Paulyn Ubial, Secretary of the Philippines Department of Health, discusses her Department’s work to achieve universal healthcare and expand access to high-quality health services to the entire Filipino population. She also discusses her work to empower women in the country as the founder of the women’s health and development program.
To begin, could you please share some of your initial goals and aspirations for your tenure as Secretary of the Philippines Department of Health?
“The problem we are facing at the moment is that we have only 13 drug rehab facilities run by the Department of Health, five within the local governments, and another 20 within the private sector. The total capacity of all of these treatment centers is approximately 5,000.”
President Duterte gave me three main objectives when I was appointed as Secretary of Health. Number one was to address the drug abuse and dependence problem in the country. We estimate that in the Philippines there are 3.7 million drug users, and since he has announced the campaign to address this problem, in just two months we have had 700,000 people surrender. The problem we are facing at the moment is that we have only 13 drug rehab facilities run by the Department of Health, five within the local governments, and another 20 within the private sector. The total capacity of all of these treatment centers is approximately 5,000. To address the issue we are facing in terms of capacity, we have developed an algorithm to identify people who can be treated in a community based program, an outpatient program, or a residential inpatient program, and through this we are projecting that one percent will need residential programs. In the short-term, we are going to build four mega-treatment centers, which will occupy 2,000 to 5,000 patients each. This will allow us to address the current need for more space, but in the long-term we are building more regional treatment and rehab centers that will be completed in 2017. We will also build an additional four centers with a 500 bed capacity. Lastly, another long-term goal is to build a 100-bed center in every province, something that will improve the sustainability of this effort.
The second goal given to me by the President was to eradicate corruption. I was a member of the Integrity Development Committee of the Department of Health, so I have been a partner in the effort to strengthen our policy of zero tolerance for corruption for many years. We are starting to organize our strategies for good governance and are building a culture of zero tolerance for corruption, for example the Department of Health is the only national agency that is ISO certified.
The third goal is to take care of the poor, which, broadly speaking, is what government is here for. As healthcare professionals, we know what needs to be done to truly take care of this segment of the population, we simply need the resources to accomplish it. President Duterte told me to not worry about resources, to simply do my job and the resources will be provided. One of our main focuses in this regard is to provide annual check-ups for the 20 million poorest Filipinos, something we hope to accomplish within our first 100 days. Through this there will be a simple check-up, including evaluations of blood pressure, blood chemistry, urinalysis and other laboratory services combined with a physical examination. For all of the issues that we identify during that checkup we will provide the medicines, operations, transportation and anything that is necessary. Through our recent efforts, 100 percent of the poor are already enrolled in our National Health Insurance Program, meaning all hospitalization costs will be taken care of.
You uniquely have had the opportunity to work under 13 different Secretaries of Health. How do you plan on leveraging this experience to benefit your tenure as Secretary?
I have been with the Department of Health for 27 years, and through this experience I have developed relationships with nearly the entire industry. I have deep knowledge of the industry and the private sector, and due to this I believe we are currently in the golden era of public health in the Philippines. Through my experience I have the ability to identify the healthcare needs of the population, and we have the support of the President and the entire bureaucracy, something that is unprecedented. All of these factors combined mean that we will move our health agenda forward.
Recently you traveled to Peru and Cuba to review their healthcare systems and stated that these trips made you confident that universal healthcare can become a reality here in the Philippines. What lessons did you learn during these trips, and how do you plan to implement them here in the Philippines?
The situation in Cuba is totally different than the situation here in the Philippines, so we cannot simply replicate their system. For example, Cuba does not have a private sector, and here in the Philippines 50 percent of the sector is private. We are working to change the paradigm in the Philippines from a dichotomist healthcare system to a unitary system, something we are working to accomplish through the national health insurance program. I have told my partners in the private sector that now nobody is coming into the healthcare system without the capacity to pay. The national health insurance will pay for whatever services people receive. Patients can go to a private facility and we can ensure that they get quality healthcare assessments, and the private facility will not be left wanting because the national health insurance program will pay. In the public facilities, patients will get services as well, and we will work to continue to improve and develop these facilities along with the private facilities. Through this process we will create one unified healthcare system, and the major payer is going to be the national health insurance program.
Raising awareness of the benefits of PhilHealth is key to expanding access, especially among the more rural and poor communities. What initiatives does the Department have in this regard?
One thing that I saw in Cuba that I plan to replicate here is increasing the number of healthcare workers, especially at the community level, strengthening the primary care in the country. All of the people, wherever they are, should have access to a healthcare provider. This is one of the strength of the Cuban healthcare system, they have one doctor for every 1,075 people. In Manila, the ratio is one doctor to every 10,000 people, and in the provinces the ratio increases to 1 doctor for every 33,000 people. These numbers reflect only the public sector doctors, however, if we utilize the strength of the private sector, we can easily improve them. We have private doctors, both in Manila and in the provinces, but we need to allow the poor to access them, and that is something that we will do by engaging the private sector in our efforts. Through this work we will have one doctor for every 16,000 people, representing a huge improvement, which will be well above World Health Organization (WHO) recommendations. To achieve these ambitious goals, we will require approximately 55 billion pesos, however, our main problem is that in the Philippines we have a short supply of doctors. To address this, we plan to utilize nurses and midwives, an effort that will also help to reduce the overall costs of this plan.
In 2017 the Department of Health is going to see a budget increase of 15 percent. Do you believe that the Department of Health has the resources that it needs, and do believe that funding will continue to increase in the future?
I was recently in a meeting with the Philippine Amusement and Gaming Corporation, which handles all of the casino operations in the country, and provide 30 billion pesos a year to the national treasury. The President has declared that all of the funds from the corporation will be given to the Department of Health. This was announced on public television, so now the discussions are focused on how to accomplish this transfer of funds. This will be of great benefit to the Department as we work to accomplish our goals.
One of the causes that you are very passionate about is decreasing tobacco use. Now that you are the head of the Department of Health, do you have any initiatives planned to address this issue?
We are using the WHO MPOWER strategy: Monitor tobacco use and prevention policies, protect people from tobacco smoke, offer help to quit tobacco use, warn about the dangers of tobacco, enforce bans on tobacco advertising, promotion and sponsorship, raise taxes on tobacco, and reduce the size of cigarettes. To accomplish these goals, we will have an executive order signed by the President, as this is something that he did in Davao through city ordinance. For example, he banned all forms of indoor smoking and banned all establishments that sell food from selling tobacco. We want to expand these policies across the Philippines as well as launch a more sustained effort to warn people about the negative effects of smoking.
You have had a very dynamic, 27-year career working in public service. What has been your proudest accomplishment?
The greatest impact I have had has been institutionalizing our immunization program and leading the Department in the efforts to eradicate polio in the country. This effort was successful and we were certified in 2000 by the WHO as being polio free. Additionally, some of my most important contributions have been through my work to empower women and gender development, for example starting the women’s health and development program. I was the pioneering, founding member of the program, and through this work we have developed facilities throughout the country in our government hospitals for battered women and neglected children where they can access all of the services they need. I am extremely proud of this work.
What is your vision for the future, what do you want your legacy to be?
We have been working towards universal healthcare for the last 20 years; however in the last survey that was released we saw that 30 percent of Filipinos die without ever seeing a doctor. I want to decrease that number to zero. Our first strategy to accomplish this is to go out into the country and see the poor, and provide at least the most basic physical exam. Lastly, I will continue to work to improve and expand the national health insurance program to attain 100 percent coverage for Filipinos. We are close to achieving this goal, but as a runner I know, the last 100 meters are the most challenging!
From the Philippines, and from our President, we want to send a message that we are coming together as a country to make sure that our population has access to the best quality health services from the government. The only way that we can achieve this is by engaging all actors in the sector. This effort is not going to be accomplished simply by the Department of Health, we cannot do this alone. Everybody, the government, private sector, NGOs and communities themselves must be engaged. All for Health, Health for All!