Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Addressing Health Human Resource Gaps in the Philippines Tony Leachon, MD Philippine College of Physicians Foundation Coalition for Primary Care May 4,2016 Disclosures • PhilHealth , Independent Director as Representative of the Monetary Board • President, PCP Foundation Inc. • Member, Coalition for Primary Care • References : Research work of Dr A.Dans, DOH,PHIC , PCP, PSGIM, AER, Coalition for Primary Care Agenda 1. 2. 3. 4. Background : Philippine Healthcare UHC : Where are we now ? Healthcare Workforce Crisis Recommendations : – Primary Care system – 5 R’s 5. Summary 47.6% of deaths among Filipinos are unattended by a medical doctor or allied health provider. Health Human Resource, Philippines. Doctors Nurses Active in Professional Regulation Comm.1 66,000 500,000 74,000 Employed in Government Facility2 2,838 4,576 17,000 0.2 0.4 1.7 Ratio per 10,000 population3 1 PRC Midwives database, 2014 2 Philippine Statistical Yearbook, 2010. 3 Total 2.3 HCW’s/10,000 pop; WHO recommends 24/10,000. Supply of Health Care Workers’ is Decreasing 1. We are #1 exporter of nurses 2. We are #2 exporter of doctors 3. ASEAN integration will open doors. Top 10 Causes of Mortality, Philippines 2010 Number affected Rate per 100,000 102,936 109.5 2. Diseases of the Vascular Sy stem 68,553 72.9 3. Malignant Neoplasms 49,817 53.0 4. Pneumonia 45,591 48.5 5. Accidents 36,329 38.6 6. Tuberculosis, all forms 24,714 26.3 7. Chronic Lung Disease 22,877 24.3 8. Diabetes Mellitus 21,512 22.9 9. Nephritis/nephrotic syndrome/nephrosis 14,048 14.9 10. Perinatal disease 12,086 12.9 Cause of Death 1. Diseases of the Heart Philippine Health Statistics, 2010 Double Burden :3 Chronic Problems • 1.Chronic healthcare workforce shortage – PH # 1 exporter of nurses, and the number 2 exporter of doctors in the world. – This shortage is at its worst where healthcare workers are needed most – in rural and urban public facilities, where they are both underpaid and overworked. • 2. Fragmented system – characterized by 46 separate but overlapping healthcare programs driven by donor initiatives rather than population needs. – This has hindered our ability to integrate, harmonize and prioritize solutions to problems in health. • 3.Healthcare system is also fragmented administratively, with local government units placed in charge of frontline healthcare delivery. – This has politicized the healthcare workforce and has made it difficult for the DOH to orchestrate a unified healthcare program. Universal Health Care(UHC) Inaugural Address 2010 • “Provision to every Filipino of the highest possible quality of health care that is accessible, efficient, distributed adequately funding, fairly financed, and appropriately used by an informed and empowered public." • It is also known as Kalusugan Pangkalahatan, which the Aquino administration describes as the "availability and accessibility of health services and necessities for all Filipinos." Universal Health Care(UHC) Republic Act 10606 • A government mandate aiming to ensure that every Filipino shall receive affordable and quality health benefits and services such as : – Human resources – Health facilities – Health financing One Peso DOH Consultant 2011-2013 Sin Tax Law Signing Dec 20, 2012 2003 Income 2013 PhilHealth Utilization Income Poorest Poor 18% 23% Middle 24% Rich Richest 28% 33% NDHS 2003 Poorest Poor High Middle Low Middle Rich Richest Faraon et al, 2013 PhilHealth Utilization 33% 71% 48% 54% 70% 88% Are patients benefiting? • Out-of-pocket spending remains high at 57% • The top conditions paid by P Pneumonia PhilHealth do not match H Hemodialysis priority health conditions and are focused on costly I Infections (UTI) interventions C CS / Cataract Sin Tax Funds to PhilHealth • Republic Act No. 10351 (or the Tobacco and Alcohol Tax), signed by President Aquino on Dec. 29, 2012 – gives the government the financial capacity to cover the full subsidy of the premium coverage of 14.7 million poor Filipino families (or more than 45 million Filipinos), amounting to P37 billion for 2015 and an increase of the Department of Health budget to P103 billion (an increase never received before). DOH Sec Enrique T.Ona , PDI July 2015 What the Sin Tax Law has already achieved 150 Php in 2015 • Revenue generation Sin Tax Revenues, 1998-2013 (in PhP billions) 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 70.4 32.9 33.0 16.8 23.9 12.4 Tobacco Alcohol Prevalence of Never, Current and Former Smokers. Philippines, NNS 1998-2015 70 Prevalence (%) Never Smoker 60 54.5 55.0 59.1 63.7 54.3 50 Current Smoker 40 32.7 34.8 31.0 25.4 30 20 10 23.3 Former Smoker 12.8 14.7 15.5 2008 2013 10.2 13.0 0 1998 2003 2015 Sin Tax Law Health Updates NNS 2015 1. Prevalence of smoking among adult Filipinos went down from 31.0% in 2008 to 23.3% in 2015. 2. This means there are ~4 million less smokers in the country today because of the Sin Tax Law. 3. The drop is not from people who stopped smoking. It is from people who avoid starting to smoke. 4. At least 70,000 deaths have been averted since 2013. 5. Health benefits were greatest in price sensitive populations – the poor, rural folk, the very young and the very old. Strategic Questions How Doctors Think 1.Where are we now ? Diagnosis ? State of The Nation’s Health 2. Where do we want to go ? Towards UHC 3. How do you get there ? Eg Plan of Action Where are we? (The Philippine Healthcare System) Good News and Bad News about the Philippine Health Situation 1. 2. 3. 4. 5. 6. 1 PhilHealth coverage has increased from 51% in 2010 to 88% in 2015 (PhilHealth) 1 But PhilHealth utilization remains low, especially amongst the poorest (only 33%) 2 The health budget increased from PhP28.7B in 2010 to PhP205B in 2015 3 But the number of Filipinos who die without seeing a HCW increased from 45% to 66% 4 We are the number 1 exporter of nurses in the world 5, and the number 2 exporter of doctors 6 In the public sector, - There are only 5 HCW’s per 10,000 population (ideal = 25) - There is only 1 doctor per 20,000 (ideal = 20) 7 Philhealth, 2 Faraon et al, 2013, 3 Department of Health, 4 Philippine Health Statistics, 5 Matsuno et al, 6 World Health Organization, 7 Dans et al Why healthcare workers leave 1 1. 2. 3. 4. Unemployment (unfilled positions for HCW’s) Underemployment (underpaid for workload) Misemployment (job orders and casuals) Unjust working conditions (eg - politicalization of appointments, non-issuance of magna carta benefits) Why healthcare workers stay 2 1. To serve the country 2. To be with their family 1 Ebesate J, 2012, 2 Lorenzo M, 2005 Where do we want to go? (Ideally ,A Primary Care System) The Philippine Healthcare Situation Too Little Health Care Too Much Health Care Mr. Jose 42 years old From Busuanga Mrs. Rosete 50 years old From Quezon City - High Blood - Diabetes - Tuberculosis - Diarrhea (gastro) - Stroke (neuro) - High Blood (cardio) - Diabetes (endo) - Kidney ds (nephro) - Gout (rheuma) - Pneumonia (pulmo) No consultation No medications 66% of deaths among Filipinos are not attended by a doctor, nurse or midwife 1.5M families a year pay for catastrophic health expenses. PHS 2011 Ulep et al 2013 A Primary Care System 1° CARE 2° CARE 3° CARE THE PROBLEM Funds have increased but services have deteriorated INADEQUATE WORKFORCE INEQUITY IN HEALTH INADEQUATE FACILITIES INADEQUATE TESTS/MEDS THE PROPOSAL Healthcare SYSTEM reform: Tunay na KP! FUNDS FOR WORKFORCE (AT THE FRONTLINES) PHILHEALTH PRIMARY CARE OUTPATIENT PACKAGE FUNDS FOR FACILITIES (AT LGUs, RHUs) FUNDS FOR TESTS & MEDS (PREVENTIVE CARE FINALLY) A Primary Care System A Healthcare System that enables patient access to healthcare providers with 3 main functions: 1. FIRST CONTACT & COMPREHENSIVE CARE 2. COORDINATOR OF HEALTH SERVICES Laboratories Patient Primary Care Provider Pharmacies 3. PRINCIPAL POINT OF CONTINUING CARE Specialists Facilities How do we get there? (How to Reform the Healthcare System) Roadmap to a Primary Care System Threshold density 5:1000 (WHO) RECRUIT - Graduate doctors, nurses, midwives RETRAIN - Current practitioners RETAIN - Private & Public sector REGULATE REASSESS Roadmap to a Primary Care System Workshops on DOH priorities: RECRUIT - Infectious Diseases - Non-Communicable Diseases RETRAIN - Health System Navigation RETAIN REGULATE REASSESS Roadmap to a Primary Care System RECRUIT RETRAIN - Pay for outpatient care! - In public sector – provide and RETAIN augment salaries of HCWs REGULATE - In private sector, subsidize payments for healthcare. REASSESS Roadmap to a Primary Care System RECRUIT RETRAIN RETAIN Facility – electronic records Health workers – accreditation REGULATE Patients – require primary care REASSESS Roadmap to a Primary Care System RECRUIT RETRAIN RETAIN REGULATE REASSESS - Better Quality of Care Better health Reduced healthcare expenses - Reduced out of pocket payment Roadmap to a Primary Care System RECRUIT RETRAIN RETAIN REGULATE REASSESS Summary • Despite the rising budget and increasing Philhealth coverage, healthcare is deteriorating. • The deterioration is mainly due to a shortage of healthcare workers caused by massive migration • Healthcare workers who stay (especially those in rural areas) are patriots who want to serve the country. • The government need to take better care of those who care for our health. • Primary care is vital in achieving genuine UHC. Walang kalusugang pangkalahatan, kung walang magaalaga sa taong bayan! – Coalition for Primary Care