philippine situationer: global health course 2010
TRANSCRIPT
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The PhilippinesNational Health Situation
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The Philippines is an archipelago of
,7 107 islands with,a total land area
including inland,bodies of water of
approximately,300 000 square
kilometers
( ,116 000 square
).miles
Its,36 289 kilometers
( , )22 549 miles of coastline makes it the country with the 5th longest
coastline in the.world
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(Dry Season March)to May
( Wet season June) to November
Averaging 20 or
more typhoons Cold Season
( - )December February
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Located in the
Pacific Ring of Fire and is exposed to
almost the full array of natural( ,hazards earthquakes, ,typhoons landslides
, .)floods etc
Ongoing complex emergency in
southernmost island of Mindanao
Highest number of disasters per( )country in 2009 26
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POpulation
Aug 2007: 88.57MProjected 2010 population: 94.01M2.04% annual growth rate (2000-2007)
More than doubled in less than 40 years!(1970-2007)
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POpulation
Aug 2007: 88.57MProjected 2010 population: 94.01M2.04% annual growth rate (2000-2007)
More than doubled in less than 40 years!(1970-2007)
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Political system
Recently concluded itsfirst automatedelection last 10 May2010
The country is made up of political localgovernment units of provinces, cities,
municipalities andbarangays (villages).
Local Government Code of 1991
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Economy
GDP (2009) = Php 161 Billion (2.8BEuro)
GDP Growth in 2009: 1.8% (Q4), 0.9%(annual) from 3.8% in 2008
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Economy
69 million Filipinos (80% of population)struggle to survive on Php 96 (1.3 Euro) orless a day
46 million Filipinos go hungry every day
(i.e., unable to meet minimum nutritionalneeds)
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Wages are not enough tosustain a decent life.
:June 2008 iving Wage ------------------------------- . (P 911 00 16
)Euros
( , NCR family of 6 according to the Nat l Wages)and Productivity Commission
aily Minimum Wage ---------------- . ( .P 382 00 6 7)Euros
( , )NCR including COLA
--------OT ENOUGH . ( .P 529 00 9 3)Euros
Prices of basic goods are rising faster than wages.
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While the rich are getting richer
Net worth of 10 richestFilipinos:
US$12.4 billion or 10B Euro(2006)
Equivalent to the combinedannual income of poorest9,600,000 families
(approximately 49million Filipinos)
(Ibon Databank 2007)
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Number of Unemployed
POEA data
2.3
2.6
3.2
3.8
Cory Ramos Erap Gloria
Number of unemployed (millions)
1987-1991 1991-1997 1997-2000 2001-2008
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Migration
POEA data
361,833469,709
693,815
1,008,303
Cory Ramos Erap Gloria
Number of migrant workers deployed yearly
1987-1991 1991-1997 1997-2000 2001-2008
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Decreasing self-sufficiency in foodproduction, including rice
-1.5
-1
-0.5
0
0.5
1
1.5
2
80 81 82 83 84 85 86 87 88 8 9 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05
$ B
Balance of trade in food 1980-2006
Pinaghalawan: WTO online database
1980 (1.41)
1995 (-0.14)
2006 (-0.49)
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Spending for health
Total Health Expenditure is 3.7% of GDP(less than WHO recommended 5%)
38% (?) of population has PhilHealthCoverage (NDHS 2008)
Most (46.4%) of the family expenditurefor health goes to drugs & medicines
Philippines drug prices are 3.4 to 184times the international referenceindex.
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Spending for health
.o t a l H e a l t h E x p e n d i t u r e P 0 2 5 p e r i l i p i n o p e r d a y
59% outof pocket
23%government
18% Shared-
Risk SchemesIncludingNational HealthInsurance(PhilHealth)
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Average spending in nationalbudget per admin (% of GDP)
Aquino Ramos Estrada
Arroyo
Education .2 7 .3 1 .3 7 .2 7Health .0 7 .0 5 .0 5 .0 3Housing .0 0 .0 1 .0 2 .0 1Defense
.1 3 .1 3 .1 1 .0 9 ebt service( &nterest
)r incipal
.8 9 .6 8 .6 6 .10 1
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Average sectoral allocation innational budget per admin (%)
Aquino Ramos Estrada
Arroyo
Education .12 3 .15 5 .18 7 .15 1Health .3 1 .2 6 .2 4 .1 8Housing .0 1 .0 6 .0 8 .0 4Defense
.6 1 .6 7 .5 6 .5 0 ebt service( )nterest only
.40 0 .25 3 .19 2 .25 2
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Debt service always atexpense of social services (1)
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Worsening State Neglect
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National Budget picture for 2010
DEBT SERVICE - INTEREST PAYMENT 17.94%
EDUCATION 10.47%AGRICULTURE 2.22%ARMED FORCES 1.98%HEALTH 1.6%
Total National Budget: Php 1.54T (27BEuros)
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700
,0 000
Average Life Average Life Expectancy of Expectancy of(Filipinos in (Filipinos in
)years )years
Filipino Babies dying of PREVENTABLE causes
ANNUALLY
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Indicators
CBR: 20.5 / 1000CDR: 4.8 / 1000Healthy Life Expectancy (HALE): 62 (M:
59 years, F: 64 years) (WHS 2010)
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IN FA N T M O RTA LITY R ATE
Decline in IMR between 2003 and2008 is statistically insignificant
(NSO)
( )DHS 2008
(Galvez-Tan, 2009)(Galvez-Tan, 2009)
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UNDER-5 MORTALITY
Survey Year
Approximatecalendar
period
Under-five mortality
Rate StandardError
95%ConfidenceInterval
Lower bound
Upper bound
1993 1988-1992 54.2 - - -
1998 1993-1997 48.4 2.8 42.7 54.1
2003 1998-2002 39.9 2.8 34.4 45.5
2008 2003-2007 33.5 2.5 28.6 38.5
Table 1. Trends in childhood mortality rates, with standard errors and confidence intervals, Philippines Sources: 1993 National Demographic Survey, 1998, 2003 and 2008 National Demographic and Health Surveys
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M AT E R N A L M O R TA LITY R ATIO
Between 1990 and 1998, the improvement ratewas 14% while that between 1998 and 2006 wasonly 6% , an almost 50% drop
(Galvez-Tan, 2009)(Galvez-Tan, 2009)
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LEB over LEB over 800 yearsyears IMR less than IMR less than 100 MM less than MM less than 155
LEB underLEB under 0 0 yearsyears IMR over IMR over 900 MM over MM over 15050
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butbut 70%70% of Filipinos haveof Filipinos have no accessno access totoessential drugs.essential drugs.
There are moreThere are morethanthan 16,00016,000registeredregistered
medicine in themedicine in thecountrycountry
ACCESSCCESS
WHO World Medicines Situation, 2004
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Health Human ResourceS
No. 1 Exporter of Nurses An estimated 85% of employed Filipino
nurses (more than 150,000) are workinginternationally. (Aiken et al 2004)
70% of all Filipino nursing graduates areworking overseas. (Bach 2003)
No. 2 Exporter of Doctors68% of Filipino doctors work overseas, next
to India. (Mejia, WHO 1975)
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Health Human ResourceS
200 hospitals have closed down within thepast two years no more doctors andnurses
800 hospitals have partially closed (with oneto two wards closed) lack of doctors andnurses
Nurse to patient ratios in provincial and
district hospitals now 1: 40 to 1: 60Loss of highly skilled nurses in all hospitals
across the country(Galvez-Tan, 2009)(Galvez-Tan, 2009)
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Health Education
The number of nursing schools
have increased
1970s: only 40
1990s: 170 June 2003: 251
April 2004: 370
June 2005: 441
June 2006: 470
Decreasing passing rate inthe national nursinglicensure examinations
1970s/80s: 80%-90%
1991: below 61%2001-2003: 44%-48%
2004: 55.9%
2005: 49.7%
2006: 41%
June 2008: 48%/35%
(PRC 2008)
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Health Services for Sale: Medical Tourism
Principally beingpromoted by thePhilippinegovernment usingthe public healthcare system
Linked to the issue of organ trade (i.e. saleof kidneys for
US$3,000-4,000)Expected revenues:US$ 10B in 5 years
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IGHT TO HEALTH OF THE PEOPLE
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ocial OBLIGATION ocial OBLIGATION .S .S PROFITROFIT