Human capital

Last Friday there were groans heard along the corridors of the Philippine General Hospital (PGH), and they were not coming from patients.

 Medical students, particularly freshmen, training at the PGH were worried about where to get the money to shoulder the laboratory fees of their indigent patients. The state hospital, which serves as the training ground for students of the University of the Philippines College of Medicine, had just imposed a fee of P45 for ordinary laboratory services such as urinalysis.

 Why is this a problem for the PGH medical staff? Because attending physicians or physicians-in-training get a black mark for a patient who dies or whose health problem gets worse. If their patients, who include the homeless and extremely poor who are not covered by PhilHealth, cannot afford the fees, the attending medical staff may end up shouldering the payment.

 The PGH is staffed by the country’s top doctors and medical students, but there are never enough of them to meet the demand. The hospital is also so cash-strapped medical staff are urged to bring their own surgical gloves, masks, alcohol, gauze and Betadine for dressing wounds even in the emergency room.

 There are pay wards but most PGH services are free or heavily subsidized, and the hospital is swamped. The emergency room is always so crowded patients often spill out into the curb in a long line. Patients are assessed according to the immediacy of the medical need, so if the problem is not life-threatening, the wait for an attending physician can last several hours.

 Each medical student can have from five to 10 patients. A patient typically needs an average of two laboratory tests daily for proper diagnosis and treatment. At P45 per test, that’s P90 a day – a fortune for the indigent. If the attending physician or student is compelled to shoulder the fee, it could mean expenses of up to P950 a day.

 PGH administrators clarified over the weekend that the lab fees could still be waived, but the patient must apply for this and the process is expected to add to the waiting time for health care. So medical personnel are still worried.

While many of UP’s iskolar ng bayan or state scholars come from affluent families, there are still quite a number who are more like Kristel Tejada, who killed herself after being barred from attending classes in UP Manila for failure to settle her tuition obligations. So the limit on charity laboratory services spells trouble for both patients and the medical staff.

 Waiting lines are long not only at UP-PGH but also in other government-run hospitals, and even in private medical centers that offer reliable but affordable laboratory tests. At one such private facility along the Alabang-Zapote Road in Las Piñas, patients start waiting in line as early as 5:30 a.m., and several of the patients are in chauffeur-driven cars.

 Such is the state of public health care in a country that is one of the largest exporters of health professionals.

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I learned of the problem in PGH shortly after I met last Friday with the World Bank’s new vice president for East Asia and Pacific, Axel van Trotsenburg.

“The ultimate asset of the Philippines are its people,” he told me at the new World Bank country office in Bonifacio Global City. “One needs to invest, invest, invest in health and education.”

The state of the country’s premier state-run hospital and the funding problem brought to light by Tejada’s suicide are good indications that we are not investing enough.

The consequences are manifested in our middling national competitiveness – among the lowest in the region – and our seeming inability to correct structural weaknesses that have derailed development, hindered inclusive growth and kept away job-generating investments.

Trotsenburg served as WB country director for Mexico, Colombia, Argentina, Chile, Paraguay and Uruguay – societies with development trajectories similar to ours. He emphasized that investing in people, whether short or long term, is “an enormous challenge of any society.”

Investing in human capital, he also emphasized, is everybody’s task; it must be “farmed out” to the private sector, the family and smaller social units. Investment in human capital starts with good nutrition and is sustained through lifelong learning, he said.

The World Bank Group is looking for possible new thrusts in its aid programs around the globe, which will support its two principal goals under its current president, Jim Yong Kim. I’ve written about these goals: to eliminate extreme poverty (subsisting under $1.25 a day) by 2030, and to promote shared prosperity for the bottom 40 percent.

During Trotsenburg’s visit, his first ever to Manila, the WB announced the transfer of $300 million to the Philippines as support for critical reforms aimed at accelerating economic growth, creating more jobs and reducing poverty. The WB-backed conditional cash transfer was expanded to cover high school education.

With the Philippines achieving impressive economic growth and sound macroeconomic policies in place, Trotsenburg stressed that growth must be inclusive and sustainable, with structural policies boosting competitiveness.

Trotsenburg is bullish about our country’s prospects: “Do we think the Philippines can do it? Absolutely.”

The WB sees a “convergence” between its goals and thrusts and those of the Aquino administration, including the focus on weeding out corruption. Trotsenburg recalled former WB president James Wolfensohn referring to the problem as “the C word.”

“Corruption is the cancer for positive development,” Trotsenburg said. “Successful development is marked by transparent government and strong anti-corruption policies.”

While transparency “is a good first step,” the World Bank doesn’t tell governments what to do to promote competitiveness and survive in the global economy.

Reform initiatives, Trotsenburg noted, can come from the private sector. Along the way, “there will be winners, and there will be people who will be challenged by this.”

“Sometimes (the issue) is also, where do you want to be in the next five years? What is preventing you from achieving those objectives?” he said.

During his visit, Trotsenburg went to the Autonomous Region in Muslim Mindanao and met with officials of the Moro Islamic Liberation Front. Peace, he said, is always good for development.

“The thing about the global economy, it’s a permanently dynamic process,” he said. “You no longer have the luxury to relax.”

Dynamism starts with the nation’s most valuable resource, its human capital. In developing this resource, the nation needs more investment.