By Dr. John Evangelista
TWO YEARS ago, my sister was diagnosed to have Stage 3 colon cancer. Her treatments have depleted her life-long savings despite the help of the Philippine Charity Sweeptstakes Office and other government agencies. Unfortunately, a lot of Filipinos are in the same predicament. In fact, one of the main reasons why Filipinos migrate overseas is to make sure that they have access to good and affordable healthcare.
The Philippines has a major opportunity to improve the health of its people with the passage of the new Universal Health Care (UHC) Law to achieve more accessible healthcare for all.
The law requires LGUs to take more responsibility for the delivery of healthcare services. Local Governments now face a challenging timeframe to lead major reform and modernise their health systems.
Running healthcare services is one of the most complex and technically demanding roles that governments undertake, requiring effective infrastructure and high levels of expertise. Poor execution of the UHC reform is a major financial and political risk for Local Governments.
The UHC Law sets in place fundamental reform to the healthcare system in the Philippines. The legislation requires universal coverage by state insurer Philhealth. It also clearly defines the roles of key agencies in the leadership and provision of healthcare.
Within the reformed healthcare system, the Department of Health is the “steward of the health system” responsible for:
• National policy direction and strategic plans;
• Setting standards and guidelines for health;
• Regulating health services; and,
• Managing specialized tertiary health care.
Philhealth is responsible for the funding of individual health care, with universal coverage within agreed funding levels.
The UHC Law makes Provincial Governments responsible for a wide range of functions, with the most substantial challenge being the development of integrated provider networks that register populations, initiate health programs, provide coordinated care, and act as gatekeepers to secondary and tertiary services. The UHC Law requires that LGUs implement the required structural changes within five to seven years.
Central to the vision is the development of patient-centered “networks” of health services that operate according to the principles of high performing primary care. These “networks” will register patients and develop a lifelong relationship to support wellness and provide coordinated care when people are unwell. In essence, these “networks” are responsible for delivering integrated care to local populations.
Presently, only a handful of LGUs are poised to implement the new Law in their respective constituencies. There are major challenges to be overcome in achieving the UHC health system reforms.
• Capacity and capability — The country’s primary healthcare system remains underdeveloped, with a lack of capacity and capability within Rural Health Units and Barangay Health Stations, resulting in people presenting at hospitals for conditions that should be managed in family medicine clinics in the community.
• Resourcing — There are relatively low levels of healthcare resourcing within the Philippines health care system by international standards. Thus, solutions must be smart and make better use of all resources, particularly the workforce, that we already have.
• Facilities and equipment — Whilst there are some modern facilities in the National Capital Region, many of the Rural Health Units and Level 1 Hospitals require upgrading with improved general amenities and access to medical equipment.
• Workforce — Generalist family medicine doctors form the core of an effective primary care system; however, most doctors prefer to specialise, leading to a shortage of a family medicine workforce and a small number of doctors working in the community, with the ratio significantly lower than developed countries.
• Management — There is an existing healthcare infrastructure across the country, but a lack of professionalized healthcare management to support organized service and integrated care.
• Monitoring and performance — There are not strong systems for monitoring performance and quality standards across the health system or for proving feedback on performance to various clinics and hospitals.
• Clinical pathways — Clinical systems, such as referral pathways, are not well defined. However, there are some promising beginnings to improve referral processes between primary care and hospitals.
Indeed, there is much to celebrate as we usher in this new era of “healthcare for all” in the Philippines. However, a lot of work still needs to happen to ensure that we make the most of this opportunity of a generation.
Dr. John Evangelista is an expatriate Filipino based in New Zealand. Over the past 30 years, he has led healthcare reform in Asia, the UK, the Middle East, and New Zealand. He is currently advising LGUs in the implementation of the UHC Law.