Underinvesting in health

Former Health Secretary Esperanza Cabral told CNN Philippines that our current situation with the pandemic is also because we have underinvested in health. We did not prioritize it. The pandemic lockdowns taught us that the economy’s health is dependent on the people’s health.

I have written about this situation a number of times even before the pandemic. I see health security as a basic right of every citizen. The cost of getting sick has increasingly become unaffordable even to the middle class.

Dr. Cabral also told BMJ.com that “we simply do not have what is necessary. While patient care is better now compared to a year ago, when a surge occurs, unfortunately we will be in the same position: lacking beds, equipment, medicines and oxygen.”

Indeed, we are suffering from the effects of years of chronic underinvestment in health. The operating budget of the department had been largely flat at around P11 billion per annum through the post-EDSA administrations.

It rose to around P24 billion during Cabral’s time at DOH. I recall it was about P30 billion during the time of Dr. Enrique Ona under PNoy’s watch.

Then again, it is not just a question of available budgets. The DOH bureaucracy has this reputation of underspending. Like most departments, they also do not have the absorptive capacity to spend productively.

Worse of all, corruption has been prevalent in the supply of medicines and other needs. DOH has always been reported by COA to have expired medicines in their warehouses, undelivered to field hospitals where those are needed badly.

A provincial patient shouldn’t have to travel to Manila to get the kind of excellent care that the UP-PGH doctors provide. Expressing exasperation after hospitals started filling up again with COVID patients, Sen. Dick Gordon reiterated his call to build a PGH in most regions of the country.

But the problem isn’t only the failure to build more hospitals. We have mistakenly adopted the dysfunctional American healthcare system, which is largely private and for profit. We need something like what they have in Canada and in Britain.

Many of our prominent doctors sneer at the mention of socialized medicine. But what’s the choice? Dr. Omid Siahmard, a fresh UP medical graduate, explained the dire situation in an address he delivered on behalf of his graduating class this year:

“We left our classrooms when we realized we were needed in the streets. People claimed that we were too radical and that UP indoctrinated us, but UP never radicalized us. We were radicalized by the long lines outside (the out patient department) at 2 am.

“We were radicalized by the insufficient oxygen tanks in the (ambulatory care unit). We were radicalized by the sight of our patients sitting down or lying on the floor of our hallways, waiting to be admitted.

“We were radicalized by the fact that every single day, thousands of our healthcare workers seek better job opportunities abroad because of the poor working conditions this country offers them. Our country’s leaders attack our actions, yet their corruption and heartlessness created the conditions for our radicalism.”

Building hospitals should be part of the plan. But hospitals are just buildings without the doctors, nurses, and other medical workers. We do not appreciate our medical workers enough so that many of them end up working abroad.

At least in Britain, Prince Charles said that the UK is “more fortunate than we realize” to have thousands of Filipino nurses and healthcare workers serving the nation. “To these wonderfully selfless people, I wanted to offer my most heartfelt gratitude for the outstanding care and comfort you give your patients.”

Our healthcare workers decide to work abroad because we don’t pay them enough at home. Our policymakers even seem to regard them as virtual slaves who can be forced to stay home by presidential edict.

During the past year, nurses were prevented from leaving to take contracted positions abroad. The reason given by Duterte is that we need them here.

But the government does not have the right to deny them their right to travel or compel them to work at home. They invested in their own education after all, with the hope of giving their families a brighter future.

The financial abuse of nurses continues with a new bill recently passed by Congress that compels them to work for a number of years here before being allowed to go abroad. It is totally unfair.

It is all economics. Those nurses do not come from rich families. Give them a decent pay and they will probably choose to work at home and be with their families.

Those who do work at home are abused by the system, and both private hospitals and DOH are to blame. Salaries are so low many nursing graduates choose to work at call centers. During the pandemic, nurses at the frontlines were even denied the pitiful amount of risk allowance they are legally entitled to by DOH.

As a result, many have resigned from private and government hospitals, overworking those who remain in service. There is this worrisome slide shown by Fr. Nicanor Austriaco during the GoNegosyo Town hall forum last Monday about this problem.

It is not just a question of available hospital beds, the Dominican priest/scientist pointed out. During the Delta surge, hospital occupancy was limited more by the personnel capacity.

So, the ability of hospitals to accept COVID patients was effectively capped at 70 percent of bed capacity because that’s all that the available personnel could attend to. Ironic, given that we probably produce the most number of nurses in the world.

Investing in healthcare also means appreciating the healthcare workers we graduate so they will stay home and serve our people. That will happen only if the financial rewards are competitive with the world’s standards.

Having experienced the pandemic lockdowns, policy makers in the government and the economic managers in the private sector must by now all agree that health is wealth not just for individuals, but for the economy as well.

Boo Chanco’s email address is [email protected]. Follow him on twitter @boochanco