Tuesday, November 1, 2016
Philippines - Prevention is better than cure
Health advocates rejoiced at the appointment of Dr. Paulyn Jean Rosell Ubial as the new health secretary, more so when she said she would focus on prevention during her watch. It is good to know that through her appointment, President Duterte plans to prioritize health in his administration.
This policy direction can be observed in his wish to send Ubial to Cuba to study that country’s world-renowned health-care system.
Yet, we all know that shifting the focus of health from curative to preventive is easier said than done. This is clearly so with all the health-destroying industries lobbying at the policy level.
Thus, to make this change happen, the new health secretary should have a clear vision targeting the very core of the health system. Pockets of change in some areas are not enough as systemic interventions are needed.
The people’s health needs and corresponding proposals must take the lead through a primary health-care approach. And to pursue this approach, a strongly progressive people’s participatory process is essential.
It is therefore hoped that the Department of Health would redefine the health system in the next six years through this four-point action plan:
Apply a “whole-of-government” (or health-in-all-policies) direction, via a whole budget approach, as a primary health-care strategy.
The highest attainable health standards for the Filipino people can progressively be realized through this approach. The Asia-Pacific Economic Cooperation also called for it through the “Healthy Asia-Pacific 2020 Initiative Roadmap.” Indeed, health advocates have long been practicing the whole budget approach in their alternative budget engagement with the DOH. By applying this, the DOH will gradually cease to be the manager of diseases. Instead, it will be forced to directly address the long-neglected social determinants of health since it would have in its arsenal the resources of the entire government.
For this to succeed, the DOH needs to do three things: 1) Ensure a systemic response to solve health problems; 2) apply, monitor and evaluate health-related policies that are consistent with the whole-of-government approach (i.e., Local Government Code of 1991); and 3) lead the way to evidence-based policymaking by prioritizing relevant researches on health, nutrition, science and technology, and climate change. Evidence must be interdisciplinary across various sectors (i.e., academe, nonprofit NGOs, and even grassroots communities).
Strengthen frontline health workers toward an integrative health system.
According to the Primary Care Coalition, 66 percent of Philippine deaths are unattended by any health-care provider.
To strengthen health workers, their pay, benefits and working conditions should be improved. Also, the Primary Care Coalition highly recommends that the government recruit health workers in sufficient numbers and retrain, retain, regulate and periodically reassess their performance. Currently, the health-care delivery system has more specialists than the most-needed primary care practitioners who address more of the people’s health-care needs daily.
In addition, I suggest that medical and allied health curricula be reoriented. In a 2005 study titled “Physician Migration: Views from Professionals in Colombia, Nigeria, India, Pakistan and the Philippines,” it was shown that training and practicing abroad provide a high level of social prestige to professionals, thus encouraging the exodus of the best and brightest of physicians.
The primary health-care strategy also offers a solution to a weak health workforce. The latter can be enhanced by making communities partners, and not just beneficiaries, of downloaded health programs. This will allow for the maximum use of local/indigenous resources and methods to address health needs.
Manage a complete, accurate, integrated and up-to-date health information system.
The need for these health-related aspects cannot be overemphasized. This is especially so given our highly mobile and globalized world where epidemics and pandemics can emerge at any time.
Address the commercialization of healthcare.
In the 2008 World Health Report on Primary Healthcare, “commercialization” was identified as one of the current trends capable of undermining a health system’s response.
Therefore, the principle of health-care services/delivery as a common and social good must be upheld at all times. Because the privatization of health facilities and services cannot be allowed, the private sector’s participation should be highly regulated. Also, the widespread use of health products and technology should be needs-driven; thus, consumer protection and education are very necessary.
In conclusion, I believe that only with the simultaneous, effective and efficient implementation of this four-point action plan can the focus on prevention be realized: not just primary, but from primordial to tertiary prevention. And surely, this should be with the highest possible participation of the people—from planning to the evaluation of programs and budgets.
Maria Fatima A. Villena is a health policy student at the University of the Philippines Manila, the owner of www.healthactivist.ph, and a member of the largest coalition engaged in the health budget (Alternative Budget Initiative-Health Cluster).