PHA-Exchange> Philippines: Gov’t Neglecting Health – Health NGO / Another Unhealthy Year for Health Workers

[Wim De Ceukelaire]

This storywas taken from Bulatlat, the Philippines's alternative weekly
newsmagazine (www.bulatlat.com).
Vol. VI, No. 49, Jan. 14-20, 2006


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Gov’t Neglecting Health – Health NGO
(First of two parts)

Five out of ten Filipinos die without receiving medical attention.  Ten
mothers die daily because of pregnancy and childbirth-related cases.
And yet the Arroyo government spends a mere P0.33 ($0.006 at an exchange
rate of $1=P49) per day for the health of every Filipino. It is even
implementing programs that are not meant to make health services
accessible to the ordinary Filipino but to earn revenues from medical
tourism, Dr.Gene Nisperos of the Health Alliance for Democracy said.  

BY AUBREY MAKILAN
Bulatlat

Along with environmental tragedies, diseases plagued the country in
2006. There were outbreaks of malaria, dengue, diarrhea and neonatal
sepsis.

Neonatal sepsis issue claimed the lives of at least seven infants at the
Rizal Medical Center (RMC). Data from the Department of Health (DoH)
revealed that there had been 69 deaths from neonatal sepsis at RMC from
January to October 15 last year, and 45 deaths during the same period in
2005. The Department ofHealth has filed administrative charges against
several doctors and staff of RMC.

The Health Alliance for Democracy (HEAD) agrees with the DOH that there
was negligence on the part of the staff of RMC. But Dr. Gene Nisperos,
secretary general of HEAD, said that “the negligence cuts across all
levels of the public health care delivery system.”

Nisperos said that the RMC issue exposed the failure of the DoH to
fulfill its obligations, which include the supervision of state-run
hospitals, to ensure the efficacy and accessibility of medical services
to ordinary Filipinos. 

Meanwhile, hundreds of dengue and malaria patients have filled even the
hallways of hospitals. Dengue severely affected the National Capital
Region, Region 4A and the Cordillera region.

What is depressing, Nisperos said, is that these diseases are
preventable.

Even before the government concerns itself with expensive biomedical
procedures, Nisperos said, it should first implement proper public
health measures like clean water and sanitation. However, Nisperos said,
the government failed miserably in this aspect.  He cited DoH data which
showed that eight of the top ten causes of morbidity in the country are
infectious in nature. In terms of infant mortality, at least six out of
the top ten causes are infectious diseases. Similarly, data regarding
child mortality across three different age groups (1-4 years, 5-9 years,
and 10-14 years old), showed that infectious diseases still account for
more than half of the ten leading causes.

Not only do Filipinos die of preventable diseases, there are also ten
mothers dying daily because of pregnancy and childbirth-related causes.
Nisperos said the fact that five out of ten Filipinos die without
receiving medical attention shows that the government is criminally
negligent.  

Government policies

Rather than focusing on better public health care, the Arroyo
administration has pushed for the privatization of health care and
medical tourism, said Nisperos.

Last year, the government drew up three projects namely, the FOURmula
One for Health, Medical Tourism and the Philippine Center for
Specialized Health Care (PCSHC).

FOURmula ONE for Health is designed to implement “critical health
interventions in a single package, backed by effective management
infrastructure and financing arrangements” for the medium term covering
2005-2010. Medical Tourism encourages foreigners to visit the country
for their medical and leisure needs. PCSHC is the integration of four
hospitals classified as government-owned and -controlled corporations
(GOCCs) and a government hospital based in Quezon City. The state
hospitals are the National Kidney and Transplant Institute (NKTI),
Philippine Heart Center (PHC), Lung Center of the Philippines (LCP),
Philippine Children’s Medical Center (PCMC) and East Avenue Medical
Center (EAMC). Except EAMC, these hospitals are classified as
government-owned and -controlled corporations (GOCCs).

But Nisperos said it is not the poor Filipinos who would benefit from
these programs.

He said that these government programs were designed to raise revenues,
thereby effectively privatizing the already inaccessible health
services.  He added that withmedical tourism, paying patients, most
especially foreigners, would be prioritized to earn more revenues. 

The planned integration of four government hospitals is already being
implemented despite theabsence of a law allowing it. In previous
articles, Bulatlat learned that an Integration Office has been set up at
the NKTI. The office is reportedly using a letterhead bearing the PCSHC
name.

Aside from itsquestionable creation, health workers are also against the
allocation of P1million ($20, 408) from each of the four hospitals for
the operations of the Integration Office.

Measly and misappropriated budget

The World Health Organization (WHO) came up with a standard prescribing
that five percent of the gross national product (GNP) of a country
should be allocated to health.  But the Philippines allocates way below
this standard.   

In 2004, only 0.33 percent of GNP or P10.4 billion ($212,244,897) was
allocated to health services; 0.21 percent or P10.3 B ($210,204,081) in
2005 and 0.35 percent of the projected GNP or P10.575 B ($215,816,326)
in 2006.

With the reenacted budget of 2006, HEAD computed that a miserable P0.33
($0.006) per Filipino per day would be spent by the government for
health this year.

Worse, HEAD said, the insufficient government budget was also
misappropriated.

The government allocates about P1.25 B ($25,510,204) annually for
confidential and Intelligence expenses. Nisperos also said that the
budget of the two hospitals of the Armed Forces of the Philippines
amounting to P1.348 B ($27,510,204) was almost half of the total budget
for 11 government hospitals in Metro Manila amounting to P2.483 B
($50,673,460).

Moreover, only P2 million ($40,816) has been allocated to subsidize the
treatment of indigent patients in specialty hospitals. This is grossly
inadequate considering that the average hospital bill is three times the
average monthly income.

Also, only P 675.434 million ($13,367,784) was allocated for Disease
Prevention and Control, of which only P 154 million ($3,142,857) was
allocated fortuberculosis (TB) prevention and control. 

TB is known as a sensitive index of a nation’s poverty. In 2003, the
World Health Organization (WHO) named the Philippines as having the
highest rate of TB occurrence in the Western Pacific with 36 percent of
82 million Filipinos infected. The same report says 75 Filipinos die of
TB daily while 100,000 contract the disease yearly.

“People's control”

With this kind of government implementing “ineffective” health programs
and policies, Nisperos said, the people should assert their rights to
health services through collective action.

He called on the people to “rescind detrimental treaties and government
policies,” among others, not only to make health services accessible,
but also to establish “a more socially equitable society, where there is
genuine freedom and democracy.”Bulatlat

Another Unhealthy Year for Health Workers  (Conclusion)

 

© 2006 Bulatlat  ■   Alipato Media Center

Permission is granted to reprint or redistribute this article, provided
its author/s and Bulatlat are properly credited and notified. 


This storywas taken from Bulatlat, the Philippines's alternative weekly
newsmagazine (www.bulatlat.com).
Vol. VI, No. 49, Jan. 14-20, 2006


________________________________________________________________________


 

Another Unhealthy Year for Health Workers  
(Conclusion)

The health sector was not spared from the crisis that envelops the
country.  Health as a fundamental requisite for development is
continuously being neglected by a government keen only in seeking
profit. Health workers continue to suffer from the lack in government
budget resulting from the flawed privatization and market-driven
policies of the Arroyo government, and made worse by corruption.The few
idealistic and patriotic health workers and professionals who have
decided not to leave had to work amid the crumbling public health
system.      

BY PHILIP PARAAN
Contributed to Bulatlat 

The year 2006 was tumultuous for the country - politically and
economically.  The health sector was not spared from the crisis.  Health
as a fundamental requisite for development is continuously being
neglected by a government keen only in seeking profit. Health workers
continue to suffer from the lack in government budget resulting from the
flawed privatization and market-driven policies of the Arroyo
government, and made worse by corruption. Having to endure low wages and
unbearable working conditions, more and more health professionals leave
the country in search of gainful employment abroad.  

The few idealistic and patriotic health workers and professionals who
have decided not to leave had to work amid the crumbling public health
system.      

Health hazards 

Administrative Order no. 2006-0011 issued May 16 and effective July 1,
2006 was meant to provide for a standardized hazard pay of P 4,989.7
($101.83 at an exchange rate of $1=P49) per month. But the hazard pay
did not benefit all health workers. This is merely a repetition of an
earlier order that benefited only a few in the health department. Only
Department of Health (DoH) officials and employees within Salary Grades
20 and up or those in the top management, would again benefit from it.
While those severely affected by the crisis, those within Salary Grades
9 and below or the rank and file employees did not have any increase in
their pay or their benefits. 

Although health workers, well understand that health hazards do not
distinguish between salary grades, those in the frontlines namely,
doctors, nurses, midwives and attendants who are most exposed would not
benefit from the proposed increase. Emma Manuel, president of the
Alliance of Health Workers (AHW), an alliance of unions and associations
of health workers, said, “Hindi  dapat dependent ang hazard pay sa
salary grade, di mo naman alam kung sino ang unang dadapuan ng
bacteria.” (The hazard pay should not be dependent on the salary grade
since you could not predict who would be the first to be infected by
bacteria.)  

But the most vulnerable to infections are the rank and file who are
directly involved in patient care and other services. They work more
than eight hours and usually takes care of 60-80 patients per shift. 

Health workers protested against the discriminatory order prompting the
DoH to consider a resolution fixing the hazard pay of all health
workers.  The resolution is being studied by the National Health Workers
Management Consultative Council under Health Undersecretary Nemesio
Gako.  

Their long fought battle for unpaid hazard pay dates back since the term
of former Health Secretary Manuel Dayrit, and with its earlier
precedents of a series of contradicting administrative orders.
Administrative Order no.17, dated February 10, 2003, ordered an increase
in the hazard pay of Salary Grade 20 from five percent of basic pay to
25 percent, using Salary Grade 19 as benchmark. Salary Grade 20 and
above employees have been enjoying this benefit from 2003 to present,
without the knowledge of rank and file employees.  

Later that year, health workers, through their protests, managed to
lobby for a hazard pay increase for all. Under AO 125, dated December
15, 2003, Salary Grade 1 employees were granted hazard pay amounting to
43 percent of their basic pay while those in Salary Grade 20 were
suppose to receive hazard pay equal to 24 percent of their basic pay.
This proposal would have been favorable according to AHW because of its
proximity to the provisions set by the RA 7305 or Magna Carta for Health
Workers.  But it was never implemented.  

The AHW is demanding for a uniform rate for hazard pay, which is 25
percent of basic pay with Salary Grade 19 as benchmark.Only the
Philippine General Hospital implemented a uniform hazard pay citing an
implementing guideline of RA 7305 issued by then Health Secretary Juan
Flavier. 

.In a dialogue last Oct.2, 2006 between the DoH and officers of various
hospital unions under AHW,  Health Secretary Francisco Duque claimed
that he was unaware of previous administrative orders regarding hazard
pay, which were never implemented.  Duque said that he was amenable to
the proposal for a hazard pay increase. But nothing has come out of it
yet.  

Reversing the gains of concerted action 

Instead of addressing the legitimate demands of the government service
sector, the Arroyo government introduced the Government Compensation and
Classification Act of 2006 (GCCA). The bill which is pending in Congress
is being proposed jointly by the Civil Service Commission (CSC) and the
Department of Budget and Management (DBM).  Under the GCCA, Salary
Grades 1-5 will get a minimal increase even if their basic salaries are
still below poverty line. The basic pay of Salary Grade 1 amounts to
only P 5, 082 ($103.71). 

Worse, the bill gives both the DBM and Civil Service Commission vast
powers including the authority to repeal or take back economic benefits
given to government employees.  This would reverse the gains achieved by
government employees through concerted action such as Republic Act 7305
or the Magna Carta for Health Workers of 1992, the Magna Carta for
Teachers, among others. Health workers also believe that the GCCA would
be used by both agencies to implement mass lay-offs in the government
sector. 

Medical tourism = streamlining 

The Arroyo government is aggressively pushing for its medical tourism
program. Medical tourism is being promoted by the government purportedly
to improve the quality of health services and to encourage health
professionals and workers to stay in the country. But one of the
government’s first projects under this program is the integration of the
five major specialty hospitals—National Kidney and Transplant Institute,
Philippine Children’s Medical Center, Lung Center of the Philippines,
Philippine Heart Center, and the East Avenue Medical Center.  This,
health workers said, would lead to duplication of jobs in hospital
services such as pharmacy and dietary leading to retrenchments.  A joint
Board of Directors would also be created with vast powers, including the
authority to reduce the allocation of charity patients.  (LINK sa
previous articles regarding these) 

The AHW also believes that medical tourism would not lead to an increase
in the salaries of health professionals and workers as revenues would be
directed towards infrastructure development and acquisition of state of
the art medical technology. Last year, the government claimed that the
medical tourism industry earned P 125 million ($2,551,020) and doctors
were asked to charge higher user fees. But health workers and
professionals have yet to receive any increase in salaries disproving
government claims that the program would also benefit them.  

In a statement in the Philippine Daily Inquirer, Secretary Francisco
Duque suggested a review of legal impediments in the constitution that
prevents the entry of Indian physicians in the country. Some 400 applied
for medical residency last year but were denied.  

“We could soon expect a lot of Chinese and Indian doctors, whose rate
are said to be cheaper than ours, working in the country leading to
streamlining in our hospitals and displacing Filipino health
professionals.  These countries would also be sending nurses to ASEAN
countries soon,” said Jossel Ebesate, chief nurse of the UP-PGH and
President of the ALL-UP Workers Union. 

Ebesate added that this move to liberalize the entry of foreign health
professionals and workers are in line with the rules of “reprocity”
under the General Agreement on Tariffs and Trade( GATT) which the
national government  adheres to. This could only mean displacement and
further neglect for our own health workers. 

Plugging an unstoppable leak  

The year 2006 was the most controversial for the nursing sector with the
much-publicized leakage in the nursing licensure examinations. Although
progressive health organizations believe that the problem of leakage in
the nursing licensure examinations has been going on for years, the June
2006 leakage generated the most controversy.  It has placed the future
of 42, 000 examinees under question. 

Moreover, the AHW said the controversy regarding the leakage exposed the
commercial orientation of nursing education in the country.   

There was a long stand off between those who proposed that examinees
retake the licensure exams and those who refused.  The issue was
aggravated by confusing statistics produced by the Professional
Regulations Commission regarding passing scores with or without
considering the controversial sections of the tests.  The Arroyo
government added to the confusion by flip-flopping in its position
regarding the call for a retake of the examinations.   

After the Court of Appeals (CA) ruled on a selective retake of Test 3
and 5 of the June nursing board exams, it has been back to business as
usual.  The government has remained mum on the fate of those who were
identified as accountable.   None of those found liable by the National
Bureau of Investigation, including Board of Nursing Commissioners
Virginia Madeja and Anesia Dionisio, former Philippine Nursing
Association President George Cordero, and operators of Inress review
centers, had their day in court.   

Immediately after, the CA ruling President Gloria Macapagal-Arroyo met
with representatives of the U.S. National Council of Sate Boards to
resume discussions on the prospects of establishing a NCLEX-RN (National
Council Licensure Examination-Registered Nurse) testing center in the
Philippines. Recently, two major employment programs recently signed by
the Arroyo government under the Japan-Philippines Economic Partnership
Agreement and the ASEAN Mutual Recognition Agreement were designed to
facilitate the entry and practice of Filipino nurses in Japan and ASEAN
countries.  

Heal and struggle 

The Philippines is reputed to be the biggest exporter of nurses and
second biggest exporter of doctors.  The country’s health professionals
are known as caring and efficient.  But those who remained to care for
the country’s ailing population are themselves neglected.  They continue
to work within a crumbling health system made worse by a decreasing
health budget.  The threat of streamlining and retrenchment hovers over
their heads.  They constantly face the challenge of being understaffed,
overworked and underpaid.  Laws and policies that worsen their living
and working conditions are being passed. 

But they are determined to push forward in their struggle for just wages
and benefits, including a P3, 000 ($61.22) across the board increase;
for job security; and for their democratic rights. They believe that
their healing starts with their participation in the struggle. Bulatlat

Gov’t Neglecting Health – Health NGO (First of two parts)

 

© 2006 Bulatlat  ■   Alipato Media Center

Permission is granted to reprint or redistribute this article, provided
its author/s and Bulatlat are properly credited and notified. 

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