Health
Situationer Ways forward.
“ … we are faced not only with large regional differentials in infant mortality rates and unhealthy children who are nutrient-deficient, but also with basic health services that are inadequate, not just on family planning dimension but even in terms of environmental sanitation and childhood healthcare (immunization). Families are unable to provide adequately for their health needs, and government is equally unable to generate sufficient per capita spending for the health needs of its population. Healthcare accounts for the largest component of out of pocket spending for Filipinos and their families. Aggravating the existing problems are fertility rates that are the highest in the region on one hand, and the unmet needs of families desiring a smaller family size on the other.
Population growth will necessarily take into account the changing demographic structure of the country so as to best provide the health care services most needed by each sector.” The Philippine health care delivery system is made up of the public facilities and personnel – hospitals, rural and urban health centers, and barangay health stations (distributed across the country according to population criteria and therefore more accessible) – and private hospitals and clinics that tend to concentrate in large urban centers.
Health care utilization is dependent on the capacity of the health sector to deliver basic services as against the effective demand by the population for such services. Demand, in turn, demands on knowledge of key services, as well as the availability of financial means to access them.
In 2000, the Department of Health formulated the Health Sector Reform Agenda consisting of 5 major reforms to improve the delivery, regulation and financing of health care. These reforms are:
(1) providing government hospitals fiscal
Life expectancy at birth for males: 57 in 1970, 63 in 1995; for females: 62 in 1970 to 68 in 1995 but we lag behind other Asian countries, including South Korea and Thailand
Infant mortality for males: 93.8/1000 live births in 1970 to 65.2 in 1980, to 58.9 in 1990, and 53.2 in 1995. (Regional infant mortality) In NCR, 37.5 infant deaths per 1,000 live births in 1995 to 71.3 per 1,000 in the ARMM. (Provincial) 42.8 per 1,000 live births in Bulacan to a high 73.4 infant deaths per 1,000 live births in Sulo.
Maternal mortality (number of maternal deaths per 100,000 births
1980-1986 213
1987-1993 209
1991-1997 172
Causes of death (mortality) : data limited to re \
pored cases of which a large number are not “medically attended” but trends are consistent
with international patterns from reliable data.
1. diseases of the heart
2. diseases of the vascular system
3. pneumonia
4. malignant neoplasms
5. TB, in all forms
6. accidents
7. chronic obstructive pulmonary diseases
8. diabetes mellitus
9. nephritis, nephritic syndrome
10. other diseases of the respiratory system.
Causes of infant mortality (1996):
1. respiratory diseases (pneumonia, diarrhea, measles
2. birth injury, difficult labor (41 percent of all births in 1998 were attended to by hilot; 66 percent of all births were delivered at home) autonomy, allowing them to collect socialized user fees to reduce their dependence on government subsidy so that freed government resources can be used to fund critical health programs;
(2) securing funding for priority public health agencies through multi-year budgets;
(3) developing local health systems to ensure effective and efficient delivery of basic services under the devolved arrangement;
[The Local Government Code Section 447 (Municipal Governments), section 458 (City Governments) and section 468 (Provincial Governments) define the functions and powers of the different local authorities. Functions of local governments or their so-called traditional responsibilities include construction and maintenance of city/municipal or provincial roads, provision of health services and agricultural extension work; “… approve measures and adopt quarantine regulations to prevent the introduction and spread of diseases within its territorial jurisdiction”.]
(4) strengthening the capacity of health regulatory agencies to ensure safe, quality, accessible, and affordable health services and products; and
(5) expanding the coverage of the National Health Insurance Program, especially for the poor. The leadership of the DOH must remain steadfast in overcoming such barriers as “bureaucratic inertia” and pressure from various interest groups.
Causes of morbidity (1996)
1. diarrheal diseases
2. pneumonias
3. bronchitis
4. influenza
5. TB, respiratory
6. malaria
7. diseases of the heart At the macro level, (1) A slowdown on population growth will put less stress on the ecology, less stress on the fragile economy and less stress on the overburdened public health sector; and (2) real economic growth will allow households and government to generate more resources for health.
8. measles
9. chicken pox
10. dengue fever
Among malnourished children, females tend to be more underweight than males; males tend to be more stunted or wasted than children. There remain large provincial and regional differentials in child malnutrition up to 1998.
Child nutrition, prevalence rates (percentages)
1990, underweight ages 0-5
9.8
1993, underweight ages 0-5
8.2
1990, stunted,
ages 0-5
6.5
1993, stunted,
ages 0-5
5.4
1990, wasted,
ages 0-5
4.6
1993, wasted,
ages 0-5
5.9
1993, underweight 8.2
1998, underweight 5.9
1993, stunted 5.4
1998, stunted 5.4
1993, wasted 5.9
1998, wasted 7.2
Micronutrient deficiencies, particularly iron and iodine, remain high among children and among lactating and pregnant women.
Environmental sanitation and surface water pollution and lack of potable water supply brought about by inadequate sanitation – deteriorating sewerage and on-site sanitation facilities, prolonged lack of investment, and limited options for safe excreta and wastewater disposal – threatens our environment and our health. In 2006, 25 persons were dying everyday from diarrhea and sanitation-related epidemics have broken out over the last few years in low-income communities. Water quality monitoring show that pollution of water is a direct result of lack of sanitation facilities.
The Philippines Clean Water Act of 2005 (R.A. 9275), complementing the Philippine Sanitation Code (P.D.856) addresses the interlinked problems of water quality, pollution prevention, and control and sanitation.
The private concessionaires of the Metropolitan Waterworks and Sewerage System (Manila Water and Maynilad), whose jurisdiction go beyond Metro Manila, have advanced the schedule of implementation of the sanitation and sewerage component as earlier provided in their concessional agreements.
References:
1. NEDA, National Framework for Physical Planning 2001-2030, 2002
2. AIM Policy Center, ed. Luningning Achacoso-Sevilla , “The Ties that Bind: Population and Development in the Philippines 2nd ed.”2004
3. GOP / GTZ / GOA, Philippines Sanitation Sourcebook and Decision Aid, December 2005
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