Health care in the Philippines

Health care in the Philippines varies with private, public and barangay health centers (many in rural municipalities). Most of the national burden of health care is provided by private health providers, with the cost shouldered by the state or by patients.

Health care in the Philippines has been defined by the World Health Organization as "fragmented", meaning there's a large gap between the quality and quantity of health services for the poor and the rich. With different reasons such as low budget, low number of personnel, or general neglect for the poor, the Philippines has always been unable to keep up with the high standards of healthcare abroad. This low number of personnel can be attributed to the increase in migration and resignation of Philippine nurses. ^[1] Comparing data from 2014 between Philippines, United States of America, and Canada, Philippines only spent 4.7% of their GDP on health while US and Canada spent 17.1% and 10.4%. ^{[2] [3] [4]} Efforts are being performed to bridge the gap. On February 20, 2019, the Universal Health Care (UHC) Bill was signed into law, aiming to provide proper healthcare services for all.

History

Pre-Spanish Era: pre-1565

Health care in the Philippines extends as far back as the 15th century. Prior to the arrival of the Spaniards, life and by extension health care, was centered around the animate and inanimate world.

Traditional Filipino medicinal herbs were used for a wide variety of ailments. Anonas leaves were applied to the stomach for indigestion. Betel-nuts leaves and areca nut leaves were common for injuries, chewed and then applied. Sambong was used to treat kidney stones, rheumatism, coughs, colds, hypertension, and diarrhea . ^[5]

Sambong (Blumea balsamifera)

Spanish historian Miguel de Loarca said the natives were "good physicians and had a remedy for every poison." ^[6] The seeds of the igasud were chewed as an antidote for poison. It was renamed Pepita of San Ignacio by the Spanish. Other antidotes include boiled bark of palanigan and the bark of the bagosabak. ^[6] While the Spanish were impressed by the medicinal knowledge of the Filipinos, they still believed that Western health care would have to be taught to the Filipinos.

Spanish Era: 1565–1898

Further Information: Spanish colonial period

As the Spanish were exposed to the unfamiliar environment of the Philippines, they were stricken with foreign disease. To combat this, they created hospitals specially for their health. Some of the first health institutions in the country were handled by Spanish friars.

Hospital Real

Built in Cebu in 1565, Hospital Real was the first hospital in the Philippines. ^[7] It was relocated to Manila to accompany the government. The hospital aimed to nurse the Spanish army and navy, those inflicted with disease, and military casualties. Miguel Lopez de Legazpi had permission from King Philip II to set up the hospital exclusively for Spanish soldiers and sailors, whereas it denied service to Spanish and mestizo women. ^[7] Although Hospital Real received funding from the Spanish Government, it lacked finances, manpower, and supplies. Administration of Hospital Real was transferred to both the Order of St. Francis and the Confraternity of La Misericordia. ^[8] Hospital Real was destroyed during an earthquake on June 3, 1863.

Hospital de Naturales

Fray Juan Clemente, a 54-year-old botanist and lay brother, was instrumental in conception of the Hospital de Naturales. He often made medicine for the many people who begged outside the convent, until eventually the number of patients grew too large for accommodations. Clemente raised funds in order to build better facilities. In 1578, two wards of nipa and bamboo were constructed by Clemente. ^[9] Called the Hospital de los Indios Naturales, or Hospital de Naturales, the hospital flourished under Clemente. Friars tended to the sick, as well as their spiritual needs. The hospital also provided free medical supplies such as oils, herbs, and ointments. Hospital de Naturales was also able to provide medical supplies to other infirmaries and hospitals. Hospital De Naturales came under the patronage of King Philip II, earning it government subsidy. Protection was also guaranteed by the governor-general. Clemente died after 20 years of working at Hospital de Naturales. A few years after, a fire destroyed the hospital once more (the first time in 1583). The reconstruction of the hospital led to the development of the Hospital de San Lazaro. ^[10]

Hospital de San Lazaro

Although previously the Hospital de Naturales, the hospital was renamed after Japanese emperor Iemitsu sent 150 lepers. ^[11] Although viewed as a hostile act to the church for its growing influence in Japan, the lepers were taken care of by the hospital, the clergy, and the community. As such, the Hospital de Naturales became known as the Hospital de San Lazaro, after the patron saint of lepers. The Hospital de San Lazaro was demolished twice. Initially when the city of Dilao was threatened by invasion from Chinese pirate Chen Ch'e Kung, and finally after it was taken over and utilized by the British as a military vantage point. ^[12] San Lazaro can now be found at Rizal Avenue. It is believed that the land on which the hospital stands belonged to a Chinese mestizo who suffered leprosy. His will stated that his lands be used to aid those with leprosy. ^[13]

Entrance to the San Lazaro Hospital

19th century

In February 1884, a Royal Order was passed to provide free medical assistance for relief of the poor. Due to the 1882 cholera epidemic of Manila, the law, Reglamento para el Servicio de Asistencia, created by the Direccion General de Administracion Civil made it mandatory for municipal physicians to give free medical services for poor families in Manila. ^{[14] : 6}

Spanish military physicians were also dispatched. By the latter part of the nineteenth century, Spanish civilian physicians increased. These Spanish physicians created a movement for the establishment of an academic society solely for medicine in 1893. ^{[14] : 10}

By 1876, public physicians were appointed across provinces. ^{[14] : 5} The latter part of the nineteenth century also saw the rise of Filipino physicians. Some of them came from rich families looking for opportunities in Manila while some were illustrados. ^{[14] : 14}

American Era: 1898–1918

After the end of Spanish rule, the Filipino Revolutionary Government was established, including a Bureau of Public Health. ^[15] Although the Americans had been an ally in the fight against the Spaniards, the Americans soon seized control of the Philippines, with the mission to "uplift and civilize".

Under General Wesley Merritt, a Board of Health for supervising public health was established on September 29, 1898. ^[15] The Board of Health's biggest challenge was smallpox, which they battled by standardizing vaccine production and campaigning for vaccination.

Despite American efforts, public sanitation was dismal, and diseases were still spreading. Manila faced Bubonic plague; smallpox still spread in provinces; lepers roamed the streets. ^[16] Laws requiring vaccination and isolation of infected were ignored by the public. On July 1, 1901, The Board of Health for the Philippine Islands was established. ^[17] The Board soon became the Insular Board of Health as provincial and municipal boards were created. As American authorities observed the incompetency of licensed Filipino physicians and the Casa Central de Sanidad, most of the responsibility of public health policies fell to them. ^[18]

The Insular Board of Health was given the power to draft legislation for sanitary and medical practices in the Philippines. They were tasked with studying diseases and prevention methods, as well as overseeing public health. ^[17] The Board of Health made strategies to counter many diseases like leprosy. Most of their approaches include quarantines and reconcentration policies. ^[18]

In 1902, the Philippines was hit by a cholera epidemic. Despite anti-cholera campaign from American authorities, Filipinos were reluctant to follow. Another factor is that some superstitious Filipinos held the belief that many of the diseases cannot be cured by human intervention but by deep devotion to Jesus Christ. As a result of the disastrous campaign against cholera, the Bureau of Health conducted massive educational campaigns to counter misinformation regarding the disease. ^[18]

Filipinization of health: 1918–1941

Under the Jones Law and the governance of Governor-General Francis Harrison, the Filipinos were slowly allowed to practice self-governance. The Department of Public Instruction, one of the four executive departments of the government, was in charge of the Philippine Health Service. ^[19] The Department of Public Instruction was managed by Dr. Victor Heiser, during whose term the Philippine General Hospital was put up. ^[19] The Filipinization of Health Services started when Dr. Vicente de Jesus, the first Filipino Assistant Director of the Department of Public Instruction, became Director in 1919. ^[19]

Succeeding Harrison was Leonard Wood. Together with ex Governor-General William Forbes, Wood found the health status of the Philippines to be below par. ^[20] Cases of typhoid, tuberculosis, and other preventable diseases were rampant. Facilities and trained medical personnel were insufficient to care for the almost ten million Filipinos. Under Wood's administration, importance was given to health education, especially for mothers and young children. Prevention rather than treatment was a key strategy, and Act No. 3029 required school children to go through a health examination at least once a year. ^[21] There were also initiatives to increase the number of Filipino health workers, such as the establishment of the School of Public Health and Hygiene. ^[21]

After Wood, Theodore Roosevelt Jr. became Governor-General in 1932. He abolished several medical agencies and combined them under the Bureau of Health and Public Welfare. ^[22] Roosevelt focused on educating the public on health. Through the Bureau of Health's pamphlet publication "The Health Messenger", public radio, posters, and festivals for lectures on health, Roosevelt was able to increase public health awareness. ^[23] On May 31, 1939, the Department of Health and Public Welfare was established through Commonwealth Act 430. ^[24] By now, the Tydings-McDuffie Act had been ratified, and the Philippines was on its way to independence.

Philippine Republic (1946–present)

The Philippines gained independence from the U.S. on July 4, 1946 with Manuel A. Roxas elected as Philippine president. Conditions in the country was worse after the destruction of the Japanese occupation in the islands. The Philippine government initially allocated 5 million USD for health rehabilitation efforts, later increasing this amount to 5.2 million USD. The War Damage Commission also reimbursed the Department of Health and Public Welfare 33,000 USD for emergency reconstruction. ^[18]

In July 17, 1946, American and Filipino health officials met to discuss communicable diseases. They prioritized malaria, tuberculosis, venereal diseases, and Hansen’s disease. However, they recognized that addressing these diseases required a broader approach, including sanitation, nutrition, quarantine, health facility rehabilitation, and training of health workers. ^[18]

Although the administration of President Elpidio Quirino allocated more budget for the Department of Health, the lack of hospitals and healthcare facilities were evident. ^[25]

President Diosdado Macapagal signed Republic Act 4073 in 1964 to liberalize Hansen's disease control and treatment. It also sought to reduce government spending by encouraging patients to seek treatment from private physicians or health centers. The law reorganized the Department of Health and integrated Hansen's disease control into rural health centers. It also removed the health secretary's authority over the Culion leprosarium, emphasizing home care. ^[18]

By 1987, the Philippine Constitution recognized that access to healthcare is considered a human right. ^[26]

Services

The Philippines' public healthcare system is primarily financed through taxes and delivered by government facilities. The Department of Health oversees government hospitals, while provincial and municipal governments manage district, provincial, and primary care facilities. ^[26]

The private sector is market-oriented, with healthcare paid for through user fees. The Philippine Health Insurance Corporation (PhilHealth) was established in 1995 to provide financial protection for Filipinos, and its membership has grown significantly in recent years. ^[26]

Universal Health Care: 2019

Universal Health Care (UHC) was signed into law by President Rodrigo Duterte as the Republic Act No. 11223. ^[27] UHC automatically enrolls all Filipino citizens in the National Health Insurance Program and expands the existing Philippine Health Insurance Corporation (PhilHealth) coverage to include free medical consultations and laboratory tests. ^{[27] [28]} UHC strives to have health providers available to every family in the Philippines to address their primary health needs. ^[28] The goal of the UHC is to expand the health benefits package of previous PhilHealth including access to services in preventive, palliative, and rehabilitative medicine. ^[27] Development of the bill was guided by the World Health Organization – Philippines who assisted by mediating public hearings and providing insight from successful implementations of UHC in other countries. ^[27] UHC seeks to undo certain medical practices that were originally established during colonial times, namely the reliance on private healthcare and a weak system of public healthcare. ^[29]

However, certain problems faced by PhilHealth continue to go unaddressed under the new UHC system. ^[30] For example, UHC does not address the disparity between rural and urban settings, and the fact that rural settings have fewer healthcare resources. ^[31] Another problem is that funding decisions are often made by a single congressman/senator with a private interest in a particular medical issue. ^[30] Finally, UHC only covers "accredited hospitals" but many rural health stations find the process of becoming accredited difficult and therefore patient services from these stations do not qualify for coverage. ^[30] Statistics showed that 8 out of 10 Filipinos have had no medical check-up or physical examination in their life even with the addition of UHC. ^[31] Progress toward effective and equitable UHC needs not only strong political commitment but also a coherent strategy to ensure different aspects of health systems are synchronized with each other and address core performance challenges. ^[32] Deficits resulting from escalating costs by the system are a significant challenge in the face of increasing demands for comprehensive benefits such as hemodialysis, breast cancer treatments, and others. ^[33]

Much of health care expenses are still shouldered by patients, according to the government research office Philippine Institute for Development Studies. ^[34]

Healthcare infrastructures

As of 2018, the Philippines has 1,224 hospitals, 2587 health centers, and 20,216 health stations. Most hospitals are small, with 64% being Level 1 non-departmental hospitals. The private sector's share of hospital beds has increased from 46% to 53%. The distribution of healthcare resources is uneven. Luzon, particularly the National Capital Region, has a higher concentration of hospital beds compared to the Visayas and Mindanao. Public medical centers have a higher bed occupancy rate and longer patient stays than private hospitals. ^[26]

See also

• Health in the Philippines
• Mental health care in the Philippines
• Dentistry in the Philippines
• History of medicine in the Philippines
• Medical education in the Philippines
• Barangay health volunteer
• Malasakit Center

References

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