Health Agenda for 2016 & Beyond Health for Juan and Juana Esperanza I. Cabral, M.D May 4, 2016.

1. Reduce MMR to < 70/100,000 LB 2. End preventable deaths of newborns & U 5 children 3. End the epidemics of AIDS, TB, Malaria, & combat hepatitis, & water-borne diseases & other CDs 4. Reduce by 1/3 deaths from NCDs & promote mental health 5. Prevention & treat substance abuse, e.g., narcotics & alcohol 6. Halve traffic accident deaths & injuries 7. Ensure universal SRH care, incl. FP 8. Achieve UHC, with financial protection, access to essential drugs & vaccines 9. Reduce deaths & illnesses from air, water,soil pollution & contamination & chemicals Unfinished AgendaNew AgendaPervasive Agenda Global Targets

High rates of avertable infectious, child and maternal illness and death Premature death from NCDs, substance abuse, including narcotics and alcohol Deaths & injuries from traffic accidents Universal Health Care including SRH & FP, with financial risk protection, access to essential medicines & vaccines Unfinished AgendaNew Agenda Pervasive Agenda Within the framework of the MDGs and the SDGs, the Philippine Health Agenda can be summed as follows: Philippine Health Agenda

Aquino Health Agenda “from treating health as just another area for political patronage to recognizing the advancement and protection of public health, which includes responsible parenthood, as key measures of good governance.” Benigno Aquino III, 2010

Able to use quality health services at affordable cost Cared for in modern health care facilities Prevented from falling ill through promotive and preventive health care The Aquino Health Agenda is to ensure that Filipinos, particularly the poor, are:

Republic of the Philippines Department of Health DEC ADMINISTRATIVE ORDER NO SUBJECT: The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos l. Financial risk protection through expanded NHIP enrolment & benefit delivery 2. Improved access to quality hospitals & health facilities 3. Attainment of the health-related MDGs

The Aquino Health Agenda After six years, the Aquino administration has a mixed bag of results to show for its efforts.

Legislation Credit must be given to President Aquino for the passage of four landmark laws that have the potential of improving the state of health care in the Philippines. The next administration must see to the speedy and proper implementation of all these laws. National Health Insurance Act

DOH Budget (in Billion Php) Sin Tax Revenue Sources: GAA ; NEP 2016

Health Spending In The Philippines 4.4% of GDP ≈ PhP 580 B (2015, current prices)

Financial Risk Protection PhilHealth coverage ~92 % Support value ~50 % Pay out – PhP B Government pays premiums of 15 million families Utilization rate by the poor, rising but low The greater insurance coverage of the population has increased health inequity in the country. The government is paying for the health care of the rich by subsidizing the health insurance premiums of the poor.

Access to quality facilities and services Health Facilities (2015) Existing Actual Ratio to Population Standard Ratio to Population No. Needed to Achieve Standard Gap RHUs 2,5861:39,2741:20,000 5,078 2,492 BHS 20,002 1:5,078 1:5,00020, Hospital beds 49,000 1:1,428 1:1,00070,00021,000

HFEP (2015) 75 Billion Pesos 5,000 Facilities

Distribution of Hospitals & Hospital Beds in the Philippines Hospitals ______ Beds Public Private Public Private Public Private Level 1 Hospitals Beds Level 2 Hospitals Beds Level 3 Hospitals Beds Level 4 Hospitals Beds Total Hospitals Beds

Access to quality facilities & services Human Health Resource in Public Health Employed Actual Ratio to Population Standard Ratio to Population No. Needed to Achieve Standard Gap Doctors2,9831:34,0471:20,000 5,0782,095 Nurses5,5961:18,1491:10,00010,1564,560 Midwives 16,948 1:5,993 1:5,00020,3123,328

2015 Human Health Resource Deployment Program DeploymentNumberFunds (PhP) Rural Physicians (DTTB) ,885,952 Nurses (NDP) 13,500 3,004,938,000 Midwives (RHMPP) 2, ,144,402 Dentists ,201,280 Medical Technologists 1, ,924,168 Medical Scholarship (Pinoy MD) ,512,155 Midwifery Scholarship (MSPP) ,845,600 Continuing Education 47,588,400

Reduce by two thirds, Under 5 Mortality Reduce by three quarters, the Maternal Mortality Ratio Reduce the incidence of HIV/AIDS, Malaria, TB, and other communicable diseases Attainment of Health Related MDGs - the measure of success

Health Service Delivery ProvidersProducts Financing Governance Better Health Environmental Demographic Political Economic Socio-cultural Information Social Determinants & Building Blocks of Health Better Health For All

Social Determinants of Health “Do we not always find the diseases of the populace traceable to defects in society?” Rudolf Virchow Diseases and disparities in health are often products of a “toxic combination of poor social policies and programs, unfair economic arrangements and bad politics,” WHO Commission on Social Determinants of Health In the Philippines: A Graying Population Urbanization Climate Change and Degraded Environments Internal and External Migration

The Greatest Challenge: INEQUITIES IN HEALTH CARE Wide disparity in health outcomes with poor areas more likely to: Not have access to medicines and facilities Lack qualified medical personnel Have higher morbidity & mortality rates Have lower life expectancy

"For unto every one that hath, shall be given, and he shall have abundance: but from him that hath not, shall be taken away even that which he hath." Matthew 25:29, King James Version. The Poor and Access to Health

Whither the health care system? “Would you tell me, please, which way I ought to walk from here?” “That depends a good deal on where you want to get to,” said the Cat. From Alice in Wonderland by Lewis Carroll. 24

The Health Agenda: 1) The unfinished business of the MDGs 2) The emerging health issues such as the NCDs 3) Access to quality health care regardless of ability to pay. 4) The social, economic, and environmental dimensions of health.

Key Actions to Address the 2016 Health Agenda Leadership and Governance Health Systems and Service Delivery Sufficient and Sustainable Financing for Essential Health Services Information and Communication Technology for Health Health Workforce Health Products

Leadership and Governance  Devolution highlighted economic, fiscal & managerial differences between LGUs and among LCEs.  Misaligned priorities and poor planning and implementation  Autonomy is a double edged sword. Autonomy → Better Governance Autonomy → Patronage Autonomy → Obstructionism Autonomy → Corruption

Leadership and Governance DOH Mandate: Stewardship and oversight of the health sector Situation: Decentralized system-managing national programs through LGUs; Creeping renationalization; Responsibility without authority

Health Systems and Service Delivery multi-stakeholder involvement to ensure adequate representation of all parts of the system; local infrastructure for system-wide capacity and health workforce development; whole of government approach to leverage resources and reduce duplication in health financing; local government ownership/partnerships with private sector even as national government provides policy directions, resource augmentation and overall leadership evidence-based M & E systems and link provision of resources to results.

Information and Communication Technology for Health  Quickly improve the quality and timeliness of data collection, recording, & analysis.  Better quality data to inform planning, monitoring and regulation of programs is needed.

Sufficient and Sustainable Financing for Essential Health Services  NHIP is main sustainability mechanism for Universal Health Care.  Shifts the driver of health care from supply to demand.  Increased resources needed to cover service expansion after universal health coverage is attained.  Programs carefully designed to ensure better service quality, good health results, and cost containment.

 Sufficient number & appropriate mix of staff that are competent, & caring, & distributed according to need.  Private sector providers needed to augment / complement healthcare workforce in the public sector.  Public & private sector providers must work together to achieve the best health outcomes possible given limited resources. Health Workforce

 Essential medicines, vaccines and technologies available, affordable, and of assured quality.  Selected based on real needs, evidence of efficacy and safety and cost effectiveness.  Medical products used appropriately so as not to waste limited resources and jeopardize the quality of health care. Health Products

 Most government health facilities in a state of disrepair. Time to increase & upgrade all public health facilities  Need for more high level health care facilities that provide quality health care at sustainable costs for the poor in all regions. Health Facilities

 progress on health inadequate despite sustained economic growth  put health as a priority  mitigate the impact of poor maternal and child health, prevalent infectious diseases, increasing NCDs and of a changing climate.  invest to achieve good health. Focus on economic growth and wealth has often missed the core reason for development—

Improving the lives of all people…