National Health Situation

The Philippines
The Philippines is
an archipelago of
7,107 islands with
a total land area,
including inland
bodies of water, of
approximately
300,000 square
kilometers
(116,000 square
miles).

Its
36,289 kilometers
(22,549 miles) of
coastline makes it
the country with
the 5th longest
coastline in the
world.
 Dry Season (March
to May)

Wet season (June
 to November) –
Averaging 20 or
more typhoons
Cold Season
(December-February)
 
  
Located in the
Pacific Ring of Fire
and is exposed to
 almost the full
array of natural
 hazards (earthquakes,
typhoons, landslides,
floods, etc.)
Ongoing complex
emergency in
southernmost island
of Mindanao
Highest number of
disasters per
country in 2009 (26)
POpulation
 Aug 2007: 88.57M
 Projected 2010 population: 94.01M
 2.04% annual growth rate (2000-2007)
 More than doubled in less than 40 years!
(1970-2007)


POpulation
 Aug 2007: 88.57M
 Projected 2010 population: 94.01M
 2.04% annual growth rate (2000-2007)
More than doubled in less than 40 years!
(1970-2007)


 Political system


 Recently concluded its

first automated
election last 10 May
2010
 The country is made up of
political local
government units of
provinces, cities,
municipalities and
barangays (villages).
 Local Government Code of
1991



Economy
 GDP (2009) = Php 161 Billion (2.8B
Euro)
 GDP Growth in 2009: 1.8% (Q4), 0.9%
(annual) from 3.8% in 2008

Economy
 69 million Filipinos (80% of population)
struggle to survive on Php 96 (1.3 Euro) or
less a day
 46 million Filipinos go hungry every day
(i.e., unable to meet minimum nutritional
needs)
 Wages are not enough to
sustain a decent life.

June 2008:
Living Wage -------------------------------P 911.00 (16
Euros)
(NCR, family of 6 according to the Nat’l Wages
and Productivity Commission)
Daily Minimum Wage ---------------- P 382.00 (6.7
Euros)
(NCR, including COLA)
NOT ENOUGH -------- P 529.00 (9.3
Euros)
Prices of basic goods are rising faster than wages.
 While the rich are getting richer…

 Net worth of 10 richest

Filipinos:
 US$12.4 billion or 10B Euro
(2006)
 Equivalent to the combined
annual income of poorest
9,600,000 families
(approximately 49
million Filipinos)


 (Ibon Databank 2007)

Number of Unemployed

Number of unemployed (millions)

3.8

3.2

2.6

2.3

Cory
1987-1991 Ramos
1991-1997 Erap
1997-2000 Gloria
2001-2008

POEA data
Migration

Number of migrant workers deployed yearly

1,008,303

693,815

469,709
361,833

1987-1991
Cory 1991-1997
Ramos 1997-2000
Erap 2001-2008
Gloria

POEA data
Decreasing self-sufficiency in food
production, including rice
2
Balance of trade in food 1980-2006

1.5
1980 (1.41)

0.5

$B

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

-0.5
1995 (-0.14)

-1
2006 (-0.49)

-1.5

Pinaghalawan: WTO online database

Spending for health
 Total Health Expenditure is 3.7% of GDP
(less than WHO recommended 5%)
 38% (?) of population has PhilHealth
Coverage (NDHS 2008)
 Most (46.4%) of the family expenditure
for health goes to drugs & medicines
 Philippines drug prices are 3.4 to 184
times the international reference
index.

Spending for health

23%
government

59% out
of pocket
18% Shared-
Risk Schemes
Including
National Health
Insurance
(PhilHealth)
Total Health Expenditure P0 . 25 per
Filipino per day
Average spending in national
budget per admin (% of GDP)
Aquino Ramos Estrad Arroyo
a

Education 2.7 3 .1 3.7 2.7

Health 0.7 0 .5 0.5 0.3
Housing 0.0 0 .1 0.2 0.1
Defense 1.3 1 .3 1.1 0.9
Debt service 8.9 6 .8 6.6 10.1
( interest &
principal )
Average sectoral allocation in
national budget per admin (%)
Aquino Ramos Estrad Arroyo
a

Education 12.3 15.5 18.7 15.1

Health 3.1 2 .6 2.4 1.8
Housing 0.1 0 .6 0.8 0.4
Defense 6.1 6 .7 5.6 5.0
Debt service 40.0 25.3 19.2 25.2
( interest only )
Debt service always at
expense of social services (1)
Worsening State Neglect
National Budget picture for 2010
 DEBT SERVICE - INTEREST PAYMENT –
17.94%
 EDUCATION – 10.47%

 AGRICULTURE – 2.22%

 ARMED FORCES – 1.98%

 HEALTH – 1.6%

 Total National Budget: Php 1.54T (27B

Euros)



 70
Average Life
Expectancy of
Filipinos (in
years)

80 , 000
Filipino Babies
dying of
PREVENTABLE causes
ANNUALLY
Indicators
 CBR: 20.5 / 1000
 CDR: 4.8 / 1000

 Healthy Life Expectancy (HALE): 62 (M:

59 years, F: 64 years) (WHS 2010)




 IN FA N T M O R TA LIT Y R A T E

NDHS ( 2008 )

 Decline in IMR between 2003 and

2008 is statistically insignificant
(NSO) (Galvez-Tan, 2009)
 UNDER-5 MORTALITY
Table 1. Trends in childhood mortality rates, with standard errors and confidence intervals, Philippines
Sources:    1993 National Demographic Survey, 1998, 2003 and 2008 National Demographic and Health Surveys

Survey Approxima Under-five mortality

Year te
calendar Rate Standard 95%
period Error Confidence
Interval

Lower Upper
bound bound

1993 1988-1992 54.2 - - -

1998 1993-1997 48.4 2.8 42.7 54.1
2003 1998-2002 39.9 2.8 34.4 45.5
2008 2003-2007 33.5 2.5 28.6 38.5
M A T E R N A L M O R TA LIT Y R A T IO

 Between 1990 and 1998, the improvement rate

was 14% while that between 1998 and 2006 was
only 6%, an almost 50% drop
(Galvez-Tan, 2009)
 LEB under 60 years
IMR over 90
MM over 150

LEB over 80 years

IMR less than 10
MM less than 15
ACCESS

There are more

than 16,000
registered
medicine in the
country…

…but 70% of Filipinos have no access to

essential drugs.
WHO World Medicines Situation, 2004
 Health Human ResourceS

§ No. 1 Exporter of Nurses

 “An estimated 85% of employed Filipino
nurses (more than 150,000) are working
internationally.” (Aiken et al 2004)
 “70% of all Filipino nursing graduates are
working overseas.” (Bach 2003)


§ No. 2 Exporter of Doctors

 “68% of Filipino doctors work overseas, next
to India.” (Mejia, WHO 1975)
Health Human ResourceS

 200 hospitals have closed down within the

past two years – no more doctors and
nurses
 800 hospitals have partially closed (with one
to two wards closed) – lack of doctors and
nurses
 Nurse to patient ratios in provincial and
district hospitals now 1: 40 to 1: 60
 Loss of highly skilled nurses in all hospitals
across the country
(Galvez-Tan, 2009)
 Health Education
§ The number of
nursing schools
have increased
 1970s: only 40
 1990s: 170
 June 2003: 251
 April 2004: 370
 June 2005: 441
 June 2006: 470
(PRC 2008)
§ Decreasing passing rate in
the national nursing
licensure examinations


1970s/80s: 80%-90%
 1991: below 61%
 2001-2003: 44%-48%
 2004: 55.9%
 2005: 49.7%
 2006: 41%
 June 2008: 48%/35%
Health Services for Sale: Medical Tourism

 Principally being
promoted by the
Philippine
government using
the public health
care system
 Linked to the issue of
organ trade (i.e. sale
of kidneys for
US$3,000-4,000)
 Expected revenues:
US$ 10B in 5 years
RIGHT TO HEALTH OF THE PEOPLE
Social OBLIGATION VS . PROFIT