Sufficient and Sustainable Financing for
Essential Health Services
• Information and Communication Technology
for Health
• Health Workforce
• Health Products
Leadership and Governance
 Devolution highlighted
economic, fiscal & managerial
differences between LGUs
and among LCEs.
 Misaligned priorities and poor
planning and implementation
 Autonomy is a double edged
sword.
Autonomy → Better Governance
Autonomy → Patronage
Autonomy → Obstructionism
Autonomy → Corruption
Leadership and Governance
DOH
Mandate: Stewardship
and oversight of the health sector
Situation: Decentralized system-managing
national programs through LGUs;
Creeping renationalization;
Responsibility without authority
Health Systems and Service Delivery
• multi-stakeholder involvement to ensure adequate
representation of all parts of the system;
• local infrastructure for system-wide capacity and
health workforce development;
• whole of government approach to leverage resources
and reduce duplication in health financing;
• local government ownership/partnerships with
private sector even as national government provides
policy directions, resource augmentation and overall
leadership
• evidence-based M & E systems and link provision of
resources to results.
Information and Communication
Technology for Health
 Quickly improve the quality and timeliness
of data collection, recording, & analysis.
 Better quality data to inform planning,
monitoring and regulation of programs is
needed.
Sufficient and Sustainable Financing
for Essential Health Services
 NHIP is main sustainability mechanism for
Universal Health Care.
 Shifts the driver of health care from supply
to demand.
 Increased resources needed to cover
service expansion after universal health
coverage is attained.
 Programs carefully designed to ensure
better service quality, good health results,
and cost containment.
Health Workforce
 Sufficient number & appropriate mix
of staff that are competent, & caring,
& distributed according to need.
 Private sector providers needed to
augment / complement healthcare
workforce in the public sector.
 Public & private sector providers must
work together to achieve the best
health outcomes possible given
limited resources.
Health Products
Essential medicines, vaccines and technologies
available, affordable, and of assured quality.
Selected based on real needs, evidence of
efficacy and safety and cost effectiveness.
Medical products used appropriately so as not
to waste limited resources and jeopardize the
quality of health care.
Health Facilities
 Most government health facilities in a state
of disrepair. Time to increase & upgrade all
public health facilities
 Need for more high level health care
facilities that provide quality health care at
sustainable costs for the poor in all regions.
 progress on health inadequate despite
sustained economic growth
 put health as a priority
 mitigate the impact of poor maternal and
child health, prevalent infectious diseases,
increasing NCDs and of a changing climate.
 invest to achieve good health. Focus on
economic growth and wealth has often
missed the core reason for development—
Improving the lives of all people…