Surviving on a tight healthcare budget

The national budget allocation to improve the health condition of 80 million Filipinos has been the subject of dispute in Congress. While this year’s proposed P10.6-billion budget for the Department of Health (DOH) is higher than the previous year’s budget, it is still inadequate to meet the requirements of the country’s health sector. Compared with the budgets of other agencies of the government, the proposed health budget is considered measly.

The bone of contention is that while interest payments for the country’s debts account for 33 percent of the national budget in 2005 and 2006, the DOH’s share of the total budget is a negligible one percent only, or even less.

One-third or P340 billion of the P1.053-billion proposed budget for this year, which is yet to be passed by Congress, would go directly to debt servicing.

A report by the Asian Development Bank (ADB) reveals that around 12 million Filipinos survive on less than $1 or P56 a day. If computed on a daily basis, debt service payment amounts to P931 million which can already feed 16.6 million Filipinos who live on a P56 daily subsistence allowance.

Government spending on health has been on a downward trend. The share of total health expenditure to gross national product (GNP) has declined over the years, from 3.4 percent in 1995 to 2.9 percent in 2003 – way below the five percent set by the World Health Organization. This is clearly a reflection of how the private and public sectors prioritize healthcare.

In 2001, the share of total health expenditure to GDP in the Philippines reached 3.2 percent. Countries like Japan, Cambodia, Maldives and Mongolia allocated more than six percent of their GDP to health expenditure.

The proportion of the country’s general government expenditure on health to total health expenditure was 36.2 percent. Meanwhile, more than half of the selected Asian countries showed higher proportions than the Philippines.

In the case of private expenditure on health in the Philippines, its share to total health expenses remained at more than 50 percent. Most of the Asian counterparts reflected larger proportions than the Philippines, except for Bhutan, Brunei Darussalam, Japan, Lao People’s Democratic Republic, Malaysia, Maldives, Mongolia, Papua New Guinea, and Thailand.

According to a recent report by think-tank Ibon Foundation Inc., "Over the past five years, the government’s real spending for social services continually declined. The budget for education is five percent lower and the budget for health is 19 percent lower, while debt servicing is 101 percent higher than its level five years ago."

The low health expenditure and high population growth are identified as two contributing factors to the poor health performance of the country.

Given this, many are curious how the government plans to realize its health-related goals as embodied in the medium-term development plan for 2005 to 2010 presented by President Arroyo in her State of the Nation Address (SONA) last year.

Among these goals are to expand social health insurance coverage, strengthen national and local health systems through the implementation of the health sector reform agenda, improve the healthcare management system, improve health and productivity through R&D, improve access to low-priced medicines, and enhance family planning programs.

Other health-related undertakings of the government this year include allocations for the Murang Gamot project, maintenance of Botika sa Barangay in 5,000 barangays, and P2.9 billion for the health premium subsidy for indigents.

The health of Filipinos, as the government claims, may have improved, but the country’s health indicators still lag behind other countries in the region.

For instance, infant mortality rates are falling due to the decline in the rates of immunization and vaccination. The Philippines has the highest childhood mortality rate in the region at 40 per 1,000 live births.

Simply put, an increasing number of children below five years old die in our country. Moreover, based on a report of the United Nations Development Program (UNDP), the Philippines had the highest maternal deaths from 1985 to 2003.

A World Bank report says, "Poverty magnifies the need for healthcare while shrinking the capacity to finance it. Low-income countries face 56 percent of the global disease burden but account for only two percent of global health spending."

"With spending levels of some $30 per capita on average, over half of it out of pocket, low-income countries face severe challenges in providing their citizens with a basic package of essential services and a modicum of financial protection against the impoverishing effects of catastrophic illness," it adds.

Whether the Senate proposal to increase the DOH budget by P300 million for the implementation of free medical/dental assistance programs to indigent patients and P50 million for information and education campaign on breastfeeding would make a significant difference remains to be seen. This proposal, after all, is still subject to debates as the budget for the year is yet to be approved.

Meanwhile, the President, in the next couple of weeks, is scheduled to present to Congress the proposed national budget for 2007, but how the health sector will be prioritized in the scheme of things is still up in the air.

Congress should allocate a national health budget that is sufficient to conduct a total health reform program, including more access to healthcare services, wider health insurance coverage for indigents, deployment of more doctors to the countryside rather than an exodus to other countries, more graduates of nursing and medicine, and government support of the Generics Law to facilitate distribution of cheap, essential medicines.