The election of maverick former mayor of Davao, Rodrigo Duterte to the Filipino presidency in May 2016 represented a dramatic departure from politics as usual and raised interesting questions about future health policy in south East Asia’s second most populous country.
“A human approach to development that leaves no citizen behind in terms of health and education.”
Rodrigo Duterte, President of the Philippines
As a candidate for president, Duterte, commonly known as “the punisher” for his hardline, uncompromising and draconian approach, raised eyebrows for floating the idea of implementing a “three-child family planning policy” and for vowing to “commit a substantial proportion of the revenues of the Philippine Amusement and Gambling Corporation into a trust fund” to be used for payment of public hospital bills up and down the country. “I only want to see three children for every family… I’m a Christian, but I’m also a realist so we have to do something to combat our overpopulation and I am more than ready to defy the might of the Church, if that’s what it takes,” he solemnly declared on the campaign trail. Another pledge has him promising to “force all private hospitals to set aside 20 to 30 beds for the poor, with their expenses paid for by the government.”
Since Duterte’s inauguration in June, public health has certainly figured high up on the new administration’s agenda. In his State of the Nation Address, Duterte himself was keen to stress that his government would be “sensitive to the State’s obligations to promote, protect, fulfill the rights of our citizens, especially the poor, the marginalized and the vulnerable” and that he would be steadfastly pursuing “a human approach to development that would leave no citizen behind in terms of health and education.” This was followed up by a flurry of controversial executive orders – among them one mandating universal access to contraception and another rolling out one of the toughest anti-tobacco laws in the region with a view to dis-incentivizing a habit that the Ministry of Health claims costs the state some $4 billion in healthcare and productivity losses every year.
Newly appointed Health Secretary, Paulyn Ubial, describes the overarching priorities of the new regime as threefold. “The first goal is unequivocally for all Filipinos to attain maximal health outcomes living longer and free from emergent public health threats like drug addiction and Zika infection,” she discloses. “The second goal centers on ensuring that all Filipinos, particularly the poorest of the poor, will gain freedom from high costs of medical care and be liberated from profit-oriented health services,” she continues. “The third and final goal is for all Filipinos to have satisfactory experience when they access health services, where they feel respected and valued, and finally are empowered to take charge of their own health care,” she concludes.
All of this represents quite a sea change from the orthodox, business-as-usual, neo-liberal economic prescription of the previous Benigno S. Aquino III administration. A point accentuated by the recent visit of Secretary Ubial to Cuba to “observe, study and emulate” the communist island’s healthcare system. “The Cuban health system represents one of the best examples of an efficient and cost-effective health care delivery system which is accessible to all, regardless of economic status and as such we are seeking to use it as the backbone for framing our own health agenda,” she proclaims. “The underlying concept in our slogan or theme is that health is everyone’s concern and not just a matter for health workers and healthcare providers.”
So far this approach has been met with a lot of public optimism. “It is very encouraging to hear that our president is keen on protecting our people’s right to health. We are at one with him in working towards a country where even the poorest of the poor and those who live in far-flung areas will not be deprived of medical care,” exclaims Atty Reyes, managing director of HealthJustice Philippines. The Philippine Hospital Association (PHA), which counts some 2,000 government and private hospitals all over the country as members, has also thrown its weight behind Duterte’s efforts to make the dream of universal healthcare a reality. “Duterte’s order for the Philippine Amusement and Gambling Corporation to dedicate its revenues to the health concerns of the poor is a fundamentally positive step because it identifies a funding source for what is an important public health service… Before, the government was struggling to reimburse the expenses of hospitals, but now the healthcare apparatus should be sufficiently equipped to deal with the inflow of sick Filipinos,” opines PHA executive director, Climaco Caliwara.
Others, however, have expressed concern that the new health agenda privileges “style over substance” and that the grand assertions proclaimed rarely result in commensurate actions. Robert Mendoza, national president of the Alliance of Health Workers points out that, “for all the bold talk and grand gestures, Duterte’s administration is nonetheless pressing ahead with a swingeing budget cuts for Maintenance and Other Operating Expenses (MOOE) of government hospitals in 2017 which risk weakening healthcare infrastructure even further.”
Writer: Louis Haynes