Chronically ailing PH public health system under Duterte

April 7, 2022

by Maricar R. Piedad

World Health Day 2022 finds the globe struggling to heal from the coronavirus pandemic, while the Philippine government goes about its usual business of catering to big corporate and elitist interests over attending to its people’s health needs.

The Duterte administration severely neglected the public health system of the country. In the past six years, the government has not taken significant measures that will strengthen the public health system and make health services accessible and equitable to the Filipino people. Aside from the already widespread privatization of health and devolution of public hospitals in the country, President Duterte took several steps that pushed the public health system further into collapse.

Below are six ways in which the Duterte administration neglected the country’s public health system:

First, Duterte’s health sector budget remains low and misallocated. Every year, the budget share of the health sector is much lower compared to the country’s military and infrastructure budget. For 2022, the Department of Public Works and Highways (DPWH) got 15.7% or Php786.6 billion while the Department of National Defense (DND) got 4.4% or Php220.9 billion of the country’s Php5.024 trillion national budget. Meanwhile, the health budget comprised of the allocation for the Philippine Health Insurance System (PhilHealth) and the Department of Health (DOH) is only slightly higher than that of defense at Php236.4 billion or 4.7% of the total budget.

A large portion of this small budget for health goes to social health insurance and not to direct health services such as the operational budget of several government hospitals and laboratories. For 2022, 30% or Php79.9 billion of the total health budget goes to PhilHealth and the remaining 70% or Php183.4 billion goes to the DOH. Of the total DOH budget, only Php55 billion is allocated for the operation of DOH hospitals and other regional health facilities, national laboratories, and blood centers.

Second, despite the Duterte administration’s focus on infrastructure projects, there is a glaring lack of health infrastructure built. Only four out of 112 of the administration’s Infrastructure Flagship Projects (IFPs) are dedicated to the health sector, compared to 76 projects dedicated to transport and mobility. The budget for these four health IFPs is only Php46.4 billion or 0.99% of the Php 4,687.2 billion total worth of IFPs. This is despite the urgent need to expand the current public health infrastructure.  As it is, even the most basic Barangay Health Station (BHS) is not available for every Filipino since only 49% of the country’s barangays have one. Additionally, not even all BHS can give basic health services because many of them still sorely lack basic equipment and healthcare personnel.

Third, Filipino healthcare workers remain overworked and underpaid in their own country. Among their biggest issues are low wages and benefits. For example, the entry level salary for a public nurse in the country ranges from Php22,000 to Php23,500 while for a public medical technologist it could be from Php25,000 to Php27,000. A 2020 study stated that healthcare workers in the Philippines are among the lowest paid across Southeast Asian nations. Filipino nurses earn 57% less than their counterparts in Vietnam and 486% less than nurses in Singapore. The dire situation of low wages among health workers in the country pushes scores of Filipinos to accept job opportunities abroad.

Even in the middle of the pandemic, medical front liners were still paid dust compared to the huge service that they have rendered to the Filipino people during the crisis. Filipino health workers called the national government out for its slow disbursement of their risk allowance—which is actually miniscule compared to the needs of healthcare workers to begin with.

The government is also not hiring enough health workers despite the huge need, especially in the country’s far-flung areas. According to latest DOH data, there is a total of 190,367 human resources for health (HRH) in the country that serves the 109-million Filipino population. The ratio of HRH to population is 17.45:10,000, which falls below the 23:10,000 of the World Health Organization (WHO). Health workers are also unevenly distributed across the country: 39,086 or 21% of the total hired HRH serve the National Capital Region (NCR); this is almost equivalent to the total number of HRH serving the whole island of Mindanao.

Fourth, the Universal Health Care Law fails to address the need to strengthen the public health system. The only achievement that it can claim is the wider population coverage of health insurance, but this does not translate to more Filipinos having access to basic health services. Among the financing agents, the majority of the country’s total health expenditure (THE) in the year 2020 still came from household expenses – 44.7% or Php400.1 billion of THE still came from the pockets of the Filipino people. Meanwhile, the contribution of the social health insurance corporation or PhilHealth continuously decreased despite the annual increase of its budget and premium contributions. For 2020, PhilHealth’s contribution to THE is only 14.9% or Php133.2 billion. This is despite more Filipinos seeking medical care because of the COVID-19 pandemic. PhilHealth’s share in 2020 was lower compared to their THE share of 17.8% in 2019 and 16.6% in 2018.

Fifth, the Duterte administration hypes PhilHealth as a solution to the worsening inaccessibility of healthcare services to the Filipino masses. But PhilHealth, which only serves as a purchaser of health services, does not in any way strengthen the country’s public health system. For many years PhilHealth showed its inefficiency as a social health insurance corporation. In 2021, the corporation boasted of giving coverage to 98 million Filipinos, but their data showed that in the same year, only 10.4 million claims were paid. Of this amount, 8 million claims were non-COVID related while 2.4 million claims were COVID-19 related. It is also remarkable that in the middle of the COVID-19 pandemic, the health insurance corporation was caught in a Php15-billion corruption issue that resulted in the resignation of former PhilHealth President Ricardo Morales.

It has also been harder for Filipinos with non-covid diseases to go to the hospital because of the additional cost of testing and the risk of getting COVID-19 when they get admitted. In fact, COVID or no COVID, the increasingly privatized Philippine health system has been charging roughly three times as much as in public hospitals, making health care unaffordable to millions of low-income Filipino households.

Lastly, the Duterte administration’s poor and inefficient COVID-19 pandemic response undermined not only the overall well-being of the Filipino people but also the country’s healthcare system. The heavily militaristic approach led to several human rights abuses and was also ineffective in battling the novel coronavirus disease. Despite the country implementing among the longest and harshest lockdowns in the world, severe COVID transmission still happened and resulted in the death of 59,422 Filipinos.

President Duterte and his team have been touting the administration’s so-called legacies that purportedly bettered Filipinos’ lives. But this government has only abandoned the public health system. Duterte’s health legacy will be that of ultimate neglect of the health sector, especially in the time of the worst pandemic that the world has ever faced. ###