The 2025 national budget is on the verge of approval, yet the ongoing shortage of essential health facilities remains a pressing issue that the government has failed to prioritize.
This lack of hospital capacity reflects the broader deficiencies in the country’s healthcare infrastructure and its inability to provide adequate care to millions of Filipinos, particularly the poor. This is especially concerning given the Marcos Jr. administration’s promise to deliver quality healthcare for all Filipinos.
It’s particularly ironic that, despite the severe shortages in essential health facilities, the government continues to pour vast sums into infrastructure projects. For 2025, the proposed allocation for infrastructure programs is Php1.5 trillion, or roughly 24% of the total national budget. But most of these funds are earmarked for transport projects that largely boost the profits of oligarchs and private businesses, or for pork barrel projects. A mere Php14.8 billion – less than 1% of the total – has been set aside for hospitals and health centers. It appears that the same mispriorities are maintained in the recently passed bicameral committee budget.
As a result, the public health system continues to struggle, operating with limited facilities, resources and technology. This scarcity disproportionately impacts the health and well-being of the country’s poor and low-income majority.
Depreciating health facilities
The latest health department statistics report more than 26,000 Barangay Health Stations (BHS) serving more than 42,000 barangays nationwide. The 2,642 Rural Health Units (RHU) that are currently operational are not that accessible and half of the population must travel 30 minutes or much more to get to the nearest RHU. There are around 1,300 hospitals but only 453 are government-owned while the remaining 847 are under private ownership. These scant facilities are expected to serve the estimated population of 115 million Filipinos.
The World Health Organization (WHO) Global Health Observatory meanwhile released a report showing the Philippines’ poor standing in terms of hospital bed density, with the country ranking 10th worst in Southeast Asia. The Philippines had only 9.6 beds per 10,000 people, trailing behind several countries in the region: Myanmar (10.6), Lao PDR (13.1), Indonesia (13.6), Malaysia (20.1), Thailand (23.4), Vietnam (25.5), and Singapore (26.5). Cambodia had the lowest bed density with just 7.4 beds per 10,000 people.
World Bank data also highlights the poor number of hospital beds in the Philippines compared to its Southeast Asia neighbors. The Philippines only has one hospital bed per 1,000 population – the second lowest after Cambodia with 0.7 hospital beds. Additionally, a cross-sectional study on Asia’s critical care bed capacity also showed that the Philippines only has 2.2 critical care beds per 100,000 population. This is much lower compared to Taiwan with 28.5 critical care beds, which is the highest in Asia, and Brunei Darussalam with 13.1 critical care beds, which is the highest in Southeast Asia.
The Philippines also ranked poorly in medical technology availability in the region. According to the Philippine Health Facility Development Plan 2020-2040, the country faces a shortage of essential medical equipment such as CT Scan and MRI machines. The Philippines has 4.3 CT Scan Machines per million population compared to Thailand (6), Malaysia (6.4), Brunei (7.2), and Singapore (8.9). Additionally, the Philippines only has 1 MRI machine per million people, while Brunei has 2.4, Malaysia 2.9, and Singapore 7.8. Another significant challenge is the uneven distribution of this equipment, with most machines concentrated in the highly urbanized regions of the National Capital Region (NCR) and CALABARZON. In contrast, poorer regions like BARMM and MIMAROPA have limited or no access to these critical resources.
Poor and middle-class families have gotten used to long lines and waiting hours just to avail of healthcare services in public hospitals. In cases of emergency, many Filipinos are compelled to seek services from private facilities despite their unaffordability. The average cost of inpatient care in private facilities was Php70,568 with only Php18,062 covered by social health insurance, according to the latest National Demographic and Health Survey (NDHS) 2022. The average cost in public facilities is one-third this at Php27,136.
The urban-centric public health system also hinders the Filipinos’ right to health. Most public hospitals are in the highly urbanized regions of the National Capital Region (NCR), Central Luzon, and CALABARZON. Poorer areas such as BARMM and the Zamboanga Peninsula have a smaller number of facilities.
The scarcity of healthcare facilities contributes to the high number of unattended deaths. More than half of recorded deaths happened at home and 48% of total deaths were unattended by any healthcare professionals.
These are long-standing issues with the public health system which the COVID-19 pandemic further aggravated. Yet the government has been turning a blind eye to this lack of health infrastructure.
Funds misused
The government might argue that the budget for health infrastructure has always been there. The centralized infrastructure funding of the public health sector, the Health Facilities Enhancement Program (HFEP), has been receiving a major chunk of the yearly health budget. HFEP received an average share of 13.8% of the Department of Health-Office of the Secretary (DOH-OSEC) budget from 2018 to 2024, with the highest share reached of 28.5% in 2018.
HFEP was first implemented in 2007 to augment the shortage of health infrastructure by funding the construction of basic health facilities such as BHS and RHUs. HFEP is also the central fund source for equipping public health facilities with vital technology and vehicles. Previously, government hospitals were each allotted infrastructure and capital outlay support in their budgets. But under HFEP, these line items were removed, and public hospitals have to request funds from the program.
All types of health facilities get their funding from HFEP. This includes funds for: the completion, upgrading, repair, equipping, and construction of new BHS, RHU or Super Health Centers (SHC), and polyclinics; infrastructure support for local government unit (LGU) and DOH hospitals, and other health facilities operated by the state universities, military and national police; and medical equipment and motor vehicles. Even the budget for the construction and rehabilitation of the DOH’s main and regional offices are in the HFEP.
The increased HFEP budget however does not necessarily translate to improving and developing basic health infrastructure. A deeper look into the HFEP breakdown shows that only a small amount of funds has been directed to basic health facilities. In 2024, only 2.5% of the HFEP fund was allocated for BHS, of which a mere 0.02% was for construction. Meanwhile, 12.4% went to RHUs, of which 5.9% went to construction and 2.4% to the rehabilitation of existing RHUs. Meanwhile, support for LGU hospitals was just 14.6 percent.
This system of pooling funds in one program to cater to several health facilities has been inefficient. Decades after its initial implementation, the Commission on Audit (COA) has consistently flagged the HFEP for problematic fund use in its reports on the DOH. Common issues include slow disbursement of funds and delayed or undelivered projects. There are also reports of misallocated or mismatched equipment delivery.
The agency’s 2020 audit report revealed that Php1.22 billion worth of equipment purchased under HFEP was found to be undelivered, unutilized, and/or without calibration and preventive maintenance. A disservice, considering that many hospitals lacked crucial equipment to treat Filipinos infected with COVID-19 during this time. That same year, Php2.83 billion worth of HFEP infrastructure projects were also declared idle or unutilized.
In 2021, the COA flagged several issues in the distribution of Php55.2 million worth of mobile X-ray machines for COVID-19 response. Three of these units were declined by the Research Institute for Tropical Medicine and Batanes General Hospital because of unavailable materials or incapacity to use such machines. Other units also went unutilized by the recipient hospitals due to similar issues. Additionally, one of the mobile X-ray machines was delivered to a private hospital that was not supposed to be among the beneficiaries.
The HFEP has had high obligation rates in the past years but its disbursement rates are concerning. In 2022, the obligation rate of the program was 85.2% but its disbursement rate was only 29.7 percent. This means that despite having planned projects, the HFEP funds for these were not spent effectively and on time.
Timely delivery of equipment and completion of health facilities are crucial to ensure that Filipinos promptly receive the needed and appropriate health services. Delaying these projects is a disfavor to the people who fund these through their taxes. Despite the failures of HFEP, the government seems adamant about maintaining this centralized funding mechanisms and has no plan on how to more effectively provide the infrastructure needs of the public health sector.
Health service commercialization
The government promised a “new dawn of healthcare” when the Universal Health Care (UHC) law was enacted five years ago. But since then, the UHC has only worsened the commercialization of the public health system, including the failure to promote the building of basic health facilities. Instead, the UHC institutionalized the Service Delivery Network (SDN) system.
SDN refers to the network or group of public and private health facilities and providers within a province or city-wide health system. Various types of health services from primary health care to curative health services such as emergency medical and even surgical interventions are facilitated through the SDN. Referral links to specialty and other health facilities may also be done through the SDN.
The SDN serves as the first direct contact of patients for their needed health interventions. Under this mechanism, basic public health facilities such as RHUs or SHCs can link patients to higher-level facilities depending on their health needs. This most likely means that Filipino patients across the country will be referred to private health facilities and providers because of the limited number of publicly owned health facilities.
This system however disincentivizes LGUs from increasing their infrastructure budget for health facilities because it becomes easier and more cost-efficient for them to just send patients to already operating private hospitals. The LGUs and PhilHealth, through its case rate packages, will just end up subsidizing the higher cost of private services.
With the UHC in place and intensifying privatized health care in the country, it is no wonder that the ills that plague the health system remain. The overall health framework, lack of resources, and poor system of spending through HFEP will result in poorer health outcomes.
The President’s promises to bring health services to the people are therefore all empty words. As long as the commodification and privatization of health services remain, health expenses will always be a huge burden for ordinary citizens.
