THE PHILIPPINES, which has a population of over 105 million, has less than one hospital bed per 1,000 people, according to Dr. Arturo S. De La Peña, president and chief executive officer of St. Luke’s Medical Center (SLMC).

“This is way below the minimum requirement suggested by the World Health Organization (WHO) of three hospital beds per 1,000 people,” he said at “The Future of the Hospital,” a webinar organized by SLMC’s College of Medicine.

To alleviate the burden on hospitals responding to the coronavirus disease 2019 (COVID-19) pandemic in the Philippines, panelists recommended a multisectoral solution that invests in healthcare, education, technology, and community development.

A collaborative effort can also address other issues plaguing the health system, including brain drain, natural disasters brought about by climate change, poor design and infrastructure of hospitals, and the rise of infectious diseases.

“Communicable diseases related to lifestyle and bad habits like smoking, cancer, diabetes, and other chronic illnesses have an impact on our healthcare delivery, especially hospitals, because in the late stages of these diseases they will also require the services of the hospital,” said Dr. De La Peña.

In Rwanda, health workers who bridge the gap between community health centers and hospitals remove the unnecessary strain on hospitals, since people receive care before reaching the point of requiring hospitalization.

“As a global health fighter, I still have a macro view on what the hospital should be. Your health system has to be taken as a whole. There are so many other components aside from the hospital that are neglected,” said Dr. Agnes Binagwaho, vice-chancellor of University of Global Health Equity and Former Minister of Health in Rwanda.

“If I had all the money now, I will not base it on hospitals. I will base it on community. The whole world is going for the idea that care is in the hospital, but it should be the idea that care is where I am on my own two feet,” she added.

The value of the patient’s voice and experience is still underrated, added panelists. “In all policy documents, you always see a pyramid and at the top you have hospitals. That’s completely false. We need to change that paradigm and reverse the pyramid to see an emphasis on patients,” said Valéry Ridde, director of health research at the Population and Development Research Center (CEPED), a joint unit of the University of Paris Descartes and the Research Institute for Sustainable Development (IRD) in France.

Kara Magsanoc-Alikpala, board member of the Philippine Alliance of Patients Organization (PAPO) and vice-president of the Cancer Coalition of the Philippines, called on hospitals to include patients at the decision-making table: “Though the patient movement around the world has evolved quickly and we patients have active participation in our own treatment, public and private hospitals have to take it to the next level.”

Hospitals should be integrated into communities, said Dr. Aileen R. Espina, member of the Healthcare Professionals Alliance Against COVID-19 (HPAAC) and former chief of the Eastern Visayas Regional Medical Center, whose experience with hospitals operating during disasters like Typhoon Yolanda taught her that surge capacity should be viewed in terms of functionality and not just beds.

“The real frontline is not the hospital, but the community. It’s an ecosystem that’s only as strong as its weakest link,” she said. “We don’t want white elephants. We want the capacity to expand services if there’s a call or need for it.

Sonia Roschnik, international climate policy director of Health Care Without Harm, pointed out that hospitals should shift to being paid by results and not by activity. “If the purpose of the hospital is to provide good health and support to communities, then that’s what we should be paying them for, not operations, pills, and medications. This requires leadership from everyone — to develop healing places,” she said. — Brontë H. Lacsamana