Philippines to follow health care model of Cuba

In a country where little more than a quarter of the population still live below the poverty line, universal healthcare – or, at the least, giving people access to cheap medicines – should be right there at the top of government’s priority programs. Fortunately, this was among the priority concerns that President Rodrigo “Rody” Duterte first took up with his Cabinet members on day one of the new administration.

When he convened his maiden Cabinet meeting a few hours after his inaugural last June 30, President Rody lost no time to identify the priority thrusts of his administration, at least on its first 100 days in office.

In the Cabinet meeting at Malacañang Palace, President Rody made this off-the-cuff pronouncement that he is sending newly appointed Health Secretary Paulyn Ubial to Cuba to study that country’s highly successful healthcare program.

I had no idea what President Rody was talking about. The first thing that came to my mind was the campaign attacks against the alleged communist links of the former Davao City mayor. I have fairly little knowledge about Cuba other than it has long been under communist rule by a dictator named Fidel Castro. It is a large Caribbean island nation located close to the United States.

Fascinated by this revelation of President Rody of the Cuban model of public health care, I browsed through Google.com. Cubans call their system medicina general integral (MGI, comprehensive general medicine). Its programs focus on preventing people from getting diseases and treating them as rapidly as possible.

Even the director-general of the World Health Organization, Margaret Chan, was all praises for Cuba’s healthcare system. She commented after her visit to Havana in July, 2014: “Cuba is the only country that has a healthcare system closely linked to research and development. This is the way to go, because human health can only improve through innovation… We sincerely hope that all of the world’s inhabitants will have access to quality medical services, as they do in Cuba.”

According to the WHO, over 100 countries are looking to the example of Cuba, which has the same 78-year life expectancy of the US while spending 4 percent per person annually of what the US does. The most revolutionary idea of the Cuban system is doctors living in the neighborhood they serve. “A doctor-nurse team is part of the community and know their patients well because they live at (or near) the consultorio (doctors’ office) where they work. Consultorios are backed up by policlínicos which provide services during off-hours and offer a wide variety of specialists. Policlínicos coordinate community health delivery and link nationally designed health initiatives with their local implementation.”

Budget Secretary Benjamin Diokno noted President Rody’s plan to replicate Cuba’s healthcare model is doable in the Philippine context.

Aside from Davao City, the DBM chief noted the province of Albay, under the leadership of its former governor and now Congressman Joey Salceda, has achieved a high level of efficiency from primary to tertiary hospital care.

Now as the country’s Chief Executive, President Rody showed how his unorthodox and revolutionary manner of doing things made him one of the most successful mayors in the Philippines. During his years serving as Davao City mayor, he had effectively addressed local health concerns of his constituents.

The President announced his plan to funnel the P35-billion annual earnings of the state-owned Philippine Amusement and Gaming Corp. to the Department of Health. It will fund essential healthcare and the pharmaceutical needs of Filipinos, particularly the poor. Because as President Rody succinctly put it, “people who cannot buy medicines will die.”

And this brings us back to the Cheaper Medicines Act, now spanning three administrations. I remember that in 2009, then president and now Pampanga Rep. Gloria Macapagal Arroyo used her favorite “moral suasion” to call on pharmaceutical firms to slash the prices of their essential medicines by 50 percent.

Actually, even those who earn more than the poverty threshold of P9,140/per month would see their capacity to spend for basic things greatly diminished when they are on maintenance drugs. This is based on personal experience, as I am also on maintenance medicine.

Being close to my heart, I also wrote opinion columns about this topic in the past, particularly because it became apparent that this appeal of Mrs. Arroyo was being met with strong resistance from giant multinational companies (MNCs). One big MNC on pharmaceutical products even faced Senate probe for the release of its so-called discount cards which was seen as a mere marketing strategy that provide calibrated discounts to their medicine products dispensed only by doctors being served by their company’s medical representatives.

As consumers of maintenance drugs who must take these medication on life-time basis, we count on the Cheaper Medicines Law to cushion us from inflation. The government needs to review the marketing campaign of MNCs at the level of the doctors, who are closest to the patients. Maybe this is one of the missing links to the successful implementation of the Cheaper Medicines Act.

This is despite the greater efforts by the previous Aquino administration, which focused on Universal Healthcare and even strengthened PhilHealth services with the support of the funds coming from the Sin Tax law.

Filipinos getting full access to cheaper medicines will not happen without the cooperation of everyone. Despite the Generics Law that has given patients cheaper priced medicines that they can afford but with same efficacy, multinational brands continue to dominate the market, particularly for essential medicines. However, these profit-motivated MNCs don’t see the need to really bring down their prices to the affordable level of lower income patients.

I remember asking former Secretary Janette Garin when she was our Kapihan sa Manila Bay guest in January this year about the sudden rise of price of a MNC branded medicine that I was taking. Believe me, I know and feel the frustration of Filipinos who are on maintenance drugs.

But I see hope in President Rody’s forward-looking directive to look into the Cuban model. We can only conclude that change is indeed coming – and it’s coming fast.