health in the philippines -...

Health in the

Philippines

Status and System

Ramon Lorenzo Luis Rosa GuintoRegional Coordinator for the Asia-Pacific

International Federation of Medical Students’ Associations (IFMSA)

Doctor of Medicine Class of 2012

University of the Philippines Manila

• Halo-halo in terms of

–Population profile

–Values and Perspectives on

Health

–Health care delivery and

financing

The Halo-Halo that is the

Philippines!

Population PyramidThe Filipino Population

Map of the PhilippinesThe Philippine Government

Catholic ChurchThe Catholic Church

• Pre-colonial Times (Before 1521)

• Spanish colonialism (1521-1898)

• American regime (1898-1945)

• Japanese puppet republic (1941-

1945)

• The Third Republic (1945-

present)

Brief History of the Philippines

Demographic Characteristics

Population, total (millions) 94,013,200 (projected, NSO 2007)

Population < 25 years

(% of total population)

52.8 % (projected, NSO 2007)

49,617,400 M Filipinos

Population > 60 years

(% of total population)

6.7% (projected, NSO 2007)

6,637,100 M Filipinos

Birth rate

(births per 1,000 population)

23.4 (NDHS 2008)

2,162,303 live births per year

Death rate

(deaths per 1,000 population)

5.48 (NSO 2007)

515,192.34 deaths / year

Top Ten Cause of MortalityCause Total Rate

1. Diseases of the heart 70, 861 84.8

2. Diseases of the vascular

system

51,680 61.8

3. Malignant Neoplasms 40,524 48.9

4. Accidents 34,483 41.3

5. Pneumonia 32,098 38.4

6. Tuberculosis 26,770 31.0

7. Unclassified 21,278 25.5

8. Chronic lower respiratory

diseases

18,975 22.7

9. Diabetes mellitus 16,552 19.8

10. Conditions originating from

the perinatal period

13,180 15.8

Philippine Statistical Yearbook, 2009

Mortality Trend: Communicable Diseases,

Malignant Neoplasms & Diseases of the Heart Rate/100,000 Population

Philippines, 1953-2005

0

100

200

300

400

500

600

700

1953

'54

'55

'56

'57

'58

'59

'60

'61

'62

'63

'64

'65

'66

'67

'68

'69

'70

'71

'72

'73

'74

'75

'76

'77

'78

'79

'80

'81

'82

'83

'84

'85

'86

'87

'88

'89

'90

'91

'92

'93

'94

'95

'96

'97

'98

'99

2000

'01

'02

'03

'05

Year

Communicable Diseases

0

10

20

30

40

50

60

70

80

90

100

Malignant Neoplasms &

Diseases of the Heart

Communicable Diseases

Malignant Neoplasms

Diseases of the Heart

Source: Philippine Health Statistics, 2005

Towards the attainment of MDGs

9.Indicators 2015 Target Accomplishment

MDG 4:

Under 5 mortality rate

(per 1,000 live births)

26.7 34

(2008 NDHS)

Infant mortality rate


19.0 25

(2008 NDHS)

MDG 5:

Maternal mortality ratio


52 162

(2006 FPS)

Proportion of births attended by

skilled health professional

70.0

(2010 NOH)

62

(2008 NDHS)

16

INDICATORS 2015 Target ACCOMPLISHMENT

MDG 6

Prevalence of HIV/AIDS among high risk

groups

<1%

5,364 cases

(1984-2010)

<1%

Malaria morbidity rate 62/100,000 pop

38,135 cases(based from 1990

baseline)

21.6/100,000 pop

19,555 cases

(2009)

Malaria mortality rate 0.75

456 deaths(based from 1990

baseline)

0.026

24 deaths

(2009)

TB morbidity rate 137/100,000

128,798 cases

(2010 NOH)

129 (2008)

121,277 cases

TB mortality rate <44/100,000

41,366 deaths

(PhilPACT)

41.0 (2007)

TB case detection rate 70 % 75 % (NTP, 2007)

TB cure rate 85 % 83 % (NTP, 2007)

Six Building Blocks

Office of Secretary of Health

Attached Agencies

Regional Offices

Provincial Health Offices

City Health Offices

(Component Cities)

Inter-local Health Zones

City

Hospitals

Health

Centers

Barangay

Health

Stations

District

hospitals

Municipal health

offices/ Rural

Health Unit

Barangay Health

Stations

Provincial

Hospitals

Regional hospital

Medical Centers

Sanitaria

City Health Offices

(Chartered Cities)

City

Hospitals

Health

Centers

Barangay

Health

Stations

Organization of Health Services

• Public- Private Sector imbalance

– Highly resourced private sector servicing 20-

30 % of population

– Health promotion/Disease prevention lag

behind Curative Service provision

• Fragmentation of Services

– Overspecialization of curative services

– Devolution of health services - national and

local

– Weak regulatory mechanisms


HEALTH CARE

FINANCINGIN THE

PHILIPPINES

Share of health expenditure per

GNP

0

0.5

1

1.5

2

2.5

3

3.5

4

Percent

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Year

Total health expenditure = P234.3 B or 3.2 percent of GDP

Source: Philippine National Health

Accounts

Total expenditure on health as a

Percentage of GDP

Source: World Health Statistics 2010

Distribution of Health Expenditure by

Use of Funds

Source: Philippine National Health Account, 2007

Total health expenditure is P234.3 B

(3.2 percent of GDP)

Distribution of Health

Expenditure by Source of Funds

Source: Philippine National Health Account, 2007

Total health expenditure is P234.3 B (3.2 percent of GDP)

Only those with money (i.e., the rich) can

fully pay for out of pocket payments and

often they have generous health

insurance

The near-poor and the lower middle

classes can become impoverished to

meet out of pocket for health care.

The very poor don’t even

have pockets

HUMAN RESOURCES FOR HEALTH


• Overproduction

• Maldistribution

• High out-migration

• Nil in-migration

• Low return migration

Lorenzo and Dela Rosa, 2011

Health Worker Migration

“It is estimated that 70% of all

health workers are employed in

a private health sector that

serves only the 30% of the

population that can afford to pay

for their health care. ”

“Sixty percent of our countrymen

who succumb to sickness die

without seeing a doctor.”

LEB over 80 years

IMR less than 10

MM less than 15

LEB under 60 years

IMR over 90

MM over 150

Source: Dr. Ramon Paterno, University of the Philippines

87% of poorest

quintile deliver at

home

84% of richest

Quintiles deliver in

health facility

71% by hilots 77% by doctors

More than 3,000 Filipina mothers die

UNNECESSARILY annually

Country 1985-2002

Philippines 170

Thailand 36

Malaysia 30

South Korea 20

Japan 8

Italy 7

Spain 0

MATERNAL MORTALITY RATEPer 100,000 Livebirths; 2002 UNDP Revision

Source: Dr. Ramon Paterno, University of the Philippines

Reproductive Health BillReproductive Health Bill

Ang Philippine Disaster

Situation• Pilipinas: Bulnerable sa Disaster

– Geographical at pisikal na katangian

– Sosyo-ekonomikal at pulitikal na

kalagayan

DOH DO No. 2011-0188

Kalusugan Pangkalahatan

Universal Health Care

Priority Health Policy Directions

of the Aquino Administration

1. A roadmap towards universal health care through a refocused PhilHealth;

2. Particular attention to the construction, rehabilitation, and support of health facilities: ◦ LGU/regional hospitals,

◦ rural health units

◦ barangay health stations

3. Attainment of Millennium Development Goals 4, 5, and 6◦ Reduction of maternal, neonatal, and infant mortality

◦ Support to contain/eliminate age old pubic health diseases (malaria, dengue, TB)

“The Conference strongly reaffirms that health9is a fundamental human right”

“The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable”

Alma Ata Declaration, 1978

RIGHT TO HEALTH OF THE PEOPLE

Source: Ravi Narayan, SOCHARA, India

Social Determinants

Basic question: What good does it do to

treat people’s Illnesses 9

only to send them back to the conditions that made them sick?

“The doctor of the

future will give no

medicine, but will

interest his patients

in the care of the

human frame, in diet,

and in the cause and

prevention of

disease.”

Thomas Alva Edison

“It is my aspiration that health will

finally be seen not as a blessing

to be wished for, but as a human

right to be fought for.”

Kofi Annan

The Power of Medicine

"Medicine is a social science, and

politics is nothing else but medicine on

a large scale. Medicine, as a social

science, as the science of human

beings, has the obligation to point out

problems and to attempt their

theoretical solution; the politician, the

practical anthropologist, must find the

means for their actual solution....The

physicians are the natural attorneys

of the poor, and social problems fall to

a large extent within their jurisdiction.”

Dr. Rudolf

VirchowFather of Social Medicine

The Power of Young People

“The youth are

the hope of the

Fatherland.”

Dr. Jose RizalNational Hero of the Philippines

Fathers of Social Medicine

It’s more fun in the Philippines

health in the philippines -...

Documents