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Speech of Sec. Enrique T. Ona 60th Annual Conference and Exhibit of the Association of Municipal Health Officers of the Philippines (AMHOP)

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DATE: 
April 10, 2013

 9:00    AM    |   Oriental Hotel, Palo, Leyte

Let me begin by conveying my sincere thanks to all of you, our partners from the Association of Municipal Health Officers in the Philippines for inviting me as your keynote speaker for your 60th Annual Convention.  I know that this convention will provide a unique opportunity to share perspectives and dialogue on the inter-related themes, which will define our partnership and commitment to achieve Universal Health Care for all Filipinos. 

The Philippines is witnessing a considerable progress in its pursuit of achieving Universal Health Care in spite of daunting challenges. Undoubtedly, the Philippine health sector is changing rapidly and for good. And part of the change comes from your dedication and commitment, my fellow and dear Municipal Health Officers.

Alam ho ninyo, my father was also a municipal health officer, my mother was a puericulture center nurse and he was the first provincial health officer of Zamboanga del Sur. So there were times when during the early years, I was with him to inspect some of those rural areas that they were supposed to. And during that time, it was indeed very rural.

Well, after three years at the helm of the Department of Health, we are halfway to fulfilling the promise that no Filipino will ever die without seeing a health professional or health worker. And midway to KP implementation, you may ask, “Is Universal Health Care within reach?”  

Well, at the beginning of this administration, meaning, the Aquino administration, the estimated Philippine population was about 20 million families with an average of five members each. And public health services such as prenatal care, immunization, and family planning, were hardly accessible to about almost  4 million poor families or more than a sixth of our population.

Moreover, 5 million poor Filipino families, that is a quarter of our population, did not have any form of health insurance. These are the very poor Filipino families who were overlooked. Owing to their unfortunate circumstances, they are more susceptible to illnesses and indeed fall ill more often, and yet they are also those with the least resources, if any, to spend on their health.

The sad reality was that around, and this study is something I want to confirm,  30 – 40 % before this administration, sick Filipinos die without ever seeing a health professional. To many Filipinos then, good health seemed illusory; it was practically unattainable due to their physical and economic limitations.                                          

It was against this backdrop that we adopted the current health reform agenda which we have dubbed as KalusuganPangkahalatan or Universal Health Care. And in fact, the unfortunate circumstances I have just narrated have directly moulded and inspired our blueprint. With the realization that it is our less fortunate countrymen who have more at stake in the perennial problems in our health sector, we have devised an approach which focuses first and foremost on our poorest countrymen and these are what we call the Q1 or lowest quintile or 20% and quintile 2. And I am made to understand based on a study in 2008 -2009 that these 5.2 million poorest Filipino families earn less than P 3,500.00 per month per family.So isipin niyo iyon, and these are really what we call the poorest. Unfortunately, they were the ones who were overlooked despite the fact that PhilHealth in 1995 mandated that all Filipinos within 15 years should have been enrolled to PhilHealth.

Our reforms today are anchored on the three pillars of KalusuganPangkalahatan, which, among others, first, includes the expansion of the National Health Insurance Program, both in coverage and benefit delivery; second, the improvement of access to quality health care facilities and services; and thirdly, the attainment of health- related Millennium Development Goals. And I may add the fourth one, which is just as important, for without the improved IT (information technology), I don’t think  we will be able to achieve the three others I earlier mentioned.

The implementation of the government’s policy of KP, in terms of financial risk protection, is reaching wider and more inclusive of the poor as reflected in the increased Philhealth enrolment, from 70 million Filipinos in 2010 to about 82.4 million Filipinos as of this date. Through this full national subsidy, these sponsored families enjoy attendant benefits and privileges in our government health facilities without hopefully paying even a single centavo in our program of no-balance billing and soon we intend to expand from the 23 most commonly diseases and hopefully include or encompass all of those for our Sponsored Program. I’m sure that you are also familiar or have heard that PhilHealth has started the Z benefit package to include selected catastrophic diseases which initially included lymphocytic leukemia, breast cancer, prostate cancer and even kidney transplantation. Hopefully and very very soon, this Z package (we call it Z for this is the last letter of our alphabet, meaning it is serious and will kill you). These are the very serious and expensive diseases. However, we have to be careful with our actuarial computation to make sure that we do not bankrupt PhilHealth as we expand its services.

Further, the licensing and accreditation requirements of DOH and PhilHealthis now unified, so that once a health facility is licensed by DOH, it will automatically become an accredited provider of PhilHealth.And, I just received a report that the accredited facilities, at least in this region, have improved tremendously. At the same time, we are about to launch what we call the Philhealth Rapid Enrollment program which will enroll these poor families who otherwise may not know, or either not yet enrolled, or may not have been included in the data of DSWD, and make they are given the services that they are entitled to.

With regards to improving access to quality health care facilities and services, from 2010 to 2012, the upgrading and rehabilitation of 3,576 health facilities are either ongoing or have been completed; of these, 29% of which are hospitals, 42% are your rural health units (RHUs) and the rest are barangay health stations (BHS).These improvements and new establishments amounted to P16 billion. But we will be doing more, because as of today, about 2,487 health facilities are in the pipeline either for construction or improvements, which will amount to P13.5 billion for 2013.

Our health facilities enhancement program, or HFEP, seeks, among others, to ensure that an effective health service delivery network is in place in your communities. I issued an administrative order whichmandates that for a health facility to qualify as a hospital, it must have, at the minimum, a functioning operating room ready for what I call emergency operations such as caesarian sections, appendectomies, some chest tube insertions for those with trauma and other emergency surgical procedures. A rapid survey last year revealed that out of our almost 350 district hospitals, more than half have no operating rooms! We are now correcting this anomaly thorough our HFEP program. Using our savings since 2011, hospital equipment such as CT scans, X-rays, beds, laboratory equipment, dental chairs, and others, have been purchased and distributed and I am sure that some of your health facilities have been recipients of these. And to help our health workers diagnose early, especially on high-risk pregnancies, we would like to start training some, if not most of you, in using portable ultrasound machines.

 

The so-called geographically isolated and disadvantaged areas have special needs that the Department of Health is now addressing. Specifically for island communities, we are developing a sea ambulance capable of providing emergent care and transport of patients to the mainland for further treatment. For example, we are equipping a dozen ambulatory bus clinics to help you cope with the difficulties in your areas.

At the same time, we have identified 38 DOH retained hospitals for modernization through various strategies including public private partnerships. The preparation for the bidding of 9 cancer centers, and 8 centers that can do heart operations and even transplants, strategically located, are now ongoing.  The DOH has the Center for Excellence in Public Private Partnership in Health, and as a matter of fact,this center has been recognized by the United Nations Economic Commission for Europe to help us in this program and strategy. We hope that with these projects, more Filipinos, especially from the provinces, will be able to access quality care heretofore only available in Metro Manila or Metro Cebu.

We are also implementing several strategies to address the gaps in our human health resources. This will ensure that the health facilities that are now being upgrading remain functional and not transformed into so-called white elephants. Nurses are now being trained to become nurse anesthetists, to supply this need, especially in our district hospitals, of course, to be supervised by anesthesiologists, for deployment. With the Philippine Academy of Family Physicians, all DOH regional medical centers will now offer residency training in family medicine. We are studying how our Doctors to the Barrios, as well as interested municipal health officers and physicians working in LGU health facilities can participate (and you should participate)in this training program. As a matter of fact, severaldoctors now of Davao Oriental Provincial Hospital are now part of the residency training program in family medicine under the Davao Regional Hospital.

We recognize in the department that due in part to a devolved system with autonomous local governments, we are having difficulties in the implementation of our Health Facilities Enhancement Program (HFEP). There are delays in bidding, procurement and ultimately, utilization of HFEP funds. But I can tell you we have to do more because for the first time today, in our history, we have a president that is so committed to making sure that we are able to use the funds he has allocated efficiently, economically, but at the same time he promised that if we are able to achieve it as fast as we can, that he will even give more. Saan pa tayo nakakita ng presidente na tayo ngang pinipilit na bilisan natin ang ating ginagawa o ang ating dapat gawin?

And particularlywith the passage of sin tax, our funding, I am sure will continue to grow quite respectably.  And that’s why we have todiscuss with you the prioritization of funds that will be generated by this sin tax. And that is why I would like to ask both Governor Bagulaya and Mayor Petilla to identify kung sinoungnaisamanasa NHTS program and those who are truly poor but have not yet been included, for those should be the families included with the expansion of PhilHealth coverage with the coming of the sin tax.

Well, the commitments and initiatives are vital to the achievement of KP. But we have to be very certain about the quality of services that are being given by our RHUs with birthing facilities and district, city and provincial hospitals  because they will be our first and foremost partners in reducing maternal mortality and that can be achieved only if we have a program wherein referral system is flowing seamlessly and services are available. At the same time, sigurowag natingkalimutan, that we are going to be judged by our MDG targets when 2016 comes along, and that will be how we are going to be graded how not only by the President but even by the international community.

For example, maternal mortality ratios estimated at 95- 163 deaths per 100,000 live births based on a study conducted in 2010. Sabi, it increased dawto 221.Talagabang iyonangtotoongmaternal mortality ratio natin?And that’s the reason why in every region I visit, that’s the first thing that I ask: What is the maternal mortality of this region, province, or maybe even the particular community. And I know that the municipal health officers, kayo, are really in the forefront of this work, whether we will be able to indeed reduce it to around 50 maternal deaths per 100,000 live births. Let me just give you an example: Turkey. They have been able to reduce it to somewhat like 15 maternal deaths. Now, with this more than 100 for the Philippines, angtanongkosainyo, mga municipal health officers, sainyo, kaya banatinito? Talaga? Parangmahina…kaya banatinito? Thank you.

While the country is on track in attaining the 2015 MDGs on child and infant mortality, unfortunately it is uneven as we go all over the country. As a matter of fact, in ARMM, I cant even determine kunganotalagang figuredoon. But things are also getting better there.

Well, one concrete action taken to meet our MDGs is the deployment of the community health teams, our doctors to the barrios, and our RN HEALS. You are actually in the best position, and I will keep asking you to inform us on the impact of our program, itongCHTs in our communities and to advise us how best to go forward. As a matter of fact, with the more than 609 (but this has been increased to almost 1,200) target communities, we would like to expand iyongtinatawagnaZuellig Family Foundation program of improved governance for our local communities and I would like to ask governor and mayor that these are the two programs that I think will improve tremendously the health situation kasiung program essentially of the Zuellig Family Foundation is handholding – governance assistance to the local government, the rural health unit, barangay health station and the mayor.

Well, admittedly, after two years of implementing KalusuganPangkalahatan, we recognize that much has to be done. Many of our poor identified NHTS families have yet to be informed of their PhilHealth benefits. Although we claim that something like 85% of Filipinos are already enrolled, ibaung enrollment at ibanamanung whether they can access or whether they are aware of their benefits. That is the challenge that we have to face today. How do we inform, or how do we make sure that indeed, the poorest of the poor (ang common cliché nanatin) are covered by PhilHealth or are able to access or whether they know the benefits that they are entitled to. So we need to bridge the gap between PhilHealth’s report of 85% enrollment, something like I say baka 65% or 75% coverage, and yet when I go around hospitals and ask a particular…and I’m talking of government hospitals and ask whether that particular patient is enrolled to PhilHealth, angsinasagotnila ayis less than 30%. So there is so much, there is a very, very significant gapbetween what we claim that the poor are being covered or have access, but indeed when you ask them at the so-called point of care, they are either not covered or they don’t know.

We earnestly ask your help in the expansion of PhilHealth membership in your municipalities. May you help us in two things (angakinghinihingisainyo): 1- to explain to your local chief executives that enrolling more people to PhilHealth will translate to increased revenue for the local government units; which can be used to make improvements on your health facilities or purchase necessary equipment, medicines and supplies. An example of this is the Petilla model which allows doctors to be paid P 40,000-120,000.00 per month. and 2- to inform the beneficiaries of their PhilHealth benefits.

I have always mentioned that the cornerstone of universal health care is a strong social health insurance system that will ensure steady financing for the health sector. And I use steady financing, which is not dependent on whether there is an approaching election. Understanding PhilHealthis critical to guarantee the fiscal sustainability of our health system.

These are some of our significant accomplishments for the past two and a half years. I admit that there is much to be done, but our incremental successes – each new health facility constructed or renovated, each new equipment given to a hospital, each family we have been able to enroll in PhilHealth, each life we have changed for the better – all these should inspire us to do more and to intensify our efforts. Each of these little victories makes us realize that we are indeed moving towards our goal of KalusuganPangkalahatan. And I made sure that I will be with you today because I know very well that as a partner, you are at the forefront of our major reforms. Well, before I end, I was looking at your program. Maybe one thing I would want to ask you is for the society to come up with a position paper on the devolution of health care. The devolution of health care is more than 30 years old and even discussing this with Senator Pimentel, the elder,sabinganiya it is time to take a look at it because all those changes where proposed then are not etched in stone. If there are some modifications to make it better, he is very open to that. And I have been going around and of course, understanding the nuances of the devolution, it was practiced in provinces, I find so many individual modifications. And I think one has to look at it and see how we can maybe modify and improve on it. So I think,if there is something I would like to get from you it is this position paper after this convention.

The Department of Health needs everyone who is willing to lend a hand in our push to provide healthcare for all our countrymen. But with more of us joining our hands together, I don’t see any reason why within the next couple of years within the term of President Aquino, we should not be able to achieve what truly universal health care means, which is access to reasonable and affordable care for all Filipinos, not only those who can afford but those who can barely afford and especially those who have nothing in their pockets. Ultimately, all of these this will benefit the Filipino people you are taking care of.

For that, I would like to thank all of you for all the work that you have been doing, for all the sacrifices that you have given, because at the end of the day, this what we are all here for.