MANILA - Although the government claims to do its best in improving health services for the people, the dire working conditions of nurses and doctors and the diminishing health budget speak of a moribund healthcare system. As if this is not enough, the Arroyo administration is even tolerating the harassment of community health workers who only wanted to serve the underprivileged in far flung areas.
Health organizations such as the Health Alliance for Democracy (HEAD) joined other labor groups in the Labor Day rally on May 1, slamming the failure of President Gloria Macapagal-Arroyo's administration to address the "woes of the health sector." Worse, under Arroyo's term, the military has illegally arrested and detained 43 community health workers, dubbed the "Morong 43," when these practitioners serve the people who do not have access to healthcare, HEAD said in a statement.
"The grossly inadequate budget allotted for health services has forced many health professionals to work abroad, while those who opted to stay are stuck in unfair labor practices and low wages," said Sean Velchez, HEAD national staff.
The 2010 national budget is P1.541 trillion ($34,543,824,254 at an exchange rate of $1=P44.61), P115 billion ($2,577,897,332) higher than the P1.426 trillion ($31,965,926,922) 2009 national budget. The amount allocated for health is only P33.678 billion ($754,942,837) or 2.2 percent of the budget, while debt servicing receives the biggest allocation, totaling P340.8 billion ($7,639542703).
This translates to a meager budget of P362 ($8.11) per person for the entire year, not even enough for a month's supply of basic medication, said Velchez, adding that seven out of 10 ill people die without even seeing a health practitioner.
Moreover, in the budget, only P16 million ($358,663) is allocated for indigent patients in all Department of Health hospitals. If P2000 ($44.83) is spent on each patient, only around 8000 patients, or less than 0.01 percent of the population, will benefit from the allocation.
Indeed, "the state of the country's health sector, along with other social services, has degraded alarmingly under the nine years of Arroyo's term," said Sonny Africa, head researcher of independent think-thank IBON Foundation (see chart).
There is nothing in the national budget to keep health workers from pursuing their careers in other countries, especially if they are underpaid and overworked in public hospitals, said Christian Mostrales, a member of HEAD. Coupled with the "export-oriented" system of education in medical schools, these working conditions push health workers to look for greener pastures abroad.
Misdiagnosis
"The Philippines, as part of a larger policy to encourage worker migration, has been training health workers, especially nurses, for export for many years-they constitute 76 percent of foreign nurse graduates in the United States, for example," according to the World Health Organization 2006 report.
Mostrales said the Arroyo administration depends on the exodus of health practitioners, along with other overseas Filipino workers (OFWs), to keep the economy afloat. Overseas Filipino workers, around 7 percent of whom are doctors and nurses, have sent back US$17.9 billion worth of remittances in 2009, constituting 10.8 percent of the country's gross domestic product (GDP), according to a report from The Bangko Sentral ng Pilipinas.
The government uses labor export to boost the economy, although the Migrant Workers and Overseas Act of 1995 states that "the State does not promote overseas employment as a means to sustain economic growth and achieve national development."
"When a country has a fragile health system, the loss of its workforce can bring the whole system close to collapse and the consequences can be measured in lives lost. In these circumstances, the calculus of international migration shifts from brain drain or gain to 'fatal flows'," the WHO report read.
Furthermore, the education system of many medical schools in the country is "commercialized and westernized," giving attention to foreign diseases such as Alzheimer's, said Velchez. "They are preparing the students to cater to the global market," he added.
"But if health workers want to leave the country, who could blame them if their starting pay here is P12,000 ($268.99) compared to P35,000 to P40,000 ($784.577 to $896.659) in other countries?" Mostrales said.
'Bled-dry'
Velchez said that in his experience in a public hospital in Tondo, the normal nurse to patient ratio is 1:50 to 1:100, while the recommended ratio is 1:4. Many nurses even work overtime - 24 hours without sleep - without additional pay.
Some government hospitals do not even provide face masks to nurses even when they have to work in a ward, Velchez said. "In my case, I have to recycle my gloves until they melt," he quipped.
The situation worsened when the Salary Standardization Law III was passed last year, said Velchez, adding that HEAD and other organizations are lobbying for the government to repeal the law.
All the benefits under RA 7305 or Nursing Act of 2002 were eliminated; while standard allowances were retained it was no longer based on the amount prescribed by Magna Carta for Public Health Workers, explained Benjamin Santos, president of All UP Workers Union-Manila. Under SSL III, most health workers will receive P18,808 ($421.609), around P4,000 ($89.665) less than the P21,766.25 ($487.92) prescribed by the Magna Carta.
With this situation, the next administration "has a lot of cleaning to do," Santos said.
Prescription
First, whoever wins the top position in the May 10 elections should generously increase the budget for health, Santos said. The allocation is best pegged at five percent of the GDP as recommended by the WHO.
The current allocation for health is less than one percent of the GDP. With an adequate budget, health workers in tertiary hospitals may receive ample salaries and benefits, which will help keep professionals from going abroad, said Mostrales.
Also, the government must deploy more practitioners especially in poor communities, where people could not afford quality healthcare, Velchez said.
"Of course, there should be no militarization in communities because it hampers community-based health services. The military clumps together armed rebels and those who only wanted to provide services to the needy," said Velchez.
However, the problems of the healthcare system do not stand in isolation, said Velchez. The problems of the health sector will only be addressed if the next administration also addresses the root causes of poverty, such as lack of genuine land reform, he added. (Bulatlat.com)