UNDER SIEGE
Startling statistics show the nation's health system can barely cope with demands, much less a national calamity
By Dong de los Reyes, Contributing Editor
An epidemic running amok in any of the country's 19 regions will likely trigger a national calamity. The nation's health system just can't cope-we'll just watch people die like flies.
Why, there's less than one physician attending to every thousand populace, a nurse for every 500 people. There's less than one midwife seeing to every 2,000 people. Meanwhile, an 8,564-strong nationwide army of dentists can hack out separate niche clientele from a population over 80 million.
Such pitiable figures on the state of the nation's health system no longer hold-those are seven years old. Culled back in 2000, plied out in the 2007 World Health Statistics as stark facts to look back in mourning. For all we care, current figures may likely point to a moribund state of the Philippine health system.
As the World Health Organization compendium of facts and figures would have it, a nation's health system isn't about a network of hospitals, clinics, day-care centers, and similar infrastructures or facilities-a synergy of professionals make up a nation's health system. Such a system consists of well-trained, competent and skilled people. The WHO lists them as physicians, nurses, midwives, public and environmental-health workers, community health workers, laboratory workers, health-management and support workers, and other health workers.
The international standard for the ideal ratio of nurses to patients in hospitals is 1:4.
At the University of the Philippines-Philippine General Hospital (UP-PGH), a nurse has to see to 15 up to 25 patients. In Davao del Sur and in most other hospitals, the nurse-to-patient ratio ranges from 1:50 to 1:100. Over at the Don Susano Rodriguez Memorial Medical Center in Naga City, a nurse has to tend to more than 300 patients.
The patient overload means overextended working hours. The 40 hours work per week in a 100-bed hospital often stretches to 56 hours weekly. Doctors and nurses have to man their stations 16 hours straight whenever there is no reliever. No exemption for health workers assigned at the emergency room, laboratory and other stress-fraught departments.
And the pay isn't that good.
The Nursing Law of 2002 mandates a PhP13,300 monthly paycheck for an entry-level nurse. Even so, violations have become trenchant: nurses in public hospitals receive at least PhP9,000, those in private hospitals get PhP4,000 a month. And there are nurses in the provinces who grub for as low as PhP2,000 monthly.
No wonder: UP-PGH contributes 300 to 500 nurses per year to the yearly outflow of 14,000 nurses going for overseas jobs. The nation's tertiary school system can only turn up 6,500 to 7,000 nurses yearly. Even midwives won't be left behind-they also seek greener pastures abroad as caregivers.
Available local supply doesn't fill in the global demand yet: The United States needs around 10,000 nurses a year. Britain, Ireland, the Netherlands and other European countries need another 10,000 nurses yearly.
Filipino nurses have to hurdle the Commission of Graduates of Foreign Nursing Schools and the National Council Licensure Examination to work in the US. Passers get migrant visa status, which includes their spouse and children. Plus a work contract that pays US$4,000 a month. Some hospitals even offer subsidized housing grants. In the UK, only an English- proficiency examination is required to obtain a work contract that pays about US$3,000 monthly.
A paper by Dr. Jaime Galvez-Tan points out that the Philippines is the second major exporter of physicians, next to India. Some 9,000 Filipino doctors have become nurses or are about to become nurses and nursing medics-1,500 have left the country, another 1,500 have just completed taking the nursing licensure examination. The 6,000 are enrolled in shortened one-and-a-half- to three-year nursing courses offered by nursing schools catering to the needs of doctors wanting to become nurses.
Four of every five public-health physicians have taken up or are enrolled in nursing with a view to leaving the country. Private-sector doctors are unperturbed though as they earn the equivalent of $800 to $3,000 a month while services of "super specialists" like neurosurgeons and heart surgeons fetch about $18,000 for one operation.
Tan also cites that student enrolment in medical school has dropped by 14 percent a year beginning 2002. This has resulted in more medical schools closing shop-they lack students. The passing rate for physicians has also turned dismal from 86 percent in 1994 to 52.9 percent in 2004.
The WHO spreadsheet on the country's seven-year old inventory of skilled professionals manning the Philippine health system can be an eye-opener for policymakers. The WHO minimum for government spending on health is five percent of the national budget or gross domestic product-our government set aside 1.1 percent of its national budget on health in 2006. Vietnam spent 4.5 percent of its national budget on health in 2002; Thailand spent 7.6 percent last year.
WHO figures can also be construed by bioterror purveyors as intelligence data that gauge a nation's health-defense capability: one physician has to tend to every thousand populace, two nurses tend to 1,000- a nurse for every 500 people. There's less than one midwife seeing to every 2,000 people. That's so pathetic a pool of health professionals stretched too thin, too near a breaking point.
An epidemic gone amok or a major bioterrorist strike would leave such a health defense system in a shambles-and an entire nation in disarray.
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BIOTECHNOLOGY BARRIERS
Why local sunshine industry still can't take off
It could happen in 60 years or so. But oil moguls aren't telling when their reservoirs of fossil fuels go dry. So there is a race of sorts to turn up fuels from motley sources. Industries and transport must be kept running headlong into this century without the difficulties of drilling for oil wells or natural-gas reserves offshore or inland.
Both tropic and subtropic nations with teeming plant life have thrown millions of idle geography for growing biofuel sources. Say, the unlikely kirisol, also known as tuba-tuba or Jatropha curcass-a hectare of it can yield five to seven tons that rake in about PhP50,000 a year. In Camarines Sur, for instance, thousands of hectares have been planted to the crop with high hopes of turning the province into a leading supplier of sulfur-free biodiesel in the next few decades.
The more developed nations are taking a different tack. They're banking on biotechnology. They're taking cue from microorganisms that feed on waste matter to turn up methane, the fuel of choice that runs public transport in South Korea, Japan, and the Netherlands. Say, the energy giant formerly known as British Petroleum-now called BP-has earmarked US$500 million for research and development on turning souped-up microorganisms that may directly produce gasoline, diesel, and such staple fuels from plant wastes. A pipe dream? Nope: anaerobic bacteria in swamps, marshes, and water-logged rotting rice stalks turn up methane or natural gas as farting shot while feeding on organic wastes.
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Fact is, an enterprising erstwhile consultant for an oil multinational has cultured colonies of methane-producing bacteria in LPG (liquefied petroleum gas) cylinders in the late 1990s. He offered his wares to transport groups, agribusiness outfits, and households. His sales pitch: turning up methane from collected organic wastes would free them from the clutches of the National Power Corporation and oil firms' capricious price spirals. Apparently, nary a gas-starved soul understood him. Nobody bought his bacterial cultures, not one bought his idea of biotechnology.
A profitable venture that could have taken off and soared was tried by the forwarder of balikbayan boxes in the US mainland whose network could have been a vast market conduit for the native rice wine called tapuy. The business couldn't push through though. Local production was too limited in quantity. That translated to uncompetitive stiff price for the elegant drink. Also, available supply of the lynchpin-a bacterial culture called bubud produced in Benguet, Ifugao, and Quezon to turn rice porridge into wine-flowed in fits and starts. That also didn't add up to smooth production-flow schedules.
In the past year, local companies engaged in biotechnology activities reported five vacancies for biotech work. No foreigner sought out any of the positions, none was recruited abroad, no local applicant turned up-one company said there were no interested applicants, another noted there were no qualified applicants while two firms cited that they can't meet expected salary, their applicants must have gone to fill in better-paying posts overseas.
Such scarcity of talent may lead us to construe that biotechnology remains a rarefied field of endeavor in this neck of the woods. As private outfits can hardly grab rare biotech talents, so does the government-and consequently leads to downright neglect and lack of rules for a fledgling industry.
Local deterrents to research and development
In
A Report on Biotechnology in the Philippines, the Biotechnology Coalition of the Philippines (BCP) notes that both research-development institutions and private firms point to an inadequate domestic pool of biotech-competent people. Available laboratory facilities for biotech activity are also inadequate, and there is lack of appropriate tertiary education in biotech that can support the emerging industry.
Most of the research and development institutions (RDIs) and private biotech firms that served as respondents were more involved in food processing and agriculture than in pharmaceuticals.
The report points out that while investor confidence in the financial viability of potential biotech products is generally low, there are enough commercial opportunities for such products worth investing on. Of 22 surveyed firms, nine indicate that business in the next three years will "somewhat improve"-10 see business to "greatly improve."
Half of the surveyed firms intend to expand their operations, 73 percent are eyeing to outsource their production, 59 percent are going to enter product trials, while 41 percent are taking steps to refocus their research and development activities.
Among surveyed firms with intellectual property, five have patents, four own trademarks, three with copyrights, five have reserved ownership to plant variety, and eight have trade secrets. More than half of these firms are into industrial and agricultural-derived processing and developing products with agricultural applications. A very small percentage was into manufacturing medicine.
The surveyed RDIs are largely into industrial and agricultural-derived processing and other agricultural applications-they're not gearing up for product development.
"Probably the perception of the respondents that the government is not fully implementing intellectual-property (IP) laws may be one of the major factors hampering the flow of investments in the biopharmaceutical industry," points out Godfrey Ramos, BCP policy specialist and head of the team that carried out the survey.
Huge costs and efforts entailed in product development coupled with the perceived soft enforcement of intellectual property laws have deterred firms from plying out new products in the market.
Ramos notes that developing one brand of medicine-from R & D to commercialization-can eat up around US$1 billion.
Respondents cite that the government hasn't been coughing up enough money to support the industry, if only to ensure that the few-and proud-best and brightest scientists employed in government-subsidized RDIs will not give in to offers from abroad.
Ramos bewails that while our Asian counterparts-India, for one-are already making significant headway in the global pharmaceutical industry, the Philippines is barely catching up.
"The Philippines has much to offer, especially those who want to go into the country's pharmaceutical industry. For one, there are plant species which have medical applications that are indigenous to us," Ramos notes as he stresses that the wealth of biomass-the country's teeming plant life-ought to fuel the country to corner a chunk of the US$30-billion global market in nutraceuticals or food supplements.
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