• regulation programs which get PhP1.196 billion;

• service-delivery programs, supported with PhP10.482 billion, the biggest portion of the health budget; and

• operation of centers for health development-DOH-run district hospitals sited in the nation's key urban centers- which takes the next biggest chunk of health spending for 2008 with over PhP5.59-billion allocation of which PhP3.488 billion pays for salaries and wages, over PhP2 billion goes to upkeep and other operating expenses, and only PhP80.5 million for fresh capital outlays.

    Aside from giving direct service provisions for the nation's 52 district hospitals, DOH coughs up funding to regional

clusters for such services as "field coordination, internal and area sectoral planning, human-resource development and other support services; implementation of health regulation and standards; and local health assistance including health-systems development and public-health-program support."

    The DOH shells out an average PhP349.7 million each for 16 health regions to pay for the operations of their respective district hospitals and tertiary medical centers-with an average 60 percent of the budget package paying for salaries and wages; 35 percent for maintenance and other operating expenses, five percent of which goes to "specific programs/activities for disease prevention and health promotion, including programs for itinerant family-planning teams."

    Central Visayas with six district hospitals gets the lion's share of hospital-upkeep outlay with PhP508.58 million. Bicol with three regional medical centers takes the next biggest share, PhP482.96 million. Davao region with two tertiary regional medical centers stands to get PhP420.29 million, the bulk of which goes to payment of salaries and wages. Metro-Manila with four strategically located district hospitals is earmarked a PhP341.69 million.

    Mindoro, Marinduque, Romblon, and Palawan provinces (MIMAROPA) take the tail end of the budget for district hospitals with PhP172.82 million-a few million pesos less than the PhP177.6-million operational outlay for the Quirino Memorial Medical Center in Quezon City. With PhP204.53 million outlay, the Caraga region in Mindanao (composed of Agusan del Norte, Agusan del Sur, Surigao del Norte, and Surigao del Sur) is next on the lowest rung while SOCCSKSARGEN (South Cotabato, Cotabato, Sultan Kudarat, and Sarangani) is third lowest with PhP206.96 million.

    Davao Medical Center, a tertiary hospital in Davao City takes the biggest slice of direct-service-provision funding for health- development centers with PhP203 million-PhP145 million for staff services and over PhP58 million in upkeep costs. Second biggest budget gainer is the Vicente Sotto Sr. Memorial Medical Center in Cebu City with PhP147 million for staff salaries and wages and some PhP52 million for upkeep, or a total of PhP199.59 million. Third-ranked budget gainer, Bicol Medical Center in Naga City, is earmarked PhP190.9 million, with 64 percent of the monies for salaries and the rest for maintenance and other operating expenses.

    Tail-ender in the allocation of direct service provisions is the Labuan Public Hospital in Zamboanga City, earmarked with PhP4.45 million with 88 percent of funding for salaries. Next at the bottom rung: Sulu Sanitarium in San Raymundo, Jolo, Sulu with PhP8.13 million, with 72 percent of the sum going to salaries. Conner District Hospital in the Cordillera hinterlands of Apayao province is third among the tail-enders with PhP9.23 million, 77 percent earmarked for salaries.

    Among Metro Manila's district hospitals, the Dr. Jose N. Rodriguez Memorial Hospital in Tala, Caloocan City got the biggest allocation at P104 million-70 percent of the funds goes to health staff salaries, the rest to maintenance costs.

    Gobbling the third biggest chunk of the DOH budget, the allocation for family health including family planning is at PhP3.019 billion-with PhP2 billion earmarked for reproductive health and family planning.

    Unlike barrio doctor and health-secretary-turned-lawmaker Juan Flavier who pitched a practical stand on artificial means of family planning, Duque adopts a play-it-safe stance, which is part of the DOH service- delivery programs. The Dagupan-born doctor echoes Malacañang's hands-off population policy-or the lack of it-as he cites that DOH espouses and will pursue both natural and artificial family-planning methods.

    Special provisions in the DOH budget spell out that PhP800 million be spent for "reproductive health and family-planning seminars to be conducted nationwide in coordination with local government units in order to create an enabling environment for women and couples to make an informed choice regarding the family-planning method that is best suited to their needs, personal convictions, and religious beliefs."

    Still treading the middle ground in the perennial "pro-life v. pro-choice" debate between religious groups and feminist nongovernment organizations, DOH is setting aside PhP1.2 billion for local government units to decide on what are-and procure-"reproductive-health commodities, both for modern natural and artificial family-planning methods and devices, which are medically and legally permissible, for free distribution to poor family-planning acceptors."

    However, DOH can be uncompromisingly clear-cut in spending for other components of its service-delivery programs that include:

• epidemiology and disease surveillance (PhP120.13 million);

• disease prevention and control-PhP4.92 billion, the second biggest single outlay;

• operation of drug-abuse treatment and rehabilitation centers (PhP294.14 million);

• operation of 12 special hospitals, medical centers, and institutes for disease prevention and control, all of them accessible to Metro Manila's teeming urban poor (PhP2.79 billion, the fourth biggest single outlay);

• health-facility planning, operations, and infrastructure development (PhP2.04 billion);

• health-emergency management including provision of emergency drugs and supplies (PhP168 million);

• health promotion (PhP133 million); and

• operation of the Philippine National AIDS Council secretariat (PhP9.8 million).

     The DOH budget identifies key targets under the disease-prevention and control program, including:

• Elimination of diseases as public-health threat such as malaria, schistosomiasis, leprosy, and filiriasis (PhP158.44 million);

• Rabies control (PhP80 million);

• Noncommunicable-disease prevention and control including breast cancer (PhP51.38 million);

• Tuberculosis control (PhP680 million);

• Environmental and occupational health (PhP51.4 million); and

• Vaccine-preventable-disease control, including expanded immunization program and self-sufficiency in vaccines (PhP513.857 million)

    From 2000 to 2006, the government has allotted only PhP154 million for its TB prevention and control program. And from the previous year's PhP240 million, the DOH budget for control of pulmonary tuberculosis-which infects 100,000 Filipinos yearly-was nearly trebled to PhP680 million "to intensify action and make swifter strides in our fight against tuberculosis. The quality of treatment continues to improve with cure rate already at 83 percent and this year, we aim to hit the 85-percent target," explains Duque.

    A bit of good news for dirt-poor patients: the previous year's PhP16-million subsidy for indigent patients now stands at PhP139 million. Also, DOH is keeping up with its "Doctors to the Barrios and Rural Health Practice Program" with a PhP42.28-million outlay.

    The money figures in the 2008 health budget look impressive enough to silence most critics and detractors. However, the figures still fall short of the World Health Organization-recommended five-percent-of-gross-national-product spending for public health. As a lawmaker points out, "even by Health secretary Francisco Duque's own admission during the budget hearings at the House of Representatives, the country's health concerns need some PhP60 Billion."

    Out of 192 countries worldwide, the Philippines ranks 174th in terms of the ratio of the national health budget to gross domestic product. In terms of general government expenditure on health, the country ranks a dismal 156th.

    Too, the fate of figures in the overall government budget hangs upon hopes for revenues hitting PhP1.236 trillion-PhP1.108 trillion from taxes and P1hP27 billion in nontax revenues-with the Bureau of Internal Revenue pitching in PhP885 billion and the Bureau of Customs, PhP254 billion. Plus prospects of real GDP growth of 6.1 to 6.8 percent, inflation rate of between three to four percent, and a foreign-exchange-forecast band of PhP46-48 to $1, "which hews on the conservative side," according to the Department of Budget and Management.

    Two years ago the budget deficit reached PhP147 billion, but the Arroyo administration is keeping its fingers crossed this will be down to zero by end 2008. Or, the promised health can be delivered if the state of the nation's economic health isn't compromised. M

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THE DOCTOR IS OUT

Health secretary Francisco Duque III says he's quitting the department in 2010 and run "toward my wife"

 

Dong delos Reyes, Contributing Editor

 

 

The sound bites he plied for a speech that Friday sounded something out of the campaign hustings, it must have been done by a ghostwriter-his off-the-cuff talk comes with wit. Asked if he's mulling a run for any elective post in the 2010 polls, Dr. Francisco Duque III ripostes, "I'll sure be running in 2010-toward my wife."

    "Pagod na 'ko. I've already given nine years of my life to public service," he confesses.

    By that reckoning, year one in public service began in 1999 when he was plucked out of a nine-year stride as board chair for the Lyceum-Northwestern University in Dagupan City to serve as representative of then vice president Gloria Arroyo in the fledgling Philippine Health Insurance Corporation (PhilHealth).

    He had the credentials for the assignment-a master of science degree in 1987 from Washington DC-based Georgetown University, and he had taken postgraduate courses in Executive Education on Health Program Management in1992 at the Harvard University School of Public Health and Graduate School of Management, and Planning and Managing Medical Education for the 21st Century in 1990 at the Asian Institute of Management.

    By June 2001 Arroyo appointed him president and chief executive of PhilHealth-and under his stewardship, the outfit grew into the nation's largest social-security agency with a membership base of 64 million Filipinos, larger than the membership of the Government Service Insurance System and the Social Security System combined.

    Duque initiated and directed PhilHealth's Plan 500/GMA Indigent Program-and it was adopted as one of the State of the Nation Address (SONA) pledges of Arroyo. The program aimed to fast-track the enrolment of 500,00 urban-poor beneficiaries into the National Health Insurance Plan (NHIP) in one year. Duque surpassed his target by 500 percent with a list-up of 2.5 million urban-poor beneficiaries and about two million rural indigent beneficiaries. By August 2002, PhilHealth has covered 5.5 million urban and rural poor-a landmark in the history of Medicare and PhilHealth. By 2003, indigent enrollment reached eight million beneficiaries.

    Arroyo herself lauded PhilHealth as one of the "most effective poverty-alleviation programs" of government in her post-SONA speech before 54,000 urban poor gathered at the Quirino grandstand on July 24, 2002. Government surveys in Regions 1, 3, 5, 7, Cordillera Autonomous Region, and the National Capital Region showed PhilHealth among the top three agencies with highest public awareness of programs.

    Plaudits pour some more: In October 2002, Arroyo announced before a Cabinet meeting that the Duque-led agency is the "No. 1 showcase of this administration" that hews close to her social-development and poverty-alleviation agenda. By 2004 PhilHealth had toted an enrollment of 5.9 million families or 29,901,890 beneficiaries.

    On June 1, 2005, he was named Secretary of/; the Department of Health.

    With him at the helm, the department has enjoyed plus 50 to 54 net-satisfaction and net-approval ratings among the populace, according to Social Weather Stations and Pulse Asia surveys. A performance appraisal carried out in 2007 by the Office of the Ombudsman and the Development Academy of the Philippines cited the DOH as "No. 1 in Integrity Development" while the National Economic Development Authority credited the department as "No. 1 in Aligning Donor Initiatives with Health Sector Program."

    "Hindi kita lang ang panuntunan sa pagiging professional," Duque ponders in fondness. "It's not only money that measures the success in one's calling-there are the ethical and moral dimensions, too."

    Long-time patients still come to see Duque at home; he sees to them-for old times' sake. He won't be ruing how he was plucked out of clinical practice as he expresses satisfaction at the grueling tasks of an administrator and policy-maker: "As a physician you help very few people but administration work allows you to help millions of people." M

 

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