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March 20, 2016

Health As A Platform: What I Want the Next President to Focus On

I am currently waiting for the second Presidential debate, I am thinking of how the next Administration should address the health challenges of the country. The facts are clear, our country still has to really achieve high performance in Immunization coverage, improve services in maternal and child health and address access to safe drinking water and sanitation. So, if given the choice, based on my experience as a former Doctor to the Barrios and working with more than 72 local government units and their municipal health offices, I want the next President to focus on the following items, from the most immediate to long-term:
1. Genuine Universal Health Care - the keyword here is genuine. The Aquino administration pushed for Kalusugang Pangkahalatan and although there have been gains it is not really Universal as what the current administration would like to believe. Universal Healthcare implies basic and essential health services are made available for everyone. And I mean everyone regardless of your economic class. For example, access to essential medicines should be made available not just to the "poorest of the poor", everyone should have access to these essential medicines made available in health centers. After all the middle class also contribute to Philhealth and through other taxes. There should be no consultation/medical fees in government hospitals for everyone. Sin Tax should be enough to cover major government medical centers and provide basic services. Why not download the money directly to these medical centers? In fact, National government must review the governance and relevance of Philhealth.
2. Focus on Preventive Health Care - more emphasis on preventive and promotive health care programs and interventions. Health Program should not be "hospital-centric" or just focus on "facilities" and "infrastructure". It is a given, infrastructure in some parts of the country is badly needed especially in GIDAs (Geographically Isolated and Disadvantaged Areas), but it should not stop there. Philhealth should start covering interventions that are preventive in nature. An example would be if a patient is diagnosed as hypertensive or diabetic in a rural health unit, he or she is enrolled in a registry wherein he or she undergoes regular monitoring by the Municipal Health Officer or Primary Health Care Physician. If patient is able to maintain BP or FBS within a normal range, in other words controlled hypertension and Diabetes, patient gets incentive as well as the doctor who ensures such. A patient enrolls in a Smoking Cessation Clinic, if patient was able to stop smoking over a period of time, he gets incentives as well as the smoking cessation clinic health worker. Philhealth pays for the incentives. If a mother was able to complete the immunization of her child on time, even if she is not a CCT beneficiary, she should get an incentive from PHilhealth, including the health worker assigned to her. Dental services as well.
3. Strict Evaluation of the Department of Health - program managers both at the National and Regional Offices should be evaluated based on outcomes and not just outputs. They should be evaluated based on the impact that their programs bring to the over-all health indicators of the country or the region. If they could not hit target within a specified time period, they should be replaced. THe government could not be lenient with its people working on the health of the citizens. Make DOH accountable for outcomes and improve the overall health information system. This is to ensure that DOH makes rational decisions based on timely and relevant data. In fact, you cannot be a program manager if you didn't have appropriate experience on the ground.
4. Review Medical Curriculum - As President he or she can give a directive to CHED/PRC to review existing medical and premedical curricula and redesign it to ensure that those who finish medical school and even nursing school should have a preference for public health and primary health care where most of the patients are found. We have too many specialists serving in urban centers where not so much of the health problems are found. The health problems are found in the rural areas, in the frontlines. The pyramid has to be inverted now. Government should make Public Health practice as the most lucrative in medical practice. This should encourage doctors and nurses to stay and serve in areas where their services are needed the most. Encourage other medical and allied health careers like midwives, medical technologists, etc.
5. Anchor other National agencies on Health - the President must understand that health is a complex issue that interventions should not just be "clinical" or "exclusively health related" to address the health issues. THere are many determinants of health that the government must consider. Like in the issue of nutrition, government must ensure access and availability of stable food sources that are nutritious and affordable. Access would entail construction of roads and markets closer to the people and exemption from taxes for organic and locally grown nutritious food. The most important factor is really access to safe drinking water. This would really require securing water sources and laying out the infrastructure that would deliver water from these sources to homes and communities.
6. Making Local Governments Accountable for the Health of their People - because delivery of health services is devolved to the local government units, National Government must make sure that these LGUs deliver health services to their people and it should have impact on the health indicators of their people. National government should engage local governments more especially in the planning and implementation of the programs. LGUs look at National Government as just "downloading" programs to them for implementation, even if at times these programs are not locally relevant or designed with the local context in mind.

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