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Speech of Sec. Enrique T. Ona on the League of Municipalities of the Philippines General Assembly

December 5, 2012


League of Municipality of the Philippines (LMP) National President Hon. Donato D. Marcos, LMP Secretary General, Hon. Joel Jaime P. Payumo, Lmp Executive Director Ms. Liann M. De Leon, all member municipalities in the country represented by the municipal mayors, LMP partner stakeholders, guests, ladies and gentlemen, good afternoon!

I am delighted to be with this afternoon,ourchampions in our health system reform.This gathering re-affirms our combined conviction that health is a shared responsibility of the national and local governments.

Kalusugan Pangkalahatan or Universal Health Care is the Aquino administration’s health agenda to ensure that all Filipinos, particularly the poor, are: 1- able to use high quality health services at affordable cost, by being enrolled in our National Health Insurance Program or Philhealth, 2- cared for in modern health care facilities through the modernization of our hospitals and other health facilities and improved health human resources, and 3- prevented from being ill by strengthening the preventive and promotive health care services.This will improve our health outcomes such as attaining health-related Millenium Development Goals of reducing infant, child and maternal mortality and morbidity and other infectious diseases.

We are almost on the third year of KP implementation. You may ask, “where do we stand today, are we on track?”

Perhaps it is best for me to talk about what we have done in the two years of KalusuganPangkalahatan, and see how these measures impact on your municipal health systems and what we in the DOH and you have to do to ensure that our joint efforts and objectives are met.

Before 2010, the national and local governments shared in the cost of enrolling indigents into the sponsored program of Philhealth. This practice was fraught with several problems, such as the inclusion of the “political poor” often at the expense of real poor and the inability of many 5th and 6th class municipalities to come up with their share of the premiums, resulting in most indigents not being enrolled to Philhealth.  A telling finding is that in 2010, out of the 4.7 million families enrolled in the Philhealth’s Sponsored Program, only about 950, 000 belong to the National Household Targeting System (or NHTS), the database for the poorest Filipino families. Why are most of the supposedly poorest families not enrolled all these years?

The Aquino administration has now enrolled automatically to Philhealth the 5.2 million poorest families under the NHTS, using full government funds.  These families, considered as Q1 or the poorest 20% of the population, earn about P 3, 500.00 or less per family per month.  From P 3.5 billion in 2011, the premium subsidies for these poorest families reached P12.5 billion this year, reflecting the increase in the premium per family from P 100.00 per month to P 200.00 or from P 1,200.00 to P 2,400.00 annually.  We hope with the passage of the Sin Tax, soon we will be able to cover the next poorest 20% families, or Q2, an additional 5.6 million families. 

These families, neglected through the years, are now afforded financial risk protection. They are now entitled to no- balance billing (NBB) orwalangdagdagbayadwhen admitted to government hospitals for aninitial 23 medical and surgical conditions, which comprise 70% of all hospital admissions in a year. They can also avail of the primary care benefits, such as physical examination, certain diagnostic procedure and medicines for selected illnesses, in rural health units and selected district hospitals. We launched in July of this year theType Z BENEFIT PACKAGEfor the so calledcatastrophic cases, diseases that wrack havoc on one’s physical and financial health.  For now, we arecovering cancers of the breast and prostate, childhood leukemias, and kidney transplantation.

Over the years, the Department of Health has funded the repair, rehabilitation and upgrading of health facilities.  From P 500 million in 2007, we have significantly increased the budget of the Health Facilities Enhancement Program (or HFEP) to P 5.1 billion this year.  We also have another P 3 billion for the modernization of 26 identified national and local government hospitals under the public- private partnership program.

In 2013, we will be allocating P 13.55 billion for HFEP to fund the infrastructure and equipment needs of 541Barangay Health Stations (BHS), 1, 635 Rural Health Units (RHUs), 220 Municipal and District Hospitals, 24 Provincial Hospitals and 66 DOH health facilities.

With strengthened public health services, such as the deployment of Community Health Teams, RN HEALS and the introduction of new vaccines like pneumococcal and rotavirus vaccines for our children, we will meet our health- related Millenium Development Goals of reducing infant, child and maternal mortality. By the end of this year, we will be hiring 32 more doctors to the barrios to add to the 112 physicians we have already deployed earlier this year. By then, we will be able to declare that there will be no more “doctorless municipalities” in our country.

How do these reform measures impact the municipal health system?

Our reforms under KalusuganPangkalahatanare meant, among others, to ensure that our municipal health systems are sustainable and capable of providing quality affordable health services to your constituents. Let me explain this in more detail.

With your constituents enrolled to Philhealth with improved and expanded benefits, and your rural health units and municipal hospitals upgraded and accredited to Philhealth through the Health Facilities Enhancement Program, your health system has potential to be financially sustainable. Philhealth will provide the income stream, paying for health services of your people, which in the past were considered “free” but are actually paid for by limited national and local government subsidy. Income from Philhealth, if used properly, can improve your health facilities, pay for additional benefits of your health workers, hire additional doctors, nurses and other health care professionals, and purchase additional medicines and other supplies.

Herein lie the challenges of making the reforms for KalusuganPangkalahatan work in your respective jurisdiction.

Enrolling the poor to Philhealth is not enough. They must be informed that they are enrolled, that they know what their benefits are and how they can avail of such.  While Philhealth has been reporting a nationwide 85% coverage rate, every time I visit a government hospital, the hospital chief reports Philhealth coverage rates of 20- 30%. The disparity in statistics has to change. You, the municipal government, working with DOH, Philhealth and DSWD, must exert all efforts for information dissemination efforts to ensure that everyone especially the NHTS families, is aware of their Philhealth membership and entitlements.

We are encountering difficulties in the implementation of our Health Facilities Enhancement Program (HFEP). There are delays in bidding, procurement and utilization of HFEP funds.  But the ultimate question is the functionality and long- term sustainability of barangay health stations, rural health units and municipal hospitals.

The Health Facilities Enhancement Program must not be seen as a dole out of the national government, but rather as an opportunity for partnership between the national and local governments.  The municipal government must ensure that competent health workers man the RHUs and hospitals, and sufficient funds for maintenance and operations must be allotted. This is your rightful counterpart in making these facilities functional and viable.

Your earnings from Philhealth will be better utilized if each municipality will establish a health trust fund that will be used exclusively for health purposes. This trust fund must be accompanied by fiscal autonomy with income retention for your health facilities. Maximizing your income form Philhealth and ensuring that this is used solely for health purposes will immensely help you in sustaining your health system.

The issue of fragmentation of health services due in part to municipal health systems autonomous of the province, and provincial health systems autonomous of the DOH regional offices, is a reality we face. This fragmentation is evident even in the way health facilities are planned and built.  In a visit to Ozamis City last year, I inaugurated a rural health unit in a nearby town.  Upon touring the vicinity, I came to discover a district hospital needing assistance located less than 100 meters aways, almost literally a stone throw’s away from the RHU.

Even with devolution, I always stress that the ODH must asser its supervisory and regulatory powers as the national health agency. At the same time, the ODH and the local health systems must find effective ways of working together given political realities on the ground to ensure that our health service delivery network is functional.

It has been 21 years since the Local Government Code, mandating the devolution of health services to the local government, was enacted. The sin tax reform bill is already in the bicameral conference committee and will be signed into law before the end of the year. This measure will guarantee 85% of P 40- 45 billion annually for health. Given the realities of fragmentation of health services and other inefficiencies through the years, there are doubts whether our health care system has the so- called “absorptive capacity” for these additional funds. The expected infusion of funds from the sin tax reform bill highlights the need for us to revisit our devolved system. 

I have the sense that limiting devolution to the provinces and putting the municipal health systems under the provincial government is a better alternative to what we have at present.  This consolidation can address fragmentation and ensure viability, sustainability and reasonable economies of scale. But this proposal, or other proposals for reforming devolution, must be supported by evidence.

You, our leaders in the municipal health systems, are in a good position to advise us how best to go forward.

The developments of the past two years in the health sector point to a brighter and more robust future as far as health is concerned, we have a President and an administration committed to significantly improve the health of our people. KalusuganPangkalahatan  is the game changer we have long needed.

Let us work together and seize this opportunity to make the promise of accessible, affordable, and quality health care a reality for all our people.

Thank you and good afternoon and Mabuhay tayong lahat!