Harnessing  the  PCP  to  Champion  Advocacies  

In  Medicine      PRA    Annual  Conven:on  

February  27,2014  

Philippine  College  of  Physicians  (est.  1954)  

• Healer    •  Execu2ve  /Entrepreneur  • Advocate    •  Leader  •  Teacher  • Hero    

Flow  of  the  Presenta:on  

1.  Background  on  Philippine  Healthcare  System    2.  The  HERO  program  of  the  PCP  in  2007    3.  Strengthening  the  PCP  organiza2on  through  

Focused  Strategic  Goals  4.  Aligning  PCP  advocacy  programs  with    PH  top  

causes  of    mortality    5.  Execu2on  /Implementa2on    of    programs  6.  Call  to  Ac2on    

Philippine  Healthcare  Situa:on      •  Epidemic  of  

noncommunicable  diseases  or  lifestyle  diseases  eg.  Stroke,  heart  aVacks,  cancers,  COPD,  diabetes    

•  Shortage  of  MDs  (primarily  due  to  maldistribu2on)    

•  Lack  of  health  infrastructures  in  the  countryside    

•  Cura2ve  rather  than  preven2ve  approach    

•  Low  level  of  health  literacy    

Why  do  we  fail  at  what  we  set  out  to  do  ?  

1.   Ignorance  :  we  may  err  because  science  has  given  us  only  par2al  understanding  ;  Educa2on  is  key.  

2.   Inep:tude  :  knowledge  exists,  yet  we  fail  to  apply  it  correctly.    

 Gorovitz  and  MacIntyre,  1970  

 2  reasons  why  we  fail    

 

SPIRIT OF H.E.R.O. Health Education Reform Order- EO 595

Better health outcomes through preventive health education

among Filipino schoolchildren

Better health service delivery for Filipinos thru relevant education of

future healthcare workers (barangay health workers, public )

HERO Launch : PCP Convention - May 2007

H.E.R.O. : Metrics of Success

In the next 5 years : 2008-2013 1.  Help reduce Burden of Communicable Disease 2.  Help reduce Burden of Non-Communicable Disease 3.  Reduction in expenditure for hospital care for the

management of preventable diseases –  Out of pocket costs –  Reimbursements from PhilHealth –  Expenses of Government Hospitals in Inpatient Care

4.  Positive change in knowledge, attitudes, and behaviors of teachers, schoolchildren and their families in both elementary and high school on preventive health concepts

–  Documented through examinations of students and surveys of parents/ families

–  Decrease in the drop rates in the school kids 5. Improvement in Health Policy

2014 STRATEGIC PLANNING WORKSHOP

8 June 2014, SMX Aura

Strategic  Ques2ons  How  Doctors  Think    

•  1.Where  are  we  now?  Diagnosis  ?  Eg  ICU  case    

•  2.  Where  do  we  want  to  go?  Eg  pa,ent    saved  and  out  of  ICU  

•  3.  How  do    you  get  there?  Eg  Plan  of  Ac,on    

1.  Engaging & Enabling Members 2.  Empowerment & Capability Building of Chapter 3.  Pursuing the Advocacy & Legislation Agenda 4.  Building a Culture of Professionalism & Integrity 5.  Enabling & Supporting Trainees and Examinees to meet

Standards 6.  Strengthening Strategic Linkages & Partnerships with

Allied Organizations 7.  Redefining College Governance & Stewardship 8.  Branding the PCP Leadership 9.  Future Funding strategy for PCP 10.  Engaging in Translational Research

STRATEGIC THRUSTS

ST  7:  Redefining  College          Governance  &  Stewardship  

Execom  (President,  Vice  President,  Secretary,  and  Treasurer)  agreed  to  pursue  thrusts  from  2014-­‐2018  for  con:nuity  

ST  3:  Pursuing  the  Advocacy  &  Legisla:on  Agenda  

– NCDs  (an:-­‐tobacco,  healthy  diet,          non-­‐motorized  traffic,  food  labelling,  environmental  change)  

– Primary  care  – Advocacy  for  ra:onal  use  of  technology/drugs  e.g.  stem  cell,  organ  transplanta:on,  HB  4477  (compassionate  use  of  medical  marijuana)    

•  Priority  Programs  

Philippines  93  Million  Popula2on  (2010,WHO  )  

Lesson # 1 Silent EPIDEMIC 300,000 deaths in PH, 800 deaths/day,35 deaths/hour !

2.HIGHER NCD RISK

4.HIGHER MORTALITY 1.NO ACCESS TO

PREVENTION

3.NO ACCESS TO TREATMENT

LIMITED RESERVES MORE Expenses & IMPOVERISHMENT

Heart Disease Stroke Cancer Chronic Lung Ds

Biologic Risk factors

Smoking Unhealthy Diet Phys. Inactivity

Behavioral Risk Factors

Blood Sugar Blood Pressure Cholesterol BMI

Chronic NCD Morbidity/Mortality

Lesson #2 NCDs: Diseases of the POOR

Predisposing Environment

Globalization Urbanization Poverty Low Education Stress

NCD deaths per 100 thousand population

0 5 10 20 30 40 50 60 70 80

400

500

600

700

800

900

Myan Camb

Laos

Viet Indo Phil

Thai Mal Sing Brun

Gross National Income (International Dollars x 103)

Dans et al (Lancet 2011)

SOURCE: WHO Report on global tobacco epidemic:Implementing smoke free environment.Geneva,Switzerland.WHO, 2009

17.5% Girls

28.3% Boys

(Philippines: Highest in South East Asia)

Lesson # 3 NCDs: Diseases of the YOUNG

Lesson # 4 Smoking is PH’s

top killer.

Counseling or Education for Risk Factor Modification Ebrahim et al, Cochrane 2011

> 55 Clinical Trials > 163, 471 patients studied

> Did not affect longevity > Did not prevent heart disease > Did not prevent stroke > Did not reduce cholesterol > Did not lower BP > Did not lower smoking rates

Lesson # 5 Education for general population is not effective.

Overcoming Resistance to Change

1. Direct the Rider 2. Motivate the

Elephant 3. Shape the Path

SWITCH,  Heath  and  Heath,  2010  

!"# To inform # To influence # To inspire

3 Principles In Communication ( Steve Jobs)

!"

6 Principles of Sticky Ideas (SUCCESs)

#  Simplicity #  Unexpectedness #  Concreteness #  Credibility #  Emotions #  Stories

Why  tax  sin  products  ?  

Universal  Health  Care(UHC)    Republic  Act  10606  

•  A government mandate aiming to ensure that every Filipino shall receive affordable and quality health benefits and services such as : – Human resources – Health facilities – Health financing  

Health  is    Wealth:    Universal  Health  Care  Realiza:on  

•  DOH  annual  budget  •  Excise  Tax    •  Tobacco  revenue  •  Smoking  related  

expenditures  1.   Indirectly,  through  loss  of    

produc2vity  and  income  2.   Directly,  household  spending  on  

chronic  medical  care,  o^en  of  catastrophic  propor2ons  

•  Php  54  Billion  •  Php  60  –  now  40  Billion  •  Php  26  Billion    •  Php  188    Billion  (Dans  

2012)  

1.  Hospitals  and  other  infrastructures  2.  Health  Informa2on  technology  3.  Human  resources  4.  Health  promo2ons  and  research  

ini2a2ves  

Why Change Hurts ? Ketan Lakhani, South Africa

!"Partnership in Advocacy

Congress  Commieee  Hearing  White  Coat  Army  -­‐  Feb  2012  

Lower  House  Plenary  Debates  :    We  won  !  

October  2012  

Recto’s  Resigna:on:  Turning  Point  15  October  2012  

Turning  Point  :  Recto  Morris  –  Drilon  (  TwiVer/FB)    

!"

Advocacy and Power of Media

# Facebook # Twitter # Prints # TV # Radio

Sec  Ona  with  Med  Org  Leading  the  Way  in  Sin  Tax  Lobbying  Nov  2012  

Sin Tax on tobacco & alcohol Approval at Malacañan Dec 20, 2012

What  the  Sin  Tax  Law  has  already  achieved  

•  Revenue  genera2on  

16.8  

32.9  

70.4  

12.4  23.9  

33.0  

0.0  10.0  20.0  30.0  40.0  50.0  60.0  70.0  80.0  

Sin  Tax  Revenues,  1998-­‐2013  (in  PhP  billions)  

Tobacco   Alcohol  

1.  Prevalence  of  smoking  among  adult  Filipinos  went  down  from  31.0%  in  2008  to  25.4%  in  2013.  

2.  There  are  3.2  million  less  smokers  in  the  country  because  of  the  Sin  Tax  Law.  

4.  Approximately  32,000  deaths  were  averted.  

5.  Health  benefits  were  greatest  in  price  sensi:ve  popula:ons  –  the  poor,  rural  folk,  the  very  old,  and  the  very  young.  

Sin  Tax  Law  Benefits    (2013)  CONCLUSIONS  (  Metrics  of  Success)  

3.  The  drop  is  partly  from  people  who  stopped  smoking.  It  is  mostly  from  people  who  avoid  star:ng  to  smoke.  

A.  Dans,  etal    

     Doctors  

 Nurses  

 Midwives  

     Ac2ve  in  Professional        Regula2on  Comm.1   66,000  

 500,000  

 74,000  

     

   Employed  in        Government  Facility2   2,838  

 4,576  

 17,000  

 

   Ra2o  per  10,000        popula2on3   0.2  

 0.4  

 1.7    

       

1  PRC  database,  2014  2  Philippine  Sta2s2cal  Yearbook,  2010.  

Health  Human  Resource,  Philippines.  

3  Total  2.3  HCW’s/10,000  pop;    WHO  recommends  24/10,000.  

New  DOH  Sec  Janeee  L  Garin  :    Maximize  U2liza2on    of  Sin  tax  funds    

 

Advocacy:  Working  Together  

If  you  want  to  walk  fast,  walk  alone  ;  if  you  want  to  go  far,  

walk  with  others.  -­‐  African  Proverb