By Patricia B. Mirasol, Reporter

MARIAN T. RIVAS, 59, went to a nearby state health center in the village of Talon Singko in Las Piñas City near the Philippine capital to get free amlodipine for her hypertension. She went home after being told that the generic drug was out of stock.

“Usually, medicines are out of stock,” she said in a Facebook Messenger chat in Filipino. “And most of the time, there’s no doctor. It’s usually the health worker that you have to deal with.”

It has been particularly difficult for poor people on maintenance drugs during a coronavirus pandemic, when visits to the local health center are limited.

Primary care, which focuses on prevention rather than cure, is supposed to provide wider coverage and prevent social disparities in healthcare, apart from reducing the financial burden on the public health system.

But health advocates complain that people are unaware of its benefits and government health centers are few and far between, not to mention the lack of funds to run them properly.

“There are no oxygen tanks at the local health center,” Becky S. Barrios, who heads a civic group that helps the Manobo tribe of Agusan del Sur in southern Philippines, said in an e-mailed reply to questions. “Medicines are incomplete. Losartan and other hypertensive drugs are usually out of stock.”

Primary healthcare, which should address 80% of a person’s health needs, is unlikely to succeed in a country that struggles to allot sufficient budget for its citizens’ health, she said. “Local villages lack the facilities to treat people,” she added, noting that there’s only one midwife for every barrio.

Indigenous people have also been hesitant to visit health centers for fear of being declared coronavirus positive in an antigen test, Ms. Barrios said.

Half of Filipinos don’t have access to a nearby primary care facility — one that patients can reach in 30 minutes, according to the Department of Health (DoH). The Philippines had 216,841 community health workers, based on government data from 2010.

Many of these workers are concentrated in poblacions, said Ellen Dictaan-Bang-oa, a coordinator for the indigenous women program of Tebtebba, a local resource center in Baguio City in the country’s north. “This is a challenge in cost, time and access especially for those in remote villages.”

In 2019, Tebtebba started a dialogue among indigenous youth and government agencies, where they discussed the need to build more health centers, hire more health workers and make them more culturally sensitive.

There was also an initiative to integrate indigenous birth attendants into the local healthcare system in Mindanao and Mindoro, Ms. Dictaan-Bang-oa said.

SPECIALISTS
Protecting medicinal knowledge is also an enduring concern, she said in an e-mail. Some local governments have issued ordinances to criminalize the practice of indigenous healers.

“Indigenous peoples visit baylans or traditional healers if they believe their illness is caused by spirits,” Ms. Barrios said. A baylan’s rituals include offering eggs and candles, using herbal medicines such as turmeric and moringa to treat stomach aches, urinary tract infection and other illnesses.

Filipinos usually consult specialists when they’re sick, betraying the country’s bias for a curative-, hospital- and doctor-centered service, said Magdalena A. Barcelon, president of the Community Medicine Practitioners and Advocates Association.

This healthcare model, patterned after that of the US, has led to expensive medical care in the Philippines, she said via Zoom. Specialists end up treating illnesses that primary care doctors could have easily managed.

“Prioritizing the role of the barangay in the healthcare system is a welcome development for us,” Ms. Barcelon said. “This is because the primary stakeholders are the people in the basic unit of the social infrastructure — the grassroots community, which consists of the barangay.”

Their group envisions primary care in which people can decide about their own nutrition, sanitation and other health concerns.

Health centers in the countryside should keep vital services in the peripheries because of their limited capacity, Raul S. Ting, a doctor and community health advocate from Tuguegarao City, told an online forum in September.

He had helped rural health units get coronavirus disease 2019 (COVID-19) supplies through his volunteer contacts. Among the beneficiaries were ward nurses who used to buy their own face masks and birthing units that were given disinfecting UV sterilizers.

“Last year’s work evolved into helping out rural health units because either the local government unit couldn’t afford to budget more for health services, or it was not among its priorities,” he said in a Messenger chat, noting that some cities only act if there’s income to be earned.

Letting the National Government enforce healthcare services would improve these facilities, Ms. Barcelon said. The poorer the local government, the sadder the state of healthcare in the area, she pointed out.

Republic Act No. 11223 or the Universal Health Care Law mandates a healthcare system that focuses on prevention.

But for primary care to really work, people have to be health literate, according to Christian Edward L. Nuevo, DoH’s chief health program officer for disease prevention and control. Primary care facilities also have to be expanded, he added.

Ms. Barcelon said primary care at the community level could boost rapport between health workers and patients. “A rural health doctor can monitor a patient from infancy onwards,” she said.

Ms. Rivas, mentioned at the outset, said free medicines from the health center are a big help to cash-strapped Filipinos like her. “But I feel like I have to beg for them. It doesn’t feel right.”