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).
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