• Fighting severe acute respiratory infection (SARS) and other emerging diseases: "All in all the DOH effectively mobilized this huge array of forces against SARS." These forces, Dayrit said, minimized the entry of imported cases, avoided local transmission, prevented deaths, and helped mitigate economic and other problems.

• Widening the coverage of public health services: Dayrit highlighted a number of important areas in the public health service expansion-among them the eradication of the poliovirus, the elimination of measles, the increase in the use of iodized salt, and the National Tuberculosis Program, which is "recognized as one of the best in the world, and you can talk to the [World Health Organization] about that."

• Half-priced medicines and other low priced drugs: "[T]he thing we have to do for high-priced medicines-we have to chase them wherever they are, and try to bring them down." Dayrit said that such programs as Gamot na Mabisa at Abot-Kaya-50 (GMA-50), and Botika ng Barangay helped contribute to the lowering of drug prices. He even pointed out the result of a Social Weather Station survey saying that up to 42 percent of respondents believe the price of medicines has decreased.

• Expanding health insurance: "When the president announced in her July 2001 state of the nation address that she was making [universal insurance] a priority, she said 'I want 500,000 beneficiaries enrolled.' Was that 500,000 families, or 500,000 Filipinos? However way [we look at it], we have reached the target, and more: by the end of 2003 [we] enrolled within that program…8.1 million indigents." For 2004, Dayrit said that the president, "who is very ambitious," aims to enroll five million families in the program.

• Family planning and population management: "This administration has gained some trust among the sectors that have never supported the government family-planning program…The media have projected that the government is against all the other methods. That's not true. We simply focused on the [recommended natural methods], but all the other methods could still be given."

• Improving the quality of hospital services: "I know personally, I'm sure there are more, [government] hospitals that have actually improved their services." He went on to mention a number of hospitals that underwent major rehabilitation and renovation.

• Cleaning up against corruption: "In the SWS survey last year, the DOH was cited as number three most sincere in fighting corruption."

• Managing the bureaucracy for efficiency.

• Human resource development and dealing with the migration of health workers: "This is really a work in progress." He admitted that making health professionals stay on in the country is a big challenge, especially because these decisions have to do with issues as job satisfaction and personal aspirations, and it is not within the State's rights to interfere in such issues.

• Managing the devolved system.

• Foreign assistance and international health.

• Revitalizing health research.

    Dayrit said he sees three major areas in which the health-care system can improve: increase in health investments, capacity building, and getting support from all sectors, especially in relation to family planning. He ended his lecture by saying that the legacy of the Arroyo administration is good governance. "Some people might not agree, but I'm telling you, we did a lot," he said.

 

 

Weighed But Found Wanting

    And just as he expected, people didn't agree. A panel of reactors, representing different sectors, challenged Dayrit's assertions. The panel was composed of Professor Roland Simbulan, UP-Manila vice chancellor for planning and development; Dr. Eleanor Jara, executive director of the Council for Health and Development; and Dr. Edgardo Clemente, surgeon and a member of the Capitol Medical Center board of directors.

    Simbulan hit the Arroyo administration for giving health care a very low priority. He pointed out that while the government spends a measly 43 centavos every day on every Filipino's health needs and PhP9.40 daily on every public elementary and high-school student, it spends close to P110 million on defense. He also pointed out that the low priority on health could be traced back to the International Monetary Fund-World Bank's desire to reorient the bureaucracy toward privatization and to enforce austerity programs to ensure debt servicing.

    He also lambasted the persistence of "patronage politics," of which naming projects after the president ("GMA-50," for example) is a blatant example. "This 'you owe me' message sends the signal that beneficiaries of DOH programs are feudal subjects dependent on the personal benevolence of a monarch rather than citizens with a right to health care services," he said.

    He lamented the "absence of any concrete master plan to manage the very serious brain drain of our health and medical practitioners to other countries." It seems, he pointed out, as if the "global marketization of Filipino health workers has even become a policy of the national government." With the country being a signatory to the General Agreement on Tariffs and Trade-which, he said, the president herself had sponsored when she was still a senator-not only have the basic services become market driven, but the training and education of health workers as well.

    Simbulan also criticized the government's population program for its refusal to "antagonize the number-one opposition to family planning, the Roman Catholic Church." "The fear of the Church and the strong influence of the Church have stunted the country's population policy, which has remained in the realm of demography studies and research," he said.

    Meanwhile, Jara, through her representative Ethel Dionisio, said: "As a community-based health programs practitioner I am well aware that the people's health is far from improving." She pointed out that aside from the prevailing socioeconomic and political condition, the absence of "genuine pro-people government health policies" continues to exact a heavy toll on the lives of Filipinos.

    While Dayrit gave impressive numbers on the improvements in major public health issues, Jara took them with a grain of salt. She talked about tuberculosis, and how there are "thousands of patients who are yet to receive treatment, and who are yet to be diagnosed," and how, based on a study, only 45 percent of actual TB patients have been diagnosed.

    In addition, she said that measles is still a scourge to many Filipinos, particularly the indigenous peoples. She said that just a few years ago, children from a Mangyan community were nearly wiped out by a measles outbreak. The same happened in several indigenous peoples in Mindanao just a few months ago.

    She also took potshots at the controversial devolution of health services. "In Isabela, for example, Governor Faustino Dy Jr. closed down 10 health centers, affecting more than 300,000 residents from 154 barangays and 18 towns," she said. Among the consequences of this act, she said, is the death of a young mother due to birth complications. "Since the nearest hospital where the woman lived was closed down, she was brought to the provincial hospital 35 kilometers away from her home. How many more suffer the same fate?"

    Clemente, for his part, also took exception to several points Dayrit raised. He called the government's "success" during the SARS scare a "classic example of 'claiming victories where there are none.' " He said that the way the government handled the scare left a lot to be desired. For instance, the DOH and the Department of Tourism's call for tourists to visit the country during the early days of the scare was both "naïve" and "unprecedented in the annals of the study of public health and sanitation." Quoting an unidentified DOH official, Clemente said: "Over and above all factors considered, the Philippines was just lucky to have dodged the bullet."

    He also said that the Philippine Health Insurance Corporation is "degenerating into a political campaign office." He revealed: "During this presidential campaign, PHIC cards are given away to indigents in an attempt to entice them to vote for the incumbent president. This is very obvious with the GMA cards that stand for Greater Medicare Access…To emphasize my point of a political agenda, the picture of the sitting president is prominently displayed on the PHIC indigent cards. [These] campaign gimmickry and antics are cheap tricks to generate votes come May 10."

    What is being done with the population program, which he said amounts to a "policy of abdication," was also not spared. "I believe the underlying reason for the DOH's soft stance on population planning is to avoid a frontal clash with the powerful Catholic Church. In allowing the government's family planning program to wither in the vine the DOH showed weakness, indecisiveness, and lack of firm leadership."

    Lastly, Clemente attacked the "number one" problem of most Filipino hospitals, which is dealing with PhilHealth red tape. He asserted that both hospitals and patients "spend billions of pesos trying to comply with fluctuating rules and regulations when filing for PHIC reimbursements."

 

 

Parting Shots

    In keeping with the use of Greek myth in Dayrit's speech, the reactors also made allusions to Greek myth in their concluding words.

    Said Jara: "Unlike Greek tragedies, our tragedies are all too real. Greek tragedies teach us about human foibles and the vanity of the gods and goddesses. Our tragedies teach us about the follies of government politicians and technocrats."

    Said Clemente: "I agree with the health secretary's speech on the 'Herculean labor' part of the title but I would certainly dispute the use of the word 'triumph.' Using 'mediocrity' or 'making a mountain out of a molehill' would have been more appropriate."

    Said Simbulan: "The [administration's] claims to have improved the health of Filipinos are nothing more than what Hercules, the Nemean lion, Cerberus, and other characters mentioned truly are: they are myths…The effort made by health workers has indeed been Herculean. In contrast the Arroyo administration's support to health care, as proven by its health budget, has been Lilliputian. And now, this election season, let us not be misled by the Medusas in our midst, lest they mesmerize us and turn us and our hearts into stone."