Today was our briefing on the national situation and the activities of CHD. In order to tackle the roots of the people’s ill health, a broad perspective must be taken. It is only within this context that a full understanding of the health crisis in the Philippines can be understood. Hence, this blog entry is long! However, I found it very interesting to learn the true situation as well as compare to what is happening to public health care in Canada.

The three key issues in the Philippines remain:
1. Foreign domination
2. Landlessness
3. Corruption

Within this overarching context millions of Filipinos get sick or die from preventable and curable diseases; the health gap grows rapidly while the public health care system is collapsing due to neoliberal policies, under-financing, and the exodus of health care professionals.

The health crisis highlights that the people’s health situation is an outcome of neoliberal policies of privatization, deregulation and liberalization.

What is the situation of people’s health?

The leading causes of morbidity are communicable infectious diseases which are preventable and have simple cures;
- Major causes of death are heart disease, cancer, and accidents, followed closely by TB (tuberculosis) and respiratory tract infections.
- TB incidence 4th highest in the world and 75 Filipinos die of TB daily
TB is a disease which follows the course of poverty, considered to be a poverty indicator (for those of you in Vancouver, compare to the rise of TB in the Downtown Eastside!). In 2003 TB accounted for 40% of the death rate per 100,000. WHO cites the Philippines as worst in the region with 36% of the population afflicted.
- Child mortality rate (1-4 yrs) is 12/1,000 – WHO cites the Philippines as one of the 42 countries that contributes to the over 90% of global child deaths; the top 5 leading causes of child death are: pneumonia, accidents, diarrhea, measles and congenital problems.
- Neonatal mortality rate (0-1 month) is 17/1,000
- Maternal mortality rate 70/100,000; 10 mothers die daily due to pregnancy and childbirth related causes.
For the midwives reading this blog, the leading cause of maternal mortality are:
Labour and delivery complications, hypertension, postpartum hemorrhage, and complications with abortion.
- The maternal mortality rate has not improved in this decade.
There is a massive DEATH GAP between the rich and the poor:
- Poorest 20% account for 66% of the under 5 mortality;
- Poor children are 3 times more likely to die than the child of a rich family.

Ill Health = the People’s Basic Needs Not Met

- 22% of the population undernourished
- 28% preschool children underweight and 27% stunted
- 27% of pregnant women are underweight
- Anemia in under one year olds is 66%
- 37% or 27 million Filipinos do not eat three times a day
- 16.5 million Filipinos go hungry daily and 15 million Filipinos eat only once a day

Of households in the Philippines
- 35% of households have no access to safe drinking water
- 48% have no electricity
- 60% have no concrete house
- 30% have no clean toilette

Going back to the introduction to this blog entry, we know that the roots of this ill-health crisis lie in the priority of the government to serve imperialism over the people!

Let’s examine the situation in the Philippines from the perspective of the WHO.

According to the WHO, the causes of poor health care systems and delivery are:
1.Poor Health Care Financing
a.GDP spending on health ranks 174th out of 192 countries; 0.34% of GDP, less than the 5% prescribed by the WHO
b.The military budget is 6 times the health budget, while debt servicing is 63 times the health expenditure! (Thank you IMF/WB!)
c.Government expenditure on health as a percent of total health care expenditure ranks 156th and only 6.3 of the governments budget is allocated to health

2.Inappropriate Delivery (i.e. focus on tertiary care over primary care)
a.The number of hospitals is growing, but concentrated in urban centres
b.Barangay (neighbourhood) health stations limited to 2/10,000 population
c.Doctor to patient ratio (population)
i.Cuba 1:225
ii.USA 1:450
iii.Philippines 1:10,000-26,000
iv.Ideal (WHO) 1:600
d.Medical tourism is rapidly expanding, directly promoted by the GMA (Gloria Macapagal Arroyo) government. Rather than providing health care to the masses, the major tertiary care centres in the country are focussing on advanced medical care to tourists and private pay patients in order to generate profits.
e.At the same time:
i.5 out of 10 Filipinos die without getting any medical attention
ii.Only 60% of the population has full access to essential drugs
iii.The average hospital bill is three times the average monthly income

3.‘Brain Drain’ of Professionals
a.Health situation exacerbated by the diaspora of health workers due to the Philippine government’s Labour Export Program
b.Philippines is the biggest exporter of nurses; thus there are a mere 5 per 100,000 population
c.Many Filipino health workers end up de-skilled in their country of destination receiving lower pay than their counterparts (Canada is a prime example, more on the LCP later!)
d.Doctors are re-training as nurses for the purposes of working abroad

4.Excessive Pricing of Medications
a.Leads to massive out of pocket expense and inappropriate use (such as failure to complete TB medication regimens exacerbating resistant TB)
b.Medicines are vastly overpriced in the Philippines due to the monopoly of the Pharma giants facilitated by government patenting laws
c.Yet, the top 10 drug manufacturer’s profits were 4 times the national health budget!

5.Insufficient Efforts on Prevention and Control of Disease
a.Public health prevention programs are grossly inadequate
b.TB control and treatment is failing miserably at the expense of people’s lives
c.Control of diarrhea diseases covers only 14% of total cases and is limited to ORS

6.Inadequate Enforcement of Regulatory Mechanisms
a.HSRA (health systems reform act) was drafted in 1999 with financial and technical assistance of the US. Neoliberal policies are couched in terms which sound conducive to the expansion and strengthening of primary health care. One must read between the lines to grasp the implications of the HSRA:
i.“Provide fiscal autonomy to government hospitals” means that the budgets of government hospitals must be garnered from private sources, primarily through private-pay schemes.
ii.“Secure funding for priority public health programs” means foreign aid and loans which would demand implementation of projects implemented by TNCs (trans-national corporations) such as population control and food aid programs.
iii.“Strengthening of health regulatory agencies” really means promoting competition in the health market by providing information from competing private entities, ultimately resulting in government sponsored direct to consumer advertising of health services and products.

Compare those 6 key points of the WHO to the key priorities of the IMF/WB neoliberal prescription for health care delivery:
1.Reduction in public health expenditures
2.Promotion of private financing
3.User-fee health services
4.Competition in the delivery of clinical services

This neoliberal prescription for health care is at the root of the dire health situation in the Philippines!

With this situation in mind, we embark upon a life-changing learning experience to witness the community and sector organizing work of the CHD and allied organizations. I thought those of you who are following our trip might benefit from this information, so that you can read our blog entries with this context in mind.