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Philippine Board of Surgery 42nd Annual Assembly & Induction Ceremonies

December 3, 2011

A pleasant evening to everyone!

Tonight, we welcome new members to our community of surgeons. To our inductees, congratulations! Years of hard work have finally paid off. Congratulations to your loved ones and mentors! All their pains and support have undoubtedly contributed to your success. Congratulations, to all of our countrymen who benefit from your enhanced skills and medical prowess. 

Getting this far is no trifling feat. I can personally attest to that. This evening is a testament to your persistence, diligence, and patience. But there lies more to this event than a showcase of successes, at the very heart of it is the undeniable fact that our profession, our craft, remains to be vital to the Philippine society.

With the ability to provide more specialized health services comes greater responsibility. This may sound cliché, but that doesn’t make it any less true. Lest we forget, providing health services to our countrymen is not just a privilege that we enjoy after passing countless examinations and obtaining our licenses. Nor is our practice mere magnanimity or commiseration, it is a duty. And this duty, we cannot easily abdicate.

This evening I feel like I have been catapulted to a similar happening several years back, only I was not speaking in front of my esteemed colleagues; I was a newbie with a cheerful, nervous yet triumphant air being ushered in into a new chapter of my life. Then, it was my time to take on the challenges plaguing my chosen profession. Now, it is your turn to surmount the hurdles of this day and age.

One of the most pervasive problems in our country is inequality. In the context of health care, this problem is even more pronounced. Previous health reforms have worked to augment persisting disparities. To be fair, much of these health reforms have indeed resulted to significant strides. Unfortunately, these are overshadowed by the fact that they have hardly benefited the poorest Filipinos, those who are most vulnerable.

In order to overcome inequities in our health system and deliver better health outcomes, we are now pursuing our goal of Kalusugan Pangkalahatan. KP represents our government’s efforts to address the health needs of the Filipinos, and it is particularly slanted to favor the most vulnerable segments of our population. It is built on three strategic thrusts, namely (1) financial risk protection through expansion of the National Health Insurance Program enrollment and benefit delivery, (2) improved hospitals and health facilities and (3) scaling up public health interventions to attain our health-related Millennium Development Goals.

Through KP, we denounce unnecessary illnesses and deaths. Our humanity demands that we not stand idly by as our countrymen suffer otherwise preventable and treatable ailments. Filipino families must likewise be shielded from needlessly spending on healthcare.

Through KP, we have endeavored to enroll such families into PhilHealth so that they may have a fighting chance against illness and its financially debilitating effects. Through full subsidy of the National Government, the 5.2 million poorest families, identified by the DSWD’s National Household Targeting System, were enrolled this year. These are the same families who have been previously left out and have been unable to receive benefits from PhilHealth.

To better serve its newest NHTS-PR members, PhilHealth is putting into effect much needed reforms. Last September, the new Case Rates Scheme was implemented, providing for blanket rates for 23 most common conditions and procedures.  This allows us to implement the no balance billing scheme or walang dagdag bayad for the poorest members of PhilHealth. I am aware of the concerns in this Case Rate scheme; trust that we are addressing them because we want to make this work.

We are also aware that even middle-class families are not covered by PhilHealth, and some of them run the risk of being thrown into poverty should they fall into the grips of catastrophic illnesses such as cancer, acute cardiac events, end-stage renal diseases and the like. The tremendous costs of these illnesses are economically debilitating to any family. This is exactly why we are working for a Catastrophic Care Fund which will augment the expenses for such illnesses.

There is an ongoing nationwide effort to rehabilitate and upgrade rural health units, hospitals, and all other government health facilities, in line with KP’s second strategic thrust. Our goal is to have as many of these health facilities to provide better health services, so that the poorest families would be able to access quality and affordable healthcare. We have considered the fact that most of our poor run to government-run health facilities in their time of need.

Upgrading health facilities is no mean feat. While we would like to achieve so much more, we are usually left to the mercy of our coffers. To get past this bump, we are tapping into resources from the private sector through Public-Private Partnerships or PPPs to facilitate the enhancement of our government hospitals. The flagship programs of our PPPs include the upgrading of the Philippine Orthopedic Center and the 2nd phase of the Vaccine Self Sufficiency Program. PPPs offer us great advantages; however we realize that these are not simple arrangements, and thereby we must exercise necessary caution. With this in mind, we have established a PPP unit within the DOH, to take due diligence in our PPP undertakings. I can safely say that the Philippines is ready for PPPs in health.

While health facilities are important in providing access to quality healthcare, we must consider other requisites such as the availability of medicine for treatment. To address this concern, we are undertaking to make DOH Complete Treatment Packs or DOH ComPacks available in health centers of over 1,000 of the poorest municipalities. This is to ensure their access to quality medicines for infections and some non-communicable diseases such as hypertension and diabetes.

Another requirement is the availability of health care providers themselves. All the best infrastructure and all the best equipment with all be futile if there would be no health professionals to man them. They would all be useless pieces of junk if we would have no nurses, physicians and specialists, such as surgeons.

In order to fully address the healthcare gap, we must therefore invest in health human resources. To this end, we have deployed close to 10,000 nurses in the past 9 months through our RNheals Program. We are currently deploying another 11,500 to DOH Retained hospitals and other hospitals. This year saw us send out the biggest batch of Doctors to the Barrios. 73 physicians were deployed to doctor-less and underserved communities in the country.

To meet our MDG goals, we have rolled out our Community Health Teams or CHTs whose primary task is to work directly with the poorest families, assist them in determining their health needs, and help them navigate through the ins and outs of PhilHealth benefit availment. By the end of the year, we expect to have over 40,000 CHTs deployed and fighting.

These are our achievements and plans so far. The tasks at hand seem daunting. But we have set for ourselves feasible and doable targets. While we once in a while pause to rejoice with our successes, we also continuously reflect on how we can better deliver.

One of the most important lessons I’ve learned from my experience for the past 1 ½ years is that you do not necessarily have to jump every hurdle, you may go around them, under, whichever way you want to get pass through them. The universe is replete with options; you need only to have enough guts and creativity.

What I am driving at is this: given our constraints, we must find new ways to maximize whatever resource we can hold of. Just like what I have mentioned earlier, the inadequacy of our budget has allowed us to craft PPPs for health.

At the heart of our efforts towards KP are health professionals – that includes us physicians, us surgeons. The success of KP depends largely on the availability of health professionals which can deliver the healthcare services most needed by our countrymen. That there are not enough midwives, nutritionists, dentists, nurses, physicians, specialists, should not deter us. If anything it is a license for ingenuity and imagination.

Globally, the developments in the medical field have been characterized by the decreased reliance on physicians and specialists in dispensing uncomplicated health services. In other countries, some of these simple tasks are not even done by physicians but by nurses or medical-aides, as they are usually referred to. I am talking about nurse anesthetists, physician assistants. Perhaps, it is high time that open our doors to these types of health professionals and to allow them to carry what physicians usually do in practice, particularly in areas that do not even have medical professionals who can perform basic yet essential medical procedures. 

In the same vein, I am also of putting forward the idea of perhaps the Philippine College of Surgeons and perhaps other specialty societies partnering with the Philippine Association of Medical Specialists and other organizations for sharing technology and expertise. My suggestion is that we allow them to be our associates or auxiliaries. As such, they will be encouraged to serve our level 1 and level 2 hospitals in the communities. Having at least one associate in every first and second level hospital will significantly improve health outcomes in their respective catchment areas.

The Department of Health would like to see how this hardly recognized and utilized pool of professional expertise can be tapped. To this end, I am asking for the support and partnership of the private sector. We are brainstorming on how we can operationalize this and I highly encourage you to sound off your ideas and insights. Our efforts will have much more impact and will bring in bigger successes with your participation. 

Of course, this does not mean that fellows of the Philippine College of Surgeons are not welcome to serve in far flung areas. I understand that tomorrow we will be signing a memorandum of agreement to provide assistance to Coron District Hospital to provide basic surgical care. This initiative is very welcome and is consistent with our goal.

I have always believed that doctors are called upon to serve their fellowmen. While I think that the essence of our profession is service, I also recognize that we have needs and that we should be justly rewarded for our expertise. Through the reforms in PhilHealth that we are pursuing, there will be adequate incentives for us to serve in areas that remain underserved.

I would like seize this opportunity to express my gratitude to the Philippine Board of Surgery for having me here. It is an honor to speak before my colleagues who take it upon themselves to continue the legacy of excellence. The pains you have taken to train more competent and skilled surgeons ultimately redound to the benefit of our countrymen. You have unwittingly taken on to improve the health status of our people one patient at a time.

Again, thank you for your unending support and confidence. I am positive that with all your help, our goal of Kalusugan Pangkalahatan will be close at hand. Our dream of a healthy and productive nation will eventually be realized.

Thank you and good evening.