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J Prev Med Public Health > Volume 55(3); 2022 > Article
Cordero: An Evaluation of the Philippine Healthcare System: Preparing for a Robust Public Health in the Future
Dear Editor,
In a recent systematic review article published in this journal, the authors explored the challenges on the road to universal health coverage (UHC) and conducted an in-depth analysis of viable solutions. They pointed out the importance of the 4 functions of health systems (stewardship, creating resources, financing, and delivering services) based on the World Health Organization’s (WHO) conceptual model [1]. This is indeed an essential study to determine whether a particular country is fulfilling the mandate for universal healthcare, where all its citizens are assured of access to healthcare. With this, let me assess the status of the Philippines concerning UHC, especially regarding the current coronavirus disease 2019 (COVID-19) pandemic. In this way, we can also determine which functions need improvement to prepare for a future health crisis.
A health system consists of all organizations, people, and actions whose primary intent is to promote, restore, or maintain health. Describing each function of the health system and exploring what the government has offered is the basic process of our assessment. Stewardship involves leadership and governance. It means that every government must have strategic policy frameworks, and these are combined with effective oversight, coalition building, regulation, attention to system design, and accountability [2]. In fairness to our government, President Rodrigo Duterte signed the Universal Health Care Bill into law last 2019, ushering in massive reforms in the health sector. Among the salient features of the UHC Law is the expansion of population, service, and financial coverage through an array of health system amendments. This is accompanied by a planned paradigm shift to primary care, which is the core and center of all health reforms under the UHC [3]. However, there was a lack of foresight among some leaders and an absence of accountability. The government was very late to impose travel restrictions and emergency measures. Duterte ordered a travel ban only for passengers coming from Wuhan, China specifically on January 31, a day after the first case of COVID-19 was confirmed in the country. This increased greatly the number of cases, which ballooned to almost 3.68 million as of March 30, 2022. Furthermore, as the country is experiencing the fangs of the pandemic, an investigation by the Senate between the Department of Health and Pharmally Pharmaceuticals Corporation, which involved up to 11 billion Philippine peso (PHP; 1 US dollar=52.00 PHP) worth of supply contracts for medical supplies in 2020, was proven to be anomalous.
In the second function, creating resource developments involves the presence of a well-performing health workforce, a well-functioning health information system, and a system that ensures equitable access to essential medical products, vaccines, and technologies of assured quality, safety, efficacy, and cost-effectiveness [2]. This area has proven to be very weak and neglected. Some nurses and other health professionals were treated as commodities when the country planned to offer these workers to take up jobs in Britain and Germany in exchange for vaccines. Scores of healthcare workers also protested several times to demand an end to what they called government neglect and unpaid benefits. How will these workers perform well with this kind of harsh treatment?
Financing pertains to adequate funds for health, ensuring that people can use the needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them [2]. There are adequate funds for health services since the government submitted a record 5.024-trillion PHP national budget for 2022 to Congress, with nearly 2 trillion PHP going to social services, including the pandemic response [4]. The problem lies in the mismanagement of this budget. The WHO has urged the mass production and use of testing kits as a basic necessity in combating the pandemic, but the government was very slow in approving the many applications of testing kit companies for immediate use. In the same way, the approved reverse transcription-polymerase chain reaction test, which costs 3800 PHP in public labs and 4500 PHP to 5000 PHP in private labs, is unaffordable for many. While other countries offer free tests, an ordinary Filipino needs to choose practically to buy first a meal for his family than this expensive test kit.
Lastly, delivering services means providing effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with a minimum waste of resources [2]. The uneven distribution of vaccines across regions may prevent the country from reaching its target of at least 70% of the total population by March 2022 and 90% by June 2022. The vaccination pace in most regions is too slow due to a lack of health workers and the absence of easily accessible primary health centers. Despite the recent availability of vaccines, efforts to get them quickly into peoples’ arms have fallen short [5].
In conclusion, the Philippine healthcare system needs an overhaul in terms of the 4 functions discussed. This is certainly one of the main reasons why herd immunity has not yet been attained and the country has reached almost 4 million COVID- 19 cases and counting. It is a sad reality, but by facing the truth, accepting it, and having a collaborative commitment to improve—both by the government and among the public—we will hopefully be more resilient and establish a robust public health system.

CONFLICT OF INTEREST

The author has no conflicts of interest associated with the material presented in this paper.

REFERENCES

1. Darrudi A, Ketabchi Khoonsari MH, Tajvar M. Challenges to achieving universal health coverage throughout the world: a systematic review. J Prev Med Public Health 2022;55(2):125-133.
crossref pmid pmc pdf
2. World Health Organization. Everybody’s business -- strengthening health systems to improve health outcomes: WHO’s framework for action. [cited 2022 Mar 30]. Available from: https://apps.who.int/iris/handle/10665/43918 .

3. Department of Health Republic of Philippines. UHC Implementing Rules and Regulations of the Universal Health Care Act (Republic Act (11223). [cited 2022 Mar 29]. Available from: https://doh.gov.ph/sites/default/files/health_magazine/UHC-IRR-signed.pdf .

4. Varcas M. Pandemic response still a budget priority. BusinessWorld. 2021. Aug. 18. [cited 2022 Mar 30]. Available from: https://www.bworldonline.com/pandemic-response-still-a-budget-priority/ .

5. Tomacruz S. What prevents swift COVID-19 vaccine deliveries to Philippines’ provinces? Rappler. 2022. Feb. 1. [cited 2022 Mar 30]. Available from: https://www.rappler.com/newsbreak/investigative/what-prevents-swift-deliveries-provinces-analysis-philippines-covid-19-vaccination-drive-2022-part-2/ .

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