BY THE time you read this, I will be in Copenhagen,
Denmark, to attend the Fourth Women Deliver Conference, a global gathering that
focuses on the role of women in advancing the health agenda.
As the
conference title suggests, women “deliver” not just because they literally and
physically deliver babies, but also because, when their energies, genius, and
voices are recognized, respected and harnessed, they deliver as well health
services and policies for the greater good.
In the
Philippines, women indeed deliver health for all. The vast majority of health
workers, the grassroots, frontline service providers, many of them volunteers,
are women. As health workers, they are also community organizers, community
builders, conduits to officials at the town center, trusted confidants, and
sources of information and counsel.
In the
health centers, the people in charge are mostly women—midwives and nurses—while
many of the doctors who have eschewed high-salaried professional posts in the
cities are women as well.
As a side
story, one municipal official once told me that about the first thing officials
like him do when a woman doctor who is single is assigned to the town’s health
center is to go hunting for a possible groom for her. “That way, we are sure
that she will stay long in the town and build roots here,” he declared. And he
claimed that such a matrimonial strategy has had a number of success stories.
MATERNAL health and survival have become a focus of the
Department of Health, and by extension the national government, said Dr. Jondi
Flavier, executive director of the Philippine Center for Population and
Development.
In a
Facebook post shared by the hosts of the radio program “Magandang Gabi, Dok”
(Good Evening, Doc), Flavier, who was a program guest, discussed the efforts of
the DOH to more purposively address the problem.
And it is
a major problem. Despite developments elsewhere in the world, where maternal
mortality rates have fallen, in the Philippines the MMR increased from 162 in
2006 to 221 in 2011, reversing a downward trend. This is why the country failed
to meet its Millennium Development Goal of bringing down the rate of maternal
deaths to 52.
Part of
the effort to bring down the number of maternal deaths, said Flavier, was the
construction of health stations in barangays or villages countrywide, usually
on the grounds of the local public school. These health stations make it
possible for schoolchildren and for pregnant mothers to come for regular and
prenatal checkups.
Also part
of the maternal health approach is the Maternity Package offered by PhilHealth,
said Flavier, that provides to members four free prenatal checkups, blood work,
immunization, delivery services and postnatal care, as well as neonatal
screening.
Significantly,
the radio interview was carried out during “Safe Motherhood Week,” which is
observed in the second week of May, providing a bit of refreshing good news on
the largely dismaying landscape of maternal health in these islands.
ALSO good news, as mentioned by
Flavier, is the policy of universal health coverage under the state-run
PhilHealth (a keystone of the campaign platform of presumptive senator Risa
Hontiveros, by the way).
Under the
P-Noy administration, PhilHealth aggressively expanded its coverage, such that
it now provides health insurance for 80 percent of Filipinos. This, said
observers, was made possible with resources derived from the so-called “sin
taxes.” The expanded PhilHealth coverage translated to better services for
mothers, because the influx of funds, said a study of the Ateneo Center for
Health Evidence, Action and Leadership (A-HEALS), served to “motivate skilled
birth attendants (midwives, mainly) to do antenatal checkups, bring their
patients to the birthing facilities, and follow up with postpartum care.”
But
first, mothers have to be convinced to visit the health centers or stations.
This is where, I think, the 4Ps (for Pantawid Pamilyang Pilipino Program), the
government’s title for the conditional cash transfer program, has played an
important role.
Part of
the “conditionalities” of the 4Ps, which means “Bridging the Filipino Family,”
is that school-age children be brought for regular health checkups (including
immunization) to health centers, while pregnant mothers pay at least four
visits for their regular checkups. At the same time, beneficiary families (but
mostly mothers) are expected to attend the monthly “family development”
sessions, where, among other topics, family health and maternal health
(including family planning) are discussed.
Targeting
poor families with young children, the 4Ps doubtless played a big role in
convincing parents that it pays to look after the health of the whole family.
The cash transfers may have eased the situation of the most desperate parents,
but it also gave them a cushion of security to prioritize health in their
hierarchy of needs.
PART of the economic agenda of the incoming
Duterte administration, we are told, is “expanding” the 4Ps (or whatever name
they choose to call it). I have yet to read details of how this expansion is to
be achieved, but I hope it is not to put it under the purview of local or
national officials, who doubtless see it as a highly effective political tool
and who had been chafing because they had no hand in its implementation or
access to its funds.
But the
4Ps succeeded mainly because P-Noy chose to keep a “hands off” policy with
regard to it, allowing the policies to be dictated by nothing but the common
good. I hope someone in the Duterte camp, if not the presumptive President
himself, protects the 4Ps from exploitation and corruption.
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