Tag Archives: Health

Poverty, SONA 2012

Sona 2012: Aquino’s failure to ease poverty and provide social services

Deceptive. How can the CCT ease poverty when the program’s beneficiaries are being driven away by big business? (Photo from Bulatlat.com)

Part III: Reviewing Aquino’s “Social Contract” and performance

Read Part I: On job creation here

Read Part II: How the rich is getting (scandalously) richer here

Two of the most important commitments Aquino made in his so-called Social Contract are the provision of social services, specifically education and health; and poverty reduction. To review, Aquino promised to make education the central strategy for investing in the people, reducing poverty and building national competitiveness. He also vowed to advance and protect public health as a key measure of good governance and not as a tool for political patronage. Finally, he pledged to reorient Arroyo’s anti-poverty programs that instill a dole-out mentality to well-considered programs that build capacity and create opportunity among the poor and marginalized.

In the run-up to the President’s third Sona, Malacañang has been pretty aggressive in its propaganda on how the administration is supposedly addressing the basic needs of the people. The new budget proposal of government for 2013, for instance, is being packaged as empowering the marginalized, with significant increases in the allocation for basic social services and bigger conditional cash transfer (CCT) budget. Government has also been advertising economic growth as inclusive, with the supposed benefits being felt by everyone.

Gradual improvement?

The administration’s propaganda is being propped up by what it makes appear as favorable results of recent SWS surveys on poverty and hunger. In its second quarter survey, the SWS reported that the number of families who consider themselves poor dropped to 10.3 million or 51% of the total from 11.1 million or 55% in the first quarter. During the same period, the number of families who experience involuntary hunger declined to 3.8 million or 18.4% from 4.8 million or 23.8 percent.

Presidential spokesman Edwin Lacierda was quick to credit the administration for this, claiming that the improvement was due to “programs on inclusive growth, education, public health and anti-corruption”. Another Malacañang mouthpiece, Secretary Ricky Carandang, credited the CCT program for the “gradual improvement”.

Steady deterioration

But what trends show is not gradual improvement but steady deterioration in poverty and hunger under the Aquino administration. In 2010, poverty averaged 48% among Filipino families; it then went up to 49% in 2011 and this year is averaging 53% (including the last SWS survey). Likewise, hunger steadily increased from 19% (2010) to 20% (2011) and to 21% (2012). In the last nine SWS quarterly surveys, which cover the Aquino presidency, poverty breached the 50%-mark and hunger breached the 20%-mark in five of the nine quarters. Also, hunger under Aquino is now twice the level during the Estrada administration due to the accumulated impact of flawed economic programs and policies, which failed to address poverty and hunger.

Such steady deterioration in poverty and hunger is happening amid the massive expansion in the coverage of and spending for the ballyhooed CCT program of the Aquino administration. Between 2009 and 2012, the number of CCT beneficiaries ballooned from 594,356 households to more than 3 million (or an enormous 407% increase); the national budget for CCT during the same period also swelled from ₱5 billion to ₱39.4 billion (or a whopping 688% hike). CCT is not only failing to make a dent in poverty and hunger, it is also helpless in even slowing down their further worsening.

Stand-alone

Despite repeated statements by the Department of Social Welfare and Development (DSWD), the agency in-charge of the program, that the CCT is not a stand-alone initiative and is being complemented by longer-term and sustainable poverty alleviation interventions, the truth is the CCT is the only program of government to supposedly fight poverty. Aside from providing direct but temporary cash assistance, the conditionalities imposed by the CCT on beneficiaries are also purportedly meant to improve the basic health and education situation in the country. To continue receiving the maximum ₱1,400 a month, a beneficiary-household’s children and pregnant women must attend health centers and posts to get regular preventive health checkups and immunizations. Children must also enroll in schools and attend more than 85% of school classes.

But a look at measurable indicators, like those being monitored by the National Statistical Coordination Board (NSCB) on Philippine social development commitments to the Millennium Development Goals (MDGs), would show that the country continues to fail to attend to the most basic health and education needs of the people. In particular, it is failing in reducing the maternal mortality rate, reducing the prevalence of underweight children under five years old, increasing the completion rate in elementary level, increasing the enrollment rate in secondary level, and improving the results of achievement tests in the elementary and secondary levels, among others.

The reason is that while the Aquino administration intends to instantly improve the coverage of public health and education in the country through the CCT, it does little to ensure the sustained and greater access of the poor to these services. While government is hyping the supposed increases in the budget allocation for basic social services in the past two years, as well as in its 2013 budget proposal, in reality the urgent social services needs of the people remain largely unaddressed and resources allotted remain significantly insufficient.

Neglecting health

Under the 2012 budget, for instance, allocations for 23 state-owned specialty and regular hospitals nationwide were pinned to their 2011 levels despite growing requirements while those which increased their operation and maintenance funds were still unable to recover the huge cuts they had in the past. Further, the Coalition on Health Budget Increase (CBHI) also reported that the state subsidy to indigent patients for confinement or use of specialized equipment has been completely scrapped by the administration.

Another major initiative of government to supposedly improve access to health and complement the CCT is universal healthcare through the country’s national health insurance program (NHIP) being implemented by the Philippine Health Insurance Corp. (Philhealth). This year, Philhealth saw its budget jump by 244% from its 2011 level and in the 2013 budget proposal, it will receive ₱12.6 billion, or almost ₱600 million bigger than its 2012 budget. But as pointed out by the CBHI, Philhealth does not ensure affordable and accessible health services since it is restricted by a budget ceiling for particular health and illness. In addition, the acute need for medicine, supplies and equipment in public hospitals forces beneficiaries to shoulder the expenses for such needs while those in far flung areas, where majority of the poor live, could hardly find Philhealth-accredited hospitals.

Further, the total budget proposed for the Department of Health (DOH) next year is only ₱56.8 billion. Although ₱11 billion higher than its 2012 budget, the said allocation is just a fraction of the ₱243.5 billion that the sector needs to cover the costs of public health care delivery system, health human resource maintenance and development, and preventive and public health programs and promotion, based on initial estimates by the Health Alliance for Democracy (Head).

Insufficient education facilities

The same thing is true with basic education, which despite the seemingly large increases in budget allotment still remains wanting in resources. Estimates by the Alliance of Concerned Teachers (ACT) said government needs to allocate ₱96.5 billion to meet basic inputs for education such as classrooms, chairs, textbooks and water and sanitation facilities. As of School Year 2011-2012, the estimated gross shortages of classrooms reached almost 153,000; school seats, more than 13,000; textbooks, almost 96,000; sanitation facilities, more than 151,000; as well as teachers, almost 104,000, according to the Department of Education (DepEd). But in the 2013 budget proposal of Aquino, allocation for basic educational facilities is pegged at only ₱25.3 billion, which despite increasing by almost ₱9 billion from its current budget is still a meager amount compared to the estimated actual and urgent needs of the sector.

Worse, the DepEd has decided to push through with its controversial K+12 program despite strong public opposition. The program will add two more years to the country’s basic formal education that is presently a 10-year program. Among other impacts, the K+12 program means additional costs for poor families while further stretching the already tight budget for public education. All this means that children of CCT beneficiaries are not assured of completing basic education (which the DepEd prolonged under the K+12 scheme nor accessing quality education (due to perennial shortages in public school facilities and teachers that the national budget could not cover).

The lack of sufficient budget for education and health is being used by the Aquino administration and its allies to justify PPP initiatives in the said sectors such as the proposed corporatization of 26 public hospitals and PPP contracts to build 10,000 to 30,000 classrooms. But this further contradicts the stated objectives of CCT to improve access to health and education as fees tend to rise with private contractors passing the full costs to the public, on top of their own profits.

Displacing the poor

The deception of the CCT is further exposed by government’s treatment of urban poor communities, where many of the beneficiaries live. Because of its centerpiece economic program, the PPP, large areas of urban poor settlements are being demolished or in several cases, set on fire. Peasant, fisherfolk and indigenous communities, who are the poorest of the poor, are also being physically and economically displaced by PPP and mining, energy, plantation and other destructive projects that the Aquino administration has been promoting. How can the CCT ease poverty when the program’s beneficiaries are being driven away by big business?

In the National Capital Region (NCR) alone, the Demolition Watch reported that some 16,000 families in 20 urban poor communities have already been displaced in the first two years of the Aquino administration. The Bagong Alyansang Makabayan (Bayan) – NCR said that the region hosts some 14 large PPP projects, including business districts and parks, port privatization, etc. which could displace as much as 1.4 million poor families.

Aggravating the condition of the urban poor is, like in the case of health and housing, state budget on housing is utterly lacking. Despite the seemingly huge increase in the housing budget for 2013 – from ₱6.1 billion to ₱16.13 (excluding the housing bduget for military and police personnel) – the amount still pales in comparison with the estimated requirement of ₱69 billion for the country to meet a portion of its 3.6 million housing backlog and at least be at par with the housing spending of its neighbors in Southeast Asia, based on preliminary calculations by think tank Ibon Foundation.

Right to decent living standard

Aquino has been massively expanding the scope and budget of the CCT despite the fact that it is not clearly contributing to sustained poverty reduction, not to mention that it is funded by $805 million in growing foreign debt from the World Bank and Asian Development Bank (ADB) that has long been debilitating the economy and depriving the poor of much needed social services. One of the biggest reasons why government could not provide adequate education, health, housing and other basic services is because public resources are being siphoned off by debt servicing, which under Aquino has already reached an all-time high of more than ₱60 billion a month.

Access to health and education, and the right to a decent standard of living including the provision of adequate shelter are basic human rights. This means that the government must work towards the creation of an environment that makes freedom from hunger and poverty, and universal access to social services possible, which includes reliable and sufficient livelihood opportunities for all families and the allocation of adequate resources for quality public schools, hospitals, health facilities, and housing services.

Requiring some poor Filipino families to send their children to school and health centers so that they can access CCT money promotes a dole-out mentality and is a distortion of the concept of human rights. It also distorts human right to health and education and to a decent standard of living by creating temporary access for a targeted portion of poor families while using the conditional cash grants as a smokescreen for the defective policies that push an increasing number of Filipinos to hunger, ignorance, and poverty such as the PPP and other programs that benefit only the rich. (End)

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Fiscal issues, Photo slideshow

Photo slideshow: groups press for increased health budget anew

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Health advocates marched to the Senate Friday (November 26) to press anew for increased allocation for public health services in the proposed 2011 national budget. The Senate is currently reviewing the P1.645-trillion budget proposal of the Aquino administration, which critics like think tank IBON Foundation said shows a “diminishing priority for health”. The proposed budget reduced the allocation for 55 public hospitals nationwide by P363.7 million while funds for specialty hospitals like the Lung Center, Philippine Heart Center, and the Philippine Children’s Medical Center, among others, have been cut by P970.6 million. Meanwhile, debt servicing continues to eat up a major portion of the national budget with interest payments alone eating up 21.7 percent of the planned spending program. Including principal amortization, the debt burden actually represents 38.9 percent of what the Aquino administration is willing to spend in its proposed 2011 national budget (read more here).

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Privatization, Water crisis

Today is World Water(less) Day

"Water for the people now!"

Unknown to most Filipinos, today (March 22) is the international observance of the World Water Day. This initiative grew out of the 1992 United Nations Conference on Environment and Development (UNCED) better known as the Earth Summit held in Rio Janeiro, Brazil.

For this year, the theme is “Clean Water for a Healthy World”, with a campaign, said the UN, “to raise the profile of water quality at the political level so that water quality considerations are made alongside those of water quantity”.

According to the World Health Organization (WHO), water, together with sanitation and hygiene, have important impacts on both health and disease. In a 2008 report, the WHO noted grim facts on the health situation in relation to access to water, to wit:

  • 3.575 million people die each year from water-related disease
  • 43 percent of water-related deaths are due to diarrhea
  • 84 percent of water-related deaths are in children ages 0 – 14
  • 98 percent of water-related deaths occur in the developing world

Meanwhile, a more recent (2010) report by the WHO and the United Nations  Children’s Fund (Unicef) noted disparities between countries, regions, and urban and rural areas in terms of access to sanitation:

  • 2.6 billion people or 39 per cent of the world’s population live without access to improved sanitation. The vast majority live in Asia and sub-Saharan Africa.
  • In the developed regions almost the entire population (99 per cent) used improved facilities as compared to 52 per cent in developing regions.
  • At current rates of progress the world will miss the MDG sanitation target by almost 1 billion people, which claims to: “halve, by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation,” by 13 per cent. And the MDGs are not the end of the sanitation challenge. Even if the target is met some 1.7 billion people will still not have access to improved sanitation facilities.
  • Rural/urban disparities are particularly apparent in sub-Saharan Africa, and the Caribbean, Southern Asia and Oceania where improved sanitation coverage is highest among the urban population despite the vast majority living in rural areas.
  • 751 million people share their sanitation facilities with other households or only use public facilities.

Such appalling global reality is reflected in the Philippines where the poor have been increasingly deprived of access to water for basic domestic use due to neoliberal policies such as privatization of water services and resources. The situation continues to deteriorate today due to the El Niño that has further limited water supply available for the people, especially the poor.

According to the 2007 Annual Poverty Indicator Survey (APIS) of the National Statistics Office (NSO):

  • 17.1 percent of all families in the country do not have access to safe drinking water and are forced to get water from unsafe sources such as unprotected well (5.7 percent); developed spring (4.8 percent); undeveloped spring (1.9 percent); river, stream, pond, lake or dam (1.1 percent); rainwater (0.4 percent); tanker truck or peddler (2.3 percent); and other sources (0.8 percent).
  • Access to water is expectedly lower for poor families as the same NSO survey show that 30 percent of the poorest 30 percent of Filipino families do not have access to safe water supply.

The advocacy group Water for the People Network (WPN) intends to draw public attention to this situation of lack of access to water for basic domestic use and for people’s livelihood amid the El Niño and continuing privatization of the country’s water resources.

Tomorrow, March 23, the WPN will hold a roundtable discussion on Angat Dam’s privatization together with the Commission on Human Rights (CHR) and other stakeholders including farmers from Bulacan, consumers as well as water agencies including the Metropolitan Waterworks and Sewerage System (MWSS).

More on the Angat Dam privatization and the WPN’s roundtable later.

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Human rights

Failed health system and the Health 43

In a poor country where one out of every two people dies without receiving any medical attention, 50 percent of the population do not have access to health care, 40 percent do not have access to essential medicine, 10 mothers die daily due to pregnancy and childbirth-related causes, and 100 municipalities are doctorless and nurseless[1] while more than 7,700 nurses, 83 doctors, and 196 professional midwives leave the country yearly[2] to work abroad, trainings to equip ordinary citizens attend to the basic health needs of poor and neglected communities should be welcomed.

And a government that is sensitive to the needs of its people should support such initiative, or at least be thankful to medical professionals and volunteers who give their skills, knowledge, time, and resources in order to help bridge the widening gap between the need and availability of health services in the country.   

So when 43 health workers – including two medical doctors, a registered nurse, a registered midwife, and 39 community health workers – while conducting a training-seminar, were illegally arrested, and later tortured, by the police and military on outrageous claims that they were making bombs, you know at once that something is seriously, terribly wrong.

Community-based health programs

The Council for Health and Development (CHD), which together with the Community Medicine Foundation Inc. (CMFI) organized the training-seminar attended by the 43 health workers, is the national organization of non-government community-based health programs (CBHPs) in the Philippines. It raises resources for the CBHPs including reading, education, and training materials as well as financial support. The group, which is registered in the Securities and Exchange Commission (SEC) as non-stock and non-profit, also conducts trainings and consultations with CBHPs.[3]    

Since 1973, non-government CBHPs has formed part of the Philippine health care system. From simply providing training for paramedics in far-flung and neglected rural communities, CBHPs have overtime become part of the common people’s aspirations and struggles.[4]

Programs considered as CBHPs aim to respond to the basic health needs of the people through education, training, and services. Unlike episodic health campaigns such as breastfeeding or immunization programs, for example, CBHPs deal with the health issue in a holistic approach, i.e. health problems of the community are recognized to be inter-related with the economic, political, and cultural problems of the society. Thus, they do not provide solution to health problems but assists and facilitates in laying the foundation of a health system that is governed by the people at the community level.[5] Maybe this concept of CBHPs is too “communist” for the Armed Forces of the Philippines (AFP) and the Philippine National Police (PNP)?

But the CBHPs have long been recognized even by the United Nations (UN). In the late 1970s, CBHPs were institutionalized globally following an international conference on primary health care organized by the World Health Organization (WHO) and the UN International Children’s Emergency Fund (UNICEF). That conference officially recognized the role of paraprofessionals or auxiliary health workers in lieu of physicians in the rapid extension of health services in the Third World. They were to play a key role in achieving universal access to health services.[6] In fact, CBHPs in the Philippines were recognized by the UN Development Programme (UNDP) as among the most “innovative social organization and practices of the South.”

Lack of human resources for health

CBHPs and medical volunteers play a crucial role in the Philippines where there has been a noticeable trend of outward migration of doctors, nurses, midwives, therapists, and other medical professionals. From 1992 to 2006, the country has already deployed 115,871 professional nurses as overseas Filipino workers (OFWs); 2,945 professional midwives; and 1,247 medical doctors. The Philippines is the biggest “exporter” of nurses in the world.[7] The Philippine General Hospital (PGH) alone is losing as much as 500 nurses every year out of their 2,000 health workforce.[8]

These exported medical professionals tend to be well-trained, skilled, and experienced because of their specializations but are enticed to go abroad mainly due to economic factors. Nurses in the Philippines, for instance, are volunteers or casuals without plantilla positions and thus do not enjoy job security and other benefits. The Philippines has been mass producing nursing graduates every year not to attend to domestic health demands. A 2000 estimate, for example, said that 85 percent of the total demand for Filipino nurses are found abroad. Health workers employed in the country, meanwhile, endure low and variable wage rates that do not allow them to earn decent living wages.[9]

The obvious and immediate end-result of this phenomenon is a shortage in health professionals to meet the country’s own requirements. One indicator is the health professional to patient ratio. In some hospitals, one nurse attends to as much as 60 patients[10], which have implications on the quality of health services. A separate report claimed that the nurse to patient ratio in some government hospitals in the Philippines even reached 1:100 while the international standard is pegged at only 1:4.[11]

Meanwhile, processed data from the World Health Organization’s (WHO) online database show that there is only one doctor for every 2,000 Filipinos and one nurse/midwife for every 167. The WHO said that countries with fewer than 2.5 health care professionals (physicians, nurses, and midwives) per 1,000 people failed to achieve adequate coverage rates for selected primary health care interventions as prioritized by the Millennium Development Goals (MDGs) framework.[12]

Consequently, the 2007 Philippines Midterm Progress Report on the MDGs shows that based on the country’s current pace, the 2015 deadline on health-related targets will not be achieved. As of 2006, the number of maternal deaths per 100,000 live births was pegged at 162. The MDG target is to reduce the maternal mortality ratio to 52. Meanwhile, access to reproductive health care was pegged at 50.6 percent while the UN goal is 80 percent access.[13]

Government neglect, double injustice

The exodus of Filipino health professionals is reflective of the backward state of the Philippine economy and aggravated by wrong policies and priorities of past and present governments. The export of labor including medical professionals has been a flawed government policy since the Marcos years to provide jobs and generate dollars for the economy. In recent years, government has even intensified the export of health workers such as through the 2008 ratification the Japan-Philippines Economic Partnership Agreement (JPEPA), which supposedly guarantees access for Filipino nurses and caregivers to the Japanese health labor market.

These policies combine with total government neglect to provide basic social services including health. At an average of 1.8 percent national budget allocation since 2001, the Arroyo administration has allocated the smallest portion of the country’s budget for health services among all post-Marcos governments.[14] Actual spending is even worse. In 2008 (latest available data), public spending for health comprised only 1.2 percent of total spending (while debt servicing for principal and interest accounted for 47.6 percent).

Lack of public health services has forced many Filipinos to rely on their own. In a 2009 survey, Sun Life of Canada found out that 76 percent of Filipinos are concerned about paying for health treatment and an overwhelming 85 percent rely on their own savings when they get sick.[15] But because of poverty, medical needs are largely not met as indicated by the alarming national health statistics

Official poverty statistics show that there are 27.6 million poor Filipinos or 32.9 percent of the total population,[16] although independent estimates such as IBON’s claim that as high as 8 to 9 out of every 10 Filipinos do not meet decent living standards.

The situation is more severe and more felt in the countryside, where an estimated two out of three poor Filipinos live. These are the people that CBHPs serve in remote barangays and sitios where government services such as health are absent.

Thus, by arresting and torturing the 43 health workers, the Arroyo administration and its armed forces have twice committed a grave injustice – first against the victims and their families, and second against the countless poor people long neglected by government and that these health workers serve. ###

Sources, references, and notes   

[1] Galvez Tan, Jaime Z. (2004), “The brain drain phenomenon and its implications for health: 10 strategic solutions for action by Filipino leaders”, p. 5, paper read at the International Conference on the Medical Workforce sponsored by the United States Educational Commission for Foreign Medical Graduates (ECFMG), Washington DC, 4-7 Oct. 2004

[2] Based on 1992-2006 (latest available data) cumulative OFW deployment per skill and per country as compiled by the Philippine Overseas Employment Administration (POEA 

[3] Council for Health and Development website, http://www.chdphilippines.org/about.php 

[4] __________ (2001), “Community-based health programs”, p. 7, Examples of Innovative Social Organizations and Practices of the South”,  Vol. 6, UNDP Special Unit for South-South Cooperation

[5] Ibid., p. 6

[6] Ibid., pp. 3-5

[7] Lorenzo, Fe Marilyn E., RN, DrPH et al. (2005), Migration of health workers: Country case study Philippines, Institute of Health Policy and Development Studies, National Institute of Health, University of the Philippines, pp. 14, 21, International Labour Office, Geneva, 2005 

[8] Op. cit., Galvez Tan (2004)

[9] Op. cit., Lorenzo (2005), 18-19

[10] Ibid., p. 44

[11] Makilan, Aubrey SC (2005), “Poor pay, working conditions are driving health professionals abroad”, Special report (last of three parts), Bulatlat.com, Vol. V No. 43, 4-10 Dec. 2005, http://www.bulatlat.com/news/5-43/5-43-poor.htm

[12] World Health Organization Statistical Information System, Human resources for health, WHO website, http://www.who.int/whosis/indicators/compendium/2008/3hwo/en/index.html

[13] __________ (2007) “Philippines Midterm Progress Report on the Millennium Development Goals”, p. 15

[14] IBON Features (2010), “Violations of economic, social rights severe under Arroyo administration”, Bulatlat.com, 12 Dec. 2009, http://www.bulatlat.com/main/2009/12/12/violations-of-economic-social-rights-severe-under-arroyo-administration/

[15] Dumlao, Doris C. (2010) “Most Filipinos have nothing to leave their children, study shows”, Philippine Daily Inquirer, INQUIRER.net website, 6 Feb. 2010 http://business.inquirer.net/money/breakingnews/view/20100206-251545/Most-Filipinos-have-nothing-to-leave-their-children-study-shows

[16] National Statistical Coordination Board, Philippine Poverty Statistics, NSCB website, http://www.nscb.gov.ph/poverty/2006_05mar08/table_2.asp

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