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July 17, 2010

Signs of A Bad Politician

I am no political science student. I am a doctor and had experience working for the local government as a municipal health officer. In the Philippine setting, the health system is a devolved system, which means, the local chief executive has the administrative role on how to run a local health system. Unfortunately, not all politicians are knowledgeable in the field of public health or medicine. Not all politicians are doctors. So, if you let a non-health professional run a health care system, expect that there can be lapses. Not all Local chief executives are poor health managers though. Some LCE's have become successful in running their health care system simply because they allowed the right health professionals to manage the health care system. But there are mayors and sometimes governors who feel that they are the very "kings" and "lords" of their towns and cities they dominate a field which they themselves are not sad to say capable of understanding, much more running it. There are bad politicians. There are good politicians. For a health care system that is destitute of reforms, we cannot afford to have bad politicians. So, I have made a list of "signs" that can tell one the local health care system will be going down the brink should these "little presidents" in their towns and cities continue to run their health care system their own stupid way:

You know you have a bad politician (when it comes to health management) when:
1. He approves purchases of medicines for his town but instead of keeping them in the pharmacy of the RHU, he keeps them in his house. (Ano, si Mayor...pharmacist na?) Again this fuels patronage politics. Besides, should hoarding medicines and storing them in "non-pharmacy" facilities be considered illegal? Only pharmacists should be legalized to dispense medications, not the politician.

2. He takes it upon himself to approve the use or not use of the ambulance of the municipality. (ano, si na?) Only the physician or nurse can decide whether a patient requires the need of the ambulance for transport to higher care. Again, another bad sign of political patronage. There are mayors who approve the use of the ambulance for patients who have voted for them and let others who didn't pay for the use of the ambulance. The mayor has no capacity to decide whether or not the ambulance must be deployed. If he so insist, then he should do the consulting of the patients instead of the doctor.

3. He hires unqualified personnel to work as part of the RHU staff. There are mayors who, to pay or return the favor, appoint unqualified personnel to the RHU staff. So, even if the personnel is not a licensed doctor, licensed nurse or licensed midwife, the LCE would hire them as contractuals or job orders and then assign them to the RHU to serve as "health attendants" or "assistants" or "clerks" or "utility personnel". While such functions are also essential to an RHU, shouldn't the LCE hire first those who are qualified? But there are LCE's who don't even want to hire a doctor simply because they do not want other professional more "capable" or "learned" than them to be working in the municipality.

4. He refuses to pay the benefits of the health workers, especially implement the Magna Carta for Public health workers. It is mandated by Philippine law that health workers should receive benefits such as "night differential pays", "hazard pays", "clothing allowances", "representation allowances/travel allowances" for departmental heads and other benefits. The law has been there for more than 10 years and yet there are still politicians, whose family has been there in power for more than 10 years, who refuse or ignore to implement this law.

5. He conducts more than frequent medical missions and believes that this is the only activity for his RHU to focus on. Medical missions can be beneficial but let's face it, this is nothing more than just another political ploy of bad politicians who think that primary health care is founded on just doing medical missions. It only brings fragrance to their rotten names and solicits some "pogi" points from their would-be voters for the next election. The job of the municipal health officer/rural health physician and other health workers goes beyond conducting medical missions. The mayor should start reading the Alma Ata Declaration of 1978. Oops, sorry, not so many mayors are even aware of such a document. (Nagmamarunong na naman ang iba dyan)

6. He doesn't even visit your RHU. A mayor or LCE who does not even visit his local health facility is not expected to run a facility effectively. How many mayors do drop by their RHU's OPD for a consultation? How many mayors would submit for a check-up at their TB DOTS center in case of a chronic cough? How many mayors would even have themselves admitted in their district or regional hospitals in case they are sick? Hypocrites. This is nothing more but sheer hypocrisy.

7. He enrolls indigents for PHILHEALTH (health insurance) but only those "indigents" who voted for him. It doesn't matter if the "indigent" is not a true indigent. What matters is those who are loyal to him and remain loyal to him will be benefited by his grace and mercy. Thus, while Philhealth and other municipalities boast of 100% coverage, at the grassroots level, those who are supposed to be covered are not 100% indigents, indigents who are in actual need of insurance or health care coverage.

There can be many variations but it all boils down to "political patronage". These LCE's don't care whether their health indicators would improve or not. All they care about is to win the next election. The people on the other hand, though they do desire better health outcomes, don't care if their politicians are bad or not. All they care about is, quite frankly and sadly, how much they can get in the next election when these politicians start buying off their votes.

Never mind if the RHU facility is dilapidated. Never mind if the RHU is lacking of personnel. Never mind if the municipality has been suffering from undernutrition or high maternal mortality ratios. Never mind if the municipality has low fully immunized children coverage. What matters for these mayors and bad politicians is their perpetuation in power and they feed upon the poverty and ignorance of their own people. So, to stay in power, they maintain the status quo of the economic status of their community so that their people will remain dependent on their graces. Thus, the continuing disparity between the rich and the poor.

It's funny that the ails of our society are reflected not on the economic indicators or our country but on the health indicators we project. After all, it is health that should be the foundation of every government activity. We build roads not only to access far-flung markets but to provide accessibility to health facilities in far-flung areas. We build schools not only to educate the young but to train them how to comprehend basic health care and hygiene and make sound decisions when it comes to their personal health. We provide electricity not only to ensure economic prosperity in small industries but also to sustain the functioning of a health facility that can serve these workers 24 hours a day 7 days a week without impedance. We ensure food security not only to instill agricultural progress for farmers but also to ensure good nutrition for our children and therefore ensure increase productivity. In other words, no matter where and how one sees it, Health is the tie that binds every knot in our society. Without health, education falls. Without health, agriculture falls. Without health, infrastructure and economy falls.

So, check if your Local Chief Executive is a bad politician when it comes to running a local health care system. Because if he cannot manage your local health system, he sure can't manage the others.

P.S. Bato-bato sa langit, ang matama-an sana dead kaagad at kunin na ni Lord.

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